What is Really "Best" for Your Mom and Dad?

CONTRIBUTED BY: GRETCHEN NAPIER - LIFELINKS CEO

When we talk about the Best service? Best value? Best advice? Best care?.......What does Best really mean?

Best/adjective; of the most excellent, effective, or desirable type or quality.

“Best” is relative.  What is best for you is different than what is best for me.  Same with our mothers and fathers.  It’s just one of the reasons why care giving is so difficult.  

I’ve raised one teenage daughter and am in progress with a teenage boy.  Through them, I’ve learned that one school and one type of education doesn't work the same for all students. This is also true in elder care.  There is no one right answer, no cookie cutter approach that works best.

This is hard for some of us to believe.  For one thing, most of us like to have a sense of control and a sure thing.  We like to analyze the data and come to a definitive “right” answer.  But human beings are more complicated than that. So even if you take two people of the same age with the same diagnosis and apply the same solutions, that set of solutions will work better for one person than the other.  In fact, they could have opposite effects.  Why? Because we each have our own life experiences, we each have been taught (by our teachers, parents, religion, our experiences) different things. We each have different family dynamics and different DNA, just to name a few of the variables.

Until Big Data finds an algorithm to match all of these variables with prescribed outcomes, hiring an Advanced Aging Life Care Professional™ is the closest thing you can get to a personalized “right” answer.  To earn this registered trademark title, individuals must have a Master’s degree in a health related field, plus two years working as a care manager supervised by an expert in the field (or more experience with a different degree). They must then pass a rigorous four hour exam.  

Why should this matter to you? 

It still may take some trial and error to get to the best solution for your loved one, but because we have already ruled out hundreds of other choices, your costs are lower.  The financial costs.  The emotional costs.  The stress-related costs.  You can avoid the costs of implementing the wrong strategies, and flailing through the system hoping something works.  

It would be great if just moving dad into an assisted living community solved all the issues.  It would be great if you could just hire one good caregiver to move in with mom.  It would be great if the primary care doctor your husband loves could just prescribe the right combination of medications to solve his mood and behavior outbursts.  It’s just not that simple. 

So let our Aging Life Care Professionals™ from LifeLinks meet with you and your family in-person to design a customized plan for your aging loved one.  You will save costs and improve your odds for success!  

This blog post is an introduction to a series titled: WHY CAN'T CAREGIVING BE SIMPLE? To continue reading the series, click here.

If you don’t live in Middle Tennessee or the North Carolina Triangle, search here to find and Aging Life Care expert in your area!

 

ABOUT THE AUTHOR

gretchen napier - ceo
 

Gretchen Napier joined the LifeLinks team to fulfill her passion for caring for aging adults, and affecting change for the geriatric care service industry. At a very young age, Gretchen volunteered by painting fingernails for the residents in a nursing home, where she witnessed firsthand the shortcomings and "one-size-fits-all" mentality of many organizations and individuals serving seniors. With many years of experience as an assisted living administrator and a publisher of a resource guide for seniors, Gretchen saw how easy it was for aging adults to fall through the cracks of the healthcare system.  Additionally, she saw how long-distance and broken family relationships make caring for an aging loved one an overwhelming task.  This inspired Gretchen to improve the quality of life for older adults and their families across America by growing LifeLinks. In addition to the community leadership roles listed below, Gretchen is raising a 13 year old son and carrying out her vision for LifeLinks every day.

Care Manager Credentials Should Matter to You

CONTRIBUTED BY: GRETCHEN NAPIER - LIFELINKS CEO

Until Big Data finds an algorithm to match all the complicated variables inherent in an individual person with prescribed outcomes, an Advanced Aging Life Care Professional™ is the closest thing you can get to a personalized “right” answer.  To earn this registered trademark title, individuals must have a Master’s degree in a health related field plus two years working as a care manager supervised by an expert in the field, or more experience with a different degree, and pass a rigorous four hour exam. Read this to find out why this should matter to you.  

WHY DO YOU NEED A PROFESSIONAL?

When you’re in your twenties, working one job with little savings, investments and deductions, using an online program to do your taxes makes sense.  But at some point you begin to have assets and investments, you’re thinking about retirement and planning for your children, maybe you own your own business or have rental property.  Now, it is wise to hire a CPA who keeps up with the ever-changing tax laws, knows where to save you money and stay within the law.  

Or what about do-it-yourself projects around the house?  With the help of online videos, I can fix a running toilet, change out doorknobs, and repaint a bedroom on my own.  But when I need to knock out a wall, move the location of a sink or cleanup after the dishwasher leaked all over the house, I need a professional to pull permits, coordinate subcontractors and save me from making costly mistakes. 

The same is true when caring for an aging loved one.  Sometimes it's simple.  But if you are reading this, you’ve probably already thought, “Why is this so complicated?” or, “I don’t even know where to start.” or, “I am so overwhelmed keeping up with it all!”  These are signs you’ve moved beyond the do-it-yourself stage and would benefit from professional guidance and support.

In all the time it takes to become an Advanced Professional Aging Life Care™ Manager, the person who already had a heart and passion for caring for older and special needs adults sees hundreds of situations, solutions and outcomes.  He or she has seen many families try and succeed and many families try and fail at getting the “best” for their loved one.  The Aging Life Care Professionals™ heart, mind and intuition have become a super computer for calculating the different variables of your loved one’s complete situation to come up with the best solutions to try.  

At LifeLinks, you don’t get access to just one such caring, super computer, you get access to our diverse team of specialists.  We have 7 Advanced Professionals, 1 Professional and 1 Associate.  One is a physical therapist, 3 are nurses, two are healthcare administrators, and 2 are social workers.  We’ve seen lots and lots of situations, solutions and outcomes and are eager to share that experience with you and your family.

This blog post is an introduction to a series titled: WHY CAN"T CAREGIVING BE SIMPLE? To continue reading the series, click here.

