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Question of Month

Caring for those who may have cared less for us!

This article presents a very difficult and probably common situation for adult care givers of parents who were abusive or even perceived to be less supportive of the kids by the kids themselves as caregivers when they were growing up. A Risk in Caring for Abusive Parents Paula Span of the NYT. While this article addresses the worse or highest risk group of caregivers who were abused by the parent they are now faced with caring for this is the tip of a much bigger social iceberg. Relationships take a life time to develop and to earn the trust, respect and commitment of others and that is the lesson I want to share for all care givers, doctors, nurses, and case workers who work with the chronically ill and the care giving teams who care for them.  All members of that team need to be aware of the feelings and emotional needs of the other groups.   Comments. Check out these fantastic Residential Care and Assisted Living Care Services.  Remember to consider all of these in your search for a care team since they all provide care –Residential care, Assisted Living, Home Care, Hospice Care, Dementia Care, Alzheimer’s Care, Memory Care and Nursing Homes all offer custodial care but what varies is the care team you choose when you choose any care setting. Who is doing the day to day training, supervision, and support and hands-on management and who is doing the custodial care?   Look for the care team to get the best care before you buy or move in. Tender Loving Care Senior Residence - Or Tender Loving Care Senior Residential Care, Costa Brava  - Educational video links TLCSRLV youtube Channel.  Subscribe for free. Assisted Living and Residential Care Home Video Tour. Assisted Living and Residential Care Home Testimonial    THANKS FOR LIKING AND SHARING  Dr Shawn McGivney

ALZHEIMER’S DISEASE LAS VEGAS: HOW WILL NEW ALZHEIMERS TEST HELP YOU?

At-home test may help diagnose Alzheimer's NEW TEST TO DIAGNOSE ALZHEIMER'S.  4 pg test, with written questions to answer and drawings.   While this article brings up another new tool the doctor can use to prompt himself to ask a wide range of questions in the interview it is not new.   A doctor always uses interview questions coupled with history and medical exam to narrow down all causes of cognitive loss so I am not sure how new this is. Alzheimer’s is very difficult to diagnoses as a single pure entity and in fact most often Alzheimer’s overlaps a lot with many other things like Dementia, Parkinson’s, Neurological issues, wide based gait, and cns vascular disease to name some.  Indeed, aging and benign forgetfulness also is in there to complicate the diagnosis and all the life causes of poor mood as one ages and declines in function.  In fact, a depressed mood in many ways is “normal” when faced with the end of life and loss of your friends, own abilities, and prospects for the future.  To call all of this Alzheimer’s or anything to me is misleading and instead I would prefer we focus on the treatment of having the best, most consistent, care team possible to deal with all chronically ill people no matter what the label. I am also not sure how they will treat cognitive loss differently from how they do today if you find it.  The current meds Aricept, Namenda, Exelon are hit or miss at best. HERE IS WHAT WORKS AND HAS WORKED FOR ALL MEDICAL CARE AND ALZHEIMER’S CARE IF INDEED “ALZHEIMER’S” EVER EXISTS BY ITSELF WITHOUT OTHER MEDICAL, SOCIAL, FINANCIAL AND LIFE ISSUES. The one treatment that works for all humans is caring and relationship building with the best care team you can find.  If you jump from one doctor to the next or the doctors don’t feel invested enough to stick with you as their / your treatment ideas are implemented and evolve you can imagine the care might be disjointed, incomplete and there by less effective. Medicine is a process of trying various treatments and then following closely the response and adjusting those treatments.  People change, treatments change or evolve, and emotional health is all about relationships so that is the best and most cost effective treatment for all chronic disease and Alzheimer’s disease. If you have a personal care team with a team leader or doctor who is active in sticking with you and willing to lead and make care decisions you can adjust to all diseases and emotional issues that arise.  Instead what we see is referral of the work and risk of the care and decision making to the next doctor.  In some ways that is kind of like warren buffets weapons of mass destruction and selling the toxic mortgages down the road to the next sucker but in this case we are hurting the humans and are passing along human suffering.  Homes are tangible products which in most cases are used and lived in and not decaying as a human being would which the service contract or mortgage is passed along.   In that case do not harm is the harm.  Being unwilling to make the diagnosis and try a treatment is more risky than not trying and just doing nothing or “no harm”.    You never know what will happen and what will change after you make the first choice of treatment to try that is why medicine is an art and clinical process and requires continuity of care and a steady relationship with the doctor to follow, adjust, and evolve your multiple level of treatments.  Even if your first treatment works you would not stop there but will add, adjust, modify treatment constantly.  There is no one flow sheet to follow.  All humans are complex beings and the choices in treatment are even more complex when you include the finance, social and emotional elements of those treatments.   Those who read my blog will recognize this quote that really sums up all medical and human caring: “If you treat the disease you win or lose but if you treat the person you win NO MATTER WHAT THE OUTCOME.” Patch Adams, the movie Patch. That last part is the key.  If the doctor and patient stick together, work together, in all care settings dealing with ALL PHYSICAL, MEDICAL, EMOTIONAL, SOCIAL, AND  COMPLEX OVERLAPPING LIFE ISSUES then you and those around you who care and are active in the care process are likely to feel  that they have made a difference and done the best possible in these difficult situations.  One might even say they feel good about whatever happens.   We all have the choice to choose our care setting and there by care team.  If you instead choose the insurance first then you really have no idea who or what care you will get.  Also if the doctor is the direct employee in practice of the insurance company and he has less or no expected interdependent relationship with the patient and their social system then it is likely both will act to protect themselves first and the care will be less consistent.  The patient might save money since that is all they can do and the doctor / representative of the insurance company might save time and pass the toxic risk / work of providing care, trying, making decisions to the next doctor. GOOD NEWS!  WE ARE IN CONTROL.  WE CAN CHOOSE OUR CARE SETTING AND CARE TEAM! We all can visit many care settings and choose the one we want to pay for.  If we have Medicaid or are on a government program we still can choose by visiting many providers of that care type and choosing one closest to our most frequent visitor and the best one.  We all need to make the time and take the time for this search when it comes. I hope all are empowered by this.  You can choose!  All doctors and care settings are not the same.  Your control is by visiting many and choosing the best care team possible.  Indeed, in the end you might find it is cheaper to pay a fixed price than the bait and switch model of a relatively lower advertised cost for the room and then add ons for the care or assistance and medication management etc. What do you think?  Share your views here. Check out these fantastic Residential Care and Alzheimer’s Care Services.  Remember to consider all of these in your search for a care team since they all provide care --Residential care, Assisted Living, Home Care, Hospice Care, Dementia Care, Alzheimer’s Care, Memory Care and Nursing Homes all offer custodial care but what varies is the care team you choose when you choose any care setting.  Who is doing the day to day training, supervision, and support and hands-on management and who is doing the custodial care?   Look for the care team to get the best Assisted Living, Residential Care, Home Care, Retirement Community, Hospice Care, Dementia Care, Alzheimer’s Care and Memory Care in any care setting.  Look beyond the setting label and find out who you are getting before you buy. Tender Loving Care Senior Residence - Or Tender Loving Care Senior Residential Care, Costa Brava  - Educational video links TLCSRLV youtube Channel.  Subscribe for free. Assisted Living and Residential Care Home Video Tour.   Assisted Living and Residential Care Home Testimonial    THANKS FOR LIKING AND SHARING  Dr Shawn McGivney      

