My 70 year old uncle visited over Thanksgiving and he had to go into the hospital for heart surgery. Thankfully, he's now doing great and is on his way to recovery. However, he's worried about the cold New England winters. We've had our first snowfall here. And I'm sure you've heard about the devastating ice storm our northern neighbors suffered through. What do you do for your senior family members and friends during the winter season? What needs should you look out for?

We sat down to talk with Andrea Cohen from HouseWorks, a Boston-based company connecting seniors with resources they need to live independently. She offered a series of tips on how to help your elderly loved ones prepare for winter.

Hypothermia
"Older people are less efficient at regulating body heat." Andrea said. "So they can develop some pretty serious complications, even at room temperatures of 60 or 65 degrees."

To save money, a lot of us watch the thermostat like hawks. Seniors doing the same thing can endanger themselves, because they often don't realize when they're cold. Instead, Andrea said, they chalk up symptoms of hypothermia like confusion, clumsiness, or slowed speech as side effects of aging and not something more serious. There are ways to prevent that from happening:

• Don't set the thermostat below 65—even at night. Install programmable thermostats to regulate the temperature and save on energy.
• Shutting off unused rooms will help keep lived-in areas of the house warmer and also keep energy costs down.
• Avoid giving in to the temptation of space heaters. They come with a dual risk of fire and carbon monoxide poisoning.
• Keep the heat indoors by making sure drafts are blocked and windows are insulated.
• If money is an issue, seniors can apply for fuel assistance by calling the National Energy Assistance Referral Hotline at 866-674-6327.
• The National Association of Area Agencies on Aging (n4a) and the National Council on Aging (NCOA) can also refer seniors to local heating assistance programs.

Falls
"Falling on ice is dangerous for everyone. But for seniors, the risk is higher and the consequences can be far worse—hip fracture, brain injury, loss of independence, or the start of a downward spiral in health," Andrea cautioned.

Thankfully, many spills are preventable by addressing risk factors in advance:

• Install overhangs above doorways to prevent ice build-up on steps and walkways.
• Keep salt or ice melt next to the door with a scooper that a senior can manage.
• Make sure there are sturdy railings on both sides of walkways.
• Don't wait until the storms hit—arrange for snow removal in advance! (If you need someone to keep the walkways clear, you can post a job on Care.com to find a caregiver near your loved ones.)

Isolation and Inactivity
When the weather turns bad, the elderly often stay indoors out of fear of ice slips, falls, or worse. But being cooped up can bring on loneliness or depression.

"That's a problem," Andrea said, "because seniors already have fewer options for finding relief from isolation."

She gave us some great ideas for helping Mom and Dad socialize regularly through all seasons:

• If they have a computer, try getting them online more often with frequent emails or updates to photo-sharing sites where they can follow the family news.
• While you're looking into a snow-shoveling service, why not hire a driver? Arrange for one to come on a weekly basis to pick up your loved one and their friends for regular outings!
• Find indoor alternatives to regular exercise. If your parent usually goes for a daily walk, but can't now that the temperature is dropping, suggest a gym membership or a walking program at a local mall.

Wintertime doesn't have to be an inconvenience or a difficult experience for your elderly loved ones. With a little advance preparation, and some extra care, you can make this time of the year as comfortable for them as any other.

What are some of the things you do for your parents or relatives who are getting on in years? Share your thoughts in the comments. Be sure to check out the other resources below, too!

More Resources:
HouseWorks – Home care services to help seniors live independently in the Boston, MA and Washington, D.C. areas.
National Energy Assistance Directors' Association
National Association of Area Agencies on Aging
National Council on Aging
National Energy Assistance Referral Hotline - 866-674-6327

November is Alzheimer's Awareness Month, so I wanted to take the time to spotlight this important issue that impacts so many. For me, it's one that recently hit home, as my aunt was diagnosed with the disease. I’m thankful our relatives in Houston are nearby to be with her.

