Caring for Elders

“Is there a doctor on the plane?!” Maybe it’s just a coincidence, but during my last trips involving air travel, I’ve witnessed two medical emergencies in flight. If you are traveling with an older or medically fragile person, or if you are up there in age yourself, there are some basic precautions that you might consider....

[caption id="attachment_1886" align="alignleft" width="150"] Client with home care needs and her loyal caregiver.[/caption]   Home care needs are inevitable for most of us, and planning instead of simply reacting helps promote a safer and less stressful home care experience for family members.  At Home Nursing Care is here to help with your home care needs. It's been called the Silver Tsunami, a burst in the number of elderly individuals and as a result, an increase in home are needs.  The Silver Tsunami definition is: a dramatic increase in the number of Americans who are 65 years or older.   Due in part to birth rates (the baby-boom), medical and scientific advancements, and more people are living longer. For the first sixty years of the 20th century, life expectancy grew by about 2.5 years.  But from 1960 to 2007 - life expectancy expanded by a whopping 4.2 years.  Currently, anyone fortunate enough to hit 65 has an average life expectancy of 18.6 more years. Keeping on the statistics train, 1 in 8 Americans is now 65 or older.  That segment currently makes up 12.9% of the population, but it will jump to 19.3& of the population by 2030, according to the US Department of health and Human Services. Many older people live alone.  Since older women outnumber older men and have longer live spans, half of all women aged 75 and older live alone. [caption id="attachment_1211" align="alignleft" width="150"] Loren is the exception - this home care client lived to nearly 103![/caption] In California, 25% of all seniors live by themselves, and about of third of those seniors have some form of disability. Being able to age comfortably, either in place or in a suitable assisted living environment, takes some planning, especially financial planning.   A recent AARP study found that 31.6 % of seniors have experienced a substantial decline in their home's value over the last three years, and a quarter of all seniors have exhausted their personal savings. Paying for in-home care, such as the care offered by my company, At Home Nursing Care, can feel out of reach for some seniors.  Those with good long term care policies experience less stress when hiring in-home help.  I know of a 60 year old man who pays $300 a month for his long term care insurance.  His father had Alzheimer's disease, so this man worries that within a couple of decades he'll need substantial home care.  His policy will currently pay $300 a day for care, an amount that will rise over time.  That amount should cover his needs, whether he chooses a live-in caregiver in his home or a specialized memory care community. Reverse mortgages are another option for seniors with limited cash reserves.  They are available to people 62 or older who own their homes.  The amount of money available is based on age, current interest rates and a home appraisal.  The draw-back is the cost/fees involved, so be sure to consult a financial planner and someone experienced with reverse mortgages.  Beware of potential scams. Home care clients are especially vulnerable to the...

[caption id="attachment_1934" align="alignleft" width="1024"] At Home Nursing Care Caregivers Becoming Physicians[/caption] [caption id="attachment_1941" align="alignleft" width="1024"] Buena Suerte! Good luck to our wonderful caregivers becoming doctors![/caption] At Home Nursing Care salutes our caregivers becoming family practice physicians. In our Culver City At Home Nursing Care branch, we held a breakfast send-off celebration to recognize four wonderful and dedicated caregivers who are well on their way to becoming  family practice physicians. Yoel is a physician from Cuba who immigrated to the United States under a special visa for Cuban professionals.   He and his wife, Alibet, also a physician from Cuba, took positions as caregivers with At Home Nursing Care while they attended a special UCLA program for foreign doctors. Both were licensed physicians in Cuba, but they needed to attend trainings and finish a credentialing program here in the United States. Yoel's 92 year old client was thrilled when he heard Yoel had been accepted into a Family Medicine Residency outside of Bakersfield, even though it means losing the future doctor as a caregiver. "He is wonderful," said 92 year old Charles, "he will make an excellent doctor for people like me." (We found a wonderful new caregiver for Charles, but Yoel will be missed!) Alibet, who is finishing her credentialing and has been taking English lessons since she first began working with At Home Nursing Care nearly 2 years ago, is hoping to also start a residency program near her husband.   She provided 24/7 care to an elderly dementia client and had great reviews.   The couple is moving from Culver City to Hanford, North of Bakersfield. "It's amazing to get these educated and dedicated future doctors and have them work inside the homes of clients they will someday serve medically.  It gives them valuable perspective that will improve care in general," said Adriana Beischl, District Manager for the At Home Nursing Care Culver City Office. Yoel and Alibet have already referred more of their colleagues to apply with At Home Nursing Care.  We are honored to have their colleages join us and we wish Yoel, Alibet, and their colleages best wishes and good luck!   [caption id="attachment_1935" align="alignleft" width="1024"] Enjoying breakfast[/caption]          ...

