It all started with a fifth-grade class project. Scott Tarde, CEO of George G. Glenner Alzheimer’s Family Centers, which has operated dementia day care facilities in California’s San Diego county for 35 years, was amazed at his 12-year-old daughter’s enthusiasm over her Junior Achievement “BizTown” field trip.

In a huge space not unlike a converted shopping mall, the young students took on civic roles such as mayor, bank teller and restaurant owner. The goal was to immerse children in what it takes to run a city and understand the economy.

For Tarde, a lightbulb went on.

Time Capsule Therapy for People With Dementia

For the more than 5 million Americans who have Alzheimer’s, their minds are trapped in a world often many years in the past. Short-term memory loss is common; they may not recognize younger members of the family such as grandchildren. Yet, long-term memories often remain intact. They recall days of their youth and may think an adult son is actually their husband or long-deceased father.

Glenner Town Square will be a dementia village-style environment that envelopes patients in a world they know but which has been gone for over 50 years.

Triggering positive memories from the past is often the goal of families and dementia-care professionals. An approach called reminiscence therapy (RT), initially presented by renowned geriatrician Robert Butler and noted psychologist Erik Erikson, can help dementia patients calm anxiety, soothe aggressive behavior, prevent wandering and improve quality of life, studies have shown.

Tarde and his business development director, Lisa Tyburski, were already using RT in their dementia day care facilities. They wanted to take the concept to a new level. Their vision is to create a completely immersive experience — a faux Main Street U.S.A. circa 1953 to 1961, when many of their dementia patients were in their younger years. Their research led them to the first dementia village. It was created in The Netherlands in 2009 and is called Hogeweyk; dementia residents and health care professionals all live in the same enclosed village.

An Old Model for a New Idea

But while Hogeweyk is a 24/7 residential care town with several city blocks, it doesn’t offer the retro style that Tarde and team are building in San Diego, called the Glenner Town Square. And Glenner is a day program, not a residential center.

The “town” encompasses 8,500 square feet, 24 buildings and 12 storefronts — including a diner, Post Office, barbershop, pet store, library, museum and even a movie theater. In it, dementia patients will be able to spend the day exploring this world independently, in small groups or with their families. It offers a secure environment, with the watchful eye of Glenner dementia care professionals operating the storefronts and other businesses and interacting with the patients throughout the day.

The $3 million Glenner Town Square will be built in collaboration with the San Diego Opera Scenic Studio using the artisans and production staff who create the environments and sets for the stage. It is scheduled to open in 2018 and will be the first “dementia village” in the U.S.

Tyburski advises that this is just the beginning. The plan is to build these villages first throughout California, and then to expand nationally. Other long-term care communities across the country may have a nostalgia room with décor and photos, such as The Easton Home near Philadelphia, but Glenner Town Square will be the first planned, and completely standalone, dementia village-style environment that envelopes the dementia patients in a world they know well but which has been gone for more than 50 years.

“A lot of thought and planning has gone into the Town Square,” says Tyburski. “For instance, we found a Hollywood prop company, History for Hire, that can provide any era furniture and other décor, and we are creating fire hydrants and other street props made of rubber or fiberglass, so they are safe for our patients.”

Memory-Triggering Details

And while the Glenner Town Square will evoke an earlier era resembling any town across the country, each village built will have some local flavor that may help trigger memories for Glenner’s Alzheimer’s patients. In this first Town Square in San Diego, an Old Town gaslight street and Navy Town section represent the real local area attractions that have been part of San Diego for decades and still exist today.

Tom Christian, an architect whose wife Grace was diagnosed with frontotemporal dementia in 2012 at age 52, finds the Glenner Town Square concept revolutionary in dementia care.

“Grace needs a lot of different activities and stimulation throughout the day to keep her from picking up objects and pacing with them,” he says. “While the current adult day care activities have helped, the idea of her having a whole ‘town’ to explore, with familiar but different settings in a controlled space, with safe confines and expert supervisors during the day, is a breakthrough for us.”

A Happier Place on Earth

It seems appropriate that Southern California will be the site of the nation’s first dementia village, and the 1950s timeframe is also suggestive of a similar genius concept. After all, it was July 1955 when a visionary named Walt Disney transformed a 160-acre orange grove in Anaheim, Calif., and created Frontierland, Adventureland, Fantasyland and Tomorrowland — a place for families to immerse themselves in other worlds. Glenner Town Square is embarking on a new era in dementia care, providing the same intergenerational opportunities and sparks of joy that are a hallmark of the Disney theme parks.

“Reminiscence therapy can be a powerful tool for dementia patients,” says Dr. Peter Whitehouse, professor of neurology and neuroscience at Case Western University and president of the Intergenerational Schools International. “It makes those with Alzheimer’s more content and happier because they return to a time in their lives when there was no perceived failure — a time when their memory was intact and they did not feel lost.”

Whitehouse adds that combining RT with the actual historic environment is not only a powerful therapeutic solution for those with dementia, but also engages family members who may have been at a loss as to how to interact and elicit communication with their loved one.

“Both children and seniors, including those with a dementia diagnosis, can feel isolated, lonely and vulnerable,” Whitehouse adds. “Creating places where they can learn from, and interact with, each other creates a futuristic playground where each generation can create and share stories. Kids experience the past through the eyes of their elders and our seniors see the future in the eyes of the children.”

The Power of Reminiscing

Bob Partridge and his wife care for his 74-year-old mother-in-law, who was diagnosed with Alzheimer’s six years ago.

“My mother-in-law gets anxious, especially when she is more sedentary and does not get a lot of activity,” says Partridge. “We believe the Town Square concept gives us a chance to involve her in a pleasant, calming but active setting that may help slow the progression of her disease. I know the idea of slowing Alzheimer’s is not scientifically proven — but we see that reminiscing about the past has a positive impact on her behavior and interaction with others, so we believe we can keep her engaged with us longer in this type of environment.”

Partridge also shares that his mother-in-law is challenged in interacting with her 17-year-old and 11-year-old grandchildren because of the barriers in communication that come with dementia. But he says this will offer them all a place to go and create new experiences based on his mother-in-law’s re-living memories of her past.

