Senior care

tour special needs family

Everyone needs a checkup regularly. But some seniors (and juniors!) reason that since they just saw the doctor last month about that sinus problem, they don't need to go again. A visit to the doctor for a specific problem doesn't take the place of a complete checkup.

Make sure your father is getting a balanced diet. Accompany him to the market to guide shopping choices, teach him to read labels, and discuss the importance of all the food groups, vitamins, fiber, and calcium.

ID jewelry with pertinent medical alert and contact information should be worn by all seniors. There is a huge variety of bracelets, pendants, and even watchbands available, many of them quite attractive, in stainless steel, sterling silver, and gold. Two companies that sell them are American Medical Identifications (1-800-363-5985 or and Medic Care Inc. (1-561-748-0840 or Know your mother's baseline-what's "normal" for her. Some seniors have a lower normal body temperature than 98.6 degrees Farenheit, and others have had chronic problems throughout their lives. Be familiar with Mom's "default setting," and be aware of changes. Know that baselines change as a person ages. If, for instance, she goes through surgery, chances are she will come out of it with a new baseline.

Know your loved one's complete medical history and keep a record of it to be taken to doctor's appointments and checked often. Just as important is to know your own medical history, in case genetic issues arise or transplants or transfusions become necessary.

Water, water, water (for senior and caregiver). Unless it is contraindicated by a doctor, you should each be drinking eight glasses of water a day. Did you know that dehydration is a common cause of many disorders in the elderly, including urinary tract infections and circulation problems?

Make sure liquids are available all day long. How about an attractive thermos for the bedside or a water cooler in the living room and on the patio? Get one on casters so it can be moved from room to room.

Blood pressure is an issue among most elderly. Get a reliable sphygmomanometer (a blood pressure monitor) and teach your loved one-and yourself-to take blood pressure readings. Some pharmacies take blood pressure readings and teach you to do it yourself for free.

At any given time, the National Institutes of Health Clinical Center has almost 1,000 programs under way that study and test the newest medical procedures, including cancer, heart disease, and Alzheimer's treatments. If your mother qualifies, she may get free health care at their 540 bed hospital in Bethesda, Maryland. Call their toll-free hotline: 1-800-411-1222.

Local community service organizations such as the Kiwanis or Lions Club often offer free eye exams and eyeglasses to seniors who can't easily afford them. Your Area Agency on Aging will tell you what's available in your area.

Free dental care is available from local dental schools, and often, a low income is not even a requirement. Reach the dental college in your area.

Keep a diary of your senior's health progress.

If you're loved one is running a temperature or experiencing any other condition that may require a doctor's care, keep hourly notes and temperature readings for later reference.

Wash your hands often when caring for your parents. Wash theirs as well.

Keep plenty of moisturizer around for your hands and Dad's. Dry, chapped hands are especially common in winter. When you visit department stores, ask the people at the cosmetics counters for free samples, and keep these around the house to be used often.

Even natural supplements can sometimes be contraindicated with certain medications or cause side effects on their own. Ask your senior if she is taking anything like herbs or other supplements. Check them out with her doctor, no matter how harmless you believe they are.

Foot massagers are great for promoting blood circulation.

A digital thermometer is easier to use than a mercury thermometer. Take temperatures using the armpit if your senior has breathing problems or is easily confused.

If Mom has breathing problems and uses an inhaler, keep several around your house and hers, in the car, and so forth.

Many trips to the bathroom may indicate a urinary tract infection, common among seniors who don't always get the fluids they need. Consult a doctor immediately.

Consult a podiatrist immediately for corns, calluses, bunions, blisters, sores and infections, or ingrown, hard, brittle, split, or discolored toenails. If your senior has problem feet, a weekly trip to a salon for a pedicure-for each of you-makes a great outing. Most salons have special discount days plus breaks for seniors. Don't forget to ask about these.

Keep a checklist-a "report card"-and update it periodically to keep track of how your parent is doing with meal preparation, house-work, mobility (in and out of the house), laundry, shopping, money issues, medications, bathing, dressing, and eating. These are key activities of daily living (ADLs), and difficulty with them indicates there may be trouble.

If your senior must live in a multilevel home but has problems with stairs, consider a chairlift. They range in price from $2,000 to $20,000. Those prices may sound steep, but they can be cheaper than moving and will help keep your parent independent for a longer time. For someone who sits a lot, an ergonomic chair that offers greater lumbar support and adjustable features (chair height, armrest height, seat depth) that address particular problems and conditions can be a lifesaver. Ergonomic chairs come in all kinds of models and varying prices. You'll find a good selection and great prices at; some models are available in every color imaginable, making them an attractive addition to any room.

If an ergonomic chair is not an option, make sure your father's chair has an adjustable height feature, the seat depth is approximately two-thirds the length of his thighs and buttocks, the back is at least fourteen inches high, and the armrests are no more than nine inches high.

