Cathy Cress

Expert in Aging Life and Geriatric Care Management

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Do You Do Cultural Assessment With an End Of Life Client?

February 13, 2021

 

 

 Each Culture Has Different Customs and Beliefs in End of LifeiStock_000063346301_Medium-1.jpg

There may be cultural differences in end-of-life decision making as a result of underlying cultural values with disclosure of a terminal illness and very critically -use of life-sustaining medical treatment. With the widespread availability of advanced medical technology in the United States, people are encouraged to do everything possible to seek a cure for a life-threatening medical condition or sustain life. However, there are many other cultures for whom quality of life is more important than the length of life.

Other Cultures Do Not Follow US Medical Model ChiCheng_hmpgHdr.jpg

There are some societies, such as Japan, where a terminal illness may not be disclosed to a patient and it is culturally inappropriate to discuss impending or imminent death. For instance, among some Chinese, it is considered bad luck to discuss death because such talk may cause death to occur. Sometimes the ethnic elder is not expected to make healthcare decisions and the responsibility may be based on a traditional family hierarchy. For instance, in many Filipino families, there may be a designated decision-maker who is not the patient (e.g., the oldest son or a daughter or son who is a health professional) and who articulates the wishes of the elder or family.

Some Cultures Follow Religious  Customs and Beliefs in Death & Dying

Other end-of-life decisions are based on religious tenets. In many Catholic immigrant communities, there may be strong resistance to an advance directive because the document would signify a “loss of hope” or be interpreted as suicide, which is against church doctrine. These beliefs may also influence the use of hospice services.

 

Deliver a Good End of Life- Add Death and Dying to Your Care Management Agency

Serve Your Client until Death Do You Part

 

Join me Thursday March 11 and learn why End of Life Services Are a perfect new service for care managers

 

In this 1 ½ -hour webinar you will learn how to

 1.Transition the patient/family through the five stages of death

2.Help clients be active participants in their care

3.Give the family/caregiver tools to manage care

4. Provide family center care to caregiver and family

5. Choose the right support services through all stages of death

6.Introduce Hospice and Palliative care and work with their team

7. Use ALCA End of Life Benefits During COVID

8.Use  COVID -19  Family Coaching for GCM

Sign Up

If you really want to add End of Life to your care management business sign up for this webinar now

 

 

 

 

 

 

 

 

 

Filed Under: Advanced Directives, advanced directives& COVID-19, Aging, Aging Life Care, aging life care manager, ALCA Role Death and Dying, Benefits of ALCA to Hospice, Cultural Assessment, Cultural Assessment Death, Cultural Beliefs in Death, Death & Dying, Death and Dying, Death and Dying Care Management, death and dying care manager, End of Life, End of Life Care manager, End of Life Cultural Assessment, End of life documents, Families, FREE WEBINAR, GCM role Death and Dying, Geriatric Care Management Business, Geriatric Care Manager, Geriatric Care Manager Cultural Assessment, geriatric social worker, Good Death, Hospice, Hospice Care, nurse advocate, nurse care manager, Palliative Care, Palliative care manager, SNF death COVID-19, US Medicalization of Death Tagged With: 5 stages of death, Acceptance Phase of Death, adding end of life services, Aging Life Care Association, care manager cultural assessment, chronic phase of death, COVID-19 Deaths, cultural assessment, Cultural Beliefs in Death, Cultural Customs in Death, cultural diversity, death and dying in COVID-19, geriatric care manager, Hospice at end of life, Palliative Care at end of life, US medicaization of Death

Adding End of Life to Care Management Agency- Advanced Directives

February 7, 2021

slide-worried-manjpg.jpg

When Does A Care Manager Begin if Terminal Diagnosis?

Once the terminal diagnosis is known with an elderly client, the care manager who has added end of life services to their agency is often the one who will initiate and guide advance care planning discussions. As difficult as these discussions may be, the burden on the family is significantly lessened if decisions about advance care planning are made before the client’s condition worsens.

Hopefully, advanced care planning has already been done but many people put it off for fear of death. A recent study found that less than 50% of severely or terminally ill patients had an advance directive in their medical record.

Advance Directives

 Advance directives are legal documents that allow clients to make decisions about their health care and finances in advance of when they are not mentally or physically able to do so. These documents must be signed, dated, and witnessed naming another person to make decisions for you.