The nurses, caregivers and staff of At Home Nursing Care understand that better nutrition can lead to better recovery and healing. This connection is very clear in a story about a 62 year old man who for 9 months suffered with a large diabetic wound on his foot.  He was only a couple of weeks away from amputation of his leg because of the sore. For months, his nurses and doctors had done everything they could think of to close the wound, from IV’s full of antibiotics to topical creams.  But the wound just wouldn’t get better. Shortly before the scheduled amputation, dietician Nancy Collins was brought in by the doctors to give her advice. “It’s not every day you get to save a man’s leg,” she says, but that’s exactly what she did. She didn’t turn to some expensive, fancy new medical device or experimental treatments.  She simply improved his nutrition. [caption id="attachment_859" align="alignright" width="150"] A nutritious, high protein meal[/caption] “Nutrition has a role in 12 of the top 15 causes of death,” she said, “but it’s been neglected historically.” Collins added more protein into the man’s diet, made sure he got at least 3,000 calories a day to fuel healing, and she had him drink water mixed with a powder called “Juven”, a combination on glutamine, arginine and HMB (amino acids.)  He drank two packets a day for 12 weeks, while his doctors continued the topical treatments on his foot. [caption id="attachment_868" align="alignleft" width="150"] Juven Powder Supplement[/caption] Thanks to his improved nutrition, his body was able to grow tissue, something that wasn’t happening before, and his foot wound finally closed. “Instead of losing his leg, he went on a cruise with his wife,” she said. Collins recently spoke at annual conference for the California Association for Health Services at Home, a group of home-based providers including At Home Nursing Care. Our staff members attended the conference to learn how to improve the quality of life of our clients and patients. Collins explained that nutrition is often the missing link in recovery, one that is too often overlooked in the medical community. And nutrition doesn’t just mean the amount of food someone eats or the amount of fat stores in the body; it’s the quality of food and the amount of amino acids and protein. “With just a 10% loss of lean body mass, wound healing is impaired, “she said. A 20% loss causes wound healing to cease and a 40% loss of lean body mass leads to death, usually from pneumonia, Collins explained. She says that most patients do not take in enough calories or protein to sustain their lean body mass, which peaks for people at age 25 and then goes downhill from there. Malnourished patients are significantly more likely than well-nourished patients to experience re-hospitalizations.  Nutrition, or the lack of it in nursing or rehabilitation centers, plays a role in 61% of malpractice lawsuits, she said, because patients who are malnourished are 200% to 500% more likely to develop pressure wounds. Why are patients not eating enough or the right kinds of foods?  Collins sites cognitive problems, financial problems, fatigue...

