AGING LIFE CARE® ASSESSMENTS: Empowering Quality Aging

Unveiling the Assessment Process

At Caring Considerations/ Aging Life Care Manager, we understand the intricate challenges families face while caring for seniors. Our assessments will create a roadmap for balanced, enriched, healthy living. We confront obstacles, align goals, and ensure documentation of your healthcare.  Assessment can mean different things to you and to us.  Here’s our most common approach.

Through targeted questions and the gathering of information, we uncover your unique situation:

Health Snapshot: Medical history and recent physician visits.
Medication Check: Medication list and reviewing management systems.
Safe Spaces: Home assessment for secure aging.
Wellness: Nutrition and overall health.
Legal Review: Your documentation for incapacity planning.
Emotional Insights: Psychosocial understanding.
Future Readiness: Funeral plans and crisis prevention.
Create a Plan of Care and Informed Steps Ahead…

Our assessment also covers these crucial aspects:

Defining Goals: Your aspirations and their aspirations.
Addressing Concerns: Primary worries and fears.
Visualizing Success: Ideal outcomes for your family.
Effective Strategies: Past successes and failures.
Family Dynamics: Understanding inter-family conversations.
Comprehensive, Electronic Health Documentation…

We finish an assessment by providing a verbal and email report packed with insights and actionable recommendations.

What’s your definition of an assessment? We want to know how we can elevate your family’s quality of life. Contact us at 571-488-9396  [email protected]




CAREGIVING TOOLBOX:  Life Enrichment Visits

Aging in Place vs. Senior Living

Yes, senior living can be the answer for many when it comes to loneliness, but parents have the right to make decisions. We are very independent beings and many of our aging parents are not prepared to live in a senior living community. For them, aging in  place is the best option.

Our response to this need and desire? A Life Enrichment program. Here’s what Caring Considerations will do to help reduce isolation.

We Want To Get To Know You

The in-person, Life Enrichment sessions are customized to meet the specific interests of seniors in ways that are meaningful and relevant. Clients typically receive weekly visits, but we will discuss a schedule to meet a loved-one’s desires.

What Are Life Enrichment Visits?

We provide hourly curated engagement, recreation, and social activities as part of a holistic Aging Life Care® plan.

Physical

  • Workout buddy – PT prescribed exercises and seated exercise videos
  • Walking Companion

Creative

  • Writing
  • Craft projects
  • Reminiscing & conversation

Brain Fitness

  • Math Brain Boost
  • Trivia (variety of topics: sports, movies, country specific, holidays)
  • Word puzzles

In our Aging Life Care® consulting practice, we witness numerous lingering issues resulting from the COVID lockdown.  Older adults want to remain independent, but often lack the insight and energy to incorporate more social opportunities.  The isolation imposed by the lockdown is perpetual and increasingly a barrier to  seniors returning to the life they enjoyed prior to the pandemic.

An Added Benefit

When your parent doesn’t want to move to assisted living, but you worry about them, Life Enrichment visits can be a non-threatening “check-in.”  Although we don’t provide personal care, we can provide feedback about your loved one’s overall well-being.

Contact Us

To learn about this program and more, call 571-488-9396 or email us at [email protected].




Solo Agers: Who will advocate for me?

Many baby boomers had fewer children or no children.

No other time in the history of our population have there been so many solo-agers. About 17% of those born from 1945-1964 are struggling to get qualified support and a safety net in order to maintain quality of life.

So, what if you had a surrogate daughter who specialized in healthcare advocacy and crisis response for older adults?  What if they had a knowledgeable relationship of your needs so that you could live your best life under your terms? Caring Considerations Aging Life Care Managers® can help.

Our services:

  • Be there for you 24/7—just like family
  • Discuss options for housing and care. Make a plan.
  • Document important information in a secure health care record
  • Coordinate resources and help create a team
  • Potentially become your legal healthcare agent with medical power of attorney

Our Goals

  • Help you remain in control and independent
  • Safety and well-being

Call us to learn more!

www.caringconsiderations.com  571-437-9396




Is My Loved-One Safe in Assisted Living?

So many of us worry about our loved ones being safe, comfortable and treated with kindness when they are living a senior community (i.e. assisted living).

The sad fact is most elder abuse is by a family member. Abuse can come in many forms such as intimidation (emotional), physical or financial, neglect, etc.

But what about in care settings? Most reported abuse doesn’t happen in care settings. But what can you do to make sure your loved one is getting the best care?

