Archives

Journal of Aging Life Care Summer 2017: Atypical Dementias

In the newest edition of the Aging Life Care Journal, Aging Life Care Professionals examine the issues faced by those who are younger and diagnosed with atypical dementias. Jennifer Pilcher-Warren, MS, PhD, CMC, is the editor-in-chief. Her message to readers is below. To read the entire issue of the Journal of Aging Life Care: Atypical Dementias, you can find it here.

From Jennifer Pilcher-Warren, MS, PhD, CMC, editor-in-chief:

Greetings!  I am very excited to present this latest issue of the Journal of Aging Life Care which explores the unique challenges for Aging Life Care Managers who are serving younger clients with atypical dementias. Having grown up in a family where both my maternal grandmother and aunt were diagnosed with Young-Onset Alzheimer’s disease, this is a topic near and dear to my own heart. However, for many of us in the care management field who have traditionally worked with geriatric clients, this is a new and often challenging population to work with.

Whether because of improved detection, increased awareness among medical providers or the fact that incidences are more frequent due to early baby boomers, the reality is we are seeing an ever-increasing number of younger clients with dementia in our practices. There is a high likelihood that these clients will have a less common type of dementia. For example, in 75% of FTD cases, onset occurs before the age of 65 (Onyike, CU; Dhiel-Scmid, J: The epidemiology of frontotemporal dementia, International Review of Psychiatry, 2013: 25: 130-137).

These clients may have recently retired or even forced to leave work, often not on good terms and thus may be experiencing devastating financial consequences. Frequently, these clients have grade school or teenage children living at home, further complicating the situation. Caregivers for clients with young-onset dementias experience levels of stress, burden, and depression that some studies suggest are even higher than for caregivers of clients with late-onset (van Vliet, D., de Vugt, M. E., Bakker, C., Koopmans, R. T. C. M. and Verhey, F. R. J. (2010), Impact of early onset dementia on caregivers: a review. Int. J. Geriat. Psychiatry, 25: 1091–1100. doi:10.1002/gps.2439). As a result, these clients, and their families, deserve a different care management approach.

Resources for this population are scarce. We, as Aging Life Care Managers, are often placing these younger clients in facilities where they have no peer group, where programming is often inappropriate, and direct care strategies are either unclear or insufficient. Moreover, in addition to age, facilities are often resistant or simply unwilling to accepting clients with atypical dementias such as FTD or Lewy Body Dementia due to stigma about associated behavioral issues. In fact, according to the Cognitive Neurology and Alzheimer’s Disease Center at the Northwestern University Feinberg School of Medicine, most adult day programs and residential care facilities are not prepared to address the special needs of a younger patient, especially if their behavioral symptoms are difficult to manage. It is understandable why facilities would worry about the safety of their other residents who are not as healthy, mobile, and functionally capable as this younger population. However, as very few placement options exist for these clients, it can leave the Aging Life Care Manager perplexed and in a very difficult position.

This issue is designed to highlight the particular struggles of this type of client and increase awareness of their unique challenges. We hope the authors’ expertise provided in this issue will serve to educate and/or reinforce each reader’s understanding of the different types of atypical dementias, present real life situations where Aging Life Care Management has been effective in working with these clients, provide some strategies and techniques for working with these clients, and inform you about new, innovative, and practical ideas being used to care for this population. On behalf of the entire board and my fellow Guest Editor, Ted Aransky, MEd, LSW, CMC, we hope you enjoy this latest issue and find it beneficial.


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.

How to Recognize When It’s Time for Older Adults to Stop Driving

One of the most difficult conversations caregivers can have with their older loved ones concerns driving. Telling someone they are no longer safe to drive can result in hurt feelings, resentment, and arguments. ALCA member Susan Birenbaum addresses these concerns and directs caregivers to useful resources.

How to Recognize When It’s Time for Older Adults to Stop Driving

Susan Birenbaum, MBA, LCSW, C-ASWCM

One of the most frequent questions that I get from Adult Children as an Aging Life Care Manager is, “I am concerned about my parent’s driving but don’t know how to discuss it with them. My siblings agree that my parent should no longer be driving, and perhaps the other parent also agrees. We have tried to bring up the subject with my parent, but he is in denial and it leads to an altercation.”

What does giving up their license mean for an Older Adult?

  • Giving up driving is a very emotional issue for an Older Adult. They view it as judgment by their children, but more importantly as a loss of independence, especially if they live outside of a major city without easy transportation.
  • People have driven for years and it is viewed as an important part of their identity.
  • Often this can result in isolation, lack of ability to socialize, and reliance on other people.
  • This can result in a very emotional conversation with the children and can turn to anger.

