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Archive for the ‘
Seniors And Aging ’ Category
Introduction
Studies have shown that caregivers of individuals with Alzheimer's disease are at an increased risk of mental and physical problems as a result of the strain that accompanies this role. Researchers have focused on the stress, sense of burden, and depression that caregivers experience. Little reference has been made to the feelings of grief and loss reported by caregivers.
1). What makes Alzheimer's caregivers sense of loss different from others? What is ambiguous grief?
Unlike the losses that caregivers of individuals with different illnesses encounter, caregivers of individuals with Alzheimer's disease experience losses over a longer duration of time (for some 20 years) and many of these losses are not socially recognized or addressed causing a situation of disenfranchised grief.
Caregivers of individuals with Alzheimer's disease and related dementia experience loss starting with the first symptom of the disease. Losses in the areas of communication, socialization, shared memories and the future, intimacy, roles and relationships, and a sense of normalcy have been identified in the literature as most commonly experienced by caregivers. These losses stem from the unrelenting cognitive changes that are occurring in the person with dementia.
Also, many caregivers are so focused on the tasks of caregiving (i.e. addressing activities of daily living) that they do not recognize these losses in their own life and the impact that unaddressed grief may be having on them.
Pauline Boss coined the term ‘ambiguous loss' to describe losses that possess some degree of uncertainty and force people into questioning their status with the lost object. For caregivers of individuals with dementia, they are faced with the fact that the individual with dementia is, as Boss stated, physically present, but psychologically absent. Thus, the familiarity with the diagnosed individual and what was once normal or standard within the relationship is suddenly changed. Therefore, caregivers may say, "This is not my husband even though he looks like my husband" or "My mother would never act like this", which all represent the ambiguity that has not engulfed their relationship with the diagnosed individual.
2. Does the caregiver experience a sense of loss when the person they are caring for is first diagnosed with Alzheimer’s disease and how does this sense of loss change throughout the disease?
Research has examined how grief changes throughout the course of the disease. Ponder and Pomeroy (1996) were the first to examine differences in grief at different stages of the disease. They suggested that grief is high following the diagnosis and then declines during the second through fourth years of the disease. Following the fourth year, the grief of caregivers tends to increase.
Meuser and Marwit (2001) were next to examine differences in grief at different stages of the disease. They found that grief, particularly in spouses was highest during the final stages of the disease. Similar findings were reported by Ott, Sanders, and Kelber (2007) who found that as the severity of the disease increased, the grief of caregivers also became more severe.
Every caregiver is different and will respond to the losses associated with the disease in unique ways. However, it is important to recognize that many caregivers do not associate what they are experiencing as loss; instead, they lump it into the broad categories of burden, depression, and stress. It has only been in the past 10 years that people have started distinguishing the experience of grief from these others experiences (see Meuser, Marwit, & Sanders, 2004).
3. What is the difference between depression and grief?
Many people confuse grief and depression because the symptoms can be quite similar. However, there are distinctions that are important to emphasize.
First, grief has a temporary impact on the individual, while depression can lost longer periods of time. This is not to diminish the impact of grief and the fact that individuals are forever changed as a result of the loss, but usually a grieving person is able to resume qualities of their life pre-loss overtime, while individuals with depression may have their overall level of functioning impacted to a greater extent for a longer period of time.
Second, grieving individuals are able to attribute their feelings of sadness and hopelessness to the loss, while individuals who are experiencing depression may not be able to identify the root causes of their feelings and mental health.
Third, grieving individuals are still able to enjoy and find satisfaction in certain aspects of their lives. While finding these activities may be challenging, once they are identified they are found to be helpful. Individuals who are depression may experience difficulty finding joy and satisfaction in any aspect of their lives.
Finally, an individual with depression may experience significant relief from pharmacological treatments. While these treatments may temporarily help a person with grief, they will not take away feelings of grief. For some individuals it actually prevents the grief work that is needed to occur, only prolonging grief reactions.
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To find a social worker in your area who can help you with these caregiving issues like these, please click here.
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Introduction
John D. Weaver, LCSW, BCD, ACSW is a founding partner of EYE OF THE STORM, Inc., a private consultation and education group practice specializing in disaster mental health, crisis intervention, and risk management related training and support. Weaver has been an active volunteer with several organizations including the Mental Health Association and the American Red Cross (ARC). He has assisted at several local and national disasters.
Q. I’m about ready to retire but I’m not sure if I should go now or stay on a bit longer, to pad my retirement savings a bit more. Any advice?
Folks generally reach a point in their careers when they realize they have retirement open to them as a serious option. Some clues that you’re there? Work you once loved and/or tolerated well is not as appealing to you. Paperwork is becoming overwhelming. It is harder than ever to leave work and/or thoughts about work at work. You are having trouble relaxing and unwinding. Work stress is starting to take a physical and/or emotional toll on you and your family. You find yourself checking your retirement nest egg more often. Bottom line – you will know when it is time to go.
Q. But I can’t go, I love my job (most of it anyway). I’d miss ______ (fill in all the good stuff). What will I do with myself all day?
