How do I handle it if my parent is refusing aged care? 4 things to consider
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It’s a shock when we realise our parents aren’t managing well at home.
Perhaps the house and garden are looking more chaotic, and Mum or Dad are relying more on snacks than nutritious meals. Maybe their grooming or hygiene has declined markedly, they are socially isolated or not doing the things they used to enjoy. They may be losing weight, have had a fall, aren’t managing their medications correctly, and are at risk of getting scammed.
You’re worried and you want them to be safe and healthy. You’ve tried to talk to them about aged care but been met with swift refusal and an indignant declaration “I don’t need help – everything is fine!” Now what?
Here are four things to consider.
1. Start with more help at home
Getting help and support at home can help keep Mum or Dad well and comfortable without them needing to move.
Consider drawing up a roster of family and friends visiting to help with shopping, cleaning and outings. You can also use home aged care services – or a combination of both.
Government subsidised home care services provide from one to 13 hours of care a week. You can get more help if you are a veteran or are able to pay privately. You can take advantage of things like rehabilitation, fall risk-reduction programs, personal alarms, stove automatic switch-offs and other technology aimed at increasing safety.
Call My Aged Care to discuss your options.
Nadino/Shutterstock
2. Be prepared for multiple conversations
Getting Mum or Dad to accept paid help can be tricky. Many families often have multiple conversations around aged care before a decision is made.
Ideally, the older person feels supported rather than attacked during these conversations.
Some families have a meeting, so everyone is coming together to help. In other families, certain family members or friends might be better placed to have these conversations – perhaps the daughter with the health background, or the auntie or GP who Mum trusts more to provide good advice.
Mum or Dad’s main emotional support person should try to maintain their relationship. It’s OK to get someone else (like the GP, the hospital or an adult child) to play “bad cop”, while a different person (such as the older person’s spouse, or a different adult child) plays “good cop”.
3. Understand the options when help at home isn’t enough
If you have maximised home support and it’s not enough, or if the hospital won’t discharge Mum or Dad without extensive supports, then you may be considering a nursing home (also known as residential aged care in Australia).
Every person has a legal right to choose where we live (unless they have lost capacity to make that decision).
This means families can’t put Mum or Dad into residential aged care against their will. Every person also has the right to choose to take risks. People can choose to continue to live at home, even if it means they might not get help immediately if they fall, or eat poorly. We should respect Mum or Dad’s decisions, even if we disagree with them. Researchers call this “dignity of risk”.
It’s important to understand Mum or Dad’s point of view. Listen to them. Try to figure out what they are feeling, and what they are worried might happen (which might not be rational).
Try to understand what’s really important to their quality of life. Is it the dog, having privacy in their safe space, seeing grandchildren and friends, or something else?
Older people are often understandably concerned about losing independence, losing control, and having strangers in their personal space.
Sometimes families prioritise physical health over psychological wellbeing. But we need to consider both when considering nursing home admission.
Research suggests going into a nursing home temporarily increases loneliness, risk of depression and anxiety, and sense of losing control.
Mum and Dad should be involved in the decision-making process about where they live, and when they might move.
Some families start looking “just in case” as it often takes some time to find the right nursing home and there can be a wait.
After you have your top two or three choices, take Mum or Dad to visit them. If this is not possible, take pictures of the rooms, the public areas in the nursing home, the menu and the activities schedule.
We should give Mum or Dad information about their options and risks so they can make informed (and hopefully better) decisions.
For instance, if they visit a nursing home and the manager says they can go on outings whenever they want, this might dispel a belief they are “locked up”.
Having one or two weeks “respite” in a home may let them try it out before making the big decision about staying permanently. And if they find the place unacceptable, they can try another nursing home instead.
CGN089/Shutterstock
4. Understand the options if a parent has lost capacity to make decisions
If Mum or Dad have lost capacity to choose where they live, family may be able to make that decision in their best interests.
If it’s not clear whether a person has capacity to make a particular decision, a medical practitioner can assess for that capacity.
Mum or Dad may have appointed an enduring guardian to make decisions about their health and lifestyle decisions when they are not able to.
An enduring guardian can make the decision that the person should live in residential aged care, if the person no longer has the capacity to make that decision themselves.
If Mum or Dad didn’t appoint an enduring guardian, and have lost capacity, then a court or tribunal can appoint that person a private guardian (usually a family member, close friend or unpaid carer).
If no such person is available to act as private guardian, a public official may be appointed as public guardian.
