Category: Giving Care

When is it Time to Move Mom and/or Dad?

Deciding when is the right time to find senior care for your kupuna can be an intimidating task. You want to provide the best care possible for them, but how do you know if it’s the right time; where do you start? First, understand and identify the level of care your senior needs to conduct day-to-day activities and care for themselves. Identifying your senior’s needs early in your search will help you understand the options available. Keep in mind that the level of care can change over time as conditions change.

There are two main categories for long-term care solutions for seniors: senior communities and residential care homes. In senior communities, kūpuna live together in an apartment-like setting and interact with one another through daily, scheduled activities. They dine with other residents. In residential care homes, three to five seniors are cared for in a home-like setting. Residents get more individualized attention and all of their needs are taken care of.

Finding great healthcare for your loved ones is hard to do on your own. Each year, we see hundreds of seniors in Hawai‘i finding themselves incapable of living independently at home.

How do we get Mom and/or Dad out of the home when they don’t see the need, even though they have fallen multiple times?

After a fall, your senior is feeling fearful and may be resistant to change. During gentle conversations over time, explain that finding care comes from a place of love and wanting them to live a safe and healthy life.

What about dementia care?

Questions to ask a care home or facility about a patient’s dementia care include:

• Is the staff experienced in working with residents with dementia/Alzheimer’s?
• What approaches are used to diffuse a situation with an agitated dementia/Alzheimer’s resident?
• What kind of activities are available to help stimulate a resident’s mind and body?
• Are they open to working with the resident’s geriatric team and family?

CAREGIVER’S HEART
91-1121 Keanui Drive, Ste. 108, PMB 193, Ewa Beach
808-425-5101 | kuunani@caregivershearthawaii.com
www.caregivershearthawaii.com

Deciding when is the right time to find senior care for your kupuna can be an intimidating task. You want to provide the best care possible for them, but how do you know if it’s the right time; where do you start? First, understand and identify the level of care your senior needs to conduct…
Partnerships in Dementia Caregiving

Hiring a home care aide represents a major transition in family caregiving, especially when the care recipient is a person with dementia (PWD), less able to express his or her needs. Initial encounters may stress both sides.

Family members may feel uncomfortable letting a “stranger” into their home and feel guilty relinquishing caregiving tasks, and may feel uncertainty about the trajectory of dementia.

The home care worker may feel anxious entering a work situation with many unknowns regarding expectations, demands and personalities. These suggestions can help families develop partnership relationships with home care aides:

Clearly define expectations and duties:

• Identify activities of daily living (dressing, toileting, eating) the PWD can’t do alone.
• Agree upon a schedule of care and tasks.
• Identify caregiving tasks a PWD (or family) prefers the care worker avoid, either because the PWD might feel uncomfortable or family members want to continue to provide it.
• Provide important phone numbers and emergency procedures.
• Develop backup plans for substitutes if the care worker cannot work.
• Develop a system of communication, e.g., leave instructions in writing, develop checklists of completed tasks or problems, maintain a daily log of the day’s events.
• Identify dietary requirements and restrictions, allergies, meds, exercise and endurance levels.
• Agree on policies (smoking, eating, using the phone on the job, payment and benefits).

The more the care worker knows about the PWD’s background, history and preferences, the better able he or she will be to converse, develop rapport and treat the PWD as a unique individual.

Information family members might share with the home care worker:

• Life history highlights
• Persons who hold influence with the PWD (a physician, favorite child)
• Pet peeves; ideas of appropriate behavior, habits and routines; food, entertainment and activity preferences; favorite conversation topics, e.g., pets, possessions, grandchildren
• What upsets or triggers challenging behaviors
• Special phrases or behaviors that may signal a need, signs of pain and other symptoms

For more information about what you should know in order to develop a successful partnership relationship with a home care aide, go to this address.

CENTER ON AGING — University of Hawai‘i at Mānoa
2430 Campus Road, Gartley Hall, 201B, Honolulu, 96822
808-956-5001 | map3@hawaii.edu
www.hawaii.edu/aging

Hiring a home care aide represents a major transition in family caregiving, especially when the care recipient is a person with dementia (PWD), less able to express his or her needs. Initial encounters may stress both sides.
When’s the Right Time for Memory Care?

Memory care communities that first began appearing in the 1990s are an important care option today for the growing number of families caring for a person living with Alzheimer’s disease or other dementia. When considering memory care, look for a community with a rich and lively activity program, and staff who are well-trained in dementia care, and exemplify a caring and kind spirit.

