Reversing cognitive decline

This new research is quickly popping up in many places. I find it interesting that the therapy suggested involves simply taking really good care of oneself! Interesting that the implication could be that not doing so causes enough stress that we compromise our nervous systems to the extent that dementia could occur!! Click here to read the article.

 

What is a Geriatric Care Manager?

As a Geriatric Care Manager,  I wanted to discuss a bit about what we do, and what this ”Geriatric Care Manager” handle means.

I love my work as a GCM. I find that the title however, while at times familiar to some people can be a strange mouthful for others. In answer to the question about what it means, there is quite a lot to say.

First of all, let’s break apart the 3 words..I am not a fan of the term “geriatric”, since it can sound strictly medical and I don’t know anyone who would want to identify as being geriatric. Essentially, the word has earned mostly a negative image. I prefer using the term “elder care manager”, but that is not name that was chosen for the certification for this field. The national organization I am certified through, formerly called the National Association of Professional Geriatric Care Managers, is now called Aging Life Care Association,   https://www.aginglifecare.org/ And the term “geriatric” does differentiate the population we work from people of other ages who may need care managing.

“Managing” could also fall into the realm of the impersonal, which is very far from the way we GCM’s normally work – we chose this occupation because it brings us in close to families and older people. But, often managing a complex situation is what is called for and as families who are supporting elders in transition know, this is a dynamic time with practical as well as emotionally demanding aspects. And often when I get a call from a family for my assistance, most of the time I see that they themselves are already being the care manager which I point out to them to help them recognize why they are feeling so overwhelmed..care managing one’s family member can become a full time job. This is a perfect time to call on a GCM so that the family helper can resume being a family member rather than the care manager.

And finally “caring”..the heart of the term. “Care”, as we know, can either refer to a state of mind..that we have concerns and personal interest in a person or possession, or it can refer to someone being in someone else’s charge or under their protection. Thirdly it could describe a type of serious attention or devotion to a task. Care managers fulfill the whole spectrum of the word “care”.

To make a further clarification, with the word “care”, as opposed to “case management”: my understanding is that it was changed some years ago to differentiate care management from medical case management in hospitals. In hospitals, a case could be followed in a more stream-lined and usually very brief way, whereas care managers tend to offer a broader range of services – even impromptu things like going to fetch a client’s personal item from home when the client had to go to the hospital, for instance.

A simple overview of what a Geriatric Care Manager might do is :

To initially meet with a family or individual who needs support particular to aging. It may be that a parent is developing some memory loss or that the family is considering moving an elder from home to a facility. Or, perhaps an older individual is alone and handling too many life details, needing a friendly ally who can join in and offer an array of support. There are care managers who do work strictly in hospitals with discharge planners, reading charts and then helping families navigate the medical system. And some care managers specialize only in helping families in which the parents live far away from the adult children..the care managers help with decisions and changes that need to be made. There is a range of what a geriatric care manager can offer, depending on where they concentrate their skills and what is called for in the particular situation. And I should add that most Care Managers have already developed foundational careers such as being Social Workers, nurses or other helping professions.

My work includes several areas: I work with individual elders, often spending lots of time talking with them, in a way that is therapeutic..we may talk about loneliness, dealing with fear of transition, grief, loss of confidence and other challenges that can heighten at this time of life. Sometimes we will go together to do errands or take care of certain business. Also I work with many families, setting up schedules, finding additional help – sometimes referring to a local home care agency and sometimes providing independent caregivers. I work with the family to galvanize their existing system so that everyone is pulling in the same direction. It’s so important to find ways to make this a very special time as a family.

I love the collaborative and creative process of working outside of a formula. Families each have a distinct style of relationships among themselves, how they work out financial resources for instance or make decisions about caregiving, and timing can vary greatly. And very often I simply consult a family or spouse, offer my sense of what might help and they take it from there. Also I have an ongoing spousal-caregiving support group which is very spirited and helpful for the caregivers there whose partners require serious, committed support. Finally I am also a referral system , with extensive knowledge of my city’s resources. I have a highly varied personal network of professionals including homecare agencies, elder law practices, fiduciaries, advocate services as well as practical things like a good place for a haircut. I have lived in Boulder for almost 30 years. And, I am listed on the ALCA national network for Geriatric Care Managers so occasionally I will get a call from far away from another GCM who has questions about my town for their client..or a referral ..and of course I can activate the network from my desk as well to find help in other areas of the country for families.

