5-Step Geriatric Care Management Plan for Dementia Patients and The Families Caring For Them

Caring for a loved one with dementia comes with a unique set of challenges that often require professional support to effectively manage long-term care. Because dementia is a deteriorating condition, a physician/caregiver/patient relationship is the recommended approach for meeting the needs of elderly patients with dementia.

Follow these 5 steps to plan ahead and find the Geriatric Care Management support you need:

  1. Making sure physicians who are overseeing medical care for your loved one understand your needs as a family caregiver and the challenges you face are essential aspects of caring for the person with dementia. The physician can help caregivers anticipate changes, plan for role transitions, and arrange for education and support that is needed to provide care.
  2. In the earliest stages of the disease, it is helpful for caregivers to identify a health care proxy for the person with dementia. Encourage the completion of a Durable Power of Attorney for Health Care form (your physician should have copies available in their office.) The copy of completed forms becomes part of the patient’s record. (See What is a Health Directive for Dementia? for a downloadable dementia-specific health care form.)
  3. Caregivers need to maintain their personal health and vitality to provide continuing care for the demented patient. Taking the time for self-care will help reduce the chances of Caregiver Burnout (Also see Dementia and Caregiving Challenges).
  4. Caregivers should become familiar early in the illness with adult day-care services and in-home or in-facility respite services.
  5. It is helpful for caregivers to visit and evaluate several long-term care facilities well ahead of the need for placement. Understand that institutionalization may be a normal progression in the process.

Contact us if you need helping finding Geriatric Care Management support and resources.

Guardianship of Adult Children

This article was kindly contributed to us by Roman J. Seckel from the Drendel & Jansons Law Group.

In my high school psychology class, my history teacher came and spoke to us one day about his disabled son. He read to us a short story in which he compared having a disabled child to a trip to Europe. The story began with a couple planning to go to Italy to tour all of the beautiful sights in Italy, however, instead of landing in Italy, the couple landed in Holland. While the couple was initially shocked at landing in Holland, they came to appreciate Holland’s beautiful landscapes, windmills, and tulips. In short, they found beauty and comfort in their surprise trip.

The surprise trip is an allegory to having a disabled child. Having a disabled child may be an initial shock; but, in the end, having a disabled child is as awarding if not more so, than having a non-disabled child. In working with many clients of disabled children, I have seen some great examples of parenting, and I have been inspired by them.

Inevitably, our children grow up, including our disabled children. One subject that gets little attention is how to protect a disabled child once he or she becomes an adult. This short article will help parents of disabled children understand the process of establishing guardianship of adult children.

Under Illinois law, a person who is 18 years or older is presumed to be an adult, regardless of physical or mental capabilities. Absent some determination of incapacity, a person who turns 18 becomes free to make decisions and be responsible for his or her own actions. An adult with significant disabilities, however, may be unable to manage his or her own affairs. Adults with significant disabilities are dependent on other people who need to have the legal authority to care for them, manage their affairs and make decisions for them.

The responsibility of caring for a disabled adult often falls on parents or other family members. Healthcare providers, including doctors, pharmacists, and therapists, require proof of legal authority for one person to make personal and healthcare decisions for another person who is an adult. Health care providers will not even discuss or share health care information without some waiver of privacy or other authority. The legal means to accomplish this is through a guardianship proceeding.

A guardianship proceeding is handled through the court system pursuant to the Probate Act (755 ILCS 5/11A-1 et seq.) The process begins by filing a petition for guardianship, obtaining a physician’s report and providing notice to the persons entitled to receive the notice who are identified in the Act (the closest adult relative including parents and adult siblings). Many counties have forms available online through the local clerk of the circuit court’s website.

After notices are given as required by law, an initial court date will be set in which the judge will appoint a guardian ad litem. The purpose of the guardian ad litem is to determine that a guardianship is warranted and that the proposed guardian is suitable. A guardian ad litem becomes the eyes and ears of the judge. A request can make to bypass the appointment of a guardian ad litem, which creates delay and increases cost Judges may waive the guardian ad litem appointment, especially when a natural parent is seeking guardianship before the child turns 18.

