Cathy Cress

Expert in Aging Life and Geriatric Care Management

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Need a Midlife Family Meeting for Aging Parent Disaster Plan

August 21, 2023

 MidLife Sibling Meeting Needed for Global Warming

A midlife sibling meeting needs to be convened after the catastrophic global warming nightmare of Hurricane Dora unleashed on Maui, where 1000 people missing many probably older residents who could not get out quickly creating a midlife sibling nightmare.  The identified dead are all elders. Scores more victims will be identified in the weeks and months to come. While the final list of fatalities will almost surely represent a broader cross-section of ages, the deaths underscore that elderly people are at greater risk in fast-moving blazes.

I was in Los Angeles during Hurricane Hilary when the hurricane struck along with a 5.0 earthquake. It was the first in 84 years because the global warming nightmare of the week is the Pacific Ocean is now warm enough to produce big hurricanes. My daughter and family whom I had a housesat for, took off for Maui finding out Maui was on fire, and went to the big island all this catastrophe in one week. I had to scramble to find flashlights etc. and call her in Hawaii. I ended up being an example of this post.

According to the US Fire Administration people over the age of 65 face the greatest relative risk of dying in a fire: 2.6 times higher than that of the general population. Research from the National Institute of Standards and Technology and the Fire Administration ties this trend among the elderly to greater frailty and difficulty escaping.

This back-to-back global warming nightmare smacks the climate change catastrophes right in our faces.  On  Dora’s and Hilary’s heels, we will have more hurricanes with hurricane season upon us, that insanely could be on both coasts, with global warming making them monster storms, with the huge elderly death toll. This should terrify adult children enough to take emergency action to protect their parents.

Emergency Diaster plan

 

Midlife Family Meeting of Siblings Need Emergency Disaster Plan

Midlife Family Meeting

This recent confluence of hurricane deaths and hurricanes looming in this global warming nightmare should be a deafening roar in the ear of midlife siblings convene a midlife sibling meeting to create a disaster plan family protecting any aging family members-, no matter where your elderly parents live or what level of care. You need that disaster plan because older people are more likely to die in catastrophes than any other population

So before another hurricane, tornado, earthquake, flood, or any disaster hits, you need to have a  midlife sibling meeting to come up with a disaster plan for aging family members.

What would be the agenda of that midlife sibling disaster family meeting?

If your loved ones are in a FACILITY- do not trust the facility to handle the situation.

Remember Hurricane Irma where above -Florida Nursing home residents are sitting in flooded water. Avoid this

Emergency Disaster Plan Have Midlife Family Meeting

1)Get a copy of the facility’s disaster and evacuation plan. Compare it to state regulations. If it does not include calling the family before the disaster, consider moving your loved one or make sure that is changed.

2)Appoint a sibling to be in charge of reading the disaster evacuation plan and be the contact person.

3)Call your state facility licensing body and find out the state regulations to see if they match the facilities- CCRC, Assisted Living, or Nursing Home

4) Have a telephonic family meeting before the disaster if possible

5) make sure the state requires backup generators for heat and air conditioning- a flaw in Florida’s regulations in Irma

If the loved one is LIVING AT HOME alone or with an adult child have midlife family meeting

Midlife Family Meeting

1) Create a disaster plan for the older person. This would map out what each sibling and family member needs to do

2) Create a disaster team. This would include every adult sibling all over the country, family nearby, caregivers, and neighbors.

4) Include someone on the team who can carry heavy objects like wheelchairs.

5) Name a substitute caregiver if the regular one can’t get there.

6) Make an evacuation plan for your aging family member’s house. Where is the nearest Red Cross shelter 

7) What disaster supplies do you have on hand? Get a list from your local Red Cross 

8)Find out how many people do you need to make the move to safety or a shelter?

9) Put all of the above in writing.

10) Share a copy of your disaster plan with everyone. E-mail copies to everyone on the family disaster team including all adult siblings, neighbors, and friends.

11) Get everyone’s agreement especially midlife siblings and the older person. Be a unified disaster team.

12 ) Call a geriatric care manager to manage the plan or help you create it with your elderly parents, if you live long distance. They can do the heavy lifting, can help moderate a family meeting- can research state laws, be there in a disaster immediately, and create and implement a disaster plan for your parent, that you approve and can be part of.

