Skip to main content

All posts by Courtney Pulitzer

Self-care During a Pandemic

//// By: Harisa Paco, MSW, CMC ////

Our nation has been moving towards reopening and Memorial Day weekend saw record numbers of people heading out and maneuvering how to kick-off summer in a socially distant way.

While social distancing will still be important, and even as salons and other places begin hanging up their “open” signs, it will be important to balance this with some of the coping techniques we’ve developed over the past two months.

 

Finding time for self-care was tough enough before the pandemic. Nevertheless, the occasional mani-pedi or spa-day sufficed. There were so many times during my quarantine it felt like I was swimming in time, and the things I used to rely on to relax were no longer accessible. Giving myself a manicure just isn’t the same.

I learned how to practice self-care during a pandemic. Being quarantined at home limited some options, but there was, and still is, fun to be had!

Taking care of our bodies is a good way to support our mental health. Here are some easy steps:

  • Eat a healthy, well-balanced diet. The “quarantine 15” is real.
  • Drink plenty of fluids.
  • Find time to get outside every day – go for a walk, bike ride, run, garden or sit in the sun and absorb that vitamin D.
  • Make sure you’re getting enough sleep. There are lots of resources online on how to have good sleep hygiene.

Just as important as our physical health is our mental health. Give one of these a try:

It took a while but setting and maintaining a daily routine has helped ease some of my anxiety and bring peace of mind.

  • Meditation and yoga. My yoga studio has been offering virtual classes via video which has been fun. YouTube has tons of free yoga videos. There are also lots of apps on the market, such as Calm, which teach and promote medication.
  • Daily affirmations. Beginning your day with an uplifting podcast or reading can help set the tone for a positive mindset.
  • Social engagement. Catching up with friends and family via video conferencing has become a regular staple in my schedule.

Sometimes all we need to feel better about things is a good distraction. Check out these online resources and ideas to help relax the mind:

Many of the above-listed activities are a great escape for the whole family. Remember to find time to have some fun and to find time for self-care. Enjoy!

About the Author: Harisa Paco, MSW, CMC is a Certified Care Manager at Aging Wisdom (https://agingwisdom.com) in Seattle, WA. Harisa also serves on the Western Region Chapter Board of Directors in the role of secretary and is the local unit co-chair in Seattle. Harisa is a graduate of Leadership Tomorrow (Seattle Chapter), class of 2018 and is the president of Seattle City Rotaract. In her free time, Harisa enjoys spending time with her nephews and exploring the beautiful Pacific Northwest.

 

One Care Manager’s experience through COVID-19

//// Written by Joan Harris, LSW,MBA, CMC ////

May is Aging Life Care Month and this is one perspective through COVID-19 by an Aging Life Care Professional.

seaport-during-daytime-132037.jpg

As professional Care Managers (Aging Life Care Professionals), when we take on clients we are 100% committed to them, their wellness, helping them to reach their goals, being there for them and their families through all their difficult times. It is not uncommon that we help our clients through the end of their lives, ensuring they have care and comfort, coordinating hospice care and supporting their families. It is an honor to do this work and we are accustomed to our clients passing. It is part of the work we do. Each of us deals with the loss of our clients differently. My process is to go to every funeral. I sit in the back and listen to all the wonderful stories about my clients in their younger years when I did not know them. I celebrate them, and then I tuck them away in my heart. This allows me to move forward and to be fully present for all my clients. This process of sharing rituals with my client’s families, whatever their faith may be, gives time and space to think about the individual and provides me with closure. This process has worked well for me over my decades of work with an older population.

In comes COVID-19. We are living through unprecedented times. I learn of my client’s fever. They are in a nursing home, and the nursing home is on lockdown. I cannot be there to orchestrate care and comfort, and suddenly they are gone.  There is nothing I can do except to provide emotional support to the families. This is not typical. There is no ritual and there is no funeral but we continue on, doing what we can. I wake up at 5 am each day, lying in bed and wondering if I have done enough to get everyone ready for this pandemic. Is the plan in place good enough? Are the caregivers following the protocols for sanitizing?  Will my client in an assisted living facility on lockdown continue to decline without structure and supports? What else should I be doing and fighting for?

