The theme this year for Older Americans Month, “never too old to play,” reminded me that none of us are too old to play.  The more I thought about this theme, the more it inspired me in my own life.   In fact, I made more time to play with my kids and realized that this was not only great exercise for our bodies but also healthy for our minds as we took time to laugh, play in the yard and act silly together.  I knew this was long overdue when my youngest son said, “Hey, Mom, you’re pretty fun to hang around with.”  A few days later, I took some time to call grandma and enjoyed asking her what she used to do for fun when she was a little girl.  The whole family felt thankful for the time we spent on the phone with grandma.  I’m impressed with grandma’s ability to use her cell phone as she had been very ill for a couple of years, and now she is healthy and preparing to turn 90!  How lucky we are to have this amazing women in our life.

It might be winter, but some of us are already dreaming of the baseball season, and I have a question for you:  What do organized sports—such as baseball—have in common with caregiving?

Well, for one thing, they both represent a rather significant amount of physical and emotional stress on the performer. For another, they both require a substantial measure of the following in order to achieve success:

• Concentration – How many times have you witnessed a pitcher lying down on the mound to take a nap after throwing the ball toward home plate?  The idea sounds preposterous, doesn’t it (unless he wanted to lose the game, of course). So, too, a caregiver must continually focus—not only to ensure that medications are taken and appointments are kept, but for seemingly countless other tasks, assessments, and pursuits of information and services.
• Physical and emotional fitness – A star athlete commands sufficient rest and sleep, a nutritious diet, sufficient water to drink, and a prescribed exercise program to maintain a healthy body, develop strength and endurance for the game, and remain competitive. Caregiving is no different!  The measure of ability to perform is directly proportionate to care of oneself, physically and emotionally.
• Teamwork – Have you ever observed a baseball game in which all of the team members except one remained in the dugout to cheer for a single player on the field?  Likewise, caregiving was never designed to be performed solo! The best caregiving situations are ones in which the caregiver receives the necessary support, whatever that might be and whether it is from family, community, or clinicians. Caregivers are more likely to provide optimal quality of care (and maintain their own quality of life) if they learn to ask for help—and if they learn to accept help when it’s offered. 

I have no doubt that the list of similarities between organized sports and caregiving could be expanded indefinitely. However, let’s not overlook the fact that there are also some dramatic differences between the two:

• Caregiving is not a game.
• Caregiving doesn’t typically stop after a couple of hours (its duties are often 24/7).
• The rewards of successful caregiving are better than any parade, trophy, or applause.

If you are taking care of a loved one or expect to be doing so in the future, why not consider making CICOA a key player on your team?

Need some ideas for holiday gifts for  the caregiver on your list?   Here are some suggestions for books that address health and caregiving.  There are lots of titles out there.  These are books that I can personally recommend.  And, the authors all have ties to Indiana.  

Patient in Affliction, by Debbye Butler, recounts her experiences as a caregiver for her mother who was dying of cancer.  The book is available through Amazon. 

Sick of Doctors?, by Lorene Burkhart, is a “prescription for patient empowerment” and encourages people to be their own medical advocate in the modern healthcare system.  You can order the book online at http://burkhartnetwork.com/sick-of-doctors/.  It is also available through Amazon.

In My Stroke of Insight, Jill Bolte Taylor, PhD  shares her experience in having, and recovering from, a stroke.  Her perspective as brain researcher and a patient in the healthcare system provides a unique look into caring for and communicating with someone who has had a stroke.  Dr. Taylor’s book is available on Amazon as well as at www.mystrokeofinsight.com.

Of course, you might be thinking, “If I want to read a book, I want it to take my mind off of caregiving or healthcare!”   I have a suggestion for that, too.  Mopey Dick, is the latest collection of humorous essays by Dick Wolfsie.  You can find it at www.wolfsie.com  as well as on Amazon.com.

Happy Holidays!  And Happy Reading!

In October, the Indiana University’s School of Social Work celebrated its 100th anniversary.  The IU School of Social Work is the oldest university-affiliated social work program in the country.   CICOA, like many other local nonprofit organizations, counts many graduates from this program among its professional staff.   Leaders from the school (Sheldon Siegel and David Metzger to name two) have also served on CICOA’s boards of directors and advisory councils.   From the beginning, the school focused on education, prevention and research to improve the lives of “the poor, ill and disabled.”   Originally housed within the School of Medicine, the then Social Services Department dealt with patients who “need more than medicine if they are to profit from visits to a hospital or dispensary.”  The School of Social Work has had a profound impact on the quality of human services programs in our community. 

