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Robert Goodman, MSW

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The 5 Stages of Grief
The 5 Stages of Grief 150 150 Robert Goodman, MSW

The 5 Stages of Grief

The grief that follows the loss of someone or something dear to us can seem unbearable, but grief is actually a healing process. The death of a loved one, loss of a limb, even intense disappointment can cause grief. Dr. Elisabeth Kubler-Ross has named five stages of grief people go through following a serious loss. Sometimes people get stuck in one of the first four stages. Their lives can be painful until they move to the fifth stage—acceptance.

Five Stages Of Grief

  1. Denial and Isolation. At first, the grieving person tends to deny the loss has taken place and may withdraw from usual social contacts. This stage may last a few moments or longer.
  2. Anger. The grieving person may then be furious at the person who inflicted the hurt (even if that person is dead), or at the world, God, or him/herself for letting it happen even if realistically nothing could have stopped it.
  3. Bargaining. Now the grieving person may make bargains with God, asking, “If I do this, will you take away the loss?”
  4. Depression. The person feels numb although anger and sadness may remain underneath.
  5. Acceptance. Anger, sadness, and mourning have tapered off. The person simply accepts the reality of the loss.

Grief And Stress

During grief, it is common to experience feelings such as sorrow, anger, loneliness, sadness, shame, anxiety, and guilt. When people suggest “looking on the bright side,” the grieving person may feel pressured to hide or deny these emotions. Denying these feelings and failing to work through the five stages of grief will make it harder for healing to take place.

Recovering From Grief

Grieving and its stresses pass more quickly with good self-care habits. It helps to have a close circle of family or friends. Seek out bereavement support groups (see pg 51), including those online. Eating a balanced diet, drinking plenty of fluids, exercising, and resting are critical. If good self-care habits are practiced, it can be very helpful in dealing  with the pain and shock of loss until acceptance is reached.

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What is Caregiver Stress?
What is Caregiver Stress? 150 150 Robert Goodman, MSW

 
Caregiver stress is the emotional and physical strain of caregiving. It can take many forms. As a caregiver you may feel:
· Frustrated/angry taking care of someone with dementia who often wanders away or becomes easily upset
· Guilty because you think that you should be able to provide better care
· Lonely because all the time you spend caregiving has hurt your social life
· Exhausted when you go to bed at night
These negative feelings coupled with not taking good care of yourself can lead to serious health issues.
Tips for reducing stress: Search out caregiving support groups, ask for and accept help, say “no” to outside requests that are draining, don’t feel guilty if you are not a “perfect” caregiver, set realistic goals, establish a daily routine, make time to do something for yourself, try to stay physically active, eat healthy, and get enough sleep.
Although caregiving can be challenging, it also has its rewards. It can provide a feeling of giving back to a loved one and of feeling needed—both which can lead to a stronger relationship with the person being cared for. To read more about caregiver stress, visit Womenshealth

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What is a Caregiver?
What is a Caregiver? 150 150 Robert Goodman, MSW

A caregiver is anyone who provides help to another person in need. Usually, that person has a serious health condition and needs help with basic daily tasks. Caregivers help with things such as: shopping, cooking, paying bills, giving medicine, bathing, toileting, dressing, eating, and more.

People who are not paid to provide care are known as informal caregivers or family caregivers. The most common type of informal caregiving relationship is an adult child caring for an elderly parent. Others include:

  • Adults caring for other relatives, ie, grandparents, siblings, aunts/uncles
  • Spouses caring for husbands/wives
  • Middle-aged parents caring for disabled adult children
  • Adults caring for friends/neighbors
  • Children caring for a disabled parent or elderly grandparent.

 

What is Caregiver Stress?

 

Caregiver stress is the emotional and physical strain of caregiving. It can take many forms. As a caregiver you may feel:

  • Frustrated/angry taking care of someone with dementia who often wanders away or becomes easily upset
  • Guilty because you think that you should be able to provide better care
  • Lonely because all the time you spend caregiving has hurt your social life
  • Exhausted when you go to bed at night

These negative feelings coupled with not taking good care of yourself can lead to serious health issues.

