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.

Over the last year, I have written several blogs on aging in place for older adults and their caregivers.  Today, in honor of Stroke Awareness month (April), I wanted to raise your awareness about this concern, which is a preventable health issue. I recently attended an educational session on stroke prevention and would like to share the National Stroke Association’s efforts to educate the public on recognizing stroke symptoms.  Most of us think of stroke as a disease of old age – one that is debilitating and causes lasting disabilities. But it can strike at any age. 

Did you know that 80% of strokes are preventable and that by acting in time, the long term of effects of strokes could be minimized?

Here are some simple tips to follow to prevent a stroke: 

• Know your blood pressure.      
• If it’s high, work with your doctor to lower it.
• Find out from your doctor if you have atrial fibrillation
• If you drink alcohol, do so in moderation.
• Find out if you have high cholesterol. If so, work with your doctor to control it.
• If you are diabetic, follow your health care provider's recommendations carefully to control your diabetes.
• Include exercise in the activities you enjoy in your daily routine.
• Enjoy a lower sodium (salt), lower fat diet.

Look for my next blog entry, where I’ll share with you an easy-to-remember way to recognize the symptoms of a stroke.  This is important for caregivers, aging adults, grandchildren – everyone should be able to recognize stroke symptoms so that quick action can be taken.
 

Maybe it's the latest social event, health craze, or the Baby Boomers wanting a fit, active life but today's seniors are anything but sedentary!  Seniors want more than just bingo...they want activities and social events that are fun, physically active, and socially stimulating.  Whether they are aging in place or have made the move to a retirement community/assisted living/other living option, seniors are getting involved!  If you're a caregiver, think about introducing your aging parent to some of the activities listed below.


Some of the activities today's seniors are involved in include:

1.  Travel clubs - On a flight to Scotland last year, I sat next to a retired couple who joined a senior travel club a couple years before.  They told me a story of getting married after high school, working their whole lives, and raising a family.  They rarely traveled during this time, so they decided it was time to see the world.  They had been to every US state except for 2 (but those were on the "to do" list) and had been to numerous countries in their travel club.  This is a goal I hope to achieve myself one day!

2.  Political events, campaign assistance

3.  Wellness and fitness clubs/activities

4.  Charity or volunteer work

5.  Dance classes (ballroom dancing, salsa, etc)

6.  Nintendo Wii game parties

7.  Creative arts classes (theater, artwork, pottery, glass blowing, etc)

8.  Trying new foods and restaurants

9.  Attending local theater events, the symphony, or historical museums

10.  Monte Carlo Night (casino games)

11.  Shopping excursions to nearby cities

12.  Book clubs

13.  Investment clubs

14.  Indulging in new hobbies (photography, coin collecting, golf, etc)

15.  Learning how to play a musical instrument

16.  Cooking classes

17.  Becoming a senior companion

18.  Winery tours

19.  Computer classes

20.  Happy hour events

This time of year, there are more home fires than any other time of the year, so home safety is especially important. Most of the fires are due to home heating devices. Burning wood, natural gas, kerosene, and other fuels also produces carbon monoxide. Unless fireplaces, wood and gas stoves, and gas appliances are properly vented, cleaned, and used, they can leak dangerous amounts of carbon monoxide and also are fire hazards.  Since older adults are three times more likely to die or be injured in a home fire than those who are younger, I wanted to share some simple tips on things that older adults can do to protect themselves this winter.

MOST IMPORTANT: HAVE AN ESCAPE ROUTE/PLAN TO FOLLOW IF YOUR HOUSE DOES CATCH ON FIRE.  Run through the plan at least once a month to identify any problems that could prevent a safe escape.

There are some other tips you should always follow. You should:

• Have fireplaces and wood stove chimneys and flues inspected yearly and cleaned when necessary. (Ask your local fire department to recommend an inspector or look in the telephone book under "chimney cleaning")
• Put a smoke detector and battery-operated carbon monoxide detector in areas where you use fireplaces, wood stoves, or kerosene heaters.
• Open a window - just a crack will do - when using a kerosene stove.
• Make sure space heaters are at least 3 feet away from anything that might catch fire (such as curtains, bedding and furniture).
• Keep a fire extinguisher that can be used for a variety of types of fires (including chemical fires) in areas where you use fireplaces, wood stoves and kerosene heaters.
• Never try to heat your home using a gas stove, charcoal grill, or other stove not made for home heating.