“Having my mother-in-law be able to talk to her grandkids about her early years is a blessing we believe will come out of this experience in a natural and spontaneous way that the grandkids can appreciate,” adds Partridge. “We support more funding to help find a cure for Alzheimer’s, but in the meantime, families need help with the care of dementia loved ones.”

The Way We Were

Tom Christian also shares that the idea of Glenner Town Square changes his perspective on his caregiving role and believes it may also help eliminate the stigma that’s typical with an Alzheimer’s diagnosis.

“With the adult day care center, I drop Grace off and then pick her up — it isn’t something we share together and that was a special and important component of our relationship — our togetherness,’ says Christian. “And while Grace and I go places together, it is sometimes hard to explain to people that she has dementia and what that means. Sometimes I have felt a stigma in how people treat you.”

Christian says when Glenner Town Square opens, he and his wife will now have a place to go together. He believes these types of advancements in dealing with the dignity of dementia families are important.

“A diagnosis of dementia doesn’t have to mean the end of your life. I’ve been able to see it isn’t a bad thing, it’s just different,” says Christian. “Grace and I always said we both wanted a marriage where we spent as much time together as possible. The idea that we can stroll through a city street together and maybe go to a 1950s movie for a while creates a positive for me out of a not-so-positive situation.”

He adds: “I don’t want to trivialize dementia in any way, but there can still be joy and magic moments to be shared and this gives us a place to do that.”

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When you are kind to another person, even in a small way, it has a positive effect by helping that person feel valued and supported. If you make such acts of kindness a regular habit, it’s actually good for your health and even slows your body’s aging process, according to research.

“Two culprits that speed the process of aging are free radicals and inflammation. But remarkable research shows that the oxytocin [hormone] that we produce because of emotional warmth reduces the levels of both culprits in the cardiovascular system and so slows aging at the source,” says David Hamilton, author of The Five Side Effects of Kindness: This Book Will Make You Feel Better, Be Happier & Live Longer.

“When kindness becomes a habit we start to produce ‘happy chemicals’ like dopamine and oxytocin more consistently and that makes us feel good.”

In addition, oxytocin — known as the love or bonding hormone — triggers the release of a molecule known as nitric oxide, which dilates blood vessels and reduces blood pressure, protecting the heart.

The benefits don’t stop there, Hamilton says. “There’s also a strong link between compassion and the activity of the vagus nerve, which regulates heart rate and controls inflammation levels in the body,” he notes.

A Boost to the Immune System

Even small acts of kindness, such as sharing a smile or holding the door for someone, give your immune system a boost, making you more resilient and less anxious or depressed.

Experts think this is probably because of our brain’s primitive “negativity bias.” To survive and evolve as a species initially, we had to be constantly on alert for danger. Today, we still focus on fear-based thoughts — think of it as an air traffic controller who is always on duty — to protect ourselves from harm. Making kindness a habit can act as an antidote and result in our being more positive, happier and healthier.

A six-week study at the University of North Carolina at Chapel Hill showed that meditating on compassionate thoughts toward yourself and others, even about people you dislike, stimulates the parasympathetic nervous system and elevates the levels of dopamine (the feel-good hormone) in our brain. In this study, participants reported an increase in positive feelings, well-being, social connections and relationships.

Random acts of kindness also make us feel grateful. That’s because when we help others — through say, volunteering — we become more aware of the blessings in our own lives.

Kindness Fosters Self-Care

Research published in the Proceedings of the National Academy of Sciences revealed another benefit from spreading kindness. The study showed that when participants had a sense of purpose in their lives they were more likely to take better care of themselves by practicing preventive health care.

More good news: Being kind gets easier with practice. Just like a muscle gets stronger with regular training, a similar process occurs in the brain when you make kindness a habit.

“It’s about training your behavior and in turn, your neural circuits,” Hamilton says. “When kindness becomes a habit we start to produce ‘happy chemicals,’ like dopamine and oxytocin, more consistently, and that makes us feel good.”

Because of this positive feedback loop we’re encouraged to repeat the behavior, he says.

The Ripple Effect

Kindness is also contagious.

“When we’re kind, we inspire others to be kind. And studies show that it creates a ripple effect that spreads outwards, just as a pebble creates waves when it’s dropped into a pond,” Hamilton says. “Acts of kindness ripple outwards touching others’ lives and inspiring kindness everywhere the wave goes.”

Spreading kindness is the mission behind Megan Murphy’s Kindness Rocks Project, which she started in 2015. Murphy, a certified professional coach and SCORE business mentor, began to decorate river rocks with supportive messages and leave them for strangers to discover. Her rock project has become a movement.

“It’s easy to become overwhelmed by negativity in the world and become anxious or depressed,” says Murphy, author of A Pebble for Your Thoughts, How One Kindness Rock at the Right Moment Can Change Your Life. “It can have an adverse effect on your health.”

Instead, the Kindness Rocks Project combines art and messages of kindness to help participants feel good about creating and giving. “It’s actually a healing process because you are giving to the world what you would most like for yourself,” Murphy says.

4 Ways to Start a Kindness Habit

Need ideas on how to start a kindness habit? Here are some suggestions from Hamilton, including a challenge:

• Make a list of people in your life who you feel need help or assistance in any way. You might not always be able to help, depending on their needs, but you might find that some people just need someone to talk to, so they know someone cares.
• As you go through your day, be alert to opportunities to be kind. These occur all the time but we often miss them because we have too much on our minds. When we make a decision to be alert to them, we notice many more.
• Think of five people in your life and make a list of all the reasons why you are grateful for their presence in your life. This will help you build a habit of thinking kindly.
• Try the seven-day kindness challenge: That means, do at least one act of kindness every day for seven days. Ground rules: Do something different each day; push yourself out of your comfort zone at least once and be sure one of your acts of kindness is anonymous — no one should ever find out who did it.

9 Ways to Show You Care

• Check in on an older adult who doesn’t get out much.
• Drop off a toy or game for kids in need at a hospital or homeless shelter.
• Call a friend to check in and let the person know you’re thinking of him or her.
• Pay a bridge toll for someone behind you in line.
• Listen, really listen, to someone who needs to talk or tell his or her story.
• Put money in someone else’s parking meter that’s about to expire.
• Pay for someone’s groceries or gas.
• Give someone who isn’t feeling well enough money to drive or get a ride to the doctor.
• Buy pet food or treats and drop them off at the animal shelter.