Deal with your own feelings
Families often feel guilt and grief during the decision-making and transition process.
Families need to act in the best interest of Mum or Dad, but also balance other caring responsibilities, financial priorities and their own wellbeing.
Lee-Fay Low, Professor in Ageing and Health, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Healing After Loss – by Martha Hickman
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Mental health is also just health, and this book’s about an underexamined area of mental health. We say “underexamined”, because for something that affects almost everyone sooner or later, there’s not nearly so much science being done about it as other areas of mental health.
This is not a book of science per se, but it is a very useful one. The format is:
Each calendar day of the year, there’s a daily reflection, consisting of:
- A one-liner insight about grief, quoted from somebody
- A page of thoughts about this
- A one-liner summary, often formulated as a piece of advice
The book is not religious in content, though the author does occasionally make reference to God, only in the most abstract way that shouldn’t be offputting to any but the most stridently anti-religious readers.
Bottom line: if this is a subject near to your heart, then you will almost certainly benefit from this daily reader.
Click here to check out Healing After Loss, and indeed heal after loss
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Leek vs Scallions – Which is Healthier?
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Our Verdict
When comparing leek to scallions, we picked the leek.
Why?
In terms of macros, scallions might have a point: scallions have the lower glycemic index, thanks to leek having more carbs for the same amount of fiber. That said, leek already has a low glycemic index, so this is not a big deal.
When it comes to vitamins, leek has more of vitamins B1, B2, B3, B5, B6, B9, E, and choline, while scallions have more of vitamins A, C, and K. Noteworthily, a cup of chopped leek already provides the daily dose of vitamins A and K, and the difference in levels of vitamin C is minimal. All in all, an easy 8:3 win for leeks here, even without taking that into account.
In the category of minerals, leek has more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, and selenium, while scallions have a little more zinc.
Both of these allium-family plants (i.e., related to garlic) have an abundance of polyphenols, especially kaempferol.
Of course, enjoy whatever goes best with your meal, but if you’re looking for nutritional density, then leek is where it’s at.
Want to learn more?
You might like to read:
The Many Health Benefits Of Garlic
Take care!
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Total Fitness After 40 – by Nick Swettenham
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Time may march relentlessly on, but can we retain our youthful good health?
The answer is that we can… to a degree. And where we can’t, we can and should adapt what we do as we age.
The key, as Swettenham illustrates, is that there are lifestyle factors that will help us to age more slowly, thus retaining our youthful good health for longer. At the same time, there are factors of which we must simply be mindful, and take care of ourselves a little differently now than perhaps we did when we were younger. Here, Swettenham acts guide and instructor.
A limitation of the book is that it was written with the assumption that the reader is a man. This does mean that anything relating to hormones is assuming that we have less testosterone as we’re getting older and would like to have more, which is obviously not the case for everyone. However, happily, the actual advice remains applicable regardless.
Swettenham covers the full spread of what he believes everyone should take into account as we age:
- Mindset changes (accepting that physical changes are happening, without throwing our hands in the air and giving up)
- Focus on important aspects such as:
- strength
- flexibility
- mobility
- agility
- endurance
- Some attention is also given to diet—nothing you won’t have read elsewhere, but it’s a worthy mention.
All in all, this is a fine book if you’re thinking of taking up or maintaining an exercise routine that doesn’t stick its head in the sand about your aging body, but doesn’t just roll over and give up either. A worthy addition to anyone’s bookshelf!
Check Out Fitness After 40 On Amazon Today!
Looking for a more women-centric equivalent book? Vonda Wright M.D. has you covered (and her bio is very impressive)!
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Planning Festivities Your Body Won’t Regret
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The Festive Dilemma
For many, Christmas is approaching. Other holidays abound too, and even for the non-observant, it’d be hard to escape seasonal jollities entirely.
So, what’s the plan?
- Eat, drink, and be merry, and have New Year’s Resolutions for the first few days of January before collapsing in a heap?
- Approach the Yuletide with Spartan abstemiousness and miss all the fun while simultaneously annoying your relatives?
Let’s try to find a third approach instead…
What’s festive and healthy?
We’re doing this article this week, because many people will be shopping already, making plans, and so forth. So here are some things to bear in mind:
Make your own mindful choices
Coca-Cola company really did a number on Christmas, but it doesn’t mean their product is truly integral to the season. Same goes for many other things that flood the stores around this time of year. So much sugary confectionary! But remember, they’re not the boss of you. If you wouldn’t buy it ordinarily, why are you buying it now? Do you actually even want it?
