Bergen County GCM
April 24, 2009 at 9:59 am | Posted in Megan Milchman, GCM | Leave a CommentMonday: Visit with M. Her Aide was rushed to the hospital the day before and she has a new Aide that she has never had before, but everything seems to be going well.
Tuesday: Mr. A, I am going to be visiting with him 4 times a week, because his Aide did not work out. I give him his meds and we go out for coffee and to staples to visit some people that he knows.
P, this is our first time really getting together, I take her to lunch so that we can get to know each other. She has a hard time getting used to new people. She seems to enjoy herself and agrees to meet with me weekly. Next week my plan is to work medi-minders into her so I know that she is taking her medication correctly.
Wednesday: A visit with Ma goes well. I fill her medi-minders and notice that she has some sores on her mouth, they don’t bother her. She said that she was going to get some vasoline for them. She thinks that she may have eaten something citric. I discuss going to a neurologist and having them check her out, because of the CT scan showing signs of a TIA and the fact that she is always tired. She agrees.
Mr. A, I gave him his medications and he takes them with no problem. We go to Target to get his granddaughter a birthday present, mission accomplished. He is happy with his choice and tells me that he appreciates all the help. We stop for coffee before I bring him home.
Dr. G, he ended up in the hospital last week with pnemonia. He is in a rehab facility now, in Bergen County, New Jersey. He seems to be doing much better.
Thursday: Visit with A, I fill her medi-minders and call the refills into the pharmacy. I look at the infection under her breast which is doing much better. She has me review some of her mail. I explain everything to her. She complains about not feeling well, I tell her that if it continues she should call her doctor.
Mr. A, I get to his house and give him his medication. He is already dressed, but goes to change his clothes. He ends up putting clothes on that are too small. We are going to go shopping for new clothes. It is very upsetting watching the decline of someone you are close to.
Reversible Dementia?
April 13, 2009 at 10:00 am | Posted in Sophia Heftler, GCM | 1 CommentTags: Drug Interaction, PCP, Tips
Many people do not realize that frequently the older adult population have a reversible form of dementia caused by prescription drugs. The elderly become more susceptible to drug-induced dementia and delirium with age and doctors frequently overlook the fact that the condition may be caused by drugs and therefore may be reversible, simply by discontinuing the medication. Elders who are suffering from some cognitive impairment are most susceptible .
Older adults are more susceptible to drug-induced delerium and dementia because the body’s ability to process and rid itself of drugs decreases with age. This is frequently due to normal age-related changes in liver and kidney function. Additionally many elders see multiple doctors who prescribe multiple medications at the same time resulting in complicated drug interactions and increased side effects. The elderly patients’ brains may be more susceptible to the medications’ effect on the central nervous system.
Drug safety experts at Public Citizen have identified 136 commonly prescribed prescription medications, especially certain antidepressants and pain medications, which can cause difficulty thinking.
Frequently drug-induced dementia and delirium are attributed to underlying medical conditions or to normal age related changes. For the elderly that are suffering from drug-induced dementia or delirium return to mental clarity can be a simple modification to dosages or discontinuation of these numerous frequently prescribed medications.
Sydney Wolfe, MD, acting Public Citizen president says, “after beginning new drugs, doctors, patients and their families should watch for changes in cognition and assume the changes may be caused by the drug therapy.”
Our nurses at Distinctive Care always perform a thorough assessment of all the medications our Clients are taking, checking for interactions and medications whose side effects could be causing changes in condition. When our Clients are placed on new medications we monitor them closely for any changes in cognition or increased difficulty performing normal tasks.
For those of you who do not have Geriatric Care Managers monitoring your care, the staff of Distinctive Care encourage you to bring a complete list of all medications prescribed by all your doctors to your primary care physician for a medication regime review.
This week as a Geriatric Care Manager
April 10, 2009 at 9:17 am | Posted in Megan Milchman, GCM | Leave a CommentTags: GCM, Weekly
Sat: I met R, Mr. A’s son, and his family for the first time. We had a meeting with a companion company to hire a companion for Mr. A. She will Start on Monday.
