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

Thursday, October 29, 2009

Holiday Blues - Depression in the Elderly

The holiday season is quickly coming upon us. If you are a caregiver for an elderly loved one, you may notice a change in your loved one's mood as the holidays approach. Perhaps you are one of many, who visit elderly parents and family during the holidays who live a distance away. When you visit you may notice that loved ones are not as physically active, or they show symptoms of fatigue or sadness and have no interest in the holiday or in their surroundings.

According to the National Institutes of Health; of the 35 million Americans age 65 or older, about 2 million suffer from full-blown depression. Another 5 million suffer from less severe forms of the illness. This represents about 20% of the senior population -- a significant proportion.

Depression in the elderly is difficult to diagnose and is frequently untreated. The symptoms may be confused with a medical illness, dementia, or malnutrition due to a poor diet. Many older people will not accept the idea that they have depression and refuse to seek treatment.

What causes depression in the elderly?

It is not the actual holiday that causes depression, but the fact that holidays tend to bring memories of earlier, perhaps happier times. Additional contributing factors that bring on depression may be the loss of a spouse or close friend, or a move from a home to assisted living, or a change with an older person's routine.

Depression may also be a sign of a medical problem. Chronic pain or complications of an illness or memory loss can also cause depression. In addition, diet can also be a factor when proper nutrition and vitamins are lacking.

As an example, Selma’s husband passed away, a few months before Christmas. Her family lived close by and would call or drop in often to check on her. Selma seemed a little preoccupied and tired, but this was to be expected as she had been the caregiver for her husband for many years. It wasn’t until the family noticed that her holiday decorations were not out and her yearly routine of Christmas card writing was not happening that they began questioning her mental and physical well being.

A trip to her physician confirmed depression, caused by not only the loss of her spouse, but a vitamin B12 deficiency. There were both mental and physical reasons for her depression.

Symptoms to look for in depression might include:

• Depressed or irritable mood
• Feelings of worthlessness or sadness
• Expressions of helplessness
• Anxiety
• Loss of interest in daily activities
• Loss of appetite
• Weight loss
• Lack of attending to personal care and hygiene
• Fatigue
• Difficulty concentrating
• Irresponsible behavior
• Obsessive thoughts about death
• Talk about suicide

How do you know if it is depression or dementia?

Depression and dementia share similar symptoms. A recent article on Helpguide.org gives some specific differences:

In depression there is a rapid mental decline, but memory of time, date and awareness of the environment remains. Motor skills are slow, but normal in depression. Concern with concentrating and worry about impaired memory may occur.

On the other hand, dementia symptoms reveal a slow mental decline with confusion and loss of recognizing familiar locations. Writing, speaking and motor skills are impaired and memory loss is not acknowledged as a being problem by the person suffering dementia.

Whether it is depression or dementia, prompt treatment is recommended. A physical exam will help determine if there is a medical cause for depression. A geriatric medical practitioner is skilled in diagnosing depression and illnesses in the elderly. If you are a care taker of an elderly person it may be beneficial for you to seek out a geriatric health care specialist. For more information on senior health services go to http://www.longtermcarelink.net/about_senior_health_services.htm or visit our website at www.livefreehomehealthcare.com.

Treating depression in older people.

Once the cause of depression is identified, a treatment program can be implemented. Treatment may be as simple as relieving loneliness through visitations, outings and involvement in family activities. In more severe cases antidepressant drugs have been known to improve the quality of life in depressed elderly people. Cognitive therapy sessions with a counselor may also be effective.

As a care giver or family member of a depressed older person, make it your responsibility to get involved. The elder person generally denies any problems or may fear being mentally ill. You can make the difference in and remove the Holiday Blues from seniors suffering from depression.

The Geriatric Mental Health Foundation offers a “Depression Tool Kit.” To read more about the tool kit and depression in the elderly go to http://www.gmhfonline.org/gmhf/consumer/depression_toolkit.html

Tags:   caregiver, dementia, depression, holiday blues

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Thursday, October 22, 2009

Communicating Effectively With Someone With Alzheimer’s

Caring for an individual with Alzheimer’s disease isn’t always a walk in the park; in fact, it can be downright stressful. Between memory loss, repetitive questions, false thinking or aggressive behaviors, each day often brings new challenges.

