Advocacy « The Professional Geriatric Care Manager’s Blog

Busy Week!

March 11, 2011 at 10:30 am | Posted in Sophia Heftler, GCM | Leave a comment
Tags: Advocacy, Aging, Caregiver, Eldercare, Help, Support

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.

Changes for the better.

March 10, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
Tags: Advocacy, Caregiver, GCM, Help, Life

I decided to talk about a client that we have been working very closely with for the past 6 months. Mrs. K started with Distinctive Care in September, 2010. We started seeing her when she was admitted to a local hospital and then to a rehabilitation center for physical and occupational therapy after a fall, when she fractured some of her ribs. During the 6 months under our care, Mrs. K has been through a multitude of change in her life. She has been hospitalized four times during this time period, twice for medical issues and twice for psychiatric reasons. She has also been taken out of her house for health and safety reasons. She was then moved to three different facilities, assisted living(2) and then to a more skilled long-term nursing facility, where she is currently.

Mrs. K has a known history of psychiatric and behavioral issues that have caused such difficulty throughout her life. I decided to write about Mrs.K to explain that she has overcome so much during these last few months, and there was a point during this time that I was not sure if she was going to have a positive outcome. After her second move to an assisted living facility, and her long time caregiver went on a 3 week vacation, Mrs. K really started to show a big decline in her health and behavior. She was not eating, sleeping or speaking clearing, and was chanting and constantly calling out. She had so many changes in such a short period of time that she was unable to manage and process them all at one time. She did not know how to adapt and instead she shut down.

After her most recent hospitalization and rehabilitation, our team was able to get Mrs K. into an excellent Psychiatric Hospital for proper diagnosis, care and treatment. She did extremely well after 12 days of intense therapy and was discharged to a small, highly recommended longterm care/nursing facility that is close to her home and family. Mrs. K has been doing very well at her new home. She will continue to receive physical, occupational, speech therapies and psychiatric counseling as well.

Mrs. K had a supply of support from her family, friends,care givers and geriatric care managers during this large transition in her life. I am happy to be apart of her continued care and progress of her life.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long-term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

Can You Hear Me Now?

March 9, 2011 at 10:30 am | Posted in Joanne Jordan, Office Manager | Leave a comment
Tags: Advocacy, Caregiver, Hearing, Personal, Tips

As I mentioned last week, I’ve been doing a lot of advocating lately for my dad, who remains hospitalized. In addition to numerous other health issues, one of his challenges is the severe hearing loss he suffered after years of working in a very loud environment. Even with hearing aids, it can be difficult for him to understand others. At home, family members and his caregivers have learned the techniques that work: minimize other distractions, get closer to him, make eye contact, speak a little slower, and above all, speak louder than normal. It’s also necessary to look for clues that he understands you, or use checkpoints in your story to make sure he’s still following you.

When Dad is out in the real world, or in this case, at the hospital, it’s even more of a challenge for him. There are new distractions, new voices, new topics with new vocabulary. Sometimes people assume he is not capable of following instructions or responding, but the truth is that he’s very sharp and capable once he understands what’s been said. We don’t hesitate to alert people to his hearing loss right up front, but it’s amazing how many people don’t adjust their speech accordingly.

Last night, Dad’s nurse and his CNA came in and gave him some instructions how to get out of bed. I could tell from his expression that he had no idea what was said, and I told them, “He didn’t hear you.” The nurse repeated himself, exactly as before, without making any accommodations for Dad’s hearing loss (which, by the way, is noted on a sign above his head.) At that point I realized I needed to be more specific: “If you get closer to his head and speak much louder, he’ll be able to hear you.” Above all, he wants to know what the plan is and be an active participant in his care.

Ideally, caregivers of the elderly should know how to communicate better with those suffering from hearing loss. By my speaking up, maybe they’ll be a little more sensitive to the next hard-of-hearing patient they encounter.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

You Can’t Be Too Careful

March 2, 2011 at 10:30 am | Posted in Joanne Jordan, Office Manager | Leave a comment
Tags: Advocacy, Caregiver, Family, GCM, Health, Safety

This week I’ve been juggling issues related to three of my family members being ill, the most serious being my dad, who is currently hospitalized. Over the years I’ve learned that you must always advocate for your loved ones when they are unable to do it themselves, and this week is no exception.

Upon Dad’s arrival at the ER, my brother handed the nurse a list of his current medications. Dad’s general physician was consulted and has seen him every day of his stay. And the hospital is the same one that has treated my father regularly in recent years and retains his medication history in the computer system.

Yet somehow, Dad’s heart medication disappeared from his orders. We noticed it after I requested a printout of his meds from his nurse. When reviewing details like these, it’s just as important to ask yourself “what’s NOT on the list?” as it is to ask “what IS on the list?” After bringing it to the attention of the nursing staff, the doctor was consulted and the heart medication reinstated.

