Pet Assisted Therapy

April 29, 2011 at 10:30 am | Posted in Sophia Heftler, GCM | Leave a comment
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Pet Assisted Therapy is a  form of therapy that has been around for many centuries.  There are many forms of it, but most people are familiar with therapy dogs.  Therapy dogs must go through a rather rigourous training program and must pass a special test to become certified.  Benefits of utilizing a certified therapy dog include the knowledge that the dog has passed the comprehensive testing process, is insured and that the handler, too, is prepared to work with the dog appropriately.

Other animals used for pet assisted therapy include fish, birds, rabbits, and many others, even some reptiles.  Van Saun Park in Bergen County, NJ, has a special program which brings various zoo animals into nursing facilities.

Distinctive Care has Romeo, our therapy dog, who is an instrumental member of our team and the work we do.  As Romeo’s mom and handler I have the privilege of working very closely with him and our Clients.  His effect on our Clients has been nothing short of amazing, as I have watched him bring catatonic Clients back into the moment, Clients who have lost the ability to speak utter words, and just plain joy to the majority of our Clients.

Romeo is available for visits.  To arrange for a visit please call Distinctive Care’s Ridgewood office at 201-857-5283.  We assist Clients in counties throughout northern New Jersey and in parts of New York State.

Additionally we have a community program available to nonprofit organizations available.  If you are interested in this program please contact our Director of Community Relations, Pat Linard directly at 551-580-5639.

Alzheimer’s Association Annual Conference

April 15, 2011 at 10:30 am | Posted in Sophia Heftler, GCM | Leave a comment
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I attended the Alzheimer’s Association Annual Conference this past Friday. I attend the conference every year and, as usual, this one did not disappoint!

From the opening remarks to the final elective workshop that I attended, the day was amazing.

I thought the most interesting session was presented by the keynote speaker, Cameron J. Camp, PhD. Called “I’m Still Here ®: A Montesessori Based Approach to Providing Care to Persons with Dementia,” the session provided the attendees with many interventions regarding activity planning that enable the caregiver to avoid pharmacological approaches. Basically, he reminded everyone of the important fact that those living with dementia have the same needs as those without dementia. The thing that really excited me about this presentation is the fact that so much of what he was talking about with regard to dementia care are practices that Distinctive Care already has in place. He spoke about how persons living with dementia have the need to feel self-worth, express one’s thoughts and feelings, and have a sense of belonging and accomplishment. He stresses the importance of “destigmatizing” dementia and “embracing the person in the person with dementia.” As I sat there listening I wanted to jump up and shout, “This is what Distinctive Care does every single day!” and to tell him the story about my lunch and shopping trip with one of our Clients which took place earlier in the week.

The workshop I attended was “Best Practices: Creating Therapeutic Activities for Quality Dementia Care” with the expectation that I would be able to provide our Care Managers with even more interventions to ensure a high quality of life for all our Clients. I was not disappointed and will certainly apply what I learned, and our Care Managers will also implement the assessment techniques and care planning information I shared with them in their practice.

I have so many new ideas that I can’t wait to implement and already am excitedly planning for next year’s program.

Distinctive Care is a care management practice that takes special pride in the care we provide for our Clients living with dementia every day with specialized, individualized care planning for each individual Client to address their specific needs and to improve their quality of life. If you have a loved-one living with dementia and are at the point where you feel you need help with your caregiving and are not sure where to turn, please contact us in our Ridgewood, New Jersey office to see if we can assist you and your family in providing the highest quality of life possible for your loved one which in turn will provide you with a more satisfying role as a caregiver. We assist families in Bergen, Passaic and northwest New Jersey and families in Rocland, Orange and Westchester counties in New York. We can be reached at 201-857-5283.

My Perfect Job

April 8, 2011 at 10:30 am | Posted in Sophia Heftler, GCM | Leave a comment
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I am so fortunate that, as the owner of Distinctive Care Geriatric Care Management, I have the opportunity to spend quality time with our Clients on a routine basis. It provides me with an opportunity to observe the Client and make a comparison, not only to the last time I saw him/her, but also to compare what I’m seeing to what I have learned about the Client at our weekly interdisciplinary care conferences. It also affords me the opportunity to be in touch with the families to provide them with my perspective on their loved-one as well as the chance to find out if they have any concerns that I should be looking into.

