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Five weeks ago, I went to a long-term care community for a meeting. When I signed in at the reception desk, I noticed there were signs warning there was a respiratory illness circulating on specific units. The units were located in the nursing home. My meeting wasn’t going to take place on any of the affected units; but, I took what I thought was a precautionary move: I told the receptionist where I was going and confirmed that the illness wasn’t circulating in the unit where I was going. She assured me it was not. So I proceeded to the locked memory unit, where the meeting was being held. I used my covered elbow to push the elevator button. And I waited for a certified nurse’s assistant to open the door to the unit. The meeting lasted no more than 40 minutes.

The next morning when I woke up, I had chest congestion, a cough, and a sore throat. Strangely enough, I did not have a high temperature or nasal congestion. I thought I had caught a common cold, but whatever illness I had acquired rendered me so fatigued that I slept for close to three days straight! The only exception I made to resting was to walk my wonderful golden retriever. By re-tracing my own steps, I don’t think I had been any place where I could have picked up a respiratory problem, although I have no absolute proof.

After a week, I realized that my cough and chest congestion were not subsiding. I decided to go to an immediate care center and see a doctor. The doctor, who was very kind, listened to my breathing and told me there was no sign of pneumonia, but that I had chronic bronchitis. It is now a month later, and I still haven’t been able to shake the cough completely.

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I worked very closely with a wonderful woman in her mid-eighties as her power of Attorney for Healthcare. After she had been hospitalized for an elevated white blood count, I transferred her to a short-term rehabilitation community, then to assisted living for a respite stay, before I took her home. The return home occurred in early December.

Two weeks before I took her home, I met with a licensed home care agency representative to arrange for a live-in caregiver until my client would be able to function on her own. I had good luck with this agency in the past and trusted the owner. But, like anything else, the situation can change overnight. I was aware that the holidays were approaching. I resigned myself to the fact that staffing my client’s case was probably going to be tough because, like anyone else, caregivers want time off during the holidays.

As it was explained to my client and me, she would have two caregivers. One would stay for four days of the week, and the other would work for three days. It was supposed to be the same two caregivers for the duration of my client’s care. While we were told by the agency in detail how the first four days would be covered, what would happen during the remaining three days remained a mystery.

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My father always told me there is “No such thing as a free lunch!” That’s why I was very wary when I received a phone call from my client’s Medicare Supplement insurance company representative. (I serve as Power of Attorney for health care for my client.) The insurance representative was very excited when she informed me that my client ‒ who is 99 years old, has advanced dementia and lives in a nursing home under Medicaid ‒ was eligible for a new program that would not only broaden her health care coverage, but also add dental insurance free of charge. As a former insurance broker, my antennae went up immediately: More coverage, free of charge? Here are stipulations of the policy:

Podiatry Services – 4 visits

Vision Services – $300 every 2 years toward lenses and frames

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Fifteen months ago, I was hired by a charming, alert, 85-year-old woman to act as her Power of Attorney for Healthcare and, if necessary, Geriatric Care Manager. I remember the first day I met her. She was running around her 2-bedroom ranch house like someone had fired her out of a cannon. I made my usual assessment, asking about her medical issues (surprisingly, she had many), list of medications, and how to help carry out her wishes when she was alive and near end of life. She was somewhat skeptical as to why she would need my Geriatric Care Management services. I explained that, since she had no relatives or friends who could handle the job if she needed help, she would need to have a plan in place. She went along with my suggestion.

Three months ago, I received a call from a skilled nursing home where she had been taken for rehab. My client had called 911 after falling. Unfortunately, her hospital was on bypass because the ER was so busy, so she was taken to the next closest hospital where none of her physicians were on staff. The hospital treated her for a heart problem and sent her to a rehab. community. I went to visit her and was astonished at how badly she had deteriorated. She said the food at the rehab facility was horrible and she felt like she was losing weight. She was a good cook and ate very healthy.

Upon developing a second health issue, my client was transferred back to the hospital where her doctors were on staff. She was treated for a high white cell count and was again ready for release to rehabilitation. She insisted on being transferred to a home that was owned by her hospital, thinking her doctors would follow her. I explained to her many times that her current physicians would not follow her unless I took her to see them myself. She was pretty unrelenting at this request, so I chose the best rehab. community available within the hospital system. I was right: Her current physician wouldn’t follow her and she was seen by the medical director at the home. While the therapy was good, she complained vehemently about the food and continued to lose weight (20 pounds).

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Even in the best of circumstances, the holidays can feel like a Keystone Kop comedy or a carousel spinning at a high rate of speed as each of us tries to keep up with shopping, cleaning, cooking, traveling, and engaging in social events and religious observances. When caring for an elderly relative, especially a person with dementia (PWD), the sense of fatigue – and sometimes farce – can feel almost double-fold. That is why I wish to share a few tips for surviving the holidays. Indeed, these tips are valuable no matter what one’s age or circumstances might be!