How to Handle the Conversation & Topics to Consider:

  • Taking the keys from Older drivers;
  • Talking with Older Drivers who need to stop driving;
  • The warning signs of unsafe driving.

It can be helpful if you arrange for someone or someway to provide transportation that the Older Adult can continue to attend social events, MD appointments and avoid isolation, thereby helping them to maintain their way of life.

A resource which can be very helpful in handling this situation of having the older driver give up driving is his physician. Generally, the physician is viewed as an authority figure and the Older Adult will listen to him/her.

Where Do We Turn?  

AARP Driving Tool

The most valuable tool in this situation is the AARP Driving Tool (www.aarp.org).  It is an online seminar which addresses all these questions. The format is as follows:

When Should Older Adults Stop Driving?

  • AARP Driver Safety: available online and in a classroom
  • Older drivers and automobile safety
  • Driving Assessment for older drivers
  • List of when to put the brakes on elderly drivers
  • AARP Driver Safety Test
  • Driver Safety, Public Transportation and Mobility Caregiving tips

Modules I –The Meaning of Driving

Module II – Observing driving skills

Module III – Planning conversation

Guidebooks for Car Safety

There are many guidebooks for helping with the conversation. The Hartford Insurance Company, in conjunction with the MITAge Lab, produced guidebooks titled “We Need to Talk.”  These guidebooks can be downloaded at www.thehartford.com. Chapters include:

  1. Your Road Ahead
  2. Comprehensive Evaluations
  3. At the Crossroad, Family Conversations about Alzheimer’s Disease, Dementia and Driving

A point to bear in mind is that just because the driver is older does not necessarily mean that he/she should stop driving.  Two ways to evaluate safety include: (1) AARP Safety Test; (2) Personally drive with the individual and see if he/she drives competently and safely.


Susan Birenbaum is a Certified Aging Life Care Manager and Psychotherapist specializing in Geriatric and family issues. She is a Principle, Humanittude LLC.

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.

life insurance

What’s Important to Consider Before Hiring In-Home Caregivers

In the Aging Life Care Association’s newest White Paper, “Agency or Independent: Considerations in Hiring”, ALCA member Bunni Dybnis examines the legal and financial questions one should examine before deciding to hire caregivers for the home. Below is an excerpt from the beginning of the White Paper; to read and download the entire document, please click here.

Agency or Independent: Considerations in Hiring
Bunni Dybnis, MA, LMFT, CMC, Aging Life Care Association Member
Fellow of the Leadership Academy

“For aging adults with physical and cognitive limitations who wish to remain in the familiar environment of their own home, paid in-home care workers often provide the solution. Understanding the differences in care providers and the roles and obligations of hiring are essential in creating a positive experience for all involved.

In-home caregivers can provide a wide range of assistance including personal care needs such as bathing, dressing, supervision, help with toileting, to medication reminders and assistance with daily living activities, such as meal preparation, light housekeeping, laundry, transportation, and companionship. Those who are hiring paid workers to provide in-home care look for solutions from a variety of sources. Being responsible for the care of a dependent or older adult is a demanding job that often involves many tasks.

Choosing a full-service agency shifts the responsibility of care and liability away from the family and can provide respite from many of these demands. Primarily because of cost considerations many families seeking to hire in- home help will turn to private individuals rather than hiring through an agency. At first glance, this may seem reasonable; however, this can cause numerous problems and can create unexpected liabilities for the individual who becomes an employer. Understanding responsibilities and employer obligations is essential.”

White Papers are essays that have been written by Aging Life Care Association members on a variety of topics, including caregiver burnout and costs. These documents are free to access, read, download, and share; they are effective ways to educate and spread the word about the mission of the Aging Life Care Association and its professionals, who provide care management services across the country for a variety of clients. You can find the collection of White Papers here.


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’m an Aging Life Care Professional®: Rosemarie Ruggero, MSW, CSW, CMC

Aging Life Care Professionals® Allow Families to Enjoy Their Relationships:  Rosemarie Ruggero discusses her love of her profession, the warm relationships she develops with clients, and the freedom an Aging Life Care Professional can provide to families.

