Posted on | October 12, 2013 | No Comments
Family caregivers are often shocked to learn that Medicare does not pay for the type of care most beneficial to family members who need care and support to remain at home. Medicare A and B pay for hospitalizations, rehabilitation in nursing homes, medical care and procedures and medical office visits. When individuals age and need help with physical activities, like bathing, dressing, toileting and continence and support walking and moving about safely, this type of care often called custodian care, is paid for privately. One exception to this guideline is long term care insurance.
Individuals with foresight and planning who purchase long term care insurance are able to use these policies to reimburse for the type of care that Medicare does not; custodial care and assistance with activities of daily living. Long term care insurance pays for a variety of support and assistance: in home care, day programs, assisted living and skilled nursing care. Long term care insurance provides individuals with a wide range of options for care that allow greater choice in where care is provided. Long term care insurance supports independence. These policies also allow individuals to preserve retirement savings as policies are purchased for a number of years with a corresponding financial limit.
Early policies were often limited to narrow types of care, for example nursing home only policies. Individuals often failed to purchase inflation protection which means that policy values increase each year with inflation. Inflation protection, usually set at 5% per year, increases annual policy premiums. Yet without this protection plans will be unable to keep up with annual costs of care and by the time a policy is accessed the daily amount payable will be at a rate so low that the policy owner is paying for the majority of care costs.
The benefit of knowing that Medicare does not pay is that caregivers will understand the importance of long term care planning and rather than relying on the Government to pay for care, will take the initiative to plan for paying for their own care.
Posted on | September 4, 2013 | No Comments
The headline of an article, this week in the Denver Post, read “Star’s doctors were also his friends”. AEG, the company being sued by Michael Jackson’s mother, contends that it was Michael’s choice to establish personal relationships with his physicians that eventually led to his death. Mentioned in the article were after hour house calls, false names on medical records and prescriptions, inviting physicians to spend the holidays at his properties and other actions that crossed the ethical boundaries of a physician – patient relationship. In this situation it’s also a question of money. How much did Michael pay for this clandestine special medical treatment?
For most of us the ability to financially pay physicians to cross ethical boundaries is not a consideration. In a perfect world, professional relationships remain professional. Physicians, attorneys, CPAs and others should not be invited to the home of a client for dinner or to consistently act or provide services in a way that crosses the boundaries of a professional client relationship. If the relationship has moved beyond professional, the professional should move to the role of a friend and recommend another professional advisor.
Boundaries are commonly crossed in professional relationships whether the professional – client relationship be with attorneys, physicians, nurses, home health care providers, nursing assistants, financial planners, accountants, bankers or other professionals. The ethics of professionalism is sometimes a situation where logic defies reason, meaning that individuals act out of love or emotion rather than using common sense, logic or reason.
Truth be told, we all want to be liked. The desire to be liked becomes sticky in professional relationships where the professional has a duty to act in the best interest of the client. At the point the relationship crosses the professional boundary into familiarity, the character of the relationship changes. It is said that character is what one does when no one is looking. How many of us refuse to compromise our character regardless of whether we are alone or with others? The longer a professional relationship exists, the higher the likelihood that boundaries will be crossed.
When I owned my own non-medical caregiving company years ago, daily reminders and coaching occurred on the subject of maintaining professional boundaries with clients. There were employee caregivers who thought nothing of consuming all the food in a client’s refrigerator when the question posed by the client was “are you hungry?” Care providers (until we procured a telephone log in and log out system) were permitted by clients to arrive late or leave early and to be paid by the client for the entire time scheduled.
Some of the situations were truly so unbelievable that we began performing skits at training sessions to allow caregivers to laugh at the situations, yet realize how dangerous their seemingly innocent actions had become. Truth be known, unsupervised caregivers in the home of a client results in many sleepless nights for the owners of home health companies. One never knows what an employee will or will not do if ongoing training about boundaries does not occur.
The boundary challenge also exists with client behavior. Some older adults are so isolated that they view in home caregivers like daughters, sons or family members and want to know everything about the life of the caregiver. Caregivers with poor boundary control spill their guts and tell clients about their divorces, issues with children, trouble with the law and the inability to pay their bills. This information, of course, elicits sympathy from the client who then wants to give, give and give, whether the gift is money, furniture or other personal belongings. This is the slippery slope that leads to caregiver abuse and neglect including the names of in home caregivers on the bank accounts of clients and in their wills. I can’t tell you how many times my own clients wanted to give me items; I quickly learned how to graciously decline without hurting their feelings.
