Get Help Navigating Nursing Home Care

October 21, 2016Aging Life Care Professionals, Long-Term CareMedicaid, Medicare, nursing home Callie Daters

Moving to a long-term care facility or nursing home can be a shock to an individual and to the family. And you’ve probably figured out how expensive it is. With questions ranging from cost to quality of care to food choices, you may feel overwhelmed or trapped. An Aging Life Care Professional™ can help you navigate the nursing home maze and be an extra set of eyes and ears.

Aging Life Care Professionals Know the Ins and Outs of Nursing Home Care

By Suzanne Modigliani, LICSW, CMC – Aging Life Care Association™ Member and
Fellow of the Leadership Academy

Why Nursing Home Care

There are many reasons someone may be living in a nursing home. After a hospitalization, your loved one may have been placed in rehabilitation; and during that rehab stay, it may have become clear the person can no longer live alone. If finances preclude in-home care, nursing home care can be covered by Medicaid if the individual is clinically and financially eligible. Or if the individual’s needs are so complex that the care of a registered nurse on a regular basis, a nursing home is a practical solution.

Paying for Nursing Home Care

All of a sudden you are told your loved one’s time in rehab is up and that he/she must go home or move to long-term care. While the rehabilitation stay may have been covered by Medicare, the transition to a long-term care can be confusing. You probably have figured out how expensive nursing home care is. Medicaid will pay for long-term care if the individual meets specific eligibility requirements. There are very specific rules, some depending on if there is still a spouse in the community, as well as others regarding how much money the elder can have spent for certain things. If you are confused or unsure about the Medicaid application process, reach out for professional assistance from an Aging Life Care Professional or even an Elder Law Attorney.

Choosing a Nursing Home

Which nursing home is best for your loved one? A great place to begin your research is with Medicare’s Nursing Home Compare website. Nursing Home Compare allows consumers to compare information based on yearly surveys conducted in person by the Department of Public Health. The website contains quality of care information on every Medicare and Medicaid-certified nursing home in the country – more than 15,000 nationwide.

For information beyond the survey, a local Aging Life Care Professional can offer up-to-date information and insider knowledge based on current or previous experiences with clients at particular facilities. Nursing home staff frequently turn over, so this personal, insider view is invaluable. Aging Life Care Professionals will know the little things like whether all those activities on the calendar actually happen.

Navigating the Maze

An Aging Life Care Professional can be your guide to all things nursing home. Whether you live in the same town or across the country, an Aging Life Care Professional can be your eyes and ears. These experts can also help you answer all of the questions that may be racing through your head, or that may come up along the way such as:

Does my relative get to choose a roommate?
Can she still have her favorite foods?
Who is my contact person at the facility?
Who do I tell that my mother never wears her hair that way, or that red lipstick makes her day?
Who is responsible for laundry and should clothes be labeled?
What if the roommate keeps the TV blasting late into the night?

Though nurses are on staff, the bulk of the care is provided by certified nursing assistants (CNA) who are taking care of a number of people on a daily basis. Forming a bond with the regular CNAs that assist your loved one will help you get timely information and also go a long way towards making sure your loved one is getting the care you hope for.

Nursing homes are required to have quarterly care plan meetings to establish exactly what they are doing for a resident. There need to be goals with progress towards those goals reviewed. Having an advocate attend with you – or in your place – can be invaluable. If the Aging Life Care Professional knew your relative before placement in long-term care, they may have important history to share with the facility staff.

With experience working in and with nursing homes, Aging Life Care Professionals are great partners to work successfully with nursing home staff. Find a local Aging Life Care Expert at aginglifecare.org.

About the author: Suzanne Modigliani, LICSW, CMC is an Aging Life Care™ specialist in Brookline, MA who works with families to find solutions to complicated elder care problems. She has been a leader in the Aging Life Care Association and quoted extensively in the media as seen on her website modiglianigeriatrics.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.

Special Needs Children and the Aging Parent

October 11, 2016Aging Life Care Professionals, Aging Parents, Caregiving, Elder Law, Family Members, Financial Managers, Guardianshipadult children, aging parents, special needs Callie Daters

Having an adult child with “special needs,” and planning ahead for his or her care, is a concern for parents throughout the child’s lifespan. Most of these adult children are extremely dependent upon their parents, counting on them to provide fully for their safety and well-being, as well as love and encouragement. As the parents begin to age, it is necessary to have a plan of care in place for both the adult child and the parents.

Planning for the Care of Your Adult Child with Special Needs Takes a Team

by Linda Fodrini-Johnson, MA, MFT, CMC – Aging Life Care Association™ Member and Fellow of the Leadership Academy

Coming up with a plan for who will take care of their child after they are gone is the greatest struggle for parents of children with special needs. The “What If’s?” are daunting.

Most parents of special needs children have learned to become resourceful in finding ways to make their child’s life the best it can be. They’ve developed special skills for solving problems and finding solutions. They know their child better than anyone and their love and patience know no bounds. They can’t imagine anyone else being able to care for their adult child like they can.

As some of these parents age, their special needs children can actually begin to help their parents. Some higher-functioning adult children with special needs might assist them with light housekeeping, simple meal preparation, laundry, or even personal care.

However, for parents caring for an adult child with special needs of lower functioning abilities, a different scenario can develop: one where the parent can no longer meet the ongoing care needs of his or her adult child.

