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Robert Goodman, MSW

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Living and Aging with a Disability – Part 2
Living and Aging with a Disability – Part 2 150 150 Robert Goodman, MSW

For many, aging with a disability is accompanied by numerous health problems that usually do not occur until 10-15 years later in non-disabled persons:

  • 3-4x increased risk of new medical problems: diabetes, obesity, high blood pressure/cholesterol, respiratory conditions, bone loss, and thyroid disorders.
  • Common complaints include fatigue, new weakness, and pain often progressing to a point of limiting independence. May need use of assistive devices. Increasing physiologic decline, disability and handicap, and cost of care.
  • Changes in health impacts quality of life for individual and family. Psychological issues, including depression affects 15-40% of people aging with a disability.

CEREBRAL PALSY

Decline in energy and activity levels. Some bladder difficulty and spinal stenosis reported. More bone fractures per year compared to non-disabled.

DEVELOPMENTAL DISABILITIES

Aging process is affected by the nature and severity of the impairment, secondary conditions , medical issues, and medication usage.

DOWN SYNDROME

  • Increased chance of hypothyroidism, hypertension, and arteriosclerosis.
  • Shorter life expectancy of 55 years old, but many live into 70s.
  • Most adults over age 40 have some neuropathological changes characteristic of Alzheimer’s Disease, but only some develop dementia.

INTELLECTUAL DISABILITIES

Outlive parents and can’t rely on adult siblings. Must plan for the future.

MULTIPLE SCLEROSIS

  • There has been little research on this topic. Doesn’t reduce life expectancy. Limited ADLs and IADLs.
  • Common issues: urinary tract infections,

pneumonia, and septicemia.

  • Loss of mobility (fatigue, falls), dependency on caregiver/family, or possibility of moving into nursing home; most require multiple mobility devices. Rehabilitation therapy has shown to help functioning.
  • Controversial study found that MS

doesn’t get worse with age and seems to disappear in the 70s, but MS remains unpredictable and attacks can occur in this age group.

TRAUMATIC BRAIN INJURY

Effects of aging vary greatly. Memory

impairment, slower learning of new material, gait and balance problems, ataxia, decreased sensory acuity, diminished executive functions, reductions in appetite and libido.

POST-POLIO SYNDROME (PPS)

  • Develops several decades after a person has had polio. Affects the muscles and nerves, causing weakness, fatigue, pain, and other symptoms. Start to experience onset of new symptoms and functional limitations, which threaten to further erode health and independence and an increase need for services.
  • Mean age of 63-Age of person at acute onset and historical period are significantly related to the severity of the initial impairment as well as the physical and psychosocial wellbeing. Contracted at a younger age and earlier in the century were less impaired. Measured by the number of limbs affected vs. contracted later during the peak of the epidemic and at an earlier age. Timing and initial severity have a big impact.
  • Excessive fatigue, slowly progressive muscle weakness with or without decrease in muscle bulk, muscle pain or twitching where effected by original disease. Joint pain and respiratory problems reported.
  • Severity and experience polio after 1940 at older ages most at risk for depressive symptoms and low scores on acceptance of disability.

SPINAL CORD INJURY

  • Effects begin around age 40 with SCI for 20 years. Effects of aging depend on nature and duration of injury—quad early 40s, lower injuries early 50s.
  • More pain, fatigue, effort to do activities, weakness, unable to do things previously done independently.
  • Diabetes at 4x the rate of nondisabled persons.

· Changes ranging from decline in health and physiologic functioning to sociologic changes, ie, increasing financial stresses, changing relationships, perception of self and roles, and spiritual growth.

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Hiring Independent Private Duty Help
Hiring Independent Private Duty Help 150 150 Robert Goodman, MSW

Hiring Independent Private Duty Help

By Patricia Waldron

 

Professional healthcare workers (home health aides, companions, homemakers) can be hired through a licensed home health care agency or these services can be obtained from independent providers who are usually called independent contractors.

