A colleague handed me a flyer today from a local cardiac physician group for cool little wallet sized CD they provide their patients with key medical information on it. 

The idea is that you carry this card in your wallet and in an emergency situation you can hand the card to a provider who can then view it on a computer capable of reading a data CD.  Even if you are unconscious, medical personnel can find the card style CD and view it.

The CD contains things like:

• medication lists
• current diagnosis
• current allergies
• discharge summaries
• diagnostic test results
• and even educational materials

All in all this is a good thing.  It also points out some of problems with "high tech" solutions to emergency information. 

• First, not all emergencies will allow time for medical staff to leave the patient in order to find a PC with a CD drive and review a set of unfamiliar computer documents.   
• Second, in order for this information to be easily read in an emergency situation, it is also easily read by anyone who steals or even simply has access to a person's wallet.  Because it's a CD, it's also not clear exactly what data is on the record; leaving seniors and families caring for aging parents to wonder what information is potentially disclosed.
• Additionally, the currency of the data may be questionable.  Frequent health and medication changes are common in older adults and this approach requires notification back to the provider, payment of an update fee, and the reissuing of the wallet CD.  Allowing reasonable times for such activity, it could be very difficult to keep this up to date.
• Even small scratches from "wallet wear" on the CD can render it unreadable.  Something that wouldn't be readily apparent until the CD was checked in a computer drive.  Often, I fear, at the time the information is most needed. 
• Lastly, the completeness of the data may be in question as it relies on the patient, often a senior with depression or memory loss, to report the activities of the disjoint senior health care system.

My Health Care Manager approaches this problem differently.  Our geriatric care managers collect, review, and update information across all of a client's health providers.  This Personal Health information (PHI) is then used to inform all providers engaged in the client's health.  For example, each of the client's physicians receives the medication list initially and then again for every medication update. 

For emergency situations, clients are given a Ready Reference Card which contains all the key medical information and alerts.  This PHI easily folds to the size of credit card for wallet use and multiple copies can be kept in other key areas, for example in a specially identified pocket on the client's refrigerator where emergency personnel are trained to look. 

Because the Ready Reference is a paper record it is immediately available to emergency personnel in settings where a CD reader may not be at hand such as the senior's home, as shopping center, and so on.  It is also quick and very inexpensive to reprint when updates are needed.

The point here is not that technology is bad.  On the contrary, technology enables both of these solutions.  We should put it to work in the most effective ways we can devise for seniors and their families.

Maybe it's the latest social event, health craze, or the Baby Boomers wanting a fit, active life but today's seniors are anything but sedentary!  Seniors want more than just bingo...they want activities and social events that are fun, physically active, and socially stimulating.  Whether they are aging in place or have made the move to a retirement community/assisted living/other living option, seniors are getting involved!  If you're a caregiver, think about introducing your aging parent to some of the activities listed below.


Some of the activities today's seniors are involved in include:

1.  Travel clubs - On a flight to Scotland last year, I sat next to a retired couple who joined a senior travel club a couple years before.  They told me a story of getting married after high school, working their whole lives, and raising a family.  They rarely traveled during this time, so they decided it was time to see the world.  They had been to every US state except for 2 (but those were on the "to do" list) and had been to numerous countries in their travel club.  This is a goal I hope to achieve myself one day!

2.  Political events, campaign assistance

3.  Wellness and fitness clubs/activities

4.  Charity or volunteer work

5.  Dance classes (ballroom dancing, salsa, etc)

6.  Nintendo Wii game parties

7.  Creative arts classes (theater, artwork, pottery, glass blowing, etc)

8.  Trying new foods and restaurants

9.  Attending local theater events, the symphony, or historical museums

10.  Monte Carlo Night (casino games)

11.  Shopping excursions to nearby cities

12.  Book clubs

13.  Investment clubs

14.  Indulging in new hobbies (photography, coin collecting, golf, etc)

15.  Learning how to play a musical instrument

16.  Cooking classes

17.  Becoming a senior companion

18.  Winery tours

19.  Computer classes

20.  Happy hour events

Continuing to explore the technology to help with aging parents, in home monitoring is becoming more and more visible. 

One of my blog readers recently called my attention to this article from the University of Missouri titled "Health-Monitoring Technology Helps Seniors Live at Home Longer, MU Researchers Find".  Click here to read the article.  Articles like this one are appearing more and more, and research in these areas is on the rise.

That's not a surprising trend given the demographic shifts and the desire for seniors to continue living independently.  The article, in fact, leads off with this premise.

