Linda Abbit is

Linda lives in California with her husband, has a son in college and has actively cared for aging parents. Linda has been the sole caregiver for her parents since 2000.  She lost her father in 2005 and in May 2009, she lost her mom as well.

I was delighted when she agreed to an interview.

Mary:  Linda—we spoke at the time, but I wanted to offer my condolences again for the loss of your dear mother.   You were the sole caregiver for her and your Dad since 2000.

The loss of anyone is never easy. How are you doing and do you have any advice to share with others for coping with these losses?

Linda:  Thank you for your sympathy, Mary.  Losing a parent is never easy, no matter how long they live – and my parents both lived to nearly 100 years old!  I think everyone grieves differently and processes their loss uniquely.  It sounds like a cliché, but I’ve found this adage to be accurate — time truly helps in the healing process.  In my experience, at first the loss was intense but as time went on, the sadness moved more to the background and the love and happier memories dominate now.  You never stop missing your parents, but you do learn to bear the loss and go on.

Mary: Can you tell us a bit about your role as your parents’ caregiver?

Linda:  My role changed from long-distance caregiver initially to then living in close proximity.  My parents chose to move to assisted living and then as needed a board and care residence, so I never had the totally hands-on physical work.  However, there is still plenty of caregiving to be done. As an only child, I was in charge of all financial, legal and medical issues and decisions, not to mention the emotional worries.  Plus no matter how good the care facility was, I constantly monitored their care and advocated for their needs when necessary.

Mary: What was the biggest challenge you have faced as a caregiver?

Linda: This is a very hard question! Two things come to mind.  Moving my parents cross-country in 2000 (at ages 93 and 90, when my mom already had Alzheimer’s disease) took a lot of time and coordination.  I couldn’t have done it without my husband’s and son’s 100% support.  The other challenge was learning not to beat myself up about decisions I’d made that, in hindsight, may not have been the best course of action. I had to learn to accept I made the best decisions I could for my parents given the information I had at the time.

Mary: What did you find the most rewarding about caregiving?

Linda:  In the book, Designated Daughter, author D.G. Fulford calls her caregiving years “bonus years” with her mom and I totally agree!  While difficult to endure at times, I am so thankful I could care for my parents in this way.  It’s all about giving back to them after they had provided such a wonderful life for me.

Mary: When and why did you decide to create Tender Loving Eldercare?

Linda:  As I was on my caregiving journey, I realized as a baby boomer my friends were starting to ask me questions about caregiving that I had answers to.  So I thought if my immediate friends had questions, many others did too.  The site was created to share my knowledge, resources, experience and insight into family caregiving with as many people worldwide as possible.  I also want to increase awareness of, and empathy for, families in this stage of their lives — both for the seniors (or Golden Oldies as I call them) and the younger generations caring for them.

Mary: What is the best advice you’ve ever received as a caregiver?

Linda:  The only constant in caregiving is that things will change!  Your parents’ or care recipients’ physical or mental conditions will likely change and a new stage of caregiving begins.  So try your best to plan ahead and be as prepared as possible for what may come.

This is part two of,  “A Look Inside Geriatric Care Management With Jim Ferry”

Mary: What types of questions should a family ask when looking for a geriatric care manager?

Jim: The most fundamental question for the family to have the answer to is how the GCM can help them?  In some cases (although not typically) the problems or  issues concerning elders and family member are so basic that less expensive alternatives may suffice such as online resources or the information and referral departments of certain elder service organizations.  Having said this it’s been my experience that most family members who inquire about my services typically have needs or issues that I can and should help with.  Family members should verify what the GCM charges for his or her services and how charges are accrued and also get some sense that the GCM’s experience, professional background and availability will make for a good fit with the elder and his or her family.

Mary: You describe what you do as, “”psychosocial” aspects of caring for seniors, while strengthening the relationships with the people who care for them.”  Can you explain that further?

Jim: It is my belief that many of the overriding issues that trigger a referral to a GCM are behavioral or/or emotional in nature.  Once the GCM begins work with the elder and family, I would argue that it is often these behavioral/emotional issues that often become salient.  Very often I find that the concrete aspects of a proposed plan of care, such as new resources or services or a change in residence cannot be implemented without some resolution of the of the more fundamental behavioral problems. 

Mary: Is this aspect your philosophy alone? If not, would it be reasonable for caregivers to ask a geriatric care manager if they follow this viewpoint?

Jim: I would say not although GCMs with backgrounds in disciplines related to psychosocial assessment and treatment will likely be more inclined to conceptualize GCM in this fashion.

