Peninsula Daily News Column 10-25-12 "Play the acronym game for Medicare"

            HEADS UP! If you’re planning on attending the 6^th annual “Building Your Caregiver Tool Box” conference on Saturday, November 3^rd (and I hope you are), you need to know that it’s been moved to the Dungeness Valley Lutheran Church at 923 N. Sequim Avenue in (you guessed it) Sequim! Everything else is the same: 8:30 to 3:30, free lunches and snacks (free everything!), a chance to learn some stuff that folks like us could stand to learn and a whole bunch of people who are doing the same thing – Taking care of somebody who needs to be taken care of.

            See you there. Now:

This is about Medicare – again.

            ‘Tis the time of the season for Medicare, because “open enrollment” for Part D and Advantage Plans began ten days ago (October 15^th) and will run through December 7^th (a day that will probably live in infamy); regardless, here we are.

            So (again), if you’re not on Medicare, about to be and don’t know anyone you like who is, feel free to go immerse yourself f in some frivolous pursuit that might actually nudge you to the brink of mental health – The rest of us have work to do and today that “work” might save a number of us a considerable amount of money.

            As threatened last week, today we’re going to venture into a land of acronyms generally referred to as “Medicare Savings Programs.” I’ll quote the acronyms and tell you what they stand for, because if I don’t, some of you will feel sufficiently neglected to warrant e-mailing me, demanding to know what they stand for; however, it is NOT important that you remember said acronyms, nor is it important that you remember what they stand for – It IS important that you pay enough attention to the numbers to see if they will do you or yours some good.

            Acronym #1 is QMB (pronounced “Quimby”), that stands for “Qualified Medicare Beneficiary.” If you qualify for it, it will pay for your Part A premium (if you have one), your Part B premium (I’m pretty sure that you have one of those) AND your Part A or B deductibles, copays or coinsurances. If you have an Advantage Plan, QMB will pay copays and coinsurances for medical and hospital care.

            Did you follow that? Did you see the part about it paying your Part B premium? So, without even trying, we’ve just saved you real close to $1,200! – Indeed, Quimby is our friend.

            You qualify for QMB if your income as a single person is at or below $931 per month and your “assets” are at or below $6,940. “Assets” means cash, bank accounts, stocks, bonds, real estate contracts, blah blah – Pretty much what you’d think it means. It does NOT mean your house, one car or your stuff; also, if you have up to $1,500 set aside in a specific account for burial costs, that isn’t counted, either.

            If you’re a couple, income at or below $1,261 per month, assets at or below $10,410.

            FYI, if you qualify for QMB, you AUTOMATICALLY qualify for the Part D “extra help” (“L.I.S./Low Income Subsidy” – I went on about this last week), so you’d have very low to $0 premium, $0 deductibles and very low copays and, probably, no donut hole.

            See? Quimby is our friend.

            Acronym #2 is SLMB (pronounced “Slimby”), that stands for “Specified Low-Income Medicare Beneficiary” (feel smarter?). If you qualify for this, it’ll pay your Part B premium only (again, do the math in your head – Real close to $1,200/year, right? Right!)  To get in the game, for a single person, income at $1,117 per month, assets the same: $6,940; for a couple, income at $1,513 per month, assets the same at $10, 410.

            Acronym # 3 is QI-1 (pronounced “QI-1”), which stands for “Qualified Individual” (I know, but I don’t make them up). QI-1 will pay for your Part B premium only. Income for a single person at or below $1,257 per month, assets the same at $6,940, and for a couple, income = $1,702 per month, assets the same at $10,410.

            I know what you’re thinking, and No: You did NOT misread something – YES, I just referenced two acronyms that both pay your Part B premium, with different income levels, so you’re thinking, “WHY???”

            Answer: I don’t know. I probably knew once, but I don’t know now; more importantly, I don’t care. I DO care that people without a lot of money get the help.

            Now, a handful of you are, for lack of a more pejorative term, “policy wonks,” so you’re thinking, “You can’t fool me, Harvey! ‘Medicare Savings Programs’ are a form of Medicaid, which means that ‘they’ will come after my estate!”

            First, I’m not in the business of “fooling” you – If I were, we’d call this “Fool Line,” and we don’t.

            Second, you’re right about these being a form of Medicaid; however, Medicare Savings Programs are NOT “recoverable” under Medicaid, so you have nothing to lose (Score one for my side!).

