Caring of Parents

Caring for Elderly P bents How to c be for fourth-year pargonnts is a major concern of many contrasted divine serve head families. Our concerns mirror those of oppositewise Ameri lot families, save how to vouch good health occupy, find the right reenforcement situation, and handle legal questions is often complicated for exotic Service families by being steaded abroad. The distance involved makes it harder to get development and overhaul so contingency planning is essential.Often alien Service families only perk up short visits during R & R or on home leave and hate to spend the precious time with their pargonnts talking near serious business or unpleasant possibilities. Or we whitethorn be caught up in feverish preparations for an overseas assignment and non want to take the time to do contingency planning with p arnts. while it is difficult to discuss the anesthetizes of ageing, the family who has discussed the options and agreed on plans go out be better ab le to handle whatsoever happens. It will be worth the time taken, if there is an emergency.The ideal situation is when the p arnts take control of their declare situations and make decisions in advance of an emergency. They should investigate the types of retirement options and decide which is most appropriate, make informed decisions or so life-sustaining aesculapian dish out, and make sure that documents, instructions, and powers of attorney are available to those who must take business in an emergency. The American Association of Retired Persons recommends that venerable volume use a document locator itemization (scroll to bottom of this page) to make sure their papers are in order.This list can then be given to the psyche(s) who will be responsible for them should an emergency arise. Going through the list with your parents should ensure that their wishes are understood. Communicating with Elderly Parents Talking with our elderly parents about their living situations and the achievable necessity for diversity is non always easy. A successful conference depends to an extent upon the relationship we break with the parent, as well, of course, as on the parents rational, emotional and physical condition.While many people put take out serious conversations to avoid assigning or awkwardness, both parent and adult child whitethorn lose an opportunity for closeness, understanding, access to development that may affect the decision, and optimum peace of mind. To the extent possible, talk with your elderly parents gently and honestly about their wishes, their abilities and their options. Far more often than non, these conversations are financial aidful and put the adult child in a better position to make decisions later when the parent may non be able to do so.The following are suggestions for conversations with your elderly parent * Share your own giftlings, and reassure the parent that you will take over them and can be depended upon to help them solve their problems. * Help the parent to stay fresh whatever control is possiblein making his or her own decisions. Respect and try to honor their wishes wherever feasible. * Encourage the smallest change possibleat each timber, so that the parent is more able to adjust to the change. Educate yourself on legal, fiscal and medical mattersthat pertain to your parent as background for your conversations, including topical knowledge on the aging process. * Respect your own take be honest with your parents about your time and energy limits. If this kind of conversation seems impossible or the situation and relationship with the elderly parent become overwhelming, professional counseling may be very helpful. You may likewise cipher using the incision of severalizes resources to approach this delicate issue several(prenominal)what indirectly.Filling out FIVE WISHES for yourself and sharing your decisions with your parents may encourage them to open up on the subject. You may also wish to raise the subject of long-run consider insurance as a practical matter. (For more education about FIVE WISHES and Long-Term Care Insurance, see below). When a life style Change May Be Necessary Physicians and geriatric social benders warn that there are a number of danger signs that refer an elderly soul needs special help or a change in living arrangement. Any marked change in personality or bearing should be heeded.However, no change in lifestyle should be made without discussions with the elderly person, other family atoms, and doctors or other health professionals. Danger Signals * Sudden weight losscould be an indication that the elderly person is simply not eating or not preparing foods. * Failure to take medication or over-dosingmay indicate confusion, forgetfulness, or a misunderstanding of the doctors instructions. * Burns or injury marksmay indicate physical problems involving global weakness, forgetfulness, or a possible misuse of alcohol. Deterioration of personal habitssuch as infrequent bathing and shampooing, not shaving, or not wearing dentures could be the result of either mental or physical problems. * Increased car accidentscan indicate slowed reflexes, poor vision, physical weakness, or general inability to handle a vehicle. * General forgetfulnesssuch as not paying bills, missing appointments, or consistently forgetting name, address, phone number, and meal times could be a signal. * Extreme suspiciousnesscould indicate many thought disorder.Your parents thinking that their neighbors, friends, family, doctor, and lawyer are all conspiring against them would be an suit. Intense ungrounded fears about dire consequences may be a danger signal. * A series of small firescould be caused by dozing off, forgetting to turn off the stove or appliances, or carelessness with matches. They may indicate blackouts or dizzy spells. * Bizarre demeanour of any kindcould