agooddaughterbuzz

Merry Christmas to my readers

2011-12-25T09:31:00.001-05:00

In this economy I feel blessed to have been offered a wonderful position as Assisted Living Administrator. Please know that although we have closed A Good Daughter Elder Care Management, I will continue to share my experiences with those interested in elder care, family caregiving, Alzheimer's disease, and issues centered around health care administration as it has evolved today. Please know that I wish you all a wonderfully healthy 2012 and much love to all my colleagues and friends that I have made throughout the years.

Activities for Alzheimer's

2011-11-21T09:00:00.006-05:00

Keeping the mind and body active and busy is important for everyone, but especially for the person with Alzheimer’s disease. Activities should focus on the person’s abilities, not their limitations. Activities should be safe, with enjoyment, not achievement being the intent. Recognize that the A.D. person’s interests can change from day to day and hour to hour. Activities that provide mental stimulation are best done in the morning, while soothing or calming ones are best done in the late day or evening. Realize that the attention span is likely to be short and the person may not be able to initiate activities but may be able to do them once the caregiver starts.

Following are some ideas for useful and interesting activities:

Helping with chores gives the person a feeling that they are still part of the household. Examples include: setting the table, folding the laundry, sweeping the floor, and sorting the silverware.

Exercise releases tension, meets physical needs, and provides a feeling of accomplishment. A stationary bicycle or easy video can be used effectively.

Gardening – simple tasks under supervision can provide satisfaction as the person “watches their garden grow’.

Arts and Crafts – i.e., making pencil holders or vases from tin cans, trivets with glued tile pieces, painting shells and stringing beads for jewelry.

Games appropriate to the individual’s level of function can be stimulating.

Puzzles can be fun but first find the most appropriate for their stage.

Sorting buttons, cards, coins, keys or socks can be a good activity for a lower functioning individual.

Drives to interesting places can be calming and life enhancing. A trip to the zoo, the botanical garden, or to a Florida Wetland is fun and provides the basis for positive communication.

Reading aloud and using visual aids to share stories, poems and pictures about days gone by.

Use of a VCR or DVD player – old movies can bring back pleasurable memories. Nature and travel films move more slowly and are easier to follow. Never have a person with A.D. watch the news. Especially during time of impending hurricanes- this can serve to agitate unnecessarily.

Scrapbooks to put in favorite or treasured small items or pictures.

Busy Boxes and Reminiscence Boxes can include everything from kitchen gadgets to sports equipment, sewing supplies, or cosmetics depending on the gadgets to sports equipment, sewing supplies, or cosmetics depending on the person’s interests and the safety of the objects.

Music which the person enjoys can be soothing or stimulating. This includes everything from active listening to sing-a-longs.

Meaningful activities can give the A.D. person a feeling that they are making a worthwhile contribution and thus enhance their self-esteem. Some positive ways to introduce an activity are: “Can you please help me with…” or “Could you show me how you do …., “ “It would be nice if you would make this for me.” It is not a good idea to ask the person to do a simplified version of an activity or craft in which they once excelled, as this could be upsetting. Above all, the A.D. person needs to feel a sense of accomplishment, satisfaction and involvement from the activities you are presenting. And as we know, caring for pets provides a sense of accomplishment.

As a former Activities director in long term care I understand the importance of activities. We have hired an assistant care manager with a degree in psychology and experienced at Activities Planning for seniors. Please call our office or visit us online at www.agooddaughter.com if you are interested in setting up an activities program for your loved one with Alzheimer's disease.

Communicating with the Alzheimer’s Patient

2011-11-20T12:54:00.002-05:00

This is a favorite discussion of mine because I remember when I cared for mom and the caregivers would tell her “Momma speak English”. I would constantly remind them that she “Speaks Alzheimer’s” and that they needed to learn her language, not the other way around. Little did I know that when I took my training to be certified as an Activities Director I learned that caregivers do indeed need to communicate with persons who have A.D. in their own language. Because I lived with mom every day, I did learn her unique language so here are some additional tips for those family caregivers and/or paid caregivers who need to communicate with the Alzheimer’s patient.

If you really need to be heard, make sure that you have the person’s attention by saying their name and making eye contact. Remember cognition level may vary from day to day, time of day, location and conversational topic. Limit the number of people in a conversation when you are communicating. Use short, simple words and sentences with minimal information. This really makes life easier all the way around. Reduce distractions and extraneous noise when trying to communicate. Use more than words to communicate. Body language, gestures, and facial expressions also communicate meaning so learn to use appropriate ones. Encourage the person to express thoughts even if having difficulty. Be careful not to interrupt them. Demonstrate tasks in easy to understand steps, one at a time. Use recognition rather than recall questions when introducing someone. Try saying, “This is Maria who we met last summer”, instead of saying “Don’t you remember Maria from last summer?” Expect that the person may ask the same question over and over again. Repetition is very common in this disease. Try to have patience, be reassuring, and move on. While on the subject of patience, ask one question at a time. If asking a question, then wait for a response. Sometimes there may not be a response, so gently move on. Above all, and this is very critical and may take some practice, but you must avoid criticizing, correcting, and arguing. It is always counterproductive. Remember, you can no longer teach them something like you can do with a two-year-old, it is up to you to:

Treat them with respect and dignity and not as if she/he were not there. I had a family member who was so happy to see me that she would have conversations about him in the third person in front of her husband with A.D. Years later I learned that after I left he would always act out in anger.
This one is crucial. Simplify tasks. Break down tasks and activities into easy steps. Limit choices. Allow time for their slower processing time. Reassure the person with each step (i.e., “you are doing great”).
Maintain a calm soothing environment. Soft sounds and voices are best. Music can be very comforting. Give a reassuring touch when appropriate. Avoid abrupt movements. Keep the environment as consistent as possible.
Know what to do if the person becomes agitated. Try to figure out the source that’s upsetting the person with A.D. Does he/she need to use the bathroom? Are they in pain? Change the subject if it appears to bother them (also known as redirecting which is successfully used in long term care). Distract and move on to a different activity.
. Use their view of reality. Reality orientation is not effective with those who suffer with severe memory loss, so validate them because their reality is different from yours. Whenever possible, go along with the person and ‘be in their world’. Don’t argue as it will not be productive. Practice reminiscence (recalling past events). Focus on pleasant experiences and achievements.

Above all, patience is essential. The person with A.D. may have little or no control over their strange verbal, physical, or sexual behavior. The affected person may not remember enough about their past reasoning or behavior patterns to always respond appropriately. What can seem like manipulative behavior is just the disease talking.

If you or your loved-one’s staff needs to learn to speak Alzheimer’s, use these tools. If you are a long distance caregiver and need someone to partner with you in achieving goals for someone dear to you, call the offices of A Good Daughter Elder Care Management in Boca Raton at 561-392-3574. We will be happy to discuss how we can be of help. Our support group for family members meets on the third Wednesday of the month from 5:30 – 7:30 pm and is free of charge.

The Caregiver's Role

2011-11-19T10:51:00.003-05:00

Everyone with Alzheimer’s disease at some point will need help from a caregiver. Sometimes a family member will meet this need; often a paid caregiver will do so. Whomever is filling this role, they will need to make many adjustments from the time the diagnosis is given. Fear of what will happen and how they will be able to manage the manifestations of the disease is very common. Thus, the best thing that the caregiver can do is to gain understanding of the disease. Most of all, if you are a family caregiver and are feeling overwhelmed, do not feel guilty if you are unable to fill the caregiver’s role yourself. Not everyone can fill this very difficult task.

If hiring a home health assistant, they must: provide adequate supervision with activities of daily living, ensure the patient’s medical well being, provide assistance with daily chores, provide assistance with personal care, and provide companionship and psychological support. If the family member is working as a daily caregiver, here are some valuable tips:

Get enough sleep. It is vital to take care of oneself. Exhaustion makes it harder to cope with your loved-one’s demands.
Eat well and pay attention to nutrition.
Keep medical appointments and follow your doctor’s orders.
Set aside some personal time just for you.
Find ways to put enjoyment and relaxation into each day.
Join a support group!!! Make friends with others in similar situations and share your concerns and helpful tips.
Cultivate patience. Becoming angry and frustrated will only make the situation worse.
Try meditation, deep breathing, and exercise often.
Let family and friends help. Ask them for help if they do not offer. Do not let yourself become isolated, as no one can do this alone. Make up schedules for other family members so everyone can share some caregiving chore.
Learn about community resources and make use of community support.
Plan ahead for emergencies and the future. Consider an elder law attorney for help with Medicaid planning, VA benefit programs for caregiving needs, and special needs trusts for asset planning.
Consider utilizing private or subsidized in-home respite care, individual counseling and day care programs.
Be realistic. Feeling guilty about what you cannot do may keep you from doing what you can.

Remember, you may always hire a certified geriatric care manager who will oversee a loved one’s needs for caregiving, medical appointments, medications management, caregiver supervision, educating family members about the illness, and teaching them that the patient’s behavior is not intentional even when it is repetitious, difficult, or abrasive . For more information go to www.AGoodDaughter.com or contact 561-392-3574 to set up a complimentary meeting with our care managers.

Wisdom for Family Caregivers caring for someone with dementia…….

2011-11-18T16:53:00.005-05:00

If your loved one has dementia, has become forgetful, repetitive, isolates him/herself, is confused about where he/she has left items around the house and confused about how others perceive him/her, please share these words of wisdom:

1. Tell them to take their time and not let others rush them.

2. Tell them to explain to people that they have a memory problem asking them to repeat things if they feel it is necessary.

3. If your parent loses a thought, tell them not to panic. It may come back later so they should relax – it happens! Try telling your parent to ask the person with whom they are speaking to remind them of the last thing they said.

4. Tell them to focus on what they can do and not on what they cannot do.

5. Try to keep them on a schedule for meals, medications, exercise and bedtime

6. Help them write notes and leave them in a visible place (for example “turn off stove).

7. Tell them to ask for help with sorting and choosing clothing.

8. Consider buying them a pocket sized voice memo recorder to jog their memory.

9. Tell them if someone comes to their door whom they don’t recognize not to let them in. They may ask for a name and phone number and give them to a family member later on.

10. If a parent lives alone, ask a friend or relative to call them each day to make sure they are alright. Make sure this friend or relative has a key to the house.

11. Make sure they take someone of trust along whenever they go out.

12. Arrange for someone you trust to pay their bills and balance their checkbook.

13. Ask them to write important things down in a “memory book” then ask them to keep it with them.

14. Label things around the house with the contents of important things such as their “sock drawer”

15. Have them make a list of what they want to do each day.

16. Keep a calendar of their appointments and commitments in a very visible place. Have them mark off the days each night before going to bed.

17. Help them feel comfortable about asking for help.

These items above and more are within the purview of a Geriatric Care Management Service. At A Good Daughter, we have a trained assistant care manager with an undergrad degree in psychology, previous experience providing cognitive stimulating activities in long term care, and who has also taken care of her grandparents – an experience which changes you forever. So, call A Good Daughter Elder Care Management and let us provide a comprehensive assessment of your loved one’s needs. We can provide a very detailed document with concrete recommendations for keeping your family member with Alzheimer’s safely living in their own home with appropriate care. Call 1-800-963-3877 and ask for the senior care manager, Olga Brunner who will be happy to meet with you for a complimentary consultation. We also conduct a support group for family members on the third Wednesday of the month between 5:30 pm and 7:30pm which is also complimentary but you must RSVP. Visit us on the web at: www.AGood Daughter.com

Symptoms of Denial When a Parent has Alzheimer's disease

2011-11-17T11:41:00.001-05:00

Many persons with dementia do not recognize or acknowledge their condition or deterioration. This is part of the disease. In fact, some may not even recognize their own reflection in the mirror. If you'd like to recognize some common reactions when a parent with Alzheimer's exhibits symptoms of denial, some of their reactions are:
1. Anger over issues of control and loss.
2. Defensive responses when confronted with facts of memory loss or functional problems.
3. Refusal to make or keep doctor's appointments.
4. Gradual withdrawal from social situations.
5. Less participation in activities that a parent once enjoyed.
6. Unusual or unreasonable fears of people or situations.
7. Excuses for changes in behavior, (such as "I'm tired, I'm a homebody, I don't like to walk")
8. Insistence on continuing activities that are unhealthy or even dangerous,such as driving. In fact we once had a client that would just go and purchase a new car whenever the daughters took away her car keys!!!!

The family caregiver may wish contact a geriatric care manager if they are in town visiting a loved one and find such symptoms of denial, if you are noticing self-neglect especially with hygiene, if driving is becoming problematic for a parent and you notice increasing car dents, or if mom or dad is just not getting out anymore.
We are your source for peace of mind.

A Good Daughter, Inc. is a Geriatric Care Management company, located on Spanish River Blvd. in Boca Raton near Federal Highway. We offer Comprehensive Assessments and will write a Plan of Care detailing our recommendations for your elderly parents in Southeast Florida. Our website can be viewed at www.AGoodDaughter.com which will provide you with information about our other services and more or call us at 561.392.3574.

Birth of a New Tradition

2011-11-16T09:08:00.004-05:00

Happy Thanksgiving-

As we anticipate being with family and friends for Thanksgiving next week, I wanted to pause and thank all of you for your support and interest in the services we at A Good Daughter provide to our seniors in PB County.

This year we have identified a community resource that we will support through donations and hope that you will also support with tangible items that may be brought to: CCC of Boynton Beach. As you shop for and prepare for your own holiday, please keep in mind the needs of our frail elderly that the Community Caring Center of Boynton Beach and the Boynton Faith Based CDC is seeking to support this year.

Here is a little information about who they are:

“CCC Green Market is a drop site for our food pantry – We are providing 250 Thanksgiving Baskets to needy families November 19^th, and cooking Christmas Day dinner for the community, homeless, and frail and elderly shut- ins. As the holidays approach Americans will give the gift of genuine concern for other Americans who are in need”. Please also visit the Secret Garden Café entirely staffed by volunteer staff at the CCC Green Market, 410 East Boynton Beach Blvd., Boynton Beach, Fl. 333435. 561-752-8598” http://www.localharvest.org/secret-garden-cafe-at-the-green-market-new-gourmet-prepared-foods-M32313

Have a wonderful Thanksgiving and we look forward to seeing our female clients at our High English Tea served by the Secret Garden in December. Please contact us at 561-392-3574 for more information.

Thank you,

Olga Brunner, M.S., CMC

Senior Care Manager

A Good Daughter Elder Care Management

Why Are Florida Drivers So Cruel???

