San Diego caregivers

Here are a few of the most important principles of “compassionate communication” with Dementia patients. Caregiver “do’s and don’ts” benefit of the Alzheimer’s Association.

Don’t

- Don’t reason
- Don’t argue
- Don’t confront
- Don’t remind them they forget
- Don’t question recent memory
- Don’t take it personally!

Do

- Give short, one sentence explanations
- Repeat instructions or sentences exactly the same way
- Allow plenty of time for comprehension
- Eliminate “but” from your vocabulary; substitute “nevertheless”
- Agree with them or distract them to a different subject or activity
- Accept the blame when something’s wrong (even if it’s fantasy)
- Leave the room, if necessary, to avoid confrontation
- Respond to the feelings rather than the words
- Be patient and cheerful and reassuring – go with the flow
- Please elevate your level of generosity and graciousness

Remember

- They are not crazy or lazy. They are saying normal things, and doing normal things, for an AD patient. If they were doing things, or saying things, to deliberately aggravate you, they would have a different diagnosis.
- Some days they’ll seem normal, but they’re not. Their reality is now different than yours and you cannot change them. You can’t control the disease. You can only control your reaction to it.
- Their disability is memory loss. They cannot remember and can’t remember that they cannot remember. They’ll ask the same question over and over believing it’s the first time they’ve asked.
- They do not hide things; they protect things by putting them in a safe place and then forgetting they’ve done so. Do not take ‘stealing’ accusations personally.
- They are scared all the time. Each patient reacts differently to fear. They may become passive, uncooperative, hostile, angry, agitated, verbally abusive, or physically combative. They may even do them all at different times, or alternate between them. Anxiety may compel them to follow you everywhere. They can’t remember your reassurances. Keep saying them.

San Diego caregivers should remember how important it is to structure daily care when dealing with their patient or loved one with Dementia. Familiarity and consistency is a great comfort to elders with Dementia. Routine conveys security and a sense of visceral continuity even while their continuity of memory is failing.

Like the rest of us, elders with Dementia need to be loved and cherished and respected for who they are. One woman we care for in her mid 80’s has developed a new talent for portrait painting and has regained a new, joyful sense of herself in this artistic expression. She feels whole when she paints. Focus on the positive and what is meaningful and pleasurable in the elder’s life. Maximize relationships with family and friends. A dearly loved pet can be as good as any medicine on the market. Maximize all opportunities for connection and affection and being “useful,” or needed.

San Diego caregivers must take care of themselves as well. If they are getting tired and burned out, they should ask for help. Contact the Alzheimer’s Association for support groups and various supportive interventions. If you are a family member of a loved one with Dementia and have caregivers that care for them, consider hiring a professional Geriatric Care Manager to assist and support your caregivers as well as the family. You don’t need to walk through this alone.

Information from the Alzheimer’s Association at www.alz.org.

Geriatric Care Managers

“Falls, depression and insomnia should not be overlooked,” says Dr. Barbara Krantz, medical director for the Hanley Center, a west Palm Beach based addiction treatment and recovery center.  She says these often are signs that elders are not taking their medications correctly or have too many medications or the wrong combinations of medications. It is not unusual for elders to have 7 – 15 different medications prescribed by different doctors. This is a recipe for disaster.

Dr. Krantz says that senior adult admissions in centers like Hanley are up 450% since 2000. Some of the elderly are on so many different medications, along with opiod pain killers and anti-anxiety medications like Xanax, mixed with alcohol that this problem is often behind what appears as other things.

Family members and friends should pay attention to any changes in an elder’s condition and report to their primary physician. Changes in appetite, weight, balance and gait, sleep habits, appearance or sudden mental confusion, etc. are signs that something may be amiss in the medication regime or that opiods and/or alcohol are being added to the mix.

If you are concerned about changes in your loved ones medications and/or behaviors, call a Geriatric Care Manager to help.

Geriatric Care Managers

If you have an elder loved one who has suffered a stroke and they’ve come home after hospitalization no doubt they will either be attending outpatient therapy or be having visiting therapists through a “home health” agency. Your home health therapists as wonderful as I hope they are will not be able to stay long per MediCare regulations.