There is no precedent for providing Care Management services under these circumstances.  I have always been skilled in powering through difficult times. I am fully functional and my mood is as even as it always is. I have a positive attitude.  But I have realized over the past few weeks, as this pandemic continues to rage through the nursing homes and assisted living communities where some of my clients reside, that deep in my heart the sadness is lurking and more difficult to ignore and push down. It is not uncommon that many of us who care for others do not do the best job caring for ourselves. So, I believe it’s time to make some changes and start practicing what I preach. Care Managers, health care workers of all types are very much at risk for burnout, depression and health problems. I plan to continue my good health. Here are some of the ways I have found to do so:

1) Let yourself grieve

These are not just “clients”. They are people who I knew, respected, laughed with, who trusted me and let me into their lives. They each had amazing stories and histories. I have started a memory book for each client I have lost. I’ve written in a journal the things I knew about them, their stories, their accomplishments etc. I reached out to each client’s family weeks after their passing to check in and reminisce with them. I have made donations to causes that mattered to them in their memory. I honor them, and allow myself to feel the sadness.

2) Peer groups

Every profession has some type of required peer supervision and case review, but I am incredibly fortunate to have a local peer group of other solo and small group practitioners.  Before COVID-19 we met monthly for peer supervision and case conferencing. We cover for each other’s vacations. We know and trust each other’s high level of practice.  Since COVID-19, we meet via Zoom weekly and offer support.  There is no monetary value you could place on having this group of intelligent, caring and excellent practitioners in your life. We share resources, ideas, we laugh, we applaud success and more than ever, it is a place where we can honestly say how we are really doing. Find a peer group that lifts you up and allows you to give.

3) Healthy routines and habits

It’s so simple to say we should eat healthy, practice good sleep hygiene and exercise, but it’s often hard to do if you have not already been in that habit before COVID-19. It is hard to change habits when you are under a great deal of stress. I will tell myself I don’t have time for a walk; too much to do!  I stay up late and get up early and feel tired. The to-do list grows, it’s difficult trying to take care of our clients through remote video calls, and I miss seeing them face to face.  On top of all that, I’m trying to figure out how to properly manage the CARES Act programs, and other business challenges the pandemic has brought.  How can I do it all?!  I’ve started walking in nature again, which makes a world of difference in my frame of mind and shakes out some of the stiffness I feel from being on my computer all day or in my office instead of being out with my clients.

4) Seek help if you need it

We are the authors of this advice. We, as expert practitioners know that we can talk to professional therapists, and see specialists if needed.  But just as a reminder, be mindful of the signs and symptoms of how stress and the pain around you is affecting you. Regenerate in the ways that feed you. Last week I was filled with gratitude when my young adult daughter set up an on-line yoga class for us. She put on calming music and lit a candle to set the mood. I could not lie on the floor and breathe. I could not focus well but my heart felt the love and caring of my family. When I surround myself with them and stay connected with people who matter in my life, I feel regenerated.

My new mantra is: “One step at a time.”

“One step at a time”. Reach out to your supports, whoever they are, and talk to them about what you are experiencing. As experts in this field we do our best and may not have all the answers in this monumental time of uncertainty. Accept that truth and breathe. Together, we will figure it out and no matter what, stand by one another and the clients and families we continue to serve.

About the Author: Joan Harris, LSW, MBA, CMC, Founder and Managing Partner of Symphony Care Management, LLC , a full-service Care Management and Life Planning Company. Respected by her peers, she served as 2018 President of the Aging Life Care Association New England Chapter. She continues to be involved in leadership serving on the Executive Board as Past President. This blog post also appears in the Symphony Blog.

 

 

 

It Pays To Have A Creative Geriatric Care Manager

Aging Life Care Manager can help in emergency situations
Aging Life Care Managers are creative in answering the call for care.

Just as the COVID-19 crisis began gripping the nation, a very determined and creative Aging Life Care Manager, Rachel Hodesh, began scheduling “FaceTime” calls with our caregiver during the caregiver’s time with a very special mutual client. In her first call, the senior client spent most of the time talking about this wonderful use of technology. She wanted to see Rachel’s house, especially the kitchen. Our client expressed a little concern about how she “looked” during that first call which was exactly what she would have discussed had COVID-19 not been sweeping the country and this was a usual face to face visit. Rachel was able to discuss how her elderly client was feeling about staying at home and they proceeded to make a Passover shopping list. They also were able to catch up on what was happening on a daily basis. Later in the month and repeatedly thereafter, Rachel spent additional technology-based face-time with the Home Helpers caregiver and client as they made Chicken Salad for lunch. They talked about everything from how the elderly client was feeling to what all needed to be done to get ready for Passover as well as what medical appointments were scheduled for April.