In either scenario, an Aging Life Care Manager™ can be that much-needed link, helping the “Special Needs Family” plan for the future, setting up a contingency plan for short- or long-term options for ongoing care of the adult child with special needs.

The Aging Life Care Manager works with the family, an attorney who specializes in either Elder Law or Special Needs Planning, and a financial planner to create options for a suitable Plan of Care which meets the needs of everyone in the household. The best plans are based on the family’s set of values, resources (both human and financial), entitlement benefits, and local services.

On an ongoing basis, the Aging Life Care Manager provides a second set of skilled eyes on the care situation of the special needs adult, making sure that the plan remains appropriate, that the care is of excellent quality, and that all needs — physical and emotional — are being met. In some cases, the Care Manager operates in a dual role, advocating for both the adult child with special needs and his or her parent.

To locate an Aging Life Care Manager near you and learn how he or she can help with the care of your adult child with special needs, visit aginglifecare.org.

About the author: Linda Fodrini-Johnson, MA, MFT, CMC, is the Founder and President of Eldercare Services in Walnut Creek, CA. She is also a partner of the VillagePlan. Linda is a Fellow of the Leadership Academy and a past-president of the Aging Life Care Association™. Linda has over 30 years experience working as a Care Manager. You can reach her at linda@EldercareAnswers.com, or connect with her via social media: Facebook, Twitter, and LinkedIn.

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Pets and Aging Adults

October 4, 2016Aging Life Care Professionals, Caregivingaging adults, family, pets Callie Daters

Aging Life Care Specialists look beyond the typical definitions of family support system, recognizing that pets often bring their client needed love and companionship. For many aging adults, pets reduce stress, lessen loneliness, and often give one a sense of purpose. As one Aging Life Care Specialist shares, pets need to be considered in the overall assessment process.

A Client, a Cat, and a Care Manager

by Miriam Zucker, MSW, ACSW, CASWCM – Aging Life Care Association™ Member

When Aging Life Care Specialists™ begin working with new clients, we perform a thorough client assessment. Many questions are asked and information gathered such as full medication lists, names of physicians, and health care directives. Aging Life Care Specialists also look at a client’s support system – family, friends, caregivers. Pets also fall into this category of support system.

Why pets? Some of the reasons are obvious. When I assist in the placement of a caregiver in the home, it is important to know about pets because some aides are allergic or fearful of animals. Or, if I am recommending the aging adult move to assisted living, we look only at residences that accept pets.

Other reasons aren’t so obvious, especially to those that are not “pet people” or “animal lovers.” For many, a longtime pet is their “significant other” and companion. This was certainly the case with my client Peggy.

Peggy and her caregiver, Joanne, were pet lovers. Joanne was devoted to Peggy and Peggy’s cat, Buttons. Joanne was unfazed by the challenge that comes with having a client who thinks there is nothing wrong with herself despite a mid-stage dementia diagnosis.

One early afternoon Joanne gave me – Peggy’s Aging Life Care Specialist – a phone call. In a quivering whisper, Joanne said “Button’s is dead. She’s lying under Peggy’s chair, and Peggy is telling me she’s sleeping.”

An immediate plan had to be put into place. A few minutes later, I called Joanne back, explained my plan, and casually stopped by Peggy’s house.

I greeted Peggy, Joanne, and Buttons. I went over to Buttons, called his name, and gently nudged him. Of course, there was no response. I turned to Peggy and said, “I think something is wrong with Buttons, he’s not responding.”

“It’s hot,” Peggy said. “He’s just sleeping.” And then Joanne repeated the same routine. Only this time Joanne turned to Peggy and said she thought Buttons had passed away.

Joanne gently placed Buttons on a towel and slowly pulled the towel out from under the chair. Peggy observed quietly and then became tearful when she realized she had lost her best friend. Peggy asked to hold Buttons. She stroked him, spoke to him lovingly, and then handed Buttons to me.

Peggy decided that Buttons should be buried in her backyard between two lilac bushes. The welcome sound of a lawn being mowed sent me across the street to ask the gardener if he would dig a hole. With the hole dug, Peggy, holding Joanne’s arm, slowly made her way down the backyard steps. I followed with Buttons.

Peggy watched as I placed Buttons in his eternal resting place. I asked her if there were any words she wanted to say or a song we could all sing? Nothing. We came back to the house, and as others do at a time of mourning, we reminisced about Buttons — his place on Peggy’s bed…the paw he would raise when he wanted a treat. It all felt right.

Buttons was soon replaced with a new Buttons. The benefit, if there was one, of Peggy’s dementia is that she forgot that there was ever any other Buttons. But for this Aging Life Care Specialist, all was not forgotten. I was reminded that the definition of “family” has many meanings, all of which we must explore and respect. And when we are with our clients at the end of life, the process of mourning is equally important for a family member with four legs, whiskers, and answers to the name Buttons.

About the author: Miriam Zucker, LMSW, C-ASWCM is an Aging Life Care Specialist. She is the founder of Directions in Aging, based in Westchester County, New York. Her only pets have been goldfish won at carnivals.

How to Cope with a Parkinson’s Diagnosis

September 28, 2016Uncategorized Callie Daters

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.

So, It’s Parkinson’s…Now What? Four Tips for Managing the Road Ahead

by Lisa Laney, MSW, CMC – Aging Life Care Association™ Member

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.

