Empowerment in keeping a positive attitude, maintaining hope, staying balanced…

• Caregiver’s Quiz
• Maintaining a positive attitude with advice for active pessimists, too
• Playground for adults described on good morning America:  http://abcnews.go.com/video/playerIndex?id=4472178 .    And since then many others have been built.  Google “adapted playgrounds”
  • Palo Alto – http://www.magicalbridge.org/Welcome.html
  • Penitentia Creek Park
• When you can’t get out, you can still interact with others by phone, on a wide range of subjects, for free:  Senior Center Without Walls is now an award winning program:  https://covia.org/services/well-connected/

Ideas regarding peoples spiritual needs:

• How to ask about spiritual needs if you don’t already know:  Stoll’s Guidelines for Spiritual Assessments
  • 1.  What is your source of strength and hope?
  • 2.  What helps you most when you feel afraid or need special help?
  • 3.  Is there anything that is especially frightening or meaningful to you now?
  • 4.  Are there any religious practices that are important to you?
  • 5.  Is religion or God significant to you?  If yes, can you describe how?
  • 6.  Is prayer helpful to you?  What happens when you pray?

• Our spiritual needs are part of our health, this article has helful ideas: http://www.helpguide.org/life/spirituality_prayers.htm
• Ways to meet the religious needs of a person who is homebound

Empowerment in working with the medical system

• Be a good historian and reporter if you want the best help:  see communication resource
• Medicarerights.org, MRC, is the largest independent source of healthcare information and assistance in the United States for people with Medicare. MRC helps older adults and people with disabilities get good, affordable healthcare.
• Resources for picking a hospital and getting prepared to go
  • Hospital Compare website: calhospitalcompare.org
  • Preparation Checklist (from the same website): http://www.calqualitycare.org/learn/hospitals/your-hospital-stay
• Tips for Picking a Hospital & Resources for working with nursing homes
  • http://www.edenalt.org/ : The Eden Alternative is seeking to remake the experience of aging around the world. The bulk of their work to date has been in de-institutionalizing the culture and environment of today’s nursing homes and other long term care institutions.
  • http://www.store4caregivers.com/Subscribers/GROW%20details.html: Grow Coalition stands for “Getting Residents Out of Wheelchairs. Please see
  • http://www.nccnhr.org/: National consumer voice for quality long term care.
  • http://canhr.org/ California Advocates for Nursing Home Reform provides a patient based and informative perspective on nursing homes and health care
• A helpful article to a helpful website, this page is about the basics of mental and physical health: http://www.agis.com/eldercare-basics/Mental-and-Physical-Health/
• Questions to be able to answer about the type of care you want in the hospital or at home:  Five Wishes  (https://fivewishes.org/)
  • The person I want to make care decisions for me when I can’t
  • The kind of Medical treatment I want or don’t want
  • How comfortable I want to be
  • How I want people to treat me
  • What I want my loved ones to know

The Eight Stations of Life

This list can help you see the stages a person might go between, and therefore might help you define and discuss your observations with others. The book, My Mother, Your Mother, listed below, has many helpful suggestions for each stage.

• Station 1: Stabilty Everything is just fine, dear -Mom
• Station 2: Compromise Moms having a little problem -Dad
• Station 3: Crisis I cant believe shes in the hospital -Sister
• Station 4: Recovery Shell be with us for a while -Rehabilitation Nurse
• Station 5: Decline We cant expect much more -Visiting Nurse
• Station 6: Prelude to Dying I sense a change in her spirit -Nurse in Long-Term Care
• Station 7: Death Youd better come now -Hospice Nurse
• Station 8: Grieving / Legacy We did the right things -Brother

Dennis McCullough, M.D. Community Geriatric Consultant Associate Professor of Community and Family Medicine Dartmouth Medical School HB7250 Hanover NH 03756 www.dennismccullough.com www.mymotheryourmother.com

An article and some books to read

• This article is powerful in its example of how lack of planning and communication can be financially and emotionally difficult. Our services are usually provided much earlier to keep you active and healthy. In some cases we help you adapt to the changes in your life, at whatever your mobility, cognition and health. Either way, we help you avoid a situation like this by empowering and educating you about your skills and hopes: http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_Gawande (Now out as “Being Mortal” and “How We Age”)
• My Mother, Your Mother: Embracing “Slow Medicine, ” the Compassionate Approach to Caring for Your Aging Loved Ones  by Dennis McCullough  (above list is from this book)
• Jane Brodys Guide to the Great Beyond, Jane Brody
• Handbook for Mortals by Dianne Lynn (available online for free)

Websites, forms and lists:

• CodaAlliance.org has many resources for helping individuals and their families plan and prepare for the concluding passages of life. See the list of resources.
• GoWish.org is an interactive online card game to facilitate communication about goals of care. You can save and change your answers.You can save and change your answers and share them with people living far away.
• POLST (Physician’s orders for Life Sustaining Treatment) can help direct emergency medical services and other providers to follow your wishes.   This is a MEDICAL document, your advance directives are a LEGAL document.  You can print your own. Print it on bright pink paper.   For more information or to download information go to http://capolst.org/
• Choosing an Agent to speak for you if you can’t
• “Listening Questions” to help you get started on a difficult conversation

Create your own alternative story boards and communication systems to help get ideas across: http://lessonpix.com/. MIGHT help for the person who is having trouble speaking.

Abuse and Neglect

These are questions that can help uncover violence, abuse and neglect. These questions are offered to you to provide simple straightforward ways to ask difficult questions.

• Have you ever been emotionally or physically abused by your caregiver, husband or wife, boy or girlfriend, partner or an ex caregiver or partner? This question asks if the person recognizes that they are being abused.
• Within the past year have you been pushed, shoved, hit, slapped, kicked or otherwise physically treated? This question specifies specific physical acts that the person may not recognize as abuse.
• Within the past year has anyone asked you for money or other favors that you were not comfortable providing? This question specifies other types of abuse that the person may not recognize as abuse
• Within the past year, have you been forced to have sexual activities? This question helps people recognize that sexual abuse is domestic violence, and helps address a subject they might not volunteer.
• Are you afraid of your caregiver or spouse, partner or ex? This question helps identify people who might not have considered their situation as abuse.

Adapted from Domestic Violence Assessment Judith McFarlane, DrPH, Texas Womans University, l992 See Protocol of Care for the Abused Publication #3367900 from March of Dimes Be ready to recognize and act on actions that don’t feel right to you: http://helpguide.org/mental/elder_abuse_physical_emotional_sexual_neglect.htm