Aging, to begin with, isn't easy for everyone. It can sometimes seem like an endless series of adjustments to new circumstances- none which were asked for, and many of which are unexpected. Changes in physical health, social circles, functional abilities, new medicines, new living situations, loss of independence: These are things that can come out of nowhere, throwing your world upside down.

The difficulties adjusting to these changes throw another wrinkle into the equation. For example, as a geriatric care manager and aging lifecare consultant, I've worked with many clients who have been in denial of their need to accept changes to the way they do things. Specifically, some life changes warrant new interventions and forms of help, e.g. home health aides, medicine, walkers.

So often I've seen that the people with the best eventual outcomes are the ones who are open to accepting help from others- be it family or hired professionals. When a client and their family are on the same page, safety can be more-easily assured.

But what should families do when an elder is help rejecting? Here's some advice:

1. If you know in advance of your loved one's actually needing help that they are likely to reject help later, start the conversation with them about their wishes now. That way, you leave them the opportunity to handle things on their own terms.
2. If you've reached the point at which help is needed, but your loved one is help rejecting, it helps to sometimes involve a third party to help mediate. Geriatric care managers, in particular, are often able to be the person who says some sort of intervention is needed, while you can concentrate instead on providing the emotional support that your loved one would probably prefer from you instead of doting, demands, or ultimatums.
3. Change tacks. Concentrate less on your loved one's deficits and more on their abilities, hobbies, and talents. Ask them what specific things you can do to help them continue to do the things that remain important to them.
4. In cases where someone has lost the capacity to agree or not agree to accept help (through dementia or other illnesses), certain legal options are available to help ensure the safety of their loved one. Feel free to contact Scott to learn more about some of these options.
   

A final note: Above all, it's important that family members of help-rejecting people in need of help try to accept the fact that there may be limitations to their ability to set up care. Clearly, this is far from an ideal option. Nonetheless, it remains a major part of many of the cases I see every day. Setting reasonable expectations is perhaps the most crucial element of this process, and should not be overlooked.

If you've been following this blog, following me on Facebook or Twitter, or if you've chatted with me in person, by now you've learned some of the issues I feel are especially important to focus on, what issues I feel have become cliche, and my general musings on caregiving, aging, and elder care as a geriatric care manager in NYC. 

Sometimes, the resources and advice I give take on different levels of importance for different people. That's especially true for LGBT seniors, and I think it's worth writing about here.

This has been written about before, so I'll try to be concise with this blog. My aim is to give concrete and specific resources and tips to LGBT seniors and those caring for them. This blog will be far from exhaustive, but I hope it helps spark a conversation or two, or inspire you to learn more. Here are 3 of many examples of things I feel are important for LGBT adults to consider as they age.

• Advance Directives: This is the issue that jumps at me first when I think about aging and LGBT partners. According to the Washington Post, "In most states, an estranged sister would be appointed proxy before a same sex partner" in the absence of a written healthcare proxy. Heterosexual married partners, in contrast, are usually considered the default healthcare proxy. Even in states where same-sex marriage is legal, there have been reports of hospitals not honoring next-of-kin laws. While that obviously needs to change, it cannot hurt for anyone to be overly-prepared. For unmarried LGBT partners, there is an obvious need. Check out my blog on healthcare proxy to learn more. 
• Financial Support & Caregiving: Older LGBT adults are twice as likely to be single and 3-4 times more likely to be without children than their heterosexual peers. The risks of social isolation and poverty are subsequently higher. Ensuring a social support network is important for all elders, but perhaps is more acute for the LGBT community.
• Medicaid: By far and away, Medicaid is the best long term care insurance policy anybody could have- provided you meet the qualifications for it. It also provides certain spousal impoverishment protections, which help prevent spouses from depleting their home or nest egg in order to qualify for Medicaid. Unfortunately, these protections do not always apply to same-sex couples. Same-sex couples are subsequently strongly encouraged to meet with an elder law attorney or consider purchasing long term care insurance policies to better prepare for potential long-term care needs.   

The real and significant impact of discrimination, unique health care challenges (40% of elderly LGBT adults say their primary care doctor isn't aware of their sexual orientation), and unequal laws unquestionably puts LGBT elders at a disadvantage. We must work to improve this, and in the meantime, we should prepare accordingly. If you are an LGBT elder or family member considering working with a geriatric care manager, be sure they are sensitive to these unique needs from the get-go.

The experts on the issues affecting LGBT seniors is SAGE, and they're based right here in NYC. Visit SAGE's website to learn more, and to get involved on their great advocacy efforts. 

If I've left anything out (and I'm sure I have), please leave a comment. Let's keep the conversation going.

Generally speaking, and perhaps relative to other segments of the population, advocates for senior citizens have had more success through recent decades in ensuring that the needs for our aging population have been met. I think about Social Security, Medicare, and the wealth of programs instituted through the Older Americans Act, and I'm so thankful that these things exist.

As the population skews ever older, these resources are clearly in need of further strengthening so that the promise they bring will be there for future generations. I'm glad we're having having regular policy discussions nationwide about how to do this.

However, as a geriatric care manager in NYC, I believe not enough attention is being given to the issue of ensuring that seniors have adequate and affordable housing. Nowhere is this issue more acute than in NYC. When I think about the cost of living for younger people with full salaries, the idea of having to make it in this city with increased needs and a decreased budget sounds downright daunting. 

In my geriatric care management practice here in New York, this issue comes up with regularity. When this issue does come up with my clients, Im able to tap into my years of experience working at an organization that deals specifically with senior housing in NYC. Here are a couple of the many ways I'm able to help:

• I help seniors with "aging in place", where assessments are made, resources & services are explored, and through comprehensive care management, plans are eventually devised and implemented. Sometimes it takes very little to accomplish this and sometimes it takes a lot more, but it's very often a worthwhile and achievable goal. 
• Others simply want to know what's available other than nursing homes, which are obviously more medical in nature than what many of my clients are looking for. Im always happy to meet with clients and their families in consultation to explore options like assisted living and so-called "enriched housing facilities".  I can help clients apply for, and facilitate transitions to these facilities, as well.

If I could give a single piece of advice to those who are thinking about these things, even if only a little bit: start planning early. The options for facilities on the more-independent (and more-affordable) side of things have huge waiting lists. Sometimes years long.

This is obviously a tremendous topic that demands more than a short blog post. If you would like to discuss this topic more, be in touch anytime. We're here to help.