Another Caregiver: Michelle Obama

In her speech last night at the Democratic National Convention, Michelle Obama mentioned her father's illness, Multiple Sclerosis.  She talked about how her father, Frasier Robinson, battled the disease from when he was in his 30's, and inspired his family by never letting his physical challenges stop him - he just got up earlier to accommodate the extra time he needed because of them.

Michelle's father died in 1990, but she mentioned that she still felt him watching over her. 

In the daily struggles of caregiving, it is nice to be reminded that how we choose to handle our difficulties can be a form of inspiration to others - and to know that a potential first-lady with a law degree from Harvard has found her inspiration in how her father lived his life after being diagnosed with M.S.

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Geriatric Care Management

What does a Geriatric Care Manager do?

This is a question I am often asked.  My best answer is that a Geriatric Care Manager does everything a terrific and caring Adult Child would do if they had the time.  However, unlike most Adult Children of seniors, the Geriatric Care Manager also has the professional expertise to understand the legal, medical, emotional and financial issues which are involved in senior care and as a non-family member, they can effectively keep all the care services on track.  A good Geriatric Care Manager is worth every penny and will often assist in solving family tensions.

Long-distance Caregivers especially can benefit from a Geriatric Care Manager to advocate for the senior and make sure they are receiving all the necessary care services.

How much does Geriatric Care Management cost?  Anywhere from $100.00 to $150.00 per hour and initial assessments are usually around $500.00 and will include a recommended or suggested Plan of Care.

Although there are not nationally standards in place for Geriatric Care Management licensing, it is usually advisable to have a manager with a background in social work and specialized training in working with or counseling seniors.  Registered Nurses are also often trained to work as Geriatric Care Managers.  Just make sure some credentials are in place and that the Geriatric Care Manager has referrals from other professionals in the community, including medical doctors and estate attorneys. , , ,

Moving Mom and Dad

Last week's Newsweek column, "My Turn" features a story shared by Anne Kennedy Rickover of Lincoln, Nebraska, who recently realized it was time to move her parents from Philadelphia to Lincoln to live near her.  Her parents were still living in the same house they lived in when she was a baby and now, 55 years later, it was requiring upkeep and her parents also were requiring "upkeep" with their day-to-day activities.

Rickover compares moving her parents to planning for a new baby's arrival.  However, unlike a pregnancy and newborn, she did not find an easy place to go for all the answers.  She talked to friends, looked for doctors and researched options.  She also is already thinking ahead to how she will feel when she loses her parents, now that they will become part of her daily life.

After working with hundreds of seniors, as a former owner of a Senior Home Care Agency, I can relate to the challenges Rickover is experiencing.  And as I am also babysitting my 3-month old niece this week, I find her comparison to a newborn baby very appropriate. 

Babies and seniors both have daily schedules.  Just as a baby will start crying if their diaper isn't changed or they are hungry, anyone who has assisted a senior with an age-related illness knows how upset they can become if their daily routine is thrown off.  One of the first questions I always asked a new client was:  what is your daily routine?  It is important to know what time they like to eat breakfast, lunch and dinner, when they prefer to take a nap, what television shows they watch and what weekly schedules are in place.  While they may not tell you specifically that it upsets them if their routine is changed, they will definitely communicate this in some form after a change occurs.

When battling all the challenges of aging, a routine is one comfort seniors can count on.  It is important to respect this and to try to not disturb their ways, however different they may be from ours, if we are to be successful in assisting with care.

You can read Rickover's entire story at:



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Alzheimer's Disease Early Detection

Last week, the Alzheimer's Association held the 2008 International Conference on Alzheimer's Disease in Chicago.  In an effort to promote early detection of the disease, advances in discovering biomarkers by recent research were shared.

It was explained that a biomarker is a substance or characteristic that can be objectively measured and evaluated as an indicator of normal body processes, disease processes, or the body's responses to a therapeutic intervention.

There is even more "scientific-speak" (which also can be very similar to "government-speak"), but in a nutshell, the research indicates that some of the brain changes such as amyloid plaques and neruofibrillary tangles begin many years before symptoms are shown.  If we could identify individuals with these brain changes while they are still cognitively "normal", we could test more future disease modifying therapies.

