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I took a short break this afternoon, and when I tuned back into the world of news, I found that the expected winter storm Friday into Saturday was now being called a BLIZZARD WATCH! Eighteen to twenty-four inches are being forecast with high winds. My goodness...
We rolled into action to consider the safety of every shift change Friday and Saturday... will the roads the safe? Will it be snowing too heavily? How can we serve clients Saturday night and Sunday morning safely? We will work with families and caregivers to create a plan for any shift changes that may be made unsafe or impossible by this storm. We will be in touch wiht impacted families and caregivers.
In the meantime, this is the right moment to share two blog posts I wrote from a past winter storm/blizzard. They contain info about prepping clients' and the caregivers' homes, and other important information. Please review this and then get into action to get ready.
Who Will Shelter Your Elder Loved One in an Emergency?
First Possible Winter Storm Coming, Eastern Massachusetts
Easten Massachusetts Winter Storm Forecast Upgraded To a Blizzard
Habilitation Therapy (HT) is considered by the Massachusetts Alzheimer’s Association to be the best caregiving practice that exists today. Learn about this comprehensive behavioral approach that will help both dementia patient and caregivers alike, which can help improve their quality of lives dramatically. HT helps difficult symptoms be reduced or eliminated, regardless of what stage of the illness the patient is current experiencing, by skillfully adapting to the capacities of the patient and communicating accordingly. Habilitation Therapy helps caregivers have positive and successful interactions with dementia patients, reducing stress, allowing greater enjoyment of each day.
There are still some seats available in this class. The 2-session training is structured to allow for learning of concepts, then practicing them, and then coming back to learn more concepts and trouble shoot difficulties encountered -- and to celebrate successes! Contact Concord Carlisle Adult & Community Ed to register. 978 318-1432.
FACULTY Deborah Bier, PhD, is certified by the Mass. Alzheimer’s Association and the Executive Office of Elder Affairs to train dementia caregivers and coach dementia families. She is the director of care for the metrowest Boston office of Caring Companion Home Care in Concord. She has trained professional and family caregivers across the US in these methods. Deborah holds a doctorate degree in therapeutic counseling.
In most settings, caregivers know a lot about their clients'/patients’ illness(es), but what about their wellness? That is, the parts of them that remains well and functioning despite not having perfect physical or mental health. Our medical system emphasizes a focus on illness, with wellness a very much trailing concern -- if it makes it onto the radar at all!
At Caring Companion Connections, we very much focus on enhancing our clients’ wellness -- we don't just help them manage their problems! What all that means exactly will take some time and discussion between us over time as this blog unfolds. But I'd like to start with a wonderful example of enhanced wellness that happened between one of our caregivers and clients a few months ago.
Mary Ann had been working with a client who has been experiencing many different medical problems. After a couple of weeks of our care and some improved medical attention, the client's feeling a little bit better and more at ease. Rearranging things a bit, Mary Ann managed to get the client's musical instrument into a setting where it could be played. Despite having issues with one of her hands, the client played it for the first time in many months -- and was much more happy, relaxed and peaceful following.
Re-engaging with something a client loves creates increased wellness -- and makes her an active part of enhancing her quality of life. Sure, her medical problems persist, but a small, renewed zest for life made an appearance with those musical notes. Research shows that such enhancements can also decrease perceptions of pain, and a preoccupation with one's illnesses, losses, and limitations. Setting up the environment to allow her to play was key, and a great example of how we as caregivers can facilitate clients' wellness.
We publish a periodic newsletter (available via snailmail and/or email) with articles about the work we do, aging in place technology, enhancing your or your loved ones' care at home, helping caregivers, hands-on caregiving, and all the other topics we talk about more extensively on this blog. Download the current copy in Acrobat (PDF) format here, or click on the image at right.
Presented by Michele Hughes, RPT
Wednesday, June 9, 20106:30 – 8:00 pm
21 Concord Road, Sudbury, MA (map here.)
Tuesday, June 29, 2010 -- 7-9 PM
Get the facts from Stuart Hamilton, an Elder Law Attorney (www.StuartHamiltonLaw.com), Linda Smith, a Certified Professional Geriatric Care Manager and Independent Registered Nurse (www.mweldercare.com), and Deborah Bier, PhD, director of a local home care agency (www.CaringCompanion.Net).
They will educate and answer questions about the many legal, safety, activity, housing, caregiver support and care options available as people age.
We recently met with Natasha Heimrath of Caregiver Homes, a community-based model of care for frail seniors and disabled people 16 and older to be cared for at home and in their community. The state-funded program pays caregivers – typically, but not always, a family member – who provide full-time care at home, and it supports each client and caregiver with a case management team. In some instances, this stipend allows families to bring an outside caregiver into the home for respite (relief) for the main caregiver.
Our experience suggests that many families are eligible for this program and don't realize it. We encourage our clients to make use of this program, and have contacted those who we think may be eligible to put them in touch with Natasha. We are happy to facilitate this relationship and will work cooperatively with Caregiver Homes any time we serve clients concurrently.
To be covered by the Caregiver Homes program, clients must be eligible for Medicare/MassHealth or be eligible for a "Frail Elder Waiver" (which has a higher income allowance than does Medicare). The caregiver to receive the stipend may not be a legal guardian or spouse, and does not need to be related to the client.
While the tax-exempt stipend this program provides can be quite helpful, it is not the only benefit – and may even be the lesser one in my estimation. It's the client and caregiver support from Caregiver Homes case management team that is a simply huge offering – another lifeline, an expanded support system, a lot more folks who are looking out for the wellbeing of both client and their caregiver. Precious stuff, indeed.
Both Natasha and we loved that each of our agencies use web-based technology to report on daily client health and function, and to facilitate communication between the case managers and caregiver. The Caring Companion system goes several steps further in that the information in our daily reports are available – with the client's permission – to the client's family members, as well as to other caregivers outside of our agency.
Adopting high tech communications and web technology into the on-site work of the home care industry is – so far – very unusual. We were so pleased to get to know another pioneering agency in this area! And we look forward to working with Natasha and her colleagues at Caregiver Homes in the future.
Here is an article a social worker friend sent me about a dozen years ago. Every so often, I come across it among my papers, taking the opportunity to re-read it... and learn from it anew. It’s a beautiful formulation of the profound difference between helping, fixing, and serving by Rachel Naomi Ramen, MD called In the Service of Life: http://www.rachelremen.com/service.html.
Remen is one of the earliest pioneers in the mind/body holistic health movement and the first to recognize the role of the spirit in health and the recovery from illness. She’s also the author of the best-selling books My Grandfather's Blessings and Kitchen Table Wisdom
For want of a nail the shoe was lost.
For want of a shoe the horse was lost.
For want of a horse the rider was lost.
For want of a rider the battle was lost.
For want of a battle the kingdom was lost.
