Thursday, October 29, 2009
Tuesday, October 27, 2009
POA- Medical Decisions
Many older adults like to keep their important papers private. Including POA- or Power of Attorney. My own grandfather has done this. Now he and I have discussed it- and he shares information with me. The person who is POA- did not even know it though. He never knew he was power of attorney. He is grateful that he now knows this tid bit- but why couldn't grandpa tell his own son?
My grandad has said- they don't need to know until it is time- So I have talked with him- and so have other family members. Often the older adults- do not want to dwell on death, or issues relating to the idea of losing control. They also confuse money and medical issues. These elders- may be willing to address their POA- with professionals- but fear the family will attempt to take over all decisions. In my case- my grandad knows I work with geriatric patients- while he is 88- he does not see himself as one of those. He does trust me in taking care of his medical issues though. Fearing that my grandfather had left his step children in charge- the biological family did not want to address it unless we were in crisis. I boldly address this topic of medical care with him. He was not aware of the different options- but he did knowthat he wanted to have "everything done" to stay alive.
Do not be afraid to ask the needed questions and clarify the various kinds of POA and explain a living will. Get the paperwork in place while your loved one is able to make wishes clear to others.
My grandad has said- they don't need to know until it is time- So I have talked with him- and so have other family members. Often the older adults- do not want to dwell on death, or issues relating to the idea of losing control. They also confuse money and medical issues. These elders- may be willing to address their POA- with professionals- but fear the family will attempt to take over all decisions. In my case- my grandad knows I work with geriatric patients- while he is 88- he does not see himself as one of those. He does trust me in taking care of his medical issues though. Fearing that my grandfather had left his step children in charge- the biological family did not want to address it unless we were in crisis. I boldly address this topic of medical care with him. He was not aware of the different options- but he did knowthat he wanted to have "everything done" to stay alive.
Do not be afraid to ask the needed questions and clarify the various kinds of POA and explain a living will. Get the paperwork in place while your loved one is able to make wishes clear to others.
Saturday, October 10, 2009
Aging and Skin Care
I think I over analyze blogging. Not sure though. I want to provide information that will help others; but is the real purpose of a blog to be more entertaining or educational?
I have recently begun to pay attention to the older females skin tone. I have several clients with incredible skin (especially for being over 85). They seem to share one common thread. Vaseline. Some of these ladies have dementia; some have had strokes. Most can't remember their address but they use that Vaseline every day. I wish I could post a few pictures. I have one client that is 93 and her skin looks radiant, now her neck- shows her age. She suggested that I use Vaseline on my neck now- because she did not and regrets it. This particular client is very wealthy- millionaire several times over. She discusses how wasteful skin care products are. She then points out that she should have invested in a skin care line- she would have even more money...
So I have taken up the vaseline challenge- and now have my duaghter using it on areas of dry skin. Save money save time; use vaseline to keep wrinkles away.
I have recently begun to pay attention to the older females skin tone. I have several clients with incredible skin (especially for being over 85). They seem to share one common thread. Vaseline. Some of these ladies have dementia; some have had strokes. Most can't remember their address but they use that Vaseline every day. I wish I could post a few pictures. I have one client that is 93 and her skin looks radiant, now her neck- shows her age. She suggested that I use Vaseline on my neck now- because she did not and regrets it. This particular client is very wealthy- millionaire several times over. She discusses how wasteful skin care products are. She then points out that she should have invested in a skin care line- she would have even more money...
So I have taken up the vaseline challenge- and now have my duaghter using it on areas of dry skin. Save money save time; use vaseline to keep wrinkles away.
Saturday, October 3, 2009
Friday, October 2, 2009
Talking to Parents About Finances
Some parents guard their finances closely, even from their children. To them, it's a matter of privacy. Some fear that their children are only after their money.
But helping your parents organize their finances and seeing whether they've planned well so that their last wishes are carried out could open the door to examining your own finances.
In some instances, older adults are reluctant to share financial and legal information with adult children. In such cases, it might be advisable that they consult with a neutral third party, such as an attorney, a qualified financial adviser, social worker or trusted friend to address legal issues and then have an attorney prepare the proper documents so that they will be accessible to family members in an emergency.
When talking to parents about their finances, children must be sensitive to their parents' need to still feel in charge.
The key thing for your parents is a sense of independence and control. Try to help them offload some of the burden of handling the finances with someone they can trust. Be careful of trying to push that on your parents because independence and control are crucial to them.
It's a delicate dance and one that will lead many people to seek a financial adviser who can help them. There are specific things you need to look for in an adviser to help your parents. Pay close attention to the questions asked by a prospective adviser. Boomers and seniors can and will sense that the conversation is not about meeting their needs, but about selling something.
It's especially important for seniors, who are prime targets for unscrupulous salespeople.
But helping your parents organize their finances and seeing whether they've planned well so that their last wishes are carried out could open the door to examining your own finances.
In some instances, older adults are reluctant to share financial and legal information with adult children. In such cases, it might be advisable that they consult with a neutral third party, such as an attorney, a qualified financial adviser, social worker or trusted friend to address legal issues and then have an attorney prepare the proper documents so that they will be accessible to family members in an emergency.
When talking to parents about their finances, children must be sensitive to their parents' need to still feel in charge.
The key thing for your parents is a sense of independence and control. Try to help them offload some of the burden of handling the finances with someone they can trust. Be careful of trying to push that on your parents because independence and control are crucial to them.