First, a tip borrowed from the commercial airlines: Be sure to put on your own oxygen mask before attempting to assist others. Self-care is an essential part of being able to help a person with dementia: At this hectic time of year, be sure that you are getting enough sleep, good nutrition, exercise and emotional support as you tend to the needs of your loved one with dementia. The commandment to “Love thy neighbor as thyself” implies that there is such a thing as a just love of self — no, not selfishness, but a proper regard to maintaining the strength and equilibrium that you will need in order to share those gifts with others. Prioritize what really matters, and don’t sweat the small stuff. Take breaks when you need them, and call on friends and other family members to pitch in and help when you feel overloaded. Often, others are happy to have the opportunity to assist.

When communicating with a person with dementia, recognize that emotional reactions and a tendency to judge are naturalhuman. However, they need not control you or a situation. As a PWD’s ability to verbalize deteriorates, he or she often will rely on body language to convey his or her emotions and wants and — conversely – to assess your mood, intentions andor sincerity. Ask yourself, what is their body language saying? What is yours saying? Clues to reading another’s mood and intentions include the following:

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I was lucky enough to be engaged by Jocelyn Newhall of Arbor Terrace (Naperville) to teach a dance class to the residents in the Evergreen assisted living memory unit. I’m not sure who had more fun…the residents or I!

I conducted a one-hour class that was divided into short segments of ballet, tap, and jazz dance. I started each section with a short stretching exercise and warm up, followed by some brief steps that were set to some of their favorite music.

There were between fifteen to twenty enthusiastic residents who attended the class. Some were ambulatory but most of them participated in the class seated in chairs. Although they worked through the ballet exercises patiently, many of them were anxious to get on into the tap portion of the class. I had them doing shuffles and flaps, along with simple flap heels set to Frank Sinatra’s, ”New York, New York.” When I turned the music on, most of them began to sing so loudly that you couldn’t hear the recording. Several of the residents chose to leave their seats and improvise.

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My colleagues in the long-term care industry are all aware of the fact that once a senior enters a long-term care community, s/he will probably not maintain a relationship with his/her personal physician. The general public may not necessarily be aware of this fact. Most long-term care communities have arrangements with certain doctors who come there and see the patients on site. The exception to the rule is, if a senior’s doctor becomes credentialed with the community and agrees to physically visit in order to see the patient, then the physician-patient relationship can be maintained. That does not normally happen, however. Sometimes if you are within a certain health system that has affiliations with certain long-term care communities, your loved one may be lucky enough to have his/her personal physician credentialed at the place where the senior moves. Let me share some experiences that you may encounter once your loved one moves.

Real-life Story

Last summer, I was hired as Power of Attorney for Healthcare/Geriatric Care Manager for a very active 84-year old woman. She had all her faculties, was ambulatory and gainfully employed until she retired. Two months ago, I received a call from a long-term care community informing me that she had been taken there to complete rehab. She had developed severe bouts with sweating and was diagnosed with a high white blood cell count. In addition, she had suffered heart problems, loss of appetite and low potassium. When I heard about which community she had been taken to, I wasn’t impressed. Unfortunately, when the emergency occurred, I wasn’t contacted immediately. The 911 hospital, which happened to be her regular hospital, was on bypass during the emergency. She was taken to the closest hospital, treated for the heart problem, and released to the rehab community.

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I recently helped a client move to a supportive living community, which is assisted living supported by Medicaid. The term Medicaid refers to the Federal and state programs that fund long-term care for people who cannot afford to pay privately. Supportive living provides the senior with standby assistance for activities of daily living, meaning bathing, dressing, toileting, transferring, walking, and eating. The senior lives in his or her own apartment and enjoys oversight provided by a nurse, three meals a day, and options for activities.

The following is a checklist of items needed for application and approval for long-term care covered by Medicaid, whether it be for supportive living or a nursing home:

Red, white and blue Medicare card

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I am often amazed at the number of clients who call me and say they are looking to place a loved one in a senior living community because their loved one is falling. When it comes to senior falls, please remember the following very general guidelines:

No senior living community provides one-on-one care. Placement in a senior living community is never a guarantee that an older loved one won’t fall. If a senior is in independent living, that level of care is not licensed. There are no nurses or nurses’ assistants. If a senior falls in independent living, 911 will be called to help the person stand or to take them to the nearest hospital. When a senior resides in assisted living or a nursing home, there will not be enough staff to prevent the senior from falling unless the staff witnesses the fall taking place and they can act on time. Don’t forget that your loved one will be sharing a certified nurse’s assistant with many other residents.

The use of full bed rails is not allowed in Illinois. They are considered to be a restraint. They can only be used if a doctor writes an order for them. The most that can be used without a doctor’s order is a half rail. A resident cannot be restrained with chemicals without a doctor’s order. There are grab bars available that attach to seniors’ beds to help them steady themselves when they rise. Many times, a mattress is placed close to the floor to lessen the distance of any potential fall.

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I was fortunate enough to be interviewed for a blog post by my colleagues at Lexington Square regarding caregiving tips for a spouse. I would like to share them with you.

When it comes to caregiving to a spouse, there may come a time when additional help and support are needed.

In this helpful Q & A with Andrea Donovan of Senior Living Advisors of Inverness, she offers expert insight on how to best handle this situation, how to overcome caregiver guilt and how to create a social and wellbeing experience for both the caregiver and spouse.

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