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Eldercare: The Benefits of a Developing a Schedule

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Our team offers eldercare advice based on many years working with numerous clients and families. Today, we share our secret to making eldercare easier for everyone (and life better for your aging loved ones): the schedule.

Why is a schedule so useful for eldercare and well-being for elders?

  • Healthy aging means staying active, both physically and mentally. The person’s health situation might place certain limitations on activities, but studies continue to show the importance of active engagement in life for physical and mental health. Exercise and physical activity can stimulate the brain’s ability to maintain old network connections and make new ones vital to healthy cognition and help elders maintain physical functioning and prevent/delay disease. Post-retirement health declines are mitigated when a person stays active, has social support or continues part-time work (or volunteer work).
  • Routine creates comfort and stability. We all tend to have preferences for when we like to get up and go to bed and things we like to do throughout the day. Our routines can be comforting and create our sense of home, even when other things change. A routine schedule is especially important for people with dementia or cognitive problems.
  • A schedule helps set expectations, especially if you have professional caregivers involved in eldercare. It helps to set expectations of what the “caree” prefers in terms of eating times, wake/sleep times and other daily routines, along with tasks and activities that should be completed. This is one of the great benefits of in-home care versus the group setting of a care facility. An elder can continue to follow whatever routine he/she wishes. Our EasyLiving team uses a unique Life History and Daily Routines Questionnaire to develop a customized home care plan.

eldercare planner

Our eldercare experts’ words of wisdom about schedules:

  1. Routine activities are the “comfort foods” of our lives. Don’t underestimate the value of these activities to someone. Make sure to let caregivers know about them. Consider important routines in planning activities (there’s nothing worse than planning a big activity when all the other person can think of is missing People’s Court).
  2. Of course, meals are the real comfort food of our lives. Don’t underestimate the importance of meals and food traditions. As we age, our appetites and nutrition needs may change, making meals even more important to us physically. Sometimes elders living alone experience loneliness at meal times, which can lead to poor eating habits (eating too little, snacking only on junk food or overeating). Having mealtime companionship and help preparing meals can improve nutrition and reduce loneliness.
  3. Channel your inner Cruise Director. Get creative with activity ideas. Your elder “caree” might not be able to do the same things they used to, but there are often ways to modify activities. Take a look around the local community for events, classes and groups. Check the local senior center, but also look at community centers, special interest groups, libraries, theaters and more.
  4. Don’t overschedule. This is especially important when you’re a long-distance caregiver making a visit, or when a hired caregiver first starts. You might be tempted to pack in lots of important appointments and make the most of the time, but remember your loved one probably doesn’t function at the same pace you do. It’s also good to allow for unexpected delays and to leave time for talking and relaxing together (and for hired caregivers to build a relationship).
  5. For hired caregivers, create a daily schedule and be specific. Schedule tasks, so that you don’t run into the problem of caregivers saying they thought it would be handled on a different day/by someone else. Schedule in tasks and appointments in specific time slots. For activities, you might set aside activity time but leave a few different ideas for what can be done during the time, or make notes about alternatives (for example, an outdoor activity with an indoor option in case it rains). Be as specific as possible and provide guidance.

For more great “insider” tips from our eldercare experts, sign-up with one click for our monthly email newsletter. Contact our eldercare advisor for a free consultation via email or at 727-447-5845.

 

Image courtesy of arztsamui at FreeDigitalPhotos.net
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Patient Advocacy Spotlight: Healthcare Planning

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patient advocates

We hope you have enjoyed the information from our Aging in America conference presentation on “A Better Approach to Eldercare Planning“. An important aspect of that planning process is healthcare planning. With National Healthcare Decisions Day coming up on April 16th, it is a great time to reflect on the importance of healthcare planning and its key components.

To frame the issue, here are a few interesting facts from the National Healthcare Decisions Day website:

  • Less than 50 percent of the severely or terminally ill patients studied had an advance directive in their medical record.
  • Between 65 and 76 percent of physicians whose patients had an advance directive were not aware that it existed.
  • Having a living will was associated with lower probability of dying in a hospital for nursing home residents and people living in the community.
  • Patients and families are often not fully informed of the relevant risks and potential benefits of artificial nutrition and hydration.

Did you know? The Federal Patient Self-Determination Act requires all Medicare-participating healthcare facilities inquire about and provide information to patients about advance directives (states also mandate such requirements for various healthcare entities, such as home healthcare and senior care providers, under their regulations). Yet, as we can see from the statistics above (and our anecdotal evidence as patient advocates, working with clients and healthcare providers day in and day out), this is just a small step in the right direction. Many gaps and misunderstandings remain in this complex process of healthcare planning and decision making.

