This post, from a wonderful Blog about caregiving, http://www.letstalkaboutfamily.wordpress.com provides an excellent idea. It’s never too late to start this project for a loved one with Alzheimer’s or other dementia.
Local and Federal governments have more red on their accounting ledgers than black. Citizens balk against any raise in taxes, regardless of how infinitesimal the increase. The same citizens demand more services from their government. How does one get what they need without paying for it?
I’m not a politician – and never will be. I’m not a brilliant person nor do I fully understand all the nuances inherent in government bureaucracies. About this one thing, however, I am absolutely certain: many valuable services that were initially set in place for those considered vulnerable in our society are still desperately needed for even a modicum of dignity and quality of life. Did the needs suddenly disappear? NO. Did the vulnerable in our society somehow experience a miracle and are now fully capable of managing their lives on their own? NO. The needs are still there and the vulnerable in our society are being pushed to the wayside and are slipping through the cracks. Do I like paying taxes? NO. I guess I’m wondering how to generate funds for needed programs without “robbing Peter to pay Paul.” Taking from one program and sliding it over to a different program robs other needed services. If ever there was a Catch-22, this is it.
Let’s look at caregiver training. In Washington State, in the year 1996, caregivers were only required to pass First Aid training, CPR and HIV training, the Fundamentals of Caregiving training (22 hours), and had to successfully pass the State’s criminal background check.
In a Seattle Times article printed January 23, 2000, Push on for more caregiver training, the following statement begins the article:
With a first-aid card and some training about CPR and HIV, you can find yourself a challenging new job caring for the elderly and infirm, bathing them, feeding them, and fielding punches from them. For this you can make about $7.50 an hour. At McDonald’s, you can make more slinging burgers and fries. It’s a wonder anyone cares for the elderly and infirm at all.
The year 2000. For the third time in four years, the Washington State’s long-term-care ombudsman (who is independent of any government agency) pushed for more training for caregivers. “The Legislature and the industry both need to step up and say this is an important key profession…People who take care of human beings are important people.” State bill I-1029 passed which would increase the number of required training hours and implement specialty training for residents with special needs such as dementia, mental health, and developmental disabilities. Implementation of this Bill’s provisions was delayed and set to go into effect March 1st, 2002.
Fast forward to February 2002. Let’s look at another Seattle Times article, Caregiver-training issue causes split in state’s long-term-care community. After the Bill from the year 2000 passed, the Department of Social and Health Services didn’t get the training curriculum revised in time for the March 1st, 2002 implementation so the State Legislature delayed the start-up of the new training requirements to September 1, 2002. Private providers of long-term care – those not accepting Medicaid – would have to foot the bill to provide employee training, most certainly passing the costs along to their residents. Long-term care facilities that accept Medicaid payments would rely on the State Medicaid program to provide the mandatory additional training and the State contended that the budget does not exist to provide the mandated training voted into law from initiative I-1029. Time to go back to the drawing board.
Bear with me. Fast forward to November 2008. Let’s look again at another Seattle Times article, Voters back more caregiver training. In 2008 a revised caregiver training Bill was passed requiring a training increase from 34 to 75 hours for new long-term care workers and required caregivers to undergo a Federal criminal background check. This bill passed overwhelmingly. It’s great that the citizens of my fair State decided that anyone taking care of the vulnerable should be held to a high standard. Oops – in the same voting cycle, initiatives that would have imposed taxes on candy, soda pop, and other piecemeal purchases failed big time. These miniscule, microscopic taxes would have saved vital services for the vulnerable and would have helped the State pay for the “mandated” new training. No money – no increased training – no Federal background checks.
One more time. Fast forward to November 2011. Washington voters asked to boost caregiver training again, Seattle Times. The Legislature delayed the implementation of the 2008 Bill because of budget cuts. And during the voting cycle of 2011, a re-worked caregiver training initiative made it to the ballot once again as Initiative I-1163, right in the middle of an ever-increasing budget crisis, and the Washington State voters overwhelming approved it. Implementation of the new training and background check requirements are set to start in 2012. Lawmakers pushed implementation to 2014 but the good news is that the Legislature won’t be able to delay implementation of the new requirements without a two-thirds majority. As of March 1, 2012 – the Washington State legislature has yet to finalize any enactment of the Bill protecting vulnerable adults; those that the voters of my state approved – and voted for – numerous times since the early 1990’s…stay tuned…
WHAT’S HAPPENING IN YOUR STATE?
HOW IS YOUR STATE PROTECTING YOUR VULNERABLE ADULT POPULATION?
I’ve found the Alzheimer’s Reading Room to be very helpful in my efforts to continually improve my understanding of Alzheimer’s and other dementia. The good news? Subscribing to the Reading Room is free! I hope all benefit from this attached article about dementia in the 21st century.
No is the biggest, most frequently used word in the Alzheimer’s World Dictionary. This article, reblogged from the Alzheimer’s Reading Room, addresses the difficulties of communicating with a person with dementia. Remember – don’t always take No for an answer.
Most people don’t want to talk about end-of-life issues but all of us know it’s a topic requiring early discussion and appropriate timing to be of any use when emotional, and sometimes emergent, decisions must be made.
My siblings and I benefited from my parents’ end-of-life documents that dictated their wishes should we need to become involved. My mother died in her sleep in 1994 so no active involvement was necessary but my father, suffering with Alzheimer’s for five years by the time he died in 2007, gave us a gift by spelling out in detail his end-of-life wishes set in place at least a decade before he died. Think of an Advanced Directive or Living Will as a gift to your loved ones. It certainly was a gift to my siblings and me.
An organization in Washington state, Compassion & Choices, worked with Seattle University Clinical Law Professor, Lisa Brodoff, to create a new advance directive for people with Alzheimer’s and other dementia. This same law professor was instrumental in the passage of legislation in Washington State creating the Mental Health Advance Directive for people with mental illness. This statute is considered to be model legislation for other states wanting to expand the rights and planning options for people with mental illness. Bravo Washington State!!!
Although not yet available, the new Alzheimer’s/Dementia Advance Directive will be based on one created by Professor Brodoff for a 2009 Elder Law Journal article titled (excerpt attached): Planning for Alzheimer’s Disease with Mental Health Directives. The new Alzheimer’s/Dementia advance directive is not intended to replace existing end-of-life documents such as a Living Will and/or Durable Power of Attorney for Health Care, but is designed to work in concert with those documents to ensure that any issues important to the patient with dementia that are not addressed in standard advance directives are honored as much as possible.
What additional issues are addressed in the new advance directive for those with Alzheimer’s or other dementia?
Potential issues that might be addressed are preferences regarding:
- care in and outside of the home;
- financing of said care;
- caregiver choices;
- involuntary commitment;
- consent to participation in drug trials;
- suspension of driving privileges; and
- any future intimate relationships.
To get on the mailing list in Washington state to receive a copy of the new advance directive contact Compassion Washington: by email, info@CompassionWA.org or by calling their office at: 206.256.1636 or Toll free: 1-877-222-2816. At the very least, regardless of where you live, using their model as a guide when creating your own Advance Directive may be helpful when such Directive affects the life of a loved one with dementia. Being prepared for the unexpected, or even what you indeed suspect might be a future health issue, provide peace of mind for the patient and for his or her caregiver.
That’s a priceless gift to be sure.