• July 12, 2021 /  Basics, Miscelleaneous

    I have worked with Elder Care Management for several years and have found them responsive, attentive, and knowledgeable. 

    This is a guest blog from Gail Arno, CMC, Director of Care Management at Elder Care Management of Northern California. They have ongoing seminars related to care of our seniors. You can view and register on their website: www.eldercm.com For other questions, please contact Maureen, their Outreach Coordinator at 916-206-4420.

    Aging can be a daunting effort and isn’t always easy for many of us, even those with supportive family members and friends, or those who have done their planning for the future and have set a course for a successful retirement and beyond. There are many people who are aging without support and are void of a safety net of friends, children, relatives, and decision-makers in their lives. How do they successfully traverse the many challenges of aging and not end up vulnerable and taken advantage of in emotional, physical, and fiscal ways?

    Too often as Care Managers, we walk into scenarios that expose the most vulnerable seniors. It is our task to support the client, untangle the mess they are in the midst of, knowingly and unknowingly, and begin the process of making their lives safer and more fulfilled. One such example can be found in our client, Betty Jean*. Never married, a professor of economics, no children, no spouse or partner, no immediate family members within a 500+ mile radius, and a number of medical issues beginning to surface with some mild cognitive concerns as well. Betty Jean agreed to well-intended family member pressure to have a caregiver come into her home a few days a week and help her with household chores and to provide companionship as her friends had fallen off with their own lives and she was finding herself more alone and more confused about things that previously came so easily to her.

    Things seemed fairly smooth for a while and then some issues began to surface. A bank teller reported Betty Jean and her caregiver to Adult Protective Services (APS) as the caregiver was bringing Betty Jean in numerous times a week, making large cash withdrawals. Betty Jean became more and more silent with each transaction and the tellers and executives at the bank became more and more concerned with each withdrawal. Adult Protective Services made a home visit, found a pleasant and very engaged (in hindsight, too engaged) caregiver at the home who spoke for Betty Jean and assured them that things were fine. On the surface, things appeared acceptable and APS went away, seemingly satisfied. More trips to the bank occurred and soon it was just the caregiver coming in alone. No Betty Jean, and now along with withdrawals, there were requests to change documents, add names to accounts, and transfers of money. Adult Protective Services was notified again and another visit was made. This time it was clear that the caregiver had taken a role not only as Betty Jean’s companion but had inserted herself in her financial world as well. Things were about to unfold and were far more complicated than imagined but thankfully with the help of the court system, legal intervention, and the wise and tender support of Elder Care Management, Betty Jean would come through this experience safely and mostly unscathed. Next month we will share another story of elder vulnerability, the entanglements of a senior’s life being taken over by a less than caring, very self-seeking, and unscrupulous caregiver who nearly got away with her devious efforts.

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  • June 2, 2021 /  Basics, Miscelleaneous

    This is a guest blog from Gail Arno, CMC, Director of Care Management at Elder Care Management of Northern California. They have ongoing seminars related to care of our seniors. You can view and register on their website: www.eldercm.com For other questions, please contact Maureen, their Outreach Coordinator at 916-206-4420.

    Making the monumental decision to move from your home where things are familiar, routine, and comfortable into a senior housing setting can be one of the biggest and most challenging decisions of a lifetime. Routine and comfort at home are key and very important but equally critical is making sure that one is safe and well served in their own home. As we age, our needs, strengths, and abilities to care for ourselves change, and often one can have difficulty keeping pace with their own needs. The question then becomes, “When is it time to consider moving, and what are the steps involved in making such a move?”

    Last month we focused on John and Sarah, a lovely couple married over 60 years with four adult children, none of them living nearby and all busy with their own lives. John and Sarah were determined to remain at home together, but at times struggled to stay safely at home. After much discussion, planning, and a formal assessment conducted by our team at Elder Care Management it was determined by John, Sarah, and their supportive family that they would remain at home with support coming to them. They needed additional formal support mechanisms in their home to stay at home and we worked closely with their family and the couple to reach their goals.