This week I had the privilege of spending the afternoon with one of our Clients who has Primary Progressive Aphasia. She moved into an assisted living facility several months ago. Last month when I visited I brought her a wreath for her door and spent time with her at her new home observing her and seeing that she was adjusting well to her new environment. It had been a while since I had last seen her, as I had been out on medical leave for some time. After spending time with her I reached out to her daughter and her Care Manager about some concerns I had and we were able to obtain an order for physical and occupational therapy for her. I was able to note a decline in her physical functioning which was not as evident to the family and Care Manager who see her on such a routine basis. The changes were subtle, but since I hadn’t seen her in some time they were very obvious to me.

Anyway, back to this week: I obtained permission from her daughter to take her out for lunch and shopping (two of her favorite things!) but was advised by her daughter that we should only do one thing because it was really difficult to get her into the car. So I arranged to take her to a nearby Lord & Taylor that has a cafe so we could do both.

When I arrived to pick her up she was waiting for me. She was all dressed up in a beautiful purple outfit (my favorite color!) and had beautiful jewelry on. We went up to her room to get her coat and I was able to observe that there was some improvement in her gait since beginning physical therapy. All of the caregivers we ran into were so happy that she was going out and asked if I could purchase her some new pull-on pants in a size medium since she had gained some weight since her move into assisted living (as most new residents do). I obtained the “okay” from her daughter to do so and off we went.

The first thing I noted was that it was not so much that she was having difficulty getting into the car, but that she was doing it incorrectly. I showed her how to do it properly and safely, and had no problem getting her into or out of the car. I will review this with the Care Managers on Monday at the meeting so that when they take her to appointments they will have no problem with this issue. I have already reviewed the procedure with her daughter, who said she understood, and although she has not taken her out since she moved to the assisted living she will keep it in mind when she does.

We had a wonderful time. I helped her to order her lunch and observed how she did when eating. She had no problem and used the appropriate utensils and did not demonstrate any difficulty swallowing. Of course I did all the talking since she has really declined in this area. But she can still laugh, and we had lots of fun while I poked fun at her and her hearty appetite.

Then off we went shopping. I had to remind her frequently to take bigger strides when ambulating, but other than that she did fine. She was able to follow directions and we went to see if there were any pants she liked. She picked out two pairs and also a blouse that matched well with both of them.

We had so much fun trying on colorful scarves and I modeled several pairs of shoes for her in the shoe department. (Everyone who knows me, knows about my wild taste in and huge collection of shoes.) She was laughing and smiling the whole time! And I was having a wonderful time too!

After almost 4 hours it was time to go home and when I dropped her off I gave her a kiss goodbye and she spoke the only full sentence of the afternoon…”You really listen to me!”. What a wonderful gift…what a wonderful day!

Distinctive Care is a full-service geriatric care management practice. All of our Care Managers are Registered Nurses and we have a Transitional Coach on staff who assists Clients as they experience the changes that come with aging. We are located in Bergen County, New Jersey, in Ridgewood, New Jersey. We serve northern New Jersey including Bergen, Passaic and other counties as well as Rockland, Orange and Westchester County in New York. We can be reached at 201-857-5283.

Additional 2010 Tax Tips for Family Caregivers

March 25, 2011 at 10:30 am | Posted in Sophia Heftler, GCM | Leave a comment
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In order to claim your elderly parents on your 2010 tax returns you must file a “Multiple Support Declaration” if multiple siblings are providing support. If a sibling provides at least 10% of the support and the total support of all the siblings make up at least half of your parent’s annual expenses, the parent could be claimed as a dependent.  The caveat is that only one sibling can take the exemption.  An agreement needs to be reached annually as to which sibling will take the exemption on their return.  The sibling taking the exemption is required to sign form 2120, Multiple Support Declaration, and have all the other siblings sign the form claiming they will not take the exemption on their own returns.

You may be eligible for the Child and Dependent Care Credit if you are paying someone else to care for your elderly parent so you can continue to work or look for work.  If you are eligible you will be allowed to take a credit of up to 35% of the expenses paid for the dependent care; with $3,000, the maximum amount of expenses for a tax credit of up to $1,050.  To be eligible, the care recipient must be unable to care for himself/herself physically or mentally.  Care recipients must be claimed as a dependent (or could be claimed as a dependent except that he/she had an gross income of $3,650 or more) on the caregiver’s return, according to the qualifications listed on IRS Form 2441.

