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Important information for Family caregivers
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Using a Professional Senior Care Manager
Services from senior care managers should be something that every family takes advantage of, but in reality very few families use them. Senior care managers could go a long ways towards helping the family find better and more efficient ways of providing care for a loved one.
The concept is simple. The family hires a professional adviser to act as a guide through the maze of long term senior care services and providers. The Senior care manager has been there many times. The family is experiencing it usually for the first time.
Hiring a senior care manager should be no different than hiring an attorney to help with legal problems or a CPA to help with tax problems. Most people don't attempt to solve legal problems on their own. And the use of professional tax advice can be an invaluable investment. The same is true of using a senior care manager.
Unfortunately there are too few senior care managers and the public is so poorly informed about the services of a senior care manager, that valuable resources that could be provided go lacking.
The irony of not using a senior care manager is that most families -- when given the opportunity to use the senior care manager -- think they can do it themselves and will not pay the money. Yet the services of a senior care manager most likely will save them considerably more money then do-it-yourself. The cost of the senior care manager might be only a fraction of the savings the senior care manager could produce. Senior care manager services can also greatly reduce family and caregiver stress and help eliminate family disputes and disagreements.
Below is a partial list of what a senior care manager might do:
- Assess the level and type of care needed and develop a senior care plan
- Take steps to start the care plan and keep it functioning
- Make sure care is received in a safe and disability friendly environment
- Resolve family conflicts and other family issues relating to long term senior care
- Become an advocate for the senior care recipient and the family caregiver
- Manage senior care for a loved one for out-of-town families
- Conduct ongoing assessments to monitor and implement changes in senior care
- Oversee and direct senior care provided at home
- Coordinate the efforts of key support systems
- Provide personal counseling
- Help with Medicaid qualification and application
- Arrange for services of legal and financial advisors
- Manage a conservatorship for a senior care recipient
- Provide assistance with placement in assisted living facilities or nursing homes
- Monitor the senior care of a family member in a nursing home or in assisted living
- Assist with the monitoring of medications
- Find appropriate solutions to avoid a crisis
- Coordinate medical appointments and medical information
- Provide transportation to medical appointments
- Assist families in positive decision making
- Develop long range plans for older loved ones not now needing senior care
Let's look at two hypothetical examples to see how a senior care manager could be used.
Here is the first example:
Mary is taking care of her aging husband at home. He has diabetes and is overweight. Because of the diabetes her husband has severe neuropathy in his legs and feet and it is difficult for him to walk. He also has diabetic retinopathy and cannot see very well. She has to be careful that he does not injure his feet since the last time that happened he was in the hospital for four weeks with a severe infection. She is having difficulty helping him out of bed and with dressing and using the bathroom. She relies heavily on her son who lives nearby to help her manage her husband's senior care.
On the advice of a friend Mary is told about a senior care manager, Susan Brown, who helped the friend's family cope with the care of a loved one. The cost of an initial assessment and senior care plan from the senior care manager is $300.00. Mary thinks she has the situation under control and $300.00 for someone from the outside to come in and tell her how to deal with her situation seems ridiculous.
One day Mary is trying to lift her husband and injures her back severely. She is bedridden and cannot care for her husband. Her son, who works fulltime, now has two parents to care for. On the advice of the same friend he decides to bring in Susan Brown and pay her fee himself.
Susan does a thorough assessment of the family's needs. She arranges for Mary's doctor to order Medicare home care during Mary's recovery. Therapists come in and help Mary with exercises and advice on lifting. Susan advertises for and finds a private individual who is willing to live in the home for a period of time to help Mary with her recovery and watch over her husband. Susan makes sure the new caregiver is reliable and honest and that taxes are paid for the employment. Susan enlists the support of the local area agency on aging and makes sure all services available are provided for the family. Susan also calls a meeting with Mary's family and explains to them the senior care needs and how they need to commit to help with those needs. Susan makes arrangements to purchase medical equipment for lifting, moving and easier use of the bathroom facilities. Medicare will pay much of this cost.
Susan suggests using a geriatric senior care Physician she works closely with to help Mary in the care of her husband. The geriatrician meets with Mary and her husband and spends a great deal of time explaining the proper treatment and care of elderly with diabetes. He rearranges medications and puts Mary's husband on a new insulin regimen to better control his blood sugar. He starts a strict diet and insists on weight loss and exercise. The previous doctor seemed more interested in treating symptoms than in changing lifestyles. In contrast to this attitude, the geriatric Physician feels that Mary's husband has a chance of improving his health with proper treatment.
