ELDER CARE GUIDES

Open Positions

2012-02-07T15:37:00.000-08:00

We're growing at Elder Care Guides, and are excited to announce the addition of two new positions to our fine team of professionals:

The Client Services Manager is a full-time business development manager position with responsibility for varied external and internal sales and marketing activities, including working with current and prospective referral sources, as well as clients and their families. We are looking for a candidate with sales experience within the local healthcare industry, and direct experience working with the elderly or disabled population.

The Lead Care Manager is a clinician with responsibility for assessments, care planning, and related care management activities, as well as individual and group clinical supervision for our care management staff. This will be a full-time position through September 2012, with the possibility of continuing on a part-time or full-time basis. We are looking for a candidate with a Masters degree in social work or RN degree (or comparable education in a related field), at least five years of clinical and/or case management experience with the senior population, and a minimum of two years of experience supervising clinical or professional staff.

For complete job descriptions and requirements for each position, please visit our website. Please feel free to forward this information along through your network to anyone who may be interested.

Long Term Care Planning: Specialty Community-Based Long Term Care

2012-01-16T10:27:00.000-08:00

Volume VII: Specialty community-based long term care

Last month’s issue provided an overview of the basic types of long term care facilities. Here we review a few models of specialty care that are available in the community.

There are several types of specialty Skilled Nursing Facilities (SNFs) in California. A Distinct Part/SNF (DP/SNF) is a hospital-based unit, rather than a freestanding facility. Intermediate Care Facilities (ICFs) provide inpatient care to those who need nursing and supportive services, but who don’t require continuous skilled nursing care.

A Continuing Care Retirement Community (CCRC) is a configuration in which Independent Living, Assisted Living, and Skilled Nursing Facility services are provided on one campus. A resident contracts for care regardless of changing needs, usually for their lifetime. Most CCRCs have a large entrance fee, ranging anywhere from $100,000 to $1 million. CCRCs are regulated by California’s Department of Social Services Continuing Care Contracts Branch.

Some residential care facilities offer specialized services for people with dementia. Dementia Care can be provided within a freestanding facility, or as a separate unit within an Assisted Living facility. Staff are trained to work effectively with people with Alzheimer’s and other types of dementia, and activity programs are tailored to the special needs of the residents. Buildings have secured perimeters to prevent unsafe wandering.

Hospice Care provides comfort and support to patients with terminal illness that is not responding to cure-oriented treatment. Hospice may be provided within the home or in a facility setting, with the goal of maximizing quality of life through effective symptom and pain management. Services provided by an interdisciplinary team address the emotional, spiritual, and social impact of the illness upon the patient and their family.

Next month we’ll explore the important issue of financing community-based long term care, considering what settings are covered by health insurance, and which require private funding.

The Cost of Probate

2011-12-08T14:12:00.000-08:00

First, let me say that I am not an attorney or a financial planner, but I am curious. I was given a handout at an estate planning group by Kim Ward, a licensed Realtor with Horizon Real Estate in La Mesa, California. This handout provides a brief rundown on the costs of probate, and the purpose of this post is to state briefly some of its main points.

My purpose here is to increase your awareness of the costs of "going through probate."

1. Probate costs are very high. Maximum statutory fees that attorneys can charge for probate, per the California Probate code section 10810, are 4% for the first $100,000, 3% for the next $100,000, 2% of the next $800,000, 1% of the next $9,000,000 and 1/2% of the next $15,000,00. A separate fee is established by the courts for anything over $25,000,000.

2. If executors are part of the probate, both the attorney and executor will receive fees, thereby doubling the costs.

3. The estate's value is determined by the inventory and debts are not included. An example: If a house is appraised at $1,000,000 and it has a mortgage of $800,000 the assets for determining the probate attorney's fee is considered on the $1,000,000.

4. Estates are appraised by probate referees who are appointed by the State Controller. These probate referees also receive a fee based on 0.1% of the assets appraised.

5. It usually takes longer to probate an estate than to administer a trust.

If nothing else, I hope these statements will lead you to contact an attorney to review probate costs and consider the less costly alternative, establishing a TRUST.

November is National Home Care & Hospice Month

2011-11-11T08:00:00.000-08:00

Elder Care Guides joins our colleagues in the California Association of Health Services at Home (CAHSAH) in celebrating National Home Care and Hospice Month during the month of November.

"During National Home Care and Hospice month, we take time to honor the thousands of individuals in home care and hospice who, on a daily basis, provide remarkable care in people's homes. Thank you for all that you do."
-- CAHSAH President Joe Hafkenschiel

Every day, Elder Care Guides' geriatric care managers and caregivers are actively engaged in our mission to better the lives of elders living with physical and cognitive impairments, providing services that center on the goals of the individual, and foster within them a lifelong sense of purpose. We see firsthand the impact of our team approach, of finding "the right match" and seeing a client transformed -- whether it is through healthier eating, more physical activity, opportunities to connect socially, or just a hand to hold in the last hours of life.

We're proud of the time, care, and attention to the details that matter most to our clients that our Human Resources department expends in selecting skilled and qualified professional in-home caregiver employees. Day in and day out, they work hard to enhance the quality of our clients' lives, and they have our full support, 24-hours a day, 7 days a week. We take this commitment to a highly professional and well-supported staff very seriously, as they are key to fulfilling our mission.

As such, we strongly support AB-899, the Yamada Home Care Services Act of 2011. This legislation will require California's Department of Social Services to license and regulate home care agencies, holding the agencies responsible for ensuring that their professional caregiver employees are qualified and reputable. For information about this legislation and how to support it, please visit: California's Legislative Information page at: http://www.leginfo.ca.gov/bilinfo.html

We're Hiring!

2011-11-10T10:19:00.000-08:00

Elder Care Guides is seeking a dynamic sales and marketing professional to join our team. Applicants must have a bachelor's degree in social work or related field, or a business degree with 2-5 years sales experience within the elder care industry. The position will include community education, and new client assessments as needed. If you have sales experience and/or a history in social work with elders, we want to hear from you!

Elder Care Guides offers a competitive salary with fully paid health and dental benefits. We are not offering relocation assistance at this time.

Please see the full job posting here, and apply online through our website.

Long Term Care Planning: Community-Based Care Settings

2011-10-14T16:50:00.000-07:00

Volume VI: Community-based care settings

Previous installments of this series have described the resources available to those planning for care at home, and the goal of this issue is to describe the basic options for community-based long term care. Those who choose to move out of a private home and into a "senior living" setting do so for a variety of reasons. For some, it is a financial decision, while for others it is a lifestyle choice - freedom from the day-to-day responsibilities of managing a household, or the opportunity to interact socially with more people on a daily basis.

Independent Living communities are also sometimes referred to as "retirement communities." Some amenities such as communal dining, light housekeeping, transportation services, and planned activities may be available, but no personal care is provided. In these communities, residents must usually be able to ambulate independently.

Residential Care refers to a range of different housing providers that are licensed (in California by the Department of Social Services' Community Care Licensing division) to provide assistance with activities of daily living such as bathing, dressing, and medication management. A Board and Care home is a small residence (usually a single family home) with between six and twelve residents and a small staff of attendants. An Assisted Living facility is a larger community that usually offers several different levels of care and more supportive services.

Skilled Nursing Facilities are sometimes referred to as "nursing homes." They are licensed (in California by the Department of Public Health) to provide skilled nursing and supportive services for those who require assistance with most - or all - of the activities of daily living.

Next month we'll explore some additional specialty community-based residential services that are available, and then we will move on to a discussion of fees and funding sources for each level of care.

Are Your Employees Orange?

2011-10-04T14:43:00.001-07:00

We have spoken earlier about the great research done by Chester Elton and Adrian Gostick in The Carrot Principle, a book about employee engagement and the effects of recognition in the workplace. The authors have done it again, this time in The Orange Revolution, which discusses teamwork. The book encompasses what makes a great team, and how an "orange" team, or one with a high sense of unity in a common goal, achieves breakthrough, positive results.

Teams exist in almost every organization, in every arena. The elder care industry is no exception, especially when you consider geriatric care management, and the team it takes to care for an elder in their home. Elton and Gostick found that once an initial level of basic competence is met, there are 5 key factors every team needs in order to achieve "orange" status and be effective:

Goal Setting (knowing where the team is going)
Communication (wise use of your voice and ears)
Trust (believing in others and being trustworthy)
Accountability (doing what you say you will do)
Recognition (appreciating others' strengths and contributions)

A geriatric care manager and an organization that employs caregivers to the elderly has a key responsibility to ensure their employees are humming the same tune when it comes to those five factors. Supervisors who set clear goals, encourage and provide detailed communication, build trust, hold team members accountable, and recognize great work will undoubtedly have an engaged team environment built around the client.

Since October brings us lots of orange in pumpkins, Halloween, and harvest colors, I encourage you to survey your employees and client care teams to see if they are engaged and orange, too.

Age of Champions

2011-09-27T10:19:00.000-07:00

It's time for another Elder Care Guides movie suggestion! "Age of Champions" is an uplifting story of a group of athletes—a 100-year-old tennis champion, 86-year-old pole vaulter, and a team of basketball grandmothers all chasing gold at the National Senior Games. The film captures the triumphant spirit of these competitors as they tackle the challenges of aging with grace, humor, and optimism. Win or lose, they inspire us to follow our dreams and find purpose at any stage of life.

"Age of Champions" is showing at the San Diego Film Festival this Saturday, October 1st at 12:30pm at the downtown Gaslamp Theatre. Buy your tickets now, and discover how you can build on your strengths, find your purpose, and become a champion too.

Long Term Care Planning: Bridging Home and Community

2011-09-15T09:53:00.000-07:00

Volume V: Bridging Home and Community

In previous issues, we’ve outlined the resources that are available when planning for the care at home of a disabled elder. It’s important to remember that those who lose connections with friends, community organizations and social groups, or who fail to build new connections and participate in engaging activities are at risk of social isolation, known to negatively impact physical and mental health. Fortunately there are community-based programs available to help those living at home with physical or cognitive impairments to remain socially connected, physically active, and mentally stimulated well into their old age.

