Source: SeriousIllness.org

You may be entitled to claim your relative as a dependent. This requires that:

- The individual’s income was less than $3,650 in 2010. “Income” includes Social Security and pension benefits. Also, proceeds from investments or withdrawals from retirement savings plans.

- You paid more than 50% of your relative’s support. He or she does not have to live with you. Support expenses include food, clothing, housing, and medical care. Also, transportation, recreation, and other essentials. If he or she lived with you, include fair rental value for your family member’s share of the lodging.

Many relatives qualify. Your parents and siblings. Other family relatives, step relatives, and in-laws. Or anyone who lived with you all year.

If others paid some support expenses, a deduction is still possible. But only one person can claim it. And everyone who shared expenses must sign a multiple support agreement.

You may be able to deduct medical expenses.

• This includes expenses paid for yourself, your spouse, or a dependent relative. Or for a relative who would have qualified as a dependent but had too much income or filed a joint return.
• The expenses must add to more than 7.5% of your adjusted gross income (AGI). For example, if your AGI is $40,000, the first $3,000 of expenses doesn’t count.

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For more information about Hospice & Palliative CareCenter, contact Ann Gauthreaux, public relations director, at 336-768-3972, or see Hospice’s website at http://www.hospicecarecenter.org!

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Source: SeriousIllness.org

When your family member is in pain, you are suffering too. The “mirror neurons” in our brains are programmed to recognize pain in others. That’s good news, in that it arouses compassion and spurs us to action. But it can be bad news, too. When you’re highly attuned to a loved one’s pain, you’re at higher risk of depression and self-neglect.

Learn about pain management. Your ability to reduce your relative’s experience of pain will help both of you.

- Report symptoms and ask questions. Download the Pain Tracking Kit offered by Partners Against Pain. And ask the doctor for a consult with a palliative care specialist. They have special training in pain control.

- Learn about medications. Master the steps you can take to lessen pain when it occurs.

Our article on managing pain provides guidelines for other remedies you can use at home.

Accept what is beyond your power and focus on what you can control.

• Emphasize comfort. Remind yourself, “Today, I may not be able to stop the pain, but I can still [prepare food, massage feet, etc.].”
• Provide distractions. If your family member is engaged in an activity, he or she is less likely to be aware of the pain.

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For more information about Hospice & Palliative CareCenter, contact Ann Gauthreaux, public relations director, at 336-768-3972, or see Hospice’s website at http://www.hospicecarecenter.org!

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Source: SeriousIllness.org

The search for meaning appears to be a uniquely human trait. Along with hope, having purpose can sustain us through even the darkest circumstances. Noted psychiatrist Viktor Frankl spent many years in Nazi concentration camps. During his ordeal he established that a sense of purpose and a goal for the future were essential to human existence. They made the difference between surviving that tragedy with grace and dignity or succumbing to bitterness and despair. When faced with a diagnosis of serious illness, we can learn lessons from Dr. Frankl’s observations. Although we cannot control many of the external events of our lives, we do have some control over our attitudes and how we approach even a life-threatening condition. This perspective in turn can have a significant effect on the quality of our life and how we experience our days, whether we have many days left or only a few.

Finding purpose in life, both in the past as well as the present day, can transform a serious illness into a deeply meaningful event. Indeed, many family caregivers and people diagnosed with terminal conditions have said that the illness brought them gifts along with the sadness. Reflection on one’s life and one’s contributions and achievements is often cited as a source of insight into the meaning of it all.

Many people struggle with identifying their contributions and achievements and tend to count only the financial and material aspects. Few of us can be a great statesman or a brilliant architect who leaves behind a legacy to be seen and remembered by the world. All of us, however, leave behind a very meaningful legacy in our friends and families. The way we have lived our lives, the values and principles that have allowed us to touch the hearts and souls of others, and that we have passed on to our children and family, is a legacy that is every bit as important, and one that will live forever as it is passed down from generation to generation.

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For more information about Hospice & Palliative CareCenter, contact Ann Gauthreaux, public relations director, at 336-768-3972, or see Hospice’s website at http://www.hospicecarecenter.org!

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Source: SeriousIllness.org

It’s unsettling when a family member is losing weight unexpectedly. If the doctor has no medical explanation, perhaps it’s the result of one of these common situations:
Access to food

- Money. Many elders needlessly limit purchases. A review of the budget, or shopping together, may help. If finances are limited, contact your local Area Agency on Aging to find senior dining programs and food banks. Or check out our listing of nutrition programs.

• Shopping. Your parent may have difficulty getting to a grocery store. And difficulty carrying packages. Have your parent try using a wheeled cart. Arrange for rides. Order groceries delivered. Or consider a taxi.
• Cooking. Cooking is physically demanding. Standing. Lifting. Carrying. With arthritis or vision loss, simply opening a package can be difficult. Help prepare meals in advance. Or identify shortcuts, such as precut vegetables.