Alzheimer's is a disease that destroys brain cells, damaging memory and the thought process, eventually leading to behavioral changes and death. According to the Alzheimer's Association, over five million Americans live with the disease. It primarily affects those in the 65+ age bracket, but an estimated 500,000 under age 50 have Alzheimer's or another form of dementia. Currently, there is no cure, and if trends continue, 10 million baby boomers are expected to contract Alzheimer's.

But there is good news. As awareness and research for treatment and prevention increases, we're beginning to understand how to care for those affected. Early diagnosis can be one of the most effective means of helping patients live with Alzheimer's. By detecting warning signs sooner, they and their families can better prepare for the future.

Tuesday is Memory Screening Day—an annual event where health care professionals offer local and confidential memory screenings to the public.

"By offering the screenings for free and in convenient locations, our hope is that more people will act on any concerns they might have or check out their brain health in general," said Eric J. Hall, President and CEO of the Alzheimer's Foundation of America. "It's a way to start the conversation."

While a memory screening isn't an actual diagnosis for Alzheimer's, it can be a method of spotting onset, helping patients determine if they need further testing.

For those of us with loved ones suffering from Alzheimer's, determining how to care for them can be an enormous challenge. Eric offered some great advice that applies to all caregivers—both professionals and family members.

"Caregivers should view a loved one as someone 'living with' the disease, and, from that vantage point, take steps to try to improve quality of life," he said. "Don't let the disease impair a person more than necessary."

He suggested having them continue to help with daily tasks as much as possible. Maybe they can't operate the stove or drive anymore, but they could still pitch in around the home on other levels. But those who have Alzheimer's aren't the only ones who need a little extra help—often, their caregivers do, too.

"Caregivers must be informed and must be willing to reach out for help—to take advantage of training and support services that are available," he says. That includes support services for themselves. Taking care of themselves helps them take care of their loved ones."

Dr. Peter Reed, Senior Director of Programs with the Alzheimer's Association agrees.

"Caring for a person with Alzheimer's disease poses special challenges and increasing levels of care that can be taxing on a caregiver's health," he said. "Our new Caregiver's Stress Check will help caregivers maintain their own health, which is crucial"

There's a wealth of terrific online resources and local support for patients, family members, and caregivers to access. No one is alone in this battle. For more information, visit the National Memory Screening Day website, the Alzheimer's Association, and the Alzheimer's Foundation of America.

There have been great advances in treatment of Alzheimer's over the past 15 years. In fact, we've learned more about combating the disease during this span than in all the years since its discovery. With continued support and research, Alzheimer's can be beaten. I hope you'll take the time this month to educate yourself about the disease and help family and friends who are at risk to get screened.

Care.com is a proud supporter of the Alzheimer's Association and its fight for a cure.

Veterans Day always reminds me of my grandfather who served during World War II, surviving imprisonment and a horrible death march. Unfortunately, we don't live nearby. He recently suffered a stroke, passing away at 89 years old. He lived a full life; he was happily married to my grandmother for over 50 years, had ten kids, 23 grandchildren, 20 great-grandchildren, and was also a successful attorney. A fellow veteran spoke a few words at his funeral, and I saw, in so many ways, that my grandfather was truly a hero.

I’m thankful I was able to see him this past July, and my parents, aunts, and uncle were all nearby to care for him. Not every family has that opportunity.

On a recent flight, I sat next to a woman who traveled back and forth from Reno, NV to Boston, MA for visits to her 90-year-old mother. Although it was a difficult trip to make, she told me it was worth it to have quality time with her mom. The woman also mentioned that, when she wasn't in town, it was important for her mom to have another steady companion, so she'd arranged regular caretaker visits in her absence.

Connecting to older generations is easily overlooked in our busy-busy, full-speed-ahead lives. But our parents and grandparents are treasure troves of information and it's important to slow down and take the necessary time to share their memories—especially for the kids. Through our older loved ones, we learn where we've come from and they help us figure out where we're going.

