Category Archives: Senior Care

Senior Care

Understanding Home Health Care Part II

In Part One of Understanding Home Health Care, we explained the most common differences between home health and home care. In this second part of the series, we will provide brief summaries of the trained professionals that you may encounter when working with a home health care agency.

It is important to remember that unlike home care agencies, home health agencies provide services and treatment that are prescribed by a doctor and are usually part of a transition from a hospital stay back into a home environment. Therefore, home health agency fees are usually covered by medical insurance, Medicare or Medicaid.

The type of care provided by health care professional will depend on the needs of each individual and may occur in-home through a home health agency or may occur on an outpatient basis.

HOME HEALTH AIDES/ASSISTANCE ADLS

Individuals trained to assist with personal care needs and activities of daily living (ADL). ADL are the essential self-care tasks, such as bathing, ability feed oneself, dressing, toileting, transferring from a bed to a chair, etc. Additional tasks and responsibilities may be assigned to aides depending upon the agreement between the home health aid agency and the family. Home health aide’s assistance may range from a few hours per week up to 24-hour care, either on a temporary or long-term basis.

SKILLED NURSING

Skilled nursing refers to the services performed by a licensed Registered Nurse (RN) or Licensed Practical Nurse (LPN) and these nurses are registered with the State Board of Nursing in their respective state. Skilled Nurses provide medical care as prescribed by physician and may also provide patient assessments, performance of prescribed medical treatments and administration of prescribed medications. Additional services may also include education for the patient and the caregiver to the disease process as well as treatment options, health measures and medication management.

PHYSICAL THERAPY (PT)

Physical therapists assess and treat large motor function skills when prescribed by a doctor. Depending upon the needs and mobility of the patient, PT may be conducted on an outpatient or in-home basis. Physical therapists will create a treatment plan with goals and utilize rehabilitative techniques, which may include exercise, gait training, prosthetics and heat to restore the highest functional level of strength, range of motion and mobility based on the individual abilities of the client.

OCCUPATIONAL THERAPY (OT)

Often prescribed along with physical therapy (PT), occupational therapists (OT) assess and treat small motor function. Occupational therapists will design a treatment plan designed to increase the client’s ability to carry out their regular day-to-day activities, such as feeding, dressing, grooming and performing household tasks. Using rehabilitative techniques such as exercise, splinting and assistive devices, the OT guides the client through specialized regimes, exercises and activities to increase function, sensory and muscle strength.

SPEECH THERAPY (ST)

If an individual has difficulty with speaking or swallowing, a speech therapist will be called in to assess and treats speech and swallowing disorders that may have been caused by a stroke, head injury, laryngectomy, voice disorders or cognitive deficits. Individually designed treatment programs will be created by the speech therapist to maximize communicative effectiveness for the client.

These are the most common types of agencies to provide in-home or outpatient care. In case of injury, such as a broken hip or knee replacement, in-home care may only be needed for several weeks. Navigating the system of elder care services and agencies can be confusing for anyone. Sometimes it can be overwhelming. Finding the appropriate level of care and caregivers you can trust can take time but it is time well spent.

If the time has come when your aging loved one is no longer able to live independently, please contact the knowledgeable staff at ElderLink. We will help you find elder care services or an assisted living facility within California that is customized for the requirements of your family.

alzheimer's, Senior Care

Understanding Home Health Care

One of the most confusing elements of securing care for seniors is deciphering the difference between home health versus home care. Although it might seem like a minor difference, the distinction between the two terms is more than splitting nouns to professionals in the industry – especially for insurance providers.

One of the most important differences is that care provided by home health agencies are usually covered by medical insurance because these services are prescribed by a doctor and are often part of a transition from a hospital stay back into a home. Home care services are not usually covered by medical insurance but may be covered by long term insurance. The main reason why medical insurance covers one and not the other? Home health services require a trained professional, such as a physical therapist, occupational therapist, registered nurse or certified nurse assistant, while home care services generally not to require professional training or education.

The type of care and the insurance coverage that will be provided depend on each individual but these are some of the key terms you should know.