Aging Adults and Suicide Risk

September 21, 2016Aging Life Care Professionals, Education, Grief and Loss, Mental Healthaging adults and suicide risk, depression, suicide prevention, Suicide Prevention Awareness Month, Suicide Risk Callie Daters

In 2013, the second highest rate of suicide occurred in those 85 years and older. It is difficult to imagine that your aging loved one may be contemplating suicide, but the aging process can bring on depression and a sense of hopelessness that may prompt suicidal thoughts. As we mark September as Suicide Prevention Awareness Month, take a moment to identify suicidal warning signs and learn how you can help someone you love.

September is Suicide Prevention Awareness Month

By Deborah Liss Fins, MSSW, LICSW, CMC, Aging Life Care Association™ Member and Fellow of the Leadership Academy

It’s a sobering fact: According to the U.S. Centers for Disease Control (CDC), more Americans die from suicide than homicide. Even more sobering: Older Americans are much more likely to take their lives by suicide than teens or young adults, the two age groups that receive the most attention for being at risk.

In a 2012 study using 2009 data, the CDC found that the national suicide rate, when adjusted for age, is 11.8 deaths per 100,000 population—about twice as high as the national homicide rate (5.5). At greatest risk are adults 45 and older, with suicide rates in the high teens.

The U.S. Administration on Aging reports that older, white males are at the highest risk, with 30.3 suicides per 100,000.

It is difficult to imagine that your aging loved one may be contemplating suicide. But the aging process can lead to isolation, painful disease or physical ailments, loss of a beloved partner and friends, loss of a home and independence—all stressful changes that can bring on depression and a sense of hopelessness that may prompt a person to want to end it all.

Of course, not every older adult who feels sad or depressed is considering suicide. Those feelings can certainly be part of the normal process of grieving when a loved one dies or the individual experiences other significant losses.

But it’s important to recognize warning signs of an older adult who is at risk of taking his or her own life.

Social Isolation and Depression Increase Suicide Risk in Older Adults

According to the Samaritans of Merrimack Valley, older adults are not only at greater risk of attempting suicide but also more likely to succeed, due to social isolation and a resistance to talking about depression:

Fewer warning signs or explicit cues—Older adults may not be very communicative about how they are feeling or what they are considering. Depression is common with painful illness and aging, although older adults often have less contact with mental health professionals.
Higher likelihood that a suicide attempt will succeed—The elderly are more likely to die from suicide attempts than younger people because they are frailer. They may be quite focused on planning, be secretive, avoid interventions and take precautions against anyone finding out what they have in mind.
Lower likelihood of discovery—Social isolation can leave older adults to their own devices, without emotional support or reality checks to help them see alternatives to suicide.
Stigma associated with mental health issues—Older adults may feel ashamed to contact a mental health professional, acknowledge depression or seek help for emotional issues and concerns.
Past history not necessarily predictive—An older individual may not have a history of past suicide attempts—one of the main predictors of suicide—but still turn to suicide when depression and hopelessness become overwhelming.

Other risk factors for suicide, for people of all ages, include:

Being male. Although women attempt suicide three times more often than men, four times more men than women die by suicide. Risk of suicide declines among women as they age, but increases for men. Other factors include:

Family history of suicide or mental health challenges
History of physical, alcohol, drug or other forms of abuse
Loss of significant other, family member or other close relationship
Major life changes, such as divorce, retirement, moving, financial problems
Previous suicide attempts
Lack of support systems, poor help-seeking skills
Access to means of taking one’s own life

How to Recognize Suicidal Warning Signs in Older Adults

There is no obvious profile for an older adult who is contemplating suicide. Probably the most important warning sign is a significant change in behavior. If your loved one was once social and outgoing, but has become withdrawn and reluctant to communicate, you may have cause for concern. Here are some more warning signs:

Depression in older adults can manifest in a variety of ways. Has your loved one become withdrawn or, possibly, angry, irritable or hostile?
Does she express feelings of hopelessness, that she no longer has a reason for living?
Is he angry to the point of raging or seeking revenge?
Does she seem reckless or impulsive, engaging in risky activities without thinking?
Does he express a feeling of being trapped, having no way out of his current circumstances?
Has she lost interest in hobbies or other favorite activities?
Has he suddenly updated his will or given away prized possessions?
Has she lost interest in keeping up her appearance?
Does he refuse to connect with others who might be of help?
Do you see any increase in drug or alcohol use?

What You Can Do to Help

Keeping the lines of communication open with your aging loved one is the best way to address issues before he or she becomes so desperate as to seriously consider or attempt suicide. The more your loved one can maintain good health habits—including proper sleep, nutrition, exercise and interaction with supportive family, friends and other valued social connections—the better his or her chances of managing the inevitable sense of loss and sadness that can accompany the aging process.

Consider hiring an Aging Life Care Professional™ to help monitor your loved one’s physical and mental health. An Aging Life Care Professional can assess the situation and make appropriate recommendations to specialists or to other resources such as housing, home care, medical providers, and social activities. The Aging Life Care Professional can keep lines of communication open and inform you of any changing needs.

If you suspect that your loved one is sliding into depression and you observe any of the warning signs listed above, don’t be afraid to ask if he or she is contemplating suicide. Bringing up the topic for an honest discussion does not increase the risk of suicide; in fact, it can be a relief for your loved one to have you notice that she or he is in emotional pain.