Get a copy of The I-Can't-Chew Cookbook: Delicious Soft Diet Recipes for People with Chewing, Swallowing, and Dry Mouth Disorders by Randy J. Wilson.

Bad posture can complicate back problems and limit mobility. Is Mom walking as upright as she used to? Is Dad favoring one leg over the other for some reason? Sometimes the answer can be as simple as a new pair of shoes.

Osteoporosis is a serious problem for older women, leading to shrinkage and serious (sometimes deadly) fractures. Schedule your senior for a bone density test, and encourage weight-bearing exercise (walking, light weights, gardening). Make sure Mom gets plenty of calcium (the new "chocolate chew" supplements are delicious), and ask her doctor about estrogen replacement therapy.

Make sure Mom is giving herself regular breast exams and that she has a mammogram annually.

If there are precautionary measures that must be remembered, make a checklist and post it in a place where it can't possibly be missed. But change the list and its location from time to time so that it doesn't get taken for granted after a while. If you use a dry erase board or a chalkboard, ask your parent to check off the points as they are followed.

The older you get, the more you are affected by the same amounts of alcohol. On the other hand, a glass of wine now and then has been known to be beneficial for the heart. Check with your loved one's doctor for a good rule of thumb. In the meantime, locate some "zero-proof" recipes and dress them up-tiny umbrellas and all-for a special or even not-so-special occasion.

Don't minimize changes in your parents’ health, even if they seem minor. These changes may be accompanied by fear, which can exacerbate even a minor problem. Address your parents’ fears; be positive about your ability to find a solution.

Anemia is very common among the elderly, usually resulting from either a loss of blood or a poor diet. Check with the doctor as to whether iron supplements (along with vitamin C, for better absorption) might be in order.

Help prevent infections by keeping antibacterial wet wipes handy at all times. Keep boxes of them around the house; individually wrapped ones can go in your purse or wallet and in the car.

Avoid foot fungus by keeping feet clean and dry. That means changing socks daily and shoes often. It's also a good idea to let feet "air out" once a day.

Nylon or synthetic socks are more likely to make feet sweat. Cotton is better.

If socks are too tight at the tops, they can interfere with circulation. Cut notches into them to make sure they don't bind.

Teach your loved one to respect pain. If something hurts, there's a reason for it.

Bedsores-or pressure sores-result when there is constant pressure on an area where bones are close to the skin's surface. Be on the lookout for problems in these most vulnerable areas: the head, the shoulders, the elbows, the base of the spine, the hips, the heels, and the ankles. Consult a physician if you see red, cracking, or dried skin. In the meantime, encourage Dad to move about when he can, and don't leave him sitting or lying on a damp surface. Make sure linens are not irritating, and wash them often.

Always wear (disposable) rubber gloves when you suspect you might have any kind of skin disorder, such as a rash, an infection, or a lesion of any type.


It's a good idea to accompany your mother to the supermarket occasionally to point out new products and to make sure she is shop-ping wisely. Encourage her to read labels for salt content, sugar, and other health considerations. If she resists, urge her to at least heed fat content. Generally, none of us should be taking in more than 30 percent of our daily calorie intake in the form of fat, and of that, no more than 10 percent should come from saturated fats. Olive oil is a good source of unsaturated fat.

Frozen foods, which are processed right after they are harvested, often retain more vitamins than "fresh" vegetables, which may sit on shelves for days before getting to the supermarket.

When ordering packaged meals from local agencies, ask for extra vegetables. Also, consider supplementing the meal with a home-made side dish.

Would a small refrigerator or a minimicrowave in the bedroom or family room make it easier for Dad to have nutritious snacks all day long?

If shopping is a problem, maybe you can fit an extra freezer in Mom's home somewhere that will allow her to stock up.

Does your grandfather need help with cooking? Contact Meals on Wheels of America (1-703-548-8024 or to find a local program that will deliver free meals to his home. All seniors older than sixty are eligible. Note that Meals on Wheels doesn't deliver on weekends, so you'll have to make other arrangements. Can a neighbor help? How about a local church or other religious organization? Or ask a local favorite restaurant to deliver a couple of meals.

If your father has vision problems, put liquid in a see-through cup or glass so he can see the liquid.

If your mother's on a special diet, write the day's menu on a black-board and ask her to check each item off as it's consumed.

Fax a weekly shopping list to your parent's local market and ask for it to be delivered. You can even pay for it over the phone with your credit card.

To find out if your loved one is eligible for food stamps, contact Human Nutrition Services, U.S. Department of Agriculture, 3101 Park Center Drive, Alexandria, VA 22302, 1-703-305-2286.

