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All posts by Courtney Pulitzer

“Dad resists every suggestion I make! Help!”

Susan is getting burnt out trying to care for her 91 year old father.  She has a part-time job teaching and takes care of her two school-age grandchildren in the afternoons.  Her mother has been gone for three years and Dad is truly struggling to stay independent, and failing at that.  His neighbors and church friends are calling Susan almost daily with stories of his poor judgment or his obvious weight loss.  Susan lives 2 hours from her dad and has tried unsuccessfully to get him to move to a retirement complex near her and her only sibling, a brother who has his own set of health problems but would visit if Dad were closer.

She has tried home-delivered meals, daily visitor programs, emergency response systems, and also purchased him a simple cell phone–all received with a smile and then canceled or not used.  Dad has some memory issues not yet diagnosed; his diet is poor, mostly fast food and salty snacks.  He is still driving to the chagrin of the neighbors; actually, he goes so slow they can’t really go anywhere.

Susan has tried local senior clubs and has even hired a caregiver for cooking and light housework, but Dad fired her too.  He says that he can do everything by himself; however, the house is looking more unkempt and clutter is covering every space.  Susan is amazed that he can find his checkbook to pay his few bills; she did successfully get most bills paid automatically.

Susan just heard a lecture from an Aging Life Care Manager about the importance of planning ahead with aging family members and wonders what will happen when Dad has a major fall or illness.  The Aging Life Care Manager (also called a Geriatric Care Manager), convinced her to have a “strategy meeting” for some “Win-Win” ideas.

She was happy to hear during her time with the Care Manager that her dad might be more likely to accept suggestions from a non-family member than from his “overly worried” daughter, which is what he calls her.

These are some of the suggestions that are working for her father now (all introduced by the Aging Life Care Manager and not Susan):

  • Instead of being called the “caregiver”, they came up with the idea of a “personal trainer.” Dad did like to work out when younger but his eyesight has diminished, making a trainer a welcome change in addition to having another male to talk with twice a week. The trainer now brings healthy meals and has extended his time to 4 hours a day, five days a week over a few months.  The trainer is actually a “home care worker” who loves to exercise – but the daughter learned not to tell Dad all the details or how much it costs.  The daughter has access to the family trust and is keeping a good record of all expenses.

 

  • The dad’s doctor finally agreed to have him tested for dementia and he does have early-stage Alzheimer’s disease. Dad understands it as an illness that impairs memory, but he still can live at home because he has “Jim” the trainer. Jim is willing to extend his hours as time goes on.

 

  • Susan was also encouraged to join a support group lead by the Aging Life Care Manager and has learned so many tricks for managing Dad’s needs without a lot of discussions with Dad. That has led to a much better relationship between the two.  She has also found a retirement complex near her and “Jim” the trainer is going to drive up to see it for the future (or so that is the story).

 

With the assistance of the Aging Life Care Manager, Susan has moved from “worried” to “grateful” that Dad can still have some quality time in his own home that is safe, well-monitored, and in line with Dad’s values for now.  She also has a plan and an ally with her Aging Life Care Manager for the strategy when it is time to move Dad.

About the Author: Linda Fodrini-Johnson, MA, MFT, CMC. Head of Corporate Care Management for Home Care Assistance. Linda is a Licensed Family Therapist and a certified Professional Care Manager. She is also a past President of the Aging Life Care Association. In 1989, Linda founded Eldercare Services in the San Francisco Bay Area and became a pioneer in geriatric care management. Linda has always been a passionate educator to families and professionals in the “aging space”. Eldercare was sold to Home Care Assistance last year and Linda now serves as the Head of Corporate Care Management. She is also a consultant with Dr. Leslie Kernisan’s, Better Health While Aging/Helping Older Parents – an online coaching team.

Caring for our Elders and Raising Abuse Awareness

Nearly 1 in 10 American senior citizens are abused or neglected each year, yet only 1 in 14 cases of elder abuse is brought to the attention of authorities, according to the U.S. Department of Health & Human Services. Elder abuse can mean physical and psychological harm, but it also may manifest through financial exploitation and theft. The United Nations has designated June as World Elder Abuse Awareness Month.

