Kim Charles

Silver Boomerang: How can a Care Manager improve the situation for family with an aging loved one?
Kim Charles: My goal as a Care Manager is to give my clients as much choice as possible.  Ideally, Care Management is a team approach involving the Care recipient, their family, medical professionals and other interested parties.  The Care Manager’s unique qualifications help him/her to coordinate information and planning efforts among those involved with the Care recipient.  By being proactive and taking an informed look at options, we can often come up with a plan of Care that captures at least most of the client’s goals.

I try to involve families as much as possible.  Many of my clients are adult children who live away from the area where their parents reside.  The stresses of long-distance care-giving can be eased to some extent by finding a trusted Care Manager who will “check-in” on the Aging loved one and is available to advocate for their specific needs.  Care Managers are familiar with area resources and can make informed recommendations for family members about services such as home care, senior housing, and local healthcare providers.

Silver Boomerang: What is the most important among often overlooked benefits of home care?
Kim Charles: Not every client desires to remain in their home as care needs increase, but many do want to live at home.  It may be obvious, but one of the biggest benefits of a familiar setting is that it is familiar.  Even the best-planned transitions can be stressful and somewhat disorienting especially to older people.  Sometimes the placement of a few strategic supports in the home setting can make it quite possible to “age-in-place”.  Another benefit is that home care is often more cost-effective than an institutional setting.

Silver Boomerang: What would you recommend as a coping mechanism to those who are caring at home for advanced stages of Alzheimer’s, dementia, Parkinson’s?
Kim Charles:I have considerable respect and sympathy for caregivers.  Caregivers often find themselves fulfilling roles for which they have had no formal training.  I try to be familiar with area Caregiver Support Groups and educational opportunities for caregivers.  My agency has a Family Caregiver Support Program.  I often make referrals to that program.  Local chapters of Alzheimer’s associations, and other organizations affiliated with specific diseases or disorders can provide helpful resources.  As a Care Manager, I try to give caregivers “permission” to take a break to care for themselves.  This is a must for their own physical and emotional health; but it is hard to do.

Silver Boomerang: How Care Manager can improve the situation for family with aging loved one? Are Care Managers for every situation?
Tina Cheplick: The nuclear family is not what it used to be and older adults must now rely on others for their Care. The need for caregivers who are compassionate and understanding of cultural differences is great. We need to continuously find a balance between caring for elders while adhering to best nursing practices, approaching every elder as a unique individual is our mission.

Silver Boomerang: What to look for when choosing a Care Manager?
Tina Cheplick: Care managers are everywhere and each Care manager provides a different model. A family member searching for a Care manager must be able to connect with the Care manager as they define what it is they think they need. Family members may ask for or think they need one particular thing but end up through the process realizing that they need something entirely different. I also think family members must look for credentials, years in the field so a sense of trust can be established.

Silver Boomerang: Do you see new Obama laws toward seniors and nursing and efficient and sufficient ones? What would you want to address?
Tina Cheplick: Health Care reform is getting a lot of attention. While there is much discussion going on, it has been fairly quiet on eldercare insurance. The Medicare and Medical/Medicaid programs must be reviewed and redefined without jeopardizing the Care of those elders using these programs. New creative ways must be piloted to see if programs can changed effectively. Congress must stay neutral as they learn from such pilot programs and not be swayed by big corporate lobbyists. The training of caregivers, higher career ladder opportunities for bedside Care with higher wages must be part of the home Care package. How we train, review, and provide leadership in understanding our elders must reflect in our nation’s health Care system and ultimately the job itself. Too many times our industry of skilled nursing looses the person while abiding by the structure.

Silver Boomerang: What is the most important among often overlooked benefits of home care?
Tina Cheplick: Most elders will agree staying at home is where they want to be. If the elder can stay there while their Care is managed safely it should be the first option as long as the essential players are in place. Families, case managers, and caregivers must be able to work together for this to occur.

Silver Boomerang: What are signs that should signal family that the aging loved one needs a caregiver?
Tina Cheplick: Usually a slip in any of the activities of daily living. If there is a need to provide supervision, cueing, and/or reminders, families members should know this signals a warning flag.