            So, what do you actually do? Well, you can come to any of the SHIBA clinics that I listed last week or you can call any of the numbers at the end of this column for help.

            You can go online to http://www.dshs.wa.gov/onlinecso/findservice.shtml or you can truck on down to the nearest DSHS office (You want the “CSO,” which stands for “Community Services Office”). FYI, it really isn’t all that tough to get signed-up, so just keep repeating to yourself, “$1,200, $1,200, $1,200…” but do it silently, so people don’t look at you oddly.

            I know this stuff can glaze you over – Me, too; but the fact is that they can save us serious money in a time when pretty much any money is “serious,” so read this two or three times, then DO IT, because waiting or “thinking about it” won’t help you or anybody else.

$1,200, $1,200, $1,200…Mental health be damned.

           

Peninsula Daily News 10-18-12 "Caregiver panel to put the 'us' in useful"

            It’s easy to be sarcastic about healthcare in America - It’s even easier to be sarcastic about health insurance! – In fact, it’s so easy that, sometimes, we can confuse those two things, so let’s start there:

            Health insurance is NOT healthcare. Healthcare keeps us going and as healthy as we can, or are willing, to be, and as a nation, we’re actually pretty darned good at it! We’re so good at it that a lot of us are living a whole lot longer than would have been imagined even a generation or two ago. Health insurance does…other stuff.

            So, the “good news” is that a lot of us are living a whole lot longer! The “bad news” is that, in the course of living longer, a number of us require “care” – You know, somebody (or somebodies) to help us get through the day. We call those folks, which most of us are, have been or will be, “caregivers,” but since “caregivers” almost never call themselves “caregivers,” here’s my standard definition: A “caregiver” is somebody who is taking care of somebody who needs to be taken care of, whether they like it or not.

            Does that sound at all like you to you? Then, WELCOME! – Because you’re “us.”

            And, yeah, there are a LOT of us. We’re very different from one another in a whole lot of ways, but there’s one way in which we are a whole lot alike: We have to remember to take care of us, which isn’t always as easy as it sounds.

            And if we don’t take care of us, what do you suppose happens to the folks that we’re taking care of? Right: Nothing good; so here’s our annual opportunity to take care of us.

            The 6^th annual “Building Your Caregiver Tool Box” conference will be held on Saturday, November 3rd, from 8:30 am to 3:30 pm, at Trinity United Methodist Church, 100 N. Blake Avenue, in Sequim, free.

            We like free.

            The theme this year is “Caregiving: How to Cope,” and if you’re somebody who is taking care of somebody, that phrase speaks to you – It speaks to me. After we get settled and get some morning munchies and say, Hi,” we’ll start the day with a panel discussion on how to recognize depression and treat it – Early! – By a panel who knows what they’re talking about. There will be breakout sessions on “Depression: What is it?” Cultural Values: Nurturing the Spirit in Our Diverse Cultures,” “Life Cycle-Life Review: Helping the Patient and the Caregiver Create a Personal History,” etc. as well as some other, more personal, options.

            There will also be a free lunch, snacks, beverages, vendor and informational tables, a lot of us “professional-types” and other stuff that I’m, undoubtedly, forgetting - But here’s the best part: There will be a room full of people who are doing the same thing (more or less) that we’re doing, which means a room full of very smart, experienced and creative people.

            That’s what puts the “us” into the us. You will walk away from this, at the end of the day, with something very special: You’ll walk away with hope.

            What do you do? Call 360-452-3221 (1-800-801-0070) to register, and do it RIGHT NOW! These conferences fill up fast, which ought to tell you something. Can you bring your “person” with you? No, and here’s why: If you bring your person, then you’ll be doing what you do all the time, which is giving care, which means that you’ll be all about them, and not about you, and this is about you.

            Us.

            Do this. Care enough about your person to care about you, and to remember that you aren’t alone.

            Now, let me talk, for a moment, to the “newbies” – The folks who are relatively new to this “caregiving” thing, be it from choice, necessity, fate, love or what seems like a CRUEL Universe:

            Show up for this thing. I know you don’t have time, or maybe even the energy. And you’ll have to go through Lord-only-knows how much hassle to make sure your person is OK, while you’re away – I know. I get it. But here’s what you’ll find when you get there: A lot of laughter. I know that those topics that I rattled off above don’t sound “fun” – Or funny! – They aren’t. But what is funny (in more ways than one) is that caregivers laugh – A lot.

