Karen Jeselun, RN, CCM returns on KXXT Radio Phoenix on 09/22/2011. Radio show “Your Long Term Care Show” with Ralph Norman and Michael Anastos to discuss some of the questions to ask when looking for a caregiver.

Click on the link below to play the audio clip:
Karen Jeselun returns on KXXT Radio Phoenix

Frustrated, Anxious, Frightened, Uncertain…..

Most of the adult children we speak with are experiencing one of more of the above emotions as they are trying to address the needs and concerns of their aging parents.  It seems to all boil down to the same issue… WHY WON’T THEY ACCEPT HELP?

The reasons are complex and often difficult for families to sift through.  But the following are the most common statements of resistance that we hear:

1. “I have to save my money for you!”
2. “I don’t want to become dependent on anyone!”
3. “It would be more trouble to have to ‘get ready’ to have someone come into my home.”
4. “If this doesn’t work out, would I have to leave my home?
5. “I lived through WWII where we had to ‘make do’.  I can take care of myself!”

No wonder we adult children are frustrated, anxious, frightened and uncertain.  How can we more effectively cope with our parents when we know they need assistance?

First of all, having a heart-to-heart conversation may be beneficial.  Helping that loved one recognize the burden that their refusal of outside help is placing on you and your relationship with them often paves the way for more open communication.  The adult child can again assume the role of child and enjoy quality time with their parent, instead of being the main caregiver.

Another strategy that is often effective is a “trial run” with a caregiver.  When my mother-in-law and father-in-law returned to their winter home in Mesa, my husband and I “insisted” that they have a caregiver once weekly for a few hours as a “trial”.  “Let’s just see how it goes”, we told them.  The day my father-in-law died, he thanked my husband for the help he had in their home.  “That was the best gift we could have ever received”.

Sometimes having an outsider, such as a Geriatric Care Manager, come in can make all of the difference.  Even if a Care Manager makes exactly the same recommendations the son or daughter does, it may be more readily accepted.

Lastly, know that you are not alone.  Most baby boomer-aged persons are dealing with these very issues.  It really does help to talk with your friends and neighbors, just for the moral support.  Many communities and churches offer support groups, as well as resources to consider.

The National Association of Professional Geriatric Care Managers (caremanger.org) is a wonderful resource to locate a Care Manager in any part of the country.
For a complimentary consultation in the Phoenix area by a Villa Home Care Geriatric Care Manager, please contact us at 602-957-9300 or visit our website at www.villahomecare.com.

(continued from part 1)

Last month, you were introduced to Maria.  Just to recap, Maria, 84 years old, was struggling in many areas of her life, and her three out of state children panicked, wondering how to best help their Mom.  They involved a Care Manager in her situation. In August, we reviewed five roles for the Geriatric Care Manager:  Assessment, Care Planning/Coordination, Physician Coordination, Medication Management and Crisis Response.  This month we will continue with the remaining five reasons to partner with a Geriatric Care Manager.

Reason #6 Transition planning. Transitioning from hospital to home, or from rehabilitation center to home, can sometimes be a precarious experience, especially related to medications. About half of adults experience a medication error after hospital discharge.  When Maria was preparing for her discharge from her rehab center, the Geriatric Care Manager (GCM) noted that she was prescribed a new blood pressure medication, and her instructions for home stated “Continue all medications as previously”.  Since she was already on a medication at home to lower her blood pressure, adding a second medication may have caused serious problems.  When asked for clarification, her physician concurred that she only needed to be taking one medication.

Reason #7 Recommendations in housing.  Is Maria able to be at home?  Does she need some type of assisted living?  Memory care?  Maria’s Care Manager really felt she would be safe at home at this time with the support of a daily caregiver for a few hours.

The 8th Reason to involve a GCM can be a local presence for check-ins. This service is invaluable for those adult children who don’t live nearby.  A monthly or bimonthly professional set of eyes looking in on Maria can really bring peace of mind.  Maria’s children could breathe more easily knowing that they would be notified of any problems – as well as a solution!

Reason #9 is a GCM can act as an extension of the family in a professional role.  Maria’s son recently said “you become me”.  And that is so true.  But as I told her son, we are really better than you, as we don’t bring years of relationships (good or bad) to the situation.   Care Managers are very objective and can truly advocate for the best decisions for the client.

