Search our Blog

Search our Blog

Thursday, February 26, 2015

Nonverbal Communication: The Power of Touch

Communicating nonverbally can be a touchy situation. If done without gauging another’s response to being touched, it can be problematical. But done with sensitivity, it can be a bonding experience with clients and colleagues.

When thinking of communication skills the first thing that comes to mind is oral, visual,
and then body language. The last thing we think of, if we think of it at all, is the sense of touch. As CSAs, we are constantly trying to improve our communication skills but how many of us ever give any thought to the largest and most important organ in our body—our skin. Numerous studies have proven that touch is essential to our human development. From the moment we are born we need touch to grow, learn, and literally to survive and thrive. Infants use it as their primary form of communication, as well as a powerful healing force.

This need does not change as we age. However, after babyhood we are touched less and less over the years. By adulthood, we think of most touching in a sexual context, leaving us devoid of one of the most basic human needs. In his seminal work, Touching: The Human Significance of the Skin, Ashley Montagu (1986) states that a human being cannot survive without the physical and behavioral functions performed by the skin. “Among all the senses, touch stands paramount and is the mother of all senses.” Touch has been shown to help our bodies maintain their defenses and decrease anxiety, depression, hyperactivity, inattention, stress hormones, and cortisol levels. The effects of the lack of touch can have lifelong serious negative consequences. 

According to Keltner (2010), the science of touch convincingly suggests that we’re wired to the need to connect with other people on a basic physical level. To deny that is to deprive us of some of life’s greatest joys and deepest comforts. A loving touch releases oxytocin or the “bonding hormone.” Physical touch can instantaneously boost our mood, strengthen our immune system, and reduce stress,” says Paul Zak, Ph.D., director of the Center of Neuroeconomics Studies at Claremont Graduate University. 

If touch is a language, it seems we instinctively know how to use it. But apparently it’s a skill we take for granted and that leads to touch deprivation. Because our culture in the United States frowns on adults touching one another except in our most intimate relations, we find ourselves being touched less and less as we age. In studies at the Touch and Emotion Lab at DePauw University (Hertenstein 2013), the subjects consistently underestimated their ability to communicate via touch, even while their actions suggested that touch may in fact be more versatile than voice, facial expression, and other modalities for expressing emotion. “This is a touch-phobic society,” Hertenstein says. “We’re not used to touching strangers, or even our friends, necessarily.” 

Keltner (2010) states that “after years spent immersed in the science of touch, I can tell you that it is far more profound than we usually realize. It is our primary language of compassion, and a primary means for spreading compassion.” 

Touch provides a far more important and complex form of communication than most of us realize. That’s where those of us who work with older adults—or with any human being for that matter—can make a difference. Incorporating touch with our other forms of communication will increase our connectedness to our clients and benefit their well-being, as well as ours. Studies have shown that just a touch of a patient’s hand by a doctor will improve their attitude toward him or her and make them feel calmer. All the reassuring words are no substitute for the gentle squeeze of the nurse’s or doctor’s hand as you are being wheeled into the operating room. According to Rick Chillot in Psychology Today (2013), recent studies have found that seemingly insignificant touches yield bigger tips for waitresses, that people shop and buy more if they’re touched by a store greeter, and strangers are more likely to help someone if the touch accompanies the request. Call it the human touch, a brief reminder that we are, at our core, social animals. Researcher Laura Guerrero co-author of Close Encounters: Communication in Relationships notes “We feel more connected to someone if they touch us.”

Hugging or even touching a loved one or friend is acceptable, but what about a colleague or client? As CSAs, many of us have even been told during training in our designated careers that touching is taboo. So is it time to rethink our training? Unequivocally the answer is yes. There is even evidence the person touching or hugging gets just as much benefit as the person being hugged or touched. It connects us with our clients. Would a handshake or touch of an arm open a whole new avenue of communication for both of you? It may be a fleeting touch but it can make all the difference in the world. It is one of the most basic ways to relate and can be very powerful. No matter how old we are, touch is nurturing. It is security. 

Cultural Considerations 

All cultures have rules about touching. It’s important to be sensitive to personal boundaries in general, and especially with people from other cultures. In Asia, people avoid touch as much as possible, similarly in Germany and England. Unless you are very sure touching is appropriate to them—don’t do it. 

Most of us in the United States view touching as something you only do with family and very close friends. We even differ from region to region. Californians touch each other more casually and more often than New Englanders. Midwesterners are considered low touch. According to our company handbooks, it has no place in the business world. Primarily Euro-American cultures in general, and particularly North American white Anglos have developed a set of unspoken taboos in regards to touch.

  • Touching anyone of the opposite sex or the same sex should be avoided because it is viewed as sexual.
  • Avoid touching a stranger especially if that person is outside your group.
  • Never touch your boss or anyone else who has a higher status than you.
Keltner (2010) states that a pat on the back or a stroke of the arm are every-day, incidental gestures that we usually take for granted. But they are far more profound than we usually realize. They are our primary language of friendship and understanding, and a means for spreading compassion. That’s where those of us who work with older adults or with any human being can make a difference.  

Learning how and when to touch will increase your connectedness to your clients and benefit their wellbeing as well as yours. On the playing field it’s acceptable to give a teammate a pat on the butt, but that same gesture won’t go over well in the office. That’s because the context must be taken into consideration. The office is obviously not the playing field.

The Art of Touching

First, what is your own comfort level? If you cringe at the thought of touching someone in a professional setting, then this is not for you. For many professionals, a handshake is more than enough. But what kind of handshake? A limp handshake may indicate uncertainty or a lack of enthusiasm, while a vise-like grip makes you seem dominant. Besides firm handshakes, the areas from the shoulder down to the hand and the back are considered the safest to touch. But if you are stiff and uncomfortable, it will show and not be effective. Of course, touch should not be a way to set yourself above your client but should be an equal exchange. 

