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Supporting Adult Day Clients and Caregivers

It is not an easy thing to walk alongside and provide care for a beloved spouse or loved one as he or she suffers the effects of Alzheimer’s disease. As we all know, Alzheimer’s disease is a thief – it steals not only memories, but also a person’s sense of identity and purpose as he or she loses the ability to do the things that have long been part of daily life.

Bob Gates lived this journey first-hand after his wife of more than 60 years, Audrey, was diagnosed with Alzheimer’s disease in July 2011.

Bob and Audrey met in 1st Grade and had their first date at the young age of 16. After graduating from high school, the couple married in 1954 and built a life together as best friends and partners. Bob’s career with Bell of PA and Bell Atlantic, which we now know as Verizon, spanned more than 40 years and took the couple to Sunbury, Pottsville, and Altoona before they settled permanently in the Harrisburg area. Audrey was a full-time mother and homemaker, raising their three children and actively helping with grandchildren as well. The couple’s favorite hobby was traveling. They traveled to many different places on the east coast, but returned time and again to Myrtle Beach, SC where they camped right on the water. An outdoorsy family, the Gates enjoyed camping, fishing, hunting, and time spent together around the campfire. The close-knit family also practiced a strong faith, which led them to serve their church and the community out of love for the Lord.

It is no surprise then, that after receiving Audrey’s Alzheimer’s diagnosis, Bob and family banded together to care for Audrey at home for as long as possible. As Audrey’s needs increased and became overwhelming, Bob found respite and support through the Adult Day program on the campus of Messiah Village where Audrey became a client in January 2017. Bob’s objectives in enrolling Audrey in Adult Day were to provide her with increased socialization, keep her physically active and stimulated, and slow the progression of her mental decline. Additionally, Bob knew that enrolling Audrey in Adult Day would allow him to recharge and renew himself as her primary caregiver and give him time to downsize their home and prepare for the next stage of life – the couple’s move to their apartment in Village Square.

“Adult Day is a godsend,” Bob says. “The team members are the most compassionate, caring, professional people I have ever seen. They are genuine – it is not an act. It takes a special kind of person to do what they do, and they are just that…special.”

The Gates moved into Village Square in November 2017, and Bob continued to take Audrey to Adult Day every day until February 2018, when Audrey was discharged from Adult Day and welcomed to the Manchester neighborhood. Now, Bob visits Audrey daily, often utilizing Kibler Bridge, which connects Village Square to Village Center. In the Manchester neighborhood, Audrey continues to receive top-notch care, and Bob is grateful for the ways that team members show love and compassion to Audrey each day.

Despite the challenges and – yes, the sadness – of Bob and Audrey’s journey, Bob is grateful. “We are highly blessed,” he says. “I have met so many people at Messiah Village that I treasure, and I am blessed to be in a beautiful community surrounded by friendly, helpful, compassionate, Christ-like people.”

Written by: Rachel Pease, Director of Development at Messiah Lifeways
Originally published in “Spolight” A Newsletter for Donors and Volunteers, September 2018

 

Caregiver Absenteeism: a Growing Economic Burden

“There are only four kinds of people in the world: those who have been caregivers, those who are currently caregivers, those who will be caregivers, and those who will need caregivers.”

– Former First Lady, Rosalynn Carter

The Family Caregiver Alliance® defines a caregiver as, “an unpaid individual (for example, a spouse, partner, family member, friend, or neighbor) involved in assisting others with activities of daily living and/or medical tasks.” We can also define most caregivers as loving, caring heroes, who give of themselves unconditionally while in many instances sacrificing their own health and wellbeing, relationships and even employment.

According to research from the National Alliance for Caregiving and AARP, in 2015 there were roughly 34.2 million unpaid caregivers in the U.S. providing care particularly for someone over the age of 50. And the average age of a caregiver across the board was 49.2, which falls firmly in the primetime of a career and raising teens or even grandkids. Statistics also show them spending on average 24.4 hours a week providing care for a loved one. This research also indicated that 70% of working caregivers suffer work-related difficulties due to their dual roles. For instance, 61% of caregivers experience at least one change in their employment due to caregiving such as cutting back work hours, taking a leave of absence, receiving a warning about performance/attendance, among others. Furthermore, 49% arrive to their place of work late/leave early/take time off, 15% take a leave of absence, 14% reduce their hours/take a demotion, 7% receive a warning about performance/attendance, 5% turn down a promotion, 4% choose early retirement, 3% lose job benefits, and 6% give up working entirely.¹