What makes this so special? As a Geriatric Care Manager, Rachel is still able to connect with her clients on a weekly basis seeing them in their homes, watching them with their Home Helpers caregivers, and then she is able to share this wonderful moment with their children. Rachel told us that she thoroughly enjoyed watching the interactions with her clients and their caregivers. Rachel said that “The magic of technology does wonders for the client, caregiver, and person on the other end. For those moments, you feel a part of their home and know that they are ok. It does not solve the problem but you show your loved one that you are there, you want to be present and that you miss them.” During this unprecedented public health crisis, Rachel’s use of technology enables her to stay connected to her senior clients, and most certainly makes them feel connected as well.

We would like to encourage everyone to take the time to reach out and connect with the seniors in their lives. Be creative! The isolation some of our most vulnerable members of society must be feeling can be made just a bit less overwhelming with the help of a little face time.

For more information on Rachel Hodesh, MS, CDP, NHA. This article originally appeared here.

Social Isolation Due to COVID-19

//// by: Kizzy Chambers ////

Photo by 5933179The pandemic of COVID-19 has increased concerns about older adults’ cognition among many family members. Most of us understand that older adults or individuals with significant cognitive impairment or dementia, need stability and routine. As a result of the COVID-19, visitors are prohibited in nursing homes and assisted living facilities. Many residents lost access to some essential basic needs and routines, such as car rides, walks in the park or around the mall, or daily lunch at their favorite restaurant.

Federal and state governments implemented guidelines to protect one of our most vulnerable populations, the older adults. However, we did not consider how the effect of these strict guidelines would have on older adults. Primarily, the impact on residents who suffer from depression, anxiety, and those with dementia. Before COVID-19, residents were able to interact with other residents. They felt some sense of empowerment and control. Now many of their usual activities have been limited or canceled until further notice. Residents are isolated to their rooms, having to eat meals in their rooms alone. Several residents do not have family members locally or have limited support in place. And the facilities are understaffed. Some nursing staff have quit or had to reduce their hours to accommodate personal life changes as a result of the COVID-19.

As an Aging Life Care Professional and Licensed Clinical Social Worker, I am concerned and afraid of the state I will find my clients in once I can resume visits with them. One family member described her mother with increased delusions since the implementation of social distancing in the facility. Another family member reported their mother sleeping more often, and her verbal ability has significantly declined. These family members feel helpless but hopeful. I provide emotional support, but it does not seem enough when you have a family member declining, and you cannot physically be there with him or her. I ask myself, “What other ways can I support my family members and clients throughout this pandemic?” How do we foster a system that forces senior living communities into an interdisciplinary collaboration with family members and community partners during a time of crisis? Or, how do we ensure residents, who are in senior living communities, needs such as their emotionally and physically, are being met?

Some senior living communities are doing as much as possible, given the limited resources that are reasonable and accessible. Some communities are encouraging some form of visual and audio contact, such as Facetime or Skype, between family members and residents. Many senior living communities arrange for window time between residents and family members. Some residents are still capable of making and receiving phone calls from family members. But other residents do not have access or are incapable of managing some of these options. For those residents who do not have family support or the ability to utilize wireless programs and social media, how are we supporting them? Nick McKeehab, a blogger, reminds us how social isolation is associated with adverse health conditions. Research supports that social isolation increases the risk of chronic medical conditions and mortality.

To reduce risks for chronic medical conditions and mortality, I suggest a senior living community model that increases one-to-one physical contact with residents, primarily for those who suffer from significant cognitive impairment or dementia. Spending 10 minutes daily with an isolated resident has the potential to maintain their quality of life, decrease the risk for depression and acute cognitive decline. This daily human connection could be with any person within the community. I am not talking about the brief minutes when the nursing staff is passing medications, or when the dietary team delivers meals. Staff can be assigned to two-three residents daily to spend at least 10 minutes of one-to-one contact while maintaining social distancing. Staff members can also be assigned to walk a few residents around the building a few times. Checking the residents’ refrigerator and helping them make a sandwich or a quick snack increases social empathy. These tasks may seem overwhelming to Executive Directors when they are burdened with staff shortages and added functions due to a crisis or pandemic. Still, ultimately, these tasks are invaluable when you are making a difference in the lives of residents with cognition impairment or dementia. These tasks can be maintained with appropriate social distancing and by wearing proper protective equipment.

How are we as Care Managers trying to mitigate the loneliness and isolation?

