Cathy Cress

Expert in Aging Life and Geriatric Care Management

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How Do You Detect COVID–19 Symptoms in Seniors While Living Long Distance?

July 1, 2020

COVID–19  Detecting Symptoms in your loved one from a Distance

We can not always be with our loved ones. Long-Distance Families make approximately 43.5 million caregivers who have provided unpaid care to an adult or child in the last 12 months.  How can you keep a watchful eye on long-distance older family members for symptoms of COVID-19?  First, you will need to know what symptoms to watch and listen to.

Did you know that COVID -19 is known to develop into a severe acute respiratory syndrome and may result in death? The elderly are more susceptible to this contagion simply due to their age. Your job is to become their health detective by paying acute attention to physical symptoms and asking questions when conversing with your loved one.

Symptoms to Listen & Signs to Look for

Signs and symptoms of COVID-19 may appear 2-14 days after exposure, commonly referred to as the incubation period. Common signs and symptoms can include:

  • Fever, cough or tiredness – If your loved one is suddenly not making sense or acting confused when you are talking with them, this could be an indication of having a fever and an infection.  Listen for coughing during your conversation and don’t be afraid to ask if they are napping more often or sleeping longer than usual or if they are weaker than usual.

Other symptoms can/may include:

  • Shortness of breath or difficulty breathing             Muscle Aches
  • Chills                                                                             Sore Throat
  • Loss of taste or smell                                                 Headache
  • Chest pain

EXTREMELY IMPORTANT TO BE KNOWLEDGEABLE OF MEDICAL HISTORY

If your loved one has existing medical conditions such as heart disease, lung disease, diabetes, severe obesity, chronic kidney or liver disease, or compromised immune systems they may be at greater risk for contracting COVID-19.  

CALL YOUR LOVED ONE’S PCP OR ARRANGE FOR THEM TO BE TAKEN TO THE HOSPITAL IMMEDIATELY IF MORE THAN ONE OF THESE SYMPTOMS APPEAR.

As your loved one’s health detective – Vigilantly Monitor their Physical Appearance

Call often.  Listen for symptoms such as coughing, shortness of breath, inability to complete sentences without having to take a breath. Are they suddenly confused or confused more than usual?

Use your technology.  Face time with your loved one. Look at them.  Are they having a hard time breathing?  Watch and count how many times their chest raises per minute. Normal breathes per minute in the elderly is 10-30. With COVID-19 the rate will be lower. Look for the appearance of lost sudden weight loss. The virus can decrease their appetite as it affects their sense of smell, making food less appetizing. Look at your loved one’s lips.  Are they discolored or have a light blue tint? This is a sign of oxygen deprivation and could potentially be very serious.

If you see any of these signs call your loved one’s PCP immediately and take/arrange for them to be taken to the hospital immediately.

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Filed Under: Aging Community & Covid-19, Aging Family, aging family crisis, Aging Life Care Assocaition, aging life care manager, ALCA COVID-19 Crisis, ALCA Products for COVID_19, Blog, coronavirus, coronavirus marketing, Coronavirus safety elders, coronavirus shut down, CORONAVIRUS Stay at Home Plan, Covid-19, COVID-19 & Care Management, Covid-19 Nursing Home, Covis-19 Services, FREE WEBINAR, GCM COACHING SKILLS, GCM COVID 19 Crisis, GCM products in COVID-19, GCM technology, GCM Webinar, geriatric care management emergency proceduress, geriatric care manager, geriatric social worker, Home From the Hospital, inquiry COVID-19, Long Distance Care, Long distance caregiver, Pandemic, Symptoms of covid -19 Tagged With: aging family, aging life care manager, aging parent care, aging parent crisis, care manager, Care Managers Working with the Aging Family, caregiver burden, COVID-19 -inquiry, COVID-19 & INFECTION CONTROL, Covid-19 Symptoms, COVID-19 Telehealth product, GCM Telehealth Product, long distance care provider, long-distance, nurse advocate, nurse care manager, social distancing covid-19

