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.


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.


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?


Social Workers: Dedication to improving quality of life, and preserving dignity and respect

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March is Social Work Month, and the values of social work are at the core of everything we do at Elder Care Guides. Our clinical team includes individuals with a broad range of education and training, three of whom have earned a Master of Social Work (MSW) degree. We invite you to get to know the professional social workers on our staff:

Amy Abrams, Cassie Farrell, and Susan Valoff

Amy Abrams, Cassie Farrell, and Susan Valoff:
our social work stars!






Amy Abrams, MSW/MPH, CMC (Vice President, Client Services)

Amy co-founded Elder Care Guides in 2004, and has worked in the field of elder care in San Diego for nearly 15 years, in medical case management, home care, and geriatric care management. She earned Bachelor of Arts degrees in Sociology and Women’s Studies from the University of California at San Diego, and a joint Master of Social Work and Master of Public Health from San Diego State University. Amy is certified by the National Academy of Certified Care Managers, and is an active member of the National Association of Professional Geriatric Care Managers (NAPGCM). She currently sits on the Board of Directors of NAPGCM, and chairs the association’s Research Development Committee. Locally, she is a long-time member of the Board of Directors of the Glenner Memory Care Centers.

“I’ve been witness to some remarkable transformations in the lives of our clients, and strongly believe that age and disability are not about ‘decline,’ but are a phase of life with opportunities for growth, development, and positive change. I watched as both of my beautiful grandmothers became most fully themselves in their final years, and hold them up as examples of what’s possible for all of us. I count myself lucky to have discovered the field of geriatric care management early on in my career, and get great satisfaction from the work I do both for Elder Care Guides and for my profession. I’m deeply dedicated to the professional standards and ethics of NAPGCM, and feel that through service to my colleagues who are doing this work around the country, I’m influencing the future of how we care for people with disabilities.”

Cassie Farrell, MSW (Care Manager)

Cassie is a social worker experienced in working with a variety of client populations, including older adults with physical and cognitive impairments, individuals with mental health diagnoses, and persons with developmental disabilities in San Diego since 2005. Elder Care Guides was pleased to welcome her to our clinical team in 2013, with her wide ranging clinical knowledge and experience. Cassie holds a Bachelor of Arts degree in Environmental Science and Geology from State University of New York at Binghamton, and earned her Master of Social Work degree from San Diego State University in 2011, with an emphasis in mental health and gerontology. She is currently working toward licensure (Licensed Clinical Social Worker), and is in the process of completing her Care Management Certification through the National Association of Professional Geriatric Care Managers.

“Unfortunately, the process of aging often comes with many losses: those of physical functioning, mental cognition, friends and family members, homes, jobs, and skills, to name a few. I have found that these losses take their toll on the individual, and often lead to depression and other mental health concerns. In my work as a Geriatric Care Manager, I strive to focus on the older adult’s strengths and the things in life that bring them happiness. I enjoy building a team that surrounds the person and highlights the joys in their life, rather than the deficits. We can look at the glass as half-empty or half-full, and I always see the glass as half-full. I strive to share that vision with my clients and their families, in effect supporting older adults to have the very best quality of life.”

Susan Valoff, LCSW, C-ASWCM (Vice President, Clinical Services)

Susan has 20 years of experience in healthcare and geriatrics, as a hospital social worker, educator, healthcare administrator, and geriatric care manager. She joined the Elder Care Guides team in 2009, and is a partner in the company. Susan earned Bachelor of Arts degrees in American Civilization and Hispanic Literature and Culture from Brown University, and a Master of Social Work from the University of Chicago. She is a Licensed Clinical Social Worker (LCSW) in the state of California, and is credentialed as a Certified Advanced Social Work Case Manager (C-ASWCM) through the National Association of Social Workers. Susan is a member of the National Association of Professional Geriatric Care Managers, and a founding member of the San Diego Geriatric Care Managers Local Unit.

“One of the reasons I became a social worker was my experience helping to advocate for my uncle, who lived with schizophrenia, within the health care and mental health systems in Missouri. In my first post-graduate job at the Rehabilitation Institute of Chicago, I worked on an interdisciplinary team whose goal was to help people achieve the greatest amount of independence possible, whether they had survived a stroke, were recovering from a traumatic injury, or were managing a chronic condition. In this setting, I learned the importance of ‘starting where the client is’: understanding an individual’s goals, and then providing the resources and support to help him or her get there. I also learned that quality of life is more important in many cases than finding a cure. At Elder Care Guides, I find my roles as teacher and advocate to be the most rewarding. And I enjoy supervising our clinical staff, helping them to be the most knowledgeable and effective educators and advocates that they can be for the clients we serve.”


Aging with a Developmental Disability

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disabilityIn addition to serving clients with chronic physical and cognitive disabilities associated with aging, Elder Care Guides provides care management and home care services to older adults with mental health diagnoses, and older adults with developmental disabilities. These two populations are not always well-served through the programs and organizations targeted at the general adult population. People with a developmental disability or mental health diagnosis will likely have specific concerns and issues as they age that may be different than that of an older adult without a developmental disability or mental health diagnosis.