Just as senior living communities are working within their limited resources, Aging Life Care Managers must get creative as well. Families hire us to oversee the medical care and well-being of our clients. Many of our goals include ensuring our clients are safe, medically managed, and have a quality of life. These goals are challenged by restricted guidelines implemented to address the pandemic of the COVID-19. During these uncertain times, family members rely on our expertise and creativity. At FHL, we are mailing greeting cards, dropping off boredom boxes, making weekly phone calls to speak with nursing staff at senior living communities where we have clients. We are asking the nursing staff to take our clients’ weight and inquiring about mood changes. We are requesting medical records to be faxed for review, phone calls, Facetime, or Skype with clients, and arrange for window visits. We also make sure clients have personal hygiene items. During this time, we have increased our communication with family members, so they know they are supported and not alone. How are you mitigating the loneliness and isolation of your clients?

About the Author:  Kizzy Chambers MSW, LCSW, CMC is a Professional Care Manager and a Licensed Clinical Social Worker with FHL Care Management, LLC in Orlando, Florida. She has over 13 years of experience in health care, working in a hospital setting, and as a Care Manager. She is also a mental health therapist, focusing on depression, anxiety, stress management, and crisis stabilization.  Kizzy attended the University of Central Florida, where she obtained her bachelor’s degree in Psychology and her master’s degree in Social Work. She is active with the Aging Life Care Association (ALCA) and currently serves on the ALCA Florida Chapter’s board of directors. She also serves as the Orlando Unit Leader for the ALCA Florida Chapter. Kizzy served on the 2020 National ALCA Conference Committee. She is  a member of the National Association of Social Workers (NASW).

Using Live-In Care To Lower The Risk of COVID Exposure

//// By: David Petroski ////

 

Did you hear the news that “…80% of [COVID-19] infections are mild or asymptomatic.” No, that quote is not from a dubious Facebook ad, or a cable news show personality, it’s from the World Health Organization’s Q&A page on the difference between COVID-19 and influenza.

If that is true, how does one screen a caregiver who services those most at risk, like our elderly parents?  I am told that many providers (agency or facility) ask a few pertinent questions and/or take the caregiver’s temperature before they start their shift. If no temperature and the questions are all answered in the affirmative, they can don PPE and see care recipients.

Now knowing that the majority of those who are infected may only have only mild or no symptoms, it stands to reason, that it would be prudent to look for other ways to reduce our care-recipient’s exposure from caregivers who pass the current screening protocols, but are part of the 80% “silent spreaders”.

The overall CDC strategy has been to limit the risk of exposure through social distancing, but how do you do that when someone needs daily help with their activities of daily living (ADLs) or memory-care?  The answer for some is to reduce the number of new daily contacts that their parents have with a caregiver or caregivers.

The below chart visualizes the number of times that a caregiver visits a care-recipient after having had contact with other people. It could be in a nursing home, where they go room to room, it could be at an assisted living facility, where they go apartment to apartment, or it could be a home-care aide, going house to house.

Each time they come into contact or recontact (after being in contact with others), they carry the risk of also bringing the Coronavirus with them. Each of these contacts is a Risk of Exposure.

What does that risk of exposure look like for your loved ones, under different scenarios?  Let’s take a look.

Of course, the risk of exposure can be reduced by the caregiver properly donning and doffing new PPE each time they enter/exit from doing hands-on care with a care recipient. We all hope that this is done, but as the number of contacts rise, so do the risks of a breach of protocol, especially in situations where PPE is in short supply, and most non-medical caregivers are new to using them correctly.

With live-in care, a screened caregiver can move into a spare guestroom at a parent’s home and help them as needed with their ADLs or memory care, on and off all day. They will even be there overnight if mom (or dad) needs help to the bathroom. Having just one person at home, not multiple aides changing shifts throughout the day or week, cuts down on exposure. Most live-ins will take only one day off a week, and that one day can be covered with one individual, for a total risk of exposure of just 2, versus the alternatives.

Being that the stakes are so high for so many of our parents, it makes sense that you may want to consider speaking to them about the option of using a live-in, even temporarily, to greatly reduce their risk of exposure. It’s simple math.

You can call your local home care agency and see if they can supply you with a live-in that can meet your needs. You can always switch back to hourly aides, or return to the assisted living facility (ALF) when the COVID-19 threat has passed.

