The Life Transition Blog

Ten Steps for Adult Children Caregivers After a Holiday Visit

Posted by Sheri Samotin

on Mon, Jan 20, 2014

Many families take advantage of the holidays to enjoy time together. While these visits can range from fun to extremely stressful for all sorts of reasons, one common outcome is that adult children who haven’t seen their aging parents in a while to come away with feelings of surprise, fear, shock and even anger. Aging parents often do an excellent job of “hiding” their declining physical or cognitive abilities from their kids, especially when those kids live far away. They do this for a range of reasons – from not wanting their children “in their business” to denial that there is a decline or even the cognitive inability to recognize it. If you’ve recently returned from your holiday visit and find yourself in a bit of panic, here are ten steps to follow to get on track.

overwhelmed adult child

 

  1. Assess the situation – Do you have a crisis on your hands? An urgent situation? Or an ongoing chronic decline? Your answer to this very important question will determine how quickly you must act and make decisions, and how much collaboration you can afford. The more urgent the situation, the less time you will have to engage in a process to allow your parent and/or siblings lots of input. If you find yourself in this place, make sure that you are in fact the person with the legal authority and responsibility to be making decisions. If you aren’t, then it is imperative that you immediately get the person who is to get involved. If no such person has been named then this should occur immediately if your parent has the cognitive capacity to do so. If not, you may have to seek a court-appointed guardianship or conservatorship..
  2. Prioritize the needs – First make a long list of everything you can think of that needs to be done, fixed, solved, or otherwise handled. Then, prioritize this list according to what needs to be accomplished right now and what can wait. It is also important to distinguish between wants and needs. Finally consider those things that are best taken care of “on the scene” and which things can be handled from afar.
  3. Remember that safety must come first – As you are prioritizing, don’t forget that your job as an adult child is to make sure that your parent stays safe. Anything that is now, or could become, a safety issue should be near the top of your list.
  4. Make every effort to prioritize your parent’s independence – While you are at it, remember that whenever you can make a choice or recommendation that prioritizes your parent’s independence you will generally get less resistance when it comes time to implement. The most difficult aspect of aging for many older adults is the real or perceived loss of independence, so if you can keep your parent safe and as independent as possible it is almost always the better choice.
  5. Get organized– Now that you have made a prioritized list of all of the current and impending needs, get that list organized. At a minimum, make a sheet with three columns. In the first column, list the needs in order from highest to lowest priority. In the second column, write down your proposed solution if you know it (and leave it blank if you don’t). In the third column, write down the next step you need to take in order to work toward that solution.
  6. Figure out what resources you have available – Add a column to your list and fill in the resources you already know that your family has. For example, if the issue is grocery shopping and your parent already has a trusted housekeeper who comes once a week, maybe you can simply ask that person to take your parent shopping or do it for them. Alternatively, if the issue is how to pay for a solution, you might know that your parent is a veteran and may be eligible for veteran’s benefits that would cover the cost. If you are not sure what resources your family has to deal with a particular need, leave it blank.
  7. Make a plan – Take a look at that prioritized list. IF there are lots of blanks, your first step is to begin to fill them in so that you can create a plan. If the list is pretty well populated, now is the time to figure out how you might be able to divide and conquer.
  8. Build a team for now and later – Identify family, friends, neighbors, volunteers along with other trusted advisors and professionals who will help you execute your plan. If you don’t know these people, network and find them. Once you know who they are, make a comprehensive list with names, contact information and notes regarding who is available to do what.
  9. Communicate with both your parents and your siblings = Don’t do any of this in a vacuum. It is imperative to include both your parents (assuming they are able to participate) and your siblings in the process of developing the plan. The more inclusive you can be, the less likely you will later face roadblocks.
  10. Execute your plan!

While each of these steps can seem overwhelming, if you try to tackle them one at a time in a logical order it will be much less so. You may find that you need to do a “deep dive” into one of the steps; if that’s the case, try to assess whether you should stop everything to do so or whether you should simply put that step in the “parking lot” and come back to it after you have moved through the others. Finally, remember that any plans you make and implement will need to be revisited from time to time as your parent’s needs or resources changes.

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Tags: caregiver, caregiving, adult children, aging parent

Facing the Finish: A Road Map for Aging Parents and Adult Children

Posted by Sheri Samotin

on Wed, Dec 18, 2013

Release date 1.7.14

www.facingthefinish.comI am very excited to announce that my first book, Facing the Finish: A Road Map for Aging Parents and Adult Children is to be released on January 7, 2014!!! But you are invited to pre-order right now and receive a 10% discount by using the promo code PRE1. This is good through the end of 2013. 