We could analyze the heck out of why that happens, but that would take a lot of the fun out of it. We laugh. And you’ll see very quickly the difference between laughing “at” and laughing “with.” And we don’t do a lot of “crowd control;” see, a big part of what makes these things work is caregivers talking to caregivers: laughing, commiserating, sharing discoveries and tricks and, sometimes, just being quiet – With other people who understand why, sometimes, just being quiet is good.

Don’t make a bigger deal out of this than it needs to be – Just figure out how to give yourself the gift of one lousy day, call the number above to register and just show up. If it turns out to be a waste of your time, you can take it out on me.

            And I am so sure of myself on this one that I’m willing to take that chance.

Peninsula Daily News Column 10-11-12 "Extra help at hand online, on Peninsula"

            Today is October 11^th, 2012. As noted last Thursday, which was October 4^th of 2012, “open enrollment” for Medicare Part D and Advantage Plans starts four days from today, which is October 15^th – Monday. If you’re NOT retired, it makes perfect sense that “open enrollment” would begin on a Monday. If you ARE retired, Monday is simply the day that keeps Sunday and Tuesday from bumping into one another; either way, Monday is (literally) “D-Day.”

            This column is going to be all about the intricacies of this process. If Part D is not part of your life and you couldn’t care less, bail out now and go shopping for Halloween candy, and remember who loves you…

            OK, October 15^th through December 7^th! There is no practical way to make a quasi-intelligent decision about these Part D and Advantage Plans without using Medicare’s “Plan Finder,” which you can find at www.medicare.gov/find-a-plan or just go to www.medicare.gov and it will be obvious. You could also call 1-800-MEDICARE (1-800-633-4227) 24/7 for help (TTY = 1-877-486-2048).

            And there is free, local, face-to-face help available – Stay tuned.

            All the Plans are now in the “Plan Finder,” so you could go into it, enter your drugs and what-not and get some extra time to think, but remember that you can’t actually enroll/change Plans until Monday.

            If you have a Part D plan now that you’re just as happy-as-a-happy-clam with, and you’re totally confident that you’ll be clam-happy with it again next year (without even looking at premiums or formularies or whatever), then feel free to do absolutely nothing, and your current plan will continue, unabated and unperturbed, into 2013. Whatever you do (or don’t do) will kick-in on January 1, 2013 – Happy New Year!

            Last week I referenced the “donut hole” (i.e. “coverage gap”), in which the Part D plan pays nothing and we pay everything, assuming that you have a plan that has a “donut hole” – That’s true; however, if you hit the donut hole in 2013 you will at least get a 52.5% discount on all brand-name drugs covered by the Plan (which will still count toward getting you OUT of the donut hole) and/or a 21% discount on generics covered by the Plan, courtesy of the Affordable Care Act.

            So, let’s talk about money. You may have heard “extra help” or “L.I.S.,” both of which refer to the Part D “Low Income Subsidy,” for which many of us qualify and don’t know it. If you’re single and your income is at or below $1,397 per month ($16,764 per year) AND your assets are less than $13,070, you qualify. “Assets” means, for most of us, money in the bank (plus stocks, bonds, contracts, etc) – It does NOT mean your house, your car or your stuff. For a couple, your income has to be at or below $1,892 per month and your assets below $26, 120; FYI, these numbers will probably increase in April of next year.

            If you do qualify, you’ll be able to enroll in one of the “benchmark” Part D plans with little or no monthly premium, drastically reduced deductibles and NO “donut hole!” If this sounds even vaguely like you to you, you can apply by calling Social Security at 1-800-772-1213 (TTY = 1-800-325-0778) or going online to www.socialsecurity.gov/prescriptionhelp (where you see a photo of Chubby Checker) and you want to do this RIGHT NOW! If you call, will you have a wait on the phone? Probably, so take the opportunity to cruise through your checkbook while you’re waiting, in order to remember why you’re waiting.