Adult day health care programs are licensed centers that provide medical services and a variety of therapies, social services, and stimulating activities, as well as meals for the participants, who usually attend the program between 4-8 hours per day, several days per week. Adult social day care provides a similar structure, but does not offer skilled medical services and emphasizes socially, physically, and intellectually stimulating activity. Senior centers are neighborhood-based facilities that offer an array of social and educational opportunities, often offered on a drop-in basis. Many provide exercise programs and nutritious meals for participants on the days that they attend. For those who are no longer driving, it is essential to plan for transportation alternatives, to ensure access to all of the types of services that have been described. To find transportation and other resources in your community, contact your local Area Agency on Aging, or log on to the national Eldercare Locator: www.eldercare.gov.

The above resources can supplement a care plan that provides safety and support at home while keeping the elder connected and engaged. Next month, we’ll discuss the different levels of community care that are available for those who are considering making a move from a private home.

Making the Move - "Home Sweet Home"

2011-08-25T12:27:00.000-07:00

Recently, at the request of some family members, I recommended some long term care facilities to a couple of my clients. The moves, when they happened, were as different as my clients but in both cases I found some similarities.

No matter how careful you are, when discussing the move, there is always the point when the client states that "this is just going to be a temporary move" or something to that effect.

This is when your diplomatic best needs to shine. Without lying or promising something that won't or can't happen, you need to encourage your loved one to focus on some positive advantages of the move. Point out the lovely accommodations, the proximity of their room to the library or the dining room. Escort them around the grounds in order to familiarize them with all that it has to offer.

Socialization is going to happen, make the best of it by making sure the Admissions Director has a good understanding of your loved one's interests, capabilities and personality.

Make sure when you visit that you are friendly to the other residents. This goes a long way in helping your mom or dad adjust and provides some common talking points when you're not around. It also can help a lonely fellow resident a chance for a personal connection.

Facility apartments and rooms are not "home". Like most anything else, they need to take on the personality of the resident in order to be comfortable and one's own "safe have" in this unfamiliar community. So make it as homey has possible from the start! Put pictures on the walls, add family photographs around the apartment, place a special quilt on the bed, provide a good reading lamp and a comfortable chair or two. Having a chair for a guest is pretty important. Really, no one finds sitting on a bed very comfortable and your mom or dad will be more likely to invite someone to sit down for a visit if they can offer a place to actually sit!

Give your parents time to adjust to their new home. You making daily visits really doesn't help in that adjustment. They need to learn how things happen within their new community and who they can turn to. Developing rapport with the staff is crucial for a comfortable transition and a happy resident.

Change is always difficult but with thoughtful planning the adjustment to one's new "home" can effectively be made and the new resident will feel that they are truly "Home Sweet Home".

Caregiving Comes from the Heart

2011-07-25T11:17:00.001-07:00

Elder Care Guides' Human Resources Director Elizabeth Reynolds was recently interviewed on Business Networking Radio. In the interview, Elizabeth touched on some of the characteristics of a great professional caregiver, and the career path for graduates of programs like Newbridge College's Medical Assistant program. In addition to training and professional experience, Elizabeth has an eye for identifying candidates with relevant personal experience providing care to a disabled loved one, and the less-tangibile "heart" qualities that are essential to the services that we provide.

To download an mp3 of the interview (air date 7/20/11), please click here.

For information about opportunities for professional caregivers at Elder Care Guides, please visit the "Career Opportunities" page on our website.

Long Term Care Planning: Bringing in a Professional

2011-07-15T12:34:00.000-07:00

We were invited to write a series of brief articles for the monthly newsletter of our friends at MDK Insurance Services, describing the continuum of long term care, and how to navigate oneself through it. You can sign up for the newsletter on their website, and each month we provide a copy of the article here as well. Please share the information with someone you know who is thinking ahead about how to plan for (and pay for) their own or a loved one's long term care.

Volume IV: Bringing in a Professional

This month we continue to outline the array of options for those planning for the care of an aging or disabled loved one at home. In addition to hands-on assistance with the activities of daily living, various professional supports are available to help families navigate the maze of long term care and manage complex caregiving situations, including fiduciaries and geriatric care managers.

Professional fiduciaries are licensed individuals who serve by court appointment as guardians, conservators, or personal representatives of an estate. They may also be designated by an individual to serve as trustee, representative payee, or agent under powers of attorney. If a disabled person is no longer able to manage their finances or health care decision-making, and no family members are available or appropriate to assume this role, a fiduciary may be brought in to undertake these essential functions.

Geriatric care managers are certified specialists trained in nursing, gerontology, social work, or psychology, with expertise in issues related to aging and elder care. Services include in-home assessments and care planning, arranging and monitoring care services, 24-hour availability for assistance during emergencies, liaising with long-distance family members, and health care advocacy. For many families and professionals caring for a person with chronic physical or cognitive disabilities, a professional geriatric care manager serves as an experienced guide and resource.

For more information, visit http://www.pfac-pro.org/, or http://www.caremanager.org/.

We've now covered some basics for planning for care at home, and next month we'll explore community-based resources that can serve as a bridge between home and facility.

Long Term Care Planning: At-Home Care Options

2011-06-17T08:07:00.000-07:00

We were invited to write a series of brief articles for the monthly newsletter of our friends at MDK Insurance Services, describing the continuum of long term care, and how to navigate oneself through it. You can sign up for the newsletter on their website, and each month we will provide a copy of the article here as well. Please share the information with someone you know who is thinking ahead about how to plan for (and pay for) their own or a loved one's long term care.

Volume III: At-Home Care Options

It's Father's Day. Are you thinking ahead about how to meet Dad's needs as he grows older? Or your own? After you've taken an honest look at your needs, it's time to consider the options.

Most individuals state that they wish to remain at home for as long as possible, and there are many service to help them achieve this goal. Health insurance does not over the cost of most care at home, which is paid for privately, or through a long term care insurance policy. Non-medical in-home care providers can be hired for assistance with the basic and instrumental activities of daily living, such as bathing safely, preparing nutritious meals, and transportation. In-home meal delivery programs (which have come a long way since their bland beginnings) often serve double-duty as a daily check on a senior living alone at home. Simple home modifications such as strategically placed grab bars, or durable medical equipment such as elevated commode seats can make a home more accessible to a disabled person. Personal emergency response systems are an essential safety net for many.

A common obstacle to bringing in home-based services is the myth of independence: "I don't want anyone in my home." It may help to realize that we are all actually interdependent upon one another throughout our lives, and this doesn't change as we grow old. The particulars of the needs may change, but we continue to be needed by others at every age, and we continue to need them as well.

This is only a brief introduction to the extensive in-home services that are available. To locate resources in your area, visit the national Eldercare Locator: http://www.eldercare.gov/. Next month we'll describe additional professional services that are available for managing care at home, and then we'll begin to explore community-based options.

Long Term Care Planning: Assessing Current and Future Care Needs

2011-05-16T08:21:00.000-07:00

We were recently invited to write a series of brief articles for the monthly newsletter of our friends at MDK Insurance Services, describing the continuum of long term care, and how to navigate oneself through it. You can sign up for the newsletter on their website, and each month we will provide a copy of the article here as well. Please share the information with someone you know who is thinking ahead about how to plan for (and pay for) their own or a loved one's long term care.

Volume II: Assessing Current and Future Care Needs

You know the importance of thinking ahead and understanding your options when it comes to long term care. But how do you know what kind of care you may need? No one can see the future, but by taking a realistic look at your current scenario and asking hard questions about what may lie ahead, you can set yourself up for success.

Consider your current health status (and that of your spouse, if applicable). Are you living with any chronic health conditions, or are you at risk of developing them? You may be functioning at an exceptionally high level right now, but consider the possibility that some day you may not. One in eight Americans over the age of 65 has dementia, which results in a decline in memory and cognitive ability, and usually prevents an older person from being able to live alone without assistance.

Think about your support system. What type of assistance can you reasonably expect from your spouse, children, neighbors, and friends? Do you live in a community where you are surrounded by these types of natural "helpers," or is your network more limited? What kind of help are you going to be willing to accept from your friends and family, and for what types of tasks would you prefer the help of a professional?

Begin giving these questions some thought, and next month we'll begin exploring the range of at-home and community-based options that are available to those who require long term care.

Long Term Care Planning: Establishing Your Objectives

2011-04-15T08:05:00.000-07:00

We were recently invited to write a series of brief articles for the monthly newsletter of our friends at MDK Insurance Services, describing the continuum of long term care, and how to navigate oneself through it. You can sign up for the newsletter on their website, and each month we will provide a copy of the article here as well. Please share the information with someone you know, who is thinking ahead about how to plan for (and pay for) their own or a loved one's long term care.

Volume I: Establishing Your Objectives

Recent survey information reveals that 75% of those aged 65 and older will eventually require long term care. Thinking ahead and understanding the options that are available helps us make better-nformed long term care choices when the needs arise. Planning before a crisis that is brought on by a sudden change in status empowers the older or disabled individual to make well thought-out decisions about their own care, versus having decisions made quickly by someone else during a time of great stress. Ensuring that everyone is working with the same information, and effectively delegating tasks preserves relationships between family members and friends.

Start by establishing your objectives: Are you looking to make a short-term decision to deal with a specific and time-limited issue, or are you thinking ahead about future care and housing decisions? Agree on who will participate in the decision-making process, and what their duties and responsibilities will be. Perhaps one sibling will research and identify potential home care providers, while another takes responsibility for making phone calls and conducting interviews. Gather information, and then take the time to weigh your options together. Remember that the landscape of long term care is constantly changing; the options available today are different from those that were available just a few years ago.

Next month, we'll look at ways to conduct an accurate assessment of an individual's current and future care needs, before examining the range of care and housing options available along the continuum of long term care.

Good News for the Elder Care Industry

2010-10-21T14:45:00.000-07:00

The first wave of the Baby Boomers turns 64 this year. It won't be long until they start the biggest retirement exodus this country has ever seen. It's time for companies to prepare, because the Boomers are being replaced by a much smaller generation of unskilled workers. With the unemployment rate close to 10%, it's hard to imagine, but in just 8 short years our country could have as many as four million more jobs than workers to fill them.

So what's the good news for us in the elder care industry? First, the idea of a traditional retirement is outdated. The 60-somethings want to continue to work, and make a difference. They want flexible, creative work that accommodates their lifestyle. I can think of a fabulous profession that meets all that criteria...professional caregiving! Additionally, many of the soon-to-be retirees already have experience, in caring for their aging parents.

