Table
of Contents
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Preface |
xv |
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1 |
The Invisible Army |
1 |
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Eldercare Myths and Misperceptions |
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Myth #1: Dementia is an Expectable Part of Aging—Especially in
Our Eighties and Beyond |
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Myth #2: Medicare Covers Most of the Cost for in-Home Care |
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Myth #3: Assisted Living Provides Round-the-Clock Access to
Medical Care |
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Myth #4: All Nursing Home Residents are Senile or Demented |
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Myth #5: Nursing Home Residents have Few Legal Rights |
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Myth #6: Nursing Homes Only Offer Basic Care—No Frills Required |
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Myth #7: Once You Enter Hospicej
There’s Only One Way Out: Feet First |
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A Framework for Caregiving |
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Plan Ahead |
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Get Advice |
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Get Others Involved |
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Keep Colleagues Informed |
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Take Care of Yourself |
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Put Things in Perspective |
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2 |
When Someone You Love Just Can’t Make it Alone: Signs and Symptoms, Strategies
and Solutions |
10 |
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Common Signs of
Functional Decline |
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What Factors Contribute to
Functional Decline? |
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Physical Changes |
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Perceptual Changes |
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Cognitive Changes |
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Psychological Changes |
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Distinguishing Temporary Decline from
Long-Term Deterioration |
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Seeking a Diagnosis and Beginning Treatment |
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Learning About the Illness and Planning Ahead |
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Considering Psychological Factors |
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Getting Your Loved One to See the
Doctor |
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Getting Your Loved One to See a Mental
Health Professional |
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The Emotional Side of Caregiving: Changing Roles |
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The Adult Child’s Perspective |
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The Spouse’s Perspective |
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The Sibling’s Perspective |
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Caregiver Stress and its Effects |
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Emotional Signs |
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Physical Symptoms |
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Cognitive Signs |
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Coping with Stress Before it
Overwhelms You |
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3 |
In-Home Care: Autonomy, Continuity, and a Bit of Extra Help |
30 |
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Finding and Funding Good in-Home Care |
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Who may Provide In-Home Care? |
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Certified Home Health Care Agencies |
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Independent Providers |
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How to Evaluate an Agency or Provider |
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Questions to Ask the Agency |
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Questions to Ask the Independent Provider |
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Questions to Ask Former Clients and their Families |
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Caregiver Qualities You’ll have to Assess Yourself |
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The Trial Period |
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When More than One Person Needs Care |
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When Problems Arise during in-Home Care |
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Important Warning Signs of a Poor Home-Care Worker |
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Confronting a Poor Caregiver |
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Signs of Abuse, Neglect, or
Exploitation |
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Physical Symptoms |
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Psychological Symptoms |
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Financial Signs |
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Reporting Abuse, Neglect, or
Exploitation |
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4 |
When in-Home Care Becomes Impossible: Screaming, Crying. Fighting…and Moving On |
48 |
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Talking About Options with Other
Family Members |
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Beginning the Discussion |
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Exploring Possibilities |
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Building Consensus |
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Turning Thoughts into Actions |
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Raising the Issue with the Care
Receiver |
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Who should Participate? |
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Where should You Meet? |
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When should You do It? |
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Common Care-Receiver Objections |
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Excuses |
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Guilt-Tripping |
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Threats |
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Recognizing and Accepting the Person’s
Fears |
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Developing a Partnership with the Care
Receiver |
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When Your Loved One is Determined to
Disagree |
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The Concept of Competency |
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If You’re in Charge |
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5 |
Choosing the Right Placement Setting: Thinking Clearly in the Midst
of Chaos |
66 |
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Varieties of Placement Settings |
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Senior Communities |
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Group Homes |
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Assisted Living Facilities |
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Skilled Care Facilities |
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Long-Term Care |
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Continuing Care Communities |
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Obtaining Information About a Specific
Setting |
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Getting Technical Ratings |
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Talking to Administrators |
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Talking to Residents and their Families |
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Inspecting the Facility |
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The Physical Setting |
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The Milieu |
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The Intangibles |
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Funding: Who Pays for What? |
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Medicare |
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Medicaid |
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Medigap Insurance |
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Secondary Insurance |
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Long-Term-Care Insurance |
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Veteran’s Benefits |
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What if We Run Out of Money? |
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Must the Nursing Home Get it All? |
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6 |
Leaving Home for the Nursing Home: Preparing for the Dreaded Day |
91 |
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Psychological Preparations |
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Discussing Last-Minute Fears and Concerns |
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Avoiding Last-Minute Surprises |
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What to Pack (and Leave Behind) |
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Clothing |
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Toiletries |
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Familiar Items |
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Orienting Cues |
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Legal Preparations |
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Last will and Testament |
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Advance Directives |
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Power of Attorney |
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Funeral Arrangements |
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Financial Preparations |
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Budgets |
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Banking, Bills, and Taxes |
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Asset Management |
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Preparing the House |
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If the House will be Unoccupied |
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If Someone will Remain in the Home |
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7 |
Anxiety Anger, Fear, and Guilt: Adjusting to the New Situation |
110 |
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Common Reactions to Placing
a Family Member in a Nursing
Home |
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Adjusting to the Nursing Home: The
Resident’s Perspective |
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The Arrival |
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The Settling-In Period |
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Long-Term Adjustment |
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Building New Routines in a Changing Relationship |
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Visits in the Nursing Home |
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The Rhythm of the Nursing Home |
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Timing of Visits |
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Length of Visits |
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Who should Go? |
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What should You Do? |
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The |
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Leaving and Returning: Practical
Considerations |
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Sign-Outs |
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Equipment |
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Medications |
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Getting Out the Door (and Back in at the End) |
