October 2022 OutreachNC

O C T O B E R 2

Feature Intro: Tips for Touring a Senior Care Community - Part 1

Each day, many people consider moving into senior living communities. There are many reasons leading to this consideration.

You might, for example, decide for yourself it’s time to make a change.

During dinner a few nights ago, your husband commented, “Seems like all our friends have either moved away or died. It’s getting lonely in the neighborhood.” You pause to consider his comment and realize, yes, in fact, there are fewer neighbors you recognize today than a decade ago. Your Bible study group has dwindled to a handful of regulars, and it seems like the meat of life has been doctor’s appointments and early dinners.

You wonder: where has our social life gone? Where have our friends gone? Why is life becoming lonelier and quieter by the day?

Or you may be considering a senior living community for a loved one, a parent or family member.

Last week, during a visit with your parents, you notice the refrigerator is empty and several food items are expired. A few months ago, your father forgot his annual wellness visit, and you needed to remind him to take his medication before bed. Your mother’s clothes were stained and wrinkled during a family outing over the weekend, and she forgot where she parked the car during a visit to the grocery store, leaving her flustered and confused.

You wonder: are my parents okay living on their own? How can I make sure they’re safe and taken care if I live a plane-ride away? How can I give them the best environment to support them as they age?

ASK THE EXPERT: NO WILL?

FEATURE: TIPS FOR TOURING A SENIOR CARE COMMUNITY PART ONE

CREATIVE MEMOIR: TIPS FOR INSPIRED STORYTELLING

Phariss,

Well, it’s official: fall is here. I had my first pumpkin-spiced latte just two days ago, as the evening temperature dipped low enough to merit a fleece.

Don’t worry. It was decaf.

October is a gentle month. There are constant reminders of change. We turn inward, toward warmth and if we are lucky, toward each other. We have lingering conversations over tea. We burn fires and sit in silence as the flames flicker. Smoke dances around us in a circle. We zip our jackets and consider hats.

In this month’s feature, we’re starting an important conversation: how do we choose the proper senior care community for ourselves or a loved one? Fox Hollow Senior Living’s Sales and Marketing Director, Robin Hutchings offers inside perspective for making this decision.

In Ask the Expert, Amy Natt answers a reader’s question regarding what to do when a loved one passes away without any estate planning. Without a will or access to important accounts, what does a family do?

Physical therapist Dr. Sara Morrison of Total Body Therapy and Wellness helps readers understand potential diagnostic tools used in physical therapy to help diagnose and treat pain. You’ll want to learn how these tools differ from what other doctor’s offices may offer.

I’m going to agree with Nathaniel Hawthorne this month, who wrote:

I cannot endure to waste anything so precious as autumnal sunshine by staying in the house. So I have spent almost all the daylight hours in the open air.

Here’s to enjoying the October sunshine, falling leaves and daylight hours.

ASK THE EXPERT: NO WILL? Amy Natt, MS, CMC, CSA | amyn@agingoutreachservices.com

Q: My father just passed away. He left no will, and when we got to his home, there is a lot of unopened mail. I don’t know his passwords, his banking information or even if the house is paid off. Where do I begin? I want to honor my father’s wishes but don’t know exactly what they are, and the rest of the family is depending on me to figure it out.

A: The best gift you can give your family is estate planning documents that clearly and legally state your wishes. However, it is not uncommon for someone to pass away without having these in place. This is not ideal, but there is a path forward. When someone dies without a will, it is called “intestate.” There are specific laws in each state that will determine what happens to any property or assets your father left behind. If your father was married, the marital assets will pass through to his spouse. If this is not the case, there will be a process called estate administration that will determine how remaining debts are paid and how any remaining assets will distribute to his living heirs. You should start by hiring an attorney who can help you navigate this process and be your advocate. It will take some time to sort out, so be patient with the process.