Visit www.FacingTheFinish.com and click on "Buy From the Author" and you will be prompted for the promo code at checkout. The book will also be available as an e-book and on Amazon and Barnes & Noble.com. You can also register there for the Facing the Finish community where you can download free stuff, the lastest updates, etc. Once you are a member of the community you will also receive updates about my schedule for live events and book signings. 

Here is some advance praise for Facing the Finish: 

Sheri has a unique perspective—she's both caring and practical—which means she's able to manage the emotions around the difficult decisions we face as our parents grow old. In her book, she boils down what feel like overwhelming problems into doable tasks for both adult children and aging parents. I recommend “Facing the Finish” for all of us, as we all face our parent's last years and plan how we'll cross our own finish line. -- Denise M. Brown, Founder, CareGiving.com

Thank you Sheri for reminding us that “age isn’t something to fear-it’s something to prepare for, and by being prepared ahead of time, it can be a comforting chapter at the end of a long, full life.” I am recommending “Facing the Finish” to my aging family and friends because I want them to feel more confident as they answer the question ‘Who will take care of you when you can no longer care for yourself?”. When you read “Facing the Finish” you will feel like Sheri has become your family’s experienced guide helping you avoid that other “midlife crisis” as she calls it. You can avoid the crisis that is caused when we or our parent’s, need care much sooner and for much longer than we ever expected or prepared for.  Sheri advises adult children to “proceed with a light touch” when they become involved in their parents care. She reminds them that they are not their parent’s parent. Sheri reminds each of us that we can set the tone and direction of care related decisions by creating our life transition plan now while we are well. “Facing the Finish” provides clear direction on how to create and implement our life transition plan. An important theme in the book is to not only have a transition plan but to have conversations about your plan with your trusted advisors, family and friends. Sheri began Facing the Finish with the quote “Happiness is something you decide ahead of time.”  So buy a copy for your advisory team and your adult children. Encourage each other to do all we can to serve well as caregivers and be gracious, and perhaps even happy, recipients of the care. - Renee Porter-Medley, CFP® Co-Founder, SWAN-Savvy Women Advice Network, Inc.

From Accepting Aging to Getting Your Affairs in Order and dealing with Family Challenges, Health, Housing and Money this comprehensive book gives those approaching retirement and their families a way to cope with difficult transitions and live without worry. This detailed book shows readers how to plan for the future realistically and proactively. Facing our aging future is difficult and Sheri’s “no nonsense” approach makes the case for doing a “A Life Plan” before it’s too late. There are varied and practical first- hand stories showing how Sheri solved the issues and many, many resources for getting the help readers need. As an individual with aging issues around the corner, I’m grateful for her superb advice to make the last half of my life easier on myself and family members. - Bonnie Michaels, President of Managing Work & Family, Inc.


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Tags: caregiver, aging parents, caregiving, caregiver resources, adult children, aging adults finances, aging parent

Caregiver's Lament: Why Your Care Recipient Is So Clingy

Posted by Sheri Samotin

on Tue, Nov 26, 2013

One of the most frequent concerns I hear from caregivers is how to deal with a care recipient who never wants his or her caregiver out of sight. This can be a real challenge for caregivers who need to work, take care of other family members, or just have a little time to him- or herself.  What is at the root of this very common situation, and what’s a caregiver to do?

clingy puppy

To best identify what’s really going on and then develop a strategy to address the problem, it is important to first sort out which of the following situations best describes the dynamic you face:

  • Puppy  - This care recipient is perfectly safe and has no behavioral disorder which causes him or her to become overly anxious when left alone (or with another friend, family member or paid caregiver) but prefers that  you be around all the time or wants to be near you
  • Nervous  - This care recipient is safe, but tends to panic when left alone (or with another caregiver), possibly due to behavioral issues which may be separate from or related to their main conditions
  • Learned – This care recipient has had a real life bad experience in the past when you weren’t around and they are afraid it will happen again
  • Oblivious – This care recipient is unaware that s/he is clingy and can’t change his or her behavior or expectations
  • Manipulative – This care recipient is well aware that they are not at risk, but they simulate a panic reaction or other tactic to keep you close at hand

 

If you are dealing with a Puppy, the best technique is training (also known as behavior modification)! In this instance, you should be able to have a reasonable conversation with your loved one and explain why you can’t be with them every minute. You can negotiate and offer “treats” for desired behavior. It sound simple, but as with a puppy, it is helpful to give choices and let your loved one pick from among alternatives that you’re okay with. Sometimes, you will just need to go and do your thing, and if they “bark”, you know that they’ll get over it eventually. Try not to carry the guilt with you. 

