I believe we need to take the fear and stigma out of the words “Alzheimer’s” and “dementia” and help improve the quality of their lives of older adults and their caregivers living with these labels. The focus on finding a cure has lead to a mind-set that there is not much that can be done for those living with the disease. We focus so much on the importance of memory and cognitive functioning we fail to recognize the person within who retains a capacity for love, humor, joy, pleasure, even contentment. I am not saying that cognitive decline can not be painful, even tragic, and definitely stressful. But that is not always the whole picture. I have seen brooding depression replaced with the simple enjoyment of the pleasures of day to day life. I have seen long estrangements melt away for a chance at a new relationship. In some cases, like that with my own father, there is an opportunity for a closer, more intimate relationship that might not otherwise have taken place.
No two people with cognitive impairment are alike. So no one “textbook” or “handbook” approach works with everyone. I work intuitively, keeping an open mind and creative heart taking my cues from for each individual keeping in mind what I already know about their and their family’s wishes, values, and preferences.
Some Care Managers work more in a consulting capacity, advising you on what actions to take. I can certainly do that but my best work is in a hands-on capacity. In fact I can do just about anything needed to be done including personally transporting a client to a new care when appropriate. An important component of my approach is to develop a trusting relationship with the client so that I can develop a plan to effect change without trauma, thereby sparing the family from the role of being the “bad guy”. You’d be surprised how often a client will allow me to facilitate something the family thought impossible. Never say never!
It is a myth that there is not much you can do for people with a diagnosis involving cognitive loss. There is a unique individual who is more than just a diagnosis, a set of symptoms and problems. Furthermore no two people with dementia are the same! It requires an astute and flexible care manager to be in touch with what will work in any individual situation.
I have a unique background of working hands-on in “mileu” settings with people with dementia. This unique background has given me an arms-length perspective of the hundreds of ways people with dementia can behave and what responses and interventions work and which ones don’t. I have gotten to know people over the course of hours, days, weeks, months and years and to develop rapport, trust, and approaches that really work. I have worked with numerous doctors and specialists and have become knowledgeable about medications, behavioral interventions, and creative problem-solving.
At the Institute on Aging in San Francisco I lead a team of professionals who sat around a table daily to adjust approaches and interventions for hundres of older adults for whose care plans I was responsible. These professionals included doctors, nurses, physical and occupational therapists, pharmacists, nutritionists, social workers, and more. I learned from all of them the true meaning of inter-disciplinary care and what to look for from each of their professional perspectives. I take all of this knowledge and experience with me when visiting a client.
How I can help?
I always start with a complimentary phone conversation so we can explore how I can be helpful in your situation. My first question is “Tell me what’s going on”. From there I can explain how I might get involved. It could be as simple as a one-hour consultation in my office to point you in the right direction. More often folks request an “informal assessment” where I come and meet the client in their home or care setting as a non-threatening “friend”. I can tell a lot about the individual just by interacting with them and asking a few non-threatening questions. From here I can make initial recommendations based on your needs or develop an action plan to address your concerns. The action plan (or care plan if you will) is a collaborative effort, involving you in the decision-making process. Then it is up to you how much of the action plan you do and what you want me to do.
I offer a range of services to the families and/or professional support systems of older adults with cognitive impairment. Here are some examples:
The “Informal assessment”
Written evaluations and care plans
Housing evaluations and referrals
Medical care referrals and/or advocacy
Behavioral Medication evaluation and adjustment in conjunction with medical specialists
Non-medical approaches to behavioral care
Transition plans for moving from home to a care setting
Behavioral evaluation and interventions
How to pay for care, who pays for what, how to apply for your entitlements
Finding the best caregivers or care setting
Ongoing care management with regular monitoring
Regular reports to long-distance family caregivers