Silver Boomerang:.What are signs that should signal family that the aging loved one needs to be moved to nursing home?
Tina Cheplick: When the need to have an “awake night staff.” Often with Sundowners caregivers redirection, personal Care or provide behavioral management

Silver Boomerang: Do you recommend social activities for aging at home? If so would you recommend a few?
Tina Cheplick: Social activities are a plus. I am an active community board member for one of our day programs here in northern California. Memory games, such a Scrabble, puzzles, and even word games found in the newspaper can occupy an hour during the day. Getting elders involved with home planning, using calendars, and even some sort of exercise not only are beneficial for health but for overall well being. One of my clients used to knit. It took some time but eventually we got her into knitting again.

Silver Boomerang: What would you recommend as a coping mechanism to those who are caring for advanced stages of Alzheimer’s, Dementia, Parkinson?
Tina Cheplick: Support groups in your local county are always a help. In addition families should contact their Area Agencies on Aging for resources. Taking Care of oneself is essential in giving to others.

Silver Boomerang: From what services of volunteers can seniors with families benefit the most?
Tina Cheplick:I think it is important for families to look at what groups have given them support in the past and rely on that source.

If we still keep our elders at home, they are happier, and often healthier, but more at risk psychologically, socially, physically and emotionally.

Often, Caregivers are unaware that they indeed are Caregivers. “Oh, I just help my mom eat.” Or, “I help bathe and dress my father.” While we do help those we love with activities of daily living (i.e. bathing, dressing, and feeding), it is important to be aware that we become Caregivers for seniors when doing these activities on a daily basis. Once we do this, we can then work towards receiving help.
Caregivers are spouses, children, parents, workers, volunteers, grandparents, and anyone who helps another person is a caregiver. These tasks can be quite time consuming.
Caregivers themselves run the risk of burnout as well. Some profit and non-profit agencies provide respite or day away programs for senior care. This alleviates the burden or providing the quality of care that our seniors deserve.

Family Caregiving Roles

• Bathe their loved ones
• Wash, dry, and brush their loved one’s hair
• Brush teeth; clean dentrues
• Shave loved ones legs, underarms, and/or face
• Do laundry
• Shop for groceries and then cook/prepare meals
• Run errands
• Drive loved ones to appointments
• Administer medications; give shots
• Make sure loved one is safe
• Provide emotional support

The family caregiving role can be quite time consuming, not allowing Caregivers to take notice of how they are feeling. In order to be effective Caregivers, it is important for us to recognize the signs of stress. Then, we are able to relieve some of this stress and perhaps stop stress before it creeps up on us.

Signs of Family Caregiver Stress

Withdrawal
Caregivers may withdrawal from family and/or friends. They may also stop doing activities that were once enjoyed, such as knitting, reading, or walking.
TIP: Look to family and friends for support. Sometimes we just need to vent our feelings about the current situation. Even if you don’t feel like going out with family/friends, try to force yourself to get out of the house. You deserve a break!

Sleeping Difficulties
Caregivers may have a hard time falling asleep and/or staying asleep.
TIP: If possible, take short naps throughout the day. If your loved one lives with you and has a nap, lie down as well. Try not to think of all the things you have not done. Those things can wait. Your health is more important than running to the store for some milk.

Exhaustion
Caregivers for seniors may be overly tired from all the caregiving for seniors tasks, such as running errands, cooking, and cleaning. They may feel that there is not enough time in a day to do everything they need to do.
TIP: Try not to overload yourself each day. Make a list and stick to it. Prioritize your list with the tasks that are most important. You know your limit the best, so if you find yourself getting tired, stop and relax.

Lack of Concentration

Caregivers have so much on their mind that I call it “brain overload.” The mind may be wandering, thinking about what else has to be done.
TIP: Take things one day at a time. Again, make a list and check tasks off as soon as they are complete. Hang a calendar on the wall, so you can see what appointments you may have and also to prevent you from making more appointments on that day.

Weight Loss/Gain
Family caregivers may find that they are gaining weight due to emotional overeating. Or, Caregivers for seniors may not eat due to not enough time or no appetite.
TIP: Being healthy is very important. It will give you more energy during the day. If weight gain is a problem, consult your physician.

