In my blog on Nov 9th, I discussed the end-stage dementia issues and raised the question ‘Is dementia a terminal illness?’  When faced with terminal illness, seniors and their caregivers often choose palliative care.  Today, I’ll discuss that further.

What is a terminal condition?

In most states, a terminal condition is a status that is incurable or irreversible, and in which death will occur within a short time.  There is not a precise, universally accepted definition of “a short time,” but in general it is considered to be less than one year.  When looking at the hospice benefit, it will define “short term” as six months or less.

What is palliative care?

Palliative care is a comprehensive approach to treating serious illness that focuses on the physical, psychological, spiritual, and existential needs of the patient.  Its goal is to achieve the best quality of life available to the patient by relieving suffering, by controlling pain and symptoms, and by enabling the patient to achieve maximum functional capacity.  Respect for the patient’s culture, beliefs, and values are essential components.  Palliative care is sometimes called comfort care or hospice type care.

For more information: go to Caring Connections which is a program of the National Hospice and Palliative Care Organization (NHPCO), is a national consumer and community engagement initiative to improve care at the end of life, supported by a grant from The Robert Wood Johnson Foundation. Caregivers and seniors can find them online at www.caringinfo.org.

Caregivers and seniors can also visit the National Hospice and Palliative Care Organization (NHPCO) home page at http://www.nhpco.org/templates/1/homepage.cfm.
 

There has been a continuing increase in the number of new products surfacing to help with the issues of health management.  Everyone's getting into the act... even the iPhone!

MedScape is a new application for the iPhone that allows you to look-up information about medications you or your aging parent are taking.  You can review lots of information helpful in medication management - dosage, drug interactions, adverse effects, costs, and so on.  The application is currently free and can be downloaded using iTunes or directly from the App Store.

Similar information is available on the Internet from lots of resources.  WebMD is a well known example.  Most to the major pharmacy sites like CVS or Walgreens also have drug information available.

I’m pleased to welcome Jane Niederberger as My Health Care Manager’s new President.  With over 25 years of experience in the health care industry, Jane is a great addition to our team.  Most recently, Jane founded Niederberger Ventures LLC and has been active in HALO, an Indiana angel investment group.  From 2004 – 2006, Jane was Vice President and General Manager of Operations for Anthem Blue Cross and Blue Shield’s Central Region, a $16 billion subsidiary of WellPoint.  Prior to leading the consolidation of operations, Jane was Anthem’s Senior Vice President and Chief Information Officer (1997-2004). 

To read the Indy Star article 'Ex-WellPoint exec to lead elder-care services startup' visit the Star's website:   www.indystar.com/apps/pbcs.dll/article?AID=2009910050305

To learn more about Jane, please visit our website: www.myhealthcaremanager.com/aboutUs_manageteam.asp.

My last post covered some general vaccination information for seniors and caregivers.  Today, I’m going to provide you with some eldercare resources for flu season.  The best advice during this flu season is to talk to your health care provider about the seasonal flu vaccination and the “novel” H1N1 (Swine Flu) vaccination.

According to the Center for Disease Control (CDC), “One thing that appears to be different from seasonal influenza is that adults older than 64 years do not yet appear to be at increased risk of novel H1N1-related complications thus far.”  To keep up with the latest information, visit the CDC (http://www.cdc.gov/h1n1flu/).

Remember to take everyday flu-prevention and well-being precautions such as:

• 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
• When you are sick (or have flu symptoms), 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.  If you have additional questions, please speak with your health care provider.  Your physician can also advise you on prevention measures, such as the flu vaccination.

For seniors and caregivers: if you would like to locate a flu center by zip code, visit http://www.lungusa.org/site/pp.aspx?c=aqKGLXOAIlH&b=1015035.

We’re pleased to announce an agreement with Anthem and Wellpoint, which was covered in the August 24 – 30 issue of the Indianapolis Business Journal.  My Health Care Manager’s Eldercare benefit (which provides senior care management and caregiver support services to covered employees) will be offered in Indiana through the Anthem 360 Health program.  After the Indiana pilot, My Health Care Manager’s benefit will be rolled out by Wellpoint to all 14 states in which they operate. 

