Communication and Alzheimer’s

Alzheimer’s disease and other dementias gradually diminish a person’s ability to communicate. Communication with a person with Alzheimer’s requires patience, understanding and good listening skills. The strategies below can help both you and the person with dementia understand each other better.

Additionally, the Idaho Commission on Aging website has Dementia Skills training that focuses on preparing and promoting communication and providing safe and comfortable care.  See

Changes in communication

Changes in the ability to communicate can vary and are based on the person and where he or she is in the disease process. Problems you can expect to see throughout the progression of the disease include:

  • Difficulty finding the right words
  • Using familiar words repeatedly
  • Describing familiar objects rather than calling them by name
  • Easily losing a train of thought
  • Difficulty organizing words logically
  • Reverting to speaking a native language
  • Speaking less often
  • Relying on gestures more than speaking

Communication in the early stage

In the early stage of Alzheimer’s disease, sometimes referred to as mild Alzheimer’s in a medical context, an individual is still able to participate in meaningful conversation and engage in social activities. However, he or she may repeat stories, feel overwhelmed by excessive stimulation, or have difficulty finding the right word. Tips for successful communication:

  • Don’t make assumptions about a person’s ability to communicate because of an Alzheimer’s diagnosis. The disease affects each person differently.
  • Don’t exclude the person with the disease from conversations.
  • Speak directly to the person rather than to his or her caregiver or companion.
  • Take time to listen to the person express his or her thoughts, feelings and needs.
  • Give the person time to respond. Don’t interrupt unless help is requested.
  • Ask what the person is still comfortable doing and what he or she may need help with.
  • Discuss which method of communication is most comfortable. This could include face-to-face conversation, email or phone calls.
  • It’s OK to laugh. Sometimes humor lightens the mood and makes communication easier.
  • Don’t pull away; your honesty, friendship and support are important to the person.

Communication in the middle stage

The middle stage of Alzheimer’s, sometimes referred to as moderate Alzheimer’s, is typically the longest and can last for many years. As the disease progresses, the person will have greater difficulty communicating and will require more direct care. Tips for successful communication:

  • Engage the person in one-on-one conversation in a quiet space that has minimal distractions.
  • Speak slowly and clearly.
  • Maintain eye contact. It shows you care about what he or she is saying.
  • Give the person plenty of time to respond so he or she can think about what to say.
  • Be patient and offer reassurance. It may encourage the person to explain his or her thoughts.
  • Ask one question at a time.
  • Ask yes or no questions. For example, “Would you like some coffee?” rather than “What would you like to drink?”
  • Avoid criticizing or correcting. Instead, listen and try to find the meaning in what the person says. Repeat what was said to clarify.
  • Avoid arguing. If the person says something you don’t agree with, let it be. 
  • Offer clear, step-by-step instructions for tasks. Lengthy requests may be overwhelming.
  • Give visual cues. Demonstrate a task to encourage participation.
  • Written notes can be helpful when spoken words seem confusing.

Communication in the late stage

The late stage of Alzheimer’s disease, sometimes referred to as severe Alzheimer’s, may last from several weeks to several years. As the disease advances, the person with Alzheimer’s may rely on nonverbal communication, such as facial expressions or vocal sounds. Around-the-clock care is usually required in this stage. Tips for successful communication:

  • Approach the person from the front and identify yourself.
  • Encourage nonverbal communication. If you don’t understand what the person is trying to say, ask him or her to point or gesture.
  • Use touch, sights, sounds, smells, and tastes as a form of communication with the person.
  • Consider the feelings behind words or sounds. Sometimes the emotions being expressed are more important than what’s being said.
  • Treat the person with dignity and respect. Avoid talking down to the person or as if he or she isn’t there.
  • It’s OK if you don’t know what to say; your presence and friendship are most important.

Please see Idaho Commission on Aging website for additional education and training, schedule of local events in our community and Area Agencies on Aging contact information.


Make the Holidays Merry For All…

How to Include an Aging Family Member in Holiday Celebrations

The holidays are meant to be a joyous time for families to gather and celebrate. However, these usually happy occasions can pose challenges for seniors and their family members.