Susan also works closely with an elder law attorney and a financial planner who specializes in the elderly. The attorney prepares documents for the family including powers of attorney, a living will and advice on preserving Mary's remaining assets. The financial planner recommends a reverse mortgage specialist to help Mary and her husband tap unused assets in their home's equity. In addition, an income vehicle is put into place to convert assets into income in order to provide for Mary for her life when her husband is gone. And finally, with the help of the financial planner, an application for veterans benefits is made for Mary's husband who is a veteran. Depending on the monthly cost of care this additional income could provide up to $1,800 more a month in household income.
With the help of the senior care manager, Mary's life and future have been significantly improved. Her husband as well, if he adheres to the senior care plan, may end up having a better quality of life for his remaining years.
Here is another example of the value of the senior care manager.
Michelle is a single divorced mother with two teenage children. Her mother, Martha, has a stroke which apparently causes some memory loss as well as some disability in being able to fend for herself. Michelle decides to move in with her mother and take care of her. In return, Michelle who is temporarily out of work, has a place to live and share her mother's retirement income.
Martha is anything but easy to take care of. She has mood swings and often forgets what she is doing. She seems to display a lot of anger and takes it out on Michelle, calling her all kinds of horrible names. She is never happy and is constantly calling for attention. In trying to take care of her own children as well as her mother, Michelle is quickly being drained of her physical and emotional strength. In addition Michelle's brother and two sisters are happy she is taking care of her mother since they are now absolved of the responsibility, but they treat Michelle terribly. They also call her awful names and accuse her of being a "leech". On the other hand they have plenty of advice on how to deal with their mother but never offer any of their own time to help. After all, they reason, Michelle is receiving benefits from caring for her mother and logically she should be responsible for all the care.
On the advice of a friend, Michelle hires a senior care manager, Brent Smith, who comes highly recommended in solving family disputes. Brent is a certificated mediator. Brent first does a senior care assessment of Martha and comes away suspecting there is more to her personality disorder than a stroke. He makes arrangements to take Martha to a geriatric Physician who does a complete physical assessment and recognizes that Martha's mental state is due more to improper medications and severe depression. Martha's medications are reduced and changed and she is put on antidepressants. In addition her diet is upgraded, she is to receive more fluids, more healthy foods and especially receive vitamin supplements. Particularly important is a prescription for vitamin B12 shots.
The doctor insists on as much exercise as Martha can handle. Brent, the senior care manager, helps convince Martha of the need for her new senior care program and helps oversee her following through on the exercise program. Over the ensuing months Martha's lack of memory and abusive behavior become less severe. She is also better able to care for herself without Michelle's assistance.
In addition to the assessment, one of the first things Brent does is to contact Michelle's older brother who is the family leader. He has a long talk with her brother and gives the brother a different perspective on the issues. With a better understanding of the situation, the brother calls a family meeting and Brent mediates a successful resolution of the family mistreatment of Michelle and the ensuing bad feelings. Everyone including Michelle is called upon to do their part in managing the senior care of her mother and to work on better family relations. The issue of Michelle "sponging" off of her mother is addressed and an adequate solution is agreed to by all. Brent will follow up in a month to make sure everyone is following through on his or her commitment.
These two examples concentrate on care in the home but senior care managers are also actively involved in helping families with the selection of facilities and any appropriate senior care services. Finally, senior care managers are indispensable in helping coordinate and arrange for care for a loved one living far away from family members.
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Frequently Asked Questions
1. My mom is declining and I know I need to do something. Where do I begin?
It is important to start with a thorough assessment of your mother's needs. A senior care manager is educated and trained to perform a thorough assessment of needs in the following areas: health and safety; legal and financial issues; medical history; daily living activities; and emotional and psychological functioning. This interview takes about 90-minutes and a report is sent to you with recommendations and referrals to specific community resources best suited to your mom.
2. Are your services covered by insurance?
Most insurance does not cover Senior Care Management. These services are primarily private pay.
3. I think my mom is becoming incontinent and I don't know how to talk to her about it. What do you recommend?
A Senior Care Manager can provide individual consultation with you and help you develop some simple strategies of communication. We can also be a liaison to the primary care physician to see if medication would be helpful.
