2010 June

Who is the Expert in Aging Care Choices?

Posted in adult children, Age Related Issues, Alzheimer's, Blog, Care Management, Caregiving, Dementia and Memory Loss, Elder Abuse and Fraud on June 29, 2010

Founder and Executive Director Linda Fodrini-Johnson, MA, MFT, CMC

There are so many websites leading in different directions, each touting they are the premier, largest, biggest, best option for aging parent home care, assisted living or even financial planning and legal advice.

Where does a family turn? How do families know they are getting someone who is working on behalf of them, with the central goal being quality of life based on client values?

The best way is to ask questions. The venture capital company that has just hit on baby boomer aging might be able to gather some health and human service experts – but do they know mom’s community or your community? It isn’t just expertise that you want guiding your choices, it is knowledge on ALL the local resources, knowledge of benefits, aging, care choices and most of all understanding the emotional toll this can bring to everyone in a family.

So, what questions do you ask? I think these are the most important ones:

1) How long has this company been in my community? Are they local or do they just have a national database?

2) How long have their “experts” been with the company?

3) Are these experts credentialed and certified by a creditable process (not a 30 hour course)? Do they have a license – if so, do they have years in the field doing aging or elder care work?

4) Do they take referral fees from outside agencies, facilities or professionals? If it is a “free” service you can assume so, if it’s not a non-profit or government agency, someone pays.

5) Is this person going to help you make a decision and help you see the pro and cons of each decision as it affects your family members?

6) If you are looking for an Elder Law Attorney, Financial Planner or Geriatric Care Manager, do they belong to a National Association that has standards for membership and certification?

Asking questions will lead you to where you will get the best guidance.

Guilt & Parent Caregiving

Posted in adult children, Age Related Issues, Alzheimer's, Blog, Care Management, Caregiving, Dementia and Memory Loss on June 25, 2010

Founder and Executive Director Linda Fodrini-Johnson, MA, MFT, CMC

View the video blog: Guilt and Parent Caregiving

Recently in talking with a caregiver who takes care of her mother, father and mother-in-law, the ever present “guilt work” came into the conversation.

“Why”, said the daughter, “do I never feel like I do enough or do the right thing”? Well, it is more complicated than this simple answer but, the answer is, you just can’t fix it!

The majority of us have a tendency to want to make something or someone better, to make those who are hurting or suffering from progressive illness, like a dementia, fell better or be less anxious. A parent can have an uncanny way of making us feel like we didn’t stay long enough or get just the right fix to whatever the problem was that engaged us in the interaction. This is often not so much because you have a controlling parent but because of the parent’s anxiety, fear or loneliness.

It is hard to know what the pull is but, if you leave feeling guilty it is often because you can’t truly make the internal feeling that they have go away, no matter what your skills, education, experience or love are. Those who are successful at balancing caregiving with self-care know they can’t fix all problems. What you can do is be “present” when you are with your parent. Express your love and admit you don’t have all the answers. Do your best knowing you can’t fix everything!

Healthy at 100 – Tips On How to Maintain Healthy Relationships In All Stages of Life

Posted in adult children, Age Related Issues, Alzheimer's, Blog, Care Management, Caregiving, Dementia and Memory Loss, End of Life, Relationships on June 22, 2010

Anne Rosenthal, Ph.D., MFT, CMC

We all want to live life fully for as long as possible. Those who live to be 100 years and beyond—centenarians– are an interesting segment of the population to study since they may provide clues as to how this may be achieved.

One of the common character traits of centenarians is the ability to remain connected to meaningful relationships. Here are some tips to help you create and sustain positive connections in your life:

¨ Be kind. You do not need to know what burdens others are carrying to know that they are heavy.

¨ No matter how great the faults of another person, strive to be aware also of his or her good qualities. Know that there is something worthy of commendation in almost everyone, even though it may lie dormant and as yet undiscovered.

¨ Make time for hearing your loved ones’ struggles and challenges. When a friend speaks, listen with your heart rather than your judgment. You may not be able to take away another’s pain, but you can hear it. Afterward, write them a card or bring them a flower to acknowledge and thank them for entrusting you with their vulnerability as well as their strength.

¨ If you are dealing with an illness or personal struggle that may be shared by others, join a support group where you can meet regularly to talk about your challenges, fears, hopes and dreams among others who will understand.

¨ Recall someone who helped you when you needed it. Write or tell him/her of your appreciation. Recognize someone in your extended family or community who has provided outstanding service. Make a certificate or plaque they can put on their wall, or send a note with flowers or food.

¨ For emotionally significant communications, don’t use e-mail. Meet in person, talk on the phone, or write letters that you can mail or hand-deliver. People love getting letters. It can be rare to get anything special in the mail anymore.

