“I saw the car, Dad.  Please don’t yell at me when I’m driving.”

My voice was measured and steady, sounding far calmer than I really felt.

Dad glared at me, then turned away and settled back.  At home I left Dad in front of the television and went outside to collect my thoughts.  Dark, heavy clouds hung in the air with a promise of rain.  The rumble of distant thunder seemed to echo my inner turmoil.  What could I do about him?

Dad had been a lumberjack in Washington and Oregon.  He had enjoyed being outdoors and had reveled in pitting his strength against the forces of nature.  He had entered grueling lumberjack competitions, and had placed often.  The shelves in his house were filled with trophies that attested to his prowess.

The years marched on relentlessly. The first time he couldn’t lift a heavy log, he joked about it; but later that same day I saw him outside alone, straining to lift it. He became irritable whenever anyone teased him about his advancing age, or when he couldn’t do something he had done as a younger man.

Four days after his sixty-seventh birthday, he had a heart attack.  An ambulance sped him to the hospital while a paramedic administered CPR to keep blood and oxygen flowing.

At the hospital, Dad was rushed into an operating room.  He was lucky; he survived.  But something inside Dad died.  His zest for life was gone.  He obstinately refused to follow doctor’s orders.  Suggestions and offers of help were turned aside with sarcasm and insults.  The number of visitors thinned, then finally stopped altogether.  Dad was left alone.

My husband, Dick, and I asked Dad to come live with us on our small farm.  We hoped the fresh air and rustic atmosphere would help him adjust.

Within a week after he moved in, I regretted the invitation.  It seemed nothing was satisfactory.  He criticized everything I did.  I became frustrated and moody.  Soon I was taking my pent-up anger out on Dick.  We began to bicker and argue.

Alarmed, Dick sought out our pastor and explained the situation.  The clergyman set up weekly counseling appointments for us.  At the close of each session he prayed, asking God to soothe Dad’s troubled mind.

But the months wore on and God was silent.  Something had to be done and it was up to me to do it.

The next day I sat down with the phone book and methodically called each of the mental health clinics listed in the Yellow Pages.  I explained my problem to each of the sympathetic voices that answered in vain.

Just when I was giving up hope, one of the voices suddenly exclaimed, “I just read something that might help you!  Let me go get the article.”
I listened as she read.  The article described a remarkable study done at a nursing home.  All of the patients were under treatment for chronic depression.  Yet their attitudes had improved dramatically when they were given responsibility for a dog.

I drove to the animal shelter that afternoon.  After I filled out a questionnaire, a uniformed officer led me to the kennels.  The odor of disinfectant stung my nostrils as I moved down the row of pens. Each contained five to seven dogs.  Long-haired dogs, curly-haired dogs, black dogs, spotted dogs all jumped up, trying to reach me.

I studied Each one but rejected one after the other for various reasons too big, too small, too much hair.  As I neared the last pen a dog in the shadows of the far corner struggled to his feet, walked to the front of the run and sat down.  It was a pointer, one of the dog world’s aristocrats.  But this was a caricature of the breed.

Years had etched his face and muzzle with shades of gray.  His hip bones jutted out in lopsided triangles.  But it was his eyes that caught and held my attention.  Calm and clear, they beheld me unwaveringly.

I pointed to the dog.  “Can you tell me about him?”  The officer looked, then shook his head in puzzlement.  “He’s a funny one.  Appeared out of nowhere and sat in front of the gate.  We brought him in, figuring someone would be right down to claim him.  That was two weeks ago and we’ve heard nothing. His time is up tomorrow.”  He gestured helplessly.  As the words sank in, I turned to the man in horror.  “You mean you’re going to kill him?”

“Ma’am,” he said gently, “that’s our policy.  We don’t have room for every unclaimed dog.”

I looked at the pointer again.  The calm brown eyes awaited my decision.  “I’ll take him,” I said.  I drove home with the dog on the front seat beside me.  When I reached the house I honked the horn twice.  I was helping my prize out of the car when Dad shuffled onto the front porch.  “Ta-da!  Look what I got for you, Dad!”  I said excitedly.

