When Cathy Greenblat was in her 20s, her grandmother and grandfather had Alzheimer’s. “I bought society’s message that nothing could be done but keep them safe,” she says. Years later, when Greenblat’s mother developed the disease, she realized that lots more could be done.

The former Rutgers University sociology professor began to see Alzheimer’s through a different lens — her camera — when her mother was in a memory care facility. Greenblat saw quality care in a place brimming with “music, art, discussions about news, smiles, touch and gentleness that changed the quality of life for the residents,” she says.

Her mission was “to show what it is like to keep your dignity when you have Alzheimer’s,” says Greenblat. For more than a decade, she’s traveled around the world taking photos of people with dementia. The self-taught photographer has taken pictures in private homes, memory clinics, residential facilities, memory clinics and adult day centers. The people are often with loved ones, often smiling and giggling.

“There aren’t many books with Alzheimer’s photos and most are of people looking miserable and showing loss. Losses are real, but they’re not the whole story,” she says.

In 2004, the California-based Greenblat published her first photography book Alive With Alzheimer’s. Last year, Greenblat, 73, put out Love, Loss, and Laughter: Seeing Alzheimer’s Differently. It, too, is a coffee table book with photos and text that show the rewards of quality Alzheimer’s care.

Along with the book, Greenblat created a photography exhibition — the largest collection of Alzheimer’s faces anywhere — that is making its way around the globe.

The exhibit was in New York earlier this year, and has made the rounds in Washington, D.C., Toronto, Glasgow, Scotland, Geneva and Salamanca. It is in Australia for the next seven months.

Greenblat’s takeaway from her research and travels is that “We give up too soon. We can’t cure the disease, but there are things we can do that bring people with Alzheimer’s joy up until the very last minute.”

Dementia treatment has evolved over the last few decades. I’m fascinated by the transformative power of the creative arts and have written several articles on innovative programs. They involve dance, singing, playwriting and acting, making music, movies, museum education, storytelling and poetry. Perhaps my favorite is the memory care facility which has a “resident” llama that visits elders in their room. (For more programs, visit the National Center for Creative Aging.)

Back to Greenblat. Her work is important! Look for the exhibit to land back in this country. In the meantime, her book shows a different vision of Alzheimer’s — and what is possible.

Photograph courtesy of Cathy Greenblat

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This digital estate planning document states what you want to have happen to your social media — Facebook, Twitter, Google, LinkedIn, email account — when you die. Just as you need an executor of your estate, you’d have to appoint a legal online executor.

As more older people go online — a 2012 Pew Research Center study found one-third of Internet users age 65+ go on social networking sites on a typical day — grow older and pass away, who has a say in their social media content is likely to become a mainstream concept. No doubt it will spawn lawsuits, or at least bad blood, among those who want to keep a loved one’s posts on the site and those who don’t. (Ultimately, those cases will be decided by state law.)

In the meantime, with a death certificate, Facebook will either remove a deceased person’s profile/account or change it from active to a memorial page. People can share memories and photos of the person and keep the timeline, but the status updates won’t pop up. (“Hi, I’m no longer among the living” or “Back in five. Gone to meet my maker.”)

Twitter and LinkedIn will also deactivate an account with a death certificate. LinkedIn and Google require an authorized representative of the estate to make the request.

Google recently introduced the Inactive Account Manager. If your account becomes inactive, Google’s “Grim Reaper Manager” will warn you by text message and email that it’s inactive (a prank-proof move). If it’s not a false alarm — you’ve really expired — you will have already told Google what you want done with your Gmail messages and other services or else appointed others to make the decision.

For those who just can’t say goodbye, there are services that allow you to keep your online presence even after you’re gone. You heard correctly. DeadSocial lets you compose Facebook, Twitter and Facebook messages for future times (birthdays, other important dates or whenever) when you’re no longer around. LivesOn, which plans to launch (unclear when) has this cheery motto: “When your heart stops beating, you’ll keep tweeting.” And, if i die is a Facebook app that allows you to create video or text messages that get published postmortem.

