Are you over 50?

If so, then you may know (or should know) that those of us over 50 are in the fastest-growing group going to the doctor’s!  We are not only heads or co-heads of households probably with children – and maybe if we’re a bit older – even grandchildren, but we are (and especially we woman) also taking care of our parents, whether near or far.  In short – we asked for the right to do it “all,” and now we find ourselves (perhaps to our own dismay?) doing it all!  This means spouses, kids, grandkids, probably a job or two just to stay afloat, and then, on top of all that, caring for elder loved ones.  Even if they are not all that “loved,” we are caring for them, whether it’s organizing helpful household services or coordinating daily care or even trucking across town every day or so to provide care ourselves.  This is driving us -already in or moving toward the “older adult” category to the doctor more than any other age group.  What’s taking us there?  Stress, of course!  Physical and mental.  We are the fastest-growing group at risk of heart disease, stroke, high blood pressure, diabetes, and other age-related illnesses that tend to come on with stress and strain.  And I don’t know about you, but that kind of everyday stress and strain over the worries of making sure that people you love are well cared for does not lend itself to dieting or actually, to much moderation of any kind when it comes to self care (or self gratification).  When 5pm rolls around, it’s a treat to be able to say the workday is done (though truth be told, it’s never really done for the women I know, including myself), but at least to pretend that there are a few boundaries with a nice glass of wine and a good dinner… well, it just helps the day round out more nicely than rabbit food and a gallon of water!

Did you know that research shows that people who think about, who plan, and who actually prepare for their futures have a better future when that day comes?  Studies of older adults indicate that people who have been willing to admit that their future may (is likely to) move beyond those “fun in the sun” days that so many retirement planners sell us into a few years when some care is needed from others end up having healthier longevity.  The Baby Boomer cohort is going to be the longest-lived group ever!  Some of us will live a long time having denied the fact that our latest years – say into our 90’s and maybe 100’s – will probably not see us windsurfing.   In this group, we will find ourselves trying to figure out how to maintain a sense of dignity at the very last minute, maybe with fewer choices for it than we would wish.   Some of us will begin to think about this block of time in our latest years and want to make sure than when all that windsurfing comes to an end (if, of course), we will have in place some ideas and mechanisms for keeping our values and voices at the forefront of daily life. 

One way to plan for the future is, of course, with life insurance, helping not only you but those around you (see, for example, this website out of the UK: .

But then, there is another way too.  That other way is to develop some kind of document that can speak for you if and/or when it’s hard for you to do it.  It’s hard for the really old-old to speak up and dominate their affairs, even when those around them are loving and well intentioned.  I don’t know about you, but I’m already more tired at 62 than I was at 52!  I can imagine that at 92 I really won’t want to struggle with other louder voices but that still, I will want my life to remain familiar to me.  And that’s why I started CustomElderCare (  Based on my own caregiving experience with my mother, who eventually needed round-the-clock care, I came to understand that if I didn’t find some way to make her values, needs, and preferences known to the wonderful caregivers who came to work with our family, she would virtually disappear into the woodwork despite that fact that the care was (supposed to be) all about her!  Ironic, no?  I came to realize with great force that she had the right to have her life look familiar to her until the bitter end and that despite all the caregiving experience the workers had, they had never had it with my mother… so how could they know her intimately enough to care for her in a way that kept her life as she knew and wanted it?

Think about it.  If you are lucky you will become old, then old-old.  Denying old age isn’t going to help anyone, least of all you.  Denying that we are, ultimately, never independent but always (more or less) inter-dependent isn’t going to help you plan or prepare for that day “when.”  You can do something for yourself, though.  You can create a caregiving service manual that someone you trust can hold on to until the day you need it.  Over the next years you can tweak it as you see fit, but you will give your family and everyone who loves you a real gift if you tell them now what you want life to look like later.  Take the guesswork out of it.

And if you are a caregiver for an elder loved one, you can give him or her that same gift.  You can create (maybe even with his/her help) a caregiving service manual that provides all the tips and guidelines that signify “quality of life” to those who care for your loved one.  The, you can share the care more confidently – maybe even go to a movie now and then – and when you say goodnight, leaving your loved one in the hands of someone else, you will know that the caregiver has all the information he or she needs to do the “just right” things.

Peace of Mind. 

Good Caregiver(r) Workbooks to download with all work materials create manuals at  Also available, Good Caregiver(r) Handbook, if you want to develop your own materials, and Good Caregiver(r) Toolkit, the  “2 in 1” tool (no pc needed) that begins as a workbook and ends as a caregiving manual!

Dominique Moyse Steinberg

Founder/CEO, CustomElderCare


Death Makes Life Possible

An important project for anyone who imagines – as Deepak Chopra says – dying some day… but especially important for Baby Boomers, mid-life caregivers, and older adults.  Learn more…

Story about elder-care family stress…

Did you read this story about scaregiver strain?   If you are approaching middle age or you see your parents dealing with grandparents or other elder loved ones, you are not alone!  Caregiver strain is enormous.

At this story shows, children of elderly parents in need in dire need of caregiving support.  That’s precisely what we are attempting to do at


In the


Meet Emily Saltz , LICSW, CMSC (Founder and Director, Elder Resources,  She is a bundle of energy, misses no small detail, and when you talk to her she seems to listen with her whole being.  It’s not surprising that Elder Resources, which she founded in 1993, is one of the longest-running and highly-respected private geriatric care management services in the Northeast.  Saltz, a social worker by profession, is steeped in this work and understands the mechanics of the health care system just as well as she grasps family dynamics and the distinct needs of elderly people.  It’s easy to imagine how Saltz’s compassion and humor help families navigate the uncharted territory they face when assisting a family elder.