Older adults with mobility issues or conditions like Alzheimer’s disease and other forms of dementia can feel isolated when everyone is getting together for celebrations and family visits. The holidays can disrupt familiar routines and often require difficult travel, which can sometimes make an aging individual feel like a burden.

It is important to be able to recognize holiday depression in your aging loved one and make sure that they feel included in some capacity during this time of year. Use the following tips to help you and your family make the holidays joyous for everyone, regardless of their level of ability.

3 Ways to Make the Holidays Merry and Inclusive for Seniors

  • Create New Traditions
    If your family traditions involve travel or other activities that would now be too strenuous for your aging loved one, it’s a good idea to discuss the possibility of creating new traditions that everyone can participate in. Baking, easy decorating activities, holiday crafts, and having friends and neighbors drop in for small gatherings can be simple and effective ways to bring the holiday spirit to your aging loved one. These types of festivities are also great ways to involve grandchildren as well.
    If your family is somewhat scattered, perhaps it is time to change the direction of travel for holiday gatherings. Instead of aging parents flying or driving to visit their adult children and grandkids, consider bringing the family to them or even meeting halfway at a new destination.
    If your loved one lives in an assisted living community, check in with the staff to see if they are hosting any holiday activities. Even when family is nearby, many caregivers encourage elders who live in senior housing to participate in onsite activities to alleviate the stress involved in attending family gatherings. Leaving the familiarity of senior housing can be very disorienting for seniors who are living with progressing cognitive decline. Instead, arrange for family to visit or accompany your elder to the facility’s event(s) as part of your new holiday traditions together.
  • Remember Together
    Many times, it isn’t the holiday itself that causes feelings of depression, but rather that the holidays may bring memories of happier times. If this seems to be the case, activities such as watching home movies together or looking through old pictures as a group can be a nice way to remember those times as a family to help alleviate feelings of loneliness in an aging loved one. Reminiscing can be an enjoyable activity for everyone and a valuable way of sharing memories and family history with younger generations.
  • Plan Ahead
    If an elder lives far away, or if an in-person visit truly doesn’t seem possible this year, make sure you plan ahead to ensure they will not be spending the holidays alone. If your loved one is living on their own, try to see if one of their neighbors might be able to visit with them.
    This might also be the time to consider hiring in-home care, even if the arrangement is only temporary. If it seems as though your aging loved one will be alone this season, look for a reputable agency that provides professional caregivers who are specially trained to meet all of your aging loved one’s needs. Most agencies can accommodate either shorter visits or extended stays. The right caregiver will be able to assist with activities of daily living (ADLs) and provide companionship, activities, and emotional support.

Your local Area Agency on Aging (AAA) is also a great resource and may have a friendly calling or visiting service free of charge. Find your local Idaho AAA here:

Or use the Eldercare Locator for anywhere in the USA and territories.

Holiday traditions and activities can be adapted in countless ways, and flexibility can help ensure your plans are successful. Regardless of whether you are able to visit with the whole family or you must bring in professional caregivers to ensure your elders aren’t spending the holidays alone, the most important thing is for your loved ones to know that you are thinking of them and committed to helping them feel included in the festivities.

Renata Gelman, RN, B.S.N., is assistant director of clinical services at Partners in Care, an affiliate of the Visiting Nurse Service of New York

The ICOA website is Idaho’s source for reliable information on healthy aging and community resources:

Five Steps for Family Caregivers

Caring for a family member or a close friend is one of the most important roles you will ever play.  It may start by simply running errands, driving them to their doctor appointment or shopping.  Later, you may find yourself handling their medications, meals, finances, activities of daily living or other medical complexities. Therefore, it is important to know your loved one’s healthcare preferences with a plan in place before a crisis occurs.  Here are five important steps to help you through this caregiving journey.

Step One:  Start the conversation – “I just read an article about gathering all your important papers. Sometime can you show me where yours are and what you’d like us to do just in case?” Be open, express your love and concern, most importantly listen, and respect your loved one’s wishes regarding home, health, finances, and legal needs. Include other trusted family members to be a part of the process.

