Senior Care Planning: Geriatric Care Manager?

Planning ahead for senior care allows both the senior and the family to be able to focus on care issues instead of major family decisions when the time arrives for senior care.

As you visit your family during the upcoming holidays, remember one solution to senior care planning is a Geriatric Care Manager.  Geriatric Care Managers provide professional guidance to family members and the senior.  They can be a valuable liason between siblings and professional senior care services.  And, if you are living in a different city than your parents or grandparents, the geriatric care manager will be able to keep the senior care on track and make sure the proper resources are used.  In addition, a geriatric care manager usually will be very familiar with geriatric medical doctors, senior home care agencies and nursing homes in the area.  This can save a famil much time in making a quality choice.

Separately, a geriatric care manager will ask the right questions to make sure advance directives have been established and all end-of-life planning has been made.



Mini-Mental Exam Can Detect Memory Loss

In only ten minutes time, a mini-mental exam screens seniors for signs of dementia.  Referred to in the medical community simply as a "mini-mental", the official name is the Mini-mental State Exam and it is copyrighted by Psychological Assessment Resources (PAR).  Geriatric care doctors will give this exam to their senior clients to keep ahead of any signs of memory loss.

The mini-mental test asks questions about the time and place of the test, and incorporates math and language skills to test cognitive and memory abilities.  It asks questions like how many nickels are in $1.25 and if you can spell a certain word backwards.

Many times memory loss in seniors can be connected with an illness or with medications.  If properly addressed, senior memory loss can be slowed or reversed. Because of age-related diseases, seniors are more at risk for memory loss and should be sure their medical doctor is conducting a mini-mental at their annual check-ups.

If you are a caregiver for a senior, you can also find a variety of memory exercises at the Alzheimer's Store.

One of my Aunts suffered a stroke a few years ago and after being air-lifted to a metropolitan hospital,  she received excellent care and made nearly a full recovery.  Now she enjoys telling how in the days following the stroke, the doctor would check on her each day and ask her if she knew who the president of the United States was.  Each day, she would answer "George Bush".  Finally, she told him he needed to ask her something new.  He then asked her if she knew what the Gettysburg Address was, and............she began reciting it.  She had memorized it in grade school.  He told her she indeed knew it better than he did!

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Planning for care after an Alzheimer's Disease Diagnosis

Alzheimer's Disease is not an easy one for the senior with the diagnosis or their family.

The very best strategy, though, is to talk about the disease and to develop a plan of action for managing the memory loss and the care needs.  This will allow the senior to feel they are still involved in the decision-making and enable the family to implement safety measures from the beginning (i.d. bracelet, medication management, regular caregiving schedule).

And, even more importantly, this will allow the senior's family to talk to prevent misunderstandings which could cause gaps in care because perhaps not everyone has the same strategy.   Usually there is "water under the bridge" with various family members after years of living.  These realities must be addressed.

One Salon columnist very openly shares his desire not to be the caregiver for his Mother-in-law, who has just been diagnosed with Alzheimer's Disease.  It is nice to find someone express their honesty - he is definitely not alone.

Often when families hire a Senior Home Care Agency to provide care services, they are able to lessen the stress for family members because a third-party caregiver simply doesn't come with the baggage a family caregiver brings.  Each family must find the right solution for them but the first step is to start the conversation.
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Paying for Long-term Care

As a senior or a senior caregiver, you have learned that Medicare does not pay for long-term care needs in a nursing facility nor in the home. 

The costs of care can easily be $80,000 per year in a nursing home and full-time senior care services in the home can be from $35,000 to $73,000 per year, depending on if you have hourly care or 24-hour live-in care.

One of the best ways to manage these costs is to purchase a long-term care insurance policy.  Long-term care insurance can be purchased piece-meal, to meet your budget needs.  Over time, it is more economical to pay a few thousand dollars a year for a long-term care insurance policy rather than to have your assets drained by paying for the expenses out-of-pocket.

If you work for a corporation, find out if purchasing a long-term care insurance policy is an additional employee benefit which is offered.  Many state government employees and university employees are offered this benefit.

You can also read answers to popular long-term care insurance questions by Caregiverslist's long-term care insurance expert, Chris Lynch.


