Last Sunday, I stopped to visit my Mother in her memory care apartment. When I knocked on her apartment door, she didn’t answer. I thought she was napping, so let myself in. She wasn’t there. I decided she must be participating in a group activity and went to look for her. I checked the 3rd floor dining room, living room, and activity room – no Mother. I looked up and down the hallways – no Mother. I could not find her. I became slightly worried and wondered if she had fallen or wandered to another floor.
I went to the Care Managers’ office and asked if they knew where my Mother might be. I saw two of the Care Managers exchange small smiles. I was told that they last saw her sitting in Tom’s room. Tom??? “Who’s Tom?” I asked. They explained that Tom was my Mother’s new “friend.” They told me that my Mother and Tom had been sitting together at meals, spending time together, and generally looking out for one another.
One of the Care Managers started to walk me to Tom’s room. As we turned the corner, we saw my Mother coming towards us, heading back to her apartment. She smiled and seemed glad to see me. We walked together into her apartment. As we settled in the living room for a chat, she looked at me and said “I have a boyfriend.” She said it in an offhand way, yet there was a challenge in her tone and a sense of pride in her voice. It was touching and cute. But talk about role reversal! So many questions ran through my head – the same ones my parents had asked when I made a similar pronouncement over the dinner table twenty five years ago. “Who is this man?”, “What is he like?”, “Will he be nice to my Mother?”, “What are his children like?”, and “Will my Mother get hurt?”
On the surface, I was very happy. In recent years, my Mother had often told my sister and me that she wanted a boyfriend. My Father had died quite young, leaving my Mother a widow at 59. Over the years I had encouraged her to date, to meet people. Yet, she had always resisted and never pursued a relationship - until now at age 80! If this friendship with Tom helped her feel more content and boosted her spirits – I was all for it.
But to be honest, it was unsettling too. As is so often the case, her past and the present blurred together – making it difficult to know how to react. Later in the day, my Mother talked about my Father, as if he was away on a business trip and was expected back at any moment. The boyfriend was easily jettisoned, at least until dinner.
I stayed for awhile that afternoon. My Mother and I talked, watched the Olympics and looked at the snow falling softly to the ground. As dinnertime approached, I gathered my things to leave and walked my Mother to the dining room. She wished me a blithe goodbye and slowly made her way across the room to join her boyfriend for dinner. He smiled as she approached and she looked happy too. She made no attempt to introduce me – the moment was for them alone.
I got in the elevator and left quietly, overcome with emotion and the beauty of God’s grace.
Today three new tools for eldercare are live! SCANS/Care Manager (V1.1), SCANS/Client Access (V1.1), and SCANS/Care Advisor (V1.5) were all released into production. Some highlighted improvements include:
SCANS/Care Manager
- Improved user interface - easier to use, improved navigation, fewer steps to complete tasks, "finger tip" utilities, and improved look-and-feel.
- Dynamic creation of assessments for increased flexibility and new programs
- Assessment printing - blank forms and completed documents
- Improved reports
- Medication look-up
- Improved provider, service, and insurance listings
- Better organization of client data
- Integrated activity and time tracking
- Activity re-assignment
- Improved calendar event scheduling
- Better branding support
- Group and sub-group support
- and many more...
SCANS/Client Access
- Dramatically improve client interface with improved look-and-feel, better ease of use, action section, more data from the personal heath record available, and more.
- Self management of passwords
- Reports now available on-line for view and print
- Direct account management by geriatric care managers for quicker turn around on access requests
- Improved communication tools
SCANS/Care Advisor
- Continuity of Care Record (CCR) Interface for improved integration
- 67 New tool revisions
My last post covered some of the key points to consider if your aging loved one has dementia and may still be driving.
To objectively assess the older adult’s ability to drive the family and/or support systems should document and then share with others:
- The frequency, type and severity of accidents/incidents
- To reinforce that while everyone has isolated incidents; when there is a pattern, conversations about driving and decisions need to be made
- Take immediate action when the older adult is confusing gas and brake pedals and/or stopping in traffic for no apparent reason
If needed, an occupational therapist can provide assessment and remedial driving training. A professional geriatric care manager can help you locate a local resource. Other resources to assist in assessing driving skills are:
Today, there are more than 5 million older adults in U. S. that have some form of dementia. If you are a caregiver for a loved one that is suffering from memory loss, one of your key questions may be is it safe for my loved one to continue to drive? Or when should I take the keys away?
