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difficult conversations

Questioning Aging Answers

Aggressive Medical Treatment- A Crisis Point for the Family Caregiver

Family caregivers of an elder with serious health conditions can often be made to feel that they must assist the elder in obtaining aggressive medical treatment for worsening conditions. In the USA, the use of aggressive medical treatment for patients in the final months of life is increasing significantly. 1

Are the physicians who recommend aggressive medical treatment near the end of life generally helping the elder or are the outcomes of aggressive treatment generally undesirable?

Studies find undesirable outcomes

According to studies published by Medicare News Group 2 and by the Journal of the American Medical Association, JAMA 3, aggressive medical treatment for Medicare patients at the end of life has been on the increase with more people receiving care in intensive care units and more people being shuffled between hospital, home and skilled nursing care in the final months of life.

Unfortunately, according to the same studies, it appears that aggressive medical care is not helping the people who receive it live longer or enjoy a better quality of life than people who receive more conservative treatment. Consumer Reports 4 has reported that “too much healthcare” can actually shorten a person’s life.

In fact, aggressive treatment can cause stress and pain for the elder and for the family caring for that elder. Consumer Reports notes that families who have lost loved ones after aggressive treatments often say they regret not having recognized sooner that treatment was not beneficial, and adjusting plans and expectations accordingly.

How do physicians fit into this problematic puzzle?

Some experts note that fee for service Medicare rules can lead physicians to pursue more treatment because fees are paid per service. This idea may have some validity, but it may be more illuminating to look at physicians’ attitudes towards aggressive care in general.

Interestingly, a new study from Stanford School of Medicine 5 and a recent poll on the physician social media site SERMO 6 both indicate that regarding their own medical care, physicians would very rarely choose aggressive treatment, but for their patients facing the same prognosis, they tend to pursue aggressive treatment.

The Stanford study noted that advanced healthcare directives had little impact on aggressive treatment even though, “more than 80 percent of patients say that they wish to avoid hospitalizations and high-intensity care at the end of life.”

Finding the Physician’s Blind Spot

Physicians have a laser focus on diagnoses and treatment of disease, but this laser focus can also cause a major blind spot. A whole person is much more than his or her body’s condition or disease, and yet in the medical treatment process, the person can be “lost” in favor of a focus on a  particular physical condition.

Physicians are trained to provide technical services based on specific and technically definable perimeters. They are not trained or paid to deeply examine a patient’s personal life philosophy, personal history and life experience, emotional life, cultural influences, spiritual beliefs, or family and personal relationships.

To put it another way, what doctors know about a patient may represent very little of what a patient may consider to be essential to “who they are.”

In this context it makes sense that a physician, who knows herself as a whole person, would choose less aggressive treatment for herself and pursue more aggressive treatment for her patient, whom she knows primarily as a condition or disease. This outcome is probably unrelated to whether or not the physician is a caring or compassionate person and is rather a result of the constraints of time, function and capacity.

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What can families do?

Firstly, patients and their families need to recognize the limitations of physicians and medical systems in general. These systems and professionals do not have a complete understanding of patients’ personal lives and issues.

When faced with significant medical decisions, it is essential to seek out as much family, friend, professional and spiritual support as is needed.

Taking the time to draft a well considered Advanced Directive for Health Care (ADHC) is a key step. Realize most “check the box” ADHC forms pertain solely to life support and tube feeding. Preferences regarding other aggressive medical treatment must be written out separately. Therefore, multiple conversations will probably be needed with a primary care provider as well as other medical specialists to draft an effective document.   

Discussing the ADHC with the persons who may act as authorized representatives is essential.  The representative must understand the principles and desires outlined in the ADHC as issues may arise in practice that are not directly addressed in the document. Choosing a representative who has the mental and emotional maturity and capacity to be an effective advocate is also extremely important.

Having an authorized representative who can successfully advocate for the principles of the ADHC to be followed may be as important as the ADHC document itself.

Anne Conrad-AntovilleAnne Conrad-Antoville has worked with hundreds of families regarding senior healthcare issues and is CEO and a founder of Champion Advocates LLC, a geriatric case management firm serving elders is Portland, Oregon and  family caregivers across the USA and Canada.

References

1 Changes in End-of-Life Care Over the Past Decade:More Not Better  Grace Jenq, MD; Mary E. Tinetti, MD; JAMA.

2 The Cost and Quality Conundrum of American End-of-Life Care Medicare News Group, (reprinted by HealthManagement.org

3 Change in End-of-Life Care for Medicare Beneficiaries; Site of Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009, JAMA

4 Too much treatment? Aggressive medical care can lead to more pain with no gain Consumer Reports

5 Most physicians would forgo aggressive treatment for themselves at the end of life, study finds Stanford Medicine News Center

6 How Doctors Die: Only 7% Choose Extraordinary Measures; SERMO

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Questioning Aging Answers

2015 McGinty Alzheimer’s Conference- Portland Oregon

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.

Register at: alz.org/oregon

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.