Tips for reducing stress: Search out caregiving support groups, ask for and accept help, say “no” to outside requests that are draining, don’t feel guilty if you are not a “perfect” caregiver, set realistic goals, establish a daily routine, make time to do something for yourself, try to stay physically active, eat healthy, and get enough sleep.

Although caregiving can be challenging, it also has its rewards. It can provide a feeling of giving back to a loved one and of feeling needed—both which can lead to a stronger relationship with the person being cared for. To read more about caregiver stress, visit www.womenshealth.gov/faq/caregiver-stress.cfm

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Caregiver Basics
Caregiver Basics 150 150 Robert Goodman, MSW

by Robert Goodman, MSW

Are you a caregiver? If you are helping a spouse, parent, child, or other relative or friend perform activities of daily living (eating, walking, bathing, dressing, grooming) then you are a caregiver. Family caregivers are the backbone of the nation’s long term care system. November is National Caregivers Month and Alzheimer’s Month. Many caregivers are caring for someone with Alzheimer’s or other types of dementias.
The first rule of caregiving is to take of yourself. If you are not healthy, then the person you are caring for won’t get the care he/she needs. Take breaks (even walking outside for 5 minutes), exercise, talk to a friend, eat healthy, and reduce stress. Caring for yourself makes you a better caregiver.
The Alzheimer’s Association recommends several things that a caregiver needs to do to be an effective caregiver:

  1. Understand what is going on as soon as possible
  2. Become an educated caregiver about the illness or disability of your loved one
  3. Accept changes as they occur
  4. Make legal and financial plans
  5. Give yourself credit, not guilt
  6. Visit your own doctor regularly

It is very important to know about community resources. People hear this term and immediately think of people who are sick, disabled, or poor. But community resources include government services such as offices that provide driver’s licenses, homestead exemptions, voter registration, or other government or non-profit agencies that help everyone in the community. They also include services for people who might be sick, disabled, or poor.
There are many agencies and organizations in our area that provide support and services for caregivers. There are support groups where members share their concerns, ideas, and frustrations relating to being a caregiver.
There are ten indicators of caregiver stress according to the Alzheimer’s Association: denial, anger, social withdrawal, anxiety, depression, exhaustion, sleeplessness, irritability, lack of concentration, health problems. If you are experiencing any of these symptoms on a regular basis it is time to ask for help from a doctor or mental health professional.
If you need help, ASK FOR IT! There is no shame in asking for help. That help might include emotional support (counseling), respite, or hiring another to share the caregiving duties.
In a previous column I discussed support groups. These are important to help you learn to be a better caregiver. Several organizations sponsor caregiver support groups. These include: Alzheimer’s Association, American Cancer Society, American Heart Association, National Parkinson’s Foundation, and others.
Resources for Caregivers:
For general information on services in the community call:

  • Information and referral 211
  • Area Agency on Aging (Elder Helpline) 561-684-5885 

 

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Do I Need the Emergency Room?
Do I Need the Emergency Room? 150 150 Robert Goodman, MSW

Do I Need the Emergency Room?

The answer is yes…if your condition is/can quickly become life threatening or if you suddenly or intensely experience any of the following:

  • Pain or pressure in chest
  • Pain or pressure in upper stomach
  • Trouble breathing or shortness of breath
  • Loss of consciousness or fainting
  • Sudden numbness or weakness
  • Confusion, change in mental state
  • Sudden change in vision
  • Trouble speaking
  • Sudden severe headache (with no history of migraines)
  • Serious injury to the body
  • Uncontrolled bleeding
  • Major broken bones
  • Seizures
  • Severe reaction to an insect bite/sting, medication, or food
  • Suicidal thoughts
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Home Health Care and Medicare
Home Health Care and Medicare 150 150 Robert Goodman, MSW

by Robert Goodman, MSW

Medicare covers home health care services for someone meeting these conditions:

  1. Your doctor must decide that you need medical care at home, and make a plan for your care at home.
  2. You must need intermittent skilled nursing care, physical therapy, speech-language therapy, or to continue occupational therapy.
  3. The home health agency caring for you must be approved by the Medicare
  4. You must be homebound, or normally unable to leave home without help.