And all for the want of a horseshoe nail.
Our caregivers are often the main shoppers for our clients. As such, we fill a very important role in their lives through maintaining their supplies. In many instances both daily and occasional home "operations" cannot go forward without necessary supplies. If you look at the rhyme above, you'll see how this is no minor thing. And since we are so often working the with frail, it doesn't take very much of a missing nail to truly negatively impact the client.
Until about a year ago and for the previous decade, as a volunteer I developed and coordinated programs for citizens about emergency preparedness. I worked extensively with the Concord (MA) police and fire departments, and I led, managed, and taught these programs. I developed the following as my philosophy, and I bring it to our work at CCC: "There are emergencies that we cannot foresee; we can only respond to those as they arise. Other emergencies we CAN foresee; we're nuts if we don't prepare for and if possible prevent them."
This doesn't apply only to emergencies, but to urgent situations, as well as wherever else some reasonable foresight would yield more convenient, comfortable and efficient results. We hear complaints about this from clients who have worked with other agencies -- particularly from the adult children who, at a moment's notice, may be expected to drop everything and get some missing item over to mom or dad's place. "Why was it when we worked with another agency, it was every day that another thing just HAD to be brought over right away?" is a typical complaint I've heard. "We'd never get a list of more than one urgent thing so we don't have to respond to these requests every single caregiver shift. I would have been happy to pick up tomorrow's prescription refill at the same time I got today's latex gloves -- if only I knew in advance. It was simply maddening that I never did!"
Let me tell you the most outrageous, avoidable emergency supply story I know. Last year, a good friend and her father were residing 3000 miles (and three time zones) apart. He was living with a serious medical condition and needed 24 hour care at home. One night, his caregiver (on the west coast) on shift called my friend (on the east coast) saying, "Your father's had a bad bout of diarrhea and we've run out of incontinence briefs. I need some right away." "What in the world was I going to do?" she later told me. "I thought of everything I could. I started calling drugstores in his city trying to find one that would deliver. I called dozens -- not one would help. I even thought that if I drove to Logan Airport and hopped a flight immediately I could be there in 6 hours. I would then be able get them to him myself. It was completely surreal that I was even entertaining this as an option." Eventually, she found a cab company serving his area that would pick up a box of his customary brand ($13) at a local drugstore, and drop them off to him -- to the tune of a $55 taxi charge!
Researching further, she found that some agencies in our own area solve this problem by having managerial staff keep boxes of emergency supplies like latex gloves, hand sanitizer and incontinence supplies in their cars. At any time, they could be called by a caregiver on a job somewhere to personally rush any of these over. If ever there was an avoidable emergency, it's running out of one of these totally sure-to-be-used-up, absolutely necessary supplies.
Surely, there has got to be a much better approach. Some colleagues recently told me that my 6-word memoir should be this: "Attempting to bring sanity wherever possible." Though some accuse me of actually causing insanity, I think CCC can ably apply methods from other disciplines to maintain our supply chain and prevent emergencies, bringing home care even furtherinto the 21st century! Surely we caregivers, clients, families, and agency management deserve this kind of sanity.
One of the ways we smoothly maintain a client's supplies is through teamwork. We place a very high value on staff like myself, our caregivers, clients and family communicating and cooperating with one another. We use email, telephone, and our unique online reporting system to keep everyone informed and on the same page. With a team, we not only know no one is in this alone, but it's one way we maintain a culture at CCC where we constantly try to discover how efficiently we can work together on behalf of the client. Having to get ONE thing EVERY day at the store is kind of embarrassing if it happens once or twice -- but as a steady habit? We see no reason to go in that direction!
We'd love to hear your ideas -- what's worked for you in keeping things organized? What HASN'T worked for you? Please add your comments!
On Monday September 20 in Sudbury, and Wednesday September 29 in Lincoln, learn how the new challenges and opportunities of aging in the 21st century can come together to benefit elders and those with disabilities. “21st Century Caregiving: Essentials for Caring for a Disabled or Aging Loved One” is a free lecture and community service. On the 20th, the lecture will be at the Goodnow Public Library located at 21 Concord Road in Sudbury (map here). On the 29th, at the Lincoln Public Library at 3 Bedford Road in Lincoln (map here). Both lectures start at 6:45 pm.
Our community is graying faster than ever. People live many more years than before, and live longer with more chronic and degenerative disease. Family members live further apart, often in different parts of the country. Many more elders are living their lives out in their own homes, often alone. This rapidly changing landscape can present a bewildering set of obstacles and challenges to anyone trying to navigate best choices for themselves or their loved ones.
People in 2010 are not having the same aging experience as their parents and grandparents did in the past. This creates new challenges, which require new solutions. This talk will help you sort out the growing number of options
Even just to understand the many complex issues can be a daunting task. Smith will help demystify these new challenges, and present recommendations to best meet 21st century aging, be it in a private residence, an independent, assisted, or nursing facility, or any of the other housing alternatives available.
While many new challenges have developed, so have new solutions. Assisted living has come of age. Technologies to help with aging in place are now available. We know more about successful aging and wellness than ever before,” said Deborah Bier, PhD, a mental health counselor and director of Caring Companion Connections, a nationally-recognized, innovative home care agency in Concord, MA. “People can live and age in place comfortably and safely for many years bringing the proper levels of care right into their homes.” Bier will talk about home care for the 21st century.
The costs of longer years of care are also growing. “That nest egg our grandparents thought would only need to last a few short years until the end of their lives now may have to last for a decade or more,” said Bier. “Making care more affordable should be everyone’s minds, and we will discuss ways to create considerable savings over the typical costs of services offered by home care agencies still operating with the 20th century model.”
For more information, go click here.
It seems to clear to me after 20+ years as a mental health clinician, plus one year working in this position at CCC, how ignored mental health problems are in the elder population. Ignored, misunderstood, and brushed off as of little importance would be more accurate.
The emotional life of people has long been the "poor stepchild" of medicine, so I've seen this problem arise in all ages in my private therapy practice. But the real tragedy of it in the elderly is that for some unknown number of dementia patients, it's connected with vascular dementia. If they are treated properly with anti-depressants, you not only address both their depression and anxiety, but you might see their whole cognitive picture improve. And that improvement may be dramatic. I've seen it happen, and it's just a great joy to behold.
And even if it's not a case of vascular dementia, why not treat a very understandable depression and anxiety? If the person is aware that they're not functioning cognitively, well, it's enough to make them depressed and anxious. People deserve help in with this. It's simply a quality of life issue.
To not even try to treat for anxiety and depression in dementia patients is just utterly heartbreaking. Since many of us in this work have big, open hearts, it's just plain painful to watch.