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Staying Connected Between Visits |
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Telephone Contact |
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Contact by Mail |
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E-Mail |
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Establishing a Communication Routine |
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8 |
Confrontation or Partnership—Its Up to You: a Down-and-Dirty Guide to
Nursing Home Politics |
130 |
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Nursing Home Staff: The Cast of
Characters |
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Administrators |
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Physicians |
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Nursing Staff |
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Social Services |
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Dietary Services |
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Activities Services |
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Pastoral/Clergy |
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Therapies and Ancillary Services |
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Housekeeping and Maintenance |
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Allied and Support Services |
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Admissions, Billing, and Human Resources |
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Interfacing with Staff: Your Arenas of
Influence |
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Admission Review Meetings: Where Plans are Formed |
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Care Plan Meetings: Where Decisions are Made |
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Resident and Family Councils: Where Concerns are Voiced |
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Interactions with Caregivers: Where Family and Staff Connect |
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Constructive Interventions: How to Get
What You Want (And be Loved While You’re Doing It) |
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When Complaining is the Only Way |
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Legal Rights of Residents |
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Legal Rights of Family Members |
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9 |
Old Age Ain’t for
Sissies: Late-Life Medical Problems and How to Deal with Them |
151 |
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The Aging Body: Different Parts Work
at Different Speeds |
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Some Processes Slow as We Age |
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Some Processes Accelerate as We Age |
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Some Things Never Change |
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Common Medical Problems
in Older Adults |
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Dementias and Other Neurological Syndromes |
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Cancers |
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Joint Diseases |
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Skin Problems |
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Vascular and Cardiac Diseases |
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Metabolic and Endocrine Diseases |
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Diseases of the Eye |
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Pulmonary Disease |
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Renal and Urinary Disorders |
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Digestive/Elimination Difficulties |
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Why Treat it if You Can’t Make it
Better? |
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10 |
A Realistic Approach to Behavior Problems: No More Peeing in the
Petunias |
171 |
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Behavior Problems: Causes and
Treatments |
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Common Behavior Problems in Nursing
Home Residents |
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Insulting and Accusing Others |
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Wandering |
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Stealing |
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Hoarding |
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Aggression |
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Repetitive Questioning and Repetitious Behavior |
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Refusing to Eat |
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Noncompliance |
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Inappropriate Elimination |
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Inappropriate Sexual Behavior |
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Hidden Factors that Set the Stage for
Problems |
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Inadequate Staffing |
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Sensory Overload |
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Boredom |
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Medication Problems |
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The Wrong Neighbors |
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Knowing When to Call in the Experts |
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Signs that a Quick Response is Needed |
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What You should Do |
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What Staff will do |
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The Suicidal Nursing
Home Patient |
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What to Look For |
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What to do |
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Maintaining a Good Relationship with the
Troubled Loved One |
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Tips for Adult Children |
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Tips for Spouses |
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Tips for Siblings |
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11 |
When Things Get Better: The Transition Back |
191 |
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Discharge Settings |
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Discharge Planning Meetings |
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Staff Input |
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Family Input |
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Resident Input |
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The Nuts and Bolts of
Discharge: Three Key Tasks |
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Establishing Current Level of Care Needs |
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Determining the Appropriate Setting |
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Establishing Follow-Up Services |
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Legal and Financial Arrangements,
Revisited |
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Legal (re) Arrangements |
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Financial (re) Arrangements |
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Social Security and its Limitations |
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Making the Home Safe and Secure |
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Accessibility |
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Injury Prevention |
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Security |
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Emergency Preparations |
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Orienting Cues and Memory Aids |
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12 |
When It’s Time to Let Go: Hospice and Beyond |
211 |
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The Pros and Cons of Aggressive Interventions |
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Arguments in Favor of Aggressive End-of-Life Care |
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Arguments Against Aggressive End-of-Life Care |
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The Hospice Option |
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What is Hospice? |
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What can Hospice Do? |
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Who is Eligible for Hospice? |
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Who Pays? |
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Emotional Reactions to the End of Life |
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The Patient’s Perspective |
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The Family’s Perspective |
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Physical Changes at Life’s End |
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Grieving Your Loss |
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Immediate Reactions |
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Short-Term Coping |
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Long-Term Survival |
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Epilogue |
You’ve Come
this Far and You’ve Survived |
230 |
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13 |
Checklists. Worksheets,
and Resources |
235 |
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Checklists |
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Home Health Care Comparison Checklist |
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Nursing Home Comparison Checklist |
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Personal Documents and Papers |
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What to Bring to the Nursing Home |
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Records a Nursing Home may Request |
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Worksheets |
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Monthly Income and Expenses Worksheet |
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Calculating a Person’s Net Worth |
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Medical/Health History |
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Resource and Contact Information |
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Accessibility/Home Modification |
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Agencies on Aging Contact Information |
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Caregiver Resources/Support |
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Elder Abuse |
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Eldercare Products and Services |
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Financial/Legal Resources |
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Funeral Planning |
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Health Information |
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Home Care Agency Contact/Accreditation Information |
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Hospice Resources |
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Housing/Assisted Living |
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Long-Term-Care Ombudsman Contact Information |
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Medicare, Medicaid, and Other Insurance Information |
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Mental Health Information |
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National Organizations/Advocacy Groups Related to Aging |
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Nursing Home Contact/Accreditation Information |
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Physical and Occupational Therapy |
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Rehabilitation Facilities |
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Tax Information |
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Veteran’s Information/Resources |
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Index |
264 |
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