More Than Just Things: Options and Tips for Downsizing

Life transitions often mean that we need to make decisions about what to do with years of accumulated personal property that no longer physically fits our new space, does not fit with our new lifestyle, or that needs to be liquidated to meet financial obligations. It is comforting to know there are professionals who can assist in providing effective advice and downsizing services during what is often a stressful time.  There are several options to consider:

I Have Too Much Stuff!  Options for Liquidation and What They Each Mean

by Marie LeBlanc, BS, MBA, – Aging Life Care Association™ Corporate Partner

Whether you are downsizing yourself or managing the estate of a loved one, there are several options for selling or liquidating personal property:

Fixed, Single Price Sale

In this option, a dealer will usually come to the home, look over the contents and offer a complete price for the entire lot. While this is the most painless and efficient method of clearing everything out, there is no way for the sellers to know if there were, in fact, items of significant value in the home nor to feel truly comfortable that they have received the “best price” for their personal property.

Auction House Placement

Placing pieces with auction houses and consignment shops allows the auction house or shop owner to likely achieve a very viable high market price for the items. However, this process takes a fair amount of time to complete the turnover of items to cash and large commissions are the norm, resulting in less cash to the client. Also, this process would only apply to a limited number of items within most households. This leaves the seller in the position of needing to find other avenues of liquidating or disposing of the remaining household items.

On-site or Estate Sales

Sales of this nature can be completed by the family or by professionals focused on that business. Items are left in the home and tagged with sale prices. The home is normally opened to the public for set hours over a two-day period while the sale is running. This option for liquidation can be emotionally and physically draining on family members and friends. In addition, most individuals are not in a position to make an educated determination on the appropriate price for pieces. Again, the seller is left in the position of needing to find other avenues of liquidating or disposing of the remaining household items.

Property Inventory

In some cases, the family, executor, or individual may simply need a comprehensive inventory of the items contained in the home along with basements, attics, garages, and other attached or detached storage areas.

High-Value Items/Collections

If there are specific items or collections that you feel are of significant value, arrange for an appraisal by a professional. If these items are determined to be of a value more in line with an auction sale, items can be sold through auction, netting the best market price. Auctions may be held through an auction house or on eBay, which is a web-based on-line auction center, as appropriate.

Full Liquidation

If full liquidation is needed, consider the benefits of working with a professional move manager. These professionals have the resources to completely arrange an on-site sale, including the arrangement and placing of items in an appropriate display, pricing and tagging all items, staffing the sale during all hours of operation, and collecting and tracking all monies. Once a sale is completed, you have various options for disposal of any remaining items, including donations to charity (with possible tax deductions), trash disposal, and sales to secondary market dealers which would yield further cash.

Just remember, you do not have to tackle “the stuff” alone. Contact an Aging Life Care Professional to find the right professional move manager and resources to make a smooth and stress-free transition.

About the author: Marie LeBlanc, BS, MBA, is the president and owner of Transitions Liquidation Services in Hyannis, MA, a move management and rightsizing company founded in 2002.  Transitions Liquidation Services has completed over 700 transitions and Marie is an active speaker on the topics of moving, rightsizing and hoarding.  Follow Marie on Facebook and LinkedIn.


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.

Ensuring Food Security: Meals on Wheels and Other Resources

Food security and hunger are issues that can strike at any point in life, and many Americans struggle with putting food on the table on a day to day basis. One of the more vulnerable groups is the elder population, particularly those without a strong network of friends and family. Physical limitations and restricted income can also play a role in making it difficult to eat well. Luckily, there are multiple programs that can help supplement an elder’s diet with healthy food and their lives with company.

Meals on Wheels and Other Resources for Elderly Food Security

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

The very simple matter of older adults getting a meal on the table can become very   complicated. Physical limitations can make shopping almost impossible. Friends and family cannot always pick up the slack for a home bound individual. Even if supplies are on hand, the chore of assembling a meal, including standing at a stove, can range from challenging to unsafe.

Aging Life Care Managers know many resources in local communities to help seniors stay as independent as possible. For many, home is their chosen environment. A program called Meals on Wheels is a lifesaver. There are slight variations across the country, but most communities have a non-profit which supplies nutritious hot meals to seniors over age 60 at lunch time. In addition to the nutritional value, this is a daily check in. This provides social interaction, which is an important factor for well being. If the elder does not answer the door, there is an alert called to a concerned person to find out what could be wrong. There is no charge for the meals, but a donation may be requested.

Aging Life Care Managers will be informed about other meal options in their communities. These range from frozen meals delivered by national companies to local private chefs who deliver custom meals. Seniors who attend adult day health programs receive a nutritious lunch and often breakfast and a snack as well. Some senior housing sites have a dining room where residents can purchase a meal and eat with others; however, I am not referring to assisted living, where all meals are provided.