4. We think mom needs to go to assisted living, but she doesn't want to move. How do we handle this?
Sometimes having a family meeting is a helpful place to start. A Senior Care Manager can perform valuable mediation services to help everyone come to a consensus. If mom has adequate financial resources, a Senior Care Manager can develop a Senior Care Plan that outlines what community services would best meet the needs your mother has and help you with a cost analysis of staying home versus moving to assisted living.
5. I live out of the area and am concerned that my dad isn't remembering to tell his doctor the symptoms he is having. Can you help with this?
A Senior Care Manager will attend all medical appointments, advocate for your father's needs and provide a follow-up medical visit summary via fax, e-mail or phone call.
6. I want some type of evaluation done on my grandmother but she says she doesn't need any help. What should I do?
This is a common problem and Senior Care Managers are very helpful in developing a positive strategy and approach to this often difficult situation. Clients often report, "this was more fun than I thought it would be!" and "mom responded quite well to a professional telling her what would be helpful."
7. Mom needs to downsize since she can't handle yard work anymore. How do we know what level of care she may need?
A professional Senior Care Manager can provide you with a basic understanding of levels of care, how much they cost and what services they provide. Our professional staff also provides assistance in planning and overseeing a move to and from a primary residence, retirement complex, assisted living or skilled nursing facility.
8. My dad refuses to discuss making someone his durable power of attorney for healthcare decisions. What happens if he gets really sick?
The elderly are often unaware of new confidentially laws that restrict family members from being able to speak to their physician. They also may have some deep fears of losing control. Senior Care Managers have a great deal of success in providing needed education about end-of-life issues and are often able to assist in getting the healthcare directive filled out.
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Sandwich Generation Adult Daughter & Entrepreneur
Nancy Priddy, daughter of Charlotte, age 93, has been advocating for her elderly family members for many years. Besides being the senior care manager for her mother and mother-in-law, she is also married with grown children of her own. Nancy says she loves working with seniors because they are so rich with history and energy and always ready to share their stories. She actively supports the OWLS (Older Wiser Lutherans) at Mt. Carmel Lutheran Church, where she is an active member.
This sandwich generation adult daughter became a big supporter of Professional Senior Care Management after experiencing some frustration and confusion in trying to find the right placement for her mother. She had done her research and found what appeared to be a wonderful assisted living facility, but it didn't work out. So, facing another move, Nancy called a Professional Senior Care Manager to help sort out the various dementia related issues that were impacting the placement. After a thorough needs assessment was completed, a more appropriate setting was chosen. It turned out that Charlotte was a night owl, not a wanderer, and she needed a place to live that would accommodate those needs. Now she has a lovely 1-bedroom apartment with separate living room and is flourishing. The Senior Care Manager continues to provide on-call services when the family is on vacation or out of the area on business.
Nancy cares for her mother and maintains a private practice as a Stress Management Consultant and Certified Biofeedback Therapist. She works with psychological issues (anxiety, depression, phobic disorder, sleep issues) and physical issues (pain management, headaches, high blood pressure.) This type of work helps individuals become aware of how life may be controlling them and provides techniques for changing what isn't working.
Stress in the workplace, communication and job search are topics Nancy addresses while giving consulting/workshops for agencies and businesses in the County. You may contact her at (805) 544-6410 for more information on the services she provides.
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Tracy & Barb's Story - 65 years together and counting!
By Cheryl Kippen, MS, CMC
Professional Senior Care Manager
Like many residents of San Luis Obispo, Tracy and Barb moved to the area in 1974. They purchased a lovely single-level home with a gorgeous view and have enjoyed their latter years living independently and traveling the world to visit their five grown sons.
Now in their 80's, and with some healthcare concerns facing them, they decided to contact a professional senior care manager because family members lived states away and were worried about their general well-being. Barb was experiencing some memory loss challenges and Tracy was providing the 24-hour care she needed. Having been a Navy captain, he was more than able to supervise their medical needs, track their medications, and assist his wife with the daily household tasks of cooking, shopping, transportation and attending medical appointments.
During this season, Tracy's concerns were largely focused on his wife's care. He was, however, anticipating some upcoming surgery and wondered how his wife would accommodate to having a stranger in their home during his absence. With the encouragement of his adult son, he contacted a senior care manager to provide a thorough assessment of their needs. The assessment report contained referrals to the EOC Senior Home Repair Program for appropriate grab bar installation and to several reputable senior care giving agencies.