2011-07-20T10:35:00.001-05:00

This morning on my way to work I was peacefully humming my mantras, enjoying an enlightened day when suddenly as I approached my exit I could see a blue Marquis on the right hand lane attempting to get to his left lane. Problem was that he must have been an elderly gentleman and was driving very slowly indeed. I stayed behind him as I was nearing my exit and wasn't in too much of a hurry anyway. Everyone behind me moved over to the left lane where this gentleman was attempting to enter whizzing by and not letting him into the lane. Why? Why are we in such a hurry that we cannot let someone enter a left lane when they clearly need to do so? It was just so painful to watch. I just knew he was going to have an accident. Thinking he was probably cognitively impaired when I observed him shying away from the left lane and then make another attempt to reenter (seems to have gone on forever), I just called the police giving them his tag number. I was sure he was not going to make it on any road today. First of all, a person who is inexperienced on a highway should not be on the interstate and secondly drivers in Florida were just totally cruel making a difficult situation downright dangerous. The elderly man finally exited the interstate at my exit and I stayed behind him until he pulled off the road and into a strip mall.

For someone interested in recommending a driver's assessment when cognitive impairment is suspected, I would highly recommend the FAU campus as they have a wonderful 2-pronged approach: assessing cognition as well as an on-the-road driver's test. Here is a link to their site. http://nursing.fau.edu/index.php?main=6&nav=685

Stay safe everyone!

Privatization of Medicaid

2011-06-22T13:54:00.001-05:00

The State’s proposed Medicaid privatization would hurt our most vulnerable Floridians. However, this unprecedented HMO giveaway is not a done deal! It must be approved by the federal Centers for Medicare and Medicaid Services. E-mail your concerns by July 15 to both: cynthia.mann@cms.hhs.gov and FLMedicaidManagedCare@ahca.myflorida.com.

Here is a copy of a letter recently distributed by an elder law attorney which may be used:

Dear CMS & AHCA:
I am a board certified elder law attorney who is very familiar with Medicaid and many of its recipients. No one wants the Medicaid system in Florida privitized and turned into a managed care system. This has been tried in Florida and failed miserably. To save money, ostensibly, the patients will suffer, doctors will drop out, and the only ones making money will be the private HMO's. This is the basic reason why Florida should not be allowed a "waiver" to turn the entire Medicaid system over to private HMO's and switch to a managed care model.

Bill Reintroduced to Address Geriatric Workforce Shortage

2011-06-09T13:08:00.001-05:00

This just in from the Alzheimer's Foundation.....

U.S. Senators Barbara Boxer (D-CA), Susan Collins (R-ME), Herb Kohl (D-WI) and Bernie Sanders (I-VT) on May 26 reintroduced the Caring for an Aging America Act, which is aimed at attracting doctors, nurses, social workers and other skilled healthcare workers to gerontology and geriatrics.
The bipartisan legislation would provide loan repayment opportunities in exchange for working in underserved areas, and would expand the U.S. Health Resources and Services Administration's National Health Service Corps Program to include primary healthcare professionals with training in gerontology and geriatrics.
The act comes In response to the projected doubling in the 65+ population by 2030 and is grounded in recommendations found in "Retooling for an Aging America: Building the Health Care Workforce," a report by the Institute of Medicine in 2008 that called for a labor pool of adequate size and competency to care for this population.

Torture of An Otherwise Lucid Individual

2011-04-11T19:37:00.005-05:00

This is what I don't like about Assisted Living Facilities.......A gentleman client at a well known facility is discharged from a rehab facility back to his ALF apartment and while acclimating him several staff members pass in front of his door smirking at a note posted on a neighbor's door. Three days later when I arrive to complete an assessment I find him agitated concerned about how they are placing a neighbor in an insane asylum and he is going to be the next one to lose his rights. When I ask him to elaborate he points to the sign on the door across the corridor from his room. Ok, I am horrified at a note which states that if you are looking for the owner of this apartment she is in the insane asylum. I immediately call the nurse on duty, have the note removed, and explain to my client how it was all a bad joke. We close the door so that I can begin my assessment when a key is inserted into his door and a nurse walks right in without even a knock on the door. What happened to the right to privacy? What happened to knocking on a door first?

Two days later our nurse visits and find his oxygen saturation levels at 83 and speaks with the director of nursing who promises portable tanks will be delivered tomorrow. Next day no portable tanks arrive so I leave a message with this D.O.N. The following day this client calls the paramedics and is taken to the E.R. When our nurse arrives at the E.R. she is told by the ER nurse his oxygen stats on arrival were at 78 and dangerously low. No call back from the D.O.N. as to the status of the portable tanks which would provide some semblance of a quality of life for our client.

Following day I received a call from the nurse on duty stating the medical equipment company refuses to deliver oxygen tanks without payment. Client is now very anxious. Payment? This client has Medicare. Following day I receive an email from out of town family member stating dad was complaining about thoughts he couldn't get out of his head in a conversation yesterday. At 9:40 am, I receive a call from our client, now agitated, visibly suffering with hypoxia, who states he is going to blow his head off. Called the nursing station and spoke with nurse on duty. Called Medical Equipment company to determine what is causing the delay of his portable tanks. I still have not heard back from the D.O.N. Owner of the oxygen company clearly informs me that 5 portable tanks had been delivered yesterday to the facility for him. What? Why has nursing not filled his tanks? Why are we being told there was no delivery of portable oxygen tanks? Owner of medical supply company states that the only missing piece is a missing nozzle and understanding the client's mental status he agrees to personally deliver the nozzle. Still have not heard back from D.O.N.

Two days later, a nurse calls stating client is having shortness of breath with jerking movements and is sending our client out to the E.R. She also states she can't make him compliant and wants the E.R. to send him back to a rehab center. Once tests come back as normal, E.R. sends him to a rehab center. Still have not heard from the D.O.N.

Three days later I answer my cell phone with the caller ID coming from my client's apartment number. I answer the call and the caller is the Director of Nursing, wanting to know if I ordered so and so and why or why not. I informed her that the only reason I picked up this call was because it was from my client's apartment, informing her that I am at an MD appointment with another client and will call her back.

Two days later I meet with the Medical Director of the Assisted Living facility defending his decision to recommend long term care placement for my client and confirming a diagnosis of Alzheimer's disease. When was this client neurologically evaluated? By whom? What tests were done to confirm Alzheimer's. He scored normal on my Mini Mental Status Exam. Ten days later I meet with the care planning team at the rehab center plus a family member and learn he is being discharged from physical therapy with 24 hour care back to the ALF.

This is what happenes at institutional living everyone. Read it and weep! A male senior, independent of activities of daily living is hard of hearing and suffers from anxiety issues because of chronic pulmonary disease. Instead of meeting his needs, the staff plays a cat and mouse game, controlling how they want his oxygen administered. You see, a standard licensed facility does not have the ability to track when a resident leaves the premises so to control him, they devise a plan to make him dependent on an oxygen concentrator in his room, preventing him from leaving the apartment for any reason other than meals. He now loses the ability to go for a walk around the premises because doing so will give him shortness of breath. Every attempt he makes to walk outside of his apartment sends him to the emergency room. His anxieties build. A former brilliant scientist, now lacks control over his own life. And the powers that be play cat and mouse in obtaining a simple piece of quipment that could give him some quality of life. They hatch a plan to keep him in long term care instead. What is wrong with this system? What is wrong with a facility who hires such incompetent individuals and staff who lack basic compassion for human beings? Because he requires too much work? Because losing his hearing ability is too much work for staff to communicate effectively with him? Because possibly they are too overworked to cater to one person's needs? Because perhaps they are not trained as to the core values one needs to work with a frail population?

So think about this family members, when you think Assisted Living is a panacea for mom or dad. This is a true story and one that has not been resolved. We are still working hard to provide resources for him to age in place while meeting his needs. And he will have a second opinion with a Board Certified neurologist who will do the proper testing to determine if this client deserves a diagnosis of Alzheimer's disease. Will update you when that happens, I promise.

Clinical Trials for a higher dose Exelon Patch

2011-04-08T16:31:00.001-05:00

Clinical Research Studies in the College of Medicine at Florida Atlantic University is currently enrolling patients with severe Alzheimer's disease for a study to investigate the safety and effectiveness of a higher dose of the Exelon Patch than is currently available by prescription.

Subjects are closely monitored by the study doctor. Eligible subjects will receive payment to offset any travel expenses.

To refer a patient, please ask the caregiver or responsible family member to call the Clinical Research Studies Department of the Charles E. Schmidt College of Medicine at Florida Atlantic University's Dept of Integrated Medical Science in Boca Raton at 561-297-0164.

10 Mountains 10 Years - Downtown Boca Film Festival, April 14 - 1pm Boca Museum of Art

2011-04-04T15:04:00.003-05:00

New posting below:

Backlight Productions would like to share information on a special Alzheimer's / Parkinson's Film screening in Boca Raton on April 14th. The Downtown Boca Film Festival will be showing "10 Mountains 10 Years", a documentary feature film chronicling the worldwide epic of an international team of mountain climbers who are climbing 10 mountains in a decade to raise awareness for Alzheimer's Disease and Parkinson's Disease, and the caregivers who care for loved ones battling these diseases. Ann Hathaway narrtes; Music contribution by Bruce Springsteen. A remarkable story that honors all caregivers in this world and also provides great support in the Alz and PD communities. At the Downtown Boca Film Festival, Thurs., April 14th at 1:00 pm at the Boca Raton Museum of Art, 501 Plaza REal, Boca Raton, Fl. 33432. Tickts may be purchased same day at venue or in advance by calling 877-733-3032.

2011-03-01T08:07:00.002-05:00

NAPA Becomes Law - Join The Cause

2011-01-05T14:09:00.002-05:00

Following the unanimous approval of Congress earlier this month, and the thousands of e-mails and messages of advocates sent to the White House last week, the Alzheimer's Association announces that today President Obama signed the National Alzheimer's Project Act (NAPA) into law. Once implemented, NAPA will ensure our nation has what Health and Human Services Secretary Kathleen Sebelius calls an "aggressive and coordinated national strategy" to confront the present and rapidly escalating Alzheimer crisis.
As you know, there is no time to waste.

Please continue to stand in the fight against Alzheimer's. This cannot succeed without you. And please ask others to join us in this effort. Every available voice will be needed to succeed. For more information go to the Alzheimer's Association website at: http://www.alz.org/join_the_cause_21243.asp?tr=y&auid=7585504

They Can't Go Home Again - Contention and heartache for aging parents

2010-12-12T20:38:00.002-05:00

I just finished reading a NY Times article which appeared on Dec 1st (The New Old Age blog) concerning adult children that have finally had it after years of painful relationships with their parents and just give up or decide to exploit in order to get even for a parent's perceived mistreatment. I am challenged by some long distance family members right now that have had such a long history of painful interactions with a parent that they have become obsessed to the extent of compulsively controlling every breathing, waking moment associated with their parent's care, relationships, outings, expenditures. Neither adult child is a power of attorney, the parent in question has no dementia diagnosis, yet the children go to an MD appointment with me and hand me a note with the word "dementia" written in quotes (at a cardiology visit). If they come into town for a visit, the criticize everything the parent does loudly and leave invariably after a bitter disagreement. I'm sad and I wish it were different because in my experience a person in their 80's is not who they were in their 50's. Although this behavior is old news to me and I realize that not everyone is meant to be a caregiver, I am at the point of offering them a mediator or counseling, or both as it takes hours of e-mails back and forth late at night and early mornings of every day and I am suffering from blackberry thumb burnout. If you'd like to go to the NY Times Blog, The New Old Age here's a link to the article: http://tinyurl.com/33apxkm

They are currently recommending 2 books which I think will make good holiday presents: Francine Russo's book, "They're Your Parents, Too." and "When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions" by Paula Span, author of the December 1, 2010 blog posted on The New Old Age, New York Times article described above.

How Families Can Challenge Ballooning Assisted Living Bills

2010-12-12T18:48:00.002-05:00

The following article appeared on December 7th's New York Times about effective methods families can use to challenge Assisted Living ever increasing, ballooning monthly bills. According to the article the most frequent cost increase used to cover rising expenses are made when the resident moves to the next level of care. That can be as a result of supervision with medications or diabetic injections, bathing or dressing help, incontinence issues, etc. But costs can also soar due to arbitrary decision-making from internal policies and may be challenged. While some of these increases may seem subjective and weighted in favor of the corporation, using a geriatric-care manager who has experience and reputation appealing these in-house assessments may help get some of these decisions reversed in favor of the many families struggling these days to keep mom or dad in a safe environment. To find a reputable geriatric care manager, go to www.caremanager.org and click on the link: Find a care manager. To read more go to: http://tinyurl.com/2923a5s

Home for the Holidays?

2010-11-10T13:57:00.007-05:00

At this time of the year, when we are preparing to visit our seniors here in South Florida for the holidays, I'd like to remind family members to take extra notice of obvious physical or mental changes since your last visit. Is there evidence of excessive spending, unpaid bills, unkempt household or personal hygiene? Is there an unusual volume of mail and solicitations for charities that you are not familiar with? Are there new "best friends" that you have not met? Eventually, most of your elder parents will either need a caregiver or a care manager. Few family members plan to handle caregiving responsibilities until an emergency arises. If you have questions about long term care for your loved one, consult with a professional who can help you do what is best. A Geriatric Care Manager will assess and plan ahead for your family member's needs. What's best, care managers are on call for emergencies 24/7 - a very worthwhile service to faraway family members. A Good Daughter Elder Care Management provides appropriate, professional care with heart and soul. If interested, ask for a complimentary meet and greet at our office or in your parent's home. See us on the web at http://www.agooddaughter.com

Tips that Might Explain Why Your Parent Is Falling

2010-11-08T15:41:00.005-05:00

If you have elderly parents who may be having repeated falls and you are apprehensive about what to do to help mom or dad stop falling, you might look into some of these reasons:

Changes in Our Body
Some of the reasons seniors tend to fall more often are changes in vision, lack of flexibility, less muscle strength, especially in our legs, and changes in sleep patterns. It is important to have an eye examination every year and wear the glasses as prescribed by the eye doctor. Exercise on a regular basis can increase muscle strength and flexibility and improve balance. Regular exercise will help you sleep better as well. Also remember to check your parent's glasses to see if they are broken due to a past fall. Perhaps it is time to have their glasses repaired or replaced.

Chronic Health Conditions
High blood pressure and heart problems can cause dizziness that can lead to falls. Remember to get up from a laying down position slowly if you have heart problems or high blood pressure. Many elders fall while trying to make a run for the restroom because of difficulty controlling the bladder. Talk to your doctor about what can be done for this condition. This will help reduce your risk of falling. Check to see if mom or dad have had recent lab work. Perhaps they have low or high blood sugar. Speak with your parents about their eating habits. Often the elderly will only eat when they are hungry. Guess what, the elderly seldom get hungry.

Medications
Both prescription medications and over the counter medications can cause side effects such as dizziness or drowsiness. Talk to your nurse, physician, or pharmacist about the side effects to expect from your medication. If the side effects continue, talk to your physician about changing the medication. Make sure if you see more than one physician that each one knows ALL the drugs you’re taking. Take all of your medications, including over the counter medications with you each time you visit the doctor. This way the doctors will be able to see exactly what you’re taking and how much. Speak with the doctor about prescribed medications your parents are not taking. Often times, more than one medication is prescribed and the elder parent might think, "I don't really need to take both of the blood pressure medications". Speak with the doctor if you've noticed certain medications are not being taken or if they are not taking medications on time. Maintaining their medications are given in a way to maintain healthy blood levels may be necessary. Tell the doctor if they are being taken sporadically. Today, there are automatic medication dispensers that will give your parent audible prompts to remind them it is time to take their medications.

