All posts by Courtney Pulitzer

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.

Addressing the Mental Health Concerns of Seniors in the Corona-virus World

by: Bunni Dybnis, MA, LMFT, CMC

COVID-19 has dramatically changed our world. The news, warnings, restrictions, instructions, double messages, shortages, politics, financial implications are never-ending.  Most are resilient.  After the initial chaos, fears, panic, and confusion, the emotional upheaval will settle down.  Most will adapt to the changing world as we have adjusted to life’s twists and turns.

For those who lack the psychological cushion, the present upheaval is of great concern.  Risk factors, background, and community supports will make adjusting more difficult for some. Those displaying complicated adjustment reactions with symptoms of prolonged depression, exaggerated anxiety, obsessions, loneliness, and traumatic stress, can suffer long-term effects.

Older people and those with chronic diseases will be more likely to be sicker and die from the Coronavirus. The extra warnings and restrictions add to the emotional and physical impact.

For Boomers over 60, who thought they could remain forever young, this can be a rude awakening. Active retirees enjoying the benefits of retirement have had that structure taken away. Identified as older adults those over 60 have been encouraged to stay at home and keep contacts to an absolute minimum. Travel, adult learning, recreation activities, group exercise, grandchildren, face-to-face volunteering are no longer options. Their younger cohorts often have employment or childcare responsibilities built into their daily lives their lives, thus making their changes less dramatic.

There are red flags to identify those that may be at a greater chance of despair and psychiatric meltdown.

  • Serious symptoms go up with age. Younger adults are vulnerable, but those in their 60s, 70s and particularly those in their 80s and 90s, have the most risk of dying.
  • The recent death of a loved one can intensify reactions of grief. Not being able to visit a critically ill loved one is heartbreaking. Having to mourn the loss of a loved one without formal ritual and community support can greatly impact the grieving process.
  • Physical decline, medical needs, loss of mobility, cognitive changes, social isolation, and risk of self-neglect and undue influence associated with aging continue to be a concern.
  • Both formal (paid) and informal (family and friends) caregivers are already at risk for burnout, depression, and stress on the immune system. Their own ability to cope with the virus exaggerates their risks.
  • Pre-existing conditions make things worse. Chronic health conditions, cancers, and other illnesses add to high morbidity rate.
  • Proximity to people who are at risk of carrying the virus, such as hospitalizations, medical symptoms, residency in nursing and homes senior living communities, all lead to stress.
  • Prior psychiatric history or substance abuse issues.
  • The way people have coped with stress, death, illness or other major life changes will give you insight into how they will cope with the fears of the virus.

Informal support of friends and family can be vital supporting many at risk. Skilled experienced professionals that are trained to work with older adults may be necessary.  

There are ways to mitigate the detrimental emotional fallout for older adults and those that are caring for them.

  • Address critical concerns that are unique to aging adults and those who care for them: Seek medical attention, support that is available through local senior services or hire a private Aging Life Care Manager to assess the situation. If there is a suspicion of self-neglect or elder abuse contact Adult Protective Services.
  • Support family and paid caregivers: To the extent possible, limit the number of people that are face-to-face with older adults. Prioritize critical needs. Supportive counseling or reaching out to those on the front line can be beneficial.
  • Continue treatment for underlying mental health conditions: If emotions become overwhelming and there is risk of harm to themselves or others, immediate actions should be taken. Call the treating medical professional or 911 for direction.
  • Maintain social connections and support technology: The expanded uses of technology have been the lifeline for millions who are now in mandatory social isolation. Many of the frailest old are not computer literate and unable take advantage of the tools.  Families, residential staff and trained professionals can assist.  Old-fashioned phone calls, letter writing, and care packages can connect. For unmet needs, there are numerous services that are geared specifically for seniors. Facilitating ordering groceries, medication and telemedicine with doctors can be vital.
  • Focusing on self-help of the body can calm and distract: People find comfort in different ways. Using meditation, walking, stretching, baths, engaging in conversation, reading, conversation, journaling can all be constructive.
  • Routine helps: Keeping a set schedule can help. Arranging for weekly schedule items as well.
  • Everything in moderation: Wise advice during the best of times, watch out for over indulging in food, drink, tv, or other behaviors that become destructive.
    • Getting necessary information and knowledge regarding the virus can be helpful but obsessing on reading, watching and listening to the news can be stressful and increase anxiety. It is important to think critically about information provided and stay focused on positive stories and progress.
    • Sharing a glass of wine with a friend during a virtual happy hour can be therapeutic. Over indulging or for those with substance abuse problemsthis can be detrimental.
  • Distraction: Around the country people are cleaning, cooking, home schooling and doing other chores to keep their minds from focusing on the present situation. Letting older adults do the household duties, projects, self-care or whatever else that can keep them safe, but distracted should be encouraged and maintained.
  • Asking for help can be empowering

If you are concerned, overwhelmed or uncertain, ask for help. Certified Aging Life Care Manager (www.aginglifecare.org)  also known as a Geriatric Care Manager can assist. These professionals with backgrounds in nursing, social work, counseling, and related fields can provide assessments, identify needs and provide appropriate resources, as well as long term care as needed.