Snail mail is a great way to stay connected. If you need conversation topics when you write, try sending pictures—not just of the family, but also of decorations, house projects, or the little ones' events. It'll give you talking points for letters and phone calls while keeping the grandparents up-to-date on everything in your life.

When it comes to war veterans, there are plenty of ways to stay in touch. For example, the Library of Congress started the Veterans' History Project eight years ago as a way to preserve our nation's oral history. Your child can pitch in by interviewing a family member or friend that served during wartime. Record the conversation with a video camera or audiotape and send it to the Library—you'll be making history.

There are plenty of opportunities to volunteer at your local VA office for children of any age. Or you can contact the area chapter and book one of the many veterans willing to come to your kids' school or organization and talk about serving in the military.

During this time of the year, local seniors have seasonal needs that you can help meet. With long lists of gifts to buy, they often need more assistance before the holidays than any other time of year. Check with your elderly neighbors to see if they want a hand (or just a little company) when they're heading to the malls this month.

Adam, our youngest, recently visited a nearby nursing home with his children's choir. The kids sang songs to a packed function hall and then spent a few minutes chatting with the residents. The smiles on both sides of the room were so touching to see (I just wish I had brought my camera)! We already can't wait to go back. If that's something your family would be interested in, call the activities coordinator at an area assisted living or retirement facility and see if there's a project you could get involved with.

What do you do for your parents when you aren't near them? With the holidays coming up, does your family plan on spending time with other elderly folks that may not have relatives nearby? Leave a comment to let us all know your plans!

My mom called me the other day asking about Facebook. She'd heard about it from some of her friends. I think it's great that they all surf the web, email and watch videos on YouTube, but I was a little surprised when I found out that my own parents are actively part of the social networking phenomena. Soon, she'll be following me on Twitter!

Jerry Shereshewsky, CEO of Grandparents.com, chatted with us about why so much of the older generation is going digital. He wasn't at all surprised—in fact, he said the move made sense. After all, the first computer users were the business people who are today's boomers and grandparents.

"Those baby boomers (and older) who faced off with a desktop computer in the workplace in the late '80s, early '90s, and beyond will remain users for the rest of their lives," Jerry said.

Jerry told me about half of the boomers are now grandparents. Boomers make up a third of all internet users. Millions have started up profile pages on social networks like Facebook and MySpace, according to this study. Perhaps the biggest reasons they go online is to stay in touch with their kids and grandkids.

"As many as half of all grandparents have at least one grandchild living more than three hours distant," Jerry said. "That means infrequent visits. Hence, we’re seeing incredible adoption of video chat, digital exchange of pictures and videos, and even newer technologies coming soon."

Getting Grandma and Grandpa online can be a great thing—both for them and your kids! If your parents, like mine, live far away, the internet is a wonderful tool for chipping away at the distance. Photo-sharing sites like Flickr or Picasa are immensely popular ways to show mom and dad the latest snapshots. If you have a digital camera, you can easily have your little ones make short videos for relatives' birthdays and post them online. Some families even set up blogs so grandparents, grandkids, aunts, uncles, and cousins can all stay in touch.

Jerry told us a touching story of a woman who lived in New York, but had grandkids in Los Angeles and London. During the holidays, she "lit" Hanukkah candles via online video so she could pass the tradition down to her loved ones. Definitely something, I'm sure, that her grandkids will never forget.

If you find your own mom or dad going online more, show your support! You can create your own set of lifelong memories. No matter how far apart you are, it's a great way for the grandparents to get involved with the kids on a daily basis. And who knows, maybe you can write on your mom's Facebook wall the next time the little guy gets sick or you just need some special parenting advice?

Are your parents joining the digital revolution? How do you use the web to keep in touch? Join the conversation by adding a comment below and check out these nifty resources I found.

Mom’s list of fun sites:
Grandparents.com – currently offering an e-booklet of 100 free things to do with grandkids
The Flip Side – from the NY Times—what happens when your kids won't friend you?
AARP’s brand new, online community
reZOOM – news and resource site for seniors
Skype – free phone and video chat over the web

This summer, we're very fortunate to have my Mama and Papa visiting us, and I realize that we sometimes take them for granted. While they're in town, I've decided we need to plan and do more things with them—especially for our boys, so they can really get to know, learn from, and bond with the elder generation while they have the time. Sound familiar?

