Eternal Love

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Image courtesy of Ben Schonewille at FreeDigitalPhotos.net.

 

As a geriatric specialist, I hear all kinds of stories. A nurse colleague told me this touching love story (I have changed the details to protect anonymity). – Angela G. Gentile, MSW, RSW.

 

One time I was speaking to a man who told me the love story about his parents Gerald (82) and Mary (80) who both had dementia. They had been married for almost 60 years.

Gerald’s dementia was more advanced that his wife’s so he was moved into a Personal Care Home. Mary moved into a seniors’ residence, which was attached to the long-term care centre.

Soon after, Mary’s needs progressed to the point where she needed to be moved into the Personal Care Home as well.

Gerald had no memory of his wife, but soon fell in love with his new neighbour, Mary (who was actually his wife.) He spent every waking minute with her.

One day, Mary needed to be rushed to the hospital. Not long after her hospital admission, she died.

After having no luck finding his love again, Gerald gave up. He died 37 days after Mary’s death.

It looks like eternal love is possible after all.

 

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Angela G. Gentile  MSW, RSW is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and two adult children. She is passionate about all things related to Aging Well. For more information, visit: www.AngelaGGentile.com

 

Alzheimer Caregivers Need Help, Too

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Courtesy of the Fort Frances Times

I enjoyed presenting at the Alzheimer Society Forget Me Not Dinner in Fort Frances, Ontario. It was my first out-of-town request to be a guest speaker. It was a sold-out crowd and they raised over $4,000.00.  Duane Hicks did a great job of covering the story. The only thing I would like to correct is that I have two children, a son (Lorenzo) and daughter (Simone). Lorenzo is the app developer for the mobile app, “Dementia Caregiver Solutions.”

 

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Courtesy of Fort Frances Times/Duane Hicks

Above is a picture of my husband, Agapito, and I getting ready to dig in! He was a big help to me as he drove the whole way (4 hours one way). He was my official assistant during my presentation as he advanced the slides for me.

If you would like more information on my services or products, please check out my website, www.AngelaGGentile.com.

Sincerely,

Angela G. Gentile, MSW, RSW

Learn About Burnout at the Transform Conference

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From Burned Out to Fired Up!

Angela G. Gentile MSW, RSW

I am honoured to be one of six guest speakers at the Transform Conference to be held on February 21, 2017 in Winnipeg, Manitoba. I will be presenting on my knowledge and experience with job burnout and compassion fatigue. In addition to discussing the issues of the costs of caring too much, I will share my personal story of burnout. I will offer advice, tips and solutions to nurses, social workers, healthcare professionals, students and other helping professionals on how to recognize, cope and survive in the demanding yet rewarding field of healthcare.

What better way to learn. Be inspired. Some consider it a gift from a wounded healer.

You may also want to read my eBook, “A Book About Burnout: One Social Worker’s Tale of Survival“. Paper copies will be available at the conference.

For more information on Transform, the conference, please visit Sycamore Care.

www.AngelaGGentile.com

 

 

When the Going Gets Tough: A Best Practice Guide for Caring for People Living With Dementia

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The Alzheimer Society of Canada website states that in 2011, there were 747,000 people living with some form of cognitive impairment, including dementia. This number is expected to double to 1.4 million by 2031. This means that many of us will be affected by dementia in some way, if we haven’t been already.

The Canadian government and health care sectors are well aware of the need for improved dementia care strategies, and a lot of research has been done on how to best serve this growing population. In some cases, dementia can affect a person such that his or her behaviour becomes very difficult to manage. Agitation, aggression, sundowning, and repetitive vocalizations are some of the most challenging behaviours to manage. In many of these cases, people living with dementia are over medicated or inappropriately managed which often results in other problems which can be quite disconcerting.

The Government of British Columbia has produced a document titled, “Best Practice Guideline for Accommodating and Managing Behavioural and Psychological Symptoms of Dementia in Residential Care: A Person-Centered Interdisciplinary Approach” (2012). In this 16-page document care providers at all levels will find ways to help improve the quality of care for people living with dementia, which includes better engagement with the person’s advocates and family members. The appropriate use of antipsychotic drug treatment is discussed, and it stresses that the first steps to best practice care are to look at environmental and behavioural modifications as well as psychosocial interventions.

In terms of pharmacological management, antipsychotic use in the older adult population comes with its own set of risks. In fact, there is a “black box” warning, as it is a well-known fact that there is increased mortality risk as well as other side effects that can be quite serious. Other psychotropic drugs, such as anxiolytics or benzodiazepines can also cause increased risk for falls and confusion. These medications should be used with caution. Other ways of managing the behavioural and psychological symptoms of dementia are now strongly encouraged as we are encouraged to shift away from using medication as a first line of defense. A risk and benefit analysis of the use of these medications is always recommended.

Person-centered care is now recognized as the most appropriate and effective way to care for people affected by dementia. It means that we consider each person as an individual, with his or her own unique history, personality, strengths, weaknesses, and challenges. It means that we take the time to learn about the person, which makes our care towards that person special, unique, and most effective.

For example, if there is a problem with a man who is up at night wandering the halls, we may want to look into his social and work history to find out what may be going on. We learn by talking to his family that he was a night shift supervisor for a large factory. This helps us learn more about his routines and lifestyle as he may be “back there” in his mind. This person-centred approach can be applied in all situations with every person we deal with. Many care providers believe that there is a reason for every behaviour. It is up to us to find out what the person is trying to communicate to us through their actions.

