Expanding the Elder Care Guides family

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Elder Care Guides Family – Now Windward Life Care!

On June 24, 2014, San Diego lost one of its visionary elder care professionals, Hilde M. Lehmann, MSW, MPH. The President of Senior Care Management Inc., Hilde founded her company in 1996 and was a respected colleague and a treasured friend. Her loss is felt deeply by many, including all of us at Elder Care Guides.

Following her untimely death, the leadership of Senior Care Management made the decision to join together with Elder Care Guides in order to maintain the extraordinarily high level of service they had worked so many years to provide to their clients, families, and San Diego’s professional community. While we are saddened by the reasons behind the acquisition, we are honored to carry on Senior Care Management’s long tradition of ethics and high standards of service.

“I am honored to carry Hilde’s memory forward with this exceptional company, and am proud to be joining this incredible group of professionals.” -Betsy Evatt, LCSW, CMC

“I am honored to carry Hilde’s memory forward with this exceptional company, and am proud to be joining this incredible group of professionals.”
-Betsy Evatt, LCSW, CMC

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Grief, Loss, and Transition

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Hope and Transformation

In my many years as a clinical social worker I am often asked, “How can you work in that field?  It must be very depressing!”

Yes, I have worked with suffering most of my life.  In high school I got a job in a nursing home and spent time preparing food for the residents, feeding the residents, and spending time with them. I recall many emotions during my many interactions with those folks.  However, most of it was compassion. I felt compassion even as a young child and felt compelled to rescue worms out of rain puddles. So, it probably isn’t surprising that I became interested in helping people and eventually got my Masters Degree in Social Work.

I have worked with a variety of suffering in my work. One client of mine lost her husband after 50 years of marriage.  She also had a history of severe child abuse from her teens. I worked with her as her mental health therapist and we explored her grief, loss, and trauma history together. She went through some really tough times.  At the end of our time together she was starting her own business! This was a transition, a transformation, a spiritual journal for her. I was so grateful to be there with her. Continue Reading →

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Suicide: Older Adults at Risk

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National Suicide Prevention Week

This week is National Suicide Prevention Week, an opportunity to discuss a subject that is too often considered “taboo.” According to the most recent statistics released by the Centers for Disease Control, the suicide rate in the United States is climbing, despite the efforts of public health and mental health advocates to raise awareness and encourage people to seek help.

The most recent statistics from the CDC (from 2011) reveal that U.S. national suicide deaths rose slightly for the fifth year in a row from 12.1 per 100,000 in 2010 to 12.3 per 100,000 in 2011 (rates are per 100,000 individuals). Data from 2012 and 2013 have not yet been released.

Older men are particularly at risk for self-harm. While the risk of suicide declines for women with advancing age, statistics show that men’s risk increases as they get older. Older men die by suicide at a rate that is more than seven times higher than that of older women. White men aged 85+ die from suicide at a rate four times higher than the average rate of suicide nationally. Firearms are the most common method of suicide in older adults (67%), followed by poisoning (14%) and suffocation (12%). Continue Reading →

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Climb Every Mountain

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Last month, we said goodbye to my husband’s beloved grandmother, a loss that we’ll no doubt feel deeply for years to come. Grammy, the last grandparent between us, was a remarkable woman who warmly welcomed me into the fold of her family and treated me as her own from the day we met. We were fortunate to have celebrated Grammy’s 95th birthday with her in the spring, which was a time not only of celebration but of reflection on a life that had been very well-lived, physically and otherwise. In the past couple of years, she had become frail after nine full decades of hale and health, and after struggling with that transition, she seemed to have reached a place of peace.

A geriatric social worker since my mid-20s, I’ve spent my entire adult life in the awed presence of the “oldest old,” as they are known in the medical community. Theoretically, I know what it is to grow old, and I don’t fear it the way many do. I think a lot about becoming – and eventually being – old, and consciously make decisions about how I live my life with the “end” in mind. If the day comes that I’ve lost much of my ability to function independently, I very much want to know that I got everything out of this body that I could have. I want to have eaten every delicious thing, visited every beautiful place, hugged every dear person, and crossed every finish line that I reasonably could have. (I’m an avid distance runner.) I am, meanwhile, mindful of the role that moderation plays in the living of a long and healthy life. So I don’t actually eat every delicious thing. (Okay I usually do. But I don’t go back for seconds. Usually.) My impulse is to travel constantly, but I know the importance of planning financially for old age, and so have learned to avoid the temptations of the New York Times travel section, and try to keep our annual vacation budget in check. There are dozens of races I would love to run every year, but out of respect for the limits of my ankles, knees, and hips, I give them lots of love and recovery time, and restrain myself.

I see no reason to hold back when it comes to the hugs, though. Grammy certainly didn’t. As she grew older, the logistics of the hugs changed, as we had to lean down to reach her in her chair to get them. But they remained big and plentiful until the end of her long life.