If the older adult has a space heater, review the following tips to increase the safety of this device in the home:

• Make sure your space heater has been approved by a recognized testing laboratory.
• Choose the right size heater for the space you are heating.
• Keep substances that can catch fire like paint, pets, clothing, towels, curtains, and papers away from the heating element.
• Keep the door to the rest of the house open for good air flow.
• Turn the heater off when you leave the room or go to bed.
• Make sure your smoke alarms are working.
• Put a carbon monoxide detector near where people sleep.
• Keep the right type of fire extinguisher nearby.

For any disaster planning (including that to encourage home safety), an excellent reference is The Hartford and the MIT booklet “It Could Happen to ME; Family Conversations about Disaster Planning”.

We are constantly hearing certain buzz words in eldercare: aging in place, healthy aging, senior healthcare, wellness, and senior well-being.  How do we truly age in place and take care of our senior health needs in our current healthcare system?  One should become aware of the truths about aging versus the myths that are out there.  One should also help health care providers to promote wellness and independent function by asking them questions and having periodic overall health assessments. 

Do you know – Is this TRUE or a MYTH?

Most older adults are sick. 

MYTH!  Most older adults (78% of 65+) are healthy and engaged in normal activities.


If you are old, you are sick. 

MYTH!  Only 23% of older adults claim to have a disability.  85% of the debilitating diseases are from cancer, coronary artery disease, stroke, diabetes, kidney failure, obstructive lung disease, pneumonia, and flu. Remember  -- Chronic illness does not translate into functional inability.


Older adults have more chronic diseases than younger persons, but fewer acute illnesses.  

TRUE!  Older adults have more chronic diseases than younger persons, but fewer acute illnesses.  There are 102 acute illnesses reported per 100 people over 65 and 230 acute illness per 100 people under the age of 65.   85% of the debilitating diseases are from cancer, coronary artery disease, stroke, diabetes, kidney failure, obstructive lung disease, pneumonia, and flu.


Your body systems are affected by age.

MYTH!  Body systems such as your heart and lungs are minimally affected by age but PROFOUNDLY influenced by lifestyle behaviors such as cigarette smoking, physical activity,  what you eat, and sometimes if you have enough resources to access the care you need.

What should the older adult expect?  The older adult can expect to lose 2 inches of height by age 80, which can lead to changes in posture and our feet - which could affect our balance and create a potential fall risk.  Another fact is that the body cannot regulate its temperature as it did when one was younger, so an older adult needs to be aware of exposure both cold and heat.  If the temperature outside is high, the older adult is at risk for heat stroke.  

The most important item for an older adult to remember?  A health assessment promoting wellness and independent function is a must.  Remember that health care needs to be individualized… and that the body can remain healthy as one ages. Although our organs may gradually lose some function, a senior may not even notice these changes except during periods of great exertion or stress.
Today, there are more than 4 million Americans 85 and older. That number is expected to grow almost 5 times by the year 2050.  By the year 2030, it is estimated that the “oldest-old” (85 years and older), will grow to 10 million people. 

Views on aging are changing  

TRUE!  Aging is no longer synonymous with physical decline and illness. 


Future Blogs will continue to address the issues of senior health care and healthy aging.

Resources:
• Luggen, A.,S Meiner,S. E. (Eds.). (2001) National gerontological nursing association: Core curriculum for gerontological nursing. St. Lois:  Mosby.
• Mezey, M, Fulmer,T, Mariano, C, (Eds.). (2005) Best nursing practices in care of older adult. Curriculum Guide. ( 3rd ed.) New York:  The John A. Hartford Foundation: Institute for Geriatric Nursing.

For the last several months, we have been discussing safety concerns for the older adult.  We all know that medication management and fall risk prevention are instrumental to healthy aging, but a holistic picture is what is most important to assist in aging in place and maintaining good “health”.  As the boomers age, we will see more and more written on wellness, well-being, and just overall aging tips. 

But what is key to a healthy life style?