Your job as a care manager is the make sure the dying client has these documents:

• A durable power for attorney for healthcare 

• A living will 

• A do not resuscitate order DNR (efforts to restart the heart after it has stopped 

If the client does not have these legal documents and wishes to create them, the Geriatric Care Manager will suggest that the documents be put in place with the oversight and consultation of an elder law attorney.

Deliver a Good End of Life- Add Death and Dying to Your Care Management Agency

iStock_000063346301_Medium-1.jpg

Serve Your Client Until Death Do You Part

 

Join me Thursday, March 11, and learn why End of Life Services Are a perfect new service for care managers

Sign Up 

If you really want to add End of Life to your care management business sign up for this webinar now

In this 1 ½ -hour webinar you will learn how to

 

 1.Transition the patient/family through the five stages of death

2.Help clients be active participants in their care

3.Give the family/caregiver tools to manage care

4 Provide family center care to caregiver and family

5 Choose the right support services through all stages of death

6.Introduce Hospice and Palliative care and work with their team

7 Use ALCA End of Life Benefits During COVID

8.Use  COVID -19  Family Coaching for GCM

Sign Up 

If you really want to add End of Life to your care management business sign up for this webinar now

 

 

 

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Filed Under: advanced directives& COVID-19, Aging, Aging Community & Covid-19, aging family crisis, Death and Dying, Death and Dying Care Management, End of Life, End of Life Care manager, End of life documents, Hospice, Hospice Care, Palliative care manager Tagged With: adding end of life services, Advanced Directives, aging life care manager, death and dying, death and dying in COVID-19, durable power of attorney, end of life, end of life care, geriatric care manager, Hospice at end of life, Navigation through END of LIfe

11 Parts of Care Manager’s Role With Family Death and Dying of COVID-19?

February 4, 2021

 

GCM Role is Working With Family In COVID-19

Care managers cannot be in the hospital with a  patient dying of COVID-19. They can support their bereft adult children, who cannot see their parents during the hospitalization, in those last moments of goodbye’s or after the death in this deadly pandemic.

In normal times care managers play a big role in end of life issues. They are their navigators through all five stages of dying, many times long before palliative care or hospice are called. Often GCM’s can help the family and client to bring in hospice or palliative care. But is COVID -19 they can offer guidance to the family through the sometimes weeks of hospitalization, intubation, their loved one is on a ventilator and ultimately often- death separated from loved ones.

Navigation Through a COVID-19 Death

 The normal final passage through life can emotionally charged.  If the family is following a long labyrinth to the end, in coronavirus, the blind alleys may be blocked by a rushed hospitalization, banned from seeing their loved one in the hospital, and not understanding the disease that is killing their loved one.

Care managers can find an opening through this maze.  Family dynamics and fear of dying can all explode a fraught crisis of care in dying of coronavirus. When vital end-of-life decisions need to be made, the stress of the responsibility and the seriousness of the situation can break into a mammoth wave of distress fear, and anxiety over the “ whole family system”. The geriatric care manager specializes in solving these end of life decisions for whole family system even at the end of life.

Facilitate Family talks over hospitalized COVID-19 Elder

Care Managers can facilitate terrified discussions outside the hospital, and clear the way for family members to come together to work as a functional unit around an unknown killer disease that preys on their loved one. Understanding the differing viewpoints is critical.  Knowing what a parent wants and does not want during the last days and hours of life help define and simplify the role of the family.  It helps the family bear the burden of having the responsibility of making decisions that their parent wants. Turning this around can also help families have some solace that they carried out their parent’s wishes after their parent’s death. 

 

Care managers can help family members handle the stress of an elder’s hospitalization and death by:

  • Encouraging routines, exercise, and social connectedness with friends and family
  • Advocate for them with the hospital staff to get updates in this chaotic time in hospitals
  • Help them maintain contact with the” hospital quarterback “ to get updated medical status and give input
  • Find technology for the family to communicate with the hospitalized family member  via text, telephone, email, or video chat
  • Support and mediate if necessary proactive discussions and advanced directive preparation in a rush if not done
  • Build a circle of care can help to reduce some of the potential conflicts,
  • Support them in having essential conversations, prior to needing  intubation, on last wishes if health status deteriorates  
  • Provide opportunities to say goodbye via technology
  • guide them in setting up rituals that can celebrate the end of life and give solace to a family during a time when there are yet no rituals for a COVID-19 death.
  • Work with the hospital to set up Zoom with the family to say goodbye to a loved one. 
  • Geriatric care managers do much more with clients and families but especially now with Covid-19 elder’s and their families facing a  separated, fractious end of life
  • Deliver a Good End of Life- Add Death and Dying to Your Care Management Agency

