Cathy Cress

Expert in Aging Life and Geriatric Care Management

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What Types Concierge Clients Can Afford Paid Care Besides Donald Trump On the Holidays?

November 1, 2020

 Types of aging families who can afford care management

Families who can afford geriatric care management and home care  long term can do so because they have the financial resources, which are usually over a million dollars in assets.. Part of this is drawn from Claudia Fine and Nick Newcombe excellent chapter ” Entitlement in the Aging Family”, Care Managers Working With the Aging Family, Jones and Bartlett) 

Narcissistic-Entitled Families:

Entitlement in these families usually develops from a specific kind of “not good enough parenting” in which the parents themselves have struggled with personality disorders, most typically, in this type of family, narcissistic borderline personality  ( example President Trump)They struggled with a borderline personality that went undiagnosed or was formally diagnosed and untreated. The narcissistic or borderline parent essentially does not experience the child/children as separate and discreet from themselves and, moreover, uses the child/children to serve parental needs.  This parent-child relationship is characterized by severe boundary issues in which seduction and abandonment are ever-present dynamics and where emotional unpredictability and instability are constant.  ( Fine and Newcombe- Entitlement in the Aging Family, Care Managers Working With the Aging Family)

 

 Rich and Famous-Entitled Families:

These families are identified by the parents’ socioeconomic, financial and political prominence.  ( example President Reagan)They are families in which all basic needs, services, resources and creature comforts are obtained via income, assets, abundant discretionary cash flow and/or come from the political position, station or power.  Once again, the entitlement of the family is passed from the parent to the child who in turn brings these behaviors and actions to the caregiving milieu and care management relationship.  In this category, the entitlement arises out of a family that is accustomed to purchasing everything.  They look to paid others to meet their needs (as opposed to families who must themselves find and orchestrate ways to meet basic and complex needs themselves or with the help of the extra-familial system).  Often these families have household staff, i.e., nannies, butlers, drivers, private pilots, cooks, and maids.  They may have available to the business and family lawyers and accountants, as well as, teams of medical professionals and concierge physicians.  Consequently, in almost all situations they are uninvolved in processes, especially those that are difficult, stressful and time-consuming.  ( Fine and Newcombe- Entitlement in the Aging Family, Care Managers Working With the Aging Family)

 

Well-heeled seniors,affluentseniors.jpg

According to the New York Times, may be middle-class retirees who buy shoes from Payless but have a defined pension can afford care at home when they need it and private care management. They rode the post-war economy, held jobs long term and through that defined pension (no 401K) face a very healthy financial picture in aging.  They worked for city, county, state government are teachers, truck drivers, social workers or were union members in all trades. They had a career at Xerox, IBM, Campbell Soup and big Fortune 500 companies.

 

Professionals- Physician, Attorneys, CPAs

This group made a very healthy living during the late 20th Century, probably had a defined pension and have very lucrative investments that allow them to afford home care and care management. They usually come from nearly iStock_000063346301_Medium-1.jpgnormal families and have been well parented although you will find a mixture of dysfunctional aging families. Their adult children tend to be supportive of their parents, although again you will find a mixture of dysfunctional families in this category.

If you are in any of these families, how will you spend the coming holidays with them- and will you spend the future COVID-ridden Holidays with them. If you are a geriatric care manager or geriatric therapist, what will you advise your clients do during this star crossed holiday on ice.?

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  • How to counsel the Aging Family to track aging decline &Twindemic risk in loved ones
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Filed Under: Aging, Aging Life Care, Aging Life Care Assocaition, aging life care manager, Aging therapist, ALCA & Skilled Nursing Facility, Blog, Concierge aging clients, Concierge Client, concierge clients, Concierge Senior, COVID & HOLIDAY SEASON, Covid 19 Webinar, Covid Holiday Remote Visit, COVID Webinar, Covid-19 and GCM SERVICES, COVID-19 Webinar, elder care manager, Families, Geriatric Assessment, Geriatric Care Management Business, Geriatric Care Manager, geriatric care manager, geriatric social worker, high end clients, Holiday Meltdown in Aging Family, Holiday Rituals in Aging Family, Holiday season, Holiday Sibling Rivalry, Holidays, HolidaySeason and COVID, home care, Long Distance Care, Long distance caregiver, Narcissistic Personality, nurse advocate, nurse care manager, Remote Thanksgiving Family Visit, Webinar Tagged With: Aging Concierge client, aging family, aging life care manager, aging parent care, aging parent crisis, care manager, case manager, Certified Senior Advisors, Concierge Care Manager, Covid, COVID & Holiday Season, COVID VIRTUAL CHRISTMAS VISIT, COVID VIRTUAL HANN, COVID VIRTUAL THANKSGIVING VISIT, Covid-19 Telehealth, COVIF VIRTUAL THANKSGIVING VISIT, Entitled, Entitled Family, geriatric care manager, Holiday COVID Celebration, Narcissistic Personality, nurse advocates, nurse care manager, Rich and Famous, Virtual COVID Holiday Celebration, well heeled seniors

