An Aging Life Care Specialist Goes Underground

An Aging Life Care Specialist Goes Underground

We Aging Life Care specialists ask a lot of questions. Most pertain to the medical, social, emotional and the home environment. Now we are going even deeper in the home and descending to the basement.

Why the basement you ask? Because in some homes, across all fifty states, evil may be leaking from the ground. It’s colorless, odorless, invisible and can only be detected by testing. This mysterious element is called radon. It is a radioactive gas that comes from the decay of uranium found in the soil one’s house is built on. It typically moves up through the foundation to the air and enters one’s home through cracks, walls, construction joints or gaps in the foundation around pipes. A home traps radon inside, where it can build up. The ventilation and the air flow patterns in a house will affect how much radon will be pulled into different areas of the house. The age of the home, does not make a difference. According to the United States Environmental Protection Agency radon is the leading cause of lung cancer in non-smokers in the United States. The higher the radon level in a house, and the longer the exposure period, the greater the risk to the occupants.

Apologies for the scare, but the good news is that radon levels can be measured and if remediation is necessary, there are solutions. The place to start is with A Citizen’s Guide to Radon, published by the EPA. In a nutshell, the average radon concentration for homes in the United States is 1.3. It is when the radon levels, goes beyond 2 picoCuries per liter (the EPA will explain the jargon) that thought should be given to resolving the potential problem. While you can hire a professional tester to determine the radon level, you can easily start with buying a do it yourself test kit available in hardware stores or online. You can also call: 1-800-SOS-RADON (part of the EPA). This testing method consists of a small charcoal canister. The radon in the air is absorbed on the charcoal and the decay products can then be measured by a laboratory. The laboratory cost is usually incorporated in the cost of the canister. It is suggested by the New York State Department of Health, that two separate charcoal canister measurements be used before deciding to correct the situation. If mitigation is necessary the most common method is to have a vent pipe system and fan installed, which pulls radon from beneath the house and vents it to the outside. More information is available from the EPA at 1-800-55RADON.

So, why this article on radon? This past January was officially declared Radon Awareness month. But beyond this, often, as Aging Life Care specialists, we turn to our personal experiences when they can enhance the lives of those we help. Some years ago, with great excitement we closed on our dream weekend home in the woods. Surrounded by nature, deer leaping thru the woods beyond, a welcoming lake for rowing and swimming, what could be better? The answer would have been a tent for camping had we not taken care of the high radon level that was noted in the inspection report. As Aging Life Care specialists, it is our goal to keep our clients safe at home. Checking for radon is another step to ensure their safety.

Making Your Bed and Other Strategies for Lessening Caregiver Stress

Making Your Bed and Other Strategies for Lessening Caregiver Stress

Covid-19 has thrust many of us into new or expanding caregiving roles. Medication management, arranging doctors’ appointments virtual and otherwise, making sure a senior is eating more than tea and crackers, and doing our best to ensure our elders feel connected in a world where quarantine and isolation have been the keywords of these last nine months.

Alongside these caregiving responsibilities, we have family and work commitments and, yes, an obligation to keep ourselves healthy. While the initial reports are promising for vaccines, we are still awaiting that GPS to give us clear and consistent direction.  While waiting for those directions to appear, I would like to share five strategies to help you, the caregiver, lessen the stress that accompanies the increased role you may be assuming:

  • Accept the feelings that come with this time. Your anxiety doesn’t have to control you when everything around you feels so uncertain. Focus on what you can control: you, your thoughts, your actions. Speak with those friends who offer you reassurance and comfort and let the other incoming calls go to voice mail, especially when those unsolicited advice-givers are on the other end.
  • Have an emergency contingency plan. Try to organize what the National Alliance of Caregiving calls a “care squad” or simply a caring support team that can help in the care of a loved one in the event you become ill. Identify trusted people who can provide help such as bringing over groceries, picking up medications, offering technical guidance for virtual doctors’ appointments, and making those all-important outreach calls to a parent.
  • Practice self-talk. Remind yourself that you have coped with difficult situations before and think back to how you handled them. Re-discover that strength and confidence. Extend to yourself the empathy that you would impart to a friend in need.
  • Stay in the present, ask yourself: “What do I have to deal with right now?” “What can I control right now?” Think about all the times you worried about the future and the outcome was not as dismal as you imagined it would be.
  • Stick to a routine. As Gretchen Rubin speaks of in her book The Happiness Project, start your day by making your bed. You may say why do that, I’m just going to unmake it at night? Making your bed sets the tone for the day, it takes little effort and goes a long way in making order out of chaos. Holding on to a routine brings a sense of normalcy during very abnormal times.