Using sensors, video, and other tools researchers at MU have built an early warning system to help identify problems and alert health care providers before problems escalate to full blown emergencies.  The study examined data collect of two years at an affliated retirement community to identify patterns leading up to adverse events.  Real time data can then be monitored - watching for these patterns.

Systems like this can help to provide peace of mind to families who are caring for aging parents and provide meaningful data to senior health care providers.

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

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

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

Just to begin to get a feel for the amount of products hitting the consumer market, consider this site a friend emailed me http://www.epill.com/.  That's right, an entire site dedicated to pill reminders.  They have reminder watches, reminder pill trays, pager systems, locking dispensers, and you guessed it an automated robotic pill reminding dog (see it here http://www.epill.com/pillpets.html).  

All of these devices probably have their place, but it's no wonder families and caregivers end up confused.  Pill reminders can sometimes even be more of a hindrance than help.  I touched on some of these problems in a earlier blog titled, Can Technology Help with Memory Loss.  The advice of a geriatric care manager can be a big help in determining what might work best.  In fact, if the care manager has a consistent relationship with the family, their advice is likely to be more tailored to the specific circumstances than recommendations of senior health care providers like doctors, hospitals, or retirement community staff.

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

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

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

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

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

How would you want to spend your golden years?  I have lots of different ideas...I'd like to travel more, spend time with family and friends, be healthy, enjoy life!  I love visiting and learning from my grandmothers (and my grandfather).  It's interesting to ask them questions about their life as children, young adults, how they met my grandfathers, jobs they worked, etc.  My one grandmother has a great sense of humor and is always on the go.  She works one day a week, spends lots of times with friends and family, travels, and likes to learn new things.  My other grandmother is just a "sweet old lady" that grew up on farm, who has a green thumb, loves animals, and is a bird watcher.  Both are relatively healthy and live independently.  Some people fear getting older, but today's world offers many services and perks to seniors, such as, travel deals, wellness programs, lavish retirement communities, etc.  The seniors that have a zest for life in their golden years are an inspiration and should be applauded!

My colleague Jennifer brought another in home communication device/service to my attention recently.  It's called Celery. 

You may remember a previous blog (click here) on the Presto Printer; a great way to communicate with parents living independently at home of in a retirement community. 
Celery is a service which combines FAX and Email capability.  It allows a caregiver or remote family member to send an email to a FAX machine in their loved one's home.  This can include a text message and even pictures.  The FAX is hooked up to a standard phone line so you don't have to obtain Internet service or have a computer.  The exciting part is that the receiver can hand write a reply and FAX it back to a special Email service that will match it to a preset list of authorized email accounts and send the message on as an image.  This makes the communication two-way.  For more on Celery see their web site http://www.mycelery.com/. 

This could be used to reduce social isolation, provide reminders about heath care, improve medication management, and just keep in touch with distant and busy family members.

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.

As nature is hitting us with all forces across the nation, hurricanes, tornados, fires & floods; a key resource for eldercare is a emergency supply kit. 

Each older adult’s needs and abilities are unique, but every older adult (and caregiver) can take important steps to prepare for all kinds of emergencies and put plans in place, even when residing in a retirement community.  Start by evaluating personal needs when making emergency plan. A commitment to planning today will help prepare the older adult for any emergency situation. Consider how a disaster might affect your individual needs.

• Plan to make it on your own, at least for a period of time. It's possible that you will not have access to a medical facility or even a drugstore.
• Identify what kind of resources you use on a daily basis and what you might do if they are limited or not available.
• Get an emergency supply kit.  (http://www.ready.gov/america/getakit/index.html)
• If you must evacuate, take your pets with you, if possible. However, if you are going to a public shelter, it is important to understand that animals may not be allowed inside.
• Plan in advance for shelter alternatives that will work for both you and your pets; consider loved ones or friends outside of your immediate area who would be willing to host you and your pets in an emergency.

When preparing for a possible emergency situation, it's best to think first about the basics of survival: fresh water, food, clean air and warmth.

Recommended Items to Include in a Basic Emergency Supply Kit:

• Water, one gallon of water per person per day for at least three days, for drinking and sanitation
• Food, at least a three-day supply of non-perishable food
• Battery-powered or hand crank radio and a NOAA Weather Radio with tone alert and extra batteries for both
• Flashlight and extra batteries
• First aid kit
• Whistle to signal for help
• Dust mask, to help filter contaminated air and plastic sheeting and duct tape to shelter-in-place
• Moist towelettes, garbage bags and plastic ties for personal sanitation
• Wrench or pliers to turn off utilities
• Can opener for food (if kit contains canned food)
• Local maps

Medications and Medical Supplies
If you take medicine or use a medical treatment on a daily basis, be sure you have what you need to make it on your own for at least a week, maybe longer.

