What the anger iceberg does not explain, though, is what to do when someone you love is directing their anger at you. Being around an angry person is very difficult. That anger can jeopardize that ability to maintain a loving relationship and have closeness. You want to get to what is under the anger.
Here are tips on responding to someone’s anger:
Do not take it personally. Their anger is usually not about you. Try taking a curious or investigative approach to the anger. This shift in perspective, from defensive to inquisitive, may help you to really see what is going on. Remember, there is something beneath the anger. Is it fear? Loneliness? Frustration?
Do not try to fix their feelings. The goal here is not to change or fix their anger. You may not be able to calm the person down, but you can hear them. You can abandon any attempts to reason or defend yourself. Just listen. When a person stops trying so hard to convince you why they are justified in being angry, they may be able to move through their anger and access the feelings underneath.
Restate what they need. There is usually some unmet need that is going unheard and unmet. Can you identify that and bring the focus to that unmet need?
Leave. If their anger is harmful, threatening, or destructive to you, leave.
Anger is usually an attempt to cover up some kind of pain or vulnerability—listen for that pain.
is never an easy task, but to salvage meaningful, fulfilling
relationships, it may be necessary. If you and your loved one are
experiencing frequent, unresolved anger issues, consider getting help.
Trained mental health professionals, like the Clinical Social Workers at
Mindful Transitions, can help you work through the anger and salvage
your relationship. To learn more about our service, please call us
at (678) 637-7166.
Each year Medicare offers its beneficiaries a chance to make changes to
their Medicare coverage. This year, the dates for Medicare’s Open
Enrollment are October 15-December 7, 2019.
Enrollment you can change your Original Medicare A & B to a Medicare
Advantage Plan, change from one Medicare Advantage Plan to another, add
or change your prescription plan, or change your Medicare Advantage
Plan back to Original Medicare. The changes you make will go into effect
on January 1, 2020.
Medicare is not a set it and forget it plan.
folks do nothing, allowing their coverage to stay the same. This
decision could cost them tremendously in both financial and care
Each drug plan and Medicare Advantage Plan can change each year. These changes impact providers and patients alike.
copays, or other out of pocket costs may go up unexpectedly, coverage
may not be as robust as in years past, healthcare provider networks may
change, and terms for providers may change, limiting providers willing
to work with certain insurance carriers at all. Please remember that
our Mindful Transitions team does not accept ANY of the Medicare
Advantage plans-only Traditional Medicare.
It is important for you to review your coverage, your needs, and your options every year.
Here are a few tips from The Medicare Rights Center to get you started:
If you are looking for a new Part D plan, you can use the Plan Finder tool from www.Medicare.gov to compare options in your area. Before you use Plan Finder, make a list of the medications you take, the amount that you currently pay for them, and which pharmacies you like to visit. You will be able to get a sense of which plans cover the medications you need with the lowest costs and fewest coverage restrictions.
If you are shopping for a new Medicare Advantage Plan, you can use the Plan Finder tool to compare options in your area. You can also call 1-800-MEDICARE and ask about plans in your area. Once you have a list of your available options, you can visit their websites to learn more.
After you have researched plans and found one that you are interested in, call that plan directly to confirm what you learned online. Ask about your doctors and hospitals to check that they are included in your plan’s network. Check also that the plan includes all the drugs you need on its formulary, and that your pharmacies are in the plan’s network. Write down everything about this conversation, including the date of the conversation, who you speak to, and the outcome of the call.
Call 1-800-MEDICARE if you decide to enroll in a new plan. This is the best way to protect yourself if there are any problems with enrollment. Write down everything about your call, including the date of the conversation, who you speak to, and any information the Medicare representative gives you during the call. Remember to confirm all the details about your new plan with the plan itself before calling Medicare.
Be wary of solicitations and advertisements stuffing your mailbox (both snail mail and email). Medicare Advantage Plans have started sending out information about their plans, but they must follow certain rules.
If you need additional help, please reach out to GA Cares at 1-866-552-4464 (option 4).
