Ageism—Is This a Thing?

Written by: Lisa Bayer, Esq., CCM, CDP

The recent decision by the democratic presidential nominee, Joe Biden, to recuse himself has made me introspect on my own biases and prejudices towards older persons. I think most Americans would agree that the reason that Biden received so much scrutiny from his peers in Congress and democratic constituents throughout the campaign was because of his age, 81, and the age he would have been, 86, at the end of four years. This would have made him the oldest president in U.S. history.

I would argue that he is a victim of ageism and that evaluations of Biden’s presidency should have focused on his policy achievements, governance style, and administrative effectiveness rather than his age alone.  President Biden has continuously “shown up” and the media and his detractors are not relying on any health or evidence-based information to judge his competency and abilities. We are human, after all, and I, like the American public, watched and, admittedly (although I am not proud to admit) judged the president for the wrong reasons.

In light of current events, I feel it is important for myself, as a professional “in the business,” to try to honestly examine my own leanings towards the abilities of older adults and to challenge society’s generalizations. I encourage readers to examine their opinions and views as well.

Whenever I open a new case, I make it a point to never lead with asking the age of the caller or their loved ones. This is not to say that age is unimportant or irrelevant. For example, it is important to know the age of a client facing early dementia symptoms. This is relevant to not just a person’s care needs but also understanding age-related public and private benefits such as commercial health insurance and Social Security/Medicare. The psychosocial supports and needs of a person in their 50’s who are working and still raising their children is not the same as a retired individual with financially dependent adult children.

For my clients in their late 90’s age can be important to appreciate testing and treatments. I often ask families who are considering invasive testing for their loved ones “to what end.” For example, is it reasonable to put a 98-year-old through a colonoscopy? Is the risk/reward of the anesthesia and procedure on a 98-year-old body going to lead to more harm than good?

It is less than 24 hours since President Biden has graciously and patriotically taken himself out of the presidential race. Politics aside, this makes me sad as I know deep down that he did so under pressure because of his age and not because he lacks the ability to serve our country.

Online-only “Placement” Company: Help or Harm?

Written by: Lisa Bayer, Esq., CCM, CDP

Having been a private care manager since 2006, I have spoken with scores of families over the years about the pros and cons of using a residential placement service for their family members who cannot receive the care that they need at home for one reason or another. However, there is one “placement” website that I ask, no I BEG my clients, to think carefully before sharing their information with the online company. For years I have warned clients that there is no personalized attention and that once they share their information it will sent far and wide to any facility that participates with them in the referral fee process. The effect is to make families even more confused and frustrated, and the less savvy, preyed upon.

Despite years of concerns among myself and other seasoned colleagues throughout the country, no one has seemingly taken our warnings seriously. Until now. Finally, the Washington Post caught on and this past weekend published a scathing report: https://www.washingtonpost.com/business/2024/05/16/place-for-mom-assisted-living-referral/

Needless to say, this is causing an uproar in the senior care assisted living world. Facilities depend on the referrals to reach their census. Care managers like myself do rely on “placement services.” But we depend on REAL people and REAL relationships. No one and no thing or care facility can be all things to all people. When an older person or couple decides to explore a residential facility it needs to approached with sensitivity and care. Most importantly, it needs to be deliberate. It is personal. Not just for the care recipient but for the family caregivers who, especially with a loved one with dementia, are often in the position of making these types of decisions for someone else. It’s a big responsibility and it needs to be addressed with careful consideration.

Whenever I’ve looked to purchase or lease a car I approach it methodically. Do I want an SUV or sedan? Electric, gas or hybrid? What is the all-in price (please do not tell me that you forgot to include the tax when I’m about to sign for the car lease)? What is the warranty? And if I need service does the dealership offer loaner cars? And the list goes on. We are talking finances, amenities, and safety for a car. The same goes for choosing a residential care facility but now we are talking about people, not an inanimate object. The stakes are so SO much higher. In New Jersey, residential care could be as high as $16,000 or more per person, per month. Quality of life is paramount. And in the end, the care that a person receives while living there could make the difference between a healthy, meaningful life or tragic death.

This is not to say that I do not work with placement agencies. I very much do! As a care manager it is against our code of conduct and ethics to have a dual financial relationship with another service provider while also working simultaneously as our client’s guide and advocate. I rely often on and work hand in hand with local placement counselors who I know and trust. They have the knowledge and experience of the intricacies of the facilities. For example, the tenure of the staff and the staff ratio is super important. When I see repeated turnover among staff mine, and my trusted placement counselor colleagues’, antennas go up. But an online service does not have access to, or frankly care about, the individual. They want to make their money any way that they can make it—even if it means not sharing or glossing over important information that could make or break the deal with a prospective move-in.