Bill Thomas, MD wrote a wonderful book called What Are Old People For? that is still well worth your time, even though I’m about to give you the answer:

Young people are for doing. Old people are for being.

I couldn’t agree more. Certainly there are exceptional old people who earn college degrees in their 80s, run marathons in their 90s, or work until they’re 100. But most of us will be met with physical or cognitive limitations that make this kind of “doing” impossible. A good old age is, in my mind, one wherein we’ve successfully adapted to the functional limits of our bodies or brains, and recognized that while the ability to “do” may be waning, what the world really needs from us now is the unique “being” that only we can “be.” By old age, we have become the holders of histories, the vehicles of values we hold dear, a connective glue binding family together. We know the stories and the secrets, and (I can’t wait for this part) we have life pretty well figured out. Even in the presence of one who has lost the ability to remember or communicate verbally, if you pay attention there is an unmistakable sense of all that they know, and of who they are. Being.

Chances are good there will be a day that I can no longer experience the physical joy of a run. Perhaps I’ll still be able to read and write about it. Perhaps I’ll have younger or healthier friends through whom I’ll continue to experience that joy. Maybe I’ll lose that, too? Someday I’ll probably seem like little more than a wrinkly old lady to someone who’s not paying attention. But I’ll still be that runner, who ran all over the world, saw life through that lens, and cared deeply about it. And I’ll probably still have something to say on the subject. I hope someone will ask.

Me and my Grammy, exploring the Yukon together.

Me and my Grammy, exploring the Yukon together.

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Trust the Process

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Sometimes, you just need to let go, and trust the process.

Sometimes, you just need to let go, and trust the process.

I’m currently working with a couple who, like most of our clients, had never worked with a Care Manager before engaging our services. They live independently in their home in San Diego, and the husband has advanced dementia. This couple started with assistance from a caregiver in four-hour shifts, twice weekly.

We introduced a caregiver who we thought would make a good match with the husband’s personality and care needs. He made slow but steady progress in building rapport with my client, and his wife came to enjoy the opportunity for some regular respite. Unfortunately, the caregiver required some time off, and we had to introduce a new employee to cover in his absence.  The family was very hesitant, reluctant to work with someone else and fearful of the change and disruption in their loved ones’ routines.

I explained the benefit of having a team of caregivers in place to accommodate inevitable and unpredictable changes that come with home care scheduling: vacations, sick days, etc. With some gentle persuasion, the family agreed and accepted the assignment of a new caregiver.  Working closely with our human resources department to make another “match,” I introduced a new caregiver, who did a great job with this elderly gentleman.  And we were delighted to find that this second caregiver was able to assist the client with things the first caregiver had been unable to.  His wife was amazed with the progress he had made in one shift. Best of all, the personality fit appeared to be even better with her husband.

Bringing someone new into your home can feel frightening, and sometimes threatening. We understand this. Families often don’t know what to expect, and have preconceived ideas of what their loved one prefers or what’s going to work (or not work). This is an area where our objective perspective, and our years of experience in developing care plans and managing care teams can be invaluable.  Many families are surprised to find just how well their loved one adjusts to the assistance of a caregiver.

As a Care Manager, I work to identify caregivers who are a good fit for each of my family’s needs.  And sometimes it does take a couple tries to find the optimal caregiver (or caregivers), but we’ll keep working until we get it right. As difficult as it may be, I encourage our families to trust their Care Manager, and trust in the process.  I love seeing how much relief and assistance a skilled caregiver can bring to a stressed household.

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Getting Older: It’s Good!

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Yesterday I went to see a new doctor. As we were talking during the appointment, he asked me about my work. When I explained my social work background, and the care management and home care services we provide to older adults, he responded, “Wow, I bet that’s depressing.”

This, I have found, is a pretty common response when people hear that I work in geriatrics. It amazes me each time I hear it, especially from a doctor, because it is so far from the truth.

What is it about getting older that inspires such fear and loathing? Why is growing old necessarily equated with sadness and isolation? Is there another way to conceptualize the process of aging?

For each of us, the answer to these questions is different, and certainly dependent on our personal experience. Some of us have positive memories of fun times with very active grandparents, while others have seen their older relatives suffer from chronic conditions that have impaired their quality of life. In my case, my mother died in her early 40s. Like many whose parents or grandparents have died young, I look at aging as a gift. So many people don’t get the chance to have a 50th or 60th birthday, let alone a 90th.  So, you might accumulate some spots and saggy areas along the way; it is truly better than the alternative.

Learn to see aging as a gift.

Learn to see aging as a gift.

Working with older adults, for me, is a privilege. Each client I have known has been an individual, with his or her own strong points, flaws, and particular sense of humor. When I learn about the losses they have suffered, their accomplishments, their goals, and their fears, I am struck by each person’s uniqueness and value.

I did my best to share with my doctor the perspective that aging isn’t so bad. In fact, it is to be celebrated. Wouldn’t it be great if we could spread that idea, one person at a time?

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