Step Two:  Form Your Team – Go deep and wide and decide who is in charge. Team members do not have to live nearby or have lots of time available to be useful.  Family or friends can work behind the scenes with meal planning/organizing, chores, bill paying, and assistive technology solutions.

Step Three:  Make a Plan – Keep the plan simple and include immediate and future needs. There are several roles’ people can help with; an assertive advocate to communicate with medical professionals or insurance companies; if your loved one wants to move, assign someone to research locations and facilities.  Someone else might offer to spend some weekends sorting through their personal belongings.

Step Four:  Find Support A variety of services are available to people aged 60 and over and their caregivers and older relative caregivers 55 or older.  This support can be found through your local area on aging.  The Idaho Commission on Aging website provides an array of Caregiver Skills videos sponsored by AARP’s Home Alone Alliance.  Additionally,

  • Hire Help – housekeeping, meal preparation, laundry, shopping, bathing
  • Secure Safety – Handrails, grab bars, night-lights, adjustable shower seats
  • Stay organized – Caregiving apps such as Caring Village and Medisafe

Step Five:  Care for yourself – Exercise, maintain a healthy diet, and sleep.  Overall, be sure to take time for activities you enjoy.

Resource:  (AARP, Family Caregiving Guide)

Visit the ICOA Website for Caregiver information

Contact your local Area Agency on Aging for programs and services

For free education on healthy caregiving topics visit the Idaho Commission on Aging’s Caregiving Education webpage.

Lead Poisoning Prevention: Be Aware of the Dangers and Health Impacts of Lead Exposure

Why is lead poisoning a concern?

There is no known safe level of lead in the body. Lead exposure can cause negative health effects. Children are especially at risk because their bodies absorb more lead than adults and their nervous system, including the brain, is not fully developed.

Lead is a naturally occurring metal in our environment. Exposure often goes unnoticed because people may have no symptoms and appear healthy. Lead can enter the bloodstream through breathing or swallowing. Children’s brains and nervous systems are more sensitive to the damaging effects of lead and exposure can result in difficulty learning, behavioral and hearing problems, slowed growth, and headaches. Even low levels of lead in blood can cause developmental delays.

Where can a child be exposed to lead?

Lead can be found in the home, air, soil, and water; all the places children live, learn, and play. The most common exposures include:

  • Lead-based paint. Homes built before 1978 may have lead paint. Deteriorated surfaces with lead-based paint, such as peeling, chipping, or cracking, can create dust that contains lead.
  • Lead contamination from clothing. Contamination of the home can occur from clothing worn by adults who work in mining, auto mechanics, and construction industries. Clothing worn during recreational activities in locations containing lead can also bring lead into a home.
  • Lead in drinking water. If your home was built before 1986, it may have lead pipes, fixtures, and solder. Lead can enter drinking water when service pipes that contain lead corrode. 
  • Lead in soil. The soil in yards or playgrounds can contain lead from different sources, including when exterior lead-based paint flakes or peels onto the ground. The use of leaded gasoline in cars or industrial sources, such as former lead smelters, or mines, can be sources of soil contamination.
  • Lead used in jobs and hobbies. Welding, auto or boat repair, making ceramics or stained glass, target shooting at firing ranges, furniture refinishing, and home remodeling are jobs and hobbies that may expose you to lead. People may bring lead dust into their car or home on their clothes and body.   
  • Lead in products. Lead may be found in certain foods, cosmetics, and traditional medicines imported or purchased in other countries. You cannot tell if a product contains lead by looking at it or tasting it. 
  • Lead at old mining sites. Historical mine sites can have high levels of lead and other metals in waste rock, tailing piles, soil, water, and historical buildings. 

What are steps I can take to protect my child from lead?

Work with your doctor.

  • Lead exposure often has no obvious symptoms and can go unrecognized. Testing is the only way to know if your child has lead in their body. If you have never had your child tested, or think your child has been exposed to lead, contact your doctor to arrange a simple blood test.
    • Be sure to follow up! If your child has an elevated blood lead level, work with your doctor for information on how to lower it. Follow-up testing should be scheduled until the level of lead in the blood is no longer a concern.

Find the source of the lead exposure.

Reduce lead exposure.