ABOUT THE AUTHOR

GRETCHEN NAPIER - CEO
 

IMG_5720.JPG

Gretchen Napier joined the LifeLinks team to fulfill her passion for caring for aging adults, and affecting change for the geriatric care service industry. At a very young age, Gretchen volunteered by painting fingernails for the residents in a nursing home, where she witnessed firsthand the shortcomings and "one-size-fits-all" mentality of many organizations and individuals serving seniors. With many years of experience as an assisted living administrator and a publisher of a resource guide for seniors, Gretchen saw how easy it was for aging adults to fall through the cracks of the healthcare system.  Additionally, she saw how long-distance and broken family relationships make caring for an aging loved one an overwhelming task.  This inspired Gretchen to improve the quality of life for older adults and their families across America by growing LifeLinks. In addition to the community leadership roles listed below, Gretchen is raising a 13 year old son and carrying out her vision for LifeLinks every day.

SERIES: Why Can't Caregiving be Simple? (Assisted Living)

CONTRIBUTED BY: GRETCHEN NAPIER - LIFELINKS CEO

This is a three part series.  This article specifically focuses on Assisted Living. It would be great if just moving dad into an assisted living community solved all the issues.  It would be great if you could just hire one good caregiver to move in with mom.  It would be great if the primary care doctor your husband loves could just prescribe the right combination of medications to solve his mood and behavior outbursts.  It’s just not that simple. Here are some examples of how each of those “simple” solutions have gone wrong for other families.

Why Just Moving to Assisted Living Doesn’t Always Work

For many families, Assisted Living eases enough of the burden to work perfectly.  Regular meals and housekeeping, scheduled transportation, medication reminders, planned activities and 24-hour staff are the main things some families need.  For other families, it’s not enough.  

Jim had chest pain and after waiting for the community nurse for over 15 minutes, ended up calling 911 himself.  It turns out the 24-hour nurse was only “available” not “on-site”. Outside regular working hours, she was on-call and would come into the community whenever needed.  But that was a surprise to Jim and his family who thought that having a 24-hour nurse available meant one would be in the building if he had chest pain or other problems that a nurse could address.  He could stay at home and call 911 himself for a lot less money, so that’s what he did!

Margaret, whose husband had dementia, found a beautiful assisted living community close to her home. At this community, she met a very smart and kind lady who had given Margaret a tour and answered all of her questions.  Margaret believed that moving her husband, Bill, would relieve her stress and anxiety and make him happier.  It seemed that nothing she did anymore made him happy and she was exhausted. Bill hadn’t wandered yet, but with a diagnosis of dementia, the community wouldn’t allow him to move to the regular assisted living but insisted on their memory care unit.  This was very upsetting to Margaret, because those other residents in memory care looked much worse than her husband, but she finally went along with it. She told herself, “The community professionals are the experts.  I guess they know better than I do and really, I am just so tired.”  After the exhausting days of packing and moving him and his things, Margaret settled into bed the first night feeling sad but hopeful the next day would be better after a good night’s sleep.  An hour later she was woken by a phone call from the community.  Her husband was being belligerent and they wanted her to come over to calm him down.  This continued for several weeks, even after meetings with the staff.  The nice lady she met with originally wasn’t involved in any of these meetings, it turned out she just helped people until they moved in.  Margaret didn’t understand how this could be such a problem if it is a normal part of dementia.  Isn’t that their specialty?  

Elizabeth, began to notice more memory problems for her mom after her dad passed away,  “He must have been handling a lot more than I thought.”  Elizabeth lived out of town and really worried about Mom’s safety at home.  Plus Mom had always been very social, so moving to assisted living would help with loneliness.  Two things prevented this from being a complete solution for this family.  1) At doctor’s appointments, Mom couldn’t remember all the things she needed to talk to the doctor about, nor could she remember what the doctor said.  Elizabeth tried phone calls and emails to the doctor’s office, but never felt like she got complete answers, so she started arranging her visits around appointments so she could be there in person.  2) Her mom didn’t like all of the people in assisted living.  So at first she got into altercations with others because, with no filter, she just told them what she thought.  Eventually, Mom started to spend more time alone in her apartment, isolating herself as much as when she was at home.  

Click here to read the LifeLinks Solution to each of these incomplete solutions. (how a LifeLinks Aging Life Care Specialist saves the family time and money by completing the solution.

Click here to read more about why just hiring one good caregiver doesn’t always work.

Click here to read more about why just getting the primary care doctor to prescribe the right medications doesn’t always work.

 

ABOUT THE AUTHOR

GRETCHEN NAPIER - CEO
 

IMG_5720.JPG

Gretchen Napier joined the LifeLinks team to fulfill her passion for caring for aging adults, and affecting change for the geriatric care service industry. At a very young age, Gretchen volunteered by painting fingernails for the residents in a nursing home, where she witnessed firsthand the shortcomings and "one-size-fits-all" mentality of many organizations and individuals serving seniors. With many years of experience as an assisted living administrator and a publisher of a resource guide for seniors, Gretchen saw how easy it was for aging adults to fall through the cracks of the healthcare system.  Additionally, she saw how long-distance and broken family relationships make caring for an aging loved one an overwhelming task.  This inspired Gretchen to improve the quality of life for older adults and their families across America by growing LifeLinks. In addition to the community leadership roles listed below, Gretchen is raising a 13 year old son and carrying out her vision for LifeLinks every day.

SERIES: Why Can't Caregiving be Simple? (Caregivers in the Home)

CONTRIBUTED BY: GRETCHEN NAPIER - LIFELINKS CEO

This is a three part series. This article will focus on hiring caregivers in the home. Our previous article was on Assisted Living Facilities. It would be great if just moving dad into an assisted living community solved all the issues.  It would be great if you could just hire one good caregiver to move in with mom.  It would be great if the primary care doctor your husband loves could just prescribe the right combination of medications to solve her mood and behavior outbursts.  