By Chrystle Fiedler

Chrystle Fiedler is a journalist and author who has been reporting and writing about health and wellness for more than 15 years. Her work has appeared in many consumer magazines, including Woman’s Day, Better Homes & Gardens, USA TODAY’s Green Living, Experience Life, Natural Health and Prevention. Chrystle is the author of seven non-fiction health titles, including The Country Almanac of Home Remediesand Dandelion Dead: A Natural Remedies Mystery, the latest in a series for Gallery/Pocket Books. Chrystle lives on the North Fork of Long Island, New York.

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My parents taught me (Barbara), “To give is better than to receive. Don’t ask for handouts. Pull your own weight.” All great advice to live a self-sufficient existence. Sometimes, however, even the strongest individuals need to ask for caregiving help.

Asking others for their assistance is hard. As we age and our physical abilities change, many of us adamantly refuse to admit we need a hand. When well intentioned folks offer to help, we feel embarrassed and decline their generosity.

Mayday!

In the book, Mayday! Asking for Help in Times of Need, author M. Nora Klaver says there are several reasons why people wait until they are desperate to seek assistance. People are uncomfortable and afraid to ask. Also, we value our independence and no one may have taught us how to ask for help.

She says that we don’t recognize we have a need until we are in a crisis. Often, we are unclear about exactly what we need, or we ask the wrong person to help fulfill our request.

Tap into local service organizations such as the Girl Scouts or teenagers who need to fulfill volunteer hours for their school.

Klaver’s book lays out a seven-step “Mayday!” process. The first step is “name the need.” That means: Be specific about your need and be open to possibilities. This may sound simple, but it will take some analysis of your situation.

Acknowledge You Need Caregiving Help

For many years, I (Barbara) tried ignoring the gradual effects of a progressive neuromuscular disease that caused my fingers to curl from atrophy, weakened my legs until I could not walk and made me a full-time wheelchair user. Despite a dramatic and obvious physical deterioration, I stubbornly refused to ask for help because no one wants to be labeled “weak.”

Gradually, Jim (my husband) took over more of the household duties, while working a full-time job. Like 44 million people in the U.S., Jim is a family caregiver. Everyday needs — like grocery shopping and preparing meals — became stressful tasks. Although Jim never complained, he couldn’t do it all.

Living a stoic life wasn’t the answer. Together, Jim and I learned it’s OK to ask for and accept a helping hand.

How To Ask for Help

Here are eight ways to do it:

1. Define your needs. If you or someone you love needs to ask for help, begin the process by making a list. Write down the precise concerns such as transportation, food preparation, household chores, running errands, yard work and pet care. What can be delegated to a service? Determine which tasks can be removed by hiring someone — perhaps a housekeeping or lawn service. Which needs could be met with volunteers?

2. Brainstorm possible solutions with friends and family. Can a meal or two each week be supplemented by purchasing entrees from the local Farmers Market? Think outside the box. If you need a ramp built and don’t have the funds to hire a carpenter, call your local builder’s association and ask if there’s a community outreach program.

3. Build your support network. Make a list of everyone you know who might be interested in volunteering their time to assist you. Talk to friends, neighbors and family members. Tap into local service organizations such as the Girl Scouts or teenagers who need to fulfill volunteer hours for their school.

4. Match talents to needs. Someone who is a whiz at organizing might be willing to help file paperwork once a month. When neighbors are running errands, ask them to text you. They won’t mind picking up a few items at the grocery store, especially when it’s a trip they planned to make. Remember to keep a stash of cash or write a check immediately when someone makes a purchase for you. A teenager in your neighborhood might be willing to rake leaves or walk a dog.

5. Keep a list of how others can assist you. Write everything down, from changing a light bulb to needing a bunch of bananas. No job is too small. People are busy, but many tasks — unloading a dishwasher, sweeping the sidewalk, or making a bed — can be accomplished in 15 minutes or less.

6. Be specific. People are sincere in their desire to help, but you have to be explicit about your needs. “Can you help me cook a meal once a week?” is a specific request. Let your list of volunteers know exactly how they can help and set a time to accomplish the task. Coordinating the helpers is your responsibility. People are not mind readers.

7. Manage the assistance. I now have a group of more than a dozen “Helper Friends.” I send my request to several people so no one person becomes overburdened. Some of my helpers stop by to assist and are gone in less than 20 minutes. Others enjoy helping and staying to chat. Be respectful of everyone’s time limitations. If you want an easy way to coordinate help, use an online care community. Setup is simple when you use websites like TakeThemAMeal.com or LotsaHelpingHands.com.

8. Say thanks. Express your gratitude. Invite all your volunteer friends over for a “thank you” lunch (order take-out) or mail personal notes to acknowledge the people who make your life easier. They’ll really appreciate it.

By Barbara and Jim Twardowski

Barbara and Jim Twardowski write about travel, lifestyle and boomer topics from the New Orleans area.

The world turned upside down 10 years ago for Chanel Reynolds, a Seattle-based digital strategist, when her husband José Hernando, then 43, died in the hospital, a week after a bicycle accident. But the tumult involved far more than becoming a widow with a young son and a stepdaughter.

Reynolds quickly learned she was wholly unprepared financially. Her education and mistakes led Reynolds to write the new, powerful, helpful and utterly frank personal-finance book, What Matters Most. It’s the best book on financial preparedness that I’ve read.

Life’s Big ‘What-Ifs’

In her book, subtitled The Get Your Sh*t Together Guide to Wills, Money, Insurance, and Life’s ‘What-Ifs,’Reynolds tells readers what she wish she’d known before her husband died and what all of us need to know. Because, as Reynolds told me when I interviewed her for Next Avenue, none of us knows if or when we will be forced to confront one of life’s big “What Ifs.” (For an eye-opening example of what happens when you die without a will, read the devastating Bloomberg BusinessWeek story, “The Mystery of the Millionaire Hermit.”)

Through the book, the Get Your Sh*t Together website she founded and the GYST.com site she co-founded, Reynolds is on a mission to help us all avoid being unprepared to deal with life’s emergencies. Without having at least a modest understanding of insurance and preparing basic estate planning documents as well as advance directives (letting others we appoint make decisions for our health and money if we can’t), Reynolds believes, we’re dooming ourselves and our loved ones to unnecessary anguish and chaos. Sadly, many Americans have done little preparation for life’s big “What Ifs.” As Merrill Lynch recently noted in its report, Wealth Planning for Shortened Life Expectancies and Senior Family Members, only one in three U.S. adults have a health care proxy or living will.

