Sometimes Not Interested Is Best

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

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

Your client's memory loss is progressing and you've known him for years. It's time to begin talking about legal matters relating to aging. Dan, your client, is estranged from his family and doesn't really have anyone close who might be a good advocate. However he mentions that he has talked to Tom, the person who has been cutting his hair for years, and Tom might be interested in being his medical Power of Attorney.

You skillfully attempt to talk to Dan about the fact that Tom is his barber and may not be the most appropriate person to make medical decisions, however Dan balks because he and Tom "know" each other. You visit Tom and find out that their degree of "knowing" each other is limited to chair time over the past 20 years. Tom really doesn't want to be responsible for making medical decisions for Dan but didn't want to say no because he is aware Dan has no one else who can do this for him.

It’s Only A “Little Memory Loss” – The Hidden Pitfalls of Doing Nothing

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

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.

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.

Controversial Benefits of Microchip Implants for Alzheimer’s Wanderers

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

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

VeriChip Corporation has developed microchip implant technology able to track Alzheimer's patients who wander, similar to the chip implants pet owners place in their dogs or cats and much like a GPS system. Interestingly enough the technology has other uses for example, serving as a "unique lifetime identifier or ULI". (1)

The chip has the capacity to hold the entire medical record of an individual. For example, in the event of an emergency room visit, the hospital can access immediate information often saving a life especially if the person is unconscious and has no one with them upon admission that can provide medical history. This would be especially relevant to older adults who live alone and access emergency services. The chip has the potential to hold other personal information such as passports, insurance, banking, social security number, birth certificate, marriage license etc. Imagine never having to hunt for this information again. The technology can also be used to track missing or kidnapped children, high profile individuals, terrorists and also decrease fraudulent social security claims by individuals using stolen social security numbers.

Children – Get Involved in Your Parent’s Planning Before It’s Too Late

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

When my mother passed away and I started going through medical bills, monthly bills and the bank account I discovered something shocking. My mother never once balanced her checkbook. This was a shock to me at the time because I was fanatical about balancing my checkbook to the penny. And not only that, I knew down to the penny what the money in my checking account was intended to do.

All those years growing up I thought my parents had it all together and never considered otherwise. My dad was from the Greatest Generation, a WWII veteran who completed high school and joined the Conservations Corps and later the army. My mother, whose mother passed away when she was five, took responsibility for raising her three younger siblings. She went to high school but did not finish. Four of my siblings included myself went to college, two did not.

It did not occur to me that my parents might benefit from my years of education even if it was to show my mother how to balance her checkbook. I have no idea how she managed their money all those years without actually knowing how much money was in their account. She obviously had it all figured out and they were able to set aside money for retirement, although probably not in the best vehicles to obtain a good investment return.

My parents passed away when I was in my thirties and I see many other children my age, now in my forties who have parents who may be in similar situations. I'm not sure how most parents would react, but I would suspect that if most children went to their parents to talk about balancing checkbooks and investing the conversation might be met positively.

This includes not only financial information but also planning for later legal needs and healthcare. I always say that caregiving is a family issue. This is because the responsibility for care of parents can and often does fall on their children. Mostly in unpleasant ways especially when there are little or no retirement savings to pay for healthcare needs. I believe that there is a significant benefit to families planning together. Sure this opens everyone up to know more about each other's finances than we might prefer, however it can avoid issues later in life when parents need care.

Also meaning that we as parents should start teaching our children at young ages the value of money and also work to protect our children from having to be shocked that we do not have sufficient savings or insurance to pay for our care when we are older.

It's never too late or too early to have this conversation with our parents or our children. After all, caregiving is both generational and financial. For free basic information on retirement savings and planning visit http://www.money.cnn.com//pf/retirement

When my mother passed away and I started going through medical bills, monthly bills and the bank account I discovered something shocking. My mother never once balanced her checkbook. This was a shock to me at the time because I was fanatical about balancing my checkbook to the penny. And not only that, I knew down to the penny what the money in my checking account was intended to do.

All those years growing up I thought my parents had it all together and never considered otherwise. My dad was from the Greatest Generation, a WWII veteran who completed high school and joined the Conservations Corps and later the army. My mother, whose mother passed away when she was five, took responsibility for raising her three younger siblings. She went to high school but did not finish. Four of my siblings included myself went to college, two did not.

Ignoring the Consequences of Moderate Cognitive Impairment

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

worried woman_250x166 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.

Missing the Signs of Alzheimer's Disease

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

three generations pink_250x167 Many family members miss the signs of memory loss, cognitive impairment, dementia or Alzheimer's disease because they assume that memory loss is a normal process of aging. And physicians, in the 15 minutes they see a patient, look for signs of chronic illness -- not signs that memory loss is creating issues with daily activities or safety. Being realistic, most of our family members are on their best behavior when they go to the doctor, they're dressed well, usually have good hygiene and have a few aches to complain about. Issues with memory loss never are discussed, because if someone has memory loss it's likely they can't remember they have the problem and due to work schedules it's less likely that family members are available to attend medical appointments with their older parents or relatives.