One theme repeated throughout the celebration was that there are people in our society who, through no fault of their own, find themselves in need of help—an understanding that circumstances can overwhelm the individual. 

America is justifiably proud of its pioneer heritage and tradition of self-reliance.  But even as we celebrate individualism, we also must acknowledge that at times we need to turn to one another for help and “there, but for the grace of God, go I.”

A young man suffers a brain injury after being struck in a crosswalk by a car; a husband cares for his wife who has been diagnosed with Lou Gehrig’s disease; a child is born with significant birth defects; a widow struggles to make ends meet after her husband’s passing. These are just a few examples of the people who turn to CICOA when they find themselves in need. 

Another theme expressed was the importance of research and education.  The social worker not only helps the individual address the needs at hand, but also explores the why and the how those needs came to be.  And by understanding the causes, he or she works to build the individual and the community.  Treating the client as a person, not merely as a list of ailments or demands, has helped CICOA develop caregiver support services, expand our nutrition education efforts, offer transportation assistance, and work with hospitals to ensure that patients successfully follow their plans of care.   We teach, and learn from, each other. 

Congratulations to the IU School of Social Work.   All of us at CICOA look forward to your continued leadership in your second century.   

CICOA’s free workshops for caregivers, Managing Work and Care and Managing Home and Care, afford many opportunities for me to meet people in virtually every venue—corporations, churches, civic clubs and service organizations. Not only do I meet caregivers who had never heard of CICOA; invariably, following a workshop I am contacted by at least a handful of people who had not known that every person in this country has a “CICOA”.

Of course, the name of the organization in other locations is not CICOA—there can only be one local Area Agency on Aging in Central Indiana—but the concept is the same throughout the United States. That is, every state has a system of Area Agencies on Aging that is designed specifically to serve the aged and/or disabled populations of its region.

If you are a long-distance caregiver, this is extremely important news for you and your loved one, as having the support and peace of mind that you both need could be only a phone call away.

If your loved one lives in Indiana but is outside CICOA’s eight-county Central Indiana area (Area 8), check out this map for all of the Hoosier Area Agencies on Aging. To locate an Agency for a loved one living outside of Indiana, take a look at the National Association of Area Agencies on Aging (n4a) website and click on your loved one’s state—or, just give us a call us right here at CICOA.  Whether your loved one is in Seattle, San Diego, Orlando, or Anchorage, we’ll get you to the right place! 

Whether you are a taking care of a loved one or have only observed caregiving as an onlooker, please take a few minutes to read “Letting Go of My Father,” an article by Jonathan Rauch published in the April 2010 issue of The Atlantic. This article presents a rare and poignant view into the life and struggles of a caregiver whose loved one resisted personal assistance despite diminishing competence for self-care.   

With extraordinary candor, Rauch relates how he moved his father—diagnosed with Parkinson’s—from Phoenix to Washington, D.C., so that he could provide help as needed. The cross-country move was challenging enough, but by about day three, the author discovered that his father (ironically) was resistant to the help he desperately needed.

As caregivers, we’re often conflicted between the desire to preserve a fragile family member’s dignity and ensuring that person’s safety and well-being.  At some point, though, a moment of reckoning may occur when a choice between the two becomes necessary. (In my opinion, safety considerations must always be the priority, even if that means losing a popularity contest.)  For the author, that moment arrived with the realization that his well-being also was at stake.

 “That was the day I realized that [Dad] could not cope and I could not cope and, emotionally, he could take me down with him,” said Rauch.

The author then explained his determination not to let that happen, and the measures he implemented to avert common stress-related illnesses, such as post-traumatic stress syndrome, anxiety disorder and depression.

“Letting Go of My Father” was republished in the September 2011 issue of Reader’s Digest by the title “The Quiet Crisis.”  I have to say that this title troubles me somewhat. Though many caregivers struggle on their own without adequate preparation or support and carry a burden that is little known or understood by the non-caregiving population, I would add that caregiving is not a crisis only for the individual caregiver.  It might be “quiet” at the moment, but be aware:  Caregiving is a national crisis that has the capacity to critically impact every segment of our society—caregivers, care recipients, employers, government, taxpayers—if we do not proactively seek measures to prepare and support the family caregivers among us. 

