Archive for the ‘Care Options’ Category

If Only There Was A Second Time Around

Posted on July 9th, 2015 by karen

If Only There Was A Second Time Around

by Kim Keller

As another anniversary of our father’s passing — July 16th, to be exact — approaches, my sister Karen and I find ourselves once again filled with regret for all the lessons learned, far too late in life, about how to help someone you love through serious illness.

Dad’s health issues lingered for quite some time, but during the last year of his life, he deteriorated at a tumultuous pace. It was a painful ordeal, and if it were possible to go back in time, Karen and I would do many things differently.

We would have more actively:

  1. Insisted that our father seek better medical care earlier in his illness. The critical lesson here: sometimes you just have to travel farther for better hospitals and doctors. Dad made his choices based primarily on location, and while we often questioned the quality of his doctors and their related facilities, we weren’t comfortable pushing this point with him, until it was far too late in the game. Given what we now know, we would have kept researching hospitals in the region until we found a teaching hospital with MAGNET status. Teaching hospitals generally attract higher caliber doctors, and a MAGNET designation indicates an impressive level of quality care bestowed upon patients by the nursing staff. Naturally, there are great hospitals that are not teaching facilities, as well as many without MAGNET status, but it’s an excellent place to start.
  2. Focused on how Dad could reduce the amount of medications he was taking. He had lots of specialists, especially as his health unraveled, and each doctor added a new prescription or two. Not enough attention was paid to the possible side effects and adverse interactions caused by combining so many medications. In fact, rather than scrutinizing the burgeoning list of drugs that were being pushed at our father, each new medical issue that cropped up heralded another new prescription. Given what we know now, we would have discussed the medication list with all the various specialists, starting with these five questions: (1) Are any of Dad’s symptoms a possible side effect of another medication? (2) What are the potential side effects of each drug? (3) Is this drug safe and/or effective for someone over 65? (4) Are there any issues to watch out for when this drug interacts with Dad’s other current medications? (5) Is there any harm in changing Dad’s diet and/or exercise regimen rather than prescribing another new medication? And to help us with our own research, we would have used, which is a great tool for fleshing out medication problems.
  3. Talked with our father about end-of-life issues. Dad already had a living will in place, so we thought we were covered in this important area, but we were wrong. We soon discovered that many common scenarios needing to be fully vetted are not handled by the average living will. For example, do you continue with aggressive treatments when they can’t cure you but can only sustain a bedridden life? Not an easy question to discuss, and we certainly never discussed this as a family, but at a certain point late in the illness, Dad was no longer able to give his input, and continuing treatments no longer held any promise of recovery. We decided to maintain the full-on treatments, but we’ve never been sure this was what Dad wanted. If we’d known back then about the critical importance of a wide-ranging end-of-life discussion, we would have used It’s an important resource that walks you through the fundamental questions that every family needs to consider.
  4. Established ourselves as coordinators for keeping track of all communication between and amongst the various medical personnel and caregivers attending to Dad. Karen and I just didn’t understand, at least not at first, that someone had to pull together all the various pieces of information relating to Dad’s care, from medication mandates and treatment instructions to exercise orders and diet alterations. Counting on the medical teams to coordinate and communicate was not realistic. We eventually learned to keep track of everything and to communicate everything. There was nothing too big or too small. Here are some of our charts and checklists.
  5. Created a support team around us to help us anticipate needs, develop a plan, make better decisions, and clue us in on available resources and tools. Frankly, back then we didn’t even realize we needed a support team, other than our father’s medical attendants. Dad had been sick for so long that we never would have believed we were facing his final year. Without a support team, we spent way too much time being reactive, putting out fires, floundering with decision-making. If we could do it all over again, without the pain and torture that Dad surely experienced, we would’ve reached out to people who had been down this path before. There are many places to start building a team: in-home care agencies, for example. Or local religious organizations, many of which have outreach programs, geriatric care managers, and senior centers. When we finally did build our team, we were relieved and finally confident that we were making sound decisions. We didn’t understand at that point how close we were to the end, but we were at least able to spend our time in a far more important and valuable way: loving our father and enjoying every last minute with him.
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In Care of Dad: A Look Back At 2014

Posted on December 24th, 2014 by kim

good caregiving tips

by Kim Keller

I remember when I was a kid, rolling my eyes at my parents when they’d talk in wonder about how fast time goes by. Of course, that was a long, long time ago, and here I am now thinking, where did 2014 go? I don’t roll my eyes any longer. Now I just smile knowingly.

