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

When you get that call that your parent has just been taken to the ER, you need to either get there ASAP with a list of current medications or fax that information into the emergency room.   If you are an “agent” under an Advanced Directive or Durable Power of Attorney, you should bring or send that as well.

This information could be critical to the care of your parent and is a great help to the attending physicians.   Having a one page history with medical diagnoses and hospitalizations is also helpful to the elder’s triaging team.

However, emergency rooms do make mistakes, as do hospitals, in general.  So, the need for advocacy increases.  On a recent ER visit and subsequent hospitalization for pneumonia, my mother was sent with a list of her current medications from her Assisted Living community but the hospital somehow reverted back to the list of medications from her hospitalization 5 months ago.

This error was not discovered until after she was re-hospitalized (within 2 hours of being discharged) for what looked to be a stroke and later was discovered to be dehydration.  By the way, it was me who was questioning the discharge medications that discovered they were not giving her the correct medications.

Not only do you need to bring a list of current medications, you need to reconcile this list and ask questions about the medications your parent is being given in each department or floor they are admitted.  Medications can change depending on the new diagnosis – but this should be explained to you and your parent.  Ask questions – be safe!

If you live a distance or detest hospitals, hire a certified Professional Geriatric Care Manager – and we will be that much needed patient advocate during any hospitalization.

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

Most of us are aware that individuals close to the end of their journey on this earth can have the care and attention of a Hospice service.  Generally this is provided for those with a diagnosis of 6 months or less of life.  If one is covered by Medicare, the services of the medical providers, comfort medications and some durable medical equipment are covered, given the individual doesn’t want to be taken to a hospital and are in agreement to be given general “comfort measures” only.  The Hospice movement has gained ground in the past 30 years after getting its start in England.

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Professional Geriatric Care Manager Supervisor Eileen Zagelow, BA, CMC

…unless it is necessary. When asked if she tasted the ribs at a recent bar-b-que my mother said, “No, I didn’t serve myself.”  One of the guests said, “Well, you were right behind me in line”.  Mom looked confused and I just changed the subject to the ingredients in a salad on her plate.

Later on while cleaning up the kitchen (something she still does a good job at) I asked her again if she tasted the ribs and she again said, “No, I didn’t serve myself”.   I just responded with, “oh, that’s too bad I will make hem again the next time you come for dinner”.

When an individual with a dementia, or illness that causes short term memory loss, makes an error, it isn’t recommend that you correct everything they say that isn’t actually true. When you are constantly correcting someone they start to feel bad about themselves and it actually affects self-esteem and could cause depression.

You do need to correct misinformation like the wrong day of an appointment, party or other date.  And
when you do this correction – do it lightly such as, “I know I can’t keep all these dates straight myself – let me put it on your calendar.  I’ll call you the night before so you have a little warning.”  However, you might also need to call the morning of the appointment as well.   Some family caregivers wait till the hour
before… choose a timing that works for you and your family member.

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

A few months ago, my siblings and I were getting ready to move our mother from her homestead, where she had lived for 48 years, to a vibrant assisted living community in another town. As we were trying to accomplish this task, it made me feel like Mom was moving away to college—the big difference being college at 18 versus assisted living at age 85. 

Think about it.  You select a college, hoping it will meet your educational, social, spiritual and political needs.  You may be going to a college town that has a different culture, meeting new people and making new friends.  Not to mention your dorm room space will be a lot smaller than the old homestead that you grew up in.   There will be structure, such as meals and classes at appointed times.  This scenario is very similar to an assisted living community.  The problem is that our parents may be frail, have complex medical conditions, unfamiliar with their new surroundings and/or not be as able bodied to accomplish the task on their own.

For starters, you may need to get the house ready to be put up for sale.  What belongings, keepsakes and furniture will she take with her?  How do you sort out the junk from the treasures?  A family activity that can be rewarding, as well as bond parent and child, is to go through household items, clothing and keepsakes together.  This will give mom a chance to reminisce, as well as take stock of her life.  Once the items are chosen to move, family members can help mom make the little apartment she will move into homey and inviting.

A parent’s medical oversight is key to their health and well-being.  If she is moving to a new town, new doctors will have to be found.  Does the assisted living community have a doctor on site?  Are there relatives, friends and/or colleagues in the area that can recommend new doctor(s)?  Can her existing doctor(s) make referrals?  Is her medical condition so complex that she may need a primary care doctor, cardiologist, neurologist, dermatologist, as well as dental, eye and foot care?  A way to get mom on the right road is for a family member (or other advocate such as a Professional Geriatric Care Manager) to accompany mom to the first visit with her new primary care MD and then see that all the physicians communicate with each other.

Making new friends may be an overwhelming proposition at the age of 85, especially if the community has over 100 residents.  Before mom moves in, be sure to touch base with the Directors to make sure that mom is introduced to people that have her special areas of interest, such as the gardeners, bridge players, classical music listeners, museum goers.  It is easy for a staff member to seat mom next to a gardener at the dinner table, if that is her thing.   A staff member can encourage mom to attend the exercise program or museum outing that other residents will be attending, if that is her special area of interest.  Once this is done, friendships can be made early and develop naturally.

Moving an older person to an unfamiliar setting can be a daunting task as we all become creatures of habit when we get older.  If we take the needs of our loved ones as the first priority and see them through in getting them settled, transition from home to residential care will be easier and make this chapter of her life one that our parent remembers fondly and can be spiritually rich.

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

Last night, after my mother called and could not remember why she made the call, she said, “My memory is really bad.” This is the first time she admitted to her memory loss since her stroke. However, she did make the call 15 minutes before Jeopardy and told me that is why she called, knowing I would be watching that program in a few minutes.

The strategic planning of when to call and what the other might be doing is part of the executive functioning of the brain and, as a clinician, it is a clue to me on the difference between someone with Alzheimer’s dementia and someone with a vascular dementia. Clients with Alzheimer’s disease would have just called at any time as they are often unaware of the needs or interests of others.

My response to Mom was to say, “Well, we are working on getting some of your other brain cells to recover.” That might not be a possibility and she might always have a severe short term memory problem – but as a family member and a professional, I never want to take away hope. Some might say that is not being honest and I that I should have just said, “You had a stroke so your memory is not going to get any better.” But, to tell you the truth, I have seen some people adapt and find ways that work for them that assist with their memory – such as writing themselves notes or consulting their calendars often.

If you get into “concrete reality” without considering the “emotional reality” in your responses, your family member could end up feeling bad and have a bruised self-esteem. Emotional assaults (even minor ones) are remembered longer. It isn’t the event or the words spoken that caused the bruise to the self-esteem, it is the feeling the person had at the time of the incident that stays with them.

When a person with any dementia leaves an interaction feeling dumb, inept, confused, scared or angry – that feeling could stay for days and cause behavioral issues that surprise family members or caregivers. It is up to us, family and professional caregivers to always be aware of how we speak and what the emotional impact might be on the other. If safety is at risk you must act quickly and not have the time to protect the self-esteem in the moment. We are all human and will make mistakes – if we do just move on and look for some positives.

In my mother’s case we just laughed and moved on in our conversation talking about pleasant things and activities. I left the door open for her to call me anytime – but she has to write down what she needs first and then dial my number.

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