To find an Aging Life Care Manager in your parents’ area to discuss your options, go to the Aging Life Care Association® website: www.aginglifecare.org

About the Author: David Petroski is the Founder of Grandma Joan’s Live-in Care Placements. He is a Human Resource Specialist that has helped staff over 10 million dollars in household payroll. David has been an expert panelist for CPE-accredited webinars educating hundreds of senior-care industry professionals about private-hire live-in care. He has been interviewed on radio and is quoted in the 2018 book “Aging With Care”.

WHO reference: https://www.who.int/news-room/q-a-detail/q-a-similarities-and-differences-covid-19-and-influenza

ALCA Members and Corporate Partners – Better Together During a Global Pandemic

//// By Nancy Avitabile //// New York City, NY ////

New York City slowly began shutting down around March 6. Some intrepid individuals continued to work until the Shelter-in-Place order was declared by Governor Cuomo on March 20. Aging Life Care Managers (ALCM) began to scramble; every day offered new information about public safety and disruptions in all aspects of commerce and daily life. After clients were safely tucked away with their “sheltering in place” home care workers, ancillary staff put on leave, and Essential Staff letters completed and delivered, reality set in.

Mid-March was gloomy; ambient sirens became the norm and we became increasingly dependent on ALCA Corporate Partners for supporting client’s needs. ALCMs were limited to only essential visits and prohibited from entering facilities. Though we managed our clients remotely, we leaned on our Corporate Partners for support.

And what a support team: CareTree offered daily gratitude messages, kept the database running, and offered new ways to capture data. Elder Pages Online helped us innovate. Redlig Financial Services supported our household employee payroll and alerted us to important benefits for furloughed workers. LK Daily Money Management and Eddy and Schein Group did not miss a beat in payments to home care workers and suppliers. Privatus Care Solutions sent a steady stream of RNs and HHAs, armed with N95 masks, to critical patients in the home. ComForCare maintained continuity of caregivers and its owner personally delivered PPE to client homes. Home Care Match workers maintained their loyalty, servicing their in-home clients with the utmost professionalism. ALCA Corporate Partners made it possible for our care managers to carry on essential work: advising families on advanced directives, making palliative or hospice arrangements, coordinating care, and triaging needed services.

As the 7:00 o’clock cheer rings nightly through New York City, I thank the ALCA Corporate Partners who have helped us be better Aging Life Care Managers during the COVID 19 Pandemic.

#ALCAbettertogether

About the Author: Nancy has been featured in Thomson Reuters, “The Business of Managing Old Age”, Consumer Reports and US News and World Reports and contributed to the Aging Life Care Association™ publications, “Inside ALCA” and “The Journal of Aging Life Care”. She is a Past-President of Aging Life Care Association™. Nancy lives in Manhattan and is the owner of Urban Eldercare, LLC,  and Aging Life Care group practice.

 

A Different Kind of Mother’s Day

//// By: Tanya Schwartz, LCSWR ////

“Please tell the caregivers that we won’t need them this Mother’s Day weekend”

“What do you think my mother will find useful and enjoyable as a Mother’s Day present?

“Could we speak about my parents’ well-being in person while I am visiting them this weekend?”

These are all questions I often hear in my work as an Aging Life Care® (ALCA) Professional this time of year.

This year however, Mother’s Day promises to be very different.  Given the current pandemic and most states with “shelter-in-home” orders, many families are not able to visit their loved ones due to travel restrictions.  They may not be able to drive or fly to see them for several months.  How do they ensure that their elderly loved ones stay safe and healthy during these unprecedented times?  How do they, worried and “anchored-in-place” caregivers, provide for their loved ones’ needs?

There have been several articles written on this subject by my esteemed ALCA colleagues.  Having a realistic view of your loved ones’ needs and abilities is important.  Having a list of important contacts, your loved ones’ medications, pharmacy and medical providers who prescribe their medications is crucial.  Treating your elderly with respect and dignity they deserve, regardless of pandemic, is paramount.

I recommend beginning by making sure you speak to your loved ones on a daily basis, during their “best” times that do not interfere with their nap, favorite TV show, or an evening routine.  Prepare to be an active, empathetic and grateful listener. By asking questions about their meals and daily routines you may get a glimpse into how your loved ones are functioning during the pandemic.  Who else do they talk to during the day?  Are they able to FaceTime or have they been frustrated by technology? Do they know and trust their neighbors?  Does anyone have a key to your loved ones’ home, in case of an emergency? Afterward you should ask specific questions about your loved ones’ needs being met- are they able to go out and get food during early “senior hours?” What do they usually buy?  Do they cook for one day or several days?  When going out, do they wear protective masks and gloves?  Gently ask about their medication routines; when do they take their medications, does their pharmacy deliver them or do they need to be picked up? Would your loved ones be comfortable with you ensuring that they have adequate food and medication supply?  Please inquire if your loved ones will give you permission to speak with their primary care providers and pharmacies in case of emergency.

