A hospitalization is stressful for patients and their families; navigating the different tests, providers, payment concerns and more can be overwhelming. Hospital patient advocacy has therefore played a large role in what Aging Life Care Managers do for their clients. This process often starts from the moment of an emergency room visit through admission, various tests and procedures and ensuring a safe transition post-discharge.

Hospital Patient Advocacy: Crisis Response at the ER

Aging Wisely offers a service in which our Aging Life Care Managers are on-call for you in case of emergencies any time. This provides peace of mind for elders and their families knowing an experienced professional who knows their situation will be there during the emergency. If you’ve ever visited an ER, you can understand why a family doesn’t want their sick, elderly (and possibly confused) loved one to be there alone. In our years responding to such situations, patients and their families have been extremely grateful for the support but ER staff have also expressed the value of having more information about the patient and someone coordinating.

Understanding Tests, Care, Treatment Plans and Costs

Another area where our care managers have consistently helped in the ER and beyond is asking clarification questions about tests, treatments, and understanding the care plan and vital issues like observation status. Many patients (and their families) find themselves surprised when they learn that even though they’ve been spending the night at the hospital they have been classified as “outpatient” while under “observation”. This can have significant implications for hospital and after-care bills. Read more.

Fortunately, a law called Notice was passed August 6, 2015 to ensure patients receive written and verbal notification of this status with an implementation deadline of one year later (8/6/16). As of this date, hospitals will be required to provide a MOON (Medicare Outpatient Observation Notification) in writing within 36 hours to anyone undergoing observation or being treated as an outpatient for more than 24 hours. Aging Life Care Managers will ensure that you receive these notifications as required and help you and your family understand all the implications and options.

Aging Life Care Managers coordinate between your providers, help make sure they have the information they need (your medical history, preferences, etc.), and make sure everything is clear so that you (and/or your decision makers) are part of the process. Sometimes this helps avoid an unnecessary/repeat testing procedure. At other times, it means your medical team can recommend a more appropriate course of treatment for you with a full understanding of your past history and your current situation and wishes. It means you and your family can make more informed choices and not feel as overwhelmed.

Eyes and Ears: Observing, Asking Questions, Focus on the Individual

An Aging Life Care Manager is hired by you and your family as your personal advocate. This means the focus is on you as an individual…and your goals and wishes, not institutional goals or requirements. We understand the institutions and systems we are helping you to navigate, but we approach the situation to find solutions that work, within the realities, for YOU.

A care manager will typically do various things on any hospital visit, including observing and talking with you and hospital staff, reviewing your chart and asking follow-up questions. With our experience and the time and attention to focus on you, we often spot little things that can turn into big issues. This could be a change in your typical cognition or mood, which might indicate an infection or some underlying medical change. The care manager’s chart review or discussions might turn up an order for a new medication which has had poor results for you before. Sometimes, the care manager notices a fall or infection prevention protocol is seemingly not being followed. The care manager’s role is to observe and raise this information with the medical professionals, who can then use this information to provide even better treatment.

Discharge planning and ensuring a smooth transition is a whole other aspect of hospital patient advocacy. We’ll cover more on that later, but you can read a few of our past articles on hospital discharge in the meantime. Make sure you’re signed up for our newsletter so you always get the latest news and information!

For help with hospital patient advocacy:

I’ve been fortunate to live abroad much of the past seven years, first in Spain and now having spent the past four years in Shanghai, China. Mark Twain famously said, “Travel is fatal to prejudice, bigotry, and narrow-mindedness.” I don’t necessarily think you have to live overseas to acquire wisdom, but I do know that my experiences have helped broaden my mind, broken down assumptions and even changed the way I deal with and approach things. Here are just a few of the life lessons (or aging wisely lessons) I’ve learned from living in other cultures and especially from my time in China.

No one (or one culture) has it all figured out.

I learn or observe something new every day, sometimes just going to the grocery store or walking around my neighborhood. I remember being so impressed with the sink setup at the local hairdresser…they have a little headrest in the sink so it’s a lot more comfortable on your neck (it may seem minor but this was a revelation to me!). Here in Shanghai, I love the amazing entrepreneurial spirit and inventiveness to create solutions with a huge population and urban environment. You can get almost anything delivered to your home…the streets are filled with scooters bearing lunch, groceries, and online shopping deliveries (and even a cart full of chairs).

Interesting new services pop up every day and the lightning speed of technology adoption is stunning (most of us now pay for the majority of things, including splitting the bill with friends, with our phones in just a couple clicks).

I love picking up new ideas, as well as gaining an appreciation of the many things the U.S. does so well. Even if you don’t live or travel abroad, just observing and being open to new things (just look at the pace of new technology) can make life easier and better.

You can always make new friends and find new things to do/learn.

When you’re an expat, you have no choice in this (unless you want to be miserable). You have to seek groups and events for your interests and get to know new people. I usually do at least a few new things each month, even though I’ve now been living in Shanghai for four years and have established favorite places and good friends. I’ve been to author talks, elder storytelling, language exchanges, cooking classes, calligraphy workshops, Chinese wine tastings, lectures on Chinese weddings and other aspects of culture, bike and walking tours, film screenings, special interest group discussions and so much more.

A holiday party at our Mandarin school

I use Meetup to find activities of interest and read the local publications for art openings, concerts, new restaurants, markets and events.

Vegetarian cooking class in a local home with new friends

If I’m looking for a group or activity I can’t find, I’ll consider starting one myself. You can do this even if you’ve lived the same place your whole life! It keeps life interesting and expands your mind.

Learning the Chinese yoyo with local elders (plus storytelling)

There’s interesting stuff all around you.

No matter where you live, take time to “smell the roses” as the saying goes. I find one of the best ways to do this is by taking walks. It’s a good way to stay healthy but it’s also fun because you get to take in your environment. When I lived in Spain, I spent an average of two hours/day walking along the Mediterranean coastline, observing the families out for a stroll, soaking in the sunlight and getting a kick out of the way the seaside restaurants hung their octopi out to dry.

In Shanghai, I love walking in the many local parks where I watch families enjoy themselves and older people dance and practice tai chi. Even just strolling through the neighborhood is fascinating, with the mix or urban life and skyscrapers with old markets (live fish and chickens for sale and more of those interesting drying methods) and colorful laundry dotting the windows and trees.

Laundry with a side of chicken

One of my favorite locals

Any time (and place) is good for a nap!

