四六级

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　　Caring for elderly parents catches many unprepared

　　[A ] Last July, Julie Baldocchi，s mother had a massive stroke and was paralyzed. Baldocchi suddenly had to become a family caregiver, something that she wasn"t prepared for. “I was flying by the seat of my pants,” says Baldocchi, an employment specialist in San Francisco. Both of her parents are 83, and she knew her father couldn’t handle her mother’s care. The hospital recommended putting her mother in a nursing home. Baldocchi wasn’t willing to do that. But moving her back into her parents’ home created other problems. Baldocchi, 48, is married and lives about a mile away from her parents. She has a full-time job and has back problems that make it difficult for her to lift her mother. “I couldn’t do it all,” she says. “But I didn’t even know how to find help.”

　　[B] With help from the Family Caregiver Alliance, she eventually hired a live-in caregiver. “But even if you plan intellectually and legally, you’re never ready for the emotional impact,” Baldocchi says. In the first two months after her mother’s stroke, she lost about 30 pounds as stress mounted. More than 42 million Americans provide family caregiving for an adult who needs help with daily activities, according to a 2009 survey by the AARP. An additional 61.6 million provided at least some care during the year. And many are unprepared.

　　[C] While many parents lack an advance care directive, it’s the most basic and important step they can take. The directive includes several parts, including: a durable power of attorney, which gives someone legal authority to make financial decisions on another’s behalf; a health care proxy, which is similar to the power of attorney, except it allows someone to make decisions regarding medical treatment; and a living will that outlines instructions for end-of-life care. (For example, parents can say if they want to be kept alive by artificial measures.) “It’s invaluable for the kids, because it’s hard to make those decisions for a parent,” says Jennifer Cona, an elder- law attorney at Genser Dubow Genser & Cona in Melville, N.Y. An advance care directive is the first line of defense if a situation arises, says Kathleen Kelly, executive director of the Family Caregiver Alliance, which supports and educates caregivers. Without an advance directive, the family will have to petition the court to be appointed the parent’s legal guardian, says AgingCare.com.

　　[D] It’s important for families to talk about long-term care so the adult children know their parents，preferences, wishes and goals, says Lynn Feinberg, a caregiving expert at AARP. But it’s not an easy conversation. Elderly parents are sometimes suspicious of their children’s financial motives, says Susan John, a financial planner at Financial Focus in Wolfeboro, N.H. One client asked John to hold a family meeting because they needed an intermediary to talk about financial issues, she says. And when there are many siblings, the family decisions can become a three-ring circus with much acrimony, says Ann-Margaret Carrozza, an elder-law attorney in Glen Cove, N.Y. Families who need information and help sorting out disagreements can call on elder-law attorneys, financial planners, geriatric care managers and caregiver support groups. In February, AARP said it will offer its members a new caregiving support service through financial services firm Genworth.

　　[E] Many families are unprepared for quick decisions, especially when they find out that Medicare doesn’t pay for long-term care, Feinberg says. The median cost of a year in a private room at a nursing home in 2011 was $77,745, according to Genworth. And only those who have spent most of their assets can qualify for Medicaid to pay for the nursing home.

　　[ F] Assisted living is another option. Residents can have their own apartment to maintain some independence. But the facilities generally provide personal care services, such as meals, housekeeping and assistance with activities. Still, it’s not cheap: The national median cost in 2011 was $39,135, according to Genworth. Assisted living isn’t covered by Medicaid.

　　[G ] If they have a choice, at least 90% of elderly parents prefer to stay at home as long as they can, according to

　　AARP research. But if the parents can no longer safely live at home, it can be hard for children to move them into an adult care facility. There may be another option. Sometimes the home can be modified so a parent can stay there. For example, Baldocchi put in a chair lift for her mother. She also arranged for a home caregiver.

　　[H] Family caregivers take over many responsibilities. One might manage a parent’s finances, while another sibling will take the parent to doctors" appointments and shopping. Those who move in with a parent take on a significant and sustained burden of care. Jan Walker moved into her mother’s home in Leesburg, Fla. After her mother, who is 83, had fallen, she wasn’t able to get around as well. Walker, 55, has three brothers. But she is the only daughter, is divorced and has no children. “I always knew that this was the role that I would have, and I guess my mind was prepared for it,” says Walker, who now is a full-time caregiver and works from home as a tutorial instructor for a digital scrapbooking website. “When you get into the trenches, it’s literally baptism by fire,” she says. “New things come up. It’s not just about advance planning for finances or medical care. It’s everything,” she says.

　　[I ] Caregivers need to also watch their own health. “There is such a thing as caregiver burnout, ” Cona says. Among female caregivers 50 and older, 20% reported symptoms of depression, according to a 2010 study on working caregivers by MetLife. “It’s a hard job,” Walker says. “But most worthwhile things are hard. She was always there for me when I needed a helping hand. It’s only natural that I be here for her now.”

　　46. When elderly parents cannot live at home safely, their children can change their home instead of sending them to an adult care facility.

　　47. To talk about long-term care is not easy because sometimes aged parents are suspicious of their children’s financial motives.

　　48. Besides advance planning for finances or medical care, family caregivers take over many other responsibilities.

　　49. The difference between a durable power of attorney and a health care proxy is that the latter allows someone to make decisions regarding medical treatment.