I guess this is similar to knowing that you are more likely to develop diabetes, for instance, due to certain factors being present and if you change your diet and start exercising, you can delay or prevent the on-set. Researchers are hoping to find a similar solution to Alzheimer's Disease by being able to identify the brain changes earlier. They would like to be able to use measurable markers to determine the presence of Alzheimer's pathology through blood or urine samples or perhaps MRI or PET imaging technology.

A blood test may be possible as healthy brain cells do not go through the process of division and replication (known as the "cell cycle") that is common in other cells in the body. However, in Alzheimer's Disease, brain cells have a tendency to prepare to re-enter this cell cycle, which may increase their likelihood of dying or directly cause their death.

This cell cycle defect can be found in white blood cells (lymphocytes) of people with Alzheimer's and this means a simple blood cell collection could be used for testing.  More trials are being conducted this summer and if all goes well, physicians will be able to use this method as another early test for Alzheimer's Disease.

Definitely a senior will benefit from early detection of Alzheimer's Disease as both medications and proper care can assist the senior and loved ones to more easily adjust to the needs of the disease.

If you are interested in reading the scientific explanations, visit the Alzheimer's Association website at:

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Estate Planning: Don't be James Brown

Singer James Brown attempted to have an Estate Plan in place but it seems there were a few glitches which are now resulting in his heirs receiving nothing and a lot of lawyers (21 showed up at the last court hearing) earning a paycheck from the resulting legal battle over his estate.

In August, 2000, Brown signed a will leaving his "personal and household effects" to his six children and created the "I Feel Good" trust to educate low-income kids in South Carolina and Georgia.  And then he married his fourth wife and did not update his will to include her and the son their son. And, to complicate matters, the lawyer he hired to create his will is serving 30 years in a South Carolina prison (another reason to be sure you are using a lawyer who specializes in estate planning and maintains a positive track record).

And then to make his estate situation even more interesting, James mortgaged the royalties to most of his songs to TIAA-CREF, the financial services company which was originally created for teacher's pensions (they opened their doors to all investors several years ago).  James Brown received $26 million in this deal and TIAA-CREF now receives the revenue for his song royalties until his loan balance is paid off.  Because of this, it could be as long as 10 years before the loan is paid off.

James Brown passed away on Christmas Day, 2006, and with his beneficiaries still fighting over his assets, the only real heirs are the lawyers.

What lesson can we all learn from this:  plan ahead, use quality lawyers, update your will when children are born or you marriage status changes and, most importantly, pull the family together in a meeting with everyone present to communicate the estate information to them.  This way you have witnesses for your wishes, to provide added credibility to your written plans, to assist when an heir decides to dispute.  Of course, it probably helps to not have as many wives and mistresses as James Brown had, but such is the life of a rock star!


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Planning for Long-term Care

Have you discussed your wishes for long-term care, if the need should arise, with your loved ones?

We are encouraged to save for retirement through a retirement plan such as a 401K or IRA and financial planners and advisors have an arsenal of charts and graphs to help you determine just how much money you will need to enjoy the same lifestyle you do now upon retirement, in an effort to encourage you to save.

This is because Medicare does not pay for long-term care.  You must provide for this need yourself.

But what we often miss, is mapping out what kind of care would be preferred and where you would want the senior care to be.  Many times senior care can be an emergency need and when families are not sure of the preferred care options, it only adds more stress to a difficult situation.  And with just a little planning, the process can be so much easier.

Separate from costs, think about where you would prefer to have care services.  In your own home with a professional care service provider?  Or, would you prefer to move into a senior community with Assisted Living services in order to enjoy an active senior lifestyle and know that care services are easily available, if needed?  And if your care needs are acute, do you want to receive the nursing care at home or in a nursing center?

Once you know how you would prefer to receive senior caregiving services, it is easy to connect with professionals in your area to find quality care providers and senior care communities.