This is such an important concern in managing independence and total well being versus safety that you should talk have conversations with your loved one about their feelings and perceptions of their driving ability.
Some points to remember when a person has dementia:
- There are different regions of the brain that cooperate to receive data from hearing and seeing
- The brain has to prioritize the information, recall related experiences, anticipate, plan and judge with some speed
- Every older adult with dementia presents with a different capabilities to execute their driving skills depending on how many of the brain functions are impaired
- With the aging process there are also physical changes that may affect driving such as poor eyesight, night vision, and slower reactions times.
My next post will talk about some of the way to assess a senior’s ability to drive safely. I’ll also provide some resources that may offer driving assessments or training for seniors.
Most readers likely already know that falls are a major problem for families caring for aging parents. Historically, fall prevention has been left to general advice offered by the senior health system. Far too often, such advice is offered after a major fall and even injury.
Recently, technology is being employed to help understand and predict fall risk. Here is a link to an excellent New York Times article on the topic -
http://www.nytimes.com/2009/11/08/business/08unboxed.html?_r=2&ref=health.
Researchers are using low cost motion sensors to examine the behavior of older adults living independently. This data can then be analyzed to better understand the overall problem and make specific recommendations to families, before falls lead to injury.
These motion sensors have a variety of other uses, as well. For example, they can be used to detect activity levels which may indicate an older adult needs help or is ill. Monitoring for wandering and other concerns could also be improved.
Beginning Q1 2010 My Health Care Manager is deploying a major extension of its Senior Care Navigation System (SCANSTM). SCANS is now a software suite incorporating and enhancing the functions previously performed by the Navigator system. The modules and a brief description are as follows:
SCANS/Client Access provides clients and authorized care participants access to key personal health information, assessment results, reports, care plans, tools, and more.
SCANS/Care Manager provides geriatric care managers with a comprehensive system to assess, plan, implement, and track the care of seniors and their families.
SCANS/Care Advisor provides care managers with an extensive knowledgebase and decision support system bringing industry best practices, recommended actions, and real world practical tools to enhance quality, completeness, and efficiency in care planning and delivery.
I recently watched a video about Alzheimer's disease and creative arts that a co-worker sent to me that I wanted to share. Often we hear about the many losses that are associated when somebody has this disease but I wanted to touch on a strength that people with Alzheimer's disease still have until the very end - creative arts. Drawing, painting, clay making are all activities that can be used as a way to tap into the person's imagination and improve their quality of life. Plus, it is fun!
Somehow, paintings speak to them and the person is able to tell a story from it. They take in the colors of the painting, the form, and design and they live in the moment. For them - it has meaning to them. This is a great non-verbal way of communicating with someone with Alzheimer's disease. Not only are they being engaged, but it is a great way to work out the muscles in their bodies. Imagination is one thing that stays with someone through the duration of the disease.
Click here to watch the video.
There is also a "Memories in the Making" program through some of the Alzheimer's Association chapters that focuses on art and those with early stage Alzheimer's disease. Contact your local chapter for more info and to see if they are participating.
This evening I'm participating in a Panel Discussion at Butler University. Nick Caldicott the President of the Management and Information Systems Technology Association at Butler has put together a discussion on careers in IT.
The event is at the Butler Pharmacy and Health Sciences Building at 7:00 in room PB156. Butler campus is located at 4600 Sunset Avenue, Indianapolis, Indiana 46208.
As I was putting my opening remarks together, I added a bullet to a slide titled "Why Love Technology?" that struck me as needing more explanation. The bullet simply said "Helping People". This is a great strength of technology and in particular creating tools for eldercare.
Most any computer system is built to help people, at least a some level; even if it's just to help do some menial task more quickly and easily. Building software that effects lives and helps families caring for aging parents with things like medication management, senior health care, following treatment plans, home safety, and overall well-being, is a special case.
What I really love about this kind of technology advance is that we can multiply ourselves way beyond our ability to help as an individual person. While we might be able to help a handful of families each day, a software system can be used by hundreds or even thousands of people everyday to make a difference in the lives of seniors. We simply can't do that by ourselves.
