Guilt and Doing the Right Thing for an Aging Parent

While parenting a parent is a privilege for some it causes a great deal of stress and strain for others. Sure it is brutal; stressful; and leaves no time to take care of oneself. Having a legal document naming an adult child as power of attorney does not empower one to take away a senior's right to live in his own home. Locking them away in a facility when the senior parent absolutely will not go may be avoided. When I hear my family members talk about their parents as nothing more than a burden, it breaks my heart. Today there are avenues that a family member may take advantage of if a parent absolutely will not go to a facility. A live-in caregiver may provide a safety net so that he or she doesn't have to be alone all night. Reverse Mortgages can greatly contribute towards providing extra income towards those caregiver expenses. Long term insurance will also pay for a live-in. But still and all, I have seen family members who've done a quit-claim deed taking away mom's Florida condo so they may have a place to vacation not realizing this will ruin a parent's approval for Medicaid when they need a nursing home placement down the road. I tell you, it's brutal out there. Although there are some truly great facilities where a senior may actively participate in having a good quality of life, oftentimes, they are better off in the familiar atmosphere of their own home. So, I advise my adult family members to put away those parent and child roles and make your relationships work. It is better to get rid of your guilt and care for your elderly parents even if they didn't take care of you. You will feel a lot better when they have passed away.

If you need to consult someone who's been there and has been through all those experiences herself, contact Olga Brunner of A Good Daughter Elder Care. She's got very big shoulders.  Our caregiver support group meets every 3rd Wednesday of the month between 5:30 pm and 7:30 pm.

What is a Geriatric Care Manager?

Geriatric Care Management is the process of planning and coordinating the care of the elderly and disabled to improve their quality of life and maintain their independence for as long as possible. Health and psychological care are integrated with the best possible combination of services such as: housing, home care services, socialization programs, financial and legal planning. A care plan tailored for each individual's circumstances is prepared after a comprehensive assessment. The care plan is modified when necessary based on the professional geriatric care manager's monitoring of the effectiveness of its components. Professional geriatric care managers accomplish this by combining a working knowledge of health and psychology, human development, family dynamics, public and private resources and funding sources while advocating for the individual throughout the continuum of care. For your loved one's Care Management needs contact olga@agooddaughter.com, president and Senior Care Manager for A Good Daughter in Boca Raton, Florida.  Our phone number is: 561-392-3574.  Be sure to visit our website: http://www.AGoodDaughter.com

Source: Wikipedia.org/wiki/Geriatriccaremanagement

Swine Flu Around the World - Where We Are Today

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HBO Alzheimer's Project

Watch "The Alzheimer's Project," HBO's series that examines groundbreaking Alzheimer discoveries made by the country's leading scientists and examines the effects this debilitating disease has on those with Alzheimer's and their families.  

Airs: Sunday May 10 at 9PM, EST - "The Memory Loss Tapes"

Takes an intimate look at seven individuals living with the disease, seen from the point of view of the person with the disease.  

Monday, May 11 at 7:30 pm and 8pm, EST - "Grandpa, Do You Know Who I am?  With Maria Shriver followed by "Momentum in Science, Part 1", a 2 part, state of science odyssey that takes viewers inside the labs and clinics of 25 leading physicians, revealing some of the most cutting-edge research advances.  

Tuesday, May 12 at 7pm and 8pm, EST - "Caregivers" and "Momentum in Science, Part 2".

"Caregivers" is a collectionof five family portraits that illustrate caring for the different stages of Alzheimer's disease.  

"The Alzheimer's Project" is a presentation of HBO Documentary Films and the National Institute on Aging at the National Institutes of Health in association with the Alzheimer's Association.  

DVD copies of this presentation may also be available directly through Amazon.com with an estimated release date of June 2nd.  

A private screening will be available at the offices of A Good Daughter. Please contact Olga Brunner directly if interested in viewing at olga@agooddaughter.com

Florida Options for Providing ElderCare in 2009

For many of our readers who may not be up to date with Florida's options for Elder Care, the following material may provide adult children some alternative sources to begin the process of looking at fees and benefits available when it becomes necessary to provide a higher level of care.

