home care

Taking Me Home?

Posted in adult children, Age Related Issues, Blog, Caregiving, Dementia and Memory Loss, End of Life, Moving an Aging Adult, Relationships on December 18, 2012

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

I moved my mother to a small residential care home that gives great care, at the same time I was scheduled to take a week’s vacation. When I returned six days later, I went to see how she was doing and the first thing she said, “How did you know I was here?” I explained I had picked out the home and she said it was a very good one (nice for me to hear).

She has vascular dementia so her short-term memory is impaired but she was very aware that she had not seen me in six days. We chatted for a few minutes with the other five residents before it was time to eat and then I accompanied her to the dinner table to continue chatting with her and all the residents.

As she finished her meal, she gave the caregiver a kiss and then a hug and thanked her for everything she had done for her and then turned to me and said, “Taking me home now?” Wow, I didn’t expect that. I said, “No, you need to stay here.” And she said, “What about my home?” Well, thinking she was talking about her home of 58 years I explained that her grandson was taking care of that house. She said, “No, the other house” and I responded with the name of the Assisted Living she had resided in for 18 months prior to two months in skilled care and she said, “Yes!”

I had to tell her we gave that up because we can’t pay for two places. She has always understood money and that was ok with her – while again telling me that this new home was a good home. I told her if she gets well, she could return to Assisted Living and she said, “Am I sick?”

Needless to say, I drove home in tears but, once I synthesized her comment, I was thinking how wonderful that she has no idea she is nearing the end of her life and that her sweet, tender heart is failing her.

Gracious, appreciative mom – I am privileged to be your daughter.

Aging Experts

Posted in Blog, Care Management on October 16, 2012

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

After watching a home repair program about fixing the messes that non-expert contractors (and I would guess not licensed) cause homeowners great headaches and expense, I could only think about families who hear, “We do free Care Management” and think they are receiving expert guidance. I guess you get what you pay for!

Professional Care Managers who belong to the National Association of Professional Geriatric Care Managers (NAPGCM) and whom are certified as Care Managers are experts and they have fees that represent the years of experience, education and supervision you would expect to see in any profession. They usually bill by the hour or fraction of.

When you trust a non-expert to guide you, it could cost you dollars and time but, most important, quality of life could be compromised when you don’t have a professional advocate.

I encourage you to hire experts to not only build your fences and fix your plumbing but to write legal documents, guide you in making challenging decisions or find care for an aging family member.

Where Should I Live? I’m 81

Posted in adult children, Age Related Issues, Blog, Relationships on August 10, 2012

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

How does one come to a challenging choice of moving from the known to the unknown? Each of us will answer this question differently based on where we are in our lives as well as from the ways we have made most decisions all of our life.

Some of us research every decision and some of us are very decisive and make decisions quickly without ever looking back. Yes, there are those who say, if it doesn’t work out, I will look for another option and then again some us are worriers and struggle to make any and all decisions.

Research says most seniors over 70 want to stay in their own homes. But, what do you think makes these adults not want a change? Do you believe they just love everything about their home and life or do you think it is more about avoiding transitions/change?

We all know with most changes comes some loss and grief of the once known and comfortable. The change that we choose pushes us out of the comfort zone with the knowledge that there will be gains greater than the loss and that is what gives us the courage to make the change in the first place.

Since I have had the honor and privilege to be with many clients on this quest – I must tell you the choice depends on three very important elements: 1) relationships, 2) needs and 3) life meaning.

Relationships give our lives dimension – they are often our mirrors and motivators. Having positive relationships with friends, partners, family, pets and hobbies can help define who we are in this life. Those individuals who stay engaged with life have less stress and are often more content than those who have few relationships. This concept has been a big contributor to living longer lives. So, when thinking about moving, who or what do you want to move closer to?

Our needs are not necessarily what we want but they might be what we need to support our physical health or emotional well-being. The reality of needing supportive devices or living environments due to a chronic health issues might be what drives the need to make a living environment change. It can be that the neighborhood isn’t safe, driving and transportation are issues, or you need to be closer to a major medical center or family member who can be your advocate. However, Care Managers can be your advocate wherever you live. It can be the needs of others and our wanting to offer support that brings a desire to move closer to a friend or family member. I have seen many a grandparent move across the country to be closer and be more of a part of grandchildren’s lives.

That brings me to the element of “life’s meaning”: Will this move bring you closer to what gives your life meaning or further away? Can you still be engaged in what gives your life meaning or are you looking for new opportunities to give back or contribute to the greater good for you, your community or the world?

I highly recommend that individuals contemplating making a move have at least one or two sessions with a Professional Care Manager who can ask you questions that will help you come to a decision.

8 Tips to Help with Caring for a Loved One Who Stays Awake During the Night

Posted in adult children, Age Related Issues, Blog, Care Management, Caregiving, Relationships on April 6, 2012

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

You may be caring for a parent or older person who wants to stay up all night and sleep at odd hours during the day. This behavior is known as “sundowning.” The Alzheimer’s Association states that 20% of people diagnosed with Alzheimer’s disease exhibit increased confusion and disorientation at dusk with the behaviors continuing throughout the night.

