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.

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!

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

Often we hear from families, that need services for a parent, that their brother or sister doesn’t think mom needs anything or they feel she needs 10 times the care she really needs to stay safe and well.  This conflict can sometimes delay an intervention that would benefit all family members.

It is hard to accept that a parent is in need of an intervention due to cognitive decline that might impair judgment and safety.  It is also hard to insist that a parent needs help who is physically frail but resists having help.  Often this resistance stems from the unfounded idea that accepting care might be a signal that the family might try to move them from their beloved home.  Having a consultation with a professional Geriatric Care Manager or attending a class for “family caregivers” often allows all the family to hear the same information and make more informed decisions.

Finding the right balance of services for mom, that allows her to retain her dignity but keeps her safe, should be the goal of meetings with geriatric professionals.  Mom’s values will have to be considered in any major decision in order to preserve quality of life.   It is important that families choose to work with someone who is certified as a care manager and a member of the National Association of Professional Geriatric Care Managers.

Making pre-mature and not well thought out decisions can cause great stress to families – know your options, know the costs and look for solutions that respect the dignity and values of the older person.

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

I have a wonderful company to lead and we always refer to ourselves as the “team”.  No matter what you do or what your job description is, you work for a common goal. In our case, it is quality of life for elders and peace for families.  We acknowledge that the journey of aging can be stressful and very hard for individuals and families to seek help.  We all think we should be able to do anything alone – forgetting we can’t excel at all elements of life – we just can’t be objective when it concerns someone we love.  We turn to doctors, lawyers, accountants, and we should also turn to those who have expertise in any area we find challenge or dilemma.

One of the values for families using Eldercare Services Professional Care Managers in the San Francisco Bay Area is that we resource each other when looking to solve a problem or find an appropriate resource/service for a client.  This means that the “collective wisdom” of 20 very experienced, well prepared and certified care managers is sourced for every challenge the family faces.  This is the reason many families choose our company over others who may have limited professional expertise.

Adding a Geriatric Care Manager to your family’s team gives them the ability to use objective eyes to see with clarity what they can’t because of past history, unrealistic expectations and sometimes just denial.   The professional Care Manager will help the family see, in their own time, what they need to see, will guide them in the options available, help them with challenging decisions and act as an advocate when or if needed.  They are the “quarterback” on your family’s team – making calls that will meet the goal of winning, when it comes to peace, during a crisis or challenging decision.

Sometimes a family only needs a map on how to get from base to base and other times they need a coach, a trainer and a shoulder to lean on when the process is tough. Teams need leadership but the leader should always take into consideration the value and goals of the client. That is what we do on our team at Eldercare.  We make recommendations based on past history, client values and existing resources.  The client (older adult) is our primary focus; however, the entire family is always in the broader picture.

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

 This was given by a 92 year old client to a Care Manager in the mid-west:

 ”Remember the five simple rules to be happy:

 1. Free your heart from hatred.

 2. Free your mind from worries.

 3. Live simply.

 4. Give more.

 5. Expect less.”

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

It has been my honor, over the past 25 years, to help people make hard decisions such as giving up a home of 50 years for a retirement community or a downsized condo.  One comes to this decision from various paths; economic reasons, health concerns, loss of spouse or wanting to relocate near adult children.  Sometimes, just because home maintenance is too much and the senior wants to travel or have less of the “have to do” chores in their life.

 What I do know is that people who are socially engaged live longer and happier lives according to research.  That individuals who have purpose and meaning in their lives are healthier than their peers without purpose.  I also know that people who have had major losses through death of spouses or friends that continue to have meaningful lives live longer as well.

 So, if you or someone you love is facing this dilemma you should consider having at least one hour with a Professional Geriatric Care Manager who can help you with your list of pros and cons before making a major move.  It is often beneficial for the elder to have this conversation with an objective professional; so the end result is your decision and not influenced by family members’ or friend’s value systems. 

 More and more Baby Boomers are thinking long range and looking at options early in their “autumn” years.  Better to be prepared than have to make decisions in a crisis.