Does Diabetes Increase Risk for Alzheimer’s Disease?
In a study at Uppsala University in Sweden, Diabetes in mid-life was found to be associated with an increased risk of developing Alzheimer’s in later life. The study tested more than 2,000 men for blood glucose levels at age 50 and then tested them again approximately 32 years later. Those with insulin problems at age 50 were almost 1.5 times more likely to develop Alzheimer’s than those who did not have insulin problems, even when factors, such as blood pressure, cholesterol, education level and body mass index, were controlled. The association was strongest among those who did not carry the ApoE 4 gene variant that has been associated with a higher risk of Alzheimer’s.

Links have been found between Diabetes and mild cognitive impairment (MCI) as well. In a study by the Mayo Clinic, rates of Diabetes were similar among people with MCI and people with no cognitive impairment; however, those with MCI were more likely to have developed Diabetes before age 65, had Diabetes for 10 years or more and had insulin treatment and/or diabetic complications.

In a study by the Salk Institute for Biological Studies, researchers tried to identify a molecular basis for the interaction between Diabetes and Alzheimer’s. Their conclusion was that blood glucose levels and levels of beta amyloid in the brain interacted in such a way that damaged the brain’s blood vessels.

Can Preventing Diabetes Reduce Alzheimer’s Risk?
Maybe. Researchers at Columbia University found that keeping blood sugar levels in check can lessen or possibly stave off even normal age-related cognitive decline in those that have Diabetes and those who do not. Their theory is that blood glucose levels affect the hippocampus, a part of the brain associated with memory, emotion and motor skills.

Although more research needs to be conducted to further clarify the relationship between Diabetes and Alzheimer’s, it seems clear that preventing or controlling Diabetes could be very good for your brain. How does one go about reducing the risk for Diabetes? Interestingly, a healthy diet and plenty of exercise are essential components of a Diabetes prevention or management program — two lifestyle factors that have also been shown to be good for the brain.

Source: http://alzheimers.about.com/od/whatisalzheimer1/a/diabetesandad.htm

75 years old lady lives next door to me. She lives alone though she has 43 years old son but he has his own family and lives far ?wawy from his mother. They installed new eNeighbor system that consists of motion detector that old lady wares all the time with her and monitors with central monitoring system that controls detector’s moving and can automatically call 911 if there is no movement for a long time.

Happily my neighbor has no diseases that normally belong to her age – she has no Alzheimer’s or Dementia, she can do most things to care about herself and she is making Sunday cookies for neighbor’s children.

Last week I’ve seen 911 rescue team cars near my old neighbor’s home late night. Motion detectors in lady’s bedroom and bathroom registered that she had not left the area in her usual pattern and relayed that information to a central monitoring system, prompting a call to her telephone to ask if she was all right. When she did not answer, that incited more calls — to a neighbor, to the building manager and finally to 911, which dispatched firefighters to break through her door. She had been on the floor less than an hour when they arrived.

Those newest devices are quite expensive and that’s why remain largely unproven and are not usually covered by the government or private insurance plans. Doctors are not trained to treat patients using remote data and have no mechanism to be paid for doing so. And like all technologies, the devices — including motion sensors, pill compliance detectors and wireless devices that transmit data on blood pressure, weight, oxygen and glucose levels — may have unintended consequences, substituting electronic measurements for face-to-face contact with doctors, nurses and family members.

Source: Julia Anna Alison. Choice Eldercare

-Kay Paggi, LPC, NCGC, CMC

“My mother doesn’t even like me, she never has.”

This statement is not uncommon at a support group for the adult children of elderly. It seems out of place, coming from someone who cares enough about the parent to be attending a caregiver group. Yet it is repeated, over and over again, at different meetings and in many different ways.

“My father moved to another city after my parents divorced. I did not see him from the time I was nine until he got off the airplane to come live with me.”

“My mother was sightseeing in Europe when I graduated from high school; she didn’t care enough about me to even attend my graduation ceremony.”

Why are these people spending their precious time and resources caring for their aging parents when they were not nurtured by these parents?

