ElderCare Solutions

Geriatric Care Management Services

Reaction to a Recent New York Times’ Article

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Reaction to a recent article in the New York Times:

“Stepping In for a Parent With Alzheimer’s”
“Your Money” section
By TARA SIEGEL BERNARD
Published: November 5, 2010

“Stepping In for a Parent When Alzheimer’s Sets In” offers some good guidelines to protect older adults who face diminished capabilities. I take issue, however, with the “role reversal” suggestion, which implies that the parent is now a child. In fact, an adult with increased needs remains an adult who deserves that ongoing recognition, even as a decline continues. The decline in dementia is variable and can not always predicted, unlike the predictable milestones of childhood. The view of the older adult as child can lead to an overreach in interventions and create more restrictions than warranted. The challenge is to provide the right amount of assistance while maintaining respect for the history and life accomplishments, which remain within the person who, once independent, can no longer do it alone.

Signe Gleeson
President of ElderCare Solutions

Reflections of the Gifts of Aging

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I visit Hank weekly and wonder at his response to my greeting, “How are you?”. His predictable but genuine response is “marvelous”. Hank lives in a nursing home and has one relative who visits briefly a couple of times a month. Otherwise, Hank is left to his own devices. Somehow he accomplishes, with few external resources, being marvelous.

I marvel and wonder what enables Hank and others in the nursing home to cope, what keeps them going and gives their lives meaning. Most older people have a sense of spirituality and/or a religious affiliation, but many elders I know seem to have a simple appreciation for “in the moment” living even without a religious or spiritual foundation.

Hank is marvelous. He teaches all of us who have the fortune to encounter him that life’s challenges lie not in what happens to us, but in how we deal with those challenges in our day-to-day moments.

Many people tend to pity older people and keep a distance from them. Visits are often seen as an obligation rather than a source of pleasure. Perhaps those who travel into their older years are to be envied. Does that fact that they have little future left give them the freedom to be more fully in the present?

The role of philosophy, religion and spirituality in aging and its impact on health and wellness is a growing focus of research. I don’t have a clear insight into the secret of inner peace that I see in so many of the elders I encounter. I believe, however, that it has something to do with the ability to gracefully exchange “being” for “doing.” My time with elders is a reminder that if I can’t make a wholesale exchange, perhaps I can find a bit more balance between the two.

Sharing time with an elder, allowing ourselves to simply be with them in the moment, can indeed be a gift and a reminder to look for that balance in our daily lives.

Choose an Independent Care Manager

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As the public becomes more familiar with the value of care managers for older adults and individuals with serious chronic illnesses, more facilities and agencies are touting their care management services. As in all consumer choices, being informed, discerning and asking the right questions is the key to making sound decisions.

When hiring a care manager, one is hiring an advocate, someone who should have no other interest than the best interest of the individual. Independent care managers have no allegiance except to the individual and family being served. They receive no compensation other than for their care management services. Facilities and agencies that offer and are reimbursed for services — such as caregivers or housing, in addition to care management — have a conflict of interest.

An agency that provides caregivers has a strong interest in keeping their staff and revenue flow in place, even when the “fit” between available caregivers and clients is not right. Additionally, they may have incentives to provide more costly care than is necessary. Most independent care managers will choose from a variety of care services with whom they are familiar to find the best and most cost effective match for the individual and the situation for which care is needed.

Facilities (independent, assisted living or nursing homes) have institutional constraints and preferences. Those considerations can unnecessarily narrow the focus and options in problem solving and may conflict with the best interests and desires of the individual. An independent care manager will consider the facility and will also question assumptions and the status quo to advocate for the needs of the individual. They will encourage creative problem solving that focuses on the strengths, abilities and possibilities that can satisfy all of the client’s needs. A well-informed and experienced care manager can look to resources outside of the facility to improve or remedy a care problem to benefit the facility and the individual.

When investigating senior care management services, inquire about competing or conflicting interests that may influence recommendation or decisions.  To avoid the potential for such conflict, an independent care manager, who does not benefit financially from any referrals made, whether to a provider, a home care agency, or a nursing home, is the best choice.