Working with Geriatric Care Management to Age in Place | Rocky Mountain Independence Services of Denver 303-322-7647

Working with Geriatric Care Managers

As an Certified Aging in Place Specialist, Jim Donohoue, Sr. Director of Construction for Rocky Mountain Independence Services of Denver stands behind the guidance and utilization of Geriatric Care Managers (GCMs) and Occupational Therapists (OTs).

Whether you want to age in place, or weighing out options for community living for yourself or loved ones, consider hiring a geriatric care manager. Their guidance can help you from start to finish in obtaining your needs and preferences for services in geriatric care, including modifying your home, long-term care placement and services.

Geriatric care managers have training in gerontology, social work, nursing or counseling, enabling them to play a critical role helping you resolve long-term care needs and lessening the weight of these decisions on family remembers and children.

GCM conduct care-planning assessments to identify potential problems, eligibility for certain types of assistance, and need for services; review financial, legal, or medical issues; crisis intervention; acting as a liaison between parents and children who live in different parts of the country; and counseling and support. They help parents maintain their role as parents and children as children, by assisting in the necessary decisions. 

Click here to locate a geriatric care manager in your area, or visit The National Association of Professional Geriatric Care Managers at www.caremanager.org.

Journies

My daughter recently went with me to a visit with my doctor. I'd had a frightening episode of extreme dizziness, which turned out to be nothing at all worrisome. While we were at the clinic, however, my child, my best friend, who should have known better, suggested I schedule baseline testing for potential memory loss. I was incensed! As with all family skirmishes, no time, place or mustering of self-control, would have done anything other than make matters worse. 

     Thank God for the young physician, who knows me, and knows I have a an eidetic memory. The doc did not blink; she simply changed the subject ... immediately. Memory loss seemed a potential blessing, once we'd left the clinic. It was a bad thought, however, because dementia mows down its victims with ruthless indifference. 

     Then I remembered what a great tool journaling is for alleviating pain, physical, mental and emotional. It helps with perspective, as well; my journals help me view my life as a progressive journey. There are many software options for journaling, not to mention a spectrum of reasons to journal. Shared or not, injuries, health crises, acquired or long existent disability make journaling a particularly relevant stress management tool. Even a "pain journal" can be very revealing, if shared with a physician. Blogging is a kind of journaling, and so accessible, even for a novice.

     Not knowing where to start may be the most difficult obstacle to overcome. Believe me, whether you are a reader, writer or neither, millions stop before starting. I read voraciously and write professionally. My angst springs more from an unstoppable inner-critic than from writer's block. It is not The Great American Novel, but I tear out the page I've just written, to start again, and repeating. I don't recommend this mindset. It may help to begin with a guided journal, such as the journal that accompanies "The Artist's Way" or "Peace and Plenty." There are many options available in bookstores, including beautiful blank or lined journals to complete and keep. A journal is a personal, intimate, production. It is your creation, so create at will, and let the devil catch up the rear.

     I've seen journals by journalists, one of the most creative of which was Dan Eldon's "The Journey Is The Destination." Dan Eldon, a British photojournalist, artist and activist, was stoned to death in Mogadishu with three colleagues in 1993. He was twenty-three years old. If you have never read his journal, find it and buy it. This is not the kind of book to borrow or rent. It is a masterpiece. Here is another suggestion. If, indeed, you know an elder, or you are an elder with early memory loss, recording a journal (and, perhaps, later, writing a life story from it) would be an immensely fulfilling project. Everyone has a story; our stories are the treasury of human experience.

Those with dementia are still people and they still have stories and they still have character and they're all individuals and they're all unique. And they just need to be interacted with on a human level. -Carey Mulligan

Start growing a journal for yourself or someone else today.

Watch Your Language!

Come again? You said ...

Mohandas Ghandi made one of the most moving declarations of the Twentieth Century. It was a single sentence. Anyone who has seen Ben Kingsley in the biographical film, Ghandi, has heard this quote: "I am a Muslim, a Hindu, a Christian and a Jew, and so are all of you." We are all, also, broken; the broken places may be healed, may be stronger than before, may not show. Nonetheless we all break one way or another, at one time or another. So I fond myself wondering, recently, about the changing etiquette of disability terms.

We should not judge people by their peak of excellence; but by the distance they have traveled from the point where they started. -Henry Ward Beecher

One or two things I've discovered. Person-first, or people-first, language is a good place to start. Generally accepted as polite, it is to use as a rule. However, I've also learned it is not universally acceptable in the Disability Community. 

