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THE NATION’S NEWSPAPER

Collegiate
Case
Study www.usatodaycollege.com

Caregivers struggle with


denial, disintegration Elderly Care
By Kathleen Fackelmann It has been projected that by the year 2020, nursing homes will need
................................................................................4-5 approximately 25,000 nurses with advanced preparation in gerontology. Given
the current nursing shortage, the baby boomer population is now at risk, and
Juggling work, care for aging physicians who provide nursing home care are threatened with an
parent overwhelming burden. This case study explores how aging parents and their
children cope with ailments and the growing cost of health care.
By Stephanie Armour
................................................................................6-7

When is it time to put the


brakes on elderly?
Seniors head south to
By Robert Davis
................................................................................8-9
Mexican nursing homes
Low costs, climate luring elderly across the border
Your aging parents and you
By Mindy Fetterman By Chris Hawley "It is paradise," says Douglas, 74. "If
.............................................................................. 10-12 USA TODAY you need help living or coping, this is
the place to be. I don't know that there
AJIJIC, Mexico — After Jean Douglas is such a thing back (in the USA), and
Additional resources: turned 70, she realized she couldn't certainly not for this amount of
.............................................................................. 14-15 take care of herself anymore. Her knees money."
were giving out, and winters in
Case Study Expert: Bandon, Ore., were getting harder to As millions of baby boomers reach
bear alone. retirement age and U.S. health care
Karen S. Dunn, Ph.D.
costs soar, Mexican nursing home
Associate Professor, Oakland University Douglas was shocked by the high cost managers expect more American sen-
.............................................................................. 16 and impersonal care at assisted-living iors to head south in coming years.
facilities near her home. After search- Mexico's proximity to the USA, low
ing the Internet for other options, she labor costs and warm climate make it
USA TODAY Snapshots® joined a small but steadily growing attractive, although residents caution
number of Americans who are moving that quality of care varies greatly in an
Are options for care
of the aging better? across the border to nursing homes in industry that is just getting off the
How are the care options for
Mexico, where the sun is bright and ground here.
aging available to you no w the living is cheap.
compared with what was
available for your parents? An estimated 40,000 to 80,000
For $1,300 a month — a quarter of American retirees already live in
what an average nursing home costs in Mexico, many of them in enclaves such
Oregon – Douglas gets a studio apart- as San Miguel de Allende or the
Same ment, three meals a day, laundry and Chapala area, says David Warner, a
13%
Source: Fi-
nancial
Better
55%
cleaning service, and 24-hour care University of Texas public affairs pro-
Freedom Worse 11%
Senior
Funding from an attentive staff, many of whom fessor who has studied the phenome-
survey of
1,063 se-
niors 62 to Not sure speak English. She wakes up every non. There are no reliable data on how
75 years
old. Margin
21% morning next to a glimmering moun- many are living in nursing homes, but
of er ror ±3
percentage
points. tain lake, and the average annual high at least five such facilities are on Lake
By Jae Yang and and Bob Laird, US A TODAY temperature is a toasty 79 degrees. Chapala.

© Copyright 2008 USA TODAY, a division of Gannett Co., Inc. All rights reserved.
AS SEEN IN USA TODAY’S NEWS SECTION AUGUST 16, 2007, 1A
"You can barely afford to live in the baked dogfish stuffed with peppers,
United States anymore," said Harry Cost of care garlic bread and a choice of four cakes
Kislevitz, 78, of New York City. A Nursing h omes and in-home health and two Jell-O
stroke victim, he moved to a convales- services are relatively new in Mexico, salads. Slater's neighbor doesn't like
cent home on the lake's shore two where m ost seniors live with a family Mexican food, so a nursing home
member. In L ake Chapala, a private
years ago and credits the staff with room in a nursing home costs $18-
employee cooks whatever she wants
helping him recover his speech and $50 per day c ompared with an on a stove beside her bed.
ability to walk. average of $206 in the USA. How the
countries compare: Like many retirees, Slater has satellite
"Here you see the birds, you smell the Number of for-profit nursin g television, so he doesn't miss any
air, and it's delicious," Kislevitz said. homes: American news or programs. When he
"You feel like living." wants to see a movie or go shopping
USA 9,900
downtown, the taxi ride is only $2-$3.
Many expatriates are Americans or Mexico 288 Guadalajara, a culturally rich city of 4
Europeans who retired here years ago million people, is just 30 miles away.
Cost of a home health c are aide:
and are now becoming more frail. (per hour)
Others are not quite ready for a nurs- For medical care, Slater relies on the
U.S.
ing home but are exploring options $19 Mexican Social Security Institute, or
average
such as in-home health care services, Mexico $9 IMSS, which runs clinics and hospitals
which can provide Mexican nurses at a nationwide and allows foreigners to
fraction of U.S. prices. Cost of a homemaker-companion: enroll in its program even if they never
(per hour)
worked in Mexico or paid taxes to sup-
"As long as the economies of the U.S. $17 port the system. He recently had gall-
average
United States and Europe continue to bladder surgery in an IMSS hospital in
Mexico $2-$5
be strong, we're going to see people Guadalajara, and he paid nothing.
coming here to Latin America to pass Note: Mexican costs are from a survey of facilities
in five cities.
their final days," said Oscar Cano, man- Sources: Me tLife Mature Market Institut e;
Mexico’s National Institute of Statistics,
Many of the nursing home employees
ager of Apoyo a los Miguelenses Geography and Information Processing; U.S.
Centers for Disease Control and Prevention;
speak English, and so does Slater's doc-
Ancianos, a group that runs a nursing USA TODA Y research tor.
home in San Miguel de Allende. By Frank P ompa, USA TODAY

