As such, there is limited security, no monitoring, no one assigned to check the residents,  no accessibility features and it is quite an old building.  In fact, while my mother was visiting me, we received a report that her sliding glass door had fallen out onto the balcony and shattered.  As it was determined not to be the result of a break-in, the manager of the apartment suggested that it was due to “a shifting of the building”.

Before you ask, let me say that no, I could not convince my mother to change residences nor to live with my sister or me.  As many senior adults do, she prefers to remain independent.

Having spent the last 6 weeks with her, I see the need to put some safety measures into place if she is to continue to remain in her current residence.  Her mind is still sharp but she is having some balance issues and has already “tripped over a blanket” and bruised her ankle quite badly.  Because there is no one who regularly checks on the residents, if she were to fall and break a hip, she might lie there for days without help.

There are many new technological advances available that help to ensure the safety of a senior adult in their home. 

There are Personal Emergency Response Systems (PERS) which utilize a button that a person can push in case of emergency (some of these systems are also outfitted with fall detectors).  There are medication dispensing systems that can be loaded (by a care provider or family member) with up to 60 doses of medication and which will send audible reminders to the senior adult that it’s time to take their pills.  There are even elaborate home monitoring systems which have information that the off-ste caregiver can monitor via the interent.  These systems can alert the caregiver if, for example, the senior adult did not rise from their bed before a designated time.

According to an article in the New York Times, entitled “The Technology of Monitoring Elderly Relatives” dated July 28th, 2010, one such system is being utilized by Carol, who is keeping tabs on her 79 year old mother who has been disabled by a brain aneurysm. 

The article stated that Carol receives cellphone alerts whenever a user-defined set of parameters is breached in her mother’s nearby Daytona Beach, Fla., home.

“I used to call and check on her constantly,” Carol said. “If she gets confused, she wouldn’t remember to push a pendant.”

Carol is automatically alerted if her mother’s front doors are opened before 7 a.m. or after 10 p.m., and a bed sensor alerts her if her mother doesn’t get out of bed by 9 a.m.

If her mother’s home is too hot or too cold, she knows that, too. And if her mother begins to get confused and wanders rapidly from room to room, her daughter also receives an alert.”

To read that full article, go here.

There are also ways that senior adults can be monitored when outside the home.  Several companies have devices that are small enough for an elder to carry with them (some can be worn around the neck, wrist or clipped on the belt) and have a variety of functions such as fall detection, cell phone capabilities, and emergency alerts.

While I agree that the development of this technology is a great asset, I have a couple of concerns.

First, if we rely too much on the technology, certain things may be overlooked. 

What about nutrition – how do we know that our aging parent or loved one is buying AND eating a nutritionally balanced meal?  How do we know how long the thawed chicken has sat on the counter or the luncheon meats have remained in the refrigerator?  How do we know how much the senior adult has eaten and how much is being tossed in the trash? 

How do we know that the senior adult is bathing and/or performing other hygiene activities often enough?  If mouth care is not done often enough, oral disease can occur and  can affect the senior adult’s appetite.

Although technology can alert the off-site caregiver to the amount of exercise that is being done by the elder adult by determining movement, the type of exercise cannot be monitored.  Senior adults need weight bearing exercises and activities that will help to maintain their balance, not just movement.  (I’ve noticed that my mother has become much less mobile since moving to an apartment of her own and

What about scam artists who aim their schemes at the elderly?  Can technology protect them well enough?

Isolation could become a problem.  Will the use of technology take the place of visitors who used to pop in to check that all is well?  (There are currently robots being developed that will aid the senior adult in their daily activities, but can these robots give hugs?) 

The off-site caregiver may be negatively affected as well.  What if he or she is not in a position to respond when the alarm for help goes off?  What if the  frequency of alarms is high?  What if the alarms continuously sound at night?  Will the off-site caregiver become glued to the home monitoring system?  All of these situations can cause increased stress to both the off-site caregiver and the senior adult who is waiting for a response. 

And lastly, the use of technology can be expensive.  Certainly, it is less expensive than an assisted living facility or a nursing home, but do the advantages of keeping the senior adult in their home without human assistance outweigh the chances of isolation,  poor nutrition, lack of exercise, possible depression and uncleanliness?

I guess what I’m saying is that the technology is a great tool to be utilized but we must be cautious not to let it be the predominant method of off-site or long-distance caregiving.

This is video that I found on You Tube.  I’m curious; what would YOU do if you were the adult child in this situation?  When is it time to step in?