Mary: Can you give us a couple of scenarios as to situations you might assist a family?

Jim: A family who’s elderly member is in a nursing home and the family has serious concerns about the overall quality of care at the facility and has had past difficulty attempting to ameliorate these problems themselves.

An elder who has had repeated hospitalizations and now has involvement from Adult Protective services.  In this scenario Protective Services may be mandating to the family that the elder accept a plan of care at home to prevent these hospitalizations but the elder is resisting.

An elderly parent who lives alone at home and is now impressing her long distance children with short-term memory loss.  These family members are finding that their mother who has always been very capable is now having difficulty with keeping house and paying bills.  They are now interested in consulting with a professional who can advise them on available services and what to expect going forward.

Mary:Where can families find a reliable geriatric care manager?

Jim: Best source to begin the search is the NAPGCM website, (www.caremanager.org), particularly the “find a care manager” tool.  Be mindful that in many areas, particularly semi-rural and rural areas, local GCMs serve a wide area so it is sometimes advisable to search for GCMs up to 50 miles away.

Mary: Could you share a few of your favorite geriatric care tips and tricks for caregivers to close?

Jim:States, Massachusetts for example, often have rated the quality of nursing homes based on their quality surveys.  I would definitely inquire these reviews in addition to any word of mouth nursing home recommendations.

Elders who are need of 24/7 care and are sometimes active during the overnight hours should have caregivers who are awake during these hours.  Given this I would recommend occasional visits in the middle of the night from family members to verify that the caregiver is awake while on duty and not sleeping in advance of attending a day job.

In nearly all cases I feel that is best to avoid making privately hired home care arrangements.  There are very compelling reasons for avoiding these along the lines of liability.  If you however feel inclined to hire privately someone who comes highly recommended or a friend or neighbor, I would first check with your lawyer and insurance agent.

James L. Ferry is a Geriatric Care Manager based in Deerfield, Massachusetts.  Jim entered Geriatric Care Management in 1992 and established Coaching Caregivers LLC, in 2003.

Jim agreed to talk to us about his Geriatric Care Management career and to give us some caregiving tips and tricks.

I began the interview by asking Jim to tell us a bit more about himself:

Jim: I have been a GCM for 17 years.  I first began on a part-time basis but over time built my practice to a full-time endeavor.  In addition, I am a doctoral candidate at the State University of New York at Albany in Social Work.  I have written several articles pertaining to geriatric care management (GCM) in both professional and scholarly journals and my brand new book, “How to Start a Home-Based Senior Care Business”Globe Pequot Press 2010), is now available.

On a personal note I am a husband, father and musician.

Mary: Please tell us how and why you became a geriatric care manager.

Jim: After college and through the completion of my Masters degree in Social Work and for a couple of years afterwards I had worked in the area of residential treatment of mentally and developmentally disabled adults.  I had planned a career in that aspect of human service work with aspirations to work at an executive and administrative level.  I did however find myself drawn to an available position as a social worker in a physical rehabilitation hospital which became my foray into the fields of aging and health.    Working with primarily older adults really resonated with me in that hospital and it was from that experience that I developed my care management practice.

Mary: Can you tell us what a geriatric manager does and a bit of history about the geriatric care management profession?

Jim: The GCM profession is understood to have commenced after a somewhat informal meeting held in New York City in 1986.  This meeting consisted a few dozen professionals in the field of aging many who were engaged in “private case management” where they were accepting out- of- pocket fees for their services.  What was to become the National Association of Professional Geriatric Care Managers (NAPGCM) resulted from this conference in 1986. NAPGCM now has over 2000 members nationally and internationally and holds two national conferences each year.

Mary: Who needs the services of a geriatric care manager and what are the conditions that warrant a family to seek out the help of a geriatric care manager?

Jim: Said very simply: it’s when the needs of the elder are exceeding the plan of care that is currently in place, (if any), and there is some reason why the elder and/or the family is unable to implement a suitable change without professional assistance.

Mary: Does insurance, Medicare or Medicaid ever cover the cost, or is it out of pocket?

Jim: Not really.  It is sometimes it is possible that an elder and family member receive some measure of GCM oriented services as part of psychotherapy treatment from a therapist who has some GCM oriented expertise.  Likewise, Medicare does offer the services of a Medical Social Worker on s short-term basis to patients who are newly discharged from a hospital. It is important however to understand that the most of the activities of a GCM are not part of the purview of a psychotherapist or Medicare Medical Social Worker who are more focused on the clinical treatment of their client.

Look for part two of Mr. Ferry’s informative interview on February 15th.