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SELF-Compassion is a Gift

Gift of Compassion eventAfter the last year and a half of living with a pandemic and beginning to see the signs of improvement, I was more than ready to listen to the June 6th virtual event by Dr. Lori Stevik Rust, “Compassion is a Gift.” As Aging Life Care Professionals in the human service field, most of us would say we are “compassionate” with our clients and families.

Dr. Stevik Rust pointed out that most people are in favor of offering compassion to others, but less able to offer self-compassion, and reminded us that self-compassion is a gift we bestow on ourselves (e.g. Put on our own O2 mask before helping others.)

She shared a poignant story of her first case during the Aids epidemic in the 80’s and how unprepared she felt. Her uncertainty led to self-criticism and the fight or flight response. She reminded us that the antidote to self-criticism is self-compassion (recognizing we are not perfect) which results in authenticity.

Self-compassion makes authenticity possible. According to Dr. Stevik Rust, research has shown that people who practice authenticity are more successful, resilient, motivated, emotionally stable, accountable, and better leaders.

Compassion Fatigue was discussed which can result in low energy, guilt, anger, self-isolation, feeling burdened, poor self-care, or denial of symptoms as well as the risk for post-traumatic stress disorder in ourselves and others. She asked us to acknowledge and have enough self-awareness that things might be escalating with compassion fatigue and to stop and say “it’s ok to take a break and care of myself.”

Easy quick self-care options were shared: massages, sexual activity, laughter, music, bubble baths, journaling, exercise, reading, etc. These can all help reduce the stress hormone cortisol.

While much of what she shared was not new information for those of us in the field, it was a good reminder of the importance of self-care for the 50 attendees.

I came away being impressed with her warm, engaging manner, and as one attendee said, “I love the fact that you present in a non-saccharine fashion. Very authentic and honest.”

About the Author: Susan Wack started SW Professional Care Management, LLC (SWPCM) in 2007 after working for over 20 years in hospitals, home health, disability services, and long-term care. She is a Certified Advanced Social Work Case Manager (C-ASWCM) and a Licensed Clinical Social Worker (LCSW). Susan received her Master’s Degree in Social Work (MSW) from the University of Iowa and her Bachelor’s of Science in Social Work (BSSW) from St. Louis University. She is a member of the Academy of Certified Social Workers (ACSW), the National Association of Social Workers (NASW), and the Aging Life Care Association (ALCA). Susan provided training on Elder Care Mediation to attorneys and social workers in Indiana, and serves on ALCA’s Midwest Chapter Board of Directors.

How to choose a Skilled Nursing Facility

people in skilled nursing facility

When families have exhausted other options sometimes the decision is made to move an older loved one in a skilled nursing facility.

Usually, this decision is made under stress, without much time, and/or without a lot of information. You do not need to do this alone. Having a partner in this process, i.e. a professional who can help guide, support, and facilitate a good move to the best possible skilled facility is critical.

This decision can be made easier with more information that an Aging Life Care Professional® — certified professionals with degrees in geriatric care management, nursing, social work, or other professions related to aging — can offer, and sometimes even be avoided.

Aging Life Care Professional® and ALCA Board Member Steve Barlam offers advice for families considering a skilled nursing facility (SNF) for their loved one.


When considering a skilled nursing facility, there are gross and fine screening issues to look at. There are several questions to consider to help in the selection process.

Let’s take a look at the gross screening considerations first: 

Gross screening

…has to do with basic issues:

  • Geography / Location – where is the skilled nursing facility located? Close to you? Far away? Will you need an Aging Life Care Professional® (ALCP) to help check in on your older family member?
  • What will be covered by insurance / HMO — Insurance issues can be daunting. An ALCP can help navigate complex insurance guidelines and forms.
  • Open beds – ensuring there is space at the facility is another initial concern that must be cleared up before you can proceed.
  • Basic skills / specialties tied to the condition and diagnosis – what skills or specialties does the staff have? Will they be able to address issues you need dealt with for your family member?

