ComForCare Home Care Serving Somerset & Northern Middlesex Countries

Archive for Aging

Monday , October 31 , 2016

Support for Family Caregivers: We Can Do Better!

In a presidential election cycle full of so many distracting and distressing non-issues, some of the pressing needs of American families have had less attention than they merit. Childcare, the cost of education, and preserving social security and Medicare have all received at least some attention and found a place on the candidates’ websites. Rightly so. These are areas of vital importance to the strength of American families and the nation as a whole.

But how to help families care for seniors has not been a significant part of the national dialogue. Don’t you think it should be? Families receive very little help in the vital task of caring for elders or the disabled. They struggle to fulfill this responsibility in the way they want—with love, compassion and the respect their parents, grandparents, aunts and uncles deserve. But they could use some help.

Thankfully, poverty among seniors is significantly lower than it was prior to the passage of the social security act in 1935 and Medicare in 1965. These were major achievements of the 20th century that led to real quality of life improvements for the elderly and families overall.

But neither of these programs directly address the burden on families of providing care for those who need it. What’s more, the past few decades have seen important changes in our economy and family structure that require us to re-think the support families need. Historically, unpaid family labor—largely provided by women—was a resource that we took for granted. That can no longer be the case. Women both want to and, for urgent economic reasons, must be contributors in the workforce.

In addition, improvements in health care mean that we are living longer. For some people these bonus years are healthy and productive, but many others do need care and help.
We need new tools to support seniors and families. I often speak with families who are shocked that Medicare benefits do not cover in-home help for the elderly, or do it on an extremely limited basis. Medicare addresses critical health needs caused by illness and injury and simply isn’t designed to assist someone who needs ongoing help with bathing, toileting or meals.

Yes, if you are hospitalized and discharged home, Medicare will provide very limited (perhaps 4 hours a week), short-term (perhaps 3 or 4 weeks) of home care service by a home health aide. If you need more than that or if you need the help ongoing, you are on your own.  Full information about the Medicare home health benefit can be found at https://www.medicare.gov/Pubs/pdf/10969.pdf.

I know from talking with hundreds of family caregivers how many are truly struggling to make ends meet and to provide the best quality care for loved ones.

Are you a family caregiver? If so, what are your needs? In your wildest dreams, what could your local community, or your state and national government do to support you and your family?

What would help you both realize your own potential and fulfill your loving commitment to family?Would it be more paid-time-off for caregiving? More access to information about resources? Being able to accrue social security even when, for caregiving reasons, you are not in the paid workforce? Having more public funding for professional in-home care? More affordable long-term care insurance? More services that come to the home?

Give me your thoughts! You can email me at somersetnj@comforcare.com. Put “Support for family caregivers” in the subject line. Your responses will contribute to the content of future posts.

 

Posted in: Aging

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Sunday , July 5 , 2015

Talk to Me

There are many ways dementia can lead to social isolation, but one of the first is that verbal communication becomes challenging for dementia patients. Sadly, family and friends sometimes respond by talking to them less. This is a real shame because all of us, dementia patients included, have a deep need to communicate with others. Talking to and listening to other people is crucial for helping dementia patients maintain socialization, emotional connection and cognitive ability.

When we interact with dementia patients we need to understand that communication is still taking place, even if the conversation doesn’t go the way we would expect. Communication can exist, in fact, even if our conversational partner is repeating herself, not finding the right words or not making sense. The rhythm and pace of conversation, the tone of voice, the facial expressions and the response we make to the mood of the speaker are all very important. These things help us keep a human connection with the dementia patient and create opportunities for moments of clarity and understanding.

So much is lost if we stop making the effort to have conversations or (one of my big bugaboos) if we talk over the heads of the dementia patients to others in the room instead of including them in the conversation.

What’s more, if you’ve spent time with early- and mid-stage dementia patients you know that clear communication can come and go, almost as a camera can drift in and out of focus. If you aren’t able to understand what you are being told at the moment, just wait. You never know when a ray of wit, clarity or insight will flash through the mist and dazzle you.

A few years ago we were providing care for a married couple who lived close to my home. At first, we had a home health aide there for just a few hours a week. Over time, the care need expanded, and eventually we were with them around-the-clock.

These two were quite challenging to care for, but a total delight to know. The wife was wheel chair-bound due to a couple of falls, and she also had a little memory loss. The husband, on the other hand, was physically quite robust, but rapidly progressing into advanced Alzheimer’s.

The wife was Florence. She was kind and quietly friendly to everyone–a reserved and gentle person. Her husband Vince was small and slight in stature, but full of energy. He had an outsized, expansive personality, a huge toothy grin, and lots of great stories to share.