Retirement gives you extra time to do the things you enjoy (e.g., read, travel, exercise, socialize, watch TV, garden, visit family, cook, enjoy recreational sports, etc.). At the same time, it gives you more time to do things that aren’t always fun (e.g., cut the grass, clean, paint, get that surgery you’ve been putting off, visit family, and other things you’ve been putting off). As long as you are able to strike a balance between time spent having fun and time spent doing things you have to do, you’ll be fine.
Q. My partner tells me that, when I retire, I can’t just hang around the house all day. I guess that would drive us both crazy, right?
Right! Both of you need to keep busy, sometimes together and other times by yourselves. The list above contains a nice mix of things that can be done solo, done with friends, and/or done with your partner. Also, consider working part time (if you need some extra money) and/or volunteering.
Either way, it will keep you busy and that will keep you from getting tired of each others company.
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To find a social worker in your area who can help you with retirement issues, please click here.
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Introduction
Kathy Black, PhD, MSW, MPH, MSG. is a Hartford Geriatric Social Work Faculty Scholar and Associate Professor at the School of Social Work, University of South Florida Sarasota-Manatee campus. Dr. Black's areas of expertise include advance care planning throughout the end-of-life, advance directives, healthcare professional communication, and aging-in-place.
Q: What is Aging-in-Place?
A: Aging-in-place refers to people getting older in their "home," or the place where they live and wish to continue to reside. The majority of older adults wish to remain in the homes they have lived most of their lives and many do; in fact most people age 65 years and older live in non-institutional settings and own their own homes.
Q: How can I Age-in-Place?
A: The ability to remain at home generally depends on several factors. Ask yourself the following questions to see if you are prepared to age-in-place:
- Personal health status and needs: Do physical or mental limitations affect your ability to manage at home? Are you able to get your health needs met at home?
- Family and other informal supports (such as friends, church, etc.): Who will provide care for you if and when needed? Is the caregiver capable of providing the care you need?
- Economic circumstances (including finances and insurance): Do you have enough money for care that you may need to stay at home? Home care services can be expensive and are generally not covered by insurance. Know that Medicare provides limited short term home health care at home under specific circumstances and that Long Term Care Insurance may not meet your home care needs.
- Physical home environment: Are you able to get around in your home? Stairs and the lack of bathrooms may impact your ability to stay at home. Although available, home modifications to add a ramp or bathroom can be costly. Also important to consider: Can you maintain your home? Home repairs can be costly, difficult, or unsafe. Have you considered where you might move to if unable to stay at home? Many assisted living facilities and other care settings have waiting lists.
- Broader community of services: What services does your community offer to help people age-in-place? Communities vary in available services; some services may be free or low cost or covered by insurances such as Medicaid, while others are not; many have waiting lists. Your state and local government may provide some services, while others are private or for-profit. Eligibility for services also vary.
Q: What services are available to help me age-in-place?
A: There are a wide range of services to support aging-in-place; however, the availability of services will depend on where you live. Generally, examples of services to help remain at home include:
- Basic homecare: having someone in to make a meal or clean the kitchen;
- Home healthcare: having someone come in to provide personal care or specialized medical care;
- Home maintenance: hiring someone to take care of the lawn;
- Transportation: accessing a ride to and from a doctor's visit;
- Home-Delivered Meals: free or low cost meals delivered at home.
Needing a variety of services is not uncommon, however it is often difficult to learn about, access, and manage the range of services you might need. Geriatric case managers are professionals employed in public and private settings to assist you in accessing and managing the care you might need. You can access public case managers through many of the governmental programs offered in your area.
Private geriatric case managers can be reached through such organizations as the National Association of Professional Geriatric Care Managers, 1604 N. Country Club Road, Tucson, Arizona 85716, 8:00 a.m. to 4:30 p.m., Mountain Standard Time (all year round; Arizona does not observe Daylight Savings Time), Monday through Friday, except holidays. Telephone number is (520) 881-8008; fax number is (520) 325-7925. Voice mail allows you to leave messages 24 hours a day, seven days a week, or via the Web site at: http://www.caremanager.org/
To learn more about services in your community, please contact the Administration on Aging's Eldercare Locator to begin your search for services to help you remain independent in your community. You can reach an Eldercare Locator information specialist by calling toll-free at 1-800-677-1116 weekdays, 9:00 a.m. to 8:00 p.m. (ET). Spanish-speaking Information Specialists are on duty. You may also access the service via the Internet using the following link, http://www.eldercare.gov/Eldercare/Public/Home.asp.
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Introduction |
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How Can Someone Help a Person Who May Be Struggling Aging? |
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Questions to Ask When Hiring a Geriatric Care Manager |
Many times older relatives experience a slowing of some aspect of their lives – be it in the functional, or social, or mental realms. Perhaps they are having a hard time making it up the steps everyday, getting out of the house more than once a week, or being confused about the simple data facts of the day (such as date, day of the week).
Not knowing the resources for elderly persons can be worrisome. Development of a plan is not interfering, but rather proactive and necessary. Communicating concerns is vital to the health and welfare of elderly family members.