In fact, the entire process can be streamlined if it is begun before the child turns 18. Before a child turns 18, a parent still has legal authority over the child so service on the child is not separately required. Presumptions in favor of the parents apply, and the appointment is usually perfunctory. After a child reaches adulthood (18), judges are required by law to impose the procedural safeguards required for adults.

There are some additional considerations to bear in mind. Parents should consider establishing a special needs trust that will allow the disabled adult to qualify for government assistance while making assets available for things other than base support and health care. Divorced parents may want to discuss and plan for care for their child who is a disabled adult in their divorce decree. A disabled adult may be eligible for support from one or both parents under 750 ILCS 5/513. Unlike child support under 750 ILCS 5/505, the responsibility of the parents to contribute to the needs of their adult children is not set as a specific percentage of net income; rather it is determined by the financial needs of the child and the respective ability of the parents to contribute to those needs.

As with anything, advance planning and thought can save time, cost and frustration down the road. Caring for a disabled child who is now an adult can present legal obstacles that are not issues while the child is a still minor. Planning for the care and management of a disabled child’s needs before reaching adulthood is highly recommended. If you are beyond that point, and your disabled child has already reached legal adulthood, there is no reason to lose heart. The law provides a relatively easy means for establishing the authority for you to continue caring for your child and making the decisions that need to be made through the means of a legal guardianship.

Roman J. Seckel
Drendel & Jansons Law Group
111 Flinn Street
Batavia, IL 60510
(630) 406-5440
(630) 406-6179 fax

The Impact of Being a Geriatric Care Giver

Family StressIf you think you are saving by caring for your loved one…think again. Below are some statistics that show the huge impacts to the individual care giver, not just in health but financially as well. There is also stress put on the family that can divide even the strongest of families. In turn, most people don’t want to have to be taken care of by a loved one. Feelings of guilt and regret, regardless of fault, can make one feel like a burden.

Navigating the system is also becoming increasingly difficult. An Advocate can help save your family from personal and financial ruin and reduce the stress that this process creates, providing you the time to spend with your loved ones, worry free…

As professionally certified guardians, we care for personal and financial matters, protecting individual rights and safety. We ensure that the life/care plan we build is consistent with the individual’s strengths, needs and choices.

Six reasons why being the care giver is not always the best option

  1. 23% of family caregivers caring for loved ones for 5 years or more report their health is fair or poor.
    Caregiving in the United States; National Alliance for Caregiving in collaboration with AARP; November 2009
  2. Stress of family caregiving for persons with dementia has been shown to impact a person’s immune system for up to three years after their caregiving ends thus increasing their chances of developing a chronic illness themselves.
    Drs. Janice-Kiecolt Glaser and Ronald Glaser, “Chronic stress and age-related increases in the proinflammatory cytokine IL-6. “Proceedings of the National Academy of Sciences, June 30, 2003.
  3. Nearly three quarters (72%) of family caregivers report not going to the doctor as often as they should and 55% say they skip doctor appointments for themselves. 63% of caregivers report having poor eating habits than non-caregivers and 58% indicate worse exercise habits than before caregiving responsibilities.
    Evercare Study of Caregivers in Decline: A Close-Up Look at Health Risks of Caring for a Loved One. National Alliance for Caregiving and Evercare. 2006.
  4. American businesses can lose as much as $34 billion each year due to employees’ need to care for loved ones 50 years of age and older.
    MetLife Caregiving Cost Study: Productivity Losses to U.S. MetLife Mature Market Institute and National Alliance for Caregiving Business. July 2006
  5. Women who are family caregivers are 2.5 times more likely than non-caregivers to live in poverty and five times more likely to receive Supplemental Security Income (SSI).
    Study conducted by researchers at Rice University and data compiled from the Health and Retirement Study funded by the National Institute of Aging and conducted by the University of Michigan, 1992-2004
  6. Caregiving families (families in which one member has a disability) have median incomes that are more than 15% lower than non-caregiving families. In every state and DC the poverty rate is higher among families with members with a disability than among families without.
    Disability and American Families: 2000, Census 2000 Special Reports, July 2005.