When it comes to the health of loved ones, I’d rather be guilty of asking too many questions, than too few.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

How the Sense of Sight Affects our Appetite

February 24, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
Tags: Advocacy, Aging, Diet, GCM

As I was feeding my kids dinner tonight, it came across me what I wanted to blog about this week. My husband and I always try to provide our children with a healthy and balanced dinner each night that also tasted good. That is the problem. What seems pleasing and tasty to me, is not the same for my children. If they do not like the smell, color, taste or consistency, you can bet they are not going to willingly eat what is given to them. They like what they know best and are familiar with. A family friend of mine just recently gave my daughter a happy meal toy alone. My daughter proceeded to ask, ” Where are the chicken nuggets and french fries that go with the toy?” Her keen sense tells her that something that she enjoys and that makes something complete was missing. This same idea holds true for our clients.

I currently have a client that is choosing not to eat and swallow her food. She states a few concerns why she is not eating well. One is that she is fearful of choking on her food and the other is that she just does not like the food that she is being given. This client has multiple medical issues and has to be placed on a special diet for better control of her diabetes, high cholesterol, hypertension and dementia. But, more specifically, this client is blind from complications due to her diabetes. Her desire to chew and swallow her food has changed drastically over the year, and we feel it is behavior related. We immediately thought that the taste of the food is what persuades our decision if we like what we are eating. It is not. Our first sense to eat something stems from our sight. If it looks good, it must taste good. Or if it looks good and smells good, it should taste even better.

Many adults over the age of 80 experience significant loss of their sense of smell and taste. Changes in taste and smell are a normal part of aging, but the situation can be made worse by disease and medication. When we lose one or more of our five original senses, it could drastically change how we eat. I remember when I was working in Beth Israel Hospital in their food service department, it was made a point to always keep every type of restricted diet meal as tasty and desirable as the one that was based on the one without restrictions of salt, fat or sugar. We even use to take pureed/mashed foods and use special molds to have them look like the actual food rather than a scoop of this and a scoop of that. It really made the difference, and made the patients very intrigued on what the food could possibly taste like.

Since my client is blind and has so many obstacles from diet restrictions due to her many health problems, I plan on working closely with the facility’s Dietitian and Speech Therapist where she currently lives. Hopefully, we will work together to problem solve how we could make the food more desirable with all her dietary restrictions, her blindness and behavioral concerns (dementia) has led her to a decreased appetite. As a geriatric care manager it is our goal to evaluate and provide care to all our clients to ensure a better quality of life for them and their caregivers.

First Week Back

February 4, 2011 at 10:30 am | Posted in Sophia Heftler, GCM | Leave a comment
Tags: Advocacy, Caregiver, Love, Work

This is my first week back to work in a very long time as I was out on an extended medical leave. I knew that I missed working with my geriatric clients and their families as well as my professional staff, I didn’t realize how much until I returned.

We have a weekly clinical meeting every Monday morning which I have been receiving summaries of from my office manager each Monday afternoon. I have also been copied on every email regarding every client so I have been aware of what’s going on and contributing my suggestions and advice as needed. It felt wonderful to be able to contribute in real time, discussing how we could best help one of our family member who visits his wife in a nursing home daily, often neglecting his needs, to using my clinical background in making suggestions about medical testing I felt would be appropriate for a client. It felt great to be helping our Registered Nurse Care Managers in careplanning and developing interventions to best assist our elderly clients and their families. It was wonderful to hear about the goals our Therapist is working on with her clients as I think the mind-body connection is so important.

Yesterday I was advocating for a client of ours with a geriatrician we work closely with. I wanted him to understand the importance of doing everything possible for this particular client to ensure that she reached her maximum potential which included some things he did not necessarily agree with. At one point I said to him, “I bet you wish I wasn’t back yet!” and his response was “I enjoy the advocacy and it’s good to see things shaken up in the right way. I missed you very much.” It’s good to shake things up in the right way and ensure the very best of care for those who can no longer advocate for themselves. This isn’t work…this is what I love.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange Counties with nurses lisenced in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you have related to long-term care. Please contact us in our Ridgewood office at 201-857-5283 to schedule a consultation.

Memorial Service and The “Only Child”

January 13, 2009 at 8:00 am | Posted in Sophia Heftler, GCM | Leave a comment
Tags: Advocacy, Caregiver, Family, Only Child, Stress, Support, Tips

Just the other day I went to a memorial service for a Client of Distinctive Care Geriatric Care Management who had passed away. She was the mother of an only child and when I saw her adult daughter grieving it really made me think about the challenges faced by an only child caring for an elderly loved-one. Most people think about the ramifications of being an only child when they are young, but for most only children it is as they age and their parents become frail and elderly that the impact of being an only child becomes an issue.