HOME CARE/ASSISTED LIVING/COMPANION OR RESPITE CARE
This type of care is often provided by friends or family members and includes assistance with daily living tasks. When looking for an extra pair of hands outside your immediate circle, Home Care Agencies can offer assistance. The types of services provided may include light housekeeping, shopping, cooking, laundry, medication reminders, companionship and even transportation to doctor’s appointments, shopping or recreational activities. These agencies usually charge by the hour and may require a minimum number of hours for each shift. Beyond any minimum shift requirements, these types of agencies may offer services for up to 24 hours, allowing the primary caregiver (often a spouse) the opportunity to get away for a few hours or even for several days. Benefits of using a home care agency include care coverage in the case the regular agency care provider is unavailable, employment taxes and fees are handled by the agency and agency caregivers often have some related training. Depending upon your policy, these services may be covered by long term insurance.

HOME HEALTH (AGENCY)
Generally licensed by each state, home health agencies primarily provide skilled care, although some may also provide companion and home care services. Common services provided by home health include nursing care, physical therapy, occupational therapy, speech therapy and respiratory therapy. Some agencies may also provide medical equipment and supplies as well as home health aide services, such as assistance with bathing, dressing and eating. In addition to providing services to patients in private homes, home health agencies may also be able to provide services to patients in assisted living facilities and adult family care homes. Scheduling the services of the medical professionals, including the nurses and therapists, is not as definite as with home care staff as home health professionals are usually going from one patient home to another. The services for skilled home heath care are usually paid in part or entirely by an array of health insurance and long term care insurance, depending upon the policy. Services may also be paid out of pocket or on a fee-for-service basis.

MEDICARE HOME HEALTH AGENCY
These agencies provide skilled care in a person’s home and paid for by Medicare if the following conditions are met: the patient must be under the care of a doctor and you must be receiving services under a care plan established and reviewed on a regular basis by a doctor. As part of this process, a doctor must certify that the patient needs one of more of the following: intermittent skilled nursing care, physical therapy, speech-language pathology services and/or occupational therapy. The agency must be approved by Medicare (aka Medicare certified) and doctor must also certify that the patient is homebound. If these conditions are met, Medicare is likely to pay for your covered home health services for as long as the patient is eligible and the doctor certifies that the services are necessary. Usually homebound patients are still permitted to leave home for medial appointments or procedures as well as brief non-medical reasons, such as a haircut or to attend religious services. Please consult your doctor and agency for specific requirements and eligibility.

These are the most common types of agencies to provide in-home or outpatient care. In case of injury, such as a broken hip or knee replacement, in-home care may only be needed for several weeks. Navigating the system of elder care services and agencies can be confusing for anyone. Sometimes it can be overwhelming. Finding the appropriate level of care and caregivers you can trust can take time but it is time well spent.

If the time has come when your aging loved one is no longer able to live independently, please contact the knowledgeable staff at ElderLink. We will help you find elder care services or an assisted living facility within California that is customized for the requirements of your family.

Senior Care

The Elderly and Falls

The older you get the harder you fall might be a misquote from the old adage, but has some truth to it. For those aged 65 and older, falls are among the leading cause of death due to injury and it is estimated that in the United States, one out of every three adults 66 years or older falls each year.

Unfortunately, research published in the American Journal of Preventative Medicine found that 60 percent of fatal falls for older adults 65 and older occur at home, 30 percent happen in public places and 10 percent occur in health care institutions. Unfortunately, many falls cannot be foreseen or prevented but there are some risk factors that can be controlled.

Risk Factors
Environmental factors, including slippery surfaces, poor lighting, steps and loose rugs
Use of equipment, such as a cane or walker
Non-adherence to safety practices
Gait and balance impairments
Visual impairment
Physical conditions, such as stroke, arthritis, muscle weakness, glaucoma, cataracts, hearing loss or foot problems
Age
Fall history and fall related injury
Neurological disabilities, including Parkinson’s disease or stroke
Cognitive impairment and/or behaviors
Medication use, side effects, multiple medications or psychotropic utilization

While caretakers cannot necessarily prevent an elderly adult’s fall, they can work to minimize the risk as well as increase the response time of medical assistance should a fall occur. The most common fractures from a fall include pelvis, hip, femur, vertebrae, hand, forearm and ankle.

