The Myth of the Perfect Facility

In Minnesota and All Over the Country

Recently, a friend of mine has spent some time in a skilled rehab facility after knee replacement surgery.  Unfortunately, her time there has not been the best.  She’s had long waiting times for ice for her knee (more than 1 1/2 hours,) she was left in the hallway when the aide who was walking with her took a personal call on her cell phone, she was having hallucinations from pain medication, and was scared in the middle of the night when a nurse wearing a black hoodie approached her.  A friend of mine who is a care coordinator wrote the following on facilities and expectations:

‘As a Care Coordinator assisting families find appropriate care and            housing for their loved ones I am frequently in the position of recommending a great variety of resources. When clients ask “What is the ‘best’ facility in my community?”, I have a conversation that I like to call “The Myth of the Perfect Facility.” I tell families seeking housing that there are no perfect facilities. I will go so far as to say that there are no “best” facilities. There is the facility, whether that is assisted living, residential care home, nursing home or continuing care retirement community that will meet your loved ones needs, that is affordable and that is in an appropriate location for the family. Some are certainly “better” than others; but, is there a “best”? No, surprisingly, there is not a best. I like to have this conversation again after family tours facilities and gets back to me waxing euphoric about the one place they loved. I remind them that problematic, difficult, unfortunate things, bad things, can happen at the “best” facilities. What differentiates facilities is how they react to those problematic situations. A good facility will listen without becoming defensive. A good facility will respond to family and resident concerns, big or small, with compassion and an action plan. A good facility will follow up with the resident and family and make sure they are satisfied. A good facility grows and changes as they learn from and with their care partners: the families of their Residents.’

Joyce M. Konczyk, LSW

Life Care Coordinator Maser & Amundson, P.A. 952-925-4147 jkonczyk@maserlaw.com

Disclaimer: This has been prepared for general information purposes only. This is information not legal advice. Legal advice is dependent upon the specific circumstances of each situation. The information contained in this presentation should not replace the advice of competent legal counsel licensed in your state.

Prior to Diagnosis

What To Do If You Are Seeing Changes and Aren’t Quite Sure

There is a lot of information about how to care for someone with Alzheimer’s disease, but what do you do if you are worried about changes in your loved one and you are concerned about what’s going on.

Alzheimer’s disease is a progressive and fatal brain disease. Over As many as 5 million Americans are living with Alzheimer’s Disease.  Alzheimer’s destroys brain cells, causing memory loss and problems with thinking and behavior severe enough to affect work, lifelong hobbies or social life. Alzheimer’s gets worse over time, and it is fatal. Today it is the seventh-leading cause of death in the United States.

Whether your loved one has Alzheimer’s disease, another dementing disorder or a treatable condition that has similar symptoms, there are steps you can take to help you with your concerns:

1)  Make an appointment  for your and your loved one to visit a doctor with the expertise to conduct a thorough examination that rules out treatable conditions.

2) If the diagnosis is Alzheimer’s or a related disease, make sure that everyone who will be involved in  care taking  is as informed about the condition and recommendations for managing his or her care.

3) Get to know the special skills and availability of care team members.  Besides friends, family, church volunteers and other informal help, you may wish to make use of trained help from a health or homemaker/companion service.  Some families have found valuable help from a knowledgeable care manager who is well equiped to help a family through the many financial, legal, and other decisions surrounding the care situation.

4) Equip all caregivers and the care recipient (if appropriate) with the resources, strategies, and plans to maintain a safe and positive relationship.

There are numerous resources available to family caregivers–books, audio-visual materialsl, online resources, support groups.  Many caregivers have found support groups to be the most beneficial resource.  Keep in mind that while some support groups provide for a special program for the care recipient, some do not, and finding someone to stay with your loved one while you attend a support group may be an important part of your plan.

The national website for the Alzheimer’s Association (www.alz.org) has a wealth of resources and can also direct you to your local chapter for more specific resources in your area.

In Minnesota, Seniors’ Choice at Home can help ease the responsibility of care by helping with homemaking tasks (cleaning, cooking, baking, laundry,) transportation to medical appointments and for other errands, and staying with the client so the caregiver can  have some time for lunch with friends, go to support groups, go for a walk or just rest for while.  For more information about Seniors’ Choice at Home, call us at 763-546-1599, or check out our website:  www.seniorschoicemn.com

 

From the Point of View of a Person With Alzheimer’s Disease

Alzheimer’s disease is a brain disease that slowly, but progressively, will erase from my memory everything that I have learned.

It can affect my behavior, my understanding of where I am or who you are, and my ability to understand what is being said to me as well as my ability to tell people what I need, or what is on my mind.  As the disease progresses, I will lose the ability to make safe choices for myself, to plan out my day, to learn new skills, and to understand the challenges that my disease has on those closest to me.  I cannot remember what just happened, even 5 minutes ago, and I often lose the ability to control what I say or how I act.