If your loved one is Nervous, the situation is more complicated, especially if s/he suffers from an anxiety disorder. In this case, seek help from a behavioral health professional who might be able to offer techniques such as cognitive behavioral therapy. Your care recipient’s need to have you close is very real to him or her, and no amount of reasoning will change their experience of the fear of not having you close. In this case, it is important to find ways to help your loved one feel safe when you can’t be around, but don’t expect them to just deal with the situation on their own. Unlike the Puppy who will bark, the Nervous care recipient may have a full blown panic attack and hurt himself or others.

For a care recipient who has Learned that when you’re not around bad things can happen, you have to acknowledge the reality of their fear that it could happen again. If you can help them to understand that they are clinging to you because of past experience, you can often create safety nets that allow them to relax and let you go. For example, an emergency alert system might do the trick, or phone calls at agreed upon intervals.

Perhaps the saddest situation is the care recipient who is Oblivious to the fact that they are constantly clinging and demanding your presence. This is often the result of dementia or other neurological or psychiatric disorders, but can occur with any type of serious illness or pain syndrome. This loved one has either lost the cognitive ability to recognize that their behavior or expectations are unreasonable, or are so wrapped up in their own pain and suffering that the result is the same. In this situation, your best bet it to grit your teeth and do what you need to do without taking anything your loved one says or does too personally.

The Manipulative care recipient is the toughest customer of all. In this case, your loved one knows exactly how to push your buttons and does so for his or her gain. Just don’t be too quick to conclude that this explains your situation – make sure that you consider all of the other reasons first because there is a way to handle them, either by working with your loved one or wrapping your own mind around the situation and changing your understanding of what’s going on. So many caregivers become frustrated and assume that their loved one is being manipulative when in fact it is really one of the other scenarios. If you are convinced that you are being manipulated, then it is up to you to decide that you’re not going to fall into the trap anymore.  You’re unlikely to be able to change the manipulator’s behavior, so your only option is to change how you allow yourself to react. 

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Tags: caregiver, caregiving, adult children, aging parent

Survey Reveals Aging Parents and Adult Children Not Always on the Same Page!

Posted by Sheri Samotin

on Thu, Nov 21, 2013

In honor of National Family Caregivers Month, LifeBridge Solutions, LLC surveyed nearly 400 aging parents and adult children. The national survey was conducted online November 12 – 14, 2013.

aging parents

Survey results indicate that adult children are generally move concerned about their aging parent’s wellbeing than the older adult is about his or her own situation. Both generations are concerned about the older adult’s general health and safety and about driving. However, the aging parents top concerns inlucde worry about running out of money and how they will pay for care, while the adult children worry about their parent not asking for (or accepting) the help they need and about their parent’s inability to manage medications.

Unfortunately, adult children often live a long distance from their aging parents and don’t see them as often as they’d like. As a result, they worry about what’s going on with Mom or Dad and feel a need to put mechanisms in place to keep their parent safe. By the same token, many aging parents are adept at hiding their need for assistance from their children as they fear that their children will try to take over.

While only 25% of the aging parents surveyed report that they are stressed because of their adult children, nearly twice as many adult children report being stressed because of their aging parents. Consistent with these results, it is not surprising that more adult children than aging parents would change something about their relationship with the other generation. However, the top thing both groups would change is to live closer to and/or see the other more often. The next most common wish for both groups is to have better relationships with one another.

According to government statistics an estimated 25% of adult children currently provide hands-on and/or supervisory care for one or more of their parents. This number has tripled over the past fifteen years and is expected to increase dramatically as the population ages. Caring for aging parents is often referred to as the new mid-life crisis.

Watch for my forthcoming book, Facing the Finish: A Road Map for Aging Parents and Adult Children to be released on January 7, 2014. Blog readers can take advantage of a 10% discount by pre-ordering before December 31. Go to www.FacingtheFinish.com and click on the "buy from the author button" and use PROMO code PRE1. You can also join our community there by registering at the "get free stuff" button. 

 

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Tags: caregiver, aging parents, caregiving, adult children, baby boomer, aging

Six Things Long Distance Caregivers Need to Know

Posted by Sheri Samotin

on Tue, Oct 29, 2013

If you are a long distance caregiver, you probably often feel like you’re in the dark. You call and call your care recipient and there’s no answer. You go to that darkest place – something must have happened. And then, if you’re like most of us, you go into full alert mode, calling every five minutes. Perhaps you call your care recipient’s neighbors. Maybe you even call the police. After all, you’re the caregiver, and you don’t want “anything bad” to happen on your watch. How often do you learn a few hours later that Mom or Dad was out visiting a friend and “forgot” to mention it to you?

speedometer

Over the years, I’ve learned through my work with hundreds of long distance caregivers that there are some things that it seems every long distance caregiver learns “on the job.” In an effort to help you up that learning curve faster, here’s my list of the top six things long distance caregivers need to know.