Caregivers:  Be careful when asked to give certain prescribed pharmaceutical drugs.  Some drugs may require 24 hour/day supervision because they put your loved one at risk for falls. Care may be provided in a nursing home, assisted living, or at home with a 24 hour a day caregiver.  24 hour/day caregiving may be provided  with a live-in caregiver costing approximately $170/day.  When a parent is at risk of falling, new agitation presents, is prone to elopement, or makes suicidal threats this elder may require 2 (12hour/day) caregivers costing $375/day.  If hiring a live-in, you must provide 2 hours off during the day to leave the home, take a meal, run errands, or simply take a rest in another room.  The live-in must also be given 8 hours of uninterrupted sleep at night.  That should help you determine your decision between hiring a live-in or providing two (12-hour) caregivers.  Long-term insurance policies are sold because of the high cost of caring for the elderly.  In lieu of that, Reverse Mortgages may offset the cost of caregiving.  To do that your parent's home must be in their name.  Work with someone who has a great deal of experience in Reverse Mortgages. 

Guardianship:  Your parent still has rights to live in his/her home versus living in a facility even if you may not want this option.  However, you may pursue Emergency Temporary Guardianship through the courts.  To do so, you will need to petition the court for guardianship.  If adjudicated incompetent by a court, this action will remove a parent's rights giving the person named as guardian the right to act for the individual.  Probate Law is very strict.  Some Judges don't favor restricting the rights of an individual.  This is also a very costly process since you will not only need to get an attorney for your position, but will have to pay for an attorney to defend your parent's rights.  Until then, your parent's rights remain intact.  Get an elder law attorney familiar with Probate Law for more information.  Go online to:  http://www.NAELA.org

Aid and Attendance is a veteran’s benefit that can pay a parent approximately $ 1000/month towards ALF expenses if your dad or mom was a Veteran.  The process takes about 6 month but once approved, it is retroactive and pays your surviving parent direct benefits.  

Medicaid Waiver programs:  If a parent's only source of income is social security, he/she may be eligible for the Medicaid Waiver Program.  A licensed nurse may be sent to the home to do medications management, and an aide may be sent to help with showering/bathing (perhaps 1 – 2 hours daily).  Some Florida assisted living facilities accept the Medicaid waiver program in their facilities.

Adult Family Care Facilities: In South Florida there are private homes in residential communities that take in elderly  individuals.  If  2 or more individuals reside in a home, an ALF license is required by the State of Florida.  If only one individual will reside, no licensing is required.  I have visited some of these homes run by nurses and they are lovely, clean, have good meals, and send residents out to day centers for activities.  

Board and Care:  I have met individuals who own their own homes and have occasionally taken in residents for care in the person's own home.  These resident's may stay in the home until the resident's passing. Some homes have been in a position of trust by some very prominent long-distance adult children and charge fees of $5000 a month. The fee is generally all-inclusive. Make sure you check references and that the home owner has a health background.

Long Term Care:  Placement in a nursing home as a private paying resident may cost $8000/month or more in South Florida.  You may pay down your assets until a Medicaid application is processed or assets are transferred to the community spouse through an elder law attorney. The Medicaid application requires completion of Form 3008.  There are two criteria for admission to a nursing home:  medical, and financial for the sake of Medicaid applications.  Contact the offices oft A Good Daughter Elder Care Management for a checklist of documents needed should you wish to pursue this avenue. 

Always remember when discussing options with a loved one to be compassionate and careful in languaging with the elder loved one.  Be careful not to create unnecessary confrontation or agitation when dealing with a parent who just doesn't wish to be moved from his home.  Be mindful of your parent's feelings and their rights as individuals for one day you may find yourself in very similar circumstances.  

For more information on any of these options please contact olga@agooddaughter.com.  All comments are welcome.  