It's a delicate dance and one that will lead many people to seek a financial adviser who can help them. There are specific things you need to look for in an adviser to help your parents. Pay close attention to the questions asked by a prospective adviser. Boomers and seniors can and will sense that the conversation is not about meeting their needs, but about selling something.
It's especially important for seniors, who are prime targets for unscrupulous salespeople.
Wednesday, September 30, 2009
Medicare A benefits
I want to explain one piece of the Medicare part A program today. One in seven medicare recipients will be in the hospital this year. Many will stay for three days or longer; and therefore be eligible for the part A benefit of rehabilitation. Please keep in mind that these programs do not guarantee a certain number of days for coverage; these benefits are based on progress within a program( or lack of progress) The primary diagnosis will play a role in particular with skilled nursing care on inpatient basis.
Part A covers inpatient hospital care, inpatient care in a skilled nursing facility, home health care services, and hospice care. Medicare Part A provides payment for post-hospital care in a skilled nursing facility. In order for a medicare recipient to receive Medicare benefits, a physician must certify that the resident requires skilled nursing facility care, and the care required by the resident must be available only as inpatient at a skilled nursing facility.
Skilled nursing facility (SNF) care is covered only if it occurs within 30 days of a three-day or longer stay in an acute hospital facility and is certified as being medically necessary. Individuals utilizing the benefits of skilled nursing facilities under Medicare are limited to a 100-day stay AT MOST) facility. Co-payments are required for the 21st through the hundredth day.
Home health care under Medicare Part A has no limitations on length of stay, no co-payments, and no deductibles. To qualify you must need skilled care and be considered home bound. Home bound has different meaning to different agencies- so check with the home health company in your area for clarification on this topic.
Medicare for hospice care: patients are required to relinquish their standard Medicare benefits for treatment of terminal illnesses in order to receive the hospice care benefits (they will no longer be eligible to pursue curative treatments with medicare coverage).
For those with Medicare advantage- the benefits will decrease!! Many will have co pays beiginning on the third or fifth day but at a lesser rate than the traditional medicare co pay. Medicare supplements will usually cover the copayment which begins on the 21st day of care.
Part A covers inpatient hospital care, inpatient care in a skilled nursing facility, home health care services, and hospice care. Medicare Part A provides payment for post-hospital care in a skilled nursing facility. In order for a medicare recipient to receive Medicare benefits, a physician must certify that the resident requires skilled nursing facility care, and the care required by the resident must be available only as inpatient at a skilled nursing facility.
Skilled nursing facility (SNF) care is covered only if it occurs within 30 days of a three-day or longer stay in an acute hospital facility and is certified as being medically necessary. Individuals utilizing the benefits of skilled nursing facilities under Medicare are limited to a 100-day stay AT MOST) facility. Co-payments are required for the 21st through the hundredth day.
Home health care under Medicare Part A has no limitations on length of stay, no co-payments, and no deductibles. To qualify you must need skilled care and be considered home bound. Home bound has different meaning to different agencies- so check with the home health company in your area for clarification on this topic.
Medicare for hospice care: patients are required to relinquish their standard Medicare benefits for treatment of terminal illnesses in order to receive the hospice care benefits (they will no longer be eligible to pursue curative treatments with medicare coverage).
For those with Medicare advantage- the benefits will decrease!! Many will have co pays beiginning on the third or fifth day but at a lesser rate than the traditional medicare co pay. Medicare supplements will usually cover the copayment which begins on the 21st day of care.
Friday, September 25, 2009
Home Health care givers
Home Health Care has become big business. As the population ages; there is a need for caregivers to help people stay home longer. Sitters as they are sometimes called; earn from $8-20 an hour depending on where you live.
Quite a few families handle the care giving duties themselves. For those who work outside the home; caring for a dementia patient can be overwhelming and emotionally draining. Studies show that more than half of all caregiving for elderly is done by family members.
As a teenager I was one of those family members. My great grandma had "hardening of the arteries" Now we know it was Alzheimer's. My aunts and uncles hired a lady to live with her during the week; two of my cousins and I took turns staying on the weekends. Sometimes she could be a handful for a 15/16 year old. She set the kitchen towels on fire one night- she told me she was trying to turn on a light to see. She locked me out of the house many times. I could go on with stories all too familiar to those who have been caregivers. Elderly with dementia or Alzheimer's may have nontraditional sleep patterns. I often wondered if she had Sundowner's; it sure did seem thatway.
Private duty caregivers such as the one my family had are less expensive but do pose risks. What if your caregiver becomes ill; what is the back- up plan? Get a back up plan. IS this person able to lift, or help your loved one into and out of the shower? These questions must be asked no matter which option you choose. Also ask them about taxes- Will they handle it? Remember you need to file them on your tax deductions- if you have a doctors prescription it is deductible. Does this person have references you can call? What are their credentials? How many elderly with dementia have they cared for in the past? How many patients with diabetes/ or any illness that runs on your family.
Companies- there are national chains with franchises located throughout the US. Local companies are also an option. I have been approached my no less than 5 new home health companies in the last two months alone. The advantage to these organizations is the back up staff and the insurance they carry when problems arise. For example- I have a client with Alheimers whose caregiver accidentally set the kitchen on fire- it was a mess- the home insurance covered it- but the family felt good about having a professional organization involved in case there was a problem. If a valuable gets broken- the insurance these companies carry will pay for the item. Most of the national companies do a background screening on all employees; and often they hire licensed CNA's. I tend to refer to a few companies that I trust and have known to work through crises with families. Talk to your friends- talk too your church- find out if they can recommend respected people to handle the care for your loved one.