            Now, I told you that there was free, local, face-to-face help available – There is. These folks know what they’re doing and will not try to sell you anything because they don’t have anything to sell – I know this to be true because they’re “us” – I also know them to be good and decent people. So, beginning Monday:

• 3^rd Tuesday, Port Townsend Community Center, Lawrence & Tyler, 1:00-3:00 pm;
• 2^nd and 4^th Tuesdays, Tri-Area Community Center, 10 W. Valley Road in Chimacum, 9:00 am to 12:00 pm;
• Every Monday and Friday, Port Angeles Senior Center, 328 E. 7^th in P.A., 9:00 am to 12:00 pm;
• Every Tuesday and Friday at the Sequim Senior Activity Center, 921 E. Hammond, 9:00 am to 12:00 pm;
• 4^th Wednesday, Quilcene Community Center, 294952 Highway 101, 10:00 am to 1:00 pm;
• In Forks, at our “Information & Assistance” office (481 5^th Avenue), the 1^st Wednesday, 9:00 to 11:00 am, or call 374-9496 for other appointments.

If you have any questions about any of that, call 452-3221 (1-800-801-0070).

Bring your Medicare card or Medicare number, any/all insurance cards/prescription drug cards/benefit booklets, any letters you’ve gotten from your insurance company on the subject, an estimate of your monthly/annual income and assets, a list of your medications, dosages and what you’re paying for them now and anything else that you think might be a good idea or that you have questions about.

These are first come, first served affairs, so remember to be as cheerful and patient as possible, because everybody else is doing the same thing that you’re doing and are equally thrilled at the prospect.

Last one today: Remember that part above about “extra help?” Well, if you’d like to see if you’re eligible and (if you are) actually apply online AS WELL AS finding out if you might be eligible for any number of other programs, go to www.benefitscheckup.org and work through it. It goes surprisingly quickly, is very straightforward and you might be amazed by what you discover.

I’d hoped to get into Medicare Savings Programs today, but I suspect that this is MORE than enough for now, so let’s call it “good;” remember, you have until December 7^th to pull this off; personally, I’m shooting for having it done before November 24^th, to put the “Thank you!” back into Thanksgiving!

Peninsula Daily News 10-4-12 "Preparation for Medicare, Advantage Plans"

            It appears to me that we’ve stalled as long as we can; in fact, the more intransigent among us are still looking at August on the wall calendar, simply to avoid looking at September, because September would have inexorably led us to October! – Alas, nonetheless, here we are.

Many of us would just as soon avoid October, because October means “open enrollment” for Medicare Part D and Medicare Advantage Plans, which means in all probability, a lot of work, hassle and migraines as we tiptoe through the minefields of health insurance. I’m sorry, and I can absolutely assure you that this was NOT my idea.

If you are not on Medicare, consider plowing through this with us so you could be of some service to people who are on Medicare and still think it’s September. If you are on Medicare, have your Part D or Medicare Advantage Plan in place, are just happy as can be with it and are absolutely convinced that nothing will change, then by all means, do nothing and, not surprisingly, nothing will change – The operative word there being “surprise.”

But maybe you like surprises! – Like changes in premiums or formularies or providers! OK, then, do nothing, continue looking the September calendar picture of the Petrified Forest, but the rest of us are moving on.

Ready? Take a breath? Holding hands? OK, here we go, because this year’s “open enrollment” happens from October 15^th (eleven days from today!) through December 7^th so consider flipping that calendar.

            Medicare Part D: “D,” as in “drug.” Drug coverage – Insurance. It isn’t run by the Feds, like Parts A or B – These are plans, run by private companies, that are approved by the Feds. There are two ways to go:

1. What many of us do is have “traditional Medicare,” which means Part A (hospital, home health, hospice, etc), Part B (doctor, outpatient, durable medical equipment, tra la), a “MediGap” plan, to pick up the 20% that Medicare “approves” (but doesn’t pay for) AND a Part D plan – Yes, it is confusing;
2. What others do is have a Medicare “Advantage Plan,” which works (more or less) like a HMO (“health maintenance organization” or, what many call somewhat derisively, “managed care”), which provides all Part A and Part B coverage (usually, around here, through a “network” of providers) and (usually) Part D coverage – Yes, it is confusing.

As of this writing, we don’t know which (if any) Advantage Plans will be available in our corner of the Universe, nor do we know which Part D plans will be available; more will be revealed, which is the way of the Universe.

If you are “new to Medicare,” you get to sign up for these during the 7-month period that begins 3 months before the month you turn 65, the month you do turn 65 and ends 3 months after the month you turn 65. If you’ve been in the game for a while, you know that “open enrollment” means a specific period of time when you can change plans – “…and,” the newbie asks, “WHY would you do that?”

Well, because plans come and go, premiums change and formularies (the list of prescription drugs that a plan actually covers) change – Oops! So, the plan that was your best-friend-forever this year, may not be so great next year, get it?