I've recently met with geriatric psychiatrist Dr. Sumer Verma with whom I've had a long and very satisfying talk about this. Dr. Verma is in the forefront of this type of treatment, and is currently the Alzheimer's Program Medical Director at Briarwood Healthcare and Rehab Center in Needham, MA, as well as in private practice in Lexington. Where anti-psychotic medication is typical in treating dementia patients, he generally uses medications that address depression and anxiety and with excellent results -- including those with non-vascular dementias. He stresses that "less is more" with the geriatric population when it comes to dosage amounts, too. Sedation to control behavior is generally not his approach.
We certainly have a very long way to go in this area. One strong recommendation I have is that families advocate for their loved ones with dementia. Bring them to a psychiatrist who specializes in the treatment of the elderly. Don't be satisfied with either too much (that is, "drugged-out," sedated) or absolutely no medication or other treatment for their emotional well-being. Find a psychiatrist and insist they at least try anti-depressant medication. And if they won't, they should say exactly why not.
Minuteman is an active member of the Meal on Wheels Association of America and is proud to help promote Barilla's Share the Table campaign. By simply visiting www.ShareTheTable.com, you can help end senior hunger now!
Barilla will donate $1 to the Meals on Wheels Association of America (MOWAA), up to $150,000, to support MOW programs across the country every time someone participates. All you have to do is click "Yes! I Do!" in response to the question, "Do you Believe in Meaningful Meals?" Please click here and support MOW!
Minuteman Senior Services has benefited from the National Meals on Wheels Association when they partner with these national companies. We recently received a $7,500 grant. So please take the time to just "click".
We do a lot of supervision of our wonderful caregivers. While it's often thought that only poor employees need a lot of supervision, in this case it's because our people are so good at what they do, that they benefit from and appreciate this kind of interaction. This generally takes place in three areas:
1) Brainstorming. Bless them, our caregivers are always looking to do things even better. They know that I am always delighted to do creative problem-solving with them to find new solutions and approaches. For example, a client who developed bowel incontinence issues refused to start wearing adult briefs when her family tried to introduce them. Over email, her caregivers and I brainstormed a variety of approaches to the situation that retained her dignity. We tried a few different approaches until we finally found one that worked like a charm. We are proud to say that she is now wearing briefs every day without a problem!
2) Coaching & Staff Development. We have so many people blessed with real caregiving talent -- and I just love to help people develop their gifts and abilities. Caregivers are not usually trained to look for opportunities to connect clients with wellness or enrichment opportunities. Since this is one of my professional strengths, and our clients benefit so enormously from wellness activities, I take the time to regularly coach our caregivers in this area. We find the best ways to reintroduce favorite activities to their clients, translated to their current level of physical, emotional and cognitive abilities. For example, if I know of a farmer's market in a real food-loving client's town, I'll let the caregiver know its hours and handicapped accessibility. The food is even fresher, and their shopping trip is much more enriching than just a stop at the grocery store. I'll encourage them afterward to stimulate the client's memories of food and farms throughout their lifetimes. It's amazing how such activities uplift the client's functioning on all levels!
3) We've Got their Backs. No one should go to work every day thinking they're all on their own... that when something difficult arises, there will be no one to help them. So often, I hear from our experienced caregivers this has often been the other case working for other agencies. But that is not the way we do things here: either Jim or I (or both of us) are available by phone or email any time a problem arises, or when the situation requires immediate decisions the caregiver is not empowered to make. Everyone deserves to have someone they can trust to help. This is particularly true of caregivers, because the problems they're having on the job affect not just them but the client and the client's family. We are readily available -- it's a small investment of resources, given what an important return everyone receives.
We know that together, we are more than the mere sum of our parts... that as a team working together, we always create the best outcomes. If you're a talented caregiver, we'd like to hear from you. Go here and send us your resume. If you'd like to have one of our talented caregivers in your or your loved one's home, go here and we'll be in touch with you quickly.
We love working with physicians, registered nurses, geriatric care managers and pharmacists as part of a client's care team. But it happens far less often than we think is most helpful for the client. Everyone is so busy, few see it as their mandate as healthcare professionals -- though we certainly do. Inter-disciplinary communication and teamwork isn't just a "good thing" -- it is absolutely vital.
Here is a powerful example of why real teamwork is necessary, and why we at CCC go the extra mile to be in touch, and to put people in contact with other healthcare professionals who can eliminate problems that stem from a lack of teamwork elsewhere. And that is the epidemic of over-prescribing of medications for the elderly. Too many specialists not talking with one another, each prescribing medications that are then not adequately reviewed by the patient's primary care physician result in lots more drugs than are needed.
Now, we at CCC are not in a position to make such judgments about whether any particular person has a problem with over-prescribed medication. We instead point to both research data and anecdotal information we hear from those who are in a position to investigate such matters. For example: a study recently published in the Archives of Internal Medicine (see the study abstract here) showed that it was possible to safely and significantly reduce the use of medications in elderly patients living in the community (as opposed to in care facilities). In fact, almost all patients in the study had nearly 60% of their medications safely discontinued, with very, very few needing to have these drugs re-prescribed. As a result, 88% of patients reported improved health! "Polypharmacy itself should be conceptually perceived as 'a disease,' with potentially more serious complications than those of the diseases these different drugs have been prescribed for," the authors write.
If you or your loved one are on multiple medications prescribed by multiple physicians, it is worth getting a professional review of their medication list. You can also sit with the primary care physician and go over every drug with them. Good preparation for such a meeting would also be reviewing the drug list with your pharmacist.
(Thanks to our eagle-eyed caregiver, Mary Ann, who forwarded me the link to this polypharmacy study!)
With Thanksgiving coming up and the December holidays right afterward, this is a time when the family visits with our elder loved ones and finds -- often to our surprise and consternation -- that things have changed since they last time we were together. Mom or dad might have deteriorated in ways the family hadn't understood until we were gathered in person.
When should you be alarmed? Jewish Family Service of Greater Boston makes this recommendation about things to look for when we visit our elders in their homes -- all of which are signs that their safety and well being may be at risk:
When we see these alarming signs, we relatives often blame ourselves, feeling terribly guilty. In some cases, yes, we could have been more attentive and connected. But in other cases, there may have been a cover-up going on -- one that we just didn't penetrate until we laid eyeballs on our folks. For example, the stronger spouse may cover up for the ailing one, not letting anyone in on what is really going on. We may not have noticed how conversations were steered away from sensitive topics, or the little fibs that were told ("Oh, Mom is in the bathroom [taking a nap, at a neighbor's]") so we couldn't hear for ourselves that Mom was experiencing problems on an especially bad day.
So, now the family is all assembled and the cat's out of the bag. What to do next? A lot will depend upon the cast of characters and how the family operates typically. There are four things I recommend, however, to create productive movement toward addressing the problems:
1) Everyone's together -- start talking. Do not be surprised if you find there unequal amount of engagement among all family members. Or that family members don't agree on the need for change, or that there even IS a problem. Consider whether or not you are reacting out of guilt and surprise, over-magnifying the urgency of the problem -- over-magnification being a not uncommon reaction of the most geographically distant or most absent family member. Be sure to give great weight to the most regularly-involved family member(s).