To take action and be part of the solution, the Aging Life Care Association sent an InstaPOLL to members to see how prevalent elder abuse may be with their clients. Of the 171 members who responded to the poll, a whopping 151 or 87% indicated they had had a client who was a victim of elder abuse!  The top three areas Aging Life Care managers saw abuse were:

  1. Financial exploitation– The unauthorized use of an elderly person’s funds or property, either by a caregiver or an outside scam artist. An unscrupulous caregiver might:
    • Misuse an elder’s personal checks, credit cards, or accounts
    • Steal cash, income checks, or household goods
    • Forge the elder’s signature
    • Engage in identity theft

Financial Abuse topped the chart with 128 responders or 86% of members indicating they had experienced this with their clients.

  1. Emotional elder abuse– The treatment of an older adult in ways that cause emotional or psychological pain or distress.

Emotional Abuse came in second with 96 responders or 64% indicating their clients had experienced this type of abuse

 Elder neglect– Failure to fulfill a caretaking obligation. It can be intentional or unintentional, based on factors such as ignorance or denial that an elderly charge needs as much care as they do.

Self Neglect and Neglect in general, were statistically close with 53% of responders indicating this type of experience with a client.

 

Elder abuse is a serious crime against some of our nation’s most vulnerable citizens. Aging Life Care Managers have focused on caring for these defenselessness, older adult members of society since its founding in 1985. The seasoned professional members of the Aging Life Care Association can identify what type of person is susceptible to abuse and the elusive signs a family may miss. They are also aware of the resources to refer to when abuse of any nature is suspected.

In interpreting the comments of those taking the survey, the Aging Life Care Managers felt that cognitive impairment due to Alzheimer’s disease and related dementia placed their elders at a high risk for abuse and neglect.

Members also indicated that the person most likely to be the abuser were often adult children, other family members such as grandchildren, or a spouse or partner. Perpetrators also frequently mentioned were those in a caregiving capacity.

An Aging Life Care Professional can help families prevent abuse by being their eyes and ears on the scene, monitoring and overseeing all interactions with the older adult. According to the poll, their primary source of referrals when abuse was identified were the Department of Aging,  Attorneys and the police. Polled members indicated they were unfortunately frequently called in to assist families after the abuse occurred.

Elder abuse is a serious crime against some of our nation’s most vulnerable citizens,

And a matter of worldwide concern that demands a global multifaceted response.

For more information on World Elder Abuse Awareness Day, visit the National Center for Elder Abuse (https://ncea.acl.gov/) website. Additionally, the Department of Justice offers an abundance of information and resources online through its Elder Justice Initiative. (https://www.justice.gov/elderjustice)

If you suspect elder abuse, call 911 for an emergency. In a non-emergency situation, use the online Elder Care Locator, (https://eldercare.acl.gov/Public/Index.aspx)

or you may call 1-800-677-1116 to find your local elder care agency.

About the Author: Barbara (Bobbi) Kolonay RN MS CCM. Owner of Holistic Aging (www.holisticaging.com) An Aging Life Care Management practice in Pittsburgh PA. Fellow of the Leadership Academy of ALCA

Suicide Among Older Adults – And Help For Them

//// By Susan Birenbaum LCSW, MBA, C-ASWCM ////

People do not realize that suicide is a major problem in the elderly. Since Older Adults have so many medical issues, it is assumed that death is a result of co-morbidity rather than suicide. Albeit, our society does not value older adults as other cultures do. In fact, if you read statistics and concerns about suicide in this country, the media reports about a rise in suicide in the youth and college-age population. The mental health community is much more active in trying to stem the suicide rate among this population. According to the World Health Organization (2012), suicide among older adults is a far more common occurrence in the United States than youth and are the highest rate of completed suicides. In 2013, more than 7,000 people age 65> died by suicide. (CDC, 2013) and14% of all suicides in the United States are among older people. In addition, thousands of older adults who die by suicide, many more have made suicide attempts and suffer from the emotional pain of suicidal thoughts.