Family is precious and living apart doesn’t mean you can’t be close.

Many multigenerational families live together in China, which is pretty different from how I grew up but doesn’t necessarily make me any less close to my family (even now that we’re several continents away). Here too nowadays, more families are separated for economic opportunities, whether it’s studying or working overseas or more commonly migrating to the larger cities. Since living abroad, I make a point to plan longer visits home and since I’m usually staying with my family, I have actually spent more time with them since living overseas.

A recent visit home with my Mom, aunt and cousin

While everyone’s situation is different we can all stay close to family members in various ways…planning longer visits when possible (and trying not to always go just during hectic holidays), meeting up somewhere (and hopefully welcoming them to visit you) and regularly Skyping, emailing, calling and texting. We also keep in touch and share our adventures with family and friends by sending postcards from all our trips.

Staying active and engaged will keep you “young at heart” (and in body).

When I talk to people about getting older in China a lot of them look to their retirement years longingly. They see it as a time when the restraints of work are gone and they can enjoy favorite activities and spend time with friends and grandchildren. Elders are often integral in child-rearing, taking on active roles in the mutligenerational household in caring for grandhildren and supporting the working parents.

The best place to see the life of older adults in China is in the local parks and street corners. On any given day, there will be a range of activities from dancing to tai chi and exercising on the outdoor gyms. This activity and engagement may very well be a big part of the high life expectancy and low disability rates among elders here (there are now over 1,000 centenarians living in Shanghai).

Elders will gather to socialize, drink tea, and play games. Others will simply enjoy the outdoors with solitary activities like reading, playing a musical instrument or practicing calligraphy (often done with large brushes and water on the pavement, symbolizing that everything in life is fleeting).

I can hardly summarize all the gifts I’ve been given being exposed to different cultures and meeting wonderful people from all over the world. I hope you enjoy these few insights and pictures. As China’s population is aging and less young people are available for caregiving, they’re facing the challenges of eldercare and developing new ways to manage the needs. I will continue to learn and share more on that topic as well. I always love to chat about travels, culture, China and more so I welcome your emails/feedback: shannonmartin(at) agingwisely.com.

There are so many great technology tools for caregivers, whether you live near or far from your aging loved ones. Our team has worked with thousands of families over the years and we stay updated on the constantly evolving technology tools for caregivers and care management.

From electronic pill dispensers to in-home safety systems and online care portals and apps of all kinds, we’ll help you understand and identify the tools that might be most useful for you. Join us to learn more!

Technology Tools for Caregivers Near and Far

Tuesday, August 2nd, 2016  1pm to 2:30pm

EasyLiving/Aging Wisely Office

1180 Ponce de Leon Blvd., Suite 701, Clearwater

Download the Caregiving Technology Workshop flier for details and share with your friends.

Limited to the 1st 20 attendees. Call to reserve your seat TODAY. RSVP to 727-447-5845 or linda(at)agingwisley.com.

The reasons individuals and families choose (or are chosen for) an expat life are varied, as are their experiences. But, the expat life comes with certain commonalities. One of these is being separated from “home” and most of your family. This can be especially challenging (and guilt-ridden) when your parents or other loved ones have health issues. I shared a little insight from my personal expat life (and tips to be prepared) in the last post and today I’ll share some useful “caregiver hacks” for those living an expat life (and all long-distance caregivers) while trying to make sure things are okay back home for older family members.

Long-Distance Caregiver Hacks

Messaging Apps

What’s App, WeChat or even Facebook messenger can be quite useful when you’re living abroad to keep in communication with loved ones back home. These apps generally use small amounts of data (or you can limit usage to wifi) and provide an easy way to send quick messages to check in. For expats like myself in China, WeChat is ubiquitous and I asked my parents and some friends to add it to their phones so we can chat easily. With WeChat and many of these apps, you can do more than simple texting. We send pictures, video, “walkie talkie” (voice) messages and can even do a VOIP phone call within the app.

VOIP/Video Calling

I highly recommend Skype, though there are other options and iOS users may be able to primarily use Facetime. However, Skype is great for the expat life for a couple reasons: you can get a dedicated phone number and you can get packages (or buy credit) to call phones. I have a $2.99/month package for unlimited calls to the U.S. and Canada. It’s handy for me to call my bank, tax/financial professionals, etc. and can be great if you are helping coordinate care for a loved one to call doctors and more (and to call loved ones who don’t use Skype or Facetime).

I purchased a U.S. phone number on Skype also and pay a nominal fee for it. I ported my old cell phone number years ago to a Google Voice number and I can go into Google Voice and forward that to my Skype # or any other U.S. # (for example, when I return to the U.S. I have a local SIM card and therefore no one has to learn a new phone number to reach me). While this may sound a bit complicated, it is very easy to set up and makes things seamless. Google Voice allows you to get voicemail (which they’ll transcribe and send via email) and text messages.

With this setup, I am never out of reach no matter where I’m traveling (unless I’m asleep due to the time difference). Skype and Facetime are also great because being able to do video calls provides a feeling of closeness (and a useful visual check) you can’t get with just voice.

Being Organized On The Go

When you start off in the expat life, you’ll need to get yourself organized and it’s easy to extend this to working with aging parents to make sure they’ve done the same. Use our document locator list (adapted from the Foreign Service Worker Family Liaison office) to get together your (and your parents’) vital documents. Store these in a secure file and make copies of documents that might be needed by others. For example, we store copies with my in-laws and have the most important documents that we would potentially need with us as well. We keep our advance directives and documents we regularly need for visas, etc. but if we need something else they can scan and send it (or FedEx it if need be).

Store the documents and information you might need access to in secure cloud storage. Even simply having a copy of the basic info (doctors’ contact information and advance directives) on your phone or computer is useful (but please backup and ensure that passwords, financial info., etc. are stored securely).

Medical Record Portals

First, an electronic medical records/care system can be very useful if there are active medical needs (or even to be prepared with a full history and information should there be an emergency…pulling all that together on the spot is no fun). There are a lot of options available. Our EasyLiving/Aging Wisely team has used several systems over the years as they’ve evolved and we’re currently using ClearCare.

Second, most doctors’ offices now offer electronic patient portals, where patients can get their test results, message the doctor and more. Even if your loved one doesn’t want to use it, you can be permitted access if they allow. This can be a lifesaver when trying to help out from a distance.