PLACEMENT AGAINST ALL ODDS

A client has been discharged from a rehabilitation facility following a brief hospital stay for pacemaker insertion.  She’s had a past history with depression and has been followed by a psychiatrist. She has been diagnosed with an Alzheimer’s type dementia by a neurologist after a series of exams and brain scans.  She has kidney problems, has recurrent anemia, and elevated potassium levels apart from cardiac issues. Out of town family member has taken her mother home to her condo but has already contracted with an ALF where she will be moved to in approximately 6 days.  Some of the mother’s furniture was already transferred to the ALF.  Somewhere between the hospital and rehab discharge her medications were changed with new prescription for Xanax added, and the Namenda discontinued.  Client is fully ambulatory and presents well except for some dysphasia which has gotten worse and new symptoms of confusion and anger at the prospect of having to leave her condo.  In order to help with the transition, I contacted a licensed clinical social worker and scheduled her for a session with the client and family member to help make this transition.

 

Yesterday I received information from in-town family member stating that her mother was calm at bedtime but was awakened within the hour saying she couldn’t sleep and had “fire in her eyes”.  She was given a Xanax and returned to bed.  In the middle of the night she awoke and left the condo.  When the family member awoke, the client was coming in from out of doors in the middle of the night.  The tantrums then began and didn’t stop all night.  The family member stated that yesterday they had a terribly volatile situation.  The mother became angry and nasty, insisting on not going anywhere and verbalizing repeatedly that she would kill herself before moving.  She has made similar threats to her 4 children in the past as well.  Although the family member states the move was discussed with the mother in the past and she’s made visits to the facility, client denies this (or just doesn’t remember).  She despises her children for not taking her to live with them and has spent yesterday screaming this dozens of times.

 

I’ve discussed several options with the family member.  I have proposed touring a highly rated dementia-specific ALF on the campus of a well known skilled nursing facility.  I have explained that the best living arrangement was ultimately aging in place in her own home with a live-in caregiver.  I even shared the fact that we know of an excellent caregiver who is available for live-in at the present time, suggesting that a Reverse Mortgage could help pay the caregiver expense.  I was informed that the condo is now listed under ownership by the adult children.

 

Not having many options I decided to tour the proposed ALF they are under contract with and divulged her new cognitive and behavioral change to the Resident Services Nurse.  Because they have a dementia lock-down unit, I decided to take a tour.  On the first floor where residents live, the apartments are identical to the ALF apartments.  All activities (meds, meals, etc) are held on the second floor which is overcrowded, filthy, and smells.  They don’t have an Activities Director so the dementia residents are warehoused with little or no stimulation.  Last night I received an email from the family member asking me to cancel the LCSW that I had hand selected to meet with this client; explaining how she was impressed with the facility’s lock-down unit (although she never toured the second floor).  I responded how concerned I am with any threat of suicide and called my client’s psychiatrist who is out of town this week.  I also informed his on-call person.  I left the family member their service emergency number with a warning that in the event mom continues to make threats of suicide, they need to be called immediately.  In canceling today’s appointment with the clinical social worker she suggested there might have been some exploitation and that Adult Protective Services should also be contacted. What would you do?

 

Is it enough to contact the psychiatrist’s nurse practitioner and family member?  The family is obviously forcing a move and has deeded mother’s property in a sibling’s name.  They are not receptive to anyone’s advice other than what’s given by the staff at the ALF wishing to keep this resident against all odds.  I am concerned that my client who is already emotionally fragile might be placed at risk given the conditions in this lock-down dementia unit.  She is a flight risk and is no longer appropriate for a standard license ALF apartment.  She will be followed by a psych nurse at this facility, will be kept medicated, will become a fall risk, and will surely decline. 

 

What are the rights of a cognitively impaired senior when four adult children advocate for placement against all odds?

 I welcome all comments below.  

How to Help Aging Parents Without Going Broke?

I recently found a great resource in March 12, 2009 issue of Good Housekeeping by Kate Ashford which states if your parents are mobile but show mild signs of dementia or forgetfulness, you may want to investigate the following services (I have augmented her research with my own knowledge as to what's available in the State of Florida):

1.  Supervised adult day services allow the elderly to socialize with other seniors and may have nurses to give out shots and medications.  You may go to Area Agency on Aging for names of reputable, convenient programs or contact staffs of nearby senior centers, churches, and synagogues.  

