Live Free Home Health Care, LLC. - Bristol, New Hampshire

Wednesday, September 30, 2009

Medication Problems for the Elderly

At 83 years old, Martha still lived in her own home, and enjoyed working in her garden and canning peaches. It was becoming harder to motivate herself, to get up in the mornings and accomplish the day's tasks. She confided to her daughter that she felt anxious and tired. Her daughter, who was taking medication for her anxiety, took Martha to her own doctor, not Martha's and got her a prescription for Valium. In doing so, the daughter's doctor, who had never seen Martha and who did not have her medical history, was only aware of a few medications they told him she was taking.

Martha, in fact, was taking 9 different medications as well as herbal supplements.

The addition of Valium to her existing list of prescribed drugs sent her to the emergency room with respiratory distress. If she had gone to her own doctor, he would have found that a dosage adjustment of her current medications would have solved her anxiety.

Medication errors are common in the elderly. Many seniors take on average 6- 8 different prescriptions as well as over the counter drugs. Many times the elderly will not go back to their doctor to have their dosage evaluated and changed if necessary. Family members should be aware, that elderly parents may tend to take the family's advice over going to their own doctor. Even though children want to help increase the health and stamina of their parents, they may in fact be causing damage by misdirecting their loved ones.

Where a younger person can benefit from herbal supplements like Ginkgo Biloba, Saw Palmetto and others, in older people, these herbals may cause adverse reactions with their prescription medications.

In 2003, a panel of experts put together a list of potential medications that would not be appropriate to give to seniors. This is called the “Beers List” after one of the research professionals.

Dr. Donna M Fick, R.N. one of the panel members for updating the “Beers List,” states in her article on Seniorjournal.com:

"Just as our bodies physically slow down as we age, changes occur in the way that older bodies handle pharmaceuticals, and this has motivated experts to develop a list of drugs that may be harmful to elderly patients.

"With age, drugs tend to build up in the body, and the distribution and elimination of drugs from the body changes as well," says Dr. Donna M. Fick, R.N., associate professor of nursing at Penn State. "Many drugs, like diazepam (Valium) and other anti-anxiety drugs build up fast."

An on-line article on HealthSquare.com , Titled "Drugs and the Elderly," talks about physical symptoms and medications.

“ Among the first signs that a drug may not be working properly in an older person is a change in mood, energy, attitude, or memory. Too often, these alterations are overlooked, ignored, or chalked off to "old age" or senility. Older people may themselves feel that their blue mood is caused by something external such as the death of a friend or simply by boredom. Nothing could be farther from the truth. Virtually every heart medication, blood pressure drug, sleeping pill, and tranquilizer has been known to trigger depressive symptoms.

When a psychological symptom appears in an older person, examine his or her medication or drug use first. Consider, too, factors like alcohol intake, poor nutrition, and hormone imbalance. And never dismiss the possibility that a real psychological problem has developed and may itself require medication.”

There are many things family members can do to help monitor medications for their elderly parents.

• Make a list of medicines prescribed and all supplements being taken.
• Give this list to the doctor and pharmacist and have one on hand for emergencies.
• Use the same Pharmacy to fill all prescriptions. Pharmacies keep a record of your prescribed drugs and will verify your doctor's instructions. They will also tell you if foods or over the counter supplements will interact with a prescription.
• Dispense pills in a daily pill organizer box.
• Have a family member be responsible to call or physically monitor the taking of medication.

Family members who live long distances from their elders have available to them new technology in medication monitoring.

• Alarms for pill boxes, watch alarms, medical alarm bands and necklaces that ring a reminder.
• Computerized pill box dispensers that ring a designated number if the pills have not been taken.
• Home Telehealth -

“Technology has developed computer and computer cameras to help the elderly in their homes stay safe and healthy. Home telehealth-set up by medical professionals in the home--enables providers to monitor such things as medications and blood pressure and actually see the patient. Patient questions are answered and advice is given, while the monitoring nurse views through the video phone how his or her patient looks physically.” The 4 Steps of Long Term Care Planning, Pg 92

• Home Care Agencies – Home care companies offer a variety of service options in helping families care for and properly dispense medication to their elder parents.

