Chronic inflammation is like the body (your “house”) catching fire. We have all dealt with acute inflammation. It comes with injury, such as a sprained ankle. Or infection, such as staph, bronchitis, etc. Inflammation is a sign that the body’s defenses are rushing in. In the normal course of events, healing occurs and the immune system stands down.

With age, our immune system becomes less effective. It overproduces cytokines and other inflammatory cells. If it doesn’t stand down, it can last for weeks, months, or even years. This is called “inflammaging.” Chronic overreaction of the immune system is hard on tissues and organs. In effect, the immune system is misreading cues and behaving as if there’s an ongoing 10-alarm fire. Under this state of siege, organs become unable to do their jobs effectively or to repair themselves well.

The potential for such immune malfunction begins around age fifty and increases sharply at age sixty and above. It may be the reason the occurrence of diseases such as heart disease, diabetes, and dementia increases significantly after age sixty-five. They are malfunctions of different body systems—the heart, the pancreas, the brain—but inflammaging is what opens the door. In the worst case, the body starts attacking itself—creating what’s called an “autoimmune condition”—or starts growing cancer cells. 

Not all inflammation is bad, of course. Constant dosing of antiinflammatory drugs, for instance, is not the answer. We need the inflammatory response to address an acute infection or injury. It’s simply that you want the right amount of inflammation for the appropriate amount of time.

In subsequent articles we will talk about ways to detect chronic inflammation and what can be done to reduce it (in your loved one and for yourself!).

Might “inflammaging” be a factor with your relative?

As the San Francisco experts in family caregiving, we at Compassionate Community Care support you in exploring ways to address underlying factors in your relative’s condition. We also support you in extending wellness for yourself. You are not immune to this! Chronic inflammation and stress go hand in hand. Let us help you find resources to reduce stress and inflammation, for both of you. Give us a call at (415) 921-5038.

“On your mark! Get set! Wait!” That is the experience, and in fact the best strategy, when hoping to persuade an older relative to move to assisted living.

You may feel sure your mom or dad needs extra help. But they may not agree. This is a common dilemma. For instance, you may have noticed your loved one 

• seems tired of cooking and is eating less and less
• forgets to take medications
• is unsteady when walking or has bruises that may indicate a fall
• is having difficulty with dressing 
• rarely leaves the house and has little social contact

Unless there is a serious safety risk, don’t push for a move. If your relative is resistant, pushing will likely backfire. Instead, “get set” by doing your homework on your own beforehand so you are ready when things change (and they usually do). 

• Figure out the finances. Medicare and Medicaid do not cover assisted living. Learn about your relative’s income and assets. What could be afforded monthly for rent, food and care? Do they have long-term care insurance? Does your loved one qualify for veterans’ assistance? 
• Consider needs and preferences. If you had to guess, would your relative like an active, urban setting or a quieter environment? Are there particular hobbies or pastimes of interest? Do they need special assistance with diet, medications, or going to the bathroom? 
• Look at facilities. Are there facilities in dad’s current neighborhood? Any close to you or another family member? Any that his friends live in already? Create a list of facilities that you can visit first on your own. Narrow the options down to a short list of ones that deserve serious consideration once your loved one is ready to consider this option.

You might also consider hiring a Care Manager to save you time. These professionals know the pros and cons of all the local facilities. Unlike “free” referral services that receive payments from the facility, Care Managers have no potential for conflict of interest. Their recommendations are based on a genuine belief that a particular facility is the best fit for your family.

Is assisted living on the horizon?

As the San Francisco experts in family caregiving, we at Compassionate Community Care have seen many well-meaning family members push for move only to have it backfire. If you would like help determining the best ways to keep your loved one safe, give us a call at (415) 921-5038. Let’s start the conversation.

Are you feeling isolated, alone, frustrated, anxious, or just plain sad as you care for your loved one? 

Meeting with others who are also facing caregiving challenges can be very helpful. You can share anything, from coping with the emotional demands of your role to handling difficult behaviors. Rather than judgment, you’ll find affirmation in a family caregiver support group. Plus, everything said is kept confidential. 

Even if you are shy about talking in a group, just listening may bring a boost. You will learn that you are not alone and might even discover new approaches and coping strategies!

