All posts by Anthony Antoville

Wait – Don’t Get Hit in the Caregiver Crosswalk!

July 27, 2016 Anthony Antoville

Current American Culture and Aging-Related Issues are often at odds with one another. We see this in a number of obvious and blatant ways, especially in mainstream media with anti-aging products everywhere, ‘active and youthful’ the focus in advertising and young families constantly on the go!

So is it surprising that seniors and the family members who care for them are caught in a “push-and-pull” relationship. A family caregiver may be trying to raise young children or teens while still being responsible to (and many times for) their elders. At the same time a senior does not want to be considered as a burden, effectively slowing down the pace or changing the course of a recently fledged family member or fledgling family.

Therefore the question is often asked, “How much do I need to change my life to accommodate for aging-related issues for myself (as I age) or for someone else?”

Having been family caregivers ourselves, we understand the many anxieties families face when confronting this challenge. As geriatric case managers, we are being told stories endlessly of how families upend their lives to assist loved ones who are aging.

Unfortunately, family caregivers often have the misperception that by living closer to an aging relative they will prevent out-of-home placement for that senior. Moving a senior across town or across the country to live with the family or relocating a family caregiver to move closer to or in with a senior can often appear to be the only option.

The reality is that over the long haul caregivers will be spending more and more of their actual time, physical and emotional energy and money (in outright expenditures and lost wages) by serving their seniors as: appointment schedulers, bookkeepers, transportation providers, Medicare advisers, home repairers, paperwork and record organizers, caregivers, medication managers, housekeepers, medical advocates, activities coordinators and list goes on and on.

Family caregivers, all too often, ‘burnout’ by attempting to take on too much responsibility while struggling to learn just the basics about their new caregiver role. Sadly after drastic changes have been made to the lives of a senior and their family with much strain endured by both, institutional placement out of the senior’s home is still usually the final result. Ask any assisted living placement coordinator, and they will tell you that families often try to go it alone but eventually give up and turn to them in desperation.

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However if the senior and the family discuss a goal of “aging in place” well in advance, it has a much better chance of being realized… and without major disruptions to anyone’s life.

As geriatric case managers, we routinely prevent many of the mis-steps taken by caring families. We work with families to discover and implement better alternatives than moving a senior out of their home to live with the family or a family caregiver moving in with a senior. We believe in Compassionate Aging as the solution for older and younger generations, alike.

© Anthony Antoville 2016

Anthony Antoville is Care Manager, Certified and COO of Champion Advocates LLC in Portland, Oregon providing geriatric case management services. Anthony is a published expert on long-term care with Edwin Mellen Press and co-created the Action-Compassion!Technique as an innovative approach to geriatric case management.

Age-Quake!

Portland Radio Project Show Considers Older Workers

June 21, 2016 Anthony Antoville

Anne Conrad-Antoville recently appeared on Portland Radio Project’s Biz503 to discuss some of the challenges and advantages inherent to Boomers in the workplace and that subsequently exist for their employers.

Anne shared her insights on topics ranging from: age-aware worksites are for all ages, to technology as a useful tool for the older worker, to how female employees and their employers benefit when caregiving needs are proactively addressed. Click here to listen to the podcast of last Friday’s show that aired on Portland FM-99.1.

By creating workplaces that utilize the fundamentals of Universal Design, both older and younger employees reap the rewards.
Boomer workers are tech savvy and technology is actually a boon for them; not a burden.
Female employees who are caring for an older parent or aging spouse could recover, on average, over $300,000 in lost earnings and missed benefits over their professional careers, when their employers make some considerations.

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Anthony Antoville is Care Manager, Certified and COO of Champion Advocates LLC in Portland, Oregon providing geriatric case management services.

Questioning Aging Answers

2015 McGinty Alzheimer’s Conference- Portland Oregon

October 28, 2015 Anthony Antoville

This year’s annual McGinty Conference on Alzheimer’s will be held November 3 at the Oregon Convention Center. It is open to family caregivers and professionals.

Be sure to attend breakout sessions presented by dementia and aging experts including:

The Action-Compassion!Technique Series:
Redefining the Assessment Process for Improved Outcomes
Session B2 from 12:45-2:15PM

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Champion Advocates LLC

Geriatric Case Management Services

The Action-Compassion!Technique is a dynamic methodology in long term eldercare management focusing on the multi-level challenges of the diagnosed elder through the lens of the family caregiver. Effective assessment processes are the first step to good care planning and worthwhile service implementation. By better understanding the full range of challenges faced by the family, it is possible for the professional to save valuable time and energy for everyone involved. This technique is designed for the case manager within a private practice, yet can be used across multiple service fields, including medical, social, legal and financial services to better
serve elders and their families when facing the many issues of long term care for dementia.

