April/May 2011 Print - Aging Care Matters

How to choose a health care decision maker

National Healthcare Decisions Day is April 16, a day when all Americans are encouraged to complete or review their advance directive. The advance health care directive allows you to name someone to act as your “agent” if you become unable to speak for yourself. That person becomes your “medical power of attorney.” Your family member should have an advance directive. So should you!

The best choice for a health care agent is someone who is

willing to listen. Someone you feel comfortable talking to about life support issues. Choose someone you know will put aside his or her own preferences to follow your instructions.
willing to act. Someone levelheaded who will advocate on your behalf. Who is not afraid to ask questions or demand answers. Who can make difficult decisions, especially under pressure. Who won’t be intimidated by other family members. (Ideally your agent would be someone who can be firm and yet communicate diplomatically enough to encourage others to rise to their wisest selves.)
nearby and available. Someone who lives relatively close by who could readily shift their responsibilities and get to you in an emergency.

Also keep in mind that

you can rewrite your health directive at any time. Your wishes or views may change over time. Just make sure whomever you name as your agent has a copy of the current document.
you cannot choose your doctor. Ideally your agent is a friend or family member. But do not choose someone out of guilt. (And when working with your relative, be open and understanding if he or she does not choose you.)
you can name at least one back-up agent. But do not make them co-agents. Having co-agents proves difficult if there is a disagreement.

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Keeping your relative safe from fraud

Elders are favorite targets for scam artists.

The most common fraud scams against elders include

prizes and sweepstakes. The elder is told they’ve “won” but must first send in money to cover the taxes.
magazine sales. They order a subscription but the magazine never shows up.
product or service fraud. They are sold “anti-aging” products or home improvement services but the goods/services are worthless. Or they pay money up front for work that is never done. Some schemes include funeral or cemetery services.
phishing schemes. Someone calls claiming to represent a bank or business. The elder is asked to verify their financial information or is told to call an 800 number to do so.
Internet fraud. They respond to a bogus email or Internet sales offer by providing their credit card information, birth date, or social security number.

To help keep your loved one safe

watch for changes in lifestyle or financial activity. For example, more spending than usual or more money worry than usual. Your relative may be embarrassed to admit they’ve been scammed.
check out unusual “new friends.” Ask to meet and get to know your parent’s new friend. A con artist won’t stick around!
help research organizations. Before purchases or donations are made, request written information about the organization. Verify claims of nonprofit status.
shred sensitive documents before disposal. Anything with a social security number or account number. Even offers for new credit cards because they could be used to open a false account.
seek nearby support. Especially if you live out of town, ask a friend or neighbor to keep an eye out.

If you suspect that fraud has occurred

contact local law enforcement immediately and file a report.
contact the bank, investment company, or credit card company to have transactions monitored or stopped.

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The journey of late life

“Life after eighty rarely ends suddenly and unexpectedly in our sleep,” states Dr. Dennis McCullough, in his book My Mother, Your Mother. Instead, caring for an aging relative is more commonly a journey of many years. As a geriatrician and care provider to his late mother, he knows this terrain well.

McCullough outlines eight “stations” in the journey of late life. For each one, he offers insights and tips to help you counter the modern system of “fast medicine” with personalized solutions he calls “slow medicine.”

Stability. A time of preparation. Get to know your relative at baseline. Stay 72 hours and observe what’s “normal.” Begin to build a support community. Learn about aging.
Compromise. The advent of symptoms. Stay in touch and informed about emerging health problems. Diplomatically join your relative and work together as a team when considering options.
Crisis. A major event, typically involving ER and hospitalization. Get involved. Look backward and forward to prevent future problems. Rally the support community.
Recovery. Often a lengthy process of rehabilitation. Stay involved. Learn what’s needed for recovery. Practice sustained community support. Encourage your relative’s patience. Assess support needs for his or her “new normal.”
Decline. An obvious drift into frailty. Frequently precipitates a move into a care facility. Stay engaged. Protect your loved one from loss of identity.
Prelude to Dying. A change in spirit that acknowledges death as a real possibility. This period often starts weeks or months before actual passing. Enroll in hospice (3 – 6 months of service is optimal). Visit; give attention. Ask their life story. Cope with the uncertainty.
Death. The last few days. A time of honoring your relative’s end-stage desires. Advocate as necessary. Address anxiety, yours and theirs. Provide comfort, often touch.
Grieving/Legacy. An intensely personal experience, often lasting years. Look for opportunities to reminisce.

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