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Featured Article:  

Of Alzheimer's, Friendship,
Hospice and Hope

By Regina McNamara RN, MSN, MPH 

My friend Bob moved his mother to hospice care today.She is very near the end of her life and will likely die within the week. I have never met Bob DeMarco. He is the prolific and tireless author of Alzheimer's Reading Room, an amazing resource for all things related to Alzheimer's. (http://www.alzheimersreadingroom.com/) He moved to Florida from New York 8 years ago to be a full time caregiver for Dottie, his now 95 year old mom, afflicted with Alzheimer's.

Bob has been extraordinarily generous with me and with our company. He has given us permission to reprint his wonderful articles and blog entries in our newsletter. He has amassed thousands of these over the past 8 years. He responds promptly to my inquiries.    

When he announced in his blog yesterday that Dottie was now on hospice, there was an unprecedented outpouring of support from his followers, most of whom have never met him or Dottie. Literally thousands of posts in less than a day. And yet I feel that I have let my friend Bob down. I should have acted more quickly for this amazing man, whom I have not met and yet admire so much. Because I had read between the lines in his blogs, I could see this coming. Dottie was closing in on the end of her life...many months ago. She was declining; I could see it from thousands of miles away. Bob could not. Dottie's doctors could not. This is not uncommon. Families are too close to see it, and many physicians are reluctant to refer to hospice "too early."

Hospice is a Medicare and health insurance covered service available to all. There are many fine hospices in your area. Just take a look at our Providers we Love section of this newsletter. Hospice provides palliative and end of life care for both patients and their loved ones. It provides medical and nursing care, aide support, social work, medications, equipment, volunteers, and bereavement services. It covers all diseases, and currently Alzheimer's/
Dementia is the one of the leading diagnoses in hospice. Today, the average length of stay on hospice is 7.4 days. Not enough time to really say good-bye. Not enough time for closure, for adequate pain relief. Over 25% of chemotherapy patients are still receiving chemo in the last 2 weeks of life.

Enough is Enough. Hospice care can last for 6 months, for over a year in some cases. The amazing hospice team will determine if a referral is "too early". This rarely happens. Those caring for elderly people need to watch for signs of decline and assert their rights to stop aggressive but futile medical intervention. A recent Wall Street poll of US physicians found that the vast majority would refer themselves and their family members to hospice as early as possible. They would stop aggressive treatment, and accept palliative care. Yet they do not extend this practice to their patients. Know the facts about hospice. Refer early. We try to do this for our clients. I wish I had done that with my friend Bob.

There is a lesson to be learned for all of us here. The best care for our loved ones is sometimes letting go and letting the hospice angels in. ■  

Photo taken by Valerie Cipriano

 

 

I just happen to
like the simple little things, and I love cats!

~ Michelle Gardner   

 Hiring Independent Caregivers...
Buyer Beware! By Regina McNamara RN, MSN, MPH

There comes a time for many seniors and their families when life simply becomes overwhelming. They realize outside help is needed, for personal care, housekeeping chores, doctor visits and other errands, mobility and safety.  

After a frustrating web search and phone calls to home care agencies, families sometimes feel this cost of care is simply too high. Many people, in hopes of saving a few dollars per hour, hire independently, without the assistance of a licensed homecare agency. However, there are many other things to consider, before making decisions for your loved one's home care needs.  

1. If you hire a caregiver independently, you are then an employer. You are required by law to provide your employees a W2 at the end of the year; you must pay Federal Taxes, Medicare Taxes, Social Security Taxes and state taxes. You are also required by law to pay Unemployment Insurance, and Workers Compensation Insurance.
2. Since safety and security of you parents should be a concern, Bonding and Liability Insurance should be in place.
3. If you are considering hiring "under the table" you should be aware of the risk involved. The type of work you are asking a caregiver to do is often very hands on assistance. If the caregiver were to get hurt on the job, this is what Workers Compensation would normally cover. If a caregiver is not a W2 employee, the family could likely be responsible to pay for their injuries. Homeowner's policies will not cover such incidents.
4. When a caregiver is hired independently and their hours are cut back, they are then likely to seek help from the state Unemployment office. Families will then likely receive a bill for any unpaid unemployment insurance taxes. This is especially true in CT, an employee friendly state.
5. Many families provide a 1099 form to the independent caregiver. This would be to designate them as an independent contractor instead of an employee. However, unless the caregiver is officially recognized and licensed as an independent contractor in CT and passes all the rules for 1099s, he cannot be designated an independent contractor.

Read full article...  

Lillian Krumenacker, daughter of e-newsletter guru Jessica

"The purpose of life is to live it, to taste experience to the utmost, to reach out eagerly and without fear for newer and richer experiences."