So much for a digital afterlife. If you’re still here and haven’t come up with a Mother’s Day or Grandma present for this Sunday, how about downloading a free app called EasyFamily Social, in English or Spanish? It simplifies Facebook (six big buttons) and makes it easier for older adults to share photos and messages with family. The company has a campaign to get 17 Million Grandmas on Facebook.

A little motherly advice: if you download that Facebook app for Mom or Granny, you might want to save the social media wills/digital legacy talk for another time!

Sally Abrahms writes about boomers and aging. Follow her at www.sallyabrahms.com or on twitter.

America’s 65.7 million family caregivers may be an army, but if you’re one of those troops, you can feel alone in the trenches. There’s the ever-changing situation, unpredictability, loss, exhaustion and, often, depleted funds.

National caregiving organizations, like the Caregiving Action Network (CAN), the National Alliance for Caregiving (NAC) and the Family Caregiver Alliance (FCA), as well as disease-specific groups, can be a huge support. But did you know there are also caregiving coalitions across the country — 90, in fact, and growing — targeted to specific communities?

A coalition is made up of organizations and agencies that come together to support caregivers. It  might be the town’s senior center, businesses, government, the local chapter of Alzheimer’s groups, hospitals and an AARP state chapter.

Coalitions steer caregivers to services, offer information, and advocate around policy issues. Some coalitions run conferences (along with respite care), stress reduction workshops, resource fairs, webinars or other activities.

Here’s a sampling of initiatives:

•  Caregiver Coalition of San Diego: California group offers free weekly webinars to caregivers along with web videos and seminars. Topic experts (Medicare, legal sources, wellness resources, conversations around difficult topics) will come to a company during lunchtime and give a presentation to employees.
• The Arizona Caregiver Coalition has a resource telephone line.
• The Caregiving Coalition of Northeast Florida puts out a monthly newsletter and runs workshops for family caregivers.
• Coalition of Caring, in New Hampshire, holds an annual statewide conference to teach practical skills, let family caregivers meet others and provide resources. (Free massages are a bonus!)
• Hawaii Family Caregiver Coalition just issued “Aging & Disability Issues 2013: A Guide for Hawaii’s Legislators, Organizations and Citizens.” It educates legislators and the community about caregiving issues.

What makes these groups so effective is that NAC connects coalitions with one another. The coalitions share strategies and mentor one another. There are quarterly calls, an e-newsletter and webcasts. NAC will also give a coalition one-on-one counseling.

Every year, NAC holds a family caregiving coalition conference. At its 2013 meeting this March in Chicago, NAC rolled out a guide to help organizations start their own family coalition.

Want to see if there’s a coalition near you, or start one? You can email coalitions@caregiving.org.

Photo by marsmet546 courtesy of Creative Commons

Sally Abrahms covers aging and boomers for national venues. For more work, take a look at her website or follow her on twitter.

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And yet, a recent report issued by the AARP Public Policy Institute shows that many older adults lack access to high-speed Internet and if they can get it, they may not be able to afford it.

AARP did a follow-up of the Federal Communications Commission’s (FCC) 2010 National Broadband Plan. That plan underscored the need to have greater high-speed Internet opportunities for older adults. Speed matters, the AARP report points out, and can make the difference between what you can, and can’t do, with the Internet.

Slower Internet connections may confine you to web browsing or email. But to video conference, for instance, or to run multiple applications concurrently, you need high-speed connectivity .

Take a look at these AARP findings:

•  In 2012, 39 percent of those 65+ had high-speed Internet connection at home versus 77 percent of ages 30-49
•  Just 18 percent of African-Americans age 60+ had high-speed Internet versus 64 percent of those ages 30-44 and 48 percent ages 45-59
• Only 20 percent of Hispanics age 60+ used the Internet compared to 38 percent of ages 45-49 and 49 percent of ages 30-44
• Whites had the most access: 39 percent of those age 60+ had high-speed Internet versus 65 percent of ages 45-59 and 81 percent of ages 30-44

If you’re looking after someone with a chronic condition, and multiple health issues, it can be complicated and stressful. Usually health care professionals and hired help, family or unpaid caregivers must work as a team.

