After 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.

Last week's Indiana Geriatric Society's Fall Conference was a terrific meeting.  Special thanks go to the speakers, the current Presidents Drs. Diane and Pat Healey, and conference organizer Kathy Frank and her team of volunteers for carrying off a great program. 

I wanted to share a few thoughts from the conference.  We are facing a serious problem in our Heath System.  The growing population of seniors, their expected longevity, and the small number of health care professionals entering geriatrics or even primary care make for an alarming future.  Health care providers simply won't be able to keep up.

This means that families will need help with aging parents.  That help will come from caregivers.  Most will be family members and some will be professionals such as Geriatric Care Managers, companions, and other eldercare service providers.

These caregivers (especially the family members) need more tools, more resources, and more expertise.  Most will not be trained health professionals and many will be caring for an senior for the first time.

I have the privilege of speaking tomorrow (October 10, 2008) at the Indiana Geriatrics Society Fall Conference. My topic is:

Vision for the Future: Impact of Informatics on the Continuum of Caregiving

At the core of the material I'll be covering I want to share ideas about how technology can improve the lives of seniors and the caregivers around them. 

This in not only a desirable thing; it is a necessary thing.  By 2030 the population of seniors in the United States will be 71.5 million, more than doubling in just 30 years according the Department of Health and Human Services, Administration on Aging, (2006). 

The truth is that there are not enough senior health care professionals, continuous care retirement communities, or even professional geriatric care managers to provide complete and meaningful support for all these seniors.  Caregivers dealing with aging parents or other loved ones must have tools that do not rely exclusively on the individual people from provider community.

After the conference tomorrow, I'll share more on these ideas. 

For a complete program on the IGS Fall Conference follow this link http://iucar.iu.edu/igsfall2008.pdf

One of our greatest challenges as caregivers for our aging parents is getting an accurate and complete understanding of their health status.  Unfortunately, it is difficult to find a single source of unbiased guidance to help understand and coordinate our parents’ complicated issues of aging.  A big reason for this is the way the U.S. health care system works.  No health care provider is reimbursed for spending the time necessary to holistically understand all of the issues involved in a patient’s well-being.  With seniors covered by Medicare, the payments for allowable claims are for specific services delivered for single or closely-related issues.  This reality requires older adults to deal with multiple health issues, care providers, prescription medicines, and care plans by themselves or with the help of a trusted caregiver or a competent geriatric care manager.  For the few that can afford the charges, some physicians operate “concierge” practices that charge annual flat fees for unlimited access for primary care services and coordination with specialists.  However, these concierge practices are only able to serve a very small number of seniors, and the concept itself is subject to significant differences of opinion among physicians and health policy specialists.

We are finding that understanding and coordinating these complexities in our eldercare services is one of the greatest values we add for seniors and their families.  If you find yourself in a role similar to what we do, it is wise not to underestimate the difficulty and time it takes to gain a holistic view of an older adult’s health status.   Accompanying seniors to their health care providers’ appointments and participating in the debriefings at the end of the office visits is an excellent way to gain direct knowledge.  Taking good notes or (with the provider’s permission) recording the debriefing allows for accurate recollection when memories often fail to remember the details.  Discussing the various physician’s care plans with your parents’ primary care physician at an office visit can further help with a caregiver’s difficult job of gaining the holistic view necessary to be effective in your critically important role.

If your loved one lives in an assisted living facility or a nursing home, it is important for caregivers to know their rights as family members - and the rights of their loved one living there.  The federal government has many rules and regulations that these facilities must follow.  Each state then has additional rules and regulations that these facilities must follow.  This information is made public through the state department of health.  These facilities are also required to provide the residents/families a copy of the Resident Rights document, which is a list of your rights and can also be accessed through the state department of health. 

The social worker at the assisted living facility or nursing home is the liaison between the facility and the residents/families.  They are also to be an advocate for resident rights.  It is important for family members to educate themselves on the rules and regulations of these facilities.  If you feel the facility personnel is not working with you properly, outside assistance can be helpful.  Each community has an ombudsman, who is an advocate for people living in the residential facility.  They are employed by the state and usually work out of the Area Agency on Aging office.  To find your local ombudsman, contact your local Area Agency on Aging. 

A professional health care manager is also a good resource to utilize as an advocate and 3rd party when working with a residential facility.  Education and advocacy is a powerful asset for family members and seniors.

Asking for help is difficult.  Accepting help can be difficult too.  For some of us, asking for help feels like failure – i.e. if we can’t do it - we must not be smart enough, capable enough or care enough.  However, nothing is further from the truth.  Asking for help is sometimes the absolutely best thing caregivers can do….not just for themselves, but for their parents. 

It is impossible for any one person to be an expert on everything.  It is impossible for any one person to manage a huge number of caregiving tasks, in addition to managing work and family responsibilities.  Sometimes going it alone is not feasible or practical. 

Finding help is not difficult.  Tap into all the resources you can think of – use your informal network of friends, neighbors, and co-workers.  Consider developing a formal network with case workers, companion services, home health agencies and geriatric care managers.  This week, I estimate that the Geriatric Case Manager I work with here at My Health Care Manager saved me about 8 hours – by making phone calls to share concerns about my Mother’s declining health with the doctor and the assisted living facility. Then she followed up to make sure the doctor’s recommendations were followed and the tests he recommended took place.  This represented hours of work that would have been very difficult for me to accomplish in the midst of a very busy work day. 

