barrier to caregiver assessment Archives ⋆ Cathy Cress

Can a Caregiver Assessment Avoid UnnecessaryPlacement ?

April 9, 2021

When a Caregiver is so Overwhelmed that A SNF is a Choice but a Very Bad Choice

If the family is so overwhelmed by the care that they are considering placement, this threat should trigger the GCM to do a caregiver assessment immediately, found in the Handbook of Geriatric Care Management If the GCM is called to relocate an older person and the underlying cause seems to be caregiver burnout, this can be another trigger to use this valuable GCM tool. By using a caregiver assessment the geriatric care manager may find that building respite for the caregiver, through other relative or paid caregivers, a caregiver support group, or coaching the caregiver to make changes that make her/ his tasks more bearable and doable and avoid inappropriate placement of the older person

Avoid Elder Physical Abuse Though a Caregiver Assessment

If caregiver abuse is suspected, a caregiver assessment is a critical immediate tool. This is a situation where the GCM must contact Adult Protective Services, following their own state’s laws. Elder abuse can be triggered by caregiver stress in some situations. Depression that reaches a clinical level in a caregiver can be predictive of elder abuse of an elderly client can prompt a GCM to do a caregiver assessment. You should also do a geriatric depression scale at the same time. Use the GDS and the caregiver assessment to help both the caregiver and the care receiver and avoid the risk of physical abuse and prevent involvement of APS making the caregiver and care receiver’s lives even more painful and chaotic and risking placement in a nursing home.

Mrs. Handy has Two Dads in Her Head

Let’s take the example of Mrs. Handy, a caregiver daughter caregiver She calls a GCM as she is about to place her Dad. Besieged by so many other stressors, her own health is deteriorating because she cannot get any sleep, due to her Dad going to bed so late and her inability to rise above her old self when her Dad was 40 and she was 19 and what he said she did. Now he is 70, very impaired with vascular dementia, incontinent and she needs to be who she is in the here and now a woman of 40, caring for an impaired Dad in her 70’s. The care manager coached her to set a new boundary for him to go to bed early. She needs help in getting rid of the old parent in her head and putting the 70-year-old demented incontinent parent before her. In addition, she sees her doctor for depression, joins an online caregiver support group, and asks siblings in other towns to take her Dad once a month for a week. Her Dad is not moved to skilled nursing. This is what a geriatric care manager can do for her to help avoid unnecessary placement.

Find out more on my playlist “Caregiver Assessment” on My Youtube channel Geriatric Care

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.

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 MSSP.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 door

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

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.

Are Caregivers Themselves Barrier To Caregiver Assessment?

February 27, 2015

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A caregiver can be one of the biggest barriers to doing a caregiver assessment. A trigger for a care manager to do a caregiver assessment is at the initial intake, when you begin services with the client. You will do a psychosocial and functional assessment on the care receiver and ask to do a caregiver assessment next visit, if the caregiver shows sign of stress and burnout.

But a large barrier to doing a caregiver assessment is whether the family caregiver will pay for this additional assessment process. In the initial intake visit, the GCM agrees contractually to assess the older client. To take this extra step and assess the caregiver makes the process more nuanced and expensive.

The caregiver may balk at both time and cost. One roadblock here is that many caregivers do not see themselves as caregivers but as family, so they may find the assessment confusing and unneeded. Often they do not see themselves as part of the client problem, but the major solution, so assessing them may be rejected. Caregivers also classically neglect themselvesand their own health in favor of the care receiver and so may balk at spending extra money to repair their own safety net.