If this is a question you or someone you know is facing, you are not alone. According to a CBS News Poll, one in five Americans have had the responsibility of taking care of an elderly family member. Eldercare issues are on the rise, along with the stress that they bring to family members. Challenges such as caregiving, driving and transportation, financial decisions, health care decisions, and end-of-life decisions present dilemmas that must be addressed. These decisions tend to be complicated and emotionally charged, and even off-limit in some families.

If you have more than one person involved in the discussion, many times you will have more than one opinion of what should be done resulting in rivalries among adult children. Some families are able to talk openly among themselves about these issues. Sometimes the solutions come easily. Other times there may be raised voices and hurt feelings. Other families put off the discussion until such time as the options are fewer, the emotional turmoil is greater, health and safety may be at risk and everyone is in crisis mode. Relationships among family members become bruised, if not destroyed.
 
This is where elder mediation can be of benefit before conflicts spiral out of control; elder mediation focuses on what is best for mom or dad while at the same time minimizing family conflict. Mediation can help those families who are unable to talk openly and calmly about these issues: how do we meet difficult challenges in our daily lives as more issues surface that must be addressed?
 
The mediator will create an atmosphere that promotes discussion and makes everyone feel safe. Everyone is given an opportunity to be heard and to understand what everyone else is saying. The mediator seeks out the underlying and often unspoken issues emphasizing that “understanding” does not always mean “agreeing.” The goal is to have the parties involved come up with a solution before one is mandated by a judge.
 
Physicians and nurses who witness disagreements can also exercise this option and recommend mediation giving everyone involved an opportunity to express their concerns in a neutral and confidential setting. It can take place in the family home, the hospital room, nursing home, or some other place where everyone feels comfortable.
 
During these trying times, it is even more important to resolve interpersonal conflicts in peaceful and effective ways. It encourages discussion of difficult topics and gives participants the tools they need to resolve their problems. These processes and skills help individuals to avoid inappropriate or unsafe behaviors and to build healthy relationships during an especially difficult time in life.
 
Mediation strengthens family ties and enables all family members to deal with the reality of the situation. It helps the family to improve their communication skills with each other. In so doing, the relationship among all of the family members improves. Solutions are only possible when everyone has had an opportunity to express his or her views. With reflection and guided discussion, a deeper understanding of how to deal with conflict effectively in our own lives and help others do the same is established. This is important for the future of that family.


In one month, the 55-year-old woman was admitted to the hospital three times for pain and other symptoms resulting from metastatic breast cancer. On the third admission, her physician requested a palliative care consultation.

Enter VITAS Palliative Care SolutionsSM (VPCS). Members of the VPCS team of palliative care experts, including a physician, nurse practitioner, social worker and chaplain, met with the patient and her family.
 
In a wide-ranging two hour meeting, they had a frank discussion of the patient’s condition and of her and her family’s goals and expectations for her care. The talk covered options in pain relief, symptom management and advance care planning. It also included an evaluation of the patient’s needs for emotional and spiritual support.
 
The VPCS physician then made care recommendations to the patient’s physician. VPCS team members will meet with the patient several more times to continue to evaluate the patient’s medical, social and emotional needs.
 
VPCS is a subsidiary of VITAS Healthcare Corporation, which also encompasses VITAS Innovative Hospice Care®, the nation’s largest and most progressive hospice care provider. Since its inception in 1978, VITAS has been a pioneer in hospice and palliative care, always finding ways to provide comfort and improve the quality of life for those who suffer chronic pain and other symptoms resulting from life-limiting illness.
 
“Over the years, VITAS recognized that many patients with serious illness or injury could benefit from palliative medicine, before hospice care would be appropriate or desirable,” says Joel Policzer, MD, FAAHPM, national medical director for both VPCS and VITAS Innovative Hospice Care®. “We created VPCS as a separate service for both adults and children. Our consultations help patients and their families identify their goals of care and expectations of how care should continue. We also help primary care teams manage their patients’ pain and other symptoms, as well as provide counseling and spiritual support.”
 
The primary goal of the VPCS team, adds Dr. Policzer, is to provide patients and their families with a forum for the discussion of treatment goals and expectations, and to provide the time, information and expertise they need to make informed decisions—especially when considering treatment options.
 
“In many cases, the palliative care team gives patients and families their first opportunity to assemble together, address questions and concerns, and gain an understanding of the big picture,” explains Dr. Policzer. “Palliative care teams can help patients and families discuss their wishes openly and frankly, draft advance care directives and nominate future decision makers.
 
Palliative care is focused on patients, not diseases, and on improving conditions in the present, notes Dr. Policzer. “It can be very effective,” he says. “Patients undergoing palliative care typically have fewer emergency room visits, shorter hospital stays and improved clinical outcomes. They also express a higher level of satisfaction with their entire healthcare experience.
 
As the U.S. population continues to age, the need for palliative care will grow, concludes Dr. Policzer. “VITAS is creating a continuum of care for patients to make sure that throughout the course of their aging process, patients and families have access to palliative care services,” he says.


The Memorial Adult Day Care Center in Hallandale Beach offers a sensible alternative to full-time residential care. The specially-trained staff provides supervised recreational and therapeutic programs for adults during the day. Structured activities are geared to stimulate both the participants’ minds and bodies.