  1. Silence isn’t always golden, but it’s not always a crisis either – Just because your care recipient goes “off the grid” for a few hours (or days) doesn’t necessarily mean that he or she is lying injured or worse on the bathroom floor. While the media gets a hold of the horror story of the nice old lady whose dog dialed 911 when she collapsed, the reality is that there are a multitude of reasons why someone might not answer the phone. So, before this happens to you, put a plan in place. If you can, have your care recipient agree to call you every day at the same time, no matter where he or she might be. That way, if you don’t get the call, you have a reasonable basis to worry. If memory issues make that approach a challenge, consider enlisting a “friendly visitor” to stop in daily and send you a quick text or email that all is well. This person might be a friend, neighbor, volunteer, or even a paid caregiver or companion. Get the phone numbers of a few of your care recipient’s neighbors and call them when you fear something is amiss. They can go knock on the door or check the driveway for the car. Consider using an emergency response monitor and/or a GPS device. And finally, make sure you call the local police department (non-emergency number please) and find out how to request a well-being check for your loved one if it becomes absolutely necessary.
  2. It’s not what you hear, it’s what you see – Long distance caregivers are familiar with hearing that everything is “fine” (or conversely, that it’s awful!) As with silence, you can’t always take what your care recipient tells you at face value. There is no substitute for making a visit and checking things out for yourself. Don’t forget to open the refrigerator and pantry and check for no food (or old food). Check for mail piled up unopened. Check for medication compliance. Look at whether repairs or maintenance are needed around the house. Talk to the neighbors. If you can’t make this visit, perhaps you can enlist another family member or friend to do so. Geriatric Care Managers are also a great resource for this type of assessment or well-being check-in.
  3. What you see isn’t always what you get – Just because the home is neat and tidy and the fridge is full of good food doesn’t mean it always looks like this! Very often, care recipients don’t want to worry their caregivers or be a burden, so they are on “good behavior” in advance of and during a visit. They work hard to make things look like everything is fine, at least on the surface. If you suspect this might be the case, consider making an unannounced visit. In any event, it’s wise to open drawers and cupboards, check inside the medicine cabinet, and at least take a peek at the basement, attic or garage. You might find that your care recipient has literally swept the true state of affairs under the rug!
  4. A go-to “owner’s manual” is the single most important resource – We have owner’s manuals for our cars and dishwashers – why not for ourselves? If you are a long distance caregiver, the single most important resource you can have is an owner’s manual for your care recipient’s life. I call this a Life Transition Plan. Not only does it gather all of the important information in one place so you don’t have to search high and low when you need it, but it also forces you and your care recipient (and any other caregivers) to form a partnership and really talk about important issues before they become crises. If you are interested in learning what should be included in a Life Transition Plan, please drop me an email at sheri@LifeBridgeSolutions.com and I’ll be happy to email you my free guide.
  5. Be specific in your requests for help – Whether you are caregiving from near or far, it’s natural to become overwhelmed and frustrated.  While a nearby caregiver can “show” someone else what they need done, a long distance caregiver usually has to “tell”. Many long distance caregivers make the mistake of requesting that someone “look in on Mom”, for example, and then are frustrated when they ask their surrogate eyes a question that person doesn’t know the answer to. Wouldn’t it be better to ask the nice neighbor to stop by and say hi to your Mom and check the refrigerator to see if there is fresh fruit and vegetables and to then call or email you with their findings? Or, how about asking your sister who is going to visit Dad to be sure to go through the mail with him and pull out any checks that need to be deposited. This will avoid the phone call where she tells you she had a great visit but has no idea that you wanted her to go through the mail.
  6. Communication is key and you need backups planned well in advance of a crisis – The most important lesson long distance caregivers share with me is that striving for excellent communication solves many issues. Caregivers must have open channels of communication with their care recipients whenever possible so that no one makes assumptions. Co-caregivers must communicate with one another to avoid duplication of effort or things falling through the cracks. Caregivers must let their own loved ones know what’s going on with them, and when they are having a particularly difficult caregiving challenge, it’s helpful to be able to share it and get some input. Whatever methods you use for communication, it’s a good idea to establish alternative channels in the event that the usual approach fails. This can be as simple as making sure you have a non-electric phone that plugs directly into a wall jack and which will work even during a power outage to setting up a phone tree to keep everyone with a “need to know” in the loop when information needs to be transmitted quickly and no electronic medium is available.

While the above points apply nearly universally to long distance caregivers and are most acute for them when they aren’t employed, they really to make sense for all caregivers. The best caregiving journey is one where you as the caregiver is able to keep your care recipient safe and as independent as possible within the reality of the situation, while at the same time, staying whole and healthy yourself. Remember, all you can do as a caregiver is your best. Part of that means remembering to make memories and help your care recipient to live a life with meaning and purpose. 

