Not to be out done by the Navigator development team, the SCANS team is continuing their "rolling release" of V1.3.  SCANS is the Senior Care Navigation System that provides geriatric care managers with expert advice, best practices, and practical tools to help families with the well-being or their parents.

The June edition of V1.3 includes 26 new resources, process, or tools.  The list includes items like these:
  • 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
These tools are available to the clients of My Health Care Manager and our affiliates.  Some of the content is also discussed in our blogs and can be accessed for free.  Check out Natalie Langley's blog titled "Healthy Aging".  Natalie is one of the principle researchers and authors of the tools in SCANS.  Her blog covers a holistic look at healthy aging and senior well-being.

My Health Care Manager's care management system (Navigator) has just been updated to version 1.9.  This is the core system that geriatric care managers use to assist families caring for aging parents.  From past blogs you may know that this includes the assessment, care planning, implementation, and tracking support for seniors and their families.

Navigator 1.9 includes:
  • 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
This system is available to our clients and clients of our affiliates and partners.  We also provide much of this information in our Guide for Senior Well-being and Eldercare.  This is a self help guide is available at http://www.myhealthcaremanager.com/guide/product.asp.



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. 



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.

Also including in the 1.2 release are a variety new solutions, actions, resources and other content for helping with senior well-being and senior health care.

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.


Walker Wonder:  Brighten a Walker, Brighten a Life

The Alzheimer's Store:  Unique products for those caring for someone with Alzheimer's

Wellhaven:  Gifts for seniors and boomers

Senior Shops

First Street:  For boomers and beyond

Elder Luxe:  Age well

Many older adults experience some type of persistent pain.  When this pain is left unaddressed, it can affect an older adult’s quality of life and may lead to decreased mobility, decreased social interaction, and depression.  Yet, it has been reported by the American Medical Association (AMA) that 25% to 50% of community-dwelling seniors have pain that interferes with their ability to deal with daily functions, and 59 - 80% of nursing home residents experience persistent pain (AMA: Pain Management: Assessing and Treating Pain in Older Adults, 2005).

Why is pain not addressed adequately? Many older adults are reluctant to report pain fearing additional tests and/or bills that they cannot pay.  Also, they want to be seen as "good patients" or do not want to waste the health care professional's time with complaints about pain.

For caregivers helping their aging loved ones, it is important to help the older adult understand that they need to report their pain and deserve to have their pain controlled.  One way for older adults to communicate with physicians is to keep a pain journal and track the following:  When they experience pain; how long it lasts; whether it is a burning pain, a stabbing pain, or an aching pain; whether it happens with movement; what makes the pain better or worse; and what activities, if any, the pain keeps the older adult from participating in.

For more information, you can contact the National Pain Foundation or the American Pain Society.

A friend forwarded an email recently about something called the "Wellness Wizard".  This is system for automated reminders.  The caregiver records messages to be played at specific times and dates.  The idea is to provide reminders about medications or important appointments.  It also provides a mechanism for the senior ask for help from caregivers.

All-in-all this tool probably has some utility.   It's relatively inexpensive and could help people caring for aging parents who live independently feel more comfortable about their parent's situation.   

The only part of this that really bothered me was the claims about this product.  The company claimed it would:

  • decrease avoidable readmissions
  • maximize the well-being of their loved one
  • reduce caregiver stress
  • and more
The product can contribute to these, but it's really a stretch.

The truth is, it takes a coordinated effort.  Eldercare is not a tool.  Tools can only help.  Be wary of "over sell".  There's nothing that can replace a caregiver's involvement.  Even a geriatric care manager still needs the connection with family. 

Care managers and tools for eldercare can save time, improve situations and even well-being, but they are aides not replacements.