Another advantage to utiltizing companies is the option of part time help. The disadvantage of companies vs. individuals is the cost. Companies are more expensive. Finances often play a role in the choice to remain home. Unfortunately state programs often help in nursing home care but ignore home health care as an option.
Wednesday, September 23, 2009
Nursing Homes - An explanation of state Audits
I spent several years working within the Rehab/ nursing home settings; and suffered through numerous state "rounds". Most nursing homes do not go by the Nursing Home title any longer. They are typically dually certified- which means that the facility takes state medicaid and is certified through the federal government to accept Medicare payments for Rehab. This being said- they often prefer to be called Health care and Rehabilitation facilities. This is a nationwide trend.
The federal government sets wide criteria for these facilities; and the state adds more detailed criteria for the facilities to receive payments. The state and federal programs are "tied together"; if a facility is not meeting state criteria they automatically lose the federal funding for the time allotted by the state.
Many websites encourage families to review the state findings which are available on the net as well as within each facility(this is required by law).
Facilities have state audits several times a year IF complaints have been made. Anyone can file a complaint (often disgruntled employees will call in complaints) the state is then obligated to investigate.
Nursing homes are highly regulated, more so than hospitals. This does not mean I am in favor of skilled nursing facilities for elderly. They are necessary on occasion; especially for Alzheimer's patients with wandering tendencies.
Each compliant results in an on site review by the government. The auditors or surveyors- as they are sometimes called- will review all aspects of the facility on each visit. They will occasionally decide to do a paper review and be gone in a day; but for the most part will remain for 3-5 days. These surveyors interview patients, staff, and families, they review admissions, discharges and will remain quiet about the actual complaint being made(to protect patients?).
At the end of the review they will tell the administrator and supervisory staff their findings, then write up a report which will be posted at the front of the building. The findings will reflect the initial complaint and any negative events that were not related to the complaint but need to be addressed.
A score is then given based on the findings from the past year of complaints. This score may not (in my opinion) reflect the daily events within a building.
It is more important to look at the cleanliness of the residents. Odors, it is against federal cover odors. SO the more often they are bathed and changed the better the building will smell. Friendliness of staff, do the CNA's know the residents by name- these are things to pay attention to. Check the bathrooms- my grandma taught me that- not for this reason- but it still applies- look in the corners of the rooms- On a tour you will see people that will yell out- they will appear confused, and those things can't be prevented. Also- ask a resident if they like the food. The audits are important but they do not tell you the whole picture.
The federal government sets wide criteria for these facilities; and the state adds more detailed criteria for the facilities to receive payments. The state and federal programs are "tied together"; if a facility is not meeting state criteria they automatically lose the federal funding for the time allotted by the state.
Many websites encourage families to review the state findings which are available on the net as well as within each facility(this is required by law).
Facilities have state audits several times a year IF complaints have been made. Anyone can file a complaint (often disgruntled employees will call in complaints) the state is then obligated to investigate.
Nursing homes are highly regulated, more so than hospitals. This does not mean I am in favor of skilled nursing facilities for elderly. They are necessary on occasion; especially for Alzheimer's patients with wandering tendencies.
Each compliant results in an on site review by the government. The auditors or surveyors- as they are sometimes called- will review all aspects of the facility on each visit. They will occasionally decide to do a paper review and be gone in a day; but for the most part will remain for 3-5 days. These surveyors interview patients, staff, and families, they review admissions, discharges and will remain quiet about the actual complaint being made(to protect patients?).
At the end of the review they will tell the administrator and supervisory staff their findings, then write up a report which will be posted at the front of the building. The findings will reflect the initial complaint and any negative events that were not related to the complaint but need to be addressed.
A score is then given based on the findings from the past year of complaints. This score may not (in my opinion) reflect the daily events within a building.
It is more important to look at the cleanliness of the residents. Odors, it is against federal cover odors. SO the more often they are bathed and changed the better the building will smell. Friendliness of staff, do the CNA's know the residents by name- these are things to pay attention to. Check the bathrooms- my grandma taught me that- not for this reason- but it still applies- look in the corners of the rooms- On a tour you will see people that will yell out- they will appear confused, and those things can't be prevented. Also- ask a resident if they like the food. The audits are important but they do not tell you the whole picture.
Monday, September 21, 2009
Transient Ischemic Attacks- or TIA's
I get calls from families that are not sure how to handle loved ones with symptoms related to TIA's. This situation can be scary for the elder and confusing for the family.The most frustrating part is that by the time the elder gets to the doctor the symptoms have improved leaving everyone bewildered. Physicians will sometimes recommend changes in medications when TIA symptoms are exhibited; but may not explain the reasons very clearly. Here is an explanation about TIA's and how they relate to strokes.
Transient Ischemic Attack is abbreviated as TIA, often commonly referred to as “mini stroke”. It is caused by the changes in the blood supply to a particular area of the brain, resulting in brief neurological dysfunction that persists, by definition, for less than 24 hours; if symptoms persist then it is categorized as a stroke. *Patients will most likely return to previous level of function within 24 hours.
One third of the people with TIA later have recurrent TIAs and one third have a stroke due to permanent nerve cell loss.
TIAs are important in predicting if a stroke will occur rather than when one will happen. They can occur days, weeks or even months before a major stroke. In about half the cases, the stroke occurs within one year of the TIA.
