• Death in the Home – Information for Caregivers
• Tips for Alzheimer Caregivers
• Delirium vs. Dementia
• Transitioning an Individual with Dementia into a Facility
• Member Portal Instructions
• Continence Education – Constipation
• Urinary Incontinence – When to Seek Immediate Medical Attention
• Crime Prevention Education for Older Adults
• IADL (Independent Activities of Daily Living) Education
• Physical Therapy and Occupational Therapy
• My Medicare Matters
• Advance Directives for Mental Health Treatment
• Drug Review and Side Effects
• Geriatric Friendly Pharmacy
• Medicine Reconciliation:  Brown Bag Consultation
• Feeding Tube Education
• Special Diet Needs Education
• Defibrillator Education
• Diabetes Education
• Fibromyalgia Education
• Pacemaker Education
• Physician Planner Case Note
• Alternative Living Options Education
• Speech Therapy Education
• Social Participation Barriers
• Social Support Plan

A big component of healthy aging is how well we are eating.  With fast food joints on every corner and the convenience of getting fast food it may be difficult to eat healthy for some.  Whether you are on your way to a book club or going to see your grandchild's sporting event if you find you must pull into a fast food restauraunt, consider ordering a salad with low fat dressing rather than a burger and fries for example.  There are other tips that can help with planning meals.  If you are cooking meals at home, consider these tips for nutritional healthy aging:

• Eat a diet that is low in saturated fats
• Eat 5 or more servings of fruit and vegetables each day
• Reduce salt to help prevent high blood pressure or water retention
• Consume more fiber rich foods to help prevent constipation
• Limit sugar and dry food

• Key changes for work flow
• Assessment and tracking improvements in the following dimensions:
  • Client Designees
  • Financial
  • Advance Directives
  • Engagement – Social Support
  • Provider Information
  • Medication History
  • Family Medical Health History
  • Functional Status
  • Assistive & DME Devices
  • Sensory Status
  • Nutritional Status
  • Anxiety
  • Environmental
• Reporting enhancements in areas like legal and Insurance, personal health record outputs, services listing, and more

My Mother has lived in an Assisted Living facility for almost two years.  In many ways she has adapted well and I think she is comforted by the fact that I live nearby.  However, as her Alzheimer Disease progresses, I often hear “I want to go home.”  In talking with others, I’ve learned that this is quite common... yet hearing it tears at the heart of every caregiver I know. 

Following are some tips you may find helpful when the senior in your life tells you repeatedly:    “I want to go home.”

• Remember that it is very common for a senior to repeat this request often.  Usually they mean the home from 60 or 70 years ago, not the one they left most recently.
• “Home” means different things to different people – love, security, belonging, safety.  When a senior asks to “go home,” try to determine if there is an “unmet” need (i.e. need to feel safe, need to belong) and try to fill that as best you can.
• Don’t refer to the senior’s current location as home.  Point out that they are staying there for “awhile.”  When they say “I want to go home” tell them you will talk about it and name some future date.
• Find a good reason for them to stay where they are – i.e. people are nice, good food, close to family, nice apartment, fun activities and try to get them to “buy into it.”

In today’s world, adult children are faced not only with the effects their elderly parent(s) aging, but now they have to understand how the economy may affect their aging parent’s financial situation.  Every time we turn on the TV, we are inundated with how bad the economy is and what is happening to our savings. But are you aware that older adults are struggling with excessive credit card debt, and that bankruptcies are increasing among the elderly?

