Long Distance Care Givers Receive Help submitted by Hospice and Palliative Care of Greensboro

Living in a different city or state — miles from aging parents — can be very difficult. Keeping in touch by telephone and making long trips to help parents or aging relatives with their needs can be time consuming and not nearly as effective as being available full time in person.

Mark Sessions spent two years juggling his restaurant business with multiple daily phone calls to his elderly parents, checking on their needs and answering their questions. Family vacations were spent traveling the 500 miles to his parent’s home to personally take care of home maintenance and provide health care visits to their doctor. During his last visit, Mark noticed his father had difficulty walking and his mother was confused as to which medications she was to take and at what time. This alarming change in his parent’s condition concerned Mark that his parents’ care needs required more than frequent phone calls and vacation visits. Running his business and handling his parent’s long distance care was now becoming very challenging.

According to a report by the Alzheimer’s Association of Los Angeles & Riverside, California, there are approximately 3.3 million long distance caregivers in this country with an average distance of 480 miles from the people they care for. The report also states that 15 million days are missed from work each year because of long distance care giving. Seven million Americans provide 80% of the care to ailing family members and the number of long distance caregivers will DOUBLE over the next 15 years.
Long Distance Caregiver Project – Alzheimer’s Association LA & Riverside, Los Angeles, CA (May 15, 2002, National Web Seminar by Judith Delaney, MFT, Clinical Coordinator)

The long distance caregiver is a new role that is thrust upon children and younger family members. Families used to live closer together, with children residing and working near their parents. But nowadays family members are more distant from each other. Society, today, is recognizing this. Some caregiver services have tweaked their programs to work as liaisons between long distance caregivers, senior loved ones and local medical professionals.

Professional care managers — a lso known as Geriatric Care Managers, Elder Care Managers or Aging Care Managers — represent a growing trend to help full time, employed family caregivers provide care for loved ones. Care managers are expert in assisting caregivers, friends or family members find government-paid and private resources to help with long term care decisions.

They are professionals — trained to evaluate and recommend care for the aged. A care manager might be a nurse, social worker, psychologist, or gerontologist who specializes in assessing the abilities and needs of the elderly. Care manger professionals are also becoming extremely popular as the caretaker liaison between long distant family members and their aging elder loved ones.

Jacqueline Marcell — author of “Elder Rage, or Take My Father…Please! How to Survive Caring for Aging Parents” (Impressive, 2000) — says,

“The most important thing to do is to find a geriatric care manager in the area where your loved one lives. She will have knowledge of all the services in the area and can be your eyes.”

Below is a partial list of what a care manager or Professional Geriatric Care Manager might do:

• Assess the level and type of care needed and develop a care plan.
• Take steps to start the care plan and keep it functioning.
• Make sure care is in a safe and disability friendly environment.
• Resolve family conflicts and other issues with long term care.
• Become an advocate for the care recipient and the caregiver.
• Manage care for a loved one for out-of-town families .
• Conduct ongoing assessments to implement changes in care.
• Oversee and direct care provided at home.
• Coordinate the efforts of key support systems.
• Provide personal counseling.
• Help with Medicaid qualification and application.
• Arrange for services of legal and financial advisors.
• Provide placement in assisted living facilities or nursing homes.
• Monitor the care received in a nursing home or in assisted living.
• Assist with the monitoring of medications.
• Find appropriate solutions to avoid a crisis.
• Coordinate medical appointments and medical information.
• Provide transportation to medical appointments
• Assist families in positive decision making
• Develop care plans for older loved ones not now needing care
  “The 4 Steps of Long Term Care Planning,” National Care Planning Council

Services offered will depend on the educational and professional background of the care manager, but most are qualified to cover items in the list above or can recommend a professional who can. Fees may vary. There is often an initial consultation fee that is followed by hourly fees for services. Health insurance does not generally cover these fees but long-term care insurance might.

In 2002, the AARP published a survey from geriatric care mangers about their fees:

“Respondents were asked how much they charged for their services, which might include: an initial consultation; fees on an hourly or per visit basis; fees for development of a care plan; and fees on a fixed-price contract basis. Hourly fees averaged $74 an hour. GCMs charged an average $168 to develop a care plan. Initial consultations averaged $175. Seven of ten current GCMs responded in the affirmative when asked if they had a statement that listed their fees. ” Written by Robyn Stone, DrPH, Principal Investigator; Susan Reinhard, RN, PhD, Co-Principal Investigator; Jean Machemer, MSG, Research Associate; and Danylle Rudin, MSW, Research Associate of The Institute for the Future of Aging Services, Washington, D.C.Barbara Coleman, Project Manager, AARP Public Policy Institute November 2002

When you take into account the time absent from work and time to find the right care resources for your loved ones, along with the cost of travel expenses to monitor their care, you will probably concur that using a caregiver is money well spent. Add on to this the stress of handling your own life circumstances combined with being a caregiver and you will probably wonder how you could have ever done without the care manager.

A professional or geriatric care manager can be an important asset to all families in elder care situations. Here is an example of how a care manager can help.

