How Not To Hire A Geriatric Care Manager (Part 2)

So I hired a GCM to take care of Mom in Florida as my surrogate.

She charged $25 an hour for her Geriatric Care Management service and, at first, I was happy to pay it. The woman came highly recommended, was a member of the GCM professional association, and she lived near Mom. She sounded personable and intelligent on the phone. What more could I ask?

Surprisingly, Mom continued to sound receptive to such assistance, and so I set up her first appointment. The GCM did an initial assessment interview and provided a written report that recommended engaging her for ongoing guidance and assistance. She felt that Mom needed someone nearby to confide in and to analyze why she alienated others. She also said that Mom had definite symptoms of early dementia.

Here are some of the services I was promised by this GCM:

• Management of personal affairs, including referrals to financial, legal and/or medical professionals, as necessary.
• Care-planning assessments.
• Coordination of in-home services, if and when needed.
• Crisis intervention.
• Counseling and support.
• Weekly communication with me.

Sounded wonderful. The last item, communication, was from my point of view the most important single benefit of the service I thought I was buying. And for the first month or so, the GCM did stay in touch, maybe not weekly, but often enough so that I had a sense of what was happening with Mom.

Gradually, though, the services provided by the GCM began to change. To find out how, stay tuned for the next post.

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"
http://www.dementia-diary.com

How Not To Hire A Geriatric Care Manager (Part 1)

So I was stuck in Michigan while my mother continued her cognitive slide in Florida. What to do?

I had a plan to help me stay better informed about her daily needs, but it would require her willing cooperation. A new profession had recently emerged to help relatives of elderly family members supervise and coordinate care and services for their loved ones. Its practitioners were known as Geriatric Care Managers (GCM) and I wanted to hire one for Mom. But how to find a good one?

A national association of these GCM’s had formed for the purpose of promoting professionalism among its membership. It provided contact information for those of their members that practiced in South Florida. With the membership list in hand I phone interviewed several GCM’s living and practicing near Mom, and selected one. But would my mother buy into this idea? I had my doubts.

There were all sorts of services that these professionals said they could provide, depending upon their individual backgrounds and training. These included, among other things, clinical services, transportation, shopping assistance, emotional support, financial management, liaison with social services, or just plain old companionship.

Perhaps the most attractive feature of this service was the potential of having an objective, third party, on the scene, able to monitor the situation and to report regularly to me about Minnie’s needs.

It was like buying a surrogate caregiving relative, I thought...someone to be there for Mom when I could not. Without question, there would be some tough choices to be made down the road, some of which might be heart wrenching and guilt producing—like the possibility of having to arrange for the dreaded nursing home, for example.

I didn’t want to face such decisions alone, always to wonder whether I had done the right thing. Here was a way, I thought, to have a partner to assist me to evaluate each situation, and to advise me on the best professional options for my mother. It was the perfect setting, I thought, for a Geriatric Care Manager. So I hired one.

Soon I was paying big bucks for this GCM to have lunch several times a week with Mom…and not much else! More next time.

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"
http://www.dementia-diary.com

How To Cope With Long Distance Care Giving

Here's a situation that I bet affects many of my readers and that causes some of you much frustration and angst.

In the beginning of Mom's decline, it was not immediately clear to me that she was losing cognitive function. More and more, after Dad died, she naturally looked to me for help with her decision-making and with her growing problems with daily living.

I had to decide things like: when to intervene forcefully about driving, housing, medical care, etc., and how to make this determination long distance. For me, living half a continent away, this is what it meant: when to hop on a plane, leave my own business and family concerns, and go to her—-and when not to go. It wasn't always easy to determine when my presence was absolutely necessary. As with most of us, there were limited opportunities for me to actually pick up at a moment's notice and go.

So you know what happened, don't you? Often, when I finally arrived to deal with her crisis, the problem remarkably got resolved while I was in transit and my physical presence turned out not to be really necessary. On the other hand, shortly after I returned home, she'd invariably face an issue that really did require me to be there…only, this time, I would not be able to get away again.

I wanted to save my trips for the absolutely essential ones, but how could I know in advance? How indeed? There was nobody but me, her only child and next of kin. Who could advise me? I needed partners to assist me.

In a future post I'll share the good news and the bad that resulted from my search for a local assistant.

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"
http://www.dementia-diary.com

Do These Behaviors Predict Dementia?

I'm often asked about examples of challenging behaviors that I noticed in my mother—behaviors that helped me to finally realize she was sinking into dementia. The list below may help you to evaluate what is happening to your loved one.

For Mom, it started slowly with just a few of these behaviors attracting my attention. I just passed them off to normal aging. Gradually, it reached the tipping point where I could no longer ignore what was happening. There was an emergency a day.

I lived 1500 miles North of Mom, trying to run a business. Every day in the middle of some crisis at work came a phone call about some calamity in Florida. Sometimes from Mom, sometimes about Mom.