A geriatric care manager can be of great service. According to the National Institute on Aging, geriatric care managers are professionals who have multidisciplinary insight into key medical, functional and social issues important to the care of older individuals with complex medical and social problems. Just as one might go to a lawyer to draw up a will, or an accountant to prepare taxes, there are professionals who are skilled in the art of comprehensive assessment of seniors in their diversity of circumstances, have a broad knowledge of the range and variety of resources locally, are trained in counseling and crisis intervention skills, and are able to make all this information practical in action.
When seeking support from a geriatric care manager, find someone who belongs to the Association of Professional Geriatric Care Managers, as well as the National Association of Social Workers. Not all geriatric care managers are social workers, but as they are trained in support, resource development, advocacy and counseling, they are the ideal professionals to be providing geriatric care services. When looking for a geriatric care manager, find someone who knows the area in which the elderly person lives.
As the job of the geriatric care manager is not just to support the "senior", but to also give familial and friend support, meet with the care manager to discuss the next steps to take. A good geriatric care manager will make sure there is support, education, and advocacy. A good geriatric care manager will be available when needed, meaning they are schooled in crisis intervention. A good geriatric care manager will bring tools and strategies on how to deal with the situation. And a good geriatric care manager is compassionate.
Be aware though that hiring a geriatric care manager can be expensive. Occasionally, a long term insurance plan may help pay for geriatric care services, but generally, payment will be out of pocket. Many times, however, only one or two sessions may be needed to resolve a situation.
Geriatric care managers can be especially helpful in situations where an aging loved one lives far away. They can be your eyes and ears, and most helpfully, they can be the planner when it comes time to either get help in the home, or when relocating a loved one to a facility where the he or she will receive more support.
The Association of Professional Geriatric Care Managers maintains a Web site where one can identify a geriatric care manager by zip code. Geriatric care managers are familiar with working with each other to accomplish tasks for their clients.
The Association of Professional Geriatric Care Managers recommends asking specific questions when hiring a geriatric care manager.
- What are your professional credentials?
- Are you licensed in your profession?
- Are you a member of the National Association of Professional Geriatric Care Managers?
- How long have you been providing care management services?
- Are you available for emergencies?
- Does your company also provide home care services?
- How do you communicate information to me?
- What are your fees? (These should be provided to the consumer/responsible party in writing prior to rendering services)
- Can you provide me with references?
Some geriatric care managers provide written information, make recommendations of books to read, or groups in which to get involved, and advise on agencies or companies that can give support. The key is the provision of comprehensive services. On all levels – physically, mentally, emotionally, and spiritually, utilizing a geriatric care manager can bring peace of mind to all parties concerned.
Sometimes, in order to have tranquility, attend to those practical matters in life. Allow a professional geriatric care manager to assist on that journey.
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A great deal is written about how to age well. The following ideas are simple and easy to learn. Try to incorporate a few of these ideas and see what a difference it may make in your everyday life.
To stay vital our minds need new information to chew on and digest, which is easier to do when we are young. Family, schools, and communities all have a hand in providing enriching experiences, but as we grow older, more of the decision making falls upon ourselves.
Some people begin to lose ground in this area as young adults because they let life happen rather than taking an active role. You want to challenge yourself even when new things make you feel a bit uneasy. Try to think of that feeling as excitement.
Push ahead in spite of your reluctance and you will feel positive results. Take a class at the community center or take the train to the city for the day. Step out of your regular routine as often as you can, you may be happy you did.
When a person's life is going well, there may be little need to do any reexamination. When younger, people tend to be more open to discussing thoughts and plans. As one gets older, this process, for some reason, slows.
Talk more about life goals and objectives. During those times when things are going well take the opportunity to think and make adjustments. Tackle an old problem from a new angle or decide to speak up about a situation that has been troublesome. In doing so, people often develop some new ways to look at the world and better ways to cope.
Do as much for yourself as possible and stay active using personal physical resources. Internal strength comes when physical abilities are maintained. It is empowering to manage daily tasks and be a help to someone else. Human bodies adjust to individual activity levels.
Everyone is unique. During the aging process, more losses are experienced and it is important to stay as positive as possible given personal circumstances. Everyone has limitations and burdens. Deciding how to deal with them is a personal choice each day.
Make a conscious choice to focus on good things. Some days are harder than others but people are only given one day at a time with which to deal. Limit your worrying and use thought-stopping techniques to get negative thoughts under control. Distracting activities such as calling a friend, reading or listening to music can often help limit worrisome thoughts.
Everyone needs a reason to get up in the morning and move forward with a positive heart. Running on auto pilot each day creates a rut. If unhappy, ask why. Ask yourself "If I could change one thing, what would it be and why?"
The changes can be small but even small changes can make a difference. Consider helping a friend with a project or call the local food pantry to schedule time to help sort and stock shelves.
Only few meaningful connections are needed in life. Prioritize how time and energy is spent. Time is precious. Many times, what was once meaningful, now feels burdensome. Feeling positive is important about activities in life. If the activities are not engaging, make a change.
Take time to just “be” every day. Practice positive self-talk. Every thought is self-talk. We consciously talk to our subconscious mind.
Be grateful. Try to sit quietly or take a walk each day. This is not the time for negative thinking. If it is a struggle with being alone this may be a sign that all is not well. Speak to someone you trust or a professional.