I wondered aloud, “How do people end up on your doorstep?  Are there usual incidents or events that prompt people to pick up the phone and call you?” “Yes.” Saltz responded decisively. “People typically call us when they are in crisis.  We wish they would call sooner.  They often call when they have noticed an alarming physical or cognitive decline in their loved one, during an elder’s hospital stay or after a fall.”

Saltz explained that people discover Elder Resources and similar groups around the country by word of mouth or a referral by doctors or attorneys.  Anyone can call or go to the website of the National Association of Professional Geriatric Care Managers (NAPCGM) at and find a nearby Geriatric Care Manager.

“Why don’t families reach out sooner?” I asked. “Is it a financial burden? Denial? Or that most of us want to handle the situation on our own?”  “All of the above,” Saltz answered, “plus, as a profession, we’re not as known as we want to be.  Geriatric Care Management is the best kept secret in the health care system.   People simply don’t know about us….until a crisis.  Then, when they search for support, they are likely to be pointed in our direction.   And even then, geriatric care management is not reimbursable under insurance.”

The lack of public awareness and financial limitations constitute two stumbling blocks.  But Saltz also talked about the ways in which family dynamics and relationships exert an impact on adult children and their elders.  “Families don’t talk enough,” Saltz said.  “Many parents and their children do not have the kinds of conversations that lead to long-term, thoughtful planning.  Most of us avoid talking about caregiving and end-of-life issues until we’re in the middle of it. When family members finally do reach out for help, they often feel terrified or paralyzed.”   The denial has lifted and the situation can seem daunting.

At Elder Resources, the preliminary assessment serves as the basis for decision-making.  One question facing so many families is whether a person can continue to live at home or not. I asked Saltz if she and her team are always able to answer that question. “Yes,” she answered.  “It’s clear immediately… though not always after the first visit; we make several home visits, providing a professional, objective evaluation that takes into account the elder’s cognitive, physical, and emotional domains.  When completed, we make recommendations that involve choices and options.  We arrive at a conclusion by doing a comprehensive assessment and listening closely to the expressed wishes of the elder as well as the strain on family, siblings’ relationships with each other and relationships with the parent. The competency and decision-making capacity of the elder is central.  We come away with a solid impression.  In all that, one important goal is to honor the elder.”

Another important part of the process, according to Saltz, is to get past “no”…an answer that can bring progress to a halt. If, for example, an elder wants to stay at home but does not want strangers in the house, and family members cannot provide daily assistance, then all participants are asked to help resolve the deadlock…to work together to get past ‘no’.  Saltz added that the elder’s ability to accept help can make a difference as does his or her network of support in the community and from friends and family.

Not surprisingly, as we age, many of us want to stay in the familiar and comfortable environs of our own home.  According to Saltz, mobility and access typically prevent people from being able to continue to live in their homes.  She noted that relatively simple modifications can sometimes enable an elder to stay in his or her own home.  For example, while a $5,000 stair lift seems exorbitant, it might ultimately provide the key to providing at-home care.  Saltz added, “People can’t stay at home when they need more care than they can afford.  At this time, the only place elders without assets are guaranteed to receive 24/7 care and supervision is in a nursing home.  There are few publicly funded programs that provide 24/7 care at home for low or moderate income elders.

Saltz and other geriatric care managers assist people during a sometimes tumultuous stage of evaluation and transition. Families are in turmoil and sometimes in conflict.  I wondered what kinds of family conflicts she most frequently encounters.  “Anxiety is heightened,” Saltz said, “and if family members shared conflicted former relationships, they generally don’t get better with added strains.  Kids might attribute (past) motives to parents that are no longer true.  And as a rule, the more kids in the family, the greater the conflict…there are simply more opinions to take into account.”

“The adult child/parent dynamic is complicated,” Saltz explained.  “The parent isn’t your child.”  Saltz repeated the advice that families should talk more to avoid strain…that they share conversations about the future, and plan ahead.  Saltz said that she has observed parents and children who come together in positive ways to support the parent’s new needs.  “They reach a greater level of intimacy and love,” she said. “It can happen.”

Eileen Lyons, Director, Custom Elder Care Research & Development


Family Caregiver Standards

The National Association of Social Workers Board of Directors in September of 2010 approved new standards for social work practice with family caregivers of older adults.. (read more)

Ravages of Alzheimer’s

Two years ago, my grandmother died of Alzheimer’s. For more than a decade leading up to her death, my mother and I watched a proud, beautiful woman deteriorate into a state that can only be described as animalistic. The horrors inflicted upon her by Alzheimer’s cannot be understated.

Memory loss was only a part of the symptoms my grandmother suffered. Crazed by paranoia and fear, she was haunted by hallucinations. She became violent; despite her tiny frame and size, her strength was at times uncontrollable. Her voice abandoned her, and she could make her needs known only through awkward gestures and noises.

The fact that one in eight Americans older than 65 has Alzheimer’s is no small number. It is an epidemic. My grandmother required 24-hour care, sometimes by multiple people. My family tried to care for her at home, but as the disease progressed, this became a living nightmare for my family. And this went on for more than 10 years…

Quality of Life in Aging

Create dignity and quality of life for elderly in care

The Secret Caregivers…

“Men care for their loved ones more often than we know.  Why do they hide it?  Inside their silent burdens – and bittersweet rewards” (continue reading this essay by Gail Sheehy)

Preparing More Care of Elderly…

“In every area of aging – education, clinical care, research – people just don’t realize how dire the situation is,” said Dr. David B. Reuben, chief of the geriatrics division of the David Geffen School of Medicine… (continue reading)

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