Every once in awhile I receive a letter from one of my readers letting me know that an article I have written has helped them in some way.  I am always so grateful when that happens because this is why I do this.  It is my joy to help make caregiving easier for those who have that calling or for those who suddenly find themselves in that position. 

I wanted to pass Greg’s letter along because he has found a great new way to make his mother’s bathing experience much better.  Thank you so much for sharing this with us, Greg.   Blessings.

“Thank you Shelley for the article!
 
This was a great read, and informative as I have been taking care of my 81 year old’s Mom showering needs for the past few years and I never gave special consideration to the things you mentioned. I could never understand why my
Mom would get so upset when it came time to give her shower. She wants to shower and she has always been very clean about her appearance. But she would get scared and very nervous. I do have a volunteer that comes in 4 times a week she is wonderful and she is a female. But My Mom does not feel as secure with her as she does with me. So I do it because I love her!!!
 
Your article made me approach my Moms showering requirements in a whole new light and now I make it an enjoyable experience for her. I call it Ladies day at the spa. My Mom gets a full shower and cleaned up and hair washed. I get her nicely dressed and do her hair for her. She feels so much more relaxed and it’s an enjoyable experience for us both. My Moms anxiety does not get as bad and she is much easier to shower and take care of this way. Perhaps you can pass this along to your other readers as a tip just to help out.
 
Greg”

PS If you have not signed up for our weekly newsletter, go ahead and do it now.  You will find the sign up box in the right hand corner of the home page. 

Here’s what happened:

My Mom, who is 86, and somewhat hard of hearing as many elders are,  lives in Canada in a senior apartment complex.  She received a call from a man who stated that her grandson was in jail for drunk driving (he had been at a wedding, had a couple beers and was caught driving the wrong way up a one way street) and needed money to bail him out immediately.  He mumbled the name a couple of times, and my Mom, being the helpful person she is, volunteered my son’s name.  “Yes, Tyler!” said the man.  “We need the money within 15 minutes and then he’ll go before the judge in an hour.”  So my Mom immediately called my sister to come get her and help her wire money to “him”.  She had all the details written down.

Praise the Lord that it just so happened that my sister and I were texting back and forth about some other banking business.  I had texted “You should go out to dinner tonight.”  About 2 minutes later, she texted back “No..no dinner celebration yet…gotta pick up Mom so she can wire $ to Tyler.  I just heard. Om goodness.”  I texted back “whaaat?  I don’t think I know about this.”

Apparently the man who had spoken to my Mom had said not to notify her grandson’s parents as he didn’t want them to know about the incident. 

So that was about the time I became frantic.  I called Tyler….NO ANSWER!  I called his Dad…..NO ANSWER!  NO ANSWER from his sister either.  Meanwhile Mom is on the way with my sister to wire the money.  I finally was able to talk to Tyler’s Dad who said he had spoken to him just a couple hours earlier and he wasn’t at a wedding; he was at school.  I texted my sister “Are you SURE we’re talking about Tyler?”  “Yup”, she responded.

You might wonder why I just didn’t dial my sister’s phone and talk to her.  Well, she was on her cell phone and not supposed to receive calls from the US because it’s about $3.00 a minute.  I texted her again “Ask Mom if she actually talked to Tyler.”  No response.

It was time for a voice to voice phone chat!  I dialed several times before she finally picked up and she told me they were just about to send the money through.  I heard the clerk in the background.  I asked where it was being sent….Montreal, I heard my Mom say.  MONTREAL????  My son lives in California. 

I told my sister to stop, don’t send the money; it sounds like a scam.  So they called the police and sure enough, that’s what it was.

Seconds away from losing $4400.00. 

If you are a caregiver for a family member who is under constant surveillance, this is less likely to happen, but for those of us with elders living elsewhere, it’s a absolute possibility, especially if they are living in a senior apartment complex or a community of “55 plus” residents.  Please advise all of your aging relatives or friends to NEVER send money by wire OR by mail  without first speaking to another family member.  Never follow anyone’s advice who tells them not to “trouble anyone else” with the information.  Tell them that if a family member is unavailable, to call their minister, rabbi or even their family physician for advice before acting on requests for money, no matter how urgent the matter might seem. 

Incidentally, Tyler was very glad to hear that he was NOT under arrest, as was his girlfriend, sister and father.

Look for a family practitioner or general practice physician to be the primary care physician for your loved one. General and family practitioners are trained to treat all aspects of a person’s health and well-being even though they have not specialized in a specific field. They treat the elderly as well as newborns, children and adults for everything from a splinter to a more serious illness.

