Nursing Home Residents Are People, Too!

By Joan Blumenfeld, MS, LPC

My client was a woman of many parts. Over the course of her lifetime, Edith had been an artist, a speech pathologist, a teacher, a counselor, a wife, a mother, a grandmother and even an astronaut! She had trained with NASA to be among the first civilians to go up in a rocket, but those hopes were dashed along with the Challenger.

Edith was an ardent American patriot, having immigrated to the United States as a young adult fleeing the spread of Nazism. She had been a beautiful, vibrant, European intellectual of the Bohemian sort.

When I met Edith, she was 85 years old and ravaged by the effects of advanced Parkinson’s. She could neither walk nor speak, but she still had a lively look in her eyes. She lived in a small house with her remarkably caring and efficient home health aide, who exquisitely managed all aspects of her care and household.

But sadly Edith outlived her money. She could no longer support her independent lifestyle. Fortunately, one of her daughters was able to step up to the plate and provide generously for her mother’s ongoing care. It was then determined that it was time for Edith to move to a nursing home and I coordinated the transition.

Her daughter wanted to bring as many of Edith’s treasured belongings to her new living situation as she could. So we hung a number of her large original paintings on the walls along with the stunning photo of Edith suited up in her NASA uniform. We covered the bed with her red, white and blue quilt. We hung an American flag and distributed other reminders of Edith’s colorful past and multiple roles around the room. The room accurately reflected who she was.

The effect on the staff was heartwarming! Word spread. They came from all parts of the nursing home to see Edith’s room and learn about who she was. They marveled at all this woman had done in her life. They began to see her as a real person, not just as a frail old woman in need of “total care.” The décor of her room focused the staff on the essence of Edith’s humanity.

PEARL OF WISDOM

Frail elderly people were once active, involved members of their families and communities. They are surely worthy of our respect and reverence.

Joan Blumenfeld is a Geriatric Care Manager based in Fairfield County, Connecticut. For more information visit her web site at www.joanblumenfeld.com. © 2010 Joan Blumenfeld.

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Sometimes It’s Funny!

By Joan Blumenfeld, MS, LPC

“Growing old ain’t for sissies!” as Bette Davis so bluntly put it. She was absolutely right. But sometimes things do happen that are downright funny!

Our father, Mark, was retired. When I arrived for a visit, he was on the phone. Someone was calling to solicit money from him for a good cause, no doubt. He listened respectfully and politely told them, “No, thank you.” The caller continued to explain why the cause was worthy of his support. Mark listened some more with a heightened sense of annoyance and repeated a still polite but firmer “No!” The caller persisted. Finally Mark reached his peak of patience, and loudly sputtered, “No! I can’t! I’m, I’m …. expired!” and slammed down the phone!

We all had a good laugh at his malapropism, which defused a tense situation.

Then there was the time we took Mother to a highly recommended geriatric psychiatrist. We went there to discuss a much touted new medication reputed to halt the progress of Alzheimer’s disease, at least for a while.

This important practitioner of geriatric psychiatry had his office in an old brownstone just off Fifth Avenue on the upper east side in New York City.

I knew we were in trouble as soon as I saw the building! There were fourteen steep brownstone steps leading to the heavy wrought iron door, which opened into a tiny, dimly lit front hall.

The waiting room was small, cluttered and messy; the walls were painted dull mustard yellow. The furniture was circa 1950s Goodwill. The wastebasket was full to overflowing. It was a joke, except it wasn’t!

As we settled down to await our geriatric consult, my father looked around. With a twinkle in his eye, in a loud and bemused voice he commented, “If I wasn’t depressed before, I certainly would be now!” He got no argument from me!

And that probably saved the day. It discouraged him from walking out then and there. After a perfunctory discussion, the doctor prescribed the new medication. Ultimately it had no effect on Mother, either good or bad. But the irony of sitting with my frail elderly parents in a geriatric specialist’s office that was so remarkably unwelcoming stays with me to this day. The incongruity makes me laugh!

PEARL OF WISDOM

Find the humor in situations when you can. These moments will become treasured memories.

Joan Blumenfeld is a Geriatric Care Manager based in Fairfield County, Connecticut. For information visit her web site www.joanblumenfeld.com. © 2010 Joan Blumenfeld.

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Selecting a Home Health Aide

By Joan Blumenfeld, MS, LPC

Mother fractured her hip while dancing at the Senior Center!

By diligently doing the hard work of physical therapy, she recovered her ability to walk. However, the whole incident highlighted her growing frailty and precipitated a downward cognitive spiral from which she did not recover.

Mark, our father, wanted to take care of Mother himself when she returned home. He understandably objected to the idea of having someone move in with them, especially since that person would be sleeping in his room and denying him free access to his TV, his desk and his lounge chair.