Mary is taking care of her aging husband at home. He has diabetes and is overweight. Because of the diabetes, her husband has severe neuropathy in his legs and feet and it is difficult for him to walk. He also has diabetic retinopathy and, therefore, cannot see very well. She has to be careful that he does not injure his feet, since the last time that happened he was in the hospital for four weeks with a severe infection. She is having difficulty helping him out of bed and with dressing and using the bathroom. She relies heavily on her son, who lives nearby, to help her manage her husband’s care.

On the advice of a friend, Mary is told about a professional care manager, Sharon Brown. The cost of an initial assessment and care plan from the care manager is $175.00. Mary thinks she has the situation under control and $175.00 for someone from the outside to come in and tell her how to deal with her situation seems ridiculous.

One day Mary is trying to lift her husband and injures her back severely. She is bedridden and cannot care for her husband. Her son, who works fulltime, now has two parents to care for. On the advice of the same friend, he decides to bring in Sharon Brown and pay her fee himself.

Sharon does a thorough assessment of the family’s needs. She arranges for Mary’s doctor to order Medicare home care during Mary’s recovery. Therapists come in and help Mary with exercises and advice on lifting. Sharon advertises for and finds a private individual who is willing to live in the home for a period of time to help Mary with her recovery and watch over her husband. Sharon makes sure the new caregiver is reliable and honest and that taxes are paid for the employment. Sharon enlists the support of the local area agency on aging and makes sure all services available are provided for the family.

Sharon also calls a meeting with Mary’s family and explains to them the care needs and how they need to commit to help with those needs. Sharon makes arrangements to rent or purchase medical equipment for lifting, moving and easier use of the bathroom facilities. Medicare will pay much of this cost. Sharon also works closely with an elder law attorney and a financial planner who specializes in the elderly. The attorney prepares documents for the family including powers of attorney, a living will and advice on preserving Mary’s remaining assets. The financial planner recommends a reverse mortgage specialist to help Mary and her husband tap unused assets in their home’s equity. Some reverse mortgage proceeds are used to pay off debt. The remaining proceeds are converted into income with a single premium immediate income annuity in order to provide Mary adequate income when her husband is gone and she looses one of the Social Security payments.

With the help of the care manager, Mary’s life and future have been significantly improved. Her husband as well, if he adheres to the care plan, may end up having a better quality of life for his remaining years.
“The 4 Steps of Long Term Care Planning,” National Care Planning Council

The National Care Planning Council promotes and supports professional and geriatric care managers on its website http://www.longtermcarelink.net/.

Caregiving Stress — Hazardous to Your Health and Sometimes Deadly submitted by Hospice and Palliative Care of Greensboro

UNDERSTANDING CAREGIVER STRESS

A 2003 study of caregivers by a research team at Ohio State University has proven the off-repeated adage “stress can kill you” is true. The focus of the investigation was the effect the stress of caregiving had on caregivers. The team, led by Dr. Janice Kiecolt-Glaser, reports on a 6-year study of elderly people caring for spouses with Alzheimer’s Disease. The study not only found a significant deterioration in the health of caregivers when compared to a similar group of non-caregivers but also found the caregivers had a 63% higher death rate than the control group.

The demands on a caregiver result in a great deal of stress. It is often observed in aging publications that stress can induce illness and depression. The resulting poor health can further decrease the effectiveness of the caregiver and in some cases, as proven by the study mentioned above, even cause premature death.

Stress can be defined as a physiological reaction to a threat. The greater the threat — the greater the level of stress. A threat is a real or perceived action against our person. Threats may include the anticipated possibility of death or injury but may also include challenges to our self-esteem, social standing or relationships to others or a threat may simply be a potential or real disruption of our established routines. What is stressful to one person may not be to another. For example, bumper-to-bumper traffic might be stressful to the woman executive who is late for an important meeting but to the delivery man who has no deadline and is being paid by the hour, it may be a welcome respite to relax and listen to the radio.

Stress produces real physical changes. In some unknown way the fears in our mind, both conscious and unconscious, cause the hypothalamus and pituitary glands, deep in our brain, to initiate a cascade of hormones and immune system proteins that temporarily alter our physical body. This is a normal human physiological response inherent to the human body when a threat is perceived–real or not. It is often called the “fight-or-flight response” or the “stress response”. The purpose is to give us clearer thought and increased strength as well as to activate the immune system to deal with potential injury and to repair potential wounds. When the perceived threat is removed, assuming no damage is done, the body returns to normal.

A team of researchers at Ohio State University Medical Center has found a chemical marker in the blood that shows a significant increase under chronic stress and is linked to an impaired immune system response in aging adults. The team, led by Dr. Janice Kiecolt-Glaser, reports in the June 30, 2003 issue of Proceedings of the National Academy of Sciences on a 6-year study of elderly people caring for spouses with Alzheimer’s Disease. With the caregivers, the team found a four-fold increase in an immune system protein — interleukin 6 (IL-6) — as compared to an identically matched control group of non-caregivers. Only the stress of caregiving correlated to the marked increase of IL-6 in the caregiver group. All other factors, including age, were not significant to the outcome. Even the younger caregivers saw an increase in IL-6.

