Erica Karp of Evanston acts exactly like the kind of lively, warm, efficient daughter who would be good to parents in their fading years, talking to them, listening, encouraging, advising and pitching in to help them deal with their growing list of problems. It`s her job.
Karp, 43, runs Northshore Eldercare Management (her motto: ”Helping families care for older relatives.”) At $70 an hour, it is work that requires patience, empathy and humor. She talked about it the other day over juice, coffee and pastry at a meeting of the Provider Council, an association of eldercare suppliers, held at the Glencrest Nursing Center in Rogers Park.
”Usually,” she said, ”I`m hired by a grown child. One who is concerned about a change in functioning in a parent or other relative. They want an honest opinion of what`s going on and what can be done to help.
”Most times, the call comes during a crisis. A relative gets sick, forgetful, or messy, and needs help. Most callers live out of town. They want someone nearby who can do what they would do if they were there. Or they find themselves overwhelmed. Trying to do everything. Feeling guilty. Not knowing if they`re doing enough. Or doing the right thing.”
In one of 300 cases she has handled in the last eight years, a 79-year-old woman was discharged from a psychiatric unit after treatment for manic depression and an ailing leg. Concerned about the risk of suicide, the woman`s doctors warned against letting her live alone at home. Her two children, who lived far away, needed a placement home.
Working with the woman`s psychiatrist, Karp found a facility that offered individual attention and a good rehabilitation department.
She also lined up a former neighbor who agreed to take the woman to doctor appointments, providing transportation and a way to keep her old social network alive. Later, the woman moved into a congregate-living facility, with separate living quarters and a common dining room. ”It worked out well,”
Karp said. ”The woman could take walks, read books, go down for meals.”
”Erika does fabulous work. I`ve seen her first-hand,” said Naomi Moskowitz, health-promotions director of Plaza on the Lake, a retirement residence at 7301 N. Sheridan Rd.
”The important thing is her individual manner of relating to another human being,” said Josephine Stewart, northeast regional director of the Chicago Department on Aging, and host of the meeting at the Glencrest.
When Marge Kountzman moved to California, she hired Karp to manage the care of her mother, 81 and ailing from dementia, Parkinson`s disease and diabetes. The mother wanted to stay in the Lake Bluff home she loved, so Karp found in-home help to clean, make meals and handle nursing care. She drove the mother to appointments and later found a lawyer to help with legal issues.
In another case, an elderly client wanted to move closer to her daughter. Karp packed the client`s home, shipped her effects and had a colleague in the daughter`s city line up a nursing home.
Another time, a colleague in Boston referred an elderly couple in Chicago to her. The man had dementia, the woman couldn`t walk. They had in-home help, but were dissatisfied with their cooking and cleaning. Karp found a team with higher standards, hired a visiting nurse, set up schedules with the couple`s doctors and monitored the results to reassure the daughter in Boston.
Family baggage
A former psychiatric social worker, Karp said she moved into the eldercare field ”because I liked working with elderly patients.”
Her 8-year-old firm is part of the National Association of Private Geriatric Care Managers, based in Tucson. In the last decade, the association, which has 400 members, including a dozen in the Chicago area, has ”grown quickly,” Karp said.
Typically, Karp spends an hour a week with each client, though in special cases, such as a move, she has spent as many as 25 hours on one case in a short stretch. Much depends on empathy and psychology. One New York eldercare manager, Lenise Dolen, often finds herself on teleconference calls with grown children scattered across the country. Finding out what they want can be tricky, Dolen says, ”because not every family is a Walt Disney family.”
In such situations, the association suggests, it helps to have a trained outsider who comes to the phones without the burden of family baggage.
As Karp noted, eldercare managers also tend to have impressive rotary card files, filled with phone numbers for nursing homes, in-home services, adult day-care centers, assessment centers, medical services, hospice services and professional consultants.
Eldercare managers know how to rate facilities for the elderly. They`ll do it themselves, often making unannounced visits to check up on care and service.