And last but not least, In addition to the practical side of GCM’ing, I feel that we come from the healing tradition. We ourselves are caregivers as well as being care managers. Most of us have had considerable experience taking care of many people in a variety of ways. Care managing brings us right into further caregiving, in this case of a family or of an elder alone. This is a deep level of work..and we learn profoundly about life from being engaged in this way. As all caregivers know, when we embrace other peoples’ challenges, there is potential for transformation, personally and with our clients. The benefits keep us going such as the natural learning for how to listen carefully without layering our interpretation onto the person or situation – how to see what is being presented clearly. Care managing is a very creative process. And it is being documented increasingly that the potency of relationship and conversation is greatly beneficial and often overlooked, underestimated. Geriatric care managers tend to be people who really appreciate relationship and bring it fully into their life’s work.

Here is an article which I find relevant and succinct which can add more detail about the work of a GCM: http://newoldage.blogs.nytimes.com/2008/10/06/why-hire-a-geriatric-care-manager/?_r=0

 

Interviewed and Featured in New York Times

I was recently interviewed for an article by Steve Knopper for the New York Times called “Mother, Lost and Found”.

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This is a wonderful and heartfelt short story about Steve Knopper’s mother’s experience with Alzheimer’s Disease.   Steve referred to my work with his mother and in particular the technique often used with people with dementia,  known as validation. (I will be writing a blog post about this concept).

I was very honored to be mentioned and included in Steve’s article. You can read the whole article here.

Project Visibility

I am really looking forward to a training happening this September 18th in Boulder. The subtitle is: “Become Culturally Competent to better serve Lesbian/Gay/Bisexual/Transgender Elders” with Project Visibility.

So many of these people are underserved and as the title tells us, invisible. I hope we can all increase and improve our tools for helping more people through trainings like this.

Their website is: www.projectvisibility.org, their Facebook page is: https://www.facebook.com/projectvisibilityboulder.

Maybe I’ll see you there at the training! It’ll be at the Houston Room at Boulder County Cleark& Recorder at 1750 33rd St, Boulder.

To register call 303-441-3583, or infoLGBT@nullbouldercounty.org

Another thing caregivers should know/a recent change in auto insurance

Recently a friend who works professionally with older people, and I were discussing an arrangement for driving a client to his doctor’s appointment. She told me that she’d discovered that her insurance company had changed its policy about driving clients in her car, without alerting her.  She had always figured that she had proper coverage for driving her clients anywhere..to do errands, to the doctor, and so forth.

So I called my insurance company (a very well known company) and sure enough, as I dug deeper with my questions, I too found out that I did not have coverage in the case of an accident, for my passenger, if they were paying me.

The insurance company was not talking about clients who pay for the ride, in particular. But clients who were paying me for any kind of assistance.  Even just companionship or just because their family lives out of town and they needed a lift somewhere or to the doctor or they are a therapy client…If they were to wind up in the hospital, I would be liable. And I had thought it was OK with this company to drive clients around.  Lucky I had that little chat with that particular friend!

I made a series of other calls – to other very well known insurance agencies, to other agents in the same company I used, and to independent agents who know about all the companies and don’t have to represent any particular one of them. I found the same answer every time. I went through as complete a picture as I could: I was not charging for the ride. I did not drive clients every day – some times not for weeks at a time. I am not a commercial transport service in any way and I don’t have signs on my car. And so forth.

So the bad news is:

You can no longer drive clients in your car, even if you have full insurance for passengers, unless you have a policy that covers paying clients.

The good news is:

There are independent insurance companies who do offer what’s known as “business” coverage..it’s not the same as a commercial plan. It’s slightly more than regular auto insurance..and very worth it. My well known company does not offer this coverage.