I also recently learned that, from Mother's Day to Father's Day, we're now recognizing the importance of that family bond with National Family Month. Time is precious, and it's important that, as parents, we help our kids engage with their elders. Kids can benefit from these bonds with their grandparents, great aunts and uncles, and elder neighbors, who are important role models and connections to the past. To celebrate, I put together a list of fun activities for kids and grandparents to share together.

Please check them out, and share your own by posting a comment!

Fun activities kids and seniors can share together:

• MAKING A FAMILY TREE
  As well as being an educational and engaging project for kids and grandparents, creating a family tree helps put connections and bonds in perspective for the entire family. It also will encourage and spark stories your kids—and maybe you!—have never heard before about how certain aunts and uncles fell in love, about family vacations long ago, or about distant relatives you never had the chance to meet. Lacking the creative streak? Check out this great family tree keepsake box from UncommonGoods.com, which does the artistic part for you.

• WRITING LETTERS
  It's no secret in this digital age that letter writing has become a lost art. Teach your child to appreciate "snail mail," storytelling, and good penmanship by becoming a Pen Pal to their grandparents or another older relative. Kids will learn important communication skills, as well as have mementos and stories from family history to someday share with their own children, and the regular communication is sure to lift the spirits of their senior relatives.

• WALKING
  Depending on the age and fitness of your elder relatives, encourage your kids to take a walk in the park or around the neighborhood with their grandparents or great uncle. As well as being great exercise, a walk outdoors will promote conversation and communing with nature that can build bonds and great memories. Kids and their older pals can spot and learn about different wildlife like birds and plants, or just chit-chat about their favorite things.

• GAMES
  Nothing says summer quite like a classic  game like Scrabble or Parcheesi. Board games are a great way to get your kids and their grandparents playing together—although it might be hard to pry them away from their Nintendo Wii. Try a swap: have your dad teach the kids how to play Rummy or chess, and then have the kids teach Grandpa how to play Mario Kart or use the Wii Fit.

• READING
  Everyone remembers the heartfelt scenes in Princess Bride, where Peter Falk plays grandfather to a young Fred Savage and spends a "home sick" day reading his grandson an epic tale. While it might be hard to recreate scenes like this in real life, having your parents read books to your kids that they read to you as a child (or that their parents read to them, even!) is a fantastic way to expose them to family history and create shared memories. Classics like Anne of Green Gables, The Story of Ferdinand, The Hardy Boys, Charlie and the Chocolate Factory and Heidi are perennial favorites from generation to generation.

• COOKING
  If they're willing and able to safely, encourage your kids and parents to share and cook favorite family recipes. Baking Grandma's apple pie her way or learning the secret ingredients in Grandpa's grilling sauce are memories the whole family will cherish, while creating wonderful continuity of tradition. Take photos and write down the recipes—or, better yet, have your kids and their grandparents write and decorate the recipe card together—and then bind or publish them at a later date into a special cookbook to be passed down through the generations.

• CRAFTS & HOBBIES
  If your parents have a special hobby they enjoy, encourage them to show and teach your kids about it. Knitting, playing the piano, or dancing the Waltz can all be fun ways for kids to bond with their elders and to gain an appreciation for old-fashioned entertainment.

What's your favorite way to have your kids spend time with—and show their love for—the seniors in your lives? Share it with the Care.com community by posting a comment!

Family members are an obvious choice when you're in a pinch for care: they love your kids or pets and like to spend time with them, or they share the responsibility of caring for your parents and grandparents with you. And, they can be wonderful sources of respite care for the overworked! But there are drawbacks to having a family member provide care, and beware that confrontations and other easily-avoidable situations may arise because of your comfort level with one another. Use these guidelines—similar to those you would use when hiring a stranger—to prevent unnecessary drama.