2.  If a parent is less independent and needs help getting in and out of bed or forgets to turn off the stove or running water, home care may be needed.  Start at the website of the Family Caregiver Alliance http://www.caregiver.org, which has put together the first comprehensive, 50-state online directory for caregiver support.  If you can get by with a live-in caregiver and not an hourly, you may be able to get more assistance for less expense.

3.  For a personalized, overall-care plan, hire a geriatric care manager, usually a nurse, social worker, or gerontologist trained in helping the elderly.  Geriatric-care Managers have their fingers on the pulse of services available locally.  For an additional fee, the GCM can also make all the arrangements.  Expect to pay about $80 - $200 an hour for this service, depending on how much attention your parents need; cost isn't covered by health insurance, Medicare, or Medicaid.  Go to Professional Geriatric Care Managers (PGCMs), who are trained, experienced professionals, by visiting their website, http://www.caremanager.org

4.  Medicare usually pays for some short-term, in-home medical help prescribed by a doctor for persons 65 and older but it won't pay for long-term custodial care.  If your loved-one does qualify for that, first see your primary doctor then check http://www.medicare.gov to find local Medicare-certified in-home health-care agencies that may help with licensed nurses who can administer insulin and do diabetic training or licensed therapists to give physical, occupational, and speech therapy (in-home).

5.  Facility Based:  The same program (Medicare) may cover nursing services in a care center or out patient day service if your 65-plus parent  requires  rehabilitation after a 3 day hospital stay. For long term custodial care in a nursing home however, your parent needs to meet low income requirements for Medicaid eligibility.  If a parent needs constant surveillance, Medicaid would likely be the payor in a nursing home or similar facility.  Check http://www.govbenefits.gov for details.  In Florida, a senior parent may be eligible for a Medicaid waiver to pay for Assisted Living.  The Veterans Aid and Attendance program may also pay a monthly stipend towards Assisted Living.  For a parent or spouse to be eligible one or the other senior must have been a veteran.  For more information go to: www.veteranaid.org/program.php

6.  Elder Law:  If you will have to exhaust your parent's resources before turning to Medicaid for help, consider consulting an elder law attorney to help navigate regulations and discuss asset-management planning before your parent's health declines.  Find a specialist at the National Academy of Elder Law Attorneys site http://www.naela.org

7.  Other:  You may lower independent living expenses through local senior programs.  Some utility companies may offer a break on energy bills.  Give them a call and ask.  Church or synagogue volunteer programs might provide companions to keep your parent company periodically.  Some counties have door-to-door wheelchair-access vans or sedans for $2 a trip.  

With some delicate conversations and aid from the right places, you can help your parents stay in their homes for as long as possible.  Research obtaining a Reverse Mortgage if your parent has equity in their home and would like a steady stream of income to pay for daily caregiver assistance.  Whatever your decision may be, respect the fact that mom or dad want to control their lives as much as they can.  Being compassionate will lead you to the right decision.  If you would like to find out more available resources you might enlist the help of a Certified Geriatric Care Manager to conduct a comprehensive Assesment and provide recommendations with specifically tailored resources for your family member.  

Olga Brunner is the President and Founder of A Good Daughter Elder Care Management in Boca Raton, Florida.  She is a Certified GCM and has a Masters degree in Gerontology and HealthCare Administration from Lynn University in Boca Raton.  For more information go to http://www.AGoodDaughter.com

Being a Mother

I received this very early today and it touched my heart. As May and Mother's Day approaches, I'd like to send this out to my readers to remind you that if you haven't taken the time to personally do something nice for your mom, perhaps it is time.

"After 21 years of marriage, my wife wanted me to take another woman out to dinner and a movie. She said, 'I love you, but I know this other woman loves you and would Love to spend some time with you.' 

