individuals when they are encouraged to perform fun,
brain-stimulating activities.  The following activities are
especially good for homebound elderly:
 
--  sew or knit,
--  be a friendly telephone caller,
--  be a foster grandparent,
--  be a pen pal,
--  be a reader to children at an elementary school,
--  save stamps for collectors,
--  write favorite recipes on cards and share them with others,
--  read books, magazines, newspapers,
--  do puzzles (jigsaw, crossword),
--  try artwork (calligraphy, painting, drawing),
--  write or record memoirs, poetry, thoughts,
--  keep a joke book,
--  care for pets or plants,
--  listen to soothing music,
--  take correspondence courses,
--  play musical instruments,
--  start or re-arrange a family photo album,
--  volunteer, at libraries, hospitals, museums, schools,
Retired Senior Volunteer Program (RSVP),
--  bake for self and others,
--  plan a potluck or brown-bag lunch at home,
--  tutor or visit with children and youth,
--  type for self and others,
--  participate in radio call-in shows,
--  learn to use a computer.
 
In addition, older people who are physically able should be
encouraged to participate in swimming, bowling, gardening,
dancing, miniature golf, nature walks, mall-walking, jogging,
shuffleboard and other activities outside the home.
 
Drawing, writing, reading, crafts, taking classes, and other
hobbies encourage creativity.  Indoor games including chass,
checkers, monopoly, cards, billiards and Parcheesi provide
interesting relief from boredom as well.
 
****************************
K.  Legal and Financial Affairs
 
Older people continue to be concerned about management of their
assets and property.  However, they may be unable to participate
because of illness, confusion or loss of memory.  It is
important to involve them whenever possible.
 
42.  Compiling an Inventory           Develop an inventory which
lists all assets and liabilities of the older person.  The
following items should be included:  bank accounts, pass books,
certificates of deposit, money market funds, stocks, bonds,
precious metals, jewelry, real estate deeds, promissory notes,
contracts, insurance policies, safety deposit boxes (including
location of the key), and retirement or pension benefits.
Location of the records for each asset and liability also should
be included.  Other important documents, such as birth and
marriage certificates, social security numbers, divorce decrees
and property settlements, income tax returns (state and
federal), death certificate of spouse (if any), and wills
(including the attorney's name and executor) or trust
agreements, should be listed and the locations designated.  If
able, the older person should compile the list.  If unable, a
family member, attorney, banker, accountant or certified
financial planner can help compile the inventory which should be
copied and kept in a safe, obvious place, possibly with a
relative or friend.  It is important that the document be
updated every year.
 
43.  Managing a Will and Financial Affairs
 
An objective of financial and estate planning for older people
is to plan for the orderly distribution of the estate upon their
death, according to their desires.  Consequently, it is
important for people to have a will drafted, which incorporates
the above inventory and states how property is to be disposed of
upon death.  Everyone over the age of 18 should have a will or a
similar legal document.
 
If a person does not have a will, an attorney should be
consulted immediately.  Proper planning is essential and powers
of attorney or trust agreements should be executed while a
person is still competent.  Otherwise, transfer of
responsibility for management of the person's financial affairs
to someone else must be completed through a court action, and
costs spent in clearing up Probate problems come directly out of
the person's assets, diluting whatever estate is left after
death.
 
Remember, as caregivers concerned about the financial affairs of
a care-receiver, you should not get directly involved without
legal authority.  Acting without clear legal authority, even
with the best intentions, can cause serious problems.
 
The legal mechanisms available for surrogate decision making
are:   durable power of attorney (DPA), probate conservatorship,
durable power of attorney for health care (DPAHC), and
(California only -- check to determine if your State has
comparable laws.)
 
Durable Power of Attorney       is a written legal document
giving someone other that the *Principal* the authority to
handle the Principal's financial decisions.  It must be signed
by the Principal while the Principal is still legally competent.
The DPA is valid without time limit until the Principal either
revokes the DPA or dies, or the court revokes the DPA due to
mismanagement.  The preferences of the Principal regarding the
management of assets can be specified.  This power to manage
assets can be transferred immediately or can be designated to go
into effect when it is determined that the Principal has become
mentally incapacitated.  Financial decisions made by an
individual given DPA by the Principal are binding on the
Principal and his/her successors, so caregiver and care-receiver
are urged to seek the advice of an attorney.
 