The benefit will help working caregivers balance the challenge of providing care to a loved one with work responsibilities, and also help improve the care and quality of life for the senior.  Employers assisting their employees by offering the Eldercare benefit look to reduced costs associated with working caregivers such as absenteeism, workday distractions, and time taken off to provide care.  My Health Care Manager provides an experienced nurse, a Health Care Manager, to guide the caregiver through their personal situation – and can assess a senior in the home anywhere in the U.S.

To learn more about Eldercare benefits for your business, or geriatric care management services for your family, please contact us at (800) 499-8020.

 

We all hear everyday the risks of smoking and what it does to our health.  But, what about older adults who smoke...is it beneficial to them to quit smoking now even though they may have smoked for 30-40 years?  The answer is yes!  It's never to late to quit smoking.  Part of healthy aging is keeping our lungs clean and free of all the tar that builds up from smoking.  If you quit smoking you are more likely to add years to your life, not to mention the money you will save from not smoking.  Food will taste better and you will have more energy.

Even if you are older than 65 and quit smoking, here are the benefits it will do to your health:

1.  Decrease your risk of cancer, heart attack, and lung disease
2.  Have better blood circulation
3.  Have a more sensitive sense of smell
4.  Have healthier family members, especially children and grandchildren

Smoking is often a difficult habit to break since nicotine is so addicting, however there are products available to help you quit smoking.  Talk to your doctor first to see what choices are best for you.  There are:

1.  Nicotine gum, patches, or lozenges that you can get over the counter
2.  Join a support group
3.  Ask a friend to quit with you.  This will help to motivate each other.
4.  Stay busy
5.  Begin exercising

For more information on how to quit smoking, please visit:  www.smokefree.gov

Likely you have seen some variant or another of this article "Helping the Elderly Keep Their Driving Skills" talking about helping seniors keep their mind sharp.  Whole companies have cropped up like the one mentioned in this article, Posit Science, around the idea computers and software can help. 

Certainly games like these are interesting and often fun, but their claims are largely unproven.  Comments like the brain is "the most important muscle in the body" is, at best, metaphorical.  The brain is, of course, nerve tissue not muscle tissue.  "Exercising" the brain has little impact on senior memory loss brought on by Alzheimer's or other serious forms of dementia. 

Driving is one of the big safety issues with seniors and for those people who are not facing serious cognitive decline, they may find these games fun and somewhat beneficial.  Of course, physical limitations such as immobility are not impacted.  At a minimum, I would expect some gains in driving skill just from the heightened awareness.  Likely most of us could gain from that lesson.

See more on Posit at http://www.positscience.com/. 

We all hear day in and day out how beneficial exercise is to our overall health.  But what about for older adults?  Is it beneficial for them too? The answer is ABSOLUTELY!  Exercise is one of the healthiest things you can do for yourself, young AND old.  Staying active and exercising regulary can prevent or delay many disabilties and diseases.  This is one healthy aging topic that keeps getting discussed within the health care world.  Some older adults are afraid that exercise will be too strenuous or that physical activity will harm them.  Older adults actually hurt their health by not exercising.  Before beginning any exercise program, it is important to discuss the details with your physician and especially if you begin a program and you notice any symptoms or changes that were not there before. 
So, what are some examples of exercises for older adults?

Strengthening Exercise:  Build muscles as well as increase metabolism
Balance Exercise:  Build leg muscles and prevent falls
Stretching Exercise: Gives you more freedom of movement to do the things you like to do
Endurance Exercise:  Any activity such as walking, jogging, swimming, raking, which all increase your heart rate

Taking your pet for a walk in the neighborhood or parking further from the grocery store are just a few of the examples to incorporate in your daily routine.  Increasing your physical activity for 30 days can be significant to your health. 