All of the Clinical Social Workers are Medicare providers and accept assignment. We do not, however, accept any of the Medicare Advantage Plans. If you want to learn more about our services, please visit our FAQ page, call us at (678) 637-7166, or email us at email@example.com
In last month’s newsletter, we announced that Mindful Transitions is growing! Last month, we added Alisa Beattie, LCSW, and Amy McWilliams, LMSW, to our team!
We have seen an incredible surge in the demand for
in-home psychotherapy services in Metro Atlanta in the last year. In
response to that need, we continue to grow and stay committed to
providing professional, compassionate, and timely therapy services to
Alisa has over 18 years of experience as a Clinical
Social Worker, focusing on older adults for the last 10 years. She will
be helping cover the Cumming, Gainesville, Alpharetta, Roswell, John’s
Creek, Suwanee, and surrounding areas alongside our other clinicians who
serve clients in that area.
Alisa, like all of the Licensed
Clinical Social Workers at Mindful Transitions, is a Medicare provider
and takes assignment. She will be providing psychotherapy and
comprehensive clinical social work services to each of her clients,
ensuring that they are connected to important services in the community
and that their care is coordinated between all providers. Taking this
holistic perspective that incorporates the whole system is important for
the well-being and optimal functioning for each of our clients.
Alisa is currently accepting new clients.
is a Licensed Masters Social Worker, working towards her clinical
licensure. She will be working with our intake coordinator to help
clients, families, and professionals inquiring about our services. Once
she is fully licensed as a Clinical Social Worker, she will be accepting
Be sure to welcome Amy whenever you call into our office!
The Clinical Social Workers at Mindful Transitions work exclusively with older adults, most of whom live in independent living or assisted living communities. To learn more about the social work services at Mindful Transitions, please contact us at firstname.lastname@example.org or (678) 637-7166.
To refer someone to Mindful Transitions, please download our referral form.
Original Medicare offers mental health benefits to beneficiaries needing mental health services. Here is a quick overview of those benefits:
Medicare Part B will pay 80% (once the Part B deductible is met) for outpatient counseling services. The remaining 20% would be the co-insurance paid by the patient (or a MediGap plan, if the patient has a supplemental plan).
Medicare allows its beneficiaries the option of getting treatment through a variety of mental health professionals such as psychiatrists, psychologists, clinical social workers and clinical nurse specialists. Most of our clients prefer to find a provider who accepts Medicare and takes assignment. If a provider doesn’t accept assignment then Medicare will not pay for the services or reimburse a beneficiary for amounts paid to non-participating providers. The Licensed Clinical Social Workers at Mindful Transitions are all certified Medicare providers and take assignment.
Mental Health Screenings
In addition to psychotherapy, Medicare covers yearly depression screenings that must be done in a primary care doctor’s office or primary care clinic. This can help with appropriate diagnosis, treatment and follow-up. There is no cost for this screening. If your doctor hasn’t talked to you about your mental health, you can always request a screening.
Inpatient Psychiatric Services
The benefits for inpatient psychiatric services are paid by Medicare the same way that general hospital services are paid. There is a $1,340 deductible for each benefit period, $0 coinsurance for the first 60 days, and $335 co-insurance for days 61-90. Medicare pays for 80% of all mental health services provided while the patient is in the hospital. Medicare limits the number of psychiatric hospital stays to 190 days per lifetime; after those days are used up, the patient must pay for inpatient psychiatric care privately.
Partial hospitalization programs (PHPs) are structured programs provided as an alternative to inpatient psychiatric care. They are more intense than traditional therapy, are provided during the day, and do not require an overnight stay. Medicare helps cover partial hospitalization services when they’re provided through a hospital outpatient department or community mental health center (assuming that the doctor and the partial hospitalization program accept assignment).
Medicare usually covers medications used to treat mental health conditions under the Part D prescription drug benefit. The Part D formularies may limit which medications are covered and should be checked. Each Part D plan creates its own list of approved and covered drugs. The open enrollment period is a great time to review your plans’ formulary and to possibly switch to a new plan.
