Cultural Competence in Caregivers - An article from HomeCare magazine (1/2017) pointed out the importance of paid caregivers being sensitive to their client's beliefs, traditions and practices. Different cultural backgrounds may cause misunderstandings. These can include how to respectfully address a person; ways of interacting with family members; forms of communications, including eye contact; customs around food; faith traditions; social rituals, and health practices that some may think are prohibited. As a family member, take these things into consideration when working with a home care service. Be explicit about what matters most to your loved one, in both large and small ways.
LONELINESS is a common condition for elders. The National Institute on Aging reports that social isolation and loneliness are linked to a variety of physical and mental conditions, including a weakened immune system, cognitive decline and high blood pressure. Next Avenue covered a story about Friendly Phone Programs, where people call into a group chat. They may share what they are grateful for, or respond to other prompts from a facilitator. You can help your elder stay connected in a more simple way, by setting up a call list, where one friend checks in on the other each day. In addition to encouraging conversation, it can also serve as a wellness check -- if a person does not respond to a call for two days, a designated relative or friend can pay a visit.
Observation: Elders who benefit from being frugal all their lives can have a 'scarcity' mentality that works against them in their final years. Hesitating to pay for personal hygiene supplies, to order prepared foods or grocery delivery service, or replacing essentials such as a mattress, can rob them of comfort. Even though they are all within their means. One friend was taken to a restaurant to celebrate her 90th, but ordered the cheapest item because 'it was very expensive there.' Her successful nephew was paying the bill and wanted to give her a treat. Like so many things in life, something good can turn against us. If you are aware of an elder's financial situation, and believe a comfort item can be purchased without causing a financial problem, perhaps emphasize the benefits vs the cost.
Difficulty receiving phone calls - For people who live alone or with intermittent aides - check if they can use their voice mail system. An elderly friend had 84 message she forgot how to retrieve. Of course, the callers assumed she heard the messages. These included visiting nurses, doctors' offices, grandchildren and long-time friends. Part of the problem can be not getting to the phone on time to pick up the call - I contacted the friend's landline provider and increased the rings to the maximum. Then I used my email as an 'administrator' (with her permission) and can see who has been trying to reach her. Also went over the voice mail instructions again. A complicating factor is that her voice mail retrieval starts with the oldest message; a high volume backlog can seen overwhelming. Missed calls add to her isolation.
Observation: Elders who benefit from being frugal all their lives can have a 'scarcity' mentality that works against them in their final years. Hesitating to pay for personal hygiene supplies, to order prepared foods or grocery delivery service, or replacing essentials such as a mattress, can rob them of comfort. Even though they are all within their means. One friend was taken to a restaurant to celebrate her 90th, but ordered the cheapest item because 'it was very expensive there.' Her successful nephew was paying the bill and wanted to give her a treat. Like so many things in life, something good can turn against us. If you are aware of an elder's financial situation, and believe a comfort item can be purchased without causing a financial problem, perhaps emphasize the benefits vs the cost.
Difficulty receiving phone calls - For people who live alone or with intermittent aides - check if they can use their voice mail system. An elderly friend had 84 message she forgot how to retrieve. Of course, the callers assumed she heard the messages. These included visiting nurses, doctors' offices, grandchildren and long-time friends. Part of the problem can be not getting to the phone on time to pick up the call - I contacted the friend's landline provider and increased the rings to the maximum. Then I used my email as an 'administrator' (with her permission) and can see who has been trying to reach her. Also went over the voice mail instructions again. A complicating factor is that her voice mail retrieval starts with the oldest message; a high volume backlog can seen overwhelming. Missed calls add to her isolation.
Watch Outs
Guardianship Fraud Court-appointed guardians can present a threat. Books and articles pop up with a simple google search. Check out this link for some guidance if someone you know is in a vulnerable position. www.familylawselfhelpcenter.org There is a guardianship section with forms, information and additional resources.
Beware the 'Familiar Fraudster' - Susan Wines, an Assistant US Attorney recently spoke at an Agency on Aging of South Central CT conference and gave compelling information about how people who get relied upon and trusted by elders can turn them into fraud victims - particularly financial. Often, 'victim stamina' gets to be an issue, presenting a barrier to confronting the fraudster. Also, there is a lot of shame about being 'duped.' This happened to our family, with a woman who had done housekeeping for over 20 years and was in our faith community - once my Mom started to decline, the fraudster stole home goods, cash and jewelry. A home health nurse helped confront this once-trusted 'friend.' In cases of large financial losses, a state Department of Banking and the SEC can get involved; but the money is long-gone!