Pooled and Special Needs Trusts

2010-11-05T07:23:00.001-05:00

This morning's New York Times article describes a little known way for some people in certain states to receive home care through Medicaid without requiring them to impoverish themselves first. Here is how it works..

In 1993 Congress created the Pooled trust to protect this country's most vulnerable and disenfranchised segment of our citizens - the elderly and disabled. Through non-profit organizations who have a Pooled Trust, individuals who meet the definition of disabled under the rules of Social Security to place their assets in the trust, can still meet financial eligibility for Medicaid and Supplemental Security income. The funds are pooled for investments but separately accounted for throughout the individuals life. The funds can be used to enrich the quality of life of the participant instead of being quickly consumed by catastrophic medical an Long term costs.

Individuals may benefit from a Pooled trust if:

Disabled in need of long term nursing care care at home or in a facility.
Over the age of 65, or any age with funds from a medical malpractice, personal injury, or workers compensation claim, or receiving an inheritance.
Need or receive Medicaid, Social Security Disability or SSI (Supplemental security income).

This Pooled Trust enables some people in certain states to receive home care through Medicaid, without requiring them to impoverish themselves first. Essentially, this law allows disabled persons to put their monthly income or assets - above the amounts Medicaid allows them to keep - into a special type of pooled trust. They Can use the money in the trust to pay for their basic monthly bills like rent, a mortgage payment or cable TV bills. Medicaid in the meanwhile will pay for their home care.

Monies left in the trust after the person dies is generally kept by the nonprofit organization running the trust or is paid back to Medicaid.

As the New York Times article states, these trusts are available only in about a dozen states for people over the age of 65. Please remember that the rules governing Medicaid are intricate and differ in each state, so while you may be able to keep a loved one home in New York State under Medicaid, that may not be true in other states. But with a Pooled Trust, each month, the participant who has been deemed disabled can deposit her or his excess income into the trust to pay the person's bills as long as the expense is for the sole benefit of the participant. The nature of the trust is to supplement needs that are not met by government programs.

The trusts work particularly well for those who have few assets, but may own a home. Many states however, do not allow persons over 65 to use the pooled trusts at all because they have interpreted the federal laws differently and some states have started to impose penalties on people over 65 so speak with an elder law attorney (http://www.naela.org/) or speak with a Geriatric Care Manager (http://www.napgcm.org/) about long term care planning and to find out more.

Putting seniors in jail and criminals into nursing homes

2010-11-04T20:12:00.001-05:00

Food for thought : Let's put Seniors in jail and Criminals in nursing homes! This way, the seniors would have access to showers, hobbies and walks. They would receive unlimited free prescriptions, dental and medical treatment, wheel chairs, etc. They would receive money instead of paying it out. They would have constant video monitoring, so they could be helped instantly if they fell or needed assistance. Bedding would be washed twice a week, all clothing would be ironed and returned to them. A guard would check on them every 20 minutes and bring their meals and snacks to their cell. They would have family visits in a suite built for that purpose. They would have access to a library, weight room, spiritual counseling, pool and education. Simple clothing, shoes, slippers, pajamas and legal aid would be provided free. Private, secure rooms for all with an outdoor exercise yard with gardens. Each senior could have access to a computer, TV, radio and daily phone calls. There would be a board of directors to hear complaints and the guards would have a code of conduct that would be strictly adhered to.--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------The "Criminals" would get cold food, be left all alone and unsupervised. Lights would be turned off at 8:00 PM and showers would be taken once a week. They would share a tiny room, pay $3500.00 per month and pay for all their clothes, supplies, medical and dental services, and have no hope of ever getting out.

This should make us think of what kind of world we have created for ourselves.

Preparing a Parent With Dementia to Move to Assisted Living

2010-10-23T11:35:00.010-05:00

I received an email yesterday from an out of town daughter wanting to know if discussing the move to Assisted Living with mom and discussing the fact she has Alzheimer's should be started even though a discussion about Alzheimer's has upset her in the past.

My response is this. A discussion such as this is not going to be easy and mom is going to be upset. I would never do it over the phone, but certainly as this is going to be a life changing event, you do need to remind her that she has an Alzheimer’s Related dementia disorder and your job as her power of attorney is to keep her safe. Actually, I am sure her mother already realizes her cognitive changes. I bet it already makes her nervous. This has got to be the most difficult time in her life and I am very sensitive to the family's needs as they undertake this challenge. I won’t pretend that it is going to be easy for the parent or the family members. But just keep in mind that persons with a diagnosis of dementia are protected such as young children are by the State. The authorities take their safety issues quite seriously and have enacted laws to ensure safety. Whether they are placed in a community setting, are cared for at home with 24 hour caregivers, or go to a nursing home when the decline is progressing, a parent should be made aware that because of wandering, cooking, and driving issues, they will no longer be able to live independently. Although a parent may get angry at you, or may get very emotional, I believe they should be told what the plans are and and why.

I have worked with other adult family members who have lied to their parents out of guilt,not having had warm relations in the past, or out of avoidance of this discussion. They have told a parent that it is only going to be a temporarily thing – much like going to camp for the summer while their condo is undergoing renovation. While that provides a sense of relief for the adult child, it is disastrous for the parent. This approach doesn’t serve a parent with dementia well because they will not forget what families have promised. When a couple of months go by and they are still living in assisted living, they get really angry and become belligerent with staff – ultimately needing to have private caregivers in addition to costs of providing care at the ALF. It doesn’t serve the parent and they feel betrayed. The one thing about Alzheimer’s I haven’t been able to figure out is why persons with this disease NEVER FORGET a memory that is tied to a great emotional experience!

Although this is an emotional experience, honesty is ultimately the best policy. Enlist the help of the facility you are considering. They have many years experience in this arena. Allow a parent to process the need for safety. Don’t use the word facility and do use the word "Community" instead. And if a parent refuses to move, then you may need to enlist the help of the courts through guardianship - always an expensive proposition.

As carer for my mother 13 years ago I also crossed this path and made the difficult choices for my mother's safety as she wandered and couldn't find her way back home one day. If any of you have gone through this journey and would like to share your comments, please do so by checking the comments link below.

At A Good Daughter offices we run a dementia support group free of charge for family caregivers on the 3rd Wednesday of every month between 5:30 pm and 7:30 pm. Please RSVP to olga@agooddaughter.com to sign up.

About Bonnie - The face of dementia

2010-10-23T10:11:00.000-05:00

Max Wallack, A Remarkable Young Man

2010-10-22T11:53:00.002-05:00

I just received a box with a donation of puzzles from "Puzzles To Remember", the brainchild of a young man whose great grandmother died of Alzheimer's in 2007. As another person affected personally when my mother died with this disease in 2003, I understand how this disease changes caregivers forever. Now, more on Max.......

Below is his mission, as posted on his website: http://www.puzzlestoremember.org/

"PUZZLES TO REMEMBER is a project that provides puzzles to nursing homes and other institutions that care for Alzheimer's patients.

WHY THIS APPROACH?

Other programs raise money for research, which is an important long-range goal. Our approach is to benefit Alzheimer's patients more immediately by providing activities that will bring them pleasure while also slowing down the progression of the disease. Instead of focusing on far-off goals, our approach will realize a more immediate benefit to today's patients.

Studies have shown that working puzzles is a form of mental activity that not only engages and stimulates Alzheimer's patients, it also slows down the progression of the disease and thus provides important salutary benefits.

This is very important for patients in the early stages of the disease, including those who have not yet been diagnosed. For these people, the working of puzzles and similar mental activities can significantly postpone the onset of symptoms or avoid these symptoms altogether. Painting and other forms of artistic and creative expression also have strong, beneficial effects, and often result in improvement in overall brain function."

All I know is that when these puzzles get distributed to our Alzheimer's clients, there will be a lot of very smiling faces because as I've learned, seniors love puzzles. As a former Activities Director in a nursing home, I realized early on that puzzle-making is something cognitively impaired individuals can continue to work on and feel a sense of accomplishment when it's done!

To help Max in his continued pursuit of suppling these puzzles, you may go directly to the "DONATE" button at the top of his web page to make a contribution. Or if you'd like to send a contribution of your new or gently used puzzles they would also be put to good use. What a remarkable young man and what a great program! http://puzzlestoremember.org/

What to do if you are ALF Shopping and a Parent Smokes

2010-10-19T10:53:00.003-05:00

I have an Alzheimer's client whose caregiver informed me recently that she found 2 packs of cigarettes in the client's bedroom recently and that on occasion she smells cigarette smoke on arriving some mornings. The family members are in the process of touring assisted living facilities for mom but don't know if they should divulge that information to the facilities they are touring. Recently they informed me of a recent decline in activity that was noticed and it prompted me to address the smoking issue. In realizing that this may be an issue with other family caregivers I'd like to share my experience in long term care administration and the regulations that govern these facilities. I'd also like to invite any comments you may have.

On the smoking issue, Assisted Living Facilities are not mandated to accept a resident if they are a smoker. Nursing homes do, but Alf's adhere to different scrutiny by the Fire Administrative Code that dictates each incoming resident meet a capability assessment. If they admit a smoker it decreases their numbers which they of course want to keep high enough to pass the regulations. This is part of the reason you don’t see people in wheelchairs in a standard license ALF. Someone coming into the facility in a wheelchair puts them at greater liability with this assessment. If they admit a known smoker, they may require that the family hire a 24/7 caregiver to keep an eye on the resident to help prevent a smoker from setting the facility on fire.

What can you do? I would not withhold the information from facilities you will be touring. I encourage families discuss any reported smoking when touring to find out how each facility deals with this issue. Remember, residents will always find a way to get cigarettes from other visitors, staff, or other residents in exchange for money or other favors. You don’t want to know some of the bribes I’ve seen. Perhaps family members should enter into this discussion with their loved one as to why he/she is smoking, but I would reserve this conversation for any future visits. Perhaps if mom or dad really wants to live in an ALF in Florida, you can help the prospective resident understand that this will not be possible as a smoker.

And definitely, if your parent has a special relationship with his or her doctor, I would elicit the primary care provider's help with this.

What do you think? Have you had to face this issue with a family member? Let me know your thoughts.

New Senior Scam Alert

2010-10-13T15:51:00.001-05:00

This just in from the Centers for Medicare and Medicaid Services
26 Federal Plaza, Rm. 3811
New York, N.Y. 10278
phone: 212-616-2515
fax: 212-264-6189

Fraudsters are targeting seniors in Burlington, NC, Kalamazoo, MI, and possibly elsewhere through phone calls in an attempt to obtain their Medicare ID numbers. In Michigan, the callers, who identify themselves as being from E-Medicare, are offering new diabetes monitoring equipment.

Several seniors in North Carolina contacted the sheriff's department to report that they received phone calls with the caller offering free medication in exchange for their Medicare ID number.

Seniors should not provide their personal information to unsolicited callers and are encouraged to report suspicious calls. Please inform those seniors whom you work with and your loved ones.

Gail Sheehy's New Book on Caregiving on the Diane Rehm Show

2010-10-11T11:36:00.004-05:00

The Diane Rehm Show

More than 50 million Americans are caring for a spouse, parent or relative who has a serious illness. Author and journalist Gail Sheehy identifies eight crucial stages of caregiving, drawing on her experience caring for her husband, founder and editor of "New York" magazine Clay Felker.

As I frequently find, the act of caring for a family member very often changes the principal family caregiver forever. In her book, "Passages in Caregiving - Turning Chaos into Confidence" Gail Sheehy very carefully advocates how to bring the entire family together early in the caregiving process -- before the crisis -- with a mediator to openly discuss and advocates sharing with siblings the myriad of duties necessary to care for a parent or a loved one at home for as long as possible.

Gail Sheehy, the bestselling author of 16 books, including Passages, has changed the way millions of women and men around the world look at the stages of their lives. Now, she takes on the most challenging and personal issue as she tells the inspiring story of her own journey of 17 years caring for her husband and fills the book with stories of families who we can all relate to, and their most creative strategies.

In Gail Sheehy's interview with Diane Rehm of NPR Radio, she advocates that family members obtain the services of a Geriatric Care Manager whom she sees as an invaluable asset in organizing care in the household and following up in a crisis when family members are located out of town. For more information on obtaining the services of a geriatric care manager go to the National Association of Professional Geriatric Care Managers.

To listen to this podcast go to:
http://thedianerehmshow.org/audio-player?nid=12462

Every Day I Cry - Story Two in the Dementia Series

2010-10-09T15:23:00.010-05:00

Mary was such a joy. She became a client in 2007 when her out of town family realized she was having word finding problems, noticed when they spoke with her over the phone each week from Nevada. I will never forget my first visit to her home and how amazed I was at her accomplishments as an artist! Not only was she a joy to be around I was impressed with how humble and gracious a lady she was and her incessant drive to improve her memory and speech problems. At one point she had me take her to a well known speech therapist in the community three times a week for "homework". She was a diligent student and practiced doing her assignments without fail each week.

Although, in the early stages of Alzheimer's, she lived in a community which supported her drive to exercise, play golf, swim, and continue painting. My role was to assist her to live independently, follow up with periodic visits to her medical providers, check her medications management which she was still doing without help. In my overall assessment, I could see she had a pretty good quality of life, helpful neighbors, and in no apparent danger except for a heart murmur for which she took medication.

All was well in Mary's life until she ran to pickup the phone one day, fell and fractured a hip. You know the rest, she had surgery and her family flew out to see her. During her hospital stay, she expressed her desire to live longer than her mother's age at her death, 83. But Mary surprised everyone and made a remarkable recovery with the rehabilitation process, going home in a couple of weeks with assistance. Unfortunately, confusion and behavior problems set in while at home and she resisted the help of caregivers cooking, grooming, bill paying, and most of all driving. She finally sold her car and traded it for a golf cart so that she could still go to the putting green.

But tragedy struck when her power of attorney arrived, cognizant of Mary's athleticism and worried that she just might outlive her resources. This adult child discontinued her heart medication without dignity and placed her on hospice where her life suddenly stopped. So much for Honor Thy Father and Thy Mother. As this family member stated in a shocking email, she was a lot closer to her father anyway! Mary died at age 85, sketching the above during an art session at a local memory day care center and she enriched my life.

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Every Day I Cry - Short Stories on Dementia Care

2010-10-08T15:25:00.007-05:00

Alright I understand that I haven't been writing much lately I have often toyed with the idea of completing the book I once started -- once or twice. Today, however, I feel compelled to pick up the pieces of a story I wish to tell and begin the process all over again. You see, the impetus came from a visit I once had by a Palm Beach Sheriff's detective, investigating certain allegations against caregivers hired by a client. I am not at liberty of using the actual names of those involved but I long to put pen to paper and perhaps by doing this, will release the vast emotions I feel as advocate to a client who was so horribly wronged by a family member, so here goes.