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Tags: caregiver, aging parents, caregiving, caregiver resources, adult children, getting affairs in order, long distance caregiving

Medicare Update for 2014

Posted by Sheri Samotin

on Sat, Oct 12, 2013

Mark your calendar!  Open enrollment season for Medicare beneficiaries has arrived.  In most cases, this will be the one chance you have to make changes to your coverage for 2014.  This year, open enrollment runs from October 15 through December 7.  Any changes you make during this time will take effect on January 1, 2014.  New costs and benefit changes, if applicable, also begin on this date if you decide to keep your existing coverage.  Don’t wait until the last moment to evaluate your options.

Every Medicare beneficiary should review their options each year.  This is because your medical status may have changed, or because the medications prescribed by your physicians may be different than they were last year.  In addition, even if nothing has changed on your side, your current health plan or prescription drug plan can decide not to participate in Medicare for the coming year, not to provide coverage in your geographic area, or to change the terms and conditions of your plan.  If you do not review your coverage, you may find that you have unexpected expenses during 2014.

There are a few global changes to Medicare for 2014.  The hated “donut hole” or “coverage gap” in Part D Rx plans is again shrinking as a result of the Affordable Care Act passed in 2010.  For 2014, the donut hole begins after you and your drug plan have spent $2,850 for covered drugs (down from $2,970 in 2013).  Whereas in 2013 you have paid 47.5% of the cost of brand-name drugs and 79% of the cost of generics while in the coverage gap, for 2013 you will pay only 47.5% and 72% respectively.  These annual reductions are scheduled to continue until 2020.   Once you have spent $4,550 out-of-pocket (down from $4,750 in 2013) you are out of the coverage gap and are in the catastrophic coverage zone where you will pay only a small coinsurance or copayment for each covered prescription.

Additional changes to Medicare for 2014 include the elimination of automatic refills for prescription drugs by mail order and a change to how co-pay amounts are calculated. In 2014, all refills must be verified by the drug plan and will only be shipped upon the patient’s approval. In addition, whereas in the past a co-pay amount for a chronic medication has been for a one month supply, in 2014 you can request a lesser supply and pay a reduced (pro-rated) co-pay. Your prescriber will have to write the prescription for less than a one month supply for it to be processed this way.

While the noted changes are positive, Medicare continues to be confusing and overwhelming to many older adults and their family caregivers.  Beneficiaries still must decide whether to subscribe to “original Medicare” (Part A and Part B) or to choose a Medicare Advantage plan (also known as Part C).  Assuming the choice is original Medicare, further decisions include whether to purchase a Medigap (a/k/a Medicare Supplement) plan or a Part D prescription drug plan, or change the one you currently have.  There can be consequences for not enrolling in such plans when you first become eligible for Medicare.   If either coverage is desired there is a further decision regarding which plan to purchase and through which insurance company. 

Medicare beneficiaries can get personalized help to sort this all out by calling Medicare or visiting the website and through State Health Insurance Assistance Programs (SHIPs).  In addition, LifeBridge Solutions offers a “medical plan selection service”.  For $149 per person we will help you understand your current coverage and options that are available for your particular situation.  We do not sell insurance – only educate and advise you without regard to external incentives.  Be sure to schedule early.  Remember, open enrollment season ends on December 7.

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Tags: medical bill help, Medicare, open enrollment

Six Tips for Handling Family Conflicts While Caregiving

Posted by Sheri Samotin

on Thu, Sep 26, 2013

When it comes time to arrange care for yourself or your spouse as you age or to help set up care for your parent, it works out best for everyone if family members can set aside their differences. With heightened emotions at play in caregiving situations, both sides are super-sensitive, tension is exacerbated, and flare-ups will occur. While this is understandable, it is not very useful. Overlay sibling dynamics, and you have a recipe for a boil over.

When a family first approaches me in search of life transition or caregiver coaching, I try to help them to avoid or handle the conflicts. I share with you my favorite tips:

caregiver stress

Find points of agreement – The one point that siblings can generally agree on is their objective to make sure that Mom or Dad receives the best care possible; interestingly, this sentiment is mouthed only by the adult children – too often, the older adult wants to do whatever is easiest or least trouble for their children. An open and honest talk among all participants, caregivers and care recipients alike, is the best way to identify points of agreement. Once articulated, it can be helpful to come back to these points from time to time when the going gets rough, sort of like pushing a “reset” button and reminding everyone of the real goal.

Identify underlying tensions - At first, everyone is on “good behavior” and tries hard to come across as agreeable. However, when I talk with family members individually, I often learn about underlying tensions that already are, or may soon be, in the way of optimal caregiving and decision making. Interestingly, when I talk with the care recipient privately, it is not at all unusual for him to raise this tension and to point to it as one of the most stressful aspects of the situation.