Legal documents are crucial for many reasons, especially if a loved one is hospitalized.  Please make sure you have HCP and/or POA paperwork, and a HIPAA release to speak with medical providers.  It may be a good idea to call providers now and introduce yourself so that they are aware of your involvement, and not just when there is a crisis.

Your daily phone call is important to assess your loved ones’ physical needs and their level of isolation.   Please discuss and reminisce about good times. Please recall hard times when your family overcame something distressing and difficult.  Let your loved ones reflect on their strength, wisdom, resilience, and connection to the world.

I receive many aging-related Mother’s Day ideas in my inbox during this time of year.  Most of them discuss what our elderly treasure most, and it is not material or physical things.  Instead, it is the gift of our time, our uninterrupted attention, our presence to allow a conversation about what has been, what is, and what may or may not be.  We have the gift of time during this pandemic, the gift to listen to our loved ones and to be holistically present with them.

This “gift of presence” does not preclude long-distance caregivers from worrying about their loved ones.  They can offer more than a daily phone call.  They can also hire an Aging Life Care® professional in your loved one’s area through www.aginglifecare.org.  ALCA professional works locally, provides continuous assessment and much-needed care coordination with consistent updates about your loved ones’ routines, monitor changes in their functioning and needs, and advocate for their well-being.  Experts in “Aging Well”, ALCA professionals utilize a holistic approach of working with older adults.  They work closely with your loved ones, their family members, providers, pharmacies, housing and financial specialists.  They know your loved ones’ routines and preferences.  Working with an ALCA professional will allow you, instead of being worried and scrambling “anchored-in-place” long-distance caregiver, to be a more present and dedicated relative, the best Mother’s gift of all times.

About the Author: Tatyana Schwartz, LCSW-R, C-ASWCM, is an Advanced Professional Member of ALCA since 2013. She is dedicated to the field of aging and is a founder of New York chapter Capital Region ALCA unit. Tatyana is employed by Care Manage for All, LLC and has a solo psychotherapy practice.  She resides in Albany, NY with her family and a therapy dog.

Covid19: Till Death Do Us Part and No Sooner-An Aging Life Care Manager Advocating for A Simple Wish

By: Bridget Ritossa ////

During the first week of April I spent 48-hours working a case given to me by an elder lawyer.  A client was at the hospital and deemed medically stable.  The nursing home that sent him there for cardiac trouble would not take him back unless the hospital agreed to the terms of providing 14 days’ worth of face masks, and gloves.  The nursing home was also demanding 2 COVID-19 swab tests within 24 hours of discharge.  The hospital did not want to use their tests and the nursing home had no PPE and was trying to protect their residents.  Who is caught in the middle?  My client.

In a previous life, I was a discharge planner at University Hospitals. Prior to that life, I was a social worker and admissions coordinator in nursing homes.  Having the knowledge of rules, laws, and how to navigate in both settings I knew exactly what I would do to advocate for this poor 88-year-old couple who longed to be back together for Easter/Passover.

Anyone who knows me fairly well knows that when I am passionate about something, I will not stop advocating until I feel I have done all that I can.  Quitting or giving up is just not in my nature.  So, with a burning fire in my belly I set out with the goal of getting this couple back together again.  They had not seen each other since the nursing home discharged him to the hospital on March 27th for heart trouble.  State orders are in place that no-one can visit a hospital making the situation that much more difficult.

I am writing this on April 10th and the hospital is stating “if the facility will not take my 88-year old client back under the hospital’s terms then they can send him 60 miles away to a facility that would”.  I thought to myself, “this is not the ‘world-class care’ I hear this hospital advertises it is.”

It was a very busy next few days on the line.  I made calls to Our State Representatives including the Governor of Ohio.   I called the Ohio Department of Health.  I called the State Ombudsman Office.   I called the President of the Hospital.  I called the Corporate office of the Nursing Home Chain.  I called the County Ombudsman.  Who didn’t I call?

It took a village to move the mountain but, in the end, we were able to unite this older adult couple in the retirement community that they bought into years ago.  Couples buy into a retirement community for the security of knowing that they will be able to live their last days of life together no matter what.  It would be a shame if this could not be honored.