If you really do, then you do you, but mindful choices will invariably be healthier than “because there were three additional aisles of confectionary now so I stopped and looked and picked some things”.
Pick your battles
If you’re having a big family gathering, likely there will be occasions with few healthy options available. But you can decide what’s most important for you to avoid, perhaps picking a theme, e.g:
- No alcohol this year, or
- No processed sugary foods, or
- Eat/drink whatever, but practice intermittent fasting
Some resources:
Fight inflammation
This is a big one so it deserves its own category. In the season of sugar and alcohol and fatty meat, inflammation can be a big problem to come around and bite us in the behind. We’ve written on this previously:
Positive dieting
In other words, less of a focus on what to exclude, and more of a focus on what to include in your diet. Fruity drinks and sweets are common at this time of year, but you know what’s also fruity? Fruit!
And it can be festive, too! Berries are great, and those tiny orange-like fruits that may be called clementines or tangerines or satsumas or, as Aldi would have it, “easy peelers”. Apple and cinnamon are also a great combination that both bring sweetness without needing added sugar.
And as for mains? Make your salads that bit fancier, get plenty of greens with your main, have hearty soups and strews with lentils and beams!
See also: Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
Your gut will thank us later!
Get moving!
That doesn’t mean you have to beat the New Year rush to the gym (unless you want to!). But it could mean, for example, more time in your walking shoes (or dancing shoes! With a nod to today’s sponsor) and less time in the armchair.
See also: The doctor who wants us to exercise less; move more
Lastly…
Remember it’s supposed to be fun! And being healthy can be a lot more fun than suffering because of unfortunate choices that we come to regret.
Take care!
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Hitting the beach? Here are some dangers to watch out for – plus 10 essentials for your first aid kit
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Summer is here and for many that means going to the beach. You grab your swimmers, beach towel and sunscreen then maybe check the weather forecast. Did you think to grab a first aid kit?
The vast majority of trips to the beach will be uneventful. However, if trouble strikes, being prepared can make a huge difference to you, a loved one or a stranger.
So, what exactly should you be prepared for?
FTiare/Shutterstock Knowing the dangers
The first step in being prepared for the beach is to learn about where you are going and associated levels of risk.
In Broome, you are more likely to be bitten by a dog at the beach than stung by an Irukandji jellyfish.
In Byron Bay, you are more likely to come across a brown snake than a shark.
In the summer of 2023–24, Surf Life Saving Australia reported more than 14 million Australian adults visited beaches. Surf lifesavers, lifeguards and lifesaving services performed 49,331 first aid treatments across 117 local government areas around Australia. Surveys of beach goers found perceptions of common beach hazards include rips, tropical stingers, sun exposure, crocodiles, sharks, rocky platforms and waves.
Sun and heat exposure are likely the most common beach hazard. The Cancer Council has reported that almost 1.5 million Australians surveyed during summer had experienced sunburn during the previous week. Without adequate fluid intake, heat stroke can also occur.
Lacerations and abrasions are a further common hazard. While surfboards, rocks, shells and litter might seem more dangerous, the humble beach umbrella has been implicated in thousands of injuries.
Sprains and fractures are also associated with beach activities. A 2022 study linked data from hospital, ambulance and Surf Life Saving cases on the Sunshine Coast over six years and found 79 of 574 (13.8%) cervical spine injuries occurred at the beach. Surfing, smaller wave heights and shallow water diving were the main risks.
Rips and rough waves present a higher risk at areas of unpatrolled beach, including away from surf lifesaving flags. Out of 150 coastal drowning deaths around Australia in 2023–24, nearly half were during summer. Of those deaths:
- 56% occurred at the beach
- 31% were rip-related
- 86% were male, and
- 100% occurred away from patrolled areas.
People who had lived in Australia for less than two years were more worried about the dangers, but also more likely to be caught in a rip.
Safety Beach on Victoria’s Mornington Peninsula. Still bring your first aid essentials though. Julia Kuleshova/Shutterstock Knowing your DR ABCs
So, beach accidents can vary by type, severity and impact. How you respond will depend on your level of first aid knowledge, ability and what’s in your first aid kit.
A first aid training company survey of just over 1,000 Australians indicated 80% of people agree cardiopulmonary resuscitation (CPR) is the most important skill to learn, but nearly half reported feeling intimidated by the prospect.