If you feel like touching a client in a more personal way, say on the shoulder or arm, start with someone you know very well. Only when you feel perfectly comfortable should you attempt to touch someone, especially giving a hug.

In professional situations, hugging is done as a form of greeting, comfort, or bonding. Because there are many different kinds of hugs, how it’s done and in what context is important. Maybe it’s a long-time client who is in distress. Or a colleague who’s just had a major achievement. As you enter their personal space, do they back away or stay put? Are they relaxed or stiff? Watch their facial expressions, especially their eyes. Body language speaks volumes.

As with all nonverbal communication, remember that everyone has their own comfort zone. But when welcomed, the benefits of touch at the appropriate time by a trusted person can have very positive effects. •CSA 

Arlene Cawthorne is a client care management advocate with Assisting Hands Home Care in San Diego, California. She has a master’s degree in counseling from the University of Phoenix. She is past president of the Senior Resource Association and the National Alliance on Mental Illness North Inland County (NAMI). She can be reached at, or 858-335-8880. 

Nonverbal Communication: The Power of Touchwas recently published in the Fall 2014 edition of the CSA Journal.

Blog posting provided by Society of Certified Senior Advisors

Tuesday, February 24, 2015

Do Your Homework before Buying a Franchise

While buying a franchise may look like an easy way to become an entrepreneur, it’s not risk free. Before jumping in, make sure you know the costs, the company’s rules and restrictions, and how much you can afford to spend—or lose.

When the HMO where Steve Garrett worked as a pharmacist wanted to do some cost cutting, it decided to outsource its pharmacy department. At 50 years old, Garrett found himself looking for a new job and competing with younger people who had more education than he had. At the same time, he had just gone through a difficult period of procuring hospice care for his father and finding assisted living for his mother. He thought about going back to school and getting more credentials, but, at 50, “Do I want to spend time and money to do that?” the Seattle resident asked himself.

Garrett’s situation mirrors that of many older adults who, for a number of reasons, find themselves out of jobs and in a labor market that’s not especially welcoming to aging workers, and questioning what they want to do next. For Garrett, a Certified Senior Advisor®, the solution was to buy a franchise that could address the problem he had encountered with his parents—how to assist those looking for senior care—while utilizing the clinical training and relationship-building skills he learned as a pharmacist. Plus, he would be able to work from his home, and avoid the expense of renting an office.

When you (the franchisee) buy a franchise, you are becoming part of a business (the franchisor) that has proven successful (Subway, for example). For this advantage, you’ll pay an initial fee, an ongoing franchise royalty fee from sales and possibly other fees, such as rentals and equipment. For comparison, buying a Denny's franchise will cost you $2 million, while Subway's franchise fee is $15,000 and Mr. Rooter, the plumbing service, costs $29,500.

Running a franchise means you create your own job and become your own boss rather than waiting and hoping for someone to hire you. If you can match up with the right franchise, you can use some or all of the skills you have accumulated in your work history, such as managing people or being an entrepreneur—and, for some, like Garrett, even combine your job with your passion, such as helping seniors.

But experts caution that buying into a franchise has many downsides as well, and that the buyer should beware. In most cases, owning a franchise is less intimidating than starting your own business, but there’s still a risk. Franchises range from well-known and established businesses such as McDonald’s and SuperCuts to smaller ones like the one Garrett bought—CarePatrol, which works to help clients find safe and quality options for senior living. Almost any business you can imagine has franchises: for example, fitness, pet care, auto repair, dry cleaning and personal services.

The Federal Trade Commission offers a consumer guide for those contemplating buying a franchise. Here are some highlights:

Help with Starting a Business
One of the advantages of buying a franchise is using the established company’s format or system and utilizing the name recognition that comes with the company name, rather than having to start from scratch to establish a reputation. In addition, many franchisors offer some kind of assistance, such as help in finding a location for your outlet, initial training, an operating manual and advice on management, marketing or personnel.

For example, if Garrett had started his own business, he would have had to build his own website, but CarePatrol already has a Web presence and provided him with Internet referrals and training and support staff to help him set up the business. Instead of having to do his own research on different assisted-living facilities, CarePatrol already vetted various ones.

Your Costs
Besides the initial franchise fee, which will range from several thousand dollars to several hundred thousand dollars (and may be nonrefundable), you may incur significant costs to rent, build and equip an outlet and to buy initial inventory. You may also have to pay for operating licenses and insurance, a “grand opening” fee to the franchisor to promote your new outlet and contribute to an advertising fund.

The monthly royalty fees can be based on a percentage of income, a fixed amount or combination of both. Garrett’s fixed amount includes a percentage fee of the placement income, if his placement (or lead) comes from the franchisor. For example, a franchisor lead could be an online search that directs clients to CarePatrol’s corporate call center, which does the initial vetting of the clients. If potential clients qualify, the call center then directs them to Garrett.

Franchisor’s Restrictions
For many entrepreneurs, one of the disadvantages of running a franchise is that the franchisor controls many aspects of the business and does not allow the franchisee much freedom in coming up with new and different ideas.

To ensure uniformity, franchisors can, among other rules, pre-approve sites for outlets, impose design or appearance standards to ensure a uniform look among the various outlets, restrict the goods and services you sell, dictate hours, demand that you use certain accounting or bookkeeping procedures and pre-approve signs, employee uniforms and advertisements. A franchisor may limit your business to a specific territory, so that you do not compete with other franchisees for the same customers, which could hurt your ability to expand or move to a more profitable location. When you end your relationship with the franchise, noncompete clauses prevent you from using the knowledge you’ve learned to open a similar business.