Medicare Advantage Plans
Medicare Advantage Plans also offer mental health services, but there are limits to their services. They have a narrow network of providers. Each plan has to be explored individually to learn what they will provide.
To locate a provider in your area that accepts Medicare assignment, use Medicare’s online tool at medicare.gov/physiciancompare. Type in your zip code, or city and state, then type in the type of profession you want locate, like “psychiatry” or “clinical social worker” in the “specialty” box.
The Licensed Clinical Social Workers at Mindful Transitions are Medicare providers and take assignment. In addition to providing psychotherapy, we also provide comprehensive clinical social work services to each of our clients, ensuring that they are connected to important services in the community and that their care is coordinated between all providers. Taking this holistic perspective that incorporates the whole system is important for the well-being and optimal functioning for each of our clients. We provide psychotherapy and so much more!
NPR recently published From Gloom To Gratitude: 8 Skills To Cultivate Joy.
This piece covered the methods and outcomes of a program designed for
caregivers for people living with dementia. Life Enhancing Activities
for Family Caregivers (LEAF) is a 6-week positive emotion regulation
intervention that taught caregivers 8 skills in an attempt to build more
positive emotions alongside the negative emotions.
Here are the skills taught throughout the program:
Take a moment to identify one positive event each day.
Tell someone about the positive event or share it on social media. This can help you savor the moment a little longer.
a daily gratitude journal. Aim to find little things you’re grateful
for, such as a good cup of coffee, a pretty sunrise or nice weather.
Identify a personal strength and reflect on how you’ve used this strength today or in recent weeks.
a daily goal and track your progress. “This is based on research that
shows when we feel progress towards a goal, we have more positive
emotions,” Moskowitz says. The goal should not be too lofty. You want to
be able to perceive progress.
Try to practice “positive
reappraisal”: Identify an event or daily activity that is a hassle.
Then, try to reframe the event in a more positive light. Example: If
you’re stuck in traffic, try to savor the quiet time. If you practice
this enough, it can start to become a habit.
nice for someone else each day. These daily acts of kindness can be as
simple as giving someone a smile or giving up your seat on a crowded
train. Research shows we feel better when we’re kind to others.
of the participants reported an improvement in mood and a decrease in
depression just by employing these practices. The shift from what isn’t
working to what is working, or from examining what is so bad to what may
still be good, can make a big difference.
This ties into another piece recently published, this one by the New York Times, on Washing Dishes. The author reframes the drudgery of life’s tasks as the good stuff in life.
“But lately I’ve been wondering what that time and space is for. Implied in the quest for convenience is a distinction between the life we deem worth living and the life we have to endure in order to get there. One is a possibility, the other an obligation; one is a means, the other an end. Look at dishwasher ads from the 1950s, when the appliance became commonplace, and you see narratives of a life reclaimed, an escape from the purgatory of work into the freedom of leisure. Life hacks, multitasking, the ruthless compression of our daily routine: We still frame the ordinary as something that exists only for the thing beyond it, as a hazard to be optimized away instead of an organism to be nurtured and interacted with.”
Your dad’s assisted living community just recommended psychotherapy for your dad. His wife died 5 weeks ago. He now rarely comes out of his apartment. When you visit, you have noticed that his clothes are getting looser, his demeanor gruffer, and his desire to sleep stronger. Once a jovial, outgoing guy, he is now grumpy and difficult to approach.
He does seem depressed.
When the nurse suggested a therapist you immediately scoffed. “Sure, he’s depressed. Who wouldn’t be?” His move to the assisted living was hard. He only agreed because your mom needed so much care. He realized he couldn’t do it any more at home. Now, he also needs a lot of care; and losing mom was really difficult. It’s been a tough transition.
But he’d never talk to a therapist.
