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

Ten Tips for Home Safety – Fall Prevention

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

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

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

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

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

Last week, I traveled from Indianapolis, IN to Litchfield, CT with my Mother to attend my sister’s wedding.  It was a long trip as we got to the airport early to deal with security, took a 2 hour flight to Newark and then rented a car and drove 3 hours to a Bed and Breakfast in Connecticut.  Along the way, we had to take our shoes off, give up our purses for a security inspection, and take escalators, elevators and a train in pursuit of a National rental car.  Everyone knows that traveling today is an exercise in both patience and logistics…b ut when you are accompanying a senior who is not steady on her feet and tends to be confused….. the patience/logistics requirements increase ten-fold.

Planning and advance preparation can help ease the journey.  In our case, I found it helpful to:

• Keep my Mother’s ticket and ID with mine, rather than risk her misplacing the paperwork.
• Consolidate all carry-on items in one bag (meds, jewelry, reading material), so there was less to keep track of during the trip.
• Dress for the security line….slip on shoes, no heavy jewelry, easy to remove jacket.
• Bring an extra sweater, as most airports are freezing.
• Pack snacks in case of airline delays, missed meals and long wait times.  The food court can be a long way from the assigned gate – a walk a senior is not up to.  If a senior has diabetes or a loss of mobility, packing snacks is essential to avoiding missed meals or long walks to the food court.
• Request a wheelchair or flag down a motorized cart to assist with transportation from gate to gate, if necessary.
• Stop when the senior gets tired and sit for a few minutes.  The airport pace is very difficult for a senior to keep up with.  This is especially true if your loved one has a loss of mobility.
• Limit information and do not provide it all at once – just focus on the next step and explain to the senior.  Discussing the entire itinerary i.e. we are catching a plane, then renting a car, then driving to Connecticut... is too overwhelming.
• Remember that the crowds, noise and fast pace of the airport can contribute to a senior’s confusion and anxiety.  Try to buffer them as much as possible by walking so that they are close to the wall and you are on the outside to take the bumps as people push past you.
• Be sensitive to their fears – dementia may cause even seasoned flyers to feel nervous about flying.
• Enlist help – ask someone else to accompany you to help with luggage, logistics and provide moral support.
• Enjoy the senior’s sense of wonder along the way – for them, a plane trip is a rare and exciting event. 

In summary, traveling with a senior should not be taken lightly.  Advance planning is key to ensuring a safe and stress-free trip for both caregivers and seniors alike. Be prepared, be patient and always remember that seniors will need extra special care and attention during the trip.

As a follow up to the Elder Abuse blog, I was reading more about the safety risk of older adults. Did you know that a government study found that most victims of health care fraud are over age 65?   Quackery has been around for centuries. We have all grown up with Grandma’s remedies but today with TV, magazines, mail, web sites, and word of mouth there are more and more ways to be sold unproven remedies and “miracle cures.” This puts our elderly at risk! The older adult is frequently targeted for such scams and they are often unaware that the unproven remedies may cause harm. Not only do they waste their money, but it can prevent them from receiving the medical treatment that they may need.

How can they protect themselves?

• Get the Facts
• Be cautious
• Don’t believe everything they hear
• Take time
• Ask questions
• Request information
• Talk with their health care providers.

If you would like more information on how to protect yourself or how to check a product, you can contact:

Council of Better Business Bureaus (CBBB)
4200 Wilson Boulevard
8th Floor
Arlington, VA 22203
Check the telephone book for the number of your local chapter.
www.bbb.org

U.S. Food and Drug Administration (FDA)
5600 Fishers Lane
Rockville, MD 20857-0001
Phone: 1-888-INFO-FDA (1-888-463-6332—toll-free)
www.fda.gov

Quackwatch, Inc.
Quackwatch, Inc, is a nonprofit corporation making information available to combat health-related frauds, myths, fads, and fallacies.
www.quackwatch.org

For more information on health and aging -
Visit NIHSeniorHealth.gov (www.nihseniorhealth.gov), a senior-friendly website from the National Institute on Aging and the National Library of Medicine. The simple-to-use website features popular health topics for older adults. It has large type and a "talking" function that reads the text out loud.