¨ Read selections from your favorite books to your family and friends. Give away copies of your favorite books. Tell others what these books have meant to you.

¨ If you want to change the way you feel about someone, change the way you treat them.

¨ Step back every now and then and take an objective look at your own behavior. If someone important to you is being defensive, ask whether you are doing anything to make them so.

¨ Nurture the friendships with which you feel at ease. Move on from those that take enormous energy and stress to maintain.

¨ Read a story to an elder who can no longer see fine print. Record your reading on tape so they can play it back and listen whenever they wish.

¨ Learn from people who are different from you. Greet them with true curiosity, knowing that you can stay true to yourself no matter what the difference. Do not let differences of opinion become causes of estrangement.

Remember that love is necessary for great relationships, but it is not sufficient. Great relationships don’t just happen because you’re in love. They take work, and lots of it.

Dementia and Appointments

Posted in adult children, Age Related Issues, Alzheimer's, Blog, Care Management, Caregiving, Dementia and Memory Loss on June 18, 2010

Founder and Executive Director Linda Fodrini-Johnson, MA, MFT, CMC

A daughter I was working with called and asked how to get her mother to agree to go to a doctor appointment for a flu shot. Her mom has dementia of the Alzheimer’s variety and is starting to become paranoid. The daughter has spent the past 65 years reasoning with her mother, a retired attorney. She was having difficulty not giving her mother all the details about upcoming events, as she had done her entire life.

I had to tell her that the days of reasoning were over. She need now only tell her mother a limited amount of information. Over communication and details justifying an action only make those who are losing the ability to process information more paranoid or angry.

Instead, I told her to just tell her mother she was coming to take her for an outing and lunch. First, they “dropped in” at the doctor’s office. Her mother recognized it when she got there – but did not remember when the daughter tried to explain to her before. She successfully got her flu shot and a brief medical evaluation.

Immediately after the visit the daughter took her mother to lunch with no mention of the medical stop. Mom commented on what a wonderful time she had and the daughter called to thank me for the advice and the reduction of stress she was had been feeling.

View the video blog on this topic: Dementia and Appointments

Incontinence and Dementia

Posted in adult children, Age Related Issues, Alzheimer's, Blog, Care Management, Caregiving, Dementia and Memory Loss, End of Life on June 15, 2010

Founder and Executive Director Linda Fodrini-Johnson, MA, MFT, CMC

Often individuals with dementia are in denial to something as evident as incontinence, deny they have a problem and make excuses for the wetness on their clothing or furniture. This is embarrassing to family members and presents a hygiene issue to the family member with dementia. This could be the sign of a urinary tract infection (UTI) or other physical dysfunction and should always be brought to the attention to the medical provider. Incontinence not cared for properly can lead to a UTI which frequently leads to more confusion and disorientation.

Families call us frequently thinking this must mark the time they need professional help or help in finding a retirement living setting that can accommodate their parent or spouse. But, before such a drastic action is taken seek a consultation with an expert, a certified, Professional Geriatric Care Manager.

This is often the time when a Geriatric Care Manager can intercede and help with individualized plans of care that respect the dignity of the elder with dementia and reduce the stress on the family care providers.

Care Managers find ways, that meet with approval, for the person with dementia to use protection – but, this is usually with very creative ideas. Each person will have a slightly different approach. Sometimes the only way is with the outside help of a professional caregiver that is prescribed by the family doctor for health reasons. Care Managers often get the physician to team with them to reach the same goals – reduced stress for the family and good hygiene for the person with dementia.

Dementia and Communication

Posted in adult children, Age Related Issues, Alzheimer's, Blog, Care Management, Caregiving, Dementia and Memory Loss on June 11, 2010

Founder and Executive Director Linda Fodrini-Johnson, MA, MFT, CMC

It is important in communicating with someone who has Alzheimer’s or a related dementia, to know the words they have always used for a room like the toilet – did they say “powder room”, “bathroom”, ”can” or another?

If your family member is going into a care center, retirement community or dementia care facility and they spoke a language other than English as a child – be sure to communicate this information to caretakers because, as the disease progresses, also do language skills. The word they used in English might be gone, but the word they learned for “bathroom” as a child remains. Language loss will affect both the receptive and expressive language skills.

So, if their most recent language is their second language, give the caretakers a list of important words in the language of origin and a way to pronounce each for communication that is important like: bathroom, bedtime, mealtime, come, stop, go, yes, no.

Loving comes without language and it is our hope that all who care for those who have lost the ability to communicate with language will continue to care with love.

Watch Linda’s Video Blog Dementia and Communication!

