Holiday Night at Liberty Station

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

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"

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

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

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

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

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

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

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

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

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

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"

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

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

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

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

Bastille Day 2009

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


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


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


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

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

Aging-In-Place

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

Discounted CPR and First Aid Classes

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

The Giving and Receiving of Care

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

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

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

The Caregiving Journey

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

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?

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

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)

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

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

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)

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

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

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

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.