Probate Conservatorship            or Conservatorship of Estate
allows for the management of the Principal's money and other
property when the Principal presently lacks the capacity to
either decide or appoint another to decide financial decisions
in his/her behalf.  Court proceedings to designate a conservator
are required.  This is a difficult and extreme procedure but may
be necessary if the care-receiver is already incapacitated to
the extent that he/she is unable to manage personal financial
affairs.
 
44.  Durable Power of Attorney for Health Care (DPAHC)
is a written document which must be signed by the Principal
while he/she still has the capacity to make decisions.  The
DPAHC gives someone other than the Principal authority to make
medical treatment and health care decisions on behalf of the
Principal for up to the maximum of seven years after the
document is signed.  It allows one to specify ahead of time how
he/she wishes these decisions to be made.  Wishes regarding
extraordinary supportive care, including breathing machines and
tube feeding, can be addressed in the Durable Power of Attorney.
All adults should have a Durable Power of Attorney for Health
Care.
 
45.  Lantern-Petris-Short (LPS) Conservatorship  (California
only -- check for comparable laws in your State)  or
conservatorship of person is a court-ordered process which
enables a person to get the psychiatric and/or medical care
needed but by reason of mental illness is refused.  The court
determines if the Conservatee, in addition to receiving the
necessary psychiatric treatment, may also retain or be denied
the right to vote, possess a driver's license, enter into
contracts, or refuse non-psychiatric medical treatment.  The
Conservator may be a relative, friend or an appointee from the
Conservator's office.  The Conservator may be given the right to
require and authorize the conservatee to receive involuntary
psychiatric and/or medical treatment and supervises and assists
in making proper living arrangements, including placement in a
Residential Care or a nursing home when indicated by the doctor.
In order to start the process, one consults either with his/her
attorney or calls the Office of the Counselor in Mental Health.
An individual has to be adjudicated to be gravely disabled
before being placed on an LPS conservatorship.  Grave disability
is defined as the inability to provide for one's food, clothing,
shelter and proper medical care due to a mental disorder.
 
46.  Selecting an Attorney              It is important to
select an attorney who is knowledgeable in the areas needed
(estate planning, will drafting, probate or conservatorship).
Ask friends or other professionals for recommendations, or
contact a Lawyer Referral Service, County Bar Association, or
Senior Citizens Legal Services.  Before agreeing upon a
particular attorney, ask if he/she has previously done what you
require.
 
******************************
 
L.  Liability of Caregiving
 
Anyone who accepts the responsibilities of a caregiver must also
understand that there are a number of legal duties or
liabilities that come with it.  Many states including California
have passed elderly abuse laws.  Caregivers are bound by these
laws in two ways:  not to abuse the elder person (physically,
mentally or monetarily) and report any incidents of abuse or
suspected abuse to (California residents only -- the Adult Abuse
Reporting line 476-6266 or 1-800-523-6444).  (Residents of
states other than California:  Check you local telephone
directory for the Adult Abuse Reporting telephone number or
contact your county mental health services for guidance.)
 
As a caregiver, you must provide a clean and safe environment,
nutritious meals, clean bedding, and clothes.  At the same time,
if you are in charge of the elderly person's finances, you must
use that money properly, purchasing necessary services for the
benefit of the person to whom care is given.  Failure to provide
care, failure to get care, and failure to purchase care are all
forms of abuse or neglect.
 
In addition, caregivers may not physically, sexually or
psychologically abuse the person receiving the care.  Yelling,
screaming, withholding affection, etc., are as much an abuse of
the person as is striking the person with the hand or with
objects.  Therefore, if you are contemplating becoming, or are
now a caregiver, you must be ready to accept the physical,
psychological and legal duties to provide the necessary care.
If you are reaching a point where you are no longer able,
physically or emotionally, to provide the proper care, we urge
you to consider the alternatives to personal caregiving and to
seek help with this decision from a counselor or one of the
resources available in Appendix A.
 
47.  When is it Time to Stop Caregiving
 
As we have stated repeatedly throughout this booklet, caregiving
is a very stressful situation.  Stress either causes or
exacerbates some 70 to 90 percent of all medical complaints,
including tension and migraine headaches, high blood pressure,
asthma, nervous stomach, bowel problems, and chronic lower back
pains.  There is research evidence indicating stress plays a
role in a person's susceptibility to heart disease, stroke, and
cancer.
 
