I’m Jean Bandos, MSN, CNS, APRN, BC. I’m a gerontological clinical nurse specialist with vast experience in care management of the older adult. I’ve spent the majority of my career assisting the older adult and their families navigate the health care system. In my blog, I’ll share some eldercare resources and assist in spreading the word on “tips” for caregivers of aging parents.
To learn more about me, please visit our website.
My previous blog,
2010 Flu Season for Seniors, focused on the symptoms of the flu and how to get vaccinated. This blog will focus on the everyday precautions you can take to help prevent the flu in you and your senior loved ones.
- Wash your hands often with soap and water - you can also use alcohol based hand cleaners
- Throw away your tissue after use
- Avoid touching your eyes, nose or mouth
- Avoid close contact with people who have flu type symptoms if at all possible
- Listen for your local public health advice especially regarding closing and crowds
- If you are sick, stay at home and have the supplies in need in your home for a week or so.
If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick.
Help keep yourself and your senior loved one safe and healthy this flu season by following the precautions above.
The U.S. Department of Health & Human Services would like to “highlight the importance of continuing influenza vaccination, as well as foster greater use of flu vaccine after the holiday season into January and beyond… the spread of 2009 H1N1 influenza is likely to continue” into 2010.
Influenza is unpredictable, but it is known that if people are vaccinated, the flu is less likely to spread in the coming months. Ask your health care provider if you have questions about the flu vaccine for you or your senior loved one.
Symptoms of Flu
Seasonal Flu- All types of flu can cause:
- Fever
- Coughing and/or sore throat
- Runny or stuffy nose
- Headaches and/or body aches
- Chills
- Fatigue
H1N1 Flu- Same as seasonal flu, but symptoms may be more severe.
Fever
- Coughing and/or sore throat
- Runny or stuffy nose
- Headaches and/or body aches
- Chills
- Fatigue
In addition to the above symptoms, a number of H1N1 flu cases reported:
If you're a caregiver, speak to your health care provider with any questions about the flu or the flu vaccine for you and your senior loved one.
My next post will give some of the most important flu prevention tips to keep you and your senior loved one healthy.
Sometimes it is hard to stay warm if you do not have monies to keep your heat turn up or even on. If your aging loved one is on a limited income and having difficulty paying heating bills, seniors may qualify for assistance. State and local energy agencies, or gas and electric companies may have special programs. Another possible source of help is the Low Income Home Energy Assistance Program (LIHEAP). This program supports some people with small incomes who need help paying their heating and cooling bills. Your local area agency on aging, senior center, or community action agency may have information on programs such as these.
Are you worried that your landlord (or that of your parent or other aging loved one) may want to cut off the gas or electricity in cold weather if you cannot pay a utility bill? Many states and cities now have laws to protect you, at least until other plans are made. Check with your local government about the laws that may apply where you live.
To find out about assistance in your area, contact your local Area Agency on Aging (AAA) who will provide information on the assistance programs. Visit them online at
http://www.n4a.org/ or call 800-677-1116.
Remember stay warm, keep your thermostat set above 65 and have a plan if you lose power. Caregivers, make sure to check on your aging loved one. You may also ask neighbors, friends, and family to help.
To learn more about winter safety, please see my last blog entry by visiting my blog
here.
It is very important for the older adult to know his/her surroundings and prepare for the winter months. Changes in the older adult that accompany aging make it harder for them to know when they are getting cold. It is also harder for the body to warm itself. So for safety’s sake, it is very important for the older adult to pay attention to the weather and how cold it is going to get. Caregivers should help their aging parents and other aging loved ones follow the tips below.