Did we have disability insurance? I didn’t know. I knew I didn’t as a freelancer. I had no idea if my husband checked the box on his form.”

Here are highlights from my conversation with Reynolds about how to prepare for life’s big “What Ifs:”

Next Avenue: Why did you want to write this book and who is it for?

Chanel Reynolds: I never wanted to write this book. I wound up writing it by accident. Thinking back on those first days in the hospital with my husband after his accident, as the days went on, I had so many questions: What were my husband’s passwords? And there were the questions from the hospital staff like: What insurance do you have? Do you have your affairs in order?

I knew financially we were not in a good spot. There was a growing pile of things I didn’t know or had done only half way. And I thought if that was happening to our family and we had two incomes and my husband and I were both college educated, with careers in creative, tech fields… if we were screwed, it felt to me that everybody else was way more screwed than we were.

The book is part memoir and part ‘here’s all the things I learned and wish I had done.’ I couldn’t notwrite it.

What did you most wish you knew, and had done, about money before your husband’s accident?

I think one of the things I realized when I was at the hospital was we didn’t have an emergency fund. We had picked and poked at it for a few years. I was grateful that some of my friends and family could float me. It was four to six weeks before the life insurance check came.

A lot of people don’t have four to six weeks, as we know from the government shutdown. Experts recommend having six months’ worth of expenses in an emergency fund, but a majority of people don’t.

And you didn’t know what insurance you had?

Did we have disability insurance? I didn’t know. I knew I didn’t as a freelancer; I had no idea if my husband checked the box on his form.

We had life insurance, but we hadn’t updated it in five years. The life insurance we had was lifesaving for me, but it wasn’t enough.

What do you wish your husband and you had talked about more?

The things I didn’t know! God, I sound like the wife who lets her husband do all the money things. But that wasn’t the case at all. I handled half of our finances.

Looking back, I don’t feel I was totally uninformed about our finances, but we didn’t have an inventory with everything in one place and everything added up so we could see how things looked cumulatively.

It’s not just: Do you have life insurance? It’s: What kind? And if something happens, what does it mean?

How did the accident and your husband’s death affect your finances? Could any of that have been prevented?

I think about that all the time. That’s a great question.

I would love to have a time machine and have had the chance to have everything done right — even the basic stuff like having emergency contact information as part of a financial plan and a roundup of all our accounts.

I would’ve burned less time when I should have been in the room with José, not in the hallways two floors up trying to get cell reception and guess the password in his phone.

How did having life insurance help?

I was able to take a year off. Had I not been able to spend that time to focus on my kids, I wouldn’t have fared as well.

You say emergency planning starts with three things: emergency contacts on a cell phone; an ‘in case of emergency plan’ with your family and what you call ‘your choice.’ Can you talk about each of these?

Having emergency contacts on your phones [yours and your spouse or partner’s] is good. But if you can’t get into your loved one’s phone, it’s good to have the information at home, maybe on a chalkboard. Just something that’s easily accessible.

The ‘in case of emergency plan’ is almost like the emergency preparedness kit we’re told to have in Seattle in case of an earthquake. Many of the tips and lists in that kind of kit are good to have.

And the ‘your choice’ — When you Google ‘What to do when someone dies,’ lists come up from specific narratives. My husband died when I was 39, so a lot of the lists I saw didn’t apply to me because I wasn’t 59 or 69. We all lead different lives. So think about your priorities.

What happened in the hospital that could have been prevented if you had done some advance planning?

We had an advance care directive, so I could make decisions on his behalf. It was easy on me because the choice due to the accident was almost made for me: his injuries were unrecoverable; both his brain and body weren’t going to be able to come back. [She removed her husband from medical support a week after the accident.]

You should have an advance directive and sign it and, as I explain in the book, it should be really, really direct: ‘I don’t want to be on a ventilator… here’s what a ‘meaningful quality of life’ would be for me…here’s what I want and what I definitely don’t want.’

And figure out who you want as the decision maker for medical power of attorney. Often, people put down their spouse. But I talked to a lot of people for the book who said: ‘God, no, my spouse would be an emotional wreck! No way!’ You want somebody who would be able to carry out the wishes and instructions on your behalf. And you want to give the person enough information so they feel confident they were relaying your instructions and not guessing.

What’s your advice about wills and trusts?

Half of us don’t have wills. But there are now many easy free and low-cost options to have a will drawn up. Without a will, it could mean that exactly the opposite of what you would like to happen will happen after you die. It takes literally one hour to write the basic stuff down.

If you can afford an attorney, you should absolutely get one. I can floss my teeth, but I’m not giving myself a root canal.

When should you update your will?

I do an annual exam, just like I get an annual mammogram around my birthday. And you should also update it when major life events happen, like a marriage, a divorce or the birth of a child. But I’d say most certainly you should look into updating your will every three to five years. Once you’ve made a will, updating it doesn’t take much time at all.

You don’t have to go somewhere to get a will legally notarized; that’s the step where people get stuck. They have an unsigned will. But you can hire a mobile notary to come over and sign it or there might be a notary where you work or at the library.

Where should people keep their important documents like wills and advance directives?

Keep the original in a safe place and a backup somewhere else, preferably with one or two people named in the documents.

You can keep the original in a fireproof safe in your house if someone has the combination and knows how to get to it. I have my originals in a binder in my house, in an easy-to-find place.

You finish the book with sections on what you call ‘Life Do-Over.’ What does that mean and what’s your advice about it?

I thought a lot about that. I was halfway through what I thought was going to be a long and happy life and then a giant invisible whistle blew at all of my plans. I was forced to reassess everything.

José used to say: ‘You don’t have to do anything you don’t want to do’ and I thought, ‘How can you possibly say that?’ I have to do some things I don’t want to do. But now, I think about that and I think he was right.

I don’t want to spend the next 30 or 40 years doing a lot of things that are not important to me. And I don’t know if I didn’t have my giant do-over if I would have had such an in-your-face lesson.