The mail can give you a great deal of information, as well as other files, documents or notes you are likely to find in the home or possibly in a safe deposit box. I would start by making a list of any account you are aware of or find evidence of. Because there is no named

executor, you will need some documentation from the attorney as well as a death certificate to gain access to most of these accounts. If you can write down any account names, numbers and contact information you can start reaching out to them once you have the documentation to act. There will also be bills that come in and perhaps other debts. These will all be addressed during the probate period. The attorney will be able to help you track down some of the more difficult things, like the mortgage and any possible life insurance policies. This will be something the attorney deals with routinely, so they can give you a clear step by step process to settle his estate.

If you have access to past tax returns, these can help you identify any sources of income or investments that you might not have been aware of. There will be a process of gathering all of the information needed and it may take a few months for things to surface. I would let your family know that you are doing your best and working with a professional to ensure things are done correctly. If there is no surviving spouse in the home, it is tempting to start dividing things among loved ones, but to avoid any unnecessary family dynamics, I would wait until the attorney has given you the green light to remove any personal items. These will all be addressed as the estate is being settled.

You can certainly do practical things like clean out the refrigerator and make sure the home stays in good working order. Begin organizing things you find in the home and take the time to grieve the loss of your father. The legal process will take some time and the pieces to the puzzle will start to fall into place.

T

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Touring a Senior Care Community

PAR T ON E

Whatever the circumstances leading to the decision to consider a senior living community for yourself or your family, the decision has been made. You’ve whittled your choices down to two or three possible options, and it’s time to tour a community. How should you prepare? Which questions should you ask? What should you consider before you visit, during the tour and your visit?

ONC sat down with Fox Hollow Senior Living Community Sales and Marketing Director Robin Hutchings with these questions. Hutchings provides real-time, on-the-ground insight into touring an assisted living and memor y care community and and guidance to help make the best decision for you and your family.

one of a two-par t feature. Next month, ONC will feature the remainder of our inter view with Robin Hutchings.

may want to know is: What do we mean when we say senior living community?

Robin Hutchings: A senior living community on the needs of the resident. For example, there are independent living communities, which are skilled nursing facilities. But all of the communities provide amenities and services to support the lifestyle of the people who wish or need to live in a community with other people 55+.

ONC: Can you explain the difference between independent living and assisted living?

RH: Sure. Independent living communities offer some services such as laundry facilities, some meals and yard maintenance. Independent living is often referred to as congregate living because the focus is on community. The residents live independently, however, without the need for medication management, transportation or assistance with activities of daily living (ADL). So, someone in a congregate living community will be able to take care of their daily lives but may want to have a few meals prepared for them, the lawn maintenance taken care of and perhaps housekeeping provided a few times each week. Also, some communities provide transportation options for convenience. Each community differs in what is provided.

In independent living, some homes (apartments) offer full kitchens while others do not. Some offer full meal plans, and others offer limited meal options. This will be important to explore during a tour

Assisted living communities offer higher levels of care. This might include medication management if a loved one is forgetting to take their medication or becoming confused about medication. Assisted living communities also provide transportation and more meals, often three meals and three snacks per day. Additionally, help with ADL is offered. Your parent might need help dressing, bathing or socialization. This help can be provided in assisted living communities.

Then, there is skilled nursing, which is another higher level of care. Skilled nursing is more like a hospital setting, with 24-hour nursing care and patient management.

ONC: Are there differences in the cost between each level of community?

RH: Yes. Independent living communities are less expensive than assisted living; this is typically less expensive than skilled nursing. With the increase in care provided, the cost of the community usually increases.

ONC: Do all facilities offer a full range of care, from independent living to skilled nursing?

RH: No. Some communities do offer all three

(independent, assisted and skilled nursing), but not every community will offer each one. Communities known as CCRCs (continuum care retirement communities) offer the full spectrum of care, from independent living to skilled nursing care. But other communities may only offer one level of care. It’s an important question to ask before or during a tour.

ONC: Once we decide we’re interested in a senior living community, what should we consider before a tour?