He has plenty of room for his two dogs The Casa de Ancianos began taking in
Cozy cottage, meals, health care and has a little patio that he shares foreigners in 2000 as part of an effort
with three other American residents. to raise extra money, director Marlene
Retirement homes are relatively new He gets 24-hour nursing care and three Dunham said. It built the cottages
in Mexico, where the aging usually live meals a day, cooked in a homey especially for the Americans and uses
with family. There is little government kitchen and the income received from them to sub-
regulation. Some places have suddenly sidize the costs of the 20 Mexican resi-
gone bankrupt, forcing American resi- served in a sun-washed dining room. dents at the home.
dents to move. Some Mexican homes His cottage has a living room, bed- The program was so successful that the
have rough edges, such as peeling room, kitchenette, bathroom and a nursing home has plans for 12 more
paint or frayed sofas, that would turn walk-in closet. cottages, a swimming pool, a Jacuzzi
off many Americans. and a gazebo with picnic area. The
For this Slater pays $550 a month, less nursing home now advertises on the
"I don't think they're for everyone," than one-tenth of the going rate back Internet and through pamphlets dis-
said Thomas Kessler, whose mother home in Las Vegas. For another $140 a tributed in town. Some U.S. companies
suffers from manic depression and year, he gets full medical coverage have also begun investing in assisted-
lives at a home in Ajijic. "But basically, from the Mexican government, includ- living facilities in Mexico, said Larry
they've kept our family finances from ing all his medicine and insulin for dia- Minnix, president of the American
falling off a cliff." betes. Association of Homes and Services for
Residents such as Richard Slater say the Aging, which represents 5,800
they are happy in Mexico. Slater came "This would all cost me a fortune in nursing homes and related services.
to Lake Chapala four years ago and the United States," said Slater, a 65-
now lives in his own cottage at the year-old retired headwaiter. However, Minnix cautioned that lax
Casa de Ancianos, surrounded by pur- On a recent afternoon, lunch at the government regulation poses dangers
ple bougainvillea and pomegranate Casa de Ancianos consisted of veg- at smaller homes.
trees. etable soup, beet salad, Spanish rice,

Reprinted with permission. All rights reserved. Page 2


AS SEEN IN USA TODAY’S NEWS SECTION AUGUST 16, 2007, 1A

"It's the same danger you have of going cover care or medicine as long as Developers look to Mexico
across the border looking for cheap patients are outside the USA.
medications," Minnix said. "If you don't Developers of "independent living"
know what you're getting, and you're Some American residents said they had facilities for seniors are also beginning
not getting it from people you trust, doubts about the quality of Mexican to look to Mexico. A Spanish-U.S. ven-
then you've got an accident waiting to medical facilities and would go back to ture is building Sensara Vallarta, a 250-
happen." the USA if they became seriously ill. unit condominium complex aimed at
Jim May, 74, a resident of the Casa de Americans age 50 and older in the
'Nice place, but it's lonesome' Ancianos, said he recently decided to Pacific Coast resort of Puerto Vallarta.
move to Texas to be closer to Veterans And in the northern city of Monterrey,
Since many nursing homes are run out Affairs hospitals. El Legado is marketing itself as a
of private homes, regulation by state "home resort" for seniors.
health departments is often spotty. The language barrier can be daunting,
Managers such as Beverly Ward of and Mexican food can be very differ- Academics and government officials
Casa Nostra and Maura Funes of El ent, some residents said. are beginning to take notice. In March,
Paraiso, both in Ajijic, said that the University of Texas at Austin held a
Mexican officials inspect them only Some residents said they miss home forum for developers, hospital officials,
once a year, unlike U.S. inspectors, who and find it hard to make friends with insurance companies and policymakers
may visit a home several times a year. Mexican residents. "It's a very nice to discuss health care for retirees in
place, but it's lonesome," said Polly Mexico.
The U.S. Embassy said it had no record Coull, 99, of Seminole, Fla., a resident
of complaints against Mexican nursing at Alicia's Convalescent Nursing Home "With the right facilities in place,
homes, but some residents in the Lake in Ajijic. Mexico could give (American retirees)
Chapala area reported bad experiences a better quality of life at a better price
at now-defunct homes. Mexican entrepreneurs are doing their than they could find in the United
best to prepare for a tide of Americans. States," says Flavio Olivieri, a member
The first home that Jean Douglas lived of Tijuana's Economic Development
in after she moved from Oregon was In the Baja Peninsula town of Council, which is seeking funding from
staffed by "gossips and thieves," she Ensenada, the Residencia Lourdes Mexico's federal government to build
said. It went out of business. opened in 2003, offering care for more retirement homes. "We think
patients with Alzheimer's disease and this could be a very good business as
Irene Chiara of Los Angeles also lived senile dementia. The towns around these baby boomers reach retirement
in a home that was shut down by Lake Chapala have at least five small age," he says.
Jalisco state authorities. retirement homes. Most of them
opened in the last five years and house Hawley is the Latin America correspondent for
"It was filthy, and the food was very from one to 25 foreigners. The Arizona Republic and USA TODAY.
bad. It was all made in the The largest, Alicia's Convalescent
microwave," she said. Nursing Home, consists of four reno-
vated homes, one of them specializing
Some Mexican managers also underes- in stroke victims and another for
timate the costs and difficulty of run- Alzheimer's patients. Prices range from
ning a retirement home. Two hotels $1,000 to $1,500 a month and include Texas
Rosarito
turned into assisted-living facilities, everything except medicine and adult Mexico
The Spa in San Miguel de Allende and diapers. The rooms are outfitted in Gulf of
San Miguel Mexico
The Melville in the Pacific Coast city of Mexican style, with murals, hand- de Allende
Mazatlan, recently abandoned the carved beds, arched ceilings lined with
Ajijic Mexico
business, their managers said. brick and individual patios. Cit y

"It was very expensive to run it," said In other American enclaves, in-home Pacific Chapala
Luis Teran, manager of The Melville. nursing services have sprung up to Ocean
Some managers said they were espe- serve the retirees. In Rosarito, just 0 500 Guatemala

cially selective when admitting foreign south of the U.S. border, INCARE pro- Miles N
residents, to make sure they'll be able vides nursing aides to retirees starting Source: ESRI USA TODAY

to pay. Medicare, Medicaid, the at $8.33 an hour, less than half the cost
Department of Veterans Affairs and of the same service in nearby
most U.S. insurance companies will not San Diego.

