Coming To Case Management?
As medicine becomes more mobile than it ever was, the opportunities for other healthcare professionals to utilize telemedicine increases as well. Linked here in this blog is an article about Case Management Telemedicine.
When we created www.cypresstrio.com it was partly our desire to help families searching for care and to help educate them along the way. But we also wanted to help the healthcare/senior care professional make their job a little easier. By introducing the insurance matching feature for short-term skilled care, we have found a tool to help case managers save time in their day while helping families make a smart choice for care. As you can probably imagine this has been a huge hit with case management, social workers and discharge planners.
CypressTrio.com and telemedicine are a perfect fit for case management. How easy would it be for a case manager communicating with a patient and their family via telemedicine as they navigate the Cypress Trio website?
As a provider of senior care, contact us for how you can show off your facility or service. If you'd like to learn more, contact: firstname.lastname@example.org
Will have to wait until their office opens next week and I will soon have an update.
Posted: 27th of February, 2016 by Olga Brunner
Labels: telemedicine. elder care management. agooddaughtersolutions.com
Posted on February 25, 2016 by Jim Koewler —
This week’s blog continues the discussion of an aging adult who wants to stay in his or her home, the emotional turmoil that can face the adult children in deciding whether to accede to the aging parent’s wishes to stay home. Today’s blog will discuss medication management.
One of the most common reasons that an aging adult cannot stay in his or her home is failure to take medication as prescribed. Compliance with prescriptions is HUGE in a senior’s attempts to age in place. There is help with medication management.
An older adult can have a complicated prescription regimen for any number of chronic conditions. “Mom” might need a blue pill, a red capsule, a round white tablet, and an oblong white tablet at breakfast. Then, she might need two red capsules, a yellow tablet, and two different white capsules at lunchtime. Then, it’s a yellow capsule and two oblong white tablets in the afternoon. Then, it’s more of the same at dinner and again at bedtime. It’s hard to keep them all straight.
The adult family member should seek out a prescription packaging service. These services can organize all of Mom's prescriptions and package them for easy identification of the pills necessary at each particular time. The Monday morning pills are all in one sealed packet, and the packet is labeled for Monday morning. The Monday noon pills are in another sealed packet labeled for Monday noon, etc. Mom doesn’t have to sort her own pills. The service has done the sorting and packaged pills together that need to be taken together based on day and time. Also, the individual packets are in a tear-off strip, in order. Monday morning’s pills are at the end of the strip. When Mom tears off that packet and takes the pills, then the next packet (now at the end of the strip) is the Monday noon packet. Then, the next packet has the pills for Monday afternoon. Mom's pills are sorted so that she needs to tear off just the packet at the end of the strip. Mom has no confusion sorting pills and making sure that she gets all of them necessary at any particular time. The service takes care of that. Mom just needs to tear off the next packet.
There was a time when Medicare services would provide nursing help to monitor how patients living at home were taking their medications. Hand-written records were left at the patient's home with details of how mom or dad were taking their medications. I'm not sure if the government has discontinued this service in your area but using the services of a nurse care manager to set-up weekly medication management pill boxes in the home also helps to keep mom living in her home if there is no dementia.
If Mom's difficulty isn’t sorting the pills but remembering to take her pills at the appropriate time, there are prescription reminders available (often from the same companies that provide the panic button necklace for seniors afraid of falling.) A reminder device can be placed in a conspicuous place in the house that will give an alarm when it’s time to take medicine. These devices generally get the senior’s attention. (Remember how annoying was the sound of your alarm clock this morning. It got you out of bed at, more or less, the right time, didn’t it? These reminders work on the same concept.)
A step above the medication reminder is an automated pill dispenser with its own alarm. A dispenser will hold all of Mom's prescriptions for a certain number of days at a time. It will dispense Mom's pills, pre-sorted, at the time necessary for her to take the pills.
A more sophisticated version of the pill dispenser will leave the pills available to Mom for a certain length of time. If Mom doesn’t take the pills out of the dispenser during that time, it will close up. (Each batch of pills necessary at a particular time are in one small drawer together on one model of such a dispenser.) The closing of the drawer prevents Mom from catching up with her pills all at once. Some models that close up the pills not taken on time can notify a family member or a care manager when Mom fails to take some of her pills. Now, someone needs to fill the dispenser. That someone is usually a nurse care manager if no familiy live nearby.