So what can you do to assist your aging parents?  How do you help yourself, as the caregiver, make plans for the future?  Start by asking some general questions, such as:  
 

• Is your parent worried about his/her finances?
• Is anyone currently assisting your parent with day to day finances?  If yes, are there any concerns about how the finances are being handled?
• Does your parent currently have someone providing him/her with advice on business or finances?  This could be a lawyer, trust officer, personal friend, family member, etc.
• Does your parent have health and financial powers of attorney?  Have the appointees been informed?  
• Is the current income stable and sufficient?
• Does your parent know what his/her sources of income are? (e.g. Social Security, pensions, investments, family support)
• Does your parent have adequate insurance coverage? Does he/she understand what’s covered by the policy/policies?
• Does your parent have long term care insurance? If yes, does he/she understand what the policy covers? 
• Are your parent’s estate documents (e.g. wills, trusts, and beneficiary) current? 
• Does your parent know where important documents are kept?  Your parent (and caregivers) should know the locations of documents like birth certificates, divorce papers, death of spouse, remarriage, estate documents, and advance directives?
• Is your parent’s advance directives document current and active in his/her state of residence?  (e.g. if your father has advance directives including financial power of attorney and moves across state lines, he needs to contact a lawyer and make sure it is still current with state of residence regulations).

Resource sites:

• The Medicare official site is www.medicare.gov.
• A site to help you as a consumer to under Medicare Benefits visit: Medicare Consumer Guide: http://www.medicareconsumerguide.com/medicare-overview.html.
• To find out more information about long term care insurance go to: www.medicare.gov then go to ‘search tools’ then go to ‘plan your long term care needs’.

I've been seeing several ads for voice recognition phones, lately .  The idea is to provide both the sound through the ear piece and a text display of what's being said.  This can be a terrific tool for older adults with hearing problems. One example can be found at the CapTel web site.

This service can have impact on senior well-being in several ways.  The example shown by most of the advertisers is reducing feelings of isolation by making it easier for grandparents to speak with grand kids and other friends and family.  It can also play a very practical role in caring for aging parents, as well.  Caregivers can communicate more frequently by adding phone conversations to face to face interaction.  The text can also help assure that advice or instructions are more accurately understood.

These phones are another tool in the emerging market to help seniors who are  living independently. 

Health professionals have been saying for years it is important to keep your brain active.  What does that really mean though?  Research has shown that as we age, mental decline may be due to altered connections of brain cells.  However, by keeping the brain active daily can help may reserve these brain connections.  So, how do you keep your brain active during the day?  Here are some tips:

• Reading
• Working crossword or sudoku puzzles 
• Take a walk
• Go a different route to work one day to challenge your brain, rather than going the same way which is routine for you
   
• Take a class that is of interest to you (exercise, art, photography, cooking, etc.)
• Play a game
• Try brain teaser games
• Exercise

As a caregiver, the responsibility for decisions regarding your parent’s care falls to you.  Often you wish you could discuss the options, choices and next steps with your parent, just as you discussed so many choices in the past…where to go to college, where to have your wedding reception, which neighborhood to select.  But parents with Alzheimer’s cannot help with current decisions as their ability to reason, compare and choose has been ravaged by the disease.  Sadly, dementia robs them of their ability to chart their own course.

So, what should caregivers do when faced with a variety of paths – how do you know how to choose what is best for your parent? How do you know when a parent’s living environment is no longer safe? How do you know when a parent needs more assistance? 

Here are a few suggestions:

• Pay attention to your parent – they may be confused, but they will give you clues when things aren’t going well.  They may seem more agitated, confused or disoriented.  Their routine may change and a situation that has worked well in the past, now poses problems.  For example, they may no longer want to eat dinner because they either can’t remember where the Assisted Living Dining Room is located, or they are afraid to leave their apartment.  
• Check in with their caregivers – have other family members, a companion, assisted living staff or adult day care workers noticed a change in your parent?  Are they concerned? 
• Take your parent in for a check-up – have the Doctor evaluate your parent and review their medications and mental and physical health. 
• Review your parent’s ability to complete Activities of Daily Living – things like bathing, dressing, continence, mobility, feeding.  Has there been a change in their ability to do these things?
• Engage a Geriatric Care Manager – have them conduct an independent assessment to provide an unbiased view of the situation.

