Case Study: Critical Elder Care

Senior citizens fallingMeet Martin he has post-polio syndrome; he is 89. He cared for his wife of more than fifty years.

Meet Martin’s wife: Alice, who had Parkinson’s and its’ accompanying dementia and several common diseases including high blood pressure, atrial fibrillation (irregular heart rate/rhythm & taking blood-thinning medication) over active bladder (incontinence), glaucoma, heart disease and poor circulation.

They needed help

These two shared a two-story house in my neighborhood with adult children living about an hour away and across the country in California.  Fiercely independent, I first met them when Martin was struggling to take out the rubbish. He wore braces to support his weakened legs and always appeared exhausted, but pleasant. As we got to know one another better, I suggested that my children and I take out the weekly rubbish, shovel their driveway, and get groceries when needed: neighborly support.  This worked for a while, but I knew so much more was going on in their house.  I had made offers to assist them; a discounted neighborly rate even. They were too proud and stubborn to accept help, certain they could manage as they always had.

Then it happened.  The first fall.

His first panicked call to me to take them to the hospital so Alice could be evaluated. She had fallen and hit her head, confused, with a large laceration, and blood everywhere. Their once immaculate house piled with day-to-day items left untended with his care-giving responsibilities.  Martin had been able to move her to a kitchen chair: he refused to call an ambulance, “costs too much!” Thus began a slide down the road of no return. Frequent falling, unplanned ER visits and hospital stays, unplanned doctor visits. Their adult children were, for some reason, not dialed in to the increasing health and care needs exhibited by their parents. Stopping by every 2-3 weeks for a couple of hours, buying groceries, but not seeing the bigger picture that these two octogenarians we no longer living safe in their home without structured support.

Simple Solutions – Not Simple To Implement

  • Home safety evaluation
  • Regularly scheduled home health aide visits
  • Skilled nursing and physical therapy
  • Utilizing a medication box for medication safety
  • Home delivered meals
  • Moving their bedroom down to the dining room to avoid using steps as frequently
  • Hospice care

So much of the pain, confusion and falls could have been avoided, if the children took the time to really look around their parents home and saw their parents declining health. This is not an easy realization but one that is critical for increased happiness and longevity.

Slipping Through The Cracks: How Seniors Need Help

senior man health issuesMeet Arnie

Dumbfounded by his fierce independence… His story includes the social isolation is not uncommon in today’s families who are geographically separated. His adult children lived out of town.  ‘Arnie’ was 83 years old and lived in an apartment adjacent to a major divided highway.  I climbed six cement stairs and then another step to get to the doorway of his apartment. This was not easily accessible for an 83 year old senior person with impaired vision.

Home Safety

Arnie looked right past me when we met because of his macular degeneration; he also had high blood pressure and several other illnesses requiring multiple prescription medications. These diagnoses dictated a complex medication schedule. What struck me was that he had such complete and utter denial that his living situation was significantly unsafe. At times, Arnie was unable to use either of his phones safely because of his vision deficit, he confessed to having eaten rotten food because he could not see it, who knows how frequently he took his prescription medications incorrectly.

So Many Falls

Don’t forget the falls, ’every once in a while’ in his apartment that were, ‘no big deal.’  The most significant issue was that he actually walked in the divided highway –in the snow– because there was not a sidewalk that was cleared.  Arnie needed groceries and cat food. Not to mention he navigates those cement snow & ice covered cement steps to leave his apartment.  At one point in the recent past he actually lost his balance and fell in the street requiring treatment from emergency response personnel; he sustained lacerations and a knee injury and was released to his apartment.

ALL BY HIMSELF.

No way to get pain medicine or home health care orders to observe his wounds and ensure healing.

Who addressed why he was walking in the street in the winter… when he could not see?

As my interview progressed he casually mentioned his children lived out of state. “They call me all the time though.”

How a Senior Care Director Can Help

  • I engaged a family member (with his permission)
  • I requated a skilled home care Nurse/Physical Therapist/Occupational Therapist regarding falling, medication teaching, and vision impairment
  • I contacted the local Area Agency on aging for community resources
  • I contacted a private duty home care agency for assistance with home upkeep/shopping/cooking
  • I discussed long-term planning and a move to a senior living community

FREE Resource

Arnie is just one example of senior family members who get lost in aging. Does your senior need help? Click here to get my free report on the 12 Warning Signs Your Elder Needs Assistance.

What Is Legal Advocacy?

elder care lawPlanning ahead for all stages of life include understanding legal terminology. I will break down some of the more important terms.

Why Is Estate Planning Important?