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July 27, 2020

 

 

 

Initial Intake

The first step for the Long-distance family members (LDF) worried about elder exposure and hospitalization is an initial consultation and intake with the client and LDF.  This consult will identify the current status of the senior in the home environment.  This care management consultation can be done with a HIPAA-compliant video conferencing service

 

  • Required Legal Documents Family Long Distance Family Needs

     

  • – The first thing that the geriatric care manager works on is to find out if the older person has the required legal documents – Advanced directives, POA/HCPOA & GCM HIPAA  release because of the risk of both hospitalization and death due to age-related COVID-19. If these documents are not present, have a discussion with senior/LDF regarding their wishes, explaining that older adults over 65 are at higher risk for severe illness. The care manager will discuss who is to be the health care decision-maker and consult a family attorney or elder law attorney to complete.  If they choose not to use an elder law attorney, as time is of the essence in the pandemic, they can suggest accessing AARP advanced directives documents for any state which can be executed quickly.
  • G0-Binder

  •  If documents are completed, locate in-home and provide explanations to the family that they must give a copy to emergency contacts and physicians as required and place in planning binder.  In the planning “Go binder” list all emergency contacts with phone numbers/e-mail addresses – family, friends, physicians, pharmacy, professionals providing in-home services.  Also, list all medications and prescribing physicians in “Go Binder”.  Upload documents into caregiving applications like caringvillage.com so the long-distance family always has the updated documents.

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Filed Under: Advanced Directives and Covid-19, Aging, Aging Community & Covid-19, Aging Life Care, aging life care manager, Aging therapist, ALCA & Skilled Nursing Facility, ALCA COVID-19 Crisis, ALCA Products for COVID_19, Blog, Covid 19 Webinar, COVID-19 & Care Management, COVID-19 Webinar, GCM COVID 19 Crisis, GCM products in COVID-19, Geriatric Care Management Business, Geriatric Care Manager, geriatric social worker, Intake COVID-19, Long Distance Care & COVID-19, nurse advocate, nurse care manager, Telehealth COVID-19products Tagged With: ADVANCED DIRECTIVES & COVID-19, aging family, aging life and geraitric care manager, aging life care manager, aging parent crisis, care manager, case manager, coronavirus and seniors, Coronavirus disaster plan, COVID_19 inquiry, Covid-19, COVID-19 Webinar, COVID-19& LONG DISTANCE CARE, geriatric care manager, nurse advocate, nurse care manager, Webinar

Why is CMS Loosening Nursing Homes Infection Control in Pandemic ?

May 9, 2020

When 20% of COVID-19 cases are in Nursing Homes -CMS Rolling Back Infection Control

Insanely CMS and the FEDS are considering rolling back infection control in a nursing home in the middle of a coronavirus pandemic -when more than 20 % of the cases in the US are in Nursing Homes.

The mind-boggling idea was reported in USA Today. A rule proposed last year by the Centers for Medicare and Medicaid Services (CMS) would modify the amount of time infection prevention must devote to a facility from at least part-time to “sufficient time,” an undefined term that lets the facility decide how much time should be spent.

Why do you need infection control in a nursing home- even before COVID -19?

Over 4 million Americans are admitted to or reside in nursing homes and skilled nursing facilities each year and nearly one million persons reside in assisted living facilities. Data about infections that occur in these skilled nursing home include on a normal day before coronavirus

  • 1 to 3 million serious infections occur every year in these facilities.
  • Infections include urinary tract infection, diarrheal diseases, antibiotic-resistant staph infections, and many others.
  • Infections are a major cause of hospitalization and death; as many as 380,000 people die of the infections in LTCFs every year.
  •  

Nursing Homes deaths May Be 50% of All Deaths in Pandemic

These infection control rationals were before COVID-19. Now, in the midst of this black plague of the 21st Century, it is thought, according to the Washington Post that nursing homes may account for 50% of death BEFORE infection control is further diluted by CMS.

Cities& States Reduce COVID-19 Risk in Nursing Homes -Feds Increase Them

In contrast to the blighted policy idea of the Federal government, Detroit, as a city, has tested every nursing home and in addition, is testing all staff and providing them with PPE.San Francisco is also now testing every resident of a nursing home. States like Maryland and Wisconsin and testing all nursing homes.

The Kaiser Family Foundation reports that at the end of the pandemic we may find out half of the deaths in the pandemic were from residents of nursing homes. In light of all of this carnage and potential destruction of the elder population in the US- why then are  CMS and Trump loosening infection control? Is this throwing salt into the would of frail elders, madness, an attempt to delete people on social security, incompetence at CMS or CMS following the bedeviled destructive policy of the Trump administration? We need answers but will we as a country get them in time?