Future Vision

Champion Advocates Supports New Medicare ACP Coverage

July 29, 2015 Anthony Antoville

Champion Advocates LLC geriatric case management services endorses the plans announced in July 2015 for Medicare to reimburse medical providers for having Advance Care Planning conversations with their patients.

Champion Advocates LLC joins numerous other organizations that have called for this proposed change, including: AARP, Alzheimer’s Association, American Geriatrics Society, American College of Physicians, American Medical Association, American Nursing Association, Gerontological Society of America, National Academy of Elder Law Attorneys, National Alliance for Caregiving, National Council on Aging, National Partnership for Women & Families, The Pew Charitable Trusts, among many others.

Dr. Patrick Conway, the chief medical officer for the Centers for Medicare and Medicaid, which administers Medicare stated in a July 8 New York Times article, “We think that today’s proposal supports individuals and families who wish to have the opportunity to discuss advance care planning with their physician and care team.”

Dr. Conway clarified that the proposal will not limit the number of conversations to be reimbursed to qualified medical professionals.

“The reality is these conversations, their length can vary based on patients’ needs,” he said. “Sometimes, they’re short conversations – the person has thought about it. Sometimes, they’re a much longer conversation. Sometimes, they’re a series of conversations.”

As reported by the Associated Press, “Medicare is using a relatively new term for end-of-life counseling: advance care planning. That’s meant to reflect expert advice that people should make their wishes known about end-of-life care at different stages of their lives, as early as when they get a driver’s license.”

Even though some private insurers have been providing reimbursement for Advance Care Planning, this new rule change would open these meaningful conversations to almost 55 million Medicare beneficiaries. According to The Kaiser Family Foundation, about three-quarters of the people who die each year in the US are 65 and older, making Medicare the largest insurer at the end of life.

Christian Sinclair, MD and Assistant Professor of Palliative Medicine Division Internal Medicine Department at the University of Kansas Medical Center, Sinclair is one of the leading US authorities on palliative care and advance directives and was on a national committee that last year produced a report called “Dying in America.”

The Kansas Health Institute news service reflected Dr. Sinclair’s enthusiasm for Medicare to cover advance care planning, as other private insurers are likely to follow. “That’s important,” Sinclair said, “because Medicare primarily covers Americans age 65 and older. Making decisions about resuscitation and living on feeding tubes or ventilators is something everyone should do once they’re mature enough to understand the choices,” he said.

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Last year’s National Academy of Sciences’ report titled “Dying in America” clearly summarized that, “As much as people may want and expect to be in control of decisions about their own care throughout their lives, numerous factors can work against that desire. Many people nearing the end of life are not physically or cognitively able to make their own care decisions. It is often difficult to recognize or identify when the end of life is approaching, making clinician-patient communication and advance care planning particularly important.”

The report further outlines, “Advance care planning conversations often do not take place because patients, family members, and clinicians each wait for the other to initiate them. Understanding that advance care planning can reduce confusion and guilt among family members forced to make decisions about care can be sufficient motivations for ill individuals to make their wishes clear. Yet even when these important conversations have occurred and family members are confident that they know what the dying person wishes, making those decisions is emotionally difficult, and families need assistance and support in this role.”

Since its formation, Champion Advocates LLC has been focusing on end of life conversations as one of our core areas of care planning to support an older individual or couple’s ability to aging in place in their own home. Routinely, we discover elders may have documented advance healthcare directives but with no practical or specific understanding as to what life sustaining measures they would actually desire when unable to speak for him or herself at a critical time.

We view this proposed Medicare change to be a good initial step for older persons considering what medical actions they would want to have performed, including the potential ramifications (positive and negative) from such procedures. Therefore, advanced directives will have more worthwhile meaning for everyone involved.

Champion Advocates recognizes that the next significant, yet more complicated, step is to ensure that agreed upon actions are timely and properly taken by creating a process whereby the patient, the medical provider and the designated healthcare agent are all on the same page before the end of the patient’s life is ever confronted.

In a future posting, we will will continue this topic by distinguishing the purpose and effectiveness of Advance Health Care Directives and the Physician’s Orders for Life Sustaining Treatment (POLST).

© Anthony Antoville 2015

Questioning Aging Answers

Medical Alert Devices – Too Little, Too Late

September 4, 2014 Anthony Antoville

An older woman cries out pleading for help from the bottom of a stairway in a large and empty house, and we are led to the conclusion that if only she had a medical alert device worn around her neck she could have emergency first responders there in minutes.

But what then…? How does the second half of this supposedly “averted” tragedy play out?