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Future Vision

Champion Advocates Supports New Medicare ACP Coverage

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

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. Currently, he serves on the State Plan for Alzheimer’s Disease in Oregon (SPADO) Taskforce to Optimize Quality Care and Efficiency.

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Questioning Aging Answers

Advanced Directives May Not Prevent Aggressive Medical Treatment

Aggressive medical treatment for Medicare patients at the end of life has been on the increase according to studies published by Medicare1  and by JAMA2.

This aggressive treatment leads to more people receiving care in intensive care units and more people being shuffled between hospital, home and skilled nursing care in their last several months of life.

Unfortunately, the aggressive medical care is not helping those patients studied to live longer, nor are they experiencing a better quality of life than people who receive more conservative treatment.

When polled, people do not generally want this type of care. A Stanford School of Medicine Study3  found that more than 80 percent of patients say that they wish to avoid hospitalizations and high-intensity care at the end of life.

In fact, aggressive treatment can cause chaos and pain for patients and their families. Consumer Reports4  notes that families who have lost loved ones after aggressive treatments often say they regret not having recognized sooner that aggressive treatment was not beneficial.

Are physicians working with the intention of Advanced Directives?

Interestingly, both the Stanford study and a recent poll on the physician social media site Sermo5  both indicate that physicians, regarding their own medical care, would very rarely choose aggressive treatment. On the other hand, these same physicians tend to pursue aggressive treatment for their patients facing the same proposed prognosis.

The Stanford study noted that advanced healthcare directives had little impact on aggressive treatment:

“In fact, the type of treatments they (the patients) receive depends not on the patients’ care preferences or on their advance directives, but rather on the local health-care system variables, such as institutional capacity and individual doctors’ practice style…”

Why are physicians pursuing aggressive treatment?

Physicians have a focus on diagnoses and treatment of disease, so this singular focus can also cause a major blind spot. A person is much more than his or her condition or disease, and yet in the medical treatment process, the person can be “lost” in favor of a focus on their condition.

As noted by Dr. Periyakoil, author of the Stanford study, “Patients’ voices are often too feeble and drowned out by the speed and intensity of a fragmented health-care system.”

Physicians are not generally trained or paid to deeply examine a patient’s personal life philosophy, personal history and life experience, emotional life, cultural influences, spiritual beliefs, or family and personal relationships.
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To put it another way, what doctors know about a patient may represent very little of what a patient may consider to be essential to “who they are.”

It makes sense that a physician, who knows herself as a person, would choose less aggressive treatment for herself and pursue more aggressive treatment for her patient, whom she knows primarily by condition or disease. This outcome is probably unrelated to whether or not the physician is a caring or compassionate person and is rather a result of the constraints of time, function and capacity.

What can you do to have your healthcare preferences followed?

Patients and their families must recognize the limitations of physicians and of medical systems, in general. These systems and professionals cannot have a complete understanding of patients’ personal lives and issues.

When faced with significant medical decisions, it is essential to seek out as much family, friend, professional and spiritual support as may be needed.

An advanced directive is an excellent starting point, but having a professional or family member who can successfully advocate for its intentions to be followed may be most important.

Anne Conrad-Antoville is CEO and a founder of Champion Advocates LLC, a geriatric case management firm serving Portland, Oregon and Northern California. She has worked with many hundreds of families regarding senior healthcare issues for the past 30 years.

1The Medicare News Group: “The Cost and Quality Conundrum of American End-of-Life Care”

2JAMA: “Change in End-of-Life Care for Medicare Beneficiaries
Site of Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009”

3Stanford Medicine News Center: “Most physicians would forgo aggressive treatment for themselves at the end of life, study finds”

4Consumer Reports: “Too much treatment?
Aggressive medical care can lead to more pain with no gain”

5SERMO: “How Doctors Die: Only 7% Choose Extraordinary Measures”

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Questioning Aging Answers

Medical Alert Devices – Too Little, Too Late

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 2014

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

 

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Respect Between Generations

Love Until the End of Life

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 2014

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.

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Questioning Aging Answers

Pets: Mirroring Our Care and Our Fear

“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 2014

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

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Chocolate and Cabernet

Disney’s “Maleficent” is a Tale of Forgiveness

Maleficent, Disney’s recent blockbuster release, reveals an unusual way to express the timeless message of forgiveness to its viewers, young and old alike. The tale of the formerly evil villainess in the classic Sleeping Beauty is provided a much needed backstory in this updated version to explain what has led her to unleash such hatred against the newly born babe, Aurora.

We learn that a great violation has been committed upon Maleficent by Aurora’s soon to be father, Stephan. This would be the mutilation and stealing of her faerie wings through deception and manipulation by Stephan to gain favor and the eventual kingship from the dying human king. A new war ensues between these two worlds and the innocent on both sides are made to suffer. All of this for the sake of the old king’s desire to destroy the faerie realm and plunder its coveted wealth of unimagined riches.

Yet, the innocent Aurora shows Maleficent the path back toward compassion and healing as only a child will. Through the years that lead up to Aurora’s fateful 16th birthday, Maleficent slowly rediscovers her own love of the natural world and a shared awe of wonder as expressed in Aurora.