Symptoms vary but most commonly include weakness, tingling, or numbness in the arms and legs on one or both sides of the body; vision and language problems; confusion; vertigo (the sense that either you or the room is spinning); poor balance; and lack of coordination. Remember these will typically have no lasting effect and the following day the senior will return to previous function.
3.6% of men age 75-79 will experience a TIA
4.1% of women age 75-79 will experience a TIA
According to the American Heart Association prevention includes:
Eliminate smoking. Smokers are two times more likely to have TIA's leading to strokes than nonsmokers.
Drink alcohol only in moderation. Heavy alcohol use also increases stroke risk, perhaps by increasing the viscosity of blood and making it more prone to clotting.
Exercise and maintain a healthy low-fat diet. These measures will help maintain proper weight and place less strain on the circulatory system.
Control blood glucose. This improves general health and reduces diabetes-associated complications.
Continue to ask questions when you are not sure if you understand the physician. It is important to have trust in the medical professionals caring for you and your loved ones. They are not volunteering their time, they get paid; become educated about the aging process so that you can be an advocate for your family members.
Transient Ischemic Attack is abbreviated as TIA, often commonly referred to as “mini stroke”. It is caused by the changes in the blood supply to a particular area of the brain, resulting in brief neurological dysfunction that persists, by definition, for less than 24 hours; if symptoms persist then it is categorized as a stroke. *Patients will most likely return to previous level of function within 24 hours.
One third of the people with TIA later have recurrent TIAs and one third have a stroke due to permanent nerve cell loss.
TIAs are important in predicting if a stroke will occur rather than when one will happen. They can occur days, weeks or even months before a major stroke. In about half the cases, the stroke occurs within one year of the TIA.
Symptoms vary but most commonly include weakness, tingling, or numbness in the arms and legs on one or both sides of the body; vision and language problems; confusion; vertigo (the sense that either you or the room is spinning); poor balance; and lack of coordination. Remember these will typically have no lasting effect and the following day the senior will return to previous function.
3.6% of men age 75-79 will experience a TIA
4.1% of women age 75-79 will experience a TIA
According to the American Heart Association prevention includes:
Eliminate smoking. Smokers are two times more likely to have TIA's leading to strokes than nonsmokers.
Drink alcohol only in moderation. Heavy alcohol use also increases stroke risk, perhaps by increasing the viscosity of blood and making it more prone to clotting.
Exercise and maintain a healthy low-fat diet. These measures will help maintain proper weight and place less strain on the circulatory system.
Control blood glucose. This improves general health and reduces diabetes-associated complications.
Continue to ask questions when you are not sure if you understand the physician. It is important to have trust in the medical professionals caring for you and your loved ones. They are not volunteering their time, they get paid; become educated about the aging process so that you can be an advocate for your family members.
Friday, September 18, 2009
Organizing your Elder
Many older adults fear loss. The income has dwindled, and they do not want to go without necessities. Often their idea of useful means holding onto EVERYTHING.
Families get frustrated, and conflicts arise. Sometimes these people are known as hoarders.
I would say that the majority of homes I enter are cluttered. Grown children do not know how to stop their parents from keeping every bag, box, and leftover. Parents can become angry and ask their loved ones to leave. It happens.
Elders fear loss of friends, loved ones and possessions. The most common claim is memories. Or to pass it on.
Those with dementia or Alzheimer's may not understand why the family feels the need to make changes.
One suggestion might include creating a memory box- I have used Rubbermaid containers for several clients with great success. Ask them what makes the item special, and if they can't remember ask when they used the item. In the event they can't answer either, then keep a box for " donations" - explain that less fortunate could use this item. This week I have a client that has kept wrapping paper and bags for many years- I counted 50+ tubes of half used wrapping paper. the rubber bands had become attached to the paper or disintegrated. Once he understood that others could use this he felt better. " I just don't want things to be wasted".
Clothing is another area that created clutter- and shoes. Often the senior can't use the item because it is difficult to button or zip, maybe it needs repair. Letting the item go means admitting a decline in ability. Allow them to keep their dignity by showing them item that do work, show them that they have adequate clothing and these can be donated or used for rags. Challenge them to think without making them feel"old".
Papers another common item that collects and causes disruption of space.
Make three separate boxes- one for shredding, one for keeping, one for trash or donations. Allow the elder to participate in reviewing the items, often old tax records, newspapers, and mail pile up and take over the tables. Do not expect them to have patience to last all day- this process needs to be done in Small increments of time. Encourage them to show off special items or particular family history.
Make the experience as rewarding as possible, give positive feedback, and remember it may take several "rounds" to eliminate the majority of over- collections.
I am heading to a cluttered home as we speak, he needs to relocate to his family out of state, which means; at least looking at every piece of clutter in the house that he is putting up for sale. I am learning patience through this experience.
Families get frustrated, and conflicts arise. Sometimes these people are known as hoarders.
I would say that the majority of homes I enter are cluttered. Grown children do not know how to stop their parents from keeping every bag, box, and leftover. Parents can become angry and ask their loved ones to leave. It happens.
Elders fear loss of friends, loved ones and possessions. The most common claim is memories. Or to pass it on.
Those with dementia or Alzheimer's may not understand why the family feels the need to make changes.