And at the end of December, my parents would sit around and reflect on all that had happened that year. I thought it was kind of silly then, living in the past and all, but I see the wisdom in that now, too. You should always bring along the lessons and whatever good life has to offer.

In that spirit, here’s a look back at In Care of Dad in 2014:


“I will never leave you — no matter what happens I will always be with you.”

Unbeknownst to both of us at the time, those would be the last words my father would ever say to me. That one sentence would carry me into my fatherless future, like a road map to guide me on the sometimes perilous, sometimes heartbreaking, always blessed journey of my life.

— Ann Meyers Piccirillo, Always Your Daughter, January 22, 2014.


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Geriatric Care Managers: The Help You Need?

Posted on March 12th, 2014 by karen

Screen Shot 2014-03-12 at 2.15.44 PM

by Joan Blumenfeld, MS, LPC

People frequently ask me what Geriatric Care Managers actually do. Though I answer the question in plain, clear English, my replies often don’t seem to hit home. So I am taking this opportunity to write a blog that explains, in vivid detail, exactly what we do to contribute to the optimum care of our frail, elderly clients.

As a group, Geriatric Care Managers are highly qualified professionals with advanced degrees in social work, counseling or nursing. We have many hours of supervised experience working with older adults and are either members or associate members of the National Association of Professional Geriatric Care Managers. We are especially good at advocating for our clients by locating and engaging the best, most appropriate resources in the community for their benefit.

We advocate, coordinate, manage, supervise and plan for the short-term and long-term care of our clients. We educate, guide and support their families. Our overarching goal is to help clients remain in their homes comfortably and safely for as long as possible and to help with life’s transitions whenever they become necessary. We build expert care teams using our extensive community networks in the fields of medicine, law, finance, social services and others.

Engaging the services of a Geriatric Care Manager is especially helpful for families who live at a distance from their elders and for family caregivers who work full-time while raising their own children. It really does take a village!

That being said, exactly what do Geriatric Care Managers actually do? Here are a dozen examples of specific contributions I have made to the well-being of my clients over the course of my 17 years in practice:

  1. I stayed in the ER with a client for seven hours, until she was admitted to the hospital. During that time I handled the multitude of repeated questions from doctors and nurses that my client was unable to answer, kept her calm and fetched warm blankets when she got cold.
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Financial Planning: Understanding Medicaid

Posted on March 27th, 2013 by kim

"Money money money" by Andrew Horowitz

by Kim Keller

I never imagined my father would need to be in a nursing home. The idea was profoundly sad but Karen and I realized that our mother could no longer manage Dad’s care at home, not even with help.

But there was yet another looming disaster: how would our parents pay for this care? They had no long-term-care insurance plan. Their money would be gone soon, as a consequence of Dad’s medical bills. Where would that leave him? And where would that leave our mother who still had a lot of living left to do?

It quickly became evident that we needed to understand our options and develop some sort of financial plan, in case our parents ran out money.

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Essential Hospital Discharge Planning

Posted on February 21st, 2013 by kim


by Kim Keller

“Nearly one-fifth of Medicare beneficiaries — roughly 2 million beneficiaries per year — discharged from a hospital return within 30 days,” according to the Medicare Payment Advisory commission.

That’s a frightening, and preventable, statistic. One major factor is poor discharge planning. The process is often rushed and slapdash, and fails to protect patients from relapsing and winding up back in the hospital.

That’s why Karen and I felt pretty fortunate that our mom’s recent stay at Shands Cancer Hospital at the University of Florida in Gainesville was professional from top to bottom, with a well-considered discharge process.

It’s critical to get this step right. So, whether your own local hospital does this well or not, it’s a good idea to have a discharge checklist ready when you find yourself in this position. Here’s the one we rely on:

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Everything Goes Better With Rehab

Posted on February 19th, 2013 by kim


by Kim Keller

On January 7th, my rather independent mom walked straight into the hospital, ready for surgery. But after several days, I realized that she wouldn’t be able to walk back out as we had hoped.

My sister and I had been thinking that she’d be in the hospital for four or five days, and then she’d go back home to start her recovery. But it didn’t work out as planned. Instead, Mom spent twelve days in the hospital, with most of the time in Intensive Care.

Mom had undergone surgery related to her November 2012 diagnosis for colon cancer. Unfortunately, stabilizing her after surgery became problematic and resulted in her unexpected stay in the ICU.

I knew from past experience that a hospital only keeps a patient when they’re being actively treated. Once Mom’s vitals stabilized, I knew the hospital would undoubtedly be looking to move her out.