As an HR professional, it is my duty to keep on top of up to four generations that are in the current workforce, and understand the needs and traits of each. In the elder care industry, however, the most common generation is the Boomers. Let's inform these new retirees of this growing, purposeful career and help reduce the gap between open jobs and skilled workers.

Medicare Part D Open Enrollment

2010-10-06T17:07:00.000-07:00

Medicare beneficiaries take note! The annual election period for prescription coverage under Medicare Part D will take place from November 15 through December 31 for coverage beginning January 1, 2011.

Why is this significant? There is only one enrollment period per year when you can change coverage. Different Part D plans offer varying coverage for certain medications, so you may wish to change Part D plans if you have experienced any health problems over the past year which have resulted in medication changes. Or, if you have added up your medication expenses and feel you may be able to get better coverage under a different Part D plan, you may wish to "shop around."

You can use the formulary finder on the Medicare website to search for the Part D plans in your area that cover most or all of the medications you are taking. You will be prompted to enter a list of your medications and dosages, and then you will be provided with a list of Part D plans, their monthly premiums, and customer ratings of each plan.

Generally you can only switch Part D plans during the annual enrollment period, though there are certain exceptions, called Special Election Periods (SEPs). You may have an SEP if you experience a special circumstance such as moving into a nursing home, or losing your Medi-Cal benefits. If you are currently covered under a union or retiree plan and this plan stops offering prescription drug coverage in the future, you can join a Medicare Part D plan without a penalty as long as you do so within 63 days of the end of your existing coverage.

Medicare Part D coverage can be confusing, but there are resources out there to help. Great information on Part D coverage, as well as Medicare and other health insurance options for seniors, is available at the website of California Health Advocates. You can also call the San Diego Health Insurance Counseling and Advocacy Program (HICAP) office at (858) 565-8772.

Quality of Life

2010-09-15T13:47:00.000-07:00

Quality of Life is tied to perception of 'meaning'. The quest for meaning is central to the human condition, and we are brought in touch with a sense of meaning when we reflect on that which we have created, loved, believed in or left as a legacy.
- Frankl VE. 'Man's search for meaning.' New York: Pocket Books, 1963.

I have had the pleasure to work with a wonderful and talented woman whose art has brought joy to many, and most importantly herself. She has patented a particular style of batik and created and sold her work but has not been able in past years to express her artistic talents.

Elder Care Guides holds as one of its main beliefs the importance of helping our clients achieve "quality of life." Knowing my client's passion for her art, I set out to discover a means to help her create again and with much luck, discovered a great resource by the name of Kat Kirby.

Ms. Kirby is an Art Therapist who believes in the "healing power of the arts" and that one should have a "good time during the process." Her studio, 2KatStudios, offers workshops in collage, mosaics and other creative pursuits. To find out more about Kat, check out her websites here and here.

Kat's patience, expertise and own excitement in creating has brought my client the opportunity to express herself, to hope and to create a legacy once again.

We Love Carrots!

2010-08-16T15:12:00.000-07:00

I recently attended the 62nd Annual SHRM Conference, the largest HR Conference in the world with over 11,000 attendees from 140 countries. As you can imagine, the general and breakout sessions were packed with valuable information on managing, supervising, and engaging employees. However, one session that stood out above the rest was "The Carrot Principle: How the Best Managers Use Recognition to Engage Their People, Retain Talent and Accelerate Results," presented by Chester Elton.

Elton is a dynamic and insightful speaker, who engaged the audience by encouraging participation, using multiple types of visual aides, and even throwing stuffed carrots into the audience. His message, backed by years of research, was simple: recognize your employees for a job well done frequently, specifically, and immediately, and they will feel valued and appreciated. As mentioned before on this blog, valued and appreciated employees stick around. The metaphor of the carrot as it relates to business is "something used to inspire and motivate the employee." In Elton and Adrian Gostick's book, it states:

"When employees know that their strengths and potential will be praised and recognized, they are significantly more likely to produce value."

So how does this relate to employees that care for elders for a living? The demographic that makes up the majority of caregivers, are those that live paycheck to paycheck. Don't those employees just want more money? Nope. At least, that's not what Elton and Gostick reported. One-third of people you give a cash award to will use that money to pay bills, and one in five won't remember in a few months how much they received or where they spent the money. But they will remember receiving a hand-written note from their direct supervisor, or better yet, the President of the company, thanking them specifically and timely for something they did that was above and beyond. If those appreciative notes and phone calls keep coming, employees will keep going above and beyond, because rewarded behavior gets repeated.

I highly recommend Elton and Gostick's book and website. Read them, study them, and implement a recognition program. Your employees will appreciate it, and become motivated to do better and be more committed, which directly translates to your companies mission, goals, and values.

A Little Bit of Fun

2010-08-12T14:52:00.000-07:00

Sharing some laughter! Click on the photo to enlarge, and enjoy!

The spaces between my fingers

2010-07-23T16:57:00.000-07:00

Earlier this week, I had the opportunity to meet the folks behind an inspiring grassroots movement whose mission is to raise awareness about Alzheimer's disease and share wisdom between the generations, called The Spaces Between Your Fingers. Matthew Smith is currently engaged in a 30-day road trip across the country, using supplies that he purchased last year with his life savings to facilitate several 90 minute workshops in 13 different cities -- with, I imagine, some unplanned stops along the way. Participants come together in small groups and Mr. Smith shares a brief personal story of the life and loss of his grandfather, Dr. William McNamee, who died of Alzheimer's disease in 2003. In a letter to his grandson he asked him to think of him when he looked at the spaces between his fingers:

"Any time you want to find me, you don’t have to look far. Just look down at the spaces between your fingers—where my hand used to be—and instead of thinking of all that’s keeping us apart, remember this great force that’s holding us together, and always will."

Through some facilitated questions and discussion, participants are guided through memories from their childhoods, think back to lessons learned throughout their lives, and conjure up a piece of wisdom that they've gained and would like to pass on to the next generation. On a postcard, they trace an outline of their own hand, and then fill it in with their advice. Mr. Smith is collecting thousands of these postcards from individuals of all ages around the country, and will eventually combine them into a physical art installation and book, which will be used to promote awareness about Alzheimer's disease.

I am a volunteer co-facilitator of a support group for individuals living with early-stage memory loss that is held on Wednesdays mornings at the San Diego/Imperial County chapter of the Alzheimer's Association, who was contacted by Mr. Smith with a request to provide this free workshop to a group of individuals living with memory loss. The idea of the project was met with enthusiasm by our support group members, and we've been looking forward to his arrival on the west coast. The workshop this week was a great experience for the participants, sharing stories from their childhoods and early careers (a few of which I had heard over the seven years I've been facilitating the group, but most of which I had not). The telling of old stories by an individual who is progressively losing their memory is always a profound experience, and it's an honor to be there to receive these fleeting treasures. Wednesday mornings are always a highlight in my week.

Naturally, my mind wandered away from the table a few times and I got to thinking about my own childhood, the people who have influenced me, and some important lessons I've already learned in my short 35 years. Not many days go by that I don't think about my maternal grandmother Phyllis, who was - and is - a central figure in my life, and died in 2005. The summer that I was fourteen, my grandma undertook the task of teaching me to sew. She was an amazing seamstress, and had passed her skills along to her own talented daughters as well. My mom had not yet had an opportunity to teach me to sew; she was raising her three kids in a different era that required her to work full time and manage a busy household. But this is the gift of grandparents! They have time and space in their days that the rest of us simply don't have, and Grandma had decided that it was time that I learned. My first project was a black calico print dress that I'll never forget. I remember selecting a pattern in the shop, browsing for fabrics, and the afternoons of learning to cut, pin, and press, and getting familiar with the feel of the sewing machine on countless scraps in my grandma's sunny sewing room. It frustrated me to spend days practicing before I could even make the first cut into that pretty black fabric, but Grandma was adamant. That summer she taught me the importance of not just "doing things," but doing them right. She taught me that anything I make should look as good from the inside as it does from the outside. Straight stitching and clean seams (even if other people will never see them) not only make your clothes fit better, but they make you feel good about your work when you put them on. The things that I do in life need to not just look good to other people from the outside; they need to look good to me from the inside as well. I hope that Grandma Phyllis knew how important that time that summer with her was, and I suspect that she did. Today whenever the spaces between my fingers are filled with pins and crinkly tissue paper, or are guiding a piece fabric through a sewing machine, I think back to that sunny room and all of the love and laughter there, and that little bit of becoming who I am.

What a gift my grandmother was to me -- and that all members of an older generation are to those who follow them. Those of us who spend our days engaged in service to our elders are constant recipients of these gifts, and every day I know I chose the right path. I thank Matthew Smith and everyone who is supporting him in his project for this opportunity to spend some time in personal reflection, and for providing the members of our support group who live day in and day out with the frustration of a failing short-term memory with this valuable opportunity to tell stories and teach lessons. To answer Dr. William Thomas' important question: this is what old people are for.

The Aging Caregiver Workforce

2010-06-24T16:05:00.000-07:00

In the elder care industry, most focus on the clients, or the elders, and rightfully so. It is them for whom we care, center our business on, and assist in finding their purpose as they move through their elderhood. But what about the caregivers? At what place in their life journey are they?

Research shows that 22 percent of home care workers, or caregivers, are 55 or older. And that number is expected to grow to 30 percent over the next decade. Traditionally, most companies may be reluctant to hire and older worker for fear they aren't as productive, slower to catch on to new technologies, and could cost the company more in health benefits. Not so in the elder care industry.

Older workers are not only preferred, but sought out as caregivers. The typical older worker not only has experience caring for aging family members, but understands the stresses families are under, has respect for age, and doesn't see age as a disability. Most often, a good match can be found between an older caregiver and an elderly client, because of the greater chance for common interests and hobbies.

Additionally, the caregiving profession is often the perfect fit for an older worker. The flexible hours, the part time hours for those not needing health benefits, and most importantly, it creates a sense of purpose, caring for someone who values their help, something they enjoy doing, and do well.

We Have A Winner!