Often the strong bond that only children share with their parents may mean that they take on the whole caregiving burden alone, often even though there are others around who are willing to help. There is a tendency to think they must sort everything out by themselves and want to give their parents the same 100% attention and dedication that they received from their parents growing up.

This often puts a strain on the only child as well on their relationships with others. Often times the only child feels torn between their own families and their jobs causing them to feel as though they are abandoning their own families and also to consider quitting their jobs to become a full-time caregiver.

Only children usually develop a strong network of friends – but need to be able to call on them during difficult times. The important thing for only children to remember is that they must let other family members and friends know what their needs are and when they need help. It is vital that only children allow themselves a break from caregiving to take time to enjoy the things they like to do.

Information and professional support are essential, though many people don’t realize how much help is available to them. Professional Geriatric Care Management is a service that can help only children cope with the challenges they face in caring for their parents. The Care Manager can assume so many of the aspects of caregiving, that the only child can get back to their own families, concentrate on their careers and get back to being the adult child of their parents.

For additional information on how Geriatric Care Management might be able to help you and your situation please contact us in our Ridgewood, NJ office at 201-857-5283. We are happy to speak with you and provide you with the information you require to “get your life back”.

Life History Review: I’m Excited About it!

January 12, 2009 at 8:00 am | Posted in Sophia Heftler, GCM | 1 Comment
Tags: Advocacy, Caregiver, Family, Life History Review

One of the new products Distinctive Care Geriatric Care Management has introduced this year is geriatric counseling for both our Clients and their families. The thing that really excites me about this new offering is that we will be providing traditional counseling as well as Life History Review.

I just read an article in the January 7, 2009 edition of the Bergen Record. Tom Meuser, who directs gerontology graduate studies at the University of Missouri is quoted as saying, “Many elderly are helped by a life review. Such a review asks the questions, How do I feel about the life I have lived? Have I done the best that I can? Will I leave with a meaningful legacy? Do I have unfinished business? Am I despairing?”

While all the answers to these questions will not be positive, when reviewed in the presence of an experienced counselor the outcome of the review can be positive. The counselor can help people who are in despair become more able to come to terms with their faults and grant themselves forgiveness. Meuser says, “Some people will die in despair because someone never asked them their story – in effect to review their lives.”

So it’s very exciting to me that Distinctive Care Geriatric Care Management is on the cutting edge of this counseling technique and have brought our counselor, Barbara on board. Most recently Barbara has attended a course on Ethical Wills presented by The Valley Hospital of Ridgewood, NJ to learn more about the techniques used in life history review and to review the importance of this often neglected way for older adults to help get their affairs in order.

In addition to helping the Client, Barbara’s documentation of the Life History Review makes an invaluable gift of themselves for their family members by providing them with a historic legacy.

If you are interested in finding out more about Life History Reveiw, please contact Barbara at Distinctive Care 201-857-5283 to explore the possibilities available to you and your loved one.

Alzheimer Advocate

January 8, 2009 at 4:36 pm | Posted in Sophia Heftler, GCM | Leave a comment
Tags: Advocacy, Alzheimer's Association, Alzheimer's Disease

A large percentage of Distinctive Care Geriatric Care Management’s Clients have been diagnosed with Alzheimer Disease. Working so closely with those who suffer the ravages of this cruel disease and the people who care for them have touched my life in so many ways, including teaching me to live in the moment which has helped me through many of the challenges life has provided for me.

With that in mind, when I received an email from the Alzheimer’s Association asking me to join their advocacy program I just had to join. There is not much to it, but it is ever so important!

Basically to be an advocate you agree to periodically receive action alerts which are calls to action asking you to contact your state or federal elected officials regarding crucial votes and decisions being made.

Today I contacted the president-elect to let him know how important funding for Alzheimer’s Disease research…all with just the click of my mouse! It couldn’t be easier.

As an advocate I will also be receiving information updates which will help keep me abreast of issues that are important to me as someone who touches the lives of so many with the disease. Information is power!

It’s so easy to become an Alzheimer Advocate. Just email advocate@alz.org. I hope you to will join as as we try to ensure that our elected officials don’t get left out of important votes. It only takes a minute to join and even less time to contact your elected officials.

For more information about dealing with the challenges involved in providing care for a loved one with Alzheimer’s Disease or other dementias please feel free to speak to a geriatric care manager at Distinctive Care. We will be happy to listen to your concerns and provide you with helpful information.

We can be reached in our Ridgewood office at 201-857-5283.

Regards-

Sophia

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