Pamela D. Wilson - The Care Navigator

Many older adults have no immediate family because they’ve been single all their lives or have family who do not live near. I become involved with many older adult clients where the relationship begins between the two of us and eventually due to circumstances, accelerating memory loss or health concerns, I contact the extended family with permission from my client. I work to make these conversations with extended family as comfortable as possible because I realize that they may not wish to become involved with their family member, my client, or due to circumstances in their own families do not have the time to be involved. My goal is to advise extended family that I am helping and to make myself available for questions. Having this contact also allows me to gather information that my client may not be able to communicate due to memory loss or other circumstances. In the majority of cases the extended family is thankful that someone is available to help.

Memory loss is a terrible thing, especially when anger and suspicion arise about family members trying to be helpful. A current male client, John, diagnosed with memory loss two years ago cannot recall the diagnosis or at this point comprehend the extent to which it affects his daily life. Rent and other bills have gone unpaid, police have stopped him due to erratic driving, and he does not take medications important to his health. The only family available is as nephew, living out of town, who agreed to help provided I manage the situation locally. The nephew, Tom, is constantly barraged by John with accusations, anger and paranoia. What John cannot comprehend is that he truly needs the assistance and without Tom the alternatives for his situation would not be optimal; it is likely the courts would appoint a non-family guardian or conservator. If you find yourself in a similar situation it is important to recognize the difficulty that your family is going through in trying to help you and acknowledge that without them you may not be able to maintain your current style of living. And, if you are diagnosed with memory loss, having this conversation early before the memory loss accelerates is extremely important to avoid ruining a family relationship that may be your only source of support.

I received a call one week ago about a client residing in a nursing home. I had seen Betty just four days earlier and we had a pleasant visit, however I was now being told that her condition was critical and that hospice was being called. Betty used oxygen 24/7 due to years of smoking. She was struggling to breathe and I was told was actively dying. Not being a family member, even I had difficulty believing this because of seeing Betty several days before. I immediately called family living out of town to advise that Betty was in critical condition. According to the hospice nurse Betty was not expected to live through the night. My question to the nurse was “were we writing Betty off too soon?” I was concerned this was a critical incident and that perhaps Betty needed immediate intervention to reverse the condition. The nurse was non-committal. I stayed by my phone through the night and by morning there was no phone call so I called to inquire. Miraculously, Betty had pulled through in spite of hospice telling me her changes were slim. As a person who knows your friend or family member you have a duty to question situations that don’t seem quite right. There was a combination of events that led to Betty’s premature diagnosis of actively dying: low blood sugar, imbalanced electrolytes and a low oxygen level. After these areas received the needed attention, the condition reversed, but not without emotional stress on the part of her family believing she was going to pass away. .

You’ve been single all of your life and are now questioning this decision. You see others needing care and they have immediate family. You don’t and aren’t sure what you’ll do. This is the main reason why it’s important to maintain relationships with friends and extended family. The time to do this is throughout life, not when you need help and it’s too late to re-establish broken relationships. I work with many families who have not maintained relationships and when care is needed the situation is stressful and emotional. Maintaining connections with friends and extended family takes work and with today’s electronic media communication is all the more impersonal. Find a way to keep in touch that fits with your style and do it now, before it’s too late.

You realize that it’s time to leave your home for a higher level of care; however you have no idea how to begin. Your children may live out of town and cannot readily assist. You’ve browsed through brochures and have even scheduled community tours. However you’re wondering what the communities are not telling you or what is in the fine print. In this case a care navigator can save you time, money and the risk of making a decision you’ll regret. I’ve know individuals who have moved from home to a community only to regret the decision.

When situations accelerate, a parent or parent denies the need for help and are at high risk or danger to self; it may be time to consider guardianship or conservatorship. There are times when family members don’t want the responsibility of serving in this capacity. In these events a professional guardian or conservator may be hired to fill this role. If family is willing to serve, the process may be completed without an attorney provided there is support from adult protective services or a professional familiar with the process. This can save the family thousands of dollars. A traditional filing if done by an attorney can range from $3-6,000. If a family files without an attorney the fee may be less than $500.

You have an interest in helping older adults but don’t know where to begin. The number of older adults permanently living in nursing homes is increasing as is the number of older adults who have no one to visit them. While many nursing homes don’t actively seek volunteers consider contacting the activities director and expressing interest. Individuals with specific hobbies like playing the piano, the ability to teach knitting or the ability to sing can benefit a large number of residents. Others who are simply interested in visiting, providing a manicure, applying lotion or brushing hair can provide one on one attention that is greatly lacking.

There are many individuals who target older adults for scams. If you’ve never had issues with stolen identity consider yourself fortunate. I’ve stopped carrying a checkbook and only use a debit or credit card. At least with this form of transaction, the Credit Card Company or bank can assist in filing fraud. If you’re a frequent internet user you will be “phished”. This means that someone posing as your bank or Credit Card Company will send you an email requesting personal information. Never respond to these emails as the poser can then access your account. When in question call your bank or Credit Card Company about the questionable email. And never give out personal information on the telephone when you have not initiated the phone call yourself.

Adult protective services can be a tool for family to provide support when parents will not accept help. This is often a difficult step; however there are times when other options have been exhausted. Adult protective services can serve as an intermediary and as an objective observer when issues arise. Depending on the county where a parent lives and the role APS plays the level of support may differ. Sometimes there is also a need to involve a private care navigator who can provide ongoing support. If you find yourself in this situation, APS may be able to provide names of individuals who might assist.

You are a friend trying to help a friend who has had ongoing problems paying her bills on time. You think it would be easier if you just had your friend’s social security and retirement checks deposited into your checking account. This would allow you to write checks and pay her bills. But stop a moment and think about how this might look to an outside party. Yes, you are trying to help and to be supportive. But why not help your friend write checks from her own bank account to pay bills? Why not discuss becoming your friend’s legal power of attorney so that her bank account can be maintained? When the need for help progresses to this point it’s best to consult a family member if one is at all available. If not then consider making your assistance formal and legal.