Reverse Magazine 0923

3.

4.

The Future of Medicine?

6.

MEDICARE SOLUTIONS

Annual enrollment is nearly upon us

ARTIFICIAL INTELLIGENCE IN MEDICINE

Are you being treated by a human or a machine?

PONDERING THE FUTURE OF SENIOR CARE COMMUNITIES

In-home care may be more affordable than you think

8. 10. 12.

9 STEPS TO BEING AN EMPOWERED ADVOCATE

Arm yourself with knowledge come what may PROJECT H.O.P.E.

How the Richland County Sheriff’s Department is caring for seniors

SAFETY FIRST

Important fire safety tips we can all use

14. 16.

ELDER ABUSE

Awareness of abuse in all its forms is the first step to prevention

MAINTAINING AND LOSING CONTROL

How guardianships can help protect certain seniors

18. 20.

FORGETFULNESS, DEMENTIA AND ALZHEIMER’S

What’s the difference?

CREATIVE COMMUNICATION

Opening new ways of communication with people suffering from dementia

ON THE COVER Sheriff Leon Lott and Lt. Tom Amaro of the Richland County Sheriff’s Department.

PHOTO: Joye King, RCSD

PUBLISHER AND MANAGING EDITOR

Anna Gelbman Edmonds

DESIGN AND PRODUCTION

Kristina Parella

ASSISTANT EDITOR

Amy Stokes

CONTRIBUTING WRITERS

Kathy Bradley

Sarah Clingman

Marti Colucci

Amy Coward

Doris W. Gelbman

Earl Gregorich

Amy LaGrant

Ken McManus

W. Thomas Smith Jr.

Caroline Ward

CONTRIBUTING PHOTOGRAPHERS

Joye King

W. Thomas Smith Jr.

Call the cops!

Yes, there are law enforcement officers on the cover, and that’s a picture of me getting fingerprinted. But, no, I didn’t get arrested. While interviewing Sheriff Leon Lott for our podcast, I asked if I could complete my CWP (concealed weapon permit) application with the fingerprints SLED requires. I have no intention of carrying a concealed weapon, but since I passed the gun safety and CWP class with the highest score, I figured it’s better to have the permit than not.

Why am I bringing this up in a magazine for caregivers? Because my son Henry is the one who got me the gun as a gift. He also purchased and installed my exterior security camera. Henry moved almost 400 miles from me nearly two years ago, so he’s not able to do most of the helpful things for me he used to. But he still makes sure I’m safe at home. I’m blessed with three other children who also call and visit regularly, so I’m in good hands (and vice versa).

Sadly, that’s not the case with many seniors, who are vulnerable to crime and abuse no matter where or with whom they live. (See page 14.) Those are ugly topics that we think are important to discuss because greater awareness helps deter crime. That’s where our cover story about the Richland County Sheriff’s Department’s Project H.O.P.E. comes in. We’re also including an article about our local fire department, which also assists seniors in the community.

Ironically, our proofreader, Amy, and I recently attended a presentation by our county coroner, Naida Rutherford, on — get this — self-care! We weren’t expecting that, but it was amazing! We promote self-care all the time in Reverse, so I’ll definitely try to get her to share some of her story in the magazine and/or podcast.

(Volume 1, No. 4)

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Along with these legal and criminal matters, we’re including an article on guardianships, written by my sister Doris who is an elder law attorney. Conservatorships and guardianships got a bad name in the press when the families of some high-profile celebrities got greedy. However, some seniors don’t have the capacity to make appropriate or good decisions, and putting temporary or permanent legal controls in place is critical to protect their assets and well-being.

And we’re finally including articles about dementia. Ideally, I’d like to include one in every issue. But how do we begin covering everything caregivers want to know about memory and brain health? We’re always looking for experts who are willing to contribute their knowledge. Maybe that’s you, or maybe you know someone who is credentialed and wants to share from their area of expertise. If so, please email me.

Which is a perfect segue to an apology for one of the most egregious and embarrassing mistakes a magazine editor can make. In the last issue, my email address was printed incorrectly under my signature line. Gah! If you tried to contact me by email and didn’t connect, my correct address is below. I’ll end on that note, and I hope you enjoy this issue.

Anna Gelbman Edmonds Publisher & Managing Editor Anna@reversemagazine.us

Turning 65?

Medicare annual enrollment is October 15 - December 7, 2023

By Caroline Ward

It’s that time of year again … back to school, football games, leaves changing colors, early holiday shopping AND all those pesky Medicare phone calls, television commercials and direct mail. If you are age 65, or a bit younger or older, you will likely be the target of an aggressive Medicare marketing campaign during the annual enrollment period (often referred to as open enrollment).

Here are important things to consider:

Only speak with a trusted Medicare advisor.

Why is this so important? Because large corporations and telemarketers are trained to coerce you into buying a Medicare plan that might not be right for your situation. When choosing a Medicare plan, you want to consider your health issues, lifestyle and budget. It is imperative that you not enroll in a Medicare plan over the phone or online without first speaking with a trusted advisor. Once you get into a plan, you might miss your opportunity to change plans for a full year.

How can you identify a trusted advisor? The best way to find a trusted advisor is to ask for referrals from friends and family who are Medicare beneficiaries. If this is not an option, do a Google search and read reviews. You want to work with someone who is local to your area, has proven experience with Medicare and doesn’t only take on a seasonal role during the annual enrollment period (October 15 - December 7). You want someone who will be available to you throughout the year.