The study also found that the caregivers had a 63% higher death rate than the control group. About 70% of the caregivers died before the end of the study and had to be replaced by new subjects. Another surprising result was that high levels of IL-6 continued even three years after the caregiving stopped. Dr. Glaser proposes the prolonged stress may have triggered a permanent abnormality of the immune system.

IL-6 is only one cytokine–an immune system mediator protein–in a cascade of endocrine hormones and cytokines that are released when the brain signals a person is threatened with harm, injury, undue mental or physical stress or death. The hormones prepare the body to react quickly by increasing heart rate, making muscles more reactive, stimulating thought, altering sugar metabolism and producing many more changes that result in the “rush” people experience when they think they may be harmed.

The cytokine release is mediated by IL-6, which takes the role of directing the immune system to gear up to prevent infection, promote wound healing and repair organs and muscles from any injury that may result from the imminent danger. The release of cytokines such as IL-1, IL-6, IL-8, TNF and other proteins such as CRP (C reactive protein) also promote development of inflammation, which is essential for blood cells to home in on injury or infection. In addition, these chemicals promote development of various types of immune system blood cells in bone marrow. This response to harm — either real or perceived — is an important and beneficial life-saving activity of a normally functioning body.

The problem is if this response is initiated over and over again, frequently, and over a long period; it can have a dangerous effect on the body. This constant initiation of the stress response is common among caregivers — especially those caring for loved ones with dementia. Providing supervision or physical assistance many hours a week and over a period of years turns out to be extremely stressful. This type of stress is often unrelenting, occurring day after day and week after week. And the long-term effects of this stress are more pronounced in middle-aged and older people who are precisely the group most likely offering long term care to loved ones.

In most younger people, when the threat lessens or disappears, the body reacts fairly quickly to shut down the stress response and return things to normal. But numerous studies have shown, as people age, the chemical cascade from stress lingers. Over a period of time, this constant chemical stimulus impairs the immune system and results in early aging, development of debilitating disease and early death. In this altered state, the body maintains high, potentially harmful levels of IL-6. The body does not return to normal without intervention.

Prolonged high levels of IL-6 and the accompanying hormones and cytokines have been linked to: cardiovascular disease, type II diabetes, frequent viral infections, intestinal, stomach and colon disorders, osteoporosis, periodontal disease, various cancers and auto immune disorders such as lupus, rheumatoid arthritis and multiple sclerosis. Alzheimer’s, dementia, nerve damage and mental problems are also linked to high IL-6. Wounds heal slower, vaccinations are less likely to take and recovery from infectious disease is impaired. People who have depression also have high levels of IL-6. Depression in caregivers is about 8 times higher than the non-cargiving population.

This debilitating response to chronic stress is not unique to humans. Animals are affected as well. A 2004 PBS Scientific American Frontiers Special entitled “Worried Sick”, explored the effect of chronic stress on animals. Observations in the field and experiments on animals exposed to chronic stress, uncovered the same phenomenon of debilitating disease and early death found in humans. Blood tests on the affected animals confirmed high levels of IL-6. The work of Dr. Janice Kiecolt-Glaser’s team was also followed in the Special.
The information above should provide a compelling reason to eliminate or reduce the stress of caregiving. Following are some strategies to deal with caregiver stress.

STRATEGIES TO REDUCE CAREGIVER STRESS

Ask for help.
Most caregivers are reluctantly thrust into their role without preparation because the need for care usually comes with little warning. Caregivers end up operating in a “crisis” mode–arranging medical care and living arrangements, scheduling care time, providing meals and household chores and so forth. Because they are so stressed and burdened, they rarely take time to find out what resources are available to help them. Ironically, caregivers often sever ties with family, friends and support groups about this time just when help from these people is most needed.

As a caregiver you must ask for help. The stress of going it alone is dangerous to your health. If it’s difficult to ask for yourself, use an advocate–a sibling, friend or professional care manager –to arrange a meeting and get formal, written commitments from those people who are willing to help you. The extra help will give you breathing room to find all those resources that are there to help you.

Seek care management advice.
A number of organizations and private companies will give you advice and guidance — many for free. If your care recipient has a very low income, you might get free help from your local Area Agency on Aging. A lot depends on available funds. Go to http://www.longtermcarelink.net/eldercare/ref_state_aging_services.htm for statewide lists of agencies.

A good source of free professional advice is the rapidly growing business of non-medical home care companies. Most will offer free consultations and these companies will also provide paid aides to help you with your loved-one…such things as bathing, dressing, shopping, household chores, transportation, companionship and much more. These people may also help you coordinate adult daycare or other community services. Go to http://www.longtermcarelink.net/a7homecare.htm for a nationwide list.

You may wish to pay for a formal assessment and care plan from a professional geriatric care manager. Go to http://www.longtermcarelink.net/a2bfindmanager.htm for a nationwide list of these valuable care specialists. Even though it may cost you a little money to hire a care manager, this could be the best money you will ever spend. Care managers are valuable in helping find supporting resources, providing respite, saving money from care providers, finding money to pay for care, making arrangements with family or government providers and providing advice on issues that you may be struggling with.

