assessing the caregiver Archives ⋆ Cathy Cress

Before a Parent Moves in-Check if You Can Handle the Care

October 14, 2019

Happy Birthday to my Dad, Harry V. Cress.

Today he would have been 99. He was a father who had severe PTSD from being imprisoned in a WW2 prison camp in Germany. So, at times , he was a difficult Dad. He worked all his life as an advertising man. But, he suffered from all the PTSD symptoms from what he thought was the good war, so he never reached out for help. He moved in with me in 1989, after he lost his house on the New Jersey coast to ” The perfect storm”. But, once I got him into the VA in Menlo Park, California, he lived with me and my family for 20 years and was the perfect great grandfather, grandfather, and father.

However, as a cautionary tale, I was first surrounded by a very supportive loving family as a caregiver and second was a geriatric care manager. I also had the full help of the VA and all their incredible GRECC services that covered all the medical care, caregivers, geriatric social workers to support me as a caregiver, as my Dad, as a PTSD survivor was 100% disabled. He was a happy independent person for 14 years making our family a three-generation web of real happiness and constant family celebrations as a living ” whole” family. But as he gradually aged, developed vascular dementia then cancer, dying at our home in 20o8

So, moving a parent in your home is not for everyone

Moving an aging parent in your home encompasses not just the present but perhaps 20-30 years in the future. It means accepting the parent as they are in the moment, which may be ambulatory, cognitively intact and independent but seeing they will be gradually affected by the decrements of aging.

What challenges do you face?

Your parent may have perfect vision now and because of macular degeneration need a great deal of support in mobility, eating, and all the activities and daily living in the future. They may eventually be bedbound or is the later stages of dementia. The geriatric care manager needs to discuss the move in terms of what the future may bring for the adult child caregiver and discuss whether they feel they can accept this increasing level of care, if they could face caregiver burnout, if there are financial assets to hire caregivers to assist them or should there is a plan that may move the older person eventually to a higher level of care when care needs to increase.

What are the answers?

The GCM can do a GCM caregiver assessment if care needs to be rendered when the parent moves in. This will help the adult child see their strengths, skills, and abilities needed to provide care. This might include their own medical issues preventing caregiver tasks like lifting and tasks that they find and tasks they find repulsive, like changing adult diapers. This assessment can include a care plan that recommends family caregiver solutions, like aging technology, social supports, formal supports, respite, and training.

At my Dad’s funeral, my daughter said, ” we thought we were saving him but is so many ways he saved us. So Happy Birthday Dad you saved all the love for you I might have missed. Thanks for that grace.

Caregiver Assessment- Can it Prevent Caregiver Burnout?

October 3, 2019

Caregiver Burnout is Big Federal Problem

Family caregivers are so many times in a complete state of caregiver burnout. From a policy perspective, the federal government and the long-term care system in the United State cannot afford to neglect the burnout and strain of millions of Americans caregivers any longer.

Despite the rewards caregivers get from giving care we know from years of research that being a family caregiver results in brutal losses. These degradations and deficits include role conflict and overload from the never-ending tasks demanded of a caregiver. Left in a permanent state of worry and anxiety much of the time, caregivers are working in a deteriorating and unpredictable situation.

Caregivers Feel Trapped

Caregivers can feel entrapped by there the restrictions on their own life. They are often beset by fiscal worries because they are not paid except in some states, like California under Medicaid. Yet the caregiving situation explodes in cost through medical bills, medical equipment and informal care that must be brought in, if the family can afford it.

Caregivers Are Not Attorneys

Family caregivers face a quagmire of legal problems including untangling wills, trusts, and inheritance issues which generally complicate care both emotionally and physically. Many times these family caregivers compound their fiscal woes by having to quit their job, running the risk of never being hired again, and that is if they can eventually return to work.

Caregivers Mental Health Ravaged

The caregivers own physical and mental health is often ravaged. They have to do medical tasks that years ago family caregivers never had to do. If they were paid by an agency, this would be a workman’s compensation nightmare for the company, yet these family caregivers are never even paid. So it is time that geriatric care managers and other professionals in aging started to respond to this family caregiver nightmare and use a caregiver assessment every time they assess an older client tended by a family caregiver.

Find out more in the YouTube below from My Geriatric Care 1 Channel.

Caregiver Assessment- When The Caregiver Loses Sense of Self

September 22, 2019

One Homeostatic System

When you assess an older client with a family caregiver, you really have two clients. The needs of the family caregiver are different than the needs of the care receiver and the geriatric care manager or aging professional must differentiate those needs to make sure the care receiver’s functional and psychosocial needs are met. The care receiver and the family caregiver are one homeostatic system encompassing the whole aging family. To keep that family healthy and whole, in the middle of swirling care crisis, the care manager must first recognize that there are multiple clients including the person who gives or supervises care. In a health care insult, family members who give care are often referred to by the inanimate wooden term “ resources”. They have also been referred to as “ informants “.