Know your options during the annual enrollment period.

Generally, annual enrollment is for people who are already enrolled in Medicare Part A and/or Part B. During this time, you can do the following:

• Join, drop or switch to another Medicare Advantage plan

• Add, drop or change a prescription drug plan

• Switch from Original Medicare (A and B only) to a Medicare Advantage plan

• Leave a Medicare Supplement and return to Original Medicare or enroll in a Medicare Advantage plan

If you aren’t sure about your Medicare

Advantage plan, you can make one change for the following year.

This is Medicare’s unadvertised secret. If you are enrolled in a Medicare Advantage plan, you can make one change to another plan between January and March. You can also join a prescription drug plan, but you cannot change an existing plan. You can only do that if you are dropping a Medicare Advantage plan and going back to Original Medicare. Your new plans will become effective on the first day of the month following your enrollment month.

As you can see, understanding Medicare becomes more challenging as you dive deeper into the enrollment rules. That’s why you need to work with a trusted advisor.

Caroline Ward is an independent Medicare advisor. You can reach her at 803-331-0527 or Caroline@AskCaroline.net.

What is AI, and how is it being used in medicine?

Artificial intelligence is generally defined as a programmed mechanical simulation of human intelligence used to perform tasks normally requiring human reasoning and thought. AI learns from observing experiences, recognizing patterns and reviewing past problem-solving methods. It learns just like we do, except it can process millions of experiences, patterns and decisions in a matter of seconds, which is beyond human capabilities.

Artificial Intelligence in Medicine

Are you being treated by a human or a machine?

By Earl Gregorich

Your loved one is in the hospital for the third time this year. She is not well enough to go home and too sick to do anything meaningful, and the medical staff keeps coming in, checking vitals, inputting data and moving on. You wonder how they could possibly be doing anything to help in the minute it takes to stop in, glance at a machine and type in a few notes.

But what if the machine and the notes were doing all the work and the medical staff were simply there to make sure everything is plugged in, recorded and assessed properly? If your medical facility is using artificial intelligence (AI) as part of its treatment protocol, this very well may be the case.

AI has been used in medical applications for years. Its goal is to improve patient outcomes, enhance diagnostic accuracy and optimize treatment. AI has helped discover new drug treatments and personalize treatment plans. It has even been used to improve billing and customer service. It should be noted, however, there are many ethical, privacy and regulatory challenges that impact the way AI is used. Nearly all applications currently require a medical professional to validate and implement AI’s suggestions.

What are the positives of using AI in medical facilities?

Improvement of diagnostics is currently the most useful application for AI. A medical professional with decades of experience analyzing X-rays may still only have seen a few thousand images, and those images may not easily be compared to their current cases. AI can review and compare hundreds of thousands of images to arrive at a more accurate assessment and an earlier detection of disease.

AI is also being used to help deliver medical care more efficiently. It can study workflows and administrative tasks to offer more effective resource allocations, thus reducing both operational costs and stress on medical staff — and improving patient care. It is possible AI can even prevent or reduce medical visits. Through remote monitoring that collects and analyzes real-time health data, AI can encourage more timely interventions

and help patients with chronic conditions avoid repetitive medical visits.

What are the negatives surrounding AI and medical treatments?

In her Wall Street Journal article “When AI Overrules the Nurses Caring for You,” Lisa Bannon provides a glimpse at the negatives AI can introduce to medical care. One of the most obvious is reduced human interaction with patients. It’s not that medical staff may not be around as much, but they may be guided by AI treatment suggestions rather than what they themselves determine is the right course of action. Bannon found that in some cases medical systems adopted strict policies that forced staff to favor AI-guided treatment over their own judgment. In one example, nurses were disciplined for overruling an AI diagnosis. The point medical professionals make is, despite all the data analysis and depth of experience it can bring to a diagnosis, AI still can’t look into the eyes of the patient and see their pain or mental state.

Another concern is with policies prioritizing AI treatments and causing medical staff to simply rely on the technology. Less experienced staff may find it safer and more comfortable to let AI do the thinking. The conflict of deciding what is right or wrong and how to navigate the AI-generated treatments may actually introduce stress on staff that it was designed to mitigate.

Yet another negative is a lack of equal availability and potential data bias. Many hospital systems cannot implement AI yet due to budget or logistics, meaning not all patients will receive the benefits of AI. Those

patients who do have access to AI may be impacted by data bias, since the information being pulled into the AI learning system may not represent all populations equally.

Can there be a balance between AI and human care?

The key to balancing the early application of AI in medical treatment is to make sure it is used as a guide, not a directive. Policies within medical systems need to be flexible enough to allow, if not encourage, medical staff to augment or overrule the suggested treatment based on human observation of a patient’s pain level or mental state.

Attaining a balance also requires educating medical staff and patients about AI’s benefits, negatives and potential. The less people know about AI, the more likely it will be seen as a problem rather than a solution. If AI and medical staff work from the position of each other’s strengths, everyone wins. Augmentation, not replacement, of medical professionals’ opinions should be the goal. Staff who understand how AI works and the algorithms behind the proposed treatment will be better positioned to make more informed decisions.

Finally, protections must be set to handle risk assessment. Safety protocols should

outline the proper course of action for when treatment recommendations contradict in life-threatening situations. Constant testing, clinical validation and the proper application of regulatory guidelines can help — as can making it a standard protocol that patients are provided a clear outline of how AI may be used in their treatment.