But the powers that be at the hospital simply would not allow Mother to go home without a live-in Home Health Aide in place 24 hours a day, seven days a week.

Freda, the woman we hired, was the niece of my parents’ trusted housekeeper and a Certified Nurse’s Aide (CNA). We hired Freda privately and paid her social security and workers compensation to protect her and my parents.

Freda was not exactly a gourmet chef, but my parents ate her cooking without too many complaints. She did the marketing, light housekeeping, laundry, assisted with bathing and other personal care, and accompanied them on walks and to their programs at the Senior Center.

She kept them safe and comfortable day and night and communicated with me regularly regarding their activities. Freda looked after our parents for the next three and a half years until they became so frail that one person could not take care of them both. (It was then necessary for them to move to a nursing home.) Freda’s presence had made it possible for our parents to stay home as long as possible, for which we are eternally grateful!

These are some of the attributes I considered in selecting our Home Health Aide:

1. A cheerful and willing disposition
2. A neat appearance
3. Solid experience with people with dementia
4. Certification and training
5. References
6. Background check
7. Backup for those occasions when she was not available

PEARL OF WISDOM

Screen an aide well before hiring. Do not hesitate to change aides if it is not a good fit.

Joan Blumenfeld is a Geriatric Care Manager based in Fairfield County, Connecticut. For information visit e www.joanblumenfeld.com. Copyright 2010 Joan Blumenfeld.

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Using Advance Directives

By Joan Blumenfeld, MS, LPC

Our mother had advance directives, but no one in the hospital was paying attention to them. She was lying on a gurney waiting to go into the operating room to have her pacemaker battery replaced surgically when the attending nurse asked me if my mother had any allergies. Indeed she did. She was deathly allergic to penicillin and bee stings. But the fact that the nurse did not know about the allergies set off my alarm!

My mother’s health care instructions (known as advance directives or a living will) were quite clear: If she was considered terminally ill or irreversibly unconscious, she wished to be allowed to die and not be kept alive through life support systems. She did not want to be resuscitated. She did not want to be tube fed. However, she did want to be kept as comfortable and as free from pain as possible.

These instructions and Mother’s allergy record were contained in the envelope the nurse held in her hand. Clearly, if the nurse didn’t know about the allergies, she didn’t know about the directives either, and that was simply unacceptable!

I asked the nurse if she had read the advance directives. She replied rather huffily that she did not get involved in such matters.

Mother had appointed my brother and me to be her health care agents and given us power of attorney for all health care decisions. Even though changing a pacemaker battery was a relatively simple procedure, I could not ignore the fact that the medical team was completely disregarding her instructions.

Sensing trouble, I planted myself firmly in front of the gurney and held Mother’s hand so the nurse could not wheel her away from me. Although my heart was pounding, I calmly insisted the nurse find someone in authority that did get involved in these matters.

Soon, two doctors appeared. Without explaining who they were or why they were there, one got in my face ready to argue. The other, noting my distress, sent the first away and sat me down to sign some sort of form that would allow the surgery to proceed, taking into account Mother’s wishes.

The battery was changed without complications and, happily, we did not need to invoke the living will. But I was grateful to have the document at hand in case we had needed it.

PEARL OF WISDOM

Advance directives are important legal documents. Be sure to take them with you every time you go to the hospital!


Joan Blumenfeld, MS, LPC is a Geriatric Care Manager practicing in Fairfield County, Connecticut. For information visit www.joanblumenfled.com. © 2011 Joan Blumenfeld


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My Pet Therapy Partner Invites Smiles and Conversation

By Joan Blumenfeld, MS, LPC

Bromley & Joan Blumenfeld

Bromley is a working dog, all nine-and-a-half pounds of him! He’s a four-year-old Maltese with the disposition of an angel, genetically programmed to be a lap dog.

Bromley came into my life, a tiny white ball of fur, when he was only eleven weeks old. I wanted him to be the kind of dog I could take with me anywhere.  By the time he was just a bit over a year old, he had earned his American Kennel Club Good Citizen Certificate and become a Delta Society Pet Therapy Partner.

Bromley and I have a genuine professional partnership. We work together with cognitively and physically challenged elders. Bromley gives unstintingly of his unconditional love, acceptance and physical warmth. He works the room, going from lap to lap, while I tease out meaningful conversations from people who often find it hard to express themselves. Bromley is much cuter than I am but I’m the better driver, so we make a good team!

The very first client Bromley visited fell madly in love with him. She was a 75-year-old woman who had experienced a mild stroke and was very isolated socially. She was eager to share her considerable knowledge of dogs with me, declared herself to be his “Grandma,” and for years after was proud of her special relationship to Bromley.