General tips for the older adult from the
American Geriatric Society are:
1. Stay indoors when it's very cold outside, especially if it's also very windy; and keep indoor temperatures at least 65 degrees
2. If you have to go outside, don't stay out in the cold or the wind for very long
3. Wear two or three thinner layers of loose-fitting clothing. (They are warmer than a single layer of thick clothing.) Always wear:
- a hat
- gloves or mittens (mittens are warmer)
- coat and boots
- a scarf to cover your mouth and nose and protect your lungs from very cold air
4. Stay dry; wet clothing chills your body quickly
5. Go indoors if you start shivering- it's a warning sign that you're losing body heat.
Know the warning signs of hypothermia: lots of shivering; cold skin that is pale or ashy; feeling very tired, confused and sleepy; feeling weak; problems walking; slowed breathing or heart rate. Note: Don't rely on shivering alone as a warning sign, since older people tend to shiver less -and some, not at all-as their body temperature drops. Call 911 if you think you or someone else has hypothermia.
In my next blog, I'll post information on finding assistance for seniors who may have trouble paying their heating bills.
Visit the AGS foundation winter safety page
here.
Caregiving is always a challenge - especially remembering to take care of yourself. During the holidays, it is so important to take care of yourself. Today, I’m sharing a few tips for caregivers of someone with cognitive decline or Alzheimer’s.
How do you take care of your aging loved one and still enjoy the holidays? The National Institute on Aging has many tips to assist you, especially during this holiday season. Some key tips are to:
- Keep or adapt family traditions that are important to you. Include the person with Alzheimer’s Disease as much as possible
- Recognize that things will be different, and have realistic expectations about what you can do
- Encourage friends and family to visit. Limit the number of visitors at one time, and try to schedule visits during the time of day when the person is at his or her best
- Avoid crowds, changes in routine, and strange surroundings that may cause confusion or agitation.
You can also visit my previous blogs on caregiving and the holidays:
Caregivers' plans for the holidaysCaregiver stress and the holidaysOr, if you'd like to read about a caregiver's experience and hear her advice, read Karen Kelsey's blog post:
Christmas and caregiving.
If you notice a change in cognition in your aging loved one this holiday season, or worry about their mobility, safety, or health, please contact their health care provider or a professional geriatric care manager for advice.
Holiday time is often an extremely difficult time for those caring for loved ones with Alzheimer's Disease. The Alzheimer’s Association has prepared a special Web page with
helpful tips to make the holidays less stressful for caregivers and family members. If you're caring for someone with Alzheimer's Disease, make sure to take care of yourself as well during the holidays. Caregivers often experience increased stress during the holidays, which can affect your well-being, and your ability to care for your aging loved one. Make sure to ask family and friends for help with your caregiving duties, and maybe even investigate respite care. A geriatric care manager can help you find caregiving solutions, and your health care provider can help you find ways to remain healthy and well during the holidays.
You can also visit my blog from last year on
Caregiver Stress and the Holidays. It includes some more tips to maintain your own well-being, and also a quiz for caregivers.
If you notice changes in your aging loved one over the holidays, a qualified professional with gerontology experience - such as a geriatric care manager or your loved one's physician - can help.
Just a reminder that the open enrollment period for Medicare drug coverage began on November 15. For quick information, The
Alzheimer’s Association has posted on their site a page dedicated to the
Medicare Part D Drug Benefit. This site can assist caregivers, family members and you find plans that best address the needs of the older adult. All prescription drug plans have changed in some way, with many including increases in premiums and cost-sharing to be paid by the Medicare beneficiary. If you or a loved one use find the best plan to meet your needs, a geriatric care manager or other professional can help. Learn more about Medicare by visiting the
Medicare site.
For additional information visit my past blogs:
It is that time of year… Medicare health and drug coverage open enrollment begins on Nov 15 and ends on Dec 31. With all the news on revamping America’s health care, you may have missed the announcement from The Centers for Medicare and Medicaid Services (CMS) that seniors or other people with Medicare (and their caregivers and/or family members) can begin to review their 2010 coverage options through Medicare’s improved online tools. Medicare Health Options Compare and Prescription Drug Plan Finder is located at www.medicare.gov.
Remember, caregivers, if your loved one is a Medicare beneficiary, they are eligible for Medicare prescription drug coverage, regardless of income, health status, or current prescription expenses.
There are two types of Medicare plans that provide prescription drug coverage:
1) Medicare Prescription Drug Plans - These plans add prescription drug coverage to Original Medicare, and certain types of Medicare Health Plans.
2) Medicare Health Plans - Some of these plans cover both health care and prescription drugs.