2010-06-02T16:05:00.000-07:00

Elder Care Guides is proud to announce that one of our caregivers, Maricela Pulido, received the award for Outstanding Home Care Service from the California Association for Health Services At Home. The award is given to an individual who is "directly involved in day-to-day care and has consistently provided outstanding service to patients in their homes." Maricela was honored with this award at the CAHSAH National Conference luncheon in Sacramento, CA on May 6, 2010.

Maricela was nominated because she not only has worked for Elder Care Guides since 2004, but she has been a caregiver for the same family for over 12 years. Maricela has managed the changing medications, the bathing routine, the various outings, all while keeping in mind her clients strengths and giving him a sense of purpose during his elderhood. Maricela is punctual, dependable, and has been throughout her tenure with this client over the last decade. She has developed a trust with her client and his family that is beyond measure. In addition, Maricela has been a consistent, reliable caregiver, rarely taking time off and always being flexible with the changing needs of her client. For all these reasons and more, Maricela was nominated for, and won this prestigious award! Congratulations Maricela!

A Great Time to Be A Caregiver

2010-05-10T13:32:00.000-07:00

"The Great Recession," as it's now dubbed, has affected all of us in one way or another. The healthcare industry, especially home care, is expected to grow exponentially over the next decade. Employment statistics show the caregiving profession grew 26% from 1996 to 2006, thanks to aging baby boomers and the 85+ group, which is the fastest growing segment of the population. According to the Bureau of Labor Statistics, caregiving is the second fastest growing occupation in the country, and is projected to grow by 51% between 2006 and 2016. This is due to a multitude of factors, which primarily include the ability to treat and manage many health conditions at home with the help of a professionally trained aide, and elders increasing desire to remain in their homes where they can keep control and independance in their lives.

Caregivers provide a greatly needed relief to family caregivers, a consistant source of companionship to elders, and expert skills assisting with activities of daily living, all combined with a warm, friendly touch. These factors and more make staying at home the most appealing option to elders, vs. relocating to an assisted or skilled nursing facility. These labor statistics further prove that not only is professional caregiving an honored occupation, it is in great need and promises to be a wise career choice for years to come.

You can read more about professional caregiving and the nations employment outlook in the March issue of Caring Magazine.

Quality of Life Programs

2010-04-27T11:15:00.000-07:00

Elder Care Guides is happy to promote two special programs created for people with mild-to-moderate Alzheimer's Disease. These wonderful programs were developed by the University of California, San Diego's Shiley-Marcos Alzheimer's Disease Research Center in collaboration with Elder Care Guides, Senior Life Assistance, The San Diego Museum of Art, Mingei International Museum, Timken Museum of Art and the Museum of Photographic Arts in Balboa Park.

The Out and About Program is a series of eight weekly outings, including lunches, that offer opportunities for socialization, learning and a feeling of independence for those with early stage Alzheimer's. The groups have various meet-up spots throughout San Diego county. They offer a variety of experiences for example; touring a museum, attending IMAX movies or even visiting the Chula Vista Nature Center.
All outings have a docent who knows how to conduct the group by providing information in an informative yet understandable way . The camaraderie that develops among the participants is probably the most beneficial aspect of these outings, knowing that they can share some of their fears and concerns in a safe and welcoming environment.
For the participant's safety, Outing Coordinators drive the them to all destinations. There is a cost which covers all entrance fees, lunches and mileage.

Another Quality of Life Program is called Memories at the Museums. This program allows the person with Alzheimer's and an accompanying family member or friend to tour one of four participating museums in Balboa Park and then discuss their experiences. This stimulates both the visual and verbal abilities of the of the participants and allows for cultural expressions.
Memories at the Museum is on the second Friday of each month from 2:00-3:00. Admission and tours are free of charge but registration is required.

For more information on either of these Quality Programs please call Lisa Snyder at the Shiley-Marcos Alzheimer's Disease Research Center at (858)622-5800.

The Power of Purpose

2010-04-03T12:16:00.000-07:00

The February issue of HR Magazine hit the nail on the head with Haley Rushing's article, "Managing with the Power of Purpose." The central theme of the article suggests that a successful career and a successful business begin with a sense of purpose for what the employees are doing. Yes, the goal of any business is to make money. However, unless the employee working for that business believes in what they are doing, and are inspired by the goals and objectives of the business, the profit will not come.

Elder Care Guides is proud of our mission statement, which centers on bringing purpose to our clients and employees:

We better the lives of elders in San Diego County living with functional impairments by providing professional care management services that center on the goals of the individual, and foster within the elder a lifelong sense of purpose. We believe that:

by cultivating every client’s unique sense of purpose, we help them develop a meaningful elderhood with a high quality of life.
by identifying and reinforcing the strengths of our clients, we promote the development of healthy relationships of interdependence amongst the elder, their family, and other supports.
our employees are fundamental to our success, and their full engagement enhances the services we provide.
professional caregivers who are employed by an agency and work as a team with a geriatric care manager deliver the best outcomes for our clients.
the standards and ethics of the National Association of Professional Geriatric Care Managers provide a solid foundation for our clinical and business practices.

Defining a company culture begins with the company's purpose. Key questions the Rushing article posed include:

Why does the organization exist?
What difference is the organization making in people's lives?
What do the employees strive for, and do their goals match the organizations goals?

Employees are an organization's most important clients. Guiding employees to define their own sense of purpose, then showing them how their desires align with the companies mission and vision is the central component of a successful business. Master that connection, and the revenue will follow.

Elder Abuse and Insurance Fraud

2010-03-15T13:47:00.000-07:00

Elder abuse comes in many forms and is often accomplished by individuals who ingratiate themselves with their victims. As in any business there are trustworthy professionals and there are those who scam the public. Many elderly have savings that they wish to safely invest for their future needs but they can be swayed by those they trust to give over their savings for investment purposes created by their "friendly" insurance agent. There is an article that was brought to my attention, written by Elizabeth Furnari, Deputy District Attorney - Insurance Fraud Division of the San Diego District Attorney's Office. She points out that being aware of the different types of insurance and annuity scams is the first step in protecting yourself. http://www.sdcda.org/files/conartists.pdf . Also the The California Department of Insurance (CDI) has created a "Senior Insurance Bill of Rights" which provides a list of precautions to take when purchasing any type of insurance policy and the regulations that protect those rights. http://www.insurance.ca.gov.
There is so much information being provided for the protection of the general public but so many times it is ignored or missed altogether. We at Elder Care Guides try to provide this forum as another way to share information and in doing so we can enlighten and hopefully protect someone from becoming a victim.

Working with Registered Dietitians

2010-03-11T16:55:00.000-08:00

Many people think of registered dietitians as individuals who work only in school or hospital settings. Did you know that a dietitian can help you improve your overall nutrition; maintain, gain or lose weight; or manage the symptoms of a chronic illness like irritable bowel syndrome or kidney disease? Since many older adults suffer from nutrition problems, including unhealthy weight gain or loss, dietitians are a valuable resource for our clients and their families.

A registered dietitian (RD) is an individual who has at minimum earned a bachelor's degree with coursework that has been approved by the American Dietetic Association (ADA). Specific areas of study include: food and nutrition sciences; sociology; biochemistry; and physiology. An RD student must also complete an approved practice program at a health care facility, community agency or food service company. To become a registered dietitian, one must also pass an examination and seek continuing education credits. According to the ADA, over 50% of Registered Dietitians hold advanced degrees. They may also earn specialized certification in areas such as pediatric nutrition or diabetic care.

What is the difference between a nutritionist and a registered dietitian? Different states have varying requirements regarding who can call themselves a "nutritionist," however, the "RD" credential is a legally protected title that can only be used by practitioners who are authorized by the Commission on Dietetic Registration of the American Dietetic Association.

I recently became aware of the benefits of working with registered dietitians through personal experience as well as with one of my clients. I worked with an RD to obtain and analyze lab results that revealed vitamin deficiencies; determine my Body Mass Index (a reliable indicator of body fat); and create a meal plan to help me reach my nutrition goals. I referred one of my clients to an RD to help address gastrointestinal symptoms including constipation, gas and upset stomach. The dietitian recommended specific foods, as well as nutritional supplements and digestive enzymes to help ease my client's symptoms. She has also provided ongoing education and support to my client and her care team.

To find a registered dietitian near you, and to read more about nutrition and disease prevention, you can go to the website of the American Dietetic Association.

Elder Abuse and Insurance

2010-03-01T12:18:00.000-08:00

Elder abuse comes in many forms and is often accomplished by individuals who ingratiate themselves with their victims. As in any business there are trustworthy professionals and there are those who scam the public.

Many elderly have savings that they wish to safely invest for their future needs but they can be swayed by those they trust to give over their savings for investment purposes created by their "friendly" insurance agent.

There is an article that was brought to my attention, written by Elizabeth Furnari, Deputy District Attorney - Insurance Fraud Division of the San Diego District Attorney's Office. She points out that being aware of the different types of insurance and annuity scams is the first step in protecting yourself. http://www.sdcda.org/files/conartists.pdf. Also the The California Department of Insurance (CDI) has created a "Senior Insurance Bill of Rights" which provides a list of precautions to take when purchasing any type of insurance policy and the regulations that protect those rights. http://www.insurance.ca.gov/

There is so much information being provided for the protection of the general public but so many times it is ignored or missed altogether. We at Elder Care Guides try to provide this forum as another way to share information and in doing so we can enlighten and hopefully protect someone from becoming a victim.

Elder Care: An Employee Benefit

2010-02-18T16:31:00.000-08:00

Until recently, day care for children and personal illness have been the major recognized reasons employees need to take excessive time off from work. But what about elder care? Here comes that word again, the sandwich generation, where adults are not only caring for their young children, but their aging parents as well. Being pulled in many different directions affects employees health and well-being, which has a negative impact on productivity, motivation, and health care costs to an organization. Additionally, employees who provide elder care contribute to work interruptions, and unpaid leave. Experts estimate 60% of Americans providing care for someone 50 or older are employed.

Federal law mandates a leave to care for an ill family member, known as the Family Medical Leave Act, and employers are now looking at elder care benefits as a retention tool, in preparation for economic recovery and the accompanying employee turnover expected over the next few years. Many companies have employee assistance programs, which now include more elder care friendly options, such as help with legal and financial issues related to elder care, medical decision support, and even geriatric care management assistance.

