Advocacy is keeping the puzzle intact…

Categories: Aging Advocacy, Caring For Elderly, Hospitalization

I think of my role as advocate as the person who takes all the pieces of my client’s healthcare jigsaw puzzle and makes sure they fit together to create a cohesive and complete picture.  With so many health issues and sometimes so many physicians and caregivers involved, the pieces become scrambled, and it’s my job to put them back together.

Example:

Recently a client went to the hospital due to a fall.  After determining there were no broken bones or lacerations, the central concerns became her balance (since she’s complaining of being dizzy) and the neuropathy in her feet.  A hospitalist, a wonderful doctor with a compassionate bedside manner, sees my client for 10 minutes each of the next three days she is hospitalized – as an inpatient I might add.  Following the issue at hand, he looks for ways to decrease her falling risk, and something he can do immediately is “adjust” my client’s medication.

So the hospitalist takes away one of her blood pressure medications, adds on another drug to help with the neuropathy (although admits that one of the side effects is dizziness), and for some unknown reason, cuts her depression medication in half.  Three days later when this lovely ady arrives at transitional care, she is crying, upset and refusing therapy.  Thirty minutes with a doctor has just undone years of seeking a delicate balance of high blood pressure and depression.

My job as her advocate is to begin unraveling why her medications were changed, which changes do we keep and which do we undo.  Remember I’m non-medical; but my role requires me to become educated about the medications involved and then be willing to ask the questions of her medical caregivers to return the puzzle to a cohesive and complete picture.

Stress of the Caregiver

Categories: Caring For Elderly

As I parked my car, my cell phone rang.  Without looking I knew who was calling me.  It was six o’clock.  The calls were more frequent; the behaviors more overt.  I looked at the caller identification; I sighed and answered, “This is Deborah!”  For the third time that day, the nursing home was calling because my aunt was confused, demanding it was dinner time and they weren’t allowing her to eat.  Or refusing to take her medication.  Or wanting to go home.  Or one of many challenging behaviors that were escalating.

But what was I to do?  I was scheduled to attend a seminar and couldn’t advise them to do anything but redirect her as they had done a thousand times in the past.  But still they called hoping I could find some magical words that would convince her to go to bed – that she had just eaten – that she did live in that “horrible place” as she liked to call it.  I listened, I cajoled, I sympathized and explained; I assured and affirmed then I was able to say good night.  With relief I turned off my phone so I could focus on the seminar’s topic – Parkinson’s Disease.

You see, I am a geriatric care manager, and for the past five and one-half years, a caregiver for my aunt and uncle.  My uncle has had Alzheimer’s Disease for all this time and is very happy, placid and without issue except for bumping his wheelchair into walls.  My aunt, slowing traveled the journey into dementia fighting every step of the way.  She never noticed he was ill; she knew every day that her capacity to think clearly and rationally was slipping away.

But I am a geriatric care manager.  I counsel with families about how to handle the stress of caring for a loved one with Alzheimer’s.  This should be a breeze – practice what I teach, for heavens sake!  But when it’s your loved one with the disease, objectivity wanes.  My heart was breaking for the strong, proud woman who cherished above all her appearance.  My nerves were frayed from the growing demands this disease was placing on me.  And, above all, I wasn’t sure of what to do.

There is a distance between us – literally and figuratively.  My aunt and uncle live 250 miles from my home.  And, incidentally, they aren’t related to me by blood but rather by marriage; a marriage that ended nearly 20 years ago.   But neither concerned us when they were well.  Now at times I felt I was an intruder knowing more than I should, making decisions about two people I loved but had no right to choose their fate.  But the job had fallen to me innocently enough, and I was happy to help them out by agreeing to be the executor of their estate many years ago.  I had no idea all that agreement would entail.

What it meant to me at that moment, in the car at six o’clock on a Tuesday evening, was that I needed to do something to ease my aunt’s anguish.  For the past two years, she had been under the care of a psychiatrist whom we visited quarterly.  I had sought out a psychiatrist to help with the overwhelming paranoia my aunt was feeling every waking minute.  She was positive people were taking things out of her apartment in the assisted living residence where she lived.  In the beginning, this thievery was mentioned in conversation during my monthly visit, then there were the phone calls insisting she had placed her earrings in a box and the box was missing, then it was her perfume, hairspray, clothing, shoes – even her underwear went “missing”.  With every visit we would locate the missing items but she was convinced that someone had taken them and then replaced them when they heard I was coming.  But now it was more than missing personal items.  It was paranoia about being able to eat or take her medication.

It’s never easy to be a caregiver but it’s is the path that I chose.  This blog was created to help people during their times of struggle and know that there are others out there going through the same thing.  I want to be able to help, comfort and give advice to those caregivers who want to give the best care they can.  What are some struggles that you are dealing with right now?  Do you have advice for others going through these same stresses, we would love to hear about it!

Can Compassion Be Learned?

Categories: Aging Advocacy, Caring For Elderly, Hospitalization

Let me begin by saying that this is not a topic I have researched in depth.  Rather it is a question that has found its way into my thoughts and won’t depart since writing my thesis for a graduate degree in Gerontology.  The thesis topic was communication; specifically, communication between the physician and their elderly patients.  My research focused on the competencies of efficient and effective communication, and whether physicians are taught such skills in medical school.  With this thought came the question of what can be taught and, more precisely, what can be learned.