“Therapy is great–I even have my own therapist I’ve been seeing for years. But my dad would never see a therapist.” Many older adults, especially men, have spent decades keeping their feeling closed off. Vulnerability is akin to weakness, they think. Or talking about problems doesn’t make anything better
He might talk to us.
be surprised by how many individuals are willing to talk to a
therapist. When we engage our clients with a kind, genuine, open manner
that expresses compassion and acceptance, they feel their suffering
acknowledged, their pain validated. And in that is healing and a
powerful therapeutic relationship. Many clients, whose families thought
they would never talk to us, have agreed to meet with us and have
effectively connected with our clinicians.
The Clinical Social Workers at Mindful Transitions work exclusively with older adults, most of whom live in independent living or assisted living communities. We are experienced in working with clients that have never been in therapy before, and we approach each client with gentleness and acceptance. If you think your loved one would never see a therapist, give us a call anyways. You might be pleasantly surprised.
NHDD started in 2008 as a way to inspire, educate and empower the public and providers about advance care planning. For Georgians this week is all about getting people to talk to their loved ones about their healthcare wishes and to complete a Georgia Advance Directive. So, let’s start talking
First, what is the Georgia Advance Directive?
It is a statutory document that combines the healthcare power of attorney and living will into one document. It is the primary advance care planning tool in Georgia and has four main goals:
Names someone to make healthcare decisions for you if you cannot or do not want to make your own healthcare decisions.
your treatment preferences if you are ever in a coma or diagnosed with a
terminal illness and cannot speak for yourself.
States your wishes for cremation or burial.
Allows you to recommend a guardian if you ever need a guardian in the future.
Who Needs an Advance Directive?
Almost every Georgian over the age of 18 should have an Advance Directive in place. This is not a form just for the elderly or the disabled. Accidents, sudden illnesses and healthcare crises are equal opportunity events that can cause severe impairment in any of us at anytime. Completing an Advance Directive proactively (before it’s too late) will authorize an informed person to make your important healthcare decisions should you be unable to do so.
Where can you find the form?
This is a statutory form and can be found for free online. Click on the picture below to download a copy! After you print it out, complete it with your loved ones, sign it, and then have two witnesses sign it. No notary or attorney is required.
What do you do with the form once completed?
You should give a copy of this completed form to people who might need it, such as your health care agent(s), your family, and your physician. Keep a copy of this completed form at home in a place where it can easily be found if it is needed. Do not keep it in a safe or a safety deposit box. Review this completed form periodically to make sure it still reflects your wishes.
Completing a Georgia Advance Directive is an important step in planning ahead for future incapacity. It is never too early to talk to your loved ones about your (and their) healthcare wishes!
To learn more about advance care planning, please visit NHDD’s resource page.
In our last newsletter, we discussed having tough conversations with aging parents about care:
If our parents live long enough, they may likely need the care, oversight, and assistance of another person to meet their needs. Transportation, medication management, meal preparation, housekeeping, dressing, bathing, toileting, transferring, and feeding assistance—just a short list of tasks that more than 52% of today’s older adults will need help with at some point in their lives.
Many older adults have the awareness, willingness, and ability to plan and execute their own long term care plan. We have worked with many older adults that selected their own assisted living community or initiated the hiring of a caregiver on their own. There are quite a few older adults, however, who have left the hard decisions up to their loved ones, usually an adult child
You may be one of the thousands of adult children who are stuck, feeling lost and overwhelmed by this situation.
Waiting for the Crisis
In reality, many families just wait for a crisis that will force a major change or transition to a higher level of care. Our healthcare system is set up to respond to crisis situations. Every day an older adult enters the ER with a preventable issue—a fractured pelvis, shoulder or hip, a medication mistake, or a UTI and dehydration. This crisis springs the older adult into the acute care and then long term care systems. From the hospital to short term rehab in a nursing home to assisted living care, to memory care, or to in-home care, the older adult is finally getting the care he needs. For some families, things have to get worse to get better.
Taking this approach works to some degree—the older adult is not confronted with the painful realities of their situations, the family members avoid uncomfortable conversations and tough decisions, and the older adult ends up in a higher level of care as a course of fate.