Take time off–find temporary substitutes.
Taking a break from caregiving is just as important as taking a break at work or taking that long-awaited vacation. A care manager may be of help in selecting the best temporary help to give you a break. Or you may make arrangements with family or friends to give you a break from caregiving.

Make plans for funding future care arrangements for you or for a healthy parent.
The analysis of data from three national surveys (Mature Market Institute, National Alliance for Caregiving and LifePlans, Inc) points out that employees caring for disabled elders who have long term care insurance (LTCI) are nearly two times more likely to be able to continue working than those caring for non-insured relatives. In addition, working caregivers of those with long term care insurance said that they were less likely to experience some type of stress, such as having to give constant attention to the care recipient or having to provide care while not feeling well themselves. Also, the group with insurance devoted more “quality time”–more companionship and less hands-on assistance–than the group without.

See if your healthy parent can still buy insurance. If he or she can’t afford it, see if other family members might contribute to premiums. There are also useful strategies using a reverse mortgage to buy long-term care insurance and life insurance for your loved ones. You should also consider insurance for yourself so when you need care someday, it won’t be so stressful on your caregivers. To learn all about long term care insurance and reverse mortgages go to http://www.longtermcarelink.net/.

Use assistive technology.
There are a number of technologies to make sure your loved-ones are safe while you’re away. Such things as emergency alert bracelets and pendants, GPS tracking for wandering, remote video surveillance, telehomecare, sensory augmentation and all sorts of assistive devices to help disabled people cope on their own. Go to http://www.longtermcarelink.net/ for more information.

Remove non-caregiving stress from your job or at home.
It’s obvious if you can remove other stressors in your life, you can cope better with the stress of caregiving, which you may not want to or can’t remove. The internet is your best resource here. Go to http://www.google.com, the most relevant non-commercial search engine on the net. Type in “work stress” and you can browse 3 million plus URL’s. For home stress type in “home stress” and browse 4 million plus URL’s. Everything you ever wanted to know is buried somewhere in those millions of pages.

Attend workshops or seminars to uncover additional strategies.
The Utah Eldercare Planning Council offers worksite or community presentations on various eldercare issues. Community workshops like these are available across the country. These learning experiences are an opportunity to find help with your own caregiving situation. To learn more about the Utah Eldercare Planning Council please go to http://www.careutah.com/.

PART II OF THIS ARTICLE

Next month, in part II of this article, we will offer lifestyle strategies that can lead to a reduction of IL-6 by reducing stress. We will also discuss holistic strategies that redirect the mind to “clear” perceptions of harm that produce the stress response.
FINDING RESOURCES FOR CAREGIVERS

The free resources of http://www.longtermcarelink.net/ are designed to provide you with government provider lists, free care assessments, information and care provider lists for reducing your eldercare burden and the attending stress. The site is a non-commercial source of help. It is the largest and most comprehensive free source of long term care information on the Internet. There are no ads or solicitations or pop-ups. A related site for the veterans aid and attendance benefit is found at http://www.veteransaidbenefit.org/. This is a benefit that could be available to up to one third of all US residents over the age of 65 under certain conditions. It could provide an additional monthly income of up to $1,843 a month for qualifying veterans households.

Putting Home Care in Perspective submitted by Hospice and Palliative Care of Greensboro

In the first century of our country’s history there was no such thing as nursing homes or assisted living. Society was mostly rural and people lived in their own homes. Families cared for their loved ones at home till death took them. In the latter part of the 1800’s because of an increasingly urban society, many urban families were often unable to care for loved ones because of lack of space or because all family members including children were employed six days a week for 12 hours a day. During this period many unfortunate people needing care were housed in County poor houses or in facilities for the mentally ill. Conditions were deplorable. In the early 1900’s home visiting nurses started reversing this trend of institutionalizing and allowed many care recipients to remain in their homes. Nursing homes or so-called rest homes were also being built with public donations or government funds. With the advent of Social Security in 1936, a nursing home per diem stipend was included in the Social Security retirement income and this government subsidy spurred the construction of nursing homes all across the country.

 

By the end of the 1950s it was apparent that Social Security beneficiaries were living longer and that the nursing home subsidy could eventually bankrupt Social Security. But in order to protect the thousands and thousands of existing nursing homes Congress had to find a way to provide a subsidy but remove it as an entitlement under Social Security. In 1965 Medicare and Medicaid were created through an amendment to the Social Security Act. Under Medicare, nursing homes were only reimbursed on behalf of Social Security beneficiaries for short-term rehabilitation. Under Medicaid, nursing homes were reimbursed for impoverished disabled Americans and impoverished aged Americans over the age of 65. It has never been the intent of Congress to pay for nursing home care for all Americans. The nursing home entitlement for all aged Americans was now gone.

 

Over the last 40 years, there has been a gradual change away from the use of nursing homes for long-term care towards the use of home care and community living arrangements that also provide in-house care.