Many people are wondering how a proposal to end a federal "exemption"for personal care attendants and home care aides will end up affecting the costs for clients and employment home health care laws for employers. In a presentation to home care employers, attorney John Gilliland tried to stress that while major changes may be in store, agencies will be able to adapt. "This wont put you out of business," he said, clients will still need help.   A sad, unintended consequence is that the higher costs associated with the changes will force some seniors into skilled nursing homes rather than aging in place at home. A proposal by the U.S. Labor Department would end an exemption that allows employers to not pay overtime to "companions" who provide care in someone's private home.   This exemption has allowed longer shifts, such as 12 hour shifts and "live-in", where the caregiver spends 24 hours in the home, but generally sleeps eight hours a night. The proposed change would also mandate that caregivers be paid minimum wage, something that's already law in California. Gilliland said that there are 17 states across the country which have already eliminated the exemption and companies and clients have adjusted. For live in care, he said, clients will be given a choice:  Do they want continuity of care with one caregiver for most of the week at a higher rate, or do they want costs lowered by having multiple caregivers in the home working less than 40 hours total? Archana Acharya, an attorney with Murphy Law Group in Los Angeles, said of the proposed changes, "It's a grey area right now." Hypothetically, in California, here is how the rule change for live in care may play out. Right now families are charged a basic rate for 16 hours of work, provided the caregiver gets 8 hours of sleep, five of those hours uninterrupted. The average rate in San Diego County is $200 - 240 per day for that service. Under the new plan, if a family wants more continuity of care, for a 24 hour "live-in" shift, they could expect to pay a regular rate for the first 8 hours, time and a half for the second eight hours, and double time for the last four hours, adding up to sixteen hours per day of work.  Eight hours of sleep time could be deducted from the employee's pay and the client's costs, if the employee actually got 8 hours of sleep.  The costs to the client would likely be as much as $300 a day. Another requirement of the proposed rule change is that records must be kept of any interruption of sleep time.   Employees would have to keep a time sheet noting any reason for waking up overnight.  In California, if an employee gets less than five hours of uninterrupted sleep, they must be paid for all 24 hours.    It's at that point that the costs would skyrocket for clients, and it would probably be less expensive to move into a nursing facility.  Worst case, the client would...

Caregivers often don’t recognize when they are in over their heads until they reach a breaking point.  Short-term the caregiver can handle it. Long-term, help is often needed. A typical pattern with an overloaded caregiver may unfold as follows: 1 to 18 months - the caregiver is confident, has everything under control and is coping well. Other friends and family are lending support. 20 to 36 months - the caregiver may be taking medication to sleep and control mood swings. Outside help dwindles away and except for trips to the store or doctor, the caregiver has severed most social contacts. The caregiver feels alone and helpless. 38 to 50 months - Besides needing tranquilizers or antidepressants, the caregiver's physical health is beginning to deteriorate. Lack of focus and sheer fatigue cloud judgment and the caregiver is often unable to make rational decisions or ask for help. It is often at this stage that family or friends intercede and find other solutions for care. This may include respite care, hiring home health aides or putting the disabled loved one in a facility. Without intervention, the caregiver may become a candidate for long term care as well. At Home Care Solution provides nurse case management, social worker case management, and high quality certified nursing assistants, home health aides and caregivers to assist when families become overwhelmed.  We provide care on an hourly basis and we specialize in high quality and affordable live-in care for 24 hour peace of mind. With the holiday season upon us, caregivers feel even more stress -- with planning, shopping and participating in holiday activities. This is a perfect time for family and friends to step up and provide some respite time and caregiving help.  Whether it is provided personally or arranged as a gift of services to be provided by a professional respite company or home care provider, it is a welcome gift. An article in “Today’s Caregiver” states: “Nearly one in four caregivers of people with Alzheimer’s disease and other dementias provide 40 hours a week or more of care. Seventy-one percent sustain this commitment for more than a year, and 32 percent do so for five years or more. One of the best gifts you can give someone caring for Alzheimer’s is something that provides a bit of respite and relieves the caregivers stress. The Gift of time: Cost-effective and truly meaningful gifts are self-made coupons for cleaning the house, preparing a meal, moving lawn/shoveling driveway, respite times that allow the caregiver time off to focus on what he/she needs.” It is also important to note that hiring professional care provider services can provide valuable ongoing support to an overloaded caregiver. A financial planner, care funding specialist or a reverse mortgage specialist may find the funds to pay for professional help to keep a loved one at home. A care manager can guide the family and the caregiver through the maze of long term care issues. The care manager has been there many times -- the family is experiencing it for the first time. An elder law...