CICOA stands ready to assist those who are caregivers and to offer important information about caregiving to those who are not.  We are here to listen, and we are here to talk!  Call us at (317) 254-3660 or email caregivers@cicoa.org for more information.

My first brush with feeling “old” was when I turned 36.  That was when I moved from the “21-35”  to the “36-50” age group on all those surveys you fill out for warranty cards, magazine subscriptions and the like.  Thirty-six meant I wasn’t part of the young adult demographic anymore.  But, that was okay.  I was married, with three kids and a mortgage. I was a grown up, and I was fine with that.   Forty came and went.  Fifty is just around the corner.  No big deal.

Then the August 2011 issue of Senior Life lands in the office, and I see Ann and Nancy Wilson on the front page.  Heart is out on tour this summer with Def Leppard. It’s an oldies tour.  Now, that made me feel old. 

“Oldies” is big business: radio stations, concert tours. Some of the biggest acts in show business are performers in their sixties (and seventies).  Classic rock tunes fill television and radio ads, movie soundtracks and video games (Guitar Hero, anyone?) And oldies aren’t as old as they used to be.  John Mellencamp, The Cars, Michael Jackson, Madonna and Bruce Springsteen fill the playlists, replacing Elvis and the Moonglows.  My new wave bands are on the oldies station.

Of course, most people don’t want to call it “oldies.” 

"Nobody that listens to the radio wants to say they're listening to oldies," said Bob Burke, vice president and managing director for the radio-industry trade magazine/website Friday Morning Quarterback. "They're just listening to their favorite songs. People don't want to be told that they're old."

To quote Oliver Wendell Holmes, “Old is fifteen years older than I am now.”  That seems to apply to music, too. 

Recently I became aware of a new guidebook by The Hartford that is just too good not to mention here. In case you hadn’t known, The Hartford publishes several excellent and very practical guidebooks that are free for the asking!

This most recent publication, Simple Solutions: Practical Ideas and Products to Enhance Independent Living contains more than 200 products and design ideas that can facilitate and enhance a greater level of independence for older persons and anyone with a disability. I must admit that most of the time I don’t really think about there ever being an occasion to need a hands-free hairdryer, a door device to make forced home entry impossible, double-sided carpet tape, suction-cupped nail clippers, or “talking” blood pressure monitors or tire gauges. However, I know that many in this audience would be delighted to find some of the products discussed in the book and would see immediate application for them.

The ideas and products provided in the guidebook—organized according to need—address assistive requirements in the general areas of vision, hearing, mobility and balance, strength/dexterity and reach, memory, and fire and burn safety. The book extends beyond the simple description of products, however. Listed with each product is the approximate price range one can actually anticipate and—very important—names of suppliers who carry the product. To make it easy to procure a product, the back of the guidebook contains a supplier catalog that provides all company web and contact information for the 80+ suppliers referenced.

Simple Solutions: Practical Ideas and Products to Enhance Independent Living concludes with a substantial home checklist that enables one to assess home for its comfort, convenience, safety, and security. Contact information for several additional resources, e.g. the National Resource Center for Supportive Housing and Home Modifications, is included.

This guidebook and others can be obtained online from The Hartford at www.thehartford.com/lifetime (for this particular book, click on “Home for a Lifetime”) or by phone from CICOA’s Aging & Disability Resource Center at (317) 254-3660.

Sometimes the smallest gift can give the biggest smile.

My Grandma lives in Ohio. She is happy and settled in to her new surroundings.  Grandma use to live alone, but now she needs more help.  She loves her new roommate and going to Bingo with her friends. 

Last time I visited her, she told me, “I have no complaints about my new home except for one, the institutional food is so bland.  The kitchen tells me that some people can’t handle too many spices, but the meals just have no flavor to me.” 

Grandma was an awesome cook and she loved to use lots of herbs and spices in her special recipes.  Now that she is unable to cook her own food, I imagine it difficult to please her.  I wanted to send her some herbs and spices that she could use to jazz up her food, but these days she doesn’t have as much space to store these items.  I decided to send her a few salt-free seasoning blends that she could use on her meals.  Grandma always loved Italian foods, so I sent her an Italian seasoning blend.  I also sent one of my favorites--onion and herb. Both of these blends are versatile and can be used on various types of foods.

She loved them both.  This little gift has made such a huge difference in her life.  It made me feel good that I could send her a little happiness, especially when I live far away and am unable to visit as often as I would like.