Nursing Home Still Deaths Camps, 40,000 Dead – Feds Skew the Stats

June 14, 2020

Rachel Maddow once again, now the House of Representatives swept a spotlight on the despicable nursing home mortality rate of COVID -19. Nursing Home residents remain the largest % of deaths in the US. Although only 0.6 of the population they  represent a whopping  42 % of the deaths 

Feds Statistics Insanely Wrong

Highlighting the Do Nothing attitude that continues in the Trump federal government, CMS just released data collected from nursing home national wide that is cast as insanely wrong. Nursing home officials said their data were somehow scrambled, either because nursing home personnel reported in the wrong columns, or the numbers were loaded incorrectly somewhere between the CDC and CMS.

Yesterday the House Select Committee Briefing Confirms Urgent Need for Federal Action to Protect Nursing Homes from Coronavirus

Chaired by Rep. James E. Clyburn, they explored the devastating impact of the coronavirus pandemic on nursing home residents and workers, including the deaths of more than 40,000 Americans in nursing homes across the country. 

 Chairman Clyburn called on the Trump Administration to take action to protect nursing homes, stating:  “[W]e need the federal government to ensure our nursing homes have enough testing and personal protective equipment to stop the virus from spreading.  That means providing coordination and resources—not just leaving it up to the states.” 

Dr. David Grabowski of Harvard Medical School explained, “Rather than pushing the logistics and costs of testing and PPE to states and nursing homes, the federal government needs to own this issue.  The federal government should set a consistent policy across all U.S. nursing homes and then provide states and nursing homes with the resources to achieve it.”  He concluded, “The buck has to stop there.” 

The Trump administration failed to provide nursing homes with testing and protective equipment.

We have focused on a lack of PPE in hospitals but what about nursing homes. Asked if the federal government has done enough to stem the outbreak in nursing homes, Dr. Grabowski replied:  “Absolutely not, the guidance was not sufficient.  I’ve actually called it ‘non-guidance guidance’ in that there were no teeth or dollars behind it.  And if you don’t put logistics, if you don’t put costs into this guidance, if it’s just simply a theoretical set of guidance for the nursing homes and for the states; it’s not actually going to happen.”  He concluded, “I would have liked to have seen federal leadership.”

Dr. Grabowski stated that nursing homes in many states still “can’t get testing fast enough” and “are really struggling to find the tests.”  He explained, “The federal government should’ve put the testing in place and actually paid for it.”  He stated, “Until we get rapid and accurate testing for all staff and residents, we won’t be able to contain COVID.”

Mr. Carlson explained that nursing homes face serious shortages of PPE and that “shipments from FEMA have been a bit late and inadequate.”  He also explained that “the lack of federal coordination” has “impeded facilities’ ability to identify infected persons and to provide care.”

PPE Feds Send Looks like Blue Plastic Trash bags

NPR reported the PPE is either never delivered, flimsy, and much less than ordered or looks like remade trash bags. Instead of proper medical gowns, many packages hold large blue plastic ponchos.

In late April I blogged about the national COVID epidemic in nursing homes. It has been a month and a half and death toll, which was 10,000 rocketed up to, 40000, now – that’s 30,000 more deaths in just a month and a half.

Workers in the facilities still have inadequate PPE to protect themselves from the virus, and CMS in some fabulist attempt to look like it actually cares about Medicare and Medicaid, comes up with an outcome study that seems to be run by drunks or charlatans.

Now Rachel Maddow is showing us nothing has changed except the bodies are piled higher and higher in nursing homes. I care and I assume every senior agency that gets this does but put that caring into action. Write your Congressman, or maybe just adopt a nursing home and raise money in the community to buy PPE for them. This is, of course, pathetic but the government does not care, CMS does not care and President Trump certainly does not care about older people.

