New posting below:
Yesterday, I had the sad duty of notifying my client's friends that their love one is in the hospital and at the end of his life. Overwhelmingly, the responses were the same, he has always been a "gentleman's gentleman" and that is how he will be remembered. Among the duties of a geriatric care manager, preparing for end of life has to be the hardest, especially when this gentle man has spent his last 18 months with our agency. I am expected to be clinical and a professional, but can't get over how heavy my heart is with this sense of loss for someone who brought us as much joy and happiness as I know we brought him. A day before his accident we were making plans for his 88th birthday and laughing about his inability to follow the DVD player's instructions that we lovingly prepared for him. This feeling of great loss has overwhelmed our staff members as well, from our nurse who managed his medications to our companion who just took him for a hair cut last Wednesday. We wish a peaceful passing onto the next life for him and know he will always be remembered as a gentleman among gentlemen. olga@agooddaughter.com
.GIF)
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Saturday, February 28, 2009
Friday, February 27, 2009
Alzheimer's nose spray: New Alzheimer's treatment?
Friday, February 27, 2009
Insulin — a hormone that helps regulate your blood sugar — appears to play a role in normal memory processes. Insulin irregularities may contribute to cognitive and brain changes associated with Alzheimer's disease.
Research in the past few years has been investigating the use of insulin to treat Alzheimer's disease. One of the challenges is how to provide insulin in such a way that it improves brain function without disrupting your blood sugar levels. If you blood sugar drops too low, for example, it can create complications such as confusion, heart palpitations, anxiety and visual disturbances.
Preliminary research suggests that when taken as a nose spray, insulin reaches the brain within a few minutes, improving memory without affecting blood sugar or insulin levels. This research involved only 26 participants who had either early Alzheimer's disease or mild cognitive impairment. Although this research is promising, more research on the safety and effectiveness of intranasal insulin therapy for Alzheimer's disease is necessary. A phase II clinical trial on the use of inhaled insulin to treat Alzheimer's disease is currently under way. It will involve about 90 participants who have Alzheimer's disease or mild cognitive impairment and is due to be completed in August of 2009. Here is the link to the clinical trial-
http://clinicaltrials.gov/ct2/show/NCT00438568
ASK AN ALZHEIMER'S SPECIALIST--The Mayo Clinic
Insulin — a hormone that helps regulate your blood sugar — appears to play a role in normal memory processes. Insulin irregularities may contribute to cognitive and brain changes associated with Alzheimer's disease.
Research in the past few years has been investigating the use of insulin to treat Alzheimer's disease. One of the challenges is how to provide insulin in such a way that it improves brain function without disrupting your blood sugar levels. If you blood sugar drops too low, for example, it can create complications such as confusion, heart palpitations, anxiety and visual disturbances.
Preliminary research suggests that when taken as a nose spray, insulin reaches the brain within a few minutes, improving memory without affecting blood sugar or insulin levels. This research involved only 26 participants who had either early Alzheimer's disease or mild cognitive impairment. Although this research is promising, more research on the safety and effectiveness of intranasal insulin therapy for Alzheimer's disease is necessary. A phase II clinical trial on the use of inhaled insulin to treat Alzheimer's disease is currently under way. It will involve about 90 participants who have Alzheimer's disease or mild cognitive impairment and is due to be completed in August of 2009. Here is the link to the clinical trial-
http://clinicaltrials.gov/ct2/show/NCT00438568
ASK AN ALZHEIMER'S SPECIALIST--The Mayo Clinic
Worry Free Care for Faraway Parents
Special Interview excerpted from Bottom Line's Daily Health News
February 26, 2009
"Geriatric Care Manager Helps Ease Stress and Get Better Care for Aging Parents"
by, Phyllis M Brostoff, National Association of Professional Geriatric Care Managers
If you are responsible for the care of an aging parent or relative -- especially one who is sick and lives far away -- you may wish you knew a wise, willing sage with answers to tough questions and the time and energy to follow through on the details. Enter the geriatric care manager. I spoke recently with Phyllis M. Brostoff, CISW, President of the National Association of Professional Geriatric Care Managers, to learn more about these professionals who offer expertise in dealing with the special needs of the aging. "Our specialty is based on an amalgam of nursing and social work, providing a variety of services for aging individuals," she told me, as we talked about how to find the right care manager to help with eldercare challenges.