It’s just not that simple. Here are some examples of how each of those “simple” solutions have gone wrong for other families.

Why just hiring one good caregiver doesn’t always work

Another downside to low unemployment numbers, is that it makes it really hard to find good people to do difficult, low paying jobs.  Like caregiving.  When jobs were really hard to come by, it was easier to find hardworking people willing to do a great, caring job.  Now that people can always find a job at a restaurant or driving for Uber or Lyft, there are fewer good people available for the often physically and demanding job of caregiving.  What is left are often people with no life or caregiving experience, people who can’t get or stay employed at higher paying and/or less difficult jobs, people who want to prey on the vulnerability of aging adults.

Some issues that you can face are listed within and below the examples following.

Examples

 

Unfortunately....sometimes no one shows up.

Michelle typically handled all caregiving needs for her husband who has Parkinson’s Disease. She was given an amazing opportunity to take an international trip.  All the experts had been encouraging her to take better care of herself and use this respite opportunity to recharge her own batteries.  She agonized over the details, screened many different caregiving companies and finally select the one that seemed to understand the importance of being on time to every shift.  Her husband must take his Parkinson's medication on time in the morning to avoid significant symptoms.  The only way she felt she could truly relax and enjoy her time away with confidence was to install cameras on the security system so she could be sure someone was there.  The first day, no one showed up.  She called the company at 15 minutes after the hour and this was the first they had heard of the problem.  It took 2 agonizing hours before someone finally showed up; her first day was ruined and she started seconding guessing the decision to come, deriding herself for indulging in this trip.  But the company bent over backwards, apologized profusely and promised it wouldn’t happen again and they would schedule a different caregiver.  The next day went well. The following day went well.  The fourth day, the caregiver from day one is scheduled again and doesn’t show up.

 

Poor communication and high turnover

Dan hired a company to take care of his mother who lives in the renovated basement of the home where he and his wife live. They had been taking care of her, but her dementia was getting worse, she was sleeping more during the day and then was up more at night. It was really starting to take a toll on Dan and his wife because they weren’t getting enough sleep.  At the initial meeting, the owner/manager of the agency asked great questions and Dan took a lot of time to go over all the details about the way his mother liked things, where everything was in the house, typical problems incurred (such as she often wakes believing her dreams really occurred).  The company promised one caregiver since Dan only wanted someone on workdays.  Dan was feeling good until the caregiver started telling him bad things about the company and explained she wouldn’t be working there much longer.  She said it every day for three days and then the following day it was a new caregiver.  The new person hadn’t been told all the things Dan showed the manager, so Dan was late to work that day because he stayed to orient her. Then Dan received a call from the previous caregiver who asked him  to hire her privately at a rate lower than he paid before (but she would receive more than she did before).  Dan forgot that would violate the contract he signed with the agency (costing him $5,000 and the nanny taxes he now had to track and pay).  After a few months, she found a “better” gig. Dan thought to himself, “I should have known that if she would be disloyal and dishonest to the agency, she would be the same to me.”

 

Employees didn't have the motivation to give mom the care she needed

For several months, Scott had been burning the candle at both ends; as a lawyer by day and husband and father by night, Scott’s mom had also been hospitalized for dehydration and a fall at home.  After the initial scare, she stabilized at the hospital and then discharged to a rehab facility for physical therapy.  Making all of those decisions, signing all the forms, paying all those bills, picking up needed personal items and visiting with his mom was really wearing him out.  Before Scott’s mom was discharged from a rehab facility, the social worker recommended caregivers to help with activities of daily living such as meal preparation, bathing, dressing and transportation, while his mom continued to recover.  The agency manager met Scott and his mom at the facility before discharge to go over details of the home, her preferences, discharge orders, etc. The manager assured Scott all of these details would be in the written care plan and an caregiver who worked with his mom would read it and be fully informed about the details.  Scott was beginning to see the light at the end of the tunnel. During the first shift, Scott meets the manager and the caregiver at his mother’s house, reviews all the details and heads to work confident this stressful period of caregiving is behind him.  Several days later one of the caregivers calls to say she noticed it seems like some of the medication hasn’t been taken.  After several calls to the agency manager, it is determined that some of the caregivers didn’t know the medicine could be crushed up in ice cream or applesauce, so his mom had refused to take it on multiple occasions.  But Scott knows that is in the care plan.  The next day, when he visits, his mom is there alone without a caregiver.  When Scott calls the agency they apologize and explain one is on the way, but the one who is scheduled got sick and the one who worked the last shift couldn’t be late to another client and had to leave. Another day, Scott received a call from the caregiver that his mom had soiled herself, but wouldn’t let the caregiver get her cleaned up.  Scott went to her house and showed the caregiver the way his mom liked to be approached for personal care and thought, “I know this was in the care plan.”  In fact, everyday there seems to be another problem for Scott to work through.  

 

Many families believe that getting one consistent caregiver will solve many of the above issues. This is a false belief for three reasons:

  1. It is unlikely any caregiver will stay with your family for an extended period of time.  If you need someone more that 40 hours per week, you will have to have multiple caregivers increasing the rate of turnover.
  2. What happens when that one person has car trouble, or a health problem, or her/his family has a need?
  3. Having only one caregiver increases the risk of manipulation and fraud, because there are no checks and balances and trust is an essential component of the caregiving/receiving relationship.

 

The best caregiving companies do a good job at the following:

  1. Creatively, proactively, constantly recruiting, screening, hiring and training new caregivers
  2. Scheduling caregivers according to some general personality preferences, your preferred schedule and the caregivers preferred schedule.  
  3. Anything else related to managing the care of your loved one will have to be handled by a family member, unless you enlist the help of a Aging Life Care Professional™ like LifeLinks.   

 

Click here to read the LifeLinks Solution to each of these incomplete solutions. (how LifeLinks Aging Life Care Professional™ saves the family time and money by completing the solution.)