Finally, some years ago at a tag sale, I picked up a small 4X4 framed piece of embroidered needlework, never knowing how relevant it would be for these times. It reads: “Long is Not Forever.”  I hope you will hold on to those words as I do.

End of Life Decisions: A Broken Promise

End of Life Decisions: A Broken Promise

As a geriatric care manager, in the early part of my journey with senior adults and their families, I ask about advanced directives: a living will, power of attorney and a health care proxy. There will be one of three responses: 1. No, my mother refuses to talk about these documents. 2. We are planning to go to an attorney or 3. Yes, there has been a designated POA and health care agent.

If you fall into the number three category, it may be with relief that you have these documents in place. As the health care agent, you have had the “discussion” and understand the wishes of the person you will represent. You are certain that you can march forward through the complexities of end of life decision making. Yet for some, when the time arrives, that confidence becomes clouded by doubt. It’s not unusual. Such was the case for Lorraine, Anne’s daughter.

Anne, my client of nearly five years, confided in me with weekly regularity that she wanted to die. She knew she was losing her memory and was humiliated by what was happening. Other indignities followed. An extremely anxious person, the only comfort she took was that Lorraine knew her wishes and would do right by her.

Lorraine did not visit her mother with any frequency despite living just over the Westchester County border in Connecticut, a thirty-minute trip. Watching these meager visits and equally few telephone calls, I was sure that when Anne’s doctor called Lorraine to suggest hospice care, she would readily agree. To my surprise, Lorraine would not acquiesce. She acknowledged to me that she knew what she was supposed to do as her mother’s agent. The problem was she could not bring herself to make those final decisions about stopping advanced medical treatment, nutrition, and hydration. “Who am I to make those decisions?” she said to me. I wondered, was it unspoken hope or unease?

Anne lingered with time becoming the final decision-maker. In the days before Anne’s death, I said to Lorraine, with no suggestion of judgment, that she would carry with her whatever decision she made. I recognized that those who generously take on the role of health care agent do so with a full heart. But sometimes, good intentions can be superseded by last-minute questioning. Doubt fogs the road we thought we could readily take.

ADL’s and IADL’s: The Alphabet of Assessing an Adult Senior

ADL’s and IADL’s: The Alphabet of Assessing an Adult Senior

Where does this geriatric care manager start when a family is eager to help an aging parent?  The answer is an assessment. It is a bevy of questions that are asked to determine how best to approach the issues at hand. Some of the questions I ask are unique to the situation, but others are basic: Activities of Daily Living aka ADL’s and Instrumental Activities of Daily Living aka IADL.

Activities of Daily Living tell about an adult senior’s ability for self-care. Is a parent able to feed herself? This does not include preparing a meal or even chewing or swallowing the food, it is bringing food to one’s mouth. Dress and undressing without assistance, from underwear to shirt and tie.  Toileting: is the older adult able to ambulate independently or with a walker or wheelchair to the toilet?  Transferring:  can the person independently move from one place to another, from a bed to a chair?  Personal hygiene: can an older person bathe themselves, brush their hair, their teeth?

While the Activities of daily living provide a gauge as to whether an adult can live safely on their own, the Instrumental Activities of Daily Living, are also of important consideration. IADL’s include the ability to manage money this would include paying bills in a timely manner. The ability to go grocery shopping or to use a food delivery service. Getting to and from doctors’ appointments.  Household chores including doing laundry, hand washed or otherwise, and selective house cleaning.

Beyond these two significant areas, an assessment will look at the finances of the older adult to determine if there can be alternate living arrangements or home care paid for privately or thru an entitlement program. Knowing about family support within the geographic area in which the older adult resides is important. The role that can be played by adult children living at a distance. The physical, emotional and cognitive conditions the senior may be confronting, and the ability to take the corresponding medications responsibly. The “story” of the senior’s life. Personality traits, occupation, significant events that may influence how best to approach a parent. Who might it be in the family or beyond the family that may have the greatest chance of influencing the senior?

By combining responses to ADL’s, IADL’s, and the topics discussed above, this geriatric care manager can help families take the first step to bringing a parent to a healthier and safer way of living.  To this end, health care directives and a power of attorney should be in place to ensure that next steps can be taken without complications.

The Anatomy of an Appetite: Aging and Our Relationship to Food

The Anatomy of an Appetite: Aging and Our Relationship to Food

Many of life’s events involve food. From the grandest of celebrations to the smallest of gatherings, there is always a place for food. As an Aging Life Care Professional®, I recall a wonderful get together this care manager had organized to celebrate a client’s birthday, her ninetieth… I thought.  She so enjoyed her birthday cake. It was only after I re-did the math that I realized my enthusiasm was premature; Dorothy had another twelve months to go to before she reached her 90th year.