When should a family consider memory care? It’s a good option when a loved one:

• Can no longer manage their own health (not taking their medications, poor nutrition or diet)
• Is wandering away from home or physically unsafe (leaves the stove on, fall risk)
• Demonstrates poor judgement and is at risk for elder or financial abuse (giving money to fraudulent charities, individuals)
• Stops managing their personal hygiene and self-care (not changing clothes, not bathing)
• Is lonely, isolated or in need of valuable, brain-healthy stimulation and socialization

Families considering this move often feel guilt. But a person living with dementia can thrive in a memory care environment rich with friendship, meaningful activity and engagement, with well-trained staff providing quality personal care.

THE PLAZA ASSISTED LIVING
6 Locations: Kaneohe, Mililani, Moanalua, Pearl City, Punchbowl, Waikiki
808-377-5292 | www.PlazaAssistedLiving.com

Memory care communities that first began appearing in the 1990s are an important care option today for the growing number of families caring for a person living with Alzheimer’s disease or other dementia. When considering memory care, look for a community with a rich and lively activity program, and staff who are well-trained in dementia…
Alzheimer’s & Time

Time can stop when memories are lost for a person with Alzheimer’s disease. At certain stages, the brain loses its recent (short-term) memories. The brain — and therefore, the present — is in the past for those with memory loss. Current thoughts are drawn to distant memories. Familiar people and places from long ago are at the forefront of the mind, even though those people may no longer be alive and those places have most likely changed. Because long-term memories can be intact for most Alzheimer’s patients, they often think they are much younger than they are chronologically. For example, it is not unusual for a medical professional to ask the patient what year it is during an exam. The patient’s answer may often reflect a time 20 to 30 years earlier. This question establishes his or her orientation to time. The absence of this orientation is a classic sign of memory issues and could indicate Alzheimer’s or another form of dementia.

Memories from long ago can be triggered while driving through a neighborhood — searching for an old friend’s home can become an obsession. Houses and streets may look different; unrecognizable. This can be upsetting and puts pressure on family members to explain why visual expectations do not match the individual’s recollection. Avoiding the neighborhood is one idea; however, conversations can take a difficult turn when it comes to people who have passed or moved away. Here are some tips to create reassurance when these lapses in memories occur:

• Find a quiet and calm environment, and sit with the individual.
• Speak with compassion. The person may be afraid and appear overwhelmed.
• Understand the timeframe this person is in. This is the reality he or she has chosen to remember.
• Talking about this timeframe will help him or her feel safe.
• Use photos to help them realize that time has passed. Suggest a correction, but do not scold with comments such as “Oh, we moved out of that house over 20 years ago!”
• Offer distractions to encourage his or her brain to move to another topic.
• Be patient and understanding; these memories will come up repeatedly.

Loss of memory also takes away relationships that may have been important. Family and friends need to understand that being forgotten should not be taken personally. Relationships with loved ones who suffer from dementia should not be judged by how well that person can remember the past. Instead, the focus should be on maintaining a personal and heartfelt connection in the present. Try some of t these ideas to foster the memories that remain intact:

• Play familiar music.
• Watch old films with familiar actors/actresses.
• Pull out old photos. You may even learn something new about the people in them!
• Enjoy memories as if you were there with them while you listen to their stories again and again.

We all spend time in the past, reliving cherished memories. The feelings of joy and accomplishment this creates should be valued for the difference they make in the present.

ATTENTION PLUS CARE HOME HEALTHCARE
Accredited by The Joint Commission
1580 Makaloa St., Ste. 1060, Honolulu, HI 96814
808-739-2811 | www.attentionplus.com
AGING IN HAWAII EDUCATIONAL OUTREACH PROGRAM
by Attention Plus Care — a program providing resources for seniors and their families, covering different aging topics each month. For class information and upcoming topics, call 808-440-9356.

Time can stop when memories are lost for a person with Alzheimer’s disease. At certain stages, the brain loses its recent (short-term) memories. The brain — and therefore, the present — is in the past for those with memory loss. Current thoughts are drawn to distant memories.
Reflections on a Caregiving Journey

Mom at the Bicol Club of Hawaii’s 40th anniversary.

My mother, Paz Pontillas Celebrado, graduated from college in the Philippines and dreamed of coming to America to start her nursing career. Her dream came true when she fell in love with my father, Felipe Celebrado, a U.S. Navy man. They immigrated to America in 1959 and she adjusted to a new life as a military wife and mother, and as a nurse for the next 40-plus years.

She expanded her traditional nursing role, becoming a home- and community-based case manager. In addition, my mother was one of the first care/boarding home operators in the state.

Mom and Dad in 1959 on their arrival to the states.