The other woman that my wife wanted me to visit was my Mother, who has been a widow for 19 years, but the demands of my work and my three children had made it possible to visit her only occasionally. That night I called to invite her to go out for dinner and a movie. 'What's wrong, are you well,' she asked? My mother is the type of woman who suspects that a late night call or a surprise invitation is a sign of bad news. 

'I thought that it would be pleasant to spend some time with you,' I responded 'just the two of us.' She thought about it for a moment, and then said, 'I would like that very much.' 

That Friday after work, as I drove over to pick her up I was a bit nervous. When I arrived at her house, I noticed that she, too, seemed to be nervous about our date. She waited in the door with her coat on. She had curled her hair and was wearing the dress that she had worn to celebrate her last wedding anniversary. She smiled from a face that was as radiant as an angel's. 

 'I told my friends that I was going to go out with my son, and they were impressed,' she said, as she got into the car. 'They can't wait to hear about our meeting.' We went to a restaurant that, although not elegant, was very nice and cozy. 

My mother took my arm as if she were the First Lady After we sat down; I had to read the menu.

Her eyes could only read large print. Halfway through the entrees, I lifted my eyes and saw

Mother sitting there staring at me. A nostalgic smile was on her lips. 'It was I who used to have to read the menu when you were small,' she said. 'Then it's time that you relax and let me return the favor,' I responded... 

During the dinner, we had an agreeable conversation nothing extraordinary but catching up on recent events of each other's life. We talked so much that we missed the movie. As we arrived at her house later, she said, I'll go out with you again, but only if you let me invite you.' I agreed. 

'How was your dinner date?' asked my wife when I got home. 'Very nice, much more so than I could have imagined,' I answered. 

A few days later, my mother died of a massive heart attack. It happened so suddenly that I didn't have a chance to do anything for her. Sometime later, I received an envelope with a copy of a restaurant receipt from the same place Mother and I had dined. An attached note said: 'I paid this bill in advance. I wasn't sure that I could be there; but, nevertheless, I paid for two plates - one for you and the other for your wife. You will never know what that night meant for me. 'I love you, son' 

At that moment, I understood the importance of saying in time: 'I love YOU' and to give our loved ones the time that they deserve. Nothing in life is more important than your family. Give them the time they deserve, because these things cannot be put off till some 'other' time. Somebody said it takes about six weeks to get back to normal after you've had a baby... Somebody doesn't know that once you're a mother, 'normal' is history. Somebody said you can't love the second child as much as you love the first... Somebody doesn't have two or more children. Somebody said the hardest part of being a mother is labor and delivery.... Somebody never watched her 'baby' get on the bus for the first day of kindergarten. ..Or on a plane headed for military 'boot camp'. 

Somebody said a Mother can stop worrying after her child gets married... Somebody doesn't know that marriage adds a new son or daughter-in- law to a mother's heartstrings. Somebody said a mother's job is done when her last child leaves home... Somebody never had grandchildren. . Somebody said your mother knows you love her, so you don't need to tell her... Somebody isn't a mother.” 

Pass this along to all the GREAT ‘mothers' in your life and to everyone who ever had a mother. This isn't just about being a mother; it's about appreciating the people in your lives while you have them.... No matter whom that person is! 

Watch your thoughts, they become words. Watch your words, they become actions. Watch your actions, they become habits. Watch your habits, they become character. Watch your character, for it becomes.... your destiny. 'Be kinder than necessary, for everyone you meet is fighting some kind of battle'.

A Good Daughter

Intentional Communities Help Neighbors Help Neighbors

Found a great article authored by Elyse Umlauf-Garneau. It was originally published in the SRES Council Website with permission on Debra Whitfield's website, www.50PlusRealtor.com. Debra is an SRES designee and an agent with Coldwell Banker United Realtors.

We’ve all read the statistics that the vast majority of baby boomers and seniors would like to age in place. But a lack of services for both small and large troubles—snow shoveling, transportation and home health care—often make it impossible for seniors to remain at home safely. That’s one reason intentional communities are popping up across the country.
The concept is a departure from the tradition of bringing seniors to the services. The intentional community model brings necessary services to seniors’ doorsteps. “These communities are really the wave of the future for aging,” comments Dianne Campbell, executive director of Lincoln Park Village, a Chicago community launching in May.