Partly it has to do with hope. People universally seek parental approval and acceptance. A hallmark of entry into adulthood is the parent’s recognition of their child as an adult and acceptance of the child as a peer. Children who have not had parental approval often will continue to seek it, even after they have children themselves. The sad reality is that, if the parent has not loved and approved this adult child during the past years, he or she is unlikely to have a change of heart now, no matter how much caregiving is provided.

Partly it has to do with love. Just because the parent was indifferent to the child does not mean that the child does not love the parent. Most children do love their parents, even when that love is not returned or demonstrated. When the parents age and become frail, the unloved child often shows his love by providing assistance for the parent, because the child loves the parent.

Partly it has to do with self-respect. Most people believe they have the responsibility to provide care for their parents as they age. If they fail to fulfill this, they lose respect for themselves.

Responsibility

Where does this belief, that adult children have the responsibility to provide assistance for frail parents, come from?

Some find it mandated in the Bible, as one of the Ten Commandments. “Honor your father and your mother, that your days may be prolonged in the land which the Lord your God gives you.”  ‘Honor’ is defined as ‘to treat with respect’. Besides being the foundation for Jewish law, these commandments provide excellent common sense guidelines for living a satisfying life. The commandments were given at a time when people continued working until they died. Retirement was unknown. When the father of the family grew too frail to work, he still retained ownership and control of the family wealth and property until his death, including the right to cede it to whomever he pleased. It absolutely makes sense to treat the person who controls your future with respect!

There is no mention made of any responsibility to provide support or financial assistance for frail adults who have ended their working lives. Such a concept was unthinkable.

In 1900 the average lifespan was 49 years in America. In Biblical times, it was much shorter. Certainly there were those individuals who lived to a very advanced age but they were the exceptions, not the average. During most of the history of the world, death has not been associated with age. Childbirth, famine, disease, and war caused death. Most people were not fortunate enough to survive to become old enough to die of old age.

In more recent times, people who had the misfortune to live long enough to be unable to work went to the poor house if their children were unable to provide food and shelter for them. Conditions in these establishments were so deplorable that families made as many sacrifices as necessary to keep their parents from the necessity of going to one. There is an excellent discussion of the history of long term care in America at http://www.elderweb.com/history by Karen Brown. There was no law requiring adult children to provide care for their frail parents.

There is no such law today. Parents are required by law to provide for their offspring. Children are not required to provide care for their parents. No one will take adults who refuse to support their parents to court.

The decision to provide care for frail parents is a choice; care for offspring is not.

The Power of Choice

There have been several studies done on improving the quality of life in long term care facilities. Once such study gave residents on the first floor eggs, pancakes bacon and fruit for breakfast every morning. They had movies every Tuesday and Thursday. During the study the residents on the second floor could choose whether to have eggs or pancakes, and they could choose whether to go to the movies on either Tuesday or Thursday. At the end of the study it was found that the residents on the second floor had less depressed mood and were generally in better health than the participants on the first floor. Why? The second floor residents exercised the power of choice; the residents on the first floor had no choice.

If adult children believe that they must provide care for their parents or else, the care they provide is far more likely to be perfunctory than if they make a conscious choice to provide care. Gifts that are freely given are more generous than mandatory ones. Angry, exhausted caregivers often say that, given a choice, they would never see their mother again. Yet, when asked to visit only when they want to visit and not at any other time, these same caregivers actually visited more often than previously.

Given a choice, most parents would rather have a cheerful adult child drop by for an unexpected visit than a scheduled visit from a harried adult child. Coerced caregiving is impossible to hide. Even dementia patients can be aware of the impatience of their children, or their reluctance to visit.

Choice impacts the quality of care. Adults who choose to visit a frail parent instead of attending their child’s school function will be much less resentful than those caregivers that believe they must visit. These caregivers feel forced by their aging parent to miss their child’s school function; they are angry and the quality of the care they provide suffers.

Authority

Parenting children is an awesome responsibility. Requirements for not only food and shelter, but also medical care, religious training, and education begin at birth. Parents of teenagers are increasingly held accountable for the behavior of their offspring.  Parents are responsible for providing an ethical foundation, culturally appropriate behaviors, manners, and driver training. It is considered an act of responsible parenting to take away driving privileges or the keys to a car as consequences for reckless driving.