Overmedication or taking medication incorrectly may lead to early mental confusion and decline in health in seniors. “If medication problems were ranked as a disease in cause of death it would be the 5th leading cause in the United States”. (from article on LongTermLiving)

Live Free Home Health Care offers several solutions to assist you or your loved one with medication compliance. Visit our website at http://www.livefreehomehealthcare.com or call us at 603-217-0149 to learn more.

Tags:   family caregivers, medication errors, overmedication, telehealth

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Tuesday, September 29, 2009

Keeping Mom and Dad Safe at Home

Generally, elderly parents want to remain living in their own home. However, remaining in the home becomes a concern when children see their parents slowing down, perhaps even having trouble with handling stairs and doing general daily activities. Yet, with parents' mental and physical health currently not creating problems, there seems to be no imminent need to search out support services or other accommodations for aging parents.

This is now the time to evaluate the home to make it safe and secure for your loved ones -- now and in the near future -- in anticipation of aging disabilities that may occur. Help and support are available. The nation as a whole is more aware of elderly needs and services and products are becoming available at an outstanding pace.

The Bureau of Labor Statistics states,

“Employment of personal and home care aides is projected to grow by 51 percent between 2006 and 2016, which is much faster than the average for all occupations. The expected growth is due, in large part, to the projected rise in the number of elderly people, an age group that often has mounting health problems and that needs some assistance with daily activities.” Bureau of labor Statistics-Occupational Outlook Handbook, 2008-09 Edition

This growing need for aides and services also encompasses

• home remodeling services -- making a home more serviceable to the elderly;
• safety alert systems and technology;
• motion sensors to monitor movement;
• telehealth services -- using home-based computer systems for the doctors office or a nurse to monitor vital signs and
• even a pill dispenser that notifies when it is time to take medication.

Where do you begin to make sure your elderly family member is safe and managing well in his or her home?

Visit often and at different times of the day and night. Make note of daily activities that appear challenging and where changes might be made to add safety and convenience. Remove rugs that slide -- causing a fall -- and move furniture with sharp edges. Set the water heater at a lower temperature. This will protect their older sensitive skin from scalds and burns. Be sure smoke detectors and carbon monoxide detectors are in place.

Bathrooms are a hazard area for the elderly. Grab bars by the toilet and shower are a must to help prevent falls. There are easy to install bars at your local hardware store if you want to do the work yourself. Another item that is good to have is a shower stool or chair.

If you are not sure of what needs to be done, consider hiring a professional. There are companies that specialize in home remodeling and accommodation for seniors. Michelle Graham of Accessible Design by Studio G4 says about senior home remodel projects,

“The main thing we incorporate in all of our projects is a careful study of needs and potential needs that may develop throughout a client's lifespan.”

Keep in mind what future home adjustments might be needed for your parents to “age in place” in their home.

Home safety or medical alert companies provide GPS-based bracelets or pendants to track the elderly at home who tend to wander. Or the companies may provide alarm devices such as pendants or bracelets which allow the elderly to alert someone if there has been a fall or a sudden health-related attack. In the event an alarm has been triggered, a 24 hour monitoring service will alert the family or medical emergency services or call a neighbor depending on previous instructions. In addition there are companies that will install motion sensors in the home to monitor the elderly on a 24 hour basis.

Don't forget your parents' community as a valuable resource for helping them stay in their home. Take Margaret Muller as an example. At 82 years of age, Margaret lives alone in her small home. She manages very well with the help of her local Senior Center. The Center's “Senior Companion” program sees that Margaret is taken to the store for groceries and other needs and checks in with her often to see how she is doing. Once a day, the Senior Center delivers a hot healthy meal to her door. Having these services and visits gives Margaret the help she needs and peace of mind that she is not alone.

Neighbors, local church groups, senior centers and city centers are some places to look for assistance. Most of the time there is little or no cost for these services.

Your state aging services unit is a valuable community resource. The National Area on Aging website www.aoa.gov states:

“AoA, through the Older Americans Act and other legislation, supports programs that help older adults maintain their independence and dignity in their homes and communities. In addition AoA provides funding for a range of supports to family caregivers.”