This behavior may be caused by a number of factors including: a change in medications, disruption of the normal daily routine, packing too many activities into the day or even something subtle, such as a change to daylight savings time.

I’ve worked with a number of clients and their caregivers over the years and have used one or a combination of the following to help them meet this challenge.

1. No coffee or soft drinks with caffeine after 6 pm. These beverages work best with breakfast or lunch. A smaller meal works best at the end of the day and a light snack before bed, such as apple slices or crackers.

2. When dusk approaches, draw the drapes and/or dim the lights in the living room and bedroom and lay out pajamas or sleepwear on the bed to remind your loved one that bed time is approaching.

3. Playing soft music sometimes helps if your loved one is agitated during this time.

4. Plan activities during the day such as walking, exercise or an outing to increase the feeling of being tired at the end of the day.

5. Stick to a routine and encourage meal times, walks, TV and other activities at the same time each day.

6. Make sure that your loved one is comfortable in the room where he or she is sleeping. Proper ventilation, familiar objects and a night light will help.

7. Discuss this problem with their primary care physician who will review their medications and may prescribe medication for sleep or agitation.

8. Bladder or incontinence problems can often cause disruptive sleep. Bedside commodes or other devices to assist with bladder control may help reduce agitation connected with getting up during the night.

Sundowning or sleep disruption can upset our own lives as well as those of a loved one. Pinpointing the cause, as well as trying the above solutions in conjunction with a conversation with the doctor, will help put them on the right road to normal days and evenings.

How to Know When Your Loved One Has Reached Their “End of Life”

Posted in Blog, End of Life, Relationships on January 6, 2012

: 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.

Proactive Planning for a Longer Life!

Posted in Age Related Issues, Blog, Care Management, Caregiving on November 9, 2011

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!

Not Correcting Those With Dementia…

Posted in adult children, Age Related Issues, Alzheimer's, Blog, Care Management, Caregiving, Dementia and Memory Loss, Relationships on September 16, 2011

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.

Mom Knows Her Memory is Poor

Posted in adult children, Age Related Issues, Blog, Care Management, Dementia and Memory Loss, Relationships on August 9, 2011

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.

Who’s on First Base? Keeping up on Parent Care Providers…

Posted in adult children, Age Related Issues, Alzheimer's, Blog, Care Management, Caregiving, Dementia and Memory Loss, Relationships on July 19, 2011

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

…does your head spin trying to figure out who is visiting your parent after a hospitalization? Does Dad tell you that a therapist visited but you had no idea he even needed one? Does one therapist or nurse talk to the others about the needs of your parent? And, oh yes, how about updating you on when they will discontinue services – do they tell you what the options to continue to make a complete recovery are?

“My-oh-my” my head is spinning trying to hold the ball in Mom’s care. Mom had a stroke – her short term memory has been affected and I told her not to worry, that I would be her memory for short-term items like appointments or changes in medications. Thank God her long-term memory is good and she is adjusting to her deficits better than I expected.

When I do talk to these caring and competent health care providers, they are on top of their skills and what they are doing with mom is appropriate but, if I don’t call them, I am left out of the communications. Then there is a possibility that another nurse or therapist filled in on the last visit and they have not talked with one another or looked at their laptop to see what is being forecasted.

As family members, my suggestion is to call each therapist or nurse who visits prior to services and, if possible, ask that they call you after each visit. In my case, they have all three of my phone numbers and I will return calls immediately if I am not in a meeting or session with a client.

Mom is on a blood thinner so she doesn’t have another stroke and, now in the beginning of this therapy, we need frequent blood draws and changes in medications. Was her blood drawn last week? Was her medication changed? What was her pro-time (blood thinning number that should be in a therapeutic range)? All questions family advocates and/or Professional Geriatric Care Managers need to know in order to stay on top of preventing another stroke or a “bleed”. This is a very important process to follow and truly not that hard if those who do these activities communicate clearly to the client, family or provider of care.

I guess this is just another lesson that the key to good health care is “communication, communication and communication”.

Ask questions and expect to be updated frequently.

The What Ifs Of A Longer Life – Webinar

Posted in adult children, Age Related Issues, Alzheimer's, Blog, Care Management, Caregiving, Dementia and Memory Loss on July 7, 2011

Dawn White, MPH, CMC, Certified Professional Geriatric Care Manager, Eldercare Services

On June 23, 2011, Dawn White, MPH, CMC, hosted a webinar at RG Financial Partners, Inc. discussing “The What Ifs of a Longer Life”. A workshop to promote staying in control of your life by making informed decisions as we age.

The topic pertains to adults of all ages and touches on what we should all expect as our population is living much longer than previous generations. If we know what to expect and communicate our values, we can prepare for the “What Ifs” of life.

Please click on the link to listen to the informative presentation. The What Ifs Of A Longer Life.