• Expectations. When hiring a nanny or a babysitter, I typically advise people to type up their key expectations and go over them with any caregiver beforehand. You should go ahead and do that with family members, too, just as if you were hiring an outside caregiver (even though—and sometimes more importantly because—they're your relatives). I would then sit down and walk them through the list and tell them that this is what you go over with any nanny, etc. Setting clear expectations upfront helps to clear up (and stem off) any confusion.

• Core values. Emphasize the key things that are important to you. For example: Education. Your child's education is really critical to you, and is the main reason you don't want them watching TV or playing video games during the week. Or Responsibility. Teaching your kids responsibility is something that you are working on at home, which is why you expect them to pick up their toys. Although these things may seem like small things, they are crucial components to keeping things consistent for your kids. Tell your relatives that, although they may be inclined to use a different method, you would appreciate their help by adhering to your rules. Explaining your overall goals will help your relative(s) understand why you are asking them to do certain things.

• Communication. Talk often! Sit down on a regular basis and discuss how things are going. Don't just meet or talk when things are going wrong. If you talk regularly, then it won't feel like you planned a special sit-down conversation that makes things a bigger deal than they are. Whether your relative is helping you out once a year when you ask, or needs to know how overburdened you are with shared responsibilities so they can offer to help, communication is crucial—especially between family members.

• "Don't sweat the small stuff." There may be small things that irritate you, such as leaving dishes in the sink or not picking up the toys after the kids. Your nanny used to do it, but now that your sister is helping out, the house is a mess when you get home. If these things aren't the most important things to you, then let it go. Remind yourself that the quality of care—that your child is loved, well-fed, entertained, and educated—and maintaining a healthy relationship with your relative should trump any trivial or mundane annoyance you may feel.

• Payment. No one likes discussing the topic of money with a family member. If your relative is comfortable getting paid, then I would offer them an hourly wage at market rate. Find market rates in your area by searching Care.com by your ZIP code and looking at different provider profiles. You can also share this information with your relative to let them know that you came up with the rate based on objective sources. That way it removes anything personal from the conversation.

• Boundaries. Respect your family member's personal time. It's very easy to get too comfortable in the situation and take them for granted: you know that your mom or sister will always forgive you when you arrive 10 minutes late and other "harmless" offenses. But, if you expect your relatives to adhere to your wishes and your rules when caring for your child, pet, or other loved one, then you should do the same by respecting that they may have other engagements, appointments, etc. Keep your word and you'll keep their respect.

• Tough conversations. Sometimes it's better to let time lapse before having an emotional conversation (especially in front of your kids). Sometimes you may have had a bad day and thus are overreacting to a situation, taking it out on your mom or sister. You may want to let it go and wait a day or two. See if it still bothers you after you've cooled off a bit, and then you'll be able to have a more rational, productive sit-down with your family member. Even though it's your mom or sister, think about approaching the conversation as you would a friend: with a respectful tone and approach and with active listening. Seek first to understand than to be understood.

Have a great tip for navigating the waters of having family members serve as caregivers? Share it with the entire Care.com community by posting a comment!

Cheers,

Sheila

I just received a question from a reader about suggestions for gifts for day care providers, but this advice can also apply to other caregivers, as well:

• Electronic Gift Cards
  If you can afford to give them an e-gift card from Amazon or Barnes & Noble, I've done that in the past for day care providers when my boys were younger and find it's always appreciated. I would suggest a $15 value so that it can cover a nice book plus the shipping.

• Magazine Subscriptions
  There are also gift certificates available at Magazines.com. for around $20 for an annual subscription to various magazines. One year, a friend gave me a food magazine subscription that I really enjoyed. Each month when I received it in the mail, all year long, it reminded me of her thoughtfulness.

• Picture Frames
  If you're looking to spend a little less (around $10), you can always check out a discount retail store like TJ Maxx or Marshalls and pick up some nice picture frames. Leave the picture frames blank--care providers, as much as they love people and pets, really don't want prints of yours, but everyone can always use a nice, new picture frame to fill with their own special memories.