Having been exposed to what it takes to be a care manager at a very young age as I watched my mother tend to disabled clients in our home, I followed in my mother’s footsteps. I pursued a social work degree from the University of Hawai‘i at Mānoa and eventually worked at HMSA as a care coordinator, supervisor and manager.

After nearly 20 years at HMSA, I realized that my husband and I had become members of the “sandwich generation,” caring for three children and aging parents. When my father became seriously ill in 2008, my mother embraced her role as his personal nurse until he passed away from lung cancer in 2009.

But after he was gone, my mom began showing signs of mild dementia or cognitive impairment. I left HMSA and looked for a job that would allow me to work from home. I found an opportunity as a community outreach liaison with Urgent Care Hawaii, working alongside a longtime case management colleague Donna Schmidt, owner of the company. Finding employment that allowed remote work provided me the flexibility I needed to earn an income while raising our children and caring for my mother in our home.

This is what I learned through my experiences as a caregiver.

My niece, Juliana, graduated from college in 2017. Mom was always proud to attend any of her family’s celebrations.

■ Caregiving is a marathon, not a sprint. It’s a cross-country run with highs, lows and unexpected obstacles. Be prepared and plan for the long course. Read, attend caregiver workshops and join caregiver support groups. Learn what resources are available at every stage of the journey.
■ Plan around your loved one’s abilities. My mom always loved grocery shopping and going to Longs. So when she lost her ability to drive, I signed her up for services through Project Dana, which provided my mom with three volunteers who would take turns taking her shopping. She relished her outings!
■ Identify what brings them joy. Surround your loved one with those whom they are familiar with and those who will bring them comfort. Is there a church group, civic group or volunteer group that your loved one enjoys? For my mom, it was her Filipino club — The Bicol Club of Hawaii. The social connection, and common native language, food and culture provided the comfort my parents needed in their final years. My mother enjoyed attending celebrations and events that would make her feel socially connected and valued. During her final months, members of the Bicol Club would bring her favorite foods that would stimulate her declining appetite. It was great to have the support and respite provided by familiar faces and friends who could bring back memories of better times for my mother. If you have that kind of social connection available, utilize these invaluable relationships.
■ Practice self-care. As a caregiver, you need a break. You cannot be a caregiver 24/7 without experiencing burnout. Schedule time for yourself to recharge your batteries. Find a niche, hobby or interest that will provide that little slice of happiness to escape from day-to-day caregiving. Exercise regularly. I have heard too many stories about caregivers who begin to experience health issues due neglect of their own health after the loved one passes away.
■ Make memories as you provide caregiving. Embrace the time you have with your loved one by including them in celebrations, special occasions and travel plans. My mother was able to travel until a year before she passed away. I became a specialized travel agent, planning all details of the itinerary. Anticipatory planning included identifying urgent and emergent medical services available in transit and at our destination. Packing included durable medical equipment and devices, sufficient medication for the entire trip and packing that extra change of clothes. The memories spent with dear family and friends were priceless and helped my mother feel a sense of completion as she checked off items on her lengthy bucket list.
■ Leverage all the support you can. The last 10 years were not easy. I could not have done it without the support of my family. As the primary caregiver, I controlled the calendar and coordination of schedules. I was the quarterback. But we were a team. Fortunately, there were builtin advantages in our multi-generational home, where we were able to provide 24/7 care for my mother among us all.
■ Cultivate good relationships with each member of your loved one’s healthcare team. My parent’s PCP took care of them for over 40 years. He was always available to help me navigate and coordinate my parents care needs. The supportive services provided by Project Dana, St. Francis Hospice – Bereavement Support Group and Hospice, Kupuna Care Hawaii, Urgent Care Hawaii and Hale Hau‘oli Adult Day Care were the foundational support that allowed me and my family keep my mom comfortable in her own home until the very end.
■ You are your loved one’s patient advocate. If they are no longer able to communicate their needs, then you must. You need to have the conversations early in the caregiving process to understand the care preferences and wishes in order to honor their wishes. There may be conflicts that arise within the family and it is important to remember that the focus should be on your loved one. It is important to consider a good mediator or elder care attorney if you and your family are not able to represent your loved one’s wishes.

Mom passed away in 2019 according to her wishes; peaceful, at home, surrounded by family and dear friends. I can look at the last 10 years of caregiving with no regrets and feel blessed with great memories. I wouldn’t have done it any other way. I hope these reflections on my caregiving journey will help you in yours. You have an incredibly difficult job, but it can be do-able with the right plan, support team and resources.