  • Provides for person health care and affairs/assets in case of incapacitation
  • Leaves a legacy for property and memories for loved ones and special causes
  • Manages and reduces taxes (state and federal) for maximal asset transfer to heirs and benficiaries

ElderCompass highly recommends meeting with an attorney versed in elder law to plan a will and trust. Establishing wishes regarding end of life, finances, and property distribution may provide peace of mind, and family-advocates clear direction.

As you read further, these terms are all used when planning your legal documents. Become familiar with these basic terms to make your experience with legal professionals more efficient and less stressful.

Advance Directive:

Statement made by an individual, usually in a written document, concerning medical treatments to be provided and decision –maker to be appointed of the patient becomes incapacitated or terminally-ill.

Durable Power of Attorney for Healthcare (Proxy Statement):

Legal document prepared by an individual authorizing a family member or friend to make health care decisions on their behalf in case of incompetence.

Do Not Resuscitate Order (DNR):

Physician order, inserted into an individual’s patient records and wishes documentation that Cardiopulmonary Resuscitation (CPR) shall not be used as a lifesaving procedure.

Cardiopulmonary Resuscitation (CPR):

Emergency treatment that compresses the heart and forces air into the recipient’s lungs. This process is used when the heart  or breathing stops.

Competence:

In the context of healthcare, ability of a patient or individual to make independent decisions about health or medical treatments.

Conservator (Guardian of Assets):

Person appointed by the court to manage financial or legal affairs of an incapacitated individual.

Extraordinary Medical Measures:

Medical treatment that would not provide a distinct benefit, would serve  a patient’s best interest, or would be considered unreasonable in improving or saving a person’s life.

Guardian:

Court-appointed fiduciary responsible for a minor or incompetent person.

Informed Consent:

Legal condition whereby a person can be said to have agreed or given consent to allow something to happen based on full appreciation and understanding of the facts and implication of the action.

Marital Trust:

Trust that mandates the income of the trust be paid to the surviving spouse.

Power of Attorney:

Written document executed by one person who authorizes another person to act on his or her behalf.

Probate:

Legal process of administering and distributing an estate after death.

Trust:

Fiduciary arrangement set up by a grantor whereby property is held and managed for a named beneficiary by a third party, known as a trustee.

Trustee:

Person or organization holds legal title to property held in a trust. The Trustee holds and manages the property for the benefit of the trust beneficiary or beneficiaries.

Will:

Legal document that specifies how a person wishes to distribute probate property and provides other instructions in the event of death.

Conclusion:

Planning ahead is a favor to both seniors themselves and family/advocates.  End-of-life documentation can provide relief to those left behind. Keep legal documents in a safe place and ensure appropriate family members and advocates have copies and key contact information.

 

 

How To Handle Multiple Medication Safety & Your Elder

Medications-pills capsules and bottlesFor many older persons, multiple medication use is the norm.

What is Polypharmacy?

Polypharmacy is the use of multiple medications at one time, and is a very common problem associated with medication use among older adults and those with disabilities.

More Medication=More Problems

Research has even shown that the more medications a person takes, the greater the risk of experiencing a medication-related problem. This is not a new theme gentle readers.

To best manage chronic diseases often requires the use of multiple medications. Diseases like Heart Failure, Parkinson’s, High Blood Pressure, Diabetes, Arthritis, Pulmonary (lung), and Dementia can require more than one medication for the best results. Both the older adult and caregiver must consider the appropriateness, effectiveness, and safety of all prescription and over-the-counter medications.

Questions to ask physicians/nurses/physician assistants/ and pharmacists:

1. Is this medication most appropriate for the condition considering other diseases present?

2. Is it absolutely needed?

3. Can it be started at the lowest dose?

4. What are interactions with other drugs or over-the-counter supplements?

5. Considering the other diseases present, can this drug be taken properly?

6. What is the best way for all treating health care providers communicate about this medication list?

Avoid Medication Problems

An important part of care giving and senior advocacy is asking the right questions. Become more active in the life of your Elder to help avoid medication related problems. More importantly, your knowledge can contribute to their wellness and safety during this vulnerable time in a senior’s life.

5 Tips For Transitioning An Aging Loved One: Housing Options

senior citizens movingIf a move is in your Elder’s future there is much to consider. Since every Elder and their family bring their own story, it will be challenge to include each detail for consideration. Please use this blog entry and list as a beginning point for discussion and assistance. You have a journey ahead and it helps to have a place to start. This journey has components that include safety, medical, lifestyle, emotion, finances, and pragmatics. Seniors often view the move to an assisted living community as one of the biggest changes in their lifetime.