Care Managers

Of course, I couldn’t leave out the value of care managers when you are caregiving from a distance. You can set up a phone/Skype consultation with a care manager in your parents’ area for help preparing and identifying critical issues. The care manager can carry out tasks so you don’t have to fill every visit with tasks, losing precious quality time with loved ones. You can also hire the care manager to check in regularly, attend doctor’s appointments and be on call for emergencies…all especially useful if there are no local family members.

Travel Tips

1. Plan longer visits. Jet lag is part of the expat life, but that alone makes it worth spending longer times when feasible (and with expensive flights or companies providing limited paid home visits, it’s best to take advantage of the time when you can). Don’t rush the time with your family members, as you will surely have tasks to complete along with observing how things are going and spending some much-needed time together.
2. Try to get airline status (if possible, picking one primary airline and looking into which credit card and partner programs are worthwhile). When living overseas, having a preferred status makes travel a lot easier. I’ve never been to the level of getting business class upgrades on the overseas flights, but I do get to join the priority line, bring more luggage for free…and the reality is that the service level is better when you need help. I’ve never done it, but it is probably worth it to join programs like Global Entry as well (or check out the brand new Mobile Passport app, rolling out in various U.S. airports). There are other beneficial programs like the APEC business traveler card.
3. When you need help from the airlines or travel companies, social media can be a useful tool. I’m not suggesting going on to Twitter to blast them, but many times the people charged with social media are more responsive than the general customer service staff, as they have the public image in mind. I’ve had good success reaching out (particularly via Twitter) when I’m running into difficulties.

Contact us for help with long-distance caregiving concerns. Our care management team is highly experienced helping caregivers all over the world and we’d love to share our insights and resources with you!

My Personal Story as a Long Distance Caregiver

Our team works with long-distance caregivers every day, so we have been through all kinds of situations that families needed to face from far away…from a middle-of-the-night hospitalization to the parent who is found lost on the highway. Even having worked with many families over the years, my personal experience as an expat caregiver really drove home the points we often shared with caregivers. I was living in Spain when my Mom broke the news that she had been diagnosed with a brain tumor that required immediate surgery.

Shock, tears, fear, and a frenzy of planning followed. Within a few hours I had to deal with changing flights on less-than-sympathetic airlines, figuring out if I could even make it prior to the surgery and how to rearrange various plans. Within a short space of time, my world (well, our world) was turned upside down and I found myself back home spending nights in the hospital while still adjusting to the time change. Fast forward a few years and thankfully (and mostly thanks to the great doctors at Johns Hopkins) my Mom is doing well, but living in China we’re even further away from our parents. I meet many expats who travel home frequently to take care of tasks for aging loved ones or do daily Skype calls to check up on things. Even those not actively involved in caregiving, like myself, can’t ignore the reality that we are far away from loved ones who might need us any time.

Long Distance Caregiver Tips and Resources

As a long-distance caregiver, you face special challenges. Not seeing your loved one on a regular basis can make it easy to miss things.  There’s added guilt at not being there and worries about what is happening. But, one of the most difficult things may be dealing with emergencies. There’s a feeling of panic when the phone rings at an odd time and the incredibly stressful reality of quickly arranging a trip when you just need to be there as soon as possible.

You can’t control emergencies, but there are some things you can do to better prepare, whether you’re caregiving now or may be called upon to do so in the future.

• Know local resources. Who would you call when you get “the call” and what resources can help now? Reading blogs like Aging Wisely’s can help you be attuned to things that might help. You can do a little research through the local Area Agency on Aging and providers, and a consultation with a professional can help you understand which resources you might wish to access.
• Establish a support system, especially people who can help in a crisis and be there until you can get there. I’m lucky to have a brother who lives near my parents, but neighbors, friends and trusted professionals can help too. If you are actively caregiving for parents who need help (whether they live at home or in a care facility), consider services like on-call geriatric care managers (for example, our team offers an annual plan which gives you access to our on-call care managers should an emergency occur, meaning your loved one doesn’t have to be alone in the E.R.).
• Check in regularly. Some emergencies can actually be avoided by spotting signs that things are changing. Regular phone calls (or better yet, Skype or Facetime) are useful but also plan sufficient time when you visit to spend time together and observe things. Check out our Warning Signs handout.
• You have to be even more prepared and organized when you’re living far away. Expats tend to be good at this. We had to figure out international health insurance, coordinate housing and schools in a foreign country, organize our records, deal with taxes long-distance and more. We need to use those skills to help our parents (P.S., It’s a good way to spark the conversation too–“I did it, let’s do it for you”). Organize medical records and advance directives, and store them securely online for easy access. Make sure someone local knows where/how to access them. Put all the important contacts into your system/phone. Use an online system to communicate with other family members. (We use a great system at Aging Wisely called ClearCare and each client gets his/her own “Family Room”. My family has also used Caring Bridge for keeping friends and family up-to-date on the person’s health journey.)
• Don’t forget actual disaster preparedness. Check out our recent Disaster Preparedness post and our library of resources at EasyLiving. Go through a disaster checklist process on one of your visits.
• Create a crisis plan. You might not know what will happen when, but you can work with your support system to create a plan for what to do if a crisis occurs. This goes back to who can get there immediately, as well as how you communicate with each other. Know who to contact at the airlines if you need to take an urgent flight (I’ve found certain airlines are much better than others and they tend to respond well on social media when you’re having trouble getting a good response with customer service). It’s easy to find information online even in the moment of crisis, but if you have a few things thought out ahead of time you can save the added stress.

This is just an overview to get you started, but stay tuned for more “long distance caregiver hacks”…resources and ideas that our team has found to be truly helpful. If you’re not already, sign up for our newsletter or join us on Facebook for the latest!

Elderly people are especially vulnerable to extreme temperatures. As we head into summer, it is vital for caregivers to know heat stroke symptoms and ways to help loved ones stay cool and safe. Extreme winter temperatures might not be on our minds now, but winter weather also affects many elders and we provide some all-year-round preparation tips.

Heat Stroke Symptoms

Older people are vulnerable to heat-related illness since it is harder for an older adult’s body to regulate temperature. Additionally, chronic medical conditions and medications can make some older adults even more susceptible.