One professional caregiver in an assisted living “borrowed” jewelry from my client to wear during the holidays. When asked what the caregiver was thinking, the reply was, “she offered.” When I asked my client what she was thinking the response was similar. The danger with this particular client is that she regularly accused individuals of stealing from her. How could this professional caregiver, knowing this, believe she would not be accused of theft?
Since I left the world of home care behind and today work in the field of care navigation, serving as guardian, power of attorney and case manager I see similar issues in all caregiving fields including boundary issues occurring between employees and residents in assisted living and skilled nursing communities. Again familiarity breeds major character fractures. A patient plans to return home and wishes to hire the nursing assistant from the care community privately not realizing that there are company rules against this practice. The company employee looking to advance their financial prospects agrees.
The client/patient naïve to hiring practices and employment agreements makes promises of personal belongings in return for needed care. Several years down the road, bank accounts, titles to vehicles and the title to the home are in the name of the nursing assistant as payment due for their personal devotion for providing care. This distribution of property and money naturally comes as a great surprise to family who may have lived at a distance and had little involvement.
In positive care situations, caregivers form emotional attachments with clients. Excellent caregivers form attachments but are also able to maintain personal boundaries. It’s the difference between focusing the relationship on the caregiver’s life versus the life of the person receiving care.
I continue to educate and tell professional caregivers that they exist to remove burdens from the daily life of a client; not to burden clients with their own personal history and baggage. It’s the difference between a professional being asked how are you, and responding with “great”, versus giving every last detail of why life is so miserable. Caregiving is not about the professional caregiver, it’s all about the person receiving care and assistance.
Once a relationship becomes familiar versus professional, common sense and logic quickly fade. Professional caregivers all of a sudden believe they know more about an individual than the individual’s family and they begin to take liberties. Pick any industry and the story can be duplicated.
In my opinion ongoing reminders and education about professional conduct is lacking in business today. It’s a subject rarely discussed unless the profession is under the oversight of a licensing or governing board with required ethics continuing education. Yet it’s a subject that should be reviewed on a regular basis. In my opinion, if a professional isn’t questioning their conduct on a regular basis, the professional is likely crossing a boundary here or there.
What truly is in the best interest of a client and how can this be decided? It takes a balanced approach of contemplating both sides of actions, the pros and the cons. Examining what appears to be right and wrong and looking at the short and long term consequences, including asking if someone on the outside “looked in”, how would the conduct of the situation be viewed? This also includes having a discussion with a patient or client about the ethical foundations of requests and actions and the why and why not of actions. Sometimes all it takes is a simple explanation.
What may seem acceptable today may look totally different if the information was to appear on the front page of a newspaper tomorrow. If you’re a professional, ask yourself this question, if your conduct or dealings with any client became a front page headline would this be a positive or a negative? If you are unable to respond overwhelmingly yes, maybe it’s time to take another look at your character, professional and ethical conduct.
If you are in a caring profession and are not discussing character, conduct, ethics and professional behavior on an ongoing basis with your employees it’s time to start today. It’s important to have similar discussions with patients or clients who may not understand company guidelines. Full disclosure of information, policies and procedures is important to eliminate faulty expectations or surprises.
A front page story, “the woman’s caregivers were also her friends”, might not be a great newspaper headline if the caregivers acted in poor conduct that resulted in injury, harm or death. It’s time we all bring greater awareness to ethics and professional conduct. Our clients deserve the best we can offer, including referring them to another professional when or if our relationship becomes too familiar that we lose perspective and objectivity about right and wrong.
Posted on | August 27, 2013 | No Comments
A local Denver area nursing home was recently cited for a number of issues including staffing and regulatory issues, allegations of sexual assault and wrongful death. Records at the nursing home revealed high staff turnover and low quality ratings. A recent expose of a large assisted living community indicated similar concerns of the community keeping residents long after care levels exceeded what could realistically be provided by assisted living staff resulting in unnecessary resident deaths. In my profession as an advocate for my clients, I have issued complaints to the Department of Health for investigation of sub-standard care on behalf of clients for whom I am responsible.
Is care disappearing from professional caregving? Are communities rushing to fill beds served by staff who see caregiving as a job rather than a vocation? Is this an industry wide trend or an isolated issue related to financial solvency and lack of management belief in the provision of ethical and dignified care? I believe it’s a little of both. For nursing homes primarily reliant on Medicare reimbursement for short term therapy the story is often different from nursing homes reliant on long term care services reimbursed by Medicaid.