Start with what is, not what should or might be – Where do things stand right now? What options are available, or could be made available, to address or solve a particular problem? Often, I see families struggle and become overwhelmed when they jump to endpoints that might never occur or wish for outcomes that are unrealistic. Doing the former makes things appear unnecessarily bleak, while doing the latter is really a form of denial. Taking a realistic and balanced look at what’s going on can help to put and keep matters in perspective.

Take a dispassionate inventory – Care recipients need to speak their mind and give opinions regarding the type of care they believe they need and would like to see arranged. Caregivers need to work together to decide who can provide what. Is one sister great at organizing a schedule of caregivers and people to drive mom to her appointments? Maybe your brother is a physician and will be the best resource to go to for future medical issues. Perhaps there is a sibling who lives far away and doesn’t have much time, but who will volunteer to be the communications director and set up a system for keeping everyone in the family in the information loop. Take stock of other kinds of resources, too – namely time and money. If each family member can find some way to contribute to the effort that is within his or her skills, time constraints, and financial ability, then things will flow more smoothly.

Talk things over– Talk to each other and reason things out. This may take several discussions, as people have trouble arriving at final decisions over such emotional issues. Allow each other time to think things over and speak again. This is one of the benefits of discussing such situations before the conversations have to be held in emergency mode, during a crisis.

If the fights are about trivial matters you are probably avoiding the core issue – Money isn’t called the root of all evil for nothing. It is often at the core of the tensions among families, even though no one likes to admit it. If you find yourselves arguing about whether mom’s home health care work should come on Tuesdays rather than Thursdays or whether a wheelchair ramp should be the fold-away variety or permanently installed, you might consider if you are skirting the important core issues. Take a break and return to just compiling an inventory of what you’ve got to work with in your family. Details can be hashed out more fully later.

Sometimes family caregivers simply get stuck in their roles or attitudes and don’t know how to change things. In these cases, it is often important to get someone involved who can serve as the objective third party. This person doesn’t have a stake in the game and isn’t aware of the baggage that companies every family. Sometimes, simply having an outsider scratch her head and ask why something is the way it is can be enough to get things unstuck.

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Tags: caregiver, aging parents, caregiving, adult children, conflict resolution

Help for Caregivers: Patient Advocates

Posted by Sheri Samotin

on Tue, Jul 23, 2013

I am very excited to introduce a new feature of the Life Transition Blog, interviews with leaders in fields serving those in transition. My hope is to help you get a better understanding of the many professions that are at your service and will help you feel less overwhelmed. If you know of a profession and/or professional you’d like to see interviewed for this feature, please be sure to be in touch.

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Maria Freed is a Managing Partner at ORNOA, a firm that provides patient navigation services that connect patients seeking a wide range of medical services to various specialists and medical centers. ORNOA does not offer medical advice. They are health advocates who coordinate care for patients. ORNOA is located in South Florida.

Maria Freed

Briefly describe the profession of Patient Advocate or Patient Navigator

We initially started our Patient Navigation service as a way to meet the needs of many international patients who are overwhelmed with the process of reaching the appropriate providers in South Florida. Eventually we were asked by local folks to help them out too, so we now focus on all patients regardless of their country of origin. 

What do you and your colleagues do?

ORNOA has four Patient Navigators and we offer a wide range of personalized services, such as: help identify appropriate specialist(s), make appointments, interface with insurance carrier for quick authorizations & appeals, gather medical records, get second opinions, accompany patient to the medical visit, make hospital visits, attend clinical team meetings, work w social workers, work w case managers, arrange for transportation, offer discounted lodging, arrange for home health, pharmacy delivery, at home phlebotomist, audit medical bills, look for financial assistance for clients in need.

Who usually hires you?

Our clients are patients or their family members, insurance companies and self-insured employers

Why are you usually hired?

There are many reasons, such as a family member who is not living locally wants us to direct the care of a loved one, or a patient is having a difficult time with a physician or medical center and wants our help resolving the matter. Insurances look to us for our expertise working with value providers so that their clients do not have to shop around. Benefit managers from a company will ask their employee to contact us directly so we can tap a specialist and coordinate the entire care process.  

How are you different from other, similar professions?

We are privately owned and independent and are not employed by a hospital, physician or insurance carrier.  This autonomy allows us to do what is best for our client-patients.

How did you get into this field? What is your “story”?

I have been working with patients for the last 25 years, and developed and ran several clinical and international services departments in hospitals including the University of Miami Medical School. It was a constant frustration to get medical centers to focus on patient needs, and not just on promotion of service lines. The phrase patient-centered was overused and the concept poorly understood. I like working directly with patients and was never totally comfortable with corporate medicine.