With an Internet connection, you can access applications and services. High-definition video conferencing, for instance, lets you “talk” to health care professionals and can be used for family meetings when there are long-distance caregivers. GPS devices and computer programs can keep track of parents or spouses with Alzheimer’s who may wander.

“Smart home” applications, as they are called, can help older adults age in place. Many let residents (and caregivers, if necessary) control home security and lighting from a distance.

The National Alzheimer Center, a division of the Hebrew Home at Riverdale in New York, just launched Balance, an app that helps:

• keep medication organized (and lets other relatives keep current, too)
• provides an RSS feed for news about Alzheimer’s
• offers caregiving tips
• and has a section for notes for the doctor and patient appointments.

Another good-to-know caregiver app: Connectmyfolks.com lets caregivers exchange email, texts, photos and videos with loved ones. While the caregiver can use any computer, tablet, laptop or smartphone, the care recipient only needs an iPad. Computer-phobes, there are just three buttons on the iPad! For other products, check out the Aging in Place Technology Watch or a blog post I wrote last year, 9 Need-to-Know Technologies for Caregivers.

eCareDiary.com is a free website that lets caregivers, and recipients if they want, store medical information, track medications, create an appointment calendar and share this information with other family members. It is developing a mobile app, but until then, there are Q-and-As with experts, webinars and an Internet radio show about caregiving.

Of course there are many other helpful apps, programs and websites. Which do you like and why? Please share!

Photo by Noii courtesy of Creative Commons

Follow Sally Abrahms at www.sallyabrahms.com and on twitter.

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According to the Centers for Medicare & Medicaid Services (CMS), in 2012 on any day, more than 1.4 million Americans live in 15,800 nursing homes; more than 3 million have used nursing home services some time during the year.

You may not be able to control an explosion, earthquake, hurricane, power outage, terrorist attack or other catastrophic natural or human-created events. But, you can make sure you know what will happen to your parent or someone else dear to you should there be one.

Some past disaster plans have been . . . a disaster. In 2005, 70 nursing home residents lost their lives when Hurricane Katrina and Rita barreled through New Orleans and the Gulf Coast area. The federal government’s General Accountability Office (GAO), the independent investigative arm of the U.S. Congress, studied why there were so many lives lost and has brought awareness for the need for more stringent policies.

Related: A Caregiver’s Hurricane Prep List

In 2006, Louisiana passed a law requiring its nursing homes to have a more detailed evacuation plan. It calls for updating their evacuation and disaster preparedness plan once a year and having state officials sign off on their transportation plans.

Last fall, Superstorm Sandy also posed evacuation difficulties in the New York City area. Because of these continuing disasters, the federal government’s CMS, which helps improve nursing home care, expects to  issue new disaster planning requirements some time this year.

In some circumstances, residents cannot be evacuated immediately and are ordered to stay where they are (“shelter in place”). There must be plans for this as well.

In the meantime, here are nine questions to ask nursing home administrators:

1. What is your evacuation plan and does it comply with government standards? Who decides to activate that plan? When was the plan last updated? Do first responders know what the plan says?
2. What’s the transportation plan in an emergency? How will you get residents out (special equipment?) if the elevators aren’t working?
3. How often does staff review these plans? When was the facility’s last drill? Do you have them at different times of the day when there are different shifts?
4. If residents are transported via buses, ambulances or vans, will there be enough to meet their needs? Is there a written document, like a memorandum of understanding or a contract with these transportation providers?
5. Is there a backup plan if they can’t handle the demand?
6. Where will residents be taken (other nursing homes, hospitals or to family?) and are these places going to be able to accommodate them?
7. Do they have a way to transmit medical records along with residents and, if so, how are they going to do it?
8. How and when will you tell a family member where their loved one has been moved? In other words, what’s your communications plan?
9. If residents need to stay in place for a couple of days, what kind of supplies do you have (food, water, oxygen, medicine and flashlights) and for how many days? Does the place have a generator? Have they thought about an emergency supply kit geared to each resident?