Happy Exercising!

Source:  National Institute on Aging

The final installment of the SCANS 1.3 rolling release is complete.  The July release includes some 22 new and revised tools and resources.  The list includes:

• Medicare Summary
• Medicare A Information
• Medicare B
• Insurance Resource
• SHIP
• Medigap
• Medicare C and Advantage Plans
• Earwax
• Visual Impairment Websites
• Hearing Impairment Websites
• Visual Impairment Devices
• Optometrist vs. Ophthalmologist
• Bladder Training
• Foley Catheter Care
• Urinary Continence Education
• Incontinence Supplies
• Catheter Education and Support
• Brain vs. Bladder
• Incontinence – Foods to Avoid
• Tips to manage Incontinence with dementia
• Continence Bladder Diary
• Modify Environment to Assist with Continence

Thanks to the SCANS research team for this successful (and popular) release which included some 74 new tools!  You can read more about these topics from a caregiver's perspective directly from one of our researchers Karen Witt Kelsey.  Click here to read more in her Caregiver Support blog.  Karen is a key member of the research team as well a caregiver for her own mother.  You'll enjoy her unique perspective on senior health care.

Last week I had the opportunity to present a paper at the Human-Computer Interaction International Conference.  This was the 13th occurrence of the conference and the event was well attended by key researchers and companies concerned about how computers interact with people. 

Jean Bandos co-authored the paper titled "Impacting the Continuum of Caregiving through Innovation in Informatics: Senior Care Navigation System (SCANS)".  Other members of the SCANS team contributed, as well.  You won't find the paper in the conference proceedings however, due to Intellectual Property concerns with the conference publisher's copyright requirements.  In spite of those restrictions the paper and the presentation were well received.

What struck me about the conference on a general level was the amount of attention being given internationally to the challenges of older adults and senior health care.  Conference attendees came from China, Japan, UK, Germany, India, Spain, and many other places - representing some 49 countries in all.  Support for seniors living independently and dealing with challenges like immobility, well-being, and cognitive decline surfaced as a major sub-theme to the conference.  World wide researchers are examining how computers can help with aging parents.  

The specifics were wide ranging from topics like augmented navigation for assistive mobility devices to ontologies for adaptive user interfaces to cope with the specific needs of the elderly. 

I was genuinely encouraged that so many top brains are looking for ways to improve eldercare services.

Lately, it has become increasingly difficult for my Mother to reach my sister and me by phone.  She gets confused about how to find our numbers and how to actually dial the phone.  We tried to solve the problem by posting our cell numbers near her phone, but over time she removed the information and we would be back to square one.

While perusing The Alzheimer’s Store catalogue (www.alzstore.com), I found a solution to our problem.  They sell a phone that has 3 pushbuttons and each pushbutton has a place for a picture.  After some programming was complete (thanks to my sister), the push buttons were aligned with our pictures and respective cell numbers!  Now, all my Mother has to do is push one of our pictures and the phone automatically dials our cell phone.  My Mother loves it and has been able to work it easily.  
 
The phone also features a button to increase the volume in the earpiece and an extra loud ringer option.  It includes a very easy to operate answering machine too – that clearly indicates when a message is present. 

The phone has helped my family stay connected and has given my Mother a measure of independence she was close to losing.  I am thankful that this product and others like it are addressing the needs of Alzheimer’s patients.

You can find the Memory Phone with a built-in Answering Machine at The Alzheimer’s Store as well as other products that can make life for caregivers and seniors a little bit easier.

Not to be out done by the Navigator development team, the SCANS team is continuing their "rolling release" of V1.3.  SCANS is the Senior Care Navigation System that provides geriatric care managers with expert advice, best practices, and practical tools to help families with the well-being or their parents.

