Are social workers on staff at care facilities or part of a physicians staff? I'd love help in working through the challenges and emotions of moving my soon to be 95 year old Dad with increasing dementia out of his home of 50 years. We will need help in managing the conflicting emotions I feel and those of my siblings. How do we communicate to him what is happening or do we? There has to be tried and true methods for managing this enormous change for him and not lose our sense of balance as a family in the process.
I would love to say do A, B, C and our lives would return to what it was, in reality it will not. We have to gather information, try it muddle through it.
One thing I can tell you, it will get easier in ways and more difficult in others, it is a “growing” or “learning” experience.
The most important thing you need to keep in the front of your mind is you first, this situation will consume you otherwise, find a balance and stick to that balance if you are planning to stay and survive to course.
Best wishes to you
This sounds more like you need counseling with a family therapist. The next sentence says "We will need help in managing the conflicting emotions I feel and those of my siblings.", so this may be much more in the balliwick of a family therapist or mediator than a social worker.
Are you and your siblings in sync, aka not fighting over whether to keep dad at home or find a facility or is that the dissention? It sounds like you yourself are fluctuating between these two options, and if your siblings are in the same or similar boat, you all need to take stock and decide what's best for DAD, not what makes any of you happy.
Is he safe in his home? Does someone live with him? Who is providing his care and/or oversight, hired help or family? Does he wander? Does he fall or need a lot of help getting around, toileting, bathing? Are those assisting running into burnout? Then hiring help or a facility would be the choices. Does anyone have POA? NOTE: POAs are not sufficient for making someone move to a facility, however they ARE important when the move happens so that you can sign as POA, not yourself, otherwise the signer can be accepting financial responsibility. If no one has POA, guardianship should be the next step.
Y'all need to resolve and agree on how to handle dad's situation first. If there's no agreement, life will be hell no matter what anyone does! This is where some family therapy or a mediator might help. If no agreement can be settled on, someone needs to take the bull by the horns and make a decision, which will require applying for guardianship. Once approved, that will override any POAs that might exist. Family therapy may need to continue, if all parties are willing. Dissention in the ranks cause more problems than they will ever solve!
Dealing with the family, coming to agreement, the decision, and determining "who's in charge" has to come first. Once that is resolved, then the move can be planned and "discussed" with dad.
"How do we communicate to him what is happening or do we? There has to be tried and true methods for managing this enormous change for him and not lose our sense of balance as a family in the process."
Personally I would have to say there are no "tried and true methods" for managing anything to do with dementia. Each person's journey is unique, although many share similar symptoms and/or behaviors. Different types of dementia present different challenges and even different progressions and manifestations. It may not be easy, but the change will need to happen. It might work with fibs, it might take some medication to tone down his anxiety, and it will take a lot of cooperation between siblings.
How you handle it depends a lot on where he is on this "journey" and what you feel you all can manage. Some people have a very difficult time with fibs, aka little white lies, and insist on the truth. But often these fibs can facilitate what needs to be done. Bending the truth sometimes works as well. The truth can very often be unreal to the person as well. They either won't accept it or will forget it shortly after the "discussion." We were advised by the EC atty that we couldn't force mom to move to MC (she was refusing to consider any move.) He suggested guardianship, but 1) I don't think she was far enough down the dementia path to get that granted and 2) the facility chosen didn't accept "committals." So, fibs it was. YB wrote a letter from 'Elder Services' at the hospital that treated her cellulitis, stating she moves to a place we choose or they will place her. Madder than a wet hen but she went with my brothers (I did all the up front work.)
So, family therapy unless you can all agree on what's best for Dad and is least negative for everyone. The facility chosen can also assist with the move. Often it's best to stay away for a week+.
However, their services are not free of charge!
If finances are not one of your major worries, you might try contacting one of them. I'm not in a position to recommend any one organization, but the one with which I'm personally familiar (and whose services I've used) is called MIR Senior Management and Care Consultants, available in many cities nationwide.
You can try to tell dad whats going on but every case is different. I would just tell him once, giving him an overview and then only bring it up again if he asks. In our case my dad doesn't really want to know or talk about his health and dying.
Good luck and God bless you
It sounds like you want a third party negotiator to set rules, tamp down emotions and have the patience to make sure everyone feels heard. Maybe a pastor or group therapist? If it lands on your shoulders, you might want to google “crisis negotiation techniques.”
It may come down to who has power of attorney and/or a voting process (I like this one: Lets say there are 4 options. You vote only if you want 1 or 2. Let’s say 1 wins. The next vote is 1 or 3. If 3 wins, the next vote is 3 or 4. The goal is to vote only the better option against the next option).
And you may have to accept you can’t maintain harmony when siblings choose emotional reaction over logical thinking.
