August 2006

In this Edition:

Are You Ready for Hurricane Season?
Hurricane or Disaster Preparedness: 10 Things
You Should Do
Remember George from last month's newsletter?

Are You Ready for Hurricane Season?
by Rona Bartelstone LCSW, BCD, CMC, Chief Executive Officer

Last month, the Miami Herald had an article about how hurricanes pose a bigger threat for the elderly. I couldn't agree more.

While the public and non-profit agencies have to focus on those with the fewest resources, people who have means also need help to get through the storm season. They may have limited mobility and be reliant on refrigeration for medications and electricity for oxygen, beds, tube feedings and other medical necessities.

People who wait until there is a storm approaching before they prepare are likely to be left with fewer options and more stress. For elders with multiple health concerns, the additional anxiety caused by the lack of planning can be debilitating. Elders and their families need to consider all their options and create a plan that will give everyone the comfort that there is a backup system in place.

Like Mrs. Allen, who was highlighted in the Herald article, many elders feel that they don't need to pre-plan. They have been through numerous false starts before. In addition, it is hard to prepare when you are burdened with the daily needs of survival issues or caregiving for someone who is dependent upon you.

Caregivers need to know that they are not alone in preparing for and surviving a hurricane. As a family of professional caregivers, my team and I understand the enormous responsibility that comes with helping the vulnerable through a storm.

Even families who are willing to help their elders may not be available to help from out of town. Last year, the Ft. Lauderdale airport was closed for five days after Wilma. A lot can happen to someone in the heat without proper supplies.

That's why we have developed a program that assures both better planning and after care. In fact, no one else provides such a thorough hurricane preparedness plan. We work with clients to develop a detailed plan, ensuring they have a place to go if evacuated. If they choose to stay at home, we make sure they have plenty of supplies and extra medications to see them through. Afterward, we contact everyone and take steps to ensure their safety — all while keeping in close touch with clients and their loved ones.

If you would like to read the Miami Herald article, click here.

CASE STUDIES: The Struggling Family | The Grieving Family

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Hurricane or Disaster Preparedness: 10 Things You Should Do

Whether you live in hurricane territory, tornado alley or other area where there is likely to be an emergency situation, you need to prepare for meeting your needs and the needs of your family. Here are the 10 basics that you should have prepared, just in case:

• Have a family disaster plan and make sure that everyone is familiar with it
• Have a safe place to go either in your home or other location (advance planning for evacuation is critical if you have special healthcare needs)
• Be sure that you have extra cash because banks and ATMs may not be available for many days
• Fill your car with gas
• Have all of your important insurance, healthcare, and other papers in a waterproof container that you can take with you, if you need to be in a safe room or to evacuate
• Secure your home, as best as you are able
• Let other family/friends out of your area know what your plan is and where you will be
• Replace batteries and check for the operating ability of radios, flashlights, cell phones, portable computers and TVs
• Be sure that you have enough first aid supplies and supplies of medications, food and water to last two weeks
• Make sure that pets are cared for, including enough supplies for two weeks of maintenance

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George was the single man who lost his brother-in-law and sister within a relatively short period of time. With the loss of his brother-in-law, there were concerns that we might loose George as well because he was so dependent.

Yet with the strength of the care manager's relationship with George, he survived the loss of his brother-in-law and subsequently his sister. George went on to make a remarkable recovery from his grief and become a more independent, social individual with the ongoing support of his home healthcare staff and his care manager.

How's that for turnaround?

When Sandy Goldberg, his care manager, had hip surgery, George became very anxious and worried about her health. Years ago, George had both hips replaced, so he understood what Sandy was experiencing.

When Sandy arrived back in her hospital room after the surgery, George was the first visitor to appear at her bedside. He brought her flowers and words of encouragement. He spent a good part of the afternoon visiting, meeting Sandy's family and grandchildren, and spreading his love and good cheer.

Now that Sandy is at home recuperating, George has his aide call her every week to see how she is doing. He checks with Sandy to be sure that she is doing her exercises and following all of the instructions for her recovery.

When the substitute care manager goes to visit George and his home healthcare aide, the first question he asks is about Sandy's progress. He can't wait for Sandy to return to work so that he can visit again with her in person.

He has truly adopted Sandy emotionally as his own family.

That's what we do at Rona Bartelstone Care Management & Home Healthcare-our family taking care of your family. And sometimes we become family right back!

Surviving Losses

George was a 95 year old, single man when he was facing the loss of his two closest relatives and friends. He didn't think he could survive these overwhelming transitions, but with the help of his care manager he continues to thrive despite his grief.

In the past 2 1/2 years, George lost his brother-in-law and then his sister. They were a very close family that traveled, socialized and finally settled as a trio in Florida. Apart from his sister and brother-in-law, George who had never married had few friends.

The brother-in-law was the first to die and George became depressed because he and his sister, who had dementia and functional limitations, depended totally on him. The brother took care of his ailing wife, he cooked, shopped and paid all the bills for the three of them. The brother also had a great sense of humor, which helped everyone to cope with their stressful caregiving responsibilities. Although there was an aide to help with the physical care of his sister, George felt incapable of supervising her care and this increased his anxiety.

George's depression wouldn't allow him to eat and he couldn't stop crying. He was totally overwhelmed by his grief and anxiety. Even the aide couldn't get him to eat.

Fortunately they had an attorney, who was also their Trustee who contacted Rona Bartelstone Care Management & Home Healthcare for support in caring for George and his sister. During the initial home-visit it was determined the George needed counseling and an antidepressant. It was further recommended that his sister have 24 hour home care to assure her physical safety and wellbeing. This was started immediately, and quickly gave George a little relief because he did not feel so alone in his new caregiving responsibilities.

With weekly emotional support from Sandy Goldberg, the care manager, George began to eat better and his depression was helped by the medication. The care manager also provided support and guidance to the aide in caring for his sister, which further helped George to be reassured that she was getting the best possible care.

Unfortunately, the sister's dementia worsened and she was beginning to have some behavioral problems. As a result of this she fell and fractured her hip and shoulder. She was considered too frail for surgery and after six months in a rehabilitation facility, she also passed away.

With this second crisis, the care manager provided additional support to George to help him through this new acute phase of his grief. The care manager worked with the physician and a psychiatric nurse who was adjusting his antidepressant medication. An appetite enhancer was also added because he was again experiencing difficulty getting enough nutrition.

With the support of his medical healthcare team, the care manager and the aide, who continued to work with George, he was able to cope with the loss of his sister without becoming ill. He knew he was being well cared for and had a sense of stability with all of the care and emotional support that was being provided. This time, instead of becoming immobilized, George was able to participate in making the funeral arrangements for his sister and helped to discard the belongings of his sister and brother-in-law.

George still has home healthcare from his trusted aide. He is functioning better and more independently now, including taking responsibility for his own medical appointments. He continues to find the support of the care management relationship as a stabilizing influence in his life. He and Sandy Goldberg have a great rapport and this provides George with a feeling of having a surrogate family, which he desperately needs for his mental health.

George is a perfect example of the power of the care management relationship in times of loss and transition. This relationship has enabled him to remain as independent as possible, to reside in the community and to cope with his losses.

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