By Richard Eisenberg

Richard Eisenberg is the Senior Web Editor of the Money & Security and Work & Purpose channels of Next Avenue and Managing Editor for the site. He is the author of How to Avoid a Mid-Life Financial Crisis and has been a personal finance editor at Money, Yahoo, Good Housekeeping, and CBS MoneyWatch.@richeis315

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One of the best supports for older adults and family caregivers might also be the least known. Here’s how you can find it and tap into the help:

The support is available from your local Area Agency on Aging (AAA). Never heard of it? You are not alone, and it might be because the work done by AAAs happens under so many other names.

Some AAAs call themselves the metro or county or state “office on aging” or “senior services.” They connect people with support that goes by even more names: the local Meals on Wheels program, a ride service, a group that gives housework help or the senior center in town.

It’s free to call or meet with your Area Agency on Aging to get answers, advice and help enrolling in programs. Some support programs are free or on a free-will-donation basis. Others require out-of-pocket costs, but that might be reduced through subsidies and sliding-fee pricing. In some cases, Medicaid or long-term care insurance will cover costs. AAA representatives know the ins and outs of how to determine what each older adult qualifies for and how to reduce and manage costs.

You can find your Area Agency on Aging at eldercare.gov by doing a ZIP code, city or state search. Or call 800-677-1116, the eldercare locator service of the U.S. Administration on Aging.

There are 622 Area Agencies on Aging across the country. They were created in 1973 as an addition to the Older Americans Act of 1965. The same federal law that created AAAs requires that they be locally governed and responsive. AAAs host public meetings and ask for local residents’ input before deciding how they will develop and fund services in their region for the next few years.

Watch this four-minute video from PBS affiliate WQED in Pittsburgh to see what you can expect when you call your Area Agency on Aging.

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By Denise Logeland

Denise Logeland is a writer and editor in Minneapolis who has covered business, health and health care. She is the author of Next Avenue’s ebook, 10 Things Every Family Should Know: Aging With Dignity and Independence.

(This article previously appeared on the site of PBS NewsHour.)

Concern about Mom or Dad’s health and wellbeing is top of mind for many boomers today. Worrisome signs of your parent’s frailty, progressive memory loss or the decline in health require more and more of your help and attention.

But what if you live a good distance away?

Whether you live an hour away, in a different state or maybe even in another country, caregiving at a distance presents very real challenges.

Help For Your Journey

No longer just a devoted daughter or son, you’re now what the professionals in the aging field call a “long-distance caregiver.” Thrust into what is often a new world of intricate responsibilities, you may find it hard to see the personal rewards ahead. But they are there, as is the help available to assist you on this caregiving journey.

(MORE: The Stress of Long-Distance Caregiving)

There is no one right way to be a caregiver; everyone’s situation is different. You will find that, among a host of things, family dynamics, financial resources and the ability of your parent(s) to provide guidance for the support that they desire will shape your situation.

You can expect your caregiving responsibilities to include, at a minimum, two key functions: information gatherer — from your parent(s), websites, books, word of mouth, etc. — and coordinator of services — contacting potential service providers, scheduling, coordinating payment and monitoring medical care. Do plan on traveling and spending some time on the phone to arrange care and services.

Pulling Together Key Information

It will help you immensely if, before there is a crisis, your parent(s) provide you with information to locate their important records, phone numbers, email addresses and other essential contact information. If a crisis has already occurred, such as a stroke or traumatic brain injury, this information is still important to gather, but it may require more detective work on your part.

(MORE: Caregiving From Afar)

Family Caregiver Alliance (FCA) has a free online tool called “Where to Find My Important Papers” that will help you collect information to simplify communication with government agencies such as Social Security or the Veterans Administration; help with banking and other financial transactions and make speaking with your parent’s attorney, accountant and physician easier.

Legal documents, such as Durable Power of Attorney for Health Care and Durable Power of Attorney for Asset Management, can and should be prepared before a health condition makes it impossible for your parent to do so. For more information, read “Legal Issues in Planning for Incapacity.” One organization to contact to find an attorney knowledgeable about estate planning or with special training in elder law is the National Academy of Elder Law Attorneys.

To keep things in order, long-distance caregivers will benefit from keeping a care notebook — a central place for the important information that you gather. A number of care notebook templates (hard copy or digital) are available for purchase or you can create your own, either a digital version or by using a good old three-ring binder with pocket dividers. Be sure your notebook contains current information on your parent’s prescriptions.

If paid caregivers are employed to provide care to your loved one, you will want them to maintain a separate notebook documenting medication administration, vital signs and other key physical and mental health status information.

(MORE: Caring for Parents With Your Siblings)

If you feel overwhelmed at any point, never hesitate to call in a friend or professional to help. An objective adviser knowledgeable about Medicare and Medicaid can be immensely helpful in sorting out health care eligibility and coverage. A social worker (National Association of Social Workers) or geriatric care manager (National Association of Professional Geriatric Care Managers) can facilitate a family meeting to help prepare a care plan and/or deal with family dissension.

No one can master everything, not even the people who are experts in their field. The solution lies in putting together a team and using each team member’s strengths — including yours.

4 Tips To Keep In Mind

Here are four key tips to keep in mind as a long-distance caregiver:

1. As much as possible, involve the one who needs care in any decision-making process, especially issues related to care and housing. Be sure to listen to his or her preferences and respect your parent’s known values, even when these differ from yours. Instructions to paid caregivers should be in writing.

2. Learn what kind of help is available. Educate yourself on the care and services in the area. Similar kinds of services are found throughout the U.S. (e.g. adult day care, home care, case management, etc.). Eldercare Locator at 800- 677-1116 can direct you to the Area Agency on Aging appropriate for your parent(s). FCA’s Family Care Navigator offers a state-by-state searchable database to help you locate help in your state.

3. Remember to take care of yourself. Caregiving can be stressful, so create a support network for yourself. Talk with friends and family. Allow yourself to hire help or involve other family members. Trying to do it all alone is not healthy for you or your loved one.

4. Understand that care needs will change over time. It’s not too early to think about possible future needs. Once you locate resources, speak to a social worker who has experience in planning for eldercare. There are many options to be considered, and you’ll want to make informed, well-thought-out decisions about your parent’s care.