Other retention strategies that encompass elder care are those more commonly thought of for child care, but make the transition easily. These strategies include flexible scheduling, paid personal leave days, telecommuting, and job sharing. So, if you find yourself struggling to balance work and elder care, suggest some of these options to your employer, and stress the benefits to the business they will bring. If your employer values retention and high employee morale, these options should be strongly considered.

Caregiver Retention and Turnover: Are You Ready for the Recession Rebound?

2010-01-26T16:25:00.000-08:00

The caregiving profession is notorious for turnover. The nature of the business dictates it, and human resource professionals hear every day "I need to work." Although we do our best to keep good employees with as much work as they'd like, it isn't always possible. Due to the recession, however, caregivers have stayed with their employers as active, steady clients have been few and far between for all home care companies. The total employee turnover rate in the U.S. was 16% in 2007, and only 8% in 2009.

The economy is going to recover though. Economists predict a slow, steady recovery, and we have already seen signs of hope. The last piece to regain strength will be employment, but employers need to get ready. Two-thirds of U.S. employees are expected to turnover as the recession deminishes, and that number is even greater for professional caregivers. All those caregivers who have been faithfully sticking by their employers, will start looking elsewhere if they can't get a steady case. Do you want to keep your key employees? What can you be doing to ensure good caregivers don't seek employment at the agency down the street?

We have spoken in this blog before about employee engagement and satisfaction. It's time to start developing a company culture that makes caregivers want to stay, because the economic impact of losing solid, top employee is too great. The most successful retention strategies encompass many factors, including employee engagement, high employer communication, and decentralized management involvement. When employees hear consistent and constant feedback from all levels of the organization, it creates a high sense of belonging and in turn, reduces the desire to seek employment elsewhere. Do your employees know what the company mission and vision is? Are you soliciting ideas from your caregivers on how they can help the growth of the company? We have all heard of exit interviews, but how about STAY interviews?

Employee retention and turnover is a process, not an event. Making sure employees know how essential they are in the success of the business will undoubtedly make them feel valued. Caregivers who are treated as professionals and feel valued and a senses of belonging are the ones that will stay.

National Flu Vaccination Week

2010-01-11T13:24:00.000-08:00

January 10th - 16th has been declared National Flu Vaccination Week. The Department of Health and Human Services has reported that in 2009 there were:

47 million cases of H1N1
200,000 hospitalizations
nearly 10,000 deaths

Thankfully, the number of flu cases has declined in recent weeks, however experts warn we should get ready for a third wave of H1N1. National Flu Vaccination Week was named to remind Americans to get vaccinated. Vaccinations are now open to everyone in most parts of the country. You can find more information here.

In San Diego county, US Healthworks Medical Group clinics are now offering flu vaccinations for $15. We encourage you to use the link above to learn more about patient eligibility and find the clinic nearest you. If you have your own doctor and insurance, inquire about a special rate for flu vaccinations this week and take charge of your health!

Holiday Night at Liberty Station

2009-12-14T15:53:00.000-08:00

Elder Care Guides was happy to participate in the Holiday Night event at Liberty Station this weekend. It gave us the opportunity to contribute to our fellow Liberty station residents, and serve the Point Loma community with a craft activity for the families. Being a tenant at Liberty Station allows us a central location to our clients, and a giving community of restaurants, retailers, and businesses alike.

Holiday Night was filled with crafts for the kids, a tree lighting ceremony, and a visit from Santa. On stage were dancers from San Diego Ballet, gymnists from San Diego Gymnastics, a karate demonstration from US Karate Academy, and the dancing waitresses from the Corvette Diner.

Elder Care Guides enjoyed having children draw a picture of their grandparent, then take a craft sheet home to interview their grandparent about what life was like growing up for them. We made an effort to bridge the generation gap, and children really enjoyed the activity. We hope you will join us at the next Liberty Station community event.

National Home Care Aide Week

2009-11-09T14:21:00.000-08:00

November is National Home Care and Hospice month, and although Elder Care Guides is not a home care company, we want to recognize and illuminate our wonderful employees, the professional caregivers. The National Association for Home Care and Hospice has named November 8th - 14th National Home Care Aide week, with the theme "Home Care Aide: Loving Hands and Compassionate Hearts." This special month and week was announced to bring attention to and celebrate those to spend their lives caring for others. A noble profession, caregiving doesn't often get the attention it deserves. Care Management support, a personalized care plan, and the expert care of a professional caregiver is what allows the growing elderly population to stay at home much longer than originally thought possible.

There are many ways to contribute to and acknowledge that special caregiver in your life, and we encourage you to branch out this month to increase awareness of this much valued career.

Educate yourself about Care Management and Caregiving by requesting books and materials on the topic at your local library.

Pass out small gifts or tiny treats to volunteers and caregivers at a local assisted or independent living retirement communities.

Talk about Care Management with your neighbors and friends who may be struggling in the sandwich generation and don't know where to find help.

As you go about your days in November, stop and notice all the caregivers that surround you. These amazing people are sitting with an elderly person at a restaurant, helping them with their meal. They are reaching for an item on a high shelf at the grocery store for a person in a wheelchair. Every day, they are giving of themselves physically, emotionally, and spiritually, all to assist another person to live with dignity and purpose. To the professional caregivers, we salute you. Happy National Home Care Aide week!

Looking "Up"

2009-10-05T08:24:00.000-07:00

On a recent cross-country flight, I enjoyed the opportunity to watch Disney/Pixar's most recent animated feature, "Up." The main character, Carl, is an elderly and childless man who, upon losing his wife Ellie with whom he'd led a long and happy life, finds himself being forced out of their beloved little house and into a retirement home when he is deemed a "public menace." He and his wife had an unfulfilled, lifelong fantasy of moving to a place called Paradise Falls in South America, and on the day the staff from the retirement home come to take him, Carl ties hundreds of balloons to his house and flies away in pursuit of his and Ellie's dream. Once in the air, he realizes he's accidentally taken along a neighborhood boy, Russell, who had been on his porch attempting to earn a merit badge for "assisting the elderly." The movie is focused on the adventures that Carl and Russell experience while in South America (and I won't spoil the plot, for those who haven't seen it!), but it brought to light some issues and themes about which I often reflect both as a professional geriatric care manager, and as a person who cares deeply about the inner lives of our elders.

Carl is a cantankerous old grump of a character, and Russell is a loud, high-energy schoolboy and "Wilderness Explorer" scout. Through the course of their journey, we learn that Russell is being raised by his single mother, and wishes he spent more time with his re-married father. Russell eventually endears himself to his aged traveling companion, and a deep friendship is born. They learn about the world and about life from one another, and fulfill important roles in each other's lives. It is a sweet demonstration of the value of intergenerational relationships, and I hope that "Up's" younger audiences will internalize this lesson and seek out friendships with the elders in their communities, and value time spent with their own parents, grandparents, aunts, and uncles.

When Carl and Russell's balloon-powered house lands in South America, they realize that they've made it close to Paradise Falls, but have an arduous journey ahead of them, to relocate the house to the precise spot about which he and Ellie had dreamed. When faced with a difficult choice, Carl comes to the realization that "it's just a house." Until then, he had been very focused on it, and the things therein, as essential to his happiness and to the fulfillment of this particular dream. This brings to mind the complex relationship that many elders have with their family homes, as symbols of independence and a source of connection to memories and former roles and relationships. For my own grandmother, leaving her house meant not only accepting a new type of dependence on others, but relinquishing an important role - her home would no longer be the gathering place for celebrations and holidays, and she would no longer be able to provide a warm meal or a bed for visiting friends and family. Warm hospitality was a central feature of my grandmother's character, and looking back with hindsight, I wish we'd found more ways as a family to continue to foster that part of her after she moved into her assisted living apartment. For my grandmother, and for many others, letting go of her house felt like a loss of independence, but was in reality only a shift to a new type of interdependence.

The most important message I received from "Up" was that setting goals and achieving dreams is an ongoing process that should take place throughout our lives. Carl and Ellie had dreamed of children - and did not have them. They had dreamed of Paradise Falls - and did not get there. But they adapted to their circumstances, set new goals, and lived a happy and full life together. When things are looking grim in South America, Carl finds a message that Ellie had left for him before her death, which reads "Thanks for the adventure - now go have a new one!" and is renewed in his efforts. Carl's dreams of a life in South America with his beloved Ellie were not realized, but through the journey and his friendship with Russell, a new purpose for his later life was revealed. We see this in our work with our clients, and know it to be true: we are always growing, it is never too late to set and achieve goals, and there is purpose in every moment lived.

Flu Season is Here

2009-09-29T16:07:00.000-07:00

The new strain of the flu virus, H1N1, is making headlines. On the radio, on the television news, in the newspaper, and online we are told the nasty virus is coming, and it's time to get ready. Just like any disease, the best way to battle it is prevention. Here are a few helpful tips on how to battle the flu, before it reaches you.

Wash your hands: Hand washing is the number one way you can prevent the spread of disease. Wash frequently, for at least 20 seconds. If a sink is not nearby, an alcohol based sanitizer will do the trick.

Take Vitamin D: Exposure to the sun helps in getting your daily dose of this important vitamin, but winter makes that more difficult. Make sure vitamin D is in your daily dose, as it has been proven to reduce the likelyhood of the flu.

Eat Probiotics: Probiotics are good bacteria found in fermented food such as yogurt and soy. Promoting a healthy balance of bacteria will help in digestion, and boost immune fighting chemicals in your body.

Eat Fruits and Veggies: This is a good idea all year round, but loading up your body with immune fighting phytochemicals found in these foods is essential during flu season.

Get Vaccinated: Although the National Institutes of Health does not have the H1N1 vaccine ready for widespread use, you can still get the general flu vaccine now.

The new Dr. Oz Show recently featured the flu on a recent broadcast, and gave several more helpful suggestions on how to prevent it. The three most important groups of individuals who should get the flu vaccine immediately are pregnant women, young children, and those in the healthcare industry. Elder Care Guides is doing what we can to inform our clients and caregivers of this important information, and encouraging them to incorporate these preventative measures. Sending out a flyer of information, offering to reimburse for the cost of the vaccine, and reminders during home visits are a few ways we have helped.

Here's to your health!