According to American Geriatrics Society it is

1. Not smoking
2. Drinking alcohol in moderation
3. Exercising
4. Getting adequate rest
5. Eating a diet high in fruits and vegetables
6. Coping with stress and
7. Having a positive outlook.  

These are important, but I feel that whether you are elderly or young, you need to understand your overall health issues, have social connections, be at peace with where you are in life, have a purpose, live in a safe environment that supports your needs, and keep your brain functioning. 

Good Morning America does a segment that highlights individuals celebrating their 100th or older Birthday.  Today a man was 107! I am always amazed at the life history of those over 100...  The majority have remained both physically and intellectually active and have remained connected with society.  Amazing, they never reference how many fruits and vegetables they have eaten!!   So stay connected… and do your brainteaser and always learn something new each day. 

The My Health Care Manager's Client Portal serves as a communication platform for families caring for aging parents. It provides easy access to information like:

• Schedule of care events (e.g. medical appointments, therapy, geriatric care visits)
• Medical issues (e.g. Alzheimer's, arthritis, incontinence, congestive heart failure, diabetes, COPD)
• Health provider contact information and specialties
• Medication list including dosage, frequency, prescribing physician, and other specifics
• Recent Hospitalizations
• Client contact information
• Updates on key issues of aging such as Caregiving, Advanced Directives, Living Independently, Family Communications, Depression, and more
• Resources
• and more

It also supports secure, private interactivity with the Health Care Manager providing geriatric care for the family using tools like a discussion board, contact logs documenting visits and phone conversations, and posting of care goals like improving home safety, reducing isolation, improving depression, improving mobility, supporting treatment plans, and so on.

Do you know of any communities that are not designated as a 55 and older community but it just seems they have naturally turned into that?  Those neighborhoods are becoming more and more common and are referred to as Naturally Occurring Retirement Communities or NORCs.  A NORC is community, neighborhood, apartment building, or street where the residents remain for years and “age in place”, allowing a naturally occurring retirement community to develop.  To “age in place” means to grow older in one location without having to move.  NORCs offer familiarity, feelings of independence, feelings of safety, and a comfortable environment  NORCs also tend to foster social gatherings, neighbors helping neighbors, neighborhood crime watches, and more accessible public transportation (as more and more people in the neighborhood utilize the transportation service, it will naturally develop a routine route in the neighborhood).

AARP reports that more than 80% of seniors wish to remain in their own home for the rest of their lives.  To age in place successfully, requires advanced planning regarding the senior's overall health care and well-being, home environment and safety planning, and preparation for aging-related changes.  A professional geriatric care manager can assist you in planning for aging in place.  For more information regarding aging in place, check out http://www.seniorresource.com.

June is Home Safety Month.  Have you assessed your parents’ home and developed a disaster plan?  With all the environmental issues that are in the news, it’s a good time to review home safety and develop a disaster plan for parents or the special older adult in your life. The focus of this blog is on falls, which are the number one safety risk for older adults. Nearly one third of America’s older adults fall each year, with seventy percent of these falls occurring at home.

Ten Tips for Home Safety – Fall Prevention

1. Remove all throw rugs; if one cannot live without throw rugs, make sure they are secure with non-slip backing
2. Install grab bars in bathroom, especially in the shower/tub
3. Provide adequate lightening, especially around stairwells and pathways 
4. Keep a flashlight by the bed 
5. Use a nightlight 
6. Keep pathways clear of objects, especially electric cords
7. Remove clutter
8. Make sure the handrails on stairways are accessible and sturdy
9. Check carpets for any tears and/or holes
10. Review all medications- prescriptions, over the counter, herbs, and vitamins with doctor and/or pharmacist to reduce risk of dizziness and weakness 

Other areas of home safety for older adults is same as for others:

• Make sure to have a working smoke detector on each level of the home 
• Have a fire extinguisher on each floor
• If there is someone in the home using oxygen, make sure there is an oxygen awareness sign and that no one smokes in the area where there is oxygen
• Make sure there is a working carbon monoxide detector on each level of the home
• Keep a telephone within easy reach with numbers large enough to see in hurry
• Have a disaster plan
• Have a fire evacuation plan

Resource:  The Home Safety Council (HSC) website, www.homesafetycouncil.org, offers more information, illustrated handouts, and virtual home safety tour.