Though this is a complex topic, there are some key steps you and your family can take. Here are some tips from our advocates about both advance care planning and decision making:

  • Get the key legal documents in place. Execute advance directives such as a living will and healthcare surrogate (also known as healthcare power of attorney). A durable power of attorney, though it covers finances and other practical decisions, is also a vital part of this planning process as these types of decisions often interrelate. Make sure to keep these documents in a handy place and provide copies to loved ones who are involved in your care. Get copies on the records with your healthcare providers.
  • Talk about it. In reality, the conversations should come first. Sharing what you wish with your decision makers is vital to help them do their job should they have to act on your behalf. Talking with others can also help you work through your beliefs and priorities. This is not a single conversation, of course, but an ongoing one. The parameters and the way you feel will likely change. There are some great resources at the National Healthcare Decisions Day website (check “resources for family conversations”). Our geriatric care managers include advance care planning as one component of our comprehensive assessment, to find out the status of client’s legal documents and also offer help with these conversations. However, the patient advocacy extends over time as the client’s health changes. The advocate can not only encourage and mediate conversations, but help ensure clients and families have the information they need to think through the options and consequences.
  • As mentioned above, asking the right questions is a vital part of the decision making process. If your family has prepared as mentioned, having the right information at the time of the decisions is the next step. This means asking healthcare providers to explain risks and benefits and asking for help when you don’t feel you really understand the prognosis and realities. When you are ill (or the worried family member), it can be difficult to process the information. The medical terminology is confusing to begin with and the decisions are often made under pressure. This is one reason why hospitals have developed resources like palliative care teams and ethics committees. This is the area where most families find huge benefits to having an independent advocate by their side as well. When you are diagnosed with a chronic disease or even in the initial stages of facing a more acute condition, gathering the right information up front can help you get the right plan in place and anticipate some of the future decisions.
  • Know where to turn for resources. The National Healthcare Decisions Day website is a great place to learn more, and the web can also be a good place to research your loved one’s condition or a specific procedure or treatment. However, the web is also full of junk and can be a very scary place when you look up a condition (just try typing in some minor symptoms and see the potential diagnoses the web holds for you!). Seek out the recognized disease-specific organizations and experienced healthcare entities for legitimate information (your healthcare providers can often tell you the sources they’d trust). This also means putting together a healthcare team that is best for you…both in expertise and in personality. You need to have good partners in your care who work cooperatively (this means you too!). Your Aging Wisely care manager can help you build this medical team, as well as serve as a liaison to ensure coordinated care.
  • Take a moment to revisit your goals, prognosis and plan. Everything can be so rushed when there is a medical emergency or urgent situation. Sometimes this will just be necessary, but it is also important at some point to pause and think about things (and ask those questions). We hear from adult sons and daughters time and time again who say, “I didn’t realize Mom was having all these tests and treatments. When we talked about what was going on, she didn’t really understand why. It went against everything she wanted.” The elderly parent is often spending most of their time in a doctor’s office, undergoing treatment or tests. Sometimes, this is the reality of fighting a condition, but many times it is because no one stopped to evaluate the situation. Your medical providers generally want to do what is best for you and comply with your wishes, but in this fast-paced system this sometimes requires an “advocacy pause” to think through the plan moving forward.

Need help with patient advocacy in Florida? Our award-winning* team is here to help! Call us at 727-447-5845 or contact us online for SOLUTIONS WHEN YOU NEED THEM!

 

*Nationwide winner 2011, Patient Advocate Organization, Professional Patient Advocacy Institute

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A Better Approach to Eldercare

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eldercare team

This client circle of care depicts the care team involved with an elderly or disabled client (also known as “the patient”, “Mom”, “Dad”, “Aunt Betty”, “resident”, “care recipient”). As our founders, Linda Chamberlain and Dr. Kerry Chamberlain, presented on “A Better Approach to Eldercare” at last week’s Aging in America conference, the focus was on how to harness the power of this care team to ensure the approach remains centered on the client.

The first stage in this approach is the beginning conversation. Too often, conversations around eldercare are done within silos and are focused by what the particular specialty wants to cover. Rather than working together (and starting with the client’s priorities), the individual may be blind to what is going on in the client’s life outside his/her office. Unfortunately, this can turn the experts’ best solutions in to failure.

