Tag Archives: family caregiver

family caregiver

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.

Nuts & Bolts

Care planning and paying for long-term care

July 21, 2016 Anne Conrad-Antoville

Currently 12 million Americans require long term care services and 70% of seniors need some type of support. Many people worry about how to pay for the long term care and support that may be needed.

Unfortunately, many people are ill informed regarding benefits for which they may be eligible. Others do not understand how to access benefits for which they have paid.

This problem is often further complicated when “cost-savings” is made the priority over the appropriateness and reliability for a specific service need. One common example is when a neighbor is looked to for advice on a Medicare issue. Another is when a college student is given room and board in exchange for personal care or a friend is put in charge of filling prescription medications or a son-in-law who is handy with tools installs safety devices in the bathroom.

The list goes on and on… Well intentioned people volunteering care or providing low-cost support to seniors and their caregivers can all too quickly turn a care situation into an expensive, unsustainable or even life-threatening risk.

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People often over-estimate or under-estimate care needs! Before looking at how to pay for care, we work to understand what types of care are essential for the individual and how much care they will actually need. The initial stages of creating a care plan include assessing what types of care are needed, what persons or services are most appropriate to provide that care and what resources are available to provide or pay for required care.

It is important not to make the mistake of under utilizing benefits that have already been paid for or are otherwise available for the person who needs care. We know it is essential to provide a clear understanding of eligibility and coverage for public and private benefits, as well as the processes for activating these benefits. We also examine all the resources that are potentially available to the person who needs care. A care plan can then be created holistically with a wide-range perspective of needs and resources within the overall context of a person’s life goals and preferences.

Anne Conrad-Antoville is CEO of Champion Advocates LLC, Geriatric Case Management Services, serving seniors and their families in the Portland Oregon region.

Age-Quake!

Caregiving: Major Impacts to Work and Health for the “Boomer Generation”

June 13, 2016 Anne Conrad-Antoville

An unprecedented number of Baby Boomers, that is people approximately between the ages of 50 and 70, are providing care for an aging relative – usually an aging parent. The substantial costs of care provided by these Boomer generation caregivers, while often considered “free” for the care recipient, translate in terms of the caregiver’s own financial, psychological and physical health.

Caring for an older family member requires time, energy and money. Often these burdens are taken on unexpectedly as a result of an accident (like a fall), health incident (a stroke for example), a chronic medical condition (such as diabetes or dementia), the progressing years of aging or a combination of any or all of these contributing factors.

Why Boomers Are More Likely to Become Caregivers

Advances in medicine and medical technology, as well as social advances, have significantly increased longevity in the US. Compared to their parents’ generation of the same age-span, the Boomer generation is more likely to have parents or older relatives who are still living. These longer living relatives are now living with chronic conditions and dementias, at never before seen rates. Furthermore, the longer a person lives with chronic conditions and/or dementia, the more likely that person will require care. ¹

Multiple studies have shown that adult women are much more likely than their male counterparts to be involved in ongoing care responsibilities. ² These duties range from managing finances, to managing medications and medical appointments to providing hands on care such as bathing or dressing a person.

Financial Issues for Caregivers

Nearly 70% of caregivers report the need of having an employer make accommodations because of their caregiving duties. These workplace accommodations include arriving to work late and/or leaving early, taking unexpected time off or cutting back on work hours. Ultimately, and employee who is a family caregiver may have to change positions, change jobs or stop working entirely. ³

A MetLife study found that the 10 million caregivers over 50 who care for their parents lose an estimated $3 trillion in lost wages, pensions, retirement funds and benefits. Costs are higher for women who lose an estimated $324,044 due to caregiving, compared to men at $283,716.⁴

Cost to Caregiver Health

Family caregivers are often suffering from chronic stress, which can comprise their psychological and even physical health. In fact, caregiving fits the formula for chronic stress so well that it is used as a model for studying the health effects of chronic stress. ⁵

An extremely high percentage of caregivers suffer from depression due to caregiving. Many caregivers report that they are experiencing stress and/or panic attacks, pain, aching, headaches and weight gain/loss. Many report that their own self care is in decline and that they have missed their own health care appointments. ⁶

When caregivers’ responsibilities and concerns are taken in the context of the responsibilities they have for their own lives, including work and family; they are often completely overwhelmed. Caregivers believe that the stress they are experiencing takes physical form as increased blood pressure, heart attack scares, arthritis flare-ups and other conditions. People who care for a person with dementia often suffer even more severe negative psychological and physical health effects than other caregivers. ⁷

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The cost to US businesses is becoming enormous and will only continue to rise as the more of the population lives even longer.

