All posts by Samantha Colaianni

The Secret Life of the Refrigerator

The Secret Life of the Refrigerator

by Miriam Zucker, LMSW, ACSW, C-ASWCM

“Ins and outs,” are what Aging Life Care Specialists™ often do during our initial walk thru a client’s home. The “ins” are such things as medication dispensers, grab bars and smoke detectors.  The “outs,” are unsecured throw rugs, old newspapers and magazines, and expired medications.  While these areas tend to be more apparent to the care manager, a visit to the kitchen may tell a story of mystery and concealment. It’s the secret life of the refrigerator.

Like opening your mouth in the dentist’s chair, opening the door of the refrigerator can reveal important information.

The first piece of information is obtained by simply opening the door of the adult senior’s refrigerator. Are you greeted by a fragrance-free refrigerator or is there the waft of soured milk?

The second piece of information is what is known as the “refrigerator rainbow effect.”  Ideally, this would mean an array of all those brightly colored fruits and vegetables. But for Aging Life Care Specialist, observing such color often represents mold and rot on foods that should have been thrown out long ago.

The third piece of information is opening the refrigerator, and none of the above characteristics are present.  There is little or nothing in the refrigerator and food in the freezer expired months or even a year ago.

For the Aging Life Care Specialist, the secrets of the refrigerator make it vibrantly clear that immediate attention is required.  Diagnosis and remediation must occur concomitantly. The refrigerator and freezer must be cleaned, expired food removed and fresh food and beverages brought in. At the same time, Aging Life Care Specialists must question why this unsafe condition has been allowed to develop. There are five primary questions we ask:

  • Are there family, neighbors, friends or social service agencies involved?
  • Is there altered cognition? Is the older adult forgetting to shop? Going shopping and not bringing money? Forgetting to eat?
  • Is the adult senior hoarding food? This often is observed with our clients who lived through the Great Depression and will not part with food no matter what its condition.
  • Is there clinical depression which is preventing a client from having an interest in eating or shopping?
  • What foods are our clients living on? What do the kitchen cabinets reveal?

For each of our clients, the response will be different. It is our responsibility as Aging Life Care Specialists to promptly assess what the refrigerator has revealed, and take the appropriate steps to return the refrigerator to a safe zone and make sure our clients are not malnourished, dehydrated or experiencing other conditions associated with improper nutrition.

 

MIRIAM ZUCKER, LMSW, ACSW, C-ASWCM is the founder of Directions in Aging, based in Westchester County, New York. she has been as an Aging Life Care Specialist for over two decades. she can be reached at: mzucker@directionsinaging.com.


This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association® and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

Aging Life Care Month

Stories from National Aging Life Care Month

Aging Life Care Professionals® across the country celebrated National Aging Life Care™ Month by providing seminars, webinars, special events, open houses, and other educational activities for the public.

Many took to social media to share Aging Life Care stories via selfies and videos. Each week, ALCA asked members to share something from their world as Aging Life Care Professionals. During the month, several common themes emerged – a passion for helping families through difficult times, an appreciation for the wisdom of an older generation, resiliency, advocacy, care, and the need for daily hope and laughter.  Below is a look at some of  the photos shared during #AgingLifeCareMonth.

As our population ages, it becomes more and more important to plan for the many years ahead. The entire reason for National Aging Life Care Month is not only to bring awareness about aging well, but to celebrate those who have dedicated their lives to helping older adults and their families. We celebrate Aging Life Care Professionals, because they bring kindness, heart, and compassion to the field. Without them, ALCA wouldn’t be the incredible organization that it is.

To learn more about Aging Life Care™ and to find an expert in aging well, visit aginglifecare.org.


This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association® and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

may is Aging Life Care Month

May Is National Aging Life Care™ Month

The Aging Life Care Association (ALCA) – the nonprofit association representing 2,000 leaders in Aging Life Care™ / care management – will celebrate the profession during the month of May. Special events come on the heels of a professional conference in Chicago, where presenters and participants tackled the toughest issues related to aging today.

What is Aging Life Care™ and Why Should I Care?

While the practice and profession of Aging Life Care is not new, there is more attention being paid to the impact our aging population has on communities and resources. Aging Life Care plays an important role as these professionals are prepared to help aging adults plan for and face age-related challenges.

Aging Life Care is a holistic, client-centered approach to caring for older adults or others facing health challenges. The Aging Life Care Professional® is a health and human services specialist who is a guide, advocate, and resource for families caring for an older relative or disabled adult. Working with families, the expertise of Aging Life Care Professionals provides the answers at a time of uncertainty. Their guidance leads families to the actions and decisions that ensure quality care and an optimal life for those they love, thus reducing worry, stress and time off of work for family caregivers.

housing, crisis, advocacy, legal, communication, financial, health and disabilityThey have extensive knowledge about the costs, quality, and availability of resources in their communities. Aging Life Care Professionals are members of the Aging Life Care Association® (ALCA), must meet stringent education, experience, and certification requirements of the organization, and all members are required to adhere to a strict code of ethics and standards of practice.

