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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8 Ways to Tame the Turmoil of the Holidays & Twindemic in the Aging Family

 Learn how!

  • How to sell services to the desperate Aging Family during the holiday surge
  • How to give hope to frantic children who call when their aging parent struggling with Loneliness and isolation on the holidays
  • How to help the Aging Family make holiday visits remotely or safely in person
  • How to counsel the Aging Family to track aging decline &Twindemic risk in loved ones
  • How to work with both dysfunctional and long-distance families who call during the holidays
  • How to use GCM tools to contain Holiday chaos
  • How to use financial forecasting to prepare for business growth during the holidays

Sidestep the Many Care Managers Who Do not know how to work with Dysfunctional family or do COVID Coaching of Aging Families so the client chooses you

THIS FREE WEBINAR IS Thursday, December 3, 2020, FROM 2 PM – 3:30 PM PST

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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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Are Rich and Famous Among the Concierge Clients Who Can Afford Long Term Care?

March 11, 2020

Four types of aging families can afford geriatric care management, home care, and long term care because they have financial resources, 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)

 

 Rich and Famous-Entitled Families:

These families are identified by the aging 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.  The entitlement of the family is passed from the parent to the child, like a virus, who in turn brings these behaviors and actions to the caregiving milieu and care management relationship. 

Entitlement That Abuses Family With Riches

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)

Free Webinar-Sales and Marketing to Find the VIP Concierge Client

March 31, 2020 -2PM -3:30 PM PST

Concierge clients are the only way a GCM or ALCA care manager can make a profit and have their business thrive. Find out who are they, how you find them, design GCM Products they will purchase, and create a marketing plan and gold standard services to have them sign your contract and use your services long term

Learn

Who They Are- 4 Types

  • How to Locate them in your service area
  • How to create a strategic marketing plan to sell to them
  • How to Develop Gold Standard GCM Products and Services
  • How to transform your GCM entrepreneurial dream into a profitable reality with 10 key marketing steps to learn more 
  • How to overcome the double bind of your caring model and learn how to care and make money
  • How to create a marketing strategy and messages that attract concierge clients 
  • How to reach this target audience
  • How to design products that exactly meet Concierge Clients needs
  • How to obtain adult children’s buy-in           
  • How to use words that will make them choose you
  • How to get care staff they will like and not fire
  • How to get the contract signed with ease

 

 

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Filed Under: Aging, Blog, elder care manager, Families, Geriatric Assessment, Geriatric Care Management Business, geriatric care manager, geriatric social worker, home care, Narcissistic Personality, nurse advocate, nurse care manager, Webinar Tagged With: aging family, aging life care manager, aging parent care, aging parent crisis, care manager, case manager, Certified Senior Advisors, geriatric care manager, nurse advocates, nurse care manager, well heeled seniors

What To Expect Narcissistic Entitled Families Who Call a Care Manager

March 10, 2020

 Four types of aging families, who can afford geriatric care management and private duty home care as they have the financial resources, will call you to inquire about your services. You need to have excellent clinical skills to manage these families.

Two are dysfunctional aging families who take extensive psychodynamic skills. One is the narcissistic entitled family.

Part of this is drawn from Claudia Fine formerly of Senior Bridge 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 develop from a specific kind of “not good enough parenting” in which the parents themselves have struggled with personality disorders. Typically, in this type of family, narcissistic borderline personality  .( example President Trump)the parent had 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.

What Will Take Your Great Clinical Skills With These Families?

Fine and Newcombe point out the adult child finds him or herself in is either of two categories. They can be elevated to the” perfect” child in the mental health challenged mother or father’s eyes, so that the parent feels worthwhile.
These children grow up to be your client’s family and the person who usually calls the care manager. If they hire you they are demanding because they are afraid if they are not inflexible with you they will get nothing from your services.worriedwoman300dpi-copy-e1425605439440.jpg
Or the second category where the child is devalued by the parent so that the narcissistic entitled mother or father feels superior ” perfect” and all-powerful. They will present, according, to Claudia Fine and Nick Newcombe, as needy and insatiable, and easily ” injured” by the care manager who is attempting to help them.

Both types of adult children who interact with you are frequently angry to care for the parent who never cared for them, gave little to them as a child, thus demanding and needy themselves. All this repulsion comes from never having a mother or dad who was there for them so in response will be difficult family caregivers to work with.

 ( Fine and Newcombe- Entitlement in the Aging Family, Care Managers Working With the Aging Family)

Free Webinar-Sales and Marketing to Find the VIP Concierge Client

March 31, 2020 -2PM -3:30 PM PST

Concierge Clients are the only way a GCM or ALCA care manager can make a profit and have their business thrive. Find out who are they, how you find them, manage them  design GCM Products they will purchase, and create a marketing plan and gold standard services to have them sign your contract and use your services long term

Learn

Who They Are- 4 Types

How to Locate them in your service area

How to create a strategic marketing plan to sell to them

How to Develop Gold Standard GCM Products and Services

 

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Filed Under: Aging, Aging Family, aging family crisis, aging life business, Aging Life Care, aging life care manager, Blog, borderline client, Borderline narcissistic family, borderline-narcissistic families, care manager, Concierge aging clients, Concierge Senior, dysfunctional aging familt, Dysfunctional aging family, elder care manager, entitled family, Families, Filial Crisis, FREE MARKETING WEBINAR, FREE WEBINAR, Geriatric Assessment, Geriatric Care Management Business, Geriatric Care Manager, geriatric care manager, geriatric social worker, Holiday Meltdown in Aging Family, Holiday Rituals in Aging Family, home care, narcissistic client, Narcissistic Personality, nurse advocate, nurse care manager, parent care, Sales to Assisted Living, Webinar Tagged With: adult children of borderline narcissistic VIP families, aging family, aging life care manager, aging parent care, aging parent crisis, Borderline VIP client, care manager, case manager, Certified Senior Advisors, geriatric care manager, Narcissistic client, nurse advocates, nurse care manager, well heeled seniors

Why Phyllis Brostoff Says You Should Get a D on Your Written Geriatric Assessment

January 16, 2020

How To Score an A Writing a Geriatric Assessment

A written Geriatric assessment is the toughest skill a care manager can have in their toolbox. You want your A-game because they frequently go to elder law attorneys who submit them to court in conservatorship or guardianship lawsuits. As evidence, they must be perfect. You the care manager pull all your other skills of assessment, care planning, investigation of a case to find the right solution for the clients and objectivity. Plus what is not taught in gerontology classes – writing skills.

Phyllis Brostoff a legendary now retired geriatric care manager an ALCA board member taught this skill and published it in the Handbook of Geriatric Care Management in the Geriatric Assessment. Here is both how you might garden a D or even a flaming F and how to present that attorney your A-game.

WHAT ARE THE BIGGEST ERRORS GCM MAKE IN WRITING A GERIATRIC ASSESSMENT?

  • Sloppiness: not enough information is gathered, or used to evaluate problems
    • You are a detective and need to gather all the information (clues about the case in the beginning). This means talk to all family members, friends, formal supports,  to understand what are all the problems and how will you evaluate them. This includes using all assessment tools and gathering all records, medical, hospital, etc.

 

  • Errors: questionable information, information not checked–

 

  • One daughter says her father is confused and needs her care– not a paid caregiver. Another daughter says that the first daughter has taken financial advantage of the client by withdrawing money from Dad’s bank and should not be the care provider. You do not check the father’s bank account to see that the daughter has made withdrawals for her father’s accounts, which she has.

 

  • Poor spelling, grammar, sentence structure

 

  • Even though your geriatric assessment has every section included and fully filled out, with your care plan and logical conclusions well stated and correct, with perfect recommendations —if you used poor spelling and grammar, the family or attorney will discount it because of your poor writing presentation.
  • Poor organization of information.
    • For example, don’t put information about the client’s depression in the Home Management section of your geriatric assessment. Mrs. Typhoon feeling depressed does not go in the home safety section. Do not commingle sections. Write a tight outline, follow it, and make your written assessment cohesive.

 

 

  • Conclusions based on assumptions, not facts

 

  • Make sure your facts are presented clearly. In Mrs. Typhoon’s geriatric assessment, you would not say Problem: Mrs. Typhoon suffers from anxiety, based on your visit where you charted.” Ms.Typhoon looked full of anxiety.” You would state, “When visiting Mrs. Typhoon on November 1, 2026, Mrs. Typhoon stated to the GCM that she very anxious and wanted to take more of her Xanex.” GCM checked with Dr. Feelgood and he said she is taking 10mg of Xanax as needed.

 

  • Lack of coherence between problems, solutions offered in recommendations
  • Your geriatric assessment must lead to coherence between solutions and problems. At the beginning of Mrs. Typhoon’s geriatric assessment, her daughter Ms. Tornado wanted you to find out why her mother had multiple falls, and what level of care her mother belonged in. You state she has fallen five times and needs a walker but never state where she falls, which is going down the steps to the laundry room or offer a solution which could be a care provider do the laundry or moving to a single floor dwelling or both.

 

  • Recommendations incomplete: no or not enough choices offered, no argument put forth to guide decision-making
    • Recommendations in Ms. Typhoon’s geriatric assessment are incomplete. As stated above

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Filed Under: Aging, Blog, Care Plan, Families, Geriatric Assessment, Geriatric Care Management Business, Geriatric Care Manager, Webinar, Written Geriatric Assessment Tagged With: aging life care manager, care manager, eldercare manager, Geriatric Assessment, geriatric care manager, nurse care manager

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