Whatever happened to the commandment, "Honor Thy Father and Thy Mother?" Detective Allen arrived promptly at 1pm today. We exchanged cards and sat for the interview regarding the allegations by Lisa concerning theft by her father's caregivers. I answered her questions as to when I started to work with my clients, what my role was; questions about the care giving duties of the 2 girls in question. She asked me about my client's mental capacity with respect to his ability to manage his financial affairs. I explained that although he may have overpaid me once or twice and I immediately returned his check and he issued a new one, my client was keenly aware of his finances. In fact as I explained to the detective, each month when I invoiced him, he paid only the dollar amount (never paid the cents) rounded down to the lower dollar amount especially when the change amount was over 50 cents. He always knew exactly what he was doing and enjoyed doing it. The detective laughed and said this was very telling as to his mental capacity. Although I am not a suspect, I was asked the last time I saw my clients and I was happy to explain the circumstances that led to my resignation and why.  You must understand this was not meant to be a witch hunt I was just interested in telling the truth as documented in my notes - and I keep very detailed notes. As a former nursing home administrator, I was trained to believe that "if you don't write it, it didn't happen".

There, I blurted it out, "I don't believe the girls stole anything from my client". I explained what I observed on a visit to the bank with my client that last day.  I was asked where the caregiver was at the time, and I said: "The caregiver sat in the waiting room while my client spoke with the manager in a cubicle".
I explained that the daughter phoned and had been abrasive with the branch manager and how the operations manager had to get involved. I explained how much money my client was disbursed in cash. I explained how he reimbursed the caregiver some money she had laid out at the grocery store, and watched as he put the rest in two bank envelopes, placing them in his pocket. I explained how I got the call later that night at 6pm from my client (who was getting a treatment) stating he wanted me to pick him up and to take him home because his daughter was "out of her mind and fired his girls".

Why was I being asked if he had called me on his cell phone or another line? After all I was not a suspect or one of the accused.  I explained: "He used his cell phone". I explained what happened when we returned to the apartment and how this family member abused me and both her parents. I explained how she completely wiped out my client's contact list from his phone and what was said when I objected to this action. But the one thing I will never forget is how my client's wife who had dementia, cried when she heard the girls had been removed from the home. She shouted: "I want my parent, please bring me my parents!" It was so hurtful to know that these women - caregivers, who had lovingly cared for this regal lady, taking care of all of her personal needs, were seen by her as her parents.

I remarked to the sheriff how after my client went to bed, the daughter went through her dad's locked desk drawer, removing all financial contents: credit cards, checks, remaining cash (from the banking transaction), keys to the car.  I told her that I refused to leave the home until the daughter left. We left together at 9:30 pm.

To my relief and amazement, the detective said the daughter would now be investigated because of her direct access to her parent's assets and how some adult children with power of attorney mistakenly think they have complete control over their parent's decision making before declaring them incapacitated in a court of law.  I explained how after I witnessed her remove the $7000 from her father’s desk drawer, she then blamed another caregiver of having taken the money in front of her father that same weekend. The PBSO detective then made the usual statement -- to contact him if something was remembered later that I may have forgotten, and left. All in a day's work of the care manager!

To be continued.......

Looking for the right person to help relocate your parent's home?

2010-08-27T17:35:00.007-05:00

Olga Brunner has recently been awarded the designation of Certified Relocation and Transition Specialist™ (CRTS™). As principal with A Good Daughter, Inc. her elder care management company specializes in assisting the senior market with elder care management and now will also serve her clients who need help with home downsizing and moving to retirement home living. A CRTS™ is qualified to act as an agent to seniors and their families faced with the overwhelming task of scaling down a home for a move to a senior community. A CRTS™ also works with housing administrators and provides a full menu of services to assist clients with everything from space planning, home organization and allocation of possessions to sale, charity, donation and more. CRTS™ professionals manage all aspects of a relocation right down to packing, unpacking and helping to identify all business resources required for each home transition. Brunner is dedicated to the standards, principals and practices of this accreditation and the many benefits this much needed service will bring to her her clients.

Olga Brunner is a Geriatric Care Manager, Certified (CMC), receiving her certification in 2007. She uses her background in nursing home administration and social services helping seniors with multiple issues such as elder care assessment and care planning, crisis intervention, advocacy with medical professionals, medications management, bill paying etc. Olga's life experiences include a Master of Science degree in Gerontology and Health Care Administration from Lynn University in Boca Raton, Florida. She has worked in social services as an Activity Director and as an Assistant Nursing Home Administrator and has also taught classes for the Department of Elder Affairs preparing those interested in taking the licensing exam for Assisted Living Administrator.

Her company has been featured in several publications, including Palm Beach Post, The South Florida Business Journal, and was recently featured on the PBS Nightly Business Report for their segment on "Careers for the Next Decade - Patient Advocates". Olga Brunner can be reached at 561-392-3574 or seen on the internet at www.organizingmoves.com and also at www.agooddaughter.com

Elder Care Management Agency Adds Senior Move Management Services

2010-08-19T17:16:00.000-05:00

August, 19, 2010, Boca Raton, Florida. Olga Brunner, a Certified Geriatric Care Manager, has added senior move management to the many services offered as President and Founder of A Good Daughter Elder Care Management based in Boca Raton, Florida. As Brunner states, “Throughout my care management experience, I have helped clients with many issues affecting their health. One of the most stressful and anxiety-producing issues found working with seniors and their families is de-cluttering, organizing, and simplifying their lives as clients downsize to move to Assisted Living”. Brunner uses her background in nursing home administration and social services to help seniors downsize and relocate. Her expertise with Alzheimer’s related dementias as an approved trainer with the Department of Elder Affairs enables her to answer questions such as: Mom who has Alzheimer’s has lived in a very large house for the past 50 years. In a recent visit I found she was hoarding. Her home is now more like a museum than a home. Where do I start?
Brunner is a member of the National Association of Professional Geriatric Care Managers (NAPGCM) and was recently nominated for a board position with the Florida Chapter of Professional Geriatric Care Managers (FGCMA). Her company has been featured in several local publications, including the Palm Beach Post, and the South Florida Business Journal. She writes a regular column for the Alzheimer’s Reading Room and was recently featured by the PBS “Nightly Business Report” for their segment, “Careers for the Next Decade”.

Besides organizing senior moves, other services offered by A Good Daughter, Inc. are elder care assessment and planning, crisis intervention for the elderly, bill paying and insurance filing, long term care consulting, estate liquidation and home sale, assistance with home health care services, medical bill reviews, assistance with Medicaid and Medicare issues, assistance with aging services, residential placement advocacy, assisted living and nursing home supervision, service of an expert witness, relocation services, medications management, hurricane planning, caregiver supervision, and advocacy at medical appointments for the cognitively impaired senior. A Good Daughter Elder Care Management is located in Boca Raton, Florida. For more, information visit: www.AGoodDaughter.com or www.OrganizingMoves.com. You may contact Olga Brunner at: 561-392-3574 or e-mail: olga@agooddaughter.com.

Independent Panel Finds Lack of Evidence for Ways to Prevent Alzheimer's Disease

2010-04-30T18:42:00.000-05:00

According to an independent panel commissioned by the National Institutes of Health (NIH) this week, the following consensus is something I've been hearing much of lately. Simply put, there is nothing new on the Alzheimer's horizon and the focus will now change on caregiving issues. See below for more:

An independent panel commissioned by the National Institutes of Health (NIH) this week determined that modifiable factors, including mental stimulation, exercise and dietary supplements, have not been shown to delay the onset and/or reduce the severity of cognitive decline or Alzheimer's disease. The panel made its statement at the conclusion of the NIH State-of-the-Science Conference: Preventing Alzheimer's Disease and Cognitive Decline after reviewing available evidence from literature, expert presentations and audience input.
"We wish we could tell people that taking a pill or doing a puzzle every day would prevent this terrible disease, but current evidence doesn't support
this," concluded Martha L. Daviglus, M.D., Ph.D., conference panel chair and professor of preventive medicine at Northwestern University, Chicago.
According to the panel, limited progress to understand how to delay or prevent these conditions stems from the lack of a consistent definition of what constitutes Alzheimer's disease and cognitive decline, an incomplete understanding of the natural history of the disease, and limited understanding of the aging process in general.
While the panel found that there currently is no evidence of "even moderate scientific quality" supporting any modifiable factors such as supplement intake, use of prescription or non-prescription drugs, diet, exercise or social engagement as way to reduce an individual's risk for Alzheimer's disease, and "low-grade" evidence showing weak associations between many lifestyle choices and reduced risk, it said that some of these interventions "are not necessarily harmful and may confer other benefits."
Richard E. Powers, M.D., chairman of AFA's Medical Advisory Board, called the process "thoughtful, balanced and inconclusive."
"While the panel determined that the published data is not adequate to tell Americans that engaging in certain activities will prevent or reduce the risk for dementia, it was careful to avoid any message that suggested individuals should abandon good health habits such as exercise, weight control or management of hypertension.
AFA's message remains unchanged: Americans should embrace health behaviors that have multiple other proven health benefits," he said.
In addition, Powers said, "It is clear that preventions and possible cures for dementia are unlikely to occur in the near future. The nation must prepare for a decade of care and expand the focus on caregiver issues while we increase the investment in dementia research."

How Painting Helps The Alzheimer's Brain

2010-01-27T12:19:00.000-05:00

Four Stages of Resolution for Alzheimer's

2009-11-10T16:51:00.002-05:00

This video was made possible by a grant obtained by Naomi Feil who deals with the four phases of resolution in Alzheimer's disease. Naomi is the founder of the Validation Method of dealing with disoriented elderly....It may be a bit graphic but the part of the Alzheimer's patient is actually Naomi Feil role playing the part. For help with a parent who has dementia, contact a geriatric care manager who can help identify the right resources in your own community.

Should Hospice Patients Get the Seasonal Flu Vaccine?

2009-10-19T14:23:00.002-05:00

This just posted by Angela Morrow, R.N., www.About.com a wonderful resource to learn about Palliative Care. Many Hospice and Palliative Care patients need flu vaccines perhaps more than any other group of people.

The CDC recommends that the following people get annual flu shots:

Children 6 months to 18 years of age
Adults over 50
Anyone living in a nursing home assisted-living facility, rehab facility
Anyone with a weakened immune system
People who have frequent contact with the general public (health care, teachers, police, etc)
Pregnant women
Anyone with a chronic medical condition
Caregivers, family members, friends of individuals that are at high risk.

Because Hospice and Palliative care patients are often over 50 years old, have chronic medical conditions and weakened immune systems, and may live in long term care facilities, this makes Hospice and Palliative care patients very high risk for contracting the flu virus. The risk of death from the flu is increased in people whose immune system cannot effectively combat the illness. Therefore it's very important for Hospice and Palliative care patients, their caregivers, and their loved ones to get the seasonal flu vaccine.

Who should not get the Seasonal Flu Vaccine?

Those with allergies to eggs
Anyone who's had a previous adverse reaction to a flu vaccine
Anyone with a current infection or fever
Those with a history of Guillain-Barre Syndrome
Infants under six months old.

Remember, normal reactions to the flu shot include redness, tenderness, and swelling at the injection site. It is also normal to experience a low-grade fever (under 101) and decreased energey.

Not normal reactions include:

Dizziness, high fever, disorientation, difficulty breathing or wheezing, rapid heartbeat.
If you experience any abnormal reactions, contact your health care provider.

Share your comments here.

H1N1 Vaccine Guidelines

2009-10-08T08:38:00.005-05:00

October 08,2009.....Just released today by Dr. Steven Chang of the Daily Dose column, the World Health Organization just reported the number of cases of H1N1 influenza has increased by at least 24,000 in just the past two weeks. With the new H1N1 vaccine just recently being distributed to the public, the CDC (Center for Disease Control) is reaffirming the current vaccination guidelines. The groups most at risk, and therefore should be vaccinated are:

Pregnant women

People who live with or care for chidren yonger than 6 months of age

Health care and emergency medical services personnel

Persons between the ages of 6 months through 24 years of age

People from ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems

Also to be noted is that the H1N1 vaccine is not intended to replace the seasonal flu vaccine. The seasonal flu and H1N1 vaccines may be administered on the same day.
Please share your comments here.

Demystifying "ObamaCare"

2009-09-30T18:01:00.001-05:00

With uncertainties surrounding the health care reform bill and with the Medicare Annual Enrollment date approaching November 15th, you might feel like you have more questions than answers. Until a health care reform bill is passed, it is uncertain how the final product will affect Medicare, but here’s what we do know:

The Future of Medicare Advantage
Don’t be overwhelmed by some of the proposals to reduce Medicare Advantage reimbursements. While there may be changes to MA plans down the road, the 1997 Balanced Budget Act includes a provision assuring Medicare beneficiaries a smooth and uninterrupted transition in their healthcare coverage should Congress mandate any program changes in the future.

Separate Fact from Rumor
Many senior citizens have been deeply upset set regarding the end-of-life counseling proposed as part of the Obama health care reform. This voluntary counseling has proved extremely controversial and may not be part of a final reform package. Currently there is no legislation to make the end-of-life counseling mandatory and seniors are increasingly making their opinions on the subject known to their elected representatives.

Decreasing the “Doughnut Hole”
The “Doughnut Hole” is reached when the full retail cost of covered medication purchased for a Medicare beneficiary exceeds $2,700 during one year. At this point, beneficiaries are forced to pay 100% of drug costs during this calendar year until they have surpassed $4,350 in covered out-of-pocket drug expenses or a new calendar year begins. Some health care reform proposals would gradually close the gap of this “doughnut hole” with a 50 percent price cut for brand-name drugs if a Medicare patient reaches the donut hole in coverage.

A Focus on Preventative Care
The proposals by Senator Max Baucus and others call for expanded preventative care benefits, including a free annual wellness visit for Medicare recipients. As stated in The Wall Street Journal article “Q&A: How Baucus’s Health Bill Would Impact Consumers”, Medicare beneficiaries also would not pay out-of-pocket fees for recommended services. Some proponents of health care reform have suggested instating a new Medicare commission that would control costs, but rest assured – they would not be allowed to change eligibility or benefits.

It is hard to say what will be in the final bill, but for now the best thing you can do is stay informed and let your representative know what your opinions are.

