Remembering Ted Kennedy

Line from his famous quote: "The work goes on, the cause endures, the hope still lives and the dreams shall never die." Edward Kennedy, may he rest in peace!

The Functional Assessment Staging of Alzheimer’s disease (FAST)

I recently became curious as to how a physician determines whether his patient with Alzheimer's Disease (AD) is in the six month widow for Hospice placement so I started to research the Functional Assessment Staging (FAST) of Alzheimer's Disease.

Staging methods are an essential tool in the assessment of disease severity in progressive dementing illness. The FAST system has been studied extensively and proven to be reliable and valid for staging dementia in Alzheimer’s disease. One of the major advantages of this system is that it spans and describes the entire course of normal aging and progressive AD until the final stages of the disease process. According to the National Hospice and Palliative Care Organization (NHPCO) FAST is used to determine hospice eligibility. The FAST identifies progressive steps and sub-steps of functional decline. NHPCO guidelines state that a FAST stage 7A is appropriate for hospice enrollment, based on an expected six month or less prognosis if the patient also exhibits one or more specific dementia-related co-morbidities. These co-morbidities are simultaneously existing conditions that make the diagnostic picture more complex, (i.e., aspiration, upper urinary tract infection, sepsis, multiple stage 3-4 ulcers, persistent fever, and weight loss greater than 10% within six months).

The FAST scale has seven stages:

1. Normal adult with no cognitive decline.

2. Normal older adult with very mild memory loss (forgetting location of objects and word finding difficulties).

3. Early dementia. Memory loss becomes apparent to co-workers and family. The patient may be unable to remember names of persons just introduced to them and may have difficulty in traveling to new locations with decreased organizational capacity.

4. Mild dementia. Persons at this stage may have difficulty with finances, counting money, planning dinner for guests, difficulty marketing. Memory loss increases. The person’s knowledge of current and recent events decreases.

5. Moderate dementia. At this stage the person needs more help to survive. They do not need assistance with toileting or eating but do need help choosing clothing. The person displays increased difficulty with serial subtraction. The patient may not know the date and year or where they live but do know who they are and the names of their family and friends.

6. Moderately severe dementia. The person may begin to forget the names of family members or friends. The person requires more assistance with activities of daily living, such as bathing, toileting, and eating. Patients in this stage may develop delusions, hallucinations, or obsessions. Patients show increased anxiety and may become violent. The person in this stage begins to sleep during the day and stay awake at night.

7. Severe dementia. In this stage, all speech is lost. Patients lose urinary and bowel control. They lose the ability to walk without personal assistance and the ability to sit up without assistance is lost. You may see individuals at this stage in nursing homes that will fall over if there are no lateral arm rests on the chair. Most will loose the ability to smile and will become bedridden and die of sepsis or pneumonia.

Although determining eligibility for an Alzheimer's dementia patient can be complex for physicians and clinicians, today, more patients than ever are now able to qualify for hospice care. To find out whether a family member is eligible for Hospice, speak to your physician or geriatric care manager for help and guidance in selecting the right Hospice agency for your loved one.

When a Power of Attorney Decides if You Should Live or Die

I recently read a blog post from bio-ethics specialist, Viki Kind, regarding strangers deciding whether a person in a nursing home or hospital should live or die which I found very stimulating and informative (www.kindethics.com)

However, should you advocate for an elder with an Alzheimer's related dementia who has had a history of depression, has been known to be suicidal, has some wandering / sundowning issues, but whose POA wishes to disconnect her pacemaker --recently implanted under recommendation of another adult child less than five months ago? The senior is still ambulatory, enjoys outings with her caregivers, loves her cat, has good appetite, and generally has no agitation except when long distance children overstimulate her while visiting. This was the case a few weeks ago when she became violent with the caregiver immediate following her son's departure. So now the POA is proposing that her primary care physician disconnect the pacer and provide a hospice consult because of an acceleration in his mom's decline; not wishing to protract her suffering. Is this ethical? Is it not? Will the primary care doctor order that the pacemaker be disconnected? What do you think? Would love to hear your comments. Please click on comments link below to submit.

Licensure of Geriatric Care Managers - What are the Facts?

FGCMA (Florida Chapter of Geriatric Care Management Association) is embarking on a journey to take every step possible to make licensure a reality for the protection of the consumer, and for care managers as well. Ongoing education and outreach is planned to bring about 100% consensus in our membership.

Why Regulate?
It's time to protect the consumer from people who may call themselves a geriatric care manager but do not have the core knowledge of a trained care manager or the oversight of a licensing board.