Look for next week’s blog addressing key components of a disaster plan of an older adult.

As the holidays come to a close, are you experiencing the holiday blues? Are your parents? While you where visiting your aging parents did you notice any signs of depression or mood changes? It is known that suicide rates increase over the holidays. But did you know that between 5% to 20% of persons over age 65 living in the community suffer from depression (2002, Primary Care Geriatrics)?

Depression is a common disorder among the elderly but is not a normal part of growing old.  It is one of the diagnoses that continue to go untreated. There are many reasons for this, one being that physicians have the tendency to focus on illnesses affecting the body instead of the mind. Another key reason is that the older adult was taught to be independent and feel that they should take care of themselves and "their” problems. Your parent may feel that they should not “bother” their physician or you with their feelings of loneliness/depression. As the adult child, you may feel that you do not have the right to intrude on your parent’s privacy.  But, if your parent has any of the common depressive symptoms such as irritability, frequent crying, loss of interest or pleasure, weight gain or loss (especially weight loss), insomnia, fatigue, decrease in ability to concentrate, feeling of hopelessness and/or suicidal thoughts, please assist him/her in making an appointment with his/her physician. If you can, go with them to the appointment and take a list of symptoms/ concerns to share with the physician.  Reinforce that these depressive symptoms are treatable and that he/she deserve to feel better, to have more energy, and to continue to age in place.  

 One day I googled “depression in the elderly” and received 369,000 results- here are some resources that might assist in you in your search.

 

Resources:

 

The geriatric depressions scale is a self - administered scale that can measure depression in the elderly.

 

GERIATRIC DEPRESSION SCALE (GDS)

 

CHOOSE THE BEST ANSWER FOR HOW YOU FELT THIS PAST WEEK.

                                                          

CIRCLE ONE (YES OR NO)

 

  1.  Are you basically satisfied with your life?     Yes     No

  2.  Have you dropped many of your activities and interests?     Yes     No

  3.  Do you feel that your life is empty?     Yes     No

  4.  Do you often get bored?     Yes     No

* 5.  Are you hopeful about the future?     Yes     No

  6.  Are you bothered by thoughts you can't get out of your head?     Yes     No

* 7.  Are you in good spirits most of the time?       Yes     No

  8.  Are you afraid that something bad is going to happen to you?     Yes     No

* 9.  Do you feel happy most of the time?     Yes     No

 10.  Do you often feel helpless?     Yes     No

 11.  Do you often get restless and fidgety?     Yes     No

 12.  Do you prefer to stay at home, rather than going out and doing new things?     Yes     No

 13.  Do you frequently worry about the future?     Yes     No

 14. Do you feel you have more problems with memory than most? Yes No

*15. Do you think it is wonderful to be alive now? Yes No

 16.  Do you often feel downhearted and blue?     Yes     No

 17.  Do you feel pretty worthless the way you are now?     Yes     No

 18.  Do you worry a lot about the past?     Yes     No

*19.  Do you find life very exciting?     Yes     No

 20.  Is it hard for you to get started on new projects? Yes     No

*21.  Do you feel full of energy?     Yes     No

 22.  Do you feel that your situation is hopeless?    Yes     No

 23.  Do you think that most people are better off than you are?     Yes     No

 24.  Do you frequently get upset over little things? Yes     No

 25.  Do you frequently feel like crying?     Yes     No

 26.  Do you have trouble concentrating?     Yes     No

*27.  Do you enjoy getting up in the morning?     Yes     No

 28.  Do you prefer to avoid social gatherings?     Yes     No

*29.  Is it easy for you to make decisions?     Yes     No

*30.  Is your mind as clear as it used to be?     Yes     No

  

*Appropriate (nondepressed) answers = yes, all others= no... or count number of CAPITALIZED (depressed) answers

Score: _____ (Number of "depressed" answers)  

 

            Normal               5 +/- 4

            Mildly depressed    15 +/- 6

            Very depressed      23 +/- 5

________________________________________________________________

 

References:

1.  Yesavage JA, Brink TL, Rose TL, et al.  Development and validation of a geriatric depression rating scale:  a preliminary

report.  J Psych Res. 1983; 17:27.