Up to 30% of my time was being consumed as a long distance caregiver and decision maker—often without the facts I needed to make correct, emotion free, objective decisions. Frequent air travel to check things out became another costly requirement. Here’s some of what I had to deal with:

• NUTRITION: She was not eating well. Things in her refrigerator were scary: ie: partly eaten fruits and cheeses with lots of mold.
• CLEANLINESS: Her house was dirty (she had been a meticulous housekeeper).
• HOUSEHOLD ORGANIZATION: There was clutter everywhere. This was not my mother!
• FIRE SAFETY: She was storing plastic bags in the oven. Then, forgetting, she was turning the oven on.
• REALITY ISSUES: Hallucinations about mice were occurring with increasing frequency.
• HEALTH ISSUES: Many health issues were threatening her well-being. Hospitalizations for pneumonia, arthritis, etc., were becoming more frequent.
• DRUG COMPLIANCE: She was non-compliant with medications with the result that her blood pressure was out of control and other health conditions were not receiving prescribed therapy.
• MEDICAL CARE: She changed doctors (and HMO's) several times each year. Continuity of care suffered and I could not build a useful relationship with her physicians.
• INTERPERSONAL RELATIONSHIPS: She was isolating herself—alienating friends and family with harsh, judgmental personality changes.
• FALLING: She fell in her room, sustained a serious head injury and no one found her for 2 days
• FINANCIAL MANAGEMENT: She was messing up her finances and making other poor judgments.
• HOUSING: She became a housing hopper: In a 2 year period she went from her Florida house to a Florida condo to a furnished condo in Michigan back to her Florida condo to senior apartment to assisted living in Florida back to assisted living in Michigan. She had trouble settling in anywhere.
• DRIVING: Her driving became a daily nightmare with multiple fender benders and traffic violations.

Sound familiar? Are any or all of these things happening to your mom, dad, spouse or significant other? I hope not, but if they are, it may be time to seek a professional geriatric evaluation.

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"
http://www.dementia-diary.com

Is Your Mom/Dad/Spouse Ill—Or Just Being Difficult?

I'm often asked the following questions:

• When did I first realize that my mother was ill and not just being difficult?
• What are some examples of her challenging behavior?
• How did I try to cope?

For this post, I will focus on the first question: when did I finally understand that what I was seeing was illness and not nastiness? While I cannot pinpoint the exact moment with any accuracy, suddenly I knew—the light bulb flashed on and it was not a happy moment.

All her life, Mom had been a well organized, high energy person. She ran my father's manufacturing business and, when she retired, she became a dedicated community oriented leader, an organizational volunteer and chapter president, a local library board member, and a worker for all sorts of charitable organizations too numerous to mention here.

My mother grew up in Brooklyn, New York, and lived there until retiring to Florida at around age 60 with my father. Dad died suddenly while shopping in a Sears store. He just collapsed with Mom shopping beside him. He was 83. Mom was 77 and, of course, was totally traumatized.

I was to learn that dementia is something that happens gradually; quietly altering a person's skills and behavior until it becomes so obvious something is wrong that it can't be ignored. After my father died, I suddenly realized that Mom had been slipping emotionally and cognitively for some time. I just hadn't noticed before because Dad had been covering for her.

Mom's behavior was becoming eccentric and embarrassing. At first, not suspecting illness, I felt angry and guilty but, as I say, dementia kind of creeps up on you. I gradually realized that something was wrong. Something very serious.

She was ultimately diagnosed with a progressive dementia, not Alzheimer's, rather a multi-infarct (mini-stroke) vascular dementia. And her only son (me), who lived 1400 miles away, was to become her primary caregiver.

Next time, I'll report on question two: Examples of Mom's behavior alerting me to the fact that something dreadful was happening.

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"
http://www.dementia-diary.com

Is It Alzheimer's?

Or is it one of the many other kinds of dementia that slowly rob our loved ones of their identities? It matters not which dementia they have. The effect is pretty much the same.

So I finally “got it.” Maybe you have too. But, if not, consider this: Chances are your loved one would be embarrassed to death if his earlier, healthy, self could see him now.

It’s up to us as caregivers to recognize that Mom or Dad (or spouse) are not being difficult on purpose, and to forgive them—daily if necessary. They just can’t help themselves.

DEMENTIA CAREGIVERS OFTEN FEEL ISOLATED

They need lots of caregiver support. For a very long time, I felt TOTALLY ISOLATED—like I was the only one in the whole world carrying the burden of caring for an aging parent. I bet you sometimes do too.

Be good to yourself. Seek dementia support services wherever and whenever you can.

That’s what I did and gradually I realized that I WAS NOT ALONE! Thousands of people were experiencing exactly what I was—dealing with memory loss and unpleasant behavior in a loved one, every moment of every day.

KNOWING THIS MADE ALL THE DIFFERENCE

Bob Tell
Author, "Dementia Diary, A Caregiver's Journal"
http://www.dementia-diary.com

COULD IT BE THE DEMENTIA?

I couldn’t tell. I was too close to it. I got mad every time she lashed out at me…or else I felt embarrassed whenever her target was someone else (usually in public places)—or when she over-ate without remembering that she had just eaten—or when she asked the same question over and over and over—or she was physically aggressive—or (you can fill in the blanks with other things that make you crazy).

Every time Mom did something socially unacceptable (I won’t catalogue these things—you know what they are), my anger raged. Afterwards, of course, I felt guilty for getting angry. Well, I didn’t have to feel this way…and neither do you.

Here’s what the social worker told me:

“DEMENTIA IS A DISEASE PROCESS”

“Cool it buddy!” she said. “It’s not about you. It’s about her. It’s a disease process—an illness.” So recognize the wisdom of the social worker’s advice.

Learn to ignore the bizarre behaviors of your loved one and to accept them as “normal” symptoms of dementia disease (and to not take them personally even when they seem to be personal). You’ll be a much happier person and a much better caregiver.

Remember: Your Mom can’t control her dementia symptoms any more than if it were pneumonia, or heart disease, or cancer. Things are happening in her brain that make her do the things that upset you.

IS IT ALZHEIMER'S?

(The Answer Next Time)

Bob Tell,
Author "Dementia Diary, A Caregivers Journal"
http://www.dementia-diary.com