Some of the programs the site lists are:

“Supportive Services and Senior Centers

Nutrition Services

National Family Caregiver Support Program

Grants for Native Americans

Nursing Home Diversion Grants

Aging & Disability Resource Centers

Evidence-Based Disease Prevention

Long-Term Care Planning

Alzheimer's Disease Grants

Naturally Occurring Retirement Communities”

A few thoughts on hiring home care aides or live-in care givers.

The classifieds are filled with people looking for work as aides to the elderly. Many of these aides are well-qualified, honest people who will do a good job; but, of course, there will be some not so reputable. If you are looking to hire someone, be sure you interview and check references and qualifications. You will be responsible for scheduling that person and doing payroll and taxes as well. Be very sure you hire someone trustworthy, as the elderly seem to trust these helpers more than they should and therefore can easily be taken advantage of.

A professional home care service will eliminate your employment concerns. Professionally-provided aides are usually bonded and service is guaranteed. Home care companies take care of the scheduling and payment of their employees. Home care companies cater to the elderly in their homes by offering a variety of services. The National Care Planning Council lists many of these companies throughout the country on its website www.longtermcarelink.net.

These providers represent a rapidly growing trend to allow people needing help with long term care to remain in their home or in the community instead of going to a care facility. The services offered may include:

• companionship
• grooming and dressing
• recreational activities
• incontinent care
• handyman services
• teeth brushing
• medication reminders
• bathing or showering
• light housekeeping
• meal preparation
• respite for family caregivers
• errands and shopping
• reading email or letters
• overseeing home deliveries
• dealing with vendors
• transportation services
• changing linens
• laundry and ironing
• organizing closets
• care of house plants
• 24-hour emergency response
• family counseling
• phone call checks
• and much more.

Thomas Day, Director of the National Care Planning Council states,

“Care in the home provided by a spouse or a child is the most common form of long-term care in this country. About 73% of all long term care is provided in the home environment typically by family caregivers.”

As their caregiver, you can make the difference in the quality of life for your aging parents and if staying in their home is a possibility, you have the resources to make it happen.

The caring, friendly staff at Live Free Home Health Care can help you or a loved one remain safe at home. Give us a call at 603-217-0149 or visit our website at www.livefreehomehealthcare.com.

Tags:   caregiver, home safety, long-term care, medical alert, safety alert, telehealth

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Monday, September 21, 2009

Preventing Dementia

While you can’t control all factors that contribute to Alzheimer’s and other forms of dementia, such as genetics and age, there are many contributing factors that you can control.

An increase in physical activity is shown to decrease the probability of developing many types of dementia. Exercise promotes an increase of blood flow to vital organs including the heart and brain. At least 30 minutes of physical activity such as aerobics and brisk walking can help lower blood pressure. High blood pressure causes damage to blood vessels in the brain. Following the DASH diet (Dietary Approaches to Stop Hypertension) can also aid in lowering high blood pressure. Another advantage of exercise is weight control, which is a crucial instrument in preventing dementia. Being overweight can affect the way the body creates and destroys insulin that may cause brain inflammation.

Alcohol intake is a contributing factor in developing certain forms of dementia, specifically alcohol related dementia, which is one of the top five most common dementias diagnosed in elderly people. Excessive alcohol consumption also worsens psychiatric and intellectual symptoms of dementia. According to many professionals a person that regularly drinks more than one ounce a day should report that to their primary care provider. People with dementia should not drink at all.

It is also very important to continually challenge your mind. Sudoku and other puzzles books are great tools for keeping ones’ mind active. Learning new languages or taking art classes can helpful as well.

Keep in mind that preventative measures are continually emerging so be sure to discuss any lifestyle changes with your doctor.

Tags:   Alzheimer's Disease, dementia

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Friday, September 11, 2009

The Hidden Secret of Elder Abuse

Many elderly people rely entirely on family or other trusted individuals to help them. Whether it is for physical needs or emotional needs, as people grow older they tend to need more and more help from others. This dependence on caregivers or family members makes an older person more vulnerable for abuse.