People with developmental disabilities are living longer as they typically have better health care and supports than earlier generations. Older adults with developmental disabilities have unique health care needs. The normal aging process is often complicated by a lifetime of reduced mobility, poorer general health, medications, surgeries, etc. It is not uncommon to experience symptoms such as pain, arthritis, joint problems, and fatigue at a younger age.

The more severe the developmental disability, the greater risk – and earlier onset – of the diseases commonly associated with aging. Most health practitioners are not prepared for these unique challenges. This includes a lack of knowledge about aging in persons with developmental disabilities, lack of available services in a system that has generally concentrated on services for younger people, and lack of available information on good health habits for these older adults.

Some of the challenges of aging associated with this population include:

  • Reduced levels of social interaction with age. This normal process may mimic the symptoms of dementia to a health care professional.
  • Difficulty communicating visual and auditory decline, resulting in isolation, anger, and/or depression.
  • Adults with Down syndrome are very vulnerable to hypothyroidism, which is frequently misdiagnosed as Alzheimer’s disease.
  • Older men with developmental disabilities may experience reduced ability to urinate but not be able or willing to tell anyone. The resulting discomfort frequently leads to behavioral changes.
  • Menopause is often not considered by health care professionals in their treatment of older women with developmental disabilities.
  • Increased likelihood of multiple medication, and medications that are not commonly used by the general population such as psychotropics.
  • Earlier onset of sensory impairments and mobility challenges, often resulting in a physical environment that is more difficult to navigate.
  • Adults with Down syndrome and cerebral palsy experience the same changes associated with aging but at an earlier age than both the general population and as other older adults with developmental disabilities.

Elder Care Guides’ experienced care managers can support adults with developmental disabilities and their families as they age. Care managers can help with medical advocacy at doctor appointments to ensure the specific needs of this population are identified and properly addressed as they age. Elder Care Guides can also help with referrals to other community resources and provide oversight of your loved ones care. We are here to help, so please call us today.


State of California Department of Developmental Services:

San Diego Regional Center:

United Cerebral Palsy:


Prescription Drug Abuse: Not just a problem of the young

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Prescription drug abuse is on the rise in the older adult population.

Prescription drug abuse is on the rise in
the older adult population.

Prescription drug abuse has become a dramatic public health concern in the United States, and it is not limited to “young people.” Mental health providers, physicians, and government agencies are noting increasing problems with the misuse and abuse of prescription medications amongst older adults, including the Baby Boomers. While there have not been many studies on the subject, some research shows that up to 26% of people over the age of 65 misuse or abuse their prescription drugs.

Why are so many older adults misusing or abusing their medications?  Older adults who have cognitive decline, including dementia, may experience confusion about how and when to take their medications. Pain, anxiety, depression and sleep problems are common in the elderly, and the medications prescribed for these conditions can lead to abuse or dependence. Some older adults on limited incomes may “borrow” or share medications. In most cases, the abuse or misuse is not intentional, and the medication is obtained legally, by prescription.

Older adults face some particular risks if they misuse their medications. According to The Substance Abuse and Mental Health Services Administration (SAMHSA), older adults are more vulnerable to this problem because as a group they use more prescription drugs than younger adults. Due to the slowing metabolism and elimination associated with aging, even small amounts of medication can impact older adults in dramatic ways. Many older adults take multiple medications, increasing the likelihood of medication interactions. The abuse or misuse of “psychoactive drugs” taken for depression, anxiety, and insomnia is of particular concern as these drugs act on the central nervous system. If used inappropriately, or mixed with alcohol, these medications can cause sedation, memory problems, functional impairment, and/or falls.  Those older adults most vulnerable to psychoactive medication abuse are socially isolated women with histories of substance abuse and mental health problems, especially depression.

What can older adults and their families do to avoid prescription drug misuse and abuse?

  • Read and follow prescription drug usage instructions and ask your health care provider for information on side effects.
  • Do not rush to increase the strength of your medication, especially pain medication. Talk to your doctor if your symptoms are not improving, and explore non-prescription methods to address your symptoms (such as massage, acupuncture or stretching/exercise). For depression and anxiety, consider talk therapy as well as medication therapy.
  • Let your doctor and pharmacist know about every medication you are taking, prescription and over-the-counter, including supplements.
  • If you are taking more than five medications, it is likely you will experience some drug interactions. Consider working with a senior care pharmacist to review your medication list and identify possible changes to discuss with your doctor.
  • Never use another person’s medications. If the cost of medication is a concern for you, ask your doctor for samples and talk to your pharmacist about medication assistance programs.
  • If you suspect you may have a problem with prescription drug abuse or misuse, know that you are not alone and help is available.  Talk to your doctor, mental health professional, or geriatric care manager for local resources.

Information gathered from fact sheet from SAMHSA:

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