December is a time of reflection – looking back over the last year and forward to new beginnings. Wishing all caregivers peace, joy, health and balance in life. And, although we may encounter many challenges as caregivers, it is a wonderful life!
The following was exclusively written for PBS/Next Avenue
It was a low point for Jenny Montalbano back in 1996. She was divorcing her husband and feeling all alone. She knew she had to get out of the house and do something to keep her mind and hands occupied. She found her solace in the preparation kitchen of God’s Love We Deliver (GLWD), a nonprofit meal delivery volunteer organization servicing greater New York City and parts of New Jersey founded in 1985.
“I was volunteering my time in the SOHO food kitchen and even though I was helping them, God’s Love We Deliver really helped me through a very tough time – it became my emotional rescue,” says Montalbano. Having grown up in a traditional Italian American family, Montalbano shares, “I grew up in a household where food was comfort so helping to give meals back to others has become my passion these last 16 years.”
According to the Meals on Wheels Association of America (MOWAA), more than 5-6 million seniors over age 60 go hungry every day. Many are homebound, unable to grocery shop or prepare meals for themselves because of things such as painful arthritis, macular degeneration or lack of energy to cook if they are battling a devastating disease such as cancer or COPD. MOWAA, the national arm of a vast network of 5,000 local community agencies, delivers one million meals daily all through the efforts of its nationwide volunteer network.
For many family caregivers, especially the 7-8 million who live long-distance from their loved one, having a nutritious, fresh meal delivered to a loved one is a gift that is truly comfort for all. Some organizations, such as Feeding America, or the many local food banks that feed the hungry and homeless, require the recipient be able to come get their meal or prepare their meal. But many seniors are homebound and struggle with cooking so the prepared meal delivered daily becomes a life-saving solution.
“We usually talk about senior hunger issues during hard economic times and then the story is over, but the fact of the matter is hunger is not dependent on economic times any more than it is dependent on the weather,” says Enid Borden, ceo and president of the National Foundation to End Senior Hunger. She also says while poverty is a predictor for senior hunger, this issue is becoming more of a middle class issue. Statistics show 50 percent of those older Americans going hungry are above the national poverty level. In fact, a MOWAA report found 1 in 9 seniors are “food insecure” and the most at-risk are baby boomers age 60-64.
Part of the issue according to Borden is many of these hungry seniors are homebound so we don’t see them in the course of our daily life the way we might see news reports of food kitchens. “Seniors who face the threat of hunger are really the hidden hungry – hidden from society in terms of their inability to be outside in our communities but also because many seniors perceive a stigma with this issue and they don’t talk about it.”
In addition to the stigma and health risks, another issue associated with senior hunger can be isolation. The MOWAA report found single seniors are most at risk for food insecurity.
One of the biggest concerns caregivers may have about their older loved one is isolation, particularly those loved ones living alone at home because they recently lost a spouse or partner. When an older person does not have someone to talk to, does not attend church or synagogue or is not seeing family and friends regularly, this can lead to isolation and ultimately depression and other health issues such as not eating. Seeing a daily volunteer who delivers meals and checks in on seniors can have a tremendous positive impact.
“Many people don’t realize that sometimes the meal delivery driver is the only social visit a senior may receive during the day,” says Em Findley, communications coordinator for God’s Love We Deliver (GLWD). “That is why we take great pride in not only delivering nutritious, delicious meals but also bringing a smiling face to the door to brighten a senior’s day.”
Caroline Sorensen, a high school senior in New York who volunteers with Meals on Wheels, recently told me, “I love knowing I made someone’s day easier and happier.” She has been a teen volunteer for Meals on Wheels through her school for four years and she has a favorite older delivery recipient. “Doris always comments on my hair, it is long and silky and we talk about the latest in hair fashion,” says Caroline. “She laughs that her hair is not quite that pretty anymore – but instead of making her sad it’s a fun conversation we have every time I see her. And, she always wants to make me tea so we sit for a few minutes and talk – I always feel good after I leave her.”
When disasters occur, such as Hurricane Sandy which devastated New Jersey and New York’s five boroughs especially Staten Island, Queens and the Jersey Shore this October, meal delivery services struggle to maintain the sustenance their clients need.
“We lost power for one week after Sandy hit,” says Findley of GLWD. “However, due to the herculean efforts of our volunteers, we created 2,300 ‘Sandy bags’ of perishable food and got them to local Red Cross shelters and local churches to continue to help and we were still able to get 8,000 meals donated and delivered.”