Worrying over little things may be a warning sign that something might be wrong. Take a step back and evaluate what is going on. Everyone knows someone who complains when a dog barks too much or when the neighbor's leaves blow in the yard. Worrying over trivial matters wastes energy and valuable resources. Cluttering one's mind with these little annoyances can cause a person to be cut off from the world.
Social Workers are trained to listen. They provide a wonderful sounding board to validate thoughts and feeling. In addition, they are able to give feedback about your life which may help with life choices . Social Workers can help identify areas to change and help set goals. They can also be invaluable in helping learn about community happenings and resources.
Try to keep these tips in mind. When able to work some of these ideas into life, there may be a difference. Have a better sense of self and know more about what gives individual days meaning. This is a personal journey and so many ways to make it better.
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For Immediate Release:
October 17, 2007
National Healthcare Decisions Day Set for April 16, 2008:
Numerous National Organizations Already Committed to Participate
(NHPCO, Alexandria, Va) – April 16, 2008 will be the inaugural National Healthcare Decisions
Day. On this day, throughout the country, healthcare providers, professionals, chaplains,
attorneys, and others will participate in a massive effort to highlight the importance of advance
healthcare decision-making. To facilitate this process, initiative organizers will provide clear,
concise, and consistent information and tools for the public to execute written advance directives
(healthcare power of attorney and/or living will) in accordance with their applicable state laws.
These resources will be available at: www.nationalhealthcaredecisionsday.org
Although several states have engaged in advance directives awareness events and numerous
organizations have devoted substantial time and money to improving education about advance
healthcare planning, only a small minority of Americans have executed an advance directive.
National Healthcare Decisions Day seeks to address this issue by focusing attention on advance
healthcare planning from a variety of directions simultaneous.
"As a result of National Healthcare Decisions Day, many more Americans can be expected to
have thoughtful conversations about their healthcare decisions and complete reliable advance
directives to make their wishes known," said Nathan A. Kottkamp, chair of the National
Healthcare Decision Day initiative. "Fewer families and healthcare providers will have to
struggle with making difficult healthcare decisions in the absence of guidance from the patient;
and healthcare providers and facilities will be better equipped to address advance healthcare
planning issues before a crisis and be better able to honor patient wishes when the time comes to
do so."
The following national organizations have already committed to participating in this event by
encouraging their members and chapters to engage in various education initiatives on National
Healthcare Decisions Day:
- AARP
- Administration on Aging
- Aging with Dignity
- American Association of Critical-Care Nurses
- American Association of Homes and Services for the Aging
- American Health Care Association
- American Health Decisions
- American Health Lawyers Association
- American Hospital Association
- American Medical Directors Association
- American Nurses Association
- Association of Professional Chaplains
- American Society of Directors of Volunteer Services
- Catholic Health Association of the United States
- Center for Medicare Advocacy
- Center for Practical Bioethics
- Center for Social Gerontology
- Duke Institute on Care at the End of Life
- Federation of American Hospitals
- Financial Planning Association
- McGuireWoods, LLP
- National Academy of Elder Law Attorneys
- National Association of Catholic Chaplains
- National Association of Social Workers
- National Association on Directors of Nursing Administration in Long Term Care
- National Hospice and Palliative Care Organization
- National POLST Paradigm Initiative Task Force
- The Hastings Center
Coordinators are being recruited to develop networks in each state to encourage and support
local activities and outreach. Organizations and coalitions interesting in participating are
encouraged to register at the NHDD Web site.
For more information on this initiative, please visit www.nationalhealthcaredecisionsday.org,
email nhdd@nhpco.org, or call 800/658-8898.
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Media Contact: Jon Radulovic, National Hospice and Palliative Care Organization,
Ph: 703-837-3139, jradulovic@nhpco.org.
Editor's Note: Nathan A. Kottkamp, project chair is available for interviews. The National
Hospice and Palliative Care Organization is providing administrative and communications
support for the NHDD initiative.
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Introduction |
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Religious Beliefs and Advance Directives |
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Changes as We Age |
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Erickson’s Theory of Psychosocial Development and Late Adulthood Decision Making |
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How Social Workers Help |
Medical evidence has shown us that that people are living longer with chronic illnesses during the 21st century than they did in the recent past. Advances in medical technology have allowed health care providers to sustain a person's life artificially. Most of us have heard of news stories of people who have remained in a coma for many years kept alive through medical intervention.
Historically, the act of dying is seen as solely a medical event. However, there is now a movement to incorporate the psychosocial, spiritual, and personal aspects of dying: advance directive planning.
An advance directive is a legal document that puts a person's wishes about medical treatments in writing. Advance directives generally fall into three categories: living will, power of attorney and health care proxy.
These documents are directions for a person’s care that they can have in place in advance of perhaps becoming incapacitated by illness or injury when they can’t make their wishes know to their physician and family. Although any adult create an advance directive for themselves, most adults who have these documents are age 65 and older.
Advance directives also allow individuals to make important medical decisions, for instance artificial nutrition and hydration, etc. According to the Patient Self-Determination Act, passed in December 1991, health care providers receiving Medicare and Medicaid funds must tell patients of their right to make these decisions - in advance – if they become medically ill and/or unable to speak for themselves.