Add all these stats and scenarios together, and you have a recipe for a residual burden on caregivers resulting in burnout, depression, poor health and a compromised commitment to their employers. This translates into poor work performance, loss of productivity, plus increases in absenteeism, health care subsidies, paid time-off, sick leave, and FMLA claims. Bottom line – caregiver absenteeism costs the U.S. economy an estimated $25.2 billion in lost productivity. ²

Employers must adapt

This problem will continue to trend upward, especially as the number of baby boomers surges and eventually grow older, frailer and more dependent. Employers will need to be more sensitive and proactive on this issue. Family Caregiver Alliance (FCA) offers employers a number of suggestions for removing barriers to equal employment such as adopting caregiver-friendly work policies and workplace flexibility, along with providing eldercare support, resources, and referral services to caregiver employees.³ [click here for the full list from FCA]. As Rosalyn Carter summarized, the potential for caregiving can affect us all, so the likelihood of being a caregiver and an employee simultaneously is a strong possibility. Are you prepared as an employer?

Messiah Lifeways Coaching encourages these ideals from FCA to employers, especially in the area of education and support. Messiah Lifeways Coaching will be offering its annual workshop entitled “Caregiver Solutions” on September 26, 2018. This workshop is designed for those seeking options, resources, and support as caregivers, especially for those who may be struggling to balance caring for a loved one and their own busy lives. The workshop is also open for professional development and education and to employers looking to gain a better perspective on the issue. Topics include: assessing and avoiding caregiver burnout, care options, costs, and making a plan. If you or a staff member would like to attend, please call 717.591.7225 or register online at www.MessiahLifeways.org/Events.

¹National Alliance for Caregiving and AARP (2015) Caregiving in the U.S.
²Gallup-Healthways. (2011). Gallup-Healthways Well-Being Survey: Caregiving Costs U.S. Economy $25.2 Billion in Lost Productivity. Based on the average number of work days missed per working caregiver, assuming $200 in lost productivity per day.
³Williams, J. C., Devaux, R., Petrac, P., & Feinberg, L. (2012). Protecting Family Caregivers from Employment Discrimination

Carlisle Adult Day Center is enrolling new clients

The National Adult Day Services Association (NADSA) defines Adult Day programs as “a professional care setting in which older adults and adults living with dementia…receive individualized therapeutic, social, and health services for some part of the day.”

Carlisle Adult Day clients enjoy gardening with the Master Gardeners from Penn State.

Messiah Lifeways Adult Day services go above and beyond in providing a positive, nurturing programming to meet a variety of needs in clients, especially those with a dementia diagnosis. Music, art, exercise, gardening, service projects, a hot lunch, special events… everything is geared towards socialization and maintaining the cognitive and physical abilities of each client. We don’t dwell on what has been lost; we focus on what is still possible.

We’re also keenly aware of the difficulties facing caregivers in Central Pennsylvania. Adult children need to continue working, devoted spouses become weary with caregiver burnout, families and neighbors feel ill-equipped to help. Adult Day programs like ours provide a safety net – a safe haven – for the clients and their loved ones. The Messiah Lifeways Adult Day programs are also strongly connected to the Alzheimer’s Association which adds an extra layer of support through training, resources, and caregiver support groups that help the entire family.

If someone you love is unable to stay safely at home during the work week due to memory impairment or another age-related concern or you know someone who would benefit from the services at a Messiah Lifeways Adult Day Services, please feel free to help spread the word. Some additional points of interest about Messiah Lifeways Adult Day programs:

• They’re secured and thoroughly equipped to put the caregiver’s mind at ease.
• They employ team members, including several Registered Nurses, who are well trained in therapeutic programming, validation and remotivation therapy, and more.
• Focus on the client – their memories, their interests, their hobbies, to make each day meaningful and positive.
• May help to reduce the unwanted behaviors that sometimes challenges families and caregivers.

Our Mechanicsburg Center is currently on a waiting list but our Carlisle Center does have openings. Melissa Brandt, the Carlisle Center Coordinator would welcome the opportunity to give tours and talk about the admission process with anyone who is interested. The Carlisle Adult Day program is located at The Meeting House, Carlisle Campus, 1155 Walnut Bottom Road.

