An Alzheimer's patient once came to me after he had got out of his house and was found hours later in a ditch approximately 2 miles from his house.  Wandering is often a scary symptom of Alzheimer's disease and dementia.  It's confusing and scary for a senior who does not know where he/she is or where they are going; and is scary and worrisome for family caregivers.  Wandering can occur anytime but tends to increase in the late afternoon/early evening hours.  There are several things caregivers can do to keep their loved ones safe at home. 

Tip #1:  Use deadbolts on doors leading outside, place them high or low on doors
Tip #2:  Take locks off of bathroom and bedroom doors to avoid your loved one from locking themselves in
Tip #3:  As the sun starts to go down, close the blinds/curtains and turn lights on
Tip #4:  Install appliances that shut off automatically
Tip #5:  Keep toxins i.e. cleaners, bleach, poisons; and prescription medications in a safe, secure space
Tip #6:  Remove clutter from around the house
Tip #7:  Install a door alarm or place a motion sensor in your loved one's room at night to alert you when they are awake and moving
Tip #8:  Label doors, drawers, and cabinets; this is most helpful in the earlier stages

A professional geriatric care manager can help you in reviewing your home and finding assistance for home modifications.  For more tips and information, check out The Complete Guide to Alzheimer's-Proofing Your Home and home modification tips.

Laurie recently posted a comment about her mom having problems mixing up her medications.  This is a very common problem.  The average person over age 65 is taking 8 prescription medications.  Someone who is battling chronic diseases may be taking many more. 

The number of medications is confusing in the best of circumstances, but clearly other challenges like declining vision, cognitive issues, or problems with manual dexterity make medication management a daunting task. 

Some of the posts in my blog can help.  See Technology in Day-to-Day Medication Management and Create Your Medication List Now.  You can also click here for our full blog list on Medication Management where you will find lots of additional advice and insight.

You can also ask question directly of a Health Care Manager by joining our Caregiving community.  Click here for that link.

Surveys show what most everyone already knows – seniors, by almost a 90% margin, desire to continue living in their current home rather than moving to an alternative living situation.  Many believe they can’t afford an equivalent senior living residence, but most do not want to leave the comfort and memories of their home.

Barring safety or health issues that would mandate a move, there are many ways to provide services that allow staying in the home – at least for awhile.  Some solutions are more expensive than moving to a senior living community, so if economics are an issue the alternatives need to be carefully compared.

The least expensive service (and not medically helpful) is a companion.  Hired directly, companions can be found in the $9 to $13 hourly range, and in the $14 to $20 hourly range if hired through an agency.  Important considerations including screening and background checking, back up for absences and vacations, supervision, taxes, insurance and turnover come in to play when making the decision between independents and agencies.  We have intervened in abusive companion cases as well as screened potential solo companions and agencies to help families arrive at the decisions they prefer.  According to the MetLife Mature Market Institute, the national average for agency-provided companion/homemaker services is $18 per hour.  Many times a companion can be utilized for shorter periods of time to provide assistance and friendship for shopping, errands, cooking or simply conversation. 

When higher skilled services are provided, they start with a certified home health worker and move up through Certified Nursing Assistants (CNAs) to Licensed Practical Nurses (LPNs) and Registered Nursed (RNs).  The national average is $19 per hour for home health aides (from licensed agencies) according to the MetLife Mature Market Institute.  In some areas, the average hourly rate is less than $13 and in other areas, it is more than $30. 

It’s important to assess the skill level and coverage needed to provide the necessary support for seniors living in their homes.  My Health Care Manager does this assessment using a Registered Nurse working with one of our 5,000 networked RNs throughout the U.S.  Using an unbiased professional helps in the analysis so the result is not skewed to a preferred alternative.

There will be more about this issue in my next blog.

To make effective use of any set of tools you need to combine them with process.  In the case of caring for aging parents, the process is something you have to repeat over and over.  The situation changes, health conditions like diabetes or cognitive concerns change, needs and desires change, and all of these play in to the decisions about the next course of action.

At My Health Care Manager we have defined, detailed and implemented processes at all levels of service delivery - over 100 in all.  These include detailed flows, processing narratives, measures, entry and exit criteria, responsibility identification, and more.  At the core, however, these processes all revolve around this simple cycle.