That same action is illegal if the keys taken belong to frail parents. According to the law of the land, even if a minor child pays for their own car and owns it outright, their parent has the right to suspend access to it. To take the keys to a car owned by a parent is considered an act of theft, punishable by law. To take the car or hide the car is illegal; to damage the car so that it cannot be driven is illegal, if it is legally owned by another adult, even if that adult is driving recklessly.

The difference is authority. You have not only the responsibility to parent children but also the legal authority to do so. No one has the legal authority to set limits on the behavior of parents, except the state. If an adult has been tried and found incompetent to limit his or her own behaviors, then the state is empowered to name a guardian for that person. The guardian is then responsible for limiting their ward’s actions, and has the legal authority.

This is very different from a Power of Attorney (POA). A POA names an agent to perform certain tasks. These tasks can still be done by the granting party, and the grantor retains the right to remove the POA at any time. A POA does not grant authority to manage money, allow medical care, or limit behavior unless it is specifically mentioned in the document.

A POA for grounding misbehaving teenagers is not necessary, nor is it necessary to have a POA for medical care to take children to physicians or authorize medical treatments.

There is a world of difference between assuming responsibility for care and having the authority to provide care.

As long as an aging, frail adult has not been found incompetent to manage their own affairs by a court, they retain the authority to make their own decisions about whether or not they will drive, how they will spend their money, and what medical treatments they will receive.

This is the appropriate place for recalling the Commandment: treat your parents with respect. To respect means to honor the wishes. There are times when as a concerned and living caregiver, it is necessary to honor your parent’s decisions, even when they seem to you to be wrong.

Limits of Responsibility

So, does this mean that at some point in life, an older adult gets carte blanche? Can an older person demand and expect to receive any attention or financial support from an adult child? Or are there limits?

At some point in life, children become adults. The authority for providing support, money, and guidance passes from the parents to the child, as well as the responsibility. The new adult becomes responsible for acting like an adult and gains the right to be treated as an adult and a contributing member of society.

When parents make a decision that is unwise or even harmful, the respect owed by the children does not require them to support it. Loving adult children can respectfully decline by stating their continuing love and respect for the parent while refusing to assist with implementing an unwise decision. A guideline is to treat parents in the same manner that good friends are treated.

For example, a good friend decides to quit working and move to a commune. You, as his friend, may advise him on the inadvisability of this decision. If he persists, then the bonds of friendship do not require you to assist him in making the move. You can remain his friend but still refuse to help him do something that, in your opinion, is harmful. This leaves the door open. Later, when your friend decides that the decision to quit work and move was a poor one, you are still his friend. He will remember that you supported him but not the decision, and will know that you are available for help with implementing a better choice.

A common problem that parents and their adult children experience is the difficulty remembering that the children have changed from dependent children into independent adults. This transition affects the nature of the parent-child relationship. Adult children who are having difficulty with their aging parents often find that they are relating to their parents in the same ways they did when they were children, and then they wonder why they feel resentful. It is the young adults’ job to remind the parents that they are now dealing with a peer. They must remind themselves that it is permissible to say “no” to mama, and to set limits on parental demands. It can be difficult to act like an adult around parents. It is very difficult to make your own independent decisions when you are still need parental approval.

This dilemma causes much grief for adult caregivers because they cannot have it both ways. Honoring parents is an adult to adult process. Adult to child (of whatever age) puts the balance out of kilter.

Summary

You cannot parent your parents. Caregiving adult children cannot take the keys  when their frail parents do not drive responsibly. Caregivers must use tact, diplomacy, deception, peer pressure and other tactics to achieve their goals. At the same time, they must treat their parents with the respect due them, even when their behavior is childish or unreasonable.

Treat aging and frail parents with respect. Is it respectful to help frail elders move into a new house that they cannot possibly manage the upkeep on? Is it respectful to drive them on numerous errands during work hours, or it is more respectful to ask that they use the van available at their facility? Is it respectful to do for them what they are capable of doing for themselves?  Do you honor your mother when you allow her to refuse care from anyone by you? Is your mother honored when you are too tired from caregiving to nourish your own children?

