Research on Planning and Quality of Life

 

Baby Boomers:  Did you know…?    

Research shows:

→thinking about later life leads to better planning

planning for later life leads to better preparation

preparation for later life leads to better quality of life

quality of life leads to longevity

What about you?  Are you a Baby Boomer?  Are you preparing for your future?  You probably are thinking about your finances… but what about that time when you might need someone’s help to have quality of life in your everyday life?

In the Know-Elders.com

 

Meet Emily Saltz , LICSW, CMSC (Founder and Director, Elder Resources, Elders.com).  She is a bundle of energy, misses no small detail, and when you talk to her she seems to listen with her whole being.  It’s not surprising that Elder Resources, which she founded in 1993, is one of the longest-running and highly-respected private geriatric care management services in the Northeast.  Saltz, a social worker by profession, is steeped in this work and understands the mechanics of the health care system just as well as she grasps family dynamics and the distinct needs of elderly people.  It’s easy to imagine how Saltz’s compassion and humor help families navigate the uncharted territory they face when assisting a family elder.

I wondered aloud, “How do people end up on your doorstep?  Are there usual incidents or events that prompt people to pick up the phone and call you?” “Yes.” Saltz responded decisively. “People typically call us when they are in crisis.  We wish they would call sooner.  They often call when they have noticed an alarming physical or cognitive decline in their loved one, during an elder’s hospital stay or after a fall.”

Saltz explained that people discover Elder Resources and similar groups around the country by word of mouth or a referral by doctors or attorneys.  Anyone can call or go to the website of the National Association of Professional Geriatric Care Managers (NAPCGM) at www.caremanager.org and find a nearby Geriatric Care Manager.

“Why don’t families reach out sooner?” I asked. “Is it a financial burden? Denial? Or that most of us want to handle the situation on our own?”  “All of the above,” Saltz answered, “plus, as a profession, we’re not as known as we want to be.  Geriatric Care Management is the best kept secret in the health care system.   People simply don’t know about us….until a crisis.  Then, when they search for support, they are likely to be pointed in our direction.   And even then, geriatric care management is not reimbursable under insurance.”

The lack of public awareness and financial limitations constitute two stumbling blocks.  But Saltz also talked about the ways in which family dynamics and relationships exert an impact on adult children and their elders.  “Families don’t talk enough,” Saltz said.  “Many parents and their children do not have the kinds of conversations that lead to long-term, thoughtful planning.  Most of us avoid talking about caregiving and end-of-life issues until we’re in the middle of it. When family members finally do reach out for help, they often feel terrified or paralyzed.”   The denial has lifted and the situation can seem daunting.

At Elder Resources, the preliminary assessment serves as the basis for decision-making.  One question facing so many families is whether a person can continue to live at home or not. I asked Saltz if she and her team are always able to answer that question. “Yes,” she answered.  “It’s clear immediately… though not always after the first visit; we make several home visits, providing a professional, objective evaluation that takes into account the elder’s cognitive, physical, and emotional domains.  When completed, we make recommendations that involve choices and options.  We arrive at a conclusion by doing a comprehensive assessment and listening closely to the expressed wishes of the elder as well as the strain on family, siblings’ relationships with each other and relationships with the parent. The competency and decision-making capacity of the elder is central.  We come away with a solid impression.  In all that, one important goal is to honor the elder.”

Another important part of the process, according to Saltz, is to get past “no”…an answer that can bring progress to a halt. If, for example, an elder wants to stay at home but does not want strangers in the house, and family members cannot provide daily assistance, then all participants are asked to help resolve the deadlock…to work together to get past ‘no’.  Saltz added that the elder’s ability to accept help can make a difference as does his or her network of support in the community and from friends and family.

Not surprisingly, as we age, many of us want to stay in the familiar and comfortable environs of our own home.  According to Saltz, mobility and access typically prevent people from being able to continue to live in their homes.  She noted that relatively simple modifications can sometimes enable an elder to stay in his or her own home.  For example, while a $5,000 stair lift seems exorbitant, it might ultimately provide the key to providing at-home care.  Saltz added, “People can’t stay at home when they need more care than they can afford.  At this time, the only place elders without assets are guaranteed to receive 24/7 care and supervision is in a nursing home.  There are few publicly funded programs that provide 24/7 care at home for low or moderate income elders.

Saltz and other geriatric care managers assist people during a sometimes tumultuous stage of evaluation and transition. Families are in turmoil and sometimes in conflict.  I wondered what kinds of family conflicts she most frequently encounters.  “Anxiety is heightened,” Saltz said, “and if family members shared conflicted former relationships, they generally don’t get better with added strains.  Kids might attribute (past) motives to parents that are no longer true.  And as a rule, the more kids in the family, the greater the conflict…there are simply more opinions to take into account.”