Wishing you peace and good fortune in helping your Dad and family through this phase of the journey.
I wouldn't make such a blanket statement. My mother had dementia and was into year 4 at a MC facility. We had not requested hospice as it wasn't necessary and likely wouldn't be approved. When she had a stroke around Labor Day last year, the MC nurse called hospice. She expected delay, due to the holiday. Nope, someone showed up Sunday evening, with the regular nursing staff off duty. She looked at mom's "records", which were out of date due to the virus and the big reason I was quoted after denial of service was she "hadn't lost weight in the previous 6 months." Seriously. She JUST had the stroke. Not only that, but this person didn't even make note of the fact that her records were over 1.5 years old!
The MC nurse made them come back. The initial denial was based on the old records. The second came because of no weight loss. AAAARGH! The stroke impacted mom's right/dominant side, so she had trouble feeding herself, couldn't assist with pivoting out of her wheelchair and had difficulty swallowing and speaking. THAT still wasn't enough for them. The MC nurse scheduled a TeleHealth with the doctor (we hadn't done that for her missed regular checkups due to dementia, hearing loss and generally confusion about "technical" stuff like that. I didn't even set her up with a TV or phone in her room, as she couldn't really manage them.
So, once the nurse could prove weight loss, they accepted mom into hospice. Dementia certainly was NOT enough. If that were the case, every resident in MC would be on it. Perhaps once they are farther into the progression or depending on the type of dementia, it might help, but all the online hits show something like this:
"To qualify for hospice care, a hospice doctor and your doctor (if you have one) must certify that you're terminally ill, meaning you have a life expectancy of 6 months or less. When you agree to hospice care, you're agreeing to comfort care (palliative care) instead of care to cure your illness."
Despite this, yes, there are many who live longer than 6 months, some actually live for years, but as long as doctor approves and certain criteria are met, a person may remain on hospice longer than 6 months. The point is dementia alone is NOT going to be sufficient to get on hospice (if that were true, my mother would have been on hospice for about 7 years!)
If you need help dealing with your emotions as a family, a counsellor would be a better option. Ask your doctor or community of faith for recommendations.
My daughter's BF is a SW, working with kidney transplant patients. That's her speciality--but if I ever need a SW to help with mother, I'd call this friend first. She would have names of other SWs and they could help.
At the hospital, recently, with DH, they kept offering him SW help and he kept refusing it. I don't know why, as he did need help navigating post hospital care.
Perhaps even calling the Agency on Aging in your area would set you on the right path.
My FIL's oncologist helped us a LOT in gaining access to the care we needed for dad. The nursing service they sent were beyond abysmal--but at least they did something.
The only other experience I had with social workers were those working as discharge planners, or in rehab centers or home care teams. One was very good; two were so pushy and obnoxious that I had to tell the agencies I wouldn't work with them, and if insistence was made to do so, I'd find another agency.
A geriatric care manager, usually a licensed nurse or social worker who specializes in geriatrics, is a sort of "professional relative" who can help you and your family to identify needs and find ways to meet your needs. Or call the Aging Life Care Association at 1-520-881-8008, or visit its website at www.aginglifecare.org.
"Geriatric care managers charge by the hour. Most insurance plans don't cover these costs, and Medicare does not pay for this service. You will probably have to pay for this service."
"Geriatric Care Managers charge clients in a variety of ways, but typically their hourly rates are between $50-$200 / hr. Medicare, Medicaid and health insurance very rarely pay for these costs. Long term care insurance might, but most often this is an out-of-pocket cost."
It also appears they are more oriented to providing for the person, not the family per se:
"Geriatric Care Managers (or GCMs) help families with an immediate care need to create and implement long term care plans. This includes an in-person needs assessment, the development and review of a care plan and arranging and monitoring care services. Some also do financial planning. Though most are not professionally certified and their planning services might be better described as "resource assessments." GCMs do not usually provide hands-on care."
Half, more or less, of OP's concern seems to be how the family deals with this impending issue, not so much the logistics (although that was touched on.) Family counseling? Mediator?
My mom's PCP had a care manager who reached out to me when she got really ill - I had no idea there was one on staff- and she was a big help in giving me names and phone numbers of resources.
If your dad's doctor doesn't have a CM on staff, the next people I would reach out to would be the Area's County on Aging for some names.
Many of the insurance companies that cover therapy (including my own Kaiser) often now decide, based upon what therapy help you need, whether you should see a Social Worker therapist or an actual psychologist. Both can work with a psychiatrist if medications such as mild anti-depressants, anti-anxiety med are required. You can otherwise just look up therapist online. It will say if it is LCSW (Licensed Clinical Social Worker). Some have their own practice; many work within the medical system.
So start at your own MD and good luck.