Mon: After a quick morning meeting I rush to get to Mr. A’s apartment before his new companion arrives. I need to be there to help him adjust to this change. Everything goes well for the first hour I am there, so I feel comfortable enough to leave and let them go about their day on their own.
I then go to see M. Minutes before I arrive she took a fall trying to go to the mailbox with out her walker. She is very afraid to tell me anything, but her Aide tells me first and then after convincing her that she needs to tell me, she does. After numerous questions, I determine that she is fine and not in any need to go to the doctor or hospital. I remind her of the importance of using her walker and allowing people to do things for her.
Tues: The day is spent arranging PT and OT for a client of mine and researching medigap coverage for another client.
Weds: A rush morning, first I visit Ma and quickly fill her medicaitons. I also remind her of adoctors appointment next week and I go on my way.
Next I go to fill Mr. A’s medicine. While there his Aide tells me that he made her leave early the day before. I go and speak to him about it, he said that he thought she wanted to go.
After clearing things up I go on my way to pick up P and take her to the doctor. I get to her house and she is a pleasant lady, waiting for me to get there. While I am waiting for her to finish getting ready, I get a phone call from Mr. A’ s Aide and he is making her leave again and she will not be coming back. I spoke to Mr. A and he apologized, but could not give a reasoning. I called his son R and filled him in on things. P and I get to the doctor he adds medication which she is not happy about and we leave to fill her medicine and take her home.
Thurs: Visit with PA and there is nothing new going on with her. She is very happy, though, that she received a new TV from her son.
I then visit A, she is exercising when I arrive and continues to do so and I fill her medication. I look at her yeast infection and tell her that the doctor needs to see it again. I also review her new medication with her.
Happy a Happy Easter and Passover!!!
One Week
April 8, 2009 at 9:20 am | Posted in Sophia Heftler, GCM | Leave a CommentTags: Dementia, Family, GCM, Love
One week ago my beloved Mother passed away. She was my best friend and I cannot describe the pain I feel when I think about the fact that I will never hear her voice again. She was the heart and soul of our family and everything seems different now.
Rose was on Hospice Care for 10 weeks during which time she lived out her life with dignity and grace. It was during this time that she received her massage! She loved it. Our whole family worked together with the hospice to ensure all her needs were met and that she was kept as comfortable as possible. She received Geriatric Counseling from Distinctive Care’s own Bobbi who provided our family with an Ethical Will which although short and incomplete our family will treasure always. Bobbi encouraged my sister, brother and me to each write her a letter describing what she meant to us. Bobbi read these letters to my Mother and she enjoyed them so much that my Mother asked other loved ones to write her a letter. My niece, Danielle bought her a special folder to keep all her letters in and she kept the folder in bed with her at all times. She chose to be buried with her letters in her coffin by her side along with a jar of Vicks, a box of Mallomars, a bag of spearmint leave candies, a special poem my brother had presented her with years earlier and one red rose.
The day of her funeral was not a sad day. It was a celebration of her life and we saw to it that she left this world with the same dignity and grace by which she lived. Those who had written her letters read them at the repast luncheon and glasses of wine were lifted to her memory.
I had been very strong through all this. I read what I am told was a very touching eulogy and there was not a dry eye in the church except for mine. I couldn’t imagine what was wrong with me and was terrified as to what might happen once I did begin to cry.
It hit me on Sunday. Although I cried it was not the overwhelming waterfall I was expecting…but something very scary for someone who suffers from chronic depression happened. I took to my bed. This is an extremely frightening thing to happen to me as it usually means the crash will follow. I had to do something! So, Dan, Romeo and I went to visit my Mother. When we arrived at her graveside I was so pleased to see that all the beautiful flowers she received had been arranged like a blanket covering her. I didn’t say much to her…I just needed to be there. It helped a great deal and I felt much better…thankfully I have not taken to my bed again.
Last night Bobbi and I had our monthly Alzheimer’s caregiver support group meeting and I spoke of the challenges I was facing with my Father who suffers from mixed dementia as he has had a tremendous decline in cognition since my Mother’s initial diagnosis in January and had really gone downhill since her death. It was extremely helpful for me to get it out in the presence of others who understood my pain.