  • Repair deteriorating surfaces containing lead-based paint that are peeling, chipping, and cracking. This repair should be done immediately by an EPA-certified contactor. Home repairs such as sanding or scraping paint can create lead dust and should be done by an EPA-certified contractor. 
    • WASH your hands often! Everyone should wash their hands before eating and sleeping, especially after playing outside. Lead dust is so small you cannot see it. Children can get lead poisoning from swallowing dust on their hands and toys.Keep lead-associated hobbies separate from living space. If you have hobbies that involve lead, such as bullet reloading, fishing, or antiquing, prevent the build-up of lead dust by regularly cleaning your work area and keeping your hobby separate from your living space.Remove shoes and dirty clothing before entering your home, especially if you have a job that includes welding, auto or boat repair, making ceramics, stained glass, target shooting at firing ranges, furniture refinishing, and home remodeling.Clean play areas, toys, and the toy containers often. If toys come from outside, clean them before bringing them inside.Lead may be found in the paint, metal, and plastic parts of toys and toy jewelry, particularly those made in other countries, as well as antique toys and collectibles.  Check the Consumer Product Safety Commission (CPSC) website or call 1-800-638-2272 to be sure your child’s toys are safe.     
    • Lead can be found in foods, cosmetics, and medicines from other counties.  Pregnant women and children should avoid use of any product that may contain lead.  More information can be found here.  

Feed your child healthy foods.

  • Foods that contain calcium, iron, and vitamin C may help keep lead from building up in the body.
    • Calcium is in milk, yogurt, cheese, and green leafy vegetables like spinach.
    • Iron is in red meats, beans, peanut butter and cereals.
    • Vitamin C is in oranges, green and red peppers, and juice.

For additional information

Resident’s Rights: What to Expect

When a loved one no longer is able to remain at home safely with supports it pays to have some basic knowledge when faced with the task of finding appropriate placement.  Long-Term Care is a system unto itself with a language that most do not know if they have not had experience with either Skilled Nursing care or Assisted Livings facilities.

Take the time to explore options available for your loved one and take the time to personally visit facilities in the area that you would like your loved one to reside. 

When you visit your facility options observe:

  • The feeling  of entering into the facility
  • Smell or odors
  • Volume of music, laughter, staff communications, other sounds
  • Staff interactions with residents
  • A meal when possible


  • You greeted and welcomed by a staff
  • Conversations with administration focused on financial rather than on resident care.

And visit during the weekend to observe staffing and the facility environment

The big Question is– are staff “Resident Centered”?

Types of Long -Term Care-

Skilled nursing care requires a skilled medical need for services to be authorized for insurance coverage.  If the resident has Medicare it pays for the first 20 days and then the resident is required to private pay for the room and board for up to the next 100 days if there is no other payment source. For Medicare to cover, the individual must have a 3 day stay in the hospital.  Medicare will not cover if the individual was admitted to the hospital for observation rather than treatment.

When an individual does not have a medical need for placement and is in need of long-term care services that is beyond assisted living care, options for payment may be long term care insurance, private pay or Medicaid.

The person Centered Care Plan in skilled Nursing Care or long term care guides the care that an individual has been assessed to need for their best quality of life.

Assisted Living level care is not a skilled level of care.  According to Idaho Licensing and Certification “A Residential Assisted Living Facility is a facility or residence operated on either a profit or nonprofit basis for the purpose of providing necessary supervision, personal assistance, meals, and lodging to three or more adults”.

In an Assisted Living facility, the Negotiated Service Agreement guides the level of care required to meet the residents needs and increase or maintain their quality of life.

Residents and resident representative should have a voice in the development of these care plans.

Prior to signing an admission agreement—read the entire agreement and do not sign until you have read and understand what you are agreeing to.  At a later time should you have questions or concerns it may be dependent upon what was in the admission agreement as to what rights you may have going forward.  Keep a copy of the Admission Agreement that was signed upon admission.   

Nationally staffing is at critical levels due to shortages.  There has never been a more important time to be aware and involved in the long-term care of a loved one.