The issue of suicide in the United States is a rapidly growing problem. The increase of the population living longer and the large cohort of “Boomers” who are transitioning into this demographic, means that we are facing a major mental health crisis that needs to be addressed now. In a review of the literature, there does not appear to be any actions by the Federal  Government or individual States that our healthcare system has any initiatives to help older people prevent suicide. Despite the fact, that suicide prevention continues to be a priority in healthcare, suicide in the elderly remains a neglected subset with little interest and few studies.

Suicide rates are particularly high among white males 65>, higher than any other group in our population. (SAMSHA, 2013b). Although suicide attempts are more common among older women, attempts are more fatal among men because 35% of men use alcohol and firearms.

 

I recommend that you watch the YouTube video by Dr. Yeates Conwell, “Suicidal Behavior in Older Adults” (2013). [1]

Dr. Conwell has identified what he considers as the 4 D Risks of Suicide:

  • Depression
  • Disability
  • Disconnectedness
  • Deadly Means

Depression:

The population attributable to suicide risk has a high association with depression. However, depression as a predictor of suicide is low. Hopelessness and suicidal ideation are neither necessary nor sufficient to predict suicide.  Depression is a treatable illness. Reduction in depression can lead to a reduction in suicide.

Signs of depression are: lack of interest, sleep issues, problems concentrating, changes in activities.

Disability:

Depression frequently occurs with impaired vision, hearing loss, heart attacks, strokes, and dementia and amplifies disability associated with them.

Disconnectedness:

Disconnectedness results in loneliness and isolation for both older men and women due to major changes and losses in their lives. Often times, their spouses die, their friends die and/or move away, they are forced to change their lifestyles and move out of the house that they have lived in for many years and move away from their community. This means going to another place, often an assisted living facility, a nursing home, or a place near their children. They also experience a loss of independence. Due to physical disabilities, dementia, they are forced to stop driving and rely on other people. They feel that they are no longer part of a community.

Women suffer these losses, but overall they are generally able to form new friendships and activities, where men are not accustomed to friendships and activities.

The loss of identity is felt most in men beginning at age 65 and becoming more extreme by the time that they reach age 85. They are usually very isolated and did not build friendships the way women do. They often resort to alcohol abuse and loneliness. They do not have family or peers to leverage interventions for their benefit.

Deadly means:

In general, it is more common for older men to end their lives by using firearms.

Dr. Conwell has reported that studies of older adults are generally composed of the female population, not including men.

Promoting Emotional Health and Preventing Suicide

It is known that older adults do not believe in Mental Health Professionals, but they do rely on their Primary Care Physicians. In fact, it has been reported that many people who have died from suicide had seen their PCP in the month prior to their death. Most PCPs are not trained in Geriatric Mental Health.

  • It is important that PCPs as part of their practice have the tools to evaluate their patients for Depression and Suicidal Risk. Ideally, it would be best if they had a trained Mental Health Professional in their office who could screen patients. There are many measurement tools available to identify risks. If there appears to be a risk, then patients should be referred to Mental Health Professionals.
  • Family members, peers, friends, and others should monitor the older person’s mood and if there is a change in regular activity or mood, they should reach out to professionals. When speaking with older adults, do not ask if they are depressed, but rather are they sad.

Tool Kit for Senior Centers/Assisted Living Facilities

(http://store.samshsa.gov/product/SMA10-4515)

An individual should be designated and trained to use the screening tool which could identify signs of depression and suicidality in residents. Although suicide is rare in congregate living facilities, when it occurs it has a devastating effect on all the residents.

Profile of characteristics associated with depression among residents in facilities:

  • Greater Disability
  • Negative attitude toward aging
  • Poorer self- rated health
  • Lose of sense of mastery
  • Less religiosity

Many of the reasons that older adults have moved to facilities are very stressful and complicate adjustment to new surroundings, new neighbors, and new norms. The events include: loss of spouse or caregiver, increased physical vulnerability, illness, cognitive impairment.  The majority of residents are women.

Resources:

American Foundation for Suicide Prevention (afsp.org)

  • The foremost organization for research, education, advocacy for prevention of suicide in the United States.