Dad looked, then wrinkled his face in disgust.  “If I had wanted a dog I would have gotten one.  And I would have picked out a better specimen than that bag of bones.  Keep it!  I don’t want it!”  Dad waved his arm scornfully, and turned back toward the house.

Anger rose inside me.  It squeezed together my throat muscles and pounded into my temples.  “You’d better get used to him, Dad.  He’s staying!”

Dad ignored me.  “Did you hear me, Dad ?” I screamed.  At those words Dad whirled angrily, his hands clenched at his sides, his eyes narrowed and blazing with hate.  We stood glaring at each other like duelists, when suddenly the pointer pulled free from my grasp.  He wobbled toward my dad and sat down in front of him.  Then slowly, carefully, he raised his paw..

Dad ‘s lower jaw trembled as he stared at the uplifted paw.  Confusion replaced the anger in his eyes. The pointer waited patiently.  Then Dad was on his knees hugging the animal.

It was the beginning of a warm and intimate friendship.  Dad named the pointer Cheyenne.  Together he and Cheyenne explored the community.

They spent long hours walking down dusty lanes.  They spent reflective moments on the banks of streams, angling for tasty trout.  They even started to attend Sunday services together, Dad sitting in a pew and Cheyenne lying quietly at is feet.

Dad and Cheyenne were inseparable throughout the next three years.  Dad’s bitterness faded, and he and Cheyenne made many friends.  Then late one night I was startled to feel Cheyenne ‘s cold nose burrowing through our bed covers.  He had never before come into our bedroom at night.  I woke Dick, put on my robe, and ran into my father’s room.  Dad lay in his bed, his face serene.  But his spirit had left quietly sometime during the night.

Two days later my shock and grief deepened when I discovered Cheyenne lying dead beside Dad ‘s bed.  I wrapped his still form in the rag rug he had slept on.  As Dick and I buried him near a favorite fishing hole, I silently thanked the dog for the help he had given me in restoring Dad ‘s peace of mind.

The morning of Dad ‘s funeral dawned overcast and dreary.  This day looks like the way I feel, I thought, as I walked down the aisle to the pews reserved for family.  I was surprised to see the many friends Dad and Cheyenne had made filling the church.  The pastor began his eulogy.  It was a tribute to both Dad and the dog who had changed his life.

And then the pastor turned to Hebrews 13:2: “Do not neglect to show hospitality to strangers, for by this some have entertained angels without knowing it.”

“I’ve often thanked God for sending that angel,” he said.
For me, the past dropped into place, completing a puzzle that I had not seen before: the sympathetic voice that had just read the right article, Cheyenne ‘s unexpected appearance at the animal shelter, his calm acceptance and complete devotion to my father, and the proximity of their deaths.  And suddenly I understood.  I knew that God had answered my prayers after all.

God answers our prayers in His time, not ours.

There are not many times that we can personally benefit by helping others.  Lucky for us, Margaret Palmer has constructed one of those opportunities.  Margaret Palmer, the designer behind Margaret Palmer Jewelry, has created the perfect way to both give and receive.  If you are like most people, you are aware that pink is synonymous for breast cancer.  Did you know that there is a rainbow of colors assigned to many other cancers?