One suggestion might include creating a memory box- I have used Rubbermaid containers for several clients with great success. Ask them what makes the item special, and if they can't remember ask when they used the item. In the event they can't answer either, then keep a box for " donations" - explain that less fortunate could use this item. This week I have a client that has kept wrapping paper and bags for many years- I counted 50+ tubes of half used wrapping paper. the rubber bands had become attached to the paper or disintegrated. Once he understood that others could use this he felt better. " I just don't want things to be wasted".
Clothing is another area that created clutter- and shoes. Often the senior can't use the item because it is difficult to button or zip, maybe it needs repair. Letting the item go means admitting a decline in ability. Allow them to keep their dignity by showing them item that do work, show them that they have adequate clothing and these can be donated or used for rags. Challenge them to think without making them feel"old".
Papers another common item that collects and causes disruption of space.
Make three separate boxes- one for shredding, one for keeping, one for trash or donations. Allow the elder to participate in reviewing the items, often old tax records, newspapers, and mail pile up and take over the tables. Do not expect them to have patience to last all day- this process needs to be done in Small increments of time. Encourage them to show off special items or particular family history.
Make the experience as rewarding as possible, give positive feedback, and remember it may take several "rounds" to eliminate the majority of over- collections.
I am heading to a cluttered home as we speak, he needs to relocate to his family out of state, which means; at least looking at every piece of clutter in the house that he is putting up for sale. I am learning patience through this experience.
Monday, September 14, 2009
ER Visits: Preparedness
I could write every day on how to deal with hospitalizations. Why? Elderly adults often have multiple health issues which require a team; in the outpatient setting the individual physician is not able to interact as easily with other specialties.
According to Reuters there has been a 34% increase in ER visits among those over 65 in the last ten years.
I have one client who goes in at least once per month. In part his family physician does not know how to handle the natural aging and dying process. This client is 96. He was at home two weeks, and now back in the hospital again. This family knows the ER staff on a first name basis. He has not once been in critical condition. SO he sits for hours before getting admitted. His son misses work, and they both get hungry.
Here are a few tips to get thru the ER visit:
Medications- do not let the staff take the pills; it may be hours before you see the medications again. Keep a copy of the list and dosages for the staff.
Keep a supply of snacks handy; cheese crackers, small package of cookies, and a water bottle.
Keep on hand a book, deck of cards, or crossword puzzles- in large print. Boredom can effect your aging relatives mental state. Your senior loved one may appreciate activity not to mention the conversation.
Keep a pillow in the car- A long night may be in store.
Write down the names of staff members that have been helpful; let them know they are appreciated.
An ER visit is usually the first step to being admitted. Doctors forget what it is like to sit for hours with increasing anxiety over health.
According to Reuters there has been a 34% increase in ER visits among those over 65 in the last ten years.
I have one client who goes in at least once per month. In part his family physician does not know how to handle the natural aging and dying process. This client is 96. He was at home two weeks, and now back in the hospital again. This family knows the ER staff on a first name basis. He has not once been in critical condition. SO he sits for hours before getting admitted. His son misses work, and they both get hungry.
Here are a few tips to get thru the ER visit:
Medications- do not let the staff take the pills; it may be hours before you see the medications again. Keep a copy of the list and dosages for the staff.
Keep a supply of snacks handy; cheese crackers, small package of cookies, and a water bottle.
Keep on hand a book, deck of cards, or crossword puzzles- in large print. Boredom can effect your aging relatives mental state. Your senior loved one may appreciate activity not to mention the conversation.
Keep a pillow in the car- A long night may be in store.
Write down the names of staff members that have been helpful; let them know they are appreciated.
An ER visit is usually the first step to being admitted. Doctors forget what it is like to sit for hours with increasing anxiety over health.
Thursday, September 10, 2009
To Take The Keys or Not to Take The Keys?
Knowing precisely when it's time to ask your elder to surrender their driving privileges is not an exact science. It's also traumatizing for the care giving son or daughter and potentially devastating to the loved one.
Recently There have been two accidents on I-30 involving elderly drivers going the wrong way. One resulted in a head on collision between the elderly man and a semi truck. All those involved died.
The effects of age can't be avoided. Thinning skin, thinning hair, thinning memory.
Here are a few issues that affect elderly behind the wheel:
1. Peripheral vision
2. Distance Judgment
3. Speed and gap perception
4. Neck and shoulder stiffness
5. Slower response times
6. Individual medical problems
7. Not being able to hear sirens and horns
The above list should be taken into account when considering taking the keys. It is not easy. There is no magic age, health and reflexes should be considered; as well as memory. Recently one family took the key of a 96 year old client. He only recently began to decline in health and reflexes. I sat down with him, and the first thing out of his mouth was " I think we need to find someone to drive me around, I can't drive" He drives his lawn mower every where he can, but never his car.
To help in the adjustment period; create a plan for transportation. Is there a van that provides rides to appointments? Can a family member take your loved one to the store each week? Is there a church member to take your loved one to church each week?
As we and our parents age, our roles also change — sometimes subtly, sometimes in ways that turn our lives upside down. But in God's plan, honoring our aging loved ones is not negotiable. Pray for His strength and guidance as you take on the caretaking role. Honor your aging parent, and God will most certainly honor you, His faithful servant.
Recently There have been two accidents on I-30 involving elderly drivers going the wrong way. One resulted in a head on collision between the elderly man and a semi truck. All those involved died.
The effects of age can't be avoided. Thinning skin, thinning hair, thinning memory.
