The Care Navigator

By Pamela D. Wilson, CSA, MS, BS/BA, CG, The Care Navigator

No one wants to say the words Alzheimer's disease or dementia so we use terms like mild cognitive impairment or moderate cognitive impairment to dance around the reality of the subject. Recently I took a client to a medical appointment. The physician performed cognitive testing with the diagnoses of "moderate cognitive impairment". There was no discussion of appropriate medications to treat the diagnosis nor was there a discussion of the consequences and future prognosis. The physician was extremely kind and compassionate. He could not have had a better bedside manner, however in my opinion he sidestepped the responsibility of telling his patient what to expect relative to progression of his memory loss.

Physicians today are limited by time and insurance reimbursements. They treat diseases and conditions but do not see the havoc that results on a day to day basis in the life of a patient diagnosed with moderate cognitive impairment.

Let me give you a slice of the day to day reality that is hidden until the point I become involved. This gentleman forgot to pay his property taxes for two years and a lien was placed on his home. Income taxes were not paid and notices were frequently sent with penalty amounts due. He purchased Canadian lottery tickets on a credit card now maxed out to $50,000. The bank was finally thankful that I intervened because checks bounced monthly on the account due to lack of funds. A plumber took advantage of my client by having him write monthly checks of $500 for plumbing maintenance. Of course there were no work receipts available to substantiate the charges. This gentleman, my client, is a prime target for abuse and financial exploitation.

After speaking with my client's neighbors, I find they were concerned but did not know what to do. His barber tells me that he has known there were issues for about two years but had no information about family to contact. His insurance agent knew there were problems due to claims for car repairs, hint: frequent accidents. So I ask how can so many people know there are problems and NO ONE DOES ANYTHING? These three individuals tell me that they did nothing because they felt "guilty" about reporting the issues and asking someone to help.

So, once involved, it becomes my responsibility to discuss the issues of cognitive impairment with my client and the consequences. I am the bearer of bad news because no one, not even his physician wanted to say the words Alzheimer's or dementia because of the reaction and fear on the part of his patient. However this lack of responsibility results in more significant problems for individuals. Some lose their entire financial savings to scams or financial abuse. Others lose medical care because they forgot to pay premiums. Others become involved in car accidents and not only serious injure others but seriously injure themselves. Some end up lost in a strange neighborhood. In working with these clients I explain the situation and the realities time after time because my clients just don't remember. One client feels responsible for the issues with his checking account and believes he should be able to handle it, but the reality is that he cannot. Another forgets discussions we have about topics and has to go back and read notes of our conversations. Moderate cognitive impairment may be called moderate but the implications are monumental if left unaddressed.

The difficulty is that many individuals diagnosed with "moderate cognitive impairment" seem to do well in social situations. They carry on appropriate conversations, perhaps forgetting something here and there. They laugh at jokes and appear moderately well groomed. They seem to be doing well. However it is the underlying, hidden issues that have the potential to cause the greatest harm. And yet friends and acquaintances feel guilty if they try to find an appropriate person to help. Some family members fear anger from their parents and are immobilized to do anything. I always ask, what's worse? Having your friend or parent temporarily angry with you or having them face financial exploitation or significant health issues that cannot be remedied?

Here's a quick checklist of signs indicating that it's time to act responsibly for a friend or family member who may not be able to manage their own affairs:

• If you have access to their home are there piles of mail, newspapers and notes everywhere? This may indicate unpaid bills and mismanaged finances. Is the home unclean?
• Do you see repairman or handyman constantly going in and out of their home?
• Have other neighbors or friends expressed concern?
• Has the individual lost weight or appear to have health issues, hearing loss, issues with eyesight?
• Do you see the individual driving and appearing unsafe?
• Is the individual wearing the same clothing day after day?
• If you've begun to help the person, are they relying more and more on you for daily tasks?
• Do you notice that the individual repeats information, asks the same questions or forgets that you spoke to them yesterday?
• Does the individual appear generally confused?
• Are there medication bottles throughout the home but no system of taking medications?
• Has someone moved into the home to "help out" but the situation seems to be getting worse instead of better? This may indicate abuse by a family member or friend.
• Does the individual express fear of a family member or friend?

You will be doing your friend or family member a kindness by reporting these issues and asking for help on their behalf. I often receive such calls from embarrassed or frustrated individuals. I thank them for caring enough to make the phone call and then make an appointment to visit the individual to see how I can reduce the risk of the hidden pitfalls I'm about to discover.

Copyright © 2009 Pamela D. Wilson All rights reserved. This publication may not be reproduced by any mechanical, photographic or electronic process, transmitted or otherwise copied for public or private use without prior written permission from the author. Website: www.thecarenavigator.com

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