Stress has also been implicated in psychological disorders such
as anxiety reactions, depressions and phobias, as well as poor
work performance, drug and alcohol abuse, insomnia, and
unexplained violence.  If you are experiencing any of the above,
it is extremely important that you learn and use various
techniques for stress reduction (some are mentioned in this
booklet), contact one of the professionals in Appendix A or come
to the decision, both for your well-being and that of your
care-receiver that *It is time to stop caregiving.*
 
Below are some telltale signs which can help you assess when you
have reached this fork in the road;  seek help professional
help, utilize more stress reduction methods, or stop caregiving:
 
--  snapping at the care-receiver constantly even over little things,
--  being constantly irritated,
--  seldom laughing anymore,
--  feeling constantly tired or pressured,
--  losing sleep, failing to fall asleep for hours, sleeping
restlessly all night long,
--  yelling or screaming, or having crying fits, or rages frequently,
--  withholding affection, feelings of goodwill from the care-recipient,
--  withholding food, baths, dressing changes, etc.,
--  constantly blaming the care-receiver for your being in this
situation (his/her isolated caregiver),
--  refusing to go out anymore, even for a walk because *he/she needs
me,*
--  withholding expenditures for goods or services he/she needs
because he/she is going to die soon and it is wasted money,
 
While these are not exclusive, they indicate a classic picture
of *caregiver burnout.*  The treatment for caregiver burnout is
simple --  get help and get away for extended periods, either
through stress management respite help or through a complete
change in caregiving.
 
No one can remain a full-time caregiver forever;  the job is
much too strenuous and stressful.  The point we wish to set
forth is:  *When should I say this is my limit;  I am not able
to do any more.*  Be honest with yourself, and when *that limit*
has been reached, STOP!  Research alternatives, request help
from qualified professionals, and rest easy, because you did the
right thing!
 
*****************************
 
M.   Choosing a Residential Care Facility
 
In making the decision to seek an alternate living arrangement
for your care-receiver you will first need to consult with your
physician.  The physician can be your best ally since most
facilities require a current complete physical exam and the
physician can assess the *level of care* your care-receiver
needs.  This is important in order to determine which type of
licensed care facility you will be seeking, from the Acute
Hospital to Sub-acute Skilled Nursing Facility (SNF),
Intermediate Care Facility (ICF) or Residential Facility for
Elderly (RFE) (more commonly referred to as Board and Care or
Retirement Homes).  The RFE is for non-medical care and
supervision which may include personal services (help in bathing
and grooming, guidance in dressing, aid in taking
self-administered medications) and help with other daily living
activities.
 
Seek a licensed facility, since people who need care and
supervision are often defenseless against abuse or exploitation.
The law requires that care facilities be licensed.  So when you
select a care facility, check for the license to assure the
protection provided by law and quality care for your loved one.
 
What Should I Look for When I Visit a Care Facility
 
It is ideal if both you and your care-receiver could preview a
care facility prior to deciding.  Both prior to and during the
preview process you have the opportunity to further discuss your
feelings in making the decision.  Since you have many things to
do during your visit, you will find the outing less stressful
and easier afterward to evaluate if you organize your thoughts
beforehand, write down the questions you wish to ask, carry this
checklist during your visit and make notes while looking around
and talking to different people.  Some items you may want to
cover during your initial visit to insure quality care are:
 
--  Ask to see the facility license,
--  Look closely at the building and grounds,
--  Talk to some facility residents,
--  Talk to the facility administrator who is in charge of daily
operations,
--  Talk to some facility staff members,
--  Ask to see a copy of the Admission Agreement.
 
Contact your County or State Department of Social Services for a
copy of their *Consumer's Guide to Community Care Facilities* or
equivalent.  (In California, a booklet entitled *A Consumer's
Guide to Community Care Facilities* details a 6-page checklist
for facility visits.  A copy may be obtained from:    The
California Health & Welfare Agency, Department of Social
Services, 744  P  Street, Sacramento, CA  95814  (tel: (916)
445-4500).
 
*****************************
 
N.   Conclusion
 
This handbook is available from San Diego County through the
efforts of many collaborators.  I hope it will serve as a
reference tool for the new and veteran caregiver.  It can never
be said often enough that that YOU, the caregiver, are
incredibly important!
 