However, you should seek immediate help from a mental health professional—or, in case of extreme risk, call 9-1-1—if you observe any of the following:

Your loved one threatens to hurt or kill himself or talks about wanting to hurt or kill himself
Your loved one seeks ways to kill herself by seeking access to pills, firearms or other means
Your loved one talks or writes about suicide, death, and dying

For more information about suicide prevention and older adults, see Older Americans Behavioral Health Issue Brief 4: Preventing Suicide in Older Adults, a publication of the U.S. Substance Abuse and Mental Health Services Administration and the Administration on Aging.

NAMI offers information through its website www.nami.org and HelpLine 1-800-950-NAMI (6264). With affiliates in hundreds of communities nationwide, NAMI also offers free education classes and support groups.

To find an Aging Life Care Professional near you, search this directory of experts.

About the author: Deborah Liss Fins has over 35 years of experience in aging life care issues. She is the President of Deborah Fins Associates, PC in Worcester, MA. Debbie is a member of the Board of Directors of the Aging Life Care Association™ and co-chair of the Education Committee. Follow her on LinkedIn and Twitter @DeborahFinsALCM or email her at DLFins@finseldercare.com. Deborah Fins Associates has a presence on Facebook – we invite you to like our page.

Journal of Aging Life Care – Summer 2016

September 1, 2016Uncategorized Callie Daters

In this recent issue of the Journal of Aging Life Care, thought leaders and experts reflect on the topics covered by the 2015 White House Conference on Aging and discuss the ways to move and shape dialogue forward.

Journal of Aging Life Care™ Takes a Look at The White House Conference on Aging One Year Later

by Jennifer E. Voorlas, MSG, CMC – Aging Life Care Association™ Member and Editor-in-Chief of the Journal of Aging Life Care

The White House Conference on Aging (WHCOA), held in July 2015, marked the historic 50th anniversary of Medicare, and included many hopeful discussions about better ways to support seniors and their families. Over the years, this national event has been responsible for a number of significant changes in public policy. The first conference was held in 1950, when President Harry S. Truman ordered the Federal Security Agency to hold a national conference on aging. The 1961 Conference led to the development of the 50 state units on aging as part of the Older Americans Act; and in 1971 the WHCOA led to the creation of the Social Security Insurance program.

Fast forward to July 13, 2015, and as Author Gretchen Alkema of SCAN describes, this conference was “for the first time onsite at The White House and celebrated in the East Room, utilizing a more modern approach to community engagement via extensive social media.” President Obama’s attendance and remarks elevated the importance of the event and served as a call to action.” She notes that it “was laser-focused on four specific issues: elder justice, healthy aging, long-term services and supports, and retirement security.”

However, “Despite the positive dialogue at the conference, there was a topic glaringly absent from the day: a clear-eyed discussion of current and future long-term care costs [the elephant in the room], which is the largest and most unpredictable factor eroding retirement security for individuals and families.” While the WHCOA was a forum for advocating resources and programs which allow seniors to age in place in the comfort of their own homes, Aging Life Care Managers™ are keenly aware that affordability for some does not mean most; as the majority of those seniors with increased health care needs and lower socioeconomic status are often thrust prematurely into long-term care arrangements.

Presenting options to finance long-term care, Author Eileen Tell in her article delves into educating care managers on the different types of policies in existence, as well as the “hybrid” policies that are now in the market place, weighing the benefits and risks, including helpful tips for care managers working with their clients. Continuing the dialogue, Helene Bergman addresses the impact of overtime laws in a diverse compilation of anecdotes from Aging Life Care Managers and home care agencies across the country, underscoring the impact on care managers, home care agencies, and ultimately the elders we care for.

In alignment with the National Institute of Health and National Institute on Aging, the WHCOA advocated for initiatives to increase healthy aging via physical exercise, and a “stepped up” effort of the National plan to address Alzheimer’s disease and related dementias. In keeping with these goals, Dr. Steven Castle’s article introduces his fall prevention program, how it has been instituted on a state and national level, and how care managers can play an important role to encourage exercise for seniors. In addition, he emphasizes the importance of physical fitness on brain health, introducing Jennifer Voorlas’s article which supports exercise as being “neuroprotective,” offering evidence of exercise as being a potential (and critical) factor in the prevention of cognitive decline such as Alzheimer’s disease and related dementias.

The topic of elder abuse still remains a national priority which was addressed through discussion of major initiatives and training programs to identify and prevent elder abuse in alignment with goals of The US department of justice and the National Institute of Health. A clear focus on initiatives to combat elder abuse is explored by authors Amy Berman, Kathrin Lozah, and Dr. Terry Fulmer of the Hartford Foundation. They identify the most vulnerable, at-risk elders, providing information on the signs of elder abuse Aging Life Care Managers need to aware of, and offer information on what care managers can do when they identify victims of elder abuse in the course of their practices.

Finally, while the WHCOA addressed how doctors will now be reimbursed for end-of-life discussions with their patients, absent from the discussion was the value of hospice and palliative care measures included in advanced care planning. Striking this chord is Dr. Nancy Berlinger’s article which focuses on the ethics of end-of-life planning as key to long-term care and support of the elderly, which is directly relevant to how care managers can support older adults and their families.

Throughout this edition, each author has contributed to enhancing our knowledge as Aging Life Care Managers about relevant policy issues which impacts the seniors we work with on a daily basis. The articles presented in this issue are not only intended to provide an update on some of the most salient points from last year’s conference; but to address their current relevancy, along with a provocative attempt to move and shape the dialogue forward. On behalf of the entire editorial board, we hope you enjoy this edition!