Independent contractors work for themselves  are not employed by a licensed home health agency. They do not have to meet the same standards that licensed agency employees must comply with.

The responsibility of recruiting, hiring, supervising, counseling, and training belongs to the client or client’s family.

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History of the non-Driver’s ID card
History of the non-Driver’s ID card 150 150 Robert Goodman, MSW

History of the non-Driver’s ID card

The Savvy Senior

By Robert Goodman, MSW

Personal Issues can result in enactment of state law. I have a visual impairment and cannot drive. At age eighteen, I could not cash a check since I did not have a driver’s license to use as proof of identity, nor did I have a credit card.

I was a student at Florida State University in Tallahassee, our state capital. I spoke to Representative John Savage and Senator Bruce Smathers about this problem. Their staffs researched how other states resolved this issue. As a result, Florida created the non-driver’s identification card (SB 1086) based on a Maryland law. The law was beneficial for people with disabilities as well as for non-drivers of all ages.

I attended a lecture by an employee of the Division of Motor Vehicles who said that the non-drivers ID card saved lives by offering an alternative to driver’s license ID, because it provided people who should give up driving an alternative means of identification.

In today’s world, it allows entry onto airplanes and trains with the Real ID.

To make an appointment (no walk ins) to apply for or renew an ID card in Delray Beach call 561-355-2264. The address is 501 South Congress Avenue.

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Adjustment to Disability
Adjustment to Disability 150 150 Robert Goodman, MSW

The Savvy Senior

Adjustment to Disability

By Robert Goodman, MSW

 

Older adults age 65 and over are at higher risk for many types of injuries that can have devastating effects. In some cases, leading to loss of independence, disability, or death. Falls are the leading cause of injury death for Americans 65 years and older. Twenty percent to 30% of people who fall suffer moderate to severe injuries such as bruises, hip fractures, or head traumas. They are also the most common cause of nonfatal injuries and hospital admissions for trauma. People age 75 and older are in one of the age groups at highest risk for Traumatic Brain Injury.

What happens when someone suddenly becomes disabled? How do you react? What do they go through? What resources can help both the accident victim and the caregiver?

The individual with a new disability may be in shock, disoriented, and confused about the future. They may be asking themselves “how  am I going to go on with my life, remain independent, or get help? “They may experience a variety of emotions such as anger, denial, sadness, or depression.

Family members may experience similar feelings. They may feel isolated, not knowing what the future will bring or who can help them in this time of crisis.

Elizabeth Kubler-Ross identified five stages of grief that the person with a disability or family members may experience: denial, anger, bargaining, depression, and acceptance. A person can go through these stages in any order and they may be repeated.  Each stage may last different amounts of time.

Various things affect how people live with their disability:

  • Type of disability
  • Cause of disability
  • Severity of disability
  • Visibility vs. invisibility of the disability
  • Coping abilities of the patient and family
  • Previous attitudes toward disability and illness
  • Reactions and attitudes of family, friends, and health care professionals
  • Personality
  • Availability of supportive services

When illness or disability strikes the patient and families may become overwhelmed with questions and information. Your doctor is key to the process of treatment and recovery, whether you have a progressive illness that develops over time, or a sudden disability caused by an accident.

Becoming disabled means you may need support from health and social service agencies. The hospital social worker or case manager can assess your needs and connect you with services. These services may include home health care, financial aid, counseling and support groups, and other services for older adults.

Patients and families need to ask their health care professionals questions about the disability or health condition, treatment and recovery, and what services are available to help the individual and the family.

Caregivers need to take care of themselves. You need to take breaks, enjoy your own leisure activities, and delegate responsibilities to others if possible.

