Why Aging in Place is Important

I am passionate about aging in place (or finding the next best option if aging in place is not possible) because I believe that the quality of life can be enhanced with appropriate systems and safety nets, even with the additional challenges that the elder population may face. We are living longer – therefore, sustaining quality of life is even more important than ever to look at and address for this extended period of “senior years.”

The reality regarding life at a nursing home (even a top-rated nursing home) is that there is no comparison in regard to the difference in setting and the amount of one-to-one attention one receives if one is able to remain at home with a private caregiver. It is true that there may be circumstances due to finances and amount of care needed which may make it necessary to consider nursing home placement, but with insight into what can happen in the future one would be best served by pre-planning for the future and looking and planning for the best case- worse case scenarios.

All nursing homes are not alike, and before a crisis occurs it would be best to select which nursing homes would benefit ones needs and then make sure that the individual has an application into their nursing homes of choice. This does not change the number one objective to remain at home successfully, if at all possible.

Although I feel home or an arrangement more “similar to home” is the best option, I do realize it is not always possible. It is for this reason that, although I facilitate services to allow individuals to remain at home, I always encourage nursing home applications to be submitted to the highest quality nursing homes in their vicinity or their adult children’s vicinity. I look at it as an insurance policy to the address what most of my clients feel is the worst case scenario which is nursing home placement.  My ultimate goal is to insure the least restrictive setting and zoning in on what is important to the client and the family as they age. I am extremely passionate about this because I have seen what can result from putting in even small changes to adapt to the increased needs. I have seen my clients and their families feel so overwhelmed and helpless and with brief counseling, encouragement, support and guidance in regard to what systems need to be in place to best serve their needs; life improves and they realize that life does not have to change that drastically. Slowly making changes early on can insure a greater period of time with little to no crisis.

So many of our communities have tremendous services to offer as one ages; all too often the elder individual and their families are unaware of the resources available to them. Education is invaluable and very much part of how I try to assist with aging in place. As a geriatric care manager with many years of experience behind me, I feel there is always hope, there are always possibilities, and it is beyond rewarding to see the changes that can be made to improve quality of life even when the most difficult challenges are thrown one’s way.

For information on services available to seniors in Fairfield County - please request a copy of the Senior GO TO Guide from us.  You can find my article about Geriatric Care Managers on page 20 of the Guide.

Behavior Problems in the Elderly Part 2: How to handle behavior change situations

What prompted the writing of my previous post was, as I said on the onset that I am often contacted by a family member or a caregiver who is struggling with a behavior that continues to escalate and attempts to redirect his or her behavior have failed.

Although this is a very condensed version it does depict what I have been referring to. I was contacted two weeks ago in regard to an 87-year-old woman who suddenly has turned on her caregiver. She is reporting to all that know her that this caregiver left her unattended and did not help her after she fell, still disappears and leaves her unattended and afraid. The caregiver feels she is more delusional and really should be started on some medication for delusions. The caregiver has been working with this woman for months, and is quite hurt that her client could turn on her like this after all the wonderful care she has given.

I visited this woman’s home with the caregiver present and engaged this woman in a general conversation regarding the recent changes in her life. She explained that she had a caregiver daily for 5-8 hours. A few weeks ago after the caregiver left for the day the woman fell, and it was many hours before she was found. She hurt her arm which is now in a sling, and is much more dependent and feeling much more depressed than she has in the past.

Since her fall and return home from the hospital, she now has 24-hour care and is never left alone. She denies this and was very firm that she is left alone for periods of time.

As the conversation continued, what unfolded was a clearer explanation of what was happening in her mind and why she has been very accusatory and angry. When the caregiver goes to the bathroom or kitchen, runs out to get the mail or bring in groceries she forgets she left. Even when she was told just one minute prior to the caregiver’s brief absence, once the woman realizes she is alone she panics and screams. The experience of falling and sustaining an injury and not being able to get immediate help has caused her to become extremely anxious and afraid. She feels loss of control.

In this case, I reassured her that this sense of panic is not unusual and that we truly understand her fear. She is mildly impaired and is aware that she struggles with short term memory loss. Although her caregiver can say “I am going to the kitchen and I’ll be right back,” after a few seconds she realizes she is alone, panics and feels abandoned. We discussed methods to use so that she feels comfortable, safe and never alone.

The caregiver said that in retrospect it all makes sense, and if she realized what the triggers were she could have made the necessary adaptations. In the future she will not only tell her client where she is going, but she will offer to have her keep her company while she is cooking, doing laundry, etc.

There are other issues such as a changed sleeping pattern due to increased anxiety, and we will need to address this behaviorally; if it continues we will discuss with her physician. This is just one example, but again very often one can figure out the triggers and alleviate the precipitating events that lead to “difficult behaviors”.

