Gentle and Peaceful Activity Reduces Agitation, Increases Quality of Life

By Carrie Esselman, Therapeutic Recreational Specialist, Valley VNA

Namaste is a Hindu word that expresses, “to honor the spirit within.” It’s the perfect name for a meaningful and peaceful practice of accompanying elderly people through the final stages of dementia, many of whom are nonverbal and easily agitated. Namaste Care™describes a program that brings honor to people who can no longer tell others who they are or who they were or care for themselves without assistance. Namaste Care™, adopted by the leadership and staff at Valley VNA in Neenah in January, requires both a special space and a special mindset where residents have the essential environment they need and crave in the last stages of their disease; namely, a peaceful, spa-like environment free of loud noises or overstimulation, warm and affectionate touch, a serene schedule free of rushing or clamoring to the next activity, and the most genuine, heartfelt presence of caregivers.

Namaste Care™™was established in 2003 in a single nursing home in Benington, Vermont, by Joyce Simard, MSW, now an internationally-known social worker in eldercare, who works to educate families and professional caregivers on how they can help people live, not just exist, with irreversible dementia like Alzheimer’s disease. “I do not think that keeping a person clean, fed, and groomed is living; this is merely existing,” Simard said. “People need to be engaged in meaningful activities, they need to feel wanted, loved, and need to feel as if they still can contribute.”

Simard recognized that traditional activities for people who reside in long term care settings are not typically designed for residents with Alzheimer’s disease or dementia. She wanted to design a program where all personal care activities, like bathing and dressing, were completed with intentional, soothing strokes, and time was spent in tranquility and company with others, not alone in a room or off to the side at a bingo game.

Joelin Mueller of the Valley VNA life enrichment department trained with Simard last year to facilitate Namaste Care™ in Neenah. It is offered to Valley VNA residents five days a week, two hours a day, in the community’s sunroom. A large lit fish tank, soothing aromatherapy, soft music complemented by birdsong and river sounds envelop eight people who stay throughout the entire time. It is quiet, but not silent. Each person is greeted and welcomed into the room and assessed throughout his or her stay for comfort and pain. There are warm blankets, the lighting is adjusted so the room is not too bright, and residents who are able are transferred to specially-provided recliners. After all of these arrangements are set, the quiet and relaxed interaction between Joelin and her Namaste Care™ participants begins.

“Our main goal is to be present to our advanced dementia residents,” Mueller said. “We slow down and meet each person’s needs in the moment. We ease their anxiety and agitation,” Mueller said. First she washes each person’s face, brushes their hair, and tells them how beautiful they are, how wonderful it is that they are there, and she gets to spend time with them. Hand massages, kisses, and hugs part of every Namaste Care™ time. After lunch, the same people return and engage in sensory and other appropriate activities.

Residents who participate in the program at Valley VNA have gained weight, take in more hydration, eat significantly more, and have better family visits, according to Mueller. “Staff, fellow residents, and families notice that our Namaste people are a lot less agitated than before. For staff, this means less stressful bathing and personal care, too.” Because of the impact of the program, leaders and staff hope to expand it to seven days a week, four hours a day. “This is the way our people live every day. It’s important to be consistent,” Mueller said.

Namaste Care does not require any special equipment, Simard does not have proprietary contractual agreements, and special certifications are not mandatory. “It’s ingenious, really, to see so much improvement, so much serenity, from returning to the basic human need to be loved and accompanied,” Mueller said. She gets choked up when she talks about her role in bringing Namaste Care™ to Valley VNA. Her favorite moment so far? When she asked a typically non-verbal participant how she was feeling and she opened her eyes and quietly said, “I’m home.”

General John A. Logan crafted Logan’s Order on May 5, 1868, to establish Decoration Day, now known as Memorial Day, on May 30 of each year. It is believed that date was chosen because flowers would be in bloom all over the country, and they could be used to honor and decorate the graves of fallen Civil War soldiers.

It’s a procession, not a parade. Many communities’ Memorial Day processions, often incorrectly called parades, are meant to be solemn occasions to remember our country’s fallen soldiers and the families they left behind.

Lincoln’s Gettysburg Address is widely believed to be the first official proclamation that memorialized American soldiers, a portion of which declares, “It is rather for us to be here dedicated to the great task remaining before us – that from these honored dead we take increased devotion – that we here highly resolve that these dead shall not have died in vain – that this nation, under God, shall have a new birth of freedom….”