The sudden realization of your new role as a caregiver is likely to be stressful. How can you be a caring daughter or son and the coordinator of a multitude of tasks required when taking on the day-to-day responsibilities of a loved one? You may feel overwhelmed and isolated.

In reality, you have lots of company. Approximately 76 million of family caregivers are boomers, many with parents who are approaching a time in their life that will require aid and assistance. And an estimated 43.5 million Americans provide or manage care for a relative or friend 50+ years or older — that number is growing every day.

The good news is that with so many of us involved in care from a distance, there’s lots of information to help. Here are additional guides offering checklists and specific tips to help you in your long-distance caregiving journey:

Family Caregiver Alliance’s National Center on Caregiving: Handbook for Long-Distance Caregivers: An Essential Guide for Families and Friends Caring for Ill or Elderly Loved Ones

The National Institute on Aging: So Far Away: Twenty Questions and Answers About Long-Distance Caregiving

AARP: Tips for Long Distance Caregivers

Long-Term Care Options Explored on PBS NewsHour

These are long-term care options featured on PBS NewsHour:

• Why More Seniors Are Going Back to College — to Retire
• Coping with Alzheimer’s: A Mother and Daughter Portrait of Long-Term Care
• Taking Cues From ‘Golden Girls,’ More Single Baby Boomers are Building a Future Together
• There’s No Place Like Home: Seniors Hold On to Urban Independence Into Old Age
• Foster Families Find and Share Support with Elders at Oregon Housing Community
• Increasing Demand Moves Long-Term Care Centers to Cater to Latino Elders

More Family Caregiver Alliance Posts

And here are two more Family Caregiver Alliance Posts in this series:

• How to Pick a Long-Term-Care Facility When Your Loved One Can’t Live Alone
• What Is the Best Strategy for Taking Care of Your Aging Parents at Home?

7 More Family Caregiver Alliance Publications

These seven FCA publications could be useful, too:

• Caregiving With Your Siblings
• Community Care Options
• Downsizing Your Home: A Checklist
• Hiring In-Home Help
• Holding a Family Meeting
• Legal Planning for Incapacity
• Home Away From Home

By Leah Eskenazi

Leah Eskenazi, MSW, is the director of operations for the Family Caregiver Alliance, whose mission is to improve the quality of life for caregivers through education, advocacy, research, service and support. She has more than 25 years of experience advising caregivers, their families and professionals providing their care.

Next Avenue Editors Also Recommend:

• When and How to Coax Your Parent to Move Closer
• How to Hold a Family Meeting to Plan Care
• Building a Network to Look Out for Your Parents
• Joan Lunden on Challenges, Guilt and Caregiving

Sound familiar? It’s a complaint I hear all the time from families worried about older parents and aging relatives.

And it’s a very real issue that we must address. For better health and wellbeing in older adults, it’s not enough to identify the underlying health and life problems — although that is a key place to start.

Because even if you’ve correctly identified the problems and learned how the experts recommend managing them, older parents often seem, well, resistant. Understandably, this causes families a lot of frustration and stress.

Here are four actions I always recommend that families take when older parents are resisting help.

1. Consider the possibility of cognitive impairment

In other words, is a problem with brain function contributing to this resistance?

Now, let me emphasize that you should not assume that your parents are in their wrong mind just because they are making health or safety decisions that you don’t agree with.

(MORE: When Menopause and Caregiving Collide)

That said, because it’s very common for the brain to become vulnerable or damaged as people age, decreased brain function is often a factor when an older person resists help. This can affect an older parent’s insight and judgment and can also affect how well they can process your logical arguments.

It’s important to spot such cognitive impairment. Some of the impairment is often reversible. For example, older adults frequently develop delirium when ill or hospitalized, and an older person may need weeks or even months to recover to their best thinking abilities. Cognition can also be dampened by certain conditions, like hypothyroidism, or by medication side effects.

In other cases, the problem is underlying dementia such as Alzheimer’s. Sometimes it hasn’t yet been properly recognized or diagnosed. Or it may be that a senior has been diagnosed with early dementia, and the challenge is figuring out whether it’s progressed to the point at which it’s a major factor in resisting help.

What to do: Get help spotting underlying cognitive problems. You can help a parent’s brain function at its best by avoiding brain dampening medications and encouraging a restorative low-stress environment. If your parent is cognitively impaired, you may need to get help assessing decision-making capacity. And avoid relying too heavily on logical arguments if signs of impairment are present.

2. Make sure you’ve heard and validated your parents’ emotions

Here’s something you may have noticed in your own life: Logical arguments often fail to convince the people we have emotional relationships with. This is true even when they are younger and presumably have good mental faculties.

(MORE: When Should You Get Power of Attorney for a Parent?)

That’s because people are not rational about many things, especially when it’s an issue that stirs up certain emotions in them. And issues that touch on aspects of our identity, self-worth and autonomy – all of which come up when we’re concerned about older parents — are especially prone to trigger emotional responses.

All people care about having their emotions validated. People also want to feel connection, love and self-worth.

Whether or not your parent might be cognitively impaired, it is crucial to remember this. In fact, if there is potential Alzheimer’s, it can be even more important to help a parent feel heard and validated because this will reduce stress and help the brain function better.

What to do: Try to understand the emotions your parent might be experiencing, and use active listening to help your parent feel heard. You may need to invite your parent to share his or her feelings by saying something like, “I really care about you, and I’d like to make sure I understand more about what you’ve been feeling about this situation.” If you can afford it, consider investing in a few sessions with a relationship therapist or another person trained to facilitate family conversations. It can be especially productive to work with someone experienced in helping families address aging issues, like a geriatric care manager.

3. Review your parents’ goals and what trade-offs they might be willing to make

As families and doctors, we often prioritize safety and longevity. In other words, we want to prevent falls, injuries, illnesses, new medical problems and catastrophes of any kind.

We also usually want our older parents to live as long as possible. Perhaps we can’t bear the thought of being without them. Or it might seem wrong to not want a person to live as long as long as they can. Furthermore, it often seems like our parents want to live as long as possible.

(MORE: Caring for Your Aging Parents from a Distance)

But here’s the thing. For most older adults, the goals of safety and longevity bump up at some point against the goals of autonomy and independence. Most conflicts that older adults have with their families end up revolving around this dilemma.