Heat stroke is the most severe form of heat-related illness and can cause death or permanent disability if not treated immediately. Caregivers should know heat stroke symptoms to monitor for such symptoms in order to seek emergency medical attention. Heat stroke symptoms include:

• Red, hot, and dry skin (changes in sweating, i.e. no sweating)
• Rapid heartbeat
• Throbbing headache
• Dizziness
• Nausea
• Altered mental state (confusion, disorientation and even seizures and unconsciouness)
• Extremely high body temperature (above 103°F)

The more mild form of heat-related illness is heat exhaustion, which often develops after being in high temperatures for several days and/or not getting enough fluids and proper balance of fluids and electrolytes. Spotting these symptoms and intervening can prevent a dangerous situation from worsening:

• Heavy sweating, paleness, muscle cramps, weakness, exhaustion, dizziness, headache, nausea/vomiting, fainting
• Skin may be cool and moist and the person’s pulse rate is often fast and weak, while their breathing is shallow and rapid

Dehydration is also a common problem in the elderly at all times of year, but especially when temperatures are high. Signs of dehydration in elders may include: confusion, dizziness, headaches, dry mouth, sunken eyes and lack of skin elasticity, inability to produce sweat or tears, low urine output (and dark urine color), constipation, and low blood pressure. Adequate bodily fluid is essential for many of the body’s functions and dehydration is one of the top 10 reasons for Medicare hospital admissions.

Tips to Prevent Heat-Related Illness

Avoid a high level of activity (especially outdoors) in the heat of the day. See our caregiver team’s ideas for great indoor activities and places you can go to enjoy an air-conditioned environment and have some fun. Take a nap or spending quite time resting in the afternoon.

Stay well hydrated. Keep water by your side at all times (caregivers can help by encouraging drinking, monitoring intake and refilling the water). Add fruit, try sparkling water, and various beverages for those who don’t like plain water (try to avoid too many caffeinated beverages which have a diuretic effect and excessive sugary drinks). Fruit and vegetables with a high water content can contribute to your fluid intake as well.

Make sure air conditioning units are maintained to avoid having problems during the heat. Schedule a “checkup” before the season and change filters regularly. Use fans to circulate the air or help if A/C is out. For those who don’t have air conditioning, visit air-conditioned venues during the day (the mall, movies, a coffee shop or library). Check on your loved one’s home throughout the summer, and especially during heat waves, to make sure the A/C is working, temperatures are at a reasonable level and they are not experiencing any problems. For those who do not have central air-conditioning, you might consider a portable/window unit or even a respite stay at a retirement community with A/C if a heat wave is predicted.

Be very careful about the sun; stay in the shade when outdoors, wear sunscreen, and get your skin checked by a dermatologist (read up on our summer sun prevention and warning signs).

Check in on your loved ones. Call or visit every few hours during extreme weather; help get them to air conditioning when needed; hire services to provide support (lawn and outdoor maintenance so Mom or Dad won’t be tempted to do those chores in the heat and/or caregivers to help with chores, monitoring and healthy diet/fluids).

Extreme Cold

The other extreme can be just as dangerous for elders. Older adults can lose body heat faster than when they were young. Hypothermia occurs when your body temperature gets very low. For an elder, a body temperature colder than 95 degrees Farenheit can cause health problems such as cardiac issues, kidney problems, liver damage, and more.

The CDC offers a great guide to preparing for cold weather. Help your loved one with the preparation steps and check in, no matter if it’s extreme heat, cold or other weather events.

Our team is here to help! Need advice on health and safety for your older loved one? Need an assessment or caregivers to help with tasks? Call us at 727-447-5845 or contact Aging Wisely online.

No matter where you live, there is some type of extreme weather or natural disaster that might affect your area. Elderly people are most vulnerable in such situations.

We’ve created a special checklist to help caregivers and family members assisting older loved ones to be prepared. The checklist is more than just an emergencies supplies list; it is also designed to help you go through all the necessary considerations in preparing and planning. Our experts share their insights about how to assess the dangers, how to put together a plan and what you need to know. We also offer the latest resources and news on our blog and social media, so join our community for more great information.

Be prepared! Download/print the disaster preparedness checklist:

Disaster Preparedness Checklist for Elders and Caregivers

Elders and those with special needs (chronic disease, mobility issues, disability, dementia) are especially vulnerable during emergencies. Death and injuries are common in this group during extreme heat waves, flooding, tornadoes, hurricanes and snow storms.

In statistics from a typhoon in the Philippines, one out of three people who died were over the age of 60 (even though they represented less than 1/10 of the population). During Hurricane Katrina, more than 70% of those who died were elderly.

Why do elders suffer disproportionately during emergencies?

• Difficulty getting out of harm’s way: 42% of Americans 65+ have a mobility/functional issue that could make dealing with an emergency difficult.
• Reluctance to evacuate: due to a feeling of safety at home, worries about exposing vulnerability (therefore someone might make them move away from home), complacency due to not experiencing problems in the past, or lack of knowledge of options. Surviving past disasters is no predictor of what will happen in the future (emergencies vary, as does the person’s current ability to manage).
• Chronic conditions can quickly worsen. About 75% of Americans 65+ have 2 or more conditions and take several medications. Without access to medication and assistance (and with added stress, heat/cold, etc.), conditions which are normally well-managed can quickly become severe.
• Survival often depends on self-preserving when cut off from support networks (for potentially long periods). When electricity is out from various disasters, elders may be stuck in high rises with no elevator. It may be impossible to get supplies or services for a few days to a few weeks.

Tips for Better Disaster Preparedness:

1. Understand potential threats. What types of natural disasters and weather would be expected in your area? Assess your location and the scope and severity of threats. Don’t become complacent because you have not had a problem before.
2. Locate resources. Read your county/city’s information about natural disasters, shelters and assistance. Follow our Aging Wisely blog or sign up for our newsletter for expert tips and special help.
3. Assess your readiness to respond to/self-preserve in a likely emergency.Could your chronic conditions become a problem? How well can you do with no support services? Will you become ill in the heat or cold, or without electricity and hot water?
4. Assess and prepare your home. You might need to make structural improvements (roof repairs for storms, wind-resistant windows, securing doors) and do preparations like cleaning out gutters, trimming trees and removing debris. Backup power options such as generators and battery packs/power banks can be useful as losing power is quite common in many emergencies. Check smoke detectors and fire extinguishers. Clear clutter and fall hazards. Know your home’s risk level (flood zone/location, age/security, mobile homes) to determine whether sheltering in place is feasible (and, in what conditions).
5. Get a battery-powered or hand-cranked radio (a NOAA weather radio is ideal).
6. Assess your support network. How can friends, neighbors and family help? What support services do you rely on and will they be available during an emergency? Can you seek shelter with a friend or loved one who may live in a safer area or be able to help you?
7. Determine evacuation (or alternative stay) options. Emergency shelters are designed as a last resort, but you should be registered with your county/city should you need them. If you plan to evacuate to a safer area, consider issues like traffic and road safety (and your access to resources away from home). Respite stays in an assisted living or nursing facility can be a wise plan as they have to prepare for such emergencies for their residents and offer a level of comfort and support you cannot get at a shelter. Having others around can also be comforting.
8. Prepare supplies. You can access our hurricane supply checklist (which applies to many types of disasters). The Red Cross offers a basic emergency kit list (you can also buy first aid kits and supplies through them), though we’d recommend preparing two-week supplies when sheltering in place, as services and supplies can be delayed for days-weeks. There are various emergency kits you can buy online (but you’ll need to add personal items, like your food, water, medications, etc.). If you have a pet, check out EasyLiving’s pet prep checklist.
9. Make a communication plan. Have a cell phone with chargers (extra batteries, power banks and car chargers are useful when electricity is scarce) and your contacts programmed into it. Decide how you will communicate vital information (and relatives should coordinate plans to check in).
10. Prepare important documents. Put your insurance papers, a list of contacts, medical history/medication list, advance directives, home documents and key account information into a waterproof container that you can access easily and take with you when evacuating.

If you need help assessing your situation and preparing, contact Aging Wisely at 727-447-5845. Our team can help with comprehensive disaster planning, as well as advice and resources. Follow us on Facebook for the latest news and tips.

Join us this summer for our Aging Wisely workshops, conveniently offered in the evenings for working professionals. Back by popular demand, instructor Linda Chamberlain will share her most well-received topics and provide valuable information you will rarely get (for free!). Make plans to join us as the limited slots fill up quickly!

All these Aging Wisely workshops will be held from 7:00-8:30 PM. Questions are encouraged and you will receive free organizational tools to help you put what you learned into practice. Please call 727-447-5845 to RSVP.

EXIT STRATEGY SEMINAR

JUNE 28TH

What you should do before you get sick

FOCUS ON YOUR HEALTH

JULY 26th

Organizing your health records, making the most of your doctor visits, utilizing insurance benefits,  dealing with a diagnosis

LEGAL DOCS EVERYONE MUST HAVE

AUGUST 30th

Preparing for your legal consult, key decisions

Download, print, share:

Aging Wisely workshops: summer evening series flyer

I will miss my Dad this Father’s Day! His idea of a great Father’s Day was a fun activity ending with a great meal – that had to include ice cream! The activity could have been as simple as a drive for him to look around, playing “Rook” or, in later years, the Hard Rock Casino (as pictured above). He was looking for an experience, not a gift.

I’m excited to share with you a variety of great experiences to share with your Dad as well as a few gift ideas he may enjoy. While bittersweet to put these ideas together, I have enjoyed thinking about many memories while putting these suggestions together.

1. Spending time with Dad, in person, having fun, creating a memory is the best gift you can give to your Dad. If you can’t make it in person, try Facetime, Skype, or Zoom to spend virtual time with Dad.

2. We have a fun and innovative Museum of Science and Industry (MOSI) in the Tampa Bay area. It has an Imax theater in addition to great exhibits. This is a great activity for all ages and perfect with families including grandchildren. If you need disability accommodations, please reach out to MOSI in advance.

3. Make a reservation for a beachfront restaurant. This provides Dad the opportunity to enjoy the beach, in the shade, with a cocktail! He can watch everyone enjoy the sand and water and not have to be concerned about too much heat and the instability of walking on sand.

• Frenchy’s Rockaway Grill
• Salt Rock Grill
• Walt’z Fish Shak
• Post Card Inn on the Beach
• Hurricane Seafood Restaurant

4. Ready for a rollercoaster ride? Busch Gardens has much to offer, rides, shows and a safari journey. Even if Dad can’t ride the rollercoasters, he may enjoy watching “you” ride the roller coasters.

5. Largo Central Park is a great venue for a picnic, with lots of comfortable shade. The Park is friendly to those with disability issues. Pack a lunch, pick up sandwiches at Publix or the local deli and a gallon of ice tea and you are ready for a great meal. And don’t forget KFC, some days you just need to have fried chicken!

6. A little-known secret in Pinellas County is The Largo Botanical Gardens. A walk around the Gardens slows you down and gives you a chance to escape and enjoy the beauty only a garden can provide.

7. Enjoy lunch in beautiful downtown Dunedin then head over and explore the Dunedin Fine Arts museum for the afternoon. Looking at art is an amazing experience no matter what age you are and it does not require your memory for you to enjoy it. Go have some fun!

8. Enjoy a lovely stroll and lunch on Beach Drive in St. Petersburg, then take some time to visit the Chihuly Museum. The glass work is amazing, and if time permits head over a few blocks to the Hot Shop and see artists prepare and design incredible glass art while you watch.

9. Take Dad out to the Ball Game! Enjoy watching the Tampa Bay Rays play the San Francisco Giants and get a free foam bat and ball set while you’re there.

10. Enjoy cocktails and dinner on Father’s Day at On Swann in Hyde Park,   Tampa, Florida. This is a shameless plug for the restaurant of my good friends, John and Trudy Cooper. I love this restaurant! The cocktails, the menu and the ambiance are all amazing. My favorite main dish was the Lemon Herb Ricotta Gnocchi until I tried the Pork Chop with the Grits – they are both amazing! You have to start your dinner with “The Farm” and “Parm Zeppole!” What a pleasant refreshing surprise full of flavor. Try it out and be sure to say “Hi” to John and Trudy for me.

11. One of my husband’s favorite gifts received for Father’s Day is a beautiful journal labeled WOD, “Wisdom of Dad.” Our son listed pages of sayings, idioms, and comments his Dad has repeated to him throughout his years. When my husband has ever wondered if he has had an impact on his children he only has to look at this “WOD” Journal and then feel good!

12. A repeat from a Mother’s Day suggested gift is the Amazon “Echo.” We enjoy walking in to our home and quickly stating, “Alexa, please play Classical Music” and in a few sections you are relaxing and listening to the music. My husband loves asking Alexa to provide all of the scores from the sporting events he follows. The Echo can be purchased at amazon.com.