 

2.  Sheikh JI, Yesavage JA.  Geriatric Depression Scale:  recent evidence and development of a shorter version.  Clin Gerontol.

1986; 5:165-172.

The Geriatric Depression Scale may be used freely for patient assessment according to the authors

 

http://depression.about.com/od/elderly/Elderly_Depression.htm

http://www.consultgerirn.org/topics/depression/want_to_know_more

http://nihseniorhealth.gov/depression/aboutdepression/01.html

 

This week marks the 10th anniversary of the "Web Log" ... the genesis of the "Blog".  Of course, sharing ideas over the internet goes back to the dawn of the net itself.  The original idea of the then government sponsored network was to connect academic institutions and government agencies for the purpose of research and collaboration.

The Blog came along originally as a way to share information about where the "blogger" had been on the internet that day and what they had experience.  It quickly became an on-line diary of sorts.  This created the "stickiness" of the concept which since evolved in that dimension and many more.  

For My Health Care Manager the concept has been extended to caregivers helping aging parents and even seniors looking to improve the health and well-being.  Take a look at the blogs listed here - you'll find information on all of the most common heath challenges facing seniors and their families.  Some examples include falls, home safety, dementia, congestive heart failure, diabetes, and many more.

Having access to key thoughts on these challenges is valuable, but even more valuable is the key blogging concept of providing direct feedback to the author.  If you have a question of a comment on an article you've read, don't hesitate to use the "Comments" link right below the posting.  You can read comments and responses from others and best of all ask your question directly. 

If you don't see an article on the subject you're most interested in, post your question as a comment to the top entry in the Blog.  We'll answer the question in a future blog, comment, or email.

The Alzheimer's Daily News website recently featured a short article on planning ahead for long-term care.  The source was our very own Indianapolis Area Vice President, Jeannie Keenan, RN.

Stories about this topic have been fairly prevalent in the news recently.  Many of the baby boomers have not planned ahead when it comes to providing care for their aging parents.  This could be paying for the cost of a retirement community or assisted living facility for their parents; it could be bearing the cost of bringing eldercare services into the home.

As our parents age, it can be difficult to address the often emotional issues of failing health, loss of mobility, cognitive decline, or just the need for a little bit of extra help or a smaller, more manageable living space.  Seniors may be reluctant to move and sometimes their adult children may not agree on what is best for their parents.  This underscores the importance of one of Jeannie's tips: Begin talking about the issues and the future early.  It is much easier to plan ahead than to be caught off-guard.  Planning ahead offers you more time to complete thorough research of the options, prepare financially for the future, and come to a decision with which the whole family can be pleased.

While this article focuses on the financial aspects of long-term care, many other variables can be involved in the issue including family dynamics, a parent's medical needs, a parent's wish to continue aging in place, or the adult children's desire to relocate parents closer to them.  A geriatric care manager can assist families as an objective third party, knowledgeable about local facilities and their capabilities and reputation, and familiar with all of the living options available for seniors based on their particular needs and desires.

Click here to read Jeannie's planning tips.  You may also learn more about Jeannie Keenan by clicking here.

A recent study published in the Journal of the American Medical Association by John Robbins, M.D. et al identifies an algorithm for identifying the five year risk of a hip fracture in postmenopausal women.  While the study is limited to one gender and further studies are needed to assess the implications and use of the algorithm, it underscores the importance for seniors to remain vigilant in maintaining their mobility and maximizing their safety.

The factors affecting the 5 year risk are as follows: “age, self-reported health, weight, height, race/ethnicity, self-reported physical activity, history of fracture after age 54 years, parental hip fracture, current smoking, current corticosteroid use, and treated diabetes.” 

What can you do? 

• Be aware of the factors, and do your best to engage in health activities like remaining active, exercising, and refraining from smoking. 
• Do a home safety check.  Remove items like throw rugs that are easily tripped over, resulting in a fall, and possibly a fracture. 
• Check with your doctor to assess your risk for a hip fracture and work with him/her to decrease your risk.

For a home safety checklist from the CDC, please click here.
To read more about the study published in the JAMA, please click here.

With the Hollywood writers strike, some of those writers may be treating this time as a much-needed break from the daily grind, as they are only required to work 20 hours a week manning the picket lines.  Unfortunately, as most caregivers know, caring for aging parents is a full-time job.  And this is often on top of the full-time hours put in at a paying full-time job.  It can often be tiring, emotionally and financially draining, and very hard.