Unless your loved one makes what is considered significant “functional progress,” (a subjective metric to be sure) they will be discontinued rather quickly. Even if they make what the therapist thinks is “significant progress,” home health is not designed to actually take the patient to the next level of their rehabilitation. One therapist I was speaking to recently said that they’re goal is just to “tweak” their home health patients. That comes as a real surprise to many patients and their families who expect substance and not tweaking.

Medicare used to be able to stay in place longer while the patient was making good progress but now MediCare cannot afford to pay for this longer-term rehabilitation. From what Geriatric Care Managers see on a regular basis in the community, they’re even having problems providing adequate short-term rehabilitation!

The length of time that home health agencies will stay on to provide therapy varies somewhat however three times a week for a few weeks to a month is not unusual. This simply does not give the stroke patient the best shot at recovery of their optimum function.

Clearly, stroke rehabilitation takes longer than a few weeks. Stroke patients can continue to make good progress for months to literally years after the event with the right help. A broad body of clinical research has been gathered over the past two decades showing that the brain has far more capacity for healing or “neural plasticity” than was previously thought. I have many stroke patients that have continued to recover function years after their stroke. They have achieved their true optimum function and highest possible quality of life due to skilled advocacy, intervention and private therapy.

There are options. Call a Geriatric Care Manager for assistance in getting the skilled assistance you and your loved ones deserve.

How can backs stand that for years and years? Nursing of any sort is not a back friendly occupation.

San Diego caregivers I remember, their amazing energy and utter dedication to their patients: Pat at Redwood who though only just shy of 5 feet, could handle 6ft plus men as artfully as a dancer on a stage; or Jose who was always kind and respectful to his patients; or Regina, Maria, Sol, Megan and Cecilia who were faithful in years past and continue to be faithful to one man for nearly a decade. There’s Barbara who daily amazes us with her skill and her humor in making life lovely and worth living for my longest standing client. There’s dear Priscilla with equal parts sweet and savvy.

I continue to be humbled and inspired by the men and women who care for others as their life calling. The caregivers who are not given all the respect due to them by a culture who doesn’t value care for children or elderly at home. Caregivers who don’t have the titles, the prestige or power of the licensed health care professionals they work with. They are however the most important factor in care for the elderly.

San Diego caregivers; nurses, care managers, doctors, therapists, come and go. Caregivers stay with their client’s day in and day out. They love those that don’t have any family left, they are friends to those whose friends have mostly died, they are surrogate sons and daughters to soothe the ragged edges of loneliness that turns into a slow torture as the days and years drag on.

There must be a special crown for these faithful caregivers in heaven. I would like to see them start to wear it here on earth.

A typical pattern with an overloaded caregiver may unfold as follows:

- 1 to 18 months – the caregiver is confident, has everything under control and is coping well. Other friends and family are lending support.

- 20 to 36 months – the caregiver may be taking medication to sleep and control mood swings. Outside help dwindles away and except for trips to the store or doctor, the caregiver has severed most social contacts. The caregiver feels alone and helpless.

- 38 to 50 months – Besides needing tranquilizers or antidepressants, the caregiver’s physical health is beginning to deteriorate. Lack of focus and sheer fatigue cloud judgment and the caregiver is often unable to make rational decisions or ask for help.

It is often at this stage that family or friends intercede and find other solutions for care. This may include respite care, hiring home health aides or putting the disabled loved one in a facility. Without intervention, the caregiver may become a candidate for long term care as well.

With the holiday season upon us, caregivers feel even more stress — with planning, shopping and participating in holiday activities. This is a perfect time for family and friends to step up and provide some respite time and caregiving help.  Whether it is provided personally or arranged as a gift of services to be provided by a professional respite company or home care provider, it is a welcome gift.

An article in “Today’s Caregiver” states:

“Nearly one in four caregivers of people with Alzheimer’s disease and other dementias provide 40 hours a week or more of care. Seventy-one percent sustain this commitment for more than a year, and 32 percent do so for five years or more. One of the best gifts you can give someone caring for Alzheimer’s is something that relieves the stress or provides a bit of respite for the caregiver.
The Gift of time: Cost-effective and truly meaningful gifts are self-made coupons for cleaning the house, preparing a meal, moving lawn/shoveling driveway, respite times that allow the caregiver time off to focus on what he/she needs.”