New York State also has a sheet to better understand evacuation plans.

Photo by peretzpup courtesy of Creative Commons

Follow Sally Abrahms at www.sallyabrahms.com or on twitter.

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“Geriatric diabetes is not as well understood as it is for the pediatric population. Treating a 40-year-old the same way as an 80-year-old is inappropriate,” says Dr. Medha Munshi, a geriatrician and endocrinologist who runs the Geriatric Diabetes Program at the Joslin Diabetes Center in Boston, Mass.

Munshi says the diabetic patient’s family and physicians may not think about other complications such as heart disease, stroke, hypertension, kidney disease, blindness and eye problems, nervous system disease, amputations, dental disease and depression. Treating more than one condition at a time can be tricky. Many older people take 10-15 medications a day.

If you are vigilant  and talk to your loved one’s doctor about age-related issues of diabetes, you may be able to head off a crisis.

Follow these five tips for caregivers of older diabetic adults:

1. Watch for low blood sugar called hypoglycemia. Symptoms might be sweating, feeling hot, shakiness and a fast beating heart. In older folks, hypoglycemia can cause confusion, irritability, dizziness, weakness, feeling faint or even a change of behavior. It’s dangerous for many reasons and can result in falls or a decline in cognitive functioning.
2.  Make sure they can take care of themselves, if they have to, when they’re sick. Are they taking their insulin on time? Are they eating? Be vigilant about excessively high or low blood glucose from being sick, weight loss, dehydration or not enough food.
3. Check that they’re taking the correct doses of insulin and medication and not skipping meals. It might mean there is cognitive decline.
4. Notice if they act depressed. Depression is a common symptom for older adults with diabetes.
5. Decide if their medical plan and regimen is too complicated for them, especially if they have multiple conditions. Are they having trouble remembering their medicine? Ask the doctor what you can do to simplify it. “You need to change their strategy to fit their coping abilities,” says Munta. “Most people say you need to educate, educate, educate your patients. What we do in geriatrics is change what we are doing to see what patients can do and what they can’t do.”

The American Diabetes Association offers a Senior Signature Series for older adults to educate, provide resources and teach ways to reduce complications. The program is available in New York, Washington, D.C., Los Angeles, Dallas,  Indianapolis, Houston, Boston and Miami.

More than 79 million Americans over age 20 may not have diabetes, but are at risk for what is called prediabetes. More than one in three American adults has prediabetes. The U.S. Centers for Disease Contro and Prevention offers information and a quiz to screen a person’s risk and many local YMCAs have prevention programs to adopt healthier behavior.

What do you think is the hardest part of caring for someone older with diabetes? Any strategies you can share?

Photo by dziner courtesy of Creative Commons

Follow Sally on her website, on LinkedIn or on twitter.

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“There are things my mother says that are so out of character and off the wall,” says McCorkle. “I can’t even imagine where it comes from. But if you don’t find the levity or learn to roll with it, what’s going to crush you anyway is going to crush you sooner.”

Alzheimer’s has many cruelties, and one of them can be a change in personality. It is what McCorkle, author of the recently released Life After Life: A Novel, which takes place in a “rest home,” calls “Alzheimer’s intersection of tragedy and comedy.” Some of McCorkle’s characters have dementia, and one even fakes it to avoid living with his son. (He figures out quickly that it was a bad move.)

Get Your Brain in Shape! Think faster, focus better. Try Brain Fitness: It’s free to start!

“At the beginning, it might seem irreverent to find something your loved one is doing amusing,” says Carol Podgorski, a marriage and family therapist at the Memory Care Program at the University of Rochester Medical Center, “but it can become a healthy coping skill when people find humor in a situation.”