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

We experience the world through our senses.  When one or more of them is affected by disease, accidents or the aging process, it diminishes one’s ability to function at optimal levels.  As one ages, the loss of hearing or sight might contribute to isolation and/or depression.

 The aging process causes some changes in vision such as a yellowing of the lenses which decreases color discrimination and depth perception.  Presbyopia is the inability of the lens to focus sharply on nearby objects. Resulting from the loss of lens elasticity, it causes the majority of us to wear magnification glasses after age 40.

 Another common age related change in the eye is difficulty with light/dark adaptation.  This is the reason many seniors decide not to drive at night or go into a darkened movie theater during the day.  To see well, Elders need about 3 times as much light as 20 year olds.

 Disease and accidents can lead to blindness.  Many individuals suffer from macular degeneration but should be aware there are new treatments for the “wet type” of this condition. Glaucoma is a silent and often undetected disease of the eye that can lead to blindness. 

 Vision should be checked at least every two years and more often for those with diagnosed conditions.  Those with a dementia should not ignore having vision tested – poor vision can contribute to increased confusion or safety hazards.

 Hearing is also important to our safety and well being as well as quality of life. About 10% of those over 65, and 25% of those over 75, have hearing loss that interferes with daily activities.  All hearing loss should be evaluated as it may be the build up of earwax, which can be removed to improve hearing.

 Throughout life, we lose taste buds mostly by burning the tongue with hot food.  A loss in the ability to smell and taste can reduce appetite and lead to malnutrition and weight loss or cause individuals to over salt or sugar foods leading to other health issues. 

 Touch and pain sensitivity can be part of the aging process or related to chronic aging related illnesses such as arthritis, Parkinson’s disease or stroke.  A decreased response to pain can lead to severe burns or other problems associated with slowed blood circulation as well as decreased heat-producing activities of the body.

 Individuals should have senses evaluated at least once every two years and more frequently if diagnosed with a condition that warrants monitoring. Those who live alone might be at a higher risk for accidents related to sensory changes and should have a system that they create – an emergency response system and working fire/smoke detectors in their homes. 

 There are many new inventions to assist those with hearing and vision loss, most notably the free communication devices provided by local telephone companies.  Seeing, hearing and helper dogs are also available to serve those with sensory changes.

 Sensory Check List

 1. Check hearing & vision at least every 2 years

 2. Be observant of changes in eating habits

 3. See a doctor about increased or decreased pain sensation

 4. Contact a Professional Geriatric Care Manager (www.caremanager.org) about tools to assist  with sensory loss

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

On August 6, 2009, I contributed to a story in BusinessWeek, “The Elderly: Finding a Good Geriatric Care Manager“. What I would have wanted to add to the story is that just because someone has an educational degree or calls themselves a Geriatric Care Manager it is best to ask two important questions:
1) Is the professional a member of the National Association of Professional Geriatric Care Managers at the certified level?
2) How long have they practiced as a care manager, not a nurse, social worker or other geriatric professional? Look for a minimum of 3 years before hiring a care manager.

Geriatric Care Managers have to be very aware of the health issues of aging, legal issues, family dynamics, local resources, overseeing home care and finding benefits and entitlements. This is a profession that requires critical thinking and staying as current as possible on all the issues presented to aging families. Most especially all care managers should have a good handle on dealing with dementia’s and the behaviors that challenge family members.

We can’t expect one person to know everything – but a good Geriatric Care Manager will know where or who to refer you so that you get your answers for questions outside their field of expertise.

Please see our website and look at the backgrounds of the Geriatric Care Manager’s that work for Eldercare Services.

Professional Geriatric Care Manager Supervisor, Patti Liberman, RN, MFT, CMC

I have a client.  Her name is Jackie.  She is dying, but she doesn’t think so.  She looks fondly at the mourning dove settled in her nest in the flowerpot hanging over the patio of the board and care home that Jackie now calls home.  “I love sitting in the garden” she says.  Even as she struggles to breathe and they are taking her out on a gurney to the hospital… she tilts her head up to feel the warm rays of sunshine.  She closes her eyes and her entire face is smiling in appreciation of this great gift.  Jackie is dying………or is she just really living?

It is a time like this that makes me feel so privileged to be a Care Manager.