So send me an email if you are interested, if you are a person who is paid to assist with anyone at all and you find yourself giving them rides here and there, I can help with what I learned. I can give you more specific names and more about what I now know!

A little humor about something important!

If you have not heard of  or seen Roz Chast’s wonderful cartoons, here’s a great place to start..talking about “the Conversation” with her aging parents. Ridiculously accurate! Roz Chast: “Can’t We Talk About Something More Pleasant?” | The New Yorker

What’s the difference between Alzheimer’s and Dementia?

What is the difference between Dementia and Alzheimer’s?

So often I hear people say things like “my father doesn’t have dementia, he has Alzheimer’s”.  I know exactly what they mean. And, it shows a need to learn more about what those words refer to. Actually Alzheimers IS a form of dementia!

Think of it this way: Dementia is the umbrella term for many different brain diseases. Alzheimer’s is only one of them.

The word dementia could be taken apart as: de (“down from” or “concerning”) + mens (“mind”).  Maybe we could safely say “apart from”..rather than “out of one’s mind”. Just not having the same access in the same ways to our normal brain activity.

The statistics used to say that 80-90% of all dementias were Alzhiemer’s. Now the current thinking is that  it’s more like 50 – 60% are full on Alzheimer’s.

It’s just that this is the first time in history that so many people are living so long..thanks to modern medicine and surgeries – so we’re seeing many more people with conditions that occur in later years, and so our languaging for older age conditions needs updating.

It’s very important now, with the numbers of people turning 65 every day, for us to really understand what happens to our brains as we age. According to Pew Research, that number is 10,000 every day in the US alone! And, the Alzheimer’s Association has statistics showing that 1 in 9 people over 65 will have a dementia. That begins to feel close to home, doesn’t it?

Run the clock forward a bit..and the same statistics sources show that after the age of 85, a full 50% of people will have some type of dementia. Think about that next time you’re in a group of people. Do the math.

So it really behooves us to know as much as we can about our brains so that we can take the best care of ourselves as we can..and also to know how to help each other. Not just relying on doctors and drugs. Also to know that the person with dementia is still a whole person, with the desire to contribute and be understood, and seen and known as a person with strengths.

An important clarification is that dementia is not just memory failure. It’s brain failure. It is a devastating, progressive condition and everyone is doing their very best to survive. Early identification is critical to being able to work with it, understand what’s happening and what kind of dementia it may be. And it is often a mix. Here are the most common of the 80 – 90 types of dementia now known:

*Alzheimers – caused by “plaques and tangles” of cells in the brain…it is a progressive brain disease.

*Vascular Dementia – the second most common, after Alzheimer’s. Caused by strokes, heart attacks, diabetes, and other blood supply-related conditions. Not seen as a disease as much as blood flow problem..still brain damage that has many parallel symptoms to Alzheimer’s.

*Lewy Body – brings on balance problems, visual hallucinations and sundownning.

*Parkinson’s type Dementia – arrested tremors and loss of memory, increased confusion.

*Frontal temporal Dementia.

*Alcohol related Dementia.

*Dementia caused by major depression.

*Traumatic Brain Injuries causing Dementia.

 

I will be writing more about the different kinds and types of dementias but for now, just to have your language more accurate..we can say a person has Dementia and have it right. What kind they have is another issue. And it does matter, so we know best how to respond to them and their families. And, I have to say, it’s most often very enjoyable for me to be around folks with dementia. Harder for their families to see them change in this way, but for non family members, it can be very rewarding, fun and in-the-moment gratifying. We can learn how to relate with them and help them still feel very valued, that they have so much to offer and that they’re still their same selves, deep down.

Here’s an Interesting Article

This article, published in the NY Times magazine June 20, 2010, entitled My Father’s Broken Heart

About Ellen

“I love this work and continuously learn from each person and situation. I feel gratitude for the special opportunity to accompany people and families during transitional times as well as in an ongoing way. I want to give back to older people, who at this point have given all their lives.”

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