Obama's Grandmother Passes

Regardless of your political choice for president, you can share in the sadness of Barack Obama's Grandmother passing away just a day before the election.  Madelyn Payne Dunham, 86, died peacefully in her Honolulu home on Sunday night, after battling cancer.  She chose to stay at home with care provided by a caregiver.

Hospice training teaches that emotionally, it is easier to go through the process of grieving when you are able to plan for the death and say goodbye ahead of time.  Barack learned this, he said, when he did not make it to his Mother's side before she passed away.  As he did not want that to happen again, he took time off from his historic campaign to visit his Grandmother a couple of weeks ago.

Still, death of a loved one is never convenient or easy, even with knowing ahead of time.  While visiting France one summer, I went to dinner at a small country restaurant.  The owners were a married couple who made the rounds to all the tables to chat with their guests.  Upon learning that I worked in senior care, they told me to be sure to visit the bathroom before I left.  There was a mural painted on the bathroom wall that included the 17th Century Nun's Prayer.  I later had my Mother write it in calligraphy and framed it for my Senior Care Agency's office wall.  Many caregivers who passed through the doors asked about it and requested a copy and now it is included as a resource on Caregiverlist.


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Discussing Senior Care Options with Family

As the news media reports on the presidentail campaigns, we now all know Barack Obama is taking a couple days off the campaign trail to visit his sick Grandmother, Madelyn Dunham, in Hawaii.  She was discharged from the hospital to her home and her condition is described as serious.  Details of her illness have not been released but it is clear she preferred to go home to recover.

Medicare will pay for a temporary stay in a nursing home for rehabilitation after a hospital stay.  Medicare does not pay for long-term care in the home nor in the nursing home.  Only Medicaid, which very low-income seniors can qualify for, will pay for permanent long-term care in a nursing home (there are a few states, such as Vermont, developing in-home programs for Medicaid care).  Typically states require a senior to have no more than $2,000 in assets to qualify for Medicaid benefits.

Have you had the discussion with your parents regarding where they would like to receive care if the situation would present itself?  Do they prefer to go to a nursing home for recovery?  If so, which nursing home in your community do they prefer?  Hospitals will send a patient to any nursing home in their area, based on the discharge planner's instructions.  One time I was going to a hospital to meet with a patient regarding her care needs.  She had no immediate family and when I arrived, I discovered she had already been discharged and sent to a nursing home.  Her Guradian thought she was going to be discharged to a different (and better) nursing home.  The nursing home she was sent to was primarily a nursing home for Medicaid patients and unfortunately all the stereotypes that go with that were present (it did smell like urine, patients were medicated and parked in a room, sitting in their wheelchairs for the day).  This client was uncooperative at the nursing home, as soon as she was moved back to her home she was eating and talking again and her health improved.

Every situation is different.  Many times a nursing home can be the best option.  But it is important to discuss the wishes for care with the senior and become educated on the options in your area.   Medicaid is what it is - a regular government check the nursing facility will receive until the senior passes on.  A Medicaid pateint is not going to threaten to leave if conditions are not up to par - they are receiving a free place to stay from the government and do not have that option.  As nursing homes are businesses seeking to make a profit, it is important to ask the right questions. Find out what percentage of beds are Medicaid and find out the staff-to-patient ratio.

As the cost is typically nearly the same, more and more seniors are opting to go home and receive a private duty caregiver rather than go to a nursing home - - they are guaranteed one-to-one care from a caregiver where most nursiing homes have one nursing aide for as many as 12 to 15 patients.




The Five Wishes: An Easy Living Will

The Five Wishes is a document which was created to serve as a living will and provides questions to prompt you to think about how you would like your medical treatments and care to be provided if you were unable to speak or communicate these desires for yourself.  This living will document accounts for your medical, personal, emotional and physical needs.  It has been called a "living will with a heart". 

When I owned a Senior Home Care Agency, I placed a bulk order for the Five Wishes and gave many copies to client's family members.  The Five Wishes makes sure all the specific questions about care are answered.  For instance, laws can vary slightly in each state regarding to what is life support (is it both a feeding tube and a breathing apparatus)?  The Five Wishes is honored in 40 states and provides a starting point for you if you don't live in one of the 40 states.