According to a 2015 Cerridian study, U.S. businesses lose an estimated $38.2 billion annually in lost productivity due to workers’ caregiving responsibilities. These costs are often associated with replacing employees, absenteeism, workday distractions, supervisory time, and reductions in hours from full-time to part-time.

The study indicates that employers could be doing more to support employees with caregiving responsibilities. For example, only 56% of study respondents report that they have the support of their direct manager in their caregiving role and only 20% of study respondents claim that their employer offers all four of the following support programs: paid time off, unpaid time off, the option to work from home and a flexible work schedule. ⁸

Anne 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.

¹ AOA-Older Americans 2012 Key Indicators of Well-Being;The Federal Interagency Forum on Aging-Related Statistics

² Unpaid Eldercare in the United States-—2013-14 Summary, Bureau of Labor Statistics

³ Valuing the Invaluable: 2011 Update: The Economic Value of Family Caregiving. AARP Public Policy Institute. – Updated: 2015

⁴ MetLife Mature Market Group. (June 2010) and National Alliance for Caregiving, Study of Working Caregivers and Employer Health Costs: Double Jeopardy for Baby Boomers Caring for their Parents- Updated: November 2012

⁵ Vitaliano PP, et al. Is caregiving hazardous to one’s physical health? A meta-analysis. Psychol Bull. 2003;129(6):946–72. [PubMed])

⁶ Evercare Study of Caregivers in Decline: A Close-up Look at the Health Risks of Caring for a Loved One, National Alliance for Caregiving, Evercare 2006

⁷ Physical and Mental Health Effects of Family Caregiving Richard Schulz, PhD and Paula R. Sherwood, PhD, RN, CNRN

⁸ Ceridian Study Reveals The Challenges Of Caregiving & Its Significant Impact On Productivity & Engagement In The Workplace – 2015

Questioning Aging Answers

Aggressive Medical Treatment- A Crisis Point for the Family Caregiver

May 31, 2016 Anne Conrad-Antoville

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.

References

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

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

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

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

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

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

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.

Nuts & Bolts

New Year’s (re)Solutions: Actions to Take for the Elders in Your Life

January 27, 2015 admin

Did anything alarm you when visiting with older relatives during the recent holidays?

You may have detected any one of the classic red-flag indicators that an accident or injury could be on their horizon.

Perhaps, you saw a trip hazard that can lead to a fall, so consider removing:

Coffee tables and ottomans
Throw rugs
Clutter in pathways
Electrical cords from foot traffic

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Also, repair:

Unstable walking surfaces, like loose steps or paving-stones
Handrails that are not properly secured to walls or posts

Maybe, you recognized poorly lit areas that can cause an accident. Light up and brighten up:

Cooking area and surfaces
Sewing, woodworking and other hobby stations
Hallways and pathways

Focus on:

Seasonal Affective Depression with appropriate lighting by introducing bright light therapy and/or using blue or blue-green spectrum light.

Did prescription and non-prescription medications appear to be a source of concern?

Get an updated list of current medications from all prescribing physicians and compare with the medications in the home.
Safely get rid of any outdated medications.
If there is any confusion regarding medications for you or your loved one, request a pharmacological review from the primary physician.

The New Year is a great time to resolve lingering concerns and worries from last year. By acting now, you can head into 2015 with greater confidence that older family members are in a better place to begin another year.

© Anthony Antoville 2015

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.

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

Self Compassion and Aging

August 6, 2014 Anne Conrad-Antoville

Let’s be clear. Aging begins from the moment we are born.