From “Give Me This Day,” an Alzheimer’s primer by Cheryl Biel, RN

Seniors’ Choice care givers in Minnesota are especially gifted.  They help clients who have significant memory loss with love, patience and creativity.  To learn more about Seniors’ Choice at Home, call us in the twin cities metro area at 763-546-1599, or check out our website:  www.seniorschoicemn.com

Laughter is Really the Best Medicine

Even When You Don’t Feel Like Laughing…

Some years ago, Norman Cousins, then editor of the notable magazine, The Saturday Review (no longer published,) was diagnosed with a painful, rheumatologic disease that included significant pain, and a not very rosy outcome.  Cousins took his treatment into his own hands, checked into a fancy hotel and spent his days watching funny, old movies like The Three Stooges, Laurel and Hardy and Abbot and Costello.  The story of his remarkable recovery using laughter therapy is the topic of a book (Anatomy of an Illness) he later wrote.

Now, researchers at the University of Maryland School of Medicine in Baltimore, using laughter-provoking movies to gauge the effect of emotions on heart health, have found that laughter is indeed linked to the healthy function of blood vessels.  It seems that laughter causes the tissue that forms the inner lining of blood vessels, the endothelium, to dilate or expand in order to increase blood flow.

When the same group of volunteers was shown a movie that produced mental stress, their blood vessel lining developed a potentially unhealthy response call vasoconstriction, reducing blood flow.  That finding adds evidence to earlier studies which suggested there was a connection between stress and the narrowing of blood vessels.

The recommendation is that we all try to laugh on a regular basis.  Laughter is almost as good as aerobic activity.  Thirty minutes of exercise three times a week and 15 minutes of laughter daily is probably very good for your heart.

Even though our work with clients at Seniors’ Choice at Home, can be heart-breaking at times, we in the office, and our care givers out with clients, find lots of opportunity to laugh and have fun.  One of the skills that persons with memory loss often retain, is the ability to make a joke and to have fun.  We like to think we make good use of our clients retained skills.

When You’ve Had it and You Don’t know What to do

There is Help Out There

Have you ever had a day when it all just got to be too much?  One of the well-known books about caring for a person with dementia is called, The Thirty-Six Hour Day.  Makes me tired just to think about it.   If  it’s just some time off that you need, consider some respite care–an agency like Seniors’ Choice at Home (Minnesota) can provide this anywhere from 3 hours for lunch with friends, a movie, a spa or hair appointment, time at the gym,  a walk or even just a nap,  to a weekend or more away to travel or see the grandchildren.  You can also just ask a friend or relative to stay with your loved one while you do whatever you need or want to do.  Some churches have volunteer programs that offer respite care, and some organizations will actually pay for a certain amount of help for some caring for a person.  Locally our Parkinson’s Foundation does that.  Some assisted livings and nursing homes offer short-term respite stays.

If you are overwhelmed by organizing care, making care decisions, deciding on a move to a facility, getting additional help in the home, a Geriatric Care Manager might be a great resource for you.  Below is an article by a colleague of mine that gives a very complete description of what a Geriatric Care Manager (GCM) does and how he or she can help you.

Geriatric Care Managers are resource specialists and advocates for seniors and their families.  They can be social workers, nurses, gerontologists, psychologists or other health and human services specialists. They are dedicated to assisting elders and their loved ones navigate the health care system. They assist with current day to day care issues, ongoing care
management, crisis management, and future care planning. They are skilled at securing appropriate living arrangements and coordinating myriad services for complicated medical/psychiatric needs. Geriatric Care Managers are professional problem solvers and can be your guide to the complicated and sometimes confusing array of services that are available in our community.
Benefits for seniors and families working with an independent geriatric care manager:

 Geriatric Care Managers represent seniors and families. They draw on their training and experience in the senior care industry to provide professional care planning, care supervision and high quality, cost effective services.
 Geriatric Care Managers conduct a needs assessment addressing medical, social, emotional, legal, financial, and housing needs. Care Options are presented based on the individual situation and patient / family needs.
 Geriatric Care Managers assist in navigating through a variety of services as the client’s condition changes. They provide continuity and coordination with doctors, home health care agencies, and other providers. This includes monitoring care and advocating on the senior’s behalf as often as necessary to ensure quality care.
 Geriatric Care Managers are a fee-for-service entity. They do not receive payment from Medicare or Medicaid and they do not take referral fees from third party providers, insurance companies or equipment manufacturers. However, some Long Term Care Insurance policies now recognize the importance of these services and cover the cost.

