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Aging Wisely April 2013 - Aging Wisely

Patient Advocacy Stories from the Emergency Room


emergency room doctor looking at XrayBob: When a Fall is More Than a Fall

Bob had recently become an Aging Wisely client and his care manager would be working with his family to set up some services and start to look at the possibility of moving to assisted living locally or near his long-distance caregiver daughter.  Shortly after their first visit, the care manager received a call from Bob’s daughter.  He had fallen the previous night and had failed to push his emergency response button.  A neighbor had finally discovered the situation that morning and called his daughter and 911.

The care manager met Bob at the hospital.  Though they had only worked together briefly, she had his updated medical history and medication list to help him provide to the E.R. staff. (Bob had a crumpled list of medications in his pocket which was a bit outdated and stumbled over a few questions, turning to the care manager to fill in some blanks.)  She was also able to gently give a little background to the emergency room physician so that he understood Bob was living alone and experiencing some self-care challenges as recently evidenced by the fall situation.  The care manager contacted Bob’s daughter to keep her apprised.  She had been scheduled to leave in the next couple days for a major overseas trip and was contemplating cancelling.

As the care manager worked with the emergency room team, Bob and his daughter, they were able to come up with a plan.  The doctor determined there was sufficient reason to admit Bob for some further testing even though it did not appear he had any broken bones.  Meanwhile, the care manager would begin working on a temporary solution for after-care involving either rehabilitation or a respite stay in assisted living.  Since they had been contemplating a transition anyway and in light of the fall, this plan seemed most logical and safe.  The care manager could handle the details and make sure the process went smoothly for Bob, while reevaluating to determine a longer-term plan.

Florida emergency room helpMary: Communication Confusion in the E.R.

Mary lived in a Largo nursing home and her care was overseen by one of Aging Wisely’s care managers.  All but distant, elderly relatives had died and her primary local contact besides her care manager was her long-time C.P.A. who managed her affairs and had agreed to serve as her power of attorney and healthcare surrogate.  Mary had mid-stage dementia and a long history of agitation and depression.  In the past, she had several “incidents” due to these issues but had been managing well lately due to consistent care coordination.  She was fairly settled in to her life at the nursing home.  When big changes might disrupt her routine, her care manager was a calming presence to her.  The care manager also helped others to understand how to best approach Mary.

Her nurses noticed some concerning symptoms when checking on Mary and contacted her care manager to let her know they would be calling for an ambulance.  The care manager was able to arrive just moments after Mary…which was a very good thing due to the potential for “communication confusion”.  For one thing, this type of change was likely to cause Mary to become agitated and act out.  For another, emergency room staff would have been able to get very little information from Mary.  She had some difficulty hearing in addition to her dementia.  The care manager was able to give the staff a full background, as well as bring Mary’s “communication board”, a small white board which could assist when staff wanted to ask some basic questions to Mary.  The care manager helped to reassure Mary and prepare her as the doctors ran some tests.  She also communicated to Mary’s C.P.A. about what was going on and discussed next steps. 

It turned out Mary could be released directly from the E.R. as her tests revealed she was stable.  The care manager made a specialist follow-up appointment and communicated about her return to the nursing home.  She made sure the nursing home would get Mary a meal upon her return since she had missed lunch.  She arranged transportation and double-checked the medication and treatment information was properly communicated to her nursing home staff.

doctor with chart in emergency roomLucille: Why Am I Here?

Lucille lived in a Palm Harbor Assisted Living Facility.  The facility contacted Lucille’s local daughter after noticing some changes to her vital signs and contacting an ambulance to take her to be evaluated.  Her daughter called her Aging Wisely care manager, who had been assisting with coordinating Lucille’s medical and care needs.  Her daughter was planning to leave work to meet Mom, but after discussing the situation decided to have her care manager meet her there initially since she had the best handle on Mom’s medical needs.

Lucille had Alzheimer’s disease and usually recognized familiar people such as the care manager and her daughter, but generally was not oriented to place or time.  She seemed happy to see the care manager, but kept asking where she was and what was happening.  The care manager was able to reassure her and also ensure she was comfortable, getting her a drink of water and a couple extra blankets when she was cold.  She helped to give the necessary background information to the emergency department staff and coordinated with the client’s daughter, who came over to the E.R. when she finished at work.

As the medical team was evaluating the patient, the care manager helped to clarify some information and answer some of the daughter’s concerns.  In the end, the client returned to the assisted living with some new medications and support services.  The care manager set up a care plan meeting to ensure consistent care for the client in accordance with her wishes and minimize potentially unnecessary hospital trips.

Need help with patient advocacy in Florida?  Worried about an aging parent who lives in the Tampa Bay area or want help dealing with (and preventing) emergencies?  Call us at 727-447-5845.