Most nursing homes have a mix of both populations. Many are struggling financially to balance staffing costs versus insurance reimbursements and other costs. Supervisory staff is stretched. Budgets for training caregiving staff, who by the way make all the difference relative to quality measures of care, are practically non-existent. It’s no wonder the quality of care is diminishing across the country while the number of individuals needing care is increasing at an alarming rate.
What will it take to reverse this trend? A good executive director in any community, just as a skilled president of a corporation, makes all the difference in setting the tone, character and values of an organization. A couple of poorly managed nursing homes or assisted living communities have the ability to damage the reputation of the entire group. A single employee with a poor attitude can drag down a company department or division.
Employees who view positions of care at nursing homes and assisted living communities as jobs rather than a privilege or a vocation chip at the very fiber of a committed organization. The unemployment rate remains high. Care communities need caregivers with a passion for caring. Turnover remains high resulting in poor quality ratings.
It seems common sense that care communities might realize that staff training has the potential to improve quality of care. Yet it’s not just the hard skills of bathing, dressing and toileting but the soft skills that make a difference. A “good morning” to acknowledge residents living in the community. Not rushing past a resident in the hallway asking for help, but taking a moment to respond and to find someone who might help, makes a difference. It’s easy for professional caregivers to becom immune to the smells, sights and sounds in a community when everyone is asking for assistance now.
When so much work has to be accomplished in a single day by so many, it is difficult to invest time in training. Community populations are becoming more complex in care needs; dementia, mental health disorders, conditions that require more time and attention. Admittedly all the complexities are no reason not to provide needed care. Caring begins one person at a time. A sense of caring can be contagious. Humor and laughter are important when stress levels are high.
A good leader, a good president, a good executive director and committed and consistent support staff make all the difference. One solution to the vanishing act of caregiving is management willing to invest time and training in the front line employees who provide care and give their heart and soul to residents day in and day out. If training cannot occur from within then organizations must seek outside experts to train.
I have worked with many amazing caregivers and some caregivers who should seek another profession. Caring isn’t something that one learns. Caring is an internal quality posessed by individuals who are truly angels on earth with a love for caring for a population in need of physical and emotional support. I am in awe and honor professional caregivers who bring joy to our older adults day in and day out. Because of my work in the aging and healthcare industry over the past 15 years, I know how hard the work can be sometimes with ittle acknowledgement or thanks.
Those of us who love working as professional caregivers have a duty to support the industry and to advocate for recognition of caregiving as an important profession and a role in life that benefits from ongoing training and support. The aging, sick and disabled needing care are relying on professional caregivers to be present, ready and available when the time comes that care is needed.
Through my organization, The Care Navigator, I support the local community through memberships in various organizations and I chair the Community Healthcare Ethics Committee offering education and support to professional caregivers inthe community. Together we can stop caregiving from becoming a vanishing act.
Posted on | August 23, 2013 | No Comments
Assisted living communites and nursing homes provide care for a large number of older adults, short or long term. What guarantees exist that the care provided will be ethical, dignified, respectful and of a quality to ensure good care? Most assisted living communities operate under ”minimum standard of care” requirements.
Family caregivers searching for the appropriate assisted living community for a loved one struggle with guilt and uncertainty. Guilt because they can’t provide more care for a loved one and are forced to choose a care community. Uncertainty because of the growing number of available assisted living communities, varied service offerings and the difficulty making the right choice.
I’ve worked in the aging and healthcare industry for the past 15 years. Assisted living and skilled nursing communities are needed and beneficial. Many of the staff working in the communities are dedicated and good care is provided. I’ve also worked with communities where due to staff turnover and other circumstances the care provided was sub-standard. Family caregivers, because of a lack of education and understanding of the system, often become frustrated because they fail to receive expected care results for loved ones. The staff of care communities at times fail to fully explain available services and service and staff limitations.
Few will argue that the healthcare industry is challenged. Professional caregivers expected to care for our loved ones earn on average $10 per hour; most have no health insurance and few receive more than the minimum amount of training. Language barriers exist for those for whom English is a second language. Turnover is extremely high affecting the quality of care. Profits are strained, especially in communities accepting Medicaid. Budgets for training are thin and sometimes non-existent.
All this being said, this week I had the privilege of attending the 5th Annual Colorado Bar Association’s Elderlaw Retreat. This morning I presented about the challenges of care in assisted living communities. While my presentation may have been somewhat controversial, it should also be noted that I am a member of the Colorado Assisted Living Association and have participated in their conferences and provided training to attendees. I support ongoing education for all involved in the care of older adults and disabled individuals. I am the chairperson of a local healthcare ethics committee also offering education and support to professional caregivers and am involved in many professional groups and organizations.