    As John and Sarah remained at home, we walked alongside them offering and facilitating more formal support primarily via caregiving services which was eventually expanded to provide around-the-clock care. We assisted them in making numerous adaptations to their home such as installing ramps at the entrances of their home, removing a glass shower enclosure for easier access for caregiving assistance with bathing, altering the guest bedroom to facilitate a caregiver living in, John moved into a hospital bed located in the living room while Sarah stayed in their master bedroom. Grab bars and toilet seat risers were added in all toileting areas for ease in getting up and down and a transfer pole was placed bedside to assist Sarah so she could get in and out of bed more easily. Ultimately, a second caregiver in the home during the day was needed to assist John while Sarah was experiencing some Sundowning behaviors. Oxygen was delivered and utilized to support John as he struggled for every breath. At the close of their journey, hospice services and support were welcomed first for John, and then shortly after his passing, for Sarah. John and Sarah worked with their family to plan and communicate their wishes regarding what they wanted as their aging journey progressed. In the end, their wishes were honored and they remained safely at home with formal support all around them and a loving family to ensure their efforts were successful.

    Many of our seniors don’t actively educate themselves regarding the services, programs, and options they might have available to them as they age. Some necessitate a move into senior living such as assisted living, memory care, or skilled nursing and benefit from guidance and information to make an informed and educated decision. This month we will continue our educational series on Successful Aging where we will discuss the idea of moving, how to approach making plans, and what the best decision might be. We hope you will join us as we tackle the complicated topic of “Moving On”.

    *Names have been changed to protect the clients’ identity

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  • May 26, 2021 /  Basics, Miscelleaneous

    This is a guest blog from Gail Arno, CMC, Director of Care Management at Elder Care Management of Northern California. They have ongoing seminars related to care of our seniors. You can view and register on their website: www.eldercm.com For other questions, please contact Maureen, their Outreach Coordinator at 916-206-4420.

    Imagine an adult child, niece or nephew, or the spouse of an individual who is aging, tasked with trying to balance and meet the needs of both individuals, all while trying to continue on with their own life. This is likely the most challenging scenario we manage with our clients; couples who have spent a lifetime together working in unison (for the most part!), tackling whatever life throws their way. Then along comes the aging process, a journey rarely done in tandem with others as we are all unique individuals who face different medical and emotional journeys. How do you plan so that you are addressing each individual’s needs while at the same time honoring each one’s wishes?  As Aging Life Care Managers, it is our job to make sure that our client’s needs are met, both from individual planning efforts to honoring the wants and wishes of a partnership. Planning is key for everyone in their pursuit of successful aging.

    A good example can be found in our clients, John and Sarah. A couple married for decades, who together raised four children, had active careers and lives, and were living independently in their own home without any formal assistance. John had numerous medical issues mostly focused on his need to attend dialysis three times weekly, along with a significant and complex medication regime.  Sarah, his devoted wife of 60+ years, had mild to moderate confusion, didn’t drive anymore, was no longer able to get meals on the table, and could not manage the tasks necessary to run the home as she did in the earlier years. John had to be transported to and from his thrice-weekly dialysis sessions as he had given up driving, stating he was often too tired to even consider getting behind the wheel (Thank you, John, for willingly making that decision!) All four children lived out of town and worried constantly about mom and dad’s well-being and showed genuine interest in their parents’ situation.

    As Care Managers, we came into the home and assessed the client’s needs, individually and with full respect to their shared history as a long-established couple. We were able to ascertain that the couple’s legal house was in order, by confirming the completion of their power of attorney documents, their Advanced HealthCare Directives, and POLST. We organized and documented their medical diagnoses, treatment plans, facilitated support systems, and opened good lines of communication with the remote adult children. Ultimately, we were able to put into place formal support mechanisms such as experienced caregivers and meals prepared by a professional chef. We brought durable medical equipment into the home after a safety evaluation that recommended adaptations made to the home to assure their ability to remain at home as desired.  A Care Manager accompanied them to all their medical appointments, making note of detailed changes of the clients’ status and of their evolving medical needs. These steps honored their wishes, supported the adult children’s vision of their parent’s living arrangement and allowed the couple to remain successfully and safely at home together. Their aging journeys were quite different and had to be addressed differently but with the same end goal of staying together at home.

    Next month we dive deeper into the details of managing couples and facilitating the ups and downs and twists and turns of the aging process with a particular focus on the divergent paths each person faces as they age.