be a warning sign. This behavior could be dressing in grueling gloves and overcoat in 90 degree weather or going outside without shoes when its gusting. reside for uncharacteristic actions or speech. Disorientation of a consistent naturemay indicate a need for help. Examples include not knowing who one is, where one is, who the family is, or talking to people who are not there. Elder Care Options If you see danger signals in your parents behavior, it is significant to discuss the changes and do some research. ( depend IQ training request below for nurture about the section of States free resource referral service. ) in that location are many housing options available to the elderly. Choosing the best one will depend on the elderly persons preference, age, health, and financial condition.Aging in Place to a lower place this option, the elderly person continues to live in his/her own a take upment. umpteen elderly people live in Naturally Occurring Retirement Communities (NORCs), apartment buildings, condominiums, or cooper atives not designed as retirement communities and where at least 50 percent of the residents are 62 eld old or senior(a). These buildings often have amenities such as grocery stores, pharmacies, limousine service, or shopping function. Recent technological advances often make aging in place easier Velcro asteners, lightweight wheelchairs, devices to control appliances and dial telephone numbers. There is even a walk-in bathtub for people who have difficulty climbing into an ordinary bathtub. Many services are available to help the elderly person stay in his/her home. Information about them can be obtained from contacting IQ Information Quest (see below) oryour local anaesthetic field of study Agency on Aging. * Home care servicesare available in many communities, providing appropriate, supervised personnel to help older persons with either health care (giving medications, changing dressings, catheter care, etc. or personal care (bathing, dressing, and grooming). * Meals and transportationare available to older people to help them retain some independence. Group or home-delivered meal programs help ensure an adequate diet. Meals-On-Wheels programs are available in most parts of the United States. A number of communities offer door-to-door transportation services to help older people get to and from medical facilities, residential area facilities, and other services. * Adult mean solar day careis alike(p) to child day care. The elderly person goes to a community facility passing(a) or 2 or 3 days per week.Activities include exercise programs, singing, guest lectures, and current events discussions. Cost varies and there are often long waiting lists at such centers. * Respite carebrings a trained person into the home to give the full-time caregiver time off to get a haircut, visit the dentist, or take a vacation. Service is generally offered through area discussion sections of Social work and is based on a sliding fee scale. Other Housing Options Th ere are several types of retirement communities that submit living arrangements and services to meet the needs of both independent seniors and those who need helper.Large hotel corporations are in this field and other facilities are set up for members of a received organization (retired military, Elks, etc. ). It is Copernican when investigating these housing options to understand completely the services provided and the cost. * Adult congregate communitiesare designed for the fully able-bodied, 55 and older. Residents buy co-ops or condominiums and pay a calendar monthly fee for grass mowing, leaf raking, and snow shoveling. A pay-as-you-go medical center is on site and a nurse is on duty 24 hours a day to make home visits in emergencies. Leisure World is the most famous example of an adult congregate ommunity. * Assisted living communitiesare rental retirement communities for independent seniors who need some doance. A homelike atmosphere, three meals a day, maid, linen, and laundry service, availability of a registered nurse, and many personal care services are provided in the all-inclusive rent. * Rental retirement communitieswith fee-for-service nursing units charge residents an entrance fee plus a substantial monthly rent. When the need for nursing care arises, residents pay an extra daily fee and stay in a nursing unit, ordinarily located on site or nearby. Life care or continuing care communitiesprovide a continuum of care from independent living to nursing home care on the premises. The individual must be independent when s/he enters the community. These communities require a substantial entrance fee and monthly service fee. Residents get one meal a day in a dining room, maid service, linen service, maintenance, transportation to shopping and ethnic events, break planning, and a pull cord to an emergency nurse. If nursing care is needed, it is provided at no extra cost. Personal care homes (board and care)are licensed in many communities to provide shelter, supervision, meals, and personal care to a small number of residents. * Subsidized housing for the elderlyis an option for the elderly poor in reasonably good health. Subsidized by Department of Housing and Urban Development, income limits apply. No round-the-clock care is provided but nurses come in to check blood pressure and assess a residents functioning. Residents take meals in a dining room and may have use of a library, recreation area, or beauty shop. breast feeding FacilitiesIf the elderly person is not capable of independent living, a nursing home may be the appropriate option. Nursing homes offer two levels of care skilled nursing and intermediate care depending on the patients needs. Most nursing homes offer both levels of care on a single site. * Skilled nursing facilitiesprovide 24-hour nursing services for people who have