Reprinted with permission. All rights reserved. Page 3


AS SEEN IN USA TODAY’S LIFE SECTION JUNE 28, 2007, 10D

Caregivers struggle with denial,


disintegration
Watching a loved one sink into Alzheimer's can be harrowing
By Kathleen Fackelmann Kathryn Betts Adams, a researcher at Case Western
USA TODAY Reserve University in Cleveland, says people with
Alzheimer's and their family members will try to stick
Barbara Center has raised four children, but now, at 59, with familiar routines. Even as the confusion gets worse,
she's helping care for her mother, who has Alzheimer's. they'll deny that a problem exists.

She's also dealing with two elderly aunts in nearby insti- Center found that out the hard way.
tutions. Both have Alzheimer's, and one is in the final
stage of the disease. She already had been providing care for her aunt with
Alzheimer's when Romine, who had already been show-
"Sometimes it is really hard," says the Springdale, Ark., ing signs of confusion, was diagnosed about a year ago.
resident. She says she has seen her 86-year-old mother, Center thought she knew how to handle the situation.
Vera Romine, become more confused and difficult.
"I just went full force into helping her," she says. But she
Center is one of 10 million Americans who struggle with soon found that her efforts sparked arguments with her
the task of caring for a relative with Alzheimer's or some mother, who didn't or wouldn't acknowledge the dis-
other form of dementia, according to the Chicago-based ease or the impairment in her thinking ability or
Alzheimer's Association. memory.

Family caregivers help out with household chores and Romine insisted she was fine, and Center's father agreed,
perform all kinds of services, including personal care. so Center had to back off — even though she was left
One in four caregivers have the equivalent of a full-time with constant worry.
unpaid job: They're spending at least 40 hours a week
providing services to a loved one, the association says. "It's so frustrating, because they don't allow me to help
the way I should," she says.
Caregivers who don't get any relief can develop anxiety
and depression and are prone to getting sick themselves, She has tried to hire caregivers to help out, but her par-
says Jan Busby-Whitehead, a spokeswoman for the ents have rejected each one for different reasons. So the
American Geriatrics Society family muddles along.

Alzheimer's often forces caregivers to step in and make Center, who works part time as a clerk in a Cracker
decisions for a relative who's showing signs of impair- Barrel store, does the grocery shopping for her parents.
ment, says Larry Wright, director of the Schmieding She buys lots of frozen dinners that her father can easily
Center for Senior Health and Education in Springdale. pop in the microwave.

About two years ago, after her mother ran a red light Center says her mother still wants to cook, even though
and got into a minor fender-bender, Center had to take she has started at least one fire. To avoid an argument,
away the car keys. she tells her mother that the stove is broken: "There's
just no reasoning with her."
Her mother disagreed with the decision. "She got very
angry," says Center, adding that her mother still insists Alzheimer's destroys the brain regions that govern
she is a safe driver. thinking ability, judgment, and even emotion and
behavior. People who have the disease can lash out in
anger, and that makes the job much harder, Wright says.

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AS SEEN IN USA TODAY’S LIFE SECTION JUNE 28, 2007, 10D

Adams says many families resist getting help until a cri- starts off with mild memory loss and other subtle prob-
sis occurs. lems. But then they have more and more trouble form-
ing even routine tasks. In the end, people with advanced
Center says her mother, who has balance problems, still disease are completely helpless and mute. They usually
takes a bath by herself. She worries that Romine will slip die of an infection or some other complication.
and fall, but she can't get her parents to agree to any Center has seen this dreadful progression up close: One
assistance with the routine. of her aunts is bedridden and doesn't recognize her. She
has stopped eating.
"It's going to take an accident of some kind before my
father ever agrees to get help," she says. For now, Center's mother still lives at home but has
become increasingly difficult. She puts household items
The stress and worry has driven Center to seek out some
in odd places. She lashes out and is sometimes paranoid.
solace, which she gets by going to a support group for
people who care for relatives with Alzheimer's. She says She repeats things over and over and sometimes can't
just talking to others who are going through the same remember past events — even the good times.
thing can help. Her children — she has three grown
daughters who live nearby — also help out from time to "I see the deterioration and it scares me," Center says. "I
time. don't know what we'll have to go through in the future.”

People with Alzheimer's can live for 10 years with ongo-


ing destruction of brain tissue, Wright says. The disease

USA TODAY/ABC News/Gallup Poll n


Who’s caring for elderly parents
USA TODAY/ABC News and G allup polled b aby boo mers ab out caring for elderly parents. Here’s what we found:
Do you have any paren ts, step-parents, ado ptive paren ts or Of those who said yes, if you are not cur rently providing
parents-in-law who are cur rently alive? assistance, do you expect to have to take care of a parent
in the fu ture?
No
opinio n
Yes 73% No 27% 8%
Yes 37% No 55%

If you have a living parent, where do Are you providing How concer ned are you ab out being
they live? any ass is tance? able to provi de care in th e future?
Assisted-living or long-term care facility Financial h elp
12% 4% Very concerned 21%
Liv ing with you in your h ome Personal care Somewhat concerned 27%
8% 30% Not too concerned 28%
Liv ing with a relative in their home Both financial and personal c are Not concerned at all 23%
8% 7% No opinion 1%
None of these Not providing ongoing care
73% 59% If you have t alked to your p arents a bout
how to handle their care in th e future,
Have you talked to your how did the discussio n go?
parents ab out how to Ver y easily
No 48% Yes 52% 32%
handle t heir health care
after t hey can no longer Somewhat easily 28%
care for themselves? Somewhat difficult 28%
Very difficult 10%
No opinio n 2%
Source: USA TOD AY/ABC News/Gallup poll of 689 baby boomers.
Margin of er ror for full sample is ±4 percentage points; margin for subgroups
(such as boomers with a living parent) from 5 to 7 percentage points.