Here are a few issues that affect elderly behind the wheel:
1. Peripheral vision
2. Distance Judgment
3. Speed and gap perception
4. Neck and shoulder stiffness
5. Slower response times
6. Individual medical problems
7. Not being able to hear sirens and horns
The above list should be taken into account when considering taking the keys. It is not easy. There is no magic age, health and reflexes should be considered; as well as memory. Recently one family took the key of a 96 year old client. He only recently began to decline in health and reflexes. I sat down with him, and the first thing out of his mouth was " I think we need to find someone to drive me around, I can't drive" He drives his lawn mower every where he can, but never his car.
To help in the adjustment period; create a plan for transportation. Is there a van that provides rides to appointments? Can a family member take your loved one to the store each week? Is there a church member to take your loved one to church each week?
As we and our parents age, our roles also change — sometimes subtly, sometimes in ways that turn our lives upside down. But in God's plan, honoring our aging loved ones is not negotiable. Pray for His strength and guidance as you take on the caretaking role. Honor your aging parent, and God will most certainly honor you, His faithful servant.
Wednesday, September 9, 2009
Auctions vs Estate sale
This past week I have learned a great deal about liquidating household items of clients. In the past I have simply recommended estate sales. The cost involved- and the strangers going thru the home for a week- can be emotionally challenging.
As I have been working with one client in particular I have attempted to think outside the box. His is widowed, a little paranoid, and very cluttered. He needs to relocate closer to his children but has been SLOW to eliminate anything from his cluttered home.
We interviewed Realtors several months ago. All said call after you get some clutter out of the home- if you want maximum price.
We look thru every item in one box, he tells stories, then gets rid of one item out of twenty. He is going from 2800 square feet to 1100 square feet, this is not working. He is fearful of people coming into the home for the estate sale- even though he will not be living there. The answer has come in the form of an Auctioneer. " John the auctioneer" came to the house, and we went thru many old items that could easily be seen. When my client realized he could make money from old toys, and furniture, he was ready to go thru his belongings much more quickly. Several toys are now going up for bid on a website this week.
As I have been working with one client in particular I have attempted to think outside the box. His is widowed, a little paranoid, and very cluttered. He needs to relocate closer to his children but has been SLOW to eliminate anything from his cluttered home.
We interviewed Realtors several months ago. All said call after you get some clutter out of the home- if you want maximum price.
We look thru every item in one box, he tells stories, then gets rid of one item out of twenty. He is going from 2800 square feet to 1100 square feet, this is not working. He is fearful of people coming into the home for the estate sale- even though he will not be living there. The answer has come in the form of an Auctioneer. " John the auctioneer" came to the house, and we went thru many old items that could easily be seen. When my client realized he could make money from old toys, and furniture, he was ready to go thru his belongings much more quickly. Several toys are now going up for bid on a website this week.
Friday, September 4, 2009
Case management is for the entire family
One of my clients is a business owner trying to care for his parents. Nice guy. Well known in the community. He was heartbroken to separate his parents. His dad does not recognize his mom and had become aggressive to this "stranger" in HIS home. We tried more than once to reunite them. It always resulted in aggression.
Recently he called me and said to please help him with some paperwork. Early in the morning. During our phone call he told me that last week he was in an accident that resulted in a head injury and later death of an employee. He was obviously out of sorts- who would not be?
I realized that our meeting should not be about his parents, it should be concerning his mental health. He was not able to help his family unless he received counseling.
The point? Every one's mental health should be considered. Don't take care of parents and ignore your own needs and mental state. Families will become irritable and less supportive of one another when depression and anxiety set in.
Recently he called me and said to please help him with some paperwork. Early in the morning. During our phone call he told me that last week he was in an accident that resulted in a head injury and later death of an employee. He was obviously out of sorts- who would not be?
I realized that our meeting should not be about his parents, it should be concerning his mental health. He was not able to help his family unless he received counseling.
The point? Every one's mental health should be considered. Don't take care of parents and ignore your own needs and mental state. Families will become irritable and less supportive of one another when depression and anxiety set in.
Wednesday, September 2, 2009
Medicaid applications- Not for the faint of heart
Medicaid is the state run program for those in need of medical insurance or for the elderly- co-insurance.
Every state has some criteria set by the federal government- with a few variances on income guidelines.
The income guidelines are based on state and federal poverty levels.
While guidelines vary from state to state; basic issues remain the same. Medicaid programs are divided into categories for babies and children, disabled adults, and elderly.
Criteria typically includes reviewing finances, and property ownership; as well as medical criteria for the needed services.
Bank statements are required, as are ownership papers for homes and vehicles.
Time consuming tasks usually include gathering birth records, marriage records, and tax related paperwork. In some cases locating medical bills can become overwhelming. Most states ask for information from the past three to five years.
When beginning the application make sure to keep recent bank statements handy, and medicare information as well as any military information.
In order to minimize chance for lost applications, make copies of everything, and fax it to the main office or ask for the name of the staff member who receives the paper work.
Every state has some criteria set by the federal government- with a few variances on income guidelines.
The income guidelines are based on state and federal poverty levels.
While guidelines vary from state to state; basic issues remain the same. Medicaid programs are divided into categories for babies and children, disabled adults, and elderly.
Criteria typically includes reviewing finances, and property ownership; as well as medical criteria for the needed services.
Bank statements are required, as are ownership papers for homes and vehicles.
Time consuming tasks usually include gathering birth records, marriage records, and tax related paperwork. In some cases locating medical bills can become overwhelming. Most states ask for information from the past three to five years.