If you meet all four of the conditions above, Medicare will cover the following types of home health care:
·        Skilled nursing care
·        Home health aide services
·        Physical therapy, speech-language therapy, and occupational therapy
·        Medical social services
·        Certain medical supplies
·        Durable medical equipment
·        Medicare does not cover homemaker services like shopping, cleaning, and laundry; and
·        Personal care given by home health aides like bathing, dressing, and using the bathroom when this is the only care you need.
There are several types of home care providers. Only Medicare approved home health care agencies are covered by Medicare. Private pay services include nurse registries and companion services. There are some private pay home health agencies that provide the services listed above.

 

Companion/Homemaker: Services include companionship, errands, escorts, meal preparation, and homemaking.
Home Health Agency: Recruits, screens, and hires their staff as employees. Services include home health care, skilled nursing, physical/occupational/speech therapy, companions, homemakers. May provide 24-hour live-in aides.
Nurse Registry: Recruits, screens, and refers aides, who are independent contractors, to clients. Services include nurses, respite care, home health aides, companions, homemakers, and 24-hour live-in aides.
 
There are many different types of personnel who may be handling your care. Besides therapists and social workers there are different types of home care workers who may come into your home.
Companion/Homemaker May do the following: Prepares/serves meals, does housekeeping, and accompany client on errands/trips. The Companion/Homemaker must have some training in topics related to human development and interpersonal relationships, nutrition, marketing, food storage, use of equipment and supplies, planning and organizing of household tasks, and principles of cleanliness and safety.
 
Home Health Aide (HHA) In addition to the services provided by a Companion/Homemaker, a HHA may provide “hands on” personal care, which includes assistance in the activities of daily living, such as bathing, grooming, dressing, personal hygiene, eating, and assistance in physical transfer and ambulation. Some HHA’s can be trained to supervise medication. Most HHA’s have a high school diploma, although it is not required. To work for a Medicare or Medicaid home health agency, a HHA must complete 75+ hours of training or successfully complete a competency evaluation given by the home health agency.
Certified Nursing Assistants (CNA) provides the same types of services as the Home Health Aide, but the CNA is certified by the state, a high school or G.E.D is required, and typically receives a higher rate of pay. The programs are 6-12 weeks in length and include “hands-on” caregiving experience.
Licensed Practical Nurse (LPN) provides services such as monitoring vital signs, preparing and giving injections, enemas, help in the evaluation of the needs of the client, and supervising nursing assistants and aides. LPN’s can also be involved in teaching and training family members in simple nursing tasks. LPN’s must go through a State-approved Nursing Program.  
Registered Nurse (RN) works to promote health, prevent illness, educate patients and families, and develop/manage nursing care plans. RN’s are educated in the science and theory behind the care they are administering and supervising. The RN assessment involves a more holistic approach to evaluating the patient, making sure both their physical and psychological needs are being addressed.
For more information log onto www.medicare.com/hhcompare

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Community Housing: What are My Options?
Community Housing: What are My Options? 150 150 Robert Goodman, MSW

Community Housing: What are My Options?

Independent Living Communities

Community housing for seniors who are able to live independently in an apartment-like setting. Optional services include: meals in communal dining room, housekeeping/laundry. Social and recreational activities often provided.

Adult Family Care Home Provides a family-type living arrangement in a private home for up to five aged or disabled people. Services include meals, medication management, arranging for health care services, health monitoring, social activities, and help with ADLs (bathing, dressing, eating, walking, etc).

Assisted Living Communities Provides housing in private or shared individual apartments for those who cannot live independently but don’t need skilled nursing care. Services include, but are not limited to, those listed above.

Skilled Nursing Facility/Residence (aka Nursing Home) Provides housing for those who need 24-hour nursing/personal care. Medicaid may offer coverage to residents who meet medical and financial eligibility requirements.

Continuing Care Retirement Communities Offers multiple levels of care (independent living, assisted living, skilled nursing) housed in different areas on the same grounds giving residents the opportunity to remain in the same community if their needs change.