It was very interesting to find that neither entity, the hospital nor nursing home were willing to bend until I became involved.  Very sad but true.   It took hours of time.  It is troubling that it took so much effort to do the right thing, to do what the patient wanted.

All that the patient and his supportive wife of 45 years wanted was a return to home, to be together forever.  The hospital eventually agreed to provide the tests to the nursing home after we elevated the situation to the hospital legal team.

My hope would be that all older adults could have an Aging Life Care Manager to assist them in times such as this; the reality is most cannot.  Most people do not even know that the profession exists.  For this reason, the state needs to step in and provide some sort of clarity to both the hospital and nursing home to protect this vulnerable population.

In the meantime, Aging Life Care Professionals® such as myself are available to advocate for families and older adults to make certain our elderly population can live their lives out as planned.

About the Author: Bridget Ritossa is the owner of Careplan Geriatric Care Managers and serves as a Midwest board member for The Aging Life Care Association™ formerly known as The National Association of Geriatric Care Managers. Bridget is the Cleveland Unit Leader for ALCA. She can be reached at bridget@careplangcm.com or (440) 476-9534.

Looking out for the emotionally vulnerable in the COVID world

By:  Bunni Dybnis, MA, LMFT, CMC

Our lives have changed dramatically as COVID-19 becomes the focus of most everything. The news, warnings, restrictions, instructions, double messages, shortages, politics, and financial implications are never-ending. For most, the initial chaos, fears, panic, and confusion settle in as we adapt to our new world.  For a small number, the major impact of their situation, combined with their adaptive coping styles is more of a concern.  Those over sixty-five will have more of a challenge.

I have three long-time friends I will call Jane, Irene, and Cathy.  Jane and Irene were diagnosed with cancer in early March, when the COVID virus was starting to make front-page news.  They are both over 70. They both are undergoing life-sustaining chemotherapy upon the recommendation of their medical teams.  They both have supportive families, close friends, and financial security.  Undeniably, they both have reason to be concerned.

Jane, after the initial shock, is responding with appreciation of her doctors, children, and others who are reaching out. She continues to be socially and mentally engaged reading, Netflix bingeing, enjoying virtual cultural events, and fine dining take-outs. She is active on social media and communicating regularly with friends. She is thrilled that her hairdresser was able to style a wig she will wear when her hair falls out.

Irene ‘s response is different. She has taken to her bed and spends her days in self-isolation.  She refuses to engage with her many supports.  She is both physically and emotionally exhausted. Irene’s family is at a loss.  The history of responding with resilience by Jane, and despair by Irene, separates the two.

Another friend, Cathy, can’t break the cycle of obsessing on every bad detail of the news. The anxiety has lead to sleeplessness and erratic eating.  Cathy is immobilized by symptoms of depression, unable to work, catch up, or engage in other activities that could reduce the stress.  Unlike Jane, Irene and Cathy are in need of further interventions to assist them in the challenges they face.

I thrive on social interaction. Being widowed with children long out of the house, my network has extended far beyond the walls of my home. Continuous contact with family, a solid network of old friends that are like family, close business colleagues and new relationships have kept me engaged.

The biggest challenge has been adjusting to social distancing that is now the reality.  Like most, I have figured out a way to cope and adjust to a new normal: Zooming, FaceTime, DIY projects, Crafts, Book clubs, Support groups, Happy hours, Lectures, Adult learning, Walking, Texting, Connecting with old friends, Organizing, Staying on top of business and personal obligations, Walks in the neighborhood, Cleaning closets, Cooking, and reaching out – keep me busy and energized.

All these activities don’t make up for face-to-face contacts, dining out, canceled vacations, and cultural outings.  One day that will all return.

Being able to cope with loss and change is the norm.  The grief or adjustment process is well documented.  Over eight-in-ten people will go through a series of emotions, and over time will move toward resolution and healing.  The self-identified introverts who no longer have to meet the regular social demands might even thrive. The vulnerability and restrictions on those over 65 is a cause for added stress. It may take a little longer and be more challenging, but most will learn to adapt and move forward.  Beyond age, there are some additional risks and challenges for family caregivers, the frailest, and most physically and cognitively impaired. They must be identified and provided additional assistance or inventions as needed.

Those older adults residing in assisted living, and skilled nursing facilities are truly under threat of exposure to COVID-19 and the high risk of mortality. Extreme responses to this threat should not be considered mal-adaptive in anyway.  The legitimate fears and isolation from loved ones must be attended to.  Many of the frailest and most vulnerable are not computer literate. They also may have sight or hearing deficits.  These folks can’t take advantage of the tools that many of us have taken for granted. There is an excellent article in the New York Times that speaks some of the ways to assist.