Watch for my next blog --  “ Crime and the Elderly”

Anyone who has dealt with an aging parent or a senior friend that has cognitive decline knows how hard it is to discuss those difficult topics such as driving, advance directives and/or their wishes to age in place. These conversations usually happen during a crisis situation, e.g. the senior has fallen and been admitted to the hospital,l or suddenly their car has a huge dent in the back end. As I discussed in my last blog, there is no easy way to begin discussions about the senior’s ability to drive when he/she has memory loss. It is even harder to conduct these conversations when you have not been involved with the senior on a routine basis. Whether it is regarding their driving ability or their end of life wishes, as an adult child you have to remember to preserve your parent’s dignity while assisting them to talk about their decisions.

If at all possible, do not have these conversations during a crisis. Plan a convenient time to have these conversations with your loved one. Remember that you want to keep the conversations positive- thinking of solutions; progressive- how the issue will be addressed over time; and productive- not argumentative. It is important to keep the senior engaged.

Decide beforehand who is best to conduct the conversation. This is a discussion for the family members, but a decision needs to be made.  For instance, if it is regarding the senior’s driving skills, the person to deliver the message needs to be aware of how the senior is currently driving. Is the area of concern a one-time accident… or is it a daily roller coaster ride?

Decide on the best time to have these conversations. You want everyone to be calm, not filled with apprehension. You want it to be convenient for all of the people involved in the discussions.  For instance, in regards to advance directives, you do not want to hold these discussion in a hospital room while waiting for surgery. The conversations regarding your parent’s wishes regarding durable power of attorney or health care representative should be held prior to any illness.

It is best to pick the topic of discussion and have it prior to the crisis. Regarding advance directives, the earlier you can have these conversations, the better. Everyone - no matter what age they are - needs to decide on their own health care decisions… especially their wishes if they become unable to make decisions for themselves.  The financial power of attorney also needs to be decided before the senior has cognitive decline.

Develop a personal conversation plan for each topic that you would like to address and solicit professional support as needed. For example, if your parent has a relationship with a lawyer from drawing up their will, encourage your parent to talk with the lawyer about advance directives, including durable power of attorney. You may even help them set an appointment with their lawyer. Hopefully they will allow you to attend, but if not, ask them how it went and talk to them about your wishes.  

There is no clear-cut right or wrong time to have these difficult conversations. The key thing to remember is to have the conversations before your parent is unable to have them. 

Some good resources are Alzheimer’s Association’s website www.alz.org and the National Institute on Aging.  Click here for the NIA’s Caregiver Guide for more tips on communication or visit http://www.nia.nih.gov/NR/rdonlyres/C2F11D41-E5FE-435D-9C9D-A3489319D4AD/6531/Caregiver_Guide307.pdf.

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.

How many times have we heard “ try to put yourself in their shoes”  when we are trying to understand actions or behavior we find puzzling?   We do this for friends and co-workers all the time.  But it is much more difficult to put ourselves in our parents’ shoes.  Because as children growing up we didn’t spend time trying to figure out much, if anything, about our parents.  For most of us, we just knew they loved us and wanted to take care of us.  It was an absolute, a given, and not something to be questioned or analyzed.  We didn’t try to put ourselves in their shoes, we just worried about our shoes, especially when we wanted new school shoes and the latest sneakers.

I had an “aha” moment when I entered the work force and became an Executive Assistant to a CEO who had a crazy schedule filled with meetings and business travel.  While managing his constantly fluid schedule, it dawned on me that my Dad’s business life had been similar.  And I wondered how my Dad had managed to attend so many of my tennis matches in high school.  I finally recognized and appreciated the effort he must have made so many years ago to be there for me.  But, I have to admit that at the time, while I was glad he was there, I didn’t realize everything he must have done to make that happen.  I wasn’t very good at putting myself in his shoes then, and I’m not very good at putting myself in my Mother’s shoes now.  I don’t think I am exceptionally dense or self absorbed……I just don’t think this is the natural order of things.