First, the words competency and compassion don’t seem to fit together.  From my perspective, “competency” belongs in the stiff corporate world of skills required to do a job while “compassion” belongs in the realm of human emotion.  In the professional world of medicine, can these two qualities be found in one person?  If not, can human emotion be taught?  Can human emotion be learned?

There are certain skills associated with communication that can be taught and learned.  Non-verbal affirmations such as head nodding, sitting and eye contact are behaviors which, with commitment and a desire to achieve, can be learned.  Then there are the innate characteristics that are inborn, a part of who we are from birth, that are central to the nature/nurture debate.  Thus the question – can human emotions such as compassion be learned?  Or must there be a predisposition for that characteristic lying dormant until such time as it is wakened through life experience or pure, simple desire?

Some behaviors, we want to believe, can be taught simply through modeling.  We strive to be good parents, children, citizens, employees, stewards in our personal lives.  But is the example enough to bring forth these qualities in others?  Or do we individually need that “gene.”  The simple answer – I don’t know.

Compassion is just one of several innate characteristics found in humans which provide the fertile soil necessary for positive growth.  Openness, warmth, honesty, a true understanding of another person’s circumstances are all traits which encourage trust.  With trust comes the opportunity for honest communication.  Being a skillful communicator requires behaviors which can be taught and learned — coupled with the quality of compassion.

My husband is the kind of guy who views his glass either half full or overflowing with goodness.  Thus, he believes in the goodness of people.  He adheres to the philosophy that people are born with a core of inner health waiting to be tapped into by life experience.  From his view, compassion is available to everyone as is honesty, empathy, love, trustworthiness and the other human characteristics that make us “good” people.

Nice.  It feels good to believe this.  I want to believe this!  I also want my doctor to demonstrate this quality when talking to me and my elderly clients.  But the question remains – can compassion be learned?  The answer isn’t clear, but I believe we should continue trying to model and teach the behavior that is a true gift to the others and especially the elderly.

Am I Here For Observation Or Am I A Patient?

Categories: Health Insurance, Hospitalization, Medicare, Medicare Part A, Medicare Part B, Medicare Part D

Does the following scenario sound familiar?

You have recently been hospitalized. After getting home you receive a bill for a lot more than you have ever been charged before. You call the hospital, the billing department gives you some explanation about not being an inpatient (what?!), that you were “probably” told at the time you arrived at the hospital (I don’t know! I was too busy being sick to listen intently!), that you “most likely” received a patient’s bill of rights or some other document telling you the difference between outpatient and observation admission, and that you have the right to appeal if you do not agree with this decision (good because I don’t agree with having to pay this bill!).

You look through your hospital papers, you call Medicare (and wait for an hour to talk to someone), and you are given the same information that the hospital’s billing department gave you. Now you are really confused as to what you should do, but you know you shouldn’t have to pay this hospital bill!

A client of mine experienced what I have just described and we decided to appeal. Following is the appeal I wrote on her behalf:

Click to see Medicare Letter

The appeal was denied.

The next time you or a loved one is sent to the hospital, listen carefully for the word “observation.” What this means is that Medicare Part A pays for the room and board, Medicare Part B pays for approved therapies and prescriptions (and very few drugs are covered under Medicare Part B). Some insurers will allow you to re-file your prescription charges under your Medicare Part D plan which leaves you liable only for deductibles and copays. But you must be aware of your rights and what you need to do to receive this additional coverage.

There’s more to this conundrum. I’ll blog about it in the near future.

Deborah Dolan An Advocate on Aging

Categories: Aging Advocacy, Caring For Elderly, Planning, Resources, Speaking

I value faith, family, friends, and integrity.  It is, therefore, very interesting that I write something that does not uphold total integrity.  You see, in my stories you will find that the names have been changed to protect the innermost lives of my clients and their families.  I refer to my work of care management as a job; and I am founder, owner and president of Senior Life Transitions, LLC, a business entity in the eyes of the law.  But my clients and their families are very real people, care management is not work and Senior Life Transitions is not a business in the truest business sense.

Care management is my passion, and I am lucky enough to explore, nurture and experience my passion every day.  Senior Life Transitions is not a business where the bottom line goals are expansion and wealth.  Senior Life Transitions is the vehicle that has taken me to my desired destination; it only goes in the direction that I map for it, and I map out a journey of love, commitment, advocacy, learning, teaching, and being as I assist families during difficult times of life.

I am writing this blog to open the doors to anyone who may need assistance and doesn’t know where to turn.  They may be experiencing a time in life where they just want to know they’re not alone or they may be seeking information for future reference.  Regardless, my goal is to help educate the world about eldercare, care management, health care and life journeys.  I am a speaker and an educator and my passion is advocating for the elderly.

Please read these educational posts and stories with this understanding:  Each person I’ve worked with – whether family or friend — has been a blessing in my life.  I promise integrity in all that I do as I “work my passion.”   These stories are simply documentation of what faith can accomplish.

I truly hope you find what you are looking for here.  Please feel free to contact me at deborah@seniorlifemn.com if you have questions or comments.