Health Insurance Coverage

Choosing a doctor can be based upon several factors. One of the first aspects to look at is whether or not the patient’s health coverage is accepted by the physician being considered.  Most physicians will accept Medicare but it’s important to determine whether or not they will accept Medicaid and/or the supplemental policy if one is available.  If the doctor will accept the health coverage, the next thing to look at is accessibility.

Location and Accessibility

It is important to choose a doctor whose office is located close enough to be easily accessed for routine care and emergencies. If the elderly loved one is homebound, a physician who understands this and is willing to work around this detail to provide care is ideal.

Physicians can order home health nurses to draw blood, administer injections, take vitals signs and other basic medical procedures then report to the doctor. These procedures would normally be done at the doctor’s office, but when dealing with a homebound patient, getting them into the office may be a problem.

In addition, when transporting an elderly homebound loved one, distance to the doctor’s office can play a part in the convenience of the location. Determine if the time spent driving and the distance to and from a doctor’s office makes the doctor in question an acceptable choice for your loved one’s needs. If the doctor requires that your loved one must been seen at the office frequently, then distance can be an important factor when choosing the physician.

Office Hours

When choosing a doctor there are a few important questions about the doctor’s schedule that you should ask. What kind of office hours does the doctor hold? Do they have evening or weekend hours? How can you get in touch with them when the office is closed? Are the physicians who cover the “on-call” hours acceptible to you?

Hospital Choices

Most doctors have privileges at specific hospitals. When choosing a doctor, it is important to find out which hospital or hospitals the doctor has privileges at. This is the same hospital the patient would go to for emergency care, tests and surgeries in most cases. The size, location and reputation of the hospital may play a large role in your decision to choose or not choose a specific doctor.  Some towns and cities have specialty hospitals for certain conditions.  If your loved one has a condition that is treated by one of these specialty hospitals, it is important to determine if the primary physician has priviledges there.

Personality

Even the most qualified and credentialed doctor may not be the best choice for your loved one’s personal physician if their personality clashes with yours. You’ll probably want to choose a doctor that you genuinely like and feel comfortable with. Remember that you will need to be working closely with this person to advocate for the best health care for your loved one.  Imagine my surprise when I asked my father’s physician if he might be discharged in the afternoon only to hear him say “What part of HE WILL BE DISCHARGED TOMORROW MORNING did you not understand?”  However, there are also surgeons that I have worked with in the past who had terrible bed-side manners yet they are the ones with whom I would have trusted my life.

Choose a doctor who will take the time to speak with you as you advocate for your loved one’s health care. The doctor should be willing to listen to your concerns and answer your questions to your satisfaction. Remember, you are hiring them and paying them for their time.  The days of the primadonna physician OUGHT to be over.

Another consideration is the physician’s staff.

Do you like the physician’s staff? Are the doctor’s employees personable, respectful and pleasant? If you find receptionists, nurses and other staff members to be rude, then perhaps you should consider other physicians. These are the people you will be working with to schedule appointments, update prescriptions and access patient information. If you find them difficult to work with initially, it might improve over time but don’t expect it to automatically occur.

Ask the doctor if they have a Family Nurse Practitioner or a Physician’s Assistant in practice with them. These medical professionals assist doctors in caring for patients in many private practices. Decide if this is acceptable to you for your loved one’s care. If not, then you may need to continue looking or specify in the patient records that care must be provided by the doctor.  Keep in mind though that Nurse Practitioners and Physician’s Assistants generally have more time to spend with the patient and are trained to be patient advocates.  They are also often more accessible.

Making the Choice

After taking all of these factors into consideration, decide which physician you would like to care for your loved one. Schedule a new patient appointment and commit to making the new relationship work.

It wasn’t until I began looking at them as a means of respite care placement for my father that I learned of their costs.  In my father’s case, the daily respite cost was $220 but the monthly cost would have been over $5000.00 for a semi-private room.  This rate did not include medications or transportation to medical appointments. (Rates seem to vary between $4000.00 and $7500.00 per month depending upon the residence.)   None of these facilities accepted Medi-Care and private insurances don’t cover such things.  A couple of them stated that if a person were 2 guarantee private payment for 3 years, then they would not “evict” the resident once their money was gone.  At that time, they would then accept Medicaid reimbursement. 

Recently I have read several articles about assisted living facilities being available mostly in areas of higher income.  In areas of lower income, rural areas and in areas where minorities live (and all 3 of these are equivalent to areas of lower mean income), there are less available assisted living facilities.