Another useful tool that is referenced in the aforementioned document is the concept of the person-centred “P.I.E.C.E.S. (TM)” approach. The cornerstones of this approach include looking at the following aspects of the person: Physical, Intellectual, Emotional, Capabilities, Environment, and Social. I am a P.I.E.C.E.S. trained assessor and these concepts help provide the best assessment and interventions from a person-centred approach.

A person-centred approach to the care of those with dementia or other related cognitive disorders takes into account aspects such as the person’s likes, dislikes, cultural and religious preferences, medical health, as well as their social history. An interdisciplinary team approach to care which includes professionals, non-professionals, family members and others with a vested interest is highly effective and recommended. Proper assessment, symptom management and ongoing evaluation is needed in order to continuously improve and manage a person’s care, especially as their dementia progresses and challenging behaviours present themselves.

Angela G. Gentile, MSW, RSW

Sources:

The Alzheimer Society of Canada: http://www.alzheimer.ca/en/About-dementia/What-is-dementia/Dementia-numbers

Best Practice Guideline for Accommodating and Managing Behavioural and Psychological Symptoms of Dementia in Residential Care: A Person-Centered Interdisciplinary Approach (2012): http://www.health.gov.bc.ca/library/publications/year/2012/bpsd-guideline.pdf

P.I.E.C.E.S. – http://piecescanada.com/

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Angela G. Gentile  MSW, RSW is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and two adult children. She is passionate about all things related to Aging Well. For more information, visit: www.AngelaGGentile.com

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How to Improve Your Sense of Belonging: The lifelong desire to feel connected and accepted by others

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One of the basic needs of humans (other than food and shelter) is the need to feel loved and like we belong. Belonging in the sense that we feel connected and accepted by others. We all have a different level of need. Some want more, some want less. I have seen many people who feel lonely, and I believe it has to do with the fact that they don’t feel like they belong. This drive for belonging never goes away, and is present at all stages of our lifespan. Sometimes our motivation for belonging lacks due to mental health problems like depression or dementia. Sometimes loss can trigger our sense of connectedness in this world. We can work on improving our need for belonging by becoming self-aware and taking a good look at our life. It may mean we need to make some changes or seek some professional help.

The need for belonging evolves across the lifespan

If we are fortunate enough to be born and raised into a family that helps us feel loved and cared for, that is one thing. However, if we are born into a family that lacks the love and protection we need, we may feel abandoned. Renowned psychologist Matthew Lieberman studies “social pain” and he believes the drive to alleviate or relieve our social pain is more important than the basic needs of food and shelter.

Those of us who feel abandoned in our younger years may not develop a sense of what “love” is. We may crave and search for that feeling of being accepted and cherished. We may search for this in relationships that are presented to us, such as in teachers, other relatives and peers. Sometimes these relationships are good and helpful. Our needs can be met in a positive way through these other relationships as long as they are healthy and free from abuse.

Sometimes we find the comfort, acceptance and connection through unhealthy relationships. Until we are mature enough to figure out what is healthy for us, we may end up learning the hard way. That is why it is so important for families (no matter what the family consists of such as a single parent) to pay attention to the basic needs of their children.

As we mature, we learn what is healthy and not healthy for us. As teenagers we may end up in troubling relationships to gain the love and acceptance we are innately or instinctually craving. We may end up getting involved with the “wrong crowd” because they are the only ones who seem to understand and accept us.

The need to feel like we belong never goes away. Just like our need for water and safety. We are social beings. We depend on others. We do things in groups. Our connections to others changes as we grow and become wiser. The basic personality traits remain the same, but our values and morals may change over time. Having children and starting our own families usually wakes up our moral compass. What is right and wrong suddenly becomes clear.

Our own innate need for belonging is often met by having children. Young children usually offer us unconditional love and acceptance (things may and will change as they become more independent). Our small and sometimes growing family helps us meet our needs for feeling loved and like we belong. For those of us who don’t have children, pets, other relatives (nieces/nephews) and friends can also provide a sense of belonging.

How do we help others feel like they belong?

Fostering a sense of belonging goes both ways. For example, if we go to a family gathering or a social outing, we may or may not feel like we belong based on our actions or the actions of others. For example, do you feel “connected” to others there? Do you feel “accepted”? Do you willingly and freely accept those in the group or do you tend to disconnect? Do you accept others as they are or do you judge or avoid?

I find that those who feel a sense of belonging have good connections with others through family, friendships and other social connections. They also know who to avoid based on the way they are treated. When we consider adults, I think about workplaces and clubs such as cultural or religious based. Friendships and family relationships can be, and need to be, fostered and nurtured.

With respect to older adults (those 65 and older) families are often a main source of love and belonging. If this is not possible, or if a person feels they want more, there are clubs and other groups that can help fulfill these needs. Examples of groups and other social opportunities for older adults include:

  • Seniors Centres
  • Retirement Communities
  • Church/Synagogue or other Spiritual Based Groups
  • Cultural Clubs
  • Women’s Groups (e.g., Red Hat Ladies, Crown Jewels of Canada Society)
  • Men’s Sheds

Feel like you don’t belong?

In some ways, we are all pieces of a puzzle and we all want to “fit in.” If you answer yes to any of the following questions (modified from the Sense of Belonging Instrument SOBI-P), then you may want to explore some ways to seek connection so you feel a better sense of belonging:

  • It often feels like there is no place here on earth where I truly fit in.
  • I don’t really fit in with my friends.
  • I feel like a misfit in most social situations.
  • I don’t feel accepted by most people.
  • I could disappear for days and my family or friends wouldn’t miss me.
  • I tend to observe life rather than participate in it.
  • I feel left out of things.

