The Myth of Independence

The month of July always starts off with a bang, as Americans celebrate the anniversary of our nation's founders having declared our independence from Britain all those years ago. The word "independence" comes up in nearly every conversation that I have with a family, as a professional geriatric care manager. Many of the phone calls and e-mails that we receive from concerned caregivers center around the dilemma of independence: wanting to allow an aging or disabled loved one to retain as much independence as possible, while ensuring their health, safety, and well-being. Sometimes we talk about independence as a living arrangement: "My grandmother is 95 years old, and still lives alone in her own home." Other times we talk about it as a feature of one's personality: "My father would never ask for help with anything." Families frequently see what they describe as "independence" as an obstacle to connecting their loved one with the resources and supports that they need.

As deeply as I understand this dilemma, I often challenge families to re-frame their thinking around the concept of independence. A person who lives alone in a private home without the assistance of a caregiver is not necessarily independent. A person who prefers solitude to socialization is not necessarily independent. And a person who has difficulty asking for - or accepting - help from others, is also not necessarily independent. It is a rare human being who could actually be considered "independent," contrary to our popular myths about ourselves as Americans. Throughout our lives, we rely upon others - our families, the other members of our economy, and society at large - to help us meet most of our basic needs of food, clothing, and shelter. We are, in reality, entirely interdependent upon one another, and this does not change as we age. The ways in which we rely upon those around us certainly change, but the fact of our needing their assistance does not. By shifting the way that we think and talk about dependence, I believe that we can begin to break down the emotional barriers to the giving and receiving of help.

Ten things you might not know about Elder Care Guides

Proud to have been nominated as a top ten finalist in this year's "San Diego's Best" Union-Tribune readers poll, we'd like to share ten things that you might not know about Elder Care Guides, and why we are deserving of your vote as the top In-Home Eldercare Services provider in San Diego County:

1) Independently-owned: We are an independent, locally-owned company, which affords us the freedom to be flexible, creative, and keep our clients at the center of our business at all times.

2) Interdisciplinary team: Our professional team represents a variety of disciplines, including social work, nursing, gerontology, recreation therapy, and counseling. Our collaborative approach to geriatric care management means that each of our clients benefits from the experience, training, and perspective of this well-rounded team.

3) Access to the top professional caregivers: We have a staff of experienced and vetted professional caregiver employees, and are also able to partner with some of the top home care agencies in San Diego as needed in order to find the perfect match of skills, experience, and personality for each of our clients.

4) Leadership: Each member of our clinical team is an actively involved member of the National Association of Professional Geriatric Care Managers (NAPGCM). Our President is a Fellow of the association, our Vice President of Client Services is on the association's Board of Directors, and our Vice President of Clinical Services is the chair of NAPGCM's local unit. We are committed to promoting high standards and ethics for professional care managers across the country.

5) Certification: All of our care managers are either certified, or are certification-eligible and actively working toward the completion of their certificate under the supervision of Susan Valoff, LCSW, our Vice President of Clinical Services. Although certification is voluntary, Elder Care Guides covers the cost of certification for our staff, and believes that there is value for our clients and their families in the ongoing supervision and education that certification requires.

6) On-call system: Our clinical team is available 24-hours per day, 365 days per year, to respond and assist our clients and their families in the event of an emergency. We handle our after-hours on-call system internally, meaning that day or night, when families reach out to Elder Care Guides for assistance, they will reach a professional who is familiar with their individual situation, and ready to respond.

7) Service areas: Elder Care Guides provides comprehensive assessment, care planning, and care management services not only to older adults with physical and cognitive disabilities, but also has the expertise to work with adults with serious mental illness and developmental disabilities. We have been providing care management services to families throughout San Diego County since 2004.

8) CAHSAH certification: Elder Care Guides is a certified home care provider through the California Association of Health Services at Home (CAHSAH), a voluntary certification that demonstrates our commitment to sound business practices that protect the safety and welfare of our clients.

9) BBB accreditation: Accredited members of the Better Business Bureau since 2008, we are proud of our A+ rating.

10) Company culture: For the members of our team, Elder Care Guides is more than a place of employment. It's an opportunity to grow, learn, and be of service while working alongside some of the best professionals in the field. We are dedicated to a company culture that emphasizes professionalism, autonomy, collaboration, and full employee engagement.

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The voting process is simple. CLICK HERE to visit the "Healthy Living" categories of the poll, and go to "In-Home Eldercare Services," where you will find us listed. You'll need to register on the website (it only takes a moment) the first time you vote. You can vote daily between now and July 7th, and to place future votes you need only log on with your email address and password. We appreciate your support, and welcome you to tell friends, family, and colleagues about the contest as well.

If we may answer any further questions about our company or the services that we provide, please feel free to leave them in the "Comments" section below, and we'll be glad to provide further information.

Creating a positive professional culture

Elder Care Guides is seeking a qualified Care Manager to join our team of professionals. This is either a part-time or full-time clinician who will perform assessments, care coordination, care planning, and related care management activities for a caseload of elderly, chronically mentally ill, and/or disabled clients, while ensuring quality and appropriateness of services consistent with Elder Care Guides' mission to create a sense of purpose for all of our clients. For a link to the full position description, please click here.

For the members of our team, Elder Care Guides is more than a place of employment. It’s an opportunity to grow, to learn, and to be of service while working alongside some of the best professionals in the field. We are dedicated to a culture that emphasizes:

• Professionalism. Our staff brings a high level of expertise to their work, and the members of our management team are leaders in the professional community.
• Autonomy. Although employees are given structure and supervision, we encourage the independent working and management styles of our professional team.
• Collaboration. We share in the responsibilities of managing multiple assignments and running a strong company, remaining at all times accountable to one another.
• Engagement. We encourage our employees to identify, understand, and develop their individual strengths, and apply those talents to their daily work.