    *names have been changed to protect the client’s identity

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  • October 7, 2019 /  Basics, Miscelleaneous

    Elder Care Management logo
    The past few months we have been talking about life transitions- when should you get more care in the home and when is a good time to move. This month’s topic, when should Hospice be brought in?

    Hospice is a service covered by Medicare, and most other insurance carriers, that provides end of life care for those with a terminal diagnosis that is likely to lead to their death in six months or less. The individual must have a referral from a physician to be eligible for hospice. For those who are unsure about hospice services, hospice agencies will often do a courtesy visit to discuss end of life and whether their loved one meets the hospice enrollment criteria. There are many hospice agencies to choose from- most major health systems have their own hospice agency in house, and others are run as for-profit or non-profit agencies.

    Hospice staff includes physicians, nurses, home health aides, social workers, chaplains, and bereavement counselors that are brought to a patient’s home, community, or clinical setting. The comprehensive approach to services brings comfort and support to patients and their loved ones, relieving much of the mystery that surrounds death and its attending complications. For most people, hospice services are brought in the last two weeks of life; a sad fact knowing that having hospice support earlier might have brought much-needed peace of mind to both the caregivers and patients.

    Hospice does demand conversations.

    Care Managers are supporters and facilitators of conversations.  We encourage all our clients to discuss critical topics dealing with health and finances with those they love and trust. End of life discussions can be fraught with emotions yet are some of the most rewarding conversations family members can have.

    How do you see your end days? If you were like my mom, you want to die peacefully in your sleep with clean clothes on and a smile on your face. Nothing maudlin, no embarrassing or undignified scenarios, just a calm, controlled ending. (I smile as I write the word “control” because death is the one thing that most of us will never control.)

    Here are some simple guidelines to consider when thinking about your end of life choices. First, what is most important to you? For some people who have strong faith beliefs, their wishes might include heroic measures taken to ensure that they are alive for as long as possible. For others, the focus might be more pain oriented, hoping to remain comfortable and pain-free without regard to how long they continue to live.

    A review of a POLST or Five Wishes is a good place to start to determine whether you want all life-sustaining measures or whether you want to be allowed to die with limited intervention or comfort measures only.

    Establishing who your Power of Attorney is and conveying your wishes to them is important, in addition to a conversation with your Primary Care Physician. Make an appointment with your doctor and have the doctor complete a POLST with you. Be sure to notify your health care provider of the name of your power of attorney accompanied with the appropriate documents.

    Finally, we encourage you to read and learn. Being Mortal by Atul Gawande, The Art of Dying Well by Katy Butler and The Five Invitations by Frank Ostaseski, are wonderful books to help guide you in aging and dying well.

    At Elder Care Management of Northern California we partner with families, elders, community members, and employers to tackle the tough issues of elder care.  Please visit our website at www.ecmnca.com or call (916) 206-4420 to get more information about our services.

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  • September 4, 2019 /  Basics, Miscelleaneous

    Elder Care Management logo
    Welcome to part two of a three-part series discussing Transitions. Last month we talked about staying home safely and next month we will discuss when it is time to call in hospice. This month we will focus on how to decide when to make a move from your home.

    With Fall fast approaching and another change of seasons, transitions are always around us. One of the least embraced transitions in our work is when our clients and families are considering a move from the family home to an independent senior community or assisted living.
    Emotions run high when you are contemplating such a major life change and discussions become more difficult when you are forced to make the decision to move your loved one. We hope that we can offer you some supportive ideas that will make the transition from home to another setting more palatable.

    First, start by having a conversation. Talk to family and friends and tell them what your wishes are. It is great to tell everyone that you want to stay home but someday that might not be realistic or feasible. Give your family a gift and go tour communities where you think you might want to live. Give them your feedback on the tours and tell them where you could see yourself living should the day come when you have to move.

    Understand that the cost of living in independent and assisted living are primarily private pay, expenses paid out of family savings or income. There are a few other alternatives that may include long term care insurance, the Aid and Attendance Program for veterans and their spouses (a qualifying program that is duty and income-based), and a small state-funded program for low-income adults who are on Medi-Cal. You will find costs ranging from anywhere from $3,000 to $10,000 per month based on what an individual’s care needs are for assisted living. Independent settings are generally less but will not have supportive services available should someone need hands-on care.
    Consider location. Do you or your loved one want to be near family? Is there a family member living in another state that is a more affordable option? Be sure to cast a wide net when looking at settings as it may give you more communities to choose from. While many of us love our home state of California, it is not always the most affordable place to live.

