Pamela D. Wilson - The Care Navigator

Did you ever wonder how many older adults become involved with people who take advantage of them? Many times it’s one of their own family members who abuses finances and property, after all, who would press charges against their own children? Think again, because it does happen. While many older adults feel the need to have someone they know personally managing their affairs, sometimes it’s a good idea to find a professional who has no vested interest in money, property or other affairs. While there may not be an initial relationship the relationship can grow over time and may avoid many of the common issues that occur with familiarity, mainly crossing the line of “what’s yours is mine”. I’ve seen children borrow thousands of dollars from parents who later have no money remaining to provide care for themselves when they desperately need care. I’ve also seen the opposite. Whoever once said never borrow money to family or friends was wise beyond years.

Older adults are a target for unscrupulous service people and contractors. Many hire contractors recommended by friends who have no idea how to determine the qualifications of contractors. It’s always a good idea to check the local better business bureau records to see if a contractor is a member. Normally individuals who pay to join such a group will ensure that their services are appropriate and at a level of quality to avoid complaints as complaint resolution is a function provided by the better business bureau. If however, it’s too late and you believe you’ve been taken advantage of, contact the better business bureau to make a complaint if the contractor is a member or contact your local district attorney’s office. Many have a division of fraud and abuse that investigates complaints especially by an older and more vulnerable population.

I recently called the hairdresser of a woman I help to inquire if she had cashed a check written by my client the other day since it was about to bounce due to insufficient funds in the account. The hairdresser was thankful for my call and more importantly relieved that my client had someone to help. She relayed stories of concern and worry to me but had no idea how to help or even where to go to find help for my client. I hear similar stories all the time from worried friends or neighbors who want to help but aren’t sure how, especially when there is no family involved. Sometimes it’s a hard decision but a good decision to contact the county adult protective services. Individuals working in this department are usually skilled in evaluating situations and accessing resources to assist individuals who have been reported. There is usually a bit of guilt in reporting a friend or a neighbor but one must also think of the fact that if no one cares enough to help this person a tragedy may occur.

If you look hard enough, there are people who care and want to make a difference. Some social workers in communities are the best kept secret, especially when they truly care. I presently am the guardian for a man who lives in a secured unit because he has dementia and is a flight risk. One of my projects is to clean out a storage unit and find homes for the belongings or donate them to a worthy cause. I asked the social worker if the community had a library or could use craft items that this man’s wife had stored away for years and she immediately became excited. Not necessarily at the thought of acquiring the items but at the thought of allowing this man to have access to items he may remember were in his home or items he might enjoy so that his quality of life might be more enjoyable or he might feel more ownership or at home in his new home to be. The community where he lives is good, but the interest and actions of this social worker to make his life even better is icing on the cake.

I was visiting a client in a nursing home the other day and spent time in the community room. It was interesting for me to watch everyone in the room, what they were doing and their level of involvement. It made me stop for a moment when I realized each person in the room had a history of family, some raised children, had careers or hobbies or did volunteer work. One man sat in a chair in the corner talking to himself. Another argued over a person wanting to sit next to them. I then realized their entire existence was limited to living in a nursing home, likely sharing a room with another person and having space for no more than a couple of containers of belongings. Sometimes it’s good to slow down and just watch and appreciate the ebb and flow of life. But it’s also hard to realize that one day my life too may consist of no more than a single container of belongings.

You’re seeing little signs with your parents that things may be getting out of control. Stacks of papers piling up with what appears to be unpaid bills or a house not as clean as it once was. However, you may choose to ignore the signs and delay the inevitable because you just don’t have time to deal with this right now or you don’t feel that your parents would like you butting in or taking over. Sometimes parents find interest from their children a welcome blessing – and other times it’s a blatant attack. Unfortunately you won’t know until you bring up the subject. The resulting conversation may not be as bad as you fear. When you bring up the subject, it’s best to bring it up early when you see the problem just beginning. It’s also a good idea to bring solutions that may not include you being the only source of help. Doing this early will allow your parents to consider the idea before it becomes a necessity. Ideas are always better accepted if the person thinks it is their own idea.

Due to the present state of the economy, many assisted living and other care communities have available openings. How do you protect yourself from a community who wants to fill a bed or a room and will tell you whatever it takes to get your family member to move in? Believe it or not, this happens all too frequently because family members are so anxious to find a place for their loved one and they settle on the first place they visit only to regret the decision later. Yes, it’s time consuming and difficult to find time to visit several communities but it’s time well spent because it will avoid yet another move due to inappropriate selection. If you think a facility will never ask your family member to leave, think again. It’s important to notice whether the marketing or salesperson seems relaxed or under pressure to fill a room. Question anyone who wants you to put down a deposit just to have “right of first refusal” or anyone who immediately wants to have you sign forms to allow an assessment. Words you want to hear are that the person wants what is best for your family member even if their community is not the right place.

You’re considering daycare for a family member who has memory loss but aren’t sure where to begin. Often the local Alzheimer’s chapter will have a resource list they can provide. But again, this is just a list with a lot of work behind the investigation and you’re not sure what to look for or what to ask. You can always hire a care navigation expert who can cut through the red tape, however if you want to do the work on your own here are a few suggestions. Call the day centers and ask if you can visit. Pick a time of day that is not a meal period so that you can see the activities provided. Pay careful attention to the level of ability of the participants so you can determine whether or not the group would be a good fit for your family member. The most important consideration is to find a group where the individuals are close to the ability of your family member. A higher functioning group with have your family member feeling left out and a lower functioning group will not allow them to engage all of their abilities and may have them bored or not participating. Sometimes it can be a balancing act. Also make sure that the day care center staff are willing to work with you to find the group most appropriate for your family member. Statements of doubt or inflexibility from facility staff are a warning sign that this may not be the right day program for your family member.

More and more individuals are experiencing difficulties with depression, dementia and medications. If your family member has behaviors that are making caring for them difficult, the first step is to consult the family physician who then may refer you to a psychologist or a psychiatrist for a medication and behavioral review. Depending on where you live, actually finding a psychologist or psychiatrist who accepts insurance or is accepting new patients may be difficult. There are many excellent practitioners who have stopped accepting insurance because of low reimbursements, and legally an ethical practitioner who does not accept insurance cannot privately accept a client who has Medicare and allow them to pay privately. This can make it nearly impossible to access treatment. How do you work around this? If your physician knows a good geriatric psychologist, this person can provide an evaluation and then work with the physician to discuss medication options. Sometimes a neurologist is also willing to do this. However there may be a time when the situation is unmanageable and it’s time to consider an inpatient admission to a geriatric psychiatric ward for evaluation. While this may seem like a scary alternative, sometimes it’s the best option to provide care for an individual needing psychiatric treatment and medication management.

Looking for assisted living facilities for a family member can be frustrating. There are so many. How do you know which will provide the best care? Many facilities will offer to provide a tour during a meal time because food is one of the top complaints of residents. If you can, tour during lunch or dinner. This will give you an opportunity to see not only the types of residents living in the community but also the ability to visit with a few and ask their opinions if you’re outgoing enough; watch how they interact, notice their ages, the degree of their mobility, and if they appear to be happy. Notice any “smells” as this is usually a good gauge of how clean the community is on a regular basis and always ask to use the bathroom whether it’s necessary or not. The bathroom in a community especially at a busy time of day can provide a good indication of how clean the community is really kept. It’s also a good idea to make a list of questions that are important to your loved one and take this with you as a checklist to ask the person providing the tour.