  1. Come from a place of support to staff. We recommend you are an active, visible advocate in the senior community. Get to know the caregivers, nurse’s and managers and even other family members.
  2. Visit often and at different times of the day.
  3. Know warning signs of the various types of abuse.

It’s always wise to ask questions of the staff when you are unsure about community procedures and situations.  And it never hurts to bring a treat or something else to the staff. Let them know you respect and care about what they do for your family member.

Questions You Can Ask Your Loved One

Older adults are often grateful for the care they receive and they may not want to complain.  It is true caregiving may never be perfect, but to some extent, we may need to pick the battles.  The other thing you can do is ask the older adult the following questions:

  • Who is responsible for caring for you (during the day, in the evening, etc.)?
  • Do you feel safe where you are living?
  • Does anyone scold you or shout at you?
  • Has anyone ever hit or slapped you?
  • Has anyone left you alone waiting for food, drink or care?
  • Has anyone ever made you do things you don’t want to do?
  • Have you ever signed something you do not understand?

When Your Loved-one Has Memory Loss

The important thing to consider in this evaluation is memory loss.  If the resident suffers from Mild Cognitive Impairment (MCI), then you can usually have faith in their answers to these questions.  However, if your loved one has more moderate or severe memory loss or his/her memory is getting worse, be aware that suspicion and confusion is common.  Older adults with memory loss can’t always understand or process what is going on around them, so they will express feelings differently.  In these cases, changes in behavior might be the best indicator of something isn’t quite right.

What To Do If You Suspect Abuse

Get your facts and information together.  Keep an open mind and seek to understand.  Local senior living communities have a grievance process which should be posted in their community in an obvious place.  If you don’t see it, ask for it.  Try to resolve a concern internally with owners and managers.

You may also wish to the local Ombudsman’s Program via the county Area Agency on Aging.  To find your local Area Agency on Aging visit https://www.usaging.org/

A last resort would be to contact the county Adult Protective Services office via the local Area Agency on Aging. https://www.usaging.org/ http://vaaaa.org/




What is an Aging Life Care™ Manager?

I’m always a little unsure how to provide a meaningful answer when we are asked, “What does an Aging Life™ Care Manager do?”.  To many, our responsibilities seem straight-forward. To others, they may scratch their head and try to imagine how we might be able to help a loved-one better than family.  Families don’t necessarily contact us when the problem is straight-forward, we are contacted as experts who can accomplish so much more in less time.

We are care consultants (RNs, Certified Care Managers, Certified Dementia Practitioners, etc.) with a responsibility for helping the most vulnerable. Care Management can be similarly described as ‘case management’.  However, Care Managers are typically involved in helping adult children help their aging parent(s).  We also support solo agers who may not have enough or any family support.

Listen to the video.  Do you still have questions?  Please contact us at 571-488-9396 or email us [email protected].




Resources to Learn More About Alzheimer’s/Dementia Research, Prevention, Treatment

  1. Alzheimer’s Association 800.272.3900  24/7

www.alz.org  https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf

  1. NIH Clinical Trials

https://www.alzheimers.gov/clinical-trials

  1. Good overview videos

What you can do to prevent Alzheimer’s | Lisa Genova

https://www.youtube.com/watch?v=twG4mr6Jov0

Gary Small MD/Successful Aging  https://www.ted.com/talks/gary_small_the_formula_for_successful_aging?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare

  1. More in-depth clinical information

Dale Bredesen, MD A Precision Approach to End ALZ

https://www.ted.com/talks/dale_bredesen_a_precision_approach_to_end_alzheimer_s_disease

  1. Reversal of cognitive decline in Alzheimer’s disease – Aging (Albany NY). 2016 Jun

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931830/

  1. Reversal of Cognitive Decline: 100 Patients-Journal of Alzheimer’s Disease & Parkinsonism 2018

https://www.omicsonline.org/open-access/reversal-of-cognitive-decline-100-patients-2161-0460-1000450.pdf

  1. Practical information about dementia care (Teepa Snow)

https://www.youtube.com/watch?v=t–mkzfHuIE

  1. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392084/

  1. More Basic Information

https://www.nia.nih.gov/health/what-dementia-symptoms-types-and-diagnosis

 10. Blue Zones bluezones.com

  1. Recent Article: Do we have to age?

https://www.theguardian.com/science/2021/jan/03/observer-magazine-do-we-have-to-age-biologist-andrew-steele

 12. Improve brain health with the MIND diet

https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/improve-brain-health-with-the-mind-diet/art-20454746

