A Holiday Gift for Your Aging Loved One

This season of joy and celebration affords us the opportunity to make special moments with our loved ones.  For some, the Holidays can also be a time of uncertainty and worry about how to embrace what the present presents us.  How do we celebrate as we always have if our loved one is declining? How do we give a gift to our dear family member with dementia who may not be able express words or understand the gifts we give?  What do we give to someone who does not always recognize us or their home?  How do we honor our loved one who does not feel like being a part of the Holidays because of depression, illness, or other life challenges?  How do we help the caregiver celebrate the Holidays as well?

Is the common reply, “nothing”, when you ask what they need? When asked how they are, is the answer always, “fine”?

The gift of presence

What does it mean to be present?  Giving your full presence to someone means offering simple awareness.  It means putting the phone down and paying attention.  Be intentional about what you are doing.  Being present means being mindful of who you are with and your surroundings.  Thich Naht Hanh, one of my favorite authors on mindfulness and presence said this, “Life is available only in the present moment.  The past is gone, the future is not yet here, and if we do not go back to ourselves in the present moment, we cannot be in touch with life (Hanh, 2004).” 

Jon Kabat-Zinn is another beloved author on this subject.  He notes that when we are fully present with someone we allow ourselves to see others as themselves in a nonjudgmental way and not as a reflection of our feelings about them.  We limit our ability to fully be in the moment with someone by failing to notice what is really going on.  When this occurs, we are at risk of overlooking the opportunity to really connect and experience what we desire most in our relationships (Kabat-Zinn, 1994).

Practical suggestions on giving the gift of presence during the Holiday Season.

Prepare ahead to create a mood or atmosphere reflective of a time when you have enjoyed each other and created memories.  Think of our five senses. Sensory changes begin to occur in our 40’s and 50’s, but begin to limit our behavior and actions in our 70’s and 80’s.  This is particularly significant in older persons trying to maintain some independence as well as those living with dementia.  In older age, both amount and quality of sensory stimulation are essential to familiarizing one with their world (Saxon, Etten, & Perkins, 2015).  Elderly persons are often isolated.  As active and well individuals, much of what we do adds purpose and meaning to our life.  It also provides stimulation to our senses to help ground us in our world.  Remember the importance of hand-holding, touching, and hugging.  Often when there are no words, we can communicate thru touch (Mace and Rabins, 2011).  When is the last time someone trimmed your loved one’s nails, put lotion on their arms, sat close to them touching their arm or back?  

For those unable to continue their usual activities (even with dementia), it is important to help them find things to do that are meaningful and within their abilities.  Music can be a meaningful component of everyday life and a wonderful way to connect with your loved one.  I recently met with a professor at the University of Indianapolis’ upcoming music therapy program.  She noted that studies have shown memories can be brought to the forefront of thought when music is heard from various time periods in a person’s life.  In particular, individuals with dementia find songs they heard in their young adult years to be the most memorable and stimulating.  Is there a genre of music that brings you two together? Play some Christmas melodies from when your loved one was in their 20’s.  See if it stimulates some memories and meaningful conversation. Tell them about your favorite Christmas song, how it makes you feel, and why.  Take things a step further and ask your loved one to dance – what a gift to give each other and an opportunity to practice being fully in the moment.

Setting out spices or scents of the Holidays can stimulate warm thoughts and memories even if they are unable to express it.  This is especially important for loved ones with dementia.  The scent of cinnamon can bring someone back to memories of baking Christmas cookies.  Sometimes holding a special object reflective of your family’s Holiday traditions can be very grounding for your loved one.  The texture, the colors, the weight of the object can be very comforting.  Bringing out old photographs, videos, or decorations can center the tone of the visit.  Is there an old family recipe or dish that your loved one always enjoyed that hasn’t been prepared in a long time because no one else likes it? (Think mincemeat pie or persimmon pudding).  The memories and feelings evoked by an old family dish maybe worth the effort of making something special just for them.

Allow them to be heard, to talk and reminisce.  Yes, it may be the same old story, but it gives them validity.  It allows them to feel they still matter.    