Religious Beliefs and Advance Directives
Studies have shown that religion is a major influence in an individual's view of life, death and the healthcare system. One study focused on the elderly and how the primary factor was based on their own life experiences which were influenced by their spiritual beliefs.
End-of-life decisions can affect a person's spirituality since their quality of life may be an important factor in their spiritual well-being. Other factors that may determine how a person feels about their end of life include the impact of where they have grown up and live, personal factors, their education, their knowledge of advance directives, their fear of death, and the amount of social support they have. Studies demonstrate that people become more religious as they age, and some people go back to their religion when faced with death. It is felt that religion promotes emotional well being later in life.
End-of-life decisions can also affect a person’s physical, emotional, and social development. Elders have had to cope with losses throughout life. Many concerns that the elderly have tend to be "psychological in nature" such as a fear of requiring 24-hour care or institutionalization due to failing health. These psychological affects can lead to depression.
Changes As We Age
During later life changes occur such as becoming frail and medically unstable. This is when advance planning decisions can be made to determine what life sustaining measures will or will not be taken to sustain life.
Social changes affect a person's decision. If they move, for example, to be closer to family, they will need to make new friends in the new environment, to cope with the loss of old friends, and to cope with the changing roles within the family dynamics as one becomes older.
Family members most likely will be the decision makers for the patient. It is important for families to inform healthcare providers of the patient's beliefs and values, as well as the family needs, expectations and concerns. The older adults have to deal with being a lower status in society and possible threat of ageism, as well as retirement and lower income.
Erickson’s Theory of Psychosocial Development and Late Adulthood Decision Making
The renowned psychiatrist Erik Erikson based his concept of a complete life cycle on Freud's theory. Erikson took a "psychosocial approach to human development," paying specific attention to the individual and their environment, as well as human services available. The emphasis was on the "person in (the) environment".
Erikson's view of life was explained through eight different life stages. A person faces a crisis and progresses through to the next stage whether or not they resolved that crisis. Erikson reported that the resolution of each life crisis is an ideal, but that does not mean it is always a reality. He defined the late adulthood stage as age 65 until death. According to Erickson, a persons' positive outlook on wisdom is important and the conflict within a person is between (ego) integrity and despair. This is when a person tends to reflect on and accept one's own life.
Some people are able think of aging as a natural progression in their life and accept death as the ‘completion of life.' To the ability that a person can resolve a crisis in the earlier stages is an indication of their ability to resolve their crises within later stages.
Others may not be able to cope with the end of their life successfully and can become very upset. They can experience a lot of regrets and suffer with deep despair over their life experiences and events they perceive as failures. They may struggle with the thought of the end of their life, and what their life means. On the other hand, some people might feel that they were an intricate part of society and are able to leave this world with the belief that their point of view was always the correct one.
Near the end of life, a person can be mentally and physically incapacitated. In order to make sure they have a "voice" during this time of important decisions, a policy and law was developed to educate and encourage people to document their wishes prior to a devastating illness. It is an individual's right to make end of life decisions and to determine what medical treatment they want or do not want.
How Social Workers Help
Social workers carry a responsibility to educate and inform patients about advance directives in order to explain their meaning. It is vital for social workers to enable patients to make informed decisions and therefore good communication skills are vital. Social workers need to be sensitive to a person's vulnerability that might be a result of poverty, bias, oppression or prejudice. We as social workers need to identify the issue at hand and work toward alleviating burdens when possible. Social workers are required to ensure that policies and practices reflect true choice and do not discriminate against traditionally oppressed groups such as people of color, women, disabled, gays and lesbians. Social workers are ethically bound to challenge injustices, and respect the dignity and value of the person.
The NASW code of Ethics, 2000, indicates social workers have a responsibility to assist clients in asserting their rights to self determination and informed consent. NASW's position suggests that for the terminally ill population, the ethical issue of the right to self determination outweighs the social worker responsibility to avoid doing harm. In June 2003, after social workers continued studying of end of life decision, NASW implemented the "End of Life Practice" policy. It states the social worker has the responsibility to assist clients and families in end of life decisions, and if for personal reasons the social worker is unable to, the social worker has the responsibility to refer the client and family to another competent professional.
Studies demonstrate that poor and underinsured persons often receive substandard healthcare which may result in a higher mortality rate. Poverty is different for each race and ethnic group; minorities are more likely to be disproportionately harmed by this issue. If the person is publicly funded, the medical doctor is more likely to write a do-not-resuscitate order.
Due to advances in healthcare, medical treatment options have become complicated. Some decisions made which intended to alleviate pain may hasten death. For others, actions being taken can lead directly to their death, such as the removal of artificial means (feeding tubes or respirator).
On a macro level, as healthcare, health policy and social contexts continue to progress, social workers need to continue to educate and inform people of end-of-life policies and practices. On a micro level, social workers need to continue to encourage people to make informed decisions and understand what their end of life care entails in all aspects: through the total body of health and illnesses by including the biopsychosocial and cultural aspects. As social workers continue to serve devalued groups (elderly, poor, disabled), they need to continue to advocate for more equitable social policies regarding end of life decisions and for better access to resources.
