• September 4, 2019 /  Basics, Miscelleaneous

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    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

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    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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  • July 4, 2017 /  Special Needs

    I know Lori Cochrane from our association at the local Professional Fiduciaries Association chapter where she is chair of the education committee. She is also a local, licensed professional fiduciary specializing in all matters of the person and practices a person-first-and-centered philosophy as a special needs and health care advocate. She earned her B.A. in Behavioral Psychology and her Master’s Degree in Special Education from CSU, Sacramento. She is a professional member of the National Guardianship Association, Professional Fiduciary Association of California, The Arc of California, and the Placer County BAR Association. She has been helping families during times of difficulty and transitions since 2000. Lori can be reached at 916-705-7309 or Lori@CochraneCSS.com.

    This is posted with permission and may also be found at:  https://www.cochranecss.com/single-post/2017/06/06/SPECIAL-NEEDS-PLANNING-Who-will-watch-over-my-child-with-special-needs-as-they-age-when-I-am-not-able

    Special Needs Planning: Who will watch over my child with special needs as they age when I am not able?

    For parents of a child with special needs many questions arise as the child becomes an adult;

    Will they be able to live independently? Will they have an adequate and dignified place to live? Will they be able to pay their own bills? Who will watch-over my child to ensure their needs are met?

    If you have come to the realization of life-long dependence for your child, planning for their transition into adulthood will go a long way to ease your mind. Before your child turns 18-years-old, becoming an adult, it is important to plan for who will make decisions on their behalf if they are not able. Consult with an attorney to discuss whether assigning an agent with power of attorney or establishing a court conservatorship is appropriate.

    Who can be assigned as a decision maker?

    Parents are the likeliest chosen decision makers. The usual recommendation is to select one parent primarily and the other parent as an alternate. Both parents may be assigned as co-conservators if your adult child does not have capacity.

    The usual recommendation when planning is to include a succession plan in the event you become unavailable, incapacitated, or die. You may consider including a close responsible adult as an alternate. Whoever is selected they must be over 18 years of age, and be willing to serve in this role.

    The qualities of a person best suited to act as a decision maker for a person with special needs is someone who will act in the best interest of the person, separate from their own interests. They must be trustworthy and capable as a strong advocate navigating and adapting the plan of care as the person ages. They must have the knowledge necessary to preserve the person’s public benefits and prudently manage their finances. Direct service providers or their employees may not serve in this role.

    There are professionals who specialize in this area who can help you plan, manage services, and advocate for your adult child’s best interest.

    How will I know when it’s time to seek help?

    Planning for your inability to serve as your child’s decision maker is wise. The loss of your ability or willingness to manage important things isn’t likely to be black and white or happen overnight. As time progresses and the realities of aging become known, you as a parent may find yourself less-willing or less-able to manage everything for your adult child. Maybe you are feeling it is best to be busy in your own lives or you want to help your adult child become less dependent on you.

    The need for less dependency or a less restrictive arrangement may become apparent. You may choose to step-back somewhat to provide your adult child the tools or resources which will be available to them as you become less available. Arranging for your adult child to live outside of your home with the necessary supports will be important to do before long. Finding an appropriate living arrangement along with navigating the maze of resources and public benefits, can be managed by a professional.  You might consider involving a licensed professional fiduciary to help with the transition between your adult child being your dependent, to your adult child living independent of you.

    What can a licensed professional fiduciary do to help the transition?

    Licensed professional fiduciaries provide critical services to help protect and maintain quality of life for vulnerable people. When it comes to people with special needs, some professional fiduciaries who specialize can identify critical needs, manage a person’s publicly provided services, protect their public benefits, and consult with doctors and attorneys as necessary.

    A Licensed professional fiduciary can open an *ABLE Act account on behalf of a person, and serve as the legal representative managing the account.

    A licensed professional fiduciary can also serve as a consultant, or as agent for power of attorney for health care and/or for finances. They can also serve as a court appointed conservator for a person with special needs under a limited conservatorship. Some fiduciaries specialize in serving as either health care agent or finance agent as trustee.