Depression is linked to loneliness and isolation and can be reversed

We also know that loneliness and isolation are linked to depression. Sometimes it’s not clear what came first, the depression or the lack of connection to others. Sometimes depression is triggered by a loss. Some people need to see a health care practitioner or mental health specialist to assess if medication can help.

To end isolation and loneliness brought on by a sense of “not belonging” or feeling left out, it takes some effort and it goes both ways. To improve your sense of belonging, you need to help others feel like they belong to help that connection and acceptance grow. Here are some ways to help nurture a sense of belonging:

  • Call a friend or family member to ask HOW they are doing and tell you about WHAT they are doing (don’t just talk about yourself, your own family and your own life, ensure they talk about their life, too)
  • Join a social group for fun
  • Volunteer for a cause you are interested in
  • Find a job you enjoy with a boss and co-workers you can relate to
  • Try out a club that is focused on one of your interests and see if you feel like you belong
  • Contribute to newsletters and share your expertise with others
  • Plan an outing or a visit with someone you care about or would like to get to know better
  • Write a letter to someone who you think will write back
  • Join a social media site like Facebook and find some groups you are interested in
  • Join a support group
  • See a counsellor if you are stuck but want to make some positive changes in your life

Our basic human need and motivation for feeling like we belong in this world can be nurtured and supported by our actions. The reverse is also true. Think about WHO you belong to, WHAT you belong to and WHO and WHAT belongs to you. If you want to increase your sense of connection and acceptance it will take some effort. The same as getting food, water, shelter and safety. It doesn’t happen all on its own.

Please provide me with your thoughts on this topic. I’d love to hear from you.

Angela G. Gentile MSW, RSW

 

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Angela G. Gentile  MSW, RSW is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and two adult children. She is passionate about all things related to Aging Well. For more information, visit: www.AngelaGGentile.com

 

This Self-Help Book for Caregivers Educates, Supports and Comforts

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When I titled my book “Caring for a Husband with Dementia: The Ultimate Survival Guide” (2015) I did not expect to have people mistakenly assume that I am a wife caring for a husband with dementia. The warmth and sympathy I receive from people who don’t know me personally has been incredible. I gently explain that I am not a wife caregiver and that the book is inspired by the experience I had in counseling eight amazing caregiving women.

When I was deciding on a topic for my master’s degree final project, I decided to focus on older women. I explored what issues are affecting them, and the subject of caregiving came up quite often. I did some research on the subject and discovered that there was very little written about women who care for husbands with Alzheimer’s or a related dementia. My career as a geriatric clinician and social worker exposes me to many different mental health issues, and dementia is unfortunately a common one. I quickly became an expert in assessing and screening for dementia, and recognizing the symptoms of caregiver stress and burnout.

The short-term, individual counseling program I designed, implemented and evaluated with eight caregiving wives was very rewarding and successful. It inspired me to want to help others like the women I had learned so much from. What started out as a small booklet turned into a 16-chapter book. “Caring for a Husband with Dementia” was written specifically to help women who care for husbands who have been diagnosed with a dementing illness such as vascular dementia or Alzheimer’s disease. I dedicated this book to caregiving wives, everywhere.

Writing this book came surprisingly easy to me. I called it a “Divine Intervention.” I received help from colleagues and other experts in the field who generously donated their time reviewing, editing and offering feedback. It is a unique, informative and therapeutic self-help type of book. The book offers opportunity to make it personal for the reader. There is space for self-reflection on important questions. Don’t know what to “Google” to find your local resources? I’ll help with that, too. There is a listing of helpful and important resources, plus more.

All of the reviews and feedback I have received thus far has been very positive. Some of the more helpful feedback has been that this book is written not only for wives, but for all caregivers. I have been told this book is like a bible and it is kept at the bedside and is read every night. It’s a reference guide, a companion, and a source of education and support. It’s like a year’s worth of therapy all in one book.

I know this book has helped spouses and other caregivers. They have told me, “Everything I was thinking, feeling and wondering about was written in this book.” I am honoured to be able to help those who are struggling with the issues of diagnosis, getting help, difficult behaviours, grief and loss, legal issues and more. I have been at book signing events where even men say they want their wives to buy this book as they want them to be prepared – “…just in case.”

My hope is that this book reaches those who are in need of education, support and tips on how to survive the difficult task of caring for a loved one with dementia. It is also a great gift for someone in need.

Angela G. Gentile, MSW, RSW

Link to original article on #AlzAuthors, published 23 Nov 2016.

 

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Angela G. Gentile  MSW, RSW. is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and two adult children. She is passionate about all things related to Aging Well. For more information, visit: www.AngelaGGentile.com

Myths or Truths? A Guide to Achieving Retirement Community Gold Standard

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(This article was written in collaboration with guest Alan S. Wolkenstein, MSW, ACSW)

As an administrator or manager of a retirement community, you likely hold specific beliefs and understandings of the residents (or tenants) and the workings of the facility. These understandings may be ones that you have learned from others, or perhaps you have come to believe based on your own experiences. Sometimes beliefs about your retirement community can hinder growth and success due to the fact that they are myths (widely held false beliefs).

Myths can hold us back from achieving our full potential for success. While myths exist to help us explain and make sense of our experiences, they can be, and often are not helpful in that they simply are not true. Sometimes these traditional stories are widely held but are not based on facts. Taking our head out of the sand and taking a close look at reality can help us move forward.