We, as a society, have to help preserve the dignity and respect that our older generations once had and deserve. They preserve our history. They are our future. This generation possesses a knowledge and wisdom that the younger generation can benefit from by learning.
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What Is a Case Manager? What Services Do Case Managers Provide? |
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Where Do Case Managers Work? |
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What Kind of Training, Certification, or License Does a Case Manager Need? |
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Who Should Consider Using Case Management Services? |
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Who Pays for Case Management Services? |
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How Can I Find a Case Manager? |
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I’ve Been Hearing a Lot About Transitions of Care, But I’m Not Sure What That Means—or Whether It Has Anything to Do with Case Management. |
Case managers help provide an array of services to help individuals and families cope with complicated situations in the most effective way possible, thereby achieving a better quality of life. They help people to identify their goals, needs, and resources. From that assessment, the case manager and the client—whether an individual or a family—together formulate a plan to meet those goals. The case manager helps clients to find resources and facilitates connection with services. Sometimes she or he advocates on behalf of a client to obtain needed services. The case manager also maintains communication with the client to evaluate whether the plan is effective in meeting the client's goals.
This sounds good, but I'm not sure about the term case manager. Do case managers really manage people? I don't want to lose control, and I'm not a case.
Excellent question. A good case manager will work with you to determine what is important to you and what you think would be the most effective way to reach those goals. Case managers don't manage people—they help people to manage complicated situations. Simply put, they help to keep you, or your loved ones, at the center of services being provided on your behalf.
Care management and care coordination are two other terms sometimes used to describe this work. Different organizations and individuals define these terms in different ways; for example, professionals providing services to older adults often call themselves geriatric care managers. (Click here to read an article about geriatric care managers.) The terms case management and case manager are used in this article for the sake of simplicity, but the information also applies to care management and care coordination.
Case managers work in a variety of specialties, including health care, mental health care, addictions, long-term care, aging, HIV/AIDS, disabilities, occupational services, child welfare, and immigrant/refugee services. They are employed in the public, nonprofit, and for-profit sectors.
Case managers come from a variety of professional backgrounds and disciplines—including social work, nursing, gerontology, to name a few. They need to understand how to both work with individuals and families and navigate complicated service systems. Social workers, who are trained to help people in the context of their unique social environments, are distinctly prepared to offer case management services. In fact, the social work profession grew out of early case management work in the early 20th century, and social workers have remained active in case management since that time.
Certification is available in case management and specialty areas of practice, such as gerontology. Knowing a case manager is certified can help you to feel confident that you are working with a skilled, well-trained professional. (Click here for information about NASW's certifications in case management and other specialties.) Some workplaces require certification, but others do not. Social work case managers should have either a bachelor's or a master's degree in social work. Depending on the state, they may also be required to have a social work license.
People coping with complex situations—either their own or of someone close to them—such as physical illness, disabilities of any sort, the aging process, emotional or psychological challenges, family problems, addictive behavior, problems with school or work—may benefit from case management services. Seeking help is a sign of strength and may benefit both you and your loved ones.
It depends on your situation. Commercial health insurance, Medicare, Medicaid, or Tricare may pay for case management services delivered within some settings, such as hospitals, rehabilitation, or long-term care settings. In nonprofit or government agencies, case management services may be available on a sliding scale basis or even offered free of charge to eligible consumers. On the other hand, geriatric care management is generally not covered by public insurance or commercial health insurance. Some long-term care insurance policies may cover geriatric care management, and some nonprofits or public agencies may offer it on a sliding-scale basis; otherwise, it tends to be a private-pay service.
How Can I Find a Case Manager?
Again, this depends on your situation. If you are hospitalized or dealing with a system such as workers' compensation, you may be linked automatically with a case manager. Don't hesitate to ask if you are unsure. Otherwise, your health care provider, school, employee assistance program, or community service agency may be able to refer you. Local departments of aging and disabilities, health, and social services frequently offer case management services or may be able to refer you to case management agencies or professionals. You may also want to check with one of the professional organizations representing case managers.
Licensed social workers who provide case management services are listed in the National Social Worker Finder. Search by specialty area, such as aging; then click on an individual provider from the listing and look for case management under theoretical approach.
Regardless of whether you personally select a case manager or are paired with one you did not choose, it is essential that you feel comfortable with her or his approach. Don't be afraid to assert your needs, perceptions, and goals. Case management should always involve, and directly benefit, you or your loved ones.
This is an important topic receiving increased attention in the media. A transition of care takes place when people move between care settings—such as when a person leaves the hospital and returns home or goes to a rehabilitation facility—or care providers (such as physicians and other members of the care team, or agencies involved with the same client or family). Care transitions also occur when a person's condition or situation changes. For example, a person with a serious physical or mental illness may have a relapse, or a child may leave a foster home and return to her or his family. Lack of coordination during care transitions is, unfortunately, quite frequent and can be disastrous for everyone involved. Failure to transfer important information and medication errors are two examples of common problems that occur during care transitions.
Case managers, and social workers in general, are integral to successful transitions of care. They help to facilitate communication among everyone involved, including you and your loved ones.