Professionals check out the chapter “ Preparing for Emergencies” in my Handbook of Geriatric Care Management  fourth edition,

Professionals Check out my book Care Managers Working With the Aging Family, Jones, and Bartlett, with its chapter on Family Meetings and the Aging Family by Rita Ghatak, director of Stanford’s Aging Program. 

Filed Under: Aging, Aging Family, Aging Life Care, aging life care manager, care manager, caregiver, case manager, elder care manager, Elderly Disaster Plan, Emergency Plan, Geriatric Care Management Business, Geriatric Care Manager, geriatric social worker, Jose, nurse advocate, nurse care manager, Nursing Home disaster plan, Siblings Tagged With: aging family, aging life care manager, aging parent care, aging parent crisis, care manager, case manager, disaster plan, disaster supplies, E Book on Family Meetings, Hurricane Dorian', Hurricane Harvey, Hurricane Irma, Hurricane Katrina, New Orleans opens flood gates, older adults in a dsiaster, Red Cross, sibling, sibling disaster family meeting, sibling family meeting

Rural Living Elders Greatest Risk to Perish in Massive Hawaii Fires

August 14, 2023

RURAL LIVING ELDERS AT GREAT RISK IN FIRES _ELDERLY 2XMORE LIKELY TO DIE IN FIRES

Rural Living elders are at great risk of fires. The U.S. Fire Administration estimates that older adults are more than twice as likely than the general population to die in fires. One-quarter of the Paradise residents, in the devastating fire that burnt down an entire California town in 2018, through PG&E Malfeasance had a disability which is double the statewide statistic. One geriatric care manager who lives there lost his home and practice trying to rescue a local older client.

Rural Living elders at great risk in fires

 

Rural Living elders at great risk in fires showed up again in the present Hawaii fire. The devastating Hawaii fire that just destroyed the entire town of Lahaina on Maui where over 90 people have now been found dead and this number is growing fast and 1000 are missing. This fire is rated above the Campfire which destroyed the town of Paradise in 2018. Many of those suspected dead in Lahaina are thought to be older people who could not escape quickly enough as it was a fire that was swept by Hurricane Dora’s 80-mile-an-hour winds spread the fire so fast that many many just could not escape. Lionel Montalvo, retired fire chief in Lahaina, said that many dead elderly would be found 

Decades of research confirm that the physical limitations that accompany advanced age make it much more difficult to escape disaster, but so do the social isolation and stubbornness that experts say is common among the elderly.

BREATHING PROBLEMS FOR SENIORS UBER RISK IN FIRES

The elderly are at the greatest risk for fire-related breathing problems according to the CDC.So if they just live in fire-prone areas and do not lose their home the very air they breathe can make them ill or actually kill them. Wildfire smoke can in the worst cases be deadly, especially among older people. Studies have shown that when waves of smoke hit, and patients experience respiratory problems, heart attacks, and strokes.

In 23 counties, older Californians overwhelmingly choose to live in fire-prone areas. Including in San Luis Obispo County, where 82% do live in rural areas.

Rural Living elders are at great risk of fires. That means nearly 2 million older Californians live in areas where wildfire is a formidable threat. It is not only the elderly who are losing homes in these rural Forest fires but those in facilities.

According to NPR in San Francisco, there are more than 10,000 long-term care facilities in California, from six-bed assisted living homes to large nursing centers.

Their analysis found that 35% of these facilities are in risky areas. With as many as 105,000 residents to safeguard if fire comes, these care home operators must now consider how to evacuate during a pandemic, a more complicated and difficult task.

California is aging faster than the rest of the country. In 10 years, the state projects the number of people over 65 will grow to 8.6 million.

RURAL LIVING ELDERS AT GREAT RISK IN FIRES SANTA CRUZ COUNTY FIRES TURNED REDWOODS INTO INFERNOS

In Santa Cruz, California, where my home and my home office are located wildfires in our Santa Cruz mountain forest burnt down 25 % of our county in 2020.  Of the two most damaged areas in the county was Bonnydoon, a rural area overlooking the Pacific which is very beautiful and rural. Among the many senior facilities damaged was Brookdale Senior Living which was evacuated due to smoke damage and inhalation by residents. They had to send patients to the Bay area, and in the Brookdale case, frail confused elders were sleeping on cots close to each other, risking COVID-19 and exacerbating their confusion, according to one daughter who moved her mother to her home in Santa Cruz permanently.