The June edition of V1.3 includes 26 new resources, process, or tools.  The list includes items like these:

• Death in the Home – Information for Caregivers
• Tips for Alzheimer Caregivers
• Delirium vs. Dementia
• Transitioning an Individual with Dementia into a Facility
• Member Portal Instructions
• Continence Education – Constipation
• Urinary Incontinence – When to Seek Immediate Medical Attention
• Crime Prevention Education for Older Adults
• IADL (Independent Activities of Daily Living) Education
• Physical Therapy and Occupational Therapy
• My Medicare Matters
• Advance Directives for Mental Health Treatment
• Drug Review and Side Effects
• Geriatric Friendly Pharmacy
• Medicine Reconciliation:  Brown Bag Consultation
• Feeding Tube Education
• Special Diet Needs Education
• Defibrillator Education
• Diabetes Education
• Fibromyalgia Education
• Pacemaker Education
• Physician Planner Case Note
• Alternative Living Options Education
• Speech Therapy Education
• Social Participation Barriers
• Social Support Plan

These tools are available to the clients of My Health Care Manager and our affiliates.  Some of the content is also discussed in our blogs and can be accessed for free.  Check out Natalie Langley's blog titled "Healthy Aging".  Natalie is one of the principle researchers and authors of the tools in SCANS.  Her blog covers a holistic look at healthy aging and senior well-being.

A big component of healthy aging is how well we are eating.  With fast food joints on every corner and the convenience of getting fast food it may be difficult to eat healthy for some.  Whether you are on your way to a book club or going to see your grandchild's sporting event if you find you must pull into a fast food restauraunt, consider ordering a salad with low fat dressing rather than a burger and fries for example.  There are other tips that can help with planning meals.  If you are cooking meals at home, consider these tips for nutritional healthy aging:

• Eat a diet that is low in saturated fats
• Eat 5 or more servings of fruit and vegetables each day
• Reduce salt to help prevent high blood pressure or water retention
• Consume more fiber rich foods to help prevent constipation
• Limit sugar and dry food

For more information on healthy eating tips for older adults go to:

American Dietetic Association
http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/home_4479_ENU_HTML.htm

 

My Health Care Manager's care management system (Navigator) has just been updated to version 1.9.  This is the core system that geriatric care managers use to assist families caring for aging parents.  From past blogs you may know that this includes the assessment, care planning, implementation, and tracking support for seniors and their families.

Navigator 1.9 includes:

• Key changes for work flow
• Assessment and tracking improvements in the following dimensions:
  • Client Designees
  • Financial
  • Advance Directives
  • Engagement – Social Support
  • Provider Information
  • Medication History
  • Family Medical Health History
  • Functional Status
  • Assistive & DME Devices
  • Sensory Status
  • Nutritional Status
  • Anxiety
  • Environmental
• Reporting enhancements in areas like legal and Insurance, personal health record outputs, services listing, and more

This system is available to our clients and clients of our affiliates and partners.  We also provide much of this information in our Guide for Senior Well-being and Eldercare.  This is a self help guide is available at http://www.myhealthcaremanager.com/guide/product.asp.

My Mother has lived in an Assisted Living facility for almost two years.  In many ways she has adapted well and I think she is comforted by the fact that I live nearby.  However, as her Alzheimer Disease progresses, I often hear “I want to go home.”  In talking with others, I’ve learned that this is quite common... yet hearing it tears at the heart of every caregiver I know. 

Following are some tips you may find helpful when the senior in your life tells you repeatedly:    “I want to go home.”

• Remember that it is very common for a senior to repeat this request often.  Usually they mean the home from 60 or 70 years ago, not the one they left most recently.
• “Home” means different things to different people – love, security, belonging, safety.  When a senior asks to “go home,” try to determine if there is an “unmet” need (i.e. need to feel safe, need to belong) and try to fill that as best you can.
• Don’t refer to the senior’s current location as home.  Point out that they are staying there for “awhile.”  When they say “I want to go home” tell them you will talk about it and name some future date.
• Find a good reason for them to stay where they are – i.e. people are nice, good food, close to family, nice apartment, fun activities and try to get them to “buy into it.”