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When Emergencies Happen: Senior Care Management at the E.R.


senior in the emergency room

Unfortunately, emergencies happen…particularly as we age.  Older adults visit the emergency department at higher rates than other age groups and those rates are also increasing more than for other age groups.  Good senior care management and patient advocacy ensures those emergencies are handled as well as possible to improve your short and long-term outcomes.

Here are just a few of the challenges and resulting problems for seniors and the healthcare professionals who care for them in the E.R.:

  • Older patients often present with atypical symptoms and have multiple conditions.  They present with a higher level of emergency and more serious illness than younger counterparts.
  • Emergency medical providers are rarely trained in geriatric-specific approaches.  Many report being less comfortable dealing with older patients.
  • Impaired mental status occurs in approximately one quarter
    of all older patients presenting to the emergency department as a result of delirium or delirium (or both).
  • Older adults are more likely to be misdiagnosed and therefore be discharged with unrecognized and untreated conditions.
  • Older adults face increased risk of return visits to the E.R., hospitalization and death.

*Older Patients in the Emergency Department: A Review

For the patient arriving alone to the E.R., it can be a scary and disorienting experience.  The E.R. team assessing the patient may also have little information to go on, particularly if the patient cannot communicate or has cognitive impairment.  All of this paints a vivid picture of the value of having an advocate with you (or your aging relative) at the emergency room.  Here’s a brief outline of some of the things an Aging Wisely patient advocate may do when meeting a client at the hospital during such an emergency.  The care manager:

  • Helps communicate vital information to emergency staff about the client’s medical history, nature of the emergency, current medications and treatment and background information.
  • Ensures the patient is as comfortable as possible, from providing reassurance to asking for staff assistance and helping them to more effectively help the patient.  The care manager might do something to improve the experience as simple as getting an extra pillow or blanket or helping the client make a call to a loved one.
  • Communicates to family members and others involved in the client’s life and care (calling to inform family members and keep them apprised, letting a home care provider know to cancel an upcoming shift, contacting the assisted living facility about the resident’s status and expected return).
  • Asks the right questions: gets a handle about what is going on, tests being done, and treatment plans (will the patient be admitted, receive treatment in the E.R., be released?).  Facilitates communication to make sure the patient and/or family understands the situation and options clearly.
  • Assists in planning next steps and coordinating a smooth transition (whether this is a hospital admission or return home) and setting up follow up appointments and care.
  • Contributes to creating the best plan of care by anticipating potential pitfalls, understanding the “big picture” for the client and applying his/her professional expertise (i.e. knows the client’s history, what services might help, past reactions to treatments, and resources to support the patient).

Our Aging Wisely care managers have been there for many clients over the years as they faced such emergencies.  The professional support provides a great deal of peace of mind for family caregivers, especially those who live at a distance. 

Professional care management in the emergency room benefits the patient and family with:

  • Peace of mind and reassurance during an unsettling time (reducing the anxiety of the situation);
  • Professional expertise in navigating the medical system and clarifying information;
  • Better outcomes by arming the medical team with an improved understanding of the patient and situation;
  • Reduced risks through personalized management and coordinated follow-up;
  • Less chance of further unnecessary emergencies.

We’ll be sharing some of our stories from E.R. care management in upcoming posts to illustrate the specific ways professional care management improves outcomes.  If you need help with emergency management or local oversight for an elder in the Tampa Bay area, you can contact us anytime at 727-447-5845.

We welcome your comments about emergency room situations you have experienced or questions about patient advocacy in the E.R. or beyond.

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Assisted Living Choices: What’s Wrong with “Free” Placement Services


senior living and life in assisted living facilities

The whole process of finding the right assisted living facility can be daunting.  You have probably faced a long decision-making journey in even considering this option.  You don’t want to make the wrong choice.  Such a move can turn out to be a positive transition (even if it starts out as a reluctant decision) or a very negative and stressful experience.  It is important to turn to the right resources for help.

So, who do you turn to for help?  We obviously believe geriatric care managers like those on our Aging Wisely team offer a special level of expertise in this area.  But, why?  What does a geriatric care manager offer that is different than what you could do on your own?  And, how do geriatric care management services differ from the “free” placement services you might hear about in your local community?