 

The following services are available in the community:

For general information: Call 211 or the Elder Helpline 561-684-5885

Palm Tran Connection

 

For people with certain health conditions:

Alzheimer’s Association 24-Hour Crisis Line 1-800-272.3900

 

Arthritis clinic

561-833-1133

MS Society for South Florida 800-344-4867

 

For people with visual impairments:

Lighthouse for the Blind 561-848-7200

Talking Books Library 888-780-5151

 

Counseling and Support Groups

Ruth Rales Jewish Family Services 561-852-3333

Center for Group Counseling  561-483-5300

 

 

 

Transportation:

Palm Tran Connection 877-870-9849

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Living and Aging with a Disability
Living and Aging with a Disability 150 150 Robert Goodman, MSW

By Robert Goodman, MSW

Have you recently lost your vision, become disabled, in need of services to help you become more independent? Are you living with a lifelong disability and notice changes in your functional capacity? There are services available to help you become and maintain your independence. Some of these services are listed at the end of this article.

It is difficult to be functioning independently one day, suddenly end up in a hospital, and have to learn to walk or function independently over again. There are services that can help you learn activities of daily living (walking, bathing, eating, personal care, etc). Other agencies help with the psychological aspects of adjusting to a disability. There is no harm in asking for help. Support groups offer support, friendship, and love.

Perhaps you have reached a point where it is becoming dangerous for you to continue driving. There are options available to help non-drivers. First, Boca Raton has several bus routes that take you to most places. The 91 bus that leaves from the clubhouse will help you connect to these routes. Century Village has buses (with steps) that go into the community. Palm Tran Connection provides door to door service throughout Palm Beach County for people who cannot use public transportation. If you are concerned about keeping your driver’s license for identification purposes, you don’t have to worry. Florida offers a non-driver’s ID card for those who need a form of identification to replace a driver’s license.

There has been a lot of research in recent years on what changes occur in the physical functioning of persons living with lifelong disabilities, such as polio, cerebral palsy, multiple sclerosis, developmental and intellectual disabilities, and mental illness. The research has found that some people with lifelong disabilities have noticed more joint pain/arthritis, problems with balance, and fatigue at an early age.

 

 

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Disability Etiquette
Disability Etiquette 150 150 Robert Goodman, MSW

What do you do when you meet someone who has a disability? Do you lean on their wheelchair, talk louder, grab their arm to help them? If you do you are violating disability etiquette and making the person with a disability uncomfortable.
First, let’s start with language of disability. Vehicles or things may be crippled, but not people. Credit cards may be invalid, but not people. People first language encourages respect and promotes dignity and a positive attitude toward people with disabilities. We refer to someone with a disability as a person who is blind or deaf or uses a wheelchair (not wheelchair bound).
There are some simple rules to live by when you meet someone with a disability. Here are some suggestions that will make your interactions more pleasant.

How to Help: General Guidelines

  • Introduce yourself and offer assistance if needed.
  • Don’t be offended if your offer of help is refused.
  • Ask how you can help and listen for instructions.
  • Assist individuals with disabilities when necessary or requested, but do not discourage their active participation.
  • Allow a person DIGNITY to do what he or she wants to do for him or herself. Encourage independence, not dependency.

Be Yourself
Treat people with disabilities with the same respect and consideration that you have for everyone else. Treat the person as an individual, not as a disability. Don’t assume that “disability” is all that person can talk about or is interested in.
As in any new situation, everyone will be more comfortable if you relax.

Hearing Impairments

  • Face the person when you are speaking.
  • Don’t eat or cover your mouth while talking. It -it makes speech difficult to understand!
  • Rephrase sentences or substitute words rather than repeat yourself again and again.
  • Speak clearly and at a normal voice level. Don’t shout.
  • Communicate in writing, if necessary.
  • Move away from noisy areas or the source of noise – loud air conditioning, loud music, TV and radio.
  • Don’t stand with bright light (window, sun) behind you – glare makes it difficult to see your face.
  • Get the hearing-impaired person’s attention and face in full view before talking.