“Food is both love and medicine,” says GLWD’s Findley. Since drivers often spend a few minutes talking to the meal recipient, they bring both food and friendship to lonely seniors. “One client told our driver, ‘I can feel the love in every bite.’”
What makes GLWD unique is each of the 20,000 meals they deliver every week is customized for clients, there is no wait list and no age requirement (to qualify for Meals on Wheels you must be age 60 or over or live in senior housing). In fact, 78 percent of their clients are age 50+ and many live in Manhattan where volunteers deliver meals on foot. They have nutritional counselors who talk to clients about special needs and personalize each meal whether it’s kosher meals, diabetic meals, gluten-free meals or even pureeing meals for those clients who have trouble chewing. As with MOWAA, meals can also be delivered for the family caregiver.
“We know sometimes the caregiver is at much at risk for hunger or poor nutrition as the senior,” says GLWD’s Findley. “Caregivers are often struggling with financial issues, physical caregiving and other challenges – if we can provide the meals to keep both caregiver and care recipient nourished that is part of our mission.” Findley reports over the last two years GLWD has seen a 40 percent increase in requests for meals for the family caregiver of those clients over age 65.
In addition, meal delivery may be the answer in helping caregivers keep an older loved one living in the home they love instead of contemplating nursing home living. A recent report from Brown University researchers found the states who subsidized meal delivery costs through the Older Americans Act have a correlation to a reduction in the percentage of relatively healthy seniors in nursing homes. Published in Health Services Research, researchers found for instance, “in Washington state, which spends just $8 on subsidized meals for every senior state resident, nearly 17 percent of the nursing home population is made up of those with minimal health needs,” meaning they may need low-care and not the full suite of services nursing homes provide.
A few years ago, Montalbano’s mom developed stage 4 cancer. Montalbano had just started a new full-time job so she turned to GLWD to help deliver meals for her mom for the last month of her life so Montalbano could keep her at home.
“I’ve been on both sides – as giving and receiving – of the special gifts God’s Love We Deliver provides,” says Montalbano. “Nothing lifts your spirit more than to volunteer to feed a senior. As a caregiver, I’ll always cherish that my mom saw a friendly driver who came to the door every day to bring her a meal and a smile. I tell people God’s Love We Deliver was a God-send. They fed my mom physically but they fed both of us emotionally.”
How You Can Help This Holiday Season – Eat, Pray, Love
In her best-selling memoir, Eat, Pray, Love, Elizabeth Gilbert discovers one of the best gifts in life is giving to someone else in need. If you want to deliver a little soul food this holiday season, here are ways you can volunteer to spread the holiday spirit:
God’s Love We Deliver – looking for volunteers for Christmas Eve and day to help with deliveries in New York’s five boroughs and neighboring New Jersey
Meals on Wheels Association of America – find a local chapter through this national site or donate – $7 feeds a hungry senior for the day
Check with your local faith-based organization and visit the National Volunteer Caregiving Network to find a local meal delivery program through faith-based groups in your area – volunteer drivers are often needed
Donate $1 to the National Council on Aging (NCOA) hungry senior campaign and NCOA will connect a vulnerable older adult to $40 annual benefits to help pay for food
Our blogs this month focus on how to have the caregiving conversation and how to volunteer to help caregivers in the spirit of the season!
If you live long-distance from older parents, in-laws or other loved ones, you may not realize how their lives are changing as they age. For most caregivers, watching for signs in loved ones’ personal habits, their home environment, their driving and their behavior are the first indicators that you may be starting your caregiving journey.
Today, approximately 44 million Americans are caring for an older loved one over the age of 50 yet most of us enter our caregiving role in a crisis. A sudden medical diagnosis such as cancer or Alzheimer’s disease, a fall at home that results in ER or hospital treatment, a stroke or heart attack or the death of one parent leaving the other parent alone are all reactionary ways to join the caregiver ranks. We become deer in the headlights – we are unprepared, uninformed and ill-equipped to understand all the caregiving responsibilities we may be facing. And the tolls we face on the caregiver highway can be physical, emotional and financial.
But what if you were able to pick up clues before your caregiving journey began? What if we had a roadmap or at least some signposts about what may be coming? These early signs would give us time to plan the journey with our older loved one. We could better prepare to ensure everyone had a say on the caregiving path including the financial and other resources for the trip.
- They have gained or lost significant amount of weight since your last visit – could be signs of a serious illness, depression, dental problems, medication interference in food taste and appetite.
- They are drinking more alcohol than usual – could be a sign of depression and fear/anxiety over a recent event such as loss of a spouse, loss of a close friend, a medical diagnosis they have not shared with you yet.