As reported by the Centers for Diseases Control and Prevention (CDC)*:

“In 2010, 2.3 million nonfatal fall injuries among older adults were treated in emergency departments and more than 662,000 of these patients were hospitalized.”

“People age 75 and older who fall are four to five times more likely than those age 65 to 74 to be admitted to a long-term care facility for a year or longer.”

So instead of lying on the floor for hours or days incurring additional life threatening conditions or worse, our female victim is whisked to the hospital and most likely will be treated and then discharged to a long-term care facility, either an assisted living or a skilled nursing facility for a year or more or until the end of her life.

The ability to lie on the floor and push a button may provide some level of comfort and security to seniors and their families yet when the fall has already occurred and resulting injuries sustained, the reality is your parent is lying there just pushing a button for help.

Now, a life will change in ways not to be desired by anyone. He or she will most likely be shuttled into a vast medical system to wind up in a bed that is not theirs and to no longer live in their own home.

This is the real fear older people live with. The fear of losing their independence and being institutionalized needlessly or prematurely.

If only the family had pushed beyond the simplistic notion that technology and telecommunications were all that was needed to keep mom or dad safe. If only our fear-based advertising could help us consider what happens after that last ditched effort is activated. Then, we could achieve compassionate aging for everyone concerned, senior and family caregiver alike.
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Like the CDC states*:

“Each year, one in every three adults age 65 and older falls. Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death. Fortunately, falls are a public health problem that is largely preventable.”

Geriatric case managers are qualified professionals to identify and evaluate many safety risks based upon mobility, vision and other physical deficits, environmental factors around the home, medical and behavioral conditions. By providing comprehensive assessments including balance and gait and home safety assessments, appropriate provisions and safeguards can be allotted and falls and many other unrealized dangers can be truly averted.

Medical alert products and services are worthwhile, but they are the very last line of safety. If they are to provide comfort and security, they should be part of a much more comprehensive approach to an elder’s care – one where that button need never be pressed.

Anthony Antoville is Care Manager, Certified and COO of Champion Advocates LLC in Portland, Oregon providing geriatric case management services. He is a recognized expert in eldercare and home safety, internationally published with The Edwin Mellen Press.

*The Centers for Diseases Control and Prevention (CDC) Website “Home and Falls Among Older Adults: An Overview” Last Updated: 9/20/2013

Respect Between Generations

Love Until the End of Life

August 8, 2014 Anthony Antoville

The recent love story that has captured the hearts of millions around the globe is the one of a 62-year marriage between Maxine and Don Simpson of Bakersfield, California.

The images of Don and Maxine holding hands, while lying side-by-side in separate hospital beds, has fired imaginations and hearts everywhere.

And while The Simpsons’ genuine devotion and enduring love for each other is wonderful, it is not the striking chord to this moving story. Nor is the amazing account of how they died only four hours apart from one another with Don finally passing at the moment the family removed his beloved Maxine’s body from the room.

The real heart here is that of the family caregivers. In particular, the two granddaughters who initiated the couples reunion were able to see beyond the many significant challenges created by their grandparents’ major health issues and the consequential logistics involved in such a move and the resulting care that would be required.

A family being sensitive to the emotional and physical needs of their elders is not unique, in itself. Countless families jump in and tirelessly perform endless caregiving tasks every day. What shines through the many layers of this tale is that this family recognized what was needed at the end of these two people’s lives. It was to bring them together in a family home setting and to allow them to simply be. No more medical interventions; no self-serving grieving at the bedside. Just time together.

Melissa Sloan, one of the grandchildren, realized that her family was committed to keeping Don and Maxine together until death did them part, and she did just that.

I have seen how people often become confused when witnessing a loved one reach the end of his or her life, let alone both parents simultaneously. It is common at those last stages of the dying process for family members to become overwhelmed with their own emotional needs and lack of ease during these “real” moments of life.
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Understandably, many families are unable to achieve this depth of compassionate aging, because our western society and contemporary culture mostly fears death and dying and rarely permits us to take the time to allow a life to gracefully and gradually repose into its final earthly state.

However, this family discovered a way to honor the elders for whom they cared, while making the most of what precious time everyone could share together.

Anthony Antoville is COO and geriatric case manager with Champion Advocates LLC in Portland, Oregon. He has been serving the psychosocial needs of seniors since 1991. Anthony is a published author with The Edwin Mellen Press.

Aging and Spirit

Mellowing with Age: Myth or Truth?

July 31, 2014 Anthony Antoville

As a grow older, I routinely return to questions regarding my personality: “Which personal characteristics are of me and which ones are not?” “Am I becoming the person I would have hoped to have become in my youth?”

“Am I a person I would want to be around?” “Is age mellowing me, or am I just becoming a cranky old man?”