2) Be gentle. Head-on confrontation followed by demands for change around what is likely a very fraught and complex topic may end up being counter-productive. Consider this the start of the process. If the elders involved are in danger for their safety, however, help and change may be needed quickly, therefore...
3) Involve professionals. The family doesn't need to go this journey alone. In fact, I recommend involving helping professionals in the process as soon as possible. In Massachusetts, each city and town has a Council on Aging, and they often get calls following holidays asking "What do we do next?" The local policy department usually has an officer who is a special liaison to the community's elders, and knows the ropes very well. If the elder is in danger, Protective Services can be very helpful -- you can reach them directly through your local Aging Services Access Point (ASAP), or through the Executive Office of Elder Affairs (EOEA). The latter has a 24/7 hotline for abuse and neglect (and this includes self-neglect) at 800-922-2275. A professional Geriactriac Care Manager (GCM) is also a blessing where family members either can't agree, or are afraid of damaging their relationship with the elder by speaking unwanted truths. A GCM will do an assessment devoid of personal involvement, giving some solidity and shape to the problems. Also, when family lives at a distance and can't be present to help sort out and carry through solutions, a GCM is a personal agent who can be present.
4. Remember to enjoy each other, too. It's important to not turn these unexpected discoveries into an unending nightmare visit. Have a slice of pie and a cup of tea together. Share some warm memories, and affirm your bonds. Look at old photos, and talk about the things that bring strength to your family. The concern we feel out of our love and caring for our elders will come through much more clearly if we spend some sweet, uncomplicated time together.
CCC is proud to say that we have been selected as part of Minuteman Senior Services' "Partners in Caring" provider network. We were carefully vetted so they could ensure their elderly consumers that we provide high quality service. MinuteMan is one of the five ASAP (Aging Services Access Point) agencies that covers our current service area of Boston and Metrowest Boston.
Minuteman has no financial interest in any of their vendors -- only that they can ensure we provide the highest level of excellence, and that we work completely in concert with their mission to help older people and those with disabilities remain independent and a part of the community. They monitor our work with them very closely. We have loved our contacts with Minuteman staff -- they are clearly highly dedicated, caring and hardworking people, whose values of service and integrity we share.
Minuteman is also a federally-designated "Area Agency on Aging" and they manage over $6 million in public and private funds for eldercare programs. Located in Burlington, Massachusetts, they provide innovative and high quality solutions to eldercare issues for residents of the following communities: Acton, Arlington, Bedford, Boxborough, Burlington, Carlisle, Concord, Harvard, Lexington, Lincoln, Littleton, Maynard, Stow, Wilmington, Winchester and Woburn. As part of statewide and national networks they help seniors and families find resources both locally and long distance.
Just two-and-one-half weeks after we published a blog post entitled Over-Prescribing for Elderly Labeled a "Disease", the Boston Globe publishes an article called Mass. aims to cut drug overuse for dementia. Thank goodness, this has come onto the Commonwealth's radar! The Globe article begins:
State regulators and the Massachusetts nursing home industry are launching a campaign today to reduce the inappropriate use of antipsychotic medications for residents with dementia — a practice that endangers lives and is more common here than in most other states.
I believe it's important to keep this thinking going beyond those in nursing homes. My prior post about overmedication was about community-based elders said in part:
Archives of Internal Medicine (see the study abstract here) showed that it was possible to safely and significantly reduce the use of medications in elderly patients living in the community (as opposed to in care facilities). In fact, almost all patients in the study had nearly 60% of their medications safely discontinued, with very, very few needing to have these drugs re-prescribed. As a result, 88% of patients reported improved health! "Polypharmacy itself should be conceptually perceived as 'a disease,' with potentially more serious complications than those of the diseases these different drugs have been prescribed for," the authors write.
I think the state's approach on this is right on: better education for carepartners. Though I would recommend that physicians -- not only nurses -- receive more updated training.
“There is a knowledge gap between the front-line workers — the nurses — and the black-box warnings on these medications,’’ said Laurie Herndon, a geriatric nurse practitioner who is leading the initiative for Massachusetts Senior Care, the trade group representing the state’s 430 nursing homes. A black-box warning is the most serious type of caution used in prescription drug labeling. "We wanted to avoid talking at them, and instead provide educational material they can use,’’ Herndon said.
One of the most wonderful -- and challenging -- aspects of working with an aging population is that best practices and the most up-to-date wisdom is quickly changing... and for the better. The challenge comes when very busy health care professionals are unable to keep abreast of ever-expanding changes -- a task difficult for even specialists in this field.
So that means it's vital that families advocate for their loved ones around medications -- and here you are, becoming better educated about the issues, right now. Bravo!
Caring Companion Connections (www.CaringCompanion.Net) is a growing home care agency based in Concord, MA. We provide high quality in-home elder care, and we have a unique approach to care combined with a proprietary, industry-leading communications system that has gained national recognition, including mentions by NPR and many industry analysts.
CCC has moved into a period of rapid expansion and has openings for district directors to continue our growth and serve requests we receive from outside our current service area. The company environment is fun and energetic – a fast-growing, nationally-recognized company that is still in start-up mode filled with enthusiastic people fanatically focused on outstanding care to clients and their families. District Directors are entrepreneurial people with compensation packages that are potentially very lucrative.
District Directors are the local face of CCC to the community. They establish and maintain a network of referral sources who recommend CCC to families who need care. They are experts in their field and serve as expert referral sources themselves. Referral sources for a district director are often hospital discharge planners, counselors at local senior citizen service centers, geriatric care managers, elder law attorneys, clergy, and assisted living facilities where we may already have clients among the residents, but there is no set requirement, and each district director establishes his or her own network within a community.
District Directors also manage the caregivers. The corporate office provides staff for scheduling, hiring, and payroll support, but final hiring decisions are in the hands of the district director. District Directors make sure that caregivers are properly trained in the CCC System, which focuses on wellness and quality of life for the client and constant communication to the family. We use our cutting-edge technology to keep families informed about their loved one's status. Our caregivers post online daily reports, real-time updates, and photos – a level of family communication unmatched anywhere in the industry. Our service to our clients and their families is second to none; it is the reason the company is in business.
A note emailed earlier today to our clients, their families and our caregivers.
But this is a perfect time to review plans for clearing driveways, steps and walkways of snow and ice at your loved one's/our client's homes. Everyone wants to prevent falls due to snow and ice, and to keep people from being trapped inside the house -- or outside unable to get in!
Do you have a plow service set up? How about someone to shovel the sidewalks? Is there sand and de-icer stationed both inside and outside the doors? A small shovel and/or broom near the door?