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What are Advanced Directives?
What are Advanced Directives? 150 150 Robert Goodman, MSW

Advanced Directives are specific instructions, prepared in advance, that are intended to direct your medical care if you are unable to communicate your wishes due to a serious accident or illness.

Examples of Advanced Directives are:

 

Verbal instructions Decisions regarding care that are communicated verbally to health care providers or family members.

Organ donation Removal of healthy tissues from the person who has died for transplantation into a recipient in need. Becoming an organ donor is as simple as completing an organ donation card and carrying it in your wallet. Register online at www.flhsmv.gov/HTML/organ_donor.html

Living Will A legal document that spells out the types of medical treatments and life-sustaining measures you do and do not want, such as mechanical breathing (respiration and ventilation), tube feeding, or resuscitation.

Healthcare Surrogate (aka Medical Power of Attorney) A legal document that allows you to appoint someone else (proxy) to make medical/health care decisions in the event you become unable to make or communicate such decisions.

DNR (Do Not Resuscitate) Order. This states that CPR is not to be performed if breathing stops or heart stops beating. The order is written by the person’s doctor after discussing the issue with the person, the proxy, or family.

 

Who Should Get Copies of Documents?

Provide copies of all documents listed here to family members/healthcare surrogate and health care providers. Carry a copy in your wallet, glove compartment of car, and/or other safe location. For a planned admission to a hospital, bring copies for the hospital to include in the medical chart.

Making Changes

These decisions can be changed at any time. Remember to inform healthcare providers, proxies, and family members about the changes made and distribute new copies of instructions to everyone involved.

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What is Guardianship?
What is Guardianship? 150 150 Robert Goodman, MSW

A guardian can be either an individual or an institution such as, a bank trust department. A guardian is appointed by the courts when an individual has been adjudicated as incapacitated or lacking the capacity to care for self and/or estate matters.

Types of Guardianships
The two most common types of guardianship are limited and plenary.
· In a limited guardianship, the guardian assumes only the delegable rights specifically given by a court order. The ward keeps all other decision-making rights not specifically outlined by the court.
· In a plenary guardianship, the guardian’s delegable rights can  be applied to the person, their estate, or both.

Guardianship of the Person
Guardianship of the person may include:
· Determining and monitoring place of the  ward’s residence
· Consenting to and monitoring medical treatment and non-medical services such as education or counseling
· Releasing confidential information
· Making end-of-life decisions
·  Maximizing independence for the ward

Guardianship of the Estate or Property
Guardianship of the estate or property may include anything that is the subject of ownership whether tangible or intangible. The court may order the guardian to take control of and be responsible for the following:
· Acting as representative payee
· Determining benefits
· Obtaining appraisals of property
· Protecting property and assets from loss
· Receiving income for the estate
· Making appropriate disbursements

Alternatives to Guardianship
Because establishing a guardianship is highly intrusive and involves the removal of rights from an individual, it should be considered only after other alternatives have been examined. When an individual still retains the capacity to act on his/her own behalf, the following may be evaluated and determined as viable alternatives to guardianship:
· Case/Care Management
· Health Care Surrogacy
· Living Trusts
· Durable Powers of Attorney
· Living Wills
· Joint Tenancy
· Community Services

Source:
Broward County Guardianship Association www.guardiansofsfla.org

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Adjustment to Disability
Adjustment to Disability 150 150 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 particular disability
·         Coping abilities of the patient and family
·         Previous attitudes toward disability and illness
·         Reactions 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 Area Agency on Aging (Elder Helpline) 561-684-5885
 
For people with certain health conditions:
Alzheimer’s Association 24-Hour Crisis Line 1-800-272.3900
 
American Parkinson’s Disease Association
954-786-2305
Arthritis Foundation
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
Radio Reading Service 800-273-6677
 
For people with hearing impairments:
Deaf Service Center 561-278-6444
 
Caregiver assistance and support:
Palm Healthcare Foundation 561-840-4222
Caregiver Magazine www.caregiver.com
National Family Caregiver Association 800-896-3650
Well Spouse Association 800-838-0879
 
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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Robert Goodman, MSW

Location:

4037 Wolverton B
Boca Raton, FL 33434

Phone:

954-806-7321

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