RH: This is a great question. For some people, the idea of moving is overwhelming or upsetting. For others, the idea of moving to a new community is exciting and feels like a relief if the upkeep of a home has become a burden. Doing your homework before a tour is a good idea. Part of that is just having difficult conversations about care with family members and loved ones. Your parents may not want to have this conversation. There can be a lot of denial when it comes to needing more care. There can be denial on the part of the person needing to make a change, and there can be denial from family members. Kids may not want to admit their parents need more help or can’t take care of the home themselves. This can be hard for any family. But you really need to identify what you’re looking for and why you’re touring a facility.

Do you need help with dressing and bathing? Are you looking for more social connection? Do you want a little help with housekeeping and chores but mostly want to live on your own?

Really think about why you or your loved one is looking into a senior living community. The why helps you identify what you’re looking for and how to find it.

Then, have all your questions ready before the tour or before the phone call to set up an appointment. You’ll have more questions after or during the tour but having a list before you begin is a good idea.

ONC: So, getting to the nitty-gritty here, what are some of the questions we should be asking during the tour? What should we be paying attention to, looking for and asking?

RH: First, remember that your first visit is to look, see, touch and feel. It’s just like choosing where you want to live in a neighborhood or in the country.

You’ll go there and look around. You get a feel for the place, the people, the environment. It’s the same with a senior living community. Take your time; pay attention to the people and how they interact. Are the residents talking with each other? Is the staff talking with residents? Are people interacting or just sitting alone? You want to pay attention to the feel of the community.

Some of the specific questions you might ask staff are:

• What is included in monthly rent?

• Aside from the monthly rent, what are extra fees or expenses I might incur?

• Are the rooms refurbished and renovated between residents or only cleaned?

• Is the community pet friendly?

• What is the longevity of staff at the community?

• Who is in charge?

• Are any of the team members or staff crosstrained? For example, the receptionist is also a CNA. If someone were to need care, she’s trained to be able to take care of that without having to call someone else.

• What is the maximum level of care you are prepared to keep within the community? When does a resident need to move from Assisted Living to Skilled Nursing, for example? What are your standards for this type of move?

• How long has the physical structure been there? Do you have a generator?

• How often do you do emergency drills or tests such as fire drills? What are your emergency preparedness plans?

• What are the patient to caregiver ratios? *There are state guidelines regarding ratios, which you should look up before your visit.

• Can we taste the food? *Food is important. As we get older, that’s one of the things we can control –what we eat or don’t eat.

• What choices do residents have regarding food? For example, if I don’t like what is served for dinner, what are other options?

• Are there set mealtimes or are meals provided all day and flexible?

• What can residents have in their rooms as far as food goes: minifridge, microwave, coffee pot, toaster, etc.

• Where do you transport residents? Will you take me to my poker game on Saturday night? Is transportation just for medical appointments, or is it for other things?

• Will you provide a way for me or my parents to vote?

• Will you take me to the senior enrichment center to do activities over there? *or any other community event/activity you wish to participate in

• Is there a library? Do you have the bookmobile come around?

• What is the age demographic of your residents?

Next month, ONC will publish the remainder of Hutching’s interview. Hutchings addresses what to ask after touring a care community as wellas common myths related to moving into a community. Finally, we’ll include tips and advice from AOS Care Mnagement’ s own Aging Life Care Professional care managers for touring and exploring care communities for your loved ones or yourself.

TIPS FOR INSPIRED STORYTELLING

Amy Phariss, Editor in Chief

When we think of memoir, we often think of a linear storyline.

I was born in 1949, on the eve of…..

The book begins with birth and ends with where we are now, typically having overcome obstacles and taken time to reflect on our journey.

While this story format is popular and familiar, it’s not the only way we can share and tell our stories. There are other methods, many of which seem less daunting and more intimate. Rather than pacing our stories by a strict timeline of events, we can share our stories by highlighting what mattered most to us throughout our lives.