For example, an older person relying on her children to provide meals and transportation and help her with financial decisions finds it difficult to complain when one of her children takes advantage of her. If, for instance, the child takes her money, hits her or neglects her care, the parent may be threatened with loss of support from the child if the parent complains. The child may also use threats of violence to keep the parent in line.

It is estimated that 5% to 10% of elderly Americans are suffering abuse. According to the National Committee for the Prevention of Elder Abuse,

“Spiraling rates of elder mistreatment are reported by both practitioners and researchers. In a recent national study of Adult Protective Services (APS), typically the agency of first report concerning elder abuse, there were 253,421 reports of abuse of adults age 60+ or 832.6 reports for every 100,000 people over the age of 60 (Teaster, Dugar, Otto, Mendiondo, Abner, & Cecil, 2006). The National Elder Abuse Incidence Study (National Center on Elder Abuse, 1998) found that more than 500,000 persons aged 60+ were victims of domestic abuse and that an estimated 84% of incidents are not reported to authorities, denying victims the protection and support they need.”

Much attention has been focused on abuse in nursing homes but most of the elder abuse in this country is at the hands of family members or other caregivers in the home.

In 2004, Utah Adult Protective Services workers investigated approximately 2,400 allegations of abuse, neglect or exploitation of vulnerable adults. In Utah, a vulnerable adult is defined as an elder adult (65 years of age or older) or an adult (18 years of age or older) who has a mental or physical impairment, which substantially affects that person's ability to protect or provide for themselves. The majority of the victims were females between the ages of 60-89 and 60% of the perpetrators were family members/relatives, while 24% were non-related paid caregivers.

The protective needs identified were as follows:

• self-neglect 31%
• physical abuse 16%
• exploitation 19%
• caretaker neglect 12%
• emotional abuse 19%
• sexual abuse 3%

In conducting the investigations, it was not uncommon to find that adults who were self-neglecting were also being exploited or abused. As stated previously, these statistics are based on approximately 2,400 cases, thus, if only one in ten cases are ever reported, it is possible that there were actually 24,000 or more cases in Utah that year. We suspect 9 out of 10 is close to the actual ratio of unreported versus reported cases in Utah.

We also believe that Utah's lack of reporting elder abuse is not unlike other states in the country. We suspect all the states are experiencing close to the same ratios of underreporting as in Utah.

There are a number of reasons why incidents of abuse, neglect, or exploitation are not reported to Adult Protective Services or other authorities. One of the most common reasons is the victim's fear of losing support. Many of the perpetrators are family members and the victim fears that reporting the crime will result in removal of the caregiver, as the perpetrator may face incarceration or may discontinue relations with the victim once accused, charged, or convicted. Many of these victims fear that by reporting abuse they will be left alone and expected to care for themselves or they will be forced to live in a nursing home.

Many states have implemented mandatory reporting laws to assist in the prevention of abuse, neglect or exploitation of vulnerable adults. Utah is one of the many states to have a mandatory reporting law (U.C.A. § 76-5-111). Utah law states that any person who has reason to believe that a vulnerable adult has been the subject of abuse, neglect, or exploitation shall immediately notify Adult Protective Services or the nearest law enforcement agency. Anyone who makes the report in good faith is immune from civil liability in connection with the report; however, any person who willfully fails to report is guilty of a class B misdemeanor.

It is important to note that the anonymity of the person or persons making the initial report and any other persons involved in the subsequent investigation shall be preserved and may only be released in accordance with the rules of the division (U.C.A. § 62A-3-311). In addition, all investigation information is confidential.

The following is a list of indicators of abuse, neglect or exploitation. It is important to note that the following lists are merely indicators and may not always be violations.