CPR training covers an established checklist for emergency situations. Using the acronym “DR ABC” means checking for:
- Danger
- Response
- Airway
- Breathing
- Circulation
A complete first aid course will provide a range of skills to build confidence and be accredited by the national regulator, the Australian Skills Quality Authority.
What to bring – 10 first aid essentials
Whether you buy a first aid kit or put together you own, it should include ten essential items in a watertight, sealable container:
- Band-Aids for small cuts and abrasions
- sterile gauze pads
- bandages (one small one for children, one medium crepe to hold on a dressing or support strains or sprains, and one large compression bandage for a limb)
- large fabric for sling
- a tourniquet bandage or belt to restrict blood flow
- non-latex disposable gloves
- scissors and tweezers
- medical tape
- thermal or foil blanket
- CPR shield or breathing mask.
Before you leave for the beach, check the expiry dates of any sunscreen, solutions or potions you choose to add.
If you’re further from help
If you are travelling to a remote or unpatrolled beach, your kit should also contain:
- sterile saline solution to flush wounds or rinse eyes
- hydrogel or sunburn gel
- an instant cool pack
- paracetamol and antihistamine medication
- insect repellent.
Make sure you carry any “as-required” medications, such as a Ventolin puffer for asthma or an EpiPen for severe allergy.
Vinegar is no longer recommended for most jellyfish stings, including Blue Bottles. Hot water is advised instead.
In remote areas, also look out for Emergency Response Beacons. Located in high-risk spots, these allow bystanders to instantly activate the surf emergency response system.
If you have your mobile phone or a smart watch with GPS function, make sure it is charged and switched on and that you know how to use it to make emergency calls.
First aid kits suitable for the beach range in price from $35 to over $120. Buy these from certified first aid organisations such as Surf Lifesaving Australia, Australian Red Cross, St John Ambulance or Royal Life Saving. Kits that come with a waterproof sealable bag are recommended.
Be prepared this summer for your trip to the beach and pack your first aid kit. Take care and have fun in the sun.
Andrew Woods, Lecturer, Nursing, Faculty of Health, Southern Cross University and Willa Maguire, Associate Lecturer in Nursing, Southern Cross University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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If You’re Poor, Fertility Treatment Can Be Out of Reach
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Mary Delgado’s first pregnancy went according to plan, but when she tried to get pregnant again seven years later, nothing happened. After 10 months, Delgado, now 34, and her partner, Joaquin Rodriguez, went to see an OB-GYN. Tests showed she had endometriosis, which was interfering with conception. Delgado’s only option, the doctor said, was in vitro fertilization.
“When she told me that, she broke me inside,” Delgado said, “because I knew it was so expensive.”
Delgado, who lives in New York City, is enrolled in Medicaid, the federal-state health program for low-income and disabled people. The roughly $20,000 price tag for a round of IVF would be a financial stretch for lots of people, but for someone on Medicaid — for which the maximum annual income for a two-person household in New York is just over $26,000 — the treatment can be unattainable.
Expansions of work-based insurance plans to cover fertility treatments, including free egg freezing and unlimited IVF cycles, are often touted by large companies as a boon for their employees. But people with lower incomes, often minorities, are more likely to be covered by Medicaid or skimpier commercial plans with no such coverage. That raises the question of whether medical assistance to create a family is only for the well-to-do or people with generous benefit packages.
“In American health care, they don’t want the poor people to reproduce,” Delgado said. She was caring full-time for their son, who was born with a rare genetic disorder that required several surgeries before he was 5. Her partner, who works for a company that maintains the city’s yellow cabs, has an individual plan through the state insurance marketplace, but it does not include fertility coverage.
Some medical experts whose patients have faced these issues say they can understand why people in Delgado’s situation think the system is stacked against them.
“It feels a little like that,” said Elizabeth Ginsburg, a professor of obstetrics and gynecology at Harvard Medical School who is president-elect of the American Society for Reproductive Medicine, a research and advocacy group.
Whether or not it’s intended, many say the inequity reflects poorly on the U.S.
“This is really sort of standing out as a sore thumb in a nation that would like to claim that it cares for the less fortunate and it seeks to do anything it can for them,” said Eli Adashi, a professor of medical science at Brown University and former president of the Society for Reproductive Endocrinologists.
Yet efforts to add coverage for fertility care to Medicaid face a lot of pushback, Ginsburg said.