Find easy recipes that allow your senior to cook with canned and packaged foods-they combine quickly and are quite tasty. There are a variety of cookbooks in this category. Mom might enjoy Desperation Dinners, by Beverly Mills and Alicia Ross; for Dad, how about A Man, a Can, a Plan, by David Joachim.

There are cookbooks available with easy recipes suitable for special diets (diabetes, heart disease), cooking for one, or microwave cooking. Browse the bookstore or search for the one that will suit your senior perfectly.

When you call, casually ask your parent to tell you what he has been eating. "What did you have for dinner last night?" is better than "How's your appetite?"

If Mom is passing up making the meals she once loved because "it's just one person," get her a small wok and a cooking-for-one cook-book. Schedule visits at mealtimes so she'll have an excuse to cook.

If asked, the grocer might break up packages to sell smaller quantities to your senior, like a half-dozen eggs, two potatoes, or just a few slices of bread (the grocer can use the rest of the loaf to make sandwiches).

Ultrapasteurized milk that comes in cardboard cartons has a very long shelf life. Just make sure your parent chills it before drinking and refrigerates it after it's opened.

If your loved one takes a long time to eat, arrange for him to start his meal before everyone else.

Be especially patient at mealtimes; older adults often eat much more slowly than what you may be used to. Try to minimize distractions at mealtimes, and don't bring up stressful subjects.

A person who is easily confused might have an easier mealtime if you serve one course at a time and clear each one away before serving the next.

A solid-color tablecloth, as opposed to a patterned one, will minimize mealtime distractions.

Maybe your senior just hates eating in the kitchen. Try moving to the dining room or even a space outdoors.

Don't ever wrap dentures in napkins, assuming you will retrieve them after the meal. Chances are they'll be thrown out.

Freeze small containers of your leftovers from home to share with your senior; label them with the date and contents.

Freeze sauces, soups, and bouillon in ice cube trays so that individual servings can be popped out and heated.

Make sure that your senior has access to lots of healthy, easy-to-eat snacks, such as berries, bagels, pitas, cheese, raisins, crackers, energy bars, or apple, melon, or orange slices.

If Mom's appetite is lagging, find out if she has a taste or yen for something special. Experiment with old recipes to make them more palatable and "legal" (use lactose-free milk, salt and sugar substitutes, ground meat instead of cubed, yogurt instead of cream, but first consult a doctor about the interaction of these substitutes with any medications). There are tons of books on the subject and most have recipes. Consult them.

If you're loved one is having trouble gaining or maintaining weight, pack his diet with liquid calories. Fruit juices, milk, and milk alternatives such as soy, rice, and nut milks are high in nutrients and calories and are much less filling than solid foods. Smoothies, yogurt shakes, and protein drinks are a little more filling but may still make a good meal alternative.

Respect your father's tastes. If he's hated yogurt all his life, don't start feeding it to him now just because he's less able to resist.

A water filter makes a great gift for a senior.

Four or five smaller meals during the day can be more manageable than three large ones. This approach has the added benefit of keeping blood sugar levels more even throughout the day.

If your parent has vision problems, use the "clock" method of serving food: the main dish is right in front of him at "six o'clock," the starch dish is farthest and directly opposite at "twelve o'clock," and so on.

When family and friends call and ask what gift they can bring, suggest prepared foods. (If your parent gets Meals on Wheels deliveries, save the goodies for the weekend.)

Use plastic bibs at mealtime.

It's OK to bring a special meal to a restaurant for your parent and ask to have it microwaved for you, just as long as everyone else is ordering off the menu. Waiters and waitresses want to help you; tell them what you need-privately, to avoid embarrassment. And a good chef, if she's not too busy, can accommodate anyone. Show your appreciation, and tip accordingly.

Dry food can be difficult to swallow. Use sauces generously, but learn to make healthy versions.

Use flexible straws.

For those who refuse regular meals, keep healthy snacks (fruits, nutritious cookies, cut-up vegetables) available around the house. Finger foods are best. Be creative-but not overbearing-in your coaxing efforts.

Try using children's nonspill cups with covers or sports drink containers with a straw.

Make mealtime more special by using fancy plates and napkins.

For some, it's easier to cut food with scissors than a knife and fork.

If Mom can't cut her meat any longer, avoid embarrassment by cut-ting it for her in the kitchen before you serve.

Soft and pureed foods don't have to be bland and tasteless. Find out which herbs and spices make an otherwise bland dish interesting. You might also serve the following in colorful combinations:

puddings and gelatin
cooked and creamed vegetables
soups and stews
egg salad and tuna and other fish salads
tabouli, baba ganoush, and hummus
cooked fish
stewed fruit
egg rolls, cut up
chicken nuggets
scrambled eggs and omelettes
pancakes and French toast
rice and risotto
meat loaf

Baby food is great if you need to get a meal together in a hurry. The fruit selections are delicious!