We believe:

• Employees who understand and utilize their personal strengths 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.

We’re always looking for people who are committed to our mission to improve the lives of our clients through services that center on the goals of the individual, and which foster a lifelong sense of purpose. We invite you to find out more about us.

Long Term Care Planning: What's Covered, and What Isn't

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 VIII: What's Covered, and What Isn't

In previous issues, we’ve described the various settings in which long term careis provided, often referred to as the “continuum of care.” Many are caught off guard in the midst of a health care crisis by a sudden and surprising lesson inwhich types of care are covered by Medicare or other forms of health insurance, and which require private payment.

The simplest way to understand whether a particular type of care will be covered is generally this: if a physician orders it, it requires the services of a licensed healthcare provider, and its goal is to treat an acute condition, then Medicare or health insurance will cover at least a portion of its cost. If those conditions are not met, then it is not covered.

Care provided within a skilled nursing facility (SNF) is frequently an area of confusion. Up to 100 days of a short-term rehabilitative stay in a SNF while recovering from an acute illness or injury after a hospitalization will in large part be covered by Medicare, but long-term “custodial” care for an individual who requires assistance with daily tasks that cannot be provided within other settings is not, and must be paid for privately. Home health care (licensed nursing or therapy services provided on a short-term basis for rehabilitative purposes) is generally a covered health insurance/Medicare benefit, as is hospice care.

Care provided within residential care facilities, including assisted living apartments, board and care homes, continuing care retirement communities, and residential dementia care, is not covered by Medicare or other health insurance. Non-medical home care services are also not covered; this includes services to assist with activities of daily living such as bathing, toileting, and ambulating, and is often referred to as “custodial” or “private duty” care. Professional services such as those provided by a geriatric care manager or fiduciary require private payment, as do most community-based adult day programs and transportation services. These “non-medical” settings are where the majority of long term care services are provided, so thoughtful planning about how they will be financed is essential.

Next month we’ll wrap up this series with a look at the costs of long term care, and tips for developing a personal plan.

Dehydration in the Elderly: Know the Signs

It's June, almost summer, and a great time to remember how significant of a risk dehydration is for the dear elderly that we care for. A call from a caregiver reporting a very healthy 84 year old's trip to the hospital today reminds us how quickly things can change. Reviewing the basics will increase awareness and support the power of prevention.

According to Jeannete Y. Wick, RPh, who wrote the article" Prevention and Management of Dehydration," the elderly are at greatest risk for dehydration, and those 85-99 years old are six times more likey to be hospitalized for dehydration than people aged 65-69.  Dehydration is fatal in 18% of these cases, not having been addressed early enough. Most importantly, this problem can be prevented. Knowing the signs and having a plan can help prevent this very common problem.

Signs:

• Confusion - Frequently an early sign. Pay attention to even mild cognitive changes.
• Poor skin turgor-  May be difficult to assess, but skind that feels warm and moist may be a good sign.
• Dry mouth
• Changes in vital signs - Usually a lower blood pressure and an increase in pulse.
• Concentrated urine
• Dizziness or fainting

Risk Factors:

• Increased age - The elderly have lower body water content compared to younger people.
• Cognitive impairment - Difficulty remembering when or how much fluid they have had to drink
• Medications - Diuretics, laxatives, blood pressure medications, some demetia medications
• Dysphasia - Difficulty in swallowing
• Decreased ability to sense thirst
• Increase in activities
• Depression
• Change in schedule
• Diarrhea

Prevention strategies for caregivers:

• Make monitoring fluid intake a priority
• Know the signs and symptoms
• Offer water every hour; even when the elder does not say they are thirsty
• Add lemons, strawberries, orange slices, or cucumbers to make water more appealing
• Offer food like, jello, yogurt, melons
• Make water available at all times especially if going on an outing, walk, or running errands
• Pay attention to temperature changes

Water is a basic nutrient of the body and is critical to human life, supporting digestion, the transport and use of nutrients, and the elimination of toxins and waste from the body (Kleiner, 1999). Let us remember to pay attention, and help prevent this big problem in the lives of the elderly.

Celebrating Nurses

 

National Nurses Week started yesterday, an annual celebration that is planned around the birthday of Florence Nightingale (the founder of modern nursing), on May 12th.

A unique strength of Elder Care Guides' geriatric care management services is our interdisciplinary approach to our work. In addition to nursing, our clinical staff represents the fields of social work, marriage and family therapy, public health, geriatric counseling, and nutritional science. While each of our clients develops a relationship of trust with a professional geriatric care manager who coordinates and monitors their care over time, they also benefit from the expertise of our full team. Our approach is a highly collaborative one, with weekly team meetings, close clinical supervision, and ongoing support and consultation. Our 24-hour on-call system is managed internally, so that clients experiencing a crisis receive a response from a professional who is knowledgeable about their specific needs.

Nursing is a critical component of this collaborative approach, and our nurse care manager Susan Bill, RN, brings invaluable expertise and perspective to the Elder Care Guides team. She earned her nursing degree from the University of South Carolina, and is a licensed Registered Nurse in California. A skilled and knowledgeable advocate for her clients, Susan builds relationships with a warm and empathetic approach. National Nurses Week is a good opportunity for us to publicly recognize her talents and skills, which Susan's clients and her families experience for themselves every day.

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

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 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.