We also work at several assisted living facilities with groups of people who have varying degrees of dementia, from mild to severe. Bromley is the star! He touches their hearts and makes them smile! And not incidentally, he is a guaranteed catalyst for stimulating thoughtful questions and conversations.

During one of our recent visits, a member of the group asked me what sorts of games Bromley liked. I told them about his love for playing tug-of-war with old socks and hide-and-seek around the coffee table. Then I asked them what they played when they were young and the next hour was spent in lively reminiscing about their childhood games: Red Light, Giant Steps, and Hopscotch. One favorite was “A My Name is Alice, and My Husband’s Name is Allan,” which they used to play while bouncing a ball to the rhythm of the ditty; the group went from A-Z, filling in the blanks, with almost everyone participating enthusiastically

Most  of the people we work with have severe memory loss but when they are told the little white dog is coming for a visit, they remember exactly who it is.

PEARL OF WISDOM

People with dementia “live in the moment.”  Love, acceptance and fun in that moment are great gifts!

Joan Blumenfeld, MS, LPC is a Geriatric Care Manager practicing in Fairfield County, Connecticut. For information see her web at www.joanblumenfled.com . © Joan Blumenfeld 2011.

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A Blog is Born!

By Joan Blumenfeld, MS, LPC

Who me, write a blog? Are you kidding? A Luddite at heart, I didn’t know what a blog was until I was asked to write one.

As a professional Geriatric Care Manager, my focus at work is on my clients, on honing my skills and increasing my resource network.  But as the sole proprietor of a private practice, I am also an entrepreneur and must give considerable attention to marketing myself and my services. “Build it and they will come” does not apply unless people know who and where you are and what you do.

Over the many years I have been in private practice, I have done all sorts of marketing: I sent out hundreds of print newsletters to my contacts and clients; I facilitated many classes and support groups for family caregivers. I did workshops for professionals. I addressed audiences large and small. And now, I’m jumping into 21st century social networking with both feet!

This state of affairs came about because of my membership in an entrepreneurial business networking organization called Business Network International (BNI). BNI is an association of professionals and small business owners committed to growing their businesses and to helping each other.

One day a BNI friend told me about friends of hers who had a website devoted to helping family caregivers take care of their elderly parents. She thought we ought to meet. Her friends are two sisters, Kim and Karen, who managed the care of their father in his last years and developed www.incareofdad.com in his honor. They wanted to support other family caregivers by sharing their experience of the problems they encountered, the resources they discovered and the successful strategies they developed for navigating a fractured health care system in his behalf.

I Googled their site and was impressed by its elegance and professionalism. So I called Karen and made an appointment for lunch. We hit it off immediately.

In the course our visit I said something (neither of us can remember exactly what that was) and Karen commented, “That’s a real pearl of wisdom!”

I jokingly responded, “That would be a nice title for an article!”

Karen agreed and on the spot invited me to write blogs for her website!  I accepted without having any idea of what a blog was! As soon as I got home I called a tech-savvy friend to find out more about blogs. When I learned about the reach and the fun of blogging, I was hooked! Writing is exciting! It’s deeply satisfying to share my knowledge and experience with caregivers who deal with the challenges of caring for their frail elderly friends and relatives on a daily basis.

PEARL OF WISDOM

New connections and ideas can lead to wonderful new places. Be open and jump in!

Joan Blumenfeld, MS, LPC is a Geriatric Care Manager practicing in Fairfield County, Connecticut. For more information see www.joanblmenfeld.com . © Joan Blumenfeld 2011

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Make a Care Plan ... for YOU

By Joan Blumenfeld, MS, LPC

Caregiver burnout is not a pretty sight! We get weepy, crabby, overwhelmed and exhausted. In time, burnout can actually lead to clinical depression and physical illness. If only we put some of our caregiver energy into our own care, we could prevent this sorry and dangerous state of affairs from developing.

In the last years of their lives our parents required live-in help around the clock as well as a great deal of attention from my brother Dick and me. In the five-year period during which we managed their care, we each evolved a unique personal care plan to renew ourselves.

Dick drove from New Jersey to the city to visit our parents most Sundays. He took them for wonderful short visits to places of interest that he, as well as they, would enjoy -- South Street Seaport, the Central Park Zoo or a museum. When our parents moved into a nursing home in Connecticut, Dick sometimes stopped on the shores of the Hudson River to rent a sail boat for an hour or so, just to clear his head before his visit.

My personal care plan was a little different. I visited from Connecticut once a week to check in with the home health aides. I brought my father a favorite treat and took Mother out to lunch at a quiet restaurant we both liked. I made sure to leave my house after 10:00 in the morning and start home by 3:00 in the afternoon to avoid rush hour traffic, which made a difficult drive impossibly unpleasant. I closed my office for the day so I could take a nap when I got home.

Although our individual care plans differed sharply, some common themes emerge.