Click here to read more about why just getting the primary care doctor to prescribe the right medications doesn’t always work.

Click here to read more about why just moving to assisted living doesn’t always work.

 

ABOUT THE AUTHOR

GRETCHEN NAPIER - CEO
 

IMG_5720.JPG

Gretchen Napier joined the LifeLinks team to fulfill her passion for caring for aging adults, and affecting change for the geriatric care service industry. At a very young age, Gretchen volunteered by painting fingernails for the residents in a nursing home, where she witnessed firsthand the shortcomings and "one-size-fits-all" mentality of many organizations and individuals serving seniors. With many years of experience as an assisted living administrator and a publisher of a resource guide for seniors, Gretchen saw how easy it was for aging adults to fall through the cracks of the healthcare system.  Additionally, she saw how long-distance and broken family relationships make caring for an aging loved one an overwhelming task.  This inspired Gretchen to improve the quality of life for older adults and their families across America by growing LifeLinks. In addition to the community leadership roles listed below, Gretchen is raising a 13 year old son and carrying out her vision for LifeLinks every day.

SERIES: Why Can't Caregiving be Simple? (Doctors & Medication)

CONTRIBUTED BY: GRETCHEN NAPIER - LIFELINKS CEO

This is a three part series.  Today’s topic is about doctors and medication. It would be great if just moving dad into an assisted living community solved all the issues.  It would be great if you could just hire one good caregiver to move in with mom.  It would be great if the primary care doctor your husband loves could just prescribe the right combination of medications to solve his mood and behavior outbursts.  It’s just not that simple. 

Why just getting the doctor to prescribe the right medications doesn’t always work.

  1. Your primary care physician may not be the right doctor for this. I know you love him or her and have been seeing her/him for decades and he knows your children and your trust her implicitly, but that doesn’t mean this primary care doctor is the best one to prescribe psychiatric or dementia related medications.  In our experience, a neurologist is best equipped to provide a detailed analysis of the specific disease affecting your loved one, a neuropsychologist is best at describing how that disease is specifically affecting your loved one via a neuro-psych exam, and a geriatric psychiatrist is best at prescribing and monitoring the medications when behaviors are causing safety or interpersonal concerns.
  2. Finding the “right” medication is difficult. In general, medicine is a science, but there is still so much we don’t know, especially about the brain, dementia and mental health.  Even with drug-gene testing, finding the medication that works best for your loved one, is usually a trial and error experiment.  It can take months and during that time you may feel like nothing is happening or your loved one may get worse or sick from the medication.  Many of the medications used to treat mood disorders have “black box warnings” because of serious side effects in the elderly population. When your loved one’s ability to think or speak clearly is impaired, it can be hard to know if benefits are outweighing any side effects. 
  3. When the disease progresses. Just when you think you’ve found the right concoction, the disease changes and you need something different.
  4. Environment, level of stimulation and approach usually matter more. There is no doubt that medication is helpful in managing anxiety, mood and pain.  But we don’t yet have a pill that will stop or fix the memory loss, self-awareness deficits, or other impaired cognition.  What we do have is a lot of knowledge about how changing the environment and our approach makes a big difference:
  • Environment- tracking the time of day when your loved is having challenges will help you narrow down what might be causing it.  Maybe it's too bright, or they are too hot, or too cold, or it always happens when a certain caregiver is working, or always when he’s wearing a certain shirt.
  • Stimulation - because everyday for someone with short-term memory loss is like the first day on a new job, it can be very stressful. Some individuals find this exciting and become over stimulated, irritable and/or nervous.  Others withdraw or shutdown.  Finding the right balance for your loved one takes and time and patience.
  • Approach - Teepa Snow has created what is universally accepted as the best training for caregivers on the topic of approach, called Positive Approach to Care. You can click here to watch her videos that describe the most effective ways to approach care with someone with dementia.  

Creating a system of care for your aging loved one is like putting together a jigsaw puzzle.  

Each of the pieces provide little meaning on their own, but together make the whole picture.  Someone who has worked the puzzle hundreds of times is always going to do it faster than a first timer.  An Aging Life Care Professional™, like the team at LifeLinks, can help you organize all the pieces of your puzzle into a clearer picture.

Click here to read the LifeLinks Solution to each of these incomplete solutions. (how a LifeLinks Aging Life Care Professionals™ saves the family time and money by completing the solution)

Click here to read more about why just hiring one good caregiver doesn’t always work.

Click here to read more about why just moving to assisted living doesn’t always work.

 

 

ABOUT THE AUTHOR

GRETCHEN NAPIER - CEO
 

IMG_5720.JPG

Gretchen Napier joined the LifeLinks team to fulfill her passion for caring for aging adults, and affecting change for the geriatric care service industry. At a very young age, Gretchen volunteered by painting fingernails for the residents in a nursing home, where she witnessed firsthand the shortcomings and "one-size-fits-all" mentality of many organizations and individuals serving seniors. With many years of experience as an assisted living administrator and a publisher of a resource guide for seniors, Gretchen saw how easy it was for aging adults to fall through the cracks of the healthcare system.  Additionally, she saw how long-distance and broken family relationships make caring for an aging loved one an overwhelming task.  This inspired Gretchen to improve the quality of life for older adults and their families across America by growing LifeLinks. In addition to the community leadership roles listed below, Gretchen is raising a 13 year old son and carrying out her vision for LifeLinks every day.

Aging Life Care Professionals™ Can Save Families Time & Money

CONTRIBUTED BY: GRETCHEN NAPIER - LIFELINKS CEO

 

We complete the solution.  

This article completes a series of articles titled "Why can't caregiving be simple?" To read the entire series, click here.

Below we will walk you through the examples you read about within the series and how an Aging Life Care™ Team with years of experience, knowledge and expertise in care management and advocacy can help others in the same situations that the families in the examples faced.