CAREOPS CONSULT LLC
808-778-2752 | melissacareopsconsult@gmail.com
Provides healthcare consultation services to organizations that need
assistance with business development, project management, product or
program development.

Having been exposed to what it takes to be a care manager at a very young age as I watched my mother tend to disabled clients in our home, I followed in my mother’s footsteps. I pursued a social work degree from the University of Hawai‘i at Mānoa and eventually worked at HMSA as a…
Emmet White at the Arcadia… life care without walls

Emmet White—local attorney turned retirement community CEO—offers us insight into the business of aging in Hawai‘i. At Arcadia Retirement Residence he sees firsthand the costs and benefits of senior care.

You may know Emmet White from his previous life as a local attorney, board member of Central Union Church or Colonel in the Hawai‘i Army Reserves; however, most know him for his work as President and CEO of Arcadia Community Services, the holding company for Arcadia Retirement Residence, Craigside Retirement Residence, The Arcadia Foundation, Arcadia Edler Services and Arcadia Home Health Services.

Emmet explains The Arcadia Family of Companies’ approach to senior care, including its future plans for “life care without walls”—or homebased care—a concept that combines services so that residents can age in place at home.

In addition to what retirement communities such as Arcadia are doing to serve seniors, Emmet says that ‘seniorhood’ as a whole needs to be reshaped. Times are changing. The demand for senior care is exceeding supply, and the effects of Health Care Reform are yet to be known. He says that smart use of technology, medical care and education are critical for successful health care in Hawai‘i. However, he cautions, on a personal level, each of us needs a shift in attitude about saving for our senior years. It’s up to all of us to bear the cost of our own senior care, as best we are able, to ensure quality of life in our later years.

GM: With your family on the East coast, why did you decide to move out to Hawai‘i? Having been here for 40 years, are you here to stay?

EW: I had roomed for a year in college with a fellow from Hawai‘i, and gorgeous warm weather all year round was very appealing to me. In 1971, I talked with my wife of 1½ years, Betty, about going to Hawai‘i and seeking jobs. With some hesitation and misgivings she said, Okay. When we arrived in Hawai‘i in late 1971, my former college roommate’s family was very welcoming and supportive to Betty and me. As fate would have it, I passed the Hawai‘i bar exam and was hired by a small law firm. Betty was initially hired as a parttime history teacher at Sacred Hearts Academy (she is now the Head of School). We haven’t had anytime to look back since!

GM: What do you love most about Hawai‘i?

EW: I love the beauty of Hawai‘i’s weather and the people who live here, as well as the opportunity to raise a family and work all these years with Betty at my side.

GM: What is something people don’t know about you?

EW: For 10 years, in my youth, I was a drummer in a summer community band on the New Jersey shore, which gave weekly concerts on the boardwalk. I enjoyed this “gig” very much!

GM: What is your favorite restaurant? EW: Betty and I have three favorites: Paesano’s in Ma¯noa when we have a yearn for Italian; Ruth’s Chris at Restaurant Row when I have a yearn for a good steak; and, Panya at Ala Moana Center when we’re alone, hungry and worried about eating too much!

GM: You and your wife Betty White of Sacred Hearts Academy must have very busy lives. What do you guys do for fun?

EW: Betty and I like to be quiet together when we’re not on the go—we both enjoy reading, or a special trip with just the two of us! I also enjoy an occasional round of golf. We enjoy entertaining—I do the food shopping and Betty does the cooking. Much of our free time is spent with three grandsons, all under the age of 3 years old.

GM: What is a good day for just you?

EW: Our Arcadia companies are devoted to providing quality care and services for our seniors. During the day I see a cheerful outlook and many little acts of love and kindness by, between and among our staff, residents and our families and friends. As I reflect on the day, usually during my drive home, I say a short prayer of thanks, and believe that life is good!

GM: Any hobbies other than work?

EW: For years I enjoyed playing softball in the lawyer’s league on Saturdays (I’m long retired), and, for now, keeping an eye on our young grandboys when their parents are busy is the hobby of choice!

GM: What motivated you to go from the legal field to working with seniors, and how was the transition?

EW: In 1995, Arcadia, on which I had served as a board member from 1983, was at a crossroads needing new leadership and direction. Based on discussions with the Directors, and after conversations with my family, I decided to give this leadership role a try. The small law firm of which I was a member, was disappointed, but was supportive of my move from the active practice of law to my working at Arcadia. The transition from law practice to a leadership role in senior living and health care services was quick and with no regrets or second-guessing. Over the last 15 years we have honed our senior care skills and developed six related companies to provide vital services for our kuˉpuna.

GM: What have you learned from your residents that inspires you?