The bottom line

Achieving a balance between AI and traditional medical diagnostics can lead to more accurate diagnoses, more effective treatments and improved patient experiences and outcomes. However, it cannot work without maintaining the essential insights, empathy and compassion of medical professionals. As more testing and validation is done and data quality improves, AI suggestions should become more dependable.

So, as you sit there at your loved one’s bedside wondering what is going on and why the staff appears passive, it may be that AI and the staff are working on a plan based on thousands of treatments that came before you. And that is the reason you are experiencing consistent attention and avoiding traumatic swings in her status. Your medical team may have found the balance between AI and human interaction.

Pondering the Future of Senior Care Communities

In-home care may be more affordable than you think

By Ken McManus

hat am I going to do when I need a place like this?” This was a common question from staff during my nearly 30 years of service as the administrator or executive director of senior care communities in South Carolina. Senior care staff know what the fees are and that they aren’t likely to be able to afford them.

“WStatewide average costs aren’t particularly informative because of the inclusion of communities that mostly serve underprivileged residents or rural locations. Additionally, fee schedules for assisted living and memory care communities are difficult to compare because most start with a base rate and then add care fees based on the level of assistance a resident requires. Those levels of care are usually determined after a potential resident has been assessed by a

facility’s staff, and the criteria aren’t consistent among communities.

Eighty percent of residents in assisted living communities are over 74 years old. The oldest baby boomers are now 77 years old, so senior living companies are gearing up for the increased demand. But will senior consumers and their families have the financial resources required to choose upscale communities? Even if they do, will they choose to spend them on chandeliers and fine dining?

Something else I often heard from staff members was: “I can do the math — I know what we charge, how many residents we have and what we pay the staff. Why do I keep hearing that we are in the red?” I’ve worked in some very nice communities where monthly operating revenue exceeded expenses, even before the mortgage payment came due. It takes a big operating margin to cover the house payment on those big, beautiful buildings.

For senior living companies, a threat to the expected future demand is that, in certain circumstances, it’s become more affordable for a person to be cared for in the home. For example, let’s look at an adult child who works full-time and can provide care for a parent in the home when not at work. The cost of private-duty, nonmedical, in-home care averages $23 per hour if you use an agency, but it’s often less if private individuals provide care. Allowing for 46 caregiving hours per week for work and commute, the monthly cost of one-on-one care for a parent in the home is roughly $4,600. A daytime caregiver in an assisted living community is usually assigned at least eight residents. In contrast, a daytime caregiver in a (likely more expensive) assisted living community is usually assigned at least eight residents. During evening and nighttime hours, a caregiver may be assigned as many as 30 residents. So, in-home care often has both benefits of greater affordability and one-on-one care.

Most assisted living communities do a good job of taking care of residents. In my opinion, however, the model for a successful community in the future is going to be a simply structured, clean facility that provides very good care with fewer amenities. If assisted living communities don’t become more affordable, I believe many seniors will choose to stay in their homes.

Below are some current pricing estimates based on certain assumptions regarding the level-of-care needs of the average resident in an upscale community in the Columbia, S.C., area:

9 Steps to Being an Empowered Advocate

By Kathy Bradley

Long-term care is a partnership between consumer, provider and advocate. Advocates often struggle to address the inevitable issues that arise in the care of a loved one. These steps offer effective strategies.

1. Stay involved. Whether care occurs in a facility or in your loved one’s home, visit often. Learn the plan of care, and make sure it meets your loved one’s needs. Provide information to staff that will help the plan of care to be complete and meaningful. Communicate regularly with your loved one’s social worker or care team leader.

2. Observe your surroundings in the care setting: your loved one, the home/building, the staff and, if in a facility, other residents. Note both the good and anything that seems off, and let the staff know. Look for trends — more than one occurrence of something. Write everything down in detail.

3. Ask the staff questions. Work with them if you see anything that needs attention, even if it is not a trend. If not addressed, it could become one.

4. Become familiar with the provider’s policies and applicable state and federal regulations so that you know what should be happening. Identify specific problems or violations, and talk with management staff.

5. Approach the provider’s administration and then the corporate leadership if violations or problems persist. Cite the policies and regulations that are in violation; give examples of your observations and efforts to work with staff to correct them. Refer to your notes so you will be thorough and accurate when you approach these officials.

6. If these efforts fail, utilize your state regulatory agency’s complaint reporting process. The agency will need the information

you have in writing and will refer you to the staff person who takes reports of complaints or violations.

7. The regulatory agency will determine whether investigation is warranted. If an investigation is conducted, follow up to learn what they found and what to expect the provider to do in response.

Additional or alternative actions:

8. Many providers have family councils, organized to provide families with a voice and a venue for discussion, learning and interacting with the administration on behalf of all consumers and their families. Often, councils also provide occasional activities for consumers. Consider becoming involved with the family council if your loved one’s provider has one. If not, you may want to advocate for the establishment one.

9. Each state has a long-term care ombudsman program to assist consumers in resolving individual quality of care issues. You can find your state’s ombudsman at theconsumervoice.org/ get_help. Ombudsman programs vary in structure and scope. Ask if yours is independent or part of a governmental agency and if they take cases in assisted living, in-home care, day services and the like. Some states serve only nursing facilities, while others serve any setting. If the program falls under a governmental agency, and the facility in question is government-affiliated in any way (funding, ownership, etc.), you will need to be alert to any potential conflict of interest.

Advocacy is hard work requiring persistence and determination. But the rewards of success are immeasurable.