For caregivers and seniors that prefer to get information over the phone,
- Contact a Medicare customer service representative at toll free 1-800-MEDICARE (1-800-633-4227)
- OR contact your local State health insurance Assistance Program office (find the number online at http://www.medicare.gov/Contacts/staticpages/ships.aspx) or other health advocacy agencies for free personalized counseling.
Medicare's customer service is available 24-hours a day and 7 days a week. English and Spanish-language customer service representatives are available.
A 2010 Medicare & You handbook for seniors and their caregivers, also available on www.Medicare.gov, will be mailed to the homes of all eligible beneficiaries this month.
Medicare can be complicated, and a qualified geriatric care professional can help you figure it out if you're a caregiver. If you're a veteran (or a caregiver for a veteran) you can also see my previous blogs, which include Information on Veterans Benefits and Part 2: Additional Information on Veterans Benefits.
In my blog on Nov 9th, I discussed the end-stage dementia issues and raised the question ‘Is dementia a terminal illness?’ When faced with terminal illness, seniors and their caregivers often choose palliative care. Today, I’ll discuss that further.
What is a terminal condition?
In most states, a terminal condition is a status that is incurable or irreversible, and in which death will occur within a short time. There is not a precise, universally accepted definition of “a short time,” but in general it is considered to be less than one year. When looking at the hospice benefit, it will define “short term” as six months or less.
What is palliative care?
Palliative care is a comprehensive approach to treating serious illness that focuses on the physical, psychological, spiritual, and existential needs of the patient. Its goal is to achieve the best quality of life available to the patient by relieving suffering, by controlling pain and symptoms, and by enabling the patient to achieve maximum functional capacity. Respect for the patient’s culture, beliefs, and values are essential components. Palliative care is sometimes called comfort care or hospice type care.
For more information: go to Caring Connections which is a program of the National Hospice and Palliative Care Organization (NHPCO), is a national consumer and community engagement initiative to improve care at the end of life, supported by a grant from The Robert Wood Johnson Foundation. Caregivers and seniors can find them online at www.caringinfo.org.
Caregivers and seniors can also visit the National Hospice and Palliative Care Organization (NHPCO) home page at http://www.nhpco.org/templates/1/homepage.cfm.
Falls are a serious danger for seniors, as they can lead to broken or fractured bones, and hospital stays. As we age, mobility often becomes an issue, and our balance can deteriorate. Many older adults rely on the help of assistive devices such as canes.
If your doctor or therapist has ordered a cane for you, this Veteran’s Day (November 11, 2009), Sam’s Club is giving away 25,000 canes to veterans. To find out more, please visit http://www.hugosalutes.com/. If you’re a caregiver who is providing care for a senior, you should work with their health care providers to make sure that your loved one has the assistance he/she needs. In addition, you can take actions to prevent falls and help ensure their safety in the home, such as removing throw rugs. For more on fall prevention, please see my previous blog (http://myhealthcaremanager.compendiumblog.com/blog/immobility/0/0/fall-prevention-).
Make sure to check with your health care provider before using a cane or other assistive device.
November is Alzheimer’s awareness month. It is time to catch up with discussions about dementia and redefining dementia. Dementia is often thought of as simply memory loss and/or a memory disorder. While memory loss is the “hallmark” of dementia in its early stages, most caregivers treat it as illness and do not think of dementia as fatal. According to Catherine Elton at time.com, “Experts in the field say dementia is more accurately defined as fatal brain failure: a terminal disease, like cancer, that physically kills patients, not simply a mental ailment that accompanies older age.” Unlike other terminal diseases, as the older adult with dementia approaches the end of their life, they are often treated aggressively rather than with palliative care. Read more about what experts are saying in Catherine Elton’s report:
Experts Redefine Dementia as a Terminal Disease.
if you're a caregiver, remember, when caring for an older adult with dementia always ask if the treatments are causing more distress AND if their pain being managed. Check to see if the older adult has made their wishes clear regarding aggressive treatments, feeding tubes and CPR. Then advocate that their wishes are carried out. As a caregiver, if your parent or loved one is in the early stages of dementia and have not made their wishes clear, now is the time to talk to them and complete their advance directives/living will. A geriatric care manager can help caregivers and their aging loved ones address these issues.