A person’s understanding of the disease as well as their attitude about the illness can have a large impact on the way day-to-day caregiving responsibilities are managed. Just because this illness has taken over someone close to you, it doesn’t have to conquer you as well.

So what do you do when your loved one blames you for something you didn’t do or becomes paranoid that you are plotting against him or her? How about when someone sees objects that aren’t there or says things that simply don’t make any sense?

If your first instinct is to try to orient the person back to reality, you are not alone. Many caregivers spend endless hours trying to prove who they are, where they are and what they are doing, but to no avail. They mistakenly believe that just by showing family photos or having other family members confirm information that the person with Alzheimer’s disease will catch on and it will become clear for them. Even though the caregiver’s heart is in the right place, these efforts most often do not succeed. Their loved ones may continue to press the issue, and even become angry or hostile at the “evidence” presented to them.

Fortunately, there are ways to manage daily challenges in order to minimize a caregiver’s stressful feelings and improve the odds that an individual with dementia will respond positively.

One of the best approaches to use with people with dementia is Validation - a technique that confirms their right to feel a certain way and express their emotions regardless of the situation. The validation theory, developed by Naomi Feil, suggests that an individual could be revisiting past events or trying to solve unfinished business. This helps explain why some people feel the need to go to work years after they retire or pay off a debt from decades ago. By validating their experience, you are meeting them where they are and sending a message that you still accept them no matter what.

Another powerful approach to utilize is redirection-a behavioral intervention that shifts the individual’s focus, by distracting the person or moving away from an undesired topic or behavior to something more pleasant. Here are some examples:

When your mother says, “I want to go home!” Instead of saying “This is your home! Don’t’ you remember? You’ve only lived here for 30 years!” Try Saying “Of course you want to go home! Your house was the prettiest on the block. Why don’t you tell me about those tulips you planted in your front yard?” Why? Memory impairments and disorientation can cause people to forget where they are. When they want to go “home,” it really signals a desire for a sense of safety and familiarity. Bring mom “home” by reuniting her with her favorite memories of what home represents.

When your wife says, “Get away from me, you’re not my husband!” Instead of saying “But I am your husband! Look at our matching wedding rings. You know, you really upset me when you don’t remember who I am.” Try saying “You must love your husband very much. I can tell by the way you talk about him. Why don’t you tell me about your wedding day?” Why? Memory loss can cause individuals to forget even their closest loved ones. When your wife becomes agitated, respect her space, validate the love she feels for her spouse, and allow her to talk about “him” while you are sitting right beside her. Even though she may have forgotten you today, hearing her talk about you will demonstrate that you are still very close to her heart.

When during meals, your father refuses to eat and says, “You’re trying to poison me.” Instead of saying “That’s ridiculous! Why would I ever do such a thing? Eat your meal and stop making up crazy stories!” Try saying “Dad I understand you are feeling afraid, but I want you to know that I would never let anything bad happen to you. You are safe with me. By the way, this meatloaf is delicious. I am having a big plate of it myself. Let’s have some together and you can tell me all about the fishing trip.” Why? It is difficult, if not impossible to rationalize with people with dementia. Instead of trying to orient Dad back to reality, instill a sense of safety, and demonstrate it by eating the same meal as him or taking a bite from his plate. Once you’ve established trust, you can quickly refocus him by shifting the conversation to something more pleasant, such as a fun day he had by the docks.

When your sister says, “You stole my money! Give it back!” Instead of saying “I’m sick of you accusing me every time you hide your money. You stuffed it in your drawer five minutes ago. I saw you do it, so stop blaming me.” Try saying “Oh no, your money is missing? I can see why you’re upset. Well, don’t you worry because I am going to help you look for it.” Why? It is common for people with dementia to hide items and forget where they are moments later. Since it can be embarrassing to admit this, individuals sometimes accuse others to take the focus off themselves. Rather than trying to deflect blame, simply let your sister know that you understand how she feels and that you understand how she feels and that you want to help her resolve the situation. Then walk her over the drawer and ask her to open it. When your sister finds her money, allow her to take pride in finding it all by herself.