By Robert W. Ahrens, USA TODAY

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AS SEEN IN USA TODAY’S MONEY SECTION JUNE 26, 2007, 3D

Juggling work, care for aging parent


Some companies help their workers
By Stephanie Armour Programs for federal employees vary by agency, but
USA TODAY some provide telecommuting, caregiver fairs and lunch-
and-learn events on elder caregiving issues.
Sheree Anderson of Sioux Falls, S.D., calls her mother, Still, attention to the issue isn't meeting employee
Virginia Harvey, her best friend. She considers it a labor needs, says Randall Abbott, a consultant at Watson
of love to care for her in her home now that her mom is Wyatt Worldwide, a benefits consulting firm.
87 and prefers not to live on her own.
"Employers are doing incrementally more but not as
But for Anderson, the need to balance her work much as you'd expect, given the changing
demands with her role as a caregiver poses a persistent demographics," Abbott says. "I continue to be amazed
challenge. When she goes on business trips, she has her there is not more attention paid to this. (The caregiving)
sister drive several hours to stay with Virginia. She also population is huge, and it's an enormous drain on pro-
structures her work hours around the need to run ductivity."
errands for her mother or take her to the doctor.
Employees who lack access to programs or flexible work
"From time to time, it causes stress," says Anderson, 51, schedules typically must use vacation time or sick days
a self-employed educational and military consultant. or limit their caregiving to weekends, notes Cali
"It's hard to have to always be there to cook the meals Williams Yost, author of Work+Life: Finding the Fit
and give her medicine. I'm tied to a routine, and I try to That's Right For You.
work in-between."
They can take unpaid time off to care for an aging parent
For both employees and the self-employed, shouldering under the federal Family and Medical Leave Act. That
the burden of caring for an elderly parent while also time off can be taken in segments, such as a few hours
meeting job demands can be a Herculean task. The to take a parent to the doctor.
nation includes an estimated 34 million unpaid care- "There are also times where employees have no choice
givers for adults, typically older relatives, according to a (but to quit)," to move closer to their elderly relative,
study released this week by AARP. Nearly 60% of male Yost says.
caregivers work full time, as do 41% of female care-
givers, according to the National Alliance for Caregiving But some employers are taking action:
and AARP.
uIBM offers an online course that covers caregiving.
But as the ranks of employed caregivers swell, a small One-on-one counseling is offered via phone to help
but growing number of employers are beginning to employees find caregivers and nursing homes, on-site
establish novel programs to provide help and scheduling classes for employee caregivers, webcasts, online lec-
flexibility. Twenty-six percent of companies offer an tures and moderated chats. A 2004 internal survey
elder care referral service, which helps employees con- found that 36% of IBM employees are affected by elder
nect with service providers or other services, according care issues, up from 9% in 1986.
to a 2006 survey by the Society for Human Resource
Management of small, midsize and large companies. "These programs are important because it's a retention
Five percent provide emergency elder care help (such as issue, but it's also to motivate talent," says Maria Ferris,
contracting with a firm that has nurses or other IBM's director of global workforce diversity. "To the
providers who can help care for an elderly relative), and degree employees are worried about an elderly parent,
3% subsidize the cost of elder care. they're not productive."

Reprinted with permission. All rights reserved. Page 6


AS SEEN IN USA TODAY’S MONEY SECTION JUNE 26, 2007, 3D

uErnst & Young provides consultations to help employ- who had Alzheimer's and died in December at age 86.
ees learn about available resources, from assisted living Her father, 93, lives in Texas.
to nursing homes. The service also addresses the emo-
tional and psychological aspects of being both a caregiv- Ray was able to use an internal website that her compa-
er and an employee. ny provided to learn more about the issue and to speak
with a specialist about how best to handle problems,
The accounting giant also provides backup emergency such as her mother's forgetfulness
adult care services, whereby a service provider will visit
an employee's or relative's home to help provide care. "I was able to read about it and talk to someone," says
Employees are allowed 12 days each year for each Ray, an IBM business analyst. "I could see I am not the
dependent, and the cost is subsidized. only one dealing with this. Peace of mind helped a lot. It
made me feel better talking to a professional in this
There are also seminars on elder care issues and, in field.”
some locations, caregiver discussion groups in which
employees can share experiences. In addition, the com-
pany offers some flexible-scheduling options to help
with work and elder care demands.
Tips for balancing care, work
uXerox provides elder care consultations and referrals Employees with aging parents or other relatives
that help employees find caregiving services. The con- often find they must negotiate with their employ-
sultants help with such issues as finding transportation ers to take time off to care for family while also
for elderly parents, meal services and Medicare. Xerox remaining productive on the job.
also has a program to help deal with the pressures of
juggling work and family duties. It's a tricky balancing act. Some advice:

Demand for such services is growing. Bright Horizons, a uFind out if your employer must follow the fed-
company that offers a network of in-home providers, eral Family and Medical Leave Act. If so (for
says it's seen a rise in employers interested in backup example, if your company has 50 or more
emergency elder care programs. The company, which employees), you're entitled to up to 12 weeks of
launched the service less than a year ago, has had about unpaid time off annually to care for a parent with
75 major employers sign up. a serious health condition. Generally, that time
can be taken in increments.
"They're trying to help employees," says Dave Lissy of
Bright Horizons, based in Watertown, Mass. "(The serv- uFind out if flexible arrangements are possible.
ice) builds loyalty to the employer and helps employees These might include formal programs as well as
be more productive at work." informal agreements. "The more you can make
the workplace fit your needs, the better," says
But for many employees, especially those also caring for Elinor Ginzler, co-author of Caring for Your
children, the need to help an elderly parent can impose Parents: The Complete AARP Guide.
an emotional strain for which referral services are hard-
ly enough, says Richard Chaifetz, CEO of ComPsych, an uFlexibility is especially vital for employees who
employee-assistance provider. are long-distance care-
givers. Employees
should find out if they Some helpful web sites:
"The psychological drain can be enormous," Chaifetz
says. "It results in more absenteeism, distraction and can work remotely (for
example, they may be www.aarp.org
lost productivity for employers. We're seeing this grow
dramatically." able to work from the
home of the relative www.caregiving.org
For some employees with aging parents, employer serv- they're caring for).
www.caregiver.org
ices have been a relief and an invaluable help. Rosemary
Ray, 42, of Cary, N.C., had been coping with her mother,

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AS SEEN IN USA TODAY’S LIFE SECTION MAY 2, 2007, 7D

When is it time to put the brakes on elderly?