When beginning the application make sure to keep recent bank statements handy, and medicare information as well as any military information.
In order to minimize chance for lost applications, make copies of everything, and fax it to the main office or ask for the name of the staff member who receives the paper work.
Friday, August 28, 2009
Hospitals- Do not Be Afraid- to ask questions
People that have not had aging relatives in and out of the hospital often look at me and even say- how can you make a living as a geriatric case manager?
Those who have had relatives in poor health; quickly jump up and tell " horror" stories from hospital experiences that left the family confused and the relative in worse health.
I receive several calls a month from families with relatives in the hospital; often asking questions they should ask the medical team. Your loved ones need you to be their advocate, you need to feel comfortable with discharge plans.
Become and advocate for yourself and your loved one. Ask questions- do not be intimidated by the white coats. If you do not feel comfortable asking questions and clarifying health issues then phone friend. Those who do not understand the changes in medications, the various follow up or the disorders themselves are at much greater risk for re hospitalization.
Here are a few tips:
*Acknowledge and assert yourself as a crucial part of the health care team. Communicate openly and regularly with the health care team so that it's aware of any changes in your family member's status
*Include your family member in the decision making as much as possible. Keep in mind that decision-making ability varies from person to person. Your loved one may not be able to make financial decisions anymore, but he might still be able to articulate his health care preferences.
*Keep a written record of key contacts, appointments, health care information, and the outcome of each doctor's appointment.
* If you must travel to aid in your loved ones care consider a geriatric care manager.
http://www.scmanagementar.com/ will help you find care manager near your loved one.
Those who have had relatives in poor health; quickly jump up and tell " horror" stories from hospital experiences that left the family confused and the relative in worse health.
I receive several calls a month from families with relatives in the hospital; often asking questions they should ask the medical team. Your loved ones need you to be their advocate, you need to feel comfortable with discharge plans.
Become and advocate for yourself and your loved one. Ask questions- do not be intimidated by the white coats. If you do not feel comfortable asking questions and clarifying health issues then phone friend. Those who do not understand the changes in medications, the various follow up or the disorders themselves are at much greater risk for re hospitalization.
Here are a few tips:
*Acknowledge and assert yourself as a crucial part of the health care team. Communicate openly and regularly with the health care team so that it's aware of any changes in your family member's status
*Include your family member in the decision making as much as possible. Keep in mind that decision-making ability varies from person to person. Your loved one may not be able to make financial decisions anymore, but he might still be able to articulate his health care preferences.
*Keep a written record of key contacts, appointments, health care information, and the outcome of each doctor's appointment.
* If you must travel to aid in your loved ones care consider a geriatric care manager.
http://www.scmanagementar.com/ will help you find care manager near your loved one.
Saturday, August 1, 2009
VA Aid and Attendance
Those who served in the military; even three months during any time of war ( even if they never left the US) are entitled to VA aid and Attendance. This is an often overlooked program that can allow an elder to remain in the home with a paid caregiver. The program also could help pay for assisted living care.
The forms are complicated and approval takes several months. One website I found helpful is:
www.veteranaid.org/apply.php. Another website ( the official VA website): http://www.vba.va.gov/ .
They do not provide detailed instructions on the VA website.
Consider these questions for potential applicants:
Are they home bound?
Does this person need help for basic daily activities? Activities include bathing, cooking, dressing, getting to appointments, taking medications in a timely manner, paying bills.
Has the family physician mentioned that the family should look into nursing care or assisted living?
Is income under $15,000 per year if widowed/single?
Keep in mind that the VA has less strict guidelines for income and assets than state programs, so those who may have been turned down for Medicaid may very well be able to receive benefits.
This program is invaluable to those needing help at home.
The forms are complicated and approval takes several months. One website I found helpful is:
www.veteranaid.org/apply.php. Another website ( the official VA website): http://www.vba.va.gov/ .
They do not provide detailed instructions on the VA website.
Consider these questions for potential applicants:
Are they home bound?
Does this person need help for basic daily activities? Activities include bathing, cooking, dressing, getting to appointments, taking medications in a timely manner, paying bills.
Has the family physician mentioned that the family should look into nursing care or assisted living?
Is income under $15,000 per year if widowed/single?
Keep in mind that the VA has less strict guidelines for income and assets than state programs, so those who may have been turned down for Medicaid may very well be able to receive benefits.
This program is invaluable to those needing help at home.
Friday, July 31, 2009
Road less Traveled
As our loved ones age they must learn to process feelings related to losing those in their inner circle. My grandad graduated high school in 1938. He had a class of over 100. Those that are still living independently meet every month for breakfast. It is less than 20. He tells me that conversation usually involves another friend or schoolmate that is in the hospital or is no longer " with us". He tells me that they also discuss their wonderful grandchildren.
Our loved ones need our support as they go through losses on a regular basis. Many of my clients read the obituaries daily. " gotta keep up with the gossip" is a statement from one of my male clients. He laughs, but also discusses the feelings of loss and even the difficulty of making new friends " at my age".
Here are a few ideas families can utilize as they support their aging loved one thru losses:
-Spending time with the person. An older adult who often seems to be alone can benefit from your company. Invite him or her to go for a walk or have a cup of coffee. Feelings of loneliness may last for a long time when an older adult has lost something or someone special, especially a spouse.