When your grandmother says, “I have to leave now. I need to pick up Jimmy from school.” Instead of saying “Grandma, Jimmy is a grown man. He’s 60 years old. You’re not going anywhere.” Try saying “Oh Grandma, you have always been such a loving mother to Jimmy. Why don’t you come with me to get a drink of water and tell me all about what you love to do with Jimmy after school?” Why? People with Alzheimer’s disease often live in the past by re-creating experiences that happened long ago. Despite the fact that Grandma hasn’t picked Jimmy up from school in decades, her maternal instinct is still very strong, and she feels an urgency to follow the same routine she did while he was growing up. Take this as an opportunity to reunite your grandmother with those happy memories: while you are distracting her from going to the front door, she will tell you all about those wonderful times she had with Jimmy and will forget about wanting to leave.

When your uncle believes he’s still at work. He treats you like an employee and tells you he needs the paperwork finished by the end of the hour. Instead of saying “Are you still starting with that nonsense again? You retired in 1985. How many times do I have to keep reminding you?” Try saying “You really run a tight ship around here! I guess that’s what makes you such a good boss. I’ll make sure to get the paperwork to you, but I could use a little help. Can you assist me with one of the documents?” Why? It’s not uncommon for people with Alzheimer’s disease to strongly affiliate with important roles they have taken on in the past. The fact that your uncle thinks he’s at work suggests that a job is still very meaningful to him. Use this moment to create an activity that can contribute to a sense of purpose. Bring him a phone bill or other document and allow him to “help” you interpret it. Support his efforts and remind him what a great boss he has always been.

Tags:   Alzheimer's Disease, caregiver, communication, dementia

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Tuesday, October 20, 2009

Get Ready for Grooming

Most people take great pride in maintaining their appearance. For individuals with Alzheimer's disease or related dementias, grooming tasks that were once simple such as combining hair, shaving and brushing teeth can become extremely complex ordeals. They may look at a comb or razor and have no idea what to do with it; they may have lost their ability to sequence tasks; or they may be experiencing emotions like fear, resistance or anxiety that can sabotage their personal care efforts. These tips can help ease the process:

• Ensure a proper setting. An environment conducive to the activity at hand can help boost a person's concentration and cooperation. Make sure the area is a comfortable temperature, is free of distractions, and has plenty of light. Also remember that privacy counts.
• Adjust grooming tools. Making the switch to safer, more effective supplies can help prevent injuries and simplify the process. Options include using an electric shaver as opposed to a traditional razor. You can also purchase items like foam grips for toothbrushes and hair washing trays or try different products like dry shampoo.
• Develop a routine. Try to perform tasks in the same order and at the same time each day. Also, doing familiar activities can be comforting to someone with Alzheimer's disease. Also consider continuing past habits. If someone is accustomed to going to the barber or beauty shop every week, keep it up if possible.
• Keep it simple. The ability to multi-task is difficult for someone with Alzheimer's disease. So it is likely to be easier to accomplish a task by telling a person what to do one step at a time, using a quiet, calm tone and smiling.
• Demonstrate techniques. Visual cues can move the process along, especially when communication skills diminish. Illustrate what to do with a comb by combing your own hair, or with a toothbrush by brushing your own teeth. Then encourage the person to copy your behavior.
• Build on a person's strengths. Encourage the person to handle self-care that is still withing abilities and do not show discouragement or lose patience if the task cannot be performed. Teamwork may be helpful. Perhaps you need to apply the toothpaste, but then the person with dementia can carry out the brushing.
• Eliminate surprises. Explain what you are doing if you have to complete a task for the person with dementia. Say "I'm going to cut your nails."
• Select favorite items. Let the person select and apply preferred products, such as cologne, make-up or toothpaste. Giving an individual with dementia input adds an element of independence.
• Be creative. A technique that worked one day may backfire the next. This is due to the progressive nature of the disease. You have to be creative in your approach. For example, one study found it effective to use wet wash clothes or to pour water from a pitcher rather than use a spray to rinse a person's hair.
• Be patient. Understand that the activity may take a while so be sure to allow enough time. Rushing the process can stress both you and the person you are caring for.
• Set realistic standards. Recognize that perfection is not always possible. If shaving becomes to difficult, for example, it's okay to grow a beard. If necessary, skip the non-essential tasks in favor of concentrating on crucial grooming like oral hygiene.
• Prepare in advance. Have everything ready for grooming before hand. The right supplies can limit confusion, simplify grooming and reduce stress.