serious health care needs but do not require the intense level of care provided in a hospital. Rehabilitation services may also be provided. * Intermediate care facilitiesprovide less extensive health care than skilled nursing facilities.Nursing and rehabilitation services are provided but not on a 24-hour basis. These facilities are for people who cannot live alone but need a minimum of medical assistance and help with personal and/or social care. Paying for Long-Term Care It is important to understand the contrasting types of insurance that are available to older people. Many people believe that Medicare will bilk long-term care needs. It will not. Medicare Medicare is a Federal health insurance program which helps defray many of the medical expenses of most Americans over the age of 65.Medicare has two parts (Part A) Hospital Insurancehelps pay the cost of yard bird hospital care. The number of days in the hospital paid for by Medicare is governed by a system of rules based upon patient diagnosis and medical necessity for hospital care. Once it is no longer medically necessary for the person to remai n in the hospital, the physician will begin the discharge process. If the person or the family disagrees with this decision, they may appeal to the states Peer Review Organization. Medicaredoes notpay for custodial care or nursing home care.It will, however, cover up to 60 days in a nursing home as part of convalescence after hospitalization. (Part B) checkup Insurancepays for many medically necessary doctors services, outpatient services, and some other medical services. Enrollees pay a monthly premium. Medicaid Medicaid is a joint federal-state health care program for people with a low income. The program is administered by each state and the type of services covered differs. There are strict income requirements so it is necessary for the person to spend down all income and assets to poverty levels ahead becoming entitled.Medicaid is the major payer of nursing home care. The Medicaid requirement to spend down all income and assets created a great hardship for the spouse of a pe rson needing nursing home care. Changes in the Medicaid rules now fall by the wayside the spouse to keep a monthly income and some assets, including the primary residence. The amounts allowed change, so you must check for current levels. Other Insurance Why buy other insurance? The purchase of additional insurance gives the constitution holder access to a greater choice of facilities without dipping into additional financial resources. Medigapis the name given to rivately-purchased supplementary health insurance. It is designed to help cover some of the gaps in Medicare coverage but does not cover long-term care. Study Medigap policies carefully to be sure they provide the protection needed and do not duplicate other health insurance. Long-Term Care Insuranceis a private insurance that is usually either an indemnity policy or part of an individual life insurance policy. An indemnity policy pays a set amount per day for nursing home or home health care. chthonian the life insura nce policy, a certain percentage of the death benefit is paid for each month the policyholder requires long-term care.Policies are priced differently depending on the age of the policyholder, the deductible periods chosen, and indemnity value or continuance of benefits. Information about other long-term insurance policies are available from The American Foreign Service Association (AFSA) Retiree Liaison 2101 E Street, NW Washington, DC 20037 Tel202-338-4045, ext. 528 Fax 202-338-6820 E-mailemailprotected org http//www. afsa. org American Foreign Service Protective Association (AFSPA) 1716 N Street, NW Washington, DC 20036 Tel202-833-4910 Fax 202-883-4918 ttp//www. afspa. org As with Medigap health insurance, it is important to read the policy carefully and understand its restrictions before purchasing. Who Can Help? IQ Information Quest (formerly LifeCare? ) IQ Information Quest is a free 24-hour/ 7 days per week counseling, education and referral service that can help Department o f State employees find the programs, providers, information, and resources they need to manage personal and professional responsibilities. IQ Information Quest makes referrals, not recommendations. IQ Information Quest counselors will help etermine what services are needed and available in any U. S. locality and refer to appropriate providers. In addition to other services, they provide referrals in the area of adult care services (anywhere in the U. S. ), including case management, emergency and balance care, home health care, long-distance call care giving and legal and financial issues. Their web site features information on caring for an aging loved one, discussing caregiving options with your loved one, adult care information worksheet, caregivers of older adults, managing work while caring for your loved one, and geriatric care management services.IQ Information Quest will also provide an Eldercare Kit upon request which features caregiving guidance, checklists, and resource s information, as well as a few serviceable practical items such as a pill sorter, night light and jar opener. Permanent employees of the Department of State, The U. S. Agency for International Development, the Department of Justice, the Department of Labor, and FMAs overseas are eligible to use IQ Information Quest. For the Department of State, this includes both Civil Service and Foreign Service employees serving at any Department assignment location nationwide and worldwide.Other employees working for the Department are not covered at this time (contractors, Foreign Service contents, PITs, PSCs). Spouses, children or others who are members of the employees immediate household may use IQ Information Quest. They verify eligibility by providing the name and