"Only the needs have changed"

My colleague Bonnie recently wrote of the concept of aging in place, which is gaining traction in the United States. Geriatric care managers are frequently consulted to help a family pull together the supports and resources that are necessary to facilitate an elder's ability to age in place. This usually means supporting an older person who wishes to remain in their family home, but can also involve facilitating a relocation to a congregate living community and ensuring that the community and its staff are prepared to adapt to the person's changing needs over time. Beyond the physical adaptations that may need to be made to a home environment, there are important psychological and emotional adaptations to be made as well, new agreements to be forged between the elder and those who care for them. As ramps are built, tubs are cut out, and grab bars are installed, it's important to remember that all physical and cognitive changes aside, who we are as we age remains essentially unchanged. William Thomas, MD, addresses this idea in his 2004 book, What Are Old People For?

"Elders whose health has declined to a substantial degree are the same people they have always been; what has changed is the manner in which they collaborate with others. Their longevity has changed the nature of their daily lives, making close cooperation essential ... the person is the same and only the needs have changed ..."

A home safety evaluation is an important feature of Elder Care Guides' assessment process. While identifying safety risks that can be mitigated through adaptations to the home, we're also looking for opportunities to foster our clients' continued development in whatever physical space they occupy. Does the home provide opportunities for the elder to safely pursue their interests and passions, and maintain relationships with others? Can the person easily access their much-beloved garden? Is it a space that is comfortable for their grandchildren to visit? 

While different relationships of give-and-take are being negotiated between elders and their spouses or children, or new relationships with paid caregivers and/or facility staff are being established, maintaining our focus on the essence of that recipient of care - who they have always been and continue to be - ensures that we will create a modified environment that supports their continued development as an elder. 

Bastille Day 2009

On Saturday July 11th, the staff of Elder Care Guides attended the Southern Caregiver Resource Center's 18th annual "Bastille Day" fundraiser at the beautiful Fairbanks Ranch Country Club. We had a great time, and hope that this fine organization raised a lot of money, to ensure that they will be able to continue providing essential information, support, and services to San Diego and Imperial County residents who care for an adult with a chronic and/or disabling condition. We did our parts, by bidding on (and winning) five different silent auction prizes between us!


Elder Care Guides staff members Bonnie Grim (Care Manager), Susan Valoff (Director of Clinical Services), and Amy Abrams (Vice President)


Scott Stewart (of The Elder Care Law Firm, a sponsor of the Bastille Day event), with his wife Rebecca.


Olga Stephens (of The Elder Care Law Firm), with her husband Kosta.

For more information about the Southern Caregiver Resource Center, please visit their website at www.caregivercenter.org.

Aging-In-Place

• As the Boomer generation gets closer to their senior years they may have thoughts about if and how they can continue living in their own homes. Aging often brings about changes both in one’s cognitive as well as physical abilities but physical transitions can take place at any time in our lives. Two concepts which have a like purpose are called Aging-in Place and Universal Design. Their similar purpose is to simplify life, making the structural environment more usable for everyone at little or no cost. Both concepts “allow us to move through the transitions of life and still enjoy equal opportunities, self determination, self respect, quality of life and safety!”
  
  Home modifications are interventions that change the physical environment of one’s surroundings in order to promote functioning and quality of life as well as safety. Some modifications can be major such as structural changes like a low cut tub or adding a ramp into the home. Others changes can be on a much smaller scale like installing locks on doors or cabinets, rearranging furniture, decreasing clutter and even posting reminders.
  
  Today many builders, interior designers, physical therapists and others interested in preserving home safety are becoming Certified Aging-in-Place Specialist (CAPS). This designation program through the National Association of Home Builders (NAHB) teaches the technical aspects, business management, and customer skills needed for the fastest growing segment of residential remodeling – home modification for those aging in place.
  
  Some resources to check out Universal Design and Aging-in-Place:
  Jordan, Wendy. Universal Design for the Home: Great Looking, Great Living Design for All Ages, Abilities, and Circumstances. Beverly, MA; Quarry Books, a member of Quayside Publishing Group, 2008.
  National Aging-in-Place Council - http://www.naipc.org/
  And Senior Resource for Aging in Place - http://www.seniorresource.com/

Discounted CPR and First Aid Classes

Save-A-Heart is holding classes for CPR and First Aid, at a discount rate this summer. The combined class is 3 hours long, and covers Adult, Child, and Infant 2 person CPR, Heimlich maneuver, drowning and disease prevention when administering CPR, and 20 basic first aid procedures. The cost of this class is $25 per person. This special rate will expire on September 1st, 2009. The instructors for this class are certified through the American Heart Association. Save-A-Heart is located in Alpine, CA, and can be contacted at 619-445-4569, or through their website: http://www.cprpros.com/.

The Giving and Receiving of Care

On Tuesday afternoon, I made a home visit with a gentleman who has been a client of ours for nearly two years, and who has bonded deeply with his companion caregiver. As he described to me his gratitude for all of her assistance over the time that she's worked with him with tasks like bathing, preparing meals, and accompanying him on daily walks, I perceived his sense that the giving and receiving of care was a one-way street. I turned to his caregiver, and asked her to tell us something about what she has received during the time that she has been working with him. She told us about all of the things she has learned about San Diego from this client (an avid historian), her new appreciation for the beauty of a Protestant religious service (she is Catholic, but attends church with him at his chapel every Sunday), and about how much her English (which is her second language) has improved over the 18 months that they have been working together. Although her English is nearly grammatically perfect, she told him early on in their relationship that she was working to further improve it, and asked for his help when he noticed improper pronunciation or usage. She told us how invaluable she has found his assistance in this regard, how much she appreciates his kind ways of correcting her and teaching her about some of our language's oddities.

This struck me as an important lesson for us all, and brought to light a concept that is well-illuminated by William Thomas, M.D. in What Are Old People For?, his groundbreaking 2004 critique of the American long-term care system. He writes that "... the bulk of the suffering experienced by those confined to long-term care environments is due to the plagues of loneliness, helplessness, and boredom," and calls for a radical transformation in not only the provision of care but our deeply held beliefs about aging. The antidote to helplessness, according to Dr. Thomas, is the opportunity to give as well as to receive care. 

I watched my client's face light up in a huge smile as the caregiver spoke that afternoon, and knew that he was seeing for the first time the positive impact their time working together has had upon her as the care giver, as well as himself as the care receiver. It gave me a chance to reflect on the ways that we as care managers, and all of us who care about an older person, can create opportunities for late-life development. The moments are all around us.