In addition to the stress and pain, the elderly who have taken a fall are also at a greater risk of complications such as pressure sores resulting from immobility as well as decreased appetite, infections, respiratory issues, pneumonia and incontinence.

So what can you do if your aging loved one does experience a bad fall? Develop a care plan that takes into account your loved one’s age, medical history, risk factors for falling again, mental health, functional abilities, expectations and willingness to follow the plan. Determine whether recovery and rehabilitation should occur in home or in a care facility and work with doctors, physical therapists, occupational therapists and other care givers on developing and following exercise, restorative and/or physical activity programs.

If the time has come when your aging loved one is no longer able to live independently, please contact the knowledgeable staff at ElderLink to help you find elder care services or an assisted living facility within California that is customized for your family.

alzheimer's, Senior Care

How To Help Alzheimer’s Patients Enjoy Life, Not Just ‘Fade Away’

Alzheimer’s disease has an unusual distinction: It’s the illness that Americans fear most — more than cancer, stroke or heart disease.

The rhetoric surrounding Alzheimer’s reflects this. People “fade away” and are tragically “robbed of their identities” as this incurable condition progresses, we’re told time and again.

Yet, a sizable body of research suggests this Alzheimer’s narrative is mistaken. It finds that people with Alzheimer’s and other types of dementia retain a sense of self and have a positive quality of life, overall, until the illness’s final stages.

They appreciate relationships. They’re energized by meaningful activities and value opportunities to express themselves. And they enjoy feeling at home in their surroundings.

“Do our abilities change? Yes. But inside we’re the same people,” said John Sandblom, 57, of Ankeny, Iowa, who was diagnosed with Alzheimer’s seven years ago.

Dr. Peter Rabins, a psychiatrist and co-author of “The 36-Hour Day,” a guide for Alzheimer patients’ families, summarized research findings this way: “Overall, about one-quarter of people with dementia report a negative quality of life, although that number is higher in people with severe disease.”

“I’ve learned something from this,” admitted Rabins, a professor at the University of Maryland. “I’m among the people who would have thought, ‘If anything happens to my memory, my ability to think, I can’t imagine anything worse.’

“But I’ve seen that you can be a wonderful grandparent and not remember the name of the grandchild you adore. You can be with people you love and enjoy them, even if you’re not following the whole conversation.”

The implication: Promoting well-being is both possible and desirable in people with dementia, even as people struggle with memory loss, slower cognitive processing, distractibility and other symptoms.

“There are many things that caregivers, families and friends can do — right now — to improve people’s lives,” said Dr. Allen Power, author of “Dementia Beyond Disease: Enhancing Well-Being” and chair for aging and dementia innovation at the Schlegel-University of Waterloo Research Institute for Aging in Canada.

Of course, the final stages of Alzheimer’s disease and other types of dementia are enormously difficult, and resources to help caregivers are scarce — problems that shouldn’t be underestimated.

Still, up to 80 percent of people with dementia are in the mild and moderate stages. Here are some elements of their quality of life that should be attended to:

Focus On Health

One notable study analyzed lengthy discussions between people with dementia, caregivers and professionals at six meetings of Alzheimer’s Disease International, an association of Alzheimer’s societies across the world.

Those discussions emphasized the importance of physical health: being free from pain, well-fed, physically active and well-groomed, having continence needs met, being equipped with glasses and hearing aids and not being overmedicated. Cognitive health was also a priority. People wanted “cognitive rehabilitation” to help them learn practical techniques for promoting memory or compensating for memory loss.

Up to 40 percent of people with Alzheimer’s disease suffer from significant depression, and research by Rabins and colleagues underscores the importance of evaluating and offering treatment to someone who appears sad, apathetic and altogether disinterested in life.

Foster Social Connections

Being connected with and involved with other people is a high priority for people with dementia. Based on research conducted over several decades, Rabins listed social interaction as one of the five essential elements of a positive quality of life.

But fear, discomfort and misunderstanding routinely disrupt relationships once a diagnosis is revealed.

“The saddest thing that I hear, almost without exception, from people all over the world is that family, friends and acquaintances desert them,” said Sandblom, who runs a weekly online support group for Dementia Alliance International, an organization for people with dementia that he co-founded in January 2014.