If you don’t sign up for a Part D plan when you’re first eligible, you will incur a “penalty,” which is 1% of the “national base beneficiary premium” times the number of months that you dithered about, and that amount will be added to your premium (if you ever decide to sign-up for a plan) AND it will never go away. IF you have prescription drug insurance from another source (e.g. retiree insurance) and IF it is deemed equivalent to Medicare Part D coverage, you then have “creditable coverage,” which exempts you from the dreaded penalty. If this is the case, your insurance will send you a letter telling you so – KEEP THE LETTER!

The “skeleton” of Part D, which we can imagine to be in four “sections,” looks like this, using my BFF (Mrs. Jones), as an example, using 2013 numbers:

1.      Mrs. Jones joins the “White Rabbit Part D Plan” on 1/1/13, and doesn’t get “extra help” (we’ll come back to that), and pays the first $325 of her drug costs out-of-pocket, plus “White Rabbit’s” monthly premium – White Rabbit pays zero;

2.      Mrs. Jones pays a copayment and White Rabbit pays a bunch, until their combined amount (plus the deductible from #1 above) equals $2,970;

3.      Mrs. Jones now enters the legendary “donut hole” (aka, “coverage gap”) in which, basically, White Rabbit pays zero. The “good news” in 2013 is that Mrs. Jones will pay 47.5% of the cost of “covered” (meaning that they’re on the formulary) brand-name drugs and 79% of the cost of generics while she resides – Uncomfortably! – In the donut hole;

4.      If Mrs. Jones’ costs reach $6,734, she emerges from the donut hole and enters the appropriately named, stage 4 “catastrophic coverage,” in which White Rabbit pays 95%.

Now remember, that was the “skeleton” – Different plans look different, e.g. some plans don’t have a “coverage gap” – Will they be more expensive? Of course! And the premium has to be affordable and the formulary has to cover the drugs you take and what about this pharmacy vs. that pharmacy, and…

Right: Assuming that you don’t have the time, patience or endurance to carpet the backyard with the policies of umpteen Part D plans for in-depth review, the only practical way to do this is to utilize Medicare’s “Plan Finder.” You can do this by going to www.medicare.gov and clicking on “Find health & drug plans.” It will ask you to enter the drugs you take, dosages, how much you pay, where you want to get them, blah blah, then will spit out a few of what appear to be the best plans for you, beginning October 15^th.

Local lore notwithstanding, the “Plan Finder” actually works pretty well for most people, most of the time, and you don’t have to be Bill Gates to navigate it, but if you’re not comfortable with computer stuff or don’t have one or your situation is “complicated” or or or, there is now (and will be) free help available, and I’ll give you those specifics next Thursday. If you need help TODAY, call any of the numbers at the end of the column and decent people will help you – For free – Without trying to sell you anything, because they don’t have anything to sell. I promise.

We’ll venture into specifics, like “extra help,” etc. next week, which will be October 11^th, which will be four days away from “D Day,” so stay calm and get this “open enrollment” thing on your “To-Do List” right now!

Look, this “Universe” is going to unfold, whether we like it or not, right? Sound a lot like “life?” Right, so we need to figure it out, deal with it and move on. Pretending it isn’t there only works with white rabbits, so go flip the calendar and continue holding hands.

Peninsula Daily News Column 9-27-12 "How to make Alzheimer's less scary"

            Last week I went on a bit about five basic principles that will generally make life a lot easier for those of us who are taking care of people with Alzheimer’s, or something else that looks a lot like it; from what you’ve told me, it helped – At least, a little – And most of us who live in that world will take all the help we can get, so today we’ll try a little more.

            Remember, working closely with your health care provider – Talking and listening and asking questions – Is guaranteed to help! And learning all you can about the disease you’re up against is…well, remember this: Know thine enemy! You have tremendous resources and expertise available to you, and most of them are free, so if you don’t know where to look, call any of the numbers at the end of the column and good folks will help you find what you’re looking for.

            OK, so, you’re a caregiver for a person with Alzheimer’s – 24/7 or a few hours here and there – And you want things to go well. Here are a few ideas (concepts, principles, do’s-and-don’ts) that will help, but let’s start here: Think about yourself (go ahead, we’ll wait). Most of how we experience other people (and, thus, our world) doesn’t come from the exact content of what somebody says – It comes from the tone, the volume, the body language, the expressions, the posture, the…expectations, that we “read,” whether we know we’re reading them or not.