What training, education, and/or experience are required or helpful to do what you do?

I have a Masters in Health Services Administration and am a hospital administrator by training. My career was focused on trouble shooting and turning around troublesome hospital units, such as diabetes, arthritis, neuroscience, and oncology programs. Being a contingency manager is great preparation for being a Patient Navigator. I am a pretty good problem solver. I never got the easy assignments. My objective was to improve programs, trained others to manage effectively and then move on to the next weak program. My assignments have taken me to Texas, South Carolina, Missouri, New Jersey and other regions within the United States, not just Miami facilities.      

Are there special certifications? If so, what does obtaining them entail, and how important is it for a consumer to look for someone who has it?

To date there is no official certification for health advocates. Patient Navigation as a profession has not been around for very long and so no national credentials exist.  I think the experience of the Patient Navigator should be an important factor for a consumer. We are members of APHA, The Alliance of Professional Health Advocates and abide by their code of ethics and try to stay connected with the patient empowerment “movers and shakers”. There are a lot of incredible folks out there enriching patients, and ORNOA is proud to be part of this tribe.

How can someone like you be found by a consumer?

Typically, local clients in Miami and Fort Lauderdale find us by word of mouth, and international clients are referred to us by their physician or insurance carrier. Consumers can search for help at www.advoconnection.com, the website provided by The Alliance of Professional Health Advocates.

What are the three most important questions to ask before hiring a Patient Advocate?

After sharing your objectives or why you think you need a Patient Navigator I would ask:

  • Is there a need: Is this something you think I could handle myself or is there a need to hire a professional? A professional should be hired only for tasks where they can really help. Most Patient Navigators are honest, and have so much work that they will want to add value to a client, not duplicate efforts. 
  • Cost: What is your fee? And how many hours do you think you would be engaged with my case?
  • Communication Flow: How often would we communicate? What is the best method (phone, email, in person)  

What are your top tips for working with a Patient Advocate?

Think carefully about what you hope to achieve by hiring a Patient Navigator. Be specific, and have a realistic timeframe. For example, for clients that have chronic illnesses and need longer oversight we recommend a yearly membership fee for our services. Otherwise, the hourly fee would be cost prohibitive given the time commitment we would give this person. When you look at a case as having a beginning, middle and a conclusion it is much easier to predict the level of service needed from a Patient Navigator.  We have clients that need us through pre op, and surgery phase but not during recuperation. Knowing this helps establish the parameters of our work. We try to discourage clients from hiring us to do “everything” or “money is no object” or “however you can help”. We try to be specific in our dialogue as this leads to better outcomes and happier clients.    

Anything to add?

I find that some clients, especially family members who are caregivers just want someone to talk to. This is understandable given the pressure of doing the right thing for a loved one. We counsel, listen, probe and try to be supportive in these cases.  Patient Navigators are good researchers, and can be the backup team for the family. 

Please visit Maria’s website at www.ornoa.com. You can subscribe to ORNOA’s newsletter there.

 

 

 

 

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Tags: caregiver, caregiving, caregiver resources, patient advocate, patient navigator

Summer Reading Guide for Caregivers

Posted by Sheri Samotin

on Wed, Jul 3, 2013

In my effort to provide my continuing series of book reviews for caregivers I have selected three works to share with you this week. Two of my recommendations are novels and the other is non-fiction originally intended for senior services professionals.

29

29 by Adena Halpern, tells the story of three generations of women – a grandmother, her daughter, and her granddaughter. The seventy-five year old grandmother identifies more with her twenty-nine year old granddaughter and this is the story of how she wishes to be 29 again for just one day. As the old adage goes, be careful what you wish for! This grandma has tried everything to stay young and her “young for a day” adventure causes her to question nearly everything about the life she has chosen. She asks her granddaughter to be her guide for her special day while at the same time, her own daughter and best friend are frantically looking for her when they can’t find her. All of these women discover important things about one another and their family relationships. Through the vehicle of a novel, Ms. Halpern allows us to question and consider our assumptions about growing older, the fountain of youth, and family relationships. You will likely laugh out loud and that’s always a good thing for caregivers!

Still Alice

The second novel is Still Alice by Lisa Genova. Unlike 29, this novel is a tough emotional read. It follows a fifty year old Harvard professor as she discovers she suffers from early-onset Alzheimer’s disease and makes every attempt to live in the moment. What I really find helpful for caregivers about this book is that it tells the story of dementia from the standpoint of the sufferer. While the work certainly incorporates the experiences of the husband, grown children and colleagues of the protagonist, the unique value is that it allows us to feel what she is feeling. The author is herself a PhD neuroscientist so the work rings very true from a clinical and scientific standpoint along with being a good read.