The Colors of Cancer*

·         All Cancers – Lavender

·         Bladder – Yellow

·         Bone/Sarcoma – Light Yellow

·         Brain – Gray

·         Breast – Pink

·         Childhood – Gold

·         Cervical – White

·         Colon/Colorectal – Dk Blue

·         Esophageal – Hot Pink

·         Stomach – Periwinkle

·         Head & Neck – Red & White Stripe

·         Hodgkin’s Disease – Violet

·         Kidney/Renal – Kelly Green

·         Leimyosarcoma – Purple

·         Leukemia – Orange

·         Liver – Yellow

·         Lung – Clear

·         Lymphoma – Lime Green

·         Male Breast – Blue/Pink

·         Melanoma – Black

·         Mesothelioma – Royal Blue

·         Multiple Myeloma – Burgundy

·         Ovarian – Teal

·         Pancreatic – Purple

·         Prostate – Light Blue

·         Retinoblastoma – White

·         Testicular – Yellow

·         Thyroid – Light Blue

·         Uterine – Peach

Margaret created her Cancer Pearl Collection as a way for us to publically acknowledge the hope that we have for all of those that we carry in our hearts as they battle for victory. Margaret’s personal mission is not only to bring awareness of cancer through education, but she also donates 15% of her sales to the fight against cancer. If you would like to support those battling cancer, acknowledge a cancer survivor, or pay tribute to someone who lost their fight you can visit http://www.margaretpalmerjewelry.com to see how you can both give and receive.

*Margaret Palmer Jewelry

1. Have you noticed new dings, scratches, or dents on the car?

2. Has your loved one recently been in an accident?

3. Are routine errands like going to the grocery store taking a little longer?

4. Is your senior starting to arrive late for appointments and a little flustered when they do arrive?

We all get lost once in awhile or forget where we are going, but if this begins to happen more frequently your senior may need to stop driving.  All of these could be signs that you need to have a conversation about driving safety.  Retesting may give you the empirical data that you need to support your suspicions, but you still need to address the emotional loss before you will be able to get them to voluntarily hang up their keys.  Encourage your loved one to voice their feelings.  Remind them that your primary concern is for their safety and those of others on the road. Many seniors aware that they should no longer be driving continue on because they don’t want to be a burden, fear loss of independence, or feel that there is no other alternative.  Before you broach the subject make sure that you have solutions to all of their concerns or protest.  Contact your city, church or Senior center for a list of driving alternatives such as public transportation, volunteers or agencies that provide transportation.  Have bus schedules and telephone numbers available.  Explore solutions like carpooling with other seniors that still drive.  Enlist family or friends to be available when your senior needs a ride.  Driving grandma or grandpa to appointments can be a great way for grandchildren to strengthen their relationship and pay it forward by providing the same help that they themselves may need one day.  If your loved one is still not convinced, consider enlisting the help of their physician or other professionals.  As a last resort, you may need to disable the car, such as removing spark plugs, or take their keys.

http://www.denverpost.com/news/ci_18141802

What is Long-Term Care?
Long-term care is help you may need due to a lengthy illness, an unexpected injury or accident, or a severe cognitive disorder such as Alzheimer’s disease.  It’s assistance with the everyday tasks, or the activities of daily living (bathing, eating, dressing, toileting, transferring, and continence).  Long-term care may be provided in a variety of locations, from nursing homes and assisted living facilities to adult day care centers and even your own home.

Who needs Long-Term Care?
Most of us strive to live active, healthy lives well into our later years, and indeed as a society, Americans are living longer than ever before.  This extended longevity is one of the things that drives the growing need for long-term care – the longer we live, the better the odds that we may need long-term care services.  It is predicted that in the year 2020, some 12 million older Americans are expected to need long-term care.(1)

While the majority of long-term care services is provided for seniors, a surprising amount of long-term care services are provided to younger people.  In fact, the U.S. Government Accountability Office estimates that 40% of the 13 million people receiving long-term care services are between ages 18 and 64.(2)

Who pays for Long-Term Care?
Long-term care can be expensive, financially and emotionally.  An unexpected need for long-term care can have a significant impact on a family’s assets and lifestyle.  Close to one-fourth of all nursing home costs are paid out-of pocket by individuals and their families.(3)

Many people mistakenly believe that their health insurance will cover the cost of long-term care.  Others believe that Medicare or Medicaid will cover long-term care expenses.  While Medicare does provide health coverage for seniors, it is limited in the coverage it provides for long-term care.  Medicaid will pay for the cost of long-term care, but you must qualify by meeting strict income and asset eligibility requirements.