Know your rights.  Every facility is required to post residents rights.  When you have concerns or questions related to resident care contact your local Area Agency on Aging Long-Term Care Ombudsmen they are a great resource for information and resident advocacy.

Know who your advocates are and how to contact them- Ombudsmen are formally trained advocates that can help when family efforts aren’t enough.

Visit the ICOA website for additional information and services to help older Idahoan’s age with safety and dignity.

Preventing Falls

What a Difference a Few Simple Things Can Make

Every day, we look for ways to optimize our efforts. If we can find activities that accomplish multiple goals at once that is even better. This is especially true when it comes to things that benefit our health. For all of us, but especially those over age 60, a significant cause of accidental injuries and death each year are due to falling. Falls often result in expensive emergency department (ED) visits and hospitalizations. Older adults often end up in costly long-term care facilities. The financial cost can be overwhelming. Beyond the initial injuries, a person’s ability to actively engage in life, impacting their physical and emotional health, can be the result.  Wouldn’t it be nice to be able to prevent falls from happening to begin with?

Yes, there is good news! Most risk factors that increase the likelihood of falling can be minimized or eliminated. A few of the most common risk factors and some solutions include:

  • Trip hazards at home and work

Improve lighting, re-route cords across walking paths, remove clutter on the floor, remove or secure loos floor coverings, add non-slip mats to showers/tubs, fix uneven/loose steps and handrails.

  • Inappropriate and poorly fitting footwear

Wear shoes that fit well and provide proper support for activities. Loose-fitting shoes, untied laces or those that hang to the ground, and especially “open” shoes like flip-flops and open-back slip-ons can contribute to falling.

  • Lower body Strength

Don’t be a body builder but ensuring strength and flexibility in our back and legs can mean the difference between a stumble and a fall with injuries.

  • Medication

Many common over the counter and prescription medications can cause issues with balance, reaction time, dehydration, and other contributors to falls. Work with your healthcare team to reduce or change problematic meds.

  • Poor Vision

Wear glasses or contacts that correct your vision as much as possible. (Sometimes we can’t fully correct all vision issues.) In addition, be sure to remove reading and computer glasses, and look through the top part of bi-focals or remove them before walking.

Every one of these risk factors can be identified and most can be completely resolved at little or no cost. At the same time, we can reduce the very significant medical costs of fall-related injuries in Idaho which is more than $253 million each year ($50 billion nationally).

Throughout September, the Idaho Commission on Aging (ICOA) will be presenting free seminars about falls prevention.  Learn more about…

  • The full impact of falls on individuals, families, and Idaho communities in the Why Falls Matter seminar.
  • Performing home and office audits for trip hazards in the Identifying and removing Trip hazards at Home seminar.
  • Simple at-home exercises you can do by watching or following along as a physical therapist demonstrates them during the Simple Steps seminar.
  • Ensuring healthcare students and professionals include assessing fall risk as part of their practice by participating in the “brown bag” Falls Assessment As a Matter of Practice seminar.

View the entire Falls Prevention seminar schedule  and other falls prevention resources:

Isn’t it a good idea to take charge of ensuring we, our families, neighbors, and communities can reduce the incidence and impact of falls? Physical and emotional health, loneliness and isolation, financial stability, and the ability to continue to live independently in our communities of choice depend on it.  Together we can learn to reduce and eliminate falls.

Thank you for standing up for Life, Liberty, and the pursuit of happiness for Older Idahoans! Visit the ICOA website for additional information and services to help older Idahoan’s age with safety and dignity.

Emergency Preparedness for Older Adults

Follow these easy steps to make sure you’re protected.

Natural disasters, such as wildfires, floods, and blizzards, may force you to evacuate your home or shelter-in-place at short notice. It is important to know what to do in case of an emergency well before disaster strikes.

If you are an older adult living in the community, you may face some challenges during an emergency. For example, you may have mobility problems, or chronic health conditions, or you may not have any family or friends nearby to support you. Support services that are usually available, such as help from caregivers or in-home health care and meal delivery services, may be unavailable for a period of time. In addition, older adults may experience challenges that come with advanced age, such as hearing or vision problems or cognitive impairment, which may make it difficult to access, understand, and respond to emergency instructions.

