Caregiver « The Professional Geriatric Care Manager’s Blog

Caregiver Burnout

May 4, 2012 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
Tags: Caregiver, Caregiver Burnout, Health, Help, Life, Love, Personal, Prevention

Caregiver burnout is a state of physical, emotional and mental exhaustion. Caregiver burnout can occur when caregivers do not get the help they need or if they try to do more than they are able. Caregivers who are burned out may experience fatigue, stress, anxiety and depression. Symptoms of caregiver burn out include withdrawal from friends, family and loved ones; loss of interest in activities; irritability; changes in appetite and weight; changes in sleep patterns and emotional and physical exhaustion. A caregiver will face disruption in work and social life, sleep habits, exercise routines, household management and financial situations.

Some have described the caregiver role as a “roller coaster ride from hell.” Each day brings new challenges, demands and adjustments. Caregivers are often so busy caring for another that they neglect their own needs. They may place unreasonable demands on themselves and may even become sick themselves. Many individuals are confused when they are forced to take on the role of caregivers. It can be difficult for one to separate their role as a caregiver from their role as a spouse or child. Many are additionally frustrated by a lack of money, resources and skills.

To prevent caregiver burnout:

Find someone you trust and talk about your feelings and frustrations.
Set realistic goals. Accept you may need help with caregiving.
Be realistic about your loved one’s disease, especially if it is a progressive disease such as Alzheimer’s disease.
Do not forget about yourself because you are too busy caring for someone else.
Stay healthy by eating right, getting enough exercise and sleep.
Talk to a professional such as a therapist, social worker or clergy member.
Take advantage of respite care services.
Educate yourself. The more you know about the illness, the more effective you will be in caring for the person.
Join a caregiver support group.
Accept your feelings. It is normal to have negative feelings, such as frustration and anger.

Remember you need to balance your caregiver role and personal life. Prevent burnout by recognizing problems you may encounter. Reward yourself for the positive differences you make in your loved one’s life. Do not stress over the things you did not get done, or can not change. Focus on the good things you do and acknowledge the reality that being a caregiver is filled with stress and anxiety. The best way to be an effective caregiver is to take care of yourself.

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 Ramsey or Ridgewood Office to schedule a consultation. 201-587-5283.

Melatonin Nightmares?

December 28, 2011 at 10:30 am | Posted in Joanne Jordan, Office Manager | Leave a comment
Tags: Caregiver, Eldercare, Health, Life, Medication

Melatonin has received a lot of press coverage in the last few years, as a supplement which may help improve sleep. It is a natural hormone secreted by the pineal gland in the brain, which regulates other hormones and maintains the body’s circadian rhythm, or “body clock.”

Several of our clients use melatonin supplements (with their doctors’ supervision, of course) to combat insomnia. Recently, the caregiver for one of them reported that our client has been having increasingly frequent vivid nightmares or hallucinations, including the very scary belief that a stranger has entered her home in the middle of the night.

In our weekly case review meeting, our care management team brainstormed possible explanations for this change in her behavior. Is the client struggling with increased anxiety which manifests itself in her dreams? Is this behavior evidence of a new or worsening physical condition such as an infection, or a different form of dementia? Could she be experiencing a drug interaction from the many prescriptions she is on? Could it be simply a side effect of one or more medications she takes? Melatonin is known to produce nightmares in some patients at higher doses.

All of these, and more, are plausible explanations for our client’s change in behavior. These will be explored by her Distinctive Care Geriatric Care Manager, who works closely with her physicians to monitor her care.

If it turns out to be melatonin at fault, discontinuing it or adjusting the dosage should provide prompt relief from the nightmares. And this case illustrates the importance of discussing all supplements with your physician, whether or not they are “all natural” or sold over the counter.

What Hospice Can Do!

December 1, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
Tags: Aging, Caregiver, Health, Help, Life, Personal

Last week was difficult one for me. I experienced my first loss of a client as a Geriatric Care Manager. I was with this client for over 16 months and she was actually one of my first clients with Distinctive Care. She was 92 years old and lived a full life. Working so closely with this woman, who had severe Dementia, and with her family, was so rewarding, both spiritually and educationally. It was a beautiful relationship that I had worked so hard to develop and embrace.

As a nurse for 16 years, I have experienced death of a patient in many different ways. When death happens in the hospital it seems to be so much worse. Patients come to the hospital to find answers and healing to prevent the worst possible outcome. This particular client was placed on hospice during the last 3 weeks of her life (she was on hospice once before for 2 months last year, then eventually graduated off) while she was living in a skilled nursing facility. Hospice is a special way of caring for people who are terminally ill, as well as care for their family members. She received excellent palliative care, love and compassion from the local hospice nursing team and so did her family.

Hospice was even amazing to the entire team that worked directly with my client. The team included her physician, skilled nursing staff, private caregiver and me. Hospice was able to educate her family and her team with frequent updates of her declining status on a daily basis. The family was so grateful to the entire team that assisted with their loved one during her last few days of life. This was my first “close” experience working with hospice. It was truly an amazing occurrence that my so sweet client rightly deserved. Hospice is covered under Medicare, Medicaid and most private insurances. It is best to speak to your physician and health care team to learn more about the benefits of hospice services.

