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

My heart and the mind are in conflict – a challenging choice.

Today the doctor suggests Hospice; a wonderful supportive process of ushering one from this life to the next, with dignity and comfort. My experience says this is a good plan as I have appreciated the wonderful care my clients have received from all the terrific hospice professionals over my 30 years in Geriatric Care Management.

But, for my mom, it can’t be that time – because I don’t want it to be that time. I want her in my life.   So do my brothers and all the grandchildren and great grandchildren. It is so hard to envision holidays and family milestones without her.

I have stepped up my advocacy for mom these past two years.  I know it was that advocacy combined with her never giving up that gave her the last year in Assisted Living in a lifestyle she enjoyed.  If she had stayed in her home I think we would have had to say our goodbyes long ago. One thing that has contributed to her 90 years is her ability to let go of stress and worry. With
every hospital stay she has never fretted or been anxious – is this a lesson for all of us?

I will need to embrace the circle of life because there is no alternative, despite my skills or incredible love for a good mother.

I will talk with the hospice team and with my mom about our choices but I will not give up on hope or the possibility of her bouncing back like she has done so many times before. For where there is love there is hope.

Mom is part of me and all my family so when she does pass from this physical life to heaven’s doors, she will live through each of us in so many little and big ways – we will never truly lose her.

Love is doing what we need, not what we want. Hard choices face us on this journey we share - life!

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

I sit listening to my mother snore – wondering, is this the trip she doesn’t return from? This is the 8th hospital visit in 13 months and she is almost 90 years old. I need to be realistic; this is my field of expertise and I know what the consequences are of her many diagnoses. Yet I can’t get that picture out of my mind of her walking into my office yesterday with one of my staff who had just taken her to a medical appointment for me since I couldn’t attend because I had a speaking engagement.

She was so happy to see me and the other staff. She always gets a certain grin that tells me she is proud of my achievements – it is a grin like no others. Who can give you that unconditional approval like a mother? Is this what I will miss – it feels self-centered to even think this because I know I will miss her for her always helpful advice and her deep faith in a loving God. Not to mention her love for all of her family.

She is a fighter and will not give in so I will stand beside her and help her understand her options and advocate for her at every step on this slippery journey.

All of us need advocates for, without them, our history might not be conveyed in ways that assist the medical team to treat appropriately. We also need advocates to see we can be gently ushered unto our next life, based on our values.

Being the guide when the ultimate outcome is loss and grief isn’t for the faint of heart but this is the role I play in mom’s life now, and it is an honor. I am fortunate she was, and is, my mother.

Thank you, kind and considerate medical providers who work in the ER!

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

As I move more and more into the role of a family caregiver and take my mother to her doctor appointments, I have been acutely aware of the conversations of daughters and occasionally a son to mom or dad.

Then I remember the last time I took mom to an appointment – seems to be about every 10 days to 2 weeks. Yes, even with 30 years experience I still answer those repetitive questions as kindly as I can and inside I feel pain for the mother I have lost due to the devastation of a dementia. I must admit I have the tools to use to divert and redirect the conversations, yet inside at the core of my being, I feel grief (and with a smile).

I don’t think my mother has a clue how her changes affect me – however she seems to tell each doctor, “I don’t have to worry, I have her” – she says as she points to me! And with that, I know my love is visible and my grief is hidden.

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Professional Geriatric Care Manager, Eldercare Services, Jean Tokarek, MPA, CMC

Realizing that your loved one’s end of life is upon you is not an easy event to face or admit.  Telltale signs can include refusing to eat or take medications, taking to their bed, sleeping all day and having more difficulty with ambulation.

When this occurs, their primary care doctor should be contacted who may order some lab tests to rule out any vitamin deficiencies, dehydration, assess for depression or other things medical going on with the body.  If the doctor clearly feels that Mom or Dad is at the end of their life, hospice services can be ordered and brought into the home to make their last months most comfortable and a reflective time to be had with family members and friends.

The hospice team can be a godsend when Mom or Dad’s household and health are in a state of flux.  The RN case manager will assess the patient for pain and symptoms, recommend comfort medication and order medical equipment such as a hospital bed to relieve pain and suffering, and educate family members and other caregivers on what to expect when your loved one declines in function.  The social worker will help out with any practical financial issues like Powers of Attorney, burial plans and hiring additional in home care if needed.  A home health aide will come to the house 2 to 3 times a week to give patient a bath or shower and change the bed linens.

Volunteers are available to be with the patient and give family members a break for a few hours a week.  The chaplain will make home visits to attend to Mom or Dad’s spiritual care and a bereavement counselor will work with patient and family members with any anticipatory grief concerns.  The hospice team will work very closely with the family and or care manager with any medical or psychosocial concerns of the patient.