No one likes to eat alone. If Mom insists that you partake of her bland, pureed diet, consider bringing along your own snacks at mealtime.

Too many items on the table can be confusing. Keep condiments to a minimum.

Freely make use of microwavable prepackaged foods. You can stock up on them and put them in the freezer after marking each with the day of the week when it should be eaten.

If your loved one can't swallow thin liquids, someone has probably recommended Thick-It, a tasteless powder that thickens hot and cold liquids. The canister is bulky; keep small supplies of Thick-It in your bag to use on outings. If Dad's not supposed to drink unthickened liquid, don't cheat, not even "just this once."

Seniors should always eat sitting up.

Take your parent to lunch, even if you're at work. Call at lunchtime, and you can eat together-you at the desk, she at home in the kitchen. But remember that it's dangerous for an elderly person (or anyone else) to talk while chewing.

Your senior's peak period of digestion (when it's easiest to digest food) is midday. Plan the large meal for that time of day, and keep supper light.

When feeding your father, only put one teaspoon of food in his mouth at once. Alternate spoonfuls of solids and liquids.

Plan your mother's weekly menu ahead of time so shopping for all meals can be done at once. Copy her recipes onto cards and write the shopping list for each dish on the backs. Take the cards with you when you go shopping.

Seniors who seem to have endless appetites often forget they have just eaten. Put stickers on the clock for mealtimes so they can see how long it is until the next meal. Making small nutritious snacks available throughout the day is also helpful.

Your senior should never lie down right after a meal-that is the most common cause of indigestion. (Eating too fast is the second most common cause.) Make sure Mom sits or stands for at least an hour after she eats.

Many medications leave an awful taste in the mouth that is far worse than anything you can imagine. They can make sugar taste like salt, and some favorite foods become completely inedible. Be especially patient during this time as you try new things to see what works. In the meantime, a lollipop may help your loved one after he's eaten something distasteful. (Don't give sucking candies to anyone who might easily swallow them whole.)

You can get someone to come to the house just to feed meals to your parent. Contact your Area Agency on Aging.

Even if Mom isn't making use of the local senior center, she can attend every day just for meals. If salt is an issue, there are a bunch of flavorful seasoning substitutes on the market.

There are tons of special utensils that can make eating a lot easier; a combination fork and knife for one-handed eating, a tilted spoon for someone with hand problems, or a two-handled mug for easier drinking are available from the many suppliers of special-needs items. You can also buy plate guards that keep food from sliding off. B Independent (1-913-390-0247 or offers a wide range of such products.

Jews, Sikhs, Muslims, and Hindus all incorporate fasting into various rituals and celebrations. If your parent is observant but you suspect he may not be physically up to the fast, speak to his doctor or his minister, who can talk to him about reasonable exemptions from fasting.

Diet supplements like Ensure are widely used in hospitals and nursing homes. Keep them cooled. Put a few cans on ice in the morning, and make them available all day long.

A glass of wine, if it's not contraindicated for other reasons, can stimulate the appetite.

How to Care for Aging Parents by Virginia Morris and Robert Butler. The Washington Post calls this book "a compassionate guide of encyclopedic proportion... What sets this book apart from other guides on aging is the recognition that parent care is an emotional roller coaster for both the parent, who may not be accustomed to being a dependent, and for the adult child, who is often frustrated by the overwhelming new task and the guilty feeling that she can't do more." Compassionate, timely, and thoroughly researched,

How to Care for Aging Parents tackles all the tough subjects: how to avoid "parenting" your parent, understanding what happens to the body in old age, easing caregiver guilt, getting help finding a nursing home, preparing for the time to say good-bye. Virginia Morris, a health-care journalist who cared for her own father through a terminal illness, has given us an indispensable source of information and support. "How to Care for Aging Parents is well-researched and comprehensive...a practical resource...that can be of enormous assistance to contemporary seniors as well as to Baby Boomers and the generations that follow." - Robert N. Butler, M.D., founder, National Institute on Aging

In the Complete Eldercare Planner: Where to Start, Which Questions to Ask, and How to Find Help, Joy Loverde shares techniques and step-by-step tactics for all aspects of seniors , from how to first broach the topic with seniors that need care and finding the best insurance coverage to emergency preparedness and managing the process of dying. Thirteen chapters are organized by a series of plans that instruct and advise the caregiver on how to research, prepare for, and manage a particular issue. An "Action Checklist" and, when applicable, a list of low-cost or free resources punctuate each chapter's end. The chapters on legal matters (estate planning, insurance fraud), money (cost-cutting strategies), and insurance (options beyond Medicare, supplementary coverage, long-term policies) will be particularly helpful to those first grappling with their elder's financial position. The Complete Eldercare Planner is an accessible, comprehensive, and thoughtful resource that will inspire caregivers in their pursuit of quality health care for seniors.

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