13. My husband is thoroughly enjoying his “Canary” home monitoring system. It alerts him via text of anyone entering our home, the temperature of our home, the humidity level, and the air quality of the home. I can’t believe how much time he spends watching our home and enjoying checking it out. It is extremely simple to set up however Wi-Fi service is required. You can purchase one at www.amazon.com.

14. SkyBell is a smart video doorbell that allows you to see, hear, and speak to the visitor at your door whether you’re at home, at work, or on the go. This is great for the Dad that perhaps is a little unsteady on his feet or perhaps slower to answer the door. Dad can directly talk to the visitor, tell them he is on the way and not hurry so much and take the risk of falling.

15. Do you want a beautiful way to maintain your tablet and all the charging cords and accessories that go with it? Check out the Mod 2 Tablet Case.

16. Fitbit or Garmin are great tools, depending upon how engaged your Dad is in following his fitness commitment. A good friend recently shared what a motivator his Fitbit is to keep him moving on a daily basis. In fact, if he doesn’t get his 10,000 steps in he starts to feel guilty.

17. The Amazon Fire TV Stick allows Dad to access Hulu, Netflix, ESPN, and literally 1000’s of shows on his TV. If Dad is not tech savvy please take time to set this up for him before you leave his house – it is the only way he will love this gift!

18. Ugg! Shearling Slippers. You can’t go wrong, no matter what the weather, giving Dad this soft and cozy slipper. These slippers are good inside as well as outside the house, and do not have slippery soles.

19. Is there a Dad out there that doesn’t need another carabiner? Check out the REI website for a full selection. Do not limit your carabiner use to just a key chain. This is a manly method to attach items to your wheel chair or your walker. When traveling it helps you keep track of your stuff by attaching the carabiner to your item and your jacket. The uses are endless and the price is good.

20. Order some Montgomery Inn (“The Ribs King”) ribs and have them ready to throw on the grill for Dad and enjoy. Be sure to order some extra Ribs King sauce. These ribs come completely seasoned ready cook on the grill or oven. The sauce is the perfect combination of sweet and spicy, any leftovers can be used on chicken or burgers. I promise you Dad will love his Father’s Day ribs!

For the latest gift ideas and aging wisely advice and news, make sure to sign up for our newsletter!

Workshop: How to Develop a CarePlan to Ensure the Best Care for Your Loved One

Join us Tuesday, July 12, 2016 for a free educational workshop. Instructor Linda Chamberlain will help you understand how a careplan can ensure the best care for your aging parents/loved ones and clients. Linda Chamberlain, Board Certified Elder Law Attorney and Founder of Aging Wisely, LLC and EasyLiving, Inc., will share her expertise from working with thousands of families over the years. Come learn:

• the important role a careplan plays in improving care delivery, quality of life and outcomes
• how a careplan provides better guidance for those assisting with the care of your loved one (and how to communicate the information)
• what goes into a careplan
• how to develop a careplan
• when to review the careplan and update it

Tuesday, July 12, 2016 

1pm to 2:30pm

EasyLiving Office: 1180 Ponce de Leon Blvd., #701

Clearwater, FL

Call 727-447-5845 to RSVP

Seating limited to 20 attendees.

Click here for  the flier for the care plan workshop.

Related posts:

The Aging Wisely Careplan

Benefits of a Geriatric Care Management Assessment

Getting the Best In-Home Care: The EasyLiving CarePlan

Getting Organized with an Exit Strategy

Join instructor Linda Chamberlain at this special evening workshop, back by popular demand, about creating your “exit strategy”.

Getting Organized Exit Strategy Workshop

Tuesday, June 28, 2016

7 PM-8:30 PM

1180 Ponce de Leon Blvd., Suite 701, Clearwater, FL 33756

727-447-5845

This workshop will focus on getting organized with your affairs, what decisions you need to make and how you may want to make them, categorizing and documenting your wishes, and tips and tricks on “really” getting it done.

A FREE “getting organized” tool will be provided to all attendees. You will not want to miss this! Limited to first 20 attendees.

About the presenter: Linda R. Chamberlain is a Board Certified Elder Law Attorney who has practiced in the Clearwater area since 1991. Linda has Martindale Hubbell’s highest rating as an AV® Preeminent™ Attorney. Her practice includes Medicaid planning, Medicaid applications, and long-term care issues. Linda is the Founder and President of Aging Wisely, LLC, a professional care management company and EasyLiving, Inc., a non-medical private duty home care company which have now merged to offer integrated services.

Click here for the Exit Strategy Workshop Flier. Reserve your seat today by calling 727-447-5845 or contacting us online.

Hoarding Disorder Case Background

A family expressed concerns over their mother, who had become increasingly isolated and confused. She fed her “needs” by buying throughout the night on QVC. During a home visit, we observed hundreds of unopened yellow QVC bags and the contents of many additional QVC purchases strewn across the home. There were pathways going between doors and several rooms, with large stacks of items (5 feet+) along the paths. Two bedrooms were closed off; the doors would only open a few inches due to floor-to-ceiling contents stacked from wall-to-wall. The floor of the master bedroom was covered with items, and only a tiny portion of the bed was available for sleeping. The client had several cats who were using the few open spaces as litter boxes.

How did this case of hoarding disorder get referred for help?

The family came to town to visit when the client’s sister died. Her sister also had hoarding disorder and had purchased hundreds of items from QVC. Her body was found in her home amidst the clutter and it took firefighters six hours to remove her body from the home because stacks of items had to be removed first. The family was distressed by their Mom’s living situation, especially in light of her sister’s death. They asked the client’s financial planner for a referral to get some help.

What problems was the hoarding disorder causing?

The client’s problems were numerous:  isolation, loneliness, confusion, and depression. She was suffering from malnutrition, and bruises and broken bones from falling in the home. Her environment had become increasingly unsafe. The family was suffering from fear, anger, frustration and overwhelming stress.

As is common in cases of hoarding disorder, the client would not see a professional and did not feel she had a problem. She rationalized each and every purchase. She could not allow any item to be moved, none of the empty bags could be tossed (She would say, “I might need the packing slip inside to return it.”). Any attempts to move items or declutter caused her great distress.

Initially, her family felt that cleaning up would be sufficient. Later, they began to understand the nature of the hoarding disorder and her depression and dementia. In cases of hoarding disorder, simply cleaning and decluttering typically won’t resolve the problem long-term. The client had only one friend, a financial planner, who did not “see a problem” and reinforced client’s right to live as she chose.