Your Financial Situation
Because you might borrow the initial investment money or withdraw it from a retirement fund, you risk losing money and/or endangering your retirement. For this reason, experts say you need to closely examine your financial abilities to pay the costs associated with the franchise, as well as your ability to endure a period of time where you are establishing your business. Ask yourself:
  • How much money do I have to invest?
  • How much money can I afford to lose?
  • Am I purchasing the franchise alone or with partners?
  • Do I need financing? Where’s it coming from?
  • What’s my credit rating? Credit score?
  • Do I have savings or additional income to live on while I start my business? 
To avoid borrowing money and going into debt, Garrett used part of his 401K retirement funds to structure a C corporation, although the downside is that he is risking his retirement funds. He was fortunate in that his partner’s income helped give him time to build up the business.

Starting your business may take several months. Estimate your operating expenses for the first year and your personal living expenses for up to two years. Compare your estimates with what other franchisees have paid and with competing franchise systems. An accountant can help you evaluate this information.

Do Your Research
One of Garrett’s strongest pieces of advice to others who want to buy a franchise is to “do as much research as possible and then do more.” He started out by using online search engines, which break down the franchise search into areas of interest (e.g., health care and food service), price (e.g., $10,000 to $50,000 fees) and location. From there, he did his own research on different franchises and worked with a broker, because he wanted to vet the franchise. Because brokers are paid by the franchisor, Garrett said he took the broker’s advice with a grain of salt. He also reached out to other franchise owners for lessons learned, including one in his area who had been established for three to four years.

Franchise brokers, who also refer to themselves as business coaches, advisors, referral sources or sales consultants, typically direct you to opportunities that match your interests and resources. A broker also may help you complete applications and the paperwork to consummate the sale.

Although couched in legal language, a company’s Uniform Franchise Offering Circular offers valuable information. Request one from potential franchises of interest. The circular contains vital details about the franchise's legal, financial and personnel history, including annual revenues per location, expectations for franchisees and names of former franchisees.

The Internet is another font of information, including “The Best and Worst Franchises to Own,” Inc. Check out the sources listed at the end of this article.

Government resources include your state office that regulates franchising (it may be the Office of the Attorney General); the Federal Trade Commission, which enforces the Franchise Rule and publishes a number of business guides; and the Small Business Administration (SBA), which provides more than 30 blog articles covering franchise tips and best practices.

Garrett got help from the SBA and SCORE, a nonprofit organization partnered with the SBA, which provides free business mentoring services.

For Garrett, the experience of owning a franchise has been both good and bad. “I feel less anxious than a year ago when I was disappointed in the job prospects in pharmacy,” he says, and his new career has given him more flexibility in caring for his and his partner’s 12-year-old daughter. However, “at this point, I was hoping to have more placements; that part is disappointing. The industry in the Seattle area is competitive.” His new business involves building relationships—with health-care providers, doctor’s offices, skilled nursing offices, etc.—and that takes time.

“When you’re younger, it was all about keeping up with the Joneses,” Garrett says, “but as you get older, instead you look at what makes you happy and fulfilled.” After decades spent getting his degree and working in his profession, he asks, “Where did it get me?” At least in his second career, he notes, “I can do something I’m passionate about.”

“Want to Buy a Franchise? Ten Reasons Not to Do It,” NOLO Law for All
“How to Buy a Franchise,” Wall Street Journal
“Franchise Businesses,” Small Business Administration
“Reasons You Should Buy a Franchise (and Reasons You Shouldn't),” Feb. 27, 2013, U.S. News & World Report

Do Your Homework before Buying a Franchise was featured in the January 2015 Senior Spirit newsletter. 

Blog posting provided by Society of Certified Senior Advisors 

Monday, February 23, 2015

Big Surprises in the Aging Industry

History is merely a list of surprises. It can only prepare us to be surprised yet again.
—Kurt Vonnegut

After a history of more than four decades working in the field of aging, I note a number of "surprises” or developments no one would have predicted in the early 1970s when I entered the field. Here are a few of those surprises:

The fading of long-term care insurance. Ten thousand boomers reach age sixty-five each day (not a surprise). The odds are that up to half of them will need some kind of long-term care if they live long enough. That sounds like a great opportunity for insurance, right? Unfortunately, most companies that offered long-term care insurance are no longer offering new policies, for a variety of reasons. The federal CLASS act is now defunct (repealed July 1, 2013), leaving only Medicaid, which was never intended for long-term care purposes.

Frustration in Alzheimer’s research. We've seen a failure to find any cure, means of prevention, or even agreed-upon cause for Alzheimer’s disease, despite hundreds of millions of dollars expended for that goal. Like the “War on Cancer” declared by Richard Nixon in 1971, we seem to have come up short. No one imagined that, after nearly four decades of research on Alzheimer’s, we would fail to produce significant results: “If we can put a man on the Moon....”

Failure of the caloric restriction hypothesis. Since the 1930s, one of the strongest findings in bio-gerontology has been caloric restriction—the discovery that reducing caloric intake extends the lifespan of rats and all mammals on which it has ever been tried. The assumption has always been that caloric restriction would also work in primates, including humans. But in 2012, a twenty-five-year trial announced that caloric restriction does NOT extend longevity for primates, refuting a long-assumed idea in gerontology. It gives new meaning to the old joke: “Doctor, if I follow your low-calorie diet, will I live longer, or will it just seem longer?”

Anti-aging medicine. The ascendance of anti-aging medicine and the diminished appeal of geriatric medicine have taken many gerontologists by surprise. There is not a single scientifically established way of slowing the process of aging in higher animals. Yet, despite lack of evidence, there are many more M.D.s now certified in anti-aging medicine than there are geriatricians. And geriatric fellowships go unfilled each year.

