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8 Mistakes People make When Choosing and Assisted Living and Comments

8 Mistakes People Make When Choosing Assisted Living and our comments below. By Shawn McGivney MD, RFA This article from A Place For Mom  is a good general article.  We feel it could be more helpful if it provided a little more detail on how to do the 8 things.  Just saying "don't over look future needs" or don't judge a book by its cover, or choose a community to match your parents needs are just not detailed enough.         This discussion of care applies to all care settings Assisted Living, Home Care, Hospice Care, Dementia Care, Alzheimer's Care, Memory Care, Residential Care.  Care is a service and you need to understand you are buying the skills of knowledge but also compassion, dedication, caring, which might be even more important skills than hard medical or nursing skills.  Indeed, the social skills are often the therapy for aging, dysphoria, depression, cognitive loss, and promoting people to feel good as they see they need increased levels of care. 8 Mistakes People Make When Choosing Assisted Living http://www.aplaceformom.com/blog/assisted-living-search-top-mistakes-to-avoid-1-22- 13/ We want to share our comments to that with you. Our comments Great article. I think the details are given better at http://tlcsr.com/blog. You need to meet the management, administrator, and care givers. This article seems to come up short of saying that but that is the only way you can see into the middle chapters of this article. Second, Continuity of Care is not mentioned. Shift work, A La Cart billing tend to promote lack of continuity of care and relationships.    Assembly line hallway Efficient Assembly for physical care Third, we agree with don't go it alone, don't judge only by proximity, don't find a place with an isolated private room because you as a younger, non sick,  persons would choose that, choose for your parents who need assistance and will need even more assistance and remember it is the staff who provide the caring and care now and in the future. Meet the entire care giving team including the management! We find superficial discussions like this are too general to be really be helpfull and can be misleading if you don't get these details.  When faced with a social and financial decision of this magnitude take the time to meet everyone involved in the care starting at the top. The management does impact  the care the staff provide. Socially, you can be respected for finding the most cost effective and best care and set the example for your entire social system. You can save money when compared to the usual course of a bait and switch type A La Cart system where they get you in for the room and meals AND NO, OR MINIMAL CARE OR ASSISTANCE, and then rasise the price to 4, 5, 6K when, not if, you need care.  24K / yr at 2K a month or 48-72 K a year at prices with minimal assistance are worth spending the time to meet the entire care team. Do not think you can or will get the same level or amount of caring you most likely expect unless you meet the entire care team. The management may define care as included in the contract DIFFERENTLY than you do.  For example, how many have found out after they bought the insurance that the "support" they purchased had indeed be re sold many times and now was bundled into who knows what, giving you some phone care from another country? Hands on management _ Do not accept management on paper, long distance calls to the corporate office as the main level of management.  This is a service and you need to meet, shake hands, and know the direct care managers.  If the Aide is the only person you meet and know like in home care then she is the de facto manager, owner, and aide but know that is who and what you are getting.  You are most likely still the manager and highest level skill person on your team.  You did not add any skilled people, advice, or a back up care team you added an aide and often times at a high dollar cost.  Home care is a great option but be sure to consider who the day to day manager is since that is part of your care team. To get these smiles you need to know the entire care giving team. People, Pets and Flowers Can provide Smiles and Caring to go with your Physical Care.     This is a service industry and you need to meet the entire care giving team from top to bottom to really start to compare what you are getting for your 24 - 72K a year. Take the time to learn all you can you will be socially viewed in the best light and your parents will get the best care and best value for their health care dollars.           By Shawn McGivney

Is physical care different from emotional care in Assisted Living or any Senior Care Setting?