 

With Proper Planning People Could Remain in Their Homes for the Rest of Their Lives
We are seeing a trend towards working conditions like those in urban America in the early 1900’s where both husband and wife are working and putting in longer hours. We are also seeing a return of the trend in the early part of the 20th century where outside visitor caregivers are becoming available to replace working caregiver’s and allow the elderly to receive long-term care in their homes. In addition there is a significant trend in the past few years for Medicaid and Medicare to pay for long-term care in the home instead of in nursing homes.

 

Given enough money for paid providers or government funding for the same, a person would never have to leave his home to receive long-term care. All services could be received in the home. Adequate long-term care planning or having substantial income can allow this to happen.

 

We only need to look at wealthy celebrities to recognize this fact. Christopher Reeve, the movie star, was totally disabled but he had enough money to buy care services and remain in his home. President Ronald Reagan suffered from Alzheimer’s for many years but received care at his California ranch. He was also wealthy enough to pay for care when needed. Or what about Annette Funicello or Richard Pryor? Income from their movie careers allowed them to receive care with their multiple sclerosis at home. We will be willing to bet that Mohammed Ali, who is severely disabled with Parkinson’s disease, will probably never see the inside of a care facility, unless he chooses to go there to die. With the proper planning and the money it provides, most of us could remain in our homes to receive long-term care and we would never have to go to an institution or a hospital.

 

The Popularity of Home Care
Most of those receiving long-term care and most caregivers prefer a home environment. Out of an estimated 8 million older Americans receiving care, about 5.4 million or 67% are in their own home or the home of a family member or friend. Most older people prefer their home over the unfamiliar proposition of living in a care facility. Family or friends attempt to accommodate the wishes of loved ones even though caregiving needs might warrant a different environment. Those needing care feel comfortable and secure in familiar surroundings and a home is usually the best setting for that support.

 

Often the decision to stay in the home is dictated by funds available. It is much cheaper for a wife to care for her husband at home than to pay out $2,000 to $4,000 a month for care in a facility. Likewise, it’s much less costly and more loving for a daughter to have her widowed mother move in to the daughter’s home than to liquidate mom’s assets and put her in a nursing home. Besides, taking care of our parents or spouses is an obligation most of us feel very strongly about.

 

For many long-term care recipients the home is an ideal environment. These people may be confined to the home but continue to lead active lives engaging in church service, entertaining grandchildren, writing histories, corresponding, pursuing hobbies or doing handwork activities. Their care needs might not be that demanding and might include occasional help with house cleaning and shopping as well as help with getting out of bed, dressing and bathing. Most of the time these people don’t need the supervision of a 24/7 caregiver. There are, however, some care situations that make it difficult to provide long-term care in the home.

 

Please note from the first graph below that a great amount of home care revolves around providing help with activities of daily living. Note from the second graph below that the average care recipient has need for help with multiple activities of daily living. Finally, it should be noted from the second graph that well over half of home care recipients are cognitively impaired. This typically means they need supervision to make sure they are not a danger to themselves or to others. In many cases, this supervision may be required on a 24-hour basis. (Graphs were derived from the 1999 national caregivers survey, courtesy http://www.longtermcarelink.net.)

 

 

 

 

 

It is precisely the ongoing and escalating need for help with activities of daily living or the need for extended supervision that often makes it impossible for a caregiver to provide help in the home. Either the physical demands for help with activities of daily living or the time demand for supervision can overwhelm an informal caregiver. This untenable situation usually leads to finding another care setting for the loved one. On the other hand if there are funds to hire paid providers to come into the home, there would be no need for finding another care setting.

 

Problems That May Prevent Home Care from Being an Option
Caregivers face many challenges providing care at home. A wife caring for her husband may risk injury trying to move him or help him bathe or use the toilet. Another situation may be the challenge of keeping constant surveillance on a spouse with advanced dementia. Or a son may live 500 miles from his disabled parents and find himself constantly traveling to and from his home, trying to manage a job and his own family as well taking care of the parents. Some caregivers simply don’t have the time to watch over loved ones and those needing care are sometimes neglected.

 

The problems with maintaining home care are mainly due to the inadequacies or lack of resources with informal caregivers, but they may also be caused by incompetent formal caregivers. These problems center on five issues:

 

1. Inadequate care provided to a loved one
2. Lack of training for caregivers
3. Lack of social stimulation for care recipients
4. Informal caregivers unable to handle the challenge
5. Depression and physical ailments from caregiver burnout

In order to make sure home care is a feasible option and can be sustained for a period of time, caregivers must recognize these problems, deal with them and correct them. The responsibility for recognizing these problems and solving them is another function of the long-term care planning process and the team of specialists and advisers involved.

 

Adequate Funding Solves Most Problems Associated with Providing Home Care
None of the problems discussed in this article would be an obstacle if there were enough money to pay for professional services in the home. These services would be used to overcome the problems discussed in the previous section. If someone desires to remain in the home the rest of his or her life, adequate preplanning could provide the solution.

 

This planning must occur prior to retirement. The most obvious way to provide sufficient funds for home care is to buy a long-term care insurance policy when someone is younger, healthy and able to afford the lower premiums. If insurance is not an option, then money must be put aside early in life to pay for care in the future. The only other option is to be rich.