Signs of Abuse:

• Unexplained bruises, welts, fractures, abrasions or lacerations
• Multiple bruises in various stages of healing
• Multiple/repeat injuries
• Low self-esteem or loss of self determination
• Withdrawn, passive
• Fearful
• Depressed, hopeless
• Soiled linen or clothing
• Social Isolation

Signs of Neglect/Self-Neglect:

• Dehydration
• Malnourishment
• Inappropriate or soiled clothing
• Odorous
• Over/under medicated
• Deserted, abandoned or unattended
• Lack of medical necessities or assistive devices
• Unclean environment
• Social Isolation

Signs of Exploitation:

• Missing/"disappearing" property
• Inadequate living environment
• Frequent/recent property title changes or will changes
• Excessive home repair bills
• Forced to sign over control of finances
• No/limited money for food, clothes and other amenities

Prevention can only occur if there is awareness, the statutes are adhered to, and any suspicions of abuse, neglect or exploitation of vulnerable adults are immediately reported to Adult Protective Services and/or law enforcement.

All states have agencies that receive complaints of abuse. In some states failure to report abuse of the elderly is a crime. To contact an abuse complaint department, call your local area agency on aging. To find an area agency on aging in your area go to http://www.longtermcarelink.net/eldercare/ref_state_aging_services.htm

Tags:   caregiver, elder abuse, exploitation, family caregivers, self-neglecting

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Thursday, September 10, 2009

One Stop Shopping for Eldercare Services

A fast-growing generation of elderly people, needing care, is starting to put a great deal of pressure on caregiving family members. More and more we are seeing articles and books about the burden of long term care on families.

According to research By the National Care Planning Council, only about 16% of long-term care services are covered by the government. The other 84% are provided free of charge by family caregivers or provided by services paid out-of-pocket by families or from those receiving care. And the bulk of government care services are provided only after a care recipient has depleted all of his or her savings. The Council also estimates that at any given time approximately 22% of the population over age 65 is receiving some form of long term care support. About 44.4 million adult caregivers provide 21 hours a week of care with 4.3 years average time spent providing care.“National Care Planning Council”

Dilemma of Finding Eldercare Services

The need for care usually occurs without warning, when a stroke, heart failure or other medical condition or illness incident to age suddenly happens to an aging senior. Family members end up in panic mode trying to understand and educate themselves on what needs to be done and what resources are available. If they need to take time from work to handle the crisis then it becomes urgent to find answers and solve caregiving needs. The need to balance work with urgent caregiving responsibilities creates untold stress on employed family caregivers.

Most family caregivers simply don't know where to turn for help and advice.

Long term care services are complicated and provider contacts are fragmented throughout the community. For the majority of Americans, eldercare becomes a frustrating do-it-yourself process. How do you find out what government services are available and what they will pay for? What legal documents are necessary and how do you protect assets? What type of home care or facility care is needed? Should you quit your job to become the caregiver? Will the government or insurance pay you for caregiving to help replace your lost income?

The question often arises as to whether to use long term care professionals or go it alone in arranging care and services.

“Using care professionals is the most cost effective and efficient way to provide help for a loved one. Hiring professional advisers or providers to help with long term care is no different than using professionals to help with other complex issues such as car repairs, dealing with taxes, dealing with legal problems, or needing trained employees to help run a business. With their education and training, long term care professionals also bring experience that only comes from dealing with countless hands- on caregiving challenges”. “The 4 Steps of Long Term Care Planning”

One Central Source for Locating Help and Advice

The National Care Planning Council recognizes the need for family caregivers to educate themselves and find the needed resources and professional help quickly.

To fill the need for caregivers nationwide, the National Care Planning Council web site "Long Term Care Link", was developed as a comprehensive resource for long term care planning. There are hundreds of pages containing articles on long term care covering all aspects of caregiving and care services. Books are also available on how to plan for long term care and how to apply for your veterans benefits for long term care. NCPC books

If you are looking for government and community resources, there are lists with applicable website links. Some of those lists include National and State Area Agency on Aging Services, Senior Centers and Veterans Service Offices.

There are over 100 links to websites filled with reference materials. For example; the Gerontological Society of America, National Nursing Home Survey, Elder Law Answers, Senior Corps.