Brostoff illustrated the difficulties facing families with two hypothetical scenarios: Nancy's father lives alone, hundreds of miles from his daughter. She calls one day and he sounds confused, unsure of her identity and unable to tell her the date or even what time it is. What should she do? Then there is Louis, who juggles a busy work schedule, his own family needs and he visits his elderly mother every few months. All's going well enough, till one day he arrives to find the usually neat home in chaos. Unpaid bills and unwashed laundry have piled up. His mother is unkempt and, of even greater concern... pill bottles are filled with medication that hasn't been taken. Where should he turn for help? A geriatric care manager can step in to solve problems like these efficiently and sensitively -- helping, for instance, with...
• Housing. Geriatric care managers can provide suggestions for relocation, as well as advice and coordination of a combination of services, including emergency response systems and meals-on-wheels that can allow an elderly person to remain at home.
• Liaison. Geriatric care managers can act as a liaison between clients and attorneys/trust officers... physicians... social workers... home care companies... residential facilities.
• Mediation. Siblings don't always agree on what's best for their parents and aging parents may not want to admit they are no longer able to care for themselves. The geriatric care manager can mediate between adult children worried about a parent's safety and well-being, and the older person who wants to maintain a sense of independence. Brostoff recalls meeting with a family who exemplified this problem. The daughters worried about their mother's continuing ability to care for their frail father, while the mother didn't want her daughters taking over her life. With Brostoff's guidance, the mother came to realize that her daughters' concern would help, not hinder, her ability to stay independent. "She was then open to suggestions, such as an adult day program or help in the home," Brostoff said.
• Crisis management. Geriatric care managers are familiar with available resources and may have creative solutions to difficult problems. Brostoff points out that it's better to establish such a relationship before a crisis occurs. If and when you face an emergency, such as a fall or sudden illness, you'll then have the benefit of an impartial local expert.
• Transitional planning. Advice from someone who knows the family and circumstances is helpful when elderly patients are ready for discharge from a hospital and need advice about the next step, whether it's a nursing home, rehab facility or their own home with outside help. Hospital discharge planners can and do assist families and patients with advice, but they don't have a personal relationship, haven't been to the patient's home and cannot evaluate how realistic the care plan for when the patient returns home actually is, notes Brostoff. For example, a hospital discharge planner may assume a spouse can care for the patient returning home from the hospital, but may not know of health problems that individual has that will make such an arrangement risky for both.
• A local presence for regular check-ins. Geriatric care managers who work with a family over time get to know the details of the client's life, their routines and likes and dislikes. The relationship that develops allows the care manager to anticipate necessary changes and perhaps even avert a crisis by providing supportive counseling and advice.
To find a geriatric care manager in your area, log onto the Web site of the National Association of Professional Geriatric Care Managers (NAPGCM) at www.caremanager.org. NAPGCM has developed Standards of Practice and a Pledge of Ethics for members that address a variety of topics including training, billing, etc. Look for a professional who has an advanced degree in nursing, social work, gerontology or psychology, and who is certified by one of these organizations -- the National Academy of Certified Care Managers, the Commission for Case Management Certification or the National Association of Social Workers. Care managers typically charge an hourly fee, which varies in different communities. Fees range from $100 to $200 per hour, depending on the region.