With these services, medication management (and compliance with medication’s requirements) becomes much easier. Compliance with prescription schedules will make it far more likely that the older adult can remain in their own home.
At A Good Daughter Solutions we've had a good experience with two providers: Life Alert, and Guardian Medical Services. A medication dispenser can be rented monthly and can be programmed by a nurse care manager to dispense either weekly or monthly. The size of the dispenser is close to a coffee machine and usually fits on a kitchen counter. The nurse will program how the medications are to be dispensed and the machine talks to the patient whenever a medication is to be taken. Medications to be taken at a particular time of day are dispensed in a small, covered, cup preventing mistakes by the patient or the caregiver. Please feel free to call us If you'd like to know more and we will send you a link to each provider. If living out of town and would like the phone numbers to a prescription packaging service near mom or dad's address please call our office at 561-235-2490 If we are out of the office with clients please feel free to leave a message. We usually return calls as soon as possible.
Also feel free to comment below. Thank you.
Posted: 26th of February, 2016 by Olga Brunner
Labels: medication. elder care medication management. agooddaughtersolutions.com
Good morning friends. I thought I'd share valuable information from a past N.Y. Times article which may help if you are experiencing problems with an ageing parent and a out of town family member.
It is no surprise to caregivers that as parents age, longstanding tension can erupt into family discord. A 2001 study found that close to 40% of adult children caring for a parent described "serious conflict" with a sibling. This frequently results in one sibling shouldering the bulk of care giving responsibility. Despite mutual concern for a parent's well-being, adult children have often lived apart for decades and have little experience working together. Visits, end-of-life decisions and estate planning all become sources of sibling strife when old rivalries begin to pay out. Lord knows that I experienced similar conflict as my siblings lived up north and I was my mother's only care giver.
It's not just adult children....Caregiving can strain relationships inside the family and out. There are now mediators available who can temper the situation, hash out misunderstandings and, perhaps most importantly, help head off estrangements.
A good mediator can delve right to the bottom of things, parse out the important issues and help the family deal with them. It's different from therapy because it is really about decision-making, not feelings and emotions.
Elder care mediation can be tricky, as mediators must balance the opinions of many parties, not only adult children but in-laws, home care aides and sometimes grandchildren. A mediator generally should be trained in such subjects as the physical and mental effects of aging and how to communicate effectively with the elderly.
If you think you might benefit from employing a mediator to diplomatically solve your family issues you might start by going to: www.Mediate.com which allows prospective clients search elder mediators by state. Have you hired a mediator? I welcome your comments below. Thank you.
Posted: 11th of February, 2016 by Olga Brunner
Labels: mediation. elder care mediation. attorney mediators
I received an email yesterday from an out of town family member wanting to know if discussing the move to Assisted Living with her mom and discussing the fact she has Alzheimer's should be started even though a discussion about Alzheimer's has upset her in the past.
My response is this. A discussion such as this is not going to be easy and mom is going to be upset. I would never do it over the phone, but certainly as this is going to be a life changing event, you do need to remind her that she has an Alzheimer’s Related dementia disorder and your job as her power of attorney is to keep her safe. Actually, I am sure her mother already realizes her cognitive changes. I bet it already makes her nervous. This has got to be the most difficult time in her life and I am very sensitive to the family's needs as they undertake this challenge. I won’t pretend that it is going to be easy for the parent or the family members. But just keep in mind that persons with a diagnosis of dementia are protected such as young children are by the State. The authorities take their safety issues quite seriously and have enacted laws to ensure safety. Whether they are placed in a community setting, are cared for at home with 24 hour caregivers, or go to a nursing home when the decline is progressing, a parent should be made aware that because of wandering, cooking, and driving issues, they will no longer be able to live independently. Although a parent may get angry at you, or may get very emotional, I believe they should be told what the plans are and and why.
I have worked with other adult family members who have lied to their parents out of guilt, not having had warm relations in the past, or out of avoidance of this discussion. They have told a parent that it is only going to be a temporary thing – much like going to camp for the summer while their condo is undergoing renovation. While that provides a sense of relief for the adult child, it is disastrous for the parent. This approach doesn’t serve a parent with dementia well because they will not forget what families have promised. When a couple of months go by and they are still living in assisted living, they get really angry and become belligerent with current staff – ultimately needing to have private caregivers in addition to costs of providing care at the ALF. It doesn’t serve the parent and they feel betrayed. The one thing about Alzheimer’s I haven’t been able to figure out is that persons with this disease NEVER FORGET a memory that is tied to a great emotional experience!