Say it to seniors Nearly a decade ago, David Solie published How to Say it to Seniors: Closing the Communication Gap with Our Elders. This work was originally intended for professionals in the senior services field but I have often recommended it to family members. The main message of this very helpful and practical guide is that older adults must balance between a desire to maintain control of their world and a desire to control their legacy or how the world remembers them. As caregivers, it is helpful to gain a good understanding of this dichotomy and to learn to use it to help you as you navigate the challenges in caring for your loved one.

While there is no shortage of advice and counsel for caregivers, I find these three works each provide a varied and important perspective. I hope you will enjoy them, and I’d love for you to share your feedback. Enjoy your summer!

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Tags: caregiver, caregiving, caregiver resources

Interview: Non-medical Home Care Agency Owner Robb Winiecki Advises Caregivers

Posted by Sheri Samotin

on Tue, Jun 25, 2013

I am very excited to introduce a new feature of the Life Transition Blog, interviews with leaders in fields serving those in transition. My hope is to help you get a better understanding of the many professions that are at your service and will help you feel less overwhelmed. If you know of a profession and/or professional you’d like to see interviewed for this feature, please be sure to be in touch.

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Robb Winiecki is the co-owner, along with his wife Tricia of a non-medical home care agency.  Their business is Assisting Hands in Naples, FL. I share many clients with Robb and Tricia and am pleased to be able to feature Robb as a spokesperson for his profession.  Robb Winiecki

What is a non-medical home care agency? Who usually hires you?

Non-medical home care agencies are licensed (in our case by the State of Florida) to provide services that help people to remain as independent as possible, typically in their own home. We specialize in helping with activities of daily living (ADLs) such as grocery shopping, errands, transportation, bathing, dressing, grooming and accompanying clients to medical appointments. We are also equipped to assist fully bedbound people as well. We can assist with medication reminders and self-administration of medications for individuals with physical limitations that prevent them from doing this on their own. We are typically hired by the care partner for the client (spouse or adult child).

Why are you usually hired?

Clients usually hire a care provider because they want to remain independent but for some reason they have insecurities about doing it alone. Often, they are not ready to move to an assisted living facility or find it is more cost effective to have the episodic care provided in their own home.

How are you different from other, similar professions?

As a non-medical home care agency, we do not provide care covered as a Medicare entitlement such as physical therapy, occupational therapy, respiratory therapy, etc. We don’t provide short term, intermittent care under the Medicare program. Rather, we engage with clients and their families to provide care with the frequency they require and on the days/times that serve their needs. We are paid directly by the client or their family and will work with their long term care insurance policy if they have one.

How did you get into this field? What is your story?

It all began with my wife Tricia who is a Registered Respiratory Therapist. She was working in this capacity at the hospital and was frequently asked by her patients or their families if she was available to stop by and check up with them upon their return home. She was asked if they could hire her to do the grocery shopping or help provide personal assistance with grooming. This was happening over and over at the same time that I was evaluating business opportunities because we had decided to open a family business. One thing led to another and we explored opening a home care agency and here we are.

What training, education and/or experience is required or helpful to do what you do?

As the owner of an agency, I need a working understanding of the health care field and the compassion to help people. It is important to me that I change people’s lives every day by allowing them to maintain their independence.

Are there other special certifications? If so, what does obtaining them entail, and how important is it for a consumer to look for someone who possesses these credentials?

Home care agencies are regulated by the state in which they are located. Here in Florida, there are various business models (e.g., agencies and registries) and levels of licensure. In our case, as a licensed agency, our caregivers are employed by us. They are licensed, insured and bonded. We conduct background checks and provide training and supervision. In short, we stand behind our caregivers and are responsible for making sure that our clients’ needs are filled by competent, appropriate people.

How can a consumer find someone like you?

As with so many personal services, the very best way to find someone to help is through a personal referral from a happy client, their care partner or a trusted advisor. You can also search online, but make sure that you carefully check the background, licenses, and references of those you find this way.

What are the three most important questions to ask before hiring a home health agency?

Are you licensed?

Are the people who work for you your employees or independent contractors?

Do I have to commit to a long term contract, and can I interview proposed caregivers in advance?

What are your top tips for working with a home health agency?

Be open and honest about the client’s needs and preferences. Communicate with us frequently, especially if there is a situation you are unhappy with regarding the caregiver or his/her delivery of services. This allows us to work with you to correct the situation before it becomes a crisis. If we don’t know that there is a problem we can’t possibly fix it! Don’t be afraid to ask questions.

Please visit Robb’s website at www.homecarenaples.com.

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Tags: home care, home health care, home healthcare

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