I spent the day today helping my Father with various banking issues and learned that my sister will be going back home to Florida on Thursday. She has been here for 7 weeks caring for our Mother and it is time for her to go home. I told her not to feel guilty, that she should go knowing she did everything she could. At the same time I am frightened about what this is going to mean to me, my family and my life as I officially become the primary cargiver for my Father. I was thinking I probably need a care manager! All kidding aside, I don’t know what the future holds but I do know that I will be there every step of the way as my Fathers continues his journey. I will practice what I preach and will accept help when it’s offered, will ask for help when it’s needed (and already have) and will be sure to practice self care because without me my Father would be lost.
I am sure I will share some aspects of our journey with you and hopefully we will be able to help each other. I do know one thing for sure. The past 10 weeks have made me a much better care manager and all my Clients and there caregivers will benefit from my experience.
Thank you Mom for teaching me so much right to the very end of your life.
I love you -
Sophia
Bergen County Geriatric Care Manager
April 2, 2009 at 9:00 am | Posted in Megan Milchman, GCM | Leave a CommentTags: GCM, Weekly
Monday: After our weekly office meeting, it is off to start the week.
First stop is to see M. I get to her place and everyone is sitting and eating, so I join them. M tells me about her morning, they went to see the new Bergen Mall and went to Shoprite to get some groceries. M also said that they went to the cemetary to visit her deceased husband. She really misses him, he has been gone for 13 years now. I remind her that she has an appointment with her doctor tomorrow. After our discussion, I fill her medications and prepare myself for the week.
Tuesday: A visit with Mr. A; he forgets that I am coming and was not there when I arrived. I wait around and catch up with him a little later in the day. I fill his medicaitons and prepare for what is coming. Saturday we are meeting with a Home Health Care agency to go over a Care Plan and prepare to bring a companion in with him for part of the day. He isn’t thrilled, but I remind him that it is necessary at this point if he wants to stay in his house. He finally agrees and I tell him that I will see him on Saturday with his son.
I Pick up M to take her to the doctor. She has to do a breathing test called a pulmonary function test. You have to breathe into this tube and a computer measures how well you breathe. The doctor says that she did very well and gave her a clean bill of health. This made M very happy, for she gets very anxious everytime she has to go to the doctor. She thinks that they will find something wrong.
Wednesday: I visit P, there is nothing new with her, she stays stable and states that she is happy with her care.
Ma has to go for testing. I arrive and fill her medi-minders, then it is off to Holy Name Hospital. On the way she has to drink 40 ozs of water. Not easy to do when you just turned 92. She also has to hold it, she is going for an ultrasound of her Kidneys and bladder, to see why she is constantly having infections. After that test is over, she has to have a CT scan of her brain, to see why she may be having memory problems. Everything goes well and I take her home. She is very grateful for everything. I tell her we will get the results when we see the doctor in 2 weeks.
Thursday: My last visit of the week is to A. I fill her medications and sit and talk for a while. She gives me her doctor reports to go over and everything looks pretty good. She is a very pleasant women to be around.
A Sad Passing
April 1, 2009 at 12:42 pm | Posted in Mark Heftler, Admin | Leave a CommentTags: Family
The wonderful thing about running a blog for a family business is the transparency. We are who we write as, we’re people, we’re a face in front of a business not a suit hiding behind it. Hopefully you get to know us and we get to know you, you’re our constituents and our colleagues, friends and family. It’s all very personal.
So it is with great sadness that I wanted to let our readers know that my grandmother, Sophia’s mother, passed away yesterday morning. I’m sure Sophia will at some point write a message herself, but for now I wanted to let you know what was happening with out family.
I run my own personal blog, which I update disappointingly infrequently, but this definitely occasioned a heartfelt entry. I’m a writer, that’s what I do, and writing this I was able to achieve some solid closure. For anyone who knew her, or knows me, or simply wants to learn about an extraordinary woman, I encourage you to spare a moment and read it. http://snipr.com/ez2y1
Thank you for your readership, and your understanding.
Mark Heftler
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