Archive for the tag “eldercare”

You found the right assisted care facility but can your parent stay there long-term?

elderman

Be very careful when you help your parents move to an assisted living facility because they may be kicked out just when they settled in and think of the place as “home.”

Why?  Assisted care is just that—“assisting” a person who isn’t doing well at home and needs help with what are referred to as “activities of daily living” or ADLs. These include bathing, toileting, dressing and transferring (from bed to walker or wheel chair, etc) and help taking medications. Think of ADLs as the “personal” chores of day-to-day life. The assisted care staff is more “custodial” versus the “skilled” care of a nursing home. However, an RN is often on staff of the assisted care facility and able to administer some procedures such as insulin injections multiple times each day if needed. The decision about what is offered can vary from facility to facility and the monthly fee usually increases with escalating care needs.

When searching for the right facility for clients, most have said they will even keep the elder if they should suffer Alzheimer’s or other types of dementia.  As long as the client isn’t on an IV or some type of advanced procedure, they would be able to live out their life within the assisted care facility. This is important to older adults and their adult children because transitions are extremely difficult for elders. I’ve known of cases where within a few days or weeks of such a move, the very healthy elder died. The move was simply too much to absorb in a life already filled with losses.

Since few older adults will require skilled care provided in a nursing home, the assisted care facility should ideally be their last move. If they suffer a fall or pneumonia or other disease or injury require skilled care, they may be required to move to a nursing home for a brief stay to recover but then they should be able to return to their assisted care facility.

However in a two situations we recently experienced with elders we knew, the elder was asked to leave the assisted care facility. In these cases, it was determined by the assisted care facility administrators that client’s level of care had escalated and now required skilled nursing care that could only be provided in a nursing home.

On the outset, while sad that the elder must move again, it seems reasonable if the care required had truly gone beyond what was normally provided in assisted care.

However, in each of these cases, the children of the elder and the elders themselves stated that while they needed more support dressing or transferring, etc, they weren’t on IVs, in a coma or requiring advanced medical procedures or experienced nursing beyond medication management.

What these cases had in common was that each of the elders had outlived their personal financial resources and had transitioned to Medicaid support which pays less than the rates typically charged by facilities. In both cases, these facilities said they would keep clients who began as private pay and moved to Medicaid so they couldn’t ask the clients to leave based on the change in finances. However, they could make them leave if they could prove the elder required skilled care. I found it interesting that in two cases mentioned, the assisted care facility had been taken over by a large chain. One can’t help but wonder if the new owners wanted only private pay clients in order to maximize their income potential.

In both circumstances, the elders and/or their adult children filed a grievance and both won their cases allowing the older adult to remain in the assisted care facility.

If you think it’s possible that your parent could outlive her resources when moving to assisted care, be sure you understand the facility’s policies about Medicaid. Additionally, if your parent is asked to move, you can and should appeal.  As part of this process, get an ombudsman involved. If you are in Oregon, go to: http://www.oregon.gov/LTCO/Pages/index.aspx. If you are in any other state, Google “long term care ombudsman in XXX [your state]” or call the local Area Agency on Aging (AAA).

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Finally, when considering the possibility of moving your parent to a facility, call a geriatric care manager (GCM). We are experienced in listening to yours and your parents concerns and needs and advising about programs and support available that may allow them to stay at home. When moving is necessary for safety, we will help select the right facility that will support safety while also encouraging maximum, capable independence.

~ Susan

 

 

5 Ways to Shake Up a Caregiving Rut

ducky

Are you feeling exhausted, stressed out, guilty or plain fed-up about caring for an elder? Often when a caregiver is frustrated, so is the elder. Stop doing what you are doing that isn’t working and consider SHAKING IT UP!