Here are some questions to ponder as you consider various groups:

• Do you want to be with people who are all dealing with the same condition? There are groups for cancer caregivers, for instance, or Alzheimer’s, Parkinson’s, or other diseases.
• Do you want to be with people in the same life circumstances? For instance, the Well Spouse Association has support groups for people taking care of a life partner. And there are groups just for adult children caring for parents. Or for people who still have children at home.
• Do you want to meet in person or online? By video conferencing? Telephone? In-person meetings are heartwarming but may not be convenient. Many groups choose to meet online. Some involve posting text or updates and members reply as they have time. Others use video conferencing and meet on an appointed day. Some groups use a telephone format.
• Do you want an educational focus or a more spontaneous agenda? Some groups have a theme for each meeting. Perhaps there’s a professional coming to talk about dementia strategies. Or someone coming to share information about adult day centers. Other groups follow a more conventional support format where people check in to share their concerns and challenges and get feedback/support from others.

Most groups are free and open to the public. For some, you may need to join the sponsoring organization. Fees are usually low. Even if a group is hosted by a faith community or medical center, don’t assume you have to be members to attend. Contact them to find out.

Looking for a support group?
As the San Francisco experts in family caregiving, we at Compassionate Community Care regularly witness the benefits of caregiving support groups. Let us help you find one. Give us a call at (415) 921-5038.

A “special needs trust” (SNT) is typically created to provide financial support for a disabled individual. Aging parents of a person with Down syndrome might create an SNT to provide for their child’s needs after they have died. 

The SNT trustee must manage the endowment to benefit the person with special needs over time. The trustee can be a family member or a professional attorney or trust officer. Often a savvy professional is hired even if a family member is a trustee. The professional provides investment guidance and ensures that funds released by the trust don’t jeopardize eligibility for public benefits (for example, money released for education might cause them to lose their Medicaid coverage).

The responsibilities of an SNT trustee include:

• Releasing funds based on the allowable expenses outlined in the trust
• Investing funds wisely
• Maintaining records for full transparency
• Filing state and federal income taxes
• Making decisions always based on the wishes and best interest of the beneficiary
• Communicating regularly with the beneficiary

While it is an honor to be chosen, if you are asked to be the trustee for a family member, talk with an SNT attorney and ask yourself:

• Do you know your relative well enough to make decisions for them?
• Do you understand investments and public benefit programs? 
• Is there a provision for hiring professionals such as an attorney, a Care Manager or financial advisor?
• How will this affect your personal relationship with your relative? You may have to regularly say “no” to their requests. 
• How long is your commitment (for your relative’s remaining life)? 
• Will you be paid? 

Do you have a relative with a special needs trust?

As the San Francisco experts in family caregiving, we at Compassionate Community Care understand the pull to help in any way that you can. Being a trustee is an immense responsibility and is not recommended unless you have professional assistance for the many mandated tasks. You don’t have to do this alone. Give us a call at (415) 921-5038.

Chronic kidney disease (CKD) affects one out of seven Americans. It is among the top ten causes of death in the United States. At first, its symptoms are very subtle and it progresses slowly, getting worse over decades. People often don’t know they have CKD. By the time significant symptoms emerge, the kidneys have been greatly damaged. At this point, CKD cannot be reversed. If caught early, however, there are ways to slow its progression.

Who is at risk for CKD? A number of very common conditions can bring it on. These include diabetes, high blood pressure, heart disease, smoking, and obesity. Also, if your loved one has relatives who have (or had) CKD, there is a greater chance of their getting it. And people of African American descent are four times more likely to get it than are Caucasian Americans. People of Asian, Hispanic, and Native American descent are also at greater risk. If any of these apply to your relative, ask the doctor to do a yearly kidney screening. This is primarily a urine test and blood test. If they find evidence that the kidneys are having trouble, ask for a referral to a nephrologist (kidney specialist) who can order more in-depth tests.

What are the symptoms? The early signs are very general and easy to discount: Fatigue, nausea, loss of appetite, and general malaise. More-specific symptoms are foamy urine, breath that smells of ammonia, and kidney pain. 

Treatments. If caught early enough, CKD progression can be slowed with a low-salt and low-protein diet, along with a variety of medications. Keeping blood pressure low and blood sugars in the recommended range will help. Also staying active, losing weight, and stopping smoking. It’s important to work with a dietitian and a nephrologist to learn which treatments make the most sense for your loved one.

Is chronic kidney disease a possibility?

This little-known condition is surprisingly common. As the San Francisco experts in family caregiving, we at Compassionate Community Care can direct you to a specialist to get help. You want to address CKD early to forestall kidney failure and dialysis. Give us a call at (415) 921-5038.

Older adults need about seven hours of sleep at night. But they often have difficulty falling asleep and staying asleep. They frequently wake up early and are not able to go back to sleep. This is due in part to normal changes of aging. We just don’t spend as much time in the deep phases of sleep. 

But for many older adults—as many as 50 percent—sleep difficulty becomes chronic. It creates emotional distress and fatigue, making it difficult to function well during the day. Moreover, ongoing insomnia has been shown to contribute to depression, anxiety, and dementia. Also, to a greater risk of high blood pressure, heart attack, and diabetes. 