This likely is not the first place that you have read about the dramatic increase in the number of older adults as the Baby Boom generation begins to enter retirement.  Over the next twenty years, the number of seniors, those age 60 and older, will double.  One person in five in Central Indiana will be of retirement age.  One might wonder where we will put them all!

As we age, most of us intend to stay in our homes and communities as long as possible.  For some, this means they will look into assisted living.  According to an October 4 list published in the Indianapolis Business Journal,  the “25 largest Indianapolis-Area Assisted Living Facilities” have as a group more than 2,600 units comprised of efficiency, one and two-bedroom apartments.ⁱ   Rents started at $650 and up, and there is a wide variety of amenities available, including pools, spas, home health services and memory care.    Some offer resort-style living, while others place more of an emphasis on the availability of healthcare services and the concept of a “continuum of care” community.ⁱⁱ

Many find the concept of assisted living appealing: no more painting the house or mowing the lawn, access to care when and if it is needed.  And, because assisted living is considered a community-based care model, it is part of the overall strategy to rebalance long-term care by making more use of home and community-based services instead of nursing homes.

Finding information about Assisted Living Facilities can be a challenge for the consumer.  There is no standard definition of “Assisted Living”.  One person’s assisted living facility may fit another’s definition of nursing home. A standard definition is important; a facility’s status as a community or an institutional setting has an impact on the services available to residents, and even whether or not the service is covered through Medicare, Medicaid, long-term care insurance or private insurance.

The US Department of Health and Human Services has proposed a rule that would standardize the definition of “assisted living.”   As proposed, to be considered Assisted Living, the following conditions would have to be met.

• The individual has a lease.
• Setting is an apartment with individual living, sleeping, bathing and cooking areas, and individuals can choose whether to share a living arrangement and with whom.
• Individuals have lockable access to and egress from their own apartments.
• Individuals are free to receive visitors and leave the setting at times and for durations of their own choosing.
• Aging in place, or allowing individuals to remain where they live as they age and/or support needs change, must be a common practice of the ALS.
• Leases may not reserve the right to assign apartments or change apartment assignments.
• Access to the greater community is easily facilitated based on the individual's needs and preferences.
• An individual's compliance with their person-centered plan (in the event that the individual has shared his/her plan or the landlord is also the provider of services) is not in and of itself a condition of the lease.

The proposed ruling is now available for public comment on the web. To read the proposed rule or comment on it, visit www.regulations.gov and follow the instructions under the "search for a proposed rule" tab, then type CMS-2296-P in the box for “enter keyword or ID”.  Comments may be posted between now and June 14. 

And, if you are looking into Assisted Living or other long term care options for yourself or a loved one, here are some helpful links to help you find the program or service that is best for you. 

CareAware
http://www.cicoa.org/careaware.html

CICOA’s Solutions Guide (online)
http://www.cicoa.org/solutions-guide.html

“How to Select a Nursing Care Facility”
http://www.cicoa.org/how-to-select-a-nursing-care-facility.html

“Housing:  Retirement Communities”
http://www.cicoa.org/solutions-guide/75-housing-retirement-communities.html

[i] Indianapolis Business Journal, “Largest Indianapolis-Area Assisted Living Facilities,” October 4, 2010. 

[ii]Continuum of Care: A range of services developed and organized to address the variety of needs individuals have as they age. This concept recognizes and considers the availability and extent of short-term and long-term care systems and services in the community and in institutional settings. Included in the continuum of care are residential alternatives, in-home care, community programs, and institutional services.

CICOA’s efforts to create Lifelong Living Communities for seniors and people of any age with a disability are based on several core beliefs.   One of those is that what is good for seniors is good for everyone.   While this may sound a bit egocentric to the younger crowd, these few examples should prove otherwise.

1. Lifelong Living Communities contain homes that have one entrance without steps; hallways and doorways at least 32 inches wide; and a bathroom on the main floor.   This helps seniors using walkers and canes to get in and out of the house, maneuver around the home and use the bathroom safely and easily. It also helps the teenager who is using crutches while recovering from a sports injury.
2. Installing single handle faucets on all sinks, especially in the bathroom, helps seniors who have trouble grabbing and turning knobs, turn on the water and switch from hot to cold. It also is advantageous to the parent who is holding an infant and has only one hand available for drawing warm water.  
3. Installing grab bars on each wall around the bathtub makes getting in and out of the tub less scary for seniors and provides them some peace of mind.  Grab bars also have saved younger adults and children from serious accidents in the bathtub.
4. Widening all sidewalks to at least four feet unobstructed (no fire hydrants or light poles in the middle) allows two wheelchairs to travel side by side so the occupants can carry on a conversation.  It also allows parents pushing strollers to pass bikers more safely.