In a study at Brown University, a conclusion was made that hispanics would be more likely to use nursing homes than assisted living facilities because they at more likely to be at the lower end of the socio economic scale and did not have the money.  Because of lack of money, they were more likely to be placed in nursing homes with less than desirable facilities, receiving less than adequate care which sent them back to the hospital and began a downward spiral.

I think that another reason that there are fewer assisted living facilities in areas where hispanics live is that their culture has the tradition of elder care being handled by the adult children of the family in a home setting.  My best friend’s mother took care of both her mother and aunt in her home until she was physically unable to do so anymore.

Assisted living facilities vary tremendously; they can contain a myriad of amenities and consist of private apartments with a nurse on duty 24 hours a day or at the other end of the spectrum, they can be closer to a nursing home environment with semi-private areas that consist of 2 beds in a room with a television set.

Assisted living homes are not the right choice for everyone.  Unless a facility has a special unit  (and many are opting to include these), dementia patients should not be placed there.  Sometimes patients have medical conditions that are too complicated for this type of living arrangement, as well.

Nursing homes don’t have much variation.  In MY words, they are simply sad places where lonely people live out their final days. 

In between, there are skilled nursing facilities, but in most instances, these are temporary placements until the “patient” can either be returned home or to a more permanent placement in a different facility.

I’m concerned about what will happen when the aging population runs out of money to pay for these expensive assisted living homes.  At between $ 50,000 and $90,000 per year, who will be able to live there long?  Our elders were a little more prepared but I don’t believe that the baby boomer generation has prepared themselves well enough to be able to cover even a year of living there.  And now that many boomers are upside down on their mortgages, selling their home won’t help to pay for that care.  Not many of us have long term care insurance either. (And in reality, how can long term care insurance continue to exist when almost ALL of us will need it at some point?)

I also think that with health reform, more families are going to be responsible for the care of their elders.  Hospitals will discharge elder patients sooner and before they are able to care for themselves.  This is happening even now !  I literally had to beg that my father be admitted to help remove the 12 pounds of fluid that had accumulated in his legs due to congestive heart failure.  Sure…..they’ll put a defibrillator in an 86 year old man with dementia (because insurance will pay for THAT)  but when it comes to managing the care of that man post procedure, they’ll leave it to the family.   (And they won’t discuss end-of-life care…but that’s a whole other issue.)

Already, a big portion (17% of employees in south Florida, according to a recent study)* are having to leave the work force in order to care for their aging loved ones and another 15% have cut their hours. 

During the past year, as we have experienced a financial crisis, more family members are gathering together under one roof in order to make ends meet.  Do you think that we will return to the days of Leave it to Beaver and Father Knows Best where Moms become the caregivers for the family while Dads return to providing the financial contribution?

In a study reported by Deborah B. Gentry, it was determined that nearly 40% of adult children acting as caregivers had serious conflicts with one or more siblings regarding the care of their parents.  Many times, this was due to the lack of participation of one of the siblings, arguements over finances or disagreements on where Mom or Dad should live.  With a help of a mediator, these issues can be sorted out in a private, non-threatening setting where the family (including the parents) meets together.

Eldercare mediators have taken classes in this type of mediation.  They may be nurses, social workers, gerontologists or they may also be attorneys themselves.  (If they are attorneys, they do not practice law during the  mediation service.)

What does an eldercare mediator do?

• they are a neutral 3 rd party who helps with decision-making processes
• they help clear up misunderstandings within the family by knowing the right questions to ask
• they provide for expression of feelings and yet, keep the family on tract
• they help the family heal hurts, avoid blame and self-pity
• they help the family consider as many options as possible
• they provide for future modification of the decisions made

Mediators do NOT:

• Make any of the decisions themselves
• Provide family therapy
• Practice law

Who is involved in the meeting?

• Parents and siblings should be present.  The meeting may also include spouses, grandchildren, other close relatives, close family friends, caregivers, medical providers, pastoral leaders and lawyers.

What is discussed at the meeting?

This is up to the family members but some ideas for discussion include living arrangements and possible assistance for the parent(s), driving ability, end-of-life provisions, financial concerns, trust and estate issues, division of responsibility amongst the siblings, etc.

The advantages of hiring a mediator are that parents (or spouse) must give permission for the meeting to take place, thereby maintaining their dignity and autonomy by being involved as much as possible.  Also, if help is needed, financial and task responsibilities can be divided up equally among the children (siblings) or a care contract for a sibling that volunteers to be the primary caregiver can be discussed.  Obstacles are more easily overcome when using a mediator who can keep the family focused on the goal of caring for the parent (or spouse) in the best possible way.  Family relationships are also improved because everyone is kept in the loop.  Those siblings who are unable to attend due to physical constraints can participate by telephone or even on the internet.