EW: I have found that when you sit quietly, listen and ask good questions, you will find in each senior resident, participant or client a unique past with wonderful experiences, insights and a special brand of wisdom that produces volumes of valuable and enjoyable knowledge for you and your fellow workers. I am also inspired daily by the great devotion to each other I witness in the couples that reside at Arcadia.

GM: Any favorite stories or residents that you can share?

EW: Indeed, there are volumes of stories, but one that is emblazoned in my memory is that of a beautiful, very petite, 95-year-old resident, whom I had known for years. She had finally agreed to be with us in our Health Care Center. Cancer was taking its toll. When I came to visit with her a few days after her move, she informed me that she had only $50,000 left. Taken back by her direct comment, I remember asking, “What, Marge, do you want to take it with you?” We both had a hardy laugh, and I told her that we would not speak of money again. Then, with her piercing wide and deep blue eyes, looking up at me with a look that at once combined wonderment and joy, she asked, “Emmet, what do you think Heaven will be like?” A host of thoughts cascaded through my mind, as I knew Marge, a wonderful person and friend, would soon be embarking on her journey beyond. I remember saying to her, “All I know, Marge, is that if St. Peter gives you any trouble, I’m doomed to purgatory forever.” A couple of months later Marge passed. But, her query always flashes before me when death is addressed, and her expression, as the start of her journey neared, has always been an inspiration to me for what awaits us beyond our life on Earth.

GM: What do your residents love most about Arcadia?

EW: There are many reasons that seniors reside at Arcadia. I believe one of the initial reasons people chose to reside at Arcadia is the promise of lifetime care, including long-term assistance, should the need ever arise. But, I think that what most residents come to love about Arcadia is being a part of a caring community where dignity, companionship and the environment bring joy and good quality to life everyday

GM: Are you planning to, or could you see yourself, living in Arcadia later on in life?

EW: With the average age of entry for Arcadia at 80 years of age, in a nutshell, if I live that long and Betty sees the value at the time, Arcadia (and 15 Craigside)—if affordable for us—are very attractive options for Emmet’s and Betty’s “very” senior years!

GM: Do you see more retirement communities like Arcadia coming in the future?

EW: No doubt. On the Mainland, there will be more retirement communities similar to Arcadia in the future. And, while the metrics suggest that Hawai‘i needs more senior living facilities, the cost, as well as the government permit and development processes in Hawai‘i, may be too prohibitive for the design, planning, construction and operation of a new Continuing Care Retirement Community (CCRC), especially for that amorphous middle class of Hawai‘i seniors who are too poor to be rich, and too rich to be poor.

GM: What is your opinion on the new Medicare reforms?

EW: The 2010 Medicare reforms come with a substantial price tag:

■ higher/new taxes on the well-to-do

■ taxes on annual health insurance plan premiums that are more than $10,200 per individual (e.g. 40% of that cost)

■ new fees on the health care industry (supposedly because they’re getting new customers)

■ cuts in Medicare spending

While these reforms promise better coverage, the “redistribution” of benefits may not produce overall satisfactory results.

Of course, change and adjustments in senior health care and services are inevitable. I do think that people need to adjust ambivalent attitudes about devoting personal wealth and assets to one’s care in their senior years. We also need to embrace the smart use of technology, medications and clinical care. Adjusting attitudes will have a lot to do with the future success of our huge and expensive health care system.

GM: What is your vision for health care in Hawai‘i?

EW: The smart use of technology, medications, and medical and clinical care are critical to future successful health care in Hawai‘i, as is consistent and continued education on health care programs and services for seniors and their families. There needs to be a major change in consumer attitudes regarding the responsibility for personally bearing much greater costs for our own senior care and long-term care. Senior long-term care and services are not and cannot be a government entitlement program.

GM: Obviously not everyone will be able to live in Arcadia even if they wanted to as there are not enough beds. In your opinion what is our future look like for long-term care?

EW: Statistically, long-term care is a possible factor in every senior’s future. But, no one knows, and the data is unable to tell us specifically, who will need it and for how long it will be required. Private enterprise and government must work in close collaboration with each other to maintain a strong safety net for those less fortunate. Nursing facilities are, and will be, needed to deal with the more intense sub-acute care required for indigent nursing home residents, as well as private pay nursing home residents, which home- and community-based programs cannot reasonably and responsibly handle.

GM: Home-based care is where most families have the challenge to care for their loved ones, is there any easy fix?