If you are caring for a senior, consider adopting a process like this one and implementing changes in the top 3 (or fewer) areas of concern in each iteration.  Clearly, trying to change too many things at once can actually be counterproductive.  Any of us, especially if we're sick, depressed, or struggling with cognitive decline, can only impact a small number or areas at one time.

Understanding that this is a cycle with re-evaluation can help manage the sometimes overwhelmingly long list of things needing attention.

Continuing on the family communications theme from my last blog, I want to share our experience with a wonderful product that helps family and friends easily communicate with an older adult.  The product and its service is called Presto, and it’s a one-way email product.  Someone (my wife in our case) serves as the manager to allow approved people’s email addresses to send messages and photos to the senior’s Presto email account.  The community can be as large as desired with adult children, grandchildren, friends and neighbors all authorized to send.  This “authorized sender” status eliminates spam and solicitations which is a great value Presto provides in its ongoing service.

At the receiving end is a HP ink-jet color printer with a dial-in modem that has been simplified for ease of use by a senior.  Adding paper is easily done by my mother and father-in-law, both 95, but one of the family changes the ink cartridges when necessary.  The Presto service dials the printer several times a day and transmits whatever is has received.

The result is the “magic” that appears from friends and family whenever it is sent.  My father-in-law has saved every message and picture he has received over the last 2 years (we bought both of them units at Christmas two years ago), and he eagerly awaits new messages.  The same with mother. 

Since My Health Care Manager is independent of all vendors and health providers, we don’t make a penny on the recommendation.  However, the Presto people will include an additional cartridge (HP95) and 2 months’ free service if you order it from www.presto.com/myhealthcaremanager in recognition of our support.

Got a headache, back pain, high cholestrol levels, etc?...then pop a pill.  That is often the "magic" solution in today's health care system.  According to the American Heart Association, 32 million Americans take 3 or more medications daily.  Seniors often take double or triple that amount and sometimes more.  The problem is, is that with all medications come potential side effects and then to treat those side effects people are often prescribe another medication and so on.  Another problem is that seniors often have multiple physicians who often are not aware of what the other physicians' treatment plans are and what medications they are prescribing.  According to Medco Health Solutions, a pharmacy benefits manager, "the risk for drug errors is 7 times greater in seniors than in people under age 65."  CNN.com released an excellent article this week titled "Is Grandma drugged up?"  This article tells a story of a 66 year old woman who was experiencing confusion and slurring of her words.  Her family took her to the emergency room where the possibility of a stroke was ruled out; she was admitted to the hospital and was diagnosed with Alzheimer's Disease.  Her children believed that the diagnosis was incorrect, as she has been functioning independently.  They took their mother to a geriatrician at the University of Oklahoma for a second opinion, where they were told that she most likely did not have Alzheimer's Disease but was overmedicated.  Dr. Jerry Gurwitz's philosophy is "that any new symptom in an older person should be considered a drug side effect until proven otherwise."  Not only do medications have side effects but they also interact with other medications causing contraindications, enhancing side effects, etc.  It is important to always keep a current list of medications, including prescriptions, over-the-counter medications, herbal medications and supplements.  All medications, not just prescriptions, can interact with each other, as well as, food/beverages and other substances i.e. tobacco.
There are several ways caregivers can assist in medication management.  If you feel that your parent is being overmedicated, talk with your primary care physician or geriatrician, and pharmacist.  There are also several online tools you can use to check your medications for interactions.  Here are two online tools:  PDRhealth.com and drugdigest.org.  Educating yourself on what medications cause potential problems for seniors is a good way to become an advocate for your parent.  As well as knowing the suggested lists of medications to avoid if a senior has a specific diagnosis.  My Health Care Manager also reviews seniors' health history and medications and can consolidate that information into one locale to assist families in managing their parent's health care.

My Health Care Manager has introduced a new FREE service that uses a little bit of technology to connect you to a lot of geriatric care research and experience. 

If you look in the upper right hand corner of this page you will see a "sunburst" linking you to a free service called the Caregiving Community.  By joining the Caregiving Community you can ask a question of our geriatric care management team and get an answer by the next business day.  Ask as many questions as you want, whenever you want.  In addition, once a month you will receive another Caregiving Community solution selected from best questions and answers we've tackled that month.  There is no cost for the service; all you need to provide is a name and email address.  We will not share or sell your name with others and we will not inundate you with any kind of high pressure sales.