Aging Life Care Professionals throughout the country will celebrate National Aging Life Care Month by providing seminars, webinars, special events, open houses, and other educational activities for the public. For more information, and locations of Aging Life Care Professionals, visit ALCA’s website aginglifecare.org.

The association was formed in 1985 by a group of about 50 members – mainly social workers and nurses –  who came together to build a profession from the ground up. “Our association was the first to represent the pioneers in a growing and developing field,” said ALCA CEO Kaaren Boothroyd.

“ALCA recognizes the vulnerable population our professionals serve, so we have developed the highest standards by which to hold our members accountable – for both the protection of the client and the public.”

Aging Life Care Professionals may be trained in any of a number of fields related to long-term care. These include counseling, gerontology, mental health, nursing, occupational therapy, psychology, social work, and other allied health professions, with a specialized focus on issues related to aging.


This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™ and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

Why I Became an Aging Life Care Professional®

by Harisa Paco, MSW, LSWAIC, CMC

When I was a toddler, my family, including my grandparents, emigrated to the United States from Bosnia in 1993. We were the first Bosnian family to live in Edmonds, Washington, just north of Seattle.

HELPING OTHERS

My grandfather had been a social worker in Bosnia. My mother, very much a social worker at heart, worked hard to learn English so that she could help other Bosnian families who were emigrating to the area. My family has always helped others.

Growing up, my parents both worked, and my grandparents helped raise me and my siblings. We kids were happy to do our share to support our family and other families. As my grandparents grew older, it was natural for me to pitch in.  One of my grandmothers had ALS, and my grandfather was diagnosed with Parkinson’s. When I was in high school, I often took my grandfather to doctor’s appointments, on errands, and eventually I assisted him with daily care tasks. I was comfortable being around older adults and helping them in ways my peers might not.

CHOOSING A CAREER PATH

Initially, I had set my sights on becoming a nurse. While completing my undergraduate requirements for nursing school, I worked as a receptionist at a nursing home, and became a Certified Nursing Assistant (CNA).  Even though nursing was my original goal, I always found myself gravitating towards the work of the social workers. It soon dawned on me that my talents lay elsewhere, so I shifted my studies to social work.

My undergraduate practicum was with Aging Wisdom, an Aging Life Care company in Seattle.  I was accepted into the accelerated MSW program, during which I also interned at Aging Wisdom and was able to eventually take on clients of my own with leadership oversight and mentoring. Three months before school was finished, I was offered a job upon graduation. That was the best decision I ever made. My practicum and intern experiences helped me recognize that becoming an Aging Life Care Professional was the ideal career path since it combined my love of social work with my passion for helping older adults.

Working with older adults is where there is such great need. I see that demand growing.

As for Aging Life Care as a profession, it is challenging and exhausting and exhilarating and satisfying all at once. I love that what I do can make such a positive difference in a person’s life, and in the lives of that person’s family, friends and community. My clients have so much to teach me too.

AGING LIFE CARE IS MORE THAN MEDICAL

One of my current clients is a wonderful example of what Aging Life Care professionals can do to promote well-being and personhood. This particular client, whom I’ll refer to as Doc A, is a retired physician. He never married.

His single-family home, a classic 1940s two-story house here in Seattle, set on a small hill, had a treacherous, crumbling 20-step walkway to the front door. Inside, the stairs from the first floor to the second, where his bedroom was located, were steep, winding, and narrow, and not particularly supportive of an unsteady, 80+ year old living with dementia. Unfortunately, the house was difficult to adapt to the changing needs of Doc A, but we did our best.

When I started, the house needed attention. I helped ensure that his broken-down appliances were replaced, got the air conditioning repaired, hired landscapers to regularly maintain the yard and set up a housekeeping service. I also hired a contractor to improve the home’s overall safety. Because it often takes a village to support an older person in their home, I introduced myself to Doc A’s neighbors to enlist their support. These are the sorts of things I never imagined myself doing as an Aging Life Care Manager, but it’s more common than I’d thought, and so helpful to the overall care of our clients. It’s part of the holistic approach we take to support and care for each client.

WORKING CLOSELY WITH ALLIED PROFESSIONALS

We also worked closely with the home care agency that had been hired following Doc A’s return home from a hospital stay after he’d fallen at home.  We worked hard to stabilize staffing, enhance the flow of communication between all parties involved in his care, as well as with his health care team, and addressed concerns about his inadequate nutrition. The overall affect was positive. Doc A was able to continue living in his home longer than expected.