Time Together

Elder: As we age in to the oldest old years it becomes a time of loss. Elders lose friends, physical abilities, independence, dignity and seemingly anything resembling control. Everyone else thinks they know what’s best for them and often do not bother to ask for the elder’s opinion. Decisions from the unimportant issues like when they may want a bath or what they want to eat to the big life changes like taking away a driver’s license or deciding where they want to live. These choices become dependent on other’s availability or needs rather than the desires of the elder.  Often days are filled with an abundance of time to focus on not feeling well, medication concerns or side effects, next doctor’s appointments, boredom, and how to get some more attention from whom ever can fit you in to their busy schedules. It’s no wonder elders have a reputation for being cranky. Depression and suicide rates are high in the elderly. White males over 80 have the highest suicide rates in the elder population. National Institute Mental Health reports, “Depressive disorder is not a normal part of aging. Emotional experiences of sadness, grief, response to loss, and temporary “blue” moods are normal. Persistent depression that interferes significantly with ability to function is not.” The problem with negative feelings in the brain is when we dwell in negative thoughts we have more negative thoughts, so disruption in the situational sadness may help those with normal mood changes become more engaged.

 

Caregiver: Maybe you love the person you care for, maybe you don’t, but either way you are the one in the trenches doing the work. If you’re lucky you have support from other family and friends, but then again they may be causing a lot of the stress involved in caring for an elder. But still, each day you roll up your sleeves and do it all from errands and medical visits to cleaning backsides and dirty dishes, only to get up and do it all again tomorrow. If you are a long distance caregiver you spend twice as much money as a local caregiver trying to support your elder and panic every time the phone rings, not to mention the struggle with guilt that you want to be with your elder more; or guilt because you are happy to be with them less. You hear about self-care and how important it is, but you are baffled by who has time when your head is down and you are just trying to get through the day, week, and month! Possibly you are part of the sandwich group who have several generations you are caring for at home and another job outside the home.

Does any of this resemble what is unfolding for you in your caregiving journey? Well you are in a very large club. In 2012, 15.4 million family and friends provided 17.5 billion hours of unpaid care to those with Alzheimer’s and other dementias alone. Eighty percent of care provided in the community

is delivered by unpaid caregivers. and the majority of caregivers are women over 45. With numbers like these, being in a caregiver’s rut could be the next national health hazard!

 

So how do we shake it up, find the silver linings or just simply do it different? Let’s begin with deconstructing the pattern…

 