Dorothy took great pleasure in eating her birthday cake. But such enthusiasm for food is not shared by all adult seniors.  There are a variety of factors that may contribute to a decrease in appetite: the side effects of a medication, dentures that do not fit, loss of taste, feelings of loneliness as a senior sits down to a table for one and a myriad of medical conditions.  A wince as an older adult bites into an apple or a change in appetite after the start of a new medication are symptoms that may require a visit to the dentist or a call to the prescribing doctor.

The potential for resolving the nutritional problem described above are far more likely than the changes an adult senior experiences as the end of life approaches.  He or she may lessen their food intake and ultimately refuse all nourishment. Family members are justly concerned, confused and frequently feel guilty.  Often, they fear they are starving a loved one to death if food, liquid or some form of artificial nutrition is not provided.  For an adult senior with advanced dementia, the scenario is made more complex.  As the dementia progresses it impacts on that part of the brain that controls swallowing. The chance of choking increases. In either of these scenarios it is important to recognize as the end of life nears the body adjusts to the slowing down process and minimal amounts of nutrition or liquids are needed, if at all. Now the focus becomes comfort care. Moistening the mouth with a special sponge, applying lip balm or offering a small amount of water through a straw, teaspoon or syringe.

Aging Life Care Professionals understand that while parents may have left specific directives for no heroic measures, a daughter may find it too cruel to discontinue nourishment or fluids. A son may hope for a last-minute miracle or a spouse may feel that only time will dictate when to say the last good-bye.  As Aging Life Care Professionals, it is our role to hold the hand of our client and reach out our other hand to support the family in whatever their decision may be.


Miriam Zucker, LMSW, ACSW, C-ASWCM, is the founder of Directions in Aging based in New Rochelle, New York. For over two decades she has assisted families in customizing plans of care and developing effective strategies to meet the needs of older adults. She has recently been appointed to the board of directors of New Rochelle Cares, a non-for profit organization devoted to helping senior adults live safely and fully at home.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association® and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

Living a Heart-Healthy Life…With a Scoop of Ice Cream

Living a Heart-Healthy Life…With a Scoop of Ice Cream

Although American Heart Month is about to end, heart disease among adult seniors shows no signs of letting up. In fact, it is the number one cause of death in older adults and has been for the last two decades.

According to Dr. Jeannette Yuen, a cardiologist in the Scarsdale Medical Group in Harrison, New York, the most common types of cardiac disease are: Coronary heart disease, where plaque builds up in the arteries that inhibits blood flow; Arrhythmia, an abnormal heart rhythm that develops due to changes in the electrical impulses through the heart; Heart attack, which occurs when the blood flow to a part of the heart is blocked by a blood clot; and heart failure, when the heart’s muscle becomes too damaged to pump blood to the heart.

While chest pain is one of the prominent symptoms associated with heart disease, there are other symptoms not to be ignored: pressure and/or heaviness in the chest that can be mistaken for indigestion, shortness of breath, palpitations, a rapid heartbeat, sweating and nausea.  For women, there can be a group of unique symptoms: extreme fatigue, pain in one or both arms, back, neck or jaws. Also, there may be shortness of breath without chest pain.

As Aging Life Care Professionals®, we recognize that in the senior population heart disease may co-exist with other chronic conditions. Treatment for one condition may have a negative effect on another condition. It is for this reason that we obtain a full medical history, such as medications that are currently being taken and ones that have resulted in adverse reactions. We guide the caregivers so that they are aware of the symptoms that are out of the norm and recognize the importance of having open channels of communication between our clients and their physicians.

For both the family and the Aging Life Care Professional, there are no sweeter words than to hear a family member “is stable.” To that goal, if, for example, a pacemaker has been implanted, it is important to have it tested at regular intervals. It is also important to take medications as directed, not skip a dose, or abruptly stop a medication without consulting with a cardiologist.  While the importance of exercise has always been touted to strengthen the heart and improve circulation, as care managers, we must question if such expectations are realistic based on the physical and cognitive conditions of our clients.

Finally, there is the inevitable recommendation to eat a healthy diet. While this is certainly important, it is also important to include moments that are simply for the joy of them. I choose to go with poet Jenny Joseph, who wrote: “When I am old I will wear purple with a red hat that doesn’t go, and doesn’t suit me.”  To which I add, while wearing purple with a red hat, I will eat ice-cream, whenever the urge comes over me. If not now, then when?


About the Author: Miriam Zucker, LMSW, ACSW, C-ASWCM, is the founder of Directions in Aging based in Westchester County, New York. For over two decades she has assisted families in customizing plans of care and developing effective strategies to meet the needs of senior adults.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association® and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.