1. “Memory & Aging: How I Can Help Myself, My Family, My Friends and Neighbors” SCHWAB HOUSE FORUM APRIL 2, 2014 Helene Bergman, LMSW, C-ASWCM Elder Care Alternatives, LLC Geriatric Care Management, New York City Guest Speaker Peter J. Strauss Nationally known Elder Law and Trusts & Estates Attorney Founder and Fellow, National Academy of Elder Law Attorneys Distinguished Adjunct Professor of Law, New York Law School

2. What are normative changes? Biological Changes with Aging In skin, hair texture, skeleton system Progressive mild sensory loss Vision Hearing Ages 75-85- smell, taste, tactile General Decrease in Ability to Respond to Stress (muscle strength; reaction time) Decline in function of certain Organ Systems (muscles, heart, kidneys, liver, skin, bones, hormones, cells and enzymes)

3. What are normative Age Related Brain Changes? Structural Shrinkage of Brain Loss of Neurons Biochemical Reduction in neurotransmitters Increase in some brain chemicals Functional Slowing of electrical activity Reduced brain metabolism

4. Consequences of Age-related Brain Changes Reduced speed and efficiency of information processing Slower acquisition and retrieval of information

5. Is It Alzheimer’s?**- Red Flags Forgetting recent events Losing train of thought in conversation Losing a word or expression Repeating questions over and over Problem handling personal finances Misplacing an important item Missing appointments Decline in hygiene care & care of the household Neglecting a pet Denial, anxiety, withdrawal **might it be depression?

6. What should I do? Evaluation of Memory Memory Screening- the MMSE Neuropsychiatric Testing  Memory Disorders Centers  Private Neuropsychologists Diagnosis and Staging (FAST & GDS) Treatment (Memory)  Aricept/Excelon  Namenda  Alzheimer’s Association  Programs (hospital/community based) Treatment (Behavioral Changes)

7. If the diagnosis is Dementia, what should I do? Family Conversations: Resistance & Dynamics Plan for the Future  Advance Directives  Estate Planning  Insurance Issues (LTC Insurance)  Personal Issues

8. Should I plan to remain at Home? Medical Issues Home Environment- adaptable to care? Support Network Family Issues Community resources Finances Emotional Needs Location-Location! Age Friendly Community?

9. What are my relocation options? 1. Move in with family 2. Senior Residence 3. Assisted Living 4. Enriched Residence 5. Adult Home 6. Nursing Home

10. What resources am I entitled to? Social Security (and Pension if relevant) Medicare (A&B&D) and therapies (PT,OT, ST) SS Disability/Medicare SSI- Supplemental Security Income Veteran’s Benefits Transportation (Reduced Cost or Free) SCRIE (Rent Reduction) Meals on Wheels EISEP- reduced home care Social Agencies (i.e. Visions, JASA)-Senior Centers (Council, Dorot) Legal Aid Alzheimer’s and other chronic disease centers Website resources Cultural Programs (Access, Connect 2 Culture, Met Programs) Financial Support (Medicaid)

11. How can I help a friend? Ask yourself: Has there been a recent event or loss? Maybe it is depression or delirium. Observe and gather information (only advise if effective) Be more active than passive (drop off food, help with the meds, check in call) Reach out to family first- make that call; suggest professional support If no fiduciary available, and there is an obvious risk, refer to appropriate agency (Case Mgmt w/local agency or Adult Protective Services)

12. What Help Can I Secure at Home? Visiting Physicians (or NP’s) Nursing Care (through Medicare) Home Health Care Therapists Adaptive Equipment Friendly Visitors Geriatric Care Management

13. All about Home Health Care Levels of Care Sources for Home Care Private Agency Registry Medicare Medicaid Issues & Liabilities

14. What happens when my money runs out? 1.Criteria for Medicaid eligibility- Means-based 2.Community Medicaid- Home Care 3.Long Term Medicaid 4.Medications, equipment, transportation 5.Medical Model Adult Day Programs

15. What is a Care Manager? A Geriatric Care Manager is a health and human services specialist who helps families who are caring for older relatives. A Geriatric Care Manager is a certified member of the National Association of Professional Geriatric Care Managers (NAPGCM) and committed to adhering to the NAPGCM Code of Ethics and Standards of Practice. A Geriatric Care Manager provides psychosocial assessment and linkage to all resources in the Community. On-going Care Management insures quality of care and quality of life.

16. The Role of a Care Manager Emotional Support- Rescue & Relief Situational Analysis Problem Solving Education & Direction Family Counseling & Mediation Advocacy Navigation of Systems Crisis Intervention Linkage- Liaison Referral Plus

17. Why a Care Manager? Acute or Chronic Problem Elder w/no problem; LTC planning Long Term Care Insurance- Care Coordination Caregivers: Long Distance Working; ‘sandwich’ generation Elder spouse Client Resistance Family Conflicts Financial Issues * Guardianship