Melissa can be reached at: 717-243-0447 or via email at mbrandt@messiahlifeways.org

To learn more about Messiah Lifeways Adult Services, please visit MessiahLifeways.org/AdultDay.

 

Adult Day Services: Enriching Lives & Supporting Caregivers

Caring for an aging parent or ailing spouse while trying to fulfill the promise of helping them age in place can be a struggle. This is especially true for a growing segment of caregivers who have a parent or spouse they’re caring for, while simultaneously still raising kids or even grandkids. Known as the “sandwich generation,” many of them are also still working, and therefore their plates are quite full, as you might imagine.

Often as the caregiver goes to work or needs to run errands, their loved one may be alone throughout the day. The fear of falling, dementia, isolation, and boredom can create an unsafe or less than desirable home life. Hiring care to look after them during the day is an option, but it can be cost prohibitive at times or it may not provide the stimulation they need or desire. Likewise, avoiding a move to a care community is counter to their goal. This is where Adult Day Services could be the solution.

Adult Day provides great balance 

Adult Day programs offer a great balance by enriching and caring for those trying to age in place, while supporting and relieving caregivers juggling their busy lives. Adult Day clients get the care, stimulation, and support they need on a daily basis. But at the end of the day they return home with their family or spouse. This takes a lot of pressure off of the spouse or the adult children as they go about the rest of their busy day. It is also reassuring for them to know that they are being cared for, eating well, having their medications administered, plus are participating in activities and socializing with their peers.

Affordable and flexible

It is also extremely affordable compared to other forms of daily care, and with financial assistance, typically through county funding, it is accessible to most everyone. Another great aspect is its flexibility. The Adult Day programs in Mechanicsburg and Carlisle are open Monday through Friday, but clients can attend as little as 1 or 2 days a week for 4 or 8 hours. They also open at 7:15 am and close around 5:00 pm to allow for early and late pick up.

Adult Day could be the solution you’re looking for

The chart below provides a great overview of the program, why it might be the right fit for you. It also gives detail on the services, support, and enrichment available to those in the program. [Hover and click on the chart for a larger view]

To learn more or to schedule a visit, please call 717.790.8224 for the Mechanicsburg Center or 717.243.0447 for Carlisle or visit MessiahLifeways.org/AdultDay.


 

Home Care: A Cornerstone to Aging in Place

Every November, the National Association for Home Care & Hospice (NAHC) celebrates National Home Care Month all month long, and Home Care Aide Week, which runs from November 13-19, 2016. It is a time to honor the care giving heroes who make a remarkable difference in the lives of those in need. This year’s theme is “Caring in Action.”

November is Homecare MonthHome care lies at the core of helping aging and disabled Americans stay in their home for longer periods of time. It can potentially lessen the amount of time someone may spend in an assisted living residence, personal care home, or nursing home. Of course there are many other resources to help people “age in place or community.” Other options include home health care, which provides short-term medical care into the home, adult day programs, respite care, technology, home modification, and in-home medical equipment. Home care services combined with one or several of these other home-based resources can create a workable blueprint to help someone age in place.

The Evolution of Community-Based Care
There are a number of reasons for this shift toward community-based care. First is the government’s dwindling ability to fund healthcare. And with nearly 76 million baby boomers reaching age 65 in the next 20 years, coverage for institutional care will become harder and harder to get. Because of this, the free market is joining the movement away from an institutional model of care and pushing for more community support services. It is the direction health care services are headed in our country. This is why you are seeing more urgent care centers, home care agencies, and hospice providers popping up in the community. It is simply cheaper to take care of someone if they don’t have to be hospitalized or placed in a facility, which is what most people want anyway.

These 76 million boomers represent a large and powerful generation whose demands and expectations of care will be very different from what we are used to seeing. Once more the idea of bringing services into the home and modifying homes will be the future for this rapidly growing number of seniors. Other factors compounding this evolution of care include our ever increasing life spans which require longer periods of care and funding. Secondly, over the last three decades, the number of family members, especially daughters, serving as caregivers has shrunk as our society becomes more mobile and career-oriented making a move out of town, state, or country more common. The way we used to care for our elders has changed. Just as nursing homes and personal care homes have provided surrogate care for aging loved ones over the last several decades, the idea of substituting care with home care aides has become more conventional. It helps working daughters (or sons), sandwich generation caregivers, out-of-towners, and spouses to replace or supplement the care they provide.