Examples of "what is good for seniors is good for everyone" also abound in the areas of transportation, housing, employment, health, infrastructure, and community service.  I will mention some of these in future blogs.  

We could all use some tips to save a little cash.  It does take a little planning and time to save money on your food budget.  I’ve found this planning makes dinner time more relaxing as well.  Picture yourself getting home from work or other activities and knowing exactly what you are going to fix for dinner.  Let’s face it… this takes a load off when you are tired from a long day.  Use the tips below and you’ll see it is possible to save money and eat healthier at the same time.

• Use foods that you already have in the house.  Take inventory of your refrigerator, freezer and shelf stable foods.  This will decrease waste and save money.
• Arrange inventory into food groups. Check for meat, meat alternatives, beans and eggs or any other protein sources.  Next look for vegetables, fruits, low fat dairy and whole grains.
• Plan your meals for the week.  Use any leftovers from a previous meal to make a future meal.  For example:  Grilled fish or chicken from last night can be used in a quick salad or whole wheat wrap for the following lunch or dinner.  Toss in some broccoli slaw or shredded carrots to add more nutrients.  Use fruit as a side or a snack.
• Make a list of what you will need to add to your inventory to make well-balanced, healthy meals.  Choose fruits and vegetables that are in season to save on cost.
• Check grocery store ads and look for stores which have sale items that match your list.  Adjustments may need to be made to take advantage of sale items at this point.  Remember frozen foods can sometimes be more nutrient dense than fresh foods.  If buying canned foods, look for low or reduced sodium.
• If saving money is your primary goal, visiting more than one store may be cost effective as long as you don’t have too far to drive.
• Clip coupons for items that you plan to buy.  Caution:  Cutting coupons for items that are not on your list will cost—not save— you money.
• Buy lean meat in bulk when it is on sale. Separate it into servings when you arrive home and freeze the extra portions for future use.   
• Purchase extra frozen vegetables and fruits when they are on sale for future use.
• Once you are home, keep foods in an organized fashion so that you will be able to find and use them quickly and easily.  For example: Store all canned beans together, whole wheat pasta together, all frozen fruit together on the same shelf in the freezer; fresh vegetables in the produce drawer in the refrigerator; and so on.
• Beware of snack food items, prepared convenience foods and sweetened beverages that can add a huge expense without the value of nutrition.

Shopping at Farmer’s Markets is a great way to support local farmers and the local economy.  It provides fresh and nutritious produce because the produce is not traveling from long distances.  It also is better for the environment due to less fuel and packaging used to deliver the produce to a closer location.  Lastly, it is fun to go to local markets and walk around to see what each vender has to offer and get some healthful activity into your day as an added bonus.  We can all use a way to get more activity.

Recipe

Crock Pot Chicken Cacciatore         

• 2 lbs. boneless, skinless chicken breast
• 14 oz. can diced tomatoes with Italian seasoning
• 6 oz. can tomato paste
• 1/2 cup chicken broth
• 1 onion, sliced
• 3 cloves garlic, minced
• 2 green bell peppers, chopped
• 1/4 cup dry red wine
• 1/8  teaspoon pepper

Place all ingredients in 3-4 quart slow cooker. Cover and cook on low 6-8 hours until chicken is thoroughly cooked and tender. Serve with hot cooked pasta, if desired.  Makes 6 servings.

Source: www.netwellness.org

This recipe is a good source of Vitamin A, Vitamin C and lycopene to help reduce the risk of cancer and great for heart health too.

Tips:  Use low sodium chicken broth to reduce the sodium content.  Non-alcoholic red wine, low sodium chicken broth or vegetable broth can be used in place of dry red wine.

Nutrition Information per serving:

Calories: 359
Fat: 8 g
Protein: 35 g
Carbohydrate: 18 g
Sodium: 369mg

Years ago I knew someone in her forties who had been diagnosed with a rare, terminal blood disorder.  At the time, no one knew when her final outcome here would occur, of course, but we all knew what that outcome eventually would be.  Upon her return to the United States for treatment following a long career in another country, a less-than-insightful person approached her in the supermarket to audaciously inquire, “Aren’t you the woman who’s dying with a fatal disease?”  My friend grinned and kindly replied, “Well, no—actually, I’m living with one.” 

