Is it Time for A Geriatric Screening?

With elder care, there are rarely black and white answers to your concerns. Do you believe that your loved one is exhibiting behaviors that indicate their inability to perform basic or complex tasks? If you find yourself answering “yes,” then you should consider a geriatric screening for your loved one. You can arrange for a geriatric screening through your local hospital or social service agency.

To have a productive conversation with the healthcare worker or elder care provider, be sure to gather enough information about your loved one’s medical condition, legal status and personal preferences.

What is Geriatric Screening?

A geriatric screening is a comprehensive assessment designed to optimize an older person’s ability to enjoy good health, improve their overall quality of life, reduce the need for hospitalization and/or institutionalization, and enable them to live independently for as long as possible. An assessment consists of the following steps:

1. An examination of the older person’s current status in terms of:

  • Their physical, mental, and psycho-social health
  • Their ability to function well and to independently perform the basic activities of daily living such as dressing, bathing meal preparation, medication management, etc.
  • Their living arrangements, their social network, and their access to support services.

2. An identification of current problems or anticipated future problems in any of these areas.

3. The development of a comprehensive “Care Plan” which addresses all problems identified, suggests specific interventions or actions required, and makes specific recommendations regarding resources needed to provide the necessary support services.

4. The management of a successful linkage between these resources, the older person and that person’s family so that provision of the necessary services is assured.

5. An ongoing monitoring of the extent to which this linkage has or has not addressed the problems identified, and modification of the Care Plan as needed.

Who Performs a Geriatric Screening?

A geriatric screening can be done in many different settings such as:

  • a hospital
  • a nursing home
  • an outpatient clinic
  • a physician’s office
  • the patient’s home

Because a geriatric screening is so comprehensive in scope, it can only be successfully conducted by a multi-disciplinary team of experts. This team might include:

  • physicians
  • ancillary personnel
  • social workers
  • physical and/or occupational therapists
  • dieticians
  • psychologists
  • pharmacists
  • geriatric nurse practitioners

You can request a referral for a geriatric screening from a primary care physician. Also, check with any large hospital or university to see whether they have a geriatric assessment unit.

For more information on geriatric screenings, I recommend you review The Geriatric Patient: A Systematic Approach to Maintaining Health. This article by the American Association of Family Physicians provides a detailed review of the standardized assessment tools typically used in an outpatient setting.

Photo Credit: simaje.

Is it Time for Assisted Living?

elder careYou’ve come to this blog for a reason. More than likely, you’ve seen changes in your loved one that have you concerned. They are likely changes that worry you, but have not fully convinced you that your loved one may need additional care. Whether a spouse, or a parent – even an aging sibling, this person has come to an impasse in life’s journey. And it’s at that impasse that you wish to help them overcome.

The first step is getting clarity about what’s going on today, and to temper that clarity with loving compassion and an understanding of what the future may hold. This assessment process can be emotionally challenging. It’s something I’ve learned firsthand.

Take a deep breath, and let’s move on to step one: the assessment of your loved one’s current capabilities and needs.

How is Your Loved One Feeling Today?

Regardless of our age, our bodies are in a continuous state of decline. Whether it is reading glasses, arthritis or a doctor’s warning about your lifestyle, our bodies emit warnings about its decline.

It’s no different with our loved ones, except that while it can be an inconvenience for us, it is a matter of independence for them. Since you are concerned about your loved one, you’ll want to do an assessment.

An assessment looks at four areas where change may have taken a toll on your loved one’s independence: the physical, perceptual, cognitive and psychological manifestations of aging. We’re going to explore those areas with one overriding premise: ensuring their safety, and the safety of those around them.

Physical changes and loss of abilities (to some degree) are natural in the aging process. Your loved one is not the same as they were 10 years ago, or even 5 years ago – any more than you are the same as you were then. With that said, the essential key in the assessment process is to recognize symptoms and actions which fall outside the range of expected and acceptable changes. What defines “acceptable changes”? I would say they are those changes that don’t significantly interfere with the way they’ve lived their daily life.

Many changes are subtle and inconsistent; and many don’t put their lives, or the lives of others, at risk. Truly then, the focus should be on risk management. Continually ask yourself this question: Is my loved one a risk to themselves or others?

The criterion most often used by doctors, social workers, and geriatric care managers is a list of activities of daily living, or ADLs. These are those most common activities, divided into two categories: basic and complex.

The early warning signs are often losses in the realm of complex skills. Usually (but not always) loss of basic ADLs comes later on in the decline in the quality of your loved one’s life. As every person is an individual, so is his or her aging; assessment can only be done on a case-by-case basis.