Once you have gathered the above information, spend time thinking and talking to others you trust about the findings.  Choose the next step based on what you think is best for your parent at this moment in time.   For instance, if you determine that they need more assistance, think about the pros and cons of providing additional assistance in their current environment vs. moving them to a new environment such as a Memory Care Unit.   There is no “right” decision.  Take comfort in the fact that you have been both thorough and thoughtful when you made the decision.  Always remember that your parent is better off when you address concerns as they arise vs. postponing decisions until a crisis arises.

Within the first 12 months of enrolling in Medicare Part B you get a one time physical exam that is covered by Medicare.  Your physician will go over your medical history with you and make you sure you have had certain health screenings and shots to help prevent certain health conditions.  This exam is a good way to get up to date on all the important preventative services you should be doing and at what age.  The doctor will also discuss end of life planning, including advance directives as part of this exam.  As long as you have Medicare Part B and you have this exam within 12 months of enrolling you pay 20% of the Medicare approved amount and NO part B deductible.  This is a great benefit to take part in to make sure you are doing all the proper things to ensure a healthy aging experience.  For more information on this physical exam, please visit www.medicare.gov for more information.

The SCANS content team headed by Jean Bandos along with the development team announced today that the SCANS Version 1.3 - May release is now available.  SCANS Version 1.3 is a major content release to the SCANS Knowledge Base.

In order to make more real-world tools for eldercare available more quickly, Jean and the team have devised a "rolling release".  For 3 months beginning in May another group of resources, processes, and tools will be made available to geriatric care managers at My Health Care Manager and our affiliates.

The May release contains 57 new and/or revised resources, processes and tools.  Some sample items include: 
 

• Behaviors and Alzheimer's Disease
• Grief Education
• Activities of Daily Living Education
• Depression and Alzheimer's disease
• Early Stages and Impact on Health
• Memory & Cognition Questions
• Memory Care Unit Checklist
• Memory Care Unit Education
• Mild Cognitive Impairment
• Sobriety Programs Resource
• Handyman Resource
• Private Handyman Contractor Checklist
• Smoke & Carbon Monoxide Detectors
• Daily  Money Management Education
• Financial Planning Education
• Trust Education
• Verifying Funeral Arrangements
• Veterans Benefit Information
• Elder Law Resource & Checklist
• Medication Management Procedure
• Medication Reconciliation
• Polypharmacy
• How to Find a Pain Specialist
• Pain Education
• Pain Resources
• Pain Visual Analog Scale
• Arthritis
• Heart Failure
• Hypertension Education
• Family History - Cancer Education
• Family History - Dementia
• Family History - Diabetes Education
• Family History - Heart Education
• Seat Belt Education
• Cataracts Education
• Glaucoma Education
• Hearing Aid Education
• Sensory Changes
• Assistive Devices
• Hospice Education
• Spiritual Connections

May is Stroke Awareness Month and I’ve posted a couple blogs recently about strokes.  Some new guidelines were just released and I think they’re very important.  A national stroke coalition called the Brain Attack Coalition (BAC) has adopted a new message this month: “Stroke strikes fast.  You should too.  Call 9-1-1.”  This should be a mantra for all caregivers, families, and friends of seniors.

If you recognize the signs of a stroke in your aging loved one, call 9-1-1 immediately.  Stroke victims need to see a health care provider immediately.  How can you recognize a possible stroke?  See my previous blog on the ‘Act F.A.S.T.’ method which has you answer a few key questions: Face – does one side droop? Arm – does one arm drift down if raised? Speech – is speech slurred or strained? Time – if you answered yes, it’s time to call 9-1-1!

The BAC is chaired by the National Institute of Neurological Disorders and Stroke (NINDS), which is a part of the National Institute of Health (NIH).  For more information see the NIH announcement here or see the NINDS stroke page here.
 

Our Senior CAre Navigation System (SCANS) has released in a new edition - Version 1.2!
 