As we’ve worked with Doc A, we’ve gotten to know him on a personal level. He frequently entertains me with his tales about hiking mountains in the Pacific Northwest, his time playing in a local orchestra and his volunteer medical work for local neighborhood clinics. Our Aging Life Care practice includes Creative Engagement Specialists, and we matched him with my colleague Amy, who visits frequently to makes sure that Doc A remains engaged in life with scenic drives and visits to the symphony and ballet, even as his abilities change.

Eventually, the time came when Doc A’s home could no longer optimally support him.  We worked with a placement specialist and helped him to move to an environment that could better meet his needs. Throughout my time working with Doc A, he has come to trust and rely upon me. I was allowed the freedom to help find his next home. I thought carefully about the best setting for him and when the time came to move, he accepted it, settled in and started a brave, new chapter of his life.

GRATITUDE FOR THIS OPPORTUNITY

For me, being an Aging Life Care Professional means focusing on the big picture while at the same time paying attention to the small details in an effort to ensure each client’s quality of life is the best it can be.  I love the part of our Code of Ethics that inspires us to treat each client as a “complete individual with their own history, narrative and unique cultural identity.”

I’m filled with gratitude to be doing this work, to be in a position where families trust us to come into a loved one’s life, get to know them, and help make decisions and work with other professionals to make the lives of our clients happier, safer, more nurturing and purposeful. I’m honored to be entrusted with the opportunity.


Harisa Paco, MSW, LSWAIC, CMC is a Certified Care Manager with Aging Wisdom. She holds a Bachelor’s degree in Social Welfare and a Master’s Degree in Social Work with a focus on Multigenerational practice from the University of Washington. Harisa is a co-chair of the Aging Life Care Association’s Seattle Unit Group. She grew up in the suburbs of Seattle where her family still lives. In her free time, Harisa serves as the fundraising chair of Seattle City Rotaract and also participates in a youth mentoring program at the King County Juvenile Detention Center. Harisa is a student in Leadership Tomorrow, a program designed to enhance civic participation of emerging leaders within the Puget Sound region – Seattle class of 2018.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™ and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

4 Helpful Tips for Coping with a Parkinson’s Diagnosis

April is Parkinson’s Awareness Month. The Aging Life Care Association® will be featuring articles that raise awareness of  Parkinson’s Disease and the ways Aging Life Care Professionals® can support clients and families affected.

by Lisa Laney, MSW, CMC 

Receiving the diagnosis of Parkinson’s Disease was the first major hurdle. Now, you are faced with another obstacle course as you plan for a life with Parkinson’s.   Here are four tips for managing the road ahead.

To put a name to all the symptoms that have been accumulating for years is the first step along a new path which leads to an unfamiliar terrain full of blind curves, steep climbs, and unexpected declines, interspersed with fairly level courses.

Most people who are diagnosed with Parkinson’s have experienced an array of odd symptoms — loss of smell, walking stiffly without normal arm swing motion, a slight twitch in the hand or chin — for as long as ten years before finally receiving a name for their troubles.

Obtaining a diagnosis is the first mystery solved.  How to plan a life with Parkinson’s is the largest undertaking for those with Parkinson’s  to tackle.  As a ten-year facilitator for the Parkinson’s support group in my community, combined with experience as an Aging Life Care Professional™ (also known as a geriatric care manager), I have seen a pattern of actions and tools that provide the most support to those with this disease and their loved ones.

1. Connect with a neurologist with whom you feel good chemistry

This is a roller coaster type of disease (that can last decades) with many symptoms that are unusual — some people experience nightmares or extreme dreams, significant constipation, and/or depression.   Each person has a unique experience with the disease, so finding a neurologist who is easily available for unscheduled appointments, who takes time with patients, and who is a good listener and a good teacher are vital.

2.  Become a student ~ information is gold
  • Read, Read, Read.  Search Amazon for books and follow national groups, such as the National Parkinson’s Foundation and The Michael J. Fox Foundation
  • Go to every seminar you can find.  Medical communities often provide day-long or several-day seminars.  Terrific high-caliber speakers will keep you abreast of the ever-changing treatments;  and sponsorship by companies who have useful resources will connect you to supplies, equipment, and technology.
  • Join a local support group.  This is useful for the caregiver and for the person with Parkinson’s as well.  Like finding the right neurologist, it is important to find the group the suits you most comfortably.  Groups vary in their styles, sizes, and personalities.
3. Exercise

Dance…Walk… Play Tennis…Bicycle…Golf…Stretch. This component cannot be emphasized enough. Consistent appropriate exercise is life-changing for the person with Parkinson’s.  DO NOT THINK THAT YOU CANNOT BECOME AN EXERCISER AT THIS POINT IN YOUR LIFE...no matter your age or the level of severity of your disease, incorporating the right type of exercise will provide physical benefit and noticeable improvement with memory and mood. Amazing positive effect of bicycling in reduction of tremors was discovered accidentally (http://www.medicalnewstoday.com/articles/253197.php ).  