In the midst of a snowy and icy winter, I have been trying to come up with new activities to do with my Mother. Going on an outing that involves negotiating slippery sidewalks is just not an option due to her decreased mobility and the risk of her falling. So I thought back to growing up in New England, when the combination of huge snowdrifts and cold temperatures meant staying indoors for long periods of time. Cabin fever often set in and my Mother would think of activities to entertain me and my sister. Now it was my turn to think of activities to keep my Mother amused.
Following are a few favorites, adapted from my childhood, that might help other caregivers:
Have a tea party – brew a specialty tea in a favorite (but rarely used) china teapot and serve with desserts from the bakery (eclairs, petit fours, tarts). My Mother’s eyes light up when I arrive and she spies a white bakery box tied with string! She can hardly wait to sample one of the elegant desserts.
Watch movies – buy or borrow movies from the library that your parent will remember from the past. I recently purchased a four movie assortment of musicals from the 50’s and 60’s – “Kiss me Kate”, “ShowBoat”, “Annie Get Your Gun” and “Seven Brides for Seven Brothers.” As we munch on popcorn and watch “ShowBoat”, my Mother smiles and sings along. (Yet another confounding aspect of Alzheimer’s – why can my Mother remember the words from a 40 year old musical, but forget what she had for breakfast?)
Window Shop – look through spring apparel catalogs or magazines and select favorite styles. My Mother enjoys debating color choices and still has firm opinions about what she likes, although she always ends the conversation with “I don’t need anything.”
Look through photo albums – use photos to reminisce about fun family times (vacations, first day of school, etc.) and laugh about horrible haircuts (think 70’s shag –agh!)
Clean out a closet or drawer – while I do the work, my Mother happily directs and admonishes me to “not throw anything out.”
If you’re a caregiver to an aging parent with Alzheimer’s, I’d love to hear some of your favorite cabin fever remedies!
Do you ever find yourself having a hard time concentrating? Do you get worried or anxious about things in your life? Is it difficult for you to stop worrying? We all have moments in our life when we are worried about things and usually our worry goes away. However, for some individuals they do not go away and may be experiencing anxiety. Experiencing stress and anxiety can be very taxing for both the older adult and the person caring for them.
The National Mental Health Association offers 12 steps that can help people cope with stresses and anxiety:
- Set realistic goals and have realistic expectations
- Let others share the responsibilities of special tasks
- Live and enjoy the present; look into the future with optimism
- Do not compare one day with the good ol' days of the past. This can and often does lead to disappointment.
- Those who are lonely should try and volunteer some time to others
- Limit drinking - excessive alcohol can increase feelings of depression
- Get exercise or do some physical activity regularly
- Spend time with supportive and caring individuals
- Reach out and make new friends
- Make time for yourself
- Find activities that are free in the community
- Keep tracking of your financial spending. Over spending can lead to stress and anxiety when the bills arrive.
If you still feel you are anxious or can't stop worrying, please get an appointment to your primary care physician to discuss them with him/her so you both can work together on how to alleviate feelings of anxiety.
A friend recently sent me some information about the use of GPS technology used in eldercare services. The idea is to bring tracking devices into Alzheimer's care. Of course this applies to any dementia related care.
One such device marketed by i-Tag identity solutions and is called the "i-Tag-a-long GPS". It's about the size of a nine-volt battery and can go about a week between charges. Families caring for aging parents with dementia can use an on-line portal to see their parent's location. Even more useful, i-Tag is providing the ability to create a "geofence" that will trigger an alert when the device leaves a user defined area. Alerts can be sent via text, email, or phone. As an added benefit the device also serves as an alert button - notifying cargivers in the event of a user signaled emergency. Read more on this use at
i-Tag's site.
When we hear of indiviuduals who have alcohol challenges we hear about statistics usually for the general public. In doing some research I found that approximately 50% of older adults aged 65 and older drink alcohol. Up to 15% may be experiencing health risks from either the amount of alcohol being consumed or the combination of alcohol use with medications.
This topic is important because many older adults are on more than one medication and many times those medications should not be mixed with alcohol.
If you or somebody you know is dependent on alcohol and would like to get more info on how to become sober, please read about the following sobriety programs to get more information:
1. Contact your primary care doctor - It is essential to communicate with your doctor on the desire to become sober and follow any safety prorcedures to prevent withdrawal symptoms.