End of early retirement. Throughout the twentieth century, the average age of retirement fell decade after decade. The trend seemed unstoppable until the 1990s, when it reversed and people started retiring later. Today, the average age of retirement is rising as people stay in the workforce longer. The reasons are many, ranging from increased life expectancy to cutbacks in Social Security. The age of eligibility has risen from sixty-five to sixty-six and will soon go to age sixty-seven. Working longer is one of the best ways of insuring adequate income in retirement.

Age discrimination. The Age Discrimination in Employment Act (1967 and 1986) made age discrimination illegal, and since the 1980s, formal mandatory retirement has been abolished. But, despite laws, age discrimination in the workplace seems as widespread as ever (and at younger ages). Experienced advocates at AARP confirm that age discrimination lawsuits are difficult, if not impossible, to win. 

Pensions. Since the 1980s, defined benefit pensions in the private sector have been vanishing, to be replaced by defined contribution plans, such as 401(k), which were never intended as the basis for full pensions. Today, defined benefit plans are increasingly limited to government employees. But even there, coverage is being scaled back and more workers are being shifted to defined contribution plans. The result of these trends is less retirement security and more need for individuals to prepare and plan for themselves. 

Cost containment in health care. We all know the bad news about health care costs. But here is a surprise, and it’s a good news story. Medicare Part D (prescription drug coverage) has turned out to be far less expensive than pundits predicted. One reason is the impact of the marketplace and greater use of generic drugs. The much-criticized Affordable Care Act also makes use of the regulated marketplace and is now projected to save enough money to extend the life of the Medicare Trust Fund from eight to fifteen years, though most Americans don’t know this. In both cases, they’re a welcome surprise about gloom and doom over health care costs.

Even more surprising, according to reports from the Congressional Budget Office, overall spending on Medicare is $1000 less per person than was projected just a few years ago—more good news on cost containment in health care.

Ageless marketing. We’ve seen the “rebranding” of successful organizations to avoid any reference to aging. For example, Elderhostel is now Road Scholar; the U.S. Administration on Aging is now the Administration on Community Living; and the American Association of Retired Persons is now just AARP. In all cases, the focus is on age as a positive development. For example, “Life Reimagined” is the slogan for AARP’s new campaign. 

Some Implications for CSAs
The following trends have implications for CSAs and other professionals who work with older adults. The familiar saying, “It isn’t your grandfather’s retirement,” is truer than ever. We live in a world where aging is going to be very different than in the past. 

One trend is very clear: Individual decision-making is on the rise. Americans are increasingly on their own when it comes to dealing with issues in later life. They face complex choices in health care, financial matters, and living options, which means that CSAs are more important than ever.

Paying for long-term care. Pay attention and learn what consumer choices are available. Too many Americans still believe Medicare will pay for long-term care expenses.

Anti-aging. Don’t trust the promises of anti-aging technologies. Companies have been hawking these products forever, but despite ongoing research, science has found no proven way to extend human lifespan. If it sounds too good to be true, it probably is.

Working longer. Everyone, including advisors and their clients, should expect to work longer in order to have financial security in retirement. This is not always easy, but it should be a consideration. Age discrimination by employers remains a reality, but some options, such as self-employment, can make a difference.

Pensions and investments. Those with a traditional pension should consider themselves fortunate. Otherwise, encourage clients to save as much as possible using tax-advantaged options, such as IRAs. But also advise them to look carefully at the costs and fees (sometimes hidden) among investment choices. Fee-only financial planning and lowest cost mutual funds, such as index funds, may be the way to go. 

Cost containment. Cost-containment begins at home. People should expect higher health care costs in later life, but there are things they can do to keep costs low, such as shopping around for health insurance. Generic drugs are less expensive than name brands. And many medical interventions may not be necessary or proven effective. Paying attention and asking questions is essential. As Ronald Reagan said, “Trust but verify.” 

“Aging” still remains a hard sell. Put the focus on positive opportunities in later life, not gloom and doom. Visiting a Certified Senior Advisor should not be like visiting the dentist for a root canal. Make sure to balance realistic advice and caution with a vision of later life as a time of growth and hope. 

Opportunities for CSAs today have never been greater. Over the next two decades, the proportion of the U.S. population over age sixty-five will rise from 13 percent to nearly 20 percent. The big surprises to date are only the prelude to more changes in years to come. Advisors who are well informed will be indispensable as the number of potential clients continues to grow. •CSA

Harry R. Moody retired as Vice President and Director of Academic Affairs for AARP in Washington, DC. in 2013. He is coauthor of Aging: Concepts and Controversies, now in its 8th edition. He serves as a consultant for the Society of Certified Senior Advisors.

Big Surprises in the Aging Industry was recently published in the Fall 2014 edition of the CSA Journal.

Blog posting provided by Society of Certified Senior Advisors

Friday, February 20, 2015

Taking Care of the Caregiver

Today’s older adults face more caregiving challenges than ever before. Dealing with the stress of what is often frequently nonstop care isn’t easy, especially during the holidays. To stay healthy, experts say taking care of yourself needs to be a priority.

Today’s older adults face more caregiving challenges than ever before. The number of adult children assisting aging parents has more than tripled in the past 15 years (from LifeBridge Solutions), and, at the same time, they are helping their adult children—some who are living at home longer and needing more financial help. Many older adults are helping children who are military veterans, especially those with serious injuries; others have disabled children who need lifelong care. Some grandparents are finding themselves responsible for their grandchildren (see “Grandfamilies Find New Challenges, Satisfaction,” Senior Spirit, Jan. 2014). And, at the older stages of life, many of us are finding that spouses and friends need additional help.