    In California, fiduciaries are licensed and regulated by the state of California’s Professional Fiduciary Bureau under the Department of Consumer Affairs.  You can learn about the high standards and stringent requirements licensed professional fiduciaries are held to by visiting their website at www.fiduciary.ca.gov.

    *You can learn more about the ABLE Act by visiting www.ablenrc.org.

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  • April 11, 2017 /  Miscelleaneous

    The Power of Music For the ElderlyIt’s impossible to imagine a world without music. For most of us, music holds special meaning, and has emotional value. It creates strong responses, such as hearing a song from your past that connects with the feelings you had back then. When you take a step further and actually create music yourself, it involves complicated processes in your brain that can be incredibly therapeutic.

    Research has shown that music shares neural networks with memory, attention, motor movement, language and executive functioning. All of this helps us understand the way our brain processes music as we age; even if we have a disease or lesion in the brain that affects our motor movements, memory, speech, etc., we can still process music and use it as a tool to re-wire our non-musical neural networks. It is virtually impossible to completely lose music perception and production processes in our brain.

    One wonderful example can be seen in this video clip, taken from the documentary Alive Inside. It highlights the reaction of an elderly Alzheimer’s patient to music from his era. You can watch it here: http://bit.ly/1sJeRx7

    Clearly, music has the ability to take us back in time, to evoke memories and feelings from the past. Hearing a tune you love can offer comfort and cheer during times of sadness, and can even turn a bad mood around almost instantly. So, how can music help you, regardless of your current age or mental abilities?

    • Music taps into our memories. Have you ever been driving, heard a song on the radio, then immediately been taken to a certain place, a specific time in your life, or a particular person? Music is second only to smell for it’s ability to stimulate our memory in a very powerful way. Music therapists who work with older adults with dementia have countless stories of how music stimulates their clients to reminisce about their life in a positive way.
    • Music is a social experience. Our ancestors bonded and passed on their stories and knowledge through song, stories, and dance. Even today, many of our music experiences are shared with a group, whether playing in band or an elementary music class, listening to jazz at a restaurant, or singing in church choir. Music makes it easy for music therapists to structure and facilitate a group process. For seniors without family nearby and who lack social involvement, signing up for a music therapy class can bring them joy and relaxation.
    • Music is non-invasive, safe, and motivating. We can’t forget that most people really enjoy music. This is not the most important reason why music works in therapy, but it’s the icing on the cake. Many seniors have found that putting on a favorite record can address mild anxiety very well, and can be a complement to any medical interventions. (Individual cases vary and medical choices should always be made with your doctor.)

    What issues exactly does music therapy address, and what is your greatest concern for your own self?

    • Cognitive skills: Music can help seniors process their thoughts and maintain memories. For dementia patients, music from their childhood or young adult years has proven to be effective in obtaining a positive response and involvement, even when the patient can no longer communicate. So starting when you are still a senior, not quite elderly, can give you a strong emotional foundation as you age.
    • Speech skills: Music therapy has been proven to help older adults answer questions, make decisions, and speak clearer. It can help slow the deterioration of speech and language skills in dementia patients; studies have shown that even when an Alzheimer’s patient loses the ability to speak, they can still recognize and even hum or sing their favorite song, as was illustrated in the video clip above.
    • Stress Reduction: Stress, anxiety, and depression are all too common for seniors. Playing music you enjoy can help you relax and work through your emotions. Slow songs, like ballads, can help prepare you for bed, or energetic songs, such as jazz, can help you stay alert while going about your daily activities. The great news is that the possibilities are endless!
    • Physical Skills: Music can inspire movement in seniors. With music comes dancing, after all! Music and dancing promote coordination and can help with walking and endurance. Even if you aren’t as mobile as you’d like, music can inspire toe tapping and clapping, thus getting the blood flowing once again.

    If you’re convinced, and want to get involved, check with your local senior center, and the community center, to see if they have any programs in place. Additionally, the American Music Therapy Association has a list of music therapists available, as well as general information on the topic. You can find them at www.MusicTherapy.org.

    Finally, you can go dig out some of your old records, or buy some new CDs, and take the time to listen and relax everyday. Take care of yourself now, and you’ll be happier in the future!