- They are neglecting their personal hygiene such as body odor, bad breath, soiled clothes, unattended skin sores or rashes – could be a sign of dementia or depression or perhaps medications are affecting them adversely.
- You notice a lot of pill bottles in the bathroom cabinet or bedroom nightstand – 40 percent of adults over age 65 take 5-9 medications. More than 100,000 seniors die from adverse drug reactions every year.
- Their home is more cluttered and unsanitary than unusual with dirty dishes in the sink, stacks of newspapers, unopened mail piling up, a lot of dust or dirt – could be signs of physical pain such as bad knees or arthritis to clean the house properly, mild cognitive impairment, depression.
- They are acting differently such as being more quiet or louder than usual, withdrawn and not engaging in social conversation, agitated – this could be a variety of issues but it should not be overlooked. Ask a neighbor or someone who sees your loved one more regularly if they have noticed this change and when it started.
- They have physical injuries such as bruises, burns or talk about recent falls – falling puts 2 million seniors in the ER every year and is the leading cause of injury death among those over age 65.
- They have given up social rituals such as going to faith services or playing in their weekly bridge game – isolation is a serious issue for older loved ones that can lead to depression and repressed immune systems.
1) Try to schedule your visit home when you can attend a doctor visit with your loved one and find out more details about their physical and mental health is the recommendation from Nora Jean Levin, CEO of Caring From a Distance, the nonprofit organization dedicated to helping long-distance caregivers.
2) Engage the help of a trusted neighbor or local friend who can keep an eye on your loved one and alert you if problems being to escalate.
3) Seek professional help – either a geriatric care manager found through the National Association of Professional Care Managers (or sometimes offered through your employer’s EAP benefit if you are working) or seek a new type of professional called a patient navigator. One new company just launched this summer is CarePlanners. CEO Alan Blaustein waged his own battle with cancer and based on his experience navigating the health care system, created the company with Dr. Nancy Snyderman, the medical expert for NBC News who is also a caregiver to her older parents.
One of the best things you can do when home for the holidays is take a drive with your loved one at the wheel even if it’s just a trip to the grocery store. If you notice any of the following, you need to find out if this is an isolated incident or an ongoing problem. Look for the following:
- They have become fearful, nervous or anxious about their driving
- There are multiple scrapes or dents on their car
- They have difficulty staying in their lane or come too close to hitting the curb
- They admit to a “little accident” such as hitting the side of the garage or a mailbox
- They have difficulty seeing and obeying road signs, lights or street markings and obeying speed limits (either way too slow or way too fast)
- They have a slower response time in basic driving skills such as braking or accelerating
1) There are driving assessments to see if your loved one’s car just needs an adjustment or if driving retirement needs to be considered. CarFit is a volunteer-based program offered at senior centers and other places to get this assessment or you can have your loved one’s physician prescribe an assessment from an occupational therapist.
2) If driving retirement may be in order, investigate alternative methods of transportation before you have the important discussion with your loved one. Most older loved ones want to hear the news from their spouse (50%), their doctor (40%) or an adult child (33%). How to have the conversation tips can be found from The Hartford or view great online videos about how to approach the conversation with your loved one from the Alzheimer’s Association (good for any caregiver not just those with dementia). Alternative transportation can be researched through the National Center for Senior Transportation, ITN America and regional services such as SilverRide.
The Alzheimer’s Association reports 5.4 million Americans are diagnosed with dementia or Alzheimer’s disease but they estimate 50 percent of those with the disease are undiagnosed. While many believe Alzheimer’s is “an older person’s disease” the reality is 200,000 Americans are showing early warning signs of the disease in their 40s and 50s. To help families better prepare for a long caregiving journey that could last 4-20+ years, the Alzheimer’s Association has created the Ten Warning Signs of Alzheimer’s Disease. Here are some of the things you should look for:
- Memory loss especially with recent information. As we age we all lose some of our recall ability but not being able to remember someone’s name again and again, forgetting appointments or forgetting things completely that were just discussed an hour ago are cause of concern.
- Misplacing everyday things in unusual places such as putting their car keys in the freezer.
- Having trouble with simple, everyday words or replacing words with unusual options such as forgetting the word for “toothbrush” and saying instead, “the thing I put in my mouth.”
- Becoming lost in familiar surroundings such as their own neighborhood or not remembering how to get home.
Visit the Alzheimer’s Association web site for more information about the 10 Signs and if concerned, schedule a doctor appointment for your loved one you can also attend to confirm what is going on and what your next steps will be.
Enjoy the holidays and be aware of the signposts on the caregiving expressway.