Freedom to Choose

November 9, 2011 at 10:30 am | Posted in Joanne Jordan, Office Manager | Leave a comment
Tags: Advocacy, Caregiver, Facility, Research, Tips

Recently, we received a call from a concerned daughter whose mother is recuperating in a skilled nursing facility following a recent hospitalization. She called Distinctive Care for advice on managing her mother’s plan of care, including possible options for her care upon discharge from the facility.

When we heard which nursing home her mother is in, we were concerned, because it is not a facility we would ever recommend for our clients. Its reputation has suffered for years due to various ongoing deficiencies, and there are better options in the same market area. We asked why the family selected the facility and learned that they went along with the suggestion of the hospital discharge planner, not really understanding that they could choose from many facilities. Of course, bed space and appropriate levels of care must be available, but clients and their families should always be able to make their preferences known.

As geriatric care managers, we pride ourselves on serving as advocates for our elderly clients. We always tailor our referrals to the facilities and professionals who can best care for the individual client’s needs. We encourage family members to take an active role in evaluating facilities and offer guidance on what to look for in a quality skilled nursing or assisted living community. We continually re-assess facilities in our service area to stay abreast of any changes, and our proposed care plans always include several choices of facilities that we believe are best-suited to meet that individual’s needs.

What a Good Read!

July 25, 2011 at 10:30 am | Posted in Pat Linard, PR | Leave a comment
Tags: Alzheimer's Disease, Caregiver, Eldercare, Life, Memory, News, Research

I read a good book recently, Finding Life in the Land of Alzheimer’s by Lauren Kessler. The author is a journalist who feels that she failed in the role of caregiver for her mother who had Alzheimer’s. So when her mother passed away, she decided to give it another try, but in a different way. She went undercover as an aide in a dementia care facility.

What Lauren found was that aides in dementia care facilities are underpaid and usually living from hand to mouth. Their workload is heavy and their day is challenging both physically and emotionally. In many cases, the job of aide is not the only one that they hold. Their day is repetitive in the tasks they do but not in the challenges that interrupt those tasks. Quite often they are the caregiver that is there when a resident falls or has an accident or has an aggressive episode.

What Lauren also found was that she became attached to these elderly men and women with Alzheimer’s and other forms of dementia. Yes, they experienced behaviors typical to the disease, such as repeatedly asking the same question or experiencing episodes of paranoia, but they also had personality. And each one was an individual in many of the same ways that they had always been an individual before they were diagnosed with Alzheimer’s. They were able to experience emotions like you or I, and although they didn’t have a memory of things that just passed, they were able to enjoy life in the moment.

The statistics for Alzheimer’s are staggering and worth us paying attention to as a nation, and as a world. Today, 5.4 million Americans are living with Alzheimer’s disease. By 2050, as many as 16 million Americans will have the disease. Of Americans aged 65 and over, 1 in 8 has Alzheimer’s and nearly half of people aged 85 and older will have the disease. For more information on this devastating disease, go to Alz.org. Geriatric care managers and other healthcare professionals can help families in caring for a loved one in caring for those with dementia. To find a geriatric care manger in your area, visit CareManager.

Did You Take Your Medicine Today?

July 15, 2011 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
Tags: Caregiver, Health, Life, Medication, Personal, Tips

Nearly three in four Americans do not follow doctor’s orders for taking prescription medications. Medication non-compliance, the failure to take drugs on time in dosages prescribed, is as dangerous and costly as many illnesses. It is a problem that is associated with 125,000 patient deaths each year, 23% of nursing home admissions and 10% of hospital admissions. One in three never fill their prescription. Some forget to pick up their prescription from the pharmacy. Others skip doses, or do not take the correct amount of the drug. Some who begin taking the medication correctly, end up eventually stopping the medication due to side effects, forgetfulness, desire to save money, or disbelief the medication is necessary or working.

A drug can not work if you are not taking it! Among the elderly, the reasons they fail to take their medications can range from cognitive issues, to depression and physical problems. Staying on medications takes a lot of work and commitment. Individuals are sometimes overwhelmed by the number of different medications they are prescribed. Those that live alone or are unmarried are more likely to miss medications.

Non-compliance is a battle that caregivers, healthcare providers and patients have to fight together. Many studies have shown that compliance increases when individuals are reminded to take their medication at doctor’s visits or with follow-up calls and visits from nurses. Some pharmacies now have reminder services, where they either call the client or alert the doctor when their patient fails to refill a prescription after a certain amount of time. Special pill boxes, such as the ones divided into sections, can be found at most drugstores and are helpful in reminding people to take their medications. As a nurse and a geriatric care manager, I fill pill boxes at weekly visits and maintain an updated medication list in the home of my clients to promote compliance. We all must work to improve compliance, as it has been shown that decreased compliance leads to worsening symptoms, decline in health, increased hospitalizations and in some cases death.