Despite the fact that the gross income was more than $3,650, you may still qualify for savings this tax year.  Medical expenses may be deducted on your tax return along with your own expenses for dependents and individuals that would have been a dependent with the exception of the income guidelines.  The IRS allows caregivers to deduct costs incurred from your parent’s healthcare, such as hospitalization, prescription drugs, dental care and long-term care expenses that are in excess of 7.5% of the caregiver’s adjusted gross income.

If you think you may qualify for for any of these tax savings consult your tax advisor.

If you are in need of geriatric care management services please contact Distinctive Care Geriatric Care Management, located in Ridgewood, NJ, serving northen New Jersey and Orange, Rockland and Westchester counties in New York.  We may be reached at 201-857-5283.

2010 Tax Tips for Family Caregivers

March 18, 2011 at 10:30 am | Posted in Sophia Heftler, GCM | 1 Comment
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For those of you supporting an elderly parent there are tax benefits available that you may qualify for that help to reward you for these efforts. It may be possible for you to claim your parent as a dependent on your income tax return or by deducting some of the contributions you have made toward their medical care and expenses. You should be aware of these tax benefits and determine whether or not you meet the criteria to determine whether or not you may qualify for any of these tax benefits. You should consult your tax advisor to help you determine if you qualify.

First you must determine if you are able to claim your elderly parent as a dependent. If you are supporting your elderly parent, claiming them as a dependent on your tax return which may result on a reduction of your taxable income by $3,650 for your 2010 tax return. There are four tests you will need to “pass” to determine if you are able to claim your elderly parent. The four tests are:

  1. Not a qualifying child test:  A qualifying child is a child under age 24 and a fulltime student who is not claimed using the remainder of the three tests. This test is basically a non-issue for caregivers.
  2. Member of household or relationship test:  If you are an adult child caring for your elderly parent you meet the relationship test. You and your parent are not required to live together to qualify. In the event your elderly parent is living on their own or in a care facility your parent may still qualify as a dependent as long as they pass the remaining tests.
  3. Gross income test:  Qualifying for this test to meet the requirements and qualify as a dependent, your elderly parent’s gross income for the year must be less than $3,650.  This income does not include non-taxable income such as social security.  If your parent receives income from other sources such as withdrawals from individual retirement accounts, pension benefits, rental income or interest and dividends from investments which would qualify toward your parent’s total income this would disqualify your parent as a dependent if he exceeds the $3,650 income limit.
  4. Support test:  Completing the support test is the final step in determining if your elderly parent qualifies as a dependent.  You must pay for over half of your parent’s expenses including food, housing, clothing, medical care and transportation expenses.

You should contact your tax advisor to help you determine if your elderly parent qualifies as a dependent on your 2010 taxes.  Next week I will discuss how to claim your elderly parents as dependents on your 2010 taxes.

Distinctive Care Geriatric Care Management is located in Ridgewood, NJ, serving Bergen, Passaic, and additional counties in New Jersey and Orange, Rockland, and Westchester counties in New York.  We provide geriatric care management, with RN Care Managers, have a therapist on staff to provide goal oriented supportive counseling.  You can reach us in our Ridgewood, New Jersey office to schedule a consultation to determine if we can help you in any way.

Busy Week!

March 11, 2011 at 10:30 am | Posted in Sophia Heftler, GCM | Leave a comment
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Wow, has it been a busy week at Distinctive Care!  We had two Clients discharged from two different acute care hospitals to a local skilled nursing and rehabilitation center.  One is there for rehabilitation and then will be staying on for long-term care in the nursing home section of the facility.  The other one is there for a short-term stay and will be returning home where we had previously set up around the clock care for him.  The care managers have been great in getting them settled into the routine and are keeping a close watch on their progress.  Our therapist has been there to see them and assist them with the transition.

I had to be involved due to the fact that I wanted to ensure that these Clients would get the very best care possible, advising the administrator of my expectations and the fact that our care managers would be there frequently to monitor progress and keep the families apprised of their progress.  I wanted her to be able to assure her staff that our role was not to check up on them, and if there was anything we could do to assist with their care for them to feel free to let us know, and we would be happy to pitch in and help out.  She was extremely accomodating and actually ensured that the one Client who would be staying on long-term was placed in a room right across from her office!  Who could ask for more than that!