2016 Summer Edition of the Journal of Aging Life Care:

Reflections on the 2015 White House Conference on Aging: One Year Later and Much More Work to Do
The Good News and Bad News for Private Financing for Long-Term Care (LTC) Needs
The Challenge of Aging in Place: The Impact of Overtime Laws
Exercise at any Age, with any Chronic Condition
The Neuroprotective Role of Exercise
Updates from the White House Conference on Aging about Elder Mistreatment: What Aging Life Care Managers™ Need to Know
Beyond Good Deaths and Angry Families: Improving End-of-Life Care in the Community

About the Journal: Each issue of the Journal of Aging Life Care is filled with in-depth articles and case studies on clinical topics and business topics that are vital in educating Aging Life Care Professionals on the latest trends, best practices, and research in the field. To view past issues visit http://www.aginglifecarejournal.org/issue-library/.

Tips for Traveling with an Aging Adult

August 24, 2016Aging Parents, Family Membersageism, Aging Well, travel Callie Daters

When deciding to travel, age should not get in the way of taking a trip. One’s health must be considered, yes, but the decision to go or not to go should not be based on age alone. One Aging Life Care Manager™ shares her story and lessons learned from traveling with her 91-year-old mother. As she writes, don’t miss out on the experience you can have together.

Flying through the Years: What I Almost Missed by Not Traveling with My 90-Something Mom

by Tracey Olson MSW, LCSW – Aging Life Care Association Member

Throughout the past few years, I found myself saying that it would be nice if my 91-year-old mother could visit her older brother in San Antonio or see my daughter in Los Angeles, I opined about how great it would be if…

But if what? Why couldn’t my mother travel from Chicago to San Antonio or Los Angeles? There is no travel ban for 91-year-olds, after all. I had simply believed travel was not an option for a ninety-year old. Hmmm, is that ageism? Surely an Aging Life Care Manager™ isn’t ageist?

My mother is healthy. She uses a walker, but besides that, is remarkably fit. We talked about the idea of her traversing around the country, and while she was apprehensive about flying, she desperately wanted to see her brother again and see the new place her granddaughter lived.

Before traveling a long distance with my mother, I asked her doctor’s opinion. The doctor said to go for it and made these suggestions:

Take an aspirin an hour before the flight takes off to help keep blood flowing
Drink lots of water
When possible, get up and move around during the flight
Wear support hose or compression stockings

We took trips to San Antonio and Los Angeles. In both cases, we had a third person traveling with us which did make everything easier. But, I would do it again by myself.

What were the highlights? My mother had a great time seeing her brother and his wife. They all took their walkers and went for a stroll on the San Antonio River Walk. At 91, my mother had never seen the Grand Canyon from the air and was truly amazed. She and I walked along the Santa Monica boardwalk together and she saw where her granddaughter lives. What could be better?

As far as a list of hints for traveling with an older adult, in truth, most things are just like planning any trip. For the best trip, I learned it is vital to go with flow—encourage it, even! My best suggestion is not to let age get in the way of taking that trip. Consider health, of course, but don’t make a decision not to go because of age.

Tips for Traveling with an Aging Adult:

1. Consult with the individual’s regular physician before traveling to address any health concerns or risks.

2. Pack carefully. Keep medicine in their original containers in your carry-on luggage. Pack an extra supply in the checked luggage. Keep insurance cards with you at all times.

3. When flying, order a wheelchair and indicate the person traveling has a disability and needs more time boarding and deplaning. The distance to and from the gate and the wait at security can be extremely tiring as well as a fall risk. The service is handled differently by various airlines, but all have the service escorts and transportation available.

4. When flying, check the luggage with a skycap at the curb if available. Don’t overload you or your loved one with carry-on bags. Choose a small bag with the medications, supplies and paperwork. When possible, use curbside check-in to access the wheel chair and escort before entering the airport.

5. Take preventative measures to prevent blood clots, such as taking an aspirin, drinking plenty of water, getting up and moving the body. Walk to the bathroom during a flight, or while driving, make scheduled stops at historic markers or rest stops along the route.

traveling with seniors — Mother resting with a book and a beautiful view.

6. If you are renting a car:

Bring the disability placard to use in the rental car for parking
Consider renting a mini-van for easier entry/exit access and storage of a walker
Take a taxi to the rental location for the extra assistance with luggage versus the often crowded shuttle

7. When booking hotel rooms, take into consideration:

Before automatically booking the handicap-accessible room, make sure it will meet your needs. For us, the handicap-accessible rooms did not have a view.
Ask about the bathroom safety features. Is there something you can bring or order ahead of time to make it safer (for example a shower chair).
Select a hotel that you feel comfortable spending time in, offers good views, that is convenient to people you are visiting, or near activities that are planned.
Choose a hotel that offers room service or an in-house restaurant.

8. Don’t overschedule activities and always include plenty of time to rest.

9. Have extra cash for tips (skycaps, bellmen, escorts). This will be money well spent and the extra assistance much appreciated.

10. Most importantly, remember that age doesn’t determine if you should or shouldn’t travel. Don’t limit yourself and your loved one and the experiences you can have together.