You or the person you care for can be prepared for emergency situations by creating a plan, reviewing or practicing it regularly, and keeping an emergency supply kit.

Creating a Plan

The first step in preparing for an emergency is creating a plan. Work with your friends, family, and neighbors to develop a plan that will fit your needs.

  • Choose a contact person who will check on you during a disaster, and decide how you will communicate with each other (for instance, by telephone, knocking on doors). Consider speaking with your neighbors about developing a check-in system together.
  • Create a list of contact information for family members and friends. Leave a copy by your phone(s) and include one in your Emergency Supply Kit.
  • Plan how you will leave and where you will go during an evacuation. If you are living in a retirement or assisted living community, learn what procedures are in place in case of emergencies. Keep a copy of exit routes and meeting places in an easy-to-reach place.
  • Create a care plan and keep a copy in your Emergency Supply Kit. Try out the CDC’s easy-to-use care plan template.
  • If you have medical, transportation, or other access needs during an emergency, consider signing up for SMART911, Code Red, or your local county registry, depending upon which service your area uses to helps first responders identify people who may need assistance right away.

Creating an Emergency Supply Kit

After an emergency, you may not have access to clean water or electricity. Make sure you are prepared with your own supply of food, water, and other items to last for at least 72 hours.

  • Visit for a list of basic items to gather for your Disaster Supply Kit.
  • Medical-Related Items:
    • A 3-day supply of medicine, at a minimum. If medications need to be kept cold, have a cooler and ice packs available.
    • ID band (full name, contact number for family member/caregiver, and allergies)
    • Hearing aids and extra batteries
    • Glasses and/or contacts and contact solution
    • Medical supplies like syringes or extra batteries
    • Information about medical devices such as wheelchairs, walkers, and oxygen including model numbers and vender.
  • Documents (Keep physical copies in a waterproof bag and take photos of each document for backup):
    • Contact information for family members, doctors, pharmacies and/or caregivers
    • List of all medications, including the exact name of the medicine and the dosage, and contact information for pharmacy and doctor who prescribed medicine
    • List of allergies to food or medicines
    • Copies of medical insurance cards
    • Copies of a photo ID
    • Durable power of attorney and/or medical power of attorney documents, as appropriate.

Taking these steps will put you and/or your caregivers in a better position to deal with emergencies that may require you to evacuate or shelter in place.  Contact your local Area Agency on Aging for information on senior services and resources in your area.

Smoke Ready Idaho

Wildfire smoke will likely be with us through the summer and into the fall. Here’s what you need to know.

Wildfire smoke can cause irritating symptoms for healthy people and more serious health issues for people with respiratory problems and heart and lung disease. It’s important to know how to protect yourself and your family from smoky air whenever possible.

Who is most at risk for the harmful effects of smoke?

Infants and young children suffer more from the effects of smoke because they breathe more air than adults for their body size. Older adults and people with lung and heart conditions are also especially sensitive to smoke in the air. Even low levels of smoke can cause breathing problems for sensitive groups with asthma, COPD, emphysema, and other chronic lung diseases.  In addition, smoke can increase the risk of heart attack or stroke for people with chronic heart conditions and can  increase the risk of premature birth in pregnant women.

When should we become concerned about the symptoms of smoke exposure? 

Common effects of smoke exposure include irritated eyes, nose, and throat. However, you should call your doctor immediately if you have shortness of breath, chest pain or tightness, headaches, fatigue, or a combination of those symptoms that become severe.

What if I have an event outside or my child has a game we can’t miss, and the air quality is low?

Visit the Idaho Department of Environmental Quality’s air quality website or the Idaho Smoke Information Blog to check local smoke conditions. Download the AIR Idaho application on your mobile device for current smoke conditions in your area. The Department of Health and Welfare also provides activity guidelines for outdoor events and other resources to help determine your risk level. If an outdoor event or game isn’t canceled because of smoke conditions, drink plenty of water and do your best to limit your time outside. If smoke-related symptoms become difficult or get a lot worse, move indoors. Your family’s health is more important than a sporting event.

Should we consider wearing masks when conditions are poor?