The cost of an eldercare mediator is about $100.00 – $300.00 per hour but is a good investment in maintaining or building family unity and working to provide a good outcome for your aging parent(s) or loved ones.

Eldercare mediators can be found through state and local Area Agencies on Aging, attorneys specializing in elder law, geriatric care managers, Alzheimer’s Association (especially support groups) and the health department.

Ironically, later in the day, I was reading a story about MSNBC anchorwoman, Mika Brzezinski and her forthcoming book “All Things at Once” where she describes the day she fell down a flight of stairs while holding her 4 month old daughter.  She had been up all night working at the newsroom and because she couldn’t sleep (during daylight hours), had let her caregiver go home early.  She stated that she had picked up the baby and was talking 100 words per hour and walked right off the top of the stairs, landing with her on top of the baby!  The “baby” is now almost a teen and is fine, but can you imagine the horror, the pain, and the guilt that went along with that experience ? 

In the interview, she went on to say that at that point she learned to ask for help.  “If you’ve got a career that you need to nurture, there are going to be times when you need to transfer your authority to others. I will forever regret that I didn’t get help sooner so I could get through that rough patch in my career. ”

I’m sharing this story not just to talk about career vs. caregiving but to say that we must not wait until something awful happens before we ask for help.  Many of have careers and even if we don’t, we may have children and a husband who need our time and attention, as well.  We must not get to the point where we are too keyed-up to even sleep.  We must not let our families go on with their lives without us. We cannot afford to be the one who is admitted to the hospital with heart problems, anxiety disorder or something even worse while our care-recipient is left behind.  When we want to say No to something, we must say No !

If you are participating in a committee that is becoming burdensome, doing work such as cleaning or running errands that could be “resourced out” to another capable person, working with the local women’s group with whom you have nothing in common, not asking your family members (I’m talking siblings here) for help (even little bits of help), please reconsider your actions.  

Don’t wait for a 911 moment.  Just say No. 

Gary’s article can be found immediately below.

“Coumadin^®, available generically as warfarin, has been widely used to reduce the risk of stroke for well over 50 years. Dwight Eisenhower, Richard Nixon and George Bush senior were all taking Coumadin during their active years of former Presidency. Despite millions of prescriptions written annually for this medication, practical, easy to use information remains a challenge.

One of the most common and historical needs of managing warfarin is diet, specifically, dietary vitamin K. Physicians use warfarin to increase the bleeding time in patients at risk for developing unwanted blood clots. The goal is to prolong the bleeding just time enough to prevent clot formation where it isn’t needed (the heart and lungs for example) but allow clotting to take place for normal blood vessel bleeding repair. While warfarin prolongs your bleeding time, dietary vitamin K increases the body’s natural ability to form clots.

The simple blood test called an INR test measures that active anti-clotting effect of warfarin. The higher the dose of warfarin, the more potent or longer the blood takes to clot. A diet high in vitamin K can reduce the effect of warfarin and lower the number of the blood test result. For this reason, it is important for patients to keep a consistent intake of dietary vitamin K to help maintain safe levels of protection warfarin provides without interfering too much.

It is difficult to monitor vitamin K intake when food and beverage labels do not provide this information and the FDA does not require it. While professionals teach vitamin K is abundant in leafy green vegetables – there are many hidden sources patients and their care givers need to know about. Salad dressings and some mayonnaise are good examples.

The vitamin K registry

An easy to use, extensive vitamin K database is available for patients and their family. The vitamin K diary allows you to simply type the first few letters of a food or beverage you’re interested in and a menu of products is displayed listing the serving size and the amount of vitamin K. The vitamin K registry can help you keep balance and choice in your diet. A printable version is also available to assist in creating grocery lists for the Coumadin patient.

The vitamin K diary

The vitamin K diary is an interactive resource for patients or caregivers to keep track of vitamin K intake. While using of the vitamin K registry as a source guide, the vitamin K diary allows the user to record the vitamin K (listed in micrograms) consumed for each meal. The diary, offered as a word document, calculates the total daily and weekly intake of vitamin K. The vitamin K diary is best used 7 days prior to the patient’s blood test to best evaluate the effect of diet and shared with the patient’s healthcare provider.

For other helpful resources on maintaining your quality of life, visit www.PTINR.com  ”

Courtesy of Tena home health products are some tips to reduce stress during this busy season, written by Ann Cason, a caregiving expert and founder and director Circles of Care.