ELDERS COLLIDE WITH CLIMATE CHANGE

“There is absolutely a colliding of the events of both population aging and climate change,” said the University of South Florida gerontologist Kathryn Hyer. The elderly population represents 1/5 of our population and growing. Climate disasters as we can see from one climate catastrophe after another this year -like the Maui fire explode in power and frequency. According to the EPA, these colliding statistics are a formula for a disaster in a disaster.

Climate change is having a significant impact on wildfires according to the National Oceanic &Atmospheric Administration 

Rural Living elders a great risk of fires and it is only getting hotter, harder to breathe more dangerous for all worldwide US residents reflected in the heat wave in Arizona and Texas with a high-risk population of aging individuals but radically  more so for elders, who are number 1 in health problems and live at home or in facilities in the middle of these mammoth forests, turned into infernos of death

 

 

Filed Under: Aging Families and Disaster, aging family crisis, Aging Life Care, ALCA Disaster Plan, Assisted Living Crisis, Black Entrepreneur RB, Black Entrepreneur RN, Black Geriatric Care Manager, Black geriatric care managers, Black RN, black social worker, black travel nurse, Black Travel Nurses, Blog, Climate change catastropes, Climate Change Fires, COVID-19 & Wildfire, Disaster, Disaster 2020, ELDER FIRE RIsk, Elderly Disaster Plan, Fire Risk to Elders Climate Change, FIRES, GCM Disaster Plan, Hawaii Fires, Hawaii wildfires, Home care disaster plan, Home Care Emergency Coronavirus Plan, Maui wildfire Elder deaths, Maui Wildfires, Nursing Home disaster plan, Paradise Fire, Rural Elder Fire Risk, Rural Elders and Climate Change Risk, Rural Elders Risk Fire Death, Santa Cruz Fires, Trump Administration, WESTERN FIRES, Wildfire risk and elders, Wildfire Tornados Tagged With: aging life care manager, aging parent care, aging parent crisis, Bonniedoon fire, Breathing Problems in fires, California wildfires, care manager, case manager, crisis with aging parents, Elder risk in fires, Hawaii Fires, Lahaina fire, Long Term Facilities Risk Fires, nurse advocate, nurse care manager, preparing for a disaster, Rural Aging & Wildfires, Rural Elders at Risk 4 Fire, Rural Fires in West, Rural Risks in Wildfires, Santa Cruz Wildfires, Trump response Ca Wildfires, Western fires & Elders, wildfires in west

5 Things Geriatric Care Managers and Concierge Physicians have in Common & and How Do you Market to Them

May 18, 2020

 

What Do you Have in Common with a Concierge Physician

Concierge Physicians and geriatric care managers have much in common

They both serve must serve the top 10% in the US. because of Income equality

Geriatric care management and long term care are not covered by Medicare, so the top 10% can only afford private geriatric care management.

Medicare rates for the physician are so low, especially Geriatricians,(who are the lowest paid that they disappearing), is one of the reasons physicians have fled to a concierge practice. This allows them to actually see a client for more than 10 minutes and make housecalls where they can actually observe the most about the patient’s ability to care for themselves.

Both in Business, Serving the Elderly & Wealthy taking health care into the world of Profit.

The third commonality is Concierge Physicians and geriatric care managers both make house calls have small practices and spend time with a patient like an old fashioned doctor. More important they both know that you see the most about the functional ability of the client/patient in their home not a brief office visit

Small CASE Loads a big Similarity

The fourth similarity is the caseload. Concierge Physician has an average caseload of 50, while the average internist has 2500 patients. The average GCM carries a caseload of 25-35. But even that may be too high when serving highly entitled concierge clients. Wealthy clients can demand boatloads of attention, have more family friction between adult siblings and the older parent-based on too much money, not enough love, and no skills passed on to nurture when the parent needs care. This constant bickering or worse cut off and often elder physical and fiscal abuse siphons lots of hours of the GCM’ s time to get the care that the older client needs. So large GCM caseloads among the uber-wealthy are almost impossible.

