At some point in our life each of us will experience the loss of someone we love dearly. With loss comes grief. Although grief is a universal emotion it may be one of the most intimate and personal feelings we ever experience. Losing a loved one evokes anxiety and feelings of loneliness that we may have never known before. Even though we may be lucky to have family and friends to support us, we feel alone in our grief.There may be times when grief seems everlasting and the pain and discomfort feels like it will never dissipate. It is true that grief has its own life span, but there are identifiable stages of grief that can help individuals navigate through their journey. Immediately following a loss you may feel numb. The responsibility of focusing on medical care for your loved one, making final arrangements and managing the paper work that comes after a death may sometimes shadow the reality of your loss. When all of the housekeeping is complete you may even experience a feeling of disconnection wondering if your loved one is really gone. When the realness of the situation begins to seep through, an extreme sadness may overcome you. This stage is often the most difficult and most frightening. It may also be the longest lasting stage. Over time this sadness will decrease and you may feel a reluctant acceptance of your loved ones death. As this acceptance takes hold you will realize that life does move forward and you can return to living even without him/her present each day. Life will be different, but you will experience joy again.Our society has made great strides in understanding end-of-life issues as they relate to the patient we still have a long way to travel to understand the impact of loss on those who are left behind. Friends and family members may suggest you move on or get over it. Grief is not something you have control over. Sometimes the loneliness of grief causes us to forget that help is available. Supports groups and individual counseling are available. It is when you are experiencing your lowest moment, that reaching out is most important. With time and support you will be able to look forward to the future once again. Editors Note: Judith Pilchik Zucker, LCSW, is a Bereavement Coordinator and Counselor with the Saint Barnabas Hospice and Palliative Care Center (SBHPCC). For information about bereavement programs and services offered by the SBHPCC, please call 973-322-4817 or visit www.sbhcshospice.com.

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Skilled Nursing Facilities (SNFs) vary greatly in their ability to provide high quality individualized Rehabilitation services to patients. Patients, families, & healthcare professionals often choose a SNF based on geographical factors, physical plant (e.g. interior/exterior design, meals, availability of private rooms); also, often used in the selection process is an environment that is clean and odor-free, as well as positive regulatory agency reports. Although these factors can play a role in the decision making process, other very important factors that should be considered are often overlooked. Successful Rehabilitation, measured by positive functional outcomes, can best be achieved in facilities that provide highly individualized Rehabilitation services -- where there is a close working alliance between patients/families/caregivers & a highly skilled team of healthcare professionals. The goal of this team is to maximize a given patients physical, functional, emotional, social, spiritual, vocational, & leisure potential --often after life changing/catastrophic illness. Healthcare professionals that should be part of this team include primary care physicians (PCP), and physiatrists, who should work closely side by side. While the PCP attends to the general medical needs of the patient, the physiatrist --a physician specializing in Physical Medicine and Rehabilitation -- attends to the patients individualized Rehabilitation program. The physiatrist serves as the team leader of a group of individuals, which include, but is not limited to: occupational therapists, physical therapists, speech language pathologists, social workers, recreational therapists, patients and their families/caregivers. Also important to the Rehabilitation process is around the clock availability of highly qualified nursing staff, as well as the easy availability of other healthcare consultants as needed. There should be close attention to the proper equipment needed for rehabilitation and the actual amount of time that a patient actively participates in the rehabilitation program, and this should reflect the actual needs of the patient. The proper matching of a specific patients need for rehabilitation services and the services that a specific SNF can actually provide, will help to maximize a successful rehabilitation outcome; this is turn, will help to minimize psychological & financial difficulties for the patient and their family -- during a usually very stressful period in their lives.Editors Note: This article was provided by Jose A. Alonso, M.D., full time physiatrist on staff at Prospect Heights Care Center. Dr. Alonso is the Medical Director of Rehabilitation Medicine Services, Prospect Heights Care Center located at 336 Prospect Avenue, Hackensack, NJ, The PM&R Center, P.A., Englewood, NJ and Assistant Clinical Professor of Rehabilitation Medicine, Columbia University College of Physicians and Surgeons, New York. He can be reached at 201-678-1800.