Long lives bring bonus time. They also bring new questions and the need for new moral and ethical guidelines. That’s your job. Your parents’ generation is the first in history to live into late life. Your generation is the first generation to provide care for parents, on average the same number of years that you provide care for your children: 18 years. The precedence you set now, as you provide care for your parents, will establish the guidelines for future generations. Be careful what you establish.

Kay Paggi is a Licensed Professional Counselor in TX who specializes in aging and caregiving. She is a National Certified Gerontological Counselor, and a Care Manager, Certified. She works as a professional geriatric care manager.

Two days later I wrote, “This is horrible. B really wants to leave Lourdes’s house and go home, and I have no business taking her. How am I going to get through this? I can see how hard it is for Lourdes to care for her, and she’s only into her third week. It’s been six years for me. I have to rise above these thoughts. Otherwise, I will either be dead or take on the traits of the disease. Neither is acceptable.”

My emotions were all over the place.  My mother had just been diagnosed with Alzheimer’s, and I was still reeling from the shock and the clarity that diagnosis brought. I loved my mother and I wanted to help her.

My journal was a lifesaver before and after the diagnosis. It let me vent, analyze, and find hope. It never argued or interrupted. It listened unconditionally, which gave me the space to process events and my reactions to them.

Why should caregivers journal? Writing gives perspective and restores sanity. Writing is a lifeline as well as a record. Writing saves lives. Do not underestimate its power.

What do you do if you have nothing to say?

Look around the room for an image or a sensory detail—the way the sun makes a path on the carpet, the way steam rises off a cup of coffee, carrying the aroma of morning with it. Listen to the high pitched whirring of an omnipresent machine, the tick of the kitchen’s black-and-white, kitty-cat clock—any image at all.

What do you do if you can’t get started? Sentence starts like those listed here can help.

Today I feel…

No one knows I worry about…

I don’t like to brag but…

I lust after…

Next time…

What if…

Pick a sentence start and finish it. Write another sentence. Voila! You are journaling.

Where can you find sentence starts?

There are over 200 in You Want Me to Do What? Journaling for Caregivers. I wrote the book once I realized how lucky I was to have a journal that helped me process my “stuff.”

You might be thinking that only writers can journal. Wrong! A writer is someone who writes. That can be you.

After she got her copy, Joanne Padley, writer and staff member at the State University of NY at Buffalo said, “What a good idea the book is.  I’m sure it will help me sort things out as well as serving as a good reference book and one day, a good remembrance.”

She’s right. According to Marilyn, who wrote in one of my workshops, “Writing from the heart seems to be all that is needed.”

Want to start right now? Finish the sentence, “Today I feel…” and keep going. Go wherever the writing takes you. Get your story, your nuances, your frustrations, your hopes, and your love on the page. Your story is buried treasure.

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B. Lynn Goodwin is the owner of Writer Advice, www.writeradvice.com and the author of You Want Me to Do What? Journaling for Caregivers. Order it from Amazon or at http://www.writeradvice.com/ywmtdw.html. You’ll also find more information about journaling, workshops, and the author there.

Elderly people often suffer from what is often termed as “pre-existing medical conditions”. The one I encounter most frequently is arthritis. The cases I see involve significant worsening of an arthritic condition resulting in disability, reduced quality of life and the need for surgery. Are you entitled to recover for damages in a personal injury accident when a pre-existing medical condition is exacerbated or worsened?  Absolutely!

The Egg Shell Theory

Under Massachusetts law, if the conduct of a negligent party contributes to cause an ultimate outcome, then that party is responsible for the aggravation of that injury.  Some Massachusetts lawyers refer to this concept as the “one percent rule of causation”.  In other words, if the negligent act of a party plays some role in an injury, even if that role is slight (1%), that party is legally responsible for all damages which flow from the aggravation of the injury.  This standard would clearly be important to persons who live with a pre-existing medical condition, which is worsened as the result of the negligent conduct of another person.