Another example occurred yesterday when I was shopping with my Mother.  As we walked from the car to the shopping center, I was focused on our destination – the World Market store – and the list of things I wanted to purchase for Christmas – gift wrap, gourmet items and some wine.  I didn’t pay attention to the other stores in the strip center, until my Mother asked this question – “Are you going to buy a Sailor Suit?”  I then realized that there was an “Old Navy” store next door to the store I planned to visit.  My Mother’s question was perfectly legitimate, albeit hysterical, because from her perspective we were going to a “Navy” store…….not the World Market store.  It made me realize how easy it is to look at things differently and how often our perspectives are not the same.  Because perspective is based on life experience and our life experiences have been quite different.  I didn’t grow up at a time when brothers, classmates, boyfriends and neighbors were likely to enter the Navy.  My Mom didn’t grow up in a world defined by The Gap. 

So, I’ve decided to make a real effort to try to look at the world more closely through my Mother’s eyes and try to walk in her shoes.  The first step occurred late yesterday afternoon – when I bought her a pair of UGG boots because I was worried about her falling in the snow in her heeled fashion-conscious boots.  I love my UGG boots, with the warm fleece lining and sturdy, waterproof soles.  I convinced my Mother to try a pair on and she liked them! So, now we truly are walking in the same shoes (boots)!

·   An excellent resource regarding evidence based practice for nurses in clinical and educational settings is the Harford Institute for Geriatric Nursing, New York University College of Nursing http://www.consultgerirn.org/ . This site covers geriatric topics including but not limited to overviews, definitions, background information such as incidence, prevalence, assessments, assessment tools, and nursing care strategies. In dealing with fall prevention, as an example, the information that you will have access to is a general overview of falls, definitions, along with assessment tools and educational material. One tool that is shared is the Tinetti assessment tool for the older adults who can ambulate independently. The site also provides nursing care strategies, treatment protocols and management recommendations.

·   Age related changes (such as altered visual acuity, decreased balance and muscle strength, hypotension, and changes in bladder function such as frequency and/or incontinence) increase the risk of falls. If you have a hospital based practice, you know that falls are the single largest category of incidents in an acute care setting and for people over 65 years of age, falls are responsible for one third of deaths (http://www.consultgerirn.org/).

·    In dealing with the elder population, always remember to evaluate for the risk of falls and provide fall prevention education. Another resource for educational materials is the National Institute on Aging  www.nihseniorhealth.gov .

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

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

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

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

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

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

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

What can you do? 

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

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

Growing up, my Mother always hosted Thanksgiving and what I remember most is my role in setting the table.  Perhaps, it was our New England heritage, but our table always looked like a Norman Rockwell painting.  Or more aptly, Norman Rockwell meets Emily Post!  My Mother was a stickler on etiquette, and the silverware, glassware, etc. were always placed just right.  It was my job to ensure the plates were 1” from the table edge, the knife blades faced inward and that the water and wine glasses were appropriately placed.  I loved doing this as I felt very grownup when I was deemed old enough to place the china and crystal in their proper places.

I still love to set the dining room table.  For it brings up memories of so many happy family times – holidays, birthdays, and other special celebrations.  This is my favorite part of entertaining….certainly more fun than making beds and cleaning bathrooms prior to guest arrival! 

My Mother is very excited about the holiday, especially since my sister and her fiancé are flying in from NYC.  She has called me several times volunteering to help and I wanted to find a way to include her in the preparations.  So, yesterday afternoon I brought her to my home and we debated different tabletop “looks” and decided on a classic ivory tablecloth with fall napkins.  Then I set up the ironing board and she ironed my tablecloth and napkins.  She was so happy to help and be a part of the preparations.   We laughed as we struggled to get the tablecloth straight and she was pleased when I suggested we use the brass candlesticks she had given me when I was first married to light the table. 

But the most special light shown in her eyes, as a new tradition was born.  This year, she won’t be cooking the turkey nor doing the grocery shopping, but she was able to help in a way that connected her with the past, by actively participating in the present.  

If you live in a part of the country where season is changing to ice and snow, I am sure your are worried about that icy accident where you could fracture your hip. Just remember to be careful and do not take chances on icy and/or wet surfaces.  A simple fall can have a dramatic impact on your life.