“I found that when I didn’t have pain, I could forget I had cancer" - Cancer patient Chronic or excessive pain does not need to be part of aging, healing, or dying, a fact that Timothy Corbin, M.D. expressed to a crowd of nurses and social workers who gathered to learn more about alleviating pain. "Sometimes pain relief medications have scary names, which makes family members or patients want to avoid them," explained Dr. Corbin.  But the fear is needless, he commented. [caption id="attachment_68" align="alignright" width="300"] left to rt: Aviara's William Adams & Connie Garcia, Timothy Corbin, MD, Lauren Reynolds, At Home Care Solution & Aviara's Ana Morfin[/caption] Dr. Corbin is a hospitalist and palliative care consultant with Scripps Memorial Hospital, Encinitas, and he's also Regional Medical Director of The Elizabeth Hospice.  He spoke at a continuing education seminar for nurses, social workers, fiduciaries and nursing home administrators.  The seminar was held at Aviara Healthcare Center in Encinitas and was sponsored by Aviara and At Home Care Solution. Dr. Corbin explained that pain is the most common symptom of illness, and that unrelieved pain interferes with healing and diminishes quality of life. Sadly, he said that many dying patients continue to suffer from unrelieved pain during their last months  of life.  He also pointed out a 2007 Meta-Analysis which found pain present in 64% of patients with advanced cancer.  Additionally, he sited a JAMA study which said that 25% of long term care patients who complain of pain receive no treatment. The good news is that most pain during the terminal phase of life can be controlled relatively easily.  Dr. Corbin cited prescribing Morphine on a 24 hour schedule as one of the basic techniques of pain control in a palliative setting. One common concern about morphine at the end of life is a fear of addiction, which Dr. Corbin called an undue concern.  He pointed out that physical dependence is an expected result of long term use but should not be confused with addiction. He recommended increasing the dose of pain medications if they don't start working within a short period of time and said that the types of medications given should increase in strength if the first options do not provide relief. The nurses, social workers and fiduciaries in the audience appreciated learning about how to advocate for their patients and clients who are suffering with pain. At Home Care Solution is a California approved provider of continuing education. We would like to thank Aviara Healthcare Center, Dr. Corbin, and The Elizabeth Hospice of Escondido for providing this important information on elderly pain management as a service to our community. Contact us or read our blog to learn more about the importance of medication management for seniors. ...

More than 35 hundred participants turned out this past Saturday to help raise money for Alzheimer's research.  At Home Care Solution, one of only three local home care companies certified by the Alzheimer's Association for dementia care, was proud to be a Bronze corporate sponsor of the event. [caption id="attachment_63" align="alignright" width="300"] Lauren Reynolds with At Home Care Solution (left) with Betsy Evatt, Senior Care Management[/caption] The Walk to End Alzheimer's, held in Balboa Park, was a big success according to organizers with the San Diego/Imperial chapter of the Alzheimer's Association. Alzheimer's is now the sixth leading cause of death in the county and the third leading cause of death in San Diego. Roughly 53,000 San Diegans are living with Alzheimer's.  In California more than 588,000 people are believed to be living with Alzheimer's. At Home Care Solution founder and C.E.O. Lauren Reynolds joined Betsy Evatt, care manager with Senior Care Management to provide information about in-home care and health advocacy. At Home Care Solution provides quality hourly and live-in care for people with varying medical, social and psychological needs. Senior Care Management, run social workers with decades of experience in geriatric care, provides coordination of care including medical issues and appointments, safety assessments and referrals. For more information on Alzheimer's or the walk,  visit the Alzheimer's Association website. Find more info on Alzheimers and Dementia home care for San Diego county or Los Angeles counties on our website....