Do You Hold Any Myths About Your Retirement Community?

It is important to identify if there are any myths you hold about your retirement community and those you serve. By asking yourself if there is truth or if it is simply myth to each of the following thirteen statements will place you in a more favorable position to exert constructive political, cultural or systems energy. By answering these statements honestly, you will be able to identify them as either truths or myths.

If you happen to recognize some of these statements as myths, you may come to realize that these untruths can inhibit the functioning of your retirement community in meeting the best needs of the residents (and families), staff and institution (bottom-line). The acknowledgement and examination of these falsely held beliefs can challenge you to take on the potentially arduous task of transforming them into truths.

There is a potential for great change in the overall success of your retirement community by focusing on challenging or debunking any myths and doing something about it. Myths are generally difficult to disbelieve due to your strong emotional attachments to them. For example, you may find it a bit troubling to realize your residents may or may not be provided all the services that are essential, available or needed.

Myths or Truths?                                            

While we have developed thirteen statements, we believe there will not be less. There may be some that have not been included that can be exchanged or added for conversation and potential action. They are not mutually exclusive, but designed in a way to encourage thoughtful reflection by individuals and for discussion within the staff or team at your retirement community.

Consider these thirteen statements and decide if these statements are myths or truths when it comes to your retirement community:

  1. Our residents are a priority, and our retirement community has all the amenities, staff and services the residents need for enhancing their quality of life.
  1. We understand that older adults who have chosen to come to our retirement community may or may not have completed and successfully coped with their Family Life Cycle¹ tasks (such as launching adult children, retirement, widowhood, accepting bodily changes and dealing with the realities of their living arrangements), eliminated their intra-familial conflicts and made all important amends. They may or may not be emotionally and psychologically prepared to handle potential losses, grief experiences and transformation.
  1. Our retirement community adopts a holistic approach to care and has fully trained and specialized staff to identify, assess, treat and monitor the physical, emotional, psychological, cultural and spiritual needs of our residents. Administrative personnel and managers are up-to-date on the resources available and continuously strive for improvements in this area.
  1. Residents are properly screened and/or assessed by qualified personnel for anxiety, depression, mood and thought disorders and mental status (including Alzheimer’s disease and related dementias). If these services are not available in-house, staff are trained to identify issues. Residents and/or family advocates are encouraged to seek out advice from an appropriate health care or mental health professional.
  1. There is an active involvement with families and social/cultural communities of residents for continuity of attitudes, values and belief systems. In addition, all elders need connections with their significant others and our retirement community fosters and encourages these relationships.
  1. Administrators, managers and select staff are encouraged and trained to provide continuing adult education programming and support within our community to individuals and families in troubled elder-parent and adult-children relationships.
  1. Our retirement community welcomes and embraces the roles of residents’ advocates and an ombudsman in the holistic and total care concept of our residents.
  1. Our retirement community has sufficient and ongoing staff training opportunities, supervision and evaluation of all appropriate staff.
  1. If present, frequent staff turnover is vigorously addressed. We believe a disjointed or fragmented system can lead to a less than viable milieu for residents and staff morale. We strive for continuity and consistency. Satisfied staff leads to satisfied residents.
  1. Administrative personnel have a clear understanding of and methodology to deal effectively with staff burnout or impairments (permanent or temporary).
  1. Our retirement community has a Human Resource Department that is staffed with (or has access to) professional mental health personnel: those who can identify, assess, and refer for proper treatment (or other actions) staff who are troubled, deficient, show signs of burnout and impairment, and those in violation of local, state, federal and institutional laws and guidelines.
  1. Our retirement community understands and encourages interagency cooperation within our communities.
  1. Our retirement community interacts with educational and academic resources to foster community public awareness and psychosocial services for older adults within our community. This includes placement, internships and fieldwork for learners in the field of geriatrics and mental health services. All such learners are supervised and guided by specialists in eldercare from appropriate professions within the institution.

While self-imposed institutional denial that services are not lacking and provided, or rationalizing that if they were needed, they would be adequately provided, ultimately such institutional defenses are insufficient and hinder best care and utilization of accumulated knowledge and skills in residential care for older adults.

No retirement community consciously chooses to deny services to their residents and staff, but may be acting only from a strong and important fiscal basis. However, this is insufficient. Boards and administrators may be very good at their roles, but not sufficiently trained to assess the holistic need of their residents and staff. They may ultimately fear resources are not sufficient to turn any of the myths into real-time community truths.

If we believe we are functioning from a more enlightened perspective than the one that a retirement community is meeting all these beliefs as truths when they are not, then conceptual shifts are in order.

Your Score and What To Do About It

If you answered “Myth” to any of the above statements, then an action plan for remediation and change may be essential.

This action plan may include:

  • an examination of policy and procedures
  • reassessment of priorities
  • modification of scarce resources
  • finding and securing new funding to change some specific myths to truths
  • a review of long-range goals and objectives

Achieving Gold Standard

We have painfully learned that if a system remains profit and profit margin motivated and not sufficiently focused on customer/family/consumer needs and satisfaction, it will not survive in these difficult and challenging times. There will be intra-system anxiety when confronted with the two, apparently opposite, goals. Anxiety can be a powerful force in creating a milieu that fosters change, enlightenment and growth. If guided and properly mentored, anxiety can help individuals achieve their full potential. We believe this is also true for retirement communities.

It is a truth that a society is best measured by how it cares for its very young and very old. Let your retirement community be the gold standard of care for its residents and their families. Maybe now is the time to secure and support consultation to reach new visions for your retirement community.