For more information on treating advanced dementia as a terminal illness requiring palliative care go to Catherine Elton’s report:
Experts Redefine Dementia as a Terminal Disease.
I already covered the everyday precautions individuals, including caregivers, should take to prevent flu infection, such as washing your hands and avoiding close contact with those who are sick or exhibiting flu-like symptoms. Read my previous post to find out more.
Here are some other important actions that you can take:
- Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
- Be prepared in case you get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs,* tissues and other related items might could be useful and help avoid the need to make trips out in public while you are sick and contagious
If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed. Caregivers should know the signs and symptoms of flu and contact their aging loved one's health care provider with questions.
According to the CDC, emergency warning signs that need urgent medical attention for adults include:
- Difficulty breathing or shortness of breath
- Pain or pressure in the chest or abdomen
- Sudden dizziness
- Confusion
- Severe or persistent vomiting
- Flu-like symptoms improve but then return with fever and worse cough
Caregivers can find out more from the CDC Flu site:
www.cdc.gov/flu.
My
last post covered some general vaccination information for seniors and caregivers. Today, I’m going to provide you with some eldercare resources for flu season. The best advice during this flu season is to talk to your health care provider about the seasonal flu vaccination and the “novel” H1N1 (Swine Flu) vaccination.
According to the Center for Disease Control (CDC), “One thing that appears to be different from seasonal influenza is that
adults older than 64 years do not yet appear to be at increased risk of novel H1N1-related complications thus far.” To keep up with the latest information, visit the CDC (
http://www.cdc.gov/h1n1flu/).
Remember to take everyday flu-prevention and well-being precautions such as:
- Wash your hands often with soap and water You can also use alcohol based hand cleaners
- Throw away your tissue after use
- Avoid touching your eyes, nose or mouth
- Avoid close contact with people who have flu type symptoms if at all possible
- Listen for your local public health advice especially regarding closing and crowds
- When you are sick (or have flu symptoms), stay at home and have the supplies in need in your home for a week or so.
If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick. If you have additional questions, please speak with your health care provider. Your physician can also advise you on prevention measures, such as the flu vaccination.
For seniors and caregivers: if you would like to locate a flu center by zip code, visit
http://www.lungusa.org/site/pp.aspx?c=aqKGLXOAIlH&b=1015035.
According the America Geriatrics Society, a person is expected to live another 16 years after turning 65, a person who is 75 can be expected to live another 10 years and person 85 can expect to live another 6 years. So even though vaccinations are focused more toward children, it is important to prevent disease as you age and practice prevention. A recent post contained information about special vaccinations that you may need to travel to certain areas of the world, but vaccines are also an important consideration for everyday life. Caregivers and seniors should make sure to stay on top of their 
preventative health plans.
A great eldercare resource is the American Geriatrics Society. Through their site and publications you can know the latest recommendations not only for flu shots and the older adult, but also the recommendations for vaccinations and prevention tests. Medicare does pay for some of vaccinations such as the costs of flu, pneumonia, and tetanus immunizations.
Some vaccine recommendations for seniors are:
- Influenza Vaccine - yearly
- Pneumococcal Vaccine - 1 dose at age 65
- Tetanus Vaccine - 1 booster dose every 10 years
- Shingles Vaccine - 1 dose in immunocompetent people
Always remember to discuss a preventative health plan with your health care provider.
My last blog focused on a great eldercare resource for travel planning, the CDC travel site (www.cdc.gov/travel), where you can get information on recommended vaccinations and precautions. I also gave you some preparation to do with your health care provider, including creating lists of your medical conditions and obtaining documentation of any special conditions for airport security (e.g. pacemakers, steel plates, etc). Now you’re ready to pack – what do you need to take in terms of health care information?