In my daily work as an advocate, I am involved with situations that complicate care for clients for whom I am responsible for in the role of guardian or medical power of attorney. The following presents a realistic situation of several issues that occur in some, not all care communities. As The Care Navigator, I advocate for higher standards of care and believe that it is possible to raise care levels with the support of the healthcare community and the recognition that it is our duty to improve current standards.
Below is a short list of challenges that exist in the assisted living industry:
1) “If you can’t get your loved one to do something – we’re certainly not going to get them to do it either”. Many communiites sell family caregivers on the idea of assistance with bathing, dressing, meals medication administration and activities. The reality is that if a loved one does not wish to participate in one or all of these, the care staff cannot make (force) a resident to do anything. This refusal of participation is considered a “patient right” and is extremely frustrating to family caregivers.
There are some limitations. The patient’s rights guidelines fail to mention the responsibility and ability of medical power attorney and guardian to make care decisions for a loved one. This is confusing to most, if not all care staff, as individuals with legal authority have the ability to override a patient’s right. For example a loved one allergic to chocolate vomits and is repeatedly sent to the emergency room at great financial expense and bodily harm. Care community staff would argue the patient’s right to consume chocolate. The legally responsible party would argue health risks and expenses from repeated hosiptalizations that their loved one is unable to comprehend. Thus a right to eat chocolate can be denied by a legally responsible party if the consequences of doing so result in physical and financial harm.
2) Assisted living communities accept residents well beyond the care they are able to provide. Empty beds equal lost profit. Many communities are accepting individuals whose care borderlines the care provided in a skilled nursing community. While it is true that an assisted living environment is more appealing, the risks of care needs not being met for individuals who require a high level of care are too great. Need proof, google the recent expose on Emeritus Assisted Living Communities called “Life and Death in Assisted Living“. While the events described happen in many communities it is also true that the staff at any one individual community and the leadership of the Executive Director dictate care levels that may be exceptional.
3) “We pay people to put you here even if – there’s a better community option for you.” Assisted living communities pay high fees, usually equal to one month’s rent, to referral services. If one of the free referral services are used, versus an independent consultant paid by the client, the best community may not be recommended.
Several years ago, Michael Berens, a Seattle Times reporter, led an expose called Seniors for Sale about misleading and under the table practices in the elder care industry including free referral services. The state of Washington and several states have passed protective legislation requiring full disclosure of fees, requirements of insurance and other protections in the aging and eldercare industry as older adults and family caregivers are extremely vulnerable. As of today, Colorado has no such legislation.
4) Professional caregivers become emotionally involved and will take sides against family. In situations where only half of the story is evident and a loved one may be diagnosed with dementia, a brain injury or a personality disorder it’s difficult for professional care staff to understand that there is usually another side to the story that is reported. I have personally experienced professional caregiving staff become enmeshed in family situations, support situations of triangulation, pit the resident against family members and particpate in other practices that damaged family relationships. This occurs due to lack of training and experience on the part of professional caregivers who become emotionally attached to the residents for whom they provide care.
5) Don’t ask, don’t tell. If family caregivers fail to ask the right questions potentialy adverse events occur. Community staff exist to provide care not necessarily to educate or consult with family about care issues. It’s always the questions that caregivers fail to ask that result in significant issues. Family caregivers must become more knowledgeable about the systems within which they place family members and not rely on care staff to be the solution to all questions.
Advocates are available to assist in this area where a lack of asking the right questions or not having sufficient knowledge can be dangerous. This is especially necessary in situations where parents or older adults are unable to manage their own care. In these situations it is truly buyer beware.
6) “We’re not federally regulated – you too can become an assisted living administrator with 30 hours of training and a little bit of experience.” Almost anyone can open an assisted living community. Large, mid-size communities and small personal care homes continue to be built to serve the growing number of baby boomers aging everyday. Again, good communities with high standards exist in equal proportion to communities with minimum standards and poor care.
7) Medicare Compare – Many families rely on this website to choose a nursing home. The information can be dated. Half of the information is “self-rated”. The main fault of this program is that it requires families and individuals to file complaints with the state health depatment in order for these complaints to show for a particular community. Most family carevivers, fearful of filing a complaint because they feel the care of their loved one will be at risk, refuse to file complaints. Thus many communities with sub-standard care are never identified.