One unintended outcome was the trips seemed to give my mother some renewed self-confidence. When we returned home to Chicago she said, “I didn’t think I could do it, but now I know I can.” Indeed she can, and many other older adults can too.

Aging Life Care Managers™ are an excellent resource for assisting aging adults with traveling. From arranging an in-flight nurse to securing caregivers or aides at your destination, these professionals have the network to help make travel as stress-free and safe as possible.

About the author: Tracey Olson, is an Advanced Professional Aging Life Care™ Expert, and a Licensed Clinical Social Worker, Masters Level. Tracey takes a strengths perspective – not just identifying and focusing on needs, but also on strengths – when working with older adult clients and their families. Tracey’s independent care management practice, AgeWell Solutions, is located in the Chicago suburbs.

If I am an Only Child, How Can I Manage the Care of My Aging Parents?

August 18, 2016Aging Parents, Sibling Relationshipbe prepared, only child, The Brady Bunch Callie Daters

If you are an only child, you may be worried about caring for your aging parents alone. But having siblings — one or a few — does not ensure you will have help. The best advice is to prepare early, stay organized, and don’t be afraid to ask for a little help.

Caring for Aging Parents Doesn’t Take the Brady Bunch

by Byron Cordes, LCSW, C-ASWCM – Aging Life Care Association™ Member

I have long imagined how the parents from the Brady Bunch television show fared as they aged. I picture Mike and Carol comfortably in their home, surrounded by their six children who are all working together to meet the needs of their aging parents. I envision something like this…

Marsha takes her parents to all their doctors’ appointments, while Greg helps manage the finances. Jan has a Mahjong group that meets at the house every Wednesday, bringing Alice and Sam the Butcher along for socialization. Peter comes by each week to refill prescriptions in pill boxes, while Cindy and Bobby prepare healthy, home cooked meals to fill the fridge and freezer. All is good at the Brady household.

Sadly, this rarely happens with even the largest, or closest, of families.

So what happens if you are an only child with no siblings to lean on?

How do you do the work of six children while balancing your work, own children, and spouse? Hope is in the planning. A well-prepared plan can make all the difference. Adult children (one or many) tasked with caring for aging parents should always start early whenever possible. Try to sit down with your parents before a crisis and get an understanding of their wishes as they age. You can also collect information now such as where important documents are kept. Open communication can be hard, and parents may not readily discuss certain aspects of their care with their children. If you run into road blocks, or just don’t feel comfortable doing it alone, involve a trusted partner; maybe a sibling of your parents, a pastor, or even their physician.

Once one or both parents need help, there are things you can do to make life easier on you while still providing the care your parents need and deserve.

Staying organized is key. Break up the activities in which your parent needs help — bill paying, medication management, cleaning, etc. — then pick a specific day or time to work on that issue. By breaking up tasks you make them more manageable.
Don’t be afraid to ask for help. There is no shortage of companies offering advice and services for seniors, but that can be overwhelming, so do your homework. Some of the “free” services may have conflicts of interest with your family’s best interest. Look for well-vetted agencies that can offer help, such as the Alzheimer’s Association, American Cancer Society, or go through the United Way. All areas of the country are covered by an Area Agency on Aging and can help link you to trusted services in your area of need. These Area Agencies on Aging are often office based, so they may not be able to help assess your parent’s needs on site.

An Aging Life Care Professional^TM can also be a valuable resource. These are health and human service professionals who know the health and social systems in the areas they serve. An Aging Life CareProfessional will complete a comprehensive assessment of your parent in their living environment and work alongside you to develop a plan of care that takes all factors into account.

As an only child, you can help your parents through their Golden Years. The bottom line is that The Brady Bunch isn’t real and having siblings — one or a few — does not ensure you would have help. The best advice is to prepare early, stay organized, and don’t be afraid to ask for a little help.

About the author: Byron Cordes, LCSW, C-ASWCM is recognized as one of the nation’s leading experts in Geriatric Care Management, derived from 25 years in the social work field. He is a past-president of the Aging Life Care Association. Byron is the President of Sage Care Management in San Antonio, Texas and can be reached at byron@sage-care.com.

The Sandwich Generation: Stuck in the Middle

August 10, 2016Aging Life Care Professionals, Aging Parents, Baby Boomers, CaregivingAging Well, care management, caregiver burnout, Sandwich Generation Callie Daters

America’s Sandwich Generation, men and women in their forties to sixties with both aging parents and children to care for, is one of the fastest growing populations. This group of people often find themselves stuck in the middle of trying to juggle a hectic schedule that includes caring for parents experiencing a decline in health, keeping up with adult children as they struggle to “make it on their own” and begin their families, and managing the financial and emotional stressors that arise throughout these circumstances. This alone is a lot for one person to handle and often leaves little time for self-care and nurturing a relationship with your spouse.

8 Things the Sandwich Generation Should Know to Help Ease the Stress of Managing the Care of Mom, Dad, the Kids…and Themselves

By Kim Miller, BSN, MSN, CMC – Aging Life Care Association™ Member

How does one work a full-time job, raise a family, care for parents who are living with medical complications, maintain a healthy intimate relationship, and have time for stress management and stress relieving activities? The following 8 tips provide suggestions and information to help you cope with these demands and provide a way for you to move gracefully forward into your Golden Years.

TIP 1: It’s never too early to start planning.

