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To Drive Or Not To Drive, That Is The Question

Posted on December 12th, 2015 by karen

by Joan Blumenfeld, MS, LPC

Driving with my dear old friend, Sarah, was becoming scary!

One evening, Sarah picked me up to go out for dinner. On the way, as we approached a red light, she was chatting with me and not paying attention to the road and we bumped right into the rear of the car in front of us. Thankfully no one was hurt, and neither car was damaged. The scariest part was that Sarah seemed to have no idea of the danger into which she had put herself, me and the occupants of the other car.

Her car was taking on an increasing number of small scrapes and dents. She was getting lost on her way home on familiar roads that she had been driving for years. The police were called four times in six weeks to locate her.

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Transitioning To Assisted Living: A Work In Progress

Posted on March 4th, 2015 by karen

by Joan Blumenfeld, MS, LPC

My 85-year-old client, Henry, lives alone as he always has. He retired long ago from his lifetime career as a history professor. He never married, has no family presence locally and is fiercely independent.

Although his health is generally good and remarkably stable for his age, Henry shows signs of frailty. His mind is quite sharp and he is very charming, but his memory lapses are alarming. He uses a cane to help steady his walk and, although he is still driving, his vision is certainly not up to snuff. He admits to being lonely since his few friends have moved away or died.

Henry has difficulty managing money and paying bills on time. He can barely take care of his marketing, cooking, laundry and housekeeping, but sees no need for help with any of it. He often doesn’t make or keep medical appointments and frequently forgets or misplaces his medications.

Henry is the perfect candidate for assisted living!

I aroused his curiosity about such facilities by telling him stories of how well some of my other clients have fared in them. The idea of eating three well-prepared and nicely served meals a day in a hotel-like dining room was especially appealing to Henry. Having nurses on staff to respond to medical emergencies and aides to assist with personal care seemed reasonable (only if absolutely necessary, of course). And people to talk to and play bridge with actually sounded like fun.

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In Praise Of Nursing Homes

Posted on June 11th, 2014 by karen

by Joan Blumenfeld, MS, LPC

Anthony lived alone. He was 82 and suffered from multiple medical problems. He was diabetic, his balance and gait were dangerously off-kilter, and he was clinically depressed and sometimes a little confused. He had never fully recovered from hip-replacement surgery and consequently used a walker. He had an irregular heartbeat that occasionally caused him to pass out. All of which put him at very high risk for falls.

He could no longer drive and seldom went out. He mostly sat alone slouched in a chair, isolated in his dimly lit apartment looking at television. His dining table was cluttered with bottles of medications (some out of date) that he clearly was not taking with any consistency. For a man who had been meticulously neat about his appearance, he was now often unshaven and unkempt. His clothes were frequently stained, and his full head of white hair was left uncombed. Sometimes his refrigerator contained spoiled food, and he was losing weight because of poor nutrition.

Anthony was fiercely independent, a stoic member of the “Great Generation,” used to toughing it out by himself. He had a daughter who lived nearby, but he refused help from her and most other sources as well. He did allow an aide to come in for a few hours each week to assist with bathing and to take him on errands and to market, but that help was not nearly commensurate with his actual needs.

Anthony was rapidly declining. His present was dreary and his future was bleak. And then the accident that changed the course of his life occurred: he blacked out and fell down the stairs. He was shaken and bruised, but fortunately did not break any bones.

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Geriatric Care Managers: The Help You Need?

Posted on March 12th, 2014 by karen

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:

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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The Heart Of Hospice: Why It Works

Posted on February 26th, 2014 by karen

For the last several weeks, we have been featuring some of our favorite blogs from years past. This entry was first published by In Care of Dad on October 24, 2011.

by Joan Blumenfeld, MS, LPC

I think I know why many families are afraid to engage the hospice alternative. It’s partly because they don’t really know what hospice offers, and they’re worried that some useful treatment may be discontinued or bypassed altogether.

And some families believe that involving hospice is tantamount to giving up and inviting the event they are most afraid of: the loss of a loved one.

I also think I know why doctors are reluctant to recommend hospice for patients facing potential end-of-life situations because it goes against their years of training to heal and to cure. Maybe it feels like a personal defeat for them — they are fix-it people with the best of intentions. Doctors can request a hospice evaluation for their patients when it seems appropriate, but it’s clearly hard for them to let go of the procedures they’ve been taught and used repeatedly to great and humane success.