These are realistic concerns that may be translated across all healthcare industries of service, mine included. However standards must be set and education must be a continuing requirement if we are to be able to change concerns about a healthcare system that places older adults at risk versus providing quality care.
Posted on | March 8, 2013 | No Comments
How many of us find ourselves too busy to really care? I recently helped a client identify a care community for a loved one who experienced a long list of health complications. This was a rather long journey of identifying communities, having assessments completed and receiving declines because the care needed was too significant for available care community staff or there were unexpressed, hidden concerns. .
As one might imagine, after multiple declines, the client became despondent. As a result his interactions and behaviors with potential care staff became impatient and filled with frustration because his desire for care of his loved one appeared to be met by people who were too busy to care, who lacked knowledge or lacked any interest in being helpful.
In caregiving, competing interests represent complications for professional caregivers, family caregivers and care advocates. Communities decline difficult patients or family members they sense to be potentially difficult or excessively time consuming. Family caregivers want the best for their loved ones and lack understanding of minimum standards of care, community rules, regulations or constraints which more than often are not fully explained at a level family caregivers are able to understand. Care staff is often perceived as too busy to care when caring is a main component of their job description.
The goal of care advocates is to advocate for family members and to simplify or ease concerns of professional caregivers who might be hesitant to provide or offer care. It’s sometime a precarious situation because we realize the complexities and support the best interest of the family and the individual in need. We’d rather receive an explanatory and respectful decline rather than have professional caregivers agree to provide care and then fail or disappoint. Yet there are situations where complications exist and we need professional caregivers who agree to go the extra mile for our client with special or unusual care needs
We work in an imperfect healthcare system. As an advocate for families and care recipients, I am at times met by community staff that walks the other way when they see me visiting their communities or who fail to return phone calls because they’re having a busy day and know I will ask questions that may take more time than they have available.
This happened recently when this same client was accepted by a community and then suddenly declined. The admissions person, who I have known for more than a year, told me he didn’t want to take my call because he knew I’d want details and explanations and this would take time he didn’t have on this particular day. I certainly hope that his response to me was not reflective of the way he would respond to a concerned family member as it lacked any semblance of compassion or caring.
If we in the caregiving industry don’t take time to support family caregivers who will? We realize there is a solution for every situation that at times does require investigation, questions, details and explanations from care staff willing to be patient with our inquiries on behalf of clients of The Care Navigator.
Professional caregivers, too busy to care or rushed for time, easily intimidate family caregivers. The reality is that a simple explanation offered by care staff appropriately trained and knowledgeable offers comfort to family caregivers. Based on my personal experience, this type of response occurs on an infrequent basis. More often family caregivers are left feeling frustrated and uncertain.
Are we as leaders in the care industry too busy to train appropriate responses, behaviors and customer service in care staff? The lack of professionalism in the healthcare industry is at times comparable to the level of professionalism of an automobile salesman, pushy telemarketer or a realtor looking to sell a decrepit house to the next willing buyer.
If we seek to be a caring industry we must take the time to develop caring individuals willing to take the time to support families and caregivers and to express caring ourselves. I’m often asked if we, The Care Navigator, are “busy”. My response? We’re never too busy to help another client or family, it’s what we do because we’re not too busy care.
Posted on | March 8, 2013 | No Comments
My niece recently posted questionable information on the internet that appeared on my Facebook page because we were friends; after reading the content I immediately and secretly “un-friended” her. I didn’t want the information in her post to appear on my page with readers assuming I approved of her conduct. Maybe I’ve become prudish in my old age, but I believe there are too many posts that simply provide too much information and photographs that belong only in a private photo album rather than on the eternal library of the internet.
That being said having a virtual life connects us to others in ways that can be beneficial, preserve relationships and be time efficient. While I’d never think of making a phone call to a friend at 10 o’clock at night, I might send an email letting them know I’m thinking about them that they’ll receive the next morning. Networking sites like LinkedIn are great for connecting with business colleagues and keeping track of the whereabouts of colleagues in our industry, who as most of us know, continually change employers and positions. Facebook is a great vehicle for tracking down long lost grade school, high school and college buddies and if you’re a business for creating a group of friends and supporters.
But, let’s not forget that information we post is also used by potential employers, internet predators and thieves who might find it very interesting that you’re posting vacation photos on Facebook. Might you NOT be home? What a great way to let burglars know that NOW is the perfect time to break into your home.