Might Assisted Living and Residential Care regulations backfire?

New San Francisco Chronicle article by Melody Gutierrez talks about more regulation to fix the Assisted Living and Residential Care Home industry.  While this is a good idea at first glance we need to be careful in asking for things that will reduce senior choice and care options.  If this raises the cost of care or forces low cost providers out of business while raising the quality for the few who can pay they might price our the majority of seniors who are now choosing to stay where they are and are currently choosing to be private pay and not going onto medicaid.     Plans for sweeping change at assisted-living homes Melody Gutierrez,  Monday, January 13, 2014 While this sounds like a great idea I wonder if there might be some unintended consequences to the low and middle income seniors that this is trying to help by forcing them out of their current low cost and acceptable minimum level care that they are choosing.  Remember, all seniors in any facility can choose to move to another facility since this is a private pay system.  No one has to stay with anyone care team.  Legislation that raises the bar and costs to provide the care too high might drastically reduce the care options for most seniors including the middle and low income seniors. I draw your attention to a quote from this interesting article. “With more than a dozen bills making up a residential-care-facility reform package - their costs not yet determined - advocates calling for greater transparency and accountability say they feel confident the money needed to fix the Department of Social Services' Community Care Licensing Division will be there” I have bolded the “their costs not yet determined”.  Not only costs in dollar costs but cost when many low income providers are forced to close their door to the broader health care system. While increased regulations and quality control is a good idea society needs to be aware of the big potential negative risk of raising quality and costs for Assisted Living and Residential Care beyond the means of most people.  While it is easy to follow the ATT TV commercials advice that “more is better” the potential costs to that might be that low and middle income people cannot afford more staff, higher quality staff, which in turn will lead to all of those people begin cared for in nursing homes on the government cost. While we do need regulations to protect seniors we also need to be much smarter about what those regulations are and how they are enforced.  I can’t go into that now but I always fear regulators who are not doing the work right now and in most instances low cost providers are underrepresented in these decisions.  The risk to the industry and overall health care system is devastating.  If there are no low cost, chronic care, places for low and middle income people even if they are somehow less but it is a lower standard they can afford and choose then that might not be so bad compared to being forced to live in a nursing home on the government Medicaid program.  Now many of these low income people PAY PRIVATELY our of their social security and other very limited resources.  Taking away low income housing choices even if they are not as good by over regulation will affect the hospitals, nursing homes, and the entire health care system who will have many long stay patients they can’t place. What do you think?  Share your views here. Check out these fantastic Residential Care alternatives to the less personal Assisted Living, Nursing Home Rehab, and Home Care.  Residential care, Assisted Living, Home Care, Hospice Care, Dementia Care, Alzheimer’s Care, Memory Care and Nursing Homes all offer custodial care but what varies is the care team you choose when you choose any care setting.  Who is doing the day to day training, supervision, and support and hands-on management and who is doing the custodial care?   Look for the care team to get the best Assisted Living, Residential Care, Home Care, Retirement Community, Hospice Care, Dementia Care, Alzheimer’s Care and Memory Care in any care setting.  Look beyond the setting label and find out who you are getting before you buy. Tender Loving Care Senior Residence - Or Tender Loving Care Senior Residential Care, Costa Brava  -   Educational video links TLCSRLV youtube Channel.  Subscribe for free. Assisted Living and Residential Care Home Video Tour.   Assisted Living and Residential Care Home Testimonial http://tlcsr.com/ResidentialCareHomes.html    THANKS FOR LIKING AND SHARING  Dr Shawn McGivney