Appetite and eating

• Flavor. We lose taste and smell as we age. And salt-restricted diets are often bland. Suggest cooking with more herbs and spices.
• Pain. Pain decreases appetite. Eating with others can create a natural distraction. Also check for correctable problems with dentures or teeth.
• Depression. Feelings of sadness, hopelessness, or loneliness commonly reduce appetite. Have your loved one evaluated for depression. Look for ways to reduce isolation, particularly at mealtime.
• Medication. Some medications cause nausea or constipation. Others bring on a depressed mood. Still others reduce taste and smell. Ask the pharmacist about side effects and possible alternative drugs.

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For more information about Hospice & Palliative CareCenter, contact Ann Gauthreaux, public relations director, at 336-768-3972, or see Hospice’s website at http://www.hospicecarecenter.org!

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From: SeriousIllness.org

Happiness is universally desired. But do you know how to increase your happiness? In his book, Stumbling on Happiness, Harvard professor Daniel Gilbert explains that it’s not about big goals or events. The better house, the extra-long vacation, don’t really make us much happier.

Instead, happiness is closer at hand. It evolves from our day-to-day experience. Little achievements, a shift in attitude, a pleasant activity, all add up to more cheer. The sum total of little victories results in a better overall feeling about life.

The Caregiving Happiness Project is currently exploring how family caregivers can create happiness despite ongoing stress.

You can participate in this study! The project supplies a monthly theme and an online support community. Themes include simple ideas such as “space,” “quiet,” and “learn.” For example, here’s how two participants interpreted November’s theme of “let go”:

• One woman challenged her belief that “uncomfortable behavior in dementia is never accepted.” When company visited, she reminded herself to “let go.” She relaxed about her mother’s behavior. And she found that “it was okay; her challenges were accepted.”
• Another participant decided to “let go” of old family photos. As she took the albums apart, she found pleasure in sending packets of pictures to other relatives to enjoy.

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For more information about Hospice & Palliative CareCenter, contact Ann Gauthreaux, public relations director, at 336-768-3972, or see Hospice’s website at http://www.hospicecarecenter.org!

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There’s a reason rivalries resurface when siblings share in elder care. According to Francine Russo, author of They’re Your Parents, Too!, the trigger is an awareness that time is running out. It often hinges on the desire to resolve unconscious needs for parental attention. Perhaps it’s a need to feel as important as another sibling. Or to feel forgiven. Or to feel capable.

When old issues operate beneath the surface, the result can be lots of emotion and little constructive progress.

What to do:

- Check in with yourself. Are you overly engaged in caregiving out of the hope for approval? Or underinvolved because you were “the baby”? Recognize how your perspective may affect your role in your parent’s care and your response to your siblings.

- Don’t blame your sibs. If you feel that Dad overlooks you, you may be right. Your parent may be unfair. This is not the fault of your siblings, however. Similarly, if you are the “favorite child,” try not to abuse that privilege. Instead, look for common ground with your siblings. Acknowledge your parent’s foibles.

- Treat your siblings as adults. If you don’t operate according to old family patterns, your siblings are less likely to do so too. Meet them as they are today. At a minimum, agree to put aside sibling issues to focus on the care of your parent. Use the forum of a “family meeting” for discussion. Hire a facilitator if problems persist.

- Get support. You may not ever receive the love you want from your parent. Your siblings may repeat old patterns. Accept these realities if they occur, and find connection in other places. Try a support group for family caregivers. Or consider individual counseling for help in letting go of old hopes.

For more information about Hospice & Palliative CareCenter, contact Ann Gauthreaux, public relations director, at 336-768-3972, or see Hospice’s website at http://www.hospicecarecenter.org!

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The changes to Medicare for 2011 provide your loved one with several free prevention services. The idea is to catch major health problems early by lowering the cost for screenings.

The changes apply to everyone with Parts A and B. If your family member has a Medicare Advantage Plan, check with the plan itself about benefits for 2011.

Following is a sample of the services to be covered. Most are offered at no cost. Some require payment of 20% of the approved Medicare fee. Important: To get these savings, your family member must use a doctor who has signed on with Medicare.

• Yearly wellness exam. An annual visit to look at current health issues. This is also a time to discuss personal risk factors and steps for preventing disease. Patients new to Medicare are entitled to a more extensive “welcome” exam within their first year of signing up.
• Bone density screening. Bone mass evaluation every 24 months for persons at risk for brittle bones.
• Cancer screening. Four types of tests are covered for colon or rectal cancer. For women, there are yearly mammograms. Plus, there is coverage for Pap smears, pelvic exams, and a physical breast exam every 24 months. For men, PSA tests and physical exams for prostate cancer are provided yearly (with a 20% fee).
• Diabetes screening. Provided twice a year for at-risk individuals (with a 20% fee).
• Flu/pneumonia prevention. Flu shots are covered annually. Anti-pneumonia shots are also covered and typically last a lifetime.

Prescription costs may also go down for your family member in 2011. If he or she reaches the “donut hole” coverage gap, the cost of brand-name drugs will drop 50%.

For more information about Hospice & Palliative CareCenter, contact Ann Gauthreaux, public relations director, at 336-768-3972, or see Hospice’s website at http://www.hospicecarecenter.org!

