January 28, 2016

Frequently Asked Questions

Frequently Asked Questions

1) Did you know if you or your loved one requires assistance at home following a stay in a hospital or sub-acute rehabilitation facility, there are professionals who may assist you in your home?

Upon discharge from a hospital or rehabilitation facility, it is essential that you have an advocate, either a capable family member, friend or professional care manager, to ensure that your hospital or skilled nursing facility discharge plan includes assistance at home from a nurse, occupational therapist, physical therapist, speech therapist, and/or home health aide, as needed.

Without effective advocacy upon discharge, you or your loved one may not get the support needed upon returning home. You may need a nurse to provide medical care and education to the patient and/or their caretaker regarding new medications and/or protocols. You may need an occupational therapist to assist you with daily living tasks that many of us take for granted. You may need a physical therapist to exercise and strengthen the body. You may need a speech therapist to help you or a loved one relearn how to speak following a stroke or other brain injury. And, you may need a home health aide to assist you with activities of daily living and/or instrumental activities of daily living (ADLs and IADLs).

2) Did you know that if you or your family member suffer from diminished capacity due to aging, illness, or other ‘non-acute’ processes, and you need custodial care (assistance with ADLs and/or IADLs) at home, you will need the assistance of an advocate, either a capable family member or friend, or professional geriatric care manager, to help identify your needs and to procure assistance?

You or your family member may struggle with memory loss and/or diminishing physical capacity that renders you unable to live independently at home. You may need the assistance of a home health aide with ADLs and/or IADLs. You may also need a nurse to teach a caregiver how to properly assist with the administration of medications such as insulin. You may benefit from an occupational therapist, physical therapist, and/or speech therapist. You may also benefit from art, music or psychotherapist to further enrich and enliven your life. These professional services can ensure that you or your loved one are properly cared for and supported so you may continue to live a safe and meaningful life at home. CompassCare Assistants can help with many of these factors on a longer-term basis once the immediate need is not so acute.

Most of us don’t realize that at some point in our lives, we will need long term ‘custodial’ care at home, and Medicare or private health insurance won’t pay for it!

If you or a loved one are unable to live independently at home, you will need Long Term custodial care: someone to assist you anywhere from a few hours per week to 24 hours a day, seven days per week.

Long Term custodial care can mean assistance with activities of daily living (ADL’s) such as eating, grooming, dressing, bathing, toileting, and transferring from a bed to a chair. It can also mean assistance with instrumental activities of daily living (iADL’s) such as managing medication, cooking, driving, shopping, keeping track of finances, and using the telephone or computer.

Medicare and private health insurance will only provide a limited amount of home care for a limited time following a hospitalization or an acute care episode. Therefore, unless you meet the stringent criteria to become eligible for Medicaid, the government program that covers long term custodial for the indigent and/or disabled, you are on your own!

Therefore, in order to obtain long term custodial home care, you will need to pay privately. There are a few ways that people obtain the funds to pay for care: 1) use their savings, 2) activate a long term care insurance policy that covers homecare and/or care management, or 3) obtain a reverse mortgage on their home to generate funds to use for care.

Most of us don’t realize that at some point in our lives, we will need long term ‘custodial’ care at home, and Medicare or private health insurance won’t pay for it!

If you or a loved one are unable to live independently at home, you will need Long Term custodial care: someone to assist you anywhere from a few hours per week to 24 hours a day, seven days per week.

Long Term custodial care can mean assistance with activities of daily living (ADL’s) such as eating, grooming, dressing, bathing, toileting, and transferring from a bed to a chair. It can also mean assistance with instrumental activities of daily living (iADL’s) such as managing medication, cooking, driving, shopping, keeping track of finances, and using the telephone or computer.

Medicare and private health insurance will only provide a limited amount of home care for a limited time following a hospitalization or an acute care episode. Therefore, unless you meet the stringent criteria to become eligible for Medicaid, the government program that covers long term custodial for the indigent and/or disabled, you are on your own!

Therefore, in order to obtain long term custodial home care, you will need to pay privately. There are a few ways that people obtain the funds to pay for care:

  1. use their savings,
  2. activate a long term care insurance policy that covers homecare and/or care management, or
  3. obtain a reverse mortgage on their home to generate funds to use for care.

After years of living independently, it can be difficult for many of us to accept that we need help. This problem is further compounded by our cultural emphasis on the value of independence above all else. In addition, older adults often resist accepting help due to a fear of burdening their children.

There are two ways to approach this issue: one is to attempt to chip away at the cultural prioritization of independence at all costs, which after a lifetime of adherence to this cultural norm, may prove difficult, or, two, to ease your family member step by step into relationship with a caring, supportive, and engaging caretaker.