     

    Join me Thursday March 11 and learn why End of Life Services Are a perfect new service for care managers

     Sign Up   

    In this 1 ½ -hour webinar you will learn how to

     

    1.Transition the patient/family through the five stages of death

  • 2.Help clients be active participants in their care3.Give the family/caregiver tools to manage care

    4. Provide family center care to caregiver and family

    5 Choose the right support services through all stages of death

    6.Introduce Hospice and Palliative care and work with their team

    7. Use ALCA End of Life Benefits During COVID

    8.Use  COVID -19  Family Coaching for GCM

    Sign Up 

    If you really want to add End of Life to your care management business sign up for this webinar now

     

     See more about Cathy and her book Care Manager’s Working With The Aging Family

  • DyingGriefandBurial in the AgingFamily

Filed Under: Advanced Directives and Covid-19, Aging, Aging Community & Covid-19, Aging Life Care, aging life care manager, ALCA COVID-19 Crisis, ALCA Role Death and Dying, Blog, care manager, case manager, CIRCLE OF CARE, coronavirus, Coronavirus emergency plan, coronavirus shut down, Covid 19, COVID-19 & Care Management, Covid-19 Death, Death and Dying, Death and Dying Care Management, death and dying care manager, elder care manager, End of Life, Families, FREE WEBINAR, GCM role Death and Dying, GCM Working With Aging Family, Geriatric Care Management Business, geriatric care manager, Geriatric Care Manager, geriatric social worker, Good Death, nurse care manager, Therapist Specializing in Aging Tagged With: adding end of life services, aging life and geraitric care manager, death and dying, death and dying in COVID-19, Death and Dying in hospital, end of life care manager, geriatric care manager, Hospice at end of life, Hospice Care, hospice for elderly parent, Navigation through END of LIfe, Palliative Care at end of life, Technolog COVID-19 in Hospital, Tools to manage end of life

What Is a Care Manager’s Role in the Hospital during COVID in End of Life

February 2, 2021

Care managers cannot meet dying  COVID-19 patients and their bereft children in the emergency room or Hospital. They are not allowed in due to COVID restrictions. However, care Managers play a big role in end of life issues, while family remains in the community and the client is isolated from them in the hospital.

Procedures for the family when loved one in the hospital.

The care manager was help by

1.creating a communication plan from the outset and figuring out who’s the “medical quarterback” in charge of monitoring a loved one. Typically, this is a specialist, such as a hospitalist, critical care medicine doctor, or intensivis2.

 2.Facilitating family meeting for family while loved one in the hospital

3.Suggesting technology family can use to communicate with loved one and with other family members or friends

4.. Help family understand the part family can play I admissions- preparing a go binder ahead of time etc.,

  1. By designating one person to speak for the whole family- the process to improve family getting information from overloaded hospital staff

6 Preparing family & loved one’s medical team for communication death in the hospital – what care manager can do to assist

7.. Supporting the family member when they are dying while not being present

8.. Bereavement of family post-death- use of hospice

Care Managers are their navigators through all five stages of dying

They many times can introduce palliative care or hospice and often GCM’s can help the family and client to bring in hospice or palliative care long before the average time, which is the last month or 15 days before death.

 The final passage through life can be emotionally charged.  

If the family is following a long labyrinth to the end, the blind alleys may be blocked by cultural, religious, and moral beliefs and now COCID -19 regulations. Care managers can find an opening through this maze.  Money, family dynamics, and fear of dying can all explode a fraught crisis of care in dying. When the important end-of-life decisions need to be made, the stress of the responsibility and the seriousness of the situation can break a wave of distress fear and anxiety over the “whole family system” the dying elder. The geriatric care manager specializes in this whole family system.

 Care Managers can often help facilitate throbbing discussions

They can facilitate family members coming together to work as a functional

unit.  Understanding the differing viewpoints is critical.  Knowing what a parent wants and does not want during the last days and hours of life help define and simplify the role of the family.  It relieves the family of the burden of having the responsibility of making decisions that may not be what their parents want. Turning this around can also avoid family conflicts when adult children may have differing values.