This version includes major extensions of the search functionality to make it easier for geriatric care managers to find specific tools and solutions.  This provides quicker access to hands on practical solutions for families caring for aging parents.  Of course, the structure and caregiver advice in each of the 25 Care Categories remains in place to assist the geriatric care manager overall care planning.

HBO is doing a documentary series on Alzheimer's starting this Sunday, May 10.  Titled 'The Alzheimer's Project', the series is comprised of four parts.

1. The Memory Loss Tapes
2. Grandpa, Do you know who I am? (with Maria Shriver)
3. Momentum in Science
4. Caregivers

Caregivers for those with cognitive decline or Alzheimer's can find free help from their local Alzheimer's Association.  Whether you're looking for ways to better communicate with someone with Alzheimer's, ways to reduce your caregiver stress, or even seeking other local resources, the Alzheimer's Association is a great place to start your search.

Local Alzheimer's Associations often give conferences for caregivers.  Topics often covered include communication, home safety, and well-being.  Presenters have extensive experience in geriatrics and caregiving topics.  In addition, you can connect with other caregivers for support.

There will be a caregiver's conference on May 15th in Indianapolis, and I encourage you to attend.  For more information, visit the local Alzheimer's Association website. 

For information on events in your city and state, visit the national Alzheimer's Association website.

It is a myth that older adults need more sleep than younger adults.  In reality, older adults need about the same amount of sleep as everybody else – between 7-9 hours each night.  Typically, many go to bed earlier and wake up earlier than when they were younger.  This could be due to the fact that their bodies are in a pattern of getting up early daily to go to work, etc.  It is true that elders experience less “efficient” sleep, meaning they spend less time in the deeper stages of restorative sleep and feel less rested when they wake up.  Hence, many older adults fall into a pattern of taking naps during the day.  It is essential to get a good nights sleep every night as a part of healthy aging.  Sleeping well will help you feel rested the next day along with being able to concentrate better.  If you do find yourself not sleeping well, here are some tips to consider:
1. Follow a regular sleep schedule – Go to bed and get up at the same time each day – even on the weekends.
2. About 30 minutes before going to bed, do things to relax your body (read a book, take a bath, watch TV, listen to music)
3. Have a comfortable pillow
4. Exercise regularly but not within 3 hours of when you plan to go to sleep.
5. Do not have caffeine late in the day since it is a stimulant and can keep you awake at night.
6. Drink less fluids in the evening.  Getting up throughout the night to use the bathroom breaks up your sleep.
7. Make an effort to get outside everyday to get some sunshine.

If you still feel tired and are not sleeping well it is important to see your doctor about this so you can get a good night’s sleep without having to count sheep. 
 

One of most touted areas of the Federal government's stimulus initiatives has been investment in Health Information Technology.  Unfortunately this has been focused heavily on infrastructure not caregiving tools (and certainly not tools for eldercare specifically).  Proponents of this investment believe that it will save billions of dollars in the long run on health care costs.  Typically they site things like the elimination duplicate tests, administrative efficiencies of an Electronic Medical Record (EMR) and other "back office" improvements.

Well, I'm skeptical.

I'm not alone,  the New York Times published an article a little while back raising some of the same concerns.  Titled "Doctors Raise Doubts on Digital Health Data" the article discusses how difficult a problem this really is.  Two significant issues surface.  First, how frequently these systems are used and second, do they actually make a difference in the quality of care and coordination between health care providers.

Read the full article at www.nytimes.com/2009/03/26/business/26health.html. 

Not surprising the use is very low - 9% of the nation's 3000 hospitals according to the article.  Data on quality or efficiencies really isn't even available.

For people caring for aging parents and the cost associated with senior health care.  I'm even more skeptical.  In reality the health situation for a senior really can change over night and repeat tests are necessary.  A senior with congestive heat failure or chronic obstructive pulmonary disease may require duplicate tests in very short time frames.

Transfer of information could provide some efficiencies, but often competitive hospitals, physician practices, and other competitive health providers are being asked to collaborate with no financial incentive.