There are numerous creative ways in which to introduce a prospective caregiver to your family member in a non-threatening way. The one you choose can be tailored to the particular personality and interests of your loved one. For example, if your family member loves good food, you might choose to have the home health aide arrive simply to cook a few meals. Or, if they love art or music, a home health aide with similar interests can be expertly matched to your loved one. Or, a home health aide can begin by driving your family member to the doctor, a card game, or lunch at the senior center, and start the relationship gradually as you would any other.

We can help our family members reframe the prospective relationship with a caregiver from one that is solely about accepting help to one that emphasizes human connection, empathy, and respect. This can help them to accept the care that is needed and maintain their dignity in the process.

Did you know that your doctor may not know the various procedures, protocols, and/or medications prescribed by your other doctors?

One unfortunate outcome of the movement towards specialization in medicine is the need for many doctors to treat one person. And, as we age, the number of specialists we see increases. One person may be seeing several doctors, but those doctors may not know what the other doctors are prescribing. Though we also continue to see our primary care doctor, they often are unable to provide the vital role of care coordination for their patients.

When a patient has several doctors and is unable to understand and communicate among and between them, they are in need of a professional geriatric care manager! Geriatric care managers are professionals that are trained to advocate for their client and communicate their health history, current medications, and current health issues to their doctors and to their families. Geriatric care managers accompany clients to their doctor appointments and update their other doctors, caretakers, and family members regarding new protocols and/or medications prescribed.

The health care coordination that geriatric care managers provide is vital as it fosters communication between patient’s doctors and importantly, prevents duplication of efforts, and/or prescription of medicines or procedures that are contraindicated based on what another doctor has prescribed.

   Often, when a parent needs care and there is more than one child, the responsibilities of caretaking are divided in a practical manner. For example, if one sibling lives closer to the parent, they may be responsible for more daily caretaking, and the other sibling may be in charge of the finances, legal planning, etc. However, even though the care is being shared based on practical considerations, there may be underlying resentment by the day to day caretaker child because she/he is bearing more of the primary responsibility for the parent.
 
   In order to avoid the buildup of resentment and family conflict, it can be helpful to meet with a professional geriatric care manager who is trained to listen to each child?s point of view as well as that of the parent in need of care, to provide a safe space to openly explore past and current family dynamics, the wishes of the children and parent/s, as well as the practicalities of dividing the caretaking responsibilities.
 
   Through an open dialogue at the beginning of the caretaking process, and throughout, geriatric care managers can provide a space to discuss difficult feelings and address issues head on to prevent conflicts and divisions within the family.
 
   The process of caring for an aging parent can be daunting and often brings to the fore family dynamics that have been in place since childhood. It is always a good idea to enter and move through the care taking process with the support and guidance of a trusted professional who can help ease this enormous life transition.

Compass Care’s 7 Choices™

Life is all about the choices we make.  Although life is unpredictable and many things are ultimately out of our control, Compass Care’s 7 Choices™ document is a ‘living will’ that will allow you to clearly articulate your personal choices regarding your medical and personal needs and desires in the event you are/become seriously ill.

7 Choices™ is designed to prompt serious thought about important decisions that should be very personal, but very often, are made by others in a vacuum.  It allows you to choose the person you wish to make medical and financial decisions for you, and it allows you to state how you would like to be treated when, and if, confronted with certain health situations.

7 Choices™ is also intended to spark a conversation regarding a topic often avoided in our culture: end of life wishes. If you are an older adult, it will allow your health care team; your family and your friends to clearly understand how you would like to be treated in the event of serious illness.  This will allow all of them to be there for you, as you would like to have them when you need it most. The difficulty of their decisions regarding your care will be mitigated because they will know your wishes and choices.

Download a copy here:

CompassCare’s 7 Choices™ VER1.3 (JAN 2019)

What you will find inside:

1. The Individual I Want to Make Medical Decisions on My Behalf
2. The Individual I Want to Make Financial Decisions on My Behalf
3. What Quality of Life Means to Me
4. Medical interventions
5. What I Want to Convey To My Family And Friends
6. The Types of Comfort Measure I Want
7. How Others Interact With Me

Memory loss is one of the most common reasons older people or their families seek medical attention.

To be sure, a certain amount of memory loss is normal with aging, in the same way we all experience changes in reflexes, strength, vision, and other areas as we get older. Geriatricians sometimes call this “physiologic” memory loss or “normal for age”.

However, a variety of diseases or conditions can cause memory loss in older people that is not normal. Especially concerning is memory loss that begins to interfere with daily functioning, such as missing doctors appointments, getting lost, or difficulty taking medications on schedule.

It’s critical that memory loss be treated like any other medical symptom; namely that it receive an appropriate medical evaluation as to cause. While all patients and families fear diseases like Alzheimer’s as the basis for memory loss, that is not always the case. A variety of medical conditions ranging from thyroid abnormalities to medication side effects -can cause memory loss. More compellingly, some of those causes are reversible when the underlying problem is addressed.