For more information on caring for a person with Alzheimer's disease or dementia visit our website at http://www.livefreehomehealthcare.com.

Tags:   Alzheimer's Disease, communication, dementia, grooming

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Wednesday, October 14, 2009

Long Term Care

(Plymouth – Oct 5, 2009) – Long-term care is a subject of growing importance in today’s aging society, since according to the American Society on Aging, after age 65, a full 70 percent of Americans will need some form of long-term care. Not only will long-term care solutions be a major issue for the parents of baby boomers who are now in their 70s and 80s, but baby boomers as well will need to plan for their own long-term care needs.

Live Free Home Health Care, LLC is raising awareness in the local community about long-term care needs and services because we understand the importance that education and planning make in positive outcomes. Too many individuals underestimate both the risk and costs related to long-term care options, or believe the government will cover their needs. Taking action now may enable an individual or couple to experience greater dignity, control and independence over how future care needs are met.

“I’m often asked if Medicare will cover all long-term care costs for seniors and the disabled,” said Jason Harvey, Co-Administrator of Live Free Home Health Care, LLC. “It’s amazing how many people think that, but the answer is, unfortunately, no.” Medicare, a federal health insurance program for disabled adults and adults age 65 and older, has specific rules that apply for payment of care, and the coverage is very limited in scope. “Most people don’t know that Medicare is not intended to cover long-term care,” added Harvey.

There are options available to finance long-term care, though, including:

• A private health insurance or retirement health plan specific to long-term care
• An individual’s own income, savings or sale of other assets
• The family home as collateral for a reverse mortgage
• Veterans; programs for eligible Veterans and spouses
• Care from children/relatives on an informal basis
• Medicaid, a public medical assistance program for people with low incomes and limited financial resources
• County/local resources aimed at keeping people out of nursing homes (where available)

It is very important to plan in advance when it comes to financing long-term care needs. To compare the costs of nursing home care, assisted living and home health care by state, a useful long-term care calculator is available at http://longtermcareinsurance.org/carecalculator.html.

Preparing a long-term care plan may seem daunting, but will help alleviate the burden if and when the time comes and it is necessary. Key areas to consider when developing a long-term care plan are as follows:

• Communication with family and friends
• Comparing and understanding long-term care insurance options
• Decisions on who can be counted on for help
• Establishing clear legal directions
• Focusing on available finances
• Learning what is offered in the community
• Making necessary home improvements
• Taking control of health and personal needs

In addition to providing in-home care services, Live Free Home Health Care, LLC also offers long-term care planning resources and help in coordinating community services outside of the usual home care setting. For more information about when home care is appropriate to help meet long-term care needs, please contact Live Free Home Health Care, LLC.

About Live Free Home Health Care, LLC

Serving Central New Hampshire and the Lakes Region, Live Free Home Health Care, LLC is dedicated to providing top quality care in the comfort of home as an alternative to assisted living facilities or nursing homes. Family owned and operated, Live Free Home Health Care offers a wide range of services, from companion care and assistance with activities of daily living to skilled nursing, and all care is supervised and updated by a registered nurse. Live Free Home Health Care also offers medical alert systems to provide extra peace of mind should an emergency care need arise. Whether the need is for short or long term care, Live Free Home Health Care’s compassionate staff promises to treat each client respectfully and like a cherished family member. For further information, contact (603) 217-0149 or visit www.LiveFreeHomeHealthCare.com.