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Sometimes its easy to know when a family member needs care and assistance. For instance, maybe he or she has a major disability or requires additional help following a hospital stay. In other cases, however, it isnt immediately obvious that your senior is in need of help with the activities of daily life.As people who have had to wrestle with our own family decisions, we thought it useful to provide early guidance, so other families might know when a more careful assessment of their seniors needs is required.Below is a list of questions to consider when determining if a loved one is in need of additional care: Pay Attention to How They Look Appearance can be a sign that they are being limited either physically or mentally from completing normal daily tasks. Are they wearing dirty or stained clothing? Have they brushed their teeth? Listen to the Senior Listening to how seniors speak can tell you a lot about their current mental status. Dont assume that old age is causing these problems. Have they forgotten to refill prescriptions or take their medicine? Have they missed doctors appointments? View the Seniors Surroundings Looking at their food and medications can help you determine if they are eating healthy or even worse, taking expired medicine. Do they have fresh and stocked pantry items? Are there piles of unopened bills? Use Your Nose Using your nose as an indicator can help you determine if your family member is bathing properly or participating in otherwise normal activities. Does their living environment possess any unpleasant odors? Are they bathing regularly? If you sense a problem based on the above indictors, you and other family members should waste no time in taking the appropriate next steps. As difficult as the process might be, keep reminding yourself that by being proactive you will not only provide safety for your family member, but will also keep them happy and healthy for years to come. Editors note: This article was submitted by Patricia Preztunik (201-483-8490) and Rich Fracaro (201-773-4900), local owners of BrightStar, a full-service in-home medical and non-medical agency offering caregiving to seniors and disabled adults. They would gladly provide assistance in these matters.

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As the population continues to age, the elderly are becoming more and more vulnerable to scam artists. These scams can come in many forms, both legal and illegal, that impact negatively on the vulnerable elderly.Seniors are often the target of these schemes because they are easier to prey on than younger people. By their nature, seniors are more trusting, and in many cases, are unlikely to report fraud to the proper authorities. Even when seniors report these crimes, they are often poor witnesses. Their age and memory make them poor candidates to report needed details to prosecute these individuals.Fraud comes in many forms: identity theft, telemarketing scams, counterfeit drug scams, loan fraud, home improvement fraud, prizes and sweepstake scams, mail fraud, information mining, internet scams, the sale of legal goods and services that are totally unneeded, and lastly, Medicare and Medicaid fraud. One kind of scam involves caretaker theft. Seniors are becoming more and more dependent on care takers, be they family members, or live-in employees. Eventually the senior can become completely dependent on the caretaker and unscrupulous caretakers take advantage of these situations. Children should be ever watchful when in these situations. I have had cases where seniors have given away homes and other very valuable assets to their caretakers. New Jersey has laws to protect seniors in these situations and if you suspect such abuse, please see an experienced elder law attorney immediately.Seniors and their families need to become educated in ways to protect their nest egg and their safety. Most fraud occurs when seniors are alone, childless or have little contact with their children. Seniors can protect themselves by seeking help from trusted relatives and professionals. Many times they resist this help, thinking that they may lose control of their lives. They must be persuaded otherwise. See an attorney to obtain a financial power of attorney, will and living will is a good start. Hiring a geriatric care manager to evaluate the seniors needs can prove invaluable. If you have any desire to discuss these issues further, we will provide you with a free initial consultation.Finally guarding your credit information, being aware of imposters and being a smart consumer are the best things they can do.Editors Note: Michael A. Manna is a Magna Cum Laude graduate of Boston College and a Cum Laude Graduate of Boston College Law School. After working in the tax department of the CPA firm of Peat Marwick Mitchell & Co., Mr. Manna entered the private practice of law in Ridgewood, New Jersey in 1975. Mr. Manna is admitted to practice in New Jersey, New York and Massachusetts and is a member of the bar of the Supreme Court of the United States. He is also a member of the National Academy of Elder Law Attorneys. Over the past thirty years, Mr. Manna has had extensive experience as a lecturer on legal topics for various boards of education and educational institutions. He can be reached at 201-447-2800.

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