I was reminded of this story last week while attending the Indiana Alzheimer Disease Center’s 2011 Spring Symposium.  While we could write pages on the incredible value of this annual event—which features renowned scientists presenting the latest in clinical research for memory and aging as well as exciting advances in such things as neuroimaging and genetics—one presentation in particular fused itself to my aging memory.

Mary Guerriero Austrom, PhD*, author of the presentation, "Finding the Joy in Caregiving," understands that some caregivers are better than others when it comes to coping.  Admittedly, as explained by Dr. Austrom, caregiving is fraught with special challenges that elicit virtually innumerable combinations of responses that are unique to every situation.  Often we talk about the frequently observed negative responses to these challenges—the depression, physical illnesses, feelings of anxiety or guilt, for example.  It seems that we speak less often of the positive responses to caregiving itself—joy, happiness, sense of purpose, sense of satisfaction and accomplishment, to name a few. 

Why are some caregivers better at coping than others?  According to Dr. Austrom, the better “copers” are those caregivers who are more likely to:

• Engage in less denial—they have a sense of acceptance and are realistic
• Speak up when necessary by asking questions, asking for help, and gathering information
• Break down difficult tasks into smaller, more manageable ones
• Take one day at a time
• Look for meaning in their role
• Maintain a positive attitude

That last one, maintaining a positive attitude, is not always easy—but it’s a key element in finding the joy in caregiving, and the presentation covered myriad suggestions for how to do so.  Of all Dr. Austrom’s very practical suggestions for remaining positive, however, I was most soundly affected by the presentation summary:  “Think of this as a journey, and pace yourself—remember, it will end” and “Focus on living, not on the disease or the dying.”

Yes—caregiving is a journey that, without exception, does indeed have an end, or “outcome”.  An outcome might not occur as we would choose (as in the case of losing a loved one)—or, it might not happen as quickly as we would prefer (as in the case of someone working to mend from a broken hip or recover skills following a traumatic brain injury).  However, the outcome will occur whether or not it is the focus of the journey.  I believe that where we choose to focus our attention most certainly will affect not only today’s quality of life, but also how well we as caregivers are able to cope, both throughout the process and when the journey is done. 

My friend who was “living with a fatal disease” consistently focused on her daily journey and lived every day to its potential until reaching the outcome of her illness.  Those of us who are on a caregiving journey can choose that same path—focusing, as my friend did, on finding the joy in the journey.

* Mary Guerriero Austrom, PhD is the Wesley P. Martin Professor of Alzheimer Disease Education in the Department of Psychiatry and Director of the Education Core of the Indiana Alzheimer Disease Center at Indiana University School of Medicine, Indianapolis IN.

My Grandma Bell was an amazing woman.  She was a great cook; no one could make better fried chicken or lemon meringue pie.  An avid gardener, the house and the garden seemed always in bloom and she knew the name of every variety that grew in the neighborhood.   She sewed many of her own clothes.  Played the piano and sang in the choir.  She did many things well.

But one thing she never learned to do was drive a car.  And so, after my Granddad passed away she relied on my dad or Uncle Ed or my brother or me to take her places she couldn’t go on foot or on the bus.   This worked pretty well most of the time.   But on one particular day, Grandma needed a ride to the mall.  There wasn’t a direct bus route, and the usual drivers (including me) weren’t available. 

I knew that our agency had a regular van shuttle each week from the senior center to the mall.  So, I took our brochure and the contact number for the center to Grandma’s house.

“Grandma,” I said, “the next time you can’t get a ride, how about using the senior center shuttle?  The van can pick you up.”

“Oh,” she said.  “I thought that was just for old people.”

Grandma was 78.

Grandma never had a problem singing in the senior choir at church.  And no one was ever prouder of her role as grandmother.  But I don’t think she ever took me up on the idea of using the senior center’s van for a ride to the store. Grandma never was old enough to need that kind of help.

Oliver Wendell Holmes once said, “Old is fifteen years older than I am now.”  He was onto something there.  Our ideas about getting old and being old change as, well, as we get older.  And all of us approach aging and birthdays a little bit differently. 

I remember the first time I felt old – it was the first time I filled out one of those customer service cards and had to check the age box for 36 – 50.  I wasn’t one of the “21 – 35” people anymore.  I’ve got another one of those bracket birthdays coming up.