EW: There is no “easy fix” for home-based senior care. The Arcadia Family of Companies’ approach to senior care and senior services in the greater community has been evolving. We are pursuing the concept of “life care without walls.” This business concept involves the need to develop the right combination of the following elements for residents who are aging in place in their homes and apartments:

(1) a reasonable financial posture

(2) a reasonable and comprehensive cost schedule

(3) a care coordinator

(4) home/apartment inspections with appropriate maintenance for a senior’s safety and convenience

(5) at least, personal annual geriatric assessments and acceptable health planning and focus

(6) an emergency response system

(7) appropriate in-home assistance with one’s activities of daily living

(8) transportation, as needed

(9) meals, as needed

(10) access to a location with social and wellness programs, including programs and therapies at Arcadia and 15 Craigside

(11) companions, as needed and as planned

(12) referral to sub-acute facilities, as may be required.

Another part of the “fix” is the recognition that one has to assume personal responsibility for the cost of a better quality of life in one’s senior years. The government may provide some help, but, generally, the lion’s share for senior care and services should, and must be borne by the senior.

GM: Do you plan or want to live to 100?

EW: It isn’t my call on reaching 100! If I am given the privilege of a longer life (at 64, I think I’ve just embarked on “those senior years”), I hope my quality of life will be good, so I prepare for the future by trying to adhere to the sound and popular core values we share at the Arcadia companies, as well as saving some money for the “senior costs” Betty and I might face!

GM: Thank you for this wonderful interview. How would you like to sign off to this?

EW: Thank you, Percy, and Generations Magazine for the opportunity to talk about thinking, learning, and planning with our families and loved ones for our anticipated walk into an exciting and rewarding “senior” future.

Emmet White—local attorney turned retirement community CEO—offers us insight into the business of aging in Hawai‘i. At Arcadia Retirement Residence he sees firsthand the costs and benefits of senior care.
The Caregiver Foundation: Your First Steps on the Care Giving Journey

The first few steps on a care-giving journey can seem fairly simple but within just a few days the path turns rocky and is full of turns and twists that confuse even the most experienced caregiver or capable family member.

The Caregiver Foundation is a Hawai‘i-based, not-for-profit organization that supports the practical and emotional needs of caregivers and those they love. Its Caregiver Support Groups are complemented by extensive on-line support at www.thecaregiverfoundation.com. The support groups meet once a month at various locations, where caregivers learn about issues from experienced professionals. More importantly, the groups provide caregivers an opportunity to share their experiences, frustrations and successes. The popular four-session Caregiver Boot Camp is held, free, wherever requested.

The foundation also provides direct services, ranging from professional money management to comprehensive care coordination services. Some services are provided at no cost and others have fees at substantially lower rates than found commercially. Community speakers, family consultations, resource articles, and an on-going information and referral service are just some of the foundation’s services.

Along the way of care giving, you might discover that love is not enough. What do you do when taking care of loved one at home doesn’t work?

Telling Mom she was moving to a nursing home was the hardest thing I have ever done …

Moving your loved one to a nursing home is difficult. He or she may feel abandoned, unloved, rejected. There may be angry accusations and emotional pleas. You may even feel guilty for making the decision.

But GUILT is an emotion that results from having done something wrong and identifies actions that should be changed. It is often misused in care giving. If we took Mom to the side of the forest and left her there, then we would have done something wrong, and could feel appropriately guilty.

Choosing a nursing home is not deciding to give up caring for your loved one. It is recognizing your own limitations and understanding that sometimes the best care is not always your care. And the best place of care may not be in your home.

Choosing to move someone to a home has to be done after taking into account the broader situation. Remember—there are no right choices— every decision you make is wrong for somebody. So caregivers often deal with feelings of regret, anger, failure, disappointment and grieving. These emotions require that you have patience with yourself. Try to understand your loved one’s feelings, and have a clear understanding of how the facility operates.

The Caregiver Foundation of America—Hawai‘i Chapter helps caregivers, and those they love, with practical and emotional assistance. Visit www.thecaregiverfoundation.com or call (808) 625-3782.

The first few steps on a care-giving journey can seem fairly simple but within just a few days the path turns rocky and is full of turns and twists that confuse even the most experienced caregiver or capable family member.
Skilled Nursing Care After a Hospital Stay

Seniors who experience a fall or stroke, or undergo surgery may be surprised they can be discharged from the hospital fairly quickly. That’s good and bad news. Seniors may be happy to leave the hospital but may then be disappointed to learn they cannot return home.

They often must first receive ongoing, skilled nursing care and rehabilitation services, such as physical, occupational or speech therapy. Depending on their condition and other various factors, this could be a short-term stay or a longer stay.

Family caregivers may want their loved one at home, but may not have the capability to provide the specialized care their loved one needs.