It is also important to note that hiring professional care provider services can provide valuable ongoing support to an overloaded caregiver. A financial planner, care funding specialist or a reverse mortgage specialist may find the funds to pay for professional help to keep a loved one at home. A care manager can guide the family and the caregiver through the maze of long term care issues. The care manager has been there many times — the family is experiencing it for the first time.

An elder law attorney can help iron out legal problems. And an elder mediator can help solve disputes between family members. There are also cash benefits for Veterans, who served during a period of war, that pay for home care or assisted living.

If you are the one providing daily care for a loved one, you owe it to yourself to seek help.  Take care of yourself and your needs, both physically and mentally.  Seek out professional help that will ease your burden and look for community service organizations that offer respite help.

The National Care Planning Council’s website www.longtermcarelink.net contains hundreds of articles with tips and advice for caregivers and their families.  Take a few minutes to find the help you need.

Article from the National Care Planning Council

http://www.longtermcarelink.net/

Several stroke victims shared their struggles and achievements. One young man, a traumatic brain injury victim, shared his journey with us and in the presence of these very brave souls, I felt humbled and inspired.

According to San Diego Brain Injury Foundation, brain injury affects over two million people each year. These injuries occur every 23 seconds. Over 11,000 people-survivors and family members- are affected by brain injury each year in San Diego County.

The causes of brain injury include: motor vehicle accidents, military related injuries, falls, sports injuries, industrial accidents, strokes, aneurysms, tumors and illness.

Geriatric Care Managers work with brain injury patients to support their home care, their medical care plan and their rehabilitation goals. We function like coaches and personal advisors to both patient and family. Unlike home health which can only visit the brain injury patient for a short time post discharge from hospital, Geriatric Care Managers are in for the long run.

There is so much support available for those in San Diego recovering from brain injury. Call SDBIF or visit their website at www.sdbif.org for more information.

Geriatric Care Managers

Dr. Sean Morrison, a geriatrician from Mount Sinai Medical Center suggests that some basic things are sometimes overlooked when elderly patients go into see their primary care doctors. Physicians are often focusing on a “presenting” problem and fail to recognize three major problem areas of huge risk to the elderly. A simple case of not seeing the forest for the trees.

The three areas most overlooked according to Dr. Morrison are:

1. Dementia

2. Risk of falls

3. Incontinence

In the first case, the patient seems alert and oriented however a simple query to the family or caregiver may tell a different story. Doing a simple MMSE or mini mental state exam (a baseline cognitive function test) would show the patient’s cognitive baseline and if they need more assistance with their activities of daily living or if they may be vulnerable to undue influence.

In the case of fall risks, both standing and dynamic balances should be assessed. An example is given of one very wise primary physician who actually goes out of his way to observe his elder patients as they get out of the chair in the waiting room and walk to the exam room. In addition, elders with poor balance or who are especially fragile and alone need a basic safety assessment of their home just to see if there are throw rugs and other obstacles that make falls more likely.

In the third case, incontinence as common with the elderly as hypertension and diabetes, is often difficult to admit let alone talk about. There is a social stigma involved that makes open communication around this issue very difficult.

These three aspects of elder’s lives are very critical to the continued well being and independence of elders in the home. Primary care physicians should take the extra steps needed to assess whether these hidden dangers are waiting like land mines in their patient’s risk profile.

If you are a family member who is aware of these things with your loved one, be sure to speak up and let your health care practitioners know what these very real concerns are and what your feelings are around these issues. Most always they will appreciate your input and observations so that they can provide better care to their patients.

If family members are unavailable to communicate about these things, hire a Geriatric Care Manager to make sure your health care providers have the whole picture on your elderly loved one’s condition and risks at home.

San Diego caregivers

While medical and geriatric professionals are important to navigating the difficult obstacle course that is chronic illnesses, the only ones in the home of dependent elders on a regular basis are usually the care givers. Whatever plan is laid out by the doctors, nurses, social workers and even family, most of the time, the care giver is the one who is actually onsite with the elder and has to execute the plan.

That is a lot of responsibility. At very least, the care giver is the only one who can notify the family, the doctor, the geriatric professionals that the plan is not being implemented or simply isn’t working!