Heed the early signs to avert disaster
By Robert Davis The way in which a person responds to small problems
USA TODAY can be an indication of how they will act behind the
wheel of a car.
As they age, drivers tend to take their cars on shorter
trips. But even so, health problems often catch up with "I get concerned when somebody doesn't problem-solve
them. very well," Coleman says. "When they tend to do the
same thing in response to a problem, I get concerned
Reflexes, flexibility, visual acuity, memory and the abili- because driving requires you be very adaptive.
ty to focus all decline with age. Because no two people
age exactly the same way, one 80-year-old can be more "You will see things happen that you have not seen
fit to drive than another 70-year-old. before. Somebody will pull in front of you. There will be
a detour. There will be something different. That is
Doctors and advocacy organizations who specialize in where it gets very challenging."
treating the elderly say medical professionals, family
members and friends must do more to watch for early As a result, the signature crash for elderly drivers occurs
warning signs of medical problems that affect safe driv- when their paths cross with others who are following
ing. traffic rules. They turn in front of oncoming cars that
they never see, studies have found. They miss red lights
uAlzheimer's disease, a disorder that causes memory or stop signs.
loss, can cause slower reaction times, problems judging
space and distance, and a diminished ability to plan And they crash while making routine trips.
ahead. It also can increase the risk of getting lost, being
confused by divided highways and one-way streets, and For instance, weekends are risky times for teenagers to
being in an accident. be on the road. But according to data from the Center for
the Study & Improvement of Regulation at Carnegie
uDiabetes, a blood sugar disorder, can damage the Mellon University in Pittsburgh, the mile-for-mile fatali-
nerves in hands, eyes and feet. This can slow reaction ty rate is about three times higher for drivers 85 and
time and limit vision. If blood sugar levels dip too low, a older on weekdays.
driver may feel dizzy or shaky and become confused or
even lose consciousness. Diabetics should check their "People should not have to get into car accidents or get
blood sugar levels before getting behind the wheel. pulled over by state police for health care providers or
*Parkinson's disease, a neurological condition that caus- families to take notice," Coleman says. "We should have
es rigidity, slowed movement and tremors, may affect heightened awareness and that is all of us, not just med-
the ability to turn the steering wheel and make quick ical professionals but your neighbors and your family."
movements.
Coleman has to push some patients hard. She has writ-
uStroke, which is caused by an interruption in blood ten letters asking the Department of Motor Vehicles to
flow to the brain, damages brain tissue and may cause retest patients who then lost their license.
balance problems, diminished vision and a loss of mus-
cle control. "Sometimes patients will never speak to me again," she
says. "But driving is a privilege and it's not a right. I
"All of the sensory input you take in constantly as you don't want to be cavalier about it, because the potential
drive is really amazing," says Laurel Coleman, a geriatri- risks and consequences are so great."
cian from Augusta, Maine, who serves on the board of
the Alzheimer's Association. "You do so many things
automatically that you do not consciously think about.
Where can the process go wrong? In so many ways."

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AS SEEN IN USA TODAY’S LIFE SECTION MAY 2, 2007, 7D

Before you get behind the wheel


Safety experts say that senior citizens can take steps to ensure that they are competent drivers. "It's part of the
responsibility of the individual to be aware of their own driving behaviors and do everything they can to be safe
on the road," says Elinor Ginzler, AARP's director of livable communities. Precautions that experts recommend,
according to USA TODAY research, include:

uDrive under less stressful conditions — during the day, in good weather, on less busy roads and in familiar
areas.

uAvoid distractions such as adjusting the radio, eating or talking on a cellphone.

uPlan your route. That allows you to concentrate on driving, not navigating.

uUpdate your driving skills in a refresher course for older drivers.

uHave your vision and hearing tested regularly. Ask your doctor how frequently you should schedule
examinations.

uPerform stretching exercises to improve strength and flexibility of the neck and shoulders.

uWalk to stay fit and keep the lower extremities flexible and strong.

Consider stopping the car


Experts suggest you retire the keys if you:

uAre inattentive, make erratic moves, react too slowly, get anx-
ious at busy intersections, feel unsure of what to do or are
afraid to drive.

uHave trouble with gas or brake pedals.

uHave received several traffic tickets or warnings from police in


the past year or two.

uMove too slowly on the highway.

uFail to come to a full stop at stop signs.

uCan't see when backing or changing lanes.

uHave frequent close calls or near accidents or if you sometimes


dent or scrape the car.

uMiss traffic signals or are uncertain of what they mean, or if


you get lost.

uGet honked at by other drivers.

uUpset your passengers, or if people refuse to ride with you.

Reprinted with permission. All rights reserved. Page 9


AS SEEN IN USA TODAY’S LIFE SECTION MAY 2, 2007, 7D

Source: AARP, American Academy of Family Physicians, National Institute on Drug Abuse,
Mayo Clinic, Medco Health Solutions, USA TODAY research

How aging affects the ability to drive


Mind Eyes
Reactio n time sl ows, confusion grows, Aging causes several vision problems
quick decisions become more difficult and that can interfere with dr iving:
distractio ns have greater impact.
Cataract s cloud the
lens of the eye, causing
blurred or hazy vision.
The dr iver be comes
more sensitive to light
and glare; night
driving c an be difficult.

Glaucoma raises
Neck pressure inside the
The neck stiffens, moti on eyeball, re ducing
becomes painful, glancing over
peripheral vision and
one shoulder to look for traffic making it more
becomes difficult. Arthr itis can
difficult to see a
make it hard to grip the steering pedestrian or vehicle
wheel .
coming from the side.

Macul ar
degenera tion causes
loss of the central
porti on of vision,
making it more
difficult to see other
cars or pedestri ans
coming toward you.
Effects simulated by
Frank Pompa, USA TODAY

Knees, ankles, feet


Joints stiffen, foot and knew
movement b ecomes difficult
and p ainful, gas pedal gets
pushed instead of brake.