Do you want to learn more? Valley VNA in Neenah will hold its annual event, “The Meaning of Memorial Day” on Friday, May 26, 2017, from 1:30 to 3 pm at Valley VNA Senior Services, 1535 Lyon Drive in Neenah. Please use the main entrance. The program will be indoors, and seating is provided. Reservations are not required.

(Part 3) A Financial Blog Series About Assisted Living Funding Sources, Payment Programs, and Possible Pitfalls

By Theresa Pichelmeyer, Valley VNA President & CEO

 My last two blogs have covered the differences between assisted living and skilled nursing care and how one might pay for assisted living lodging and services. After move-in day, finances will continue to play a pivotal role in your housing options. Just within the field of assisted living communities, there are many different business models and motivations. These motivations are behind the answer to a very important question: “Under what circumstances would I or my loved one be asked to move from my assisted living community?” A non-profit organization like Valley VNA is driven by a different set of values than a for-profit company. For instance:

• If you (or your loved one exhausted) your financial resources and went on Family Care (Wisconsin’s Medicaid program), would you automatically be asked to move? At Valley VNA, we work collaboratively with families whose loved ones have been paying for their own care for at least two years to keep them in the home they’ve grown to know and love. It’s a balancing act to keep an optimal number of private pay and Family Care residents in a community and be able to operate in a financially sound manner. Based on their business model and mission, some companies are not willing to accept a decrease in their reimbursements. As a result, they do not accept Family Care and these residents can be asked to move.

• What circumstances of care would cause a resident to need to move? Generally speaking, people with complex medical conditions, people who are a danger to themselves or others, and those who are a very serious flight risk due to Alzheimer’s or dementia cannot be accommodated in an assisted living setting and may do better in a skilled nursing home or an assisted living home that specializes in this type of care. At Valley VNA, each resident’s situation is thoughtfully considered on a case-by-case basis during the assessment process and as conditions change.

Some of my elderly friends tell me, “I never expected to live this long.” They are often thinking of their parents or grandparents—generations who lived in completely different times of work, safety, and health care. The reality is we do live a lot longer, and we squeeze a lot of good life and love out of our years here on earth!

In my last three blogs, I hope I’ve helped clear up some of the financial confusion that surrounds the decision to move to into assisted living. In the meantime, do you have more questions about choosing or planning for assisted living? Call us at (920) 727-5555 and we’ll connect you with a helpful, knowledgeable person to help you navigate the process.

(Part 2) A Financial Blog Series About Assisted Living Funding Sources, Payment Programs, and Possible Pitfalls

By Theresa Pichelmeyer, Valley VNA President & CEO

In a recent blog, I wrote about one of the Big Elephants in The Room; that is, how to address the guilt we often feel when we help move a parent or other loved one from his or her longtime home into assisted living.

Another major source of anxiety is how to pay for this new level of care. This is the second of three blogs about how to finance assisted living.

As you may recall, assisted living communities like Valley VNA are private pay. The individual and/or his or her family needs to have the resources to pay for assisted living housing and care. In very specific circumstances, government programs (like Medicaid) might help pay for a senior’s stay in an assisted living facility, but not for sure, not right away, and not entirely.

There are many, many different levels of care at Valley VNA, all dependent upon the changing personal needs and preferences of the individual resident. Therefore, monthly rates can vary from around $3600-$7000 per month (updated Mar. 2017). There are several sources that can be combined to pay for these customized levels of lodging, dining, and care services:

• Pensions and Retirement Accounts
• Social Security
• Veteran’s Benefits
• Long Term Care Insurance
• Proceeds from the Sale of a Home
• Other Savings & Investments

There is planning and prep work you and your family can do now, before an emergency puts you in a time crunch for completing paperwork and administrative tasks. Remember, a last-minute rush may limit your choices for getting you or your loved one into your desired care setting.