~ Eleanor Roosevelt 

Creating Fun for Frail Seniors

By Regina McNamara RN, MPH, MNS

As a caregiver, either a family member or a paid caregiver, you are focused on your family member or client's personal care, safety, medical treatment, nutrition and activities. You busy yourself with doing everything in your power to keep them comfortable. You worry about their reduced energy level, increasing fatigue, physical weakness and variable mental status. But do you know how important it is for them to just have fun? To laugh deeply, live in the moment, to briefly not be just old and frail; to forget pain?

Below are some ideas on how to add fun and stimulation to their lives.

Mini-Field Trips   

Seniors look forward to having a day out, but as they age, they don't have the stamina or mobility for trips to museums, monster malls, wooded parks, loud modern restaurants, etc. But they may be able to enjoy an hour or two in a new and fun environment. Many folks enjoy a simple trip to the supermarket-colorful flowers, fanciful balloons, acres of fresh, bright produce, bakery smells, energetic families with huge carts. This is an activity, which they had enjoyed for many years when they may have been responsible for meal preparation.  

Another fun activity is a trip to a local antique or consignment shop. Wandering through these shops may bring back memoirs as they explore old magazines, toys from decades gone by. These stores usually have soothing environments, and are not too crowded. You can browse many articles from bygone eras, which may hold special memories to elderly folks. As they push their walkers (and we recommend walkers with seats for these expeditions) through these stores, the memories continue to come to life, providing enjoyment to the elderly person as well as the caregivers.

Read full article...  

Jean Fornaci, Kelly's grandmother, Regina's mom,
with her caregiver Antoinette 

"When you can think of yesterday without regret and tomorrow without fear, you are near contentment."

  ~ Source Unknown 

KUDOS from Kelly

 By Kelly McNamara     

Elizabeth Paintsil

Elizabeth's care to N D has been wonderful. She helped her regain her strength and rejoin her friends and activities at Arbor Rose after a hospitalization. ND is a very bright client and Elizabeth is as adept at keeping up conversation with her as she is with her personal care and monitoring of her condition. Though ND is back in rehab after a bit of a setback, Liz continued to visit her and keep her spirits up. Liz has also been a great help in relieving other caregivers and taking on a few short cases while she awaits ND's return. Thanks, Elizabeth for a doing such a wonderful and professional job with all your clients.

Moses Hlongwane  
Moses came in to care for FP when her caregiver accepted a job as an LPN. He is not only a superb caregiver to FP, he is also a friend and companion to her husband EP.   His care of FP includes scrupulous attention to skin care, grooming, fluid intake, and avoiding complications. Even her hair looks especially fetching these days! It can be difficult to step into a case when a regular caregiver leaves suddenly, but Moses has done an extraordinary job and is a true professional at all times. We are so glad you're with us!     

Edith Dorman   

Edie has been a caregiver to G L, a new client to the agency, for several weeks now. G L is a fiercely independent and accomplished woman who did not initially see the need for any assistance. Edie has been patiently professional, and has become not only a valued caregiver but also a friend to GL, who is improving daily. It is an added bonus that Edie is an amazing cook! It is very clear to the family and any visitor to G's home, that there is a high level of respect between Edie and G. In fact G has suggested that Edie may be a valuable resource to the agency to help mentor less experienced caregivers. A great Idea!    

All caregivers mentioned in this column will receive a gift card and our sincere appreciation! Many many thanks to all of you for once again extending yourselves to ensure that we are of course Always There...!!   

 Providers We Love   

We are privileged to have received referrals from and be able to coordinate care with many Assisted Living facilities, rehab facilities, and Medicare Home Care and Hospice agencies. Our growth is in large part due to the trust the staff in these organizations have put in our caregivers.  We are likewise impressed with them and we are committed to referring to them on a regular basis. 

Vitas Hospice, Waterbury, Fairfield, Hartford    

Emeritus also has facilities in Woodbridge, South Windsor, and Rocky Hill.They were recently voted the Best Assisted Living Communities in CT. It is easy to see how they earned this award. All their facilities boast lovely exteriors, inviting interiors, personable, helpful and competent staff, great food, and varying levels of care to meet the specific needs of an aging population.

Established in 1901, VNA Health Care provides home health care, hospice and independent living services to more than 60 towns throughout Greater Hartford and Waterbury communities. They provide a full range of Medicare covered services including nursing therapy and Hone health aides. They also hold wellness clinics throughout the state, meals on wheels, telemonitoring so that their patients health conditions can be monitored remotely thus preventing hospitalizations. They have a wonderful hospice program (with pet therapy!) They also have specialized programs in cardiac care and Geriatric care management. With a century of experience a coverage area that spans the state of CT, and a wonderful caring and professional staff, they are well equipped to meet all your skilled nursing needs at home. The easiest way to inquire about their services is to call 1-800-466-3227.

We take our recommendations of providers very seriously. Please consider our favorites in deciding care for yourself or your family members. We would choose any of them for our loved ones.