People in a neighborhood or city come together to organize, fund and manage not-for-profits that serve as connectors between seniors and the services they require to age in place. The organizations often are buttressed by an army of volunteers, and the side benefits include social and emotional connections for both for the seniors and the volunteers.

Though there are more than 100 such communities either operating or starting up around the country, no community is exactly the same. That’s the beauty of them, say supporters. Each has its own culture and services, depending on residents’ needs, interests and desires.

If there’s not one in your area, you could be the catalyst and create your own group. Here are some starting points:
-Research other similar communities that have been established and learn from their successes and mistakes. Boston’s Beacon Hill Village was the earliest intentional community, and its workbook (see “Resources”) guides newbies through the process.
-Develop a founding group. Ideally, you want those committed to donating skills, time, knowledge and funds. Staying Put In New Canaan, a New Canaan, Connecticut community, for instance, tapped local marketing, finance, accounting, legal and administrative talent who offered services pro bono. Many continue to do so. And Lincoln Park Village started with just three couples chatting and seeking alternatives to existing senior care options.
-Assess interest and recruit prospective members. You’ll likely find enormous interest because so many have the desire to stay put. That, in fact, was the starting point for New Canaan’s Staying Put, which celebrated its first anniversary in January. “People came together who didn’t want to leave town as they aged,” comments Jane Nyce, the group’s executive director.
-Fund the plan. Particularly in this economy, locating funding sources is a challenge. Seed money can come from local businesses and corporations and board members.
-Create a business plan, including staffing needs, operating cost estimates and funding resources.
-Develop relationships with neighborhood groups. Include healthcare ventures, businesses and government groups geared to seniors, along with art and education programs to figure out what’s already available and where holes exist. “Not duplicating what already exists is important,” comments Campbell. And networking with local groups has offered expertise, advice, insight and access to data and studies that have been invaluable to Lincoln Park Village.
-Determine membership costs. Annual membership fees for Staying put are $360 for individuals and $480 for multiples, such as couples. Right now 45 percent of Staying Put’s operating costs stem from membership, though the long-term goal is to have an endowment in place. Lincoln Park Village anticipates annual membership fees of $540 for individuals and $780 for households.
-Estimate costs of services. Some services are included in the membership fee and some are provided free by volunteers. Others are offered on a fee-for-service approach, and groups typically negotiate for discounted rates with providers. “We have more than 50 volunteers in place to get us off the ground,” says Campbell. “Having that volunteer framework in place is key.” Not only does it keep costs down for members, it also leads to new friendships among neighbors and strengthens community bonds.
-Promote the idea. Nyce recalls that Staying Put had three town meetings to introduce the concept, get people interested and recruit volunteers and members. Nyce notes that having a passionate, respected spokesperson can be advantageous. In Staying Put’s case, a local doctor who had been practicing in town for more than 50 years and was fluent in senior and aging topics served as the voice and as something of the backbone for the group.
-Locate service providers, ranging from home health care providers and computer technicians to handymen, landscapers and plumbers. What services you offer depend on members’ needs. Recognize that the needs in urban areas may differ from those in rural and suburban communities. “Transportation is one of our greatest challenges,” says Nyce. “We have volunteers who provide personalized transportation, helping member run errands, taking them to doctors’ appointments and car pooling for special events,” says Nyce.
-Develop enrichment programs. Though one aim of intentional communities is to allow people to age in place, the other goal reaches beyond just servicing the members’ physical needs. A critical component is the social aspect. That includes providing a broad array of outings and events, including museums and concerts, dinners, classes, lectures, exercise groups, and so forth. “Community-building is so important. We want to weave a network of community support and give multiple generations an opportunity to interact, make new friends and build programs,” Campbell comments.
Such groups can also help members fend off loneliness. “As seniors age, they tend to get more isolated. We try to do very personal things—home visits and calls—to minimize that isolation and keep up with what’s happening with our seniors,” says Nyce. “It’s all about respecting and caring for seniors and neighbors caring for one another,” she adds.