Recently several online email provider accounts were hacked. How many of you have received emails from friends through Yahoo that you eventually realized were SPAM sent from some annoying hacker in Russia or Australia. It can be challenging to know which emails to open and which emails to delete. My advice, change your passwords often and don’t make them easy to decipher. Use capital and lower case letters, number and symbols that are at least 8-10 characters. Don’t use the name of your spouse, your children or your pets especially if you you’ve shared this information elsewhere on the internet. Protect your virtual life as you do your physical life and keep private information private.
Then there’s the items we collect and purchase online. What about I-tunes, downloaded books, online games and family photo albums. What happens to these when we die if we don’t leave a list of passwords accessible somewhere? Imagine how many personal online accounts exist of persons now deceased. This is an issue for online companies and lawyers to settle. But at least for now take care to protect your virtual life and enjoy connecting with business colleagues and friends. Connect with The Care Navigator on Facebook.
Posted on | March 2, 2013 | No Comments
If you have a loved one who is a resident of a long term care community does it seem that morning care including getting out of bed, appropriate hygiene, tooth brushing, toileting and dressing is hit or miss? If this is your experience you may be right at least 40% of the time. Research completed in long term care communities, also called nursing homes, indicates that residents who require greater than average physical care often miss morning care routines.1
I attest that performing morning personal care is time consuming. How long does it take for us to get out of bed, shower or bathe, get dressed and begin our day? For most of us this daily routine consumes up to an hour of time. In long term care communities where residents outnumber staff, this routine is even more challenging and at times one or more components of getting out of bed, using the toilet and getting dressed is missed in the morning and postponed until later in the day.
How many individuals working in long term care dread working mornings because of time pressures, performing multiple components of care and every resident requiring attention? Time and staffing indicate that not everyone can receive care at the same time especially if preferences indicate 7 a.m. is the perfect time to get up and out of bed. What about those individuals who want to rise earlier and those who want to sleep in? Is it possible to accommodate the wishes of every resident?
Resident behaviors and different responses from day to day complicate care schedules. Residents with memory loss when asked a question often immediately respond “no”. These individuals are easily bypassed relative to morning care routines because the time involved in persuading them to agree is too time intensive when a large number of residents who will say yes are waiting for care. Another resident, who may exhibit negative behavior, refuses to get out of bed and is viewed as exerting a “patient right”, thus left to remain in bed until care staff completes their morning routine and has time to return sometime not until after lunch. Thus it’s not surprising that many long term care residents spend at least 18 hours a day in bed or substantial amounts of time sitting is wheelchairs lined up in hallways or in front of nurses’ stations.
Some long term care residents (without memory loss) report that they have become “used to” not being asked their preferences. For example, rare are questions of “are you ready to get up and get going?”, ‘what do you want to wear today?” or “may I help you to the bathroom?” are rarely if ever asked. I had a client who pressed used the call button for mobility assistance to the bathroom and who was left sitting on the toilet for over an hour until care staff walking down the hallway heard her yelling for help. Other clients have been left lying in bed for extended periods of time in soiled undergarments.
Residents requiring continence care should be checked and changed every 2 hours at a minimum. This is no different from the idea of a 2 hour toileting schedule for an individual with memory loss to avoid the occurrence of accidents.
Complaints by residents are seen as a futile effort. Fear of retribution by care staff is an often expressed resident reality. Older adults also don’t want to be seen as a bother or to get staff they see on a daily basis into trouble with management. The absence of expressed concerns results in supervisory and care staff believing that resident care is acceptable and appropriate when the opposite is true.
If those of us working in the industry really care about providing care what can we do differently? Population estimates for the next 15 years indicate that the number of residents living in care communities will grow to exponentially as baby boomers retire, age and require care. Long term care staff assumptions that 40% of resident morning care routines are acceptable without verifying this assumption with residents is irresponsible and ethically and morally faulty.
If your family member is experiencing sub-standard care in a community speak up or retain a care advocate to provide support on your behalf. If you work in a care community and see a sub-standard resident care, speak up on behalf of the residents who are likely fearful of speaking up for themselves. It’s our responsibility to advocate for those vulnerable and less able.
1 Simmons, Sandra F. et al., Resident Characteristics Related to the lack of Morning Care Provision in Long Term Care. The Gerontologist, Vol. 53, No. 1, 2013 pp. 151- 161
Posted on | March 2, 2013 | No Comments
Caregivers are happy, energetic, helpful people ready to jump in to lend a helping hand. Caregivers are individuals who find it impossible to say no and who refuse to manage their schedules but instead allow schedules, requests and demands to manage them. It’s this inability to say no in addition to readily accepting additional caregiving responsibility that results in caregiver stress and burden. After all who wants to admit we can’t do it all? Not us.