Adequate nutrition is necessary for health, functionality and the ability to remain independent. Healthy eating can increase mental acuity, resistance to illness and disease, energy levels, immune system strength, recuperation speed and the ability to manage chronic health problems. Meals on Wheels ensures that seniors have access to adequate nutrition even when family support, mobility and resources are lacking.

For many seniors, the trusted Meals on Wheels volunteer or staff member who shows up every day with a hot meal and a warm smile is the only person they see or speak with all day. This special delivery is the reason to get up in the morning, something to look forward to, and a reminder to take good care of themselves. Seniors traveling to group settings for meals also receive valuable social interaction and companionship. All of us can attest that a meal can be much more than the food on the plate, but also the company across the table.

Along with the inevitable impacts of aging come the increased risks of medical emergencies, falls and other accidents. The safety check that accompanies each meal delivery ensures that, in the case of an emergency or problem, medics will be called, families will be notified and our seniors will not be forgotten.

 

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.

Why I’m an Aging Life Care Professional: Dorian Maples, BA, RN, CMC

How Aging Life Care Professionals Can Aid Families with Difficult Decisions: Dorian Maples discusses the ways Aging Life Care Professionals help caregivers, such as adult children, make difficult care decisions. Ms. Maples also discusses the value that the Aging Life Care Association brings to its members.

doctor medicare medicaid

A Tale of Two Programs: The Difference Between Medicare and Medicaid

Medicare and Medicaid may seem similar at the outset, but are in fact two very different programs. Each one has difference qualifications and serves different purposes, but deciphering and understanding those differences can be confusing. Here are a few points of distinction to help make Medicare and Medicaid more clear. 

A Tale of Two Programs

By Byron Cordes, LCSW, C-ASWCM

Medicare and Medicaid; there could not be two more confusing programs for seniors. The first problem is the names. They sound so similar that the consumer cannot keep them straight. The truth is that the programs could not be more different. In this post, I will try to give a quick differentiation to help make some sense of the differences.

Medicare

In its current form, Medicare is simply a health insurance program for adults who reach 65 years in age or become disabled. The individual or spouse must have paid into the Medicare insurance fund; seen on paychecks as FICA (Federal Insurance Contributions Act). Once on Medicare, an individual will have their medical expenses covered with some coinsurances and copays. Medicare has an automatic hospital benefit known as Medicare Part A, and a voluntary outpatient benefit called Medicare Part B. There have been additional programs added to Medicare over the years; Medicare C (or Medicare Advantage) is an assignment of the Medicare benefits to a 3rd party insurer, sometimes with additional care, but always managed by the new insurer. Medicare Part D is a prescription program introduced in 2006. To sum up, Medicare A is generally covered by premiums paid in; Medicare B is voluntary and at a fee with penalties if you do not accept it when first eligible; Medicare C is a voluntary assignment of your A & B benefits to another party; Medicare D is voluntary and at a fee with penalties if you do not accept it when first eligible. Medicare is not a social program, so it does not cover the cost of living or long-term care; it is only a medical insurance.

Medicaid

Medicaid is a more cumbersome program to describe. Title 19 created the Medicaid benefit as a joint state-federal program. Because each state administers its own program, Medicaid looks a little different in each state, with different qualification rules. Medicaid, at its core, is also a medical insurance program, but with a social services overlay. Medicaid is paid for through general tax revenues, not premiums, and is known as an entitlement program. This means a person who meets all qualifications cannot be denied. Medicaid for seniors and adults with disabilities typically pays for healthcare needs by itself or as a secondary to Medicare. The program can pay for additional services (unlike Medicare and only in certain circumstances) such as: as help in the home, nursing home care, or even modifications to the home.

While Medicare and Medicaid share similar names, we hope this helps clarify how different the two really are. An Aging Life Care Professional in your area can help guide families on how the two programs can benefit a senior. For more help, visit: www.aginglifecare.org.

 

About the author: Byron is recognized as one of the nation’s leading experts in Geriatric Care Management, derived from 25 years in the social work field. He has had his writings and interviews on geriatrics, families and caregiving published nationally. Byron served as the 2012 President of the Aging Life Care AssociationTM. He received his Masters in Social Work from the Worden School of Social Services at Our Lady of the Lake University and a Bachelor of Science in Psychology from Oklahoma State University.

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.