• Make a list of prescription medicines including dosage, treatment and allergy information.
• Talk to your pharmacist or doctor about what else you need to prepare.
• If you undergo routine treatments administered by a clinic or hospital or if you receive regular services such as home health care, treatment or transportation, talk to your service provider about their emergency plans. Work with them to identify back-up service providers and incorporate them into your personal support network.
• Consider other personal needs such as eyeglasses, hearing aids and hearing aid batteries, wheelchair batteries, and oxygen.
• Include copies of important documents in your emergency supply kits such as family records, medical records, wills, deeds, social security number, charge and bank accounts information and tax records.

For more information on special needs, see Disaster Preparedness For People With Disabilities  from FEMA, and Disaster Preparedness for Seniors by Seniors from the Red Cross.

Keep in mind a disaster can disrupt mail service for days or even weeks. Consider direct deposit by calling the Go Direct toll-free helpline at (800) 333-1795 or sign up at www.GoDirect.gov. Sponsored by U.S. Department of the Treasury and the Federal Reserve Banks, this option will ensure you get your social security or SSI payment on time each month.

Preparing makes sense. Get ready now.

We thought we were organized.  We thought the file in my mother’s desk labeled “HLK will” actually contained her will.  We thought all we needed to do was to have the will reviewed by a local attorney, once my mother moved to a senior residence in Indiana from Pennsylvania. 

That was until we looked in the file and realized that “the will” was not there.  We looked in the adjacent files, we looked in the safe deposit box, we looked everywhere.  NO WILL.  To this day, my sister and I have no idea what happened to it.  We knew it was reviewed and updated by a Pennsylvania attorney a decade ago.  We always assumed it was in the file.

The problem was we assumed.  We assumed the will had been efficiently filed, labeled and housed in a place that made sense.  What we discovered was exactly the opposite – nothing made sense about its disappearance.  To this day, we don’t know where it is.  There is a chance my Mother “hid” it in a safe place and forgot to tell us.  For all we know it is taped to the bottom of the dining room hutch that we sold at auction.  Or perhaps it was inadvertently thrown away with the junk mail 

Thankfully, I remembered the name of the law firm in Philadelphia that my parents had used many, many years ago.  However, the paper chase did not end there.   The suburban branch office my parents used had closed.  So, I contacted the downtown office and learned that they had transferred my mother’s file to a different law firm at my mother’s request about five years ago.  Several phone calls and an hour later, I located the will with the help of a sympathetic paralegal.  Copies were quickly dispatched via e-mail to the Indiana attorney for review.

But what would have happened if I hadn’t known the name of my parents’ first law firm?    What would have happened if we couldn’t find the will?  The sad fact is that my Mother’s wishes would have been unfulfilled and a probate court would have made the decisions. 

My advice to everyone is to look now for important documents and review them to make sure they are up to date.  Then file them appropriately and make sure family members know where they can be found in case of an emergency.  

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

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

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.

Again facing an important issue with no trusted advisor, we began meeting with the sales representative for the nursing home where she had several friends.  (Little did we know how many options exist even once a “retirement home” direction is chosen.  Now it’s clear that there are major differences in the economics, quality, safety, security, staffing, meals, ancillary services, transportation options, continuing care availability and long term options among the retirement community  and alternatives.)  So our meetings quickly focused on Mother’s health and economic situation that could meet their entrance requirements.

We didn’t even look at many of her alternatives to living alone.  We now know the options include an independent living community (IL), a continuing care retirement community (CCRC), a “senior-friendly” apartment or condominium, a neighborhood shared home, and several others.
And within the options are many varieties including for-profit or not-for-profit, public or private, local or nationwide chains, and the “scorecards” they all receive from their respective state boards of health.

In the economics criteria alone, we now understand there are monthly rental, deposit, and equity plans with varying percentages of returns if occupancy is ever terminated.  We were fortunate to pick “the gold standard” in our community, and they had a one bedroom unit available within the next 90 days after some desired renovations were completed.

Now we had to figure out which plan was best for our situation.  The variables were the percent, if any, of the initial deposit returned if the person moves out or dies, the costs and credits if the person moves from Independent Living to Assisted Living or Full Health Care, and other important items.

We included Mother in the discussions so the ultimate decision was hers, and with her supporting the move we signed the papers and started planning the downsizing and move for the next 3 months.

Our experience with the decision to move into a Continuing Care Retirement Community was very good, but we hear and are involved with many situations that don’t work out as well for caregivers and their aging parents.  Really working on our family communications throughout the decision process and including her in all decisions turned out to be one of the most valuable lessons learned.

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.