The moment is now and the options are many. From making room in your budget now to prepare for the costs involved with aging parents and growing children to delaying the downsizing of your home to reviewing the benefits of long-term care insurance, there are many ways you can help yourself by planning now for what is in store. Rather than feeling suddenly overwhelmed in the face of difficult decisions, seek advice from financial, medical, and qualified professionals to help shore up your financial and physical resources. There are many professionals in the legal and financial sectors that specialize in elder care and long-term care planning.

TIP 2: Don’t make any assumptions and trust your instincts.

Recognizing when to seek advice is key. Early signs of feeling like you’re squeezed in the middle can be identified by simply noting if you have asked yourself the following questions:

How can I spend time with my children and help my parents every time they ask?
How many hours in a day are too many spent in the role of caregiver?
How do I fit in time for my marriage?
When was the last time I sat down?
Why do I feel so isolated?

It’s important to recognize when you begin to feel stretched too thin. Listen to that voice inside and seek the advice of a professional. This is especially important for women who often assume they should know about caring for the aging in the same way that they instinctually know about childcare. Everyone ages differently and every situation is unique. It’s impossible to know in advance how to handle the needs that will arise. It’s best to not assume anything.

TIP 3: Don’t try to go it alone. Seek expert advice and assistance.

Don’t be ashamed about feeling overwhelmed or ill-prepared. This is the case for most of us. There are a wide variety of services and professionals available to help you. A great place to start is to find an Aging Life Care Professional™. An Aging Life Care Professional is typically a nurse or social worker who has expertise in the aging process and the issues that may arise. An Aging Life Care Professional can assess all aspects of your unique situation and help you develop a plan that will meet your aging parent’s needs over time.

Ultimately, someone may need a geriatrician, psychiatrist, or lawyer. There may be a need to provide personal care by a professional. All of these individual providers are focused on a particular service while an Aging Life Care Professional can partner with you to coordinate the care your aging parent needs. Many people feel that this is a job for them to do on their own because they know their parent the best, however, this can be overwhelming. Partnering with an Aging Life Care Professional allows you to extend your reach in caring for you parent while remaining in balance with the other factors in your life.

You can find an Aging Life Care Professional™ by searching aginglifecare.org. You can also contact your local Area Agency on Aging, which can give you information about programs, services, and facilities available right in your community.

TIP 4: Bring them to the table and let them keep their seat at the head.

Talking with mom and/or dad about seeking assistance or advice about how to care for them can often feel daunting. It challenges the typical roles of parent and child. Even though they are aging, the need to be the parent and to feel in control does not fade away and can often become even more present. The first step is to recognize this fact, accept that it will be challenging and then move forward with respectful nurturing and loving care. The rest is artful conversation and psychology.

Here are some considerations when approaching your parents about needing help:

Give them the sense that they are the employer, even when they are not and that this is something that your parents will be managing. Try referring to them as a consultant. Find something in the home that they have been frustrated by and suggest that the person will help them make a plan to solve the problem.
Explain to your parents that this is someone who will be helping you (their child) by assuring your peace of mind that they are safe. This keeps you in the position of the child who needs help, and the sense that the parents are still needed to support you.
If the above are not successful, then it may be time to bring in an expert like a well-respected physician, lawyer or financial advisor who will then provide a prescription for the geriatric care manager.

TIP 5: Sharing is caring. Incorporate your family into the daily mix.

As corny as it may sound, a family meeting can be a great way to get everyone onto the same page about priorities and responsibilities. It provides the opportunity for everyone to share what they are going through and develop strategies to help meet everyone’s needs. It is an opportunity to discuss the caregiving needs, household chores and scheduled tasks to be accomplished on a daily and weekly basis. Bring a pad of paper and make a “to do” list for each person. Don’t forget that your close friends can also be a part of this meeting – the more, the merrier!

TIP 6: Anticipate and address the questions of children and grandchildren.

Even when they don’t ask, your children are likely wondering why their grandparents are more forgetful (especially about remembering their name, etc.), why they need assistance getting dressed, or why someone is coming to help them each day. It is important to educate your children, even at an early age, about these normal parts of life. You can also assure your children that grandma may not remember things but she still loves them. Explain that she can’t express herself but she is still thinking about them. There are many books available for children of all ages to help them better understand topics such as memory problems, feelings of sadness, death and so on. These books will allow them to acknowledge the sadness while also realizing the importance for grandma to have people around her who love her and can take good care of her. Additionally, the books can help you approach the delicate, difficult and sad parts of decline as well as finding the good parts worth celebrating about getting older.

There are many books available for children of all ages to help them better understand topics such as memory problems, feelings of sadness, death and so on. These books will allow them to acknowledge the sadness while also realizing the importance for grandma to have people around her who love her and can take good care of her. Additionally, the books can help you approach the delicate, difficult and sad parts of decline as well as finding the good parts worth celebrating about getting older.

TIP 7: Speak with your employer.

Many employers are familiar with or sympathize with the demands that are involved with being a part of the Sandwich Generation and are willing to work with you to keep you working for them. Since you never know until you ask, make an appointment to discuss the different ways your employer may be willing to accommodate you. Some companies allow you to work from home, adjust your hours or change the days of the week that you are in the office. It is also becoming more common for employers to offer brief periods of leave so you can attend to unexpected family matters. Your employer likely has an Employee Assistance Program (EAP) that may be able to help you access resources or provide you with support.

TIP 8: You are not the last or the least. Make time for number one.