 

Unfortunately, very few people address the issue of needing long-term care when they are older. This leads to a lack of planning and in turn leads to few options for elder care when the time comes. Lack of planning means most people do not have the luxury of remaining in their homes and must rely on Medicaid support in a nursing home to finish out the rest of their lives.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Medication Problems and the Elderly submitted by Hospice and Palliative Care of Greensboro

Medication Problems and the Elderly

At 83 years old, Martha still lived in her own home, and enjoyed working in her garden and canning peaches. It was becoming harder to motivate herself, to get up in the mornings and accomplish the day’s tasks. She confided to her daughter that she felt anxious and tired. Her daughter, who was taking medication for her anxiety, took Martha to her own doctor, not Martha’s and got her a prescription for Valium. In doing so, the daughter’s doctor, who had never seen Martha and who did not have her medical history, was only aware of a few medications they told him she was taking.

 

Martha, in fact, was taking 9 different medications as well as herbal supplements.

 

The addition of Valium to her existing list of prescribed drugs sent her to the emergency room with respiratory distress. If she had gone to her own doctor, he would have found that a dosage adjustment of her current medications would have solved her anxiety.

 

Medication errors are common in the elderly. Many seniors take on average 6- 8 different prescriptions as well as over the counter drugs. Many times the elderly will not go back to their doctor to have their dosage evaluated and changed if necessary. Family members should be aware, that elderly parents may tend to take the family’s advice over going to their own doctor. Even though children want to help increase the health and stamina of their parents, they may in fact be causing damage by misdirecting their loved ones.

 

Where a younger person can benefit from herbal supplements like Ginkgo Biloba, Saw Palmetto and others, in older people, these herbals may cause adverse reactions with their prescription medications.

 

In 2003, a panel of experts put together a list of potential medications that would not be appropriate to give to seniors. This is called the “ Beers List ” after one of the research professionals.

 

Dr. Donna M Fick, R.N. one of the panel members for updating the “Beers List,” states in her article on Seniorjournal.com:  

“Just as our bodies physically slow down as we age, changes occur in the way that older bodies handle pharmaceuticals, and this has motivated experts to develop a list of drugs that may be harmful to elderly patients.

“With age, drugs tend to build up in the body, and the distribution and elimination of drugs from the body changes as well,” says Dr. Donna M. Fick, R.N., associate professor of nursing at Penn State. “Many drugs, like diazepam (Valium) and other anti-anxiety drugs build up fast.” 

An on-line article on HealthSquare.com , Titled “Drugs and the Elderly,” talks about physical symptoms and medications.  

“ Among the first signs that a drug may not be working properly in an older person is a change in mood, energy, attitude, or memory. Too often, these alterations are overlooked, ignored, or chalked off to “old age” or senility. Older people may themselves feel that their blue mood is caused by something external such as the death of a friend or simply by boredom. Nothing could be farther from the truth. Virtually every heart medication, blood pressure drug, sleeping pill, and tranquilizer has been known to trigger depressive symptoms.

When a psychological symptom appears in an older person, examine his or her medication or drug use first. Consider, too, factors like alcohol intake, poor nutrition, and hormone imbalance. And never dismiss the possibility that a real psychological problem has developed and may itself require medication.”

There are many things family members can do to help monitor medications for their elderly parents.

• Make a list of medicines prescribed and all supplements being taken.
• Give this list to the doctor and pharmacist and have one on hand for emergencies.
• Use the same Pharmacy to fill all prescriptions. Pharmacies keep a record of your prescribed drugs and will verify your doctor’s instructions. They will also tell you if foods or over the counter supplements will interact with a prescription.
• Dispense pills in a daily pill organizer box.
• Have a family member be responsible to call or physically monitor the taking of medication

Family members who live long distances from their elders have available to them

new technology in medication monitoring.  

• Alarms for pill boxes, watch alarms, medical alarm bands and necklaces that ring a reminder.
• Computerized pill box dispensers that ring a designated number if the pills have not been taken.
• Home Telehealth –

“Technology has developed computer and computer cameras to help the elderly in their homes stay safe and healthy. Home telehealth-set up by medical professionals in the home–enables providers to monitor such things as medications and blood pressure and actually see the patient. Patient questions are answered and advice is given, while the monitoring nurse views through the video phone how his or her patient looks physically.” The 4 Steps of Long Term Care Planning, Pg 92  

• Home Care Agencies – Home care companies offer a variety of service options in helping families care for and properly dispense medication to their elder parents.

Find a home care agency in your area http://www.longtermcarelink.net/a7homecare.htm

Overmedication or taking medication incorrectly may lead to early mental confusion and decline in health in seniors. “If medication problems were ranked as a disease in cause of death it would be the 5 th leading cause in the United States”. (from article on LongTermLiving)

 

Keeping Mom and Dad Safe at Home submitted by Hospice & Palliative Care of Greensboro

Generally, elderly parents want to remain living in their own home. However, remaining in the home becomes a concern when children see their parents slowing down, perhaps even having trouble with handling stairs and doing general daily activities. Yet, with parents’ mental and physical health currently not creating problems, there seems to be no imminent need to search out support services or other accommodations for aging parents.