Family members are finding themselves in the "Sandwich Generation"...still working full-time, raising children, and caring for an elderly parent.  Alzheimer's Disease costs businesses "more than $67 billion dollars each year."  $40.5 billion of that cost is due to "family caregiving resulting in absenteeism, productivity losses, and replacement worker costs."  These statistics are a red flag to businesses of what is to come...the amount of people living longer is growing and the number of individuals with Alzheimer's Disease will more than double in the next 30 years. 
Family members who provide some form of care to an aging parent are more at risk for developing physical illnesses and stress which can affect a person's mental health, overall well-being, and work productivity. (Teepa Snow, Dementia Care & Training Specialist)

Providing a safe, structured, and supportive environment to the person with Alzheimer's Disease can be difficult especially if one lives in an area with limited resources.  Caregivers are often trying to handle "home situations" during the day while at work...dealing with insurance companies, managing home care staff, running home on your lunch break to check on mom or dad, etc.  US businesses are starting to realize the tremendous effort families are working with in being a caregiver.  Some businesses are adding additional resources to their employee benefits program to assist family caregivers. 

As a caregiver, is the company you work for equipped to provide assistance and resources to you?  I'm interested to hear how businesses are addressing this important issue.

The following article is from Agingcare.com:  The Community for Caregivers and is in addition to the previous blog, Caregivers and Stress.

"Don't Let Caregiving Ruin Your Other Relationships
by Carol Bradley Bursack
In the 1970s, there were ongoing debates about whether a woman could balance a family with a career. The discussions centered on being a good wife, mother and employee.  The question seldom posed, in those days, was how, besides being a wife, mother and career woman, could a woman also be a good daughter?

Today, we hear about the toll elder care takes on families as routinely as we heard the former arguments in the ‘70s. Adult children are being faced with choices (or seemingly, assignments) they never thought about before. They are raising children or teenagers and holding down a job, when suddenly they find that their aging parents need an ever-increasing amount of attention.


Why is elder care more of an issue now than in the past?  For one thing, people are living longer than they used to and, often, they are not living with good health. Yes, we all love to point to the 93-year-old guy out there playing golf everyday, and these people exist. I know a couple of elders like that and they are a joy to behold.

However, many elders today are stroke survivors, or are suffering from diabetes, lung problems or dementia. Sometimes they have a combination of these ailments, and others, which likely would have caused death even a decade ago. Now, medical advances provide lifesaving options. Many of these people live – some even living fairly good quality lives – but they need assistance from family or paid attendants.


--------------------------------------------------------------------------------
We have partnered with ElderCarelink.com to provide a free referral service that helps you find everything from Home Care and Assisted Living to Financial Planning and Personal Emergency Responses. Let us assist you.
--------------------------------------------------------------------------------
 Another piece of the puzzle is that many people have chosen to have children at a later age, thus putting them in a position where they have young children and older parents at the same time. This can be a delightful combination, as long as the elders are reasonably healthy, but when they are not, the adult children of the elders, also parents of young children, can be faced with very difficult choices. These are the people now famously known as the Sandwich Generation.

Whatever the circumstances are that propel people into elder care, the problems that can come from it are myriad. All you have to do is click on the Agingcare.com community forum and you’ll quickly see that many caregivers, both men and women, find themselves feeling pulled in so many directions that they can no longer find their soul.

They fear for their own health – mental and physical – as they try to take care of the needs of three generations, the most demanding often being the elders. Caregiving for a sick elder, especially one with dementia, can become so all-consuming that the caregiver’s other relationships suffer.

First to go is the time, or even the energy and desire, to maintain friendships. Even maintaining friendships that go back years can seem like just one more thing to do when a caregiver is so swamped with demands.

So, caregivers stop seeing friends, hence friends stop asking them to do anything fun. Friends get tired of being turned down. And caregivers forget that life was once fun. They are too busy giving care to everyone else to even notice the loss.

Then there are the children at home. I had two young sons when I started going through my two decades of elder care, seven elders total. One of my sons has multiple health issues. I believe I gave my sons as much attention and care as any mother could, but I was always torn. It seemed someone always needed me. A child was sick and an elder’s personal alarm was set off. What should I do? How should I handle it?

Or I’d just be having fun with my sons, and I’d get called away on an emergency. My sons got used to me telling them that we had to stop what we were doing, be it playing music, reading or a craft, because I had to run to Grandma’s and see what’s wrong, since her personal alarm was set off. Or I had to meet the ambulance at the emergency room, because Grandpa fell at the nursing home and broke his arm. Or I needed to reschedule my uncle’s doctor appointment, because he was had gotten the flu.