 

For family caregivers that are in need of a well-deserved respite, don’t hesitate to ask for help...  Don’t hesitate to take a well-deserved break!  Accept the help that your family and friends offer or hire outside help to give you a few hours (or a few days) of help each week.  Caregiver burnout is real – especially for working caregivers.  Understand that you must first take care of your own health, and that asking for help or accepting help may make you a better caregiver in the long run by reducing your stress levels and allowing you some respite.

 

Providing care for a loved one, organizing their health care and managing appointments, checking on their home safety, spending time with them to prevent isolation, AND doing all of the other duties that come with the territory is extremely time consuming, sometimes confusing, and sometimes stressful.  If you find yourself ‘in over your head’ or just needing some advice, you may consider enlisting the help of a geriatric care manager.  Geriatric care managers can help facilitate communication within your family, give you advice on avoiding caregiver burnout, and offer tips and tricks to help you manage the health conditions of your loved one (whether it be helpful ways to remind your mother with diabetes to check her blood sugar, tips on communicating with a senior suffering from Alzheimer’s, ways to improve your father’s quality of life or help manage your uncle’s arthritis, or a better way to manage the multiple medications prescribed to your grandmother).

Discharge from the SNF was a big benchmark in Mother’s rehabilitation from her broken hip.  But even with 3 children in the same city sharing eldercare duties, going back home found nearly everything had changed.  Just choosing a home health agency became a case in point.  Dispatched from the SNF with a long list of home health agencies but with no recommendation – only a small step better than tearing out the Yellow Pages – we had to figure out which one to use.  (We didn’t know that thousands had gone before us in making decisions – some right and some wrong.  Additionally, we didn’t know that there were ways to check out the candidate home health agencies to help in the decision.)  The agency we went with sent one worker who had the misfortune of an unreliable car and getting stuck in snow, so with two misses we requested a more reliable worker to assist Mother.  In the second week of the coverage I was surprised by Mother’s advising me she had fired the worker because “she just sat there and made notes in her notebook.”  So we were back to square one.

Luckily Mother offered that she didn’t feel safe driving her car anymore, and we had it sold in a week!  (Giving up driving remains one of the most difficult situations a family has to resolve.)  Still struggling with mobility issues (moving around with difficulty and a walker), we were preparing for 7 day, two shift coverage (around $20-28 thousand a year at $14-18 per hour for qualified companions with no health care services) to let her stay in her home.  Since we had already inspected her home for environmental safety, that plan could have worked.  But Mother perceptively guessed that her opportunities for social interactions would rapidly decline, and she offered that she would be willing to consider a retirement community for more security, easy access to old and new friends, and the peace of mind that she was in a supportive and protective environment.

Having promised her when she was mobile and independent that she would never be forced to move to a “retirement home,” it was now time to consider alternative living options once she brought it up.  I’ll share this next passage in my journey as a caregiver in my next Blog.

Please share any experiences you have had with home health services by posting a comment below.

Today is the last day of National "Talk About Prescriptions" month - so hopefully you have spoken with your aging loved one- especially if they are taking multiple medications. However, I would also like to encourage everyone to talk about another kind of prescription- not for a medication, but for glasses or contacts.  Our vision deteriorates as we age and this can affect our mobility.  Home safety is incredibly important for preventing falls- and one key to preventing falls is recognizing a change in vision.

A recent study proves that worse vision or 'visual field deficit' is associated with falls- especially peripheral vision deficits.  The study also provides information about the occurrence of falls among older adults and the association of falls with a greater likelihood of hospitalization, nursing home admission, and death.  The bottom line: making sure your loved one has regular exams by a health care professional- including vision exams- is a smart move!  You may also speak with your geriatrician or health care professional for more information on preventing falls.  To read the study abstract issued by the  Institutes of Ophthamology at Johns Hopkins School of Medicine and the University College in London, please click here.