 Geriatric Care Managers can be the ‘eyes and ears’ for out-of-town family members.   Not only to assist with services in the home of a senior, but, also to objectively assess care in a facility and function as a liaison with far away family.
 Geriatric Care Managers facilitate family communication and aid in the decision-making process.
 Geriatric Care Managers can help in selecting the appropriate Assisted Living Facility or other housing options. They can save a family time and money by researching facilities and negotiating the lease and/or contract for them.

Professional Geriatric Care Management
 Most families truly want to do the best for their seniors, but without the aid of a knowledgeable professional, they may still be worried and unsure. Geriatric Care Managers help to give the family “peace of mind” and the certainty that they have done all they could.
 Geriatric Care Managers can help family communicate the need for services or the importance of making a move. They can assist the senior in securing family support for their decisions. Also, they can help explain the situation to family members who may be overwhelmed, resistant or in denial.
What to look for in a Geriatric Care Manager · Experience in the field is essential.
· Affiliation with a professional organization such as social work or nursing is important so there is a governing body to whom they are responsible and from whom a code of ethics is based.
· Geriatric Care Managers should not be affiliated with other care providers (such as home health care agencies) to avoid conflicts of interest.
· Clarity regarding their fee schedule.
· Availability for emergency situations. Many GCMs are available 24/7.
When to call a Geriatric Care Manager
· When you are overwhelmed with the options or don’t know where to start researching options.
· When you are out of town and unable to attend to the needs of your loved one.
· When there is a crisis and you need help right away to facilitate change.
· When family is conflicted about the direction to take for a loved one’s care.
· When an objective opinion is needed to assess a living situation.
· When you want a professional to attend a care conference with you or for you.
· When you are having difficulty communicating with family members or with the professionals caring for your loved one.
· When you are not satisfied with the care your loved one is receiving.
· When you are not sure if you should call. Call.
How to find a Geriatric Care Manager
· Care Options Network, www.careoptionsnetwork.org, 952.945.4077
· Senior Linkage Line www.minnesotahelp.info, 800.333.2433
· Alzheimer’s Association www.alzmndak.org, 800.232.0851
· National Association of Elder Law Attorneys www.naela.com
· National Association of GCM at www.caremanager.org, 520.881.8008
This is the unedited version of an article for the 2008-2009 Care Options Network Senior
Housing Directory. Information was contributed by Joyce M. Konczyk, Geriatric Care
Manager. Call Mike Sisko at the Care Options Network 952.945.4077 for a copy of the
directory.
Joyce,
–
Joyce M. Konczyk, LSW
Geriatric Care Manager
612.227.7414
joycek@helloworld.com
www.jmkseniorconsults.com
www.helloworld.com/joycek

Like a Breath of Fresh Air

Taking a break

[I read this in the Catholic Charities newsletter f or care givers and got permission to use it in my monthly newsletter for the Twin Cities Seniors' Choice at Home employees.  I thought it would be a good reminder for all of us.  Many thanks to Ann Puglisi (see note below) for her kind permission to include it there and for you in this blog.]

Taking a break  is the single most important thing we as care givers can do to maintain our mental and physical health. Scheduling time for ourselves at regular intervals is essential for releasing stress and restoring energy. At a minimum, find time each day to get some fresh air, stretch, and eat a proper meal. Just one minute of stretching in an hour really is good for our body and prevents repetitive injury.

Think about what it feels like to sit outside and enjoy a perfect day, smell a rose, or remember a vacation place you loved. These things take very little time but they’re like taking a breath of fresh air. Some folks call these micro breaks or mini-vacations. What can we do to take a mini-vacation? Perhaps it’s something as simple as watching the birds at a bird feeder or taking a bubble bath. Perhaps it’s indulging in some sort of artistic project. One caregiver enjoys making silk flower arrangements and is able to draw her mother into conversation about them.

What could we enjoy if we had an afternoon to ourselves? Would it be going to a movie, going to lunch with friends, or going clothes shopping? Try to find the time for a “breath of fresh air’ for yourself.

[Many thanks to Ann Puglisi of Catholic Charities for the “breath of fresh air.”  The Catholic Charities Caregiver Support website is:  www.cctwincities.org]

It’s That Time of Year Again

Summer Means High Temperatures and High Humidity–even in Minnesota

We know it’s hot when it’s in the 90’s, but when the dew point is higher than 57, the effect of the temperature is greater than the numbers.  For instance, on June 23 in the Twin Cities, we were told to expect temperatures of 96 0r 97 degrees.  With the dew point around 70, it felt like around 108 degrees–a very dangerous temperature that resulted in heat warnings for Hennepin and Ramsey counties (Minneapolis and St. Paul and suburbs.)

As we age, we are less able to respond to heat and cold.  During hot and humid weather, a buildup in body heat can cause heat stroke or heat exhaustion.  This is especially true for people with heart and circulatory disease, stroke or diabetes.

