Senior Care Management Newsletter
August 2008 - Now And Then
The phrase “now and then” often defines something that occurs sporadically, perhaps even inconsequentially. Every now and then you may discover a book you really enjoy. Every now and then you meet someone who potentially might become a good friend. Whatever happens “now and then” may well have a superficial, perhaps even a transient quality to it.
However, these two words do have a far more critical and urgent quality to them when considered in the light of our aging population and their families. When two people look at each other, sharing a desperate look on their faces, the question “What do we do now?” can have great significance. Such a question may have the note of a dawning awareness or the confirmation of knowing something that you would really rather not know. At times, holidays are like that. The extended family gathers for Thanksgiving, Christmas, or the 4th of July celebration and some of “the kids” see Mom or Dad reacting, or not reacting, in different and disturbing ways.
In preparing for the shared family meal the question arises, “Mom, where do you keep your corkscrew?” The family members are shocked and concerned when they realize that not only does Mom not know where the corkscrew is but at that moment she does not even know what a corkscrew is! And Mom lives alone! “What do we do now?” become the critical question of the day. For another family such a group gathering may have involved Dad volunteering to run to the store for a few grocery items. He was out and gone before anyone could go with him, and it is now several hours later and he is just pulling into the driveway. He rather sheepishly confesses that he became “lost” and has just now found his way home. The family looks at each other and they almost say in unison, “What do we do now?”.
These situations and these questions are disconcerting to “the kids”, who themselves may be 50 - 65 years old. After several family meetings, whether in person or on the phone, the group comes to realize that as important as the “What do we do now?” question is, it is only the first half of critical double question, for soon the group question, becomes, “What do we do then?” If we can arrive at a quick, yet momentary, resolution to the more difficult or crisis-driven question of “What do we do now?” the equally important question comes of “What do we do then?” Now and then, short term and long term, present and future, these questions just keep coming, often with no comforting answers.
One possible solution for both of these families would be to engage the services of a professional geriatric care manager (PGCM). Care managers are skilled health care
professionals who understand the world of the senior adult and are experienced in aiding families to find creative solutions such dilemmas. Being well versed in the availability of community resources the PGCM can be the guide through the forest of decisions where the family has never had to travel. The issues surrounding Medicare, Medicaid, in-home services, assisted living, skilled care, health care power of attorney, family finances, and eldercare legal issues can be as perplexing as they are crucial for the senior adult and families to understand.
For senior adults and their families “now and then” is far more than a casual or inconsequential moment. The realities of “here and now” become their immediate focus. The presence and information of a PGCM can make this critical time in the life of any family less disturbing. Usually one call is all it takes to begin the healing process for all concerned.
February 2008 - Valentine's Day - A Strange Love Story
The history of our celebration of Valentine’s Day is an intriguing mixture of the joy of new – and ever renewing – emotions of loving relationships, as well as the possible pain experienced when such love goes awry. Even the alleged history of the young priest who became “St. Valentine” was filled with the joy in his relationship with a young lady, later known as “St. Marius”, and his ultimate martyrdom at the hands of a Roman Emperor who has the dubious title of “Claudius the Cruel”. What was the crime of St. Valentine? He performed wedding ceremonies, against the decrees of Claudius forbidding such marriages, even knowing that the couples potentially would face great hardships.
Even today, pastors stand with couples in ceremonies that joyously unite them, yet those very relationships have the potential for many tough and tender moments as the couple creates life together. St. Valentine’s Day is the annual event where couples can celebrate the current reality, or the memory, of their loving relationship.
In the 1970 tear-jerking and overly sentimental movie “Love Story” Ryan O’Neal and Ali McGraw pandered the philosophy that “love means that you never have to say that you are sorry”! While the movie brought in millions of people, and dollars, we really know that the Ryan-Ali philosophy is dead wrong. Loving relationships certainly celebrate the good times but they must also possess the humility of recognizing when they have brought pain to another person and seek to repair fabric of that relationship. Asking for forgiveness for our own actions and offering forgiveness to those whom we love yet whose actions have brought us pain is at the core of what a St. Valentine’s Day relationship can be.
As couples age, the elements of celebration and sadness in their relationship can come with an even a greater impact than in youthful “first love”. At times couples do not even have to look at the other to know what the other is thinking – or feeling. A beautiful sunset, a bunch of flowers, the melody of an oft remembered song, all can bring back memories of St. Valentine’s Days past.
This Valentine’s Day is an opportunity to recognize the special place your loved ones have in your life. The greatest gift that you can give to anyone is to say, “Happy Valentine’s Day! I love you.”
November 2007 - The Conversation
Have you been anticipating having "the conversation" with your parents? You know the one I mean. You have perhaps spoken with any available siblings, close friends, a clergy person or physician, or perhaps a geriatric care manager about "the conversation". You have started the conversation dozens of times in your head. "Mom, I am worried about you," you begin, or maybe "Dad, I don't think you should be driving the car anymore", or "Hi Mom and Dad, Have you ever thought about moving to a nursing home?" Yet you fear that right after you speak these words you might feel like you are rearranging the furniture in your stateroom—on the Titanic. Your fear is that no matter what, you—or just this conversation—are going down!