Reason #10 is that we all need help.   Navigating the aging process is not easy.  Often we face crises without any kind of time to prepare. It is OK to ask for help.

The National Association of Professional Geriatric Care Managers (caremanger.org) is a wonderful resource to locate a Care Manager in any part of the country.
For a complimentary consultation in the Phoenix area by a Villa Home Care Geriatric Care Manager, please contact us at 602-957-9300.

We find Maria, 84 years old, living alone with her two cats in south Scottsdale.  Her husband died six months ago, and she has three children, all living on the east coast.  One day her son received a phone call from a Gilbert police officer.  His Mom was sitting in her car in the Safeway parking lot in Gilbert, she had no idea how she got there, nor how she was going to get home again.

Her children were scared to death – the son made call to the family attorney asking for help.  “What can we do?”  This trusted adviser contacted a Villa Home Care Geriatric Care Manager.

Reason #1) Assessment –With the goal of preserving Maria’s dignity, independence and resources, the Geriatric Care Manager met with Maria.  She found a very lonely lady with definite memory loss, mismanagement of medication, poor nutrition, at risk for falls, and, of course, driving problems.  While in the home, the mailman showed up with stacks of envelopes from her mailbox.  The Care Manager went through the mail with Maria and found two photo radar tickets and a cancellation from her LTC policy for no payment of premiums.  An assessment was also completed of Maria’s financial status, including a review of her Long Term Care Policy, qualification for VA benefits, and eligibility for the State Medicaid program.

Based on the above findings, the Geriatric Care Manager completed an individualized “stay-at-home” plan with recommendations for a caregiver for three hours daily to help with personal grooming, meal preparation, medication reminders, transportation, and socialization, as well as ongoing services from a Geriatric Care Management to set up her medications monthly, and accompany her to MD appointments – communicating updates with Maria’s children.

Reason #2) Care Planning/Coordination with others – Geriatric Care Managers are a resource for families.  Referrals are frequently made to Hospice, Medicare Home Health services, home physician services, assisted living communities, Meals on Wheels, transportation services, or even dog walking.  A Geriatric Care Manager can figure it out!

Reason #3) Coordination of Care with physicians- As Maria was declining, she would tell her children following her MD appointments that “all was fine – don’t worry about me”.  She was also not able to provide her physicians a real picture of her status.  The Care Manager was able to share with the doctor what really was transpiring, and again communicate with the family.  Maria had 5 specialists as well as a primary physician.  Unfortunately each of those physicians were concerned with just a piece of her health care – the Care Manager served as the central link to coordinate each plan, functioning as the central repository.

Medication Management is Reason #4)-  Maria had 8 prescription medications.  Two were for high blood pressure, two were for memory, one was for depression and two other medications to aid in digestion.  The Care Manager had serious concerns if she was 1) taking at all, taking as ordered (doubtful) or 2) double or triple dosing.  A system was set up in Maria’s home using an automated medication dispensing system that alerted the Care Manager if she did not take her meds on time.

Reason #5) Crisis Response- Families have someone to call in the middle of the night or on Sunday afternoon when they receive that panicked call from an older adult or that daughter out of state.  It happens.  It happened when Maria fell in her backyard. Villa’s Geriatric Care Manager met Maria in the hospital Emergency Room and learned the Maria had fractured her hip.  She arranged for a caregiver to stay with Maria until her son could arrive, and surgery was over.

(To Be Continued)

For a complimentary consultation by a Villa Home Care Geriatric Care Manager, please contact us at 602-957-9300.

July brings the celebration of freedom.  Independence Day is our time to recognize those who have fought for our freedom, and those who continue that fight today.  This was certainly brought to mind for me while visiting my parents in Northern Wisconsin recently.

My 92 year old father, a World War II veteran, is an active participant in the American Legion Honor Guard.  I was able to observe a military funeral and listened to my Dad’s bugle sound out Taps into the still evening air – revering the service and sacrifices the deceased veteran made for our country.  What a moving experience for his family, and for all of us in attendance.  I am so very proud that Dad has made this commitment for over 60 years now, and plans to continue for as long as he is able.  I know that there are veterans all over our country who are still giving of themselves in so many ways.