One of the hardest things for both family members and caregivers to watch is when your loved one stops eating.  When this happens, they can lose weight very quickly and rarely relieve their bowel or bladder.  It is best to encourage Mom or Dad to eat but not force feed.  At this point, the patient knows when they have had enough and gradually their body will begin to shut down.

When the eating process slows down, it is not painful to them but important to know that the patient needs to be kept comfortable.  An extra blanket, some soft music that they enjoy, ice chips for thirst, a cold cloth on the forehead and a gentle touch of the arm can mean so much.  It is also during this time that meaningful conversations can be conducted with family members and friends to reminisce about happy, earlier times and to let your loved one know how much he/she means to you.

Hospice RN’s are also available to the patient and family 24-hours per day.  If there is a drastic change in medical condition with your loved one, it will provide comfort to the family to know that an RN on the other end of the line and his/her expertise is only a phone call away.

End of life situations can be a very difficult thing to plan for and discuss with family members.  Knowing that there are resources available and having the discussion on how to proceed sooner rather than later will make the last chapter of a loved one’s life less chaotic and will be spent comfortably and surrounded by people who are very important to them every step of the way.

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

My mother was hospitalized with pneumonia for four days and when I went to help with the discharge I brought her clothes.  As I helped her get dressed we struggled with her camisole and she said, “When you were little I helped you get dressed now you are helping me.”  And, I said, “but I didn’t have all the same body parts as you then” and we laughed till the tears came as she was caught in the camisole!

There was pure joy in that laughter even though for both of us on some level experienced grief from the lost of independence for mom and the loss of my once fiercely independent mother for me.

As a daughter and a professional, I am able to take her comments that might hurt me and softly explain without defending myself or using rationalization in my response in order that she doesn’t feel bad about her loss of memory or independence.  This doesn’t mean I don’t need to process my feelings with family, friends and colleagues.

A good example is she called yesterday and said, “Did you know I was in the hospital?”  Of course I did!  I brought her there and I was there till 9PM the night before.  But, my answer was not that – it was, “Yes, I know and I am waiting to hear what time
you will be discharged today.”   This answer completely made her feel heard and not bad that she could not remember.

Our responses to our parents who are losing memory and independence can make all the difference to their quality of life.   Love does get though; however, it can bring joy as you look at this passage as a gift of learning, giving and just being!

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

Many individuals experience great anxiety when they see items in a home that they once used and operated but no longer can due to the advancing ravages of a progressive dementia.

Most families and professionals feel home is the greatest place of comfort – and for many that is true.  In fact, for some individuals with a dementia, a trip away from the home causes great anxiety and challenging behaviors.

However, it has been my experience with some individuals who see a bank statement or a cooking utensil, that they once used but now don’t know what to do with that item, become very anxious.   Sometimes they can become angry thinking someone or something made the items not usable and this anger gets projected on the spouse or family caregiver.  This is because they are constantly reminded by the familiar of what they can’t do and that causes great frustration.

Those individuals, who experienced a high level of anxiety and frustration in the home, often settle down in a “dementia designed” care facility.   This is because they are not presented with any activity or request that reminds them of what they once did.

One of my clients became extremely angry whenever she saw her husband start to cook (in 60 years he had never boiled water).  She would yell at him to leave the kitchen – yet not be able to make a meal.  He learned to gently get her in the den with a cup of tea and then he would quickly prepare a frozen meal, put it on the table and tell her the dinner she made was done.  This worked for him, but for others it might not.

The environment can be the problem, as can be our communication style.  Learning new tools to live each day with a family member with a dementia, such as Alzheimer’s, is critically important to preventing caregiver burn out.

If you are unsure of what is best for your parent find a Professional Geriatric Care Manager to give you an objective assessment of what would be best for all family members based on values as well as needs.

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Certified, Professional Care Manager John Doxey, MA, CMC

When families conclude that it’s no longer safe or feasible for an elderly relative to remain in his or her own home and the search begins for long-term care facilities, the first thought that comes to mind for most people is “assisted living.” And when thinking of assisted living, the image that pops to mind most often is a large, hotel-like facility with multiple dining rooms, an upscale ambience and a robust activity program.

But there is another, often overlooked type of assisted living facility, commonly known as “board and care,” that can be a good option for older adults needing residential care, particularly those with dementia or complicated medical conditions that require regular monitoring.

Board and cares are smaller-scale facilities, often converted family homes tucked into residential neighborhoods, and most are licensed to provide care to between four and six residents. Unlike the larger assisted living communities, which are often owned by regional and national chains like Aegis and Sunrise, board and care homes are typically owned and operated by individuals or families.

Although they aren’t as widely known as their larger-scale cousins, board and cares have been around for decades. And more people than you may think live in board and cares: about one-third of all American assisted living residents live in facilities with fewer than 16 residents, according to the National Council on Assisted Living.