Also, if you are looking for that unique gift for your friend, co-worker or loved one, our team here at Care.com came up with "The Gift of Care", which allows you to give someone access to sanity-saving solutions for child care, elder care, pet care, and tutoring--and for just $10!

Cheers,

Sheila

Since those who care for our loved ones have an important role in our lives, we should tip them well to show our appreciation, reward them, and give them an incentive to continue providing the excellent care we want for our children, parents, and pets.

When do we tip?

When two things are provided to me:

• Personalized service. A waiter taking my specific request from a menu, a cab driver taking me to my chosen location, my hair dresser who cuts my hair that addresses my personalized needs, a clown who came over and entertained all the kids at your child’s birthday party, and etc.
• Great service. Service providers spend time to listen to my needs and are focused on me as a customer. It is my way of saying thank you and also giving someone the incentive to deliver great service next time I'm in need of their help and attention.

Who should I tip?

So many people help us throughout the year. Here are some of the caregivers you might want to tip during the holidays: Nanny, babysitter, au pair, day care staff, coaches, tutors, music and dance instructors, dog walkers and groomers, home-care attendants, housekeepers.

• In general, the more professionally credentialed (certification, license, degree in a specialty) someone is, the less they wanted to be treated as a service professional that gets a tip. I'd err on the side of giving a gift during the Holidays or a special occasion rather than a regular "tip" for their services.


• For a sitter that comes over regularly, you may consider tipping them for a job truly well done, but it isn't the norm for them to expect to get a regular "tip" every time they babysit for you.


• If you have a periodic sitter, such as a teenage babysitter or dog walker, you may want to consider tipping them for each job since they only come over occasionally. They will also feel valued and, with the competitive hiring out there today, it is worth being generous to keep quality care for your loved ones.

How much should I tip care givers and how much should I spend on a gift?

• Restaurants and wait staff: It is common in our culture now to tip for personalized service at about 15% of the typical fees you are charged—even 20% for exceptional service. We do this for restaurant wait staff, cab drivers, etc. I'd apply the same % rule for caregivers.


• Hosting a party at a venue: If you are paying a venue to host a party, but there are service providers assisting you, you should tip them 15% of an estimated $10-$12/hour (depending on years of experience of your service providers) and the number of hours they worked. For example, if you have a child's birthday party at a gym and you bring along two babysitters to help you manage the party, do tip those sitters. Check with the venue when you schedule the party—the charge for rental of the venue may include a gratuity for their staff.


• Workplace gift exchanges and showers: For a gift, most companies that plan gift exchanges over the holidays suggest $20 or $25 gifts for your secret co-worker whose name you pulled out of a hat. For a girlfriend's baby shower, a $25 to $50 gift is typically a nice budget for a cute present. For a gift for our caregivers, I like to give something in between the range of $25-$30 since they take special care of my kids and pets and I want them to feel that I took the time to choose something special for them. Also, sometimes a very inexpensive but personal gift, such as a picture frame with my child's photo on it, goes a long way.


• Recommended tips for care givers:
• Nannies and Au Pairs: If they work for you full time, give a tip that reflects 10%-15% of one weeks pay. For example, if you have a full time Nanny or Au Pair that you pay $800 per week, a 15% holiday tip would be $120.
• Regular babysitter: Depending upon how long your sitter has been with you and how experienced she is, tips range from one or two night's pay or the equivalent of a week of service.
• Coaches, tutors, and instructors: A small gift from your child is perfect, such as a photo of your child playing their musical instrument (for your child’s music instructor).
• Dog walkers and groomers: One to two week’s pay for a dog walker and about half a session’s worth for your regular groomer.
• Home-care attendants: One week's pay is recommended but give two weeks for extra special care or long-term service.

I hope this helps. And again, being generous to the people who provide personalized service for your loved ones means so much when it comes to developing long-term relationships with your care givers.

Cheers,
Sheila