 

The Aging Experience for Families

The aging experience for most families begins gradually and the family begins to notice little changes, little concerns along the way.  Usually the aging adult is insistent that it's no big deal and they are just having a temporary problem.  Usually, adult children are busy with their own lives and don’t want to upset mom or dad, so things perk along until an event occurs, causing more concern or even bringing the family to a crisis moment during an emergency.  It could be a car accident, or a fall, or a medical event like a stroke or heart attack.  Generally speaking, the family may have been considering new options, but this is the tipping point when action needs to be taken.  Ideally, a comprehensive look at the full picture is the best approach (considering both aging parents if a married couple is involved, finances, religious or cultural preferences, long term expectations, pets, dietary needs and preferences, realities of diagnoses, safety of current home, medications, etc.).  But this is overwhelming.  And most families assume whatever has caused this crisis is the primary problem to be addressed.  They are wrong. This approach sets the family up to fight one crisis after another.  Kind of like plugging a hole in a dam with your finger.

No human lives in a vacuum, and elderly adults systems are more acutely intertwined than at any other time in life.  If a 40 year old doesn’t eat healthy, they will gain weight over time, but on a day to day basis, they continue functioning at the same capacity.  Something as simple as dehydration in an aging adult can upset eletrolytes cause mental confusion and extreme lethargy within days.  A urinary tract infection in a middle-aged adult is simply uncomfortable, but the psychotic side effects it can have in an elderly person can be frightening.  So a comprehensive look at all systems, is the best way to get ahead of future crises and get the whole family moving in the same direction toward agreed upon goals.

 

LifeLinks completes the Assisted Living Solution

The very best independent and assisted living communities, do an excellent job and providing services within their building in a congregate setting.  Meals in the dining room with a variety of choices, medications at  a scheduled time that accommodates timing needs of 40+ other residents, activities popular with enough residents for a reasonable turn out, scheduled transportation (i.e.grocery on Tuesdays, doctors on Wednesdays, Wal-Mart on Thursdays, etc.) are all done well in the best communities.  Between a private apartment, meals and activities, a great balance is provided between privacy and socialization.  But if your loved one needs help advocating for herself at a doctor’s appointment or remembering what was said there, the assisted living facility can’t help.  Or if your loved one has behaviors that aren’t conducive to groups (messy eating, toileting challenges, inappropriate outbursts) then they are likely to be isolated in that private apartment.  

In the first part of our series, Why Just Moving to Assisted Living Doesn’t Always Work, Jim needed a community with an “onsite” nurse, not an “available” nurse.  A LifeLinks Aging Life Care Professional™ could have helped the family identify that need, as well as the communities who provide it. Instead his family came to us after he had already moved back home and we joined their team to coordinate the right balance of services so he could remain at home until the end of his life.   

Margaret just adored the salesperson, and her promises, at the community she chose for her husband, but had no way to evaluate the true quality of care provided there.  Additionally, she lacked confidence to follow her own instincts when things didn’t seem right.  Our Aging Life Care Professionals™ spend many hours each week working with the staff at retirement communities and long term care facilities all over town.  We know who is really good with residents in early stages of dementia and who is better in later stages.  We know who provides the best nursing care for medically frail residents and who is better at providing interesting programming for more active and cognitively engaged residents.  So we would have helped Margaret look behind the curtain and choose the best community for her husband.  Instead, she came to us after the move when the community didn’t seem to be meeting his needs.  As part of the care team, we worked with her and the community to provide training to their staff about the specific needs of Margaret’s husband and we supported her efforts to take care of herself and set appropriate boundaries with the facility.  We helped her check in on him to ensure quality care continued to be provided and worked with the community team anytime things got off track.  They were thankful for more ideas and for someone else to provide the one-on-one, problem solving attention to this family.  Everyone benefited when Margaret’s husband was able to remain living at this community for a many years, getting all of his needs met. 

Elizabeth was the out-of-town daughter who struggled to know what was happening medically with her mom, since her mom couldn’t remember what happened at the doctor’s appointments and couldn’t remember to tell the doctor important things.  Eventually, Elizabeth was scheduling her visits so she could attend the appointments.  After engaging LifeLinks, one of our Aging Life Care Professionals™ attended every appointment to ensure the right issues were brought to the doctor’s attention and Elizabeth promptly received a written report after every appointment that was so detailed, she “felt like I was there!”  When Elizabeth’s mom stopped attending activities at the community, we helper her hire a companion to take her mom on outings at Cheekwood, walking around the mall and getting treats like her favorite, Christie Cookie.  

 

LifeLinks completes the Caregiver at Home Solution

The downside to low unemployment numbers, is that it makes it really hard to find good people to do difficult, low paying jobs.  Like caregiving.  When jobs were really hard to come by, it was easier to find hardworking people willing to do a great, caring job.  Now that people can always find a job at a restaurant or driving for Uber or Lyft, there are fewer good people available for the often physically and demanding job of caregiving.  What is left are often people with no caregiving or life experience, people who can’t get or stay employed at higher paying and/or less difficult jobs, people who want to prey on the vulnerability of aging adults.

In the series, our blog titled; Why just hiring one good caregiver doesn’t always work, Michelle needed reliable and competent caregivers to take care of her husband with Parkinson’s Disease while she took a much needed, and well deserved vacation.  Unfortunately, that is hard to find.  With the increased support from their LifeLinks’ Aging Life Care Professional™, we could have called the caregiver an hour before his shift was supposed to start to be sure he was awake and planning to show up.  We could have called 30 minutes before the shift, to be sure he was on his way.  And then we could have confirmed at medication time that the caregiver was present and medications had been given.  At any step along the way if the caregiver wasn’t available or it seemed like he wouldn’t show up on time or at all, we could have gotten another caregiver on the way from the agency, rather than starting that process when it was already past time for the shift to start and the medication to be given.  Unfortunately, Michelle did not hire LifeLinks and resigned herself to staying home and providing all of her husband’s care herself.  