Filed Under: Aging deaths, aging family crisis, Aging Life Care, Aging Life Care Assocaition, aging life care manager, Aging therapist, ALCA COVID-19 Crisis, Assisted Living, Blog, care manager, case manager, CMS & Nursing Home Policy, Coronavirus safety elders, Covid 19, Covid-19 Death Nursing Homes, Covid-19 Nursing Home, geriatric care management emergency proceduress, geriatric care manager, geriatric social worker Tagged With: aging life care manager, aging parent care, care manager, CMS COVID response, geriatric social worker, nurse advocate, nurse care manager, nursing home COVID statistics, Nursing home COVID testing, nursing home death, PPE in Nursing Homes, Skilled Nursing death

Memorial Day Trail of Dead Aging Veterans’ Felled By COVID-19 &VA Cuts

May 25, 2020

 

Stalag-VII-A Moosburg Bavaria

My father was held in a prison camp during World War II. He was an officer and his camp only housed the higher ranks. He never spoke about the war. He was a World War II navigator shot down in Poland and transferred to Stalag-VII-A Moosburg Bavaria.  He returned home a broken man with PTSD, never took a bus, drove or flew on a plane again. His disability, like so many vets was untreated for 50 years. He worked as an advertising agent ala Mad Men and drank like Don Draper. Our family crumbled into a dysfunctional maelstrom, as most families do. Literally saved by the Palo Alto VA GRECC Program in his late 60’s, he lived a very good life with my family for his last 25 years.

Patton Liberates The Prison Camp

My mother told me that near the end of the war, his prison camp was abandoned by the Germans. Most of the men had dysentery and were skeletons. Patton liberated the camp, according, to the story I heard and he cried when he saw his officers so very ill, burning up the bunks they slept in to keep warm in the freezing German winter. My father would say verboten when we asked questions, as he learned German while imprisoned. We were told by my mother never to talk about the war.

Holyoke Soldier’s Home Prison Camp

In today’s New York Times front page there is another story of another soldier who never talked of the war. But this World War II soldier, James Leach Miller, lived to be 98. He survived  D day the deadliest battle of the war but did not survive his own prison camp, the Holyoke Soldiers Home in Massachusetts. There was no Patton to roar up in tanks and save the 89 soldiers who died in the VA facilities that housed 210 frail older men. 74 were diagnosed with the virus. The state investigation shows there was limited staffing and workers that remained did double shifts. This was before the Pandemic hit. The Times reported that Holyoke had scarce PPE, was understaffed, and put veterans infected together with residents who did not yet have the virus.

Death By A Million VA CUTs

Erin O’Brien an associate professor of political science at the University of Massachusetts, said Massachusetts folk are outraged. Veterans programs require funding. President Trump has been making radical cuts in VA care and caregiver funding.

 

Trump Administration Batters The VA

The Trump administration has left the VA as battered as the fleeing Germans left my father’s prison camp. These poor soldiers in their 90’s were left as the Times headline says “to Languish in a Home Ravaged by Illness “with few staff , PPE a raging epidemic and no President Trump coming in to cry at his army’s plight and save them when he saw men who had risked their lives for all of us- and lived on – only to felled by VA cuts.

Filed Under: Aging, Blog, coronavirus, Coronavirus safety elders, Covid-19 Death Nursing Homes, Covid-19 Nursing Home, COVID-19 VA deaths, Dysfunctional aging family, Emergency Plan, Geriatric Care Management Business, Memorial Day, VA cuts by Trump, Va Holyoke Soldiers Home, VA Nursing Home Deaths, Veterans Administration, Written Geriatric Assessment Tagged With: aging life or geriatric care manager, COVID-19 deaths SNF's, COVID-19 VA Facilities, Federal Response To Covid-19, geriatric care manager, Memorial Day, Memorial Day WWII Vets, nurse advocate, nurse care manager, VA Deaths COVID-19

California Cuts Pushing Frail Elders into the Cesspools of COViD-19

May 22, 2020

Here in California, the frailest, poorest and oldest in the state are being potentially knifed in the back by slashing budget cuts to the very services that keep them out of nursing homes.