This article, was written by Jenny Rose of PlanPrescriber at 800-819-6906

Anxiety Disorders

2009-09-25T18:31:00.008-05:00

Many of us have suffered from anxiety from time to time due to the pressures we may experience, managing family and professional lives so we understand that anxiety disorders are fairly common. But there are some anxiety disorders that can give symptoms which are intense and create a painful experience of anxiety, often accompanied by feelings of guilt or worthlessness. The person with this type of anxiety disorder typically feels nervous and afraid, and may appear frightened or terrified for no apparent or logical reason. Persons with these disorders may try to defend against the anxiety by denying, rejecting, fixating or repeating behaviors. One of my elderly clients just recently went through a combination of depression and anxiety disorders right after the passing of her spouse of 60 years. She cancelled every appointment both socially and professionally. Her neighbors finally decided to take matters in their own hands and contacted me for help when she began experiencing physical symptoms such as trouble breathing, headaches, bowel distress, stomach upset, and insomnia. But hyperactivity, fatigue, trembling, palpitations and dizziness may also be experienced. Individuals with anxiety disorders may additionally experience flushes or chills, sweating, frequent urination, and / or sleep problems.

Anxiety disorders include conditions such as panic attacks, obsessive-compulsive disorder (OCD), post-traumatic stress disorder, and generalized anxiety disorder, as well as general and specific phobias. When a person has a panic attack, he/she experiences intense fearfulness and terror which is often associated with feelings of impending doom.

We've all seen the Monk TV show (left) which depicts the recurrent obsessions of this detective character which are intrusive and cause distress to his co-workers. The person with OCD may respond to such compulsions aimed at either preventing an event or situation, or directly in response to the obsessive thoughts. For example, a person may have intrusive thoughts or images about whether or not he/she has locked all the windows and doors in the house. In response to these thoughts, the person gets up hourly during the night to check all the windows and doors.

Post-Traumatic Stress Disorders (PTSD) follow psychologically disturbing events that are beyond the usual human experience. Veterans of combat and victims of childhood sexual abuse often experience this type of disorder. This disorder typically creates intense fear, helplessness, avoidance of reminders of the event, and increased arousal. Individuals with PTSD may have difficulty falling asleep, may re-experience the event (flashbacks), or have recurring nightmares, and often maintain a state of watchfulness. They may also startle easily and unexpectedly. In addition, they may have difficulty concentrating and often become depressed.

Someone with a generalized anxiety disorder may experience persistent and excessive anxiety and can worry about a number of events for at least six months. Minor tranquilizers often are used to help reduce anxiety, agitation, aggression, and hyperactivity associated with anxiety disorders. Several practical techniques may be also used to help reduce anxiety such as: providing a calm and quiet environment where a person can go and sit quietly, listen to music or relaxation tapes; establishing daily routines that are structured as much as possible, scheduled every day at the same time to alleviate some of the anxiety; using non-threatening affirmations of worth or recognition of positive personality traits or accomplishments; acknowledging fears or anxieties experienced and never dismissing them as "silly" or unsubstantiated; and using activities to divert attention. Soothing music or massage may reduce a person's fears and anxiety. Others may benefit from involvement in a focused activity such as gardening or arts and crafts. Yoga and deep breathing exercises are also helpful as well as participating in insight and/or behavior therapy modes. In my client's case, we formed a team, collaborating with the psychiatrist, psychotherapist, medical doctor, and care manager to match competent, compassionate and professional caregivers to the client's personality. Once the right medication was prescribed and with good nutrition and counseling, she rejoined her neighbors in daily activities. Sometimes it just takes a village.

More Than 35 Million People Have Alzheimer's - World Alzheimer's Report

2009-09-23T13:02:00.002-05:00

According to a press release issued two days ago by Alzheimer's Disease International (ADI), a London-based, nonprofit, international federation of 71 national Alzheimer organizations, more than 35 million people worldwide will have dementia in 2010. This report was released on World Alzheimer's Day to raise awareness for this disease that will have a dramatic impact on individuals and healthcare systems globally. Methadology used to prepare the 2009 World Alzheimer's Report is explained in the full printed report and can be found online at: http://www.alz.co.uk/worldreport

The report contains eight recommendations for the World Health Organization and national governments. The research shows that the number of people with Alzheimer's and other dementias is rising substantially worldwide and that the impact on families, governments, and national health care systems will be immense. Following are their recommendations:

The World Health Organization (WHO) should declare dementia a world health priority.
National governments should declare dementia a health priority and develop national strategies to provide services and support for people with dementoia and their families.
Low and medium income countries should create dementia strategies based first on enhancing primary healthcare and other community services.
High income countries should develop national dementia action plans with designated resource allocations.
Develop services that reflect the progressive nature of dementia.
Distribute services with the core principle of maximizing coverage and ensuring equity of access, to benefit people with dementia regardless of age, gender, wealth, disability, and rural or urban residence.
Create collaboration between governments, people with dementia, their caregivers and their Alzheimer Associations, and other relevant Non-Governmental Organizations and professional healthcare bodies.
More research needs to be funded and conducted into the causes of Alzheimer's disease and other dementias, pharmacological and psychosocial treatments, the prevalence and impact of dementia, and the prevention of dementia.

Examining Bipolar Disorder

2009-09-23T11:27:00.004-05:00

LaFave: I don't want to blur the lines between doing something as heinous as what I did, and being bipolar. But, yes, symptoms of bipolar [disorder] definitely contributed to my mind frame. These were her words during the Sept 12, 2006 exclusive interview by Matt Lauer on the Today Show regarding a 2004 criminal case making Debra LaFave one of the most infamous school teachers in America after a sexual affair with her 14 year old student in Florida.

Bipolar disorder (formerly called manic-depression) is an affective disorder which involves alternating mood swings of depression and mania. A person with bipolar disorder experiences episodes of mania and depression, usually with periods of relative stability in between. The symptoms of this disorder may range from very mild to severe. Some of these symptoms are depressive episodes very similar to those found in clinical depression. The difference is that depressive episodes alternate with manic episodes separated by intervals of relatively normal behavior. In the manic periods, a person's mood is elevated or irritable. Manic periods may begin suddenly, and involve an increase in talkativeness and activity and a decreased need for sleep. A person may be able to get by with only a few hours of sleep or go days without sleep (without loss of energy). Another symptom you may encounter is the person's speech may become loud, rapid and difficult to interrupt.

Mania often involves occasional outbursts of irritability, particularly in disagreements with others. Someone who is in the manic phase may experience an inflated sense of self esteem or grandiosity, and tends to engage in activities that have a high potential for risk or undesirable consequences (for example, shopping sprees, extreme exercise, sexual indiscretions, and/or reckless driving. Knowing that, would you agree that behind her good looks, Debra LaFave was a deeply troubled woman suffering from bipolar disorder, or was it a too convenient excuse used in court systems these days?

Lithium carbonate is one of the most commonly used medications for treating manic depression. This medication is generally effective in stabilizing mood swings and lessens the severity of the cycling between manic and depressive episodes. This medication however is not effective for all persons who have manic-depression and some persons who do get symptom relief do not like the side effects because of the tendency to blunt emotions. Some persons with bipolar disorder miss the emotional highs which they experience during their manic episodes. A medication review by a psychiatrist is advisable if the side effects are intolerable to the person.

Following are some practical strategies that may help someone with the manic episodes: Reduce activity and/or movement around the individual. Bright lights should be dimmed and extra noise should be eliminated; use a non-threatening approach by watching your own speech and body language; be careful of placing undue restrictions on their behavior (unless harmful to the person or others); and observe the person's behavior and language in order to detect any increase in risk-taking behaviors which could be harmful to them or others. As a family member or professional caregiver, you will learn that as you become familiar with the person's disorder you will anticipate their mood swings into depression and mania, adjusting your behavior accordingly.

What are Mood Disorders?

2009-09-21T18:48:00.004-05:00

Mood disorders are also known as "affective disorders" usually occurring when the mood (affect) of an individual is impaired usually involving extremes of two basically normal moods, happy and sad. Abnormally low moods are called "depression" and abnormally high moods are called "mania".

There are three main types of depression. The first (situational) is temporary, usually caused by an event, such as the loss of a loved one, stress, or an illness. This type of depression typically lasts only a short time and is resolved when the situation returns to normal. But be aware that this may also turn into clinical depression. Clinical depression is more enduring and /or recurring and requires treatment. This type of depression is usually not triggered by external event but if associated with situational factors, the emotional reaction to the event may be exaggerated. Individuals with clinical depression often withdraw from their usual activities and may become passive and dependent. In addition, such persons may have difficulty experiencing or expressing pleasure, may become preoccupied with physical health, may frequently report difficulty concentrating or making decisions and thoughts of death are common. Dysthmia is a low grade, chronic depression.

A person with depression may experience considerable lethargy and fatigue or engage in pacing, wringing their hands, and/ or pulling or rubbing their hair, body, or clothing. A stooped posture and slow gait can also be a sign of depression. Sometimes the person who is depressed may speak in a low voice and in a slow or monotonous manner. In addition, he or she may not talk very much or may pause significantly before responding to questions from others. Sleep difficulties are common as well as problems falling asleep, staying asleep, sleeping too much or waking early. Changes in appetite are also common. Weight loss or weight gain often accompanies clinical depression. Sometimes they may report a decrease or increase in their sexual drive. In extreme cases, a person may exhibit a history of self mutilation. Individual and group therapy are most commonly used for treating depression. Antidepressants are used in the treatment of clinical depression and are often effective in stabilizing mood swings.

Some of the symptoms of depression and dementia are similar but be aware that significant differences do exist. A person who exhibits dementia-like symptoms should be thoroughly evaluated. With the elderly patient, geriatric care managers routinely assess their clients for depression using a tool known as the "geriatric depression scale". On another post, we will explore the symptoms of depression which mimic dementia. Stay tuned....

Schizophrenia

2009-09-20T17:45:00.005-05:00

When I think of Schizophrenia I think of Nancy Spungen girlfriend of Sid Vicious (Sex Pistols) who on October 12, 1978 died at New York's Chelsea Hotel. Sid and Nancy became the stuff of tragedy, the punk Romeo and Juliet. As a child, Nancy who by age 11, had been expelled from public school and was receiving psychotherapy, reportedly attempted suicide numerous times before the age of fourteen and suffered from some form of mental illness, mostly paranoid schizophrenia disorder.

Schizophrenia is the disorder that most frequently comes to mind when one thinks of mental disorders. Schizophrenia is a general name for a group of mental disorders where symptoms include disturbances in thinking, behavior and mood. Persons with schizophrenia may experience major distortions of reality, along with disorganized and fragmented thoughts, perceptions and emotions. They also may experience delusions or hallucinations which, in addition to other severe symptoms, can affect their ability to complete daily activities, relate to other people, and cope with difficult situations. Many people with schizophrenia recover and lead normal lives however.

Schizophrenia typically originates in childhood, although symptoms may not become clearly evident until the teens or early twenties. Schizophrenic disorders are not usually diagnosed for the first time beyond middle age. However, persons with schizophrenia do grow old and may become or remain residents in sheltered environments. Symptoms can range from mild in some, to severe in others. Primary symptoms include delusions of grandeur, delusions of persecution, delusions of beliefs that other people or events have a particular significance, usually negative, delusions of control, and delusions of sin or guilt. Pych professionals believe it is best to avoid talking to the person about the delusions. Debating or arguing about delusional ideas is likely to increase the person's anxiety. Some people will readily share their delusional ideas, while others will only share these ideas with a few people they trust. It is important that families working with someone experiencing delusions communicate using active listening skills and attend to their concerns.

Some persons experience hallucinations, if they are hearing voices. Some people are reassured when you inform them you cannot hear the voices, while others may react in a fearful or hostile manner. If hallucinations are a new symptom, they should be communicated immediately to the person's health care provider, and if applicable, case manager. Not all persons with schizophrenia have delusions and /or hallucinations and not all persons who have these symptoms are schizophrenic. It is the disturbance of thinking which is central to this disorder. Individuals with schizophrenia typically have distorted perceptions, false ideas, and lack clarity and logic in their thoughts.

Today, when schizophrenia is mentioned in the news, it is almost always in connection with some alarming crime. Some stories that have been popular in the media and which have added to the public view that schizophrenics are violent and dangerous include the case of Andrea Yates, who drowned her five children in a bout of postpartum psychosis, David Berkowitz, the serial killer infamously known as the Son of Sam who claimed his dog spoke to him and urged him to kill, Mark David Chapman, the man who killed Beatle John Lennon, and John Hinckley, who attempted to assassinate President Ronald Reagan. Symptoms of schizophrenia vary greatly and may come and go over the course of a person's life. However, for some people, their symptoms can completely disappear.

The most common treatment for schizophrenia is drug therapy. Antipsychotic drugs are often used to help individuals manage their symptoms. Unfortunately, many antipsychotic drugs have unpleasant and/or serious side-effects. Consequently, individuals may not want to take their medications. But persons need to be encouraged to take their medications as prescribed, especially when it is critical to their ability to live successfully in the community.

Tomorrow, we'll look at depression.....

Mental Health Disorders

2009-09-19T16:27:00.002-05:00

Some seniors living in their own homes may be afflicted with a mental disorder. Mental disorders are conditions involving emotions, behavior, or thought which produce significant problems for the person experiencing them or which interfere with the person's ability to function in their home with their caregivers, family members, or in their relationships with others. It is believed that many mental disorders have a organic origin. A person's character has nothing to do with the development of a mental disorder. Mental illness strikes persons of all backgrounds and with all kinds of temperaments, beliefs, and morals. Many of our great works of art, music, and literature were produced by persons with mental illness. A surprising number of high level jobs are filled by persons who have experienced a mental disorder. While only 40-50% of persons with heart disease will recover, 80% of persons afflicted with depression will recover, and 60% of persons afflicted with schizophrenia will recover given proper treatment. Furthermore, violence among persons with mental disorders is not common. In fact, persons with mental disorders are more often victims of violence than perpetrators of it. In the cases where violence does occur, the occurrence typically results from the same reasons as with everyone else. These reasons may be feeling threatened, or excessive use of alcohol and/or drugs. Because there are so many caregivers who may be working with a person who has a mental health disorder, we are going to examine the different aspects of mental disorders beginning with schizophrenia and ending with how to handle a crisis if confronted by a friend or family member who is experiencing his or her own crisis. Stay tuned.

PBS Special "Retirement Revolution" Airs tonight

2009-09-15T07:41:00.001-05:00

I just received an announcement from the Alzheimer's Association that says:

Even if you're not a regular public television viewer, you should tune into PBS' "Retirement Revolution," which premieres this Tuesday, September 16, 2009.

"Retirement Revolution" focuses on the stories of seniors who are planning for their futures in the wake of the financial collapse of 2008. The broadcast also highlights living with Alzheimer's disease, featuring interviews with Alzheimer's Association staff members Bill Thies, Beth Kallmyer and two former Early Stage Advisors, Mimi Steffen and Gary Shelton.

Find out what time your local PBS station is broadcasting "Retirement Revolution."

When the Doctor Says It's A Stroke

2009-09-14T15:58:00.010-05:00

My mother was in her late 80s when she suffered her last stroke. This time it was not a mini stroke but a pretty lethal one. By then Mom's memory was obviously having problems as she also had been diagnosed with Alzheimer's related dementia disorder. So, to make sure caregivers understand what to expect with a stroke, I'd like to provide the following information.