Residential Care Homes: Cost Saving Residential Care Solutions

 Dealing with maturing parents is expensive and can cost $20,000-$40,000 $/ yr and many times is socially difficult for the entire household. We have one-of-a-kind views to share with you. Visit this site for solutions starting with Residential Care Homes and Residential Care. http://tlcsr.com/ResidentialCareHomes.html Find out: What alternatives there are to all care choices including Assisted Living, Residential Care Homes, Home Care, Hospice Care, Dementia Care, Alzheimer’s Care, Memory Care, and Retirement Communities? Find out how all of these care settings actually offer the same thing – Senior Care!  Learn how sub specializing in health care can have large costs in emotional health, continuity of care and the caring felt between and among patient, family, and all members of the care team. Get practical, non-sales, information about each so you can better start to compare what you get, what you don’t get and at what prices. Learn the single most important rule in choosing any senior care setting.  No matter what the brochure, sales staff, or add says you need to meet the individuals in the entire care team to know who you are getting to know what you are getting.  Second, only by knowing who you are getting can you begin to compare prices and value. Learn the most common mistakes in choosing Elder Care. The most common mistake is to focus on the amenities and nice furniture and to undervalue the individuals, the care givers and care team, who will do the direct care and problem solving when it occurs. The second most common mistake is to forget that if you need a little assistance today you will most likely need more assistance in the future.  In that case, most people forget to investigate the care team’s abilty to adapt and provide more care as you age.  In many cases forgetting to check that out will result in your being either forced out because the care setting can’t do the needed extra work when you need it or priced out when they raise the price for that extra care.  Indeed, some places charge 300 / day for a private duty care giver in an Assisted Living setting.  That is an extra $9,000 / mo. on top of the basic rate for room and board. Reading this resource will help everyone get more care, better care, and save money when they need any amount of assistance with living.  Check out these fantastic Residential Care alternatives to the less personal Assisted Living,  Nursing Home Rehab, and Home Care.  Residential care, Assisted Living, Home Care, Hospice Care, Dementia Care, Alzheimer’s Care, Memory Care and Nursing Homes all offer custodial care but what varies is the care team you choose when you choose any care setting.  Who is doing the day to day training, supervision, and support and  hands-on management and who is doing the custodial care?   Look for the care team to get the best Assisted Living, Residential Care, Home Care, Retirement Community, Hospice Care, Dementia Care, Alzheimer’s Care and Memory Care in any care setting.  Look beyond the setting label and find out who you are getting before you buy. Tender Loving Care Senior Residence - Or Tender Loving Care Senior Residential Care, Costa Brava  - Educational video links TLCSRLV youtube Channel.  Subscribe for free. Assisted Living and Residential Care Home Video Tour. Assisted Living and Residential Care Home Testimonial http://tlcsr.com/ResidentialCareHomes.html IF YOU ENJOYED THIS POST – LIKE AND SHARE IT. Dr Shawn McGivney

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