-Talking about the loss. Ask the person to talk about his or her loss. Older people, especially those who have experienced several losses over a short period of time, are often helped by sharing memories of the person they lost.
-Older adults often have more than one loss to deal with at a time. Talking about each separate loss may help identify the person's feelings. Separating losses from one another may also help the person feel less overwhelmed and more able to cope with emotional distress.
Try not to remind them that this is a normal part of aging. We all know that one- maybe to well.
Do not try to keep them busy- A few activities is fine- encourage them to keep the normal routine is also fine, but occupying every moment does not give them the opportunity to process the losses, at some point they need to explore their emotions. Some older people may not even realize their feelings of sadness are grief.
As a case manager I have met with more than one person over the age of 100, most have even outlived at least one of their children. They have all shared with me how it feels to outlive loved ones. I met with a 104 year old this past winter, she said " I think I am on the road less traveled, so I guess I should pass on wisdom " She told me- read the Bible, give and receive an overabundance of hugs, and eat chocolate.
Advice I definitely will use.
Our loved ones need our support as they go through losses on a regular basis. Many of my clients read the obituaries daily. " gotta keep up with the gossip" is a statement from one of my male clients. He laughs, but also discusses the feelings of loss and even the difficulty of making new friends " at my age".
Here are a few ideas families can utilize as they support their aging loved one thru losses:
-Spending time with the person. An older adult who often seems to be alone can benefit from your company. Invite him or her to go for a walk or have a cup of coffee. Feelings of loneliness may last for a long time when an older adult has lost something or someone special, especially a spouse.
-Talking about the loss. Ask the person to talk about his or her loss. Older people, especially those who have experienced several losses over a short period of time, are often helped by sharing memories of the person they lost.
-Older adults often have more than one loss to deal with at a time. Talking about each separate loss may help identify the person's feelings. Separating losses from one another may also help the person feel less overwhelmed and more able to cope with emotional distress.
Try not to remind them that this is a normal part of aging. We all know that one- maybe to well.
Do not try to keep them busy- A few activities is fine- encourage them to keep the normal routine is also fine, but occupying every moment does not give them the opportunity to process the losses, at some point they need to explore their emotions. Some older people may not even realize their feelings of sadness are grief.
As a case manager I have met with more than one person over the age of 100, most have even outlived at least one of their children. They have all shared with me how it feels to outlive loved ones. I met with a 104 year old this past winter, she said " I think I am on the road less traveled, so I guess I should pass on wisdom " She told me- read the Bible, give and receive an overabundance of hugs, and eat chocolate.
Advice I definitely will use.
Receiving an Education
I think I learn more from my clients than they could ever imagine. I have been assisting a widow as he relocates to his daughter's home in another state( he is 80). He was educated at Princeton, and has traveled the world. This is a highly intelligent gentleman entering the time of reflection in his life.
This man has not let go of any tangible items in at least thirty years. He knows he has " a lot of stuff"- and sometimes laughs as we go thru his belongings "Why did I keep this?" We found his check statements back to 1972. He did let me put those in the shredder( to 2003).
I have learned about investing, traveling, photography and true love.
I told him last week- about my new effort to take less pictures. He laughed- " because of me".
Yep- I have packed away 6 large rubbermaid containers of his photos- most of which he admits he has never viewed. " I will get to it".
His daughter calls me- " please get him to get rid of some things". I was able to eliminate two boxes worth. I did get him to throw out old newspaper clippings- " I want to give them to the kids". I remind him that the kids have said that they would prefer that he did not keep these items. We are having an estate sale- he is not keeping his furniture.
As we go thru pictures of his wife- he shows me pictures from every anniversary. He still smiles when he looks at the pictures. I do not think my blog can do justice to his love for his wife. They met in High school, married had three kids and lived a "happily ever after life".
I feel so privileged to be a part of lives of older adults.
Next week- we take on the spare room and the " kids rooms"( the youngest has been out of the house since '88). I already did a quick look around- I found the silver in his daughters old room.
As a senior case manager at Senior Care Management ( http://www.scmanagementar.com/) I am able to work with aging adults and their families to provide service coordination and to work as liaison when families live out of state. I look forward to posting more adventures.
This man has not let go of any tangible items in at least thirty years. He knows he has " a lot of stuff"- and sometimes laughs as we go thru his belongings "Why did I keep this?" We found his check statements back to 1972. He did let me put those in the shredder( to 2003).
I have learned about investing, traveling, photography and true love.
I told him last week- about my new effort to take less pictures. He laughed- " because of me".
Yep- I have packed away 6 large rubbermaid containers of his photos- most of which he admits he has never viewed. " I will get to it".
His daughter calls me- " please get him to get rid of some things". I was able to eliminate two boxes worth. I did get him to throw out old newspaper clippings- " I want to give them to the kids". I remind him that the kids have said that they would prefer that he did not keep these items. We are having an estate sale- he is not keeping his furniture.
As we go thru pictures of his wife- he shows me pictures from every anniversary. He still smiles when he looks at the pictures. I do not think my blog can do justice to his love for his wife. They met in High school, married had three kids and lived a "happily ever after life".
I feel so privileged to be a part of lives of older adults.
Next week- we take on the spare room and the " kids rooms"( the youngest has been out of the house since '88). I already did a quick look around- I found the silver in his daughters old room.
As a senior case manager at Senior Care Management ( http://www.scmanagementar.com/) I am able to work with aging adults and their families to provide service coordination and to work as liaison when families live out of state. I look forward to posting more adventures.
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