The National Association for Home Care & Hospice states that demographic shift studies translate into some [troubling] data. The number of frail older people over 65 is expected to increase from 11 million in 2010 to 18 million in 2030. The percentage of frail older people who are childless is expected to rise from 14 to 18 percent during this period, and the ratio of frail, older people who have only one or two adult children is expected to increase from 38 to 49 percent. Most of these aging boomers will want to remain in their homes, but they may not be able to count on their families for long-term care when it’s needed.

Home Care Can Fill Many Niches
Not only has health care evolved to put a greater emphasis on community-based services, but home care itself is evolving. Traditional housekeeping, cooking, companionship, transportation and assistance with activities like bathing and dressing are generally offered by most non-medical home care providers. However, home care providers such as Messiah Lifeways At Home now offer a unique array of services that buoy one’s ability to live safely and more carefree at home. Some of these newer and less known options include: pet and plant care,  non-skilled home maintenance, downsizing services, assistance with home exercise programs, and technology/computer assistance.

Lastly, in a time where the expanding need along with the absence of consistent familial support continue to grow, home care staff fill a void and become more than just caregivers for their clients. They become almost like close friends or even family and are poised to play a key role at the center of caregiving in our country.


To learn more, go to MessiahLifeways.org/AtHome or call 717.790.8209. For information on home care services for the entire state, visit the Pennsylvania Homecare Association (PHA) home care locator link [click here].

Originally posted November 2013- Revised for November 2016
by: Matthew Gallardo, Messiah Lifeways Coach, BASW, CCP

Adult Day Programs: A Lot to Celebrate

 

NATIONAL ADULT DAY WEEK- SEPTEMBER 18-24

Worthy of celebration all year long, adult day services provide care and companionship for older adults who need assistance or supervision during the day. These programs offer relief to family members and caregivers which allows them to go to work, run errands, or simply gives them time to relax, knowing their loved one is being cared for and safe.

CELEBRATE ADULT DAY WEEK SEPT. 18-24

Messiah Lifeways Adult Day offers inter-generational activity as one component of programming along with music, exercise, community outings and much more.

Affordable, flexible and stimulating
One of the greatest advantages adult day programs offer is their affordability. When compared to other forms of assistance, the median cost is very reasonable. According to the Genworth financials 2015 Cost of Care Survey, the average annual median cost of adult day programs nationally is $17,904, compared to the annual cost of assisted living/personal care which sits at $43,200 a year. Adult day (AD) programs can also be much more cost effective than if you were to hire non-medical caregivers for the same number of hours per day coming to the home. The national median daily cost of adult day is $69, which typically provides 8 hours of care, medication administration, a meal, snacks, activities and socialization. Furthermore, most states offer financial assistance through waiver programs and Medicaid.

“Adult day care and adult day health care are, without question, the most economical way to provide supervision and personal care for an elderly loved one on a daily basis.” PayingforSeniorCare.com

Adult day programs are also very flexible. Primary caregivers can have their loved one attend a program like this as many as five days a week or as little as one day per week. Many providers across the country offer full-day and half-day programs. They also have extended hours to allow for early drop off and late pick up, especially for those caregivers who have long work days.

Adult day programs fill a niche for many older adults who continue to live and focus on aging in place in their own home. For many there’s a part of staying in one’s own home that can actually be detrimental, which is the lack of socialization and stimulation, particularly with their own age bracket and peers. For caregivers and families who have a loved one living at home with them, quite often they can still feel isolated and, in certain cases, trapped in the home. Adult day programs are a great way for these loved ones to still get out, interact with others in similar situations, and participate in activities such as exercise, cooking, arts and crafts, special interests and speakers, and even religious ceremonies.

This gem of a program provides a great balance for the caregiver and loved one. Again it fortifies the ability to stay at home, but gets them out of the house on a daily basis to a caring and stimulating environment, but happily at the end of the day, they come home and sleep in their bed, in their own home, which is certainly worth celebrating.

If you’d like to learn about the Adult Day Services provided by Messiah Lifeways, please contact the Mechanicsburg location at 717.790.8224 or the Carlisle location at 717.243.0447 or visitMessiahLifeways.org/AdultDay.  Also check out these great testimonials on adult day services.