My First Year As a Geriatric Care Manager

June 16, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
Tags: Caregiver, Eldercare, GCM, Life, Love, Personal

I usually never write about myself in these blogs. But, I thought that it would be nice to express myself this week about what I have liked so much about my new career choice as a Geriatric Care Manager (GCM). I have now completed my first year as a GCM. It is so hard to believe a year has gone by so quickly. I was worried when I left my previous position. Was this new path going to be as rewarding to me as I hoped it to be? I always need to feel that I have accomplished something big. This GCM position had to really make me feel it was so worth my while. So far, it really has. I find this newly found career as a GCM so satisfying. It has really made a large difference in my life. I treat each of my clients as if they were part of my own family. Seeing my clients happy and medically stable is what I can only strive for. I am constantly using my nursing skills. Great nursing skills are very much a part of this position. Being able to help people with all my years of experience and knowledge is a wonderful feeling. Also, learning about all these new resources that are available for our older adults in our community is so remarkable; Home Health Care Agencies, Transportation Services, House Cleaning and Maintenance Services, Pet Therapy, Senior Exercise Specialist, Geriatricians, Psychiatrists, Neuro-Psychiatrists, Elder Care Lawyers and the list could go on.

Having so many exceptional resources available and working with a wonderful staff has in fact made my change to becoming a GCM a relatively easy transition. I am learning something new about the geriatric patient and medicine every day. I really enjoy this and always want this to transpire in my career as a Registered Nurse and GCM. I can see what a difference I have made on my clients well being as I see the change on my weekly visits.

Falling…Up?

June 1, 2011 at 10:30 am | Posted in Joanne Jordan, Office Manager | Leave a comment
Tags: Aging, Caregiver, Eldercare, Falls, Help, Life, Tips

According to the American Academy of Family Physicians, falls are the leading cause of injury-related visits to emergency departments in the United States and the primary cause of accidental deaths in persons over age 65. Falls account for 70 percent of accidental deaths in persons 75 years of age and older.

Risk factors for falls in the elderly include increasing age, medication use, cognitive impairment and sensory deficits. Here at Distinctive Care, our R.N. geriatric care managers try to identify these risk factors and implement changes to minimize these risks wherever possible. We conduct a comprehensive assessment of each new client. Among the many components of the assessment is a 130-point safety checklist of the home, which includes looking for things like loose throw rugs, as well as a complete medical history and review of all medications which can increase fall risk.

Clients are often unaware of little changes that can be made to improve the safety of their living environment. After all, in many cases, their furnishings have been in place for years, and they’ve never had a problem. But they fail to realize how increasing age and increasing fall risk go hand in hand. It helps to have a trained eye review the living environment to identify potential pitfalls.

Overcoming Dysphagia

April 21, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
Tags: Aging, Caregiver, Family, Health, Help, Life, Prevention, Tips

I wanted to provide a follow-up on my blog from last week about one of my clients that was having difficulty swallowing (Dysphagia). I found out earlier this week that she has been upgraded back to a regular diet coupled with thin liquids. I was so ecstatic that she has bounced back and has regained her happy state of mind and comfort level to return to her usual diet. She had announced to her family, her caregiver and myself that she is in a much better state of mind and feels very safe and comfortable in her new nursing home facility. It was very important to her family, geriatric care managers, caregivers, doctors and therapists that we get our client back to where she once was with her eating habits, nutritional intake and requirements. This client knew that we were not going to give up on her.

With determination, perseverance, positive reinforcement and a great speech therapist team, a person who is having problems with Dysphagia can truly work through it. Here are some good exercises that may help you or someone you know regain the ability to swallow normally.

Tongue exercises are a very effective way to improve swallowing ability.
Lip exercises are very important for the movement of food around the mouth, as well as subsequently swallowing. The lips create a tight seal which prevents food and liquids from leaking out of the mouth during the initiation of the swallowing reflex.
Jaw Exercises. These muscles used during chewing are controlled by the brain, and if a stroke or accident occurs, it can affect the way we chew. Jaw exercises can dramatically improve the ability to swallow.
Swallowing Exercises. When dysphagia results from a stroke of emotional problems, the best way to regain swallowing ability is by performing actual swallowing exercises that are taught by a speech therapist.

Sometimes dysphagia is so severe that a patient is required to have a temporary, or even permanent, placement of a feeding tube. It is an extremely difficult decision for someone to make whether or not a feeding tube is needed for you or someone close to you. Talk with your doctor, about the possibility of the being an absolute necessity. I know it was a very hard for my client’s family to think about placement of a feeding tube. But, again I am so thrilled that my client had overcome so many obstacles and returned to her regular diet and food that she enjoys so much.

Alzheimer’s Association Annual Conference

April 15, 2011 at 10:30 am | Posted in Sophia Heftler, GCM | Leave a comment
Tags: Alzheimer's Disease, Caregiver, Dementia, Education, Memory, Seminar

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.