Kathy Bradley is the president of the advocacy nonprofit Our Mother’s Voice. For more information visit ourmothersvoice.org.

Every long-term care situation is different, so arm yourself with knowledge come what may

Project H.O.P.E.

The Richland County Sheriff’s Department aids seniors through its special unit

By W. Thomas Smith Jr.

When Richland County Sheriff Leon Lott assumed the reins of the Richland County Sheriff’s Department (RCSD) in 1997, one of his first acts was to establish a servicing outreach organization — a special RCSD unit if you will – that would regularly check on, assist, befriend, provide for and protect (beyond the traditional law enforcement means of protection) the county’s senior population: Enter Project H.O.P.E., which stands for Helping Our Precious Elderly.

“Our elderly are among our most precious resources,” said Lott. “And as a culturally instilled component of our responsibilities as law enforcement officers and leaders, we want to take care of them, honor them, celebrate them, and help provide for them a level of comfort within our means, a sense of security, and a knowledge that they will never be forgotten or taken for granted.”

Seniors and their well-being became a focused passion of Lott’s as early as 1993 when he became chief of police for the town of St. Matthews, S.C., according to Lt. Tom Amaro, who has served as director of Project H.O.P.E. since 2019.

“I think the sheriff was concerned that elderly people were sometimes isolated from family members, sometimes deliberately so,” said Amaro. “That, and maybe they simply no longer had anyone relationally close who also lived close by. They needed and continue to need care and a measure of hope.”

Photo courtesy of Joye King, Richland County Sheriff’s Deparment

Hope

indeed. Project H.O.P.E. has become the answer for Lott, whose program today provides services to more than 600 elderly residents in Richland County. “Those numbers are increasing as the good word about our important work gets out into the community,” said Amaro.

Currently, there are 16 Project H.O.P.E. senior coordinators, including three fulltime personnel and 13 part-time employees. Additionally, there are RCSD volunteers, all of whom receive project support from deputies operating in the various regions and RCSD’s Community Action Team (CAT). Among those volunteers are retired law enforcement officers, most of whom are former or retired RCSD deputies. Project H.O.P.E.'s paid staff coordinators make regular calls — both telephone and face-to-face — to seniors and disabled citizens (primarily seniors) every month. Volunteers make weekly calls, both phone and at-the-door, to as many elderly citizens as possible. The questions when calling on seniors are: How are you getting along? What do you need? What can we do for you? When will it be convenient for me to stop by?

RCSD employees (including Project H.O.P.E coordinators) and Project H.O.P.E.

volunteers also visit area senior centers, churches and senior events. During their home visits, Project H.O.P.E. coordinators conduct visual safety checks of the premises, often installing smoke detectors or replacing smoke detector batteries and light bulbs. They also place street address numbers on seniors’ homes so emergency personnel and programs like Meals on Wheels can more easily locate them. And they inform seniors about the risk of telephone scams and unknown persons who might, for instance, pose as utility workers or door-to-door salespeople in order to enter their homes.

Project H.O.P.E. coordinators also help assist seniors in finding rides to various appointments and how to receive special counseling if needed or requested. They deliver gift bags during special holidays and upwards of 65 to 70 Thanksgiving dinners to lone senior shut-ins every year. Project H.O.P.E. also delivers approximately 120 to 150 electric fans every year and between 15 to 20 small air-conditioning window units, all donated to RCSD by businesses and business groups supporting Project H.O.P.E.

In fact, numerous area businesses, associations and other organizations have come alongside RCSD and Project H.O.P.E. over

the years in support of seniors. Among them are the Central Carolina Realtors Association, RE/MAX Advantage Group, Senior Resources and Meals on Wheels, Lowe’s, the South Carolina Department on Aging, Pilot Club of Columbia and AARP.

Among the supporting churches are Bible Way Church of Atlas Road, Brookland Baptist Church, Good Shepard Lutheran Church, Saint David’s Episcopal Church, Northeast Presbyterian Church, First Baptist Church of Columbia, Shandon Baptist Church, Forest Lake Presbyterian Church, Eastminster Presbyterian Church, North Trenholm Baptist Church, Lebanon United Methodist Church, Greater Saint Luke Baptist Church, Oak Grove Baptist Church, Spring Valley Baptist Church, First Presbyterian Church, Ebenezer Lutheran Church, Saint John Neumann Catholic Church, Saint Peter’s Catholic Church and Gethsemane Missionary Baptist Association.

Schools supporting Project H.O.P.E are Benedict College, Columbia College, Columbia International University and the University of South Carolina.

Amaro loves his work. He is very accessible. And he says the best part of his day is “hearing the expressed gratitude and seeing the joy on a person’s face” of whom his team is providing tangible, time-sensitive assistance.

For more information about Project H.O.P.E., please visit rcsd.net/our-programs/project hope.

Lt. Tom Amaro with other RCSD deputies collecting donated items for seniors.

Safety First

Important fire and safety tips for seniors — and everyone else!

By Amy Coward

When Ariel Thomas of the Columbia-Richland Fire Department (CRFD) arrives at your door, you immediately know you’re in good hands. Whether it’s your elderly parent’s home or your own, Officer Thomas has all the advice you need to make your home safe.

A 16-year veteran of the Columbia Fire Department, Thomas began her career as a firefighter and moved into the role of public education officer two years ago. She has seen firsthand the devastation that a house fire can cause and takes great satisfaction in helping

families avoid and prepare for a fire emergency.