Senior Caregiving Help During the Holidays

Make Caregiving Manageable During the Holidays

Ah, the holiday season. It’s the most wonderful time of year- right? As we all know it can be a very busy and stressful time as well. Between the shopping, cooking, and traveling it gets hectic, especially for those who serve as a primary caregiver to a loved one. In particular, the sandwich generation may be caring for an elderly parent and bringing kids back from college for winter break. Caregivers deserve to enjoy Thanksgiving or Hanukkah or Christmas just as much as the next guy, if not more. But sometimes there just are not enough hours in the day.

Whether you need a few good hours to fight the Christmas shopping crowds or plan to travel out of town to spend Christmas with your very first grandchild; is it feasible to do so with a frail loved one living alone, who needs your daily attention? As the holiday season quickly ascends upon us it’s good to know that there are some great options out there for those caring for an aging parent or loved one.

Beat Black Friday Blues

For many shoppers Black Friday is a holiday unto itself. Whether you think it’s a good idea or not, we know that people are determined to get up at the crack of dawn, get the best deals possible, and buy that “gotta have it” doll or action figure for the grandkids, which they will love and play with for approximately 3½ days.  You then realize as you plot your shopping trip, I need to sit with dad while he takes his shower plus restock his weekly pill box, even though he insists he doesn’t need your help.

If you have shopping to do or you’re just plain busy no matter what season it is, several solutions can make your life a bit more manageable.  Let’s explore. First, there are some great technology solutions. An emergency call system, such as Philips Lifeline, can be the difference between your father getting help immediately after falling versus laying there for hours before someone discovers him. The Lifeline Auto-Alert option can even detect a fall and send a signal if the person is knocked unconscious. Philips GoSafe emergency call system works both in the home and out featuring GPS tracking technology. Philips also offers the Philips Medication Dispensing (PMD) System, which can help dad manage his medications safely and effectively. Face time, which is available on most Apple mobile devices, or Skype can be a great way to provide face to face interaction as well to view how dad “looks” today.

If you have aversion to technology, another option is non-medical home care. Hire an aid to come stay with mom or dad for several hours or several days. There are number of non-medical home-care agencies around to pick from. Particularly, Messiah Lifeways at Home offers traditional home-care services like help with bathing, housekeeping, and cooking, but they also provide unique home care services like non skilled home-maintenance like lawn care, minor home repairs, transportation, and even pet and plant care. Another great choice are Adult Day Programs. Messiah Lifeways Adult Day offers a day program where a loved one can come for a full or half day of activities, socialization, meals, plus receive assistance with activities of daily living. These programs are cost effective and offer great flexibility because your loved one can attend once a week or multiple days. What a great gift to give yourself, the gift of time and security.

Peace of Mind for Holiday Travel

As family becomes more spread across the country, it leaves many caregivers with the predicament of traveling versus staying home for the holidays. This is especially true if the person you’re caring for can’t make the 10 hour drive or the cross country flight. This decision is tough. However, if you choose to go away for the holidays or any other time for that matter, a respite stay for the person you care for may be the answer. Respite provides short-term or temporary care and is typically available at most personal care homes or assisted living facilities. As a respite your loved one can receive the same services a permanent resident would, like meals, activities, medication monitoring, and assistance with activities of daily living. You can arrange for the individual to stay for several days up to a month. Messiah Lifeways at Messiah Village offers respite in personal care for as little as a five day stay. It provides a safe, secure, and nurturing place for them to spend while you are out of town. Holiday activities and cooking, plus special events like Christmas concerts and celebrations make the time even more enjoyable. Respite can also include a combination of overnights in personal care or adult day services and home care to supplement care. There are many different options to consider.

Additional Holiday Caregiving Tips

Unlike Santa Claus, we do not have magical powers. You cannot be in multiple places in a flash. Ask for help from family and friends and learn how to delegate tasks. Don’t try to do it all yourself. Another thing to consider, and though it may be a hard choice, you may want to re-evaluate old traditions and family rituals that involve lots of travel or preparation time. You should also develop priorities for the things that matter most. You can’t be all things to all people and don’t feeling guilty about the things you cannot change. You should also schedule time to do the things that you like to do around holidays. You deserve to enjoy the holidays too. Set aside time to relax and talk to your loved one about the holidays and really listen to as they reminisce.