As the sherpa of all things elder care, LMR Elder Care offers a complimentary discovery call for prospective clients who want to learn more about our process and how care management can help you and your loved ones make informed care plans and decisions. Contact us @ https://www.lmreldercare.com/contact

The Grass is NOT Always Greener

Written by: Lisa Bayer, Esq., CCM, CDP

The saying the “grass is always greener” is a hard NO when it comes to the oftentimes difficult relationships between adult children and their aging loved ones. The TV and media often portray loving white-haired older ladies doting on their beloved adult children and grand-children.

Having worked in elder care for almost 20 years I can tell you that this is most definitely not always the case in all families, mine included. As children who grew up in families where there was emotional and often physical abuse, we were taught to not speak up or out and to maintain the façade of intact Leave It to Beaver family dinners, road trips and get-togethers.

But now our parents are older, many with mild or advanced cognitive impairment, and as Boomers and Generation Xers we are now in charge of their care. Our parents do not understand technology and perhaps never paid their bills themselves or filed their own taxes. They are increasingly physically and mentally frail and vulnerable.

They hurt us. And they continue to do so. But we are good people and many of us now have our own children. The question is: How can we reconcile these feelings of resentment and physical/emotional pain and still do the “right” thing?

The answer is that it is complicated. In addition to finding a person or support group where you can feel safe in sharing your innermost thoughts, I highly recommend bringing in a 3rd party (shameless plug for LMR Elder Care) to protect yourself while making sure that your aging loved one gets the care and support that he or she needs. A geriatric care manager can do the heavy lifting and be the objective front-facer with the care recipient, allowing the adult child to engage how, and if, she or he wishes.

A poster on a social media page that I follow recently shared the following article:  https://grownandflown.com/dementia-improved-mother-daughter-relationship/ .  It’s raw, honest, and incredibly, incredibly brave. As a first-person recount, there is no way anything that I can share can do more justice to support caregivers who have been through so much and still find it in themselves to give even more. Thank you, Ms. Gaines, for sharing your story!

You’ve Got Mail!

Written by: Lisa Bayer, J.D., CCM, CDP

“Raise your hand if you use email on a daily basis.” Everyone in the room did. “Raise your hand if you know how to tell who sent you an email.” Only 11 people in the room of 120 even knew what I meant. I was speaking to a church group of active older adults at their monthly meeting. We were talking about fraud and email scams.

As a first step, I explained the importance of never opening an email from an unrecognized address. But the fraudsters are so good! They can make the subject line and email really look like it came from Bank of America, UPS or Netflix. In fact, a client called me the other day to say that he got an email from the US Postal Service about a package that could not be delivered. As it happened, I had ordered for him something on Amazon and he assumed that this was the reference. I told him not to click on it as I ordered from my account and Amazon most definitely did not have his email address.

And herein lies the problem. One time, my super smart friend told me how she got a pop up on her computer advising that she had a virus and that she needed to call Microsoft to remove it. How kind of “Microsoft” that they even provided an 800# for her to call. She called, provided a credit card for the repair fee, and turned over control of her computer so that they could “fix” the problem.  I’m pretty sure you know what happened next. The point is, its not a question of how smart or savvy a person is; the cyber criminals are extremely cunning and convincing.

So how do we protect ourselves? First, learn to tell what a (probable) real email is and what is spam. Unless you are 100% certain, I recommend going to the source and never clicking on anything. For example, log into your Facebook or bank account directly to check on any issues. Change your passwords often and do not use the same one for all of your online accounts. I also recommend turning on two-factor authentication. As I tell my clients, if you do online banking and have not set up two-factor authentication (or do not even know what it is!) you should not do online banking.

I can share story after story of the various frauds and scams my clients, friends and even family members have encountered over the years. I am no expert and I’m sure now that I’ve written this I will be the next victim. But there are things that we can do to protect ourselves and our loved ones, especially persons living with dementia who need even less convincing to turn over their personal information such as credit card numbers.

If you would like to learn more about how to protect your loved ones from falling victim to fraud or would like to invite us to speak with your organization about elder financial exploitation please email us at: hello@LMReldercare.com or call 973.533.0839 to schedule.

