Meeting Notes 1998

Coping with the Unique Stresses of Caregiving

We were privileged to have Ms. Marion Poirier, M.A., R.N., Executive Director, Oahu Alliance for the Mentally Ill, speak to us on coping with stress. Her long professional career with various United Way organizations (including the Alzheimer’s Association) has provided her with keen insight into the issues of caregiving.

“Caregivers must focus on themselves and take care of themselves first, with proper nutrition, time for exercise, primping, shopping, time for reflection. How,” you ask, “is all this possible?” Marion recommended creativity, adding structure to daily routines, asking others for help, and making time during the day for personal care. One member mentioned that the early morning hours, while others are sleeping, is her time to read and work without distraction. Another member resolved to leave the car unwashed and use the time instead for brisk walks.

“Exercise helps to relieve stress,” Marion mentioned, “and personal journals also help with emotional well-being. If you are worried or upset, write it down in your journal, read and reflect upon it later. This therapeutic process often leads to a more positive attitude.” Marion reminded everyone that “nothing is forever, neither the good nor the bad. All things change. Do your best.”

Delicious brownies, baked by one of the members, and a lively discussion with our guest speaker followed the “formal” presentation. We appreciated the time and the valuable information that Marion gave to us.

Advance Directives

Our guest speaker and oftentimes special “advisor,” Ms. Carolyn Mueller, L.S.W., A.C.S.W., Licensed Social Worker, Wahiawa General Hospital, provided general information on advance medical directives, documents prepared to direct personal choices on future medical care.

These documents include a Living Will, Durable Power of Attorney for Health Care, and Compassionate Care Only - Do Not Resuscitate. For the latter, a State of Hawaii form is available that allows the patient to direct out-of-hospital emergency medical services personnel, first responders, etc., to give care for comfort only. A physician must certify on the form that the patient has a terminal illness from which recovery is not expected. Once the form has been completed, a bracelet and necklace, imprinted with the pertinent information, can be ordered. Call Department of Health Emergency Medical Services at 733-9210 for information and application forms.

Planning is the key to protecting your rights! Call Carolyn Mueller at 621-8411 or 621-4268 to inquire about how caregivers and patients can make arrangements for a Living Will or Durable Power of Attorney. A booklet containing general information about advance directives is also available. Because laws and regulations are subject to change, the booklet cannot take the place of legal counsel.

~ No Speaker ~

For the first time since the group started, no speakers had been invited. The meeting agenda consisted of eating, updating, and support. Refreshments included pastries, sushi, and tea (brought by several individuals). Everyone agreed that although discussing personal situations (especially for the first time) can be a bit uncomfortable, it has led to the realization that all caregivers ride the same roller coaster of emotions.

Handouts at the meeting included: (1) nine pages listing books for caregivers (the list is available on the Internet at www.amazon.com or call Lani for a copy — local bookstores should be able to fill your orders); (2) information on St. Francis Health Services; (3) information on Catholic Charities Elderly Services; and (4) the qualification guidelines for the “Compassionate Care Only - Do Not Resuscitate” order bracelet and necklace.

Legal Documents and Issues

Ms. Sheryll Bonilla Kresnak, Esq., Attorney-At-Law, provided group members with general information on various health-care related documents and situations. She stressed that assistance of personal attorneys should always be sought for specific situations. Hawaii law provides that “all competent persons have the fundamental right to control the decisions relating to their own medical care, including the decision to have medical or surgical means or procedures calculated to prolong their lives provided, continued, withheld or withdrawn.” (HRS 327D - Living Will)

Sheryll mentioned four legal documents that a person can execute in preparation for the time when he or she no longer is competent: a power of attorney, a living will, a health care power of attorney, and a compassionate care only order. In addition, if an individual loses competency, several legal actions are available, including guardianship proceedings, one for the person and one for the property, heard in different courts.

In addition to her discussion on “Preparing for Death with Dignity,” Sheryll has prepared a number of other newsletters and articles for her friends and clients. Anyone interested should call her at her office (678-8357).

A lively question and answer period (with snacks) continued after the prepared presentation, with members inquiring about their own situations. We truly appreciate the time and consideration given to us by Ms. Kresnak.

Medicaid Long-Term Care Assistance

Who is eligible to receive Medicaid payments for nursing home stays? How much in assets can an individual possess and still qualify? Are homes ever an exempt resource? Our oftentimes advisor, Ms. Carolyn Mueller, L.S.W., A.C.S.W., Licensed Social Worker, Wahiawa General Hospital, addressed these questions and others pertaining to Medicaid long-term care assistance.

Carolyn explained that the Department of Human Services (DHS) held a workshop on recent eligibility changes. An individual without a spouse may live in a nursing facility and retain a home if the person indicates the intention to return if discharged. Carolyn pointed out, however, that a lien could be placed on the home; if the individual died in the facility, reimbursement of Medicaid expenditures would be expected. Living trusts will also be considered as countable resources for determining applicant eligibility, as they are considered available assets. A “look-back” period of 60 months for transfer of assets applies to living trusts, compared to a 36-month period for other assets.

Members received DHS Brochure 1177 (Rev. 01/98), which provides answers to some of the basic questions on Medicaid assistance, including the different requirements for married and single applicants.

Carolyn stressed that final approvals can be made only after applications have been processed through the Med-QUEST Division of the DHS. After the initial appointment with a Med-QUEST case worker, review and approval could take several weeks. Follow-up is always recommended to ensure all paperwork has been completed and to avoid unnecessary delays. The phone number of Oahu’s Med-QUEST Eligibility/Applications Unit is 587-3521.