While the surgery ended up being unnecessary, Tracy did experience a traumatic fall while visiting family in Alaska. His injuries left him unable to provide the personal senior care services his wife needed. His senior care manager came to the home and together they decided how much help would be needed for meal preparation, transportation and personal senior care needs.
The agency sent a caregiver several hours a day, 2-3 times per week. Much to his surprise, Barb got along quite well with the caregiver and he felt greatly relieved.
Tracy maintained a monthly On-Call service contract with his senior care manager during this time. A couple of months later, he was hospitalized with a compression fracture in his back. So the senior care manager arranged for 24-hour care for Barb, provided some family history and assumed medication management oversight.
During Tracy's hospitalization, the senior care manager stepped in to provide monitoring of the care at home and also met with the adult son when he visited and provided consultation about what to expect during rehabilitation and recovery.
A referral to Home Health was made and a team of healthcare specialists were provided for nursing care, physical therapy and occupational therapy for Tracy. When recommendations for home modifications were made, the senior care manager followed through and hired a reliable handyman to build a raised platform for a favorite chair and purchased a new dining room chair so he could sit safety with less stress to his back. The home health team phoned the senior care manager after each therapy session, so needed follow-up care and services could be provided in a timely and efficient manner. Along with this assistance, and the daily care giving support, Tracy and Barb received the care and comfort they needed during their time of transition.
A senior care manager's dream is to work with a client and their family to stabilize the home environment during a time of distress and to coordinate the healthcare services, so they can thrive in the middle of a challenging event in their lives.
Tracy and Barb have remained resilient and empowered to stay in their comfortable and familiar environment. He recovered from his compression fracture and his lovely wife, Barb, thrived with the added household help. Their caregivers bring the joy, humor, care and extra social contact needed, when family lives at a distance and are not able to visit regularly.
The goal of professional senior care management is to provide assessment of current needs, coordinate care, evaluate and monitor their client's ongoing needs and provide appropriate recommendations and quality referrals. We strive to provide quality senior care for a smooth transition and speedy recovery.
Picture provided by:
Professional Senior Care Management for Older Adults
San Luis Obispo, CA 93401
www.professionalcaremgt.com
(805) 709-2254
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Visiting the Elderly- Red Flags for family members
Visits home to see aging parents or family members provide wonderful moments of togetherness in a loving and warm environment. They also provide a special opportunity to observe firsthand how well your loved one is doing on an hour-by-hour or day-to-day basis.
Talking to loved ones on the phone may occur more frequently than family visits, but when you live at a distance it isn't always easy to get the full picture.
It is normal for aging parents not to want to burden their children, so they may under report their concerns. If they had a fall and their memory is declining, they may not remember to report the incident or the injuries sustained. Phone calls from family members are treasured moments, so time is spent on happier topics such as how the grandchildren are doing and how your job is going. It is likely that signs of decline may not be detected during those conversations.
Professional Senior Care Managers are trained to observe the Red Flags that often indicate changes are taking place in a loved one's ability to care for themselves. So, if you are planning a family trip in the near future, here are some Red Flags that often give valuable clues that special attention may be needed.
The general condition of the home is often a Red Flag.
- Is there more clutter than usual?
- Do the counters and tables seem to be accumulating old mail or bills that appear unopened?
- Does the refrigerator have old or outdated food in it?
- Do the foods in the refrigerator or freezer represent healthy nutrition?
- Are the dishes washed and put away or are they accumulating in the sink and on the counter tops. Is this normal or out of character?
- Are there any signs of burned food on the stove?
Clothing worn daily might give you clues about failing eyesight or memory.
- Is there food or stains on the clothing indicating neglect or that the clothes are not washed when needed?
- Are the medication containers up-to-date? Does this person know what condition each medication is being prescribed for?
- Is there confusion about the date, time or place where they live?
- Does the person verbalize paranoia (i.e. people stealing things from them?
Driving safely can be a concern.
- How do you feel when in the car and the elderly person is driving?
- Does the senior's car have marks, scrapes, or dents you don't remember from your last visit?
- Any clues or signs that medication, physical or psychological symptoms may be impairing the person's ability to drive safely?
If you observe any of these Red Flags and you feel concerned, contact Cheryl Kippen, MS, CMC, regarding a professional in-home assessment. Having a clinical perspective will help you determine the appropriate next step.
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