Although it works, waiting for a crisis is unlikely to result in the best outcomes. When reacting to a medical emergency or a quick discharge from a hospital or nursing home, most adult children find themselves scrambling to set up the appropriate level of care. Additionally, the older adult may now be recovering from a preventable surgery or illness.
Making Hard Decisions
When your parent or loved one needs more care, you may have to force the issue if they are not taking any steps or making any decisions. You may be one of the many adult children who have to make decisions for an aging parent.
You may be in the position of having to initiate discussions on long term care needs, select long term care providers, handle all decisions and logistics, urge a loved one to accept more care, and convince others (like siblings or spouses) of your plans.
No one wants to tell their parent that they need to move, that they can no longer care for themselves adequately, or that they have to do something they don’t want to do. When safety is a primary concern, though, hard decisions have to made.
Feeling like a Traitor, a Failure, or a Terrible Human Being
You may have to make a hard decision for your aging loved one. And you can expect that it will not feel great. Many adult children report feeling guilt, shame, grief, and resentment about having to interfere in their parents’ lives. Dealing with the realities of caring for an aging parent often brings up some strong emotions.
Know that just because it feels awful, it isn’t wrong. You haven’t failed as a daughter, you’re not a failure of a son. Moving your loved one to assisted living or memory care doesn’t mean that you’ve failed to take care of them. It means you’re making a smart decision to get them the level of care they need. As a family member, your responsibility is to make sure your loved one gets the needed care but not necessarily to be the one to physically provide it yourself.
There is hope. This will get better. Adjusting to living in an assisted living community, memory care unit, nursing home or with regular caregivers is a huge transition. Acknowledge that this is necessary but awful. See it for what it is and know that you have done everything that you can. Your heart may need time to heal and to catch up with what you know to be true and right in your head.
Reaching out for Help
At some point on this journey, you may need help. Moving to an assisted living community, memory care unit, or personal care home, hiring private duty caregivers, or even planning for the future can cause tension, stress, and friction in families. Geriatric social workers, aging life care specialists, and other trained professionals can help you and your family navigate the complex elder care world.
Mindful Transitions is a team of clinical social workers that is dedicated to helping older adults and their families. We provide on-site mental health services, and we offer a Family Care Counseling package that includes 3 family sessions. This service is most helpful for families that have a hard time communicating about elder care needs. If you’re interested in learning more, please call visit our website or call our office at (678) 637-7166.
It is uncomfortable for us to be around someone that has just experienced the death of a loved one. What do you say? Do you say anything about the death or the loss? Do you act like nothing happened? What if you make it worse? What if he starts crying? What if I start crying?
Mindful Transitions’s last Mindful Minute (our monthly e-newsletter) offered tips for grieving the loss of a spouse. Our follow-up to that newsletter is a list of tips for supporting a grieving friend, co-worker or loved one.
Acknowledge your discomfort and let it be—witnessing someone’s pain is hard.
Be patient, empathetic, and understanding.
Be an active listener.
Allow silence; listen without giving advice.
Know that nothing with “fix It.”
Accept the tears, rages, and silences as normal and healthy.
Acknowledge birthdays, death dates, anniversaries, etc.
Accept that you cannot make them feel better.
Avoid talking about the loss or death.
Force the grieving person to talk about the death or loss.
Claim to fully understand by saying, “I know exactly how you feel.”
Minimize the loss by saying, “Think of how much worse it could have been,” or, “At least…”
Offer cliche sayings such as “She’s in a better place now.”
Try to fill the empty space with chatter.
Let your sense of discomfort and helplessness keep you from reaching out.
Talking to a friend, neighbor, co-worker or family member after a death can be uncomfortable and intimidating. Nothing is gained, though, by avoiding them or the topic. Remember, by reaching out and letting the person know you care and can be there through the discomfort along side them, you ARE doing something to help.