These two had many accomplishments in their long and collaborative marriage. Both had served in World War II. Florence in the Women’s Army Corps (WACs), and Vince in the army, where part of his duties had been to give navigational guidance to American pilots flying into Germany.

The walls of their small townhouse were hung with numerous paintings Vince had made after the war. They were scenes of small town neighborhoods and soft evening light. For decades he had managed a thriving photography business in Manhattan, but he was a painter by avocation and the walls of his home showed his skill.

Like many Alzheimer’s patients, Vince’s mind was quite sharply present at times. Other times his thoughts took some lengthy detours of time, person and place. Awareness came and went. With help in the home, most days he was managing quite well.

One day I got a panicked call from our home health aide, telling me that, while she was helping Florence in the bathroom, Vince had wandered out of the house. That’s when we realized we needed a lock high on the inside of the door.

But, in the meantime (Oy vey and Sacre bleu!) our gentleman was on the loose. The home health aide went in pursuit and, as I was nearby, I joined her in few minutes. We found him quickly and gave him a friendly escort home.

Vince wasn’t quite sure what had just happened, but he did have a sense that we had rendered him a service. So like the true Manhattan gentleman he was, he felt a tip was in order. He clutched his pants with his left hand and rummaged deep in his right pocket to find us a $10.00 bill, staggering and almost losing his balance in the process.

It took another five minutes to assure him that the service we had rendered was negligible…”our pleasure… no gratuity required, truly.” Then it was dinner time, and the day ended happily.

Another time I had driven the couple to a doctor’s appointment and, while Florence was being seen, I sat in the waiting room with Vince. To pass the time, I asked him about his service in World War II. Like many dementia patients, his long term memory was often quite sharp and he loved talking about this time in his life.

Remembering that his wife had also been in the military, I asked him, “So, Vince, when you were stationed in France, where was Florence?” His bushy eyebrows raised a bit and he replied slowly (as though to a slightly slow-witted school child), “In the middle of Italy.”

Nothing wrong with his geography.

Posted in: Aging, Dementia, Home Care

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Tuesday , April 21 , 2015

Seeing the Whole Elephant

Remember the ancient Indian parable of the blind men and the elephant? In the story, six blind men are brought before an elephant. Their task is to figure out what it is they are dealing with. But each man’s experience of the elephant is limited to the part right in front of him. Touching the elephant’s trunk gives a completely different experience than touching the ear or leg, so they come to very different conclusions about what the elephant is.

So often our experience of being a patient in the health care system can feel like being that elephant. Every specialist we see understands a part of us, but no one is looking at the big picture, or seems to have responsibility for making all the parts work harmoniously.

That’s certainly what I felt after my mother had surgery to remove a hematoma in the brain resulting from a fall on her back porch. There was a neurologist, a cardiologist and a pulmonologist to track down and get updates from. But you could never get them in the same room at the same time. And no one pulled all the data together to present to me. No one spoke for the whole person that was my mother.

Even worse, at moments, I could see her through their eyes and realized they were seeing a passive, diminished person. She looked somehow shrunken sitting in a chair in her hospital room. And, face it, no one looks powerful in a hospital gown.

But she was only 78, and I knew that just a week before the surgery, despite some health problems, she was a dynamic, vital woman who was looking forward to starting another season of teaching her piano students. She had been teaching piano and music pedagogy for over 50 years. She was a recent past president of the Music Teachers National Association.  In many ways, she was just as smart and just as on top of her game as the doctors were. It was painful that they didn’t see it.

That experience informs the way I want to interact with our home care clients. No matter their age or health status, these are human beings with goals, values, abilities and desires that matter. Our job is to give them support for their health and well-being with as little compromise as possible to their independence and personal integrity.

To succeed in this we need to gain an understanding of the whole person. That means considering not only a client’s health needs, but her personality, physical environment, social support network and her preferences. Everything from the client’s medication schedule to the fact that he prefers his coffee in the blue cup can be important to providing high quality, respectful care.

We are fortunate in home care that we can take the time to talk to the families and clients we serve and get to see them as individuals. Our initial RN assessments and interviews are extensive. Our nurse always asks the client what his or her goals are, and we judge our success by how close we can come to achieving them.

And with my mother’s experience in the health care system in mind, we spend a lot of time communicating with other care providers and encouraging them to share important information with the clients, their families and each other.

Looking at the whole person helps us do a better job for our clients, and it makes our days a lot more fun and interesting.

Posted in: Aging

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