Family caregivers, it turns out, are the “backbone of our country's long-term, home- and community-based care system”—with nearly 66 million family caregivers in the United States caring for parents, relatives, spouses and children. The estimated economic value of their unpaid contributions—about $450 billion in 2009—is more than twice what is spent nationwide on nursing homes and paid home care combined, according to the Rosalynn Carter Institute for Caregiving. Yet these informal caregivers get little to no help from the government.

It’s no surprise that many older caregivers are feeling overwhelmed, and the holidays can make it simultaneously more difficult and easier. There’s more joy from being with loved ones but also more stress to create the perfect celebration. The holidays are also a good time to take stock of your own needs, to make a resolution for the new year to find time to take care of yourself.

How to Find Support Groups Support groups offer a safe haven to share feelings, make new friends, learn about resources and coping mechanisms, and get advice for handling problems that others have experienced.
Different types offer slightly different kinds of support (from “Finding the Right Support Group,” Caregiver Action Network).
  • Condition-specific groups focus on a particular disease, disability or condition, such as Parkinson’s or Alzheimer’s, and can provide the latest information on the condition and available resources.
  • Family-caregiver groups are especially appropriate if you are feeling isolated and need to have your feelings validated.
  • Relationship-oriented groups focus on those who are caring for a spouse, a parent or a child regardless of their condition.
  • Online forums offer the advantage of connecting with others from home and are especially good for those in rural areas or who are caring for people with rare conditions.

You can find the right group through
  • The social work department of hospitals
  • Adult day care centers
  • Voluntary organizations that deal with your care recipient’s condition—for example, Alzheimer’s disease or MS
  • Area Agencies on Aging
  • Your faith community
Signs of Stress

Stress from caregiving can affect your own physical health. Stressed-out caregivers aged 66 to 96 have a 63 percent higher risk of dying than that of people the same age who are not caregivers (Family Caregiving Alliance). Baby boomers who are taking care both of parents and children, while working, face an increased risk for depression, chronic illness and a possible decline in quality of life.

Caregivers are often so focused on their loved one that they don't realize that their own health and well-being are suffering. Watch for these signs of caregiver stress:

  • Feeling overwhelmed by everything that needs to be done
  • Unable to relax without drinking, taking sedatives or smoking
  • Feeling hopeless about the future
  • Eating poorly
  • Lacking energy to do everyday chores
  • Refusing to take care of yourself when ill
  • Unable to concentrate
  • Putting off making medical appointments for yourself
  • Unable to get a good night's sleep
  • Feeling tired most of the time
  • Feeling overwhelmed and irritable
  • Gaining or losing a lot of weight
  • Losing interest in activities you used to enjoy

How to Relieve Stress

Experts say that if you don't take care of yourself, you won't be able to help anyone else. Here’s their advice:

Accept help. Many caregivers are reluctant to ask for help, not wishing to burden others. But often family and friends are happy to be of service, especially if they can be presented with a list of specific requests, such as picking up food from the store or giving you a one-hour break to go for a walk. Help is also available from community resources. Websites, including Family Caregiver Alliance or the Eldercare Locator, can help you find local assistance.

Take a break. Getting away from the situation, for a half a day or whole day, is one of the best things you can do for yourself as well as the person you're caring for. Most communities have some type of respite care available, such as adult day care centers, short-term skilled nursing homes and assisted living facilities, or in-home respite. Health care aides can come to your home to provide companionship, nursing services or both.

Join a support group. Talking to others who are in the same or similar situation can go a long way toward easing the isolation that most caregivers feel. Members of a support group can offer support, suggestions on ways to make your life easier and connections to other possibilities for assistance. Organizations specific to your loved one’s situation (Alzheimer’s or cancer, for example) also offer local support groups (see sidebar, “How to Find Support Groups”).

Maintain social contacts. Find time to see friends, if even for a short period, like a walk or lunch together. Having a strong social support system greatly lessens the stress of caregiving.

Be easy on yourself. As hard as you might try to keep everything running smoothly, it’s going to fall apart at some point. Those are the times to avoid feeling guilty or that you’re not good enough. You have to accept that some things will be out of your control. No one is a "perfect" caregiver. You're doing the best you can at any given time. If it eases your burden, let the house get a little dirty or buy prepackaged meals.

Stay physically healthy. Whether it’s going to a yoga class or walking every day, getting exercise is one of the biggest stress relievers. Exercise promotes better sleep, reduces tension and depression, and increases energy and alertness. Walking is one of the best and easiest exercises and can be done in short bursts, like a 15-minute walk around your neighborhood.

Dial down the holidays: Everyone wants a perfect holiday, but if it adds to your burden, it’s not worth the effort to make sure the meal is perfect or that you’ve found the perfect gifts. Order a prepared meal, if it makes your life easier. Focus on what is most meaningful and let everything else fall by the wayside. If it’s important to make the best holiday presentation, find someone to help, even if you have to pay.


“Caregiver stress: Tips for taking care of yourself,” Mayo Clinic

“Caregiving as a Risk for Mortality: The Caregiver Health Effects Study.” JAMA, December 15, 1999, quoted in “Taking Care of YOU: Self-Care for Family Caregivers,” Family Caregiving Alliance ).

“Taking Care of YOU: Self-Care for Family Caregivers,” Family Caregiving Alliance

“Are You Heading for Caregiver Burnout?,”

“10 Tips for Caregivers during the Holidays,” AARP

Taking Care of the Caregiver was featured in the December 2014 Senior Spirit Newsletter

Blog posting provided by Society of Certified Senior Advisors 

Tuesday, February 17, 2015

Advocacy and Coordination of Care for Older Adults

Advocacy in health care, especially for those with mental health issues or who live alone without immediate family, is critical. The need for coordinated, integrated care is becoming a significant and recognized issue.