Licensure says that as geriatric care managers we have a body of knowledge and the skill set necessary to be proficient in our practice. It demonstrates a level of competency.

What's the motivation?
It assures consumers that there is public regulation on behalf of a vulnerable population and it may provide protection for the use of the geriatric care manager title that we've all worked so hard to attain. For the consumer, licensure assures the consumer that the geriatric care manager has achieved a standard of knowledge and experience.

Informed Choices
Licensure helps the consumer select the best geriatric care manager and sets the standard for service delivery. Licensure will give care managers a marketing advantage by identifying those who meet the criteria set by the law. And finally, licensure will allow for research to measure specific outcomes and accountability. This should lead to consumer protection.

So protect the consumer....stand out in the market and support Florida licensure for geriatric care managers. For more information: Contact Linda Cramer in our public policy committee - linda@myparentcare.com

Working With A Geriatric Care Manager

Putting the Needs of the Parent First Over Visiting Children

It is difficult to turn the focus on mom or dad and away from the visiting adult children who believe they are caregivers but aren't aware of a parent's needs. Most of what is written about nowadays focuses more and more on the stress and sacrifices of the caregivers. However, when mom or dad's needs are not being served the best, it may help to find out who is the family leader and advocate on behalf of the elder who's needs aren't being met because visiting adult children have flown into town and have no idea of the needs of an Alzheimer's patient for consistency, a quiet/safe environment, and the importance of routine. For example, a patient (let's call her Mary) who started having behaviors associated with sundowner's syndrome -- common in Alzheimer's type dementia -- back in December was being visited by out of town children who kept her out all night at the local gambling casino, missing adequate sleep, medication, and the routine of her daily caregiver who had established a set of daily activities with Mary. An earlier post warned against family interruption of routines and while they are encouraged to visit, adult children must also be cognizant of the needs of the elder not to have routine interrupted by activities that are over stimulating.

Once again, eight months later, the elder has now progressed to the wandering stage with new agitation against her daily caregivers once again preceded by overstimulation during a visit. When alone with the caregivers, Mary follows a simple routine with activities outside the home which she enjoys but are not designed to overstimulate. However, a family member flies in to see the parent but decides to participate in activites which are outside of her routine and have overstimulated her psychie. When the children leave, she gets agitated, confused, and resumes wandering behavior patterns, acting out against the caregivers to the point of violence.

The lesson in this scenario is that mom or dad definitely shouldn't suffer while trying to accommodate the family's schedules.

Care Managers who take time to put an action plan in place for the elder and communicate the changes in a client's needs for a comfortable stable routine as Alzheimer's disease progresses, take great pains to make sure overstimulation doesn't take place. Mom or dad's needs shouldn't suffer as a result of well meaning adult children. To discuss your parent's caregiving needs, contact: olga@agooddaughter.com

Our team of care managers will complete an assessment and put together a plan of action to ensure your parent's needs are being adequately met.

From his autobiography, Wanderer

Sterling Hayden is a much admired old Hollywood actor, sailor, and author. In these hard economic times I thought I'd stray a bit from the usual information and give you a glimpse of the other side of the good daughter before she became enmeshed in the world of elder care. The world of sailing and cruising which most folks passing through San Diego waters in late fall each year are usually moved to do. Because of Sterling Hayden, I too, got wanderlust in my heart and set off on my own journey in 1996. It was a very special experience indeed and one I needed before I embarked on the road to Alzheimer's. Here are some of the those words which inspired me so in the mid 90's when I owned a 30 foot sloop named "The Loon".

To be truly challenging, a voyage, like a life, must rest on a firm foundation of financial unrest. Otherwise, you are doomed to a routine traverse, the kind known to yachtsmen who play with their boats at sea... cruising, it is called. Voyaging belongs to seamen, and to the wanderers of the world who cannot, or will not, fit in. If you are contemplating a voyage and you have the means, abandon the venture until your fortunes change. Only then will you know what the sea is all about. "I've always wanted to sail to the South Seas, but I can't afford it." What these men can't afford is not to go. They are enmeshed in the cancerous discipline of security. And in the worship of security we fling our lives beneath the wheels of routine - and before we know it our lives are gone. What does a man need - really need? A few pounds of food each day, heat and shelter, six feet to lie down in - and some form of working activity that will yield a sense of accomplishment. That's all - in the material sense, and we know it. But we are brainwashed by our economic system until we end up in a tomb beneath a pyramid of time payments, mortgages, preposterous gadgetry, playthings that divert our attention for the sheer idiocy of the charade. The years thunder by, the dreams of youth grow dim where they lie caked in dust on the shelves of patience. Before we know it, the tomb is sealed. Where, then, lies the answer? In choice. Which shall it be: bankruptcy of purse or bankruptcy of life?