Adapt Communication

Not knowing how to communicate with someone with dementia is a common problem.

Laura Gitlin, a dementia researcher and director of The Center for Innovative Care in Aging at Johns Hopkins School of Nursing, offered these suggestions in an article in the International Encyclopedia of Rehabilitation: Speak slowly, simply and calmly, make one or two points at a time, allow someone sufficient time to respond, avoid the use of negative words, don’t argue, eliminate noise and distraction, make eye contact but don’t stare, and express affection by smiling, holding hands or giving a hug.

Also, understand that people with dementia perceive things differently.

“You have to understand that when you have dementia you lose a lot of your natural perceptions of what others are doing,” Sandblom said. “So, a lot of us get a little nervous or suspicious. I think that’s a natural human reaction to knowing that you’re not picking up on things very well.”

Address Unmet Needs

Needs that aren’t recognized or addressed can cause significant distress and a lower quality of life. Rather than treat the distress, Power suggested, try to understand the underlying cause and do something about it.

Which needs are commonly unmet? In a study published in 2013, Rabins and colleagues identified several: managing patients’ risk of falling (unmet almost 75 percent of the time); addressing health and medical concerns (unmet, 63 percent); engaging people in meaningful activities (53 percent); and evaluating homes so that they’re safe and made easier to navigate (45 percent).

Respect Autonomy And Individuality

Rabins called this “awareness of self” and listed it among the essential components of a positive quality of life. Sandblom called this “being seen as a whole person, not as my disease.”

At the Alzheimer’s Disease International meetings, people spoke of being listened to, valued and given choices that allowed them to express themselves. They said they wanted to be respected and have their spirituality recognized, not patronized, demeaned or infantilized.

In a review of 11 studies that asked people with dementia what was important to them, they said they wanted to experience autonomy and independence, feel accepted and understood, and not be overly identified with their illness.

None of this is easy. But strategies for understanding what people with dementia experience and addressing their needs can be taught. This should become a priority, Rabins said, adding that “improved quality of life should be a primary outcome of all dementia treatments.”

By Judith Graham | California Healthline. This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

Senior Care

Make New Friends But Keep the Old

One is silver and the other gold

The old Girl Scout song may be more true than you knew as recent research has shown that a variety of social isolation elements may “pose health risks, including living alone, having a small social network, infrequent participation in social activities, and feelings of loneliness” for adults, particularly older adults.

Luckily, there are some simple solutions that may have immediate health benefits, such as spending time with family and friends as well as making new friends. A New York Times headline event went so far as to claim, “Study Shows The More You Hang Out With Your Mom, The Longer She’ll Live – Make sure you call grandma over for dinner tonight.”

According to the NYT article, University of California, San Francisco researchers discovered that loneliness is a factor in the decline that often associated with old age. Controlling for socioeconomic status and health, the study followed 1,600 adults (with an average age of 71) and found the lonely consistently had higher mortality rates. In fact, “nearly 23 percent of lonely participants died within six years of the study, as opposed to only 14 percent of those that reported adequate companionship.”

The need to have people who know and value us never goes away and as we age, we tend to be more tolerant of our friends’ imperfections and idiosyncrasies. The rashness of a hotheaded youth often mellows as the years go by, bringing awareness of what’s worth fighting (or not) over. That patience and experience may carry over when spending quality time with their grandchildren, though the symbiotic relationship benefits everyone. The parents can take a bit of a break from the daily demands from their kids, the grandparents receive companionship, conversation and a sense of value, while the children can to learn about their family history, hear stories and share secrets while everyone feels the love. If you live close enough to visit your aging parents or relatives regularly, so much the better for everyone.

But, if you don’t live near your parents or if they are no longer able to live independently, there are still options. Encourage your elderly loved ones to reach out to older friends or make new ones. Help them form new relationships within an independent or assisted living facility if that is where they are currently residing. Despite popular beliefs, these types of living arrangements can provide more than physical assistance; they offer new ways to mingle and to connect, combating loneliness and possibly prolonging life.

If the time has come when your aging loved one is no longer able to live independently, please contact the knowledgeable staff at ElderLink. We will help you find elder care services or an assisted living facility within California that is personalized for your family.