Here are 7 examples of non-traditional storytelling options for exploring personal history and sharing our lives with the ones we love:

1. Recipe Collections - For many people and families, nothing is more personal than food. The way we cook it, eat it and share it is a story in itself. Sharing our most prized, oftencooked recipes is a way to also share the stories that go along with those foods. Whether it is a special Christmas cookie collection or a birthday cake memory, recipes take us back in time. We can smell the spices and feel the warmth of the oven. We remember the seasons, the conversations and the people with whom we shared these foods, and we pass on to future generations both the intangible memories as well as the tangible way to remembering those stories: the food.

2. Short Story Collections - Often, a whole life history seems overwhelming. Pairing this history down to 10 or 12 stories can be poignant. Short stories require thought and consideration. Which stories matter most? Which stories reflect my life and the message I want to share?

4. Themed Stories - Are there themes that define your story? Love, trust, faith? Redemption, ambition, honor? There are themes in all of our lives. Exploring these themes helps us flesh out what we’ve learned, how we’ve traveled through our lives and what has meant most to us. I’ve worked with writers who focused on what love has meant in life – romantic love, parental love, community love, self-love.

5. Lessons Learned - Often, when we talk about legacy, we talk about sharing our wisdom with others. Perhaps we’ve learned how to achieve great financial or professional success. Or maybe we’ve learned how to overcome hardship such as physical pain, emotional setbacks or social obstacles. Throughout our lives, we will face challenges. When we overcome these challenges, we learn lessons, and these lessons can be valuable for others. Think of the top 10 lessons you’ve learned and share the stories of how you learned them. As you write, your personal story will come through and take shape. This is an impactful and meaningful way to write your personal story for both the writer and the reader.

6. Letters - Letters, emails, notes, diaries and even text messages tell stories. Many famous novels are written in letter form, known as the epistolary novel. Some examples are Possession by A.S. Byatt and Screwtape Letters by C.S. Lewis. Who would you write to if you could write someone a letter? Would you write to your children or grandchildren? Do you have letters written between someone special and you, over the years or throughout a particular time? Sometimes, telling our feelings and stories can be much easier when we think of writing only to one person, and letters allow us to do this. You could write a series of letters to one person or a letter to each member of your family, including how you feel about this person, what you remember of your history together and what you wish them to know about your story. Collected, these letters will create a rich tapestry of your personal history.

CREATIVE

3. Poetry - I helped a woman once transcribe her poetry into a document for her family. It was truly amazing to read each poem and a few essays. As I typed, I really began to grasp the story of her life, from her childhood through her career and alongside her on her travels. It was a soothing, lovely way to spend my evenings, joining her by the sea, in a church pew, with her mother as a small child. I was surprised by how much a short poem conveyed about her personality and her history. Poetry can seem daunting for many of us, but like short stories, poetry forces thought and focus. Which are the best words? How do you convey an entire experience in a few stanzas? It’s an excellent reflective exercise.

7. Travel Memoirs - Have you lived overseas? Did you or do you love travel? Have you learned about yourself and the world in ways you want to share? We can tell our own stories through the way we interact with the world. Sharing what we’ve seen, heard and experienced outside of our hometowns can be a way for our loved ones to explore the world with us. It also lets us share what those stories have meant in our own lives.

Each of these options shares your story in a way that is less confined or restrictive than a traditional memoir format. These are creative ways to share our pasts and leave a legacy for the people we know and love as well as for the people we’ve yet to meet.

PT: WHERE DO SYMPTOMS COME FROM?

No one likes to be in pain. In fact, I have spent the past 20+ years helping people get out of pain. The most common question I hear is “How can I get this pain to go away?” The answer to this is simple. We first need to know Why you are hurting. Then we can figure out how to stop the pain. So, why are you hurting? There are many different reasons for pain to occur in our bodies. Pain can be due to a problem in the Muscles, Joints, Tendons, Organs or Nerves. It can also be due to Medication, Psychological reasons, or Nutrition

Many health care professionals diagnose pain by Special Tests. During these tests, your practitioner will use their hands to push, pull and twist the areas that are causing you pain. These tests are very useful to find what structure is causing you pain. If you place stress on a structure and it increases your pain, it is likely that structure is contributing to your symptoms. Although helpful, many of these special tests are only 60-80% accurate. While this may look good at first, changing the way the question is framed will show that this also means they are 20-40% inaccurate. Misdiagnosis of pain can be very costly. At best it keeps you in pain longer, while in other cases it can allow symptoms to intensify. When you are dealing with pain, missing your favorite activities and sleepless nights… you want to be as accurate as possible!