Unfortunately, there is usually no easy answer to this question. Once an older person becomes more vulnerable in body or mind, you cannot have perfect safety as well as perfect independence.

But when the trade-offs are identified and goals discussed, it’s usually possible to help everyone feel better.

Common goals that I hear from my older patients include:

• Living in their own home for as long as possible
• Dictating the terms of their daily life
• Living their usual life for as long as possible
• Minimizing pain, illness and suffering
• Spending quality time with family and loved ones
• A good quality of life, which generally means more enjoyable activities and fewer stressful or burdensome activities.

Safety is important, but don’t fall into the trap of assuming it should always be your family’s No. 1 priority. Because when faced with a trade-off between safety and autonomy, most older adults choose autonomy.

This is especially true of people with dementia. And even though they may have lost the insight and judgment abilities needed to properly weigh the risks, their preference for independence is still very important for optimizing their quality of life. In fact, an approach called “positive risk-taking” is now being advocated as a way to make communities more dementia-friendly.

What to do: Ask your parents to discuss their goals regarding medical care and their living situation. You will want to have a frank talk with the doctors beforehand to ensure your parents understand their health problems and what declines or crises they should plan for. Be sure to talk about the pros and cons of the available options, and try to find out what kinds of trade-offs your parents might consider acceptable.

Remember, most families eventually face a trade-off between safety and independence. Being Mortal, by Dr. Atul Gawande, is a good book that explores how several families, including that of the author himself, navigated these dilemmas.

4. Distinguish what you need from what your parents need

When we get anxious about our parents’ safety, or their reluctance to accept help, what is it we really need and want? What fear or desire is driving us?

I try to explore this with families when there’s conflict or resistance because I find it helps untangle sticky situations. Some common underlying issues include:

• A need to minimize guilt
• A fear of conflict with other siblings
• A fear that a parent is going to decline further and require more help
• A desire to know that a parent is happy and comfortable
• A desire for control and for knowing what will happen next
• A fear that what is happening to our parents might eventually happen to us.

People being people, we all have a tendency to try to address our needs by wanting other people to do something differently, or by trying to keep things from changing.

But as the relationship experts have been telling us for decades, the best approach is to accept that things change and to focus on what we can do differently. We shouldn’t try to meet our own needs by controlling what others do.

What to do: List your fears, frustrations, desires and goals regarding your parents’ wellbeing and health. Notice the ways in which they are distinct from what your parents’ own fears and desires might be for themselves. Look for ways to address your fears and desires while respecting your parents’ preferences. This often means giving up the idea that your parents have to do this or that. Relationship counseling can help.

There Are No Silver Bullets

Now, I won’t sugarcoat this. Even when you get informed, are thoughtful in your approach, and obtain the right kind of assistance, helping older parents through this stage of life will be a challenge. Of course you will worry about them. And they will probably never be entirely free of reluctance to make changes and accept help.

But over the years, I’ve seen that some families get stuck in a rut of conflict and frustration, whereas others find ways to move forward more constructively.

It might feel like an extra effort to do these things. But by investing in your ability to better navigate these difficult situations with your parents, your family will get closer to what we all want: less stress for ourselves and better quality of life for our parents.

By Leslie Kernisan, MD

Leslie Kernisan, MD, is a practicing geriatrician in San Francisco who believes that it shouldn’t be so hard for older adults and families to get the right kind of help with health concerns. For more practical tips, and to get her free quick guide to checking aging parents, visit her new blog at HelpingOlderParents.com.

Next Avenue Editors Also Recommend:

• Dementia Patients Have the Right to Be Loved
• When Should You Suggest Mom Leave Her Home?
• Dividing Caregiving Costs Without Splitting the Family
• How to Balance Work and Caregiving Responsibilities

But you may find that your loved one is reluctant to try it out. We offer seven tips on how to encourage your mom or dad below.

What Are They?

Adult day centers may be located at a hospital, community center or church. They may be run by a nonprofit or a for-profit company. Some provide health care and supervision as well as group activities like crafts, games, exercise and pet therapy. Some specialize in caring for seniors with dementia or other illnesses.

There are more than 5,000 adult day centers across the country with more than 260,000 participants, according to the National Adult Day Services Association. At a median cost of $69 a day, according to the 2015 Genworth Cost of Care survey, they may be considerably cheaper than hiring home health aides.

Make sure you plan for the first day so they’re engaged right from the start.

— Leah Eskenazi, Family Caregiver Alliance

Once you decide which center is best for your parent, the following ideas may make the concept of an adult day program more appealing to him or her.

1. Don’t call it day care.

Referring to the programs as “adult day care” may offend some who consider “day care”  infantilizing.

“Most of them don’t call it adult day care,” says Leah Eskenazi, director of operations for the Family Caregiver Alliance. “They’re going to meet their group. Some people call it going to their club or their class.”

At their club or class, there may be yoga, music, movies, art and crafts projects, plus snacks and meals.

2. Make it fun.

Give your parent a fun reason to go. Is there a fantastic arts program? Or another activity that your mother or father would really enjoy?

“The first day, look for a hook,” Eskenazi recommends. “Is there a trip or an activity they would like? Make sure you plan for the first day so they’re engaged right from the start.”

3. Encourage your parent to volunteer.

If mom or dad seems lukewarm on going to a day center, you might say: ‘They could use your help as a volunteer,” Eskenazi says. Of course, check with the center first.

4. Ask a professional to step in.

If you and your parent just aren’t seeing eye-to-eye on attending a day center, you may wish to reach out to a third party for help. Your mother or father may go willingly if a doctor or a social worker offers the suggestion.

At Alzheimer’s Community Care, which runs 10 dementia-specific adult day centers in South Florida, a family nurse consultant will often encourage a parent to attend a day center when an adult child is having no luck. Once through the door, he or she is often happy to be there.

“We hear these stories all the time,” says Kathleen Herd, vice president of development for the organization.

In one case, the family nurse consultant drove the mother right to the day center. “Her face lit up. Here was her peer group and she didn’t even know she was missing it,” says Mary Barnes, executive director of Alzheimer’s Community Care.

5. Start with a short schedule.

Don’t ask a parent to stay too long at a day center on the first day.

“Make it short. Make it easy. Don’t make someone stay the whole day,” Eskenazi says.