Helping family Legally plan for Death

 Proactive discussions and legal planning building a circle of care can help to reduce some of the potential conflicts. Good legal guidance can also help to pay for care when an adult child wants to finance in-home care. They can point the family to legal guidance to prepare end of life documents, that are so important, especially now with COVID when death can come so quickly but geriatric care managers do much more with clients and families who are facing the end of life

 

 

Free Webinar-Deliver a Good End of Life- Add Death and Dying to Your Care Management Agency

 

Serve Your Client until Death Do You Part

 

Join me Thursday March 11 and learn why End of Life Services Are a perfect new service for care managers

 

 In this 1 ½ -hour  FREE webinar you will learn how to

 

 

1.Transition the patient/family through the five stages of death

2,Help clients be active participants in their care

3.Give the family/caregiver tools to manage care

4 Provide family center care to caregiver and family

5 Choose the right support services through all stages of death

6.Introduce Hospice and Palliative care and work with their team

7 Use ALCA End of Life Benefits During COVID

8.Use  COVID -19  Family Coaching for GCM

Sign Up 

If you really want to add End of Life to your care management business sign up for this webinar now

 

Gwendolyn LAZO Harris MA, CT,Seniors at Home , San Francisco and Diane LeVan MA both highly expert care managers, created a seminal chapter on Palliative Care and End of Life Care Manager in my book Care Manager’s Working With the Aging Family 

Filed Under: Aging, Aging Life Care, aging life care manager, Blog, care manager, case manager, Death and Dying Care Management, death and dying care manager, elder care manager, Families, Geriatric Care Management Business, Geriatric Care Manager, geriatric care manager, geriatric social worker, ife care manager, nurse care manager Tagged With: 5 stages of death, adding end of life services, aging family, aging life and geraitric care manager, aging life care manager, aging parent care, aging parent crisis, ALCA COVID benefits, death and dying, death and dying in COVID-19, disputes at end of life, elderly at end of life, end of life care manager, end of life family meeting, Fighting and Feuding at end of life, GCM Family Coaching end of life, geriatric care manager, Hospice at end of life, Hospice Care, hospice for elderly parent, nurse advocate, nurse care manager, Palliative Care at end of life, support services in death, Tools to manage end of life

Avoid Aretha Franklin’s Fate- Help Elders at Risk of Covid & Prepare End Of Life Docs Fast

January 30, 2021

Preparations for Death a Hard Step for Some

Everyone must prepare for the end of life. When Aretha Frankin died a tribute to her was an armada of 100 pink Cadillacs at her funeral. But in spite of the glittery homage to her storied life and career, she died without a will.

According to Aretha’s ‘lawyer, Ms. Frankin was aware she needed to take care of this but ” never got around to it”. This left her estate liable for potentially millions of dollars of taxes and attorney fees and a drawn-out timeline for her 4 sons to inherit the proceeds from her estate.

Franklin was, as many have said, ” a force of nature” and a woman who would be hard to sway. But care managers specialize in working with VIP clients and the rich and famous. These clients are often uber difficult to work with- entitled, narcissistic equally hard to sway. Aretha Franklin’s attorney might have convinced her that she needed to work with him to protect her family and her estate before she died.

In the Year of the Plague Care Managers Preparing Clients For Death  More Urgent

You as a care manager must take a more urgent  approach by yourself or with the client’s attorney because the stakes are so much higher as now elders are likely to die with this virus rampaging throughout the world, striking the people with comorbidity, like people over 65, the hardest

Most geriatric care managers work with the wealthy top 10% if they want to survive as a business as Medicare does not cover long term care. Only the top 10%, like Aretha Frankin, can afford it. But what comes from being a good care manager is knowledge of death. End of Life care is one of their jobs.  Making sure their client has all their legal documents ahead of time is critical at this minute. With COVID-19 that clock runs on speed.

, these documents- one a living will- are an important job of the geriatric manager, as death

may be shrouded and waiting around the corner for many of your clients 

Advanced  Care Planning Discussions In Covid Critical

Once the COVID-19 is known with an elderly client, the care manager who has added “end of life services” to their agency, is often the one who will initiate and guide advance care planning discussions. The problem with COVID-19 is that the onset of the disease can be rapid.  As difficult as these discussions may be, the burden on the family is significantly lessened if decisions about advance care planning are made before the client’s condition worsens.

