5 Geriatric Care Management Tips for the Sandwich Generation

The Sandwich Generation refers to a generation of people who are caring for their aging parents while supporting their own children. If you’re a caregiver in this generation you might liken the associated financial and emotional stress with the feeling of being “sandwiched” between the two responsibilities that are taking up most of your time.

Sandwich generation providers can create a care management sandwich that meets their needs and the needs of their aging parent(s) through effective planning, support, and advocacy.

5 crucial ingredients for a balanced care management sandwich:

  • Emotional well-being
  • Financial Planning
  • Healthcare
  • Career
  • Family

1. Emotional Well-being

For those taking on the greatest time commitment for providing care for an aging parent or parents and also trying to fulfill their own parenting obligations, finding time for self is an important part of maintaining balance in life. Caregiver burnout can seriously impact your quality of life and your ability to continue caring for your loved ones. It is essential that you carve out some time for yourself every day to do something for yourself. It might be a session at the gym, coffee with a friend, reading a book, or any activity that recharges your emotional batteries.

2. Financial Planning

Perhaps one of the biggest contributors to sandwich generation caregiver stress is managing the costs associated with raising children and maintaining the health of aging parents.

To help ease the financial burden talk to your family members and involve them in the financial planning process. Assess all of your financial resources and create separate accounts with allocated budgets for long-term care management and day-to-day expenses for the whole family. If this task seems too overwhelming, seek the help of a Certified Financial Planner that deals with long term care planning. Contact us to help find a specialist that meets your needs.

3. Healthcare

As your parents age, medical issues are likely to arise. Advance planning for possible physical and mental healthcare issues is key to effectively managing them. 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. Encourage the completion of a Durable Power of Attorney for Health Care form or an Advance Health Directive for Dementia in the event of your aging parent(s) being unable to make healthcare decisions for themselves at a later stage. Also see: Practical Advice on Caring For a Parent with Dementia5-step Geriatric Care Management Plan for Dementia Patients and the Families Caring for Them

Part of your planning should also include ways of keeping your aging parent(s) active. Involve them, as far as possible, in the day-to-day chores in the household and plan simple mental and physical activities like reading to the children, doing a crossword, going for a walk, joining a senior activity group etc.

4. Family

Multiple generations living together in one household can be stressful. There are so many voices that need to be heard, and often not enough time for everyone to have their say. Open, honest family communication is so very important for maintaining household balance. Try and set aside a time, perhaps around the dinner table, for each family member to talk about their day or share a personal experience. Plan a monthly family outing, even it’s in the back yard with a ball. Laugh together as often as you can and learn to sweat the small stuff.

5. Career

Juggling work-life balance is an art that requires a lot of planning and support – from your family and your employers. Don’t be afraid to ask your family members and colleagues for help if you need it, and you probably will. A geriatric care manager can also help you find the care management support and resources you need.

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.

Mental Illness and Disorganization

In honor of Mental Health Awareness Month this May, I would like to share some information about the link between mental illness and disorganization/hoarding.

Many individuals with mental illnesses also have issues with disorganization. This is primarily because the area of the brain most often affected by mental illness is the Central Executive. The CE is the primary area for planning future actions, initiating retrieval and decision processes, and integrating information coming into the system, all necessary for successfully organizing.

Disorders that can arise from a faulty CE are depression, attention deficit hyperactivity disorder (ADHD), learning disabilities, compulsive disorganization, and hoarding.

To clarify, disorganization is not the same as clutter. Clutter can also be thought of as messiness whereas disorganization is broader. Disorganization is a lack of basic categorization accompanied by excessive clutter.

The Institute for Challenging Disorganization defines chronic disorganization using three criteria: having a past history of disorganization in which self-help efforts to change have failed, an undermining of your current quality of life due to disorganization, and an expectation of future disorganization.

Sometimes, we all suffer from faulty CE functioning, especially where time management, attention and switching focus is concerned. Ways to help CE include: organizing workspace, minimizing clutter, and creating “to do” checklists.

When dealing with your own or someone else’s clutter and disorganization, it’s important to approach with compassion. Staying organized and relatively clutter free is difficult for everyone at some point in time. Compassion will create a nurturing environment in which to learn good organizing skills.

Identity Fraud Targeting the Elderly

The largest coordinated sweep of identity fraud involving US seniors has recently been conducted. The US Department of Justice has reported that more than one million elderly people have collectively lost hundreds of millions of dollars because of this targeted financial abuse. The Department has criminally charged 200 out of 250 defendants identified in the sweep. These third party scam artists account for 27% of seniors who are financially exploited.