Many experience normal feelings of sadness, depression or anger. Some view the move in a more positive light and as a way to feel more secure that their care needs will be met and to unburden their advocates.  Assisted living caregivers receive special training to meet the needs of the elder population.  Families and advocates can work with staff and with seniors to help them adjust. There is often a busy social structure in place so residents can engage as much or as little as they desire. Activities address mental, physical, and social activities that are appropriate and matched to ability. Peer interaction and reminiscence can be very powerful: many seniors are surprised by how enjoyable and rewarding community living can be.

FINDING THE RIGHT NEIGHBORHOOD:

Please note I did not use the term senior living facility- would you want to move to a facility? Ask about state licensure- do not take another step if the facility is not licensed. There are both public and private resources that can assist families with finding the right fit for senior living. Individual resources can be found in through your state’s Department of Human Services website. Look for  http://www.type in your state.gov/dhs.  Private geriatric and medical case managers, usually nurses (like ElderCompass) and social workers, can also be hired to assist with a more personalized approach.  Other services assist free of charge and receive their payment from the senior neighborhood where the client is placed in the form of a referral fee. Please see this link for an excellent and comprehensive check list of questions.

1. NEEDS ASSESSMENT:

Prior to being accepted in an assisted living neighborhood, an assessment is performed. This is done to clarify that the resident’s needs for care and socialization can be safely met.  Usually a nurse will review medical history, perform a physical assessment and interview. Activities of daily living, mobility, eating/feeding, medication management, bathing, social needs, and memory care are evaluated to assure proper placement.

2. COST:

Most families are surprised at the high cost of living in assisted living neighborhoods. In the US, expect $1,000-$8,000/month charges. Fees vary based on the amount of support and care that is required.  Facilities include rent/lease/ or purchase, then base their additional fees on personal care, medication administration, medical visits, meal plans, laundry, transportation, or security deposit. Each facility has their own fee schedule equation, be sure to take this into account when comparing.  Also consider a roommate to decrease monthly cost; this may seem strange, but this arrangement can offer instant companionship and camaraderie, as well as another safety net. As an extra set of eyes is watching out for your aging loved one.

3. PAYMENT RESOURCES:

Assisted living communities are most-often private pay facilities; Medicare and private health insurances [Long term Care Insurance is a separate entity] do not cover the costs. There are ways to reduce out of pocket expenses, and even some financial assistance programs. Inquire about these with regards to financial assistance, and saving money: Veterans Aide and Assistance**, Shared Apartments, Family Involvement (like rides to medical appointments and medication administration), Long Term Insurance, if the senior has an existing policy (You can request an assessment if your senior now requires assisted  living), Low Income Apartment availability, Reverse Mortgages (ElderCompass staff included this topic to ensure  comprehensiveness, but we vary rarely find this the right solution and warn against elder fraud and whether this actually works in favor of families), and potentially Medicaid*.

*The individual state Medicaid requirements are extremely strict, but in some instances, may be instituted.

**It is advisable to obtain the initial consultation of a Veteran Accredited attorney, and or one versed in Medicaid to assess potential resources for care and housing.

4. MOVING-OUT, THEN IN:

Downsizing for a move to assisted living is a process- please see our earlier blog-MMMMM- for pointers and insights.  Keep a file of pertinent housing and financial documents and have it with you at all times during this period of advocacy. Have your senior pick several of their favorite pieces of furniture, pictures, and art that will best fit in their new space; these items can make them feel more at home more quickly, and it gives them things to talk about with their new neighbors. Draw a scaled picture of the room to ensure desired furniture can fit safely. Make arrangements for the sale or distribution of older furniture and try to avoid expensive storage facility fees. There are Certified Move Managers that assist with moving and more – stay tuned for a blog entry detailing such service.

In the meantime, see this site.  Change mailing address and send postcards to friends and family. If there is an empty house, be sure to arrange for lawn care and snow removal, clean out the house as time allows and throw out garbage a little at a time so the home looks lived-in. Turn off water in cold weather and drop heat to 55 degrees, notify neighbors and friends of vacant home, place lights with timers, and arrange for intermittent driveway traffic and mail checks.

5. TRANSITION NEEDS:

Many senior communities offer respite packages and weekend trials before people move-in. Another way to test the water is to eat several meals at the community. Once moved in, ensure your senior knows who their main contact is for questions and concerns. Be sure you too have a contact that is available 24/7. Establish a visiting schedule with friends, family and religious organization members so seniors feel secure and still have familiarity in their life. Try to participate with activities with other residents to facilitate friendships  Know your senior’s laundry and bathing schedule and plan your visits at different times to ensure new processes are going smoothly.

CONCLUSION:

As with any major transition there will be some stress. Most importantly, be present and make sure your senior knows you have helped to make the best decision for all parties involved to ensure safety and contentment.