Medications
Prescription drugs that Benzodiazepin es Opioids Antidepressants Hypnoti cs Antips ychotics Antihistamines Glaucoma agents Muscle relaxa nts
may cause drowsiness v Ativan v Morphine v Paxil v Ambien v Risperdal v Benadryl v Xalatan v Flexaril
or slow reaction time: v Valium v Oxycodone v Elavil v Lunes tra v Mellaril v Clar inex v Trusopt v Skelaxin
Source: AARP, American Academy of Family Physicians, National Institute on Drug Abuse, Mayo Clinic, Medco Health Solutions, USA TODAY r esearch By Frank P ompa and Alexandria Newman, USA TODAY
By Frank Pompa and Alexandria Newman, USA TODAY
AS SEEN IN USA TODAY’S NEWS SECTION JUNE 25, 2007, 4A

Your aging parents and you


First you get phone calls that seem kind of strange
By Mindy Fetterman up. Families pay and pay and pay, emotionally and
USA TODAY financially.

MOM is quitting her bridge club because "they think I'm The typical unpaid caregiver is a 46-year-old woman
stealing from them." A week later, she mentions an old who works outside the home while taking care of a rela-
boyfriend from the war who's coming to take her to din- tive, according to AARP. That burden forces her to cut
ner. * You think, OK, it could be true. Then the police call the hours she works at her regular job by about 41%,
from her house. "Your mom thinks there's someone hid- causing her salary and benefits to fall sharply.
ing under her bed." * Now you know. The forgetfulness,
the fantasies, are dementia, Alzheimer's, something like The National Alliance for Caregiving (NAC) estimates
that. Your sister suspects the worst. * This isn't just the that $659,000 per person is lost in pensions, Social
story of one petite brunette with terrific legs who was Security benefits and wages as adult children — mainly
called "Shorty" by her husband, granddaughters and women – take time off from work to care for their par-
daughters, including me. * This is the story of millions of ents.
Americans caring for elderly parents and maneuvering
in the murky worlds of medicine, law, hospitals, nursing The physical toll can be severe, too. Caregivers report
homes, guilt, fear and family ties. A USA TODAY/ABC having one or more chronic conditions, such as high
News/Gallup Poll of baby boomers finds that 41% who blood pressure, at nearly twice the rate of all Americans.
have a living parent are providing care for them — either Of those who say their health has worsened because of
financial help, personal care or both — and 8% of caregiving, 91% report depression.
boomers say their parents have moved in with them. Of
those who are not caring for an aging parent, 37% say Caring for elderly parents also can threaten the emo-
they expect to do so in the future. About half say they're tional health of caregivers and their families. Being the
concerned about being able to provide such care. "parent of your parent" can unlock your family's hidden
dysfunctions — "You were always Mom's favorite!" —
It's estimated that 34 million Americans serve as unpaid and reopen old sibling rivalries and conflicts: "You're
caregivers for other adults, usually elderly relatives, and trying to kill our father!
that they spend an average 21 hours a week helping out,
according to a study being released today by AARP. If you never really got along with your parents or your
Millions more grown children are calling regularly, fly- siblings, it can be even more stressful. Elder care can
ing into town every few weeks or months or just stop- exhaust and sometimes demoralize the caregiver who's
ping by to take Mom or Dad to the doctor. on the front line. And it can frighten and confuse elderly
parents.
Among boomers who are helping their parents, 89% say
the responsibility is only a "minor sacrifice" or "no sacri- "My dad was never a gentle soul when we were growing
fice at all," according to the USA TODAY poll. But as their up; he was a military guy," says Nia Wilson, a lawyer
elderly parents get older, some boomers are beginning with the state of Pennsylvania. "His kids were additional
to worry they won't be able to care for them in the troops he had to keep in check."
future.
Now she spends most weekends driving about five
AARP estimates that the economic impact of this "free" hours from Harrisburg, Pa., to Washington, D.C., where
care was about $350 billion in 2006. That's more than her 84-year-old mother is caring for her 90-year-old
the U.S. government spent on Medicare in 2005. It father, who has Alzheimer's. Her two brothers live near-
exceeded the size of the federal budget deficit in 2006. by but don't help much, Wilson says.

AARP estimates that unpaid caregivers who contribute "They think they help, but not as much as I would like,"
financially spend an average of $2,400 a year on care. she says with a sigh.
Those who put in more than 40 hours a week spend
much more: an average of $3,888 of their own money In most families, women — daughters or daughters-in-
each year, AARP says. But when a parent actually moves law, aunts or nieces — typically assume the burden of
into the children's home, the total cost isn't really added care, according to the NAC. Wilson says her parents

Reprinted with permission. All rights reserved. Page 10


AS SEEN IN USA TODAY’S NEWS SECTION JUNE 25, 2007, 4A

want to stay in their home, even though they probably "Right now," she says, "we're fighting about his driving.
belong in an assisted-living facility, she thinks. Not out of malice, but because I know it's better for
everyone if he doesn't drive anymore. Heaven forbid if
"We keep raising the idea with Mom," Wilson says. "But he injures himself or someone else."
she says, 'Don't worry about me. I'm OK.'"
Her father, who has had some fender benders and mis-
Starting to take over takenly parked in the wrong driveway, disagrees. "They
can take away my driver's license, but I'm still driving,"
After a second midnight call from the police, the ser- he declares.
geant tells my sister: "You all need to do something
about your mom." But what? After Shorty had been driving fairly cluelessly for two
years or so, we hid her keys. Her dementia had pro-
A plane trip back home to Louisville, and we face her: gressed to the point that she didn't remember that she
"Shorty, you have to see the doctor. We've made an couldn't find the keys. She had been a widow for 25
appointment. Let's go." years; driving was vital to her.