Although this is an emotional experience, honesty is ultimately the best policy. Enlist the help of the facility you are considering. They have many years experience in this arena. Allow a parent to process the need for safety. Don’t use the word facility and do use the word "Community" instead. And if a parent refuses to move, then you may need to enlist the help of the courts through guardianship - always an expensive proposition.
As caregiver for my mother 19 years ago I also crossed this path and made the difficult choices for my mother's safety as she wandered and couldn't find her way back home one day. If any of you have gone through this journey and would like to share your comments, please do so by checking the comments link below.
At A Good Daughter Solutions, we are here to help. Please call if you are in need of a an Elder Care Manager to help plan a move for your parents. We are more than happy to help. You may contact a care manager at: email@example.com
Posted 10th February 2016 by Olga Brunner
Labels: ALF placement, guardianship, moving a parent with Alzheimer's, wandering
Today we will present information describing a little known method for some people in certain states to receive home care through Medicaid without requiring them to impoverish themselves first. Here is how it works.
In 1993 Congress created the Pooled trust to protect this country's most vulnerable and disenfranchised segment of our citizens - the elderly and disabled. Through non-profit organizations who have a Pooled Trust, individuals who meet the definition of disabled under the rules of Social Security, can place their assets in the trust and still meet financial eligibility for Medicaid and SSI (Supplemental Security Income). The funds are pooled for investments but separately accounted for throughout the individual's life. The funds can be used to enrich the quality of life of the participant instead of being quickly consumed by catastrophic medical and long term costs.
Elder individuals may benefit from a Pooled trust if they are: Disabled in need of long term nursing care at home or in a facility; over the age of 65; and in need of or receiving Medicaid, Social Security Disability or SSI. Essentially, this law allows disabled persons to put their monthly income or assets - above the amounts Medicaid allows them to keep, into a special type of pooled trust. They can use the money in the trust to pay for their basic monthly bills like rent, a mortgage payment or cable TV bills. Medicaid in the meanwhile will pay for their home care.
Monies left in the trust after the person dies are generally kept by the nonprofit organization running the trust, or is paid back to Medicaid.
You should also be aware that the rules governing Medicaid are intricate and differ in each state so while you may be able to keep a loved one home in New York State under Medicaid, this may not be true in other states. With a Pooled Trust however, each month, the participant who has been deemed disabled can deposit her or his excess income into the trust to pay bills as long as the expense is for the sole benefit of the participant. The nature of the trust is to supplement needs that are not met by government programs.
The trusts work particularly well for those who have few assets but may own a home. Many states however, do not allow persons over 65 to use the Pooled Trusts at all because they have interpreted the federal laws differently and have even imposed penalties on people over 65, so please speak with an elder law attorney.
In the State of Florida, Pooled Trusts are used quite well. For example if you have a client with approximately $40,000 to $50,000 in need of nursing home placement, the client can deposit funds into a Pooled Trust. They must be eligible for Medicaid, pay for a private caregiver or Care Manager, used for a semi-private or private room charge, or other services. A great resource is the Alpert Jewish Family Services Pooled Trust. For information please visit: http://jfcsonline.com/pooled-trust
Posted 9th February, 2010 by Olga Brunner
Labels: Elder law, Alpert Jewish Family Services, Medicaid Pooled Trusts, Special Needs Trust.
Although today's article appeared in the New York Times several years ago I've kept it just in case it came in handy as I enjoy sharing good information with others who may be looking for help these days. The article described methods families can use to challenge Assisted living Facilities when their ever increasing, ballooning monthly bills are standing in the way of a parent's ability to remain in an ALF. According to the article, the most frequent cost increase used to cover rising expenses are made when the resident moves to the next level of care. That can be as a result of the parent requiring supervision with medications or diabetic injections, bathing or dressing help, has incontinence issues, etc. But these costs can also soar due to arbitrary decision-making from internal policies and may be challenged. Using an elder care manager who has experience and reputation appealing these in-house assessments may help get some of these decisions reversed in favor of the many families struggling to keep mom or dad in a safe environment. I've taught the classes needed under state law for new Assisted Living Owners or Administrators and one thing I've learned is it is not whether or not mom or dad will have a rent increase, it is when they will have a rate increase.