Fine-tune screening

…has to do with items that are important to you.

Not everything will be important, so you would want to be clear on what is important to you:

  • The reputation / record / licensing deficiencies – does the facility have a good reputation? Is it up-to-date on its licenses?
  • The look / feel / smell of the place – How is the lighting? Is it well-lit and welcoming?  Is there an outdoor space available for residents? Visit at two different times if possible, once during the day, and once during the evening to get a sense of the facility for a fuller perspective.
  • How is mealtime handled? Are meals served communally or in the patient’s room? What would your family member be comfortable with?
  • The ability to visit / access the patient? Is it convenient, accessible? What are the visiting hours? During the pandemic, are there more stringent requirements?
  • Staffing – What is the ratio of staff-to-resident? How many patients does the C.N.A. have on the day shifts?  Night shifts?  Who is ultimately responsible for the care?   Director of Nursing? The Administrator? How long have they been in their position? Are they there on-site daily?
  • Communication – If you have identified a need, who will you be able to speak with? If there is a problem, with whom will you be able to speak? Get their name and phone number.
  • Roommates – If your family member will be placed with a roommate, how are they matched? If there is a problem, how is that resolved?
  • Social needs? What is done for the patient’s social needs? Are there activity programs tailored to the individual?
  • Other events – Are religious services accessible? Cultural events?
  • Medical Doctor – Ask who would be the medical doctor following my family member? How long has s/he been there? What’s their bedside manner? Ask “How often will my family member be seen? How does information get communicated with his/her primary care physician and me?”
  • Interdisciplinary Team Meetings? How often does the team meeting? Is the family invited? How often is the plan reviewed?
  • Cost – What is covered and what isn’t.  Is it certified by Medicare / Medicaid?
  • A specialty? What does the facility specialize in? – Dementia care?   If so, is it distinct/separated?
  • Additional Services – If additional services (chemo/dialysis / other specialized rehab) are not provided in-house are needed, how is transportation arranged?

These questions and considerations can help a family get started when considering a skilled nursing facility. However, engaging an Aging Life Care Professional® can help even the savviest family navigate these questions, and can help in the coordination process. Time and money invested in engaging a qualified, certified Aging Life Care Professional® can be a time and money saver in the long run.

FIND AN AGING LIFE CARE EXPERT HERE TODAY: https://www.aginglifecare.org

About the Author: Steven Barlam, MSW, LCSW, CMC. As a Licensed Clinical Social Worker, and after 30 years in the private sector, Steve has assumed the CEO role at JFS Care in Los Angeles, which provides quality eldercare solutions for seniors and their involved families including in-home care, and professional coaching/guidance through Care Management Services. His driving motto is, “It has to be good enough for my mom,” as he is all about ensuring quality care experiences for clients and their families. Steve values both tradition and innovation as he leads his team to grow JFS Care’s presence to deliver better care solutions in Los Angeles. Steve has been a member of ALCA since 1991, was Board of Director’s President in 2003, is currently on the Board of Directors and serves as Co-Chair of the Chapter President’s Committee.

Six Steps to Better Brain Health

While the COVID-19 pandemic has presented us with challenges, it has also taught us lessons. Likely, you have tapped into your emotional reserves and discovered how resilient you are during this time.

Brain health, of which mental health is an essential component, has been at the forefront of many conversations with family, friends, and colleagues during the pandemic.  We have all experienced varying levels of uncertainty, stress, anxiety, and grief during this time. Our brain health has helped us manage and process these emotions as well as exercise resilience.

June is Brain Wellness and Alzheimer’s Awareness Month. Take this opportunity to review and strengthen these 6 key practices, necessary for rebuilding your reserves, strengthening your brain, and lowering your risk of developing dementia, including Alzheimer’s.

Six Steps: Move. Eat. Sleep. Monitor. Engage. Challenge.