Stroke is the term used to describe the loss or change in neurological function caused by sudden blockage or rupture of an artery of the brain. Damage to brain tissues can be temporary or permanent. Symptoms of stroke may appear suddenly or gradually. Transient ischemic attacks (TIAs), also referred to as “little strokes”, are strong indicators of an impending stroke. TIAs occur when a blood clot briefly clogs an artery, blocking part of the brain from receiving the blood it needs. Symptoms/Signs of Transient Ischemic Attack

q Sudden temporary weakness, clumsiness, or loss of feeling in the face, leg, arm, or leg on one side of the body.

q Sudden, temporary blindness, or dimming or double vision.

q Dizziness.

q Staggering.

q Loss of speech, slurred speech, trouble talking or understanding speech, particularly with weakness on right side.

q Mental confusion.

Most TIA symptoms occur and disappear quickly, usually in less than 5 minutes. Occasionally symptoms last several hours, but never over 24 hours. The short duration of symptoms and the lack of permanent damage are the main differences between TIA and strokes. The cause of a stroke determines treatment. Aspirin and medications for depression and heart disease are often indicated for stroke recoveries. Stroke changes the rules of daily life for individuals. The consequences and complexity of a stroke cause frustration for everyone concerned. Recovery from a stroke depends on the amount of permanent brain damage and rehabilitation efforts. Rehabilitation can help a stroke recovery regain function, adjust to changes, and prevent another stroke.

At first, when loved ones make rapid improvement, relatives expect full recovery. For example, a daughter said, “At the rate Dad was improving, I thought he would be his old self again.” Later, when the rate of progress slows, some family members believe it is because the client wants to be “taken care of.” They often feel problems are out of proportion to the stroke. In fact, I heard this just today from a long distance family member. Stroke affects each person differently. For example, two people the same age, sex, and physical condition, which have a stroke on the same side of the brain, may experience entirely different neurological changes. Recovery and rehabilitation depend on a large extent on the location and amount of brain damage.

Stroke recoveries commonly experience problems in the following areas: motor functions, sensation, vision, communication, automatic function, cognition, and emotional expression. Stroke recoverees often lose the ability to perceive or conceptualize their environment accurately. They may have difficulty understanding abstract ideas, as well as reality. The once carefully groomed, self-sufficient, and kind person may become sloppy, demanding and rude. It may seem as though a loved one has been transformed into a stranger.

Dramatic mood swings are common. A recoveree may laugh and then cry for no reason. The emotion displayed may not reflect mood. For example, a person who cries spontaneously may not, in fact, be sad. To determine the person’s mood, it may be helpful to ask how he or she is feeling. Depression is commonly experienced by stroke recoverees. When a recoveree cannot live up to demands to be more independent, responsible, and helpful, depression may deepen. Family members, therapists, and providers sometimes expect performance and behaviors beyond a recoveree’s capabilities. It is important to remember that a recoveree may be more impaired than appearance suggests.

Recoverees of a stroke experience unexpected bursts or loss of energy. A person may be able to dress independently on Monday, but need help on Tuesday. This problem is not caused by laziness and usually does not represent a change in health. Fluctuating moods and energy levels affect the level of performance.

Many may fail to recognize pangs of hunger, forget they just ate, or tell relatives you are not feeding them. Poor control of muscles of the face, tongue, and throat may cause drooling and difficulty in swallowing. Food may be stored in the cheek. These factors increase the risk of choking. The effects of stroke, combined with wearing dentures, reduce the ability to taste. Poor fitting dentures pose a serious problem because recoverees may not feel the pain of pressure areas. Use of the non dominant hand to eat, plus vision problems, causes food spillage and feelings of distress.

As a caregiver, you need to maintain a positive attitude. For example, a recoveree may put clothes on wrong-side out. This may be humorous to you, but embarrassing to the client. Respond in a manner that protects the person’s dignity and self-esteem.

Communicating with a stroke recoveree may be difficult, particularly if the person suffers from aphasia (word finding problems). Other barriers to communication are poor hearing and eyesight, mental confusion, depression, and withdrawal. Recoverees may turn away or respond without turning when people talk to them on their affected side. They may appear to ignore the speaker and be uninterested in what is happening around them. They may recall only bits of information from what they have seen or heard. Communicating with recoverees is important because it reduces their feelings of isolation and depression. What to do as a family member? At the minimum demand that the doctor refer your loved one to a neurologist and exercise patience. I have personally seen clients with very good outcomes following a good rehabilitation experience.

Readers are encouraged to offer comments and suggestions. See the comments link below. If you are an out of town family member with a parent in South East Florida who has suffered a stroke, care managers with A Good Daughter Elder Care can provide a comprehensive evaluation of the following areas: Medical, Mental, Financial, Legal, Environmental (Safety), and Social areas. Once the assessment is complete we prepare a complete plan of care going forward to provide all of the benefits, entitlements, options available for your loved one's care. Call: 1-800-963-3877 for our FREE REPORT revealing how we can keep our loved ones at home safely.

Remembering 9/11

2009-09-11T08:51:00.007-05:00

Even all these years later, the memory of that awful morning watching the events unfold on NBC with my colleagues at work, then listening to my daughter call from California hysterically sobbing about what had just happened to our country, still sends chills down my spine. My thoughts and prayers are with our country on this day remembering the tragedy of lost family and friends on this day.

Are Psychiatric Hospital Admissions Always Needed for the Person With Alzheimer's Behaviors?

2009-09-09T17:41:00.012-05:00

I received an email from an adult child of a client recently who is "at the end of the rope with a parent's behaviors, suggesting an admission to a psychiatric hospital so she could be seen by a doctor daily who will manage medications on site". Sometimes adult children have simplistic solutions that don't always work out for their parents. Case in point......At the beginning of my work with Alzheimer's patients of a local psychiatrist, I witnessed a delusional episode which proved just how the system worked against an elderly individual with an Alzheimer's related disorder.

A number of years ago, while visiting a client who was obviously in a delusional state, I called the client's power of attorney, her primary care physician, psychiatrist, therapist who all advocated that she voluntarily sign herself into a local psych hospital. One thing I have observed throughout the years is that the person afflicted by Alzheimer's who has an emotionally negative experience, will remember it forever. This was the case with this client. I drove her to the psychiatric hospital and as I said earlier it was a voluntary admission, but as soon as my back was turned she was brought before a judge who changed it into an involuntary admission, keeping her there for two weeks against her will as my daily visits bore out. It was an awful experience for her.....multiple doctors who changed her medications so many times that even after discharge nothing seemed to work, keeping her with the general psych population which consisted of males, females, young, and older persons who needed psychiatric intervention, and managed by staff who weren't experienced with the word-finding problems that a person afflicted with Alzheimer's sometimes has and the exasperation that it brings. On her return home, she was far more agitated than she was on admission. She never forgave me because I was the one who drove her "to the crazy house". I went from being her loving advocate to "the enemy". Her disdain for me made my life a living hell (again, because of the emotional connection she made to that memory). I vowed never to recommend a psych admission to another client (unless they are a threat to themselves or others) as it served no purpose. My client eventually went through a series of psychiatrists before finding a geropsychiatrist who put her on gradual increased doses of Seroquel which finally seemed to work. She is now at home with live-in caregivers and the love of her small puppy, is peacefully managed, and will remain in her home until the end.

Even with the most highly credentialled psychiatrist, medications are not always a one-size-fits-all solution. After many years of working with dementia behaviors, I have observed that not all agitation is resolved with a change of medication. Sometimes an inexperienced caregiver can accidentally trigger behaviors and it takes gentle patience and training to get to the heart of the problematic behavior. When you have caregivers working different shifts and one caregiver gets easily agitated while the other more mature and experienced caregiver elicits cooperation from her patient without reported incidents, you can surmise that more training may be needed. Persons suffering from Alzheimer's disorders can also be affected by changes during a particular time of day (i.e,. sundowning), so careful monitoring of progress notes in the home can give the information necessary to determine if that is the case.

So, I close with the following advice: If sudden confusion or sudden changes in behavior are apparent with a parent, check with the primary care physician to rule out a urinary tract infection or push fluids if you suspect dehydration; follow trends with caregivers to see who may need more training; have them keep progress notes documenting their observations, finally report new behavior changes to the psychiatrist to see if medication adjustments are warranted. Alzheimer's disease presents extreme challenges not only to the affected individuals and their families, but also to care providers. The nature of the disease is such that our healthcare system sometimes fails to function in an appropriate manner. As the baby boomers age and more persons are afflicted with dementia, our health system will not be in a position to handle the anticipated influx of Alzheimer's patients over the next decades. I hope this post helps examine some of the challenges presented by this disease and has suggested several possible methods to improve our response to observed behaviors. A Good Daughter Elder Care Management helps provide high quality resources for family members who have parents afflicted by Alzheimer's disease. We provide advocacy, caregiver supervision and training, medications management, medical coordination, mediation, and host a free monthly dementia support group for families and caregivers. We are available to our clients and their families for emergencies 24 hours a day 7 days a week, 365 days a year. Please feel free to leave a comment below or contact: olga@agooddaughter.com for more information.

Should European Advocates lobby to Remove film by French Alzheimer's Association?

2009-09-02T20:30:00.001-05:00

Unfortunately, as a person who deals with Alzheimer's every day of my life and one who knows all too well that the faces of real life persons afflicted by this disorder are often very much like the images represented by the film makers in this case, I ask myself "why are we so afraid of to confront the reality of what is?" While I am extremely compassionate of my clients and can understand the behaviors of my former nursing home residents and some of our clients who are in declining stages of this disorder, I feel we need to see the face of Alzheimer's as it really is (or can be) because there are too many adult family members who are in complete denial of what is happening to mom or dad as they fly back to the safety net of their homes and we are left to pick up the pieces on a daily basis. See a clip of this film for yourself and leave your comment.

Remembering Ted Kennedy

2009-08-27T21:48:00.001-05:00

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)

2009-08-27T18:55:00.002-05:00

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

2009-08-24T15:13:00.009-05:00

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?

2009-08-18T17:27:00.004-05:00

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

2009-08-17T21:57:00.001-05:00

Putting the Needs of the Parent First Over Visiting Children

2009-08-15T19:17:00.006-05:00

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

2009-08-11T12:46:00.004-05:00

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

2009-08-10T13:35:00.007-05:00

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.

Health Insurance Reform

2009-07-23T15:37:00.008-05:00

Health insurance reform is a complex issue and many of you have questions about what it means for you and your family. Last night, President Obama addressed the nation in a primetime press conference about health insurance reform. In the event you missed it, here is the video:

http://www.whitehouse.gov/blog/The-Presidents-Press-Conference-Full-Video/?e=8&ref=image

In summary, the bill provides quality affordable health care for all Americans and controls health care cost growth. The key provisions of the House of Representatives Health Care Reform Bill follow below:

1. Coverage and Choice. This bill protects current coverage allowing individuals to keep the insurance they have if they like it. It creates a Health Insurance Exchange allowing individuals and small employers to comparison shop among private and public insurers. It administers affordability credits to help low-and middle-income individuals and families purchase insurance. There will also be a public health insurance option guaranteeing coverage and providing insurance reforms. It limits the ability of insurance companies to charge higher rates due to health status, gender, or other factors. A new independent Advisory Committee chaired by the Surgeon General will recommend a benefit package based on standards set in the law. This essential benefit package will become the minimum quality standard for employer plans which will include preventive services with no co-pays, mental health services, and oral and vision care for children.

2. Affordability. In order to insure all Americans have affordable health coverage, the bill provides sliding scale credits available to low and moderate income individuals and families. All new policies will cap annual out of pocket spending to prevent bankruptcies due to medical expenses happening under our current system. The bill will expand the Medicaid program for low income children, individuals with disabilities, and people with mental illnesses. Medicare will be improved by filling of the donut hole in the current Medicare D drug program, eliminating co-pays for preventive services, and will extend the solvency of the Medicare Trust Fund.

3. Shared Responsibility. Once market reforms and affordability credits are in place, individuals will be responsible for obtaining and maintaining health insurance coverage. Those who choose to not obtain coverage will pay a penalty of 2.5 % of AGI (adjusted gross income). Employers will have the option of providing health insurance coverage for their workers or contributing funds on their behalf. There will be assistance for small employers (payroll that does not exceed $250,000) who will be exempt from the employer responsibility requirement. A payroll penalty will phase in starting at 2% for firms with annual payrolls of over $250,000. A new small business tax credit will be available for those firms who want to provide health coverage to their workers.

4. Controlling costs. Modernization and improvement of Medicare will be implemented to reward efficient provision of health care and aim to decrease preventable hospital readmissions, create new consumer protectons for Medicare Advantage Plans, eliminate the "donut hole", and will improve low-income subsidy programs so that Medicare is affordable for all seniors and other eligible individuals. The public health insurance option will be empowered to be the purchaser of health care to get more value for each health care dollar spent. New tools will be provided to combat waste, fraud and abuse within the entire health care system. The bill will simplify the paperwork burden that adds tremendous costs and hassles for patients, providers, and businesses.

5. Prevention and Wellness will be expanded by the use of Community Health Centers.

6. Workforce Investments will be made by increasing funding for the National Health Service Corp; increase training of primary care doctors; increasing an expansion to promote individuals going into health professions (primary care, nursing, and public health); expansion of scholarships and loans for individuals in needed professions and shortage areas; and redistribution of unfilled graduate medical education residency slots in order to train more primary care physicians.

In listening to the President's remarks about the new emphasis on programs that contribute to health and wellness, I couldn't help but wonder about Medicare's Hospice Program. I would hate to see the much needed non for profit and for profit Hospice programs be cut back in funding as the pre- baby boomer population continues to age. More about Hospice in Part II.

We wish to thank Francine Hardaway of Arizona Health Futures.org for her very concise blog posted on July 14th explaining the proposed House of Representatives Health Care Reform Bill which even I could understand.

If you'd like to leave your comments, we'd love to hear what you've got to say. Follow the link provided below.

Elder abuse done mostly by family, caregivers | Recordnet.com

2009-07-21T17:24:00.007-05:00

Having experienced elder exploitation perpetrated against an 80 year old distant relative and now recently against his wife by the same family member, I am compelled to share this article written by Michelle Singletary, Washington Post Columnist.

The annual financial lost by victims of elder financial abuse is estimated to be at least $2.6 billion. The average victim of elder abuse is a woman older than 75 who lives alone. According to Fred Joseph, Colorado's securities commissioner and president of the North American Securities Administrators Association, "Elder financial abuse is becoming the crime of the 21st century as the growing senior population is increasingly targeted."

It is not surprising that the more health issues seniors have, the more likely they will be victimized. Searching media reports of abuse for this year, the writer found numerous cases where family members and caregivers took advantage of seniors with dementia.