In any event let's begin with person-first language, because it helps eliminate outdated, downright ugly, labels. Here are examples of terms that are offensive and, for each, the correct descriptive:

1)   Has a birth defect vs. Is a person disabled from birth, born with a congenital disability;

2)   Palsied, has cerebral palsy vs. person who has cerebral palsy;

3)   Cripple(d) vs. person who needs mobility assistance;

4)   Deaf and dumb, deaf mute vs. person who is deaf and does not speak;

5)   Deformed vs. person who has a physical disability;

6)   Emotionally disturbed, imbalanced vs. person with an emotional disability;

7)   Handicapped vs. person with a disability;

8)   Hunchback(ed) vs. person with a spinal curvature;

9)   Insane, deranged, deviant (and all offensive adjectives) vs. person with a mental illness;

10) Midget/dwarf/cretin vs. person who is small in stature;

11) Mongoloid vs. person with Down Syndrome;

12) Normal vs. able-bodied person, non-disabled person;

13) Retarded vs. person with a cognitive disability;

14) Wheelchair bound or confined to a wheelchair vs. person who uses a wheelchair.

While using the correct term avoids socially and politically deadly mistakes, groups like the American Deaf community and some Austistic people/Autistics prefer not to use people- or person-first language. Their preference stems from the view that their disabilities are part of who they are. Some also feel, using person-first language turns a disability into a negative. 

Weeding out nasty labels, such as spastic or retarded, is not just politically correct. It is a question of social acceptability and accuracy. It may just be a step toward empowering language, but it is an important skill.

Setting Sail For Home

In the last post we looked into the background of the HCBS Waiver Program, beginning with the ADA and Olmstead v. L.C., 527 U.S. 581 (1999). In the 1980s, while Medicaid continued to be instrumental in keeping people shelved in institutions, Congress enacted Section 1915 (c) of the Social Security Act. The section was part of the Omnibus Reconciliation Act (OBRA). This was important, because Section 1915 (c) opened the door for sweeping reform, but change was cumbersome and slow to come. 

Over decades the cost of institutional care continued to escalate. Meanwhile media coverage of nursing home scandals, consumer discontent and a major movement in consumer advocacy were on the rise, as well. Ultimately the concept of MFP, Money Follows the Person, proved an innovative, simplified vehicle for funding individual transitions from institutional care in all the states. The Deficit Reduction Act of 2005 authorized MFP funding; under President Obama, The Affordable Care Act expanded it.

Today HCBS can work miracles in peoples lives, opening a world of opportunity, while keeping costs down. In March 2013 Colorado Medicaid announced the launch of the Colorado Choice Transition Program. The Colorado program will be funded through a $22 million, five-year grant; one goal of the initiative is to move 490 Medicaid recipients from long term care facilities to home and community-based environments. 

An end to discrimination also brings the benefits of inclusivity to communities. An inclusive community is a vibrant, one in which the energy, talents, creativity and experience of all members are valued. In a June 2013 press release, Housing Secretary Shaun Donovan, made the following statement:

“There is a tremendous need for affordable housing where individuals with disabilities are able to live and be part of the very fabric of their communities,” said HUD Secretary Shaun Donovan. “HUD is committed to offering housing options that enable individuals with disabilities to live in the most integrated settings possible and to fully participate in community life.”Read the rest of the release here: 

http://portal.hud.gov/hudportal/HUD?src=/press/press_releases_media_advisories/2013/HUDNo.13-086

Jimmy Dean once said, "I can't change the direction of the wind, but I can adjust my sails to always reach my destination." Through CCT, so many people will be able to adjust their sails to reach home. 

 

Changing Assumptions

This is the first post of a series about HCBS and HCBS waivers. To begin on the ground level, however, I'll start with a Supreme Court Decision, because, like certain Supreme Court justices, we don't like to read legal decisions or statutes. The stuff, let's face it, is so dry, if it is on paper, it crumbles to dust in the hands of the reader; it is that dry! Relax. I'll make this as brief as possible.

Two Georgia women, Lois Curtis and Elaine Wilson, both developmentally disabled, had become mentally ill adults. Each woman voluntarily admitted herself to Georgia Regional Hospital, a state-run institution. The treatment the women received in the hospital was successful. Both were declared ready to leave the hospital, and, once again, live in the mainstream. Community-based housing was available to each woman. Neither had an opportunity to reintegrate into her community; both remained confined to Georgia Regional Hospital. Several years passed. Curtis and Wilson filed suit to be released from the hospital under the ADA.

We can learn the art of fierce compassion - redefining strength, deconstructing isolation and renewing a sense  of community, practicing letting go of rigid us vs. them thinking, while cultivating power and clarity in response to difficult situations. -Sharon Salzberg

In June 1999, the U. S. Supreme Court held that the hospitalization of these women was discriminatory (unjustified segregation) in violation of Title II of the Americans with Disabilities Act. The implications were sweeping Thanks to the decision, public entities are legally obligated to provide community-based services to persons with disabilities, provided the services are appropriate and agreeable to the persons affected and accommodation is reasonable, given available public resources and the needs of others who receive disability services from the public entity.