Basic Skills

  • Ability to feed oneself
  • Ability to use the bathroom appropriately
  • Ability to maintain good personal hygiene
  • Ability to dress appropriately for the season

Complex Skills

  • Cooking
  • Shopping
  • Effective communication
  • Following directions
  • Taking medications appropriately
  • Money management

This list of activities appears rather brief; however you can see that each element listed, whether ‘basic’ or ‘complex’ is essential. Everyone should be able to use the bathroom appropriately, or follow directions.

If your loved one is having difficulties with one or more of these tasks, then they are in a state of functional decline and you should more thoroughly asses the state of their decline and possible solutions. In my next post I will discuss common signs of functional decline in greater detail.

Photo Credit: Flickr user Titoy.

My Experience with Elder Care and Assisted Living

elder careEighty-four percent of Americans over the age of 50 expect an immediate family member to move into a senior living community within the next 10 years, while 24 percent over the age of 65 expect the same for themselves, according to a new national survey of American attitudes on assisted living released today by the Coalition to Protect Choice in Senior Living (CPCSL). The poll found just more than half (51 percent) expect their parents to live in a senior living community within 10 years, with 15 percent expecting the same for their spouse and 10 percent for a sibling.

My Story

I’d like to briefly share the story of the event that started me on this path. I imagine it’s similar to your own in that it begins with an unexpected phone call.

My wife and I had just returned from celebrating our engagement in Greece, and we were sharing stories over bowling with some good friends.

I was the product of a second marriage, and my mom and I had become quite close since my father’s passing while I was in high school. We spoke often, so I wasn’t surprised when my cell phone rang and the caller ID showed it was her.
I was surprised when I answered and it was the paramedics.

Apparently, my mother called 411 asking for my name and phone number as she could not remember it. The operator called 911, and in a matter of minutes, they had arrived, kicked down the door and called me.

My mother had a stroke. I was only 33, and totally unprepared for the depth of emotions, or the complexity of the decisions I was about to face.

That a 73-year old woman had a stroke is not unusual. My mom’s case was unique because of the series of complications that nearly killed her. In the eighteen months following her stroke, she endured major back surgery to remove a staph infection from her spine, a perforated intestine that required stomach surgery, several MRSA infections1 requiring IV antibiotics and a broken hip. She spent several weeks in the surgical intensive care unit recovering from her back surgery. Many of these nights, I feared the worst. But my mom is a fighter.

The medical system these days isn’t designed for long-term recovery. Hospital personnel are highly trained at treating acute problems and dealing with specific injuries and conditions. In fact, we have some of the most skilled doctors in the world.

But when you’re older and recovering from a serious illness, your options are usually to go home, or go to a skilled nursing facility – where staff can provide physical or occupational therapy, administer IVs and perform other functions requiring a registered nurse.

During this time, she spent nearly six months moving back and forth between the hospital and skilled nursing. In January of 2006, I moved Mom from San Diego to Orange County. She graduated from skilled nursing and was on her way to assisted living.

Trust, Hope and Hard Work

When Mom arrived in assisted living, she could not stand or walk and required a 24-hour caregiver. She could not eat or drink on her own and was in a deep state of depression.

While I found much advice on medical conditions and treatment, I found virtually nothing on understanding assisted living. Sure, there were some Websites that taught you the basics, like “make sure a nurse is on duty” or “make sure the kitchen is clean.” But this is my mom and I wanted far better for her. I wasn’t putting her away; I was playing a key role in her recovery.

Because of the lessons I learned – and a lot of hard work on the part of my mother – she is doing very well. In fact, we’ve become very close friends. She walks with a walker; her memories are clear and vibrant. She has a circle of friends and a packed calendar.

She even made it to my wedding. And she looked beautiful. I cried. They say your wedding toast is one of the most important speaking opportunities you’ll ever have. And I consider myself to be a good public speaker, routinely speaking at tradeshows and other events. But when I looked into the crowd and saw my mother smiling, I fell apart.

The joy I felt at seeing her on that special day was overwhelming. So was my commitment to her continued well being. It was my clear intention that she be given every opportunity in her assisted living situation to thrive, to grow, and to be fulfilled.

Recall the statistics at the beginning of the chapter. While I was shocked these numbers were so high, I completely agree. I did some homework. In an informal study of about 40 people, I sensed an almost inevitability about needing assisted living. I also found that financial issues and quality of care topped the list of concerns for both Baby Boomers and their children.

I followed up my informal study with a formal study of nearly 200 families. The Assisted Living Family Attitude and Preparedness Report showed that 75% of respondents believed a friend or family member would soon require assisted living. The report is free to anyone who wants to read it and can be accessed at the link above.

My goal is to share with you some of what I learned through my journey. My hope is that these lessons can make it easier for you and your mom, dad, relative or loved one. I assume you’re reading this blog because you or a loved is considering assisted living. Since you likely haven’t gone through it before, the decisions can be overwhelming. I’ve written this blog to help you make more informed decisions, and to be calm in what is likely to be an emotional storm. I sincerely hope I can help you avoid some of the pitfalls of learning the assisted living ropes.