“I love my new role with the department,” said Thomas. “I love my community, and I really enjoy helping people. I help people learn about safety issues and how to prepare ahead of time for an emergency.”

Thomas arrives at your door with a box filled with safety information, smoke detectors, carbon monoxide (CO) detectors and a toolbox — everything she needs to improve the safety of your home. She conducts a complete home fire safety survey, reviewing your home and making suggestions on how to improve safety and what to do in case

Officer Ariel Thomas with Assistant Fire Chief Mickey Folsom

Photos courtesy of the Columbia-Richland

Fire Department

Safety Tips

Thomas’s home-safety tips for all residents involve:

• Placement of rugs and runners

• Placement of space heaters and help providing safe electrical access

• Safe use of candles

• Removal of clutter from exits

• Instruction on how to conduct a home fire drill

• Removal of lint from the dryer

• Safe use of extension cords and multiple plug adaptors

When visiting senior citizens, Thomas provides additional health-related advice:

• Monitor blood pressure regularly

• Stand slowly after sitting or reclining

• Follow safety protocol in case of a fall or choking

• Wear slippers and shoes with good gripping soles

• In case of an emergency, stay calm and call 911

of an emergency. And she does so with the warmth of a caring family member.

“I make sure to show people compassion when I’m sharing information,“ said Thomas. “It can be hard to be elderly.”

During the survey, Thomas determines the best placement for smoke detectors and CO detectors and installs them free of charge. She even changes batteries or replaces units in hard-to-reach spaces, such as vaulted ceilings.

“Many people don’t realize that you need CO detectors, even if you don’t have gas logs

in your fireplace. Burned firewood also gives off carbon monoxide,” said Thomas.

As part of her safety survey, Thomas shows you the safest escape routes in case of fire and how to prevent fires in general. She’ll point out where clutter is blocking escape and demonstrate how to use your fire extinguisher. She even provides address numbers for your mailbox or curb so emergency responders can quickly find your home.

“Most fires start between 11 p.m. and 7 a.m., so it’s important for people to know how to prevent injury and how best to escape,” said Thomas. “For instance, you should always put your hand to your bedroom door if you suspect a fire. If it’s hot, it means there is fire outside the door, and you need to escape through a window.”

The Columbia-Richland Fire Department has been given the “Fire Safe South Carolina” community designation for the fourth straight year for its year-round work promoting fire safety and education. Thomas is likely a major reason why. In 2022, the department conducted 357 public fire education demonstrations and installed 449 free smoke alarms and 118 CO alarms. They provide these services for any resident in Richland County, regardless of age.

Celebrating 60 Years

TEMPORARY HOUSING. PERMANENT HOPE. Bless a man overcoming alcohol, drugs or incarceration.

Learn more at PHCola.org

Abuse of our Elders

Recognizing and preventing elder abuse in

By Sarah Clingman

Elder abuse is a phenomenon earning fast global attention as it becomes a large and growing problem. Globally, the aging population is outpacing in size the younger population, giving way to a surge in opportunities for the abuse of vulnerable individuals needing care.

People are living longer, too. The average life expectancy in the U.S. has grown from 68 years in the mid-20th century to the current average of 75 to 81 years. Add to this COVID-19, which resulted in people being forced into isolation. Many people were and still are experiencing altered mental health and capacities due to seclusion. Together these factors create an evolving and concerning issue, causing global organizations and governmental agencies to get involved creating a plan of action.

Abuse happens when a caregiver or other involved person intentionally acts or fails to act, resulting in harm to an elderly person. Elder abuse can happen to anyone, regardless of race, socioeconomic background, gender or sexuality. Especially vulnerable to abuse are those with physical or mental disabilities, those who live alone and the frail.

Although instances of abuse are underreported, what has been researched and studied tells us abuse takes place both in private homes and assisted care facilities. Most abuse occurs in the private home, with family members committing abuse in six out of 10 cases, according to the American Psychological Association. Statistics on facility abuse are limited because it is easier to cover up and people’s jobs are at stake. Still, according to the World Health Organization, a worrisome two in three staff members in high-care institutions admit that they’ve committed some form of abuse within the last year.

all its forms

Types and signs of abuse

Neglect involves the failure of a caregiver to perform their duties of care. This can involve not providing necessities: food, water, safe living space, shelter and medication. Untreated health issues, presence of bedsores, dehydration, malnutrition and unclean living spaces are all signs that an individual may be experiencing neglect. My law practice has seen our fair share of neglect over the years — neglect being the basis for many nursing home negligence settlement cases we’ve been involved with. Family members visiting their loved ones are usually the ones to discover bedsores or other signs of mistreatment and neglect.

Instances of harassment, isolation, humiliation, threats, manipulation and verbal assault fall under the psychological abuse category and typically cause the individual to feel distress or even agony. Someone might be experiencing psychological abuse if they suddenly display emotional distress, are easily bothered, begin to isolate themselves or become non-responsive or if their self-esteem and self-care decrease.

Sexual abuse involves nonconsensual sexual acts or exploitation committed on an elderly individual who doesn’t have the capacity to consent. Signs are the same as in sexual abuse cases occurring in other age groups: bruises or lacerations in genital areas, unexplained sexually transmitted infections or diseases, genital bleeding, incontinence, a spike in anxiety and depression, and general unease and restlessness. It can lead to PTSD, disassociation, increased hospitalization, decline in physical and mental health, and feelings of guilt and shame.