  1. Move your body. What’s good for the heart is good for the brain. Regular physical activity improves blood flow to the brain, enhances memory and learning, improves mood and thinking. And it’s never too late to start. Begin with a short walk in your neighborhood or gentle chair yoga. You can find helpful videos online. Here’s one video to get you started. Please check with your healthcare provider first to make sure you are cleared for exercise. And be aware of any hazards (cords, shoes, rugs, poor lighting, uneven sidewalks) in the area where you chose to exercise.

 

  1. Eat smart. It’s true: We are what we eat. One of the best approaches to eating in support of brain health and lowering the risk of developing dementia is adopting a Mediterranean diet. The foundation of this diet is fresh vegetables and fruits, nuts, seeds, legumes, whole grains, herbs, spices, fish, seafood, and extra virgin olive oil. Eat poultry, eggs, cheese, and yogurt in moderation. Only rarely eat red meat. Don’t eat added sugars, processed meats, refined grains, or highly processed foods. Farmers markets are opening again. Fresh produce is abundant. If you garden, all the better.

 

  1. Get your Zzz’s. Often overlooked, sleep is fundamental to brain health and lowering dementia risk. Seven to eight hours of consecutive sleep a night is restorative and cleansing. Sleep also plays an important role in restoring our immune system as well as helping manage stress and balance mood. Regular physical activity and eating smart can also help aid sleep. If you suspect you have sleep apnea, which disrupts sleep patterns and is harmful to brain health, please talk with your health care provider.

 

  1. If you have a health condition such as hypertension, high cholesterol, depression, or diabetes, follow your doctor’s advice closely. Take medication as prescribed. Let unchecked, these health concerns could result in serious complications. All these conditions have been shown to contribute to an increased risk of developing dementia. And if you smoke, quit. Try a smoking cessation program.

 

  1. Social engagement and interaction are important. Many of us have experienced isolation during quarantine. The pandemic has reinforced how vital human connection and interaction are to our overall health, especially our brain health. Research shows that individuals who stay socially engaged experience the slowest rates of cognitive decline. Fortunately, public spaces are slowly reopening and more people are getting vaccinated. Pace yourself but get out there and spend time with family and friends once again. Something as simple as an in-person coffee chat with an old friend can do wonders to brighten your day, enhance your mood, and benefit your brain.

 

  1. Stimulating the brain with intellectual challenges helps trigger new brain cell growth and builds new neural pathways. To strengthen and flex your brain, try something new. Learn a new language. Always wanted to play to piano? Start now! Take a poetry or memoir writing class. How about those salsa dancing lessons you’ve always dreamed of? Here’s your excuse to find a class and get started. The possibilities are endless.

For more ideas, check these Additional Resources & Encouragement:

About the Author: Contributor Keri Pollock directs marketing and communications for Aging Wisdom, an Aging Life Care practice based in Seattle. She is a member of the Age Friendly Coalition for Seattle and King County (WA), serves on the Frye Art Museum Creative Aging Programs Advisory Committee, the Marcomm Council of the Washington State Chapter of the Alzheimer’s Association, and the ALCA PR Committee.

Gray is a Color on the Rainbow

Two men having coffeeJune is Pride Month, a time to celebrate and affirm the diverse mosaic of our humanity. Part of this rainbow coalition includes a growing number of LGBTQIA+ elders. Conservative estimates are that there are over 3 million LGBTQIA+ people over 50 living in the US today. According to SAGE, an advocacy organization for the older LGBTQIA+ community, that number is expected to grow to over 7 million by 2030. LGBTQIA+ adults (ages 65 and older) came of age during the McCarthy Era when their identity was severely stigmatized and criminalized. They had to deny who they were and live under a blanket of silence or risk verbal or physical assaults, job loss, discrimination, and ostracization. Since then, several hard-won victories, such as the Equality Act, bans discrimination based on gender identity and sexual orientation.