While a move to assisted living may initially be seen as negative, I know first- hand that with some careful and thoughtful planning, you can make it a huge positive for all concerned. Over the last several years, my relationship with my mother has strengthened. She has become one of my best friends and an integral part of my life.

I hope you enjoy reading this blog and that I’m able to somehow make your journey a bit easier.

Photo Credit: andrewmalone.

Finally, a Vision for Care Referrals That Will Improve Outcomes

Picture this: you’re one of millions of Americans who needs care at home either because of aging, dementia, recovery from surgery or other disabilities.  You’ve got a family—and often an unpaid caregiver who helps with your care.  They’re part of an elaborate team of caregivers, physicians, therapists and non-medical assistance.  I’ve lived this first-hand as I’ve cared for my mother, and I’ve spoken to literally hundreds of families in the same situation.

Insurance companies and other employee benefit programs often deliver these care recommendations.  They do the best they can considering maintaining these programs—and the underlying data—is not their primary business.  Unfortunately, they struggle to extend these programs across the whole company so that each member-facing group can leverage the same data to provide the best care referrals to their members. I’ve just assumed it was one of those “not-yet-solvable” situations, as healthcare technology is always a bit slower than other industries.  So we did the best we could and used what was not an ideal support system.

The Future of Care Referral Programs

I think I finally found a vision for the future.

I ran into a white paper from SNAPforSeniors that really caught my eye.  If SNAP can deliver on this vision—and if insurance companies, call centers and other providers have the vision and foresight to adopt it—it will dramatically change the outcomes of care coordination as part of the age in place movement.  More important, it will give families like mine the peace of mind that we are getting referred to the best matched providers for our care.

I know this vision may not concern some of you, but I highly recommend you check it out.  These types of ideas are the ones that are going to make the biggest impact. If you think your family would benefit from your insurer adopting programs like this, you should let them know.

Here’s the link to the paper – http://bit.ly/aPPsWU.

How to Choose a Caregiver

The title of caregiver is not as obvious as it may seem.  Caregivers can aid in eldercare on many different levels and depending on your needs their roles can provide key benefits.

Benefits of caregivers

Your eyes and ears: Whether you live close by or far away, a caregiver can observe and update you on areas of nutrition, hygiene, activity level, services and other daily issues.

A concierge: Scheduling and staying current with weekly and monthly activities such as doctor’s visits, shopping, hair appointments, and therapy requires phone calls and follow up.  Allow the caregiver to take some of this off or your mind and your to-do list.

An influencer: Communication and opinions by close family members are sometimes not seen as being objective or carry as much weight as a professional caregiver.  Therefore it may be easier on everyone if the caregiver steps in at times to advise the patient rather than a family member.

Finding a caregiver

Before you choose a caregiver, you should determine the range of services you want so that you are making a decision that covers your predetermined needs.  Consider the following:

Make a list of daily activities: By reviewing the activities of a typical day of the patient you will be able to determine the specific duties required.  It helps to create a timeline of activities so that you plan for meals, naps and regular appointments.

Assess the degree of specialty: If the patient suffers from any degree of dementia or physical disability make sure you look for a caregiver with appropriate knowledge and experience.

Determine the need for meal preparation: Not only should you make a choice for a caregiver on their ability to prepare meals if necessary, but also their understanding and ability to create diet-specific meal choices.

Once you have your specific needs list refined, go to the following resources to be connected to the appropriate pool of caregivers to begin your interview process.

Additional resources:

www.caregiverlist.com

www.caregiver.com

10 Caregiver Questions

To make the most of your time during the interviewing process, conduct preliminary interviews on the phone rather than starting with in-person appointments.  Describe the job in detail along with the required hours needed and wages available.  If you feel the applicant may be a good match based on their experience and ability to provide references, then schedule the in-person interview.  It is a good idea to have another family member or friend participate in the interview to provide an objective perspective.  Finding that great match may be easier with a second opinion.

In preparation for the interview, create a list of questions pertinent to the job description.  Ask questions relevant to the caregiver’s experience and expertise surrounding the daily activities list you previously created.

  1. Where have you worked before?
  2. What were your duties?
  3. What type of patient medical limitations have you worked with in the past?
  4. What is your experience cooking for other people (including dietary restrictions)?
  5. Is there anything in the job description that you are uncomfortable doing?
  6. Have you had to deal with a patient emergency in the past?
  7. Can you keep track of and administer medications?
  8. Would you be able to transfer someone from a wheelchair into a car or into a bed?
  9. How do you feel about caring for a disabled person? Or a person with memory problems?
  10. Can I contact at least two work-related and one personal reference?