 

This is now the time to evaluate the home to make it safe and secure for your loved ones — now and in the near future — in anticipation of aging disabilities that may occur. Help and support are available. The nation as a whole is more aware of elderly needs and services and products are becoming available at an outstanding pace.

 

The Bureau of Labor Statistics states,

“Employment of personal and home care aides is projected to grow by 51 percent between 2006 and 2016, which is much faster than the average for all occupations. The expected growth is due, in large part, to the projected rise in the number of elderly people, an age group that often has mounting health problems and that needs some assistance with daily activities.” Bureau of labor Statistics-Occupational Outlook Handbook, 2008-09 Edition 

This growing need for aides and services also encompasses 

• home remodeling services — making a home more serviceable to the elderly;
• safety alert systems and technology;
• motion sensors to monitor movement;
• telehealth services — using home-based computer systems for the doctors office or a nurse to monitor vital signs and
• even a pill dispenser that notifies when it is time to take medication. 

Where do you begin to make sure your elderly family member is safe and managing well in his or her home?

 

Visit often and at different times of the day and night. Make note of daily activities that appear challenging and where changes might be made to add safety and convenience. Remove rugs that slide — causing a fall — and move furniture with sharp edges. Set the water heater at a lower temperature. This will protect their older sensitive skin from scalds and burns. Be sure smoke detectors and carbon monoxide detectors are in place.

 

Bathrooms are a hazard area for the elderly. Grab bars by the toilet and shower are a must to help prevent falls. There are easy to install bars at your local hardware store if you want to do the work yourself. Another item that is good to have is a shower stool or chair.

 

If you are not sure of what needs to be done, consider hiring a professional. There are companies that specialize in home remodeling and accommodation for seniors. Michelle Graham of Accessible Design by Studio G4 says about senior home remodel projects,  

“The main thing we incorporate in all of our projects is a careful study of needs and potential needs that may develop throughout a client’s lifespan.”

Keep in mind what future home adjustments might be needed for your parents to “age in place” in their home.

 

Home safety or medical alert companies provide GPS-based bracelets or pendants to track the elderly at home who tend to wander. Or the companies may provide alarm devices such as pendants or bracelets which allow the elderly to alert someone if there has been a fall or a sudden health-related attack. In the event an alarm has been triggered, a 24 hour monitoring service will alert the family or medical emergency services or call a neighbor depending on previous instructions. In addition there are companies that will install motion sensors in the home to monitor the elderly on a 24 hour basis.

 

Don’t forget your parents’ community as a valuable resource for helping them stay in their home. Take Margaret Muller as an example. At 82 years of age, Margaret lives alone in her small home. She manages very well with the help of her local Senior Center. The Center’s “Senior Companion” program sees that Margaret is taken to the store for groceries and other needs and checks in with her often to see how she is doing. Once a day, the Senior Center delivers a hot healthy meal to her door. Having these services and visits gives Margaret the help she needs and peace of mind that she is not alone.

 

Neighbors, local church groups, senior centers and city centers are some places to look for assistance. Most of the time there is little or no cost for these services.

 

Your state aging services unit is a valuable community resource. The National Area on Aging website http://www.aoa.gov/states:

 

“AoA, through the Older Americans Act and other legislation, supports programs that help older adults maintain their independence and dignity in their homes and communities. In addition AoA provides funding for a range of supports to family caregivers.”

 

Some of the programs the site lists are:

“Supportive Services and Senior Centers

Nutrition Services

National Family Caregiver Support Program

Grants for Native Americans

Nursing Home Diversion Grants

Aging & Disability Resource Centers

Evidence-Based Disease Prevention

Long-Term Care Planning

Alzheimer’s Disease Grants

Naturally Occurring Retirement Communities”  

A few thoughts on hiring home care aides or live-in care givers.

The classifieds are filled with people looking for work as aides to the elderly. Many of these aides are well-qualified, honest people who will do a good job; but, of course, there will be some not so reputable. If you are looking to hire someone, be sure you interview and check references and qualifications. You will be responsible for scheduling that person and doing payroll and taxes as well. Be very sure you hire someone trustworthy, as the elderly seem to trust these helpers more than they should and therefore can easily be taken advantage of.

 

A professional home care service will eliminate your employment concerns. Professionally-provided aides are usually bonded and service is guaranteed. Home care companies take care of the scheduling and payment of their employees. Home care companies cater to the elderly in their homes by offering a variety of services. The National Care Planning Council lists many of these companies throughout the country on its website http://www.longtermcarelink.net/.

These providers represent a rapidly growing trend to allow people needing help with long term care to remain in their home or in the community instead of going to a care facility. The services offered may include:

• companionship
• grooming and dressing
• recreational activities
• incontinent care
• handyman services
• teeth brushing
• medication reminders
• bathing or showering
• light housekeeping
• meal preparation
• respite for family caregivers
• errands and shopping
• reading email or letters
• overseeing home deliveries
• dealing with vendors
• transportation services
• changing linens
• laundry and ironing
• organizing closets
• care of house plants
• 24-hour emergency response
• family counseling
• phone call checks
• and much more.