To find a credentialled care manager in Southeast Florida, contact: Olga@agooddaughter.com
February 26, 2009
"Geriatric Care Manager Helps Ease Stress and Get Better Care for Aging Parents"
by, Phyllis M Brostoff, National Association of Professional Geriatric Care Managers
If you are responsible for the care of an aging parent or relative -- especially one who is sick and lives far away -- you may wish you knew a wise, willing sage with answers to tough questions and the time and energy to follow through on the details. Enter the geriatric care manager. I spoke recently with Phyllis M. Brostoff, CISW, President of the National Association of Professional Geriatric Care Managers, to learn more about these professionals who offer expertise in dealing with the special needs of the aging. "Our specialty is based on an amalgam of nursing and social work, providing a variety of services for aging individuals," she told me, as we talked about how to find the right care manager to help with eldercare challenges.
Brostoff illustrated the difficulties facing families with two hypothetical scenarios: Nancy's father lives alone, hundreds of miles from his daughter. She calls one day and he sounds confused, unsure of her identity and unable to tell her the date or even what time it is. What should she do? Then there is Louis, who juggles a busy work schedule, his own family needs and he visits his elderly mother every few months. All's going well enough, till one day he arrives to find the usually neat home in chaos. Unpaid bills and unwashed laundry have piled up. His mother is unkempt and, of even greater concern... pill bottles are filled with medication that hasn't been taken. Where should he turn for help? A geriatric care manager can step in to solve problems like these efficiently and sensitively -- helping, for instance, with...
• Housing. Geriatric care managers can provide suggestions for relocation, as well as advice and coordination of a combination of services, including emergency response systems and meals-on-wheels that can allow an elderly person to remain at home.
• Liaison. Geriatric care managers can act as a liaison between clients and attorneys/trust officers... physicians... social workers... home care companies... residential facilities.
• Mediation. Siblings don't always agree on what's best for their parents and aging parents may not want to admit they are no longer able to care for themselves. The geriatric care manager can mediate between adult children worried about a parent's safety and well-being, and the older person who wants to maintain a sense of independence. Brostoff recalls meeting with a family who exemplified this problem. The daughters worried about their mother's continuing ability to care for their frail father, while the mother didn't want her daughters taking over her life. With Brostoff's guidance, the mother came to realize that her daughters' concern would help, not hinder, her ability to stay independent. "She was then open to suggestions, such as an adult day program or help in the home," Brostoff said.
• Crisis management. Geriatric care managers are familiar with available resources and may have creative solutions to difficult problems. Brostoff points out that it's better to establish such a relationship before a crisis occurs. If and when you face an emergency, such as a fall or sudden illness, you'll then have the benefit of an impartial local expert.
• Transitional planning. Advice from someone who knows the family and circumstances is helpful when elderly patients are ready for discharge from a hospital and need advice about the next step, whether it's a nursing home, rehab facility or their own home with outside help. Hospital discharge planners can and do assist families and patients with advice, but they don't have a personal relationship, haven't been to the patient's home and cannot evaluate how realistic the care plan for when the patient returns home actually is, notes Brostoff. For example, a hospital discharge planner may assume a spouse can care for the patient returning home from the hospital, but may not know of health problems that individual has that will make such an arrangement risky for both.
• A local presence for regular check-ins. Geriatric care managers who work with a family over time get to know the details of the client's life, their routines and likes and dislikes. The relationship that develops allows the care manager to anticipate necessary changes and perhaps even avert a crisis by providing supportive counseling and advice.
To find a geriatric care manager in your area, log onto the Web site of the National Association of Professional Geriatric Care Managers (NAPGCM) at www.caremanager.org. NAPGCM has developed Standards of Practice and a Pledge of Ethics for members that address a variety of topics including training, billing, etc. Look for a professional who has an advanced degree in nursing, social work, gerontology or psychology, and who is certified by one of these organizations -- the National Academy of Certified Care Managers, the Commission for Case Management Certification or the National Association of Social Workers. Care managers typically charge an hourly fee, which varies in different communities. Fees range from $100 to $200 per hour, depending on the region.