For additional information about the many options available to make the holidays more manageable please contact the Messiah Lifeways Coaching Office at 717.591.7225 or online at coach@messiahlifeways.org.

Everyone is a Potential Caregiver

The Joy and Pain of Caregiving

Serving as a caregiver for an aging loved one or parent is an incredible act. According to the Alzheimer’s Association, in the U.S., there are as many as 44 million¹ unpaid caregivers performing these incredible acts every day for someone over the age of 50. That is a huge mass of people serving the needs of an ailing spouse or loved one, where you will find lots of heartwarming, courageous and selfless caregiving stories. You’ll also hear stories of burnout, frustration and despair. Anyone who’s served as a caregiver for a significant amount of time can tell you that it can be wonderful yet woeful, and joyous and painful all at once. It’s assuming a lot of responsibility, which can be unfamiliar and often uncomfortable from handling their finances to helping a parent bathe or get dressed. It’s also a time to discover your own altruism or rekindle the bond between parent and child or between a husband and wife.

I’ve connected with hundreds of caregivers throughout my career including family, friends, but mostly through experiences at work. They hold a special place in my heart. Several years ago I helped develop a workshop created to help caregivers who were stressed and overwhelmed. The goal was to help this constant cycle of individuals avoid burnout and find options and resources to make the task of caregiving for an older adult easier and more manageable.

Everyone Is a Potential Caregiver

In the book “What to Do about Mama?” authors Barb Matthews and Barbara Trainin Blank exclaim, “Everyone is a potential caregiver.” So whether you have, are or will be a caregiver at some point in your life you can expect the highs and lows of this process. As you begin to read articles or books like “What to Do about Mama” you begin to see patterns and statistics that paint a very taxing picture. Over two-thirds of caregivers are women, many of whom are in the “sandwich generation,” which means they are caring for a parent or loved one while simultaneously caring for their children. Caregiver.org also states that anywhere from 40-70%² of caregivers suffer from various stages of depression. It also takes its toll on physical health, relationships, and work. Juggling all this can lead to burnout.

However, there is hope. There are a multitude of books, online resources and workshops like the one Messiah Lifeways Coaching offers to help caregivers avoid burnout. One of the most fundamental tools to elude burning out is taking care of YOU. Simply put – you cannot care for someone else if you yourself are ailing or worse. The comparison is often made to being on an airplane, and oxygen masks descend during an emergency. The rule is to place your oxygen mask on first and then assist those who need help. It’s a simple concept, but quite often forgotten.

Another important choice is seeking and accepting help from others. So often, women especially, think they can run all of mom’s errands, provide her the care she needs and drop in all hours of the day without the help of anyone else. It’s noble, but can be quite foolish as well. Ask others for help or hire help, plus take people up on their offers to help because eventually they may stop asking.

Caregiver support groups are also a very valuable asset in the effort of avoiding feeling overwhelmed, depressed or inadequate. They serve as great outlets to gain support from those who know what you’re going through. It’s a time to share, laugh and cry, to console, validate and commiserate. Jeanne McClintick RN, CHLPN from Hospice of Central Pennsylvania, runs several local caregiver support groups and shares wonderful supportive stories between members. She also states many participants continue to attend these groups even after the person they care for passes. It’s a way for them to heal and to help others new to the caregiving arena. So whether you chose to be or are thrust into the position of caregiver, do not take it lightly; however, do not fret. Remembering some of these tips along with other resources and insight can make it a better situation for all involved.

For more caregiver support and resources read “What to Do about Mama?” or visit cargiver.org or alz.org. If you’d like to attend The Caregiver Solutions Workshop on September 22, 2015 at the Carlisle Brethren in Christ Church, call 717.591.7225 or go to MessiahLifeways.org/Events.

¹Alzheimer’s Association, 2011 Alzheimer’s Disease Facts and Figures, Alzheimer’s and Dementia, Vol.7, Issue 2.] – Updated: November 2012
²Zarit, S. (2006) Assessment of Family Caregivers: A Research Perspective in Family Caregiver Alliance (Eds.), Caregiver Assessment: Voices and Views from the Field. Report from a National Consensus Development Conference (Vol. II) (pp. 12-37). San Francisco: Family Caregiver Alliance.] – Updated: November 2012