Recognizing the importance of care transitions, NASW has been actively involved in efforts to ensure better care transitions for people receiving health and behavioral health care. As a member of the National Transitions of Care Coalition (NTOCC), NASW is developing resources to educate other professionals, the public, and policymakers about this crucial issue. For more information, please visit www.ntocc.org
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A social adult day program provides structure, support and stimulation to older adults living in the community, as well as a break for their caregivers. Social adult day programs, when coordinated with additional supportive services, often enable older adults to remain in their homes for as long as possible.
In a social model, medical services are not provided, and there are no medical personnel on-site. In the event of an emergency, social programs call 911. Social programs cannot administer medication but can cue a client to take medication independently. Medical models are more appropriate for clients who require medical attention throughout the day, for example, a diabetic client who needs an insulin shot every few hours.
- Population: What is the composition of the group? Some programs are designed strictly for people who have been diagnosed with dementia; other programs serve people who are physically frail but cognitively intact, while others serve a mixture of the two. Even groups with the same client of people may serve participants in varying stages of a certain condition.
Ask the program staff for population specifics prior to your first visit so you know what to expect. You may also be interested in the program’s clients by gender, ethnic and economic diversity, and languages spoken.
You definitely want to know how many people the program accommodates per day. Programs vary in size. There are benefits to both smaller and larger groups, but ultimately it is a matter of personal preference.
- Schedule: What time does the program start and end? The length of a day program often replicates that of a typical work day, and for many participants, this schedule elicits familiar feelings of productivity. Ask if there are there a minimum number of hours a participant must stay or a minimum number of days a participant must commit to. Generally, programs are open during the week, but some programs may be open or may offer special trips on weekends.
- Affiliation: Is the program affiliated with a larger organization? For example, is it affiliated with a hospital, settlement house, or senior center? What additional services are provided by the overarching entity? Some organizations serve as "one-stop shopping centers," offering services such as case management, caregiver support, legal assistance, and/or home care.
- Funding: Who funds the program? A program that is publicly funded (even partially) must comply with standards set forth by the governing body (usually state or city) issuing the funds. Privately funded programs must comply with standards set forth by the funding foundation; however, these standards vary from foundation to foundation.
- Environment: Where is the program held? Factors that facilitate an optimal environment include ample natural light, a separate room specifically devoted to the program, sufficient space between participants, supportive chairs with arms, minimal audible distractions, and a home-like rather than institutional feel. Programs specifically designed for people with dementia should have a locked door to inhibit wandering.
- Programming: Programming distinguishes the exceptional from the mediocre group. Get a copy of the schedule and ask questions about anything that may be unclear. The program's goal is to provide social stimulation and to reduce social isolation. You want to find out how this goal is actualized. Schedules range from highly structured to extremely flexible. You want a program that best suits a participant's needs and temperament. Ideally, each day should blend physical, cognitive and social activities.
Additionally, you want the majority of activities to require active rather than passive participation. Active programming facilitates interaction between participants. Examples include low-impact exercise, expressive therapies (i.e. art, music, drama, or animal-assisted), and cognitive challenges. An example of a passive activity is watching a movie.
Programming should focus on capabilities rather than deficits, and all activities should be failure-free. In a good program, participants will find new opportunities for creativity and will develop alternative standards of productivity. Perhaps most importantly, day programs can provide participants with a renewed sense of purpose and belonging during later life.
- Staff: How many full-time, part-time, and per diem staff members are there? What educational and professional training does the staff have? What is the ratio of staff to clients? Does the program utilize volunteers or students, and if so, in what capacity? You should meet as many staff members as possible to ensure you are comfortable with the program's leadership.
- Personal Care: What personal care needs does the program address? Personal care refers to assistance with one or more of the following: eating, toileting, transferring out of a wheelchair, and walking. If the prospective participant requires additional assistance, inform the staff and inquire if they are able to meet the specific need.
- Home Attendants: Some programs welcome privately-employed home attendants to sit, and in some cases, participate in activities. Other programs do not allow home attendants to be present.
- Fees: How much does the program cost per day and what is included in that cost (i.e.: meals, transportation, trips, etc.)? Are there subsidies available for clients demonstrating financial need? How and when will you be billed? Some private long-term care policies will reimburse you for the fees; find out if social adult day programs are covered under your policy.
- Transportation: Is transportation offered to and from the program? Is the vehicle wheel-chair accessible? Does the driver have a Commercial Driver's License (CDL)? In addition to the driver, is there a bus monitor/escort to assist clients with boarding and disembarking the bus? When and where is the client picked up, and how long is the bus ride?
Day programs provide critical assistance to both consumers and caregivers, but remember that not all programs are created equally. Visit several so you can compare and contrast, and make an educated decision. Don't hesitate to ask questions and to raise any concerns. Ask if a caregiver can accompany and remain with a participant if he or she appears extremely anxious in the beginning.
Keep in mind that the length of time needed to acclimate to the group setting varies from person to person. Some people may never have been comfortable in groups so this may be a completely unfamiliar experience. Others may have always been at ease in groups but may have become withdrawn due to current physical or cognitive difficulties.
You may need to visit a program a few times before you can determine if it is a good fit. If, after numerous attempts, a day model does not seem appropriate at this point, don't lose hope. Keep the program's contact information because you can always try again later.