Geriatric Care Managers Featured in Business Week

Members of the National Association of Geriatric Care Managers were interviewed by BusinessWeek for "The Elderly: Finding a Good Geriatric Care Manager." One on camera interview with a care manager is included in the article written by Lauren Young which explains the use of a care manager, how to find one, what are the benefits of hiring one, credentials, services and fees.The article will also appear in the printed magazine, which has a circulation of one million so please go to your newstand. Excerpts from the article follow below......

"Such professionals can be a tremendous help if you're trying to take care of ailing parents but live far away." Following is a scenario of how a care manager may be used:

On a Tuesday night in late July, Jon Meyers, 42, got the call every child with an elderly parent dreads. His 84-year-old mother, Ruth, who suffers from dementia, had fallen in her kitchen and was heading to a New Jersey hospital by ambulance. But instead of agonizing over not being able to get there quickly -- it's four hours from his home in Washington, D.C., to Point Pleasant, N.J. -- Meyers took comfort in the fact that Stephen Mielach, a geriatric care manager, was following the ambulance, ready to take control. On recommendation of his mother's physician, Meyers, an only child, hired Mielach. He accompanies Meyer's mother on doctor visits, looks after her dog on occasion, and even helped with the paperwork for a reverse mortgage so that she could stay in her home.

The role of a geriatric care manager goes well beyond that of a home health aide. Care managers oversee many things busy family members might not be able to stay on top of: vetting nursing homes and assisted living facilities, overseeing home health aides, providing guidance about entitlement programs and benefits, making sure that rugs in a parent's home don't slip and that refrigerators are stocked.

An estimated 7 million people care for adult relatives from a distance, according to the National Alliance for Caregiving. Preliminary research by United Healthcare (UNH) Evercare indicates that elderly patients who have a GCM get more thorough care than patients who do not. This research was conducted in conjunction ith Santa Monica (Calif.) think tank, Rand Corp.

According to Linda Fodrini-Johnson, president-elect of the National Association of Professional Geriatric Care Managers, 35% of members have nursing degrees, 50% have social work or counseling backgrounds, the other 15% have experience in fields such as physical therapy or occupational therapy or have advanced degrees in gerontology and related fields.

Care Managers begin the process with an assessment. This review includes medical/mental history, environmental or safety review, and looking at financial, legal, and social issues. Hiring one of these professionals for a comprehensive assessment ranges from $200 to $850. Hourly rates can range from $80 to $200. As the article states, finding someone to help you take care of an elderly relative can benefit your health as well as theirs. In Suzanne and Peter Cooper's case, they were raising their five-year-old son while living with her 84-year-old mother who has Alzheimer's disease. Suzanne, 49, says her own mental and physical state has improved dramatically since she hired Nancy Bortinger, of geriatric services at Vantage Health System in Dumont, N.J. Bortinger plowed through a list of 20 local day-care facilities to get Suzanne's mother out of the house for stimulation and socialization. Now she is helping Suzanne place her mother in a respite care center for one week while the family takes a much needed vacation.

According to Suzanne, GCMs are like a GPS system for a car, the GPS gets you right to the place you need to get to even if you have maps in the car.

To find a certified geriatric care manager in Boca Raton, Florida with 30 years experience in healthcare and with an advanced degree in gerontology and experience in nursing home administration and therapeutic activities management contact: Olga Brunner, MS, CMC of A Good Daughter Elder Care Management at 561-392-3574 or at www.AGoodDaughter.com

To find a certified geriatric care manager elsewhere in the U.S. contact the National Association of Professional Geriatric Care Managers at http://www.caremanager.org

To find out what credentials are accepted by the National Assocation:

Care Manager Certified (CMC)

Applicants need an advanced academic degree in a related field with up to six years of experience caring for people with chronic disabilities. Must pass a four-hour exam after supervision with direct case management experience and recommendation.

Certified Case Manager (CCM)

Must pass a 180-question exam and get a license or certification that allows the caregiver - such as a nurse - to operate independently, without supervision.

Certified Advanced Social Worker in Case Management (C-ASWCM)

In addition to a master's degree in social work, an applicant needs 1,500 paid supervised hours with direct case management experience.

Certified Social Work Case Manager (C-SWCM)

Similar to advanced certification, but designed for people with bachelor's degrees in social work.