  1. Diet: Ketoflex 12/3

https://www.apollohealthco.com/ketoflex-12-3/Keto

14. George Washington Center for Integrative Medicine  www.gwcim.com

202-833-5055

15. Brain Growth Exercises

Elevate – Brain Training Games (phone app)

https://www.dakim.com/  Online and best used on a touch screen/iPad/Tablet

https://enrichvisits.com/  Workbooks for purchase

www.luminosity.com   Online, phone, tablet

https://www.goodwinhouse.org/stronger-memory/  Down loadable, free, worksheets

  1. Help for Families

Aging Life Care Association  www.aginglifecare.org

National Alliance on Caregiving www.caregiving.org/

Dementia Action Alliance www.daanow.org

Other recent news…

Alzheimer’s Association International Conference 2020  HIGHLIGHTS

Flu and Pneumonia Vaccination Tied to Lower Risk of Alzheimer’s

New research at AAIC 2020 suggests that flu and pneumonia vaccination are associated with a reduced risk of Alzheimer’s. Two studies of older adults found that those who received either a flu or pneumonia vaccination were less likely to develop Alzheimer’s. Those who received the flu vaccine more regularly had an even lower risk. For pneumonia vaccination, the largest risk reduction was observed in people who do not carry one of the known genetic risk factors for Alzheimer’s — a variant of the TOMM40 gene.

  • Blood tests that measure abnormal versions of the tau protein may — if verified through further research — diagnose Alzheimer’s dementia without additional confirmation; that is, not requiring autopsy examination, or both an amyloid and tau positron emission tomography (PET) scan.
  • Heart health risk factors — such as high blood pressure, diabetes and being overweight — as early as adolescence can influence late-life memory and cognition, especially in African Americans.
  • Higher quality early-life education is associated with better language and memory performance and lower risk of late-life dementia. This association can differ between men and women and between Black and white individuals.



Living with Family – Expectations and Boundaries

If your family has decided that an older adult needs constant care and that living together is probably the best solution, then you may be wondering why any further discussion is necessary. Even if you think it isn’t, consider taking a few minutes to sit down with your loved-one to answer the following questions. Doing this may help prevent misunderstandings in the future.

1.Will home care still be used to care for a loved one? If not, who will take time from their career (family) to care for an aging parent? What will be the trigger to get professional help?

2. How will this affect lost income? Will that person be compensated by the family? Who will relieve the primary care provider when they need a break?

3. Is the home accessible: ramps, railings, stair lifts, spacious bathrooms, etc.? Will there need to be modifications/renovation? How much will the modifications/renovation cost? Who will pay for them?

4. What is the budget for caregiving, room and board, etc.? Will you need to learn about Medicaid Community Based Services? What other services are needed?

5.What training will the primary caregiver need? Who will pay for the training?

6. If there is dementia, wandering, or severe behavior issues that become unmanageable, how will they be handled?

7. How and who will be educated about dementia? Everyone in the family or only the primary care provider?

8. Will there always be joint (family) meals? How much time will be spent together daily, weekly, etc.?

9. What household space is available (or can be designated) for private, more secluded time for everyone in the family?

10. How will grandparents interact with grandchildren or participate in discipline?

11. Do family members living together agree on the division of duties? Are there conflicts over tasks, duties & expectations?

12. Will the family be willing to or need to hire a professional counselor or mediator to resolve issues?

13. What will the older adult (e.g. grandparent) be able to contribute to the household activities?

14. Do the grandparents have local opportunities to engage with peers (e.g. senior center)?

15. What if an adult child needs to move? Is there a back-up plan?

We all have expectations and boundaries when living together. Communication early on may help set the stage for future conversations and negotiations.

If you find it difficult to come to a consensus, or you need help in exploring living and care options, contact us at 571-488-9396 [email protected]




Decisions: From Independent Households to Extended Family Households

You may recall the days when parents lived with their grown children (think The Walton’s).  Many cultures adopted this arrangement for financial or traditional reasons. Then an era of independence became more common.  I recall my grandmother wanting her own household in the sixties. Over time, changes in society have caused us to re-examine independent households in favor of extended family households.  The 2008 recession, living longer, and managing chronic conditions have been catalysts for change.  The fact is, living with family is becoming more popular.

Is it right for you?*

We spoke with a few families who have made the change.

Kathy and her husband, Richard lived very close to Kathy’s father, Bill.  The grandchildren enjoyed frequent visits to Grandpa’s house.

One day, they found Grandpa Bill unresponsive on the kitchen floor.  Fortunately, he was okay, but Kathy and Richard agreed it was enough of a scare to start the conversation. There was no reason why Dad couldn’t live with them.