Tags:   communication, in-home care providers, insurance, long-term care

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Tuesday, October 13, 2009

Planning for Your Elder Years

If we were to ask an older person what his or her most important concerns for aging are, we would probably get a variety of different answers. According to surveys frequently conducted among the elderly, the most likely answers we would receive would include the following three principal concerns or life wishes:

1. Remaining independent in the home without intervention from others
2. Maintaining good health and receiving adequate health care
3. Having enough money for everyday needs and not outliving assets and income

To address these concerns or wishes and maintain the quality of life wanted in the elder years, it simply takes a little preplanning.

Few people do this kind of planning.

It is human nature not to worry about an event until it happens. We may prepare financially for unexpected financial disasters by covering our homes, automobiles and health with insurance policies.

However, no other life event can be as devastating to an elderly person’s lifestyle, finances and security as needing long term care. It drastically alters or completely eliminates the three principal lifestyle wishes listed above.

The majority of the American public does not plan for this crisis of needing eldercare. The lack of planning also has an adverse effect on the older person's family, with sacrifices made in time, money, and family lifestyles.

Because of changing demographics and potential changes in government funding, the current generation needs to plan for long term care before the elder years are upon them.

Let us look at some facts.

• The population of the "very old,"--older than age 85--is the fastest growing group in America. This population is at highest risk for needing care. (Statistical abstract of the United States, 2008, population)
• Medical science is preventing early sudden deaths, which means living longer with impaired health and greater risk of needing long term care.
• The Alzheimer's Association estimates the risk of Alzheimer's or dementia beyond age 85 to be about 46% of that population.
• It is estimated that 6 out of 10 people will need long term care sometime during their lifetime.
• Children are moving far away from parents or parents move away during retirement making long distance care giving difficult or impossible.
• Government programs--already stretched thin for long term care services--will experience even greater stress on available funds in the future.

One of the important things for planning is how to maintain your lifestyle as you age. You may be healthy enough to stay in your own home with help provided for the following activities of daily living:

• maintaining a home,
• providing meals,
• supervision,
• companionship,
• transportation and
• shopping services.

This type of care at home is non-medical and must be provided free of charge by family, friends, or volunteers or the care must be paid for out-of-pocket by the family.

Government programs, in most cases, will not pay for this kind of care. It is estimated that 80% of all long term care is non-medical, with 90% of that care provided in the home. It is most likely that your long term care will begin with home care.

It is wise to plan now how you will pay for care when it is needed. In evaluating your future income you may find it necessary to add some resources such as long term care insurance to pay for assisted living or nursing home costs. Long term care insurance must be purchased while you are younger and healthy. Failing health, stroke or other aging issues will not allow you to qualify for this insurance.

A reverse mortgage will also help pay for home care if staying in your home is an option.

Consider where you may want to live in your elder years. Many assisted living facilities offer complete care alternatives with a nursing home wing if needed. Senior retirement communities also offer many amenities with some including home care options.

Now is the time to do estate planning. A professional estate planner will give you direction on how best to protect your assets for future needs and for Medicaid planning.

Do your paper work. Now is the time to create your trusts, will, medical directives in a living will and any other documents you want noted for future use. Gather insurance policies and bank records where they can be found by family members in case you are not able to get them yourself.

We don’t like to think of our elder years in terms of health problems, but a sudden stroke, heart failure or onset of dementia could make it impossible to carry out our own wishes if preparation was not made ahead of time.

The process of long term care planning involves the following four principles:

1. Knowledge and preparation are the keys to success.
2. Having funds to pay for care expands the choices for care settings and providers.
3. Using professional help relieves stress, reduces conflict, and saves time and money.
4. Success is assured through a written plan accepted by all parties involved.

(The above excerpt is quoted from "The 4 Steps of Long Term Care Planning," National Care Planning Council)

The National Care Planning Council' s website -- www.longtermcarelink.net -- provides over 700 pages of information for long term care planning and lists services of professional care providers in estate planning, long term care insurance, reverse mortgage, home care and many other important long term care services.

The National Care Planning Council' s book, “The 4 Steps of Long Term Care Planning,” provides information on what Medicaid and Medicare will cover as well as an overview of professional long term care service providers and how their services can help you create and execute your long term care plan. A check list of what to do to create a plan and forms for creating necessary paperwork are also included in the book.

You can also visit Live Free Home Health Care for more information.

Tags:   home care, insurance, long-term care

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