While the most effective way to protect yourself from smoke is to stay indoors, we recognize this is not always possible. People who must be outside in the smoky air may benefit from wearing “particulate respirators” or N95 respirators. Respirator masks worn correctly may provide protection by filtering out fine particles in the smoke. However, many people find it difficult to wear a mask correctly. If a mask does not fit properly, it will provide little or no protection. For some, masks can make it harder to breathe normally. It is a good idea to check with your health care provider before using any mask. 

How can we limit our exposure to smoke?

When conditions are poor, you should reduce your time and activities outside as much as possible. Stay indoors, in an air-conditioned area, if you can. If you don’t have air conditioning, go someplace that does, like the mall or library. Otherwise, there are several things you can do to limit the smoky air you breathe:

  • Keep your windows and doors closed.
  • If you have central air conditioning, use an air filter rated MERV 8 or higher and turn the system fan on.
  • If you must drive in smoky areas, keep all windows closed and turn the vehicle airflow to recirculate to reduce the amount of smoke in the vehicle. Use caution and slow down when driving in smoky conditions.
  • Do not add to smoky conditions (e.g., burn candles, use propane/wood-burning stoves, aerosol sprays, smoke tobacco products, or vacuum. All of these and more can increase air pollution indoors.
  • Change air-conditioning filters more frequently as they may become clogged or dirty.
  • Use portable air clearers to reduce indoor air pollution.
  • Pay attention to local air quality reports and health warnings.

Where do I go for more information?

Please visit the resources listed below for up-to-date information on smoke conditions and resources on how to stay healthy during wildfire smoke events:

Brigitta Gruenberg is the Environmental Health Program Manager for the Department of Health and Welfare.

The Idaho Department of Health and Welfare is dedicated to strengthening Idahoans’ health, safety, and independence. Learn more at

Choice and Autonomy

We all Cherish Choice and Autonomy

Every July Americans come together and revel in our freedoms. The freedom to make choices and pursue our own path is celebrated as a fundamental right.

Unfortunately, as we age people lose sight of the fact that we retain our civil rights, and often take away choice and self-determination of older Americans in the name of safety or concern. This is commonly called ageism and is a subtle prejudice we must avoid personally and call out in others when we see it.

It is true that many older Americans need support as they age but this should be done via honest conversation with the elder using a respectful attitude as we explain their options. Yet even today well-intentioned relatives and caregivers are stripping away older and disabled Idahoan’s civil and legal rights, self-esteem, and quality of life by pursuing guardianship with the motivation to keep their older loved ones safe.

Although we applaud the motivation, the Idaho Commission on Aging advocates for older and disabled adults by urging concerned caregivers to consider the multitude of alternatives to guardianship for as long as possible.

What are alternatives to guardianship? Some examples include:

  • Representative payee
  • Durable powers of attorney
  • Health care surrogacy
  • Living wills
  • Trusts
  • Community advocacy systems
  • Joint checking accounts
  • Case management

Power of attorney – A power of attorney is a legal document. The document grants one person, generally called an agent, sometimes known as an attorney in fact, the authority to act on behalf of the person appointing them. The person appointing the agent is called the grantor. To create a power of attorney, an adult must be able to understand they are appointing the agent and understand the kinds of authority they are giving the agent. The scope of the agent’s authority is limited by the terms of the document and by state laws. A grantor with capacity can revoke or modify the appointment of an agent in a power of attorney. Revocation of a power of attorney should be in writing, signed by the grantor, with a copy delivered to the agent and anyone who is likely to be dealing with the agent. In some states, the revocation needs to be recorded in the public records like a deed. A power of attorney is a private agreement and is not subject to automatic oversight by the Courts.

Health care surrogate – A health care surrogate is a person who makes health care decisions for a person, when the person lacks capacity to make health care decisions. This person may also be called a health care agent or proxy. In every state, a person with capacity can appoint a health care surrogate in a durable power of attorney that incudes health care authority. Many states have a short form for naming a health care surrogate. A person has capacity to appoint a health care surrogate if they understand what a health care decision is and can name a person they trust to make health care decisions. If a person does not appoint someone, 45 state statutes give guidance on who can make health care decisions. Generally, statutes turn to the nearest relatives to make health care decisions. Health care decision-making is the only area of decision-making where the law creates a default agent when a person does not name an agent in writing.