            We do; so do people with Alzheimer’s – Whether they know it or not. OK? Please remember that; so, what are some good things to do:

            Smile and laugh – A lot! Be cheerful! Watch the volume and don’t go crazy, but be “happy.” Talk in soft, gentle tones and generally be warm and friendly. Praise what deserves praising and use kind words. Show appreciation, say “thank you” and GO SLOW: Approach your person from the front (You don’t like to be startled, right?) and establish eye contact. Right: That’s how I prefer to be treated, too.

            Use short, simple words and sentences. Agree, even if you don’t agree, remembering that there are limits to what you can agree to and apologize, even if you didn’t do anything wrong. Remember what you’re trying to do here: You’re trying to provide CARE, so we want everything to be soft, mellow – Easy. Show respect, be consistent and do everything you can to help your person remain as comfortable as possible. Right.

            Here’s one that can be tough, sometimes: Step into their reality. Arguing or correcting won’t help – If they could get it “right,” they would, so don’t worry about accuracy or real “reality” – It doesn’t matter, because they are where they are, so be there with them, because anywhere alone doesn’t feel good to anyone. ANYone.

            This can be tougher than it sounds, particularly when your person thinks you’re somebody else. Here you are, knocking yourself out to help them be OK and they don’t even know who you are! Or that you’ve ever existed! Maybe you’re a complete stranger to them – It isn’t fair!

            No, it isn’t and No: You don’t deserve that, but here you are and there they are, so correcting them – “Reminding” someone who can’t remember – Is pointless. Just try to be where they are, if “there” seems to be a pleasant place, and be grateful that they have a few moments of relief from what has become a very scary life. Maybe “there” isn’t so pleasant? OK, then try to distract them away from it to a happier place.

            Getting resistance? Push-back? Don’t push back – Just back off and try again in a bit, because their reality changes faster than yours. And try to remember that your person’s soul – Their “core,” if you will, loves you and appreciates who you are and what you’re doing. A little faith can go a long way.

            If you’re getting angry or frustrated, then you back off and breathe, and try again in a bit. Don’t argue or punish or confront or over-explain – Reasoning probably won’t help; if it would, then you wouldn’t be doing what you’re doing, right? Right, so don’t be harsh or directive or give orders, because all you’re doing is pouring gasoline on the forest fire.

            Sometimes, you’ll lose it. You’ll get so tired or frustrated or hurt or scared that you “lose it” before you even know it! It happens. It happens to almost all of us, so accept that you’re a human being and doing the best you can out of love, so forgive yourself, back off and try again. Physical abuse is NEVER OK, but emotions come and go – Let yours ago. Alzheimer’s, in its own, horrible way, is generally very forgiving.

            Don’t use baby-talk or talk in childlike tones, and never mock, mimic or laugh at your person, because they will feel it. Time out: Most of us who have lived (or are living) in this world know the difference between “laughing at” and “laughing with,” because laughter is a wonderful, sharing thing. How do you know the difference? If the humor makes your person “less,” then you’re laughing AT. Alzheimer’s caregivers laugh a lot! It’s mandatory.

            Stay away from words like, “No,” “Don’t” or “Can’t,” and rely on distracting or redirecting their attention. Stay as positive and pleasant as you can; remember, this is about “success,” not winning.

            And, No: It isn’t fair. I’m sorry this is happening to you and I’m sorry this is happening to them. And thank you for doing what you’re doing.

            Two days from today will be the “Walk to End Alzheimer’s” at the Boys & Girls Club in Sequim, starting at 9:00 a.m. and going until a little after noon. If you can walk, please do, but many of us can’t, for any number of reasons, so just show up and register and be a part of it, because you already are – Laugh, cry, hold hands, learn stuff, meet people who are doing what you’re doing or just get out of the firefight for a little while.

            Or just come and be quiet. You are, after all, a whole person.

            And, sometimes, it’s easy to forget that.

.

Peninsula Daily News Column 9-20-12 "'Behavior problems' hide a message"

            I’m not sure why I’m hearing the same questions, more or less, from a lot of different folks – Maybe it’s because most of us are beginning to feel “Fall” in the air: A bit of a chill, an “edge,” that drives our lives back inside, or maybe it’s just because there are a lot more of “us” – A lot more of us dealing with a monster called Alzheimer’s. It probably doesn’t really matter.