Is physical care different from emotional care in Assisted Living or any Senior Care Setting? By Shawn McGivney In fact there is a significant difference between doing the physical task of giving a shower and then giving a shower combined with a friendly discussion of recent events, recent visitors, or activities both care giver and resident have experienced in the day to day life. That later is emotional health and goes a long way to change physical care inot caring and maximize emotional health for both caregiver and resident. We believe this is a small part of starting to explain the power of relationships, the humanism needed for and involved with in care and caring. This distinction applies to "care" in all care settings Assisted Living, Assisted Living Facilities, Home Care, Hospice Care, Medical Care, Dementia Care, Alzheimer's Care, Memory Care,  Elder Care, Respite Care, Hospital Care, Residential Care, and all of the care settings. What is "skilled" care vs custodial care. Doctor Nurse Care Giver or Mother Insurance companies constantly try to define custodial care as something less, of lower value, lower price than "skilled" care. In fact, people pay more attention to the caregiver than the insurance defined skilled views of the nurse or doctor. the reason for that is trust and continuity of care. When, not just if, something happens in the day to day life of a frail senior who needs assistance the only skills that will matter are the skills of the person the resident can get and that in general is of the caregiver. The caregivers interpersonal skills, compassion, caring are used every minute of every day to provide feeling good, comfort, redirection and to help empower the senior to remain positive, active, productive and feeling good. That in fact is a skill. Call it patience, compassion, good family values, faith in God, but whatever you call it that is indeed what the senior needs and wants.           Mothers What is the "Value" of not getting "care" from the controlling Caregiver?  How can a senior who needs assistance really monitor and protect against this?  Care Setting and the leadership being hands on, day and and day out, from top levels of ownership down to the caregiver is essential and the only way to provide care with caring?  Cost to the Senior of a Controlling  Caregiver?         Patience, interpersonal skills, and familiarity with dealing with a person who is older and has many complex medical issues that are unlikely to resolve is a skill. Unlike dealing with a child where cure is likely and possible in this case cure and getting younger is much less likely. Seniors know that but no one including the senior will say that. It is ego dystonic, to say you want to die or accept getting old even though we all do it every day. God or a higher being can play a role and does increasingly play a role as we get older and more disabled. As humans we need things to believe in and God and the best interpersonal skills you can find are the first line treatments for all that ales you. All disease is expressed in not feeling good. No matter what the label Alzheimer's, Chronic Pain, CHF Congestive Heart Failure, Arthritis the end result will be I don't feel good.  Doctor  are trained to look only at the physical part but the many levels of social and emotional therapies are often over looked or discounted.    Be it due to physical pain, depression, fear of the future all diseases are expressed the same way. You feel bad. Doctors cant describe it, define it, or study it but we all feel it and can understand it.   Indeed, your doctor is uniquely positioned to help you balance cost, effect, side effects, incidental social and implementation and even financial consequences of all the physical and emotional or social choices that are available to you.  If you were a doctor you would know the physical stuff and if he were you he would know the social stuff but when both of you have a relationship and know each other continuity of care, caring and the best outcome are possible.  That outcome is feeling the best you can given your unique, individual, set of physical, social, and financial illnesses.  While many try to be "case managers"  including elder law attorney, social workers, nurses in fact there are only two real choices you since you are the most aware of your social and emotional health or how you feel and / or "your doctor".  I use the term "your Doctor" going back to a time when continuity of care was the standard.  Hopefully this blog and your examples can help others value people in our lives. People some say are less valued or skilled. -A mother who works all day to care for the kids and husband and arranges the social system. Not easy, but not values by dollars. -a Teacher who listens, stays after class to help someone who is behind so they are not embarrassed to catch up or get a head. -a care giver who calls and visit when you go to the hospital. or is available to look after your kids and your grandmother because she can it helps the bigger system out. -a doctor or lawyer who goes beyond the standard description to help you understand the system and potential related costs. All of those examples are things that are "not needed", not valued in dollars, but are often provided to take physical, "less skilled" care to the highest level of care and include caring. Comment to help others see the value of people in their lives. Help us spread the word.  Click for Free Ways to help. Click for The Best, Most Cost Effective, Assisted Living and Senior Care Alternatives. By Shawn McGivney

Your Choice-Big Assisted Living Institution or Small Residential Care Home.

Your Choice-Big, Assisted Living,  Institution or Small Residential Care Home. Feel the power of choosing! Change is part of living! Feel Good that you took the time to look at several places and then made a choice instead of just accepting the first persons suggestion or suggestions of a person you may never see again.   Big Institutions like Assisted Living Facilities or Nursing Home VS a Smaller, Single Family Home. While both Big and Small say they are Home-Like you have to decide how at home you feel in a small studio apt with a kitchenette VS a real house with a family of friends and the familiar set up you have lived in for your entire life. Assisted Living or Nursing Home Institutional Hall Way Choose people over things when choosing Senior and Health Care. Food for Thought If the sales person promises work that will be done by someone else,  it is usually a good idea to meet the person who the sales person is promising for.   Health care, Senior Care are Personal Services and are not  sales of an inanimate object.  Services do require a relationship, social skills, and continuity of care.  Consider those when choosing any Health Care service including Assisted Senior Living Services. Big Institutions like Assisted Living Facilities or Nursing Home VS a Smaller, Single Family Home. While both Big and Small say they are Home-Like you have to decide how at home you feel in a small studio apt with a kitchenette VS a real house with a family of friends and the familiar set up you have lived in for your entire life.                                  Nice furniture without a family of caregivers and other residents to interact with is a lonely place. Assistance, Care and Caring require a relationship for All people to feel needed and welcome. Take the time to find the best care team for you. Spend time meeting all the care team in any care setting. How do you feel when you think of living in a studio apartment with a kitchenette, the standard setting in a Big Assisted Living Facility? Compare that to how you feel when living in a house, like the house you have lived in for your entire life, with the same private room but now access to the "house". Which makes you feel safer, better, happier, more independent, more involved in day to day life? IN ALL CASES "THE CARE" IN ANY  SETTING OF ASSISTED LIVING, NURSING HOME OR A SINGLE FAMILY HOME CARE COMES FROM THE PEOPLE YOU CHOOSE TO ASSIST YOU IN THAT SETTING. While the idea of care in your old home is  a nice thought, consider  how likely it is that the caregiver takes over to some degree?  If you need assistance you might not be at your best, coordinating your care and that care giver.  Look for some management, with the in home care options, to ensure you will maintain as much control over your life as possible. We recall a quote from Patch in the movie Patch. If you treat the disease you win or loose but if you treat the person you win no matter what the outcome. Believe, trust in, and develop relationships with those who you now live with and who help you day in and day out as friends and caregivers. Senior Care and Health Care are services in any care setting Home Care, Hospital, Rehab, Assisted Living, Memory Care, Dementia Care, Alzheimer's Care, Hospice care.  In all cases look beyond the furniture and the pills to see the care and people who are directly implementing the care and treatments.  For seniors cognitive care, depression, sense of loss, are present in all cases and one of the best treatments for that is to find the home like setting and family like staff. Help us spread the word.  Click for Free Ways to help. Click for The Best, Most Cost Effective, Assisted Living and Senior Care Alternatives Dr Shawn McGivney