The main types of care options are:

-In-home Caregiving services

-Assisted Living Community

-Nursing Home

-Continuing Care Community

-Independent or Supportive Living

-Outpatient Adult Day Care

Caregiverlist does offer Experts who answer your questions in these areas for free, to assist you to plan ahead for your senior care needs.

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Background Checks for Caregivers: Just the First Step

This past weekend, I was at a backyard BBQ and the hostess was telling about their move into their current home.  As her husband had been transfered to a few different cities for business, she was experienced at managing a move.  They had decided to stay in a hotel for a couple weeks in order to make some repairs to the home before living there.  She had labeled each box for the room the items would be going to and had separated out the items they would need in the short-term.

The moving company seemed very happy that she was well organized and the move went smoothly.  The day the moving truck was scheduled to arrive, she had been working on her laptop computer awaiting their arrival.  Once the movers drove up, she packed up her laptop and put it in a closet to be out of the way while the movers brought in the furniture and boxes.

The next day, she went to get her laptop computer out of the closet and it was not there.

The only people who had been in her home at that point were the movers, so she called the moving company and told them what happened.  After many more phone calls, one of the men on the moving crew did confess to stealing the laptop.  He had tossed it into the bushes by the house the day of the move and drove back that night to retrieve it.

My friend just wanted her information on the laptop back, but at that point all she was going to receive was a check from the the moving company's insurance to buy a new laptop computer.  She chose not to press charges, even though the moving company encouraged her to do so, because the thief knew where she lived, knew what belongings she had in her home and knew all about her family (which includes two small children).  She did not want the thief to retaliate in any way.  The biggest bummer of all, she said, was that the guy who stole her computer was her favorite guy on the moving crew.

If you talk to law enforcement officials, they will tell you this often happens - people choose not to press charges even when they have all the evidence to convict the guilty party of the crime, just because they don't want to deal with the legal bureaucracy, any negative publicity and backlash from the thief.  It is easier to just move on, lessons learned.

This is especially true when stolen items are either recovered or insurance compensation is received.  It then seems unnecessary to have the added headache of pressing charges.

However, what this means is that the person who is guilty of the crime will not have the crime information show on their record.  They can go and apply for a job the next day and their Background Check will come back clean  - because it is - no charges were "filed".  Similarly, sometimes a Judge will allow information to be taken off someone's record in exchange for community service.  Just like when you show up in court for a traffic ticket, sometimes if you agree to certain conditions, the Judge will delete the information from your official record so that your car insurance rates will not increase. 

Because of this, a Background Check should just be a starting point when hiring a Caregiver.  It should be used to verify that the name and Social Security number the individual provided do match their past names and addresses which are on record and that they are not listed as a Sex Offender or criminal.  It keeps the really bad guys and gals away. 

But then it is necessary to check multiple personal and business references to find out the person's character and to see if there is a steady employment history, long-term friends and associates who are able to provide feedback on their capabilities and consistent information.

Because another reality is that, just as in my friend's situation where her favorite mover was the thief, many times the person who is successful at having their crimes removed from their records or able to prevent charges from ever being filed is really charming - it comes with the territory! 

And these individuals, more than anyone, should not be caring for vulnerable seniors who may be lonely and looking for not just a Caregiver but also a friend.    




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Costs of Senior Home Care

How much does senior home care cost?

Senior Home Care Agencies charge an hourly fee and a daily fee for caregiving services.  The hourly fees may be discounted when more weekly hours are booked.

Usually the hourly fee is from $16 to $25 per hour and the daily fee for live-in care is from $150 to $275 per day.

These fees will vary, depending on the amount of care required and the area of the country you live in.

Senior Home Care Agencies deliver the added advantage of active care management (they will train and supervise the Caregiver and staff a replacement Caregiver when the regular Caregiver needs off).  The Agency will also provide policies and procedures for the Caregiver to follow and make sure a positive connection is established between the Caregiver and client.  The agency will staff a different Caregiver, when the situation requires a change.