4. Add specialized professionals to your team

Elder Care Attorney… Estate Planner…Certified Professional Accountant…Aging Life Care Professional.Start planning early so that you are not caught in a crisis without the compass you need to navigate through unfamiliar territory.  Although all of us should have a workable knowledge and actual plans and documents in place as we age or manage a disease, it is more crucial for the family who is managing Parkinson’s.  This is the case due to possible changes in cognitive function impeding  decision-making or financial management. And sudden physical changes mandating the need for rehabilitation, caregivers, or medical equipment.

Parkinson’s is a complex disease that is made more manageable when you have created a useful and available team. In my area of expertise,  I often find all the professionals listed above serving together and communicating  in tandem with the client who has Parkinson’s.

More about the Aging Life Care Professional

All you have read above comes from the experience of an Aging Life Care Professional.  Connecting with one of these professionals will make your journey more manageable, with fewer dead ends, and quicker connection to resources, support, doctors, caregivers, and even equipment.

This professional can provide a one-time consultation to get you started with understanding various points to prepare as you begin living with Parkinson’s and be available to you through the years on and off as you need, or can be active on your team ongoing and as involved as you desire.

Not only do  individuals with Parkinson’s and their immediate support persons appreciate the relief of having a professional to lean upon, but adult children also express gratitude  knowing there is a local person providing support as the terrain becomes more rugged, serving as the resource for knowledge and direction as they support parents along this path.

To find an Aging Life Care Professional near you, search our directory of experts at aginglifecare.org.

About the author: Lisa Laney, MSW, CMC is the owner of Mountain Premier Care Navigation in Asheville, North Carolina, and has worked with the aging population in the healthcare system since 1988. She serves as the facilitator for the Asheville Parkinson’s Support Group and is on the Board of Directors for the Aging Life Care Association.  She can be reached at lisa@premiercarenavigation.com or on Facebook


This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™ and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

Be Proactive: 12 Tips to Reduce Falls for People Living with Parkinson’s Disease

April is Parkinson’s Awareness Month. The Aging Life Care Association® will be featuring articles that raise awareness of  Parkinson’s Disease and the ways Aging Life Care Professionals® can support clients and families affected.

by Amy Natt, MS, CMC, CSA

According to the Parkinson’s Disease Foundation, an estimated 7 to 10 million people worldwide are living with Parkinson’s disease, a chronic and progressive movement disorder for which there is no cure. For people living with Parkinson’s, falls are a frequent and hazardous complication because of the symptoms related to Parkinson’s –  muscular stiffness, freezing, shuffling gait, balance impairment or stooped posture.

If you have Parkinson’s and live alone, being proactive and planning ahead can help you reduce your fall risk and maintain your independence. Gait is one of the most affected motor characteristics of Parkinson’s disease (PD). While it affects each person differently, falls are a common challenge to address. The Parkinsonian gait is characterized by small shuffling steps and a general slowness. For those living with PD, reduced stride length and walking speed are common, as well as difficulty starting, and difficulty stopping after starting. Poor balance and unstable posture can also lead to increased falls. It is important to always report these to your physician.

There are several things you can do to be proactive around the house in an attempt to reduce falls for people living with Parkinson’s disease:

1. Before you start a movement, get your balance. If necessary, hold on to something until you feel steady, and then start forward motion.

2. Consider physical therapy programs. You can learn exercises to help maintain balance and movement.

3. Find a community support group. You can share success strategies with others diagnosed with PD.

4. Recognize that at some point a piece of mobility equipment may be necessary to help keep you safe. With all the choices on the market, you can find something that fits your lifestyle.

5. Arrange furniture to create a clear walking path. You can place furniture in strategic places to provide a place to hold onto if you lose your balance.

6. Remove throw rugs and narrow carpet runners. These can create an edge that may cause you to trip or catch your foot.

7. Pay attention to your footwear. Socks may be too slippery but heavy soles may catch or make it harder to lift your foot. See a specialist to get the right pair of shoes.

8. Have grab bars or secure rails placed in strategic places. These allow for increased balance and something to safely grab for support. Use a professional to properly install them.

9. Make sure you have adequate lighting, especially at night.

10. Keep the products you use on a routine basis between eye and waist level. You don’t want to have to bend down or reach up to get an item. There is no need to create unnecessary risk.