The Court explained it's holding this way. First the institutionalization of people who are capable of living in community settings and would benefit from reintegration into community life, "perpetuates unwarranted assumptions" those held in institutions are incapable or unworthy of participating in community life. Second institutionalization severely diminishes the day-to-day lives and activities of the disabled, including family relationships, social interaction, the possibility of work and financial independence, not to mention educational and cultural opportunities.

The 1999 decision subsequently proved controversial, particularly in affordable (government subsidized) senior housing, as much of that housing now opened to younger, disabled applicants. There were successes and failures, but the principles upheld by the Supreme Court in Olmstead continue to contribute to the greater good.

My next post will talk about changes we've seen in the decade since the Olmstead decision. Stay tuned!

Universal Design

     Born too late to be a Beatnik and too early to be a Boomer, I've pinned my hopes on the Baby Boom.  "No Baby Boomer will accept sitting on the porch of an Old Folks' Home," one of my neighbors in senior housing exclaimed. Sitting on the porch of our senior residence, we agreed; changing demographics, alone, will bring shifts in how we approach aging and independence.

   Added to the challenge of an aging population, American athletes, service members and survivors of acts of terrorism continually enter the mainstream. These realities have changed the face of engineering research, which now includes a medical component. Engineering design for increased function becomes available in the mainstream, as does friendlier home, public and systems design.

“When you focus on someone's disability you'll overlook their abilities, beauty and uniqueness. Once you learn to accept and love them for who they are, you subconsciously learn to love yourself unconditionally.” -Yvonne Pierre, The Day My Soul Cried: A Memoir 

    Decades ago Ronald (Ron) Mace, a Fellow of the American Institute of Architects, introduced a concept he called Universal Design. His concept honored the need of aging Americans to stay in their homes for as long as possible. Mace was also instrumental in the creation of the Center for Universal Design in Raleigh, North Carolina. His idea was not to create a style of design. Rather it was a revolution in how we view design. The end result is products, buildings and outside spaces, which serve as many people as possible, to the greatest extent possible. It is also cost-effective.

    Universal design aesthetically pleasing, as well as functional; the two are, by no means, mutually exclusive. The idea of Universal Design is not to set disabled users apart from others -- disability affects most people at one time or another. Ease of acces and use benefit everyone. You may be surprised to learn of an international grassroots organization, Concrete Change, that seeks to make all homes more accessible to visitors (more "visitable".) 

http://concretechange.home.mindspring.com/index.htm  

   We've long needed to redefine 'normal' and, next, be seeing people as enabled, rather than disabled. Here's to better homes and futuristic communities everywhere!

Finding Freedom

     

 I can never resist telling a story. Eons ago I was excited to shop for my newlywed husband's birthday. I should explain a couple of key differences between us. Gene was a Virginian, whose young life had been rich with cultural and intellectual pursuits. He was a great chess and bridge player. I was a Coloradan, who loved to ski, climb and prospect for minerals in Saguache, but could never have sat through a bridge game.  So what to do?

Never one to shy away from risk, I headed for Holubar Mountaineering, a favorite store in Boulder. I bought a ton of rope and other climbing equipment, right down to a hard hat and proper boots. I proudly made a birthday heap in the doorway of our den. On top I placed the piece de resistance, a certificate to the Colorado Mountain Club Climbing School. 

My beloved's reaction wasn't quite what I'd expected. He was convinced my goal was premature widowhood! "Climbing is so freeing," I protested! Off he went to climbing school, eventually becoming an avid climber.

Freedom is everything isn't it? The price of freedom is risk; it is embracing change. Disability comes to some of us young,  to others late in life. If it comes in our dotage, we simply soldier on, often alone. We keep as much of our dignity as we can, and we cope. Any young person will tell you, to cope is not the same thing as to adapt. 

In recent years, with arthritic knees, I developed a routine for many daily activities. The drill for getting out of my tub was a twenty-step process. In retrospect it was neither comfortable, nor safe, but I'd coped for years. 

Action and reaction, ebb and flow, trial and error,change -- this is the rhythm of living. Out of our over-confidence, fear; out of our fear, clearer vision, fresh hope. And out of hope, progress. 

-Bruce Barton

 
My routines were entrenched, when I met Leonard Lujan. Leonard had been instrumental in modifying my neighbor's bathroom. It was beautifully constructed, but I felt no need to have a similar modification, let alone a free modification. A good friend suggested it would be okay to ask about the bathroom modification program. The rest is history. I love my reconfigured bath; it is like a private spa. Home modification can free people from burdensome, often dangerous, routines. In my next post, we'll tackle universal design, and how major modifications can be brought within financial reach.

We wish you healing! More than this, we wish you freedom! We are here to help!