I recently overhead a loving, well-meaning adult child share that her mother’s legs would not be so swollen if she would just wear her stockings. Have you experienced a frustration with your loved one?  Make the time to consider why they may not be doing something for themselves that would benefit them.  Is it too difficult to do?  Are they too proud to ask for help?  Do they forget? Do they not have the strength?  Be present with them.  Put yourself in their shoes, or literally put yourself in their stockings.  They really are difficult to put on.  What your loved one really needs will present itself when you take a moment to connect and be present with them, where they are, in that moment.

The best gift you can give your loved one this Holiday Season is the gift of you.

REFERENCES

Hanh, T. (2004). Taming the tiger within: meditations of transforming difficult emotions. New York, NY: Riverhead Publishing.

Kabat-Zinn, J.(2014). Wherever you go there you are. (10th ed.). Boston, MA: Hachette Books.

Mace, N. & Rabins, P. (2011). The 36 hour day. (5th ed.). New York, NY: The Johns Hopkins University Press.

Saxon, S., Etten, M., & Perkins, E. (2015). Physical change and aging: a guide for the helping professionals. (6th ed). New York, NY: Springer Publishing.

Medicare and SHIP Counselors

I recently completed training to become a Certified Counselor in the Indiana State Health Insurance Program, otherwise known as SHIP. This is a free and impartial counseling program provided by the Indiana Department of Insurance for Medicare beneficiaries in Indiana.  SHIP counselors and counseling sites are available thru out the state of Indiana (other states have this program as well).

If you are Medicare eligible or will be turning 65 soon, I strongly recommend scheduling an appoint with a SHIP counselor at a SHIP site near you.  Medicare coverage options are complicated and choosing the right plan makes a big difference in your pocketbook. Know that if the Counselor cannot figure it out, they have access to experts and additional resources.  Be proactive and plan ahead.  Remember it’s free of charge. Your tax dollars pay for this service.  You can find the SHIP site nearest you on the SHIP website below and call to make an appointment.

Open Enrollment for Medicare Advantage (Part C) and Medicare prescription drug coverage (Part D) is October 15-December 7.

Did you know? ……

The “donut hole” for Medicare Part D drug coverage will no longer exist starting 2020! That’s good news for those 65 and older.  Being in “the donut hole” is financially straining and frustrating.

Information about the donut hole regarding Medicare Part D

o   Annual deductible cannot exceed $360

o   Currently, Part D pays at least 75% of the drugs until the total drug costs reach $3310 for the year.  The gap or “donut hole” then begins until your out of pocket prescription costs reach $4850 for the year.  The plan then restarts coverage and pays at least 95% for rest of year.

o   Donut Hole to go away by 2020.  Drugs will be 75% covered by Part D continuously with no gap in coverage.

Did you know? …..

The Shingles vaccine is not covered under your Medicare Part B like your flu shot and your pneumonia vaccine. 

The Shingles vaccine is covered under your Medicare Part D coverage. 

How do I avoid a bill and the least amount of hassle?

o   Get your shingles vaccine at the pharmacy if you have Part D coverage

Did you know? …..

If you are age 65 and older, working, and still carry your employer’s insurance you could be switched to a Medicare Advantage Plan.

Recently in Northern Indiana, some Medicare eligible employees found their traditional insurance thru their employer had been switched to Medicare Advantage.  Medicare Advantage plans will likely not have the same coverage as your current plan.  Insurance companies are required to notify you that your insurance will be changed to an advantage plan unless you choose to opt out and keep your current plan.  Unfortunately, some of these notifications have been thru the local newspaper or a mailed letter that was not opened. 

The take away message here is if you are 65 and older and covered by your employer’s insurance, talk to human resources and talk to the insurance company and find out what their plans are.  You can get stuck with a Medicare Advantage plan if you miss the period in which you need to inform them you want to opt out.  I plan to reach out to my state elected officials and share my concerns about this approach.

 Important websites

Social Security:  www.socialsecurity.gov

Medicare:  www.mediare.gov

Indiana State Health Insurance Program (SHIP):  www.medicare.in.gov