Other signs of insomnia include

• daytime sleepiness and fatigue that gets in the way of normal activities
• difficulty concentrating or remembering things 
• increased irritability or moodiness
• more-frequent mistakes or accidents

Bring any such symptoms to the doctor’s attention. Beyond insomnia, they may be related to an underlying health issue, such as

• sleep apnea (halted breathing during sleep)
• restless leg syndrome (leg movements during sleep)

Many sleep problems in older adults can be related to a chronic condition, such as diabetes, chronic pain, dementia, or depression. Medications can also be at the root of older adult insomnia.

Ideally, provide the doctor at least a week’s worth of notes about your relative’s daytime and nighttime sleep habits. Also bring information about health and current medications (both prescribed and over the counter). Sometimes an overnight sleep study is needed to determine the cause of the insomnia and pinpoint the most appropriate treatment.

Depending on the cause, the doctor may suggest your relative change sleep-related routines. They may also suggest cognitive behavioral therapy. This will teach your loved one to recognize and interrupt the thoughts that contribute to insomnia. Medications may be prescribed. But these are problematic for older adults. They can increase the risk of falls. They can also pose conflicts with other medications and even become addictive.

Is insomnia an issue for your relative?

As the San Francisco experts in family caregiving, we at Compassionate Community Care hear a lot about insomnia from clients and the way it affects quality of life. Treating the condition can be challenging. You don’t have to go through this alone. Give us a call at (415) 921-5038.

There are many options for older adults who can no longer live at home independently. 

Assisted living facilities (ALFs) are tailored to individuals with health concerns that do not require the 24-hour medical attention provided by a nursing home. ALFs enable residents to be freed from the chore of meal preparation and housework and be supported in those activities that are challenging. They also offer social opportunities. 

The majority of residents are age 85 or older, and female. Forty-two percent have some form of dementia.  

The average ALF houses thirty-nine residents, although there is a wide range, from ten to more than one hundred. According to the National Center for Assisted Living, 56 percent of ALFs are part of a chain with two or more communities. Forty-two percent are independently owned.

ALFs typically provide these services: 

• Private “apartments” for each resident. Usually studio or one bedroom. Most include a bathroom and kitchenette. Microwave ovens are usually available. Stoves are not.
• Meals with others. In most cases, residents gather in a common dining hall for three meals a day.
• Activities and a common area. Lounge areas are available for social interaction. Some facilities have exercise programs. Others offer music or field trips.
• Housekeeping, laundry, and a van service to nearby shopping centers. 
• Security and supervision. Call buttons provide 24-hour access to staff as needed.

Smaller facilities may have fewer features. 

Personal care services are provided when needed. 

• A personalized care plan is developed for each resident.  
• Help can be provided with managing medication. Also with such tasks as bathing and dressing, or walking to the dining room or to social activities. Additional fees are charged for these services. 
• Residents are reassessed periodically to ensure needs are met. 

Nonmedical assistants provide most of the daily hands-on care. ALF staff may or may not include a nurse to manage residents’ medical needs.

Medicare does not pay for the cost of an ALF. Some long-term care insurance policies allow for coverage of ALF fees. Veterans who qualify for the Aid and Assistance benefit may also apply this for an ALF. Talk to the facility in question and the insurer. As a general rule, facility fees must be paid with personal funds.

Are you considering an ALF for your loved one?

As the San Francisco experts in family caregiving, we at Compassionate Community Care can advise you concerning the pros and cons of this option for your unique situation. Give us a call at (415) 921-5038.

The emotion of disgust is a natural response. It evolved to protect us from potentially dangerous, scary, or infecting situations. But when it arises in the course of caring for a loved one—you involuntarily gag, for instance—it may cause you both distress.

Getting to the other side of the disgust response can lead to deep trust and appreciation between you and the person you care for. It may also be challenging and initially embarrassing.

As an example, it’s common to feel disgust about a loved one’s incontinence.

• Accept and allow your reaction. Pretending it’s not an issue doesn’t help. Nor does willing your response away. Instead, remind yourself it’s your body and brain trying to protect you.
• Objectively explore what concerns you. Like a scientist observing without judgment. What is the threat? Is it concern about infection? Worry you might throw up? How likely is this to occur? What if it did? What could you do then?
• Reassure yourself that you can cope. Studies have found that you can weaken your disgust response by thinking of it as momentary, something that passes. Also, reminding yourself that you can handle whatever happens (even if you’d rather not).
• Empathy for your relative. You may also feel anger toward your relative as the source of your disgust. But remember, they aren’t incontinent on purpose. They, too, may have feelings of self-disgust and embarrassment. Focusing on your caring for them can quell your reaction.
• You don’t have to do everything. Over time, your disgust is likely to diminish due to repeated exposure. But if the situation is too much, consider having another relative do this task. Or hire home help or consider a move to a care setting. Professionals have more experience handling disgust and have no personal involvement, which may be easier on your relative also.