The bottom line is that my Mother’s care is better when I utilize help.  Problems are more quickly identified and addressed.  Our Health Care Manager always keeps my sister and me informed, so we don’t feel disconnected from the issues surrounding my Mother’s health or care.  Additionally, our Health Care Manager offers suggestions and insight based on years of geriatric experience that help us provide the best care possible for our Mother. 

Don’t be a hero by trying to go it alone.  Caregivers don’t look good in capes.

Ask for help!

SCANS (Senior Care Navigation System) goes live today with the first Health Care Manager training session.  A second session will be held this Thursday.  Our Training Manager, Katie Eller, has put together an exceptional train module for the introduction of this exciting new product.

In just a few short days all of My Health Care Manager's and our Affiliates' geriatric care managers will be using this knowledge base to provide eldercare services.

The system is directly integrated with our case management system called Navigator.  Navigator has been in use for well over two years.  The two systems together provide a comprehensive package for Health Care Managers to help with aging parents.

Technology is helping seniors with their health, safety, and overall well-being.

I'm going to cheat just a little bit and pre-announce to my blog readers that SCANS Version 1.0 is about to go into production release. 

This is the Knowledge Repository Edition of SCANS.  It provides Health Care Managers at My Health Care Manager and our Affiliates with a comprehensive knowledge base of best practices in geriatric care. 

It contains information on all of the most common problem areas encountered when caring for aging parents.  More importantly it provides concrete geriatric care solutions, step by step actions, and powerful, practical tools for implementation.    Some examples of the issues addressed by SCANS include:

• Behavioral Issues
• Caregiver Support
• Cognitive Issues
• Family Communications
• Continence Problems
• Emotional Concerns
• Environmental Issues
• Information Management
• Intellectual Engagement
• Medication Management
• Nutritional Needs
• Pain Management
• Prevention/Wellness
• Provider Coordination
• Service Coordination
• Social Support
• Spiritual Well-being
• and many more

Our Director or Research, Jean Bandos, puts it this way:

"My Health Care Manager is in the process of developing an advanced technology Knowledge Management and Decision Support System that will change the way geriatric care management is delivered. This system is directly concerned with the caregiving challenges of the senior and their family ...  (this) Knowledge  management and Decision Support System will assist the Health Care Managers in delivering complete, comprehensive, and predictable services."

Our Research and Development team is particularly proud of delivering this first version to commercial use in less the 4 months of receiving a major grant from the Indiana 21st Century Research and Technology Fund of the Indiana Economic Development Corporation.

More advances are in the works...

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.

In addition to general communication sites like those mentioned in my previous post, family communications can be aided by a geriatric care manager.  The geriatric care manager is actively involved in the day to day care.  As such they often serve as a communication bridge between a variety of caregivers (such as home health providers, companion services, or home aids) and the family.

At My Health Care Manager our Health Care Managers use technology to help with this communication.  Some of this is done with simple reports or other outputs from our case management system that help to plan and organize the activities of the visiting agencies helping with eldercare.

A more advanced tool used by our Health Care Managers is the client portal.  This is a special purpose portal that allows authorized family members to view key data about their loved one.  It also provides a discussion board and other communication capabilities between the Health Care Manager and all the family members authorized to view information.  Caregivers can also provide updates regarding upcoming appointments or other events and even updates to the Personal Health Record such as prescription drug changes.    One of the favorite features for families is the posting of Contract Logs showing the most recent direct activities with the Health Care Manager and their loved one.  Instead of wondering what went on the doctors visit yesterday or relying on sketchy details from mom or dad the portal user can read the Health Care Manager's firsthand account.

This week, one of our fellow Health Care Managers, Jeannie Keenan, was interviewed and featured on the New York Times' New Old Age blog in a post titled "How to Make a Better Sandwich."  The article focuses on the "sandwich generation"- adults today caring for aging parents while also juggling work and their own families.

To read the article, click How to Make a Better Sandwich.

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.

Lots of questions are coming in about our latest major technology initiative - SCANS.  SCANS stands for Senior CAre Navigation System.  This is a development effort that has been underway for some time at My Health Care Manager.  The first full production release is due out in August.

We already use a complete set of Informatics tools to track, manage, and communicate with families regarding the issues faced by our senior clients and their caregivers.  SCANS goes to a whole new generation of support for our health care managers. 

The system provides a comprehensive set of geriatric care knowledge and decision support to our team in the field.  This includes a holistic, consumer-side view of the many issues faced by families grouped into 25 Care Categories.  All of the primary issues in each category are explored and specific solutions are recommend along with practical tools and actions steps for the caregiver.

This puts the best practices of the industry and a full time research team at the fingertips of health care managers and the families they help.

Several of us at My Health Care Manager share important eldercare information on our blogs each week, but this Saturday (July 26) at 11am ET, I will be live on the ‘Ask Mr. Eldercare’ internet radio show to share my perspectives and discuss the issues (click here to listen).  The host, Martin Sabel, and I will address the endemic problems of the health care system – and how geriatric care management can help seniors and their families make the most of the health care system and achieve the best quality of life possible.  If you are able to tune in at 11am ET (10am Central), you can call in to ask questions and share your thoughts or concerns.  If you’re unable to make it, you can listen to our conversation anytime by visiting the Mr. Eldercare show website by clicking here or visiting http://www.blogtalkradio.com/mreldercare and listening to the archived show.  Access to our previous blogs and additional eldercare information is through our website, www.myhealthcaremanager.com. 

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.