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  • December 10, 2013 /  Difficult Conversations

    Each of the 5 tips listed below are shared with us courtesy of Help Guide.org about effective tips when having this type of conversation with an aging loved one about driver safety, or possible confiscation of car keys. 

    • Be respectful. For many seniors, driving is an integral part of independence. Many older adults have fond memories of getting a driver’s license. At the same time, don’t be intimidated or back down if you have a true concern.

    • Give specific examples. It’s easier to tune out generalizations like “You just can’t drive safely anymore.” Outline concerns that you have noticed, such as “You have a harder time turning your head than you used to,” or “You braked suddenly at stop signs three times the last time we drove.”

    • Find strength in numbers. If more than one family member or close friend has noticed, it’s less likely to be taken as nagging. A loved one may also listen to a more impartial party, such as a doctor or driving specialist.

    • Help find alternatives. The person may be so used to driving that they have never considered alternatives. You can offer concrete help, such as researching transportation options or offering rides when possible. If your family member is reluctant to ask for help, it can lead to isolation and depression.

    • Understand the difficulty of the transition. Your loved one may experience a profound sense of loss having given up driving. Don’t dismiss their feelings but try to help with the transition as much as possible. If it is safe, try slowly transitioning the senior out of driving to give them time to adjust. For example, your loved one may begin the transition by no longer driving at night or on the freeways, or by using a shuttle service to specific appointments, such as the doctor’s. ~ Source: Help Guide.org

    This can be a difficult conversation for several reasons including sensitivity some aging loved ones might feel, or head strong aging relatives like Uncle Oscar who are used to having everything their way.

    Join our conversation and share with us any helpful tips and suggestions on what can make this sometimes dreaded conversation end with a favorable result.

    A friendly reminder is the week of December 2nd is National Older Driver Safety Awareness Week, so these helpful tips are ideal for future reference information.

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    I serve the counties of El Dorado, Placer, Sacramento, Solano, Sutter, Yolo, and Yuba, as well as cities like Auburn, Lincoln, Rocklin, Roseville, Sacramento, Placerville, and Woodland.

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  • September 26, 2013 /  Dementia

    Urinary Tract Infections and DisorientationUrinary tract infections (UTI) can cause serious health problems. A urinary tract infection is caused when bacteria in the bladder or kidney multiplies in the urine. Left untreated, a urinary tract infection can lead to acute or chronic kidney infections, which could permanently damage the kidneys and even lead to kidney failure. UTIs are also a leading cause of sepsis, a potentially life-threatening infection of the bloodstream.

    According to the National Institutes of Health (NIH), the population most likely to experience UTIs is the elderly. Elderly people are more vulnerable to UTIs for many reasons, including their overall susceptibility to infections due to the suppressed immune system that comes with age and certain age-related conditions.

    The normal symptoms of UTI’s are urine that appears cloudy or bloody, a strong or foul smelling odor, the frequent need to urinate, painful urination, or low grade fever. A UTI in the elderly can be mistaken for disorientation, confusion, a delirium like state, agitation, or hallucinations.

    I have found that there is a high likelihood that if these symptoms develop suddenly that there may be a UTI involved. I also look for a UTI to develop if there has been a recent surgery, especially on the hips.

    This was true of a case I took on where my client had been declared by the attending doctor to be without capacity, had lost her appetite and the staff was recommending palliative care. I spoke with a couple of people who knew her for a long time and noted that she seemed to have lost her memory and reasoning functions rather rapidly. She had just had a major surgery (hip), and been in a skilled nursing community for a month. As her newly appointed agent for her medical power of attorney, I asked for her records and determined that they had not completed a urine test on her so I ordered one. The next day they reported she had a bladder infection (part of the UTI) and put her on antibiotics. After a full week of medication the UTI was gone and she had significantly recovered memory and reasoning abilities. The doctor completed a reassessment (he used the mini-mental exam) and she passed thus “regaining” capacity.

    Not everything is this easy nor do I always have such a wonderful outcome but it is worth evaluating the patient/family member/friend starting with the simplest things (UTI and/or major surgery) before going to the more complicated treatments.

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