Stripping Caregivers Personhood

This stripping of personhood denudes them of their status as individuals and melts them into the caregivers, thus breeds professional ignorance, like the crowd who watched the emperor with no clothes. We are blind to caregiver’s humanity and thus their own needs.

Seld-Esteem Vanishes With Caregiving

Many family caregivers lose their self-esteem because they fail at so many other parts of their lives when their whole life seems to be taken up by caregiving. They do not get vacations as the care-receiver does not take a break from illness and aging. Often there are few others to give them respite. Caregivers, often they just do not know where to find help or even ask for it. If family caregivers have children and husbands, they are often squeezed between their needs, the needs of the care receiver – thus have no room for their own needs. They are breathless and slogging forward.

Find out more in the YouTube from My Geriatric Care 1 Channel.

Family Systems Theory key to Caregiver Assessment

September 13, 2019

The reason to assess the caregiver is based on Family systems theory

Care receiver’s ( older client’s )and caregiver’s are a system. Like all systems if you change one part it changes the other part. So if you as a care manager’s repair the caregiver’s problem, like caregiver stress or burnout or no family support from others ,you change the care receiver because they then get better care. The solution a care manager brings to the situation in the form of a care plan- defining the problems and offering solutions almost always involve working with the caregiver to make changes in the situation.

Look at exhausted caregiver Ms. Handy

If a client like our fictitious Mrs. Handy is so burned out from caring for her kids husband and difficult elderly father that she is about to place him you offer coaching to stop that placement. You coach Ms. Handy to ask her family for help. You coach her to be firm about her Dad going to bed earlier not at 1:00 AM when he often wakes her out of an exhausted sleep. How did you the care manager know to do this. You did a caregiver assessment. You fixed both problems with this powerful assessment.

If the problem is that the care receiver can’t remember to take his or her medications, it is usually the family caregiver who either sets up the meds or actually gives them. If those meds involve medications for anxiety on the care receiver’s part this may stop her from calling the family member over and over. So when you the family member tells the care manager that she is being driven crazy by her mother calling over and over, the daughter as caregiver is part of the problem and part of the solution that you as a care manager design. You suggest a medication reminder system and medication reminder service in the mother’s home to solve the problem. You also suggest a call from the daughter to her Mom to assure her she is there.

You are fixing the problem of her mother calling over and over, using the daughter to fix the mother’s problem that then fixes the daughter’s problem (many less calls.)

So using a caregiver assessment has usually a dual result of defining and finding a solution to an interaction between the caregiver and the care receiver.

Check my GCM Operations Manual with the complete service /product of Caregiver Assessment along with 13 other care manager products in a full menu of caregiver products services.

Geriatric Care Management Coaching Needs to be NBA Level in PLayoffs

June 10, 2017

The whole family approach involves ” coaching the family” and using CORE skills that help a family caregiver give better care and allow the family to have a more success in their outcome.Care Manager and geriatric social workers have to be winning coaches or they loose not the game but the opportunity to really help the family.

The desired outcome of the Care Planning process is for care managers to secure agreement to the Plan of Care. Time is needed to engage the senior and their family caregivers in the process in order to help them understand the rationale of the plan. This is a critical stage in the process due to the fact that in spite of the care manager’s skill in developing and presenting a quality Plan of Care, it can all fall apart if those involved do not genuinely agree to it.

Dan Sullivan, the Strategic Coach, Inc.,https://www.strategiccoach.com/our-team/ has said “aging parents do not know how to discuss their economic, medical, psychological, emotional, and lifestyle requirements with their adult children and their children are not confident about broaching any of these subjects. This is causing an expanding number of family-stressful maladies including neglect, estrangement, bankruptcy, poverty, guilt, resentment, and depression.

One important tool that the care manager can offer is the tool as the expert communicator. The value to family caregivers is that the care manager can facilitate often hard to raise issues, opening up the conversation. Family caregivers often feel compelled to take action prior to discussing the situation with the senior. The results are often disappointing. Family members may have different agendas while moving at different paces with differing needs to maintain control. With the care manager’s expertise, they can offer family caregivers insight into the differences. The care managers have the expertise in helping family members communicate in a manner that respects all parties. This process can create better understanding, enhanced empathy, and compassion between family members.

Bunni Dybnis MA, LMFT, CMC Director of Professional Services LivHome, LA
andSteve Barlam Chief Professional Officer, Co-Founder LivHome
MSW, LCSW, CMC, both highly expert care managers, created a seminal chapter on the Tools that a care manager or geriatric social worker need to work with aging families in my book Care Manager’s Working With the Aging They cover these CORE skills in that chapter, including how to see a care plan may be blocked.

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