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New Medicare rule could cost hospice providers more and limit their reach

Source: Journalnow.com
By RICHARD CRAVER

A new Medicare rule requiring a doctor or nurse practitioner to visit patients in person after 180 days of hospice care is likely to raise staffing costs for providers and could limit the reach of assistance in rural areas.

The rule, which goes into effect today, requires a face-to-face visit before a hospice patient can continue to receive care after two 90-day periods. However, Medicare agreed Dec. 23 to postpone enforcing the rule until April 1 to give providers more time to meet its requirements.

The primary functions of the visit are to make sure that the patient still needs end-of-life care and that the care is appropriate for the person’s needs.

The goal of hospice care is to provide comfort to a patient who is close to dying rather than to continue treating the patient to extend his or her life. Some hospice care is provided in facilities, and some involves visits to patients’ homes. Care is provided by medical professionals and lay volunteers.

Local and state officials said the rule would affect about 9 percent of North Carolinians who receive hospice care.

Where the cost comes into play is that Medicare will not allow a provider to bill for the doctor or nurse practitioner visit. It’s considered an administrative requirement, so the bill must come out of Medicare’s per diem rate of about $130 a day.

“It’s going to stretch all of us, no question about it, more so with the smaller hospices,” said JoAnn Davis, the president and chief executive of Hospice & Palliative CareCenter, which is based in Winston-Salem and serves 13 counties.

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For more, visit http://www.hospicecarecenter.org!

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Driving performance, not age, dictates when it’s time to curtail driving. If your parent is showing problems with driving, it could be time for “that” conversation.

Ideally, you’ve set the stage through candid discussion over the past months or years. Perhaps you’ve even talked about how others have handled this phase-of-life issue. Sensitivity to your own emotions can help guide you when you talk with your loved one. It’s better to acknowledge the sadness than avoid the conversation and risk an accident.

- Consider who should deliver the news. It’s typically best received from a trusted family member or a health professional. Choose someone who can be supportive and empathetic. If Mom is able, have her talk to Dad, or vice versa. If it’s your role, go easy. Expect to have several conversations. Show your concern for maintaining your parent’s ability to get around and participate in life activities.

- Practice using alternatives. Work toward zero driving. Have family members and friends provide rides more often. Make it natural by saying, “Let’s go shopping together today.” Join Mom in trying public transportation. Arrange for home delivery of goods and for automated bank deposits/payments.

- Work with resistance. If Dad doesn’t follow through with promised changes, you need to take further action. See if the doctor will set limits. Remind Dad his behavior puts others at risk. Impose family restrictions, such as telling him he can no longer drive when the grandkids are in the car.

- Be firm. If all else fails, contact your state department of motor vehicles and find out how to report an unsafe driver. This will trigger a driver evaluation. If the license is revoked but your parent continues to drive, consider disabling the car or “losing” the keys.

For more, visit http://www.hospicecarecenter.org!

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Death and dying are not topics we talk about easily in our culture. As a general rule, in fact, we avoid them, almost as if to talk about them would bring on a premature demise. As a result, many families are unaware of their loved one’s wishes at the end of life and are faced with making difficult decisions. This can lead to family discord and can make a trying situation even harder than it already is.

Norene’s father, Richard, showed caring and foresight in planning ahead. He thought about what “quality of life” meant to him. Reflecting on what made life worth living helped him to make decisions about life support issues. (It also helped Richard and his family maximize the things that gave him pleasure!) After clarifying his own values, Richard was able to write an advance directive, a document that stated his wishes concerning health care decisions in case he was unable to speak for himself. He talked with his family about his wishes and asked his eldest son to be his health care representative if a situation came up that was not covered in the advance directive. By planning ahead, Richard was able to lay the groundwork for things to unfold the way he would have wanted them to.

In addition to health care planning, Richard took steps to plan his finances. When he began to have difficulty getting to the bank, he gave his daughter Norene “durable power of attorney.” He was able to continue making financial decisions on his own, but this simple document legally allowed Norene to step in and handle his affairs during those times when he was too ill to do so himself. Richard prepared documents stating his wishes for how his belongings were to be distributed. He was also mindful of the fact that medical expenses could eat up the resources he did have and leave very little for his wife to live on afterward. With some planning, Richard was able to protect his assets and safeguard his wife’s security.

Not all patients are able to make these kinds of decisions ahead of time. Many need help from family members who can assure the patient that it’s okay to talk about these things and, in fact, would be helpful for the family if they were discussed. Ideally, all of us adults would have documents stating our desires for the distribution of our belongings and the handling of our medical care at the end of life. After all, any one of us could get in an accident tomorrow! These decisions especially need to be made when a serious illness has been diagnosed, and the sooner the better while the patient still has the ability to think and communicate clearly. To help you, we have tips to start the conversation about planning. Although it can be awkward at first, families who do have these discussions fare a lot better emotionally at the end, not having to guess and knowing they are doing what their loved one wanted them to do.

For more, visit http://www.hospicecarecenter.org!

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