Digital FraudsterCon artists and scammers employ many different schemes to defraud seniors of their identity information and money. A large number of them are conducted over the telephone, for instance posing as an Internal Revenue Service agent claiming back taxes are owed, or frightening a grandparent to think that their grandchild has been arrested and needs bail money wired to them. Other schemes include the promise of a prize or lottery cash if they just send a large fee in order to collect their “winnings.” Seniors become easy victims when targeted by these social engineering schemes and it is likely to get worse because of the proliferation of smart phones and other devices that get seniors to explore the online world.

USA Today reports that while phone scams target one senior at a time the online environment is opening doors to thousands or even millions of seniors falling prey to a single scam. Email and other online channels can reach a vast number of potential victims and more elderly people have an online presence than ever before.

Romance scams that used to be conducted in person can now be achieved in the online dating environment and even in social media. The attacker can befriend multiple seniors online and then ask for money to cover “travel expenses” to visit them. This is particularly successful as many seniors are dealing with isolation and loneliness.

The online shopping world is another vehicle employed by scam artists to defraud seniors of money. All that is needed is a picture of an object that seems to be owned by the scammer and you have the potential to sell that item over and over again to thousands of seniors. All the scam artist has to do is set up a mirror web site that appears to be a legitimate online auction house such as E-bay to drain seniors of their money as well as obtain credit card and other identity information. These mirror sites masquerading as official websites are often in the email accounts of seniors and a mere click on a link can download malicious software to their device that is designed to steal critical identity information.

Of the 27% of seniors who do become financially exploited by a third party, 67% do not exhibit symptoms of cognitive decline. That is a huge number of mentally fit seniors being financially exploited. This is a pervasive problem in the elderly community. According to the Federal Trade Commission’s “Consumer Sentinel Network Data Book 2017” identity fraud is second only to debt collection with regard to consumer complaints. Identity fraud accounted for 14% of all consumer complaints last year. The Commission also reported that seniors who are financially exploited suffer higher median losses than other age groups.

Many seniors who have been targeted are embarrassed, ashamed, or scared as a result. Many never saw themselves as being at risk, they fear retribution from the perpetrator, and they fear that government agencies or family members will label them unfit to care for themselves.

Systems can be put in place to monitor senior accounts and make their money less easy to access by scammers. In addition, there are legal documents that can protect the accounts of seniors during their lifetime, and eliminate the chance of fraud or abuse.

This blog post was written and submitted by the St. Charles Illinois Estate Planning & Elder Law Firm, Fitzgerald Law Office LLC

Please contact them for more information on how they can help you or your loved ones reduce the chance of financial fraud or abuse.

The Different Levels of Clutter/Hoarding and How to Recognize Them

Clutter can mean different things for different people. For some, a small pile of clothes in the corner of an otherwise well-ordered room constitutes serious clutter. For others, the clutter might only register when a room in their house becomes inaccessible.

To help us more accurately distinguish the level of the clutter and provide appropriate help, we use the International OCD Foundation Hoarding Centre Clutter Image Rating and The Institute for Challenging Disorganization (ICD) Clutter–Hoarding Scale™ (C–HS™).

Clutter Image Rating

The International OCD Foundation Hoarding Centre created a series of 9 pictures of rooms in various stages of clutter – from completely clutter-free to very severely cluttered. People can just pick out the picture in each sequence that comes closest to the clutter in their own living room, kitchen, and bedroom. In general, clutter that reaches the level of picture # 4 or higher impinges enough on people’s lives that we would encourage them to get help for their hoarding problem.

Example of the International OCD Foundation Hoarding Centre Clutter Image Rating

Example of the International OCD Foundation Hoarding Centre Clutter Image Rating

Clutter–Hoarding Scale™

The Institute for Challenging Disorganization (ICD) developed the Clutter–Hoarding Scale™ (C–HS™) to serve as an observational guideline tool for the assessment of residential environments, and is intended for the assessment of the household environment only. There are five levels to indicate the degree of household clutter and/or hoarding from the perspective of a professional organizer or related professional.

 

The levels in the scale are progressive, with Level I as the lowest and Level V the highest. ICD considers Level III to be the pivot point between a household that might be assessed as cluttered and a household assessment that may require the deeper considerations of working in a hoarding environment.

Within each level are five specific categories that describe the degree of clutter and/or hoarding potential.