###
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Caregiving, Seniors And Aging, Tip Sheets |
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A social adult day program provides structure, support and stimulation to older adults living in the community, as well as a break for their caregivers. Social adult day programs, when coordinated with additional supportive services, often enable older adults to remain in their homes for as long as possible.
In a social model, medical services are not provided, and there are no medical personnel on-site. In the event of an emergency, social programs call 911. Social programs cannot administer medication but can cue a client to take medication independently. Medical models are more appropriate for clients who require medical attention throughout the day, for example, a diabetic client who needs an insulin shot every few hours.
- Population: What is the composition of the group? Some programs are designed strictly for people who have been diagnosed with dementia; other programs serve people who are physically frail but cognitively intact, while others serve a mixture of the two. Even groups with the same type of clients may serve participants in varying stages of a certain condition.
Ask the program staff for population specifics prior to your first visit so you know what to expect. You may also be interested in the program's gender ratio, ethnic and economic diversity, and languages spoken.
You definitely want to know how many people the program accommodates per day. Programs vary in size. There are benefits to both smaller and larger groups, but ultimately it is a matter of personal preference.
- Schedule: What time does the program start and end? The length of a day program often replicates that of a typical work day, and for many participants, this schedule elicits familiar feelings of productivity. Ask if there are there a minimum number of hours a participant must stay or a minimum number of days a participant must commit to. Generally, programs are open during the week, but some programs may be open or may offer special trips on weekends.
- Affiliation: Is the program affiliated with a larger organization? For example, is it affiliated with a hospital, settlement house, or senior center? What additional services are provided by the overarching entity? Some organizations serve as "one-stop shopping centers," offering services such as case management, caregiver support, legal assistance, and/or home care.
- Funding: Who funds the program? A program that is publicly funded (even partially) must comply with standards set forth by the governing body (usually state or city) issuing the funds. Privately funded programs must comply with standards set forth by the funding foundation; however, these standards vary from foundation to foundation.
- Environment: Where is the program held? Factors that facilitate an optimal environment include ample natural light, a separate room specifically devoted to the program, sufficient space between participants, supportive chairs with arms, minimal audible distractions, and a home-like rather than institutional feel. Programs specifically designed for people with dementia should have a locked door to inhibit wandering.
- Programming: Programming distinguishes the exceptional from the mediocre group. Get a copy of the schedule and ask questions about anything that may be unclear. The program's goal is to provide social stimulation and to reduce social isolation. You want to find out how this goal is actualized. Schedules range from highly structured to extremely flexible. You want a program that best suits a participant's needs and temperament. Ideally, each day should blend physical, cognitive and social activities.
Additionally, you want the majority of activities to require active rather than passive participation. Active programming facilitates interaction between participants. Examples include low-impact exercise, expressive therapies (i.e. art, music, drama, or animal-assisted), and cognitive challenges. An example of a passive activity is watching a movie.
Programming should focus on capabilities rather than deficits, and all activities should be failure-free. In a good program, participants will find new opportunities for creativity and will develop alternative standards of productivity. Perhaps most importantly, day programs can provide participants with a renewed sense of purpose and belonging during later life.
- Staff: How many full-time, part-time, and per diem staff members are there? What educational and professional training does the staff have? What is the ratio of staff to clients? Does the program utilize volunteers or students, and if so, in what capacity? You should meet as many staff members as possible to ensure you are comfortable with the program's leadership.
- Personal Care: What personal care needs does the program address? Personal care refers to assistance with one or more of the following: eating, toileting, transferring out of a wheelchair, and walking. If the prospective participant requires additional assistance, inform the staff and inquire if they are able to meet the specific need.
- Home Attendants: Some programs welcome privately-employed home attendants to sit, and in some cases, participate in activities. Other programs do not allow home attendants to be present.
- Fees: How much does the program cost per day and what is included in that cost (i.e.: meals, transportation, trips, etc.)? Are there subsidies available for clients demonstrating financial need? How and when will you be billed? Some private long-term care policies will reimburse you for the fees; find out if social adult day programs are covered under your policy.
- Transportation: Is transportation offered to and from the program? Is the vehicle wheel-chair accessible? Does the driver have a Commercial Driver's License (CDL)? In addition to the driver, is there a bus monitor/escort to assist clients with boarding and disembarking the bus? When and where is the client picked up, and how long is the bus ride?
Day programs provide critical assistance to both consumers and caregivers, but remember that not all programs are created equally. Visit several so you can compare and contrast, and make an educated decision. Don't hesitate to ask questions and to raise any concerns. Ask if a caregiver can accompany and remain with a participant if he or she appears extremely anxious in the beginning.
Keep in mind that the length of time needed to acclimate to the group setting varies from person to person. Some people may never have been comfortable in groups so this may be a completely unfamiliar experience. Others may have always been at ease in groups but may have become withdrawn due to current physical or cognitive difficulties.
You may need to visit a program a few times before you can determine if it is a good fit. If, after numerous attempts, a day model does not seem appropriate at this point, don't lose hope. Keep the program's contact information because you can always try again later.
###
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Posted in
Seniors And Aging, Tip Sheets, Vital Aging |
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