The addition of Diagnostic Imaging in Physical Therapy has revolutionized the way pain is addressed. By utilizing Diagnostic Imaging, PT’s are now able to look inside you

and diagnose your pain with over 98% accuracy. That means that we can find the real problem, or problems, and address them from the beginning. No more trial and error. No more “try this for a few months and if it doesn’t get any better we will try to get an MRI”. With the addition of Diagnostic imaging, your Physical Therapist can now say “From my evaluation it looks like you have a problem in ____. We are going to do a Diagnostic Ultrasound and confirm this and fully check your joint.”

In a matter of a few days, we can have your test performed, results given to you and a new, more comprehensive plan to improve your pain.

Diagnostic imaging in physical therapy includes:

1. Musculoskeletal Ultrasound (MSKUS)

MSKUS is a safe, non-invasive, and painless diagnostic tool. It is used to diagnose structures such as tendons, muscles, bursas, ligaments, nerve entrapment/pinching and joint structure changes. Like a video, MSKUS captures real-time images of body structures and can assess a joint/area while it moves. This feature is especially useful as many times pain does not occur at rest, only with movement.

With MSKUS, you can view the joint while it is moving and assess if something is pinched, squished, or moves abnormally when it is used. MSKUS is much less expensive than MRI or CT Scan tests. Therefore, it does not require pre-authorization to complete. This means the results are obtained much faster, allowing for faster pain relief. No radiation is used, and MSKUS is safe for any individual.

Compared to MRI or CT scans: Similar to a picture, MRI/ CT scan provides only a static/ non-moving image. This will not allow for assessment of a joint in motion. The picture is grainier and not as detailed as MSKUS. These tests are much more expensive and often require pre-authorization or other procedures to be performed first before insurance will allow them. They also utilize radiation.

2. Electromyography (EMG)/ Nerve Conduction Test (NCS)

present and the extent of the damage. Many times, nerve pain can shoot or radiate from one location to another. This makes finding the true source of pain challenging. EMG/NCS will not only detect damage, but it will pinpoint the exact location of pain and the extent of the damage.

For example: You have pain in your neck which shoots down your arm all the way into your fingers. Your pain can be the result of a problem anywhere from your neck, shoulder, elbow, wrist, or hand. An MRI may show arthritis in your neck, and you may be told this is causing your arm and hand pain. EMG/NCS can show that the nerve damage is in your elbow. EMG/NCS will show your PT exactly where your issue is, how bad it is and give them information on what needs to be done to fix it. Your PT will also have information on how long this will take to improve.

As we age, many people often have more than one problem. Just because you have arthritis in your neck, it does not necessarily mean that this is the cause of the pain that is in your arm. I have seen many people in this condition have surgery on their neck when in fact they had a pinched nerve in another area. The surgery did not fix their pain and now they are in worse shape than when they began. If an EMG/NCS test had been performed, they may have been able to avoid an unnecessary surgery.

These tests are used for those suffering from nerve pain (numbness, tingling, burning, coldness, heaviness, unexplained weakness). These tests measure the electrical activity in the muscles and nerves. It can help identify if nerve damage or pinched nerves are

Diagnostic imaging has paved the way of the future to allow people to heal their pain faster and less expensively than ever before. If you are in pain and interested in real answers, contact your physical therapist. Be sure to ask if they utilize diagnostic imaging. No order or referral is needed for physical therapy when using Medicare or commercial insurances.

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Thank you for supportingMums for Memory!

Your donations allow AOS & Friends Care to provide a a variety of services to older adults, focusing on those with dementia, including direct care grants, personalized music players, robo companion pets, resources, and education.

The need for funds and community support is yearround. We invite you to include AOS & Friends Care in your end-of-year donations.

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