Visual Impairments

  • When greeting the person, identify yourself and introduce others who may be present.
  • Be descriptive. You may have to help orient people with visual impairments and let them know what’s coming up. If they are walking, tell them if they have to step up or step down, let them know if the door is to their right or left, and warn them of possible hazards.
  • You don’t have to speak loudly to people with visual impairments. Most of them can hear just fine.
  • Offer to read written information for a person with a visual impairment, when appropriate.
  • If you are asked to guide a person with a visual impairment, offer your arm instead of grabbing hers. They should hold your arm just above the elbow.
  • Don’t leave the person without excusing yourself first.
  • Don’t leave cabinet doors open and remove other obstacles that may present a hazard to someone who cannot see well.

Mobility Impairments

  • Try sitting or crouching down to the approximate height of people in wheelchairs or scooters when you talk to them.
  • Don’t lean on a person’s wheelchair unless you have his permission – it’s his personal space.
  • Only push someone’s wheelchair when asked.

I hope these hints will make your interactions more comfortable with your neighbors who have disabilities. 

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Vision Impairment and Older Adults
Vision Impairment and Older Adults 150 150 Robert Goodman, MSW

The Americans with Disabilities Act

As it Applies to Persons with Visual Impairments

ADA INFORMATION RESOURCES

 

U.S. Dept. of Justice ADA Website            www.ADA.gov/

ADA Information Line                              800-514-0301 (Voice)

 

Title III: http://www.ada.gov/t3hilght.htm

  • Businesses (including all health care providers) that provide goods or services to the public are called “public accommodations”

 

  • Health care providers must modify their policies and procedures when necessary to serve customers with disabilities and take steps to communicate effectively with customers with disabilities.
    • Assistance with filling out paper work
    • Provide materials in large print, Braille, or other accessible format
      • Admission information
      • Doctor’s orders, discharge plan
      • Information on community resources from home health agencies
      • Prescription information
      • Test procedures

 

Internet Resources:

  • ADA Accessibility Requirements

www.adaag.com/ada-accessibility-guidelines/index.php

  • ADA and Health Care

www.pacer.org/publications/adaqa/health.asp

  • ADA and People with Visual Impairments

www.ada.gov/effective-comm.htm

  • ADA and Deaf and Hearing Impaired

www.ada.gov/hospcombr.htm

 

Tax Credit and Deduction

http://www.ada.gov/taxcred.htm

  • To assist small businesses to comply with the ADA, the Internal Revenue Service (IRS) Code includes a Disabled Access Credit (Section 44) for businesses with 30 or fewer full-time employees or with total revenues of $1 million or less in the previous tax year.
  • Eligible expenses may include the cost of making material available in accessible formats such as Braille, audiotape, or large print and sign language interpreters

 

 

After a patient with a visual impairment leaves their doctor’s office or is discharged from a health care facility and is unable to read the doctor’s orders or discharge plans, how can they be expected to follow the doctor’s orders, improve health outcomes and avoid rehospitalization?

 

Reasonable Accommodation Requirements

 

Doctor’s Office

  • Provide assistance with filling out paperwork
  • Doctor’s orders, test procedure instructions, prescription information, etc should be provided in large print or other accessible format
  • Examination areas need to be wheelchair accessible
  • Efforts must be made to communicate with hearing impaired patients

 

Hospitals and Skilled Nursing Facilities

  • Brochures that describe the facility’s services and admission information must be available in an alternate format.
  • Clear paths of travel on each floor are necessary.
  • Menus should be read to patients with visual disabilities.
  • Examination areas and labs must be accessible.
  • Are discharge plans written in large print or other accessible format?
    • How can we expect patients to follow discharge plans if they cannot read and understand them?

 

Note: Assisted Living Facilities must also provide printed materials in alternate format

 

Home Health Care

  • When a home health care patient is given a stack of papers that are difficult to read, how are they expected to improve health outcomes and prevent rehospitalization?
  • Admission booklets and important information on community resources and agency policies need to be available in an accessible format so the patient can refer to them as needed

 

Staff should receive training on the requirements of the ADA and other disability rights laws and working effectively with people with disabilities

 

 

For information on staff training, disability rights laws or to arrange an appointment to review your policies and procedures contact Robert Goodman at 954.806.7321 or rgoodlobby@aol.com.