• Barring emergencies, we set limits on how often we would visit and for how long we could stay. (Setting limits to what you can do and when you can do it is crucial to preserving your energy for care giving and for your other life responsibilities).

• We arranged activities that were fun and pleased both ourselves and our parents (Fun is the key word here. Fun replenishes energy).

• We each planned time to be alone to recharge our batteries. (Even 10-15 minutes a day, without electronic interruption, is renewing).

PEARL OF WISDOM:

Taking care of yourself is a lot like using the oxygen mask on an airplane. You have to put on your own mask first, or you can’t help anyone else.

Joan Blumenfeld, MS, LPC is a Geriatric Care Manager based in Fairfield County, Connecticut. For information visit her web site www.joanblumenfeld.com © 2010 Joan Blumenfeld

Managing Care Long-Distance

By Joan Blumenfeld, MS, LPC

I was tired. I was weepy. I was overwhelmed. In addition to my work, I was managing the care of my frail elderly parents in New York City as well as my declining elderly aunt in Chicago. Something had to give!

A social worker suggested I hire a Chicago-based care manager for Aunt Syd. This was before I became a geriatric care manager myself. I had never even heard of such a profession!

I learned that good care managers really do manage care. They identify eldercare resources. They organize and coordinate a care plan. They monitor the hands- on personal care provided by Home health Aides. They keep caregivers informed regarding the medical condition and quality of life of the older adult. Knowing that my Aunt Syd was in the capable hands of someone who would manage her care freed me to focus on my parents’ needs.

I found a directory of Chicago social workers and interviewed three prospective care managers by phone. (These days you can check with the National Association of Professional Geriatric Care Managers at www.caremanager.org).

The first began our conversation by asking who would be paying for her services. The second didn’t return my call for three weeks! The third sounded compassionate and experienced.

So I hopped on a plane to Chicago to interview her. I hired Marion on the spot. She was well qualified: a Master’s level, licensed social worker with broad experience with the elderly.

She did everything for my aunt that I would have done: she screened the aides and then supervised them; she made doctor appointments and took my aunt to them; she saw to it that there was enough good, fresh food in the refrigerator; she purchased and hooked up a TV for the aide; she was by my aunt’s side when she was hospitalized.

Marion was Aunt Syd’s strong, on-site advocate. She was my eyes and ears in Chicago. She kept me informed about every aspect of my aunt’s care through weekly phone contact.  And best of all, I didn’t have to be in two places at once, managing the care of three beloved, frail, elderly people!

Here are some of the questions I asked Marion at the interview:

• How long have you been a care manager?
• What is your background and training?
• How will you keep in touch with me?
• What was your most difficult case? What was your easiest?
• What services will you offer my aunt?
• What is your fee?
• How do you find and screen home health aides?
• Do you have references?

PEARL OF WISDOM:

Trust your gut feelings. There are many well-qualified care managers, but not all will be right for you.

Hospital Stay? Advocate Needed!

By Joan Blumenfeld, MS, LPC

Imagine a frail old woman alone in a hospital bed. She does not see well. She does not hear well. She does not feel well. She does not know exactly where she is or even why she is there. She is hooked up to beeping monitors. They are taking blood samples for testing. Bright lights are shining in her eyes so she can’t sleep. She is dressed in a thin hospital gown, covered with an even thinner hospital blanket and she is cold.

She is being barraged with questions many of which she is too distraught to answer. Questions come from doctors, from nurses, from residents, and  from the social workers.

“Do you know where you are?”

“Do you know why you are here?”

“Who is our President?” “What year is this?”

“Do you have pain?”  “Where?”

“How long have you had this pain?”

“When did it start?”

“Have you had this pain before?”

“What medications do you take?”

“Do you have any allergies?”

“Do you have family?”

“Should we call them?”

“Where do you live?” “Who will take care of you?”

And the questions go on and on, often repeatedly. The answers are seldom passed on in full to the next department or even to the next person attending to the patient.

The old woman is tired, fearful, and confused. She desperately needs an Advocate who can calm her, support her, give the needed information to the medical staff and maybe even get her a warm blanket!

A Geriatric Care Manager is just such an Advocate. We stay with our clients in the ER. We visit them daily in the hospital. We arrange for aides to sit with them if necessary. We are in at the first step of the discharge plan. All this is done to insure that the hospital stay and after-care are as organized, kind and effective as can be.

PEARL OF WISDOM:

If a loving family member cannot attend to the hospitalized elder, find a seasoned Geriatric Care Manager who can. She will be your eyes and ears, making the hospital stay as smooth as possible.

Joan Blumenfeld is a Geriatric Care Manager based in Fairfield County, Connecticut. For information visit her web site  www.joanblumenfeld.com.  ©2010 Joan Blumenfeld