Alan S. Wolkenstein, MSW, ACSW
Clinical Professor of Family Medicine (Ret.)
University of Wisconsin School of Medicine and Public Health
Wolkenstein and Associates, LLC
Mequon, Wisconsin, 53092
Alan.Wolkenstein@gmail.com

Angela G. Gentile, MSW, RSW
Specialist in Aging

¹ Wolkenstein, A. S., Lawrence, S. L., & Butler, D. J. (1985). Teaching “family”: The Family Medicine Chart Review. Family Systems Medicine, 3(2), 171-178.

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Angela G. Gentile  MSW, RSW. is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and two adult children. She is passionate about all things related to Aging Well. For more information, visit: www.AngelaGGentile.com

 

Family Estrangement – When a Parent’s Heart Aches to Reunite With a Child

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I have assessed hundreds (perhaps thousands) of older adults over the past 16 years. Sometimes it was for Home Care eligibility, and other times it was for a mental health assessment. On occasion, I will interview someone who talks about an adult child who he or she hasn’t talked to or heard from for years. It is often an emotional topic. The term we use for this is estrangement. Family estrangement is when there is a physical or emotional distancing between at least two family members when one of the parties is not happy with the arrangement.

When older people talk about the estrangement, it is often very painful for them. I often wonder why and when the separation occurred. I wonder who was at fault? Was anyone at fault? Or is this something that just happens naturally between two people? Sort of like what happens to friends or acquaintances sometimes. Is the adult child unhappy with the arrangement? Or is it just the parent?

There was one man in particular I remember who’s heart was obviously broken. He was about 85 years old. He lived in a nursing home. One of the things that was causing him such grief and sorrow was the fact that he had not heard from his son for years. He told me he wanted to contact him so he could feel at peace. I was not able to facilitate this for him. I wish I could have.

What causes estrangements between a parent and child? Perhaps the parent mistreated the child when they were younger, and now the adult child would rather not be subject to any more mistreatment. Perhaps the adult child cannot cope with the changes that aging brings to their older parent. Maybe mental health problems influence the child into not wanting to talk to his/her parent. Perhaps an abusive and controlling mate keeps the person away from their family. Then I wonder, what if the child is feeling the same way and is waiting for the call from his or her parent? (A waiting game called: “Who will call who first?”)

Whatever the reason for estrangement, I have seen a few cases now that cause a parent to be heartbroken in later life. These situations cause feelings of loss, confusion, worry and guilt. I know that as we grow older, many of us want to make peace and right some of our wrongs. Perhaps we want to die without regrets. I am a parent myself, and I can only imagine how difficult it would be to lose a child in that way.

I wonder if there is any hope, ever, to reunite an older adult with their estranged child. If so, how does one go about doing that?

Angela G. Gentile

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Angela G. Gentile  MSW, RSW. is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and two adult children. She is passionate about all things related to Aging Well. For more information, visit: www.AngelaGGentile.com

Twelve Areas to Consider When Thinking About a Retirement Community with Lifelong Services

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(This article has been written with guest blogger, Alan Wolkenstein MSW, ACSW)

As family members age, there may come a time when an older person’s needs can no longer be met in his/her current home. It may be unsafe, there may be too many worries, or it may be stressful for all involved. For example, if Mom and Dad lived in their moderate-sized bungalow for the past 40 years, things may change dramatically when one of them passes away. Maybe Mom is now left in this house on her own, and she is overwhelmed with all there is to do. Even with family support, and the supports from other agencies and programs, Mom is still not being cared for the same way she was when dad lived with her. Although Mom does not want to move from the home she has known for so many years, sometimes a move to a more supportive environment is needed. Having this discussion can be difficult.

There are many issues that can arise with respect to an aging family member and housing needs. Illness, finances, mobility, socialization, recreation and access to services are some of the issues that may have to be considered. How does one make the right choice? Should the older family member stay in the house longer, or move to an appropriate “elderly persons housing”? Maybe he/she should move to a retirement community, or a place that also has lifelong service options. Should the person move to a 24-hour care facility like a nursing home? A good quality of life is usually the overall goal.

Conversations About Moving Can Be Difficult

Conversations about relocation may become uncomfortable and anxiety-provoking because they usually consist of making major changes in where one lives, relationships and even in family dynamics. The older person him/herself or other family members may be thinking about these issues, but the conversations may be avoided in order to prevent upset or problems in the relationship. We already know that everyone seems to have a slightly different opinion on the subject.

For those directly involved, the stakes are very high, and previous attempts to have such conversations may have not turned out very well. People can feel unsure of themselves and the older adult may experience that their own wishes may be disregarded by their children who push for changes to ensure a more safe and healthy environment. Relocation usually involves downsizing, a major disruption, adjustment issues, loss, and a change in daily routines. Ultimately, it should also come with benefits that outweigh the negatives.

This may be the first time adult children have seen their parent(s) unsure of themselves, possibly afraid of the future, and even angry or refusing to participate in these talks. It seems that no matter what is decided, many feelings may be hurt and someone will feel disregarded and not appreciated for their wishes.

Conversations About Moving Can Be Welcomed

However, in many situations, the family discussions around this topic go well. For example, an older adult may want to move on. In this case, the family can come together with a unified plan that seems positive and helpful to the whole family. Then the issues become where to look, how to assess, and when to choose a place.

Making Decisions Regarding Housing Needs Can Be Confusing and Complex

For others navigating the housing dilemma, the situation is confusing and complex, and there seems to be no way to satisfy all. In the end, no one feels or experiences satisfaction. If an older person moves into a retirement community following this scenario, the likelihood of a successful adjustment is deeply compromised.