Certainly, it doesn’t hurt children to know that elders need care, and children need to share their parents with the older generation. Likely, my kids had a little too much of that, but they survived. However, some children have much tougher issues than mine had to face. Some have grandparents with dementia living in their home, verbally or even physically abusing them. Or a single mom and her kids find it more economical to live with the grandparents, but the grandparents end up sucking up all of Mom's time. The parent – the caregiver to generations – can’t see a way out, so the family stays. But the relationships with the children are damaged.

And then there are the marriages. I hear from many caregivers who have supportive spouses, but I also hear from many who do not. The spouse feels neglected. The spouse never liked the elder, and now that the elder needs a lot of care, the spouse becomes even more resentful. The stress in the marriage can be intolerable for both sides. Marriages can and do break, under the stress of caregiving.

How much do caregivers owe their aging parents? Do they owe their health, their financial future, their family relationships? Where does “honoring your parents” begin and end?

I don’t believe anyone owes their own health, their marriage or their children’s emotional well-being to the elder that raised them. In most cases, the elders, if they could think straight, wouldn’t want that kind of sacrifice made for their benefit. However, often they’ve gotten to a point where they don’t recognize what they are demanding of the caregiver, so they resent not getting every need met and make that resentment well known.

This is where caregivers must take a stand. They must look for outside resources such as their state aging services for some direction. They must learn to balance their love and their time, giving as much care as possible to the elder, yet making sure that they have time, patience and energy for their children, their spouse and even their friends. If they don’t do this early on, breaking the pattern will become harder, though not impossible, as time passes.

Certainly, if the elder’s life is coming to a close, the whole family should gather around in support. But if elder caregiving is a long-term situation, the caregiver should look for balance. She needs to set boundaries as far as the elder care goes.  If she does not, all relationships that matter will be damaged, even the relationship with the elder. The caregiver who feels she has given up everything for everyone else will find that no one got what they needed. If the elder care situation sucks the life out of all other relationships, everyone loses.

For over twenty years author, columnist and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members. Because of this experience, Carol created a portable support group – the book “Minding Our Elders: Caregivers Share Their Personal Stories.” Her sites, www.mindingourelders.com and www.mindingoureldersblogs.com  include helpful links and agencies. Her newspaper column, “Minding Our Elders,” runs weekly, she speaks at many caregiver workshops and conferences and has been interviewed by national radio, newspapers and magazines. She is the moderator of the AgingCare.com forum."
 


I got several comments on my caregiver blog about Therapeutic robots.  Several people were intrigued and others where "cautionary".  The cautions are well founded.  If you are caring for aging parents, you have to view technology as a tool, not a pat answer.  Some dementia patients might find a robot a cause for paranoia or even an object of anger.  So instead of enhancing a sense of well-being it could actually damage it.

A professional geriatric care manager can help with these kinds of decisions along with other health professionals.

Here is another article about Paro which you may find interesting titled, Robot baby seals to replace cats and dogs as pets in hospitals, nursing homesThis article explores the artificial intelligence capabilities in a little more depth.


While qualifying hospitalization rules vary for long term and home health insurance policies, sometimes any portion of a day while admitted counts as a full day in determining eligibility.  But for Medicare coverage, REMEMBER the three day rule: In order to received skilled care post hospital such as rehabilitation benefits, the 3 day rule is strictly defined as being admitted for 3 consecutive midnights. 

While nearly all physicians and hospital workers know the rule, there are times when a hospital case manager or “utilization management” social worker or nurse recommends discharge before the qualifying third midnight.  If the decision is subjective or a case exists for a slightly longer stay, seniors and caregivers should discuss all factors – including the loss of some Medicare benefits for rehabilitation – with the physician before the discharge occurs.

While nobody should remain in a hospital any longer than necessary, often there are subjective factors that influence discharge recommendations.  A well-advised senior patient and his or her caregiver need to understand the economic significance of the discharge decision and address any concerns with the health care provider.
 


Just in case you thought the robot dog was too silly, I wanted to share this article from the Washington Post.  "Dementia Patients Find Comfort in Robot' discusses the use of a robot to provide comfort and companionship to dementia patients living in a retirement community.