So far, I have discovered that I have developed and refined the characteristics that I have picked up over time. Some are good and express attributes I would fondly wish to see in people close to me. Other qualities are less than desirable and not worthwhile to retain in any fashion, and I consider myself irresponsible when I perpetuate them in the world.

Just as certain stones are conglomerations of multiple minerals, I have picked up and acquired various aspects of personality that I have encountered throughout my life; some thoughtfully and others carelessly. Some I now carry due to my adaptable nature. Others I carry because life has hammered them into weak points of my armor. I have moulded both types into my persona, while time, experience and repeated use have worn them into a shape of my own fashion.

Yet I find myself left with a choice: Shall I become a stone that is smooth, well polished and highly reflective of surrounding sources of light? Or will I be a rough-edged, brittle and dull amalgamation of lesser qualities in need of further purification to reach a higher state of being?

Clearly, we make due with qualities that are presented to us over a lifetime beginning at birth. We carry with us what we choose. Some qualities are fostered consciously, while others we self-integrate with less awareness. We are presented with an endless stream of opportunities to shed what does not serve us and retain what we believe to be of use.
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What I see as essential in my life is to pay close attention to what my responses are as I am ceaselessly tumbled about in the surf of life. As I encounter situations, people and events, I shall work to repeat, reiterate and reflect only the qualities I wish to see in myself to the best of my ability. To attempt to do any less, would diminish who I am and my potential to contribute anything of worth and meaning to the world in which I live.

Questioning Aging Answers

Pets: Mirroring Our Care and Our Fear

July 24, 2014 Anthony Antoville

“Arthritis – How diet, supplements and alternative therapies can ease those aching joints; How to Care for Your ‘Super Senior’; Catching Cancer Early; Chiropractic Care for Your Senior.”

What reader is this table of contents written for?

Apparently, a popular pet magazine has keyed into our Western obsession with wellness and longevity. It appears to be encouraging us to transfer this obsession onto our pets. If it were not for the cover picture and the magazine’s title, I could very well have been looking at a periodical geared for the non-pet owning reader.

Eventually, some of the article titles returned me to the reality of the subject at hand: “Protect Your Dog’s Joints; Cognitive Dysfunction in Cats; Pancreatitis in Dogs and Cats.”

Now, don’t get me wrong. I have loved and cared for animals all of my adult life and have seen these animals as members of my family. I feed my cats the best foods that I can discern from reviewing nutritional content and food sources. When my Shepard-lab mix suffered from hip dysphasia in his mid-teens, I improved his bed, gave him a daily glucosamine chondroitin supplement and even cared for him through bouts of incontinence until he could no longer easily walk.

Clearly, we need to care for the animals that are dependent upon us to thrive and survive, but have we taken our society’s obsession for longevity too far by imposing it onto our family pets?

Is our fear of disease and death causing our pets to live with conditions and undergo therapies and surgeries primarily to make us feel better about ourselves?

Some parents suggest affixing a kids GPS device to the belt loop on the back side of your child’s free sample viagra pants. Many of men feel hesitate on buying viagra from canadian pharmacies from physical pharmacy store. Urology has various branches, such as endourology, where the urologist performs minor surgeries, neurourology, which covers order cialis the nervous system as it secretes lipase, amylase, and protease. Kamagra is also very effective in inhibiting PDE5 enzymes and lead to healthy erection of the penis. generic cialis 20mg In the book, Withrow & MacEwen’s Small Animal Clinical Oncology (Fourth Edition); the authors reveal that cancer in pets is on the rise due to increased longevity in pets. Furthermore, cancer treatments for pets are on the rise due to increased demand from pet owners, who are largely driven by media on the subject. The authors clearly state, “Pet animals with spontaneously developing cancer provide an excellent opportunity to study many aspects of cancer from etiology to treatment.” They further outline fifteen superior opportunities for studying human cancer and treatment through treatment of pets, over laboratory studies of mice and rats.* Therefore we might ask, Who is really benefitting here?

Pets are a primary connection between us and the natural world of animals and other forms of life. How do our societal obsessions affect our relationships with the natural world and to our own natural cycles of life? How far out of control have our fears become?

Anthony Antoville is COO of Champion Advocates LLC in Portland, Oregon. He has been serving a wide range of elder needs since 1991. Anthony is a published author with The Edwin Mellen Press.

*Introduction: Why Worry About Cancer in Pets? Withrow & MacEwen’s Small Animal Clinical Oncology (Fourth Edition) Edited by: Stephen J. Withrow, DVM, DACVS, DACVIM (Oncology), and David M. Vail, DVM, DACVIM (Oncology)

Animal Wellness Magazine Vol 16 Issue 4

Cherishing the Future of All Generations!