Many situations regarding decision-making related to relocating an older family member require and benefit from professional intervention. Professional assistance could come in the form of:

  • helping the older person and his/her family members choose a suitable place
  • mentor and support the family so they can choose for themselves
  • help them sort through the levels of conflict

12 Areas to Consider When Choosing Seniors’ Housing

The following are a number of questions to be used as a working outline in maneuvering through these scenarios. Each requires input and shared conversation with a guide or mentor to monitor and direct the conversations and the powerful emotions they generate. In order to get answers to these question, you (the person seeking housing and/or the person’s advocate) will have to make arrangements for tours and meetings with key people. A trusted professional or seniors’ organization can help you get a list of possible options to choose from. Keep a log of the answers so when decision time comes, you will have some notes to look back on. The questions are not listed in any rank order of importance, but as they come to our mind as we have worked with older adults and families during these potentially troubling and stressful times. As always, take with you what seems most helpful to your unique situation. Note: These questions are written for the person who will be moving. Sometimes a trusted family member or advocate (someone who knows the older person very well) can assist through this process.

1. Costs and how they will be paid for. Remember that the highest cost establishments may not be the most rewarding one. Many have entrance fees that may or may not be refundable in some degree if you leave or pass on. All require fees for their services. Ask if there are any move-in incentives. What is included in the costs (i.e., meals, housekeeping, recreation, etc.). Do they have a free or low-cost “trial stay” option? In the United States, some may take Medicare. In Canada, some of the facilities may be government subsidized. Get the facts down right. Higher cost is not always an indicator of better service and dedication to you. You may also want facts about the establishment’s financial health to guarantee their viability.

2. Location, location, location. How far is it from your family and friends? How close or far are familiar places such as services, restaurants, theatre, clubs, church or synagogue? Are there plans to establish all these in the retirement community once there, or will your time be split? Remember that connection with important people in your life is a definite component of good quality of life.

3. Values and commitment. Ask the management or representative at the establishment about values and commitment to each person. Get this from the people you talk with, not the brochures they send out. While it is good to talk to folks who are available to talk and share their experiences there, they will probably have you speak with the most satisfied members.. Ask for a list of complaints they have received and dealt with. Seek a place that shares your values about what is important in your life and maintaining a high quality of life: continuity here is also important to your quality of life. Ask what procedures are in place to ensure they uphold their commitment to these core values. Ask how these core values are implemented and evaluated. Are they open to improvements? Is there a “Comment Card” system where the residents/tenants can forward their comments and concerns anonymously? Alternatively, what avenues are in place to motivate, celebrate and encourage outstanding service and achievements by staff?

4. Religious affiliation is only part of the equation. Try not to select by religion alone. You may find the system falls far short of meeting your overall needs. While many families share they receive much comfort if the community is of their religion, this does not guarantee a successful placement.

5. Processes in place to ensure a warm welcome and adjustment. What processes are in place to help you or your loved one transition into their system and become part of their “community”? Who is the “go-to” person if there are questions?

6. Supports to help with the adjustment. How will they assist you or your loved one in coping and adapting to their environment? You or your loved one may find it more complicated and anxiety-provoking to move through the process of adjusting there. Who are the staff and what are their qualifications to do this with you or your loved one?

7. Availability of care and counseling after a major life stressor. Many people and families seek out a place following a serious loss to them, such as death of a loved one; illness; financial problems; or diminished ability to provide activities of daily living (ADLs). Attempting to adjust now can strain an individual’s ability to cope and adapt. How will the community provide care and counseling? Does administration view the need for counseling as necessary for enhanced quality of life for some tenants/residents? Is this included in the overall fee? Is it an add-on expense? If counseling is an additional expense (versus an available built-in service), administration does not view this need as a normative cost to them.

8. Counseling and advocacy for relocation concerns. Most people have some degree of ambivalence and uncertainty about such an important move. Who is there to smooth the way and champion their concerns?

9. Counseling for family members. What family counseling services are available to your family? Not all of us have made our amends with our family, dealt with the issues that cause us strife and worry, and resolved any family guilt or anger between members.

10. Regular assessments to assist with adjustment. Are there regularly scheduled assessments of how you or your loved one is coping and adapting? Who are the people and what are their qualifications?

11. Health services. Your health is crucial. How do they incorporate physicians, nursing, and allied health services into their system?

12. Future care needs. What does the facility offer in terms of long-term care needs? Do they adhere to an “aging in place” concept? Meaning, if your health or condition declines, do they continue to support you in their facility, or do you have to move again? Ask them how long you could stay, and what are the reasons you may be asked to leave (“Exit-criteria” or reasons for “eviction”).

We have listed for you 12 areas of concern we feel are important. There are certainly more and some may be equally as important or more important that any on this list. Think for a moment what they might be for you or your loved one. You may be surprised how these questions and concerns bring other ones to the surface. For example, is there a pet involved? Is the pet welcomed?

Reconsidering a Move

What if you began to rethink about your loved one remaining in their home? What services would they need? What services would they accept? Where would the funds come from? Is this just a temporary measure, and if so, would it give everyone time to breathe easier and simply let the person remain in his/her home for a little while longer? Would this be reasonable for a family with many different opinions? Would it be reasonable for an older person who may perceive these service providers as strangers intruding their home further solidifying their sense and awareness of growing frailty and needs?