If you need a template for a caregiver interview, download this form as a guide:

http://www.agis.com/Document/38/professional-caregiver-interview-form.aspx

Once you narrow down your field of applicants, make sure you observe the applicant’s interactions with your family member on a casual basis before making a decision.  If your family member is able, he or she should be included in the interview process and in making the final decision.

Consider the person most qualified for the job and with whom you feel most comfortable. Always check the references of at least two final applicants. Good applicants may have more than one opportunity at a time, so don’t wait too long before proceeding with an offer.

10 Benefits of Culture Change on Skilled Nursing

Culture Change (also known as person-centered care or resident-directed care) transforms the traditional long-term care model from medical facility to a supportive home environment.  This movement is designed to change the overall mindset and environment of nursing homes into personal communities.  Culture change is designed to nurture the human spirit of aging residents as well as take care of their medical needs.  Its focus is on both quality of care and quality of life as guiding forces for improved life experience and life expectancy.

Within the culture change model, seniors have more privacy and choices, much like they would in their own homes.  They are given more control over their daily lives including meal and bed times and the caregivers are given more autonomy to care for residents in this flexible environment.  Residents’ needs and preferences come first, and care community operations procedures are shaped by this perspective.  Even the physical structures are changing from large hospital-like units to smaller communities resembling more of a group-home atmosphere in which they are cared for by a dedicated team of caregivers.

10 Benefits of Culture Change

  1. Respects the right of the resident to make their own decisions and honors their need for control over choices in their daily lives.
  2. Reduces boredom and helplessness in residents.
  3. Improves mental health (reduces loneliness, depression, behavioral issues).
  4. Encourages a personalized home atmosphere by allowing residents to create their own living style in their rooms.
  5. Increases enjoyment and life expectancy of the patients.
  6. Focuses on using person-centered language that respects and honors the patient by putting the person first and then the characteristic second.  For instance, instead of a wheelchair-bound resident, the description is modified to a person who uses a wheelchair for mobility and instead of a feeder the patient is referred to as someone who needs assistance with dining.
  7. Focuses caregivers on person-centered care, rather than completion of tasks.
  8. Individual care focusing on personalized needs and preferences of the staff and the residents creates a supportive environment that puts people first, over the facility.
  9. Promotes a dedicated team approach rather than rotating assignments for staff thereby creating personal connections and familiarity for the residents.
  10. Creates a team-building environment for the staff based on consistency of staff teams.
  11. Reduces employee turnover which in turn keeps a steady team of familiar faces rather than the need for temporary staffing agencies with training needs and learning curves.

The essence of culture change is about transforming philosophies and management style so that aging is no longer synonymous with decline and illness.  The principles of culture change are founded in a new way of caring and being cared for that is based on choice, creativity, and flexibility.  The future of culture change lies in the commitment to improve resident and staff quality of life through empowerment.

For more information on the culture change movement, visit the Pioneer Network.

Photo credit: K?vanç Ni?

Assisted Living Saved My Mom in Oregon

A couple weeks ago I had the pleasure of traveling to Oregon to speak at three assisted living communities across the state.  I posted some pictures of the event on the Inside Elder Care Facebook page at http://www.facebook.com/eldercare.  Brookdale brought me up from California to visit three communities—all from distinct areas within Oregon.  They were:

  • Albany – small towns set in an agricultural area just southeast of Portland
  • McMinnville – right in the center of Oregon wine country
  • Gresham – at the base of Mount Hood (yes, I was cold)

At each community, I gave a talk entitled Assisted Living Saved My Mom—a presentation communities ask me to give that provides an insider’s view about how to determine which assisted living community is best for your family.  Assisted Living Saved My Mom shares many techniques that uncover information you would never get from just speaking to an admissions director.  Brookdale provided a copy of my book to each who attended—something appreciated by the attendees.  Based on the large amount of feedback I received from attending families and people in the industry, the message really hit home and benefited many people.

Despite the obvious differences in the locations of each of these communities, I found a few things in common:

  • Warm and friendly: nearly every person I met—from the staff to the residents—were very welcoming and warm.
  • Pride: there is a strong sense of pride in the residents that carried over to their feeling that it was their responsibility to make new residents comfortable.
  • Camaraderie: I got the feeling that the residents genuinely enjoyed each other’s company. You could tell because they all knew each other’s little quirks and habits—something they found amusing.

One thing that came up repeatedly was the concern over “How do I pay for this stuff?” Many people were surprised there were other payment options beside just selling their house and paying cash.

When I wrote the By Families, For Families Guide to Assisted Living, I interviewed nearly 200 families to ask them about the concerns related to assisted living and elder care.  The issue of paying for elder care came up as a primary concern from almost three-quarters of those families.

The financial issues are the elephant in the room.  Most people don’t know how to solve them or even where to start, because there is no holistic guide for families on how to navigate these issues.  I am a month or two away from releasing my second book that gets into these answers—the feedback from those that have seen it has been really positive.  Stay tuned.