Please See Me Through My Tears by Kelly Osmont
You asked, "How am I doing?" As I told you, tears came to my eyes... and you looked away and quickly began to talk again. All the attention you had given me drained away.
"How am I doing?"...I do better when people listen, though I may shed a tear or two. This pain is indescribable.
If you've never known it you cannot fully understand. Yet I need you. When you look away, When I'm ignored, I am again alone with it Your attention means more than you can ever know.
Really, tears are not a bad sign, you know! They're nature's way of helping me to heal... They relieve some of the stress of sadness.
I know you fear that asking how I'm doing brings me sadness ...but you're wrong.
The memory of my loved one's death will always be with me, Only a thought away.
My tears make my pain more visible to you, but you did not give me the pain...it was already there.
When I cry, could it be that you feel helpless, not knowing what to do? You are not helpless, And you don't need to do a thing but be there.
When I feel your permission to allow my tears to flow, you've helped me You need not speak. Your silence as I cry is all I need. Be patient...do not fear.
Listening with your heart to "how I am doing" relieves the pain, for when the tears can freely come and go, I feel lighter.
Talking to you releases what I've been wanting to say aloud, clearing space for a touch of joy in my life.
I'll cry for a minute or two... and then I'll wipe my eyes, and sometimes you'll even find I'm laughing later.
When I hold back the tears, my throat grows tight, my chest aches, my stomach knots... because I'm trying to protect you from my tears.
Then we both hurt...me, because my pain is held inside, a shield against our closeness...and you, because suddenly we're distant.
So please, take my hand and see me through my tears... then we can be close again.
In our last newsletter, we discussed medication issues and the importance of medication reconciliation and regular medication reviews to make sure all of the right medications are being taken. Medication issues are no small matter for older adults. The financial and physical costs of taking too many medications can be quite high.
Our primary recommendation from that newsletter was to talk to your doctor regularly about all of your medications. The goal of this is to:
1. Verify your medication list, making sure you both know what you are taking.
2. Make sure you are only taking what is needed.
3. Evaluate if all medications are necessary and are worth any potential side effects.
But what if your primary care doctor says that she cannot oversee or manage your psychiatric medications? What should an older adult do to get good advice on their medications?
A geriatric psychiatrist is a doctor with special training in the diagnosis and treatment of mental disorders in older adults (e.g., depression, anxiety, substance use disorders, dementia, etc.). A geriatric psychiatrist may be preferred over a psychiatrist that specializes in adults because older adults have special physical, emotional, and social needs that impact their mental health treatment plans. Keeping this in mind, geriatric psychiatrists take a comprehensive approach that addresses co-existing medical illness and medications, family issues, social concerns and environment issues.
Establishing a relationship with a geriatric psychiatrist is usually recommended for our older adults dealing with mental health issues. We value their knowledge and approach and have witnessed the significant changes that usually follow their interventions.
Atlanta’s Geriatric Psychiatrists
Atlanta, like most communities, has a shortage of geriatric psychiatrists. We are lucky than most communities, but it can still be frustrating to find a geriatric psychiatrist and to get a timely appointment. You can begin the process by asking your primary care physician for a referral. If she does not have a geriatric psychiatrist referral for you, please contact our office at (678) 637-7166 or email@example.com. We would be happy to help you navigate this issue.
Mental Health Crisis
If you are in a mental health crisis, it may be difficult to wait for a doctor’s appointment. Here is a list of the mental health emergency resources in Georgia:
Georgia Crisis and Access Line— A free 24/7 helpline providing mental health crisis assistance and access to mental health resources throughout the state of Georgia 1-800-715-4225 mygcal.com
9-1-1-For emergencies in which law enforcement may be called, ask for a Crisis Intervention Team (CIT) officer
If you are in the Metro Atlanta area, many of our psychiatric hospitals are available for walk-in assessments 24/7:
For questions about Mindful Transitions or to learn more about our team of Clinical Social Workers, please visit our FAQ page, call us at (678) 637-7166, or email us at firstname.lastname@example.org .
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