National Suicide Prevention Help Line

  • 1-800-273- talk (8255)
  • Text 741741 to speak with a trained counselor 

Federal Communications Commission

  • Is implementing a number to call if someone is in crisis of suicide. The number will be 988. It is not operational yet, but will be soon. Check their website for updates.

[1] Dr Conwell is Professional & Vice Chair, Co-Director of the Center for Study and Prevention of Suicide Prevention and Director of the Geriatric Psychiatry Program in the Department of Psychiatry at the University of Rochester.

About the Author: Susan Birenbaum is the founder of Susan Birenbaum Associates LLC. She is a certified Aging Life Care™ Manager for over 12 years; a New York State Licensed Clinical Social Worker (LCSW); and has Guardianship Certification by the State of New York. Follow Susan on Twitter @SBLCSW, Susan Birenbaum on Linkedin and Susan Birenbaum on Facebook or email her: susanbirenbaumllc @ Gmail .com

 

Putting Pen to Paper in the Time of COVID-19

“To write a letter is human, to receive a letter, divine” – Susan Lendroth

Four years ago, I downsized. Living in an apartment house, I am now part of a community, not a formal one, but one with a passing hello in the lobby or weather conversation in the elevator. However, it was my relationship with our fifth-floor neighbor that went beyond the hello and the weather.  Meg was of an earlier generation, there was no computer in her home and only the most basic of cell phones. In lieu of these items were plenty of paper and pen.

Given the generational gap, Meg was a woman of notes. Invariably, they would be slipped under our kitchen door. They varied in nature, telling us she would be visiting family, wishing us a happy Thanksgiving or my favorite, letting me know how much she enjoyed looking at my hanging geraniums that she could see from her living room window. In our three years as neighbors, I left my computer and iPhone behind. From my side of the hallway, it was a note thanking her for taking in our newspapers or a holiday card with an accompanying note. There was something so special about our across-the-hall communication. These notes were acts of thoughtfulness. Sometimes on a random piece of paper or other times on a real piece of stationery, especially when Meg’s birthday rolled around. The common characteristic that each of our exchanged notes shared was gratitude.

As much as I delighted in having Meg across the hall, I knew that a woman approaching her ninetieth birthday with an array of minor health problems, should not be living alone. Her children, also knew this. Meg would tell me in her soft voice, that while she understood the logic of a move to assisted living, she was saddened to leave her beloved New Rochelle where she was born, and raised her family. Inevitably, acceptance trumped resistance.  We had said our good-byes many times, voicing how fortunate we both were to have each other as neighbors. I returned home one day, the wreath that changed with the season was off Meg’s door and Meg was gone.

In the weeks following Meg’s move, I sent a note, bringing her up to date on what was going on with my family and inquiring about how she was doing.  In return, I received a lovely card from Meg. A few brief sentences, with her ever-thoughtful sentiments.

Quoting Phyllis Theroux, a writer based in California: “to write a letter is a good way to go somewhere without moving anything but your heart.”  In these times of COVID-19, where going anywhere is done with an abundance of caution or not at all, a note not only moves the heart but let’s those we care about know they are remembered.About the Author: Miriam Zucker, LMSW, ACSW, C-ASWCM is the founder of Directions in Aging, an Aging Life Care practice based in New Rochelle, 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.

 

7 Common Myths About Elder Abuse

World Elder Abuse Awareness Day was launched in 2006 on June 15th by the World Health Organization. Elder abuse is one of the most overlooked public health problems in the United States. Victims of abuse are three times more likely than those who weren’t mistreated to die prematurely. Learn how to identify those at risk and what to do if you are concerned about a vulnerable adult.

//// By: Jullie Gray, MSW, LICSW, CMC – Aging Life Care Association™ Member and Fellow of the Leadership Academy ////

Perceptions people have about elder abuse are usually wrong. That’s disheartening because the way we think about elder mistreatment affects our ability to recognize the signs of abuse and our sense of urgency and commitment about stopping it.

Let’s take a look at the most common myths and learn the facts.

Myth #1 – Elder abuse occurs mostly in nursing homes.