So what's the catch?  Well, we do have a company interest here.  We believe that by providing valuable information to people caring for a senior in their life those caregivers will turn to us if they ever need help.  No tricks.  We know that if we can help families with the complex issues of aging everyone wins.

When your other family members do not give you (the main caregiver) enough help or support, or do not agree or criticize your actions, what do you do?  Roles and responsibilities of adult children caring for their parent changes over time.  Statistically, the adult child who lives closest to the aging parent assumes the role of the main caregiver.  Most often this adult child is also a daughter.  This person often feels a sense of joy and pride in being able to assist mom or dad but also often feels overwhelmed, alone or deserted by the rest of the family.  The responsibility of caregiving is often not shared equally among the adult children or the rest of the family.  Some family members may be in poor health and physically unable to help, financially unable to help, have demanding jobs or live far away.  Family members who do not have the day-to-day experience of caring for an aging parent may not know what it's "really" like to care for mom or dad, or may not know enough or understand mom or dad's health conditions. 
All family members need to do their homework about mom or dad's health conditions. For example, knowing the symptoms of dementia will help give adult children a better understanding of mom or dad's actions. 
It's important for the main caregiver to recognize and acknowledge when you need a break or need some more help.  Remember...you need your family.  Keep other family members informed of what's going on with mom or dad.  Try Lotsa Helping Hands a handy web tool for keeping families connected.
Some family members and even the main caregiver cannot always commit the amount of time they truly want to towards mom or dad for multiple reasons.  Having a Health Care Manager to assist with eldercare management is a welcomed relief for several families and especially for the Sandwich Generation, adult children in the workforce raising their own family and trying to care for an aging parent.

In past blogs I've talked about the 17 dimensions My Health Care Manager uses to build the Personal Health Record.

We've spent a lot of time on some of the most used data like the medication list, provider list, and other "current state" information.  By "current state" I'm referring to information which is primarily valuable for it's current data values.  For example, when you are caring for aging parents it may be of some very slight interest which doctors your parents went to 3 years ago, but the current doctors are far more important.  The same would be true in medication management.  It's the current prescriptions and treatment plans that are most relevant.

However, 10 of the 17 dimensions deal with "longitudinal data".  That is, data that should be measured over time.  If you are primary caregiver it is very easy to miss major changes because they happen incrementally. 

It's just like watching children grow up.  Parents, who see their kids every day, know they're growing, but its the Aunt from across the country who's stunned by how much they've grown each Thanksgiving.  Parents can get a sense of this themselves by looking at pictures.  So it is with eldercare.  The people closest to the situation need to take an actual "snapshot" of the key data items and periodically look at those for problem areas.

My Health Care Manager does this through the use of a formal assessment.  At least annually and at every major health event key areas like Activities of Daily Living, Socialization, and Cognitive Skills should be assessed, scored, and tracked. 

As we entered into spring, the presidential candidates continue the health care debate.  The real issue is that the US has an aging population.  By 2030, the number of adults age 65 and older will nearly double to 70 million. With twenty percent of the Medicare population having at least five chronic conditions (e.g. hypertension, diabetes, arthritis), the question remains: How do we care for these elders? 

Geriatrics is a growing specialty where physicians, nurses, social workers and other health care providers receive special training dedicated to improving the health, independence and quality of life of all older adults.  Geriatricians are physicians who are experts in caring for older persons; they are initially trained in family practice or internal medicine and then complete at least one additional year of fellowship training in geriatrics. They have the expertise to coordinate services among multiple specialty care providers.  For more information on the profession, visit the American Geriatrics Society website at http://www.americangeriatrics.org.

A geriatrician will coordinate a health assessment for older adults with the primary goal of encouraging and promoting wellness and independent function. The health assessment will include an interdisciplinary team approach to the physical, emotional, cognitive, functional, and medication status of the older adult.  If you would like to locate a physician in your area who is sensitive to the special needs of older adults, you can submit your request by completing a form on line located at http://www.healthinaging.org/public_education/physician_referral.php  or contact a geriatric care manager in your area.  To locate a local geriatric care manager, visit http://www.caremanager.org/.  In addition, telephonic geriatric care management services are now offered by My Health Care Manager.  To learn more, visit our website by clicking here.