In contemporary western society, we tend to view the aging process as positive up to a certain point. The turning point is somewhere in that upward “moving target” that counts as mid-life. From that point, we tend to view aging as a negative process and something to be fought against.

We have all become strongly influenced by advertising for a plethora of “anti-aging” products, counterbalanced with a youth-obsessed focus. Medical efforts and campaigns to cure countless conditions and diseases have been woven into our everyday experience, which can create for us a strange unspoken expectation that western medicine will someday cure us of all diseases and even overcome death itself.

We may experience unwanted reactions to these “anti-aging” and medical messages. The reactions can include unrealistic and unattainable expectations for ourselves and for those we may care for. If our baseline is unrealistic, we can be much too hard on ourselves.

For example, for the person who is a caregiver of an older family member; guilt can become overwhelming when the older person’s health goes into decline. The flawed expectations of a treatment for aging and eventual death cannot be realized. This form of guilt can become self-debilitating and detrimental to the caregiver’s physical and mental health.

For those of us who are passing the mid-life point, our own thoughts can become self wounding and cruel as we find it increasingly difficult to fit ourselves into the a youth-based straightjacket as we age.

Moreover, other cultural conditioning can make it difficult for us to allow ourselves to be self compassionate. At a recent leadership training that I attended, the accomplished female speaker noted in an offside comment, “I have always found it easy to be compassionate for others, but difficult to be compassionate to myself.”
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Why be self compassionate about aging?

Self compassion allows us to be present in the true moment. It helps us to forgive ourselves, to heal our wounds and to appreciate our own best efforts. It allows us to be truly compassionate in our service to others. Self compassion frees us of unnecessary burdens, allowing us to age from our center of being with grace and with wonder.

Anne Conrad-Antoville cared for her disabled mother from her pre-teens through her mid-thirties, when her mother passed away. This experience inspired Anne’s eventual work in professional aging services. Anne is currently CEO and a geriatric case manager for Champion Advocates LLC and manages Working Woman Aging Parents.

Chocolate and Cabernet

Disney’s “Maleficent” is a Tale of Forgiveness

July 8, 2014 admin

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 16^th 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, 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.

Age-Quake!

Caregiving: A National Workforce Crisis in the Making

June 27, 2014 admin

A study from the National Alliance Caregiving and AARP determined that about half the workforce will be providing some type of eldercare by 2017. ¹

This stunning statistic has been steadily increasing over the past few decades due to increased longevity of people with increasingly significant medical and care needs.

In 2006, the MetLife Mature Market Institute determined that the annual cost to US employers for worker accommodations due to caregiving topped $33 billion. ² This is a significant chunk for the US economy.

On the individual front, caregivers who need to take time off work, cut hours, change jobs or even stop working entirely can significantly impact their personal income, career goals and lifetime financial health.

Working caregivers who cut hours or change jobs may also lose benefits including company health insurance, potentially affecting their personal health over time.

Unfortunately, my experience as a geriatric case manager in the field reveals that family caregivers often spend time and energy in misdirected actions.

These misdirected actions are often the result of unreasonable expectations, lack of knowledge and expertise and absence of meaningful support. The wasted time and effort negatively affects a large circle including the caregiver, their spouse and family, the employer and work teams, and most importantly the family member who is receiving the care.

The possibility to head off a national crisis begins by addressing the implicit and unreasonable expectation that all responsibilities of care must default to the family caregiver.

The “default to the family caregiver” concept is promoted by government, medical institutions, medical providers, cultural institutions unwilling to fund multifaceted support and members of older generations who have not had the experience of parents with these current longevity issues.

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Anne Conrad-Antoville is CEO of Champion Advocates LLC in Portland, Oregon. She has helped hundreds of families with professional geriatric case management services and other supportive services for seniors. Anne is also President of Working Woman Aging Parents.

¹2012 AARP Fact Sheet – Understanding the Impact of Family Caregiving on Work

²MetLife Mature Market Institute®National Alliance for Caregiving
July 2006The MetLife Caregiving Cost Study:Productivity Losses to U.S. Business

Cherishing the Future of All Generations!