Heat Stroke is a medical emergency requiring immediate attention and treatment by a doctor.  Among the symptoms are:  faintness, dizziness, headache, nausea, loss of consciousness, body temperature of 104 degrees F. or higher, rapid pulse, and flushed skin.

Heat Exhaustion takes longer to develop than other heat-related illnesses.  It results from a loss of body water and salt.  Symptoms include:  weakness, heavy sweating, nausea, and giddiness.  Heat exhaustion is treated by resting in bed away from the heat and drinking cool liquids.

Protective Measures include remaining indoors in an air-conditioned room.  If the home is not air-conditioned, you might take your loved one to a cool public place (library, movie theater or store) during the hottest hours.

Other ways to cool off include taking cool baths or showers, placing ice bags or wet towels on the body and using electric fans (being careful to avoid an electrical shock.)

Remember that persons with memory loss and the other cognitive impairments that go along with dementias like Alzheimer’s disease often lack good judgement.  You may need to make sure that those you care for wear appropriate hat, sunglasses and sun screen.

It’s the Fourth of July–Celebrate the Holiday

Celebrate our Freedom, but Keep it Simple

The Fourth of July can be such a fun holiday–picnics, music, fireworks, family get-togethers.  But for the person with dementia,  it can be a trying, sometimes even frightening time.  For people in the early stages of the disease, celebrating can be pretty much the way it’s always been, but as people progress into the middle and later stages of Alzheimer’s or other related dementias, keeping the day simple is the best choice.

For some people with significant memory loss, leaving home, wherever that may be–home, apartment, assisted living, skilled facility–may be difficult.  For some it may be something as simple as the comfort of the place that is most familiar.  I’ve often thought that for people with incontinency issues, it may just be remaining in a place where they know where the bathroom is.   So one solution is to bring the celebration to the person’s place of residence.

Don’t plan for a whole day; if your celebration is go on for more than two hours, try to have a quiet place available for a short rest time.

Other ideas about keeping it simple are to limit the number of people who will join in the celebration.  Sometimes the over-stimulation of a lot of people is overwhelming and too tiring.   Food choices should be kept to a minimum of familiar favorites, and for those who are having difficulty with meals, finger foods would be a good choice.

Fireworks may be fun for the kids, but Grandpa may not understand exactly what is happening and may be frightened by what sounds like gunshots to him.  Music is usually a source of great enjoyment for people with memory loss, but include music that is familiar and that the person enjoyed in the past, and limit the volume and the amount of time devoted to it.

Celebrate our freedom and have a wonderful weekend.

CPR for Caregivers

Reviving  Caregivers

Everyone knows what CPR in the medical world is–Cardiopulmonary Resuscitation.  Perhaps you know of someone who has taken a CPR class, or maybe you even know of someone on whom the life-saving technique has been used.  But now I’d like to tell you about another kind of CPR, one you can use to help revive yourself.

CPR for caregivers is a set of principles for healthy communication.  By communicating with yourself and with others in a healthy manner, you can avoid burnout and gain energy to care for a loved one who needs you.

Caregiver communication is based on three principles:  Connect, Project, and Reflect (CPR.)

Connect–Giving effective care depends on establishing a mutual bond with the person for whom you are caring.  This bond is built on trust, acceptance, and respect.  The necessary foundation for developing this bond is connecting with yourself.

Project–the way you communicate with others (what you project,) whether verbally or non-verbally, can enhance or obstruct the connection.  Be aware of what you project so that the connection remains strong.

Reflect–your positive or negative thoughts.  Reflections determine how you project to others Learn to keep your reflections positive.

By using these principles you will have energy to become your own renewable resource and avoid caregiver burnout.

Used with permission from the author, Grant Watkins at:  www.grantwatkins.com.

Validation Therapy Continued

Ten Principles of Validation

The following principles are the basis for Validation Therapy as developed by Naomi Feil and listed in the Validation Training Institute website:

www.vfvalidation.org/whatis.

Jan Allen, CSW, MSE gives more information about Validation Therapy along with some interesting examples of conversations with disoriented patients n her website/blog:

www.ec-online.net/community/Activist/difficultbehaviors

1. All people are unique and should be treated as individuals.
2. All people are valuable, no matter how disoriented they are.
3. There is a reason behind the behavior of disoriented old people.
4. Behavior in old age is not only a function of changes in the brain, but reflects physical, social and psychological changes that take place during the whole lifespan.
5. Behaviors of older people can be changed only if the person wants to change them.
6. Old people should be accepted non-judgmentally.
7. Each stage of life has particular life tasks to be completed.  Failure to complete these tasks may lead to psychological problems.
8. When recent memory fails, older adults restore balance to their lives by retrieving memories from the past.
9. Painful feelings that are expressed, acknowledged and validated by a trusted listener will diminish.  Painful feelings that are ignored will gain strength.
10. Empathy builds trust, reduces anxiety and restores dignity.