NO WAIT TIME TO SEE GCM OR CONCIERGE PHYSICIANS

The fifth kindred feature between the GCM and concierge physicians is “wait time”. Wait time to see your doctor in the US can be a very long time. According to the New York Times”A survey released in March by Merritt Hawkins, a Dallas medical consulting and recruiting firm, found it takes 29 days on average to secure an appointment with a family care physician, up from 19.5 days in 2014. For some specialties, the delays are similarly long, with a 32-day wait to see a dermatologist and a 21-day delay at the typical cardiologist’s office. But Concierge Physicians get back to their patient’s right away because of the small caseloads and the personalized one to one care they represent. Care managers, who offer gold standard care, generally get out to see new clients within a day. Both professionals go by ” Ask and Ye Shall Receive”.

BOTH TREATING COVID-19’s Hand of Death Reaching for Seniors

During the coronavirus both doctors and care managers, see their clients/ patients the largest target of the deadly virus, dying in deadly droves, especially in

nursing homes and are themselves overwhelmed by the stress of not being able to save or even see their caseload.

So when you market the Concierge Physicians, what benefits to do you offer that will allow her or him to refer to you.

We will use the “So What” that show benefits to any profession

1) You serve the same upper 10% with the same 1-1 hands-on excellent care  “So What” you can support the physician’s patient without training

2) You do facilitation with dysfunctional families ( often in these patient caseloads) “So What”  You will  use your skills to get families to agree on care for the older person so concierge physicians  will not have to deal with these difficult barriers to care

3)You will manage adult siblings who often disrupt older parent care because of ” Mom Loved You Best” squabbles “So What” so the Concierge physician can give the medical care the parent needs without hiring a social worker or trying to be one.

4)You can counsel families through technology through the fears of COVID1- and strategies to help clients cope with the choices they may have in the epidemic so what so the mental health breakdown of the aging family can address.


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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.

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Medicare For All Includes Long Term Care – Perhaps Pay Attention Now With -Covid 19 Raging ?

March 25, 2020

Long Term Care Not Covered by Medicare

Geriatric Care management and home care, among other critical services tin aging are not covered Long term care services, is not covered by Medicare. In Bernie Sanders & Elizabeth Warren’s Plan, Medicare for all would cover long term care, a point that the Washington Post said that Sanders did not emphasize enough.

Medicare For ALL Would Cover Long Term Care 

Time Magazine, recently reported that Covid-19 ‘s effect right now is making Medicare for all seem like the present need nor an unaffordable dream . The “Department of Housing and Urban Development halted foreclosures and evictions during the emergency; the Department of Education slashed federal student loan interest rates to zero and will allow borrowers to completely suspend payments if needed; Congress is negotiating a plan to send direct cash payments to families, and a version of paid sick leave just became law.”

What If We Had Medicare For All During Covid 19 Pandemic?

If we had Medicare for all during the Covid 19 pandemic, we would be better able to disburse funds in emergency situations and to purchase necessary machinery, such as ventilators ( that only the president seems to be able to dispense through the Defence Production Act & does not, during a crisis and get them where they need, like the 30,000 needed and missing in New York) face masks that as so needed that the CVC recommended bandanas and a 10-year-old student in Boston is sewing herself the height of the pandemic right now.

Unlike our current health care system, Medicare for All would include specific funding for dealing with pandemics or other health emergencies that could be distributed quickly without requiring additional legislation of presidential planning, which seems not to have happened at all. The United States cannot be left unprepared for mass health risks like COVID-19. It is time to put in place Medicare for All and better protect the health of the American public.

 

Ethical Dilemma

This lack of Medicare covering Long term care leaves geriatric care managers in an ethical dilemma of being able to only be able to serve the upper 10% and leaving 90% of seniors and thus under 64 with chronic care needs like MS, unserved.

 

Elizabeth Warren’s plan for Medicare for all could cost 20 Trillion over 10 years. Existing Medicare over the 10-year period would cost 16 trillion. The bill we are just passing in Congress to fund is 2 Trillion. We will need another bill. Are all the mounting deaths from Covid 19, 55,000 people with Covid 19 and counting, disruption to business, our lives and the hospital really worth not paying attention to Medicare for All- which it looks like we just might be able to afford?

Find out about this ethical dilemma and what care managers must do to serve the upper 10%, and ignore lower 90%, who have no long-term care under Medicare .

Since geriatric care management must be privately paid for, in the absence of coverage under present Medicare, in spite of our moral dilemma

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