Sepsis can be deadly, and often strikes people 65+. It contributed to my father's death. A campaign is underway to heighten awareness of symptoms, which include chills/fever, extreme pain or discomfort, clammy or sweaty skin, confusion/disorientation, shortness of breath, high heart rate. Time is of the essence; ask for a sepsis screening! Full NYT article here: http://nyti.ms/2cWFn4E
Elders can lose coverage for therapies and skilled care because the are not improving. Which is ridiculous, as they will likely decline, fall, and worsen without ongoing treatments. A class action suit and a recent ruling is now requiring Medicare & Medicaid to address this outdated standard of care. But old habits die hard; read about one family's $100K fight in the attached NYT article by Paula Span: http://nyti.ms/2cDUWxZ
Arbitration clauses in nursing home contracts are being challenged. Usually buried in reams of admittance paperwork, they require any disputes to be handled out of court. If you sign for your loved one, but do not have power of attorney, but only act as a healthcare agent, it may be a loophole to your advantage. Read about it in this NYT article:http://nyti.ms/1Q92l6E UPDATE: In September, 2016, the Centers for Medicare and Medicaid Services ruled to bar nursing homes or assisted-living facility receiving federal funds from using arbitration clauses. Families and patients now can demand their day in court.
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Nursing homes can threaten Guardianship when there are billing disputes, which means total financial and legal control of the patient. Be on Guard! Full NYT article here: http://nyti.ms/1EmgQPc
Elders may look hardy in the hospital, only to be readmitted in a few short days. An excellent NYT article by Abigail Zuger, M.D. cautions about medical staff gaining a false sense of an elder's wellness, as he/she is propped up by medical devices and services. Once home, sans oxygen, bedside nourishment and nurses -- the elder's true level of frailty is revealed. "Hard Cases" - Well section - 6/10/14
"Admitted to the hospital - but only in the physical sense: Observation care can cost" Elders & Families are facing HUGE bills for hospitalizations that are classified as "observation". In a USA TODAY article by Susan Jaffe / Kaiser Health News, horror stories of uncovered care demand your attention. (Money Section - 05/03/13). Seems elders are kept after an incident, but the patient is not informed that Medicare will not pay. This issue is in federal court in Hartford, CT, but eyes open, in the meantime. ASK ... and ask again. UPDATE: The CT Commission on Aging worked to get PA-1480 passed -- "An Act Concerning Notice of a Patient's Observation Status." CT hospitals are now required to notify a patient of their status (observation vs. inpatient), with likely Medicare payment implications. Judy Stein, a national champion at the Center for Medicare Advocacy, has supported these efforts. Thanks to Susan Raggo, MSW, for the update! 7/14. A Federal law now also requires notification of observation status - The NOTICE Act - 2016. This issue is an example of how important it is for caregivers to be informed and ask questions. Read the whole NYT article here: http://ift.tt/1wfm2Rw ********************************************************************************************************************* Medical Assistants cannot administer injections in orthopedic practices, but they sometimes do! Insist that a physician or certified nurse perform all treatments. The Patient Advocate 4 You service just reported such an incident with a client. The Doctor did NOT like being challenged; don't be intimidated. Visit www.ptadvocate4u.com for other helpful watch-outs. |
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Another hospital watch out - a recent news article reported patients receiving services from "out of network" docs - and families getting surprise bills in the thousands $$$$$. One grandmother of an ill infant doggedly tracked down all related expenses and negotiated much smaller fees. If your parent is admitted, ASK how you can be assured all services are covered by his or her insurance, unless you are consulted with, first.
Using WEB CAMS or other emerging technologies to monitor the elder's daily activities are worth consideration. Some family members of elders in nursing homes have monitored staff on-site; privacy and legal issues make this far from a simple approach. But it may be a way to confirm or deny suspicions about third-party caregivers, whether in a facility or the elder's home.
Using WEB CAMS or other emerging technologies to monitor the elder's daily activities are worth consideration. Some family members of elders in nursing homes have monitored staff on-site; privacy and legal issues make this far from a simple approach. But it may be a way to confirm or deny suspicions about third-party caregivers, whether in a facility or the elder's home.
"In Race for Medicare Dollars, Nursing Home Care May Lag" http://nyti.ms/1zdkLaR (link to article)
This NYT article rings true for me. My Mom went for 'rehab' after a stroke. In order to keep receiving services, she went through daily PT and OT services, but in essence, she was dying. I became her caregiver with home hospice when her six weeks were 'up', against the facility's advice. In her case, the facility did have room for her in their nursing home wing -- but at about $7K a month, once her money ran out I would have had to liquidate her assets. Rehab services is how facilities make money, other than high-priced, private-pay, assisted living units. Be aware of the dynamics of the money flow.
This NYT article rings true for me. My Mom went for 'rehab' after a stroke. In order to keep receiving services, she went through daily PT and OT services, but in essence, she was dying. I became her caregiver with home hospice when her six weeks were 'up', against the facility's advice. In her case, the facility did have room for her in their nursing home wing -- but at about $7K a month, once her money ran out I would have had to liquidate her assets. Rehab services is how facilities make money, other than high-priced, private-pay, assisted living units. Be aware of the dynamics of the money flow.