 

Visit our website at www.americanswithdisabilitiesact.net

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Older Americans Month: Blazing a Trail
Older Americans Month: Blazing a Trail 150 150 Robert Goodman, MSW

Older Americans Month: Blazing a Trail

The Savvy Senior

By Robert Goodman, MSW

 

A recent theme for Older Americans Month in May was “Blazing a Trail”. The focus is on how older adults in our community are leading and inspiring others, how we can support and learn from them, and how we might follow their examples to blaze trails of our own.

Every day I walk around our community I see our residents debunking stereotypes about older adults. I see people in their 80s and 90s in the gym, others are working hard to better our community while many residents are still working either in paid jobs or volunteering. The people participating in the annual resident’s show are certainly an inspiration to us all. All of these residents are blazing a trail for future generations of older adults.

Many retirees are finding new inspiration in second careers, helping others, discovering new interests, and pursuing dreams.

Reinventing yourself can be fun and rewarding.

It is never too late to get more active or revamp your diet. It

Securing your financial future and improving your health and diet are also part of the “Blazing the Trail” theme.

Getting involved in your community means working to make a difference in the lives of community members through volunteering. Older Americans are volunteering in higher numbers than ever before.

Beyond helping and the people around you, being involved in your community benefits you. From preventing mental health issues by engaging in meaningful work to the physical benefits of being active and social, civic engagement is a win-win. It is never too late to give back!

Another way to spend your time and give back to the community is by volunteering. There are many volunteer opportunities available. You can start by volunteering in your own community.

I have recently been involved with SCORE, the Service Corp of Retired Executives. They are a wonderful organization with dedicated volunteers who make themselves available to help up and coming entrepreneurs. SCORE offers information and assistance for a business or business idea. Every month SCORE provides FREE counseling to hundreds of budding entrepreneurs in the South Florida area. They also offer a variety of workshops. If you have at least 10 years of business experience as an owner, officer of your own business, or served at mid-level management or higher in the corporate world, and would enjoy helping men and women seeking to start or grow their own businesses, call SCORE at 561-981-5180.

The local hospitals use volunteers for a variety of patient related duties, like answering phones, transporting patients, and delivering flowers.

Other volunteer opportunities include organization such as the American Red Cross, agencies working with seniors, literacy coalitions and hospice.

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A Neighbor Needs Help
A Neighbor Needs Help 150 150 Robert Goodman, MSW

The Savvy Senior

By Robert Goodman, MSW

A Neighbor Needs Help

 

Perhaps you know of someone who can no longer take care of him/herself and has no one to help. Or perhaps you know of someone who is getting inadequate help. The question you need to ask is, does this person pose a danger to him/herself (or others)?

We all want to live independently for as long as we can. The idea of going into a nursing home is a horrible thought. Even assisted living is not considered a viable option by many. Families don’t want to institutionalize their loved ones. An aide 24/7 may not always be the best answer. So, what do we do?

First, we are our neighbor’s keeper. If you suspect a neighbor is having difficulty taking care of him/herself you may want to voice your concern to a friend or member of the family. If no one is taking responsibility and that person is in need of help you can call a local social service agency or call your state abuse hotline (1.877-Elder80). You can call anonymously. The Elder Protection Center www.elderprotectioncenter.com lists the elder abuse hotlines for each state.

Here are some indicators that there may be a need for intervention:

1. APARTMENT:

· Garbage piling up in the apartment.

· Hazardous living conditions due to lack of repairs, utilities and/or equipment

· Human excrement on floors and furniture

· Evidence of obvious fire hazards, such as piles of boxes, newspapers, old clothes, blocked exits

2. FOOD AND CLOTHING:

· Little or no food in the house

· Food is spoiled or lying around

· Insufficient/inappropriate clothing for the weather

When calling the Florida Abuse Hotline to report personal neglect (or abuse or exploitation), be prepared to provide the following information:

1. Person’s name, address or location, approximate age, race and sex;

2. Physical, mental or behavioral indications that the person is infirm or disabled;

3. Signs or indication of harm or injury or potential harm or injury (physical description or behavioral changes);

4. Relationship of the person responsible for the senior’s care, if known. If the relationship is unknown, a report will still be taken if other reporting criteria are met.