To review what our caregivers are able to do to help: if we are on site during the storm, we keep the egress to/from the house open as much as possible so that in an emergency, safe exit can be made. Or emergency personnel can get into the house if needed. If CCC is there during a large storm, we ask caregivers to sweep, sand and salt doorways, walkways and stairs regularly so no heavy shoveling is needed -- unless it is too dangerous to be outside. We are unable to do heavy snow clearing on walking areas, or to clear the driveway.
Families need to make arrangements with a service to keep the driveway plowed and the walks and stairs clear. It's important that your service know when our caregivers would need to come and go, so that we can serve you without interruption or delay. These service are used to such requests -- and if not, they're maybe not the right one for you! They are also open to being phoned by caregivers in anticipation of arrival/departure, and are generally able to make a pass beforehand so things go smooth and safe. Please let our caregiver(s) know the contact info for your service.
In the event of an expected severe storm that might make roads impassable, we would work to position caregivers where they are needed most before the roads become dangerous, and keep them there until they can safely leave. This might mean getting them to the client's home before usual, or having them stay later. We would consult with families about this whenever we anticipate this could happen.
All that aside: have a warm, safe, wonderful, healthy and peaceful holiday, with many blessings to you and your family!
(Email sent this evening to Clients, Families and Caregivers)
After yesterday's early storm"heads up", I'm back to encourage you in your plans to prepare households and our clients for what is now being talked about as a blizzard: up to 20" of snow and 50-60mph winds, beginning Sunday afternoon and into sometime Monday. This is being predicted to be "heart attack snow" -- meaning it's so heavy that people have heart attacks exerting themselves while clearing it. This kind of heavy snow might be hard to keep cleared from roads and driveways, and street plows when they pass by will deposit "cement-like" snow and ice at the ends of driveways. High winds with heavy snow can also bring down power lines; power outages should be prepared for.
These are the kind of conditions where we should all be hunkering down before it gets bad and waiting for the roads to be opened afterward. I'm starting to position caregivers in households for Sunday overnight where the occupants will be the most in need if we can't get there Monday, or if there should be a power outage at any point.
I have a few preparedness recommendations to make, and they're based on my 10+ years as a volunteer doing emergency planning and response with the my town's public safety departments (caregivers: please consider these instructions from me if you are working during the storm).
1) Locate and find available flashlights and battery-operated radios. Change batteries now if needed and have spare ones easily available. This is a great time to set the radio to local news. Caregivers: you might bring any extra flashlights, radios and batteries you have at home. These may not be easy to find in clients' homes, or at stores as they can be quickly sold out. Put batteries on the client's shopping list for next week to replace any used from your own supply.
2) Please do NOT provide light with open flames like candles should power be lost. Candles can be sweet and romantic, but it's too easy to start a fire with them.
3) Do NOT use bbq's and other propane or gas devices for heating inside should we lose power, unless the device is designed specifically to provide space heating. They can be deadly sources of carbon monoxide.
4) Does the house have natural gas or propane heat? It's VERY IMPORTANT to check where the flue/vent is -- they are supposed to be no lower than 4-feet above the ground, but I've seen lower -- also, snowy shrubs in front of vents can interfere with them. In heavily drifting snow, these flues can become blocked, sending dangerous carbon monoxide gas into the house. Caregivers, please find out the source of heat for the house you'll be in and if it's natural gas, find where that flue is located. This must be kept unblocked during any storm with high snow drifts. (Older natural gas heating systems will -- they are generally vented through the chimney. The type of vents/flues to worry about during snow are high-efficiency, newer models)
5) Caregivers: be VERY careful clearing egress to/from homes. I know you want to help as much as possible (and we love you for that!), but if you become injured, chilled or exhausted from too much shoveling of heavy snow, you can't fully care for your client. Go easy... go slow!
6) Best to prevent hypothermia if heat is lost. If the stove is electric, find some thermoses you can fill with boiling water, and keep them filled for use if the power goes out. Serve hot drinks regularly, which warm the hands when held and the body when consumed. Don't wait until the client feels chilled to have them put on extra layers of clothing, including hats and gloves. Encourage the client to do some moving around regularly to keep their blood flowing and their hands and feet warm.
7) Caregivers: charge your cell phones NOW, and keep them charged in case landline communication is lost. Data services like texting and email take a lot less power than voice phone; use this info to conserve power. If it gets too cold, you may need to call that city/town's police department for info on warming shelters or other ways they are helping at-risk citizens -- why not program in their business number? (warming shelter info might also be found on local news radio) Also client family phone numbers and email addresses. Keep an eye on your smartphone's email more than usual as it may be easier for us to communicate that way.
8) Start talking about the weather forecast with clients immediately. Be calm, but don't brush it off as a nothing: psychological preparedness is important and sets the groundwork for resilience and lower anxiety. Ask them to recount experiences they've had in bad weather, and how they handled it. Tell them about some of your stories! Talk together about some of the suggestions I've put down here, plus any that might be special to their particular situation. If they are anxious, let them know that there are plans being put into place, and that everyone will be working to keep them safe and comfortable. Caregivers: please speak with their family members, care managers and other members of their care team to make sure you get info about plowing services, any medication refills that MUST be picked up before the storm, and any other info needed. For example: are there neighbors with alternative heating sources (like wood stoves)? Might they have overnight space for an elder who is at high risk for hypothermia?
When all is said and done: I would prefer to find out that this storm system has "gone out to sea" and that we only get a dusting with light winds! IF YOU HAVE ANY CONCERNS AT ALL: CONTACT ME! Everyone, please take extra good care!
Old Man Winter is back at it again! We are postponing the below panel discussion set for tonight to another date. More when that date is known. (Would it be more politically correct now to call him "Senior Citizen Winter?")
POSTPONED: Wayland, Ma, Tuesday, Janurary 18, 7 PM, Public Library: Part 1 of 2, "What's New in Aging?" Join a distinguished panel of elder experts speaking on navigating the new terrain or aging in the 21st century, followed by Q&A period. Juergen H. Bludau, MD, Harvard Gerontologist, Carol Sneider Glick, Esq, elder law specialist, and Deborah Bier, PhD, mental health counselor and home care agency director. (more info here) REGISTER HERE TO BE INFORMED OF FUTURE DATE
On February 1 -- despite the start of yet another snow storm! -- a lovely group of professionals gathered to hear Paul Raia, PhD of the Massachusetts Alzheimers Association speak to the Metro West Alzheimers Partnership, hosted at Traditions of Wayland, MA. This was primarily a Q&A session -- what types of questions did we need help answering for ourselves, patients and families?
It was a real treat to have an opportunity for such a free-ranging discussion with Dr. Raia, who is both a delight as a human being, and a master source for such information. Also, it was a chance for group brainstorming of common challenges, gathering the experience and wisdom of all the professionals in the room -- which added together among the 40 or so of us was probably most of the way to the 1,000-year mark!