At Home Care Solution is proud to announce that we have been awarded Certification through the Alzheimer's Association. [caption id="attachment_55" align="alignright" width="300"] Laura Printy of the Alzheimer's Association and At Home Care Solution C.E.O. Lauren Reynolds[/caption] "Our mission is to provide the very best care from the most professional caregivers, and this certification demonstrates our continued commitment to that mission," said Lauren Reynolds, At Home Care Solution Founder & C.E.O. This designation is rare among home care companies in San Diego County.  Of the hundreds of companies which offer Alzheimers in home care, only 3, including At Home Care Solution, have earned certification from the Alzheimer’s Association. "We are very proud to be among the minority of agencies which take the time and devote the resources for this distinction," said Reynolds. Over the past several months, At Home Care Solution caregivers have completed 8 hours of specialized training in the area of dementia care at home.  Caregivers learned not only the health aspects of dementia and the various causes, but they also practiced effective communication techniques.  They've learned how to always practice patience and empathy while understanding the best ways to calm and encourage clients with memmory loss. If you or someone you love is living with memory loss, see how our advanced home care in San Diego or Los Angeles sets us apart. Call for a no-cost, in-home assessment at 760-634-8000.      ...

More Seniors Seek “Friends with Benefits.” Dr. Daniel Sewell, clinical professor and Medical Director at the Senior Behavioral Health at UCSD, first took an interest in researching sex in older adults when a nursing facility called him for advice. “A man and woman living at the nursing facility had fallen and love and began a physical relationship,” he explained, “and the woman had a husband living elsewhere.” The question about what to do sparked a research project and a lecture that now is in high demand. “I talk on a variety of topics, but when I’m requested as a speaker [the topic of age, sex and dementia] is what people request.” [caption id="attachment_46" align="alignright" width="300"] Lauren Reynolds - At Home Care Solution, Dr. Daniel Sewell - UCSD, Inan Linton & Shevonne Farrell - Belmont VillageThe UCSD professor spoke to two dozen elder care professionals including social workers, nurses, and case managers at a seminar sponsored by At Home Care Solution and Belmont Village in Cardiff.[/caption] “Sleep is important, appetite is important and sex is important.  Getting older or getting dementia doesn't necessarily change that,” Dr. Sewell pointed out. He said there are 5 primary drives of human behavior, thirst, hunger, pain avoidance, attachment, and libido or sex drive.    He said the last drive is one that is talked about the least when it comes to older adults. However, there are a couple of studies he cited.  He had to chuckle when telling the crowd that one study considered older to be age 50 and upward.   It found that 20 to 30 percent of men and women are sexually active into their 80’s. The biggest determinants of whether an “older” person will be sexually active is their relationship status and health. “If you have a partner, you’re more likely to have sex, and if you are healthy, you’re more likely to have sex,” he said. A newer phenomenon, he explained, was the fact that one out of 5 men is having sexual contact with a “friend” or “new acquaintance”, the “friends with benefits” as it’s called in media. The percentage of women doing the same is less, but still significant, at 13.5%.  He suspected that this more casual approach to sex has to do with the fact that older adults don’t want to complicate their lives with second or third marriages, so they’re open to the idea of sex with a less rigid relationship structure. The drawback is that this behavior puts older adults at risk for sexually transmitted diseases if they don’t practice safe sex.  Older adults may think that because birth control is not needed, protection is also not needed. Another interesting fact is that 14% of men report using some kind of supplement to improve their sex life. A 2007 study also found that adults age 57 to 64 had a 73 % prevalence of sexual activity, for those 65 to 74 it’s 53%, and 75 to 85-year-olds had a 26% prevalence of sexual activity. Dr. Sewell pointed out that older adults are rarely asked about sexual issues by their doctors or case...