This is not a whim, the National Institute of Advanced Industrial Science and Technology developed the robot called "Paro" over 12 years.  These same kinds of research are being explored at IUPUI in the schools of Informatics and Computer Science.  Creating animal like or child like responses in a robot seems to have significant impact in treating cases of dementia.  Sights, sounds, tactile sensation, and responsiveness all appear to be important influences.  This make a robot an ideal tool.

It's exciting to hear of real help with senior health care that doesn't involve extensive medication and actually enhances well-being.

Perhaps the most difficult thing for a senior to do is give up the car keys.  Eventually nearly everyone has to, but driving is a major key to living independently and person's sense of well-being. 

Consumer side technology is being developed to help improve safety issues with seniors.  GM is developing a car windshield that uses infrared sensors, cameras, and lasers to enhance sharpness of items on the road.  The idea is to make lane marks or objects in the path of the vehicle more distinct.  See this article General Motors designs windshield that enhances objects to help seniors for more details on the development.

This is a example of a home (car) safety product targeted specifically at older adults.


The following article is from washingtonpost.com:
"FRIDAY, Dec. 19 (HealthDay News) -- Much has been reported about the stress and burden of caregiving, but a new study suggests there may be a flip side to taking care of someone you love as they age -- a decreased risk of death.
"We found that caregivers who spent an average of 14 or more hours a week caregiving lived longer and reduced their risk of dying by about half," said study author Stephanie Brown, an assistant professor in internal medicine at the University of Michigan in Ann Arbor. She added that even after they controlled the data to account for things such as age or previous illness, "there was about a 36 percent reduced risk of dying in the seven-year time period."
Results of the study were published in the current issue of Psychological Science.  The study included 1,688 couples who lived on their own, not in assisted living or a nursing home. All of the study participants were over 70.
The researchers gathered health and demographic information as well as information on how much each spouse helped the other with normal activities of daily living, such as eating, dressing, managing money and taking medications.  Eighty-one percent received no help at all with their daily tasks, while 9 percent said they received less than 14 hours a week of help from their spouse. Ten percent reported receiving more than 14 hours a week of help from their spouse.  Over the seven-year study, 27 percent of the study volunteers died.
When the researchers analyzed the data and controlled for factors such as age, race, gender, education level and net worth, they found that providing care for your spouse for more than 14 hours a week was associated with a significantly decreased risk of death compared to those who provided no spousal caregiving.
"Other studies caution against caregiving, but our study suggests that the actual act of caretaking may not be harmful," said Brown.  "This study shows that the burden of caregiving can sometimes be lightly born," said Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City. But, he said that the results might be different depending on the type of care a spouse has to provide. Taking care of someone with early-stage Alzheimer's disease, who can still function fairly well and still behaves normally for the most part is much different from taking care of someone in the middle stages of the disease, who may be aggressive or may not sleep well.
Brown believes that the decreased risk of death comes from physiological benefits from caregiving instead of psychological ones. The authors suggest that stress regulation may play a role in this benefit. Helping others is associated with a release of oxytocin, a hormone that may help buffer the effects of stress, Brown explained.  Kennedy said the survival benefit is likely caused by both physiological and psychological factors...  Plus, he said, having a partner to care for provides structure and a sense of purpose."  (Serena Gordon)

Most articles and studies discuss the stress caregivers face and how it affects their health.  The stress of caregiving is often triggered by one's feelings...feelings of guilt, anger, frustration, and sadness.  It is very important for caregivers to take CARE of themselves!  Take a break, ask for help, use community resoucres and respite care options, utilize other family members, set realistic goals, see your primary care physician (take care of your physical and emotional health), say no to additional tasks, and keep a sense of humor.  For more information on caregivers and stress, check out the National Women's Health Information Center.


I bet you don't think of a contemporary style nursing home when you hear the words "green houses?"  Green House homes are small homes that are designed to accommodate up to 12 seniors.  These homes provide nursing care and clinical support in a home-like environment while maintaining a sense of well-being and quality of life for the residents.  Green House homes are designed to look like a private residence, with additional bedrooms so each resident has their own.  The living room, dining room, and kitchen are all shared quarters.  The staff eat all meals with the residents, and families are encouraged to join in as well.  The philosophy is to provide good medical care and improve or sustain a quality of life through person-centered care.  Currently, there are 10 states participating in the Green House initiative.  The Robert Wood Johnson Foundation provides grant funding for the initiative.  Green House homes are developed and operated by long-term care organizations in partnership with The Green House Project and NCB Capital Impact.