Seniors and their caregivers must make decisions quickly regarding finding a skilled nursing facility. Many may not know where to turn.

Since each of us will likely need long-term care at some point in our lives, we should identify potential facilities we prefer well before our actual time of need.

It is wise to do this homework in advance to help alleviate undue stress at an already stressful time.

KALĀKAUA GARDENS
1723 Kalakaua Ave., Honolulu, HI 96826
808-518-2273 | Ruth.Kawano@kalakauagardens.com
www.kalakauagardens.com

Seniors who experience a fall or stroke, or undergo surgery may be surprised they can be discharged from the hospital fairly quickly. That’s good and bad news. Seniors may be happy to leave the hospital but may then be disappointed to learn they cannot return home.
Dementia: Compassionate Communication

As a dementia educator, I am often asked why people living with dementia (PLWD) ask the same question over and over again. My reply is, “Because their brain is failing.”

Every day, PLWDs are going through chemical and physical brain changes. Due to brain failure causing multiple problems with short-term memory, a PLWD can get themselves caught in a loop of asking the same questions.

Here are some suggestions for the next time you recognize the start of another loop of questions.

■ Listen to the important details as they speak. As dementia progresses, language will become increasingly vague. Therefore, objects or activities will be difficult for a PLWD to accurately describe. Instead of asking for the artificial sweetener Splenda, the PLWD might describe it as “the yellow stuff to put inside.” Take note of their descriptions and work like a detective to decipher the message using context clues in the environment.

■ Validate their emotions. Oftentimes, PLWDs create fictional stories that make complete sense to them. As a care partner, we choose to overlook their confabulated stories and attempt to reorient them back to the “truth” in our reality. The key here is to remain patient and just listen to their story. The PLWD is expressing his or her anxiety, which translates into made-up stories. You don’t have to agree with them, but offering validation, such as “wow, that must be hard,” can help the PLWD feel that they are respected and heard.

■ Redirect their attention toward an engaging task. Identify a highly preferred item or activity that you can provide in that moment. After validating the PLWD’s emotions, you can redirect the conversation toward the previously identified preferred item or activity. The reason we want to redirect their attention is so that their focus and attention will shift onto something productive or engaging. If we only validate their emotions without redirecting, then the PLWD is more likely to start the same behaviors again.

■ Check in on them as needed. Let’s admit it; we all have good and bad days. One day a task might be easy for the PLWD and the next day it could be the most frustrating thing ever created! Checking in on your person every five minutes or so is a good way to ensure that they are still engaged in the task. If the task is too difficult, then consider switching to an easier task before their agitation escalates to an unmanageable state.

HAWAII MEMORY FRIENDS LLC
Caregiver Education & Consultation
Mapuana Taamu, Certified PAC Trainer
808-469-5330 | mfriends808@gmail.com
Learn more about dementia at our upcoming 2020 workshops.
Contact Hawaii Memory Friends LLC for details.

As a dementia educator, I am often asked why people living with dementia (PLWD) ask the same question over and over again. My reply is, “Because their brain is failing.” Every day, PLWDs are going through chemical and physical brain changes. Due to brain failure causing multiple problems with short-term memory, a PLWD can get…
Addressing Seniors’ Spiritual Care Needs

With advances in medical technology, including diagnostic testing, prescription ordering and even making appointments, we may struggle with how care is coordinated and delivered. The focus on current clinical treatment and replacement of a real person with a recording has moved us farther from the traditional approach of face-to-face care and compassion-oriented interactions. The Latin root for the word “compassion” is “pati,” which means to “suffer;”
the prefix “com” means “with.” Therefore, to have compassion literally means to “suffer with.”

Compassionate care involves addressing the needs of the individual as a whole — their physical, emotional, social and spiritual needs. While providers dedicate themselves to managing the physical symptoms of aging and disease, seniors may experience other pain as well, on a mental and spiritual level. Why is this happening to me? What will happen when I die? Will my family survive my loss? How will I make it through this? The time has come for us to find other avenues to help our family members cope. Here are some thoughts that may help find meaningful answers to these questions:

✦ Helping patients practice some form of religious or spiritual belief has been found to promote a happier disposition in individuals with advanced cancer diagnoses, who also, consequently, report having less pain. Common spiritual practices are performed by those who bring a faith-based system into their lives. The idea they would be in the loving presence of a higher power and that death was not an end, but a transition to another life, provides comfort.

✦ Promote daily routines that boost emotional well-being, such as bringing back cherished memories with a review of the family photo album. This will help to reduce worry, which leads to better health outcomes by allowing an individual to “let go” of concerns about their medical condition and live more in the present moment with loved ones who are eager to share these moments.