I have two challenges for all of us this July.  First of all, thank a veteran!  It doesn’t matter if they are 22 or 92.  They are protecting us, our families, and our country.

And secondly, help us spread the word about the Veteran’s Administration Aide and Attendant Care Program.  This provides financial assistance to qualifying veterans and/or their spouses for caregiving services. We find that many, many veterans and their families are not aware of this program.  This financial support may make the difference in their “independence”.  It could mean staying at home instead of relocating.

So as our sparklers die out, and the hot dogs and watermelon are eaten, reach out and say “thanks” to those military veterans who serve us so well.

For more information about the Aide and Attendant Care Benefit and other home care services, please contact Villa Home Care at 602-957-9300 and request a complimentary consultation from one of our Care Managers.

Did you know….

*35% of all hospital admissions for older adults is related to medication mismanagement?

*125,000 older adults die each year (or 342 each day) due to medication related problems.

*The average older adult takes 8.8 medications?

Medication Management for any of us can be perplexing; however, older adults bring their own set of issues to the equation.

Very often medications are not taken as prescribed due to adverse effects.  Lasix, a diuretic or “water pill” often prescribed for Congestive Heart Failure, may be skipped because a person decides since they have an appointment or an outing, and they don’t want to have to use a bathroom enroute.

Cost can frequently impact compliance.  When a prescription for 30 days costs over $300, many of us would take pause.  Being on a limited income, as so many older adults are, just means that sometimes these difficult decisions have to be made.   With cost being a concern this also means that discontinued medications may not be discarded, but “saved” in case it is needed again.

Generic vs. brand names can be quite confusing.  Using the Lasix example noted above, many medicine cupboards include both Lasix and the generic form, Furosemide.  When both bottles say “Take one daily”, that is exactly what is done – leading to serious consequences.

One last extenuating factor concerns multiple physicians prescribing medications.  One of our Villa Home Care clients saw 4 Specialists, as well as his Primary Care Physician.  All of these physicians were prescribing various medications for him.

What’s the answer?

Having a medication management “system” in place can promote compliance.  That system can take many forms.  We have all seen the plastic medication boxes that many pharmacies sell that are labeled with the day of the week and the time of day.  These plastic boxes work quite well for many folks, and they are very inexpensive.  Medications can be placed in the appropriate sections for a week, or even a month.  It is easy to see if medications are left behind.

If an individual likes to “rearrange” the medications in the plastic boxes, then this is not the solution.  However, there are more sophisticated medication systems available that are locked, and only dispense the medications needed for that dosing time.  These kinds of devices can also notify a designated individual when the medications are not removed from the devise, so that a phone call can be placed as a reminder.

Villa Home Care offers a Pharmacist Review of medications.  The services of a pharmacist are available to our clients to review that lengthy list of medications.  Being specially trained in the geriatric field, the pharmacist can look for correct doses, consolidation of doses, duplications, potential side effects, and even the appropriateness of the drug itself.

Lastly, having a Geriatric Care Manager present at all of the physician appointments can greatly promote coordination of prescriptions.

For more information on Medication Management services, contact Villa Home Care at 602-957-9300 or www.villahomecare.com.

What in the world do you do for an older parent when Mother’s Day or Father’s Day rolls around?  I would guess that my parents are like most when they tell me “Don’t buy me anything, Karen.  I don’t need anything”.  That may be true in – they don’t need anything, but I know that I would still like to recognize their special day.  It can be a dilemma for us adult children.

At Villa Home Care, we came up with a solution a few years ago that many families have taken advantage of, and that is our “Gift of Tuesdays”.  We read in one of the newspaper advice columns about a son whose Mom was the primary Caregiver for his Dad with dementia.  As we all know, being that main caregiver is absolutely a 24/7 commitment.  The son decided that each week, he would give his Mom a gift of a day away.  She could use that time to get her nails done, meet her friends for lunch, go shopping, or whatever she might enjoy.  He then paid for a professional caregiver to come and care for his Dad for that day.