The welfare of another person, the care-receiver, depends on
you.  If you are not in good health, the care-receiver also may
suffer.  If you have taken on the role of a caregiver you have
also accepted a special responsibility to take care of yourself.
So, good luck and good care;  You are important!
 
****************************
 
Appendix A
 
Selected Community Resources for Caregivers
 
(This Appendix in the San Diego County handbook lists important
resources for the caregiver by county locality, resource title
and telephone number.  The specific titles of the activities and
their telephone numbers would be of little use outside the
county.  For the purpose of this copy the resources are
identified by functions to serve as a guide for preparing a list
suitable to your needs.  Specific activity titles, locations,
telephone numbers, times open for calls, etc., may be available
from your County Mental Health Services, United Way directory,
or telephone directory.  The following examples include several
not listed in the handbook.  Mike)
 
EMERGENCY  (Large print. Post near telephone)
Your physician(s)
Ambulance Services
Hospital to which care-receiver would be taken
Oxygen Support
Suicide Prevention/Crisis Intervention
Poison Control Center
Pharmacist
Police
Fire Department
Neighbors you can count on in emergencies
Domestic Violence Hotline
Elder Abuse Hotline
 
GENERAL INFORMATION AND REFERRALS
Area Agency on Aging - Senior Hotline
American Association of Retired Persons (AARP)
Alzheimer's Association Help Line
State/County Self-Help Center
Medical Information Service
Older Women's League (OWL)
Senior Citizen's Centers (near your home)
 
AGING SERVICES
 
LEGAL SERVICES
 
ADULT DAY HEALTH CARE CENTERS
 
ALZHEIMER'S CENTERS - SOCIAL DAY CARE
 
SENIOR SOCIAL CENTERS
 
CAREGIVER SUPPORT/TRAINING GROUPS
  (check with your County Mental Health Services)
 
NUTRITION INFORMATION CENTERS
  (Meals on Wheels)
 
HEALTH INFORMATION
  (Hearing aids maintenance, MedicAlert, prostheses maintenance and
repair,
etc.)
 
IN-HOME CARE SUPPORT & SERVICE
  (Homemakers, Hospice, Visiting Nurses, etc.)
 
CLERGY
 
**************************
 
Appendix B
 
Further Readings
 
A. Calder and J. Watt,   I LOVE YOU BUT YOU DRIVE ME CRAZY, a
guide for caring relatives,  Forbez, Vancouver, Canada, 1981
 
D. Cohen and C. Eisodorfer,   THE LOSS OF SELF, a family
resource for the care of Alzheimer's Disease and related
disorders, NAL Penguin, Inc. New York, 1987
 
Norman Cousins,   ANATOMY OF AN ILLNESS, Bantam, New York, 1981
 
H. Edwards,   WHAT HAPPENED TO MY MOTHER?  Harper and Row, New
York, 1981
 
D.R. Eyde and J. A. Rich,  PSYCHOLOGICAL DISTRESS IN AGING, a
family management model, Aspen, Rockville, MD, 1983
 
J. Halpern, HELPING YOUR AGING PARENTS, a practical guide for
adult children, Ballentine, New York, 1987
 
Julie Tallard Johnson, HIDDEN VICTIMS, an eight-stage healing
process for families and friends of the mentally ill, Doubleday,
New York, 1988
 
N.L. Mace and P.V. Rabin, THE 36-HOUR DAY:  a family guide to
caring for person with Alzheimer's Disease, related dementing
illnesses, and memory loss in later life, Johns Hopkins
University Press, 1981
 
L. Mortain et al., WHO CARES?  helpful hints for those who care
for a dependent older person, U.S.C., Los Angeles, CA 1985
 
B. Shulman and R. Berman, HOW TO SURVIVE YOUR AGING PARENTS, so
you and they can enjoy life, Surrey, Chicago, 1988
 
B. Silverstone and A. Burack-Weiss, SOCIAL WORK PRACTICE WITH
THE FRAIL ELDERLY AND THEIR FAMILIES, C.C. Thomas, Springfield,
IL, 1983
 
B. Sloan, THE BEST FRIEND YOU'LL EVER HAVE, Crown, New York,
1980
 
 
***************  END  ********************
 
 
John Cottingham         NEW ADDRESS:          [log in to unmask]