    Care needs will also play into choosing a community. For many families, an independent apartment with meals and housekeeping is all they need. But as we age and personal care needs increase, assisted living often becomes a necessity. Each community will typically have a base rate for a room or apartment. Where the unknown factor comes in is how they price the personal care. There are some settings that are all-inclusive with one set price while others charge per pill and task they do. As Care Managers, we always ask for a formal assessment by the community prior to notifying the family of price. Be aware that if you are making a sudden move out of the hospital, that you should ask to tour any community your loved one is sent to, ask for more than one setting to choose from and once you decide on a place, have the community come to the hospital to assess your loved one. You may feel pressure to move your loved one out of the hospital- slow the process down by asking for time to find the appropriate setting for your loved one to transition to. Be timely, know that your clock is ticking and you will need to be prompt in your decisions.

    So, when is the right time to move? Here are a few scenarios.

    You are finding that you or your loved one is unable to get around the house safely. Stairs and multi-level homes are no longer easy to navigate. Medications and food routines are neglected. Personal hygiene is left untended and increasing isolation are all good signs that a move would be indicated. If the primary caregiver is no longer able to care for themselves and are exhausted by the demands of care, then change becomes imminent. Caregivers often fail long before the ones they are caring for.

    To summarize: talk to family, come up with a budget, tour local communities. Remember our adage, “create the toolbox you will need for the future,” and don’t make decisions during a time of crisis if you can help it.

    At Elder Care Management of Northern California we partner with families, elders, community members, and employers to tackle the tough issues of elder care.  Please visit our website at www.ecmnca.com or call to get more information about our services.

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  • August 9, 2019 /  Basics, Miscelleaneous

    Elder Care Management logo

    By Ginger McMurchie, Elder Care Management of Northern California Owner & Care Manager

    In this edition of our newsletter, we would like to introduce the idea of transitions. For the next few months we will focus on three topics-

    When should a family bring in outside help to the home?

    When do you know it is time to move to assisted living?

    When should a person consider hospice?

    Our first topic is likely the easiest to navigate. The home where you or your loved one lives is getting too big for one person to handle. Tasks take longer to accomplish; they take more energy and sometimes things get left undone. Driving is complicated by poor vision, difficulty getting in and out of the car and demands too much brainpower- it is no longer the independent pleasure it used to be. The simple task of bathing now seems overwhelming and gets put off until another day and putting on clean clothes seems unnecessary or goes unnoticed. Your doctor, family, and sometimes friends are telling you that you need more help around the house. So, what are the options?

    If the house is all you need help with, that is a simple fix. A housekeeper once or twice a month can keep bathrooms clean, the kitchen scrubbed and can get the vacuuming and dusting taken care of. Tired of gardening? Hiring a gardener or young adult from the neighborhood to mow the lawn and rake the debris keeps the yard tidy. If you need assistance with personal care, then it may be time to consider a caregiver. As care managers, we always encourage people to use licensed home care agencies for help. A licensed agency will act as the employer, pay the payroll taxes and will screen the caregivers by doing background checks. These caregivers should come to you with ample training on personal care and with some coaching from you might be able to make your favorite mac and cheese. While it may sound simple, having a stranger in your home is not easy. It takes time and patience to establish a relationship with a caregiver and home care agency. If the caregiver does not feel like a good fit- ask for someone else!

    We want to acknowledge that all the above ideas come at a price. Caregivers across the state average anywhere from $26-33 per hour with the agency typically asking for a four-hour minimum. Housecleaners may cost an additional $100-200 per month. For those on a fixed income, applying for Medi-Cal, getting on IHSS or if you are a veteran or spouse of a veteran looking into the Veterans Aid and Attendance Program may be good ideas. We encourage you to start a conversation with loved ones about how things are going around the house. Ask your friends and family for recommendations on housecleaners and gardeners. Research and meet staff from local home care agencies. Keep everyone’s phone number handy because the day will come when we all need additional help!

    At Elder Care Management of Northern California we partner with families, elders, community members, and employers to tackle the tough issues of elder care.  Please visit our website at www.ecmnca.com or call to get more information about our services.

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