Family members of aging parents who have dementia or Alzheimer's Disease have a difficult job.  Individuals with dementia and Alzheimer's often show changes in personality, emotions, and social behavior.  These changes are common symptoms of the disease and occur with the cognitive decline.  Family members often feel a sense of ambivalence, having both positive and negative feelings toward their aging parents.  In a 2007 USA TODAY/ABC News/Gallup poll, "Slightly less than half of those [family members] providing help say it has caused them some stress or a great deal of stress." (USA TODAY/ABC News/Gallup poll, May 24-June 3, 2007).  Feelings of anger, resentment, and guilt are all common among family caregivers.  Lack of assistance and support from other family members and lack of time can all contribute to these feelings.  This person is your mother or father whom you love, and your feelings of anger and resentment can cause feelings of immense guilt.  Family members often express depression and a sense of sadness watching their once independent and capable parent decline.
You are not alone!  Most family members caregiving for a parent of dementia or Alzheimer's express these same feelings.  It's important to care for yourself!
Here are a few tips for caring for yourself:
1.  Take time for yourself!  Set aside time each week to go to a movie, out to dinner with a friend, shop by yourself, take a yoga class, read, golf, enjoy time by doing your favorite hobby, etc.
2.  Deep breathing exercises.  When your loved one has you frustrated, try to take deep breathes and de-stress.
3.  Set up a schedule with other family members to help out with mom/dad.
4.  Enlist the help of friends, neighbors, church members, etc. 
5.  Maintain connections with friends and your community.  Caregivers often isolated themselves from others and focus all time on mom/dad.
6.  Join a caregiver support group.  See the Alzheimer's Association for local support group information. 
7.  Educate yourself.  Learning about dementia and Alzheimer's Disease will help you understand the impact of cognitive decline on everyone involved.
8.  Call on a geriatric care manager for assistance.
9.  Be aware of your stress level.  Know your stress level and know when it's time for a break.
10.  Don't be afraid to ask for help.  Caregiving is a 24/7 job and even the best caregiver needs a break!

Let's return to the question of the impact of technology.  In particular, to the impact on a key issue facing seniors and caregivers, medication management.  We've touched on the fundamentals - preparing and communicating the medication list with simple computer tools.  What we haven't spent much time on is the day to day management of medications.

Technology can help.  For example, one of the tools My Health Care Manager makes available to seniors and their families is a weekly medication schedule.  This schedule provides a map of the all medications with the day and time and dosages they are to be taken over the course of the week.  This schedule can also provide a variety of additional information such as sliding insulin scales or even life style guidance for exercise or other activities.  In many cases our clients will actually record daily health monitoring results on the form (like blood sugars, blood pressures, and so on).  This is a great way to help aging parents and their care givers stay on top of the weekly regimen.  

There are some limits.  We have found that people dealing with Dementia (Alzheimer's disease or other forms) need the assistance of a caregiver to use a tool like this.  Often they will also need reminders through the course of the day to prompt taking their medications.  Technology can help here, as well.  There are a number of medication reminder systems emerging in the market.

 

Many families will get together this weekend for Easter.  Sons and daughters who may not see their aging parents often will travel to visit them and families will be reunited.  The holidays are often when adult children notice signs of aging in their parents, whether its a physical decline or a change in cognition. 

Encourage your parents to see their health care providers to address any changes that may inhibit their daily lives, whether it's a change in mobility or trouble with balance, or difficulty remembering things or worsening arthritis.  Proactively addressing these issues can help seniors maintain their mobility, better manage chronic illnesses, and put support systems in place prior to a crisis.

It can be difficult to bring up issues like this during a family holiday, so you may consider scheduling another visit in the near future.  Sometimes denial is the reponse to the aging process.  If your parents don't want to discuss the issues with you, you can enlist the help of a health care provider or other trusted advisor (whether it's a geriatric care manager, their long-time CPA or attorney, or even a close friend) to encourage them to proactively address the issues.

Don't procrastinate any longer.  Create your medication list or, if you are a caregiver, create one for your aging parents.  If you want help and advice get a geriatric care manager. 