Here’s a quick overview of what a geriatric care manager offers in the process of deciding upon and transitioning to senior living:

  1. Expertise to provide a personalized assessment, to ensure you know the correct “level of care” needed and the types of resources that will best match your needs, desires and budget.
  2. Support and suggestions throughout the process.  For example, many families come to us considering a move to assisted living but not quite ready to make the decision.  We can suggest home safety measures. In other cases, a client is in the hospital and can benefit from (Medicare-covered) inpatient rehabilitaton before making the eventual move.  We have the knowledge and perspective to offer different solutions.
  3. An unbiased overview of a range of options.  First, our code of ethics and standards of practice along with our practical experience dictate that we don’t think there is one right option for everyone.  This means that some clients we work with remain in their own homes with supportive services, while some move to various types of care facilities and all follow very different paths depending on their needs.  Second, we don’t ever accept payment or marketing arrangements from facilities.  We only recommend places that we feel are appropriate for you.  You are our client, not the facility.
  4. Practical knowledge of facilities’ quality.  Our team works with clients who live in care facilities, so we know not only specific information on the “inside scoop” about local facilities but also broader “inside scoop” on what to look for, what to ask and how to really make sure you are making the most informed choice.
  5. Awareness of the financial component in the assessment of your options: help with connecting to benefits programs, locating options at different price points and connecting you with programs and professionals to assist (such as elder law attorneys, Veteran’s benefits, etc.).
  6. Help negotiating when your decision has been made.  We can help answer your questions about the agreements and potentially negotiate or determine what type of specials or offers might be available to you.  Sometimes we can negotiate some help with reducing initial fees or help you find out when communities are running special offers.  Additionally, we’re there for you down the road if prices increase or you are not sure about certain fees.  We can be your advocate in ensuring you have the right answers.
  7. We’re not just there until the day you move in, then gone.  We are available to help throughout the transition and beyond.  Our care managers can help make the transition smoother and assist on moving day, but also help troubleshoot if there are any concerns as you adjust to your new home.  We can help with all the little details that make moving a hassle.  Also, particularly for families at a distance, we can provide local oversight and contact for your peace of mind.

Need help with choosing an assisted living facility, evaluating senior housing or senior care options in Tampa Bay, Pinellas and Pasco counties?  Call us today at 727-447-5845.

You might also want to grab a copy of our overview to “Evaluating Senior Living Options“.

Asking the Right Questions About Free Assisted Living Placement Services

Increasingly we hear from families who have come in to contact with “free” placement services.  These services, much like an apartment locater service, specifically operate to match clients to local facilities.  Most often they have marketing arrangements with groups of local facilities, which is how they get paid.  We believe it is up to each family to decide what is right for them, but it is important to ask and understand the following:

  1. How is the service paid (remember, unless they specifically share that they are a non-profit funded by donations or a public program, they have to make money to stay in business)?  How might that affect the options you are shown (i.e. will a service show you facilities with whom they have no marketing arrangement)?
  2. What is the person’s expertise and background?
  3. Can the person tell you about other options (in-home services, assistance moving to be closer to a relative) and can he/she help with benefits programs such as Medicaid and VA?
  4. What help can they offer in negotiations and dealing with ongoing costs/fees? 
  5. Does the service offer follow-up services, help with the moving process, oversight and troubleshooting afterwords?

If you have additional questions or need assistance in Tampa Bay, we’re just a phone call away any time!

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Scams on the Elderly: Senior Care Tips for Fraud Prevention


scams on elderlyAs much as Florida is the land of sunshine and beautiful beaches, it can also lay claim to being the top spot for fraud and identity theft (per the Federal Trade Commission).

Unfortunately, many scammers target the elderly as a recent WMNF Tampa radio show pointed out.  Scammers prey on the trusting nature of many elders as well as fear and intimidation.  The scams are constantly evolving and often target common services and products used amongst elders.  Water filtration systems and other items for the household have often been targeted, convincing the person to buy something they don’t need or something at an astronomical price or taking a deposit for work which is never completed.  Medicare and other official sounding programs are often used as a means of fraud and identity theft.  There have been numerous scams “phishing” for information in order to steal personal/financial information or obtain someone’s identity.  Targeting seniors, this has often been done under the guise of Medicare.

One of the most difficult aspects of fraud targeting seniors is that it is often perpetrated by a trusted person.  Family members are the top source of financial abuse and other neighbors, friends and caretakers may also take advantage of their relationship to begin financially abusing the situation.

Some things you might notice in an elder loved one which could indicate financial abuse or being the victim of scams:

  • Worrying about finances, having unanticipated financial problems.
  • Unexplained purchases, missing cash or valuables.
  • Difficulty explaining purchases or confusion over a purchase or service contract; excessive repairs or items being purchased for the home.
  • Giving financial control to a new caregiver, neighbor or friend.
  • Fear or intimidation signals (mentioning, for example, that the daughter who helps out “doesn’t want me to talk about that” or doesn’t allow the elder to see the checkbook any longer or review accounts).