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Enjoying The Moment, One Gift At A Time

Posted on December 10th, 2013 by karen

by Joan Blumenfeld, MS, LPC

Buying gifts for Mom was always easy. It didn’t matter if it was something to wear or something to eat, something to read or something for her kitchen. It didn’t matter if she really loved it or not. And it didn’t even matter if it was only a pink and black lanyard I made for her while at summer camp. She was always so appreciative and gracious in accepting whatever I brought her that I was certain I had found just the right thing.

What did matter to Mom was that I thought of her — that I loved her and that, whatever the gift, it was a true expression of my feelings for her. And her delight in the simplest of gifts continued even as she sank further into Alzheimer’s devastating grip.

However, what did change was the range of gifts I could select for her. As her abilities diminished, I had to become more creative. She could no longer read, so books were out. She could no longer cook, so kitchen gadgets were out. She lived in a nursing home where dressing up in finery was no longer practical, so elegant clothing and fine jewelry were out.

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In Praise Of The “Therapeutic Fiblet”

Posted on November 7th, 2013 by karen

by Joan Blumenfeld, MS, LPC

We all agree that lying is awful. It’s rotten and reprehensible. People lie to escape punishment for doing something they know is wrong or for manipulating others to their own advantage. But a therapeutic fiblet — now that’s another matter altogether! A therapeutic fiblet is kissing cousin to a white lie and delivers a partial truth, something to guide another person in a direction that is deemed to be good for them, even when they would prefer to be left alone.

At first, the very concept of a “therapeutic fiblet” really went against my grain. But over time I’ve learned that it can be quite a useful tool, especially when working with people who have dementia, and when the full, unvarnished truth would only escalate their agitation and resistance.

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The Family Conversations You Shouldn’t Put Off

Posted on October 15th, 2013 by karen

by Joan Blumenfeld, MS, LPC

Important conversations with your parents about their future can be really difficult. They have managed their lives very well without your interference, thank you very much! They may appear to be stubborn and inflexible, but in reality their attitude has an undercurrent of fear: fear of losing independence; fear of losing control; and, ultimately, fear of death. So it’s no wonder these conversations can be tense and emotional.

Nevertheless, you can all agree on at least one thing: the goal for the future is for your parents to live as independently as possible, for as long as possible. In the interest of achieving that goal, it is imperative that you talk with your parents about their future before there’s a medical, financial or emotional crisis. These conversations can never be too early but can easily be too late.

So here are 10 topics to discuss, and the sooner, the better. They are listed in order of least likely to be emotionally charged for most families, beginning with the simplest of requests, updating all personal information. Recognize that these conversations are a long-term process, not something to be rushed through or approached clumsily. Respect, affection and humor are excellent tools to employ when discussing such delicate matters, but resistance and disagreement should be expected along the way. The overall purpose, though, is to help your parents as they age and to make their late-life transitions as smooth as possible.

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Alcoholism And The Elderly: A Dangerous Mix

Posted on September 12th, 2013 by karen

by Joan Blumenfeld, MS, LPC

Alcohol and the elderly are a risky combination. Older adults metabolize alcohol very differently from younger people. Consuming alcohol in moderation at age 50 may have a modest effect. But the same amount imbibed at age 80 can seriously impair judgment, balance and the ability to manage daily life.

Lifelong alcoholics will likely experience brain and liver disease by the time they reach their 70s and 80s, while some older adults begin drinking in their later years, quietly but heavily, to alleviate the grief and depression that results from the death of a spouse or family member, as well as other big and small losses that accrue with advancing years.

So it behooves those of us who care about the elderly to take a close look at the problems caused by excessive drinking, and also at the available treatment options.

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Wrenching Choices At The End Of Life, Part II

Posted on June 24th, 2013 by karen

by Joan Blumenfeld, MS, LPC

I read an obituary last week that gave me pause. It was for a Mr. John Davis who died at age 87, peacefully, at home surrounded by his loving family. A true marvel in this age of high-tech medicine, an incredible array of medications for every ailment, and frequent hospital admissions for the elderly. I was envious!

Too often these days we die alone in a hospital bed, tubes in every orifice, surrounded by machines that beep and blink and hordes of medical personnel, all struggling to prolong life instead of allowing for a natural death. We seem to be so much more concerned with preserving life at any cost than we are at letting go when it’s time.

In the interest of my own end-of-life concerns, I have signed advance directives that give my adult children the responsibility of making decisions for me if I am unable to do so for myself, and I have spoken to them about this innumerable times. I know full well that when such a time comes, they will have to make difficult choices between maintaining my life even if there is no quality left or letting nature take its course.

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