I can't say enough about how such peer-to-peer sessions are an important addition to any professional's work. While that was my first meeting with this local partnership (partnerships are local working groups with the Alzheimers Association -- here is the list of partnerships in MA), it certainly will not be my last -- the Metrowest Area Partnership is beautifully organized and has really high-quality offerings at their meetings.
For those for whom Dr. Raia's name is not familiar, he deserves some introduction. Following that, I will list about four things I thought were vital take-aways from the session.
Paul Raia, PhD (photo at right) is an innovator along many dimensions in the field of dementia. He's been directing patient care and family support at the Alzheimer’s Association over 20 years, and now serves as vice president of clinical programs at the MA/NH Chapter. He developed the "Habilitation Therapy" approach to dementia which focuses on the patient’s emotions and their remaining capacities -- which is an approach we very much support and use at Caring Companion. He started the first support group in the US for early-stage patients, and the first support group for young children with parents or grandparents who have Alzheimer's. Many of his projects have become best-practice models and have been replicated nationally. Spending a morning with him, I saw how his enormous clinical experience and expertise clearly shone through, as did his great warmth, compassion and understanding. This is a very special man, and if you have the chance to hear him speak, I recommend you snap it up immediately.
Here are the four important take-aways I want to talk about here; these I'll post more about each of these in coming days:
(This post is a continuation of a previous one, found here.)
These are the four as Dr. Raia listed them:
First, it's important to point out why slowing down the illness is most important in its early stages, and why it presents such a conundrum. Yes, there are good lifestyle interventions that can increase the number of years a person can enjoy before greater progression. But since only about 50% of dementia patients ever receive a diagnosis, and most people who do receive a diagnosis do so when the disease has become quite progressed, it's very hard to intervene during the early stages.
Personally, I recommend these four inventions be practiced at EVERY stage of life because from the time of early childhood all the way through the last days of life at -- whatever age they might occur -- because they really make a difference to overall health. But as applied to dementia, if most of us aren't receiving an early diagnosis, having these four interventions as part of an ongoing lifestyle, they're going to do their job whether we are diagnosed or not.
Also, as Dr. Raia reminded us, we want to build the greatest "cognitive reserve" (resilience to neuropathological damage of the brain) we can, and this is still possible to do only during the earliest stages of Alzheimer's. Again, if we practice these four interventions our entire lives, we will have the greatest cognitive reserve possible. But for those who are Johnny-come-latelies not in the mid and late stages of dementia, starting as soon as possible will still make a significant difference.
I feel all of these four aspects are vital to be aware of in home care; we train our aides to be a part bringing good food into the home, encouraging and finding opportunities for exercise and intense cognitive engagement, being an important part of and reinforcing the client's social network.
Diet: Over the years, I've written a lot about the importance of food to health -- both the art and the science of it -- including with elders. But Nancy Emerson Lombardo, PhD, truly brings the science of it to its highest order, and was specifically cited by Dr. Raia as a go-to person on this subject. (See her website here for specifics about her program.) In short: research shows that the food we choose to eat (and the foods we choose NOT to!), plus some food-based supplements can create a healthier, more resilient brain, and can benefit anyone of any age, including those who do not have memory loss.
Exercise: There is the greatest research evidence of these four interventions that exercise does positively effect the progression of dementia. In fact, just this week a study was published showing how a regular, brisk walk can rebuild the hippocampus (a part of the brain involved early on with Alzheimer's). Let me say that again: it can help rebuild (not just delay or reduce, additional damage to) the hippocampus! That is just huge!
Socialization: This refers to building, nurturing and maintaining our social networks. And no, we're not necessarily referring to Facebook and Twitter, though if they help us keep our relationships going, than let's make that part of the prescription ("Take two Twitter feeds and call me in the morning"... well, hmmm...). Frequent, active, muti-faceted and rich social involvement correlates with decreased risk of Alzheimers.
Intense cognitive engagement: Perhaps this falls under the rubric of "you don't use it, you lose it." The more intensely we use our brains, the more neural connections we make. The more neural connections we have, the more cognitive reserve we have. The way I like to explain this is it's like having two buckets of sand one huge and the other tiny -- let these represent the intensely engaged brain, and the "let's watch TV all day and night" brain respectively. Each grain of sand is a connection between any two brain cells. A one-inch hole in both buckets will result in loss of sand, but the huge bucket will still have lots more time before all the sand runs out.
The rest of the important Dr. Raia take-away points in coming days...
(This post is a part of a series; the first one can be found here.)
I was very interested in question #2 , in fact, I would have asked it myself! His answer will allow us to also cover the third take-away about depression and dementia here, because the two are deeply interwoven.
We have clients who have undergone differing levels of the diagnostic process (from none to examined within an inch of their lives). I have been concerned in some cases that an all-too-brief look at the client has been done so we can't have confidence in the diagnosis, and also concerned that the rigorously in-depth process is just too much to put some people through.
I was very interested in this question, in fact, I would have asked it myself! We have clients who have undergone differing levels of the diagnostic process (from none to examined within an inch of their lives). I have been concerned in some cases that an all-too-brief look at the client has been done so we can't have confidence in the diagnosis, and also concerned that the rigorously in-depth process is just too much to put some people through.
Dr. Raia says his answer has changed over the years. Long ago, he would have said "Yes!" But now he has to greatly temper that. He feels a really good primary care physician can handle the diagnosis, since it is a diagnosis of exclusion. That is, a list of other problems need to be eliminated first and foremost. Among them: infection, thyroid disease, anemia and depression. The first three can be handled with blood tests. The last -- depression -- well, that's a bit of a sticky wicket. He feels that primary care physicians are not known for their fine attention and ability to correctly diagnosis depression.
This completely matches my own clinical experience; undiagnosed depression is widely (and to me as a professional counselor, fairly easily) seen in all populations, yet is is very frequently not "caught". To my reasoning: considering how much medical care our elder population receives, it is less understandable that there remains such widespread lack of depression diagnoses within this group.
After more than 20 years as a therapist, I quickly pick up on the presence of depression... part experience, part instinct. People who are drawn to practicing physical medicine may not have the acuity of instinct for psychological problems as someone drawn to practicing in the realm of psychology. Another big problem is time: making a diagnosis of depression takes time sitting and talking with the patient. PCPs simply do not have enough time scheduled in their appointments to pick up on depression frequently enough.
Therefore, we should never assume that because an elder has been seen by a physician, they have been adequately screened for depression. Since Alzheimer's can be mistaken for depression, it is important to make sure a good quality screening for depression goes on before a diagnosis of dementia is settled upon. I would add that if there has been a past history of depression in the individual in question, and/or a history of significant depression in the family, such a screening would be extra important.