Save money on Last Will and Testament

People of all ages, not just seniors, should take the time to create a living will so that family caregivers will know your desires.  The Five Wishes makes this an educational and easy task.  Definitely if you are a senior or if you do not know what your senior parent's wishes are, the Five Wishes can be a nice starting place for a discussion.

I really like The Five Wishes because it breaks it all down into specifics:  do you want life-support if you are sure to die in a short time or if you are in a coma and not expected to wake up or if you have permanent and severe brain damage and are not expected to recover?

The Five Wishes

Wish 1:  The person I want to make health care decisions for me when I can't make them for myself

Wish 2:  My wish for the kind of medical treatment I want or don't want

Wish 3:  My wish for how comfortable I want to be

Wish 4:  My wish for how I want people to treat me

Wish 5:  My wish for what I want my loved ones to know

There is a page for witness signatures and wallet cards are provided.

Creating a living will in the form of the Five Wishes makes sure you will have your desires spelled out and will prevent added stress for family members who may all have their own beliefs and desires, which may differ from yours.  You will be able to avoid a Terry Schiavo situation where the husband wanted life support removed after 15 years and her parents did not (the autopsy did confirm her brain was severly damaged, weighing half of a normal human brain, which meant she was unable to think, feel, see or interact in any way with her environment - for all that time).

The Five Wishes was introduced and originally distributed with support from a grant by The Robert Wood Johnson Foundation, the nation's largest philanthropy devoted exclusively to health and health care.

You may order a copy of The Five Wishes for $5.00 from (just $1.00 per copy if you order 25 or more copies).




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Ronald Reagan: We are All the Same When it Comes to Aging

About ten years ago, I was in Los Angeles attending a trade show for business.  At the end of the trip, I had made plans to meet a former intern for brunch before flying out of town.  We decided she would pick me up at my hotel, we would grab brunch and then she would drive me to the airport so we would have more time to catch-up (she was pursuing an acting career and had some good stories to share).

We decided to go to a hotel restaurant on the beach in Santa Monica since it was on the way to the airport.  We had not made reservations anywhere because we knew we would be so busy talking that any place would do.  The Concierge informed us that their restaurant was booked, but, if we didn't mind, they would seat us in their breezeway section, right off the hotel lobby as their outside patio was closed.  We said that would be fine.

We sat down and proceeded to start talking away.  A little later a few people sat down at the other table near us but we didn't really pay attention to them as we were deep in conversation.

The waitress brought our omelets and then she delivered a bowl of fruit to the table next to us and said, very loud and slowly, "Here you go, here is your fruit".  My friend turned to me and said, "She is talking to them like they are in an old folk's home".  I looked up and then I realized that the person sitting at the other table was former President Ronald Reagan and his nurse and 2 Secret Service officers. 

He had a baseball cap on and took it off and read the name of the team logo on it as if he were seeing it for the first time.  He then looked up at me and waved and then said something to his nurse and pointed at me.  I winked at her to let her know that I knew the situation and that everything was cool.  She then said to me, "he is flirting with you".  We then all laughed and so did he.  He seemed to think that I was someone he knew. 

We continued with our breakfast and they continued with theirs.  One of the Secret Service officers came over to our table to say hello and told us that they had just gone for a walk on the beach and sometimes stopped in for breakfast afterwards (I think he probably really was flirting with us).  President Reagan finished his breakfast at about the same time we finished ours.  We decided we would hit the bathroom and then leave.  The Secret Service officers and the nurse told President Reagan it was time to go but he did not want to get up.  After we finished in the bathroom, he was still sitting at the table, refusing to leave.  The Secret Service officer said goodbye to us and said that this happens sometimes with the President - I told him I understood because we experienced the same thing with my own grandfather when he had Alzheimer's Disease.

It was amazing to me that we were next to a man who had been president of the United States for two terms but no one in this busy restaurant and hotel even knew he was there - he was sitting in the "leftover" section with us.  For all his success, he was just another guy trying to get through another day while dealing with the effects of Alzheimer's Disease.

"Meet them where they are" is the advice given to caregivers.  No matter who you are or what you've done in this lifetime, we are all equals when it comes to aging.

And that's my story about breakfast with the President.






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