A nursing assistant from the state of Washington was charged with stealing more than $770,000 from the elderly woman she was caring for. In a Florida case, a man called authorities to report his 80-year old mother's hairdresser had stolen her checks. They stylist was accused of taking $25,000 from the woman's checking account. But during the investigation, police charged the victim's 52-year-old son - who first alerted police - with fraudulently cashing $6,900 in checks from his mentally incompetent mother.

Last month in Virginia, a home health caregiver was sentenced to six months in jail for taking $15,000 from an 85-year-old woman suffering from dementia. The victim was bedridden.

The financial abuse of seniors has become so prevalent that the North American Securities Administrators Association and the National Adult Protective Services Association recently united to develop tips and strategies to protect them.

"A silent crime is taking its toll on American -- silent because so many of these cases go unreported," said Kathleen Quinn, executive director of the protective services association. "This announcement is the first step in a partnership we hope will grow to close the gap on elder abuse."

Following are some of the ways elder financial abuse can happen:

Forging an older person's signature.
Getting a senior to sign a deed, will or power of attorney through deception, coercion or undue influence.
Using the elder person's property or possession without permission.
Promising lifelong care in exchange for money or property and not following through on the promise.
Making charges against victims' credit cards without authorization.
Confidence crimes in which victims are scammed by gaining their trust.

Following are some red-flag warnings given to adult protective service workers:

Is the senior receiving information about or being asked to invest in unregistered securities or start up companies? Securities fraud can be detected by checking with your state securities regulator. Contact information available at www.nasaa.org
Is the investment high risk or possibly speculative, such as oil and gas exploration, new or untested technologies, rare metals or involve currency trading?
Has the senior been asked to sign blank paperwork or to give discretionary authority over her accounts to an advisor?
Is the senior complaining that his investment advisor won't give him his account statements or documentation?
Has the senior made out a check directly to the advisor or broker for the purchase of an investment?

Information is available on the groups' website that will assist you in helping seniors avoid these problems. Go to http://www.nasaa.org and search for "Senior Investor Resource Center."

To report elder abuse, you can contact an Adult Protective Services office at http://www.apsnetwork.org or through the National Center on Elder Abuse at http://www.ncea.aoa.gov or (800) 677-1116.

If you suspect a senior is being financially exploited, report it - even if the suspected scoundrel is a family member. In my family member's case, I took my uncle down to the local police department and charges were filed against the family member who was exploiting him. What broke my heart was that after the seniors death, the wife took in the same family member and he exploited her as well.

Contact Michelle Singletary, a personal finance columnist at the Washington Post, at singletarym@washpost.com.

Why Geriatric Care Managers Should Take ALF Core Training

2009-07-16T17:57:00.006-05:00

A number of years ago when I first became a geriatric care manager, I decided to take the CORE training in order to give myself some options if things didn't work out as a care manager. Little did I know that the material learned through my instructor would also serve to make me a better geriatric care manager. Not only did we learn the Florida Statutes and Administrative Code pertaining to licensing and operating an Assisted Living Facility, but I benefited greatly by learning the material about following the Occupancy Cycle which governs the paperwork process for admission into a facility. Up until that point I thought it was similar to renting an apartment and all I had to do was bring my client to the facility with a check on move-in day! Boy, was I wrong. We were taught about age related changes, managing food service in a facility, medications, what is involved in offering personal care to a resident, mental health, Alzheimer's disease, Resident's rights, the Ombudsman program, abuse, neglect, and exploitation, providing stimulating activities, and so much more. Because we practice so independently, learning the State regulations will add a framework for running your practice. Since GCMs basically provide assisted living for our clients in their own homes these regulations remove all ambiguity and offer care managers clear direction when faced with the best course to follow for our clients.

So, if you are a newbie geriatric care manager and feel you could add to YOUR CORE training, get in touch with me at: olga@agooddaughter.com

We are in the process of putting together our calendar for the August schedule. We only teach the CORE training program during the 2 middle weekends of each month. If you would like to learn more, go to: http://olgabrunner.com -- You won't regret it. And you may even have some fun in the process.

Hiring Caregivers for the Home - What You Need to Know.

2009-07-12T15:22:00.007-05:00

When frail or elderly parents start having difficulty with every day tasks, it is generally recommended that a private caregiver be brought into the home to assist with ADLs (Activities of Daily Living). These activities can be related to assistance with ambulation, bathing, dressing, driving, eating, finances, food preparation, housekeeping, laundry, medication assistance, shopping, telephone, toileting, and transportation. But before you hire someone, you will need to consider the person's medical and mental status, environmental and safety issues, psychosocial and financial issues which must be considered before deciding that keeping your parent living safely in his/her own home is going to be the best option. A Geriatric Care Manager (GCM) has the expertise to complete a comprehensive assessment to assure the decision is made.

Once your decision is made to age in place at home, a qualified caregiver overseen by a geriatric care manager who has the clinical knowledge to establish a professional plan of care and offer direction to the caregiver would be in the best interest of the older adult. Caregivers of all types do not have the education to function independently without supervision by a qualified professional such as a GCM. How to tell the difference in credentials of your prospective caregiver?

Certified Nursing Assistants (CNAs) have medical training and must pass an exam to get certified. CNA's can check vital signs, care for wounds, have knowledge of transfer techniques, and can help with activities of daily living such as bathing and dressing. CNA's typically have received training under a nurse at a facility such as a hospital or nursing home and can assist with household tasks and meal preparation as well.

Home Health Aides (HHAs) may have some formal training provided by their employer but have not taken a certification exam. They can assist with ADLs but have not had formal training on medical issues unless they have been taught through their own experience. They can also assist with light housekeeping, transportation, and meal preparation.

Companions usually will not provide direct patient care but are available for companionship. They can assist with cooking, cleaning, shopping, transportation, and stimulating activities and outings.

Hiring a caregiver through word of mouth is usually the least expensive option and the one most used but this arrangement can create legal liabilities for the family because the family becomes the employer. For example, the family can be held liable for injuries that may happen on the job. If you choose to hire a private caregiver, have the GCM conduct a background check, check prior employment history and references. If you hire them as an indepdendent contractor you will need to file a 1099 on any wages over $600 yearly. If you hire them as an employee, you will be responsible for paying taxes and benefits such as Social Security and Medicare and federal withholding and unemployment tax. Remember, hiring privately may leave you without a backup if this person leaves unexpectedly or becomes ill. Sometimes there are unscrupulous persons who will take advantage of vulnerable clients, so do not skip any of the steps above. If you have found someone on your own who has met the above criteria it may be a good idea if you have a geriatric care manager oversee the caregiver and make spot visits from time to time to make sure there are no problems if the family lives in another state.

Hiring from an agency may be just a bit more expensive because the agency will pay FICA taxes, cover worker's compensation insurance, and will screen potential employee backgrounds. You will want to make sure the agency bonds and insures their caregivers, that caregivers have received training on CPR and first aid skills, and that the agency has a large number of caregivers offering you a guarantee of a substitute caregiver if your primary is sick or on vacation. A good agency will have a RN who follows up on the plan of care, and will oversee and offer advice to the caregiver.

Remember these employees are not your friends. You may be friendly when you come to town for a visit, but keep it professional. If your employee thinks of herself as your friend, she may take liberties of a friend, not an employee of your vulnerable parent. Make sure there are clear expectations as to what she should be doing at all times. Have them use a notebook for progress notes or observations daily. Have a GCM develop a plan of care and have the caregiver keep a record of how she is following the plan of care. Make sure they are clear about the personal care that should be provided.

Most of the calls received at A Good Daughter Elder Care Management are when a parent has a crisis following a fall or hospitalization. At first, a parent will not acknowledge they need a stranger in their home but children need to convince their parents they need in home care. Use a GCM to mediate the safety issues for an aging parent. GCMs recognize how to respectfully allow the older adult to feel in control of their lives while helping them recognize that accepting help actually allows them to maintain their independence.

To find out how a geriatric care manager can help with your aging parent's need for more help as they age in place, go to our web site: http://www.agooddaughter.com or email: olga@agooddaughter.com We are available via our toll free number: 800-963-3877 on a 24 hour basis, seven days a week, 365 day a year for emergencies.

Johns Hopkins Health Alerts

2009-07-04T13:38:00.001-05:00

What is the single most important thing people can do to protect their brains and guard their memory? In this article from the Johns Hopkins Memory Bulletin, Sandra Aamodt, Ph.D and Sam Wang, Ph.D answer this important question.

Q. What is the single most important thing people can do to protect their brains and guard their memory?

Sam: The answer is simple and surprising. It's physical exercise, especially the kind that raises your heart rate and makes you sweat. It's not known exactly why exercise works, but the best idea is that it improves blood flow to the brain. It also stimulates the secretion of neurotrophins, which are signaling molecules that help neurons grow.

A recent meta-analysis of 18 studies reports that a physical exercise program -- even one started when people are in their 70s -- can significantly boost executive function. In this case, the effect size is quite large. To return to our example, if you are an average person out of a group of 20, which would rank you as number 10, exercise can improve your rank to number five -- a huge improvement.

Sandra: What's important to remember is that there have been actual intervention studies reporting that exercise programs can significantly improve executive function and the ability to plan and execute behaviors. A meta-analysis of 18 studies published in Psychological Science concluded that a variety of physical exercise programs improved executive function substantially. Another study, published in the Journal of theAmerican Geriatrics Society, found evidence that exercise also protects cognitive ability.

Older people who had better aerobic capacity -- meaning they were in better physical condition at the beginning of the study -- were most likely to have maintained their level of cognitive functioning six years later. People who were otherwise healthy but had poor aerobic capacity had worse cognitive scores after six years.

Physical fitness also influences brain volume. In a study published in the Journal of Gerontology, researchers asked people ages 60–79 to either walk or perform stretching and toning exercises for one hour three times per week for three months. A third group did not exercise. The researchers used magnetic resonance imaging (MRI) to measure the participants' brain volumes before and after the exercise programs. After three months, brain volume had increased significantly among the people who had walked. The biggest increases were in the frontal lobes, the area of higher-order mental activity like memory and attention. Brain volume did not change in the other two groups.

Q. How much exercise is needed for optimal memory and brain preservation and brain health?

Sam: The meta-analysis of exercise programs and executive function found that 30 minutes of moderate activity three times per week had significant benefits for brain health. The U.S. Surgeon General and most health organizations recommend at least 30 minutes of moderate activity on most days of the week to maintain good health.

Brisk walking is a popular aerobic exercise that has been found to reduce the risk of cognitive decline. In a study published in the Journal of the American Medical Association, researchers asked 2,257 men (ages 71–93 and with no signs of dementia) how far they walked each day. Cognitive assessments performed four to eight years later showed that the men who walked less than a quarter mile a day were nearly twice as likely to have developed dementia as those who walked two miles or more each day.

In the same issue of the journal, a study of 16,466 women found that regular exercise (including walking) reduced the risk of cognitive impairment by 20%, and the more exercise, the better. Women who exercised at least 1.5 hours per week showed less cognitive decline than those who walked 40 minutes or less each week.

Sandra: If you do a half hour to 45 minutes of exercise three times a week, you are well into the effective range. You don't have to spend an enormous amount of time exercising to benefit. Although there's no statistical evidence right now that more exercise would be any better for your brain, it wouldn't hurt. I think we could say with some confidence that it would be better for your heart, so my best guess is that it would be better for your brain, too.

Q. What's the link among exercise, stroke, and memory protection?

Sam: Exercise can dramatically reduce your risk of stroke, which is the brain equivalent of a heart attack. In the most common type of stroke, a blocked blood vessel prevents blood flow to a particular brain region, leading to neuron death and dysfunction. If you survive a stroke, you have a significantly increased risk of cognitive impairment, memory loss, and AD. A report from the Archives of Neurology showed that people with a history of full-blown stroke were about 60% more likely to receive a diagnosis of Alzheimer's disease than were those with no history of stroke.

If you have significant risk factors for stroke -- such as hypertension, diabetes, and smoking -- you may have an increased risk of declines in executive function, according to a study published in Stroke that assessed the 10-year risk of stroke in more than 2,000 men and women. Obviously, a major stroke -- for instance, one in which you get a big clot in a big vessel that cuts off blood flow to a significant portion of your brain—can have a major effect on brain function and memory. But so can so-called microstrokes, which are caused by little blood clots that lodge in little vessels and deprive a small part of your brain of blood. A lot of older people have microstrokes, which are a risk factor for subsequent major strokes.

Most people don't even notice microstrokes, which usually affect only a small number of brain cells. Although microstrokes sometimes show up as tiny spots on brain scans, other times they can't be picked up at all. The bottom line is that there's no way to interpret killing off of neurons as being a good thing, even in small numbers. So it seems pretty obvious that doing anything you can to prevent microstrokes -- especially engaging in regular physical exercise -- is essential for protecting your brain and guarding your memory.

Connect For Healthcare

2009-07-01T21:22:00.004-05:00

I am always blown away by the way you have to beg and plead to get medical staff in our Florida nursing homes to connect with the families who have placed their loved ones in their care.

Well, now there is a solution. "Connect4Healthcare.com" has devised a revolutionary new system for long term care providers to stay in touch with long distance family members. Please watch this video:

Benevolent Ballet and Fall Prevention for the Elderly

2009-06-29T14:55:00.002-05:00

Imagine engaging residents of assisted living and long term care facilities with an innovative exercise program designed to reduce falls by improving posture, balance, range of movement, coordination and awareness. According to Sheila Lehner, Member of the Royal Academy of Dance for over forty years and author of the Benevolent Ballet program for the elderly, when implemented regularly, fall rates are drastically reduced and quality of life improves.

This approach will engage the elderly with a person centered care approach that restores dignity, self-esteem and improves mood. Improved mood and self esteem may also reduce inappropriate behavior. Even the need for restraints may be reduced, according to their website: www.benevolentballet.com

This activity inspires even residents with Alzheimer's Disease or other dementias because the use of classical music and personalized approach speaks directly to the heart. The heart and soul cannot be affected by these conditions. So if you are an activity director, physical therapist, occupational therapist, or part of a Restorative Program at a long term care facility, Training seminars are being held in 2009. Contact: Sheila Lehner, lehners1@yahoo.com or directly at: 407-889-7770 in Florida.