“The adult child/parent dynamic is complicated,” Saltz explained.  “The parent isn’t your child.”  Saltz repeated the advice that families should talk more to avoid strain…that they share conversations about the future, and plan ahead.  Saltz said that she has observed parents and children who come together in positive ways to support the parent’s new needs.  “They reach a greater level of intimacy and love,” she said. “It can happen.”

Eileen Lyons, Director, Custom Elder Care Research & Development

 

Custom Care Principles

 

At Custom Elder Care, we have developed a number of quality-caregiving principles that we believe reflect the “custom-care” approach to elder care.  It is on these principles that our products (workbooks, and soon a toolbox and guidebook) are based.  They guide the tips and guidelines that we have developed to help people customize care to their needs, and they stem from the best available current science, which shows that humane caregiving benefits both the person in care and caregivers. 

Custom Elder Care has 12 quality-care principles (on our website), two of which we consider “umbrella” principles because they reflect the overarching moral base on which we believe all care should be based.                            

Here is CustomElderCare Umbrella Principle #1: 

Promote    Altruism.

To be a good caregiver is to be felt as relevant and useful to the person you’re helping.  It doesn’t take much to impose our own ideas of what “should” be.  But is that really helpful? Of course we all want to think that our efforts to help are appreciated, but not all styles of helping are equal! 

Every single person has a personal context from birth to death that guides lifestyle and is composed of genetics, personality, culture, experiences, material and spiritual values, priorities, preferences, etc. 

Knowing someone’s personal context elevates care from good enough to really good because you can customize your actions to that person’s usual way of being in life. 

Good enough care may be based on training and experience, but really good care is based on training + experience + knowledge about what’s special about the person in care, and this is what elevates care to best practice, or said otherwise, your ability to do the just-right thing.  There are three basic approaches to helping, and they are not all perceived as equally helpful by the person asking for help.

The self-referential approach is based on the helper’s own context (his or her feelings, attitudes, culture, etc.).  The mindset is this:   I think you should…  Advice often falls into this category, which is why you often hear people respond, You  don’t understand or This doesn’t feel right.  This approach pays no attention to the other person’s context (feelings, attitudes, background, circumstances, life experiences, goals, etc.). 

The empathic approach – often referred to as walking in someone’s shoes – is promoted by helping professions.  The mindset is this:  If I had your eyesight, I would wish soft lighting. Therefore, I will provide this for you.  In this case, the helper acts as if he were in the other person’s circumstances, but the issue here is that the solution is still something the helper would do in a given situation, so to some degree this approach is still helper-centered, although it’s higher on the totem pole.

Finally, the altruistic approach – promoted by CustomElderCare – is driven solely by the context of the person needing help (his/her feelings, goals, attitudes, usual ways of doing things, etc.).   The mindset is this:  I know that you would do this if you could.  Therefore, I will try to make this happen for you.  This approach can be called person centered, and it’s the most effective approach to helping someone, because it is evidence based; that is, solutions are based on knowledge (evidence) about what the person has done or would do (or be likely to do given his or her history) under these circumstances if able to function independently.

This is where Custom Elder Care comes in.  We believe that quality care is altruistic.   We believe that people in care have the right to recognize their own lives and to have that life stay true to their values no matter what.

Dear Abby, “My mother lives in an assisted living community…

in the memory care unit.  During a recent visit, I became upset because the care staff addressed my mom as “Granny,” “Grandma,” “Mamma,” etc.  Mother struggles with the time of day, the day of the week and sometimes forgets who we are – so I don’t see the benefit of using names other than her own.  I think it is disrespectful, unacceptable and unprofessional.  When I asked the attendant to please address Mom as “Mrs. Smith” or “Ms. Ann,” she laughed and said, “Granny wouldn’t know who I was talking to if I called her by those names.”  My siblings and I took this issue to the director, who told us we shouldn’t be hurt and that the staff was showing our mom she is loved.  I am interested in knowing your opinion on this matter.” from She Has a Name in Georgia

Response:   “Dear She Has a Name in Georgia.  Not knowing the national origin of the attendants in your mother’s care unit I can’t be certain, but what you encountered may be a cultural difference.  In other cultures, calling someone “Mama,” “Auntie” or “Grandma” is considered respectful.  While it made you uncomfortable, if it didn’t have that effect on your mother, you should take your cue from the director of the facility.  However, because you have formally requested that your mother be addressed by name, then that is what should be done in the future.”

from the Brattleboro Daily Reformer, December 2, 2011

“you should take your cue from the director of the facility” WRONG

 “you have formally requested… that is what should be done…”  RIGHT!