Standing alone in her closet, my then 91 year old Mother’s femur suddenly broke and she fell.  Alone, and up to that moment living well independently in her home, she pulled herself to the phone and made the 911 call.  My wife and I were 2,000 miles away when the call came, and the next flight out got us back to the hospital just after the orthopedic surgeon had spiked her femur and placed an artificial hip cap.  Up to that point, all of the decisions were made for us, and thankfully they were good ones.  Now it was our time, with no map or experience, to navigate the health care maze that older adults and their families have to face alone.

The hospital’s case manager met with us and advised that Mother was going to be discharged after her third night (afterwards, but not at the time, it was clear that her capitated Medicare reimbursement would reach its end so it was time to go) to a rehabilitation facility that we could choose from a list she provided.  Miraculously, a skilled nursing facility (SNF) sales liaison appeared and assured us all details would be handled and a bed awaited Mother.  We were lucky.  Later we learned in another experience that ongoing relationships with the SNF sales liaisons and the case/discharge managers are well lubricated relationships – but thankfully referral fees are illegal.  But the big questions of how well matched the SNF was for Mother, the short or long-term nature of the facility (a big factor in short term rehab motivation), in or out-of-plan for supplemental insurance coverage, the staffing ratios of the SNF (patients divided by nurses and other skilled assistants), and the state’s and Medicare’s results from surprise audits were lost in the emotion of the family decision.

We’ll pick up with the first night in the SNF in my next blog, and you will soon understand what motivated me to create and found My Health Care Manager, as a consumer-side rather than provider-side, professional advisor for older adults and their families for navigating the issues and options of aging and eldercare.  But, in the meantime, please share your experiences and advice as a caregiver or senior from similar encounters involving home safety issues, falls, or unexpected hospital stays.

So what exactly is in a Personal Health Record (PHR)? 

You won’t be surprised to know that the answer varies depending on who you ask.  Let’s start by looking at what My Health Care Manager includes in its PHR.

 

We have identified 17 dimensions to examine as part of initializing a PHR.  These are:

1. Demographic:  General demographic information including but not limited too the senior’s current living and marital status; accessibility to bathroom, bedroom, and laundry; and work/volunteer history. 
2. Family: Family members deceased and living.  Family health history and availability.
3. Social support:  The family’s/friends’ level of support, communication techniques, and the senior’s engagement in social activities.
4. Representatives/Key Contacts: Individuals that the senior has identified to have permission to health and/or financial information, including the level of information they may access and the manner in which the information can be shared.
5. Financial:  The senior’s perception of his/her financial needs and if additional assistance is required to support health or alleviate stress.
6. Spiritual:  The senior’s perception of his/her spiritual needs and level of comfort/peace with current health status.
7. Legal: Arrangements for an individual to act on the senior’s behalf including the status and copies of the senior’s advance directives, funeral, and/or burial/cremation arrangements.
8. Insurance:  Current insurance information and identified gaps or needs for continued education.
9. Support Services:  Multiple service providers and the level of communication between the providers.
10. Caregiver Support: The stress level and needs of the caregiver.
11. Physical Health:  The senior’s past medical history, treatment plans, and current health status - capturing chronic illnesses, chronic pain, incontinence, weight loss/gain, nutritional status, and sleep habits.   
12. Functional Health Status:  The senior’s perception of and satisfaction with his/her health status while assessing the senior’s physical functional status including activities of daily living, balance, ambulation, assistive devices, and sensory status.
13. Emotional/Psychological:   The cognitive, emotional, and behavior status of the senior including screens for cognitive impairment, anxiety, depressive symptoms, and substance abuse.
14. Medication History:  Medications list, multiple providers, multiple pharmacies,   allergies, polypharmacy, and medication administrative needs. 
15. Home/Residential Environmental & Safety Assessment:  Visual assessment of the senior’s environment.  Assessing fall risk, elder abuse, disaster plans, fire/burn prevention, crime/injury, injury prevention, communication system, and support network.          
16. Preventive Health Activities:  Preventative recommendations and attending health screening activities. 
17. Wellness: The senior’s understanding of activities that promote improved health status such as wellness classes, tobacco use cessation, and/or intellectual stimulation.

This information can be gathered and assessed by an individual, a caregiver, or even a Health Care Manager.  We use a 3 ring notebook to collect and organize this information so that it can easily be updated and kept current.  The binder is easily taken along on medical provider appointments and is large enough to be difficult to misplace.