I often hear “ I’ve never been sick in my life“ or “I’m never sick” from caregivers as if what they’re experiencing, not feeling well, is a shock or a surprise. These statements are the first in a long sequence of denial and faulty beliefs about the individual invincibility of caregivers. These statements are a reality check that the rapid recovery, the ability to bounce back quickly from health issues occurring in our youth is a memory of the past. “I’m never sick” is a reminder that we can no longer abuse our bodies by not sleeping, not eating properly, not exercising and not paying attention to stress that affects our bodies. It’s a reminder that remaining healthy and resilient as we age now takes effort and work.
Caregivers experiencing “ I’ve never been sick in my life” tell me that they don’t have time to attend to their health or go to the doctor. This is when I pose the question, “then you do have time to be sick?” A caregiver recently told me that caring for her mother took such a toll on her health and wellbeing that she retired from her job. To make sure I understood her statement, I asked, “You retired from your job so you could spend even more time being burdened by caring for your mother?” The caregiver smiled back at me and nodded her head realizing that this may not have been the best choice. Hindsight is 20:20.
Caregivers are irrational. We make excuses and poor decisions rather than taking a step back and taking responsibility for our actions or inactions or heaven forbid do we ever say no to requests to add one more item into our already over-scheduled schedules. We do this because we lack the skills to cope with our day to day reality. We continue to allow our schedules to spiral out of control.
Caregivers find working on their own health issues too much work, we’re not that sick — yet. You’ll rarely hear a caregiver say that caregiving is too much work. That is until the caregiver is forced to take a step back and look at the current situation because of a now serious health issue that can’t be ignored or because of repeated statements from loved ones of concern that are now final demands instead of gentle caring reminders. How many relationships and marriages are ruined because of irrational caregivers who continually insist they have to run errands, grocery shop, clean house, pick up prescriptions, pay bills or help with other tasks?
How many of us realize that when we’re not feeling well we’re not as effective in managing our day to day lives? Physically we’re slower. Mentally our brains feel tired or sluggish. We make poor decisions because we’re distracted or overwhelmed. And if we’re a caregiver, how beneficial are we to loved ones requiring our full attention? We’re not. Rather than being a positive force we’re a sinking lead weight. In these situations both the caregiver and the care recipient are at risk.
Caregiving doesn’t have to be stressful and burdensome unless we allow the role to affect and consume our entire life. Both part time and full time caregivers easily fall into this trap. Caregiving is like quicksand. Only when caregivers are neck deep and drowning are we willing to accept help or realize that something in our daily scheduling and planning must be altered. Change is challenging.
Hmmm, how could this be? It is possible that caregivers are as stubborn and unyielding as the person for whom they now care, who initially refused all offers of change in routine, care and assistance? Similar to innocent statements of “I hope I never become like my mother”, caregivers have become the exact person who previously angered and frustrated their daily lives. The caregiver has behaviorally transformed into the frustrating and irritating person for whom they provide care. Caregivers become their own worst nightmare, especially when they need care.
How do we as caregivers begin to change our behaviors? By first recognizing that we’re not invincible, that the experience and advice of others who may have walked in our shoes is valuable. By acknowledging that it’s not possible to do it all if we hope to preserve our health and our relationships. By asking for and accepting help and support, similar to the actions of the person for whom we’re providing care and by realizing that life does come full circle. If you’re a caregiver ready to acknowledge outside support may be helpful, request a care navigation assessment to provide recommendations and options and seek other beneficial support.
Posted on | September 8, 2012 | No Comments
Caregivers deserve kindness, support and empathy. That’s often the opposite of a caregivers daily experience. The general public isn’t drawn to sad, unexpected or unpleasant events in life. Sad events happen only to other people: a diagnosis of cancer, the death of a parent or loved one, an injury from a car accident. If caregivers talk about negative or unpleasant events, friends or acquaintances turn away because the subject matter is uncomfortable and they don’t know how to respond in words.
I can clear a room in a few minutes when I start talking about the realities of caregiving with non-caregivers. The looks on their faces and their body language tell me how uncomfortable they are by the subject matter. Yet, they’re the ones who asked what I do for a living and then minutes later regret the question. Sometimes I’ll run on a bit about the subject of caregiving, on purpose, just to see their reactions. I feel the rejection many caregivers experience when they relay their stories and feel the sting of isolation when they realize the other person has no interest in their experience.