Is disgust a problem?

As the San Francisco experts in family caregiving, we at Compassionate Community Care understand how distressing it can be. Let us help. You don’t have to do this alone. Give us a call at (415) 921-5038.

“Dementia” is not a diagnosis in and of itself. It describes a collection of symptoms that involve memory and thinking that are enough to interfere with daily life. Alzheimer’s is the most common cause, but there are many other reasons a person might have dementia symptoms. 

Most of the conditions that cause dementia cannot be cured. There are, however, some situations where the dementia symptoms are present but are reversible.

If you are worried about changes in a loved one’s memory, thinking, mood, or behavior, there may be a treatable cause. For instance:

• Drug reactions. Confused thinking may be a side effect of medication or a bad combination of drugs. Or mixing drugs with alcohol.
• Hearing loss. People with hearing loss often become withdrawn. They may seem forgetful or nonsensical when in fact they simply didn’t hear a conversation. Hearing aids can solve the problem.
• Other medical conditions. Diseases of the kidneys or liver can cause memory problems. As can head injuries. People with especially high or low thyroid levels can have dementia-cluster symptoms. As the medical conditions are treated and cured, the symptoms go away.
• Infection. A high fever can cause confusion. Cure the infection, and thinking returns to prior function.
• Nutritional deficiency or dehydration. Lack of B vitamins, particularly B12 and thiamin, can result in confused thinking. So can insufficient fluid intake.
• Emotional distress. Grief and bereavement following a loss can result in poor memory and confused thinking. So can the disruption of a move, say from home to a facility. Depression can affect thinking as well as mood. Fortunately, when the distress is treated—through counseling or medications—the confused and foggy thinking typically clears up.

It’s important to get tested. Before assuming it’s dementia, get your loved one a thorough medical workup. Testing could uncover a cause that is indeed reversible.

Are you worried a loved one has dementia?

As the San Francisco experts in family caregiving, we at Compassionate Community Care frequently see families assuming the worst. Very understandable! The best cure for that worry, however, is to ask for a full evaluation. It could be that the problem can be easily addressed. And if it is Alzheimer’s, the earlier you get started with medications, the sooner the symptoms can be reduced. You don’t have to do this alone. Give us a call at (415) 921-5038.

Technology has done wonders to help us stay connected with family members. But beginning users have to learn new terms and skills. In-person classes are often available through senior centers or the library. And AARP’s AgeTech Collaborative offers online video tutorials and classes through SeniorPlanet.org. 

Even if you seek to provide less complicated devices, it’s still likely your loved one will need tech support, most commonly for

• updating a system or app 
• converting an older program to a subscription-only service
• installing and starting a basic app such as Zoom
• “it stopped working” (rebooting the Wi-Fi if it’s down, or charging the device)

Handling these tasks can be inconvenient and time consuming for you. You might try a monitor-sharing program such as Zoom or SplashTop. In this case, you take virtual control of your relative’s computer to help them from wherever you are. Other options include

• In-person appointments. Many senior centers and libraries offer one-on-one tech support or group classes from knowledgeable volunteers. They are often free or low cost. Some retailers offer in-store services for their products. 
• Home visits. Again, some retailers will allow you to purchase in-home tech support for a new device. Your family member receives help at home from a tech-smart individual. Be sure the service provider does background checks on staff. You might even consider purchasing a “whole home” plan from retailers or a local IT company. It would cover all your relative’s devices: Wi-Fi, phone, tablet, computer, television, etc.
• Virtual or remote support. CyberSeniors.org offers free online tech support “office hours.” Also, scheduled one-on-one training appointments. This service is specifically geared for older adults. It pairs them with senior-friendly high school or college mentors. Call 1-844-217-3057, toll-free.

Does your loved one lack a device set up for video visits? Consider ordering a phone or tablet online from a private company such as CanDooTech.com. (It’s a member of AARP’s AgeTech Collaborative.) CanDoo preconfigures the new device and mails it to your relative. Then their team of senior-friendly “tech concierges” can be hired one hour at a time. Or you can purchase a yearly rate for ongoing tech support and troubleshooting.

Are you the IT person in the family?
As the San Francisco experts in family caregiving, we at Compassionate Community Care see many in the younger generation get conscripted to troubleshoot or update devices. This may not be how you want to spend your time with your relative. We have resources to help. Give us a call at (415) 921-5038.