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.

Caring for Aging Parents during a Pandemic? Professional Support is Available!

by: Linda Fodrini-Johnson

Millions of families, and my own family, are under great pressure during this unprecedented time in our nation’s history. We had been worried or concerned about our aging parents before the pandemic, but now we are even more stressed worrying about them contracting this devastating disease.

There is so much conflicting (and sometimes just plain bad) advice that all of us are exposed to every day. Most of us know to trust the CDC and major health institutions, but our parents might be getting information from friends, social media, or bad press. The new “senior only” shopping hours find more seniors in grocery stores during those hours, but they aren’t always distancing themselves. And in some areas, it looks less congested to shop mid-day. Of course, this differs all over the country.

Do you have any idea where your parents are shopping and what time of day they should go? Do they practice protective routines if they do go out? Are they insisting on going to see medical providers for non-urgent medical issues? Do they have the cleaning products they need to be safe when they are out or at home? Do they have enough medications and have at least two weeks’ supply at all times?

Do you or another family member have an “Advance Health Care Directive” for your parents? If so, now is the time to read it. Does it give clear direction on “end of life” choices and are those still the choices that they want if they face hospitalization during this pandemic? And if not, now is the time to have one created.

Here are some concrete actions you can take to help reduce stress and care for your elder loved one:

  1. Make a list of important contacts – doctors, friends, neighbors.
  2. If you can’t visit because of distance or not wanting to spread the illness, make daily calls.
  3. Gather legal documents in the event they are hospitalized. You want to stay in touch with medical providers.
  4. Have a list of current medications, dosages and why each one is prescribed – sometimes the EMT does not get a good history from the older adult.
  5. You can order groceries and other products to be delivered for them – and reduce their exposure. This takes hours sometimes and many older adults are not tech-savvy.

This is where an Aging Life Care Professionals® can help you organize beyond the above-listed action steps. An Aging Life Care Professional that lives and works where your family member lives would be the best resource.

Aging Life Care Professionals, also known as Aging Life Care Managers® or Geriatric Care Managers, can be the lifeline between you, your parents and their safety during a crisis such as what we are in now. These professionals are usually Social Workers, Nurses, Family Therapists, Psychologists and Gerontologists having years of experience. Most are also certified as Care Managers and have to adhere to a strict Code of Ethics and Standard of Practice.

The Aging Life Care Manager can offer you support and help you put a plan together that will try to protect your older adult, including obtaining the necessities of daily living such as medications. But the Aging Life Care Manager also assures that they are not isolated and have technology in order to stay connected to family and activities that are both educational and entertaining.

During these times, many Care Managers are spending more time coaching and listening to the worried adult children, similar to what they do with the aging family members. Since many are also therapists, the Care Manager could be a welcome support to worried older adults who don’t want to pass the worry to family, but need someone to talk with. This support is very helpful in reducing stress for everyone in the family and can be done via phone, zoom or FaceTime.

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

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 on line coaching team.

Could COVID-19 have contributed to my mother’s death

by: Charlene Neu

Could COVID-19 have contributed to my Mom’s death on March 2? We will never know, though she was considered to be in the most vulnerable group and had been diagnosed with Pneumonia mid-February.

What I do know is that as heartbreaking it was to lose her then, it would be devastating to be losing her now, when the family she loved couldn’t be with her in hospice.

I’ve tried to integrate that very personal experience with my professional responsibilities to the families I work with as their Aging Life Care™ Manager. In particular, for one family, who’s loved one, living at home, with round-the-clock care, provided by a home care agency, is now in hospice.

For this family, with a daughter located in another shelter-in-place state and unable to travel, it’s important to keep them connected. We’ve been able to do so with Face Time or regular phone calls. Daily caregiver notes, with photos, have helped with “virtual visits.” The caregivers have been extraordinary, selecting well-loved music, while paging through photo albums and reminiscing about travels and experiences.

Care Management, collaboration, communication, and compassion are vital, especially in today’s environment. Ensuring that our clients and their families have an opportunity to be present, even if it’s virtual, is of the utmost importance.

My family was fortunate to have had that opportunity with my Mom and it’s my commitment to my clients to do the same for them.

Charlene Neu MA, MS, PREP
Gerontologist, Aging Innovator
NeuAgingSolutions (at) gmail (dot) com