Dan had two incomplete problems with the caregiver solution.  When new caregivers showed up, he had to retrain them to the specifics of his mom and their household.  A LifeLinks’ Aging Life Care Professional™ could have worked with the caregiving agency to notify us whenever a new caregiver was assigned, so that we could meet them at the client’s home to review all the details.  Dan’s other problem was a manipulative caregiver, trying to work the system to her advantage.  Because she’d been working the system for many years and this was Dan’s first experience with it, he mistook her earnestness for trustworthiness and it cost him money and time while he sought out the longer term solution. Once LifeLinks’ got involved, we helped him find a reputable agency and partnered with Dan and the agency to hold caregivers accountable.

Scott is a busy attorney and dedicated son, but there are not enough hours in his day to handle all the problems that seem to continually arise with the caregivers for his mom.  The LifeLinks’ Aging Life Care Professional™ has been a real sanity saver, by taking over all of those details.  Anytime there is a change to the care plan, the Aging Life Care Professional™ personally meets with and talks to every caregiver on the team to be sure they understand how to implement it and answer any of their questions.  If a specific technique is needed, she involves the LifeLinks’ nurse or physical therapist for training.  In emergency situations when the caregiver unexpectedly doesn’t show up,  the LifeLinks’ Aging Life Care Professional™ even stays with his mom until someone arrives.  Now Scott can focus on his work, knowing his mom is taken care of, and when he visits with her, they reminisce and look through old picture albums, instead of him running around “putting out fires.”

 

LifeLinks completes the Medication/Doctor Solution

Primary care physicians are excellent generalists.  When you have a heart problem, though, you need to see a cardiologist.  Everyone pretty much agrees on this, and most doctors easily make that referral. When it comes to managing dementia, Parkinson’s Disease, and difficult to manage behaviors, a specialist such as a geriatric psychiatrist or movement disorders neurologist may be a better fit.  But due to the stigma related to mental health many doctors are reluctant to make these referrals or unaware they exist and families can also be afraid to see this kind of specialist.  LifeLinks’ Aging Life Care Professionals™ work with many of these specialists and can help your family understand when and why their expertise is warranted.  These specialists excel at the tricky process of identifying the right medication.

During the process and even once the most effective medication is determined, there are many more factors influencing the mood, pain level and behavior of your aging loved one.  Our LifeLinks’ Aging Life Care Professionals™ evaluate the full support system, make recommendations and help you implement the right level of stimulation, information about creating the right environment and training for the best way to approach care with your loved one.  

Creating a system of care for your aging loved one is like putting together a jigsaw puzzle.

Each of the pieces provide little meaning on their own, but together make the whole picture. Someone who has worked the puzzle hundreds of times is always going to do it faster than a first timer.  An Aging Life Care Professional™, like those on the team at LifeLinks, can help you organize all the pieces of your puzzle into a clearer picture.

*Fictitious names are used to protect the privacy of our clients
 

This blog post is an introduction to a series titled: WHY CAN"T CAREGIVING BE SIMPLE? To read the series from the beginning, start here.

 

ABOUT THE AUTHOR

GRETCHEN NAPIER - CEO
 

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Gretchen Napier joined the LifeLinks team to fulfill her passion for caring for aging adults, and affecting change for the geriatric care service industry. At a very young age, Gretchen volunteered by painting fingernails for the residents in a nursing home, where she witnessed firsthand the shortcomings and "one-size-fits-all" mentality of many organizations and individuals serving seniors. With many years of experience as an assisted living administrator and a publisher of a resource guide for seniors, Gretchen saw how easy it was for aging adults to fall through the cracks of the healthcare system.  Additionally, she saw how long-distance and broken family relationships make caring for an aging loved one an overwhelming task.  This inspired Gretchen to improve the quality of life for older adults and their families across America by growing LifeLinks. In addition to the community leadership roles listed below, Gretchen is raising a 13 year old son and carrying out her vision for LifeLinks every day.

The Difference Between Medicare and Medicaid

Many people are confused about Medicare and Medicaid. They sound a lot alike but are extremely different forms of medical insurance coverage.

Medicare is a Federal government program that is available to people who:

  • are age 65 or older

  • have a disability, but are under age 65

  • people with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant).

It consists of 4 parts:

  • Medicare Part A is hospital insurance and most people do not have to pay for it.
  • Medicare Part B is medical insurance and most people pay a monthly premium for it. For details visit www.medicare.gov.
  • Medicare Part C are Medicare Advantage plans like PPOs and HMOs.
  • Medicare Part D is Prescription Drug Coverage

Medicaid is a state run program and is based on being eligible due to age, blindness, disability, having dependent children (categorical requirements). Its eligibility criteria vary greatly from state to state.

In addition to having to meet categorical requirements, Medicaid looks at assets and income to determine eligibility. The eligibility rules vary depending on whether you are applying for assistance while living independently in the community, applying for State/County Special Assistance for help paying for assisted living, or Medicaid for nursing homes.

For details in Wake County, visit www.wakegov.com.
For details for Tennessee visit https://www.tn.gov/tenncare/section/long-term-services-supports
For help sorting out Medicare and insurances, you can contact the NC SHIIP office – Senior Health Insurance Information Program through the NC Department of Insurance , visit.

What is MEDICAID?

An assistance program for low-income people. It is based on income. Some programs require that you be responsible for part of your medical bills before you can get a Medicaid card. This is known as “meeting” a deductible.

A person who receives a Medicaid card pays no part of the medical costs other than a small co-payment to the doctor or pharmacist. Medicaid will pay the Medicare premiums for most people. It also pays the Medicare deductibles and coinsurance for services which are covered by Medicare and Medicaid. Most Medicaid programs pay for prescription drugs. 

Is run by the State Government, but has Federal guidelines. Medicaid varies from State to State. The money for Medicaid costs comes from Federal, State, and County funds.

What is MEDICARE?