Fear-Abandonment when choosing Assisted Living and senior care settings

Fear/ abandonment when choosing Assisted Living and Senior care settings Just saw the movie The Impossible about the 2004 Thailand tsunami and thought how seniors might feel after a devestating accident that put them out of a home and forced them to choose an Assisted Living setting.  In the movie the survivors. 230K dead in many countries and all I could think of was the feeling we all get when we are separated, or abandoned, whether due to natural disaster like this or from a more chronic event like aging that forces us to move to a new care setting. The feeling of the people in that event might give us some idea of the feeling each of us will get if we are lucky enough to live to a ripe old age and experience the need to move to a new home at a time when we are physically and cognitively losing the ability to do for ourselves. The people of Thailand and all disaster places feel that hopelessness, not having the stuff you need. Food, water, shelter but also medial care and supplies. They were looking for companionship, being around the ones they loved. The ones who are sick are aware of death but don't seem to fear it, they work with that, what they fear is abandonment, not saying goodbye, that is unpleasant but understandable, what is harder for humans to do is to not know, not say goodbye  and to feel abandoned, or totally dependent and without out hope or someone to listen.   For example not having anyone to "help", even get a glass of water or to make sure their family is ok for them. That is just like aging and not having continuity of care. Care in ER, hospital,  then down stream in many disjointed places is a level below the devastation in the movie but should help us to start to see and feel,  why the choice of a care setting, care team and continuity of care is such a powerful treatment for aging.  We all try to take pills to treat disease - Dementia, Alzheimer's, and claim they help your Memory.  In fact, choosing the best care team and continuity of care might be another way to go.  People over pills.  I know many talk about how bad the problems of the age wave are or will be and that it is getting worse. That is old news and obvious. You don't have to tell a person who forced to move out of the independent living apartment part of an Assisted Living Facility and into the Nursing Home that it is not good, they know that. Older people know the arthritis hurts, quantifying it, "studying" it may help somehow but one thing we can do right now, for sure, that is well studied to be effective is value people, and continuity of care.  Not continuity of the chart or continuity of the where the money goes, continuity of the care and people providing that care.   The time is upon us to change the system, value people, value continuity of care, value the care team. Just my thoughts. Hold my hand, a friends, help right here at home, help your family and those around you. When you find continuity of care share that finding with the world. I go back to one of my favorite quotes, if you treat the disease you win or lose but if you treat the person you win NO MATTER WHAT THE OUTCOME. Sick people know about death,  help them to live up until that time God Calls them.  You can't decide but you can help promote continuity of care. Help us spread the word.  Click for Free Ways to help.   Click for The Best, Most Cost Effective, Assisted Living and Senior Care Alternatives       By - Dr. Shawn McGivney MD, RFA  

When to Give Up Driving and move to Assisted Living?