This is also known as the Egg Shell Theory. This theory says that a negligent person takes his victim as he finds him, egg shell and all. The Massachusetts law of personal injury requires persons who are negligent to be liable for reasonably foreseeable injuries they cause. Court decisions have concluded causing an injury to a person with a pre-existing medical condition is reasonably foreseeable. Put another way, a negligent person, must take the injured person as he finds him. The egg shell theory holds a negligent person liable for all consequences resulting from his or her conduct resulting in an injury to another person, even if the victim suffers an unusually high level of damage. Let’s say someone is caused to fall his knees by the negligence of another person. Let’s also say that such a fall usually does not result in significant injury. However in this case the person who falls to his knees suffers from a pre-existing arthritic condition of his right knee. As a result of the trauma to his knees he can no longer use the right knee as he had previously and now needs knee replacement surgery to regain pain free use of his knee. This person is considered and “egg shell.”

Various Kinds of Pre-Existing Conditions

I handle many personal injury cases where a person suffers an injury due to the negligence of another. The diagnosed injury is to a body part that was already injured prior to the accident. Where the prior injury was exacerbated or developed pain symptoms after the accident, the injury can be compensated.

Many people who have pre-existing conditions learn to live with the discomfort associated with their conditions.  Others are pain or symptom free (this is especially true of backs) Others may live with a significant pain accompanied by loss of mobility or function. However, if a trauma worsens this condition to the point where, for example, a knee or hip replacement surgery is now necessary, then the injury is compensable. Although the law states that a negligent person is responsible for the cost of the surgery, rehabilitation, physical therapy, occupational therapy and continued medical care as well as  “pain and suffering damages” insurance companies are often reluctant to settle these cases. In fact insurance companies will try to avoid or minimize  responsibility to pay compensation for pre-existing conditions. They will claim that the injured person did not sustain injury in the accident, at all.

Therefore, ligation is often the only method by which to obtain reasonable compensation.

The bottom line is that any person who is injured due to the negligence of another, and who has a worsening of pre-existing medical condition, is entitled to recover compensatory damages directly related to the accident.

The legal treatment of preexisting conditions may differ depending on the State where you live.  Accordingly I have developed relationships with personal injury lawyers in other states to assist me with claims  that require the application of another State’s law.

It takes a good, aggressive personal injury lawyer, armed with knowledge and experience to get you what you deserve.

My experience in senior care has started as the personal one. That is not an atypical situation.  I can’t say that my mother’s Alzheimer changed the field of my occupation. Yet my personal story certainly affects my professional life. The approach to senior care care was quite different in those days. There were fewer options.  Geriatric care managers didn’t appear quiet yet. There was no wide range of home care agencies. Essentially, there was virtually no one you could turn to for advice.  Alzheimer disease itself wasn’t as well known as it is today. Consequently, when I realized that  my mom could no longer live alone , a  nursing home  began to sound  as a suitable outcome. I’ll never forget my desperate search for a decent one I could afford.  Did  I have  doubts regarding the move ? Certainly. That’s  precisely what I had referred to at the beginning of this article . The judgment was poor, the courage was lacking. “It would be so good to have nice person in the house with Mom…”  That thought kept reappearing in my mind. But  there was no support and I backed off.

Don’ get me wrong, I’m not trying to say that the care was poor . What I wanted, was for it to be personal. In fact what had become clear was that the the only crucial things that nursing   homes didn’t seem to provide were: A personal touch and continuity. It wasn’t deliberate. It  just wasn’t in “their love map”.  Nursing home  were clearly geared as homes for the masses.What I wanted  was a true  home for an individual. “There is no place like home”., concept firmly planted its roots in my head. The concept seemed to be especially true when any part of the body or mind declines.

Ladies and gentlemen, fellow caregivers, presence of spirit and patience might come in handy. Finding the right  caregiver   is no easy job.  Yet,  to me  this was the  only path to take. Succeeding in  home care, making it personal  led to amazing rewards : Optimal care for your parent and,  and crucial  peace of mind for yourself.

It’s no secret  that I’m passionate supporter of home care. At times the passion carries me away. Consequently, I  have neglected to mention the difference in cost. That difference is tremendous. However, even if you are so well off that you can spread money like confetti, choose the home care road.  The care of your loved ones are  will be hand crafted to satisfy their needs as well as your wishes.  In return, you will receive the reward of satisfaction and true  joy.

Good luck!