• First and foremost, save something for yourself. Spend time thinking and talking about how you intend to pay for your long term care. Don’t prioritize leaving an inheritance for your kids and grandkids over your own comfort and care. If you sell your home, set that money aside to pay for your new living arrangements. If you’ve saved and invested money over the years, reserve it for yourself. It is good and rewarding to give gifts that support the dreams of your individual family members, but do not give away or tuck away nearly all your assets before you know what your own living expenses will be. You’ve earned it; you have a right to use it.
• Get all your documents in order. This includes a list of your pension income, retirement account disbursements, and monthly Social Security payments, typically very important sources of income to pay for assisted living expenses.
• Talk to a trusted accounting or financial planning professional. Upon your death, there is a look-back period when the government may seek the return of assets you gave to family members and others in your effort to qualify for government programs like Medicaid (sometimes called intentional impoverishment). This money could be taken back from your family as reimbursement for Medicaid funds spent on your care.
• Research your veteran’s benefits. This is often a long, arduous process. That’s why it makes sense to do the investigation now. Start by contacting your county veterans’ services office and remember to ask about veterans’ spousal benefits.
• Research and invest in long term care insurance. Many people do this around age 50-55. Go through a trusted insurance agent or financial planner and read the fine print. Does the policy cover in-home care? Skilled nursing care? Assisted living care? For how long? How and when does coverage kick in?

My next blog will talk about a very important question you should ask when looking for an assisted living facility; namely, “Under what circumstances could I or my loved one be asked to move from my assisted living community?” In the meantime, do you have more questions about how to choose or pay for assisted living? Call us at (920) 727-5555 and we’ll connect you with a helpful, knowledgeable person to help you navigate the process.

ss. That’s why it makes sense to do the investigation now. Start by contacting your county veterans’ services office and remember to ask about veterans’ spousal benefits.
Research and invest in long term care insurance. Many people do this around age 50-55. Go through a trusted insurance agent or financial planner and read the fine print. Does the policy cover in-home care? Skilled nursing care? Assisted living care? For how long? How and when does coverage kick in?
My next blog will talk about a very important question you should ask when looking for an assisted living facility; namely, “Under what circumstances could I or my loved one be asked to move from my assisted living community?” In the meantime, do you have more questions about how to choose or pay for assisted living? Call us at (920) 727-5555 and we’ll connect you with a helpful, knowledgeable person to help you navigate the process.

A Financial Blog Series about Funding Sources, Payment Programs, and Possible Pitfalls

By Theresa Pichelmeyer, Valley VNA President & CEO

 In my last blog, I wrote about one of the Big Elephants in The Room; that is, how to address the guilt we often feel when we help move a parent or other loved one from his or her longtime home into assisted living.

Another major source of anxiety is how to pay for this new level of care. My next three blogs will cover a number of financial topics. First, a review of what assisted living is versus nursing home care (or skilled nursing):

Assisted Living Facts:

• It is an environment where a person gets daily help to safely dress, bathe, eat, and use the toilet. (The medical term is ADLs, or activities of daily living.)
• It is a home that is chosen by an older person and his or her family. There is no medical diagnosis required to move into assisted living.
• The staff at an assisted living home carefully tracks and administers residents’ medications.
• Some assisted living communities employ registered nurses. Valley VNA does. Our RNs help assess and coordinate the care of our residents. Our primary direct caregivers are resident assistants and CNAs.
• Residents typically have access to therapy services. Valley VNA welcomes outside therapy providers (physical, occupational, speech), as chosen by the resident, to give therapy sessions on site.
• Assisted living communities like Valley VNA are private pay. The individual and/or his or her family needs to have the resources to pay for assisted living housing and care. In very specific circumstances, government programs (like Medicaid) might help pay for a senior’s stay in an assisted living facility, but not for sure, not right away, and not entirely.

Nursing Home Care (provided at Skilled Nursing Facilities, or SNFs)

• Medicare may pay for a short-term rehabilitation stay at a SNF (like recovery from a hip or knee replacement), but it does not pay for long-term personal or custodial care at a SNF. Many people think the government will pay for their long term care straightaway, but this is not true.
• By definition, a skilled nursing facility is a medical facility. Skilled nursing facilities are required to employ registered nurses and CNAs to provide hands-on patient care to those with complex medical cases. Similarly, nursing staff directly administer medications and therapists are on staff to provide physical, occupational, and speech therapy to residents.
• Skilled nursing residents often start out as private pay. Long-term residents who later exhaust their financial resources may become eligible for Medicaid to pay for their care. Wisconsin’s state-administered Medicaid program is called Family Care. Once a person qualifies for Family Care, (generally $2000 in remaining assets plus what a spouse needs for his or her living expenses), he or she forwards all remaining assets and income directly to Family Care and the agency manages them on his or her behalf from that point forward.
• Not all facilities accept Family Care because its reimbursement rates are below the cost of providing care. Some facilities limit the number of Family Care residents they accept.