In today’s culture, we are at the crossroads of a public policy and cultural paradigm shift in health care. Two major assumptions are changing the way professional advisors approach solutions to their clients’ needs for quality care in aging. The first major hurdle
is the American health industry. While changes are ongoing with the advent of the Affordable Care Act, many people still find that their mental health needs are treated separately from their physical health needs. 

The second layer of complexity is that our culture is shifting away from a multigenerational caregiving approach that has long been a cornerstone of inter-familial care. Within this multigenerational approach, older people have primarily relied upon immediate family members to provide a support system for their health care needs. However, for those who find themselves living alone and without immediate family, that support system must be replaced. This article discusses the current state of our disparate health treatment approach, the decreasing likelihood of immediate family caregivers, and the options available for those in need of care.

A Fragmented Treatment System
In 2006, a report issued by Joe Parks through the National Association of State Mental Health Program Directors cited research showing that adults with serious mental illness die, on average, twenty-five years earlier than the general population and that the rates of illness and death are rising for this population. This mortality among people with mental illness can be explained by their disproportionately high rates of mortality from potentially preventable conditions, including cardiovascular and pulmonary disease, that are among the leading causes of death in the general population. So, those with mental illness are much less likely to care for their physical illnesses. People with mental illness often have higher rates of modifiable or potentially manageable risk factors for their conditions, such as smoking and obesity; they experience  higher rates of homelessness, poverty, and other causes of vulnerability; and they face symptoms associated with mental illness, such as disorganized thoughts and decreased motivation that impair amenability with health care needs and self-care. 

An additional concern is that co-occurring substance abuse disorders are prevalent among individuals with mental illness. But despite the high rate of substance abuse comorbidities—medical conditions that occur simultaneously—among people with mental illness, the mental health and substance abuse systems are often entirely separate, and both are segregated from the physical health system. This fragmentation of the health care system can lead to inappropriate, redundant care, disjointed care, gaps in care, and can result in increased health-care costs. 

In 2001, the World Health Organization’s World Health Report called for the integration of mental health into primary care, acknowledging the burden of mental, neurological, and substance abuse disorders globally, the lack of specialized healthcare providers to meet treatment needs, and the fact that many people seek treatment for these disorders in primary care.

Even when individuals with behavior health problems get screened for other medical conditions and referred for care, obtaining the recommended follow-up services can be extremely challenging. People with serious behavioral health conditions often lack trust in
professionals and agencies. Also, by the nature of their disorders, they may find the task of seeking medical care overwhelming or frightening. Further, people with chronic mental illness can be poor historians of their own health and unable to provide information that
medical professionals need to diagnose their problems. 

A Holistic Integration of Physical and Mental Health Care Coordination
The foundation of integrated care is a holistic view of the individual and personal health as complex, integrated systems. Integrated care must then begin with an assessment of conditions and/or the risk of developing conditions in addition to the ones patients present for. This means the adoption by primary healthcare providers of tools to screen for behavioral healthcare needs. Today, it is more common for primary care providers (PCPs) to screen for behavioral health needs than for behavioral health-care providers to screen for physical health needs. Integrated care lends itself to holistic management of exposure to risk, the delivery of preventative interventions, and the treatment of symptomatic disease across the lifespan.

Care coordination and integration has demonstrated value in removing barriers to effective management of mental health conditions. This includes care management with tracking and monitoring by RNs, procedures to encourage medication adherence, and linking of patients to community-based health professionals other than physicians, including pharmacists. 

A 2006 study by Eric A. Coleman, M.D., which addresses the transition of care between different health care settings and the risk involved in such transitions, demonstrated RN care coordination of patients sixty-five and older living in the community also resulted in improved quality of care and cost savings. The main components of the coordination included medication self-management, a patient-centered record, primary care and specialist follow up, and patient education of warning signs and symptoms indicative of a worsening condition. Participants in the study reported increased confidence in the ability to self-manage their care. The findings demonstrated that care coordination improved the quality of care and reduced costs, while ensuring the safety of older adults in need of this kind of care.

A Cultural Challenge
An additional challenge is now presenting itself in the American culture. Over the last century, medical advances have lengthened the average life span by nearly two years every decade. The average American can expect to live to the age of eighty. Concurrently, the country has seen a dramatic downturn in family size. One effect of these changes is that people will routinely reach old age with very few, if any, immediate family members. This is problematic because care for those who are older and/or disabled in the U.S. remains with immediate family members.

It is unknown how many Americans living alone happen to be sick or disabled, but hospital discharge planners and home health care providers state that they service a growing number of single people who have no default or immediate family caretakers. Recent predictions have shown a trend of older generations increasing in single person households, and while there are some federal programs to help them age in place, resources are limited for those living alone who require more advanced caregiving.

Many who live alone rely on what anthropologists have termed “chosen family”—people within one’s network who rely on one another as resources for emotional, physical, and financial support. Chosen families have drawbacks, however. They are at a significant
disadvantage in terms of care-giving burdens because the entire network is often comprised of individuals who are in the same age group. This is problematic because aging policy in the U.S. assumes the existence of a multigenerational network of support. Eighty percent of all long-term care is provided by informal, unpaid caregivers who are most often spouses or younger relatives. A 2009 study by the National Alliance for Caregiving and AARP, showed that relatives comprise 9 percent of all unpaid caregivers for individuals fifty years of age and older, and the average age of caregivers for individuals seventy-five and older is fifty-one. For those whose chosen family includes only a single generation, its members will age at the same time, resulting in overlapping caregiving responsibilities. 