San Diego caregivers need to be educated as to what the plan is for their client. This means they need to understand what medications their client is taking and know what they are for. They need to be aware of when their client is not taking medications and report that to their supervisors who can in turn then notify the doctors or other professionals in charge. They need to be aware of the nutritional status of their client and be sure to provide the right diet as well as encourage their clients to eat.  They need to be aware of their client’s skin condition and whether they are getting enough fluid of not. Dehydration can pose a huge health risk as it can contribute to low blood pressure and a host of other problems.

Caregivers need to be careful about safety issues in the home paying special attention to anything that may pose a fall risk to their client.

They need to be aware of any “changes of condition” especially changes in their client’s “level of consciousness,” and again be proactive in communicating this to their supervisors and care managers.

Obviously, this is not an exhaustive list but just long enough to make the point that caregivers are invaluable sentinels of elder health in a home and community based setting.`

While care giving for home bound elders is not a “medical” role, it is however critical to the elder’s health and wellbeing that their non-medical caregivers understand that they need to be on their toes, aware and communicating all the aspects of their client’s care in order to meet what is an ever rising community standard for San Diego caregivers providing elder care at home.

One of the benefits of hiring a Geriatric Care Manager is that they can monitor medication use and side effects.Anticholinergics are one family of medications that are on the usual offender list. This family of drugs blocks the neurotransmitter acetylcholine and includes such common drugs as Paxil, Detrol, Demerol and Elavil. Common sleep aides such as Tylenol PM, Excedrin PM both contain Benadryl which is an anticholinergic as well. Geriatric Care Management‘s role in patient advocacy is to protect their clients from not only polypharmacy but from “PIM” as well.

The most well known reference for which drugs are not tolerated well by the elderly is called the “Beer’s List.”  This is the standard to consult when reviewing your loved one’s medications for possible inappropriate medications. Beer’s list is not limited to anticholenergics but many of the medications on the list are.

Anticholinergic medications tend to produce these side effects:

1.      Dry mouth

2.      Constipation

3.      Blurred vision

4.      Confusion

5.      Urinary retention

6.      Dry eyes

7.      Drowsiness

One geriatrician quoted this saying when trying to make an impression on his audience at a workshop. When describing how these meds make the elderly feel, he said it makes them “Red as a beet, dry as a bone, blind as a bat, hot as a hare and mad as a hatter.”

Anti-cholinergics tend to slow GI motility, decrease secretions and increase heart rate. They decrease tolerance to heat and put the elderly at risk for cognitive decline and decreased overall function.  Always review your loved one’s medications with your primary physician and pharmacist for potentially inappropriate medications. Sometimes the medications on the “Beer’s List,” cannot be avoided and your primary physician has made the determination that the benefits outweigh the risks of the particular medication being used.  However, it is worth having the conversation to see if there are safer options which could be used. If there are not, then there may be counter measures to be used to be proactive in decreasing some of the expected side effects.

Quality control of medication usage for elderly clients is one of the functions of good Geriatric Care Management.

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While is it obviously a good thing to have caregivers background checked, live-scanned and trained, it is simply not enough. It is not even the most important part of vetting the caregiver who will take care of your loved one in the most vulnerable time of their lives.

The most important piece of making the right match for a caregiver is investing the time to observe if the skill level of the caregiver is adequate and the personalities of the caregiver and client match for this relationship to be “therapeutic.”

Far too many times have I gone into a patient’s home who has a caregiver and they are wholly inappropriate for the client.  This is because either they haven’t been trained thoroughly enough in the specifics of care for their particular client or the caregiver is clearly detached and disconnected from their client. The match is anything but therapeutic.

Making the right fit for your loved one is an art and practiced only by people who are professionals dedicated to providing customized care. Don’t go to a one size fits all company to provide the right match for your loved one. It’s best to go to a San Diego caregiver company who will take the time to make sure you have the right match.

You wouldn’t put your children in the care of someone who has simply passed a background check and you are sure is not a felon. You wouldn’t think of trusting your children to caregivers only because they are “bonded” and “licensed,” according to minimal standards. You would make sure the caregivers were really skilled people who loved children and with whom your child felt safe.

Our elders deserve the same care and diligence when choosing their San Diego caregivers.

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