The state agency assigned to investigate elder abuse will conduct an investigation of all reports received that alleges self-neglect by a vulnerable adult. The purpose of the investigation is to determine if there is evidence that a person is a danger to him/herself, and if assistance is necessary to protect the individual’s health and safety.

A protective investigator from the department will make face-to-face contact with the vulnerable adult within 24 hours of receiving an abuse, neglect or exploitation report. The protective investigator will interview all people who may have knowledge of the victim’s situation, evaluate the information obtained, and make a decision as to whether the reported allegations did or did not occur. The investigator then refers the case to an agency for

follow up so the victim can get the services s/he needs to be safe. This may include placement in a more suitable living environment.

Remember to report abuse, neglect, self-neglect, or exploitation call your state Abuse Hotline. Help your neighbors who cannot help themselves.

Many 211 services have a telephone reassurance program for those who are homebound.

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Aging is Not for the Faint Hearted
Aging is Not for the Faint Hearted 150 150 Robert Goodman, MSW

Aging is Not for the Faint Hearted

The Savvy Senior

By Robert Goodman, MSW

 

You’ve heard the expression “aging is not for sissies”. It’s true. It takes a lot of energy to successfully age. Everyone ages differently. Our bodies go through many modifications as we age. These include changes in memory, bone health, hearing, vision, taste and smell. Our skin also can be affected by too much sun. It is important to stay out of the sun as much as possible and keep covered.

Changes in memory are a normal part of aging. As we get older, we may become more forgetful and feat that we are getting Alzheimer’s Disease or other types of dementia. However, scientists now know that people can remain both alert and able as they age, although it may take them longer to remember things. Engaging in new activities or doing crossword puzzles are ways to keep your mind alert and active.

The weight-bearing bones and the movable joints undergo much wear and tear as the body ages. The most common age-related conditions are osteoporosis and arthritis.

The question is how to cope and adjust to these changes. Here are some suggestions.

Regular physical, dental and eye exams are important to catch any problems early. Following doctor’s orders and treatment regimens are crucial to staying healthy.

It is important to stay active. Exercise is important to keep your body in good condition. Exercises can be vigorous or non-strenuous, like chair exercises. Exercise is also important to prevent falls. Falls are the leading cause of injury and death among older adults.

Volunteering your time to help others is another way of staying active. There are many volunteer opportunities in your community.

One of the hardest things to adjust to is giving up driving. People feel they are giving up their independence. No one wants to be dependent. However, many larger communities offer public transportation and special transportation services (paratransit) for people with disabilities who cannot use regular public transportation.

As we age, one of our biggest fears is becoming dependent on others. Don’t be afraid to ask for help if needed. There are many social services available to provide assistance. Family members and friends may be available to help but you need to let them know what your needs are. If you find yourself in a situation where you need assistance, make a list of the types of assistance you need, who might be available to help and ask them when and how often they can help.

Depression can result when we feel we are losing control over the changes in our lives. It is okay to ask for help. Many services are available in the community to help older adults cope with loss and grief and other changes. These agencies offer individual and group counseling. Support groups can also be of help. Sharing your thoughts with others can be cathartic. There are support groups for people who are experiencing a loss. Depression can be treated.

There are many services in the community to help us age gracefully. Call 211 or the Elder Helpline at 800-677-1116. There are some very good websites on this topic. Do a search for coping with age-related changes and you will find many resources on aging. Two excellent websites on coping with changes as we age are www.familycaregiversonline.net and www.nlm.nih.gov/medlineplus/magazine/issues/winter07/articles/winter07pg10-13.html

Florida Navigator
Americans with Disabilities Act
Robert Goodman, MSW

Location:

4037 Wolverton B
Boca Raton, FL 33434

Phone:

954-806-7321

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