　　50. Baldocchi did not want to send her mother to a nursing home, but she had difficulty taking care of her.

　　51. Over 42 million caregivers helped an adult with everyday activities in the USA in 2009.

　　52. If a family needs information or help to sort out disagreements, there are many people they can call on.

　　53. Caregivers should pay attention to their own health, or they may burn out or become depressed.

　　54. One will have to petition the court to be the parent’s legal guardian, if there is no advance directive.

　　55. The national median cost of assisted living in 2011 was $39,135 and it is not covered by Medicaid.

　　【参考答案解析】

　　46. [G]。题干意为，当上了年纪的父母住在家里不安全时，他们的孩子可以改变他们的家，而不是将他们送 到成人看护中心去。注意抓住题干中的关键词live at home safely和adult care facility。文章段落中，[G]段提 到了上了年纪的父母住在家里不安全和成人看护中心的内容，该段第二至四句提到，如果上了年纪的父 母住在家里不再安全，对于孩子来说将他们送到成人看护中心也很难，不过有另外一种选择——可以改 变他们的家以适合他们在那里度过晚年。由此可知，题干是对原文的同义转述，故答案为[G]。

　　47. [D]。题干意为，谈论长期护理问题并不容易，因为有时老年人会怀疑自己孩子有金钱方面的动机。注意 抓住题干中的关键词talk about long-term care、suspicious of和financial motives。文章段落中，[D]段提到了 谈论长期护理和老年人会怀疑自己孩子的内容，该段前三句指出，家庭成员谈论长期护理问题是很重要 的，这样才能了解父母的喜好和意愿等，但是这并不容易，有时候父母会怀疑子女有金钱方面的动机。由 此可知，题干是对原文的同义转述，故答案为[D]。

　　48. [H]。题干意为，除了提前进行资金和医疗方面的规划，家庭护理人员还有其他许多责任。注意抓住题干 中的关键词planning for finances or medical care和many other responsibilities。文章段落中，[H ]段首先就提到 了家庭护理人员要承担许多责任，该段最后指出，家庭护理不仅仅要提前做好资金和医疗规划，一切问题 都要考虑到。由此可知，题干是对原文的同义转述，故答案为[H]。

　　49. [C]。题干意为，永久授权书和医疗保健代理委托书的区别在于，后者允许某人做出有关医疗方面的决定。 注意抓住题干中的关键词a durable power of attorney和a health care proxy。文章段落中，只有[C]段提到了 这两个专有名词，该段第二句指出，护理指示应该包含a durable power of attorney、a health care proxy和a living will。在介绍health care proxy时提到，它与durable power of attorney相似，只是它允许某人做出有关医疗方面的决定。由此可知，题干是对原文的同义转述，故答案为[C]。

　　50. [A]。题干意为，Baldocchi不想将母亲送到疗养院，但是她又很难照顾她。注意抓住题干中的关键词 Baldocchi和nursing home。文章段落中，有几段都提到了 Baldocchi,但是提到她不想将母亲送往疗养院但 自己照顾母亲又有困难的只有[A]段。题干内容是对原文第一段的总结，故答案为[A]。

　　51. [B]。题干意为，2009年，美国有超过4200万护理人员帮忙照料成年人的日常生活。题干中的关键词为Over 42 million caregivers和help an adult with everyday activities。文章段落中，[B]段倒数第三句提到 了 More than 42 million Americans provide family caregiving for an adult who needs help with daily activities,其中 More than 42 million和daily activities分别与题干中的Over 42 million和everyday activities为同义互换。故答案为[B]。

　　52. [D]。题干意为，如果一个家庭需要解决纠纷的信息或帮助，他们可以向很多人求助。注意抓住题干中的关 键词sort out disagreements和call on。文章段落中，[D]段倒数第二句提到，如果一些家庭需要解决纠纷的信息或 者帮助，他们可以向老年法律师、金融规划师、老年人护理经理和护理人员组织求助。由此可知，题干是对 原文的同义转述，故答案为[D]。

　　53. [I]。题干意为，家庭护理人员应该注意自己的身体健康，否则他们可能会累垮或者变得心情抑郁。注意抓 住题干中的关键词their own health、burn out和depressed。文章段落中，提到要护理人员注意自己身体的是[I] 段，该段前三句指出，家庭护理人员也要注意自己的身体，有的时候护理者可能会累垮。对年龄在50岁及以 上的女性护理人员的调查显示，有20%的人称自己有抑郁症状。由此可知，题干是对原文这三句话的同义转 述，故答案为[I ]。题干中的 pay attention to their own health和原文中的 watch their own health对应。

　　54. [C]。题干意为，如果没有提前准备一份护理说明，那么想成为父母的合法监护人需要向法庭申请。注意 抓住题干中的关键词petition the court、parent’s legal guardian和no advance directive。本题比较简单，这几个关 键词均在文章[C ]段中直接出现，该段最后一句提到，Without an advance directive, the family will have to petition the court to be appointed the parent’s legal guardian。由此可知，题干是对原文的同义转述，故答案 为[ C]。

　　55. [F]。题干意为，2011年，全国生活协助的平均花费为39，135美元，而且这项花费也不在医疗补助计划的范 围之内。注意抓住题干中的关键词2011、$39，135和Medicaid。本题也比较容易，扫读全文，可以发现在[F] 段出现了2011和$39，135这两个关键词，并且后面也提到生活协助并不包含在医疗补助计划之内。由此可 知，题干是对原文的同义转述，故答案为[F]。

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