            And it probably doesn’t really matter whether or not “it” really is Alzheimer’s or some other kind of dementia, a lot of our questions are still the same. The actual diagnosis can matter – A lot! – Especially if you’re on the front end of what seems to be “cognitive decline” (memory loss, confusion, etc) because the diagnosis can make a huge difference in what types of treatments and medications could truly make a difference, so don’t be too quick to say, “Oh, it doesn’t really matter…” It does, so go see your health care provider, right now!

            But if you’ve already done that – Are doing that! – And can’t bet the farm on “it” being Alzheimer’s or some other type of dementia, then it probably doesn’t really matter, because YOU, Caregiver, are still trying to do what you’re trying to do. Caregiver? – Somebody who is taking care of somebody who needs to be taken care of, whether you (or they) like it or not. And what you’re trying to do – 36 hours per day – Is take care of someone with Alzheimer’s.

            So, the questions I’m getting have to do with “behavior problems:” resistance or fighting care, restlessness, wandering and rummaging, poor intake, yelling, crying, etc – You get it. Any of that sound familiar? I know, and…

            …Yes, I really do know.

            Clearly, there’s no way that we could take on every “behavior problem” there is in this little column; besides, there are people and organizations who are much more skilled at these things than I am; for instance, if you’re a caregiver who’s embarking upon this journey, start with going to http://www.alz.org/alzwa/ when you have the time to really see what’s in front of you. You’ll find access to amazing resources and amazing people who can and will help you, for free.

            Then, please consider joining a support group. I know: You’re thinking that there’s NO WAY you could find that kind of time, or how would you manage to be away, or or or…And you’re probably right, but if you want to find the smartest caregivers in the world who are “walking the walk” every day, this is where you’ll find them. And how do you find these mystical support groups? Just call any of the numbers at the end of this column, and good folks will direct you.

            So, if we can’t take on all of these “behavior problems,” what can we do? Well, we can talk briefly about five important principles to caring for a person with Alzheimer’s that will, if you really follow them, make life easier for both of you – I promise. These will sound, to a lot of you, simple and obvious, but when you’re “in it,” they aren’t, so step back for just a minute, and consider:

*First and foremost, be sure you’re “person” is as safe as you can make them, without restraining them – It’s in both of your “best interests;”

*Do everything you can to maximize your person’s comfort. Yes, it is simple, but think about it: How do you get when you’re UNcomfortable? I know – Me, too – So…

*Assume that “behavior problems” are a way of communicating with you, because they are. What is your person trying to tell you, in the only ways they have left? You’re being told that something is wrong and needs fixing; so, solve the problem and the “problem” and will go away;

*In the same vein, the message is often about “unmet needs” so, again, the “behavior” is a way of communicating with you – Too hungry? Too cold? Too warm? To…? If you can anticipate and address those needs before they come up (just like you would your own), everybody will be happier; remember, your person isn’t out to torment you, although sometimes on a bad day it can certainly feel that way – They’re sending you a message, so if you can “get” that message or prevent the need to send it in the first place, life mellows. There is absolutely no substitute for knowing your person very well – Understanding their rhythms and preferences and histories and habits – So, use that information. Your person hasn’t changed – He or she has just…changed;

*Use a “soft approach:” Soft voice, soft actions, soft expressions, soft touch. Smile. Go slow. Keep it simple. Be gentle and respectful, and NEVER correct or confront. Didn’t work? OK, back off – Maybe step out of the room – And try again, after you’re sure that you are calm and collected and capable of being “soft” – Because, sometimes, we aren’t.

            And will we all live happily-ever-after if we do all of these things religiously? I doubt it, but the level of uproar and fear and frustration and exhaustion (Remember “exhaustion?”) will decrease significantly. The more you know about the disease and about your person, the better it will go. The better it goes, the better you’ll both do. The better you both do, the longer you can do it – Which isn’t, always, forever.

            But most of us would settle for having a soft “today.”

            On Saturday, September 29^th, a group of good, local folks have put together the first-ever LOCAL “Walk to End Alzheimer’s,” 9:00 a.m., at the Boys & Girls Club in Sequim. Yes, it is a “fundraiser,” but there are going to be a lot of resources there. And folks who are doing – Or have done – What you’re doing.

            We’d love it if you’d “walk,” but you certainly don’t have to; just show up, register and be a part of what’s happening. Just come say “Hi” (I promise to say “Hi” back) and look around, hang around, see what you see – And feel.