Families are really excited to have this available at Villa Homecare.  We have siblings who all chip in for a monthly outing for their mother with a Caregiver.  They go to a movie, get lunch, and watch the fountain go off in Fountain Hills.  We took one of our lady clients to the English Rose Team Room in Carefree for a very special treat – complete with hats and pictures!  The Desert Botanical Garden is always a great outing, as it the Desert Belle Cruise.   How about a spring training game at one of our baseball stadiums for your Dad?  Or a tour of the AZ Wing Commemorative Air Force Aircraft Museum.  Living in the Phoenix area, we have so many opportunities to enjoy with our clients.

Of course, a “Gift of Tuesday” can be any day of the week, for as many hours as you would like, and any specific activity your loved one would enjoy.  It can be a one-time event or on-going. We can help you design a very special outing – one that will bring special memories.

For more information, please call 602-957-9300 or email us at contact@villahomecare.com

More than 3.3 million of us live an average of 480 miles from the loved one we care for.  This means that we come to visit for a few days, perhaps a week, and then get in our car or on a plane, and leave Mom alone once again.  Compounding that horrible feeling that we get in the pit of our stomach as we’re driving away or boarding our flight is the knowledge that 1) the potential for harm is great due to a fall or injury, 2) there just is not enough money available to pay for caregiving assistance, and 3) Mom insists that she is fine and does not need help!  Does this sound familiar?

Mary Smith’s husband died 6 years ago, leaving her alone in her Sun City, Arizona home.  Their only child, Susan, lives in St. Louis, with her own family where she is a practicing attorney.  Susan and her husband flew in to visit her 86 year old Mom over the Thanksgiving holiday.  After spending six days together, it was time to leave.  It was especially hard for Susan this year as she knew that her Mom’s recovery from her hip fracture last spring had not gone very well. Compounding her physical limitations were noticeable memory lapses which were happening more and more frequently.

Mary was very much a part of the “make-do” generation.  Being young during the Depression and World War II years has taught her that resiliency, frugality and self-reliance were the keys to survival.  When Susan had suggested hiring a Caregiver for a few hours each day, Mary was adamant that this was “wasteful”.  “Save your money”, her Mom said.  She added “what would they do here besides get in my way?”

So back to St. Louis for Susan with a real heaviness in her heart.  What could she do when her Mom was so adamant that she be left alone?  How could she respect her Mom’s autonomy when she didn’t feel that her Mom was making the best decision?

Using internet research, Susan found a Geriatric Care Manager through Villa Home Care who consulted with her about her Mom’s situation.  The Care Manager recommended Susan consider the use of technology as a solution to the dilemma she was experiencing.  Technology could offer 1) a less expensive set of “eyes” than a Caregiver, 2) less obtrusiveness than a Caregiver, and 3) provide the peace of mind to Susan knowing that her Mom is safe and secure in her home.

The Care Manager specifically directed Susan toward sensors and monitors.  Susan felt that having a motion detector in her Mom’s living areas would be very helpful as Susan would be notified if events happened (or didn’t happen) outside of preset parameters.  In other words, if the motion detector did not detect any movement in the living room between 1-3pm when Mary typically watched her soap operas, Susan would be notified on her cell phone or via email.

Susan was also concerned that her Mom may leave the stove burner on after heating water for her tea.  She learned that a sensor could be placed next to that burner – again alerting Susan if the burner was left on longer than was needed.

Lastly, the Care Manager talked with Susan about getting an S911 bracelet for her Mom.  This technology provides several benefits for Susan and Mary:  if Mary falls, Susan is immediately notified; if Mary is in distress, she can push one button to summon assistance; and, if Mary drives off past a preset boundary, Susan is notified of her exact location.

Susan is thrilled to learn of these options and feels that her Mom will be very receptive to all of these suggestions.  They meet all of the goals above – cost effective, unobtrusive, and give Susan the comfort knowing that her Mom is able to continue her independent lifestyle – safely.

Technology can help solve a myriad of concerns for older parents and their adult children, while keeping dignity, independence and financial resources intact.

To learn more about available options, please contact Villa Home Care at 602-957-9300 and schedule a complimentary assessment with a Geriatric Care Manager.

Karen Jeselun, RN, CCM returns on KXXT Radio Phoenix on 01/06/2011. Radio show “Your Long Term Care Show” with Ralph Norman and Michael Anastos.

Click on the link below to play the audio clip: