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,

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 20^th 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 normal 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 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

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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.

5 Things Geriatric Care Managers and Concierge Physicans have in Common & and How Do you Us That in Marketing to Them

February 18, 2020

Concierge Physicians and geriatric care managers have much in common. The first parallel is they both serve the top 10% . The second correlative is both are a business, mainly serve the elderly and wealthy and both take health care into the world of profit. Here is an NYT article,

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.

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.

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”.

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 same 1-1 hands-on excellent care “So What” you can support the physician 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 care the parent needs without hiring a social worker or trying to be one.

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