11. Place reflective tape on steps. This helps with depth perception.

12. Consider an emergency alert button. If you do have a fall, these aids provide you with a way to call for help. Do not assume you can get to a phone.

The PD symptoms that can impact your gait can progress over time. Be in tune to changes that you experience and put safety measures in place before you need them. Create a safety net in your environment to enable you to remain as independent as possible. If you are in need of specific recommendations for your home, find a certified aging-in-place specialist, Parkinson’s specialty clinic, or an Aging Life Care Manager™ who can help you assess your home environment and provide you with additional feedback and resources.

About the author:  Amy Natt, MS, CMC, CSA is the CEO of Aging Outreach Services in Southern Pines, North Carolina. Amy also serves as the President of the Southeast Chapter of the Aging Life Care Association. She can be reached at amyn@agingoutreachservices.com.


This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™ and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

The Aging Life Care™ Manager’s Roadmap to Working with the Parkinson’s Disease Client

The Aging Life Care™ Manager’s Roadmap to Working with the Parkinson’s Disease Client

By Debra Moler R.N., B.S.N., C.M.C

April is Parkinson’s Awareness Month. The Aging Life Care Association® will be featuring articles that raise awareness of  Parkinson’s Disease and the ways Aging Life Care Professionals can support clients and families affected.

Parkinson’s Disease affects 1 million people in the United States and 50,000 are diagnosed each year.  One in 100 people over age of 60 years of age has Parkinson’s Disease. There is no cure for Parkinson’s Disease but it is a disease that needs to be well-managed in order to maintain quality of life and manage the signs and symptoms of disease.

The following is a road map to managing a client with Parkinson’s Disease.

  • Build the Health Care Team
    • Work with a Movement Disorder Specialist. This is a neurologist who has taken additional training in diseases that affect physical movement like Parkinson’s.  Contact one of the national Parkinson’s organizations for recommendations such as American Parkinson Disease Association or Parkinson’s Foundation if you need a recommendation.
    • Identify and work with Speech Therapist preferably that is LSVT (Lee Silverman Voice Technique) certified. It focuses on increasing vocal loudness. Speech Therapy will also assess swallowing function and provide strategies to avoid aspiration.
    • Identify and work with Physical Therapist that specializes in Parkinson’s Disease preferably one that is LSVT BIG trained. Therapy is critical even if newly diagnosed. The benefits of therapy are that it will increase motor coordination and balance.  It will also reduce the risk of falls which is a number one reason for trip to the hospital.  Another benefit is it also helps improving positive outlook for your client.
  • Keep Them Moving
    • Thirty minutes of exercise daily. Check local Parkinson’s organizations for assorted classes such as Rock Steady Boxing, Yoga, Tai Chi, and a dance therapy program. These type of classes helps the body with turning, balancing, controlling the posture and walking.
  • Monitor Their Medication
    • Assist in ensuring medications are taken on time every time to ensure optimal effects of medications and to minimize off periods when the symptoms of Parkinson’s Disease are exacerbated. Set alarms on phones or timers to ensure timely delivery. Instruct on taking medication 30 minutes before meal or 60 minutes after the meal allow for best absorption of medication.  Obtain an Aware and Care kit from the Parkinson’s Foundation so that they are well prepared in event of an Emergency Room visit or hospitalization. Instruct client and care partner use of the Aware and Care Kit.  This kit includes important information for health care staff such as drugs to avoid using for Parkinson’s clients.  Keep your client’s current list of medications and actual medications in it to avoid interruption of their medication schedule.
  • Support the Spouse or Care Partner
    • Encourage them to attend Parkinson’s Support Group meetings
    • Encourage them to take care of themselves. Encourage them to accept help from family and friends who are willing to help. Obtain help in the home for respite care.
    • Encourage them to continue with social activities even if client is reluctant to socialize. Most times once at social activities the client enjoys the socialization.
    • Develop a contingency emergency plan on what happens if spouse or Care Partner is hospitalized.

Building your health care team, involving client in regular exercise, getting medications on time every time and supporting the spouse or Care Partner will achieve and maintain quality of life for your client with Parkinson’s Disease.


About the Author: Debra Moler, RN, BSN, CMC, is an Advanced Professional member of the Aging Life Care Association and works at Firstat RN Care Management Services.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association® and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

Making It Work: The Challenging World of Skilled Nursing Homes

Making It Work: The Challenging World of Skilled Nursing Homes

by Bunni Dybnis, MA, MFT, CMC

I receive calls on a regular basis from individuals concerned with aging, ill or dependent adults. They want to find the best nursing home.     The callers typically will request options from long list of skilled nursing options given to them by a hospital discharge planner.   These decisions need immediate attention.   For others the calls vary from concerns regarding financial issues, medical necessity or other long term planning situations.  Like is often the case, one size doesn’t fit all.  Setting realistic expectations is essential.  Nursing Home often becomes the generic term for someone in search of facility placement.  Nursing homes certainly have their place, but they are not right for everyone.  Whether it is from lack of knowledge, a medical and reimbursement bias, lack of time or misinformation ,other options are often not considered.  Aging Life Care Professionals® provide knowledge that goes beyond a simple list with the nursing homes. 