My next blog will address the private payment sources that many of our Valley VNA residents use to pay for their care. In the meantime, do you have more questions about how choose and pay for assisted living? Call us at (920) 727-5555 and we’ll connect you with a helpful, knowledgeable person to help you navigate the process.

When You Help Move Mom or Dad into Assisted Living

By Theresa Pichelmeyer, Valley VNA President & CEO

We often feel guilty in the process of planning and moving our aging parents(s) into an assisted living community. Family and societal pressures have wrongly characterized these moves as “abandonment” or “disloyalty” or “laziness.” Why do these feelings of guilt arise and how can we shape a healthier, more peaceful and realistic perspective?

The Reality of Your New Role

As grown children, we continue to rely on our parents for decades as caregivers, problem-solvers, and “safe shelter in a storm.” Gradually, things begin to change and we realize this role is shifting. A fix-it project in the home workshop used to be run by dad and you were the assistant. Now he stands back and watches you take the lead. (It is a very powerful moment when you realize what just happened!) Or you start to go to medical appointments with mom to take notes and be her advocate, something she always did for you.

Many adult children find this role reversal unnerving. They feel vulnerable because they’ve lost some feelings of stability and normalcy. It is a natural evolution of almost every family on the globe to begin caretaking for aging parents, and it would be wrong to assume otherwise. Frailty, illness, or dementia will continue regardless of your attempts to stop their progression. As your relationship changes, don’t try to “fix” issues of aging. You will be overwhelmed by feelings of failure and aggravation if you strive to make everything the way it used to be.

With proper help, you can keep your parents’ options open. It’s difficult to predict the progression of natural aging or a chronic disease, and a fall or health emergency at home immediately narrows your family’s options for getting them care in a setting of their choice. A decision to help mom and dad move into a safe, comfortable apartment is a decision to accept this very serious adult reality. Do not wait for a broken hip to make all the decisions for you.

When It Feels Like You Are “Giving Up”

Moving your parents may feel like a public acknowledgement that you no longer have the ability or the loyalty to care for them yourself. This is especially true when others also see the move will help lighten your caregiving load. And why shouldn’t it? Few aging parents or spouses would want their adult children or mate to give up living any kind of life apart from their needs. If they do, reject that premise as unfair and unrealistic.

Just as your parents cared for you when you were young, you are doing your best with the information and resources you have. Remember, your mom and dad taught you many of the life skills you are using to navigate this big change, and your commitment to your parents is a direct result of their commitment to you.

Even after a decision is made, doubts can linger over whether your parent’s new home is the best choice. Did you tour and ask plenty of questions? Was it clean? Have you checked the facility’s state record for infractions? Did you speak to people around town and get their opinions? Anyone who has been through this arduous process knows it’s not for the faint-of-heart—it’s hardly “giving up,” more like “stepping up.”

But I Promised Her

“I promised her I’d never put her in a home.” Ask yourself what were you really saying when you made that promise. Were you saying you would always care for your mom, never abandon her, and keep her at the heart of the family she helped form? Your mom may have also been working off a set of outdated impressions—perhaps a 1970s-style nursing home without the activities, décor, and dining options of today’s senior living communities.

The decision to help your mom find a new safe place to live is in keeping with the spirit of the promise you made to her. In fact, it will go a long way to preserve a loving mother-child relationship. You won’t be exhausted and exasperated from the demands of caretaking and can once again visit her at home for the simple pleasure of a cup of coffee, a conversation, or a card game.

What Do I Do Now?

After mom and dad move to their new home, your responsibilities change but do not evaporate. Continue to advocate for your parents and be visible to other residents and staff. Visit them and bring the kids and grandkids. Help decorate their new apartment with meaningful furniture and pictures from their prior home. Introduce them to residents and staff, especially if they’ve become isolated in their previous home due to illness or immobility. They may complain. Try not to engage and redirect the conversation the best you can.

Your visits together will no longer be focused on the “to do” list of mowing the lawn, grocery shopping, or the more intimate duties of bathing, dressing, and toileting. When you share the care, it frees you up to enjoy your parents without being physically and emotionally worn out. Joy can once again blossom in your relationship; and with this newfound joy, let the guilt slip away.