When it comes to healthcare, listing an emergency  contact person can be a tough question for anyone without a spouse, partner, or child. For single older adults, it can be one of the most difficult questions to answer due to their lack of immediate caregivers, such as a family member or close relative. People with no family members in charge worry about who might be around to sit in a waiting room, argue with the insurance company, and see that medications are dispensed regularly and correctly. To be sure, having a spouse or grown children is not always the best solution. However, people who live alone without the obvious next of kin for those emergency contact forms must rely on patchwork support from professionals and friends, or end up as their own advocates at a time when they are particularly vulnerable.

Advances in medical technology have greatly increased the likelihood that individuals will experience some period of incapacity prior to death, making some type of advocate, whether durable powers of attorney or advance directives. For those who are incapable of
expressing their desires regarding medical care, these essential documents and advocation help to ensure that their wishes are followed. In addition, they can appoint a surrogate to act on their behalf in the event of incapacity, designate a guardian, or direct the terms of end-of-life care.

The Need for Advocacy
The advocacy workforce in behavioral health settings includes professionals such as nurses and licensed clinical social workers, as well as paraprofessionals. The role of advocates may be as simple as assisting individuals with behavioral health conditions in seeking medical help, or as sophisticated as direct interaction with medical professionals to advocate for a certain medical procedure or reconcile medications. Their role also involves promoting patient engagement to help achieve better-integrated, more holistic care. Whatever the credentials, effective advocates must have the ability to establish a trusting relationship with their clients. In addition, the relationships they establish with providers can foster a culture of coordination and integration between physical and behavioral health professionals. 

Health advocacy services should include comprehensive care management; care coordination and health promotion, comprehensive transitional care, patient and family support, referral to community and social support services, and the use of health information technology to support these services. The idea is that health advocates connect, coordinate, and integrate the many services and supports, including primary healthcare, behavioral healthcare, acute and long-term services, and family and community-based services, that patients with chronic and often complex conditions need.

Cost Concerns
A December 2008 study by the McKinsey Global Institutes of McKinsey and Company noted that the U.S. spends more on health care than other industrialized nations even when adjusting for relative wealth. The study went on to note that this pattern occurs despite the fact that the prevalence of many diseases is lower in the U.S. than in other areas.

Care coordination has the potential to reduce cost and improve outcomes for all populations in all health care settings. The most impressive outcomes occur in high-risk populations whose complex health issues involve costly treatments and repeated hospitalizations. On average, patient costs of those with uncoordinated care were 75 percent higher than matched patients whose care was coordinated. Additional studies suggest that enhanced care coordination could reduce 35 percent of costs. Various care delivery models, including nursing-led models, have been evaluated in relation to improved clinical and financial outcomes. In general, care coordination results in better care at lower cost, particularly for populations with multiple health and social needs.

For professional advisors, two systems impacting care and health are adding tremendous complexity to our clients’ lives. First is the fragmented practice of treating mental and physical health independently. Second is the continuing societal trend of “singleness,” resulting in a lack of traditional immediate family caregivers. For those clients with multiple physician providers, care coordination is a must. For those clients with the additional complexity of no “default” caregivers, advocacy and care management is critical. Several options exist, ranging from private-pay RN advocates to local aging agency volunteers. Advocacy and care management are imperative for anyone in need of these services. CSAs and other professionals who work with older adults should know the options in their areas and be prepared to advise their clients who need these solutions. •CSA

Mindy Jones is the founder and managing principal at Pyxis Care Management. Located in Texas, its mission is to fill the need for holistic advocacy and guardianship services. Contact her at, 817-591-1592. Or visit her website at

Advocacy and Coordination of Care for Older Adults was recently published in the Fall 2014 edition of the CSA Journal.

Blog posting provided by Society of Certified Senior Advisors

Monday, February 16, 2015

From Hearing Loss to Hearing Aids: Making an Important Decision

The reality of hearing loss and the need for hearing aids is a difficult subject
for many older adults to accept. The emotional issues involved too often
override the significant health and safety issues of not hearing well.

An enormous wave is beginning to build as ten thousand boomers turn sixty-five every day. This tsunami will continue until 2030 when it will crest. Within this population, and older adults in  general, hearing loss is a significant health issue. This article will discuss the health-care process experienced by someone who enters the system to be tested and fitted for hearing aids, as well as detail some of the physical, mental, and emotional issues related to those who suffer from untreated hearing loss. 

Anatomy of a Hearing Test
The ear examination. The hearing test process begins with a visit to an otolaryngologist, an ear, nose, and throat specialist, who will ask questions about the patient’s medical history, such as, previous head injuries, chronic ear infections, job or hobbies involving loud noise. Following a chronological history of the patient’s hearing loss, the doctor will examine the patient’s ears with a very bright light called an “atoscope” to look for a broken ear drum or other inner ear damage. If the results are negative, the doctor will refer the patient to an audiologist for a hearing evaluation. 

The hearing examination. The audiologist will administer two tests. The “pure tone” test identifies the quietest tones the patient can hear in the low, medium, and high frequencies. The “spoken word” test evaluates how well the patient hears and understands the spoken word at different levels of tone and frequency. Together, the tests provide information that allows the audiologist to determine the range and extent of hearing loss. 

Selection and fitting of hearing aids. After the audiologist has reviewed the test results with the patient, and the patient has decided to wear hearing aids, there will be a discussion concerning the extent to which aids will improve the person’s ability to hear, and the choice of hearing aids that will best meet the person’s needs. 

Understanding and Selecting Hearing Aids
Basic function of a hearing aid. A hearing aid is a sound-amplifying device made up of four basic components: 

• a microphone that picks up sound,
• an amplifier that increases volume,
• a receiver/speaker that changes the collected signal back into a sound and sends it to the ear,
• a battery to provide power to the process.