Aging Life Care Managers focus on understanding goals, needs, obstacles and finding solutions.  Understanding why skilled nursing is the recommendation is essential.  An assessment by a skilled Aging Life Care Manager can be invaluable.

Let’s start with goals:

  • Situation #1: Hospital Discharge

“My family member is about to be discharged from the hospital and the doctor says they need a nursing home.  I was given a list and need to know the best place. “

Rehabilitation after a hospitalization is a common process.  Following a hospital admission a skilled need nursing home placement is often a short term solution.   Rehabilitation following a stroke, hip replacement or other skilled needs often makes this choice a reimbursable event which can support an individual’s move to a less restrictive environment.  When situation involves brain injuries and other neurological issues there are specialized care facilities that might be available.   These individuals can benefit from the skills of a multi-disciplinary team of trained therapists and nursing staff.  Therapy is often provided several times a day.   If hospital discharge is a qualifying event commonly three weeks and sometimes up to 100 days can be reimbursable, at least in part, by insurance. On-going reviews by facilities occur to maintain eligibility. Skilled nursing is reimbursed at the highest level, by Medicare and private insurance companies, so skilled nursing often compete for these clients and choices can be robust.  If a patient has an HMO or on MediCal/Medicaid, options are smaller.

Alternative solution- For many going home for rehabilitation is their preference.   Risk of infections, institutional related confusion and the often depressing environment are a consideration.  With doctors’ orders skilled occupational, physical and other services can come to the home for a set amount of visits.  These services can be reimbursed by Medicare and other insurance carriers.   The need for custodial care done by family, friends or paid caregivers can support the therapists.   Cost and caregiver burden must be considered. 

  • Situation #2 : Skilled needs that necessitate move from assisted living or home

My father has a feeding tube and is not able to assist with transfers of any kind. The assisted living tells me they can no longer care for him.  Private skilled nurses are unaffordable, so he can’t be taken home.  What are the options?

Long term stays when skilled needs are present are another reason for skilled nursing placement.  For these individuals nursing homes can be the best option.    These admissions generally relate to tasks that can only be provided by a Registered or Licensed Vocational Nurse or require the skills and necessity of more than one person to transfer.  Feeding tubes, catheters, ventilators, and medical situations often necessitate long term stays. Costs, insurance reimbursement, physical demands on family caregivers and licensing all play into this. If an individual will eventually run out of assets, then MediCal/Medicaid Certification is an important consideration when looking for placement. If a skilled nursing facility is a long term consideration an Elder law attorney or community legal aid should be consulted earlier than later.

Alternative solutions- In many states there are Assisted Living Waiver programs that provide all the care available in a Skilled Nursing Home in more home like life assisted living facility.  Availability is limited and priority is given to those already in Nursing Homes so it is important to be proactive.  Hospice waivers and some assisted livings who have licensed staff can provide skilled care that formerly was only provided by nursing homes.  It is important not to just assume nursing homes are the only options for long term care.  For individuals who do not have skilled needs and are paying out of pocket or through long term care insurance an assisted living may be a preferable cost effective options.

  • Situation #3- Lack of resources to address care needs

“My parent needs around the clock assistance. We cannot take care of her or afford to pay for services needed.  She has very limited resources.   Where can we place her?”

Skilled Nursing is the safety net for the indigent individuals who require long term care. Individuals who meet functional and financial criteria are often placed in nursing homes as a last resort.  The medical model of shared rooms with a nursing staff at a front desk, which is the only option available in many communities are often in contradiction with emotional, social and cognitive needs.  Throughout the country, MediCal beds in nursing homes are where most impoverish older adults will spend their final days.

Alternative solutions- The nurturing supervised environments that would best serve the emotional as well as physical needs of individuals is for a lucky few available in waiver programs, but these are limited in number and location.  Specific criteria for MediCal/Medicaid long term care is needed.   If criteria is met without the need to spend down or protect assets the facility will often assist with application.   If there is any questions or sophisticated planning is needed an Elderlaw attorney should be contacted.  An Aging Life Care Manager, knowledgeable in this field, can often guide you to less restrictive options.  In-home supportive services and Veterans assistance can also provide resources for those who chose to stay home.

There are many check lists available to assist individuals looking for skilled nursing for themselves a loved one or client.  Rather that reproducing an exhaustive list I will review a few important considerations and priorities that need to be evaluated.