At that point, though, I couldn’t imagine how she’d be able to go home safely. The surgery and accompanying complications had taken their toll — her energy was sapped and she couldn’t even get out of bed without a great deal of assistance.

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When Home Alone Is No Longer Safe

Posted on January 31st, 2013 by karen

by Ed Moran, LCSW

I don’t think I can pinpoint the exact moment I first noticed my mother was getting older. Sure, I know on an intellectual level that Mom, like everyone else, gains a year with each birthday, but I’m talking about the physical changes that accompany aging. They were so subtle at first that I hardly took note. Though Mom is still very active at 75 and sharp as a tack, I’ve begun to wonder what life will be like for her in five or ten years. Can she stay in Florida, or should I try to bring her to Connecticut to live with family? Should she sell the house? Will she need home care? Will she need assisted living? Will she want any of these things? And what if she doesn’t want them? What will I do then? You may have noticed already how my anxiety over Mom’s advancing age is beginning to color my thought process, which is not necessarily a bad thing, if kept in moderation. Understanding our own feelings about our aging parents — anxiety and all — is crucial for making the best decisions about their care.

My mother has been very good about communicating her wants and needs, as well as discussing pertinent “what ifs.” If additional care were ever needed, I think my siblings and I would have a great chance of being on the same page with each other, as well as with Mom. But what about the situations where an aging parent is resistant? Naturally we all worry about our parents, especially if they’re alone. We see signs that living independently is becoming increasingly difficult, yet the parent denies the need for help. The situation becomes even more complicated when one parent accepts the need for change while the other parent resists.

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Finding Dedicated Doctors Makes All The Difference

Posted on January 21st, 2013 by kim

by Kim Keller

“Mom put her lipstick on today!”

I joyfully announced this during my daily round of phone calls to concerned family and friends. I realize it doesn’t sound like it should be such a big deal, but it was. Everyone I told laughed knowingly and then sighed with relief.

As I’ve reported earlier in these pages, just before Thanksgiving my mom was diagnosed with early-stage colon cancer and went into the hospital six weeks later to have the cancerous part of her intestine removed. For a variety of reasons, stabilizing her after surgery was difficult. She spent more than a week in intensive care, but when she finally got up today and applied her Maybelline “Yummy Plummy” lipstick, we all knew she was finally on the mend.

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Save Your Pennies!

Posted on November 15th, 2012 by karen

by Joan Blumenfeld, MS, LPC

In Connecticut, if a person can pay for nursing home care out-of-pocket for several months, or in some cases show enough assets to pay privately for a year, they can select the facility they want and reduce waiting time. If they have spent down their assets and are subsequently accepted by Medicaid, then Medicaid will select the facility, depending on wherever there is a long-term bed available. Thus, setting aside money to privately pay for nursing-home care allows people to make crucial choices they cannot otherwise make.

My 72-year-old client, Sylvia, was outliving her money. And her worst nightmare was inexorably unfolding.

Sylvia was recovering from a stroke and was about to be discharged from rehab when I was hired by the court-appointed conservator to manage her care. Sylvia desperately wanted to return to her nine-room home in one of Connecticut’s lovely shoreline suburbs, but she was ill-equipped to do so.

As a result of the stroke, her walking was impaired, though she could ambulate unsteadily with a walker. One arm and hand were weakened. Sylvia had already been experiencing some dementia, which was exacerbated by her stroke, leaving her judgment and ability to manage her money, her meals, her medications — her life in general — severely diminished. She also struggled with an unrelated life-long mental illness that resulted in hallucinations and delusions, which impaired her relationships with others and required careful medicating.

From a Geriatric Care Manager’s point of view, Sylvia was a challenge!

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When Pride Delays The Need For Help

Posted on March 1st, 2012 by karen

When Pride Delays The Need For Help

by Myra Marcus, Ph.D.

My mother turned 91 this past December.  A strong, stubborn, and determined woman, she prides herself on her ability to drive, play bridge, manage her finances, and even have a boyfriend.

She has no qualms about summoning an ambulance at 2 a.m. when she experiences chest pains, and she knows if she’s convincing enough, she’ll be admitted to the hospital.  This does not mean that she is crying wolf — it is just her way of getting the care and attention she feels she needs.

She is also quite canny and has figured out how the health care system in this country would leave her behind if she was not able to advocate for herself.  She prides herself on her independence and resilience but she is tired — tired from the stress and strain of “keeping up” and never “letting go.”

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