Physical abuse is most often detected by visible physical injury on the elderly individual’s body: bruises, welts, lacerations, evidence of physical restraint, medical overdoses, burn marks, marks on the neck, bite marks, sprains, internal injuries and bleeding, and broken glasses. But, as with the other forms of abuse discussed, sudden change in behavior is also a red flag. Physical abuse can result in increased hospital-

ization, psychological trauma and a general decline in cognition.

Financial abuse happens when an elder’s assets (monetary, property, possessions) are illegally misused. Signs of financial abuse include swift changes to financial accounts or practices or to legal documents (such as a will or power of attorney); mysterious disappearance of funds or valuable possessions; poor financial choices; racking up of unpaid bills; and paying for unnecessary services.

Financial abuse is something our practice witnesses firsthand. We see both in-person cases and cases of telephone scams. Elderly females living alone are particularly susceptible. I recall one elderly female client who lived alone, had good mental capacity and was independent, yet she had natural forgetfulness from aging. A neighbor who occasionally cut her grass realized if he came back a few days later, she would forget she had paid him and pay again. This went on for about a year before anyone noticed. An example of a phone scam I see frequently is the lottery scam in which the scammer asks the “winner” to provide their bank account information for the prize money to be wired into their account. We also see elderly family members of clients give away their monthly social security checks to friends or family out of sympathy for their phony sob stories.

Awareness of elder neglect, psychological abuse, sexual abuse, physical abuse and financial exploitation is the first step in prevention. A fast-growing aging population likely means an increase in abuse cases, especially in an era where many people are forced to stay isolated at home. To combat elder abuse, reach out to overburdened caregivers and the elders they care for, check in on older folks living alone — keeping in mind the signs and effects of abuse — and know and contact the available resources (some of which are listed in the sidebar).

Sarah Clingman is an elder law attorney in Columbia, South Carolina. Contact her at sarah@clingmanlaw.com

Preventing Elder Abuse

The aim is to reduce the above statistics. But how?

• Caregivers NEED breaks. If you see an overburdened caregiver, try connecting them to therapy groups, counseling or adult day care programs, or simply offer them help.

• Be supportive of caregivers and elderly folks in general by listening to them and gaining a better understanding of their workload or struggles.

• If you see a caregiver selfmedicating, encourage them to seek help.

• If YOU are a caregiver who is feeling overwhelmed, take a step back, take a breath and ask for help.

• Check in on elderly individuals who have limited or no family or friends. They might share something concerning with you that you can then address.

If you witness or suspect elder abuse in South Carolina, call 888227-3487 (if it occurs in a community setting) or 800-868-9095 (if it occurs in a facility setting). If you suspect mistreatment or abuse of an older adult, visit eldercare. acl.gov.

For further resources and initiatives, call the South Carolina Department on Aging at 803734-9900 or visit aging.sc.gov/ programs-and-initiatives.

MovingYou Where LifeTakesYou

Maintaining and Losing Control

Why guardianships or conservatorships may be necessary for making decisions

SBy Doris W. Gelbman

ometimes the law has to address big, complicated matters and demands big, complicated words. Conservatorship is one of them. It is often paired with guardianship.

Guardianship laws differ by state. I’ll use guardianship here to also include conservatorship. More on that below. Just know that laws can be different depending on where you are.

What is guardianship? When does the subject come up? It usually starts with a call to an attorney from someone caring for an aging parent with a mental impairment, such as dementia, Parkinson’s disease or chronic psychiatric issues. They start out asking about power of attorney. But they are really calling about surrogate decision-making authority.

Maintaining control

One form of surrogate decision-making is a power of attorney (POA). POA lets you voluntarily choose someone — an agent (sometimes called attorney-in-fact) — to make decisions for you. You grant power of attorney to someone you choose, who can be anyone: a family member, a friend or someone you trust. The agent you pick will have legal authority to manage your money, buy and sell real estate, and pay for your care. It is a big job that should only be given to someone you completely trust. Just as you choose your POA, you can also revoke it. You are still in control.

When someone is no longer willing or able to appoint their own POA, guardianship becomes a potentiality. When someone lacks the capacity to make decisions in their own best interest, a court has to do it. Lack of capacity means the inability to understand the consequenc-

Melissa Sprouse Browne Real Estate Broker

es of one’s choices, even if they can still read words on paper. Such lack of mental capacity means they cannot even choose an attorney. The whole subject of mental capacity or lack thereof is extremely complex.

Losing control

Guardianship is the court process appointing a surrogate decision-maker if you are unable to manage your own affairs. The court-appointed guardian will choose where you live, your doctors and the treatments you receive. A conservatorship is the authority to control your money and property. In some states the term guardian refers to both roles: making the personal and financial decisions. Guardianship occurs in court, which involves lawyers and complicated processes, including a trial. It is not a form one can download for free off the internet. Because of the difficulty in discerning whether someone has the capacity to make their own decisions, lawyers and judges depend on medical professionals for expert opinions. A judge will weigh the medical evidence carefully and ultimately make that determination.

A person may lose many of their rights in guardianship. The court in most states will appoint a temporary guardian ad litem (GAL). (Ad litem means for the duration of the case.) Some states call this the incapacitated person’s “next friend” or a similar term. The GAL’s job is to investigate all the facts, report to the court and make a recommendation as to whether a permanent guardian should be appointed and who that person should be. The GAL’s job is to protect the rights of the person who may be put under guardianship.