In “A Better Approach to Eldercare”, Linda and Kerry discussed using a comprehensive questionnaire to begin this conversation. This serves to help the client and family gather facts and information that will be needed to make informed decisions and gets information organized to spur the conversation (i.e. bring up “issues”). While a professional may not immediately address all the issues (or ever address them in his/her specialty specifically), having a broad sense of information guides the conversation, helps inform proper recommendations and points to issues that need to be addressed to make the whole puzzle work. It is also vital to understand what the client’s and family’s main concerns are. A good questionnaire and initial meeting help draw out these, often unspoken, concerns.

Some of the top concerns and issues elderly clients might have include:

  • Ability to stay at home
  • Costs to stay at home
  • Trying to keep children happy and not rock the boat
  • Refusing children’s care
  • Remaining the parent, even when ill
  • Loss of dignity
  • Not being a burden
  • Choosing the right people to name in their legal documents
  • Ensuring loved ones understand their wishes and recognize the boundaries

Some of the common family concerns (besides the major underlying thread, which is usually worry over Mom or Dad’s well-being and a desire to ensure it moving forward) we see in our work include:

  • Children concerned parent cannot afford desired choice
  • Children concerned regarding their potential need to help pay or provide for care
  • Family turmoil and breakdown over lack of direction by parent
  • Sometimes it comes down to one of the biggest decisions which is whether to spend all the money on any care needed or protect assets and choose Medicaid/public benefit options (particularly when long term planning was not done in advance).

With a proper understanding of these issues and a good conversation started, the professional can now share his/her expertise with the client and family to help them understand topics that need to be addressed and implications of different decisions/options. Check out our checklist of items to review during eldercare planning with the client and family, for more detail.

Coordinated eldercare planning centered around the client offers an approach which not only works, but helps all members of the client care team do a better job. The benefits of coordinated planning include:

  • Choices for the client and family (planning opens up more options)
  • Reduced suffering
  • Peace of mind
  • Maintaining dignity and independence
  • Bringing together the power of your circle of care (rather than dividing their strengths and potentially working at odds)

For more information on eldercare planning, contact us at 727-447-5845 and read our blog for regular updates and information. You can email us to receive our monthly Wise Words™ newsletter or to meet to talk further about coordinated eldercare planning for your loved one or client.

 

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Why Better Eldercare Planning is Essential

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ASA conference 2014 Aging in America

Attorney Linda Chamberlain and Dr. Kerry Chamberlain, founders of Aging Wisely, will be presenting this week at the American Society on Aging’s 2014 Aging in America conference. Bringing together their broad experience in eldercare over the past fifteen years running Aging Wisely and EasyLiving along with their specialties of Elder Law and Hematology/Oncology,  Linda and Kerry will discuss “A Better Approach to Eldercare Planning”. Why is this topic so vital?

  • There are over 65 million caregivers in the U.S., providing greater than $450 billion worth of (unpaid) services.
  • Total estimated aggregate lost wages, pension, and Social Security benefits of caregivers of parents is over $3 trillion dollars (per average caregiver the losses add up to just over $300,000).
  • Over 1.4 million Americans live in nursing homes (only 5% of individuals under age 85 reside in nursing homes, but 11% of those over age 85 do) and more than 735,000 U.S. residents live in Assisted Living Facilities (54% of ALF residents are 85 and older)
  • The median daily rate for a semi-private room in a Skilled Nursing Facility in 2013 was $207 (up about 3% from prior year, from the Genworth Cost of Care Study). The national median rate for an Assisted Living Facility (monthly rate for 1 bedroom apartment) was $3450.

A few additional statistics about family caregiving:

  • Caregivers spend on average 20+ hours per week providing care.
  • If the caregiver lives in the home with person, care increased to 40+ hours per week.
  • The average duration of caregiver role is 4.6 years.
  • About 15% of caregivers live an hour or more away from the care recipient.
  • In the MetLife/National Alliance for Caregivers Study of Long-Distance Caregivers, despite an average distance of 450 miles and 7.23 hours of travel time one-way, long-distance caregivers reported substantial regular personal contact with the person they were helping; 51% reported visiting at least a few times a month.
  • About 1/4 of these long-distance caregivers were the only or primary caregivers and many had to rearrange work schedules (and spent an average of over $300/month on caregiving travel and other out-of-pocket expenses).

