What is Aging Life Care Management?

Me: “Hello, Holistic Aging, this is Bobbi, how can I help you?”

Caller Mary: “I am so glad to talk to someone, (big sigh) you won’t believe what I am going through trying to manage EVERYTHING with my mom and dad (bigger sigh) I wish I would have found you years ago! Jennifer, the elder law attorney thought we could use your service. What do you need to know?”

Me: Tell me your story

Meet Jane and Joe Jones from Pittsburgh PA – both in the upper 80’s and according to their perception, are doing just fine! They do not agree that they need help, and really have a difficult time seeing their daughter Mary, who lives in Dallas, prospective of the situation. Despite a significant income, they are living in the typical Pittsburgh older adult frugal manner, in the 2 story home with only one bathroom on the second level home they raised their children in. They love their home and plan on spending the rest of their life there. At one time, they had Mary agree she would “NEVER PUT THEM IN A HOME.”

Mary the daughter’s story

Mary is married and works full time in a professional capacity in Dallas, she also has three children of her own and is helping manage her MIL care who lives by them in Dallas.  She has a brother, Tim, who resides with her parents (more about Tim later).

My mother Jane, is 87 years old and is very physically fit but has progressive memory  issues that my 89 year old dad, a retired executive from Westinghouse, Joe is minimizing. Dad’s mind is sharp but he has physical issues limiting his mobility. I am really worried about both of them; if their positive qualities were both combined into one person that person would be so healthy!

A little about Mom

Mom has memory issues and continues to drive both her and dad since dad’s stroke a year ago has limited his mobility. Dad feels it is safe as he guides and directs her from the passenger seat and they only drive locally. There are dents on all the sides of the car, and into the garage entrance. They have gotten lost a few times, and I received a call from police who helped get them home.

Mom can no longer clean the house, do laundry or cook. I really do not think she is bathing or changing her clothes regularly.  Her perception is that she is still doing these things well. I tried getting caregivers in to help, but my parents fired them, as they felt they were not helping. Dad is trying to take over, but it is out of his comfort level and he has never cooked. They are both losing weight and eating processed foods for every meal. Mom can be really mean to me and Dad, especially when I challenge or question her ability in any way. It has really become a strain on our relationship.

Mom also use to be the bill payer. Dad and my brother (more on him later) have taken over this but neither are that reliable with managing money or scheduling regular payments. I probably need to mention again about how frugal my parents are not wanting to spend money on anything.

A little about Dad

Dad had a stroke last year that left him with weakness his left side. He was a real trooper with therapy and has really progressed. He uses a walker, and has one on both levels of the home. It is terrifying watching him go up and down the stairs to the bedroom/bathroom, which he limits to once a day. We were going to get a stair lift but afraid that mom would fall on it as she runs up and down the stairs. There is also concern about Tim and the stairs (more about Tim later). Dad is very resistant to any help coming in and views the need for help as a sign of weakness; he believes family should take care of each other.

Tim

Mary is very hesitant to talk about Tim at first but with some coaxing she reveals that Tim has lived with her parents since returning from Vietnam in 1975. He has had a difficult time retaining a job, cannot drive due to DUI’s and is most likely an alcoholic, but the family does not like to acknowledge this. Mom and Dad are accustom to taking care of Tim. Although Tim is another adult present in the house, Mary does not feel she can depend on her brother to help and if anything. Although she loves her brother, he is another person Mary has to worry about. Her parents don’t see it that way.

The Holistic Aging Life Care Plan

First we will get a more detailed history from the family, and agree on a contract for service. We completed an assessment on the 9 areas for both mom and dad offering solutions. A mutually agreed plan of care was established and adjusted as changes occurred.

Brief synopsis of our solutions for this family

We are excited to report this family remained a client with us until both parents passed, and we are still helping the brother Tim who eventually also became a client of ours when his parents passed.

We were able to convince dad to “just try our service for a month” and it didn’t even take that long for dad to see how we directly allowed them to be more independent of their children with increased autonomy; our service not only assisted him and his wife but also his daughter Mary and son Tim.  We also worked with Mary to assume the financial Power of Attorney, POA, so that she could oversee paying of the bills (including ours) and allow us to act as the extension of her medical POA on sight. This freed up a lot of Mary’s time to return to being a daughter and greatly improved her relationship with her parents.

Mom’s Care

We got an appropriate dementia diagnosis (Alzheimer’s) for mom so that we could plan for the current and future needs. After some convincing on our part to be able to stay in the home safely, she agreed to 8 hours of caregivers with Holistic Aging concierge Senior Care Consultants a day. We provided what we call a 360 support for dementia – addressing all the issues surrounding the long-term management including caregiver and family education, responding appropriately, Medication monitoring (less the better), working with the doctor and other practitioners to allow her to age well, providing stimulating activities, assisting with her ADL’s, allowing autonomy yet maintaining an environment which kept her safe. We also had mom’s driving tested by a certified Occupational Therapist who conducts both in-person reaction time and on the road ability. Mom did not pass and although reluctant to accept; it was nice being able to take the blame of removal off an adult child. The caregivers we had in place were able to bring mom out and the Life Care Managers arranged for and attended all medical appoints acting as an advocate for both parents.

Dad’s Care

Dad’s overall health greatly improved with Life Care Management visits monitoring his health and contacting the doctor to prevent decline and hospitalizations. We convinced dad to move to the first level of the home, changing the dining room into his bedroom and adding a handicapped bathroom to this level (which added value to his home).  Dad agreed to PT and we maximized his part A and Part B Medicare benefits of this. Dad also had us as a sounding board to talk to about his concerns for his wife’s decline, sometimes not recognizing who he was. We were able to offer counseling and tactics to improve and accept his changing relationship with his wife.

Now about Tim

Tim developed a great trust in us as time went along, eventually asking us to assist him with his alcoholism. Over a two year period with many ups and downs, we assisted Tim to find the resources to detox from alcohol, rehabilitate himself, and accept counseling and get is license back.  We were able to get Tim involved with local Vietnam Vet groups, and the VA system for his access to some great health care benefits. He also had a few diagnosis that entitled him to veteran disability benefits which we assisted him to acquire. Tim has been alcohol free for six years now and still uses our service to help him manage his personal health care.

Eight years later

The last 2 years of Mom and dad’s life required us moving them to an assisted living when the level of care needed surpassed what could be provided in the home. Fortunately, a few years prior we had assisted Mary and Tim in picking out the appropriate facility and had their parents added the wait list.  Both parents passed gently within a year of each other with our support and on hospice.

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