Care Management Featured in the New York Times

2009-09-28T12:39:00.000-07:00

An article titled "When Elder Care Problems Escalate, You Can Hire an Expert" appeared in Saturday's New York Times Health Section (9/26/09). It provides some excellent, concrete examples of situations in which the interventions of a professional geriatric care manager can make a positive impact on the lives of elderly parents and their adult children who are caring for them. The author provides some guidelines for identifying a good match, and a list of questions to ask when interviewing a professional geriatric care manager.

We encourage families to call Elder Care Guides with their list of concerns, and the particular criteria they seek in a care manager for their aging parent. We welcome the opportunity to meet face-to-face at our office or in a parent's home at no charge, to discuss the needs and how the services of a care manager may be of assistance, and to determine whether there is a good personal "fit" between the family and the care manager.

Our Greatest Teachers

2009-09-21T13:15:00.000-07:00

Last Thursday September 17th, we celebrated five years of service to San Diego County with several dozen of our friends and colleagues from the community. We enjoyed a beautiful late-summer evening on the promenade in Liberty Station, with food, wine, networking, and our delightful guest speaker, Marsha Kay Seff.

When we created Elder Care Guides in July of 2004, our goal was to design a care management system that does more than simply respond to the needs of the aging population. A skilled care manager can assess an unrecognized need before it becomes a crisis, and we have worked hard to remain flexible and nimble in the face of the constantly-changing needs of our clients and their representatives, and as the larger landscape of long term care undergoes significant changes. We provide services with a spirit of support and collaboration, and our community has responded.

When I asked Marsha to speak on the topic of the hidden powers of elders, she replied with the question, "What is hidden about their powers?" Through beautiful stories about her own parents, as well as the others she has had the good fortune to know through her quarter century of working and writing in San Diego's elder care community, Marsha painted a portrait of "geysers" (not "geezers") who continue to learn and teach, volunteer and contribute in their communities, participate politically, and leave important legacies to their families.

Through the years, we have learned that the challenges of aging are not something to be simply "managed," but that they are a gift, a set of strengths and resources from which we and our clients can learn and continue to grow. We thank everyone who joined us for being a part of an evening that was very special to all of us, and held those who could not be with us close to our hearts.

Preventing Suicide Amongst Elders

2009-09-09T17:14:00.000-07:00

National Suicide Prevention Week is observed September 6th through September 12th, with World Suicide Prevention Day falling on September 10th.

Older adults are at great risk for depression and suicide. Consider the following statistics from the National Strategy for Suicide Prevention:

The highest suicide rates of any age group occur among persons aged 65 years and older.
Suicide disproportionately impacts the elderly. In 1998, this group represented 13% of the population, but suffered 19% of all suicide deaths.
Firearms (71%), overdose [liquids, pills or gas] (11%) and suffocation (11%) were the three most common methods of suicide used by persons aged 65+ years.
In 1998, men accounted for 84% of suicides among persons aged 65 years and older.
It is estimated that 20% of elderly (over 65 years) persons who commit suicide visited a physician within 24 hours of their act and 41% visited within a week of their suicide.

Older adults as a group have special characteristics that contribute to a their risk for suicide:

Suicide rates in the elderly are highest for people who are divorced or widowed.
Elders have a higher prevalence of depression versus the general population, putting them at higher risk for suicide.
Older adults are frequently isolated due to physical disability, lack of transportation, or separation from family, which can contribute to feelings of loneliness and depression.
Seniors use more lethal methods for suicide, resulting in more deaths from suicide.

Health care providers and families can be alert for the following signs and symptoms of depression or possible suicidal ideation:

Talking about suicide or death.
Giving verbal cues such as "I wish it were all over," or " What's the point of going on?"
Isolating oneself from friends of family, or not participating in activities that were once meaningful.
Giving away personal belongings that have value to that person.
Neglecting hygiene or personal appearance.
Demonstrating a sudden improvement of mood or outlook after a period of "the blues" or depression (this can indicate that the individual has created a plan for suicide).
Having firearms, medications, or other toxic substances on hand.

If you notice a loved one or someone close to you with these symptoms, you should talk to them about their feelings. It is a common misconception that talking to someone about suicide will lead that person to hurt themselves.

If you are having symptoms of depression or thoughts of suicide, talk to your doctor, another health or mental health provider, or call the San Diego Suicide Hotline at 1-800-479-3339. If you need help urgently, call 911.

Geriatric Care Management: A Profession, and Not Just a Business

2009-09-05T07:03:00.000-07:00

I recently received an inquiry from someone considering starting a business managing the medical, legal, and financial affairs of retirees, who sought my feedback regarding the feasibility of such a consultancy. He has several years of experience managing his father's affairs, and a business education; he is a person that I know, and for whom I have a great deal of professional respect. I sat down and sent him a thoughtful response and, when it was sent, realized it was a great reflective exercise that may have some value to others. And so I decided to post parts of it here (with adaptations made for a wider audience) as an open letter to those who would consider a career in this unique service to our aging population:

Care management is more than an interest in the well-being of elders, or a passion for service. It is a profession, and requires education and supervised experience, as well as a healthy dose of discretion -- we need to know what we don't know, and work collaboratively with others to create a support system that protects and honors the elder client. The management of an individual's medical, financial, and legal affairs should not be provided by one person or organization (unless it is under the careful supervision of the courts), and while it's generally acceptable - although not ideal - for an individual family member to serve in multiple roles when necessary, it is inappropriate for a professional to do so. A single entity that helps members of this vulnerable population make decisions regarding their long-term care, provides and/or manages those services, and then arranges for payment to be made for the services has a very clear conflict of interest and a lack of objectivity.

As geriatric care managers, we are usually the hub of a team of professionals working together in service to our client, often alongside devoted and hard-working family members. We assess and manage medical, psychiatric, cognitive, social, and care needs, while private fiduciaries manage financial affairs and can serve as legal representative (power of attorney, conservator, guardian, etc.) when necessary. Estate planning and elder law attorneys assist in the preparation and continuous update of documents such as the estate plan and advanced directives, and there are often other professionals involved as well, including financial advisers or trust administrators.

This might all sound like overkill (does one client really need all of these people involved in their affairs?), but the fact is that young and healthy seniors do not want or need this type of assistance. Families that hire care managers are usually dealing with complex circumstances, often after years of familial strife and decline due to advanced age and a chronic, disabling condition (usually several). Every day, we are negotiating long-standing family conflicts, working with physicians regarding complicated medical conditions and treatments in an increasingly fragmented health care system, and shepherding people through the spiritual journey at the end of their lives, helping them continue to find meaning and purpose. These are not simple transactions.

As an adult child, one has the time (albeit limited) to do one's research, to learn what needs to be known about a parent's health insurance coverage, medical conditions, and financial/legal affairs as one goes along. There is also an understanding, a permission of sorts, to make mistakes along the way: to hire a home care company that did not fulfill their commitments, to churn through several health care providers before finding the one with the right skills to manage your loved one's medical situation. Expert consultants do not have this time or permission. Families rightfully expect a paid professional geriatric care manager to understand the national and local health care landscape, to know which facilities in their area provide the best dementia care, how to effectively supervise in-home caregivers, which medications are considered unsafe for elders according to the Beers criteria, the basics of applying for Medicaid, how to help a conflicted family reach consensus regarding a plan of care, etc. When we come to a new client untrained in these issues, or without the skills to efficiently obtain necessary information or services, we are not being good stewards of their resources. Experience as a family caregiver is an enormous asset to a professional geriatric care manager, but it is not enough.

My advice (for those who would seek it) is to find a service niche that makes the best use of your interests and skills, and seek out the education, training, experience, and certification/licensure that is required. It is a road that may take several years, but it will be a rewarding journey that will serve you and your clients in countless ways.

For more information, please visit the websites of the National Association of Professional Geriatric Care Managers, and the National Guardianship Association.

First Annual Caregiver Appreciation Event

2009-09-02T16:14:00.000-07:00

Thanks to a large group effort, our first annual caregiver appreciation event on August 21st was a smashing success! The open house style picnic boasted chicken and vegetable skewers, green salad, chips and dip, brownies, and fruit punch. Caregiver Maricela P. brought her famous Tres Leche cake, and caregiver Ana Maria brought apple pie. Several caregivers brought their clients, and we were pleased to see them as well. We took time out to present our Caregiver of the Quarter award to Ana Maria, a fabulous employee who has been with us for over 4 years. Thankfully, the weather cooperated, and we were able to enjoy the afternoon in the South Promenade area of Liberty Station, by the beautiful fountain. We are already looking forward to next year's event!

Out & About: A Quality Life Program for people with Alzheimer's Disease

2009-08-27T14:17:00.000-07:00

Do you have a loved one who has Alzheimer's disease? Are you looking for a wonderful program that will provide them four hours of mental and social stimulation, and provide respite for the family as well? Well, do we have a program for you!

Let me introduce you to the UCSD Shiley-Marcos Alzheimer's Disease Research Center's program called Out & About. This lively program provides outings for individuals who have beginning stage Alzheimer's disease or other related forms of dementia.

The program runs for a series of eight weeks, meeting every Tuesday from 11:00 am to 3:00pm. The event includes lunch, transport to and from the outing, docent tours, staff to drive and accompany the group and mileage.

Examples of some of the outings are the IMAX Theater, Museum of Man, Chula Vista Nature Preserve, Cuyamaca Water Conservancy Garden and many more. We've enjoyed lunches at Pizza Nova, Chicken Pie Shop, and Perry's, just to name a few. The outings are enjoyable not only because they are culturally enriching but because of the interaction the participants have with each other.

I have hosted the Point Loma group for three 8-week sessions and I can say from experience that friendships develop, good natured teasing and laughter are heard and most importantly, the participants have a wonderful time.

Participants need to be able to walk short distances, stay on their feet for periods of about 1 hour, use the restrooms independently, hear and see adequately (enough to enjoy the outing), and be willing and interested in the activity.

The Out & About Program is also brought to you by the Alzheimer's Association, Elder Care Guides and Senior Life Assistance. For more information regarding this program please contact Lisa Snyder, LCSW, Program Director at UCSD Shiley Marcos ADRC at 858-622-5800 or lsnyder@ucsd.edu.

How to Save Money on Prescription Drugs

2009-08-11T14:05:00.000-07:00

Everyone is looking for ways to economize, and the medicine cabinet is a great place to begin. According to Cigna Healthcare, people over 65 make up just 13 percent of the population of the United States, but they account for 30 percent of the prescriptions filled. That's a lot of money being spent on medications.