She smiles and nods. A battle over keys can be the first struggle between eld-
erly parent and child. "It's my responsibility now,"
The next thing we know, the skittish 75-year-old Lucero says. "I have to decide."
woman has sneaked out of the front door and scam-
pered across the street to a neighbor's house. We find Obtaining legal rights
her hiding — literally hiding from her daughters —
behind a tree in Mr. Trinkle's backyard. One trip to a gerontologist with Shorty confirms what
we suspected.
She's frightened by what she senses is happening to her.
On some level, she realizes she's losing her ability to "Your mother is very charming," the young doctor says.
think and reason. But right now, she's afraid of what "She even flirted with me. But she really doesn't know
might happen to her. She's afraid she'll be taken from what's going on." She couldn't tell time or count change.
her home and placed in a nursing home. She didn't know who the president was. She didn't
know what day it was.
So she runs. What now?
The doctor prescribes an anti-psychotic drug to help
A friend suggests calling in a man. "Women of that era with the voices in her head. He checks her into a psychi-
will do what a man tells them," she says. atric ward for four days, primarily to give my sister and
me time to figure out what to do.
I call my ex-husband, a man Shorty has known since he
was 8 years old. "Put on a suit and tie and bring the "She can't live alone," he says. "She needs 24-hour care."
Mercedes over," I tell him. "Shorty will go to the doctor
with you." So we begin the trek across town to assisted-living facil-
ities and nursing homes. Both of us are single working
He does. He talks her out from behind the tree and into women, so taking Shorty into either home isn't an
the front seat of the big car. "Can I go, too, Mom?" I ask, option.
tentatively.
Some facilities we see are elegant replicas of colonial
Shorty talks only to John: "Tell her she can come, but homes with oriental rugs and cherry wood furniture.
she has to sit in the back seat." Lovely, but we realize she likely needs more medical
care than those retirement homes could provide. (We
Starting to take over for your parents can be one of the suspect they were decorated more to please the adult
most distressing experiences of a lifetime. "It's so much children than the residents.)
more difficult, because they are our parents; we are the
children," says Julie Lucero of Vacaville, Calif. Other facilities are starker, more medicinal. In one, a
man was screaming. Shaken, we go home.
For the past two years, Lucero's 79-year-old father, We try in-home care. But Shorty keeps firing people. We
Edward, has been living in her home with her three chil- try her former house maid of 30 years, a woman who
dren. was 78 herself. She stays about five days, until Shorty
throws her clothes out an upstairs window, yelling, "Get
your — out of here!"

Reprinted with permission. All rights reserved. Page 11


AS SEEN IN USA TODAY’S NEWS SECTION JUNE 25, 2007, 4A

We try an apartment at an assisted-living condo. Shorty They've spent thousands of dollars on a new air-condi-
calls a taxi three days later and has herself taken home. tioning system for their home because of his mother-in-
She lives at home alone for another year, with my sister law's lung problems. He loves and admires her but feels
stopping by each day after work to check on her. Very crowded in his own home.
stressful.
"The toughest thing is that she is a beautiful woman, the
Finally, we have her committed. We get a lawyer, take kindest and nicest person," he says. "She'd do anything
her to court and have her declared incompetent. for you. But as soon as you live on top of each other, it's
hard."
We sit across from a jury and testify against our own
mother. My sister is named her guardian. We check her Lucero has nine half-siblings. Her father, who divorced
into a nursing home with an Alzheimer's wing. That her mother when Lucero was young, lived with one son
means the doors are locked. for two years. He has only Social Security and some vet-
eran's benefits, about $600 a month. No savings. He
"You're doing the right thing," the lawyer says. can't afford a nursing home or an assisted-living facility.

Maybe, but we feel terrible. She wishes his other children would help more. "It was
my choice to take him on, but now that he lives with
Ray Payton knows the feeling. me, they say, 'Oh, Julie's got it covered.'"

She had to go to court to have her grandmother declared In my mom's case, one daughter lives near Shorty, the
incompetent. Now she must file forms with the court other — me — lives hundreds of miles away. So the near-
every six months to prove she's not wasting or stealing est sister gets the burden of visiting every week, often
her grandmother's money. twice. She's saddled with the emergency runs to the
hospital and trips to the doctor's office.
"I'm the legal guardian of my grandmother, who has
dementia," says Payton, 35, whose parents are deceased. The faraway sister spends thousands of dollars on plane
"I thought, 'How could me, a grandchild, take her to tickets and rental cars and buys most of her mother's
court so I could pay her bills?' clothes and necessities. She spends money to keep up
her mother's house, so we can sell it. She spends money
"I felt like I was being a bad granddaughter." because she's not there to help, and she feels guilty
about everything.
Straining a family
Shorty's money starts draining away, faster and faster.
Every rivalry you had with your brothers and sisters, Nursing home care is $60,000 a year. After a few years,
every argument you had with your parents, every effort her savings are nearly gone. So we sell the house and
you ever made to become independent can be put to the most of her stuff. We divide the valuable and sentimen-
test once your parents become old and sick. tal things. I ship home my new antiques.

You find yourself arguing with your siblings, arguing We realize we've done exactly what Shorty feared that
with your spouse, arguing with your parents, arguing day she ran across the street and hid behind the tree:
with yourself We've sold her belongings, taken her rights and put her
in a nursing home.
"The No. 1 thing you'll fight about is money," says David
Horgan, a producer of TV commercials from Ludlow, In our minds, we know we did the right thing. But we
Mass. His 69-year-old mother-in-law moved in with him feel terrible.
and his wife, Julie, and three kids about three years ago.
Epilogue: Evelyn Fetterman died in February at age 84.
"We fight about Grandma a lot. My wife will say: 'What She had been living in assisted living or a nursing home
do you want me to do? It's my mother!' And it goes for 10 years. Her daughters are sad and tired. They miss
back and forth, and then it escalates. As a good daughter, their mom the way she used to be. They're relieved that
she always feels guilty, and I always come out the bad it's all over. And for that, they feel terrible.
guy."

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Discussion Questions:

1. Most often, the role of taking care of older adults is viewed negatively because of ageist stereotypes. The major
reasons for this are a lack of knowledge regarding what are normal age-related changes and consequences of illness
or disease. For example, most people think that if they live long enough, they will become senile. This is a myth. Even
among those who live to be 80 or older, only 20-25 percent will develop Alzheimer's disease or some other incurable
form of brain disease. "Senility" is a meaningless term which should be discarded. Therefore it is essential to know
what is normal and what is not. Discuss what you believe are normal age-related changes and what are consequences
of illness or disease.

2. Mistreatment and neglect of elders still prevail even though our government has attempted to intervene through
stricter laws and regulations. Much of this can be attributed to caregiver burden and stress. Discuss other
governmental strategies that can help decrease or eliminate caregiver burden and stress.

3. Many older adults have begun to look outside of our country for cheaper housing and caregiving. Given our
global economy, discuss what impact this may have on our economy. What are the pros and cons? Discuss
how other countries may view these changes and the American culture.

