June/July 2018 Print - Aging Well Rochester

"I don't need help" – Part 1

It’s a common refrain and the bane of many family members: Your loved one is having trouble, yet he or she refuses outside help.

This can put your relative at risk. But if the worst happens and things go south, it also ends up making more work for you. Doubly frustrating when you know it could have been prevented.

Rather than battling head on for acceptance, you might try a softer approach:

Build empathy. Ask your loved one what their concerns are. Just listen and try to identify the hot-button issue underneath the reaction:

Is it an issue of cost? – He or she may not know about Medicare coverage or the actual cost of the service. Your loved one may also underestimate his or her financial resources.
Is it an issue of control? – Fear that this is the beginning of the end in terms of living independently.
Is it an issue of privacy? – “My home is my refuge from others.” Or concern about being judged for lifestyle choices.
Is it an issue of pride? – “I don’t need a babysitter!”
Is it lack of knowledge (or denial) about their health? – Some people minimize the toll an operation or disease is likely to take.
Is it an issue of feeling loved? – “My family will take care of me.”

Validate feelings. All of these are valid reactions and worthy of exploration. You might start with, “I hadn’t thought of it that way. I see why you’re concerned….”

Explore thoroughly. Before problem solving, ask more questions. “Tell me more about that. It’s important that I understand.” The more your relative feels “heard” and the more you genuinely comprehend his or her issues, the easier it will be to work together to find a viable solution.

In subsequent articles, we’ll talk about ways to address these concerns with dignity and respect.

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The habit of happiness

Happiness is in our nature. We are born with the ability to be happy. And then life happens. Our life experiences affect our attitude about happiness. They influence how much we believe we deserve happiness or convince us we don’t deserve it. Especially in stressful situations like caregiving, feelings of happiness can be rare!

A happiness set point. Research suggests that we each develop a happiness “set point”—a level of happiness or unhappiness that is our usual attitude. Like a bad habit, we may feel at the mercy of our happiness quotient. But like a habit, it can be broken and reset to a new level.

Happiness training. If caregiving has taken your level of happiness down a few notches from usual, or you would like to raise your set point a bit, some simple mental exercises can help. Far from self-help mumbo jumbo, research has shown brain training to be effective.

Make strategic choices. You wouldn’t start training for a marathon with a 26-mile run. Similarly, there are many ways to strengthen your happiness. Be choosy about which happiness exercises you try first.

Start with a quick win. Some exercises are more difficult than others. For instance, mindfulness techniques are very effective. But they take time to master. Instead, try an easier strategy, such as consciously savoring an experience you enjoy. Extend the pleasure by telling others about it.
Pick a strategy that is fun. In happiness studies, researchers found some strategies were considered more fun than others. For instance, study participants reported that reflecting at the end of the day on three things that went well was more enjoyable than practicing forgiveness.

Get the biggest bang for your efforts. Some strategies are more effective than others. Exercising, for instance, is a proven winner in terms of improving mood quickly. Plus it has other health benefits.

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Using long-term care insurance

Your relative may have bought long-term care insurance to cover the expense of care when help is needed. Activating the policy takes some lead time. It’s wise to learn all the steps and definitions so you can be strategic with your timing.

Types of care covered. Read the policy and see what kinds of care it will pay for. Options may include nursing homes, assisted living facilities, or private care at home. Check for exclusions.

“Elimination period.” Time is money in long-term care, literally. Think of this as a deductible measured in time. Check to see if the policy requires that you pay out of pocket for care for the first 30-120 days AFTER you have initiated the claim.

“Benefit trigger.” To open a claim, you must prove the need for assistance with personal care tasks: bathing, dressing, using the toilet, eating, or walking. In the case of dementia, such as Alzheimer’s, testing will be needed to prove the degree of memory loss.

Length of the benefit. Most policies have a three-year or five-year limit. Be cautious about starting your loved one’s policy too early. If your relative has dementia or any type of very long-lasting illness, you may want to delay opening a claim until he or she is quite impaired. (But don’t wait too long!)

The claims process. Each company is different, but the process starts with a “claims packet” that includes

claim forms. This is a statement of needs and permission to obtain information from providers;
physician’s statement. This is a critical document in which the primary care doctor certifies your relative cannot perform personal care tasks;
nursing assessment and plan of care. This is usually completed by a nurse from the company providing care;
provider statement. The home care agency or facility you choose must meet the policy’s criteria for payment.

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