Ask me if interested in help with a similar situation you may be having. I've reassessed some clients having successfully reversed some of these charges.
To read the actual article click on the following link: http://newoldage.blogs.nytimes.com/2010/12/07/when-the-assisted-living-bill-balloons/?src=tp&_r=0
Posted 8th February 2016 by Olga Brunner
Labels: Assisted living facilities, elder care manager, levels of care
As usual, feel free to comment below:
I read an article in the New York Times some time ago which left quite an impression. It concerned adult children that have finally had it after years of painful relationships with their parents and just give up or decide to exploit parents in order to get even with a perceived mistreatment.
Throughout the early years of my Geriatric Care Management practice I was challenged specifically by a long distance family member with this precise history with a parent. This adult family member became obsessed to the extent of compulsively controlling every breathing, waking moment associated with his father's care, relationships, outings, expenditures. The parent in question had no dementia diagnosis, yet the family member went to an MD appointment, handing a note with the word "dementia" in quotes to the cardiologist. When visiting from out of town he was critical of everything the parent did loudly, ultimately leaving after a bitter disagreement.
It left me sad and I wished it had been different because in my experience I have learned that an aging person in their 80's is not who they were in their 50's and chances are that those old family issues aren't even an issue anymore from the parent's perspective. Although this family member's behavior was old news to me and I realize that not everyone is meant to be a caregiver, I came pretty close to offering mediation, counseling, or both as it was taking hours of e-mails back and forth late into the night and early mornings of every day and my blackberry fingers were suffering from burnout. (that should describe how long ago it was).
If you'd like to read the New Old Age article here's a link below: http://newoldage.blogs.nytimes.com/2010/12/01/they-cant-go-home-again/
The article recommends 2 books which I think should be read if you are going through this with a parent: "They're Your Parents Too." by Francine Russo, and "When the Time Comes: Families With Aging Parents Share their Struggles and Solutions." by Paula Span, author of the New York Times blog described above.
As usual, I welcome your comments below.
Posted 6th of February, 2016 by Olga Brunner
Labels: Difficult children caring for Difficult Elder Parents
Many persons with dementia do not recognize or acknowledge their condition or deterioration. This is part of the disease. In fact, some may not even recognize their own reflection in the mirror. If you'd like to recognize some common reactions when a parent with Alzheimer's exhibits symptoms of denial, some of their reactions are:
1. Anger over issues of control and loss.
2. Defensive responses when confronted with facts of memory loss or functional problems.
3. Refusal to make or keep doctor's appointments.
4. Gradual withdrawal from social situations.
5. Less participation in activities that a parent once enjoyed.
6. Unusual or unreasonable fears of people or situations.
7. Excuses for changes in behavior, (such as "I'm tired, I'm a homebody, I don't like to walk")
8. Insistence on continuing activities that are unhealthy or even dangerous,such as driving. In fact we once had a client that would just go and purchase a new car whenever the daughters took away her car keys!!!!
You, as a family member may wish contact an elder care manager if you are in town visiting a loved one and find such symptoms of denial, if you are noticing self-neglect especially with hygiene, if driving is becoming problematic for a parent and you notice increasing car dents, or if mom or dad is just not getting out anymore. We are your source for peace of mind.
A Good Daughter is an Elder Care Management company, located in Palm Beach County. We will cover your aging parent's needs from East Boca Raton to North Palm Beach Gardens and West to Wellington. We offer Comprehensive Assessments and will write a Plan of Care detailing our recommendations for your elderly parents in Southeast Florida. We can assist in implementing our recommendations once they've been reviewed by you and discussed. Our blog aims to provide information about our services and provide solutions. Have questions? Call us at 561.235.2490 to schedule a complimentary visit with you and your parents if you will be in town visiting parents. Please feel free to share our site with other families who may need this kind of help and as always feel free to ask more questions submitting a comment below.
Posted 5th of February 2016 by Olga Brunner
Labels: geriatric care management Living with Alzheimers
I Have worn many hats in my day: Nursing Home Assistant Admin and Activities Director, Assisted Living Admin, Case Management for the State-wide Medicaid Program, and Trainer for Dept of Elder Affairs.