The authority of a health care surrogate to make health care decisions does not start until the person loses capacity, or knowingly defers to the agent. The determination of loss of capacity is made by the person’s health care providers. The criteria and documentation for the loss of capacity is based on state law. The scope of the authority is defined in the document and by state law. If the person has capacity, the person can revoke or modify the appointment of a surrogate. Many states have a very low standard of capacity for revocation of an advance directive. Aside from leaving directions on who can make health care decisions, many people leave directions about the health care they want or do not want in the form of an advance directive or living will directive. When making health care decisions for another person, it is helpful to understand their health care values, goals of care, and specific wishes.

Social Security Representative Payee – A Social Security Representative Payee (rep payee) receives the benefits for a beneficiary who has been determined unable to manage money by the Social Security Administration (SSA). Rep payee is specific to Social Security benefits, including Social Security Disability and Supplemental Security Income (SSI). VA pensions and some private pensions have separate payee systems. Social Security will place the benefits in payee status if SSA has reason to believe that the beneficiary is unable to manage benefits. The evidence is either a verification from a physician who has seen the person recently, or evidence in a disability case of serious mental illness or substance abuse. The beneficiary can file voluntarily if they are unable to manage their benefits. The process is entirely administrative. Social Security does not recognize any other agents. Guardians and agents under powers of attorney must apply to Social Security to be recognized as a representative payee.

Someone seeking to be appointed as a rep payee should contact Social Security with the name and identifying information for the beneficiary, the reason the person needs a payee, and name and contact information of a physician who has recently seen the person and may include a proposed payee. Social Security then sends notice to the beneficiary, and a verification form to the physician. The beneficiary has a right to object to the need for a payee, or to the proposed payee. Upon finding of need for a rep payee, Social Security does a basic background check on the proposed payee. The payments must be directly deposited into a separate account, titled “payee as representative payee” for the benefit of the named beneficiary. Most payees file a very basic annual accounting. Representative Payee status can be terminated, at request of the beneficiary, with proof that the beneficiary has regained the ability to manage benefits. If the payee resigns or becomes unable to serve, benefits are held until a replacement payee can be appointed. There is a shortage of reliable volunteer payees and a need for representative payees. All payees are volunteers, with an exception for narrowly defined non-profits who are allowed to receive a limited fee from the benefits. In some states, inpatient residential settings, such as nursing homes, are allowed by state law or regulation to serve as representative payees.

Bank accounts – A common way to manage another person’s finances is to authorize an agent to sign on to that person’s bank accounts. There are two ways to do this: 1) add a person authorized to transact business on the account; or 2) make the bank account a joint account. A joint account creates a presumption of ownership in the account assets and may create inheritance rights. Joint accounts are very helpful for married or committed couples. For more distant family members or friends, joint accounts should be used with great caution. Rather than create a joint account, the bank can authorize someone to sign on the account without creating an ownership interest in the account.

This is commonly accomplished by the bank recognizing the authority granted under a power of attorney. In many states, the banks may insist on a state standard form, or a bank approved power of attorney form. Banks can also authorize signers on accounts without creating an ownership interest; many business accounts are structured this way. Direct deposit and automatic payment for All Social Security benefits and virtually all retirement benefits are paid by direct deposit. Direct deposit eliminates the need to make deposits and prevents lost or stolen checks. Nearly all reoccurring bills can be set up on automatic payment. The combination of direct deposit and automatic payments can help to assure that necessary bills are paid when a person is unable to attend to finances. These arrangements should be monitored to assure that all income is properly received, and automatic payments are correct. Increasingly, financial institutions and utility providers are willing to send copies of invoices and statements to a third party, or to arrange online access for accounts oversight.

This information was supported by a contract with the National Center on Law & Elder Rights, contract number HHSP233201650076A, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201

Additional resources to help concerned family and caregivers support their older relatives without the civil death of full guardianship are:

A Guide to Managing Other’s Money

Supported decision making

A Guide from AARP

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