date of birth (month and day) of the eligible employee. Employees of agencies other than the Department of State should check with their headquarters for guidance in how to contact and use IQ Information Quest services. IQ Info rmation QuestTel1-800-222-0364or1-888-222-0364for the hearing impaired http//www. worklife4you. com For access to the passworded area of the site, contact your agencys HR Bureau. The Employee hearing Service (ECS) The Employee Consultation Service (ECS) at the Department of State should be the first stop for Foreign Service members with eldercare concerns. The clinical social workers offer brief counseling and help in coordinating an military rank and assessment anywhere in the United States.ECS social workers act as a liaison in providing appropriate and necessary services for the elderly. All services are free and confidential. In Washington, make an appointment for a personal consultation from overseas write or cable for advice. ECS also conducts fend for groups for employees and their families who are responsible for an aging relative. The groups meet at the State Department to share issues, resources, and approaches to the problems that arise as an elderly person declines, i ncluding the issue of emotional stress that occurs for family members watching such decline.Employee Consultation Service (M/MED/ECS) Columbia Plaza, dwell H246 Washington, DC 20520 Tel202-663-1815 FAX 202-663-1456 Emailemailprotected gov The Administration on Aging (AoA) The Administration on Aging (AoA) is part of the U. S. Department of health and Human Services. It was set up to remove barriers to the economic and personal independence of older persons and to assure the availability of a range of appropriate community and family based services for older persons in social or economic need. AoA supports a network of the state and atomic number 18a Agencies on Agingthat reinforce and supplement the daily support that the elderly receive from family, friends, and neighbors. Administration on Aging Department of Health and Human Services 330 Independence Avenue, SW Washington, DC 20201 Tel202-619-0724 http//www. aoa. gov To get information on eldercare services in a particular comm unity, contact the Area Agency on Aging. One can locate a specific state agency on aging through the Eldercare Locator Service via telephone (1-800-677-1116) or the website athttp//www. ldercare. gov. TheEldercare Locator Serviceis sponsored by the AoA and operated by the National Association of Area Agencies on Aging. National Association of Area Agencies on Aging 927 15th Street, NW Washington, DC 20005 Tele202-296-8130 http//www. n4a. org Services provided by Area Agencies on Aging include information and referral, homemaker/home health aides, transportation, congregate and home delivered meals, line and other supportive services. Types of services available vary in each community based upon needs and resources. Private Geriatric Care ManagersPrivate geriatric care managers are professional social workers and nurses who assist the elderly and their families by assessing need, coordinating services, and monitoring care for a fee. They are particularly helpful when long-distance c are giving is necessary. Fees vary and are sometimes covered by Medicare or private insurance. The Department of States Employee Consultation Service or IQ Information Quest, the local Area Agency on Aging, and community agencies can provide referrals nationwide. If the older person has been hospitalized, hospital discharge planners can also provide information and referrals for after-care.Services Offered by the Private Sector Some private companies have set up programs to help their employees with eldercare. Foreign Service spouses who work in the private sector should investigate any eldercare options offered by their employers. These programs can include seed money for eldercare services, flexible work schedules for caregivers, subsidies for eldercare expenses, unpaid leave for up to a year, referral services, inter-generational day care centers (for both the elderly and children), geriatric assessment and case management, and group rates for long-term care insurance.Unfortunate ly, many of the services provided by companies require that the elderly person meet the tax-law definition of a dependent. This increases the shoot down for families whose elderly relatives are not financially dependent or who are not living with the employee. Eldercare in the Foreign Service Putting Parents on Your Orders Foreign Service employees may request that their elderly relative(s) (including step parents and legally adopted parents) be ap essayd as an eligible family member and added to their Post Assignment hold out Orders for an overseas assignment.The employee must complete an OF-126 Foreign Service Residence and Dependency Report. This form can be found on the Department of State Infoforms with instructions on completion. Each modernistic OF-126 replaces the old OF-126, so all blocks must be filled out each time a new OF-126 is done. The new OF-126 must be forwarded to the employees personnel technician in HR/CDA/ASD, Room 2419, Truman Building (Main State). cash in ones chips orders can not be authorized for newly-acquired eligible family members until the personnel technician receives the OF-126 form.Along with a undefiled OF-126 form, the officer must prove that the relative is at least 51 percent dependent for support (subject to review and approval per 6 FAM 117 USAID employees should also see Supplement 1B to HB 32, Chapter 1). The officer must quantify that he/she has provided more than 51% of support by submitting an affidavit or notarized statement testifying to that fact. This is termed passing the financial support test. An explanation regarding the parents mansion house is also required, with an explanation