Seek Professional Consultation

Consider a consultation by a specialist during this challenging time. Seek out someone who has the experience and expertise to guide you and your family with and through this process. Meeting with this person can illuminate a path that you may not have thought of, and provide guidance to see you through.

Many older adults and their families find selecting appropriate seniors’ housing and the accompanying transition somewhat stress-free. Many do not. If your loved one or family is finding this transition difficult, there is help available. There are many fine people in the community to serve you. Start by discussing with your loved one’s mental health professional or doctor. Start by making an appointment.

We wish you and your family well.

Alan S. Wolkenstein, MSW, ACSW
Clinical Professor of Family Medicine (Ret.)
University of Wisconsin School of Medicine and Public Health
Wolkenstein and Associates, LLC
Mequon, Wisconsin, 53092
Alan.Wolkenstein@gmail.com

Angela G. Gentile MSW, RSW
Specialist in Aging

 

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Angela G. Gentile  MSW, RSW. is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and two adult children. She is passionate about all things related to Aging Well. For more information, visit: www.AngelaGGentile.com

Watch Your Step! Fall Prevention Tips

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Source: Simon Howden, Free Digital Photos.net

Did you know that one in three Canadians over the age of 65 will fall this year?

Some of these falls are life-threatening. In fact, falls are the leading cause of injury-related hospitalizations of older adults in Canada (Smith, Wager & Elliott, 2010). In 2004 Statistics Canada reported falls cost the health care system an estimated $2 billion.

In Canada, falls are the leading cause of head injury hospitalizations in adults (Canadian Institute for Health Information). Thirty-five percent of injuries from a fall result in broken or fractured bones (Statistics Canada). The cost to the health care system and to personal quality of life is staggering.

It is important to know the risks and to prevent falls from happening.

These falls happen everywhere; be it in the home, the community or in long-term care. There are some helpful online risk assessment tools and other resources to help older adults who are at risk, or who simply want to be pro-active in fall prevention. A study done in 2009/10 showed that fall related injuries from simply walking comprise forty-five percent of self-reported injury. (Statistics Canada, Community Health Survey).

Self-Assessment for Older Adults Who Live Independently

For older adults who live alone, the Staying on Your Feet website provides a self-assessment questionnaire for older adults, called Prevent Falls Check-Up. Once completed, a Check-Up report is provided which offers a variety of suggestions and tips for falls prevention. The main message here is that most falls are preventable, and steps can be taken to reduce risk.

Safety is far more important than what preventative and risk-reducing measures “look like.”

Concerns about getting in and out of the bathtub? Arrange to have grab bars installed. The Canadian Mortgage and Housing Corporation has released guidelines on the best placement for grab bars for maximum effect and ease of use. We have to get past the idea that grab bars may make us look weak or frail.

Taking medication? For those on three or more medications who are experiencing bouts of feeling light headed or dizzy, regular medication reviews are recommended. Medication adjustments may be required to help reduce unwanted and potentially harmful side effects that can cause an increased risk for falls.

Could the home surroundings be made safer? When a person has lived in a place for many years, they tend to not see where improvements can be made. If the person tires easily, perhaps a relative can help select rest areas where small chairs can be set to provide breaks. If the person tends to walk the same path through his/her home, move furniture to ensure a clear pathway.  If a small pet tends to get underfoot, install a bell on its collar. Move commonly used kitchen items to easy-to-reach areas to reduce the need for step stools. For hard to reach items, never stand on a chair – always use an appropriate stool or short step-ladder made for such a purpose, and preferably one with a handle at the top to provide steady support.

Is footwear safe? Slippers or mules with no backs, overly worn soles or shoes that are too tight, can all contribute to falls. Ensure the person has a good pair of well-fitting shoes, preferably without laces that could cause tripping, and with lots of room in the toe box. Wear these shoes in the house. Shoes that move with one’s feet will help reduce falls in the home.

Problems with blood pressure? Postural hypotension, or a sudden lowering of blood pressure when changing head elevation, is common among those 65 and older. A good tip is to get in the habit of sitting on the edge of the bed for a few seconds upon awaking before standing up. This allows the blood pressure to adjust to reduce the risk of dizziness upon rising.

Overactive bladder? If bladder incontinence or urgency poses problems, rushing to the bathroom can be a fall risk, especially in the night, and especially for homes where the bathroom is not close to the bedroom. Consider purchasing a bedside commode. The commodes of today are much more user-friendly and attractive than in our grandmother’s day, and we should not be embarrassed to install one in our bedroom. Purchase a screen to hide it during the day if embarrassment is an issue.

Need to use the stairs? Falling on stairs is the third most reported reason for falls, (Statistics Canada, Community Health Survey) after walking and snow/ice slips. 12 Steps to Stair Safety at Home is a one-page checklist on stair hazards and ways to look at stair issues effectively. First and foremost handrails should be on both sides of the staircase and should be used in every instance, no exceptions.

fall

What to Do After A Fall is a poster that can be printed off and kept in various places around the home. It is especially recommended for those who live alone and have already experienced a fall.

Personal Response System to Ensure Safety

If the risk for falls is high or family members are concerned about their loved one falling, one popular option is to get a personal response system. The Philips Lifeline AutoAlert service is a great optional feature that will automatically summon help if the person falls. There are many other such services and some of them are:  ADT, Alert1, Bay Alarm, Care Innovations, LifeAlert, LifeFone, LifeStation, Medical Guardian, Mobilehelp, and RescueAlert. Some research may be needed to find the one right for the circumstances, and these may not all be available in Canada. Some people are worried about the appeal of wearing a device such as a necklace or bracelet but modern technology makes many of these devices appear as regular jewellery. In Canada, Costco stores provide two such devices – Medical Alert and Direct Alert.