This first job is easy to start.  Even if you are going to enlist help from a geriatric care manager or other in home services, having this list will only speed up their ability to help you or your loved one.  The medication list is the first step in any program of medication management.

Click on this link for a FREE quick spread sheet from one of my previous posts - Medication List Spreadsheet.

Make copies of the list and let your doctors know, it's critical.

When I became a stepmother to my then 7 year old stepson, it was easy to find people to turn to for advice.  For I lived in the midst of a community of  mothers……in my neighborhood, at work and at church.  These built-in communities provided support and guidance as I assumed the joyous role of being a Mom to a precious little boy named Michael.  That was 20 years ago and the friendships I made with those other Moms still exist. Today,  we continue to share stories about our “children,” but have excitedly expanded the conversation to include “grandchildren” and the happiness we experience as we watch our children become parents. 

As a caregiver for a parent, I find this type of community missing in my life.  There is not a natural group of people, who are caring for their parents, as readily available to talk with and exchange experiences.  Some organizations, such as the Alzheimer’s Association, offer support groups that do wonderful work.  But it is not the same as simply walking out the front door anymore.  The fact is that caring for children is much more common than caring for parents…..or at the very least…..more frequently discussed.   

I’ve found that I need to actively seek out support and this has come from many different sources.  I frequently browse the eldercare section at my local Barnes and Noble.  I talk to my RN friends and co-workers.  I subscribe to the Alzheimer’s e-newsletter.   But the outpouring of support that comes so naturally when caring for children at the beginning of life is rather hard to find when caring for parents at the end of life.

Recognizing that a lack of community and support is a common occurrence among senior caregivers, my company recently established an on-line complimentary “Caregiving Community” to provide answers to difficult caregiving questions.  The goal is to provide assistance and support to adult children who are worried or concerned about their parents.   Each month, My Health Care Manager will send members of the “Caregiving Community” an e-mail update which will focus on common caregiving concerns and practical solutions in a quick, easy to read, question and answer format.   The first issue tackled the following:  “Dad’s car has new scratches and dents.  Is it time to take the keys away?” 

I’d like to personally invite you to join the “Caregiving Community.”  Its goal is to help you….help your parents.  Please click here to join the “Caregiving Community”.  I also encourage you to e-mail your questions to CaregivingCommunity@MyHealthCareManager.com.  These will be addressed in a future issue.  Rest assured, your e-mail address will not be shared with any other organization. 

I work for a Geriatric Care Management company – My Health Care Manager.  I work with RN’s that have in-depth geriatric experience.  I read about geriatric care and caregiving on a daily basis.  I even give talks on Caregiving to employer groups in Indianapolis. So, I thought I was prepared, I thought I was handling things well, I thought I was the “exception” – the caregiver who takes everything in stride, who gets enough rest and who effortlessly achieves work/life balance without giving it a second thought.  That was until last weekend.

Last weekend, I crashed.  I was tired and irritable, got in arguments and cried without provocation.  I had finally had it.  I was tired of trying to be all things to all people – a devoted daughter, an attentive friend, a dedicated employee and a caring partner.  I was tired of not finding time for myself, tired of not curling up with a good book, tired of doing too much laundry and tired of sorting through tax records.  I was tired of answering my Mother’s questions over and over, I was tired of grocery shopping and most of all I was tired of being responsible.   

With shock, I realized my energy was all but depleted and I couldn’t believe the depth of my tiredness both physically and emotionally.  So, I crashed and slept a lot, read books and a caring partner took me out to dinner, cooked dinner for me and took my Mother and me to lunch.  He stepped in to prop me up and I was grateful for his help.  By Monday, I was feeling much better and ready to face the world.

When I spoke with a close friend about what happened – she wasn’t surprised and pointed out that my Mother had moved here six months ago.  She reminded me that I had been on the go ever since. I hadn’t realized how much time had passed or even thought about it, but realized she was right.  No wonder I was tired and cranky and motion sick from my merry-go-round life.