To find a credentialled care manager in Southeast Florida, contact: Olga@agooddaughter.com
Saturday, February 21, 2009
Caregiver Has a Psychotic Episode on the Job
I am writing to share a recent experience with all of you, partly to help me process the event, and partly because this sort of occurrence makes me consider just how vulnerable our clients are, and how important it is to have multiple layers of back-up and protection for them.
A home health aide who has been the weekday anchor for a 104-year-old, non-ambulatory, non-verbal client of mine, suddenly had a psychiatric emergency while on the job. The aide became completely non-verbal, with bizarre, slightly agitated behavior. She was still trying to care for the client, but was unable to. The only family we could reach was a 70-year-old son who had arrived to live with his mother from their home country only 2 weeks ago. He was unaware of any psychiatric history. We called 911 for her, and she was hospitalized.
The only reason I found out about it as quickly as I did was because of the unusual circumstance that the client's 70-year-old son, who lives in another part of their enormous apartment, also has a home health aide for himself. It was the second aide who spotted the bizarre behavior, and called me for help. If not for that circumstance, I wouldn't have heard about it possibly until the evening aide arrived.
This woman has been been the anchor, 5 days per week, for almost a year for my client. She has been extraordinarily competent, cheerful and reliable. She had 7 years of solid references from an agency for almost 20 years.
I will certainly have this incident in the back of mind any time from now on that I formulate a care plan, especially with any clients who are unable to call for help on their own. I would be interested to hear any of your responses, whether you've had any experience like this, or what systems you have in place that would provide a prompt notification if something like this was to happen with one of your clients.
olga@agooddaughter.com
Tuesday, February 17, 2009
Assessment Tools
When care managers assess an individual we look to determine if the client is mentally capacitated by evaluating their cognitive status often using standardized Assessment Tools like the clock-draw, SLUMS, MMSE, CPT or whatever other tools are available. These are all helpful screening tools, but we try not to place full weight on the score to determine someone's capacity because sound or lack of sound judgment may also have a bearing in determining someone's capacity. Sometimes a client may present with a pseudo-dementia borne out of depression which might impact cognition. One of the best tools we have is our interviewing skills. First, we ensure the client is functioning at baseline (not sick, tired, confused from a new hospitalization or illness, etc., well nourished and hydrated). The evaluation is happening in a calm, non-distracting setting as well. In interviewing the client, we spend some time really discussing the particular issue which needs a decision. Capacity should be assessed as pertains to a particular decision. A client may be incapable of making some decision, but quite capable of others. We attempt to discuss the particulars of the decision at hand in language the client can understand or by coming back to it another time if necessary to ensure comprehension. Care managers discuss consequences or outcomes of different options. So when assessing, ensure a client has been given sufficient information in order to understand the situation and possible decisions. In other words, determine if the client is capable of giving an informed consent for a particular question. We'd love to hear what other strategies are used to determine decision making capacity. Please feel free to comment.
olga@agooddaughter.com
Saturday, February 14, 2009
To the readers of this blog: Happy Valentine's Day
I know I haven't been writing lately. Business has been good and we're having a busy winter season with many new assessments. Together with the nurse, our team has become so experienced at doing them that we can literally walk into a new home and instantly see what's needed or probe sufficiently to get to the meat of the problem then come up with a practical solution. The person hiring us may be the actual older client; sometimes it is the adult child who wants the outcome scewed to his/her advantage. Nevertheless, our assessments are honest evaluations of the elder client's condition and a recommendations list is produced to allow that senior client to live independently with high quality resources that we are able to tap into. Today's assessment was difficult, but the outcome will steer this particular client to a better quality of life and that makes it all worthwhile. Following the principals learned by Don Miguel Ruiz, author of The Four Agreements we assess each client being impeccable with our word; faced with a difficult client we don't take anything personally; by not making assumptions we probe sufficiently to get to the heart of a problem; and lastly we strive to always produce our best plan of care for the client. These principals guide how and why we are a successful GCM practice. Following the principals of The Four Agreements will certainly help any business who is stiving to do their level best in these difficult times. Actually, it's not a bad way to live your life!
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