Don’t forget
- a complete medication list
- enough of your medications for the duration of your trip
- a list of medical conditions (and treatments) created by your health care provider
- documentation of any conditions that airport security needs to be aware of
- alcohol-based hand sanitizer (for times when you can’t wash your hands
The medication list (including any over the counter drugs you’re taking) should include the drug names, doses, when you take them, any special instructions, and the amount of each drug you should take on the trip.
Having all your medical information on paper (including the medication list described above) will assist you on getting through customs easier and help you if you need emergency medications. Keep a copy on your person and copy in your luggage.
As always, protect yourself from infection by washing your hands and/or using an alcohol-based hand sanitizer prior to eating or after spending time in crowds such as on plane, bus or train. Watch what you drink and eat.
Plan ahead and enjoy!
Fall is a great time of year to travel for the older adult - with school in session, fares drop and popular vacation sites are less crowded. When planning a trip, an important step is to always check for health and vaccination information for your destination. A great resource for this is the Center for Disease Control (CDC), where you can access health and vaccination information. For caregivers and seniors, travel may require a bit more preparation.
Certain vaccines are required 6 weeks before departure, so schedule an appointment with your health care provider to discuss any travel plans and any precautions you should take.
Also, ask your physician to write down any medical problem(s) that you have - and how they should be treated.
If you have pacemaker, steel plates, total joint or any condition that airport security needs to be aware of, have your physician provide you with the appropriate documentation. This should help you avoid unnecessary hassle or delays with airport security.
Visit the CDC travel site (
www.cdc.gov/travel/) for the latest updates and information.
With all of the choices available, finding the best options for insurance can be time consuming and confusing for the elderly and their caregivers. The State Health Insurance 
Assistance Program can help you sort out your options.
State Health Insurance Assistance Program
SHIP, “State Health Insurance Assistance Program”, is a national program that offers one-on-one counseling and assistance to people with Medicare and their families. SHIPs provide free counseling and resources. If you want to contact a SHIP counselor in your area who will provide you with state specific information including a counselor to help guide you through the process of picking a supplemental policy and the required paperwork visit the SHIP website www.shiptalk.org.
Caregivers should explore eligibility for Veterans benefits. Veteran health benefits are open to all Veterans. Family members may also be eligible to receive benefits. There is no monthly premium for VA care, but there may be a co-pay. For more information, visit the VA Health Care Eligibility & Enrollment www.va.gov/healtheligibility .
Additions resources are available at:
Veteran or Surviving Spouse Benefits Information
Veterans Financial, Inc. is a national company (not a part of the Veterans Administration) that provides free financial advice to veterans and their families who may now or in the future need assistance in their home, assisted living, or long term care facility. Veterans Financial helps veterans and their surviving spouses apply for the VA’s Aid and Attendance benefit to ensure they are getting the benefits they are eligible for. Aid and Attendance
The Aid and Attendance benefit is a benefit paid in addition to a monthly pension.
You may be eligible for the Aid and Attendance benefit if the veteran or the surviving spouse:
- Requires the ongoing aid of another person in order to perform basic personal functions required in everyday living (i.e. bathing, eating, dressing, etc.) -OR-
- Is bedridden -OR-
- Is a resident in a long term care facility due to cognitive or physical incapacity -OR-
- Is blind, or nearly blind
Once Veterans Financial has an idea of your specific situation, they will advise seniors and/caregivers on options you have and help with the application process to help obtain the Aid and Attendance Benefit.
For more information on Veterans Financial, Inc. please visit: www.veteransfinancial.com or contact them at 800-835-1541.
Long term care insurance is separate from Medicare, and may be a good option depending on your situation and that of your loved one. Senior and caregivers should thoroughly investigate the long term care insurance policies available, and consider finances, health, long term wishes and goals, and other factors.
Long Term Care Insurance
- Long term care is not covered by Medicare
- Long term care insurance can be purchased to cover the expense of long-term care
- Policies protect assets should you need extended care, such as a house for your spouse
- Many are standardized and may be purchased through authorized insurance brokers through the state. Policies differ from state to state. Each state must honor the policy from another state
- 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’
An experienced geriatric care manager can help you identify local resources.
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Eric Tinsley
Alan Stanford 
Jean Bandos
Karen Kelsey
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