Last night I received a message from the care manager who is working with the short-term stay Client.  Apparently he was having some episodes of confusion yesterday and was demanding to go home.  He was brought to an activity between his therapy sessions and thought he was in occupational therapy when he was there.  He was very upset that he had spent an hour in occupational therapy singing!  This poor gentleman was watching an opera singer who was there to perform and unfortunately, because of a miscommunication, he thought he had wasted an hour of his rehab time singing. I could understand why he thought “the place was a fraud” and wanted to go home.  At any rate, I called to leave a message for the administrator to get back to me and despite the fact that it was well into the evening she took my call.  We discussed the Client and how highly motivated he is, discussing his individualized care plan.

Today I went to see all our Clients who are there.  Distinctive Care has another Client there in the nursing home so I saw her and her devoted husband.  She is doing wonderfully and he is there everyday by her side.  The other Client who will be there long-term was happily singing in the activity room with many other residents.  She looked so happy, I didn’t disturb her. I stood outside the room watching her for about 10 minutes.  It was amazing to see this Client, who had been so lonely in her home, with the group singing the songs she knew from the old days.

And finally I saw the gentleman who wanted to go home last night.  He asked me if I had made a phone call last night.  I told him that I had and he said he could tell and he had a much better day today.  He said he was so embarrassed about the singing incident. I told him not to worry about it!  He told me about the rehabilitation he received today and what his goals are prior to returning home.  I promised I would return next week with Romeo, our Therapy dog and a special treat for him.  He said I spoil him.  He blew me a kiss when I left.  Who has a better job than me!

If you are looking for placement in a nursing home or subacute center and need assistance please feel free to contact us in our Ridgewood, New Jersey office.  We are very familiar with the the high quality centers in Bergen County and the surrounding areas, including Rockland County in New York  and will be able to assess your particular situation and help you to find the right place to meet your individual needs.

Validation Therapy

March 4, 2011 at 10:30 am | Posted in Sophia Heftler, GCM | Leave a comment
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In my earlier post I talked about the stigma associated with nursing homes.  Today I thought I would share with you the experience I had in providing sensitivity training to the staff of a local nursing home.  This particular nursing home is a facility that Distinctive Care makes referrals to, so we know they are a high quality facility.  The fact that the administrator (who has been with the facility for 8 years) and the Director of Nursing (who has been with the facility for 7 years) decided to bring this program in for the staff is telling with regard to the fact that they are dedicated to ensuring the best of care for the residents with dementia.

Validation Therapy is the brainchild of Naomi Feil, a social worker.  It is a process in which the caregiver doesn’t try to change the person she is caring for, but instead changes herself and actually enters the world of the person with dementia.  Reality Orientation, which is a technique used in the past, is no longer used when the resident with dementia is asking for her mother who has been deceased for more than 40 years because researchers have determined that this causes the resident to relive the painful memory.  Validation Therapy is not the same as “therapeutic lies” because, as Ms. Feil discovered, the person with dementia knows on some level that she is being lied to and this creates an environment of mistrust toward the caregiver.

Validation Therapy is used to validate the feeling behind the behavior the resident is displaying and to provide empathy and understanding, creating a feeling of trust and assisting the resident to resolve open issues they have in their lives before they die.  It is not something that one can master overnight, but the interest and openess of these caregivers to learn about this technique and to incorporate it into their practice was amazing.  The level of care and concern they showed during the inservice I provided was amazing.

They have promised me they are going to give it a try. A big part of Validation Therapy is asking questions of the resident to determine what the feeling behind the behavior is, as all behavior has meaning.  As I was leaving the facility I heard a caregiver ask a resident who was repeatedly asking for her mother if she felt scared.  The resident responded that she felt lost and scared.  The caregiver then asked what her mother used to do for her in the past when she felt lost and scared.  The resident replied that her mother used to rub her back and sing to her.  The last thing I noted as I was walking down the hallway was the caregiver rubbing the resident’s back.  She really understood what Validation Therapy is all about; I was very proud.