Hearing aids are produced in two technological designs: analog and digital.

Analog hearing aids make continuous sound waves louder. They amplify all sounds, such as speech and noise, in the same way. Newer analog aids can be programmed using a microchip for specific settings, such as library (quiet) and restaurant (loud). In summary, analogs are less expensive, have a limited ability to program, and make sounds louder but do not discriminate among them. 

Digital hearing aids have all the features of analogs, but can convert sound waves into digital signals and produce an exact duplication of sound. They convert sound to digital noise and speech, can suppress background noise, can be programmed to the person’s hearing test results by an audiologist, and are more expensive.

Hearing Loss Statistics
The Administration on Aging’s “A Profile of Older Americans 2012,” reported that in 2010, there were forty million boomers in the United States. By 2030, there will be seventy-two million. In 2010, one-third making it the third largest chronic illness among that population. Even though hearing loss is correctible in 95 percent of the cases treated, only 20 percent seek medical treatment. Although the boomer population continues to grow, the 2010 statistics are still considered accurate. 

Federal Government Study of Hearing Issues in America
Our government has recognized the severity of the hearing loss issue in America. As part of the Department of Health and Human Services’ (DHS) “Healthy People 2010,” a nationwide health promotion and disease prevention agenda, the Surgeon General has identified twenty-eight focus areas regarding the most significant, preventable threats to public health in the U.S. One of them is hearing, and “Healthy Hearing 2010” is DHS’s initiative to treat and prevent hearing loss. The National Institute on Deafness and other Communication Disorders (NIDCD) has contracted with DHS to lead the effort. 

Why Don’t People Who Need Hearing Aids Get Them? 
A Scholar’s Opinion. In his article, “Why People Won’t Wear Hearing Aids” (1995), Mark Ross, Ph.D., identified age as the primary stopper. “Our culture is obsessed with youth and the youthful image. It spends millions on cosmetics, plastic surgery, personal trainers, and so on to remain ‘young,’ while other cultures value age and the wisdom of experience. “We disparage and mock it. We deny the aging process,” he wrote. “We deny hearing problems.” 

Ross continues: “The pity of this attitude, of course, is that while they can refuse to wear hearing aids or use any other acoustic prosthesis, they cannot disguise communicative consequences of a hearing loss. They still miss and misunderstand much in everyday conversation. Their social and cultural activities gradually diminish and their lives become more and more constricted. Their attitude is self-defeating in trying to deny the reality of hearing loss, because of its association with aging.”

A Daughter’s Opinion. Susan Seliger, in her New York Times article, “Why Won’t They Get Hearing Aids” (2012), wrote about her parent’s inability to hear and her attempts to discuss the problem with them. The article relates the following communication between her parents.

Mom, in the dining room: “Did you take out the trash?” 

Dad, in the living room: “I have plenty of cash. What do you need money for?” 

Mom, still in the dining room: “What? I don’t want any money.” 

Dad: “Why did you ask for it?”

“I felt as if I was in the middle of that Abbott and Costello routine. The only difference is that after a while, the daily misunderstandings and frustrations of having to repeat yourself become a lot less funny,” Seliger wrote. 

She was never successful in getting her parents to consider hearing aids, but her experience with them led her to study the why of people’s failure to deal with hearing loss. She went on to report: 

• It is seven to ten years before the average person with a hearing loss seeks professional help;

• Of the 26.7 million people over the age of fifty with hearing impairment, only one in seven (14 percent) uses a hearing aid. The primary reason is denial of the problem; 

• Hearing loss can play a role in balance and can lead to falling;

• Hearing loss, in some studies, suggest a link to suffering from dementia;

• Hearing loss can cause isolation and depression;

• Vanity is a primary issue;

• Cost can be a deciding factor.

The Cost of Hearing Aids 
Tricia Romano, in her New York Times article, “The Hunt for an Affordable Hearing Aid” (2012), wrote about researching for replacement hearing aids when decade-old analog hearing aids failed. “A hearing aid is basically just a microphone and amplifier in your ear. It isn’t clear why it costs thousands of dollars.”

Unfortunately, Medicare does not cover any testing for or treatment of hearing loss or hearing aids, nor do most Medicare supplement plans. However, if the person has suffered hearing loss due to illness or injury, Medicare may pay for most or all costs of a hearing aid. Otherwise, the cost of quality hearing aids and implant systems can run from $3,600-$7,000, and paying for them comes out of the person’s pocket. The Veterans Administration will pay for hearing aids for all eligible veterans.

CSAs and other professionals working with older clients should read the article by Marilyn Ellis, CSA, CTACC, “The Best Gift Ever: Learning How to Listen-Especially to Difficult People” featured in the CSA Journal (Winter 2013). Finally, David Solie’s book (2004), How to Say It to Seniors, offers excellent ideas on how to offer assistance, how to listen, and what to listen for.

When relating the large number of older adults suffering from impaired hearing and the small percentage who seek treatment, we as professionals are charged to improve our listening skills. We should also suggest to our hearing-impaired clients that they may want to visit a medical specialist and consider the use of hearing aids. •CSA

John Parr is a partner in the law firm of Parr Bylerly in Olympia, Washington. His focus is on estate planning, elder law, probate, and the “what if” questions of aging. He is a Fellow of the American Bar Foundation, and a member of The Washington Bar Foundation and American Bar Association. He can be contacted at Visit his website at

From Hearing Loss to Hearing Aids: Making an Important Decision was recently published in the Fall 2014 edition of the CSA Journal.

Blog posting provided by Society of Certified Senior Advisors