However, many older adults in the community still face unique obstacles. Elderly LGBTQIA+ adults are less likely to have had the opportunities to parent, reduce their support system, and increase their likelihood of living alone. The resulting isolation has often led to financial insecurity. As they age, they are much more likely to be caregivers for their friends in the LGBTQIA+ community. Because they have experienced many challenges throughout their lives, they have higher incidences of depression, substance abuse, and HIV. Many older LGBTQIA+ adults experience high levels of discrimination in accessing assisted living or affordable housing. In fact, a transition into senior living for many can mean going back “into the closet” as they do not have confidence that senior residences can accommodate their care and safety needs. This is compounded if they have memory issues. Many same-sex partners are still denied visitation rights in hospitals and long-term care residences. Many LGBTQIA+ elders are not candid about their sexual orientation for fear of receiving inferior care from medical providers.

Some positive developments are on the horizon. There are now an increasing number of senior living residences and aging in place communities that are creating more welcoming and inclusive environments. More and more people realize that LGBTQIA+ cultural competency training for a medical, facility, and home care staff is key to developing affirming and inclusive care. On advocacy, we must continue to pressure federal, state, and local governments to include sexual orientation and gender identity protections in existing housing laws. Senior housing providers must be pushed to adopt anti-discrimination policies (SAGE LGBTQIA-friendly housing resources). On a broader level, the community’s unique needs need to be integrated into systems of care across the continuum so that services for older adults are assessed on their ability to be both welcoming for people who are older and who identify as LGBTQIA+. As we continue to evolve into a more inclusive society, it is past time to show our LGBTQIA+ elders who fought for equality the dignity and respect they deserve and acknowledge and affirm that their dreams for aging well matter.

This blog originally appeared on the HealthSense blog.

About the Author:  Anne C. Sansevero, RN, MA, GNP, CCM is the founder and CEO of HealthSense LLC, an Aging Life Care management consulting practice. She is a master’s prepared geriatric nurse practitioner, and a seasoned nursing professional with over 30 years of experience in the field. Anne has a sub-specialty in neurological disorders and is well versed in all aspects of geriatric nursing. She has particular expertise with communication disorders relating to stroke and dementia and has developed a number of innovative nursing assessment tools and standards to improve the nursing care for frail elders. Anne is a member of the Aging Life Care Association® (ALCA) and Fellow of the Aging Life Care Leadership Academy. She is currently serving on the board of the ALCA, and is Vice President of the New York Chapter. In addition, Anne is a member of the American Academy of Nurse Practitioners and the Nurse Practitioners of New York. Anne is a registered nurse, certified care manager, and a master’s prepared geriatric nurse practitioner.

“Born in Ireland, I come from a strong medical family of physicians and nurses. I was naturally drawn to a career in health care where you can make a real difference in the lives of others. In the 1980s, I was recruited for a nursing career opportunity in the United States and fell in love with the energy and optimism that is part of this country’s cultural DNA. In the acute care work setting, I became very attuned to how stressful hospitalization can be for older, frail adults. I found my calling as a nurse practitioner and Aging Life Care Professional while advocating for the elderly and working to improve their quality of life and to avoid hospitalizations. I have a deep appreciation for the wisdom and resilience that I see in my older clients and feel grateful to be able to contribute to helping them and their families lead happier lives.”

Equity in Aging for LGBT Older Adults: A Review of the Past Ten Years and Progress for the Future

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//// By: Denny Chan And Natalie Kean, Originally published in the May-June 2021 issue of Generations Today by the American Society on Aging. ////

Ten years ago, Justice in Aging and SAGE wrote a report, “Stories from the Field,” on discrimination LGBT older adults experience in nursing homes. We heard reports of staff at these facilities refusing to help gay men bathe or to use transgender residents’ correct pronouns. This was in addition to discriminatory policies that made it difficult or even impossible for transgender people to get Medicare coverage for prostate and pelvic exams and bans on gay men of any age donating blood. LGBT older adults living in the community have faced other barriers such as discriminatory housing policies.

While new legal protections have been enacted since we published our report, unfortunately many LGBT older adults are still discriminated against and many more continue to live in fear that they will be.  As we documented in our special report on the legal needs of low-income LGBT older adults, the effects of discrimination and poverty among LGBT individuals compound over the lifetime, such that many experience increased levels of poverty and other barriers as they age.