NAPGCM Senior Housing Locator

2009-06-24T11:51:00.003-05:00

It's about time. The National Association of Professional Geriatric Care Managers has just entered into an agreement with a National Multiple Listing Service that has been under development for the past four years featuring a Senior Housing Locator. This single database of all senior housing in the country plus US territories has just been completed and we had our professional user training this morning. This new site will pull from all federal and state regulatory agencies, will eventually expand to include other providers such as vetted listings of GCMs, elder law attorneys, durable medical equipment companies, and Area on Aging agencies with complete profiles and descriptions in an online database application and searches that may be conducted on mobile phones. More to come as I start using it but it promises to be a very innovative database which will give us much more complete descriptions such as breakdowns of Alzheimer's care provided by levels of care so we may conduct more complete and honest searches for our client families. All information has been completely vetted by regulatory agencies and maintenance will be conducted for name changes, company changes, etc. every 8 weeks. For more information, please contact: olga@agooddaughter.com

A New Option to Help Pay for Assisted Living Admission

2009-06-23T12:00:00.004-05:00

An ElderLife Financial Line of Credit can help you pay for assisted living and senior living. In this new economy, families waiting for a house to be sold, for VA benefits, or those who simply want flexibility may find this resource helpful. Please watch this video:

Revised Quality of Life F-tags

2009-06-18T08:36:00.006-05:00

CMS (Center for Medicare and Medicaid Services) recently released several revisions to its Quality of Life F-tags. The revisions under the State Operations Manual, Appendix PP, Guidance for Surveyors went into effect on June 12, 2009 and can be viewed at: http://tinyurl.com/nvnwx5. Apparently, no one told the nursing home in Boca Raton where I was visiting this week. Because of a medical situation involving a client I called the State Ombudsman's office for assistance in resolving the dispute. As a result, when I arrived for a 2pm meeting with the Ombudsman at the administrator's office, I was denied access. I will therefore arm myself now with a copy of the updated regulation which states under tag: 483.10(j)(2) - The facility must provide reasonable access to any resident by any entity or individual that provides health, social, legal, or other services to the resident, subject to the resident's right to deny or withdraw consent at any time and attempt to speak with them again. As my client’s geriatric care manager, I will exercise her right to advocacy.

Many thanks to Elizabeth Peterson, Executive Editor at HCPro, Inc. in Boston for sending me that information.

Sundowner's and Tough Love

2009-06-11T20:17:00.001-05:00

We’ve had an Alzheimer’s client for the past three years whom we’ve lovingly cared for and have educated her boomer adult children in all aspects of the disease. Sometimes they listened and sometimes they made poor choices. But just recently she has developed sundowners behaviors and becomes quite irritated at approximately five every afternoon. Her caregiver who tends to her from 10 – 5 each day cannot stay past five pm and the client starts calling our offices pleading not to be left alone. Two days ago, our nurse stayed with her for hours until her medication took effect and last night she called me at 6PM asking if I could stay with her - - she was afraid to be alone. I picked her up and took her to the beach where we fed the birds, walked in the warm sand, ate ice cream and then drove her home. Once home she became agitated again. I asked her to take her evening medications and redirected her attention away from her latest troubles. After about one hour of reading to her from the Oprah Magazine and discussing the latest celebrity interview, she began to relax stating she would be ok for the night.

The problem is that she needs continuous supervision because she has suicidal ideations, has been known to wander, is depressed, and now has sundowner’s syndrome. We orchestrated a team effort organizing a crew consisting of the new evening aide, a nurse practitioner from her psychiatrist’s office, our nurse care manager, her daytime aide, and asked her children not to answer the phone for a few hours until the task was done. Yes, this was tough love, but it has now become apparent that her safety is more important than her reliance on our staff alone for her needs. If she is going to age-in-place at home, she will need either a live-in caregiver or round the clock certified nursing assistants to keep her safe. I’ve just heard that she didn’t throw out the aide, her medication has started to work, and all is well with her world. This story promises to have another happy ending. One I hope will last but will continue to monitor in the event it doesn't.

What is an Elder?

2009-05-27T18:40:00.002-05:00

"An elder is a person who is still growing, still a learner, still with potential and whose life continues to have within it promise for and connection to the future. An elder is still in pursuit of happiness, joy and pleasure and her or his birthright to these remains intact. Moreover, an elder is a person who deserves respect and honor and whose work it is to synthesize wisdom from long life experience and formulate this into a legacy for future generations."

The author of this is unknown but because it was so directly and aptly stated, decided to share this with the rest of you. Olga@agooddaughter.com

55 Ideas on Ideas

2009-05-27T08:45:00.001-05:00

Check out this SlideShare Presentation:

55 Ideas on Ideas

View more OpenOffice presentations from Ricardo Sosa.

The best way to succeed in any challenge that arises is to surround yourself with an Expert.

2009-05-25T20:14:00.005-05:00

32 Hours Towards a New Career

By Olga Brunner

ALF Training Classes will cover the following coursework over two consecutive weekends. Our classes include licensing, facility administration, marketing, resident records, facility records, food service, medications management, personal care of your residents, providing stimulating activities, Alzheimer's, Mental Health problems, Hospice, Resident Rights and Abuse.

Besides that we will look at what a business owner does when she "wears all the hats". Why? Because as you build your business that is exactly what you will do. We will look at networking in the community, press releases, advertising, etc.

Remember, Entrepreneurs live their lives being non-negotiable, No maybes, or I'll try! See you in class! REGISTER NOW!

Olga Brunner Resumes ALF CORE Training for Florida Administrators

2009-05-23T15:19:00.006-05:00

FOR IMMEDIATE RELEASE:

Contact Person: Olga Brunner, MS CMC
Company Name: A Good Daughter Elder Care Management
Telephone Number: 561-392-3574
Fax Number: 877-226-9219
Email Address: olga@agooddaughter.com
Web site address: http://olgabrunner.com

Olga Brunner Resumes ALF CORE Training for Florida Administrators

Boca Raton, Florida, May 23, 2009 — Olga Brunner, Founder and President of A Good Daughter Elder Care Management in Boca Raton, has resumed classes targeted to train administrators in passing the ALF CORE Training course for licensure by the State of Florida. Classes will be held during two consecutive weekends a month at the Boca Raton offices of A Good Daughter Consulting beginning Saturday, June 6, 2009 from 9:00 am to 5:00 pm. Among the coursework presented will be “Steps towards licensure, Marketing, Diseases of the Aging, Florida statutes, Occupancy Cycle, Food Service, Medications Management, Bill of Rights, Dementia, Mental Health, and Elder Abuse Reporting, etc.” Attendees will be provided with a Training Manual, handouts, power point slides, videos, and multiple aids throughout the course.

A series of four quizzes and a final will be administered. During the last class applications will be submitted to the University of Florida for the State Exam. Exam fee and application will be sent overnight via FedEx to Tallahassee and a recommendation will be made by our trainer for those students participating in the examination.

Olga Brunner runs A Good Daughter, Inc., a Boca Raton Geriatric Care Management agency that does what long distance families cannot: Be there at a moment’s notice. As Brunner recently stated: “As a senior care advocate, my goal is to help qualify individuals interested in providing affordable Assisted Living in the community to our elderly population.” Brunner comes from a background of hospital administration, nursing home administration and activities planning for seniors. She relocated to South Florida to care for her own mother who had Alzheimer’s related dementia in 1997.

Our training staff may be reached (toll free) at 800-963-3877 (seven days a week). For more information about what makes us different, feel free to contact Olga Brunner at: http://olgabrunner.com

# # #

When a Private Duty Caregiver Steps Over the Line

2009-05-22T14:45:00.006-05:00

Are private duty aides guests of the facility in which they work? I recently went to see a client who’s in a rehab facility and was stopped by the Assistant Director of nursing (ADON), the Unit Manager, and the Director of Nursing (D.O.N.) about a private duty caregiver presently caring for a client of ours. It seems the private duty aide hired by the family on my recommendation has interfered with the operations of the unit and has alienated staff with constant interventions, accusations, and mistrust of the facility’s caregivers. Although an exceptional caregiver in a private home setting, she doesn’t understand how a nursing facility operates and is a bit too compulsive when it comes to the facility’s staff. In her defense, she has been wonderful about keeping me abreast of the client’s condition, lets me know when the doctor visits, how the client reacts after physical therapy, etc. She has not only sent long emails describing every person who has entered the patient’s room and what was done, but all too often these emails are peppered with, “they don’t know how to do this”, or “they did that”. I have been good about listening and not reacting but when I was told she had been visited by an administrative person, I decided to see for myself what the problem was. Having been trained as a nursing home administrator I understand the numerous regulations imposed on facilities and the fact that extensive documentation is done by the nursing staff. I was right, the moment I approached the A.D.O.N., I was informed that this caregiver’s excessive watchfulness of the facility's staff and not the patient has been documented “ad nauseum” in their records.

Private duty Caregivers need to be aware of the scope of their duties when in a nursing home facility or rehab facility. These facilities are “nursing” centers for a reason. Patients are moved to these facilities because they need nursing care. No matter who the administrator is, the Director of Nursing has the overall responsibility for patients in her building and takes her position very seriously. Not only responsible for the care of the individual patient, she is responsible for employee training and ongoing monitoring; interacting with the professional staff (individual therapy modalities), doctors, family members, geriatric care managers, administration; scheduling staff and switching personnel when she or he has personnel calling-off; is knowledgeable with Agency for Health Care Administrations numerous regulations; is responsible for grievance procedures, and takes risk management seriously so everything has to be document. Anyone who has worked in a nursing home realizes, “if it isn’t documented, it didn’t happen.”

In this case, the Unit Manager knew me personally so the issues were resolved amicably, the caregiver was admonished to pay closer attention to her patient and not to be so involved with subjective observations of the facility’s nursing staff. The family has paid her to do a job and not be a “house monitor”.

In her defense, I was a personal caregiver to my mother when in decline from Alzheimer’s disease. I finally realized what a pain I was to the staff. I was riddled with guilt for placing her in a home which created the “nothing is good at this facility” mentality and "nobody can care for her like I can". I even attempted to do the caregiver’s job once and dropped my mother accidentally on the floor as I was untrained. The outcome was that it prompted me to pursue Nursing Home Administration as a career choice. Once I realized what was involved in obtaining and maintaining the license for the building and the scope of responsibilities that nurses and nursing assistants are challenged with, I sang a different tune. Next time I need a private duty caregiver in a nursing home setting, I will staff from an agency with personnel familiar with nursing home procedures or perhaps start my own agency. I think it's time. If you have comments, please feel free to post them below or contact me at: olga@agooddaughter.com

Part 1: The Memory Tapes

2009-05-10T21:58:00.002-05:00

I watched this episode twice and still needed the Kleenex. It seems what touches me most is that last gentleman in his dying bed. I have witnessed that end of life scene a dozen times with dying clients and I've never had an opportunity to release them the way I have managed to release them viewing this film. I am looking forward to viewing tomorrow's segment with Maria Schriver. So far The Alzheimer's Project has been a realistic window into the various stages depicting varying options of care from Josephine and her daughter on the farm to Yolanda at the nursing home having hallucinations about bugs and snakes in her wheelchair. Please feel free to leave your comments below.

Olga at A Good Daughter Elder Care Management will be reviewing segments of the HBO Alzheimer's Project during our Dementia Support Group on May 20th at 5:30 pm at our elder care management office. Please call to RSVP: 561-392-3574 or email: info@agooddaughter.com

Happy Mother's Day!

2009-05-09T10:06:00.004-05:00

I thrive on family. Although mine is shrinking and my own daughter resides on the California coast, I would just like to take this time to reflect on Mothers, Grandmothers, and New Mothers out there. Don't ever take each other for granted as we women share a common sisterhood that should be supported by one another each and every day. Be good to one another. Take some time to be with someone special tomorrow and make tomorrow a good day by putting away CNN news for a day, employment worries, economy worries, and just laugh at it all. Soon this economic downturn will stop being the talk of the day and we will all be in a better place. Have a very happy mothers day to all. Enjoy practicing your faith, enjoy the grandchildren, enjoy some good music and food, and enjoy each other's company.

Dr. Bill Thomas' Plea to Oprah

2009-05-07T10:09:00.002-05:00

This morning I watched a video that needs to be shared with anyone who advocates for the elderly. This is an amazing person who is taking his role as geriatrician and advocate for Seniors to new heights with his personal plea to OPRAH. Please enjoy.

A Great Lady Has Passed - A Testament to Love

2009-05-05T14:34:00.006-05:00

A short time client who lived with Alzheimer's disease these last few years of her life and died all too soon at age 68 was loved by all who knew her. She participated at the FAU Memory and Wellness Center and her artwork is on exhibit there. She was a resident of Arden Courts in Delray Beach and her husband who was a White House correspondent still participates in a weekly lecture series at both FAU and Arden Courts. He will continue to do so which is a great testament to their love for one another. This morning I saw him briefly after his lecture and he handed me the newspaper article written by him on the day she left this life entitled, "A Farewell To My Dear Wife". I have never been so moved as I have been by his words of praise and recognition of her talents, poise, dignity, and nurturing soul. Among her numerous files kept during the White House years was a handwritten note kept in a "Capital Speakers" folder which says:

Live your life to the fullest, Enjoy here while here because there is no here there - think about it... There is no here there. So many people die before their time, for reasons difficult too difficult to understand..For reasons so difficult to accept. Don't we hear so much of people who have been dealth the wrong hand by destiny? On the other hand how many people having it all, make their lives a living hell?

So many people die who wanted so desperately to be here with us, so many people live that are wasting their lives - not really living--Feeling miserable all the time. When I think of all those who have gone never to return , their hopes unfulfilled, their goals unrealized, it brings to mind a beautiful and tender poem which I would like to share with you:

To Those I Love

If I should ever leave you whom I love, to go along the Silent Way, grieve not, Nor speak of me with tears, but laugh and talk, of me as if I were beside you there. (I'd come - I'd come, could I but find a way!, but would not tears and grief be barriers?)

And when you hear a song or see a bird I loved, please do not let the thought of me be sad...for I am loving you just as I always have... You were so good to me! There are so many things I wanted still to do -- so many things to say to you...Remember that I did not fear...It was just leaving you that was so hard to face...We cannot see Beyond..But this I know:

I loved you so - 'twas heaven here with you!

Frances Goldstein passed away on March 24, 2009. Her memorial service in Washington D.C. was attended by family members, friends and fellow journalists. Among the speakers honoring Frances was white house correspondent, Helen Thomas.

Black Box Warnings - FDA Warnings

2009-05-04T06:58:00.005-05:00

While there are blackbox warnings against using these drugs for Alzheimer's behaviors, you must also be aware that this video was produced by "Lawsuit Guru". My advice is that you speak with a trusted mental health professional first before making a decision about using any of these drugs for the treatment of behaviors associated with Alzheimer's disease for a loved one. Carefully weigh all of the options. If you'd like to know more, contact a Senior Care Pharmacist who specializes in this field. olga@agooddaughter.com

Guilt and Doing the Right Thing for an Aging Parent

2009-04-29T17:45:00.005-05:00

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?

2009-04-29T10:50:00.007-05:00

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

2009-04-28T13:50:00.002-05:00

View H1N1 Swine Flu in a larger map

HBO Alzheimer's Project

2009-04-25T14:47:00.008-05:00

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

2009-04-20T17:26:00.010-05:00

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

2009-04-18T11:50:00.001-05:00

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?

2009-04-13T14:38:00.018-05:00

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

2009-04-11T09:43:00.003-05:00

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

2009-04-10T23:39:00.003-05:00

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

2009-04-10T14:27:00.002-05:00

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

2009-04-08T16:08:00.004-05:00

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.