Even though elder abuse does occur in nursing homes, it most often happens at home, behind closed doors in every community, regardless of socioeconomic status.[1]

Myth #2 – Strangers and paid caregivers are the ones preying on older people.

It’s heartbreaking, but most vulnerable adults are abused by a known, trusted person – usually a family member.  Abuse is frequently cloaked in a shroud of family secrecy that sometimes makes detection very difficult.

Myth #3 – The bad guys always get caught.

Criminal prosecutions of abusers are actually the exception rather than the rule because most victims don’t tell. They’re afraid, embarrassed or simply unable to report any wrongdoing to authorities.

Myth #4 – If there are no bruises or physical signs of abuse, there is nothing to worry about.

When thinking about abuse, nearly everyone immediately pictures bruises, broken bones and other types of physical cruelty. However, neglect and self-neglect are the most common types of abuse. Emotional abuse and financial exploitation happen frequently too. None of the typical forms of abuse result in obvious outward signs such as black eyes, welts or broken limbs.  If you are only looking for the physical signs of abuse you will inadvertently overlook the vast majority of cases.

Myth #5 – Caregiver stress causes elder abuse.

Caregiving by its very nature can be stressful – but stress doesn’t cause elder abuse. Most stressed caregivers do not harm the person they care for. By focusing on caregiver stress as an explanation, we tacitly excuse inexcusable behavior. Using “stress” as a rationale also shifts the focus to the abuser and away from the victim by evoking a perception that if the older person was just easier to care for, not sick, and not so demanding, the abuse would never occur.[2]

Myth #6 – Elder abuse happens to men and women equally.

Elder abuse happens most often to women, but plenty of men fall victim too. Regardless of gender, those with some type of cognitive impairment are at greatest risk of being abused.

Myth #7 – It’s not that big of a deal.

Elder abuse is one of the most overlooked public health hazards in the United States. Victims of abuse are three times more likely than those who weren’t mistreated to die prematurely. The National Center on Elder Abuse[3] estimates that between two to five million elderly Americans experience some form of abuse each year. It is believed that for every one case of elder abuse, neglect, exploitation, or self-neglect reported to authorities, about five more go unreported.

Observing signs of abuse

Since a victim may not be able to report abuse, it’s up to others to observe the signs and intervene.types and definitions of abuse

Physical indicators can suggest abuse is occurring

  • Injuries that are inconsistent with the explanation for their cause
  • Bruises, welts, cuts, burns
  • Dehydration or malnutrition without illness-related cause

Behavioral signs shown by the victim indicating possible abuse

  • Fear, anxiety, agitation, anger, depression
  • Contradictory statements, implausible explanations for injuries
  • Hesitation to talk openly

Patterns seen in caretakers who abuse

  • History of substance abuse, mental illness, criminal behavior or family violence
  • Anger, indifference, aggressive behavior toward the victim
  • Prevents victim from speaking to or seeing visitors
  • Flirtation or coyness as possible indicator of inappropriate sexual relationships
  • Conflicting accounts of incidents

Signs a vulnerable person is being financially exploited

  • Frequent expensive gifts from victim to a caretaker or “new best friend”
  • Drafting a new will or power of attorney when the victim seems incapable of drafting legal documents
  • Caretaker’s name (or the name of the victim’s “new best friend”) is added to the bank account
  • Frequent checks made out to “cash”
  • Unusual activity in bank account
  • Sudden changes in spending patterns

What to do if you identify someone at risk

We all need to vigilantly look for abuse around every corner of our neighborhood and in the care facilities we visit. One problem, though, is that our culture has taught us to avert our eyes, cover our ears, and mind our own business.

If you are concerned about a vulnerable adult, call 911 or your local adult protective services agency.

Many families also contact Aging Life Care Professionals™ who can provide an unbiased look at the situation, facilitate family meetings to discuss concerns and provide information about care options or ways to approach the situation.

These dedicated professionals understand the laws concerning elder abuse in the state where they practice and can help navigate complicated bureaucracies, act as an advocate for the older person and help develop a safe plan of care.  They work hand in hand with adult protective service caseworkers, police departments and elder law attorneys to ensure the safety of the older person and to coordinate appropriate services.