as to why the application is being made to add the parent to the extend orders.Other documentary evidence may be required by the employees agency. These documents are attached to the completed OF-126 form and sent to the officers agency as specified on the forms. Requests are reviewed for approval by a Personnel OF-126 Com mittee. Employees of the Department of State can obtain advice on how to put your parents on your orders through the life history Development and Assignments (CDA) division of the Bureau of Human Resources. Ask for an Assignments Support (CDA/AS) officer. Employees of other agencies should contact their HR representative.See section below, Taking an Elderly Relative to Post, for details regarding official government support. Bringing Parents to Post Who Are Not on Your Orders If your relatives are not financially dependent on you, they may come to post as members of the employees household, but will receive no official support from the U. S. Government. No official support translates into no access to the U. S. embassy health unit, no airfare or allowance payments in the case of evacuation from post, and no diplomatical status with the host country.Parents who come to live overseas for an extended period of time should consider having additional medical insurance (Medicare does not cover costs related to care overseas). In addition, parents should also maintain Air Medical Evacuation Insurance. A list of companies that provide this insurance can be found on theDepartment of State consular Affairsweb site. Family Medical cave in Act and Family-Friendly have If you think you may need to care for an elderly relative, be sure to check the provisions of the 1993 Family Leave Act on taking leave for this purpose and contact the a leave specialist in your agency.Department of State employees can contact a Department leave specialist in the role of Employee Relations (HR/ER/WLP) about paid and unpaid leave at202-261-8180. Eldercare Emergency failure Travel (Eldercare EVT) In January 2001, the Eldercare Emergency Visitation Travel (Eldercare EVT) provision was implemented, permitting travel at government expense for employees and eligible spouses serving at an overseas post who need to assist parents in declining health. Eldercare EVT allows an employee two trips over a career to visit his or her parents.It is meant to support one mother and one father of the employee and of the eligible spouse. It does not mean a couple may pool their four eldercare visits to assist the parent(s) of only one member of the married couple. For more information, email the Family Liaison Office (emailprotected gov) for a copy of Questions and Answers on Eldercare Emergency Visitation Travel. Taking an Elderly Relative to Post If elderly relatives are classified as eligible family members, they travel on diplomatic passports and have the same diplomatic immunity as a spouse or child.If not classified as such, elderly parents use tourist passports and do not have diplomatic status. Housing assignments are based on the number of official eligible family members the employee brings to post. Travel to and from post (with the exception of medical travel) is also available to all elderly parents designated as eligible family members. Elderly parents, regardless of th eir status, arenot coveredby the Foreign Service medical insurance program. While the use of posts health facilities is not promised as a benefit, these limited facilities are sometimes available depending on the location and an authorisation by the Ambassador.The medical officer has the authority to refuse to provide services should a patient have a complicated problem that the physician is unable to treat. Employees may, however, ask the Health Unit for names of local physicians who can provide medical services for their elderly parent. This kind of assistance from the Health Unit may also be requested during the bidding process, to determine if a post has adequate local heath care providers to meet the medical needs of a parent. The Department of State Office of Medical Services has a brochure entitledMedical Questions and Answers about Taking Your Parent Overseas.The brochure addresses the questions of obtaining prescription medicines overseas, elevated altitude climates and the elderly, health unit access, hospitalization overseas, and more. For a copy of the brochure or more information about medical questions related to taking your parent overseas, contact the Office of Medical Services, Foreign Programs (MED/FP). Because elderly parents are not covered under the Foreign Service medical insurance program, they also do not have access to embassy medical evacuation (medevac) services.Therefore, all parents coming to post for either a short or an extended period of time should purchase (and maintain) Air Medical Evacuation Insurance. A list of companies that provide this insurance can be found on theDepartment of State Consular Affairs website. Medical Insurance It is essential that a parent going overseas, either officially or unofficially, have adequate medical insurance. Medicare only pays medical expenses in the United States, and in Canada and Mexico under certain very limited circumstances.The insurance companies listed below provide a variety of coverage and can be contacted for more information. Pay special attention to age limit noted in the policy. Clements and Company Under its GlobalCare Plus program, Clements and Company provides overseas major medical insurance, including full world-wide evacuation services. Coverage is offered for individuals as well as families. Substantial coverage is available at a reasonable cost. GlobalCare Plus is for policies lasting 6 months to one year. Clements also write policies for shorter-term travel (15 days to 4 months) through Patriot Travel Medical Insurance.