Filed Under: aging life care manager, Aging therapist, ALCA & Skilled Nursing Facility, ALCA COVID-19 Crisis, Blog, CMS & Nursing Home Policy, coronavirus, coronavirus shut down, Covid 19, COVID-19 & Care Management, Covid-19 Death Nursing Homes, Covid-19 Nursing Home, death and dying care manager, geriatric care manager, INFECTION CONTROL & COVID-19, infection control SNF, Nursing Home Deaths, Pandemic, Trump Administration Tagged With: aging life care manager, care manager, coronavirus, Covid-19, COVID-19 & INFECTION CONTROL, COVID-19 deaths SNF's, Federal Response To Covid-19, geriatric care managers, geriatric social worker, nurse advocate

The 2 Deadliest US Sites of COVID-19 Nursing Homes & Prisons

May 2, 2020

PRISON INMATES AND NURSING HOME PATIENTS NOT  6FT APART – 6 FEET UNDER

70% of inmates in federal prisons have COVID-19.  In Kansas, the Lansing Correctional Facility had a riot of inmates over COVID-19 lack of care or protection  It took the rebellion to get the coronavirus testing PPE and care. The  Bureau of Prisons in Kansas confirmed finally that 79 staff have coronavirus and 88 prisons and prisoners dead.   

Older residents in nursing homes cannot rebel like prisoners. Many can’t even walk. The Atlantic Magazine just published an article, We are Killing Elders Now. The writer states “In at least six states, these fatalities account for half of all COVID-19 deaths, and according to the World Health Organization, half of all coronavirus fatalities in Europe have been traced to nursing homes too. Some of this mortality is linked to long-term-care facilities that are shoddily run or that violate health standards. But most of them are doing the best they can with what they have. And they don’t have much”.

KAISER FOUNDATION NURSING HOME STAFFING AND USE OF PPE NOT REQUIRED IN MOST STATES

Kaiser reports -Staff Screening. It is more common for states to recommend rather than require daily screening of staff for illness in NFs (24 states recommend, 16 states + DC require)

Use of PPE. More states recommend (23 states) than require (7 states + DC) staff to use PPE

 Two States that require testing for coronavirus of ALL  residents of nursing homes are  Maryland where 556 have died as of the Washington Post article. and Tennessee 

THE FEDS HAVE NO CMS FEDERAL GUIDELINES OR REPORTING

We have no federal guidelines for safety testing according to an article by the Kaiser Foundation

It is now estimated that 16,000 deaths have occurred in nursing homes and that is without the federal government revealing any numbers and not making available any testing. But the numbers are probably huge- if we could just do testing. 

CMS announced it would have a meeting of a “panel” of experts “ sometime at the end of May”. After probably 20,000 older people died and the feds did nothing this shows their sense of urgency about this pandemic’s national “elder cleansing”.

WHAT CONNECTS PRISONS AND NURSING HOMES – CONCENTRATION CAMPS

So, what is the connection between the viral spread of COVID-19 in nursing homes and prisons- 6 feet ? Prisoners and residents, in nursing homes, and prisons cannot social distance. Jails and prisons have human beings crammed together with no choice. Nursing homes have 2 beds or if you are on Medicaid three to a room. Neither group has a choice to social distance. They are ” concentrated” as in concentration camps or death camps.

Do SOMETHING – HELP NURSING HOMES PREVENT MORE CARNAGE

So, as someone who has spent her career in aging, I am calling out to everyone, especially professional in aging – do something. Since the feds appear to be doing little- call your congressman, write a letter to the editor.

BE KIND LIKE RACHEL MADDOW REPORTS LA JEWISH HOME LA WAS

Rachel Maddow suggests calling your local nursing homes and see what they need. Be kind like the LA Jewish Home was to a smaller nursing home LA Brier Oaks. They wanted to test their residents and had no tests and the larger LA Jewish Home had tests and shared them with the smaller as a good neighbor. What they found was ravaging but it also showed caring and generosity. Care and be generous and show the helpless elders in nursing homes in your town you are opposed to -nursing home being prisons or concentration camps.

Filed Under: 4th of july, 7 touches marketing, adult child physical abuse, Adult children, adult emotional abuse, ADULT SIBling, Aging, Aging Alcohol Abuse, Aging Community & Covid-19, Aging deaths, Aging Family, aging family crisis, aging life business, Aging Life Care, Aging Life Care Assocaition, aging life care manager, Aging therapist, ALCA & Skilled Nursing Facility, ALCA Beneifits, ALCA business Loans, ALCA Cobtract, ALCA COVID-19 Crisis, ALCA Disaster Plan, ALCA Ethical Dilemma, ALCA Financial literacy, ALCA Products for COVID_19, ALCA sales, Alcohol Abuse and Aging, Angela Jolie, Aretha Franklin, Assisted Living, Assisted Living & Geriatric Care Managers, Assisted Living Crisis, Assisted Living sales, bankruptcy, Barack Obama, Benefits, Benefits of ALCA to Hospice, Benefits of Care Management, Benefits of Care Management to Hospice, Benefits of Geriatric Care Management, Benefits vs Features, Benifits & Assisted Living, Bill Clinton, billing, Billing 85%, billing 85% of GCM 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Why is Rachel Maddow Telling Aging Professionals About Nursing Homes Death Instead of the Feds????