It is human nature to want to put our heads in the sand and change the subject to something more pleasant. But if we identify and report abuse when it occurs, we can stop the cycle and protect our most vulnerable elders.

About the author: A Fellow of the Leadership Academy, Jullie Gray has over 30 years of experience in healthcare and aging. She is a Principal at Aging Wisdom in Seattle, WA. Jullie is the President of the National Academy of Certified Care Managers and the Past President of ALCA. Jullie Serves on the King County Elder Abuse Council in Washington State. Follow her on LinkedIn and Twitter @agingwisdom, or email her at jgray@agingwisdom.com. Aging Wisdom has a presence on Facebook – we invite you to like our page.


[1] https://www.justice.gov/elderjustice/research/

[2] Brandl, B. & Raymond, JA. Generations. American Society on Aging. Fall 2012. Vol 36. No. 3. http://www.ncall.us/sites/ncall.us/files/resources/32_39_Gene_36_3_Brandl_Raymond.pdf

[3] http://www.ncea.aoa.gov/

COVID-19 Highlights Caregiver’s Need to Plan Ahead

//// By: Lakelyn Hogan, MA, MBA, Gerontologist and Caregiver Advocate ////

Caring for a family member can require a lot of coordination. Often family caregivers are living day-to-day juggling their responsibilities of caregiving, work and family. Few have the time or make the time to stop and consider plans for the future. COVID-19 (Coronavirus) has provided a bit of a wake-up call as it highlights the reality of illness for caregivers and their loved ones.

Credit: Home Instead Senior Care

A recent survey in the United States, conducted by the A-List, of dementia family caregivers asked about their plans should the virus impact them or their loved ones. The survey found that 73% of people taking care of an individual living with Alzheimer’s disease at home are unsure what would happen to their loved one if they themselves (the caregiver) got sick with COVID-19. Results also found that 42% of caregivers are unsure what to do if their loved one with Alzheimer’s became sick with COVID-19.

It is important for family caregivers to put a plan in place before an illness or crisis hits. This not only ensures that the proper care is in place, it can also help to reduce the stress of decision-making under pressure. The following are tips to for caregivers to consider when planning ahead.

7 Tips for Family Caregivers to Consider When Planning for Care

1. Prompt the conversation and involve your loved one. When putting together a plan, it is necessary to talk with your loved one and involve them in the planning process. These planning conversations are not likely to happen all at once but can be accomplished through a series of discussions. Keep in mind that prompting the conversation may not be successful on the first attempt but do not be discouraged.

You may try setting up a time to discuss: “Mom, I have been thinking about what would happen if you or I got sick. I would really like to talk more about this and get your thoughts on the best plan for us both. Can we talk more about this tomorrow afternoon?”

This approach allows your loved one time to process the conversation and put thought to what their wishes truly are.

2. Actively listen. Once your loved one is open to the conversation, it is important for you to listen. You want to ensure that your loved one feels understood. Resist the urge to criticize or discourage with comments such as “don’t think like that” or “don’t say that.” Allow the individual to talk about their feelings, thoughts and ideas before jumping in with your own opinions.

3. Plan for the short and long term. It is hard to know what tomorrow will bring, so it is imperative to create a short-term plan for an illness such as COVID-19. It is equally important to create a long-term plan should an illness or crisis occur down the road.

Consider who, what, and where.

  • Who is available to step in should you (the caregiver) become ill?
  • What support and care will be needed by your loved one while you recover?
  • Where will the care take place, and will it require a move?

You can also approach the conversation with the intent of creating options: plan A, B and C. Hope for the best-case scenario, plan A, but also have a plan B and plan C if the ideal outcome is not possible. This can be challenging, especially if your loved one wants to remain at home or age in place. It is important to communicate and ensure your aging loved understands that family will strive for plan A, but the reality of the situation may require alternative options.