It is important to note there are certainly instances that medications are needed, however medication is not the only solution or the best solution. Non-drug interventions should be used first unless the behavior cannot be controlled from the onset and the behavior is potentially dangerous to the individual or others.

Ways to Control Behavior Problems – Part One: What is causing the problem?

            As a GCM, I am often consulted when a family member or caregiver is extremely frustrated due to ongoing issues with their loved one’s behaviors that they have had increasingly more difficulty controlling. I often feel like a broken record, but the bottom line is that when working with an individual with dementia one cannot expect to change the individual with the dementia, but we can adjust, change and/or adapt the environment that may be triggering the behavior.

Working with someone with dementia can certainly be a challenge and is often frustrating. It is important to understand “dementia.” because without an understanding one could think that the person with “dementia” is simply “acting out” or “annoying, irritating and stubborn” when in fact there are important factors behind the behavior. These behaviors must be looked at and understood so to facilitate better controlled behavior.

The ‘tools’ we were accustomed to using when dealing with our loved ones prior to the onset of dementia is quite different from the tools we need with this new set of circumstances – memory loss, forgetfulness, and confusion can all be symptoms of the dementia.  The behaviors vary as well as the difficulty handling the behaviors. The causes of these new behaviors such as agitation, wandering, and irritability can be attributed to different causes.

It is always very important when dealing with behaviors – particularly when the behaviors are new – to determine if the behavior is strictly due to “the dementia.” There may be something “medical or physical” going on such as a reaction to a new medication, a urinary tract infection, or an undiagnosed depression in addition to the dementia.

If the behavior is new and you cannot determine a contributing factor always call your doctor. You do not want to assume that it is simply due to the dementia if it is out of the ordinary. A simple urine test can reveal a urinary tract infection which can be easily treated with an antibiotic.

What I always recommend is to keep a journal and try to determine a pattern. Eventually, if there is a particular behavior such as intermittent agitation, restlessness, anger, or pacing happening, documenting the time these behaviors are exhibited and events that took place before the behaviors began or started to escalate can be very helpful for diagnosis. Here are some links to a few helpful documents which will help you keep track of the behaviors:

• This chart documents the date and time, what happened before the behavior, what behavior was exhibited and what happened as a result of the behavior: http://www.scribd.com/doc/13030287/Behavior-Chart-FormGrowing-Options

• This chart documents the same as the first, but also has a column to document the duration of the behavior and the intensity on a scale from 1 to 5:  http://www.scribd.com/doc/13030291/Behavior-Duration-and-Intensity-FormGrowing-Options
  

• Tip: Keep these charts in a binder to bring to the doctor.

More on the National Association of Professional Geriatric Care Managers

This video illustrates how stressful long-distance caregiving can be, and also offers statistics, “34 million Americans are caring for an elderly loved one, usually a parent or a grandparent.”

Offering ‘Peace of Mind’ for Long-Distance Caregivers

For those who are long-distance caregivers, worrying about if a parent might take a fall or have other health issues without them knowning is a major concern. Lifeline is a medical alert system available in 50 states. I spoke with Lifeline Representative, Joy Balsamo to find out more about how, exactly, this system works.

How does Lifeline work?

People wear their personal help button on their neck or wrist which dials out their phone to the response center in Framingham, Mass. When the person pushes the button, a personal response associate takes the call; they are literally sitting in a cubicle waiting for the calls to come through. When the subscriber sends in a signal for help, on the computer is the profile of the client calling in front of them. This contains information from their address, information of the local response team, names of family members and neighbors, native language, even down to if the person has a dog that bites or where an extra key might be hidden.

How does the person wearing the alert button know what’s going on after they’ve called for help?

They will come over the communicator, which is typically in the bedroom. The person talks into the air, “I fell, I’m having chest pain,” and an associate determines what level of help is needed. They may ask “Call my daughter,” or “Call an ambulance.” The person will then call the local emergency responder, and they’ll be on their way.

Listen to a samples of real calls made here.

How do the responders know when help has arrived?

We have what is called a closed loop system; we check back in to make sure that help has arrived or we Once emergency help or responder checks in at the house they alert us and we know, absolutely, that help has gotten there. After we’ll also contact people like their case manager to say that that “‘Mary Jones’ had a fall on she’s on her way to St. Francis Hospital.” we’ll stay on the line if the person asks and keep checking back in.

How does Lifeline contribute to home health care?

It helps to keep people at home just a little bit longer. The average subscriber is an 82-year-old female who lives alone and needs help with one or two [Activities of Daily Living ] ADLs. Lifeline is a nice complement to home health aides or nursing staff that may be going in to help a patient. If someone lives by themselves, the family as well as the subscriber has peace of mind that if they need help they will be able to get it and they will be contacted.

How many people are using Lifeline?