Synergy b/w Elder Care Mediation & Geriatric Care Management

This month, I am thrilled to share an article written by my friend and professional colleague, Linda F. Spiegel, Esq.. In it, Linda does an excellent job highlighting the importance of planning/mediating when working with families and older adults who are not yet “on the same page.” In the article, Linda highlights the important role that a geriatric care manager can play in assessing, facilitating and implementing a plan of care. Enjoy!

©2023 by the American Bar Association. Reprinted with permission. All rights reserved. This information or any portion thereof may not be copied or disseminated in any form or by any means or stored in an electronic database or retrieval system without the express written consent of the American Bar Association.

Originally posted: January 25, 2023 in the ABA Voice of Experience e-magazine

Elder Care Planning Mediation

by: Linda F. Spiegel

When we are young, our parents take care of us. As our parents age, they may need us to take care of them. It may be very difficult for our parents to have that discussion with us. They don't want to impose. They are not accustomed to discussing their financial situation with us, their children, no matter what age we are, what professional recognition we've obtained, or our area of expertise. No one in the family may be comfortable raising the issue of long-term care and end of life decisions.

As you watch your loved ones grow older, you should try to discuss their plans with them in the event they can no longer care for themselves without assistance. This discussion can at times be very difficult, either because you and other caring relatives find it hard to discuss end of life issues with your elderly relatives, or your elderly relatives don't want to acknowledge or don't realize that they may need assistance. Sometimes the discussion is difficult because elderly parents don't want to appear to favor one child over the other and want all of their children present for the discussion.

How do you know when it is time to have this discussion? Having just spent time with your family for the holidays, you may have noticed some of the signs that should have alerted you that your elderly relatives, including your parents, aunts, uncles, etc., may need some additional care. Some of these signs include piles of correspondence, bills, etc. that have not been attended to, lack of attention to personal hygiene, or lack of cleanliness in their home.

As of 2015, about 40 million Americans are helping at least one parent and one out of every four households is involved in some kind of elder care, according to the Pew Foundation.

Your level of concern should focus on what is called "Activities of Daily Living," also known as ADLs. Does the elder need assistance with ADLs? These include getting in or out of a bed or a chair, toilet hygiene, bathing or showering, getting dressed, personal hygiene, eating, walking, climbing stairs, and responses to their own safety and emergency situations, such as knowing when to call for assistance, take medications, or call a physician.

Elder care planning mediation is "all mediation in which participants address issues that occur as a result of life cycle events, transitions, and/or losses often associated with aging and dying." (Association for Conflict Resolution Section on Elder Decision-Making and Conflict Resolution Committee on Training Standards, 2012)

In the mediation, the participants meet with a mediator who facilitates the discussion by creating a space where participants listen to each other, ensuring that the voices of the elders are heard and respected, finding out what is most important to each person participating, and ultimately helping the family explore options and reaching decisions to which everyone can commit. Having a professional mediator involved will lessen the stress and tension among those present. Depending on the specifics of the situation, the mediator may suggest that a geriatric care manager and/or an elder law attorney participate in the mediation as well.

The discussions may include medical issues, legal issues, financial concerns, your loved ones' living situation, caregiving, the plan for your loved ones' futures, the allocation of responsibilities among those present in regard to the elders, and other concerns. Mediators can also develop a process for revisiting decisions as the needs of the elder changes or the situations of those assisting the elder changes.

"What is most difficult, I think, are the situations in which family members cannot agree with one another and they argue about everything from course of treatment to choices that may impact their loved one's comfort. It happens more often than you would think and, perhaps, more often than it should."( https://blogs.timesofisrael.com/family-times/, by Carol Silver Elliott, President and CEO of The Jewish Home Family)

The decisions that must be made – including financial, residential, and health-related decisions – tend to create conflict within some families, or to exacerbate existing conflict, due to the stress that accompanies these decisions. If the elder has not executed a Power of Attorney appointing an attorney-in-fact, adult siblings oftentimes find themselves in court arguing over decisions for an elder parent. The first lawsuit filed is usually an application for guardianship and, when there is no agreement among family members as to who will be the guardian, this issue is litigated.

Unfortunately, litigation may also ensue when there is an attorney-in-fact or a court-appointed guardian and a family member (or members) disagrees with the decisions of the named representative and looks to the court to remove the attorney-in-fact or guardian. Litigation is a costly process and extremely stressful for all parties. There is usually no winner and most times it causes harm to the elder due to the conflict and stress. Mediation, by providing a safe space for all involved, reduces the stress and creates an environment of cooperation rather than encouraging adversarial behavior.