An insurance program for people over age 65 and some disabled people under age 65. Most people receive Medicare because they receive some type of Social Security Benefits.

You must pay a deductible for hospital visits. You must also pay an annual deductible for doctor visits and other medical services. You pay coinsurance(a portion of the total bill) for medical services. You also pay a monthly premium for coverage of medical expenses.

Medicare Part D is prescription coverage. You must choose a plan that is run by the Federal Government and it is the same everywhere in the U.S. 

The money for Medicare comes from Federal funds.

Signs You May Need Additional Help

Caregiver burnout is something we talk about a lot at LifeLinks because we see it all of the time with our clients and families. There are times when the needs for your love one may be too much for you to handle on your own and still continue taking care of yourself and others that may need you. That is why our clients hire us, we not only advocate for their loved one and help them find programs in their area, but we also support their family so that everyone can enjoy their loved ones as they age.

If you are caring for a loved one with Dementia, we have some helpful warning signs for you to pay attention to that may clue you in to get additional help.

 

WANDERING
• Getting lost, wandering off, not knowing how to get back home or going outside at inappropriate times

BEHAVIOR OR PERSONALITY CHANGING
• Rapid mood swings or increased suspicion or paranoia

POOR JUDGEMENT LEADING TO SAFETY CONCERNS
• Leaving the door open or unlocked, letting strangers into the house
• Leaving stove on or burning pots
• Dressing without regard for the weather
• Giving large sums of money away or falling prey to telemarketing scams
• Poor housekeeping giving way to chances of falling

POOR EATING HABITS & HYGIENE
• Ignoring all over cleanliness like bathing, changing clothes, brushing teeth and shaving, etc.

PHYSICAL DECLINE
• Unable to use stairs safety, lack of mobility, forgetting to use walker or cane

INCONTINENCE
• Frequent accidents or increased odor

DEPRESSION OR BOREDOM
• Loss of initiative, socializing, maintaining friendships and activities
• Watching TV excessively

If some of these signs seem all too familiar or you would like to talk to someone about the behaviors that are happening - call us. Our care managers are ready to support you and your family.

The Challenge of Acknowledging Change

We cannot escape it. We observe changes in our parents or family members that are telltale signs of the aging process. We may be caught off guard, dismiss any concerns, or try to continue as if all is normal and undisturbed.

Witnessing physical and cognitive changes in our parents is so very difficult.  Not only do we realize that they are reaching a stage in their life that warrants change and guidance, but we are also confronted with our own mortality.  As our parents age, we must acknowledge that so do we.  Once the new reality of our parents’ lives is accepted it is important that we try to remain open-minded and maintain a positive outlook.  This is a time in life when we have the opportunity to advocate and support our parents and by doing so help them maintain their independence and sense of self worth.  Encouraging our parents to remain actively involved and in control of their future may diminish any feelings of intrusion, and they may welcome our inclusion into discussions of change.

Occasional brief periods of forgetfulness may be normal signs of aging or an indicator of a serious problem. We may have to struggle to not appear alarmed.  How do we approach creating change in our lives and in the lives of others?   Where do we start?

It is not unusual that during visits or phone calls with family we notice behavioral changes or signs of declining health.  It may be a challenge to discuss our concerns without appearing intrusive or without expressing doubts in their abilities to function independently and safely.  Returning home to our own life of stress and responsibility may lead to feelings of guilt or relief to be away from our parents and our observations. 

When an opportunity presents itself to speak candidly with our parents, we should try to approach the discussion in a non-threatening way by using safe topics of conversation.  A discussion about current events in our life may prompt them to share their own day-to-day activities, providing us with some insight into how they are managing and adjusting to new changes that aging may have introduced.

In determining how the aging process is affecting our parents, we should ask ourselves the following questions:

  • Medical appointments – Are they maintaining contact with their physicians and keeping appointments?  Is doubt expressed about their physician’s care or guidance?
  • Medications – Are they managing their medications independently, using a pharmacy service or pill box? Are they having difficulty with the costs of their medications or are they noncompliant and have mentioned making self- prescribed changes in order to save money or because they feel the drugs are not effective?
  • Socialization – Is their level of activities with others changing? Have they stopped participating in activities that in the past were important, such as church, volunteering, seeing friends? Are they in touch with family less?  
  • Home maintenance – Are you concerned with changes in their environment, such as the cleanliness of the home, strong odors, collecting clutter? Are they using makeshift items for support when walking, such as holding onto furniture to move about the house, or to assist in standing or sitting? If they own a pet(s) are they able to manage their care? If they smoke do they do so safely?
  • Shopping and meals – Are they having difficulty with getting groceries or appear to be eating poorly?  Is food stored properly, spoiling? Are they hoarding food or displaying poor judgment with what they eat? Have they lost or gained weight, can they recall what they have had eaten lately? Are they drinking enough liquids, consuming too much alcohol, or overusing an unsafe substance?
  • Personal care – Are they dressed appropriately, have their personal cleanliness habits changed? Are they unaware of the condition of their clothing; is it soiled, torn or ill fitting? Is their clothing appropriate for the season?
  • Financial management – Are they still independent with managing their checkbook and investments or do they require the help of others? Have they expressed frustration over their finances? Have bills gone paid or utilities discontinued? Do they respond to sweepstakes opportunities, donate frequently to charities? Have they recently purchased an item or had work done in the home that you think was unnecessary?
  • Driving – Are they driving safely? Have you noticed any new damage to their car, are they maintaining the car? Have they had any experiences with getting lost or taking too long to arrive at a destination? Do they have any vision changes that would impair their driving? Do they drive at night?

Some families are more comfortable with these discussions than others.  It may be typical of ongoing contact with our parents to share this type of information.  Depending on our family history of communication, broaching these topics may be difficult, if not impossible.  Some talks may arise from our own disclosure of how we manage multiple tasks in our daily life.

