AGAINST ALL ODDS: HELPING LOW- INCOME SENIORS WITH DEMENTIA IN THE COMMUNITY

Transcription

1 AGAINST ALL ODDS: HELPING LOW- INCOME SENIORS WITH DEMENTIA IN THE COMMUNITY Barbara Korenblit, LCSW Manager, Community Outreach Program Baltimore County Department of Aging

2 Seventy percent of individuals with dementia live in the community. - National Institute on Aging

3 What we will cover Challenges we face Goals Ethical issues Assessment Intervention Resources

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5 One third of community-dwelling individuals with dementia live alone. The proportion of primary caregivers working alone rose from 34.9% in 1989 to 52.8% in 1999.

6 Our goals Improve quality of life for people with dementia in context of their informal support network. Keep persons with dementia in the community as long as safely possible.

7 Ethical Issues How to maintain a reasonable degree of safety while providing the individual with some degree of autonomy? When social workers act on behalf of clients who lack the capacity to make informed decisions, social workers should take reasonable steps to safeguard the interests and rights of those clients. NASW Code of Ethics

8 Ethical Issues How to work within a stressed informal support system that may not be able to provide optimal care for their loved one?

9 Assessment Person with dementia Interview privately Collateral sources Dementia work-up? Primary caregiver Health/mental health/substance abuse Relationship with care recipient Social supports Knowledge and skills related to dementia Preferences and values regarding care Impact of caregiving on caregiver s life Dependence on care recipient Legal and financial issues

10 Assessment Family system - observation is key! Caring for a relative with dementia is a stressor to the family system. To what extent is the family organized and able to carry out tasks? Helping with ADL s/iadl s Reading and completing applications Negotiating and advocating for services Organizing records and documents Assigning responsibilities and working together Making and communicating decisions

11 Assessment Family system - observation is key! What is the role of the person with dementia in the family system? How do other family members view the person? Does the person with dementia perform tasks that help the family to function? Is the person consulted in decisions that affect him/her?

12 Building the relationship Start where the client/family is. A gift can help establish trust. Be clear about your role. Find strengths in everyone. Empathize. Build realistic expectations.

13 Address physical safety Supervision/monitoring Informal supports eyes and ears Meals on Wheels Emergency response system Medication management Behavioral issues how are they being handled? What education does the family need?

14 Resource linkage Entitlements M.A./QMB/SLMB Food Stamps Funds for services Senior Care In-home Aide Service M.A. Personal Care Alzheimer s Association NFCSP funds Low-cost day programs Senior Center Plus Center Connection Home delivered meal subsidy Waiver programs Assistance with cost of medications Medicare D Extra Help Maryland Senior Prescription Drug Assistance Program Partnership for Prescription Assistance Medbank

15 Resource linkage Fuel Assistance MD Office of Home Energy Programs Community Action agencies AAA s, DSS Local community organizations, churches Transportation Locally-run paratransit, such as CountyRide MTA Mobility and Taxi Access M.A. Transportation Volunteer programs Friendly visiting Grocery shopping Transportation Handyman chores Food pantries Emergency meals Housing Choice and other rental assistance programs Loan closets Hospital indigent programs for medical bills

16 Address emotional safety Reinforce the personhood of the person with dementia. Encourage a purposeful role expectation. Serve as a role model in your interactions with the person.

17 Organizing Finances Family member keeps copies of person s important records. Direct deposit of person s check(s) Automatic bill-pay Joint access to a bank account BGE 3 rd party notification Decide what to do about checkbook, credit cards. Develop a system for handling mail. Consider Volunteer Rep Payee Program.

18 Organizing Health Information Orange card for caregiver and care recipient Caregivers Health Guide or other recordkeeping system Advance Directive if person is able to complete

19 Psychoeducaiton Don t assume the individual and family understand what dementia is! Communication skills Behavior management How to talk to the doctor Planning for the future Handling daily routines finding practical solutions to make life easier Another family I know tried..

20 How to present information Give information in small doses. Tackle one issue at a time. Limit the length of your visits. Verify that families understand. Give manageable homework assignments and write them down!

21 Living alone by choice or circumstance Of Americans 85 years of age and older, 47% live alone, yet this same age group experiences at least a 33% prevalence of dementia. In our experience, most of these individuals have some supports, often neighbors, church volunteers or even local shopkeepers.

22 Considerations for continuing to live alone vs. living alone with more supports vs. moving Does the person enjoy living alone? Is there adequate stimulation during the day? Can the person take care of daily hygiene? Is the person eating adequately? Does the person take medication properly? Would he be able to get help if sick? Would she be able to respond to emergency?

23 Considerations for continuing to live alone vs. living alone with more supports vs. moving Can the person handle mail, bills? Can he stay safe from financial exploitation? Does she let strangers in the house? Does the person get lost outside the house? Can he take care of housekeeping? Is the person willing to accept help in the areas where she is having difficulty?

24 Weighing risks and benefits of continuing to live alone Consider impact of person s behavior on the safety of others. Consider the context of the person s environment. Weighing risks and benefits is a shared, negotiated responsibility. If person is vulnerable and at risk of abuse, neglect, self-neglect or exploitation, call APS.

25 Resources for common problems of live-alones Nutrition MOW (with Title III subsidy), Eating Together, someone to check food supply Medication management Informal support persons administer, use of medication manager or bubble pack, automated systems, simplified regimen Isolation Friendly visitors, inexpensive day programs, telephone visitors Heating and cooling Thermostats with timers, calls in extreme weather

26 Red Flags Increased confusion Significant weight loss/gain. Deteriorating hygiene Falls, accidents, injuries Disorientation Increased suspiciousness, irritability, withdrawal Loss of interest in activities, hopelessness Swollen legs or feet More difficulty walking

27 Community Resource Websites Entitlements M.A./QMB/SLMB/FS Funds for Respite and In-home Services Senior Care In-Home Aide Service (DSS) M.A. Personal Care Alzheimer s Association National Family Caregivers Support Low-cost day programs Senior Center Plus Center Connection (Baltimore Co.) Energy Assistance MEAP

28 Citations 1. Ebly, Hogan, and Rockwood, Living Alone with Dementia, Dementia and Geriatric Cognitive Disorders, Basel: Nov/Dec Vol 10, Iss. 6; pp Lusis, Living Alone: When is the Elder No Longer Safe? American Geriatrics Society 2002 Annual Scientific Meeting. 3. National Institute on Aging, 4. National Long Term Care Survey, Duke University/National Institute on Aging, Tremont, Davis, and Bishop, Unique Contribution of Family Functioning in Caregivers of Patients with Mild and Moderate Dementia, Dementia and Geriatric Cognitive Disorders, Basel: Jan Vol 21, Iss. 1; pp Zarit, Caring for the caregivers of the elderly: Having fun while doing good, Family Relations, Minneapolis: Oct Vol 48, Iss. 4; pp

29 AGAINST ALL ODDS: HELPING LOW- INCOME SENIORS WITH DEMENTIA IN THE COMMUNITY Barbara Korenblit, LCSW Manager, Community Outreach Program Baltimore County Department of Aging