“The goal of the Memorial Adult Day Care Center is to help keep adults at home as long as possible by offering companionship and care for our participants and relief for their caregivers during the day,” said Vilma McKay, director of the center. “We are dedicated to maintaining – and often improving – the functional levels of our participants to help make life more enjoyable for everyone involved.”
 
She explained that the Center is available to those individuals who should not be left alone during the day because they are confused, suffer memory loss, have a physical handicap or have a medical condition which requires supervision.
 
As part of the registration process, potential Adult Day Care Center participants go through a personal interview, conducted by a registered nurse, which evaluates the functional, emotional and mental status of the individual to determine if the program is appropriate.
 
Once the individual begins attending the center, programs are designed to meet his or her specific needs. The safe, pleasant environment promotes a feeling of belonging and encourages participation. A hot noon meal is served in a social dining atmosphere, often improving appetites.
 
A typical day’s activities might include:
• Adult education
• Community outings
• Discussion groups
• Exercise therapy
• Music and dancing
• Pet therapy
• Recreational activities
• Relaxation therapy
 
There are some additional benefits to participating, according to McKay. While each program participant must continue to be seen by his or her personal physician, the Memorial Adult Day Care Center offers select health services, including:
• Blood pressure monitoring
• Exercise classes
• Individual/family information and referrals
• Individual nursing assessment
• Medication supervision
• Nutrition monitoring and counseling
• Personal care assistance and classes


When fitness is mentioned, the usual thought is the gym, lifting weights, running, jogging, walking, riding a bike, hiking, playing tennis, golf, lifting weights or swimming, which are all great fitness activities. How many times do we look down at our feet and thank them for being able to help us do the above activities? Your feet are one key essential to your health. As a Lifestyle Fitness Coach, working with my older Clients, the most requests I receive is to help them with their balance. Balance starts with the feet. Of course you need strength to get out of a chair, but the feet must touch the floor first, if you plan on standing up. You also need flexibility in those feet. Without flexibility and strength it is very difficult or next to impossible to bring the body to a standing position.

Once you are standing and take that first step, if the ankle joint is not flexible, your foot might as well be in a concrete shoe and that is how you will walk, with heavy feet. Next you may feel pain in the knee or the hip and before too long, your back will start hurting.
 
By this time, the feet are long forgotten. Let’s take one step at a time giving the feet the good health they deserve.
 
Flexibility – If the ankle joint is flexible walking will be almost effortless. If the foot is not flexible walking heel-toe will not happen. Walking will become a shuffle. When we walk, we should be able to pull the foot back in what is called Dorsi Flexion and have the heel touch the ground first, then transfer the weight to the toe and push off from the toe into the next step. The toes should be flexible enough that they are able to bend and push you into the next step. Many times, with my older Clients, I find that the toes do not bend and the pushing is directed at the tip of the big toe, like a ballerina dancer, which then could create other foot issues like Plantar Fasciitis, Morton’s Neuroma, Ingrown Toenails and possible stress fractures.
 
Stretching of the foot is a great way to regain flexibility. Sitting on a bed with one leg straight on the bed, pull that foot back towards your knee. To increase the stretch, use a towel, rope or and old belt, place it just under the toes and gently use that assistance to Dorsi Flex, pulling towards your knee. Then point the foot in the opposite direction, Plantar Flexion. Keeping the knee still make circles with just the ankles, to the right and then to the left. To stretch the toes, sit in a chair, place the foot flat on the ground. Then raise the heel off the floor, keeping all of the toes in contact with the floor. This will not be easy if the toes are not flexible, but will get easier the more it is done.
 
Peripheral Neuropathy (loss of sensation in the feet or lower limbs) also makes it difficult to walk, as the feeling is lost in the feet. Keeping as much flexibility in the feet will help maintain the balance and ease of walking.
 
Key Points to remember:
• Walk “Heel/Toe
• Make Circles with the ankles during the day
• Pull the foot back to the knee several times during the day
• Point the foot in the opposite direction
• Wiggle your toes
 
Keeping your feet strong and flexible will greatly improve your balance. Your feet will be able to make the small shifts to accommodate the uneven surfaces you walk on. Walking will be easier with less effort and daily activities will not be such a chore. Put your best foot forward and start today, by stepping into better health not only for your feet but your whole body.


Hospice by the Sea’s Pat O’Meara (left), Director of Corporate and Media Relations, and President and CEO Paula J. Alderson with the Caregiver Friendly Award and winning caregiver DVD.

Hospice by the Sea, Inc. has received the 2010 Caregiver Friendly® Award in the media category from Today’s Caregiver. The organization won for its user-friendly DVD, “A Lifeline for Caregivers,” designed to teach and enhance the skills of individuals caring for loved ones at home.

Accepting on behalf of Hospice by the Sea was Pat O’Meara, Director of Corporate and Media Relations, who produced the DVD. “Ensuring caregivers have the skills necessary to provide care for those who need help or are homebound is part of our organization’s mission. It is gratifying to know we are able to help make their jobs easier, safer and more effective,” she said.