 This is where Custom Care Trust comes in!  A CustomElderCare® Workbook prevents precisely this kind of misunderstanding!  Give the gift of familiarity, comfort, and dignity to a loved one!  customeldercare.com

 

Moyse celebrated with joyful Bach

 Rutland Herald (VT)

October 4, 2011 
Section: FEATURES17 

Music Review: Moyse celebrated with joyful Bach 

 

MARLBORO – New York bassist Jack Kulowitsch said, “She’s here. I’m getting nervous already.” She was Blanche Honegger Moyse. Kulowitsch and some 70 musicians – and an enthusiastic audience – had gathered at Marlboro College’s Persons Auditorium Sunday afternoon to honor the founder of the New England Bach Festival, as well as co-founder of Marlboro Music Festival, the Bratlleboro Music Center and the Marlboro College music department. Moyse died at her West Brattleboro home in February at the age of 101.

Veteran members of Moyse‘s Bach Festival (1969-2004), including world renowned vocal soloists, herBlanche Moyse Chorale and NEBF Orchestra, returned to the festival’s Marlboro home and perform three of Bach’s cantatas, Nos. 42, 142 and 30. Moyse‘s spirit, indeed, insinuated itself on the performance and what emanated from the stage was pure joy.

Moyse‘s approach to Bach was unique in its combination of academic understanding of historical performance practices with a romantic expressiveness learned from her European training. That resulted in acclaimed performances that delivered Bach’s spiritual depth. Despite the lack of Moyse‘s physical presence – and a little too much exuberance here, a few uncontrolled details there – Sunday’s concert could have been directed by her. After all, these musicians were trained by Moyse over several decades.

 Moyse‘s presence wasn’t clear at first, but with the first aria in the opening Cantata No. 42, it felt like her celebrated Bach Festivals. Mezzo-soprano Mary Westbrook Geha sang “Wo Zwei und Drei versammlet (Where two or three are gathered)” with such delicacy and tenderness that it was difficult to keep tears at bay.

Another magic moment before intermission was the lyrical and deeply touching duet between soprano Hyunah Yu and violinist Mitsuru Tsubota, “Bereite dir (Prepare, Jesus),” from Cantata No. 147. That was followed by the Chorale in a richly delivered, “Jesu, Joy of Man’s Desiring.”

Still, the Blanche Moyse experience was summed up with the large scale Cantata No. 30, “Freue dich, erloeste Schar (Rejoice, redeemed flock),” which was recorded commercially at the first festival in 1969. The Chorale began the cantata and ended it with a brilliant and joyful performance of the massive title chorus.

Baritone Sanford Sylvan lent his overt expressiveness to one aria, while Yu returned for a powerful and deeply felt performance of another. Tenor Stephen Paul Spears brought his rich lyricism to a moving recitative. But it was Westbrook-Geha in a quietly lyrical duet with flutist Carol Wincenc, “Kommit, ihrangefochtnen Sünder (Come, you tempted singers),” that truly evoked the sprit of Moyse.

Mezzo-soprano Mary Nessinger lent her rich lyricism to two arias, while baritone Randal Scarlat delivered others with stentorian presence. Wetbrook-Geha conducted most of the concert, while Zon Eastes, who organized the performance, assisted.

Moyse‘s daughter, Dominique Moyse Steinberg, in thanking everyone, suggested that this was such a success they return next year for another. What a great idea – then Moyse‘s spirit would continue its already incredible run.
Copyright, 2011, Rutland Herald

(My mother conducted her last concert, in New York City, at young and tender age of 95)

 

Wow, you look good!

One morning, when I was about 30, I met one of my aunts, who was about 60, for breakfast.  She looked great – so well put together, well coiffed, made up, etc.  I thought to myself how she always looked this way, so I said to her, Wow, you always look so great! — to which she replied, Yeah, but every year it takes me half an hour longer!

Vigilant caregiving families a must!

To avert potential disasters in caring for older adults in care, an engaged family is essential… (read more)

The Caregiver’s Dilemma: Are you afraid to tell your boss you’re a caregiver?

Even though Roxanne Aune’s boss is aware that her 59-year-old husband has early onset Alzheimer’s, he’ll never know how much it impacts her work. “I feel I can’t say I’m a caregiver because a red flag will go up and my boss will think, ‘Oh, there’s something wrong with her husband again,’ ” says Aune, 57, of Minneapolis. “I can’t afford to be absent, or start over again, so I don’t discuss this part of my life.”  Continue reading…

Easing the Stress of Daily Care-Giving

Q. You find yourself having to care for an ill family member while holding down a full-time job. How can you handle both of these demanding duties without feeling overwhelmed?

A. Caregivers often feel they have one choice: quit their jobs and become full-time caregivers or keep working but do an inadequate job of meeting the needs of their ailing family member, says Denise M. Brown, founder of Caregiving.com, an online resource and forum for family caregivers. Fortunately, she says, it’s not nearly that cut and dried.

As you look for solutions, don’t be afraid to ask your employer for help. Ms. Brown suggests tapping into your company’s employee assistance plan or looking into work/life benefits that the company may offer. Those often include the services of a geriatric care manager who can research and coordinate care in the community where you need it.  Continue reading

Aging in Place

Housing projects increasingly geared toward aging in place. 

http://www.reformer.com/ci_18203904


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