1. Structure and Zoning

Assessment of access to entrances and exits; function of plumbing, electrical, HVAC (any aspect of heating, ventilation or air conditioning) systems and appliances; and structural integrity

2. Animals and Pests

Assessment of animal care and control; compliance with local animal regulations; assessment for evidence of infestations of pests (rodents, insects or other vermin)

3. Household Functions

Assessment of safety, functionality and accessibility of rooms for intended purposes

4. Health and Safety

Assessment of sanitation levels in household; household management of medications for prescribed (Rx) and/or over-the-counter (OTC) drugs

5. Personal Protective Equipment (PPE)

Recommendations for PPE (face masks, gloves, eye shields or clothing that protect wearer from environmental health and safety hazards); additional supplies as appropriate to observational level

Example of Clutter- Hoarding Scale Level 5

 

Visit the Kane County Hoarding Task Force website for more resources on help for hoarders: https://www.kchoarding.org/

Hoarding and Mental Health – Finding the Support You Need

Living Life with Dignity on TLC's Hoarders: Buried Alive
Fran Piekarski (left), President of Living Life with Dignity, on TLC’s Hoarders: Buried Alive

For adults with disabilities or special needs, disorganization can be a huge problem — for both the individual and the family.

Individuals with mental health issues often exhibit the attributes of hoarding disorder.

Understanding the delicacy, privacy and pain of a hoarder’s situation is key to gaining their trust and reducing their stress during the process of change. Living Life with Dignity helps people who hoard by providing them with the tools to make decisions about their belongings and their future. We work with mental health professionals, condo associations, municipalities, and families to address the needs of those suffering with chronic disorganization and/or hoarding.

We offer the following services for clients affected by hoarding:

  • Confidential assessment
  • Assembly of customized team
  • Collaborative planning in coordination with your therapist or recommended mental health professional
  • Assistance with execution of our recommendation and collaboration

Transitions – Finding you the place that meets your needs

Often a disability will require a change in an individual’s environment. You or your loved one may be dealing with a temporary or permanent new need and the current environment may no longer suit your needs.

With over sixteen years of experience, we are skilled in working with the hoarding community, including crisis situations and eviction threats.

We can assist you in either re-equipping your current environment or providing new accommodations. Our goal is to locate the least restrictive, most beneficial option available. After all, part of quality living is a quality living environment.

Contact us for more information on help with hoarding.

Image Credit: St. Louis-based artist and photographer Carrie M. Becker created a miniature diorama of a hoarder’s house.

10 ways to Maintain Your Brain© from The National Alzheimer’s Association

  1. Head first: Good health starts with your brain. It’s one of the most vital body organs, 10 ways to keep your brain healthyand it needs care and maintenance.
  2. Take brain health to heart: Heart disease, high blood pressure, diabetes and stroke can increase your risk of Alzheimer’s.
  3. Your numbers count: Keep your body weight, blood pressure, and cholesterol and blood sugar levels within recommended ranges.
  4. Feed your brain: Eat a low-fat, low-cholesterol diet that features dark-skinned vegetables and fruits; foods rich in antioxidants; vitamins E, C and B-12; foliate; and omega-3 fatty acids.
  5. Work your body: Physical exercise keeps the blood flowing and encourages new brain cells. It doesn’t have to be a strenuous activity. Do what you can – like walking 30 minutes a day – to keep both body and mind active.
  6. Jog your mind: Keeping your brain active and engaged increases its vitality and builds reserves of brain cells and connections.  Read, write, play games, do crossword puzzles.
  7. Connect with others: Leisure activities that combine physical, mental and social elements may be most likely to prevent dementia.  Be social, converse, volunteer, join.
  8. Heads up! Protect your brain: Take precautions against injuries. Use your car seat belts; un-clutter your house to avoid falls; and wear a helmet when cycling.
  9. Use your head: Avoid unhealthy habits. Don’t smoke, drink excessive alcohol or use street drugs.
  10. Think ahead – start today! You can do something today to protect your tomorrow.

For more information and tips visit: http://www.alz.org

Dementia and Caregiving Challenges

You probably know that caring for a loved one with dementia won’t be easy, but these sometimes embarrassing and unfamiliar behaviors might drive you nuts.

Dementia and Caregiving Challenges

  • Dementia Sleep disorderSleep problems and caregiver exhaustion are two of the most common reasons persons with dementia are placed in nursing homes. Causes of sleeplessness in dementia patients include pain, lack of exercise and activities, anxiety, agitation, or too much fluid or caffeine late in the day.
  • Urinary incontinence is the second leading reason that families institutionalize their loved ones with dementia. Urinary incontinence in persons with dementia should be evaluated for treatable causes, including urinary tract infections, electrolyte and calcium abnormalities, prostatic hypertrophy, and estrogen deficiency. A regular toileting schedule at two to three-hour intervals or verbal prompting may also alleviate this symptom.
  • Agitation and aggressive behavior have been reported in 65 percent of community-dwelling persons with dementia. Reasons for agitation or aggression include overstimulation, physical discomfort, unfamiliar surroundings or persons, complicated tasks, and frustrating interaction, as well as more serious reasons as paranoia, delusions, or hallucinations.
  • Caregivers may be embarrassed or ambivalent about discussing inappropriate sexual behaviors exhibited by persons with dementia.
  • Persons with dementia are often reluctant to stop driving when safety is at issue.
  • Repetitious questions may be due to short-term memory loss and an under-stimulating/over-stimulating environment leading to anxiety, feeling out of control, or fear.