Here are five ways to look at humor:

1. Separate the disease from the person you love who has the disease. If your parent or spouse says something that doesn’t make sense but is funny, tell yourself, “It’s the disease talking and not Mom.”
2. Don’t feel guilty about finding something they say funny. Humor is a form of relief.
3. Educate yourself about dementia and Alzheimer’s. The more you understand them, the more you’ll see your loved one’s comments are par for the course.
4. Understand that not everyone in the family is at the same place with the disease as you may be. You might see the humor, but a long-distance sibling or your adult child might say, “how dare you” and find your reaction tasteless. Tread lightly.
5. Find someone who appreciates these funny exchanges. That’s what friends and support groups are for!

Sally Abrahms writes for national magazines, newspapers and websites on aging and baby boomers. Follow her at www.sallyabrahms.com or on twitter.

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Cray Cothran, who lives in assisted living, interacting with residents

There’s a children’s book series that has come out in the last year about a young girl named Carlyn and her visits to her grandmother in assisted living. It debunks the stereotypes about old people and long-term care. Here’s one line from Carlyn Meets Granny Girl’s New Friends: “Wow, this does not look like a place creepy people live, and I do not smell anything weird, either!” Carlyn said.

There’s an even more interesting story behind the book. It’s written by a registered nurse, Alison Cothran, who lives and works at Homestyle Assisted Living in Springdale, Ariz., along with her husband Wade and their children. She and Wade, who acts as the administrator, have been co-owners and residents since the facility’s inception 15 years ago.

Get Your Brain in Shape! Think faster, focus better. Brain Fitness. It’s free to start.

The Cothrans have a three-bedroom apartment built for their family. Their oldest daughter, now in college, grew up there, and so do Alison and Wade’s two sons, ages 13 and 10, and 8-year old daughter. That would be Carlyn of book name/fame.

The family considers the entire facility their home. So, for one of the children’s birthday parties, the kids asked residents to participate in games along with their pint-size guests. When the children got sneakers with lights on them, they turned off the lights in the main dining room and moved around. One Fourth of July the Cothran children had a bicycle parade in the dining room.” It’s intergenerational to the max. “We’ve been able to share a lot,” says Alison.

The families of the residents, the family caregivers, are thrilled to have the children around. One adult child bought a teepee for the kids and kept it in her mother’s closet. The kids would set it up and play in her living room. Another resident’s child purchased and stocked a toy box so Cothran’s children would hang out in her mom’s room.

Alison says each of her four children has formed his or her own special relationships with residents — relationships that have developed without prompting.

Having kids at the 76-bed facility may also be good for business. When prospective families tour Homestyle Assisted Living, they always comment on the Cothran children’s school pictures and sports trophies in the corridor near their apartment.

Back to the book. So far Alison has published three of what she expects to be a five-part series about Carlyn visiting the assisted living residents. “I wrote it to help other children who come to these facilities. I want it to be a positive experience for them.”

Sounds like the Cothrans have had a lot to talk about at show-and-tell. And the rest of us have a lot to learn.

Take a look at Sally Abrahms’s website and follow her on Twitter.

Photo taken by Wade Cothran, father of Cray

Click here to view the embedded video.

The U.S. Department of Housing and Urban Development reports there are 1.6 million homeless people a year on any given day. According to an NPR story, more than half of single homeless adults are age 47+. Younger boomers born between 1955-1965 are driving the aging homeless population, says Dennis Culhane, professor of social policy at the University of Pennsylvania. He is the lead author of a new study, “Age Structure of Contemporary Homelessness.” Culhane says it’s the dismal economy from 1979-1984 that first put these now older adults on the streets. He believes this population is almost twice as likely as other age groups to be homeless.

But take note: it’s not that older people are becoming homeless at a rate they hadn’t before. It’s that those who have been homeless and near homeless for the last 35 years are getting older.

For the most part, not really old. The homeless usually die prematurely. (I’ve seen different statistics on life expectancy for the homeless, from ages 42-52, but also some reports that it can be as high as 64 .) Regardless, it’s at least 20 years younger than the non-homeless population. Says Culhane: “Most will die over the next 10 years and will face all sorts of health care hurdles. It’ll be very costly to society if we don’t try to get them into housing.” The shortage of affordable subsidized housing for the poor and a struggling economy isn’t helping, either.