Questions continued while we snacked on ice cream and homemade cake (courtesy of Marilyn Lee) and sushi and cookies by one of the other members. We all sincerely appreciate Carolyn Mueller’s continuing efforts to keep us informed and educated on a variety of health related topics.

Relaxation Breathing Techniques

’When a young child breathes, the stomach can be seen expanding; adults breathe from the chest, the elderly breathe from their throats, the dying from their mouths.” Thus began the breathing instructions of Steve Miyashiro, former caregiver and Tai Chi instructor. Steve shares his knowledge with others during sessions at the Honbushin Mission, Olaloa Retirement Community, and Wahiawa Recreation Center, the latter on Mondays at 1:15 p.m.

To take us back to the breathing method of our youth, he explained that we should breathe in through our nose, letting our stomachs expand like balloons, then slowly exhale through our slightly opened lips. The goal is to breathe out at the count of 10, starting at first with a count of 6 and working toward 10. Unaccustomed to deep breathing, some may initially experience a feeling of lightheadedness. After just a very short time, all could feel muscles relax, tensions ease, and a tingling in the hands. “Are your hands tingling?” Steve inquired. “That is the chi, the body’s ultimate energy.”

In addition to the breathing, members also performed hand exercises, which included activating fingers, hands, voice, ears, eyes, and breathing. Steve and a member demonstrated the 18 steps of Tai Chi (Chi Kung method) with graceful, fluid movements, in harmony step-by-step.

The evening was memorable for its enjoyment, knowledge gained, companionship, and snacks (homemade brownies, cookies, manju, iced and hot tea).

One of our members, a Tai Chi student of Steve Miyashiro, has agreed to start our meetings with the relaxation breathing exercises. We look forward to performing them.

SagePLUS

“Sage: elderly, wise; PLUS: People, Learning, Understanding System,” explained Ted Miyamoto, SagePLUS coordinator for Central Oahu and former caregiver. For the past five years, he has been volunteering his time and his wisdom to ensure that elders receive proper health care information and benefits.

SagePLUS has been in existence for six years, funded by the U.S. Department of Health and Human Services and sponsored by the State of Hawaii Executive Office on Aging. The program benefits those 60 years or older, their families, and people who care for them. State trained volunteers provide counseling (by telephone and one-on-one) on Medicaid, Medicare, and Medigap. All discussions and names are kept confidential.

Anyone with questions about their health care needs should not hesitate to call SagePLUS at 586-7299. Volunteers that speak Chinese, Tagalog, Vietnamese, Korean, and Japanese are also available to assist non-English-speaking callers.

Discussions continued while snacking on homemade sushi, cookies, and cake. Each member received a stack of brochures and information on current “must-have” publications, such as The Elder Law Hawaii Handbook: Protecting Your Health, Wealth, and Personal Wishes by James H. Pietsch and Lenora H. Lee, University of Hawaii Press, 1998.

We truly appreciate the time Ted Miyamoto spent with us. His “caregiving” days have ended, but he continues to care for others.

The Ponds at Punalu‘u

Deborah “Debbie” Morikawa considers The Ponds at Punalu‘u to be not only an assisted living community but also a community gathering place, where residents and people from the area can assemble for meetings or spend time with friends.

According to Debbie, The Ponds offers a variety of suites for rent, several programs for care, and a number of wellness and exercise programs — all this in a beautiful homelike setting designed with a turn-of-the-century feeling reminiscent of old New England summer hotels.

In “Catered Living,” services are designed to release healthy seniors from the tedious tasks of cleaning, grocery shopping, cooking, yardwork, etc., allowing time for other pursuits. The “Assisted Living” program includes the same services plus others intended to provide assistance with medications and medical appointments. Daily assurance checks confirm the well-being of residents in this program. “The Gardens at Punalu‘u” provides a residential care program for individuals afflicted with dementia and related conditions. A number of other services for people requiring more assistance than offered by these programs are available at an additional cost.

The Ponds maintains a 24-hour emergency staff and emergency call system. A respite program with a minimum month stay is also available. In the future, The Ponds hopes to also include a facility for individuals who require a higher level of care than presently offered at the community.

Members expressed a sense of relief that developments such as The Ponds exist, providing elders with a variety of residential options to ease their senior years. Questions and discussions continued while we snacked on delicious homemade cake, sushi, cookies, and senbei. We all appreciated and enjoyed the presentation given by Debbie Morikawa.

Kuakini Aiea Adult Day Care Center

Suzette Yamasaki, Manager, Aiea Adult Day Care, Kuakini Geriatric Care Inc. (KGC), brings to the Aiea center a keen understanding of senior needs, much of it gained from her long administrative career focused on older adults.

The Kuakini day program, located at the Aiea St. Timothy’s Episcopal Church Family Center, operates Monday through Friday from 6:45 a.m. to 5:15 p.m., except designated holidays. A completed application form, physical examination, and TB test are required prior to participation. In addition, applicants must be continent, ambulatory, able to feed themselves, non-wanderers, and non-combative. A licensed practical nurse, volunteers, and staff monitor and assist with daily activities.

According to Suzette, attendees range in age from 58 to 100, with 82 as the average age. The program includes lunch, snacks, exercises, cognitive activities, and time for resting, socializing or playing cards, bingo, and board games. Volunteer groups and individuals often visit to entertain the participants with music, singing, and presentations. The program costs $620.00 a month for full-time or $36.00 a day for part-time (regardless of hours spent.) For more information call 487-1586.

We appreciate all of the information Suzette provided to us during her presentation and at the discussion period that followed (which, as usual, included a table full of delicious food to eat).

A few attending members offered year-end critiques of our caregiver monthly meetings: (1) enjoyed the unstructured, easygoing meeting format; (2) excellent speakers have given us valuable information; (3) support given has helped members during difficult times. No one had suggestions for change.