Confusion in Seniors During Hospital Stay – It Can Be Confusing…

Posted in adult children, Age Related Issues, Alzheimer's, Blog, Care Management, Caregiving, Dementia and Memory Loss on June 8, 2010

Professional Geriatric Care Manager Supervisor Eileen Zagelow, BA, CMC

How often I have heard from a family member that their mother is in the hospital and seems so confused!

Patients who were functioning fairly well at home often seem unaware, forgetful or anxious when in the hospital. Sometimes there are reports of combative or agitated behavior; or concerns that a patient can no longer function in their current living situation. Disorientation, unusual behaviors and the inability to follow directions are words that break families’ hearts and cause them enormous stress.

It is important to remember that even for slightly confused seniors being out of their regular environment and structure can be overly stimulating. When that is added to their current illness, treatment and a parade of strange people popping in and out of their room all day, confusion can rise dramatically.

Dementia has many faces. Alzheimer’s disease, vascular disease, medication related confusion and oxygen issues are just a few of these faces. When a person suffering from dementia finds themselves chemically altered, physically displaced and surrounded by unfamiliar faces it is “normal” for them to experience an exponential increase in confusion.

When concerns arise about whether Mother or Dad can return home, it is very important to know that this is not a desirable time to make a placement decision. Often times once seniors have been medically treated for their illness and return to the familiarity of their home they can recoup a level of function befitting their living environment, not necessarily back to their previous level, but possibly enough to manage. Indeed, the familiar environment itself can often help in stabilizing seniors. This happened with my own father who had COPD. The doctor said that although he would like to keep my father in the hospital a bit longer, he could see that his confusion and agitation were getting worse. He thought Dad would improve more rapidly in his comfort zone – home. And he did!

There are occasions when a temporary stay at a skilled nursing facility might be part of the “return to home” care plan and other times when bringing in live-in or hourly caregivers may be appropriate until the patient has an opportunity to stabilize.

Fortunately, Geriatric Care Managers are highly skilled in navigating these waters. Their knowledge, empathy and organizational abilities can clarify options and assist families and patients in attaining the best solution for the senior.

“Slow Medicine” a New Approach for Seniors Over 80

Posted in adult children, Age Related Issues, Alzheimer's, Blog, Care Management, Caregiving, Dementia and Memory Loss, Elder Abuse and Fraud on June 4, 2010

Founder and Executive Director Linda Fodrini-Johnson, MA, MFT, CMC

Dr. Dennis McCullough has written a book on Embracing “Slow Medicine,” The Compassionate Approach to Caring for Your Aging Loved Ones called “My Mother Your Mother”.

Dr. McCullough’s approach is a gentle, kind common sense approach to extending medical care to the very frail elderly. He calls for a movement in “attending” to seniors changing needs and not waiting for a crisis that can force extreme medical interventions.

In a nutshell, he is talking about quality of life during the final years. This is a book worth reading if you work in the field of geriatric medicine; eldercare or you are caring for a senior family member.

Autonomy vs. Safety: A Dilemma for Families Caring for Seniors

Posted in adult children, Age Related Issues, Alzheimer's, Blog, Care Management, Caregiving, Dementia and Memory Loss on June 1, 2010

Founder and Executive Director Linda Fodrini-Johnson, MA, MFT, CMC

Do you allow Mom to smoke, despite her dementia and living alone in a senior apartment complex? Do you respect your Dad’s right and autonomy despite his 90+ years of life? With poor vision and beginning forgetfulness, do you allow him to drive across the state to see an old friend who is ill?

Adult children of aging parents face many challenges when concerns of safety conflict with the elder’s choices that relate to independence. At other times, adult children face “resistance” to their well meaning rationalization to the elder family member on why a different choice should be made.

In the first story above, the daughter decided, after attending a support group for adults of aging parents, to tell the property manager who then gave the mother an eviction notice. Daughter colluded with mother and helped her find an assisted living facility that would manage the smoking and the cigarettes as part of the “rules or laws” of that new community. Mother adjusted and daughter wasn’t the bad guy; the apartment manager was. Mom didn’t know it was her daughter who brought this danger to the attention of the manager.

In the second story the son decided to take some time off work and told Dad he would love to drive with him and in fact they could take the son’s newer car (knowing Dad would not want to drive it).

In both stories, dignity and respect were honored and the bad choice was made manageable and without unnecessary drama.

These are examples of some creative family problem solving that respected the elder’s desires and kept them out of harms way. It is not always easy to do this. If you are facing one such dilemma, you might want to attend a support group for adults concerned about aging parents or schedule a consultation to talk with a professional Geriatric Care Manager who can help you with specific, creative interventions.