  • What is the need? Short term placement with the goal of rehabilitating or recovery from a hospital stay as opposed to long term skilled or financial needs will greatly affect choices
  • How critical are the care needs? For those with complicated rehabilitation and breathing needs finding the top rated rehabilitation or sub-acute services may trump other criteria such as location, esthetics or proximity to personal medical team.  Insurance coverage always remains an important consideration for most.
  • What are the family and patients priorities? People are different and what they desire must be evaluated case by case.  When I ask families what they mean my “best choice” I often get differing responses.  Here are a few:
    • Financial coverage by insurance or long term MediCal remains the number one priority for most. It is essential to check admission status and reimbursement, particularly following hospital discharge and Medicaid/ MediCal coverage.  If an individual needs to move from Medicare reimbursement to Long Term MediCal a facility has to be licensed to cover those expenses. It is essential to understand regulations and rights concerning these issues.  org is a great resource.
    • Personal doctor or medical team will visit remains a consideration for some.
    • Close proximity to social network. Having regular visits from family and friends can make all the difference
    • Physically esthetic. For many the “bricks and mortar” is an important consideration.  Remember, as enticing as it might be, “you can’t always tell a book by its cover”.
    • Private rooms available at an extra cost. If an individual is sensitive to noises or other situations where having a roommate may be distressing there is a cost involved.  Patients with contagious infections need to be isolated by law.  This can make finding the facility of first choice a challenge.
    • Ideal nursing and other care services are not a given. Families need to understand regulations regarding staffing ration are about 9 patients to 1 staff. This assumes the facility is fully staffed.  If patient needs individualized care or attention it is not realistic to assume facility staff will meet those needs.  Unless there is family participation or additional private caregivers to advocate or provide oversight expectations much be managed.
    • Ratings in terms of violations, licensing and deficiencies. Information is available on Medicare.gov.  Unless violations are continuous and/or egregious checking current situation is recommended.  Not all is as it appears.
    • Social and other considerations for long term care residents. If an individual is placed for short stay rehabilitation or recuperation having activities beyond medical and care is probably not an issues.  For longer stays activity programs, volunteers, outside patios and other quality of life considerations need to be considered.

I know we all want a quick easy answer to our questions, but like most other important issues making decisions regarding care for an aging or dependent adults is not that simple.  Understanding the options, needs and challenges is the first step in making the right choices.  Aging Life Care Managers are equipped with the training, knowledge, experience and objectivity to support decisions involving older adults and their families.


About the Author: Bunni Dybnis, MA, LMFT, CMC has spent the last twenty-five years working exclusively with older and dependent adults as an Aging Life Care Manager,  educator, consultant , expert witness and mediator. As Director of Professional Services at LivHOME and Fellow in the Aging Lifecare Association she has received numerous awards and acknowledgement from her peers and greater community.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association® and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

5 Common Myths about Nutrition and Seniors

Five Common Myths About Nutrition and Seniors

By Marie LeBlanc, ALCA Corporate Partner, Transitions Liquidation Services

Think you know what’s best nutritionally for loved ones in their elder years?  Here are five common but false beliefs about senior nutrition:

#1 Seniors should follow healthy eating guidelines and they’ll be OK.
Most nutritional guides, such as the Food Pyramid or online educational aids, such as www.choosemyplate.gov/guidelines provided by nutrition experts and the U.S. Department of Agriculture do not provide for the special nutritional needs of seniors.  Guidelines may suggest foods that could interact dangerously with medication.  Or they might worsen diabetes or heart disease conditions.  They may not take into consideration an elder’s difficulty chewing or swallowing.  Also, seniors need more of certain vitamins and minerals to maintain optimal health than suggested in guidelines written for adults or children.

#2 It is natural for older persons to lose their appetites.
Because of metabolic changes and decreased activity, some seniors may need less food than younger adults, but a “loss of appetite” is not normal and could be a sign of a serious health problem.  Dental issues or a decreased sense of taste can lead to eating less rather than a lack of appetite.  Seniors should weigh themselves or have their weight checked routinely and any sudden weight loss be brought to the attention of a physician.

#3 There is nothing wrong with eating alone.
Elderly people who live alone and are left to prepare food by themselves, often don’t eat as well as they should. Physical and cognitive problems can cause seniors to become unable to prepare adequately nutritious or filling meals. Eating almost every meal in isolation can also contribute to loneliness, stress and anxiety. Eating alone can put seniors at risk.
It’s ideal for seniors to, at least some of the time, eat with others. Even those who live alone can visit a senior center where meals are available along with activities and social interaction with others. Senior communities are also a good solution for seniors unable to prepare meals. One of the primary benefits of living in a senior community is careful attention to detail and the ability to eat and socialize with others in a common dining room.