            More info? OK, go to http://act.alz.org/nop or call 360.461.3402.

            Sometimes, the worst thing is that feeling of being alone, so just come say “Hi” and we’ll say “Hi” back, and you won’t be alone; at least, for a little while.

Peninsula Daily News Column 9-6-2012 "Grandparents get a little appreciation"

            I know what you’re thinking.

            You’re thinking what lots of people think on the sixth day of September every year. You’re thinking, “My kingdom, if I only knew the most popular baby names in Washington State last year!” (Well, OK, you may not have offered up your entire kingdom, but you’re pretty doggone anxious about it!) Don’t panic – I’m here.

            For girls, in Washington, in 2011, in this order: Sophia, Olivia, Emma and Isabella; for boys, Mason, Liam, Alexander and Jacob. Feel better? Good.

            And how, pray tell, do I know this? Well, I know this because the Social Security Administration announces it every year, based on applications for Social Security cards in the previous year. Now, in fairness, let’s just accept that (1) apparently, parents have enough faith in the future of Social Security to even bother to get their babies Social Security numbers, and (2) that, Yes: There probably is something else that the Social Security Administration could be doing besides compiling lists of babies’ names, but that everyone needs a hobby, so we probably ought to just celebrate the fact that, given the times in which we find ourselves, people are even inclined to continue to make babies at all!

            Apparently, despite the daily predictions of the END OF THE WORLD, life goes on; in fact, do you know what day Sunday is? Yeah, OK…Do you know what else it is? Right! It’s “Grandparents Day!” Really! “Grandparents Day!” Well, OK, but if we set aside, for a moment, our all-too-sophisticated cynicism and just take it for what it seems to be, how cool is that? Grandparents Day! And if you think I’m making this up, go to http://grandparentsday.org/ and see for yourself; by the way, you’ll find some great suggestions for “doing something grand” on Grandparents Day, so go look.

            And sure, I could go on indefinitely about grandparents and grandparenting and the joys of intergenerational interaction and the “cycle of life” and have it all be absolutely true – So could you, so please do! But I’m going to take a little detour here, because we all know that, sometimes, all those little Sophias and Masons and Olivias and Liams aren’t always born into the happiest of circumstances; sometimes, they’re born into hell.

            You’ve heard the horror stories, just like I have, so I’m not going to make you hear them again. And you know, just like I do, that it isn’t just happening “somewhere else” – It’s happening right here, right now, today. It’s sad.

            So, often, who are the only ones left standing who can-and-will stand up and step in to rescue the little ones – Take them, love them, protect them – When no one else can? Yup, the grandparents. The grandparents who didn’t plan on it, budget for it or expect it – The grandparents who weren’t…ready. The grandparents who quit thinking about stuff like that a LONG time ago, who now have to relearn it all – Except a lot of it has changed; at least, on the outside.

            And what about their own kids, who were/are the “parents?” Do they need parenting? Probably. And these little ones – Are you the “parents?” Well…yeah, but…

            Yeah. But…

            I know; so, on the ninth day of September, 2012, happy Grandparents Day! If anybody deserves a day, you guys do! Could you use a little help? Maybe? OK, if you’re around Port Angeles/Sequim, call Carolyn at 417-8554 (1-866-450-3152). A little closer to Port Townsend? OK, call Heaven at 379-4421 (1-800-801-0050). More toward the West End? OK, call Susie at 374-9496 (1-888-571-6559), or just e-mail me and I’ll connect you. Just talk it over – You don’t HAVE to do anything! – But you might be surprised.

            By the way, if you feel like doing a little celebrating on Grandparents Day, how about going to a “Grandparent Celebration Day,” 9/9/12, Sequim Senior Center (921 E. Hammond, if you didn’t know that), 1:00 p.m. to 4:00 – Free: Good info, some organizations around that could help support you, refreshments/munchies – Why not? Kids are allowed.

            One more thing, to you “grandparents raising grandchildren,” and all the other kin who are raising somebody else’s kids because there isn’t somebody else: Thank you. I know, and I know why you do it, but that doesn’t mean that someone can’t just say “thank you,” and mean it.

            Thank you.

            And for the rest of us? Celebrate what we have – And what we don’t – And the universal justice that resides squarely in the “payback.”

So, what’re we gonna do on “Grandparents Day?” Right – Ready? Set? Go SPOIL somebody!!!