Long-term care insurance could be a solution.  Long-term care insurance can be a very smart way to address the challenges from a long-term care need.  Long-term care insurance can help pay for nursing home care, as well as, a variety of home and community based care services.  Long-term care insurance may not be for everybody, so if you are considering a policy, read it carefully and be sure to work with an insurance agent who understands long-term care issues.

With long life comes long-term planning.  Make a plan for you and your family today.  For more information on long-term care insurance, please contact Brian A. Walker, Agent, New York Life Insurance Company at 972-774-2046.

Health Insurance Association of America. A Guide to Long-Term Care Insurance. 2007. Page 2
Health Insurance Association of America. A Guide to Long-Term Care Insurance. 2007. Page 2
3 Health Insurance Association of America. A Guide to Long-Term Care Insurance. 2007. Page 4

The purpose of this piece is solicitation of insurance. An insurance producer (agent) may contact you. New York Life Insurance Company long-term care insurance is issued on policy form series ILTC-5000 and INH-5000 with a state identifier and edition date. Example: Examples: for Idaho ILTC-5000 (ID) (1001) and INH-5000 (ID) (1001) and for North Carolina ILTC-5000 (NC) (Rev. 0606) and INH-5000 (NC) (Rev. 0606) and for Pennsylvania ILTC-5000 (PA) (1001), FLTC-5000 MLP (PA) (0503), for Tennessee ILTC-5000 (TN) (1001) and INH-5000 (TN) (1001) and for Texas ILTC-5000 (TX) (0305) and INH-5000 (TX) (0305). New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010.

Parkinson’s disease (PD) belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells. The four primary symptoms of PD are tremor, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks. PD usually affects people over the age of 50.  Early symptoms of PD are subtle and occur gradually.  In some people the disease progresses more quickly than in others.  As the disease progresses, the shaking, or tremor, which affects the majority of PD patients may begin to interfere with daily activities.  Other symptoms may include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions.  There are currently no blood or laboratory tests that have been proven to help in diagnosing sporadic PD.  Therefore the diagnosis is based on medical history and a neurological examination.  The disease can be difficult to diagnose accurately.   Doctors may sometimes request brain scans or laboratory tests in order to rule out other diseases.

Is there any treatment?

At present, there is no cure for PD, but a variety of medications provide dramatic relief from the symptoms.  Usually, patients are given levodopa combined with carbidopa.  Carbidopa delays the conversion of levodopa into dopamine until it reaches the brain.  Nerve cells can use levodopa to make dopamine and replenish the brain’s dwindling supply.  Although levodopa helps at least three-quarters of parkinsonian cases, not all symptoms respond equally to the drug. Bradykinesia and rigidity respond best, while tremor may be only marginally reduced. Problems with balance and other symptoms may not be alleviated at all.  Anticholinergics may help control tremor and rigidity.  Other drugs, such as bromocriptine, pramipexole, and ropinirole, mimic the role of dopamine in the brain, causing the neurons to react as they would to dopamine.  An antiviral drug, amantadine, also appears to reduce symptoms.  In May 2006, the FDA approved rasagiline to be used along with levodopa for patients with advanced PD or as a single-drug treatment for early PD.

In some cases, surgery may be appropriate if the disease doesn’t respond to drugs. A therapy called deep brain stimulation (DBS) has now been approved by the U.S. Food and Drug Administration. In DBS, electrodes are implanted into the brain and connected to a small electrical device called a pulse generator that can be externally programmed. DBS can reduce the need for levodopa and related drugs, which in turn decreases the involuntary movements called dyskinesias that are a common side effect of levodopa. It also helps to alleviate fluctuations of symptoms and to reduce tremors, slowness of movements, and gait problems. DBS requires careful programming of the stimulator device in order to work correctly.

What is the prognosis?

PD is both chronic, meaning it persists over a long period of time, and progressive, meaning its symptoms grow worse over time.  Although some people become severely disabled, others experience only minor motor disruptions. Tremor is the major symptom for some patients, while for others tremor is only a minor complaint and other symptoms are more troublesome.  No one can predict which symptoms will affect an individual patient, and the intensity of the symptoms also varies from person to person.