4. The ability to drive is highly valued resource in this country and has been linked to independence, autonomy,
and quality of life. Therefore, losing one’s driving privileges is inconceivable, especially for older adults. By
2030, 70 million people (20%) of the population will be 65 years and older. Older adults however, are at
increased crash risk per mile driven and are predicted to cause 40% of all fatal crashes by 2025. Discuss why
older adults are at a higher risk for fatal car crashes. Discuss strategies that can be implemented to promote
older drivers’ safety and mobility.

Future Implications:

1. Many assisted-living and long-term care facilities have adopted principles and practices highlighted in the “Eden
Alternative.” The major goal of the Eden Alternative was to eliminate helplessness, hopelessness and boredom that
plagued nursing home residents by creating richer human habitats. Dull institutional environments would be
transformed into home-like habitats with the inclusion of animals and plants that the residents could care for. In
addition, children would be brought in to provide companionship, recreation and play for the residents. This
alternative model however, has not successfully eliminated the three plagues as was intended. Families and staff,
rather than the residents, have benefited from this. What do you think are the reasons for this failure? What
implementation strategies can be done to improve the outcomes of this alternative model? Develop a new model that
you feel would be more successful based on your reasons for failure and your implementation strategies.

2. Technological advances in many fields can be used to improve elder care in America. Specifically, informatics,
healthcare, stem-cell research, and genetics have been highlighted. Discuss how these fields can improve elder care in
America.

3. Most people believe that older adults with Alzheimer’s disease are institutionalized. This is a myth. The majority are
cared for in the home by spouses, daughters, or daughter-in-laws. Discuss strategies that can be implemented to
improve elder care of these older adults and decrease caregiver burden and depression.

4. Environmental modifications are necessary to ensure safety for older adults. Discuss what types of environmental
modifications are needed for older adults in the home and in the community.

For more information, log on to www.usatodaycollege.com Page 13


Experts’ Perspective:

As the growth of our older adult population continues to expand with the baby boomer cohort nearing retirement age, the
need for cost-effective and innovative leadership in eldercare programs will concurrently expand and grow. American life
expectancy has increased dramatically since the early 1900s from 49 years of age to 79 years for women and 74 years for
men. New Census Bureau projections for the United States (US) estimated that by the year 2030, the over-65 age group
would double to approximately 70 million, with the fastest growth rate to occur in the over-85 frail elderly age group (e.g.,
9 million).

Frail elders are a medically vulnerable population, often experiencing problematic accessibility to health care and costly
medical services that require case management of medical, nursing, rehabilitative, mental health, social and environmental
assessments and interventions. Current health care reform and the restructuring of the health care system that focus on
cost-containment of health care expenditures have posed additional challenges to this aging population.

It has been projected that by the year 2020, nursing homes will need approximately 25,000 nurses with advanced
preparation in gerontology. Given the current nursing shortage, the baby boomer population is now at risk, and physicians
who provide nursing home care are threatened with an overwhelming burden. Interdisciplinary geriatric health care teams
that adopt primary care-prevention models, and demand particular attention to cost-containment of health care
expenditures, have been found to be extremely successful in the care of older adults. These geriatric teams consist of
physicians, gerontological advanced practice nurses (GANP) and social workers.

The GANP has been recognized as a vital member of this core team by delivering primary care within a holistic framework
that addresses cultural diversity, family functioning, and the bio-psycho-social, and spiritual dimensions of aging adults.
The role of the GANP is diverse, ranging from independent to collaborative practices in multiple practice sites (e.g. acute
care, long-term care, physician offices, rehabilitation centers, and home care settings). As reported in the research
literature, GANPs provide cost-effective care, decrease hospitalization rates, improve the image of the health care facility,
increase residents’ satisfaction with care, and educate ancillary staff. Therefore, GANPs are recognized leaders in elder care
management and will be instrumental in the development of cost-effective and innovative elder healthcare models.

Additional Resources:

uElderWeb: Cost of Eldercare uAlzheimer’s Foundation of America


www.elderweb.com/home/node/891 www.alzfdn.org

uUS official site for Medicare/Medicaid Benefits uMedline Abstracts: Caregiver Burden and the Geriatric
www.medicare.gov Patient
www.medscape.com/
uA Practical Guide to Caring for Caregivers
www.aafp.org/afp/20001215/2613.html uInstitute of Gerontology: Aging and Health Resources
www.iog.wayne.edu/resources.php
uOlder Adult Drivers: Fact Sheets
www.cdc.gov/ncipc/factsheets/older.htm uGerontological Advanced Practice Nurses
www.ngna.org

For more information, log on to www.usatodaycollege.com Page 14


A B O U T T H E EXPERT: Dr. Karen S. Dunn
Associate Professor in the School of Nursing
Oakland University, Rochester Michigan

Karen S. Dunn, PhD, RN is an Associate Professor in the School of Nursing


at Oakland University located in Rochester Michigan. Her clinical
experience is in Medical/Surgical Critical Care Nursing. Her program of
research is in the fields of gerontological nursing practice, holistic self-
care practices, aging and spirituality, end-of-life care and pain
management. Her research efforts are to promote wellness through the
effective use of holistic self-care practices.

Dunn has presented her research at numerous professional conferences.


Publications include:

uPredictors of self-reported health among older African-American


central city adults
uPsychometric properties of a new geriatric spiritual well-being scale
uPsychometric properties of a new geriatric spiritual well-being scale
uTesting a middle-range theory of adaptation to chronic pain
uNursing experience and the care of dying patient
uReligious and non-religious coping in older adults experiencing chronic
pain
uTowards a middle-range theory of adaptation to chronic pain
uEveryday spirituality among central city elders
uThe efficacy of physical restraints in institutionalized elders
uPain in nursing home residents: Comparison of residents’ self-report
and nursing assistants’ perceptions
uThe prevalence of prayer as a self-care treatment modality in elders.

Dunn achieved a PhD in nursing at Wayne State University in 2001, MSN


at Valdosta State University in 1997, and a BSN at Wayne State University
in 1982.

For more information, log on to www.usatodaycollege.com Page 15

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