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:
- use their savings,
- activate a long term care insurance policy that covers homecare and/or care management, or
- 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.
Your Will
Did you know if you die without a will, the State will decide to whom your assets are distributed, and if you have minor children, to whom the guardianship of your children will be granted?
The provisions of your will determine how your personal property, and all assets that do not have a designated beneficiary, and thus, do not pass by ‘operation of law’, will pass. If you do not have a will, and die ‘intestate’, each state has laws that govern who the beneficiaries of your estate will be. Even if you think that you have taken measures to designate beneficiaries of all of your assets, or if you think you don’t have enough assets to warrant making a will, it is still important to have one, because if you die intestate, an Administrator will be appointed by the court, initiating a lengthy, costly, and unnecessary legal proceeding.
Lastly, and most importantly, if you have minor children it is imperative that you have a will! Only through a will can you legally designate a guardian of your choice to care for your children.
Your Power of Attorney
Did you know that if you become unable to handle your finances, unless you as the ‘Grantor’ designate a Power of Attorney (also called an ‘agent’ or ‘attorney in fact’), your loved ones or a state agency, will have to initiate a lengthy, costly, and unnecessary legal proceeding called a Guardianship?
A Power of Attorney enables you to designate an agent (or co-agents), to handle your finances should you be unable to do so yourself. You can specify what financial transactions they are authorized to handle and whether they need to work together or can work independently to carry out their duty. You should take care to appoint someone you trust, but bear in mind, whoever you appoint will be your fiduciary and is legally bound to act in your best financial interest.
Lastly, a Power of Attorney can be ‘durable’ or ‘springing’. The Durable Power of Attorney authorizes the appointed agent to act as soon as the document is signed and notarized. The Springing Power of Attorney requires a court proceeding along with medical evidence that the Grantor lacks capacity and needs an agent to handle his/her finances.
Your Health Care Proxy
Did you know that if you don’t have a Health Care Proxy, and you become unable to make health care decisions for yourself, loved ones or a state agency will have to initiate a Guardianship proceeding?
The Health Care Proxy is a legal document that designates an ‘agent’ to make decisions about your healthcare should you be unable to do so. Once you determine who you want your Health Care Proxy to be, you should ask if they are willing, and if so, have an important conversation about your health care and end of life wishes. You should make sure that your doctors have copies of the Health Care Proxy, and that you have a copy available should you become hospitalized.
Your Living Will
The Living Will is the document where you can explain in writing what your health care and end of life wishes are. The Living Will should be given to your Health Care Proxy and provides guidelines for him/her to follow. The Living Will may or may not include a DNR (a Do Not Resuscitate) provision. Even if your Living Will includes a DNR, you should execute a separate one and provide it to your doctors as well as post it prominently in your home (perhaps on the refrigerator) in the event you are taken by ambulance to the hospital. Some people also choose to keep their DNR on their person, perhaps in their wallet, to try to ensure if they are taken to the emergency room when they are away from home, their wishes are adhered to. Compass Care’s 7 Choices document is a sample form of Advanced Directives that frames many key decisions in a more colloquial, less intimidating manner. You can download this document by clicking here: Compass Care’s 7 Choices VER1.3 (5-23-2016).
As you can see, all of these legal documents are essential for all adults, no matter your age, so you can best maintain control over your estate, your finances, your health care, and your end of life wishes should you be unable to communicate them yourself
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.
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.