Hoarding Disorder Case Approach

An initial meeting was set up by the family via the referral from the financial planner, with the thought that an assessment was needed to identify services that could allow the client to remain in her home.

The care manager did a full assessment on the client and home environment, with a review of medical records and discussion with primary care physician. The care manager showed photos of the house to the physician, who had initially stated there were no concerns, no dementia, and no hoarding disorder. Once the physician saw the photos and discussed the situation with the client, he gave a diagnosis, started medication, and recommended that the client should not remain in the home.

During this process, the care manager took the client to her physician for a routine exam. He discovered she had an infection from one of her cats and she was hospitalized for treatment. During her stay at a rehabilitation facility after the hospitalization, the care manager helped the family to set up an independent living apartment for her. This provided an opportunity for cleaning out the home (the family arranged to change the locks and items were packed up for donation, sale, etc.).

Fortunately, the client was successful in the apartment for a few years. The care manager helped to arrange for the shopping channels to be blocked from her TV, and outgoing long-distance calls blocked on her phone. Her Power of Attorney helped manage the situation and safeguard her credit cards. The POA paid the bills and provided limited funds for spending money, to halt excessive purchasing.  

What were the biggest challenges in this hoarding disorder case?

The biggest challenge was the client’s dementia. While not severe, it was enough to keep her from moving forward with any treatment. She was also easily manipulated, and her one friend became overly involved in her situation. He took her to an attorney to appoint a new Power of Attorney (DPOA) and Healthcare Surrogate (HCS).

Once the new DPOA/HCS was in place, her friend hired a new company to oversee things and she became estranged from her family.  The new arrangement only worked out for a few months, and then the friend began overseeing everything personally. He eventually moved her to an assisted living facility, where she died following a fall. Unfortunately, the client never reconciled with her family.

What lessons can we learn about hoarding disorder from this case?

Patience, patience, patience! Family members need to understand that hoarding disorder is not about “the stuff.” It is about control and feelings. If there is no dementia present, there is potential for therapy and support to move a person along. It is a long, slow process, and therefore can be quite expensive.  

It is important to have planning documents in place (DPOA and HCS).  The DPOA/family can help situations of hoarding disorder by restricting access to credit cards and cash available for purchases. But, as this case shows, those documents can be changed. Hoarding disorder can be very persistent and many clients will undo the efforts.

If there is dementia present, the likelihood of any successful resolution in the home is minimal.  If dementia is present and the person is at risk due to safety issues in the home, it may be necessary (and quickest) to contact Department of Children and Families (DCF). If they find the client is in danger, they can get the client out of the home and into a supervised, restricted setting.  If safety is not an issue, and if the person is eccentric but not demented, there is little that one can do.  People have a right to make bad decisions, and families may have to wait until the situation becomes worse.

Help for Hoarding Disorder

Contact Aging Wisely online or at 727-447-5845 to discuss how our team can help you if you are concerned about a loved one’s hoarding.

For more information and hoarding resources, check out these related posts:

Signs of Hoarding: How to Know if Someone is a Hoarder

Mail Hoarding and Scams

Pet/Cat Hoarding

The ASPCA defines cat hoarding (or animal hoarding, in general) by three criteria:

• possessing more than the “typical” number of companion animals
• inability to provide even minimal standards of nutrition,sanitation, shelter and veterinary care
• being in denial of the inability to provide the care (and the impact of that failure on the animals, the household and themselves)

These symptoms and the triggering factors are much the same as other types of hoarding, though the physical situation may be quite different and the harm to the animals adds an additional twist.

Cat Hoarding Case

This wealthy, elderly gentleman in Tampa was being treated for cancer at Moffitt Cancer Center. The social worker had referred him to home health for some home services while he waited for treatment. The home health agency had contacted Department of Children and Families (DCF) when they saw the condition of the home and feared for his safety; DCF had referred him to Aging Wisely care management.

The client’s home was sparsely furnished.  The house was full of cats, with dozens of litter boxes buried in cat feces. Cat feces and urine stained the floors and carpets (piles of cat feces 6-8 inches thick in parts of the living room and dining room). The client’s room was cluttered with trash, soiled clothing and old papers. The plumbing was not working in the bathroom which he continued to use, so the bathroom was completely unsanitary and unsafe.

DCF Referral to Aging Wisely

This gentleman was scheduled for surgery at Moffitt, but needed a stable place to go to recuperate.  He had no family or friends. The social worker was not aware of his home situation. The home health agency pulled out when they saw the home situation and contacted DCF. He did not have dementia and DCF was not equipped to deal with him. His assurances that he would clean up his house allowed him several chances. There was food in the refrigerator, the cats were fed and had water. Cat hoarding (or other animal hoarding) is never an easy situation, and it is not clear why animal control was never called.

The client had to agree to assistance from an agency to avoid being removed from his home by DCF. He was referred to Aging Wisely. Care manager Julie Scott shares more about her work on this case.

What approach was used for this case?

The referral started with a home evaluation, during which I quickly determined the scope of the problems. I contacted the Moffitt social worker to get him admitted to the hospital. I then pulled in a company that specializes in this type of work, to do the initial cleaning. I engaged a home health company to clean the kitchen, restock the pantry and refrigerator, and to work with the cleaning company on the organizational tasks.

What happened with this case of cat hoarding?

The biggest challenge is that we were really limited in fixing this up in a “short intervention”. There was going to be no ongoing care management/oversight once he returned home. We were able to resolve the immediate problems: getting the client admitted and quickly getting house cleaned, plumbing fixed and purchasing a new bed and some furnishings. The client returned home after surgery with home health and private caregivers coming in 2-3 times a week to cook, clean, and declutter. Unfortunately, the client eventually had to move from his home to a skilled nursing facility. The cats were taken to a local shelter.

What are the important take-away lessons from this case?

Cat hoarding/animal hoarding is a nightmare. Not only is the person at risk, but so are the animals. The relationship between the client and their animals is distorted, with the overall neglect that these animals are actually experiencing despite the meaning they hold to the person.  It becomes difficult to focus on the needs of the person because the animal neglect is overwhelming. While this man thought he was giving these animals good food and access to water (and he was), he was not able to keep up with the litter boxes, or their shots/veterinary care.  He would bring in a stray, a cat would have kittens, and the cycle would repeat.  He loved these cats; he had no family or friends.