WHEN TO GIVE UP DRIVING? Story submission by blogger:    When she was in her mid-1980s, my mother's car keys and license were taken away from her by a police officer who found her driving the wrong way down a major road at night. At first she was very angry but eventually, with the help of a social worker, she accepted the wisdom of giving up driving. This event turned out to be a blessing, but I shudder to think what kind of accident might have happened. I do think that at some point perhaps age 80 drivers should be routinely checked like the woman in the video by either their doctors or the DMV. We test younger drivers before allowing them to drive; I think testing older drivers is equally valid. Older drivers are far more likely to accept a decision from an authority figure such as a doctor or police officer than one of their grown children. (Spell checked sm)   Dr McGivney’s reply: The topic of what to do and how to help a senior balance personal freedom and loss of control over their life with risk to themselves and others when the time comes to give up driving is a difficult issue.  I had the same issues with many residents and both of my parents. Negotiated Risk Agreement - Drive until you have two bad events.  My approach was to set a standard of they can drive until they have two bad events. Then we will agree to take the keys. That way it is not just I am taking that life line away from her but am doing a more sensitive negotiated risk agreement that is based on events. Senior adapt well, Don't just throw them under the buss or car.  We all adapt in many ways and seniors drive slow, go during the day when traffic is less, and have other ways to adapt. Their feelings even if they rarely drive or drive only when you are in the car are also powerful things to consider and help them maintain control over what are small thing to you but big things for her. Balance Senior and Societies Safety with Seniors Rights to life, independence, and Control over life.  This decision may be considered  more of a restraint that a wheelchair seat belt that might be needed but is deemed "unsafe" in many cases.   Seniors have a right to take risk that is called Living!  Risks are choices and Seniors have a right to choose.  We can try to protect them but do not err on the side of controlling them.  I find that in many cases the use of the word safety is for the care persons convenience.  Would you give me your care keys at age 20 if I wanted to protect you from the leading cause of death up to age 40, Accidents and Motor Vehicle Accidents is number one. ? Senior and society safety.   My mom and dad drove well within their skills as most seniors do. One can easily make the case of young people who often do not know their limitations especially at night or after a social drink or two, and might be more reckless than a senior who is being extra cautious not to loose that valued privilege and element of control over their life. Even the thought that they might drive has a lot of value to them. In the end both mom and dad had several events and agreed reluctantly to give up driving. Fortunately, for them we took them with us everywhere to ease the burden. Loss of control over life when they are forced to give up health and mobility. For those faced with having to move to a new care setting what ever it may be ( moving with a different relative, Assisted Living, Residential Care Home, Home Care, Hospice Care, Dementia Care, Alzheimer's or Memory Care)  they need to evaluate how much continuity of care and ability to maintain control they will have in that setting. That is a very difficult thing.  Indeed, finding the care team that can help but not sacrifice a seniors control over life is the things seniors value most.  It is not safety, cleanliness, pain control, but control over your own life that seniors worry about most.  That fear of loss of control and independence also is related to another feeling of abandonment.  if you can't do for your self and do need any level of assistance you are at risk of feeling abandoned.  I believe we all covet - Freedom, Independence, Right to choose and live.  If they want ice cream why can a doctor or care setting tell them they "can't" have ice cream because it is "bad" for their health when they choose their entire life to eat it.?  Or drive.  Of course, there is a wide scale upon which to balance Freedom and right to choose.  Each senior and family needs to exercise that right BEFORE THEY CHOOSE A CARE SETTING by meeting the actual care staff who will be "helping" them.   Choosing a care setting is choosing the amount of independence and freedom you will have for the rest of your life.  BE CLEAR, IT IS THE STAFF, ADMINISTRATOR, OWNER, of the new care setting or your family care giver who will assert a lot of control over your life when this move arises.  Choose the care team wisely.  Do not focus on the color of the sofa, or the physical plant, that is less likely to help or control you. Give Seniors an equal playing field.  My own opinion as a senior advocate and doctor on your mother case and not knowing all the details is that many people drive the wrong way on a one way street and I would prefer not to let a police officer hold your mom to a standard that was higher than for any other person. If a young, drunk driver, often times with no remorse or recognition of the event, drove on a one way street at night that would not result in a mandatory loss of the license. Of course if your mother had no insight to the problem and the danger of what happened and could not rationalize the limit setting plan and had a long string of events then I fully understand. I just like to discuss many options so that each family and continuity of care team can work within some social system to be fair and safe to all. Thanks, we can work together to help others. Your story and my story will start the string. Spread the word. By Shawn McGivney MD, RFA Thanks for reading this post .  If you liked this post please help us by sharing the message of Care, Caring, and Continuity of Care by likeing, friending, and following our works on Facebook     (tlcsr.kerrymcgivney), Twitter ( TLCSRLasVegas), Youtube (TLCSRLV),  Joining our Email List and this Blog, and sending this to any sons, daughters, or seniors you know. Here are links to make it easy! Like Our FaceBook Page: Friend Us On FaceBook: Follow us on Twitter: Like our videos on Youtube: Join our Free Blog and Email List: Click for The Best, Most Cost Effective, Assisted Living and Senior Care Alternatives. Contact: Shawn McGivney MD, RFA

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