All of these statistics point to the necessity for good eldercare planning. Needing some type of assistance (and the related caregiving duties for the younger generation) has become relatively common to the aging experience, with longer life expectancies and increased chronic conditions. The way we plan and prepare can have a big impact on our choices and help both the elder and family members. As aging professionals, we can be allies in helping families through a better approach to planning. Too often, aging issues have been approached in a fragmented way, mostly from the perspective of the specific program or entity leading the conversation. We will share more in next week’s blog post from Linda and Kerry’s presentation, which is aimed to help participants:

  • Understand how a holistic approach to the client/family system results in more successful solutions.
  • Know the key components of a successful care consultation and how to approach an initial conversation.
  • Learn how to avoid breakdowns in communication, misunderstood goals, and missed opportunities by using a coordinated planning approach.

If you are attending the Aging in America conference, we hope to meet you there! Linda and Kerry’s session will be held Thursday, March 13th from 4:30-5:30. We hope you will consider taking part! You can also follow some live updates on our Aging Wisely Facebook page and Twitter feed.

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What is a Patient Advocate?

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A professional patient advocate is someone trained to help individuals (and their families) navigate the often complex healthcare system. Many family members and friends act as an advocate on a regular basis as a loved one faces a hospitalization, health crisis or chronic illness and treatment path. However, a professional advocate such as a care manager offers experience, training and in-depth knowledge of how to ensure the best care and pathway to good health and quality of life.

As stated by the Professional Patient Advocacy Institute, “The cost of healthcare increasingly is the responsibility of the individual consumer, which has made consumers more and more cognizant of the true cost of services and the value of traditional sources of care and information. Yet still today, the healthcare system is not set up like other commodities where comparisons can be made easily. To provide advice when faced with healthcare challenges, an emerging group of healthcare professionals known as patient advocates are positioned to assist consumers in making informed decisions while providing guidance, advice and direction in navigating the complex healthcare system.”

What are some of the ways a professional healthcare advocate helps?

*Providing a professional assessment and recommendations for resources, education and care plan options.
*Reviewing your chart and medical records to identify any concerns, questions and to help you and your family understand your health situation and options in lay terms.
*Accompanying a patient to appointments, treatment, ER visits for care continuity. Helping to formulate questions for providers and ensure good communication.
*Helping organize your medical information and create an online, personal health record.
*Assisting during key transition periods (such as hospital discharge, transfer to a care facility, or a switch in providers, where most problems occur) to ensure continuity and anticipate and avoid concerns.

When does someone use a professional patient advocate?

*When recently diagnosed with a chronic illness or acute problem–to locate good providers, evaluate options for treatments and handle the emotional and practical impacts of the diagnosis.
*During key transitions or health crises such as an Emergency Room (ER) visit, hospitalization, hospital discharge to home, inpatient rehabilitation or choosing a care facility.
*On an ongoing basis, especially when managing a chronic illness, multiple diagnoses or some form of dementia, to ensure continuity of care and be a liaison between providers, patient and family.
*To help in organizing records, putting together a care plan, creating an online personal medical record and to generally get a better handle on one’s medical situation and be proactive in managing chronic conditions.
*During end of life care, to support patient and family in decision making, emotional support and navigating options.

What are the benefits of a professional patient advocate?

*When you work with an independent advocate, such as our geriatric care managers, you get an independent assessment, someone who works for you and can ensure you get what you need.
*Expertise in the healthcare system (as well as eldercare, social services and related support services).
*Professional training and specialized expertise in the areas you need–someone who can quickly point you to resources and has knowledge of some of the issues you might not even anticipate.
*Emotional support for you and your family. Health crises can be emotional and it can be difficult to manage the practicalities and make clear decisions when facing these emotions. A professional advocate is your sounding board.

Who are professional patient advocates?

Patient advocates come from a variety of backgrounds within the medical world. Some may work for insurance companies, employers or healthcare systems or providers. Others, like our Aging Wisely care managers, work directly for the individual and family–objectively, independently–navigating a range of healthcare systems and providers and providing patients with continuity.

Our Florida geriatric care managers not only have strong professional backgrounds (both academic and experiential) in social work, gerontology, and case management, but continue to pursue specialized training areas. Our team offers experts in areas such as end of life care, Multiple Sclerosis (MS), Alzheimer’s/dementia, transitions to care facilities and much more. To read more about our professional care management and patient advocacy staff, we invite you to review our team section.

Contact us today so we can answer all your questions about patient advocacy and to find out how we can help if you or a loved one is facing chronic illness, a healthcare crisis, or just want to be assured the best quality of care.

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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.