It was a rude awakening and I realized that I needed to follow some of the advice I often share with others. So I expressed my concerns to several friends and two volunteered to take my Mother on an outing (without me).  I worked less.  I engaged an Accounting Firm to help me with some financial tasks.  And a very thoughtful partner continued to provide encouragement and support as well as “date nights” and flowers.  And, most importantly, I gave myself a break!  I read books in the evening and let the laundry pile up.  I treated myself to an extravagant spring purse and savored chocolate covered blueberries.  It didn’t take much to bring the balance back to my life, but I learned a valuable lesson. 

So, the next time I give a talk about Caregiving – I’ll admit I didn’t follow the rules espoused in my carefully crafted Powerpoint presentation.  I’ll share my story.  I hope my experience will help others recognize that trying to be all things to all people is a useless endeavor, especially when it means you lose yourself in the process.

 

Families caring for aging parents or other aging loved ones know that it can be a difficult balancing act- especially for the primary caregivers, who often work full-time.  In addition to being a caregiver, you want to spend time with your family and children, you want to keep your close friendships, you want to maintain your performance (and attendance) at work, and on top of all of this- you know you need to take time for yourself as well!  You can only be 'Superman' or 'Superwoman' for so long... taking time for yourself can help prevent caregiver burnout- a very real problem.

Employers are realizing that caregivers may need extra help, and many are stepping up to help their employees.  Some are offering flex-time to allow caregivers more flexibility, and others provide general referral services to things like adult day care centers.  Many are starting to offer even more extensive eldercare benefits to their employees, like access to our company (My Health Care Manager) and geriatric care management services... to read an article from the IndyStar on 'Balancing Burden of Eldercare', please click here.

Even though Mother was safe and secure in Independent Living (IL) in a Continuing Care Retirement Community (CCRC), we quickly realized that managing her prescription and over-the-counter (OTC) medicines was a challenge of its own.  With 10 prescription medicines and 4 OTCs, the variables of continuing supply with many expirations and prescription renewals combined with generic vs. brand names, dosages and time-of-day preferences were an overwhelming task for her … and her caregivers!  Fortunately, we devised a Weekly Schedule and medicine reconciliation program that allowed her to manage her own meds (with our assistance) that has now become a My Health Care Manager computer-based decision aid.  However, loading her pill tray every week and managing the time for her diabetes blood sugar tests and consumption of the pills became (and remains) an ongoing challenge.  Until becoming exposed to the issues of polypharmacy and older adults, I didn’t understand that normally-prescribed medicines and dosages affect many seniors differently – sometimes even causing symptoms such as confusion and loss of balance.  Even multiple medication regimes that were tolerated in the past can at any moment cause problems or unwanted symptoms.

When trying to get my hands around the multiple medications challenge, it became clear that no single health care provider had information on everything that was being taken by Mother.  Each knew what he or she had prescribed, but the rest of their knowledge was based on answers given to the common question, “What medicines are your taking?” at office visits.  Often confused over generic vs. brand names, dosages, and omitting OTC products, older adults often can’t be counted on to correctly answer this important question.  In developing My Health Care Manager’s suite of decision aids, we added a letter that the senior can choose to send to all of their health care providers (or only to the ones they designate). The letter lists the providers, their prescribed medicines, and any other OTC products being taken by the senior.  Several doctors have remarked that this simple summary of information is not available from any single source in our health care system.  You might try this important task on your own if you are immersed in eldercare.  We’ll have more on managing medicines in my next blog.

We recently had some experience with the "set it and forget it" approach to the medication list.  It's too easy to make a medication list during a flurry of activity to get organized and then consider it done... for good.  Of course medications, dosages, and frequencies change over time and the list needs to be kept current.

For anyone dealing with multiple medications, keeping it current isn't enough.  It also needs to be communicated.  When you first build a medication list for yourself, your parents, or other loved one you should send it to every provider involved.  Yes EVERY provider and caregiver.  If you expect the health care community to make the best choices, they need to know all the medications in play.

At My Health Care Manager our best practice is to write a cover letter to all the health care providers and attach the full medication list.  For members under our Medication Management Program we extend this same notification every time there is a change to the prescription list.  This lets the provider know who else is involved in the care and what medications may be impacting their treatment recommendations.

As a caregiver or active senior, you can certainly do this yourself without the help of geriatric care manager.  Remembering to communicate is the key.  Don't forget to tell the other caregivers involved.  This is critical to making certain the proper amounts are taken and that potentially serious mistakes are avoided.

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.