When loneliness starts, the opportunity for intervention needs to be acted on as soon as possible. Though healthcare professionals are subject to mandatory reporting of abuse and neglect, this case shows just how widely that can be interpreted (and therefore ignored) and how cat hoarding and other types of hoarding can manage to stay hidden or not addressed for so many years.

Resources for cat hoarding cases:

Animal control/advocacy: Visit Pinellas County animal services and Hillsborough County, for information in the Tampa Bay area. The SPCA of Tampa Bay takes reports of animal cruelty and receives animal surrenders.

Cleaning companies: Look for companies that specialize in hoarding or crime scene cleanups (if you can’t find them online, funeral homes and local police may be able to give you a resource). Spaulding Decon is one of the companies we have used in Tampa, with multiple locations.

Home health agencies/caregivers: In these cases, someone is often needed to help with organizational tasks, working with the cleaning company and doing follow up after the “big clean”. Also, of equal importance, having ongoing support is going to be vital to ensuring continued upkeep and supervision. Regular caregivers in the home can also reduce the loneliness and troubleshoot as problems arise.

Aging Wisely’s care management team is here to help you and your family with hoarding situations or home safety concerns. If you have concerns about a situation, we highly recommend you reach out to us sooner than later. Just talking to one of our advocates can be quite a relief and get your pointed in the right direction for help. Call us any time at 727-447-5845.

*Image courtesy of scottchan at FreeDigitalPhotos.net

We will be sharing three cases of hoarding that our care management team have helped with over the years. If you are concerned about someone who is hoarding, we hope that seeing these case examples and the care plan, challenges, outcomes and our team’s related advice will help you. Our team is just a phone call or email away if you need help for hoarding.

Hoarding can take many forms (check out our post on signs/what distinguishes a hoarder). Our first example is a specific type of hoarding and may be a little different than cases you have heard of or seen.

Hoarding Scenario

The client was an attractive, bubbly and social elderly woman who lived alone in a condo. Her family lived out of state and seldom visited, though they did talk to her on the phone almost daily. This client was the victim of multiple email and sweepstakes scams. She was also on every mailing list imaginable, and her mail box was overstuffed daily. As she wanted to read, respond, and write checks to help causes or win prizes, her home was full of mail/paperwork clutter to an extreme degree. Aside from the many thousands of pieces of mail everywhere, the home itself was clean and tidy.

Common signs distinguishing this behavior as hoarding include the inability to throw items away, difficulty organizing, severe anxiety about throwing anything away (in this case, a compulsive need to look through and respond to everything) and distress over the mail. She was quite social, but she would not let her many friends into the house.

Impairments/Problems from the Hoarding Behavior

In terms of functional impairment, not only was the mail and paperwork overtaking the home but the behavior was resulting in financial problems. Stacks, bags, boxes, piles and drawers full of mail were everywhere.  As she worked through a little at time, she would toss the envelopes to the floor, creating a slipping hazard.  She would eventually gather these up and recycle some. She would bounce checks because she would continue to write checks for the sweepstakes, the charity solicitations, etc. Even when she knew she had no money left, she would continue to write the checks. Family members were constantly being asked to send money for food, which would go towards one or two meals, and then go to feed her habit.

How did the client or family come to seek help for the hoarding?

The client’s son came down to help find paperwork for her CPA to do her taxes and found the house full of papers. Though they were aware she had been having money problems, as with many hoarders, she hid the problem as much as she could and they didn’t understand the full extent of the issue until they saw the home. The son took care of getting what was needed for the CPA but had to return home. He sought help from home and was referred to Aging Wisely.

First Approach to the Hoarding Problem

As with all hoarding cases, a careful and gentle approach is necessary. If a professional doesn’t understand hoarding, he/she will often fail at the first approach (it’s not an easy problem to tackle even for seasoned professionals, but knowing how to approach someone who is highly anxious about their items and deeply distressed is vital to getting anywhere with solutions).

In this case, a home visit was conducted as a possibility of getting a “housekeeper” in to help with “tidying”. The care manager used her experience with hoarding to gently work with the client toward solutions that would not overwhelm her. In this case, she would not agree to any other outside party to come in but would allow the care manager subsequent visits to help sort through the papers. The process began with client and care manager going through the mail piece-by-piece, but as the care manager built rapport and reduced the client’s anxiety, she permitted a more general “sorting” and recycling of many of the papers. It was essential that the care manager create a calming presence and discreetly handle the items chosen for recycling to minimize the anxiety-producing cues.

Case Challenges

Time was the biggest challenge in this case because so much work was needed, and there was not much money to fund care management assistance. In other cases, we have been able to bring in partners and/or get a client medical/psychological help but in this case only the gentlest approach would work and the client refused outside help.

The care manager made attempts to take the client off mailing lists, but the volume of mail (and continually being added to more lists) was staggering. The volume of papers was being reduced slightly, but more and more were being delivered. In other cases, the care manager has been able to convince the client to permit a change of address to redirect mail, but this client refused.

Outcome of Mail Hoarding Case

Unfortunately, the client was arrested for writing a bad check one weekend and spent the weekend in jail (due to her age, she was placed in the medical unit). Once released, she returned home and the care manager recommended a move closer to her family (and away from the overwhelming home environment). The client moved to an assisted living facility near her daughter, where the family could check in regularly and handled her paperwork for her.

Advice/Take-Away Lessons

It is important to evaluate changes in behavior (either new or increased) sooner rather than later.  This can be very difficult for family members and it is easy to find yourself justifying, condoning, placating, etc. as your loved one denies the behavior and even hides the extent of it.  Unfortunately, this often results in the problem becoming out-of-control and difficult to solve. As soon as you see it, you should attempt to bring in professionals to deal with the underlying issues. Hoarding is not about the stuff, it is about control, and the person’s feelings (real or imagined).

When there are functional signs (in this case, even if the family may not have seen the home safety dangers, but the financial problems were a strong sign of an increased problem), seek an experienced professional to do an evaluation and make recommendations. Someone experienced with hoarding can usually find a way to access the environment and make progress towards solutions (it may be slow progress, but the earlier that intervention starts the less urgent it will be).

Stay tuned for next week’s hoarding case studies, where we will discuss animal hoarding, online/phone shopping, and severe home safety/cleanliness issues and the resources and techniques our care managers used in helping these clients and families deal with hoarding.

Thanks to care manager Julie Scott for providing information on her work on this case. To read more about Julie’s extensive experience with professional care management and her specializations, click here for her complete bio.