• 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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  • November 22, 2011 /  End of Life Issues

    have a healthy healthcare directiveDenny Welch is one of the attorneys I work with and actually, he is the very first one I worked with.  His website for more information is after the article. This is not meant to be technical but to get you to think about end of life issues.  

    The trust is just the tip of the iceberg. Equally as important, in my opinion, is the power of attorney for health care, better known as the Advance Healthcare Directive.

    My wife has been an oncology nurse for a long time. We’ve been married for a long time, and we talk. I get the image of the family in the hospital corridor when the doctor walks out of the patient room. “Well, folks, there’s nothing else we can do. What do you want us to do?” It’s like the deer being caught in the headlight. Nobody knows what to do, because they’ve never talked about it. Even if they did, no one has the legal authority to make a decision because there’s nothing in writing.

    The Advance Healthcare Directive allows you to make a decision today on what you want done if you were that person in the hospital bed. You can make that decision today while you are still in good health and have a clear mind and a clear purpose on what’s best for you.  By making that choice today, you are taking the onus away from your loved ones on what you want done.  Your desires can be as specific as you want.

    Most of us feel that “when my time’s up, my time’s up. ” If all the quality of life indicators are gone, and to a medical certainty they aren’t going to come back, then, under those circumstances, “keep me comfortable and keep me pain free, but don’t keep me alive just because science says you can.” But no one would know that, or have the authority to act, if you hadn’t gotten your ducks in a row.
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    Donald D. Welch  is an Estate Planning Attorney servicing the Northern California region. To find out more about Estate Planning, please visit www.dennywelch.com.

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