April 27, 2020

Nursing Homes Turning into Death Camps

I have been learning that nursing homes are turning into death camps from Rachel Maddow not the federal government or aging community. I watch her every night as she is someone who reports the news fairly, focuses on facts and science,not what politicians and the president says. She reports what politicians actually do to avoid what the Trump camp calls fake news. This enrages me as why aren’t I hearing this from the aging community?

 I learned that 17 dead bodies piled up in an NJ Nursing Home a week ago . Three days ago it was reported  by the Kaiser Family Foundation that Nationwide, among the states reporting data, states indicate that cases have occurred at more than 4,000 facilities, and nearly 51,000 cases and over 10,000 deaths have been reported  by in-long-term-care-facilities/

No Fed Requirements To Report Covid-19 Deaths

According to the Kaiser Foundation until recently, there was no federal requirement for nursing homes to report coronavirus outbreaks and COVID-19 deaths. This lead to an information gap for families, residents, and policymakers. After gutting the Obama regulations to improve care in nursing homes in 2017, On April 19, 2020,( many days after Rachel Maddow and the NY Times were reporting the horror(,CMS released guidance that would require nursing homes to report cases of coronavirus directly to the Centers for Disease Control and Prevention (CDC).This move is totally hypocritical after Trump is the one who caused the horror by slashing regs that would have prevented deaths.  This new data is not yet available, but there are a number of states that are already reporting data on long-term care facilities.

When I  saw the carnage of nursing home deaths, yet SNF’s asking feds for immunity I was even further outraged.

 We Need Inquiry Into Federal Response

I blogged about the root of this problem a week ago  We need an inquiry but more than that we need a federal response, which there is none and national coverage which is just starting to occur after the most vulnerable on the planet were locked up in buildings where no one  could visit, filled with the people with the highest risk, and staff going from facility to facility as they need three jobs to keep them afloat and spreading the virus then becoming ill themselves 

TRUMP CUT BACKS IN NURSING HOME STAFFING INFECTION CONTROL

This lack of staffing and cut back in infection control federally mandated by the Trump government. Trump cut back regulation upgrades mandated by the Obama administration

The Obama administration effort, finalized in 2016, requiring all long-term care facilities to develop infection control and prevention plans to detect, report and contain communicable diseases.  

It also covered telemedicine, so required publishing infection control rates weekly in Nursing homes that manage from 1.6 million to 3.8 million infections each year, according to the Centers for Medicare and Medicaid Services. A 2017 analysis by Kaiser Health News found that 74 percent of nursing homes have been cited for lapses in infection control — the most frequent type of health violation.

So, aging professionals, I am going to give you Rachel Maddow’s sage advice,

Sound the alarm- Aging Professionals

Read your local paper for nursing home problems in your area. Now they are only being reported cumulatively by the New York Times and major papers. Send letters to the editor. Write to your governor. Alert your Area Agency on Aging.

Call Your Local Nursing Homes

Call the nursing homes locally and ask what you can do. Besides setting off the alarm can you organize PPE by getting a local club or group of women who sew to help, Even kids have contributed like this child in Boston who sews masks.

Scream to the top of your lungs.

A holocaust is happening and the Trump administration is ignoring the carnage – Rage against the coming of the night for the older people we all love and have devoted our lives to helping.

Filed Under: adult child physical abuse, Aging Community & Covid-19, Aging deaths, aging family crisis, aging life business, Aging Life Care, Aging Life Care Assocaition, ALCA & Skilled Nursing Facility, ALCA COVID-19 Crisis, Blog, coronavirus, coronavirus shut down, Covid 19, Covid-19, Covid-19 Death Nursing Homes, Covid-19 Nursing Home, Death and Dying Care Management, geriatric care manager, infection control in SNS, Nursing Home Deaths, Nursing Home disaster plan, Poor Nursing home staffing, Rachel Maddow Tagged With: aging community, aging life and geriatric care management, aging parent crisis, Aging SNF deaths, COVID-19 Deaths, COVID-19 deaths SNF's, elder abuse in nursing homes, Federal Response To Covid-19, geriatric care manager, nurse advocate, nurse care manager, nursing home deaths, poor nursing home staffing, Rachel Maddow

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