2. Contact the national helpline to assist in locating treatment providers
1-800-662-HELP (4357) or
http://findtreatment.samhsa.gov 3. Other treatment options include:
a. Self help groups (Alcoholics Anonymous, www.aa.org)
b. Day treatments, outpatient therapy or community based groups
c. Counseling
My previous blog,
2010 Flu Season for Seniors, focused on the symptoms of the flu and how to get vaccinated. This blog will focus on the everyday precautions you can take to help prevent the flu in you and your senior loved ones.
- Wash your hands often with soap and water - you can also use alcohol based hand cleaners
- Throw away your tissue after use
- Avoid touching your eyes, nose or mouth
- Avoid close contact with people who have flu type symptoms if at all possible
- Listen for your local public health advice especially regarding closing and crowds
- If you are sick, stay at home and have the supplies in need in your home for a week or so.
If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick.
Help keep yourself and your senior loved one safe and healthy this flu season by following the precautions above.
The U.S. Department of Health & Human Services would like to “highlight the importance of continuing influenza vaccination, as well as foster greater use of flu vaccine after the holiday season into January and beyond… the spread of 2009 H1N1 influenza is likely to continue” into 2010.
Influenza is unpredictable, but it is known that if people are vaccinated, the flu is less likely to spread in the coming months. Ask your health care provider if you have questions about the flu vaccine for you or your senior loved one.
Symptoms of Flu
Seasonal Flu- All types of flu can cause:
- Fever
- Coughing and/or sore throat
- Runny or stuffy nose
- Headaches and/or body aches
- Chills
- Fatigue
H1N1 Flu- Same as seasonal flu, but symptoms may be more severe.
Fever
- Coughing and/or sore throat
- Runny or stuffy nose
- Headaches and/or body aches
- Chills
- Fatigue
In addition to the above symptoms, a number of H1N1 flu cases reported:
If you're a caregiver, speak to your health care provider with any questions about the flu or the flu vaccine for you and your senior loved one.
My next post will give some of the most important flu prevention tips to keep you and your senior loved one healthy.
Brrr, it's cold outside and this is a good time to highlight a dangerous concept among older adults during winter -
hypothermia. We all know about the winter damages such as broken bones from falls on ice or slippery snow, however, there is something else to watch out for also. The cold weather and wind chill also lowers the temperature inside your body, which can be extremely dangerous if not treated quickly. Signs of hypothermia include: weak pulse or decreased blood pressure, chilly room temperatures, shivering or stifness in legs, slowed speech, confusion, or sleepiness.
There are several safety precautions to take to prevent hypothermia:
- Ask your physician how the medicines you are taking affect body heat.
- Make sure you are eating enough food to keep up your weight. Fat keeps heat in your body.
- Make sure your living environment is set to 68-70 degress.
- Sometimes you may need to put on more clothes to help keep warm.
- If driving, always start the car and allow it to warm up before driving in the winter months.
If you suspect hypothermia with yourself or anybody else, make sure to get the person to the doctor or hospital quickly.
Source: National Institute on Aging
Sometimes it is hard to stay warm if you do not have monies to keep your heat turn up or even on. If your aging loved one is on a limited income and having difficulty paying heating bills, seniors may qualify for assistance. State and local energy agencies, or gas and electric companies may have special programs. Another possible source of help is the Low Income Home Energy Assistance Program (LIHEAP). This program supports some people with small incomes who need help paying their heating and cooling bills. Your local area agency on aging, senior center, or community action agency may have information on programs such as these.
Are you worried that your landlord (or that of your parent or other aging loved one) may want to cut off the gas or electricity in cold weather if you cannot pay a utility bill? Many states and cities now have laws to protect you, at least until other plans are made. Check with your local government about the laws that may apply where you live.
To find out about assistance in your area, contact your local Area Agency on Aging (AAA) who will provide information on the assistance programs. Visit them online at
http://www.n4a.org/ or call 800-677-1116.
Remember stay warm, keep your thermostat set above 65 and have a plan if you lose power. Caregivers, make sure to check on your aging loved one. You may also ask neighbors, friends, and family to help.
To learn more about winter safety, please see my last blog entry by visiting my blog
here.
It is very important for the older adult to know his/her surroundings and prepare for the winter months. Changes in the older adult that accompany aging make it harder for them to know when they are getting cold. It is also harder for the body to warm itself. So for safety’s sake, it is very important for the older adult to pay attention to the weather and how cold it is going to get. Caregivers should help their aging parents and other aging loved ones follow the tips below.