Below are some ways that Elder Care Guides helps our clients to evaluate their prescription drug costs and take action to save money.

1) Ask for generics - This may seem obvious, but it turns out that some physicians prescribe medications without discussing with the patient whether they would prefer generics. Not all prescriptions have a generic available, but there is usually a significant cost savings if you "go generic" so it is worth inquiring. Cigna estimates a cost savings of approximately $250 per year for those seniors who switch to generics. Ask your doctor or pharmacist to review your medication list with you then ask your physician to re-write any prescriptions that have a generic option.

2) Check for over-the-counter options - There are many medications that used to be "prescription only" that are now available over-the-counter (OTC). Examples include ranitidine (brand name Zantac) and loratadine (Claritin). Check with your pharmacist to determine if the dose you need is available in non-prescription form. Don't rely on your doctor to tell you if your prescribed medication is also available over the counter. You are your own best advocate, so ask!

3) Look into retailer discounts - Major retailers including Wal-Mart and Target offer a host of generic prescriptions for as little as $4 per month, and $10 for a 3 month supply. These are the costs without insurance. Go to each retailer's websites where they publish current lists of the drugs available for lower prices.

4) Go postal! - Many insurance plans offer mail-order pharmacy options where you can purchase a 90-day supply of medications at a lower cost than if you were to pay a monthly co-payment at your local pharmacy. Call your insurance company to find out if they offer this.

5) Evaluate your Medicare D plan - Not all prescription drug plans under Part D are created equal. Do your homework to find out if you plan is the best one given your prescription needs. The Medicare website offers a "formula finder" feature where you can enter your medication list and it will produce a list of the plans that cover your specific prescriptions. You then need to call each plan to discuss the premiums and co-pays.

If you have not enrolled in a prescription drug plan under Medicare Part D, you can enroll during the Annual Election Period which begins each year on November 15 and ends on December 31. Coverage begins the following January 1. Health Insurance Counseling and Advocacy Program (HICAP) has a great website and a toll-free hotline staffed with knowledgeable volunteers who can answer your questions about Medicare, including prescription drug plans. If you have a Part D plan and are trying to manage your out-of-pocket costs, AARP has a "doughnut hole" calculator that helps you to determine when and how much you might have to pay.

6) Reduce consumption - Ask your doctor what lifestyle or dietary changes might help you to reduce your need for certain medications. I have a client who was able to discontinue three of her blood pressure medications through daily monitoring of her blood pressure (the charts were given to her doctor for regular review); stress reduction techniques; exercise; and menu planning. The more medication you take, the more potential for side effects and drug interactions, so reducing the drugs you take may help your health as well as your wallet.

What Makes a Good Caregiver? - The Art of Thin-Slicing

2009-08-04T16:06:00.000-07:00

Determining if a caregiver will be a valuable employee at the interview is no small feat. There are a multitude of factors to consider, including past experience, hands-on training, knowledge base, and personality. Of course we crave dependability and consistency in caregivers, but how can we tell at the initial meeting if a potential caregiver will be reliable? We can tell through the art of thin-slicing, says author Malcolm Gladwell, in his book "Blink."

Gladwell describes thin-slicing as the ability of or our unconscious to find patterns in situations and behavior, based on minimal "slices" of knowledge and experience. By using the thin-slicing technique, we find it is possible to gather enough necessary information to determine if a caregiver will be a valued employee for the long-term.

Therefore, instead of trying to consider all possible aspects of what makes a good caregiver, focusing on a few main essential traits and thin-slicing the potential employee is often more effective. Does the applicant have a calming personality? Are they sociable and helpful? Are they organized and have original ideas? Do you sense a strong desire to relate to and encourage an elderly individual? What are their emotions as they tell you a story of one of their past clients? Using this observational technique when conducting interviews takes practice, but will most likely bring your percentage of quality caregivers up dramatically. As Gladwell states in his book;

"...judging people's personalities is a really good example of how surprisingly effective thin-slicing can be."

All humans thin-slice. We do it when we meet a new person, or have to analyze a situation quickly, and we rely on our ability to thin-slice to keep ourselves out of danger. Paying attention to a few key personality details can tell you a lot about a person, which is especially important in finding a long-term, valued caregiver.

"Only the needs have changed"

2009-07-30T08:26:00.000-07:00

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

2009-07-16T06:15:00.000-07:00

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 ww w.car egi vercenter.or g.

Aging-In-Place

2009-07-14T08:50:00.000-07:00

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

2009-07-10T14:23:00.000-07:00

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

2009-07-09T09:53:00.000-07:00

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.

The Caregiving Journey

2009-06-23T17:00:00.000-07:00

Announcing a free town hall forum for those providing care to a person with Alzheimer's disease or a related dementia, "The Caregiving Journey: Practical Advice from Experts in the Field." This informational morning session will feature local professionals providing information for caregivers to protect themselves and their loved ones.

Thursday July 30, 2009
8:30 a.m. to 12:30 p.m.
Lake San Marcos Resort Conference Center
1025 La Bonita Drive
San Marcos, CA 92078

Featured speakers:

Alan Berkowitz, MD (Geriatric psychiatrist)
Dawn Carnerie-DeStefani, BSW (Social worker and adult day center manager)
Neil Levine, MD (Internist)
Scott Stewart (Elder law attorney)

Topics to be covered:

Overview of the different stages of Alzheimer's disease
Nutrition and hydration in Alzheimer's disease
Long term care costs and planning for the future
Legal decisions following a diagnosis of dementia
Exploring adult day care centers

To RSVP, call Health Care Group at (858) 565-4424. Three hours of continuing education credit will be offered for professionals through the California Board of Behavioral Sciences and the Board of Registered Nursing.

Health Care Group, Glenner Alzheimer's Family Centers, AARP, and the Southern Caregiver Resource Center are presenting this event, and free adult day care will be offered at the Glenner Alzheimer's Family Center in Encinitas. Call (760) 635-1895 to arrange.

Young @ Heart

2009-06-15T14:30:00.000-07:00

If you have not seen this documentary, run to the video store, or put it at the top of your Netflix queue. This heartwarming story about a choir consisting of members in their 70s, 80s and 90s is a perfect example of how staying active physically and mentally keeps one vibrant and healthy. Young @ Heart is no ordinary choir. You won't be hearing Handel's "Messiah" from them. They sing musical hits from today's current pop artists, like Coldplay and The Clash (with a little James Brown thrown in) with as much gusto as they can conjure.

The documentary follows the chorus as they learn new songs, and practice for upcoming concerts, all while battling personal health issues and building friendships. Bob Cilman, the choir's director since it's inception in 1982, can be firm with the members at times, but they don't seem to mind. Putting on a great show is everyone's goal, and they will do what it takes to make it happen, even if it means ignoring doctor's orders. Learn more about this fantastic group on their website: http://www.youngatheartchorus.com/. Maybe they will be performing in a city near you soon.

This film will give you a new perspective on the elderly population. To borrow a quote from their website, "It is possible to grow old without growing boring." Young @ Heart will make you laugh and cry...so grab some popcorn, a box of tissue, and enjoy!

What's So Important About a Diagnosis?

2009-05-27T10:26:00.000-07:00

When I meet with an elder to conduct an assessment, I often learn that he or she has a memory problem. Unfortunately, many elders and their families do not have good information about memory loss, including what the term "dementia" means and the significance of a dementia diagnosis.

Dementia is an "umbrella" term that refers to an array of symptoms. A person with dementia exhibits problems with his or her memory as well as his or her ability to plan or think abstractly; to produce or understand language; to recognize or identify objects; or to perform motor activities such as walking or grooming. Having a memory problem by itself does not mean that the individual has dementia.

It is critically important for elders and their families to know whether the elder has Alzheimer's disease which accounts for approximately 2/3 of dementia cases, or one of the many other types of dementia such as those caused by head trauma, alcohol use or metabolic disorders.

Why is having a clear diagnosis so important?

Some memory-impairing conditions are not considered to be dementia and should be handled differently. For example, a delirium is a change in cognition due to a medical cause such as a urinary tract infection which can be reversed when the condition is treated.

The type of dementia determines the treatment options available. Someone with dementia related to Parkinson's disease will have different options available to them versus someone with a Alzheimer's diagnosis.

If the elder has a clear dementia diagnosis, his or her physician may recommend psychotropic medications that may slow the progression of memory loss.

The family has the opportunity to plan for the course of the illness as different types of dementia can have different symptoms and prognoses. It is important for families to be able to plan emotionally, we as make financial and legal arrangements.

The elder may choose to enter into a clinical trial and possibly benefit from investigational medicines or treatments.

I encourage older adults and their families to talk with their physicians if the elder is experiencing memory problems, or symptoms such as paranoia or problems with language. Neurologists and psychiatrists are physicians with specialized training in diagnosing dementia and managing symptoms; in addition, there are diagnostic programs with teams of professionals who help to make the diagnosis and establish the plan of care.

While it is daunting for most people to consider the fact that they may have dementia, an early diagnosis can empower elders and their families to make informed choices about their care.

The Culture of Caregiving

2009-05-26T16:34:00.000-07:00

The caregiving profession is one that attracts individuals from all types of cultures. One quality they all have in common, however, is their desire to help the elderly in a way only a few can.

One needs to dig deep in the screening process to find out about experience, and the quality of that experience, in order to determine if the candidate would make a good caregiver for your company. Sometimes, the best caregivers won't articulate their experience in a way that portrays their desire and/or ability to do the job. Upon initial judgment, many candidates might be turned away. Once their personal history and background are considered, however, their experience can be more than sufficient to be an outstanding caregiver.

A perfect example of this was when I didn't schedule an interview with a potential caregiver because she told me she didn't have any experience. However, since she was referred by a current, long standing employee, I reconsidered later and invited her for an interview. Upon asking her again, "Do you have any experience caring for an elderly individual?" Her response was, "Well not really. Just my husband who was over 70, had Alzheimer's, and was bed bound for the last 4 years of his life." BINGO! She is now one of our highly respected, dependable caregivers.

Caregiving comes from the heart. If an individual's culture and experience come from the same caring, positive attitude, you can rarely go wrong.