Don’t overwhelm a parent by booking too many days early on. Keep the schedule as light as possible. “Start with maybe one or two days per week. I would recommend someone starting with a shorter schedule and then working up to more days and more hours over time,” Eskenazi says.

Be supportive. If a day center is a positive experience for a parent, be upbeat and positive and encourage him or her to attend. “Let them decide if they want more days,” Eskenazi says.

6. Expect a few complaints.

It may take a parent a little bit of time to adjust to attending a day center. And you may hear some kvetching during that transition. For example, a parent might complain, “There are too many old people here!”

“You might say, ‘They could use a little young blood there,‘” Eskenazi suggests.

Be patient during the adjustment period.

“It often takes several visits for a new person to feel comfortable in a new setting and new routine,” Barnes says. “The ideal situation [in their eyes] is for them to be with you, and you can’t do it 24/7. Ask the staff for help in making the transition from home to the day center.”

A parent with a neurocognitive disorder may be insecure about new experiences. But if you are a strong proponent for the day center, a parent may feel more comfortable attending.

7. Use good judgment.

If a parent just needs a little encouragement to attend a day center, keep encouraging. But if a day center just isn’t working out for your parent, take a step back for a while.

“Sometimes, it doesn’t work. Sometimes, the person is not in the right place. You can’t pressure somebody,” Eskenazi suggests. “Step back and wait a month or two and try again.”

Next Avenue Editors Also Recommend:

• Why People Don’t Buy Long-Term Care Insurance
• Respecting the Person with Dementia
• How to Manage Your Parents’ Finances When They Can’t
• Cancer Survivor Fran Drescher’s 3 Tips on Caregiving

After retiring, the chance to stay in the home where you’ve built up memories and grown comfortable may sound perfect. But to age in place well, you may need to do some renovations. The question is: Which ones are worth the cost?

“If you plan on aging in place, there are two things to keep in mind,” says Cristina Miguelez, a remodeling specialist at Fixr.com. “The first is what it is that you need to remain in your home. The second is that you need your home to maintain its value and salability regardless of what you do to it.”

As you look around your home, it may be helpful to draw up a list of potential renovation projects and then evaluate them based on what you think you’ll need in coming years.

You may want to arrange for a consultation with a home renovation pro to discuss possibilities. Due to growing numbers of people wanting to age in place, the Chubb insurance company just started offering its homeowner clients a free home accessibility risk consultation service.

6 Home Renovations Worth Their Cost

Here are six home renovation projects that experts say are worth their cost in retirement:

1. An Accessible Kitchen

“What modifications you actually do will be dependent on your needs,” Miguelez says. Putting in a pullout pantry and placing the microwave on a counter or below counter height might make the space easier to work in. Adding space and lowering counters could create a kitchen that would be wheelchair-friendly if you ever needed that option.

“Widening narrow doorways is one of those less glamorous, yet important renovations to make if you plan on aging at home after retirement.”

A mid-range minor kitchen remodel in 2019 costs an estimated $22,507, according to Remodeling magazine’s Cost Vs. Value Report.

You might spend more or less, depending on the adjustments you make.

2. A New Home Office

You may not head to work every day in retirement, but you might want a place to work part-time from home, as well as look over the bills. Designing a home office you love offers the opportunity to have a productive, comfortable area.

“Whether this means repurposing a current space or completing a small home addition, it’s definitely a good investment — not to mention it holds a solid ROI  (return on investment) when it comes time to resell,” says Kaitlin Martin, of Choice Windows, Doors & More, a home renovation company in Lancaster, Pa.

The cost of turning a room into a home office will depend on its size and your preferences. But Remodeling magazine says you can figure a home office remodel running about $187 a square foot.

3. An Easy Entrance

To make sure your home will be easy to get in and out of as you get older, make sure it has at least one exterior door with a flat entry or a ramp, rather than steps.

“Designs and materials today allow accessible ramps to be an integrated part of the finish and architectural design of the home,” says Jim Magliaro, vice president and risk consulting technical leader at Chubb Personal Risk Services.

If the interior has tight doorways, consider adding several inches to the frames. That will make it easier to get around in a wheelchair or a walker one day, if need be.

“Widening narrow doorways is one of those less glamorous, yet important renovations to make if you plan on aging at home after retirement,” Martin says. “This is a quick renovation for a contractor to do and typically only costs a few hundred dollars per doorway.”

4. A First-Floor Bedroom

While climbing stairs might seem effortless now, in the years ahead, a health condition or disability might make the trip difficult. If your home’s bedrooms are all located on an upper floor, consider putting in a sleeping and main living area on the ground floor.

“Open floor plans — especially flow in the kitchen, dining and living rooms areas — will allow you to make maximum use of the living space,” says Lukasz Kukwa, a real estate agent with Coldwell Banker Residential Brokerage in Westfield, N.J.

Try turning a room on the lower level into a bedroom or build a bedroom onto the main floor of the home. “If possible, adding or converting for a laundry room on the main floor is a desired feature future buyers are looking for,” Kukwa says.

5. Bathroom Modifications

A mid-range bathroom remodel (new fixtures, toilet, sink and counter and medicine cabinet plus a tile floor and wallpaper) could cost about $20,000, according to Remodeling.

If you focus on several low-cost modifications — like installing grab bars and rails — you can create an age-friendly space for less. These days, grab bars come in elegant styles to blend in with the bathroom design and avoid an institutional appearance.

Other suggestions: a no-threshold shower, so you won’t trip over the edge, and a higher toilet (perhaps 19 inches high) in case of potential mobility or balance issues someday.

Switching knob-style bathroom faucets to faucets with a lever-style handle is pretty inexpensive and could be helpful, too.

6. Proper Lighting

Go through each room of your home and take note of spots that could use extra lighting to prevent falls. An electrician can install fixtures in dark areas, such as a hallway or dining room. You might also put light strips on the stairs or a lamp in a living room corner.

When replacing bulbs, use LEDs, which have a longer life than incandescents and can reduce your energy bill each month.

Before starting any renovation project, talk to your homeowners’ insurer to be sure you’ll have the proper coverage. You may even qualify for discounts if you make your home safer.

By Rachel Hartman

Rachel Hartman is a freelance writer specializing in finance, business, lifestyle and travel topics. She has written for Parenting, Yahoo Finance and MSN Money, among other outlets.

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