 The Multipurpose Senior Services Program , one of the first geriatric care management programs in the nation, designed to keep fail elders out of nursing homes, is set to axed from the California State budget.

The Governor has also proposed elimination of $2.9 million of state funding and $3.9 million in federal matching funds for the 11 statewide Caregiver Resource Centers, 

providing critical respite care and counseling to caregivers of adults with chronic and disabling health conditions.images_20130906-154817_1.jpg

Both programs were designed 4 decades ago to keep elders at home and out of more expensive nursing homes and staunch family caregiver burnout. They offer huge safety nets, designed to keep frail seniors in the community.

MSSP is of a daycare program providing rich social and health services to frail elders and their families. The Care Resources Program caregiver respite and support to overwhelmed family caregivers.

These programs save the state a bundle of money. Each of the MSSP clients is disabled enough to be eligible for nursing homes and poor enough to be eligible for MediCal. So instead of the state paying $80,000 or $90,000 per person per year in a nursing home, the State pays only on average a little over $5,000 for the person to be in GunnDadJacket.jpgMSSP.This makes the cuts both fiscally stupid and mystifying.

What California government is doing is ripping giant holes in this web plummeting 45,000 seniors into the cesspool of COVID-19 skilled nursing facilities, where almost  half of California COVID-19 deaths occured.

 Without the services and supports available through MSSP, and the Caregiver Resource Center, many older Californians will have no other choice but to be admitted to nursing homes, where nearly half of all deaths related to COVID-19 have occurred. 

But the doors may be barred. Given the high risk of COVID-19 in nursing homes, owners are reluctant to take new patients. So, the elimination of the Caregiver Resources Center and  MSSP is really a death sentence to frail elders. It leaves no fire extinguisher for caregiver burnout of the family caregivers who care for elders with the toughest disease: brain impairment- Alzheimer’s, stroke, dementia, Huntington’s disease, Parkinson’s other conditions that may cause memory loss or confusion.

This may cause a cascade effect- placement of these horribly demented elders, into the plague-infested nursing home or also to death’s doorKali--Bill-Connies-book-.JPG

Governor Newsome has been a national hero as the first governor to issue a stay at home order to close counties down in California. He slowed the spread of coronavirus and kept California in a safe zone compared to most other states. But this was at the cost of taxpayer dollars as 4.7 Californians were put out of work. 

 He finds himself in a double bind now with a chasm of a budget hole, that he is trying up to fill with cuts like the ones proposed to the senior program. But the cuts will lead seniors to nursing homes  costing $80,000 a year instead of the $5000 for MSSP  into those caldrons of coronavirus

California is always the canary in the coal mine- the innovator that most states follow. So, these cuts can be expected across the nationwide. Who is the real villain in these cuts, the Trump Presidency. 875 billion was approved in the House of representatives in the HEROES Act. Cutting both programs saves $119 million. But these cuts would be eliminated if Congress OKs this aid for state and local governments — a prospect many state lawmakers believe is unlikely as President Trump is threatening to veto the money to the states . This has spurred a cacophony of outrage from local legislators and senior advocates. angered state lawmakers from both 

major political parties who say it’s irresponsible in light of the coronavirus pandemic that has spread through nursing homes across the state. It’s one of many conflicts emerging this week as lawmakers hold public hearings examining Newsom’s proposal before they must vote on a spending plan by June 15.

Want to help save these programs

 

PUBLIC COMMENTS – WRITTEN: Submit written public comments by email to: sbud.committee@sen.ca.gov

Filed Under: Adult children, Aging, Aging Family, aging family crisis, Aging Life Care Assocaition, Blog, Caregiver Burn Out, caregiver burnout, caregiver mental health, CAREGIVER RESOUCES, case manager, Coronavirus emergency plan, coronavirus shut down, Covid 19, Covid-19 Nursing Home, Dementia Activities, elder care manager, Families, geriatric care manager, MSSP cuts in California, nurse advocate, nurse care manager, quality of life in senior centers, SNF death COVID-19 Tagged With: aging family, aging life care manager, aging parent crisis, barrier to caregiver assessment, California Budget cuts for seniors, california caregiver resource center, caregiver burden, caregiver depression, case manager, Cuts to programs for frail elders, Family Caregiver Alliance, geriatric care manager, MSSP cuts in California, nurse advocate, nurse care manager, Trump veto