It took Bill, a widower, a little while to get used to the idea. But when he thought about the future and his daughter’s responsibilities, he felt it would be a wise move.

“What really helped my father accept a new living arrangement was having a lot of control.  He helped hire an architect and Dad directed most of the in-law addition designing.  Dad was still sharp. He listened to our ideas, and he enjoyed the process.”

When I asked Kathy how they prepared to combine lifestyles, she said it was pretty easy.  Richard, the son-in-law, worked during the week and Kathy was able to spend some time with Dad.  When the weekend came, Grandpa Bill respected their family time.  Richard had no problems with his father-in-law being around. There were some shared meals, by invitation only. Grandpa Bill always knocked on their door in the morning just to say Hi and I’m okay.

What really worked out well is the in-law suite. It was very private and self-contained.  Hiring a good architect made all the difference, according to Kathy.

To finance the home addition, Grandpa Bill paid for most of it. Kathy and Richard were able to create an upper level master suite and bath, so they agreed to pay a portion of the renovation taking into consideration future home equity.

What didn’t work so well, according to Kathy, was her brother’s  response.

“During this time, my brother had to learn that I was the Executor of my Dad’s estate and that I was named as having Power of Attorney. I let my Father have that conversation with my brother.  But I knew my brother didn’t want the responsibility of caring for Dad full-time and everything that comes with it.  Eventually everyone came to terms with the financial implications.”

Parents Living with Dementia

Kathy’s family was blessed with a relatively smooth arrangement.

Other families have a more complicated situation. For instance, when memory loss affects one or both parents.

The person living with dementia may experience confusion, suspicions, and even more severe behavior issues. Some families assume resistance is stubbornness. Most of the time, it is fear of the change and a new environment.

The trigger to change living arrangements? When one-on-one caregiving becomes necessary, many older adults move in with their families.  Without some forethought, the primary caregiver, usually a daughter and her family, can find the arrangement burdensome to a point of compassion fatigue.

Did the Walton’s have the right idea? In our next blog, we will discuss questions, expectations and boundaries.

If you or someone you know is exploring living and care arrangements for a loved one, we can help make the transition a little easier. 571-488-9396 [email protected]

*Names are fictitious.




9 Questions to Ask Before You Hire a Home Care Company: Especially During COVID-19

Selecting a home care company can be a little like a walk in the dark. There are thousands of across the country and probably hundreds to choose from where you live. How do you choose?

  1. Select a small or large company? Do they utilize company employees or a registry for aides? You will probably want to go through a well-known agency. This does not necessarily mean a large franchise is the best choice. Ask what the advantages or disadvantages are when you interview each location’s representative.

WHY ASK?  Small or large, whichever company you choose, do your homework. Are they licensed? In Virginia, for example, an office location is required to be licensed by the state.  Ask about the management staff, schedulers, and support teams. Learn how they operate. The most important thing is to like the management staff when comparing companies. 

It is extremely important to ask the agency if they are licensed by their state and if they conduct both state and national criminal background checks on the caregivers as well as conduct drug tests and check their driving record.  Currently, with the outbreak of the Covid-19 virus, it is equally important to ask for the best practices that agency has in place to keep both their caregivers and clients as safe as possible from the spread of the virus.

 -Staff person for a local Agency

2. What services are and are not provided? Make sure they can accommodate all the needs of your loved one.

WHY ASK? Understanding services offered will help prevent miscommunications. Get it in writing. Customer service is as important as comparing cost. Do they answer the phone 24 hours a day?

3. How does the agency assess each caregiver’s capabilities? What is their proficiency level in basic care. What are their strengths and weaknesses? The interests the caregiver has also plays a role in finding a good fit for their clients.

WHY ASK? You will need to compare and determine how satisfied you are with the answer to these types of questions. Cumulative responses to the questions give you a better understanding of what to expect.

4. What screenings are performed before hiring? Federal and state criminal background checks? Drug screening?

WHY ASK? You may want to check the licensing status of any C.N.A. (Certified Nurse’s Aide) with their license number through the state.

5. Tell me about the training you provide? Ask for details and the schedule for required and in-house training. When was the last in-service training and what was the topic? Do you offer First Aid/CPR or dementia training?

WHY ASK? Agencies should be able to describe how, when, and what training they provide.

6. What is the procedure if there is ever a suspicion or accusation of theft or abuse? They should not only tell you their procedures, but also provide you with the phone number for the Elder Abuse Hotline.