This is especially true for LGBT older adults of color and individuals with limited income and wealth, including immigrants who, depending upon their immigration status and length or residency, may be barred from Medicare, Medicaid, Social Security, Supplemental Security Income and nutrition and housing assistance. These immigrants can end up with little or no choice in providers of health, long-term care and social services.

Foundation for Equal Rights for LGBT Older Adults

In the past ten years, we have seen a foundation being built for equal rights and nondiscrimination for LGBT older adults, and it is worth celebrating. The courts have decided cases establishing landmark anti-discrimination protections and expanding rights for LGBT individuals, including older adults.

The U.S. Supreme Court’s decisions striking down federal and state bans on same-sex marriages in U.S. v. Windsor and Obergefell v. Hodges allowed Social Security spousal and survivor’s benefits to go to LGBT couples and their families and opened the door for Justice in Aging and others to fight against the Social Security Administration’s other discriminatory policies. These decisions continue to help LGBT older adults get relief from benefits miscalculations that occurred even before the cases were decided.

‘THE 2016 HEALTH CARE RIGHTS LAW REGULATIONS ALSO RECOGNIZED INTERSECTIONAL DISCRIMINATION.’

Most recently, in Bostock v. Clayton County, the Supreme Court decided that the prohibition of discrimination in employment “on the basis of sex” in Title VII of the Civil Rights Act of 1964 also prohibits discrimination against individuals based on their sexual orientation or gender identity.

The Affordable Care Act included the Health Care Rights Law (Section 1557). It is the only federal law that bans discrimination on the basis of race, color, national origin, sex, age and disability specifically in health programs and activities that receive federal financial assistance, and it is the first federal law to prohibit sex discrimination in healthcare.

The implementing regulations, finalized in 2016, interpreted Section 1557’s ban on sex discrimination to include prohibitions on discrimination on the basis of sex stereotyping and gender identity. The 2016 Health Care Rights Law regulations also recognized intersectional discrimination, providing a new avenue to challenge discrimination under Section 1557 for LGBT older adults who experience discrimination in federal health programs and activities on the basis of multiple identities, such as gender identity, age and race.

The Push Back Against Progress

Unfortunately, the past ten years have also been met with persistent attempts to attack the rights of the LGBT community. In 2020, the Trump Administration eliminated these explicit protections for LGBT individuals in the Health Care Rights Law regulations. These rollbacks, along with removal of protections for limited English proficient older adults, undermine LGBT older adults’ rights and make it harder to seek redress from healthcare discrimination in court.

Other regulatory actions, such as expanding grounds for health and social services providers to deny services to LGBT individuals and proposals to permit homeless shelters to discriminate against transgender individuals when assigning housing, demonstrated the severe and ongoing hostility toward LGBT individuals.

The attacks continued in court, as well. Last fall the Supreme Court heard oral arguments in Fulton v. City of Philadelphia, a case challenging Philadelphia’s decision to end its contract with a social services agency that refused to certify same-sex couples as foster parents. And the effects of intersectional discrimination against LGBT individuals play out in the COVID-19 pandemic, too, with LGBT people of color twice as likely as white non-LGBT people to report testing positive for COVID-19.

That is why Justice in Aging has joined other advocacy partners in actions to undo these harmful changes and repair the damaging effects of this discrimination. We are challenging the rollbacks to the Health Care Rights Law in court and joined a brief with many other aging advocacy organizations in Fulton.

LEGAL PROHIBITIONS ON DISCRIMINATION CAN BE ADVANCED QUICKLY THROUGH LAWS AND POLICIES—BUT, IT TAKES THOSE POLICIES BEING IMPLEMENTED AND LITIGATED TO MAKE PROTECTIONS REAL.