What research is being done?

The National Institute of Neurological Disorders and Stroke (NINDS) conducts PD research in laboratories at the National Institutes of Health (NIH) and also supports additional research through grants to major medical institutions across the country.  Current research programs funded by the NINDS are using animal models to study how the disease progresses and to develop new drug therapies. Scientists looking for the cause of PD continue to search for possible environmental factors, such as toxins, that may trigger the disorder, and study genetic factors to determine how defective genes play a role.  Other scientists are working to develop new protective drugs that can delay, prevent, or reverse the disease.

More information about Parkinson’s Disease research is available at http://www.ninds.nih.gov/research/parkinsonsweb/index.htm

Exceprt from the National Institute of Neurologic Disorders and Stroke

http://www.ninds.nih.gov/disorders/parkinsons_disease/parkinsons_disease.htm

*Not their real names

The Geriatric Care Manager assists older adults and persons with disabilities in attaining their
maximum functional potential.  In addition, the Geriatric Care Manager is an experienced
guide and resource for families of older adults and others with chronic needs, including
helping those suffering from Alzheimer’s Disease or Parkinsons or exhibiting
symptoms of dementia.

Geriatric care managers who are members of the National Association of Professional Geriatric
Care Managers (NAPGCM) are committed to adhering to the NAPGCM Pledge of Ethics and
Standards of Practice.

What Can a Geriatric Care Manager Do for Me?

• Conduct care-planning assessments to identify problems and to provide solutions solutions.

• Screen, arrange, and monitor in-home help or other services, including assistance in hiring a qualified caregiver for home care.

• Provide short- or long-term eldercare assistance for those engaged in local or long distance caregiving.

• Review financial, legal, or medical issues and offer referrals to geriatric specialists.

• Provide crisis intervention.

• Act as a liaison to families at a distance, overseeing care, and quickly alerting families to problems – especially important when families are engaged in long distance caregiving for a loved one.

• Assist with moving an older person to or from a retirement complex, assisted care home, or nursing home.

• Provide consumer education and advocacy.

• Offer eldercare counseling and support.

• Some Geriatric Care Managers also provide family or individual therapy, finance management, conservatorship or guardianship assistance, and/or care giving services.

Excerpt from The National Association of Professional Geriatric Case Managers http://
www.caremanager.org/index.cfm

Accreditation

Is the agency accredited (certified and licensed) by a nationally recognized group, such as the Joint Commission?  The Joint Commission is an independent, not-for-profit organization that evaluates and accredits health care organizations and programs.  It is an important resource in selecting quality health care services.

Certification

Is this hospice program certified by Medicare?  Medicare-certified programs have to meet at least minimum requirements for patient care and management.

Licensure

Is the program licensed by the state, if required by your state?

Consumer information

Does the agency have written statements outlining services, eligibility rules, costs and payment procedures, employee job descriptions, and malpractice and liability insurance?  Ask them to send you any brochures or other available information about their services.

References

How many years has the agency been serving your community?  Can the agency give you references from professionals — such as hospital or community social workers — who have used this agency?  Ask for names and telephone numbers.  A good agency will give you these if you ask for them.  Talk with these people about their experiences with the hospice.  Also, check with the Better Business Bureau, your local Consumer Bureau, or the State Attorney General’s office.

Admissions

How well does hospice work with each patient and family to apply policies or negotiate differences?  If the hospice imposes conditions that do not feel comfortable, it may be a sign that it is not a good fit for you.  If you are not sure whether you or your loved one qualifies for hospice, or whether you even want it, is the agency willing to meet with you to help you talk through these concerns?

Plan of care

Does the agency create a plan of care for each new patient?  Is the plan carefully and professionally developed with input from you and your family?  Is the plan of care written out and are copies given to everyone involved?  Check to see if it lists specific duties, work hours/days, and the name and telephone number of the supervisor in charge.  Is the care plan updated as your needs change? Ask if you can look at a sample care plan.