Also see:

Information for this blog cited from the Alzheimer’s Association and the American Medical Association

Written by Author and Keynote Speaker Sue Salach-Cutler. Sue has a Master’s degree in Gerontology and has worked in the healthcare field for over 25 years.  She is the Author of “Along Comes Grandpa”, a caregiving resource guide, and the novel “If I Walked in Her Shoes”. Her programs and books provide the vital resources needed to help family caregivers as they maneuver through the caregiving journey. Find out more about her books and programs here: CaregiverLife.com.  Adapted from: https://theworkingcaregiver.org

What is a Health Directive for Dementia?

People with advancing dementia lose the ability to make decisions for themselves. Their families need to make medical decisions for them. Giving family members guidance about what kind of care you’d want if you were to develop worsening dementia can ease the burden of their decision making and make you feel more secure that you’ll receive the care that you would want.

Following our articles on Late Life Depression, Late-onset Depression and Dementia, and Practical Advice on Caring for an Adult with Dementia, here is a Dementia-specific Advance Directive download that allows you to map out your care and medical intervention plan should you or a loved one become ill with dementia in the future.

Late Life Depression, Late-onset Depression and Dementia

Can you develop depression when you are past some of the most stressful times of life?

LLD is caused by the underlying neurological changes in the brain

So, you’ve raised your children, achieved success in a career and now you’re considering downsizing and finally, retirement. But, you don’t feel quite like yourself. You tell yourself, “I should be happy, but I’m not.” You don’t enjoy things like you used to, you lack energy and engagement with others, and your appetite is poor and you’re not sleeping well. Maybe you’re moving a little slower and not as quick to solve problems or remember things you’re supposed to do. What could be wrong?

You see your physician, who is all too familiar with this condition, and sends you for a neuropsychological evaluation, which reveals that you are suffering from Late Life Depression (LLD). You protest, “I’ve experienced sadness like everyone else, but I’ve never been depressed in my life!” So, what is LLD?

This diagnosis is not to be confused with late-onset depression, which means, more simply, that a typical clinical depression develops later in one’s life. Confused? What differentiates LLD is the underlying neurological changes in the brain. Both are treatable, but LLD has greater implications for more serious, long-term health concerns like dementia.

LLD is defined with an age threshold of 60. Approximately 10 percent of the 60-and-over population is estimated to suffer from LLD in the United States. There is considerable reduction in discrepancy between genders in this population since middle-aged females already suffer from depression at higher rates. If you have chronic illness such as a myocardial infarction or stroke, chances are greater that you will develop LLD.

A key feature of LLD is often the presence of cognitive deficits in meaning, memory, organization, planning, and reasoning, to a degree greater than that expected for your age. Generally, LLD is more difficult to treat than Late-onset Depression, and relapse rates are higher. Furthermore, those with LLD are more likely to age into dementia. See Practical Advice on Caring for an Adult with Dementia.

Differentiating these two types of depression is imperative for accurate diagnosis, prognosis and treatment. If you or a loved one are experiencing these symptoms, a neuropsychological evaluation may be warranted and recommended.

About the Author

Jennifer Wilson-Binotti

Compassionate Neuropsychology, LLC
Neuropsychological Assessment with a Human Touch
Jennifer Wilson-Binotti, Psy.D.
Licensed Clinical Psychologist
Clinical Neuropsychologist
www.compassionateneuropsychology.com

Dr. Wilson-Binotti has worked with older adults since 2012 during her post-doctoral training in Downstate Illinois. She has experience working with those aged 50+ who have increased anxiety or depression, or a decline in functional or cognitive (thinking, memory) abilities. She previously served over 20 nursing/rehab/long-term care facilities and was on staff at six suburban hospitals, remaining on staff at Edward and Linden Oaks Hospitals in Naperville, IL. Currently, she sees patients at nursing facilities and in private residences when seniors are no longer able to physically leave their homes.

Her relaxed and warm demeanor helps patients feel comfortable and perform their best during neuropsychological testing. Many patients have described their experience with Dr. Wilson-Binotti as “fun,” and some even look forward to doing it again!