But remember that falls happen everyday, even on beautiful days.  As you age, your sight, hearing, muscle strength, coordination and reflexes begin to change. You may notice that your balance may be off or that you lose mobility.  If you have diabetes or heart disease, your balance can be affected and some of the medications that you are taking can cause dizziness. Then there is Osteoporosis, where your bones become thin and break easily.  All of these things can contribute to your first fall- creating that change in your life that affects your overall well-being.  So how do you take care of yourself to remain active and maintain your quality of life?  Here are a few simple tips:  

Ø      Contact your doctor and ask him about Osteoporosis and a bone density test that will tell you how strong your bones really are or if you need medications to help strengthen your bones.  

Ø      Plan an exercise program that is right for you. Always talk with your doctor before beginning your exercise program  

Ø      Review your medications with your pharmacist and/or physician for any side effects. 

 Ø      Stand up slowly – this will prevent you from feeling faint if your blood pressure drops too quickly  

Ø      Wear shoes and socks (low-heeled shoes that fully support your feet).  

Ø      If you have handrails in your home, make sure they are safe and use them.  

Ø      Pick up your throw rugs.  

Ø      Don’t take chances.  

Ø      Make your home safe by making sure you have good lighting and keeping areas tidy.  

Ø      In your bedroom, put your telephone next to your bed.  

Ø      Keep night lights on.   

Some additional fall prevention resources are:  

Ø      The Older Consumers Safety Checklist is free by contacting the U.S. Consumer Product Safety commission at www.cpsc.gov  

Ø      National Institute on Aging provides Age Pages on osteoporosis, home safety and fall  prevention tips at www.nia.nih.gov    

A recent study has suggested that correcting vision problems in seniors residing in nursing homes may reduce their symptoms of depression.  Not only were their symptoms of depression reduced, but also their involvement in social interactions, activities and hobbies, and reading increased.  Of course this doesn't pertain to only those seniors living in retirement communities.  Correcting poor vision can be a relatively easy and quick way to positively affect quality of life in the short term.  To read the study synopsis, please click here.  The study is specific to refractive errors, but other common conditions in older adults include glaucoma, macular degeneration, and cataracts.

While I've already mentioned the link between falls and certain types of loss of vision, this is one more reason to make sure the older adults in your life have recently had their vision checked by a health care professional.  Aging can often mean a change in vision, and it is important to proactively address this, as some common conditions can be treated (e.g. the refractive errors in the study, cataracts, etc).  Caregivers may often be the first to recognize the signs, and your loved one's geriatric care provider or health care professional can recommend a specialist if your loved one does not have an optometrist or eye doctor.

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

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

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

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

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

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

The admissions process was handled well at the SNF, and we met the director, marketing liaison, and director of nursing in a welcoming visit.  Thankfully Mother came in during the week, as many of these managers are often not available on Friday evenings, or over the weekend, the interval following frequent Friday afternoon discharges from hospitals to geriatric care facilities.  But the first night experience was still ahead, and my experience in care management was only beginning.

Visiting a sobbing Mother the next morning, I learned that she thought help would arrive quickly after she pushed her “Help” button, and it didn’t come for over an hour after her 4am page.  Her accident was totally avoidable, but staffing during third shift was so low that timely rounds and responses were nearly impossible.  After a one-on-one meeting with the director and a frank discussion of expectations and responsibilities, her page was answered promptly from then on.  Fortunately we were right there and not timid in asking for improved service.  My thoughts now focus on those families that don’t have the good fortune of being in the same city during a crisis or rehabilitation.  Eldercare from fifty or over a thousand miles away nearly always stresses both caregivers and their parents sometimes beyond belief.

Learning that Medicare covered the first 20 days in the SNF when preceded by 3 nights in the hospital, we concentrated on making her stay as comfortable as possible.  We quickly moved in her credenza and chair from her home, her TV, and her CDs and stereo.  This turned out to be a great idea, and others facing a similar situation should seriously consider doing it – even if the SNF doesn’t encourage it.  Next came physical therapy (PT) and occupational therapy (OT) to increase her mobility.  Luckily she didn’t need speech therapy (ST).  PT was performed by in-house employees (it is often outsourced), and all went well toward her 30 step benchmark test.

For more information on Medicare coverage of Skilled Nursing Facility care, please click here.

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

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

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

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

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

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

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

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