Over the years, Barbara Collura, president and CEO of the advocacy group Resolve: The National Infertility Association, has heard many explanations for why it doesn’t make sense to cover fertility treatment for Medicaid recipients. Legislators have asked, “If they can’t pay for fertility treatment, do they have any idea how much it costs to raise a child?” she said.
“So right there, as a country we’re making judgments about who gets to have children,” Collura said.
The legacy of the eugenics movement of the early 20th century, when states passed laws that permitted poor, nonwhite, and disabled people to be sterilized against their will, lingers as well.
“As a reproductive justice person, I believe it’s a human right to have a child, and it’s a larger ethical issue to provide support,” said Regina Davis Moss, president and CEO of In Our Own Voice: National Black Women’s Reproductive Justice Agenda, an advocacy group.
But such coverage decisions — especially when the health care safety net is involved — sometimes require difficult choices, because resources are limited.
Even if state Medicaid programs wanted to cover fertility treatment, for instance, they would have to weigh the benefit against investing in other types of care, including maternity care, said Kate McEvoy, executive director of the National Association of Medicaid Directors. “There is a recognition about the primacy and urgency of maternity care,” she said.
Medicaid pays for about 40% of births in the United States. And since 2022, 46 states and the District of Columbia have elected to extend Medicaid postpartum coverage to 12 months, up from 60 days.
Fertility problems are relatively common, affecting roughly 10% of women and men of childbearing age, according to the National Institute of Child Health and Human Development.
Traditionally, a couple is considered infertile if they’ve been trying to get pregnant unsuccessfully for 12 months. Last year, the ASRM broadened the definition of infertility to incorporate would-be parents beyond heterosexual couples, including people who can’t get pregnant for medical, sexual, or other reasons, as well as those who need medical interventions such as donor eggs or sperm to get pregnant.
The World Health Organization defined infertility as a disease of the reproductive system characterized by failing to get pregnant after a year of unprotected intercourse. It terms the high cost of fertility treatment a major equity issue and has called for better policies and public financing to improve access.
No matter how the condition is defined, private health plans often decline to cover fertility treatments because they don’t consider them “medically necessary.” Twenty states and Washington, D.C., have laws requiring health plans to provide some fertility coverage, but those laws vary greatly and apply only to companies whose plans are regulated by the state.
In recent years, many companies have begun offering fertility treatment in a bid to recruit and retain top-notch talent. In 2023, 45% of companies with 500 or more workers covered IVF and/or drug therapy, according to the benefits consultant Mercer.
But that doesn’t help people on Medicaid. Only two states’ Medicaid programs provide any fertility treatment: New York covers some oral ovulation-enhancing medications, and Illinois covers costs for fertility preservation, to freeze the eggs or sperm of people who need medical treatment that will likely make them infertile, such as for cancer. Several other states also are considering adding fertility preservation services.
In Delgado’s case, Medicaid covered the tests to diagnose her endometriosis, but nothing more. She was searching the internet for fertility treatment options when she came upon a clinic group called CNY Fertility that seemed significantly less expensive than other clinics, and also offered in-house financing. Based in Syracuse, New York, the company has a handful of clinics in upstate New York cities and four other U.S. locations.
Though Delgado and her partner had to travel more than 300 miles round trip to Albany for the procedures, the savings made it worthwhile. They were able do an entire IVF cycle, including medications, egg retrieval, genetic testing, and transferring the egg to her uterus, for $14,000. To pay for it, they took $7,000 of the cash they’d been saving to buy a home and financed the other half through the fertility clinic.
She got pregnant on the first try, and their daughter, Emiliana, is now almost a year old.
Delgado doesn’t resent people with more resources or better insurance coverage, but she wishes the system were more equitable.
“I have a medical problem,” she said. “It’s not like I did IVF because I wanted to choose the gender.”
One reason CNY is less expensive than other clinics is simply that the privately owned company chooses to charge less, said William Kiltz, its vice president of marketing and business development. Since the company’s beginning in 1997, it has become a large practice with a large volume of IVF cycles, which helps keep prices low.
At this point, more than half its clients come from out of state, and many earn significantly less than a typical patient at another clinic. Twenty percent earn less than $50,000, and “we treat a good number who are on Medicaid,” Kiltz said.
Now that their son, Joaquin, is settled in a good school, Delgado has started working for an agency that provides home health services. After putting in 30 hours a week for 90 days, she’ll be eligible for health insurance.
One of the benefits: fertility coverage.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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