Distinctive Care Geriatric Care Management has many in-services available for staff in facilities throughout New Jersey.  If you are interested in bringing one of our programs to your staff please contact Pat Linard, our Director of Community Relations who will be able to provide you with a list of our current programs or let you know if we can customize a program based on your needs.  She can be reached in our Ridgewood office in Bergen County at 201-857-5283.

Nursing Home Stigma

February 25, 2011 at 10:30 am | Posted in Sophia Heftler, GCM | 2 Comments
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I have been doing CEU presentations all week about when the time comes for families to consider nursing home placement.  There is a huge stigma associated with nursing home placement however as I went about educating professionals this week about the importance of nursing homes in our society.  Many families I have dealt with have made promises to their loved-ones that they would never place them in a nursing home.  Unfortunately in many circumstances this is a very unrealistic promise.  For many Clients there comes a time when nursing home placement is actually the desired outcome because the nursing home is truly the place where their loved-one will receive the best care possible.  There are times when it is just impossible to provide the necessary level of care in the home environment or in an assisted living facility.

It is important when looking for nursing home placement that you do your homework, and many times families do not know where to begin.  Often they are handed a list of nursing homes from a hospital discharge planner and feel overwhelmed.  Of course at Distinctive Care we can help with placement; however, I realize that frequently families cannot afford to pay for assistance with placement.

This is when it is very important that you check the nursing home, compare information available at medicare.gov and do the actual leg work. Visit the different facilities and use the checklist available at the website.  Evaluating the nursing home’s 5 star rating and their survey results are extremely important, but nothing can take the place of an actual site visit.

At Distinctive Care, we make referrals to local nursing homes that have undergone our vigorous review and continued unannounced visits to ensure they continue to meet our stringent standards to remain on our referral list.

In the event you require assistance with nursing home placement Distinctive Care, located in Ridgewood, New Jersey can provide you with the help you need.  We have evaluated nursing homes in Bergen, Passaic and Essex Counties in New Jersey and in Rockland and Westchester Counties in New York.  Assessing your loved-ones needs and assisting with placement in and the transition to nursing home placement is one of our specialties.  We also are able to provide the family with counseling to assist with the guilt often associated with this major change.

The most important thing to remember is that by and large the folks working in nursing homes are doing so because they are caring people whose goal is to provide quality care for your loved ones.  The professionals and paraprofessionals who provide care genuinely want to do what is best for your loved one – sometimes it is more difficult because of constraints placed on them related to ownership issues – these are the things you should be able to learn about when reviewing the nursing home compare at medicare.gov.

Stress and the Older Adult

February 18, 2011 at 10:30 am | Posted in Sophia Heftler, GCM | Leave a comment
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Stress affects individuals throughout their life span, but in the older adult even those who have previously handled stress with ease may find they are having more difficulty dealing with the everyday stress in their lives. The reasons for this are two-fold:

  1. There is a decrease in homeostatic capacity. Basically this is a physical cause in which the systems in the brain that respond to stress simply begin to wear out.
  2. Older adults tend to deal with more chronic loss than other age groups.

Sources of Stress for Older Adults:

  • Loss – the older adult may fear the loss of:
    • Control over their life or environment
    • Physical strength and coordination
    • A sense of purpose and productivity
    • Independence
    • Memory and other thinking processes
    • Friends and relatives through death or social isolation
  • Health problems
  • Finances/Income
  • Relocation
  • Children/Grandchildren
  • Abandonment
  • Caregiving

Manifestations of Stress in the Older Adult:

  • Physiological
    • Insomnia or nightmares
    • Loss of appetite
    • Increased appetite
    • Heart palpitations
    • Frequent urination
    • Diarrhea or constipation
    • Muscle pain and tiredness
    • Headaches
    • Weight loss or gain
  • Emotional or Psychological
    • Anxiety
    • Fear
    • Frustration or agitation
    • Depression/crying
    • Restlessness
    • Poor Concentration
    • Forgetfulness

Stress Management for the Older Adult:

  • Involve someone – talking to someone about your concerns, your complaints, your feelings. You and your body will feel better getting things off your chest.
  • Take care of your own health.
    • Eat right
    • Get enough sleep
    • Exercise
    • Enjoy doing things that you want to do/Volunteer/Sr. Center or Social programs
  • Stress Relaxation Techniques
    • Muscle relaxation
    • Visualization
    • Gentle exercises such as Yoga, Tai Chi or Pilates
    • Listening to soft music
    • Massage, including hand massages
    • Aromatherapy
  • Pet Therapy or Pet ownership
  • Life Review
  • Active Social Life
  • Positive thinking
  • Smoking, drinking and substance abuse are harmful and should never be used to cope with stress!