It’s a similar experience to asking someone how they are. Most people politely say “great” and the conversation moves on. How do we feel when someone actually gives an honest answer and a troubled story ensues? Many of us are sorry we even asked because the response isn’t what we expected and even though we asked, we didn’t really want to hear any response but “great”.
Most people would rather spend time in pleasant endeavors that are positive and attractive like going to a movie, watching a stand up comedian, going to the gym or getting a massage. Persons who become caregivers feel overwhelmed and isolated because of the extent of caregiving activities that take up entire days and weeks and months of their lives. Caregiving is an unknown. Caregivers hide their feelings, and sometimes even their caregiving experience because they don’t want friends to know what’s realy happening in their lives.
Spousal caregivers, if children are not available, can become prisoners in their own home if they are caring for a loved one who requires constant care and cannot be left alone. Many adult children caregivers give up their homes or careers to move in with parents to care for them. Caregiving quickly becomes a 24 hour a day job with little relief.
Caregiving isn’t a role we expect in our lifetime. Caregiving is work, it’s stressful. Unless you’ve been a caregiver you may not know how to respond to a person who is a caregiver. When the subject is mentioned in casual conversation, non-caregivers become speechless and wish they could run the other way. Non-caregivers don’t want to hear about the experiences of caregivers; they think caregiving will never happen to them so the conversation isn’t relevant. Non-caregivers avoid the unpleasant subject matter and eventualy stop visiting and calling their now caregiver friends. Little do they realize, they one day will likely be a caregiver.
At one time or another in our lives we all will become caregivers. The reality of life is that we will all die. More than likely we’ll lose our parents before brothers or sisters. If you meet a caregiver, realize that a few words of kindness and empathy go a long way. Realize that even if this isn’t your current life experience, you one day may be a caregiver whose day may be brightened by a kind word or a person who listened, if even for only a few moments.
Posted on | February 19, 2012 | No Comments
Emergency Room Visits – Many are Unnecessary
Emergency room visits for many older adults are unnecessary because they are not true medical emergencies. Unnecessary emergency room visits add cost to the already overburdened health care system and drain money from savings and retirement accounts of older adults. Yet, when older adults don’t feel quite right, 911 is the first number they call.
What are the most common causes of unnecessary emergency room visits? Urinary tract infections are one of the reasons older adults end up in the emergency room. Caregivers see their loved one experiencing mental confusion or strange behaviors and have no idea that the diagnoses can be as simple as a urinary tract infection. Urinary tract infections are extremely common in individuals with memory loss, dementia or Alzheimer’s Disease and can be easily diagnosed and managed with a regular physician visit rather than going to the emergency room.
Other common reasons for unnecessary emergency room visits for older adults include: dehydration and/or poor nutrition, bacterial pneumonia, high blood pressure, chest pain, asthma, poorly managed diabetes, congestive heart failure, COPD and dementia and associated behaviors. In 2012, the Medicare co-pay for a hospital admission from the emergency room is $1156. The co-pay for day 20+ in a skilled nursing home is $144.50 per day. Older adults and their families are shocked to learn that Medicare doesn’t pay for all types of care including emergency room visits and rehabilitation.
Being admitted to a hospital emergency room and having subsequent treatment is extremely expensive for older adults in more ways than the obvious. After an emergency room hospitalization or nursing home stay many older adults are less able to continue to live independently and to care for themselves. Hospitalizations often result in significant cognitive and physical declines for many older adults who also experience delirium. After a hospitalization many older adults find it necessary to move to assisted living; some remain in nursing homes for the remainder of their lives.
Rather than rushing to the emergency room, it is important for older adults to be proactive in their health care. Medicare does not pay for care oversight and supervision that may prevent unnecessary hospitalizations and reduce greater out of pocket costs to consumers. Many older adults are unaware of services that can save money and improve quality of life. This includes regular and ongoing medical appointments with physicians. Care management and oversight helps older adults avoid emergency room visits and health emergencies and is a service offered by The Care Navigator. Care management provides oversight and an advocate to ask questions of physicians and to coordinate follow ups for care, avoiding unnecessary emergency room visits.
Many family members miss common signs that loved ones would benefit from care oversight. In addition to the reasons listed above, these signs include weight loss, depression, poor hygiene and a number of other issues. The Caring Generation educates caregivers about caring for older adult loved ones.
It’s time for older adults and their caregivers to become more educated about options to manage health issues. This can only happen if education about available services occurs to eliminate hospital stays and the associated risks of not monitoring health conditions. Informational videos about care options and services are available.
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