caregiver burden Archives ⋆ Cathy Cress

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

What are the 3 Steps to Do a Caregiver Assessment?

October 12, 2019

Where Do You Do A Caregiver Assessment?

Caregiver assessment is best done in the care receiver’s home so you can actually observe the care. It is best completed out of earshot of the older person who is cared for so the caregiver can feel free to talk openly. As caregivers suffer high levels of stress, giving them a separate space to share their feelings is an important part of the caregiver assessment. However, the caregiver assessment should be done in a place that is convenient to the caregiver, which could be a donut shop, the home, or any comfortable venue. If to do the caregiver assessment the GCM must arrange respite, like bringing in another family member or paid caregiver, then that is another way to make this assessment go forward.

How Will A Genogram Help A Caregiver Assessment?

A genogram also helps the GCM assess whether any extended family and friends will make suitable and emotionally appropriate caregivers or not. For example, if a son has a historically strained relationship with his father, is he a good choice as a caregiver? The genogram helps to assess this old family tension and helps the GCM decide with the family as to who can really be good caregivers.

How Does a Psychosocial Assessment Bolster a Caregiver Assessment?

In addition, a psychosocial assessment, done at intake or updated as more care is needed, assesses key abilities and availability of the extended network of family caregivers. The psychosocial assessment illuminates the client’s financial status, including income, assets, benefits currently being received, health and long-term care insurance coverage, and eligibility or potential eligibility for entitlement programs. This information helps the GCM assess whether outside paid care providers can be afforded if needed to replace a family caregiver. The psychosocial assessment also tells about the family, formal and informal support networks, present and potential caregivers, and cultural variables.

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

Innappropriate Threat of Placement =Caregiver Assessment

September 30, 2019

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 for 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 at the same time.

Mrs. Handy has Two Dads in Her Head

Mrs. Handy our caregiver in many other blogs is about to place her Dad because she is 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. She needs to set the boundary of him going to be 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. This is what a geriatric care manager can do for her to help avoid unnecessary placement.

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.

Caregiver Assessment – Ms. Handy the Burnt out Caregiver

September 16, 2019

The Dutiful Daughter Syndrome

A caregiver assessment can reveal the problems of the dutiful daughter syndrome of who daughters take on all the care because in her family ” that was just her fate” . When the caregiver assessment reveals overload, depression, and or burn-out or a caregiver is thinking of placing an elderly parent inappropriately , then the GCM should come to the rescue with alternatives

GCM Coaching Skills Needed

One other choice can be the GCM using coaching skills to help the main caregiver ask adult brothers and sisters for help. Often the communication between brothers and sisters involving parent care is very poor and weak. Sisters especially need help in asking assistance from brothers, and all need help in asking for assistance from estranged siblings. After the help is requested, coaching siblings to say, “Thank you, and I love you,” and then to set up the new caregiving system, which is an expanded circle of care, is a primary GCM job.

Coaching Sharing the Care Between a Family

The issue of how the family can fairly share the caregiving with the primary family caregiver may be a key issue that can be discussed after a caregiver assessment. To offer the main caregiver respite, periodically one family member could take the care receiver for a weekend. Another may foot the bill for formal paid caregiving rather than do direct care; one may handle all bill paying using an online bill-paying account and have the care receiver’s mail forwarded to them.

One family member could manage a social media group, like a Facebook page, or organize a chat room dedicated to the older adult where friends can communicate with the person. One family member could set up a caregivers’ sharing site such as through Lotsa Helping Hands . One may do a family newsletter summarizing the caregiving month. A family member or friend who is tech savvy could set up all caregiving websites, calendars, emails, and videoconferencing needed by the family. One family member could manage ongoing house repairs for the care receiver. The idea is to be creative, meet the care receiver’s needs, and divide tasks up so that long-distance and local family members can share the tasks according to their abilities, skills, time available, location, and preferences. This is called striking a balance in the family.

Watch Ms Handy Almost Going Over The Edge

Watch my YOU TUBE channel to how GCM coaches Ms, Handy , after a caregiver assessment , when she requested help as an overwrought family caregiver who is is going to place her Dad because she cannot ask for help.