Erica Wood, the retired former Assistant Director of the American Bar Association Commission on Law and Aging, noted that once families have the opportunity to discuss elder care in mediation and are informed of community resources, "the resulting solutions can be more creative and better tailored to individual needs than a court proceeding, and parties are likely to adhere better to solutions they have designed themselves."

What happens once you decide to proceed with Elder Care Planning Mediation?

In Elder Care Planning Mediation intake and pre-mediation conferences are very important. It is also important that all necessary persons are included in the mediation. The mediator will explore in the initial intake interview with the person contacting the mediator who these persons are and discuss whether or not they are willing to participate. The mediator should inquire as to the existence of a Power of Attorney for Banking and Property Management, Power of Attorney for Healthcare Decisions, and Advanced Directives/Living Wills executed by the elder. The mediator should also inquire if there are any court orders or judgments addressing the capacity of the elder and appointing a conservator and/or a guardian. The mediator should obtain copies of all such legal documents. The mediator will also discuss the setting for the mediation, whether it will be in-person, telephonic, or virtual.

Another area of discussion is what accommodations are needed to be made for the participants and the length of each mediation session. I have found that one hour or one and a half hours is the optimal length for a mediation session because it is difficult for participants to concentrate and absorb all that is being discussed in a more lengthy session. However, if you are meeting in person and there is a substantial travel time involved for one or more participants, the session can be expanded to accommodate that situation. If travel time is an issue, having virtual mediation sessions should be considered.

It is important for the mediator to meet with the elder individually, without anyone else present, to screen for elder abuse, assess the capacity of the elder, and ascertain the elder's ability and desire to participate in the mediation. This screening should take place before the first mediation session. If the mediator is concerned that elder abuse is an issue, the mediator should comply with reporting requirements in the mediator's state.

In the initial mediation session, it will be important for the mediator to listen to all those present voice their concerns for the elder, to observe their interactions with each other, and to learn the needs of the elder. The initial mediation session may or may not include the elder depending on each situation and the mediator will make that recommendation based on the mediator's meeting with the elder and the pre-mediation conferences.

Many mediation participants come to the mediation with limited or no knowledge of the resources available to elders in their community. Elder Care Planning Mediation should include a discussion of available resources and how participants may get the specialized information they need to make and carry out informed decisions. As stated earlier, a geriatric case manager may be included in the mediation as a resource person.

Having just been together for the holidays, please look back at your time with your family and ask yourself if now is the time to become involved? If the answer is yes, please reach out to an elder care planning mediator to start the discussion.

Linda F. Spiegel—Spiegal Law Firm

Ms. Spiegel is a Court approved R. 1:40 Arbitrator and Mediator in civil, foreclosure and family matters. She has served as an Arbitrator for the American Arbitration Association for over 30 years in construction and commercial matters and is also a Mediator for the American Arbitration Association on the Association’s commercial and construction panels. In her private practice, Ms. Spiegel is available to mediate and arbitrate all types of civil and family matters. She is also available to mediate elder care issues. She has presented on mediation and arbitration to the Bergen County Bar Association many times.

Challenges (and Solutions) With Medication Management

Written by:  Gary Rich, RPh, MBA

One of the tasks that can become more challenging for adults as they age is managing the medications they are prescribed.  Former US Surgeon General C. Everett Koop, once said “Drugs don’t work in people who don’t take them.”  While true, it oversimplifies the more complex issue of medication non-adherence, defined as the failure to take medication as prescribed.  Some of the reasons for medication non-adherence include:

• Taking multiple medications

• Bothersome side effects

• Diminished vision, hearing, or memory

• Confusion with directions

• High prescription costs/complex insurance

In the US, medication non-adherence affects as much as 50% of people taking chronic medications, and accounts for up to 25% of hospitalizations and 125,000 preventable deaths each year.  Unfortunately, family members or friends often don’t live close enough or have the time or knowledge to provide adequate assistance to their loved ones.

I have been a practicing pharmacist for over 40 years, and the primary caregiver for my parents as they aged. I am very aware of the difficulties older adults face managing their medication regimens.  Often, utilizing a weekly pill planner can be helpful for a patient to remember to take their medications every day and reduce the potential for accidental duplicate doses.  Smartphone apps can also be useful tools to improve adherence.

Gary Rich is the President and Founder of MyPharmaGuide. His company helps make sure that patients take their medication at the right time, in the right way, and with the most cost-effective approach. To learn more about MyPharmaGuide, please call 201.981.4978 or visit: https://www.mypharmaguide.net/