Or, for people who want to cut costs by doing the leg work, eldercare managers give their own street-smart advice, sliding between the languages of doctors, lawyers and bureaucrats.
Surrogate sibling
They also know how to relate to elderly clients who may be hard of hearing and tough to understand.
In Karp`s case, not every client knows why she is there.
”One client, a little vague, sensed that I was hired to help with things,” Karp said, ”but she didn`t really track why this person was arriving to take her to the dentist, buy a coat for her when it was cold or bring new underwear. She didn`t complain. She just didn`t really understand it.”
Othring business hours.”
”I`m really more of a surrogate sibling to the grown child than a surrogate child to the parent,” she said. Often, mothers and fathers who are draining to their children turn out to be charming to her. The reason, she suggests, is that there is no emotional baggage. ”Your mother is very interesting,” she told one client who, astonished, blurted out, ”She is?”
”Children burn themselves out trying to do more than anyone could expect to reach a mythical breathrough and have a parent say, `I love you,` ” Karp said. Some parents simply can`t do that. ”Unfortunately, unlike the movies, that rarely happens,” she said. ”I help children grieve over the loss of the love they felt they never had.”
It`s better, Karp suggested, ”to create a realistic level of involvement that doesn`t burn you out.”
Making connections
One crucial first step is to take a social history from a client, especially one whose memory is fading. What was this person`s greatest achievement? What is he or she proudest of? What, to him or her, was a big deal?
For one, it was raising kids. For another, being a sportswear buyer who traveled to New York.
”One told me her biggest joy was cooking,” Karp said. ”When she moved to a nursing home, she told me to go into her den and take her little yellow cookbook. I used her recipes, to keep them going.”
Making such connections is important to prevent patients from giving up.
”You have to be creative to get some people out of a stupor,” Karp said. That can involve music such as, in recent cases, Russian folk tunes and Duke Ellington. Or poems. Or jokes. Or going through photo albums. Or making new ones, which Karp once did, taking photographs of a client`s former home, then discussing them at length with the client to revive memories.
More than words
Many clients need help with letter writing, an activity with a double bonus: It encourages focused thinking, and the people receiving the letters usually write back. Often, Karp has to lead clients to express their real emotions.
”Do you want to say, `I`m fine?”` she asked one client.
No.
”`Do you want to say, `I miss you?` ”
Yes, that was it.
”We read about throwaway elderly,” Karp said, ”but there are many ways we can bring joy into a life. Sometimes we have a tunnel approach. We have to learn that language is not just words. It is music, art, a lot of other things. It also is play, and that`s not part of our culture.”
Issues of adjustment
Karp uses art, music, poetry, letter writing, stuffed animals, even Mexican worry stones to break the mold of simply sitting and talking.
”Often, there are adjustment issues,” Karp said. ”There can be isolation, holing up in a room. Or dependency, expecting a daughter to visit every day.”
One time, Karp got a grown son to escort his mother to senior-citizen activities, introduce her around, break the ice. ”Mom is not going to be the way she used to be,” Karp told him. ”Accept Mom as she is now. Otherwise, she`ll feel like a failure, not good enough.”
Draining work
One client, with whom she worked for almost four years, died in early May. ”It`s tough,” she said. When they first met, the woman was very depressed, Karp recalled. ”She didn`t want to talk about her plans, or how she felt,” Karp said. ”I asked her if I could draw her portrait. `I`m too ugly,` she said at first, but she was thrilled that someone wanted to look at her face.”
Sketching allowed eye contact without the drain of talking. Later, the finished portrait, framed and hung in the woman`s room, became a conversation starter, opening up other areas of interest.
It can be draining work. Her clients die. Yet, Karp said, ”I feel rewarded by very small changes, maybe five minutes out of an hour when there`s a bond.
”It`s a real service to families and they are very grateful. It also makes me feel good, with someone who`s out of it, for them to find something, or someone, they can connect with.”
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For more information, contact the National Association of Private Geriatric Care Managers, 655 N. Alvernon Way, Suite 108, Tucson, Ariz., 85711 1-602-881-8008.