President Biden signed an executive order extending housing anti-discrimination protections to LGBT individuals, and recently withdrew the prior administration’s proposal to permit discrimination against transgender individuals in housing programs and homeless shelters. The Biden administration also announced that it will interpret and enforce Section 1557 prohibitions on discrimination in healthcare based on sex to include sexual orientation and gender identity, consistent with the Supreme Court’s ruling in Bostock.

Congress has taken up the Equality Act, which builds on Bostock to codify that the prohibition on sex discrimination in major civil rights laws includes sexual orientation and gender identity. The bill, which has passed the House, would directly impact LGBT older adults by expanding the definition of sex discrimination in the Civil Rights Act of 1964, the Fair Housing Act, the Equal Credit Opportunity Act and other laws.

The Equality Act would also expand the definition of “public accommodations” to include healthcare and legal services providers, banks, transportation, food banks and online retailers and service providers, among other businesses and locations. This expanded definition would increase anti-discrimination protections for LGBT older adults, not only on the basis of sexual orientation and gender identity, but also race, national origin, including limited English proficiency, and other protected classes.

If it becomes law, the Equality Act will strengthen LGBT older adults’ rights to access healthcare, housing, long-term services and supports and other aging services without discrimination. Ongoing discrimination also is why Justice in Aging has been championing principles for equitable COVID-19 vaccine distribution to ensure that older adults who are most at-risk do not encounter barriers to getting the vaccine.

As the past 10 years have shown us, legal prohibitions on discrimination can be advanced rather quickly through laws and policies—and this is certainly important. However, it often takes those policies being implemented and litigated to make the protections real. We are encouraged by the Biden administration and Congress taking steps to put more anti-discrimination and equity-centered policies on the books.

Justice in Aging will continue to fight for these types of protections and make sure that those that are passed are robustly implemented so that LGBT older adults, especially those who have been harmed the most by systemic discrimination, can age in dignity and justice.

Denny Chan is directing attorney of Equity Advocacy in Justice in Aging’s (JIA) Los Angeles office and Natalie Kean is senior staff attorney in JIA’s Washington, DC office.

Navigating complex health-care systems with an Aging Life Care Professional®

Now that the Pandemic has BLOWN UP THE HEALTHCARE SYSTEM, especially long-term care, the need for a savvy and experienced Aging Life Care Manager® is more evident than ever.

Aging Life Care Professionals® are members of the Aging Life Care Association® (ALCA) and differ from Health Care Advocates, Patient Advocates, Senior Advisors, Senior Navigators, and Elder Advocates. ALCA members 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.

Long-term care facilities have long been under-resourced and under-staffed. Low expectations lead to low performance. Many assisted living and nursing homes have experienced a complete turnover of administrative staff: Executive Director, Nursing Director, social workers….leading to disarray at the point-of-care. Staffing shortages make this all worse, and it will be years before the long-term care system catches up. Hands-on staff shortages will be persistent.

Sometimes I get pushback from families who are concerned about spending their Mom’s money or other issues. What I tell these families is:

  1. A nursing home bed can cost more than $400 per day and assisted living can be more than $250-300 per day.
  2. Families could potentially spend this anyway, so spending it wisely to ensure your loved one is cared for in a quality way makes good financial sense.
  3. I compare to going to court without a lawyer as dealing with complex health care systems the same way: You could be more confident of an optimal outcome with a trained and qualified professional who knows the written (and unwritten) rules and how to negotiate in that space.
  4. When families engage an Aging Life Care Professional – they get a qualified expert with experience with these systems and our BEST JUDGEMENT.

About the Author: Michael Newell MSN, RN, started LifeSpan Care Management LLC in 2004 after 20 years in ICU and ER nursing. Similar to a rehab nursing model used in medical case management, LifeSpan Care Management gets many complex cases that other care managers may not be comfortable undertaking. Michael speaks (with CE approval) and writes on nursing, case/care management topics, such as dementia, medication and the elderly, outcomes measurement tools & insurance appeals. As vice president of the Central NJ chapter of the Case Management Society of America, Michael is also on the board of several local non-profit groups.