In addition, agencies providing private-duty home care will employ the Caregiver and provide all the added insurance benefits required by law, such as Worker's Compensation Insurance and Professional Liability Insurance.  Most agencies also offer bonuses, performance incentives, health insurance and on-going training for their Caregivers.  Active case management allows the Caregivers to have a shoulder to lean on when they are dealing with daily care challenges.  Agencies also provide a Plan of Care for the Caregiver to follow.

The agency will also make sure they understand any special Caregiver requirements and will professionally address any client issues with the Caregiver.  It is important to provide the care in the manner the client desires and to understand any personal preferences, especially when providing care in a senior's home - the agency will not want to change the senior but rather adapt to their preferences.

One nice advantage of starting with care in the home through a Senior Home Care Agency is the ability to change the schedule.  Many times seniors need to adjust to needing additional help.  An agency can start with care just one day a week and then increase the hours as the senior becomes comfortable with allowing a Caregiver into their home and accepting help. 

When I owned a Senior Home Care Agency, many times we started out services for a client just one day a week because they were resistant to accepting care.  However, once the senior experiences the advantages of having assistance and realizes they are still the decisionmaker in their own home, they nearly always increase hours to match their care needs.  This is especially true when memory loss is just beginning.

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Senior Care Agencies offer Added Protection for Caregiving

Yesterday's Chicago Tribune reported a Caregiver was sentenced to 3 1/2 years in prison for stealing jewelry from the 61-year-old paraplegic client she was caring for as an independently hired Caregiver.

One huge advantage of hiring a Senior Home Care Agency to manage in-home care needs is that the agency, as a business, employees the Caregivers and provides Worker's Compensation Insurance (required by law) and carries a Fidelity Bond and Professional Liability Insurance.

In addition, the Senior Home Care Agency will do a Background Check on the Caregivers they hire, complete with matching prior addresses to the Social Security number the Caregiver has submitted and checking both professional and personal references.  The Senior Home Care Agency will also manage the entire care for their elderly and disabled clients, making sure that any valuables are managed effectively so no temptations are offered (as the Agency also must follow certain guidelines to maintain their insurance coverage).  In addition, as Caregivers are employees of agencies, they want to receive their employee benefits, such as Social Security so they can collect Social Security payments when they retire and other benefits such as health insurance, performance bonuses and the security of Worker's Compensation Insurance (Indpendently hired Caregivers, also called "hire-direct Caregivers" or "Independent Contractors" will not have these employee beneftis and their clients will not have the insurance protections either).  

Caregivers working for Senior Home Care Agencies are providing care as a career and because of this, if they suspect there is even slightly the chance of a situation which would place their performance in question, they will report this to their Supervisor.  Caregivers working for agencies will make sure that even if they are just  running an errand to purchase an item for a client that the agency is aware and that it is tracked through a Petty Cash account.  But even more importantly, the Senior Home Care Agency has created Policies & Procedures for both the Caregiver and the Client to follow to make sure proper care is provided and the opportunity for theft is eliminated.  The Agency would not stay in business and the Caregiver would not have a job if they were not professionally providing quallity care.

As Senior Home Care Agencies want to maintain a positive reputation in their community, in order for referrals from healthcare industry professionals to continue, they will make sure that a case is managed effectively and that any valuables are secured.  In the event that something did occur, they maintain insurance coverage to reimburse the client- just as we all maintain homeowner's insurance and car insurance.

A professional Senior Home Care Agency knows how to effectively manage the care to avoid situations that would provide an opportunity for theft.

The Illinois Caregiver who was stealing from her client had no insurance coverage - no Fidelity Bond and no Professional Liability Insurance to provide compensation for the rings she stole from her senior client  (she sold some of the stolen jewelry at a pawn shop and the transaction was caught on video-tape).  The DuPage County Judge Robert Anderson said that because there was little prospect of getting any restitution from the Caregvier, he did not order her to pay it (this Caregiver will also get free room and board for 3 1/2 years while she is in jail). 

If this Caregiver would have been employed through a Senior Home Care Agency, the agency would have made sure a system was in place to protect her jewelry collection and the insurance protection would also have been in place to provide restitution.  Not sure if the Judge thought to mention this so that in the future this paraplegic can enjoy the added protections a Senior Home Care Agency delivers.

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