It is important to remain open with parents about any concerns and plans to take action.  The degree to which we can become involved and make decisions for them will be limited by their knowledge, their involvement in the decision-making process, and their Advanced Directives. Prepared legal documents such as a Living Will, Durable Power of Attorney, and Health Care Power of Attorney will determine the level of involvement that we may have when participating with our parents in making changes in their lifestyle and care. 

Becoming aware of aging changes is just the beginning of a new journey for children and parents.  Fear, anger, and feeling overwhelmed are typical reactions that we may encounter as we acknowledge change.  Encouraging independence is a very important piece of this process for both generations.  We want to believe that our parents are still very capable of remaining active and independent.  Our parents need to maintain as much involvement and control over heir life as possible, delaying any dependency on us or others.

As children, we do not need to feel alone on this journey. There are many resources available to guide and support us in understanding and preparing for the increasing needs of our parents. Planning ahead and being aware of their future needs and wishes may make the difficult transition of introducing change a little easier.  

ABOUT THE AUTHOR

LAURIE RAY, MSW, CMSW, C-ASWCM
ADVACED AGING CARE SPECIALIST

Over 20 years’ experience in the field of Social Work, Laurie’s background includes extensive work in hospice care where she provided end of life support to patients of all ages in a variety of settings.  In 2004 Laurie established and was Executive Director of COPE Eldercare, the area’s only nonprofit 501(c)(3) charity providing geriatric care management services regardless of the ability to pay. In addition, the 2013 January/February issue Social Work magazine named Laurie in its annual recognition of “Ten dedicated and Deserving Social Workers”. Laurie has been teaching Pet Therapy for ten years assisting volunteers and their canine companion to become a certified team.

 

 

    

Including Pets in Long Term Care Plans

Contributed by: LAURIE RAY, MSW, CMSW, C-ASWCM

Aging and the Human-Animal Bond: The Multiple Benefits Nurturing These Relationships

What is healthy aging? Is it having a plan, remaining realistic, or just being grateful for the benefits of good health? Aging is inevitable, though some of us accept it more graciously than others. Planning for our later years requires some insight into our wishes, expectations, and is frequently more involved than how well we have saved for retirement.

We may forget or take for granted quality-of-life details. Many of us who are animal lovers cannot conceive of the notion that at some point we may not be able to physically, cognitively, or financially maintain the ability to be responsible for a pet. We will always expect to have a pet in our life, regardless of our living environment, and not worry about the ability to provide adequate care.

Historically animals have been an integral part of society—both past and present— whether they met agricultural needs, provided companionship, or assisted with functioning. For some, maintaining a connection with an animal is vital in ensuring a sense of self-worth or purpose. Acknowledging and respecting one’s history with animals may aid in validating a sense of self.

As we age, our ability to live independently may change. When living in a communal environment individual relationships with a domesticated animal may be lost due to facility policy, the physical or cognitive limitations of the individual, or financial and environmental restrictions. Creating alternative ways for maintaining contact with animals may not only enhance one’s lifestyle but may also provide health benefits.

For all of us, relationships change as we age, including those with our animals. In addition to companionship and unconditional love, our pets may meet the changing needs in our lives in a wide variety of ways, including:

  • providing assistance
  • helping maintain a sense of purpose and responsibility
  • increasing our mobility or exercise opportunities
  • serving as a status symbol that sets us apart from others
  • increasing socialization—as the pet may serve as a conduit to interactions with others
  • helping normalize our environment
  • having a calming effect and reducing anxiety
  • providing sensory stimulation through touch, sight, and smell
  • decreasing our focus on an illness or stressful situation
  • serving as a buffer with family conflict and relationships.

It’s an impressive list of supportive benefits.

Sadly, however, it is not uncommon for seniors to be separated from their pets due to their inability to provide proper care, financial restrictions, or safety concerns. Some older adults may not seek help for their own care and remain isolated from others out of fear that they may be separated from their pet; their love and concern for their companion supersedes their own needs.

Many seniors are fortunate to have family, friends, neighbors, or the financial resources for paid assistance to possibly help out with the care of their pets but others may not. While society generally appears to value the relationship we have with our pets, it may also be perceived as dispensable as one ages and one’s needs and abilities change. In order to continue benefiting from the bond we have with animals incorporating them into our long-term care plan is vital.

Including Pets in Long-Term Care Plans

In my role as a geriatric care manager (GCM), I consider pets to be a part of the family system that need to be considered in the decision-making process of planning for current and future needs. Pets are important not only as companions but also for their therapeutic benefits to the older adult. For example, housing options may limit the older adult’s choices if a pet is involved. It is our role to advocate for that relationship but also help with solutions and resources for ongoing care.

It is also important to help seniors acknowledge the reality that at some point difficult choices may need to be made regarding the care and appropriateness of maintaining pet ownership. Many of these decisions will be dictated by the health status and financial resources of the senior. That said, it is important always to keep in mind that relationships and our interactions with others is an important aspect of our quality of life. Socialization and the stimulation it provides may come from our family, friends, neighbors—but, as importantly, it may also come from our animals. Whether we are animal lovers or not we all need to be sensitive to this relationship and its impact on the aging process and the source of significant happiness and purpose for many.

 

ABOUT THE AUTHOR

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LAURIE RAY, MSW, CMSW, C-ASWCM
ADVACED AGING CARE SPECIALIST

Over 20 years’ experience in the field of Social Work, Laurie’s background includes extensive work in hospice care where she provided end of life support to patients of all ages in a variety of settings.  In 2004 Laurie established and was Executive Director of COPE Eldercare, the area’s only nonprofit 501(c)(3) charity providing geriatric care management services regardless of the ability to pay. In addition, the 2013 January/February issue Social Work magazine named Laurie in its annual recognition of “Ten dedicated and Deserving Social Workers”. Laurie has been teaching Pet Therapy for ten years assisting volunteers and their canine companion to become a certified team.