Buddy Systems

Although there are reportedly only one fifth as many falls in residential care facilities as in private homes (according to Statistics Canada), it is still important to be aware of fall risks and prevention strategies in seniors’ residences.

Some seniors’ residences have a buddy system or a safety check program in place. Examples would be where the tenant puts a door knob hanger or other signal (garbage can for example) outside their doors at night and remove them in the morning to signal that all is well. Alternatively, a phone call once or twice a day can ensure one’s safety with the added bonus of social interaction.

The Prevalence of Falls in Long-Term Care and Residential Facilities

Some people who live alone move into long-term care settings because of their complex medical needs and increased risk for falls. Nursing Home (NH) residents who fall are at risk for injury such as a fractured hip or other bones. Sometimes a fall results in death.

The Winnipeg Regional Health Authority listing of Critical Incidents Reported to Manitoba Health from October 1, 2013 – December 31, 2013 identified 34 NH resident falls over the three-month period. One of these falls resulted in death. Seven of the falls were witnessed by a staff member, and 27 were unwitnessed. Of these unwitnessed falls, 16 resulted in a fractured hip and a trip to the hospital for surgical repair.

According to a 2008 Winnipeg Regional Health Authority publication, the Personal Care Home View, 18,868 falls were reported in nursing homes in Winnipeg in one year. Most falls occurred in residents’ rooms on evenings and weekends.

Falls Risk Assessment Tool for Long-Term Care Facilities

The Johns Hopkins Falls Risk Assessment Tool (FRAT) helps identify the level of risk in NH residents, based on the following criteria:

  • Recent falls
  • Medications
  • Psychological factors
  • Cognitive status

If a person has had recent falls, it increases the risk for a repeat occurrence. Certain medications, such as sedatives, antidepressants, antipsychotics, anti-Parkinson’s, antihypertensive, diuretics or hypnotics can also increase risk. Psychological factors such as dementia, anxiety, depression, decreased cooperation, impaired insight or judgment (esp. re: mobility) also increases risk for falls. Finally, the higher the level cognitive impairment, the higher the potential for an incident.

The overall FRAT score is out of 20, with a higher score indicating increased risk. A low, medium or high Fall Risk Status is identified on the resident’s care plan. For those with identified risks, intervention strategies can be formulated, and referrals to other specialists may be initiated. For example, a geriatric psychiatrist or pharmacist may be consulted to review medications. Additionally, an occupational therapist may be required to assess mobility to determine the need for mobility aids and appropriate footwear. For example, hip protectors may be recommended. Also, anti-slip etching can be applied on the floor around the bed and most certainly should be in the bathroom in the shower area.

Identify, Prevent and Reduce Risk

Most falls can be prevented, and education is key. If You Fall is a guideline that can be kept on hand regarding what to do if a person has a fall including “How to get up” and the importance of “Telling the doctor.”

Regular exercise can help strengthen muscles and keep the body limber. It can also help with balance issues. Seek out the help of a qualified professional such as a physiotherapist for a tailor-made exercise program.

A healthy balanced diet and regular doses of sunshine (or Vitamin D) are also important to help keep bones and muscles strong and healthy.

Whether the older adult is living independently or in a long-term care setting, education and assessment can help identify, prevent and reduce the risk for falls. If you are keen on the subject, consider holding an awareness month, week or day like the Fall Prevention Awareness Month promoted in British Columbia and consider what kinds of activities you would like to include.

 

Angela G. Gentile, MSW, RSW

August Janice Bailey, Dip. Herb, HCA

 

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Angela G. Gentile, M.S.W., R.S.W. is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and two adult children. For more information, visit: www.AngelaGGentile.com

August Janice Bailey, Dip. Herb, HCA is a Health Care Aide, an herbalist, a writer, and a falls prevention researcher and analyst. She is interested in many aspects of healthy aging including  nutrition and movement strategies. She works with seniors to reduce fall risks in their homes. August lives on the West Coast in Courtenay, British Columbia with her daughter. She can be reached through LinkedIn.

 

Additional References/Resources:

Government of Manitoba (2014). Critical Incidents Reported to Manitoba Health. Retrieved from http://www.gov.mb.ca/health/patientsafety/docs/ciq31314.pdf

Preventing Falls in Older Adults – Winnipeg Regional Health Authority, Manitoba, Public Health Resources  http://www.wrha.mb.ca/community/publichealth/PREVENTINGFALLSINOLDERADULTS_000.php

Partners Seeking Solutions with Seniors and Manitoba Pharmaceutical Association. Date Unknown. Fall Prevention: How does what I take or what I drink affect my risk of falling?  Retrieved from http://mpha.in1touch.org/uploaded/web/Legislation/Practice%20Resources/PSSSFallsPreventionPamphlet%20Updated%20Nov2014.pdf

Scott, V., Wager, L. and Elliott, S. (2010). Falls and Related Injuries Among Older Canadians. Retrieved from http://www.hiphealth.ca/media/research_cemfia_phac_epi_and_inventor_20100610.pdf

Statistics Canada (2014) Seniors’ Falls in Canada: Second Report. Retrieved from http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/index-eng.php

Winnipeg Regional Health Authority (2008). Personal Care Home View, April 2008. 5:4. Retrieved from http://www.wrha.mb.ca/ltc/pch/files/PCHView_Apr08.pdf