4. Assemble important documents. Having important documents in place is one thing, but assembling the documents together and having them easily accessible can make all the difference. Have these documents accessible:

  • Power of attorney – ensure one is in place for legal or financial matters
  • Health care proxy – designate someone who can step in to make health-related decisions if needed. Document advance directives to make sure your loved one’s wishes known.
  • Emergency Contacts & Financial Information – Keep an updated list of health care providers, medications and emergency contacts. It is also helpful to have bank information, insurance information and even passwords assembled.

5. Keep a journal or log of key information. In addition to important documents, it can also be helpful to have a record of key information that a person would need to know about your loved one. This is especially important for those living with cognitive impairment such as Alzheimer’s or another form of dementia. Writing down daily routines, preferences and favorite activities can be helpful if someone needed to step in and provide care on short notice.

6. Enlist the help of an expert. If possible, seek help from professionals to assemble key documents. These experts could include an insurance agent, a financial planner or an attorney, particularly one that specializes in elder law. Legal aid may be available for those who cannot afford a private attorney.

7. Regularly communicate the plan. Having a plan in place is most effective when it is up to date and communicated to those involved.  Ensure updates are made on a regular schedule. For example, a family could evaluate the plan every six months. It is also necessary to update the plan as circumstances change. For example, if a family member passes away, the power of attorney may need to be changed or if a new diagnosis is received, the advance directives may need to be updated.

While family caregivers may try to avoid awkward conversations about planning for care and end of life, or simply hope for the best, it is necessary to plan for the worst. Having a plan in place can help to ensure that everyone: aging loved one, family caregiver, adult children and other important contacts are on the same page. This consistent plan and communication can reduce anxiety and provide clarity should illness or a crisis occur. For more information about planning ahead, getting the planning conversation started and to download a free aging plan, visit 4070talk.com.

About the Author: Lakelyn Hogan is Gerontologist and Caregiver Advocate for Home Instead Senior Care. Lakelyn has been with Home Instead for seven years, starting in the local franchise working one-on-one with seniors and caregivers. Now, her role at the Global Headquarters is to educate professionals, families and communities on Home Instead’s services and the issues older adults face. In partnership with the American Society on Aging, Lakelyn facilitates a monthly webinar series for professionals in the aging field. She also hosts monthly family caregiver live chats with Alzheimer’s and dementia experts from across the country.

This post originally appeared here, and is reposted with permission.

Stories of Celebration During COVID-19

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

During March and April our whole world saw this pandemic wreak havoc on our lives. And yet, I’ve been amazed by creative ways that people have celebrated while social distancing. It feels like we’re constantly being bombarded by bad news, it’s tough to think about the current status of our cities, our country, and the world.

And so, to keep us in good spirits, and remember the good work that some have done, here is a compilation of stories of celebration from across the globe. May and June are usually big celebration months — we hope you take inspiration from these stories and find ways to celebrate every day.

Birthdays

Families with loved ones in LTC

Intergenerational

 

Music and Dance

SomeGoodNews with John Krasinski

Teachers reaching out to their students

Thanking Frontline workers during the pandemic

About the Author: Harisa Paco, MSW, LICSW, CMC is a Certified Care Manager at Aging Wisdom 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.

COVID-19 Changes Caregiving at Home Care Facilities

//// By: Annette Murphy, BA, MSW, C-ASWCM ////

The challenges of COVID-19 and the fundamental change it’s bringing to caregiving and our healthcare system will be felt for years to come. Social isolation, hard to find supplies, and worry over the advisability of face-to-face medical visits are just some of the concerns of family and professional caregivers.

The stark differences in today’s caregiving world and how we overcome these new challenges are a topic of conversation at the local, state and national level of the Aging Life Care™ Association (ALCA) and its Aging Life Care Professionals®

Experts in aging well, these professionals are adjusting to a landscape that is shifting for the seniors they serve and in their work life. In this “high touch” profession, the biggest hurdle is not being able to access clients face-to-face.

“You can learn so much face-to-face. By assessing how our client looks, reviewing medications and observing the home environment, we can see indications of decline, functional problems or regressions. With the lockdown, we are making phone calls and relying on observations by home health aides. It’s not the same.