Dr. Raia also said that the super-rigorous diagnosis processes that many major hospitals offer have a lot to do with the research they are doing on this subject, and are not necessarily required to make a good diagnosis. If the person being diagnosed can withstand such an many-faceted, rigorous examination, then go ahead and do it. If not, then they can undergo some lesser -- but adequate -- process.
I did ask a follow-up question: how important is it to find out what type of dementia the person had once dementia has been determined to be present? He felt, if the person could manage a neuropsychological evaluation, that it could provide a lot of really valuable information, not just about the specific type of dementia present, but about the deficits and abilities the person had -- which would greatly impact the types of care and environment in which they would do best. Such evaluations can be difficult in that some people undergoing them might find them depressing; again, judge by the individual and their situation.
Additionally, it's vital, Dr. Raia said, that the diagnostician must be adept enough to make sure they have eliminated Lewy Body Dementia and Parkinson's, because drugs given for other types of dementia can speed decline of patients with Lewy Body and Parkinson's.
Another point to made about the elegance of the diagnostic process, and finding the right person and process through which do undertake it. Depression frequently arises as a result of dementia. The person's functioning becomes more difficult, and in response, they become depressed. To tease apart potentially-present dementia from an also-present depression, to figure out if the cognitive impairment observed is due to depression, or if the depression is due to difficulty functioning due to dementia, is something that must be determined carefully. Given the lack of engagement and time taken around diagnosing depression that too many physicians have, I feel dubious that this can be handled within most primary care relationships.
We ran out of time while discussing this question, and this left me pondering afterwards: so, then, what is the best route to take? I have long suggested that a psychiatrist who specializes in geriatrics be the diagnostician when it comes to dementia. Second choice: a neuropsychologist. And after listening to Dr. Raia and thinking about what he shared, I have come to the same conclusions.
The last important take-away point in the coming days...
(This post is a part of a series; the first one can be found here.)
Learning to Speak Alzheimer's: A Groundbreaking Approach for Everyone Dealing with the Disease, Joanne Koenig Coste, 2004 -- Koenig Coste and Dr. Raia together developed Habilitation Therapy. This book introduces the methods behind this therapy, and gives lots of hands-on examples and suggestions about how caregivers -- from family to professionals -- can apply it. I agree that this is a vital read!
Ten Thousand Joys & Ten Thousand Sorrows: A Couple's Journey Through Alzheimer's, Olivia Ames Hoblitzelle, 2010 -- originally published under a different title, this has been recently re-released. Dr. Raia knew Mr. Hoblitzelle, and recounted to us Dr. Raia told him he was nuts to try to teach meditation to Alzheimer's patients. "I said, 'Attention is exactly their deficit! It'll never work!' I told him. Well, that what he did for two years, went all around the world teaching. It worked great!" I've not read this title, but look forward to doing so very soon.
By Guest Blogger, Roberta Carson, Founder of ZaggoCare
June 29, 2005: the day our vibrant 17 year old son Zachary (photo at right, I'm beside him) was diagnosed with an inoperable, terminal brain tumor and given 4-6 weeks to live. I was completely shocked and overwhelmed by this horrible news, barely able to manage even the simplest of tasks. However, as anyone who has been a patient or family caregiver knows, the job of navigating through the medical world is enormous and very stressful. We are not trained or prepared; we are thrust into a whirlwind of appointments, learning medical terms we cannot pronounce, making treatment decisions without fully understanding all that is involved, taking care of the daily needs of a patient, and more, all while trying to maintain a sense of “normalcy”.
Zach’s tumor responded well to chemo and radiation, allowing him to live for 27 months, during which time I was his primary caregiver. As do all caregivers and patients, I learned as I went, with some lessons coming a bit later than I would have liked.
From this experience, I developed the ZaggoCare™ system to teach patients and families dealing with any type of medical issue a simple, smart way to become fully involved, more effective members of the healthcare team – so they can get more from their medical care.
What is the ZaggoCare™ system and how does it help?
ZaggoCare is an innovative system of educational information and tools designed to turn the chaos of a medical ordeal into manageable order. The ZaggoCare Guide, an 80-page book packed with extensive practical guidance and proven tips, is the central element. It comes with a set of user-friendly organizational tools to implement the book’s straightforward advice.
To learn more, and to order a system, visit www.ZaggoCare.org
As a 501(c)(3) charitable organization, 100% of the profits from the sale of the ZaggoCare™ system will be donated to the Zachary Carson Brain Tumor Fund to support innovative cancer research.
By Guest Blogger, Paula von Kleydorff, Program Director, Carleton-Willard At Home
(Editor's Note: Caring Companion is proud to be a Carlton-Willard At Home recommended provider; CWatHome members enjoy special pricing or other considerations from recommended providers)
Carleton-Willard At Home is in the forefront of what is being called a “Village Movement.” In 2001, Beacon Hill Village was the first in the country to begin providing comprehensive services to local residents who preferred to remain in their homes as they aged. Across the United States there are now 54 organizations similar to At Home and another 100 in development. Some are in the middle of urban areas, others are suburban and one in California covers hundreds of miles. But all have a common goal – giving local residents the peace of mind and support needed to age in place.
This past November, representatives from many of these groups came together in Philadelphia under the auspices of the Village to Village Network, a national organization launched last year. Throughout the two day conference, new and developing groups listened to and shared their stories, compared program offerings and brainstormed about ways to operate more effectively and efficiently.
There were a number of common themes: a willingness to do whatever it takes to meet a members’ need; the importance of top quality service providers; the need for good transportation options and pride in being at the forefront of a new type of community.
But there were also some very striking differences. Some differences are based on geography -- urban, suburban and rural organizations have had to adapt services and structure to their very different locales. Other differences are demographic -- some groups target low income and inner city seniors without any other resources to fall back on.
One of the most discussed conference topics was how to reach the myriad of people who support the concept of staying in place in retirement, and will certainly join an organization like At Home at some point but who consider themselves “not ready yet”. All too often, people decide to become members only when a crisis strikes. We welcome those members and marshal our resources to help them through their crisis. Yet experience shows that it is much better to operate from a position of strength, making decisions and setting up support before there is a compelling need. Having the foresight to join At Home before you need help can provide a sense of security and wellbeing, the peace of mind that makes aging in place a comfortable reality.
As we all struggle with the inevitable cold and snow, this winter might be the perfect time to let At Home support your independence and give you peace of mind.
We meet regularly with other firms serving the Massachusetts elder care and home care market to discuss how we can work together to serve our clients better. At one meeting recently, I was especially impressed with the elder law firm of Summers and Summers in Acton, MA. They are trying to think about elder law and elder care in new ways to serve a changing market. This is the kind of thinking required to address the demographic and market changes facing us today.