Since we know stressors can contribute to and lead to health problems of a mental and physical nature, start out on the right foot and make time throughout the week for you. While it is essential to build important things like exercise, regular sleep, and healthy eating into your schedule, there is also no shame in giving yourself the opportunity to continue your hobbies, favorite pastimes, friendships and even alone time. Maybe you won’t have as much time for extracurricular activities as before, but just several hours a week can elevate your spirits and do a world of good for your health.

Here are some suggestions for keeping in touch with your sense of well-being:

Take 10 minutes a day to sit down, listen to music, meditate or even just close your eyes.
Keep your marriage on the priority list and add a weekly activity for just you and your spouse to enjoy.
Give laughter a chance and enjoy the funny moments that life brings along each day.
Try to set aside one hour a day for something you love to do like reading the paper, taking a walk during your lunch break or calling a friend.
Look for the ways that providing care enhances your relationships with your family and affords a sense of satisfaction.
Listen to your body and learn to recognize when it is telling you to slow down or that something is not right. It’s very important to immediately take action, take a break and seek medical attention when necessary.

No matter how much the above might seem like an indulgence, doing any or all of them can help save you from hitting the proverbial wall. Once you are at the point of burn out it is very easy to wind up sick which often happens when constantly being the caregiver and never the care recipient. To help avoid reaching that run down state, remember to check in with yourself on a daily basis.

In the end, it is good to remember that you are the most qualified person for taking care of yourself. By helping yourself stay strong and healthy, you are ultimately helping your family and parents by remaining available and capable for the challenges that live in the middle of that very tightly squeezed sandwich.

About the author: Kim Miller, BSN, MSN, CMC is a Certified Care Manager at SeniorBridge, a national health care company offering individually tailored care management and home care services. She has over 30 years of experience as a nurse, with 16 of those years as a nurse practitioner. Email Kim at kmiller@seniorbridge.com or follow SeniorBridge on Facebook, Twitter, and LinkedIn.

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Copyright: Sergey Peterman

Is There a Gun in the Home?

August 8, 2016Aging Life Care Professionals, Care Recipients, Caregivingfirearms, gun safety, guns, instaPOLL Callie Daters

Aging Life Care Professionals™ who serve elders in their homes assess a number of factors to ensure the safety and security of the family, paid caregivers, and other professionals working in the home. A recent survey by the Aging Life Care Association™ identifies many diagnoses that can compromise safety if there is an unsecured gun in the home.

Professionals Employed by Elders Assess Safety Risks of Guns in the Home

The heightened awareness of the responsibilities of gun ownership and gun safety prompted the Aging Life Care Association ™ to conduct a survey to learn whether their members discuss this topic when conducting their initial assessment. The survey of Aging Life Care Managers™ indicates that unsecured firearms, sometimes combined with a variety of diagnoses, is a safety concern of many professionals.

During the mid-summer survey (July 15-20, 2016) Aging Life Care Managers™ were asked if they include questions about firearms when interviewing prospective clients and, if so, how that affected their providing services in the home.

gun in the home of aging adults — • The majority of Aging Life Care Professionals found the frequency of guns in the house “Very Rarely” (31.2%) or “Sometimes” (27.2%).

Fully 50% of those surveyed (141 of 282) said they include a question in their assessment regarding the presence of firearms. Some respondents said it was their employer’s requirement to ask this question; others said it was as important as knowing about the client’s driving ability, medications, alcohol or tobacco use, or potential sources of elder abuse. Many commented that they have not asked the question in the past, but will in the future. In addition,

52% require that firearms are securely locked up
10 % require that firearms be removed
1% decline services if firearms are present

Further findings show:

The majority of Aging Life Care Professionals found the frequency of guns in the house “Very Rarely” (31.2%) or “Sometimes” (27.2%).
The biggest threats to firearm safety in the home included diagnoses of dementia, depression, PTSD, or mental illness of any kind.
Most respondents said if there are firearms in the house they require that they are securely locked up (52%).
A very few (less than 1%) felt it was not appropriate to ask clients about gun ownership.
Overwhelmingly, respondents said they had to evaluate the safety implications of guns in the house on a case-by-case basis, citing cognitive functioning, medications, diagnoses, family dynamics, etc.

Several respondents recounted stories of suicides by clients that took place while professional caregivers were in the home. Said one Aging Life Care Manager™, “I had a client commit suicide after the family said all firearms were removed from the house. He had one hidden. He was terminal with brain cancer with metastasis.” A similar circumstance was described by another care manager as “one of the worst days of my life.”

The topic of guns can sometimes offer a positive influence in a client-care manager relationship. Said one care manager, “Discussing firearms, hunting stories, and war stories involving the use of firearms is a great way to bond with your client.”

As the survey found, certain diagnoses can result in a dangerous environment both for the client and those working in the home. And even with professional supervision, mistakes can be made. One respondent described this case: “Client 92, former military. Family felt guns were out of the house. Professional guardian (former military herself) conducted detailed search of the home after appointed and assured me that there were no weapons in home. The client threatened to shoot the night caregiver but never produced a gun. However, while filling medication boxes and securing extra meds in a lockbox in a spare room, I found a handgun. Now I always assume there could be a weapon even if I am told there is not one.”

The Aging Life Care Association (ALCA) does not take a position on guns or gun ownership. As a professional society, their purpose is to provide education, networking, and professional development to their members.