Like other assisted living facilities, board and cares help residents with activities of daily living such as bathing, eating, dressing and using the bathroom. Live-in staff also provide meals, activities, transportation to appointments, medications management and other services. Most board and cares are licensed and equipped to accept non-ambulatory residents, most can accept “wanderers” as long as there are alarms on the doors, and many have waivers that allow them to accept residents with dementia and hospice care.

One major advantage of board and cares is their high staff-to-resident ratio – usually two staff members for every six residents. In comparison, standard assisted living facilities, which often have more than 100 apartments, typically have about one staff member for every eight residents during daytime hours and as few as two staff members for every 100 residents at night, although staff ratios are higher on floors with higher-acuity residents.

The higher staff ratio allows staff to get to know residents more intimately and to keep a closer eye on their habits and routines, such as whether they are eating less or sleeping more than usual. The higher ratio gives staff more time to help residents with high levels of physical or cognitive care needs, including those with moderate to advanced dementia, Parkinson’s disease, incontinence and problem behaviors like resisting care.

Their smaller scale and home-like environment can also make board and cares a more comfortable place for people with dementia, who may become confused or over-stimulated in facilities with long halls, large dining rooms, and lots of staff and residents.

Another reason to consider board and cares is their cost. While basic fees at larger, upscale assisted living facilities average around $2,500 to $5,000 per month for a studio apartment in areas like Walnut Creek, Lafayette and Moraga, basic fees at board and cares in the same areas range from about $3,000 to $4,500 per month for a private room. And unlike most assisted living facilities, board and cares typically do not charge extra for medication reminders or use tiered pricing that raises monthly fees as residents’ care needs increase. Long-term care insurance and other types of assistance programs may help people pay for board and cares, which is also the case with standard assisted living.

Naturally, board and cares are not the right fit for everyone. Older adults seeking a higher level of social interaction and a wider variety of stimulating activities, and those who are more independent and need less care, may find a better fit in larger assisted living buildings. Board and cares generally offer fewer activities and residents often spend a lot of time watching TV.

Some families may also feel more comfortable moving their loved ones into larger assisted living buildings because they are a more familiar commodity, with a standardization enforced by national and regional chains. There is greater variation among board and care homes, and therefore a greater need for due diligence by family members both before and after a loved one moves in.

In addition, some people may be turned off by the home-like atmosphere at many board and cares. The daughter of one of my clients told me she wouldn’t consider moving her father into a board and care because it felt too much like their family’s home and that her father would prefer a more upscale and more institutional environment.

So…different strokes for different folks. But board and care homes are often an option worth considering.

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

Cynthia Ramnarace of AARP released this article in November 2011 and I think it is worth sharing.  Anyone with an aging loved one will know exactly what the writer is talking about.

There are several compelling tips on how to manage the inevitable caregiver crisis.  Knowing what to expect and how to react is half the battle.  <<Read the Article>>

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

None of us want to lose capacity – with our mobility, energy or cognitive abilities (memory).  But, with longer lives comes changes in physical and sometimes mental abilities that face the best of us.  Many of these changes are natural and are expected. Some, like a diagnosis of a progressive illness or medical incident like a stroke, hit us suddenly.

Often times we don’t even seek a consult as we experience changes as we age because we attribute each change to a part of the circle of life.  However, that is called “reverse ageism” – not advocating for the highest quality of life and highest level of functioning possible because you think the change is just part of aging.  There have been many medical breakthroughs in the past 10 years and we should always seek ways in which to make our lives better.

The best way to be proactive is to sit down with an expert (Professional Care Manager) and go over your needs, desires and wishes for all the days of your life.  This is an endeavor you take on when you are healthy, not during a crisis.

The professional will gather your values, interests, wishes, desires and help you look at options should you ever need support or assistance for a short or an extended amount of time.   Once you have done this, you can take this information to your estate planning attorney and/or financial planner to be sure they document your wishes in order to have your decision maker follow them should you lose capacity.

Our care managers meet with “you” the client annually and call quarterly with those who want to be part of our “Proactive Planning” club.  This allows an opportunity and time to update the professional on any desired changes. This gives the individual or couple the reassurance that, if something does change in their health status, they have a professional patient advocate, care manager available 24/7 to pave the way to a good outcome. 

The professional will advocate for the client and work with the client’s care team and family and base all decisions on the desires and values of the individual and not others.

If you are interested in our “Proactive Planning” club, give us a call and we will give you all the details that will leave you feeling free to live your life not worrying about what will happen when health or environmental changes occur.  You know you will have an “angel” with great skills who knows you to guide any care or decisions based on your values!

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Professional Geriatric Care Manager Supervisor Eileen Zagelow, BA, CMC

Life is filled with processes. Although we would sometimes like to think of life changes in a linear mode, it is true that a process or several processes often need to take place. Sometimes we “see a need and fix it”. That works well for certain things for example, providing transportation to medical appointments and helping with the grocery shopping.

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