Elder Abuse - A Personal Story (part 2)

2009-05-14T14:07:00.000-07:00

Continuing story from Elder Abuse - A Personal Story (part 1):

As already described, while visiting with my mother in the nursing home, I discovered that she was being abused by someone in the facility. Although her cognitive abilities were intact, she did have aphasia caused by her stroke and the only word she could verbalize was "waiter" which really held no specific meaning.

Since my mother couldn't identify her abuser by naming her, I had to come up with another way for mom to let me know who this person was. I wanted to inform the facility Administrator immediately but my mother, in her way, begged for me to hold off. She had such a look of fear, I realized she was afraid of retribution so I devised a new plan.

The plan was to push my mom in her wheelchair throughout the facility coming at various times of the day so I could cover all the different shifts. When we came upon the individual, my mom was to put her foot down, stopping the wheelchair, grab my hand and acknowledge the person.With this plan understood and agreed to, we entered the building and proceeded towards her wing.

It was a busy time and many of the staff were in the area. All at once, a caregiver (I'll call Mary- not real name) stepped out from a room. My mother put her foot down and grabbed my hand. Mary came directly over to mom, putting her arms around her in a hug and giving her a big kiss. The look on my mother's face said everything, there was fear, disgust and revulsion.

Mary had worked with my mother for a few years and was a very friendly type. Because of this, I had to ask my mom if she was sure that Mary was the abuser. She nodded yes, but I still hesitated because this all happened so quickly. I looked mom directly in the eyes and asked again, she grabbed my hand squeezed it, nodded and started to cry.

We immediately went to the Administrator, explained the situation and resulting discovery. He asked mom a few questions and agreed to take Mary off her care. Because of mom's aphasia she could not identify Mary verbally so they couldn't fire her but two years later, after my mother had passed away, I met some people who had had their relative at the same nursing facility and at the same time. They told me they had personally caught Mary abusing their relative. She was fired on the spot.

This experience ignited my resolve to help advocate for those who have no one to speak on their behalf and it is why I became an Ombudsman and ultimately a geriatric care manager. Sadly, my mother's story is not unusual but with more awareness of elder abuse and involvement in the programs helping prevent it, we will make a change.

Novel Highlights the Transformative Power of Support Groups

2009-05-05T10:41:00.000-07:00

Still Alice is a 2009 novel by Lisa Genova, a fictional account of a professor of cognitive psychology who is diagnosed with early-onset Alzheimer's disease at the age of fifty, while at the height of her career. At the opening of the novel, Alice Howland, who has a loving and supportive husband and three young adult children, has noticed some minor changes - difficulty concentrating and frequently misplacing items around the house. When she becomes lost in a familiar square a mile from her home, she begins to suspect that there are more significant physical changes taking place. Her first suspicion is menopause, and when she seeks the advice of her physician, she begins the journey toward a terrifying diagnosis of Alzheimer's disease.

The writing is clean and simple, and I found it a very enjoyable read. Although many of the "uglier" aspects of dementia are not confronted in this novel, I appreciated the author's descriptions of some of the complex family issues that arise -- the initial denial of the diagnosis, a husband who jumps into high-gear to "take action" and "fix the problem," and children who disagree about the nature of the disease and quarrel over how best to care for their mother.

As her career comes to an early end and she becomes dependent upon others for the tasks of everyday life as the disease progresses, Alice battles depression and struggles to maintain her identity. She turns to her health care system for support services and is surprised to learn that there are no local support groups for individuals living with memory impairment. So she starts one herself in her home:

"They shared stories of their earliest symptoms, their struggles to get a correct diagnosis, their strategies for coping and living with dementia. They nodded and laughed and cried over stories of lost keys, lost thoughts, and lost life dreams. Alice felt unedited and truly heard. She felt normal."

Having facilitated a support group for individuals with early-stage memory loss for the past six years, I can testify to the healing power of social support for a person feeling isolated and frightened by a diagnosis of Alzheimer's disease. I thank author Lisa Genova for bringing this resource to light, and encourage families everywhere to reach out to their local chapter of the Alzheimer's Association to identify a support group in their area.

Caregiver Appreciation

2009-05-01T11:43:00.000-07:00

The most important customers any company has are its employees. If your employees are given the highest quality customer service (employee relations), benefits and guidance, your company will flourish. This is certainly true in the elder care industry, when the employees are caregivers.

Caregiving is an extremely demanding position, both physically and emotionally. There are many ways in which a company can express appreciation to their caregivers. The most obvious choice is offering benefits, which come in many forms including medical and dental insurance, holiday pay, tuition assistance, educational offerings, and regular performance reviews. Additional appreciation avenues can include soliciting feedback via quality assurance surveys, caregiver appreciation parties, holiday gifts, and sending birthday cards.

An important way Elder Care Guides is showing Caregiver appreciation is through our quarterly newsletter, dedicated solely to our caregivers. Included within the newsletter is an announcement and spotlight on a chosen "Caregiver of the Quarter," one who has gone above and beyond in their work with their client, or employment in general.

A little goes a long way in Caregiver appreciation, and the dividends can come back tenfold. A happy caregiver is not only likely to refer quality prospective Caregivers, but future clients as well. Caregivers who feel valued produce high quality service, which translates directly to your clients and subsequently, their families.

Elder Abuse - A Personal Story (part 1)

2009-04-20T09:25:00.000-07:00

Elder abuse is a term referring to any action or non-action that results in harm to an elderly or older helpless person. Abuse can happen anywhere, in the older person's home, nursing home or hospitals and it can happen no matter the person's socio-economic group, culture or race.

This problem and its resulting consequences have personal meaning for me because my mother had been abused while a resident in a nursing facility.

My mother had suffered a massive stroke which affected her speech and left her paralyzed on her right side. Because of the severity of the stroke and her declining health, she needed on-going nursing care so she had to be placed in a nursing home.

She lived in this facility for 4 years. My children and I were constant visitors and we knew the administrative staff and caregivers very well, or so we thought.

One day while visiting my mom and after a lovely walk around the grounds I was getting up to leave and said I would take her back to her room. She didn't want me to leave or to go back in. Her aphasia prevented her from verbalizing words but one sound she could make was "waiter". She was able to understand things, so for the next hour I tried coming up with reasons why she didn't want me to leave when finally I was inspired to ask if she was afraid of something. That was the breakthrough question and when she nodded affirmatively, I knew there must be more to this fear of hers.

Restraint Use Declining in Nursing Homes

2009-04-17T10:08:00.001-07:00

There was an article in USA Today recently that described a decline in the use of restraints in nursing homes in the United States. This is good news for nursing home residents across the country, and for those of us who advocate for seniors.

Restraints were once commonly used in nursing facilities to control the behaviors of residents with dementia or other psychiatric conditions and to prevent falls. The use of restraints in facilities has declined over time, but education is still needed to help families and health care professionals seek alternatives. In fact, California is one of the U.S. states with the most room for improvement. The most recent data from Medicare in 2007 indicated that 10% of nursing home residents in CA were restrained, while the national average was 5.5%

What is a restraint? The National Consumer Voice for Quality Long-Term Care (NCCNHR) defines a physical restraint as an object or device that an individual cannot remove easily and which restricts freedom of movement or normal access to one's body. Common restraints include: seat belts on wheelchairs, vest restraints, geri-chairs, hand mitts, side rails and lap trays.

Many families and health care providers believe that restraints help nursing home patients to be "safer," though research shows that often times the opposite is true: individuals who are agitated frequently become more agitated when they are restrained. Behavioral approaches such as validation and redirection, as well as activity engagement, can often help agitated people to become less agitated.

As a Geriatric Care Manager monitoring the well-being of clients in nursing homes and in the home setting, it is my responsibility to advocate for no restraint use, or minimal restraint use that is re-evaluated frequently and discontinued as soon as possible.

Finding the Right Nursing Home

2009-03-20T14:19:00.000-07:00

This morning's Today Show (NBC) featured an interview with Sarah Baldauf, who wrote a comprehensive, step-by-step guide to finding the right nursing home for U.S. News & World Report. Click here to read the article and watch the video.

Elder Care Guides is proud to support the Glenner Alzheimer's Family Centers

2009-02-20T17:02:00.000-08:00

I'm reaching out to you on behalf of all of us on the Board of the Directors of The Glenner Alzheimer's Family Centers -- an extraordinary organization providing assistance to families struggling with Alzheimer's and other memory impairing diseases. Over the past 25 years Glenner has provided over 150,000 San Diegans with compassionate adult day care, family training and education, crisis management, and more. For more information, visit www.alzheimerhelp.org.

Times are tough for the Glenner Centers. In order to keep program costs affordable (and to provide scholarships for those families that cannot pay), we rely heavily upon the financial support of our community. We're holding only one fundraiser this year, and it's coming up on March 14th, 2009.

An electronic version of the invitation to "Let Us Entertain You" is available for download here. Tickets for the "preview party," which runs from 4-7 p.m., and include food, games, live entertainment, and valey parking downtown cost just $100. Tickets for the gala dinner cost $250 and include all of the above, as well as a seated dinner from 7-9 p.m. We at Elder Care Guides hope you can join us! You can print and mail in the ticket order form (available at link above) to the Glenner Centers at 3702 Fourth Ave., San Diego CA 92103.

If you can't attend the event but want to get in on some of the action and support the cause, opportunity drawing tickets are available for $20. We're giving away 50 different prizes, including a $500 Costco gift certificate! To purchase opportunity tickets, please call the Glenner corporate office at (619) 543-4700. The George G. Glenner Alzheimer's Family Centers, Inc. is a 501 (c)(3) non-profit organization, and all event and opportunity drasing tickets are tax deductible (Federal Tax ID#95-3794678).

Yesterday morning I took two of my clients to visit Glenner's Hillcrest center, and was amazed by what I saw. Although neighter were particularly excited about the idea of Mrs. N attending an "adult day care program," within a few minutes they were totally won over by the engaging activities and the kind and attentive staff. Her regular attendance at the center will not only provide my client with more social and intellectual stimulation during the day, but it will give her 90 year old husband a much-needed break from his caregiving responsibilities. I'm so grateful that we have an affordable, accessible reesource such as the Glenner Centers in our community, and hope you'll turn out for a fun night on the town to help ensure that this important organization continues to provide these needed services.