10 Parts of Care Manager’s Role With Family Death and Dying of COVID-19?

May 13, 2020

 

GCM Role is Working With Family In COVID-19

Care managers cannot be in the hospital with a  patient dying of COVID-19. They can support their bereft children, who cannot see their parents during the hospitalization, in those last moments of goodbye’s or after the death in this deadly pandemic.

In normal times care managers play a big role in end of life issues. They are their navigators through all five stages of dying, many times long before palliative care or hospice are called. Often GCM’s can help the family and client to bring in hospice or palliative care. But is COVID -19 they can offer guidance to the family through the sometimes weeks of hospitalization, intubation, their loved one is on a ventilator and ultimately often- death separated from loved ones.

Navigation Through a COVID-19 Death

 The normal final passage through life can emotionally charged.  If the family is following a long labyrinth to the end, in coronavirus, the blind alleys may be blocked by a rushed hospitalization, banned from seeing their loved one in the hospital and not understanding the disease that is killing their loved one. Care managers can find an opening through this maze.  Family dynamics and fear of dying can all explode a fraught crisis of care in dying of coronavirus. When vital end of life decisions need to be made, the stress of the responsibility and the seriousness of the situation can break in a mammoth wave of distress fear and anxiety over the “ whole family system”. The geriatric care manager specializes in this whole family system even at the end of life.

Facilitate Family talks over hospitalized COVID-19 Elder

Care Managers can facilitate terrified discussions, and clear the way for family members to come together to work as a functional unit around an unknown killer disease that preys on their loved one. Understanding the differing viewpoints is critical.  Knowing what a parent wants and does not want during the last days and hours of life help define and simplify the role of the family.  It helps the family bear the burden of having the responsibility of making decisions that their parent wants. Turning this around can also help families have some solace that they carried out their parent’s wishes after their parent’s death. 

Care managers can help family members handle the stress of an elder’s hospitalization and death by:

  • Encouraging routines, exercise and social connectedness with friends and family
  • Advocate for them with the hospital staff to get updates in this chaotic time in hospitals,
  • Help them maintain contact with hospital personal to get updated medical status
  • Create opportunities to communicate safely with the hospitalized family member via text, telephone, email, or video chat
  • Support and mediate if necessary proactive discussions and advanced directive preparation in a rush if not done
  • Build a circle of care can help to reduce some of the potential conflicts,
  • Support them in having essential conversations, prior needing  intubation, on last wishes if health status deteriorates  
  • Provide opportunities to say goodbye
  • guide them in setting up rituals that can celebrate the end of life and give solace to a family during a time when there are yet no rituals for a COVID-19 death.
  • Work with the hospital to set up Zoom with the family to say goodbye to a loved one. 
  • Geriatric care managers do much more with clients and families but especially now with Covid-19 elder’s and their families facing a  separated, fractious end of life
  • See more about Cathy and her book Care Manager’s Working With The Aging Family 

Filed Under: Advanced Directives and Covid-19, Aging, Aging Community & Covid-19, Aging Life Care, aging life care manager, Blog, care manager, case manager, coronavirus, Coronavirus emergency plan, coronavirus shut down, Covid 19, COVID-19 & Care Management, Covid-19 Death Nursing Homes, Covid-19 Nursing Home, Death and Dying Care Management, death and dying care manager, elder care manager, Families, Geriatric Care Management Business, Geriatric Care Manager, geriatric care manager, geriatric social worker, Hurricane Irma, ife care manager, nurse care manager, Therapist Specializing in Aging Tagged With: aging life and geraitric care manager, death and dying, end of life care manager, geriatric care manager, Hospice Care, hospice for elderly parent

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