Find Eldercare Professional Service Providers in Your Area

The National Care Planning Council lists eldercare specialists and advisers who help families deal with the crisis and burden of long term care. These specialists can be found under the services category lists like the ones below, on the website. Each professional is listed under the State and area in the State that he or she services. A caregiver can go to the National Care Planning Council website and find someone in the area of need and read about the services of the listed company, individual or facility. Website visitors needing help can then call, email or fill in a request form to receive contact from a listed provider.

Listing categories on the website include the following specific services.

• Care Management, Guardianship, Conservatorship and Dispute Resolution
• Non-Medical Home Care
• Home Health Agency – Medicare-Covered Home Care and Hospice
• Home Maintenance, Deep Cleaning, Remodeling and Yard Work
• Veterans Benefits -- Consultant for the Aid and Attendance Pension Benefit
• Geriatric Health Care Practitioner or House Call Doctor
• Reverse Mortgage Specialist
• Elder Law Advice and Medicaid Advice
• Estate Planning, Tax Planning, Trust Management Services and End-Of-Life Planning
• Care Facility or New Home Search, Relocation, Downsizing and Real Estate Services
• Adult Day Care Services
• Insurance Products, Retirement Planning and Financial Advice
• Funeral & Burial Preplanning

THE NATIONAL CARE PLANNING COUNCIL INTRODUCES ITS STATE CARE PLANNING COUNCIL WEBSITES

A state care planning council is an informal statewide alliance of eldercare specialists and advisers that helps families deal with the crisis and burden of long term care. When you go to your state care planning website, your search for help is right in your neighborhood.

Purpose of the State Care Planning Council

1. Educate the public on the need for care planning before a crisis occurs.
2. Provide, under one source, a list of providers representing most of the available government and private services for eldercare.
3. Offer a trusted team of providers and advisers that the public will recognize in their area and can turn to for expert help in dealing with the challenges of long term care.

One Stop Shopping for Eldercare Services

State Care Planning Council websites offer a closer-to-home option for finding help and services to solve caregiving problems. Many of the local service providers work together as a team to help meet specific eldercare needs of the individual.

For example:

Tim and Debra, both in their late 80’s, were adamant about staying in their home. Both were taking medications and were mobile with walkers. Their daughter, Julie was concerned about their safety in the home, especially with avoiding hazardous falls, bathing and preparing meals. Tim insisted he could drive his car, even though he was a hazard on the road. Julie had taken the car keys and therefore faced an argument every time she went to their home.

Lately, Julie noticed that the required medications were not being taken. Tim was a diabetic and required monitoring with his insulin and diet. Julie ordered “Meals on Wheels” which her mother quickly canceled. Frustrated at having no cooperation from her parents, Julie realized she needed outside help.

Checking the internet for resources in her area, she found the name of a Professional Care Manager in her area listed on her State Care Planning Council website. Jackie -- the professional care manager and family dispute professional -- had worked many times with families like Julie and her parents.

A meeting was arranged where all parties to the caregiving were involved. Tim expressed that he did not want to give up his freedom driving to the store or other places he liked to go. Jackie suggested selling the car and using the money to pay a taxi or community transit. She arranged for Tim to see a geriatric physician to get his diet under control for his diabetes. Some in-home help with bathing, meal preparation and medication reminders was arranged by having a local non-medical home care company come in daily. Jackie gave Julie explicit instructions on how to organize the house to help prevent falls. To pay for the extra expense, Jackie introduced a reverse mortgage broker who explained how their home equity-- on a risk-free basis --could provide the money they needed for their care.

Every service provider or adviser Jackie brought in worked side-by-side with her on the state care planning council. Jackie knew they could provide the needed help with expertise and integrity.

Julie found that using professionals gave her peace of mind and confidence that her parents' care was in good hands.

The State Care Planning councils are just starting to grow and be populated with professional service providers throughout the Untied States. Like the National, the State websites are filled with resource material and articles for the public use.

Locate a State Care Planning Council at http://www.longtermcarelink.net/a15state_councils.htm

If you or a loved one would like more information or assistance in obtaining home care contact Live Free Home Health care at 603-217-0149 or visit our website at www.livefreehomehealthcare.com.

Tags:   caregiver, eldercare, family caregivers, home care, long-term care

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