Hopefully, this has already been done but many people put it off for fear of death. A recent study found that less than 50% of severely or terminally ill patients had an advance directive in their medical record.

Advance directives are legal documents that allow clients to make decisions about their health care and finances in advance of when they are not mentally or physically able to do so. These documents must be signed, dated, and witnessed naming another person to make decisions for you.

Your job as a care manager is the make sure your older client has these documents before they have COVID-19:

  • A durable power for an attorney for healthcare 
  • A living will
  • A do not resuscitate order DNR (efforts to restart the heart after it has stopped

 If No Advanced Care Documents & COVID Strikes Elders Wishes Unfulfilled

If the client does not have these legal documents and wishes to create them, the Geriatric Care Manager will suggest that the documents be put in place with the oversight and consultation of an elder law attorney.

But During Covid-19 could rush an elderly client towards death like a mammoth mudslide sweeping them into a hospital where no one can enter, even the family.

Care Managers play a big role at end of life issues. They are their navigators through all five stages of dying, which is the time before COVID-19 could be long before palliative care or hospice are called. 

 

But in this plague reign, there is little time to plan so the five stages of death are on steroids. So, talk to your clients now before they get into a screaming ambulance to the hospital where no one can follow the including you, and may never return.

GCM Care Planning Stope Elders From Dying Without a Will Like Aretha Franklin

 Proactive discussions and legal planning now can help to reduce the risk of dying like Frankin leaving the legacy of her music, a soundtrack to her life but a family both shattered and at war with each other. The COVID-19 clients you see now could be in this position and their families will be left with no rituals no funeral no advanced directives and only hopefully a zoom family meeting to say their last words. Good legal guidance can also help clients make better decisions,  avoids all this other legal horror on top of the torturous death of coronavirus. Making a will or a trust now will save the family from adding to the burden of a lonely painful death.

SIGN UP FOR MY LATEST FREE WEBINAR

Deliver a Good End of Life- Add Death and Dying to Your Care Management Agency

 

Serve Your Client Until Death Do You Part     

S

 

Join me Thursday, March 11 and learn why End of Life Services Are a perfect new service for care managers

 

 

In this 1 ½ -hour webinar you will learn how to

 

 

1.Transition the patient/family through the five stages of death.   

 

2.Help clients be active participants in their care

3.Give the family/caregiver tools to manage care

4 Provide family center care to caregiver and family

5 Choose the right support services through all stages of death

6.Introduce Hospice and Palliative care and work with their team

7 Use ALCA End of Life Benefits During COVID

8.Use  COVID -19  Family Coaching for GCM

Sign Up

If you really want to add End of Life to your care management business sign up for this webinar now

Recommendations

 Cathy is a great consultant who has helped me remain focused and balanced while developing my business and juggling other responsibilities.   I highly recommend using the operations manual as a guide for businesses, especially startups.   Also, tools such as Cathy’s competition survey, marketing survey, and Cathy’s book entitled Handbook of Geriatric Care Management are great resources to use now and future.  Cathy is the business coach/business consultant I needed.  I will always be grateful for the time and money she saved me during this process.  Thanks, so much Cathy for all that you do!  I appreciate you!

Patrice Harrison LMSW, IPR

 

 

 

 

Presented by:
CATHY CRESS, MSW

 

 

Filed Under: Aging, Aging Family, aging family crisis, aging life care manager, Aretha Franklin, case manager, Concierge Senior, coronavirus, Coronavirus emergency plan, coronavirus shut down, Covid-19, Death and Dying Care Management, death and dying care manager, DNR, elder care manager, Elderlaw Attorney, End of Life Care manager, End of life documents, Geriatric Care Management Business, Geriatric Care Manager, geriatric care manager, living will, nurse advocate, nurse care manager, Quality of Life in Dying, Wealth Management Departments Tagged With: Advanced Directives, aging life and geraitric care manager, aging parent crisis, coronavirus, coronavirus and seniors, COVID_19, COVID-19 Deaths, COVOD_10& Advanced directives, death and dying, death and dying in COVID-19, geriatric care manager, Hospice Care, hospice for elderly parent, nurse advocate, nurse care manager

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