Summers and Summers has expanded their elder law practice to offer Geriatric Care Management services as well. Attorney Cathleen Summers is a Registered Nurse and a Geriatric Care Manager as well. We know many outstanding GCMs, but most are independent or work at hospitals or home care agencies. Combining elder law and geriatric care management is rare -- unique, in our experience -- but makes a great deal of sense. The job of a Geriatric Care Manager is to look at and to manage the "big picture" of a family's elder care needs. This usually includes estate planning and other legal services, many of which are offered on a transaction basis without developing a relationship between the law firm and the family.
Offering GCM services in addition to legal transactions like wills and trusts provides an opportunity for the client family to develop a closer long-term relationship with the firm that also handles their legal services. It allows them to be more of a one-stop shop for planning needs. Because of this, Summers and Summers offers a service they call the Provisio Life Plan, which provides a road map to current health and lifestyle planning needs.
Another way they show their forward thinking is through an online document vault service that they offer families and other law firms in the industry. This allows families to securely store important documents online so that they can be retrieved remotely if needed, and are always accessible. Anyone who has had to search endlessly for a parent's car registration or other important document will immediately see the value of technology that provides an always-available, remotely-accessible, secure and organized safe deposit box for documents.
With this industry changing as fast as it is, and the needs of the aging population growing so fast, it is a pleasure to run across forward-thinking agencies and individuals working hard to serve their clients and seeking new, better ways of solving problems. Summers and Summers is that kind of firm and we are proud to be their colleagues.
Recently, I was honored to be part of a four-person panel at the Wayland Public Library speaking on the topic "What's New in Aging?" We discussed navigating the new terrain of aging in the 21st century, followed by a question and answer session from the audience. Juergen H. Bludau, MD (photo at right), Harvard University and Brigham and Women's Hospital geriatrician, and Carol Sneider Glick, Esq, elder law specialist with Squillace & Associates of Boston, were wonderful fellow panelists. (Part 2 of this talk is scheduled for April 6, 7pm at the same location - register here)
I want to note here high points of the evening, including the excellent questions the audience brought. I felt very much at home in the company of these speakers, all on the front lines of bringing best-quality care in a quickly changing landscape. My fellow panelists as well as the audience of about 45 from Wayland, Weston and beyond were enthusiastic and engaged with every presenter's points.
Dr. Juergen H. Bludau, MD (photo, above right), a Harvard University and Brigham and Women’s Hospital geriatrician, built a powerful case for why geriatricians are so vital for elders. Despite the enormous demographic change of aged and aging people in our society, the need for geriatricians is not universally accepted. "Older people are biologically different from people of other ages," said Bludau, "this must be understood to treat them correctly." During their standard training, physicians receive very little information about treating elders. Because symptoms of serious conditions like pneumonia or a heart attack often present very differently in elders, it takes a specially trained eye to not brush off what may otherwise appear to be insignificant conditions. Though children now are widely understood to benefit from specially trained pediatric practitioners, there is still a long way to go for such general acceptance to extend to physicians specially trained to treat elders.
Bludau pointed out that even among aged individuals who are enjoying good health and vitality, they may be living very close to the edge of their their ability to rebound from an illness or injury. "Homeostenosis, the point at which a person has used up all their inner reserves and resilience, may be close to the daily functional level of many elders," he said. This is why once an elderly person who was healthy becomes ill or has an injury, one problem after another may develop, and they may not be able to regain their health. Seemingly small health events may appear to have disproportionately negative effects on elders if they are viewed through a non-geriatrician's lens.
Attorney and Wayland resident Carol SneiderGlick (photo, right), elder law specialist with Squillace & Associates, P.C., in Boston, made it clear that being an elder lawyer isn't just about preparing documents like a will and power of attorney. While these are important to have, the attorney has to get to know much more about the elder's life and goals, as well as their financial situation, and should be a specialist in elder law, including Medicaid and tax planning, in order to be able to prepare the correct documents so that the client can be adequately protected and that the documents serve them as intended. "Many aspects of elder law are complex, such as tax planning," said SneiderGlick, who holds an advanced law degree in this area. "It's heartbreaking to see a client who thought they were all set with their asset protection and tax planning, to find that they haven't even come close to meeting their goals."
I spoke about how dramatically aging has changed in the last 40 years, with people living substantially longer with many more complicated medical conditions, with family often no longer nearby, or nearby but so busy with work and raising children that they can't consistently help. But also in the past 40 years, many of the ingredients for successful aging have become available, but that they are not being put together and used nearly as frequently as they should be. The audience and my fellow speakers warmly received the messages I offered about bringing home care into the 21st century: the importance of choosing caregivers who perform up to modern care standards, reducing at-home care costs by bringing in monitoring technology, how teamwork is vital, and the way we are keeping the family and care partners informed about care in the home through our one-of-a-kind online system.
The audience was very attentive, and had a wide range of questions the panelists answered. In the final analysis we can see that regardless if they were asking about lawyers, medicine, physical therapy or other disciplines, many questions were touching the same point: "How can family and professionals know that others on the care team know what they are doing, are making the right decisions, and carrying out the right care?"
In general, the panel said it was important to make sure there is proper credentialing of professionals, that when possible you choose care team members from institutions or private practices that specialize in your area of need, and that if necessary you get a second opinion from some other institution or practitioner.
After continuing to think about this question, I would add that this underscores the need for a fully integrated team approach with great communication: it's likely that team members have worked with similar circumstances to your or your loved one's, and have also worked with other professionals in many different disciplines. Periodically check in with those seasoned practitioners to get their take on how the team is performing. If they are all from the same practice or institution, my experience is that it's likely you may not get straight answers as politics may overwhelm an urge to speak frankly. However, if you watch their body language, listen to their voices, to what they say and especially to what they won't respond to, you will get clues to what they really think. More direct questioning may or may not bring out their true opinions. Do your best to be uncritical, non-blaming and calm, and try to elicit their best recommendations for improvements without pointing fingers at any particular team member.
SneiderGlick concurred. "A good, caring professional is going to notice if something isn't going right, even if it's in an area that isn't their specific expertise," she said. "I was just referred a client by a financial planner who had an instinct that her client's trusts weren't set up correctly, although she didn't know enough about it to know exactly what was wrong." Upon review, Sneider-Glick found several deficiencies in that client’s estate planning client’s estate planning documents that if left uncorrected, would have defeated that client’s goals. Fortunately in this instance she was able to correct them before it was too late. "Talking fully with the client and talking among professionals is vital -- there is no substitute for working together as a team," she concluded.
The second part of this series is scheduled for April 6 at 7pm at the Wayland Public Library, and focuses further on 21st century care essentials, helpful to both elders and adult children looking for help with aging parents. Both presentations are a free service to the community, and are sponsored Caring Companion Connections of Concord. To reserve a seat, sign up at http://info.caringcompanion.net/21st-century-caregiving/.