Many families are introducing technology when there is an opportunity. It can be a time to be creative.

  • For those whose family member is in a senior care facility, and outside visitors are not allowed, staff can act as a surrogate introducing an Ipad, computer, or other technology.
  • Checking in by phone, old-fashioned letter writing, greeting cards, and outside window visits from loved ones can all make a difference.
  • IPods with generational appropriate music and art kits can bring enjoyment.
  • Don’t forget the normal maintenance to enhance sensory enjoyment.
    • Keeping hearing aids and corrective lenses current is essential.
    • Volume enhancing telephones and other adaptive devices are available online.
    • There is a huge network of senior service providers and professionals who specialize in working with seniors available to assist.

Unfortunately, there is still a stigma around the on-going fatigue of caregivers and front line workers. The chronic nature of symptoms for those with mental health needs are often ignored until a crisis hits. Those with a history of depression, anxiety, or related disorders are particularly affected in these times of danger, chaos, and change.  Proactive intervention by medical or mental health professionals should be considered for those at high risk. The accelerating use of telemedicine makes these interventions easier to assess than ever before.

It is no longer just the other.  Grieving what has been taken from us, affects us all.  Older adults are more vulnerable to both short term and long-term consequences of not having the coping skills to maintain their health and emotional well being.  If there is a concern an Aging Life Care Manager can provide an evaluation of the situation and provide options for intervention (www.aginglifecare.org)

ABOUT THE AUTHOR: Bunni Dybnis, MA, LMFT, CMC is the President and Founder of Aging Life Matters.   She has spent the last twenty-five years supporting families and their trusted advisors addressing the often-complex issues of aging, end of life and family dynamics.  A Fellow in the Leadership Academy of the Aging Life Care Association Bunni has received multiple awards for her leadership, participation and achievements in geriatric care from both the Association and organizations both national and local.

The Art of Listening: Achieving Successful Communication

By: Miriam Zucker, LMSW, ACSW, C-ASWC

As Aging Life Care Specialists(r), we are called upon to provide an assortment of services. The needs are as varied as the families we are helping.  We continuously strive to be experts in our knowledge of homecare, entitlements, senior residences, elder law attorneys, and providing skilled and supportive counseling. But we are only effective if, throughout our dialogue with families, we listen. Effective listening combined with effective communication sets the foundation for successive and successful outcomes.

The art of listening, sometimes referred to as “active listening” requires two essential tasks. First, that we as care managers, listen, making a mindful effort to hear the words that seniors and their family are saying. Second, we must concentrate on what is being said establishing a virtual stop sign that leaves no room for our own assumptions and prejudices. We cannot assume or anticipate conclusions. With these two tasks as starting points, our listening is enhanced by four other components.

We listen mindfully, putting aside any distracting (as opposed to professional beliefs) thoughts. We listen without having an inner dialogue that will have an automatic response to a situation that is verbally evolving.

We listen without interrupting, knowing it may disrupt a client’s train of thought, especially if the person is cognitively compromised. A semi-smile (think Mona Lisa) or an encouraging “uh-huh,” let’s the person know we are with them, we are listening.

We ask for clarification at the appropriate time. Siblings may finish telling of their conflicting feelings about what they each think is best for mom, and we reply: “So let me make sure I understand.” It is that clarification that allows for modification and affirmation.

Finally, after all information has been shared, the Aging Life Care Professional(r) summarizes what has been said and listens for what has not been said, the latter perhaps a clue to the issue at hand.

Our listening skills remain strong as we adapt to the challenges brought on by the COVID-19 virus. Historically, families have sought the guidance of an Aging Life Care Specialist as they pondered whether a parent would be better served in assisted living or remain at home with help. Now, families are asking our guidance as they question if a parent should return home or remain in their senior residence. Whoever would have thought?  Through this crisis, we will stand strong with our families, listening deeply and fully, a north star during uncertain times.

ABOUT THE AUTHOR: Miriam Zucker, LMSW, ACSW, C-ASWCM is the founder of Directions in Aging, an Aging Life Care practice based in Westchester County, New York. She did her post master’s training at the Brookdale Center for Healthy Aging where she later served as a faculty member. Founded in 1988, Directions in Aging brings over two decades of experience working with older adults and their families.