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 safely 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.

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.


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  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.


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.


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.


Downsizing for a move to assisted living is a process- please see our earlier blog – 10 Ways…- 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.


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.


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.

7 Easy Steps To Help Your Elder

senior financial documentsAs an elder advocate and or caregiver, there are simple things you can do to make sure your elder receives timely and quality care. Being an advocate includes planning ahead and being prepared to make decisions on behalf of your elder. Consider obtaining legal advocacy documents called Power of Attorney for Health and a separate one for Finance, if you do not yet have them.

Visit us again next week as we discuss legal advocacy in more detail and important conversations to have with your elder that are crucial to maintaining their wishes.

7 Easy Steps To Help Your Elder:

1. Gather important documents.  

Prepare your own “face sheet” that includes: Complete full name, (and maiden name if applicable), date of birth, Social Security Number, home address, types of insurance [Medicare, Medicare Supplements, Long term Care, Life Insurance etc.] and all contract numbers. To protect identity, keep this information in a secure place.

2. Record.

All current and recent treating physician contact information, as well as hospitals and/or rehabilitation centers where care may have been received.

3. Make copies.

Driver’s license or state identification card, Medicare card, and any other supplemental insurance cards. Again, keep this information in a secure place.

4. Obtain and sign HIPPA (Health Information Privacy Protection Act) forms.

Sign these with your elder, from medical offices so you can communicate about health-related information.

5.  Gather contact and account information.

Banks, investment firms, and credit unions- remember to secure this information to maintain security.

6. Contact.

Insurance agents and inform them you are advocating for your elder.

7. Complete a medication list.

This should include all names, time, dose, indication of medication.

Being prepared can make elder care that much easier,  in times of crisis especially.

Join us next week as we continue the advocacy conversation. Plan ahead so any health situation can be managed and you can be available to provide support efficiently.

National Glaucoma Awareness Month

January is National Glaucoma Awareness Month.

Glaucoma âge elderlyAccording to the Glaucoma Research Foundation, almost 3 million people in the US over the age of 40 have glaucoma. Half of those affected do not even know they have it. The National Eye Institute projects a 58% increase by 2030 to total of more than  4 million people affected. This disease is sneaky, since there are not symptoms. Once vision is lost, it is permanent. It has been called “the sneak thief of sight.” It’s hard to believe that one can lose as much as 40% of their vision without noticing.

Our goal for this post is to raise awareness and educate readers about this sight-stealing disease.

What is Glaucoma?

Glaucoma refers to a group of eye conditions that lead to damage to the optic nerve: often without symptoms. The optic nerve is responsible for carrying images from the eye to the brain. In most cases, damage to the optic nerve is due to increased pressure in the eye, also known as intraocular pressure (IOP). Most common forms primarily affect middle-agers and seniors, but glaucoma can be present in all ages.

Is there a cure for Glaucoma?

Presently there is no cure for glaucoma. EARLY DETECTION IS KEY! Medication and surgery can slow or prevent further vision loss. Treatment is determined by the type of glaucoma and other health factors.

There are two main types of glaucoma:

  • Primary Open-Angle Glaucoma(POAG) and Angle-Closure Glaucoma(IOP). Both of these types are distinguished by an increased intraocular (inner eye) pressure. Normal Tension Glaucoma is marked by optic nerve damage even with normal inner eye pressure.
  • Secondary Glaucoma is optic nerve damage caused by another disease or factors that contribute to increased eye pressure, resulting in optic nerve damage and loss of vision. There are other types of glaucoma as well.

How to prevent Glaucoma?

To best protect sight from glaucoma, get regular and comprehensive eye examinations. Again, early detection is most important. Those at highest risk are African-Americans, Asians, and Hispanics. Siblings of those affected with glaucoma are also at significant risk for developing it. Others at rsik are people over age 60, family members of those diagnosed, diabetics, and people who are severely near-sighted. Regular eye exams are especially important for those at risk and may prevent unnecessary loss of vision.

If eye drops have been ordered for treatment, these simple steps can help those who need them. Eye drops are most often prescribed for treating glaucoma; using them properly is really important. Use just as instructed by your eye care professional. Proper use of your glaucoma medication can improve the medicine’s effectiveness and reduce risk of side effects.

How to use Glaucoma Eye Drops:

  • Wash your hands.
  • Hold the bottle upside down.
  • Tilt your head back.
  • Hold the bottle in one hand and place it as close as possible to the eye.
  • With the other hand, pull down your lower eyelid. This forms a pocket.
  • Place the prescribed number of drops into the lower eyelid pocket. If you are using more than one eye drop, be sure to wait at least 5 minutes before applying the second eye drop.
  • Close your eye OR press the lower lid lightly with your finger for at least 1 minute. Either of these steps keeps the drops in the eye and helps prevent the drops from draining into the tear duct, which can increase your risk of side effects.

More information on Glaucoma:

There are many resources available for learning more about glaucoma visit:

Do you have or someone you love been diagnosed with Glaucoma? How have you or they been treated?