✦ Understand that the interpretation of “faith” can encompass many activities not directly related to traditional, religious beliefs. Meditation, massage, singing and following certain rituals all may have a spiritual component that is recognized by the individual, and thus defines what faith means to that person. The positive impact of a faith-based system, therefore, is not necessarily defined on society’s terms, but rather on its importance to the individual, in their own mind. Simple daily routines that promote joy and happiness can have a significant impact over time.

Chaplains and local faith groups may be able to provide support in this respect, which in turn will have a positive impact the patient’s quality of life. Whatever the practice is — praying, meditating, performing a ritual — the practice supports a meaningful personal existence, the fulfillment of life goals and a feeling that life as been worthwhile for the individual.

Even the World Health Organization has recognized the meaning of “health” as “a state of complete physical, mental and social well-being, not merely the absence of disease.” It’s up to us to provide compassion and spiritual experiences for our loved ones when and where we can. This interaction is best accomplished face to face.

ATTENTION PLUS CARE HOME HEALTHCARE
Accredited by The Joint Commission
1580 Makaloa St., Ste. 1060, Honolulu, HI 96814
808-739-2811 | www.attentionplus.com
AGING IN HAWAII EDUCATIONAL OUTREACH PROGRAM
by Attention Plus Care — a program providing resources
for seniors and their families, covering different aging
topics each month. For class information and upcoming
topics, call 808-440-9356.

Compassionate care involves addressing the needs of the individual as a whole — their physical, emotional, social and spiritual needs. While providers dedicate themselves to managing the physical symptoms of aging and disease, seniors may experience other pain as well, on a mental and spiritual level. Why is this happening to me? What will happen…
Hospice Support for Body, Heart & Soul

Navian Hawaii is grounded in a comprehensive care philosophy, providing an interdisciplinary program of care to support patients and their loved ones’ physical, psycho-social, emotional and spiritual well-being. Complementary therapies are a vital part of this care philosophy:

Pet Therapy has been proven to reduce depression and fatigue, and ease stress and pain.
Art Therapy uses various forms of visual art to encourage self-expression, reduce stress and improve well-being. It can also be very effective in helping patients’ children understand and cope with death and bereavement.
Aromatherapy provides a variety of benefits, including easing tension, increasing breathing and circulation and promoting a sense of peace.
Healing Touch & Reiki are also offered. Healing touch is an energy-based technique that restores patients’ energy system. Reiki is a Japanese hands-on technique that promotes relaxation and healing.

Additional therapies, such as Hand Casting, Therapeutic Music and Massage Therapy, are available to all patients. We encourage our patients to take advantage of this additional layer of support to help them embrace their end-of-life journeys with comfort and dignity.

NAVIAN HAWAII (501(c) 3 nonprofit)
860 Iwilei Road, Honolulu, HI 96817
808-924-9161 | www.navianhawaii.org

Navian Hawaii is grounded in a comprehensive care philosophy, providing an interdisciplinary program of care to support patients and their loved ones’ physical, psycho-social, emotional and spiritual well-being. Complementary therapies are a vital part of this care philosophy.
Finding the Right Type of Caregiver

Evaluate the logistics and duration of the care you want and need. If seniors prefer to stay at home for comfort and convenience, the family should consider long-term, in-home caregivers who are part-time, full-time or can reside in-home. Those needing specialized care or end-of-life care often chose full-time caregivers, whose skills, credentials and fees vary.

There are three primary types of caregiver roles: companions/homemakers; home care aides/assistants; and medical caregivers, such as certified nursing assistants and registered nurses.

Although companion caregivers are limited when it comes to medical or hands-on assistance, they play a very valuable role, providing support and comfort to seniors when family members are in need of respite.

Home care aids/assistants can perform the same duties as companion caregivers. In addition, certified home healthcare aides can render hands-on care and help seniors with activities of daily living — bathing, dressing, grooming and ambulation.

Medical caregivers work in both home and facility settings. They include certified medical assistants (AMAs), certified/registered nursing assistants (CNAs/RNAs) and registered nurses (RNs). An AMA or CNA can fulfill most needs; RNs meet more specialized needs, aiding cancer, advanced dementia and stroke patients.

OHANA HEARING CARE
Kona Smith: 808-593-2137
www.ohanahearingcare.com

Evaluate the logistics and duration of the care you want and need. If seniors prefer to stay at home for comfort and convenience, the family should consider long-term, in-home caregivers who are part-time, full-time or can reside in-home. Those needing specialized care or end-of-life care often chose full-time caregivers, whose skills, credentials and fees vary.