When exactly do people get old? When should a person think about calling CICOA?

The right time to call CICOA is when you need us. 

March is National Nutrition Month, and the theme for this year is “Eat Right with Color.”

It is easy to add variety and delicious flavors by splashing various colors of fruits, vegetables, whole grains, low-fat dairy and lean meats into your meals.  When choosing fruits and vegetables, think color—green, orange, red, purple and white.  These colors in fruits and vegetables provide an array of vitamins and phytochemicals.  Phytochemicals are naturally occurring plant compounds in fruits and vegetables that may have health-promoting abilities.

• Dark orange and dark green leafy vegetables are a good source of the phytochemical beta carotene.  This nutrient is important for vision and immune function.  Some sources include sweet potatoes, carrots, winter squash, spinach, kale and other dark green vegetables.
• The major phytochemical in the blue category is anthcyanidins.  These super antioxidants have been linked to improved blood vessel health and can be found in many types of berries, plums and red onions.
• Another family of vegetables called cruciferous vegetables have been shown to have anti-cancer properties.  My kids love to say “cruciferous” because they think it sounds like an alien word.  Include broccoli, brussels sprouts, cabbage and kale to get these super phytochemicals into your meals.
• Your mom always told you to eat carrots, and she was right. Zeaxanthin is a carotenoid found in carrots with antioxidant power to keep your eyes healthy.  Yet carrots aren’t the only foods that are good for your eyes.  Eating plenty of green leafy vegetables like kale, spinach and collard greens may help to prevent macular degeneration.
• We can also benefit from eating red fruits and vegetables.  These contain lycopene and help to reduce the risk for many cancers, especially prostate cancer.  Add more raw and cooked tomatoes, watermelon and red peppers. These also are great for heart health.

For the most health benefits, consume a wide variety of fruits and vegetables of different colors each day.  For more information on fruits and vegetables, go to the Purdue extension web site: www.extension.org.  Also go to www.eatright.org for daily nutrition tips. 

Sources: www.extension.org and www.eatright.org 

Rebalancing Long-Term Care in Indiana

Imagine if Indiana’s long term care services resembled the State of Washington’s. . .

·         Indiana would spend $974 million for long term care services annually for the 37,000 people currently enrolled in the programs (a savings of almost $500 million).[i]

·         The savings would be enough to serve the 6,000 people currently on the waiting list for Medicaid A&D Waivers, with $342 million left over.

·         Nursing home reimbursements would be higher and care would be of higher quality. 

To be fair, Washington’s long-term care programs are the result of thirty years of focused effort on increasing access to home and community-based care.  Indiana has a lot of ground to make up. 

Indiana has made tentative steps in this direction.  The CHOICE program, a state-funded program to provide home and community-based services was started in 1987 and served more than 9,000 Hoosiers in 2009.  From August 2008 through December 2009, the state adopted a “no waiting list” policy for Medicaid Aged and Disabled Waivers, which greatly expanded the number of people able to access services outside of a nursing home.  In 2009, Indiana began participating in Money Follows the Person (MFP), a program that targets nursing home residents for re-entry into the community.  And the Division of Aging put forth a plan in December 2009 aimed at improving nursing home quality and expanding the use of home and community-based services.[ii] 

But as I write this blog post, Indiana has reduced the number of Medicaid A&D Waiver “slots” in use, and the proposed state budget for 2011 and 2012 includes a reduction in funding for CHOICE.   CICOA has a waiting list for Medicaid A&D Waiver services numbering 1,200 people in Central Indiana alone. And, while Indiana projects it will spend $30 million less on home and community care in 2011 than in 2009, it will spend $368 million more on nursing home care.[iii]  Indiana’s older adults deserve better.   

Home and Community Based Services save money.  They improve the quality of life for older Hoosiers.  And they provide services in the way preferred by the seniors and their families.  These programs and the people they serve need your support.

Participating in the "Living a Healthy Life" workshop is an experience that will change your life.  It has been the light bulb that many of our clients have needed to take much needed steps to make their lives better.  This evidence-based workshop has been proven to decrease fatigue and visits to the physician, increase activity and improve one's overall feeling of well being and self confidence.  It allows people to take control of their lives even when they have multiple health conditions.