Thomas Day, Director of the National Care Planning Council states,

“Care in the home provided by a spouse or a child is the most common form of long-term care in this country. About 73% of all long term care is provided in the home environment typically by family caregivers.”

As their caregiver, you can make the difference in the quality of life for your aging parents and if staying in their home is a possibility, you have the resources to make it happen.

Holiday Blues – Depression in the Elderly submitted by Hospice & Palliative Care of Greensboro

The holiday season is quickly coming upon us. If you are a caregiver for an elderly loved one, you may notice a change in your loved one’s mood as the holidays approach. Perhaps you are one of many, who visit elderly parents and family during the holidays who live a distance away. When you visit you may notice that loved ones are not as physically active, or they show symptoms of fatigue or sadness and have no interest in the holiday or in their surroundings.

According to the National Institutes of Health; of the 35 million Americans age 65 or older, about 2 million suffer from full-blown depression. Another 5 million suffer from less severe forms of the illness. This represents about 20% of the senior population — a significant proportion.

Depression in the elderly is difficult to diagnose and is frequently untreated. The symptoms may be confused with a medical illness, dementia, or malnutrition due to a poor diet. Many older people will not accept the idea that they have depression and refuse to seek treatment.

What causes depression in the elderly?
It is not the actual holiday that causes depression, but the fact that holidays tend to bring memories of earlier, perhaps happier times. Additional contributing factors that bring on depression may be the loss of a spouse or close friend, or a move from a home to assisted living, or a change with an older person’s routine.

Depression may also be a sign of a medical problem. Chronic pain or complications of an illness or memory loss can also cause depression. In addition, diet can also be a factor when proper nutrition and vitamins are lacking.

As an example, Selma’s husband passed away, a few months before Christmas. Her family lived close by and would call or drop in often to check on her. Selma seemed a little preoccupied and tired, but this was to be expected as she had been the caregiver for her husband for many years. It wasn’t until the family noticed that her holiday decorations were not out and her yearly routine of Christmas card writing was not happening that they began questioning her mental and physical well being.

A trip to her physician confirmed depression, caused by not only the loss of her spouse, but a vitamin B12 deficiency. There were both mental and physical reasons for her depression.

Symptoms to look for in depression might include:

• Depressed or irritable mood
• Feelings of worthlessness or sadness
• Expressions of helplessness
• Anxiety
• Loss of interest in daily activities
• Loss of appetite
• Weight loss
• Lack of attending to personal care and hygiene
• Fatigue
• Difficulty concentrating
• Irresponsible behavior
• Obsessive thoughts about death
• Talk about suicide

How do you know if it is depression or dementia?
Depression and dementia share similar symptoms. A recent article on Helpguide.org gives some specific differences:

In depression there is a rapid mental decline, but memory of time, date and awareness of the environment remains. Motor skills are slow, but normal in depression. Concern with concentrating and worry about impaired memory may occur.

On the other hand, dementia symptoms reveal a slow mental decline with confusion and loss of recognizing familiar locations. Writing, speaking and motor skills are impaired and memory loss is not acknowledged as a being problem by the person suffering dementia.

Whether it is depression or dementia, prompt treatment is recommended. A physical exam will help determine if there is a medical cause for depression. A geriatric medical practitioner is skilled in diagnosing depression and illnesses in the elderly. If you are a care taker of an elderly person it may be beneficial for you to seek out a geriatric health care specialist. For more information on senior health services go to http://www.longtermcarelink.net/about_senior_health_services.htm

Treating depression in older people.
Once the cause of depression is identified, a treatment program can be implemented. Treatment may be as simple as relieving loneliness through visitations, outings and involvement in family activities. In more severe cases antidepressant drugs have been known to improve the quality of life in depressed elderly people. Cognitive therapy sessions with a counselor may also be effective.

As a care giver or family member of a depressed older person, make it your responsibility to get involved. The elder person generally denies any problems or may fear being mentally ill. You can make the difference in and remove the Holiday Blues from seniors suffering from depression.

The Geriatric Mental Health Foundation offers a “Depression Tool Kit.” To read more about the tool kit and depression in the elderly go to http://www.gmhfonline.org/gmhf/consumer/depression_toolkit.html

To find a Senior Health Care Services in your area on the National Care Planning Council website go to http://www.longtermcarelink.net/a7seniorshealthservices.htm

The National Care Planning Council supports the work of geriatric practitioners and their services to the growing senior population. If you are a geriatric practitioner and would like to list your services with the NCPC please call 800-989-8137.

Planning for Your Elderly Years submitted by Hospice & Palliative Care of Greensboro

If we were to ask an older person what his or her most important concerns for aging are, we would probably get a variety of different answers. According to surveys frequently conducted among the elderly, the most likely answers we would receive would include the following three principal concerns or life wishes:

1. Remaining independent in the home without intervention from others

2. Maintaining good health and receiving adequate health care

3. Having enough money for everyday needs and not outliving assets and income

To address these concerns or wishes and maintain the quality of life wanted in the elder years, it simply takes a little preplanning.

Few people do this kind of planning.

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