Resources:
-Beacon Hill Village www.beaconhillvillage.org) sells a workbook, “Beacon Hill Village Founder's Manual,” and offers workshops and consulting services to start-up groups.
-HouseWorks, Boston (www.house-works.com)—Andrea Cohen, the company’s co-founder and CEO, has helped multiple intentional villages get started. The site offers information launching villages.
-Lincoln Park Village (www.lincolnparkvillage.org)
-Staying Put in New Canaan (www.stayingputnc.org)

Why You May Need A Care Manaager

Whether you are a long distance family member or located right around the corner, you can rely on the services of a professional geriatric care manager to keep your loved ones aging safely in place in their own home. Contact us for service fees and to schedule an assessment. Call 800-963-3877.

Nursing Home Frustrations - Update

Just an update to those who've joined this discussion. Today I showed up at the nursing home first to purchase a ticket for this client's wife so that she could join him for the Seder dinner, then visited the Social Worker who was very conciliatory about not informing me last week to the care plan meeting. I quickly informed her that the daughter also never received the invitation as the social worker stated. Her face was rather red and said it would never happen again. She took my card and stapled it to her private files and was actually very nice to me. I then visited my client while he was having lunch and asked his permission to decorate his room which I did with memories of his den at home and lots of nicely framed photos of his family. I can't tell you how good that made me feel when he saw his room. He is one of the few remaining holocaust survivors left in long term care and I am so pleased to have honored him today during his holiday. He is so excited about having his wife present at the Passover Seder tonight. I decided to wait and see what happens in three months when the next care plan conference is scheduled. If I don't get invited, I will call the Ombudsmen's office.

Why Nursing Homes Frustrate Care Managers

Even after having been inside the nursing home industry for 12 years first as an adult daughter of someone with an Alzheimer's related disorder, then as an Assistant Administrator and Activities Director, it never ceases to amaze me when I meet with roadblocks to care of a Dementia client.

Earlier in the week I located my tickler file to remind me of an upcoming care plan conference for a client I placed in long term care about one year ago. Since I had not heard from the social worker at the facility, I left a voicemail message which she ignored. On Thursday, I heard from the client's psychologist who sees him twice a week stating my client was moved from his wing to another wing where the nurses don't know him and he is very depressed. I immediately called and left another message for the social worker. Yesterday, I finally heard from the social worker who apologized for not inviting me, stating they had the care plan conference yesterday and she forgot to invite me. How could she forget to invite me when my name is on his Face Sheet as the in-town contact; when I have a valid HIPPA form in his chart, and my business card has been given to her at every single care plan conference I have attended previously? Because I know this resident is bipolar, has dementia, is a holocaust survivor and we have been providing care management for him for the past four years I very explicitely spoke to everyone involved to make sure I was invited to his next case conference. Didn't happen!

In speaking with the social worker who apologized for forgetting stating she has 120 residents (when I had done care planning for 170 and didn't forget to invite GCMs when the nearest family member lived up north) she stated they moved my client because he was hitting the nurses on his wing and was very disruptive. Even moreso, this would have been an important conference to attend but I doubt they wanted my input so she claimed to have sent the invitation to the out of town family member instead.

In speaking with the client's out of town daughter she said the social worker called her yesterday, informing her of the change, about his being abusive, about having punched a female resident in the face. Now, I understand the laws that regulate nursing homes in Florida and am fully aware of the requirements by the Agency for Health care administration (AHCA) which clearly are there to protect residents rights. If a female resident had been punched in the face by another resident, this would have required an investigation by AHCA and my client would have been admitted for psychiatric observation under the Baker Act which is the law in Florida that protects someone who is a threat to himself or others. Under this admission, his medications would have been regulated and he would be monitored until able to return to his home. This didn't happen.

For adult children interested in knowing more about nursing home selection, please visit this recent informative interview by Meredit Viera of the Today Show at:
http://today.msnbc.msn.com/id/29636865/