This self-management workshop has a focus on various topics including action planning, better breathing, improving communication, healthy eating and increasing activity. It is the process in which the program is taught that makes it effective. The workshop includes many opportunities for class participation where support and motivation from classmates and leaders have an amazing impact on participants in the class.  It is a joy to participate in the growth and self confidence that participants gain from managing their health and maintaining more active and fulfilling lives.

"Living a Healthy Life" is specifically designed for adults age 55 and older and caregivers who aim to gain control over ongoing health conditions.  The course is six weeks in length, once per week, and two and a half hours long.  This may appear be a large time commitment, yet everyone is amazed at how fast it goes by when you are in the class.  To get more information and register for the next upcoming class, please call 317-803-6029. Training is also available for individuals interested in volunteering to become a trained leader for the "Living a Healthy Life" workshop.

The title to this blog could mean the score in a tennis match, but it deftly refers to the ad-vantage In-diana has over other states in making our neighborhoods, our communities, and our state “elder friendly.”  CICOA began the process in 2002 when it was selected as one of ten cities in the country for the AdvantAGE Initiative. 

The AdvantAge Initiative is a community planning process and a framework for creating communities where older adults can enjoy healthy, independent, productive and satisfying lives.  It was founded on several core principles:

• Life’s later years are a time of opportunity, self-actualization and contribution.
• All people want to live at their most independent level.
• All people require access to fulfill basic needs, such as food, shelter, clothing and transportation.
• All people need access to adequate physical and mental health care.
• What’s good for seniors turns out to be good for everyone.
• Seniors have a store of accumulated wisdom, experience and positive relationships that should be seen as assets to the community.

In short, the AdvantAge Initiative recognized our older residents as community resources.

Since its inception in 2002, CICOA has championed the cause in Central Indiana.  Using an AdvantAGE Initiative survey we ascertained the “elder friendliness” of our community, identified needs, and developed strategies to address them.  Our Lifelong Living Communities department was then created to implement those strategies. 

From the survey, we found that almost 94 percent of the seniors in Central Indiana wish to remain in their homes as they age.  And, many of them realized they would need accessibility modifications to continue living there.  So that became priority one.  We sought and acquired grants from foundations, estates, and corporate and personal donors.  Using those funds, we have made accessibility modifications to more than 100 homes for low-income, senior homeowners.  While that is good and great, it is only a drop in the bucket of needs.  Our research reveals that there are as many as 11,000 seniors in Central Indiana who need home modifications to continue living independent, healthy and safely in their homes.

How One State Does It

Washington and Indiana have similar demographics.  Washington‘s senior population (age 65 and older) is slightly lower (760,000 vs. 800,000).  The states have similar numbers of adults with a disability (approximately 1 million).    The two states have similar program eligibility requirements for home and community-based services for older adults and adults with a disability. Washington’s Medicaid payments for long-term care are slightly higher ($1.5 billion compared to $1.4 billion).   But, while Washington spends 7.1 percent more on long-term care, the state serves 54.1 percent more people.  How does Washington state manage to support 57,000 older adults when Indiana serves 37,000 for a similar amount of money?

Put simply, Washington makes more use of home and community-based services for long-term care needs.   Eighty-one percent of Washington’s seniors receive attendant care, therapeutic services or skilled nursing care in their homes.  Nursing home residents comprise 19 percent of the population served through Medicaid. By comparison, more than 75 percent of Indiana’s low-income seniors with long-term care needs are institutionalized.  Washington’s Medicaid payments to nursing homes in 2009 came to $580 million.  In the same year, Indiana spent $1.2 billion.ⁱ

Washington’s commitment to home and community-based services helped it reduce its nursing home caseload by 16,000 from 1972-2010. The senior population more than doubled over that same period.  Reimbursement rates for care providers are higher, as is program quality.  Out of 229 nursing facilities in the state of Washington, 15, or 6.5 percent were rated as “one star” homes by Medicare (compared to 20.2 percent of Indiana nursing homes).ⁱⁱ  And, there are no waiting lists for home and community-based services through Medicaid.

In my next blog post we will take a look at how to rebalance long-term care in Indiana.

These statistics on Washington’s long term care programs were provided by Kathy Leitch.  Leitch served in a variety of leadership roles in Aging Adult Services in the state of Washington from 1993 to 2010 and is a past president of the National Association of State Units on Aging.   Today she is a passionate advocate for the effectiveness of a robust home and community-based services program in improving quality, building consumer choice and controlling the costs of long-term care. 

[i] Thomson Reuters, 2009 Medicaid Data

[ii] Ratings from Medicare.gov