Eventually, Maleficent strives in vain to reverse her dreaded spell that she had cast upon Aurora, and is left with but one final measure to cure the girl of the forever deathlike sleep. She must travel into the human kingdom, enter King Stephan’s castle and face his knights who are armed with weapons of deadly iron.

Forgiveness is a cornerstone of compassionate aging. Several times and in many ways, this compassionate message is conveyed.

Stephan as a young boy and would-be thief is forgiven by a young Maleficent and her faerie co-beings of his original trespass; the three tiny pixies repeatedly tussle and argue with one another to remain each others faithful companions over the years; Maleficent again forgives Stephan later as a grown man who had abandoned her to pursue his ambition among men, and Aurora forgives Maleficent of casting the doom-filled spell upon her.
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But most dramatically, Maleficent, in the heat of battle and clearly in a position to defeat King Stephan, gives him quarter and is willing to spare his life. It is only Stephan who chooses to cling to a hardened and merciless heart, thus seeking final vengeance.

By the re-vision of this tale, we are shown that forgiveness begins when we strive to rise above an insult, a trespass, a wound, an injustice.

Forgiveness is ultimately realized, when we knowingly attempt to break a painful or disastrous cycle in favor of reaching a new state of awareness within ourselves and in others. This process is one that can occur naturally over time as memories fade, the mind weakens and the ego-driven self slowly diminishes. Or, we can consciously decide which aspects of our lives that we wish to truly cherish and nurture through our remaining years.

© Anthony Antoville 2014

Anthony Antoville, CMC is Care Manager, Certified and COO of Champion Advocates LLC in Portland, Oregon. For more than 20 years, he has professionally served hundreds of families in addressing family relations and other elder issues.

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Respect Between Generations

Are You Your Parent’s Secret Emergency Plan?

Recently, I received a call from a gentleman in his early eighties, who was caring for his wife with dementia.

He told me, “I’m calling you, because I need an emergency plan if anything happens to me. I need someone who will come in and handle my affairs and my wife’s issues at a moment’s notice. Then my kids, who live in another state, will come and take care of my wife.”

I asked him, if his adult children were aware of this plan he had. No, he hadn’t actually discussed this plan with them, but he was sure it would be fine.

I asked why he thought it was a good plan to wait until an emergency situation to happens, before he could ask for help or let his children know of basic issues in advance. He said bluntly, “Look, I know what I need! I only want someone to be able to come in on a moment’s notice, then my kids will take care of everything.”

This exchange illustrates a common and complex issue that is happening across the country for many families with aging parents. A spouse caring for another spouse who suffers from dementia or another chronic condition will often become fatigued, burned  out and develop their own health problems brought on by stress and overwork, thus putting both elders at risk.

Often, the senior providing care will refuse help or underestimate the amount of help that is actually needed.

The adult children are often kept in the dark, while simultaneously being made part of a secret emergency plan that no one has actually examined. The secret plan is revealed only once the crisis hits, and the adult children are caught in a web of issues that are usually serious, intricate and deteriorating rapidly.

For the family members trying to help, coming in at this stage of the crisis can result in significant stress, significant time commitments and significant financial cost. It can negatively impact employment or business and overwhelm personal relationships.

Waiting to respond until a crisis hits almost always results in substantially reduced options for the aging parents and for the family caregiver. Reacting is never planning!

It seems like many a Los Angeles film school are missing out on a great opportunity – if they provided such one-on-one mentoring programs, there would possibly be a lot more stories of free samples viagra big achievements from their students. It helps to viagra 20mg in india boost sperm count, sperm motility and necrospermia are two of the important causes of male infertility. But at the same time fend off having dose more than dictated by your cheap levitra professional https://pdxcommercial.com/property/516-high-street-oregon-city-oregon-97045/ health expert. On account of an erection which goes on for over 4 hours medical consideration is sales cialis required. So, what is the best way to avoid this type of emergency crisis?

Open up the conversation with your aging parent sooner than later! Chances are, you already have a feeling that something is going wrong.

Ask your parent how things really are with questions that elicit more than simple “yes” or “no” answers. Ask how tired, stressed or overwhelmed is the parent who is providing care? What are the health and household issues? How much time, energy and work can be realistically expected of other family members, if help is needed?

How do you respond to this information and what are the next steps?

As a geriatric case manager, I highly recommend having a family meeting with a geriatric case manager. Geriatric case managers are aging professionals with broad expertise and knowledge. We can perform assessments based on multiple issues and coordinate planning and services to meet goals for the entire family. Best of all, a geriatric case manager can continue to work with the family and the senior over a period of time, providing continual monitoring, oversight, coordination and support as needed.

© Anne Conrad-Antoville 2014

Anne Conrad-Antoville is a geriatric case manager with Champion Advocates LLC in Portland, Oregon. She has spent the past 15 years of her professional career successfully troubleshooting complex issues for seniors and their families.

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