I really like the concept of "treating the person" not the disease.  Of course, people's medical conditions should be addressed but we shouldn't let our residential facilities get stuck in the rut of just taking care of people medically.  I once worked for a nursing home that could house over 200 residents, and I worked with some great staff members who really focused on "treating the person."  So, while a smaller residential home might provide more of an opportunity for staff to provide more personal attention, overall I think it all of our responsibility as caregivers to provide the utmost care and quality of life for our seniors.

Technology is being developed in a variety of areas to assist in geriatric care.  Significant efforts are underway in both the consumer and professional markets.  Already these efforts are bearing fruit.  You can read about some in my earlier blogs and I'll be highlighting others in the coming weeks.

Let's start the discussion with some categories.  Technology is entering the the consumer side of eldercare both in the home and on the Internet.  This work could be grouped as follows:

In Home:

Consumer Products 
- Family Communication 
- Wellness and Assistance
Health Products 
- Services 
- Diagnostics Reporting
Safety 
- Monitoring Services 
- Products
Research Initiatives 
- Continuous Monitoring – Automatic Detection 
- Decision Support

On the Internet:
Person Health Records
- Microsoft Vault 
- Google Health
- Hundreds of Others
Medical and Non-Medical Information
- Health Sites
- Support Group Sites
- Commercial Sites


Dear AbbyAfter posting my blog yesterday about caregiver stress, I discovered that Dear Abby just gave advice to a stressed-out reader on the 10th (read the letter by clicking here).  The letter was from ‘Overwhelmed in Cincinnati’, who is struggling to balance her roles as a caregiver for her mother, who has Alzheimer’s, and a mother of three – while also juggling a career.  She feels she’s in over her head with worries about her mother’s safety, well-being, and financial considerations. 

Dear Abby wisely referred ‘Overwhelmed’ to the Caregiver Stress Check from the Alzheimer’s Association (www.alz.org) that I mentioned in my blog yesterday.  If you’re a caregiver, please remember the importance of taking care of yourself.  If you are experiencing a lot of stress, take the quiz here.  Your local Alzheimer’s Association, health care provider, or a geriatric care manager are all good resources to help you manage your responsibilities and reduce your stress.


My Mother’s  sixteen month stay at an Assisted Living facility has been tremendously impacted by staff turnover.  Every time a “new” Assisted Living Director starts we schedule a care conference to ensure that the plans for my mother are well understood and will be implemented.  However, we have found that it is not that simple… for things don’t seem to go as planned.  A recent change in Assisted Living Directors has resulted in a scarce nursing staff, laundry that does not get done, lunch that doesn’t get delivered and dishes that remain in the sink. 

The bottom line is that my Mother suffers each time staff turns over.  Caregivers suffer too, as they are concerned about lapses in care and frustrated by dealing with the same issues over and over.  It doesn’t  seem that it should be that difficult to get the laundry done….esp. when the facility is charging $5K a month. 

Turnover is a problem for everyone.   Number one – it impacts care.  Number two – it is time consuming to constantly readdress the same issues.  Number three – it can’t help but influence staff morale which can affect actions and attitudes during daily resident interactions.

Based on our experience, I would definitely ask questions about management and staff turnover when touring  Assisted Living Facilities or other senior residences.  If the number seems high, think seriously about how this will affect your parent’s care and well-being.  The most beautiful building in the world won’t make up for a breakdown in staff communication, training and service delivery.

In addition to caregivers having to shoulder the work load of the growing senior population, they are also naturally more engaged in caring for aging parents than health providers for most time their parents face the challenges of aging.  

If you create a "smoothed" picture of the health challenges faced by older adults, you get a continuum like the one shown below.

Caregiving Continuum

Each of the "humps" corresponds to major health incidents or living circumstance changes.  In the early part of the continuum, the senior is aging at home and later may require assistive care at a retirement, assisted living, or long term care community.

The health care providers only intersect with the caregiving need at the green arrows for acute or assistive care.  The vast majority of the continuum is addressed by family caregivers who are typically not trained health professionals.  These caregivers need support tools and services to provide the best quality of life for their parents and themselves.