When memory loss winds up being from a less reversible cause (like certain dementia), there are still a variety of lifestyle interventions and medications might can slow the progression; another reason to get memory loss properly evaluated.

Sometimes the first indication that something is amiss in an older person’s life is difficulty handling personal finances. Checks may suddenly start bouncing. A letter may come from the utility company threatening to turn off the electricity because bills haven’t been paid. Previously sophisticated and successful investors may suddenly make uncharacteristically risky and ill-advised stock trades. Another very common and serious scenario is an older person being taken advantage of by scammers intended to fleece them out of hard-earned retirement saving.Why does this occur? While sometimes difficulty managing personal finances can signify the early stages of Alzheimer’s or other Dementias, this is not always the case. Recent research suggests that normal aging can cause changes in the brain that can affect judgment, trust, and risk perception. Also, There are many treatable conditions that can affect reasoning and financial literacy. These range from thyroid disorders to the mental side effect of drugs.
 
That’s one of the many important reasons why an older person beginning to exhibit difficulty in managing personal finances be formally evaluated – to make sure that a treatable condition is not being missed.
 
But let’s say your loved one is found instead to have a progressive condition that is causing this difficulty. While that’s certainly hard to come to grips with, there’s still a lot you can to make sure you or your loved one is protected. This includes making sure a variety of legal documents have been created to protect them. In addition to conventional and living wills (also known as advanced directives) this should include a legal power of attorney that enables someone to make financial decisions should you or your loved one become truly incapable of paying bills and handling more complex financial matters.
 
Older people in this situation are also unusually susceptible to fraud and other forms of exploitation. Often family members learn this far too late, sometimes after retirement savings have been decimated. Awareness of this vulnerability enables you to keep a respectful eye on things.
 
By putting some simple safeguards in place, you can avoid lots of headaches when it comes to handling personal finances.

What is Dementia/Alzheimer’s Disease?

Dementia is a condition where there is a decline in memory or other cognitive skills that affect a person’s ability to perform daily activities.  Dementia is caused by damage to neurons in the brain.  This damage can cause changes in behavior and cognitive function.  Alzheimer’s disease is the most common form of dementia.  With Alzheimer’s disease, the damage and death of neurons ultimately cause a decline in bodily functions resulting in death.

Who suffers from Dementia/Alzheimer’s Disease?

As of 2014, an estimated 5.2 million Americans have Alzheimer’s disease.  This includes an estimated 5 million people age 65 and older and approximately 200,000 people under age 65 who have younger-onset Alzheimer’s.  The vast majority of those with Alzheimer’s disease are age 75 or older.  The prevalence of Alzheimer’s disease is expected to rapidly increase as the baby boomers age.

How does Dementia/Alzheimer’s effect the family caregiver?

Caring for someone with Alzheimer’s disease can be a heavy burden impacting the health, family relationships, finances, and employment of the family caregiver. However, there are ways to minimize the caregiver burden.  Caregivers who have help caring for their loved one receive much-needed respite that allows them to focus on their other responsibilities at home and work.  Some other helpful evidence-based interventions are caregiver support groups, mindfulness-based stress reduction, and psycho-educational groups with both family caregivers and early-stage Alzheimer’s patients.

How can Compass Care help?

Compass Care Assistants (“CCA”) receive extensive training through our Home Care Institute in best practices of caring for people with Alzheimer’s Disease and Dementia.   Our CCAs receive hospitality training that is focused on the development of a nurturing and supportive caregiver relationship.  Our caregivers receive specific instruction in the behavioral effects of Alzheimer’s Disease and Dementia and we provide concrete strategies for how best to manage and assist with these behaviors.

What is Palliative Care?

Palliative care is specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness.  The goal is to improve the quality of life for both the patient and the family.
 

Who can benefit from Palliative Care?

Palliative care provides extra support that is appropriate at any stage in a serious illness and can be provided alongside curative treatment.  It can improve the patients’ ability to tolerate medical treatments and helps the patient to gain control over their care by improving understanding of the choices for treatment.
 

How does Palliative Care help the family Caregiver?

Palliative care helps the patient and family by alleviating pain and anxiety associated with serious illness.  There are several methods for addressing pain and anxiety such as drug therapy, counseling, visualization, cognitive methods, and relaxation therapy.  Palliative care is provided by a team assembled to meet the needs of the patient and family.  The team aims to provide support to the patient and their family through a better understanding of the illness and treatment, open and supportive dialogue, and symptom relief.
 

How can Compass Care help?

Compass Care Assistants (“CCA”) receive extensive training through our Home Care Institute in best practices of caring for people with serious illness and in end of life care.   Our CCAs receive hospitality and communications training that is focused on the development of a nurturing and supportive caregiver relationship.  Our CCA caregivers receive specific instruction in the objectives of Palliative and Hospice care and are trained to work with a team to best support the patient and their family.