You have heard everywhere to see your physician regularly for your health and get annual exams, etc.  Along with your physical health, it is important to have good “social health” too.  The outcomes of being with friends or family have very positive effects on your health.  The support of having friends or family can also help get you through tough times.  Some benefits of being social may include:

• Mental and physical well being increase, along with self-confidence and reduced depression
• Improved cognitive abilities
• Reduced negative effects of stressful life events (loss of a job, death of a spouse) 
• Improved cognitive abilities
• Reduced disability and mortality risk

So, grab a friend (or 2 or 3) and go do something fun together!

I've been seeing several ads for voice recognition phones, lately .  The idea is to provide both the sound through the ear piece and a text display of what's being said.  This can be a terrific tool for older adults with hearing problems. One example can be found at the CapTel web site.

This service can have impact on senior well-being in several ways.  The example shown by most of the advertisers is reducing feelings of isolation by making it easier for grandparents to speak with grand kids and other friends and family.  It can also play a very practical role in caring for aging parents, as well.  Caregivers can communicate more frequently by adding phone conversations to face to face interaction.  The text can also help assure that advice or instructions are more accurately understood.

These phones are another tool in the emerging market to help seniors who are  living independently. 

Health professionals have been saying for years it is important to keep your brain active.  What does that really mean though?  Research has shown that as we age, mental decline may be due to altered connections of brain cells.  However, by keeping the brain active daily can help may reserve these brain connections.  So, how do you keep your brain active during the day?  Here are some tips:

• Reading
• Working crossword or sudoku puzzles 
• Take a walk
• Go a different route to work one day to challenge your brain, rather than going the same way which is routine for you
   
• Take a class that is of interest to you (exercise, art, photography, cooking, etc.)
• Play a game
• Try brain teaser games
• Exercise

These activities can be slowly adapted to your normal daily routine.  Maybe start doing one crossword puzzle in the evening after dinner or taking a stroll in the neighborhood and then start participating in other activities.  Any activity that is challenging for the brain is a good way to help stay mentally active and brain healthy.

As a caregiver, the responsibility for decisions regarding your parent’s care falls to you.  Often you wish you could discuss the options, choices and next steps with your parent, just as you discussed so many choices in the past…where to go to college, where to have your wedding reception, which neighborhood to select.  But parents with Alzheimer’s cannot help with current decisions as their ability to reason, compare and choose has been ravaged by the disease.  Sadly, dementia robs them of their ability to chart their own course.

So, what should caregivers do when faced with a variety of paths – how do you know how to choose what is best for your parent? How do you know when a parent’s living environment is no longer safe? How do you know when a parent needs more assistance? 

Here are a few suggestions:

• Pay attention to your parent – they may be confused, but they will give you clues when things aren’t going well.  They may seem more agitated, confused or disoriented.  Their routine may change and a situation that has worked well in the past, now poses problems.  For example, they may no longer want to eat dinner because they either can’t remember where the Assisted Living Dining Room is located, or they are afraid to leave their apartment.  
• Check in with their caregivers – have other family members, a companion, assisted living staff or adult day care workers noticed a change in your parent?  Are they concerned? 
• Take your parent in for a check-up – have the Doctor evaluate your parent and review their medications and mental and physical health. 
• Review your parent’s ability to complete Activities of Daily Living – things like bathing, dressing, continence, mobility, feeding.  Has there been a change in their ability to do these things?
• Engage a Geriatric Care Manager – have them conduct an independent assessment to provide an unbiased view of the situation.

Once you have gathered the above information, spend time thinking and talking to others you trust about the findings.  Choose the next step based on what you think is best for your parent at this moment in time.   For instance, if you determine that they need more assistance, think about the pros and cons of providing additional assistance in their current environment vs. moving them to a new environment such as a Memory Care Unit.   There is no “right” decision.  Take comfort in the fact that you have been both thorough and thoughtful when you made the decision.  Always remember that your parent is better off when you address concerns as they arise vs. postponing decisions until a crisis arises.