  1. Dialogue ~ look at the routine you have when talking with an elder. Is it utilitarian habit or are you engaged in meaningful conversations? Do you talk to them as a petulant child or cower every time they raise their opinion? Communication tools can go a long way here. If the elder you care for has cognitive disorders, watch some of Teepa Snow’s http://teepasnow.com/wp/ training videos on communication skills for elders with dementia and Alzheimer’s disease or catch one of her talks locally (see her website for details). Some very basic changes can make a world of difference. For mentally healthy elders, communication tools are still very useful. Lifelong patterns over the family life course can make it difficult to change patterns but there are tools to help. Activities that create new ways of talking can be around the elder’s need to share stories. Engage in storytelling tools and activities at a level the person can handle. From computers, journaling, genealogy research or simply inquisitively chatting over a bath or over the phone can make a mundane activity more of an adventure. Elders have a need to tell their stories over and over as a way of processing their lives as time here grows shorter. This is where the details of life live and this rich activity will yield pearls for you as well as the elder.
  2. Outings ~ A friend recently told me that upon visiting her parents a few months ago in another state she took them out for a drive. Her father barely ambulatory and her mother prone to falls were thrilled to be going out. On this journey she surprised them and took them to their favorite Jazz Club where they went when they were younger. She enlisted the help of a waiter and got them situated in the back of the room. As the music played on she said she could see the years melt away and their younger selves emerge. For 3 hours they enjoyed a part of life that had been lost to them. They have a code name now for when she comes to visit so that other family members do not know what they are up to on these outings. How empowering! This could not have been an easy outing for my friend, but it gave her immense pleasure and changed her parent’s outlook completely. If this is too adventurous for your elder perhaps just a drive around town; or closer to home set up a Skype session with an old friend, do some snail mail letter writing or perhaps engage in a beloved hobby like baking where they can sit close by and “teach” you a favorite recipe. If your elder has cognitive issues, setting the table, walking through the garden, folding laundry, or dancing all become enjoyable new adventures. Don’t give into the usual routine; Shake It Up so it is fun for you as well. Portland has a beautiful Alzheimer’s memory garden where you can take your elder (http://www.portlandmemorygarden.org/PMG/Welcome.html).
  3. Self Care ~ OK we are diving in the deep end now. Funds are low, time is scarce and what is self care anyway? Simply put it is a change of environment to recharge your batteries. Connect with the spiritual side by gardening, taking a labyrinth walk, attending church or joining a choir or painting class. Identify something that brings personal joy and fulfillment for a few minutes a day and a few hours a week and a few days a month. No one will give you permission to enjoy something without regard for others, so you must be strong enough to go for it without permission from anyone but yourself. Typically caregivers put themselves last, which makes you the worst advocate for your own selfcare. By putting yourself last, you will likely have less patience and unlikely to find joy in your caregiving role. Magical things happen when you practice self care. Perhaps your biggest challenge is getting a good night’s sleep. If you can afford it, hire a professional caregiver to come in 2 nights a week so you know you will get some relief. If you are long distance, hire a Geriatric Care Manager to pop in and check on your elder and/or his care givers every week or month. If funds are tight, barter with friends to come spend the night in exchange for a homemade pie or watching their elder or child during the day. Get creative and reach out to local support groups and social services that will allow you the time you need when you need it. If you schedule it on the calendar it will happen. There are some ways to combine self care with your care giving activities. Give your elder a sacred foot massage and make a ritual of lighting a candle and using lotion or oil with a scent like lavender or chamomile. Then if the elder is able have them do the same to you. If you can afford to have someone come in and give you both foot massages then make it a weekly or monthly routine. There are many massage therapists who will come to your home. My favorites are Sister Emma at the Franciscan Center in Milwaukie, Oregon (503-794-8542) or Sister Delores at St. Mary’s in Beaverton (503- 944-9641). The important thing is to schedule the time and make sure it happens. Have someone come in for one day a week and you decide what you feel like doing that day. The answer may be nothing or a nap. That is OK! Learning to ask for help is the biggest challenge for caregivers. Do it, you will be surprised where the help comes from. You will be surprised once a routine is in place how your relationship with your elder improves. They may protest at first or even always when you leave them, but the benefits will come.
  4. Empowerment ~ it can be exhausting making decisions for another human being. Too often feelings of guilt or inadequacy flood in even when you are doing just fine. Know that nothing in the world is perfect and you simply being there is an amazing gift. The rest is all gravy. To help cope with the times it can be emotionally overwhelming, try learning a few mindfulness techniques. Our local psycho-therapist Donald Altman (http://www.mindfulpractices.com/) has some great tools for breathing and meditation that can help when things get stressful for you or if your elder is in a funk. Space cannot always be achieved physically, so having techniques to navigate through these times is priceless. These tools can be used by your elder as well. One of the best methods to decreasing your decision fatigue is by giving back some of the responsibility to the elder. Depending on your situation, the answer may be a modified version, but honoring their level of ability to give an opinion can go along way for both of you. Give your elder decision making power whenever possible. You are there to keep them safe. There are also local classes available designed by Legacy Health for Caregiver Help. This course is offered in many places from senior centers, hospitals, and even at the Franciscan Spiritual Center. The course is designed to teach you about community resources, care strategies, support group and self care. All great ideas to Shake Up your current routine.
  5. The Unexpected ~ If you haven’t already, begin building a support network: Online, in-person or host a weekly meeting in your home. Whatever you have to do to be with others going through the same important work you are doing. It is too common to become isolated with an elder. This is not good for you or them. Have some social activities in the home even if your elder does not engage. The presence of others can be soothing or annoying, so be aware of the best format for your situation. Online could be a great way to support long distance caregivers, start a facebook group and open it up for members. As life unfolds with your elder health challenges may increase, a need for hospice may arrive, or a medical need for a move into a nursing home or rehab center may happen. All of these situations can create crisis and stress for the caregiver and elder alike. Having medical, social, and caregiver support nets in-place can make the transitions easier. Our Geriatric Care Manager services can also be part of this safety net, there to pull the resources together to make sure the decisions for your elder are coordinated and serve the elder’s best interest through advocacy and care planning. Our website also offers tools and resources to help with these transitions www.FiresideCMG.com

 

As we advance in life it becomes more and more difficult, but in fighting the

difficulties the inmost strength of the heart is developed.

                                                                           – Vincent van Gogh

 

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