So much of how we support our elders is in activities of daily living like grocery shopping. I can’t go into their home, access the food in a refrigerator and purchase what needs to be restocked. I’m asking them to really think ahead about what groceries they need, including pet food, because when I shop online for them, delivery dates can be weeks out.

Then there are systems in place for things like medication management that are no longer working. Getting the correct medication, in the correct format to clients can be a challenge. It’s required adjusting how the meds are dispensed and how the client gets them, but we make it work.

5 things you should know about your aging parentsIt’s difficult on a personal level as well. We know our clients so well. It’s hard not to be able to interact and give them a hug.” Wendy – Care Manager at Springpoint at Home


Parents Aging at Home“The one thing that has surprised me is how creative we can be in working around not being able to see people. We are demonstrating that a lot can be done using technology, from counseling, service recommendations to telehealth visits. I’ve been impressed with the dedication of everyone to ensure that clients continue to get the best care possible despite current challenges. It’s proving that people who are isolated can still be helped, supported and have an improved quality of life with these types of services.” Mary Ann – Care Manager at Springpoint at Home

Technology is helping much of society to overcome isolation barriers. But technology is often problematic for the people these care managers help. Few of them have cell phones or computers that allow for Skype and Zoom video visits. Many are living with dementia and don’t have the capability to use these technologies, regardless of availability.

Like many professions, the impact COVID-19 is having on aging life care services is occurring at two levels simultaneously. Everyone from national ALCA staff to local agencies are still grappling with these challenges. The more difficult ones are those happening TO them. Client hours are down, there are less hospital and doctor visits and staffing changes can be daily. At the same time, there is a need to shift service and client interaction models.

“As we figure out how to best serve our clients, care managers and staff during these unprecedented times, I am grateful for the 2,000-strong Aging Life Care Association®. This year is the 35th anniversary of ALCA and I am struck by how appropriate our “Better Together” theme is for the time we are in right now.

As Co-President for the NJ Regional Chapter of ALCA, I’m impressed by how all these amazing professionals are working together to embrace change, serve our clients and keep them safe. We are sharing resources on everything from procuring and normalizing protective equipment for our Alzheimer’s clients, to tips on successful telemed and telecounseling sessions.

I always thought of my field as being high touch and low tech. But there is a shift in my thinking that technology is a disconnect. The fact that a fragile elder can see a doctor with telemedicine without going out in bad weather or sitting in a waiting room during flu season is a good, safe alternative. The fact that an isolated elder can push a button and get an LPN on the other end to answer a question is great. I hope the shift in payer sources being open to these options continues.

Some changes are likely to stay beyond this outbreak. Many families live at a distance and user-friendly technologies like Skype or Zoom keep them connected. It means our care managers might use their own device for the meeting, but it is proving to be an emotionally connective tool for families.

There are some things I don’t believe we will go back to any time soon. The days of our care managers visiting 15 nursing homes in a week, meeting with 100’s of people and shaking hands are some of them. It means we can’t be paralyzed by these changes; we have to embrace them.

One of the hardest challenges for me is the sense of collective grief we all feel. In this business, you expect to lose clients and we have coping mechanisms. But the volume of elders we are losing across this nation in a short amount of time is hard. We are powerfully connected to the people we serve through our long-term relationships and it compounds the collective grief. It helps to be a part of a dynamic, experienced group of leaders. When we share stories, experiences and memories, it makes me realize we are better together and it’s OK to be optimistic.

About the Author: Annette Murphy, BA, MSW, C-ASWCM. Annette is the Director of Home Care, Springpoint, and has over 20 years of experience in a variety of healthcare settings. Prior to Annette’s current role as director of home care, she worked as a geriatric care manager and supervisor for Springpoint at Home. She is a licensed clinical social worker, a certified advanced case manager, and a member of the National Association of Social Workers. Annette serves on the Board of Directors for the Aging Life Care® Association of New Jersey, is the New Jersey Chapter Co-President, and is an avid community volunteer. She is a member of the Springpoint Senior Living Ethics Committee and attends the Mercer County Workforce Development Committee meetings.

 

 

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.

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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.