Because they don’t take care of themselves, they have health problems often seen in much older people such as heart disease and diabetes. John Lozier, executive director of the National Health Care for the Homeless Council, says the homeless have three to six times the rates of all illnesses, often with multiple diseases (i.e. mental illness, renal disease and foot problems).

It wasn’t until I attended a health care conference this month that I thought about who takes care of this aging demographic, or really, the homeless of any age. What do they do if they need rehab after surgery? Are undergoing chemotherapy? Are diabetic and need to refrigerate their insulin? What if they’re dying?

The health care conference highlighted an innovative program, the Boston Health Care for the Homeless Program (BHCHP). Part of its program takes place at the Barbara McInnis House, which has a 24/7 medical respite care facility. (In 2012, 51 percent of those who were enrolled in the program were age 45 and over.)

It’s one of 60 or so medical respite programs around the country for the homeless. They’re designed for those who don’t need a high level of nursing care and aren’t well enough to go to a shelter. Usually, someone goes for medical respite and then gets discharged back into the shelter system. But the McInnis House happens to be in the forefront of end-of-life services for the homeless. In fact, it may be the only end-of-life program of its kind.

“We try to help patients reconcile with family members before they die,” says Cheryl Kane, director of nursing at BHCHP’s Barbara McInnis House. “We have a man who is dying who had been estranged from his sister in Mexico for 30 years. We made it possible for him to Skype with her.”

Some families do take back their long-lost siblings, spouses and adult children at the end of their lives, but that’s not typically the case. “It used to be the expectation that you took care of your own but that seems to be less the case in today’s world,” says Lozier.

For more information on homelessness, go to the website for the National Coalition for the Homeless.

Know of any good programs for the older homeless population?

Sally Abrahms covers aging and boomers for national publications and websites with a focus on caregiving, housing, livable communities and work. Follow her on Twitter or visit her website.

Software tax programs like TurboTax, TaxAct and H&R Block at Home are easy to use and do many of these calculations for you. It’s still good to know if you qualify.

You might be able to claim your parent, grandparent, stepparent, mother- or father-in-law, sibling, half sibling or step-sibling as a tax dependent even if he or she doesn’t live with you. Here are the rules:

1. His or her gross income in 2012 must be less than $3,800 (last year it was $3,700) excluding disability and Social Security payments. That number includes rental income and wages, interest and dividends from investments or pension benefits and withdrawals from retirement plans.
2. You must be paying more than 50 percent of his or her expenses.
3. The person cannot be claimed as a dependent by anyone else.
4. Mom and Dad can’t file a joint tax return unless it’s to claim a refund, and neither parent can owe tax on a separate return.

What if your relative’s gross income is more than $3,800? Then that person can’t be a dependent but might still qualify for a deduction on his or her medical expenses. Those expenses will need to be more than 7.5 percent of your adjusted gross income. (For 2013 taxes, the threshold will be 10 percent.)

You might also be eligible for the child and dependent care credit. If that’s the case, you’d get a credit of up to 35 percent of expenses paid for dependent care, with $3,000 in maximum expenses. That translates to as much as a $1,050 tax credit. Qualified long-term care services may be deductible as well.

To qualify for the child and dependent care credit, you must have earned income, your relative must be unable to take care of himself or herself because of mental or physical limitations, and the care recipient typically must live with you.

There’s also a credit for the elderly or the permanently and totally disabled, but just 100,000 a year lucky filers can take it. Generally, your annual income can’t exceed $25,000.

Confused? Overwhelmed? You can always call the Internal Revenue Service telephone assistance help line. Dial 800-829-1040 Monday-Friday, 7 a.m. to 7 p.m. local time.

Follow Sally Abrahms at her website and on Twitter.

Photo by 401(k) 2013 courtesy of CreativeCommons.org