#4 Senior Communities Have Awful Food.
Most senior living communities employ talented chefs and nutritionists to ensure that the meals served are nutritional as well as tasty.  If seeking an assisted living community for a senior loved one, be sure to experience at least one meal at each location you are considering.  Visit during mealtimes to see the dining room interaction for yourself and use the opportunity to interact with other residents.

#5 Seniors Have Slower Metabolisms and Need Fewer Nutrients.
While seniors may need slightly fewer calories and food-bulk than younger adults, they need just as many nutrients, if not more. One reason is that as we age, our ability to absorb nutrients decreases. Doctors recommend that older adults increase their intake of calcium as well as Vitamins D and B12.  Check with your physician before adding supplements to the diet.

Just because a person has reached an advanced age, it doesn’t mean they cannot benefit from healthy eating.  It’s never too late for anyone to make efforts to improve their health and diet, which can make one’s quality of life more enjoyable, with better tasting meals and well-being.


This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™ and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

About the Author: Transitions Liquidation Services is an ALCA Corporate Partner, and helps seniors and their families deal with issues concerning right-sizing, transitioning, and elder care.  For more information, call Marie LeBlanc at Transitions Liquidation Services at 617-513-0433.

5 Easy and Enjoyable Activities to Share with Older Loved Ones

By HomeCare Assistance, ALCA Corporate Partner

As our family members and friends reach their later years in life we glean the opportunity to slow down and appreciate our time with them. There are a variety of activities that they can do in that offer the opportunity to stimulate and exercise them physically, mentally and emotionally to ensure a holistic approach to maintain overall health and happiness.

In this article, we’ll go over 5 enjoyable activities seniors can partake in that’ll help inspire them to keep loving and learning.

#1 – Exercise

Exercise is one of the best activities someone in their later years can do. Of course, the types of exercises one can do will depend on their state of health, mobility and flexibility. Exercise has a variety of benefits which include increased blood flow to vital organs, cardiovascular (heart benefits), maintenance of muscle mass, cognitive improvement and overall flexibility and mobility of limbs and joints.

Depending on mobility and energy levels, some great exercises including walking, swimming, biking, chair exercises, leg raises, arm circles and body weight air squats.

Exercise (along with diet) serves as the foundation for a healthy body and mind and should always be a priority even in a senior’s later years!

#2 – Puzzles or Board Games

As you age, it’s normal to experience some level of cognitive decline including processing speeds or reduction in attention span, which makes it important to actively engage in various types of mentally stimulating activities to help keep sharp.

Games and puzzles are a great way to mentally stimulate your brain to help maintain cognition such as memory, attention and processing speed. Games and puzzles also make learning fun and at times exciting which is a great way seniors can engage while learning and maintaining their brain’s health.

Some studies have shown that doing crosswords or puzzles may help maintain cognitive health and prevent further memory loss. Reading can also be a part of this activity as it also helps stimulate verbal fluency and imagination.

#3 – Arts and Crafts

Creating art, whether it be in the form of paintings, sculptures, jewelry or even knitting can be a great activity as it allows for creativity and stimulation of the senses including sight, touch and sound. In addition, it’s nice to play music while engaging in making art as it helps provide a soothing and relaxing touch which helps you really get in the moment and engaged with what you’re doing.

For many, making art is a form of meditation so this can be a great way for seniors to relax and enjoy their time.

#4 – Visit a Pet Shop

Many studies have shown that animals like cats and dogs can help induce calmness, relaxation and feelings of well-being for seniors. Visiting a pet store every so often and being around some happy felines and pups can be a great way for seniors to stay in touch with their furry friends while getting a dose of happiness and comfort.

Even better, many seniors choose to have a (usually small) dog of their own. Dogs are a great companion to have around the house which helps prevent feelings of loneliness or isolation. It also helps induce feelings of responsibility and provides some routine and structure since you have to stay on top of taking care of them.

#5 – Movie Night!

Movie nights can be a great way to bring family and friends together to enjoy a classic film and entertainment for a couple hours. They provide the opportunity to have discussion before and after the movie to build excitement and “recap” parts of the film everyone enjoyed which is mentally stimulating.

If possible and nutritional guidelines allow it, prepare some popcorn or Ice cream for everyone to enjoy during the movie to make things more fun.

Picking a classic or favorite that your senior friend or family member loves is a great way to help remember old times while bringing up good memories and feelings.


HomeCare Assistance is an ALCA Corporate Partner. Thousands of families across the nation trust Home Care Assistance for their warm, welcoming and family-style assistance programs which help improve the quality of life and comfort of seniors across the nation! You can find more information at homecareassistance.com.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™ and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.