Primary caregiver

Does the hospice require you to have a primary caregiver as a condition of admission?  What responsibilities are expected of the primary caregiver?  Will someone need to be with you all the time? What help can the hospice offer to organize and assist the family’s efforts?  Can the hospice help you fill in around job schedules, travel plans, or other responsibilities?  If you live alone, what other options can the hospice suggest?

Initial evaluation

Does a nurse, social worker, or therapist come to you to talk about and evaluate the types of services you may need?  Is this done in your home, rather than over the telephone?  Does it highlight what you can do for yourself?  Does it include input from your family doctor and/or other professionals already involved in your care?  Are other members of your family included in this visit?

Personnel

Are there references on file for home care staff? Ask how many references the agency requires for each staff member who gives home care (2 or more should be required).  Does the agency train, supervise, and monitor its caregivers? Ask how often the agency sends a supervisor to the patient’s home to review the care being given to the patient.  Ask whether the caregivers are licensed and bonded.  Who do you call if you have questions or complaints?  What is the procedure for resolving issues?

Costs

How does the agency handle payment and billing?  Get all financial arrangements — costs, payment procedures, and billing — in writing.  Read the agreement carefully before signing.  Be sure to keep a copy.  What resources does the agency provide to help you find financial assistance if it is needed?  Are standard payment plan options available?

Telephone response

Does the agency have a 24-hour telephone number you can call when you have questions?  How does the hospice respond to calls?  Does the telephone staff seem caring, patient, and competent from the first contact, even if they need to return your call?  Do they speak in plain, understandable language? What is the procedure for making and resolving complaints?

How did the hospice respond when you made the very first contact with them?  How a hospice responds to your first call for help may be a good sign of the kind of care to expect.

Emergency

Does the agency have an emergency plan in place in case of a power failure or natural disaster?  Ask to see a copy of the plan.  In case of an emergency, you need to know whether the agency can still deliver services to your home.

Services

How quickly can the hospice start services?  What are its geographic service boundaries?  Does the hospice offer specialized services such as rehabilitation therapists, pharmacists, dietitians, or family counselors when these could improve your comfort?  If needed, does the hospice provide medical equipment or other items that might improve your quality of life?

Limits on treatment

During your first visit be sure to talk about all of the treatments you are currently getting.  If you want to continue these things you must make that clear to the hospice provider.  Some hospices will not cover things like dialysis, total parenteral nutrition (TPN, or intravenous feedings), blood transfusions, or certain drugs.  But some hospices, most often the bigger ones, do offer open-access care which allows you to add hospice care to your current medical treatment.  Still, this is not always an option.  Find out how the hospice would handle your current treatments before committing to their services.

You may also want to find out how the hospice would manage it if you should get a health problem that is curable, such as a urinary tract infection or pneumonia.  Even though they cannot cure your cancer, you may be more comfortable if they are able to treat these smaller problems.

Inpatient care

What are the policies regarding inpatient care?  Where is such care provided?  What are the requirements for an inpatient admission?  How long can the patient stay?  What happens if the patient no longer needs inpatient care but cannot go home?  Can you tour the inpatient unit or residential facility?  Which hospitals contract with the hospice for inpatient care?  What kind of follow-up does the hospice provide for inpatients?  Do nursing homes contract with the hospice?  Does the hospice provide as much nursing, social work, and aide care for each patient in the nursing home as it does in the home setting?

Patient’s rights and responsibilities

Does the agency explain your rights and responsibilities as a patient?  Ask to see a copy of the agency’s patient’s rights and responsibilities information

Excerpt from the American Cancer Society

http://www.cancer.org/Treatment/FindingandPayingforTreatment/ChoosingYourTreatmentTeam/HospiceCare/hospice-care-questions

Hospice Help for Texans

http://www.dads.state.tx.us/services/faqs-fact/hospice.html