WHY ASK? Any personal service business should have a grievance policy. Ask what’s been done in the past. Keep in mind that YOU are responsible for securing valuables and sensitive information and keeping a record of belongings. Those living with dementia may consider something stolen when it may have simply been misplaced. Reducing clutter helps.

7. How do you keep to a minimum the number of employees who are part of my loved one’s care team? What happens when a caregiver is ill? Will you be able to provide another aide or will I need my own back-up plan?

WHY ASK? Agencies will do their best to minimize change, but agencies are required to pay overtime to anyone working more than 40 hours. Families are usually asked to pay for the overtime. To avoid higher rates, multiple caregivers may be more cost-effective.

8. If we are not satisfied with a care team member, will the agency provide someone else?

WHY ASK? This is an important question because many families may not know they have a choice. The right fit is important.  Keep in mind, it may never be perfect, and caregivers may transition from time-to-time.

9. Does the agency evaluate the quality of their provided care on a regular basis? How is it done, when is it done, and who conducts the evaluation?

WHY ASK? In the state of Virginia, home care companies are required to have a Registered nurse (RN) visit the client every ninety (90) days. Most do it more frequently.

Family advocacy is important. The role of a Home Care company is not to provide advocacy for or management of a loved-one’s overall life.  Their role is to employ and supervise aides.

If an older adult doesn’t have enough family support, they can benefit from an Aging Life Care™ Manager who provides 24/7 response, medical advocacy, and care coordination. Want to learn more? Contact us.




Dementia Communication: Our Four Best Tips

Many of us often make mistakes when communicating with people who are living with dementia. It’s a learning process, but here are a few key practices which may help you. Remember, those living with dementia have a disease and cannot control their behavior. Their reasoning and logic skills are impaired. Changing our approach can reassure them and reduce anxiety.

Try these tips for successful interactions.  Above all, empathize.

  1. REDIRECTION
  • Be patient. To redirect is to lead. People prefer to follow someone they trust and enjoy, not someone who frightens or shames them.
  • Use a calm, friendly tone. Make sure your body language reflects your soothing words.
  • Avoid arguing or using reason. Do not say “Mom, if you do that, you’ll fall!” People with dementia lose the ability to follow logic. This is not an effective motivator. It only makes them defensive, which is counterproductive.
  1. VALIDATION
  • Enter their reality. Validation works through empathy, building trust, and developing a sense of security. If they believe their Mother is still living, ask them to describe Mom rather than say their Mother died years ago.
  • Acknowledge their feelings. Do not argue. Instead, acknowledge their frustration and fear. Let them know you recognize their anxiety. Start with, “That must be upsetting.” instead of, “You’re wrong about that.
  • Dealing with paranoia. Do not dismiss their comments with “That’s not true.” Instead say, “I’ll help you with that problem.”  Recognize that although hallucinations can be disturbing, they are very real for those living with dementia. Empathize and reassure.
  1. FIBS/LIES
  • Last resort. You must know your family member to know if fibs/lies will be helpful to reduce anxiety, help by redirecting them.

I knew a daughter who received multiple phone calls from her Mother daily.  “Have you seen my sweater?  Do you have my sweater?”. After a lot of frustration and multiple times of saying “No, Mom.”, she  finally just said, “Yes Mom.  I have your sweater.”  She said, “Ok” and hung up.

  •  When therapeutic fibs don’t work. If a person is suspicious, do not use fibs/lies. They can cause an escalation in the situation and distrust in current or future interactions.
  1. TRUTH
  • Share the truth. We often try to protect those with dementia by not telling them the truth. Not sharing the full truth can be frustrating and lead to agitation. Sometimes, calmly telling the truth can help the person. Communication practices should take into consideration the stage of dementia.
  • The truth is better. In early stages of dementia, the truth is better.
  • When the truth is better left unsaid. If what you share with them will only make them sad or experience emotional pain they will not remember later, it is not always best to be truthful. It’s not helpful to make someone re-live sad moments by being truthful.  In these cases, try to change the subject.

A FEW MORE TIPS

  • What might be causing the behavior? Are they uncomfortable? Are they in pain? Thirsty?
  • What caused the behavior? What did you learn that will help for next time? How did you respond? What did you do right? What might you try next time?
  • Allow free-will. Do not restrict or try to stop a behavior unless it is harmful. Use the techniques above to prevent harm.

A consultation may help you cope with a loved-one who is experiencing certain behaviors.  Call or e-mail to learn more. 571-488-9396  [email protected]