There are good reasons for strict procedures and the appointment of a GAL. Under guardianship, the ward will lose their right to make independent choices — choices we take for granted, such as getting married, driving, choosing where to travel or live, voting and owning firearms. They will lose the right to spend their own money. This can be a serious affront to one’s dignity and a very real way to strip one of some of their civil rights. For that reason, guardianship should be the absolute last resort. The court and GAL look for any other possible less restrictive means.

How things can get out of control

In many states ANYONE can petition the court for guardianship. Usually it’s a well-intentioned family member. It might be a complete stranger or some government agency, like your state’s department of social services. However, the person seeking guardianship is sometimes not at all well-intentioned. This happens when either the laws or the court fail to fully protect the rights of the incapacitated or disabled adult. Abusive guardianships are the result.

Both voluntarily chosen powers of attorney and court-appointed guardians who control their ward’s money have a fiduciary duty to act and provide care with loyalty and in their ward’s best interests. Tragically, that does not always happen. A very public example is when Britney Spears’ father was appointed as her guardian when she was a young adult suffering from mental illness. Years later, however, Spears claimed she was restored to good health and wanted to be released from her father’s allegedly abusive control over her life and money. It took years of court battles and hundreds of thousands of dollars before Spears won back

her freedom. She is not alone. Both iconic top-40 radio DJ Casey Kasem and legendary Hollywood superstar Mickey Rooney ended up in messy guardianships.

The bottom line

The best way to avoid guardianship is to plan ahead. None of us has a crystal ball. Anyone can have a stroke, develop Alzheimer’s or be injured in an accident and rendered unable to manage their own affairs. Plan for the worst; hope for the best. Do not wait! Do it while you still can. Create and appoint a POA early; if later that person is not right for you, fire them by revoking the power. If you don’t put a POA in place, and the court chooses a guardian, you will not be able to change it. Only the court can.

Don’t have someone you trust to appoint? Talk to your lawyer about who might serve as a professional fiduciary. The cost of a POA drafted by your lawyer is a minimal price to pay to preserve your independence.

Doris W. Gelbman is an elder law attorney practicing in Charlottesville, Virginia. Learn more at gelbman-law.com.

by Melissa Sprouse Browne, founder

Dementia

An umbrella term used to describe a collection of brain disease and their symptoms, which include: memor y loss, impaired judgement, personality changes, and an inability to perform daily activites

By Marti Colucci

ou’ve just walked out of the grocery store when panic sets in. It’s been one heck of a day, and on top of everything else, you can’t remember where you parked your car. Thoughts begin to swirl. “Am I losing my mind? Did someone steal it? I’m almost certain I parked on this aisle. How could I lose my car at a store I’ve been coming to for years?”

Forgetfulness or dementia? Should I be concerned?

How do you know if there is cause for concern in the above example? The brain’s capacity for remembering is an absolute marvel, but even the healthiest of brains can experience delays and forgetfulness from environmental factors and normal aging. Here are a few common contributing factors to forgetfulness:

• Stress, anxiety, depression and grief

• Distraction

• Fatigue and lack of sleep

• Side effects from medication, alcohol and other drugs

• “Chemo brain” or brain fog resulting from chemotherapy

As a rule of thumb, if you’re aware of your forgetfulness, and it isn’t keeping you from living a full and productive life, you’re probably okay. An occasional memory lapse is normal, but persistent and more severe memory loss warrants a visit with your doctor. They can help you determine if your symptoms are most likely a result of typical forgetfulness or if there is something more serious causing them, like dementia or Alzheimer’s.

Understanding dementia

Although we often hear the terms dementia and Alzheimer’s used interchangeably, they are not the same. In fact, dementia is not a disease or an official diagnosis. It’s an umbrella term used to describe symptoms caused by an underlying disease or condition; it’s associated with a decline in cognitive abilities severe enough to interfere with your ability to carry out daily activities. Common symptoms of dementia include the following:

• Memory loss

• Confusion and reduced ability to focus

• Poor judgment

• Decline in reasoning skills

• Behavioral, mood or personality changes

Understanding Alzheimer’s disease

Alzheimer’s is a disease and the most common type of dementia, accounting for 6080% of all cases. The disease starts by affecting parts of the brain responsible for learning and worsens over time. Alzheimer’s is not a part of healthy aging, although the biggest risk factor is age, and the majority of

Stretch Your Brain!

Brain plasticity (aka neuroplasticity) is the biological, chemical and physical capacity for the brain to reorganize its structure and function. Learning and new experiences cause new neural pathways to strengthen, while those used infrequently become weak and eventually die. Every time you learn something new, your brain makes a new connection. Learning enhances blood flow and activity in the brain. If you go for long periods without learning something new, you start to lose some brain connections, causing struggles with memory and learning.

It’s easy to make your brain think during your already busy schedule.

• Drive a different route to work or the store. Don’t use your GPS all the time.

• Memorize your grocery list or at least five items.

• Sing out loud.

• When you can’t think of a name or something you should know, stop and really focus on it. Imagine those cogs spinning, and just keep thinking.

• Brainstorm when faced with a problem; try to find several ways to get to a solution without using Google.

• When doing simple chores, such as washing the dishes, leave the TV off, and let your mind wander to new places.

• Find the sum of your date of birth (mm/dd/yyyy). Now do your spouse’s or your kids’.

• Name two objects that start with every letter in your first name. Work up to five objects, trying to use different items each time.