With the burgeoning senior population in this country the prospect of needing to have a similar conversation with a senior adult is steadily growing greater. The statistics on needing to have such a conversation are increasing exponentially, with someone in our country turning 55 years old every seven seconds of every hour of every day and this will continue to be true for the next 20 years. Or the fact that the age group of 85 years and over is the fastest growing age cohort in our country today.
So, here are a few tips both for aging parents and for their children—who are probably between 50 and 65 years old themselves. What will you do when the time comes for "the conversation" in your house? First, before the need becomes blatant, start early by paying attention to any physical, mental or emotional changes in your loved one. Be aware that the changes you observe may be subtle, almost imperceptible, but increasingly evident to the senior adult and to their family, such as memory problems that may create safety issues in the home, or the lack of physical stamina to walk as far as they once did, or a greater than usual amount of confusion regarding past activities. The first response is often to overlook or excuse these issues, but should we?
The word that has become increasingly important for both seniors and their families is planning. A great percentage of all adults today still do not have a will, a health care power of attorney, nor have they completed the legal steps in forming an advance directive. Not only is this a critical issue for seniors, it is clearly an important part of planning for everyone. Evaluating and purchasing a long term care policy not only makes financial sense in most instances, a growing number of continuing care retirement communities are requesting or requiring incoming residents to have such a policy. Being informed about these issues can often make having "the conversation" go much more easily.
One of the most important skills going into "the conversation" is the ability to listen. Rarely have I had an initial conversation with older adult(s) about these issues and had them indicate that they have given no thought to their increasing limitations. At times they have refused to think about their future needs because such thoughts are scary and unsettling for them. Families must take the time to listen, carefully and lovingly, to their older family member before they attempt to "sell a solution" that the family has devised. As these conversations begin, senior adults need to know that their wishes will be heard and respected in the formation of future plans, or the conversation can take on the symbolism of the Titanic mentioned earlier. Over several conversations the topics of finances including who is legally designated to sign on bank or savings accounts, in-home care vs. assisted living, how the senior adult wants (or can) spend their final days, and funeral arrangements are among the topics that need to be considered. These are obviously not easy conversations to have for any member of the family but be assured that without them some issues that are critically important to the senior family member will be unheard.
Finally, all members of the family must be heard and respected in "the conversation". Clearly, these can be tough and tender moments. In addition to the joy of reminiscence, the feelings of fear, guilt, anger, or anxiety may also be expressed. At times these may come in destructive ways. Often having a pastor or geriatric care manager present can assist in finding a way for these issues to be expressed with the greatest opportunity for a caring and loving outcome.
"The conversation" whether easily achieved or an anticipated moment of concern and anxiety is an important aspect of planning for all families. As is often the case, the anticipation of the conversation may be more uncomfortable than the conversation itself.
August 2007
With the burgeoning population of older adults, eldercare has become a significant family and social issue. Our increasingly mobile society often separates older parents from their children, many times measured in the thousands of miles. And the dilemma of younger adults is that they may be caring for aging parents for more years than they care for their own children. The absentee rate of those employees who are caring for an aging parent is a growing HR issue. And we have not reached the Baby Boom Generation yet! "A baby boomer will turn 55 years old every seven seconds for the next 20 years, and their parents are living longer than any generation in history," states the authors of Eldercare: The New Frontier, Performance Resource Press.
The following family scenes have become all too familiar. A parent has a major health crisis and needs both immediate and long term care assistance. The daughter or son lives nearby but has both a full time job and an active family life that leaves little time for "care giving". Or, an aging parent moves in with the family of one of their children. As that parent become increasingly frail the family realizes that care giving is no longer a safe possibility in their home and taking more time off from work for care giving is almost impossible. What alternatives are available and where does the daughter or son even begin to get information.
The National Association of Professional Geriatric Care Managers states that a Geriatric Care Manager (GCM) "is a health and human services specialist who helps families who are caring for older relatives." A GCM is trained and experienced in any one of several fields relating to long term care, including social workers, nurses, gerontologists, and psychologists who have specialized their practice in elder care issues.
As a GCM, Bill has often used the analogy of an orchestra conductor for his work, with all of the sections of the orchestra representing non-medical home care, home health issues, assisted living, skilled nursing care, medical care, long term care insurance, legal issues of a will and a health care power of attorney, financial assistance when basic home accounting and Medicare billing grow onerous, and many others.
Each person and family will face many different concerns as a loved one ages. Bill Crittenden will assist you by addressing your concerns in a caring and competent fashion. You and your family need not feel overwhelmed by your situation. Together we can create a plan of action that will provide assistance for all concerned.