Financial elder abuse and scams can be very difficult to prevent or even resolve.  Often elders will not report the abuse and feel embarrassed over the situation.  There may be a level of intimidation and control that is hard to break through.  Here are some steps we think can help, though, in overall safeguarding for elders and resources to help:

  • Regularly evaluate how things are going for your loved one.  Hire a geriatric care manager to help you keep an eye on things from a distance, get a periodic evaluation and check in with calls and in-person visits.  Continual communication can help you spot issues, as well as give your loved one opportunities to mention concerns. A professional assessment (and ongoing evaluations) can help determine when it may be necessary to assist with managing finances and household maintenance.  Contact us to learn more about geriatric assessments and other eldercare assistance services.
  • Share information about popular scams with your loved one and educate on issues such as giving out personal information.
  • Help set up a dignified “out” for solicitations.  Perhaps your loved one can say they have their “advisor” review everything before they make decisions (whether that really is some type of professional advisor, or running it by you).  You might even suggest/share that you do the same yourself, as it is easy for anyone to get caught up in scams and some time to think about purchases and decisions helps.
  • Determine ways to simplify finances and possibly consider a system for oversight (regular review/access by a trusted professional or family member).

You might also want to check out our resources: Senior Safety Warning Signs and Caregiver Concerns and Florida Attorney General’s Protecting Florida’s Seniors page (with various resources and hotlines included).  Reach out to Aging Wisely’s Senior Care Consultant if you spot concerns or want to find out how we can help.  We offer caregiver consultations and an array of services for Florida seniors in the Tampa Bay area. 

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Simplifying the Solutions to Not So Simple Senior Care Problems


solutions to the senior care mazeThe Wall Street Journal recently published a great essay entitled, “When Simplicity is the Solution” which details our growing “crisis of complexity” with more choices and dozens of details we encounter every day that slow us down.  Of particular interest to us were the examples about Medicare, medicine bottles and the patient experience at hospitals.  We wanted to share a bit about how we think this concept might just apply to you if you have been searching for eldercare answers or senior care help:

The Medicare example, “a web search on will return 45 plans for you to consider”, reflects the complexities families face in an array of areas when it comes to eldercare.  One of the laments we hear most from families is that they have been going in circles getting more lists of numbers to call when what they’re looking for is simple…an answer.  Forty-five choices is not an answer, it’s just more questions.  Someone getting ready to retire has an even more complex puzzle, with all the parts of Medicare along with company benefits, VA and other insurance options playing in to the choices.  Medicare has done a good job providing educational information and tools, but the complexity remains built in to the product.  We created a simple solution for this common dilemma, with our Medicare Analysis package.

The article showcases another great example in the design of medication bottles.  This example shows that sometimes complexity is not just an inconvenience, it is downright dangerous.  Medications are a great example of how simplicity can be the solution.  Beyond simplifying the packaging, reducing the complexity of the overall regime (less medications, less varying times) helps patients comply better.  We talked about this and some of the other simple solutions to medication management in our recent post, Managing the Dangers of Medications: Senior Care Resources.

Our care managers often point out simple solutions like this for various senior care and elder safety issues.  A simple solution can have a big impact. In a home assessment, the care manager might observe how a client has organized items in the kitchen in a way that’s making them hard to reach or leading to nutritional problems.  No fancy gadgets or expensive remodeling needed, just some quick reorganization.  It’s easy to feel overwhelmed with thoughts of what your elderly loved one might need to be safe.  It is not unusual for us to first meet with a family and find they have a notebook full of names and numbers with long lists of assisted living facilities and various products they have been told will help, but yet they don’t really know where to start.

The Cleveland Clinic example shows how an organization can distill things down to the customer experience. They discovered it was the small details that mattered to patients, not necessarily complex initiatives or things that cost a lot of money for the organization.  If you’ve ever been a hospital patient (or the advocate for a loved one while there), you can probably point out a range of examples: the drafty hospital gown, endless nighttime interruptions, communication breakdowns.  We know how much the “little things” mean to our clients.  When moving to an assisted living facility, for example, our care managers focus on organizing the day of the move to optimize the experience.  The little details make or break that first impression, a time so filled with anxiety already.  Having done it so many times, we can use that knowledge to create the best possible experience for the client (and family).

This concept is really what Aging Wisely is all about (and what we think “aging wisely” as a concept is all about too) and it is why we use the tagline, “solutions when you need them”.  When we started Aging Wisely fifteen years ago, the idea was to provide simple solutions to sometimes complex problems.  We did not see that available for families at the time.  Perhaps now, this is even more true.  Every day there is a new website or technology related to senior care.  But, families still tell us what they want is solutions and answers and generally what they get is just more questions (or frustration with systems and processes that don’t seem to address little things that are important to them)…until they come to us.

Want to be lifted above the maze of eldercare, with solutions for YOU?  Call us today!  You can reach us at 727-447-5845.

What frustrations have you experienced in trying to find eldercare solutions?  Have you found seemingly unnecessary complexities trying to navgiate senior care options?

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Mission Statement

Our goal is to enable every individual we work with to live the most fulfilling life possible, with utmost dignity, focusing on their physical, mental, spiritual, family and financial wellbeing.