• Look around you, wherever you are, and, within two minutes, try to find five red things that will fit in your pockets and five blue objects that are too big to fit in your pockets.

those living with the disease are aged 65 and over. The image on the facing page describes the most common types of dementia and their related symptoms.

Why understanding the difference matters

Not all types of dementia are chronic or progressive. Some causes of dementia are short term or treatable. Knowing the underlying cause or disease can help those experiencing symptoms and their families prepare for necessary care and identify unusual symptoms worthy of concern. Below are examples of temporary or treatable causes of dementia.

• Concussions and TIAs (ministrokes) caused by falls or head traumas

• Medication side effects

• Urinary tract infections (UTIs)

• Thyroid and liver disorders

• Dehydration

• Vitamin B12 deficiency

If you’re concerned about your memory or someone else's, check with a doctor. Online assessment tools are also a great place to start, even if your goal is to keep your brain healthy. BrainHealthAssessment.com, BeBrainPowerful.org and MyBrainGuide.org are a few I recommend.

Marti Colucci is a dynamic speaker, educator and consultant focused on brain health and Alzheimer’s prevention. She can be contacted at PieceOfMindCompany.com.

Creative Communication

Opening up new ways of connecting with those suffering with dementia

By Amy LaGrant

Hi, my name is Amy, and I’m a gerontologist. People often ask me, "What is a gerontologist?" Simply put, I’m a social scientist who studies the effects of aging on social norms related to age. Gerontologists explore how life changes as we get older, encompassing cultural, social and physical elements that shift as we age. It's essential to remember that aging starts from the moment of birth, but most of my work in gerontology focuses on older age groups, where the effects of aging become more apparent.

As a gerontologist, I've come to understand the challenges created by aging. However,

I've also witnessed the moments of wisdom and opportunities for personal growth that come with aging. Unfortunately, our society tends to be youth-centered, often neglecting the needs of older adults and lacking in environments friendly to their age group.

My journey as a gerontologist became deeply personal when my grandfather was diagnosed with Alzheimer’s disease. Decades later, my father faced the same diagnosis. As both a gerontologist and a daughter providing care, I had to adjust my perspective and approach. In 2022, I was privileged to share my caregiving journey on the TEDx stage. During that talk, I described feeling vulnerable and uncertain, familiar feelings for any family caregiving daughter.

One important aspect I've learned as both a gerontologist and caregiver is the significance of thoughtful communication when interacting with individuals with Alzheimer’s and dementia. Simple questions like "How are you doing?" or "What did you have for lunch?" may cause confusion for them. Therefore, I used to shy away from engaging in conversation because I felt unsure of what to talk about. I came to realize, however, that communication is not solely verbal; it can involve touch and nonverbal cues. We can show love, support, compassion and empathy without uttering a single word.

I vividly remember when a friend of mine developed a way to communicate with her mom by brushing her mom's hair. As they sat together and she brushed, they would connect in their own way; it became a meaningful event for both of them. Similarly, I found a way to connect with my dad — but he was bald, so hair brushing was out. Tapping into his past as a proud businessman, I found an activity to evoke his entrepreneurial spirit: We started a fictitious company called Dryer Ball, Inc. We debated various aspects of the company, such as how we would design the dryer balls, how to market them and how to handle production and sales. This creative venture allowed us to delve into my dad's expertise as a 40-year veteran of various organizations, where he used to discuss operations, processes, procedures, budgets and getting things done.

As we conversed about Dryer Ball, Inc., I discovered a side of my father I had never explored. It was fascinating to see his business acumen shine through, even as his dementia progressed. Through this shared project, we built memories together, and it became a way for us to communicate beyond the challenges of his condition. His enthusiasm and passion were heartwarming, and it made me feel closer to him, even as the effects of dementia took their toll on his day-to-day life.

Though an informal, imaginative venture, Dryer Ball, Inc. had a profound impact on our relationship. It allowed us to connect on a level that surpassed the limitations imposed by dementia. The project provided us with a purpose and a sense of joy during what was a challenging and isolating time. Unfortunately, Dryer Ball, Inc. folded within six months when Dad could no longer manage operations. Nevertheless, our strengthened bond remained — as do the memories we created.

This experience taught me the significance of finding creative ways to engage with loved ones with dementia. It reinforced the idea that meaningful activities, no matter how simple, can become

powerful tools for communication and emotional connection. Dryer Ball, Inc. became a testament to the power of creativity, love and understanding in maintaining relationships with individuals living with dementia.

It’s true that creating these opportunities for connection becomes increasingly challenging as the disease progresses. However, finding ways to connect amidst the chaos is essential for both the caregiver and the individual with dementia. Trust plays a crucial role in successful family caregiving, and creating trust should be a priority. Reflecting on our own grief is also essential; support groups can be a key to understand why we communicate the way we do and to allow ourselves compassion when we make mistakes. Regrettably, within the caregiving industry, professionals can at times shame caregivers, urging them to exert more effort. I strongly hold the belief, however, that consistently showing up every day and striving to establish meaningful connections is enough. Caregivers should choose their battles wisely and be mindful of triggers that can surface while caring for someone. Caregiving for an individual with dementia is challenging for anyone, and any effort to create connections, no matter how small, can make a significant difference in building a trusting and positive relationship.

Gerontologist Amy LaGrant owns BrandMETTLE, which specializes in products and services tailored to the senior and caregiver marketplace. Learn more at yourbrandmettle.com, or email her at alagrant@yourbrandmettle.com.