If you have an older adult loved one who is experiencing on-going stress, feel free to contact Distinctive Care in our Ridgewood, New Jersey office at 201-857-5283 and we will be happy to arrange for a consultation with our Geriatric Therapist.  Our Registered Nurse Care Managers can also conduct a complete assessment and develop a care plan to address all the needs your elderly loved one may have.

Post Traumatic Stress Disorder

February 11, 2011 at 2:30 pm | Posted in Sophia Heftler, GCM | 1 Comment
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Many of you who have been following this blog know how important mental health is to me, as I suffer from several psychological disorders and work very hard to help eliminate the stigma associated with mental illness.  It’s very hard work and people are still very frightend by things they don’t understand.  Recovery is possible, although it is an ongoing process.  In the older adult population it is often difficult to diagnose and treat mental illness.  Our Geriatric Care Mangers and Geriatric Therapist work with our Clients to determine whether treatment is necessary as part of the overall care plan and our goal of helping our elderly Clients reach their maximum level of functioning.

One of the things that I have noted during Distinctive Care’s assessment and evaluation process is that many of our older adults and senior citizen population actually suffer from Post Traumatic Stress Disorder (PTSD), which has a profound affect on their current quality of life.

Many people think about Vietnam War veterans when they think of PTSD, and of our current soldiers fighting in Iraq and Afganistan; however, the disorder was actually first noted after soldiers returned from WWII and it was referred to as “shell shock” or “combat fatigue”.  Many of our Clients are veterans and we have found that those who present with behavioral or cognitive issues do have PTSD and are experiencing the signs of the disorder.

There are three cardinal symptoms of PTSD and to meet the criteria of diagnosis these signs must be present for a period of time greater than one month.  After experiencing or even witnessing a traumatic event which resulted in intense fear, helplessness or horror the person involved in this may begin to experience symptoms either immediately or many years after the event.  (In my case a devastating event triggered memories of a trauma I had experienced as a child some 30 years after the event.)  If your elderly parent or loved one suffers from reexperiencing the event, avoidance (or numbing) of things associated with the event, and a heightened sense of arousal (anxiety attacks, hypervigilance or behavioral changes), he or she may be suffering with PTSD.

With proper treatment, recovery is possible.  Current treatments include cognitive behavioral therapy (talk therapy with a mental health professional), medical management (prescribed antidepressant medication and monitoring) or a combination of both.  The combination treatment has been found to be most effective.

Interestingly enough studies have found that women suffer from PTSD at higher rates than men despite the fact that most of our veterans are men.  In the older adult population many women suffered abuses that were never spoken of, and as they age and begin to suffer from cognitive decline associated with Alzheimer’s Disease and other dementias they begin to relive the abusive event and behavioral symptoms which are really symptoms of PTSD.

Many of our elderly have lived through The Great Depression, are Holocaust survivors, victims of Japanese Interment Camps and are WWII veterans.  We have discovered that many of these elderly loved ones are sufferning with PTSD and have witnessed the improvement in their quality of life with proper treatment.  This is something I am passionate about having experienced what it is like to live with this disorder and have worked with our staff to educate them on the importance of thourough investigation of the root of behavioral problems…all behavior has meaning and as Geriatric Care Managers it’s our mission to investigate the meaning behind untoward behaviors that are affecting the quality of life of both our Clients and their caregivers.

Please feel free to contact me at Distinctive Care if you need help dealing with behavioral issues.  I can best be reached at our Ridgewood office in Bergen County at 201-857-5283 to discuss your individual issues.  Distinctive Care serves Clients in Bergen and Passaic County in New Jersey and Rockland, Orange and Westchester Counties in New York.  Our Professional Care Managers are all Registered Nurses and we have a Geriatric Therapist on staff.  We work very closely with the area’s most highly regarded geriatricians and are very strong advocates for our Clients.  If you are at the point where you are thinking about making the call, it’s probably really time to make the call…you will speak with me personally and may find that just having the conversation is exactly what you needed to help get you through the challenges that come with being a caregiver.

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