There are 718, 672 subscribers as of today. It is available in all 50 states, including Alaska, Hawaii, and Puerto Rico.

How much does it cost?

After the activation fee there is a monthly fee for subscribers. It varies depending part of the country you’re in, but it is safe to say that it costs just a little more than a dollar a day.

When was this created?

Lifeline came out first in 1974. When they first came out they were about the size of a garage door opener, that [subscribers] would clip to their belt! It was invented by Dr. Andrew Dibner. He was shaving for work, and cut himself while getting ready. Then he stopped to ask himself, “If I did this and no one was home how would I get help?” And that’s when he got the idea.

My Journey to Becoming a Geriatric Care Manager

My adventure into Geriatric Care Management grew from a small seed of thought, which grew into more serious thoughts due to my experiences as the Director of Social Services at a Skilled Nursing facility (SNF). Time after time, as a discharge planner, I would need to facilitate a discharge home for senior after senior knowing that the plan was a short term plan; without greater and more secure safety nets the senior would end up back in the ER and then back into the SNF.

Upon discharge a Visiting Nurse Service can and usually does provide brief services which are paid by Medicare. Unfortunately, these services are short lived and do not address the long term needs and services, therefore the senior is back in the emergency room within weeks, if not sooner. These seniors are known by the EMT’s and the Emergency room staff closest to their homes. It is quite common for these seniors to have multiple trips to the ER and the SNF before one would question …why ? and/or or say, “Well, this patient needs to remain in a SNF. ” Why…is simply answered, and NO, more often than not, it is not time for permanent placement. The reality is there are many long term residents living the remainder of their lives in a nursing home at a much greater expense, when they could be in the comfort of their own home, with a 24-hour caregiver providing ongoing one-to-one attention at a much lower, daily rate.

I would see this repeatedly and feel so frustrated that I could not do more to guarantee greater success at home. I knew with better safety nets in place and closer monitoring and medical attention at home, most ER trips could be eliminated as well as the subsequent return to the SNF.

The formula seemed simple but I could not do what was needed as a discharge planner in a SNF with a caseload of 100+ seniors.

I would say to myself, “These seniors need a Senior Manager to go to their home, assess the ongoing needs, make recommendations and set up services. Ongoing monitoring would insure that the recommendations were being followed, and as a trained Senior Manager it would be easy to see signs of change or concerns and make the necessary adaptations.”

As time went on I thought of this more and more, and went online to “Goggle” keywords. To my amazement I found out that there really were Senior Managers and they were called “Geriatric Care Managers.”

I felt it was time to take this seed of thought and actually pursue what I had thought about so often. I would build a private practice that would allow me to reach out to seniors and their families and give the gift of providing “Options” that families were probably not aware of…”Growing Options”. I pursued the necessary credentialing and became a Certified Care Manager (CCM).

Since that time I have slowly and successfully been privileged to work with many seniors and their families, and fulfill a vision I knew was possible to provide the bridge to success once leaving a SNF after subacute rehabilitation or discharge from an Emergency Room.

The “age-old” question: How do I know what to do with my elderly parents?

The number of Americans caring for their elderly family members is estimated to be 34 million and growing. Eighty percent of elderly care is provided by family members – spouses, children, grandchildren and other relatives. Many of these caregivers struggle with the task of caring for their elderly relatives while also addressing the needs of their own families.

You may have noticed your aging parent showing signs that he or she needs help. Simple tasks like climbing stairs, understanding medications and taking them on time, preparing meals, etc. are becoming increasingly challenging. You may see your parent becoming socially isolated, disinterested in activities, confused and even losing his or her appetite. However, it’s difficult for you to accurately assess just how much help and how to access it. Whether you live close by or hours away, putting your finger on the problems that need to be addressed and finding the solutions can be overwhelming.

Orchestrating care for loved ones is not an easy task. Every case and family is unique. There is no “one size fits all” remedy. The big question is, “Who can help you in assessing your loved one’s needs while keeping everyone’s best interests in mind?” That’s where a Geriatric Care Manager (GCM) comes in. A GCM provides a comprehensive catalog of services starting with a personalized in-home assessment to address your specific needs, as well as that of your parent.

GCM’s generally follow a four-step process:

1. Assessment: Perform initial assessment of the client’s situation.

2. Care Plan: Determine goals for client’s care and establish necessary steps needed to reach the goals.

3. Implementation: Put steps of care plan into action.

4. Monitor: Observe the client and make any necessary plan adjustments.

GCM’s have a background in a number of fields including gerontology, social work, nursing and psychology. The basic service provided is arranging services for clients; whether it’s providing medications and groceries, escort to physician’s appointments, transportation, home repair, socialization and emotional support or arranging 24 hour care. The GCM’s goal is to help the elderly stay as independent as possible.

If you’re struggling with this find a GCM in your area.