General tips for the older adult from the
American Geriatric Society are:
1. Stay indoors when it's very cold outside, especially if it's also very windy; and keep indoor temperatures at least 65 degrees
2. If you have to go outside, don't stay out in the cold or the wind for very long
3. Wear two or three thinner layers of loose-fitting clothing. (They are warmer than a single layer of thick clothing.) Always wear:
- a hat
- gloves or mittens (mittens are warmer)
- coat and boots
- a scarf to cover your mouth and nose and protect your lungs from very cold air
4. Stay dry; wet clothing chills your body quickly
5. Go indoors if you start shivering- it's a warning sign that you're losing body heat.
Know the warning signs of hypothermia: lots of shivering; cold skin that is pale or ashy; feeling very tired, confused and sleepy; feeling weak; problems walking; slowed breathing or heart rate. Note: Don't rely on shivering alone as a warning sign, since older people tend to shiver less -and some, not at all-as their body temperature drops. Call 911 if you think you or someone else has hypothermia.
In my next blog, I'll post information on finding assistance for seniors who may have trouble paying their heating bills.
Visit the AGS foundation winter safety page
here.
This past week I got a handful of comments about a Wall Street Journal article titled "Your iPhone Just Called: Your Blood-Sugar Is High". Pretty neat concept, but the article really doesn't talk about the future convergence of in home heath monitoring/diagnostic equipment with personal health information repositories, as the title might imply.
Instead the article focuses on something much more accessible today - the use of mobile devises to view and even update personal health information. One family cited in the article actually uses such an application to help in caring for aging parents. The iPhone application in question is Polka. Polka, like nearly all the applications mentioned in the article, uses a central web application to house the personal health record. Polka is primarily and personal tool, but the "team" tools allow some sharing of information across a team or family in the case of senior health care.
Most of the applications mentioned in the article, including Polka, have a strong bias toward disease management. This is certainly an important issue in geriatric care. Polka also has some more holistic tools including over all well-being.
For easy reference, here are the products mentioned in the article with hyperlinks to their web sites:
Caregiving is always a challenge - especially remembering to take care of yourself. During the holidays, it is so important to take care of yourself. Today, I’m sharing a few tips for caregivers of someone with cognitive decline or Alzheimer’s.
How do you take care of your aging loved one and still enjoy the holidays? The National Institute on Aging has many tips to assist you, especially during this holiday season. Some key tips are to:
- Keep or adapt family traditions that are important to you. Include the person with Alzheimer’s Disease as much as possible
- Recognize that things will be different, and have realistic expectations about what you can do
- Encourage friends and family to visit. Limit the number of visitors at one time, and try to schedule visits during the time of day when the person is at his or her best
- Avoid crowds, changes in routine, and strange surroundings that may cause confusion or agitation.
You can also visit my previous blogs on caregiving and the holidays:
Caregivers' plans for the holidaysCaregiver stress and the holidaysOr, if you'd like to read about a caregiver's experience and hear her advice, read Karen Kelsey's blog post:
Christmas and caregiving.
If you notice a change in cognition in your aging loved one this holiday season, or worry about their mobility, safety, or health, please contact their health care provider or a professional geriatric care manager for advice.
The Research and Development team at My Health Care Manager has rolled the latest release of our SCANS(TM) application into full production.
SCANS is a one-of-a-kind decision support and knowledge management system specifically designed for geriatric care management. The system provides families help with aging parents through comprehensive best practice information in 40 geriatric care categories. This information is made available to Health Care Managers and other advisors working as licensees or directly for My Health Care Manager. This information is support with an extensive list of practical, hands-on tools to help seniors living independently or in a senior health care setting.
Version 1.4 introduces a major productivity advance - Point and Click Care Planning. This feature improves productivity and saves money for clients. At the same time it also improves quality and consistency.
More new features include:
- Care Plan report delivered in consumer language
- 136 new tools in SCANS
- Medical Support Information database powered by Healthwise
- Automatic logo branding of SCANS tools for all affiliate and partner
- Full integration with Navigator
Eric Tinsley
Alan Stanford 
Jean Bandos
Karen Kelsey
Natalie Crohn
George Slater
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