Tuesday, January 27, 2009

The risk of wandering in Alzheimer's

In today’s newspaper I saw two reports of seniors freezing to death in the cold spell that has trapped much of the country.

Yesterday I was editing a caregiver course on the topic of wandering, so maybe I was especially aware of this topic.

In one report in the Chicago Tribune, the two people in the story actually died right outside their residences. One was a younger woman who slipped and fell, and, with a broken leg, was unable to make it to the door of the house where her ex-husband and sons were sitting, warm, cozy and unaware, just inside. The other was an elderly person who died on the sidewalk outside the assisted living community where he lived.

Researching the topic of seniors with Alzheimer’s or memory loss wandering away and becoming lost, it was clear to me that this is an event that happens all too often in our country.

It is an opportunity for inventors and makers of tracking devices and alarms. Sensors, monitors and all sorts of tools exist to help us keep these vulnerable people safe.

Sometimes, though, it’s like all the guards, sensors and razor-topped fences at the maximum security prison. Pretty effective for most of the residents, but never, ever, 100% guaranteed safe.

Stories like those I read today make my stomach knot up. I can’t imagine how the families must feel, or the staff who didn’t know the person was outside and missing for too long.

What is do know is that good training, for families, caregivers and managers, is one of the best wandering tools available. Knowing how to keep the person busy and engaged so he doesn’t try to get out; offering frequent walks with a companion; having a regular check-in system to keep track of people throughout the day; knowing what to do the minute you identify someone as missing – no amount of razor wire can protect you as well.

I believe in training because I’ve seen the difference it can make in outcomes of care. And I believe that, in this country, in this century, the least we can do is everything we can possibly do to prevent the tragedy of a missing loved one for just one more family.

Wednesday, January 21, 2009

Senior care providers contributing to the change

More than just caregiving is at a crossroad today.

We’ve got a new President. We have unlimited potential, and new leaders throughout government.

It’s a breath-taking moment of possibilities; an exciting time to be alive as we witness history being made.

As my friend Patrick commented yesterday during the inauguration, “The hope is palpable and we believe a change can take place. WE WILL make sure to contribute to that change!”

Change is in the very air today. Change in how we view one another; how we care for each other.

There are many aspects of our society that need changed. We need to change the way we as a society care for our elders, and even more importantly the way we care for those who directly provide the care.

We need to honor and respect those who choose caregiving as a profession.

We need to recognize that as our society ages it is ourselves – our mother, fathers and our husbands and wives – who will need care.

We need to commit to train enough people to become caregivers – nurses, doctors and aides – so that we don’t have a shortage of providers.

We need to express our appreciation for these skills, by raising geriatric physicians below the lowest paid specialty, for example. By opening our eyes to new approaches to train the many people wanting to become nurses but who cannot get into any current programs because of severely limited instructional capacity, at the same time we have a nursing shortage that approaches a crisis in some parts of our country. By raising the wages and benefits of nurses aides and direct care workers in homes and care settings.

We are at a crossroad in our country. We have a choice to continue business as usual, or to join my friend Patrick in saying, “WE WILL contribute to that change!”

Friday, January 16, 2009

Caring for a senior parent is simpler with a medical alert system.

Guest posting by Igor Mordkovich, LifeStation, Inc.
The role of a primary caregiver to an elderly parent is not an easy job, especially when you can’t be with them all the time. Constantly worrying about their safety and wellbeing can take a toll on a caregiver so any bit of help counts.

“More than 90% of hip fractures among adults ages 65 and older are caused by falls”… reported by CDC

SeniorCarePharmacist.com reports

“More than 11 million seniors - one of every three - will fall this year (Sattin 1992; Tinetti, Speechley, and Ginter 1988), and approximately one in 10 of those falls will result in a serious injury such as a hip fracture or head injury (Tinnetti 2003). More than 500,000 seniors will suffer hip fractures annually by 2040 (Cummings, Rubin, and Black 1990).”

For many years, medical alert systems have helped caregivers gain valuable peace of mind knowing that their parents can get assistance 24 hours a day by simply pushing their medical alert emergency button. This works well for situations when they simply can’t reach their phone to call for help.

The operation of a medical alert system is incredibly simple. The user can wear a portable help button around their neck, wrist or on a belt clip. The button is waterproof, allowing a senior to be protected even when taking a shower. In case of a fall, heart attack or any emergency situation, the user can simply press their emergency button and within moments an operator from the medical alert company will come on the line via the console’s hands free speakerphone. After assessing the situation, the operator will contact neighbors, relatives or local EMS personnel if needed.

This service has saved thousands of lives and given caregivers the comfort they desire. With the rapid pace of daily living, we cannot be with our parents all of the time. Having a medical alert system provides safety for the user and peace of mind for the caregiver.

There are a number of companies that provide medical alert monitoring services. An excellent article to read is the one published by LifeStation medical alert company on how to choose the best medical alert provider.

Monday, January 12, 2009

Aging and healthcare: an impending crisis

A news article titled “Here come the seniors” caught my eye today. It describes the challenges for the health care industry as all of us boomers age and need more medical care.

More importantly, however, it outlined solutions. Here’s how it starts:
The silver tsunami. The age wave. The graying of America. Whatever cliché you want to use, the strain that the aging baby boomer population will place on the healthcare system in the near future has been well-documented and thoroughly discussed. Yet the industry as a whole remains surprisingly unprepared to care for a wave of new elderly patients who may fill as many as two-thirds of hospital beds in the next 30 years.

So that’s the problem, in a nutshell. Here are some of the recommended solutions:

Success Key No. 1: Look downstream
Tie in acute hospital care with other services like long-term care, hospice care, outpatient care and fitness programs.

Success Key No. 2: New models of care
The ACE program in Cleveland, OH, is a model for senior care that not only treats the whole person using an interdisciplinary approach, and incorporates principles of patient-centered care. It’s a program that is effective in reducing hospital and long term care stays – both things that seniors would applaud.

Success Key No. 3: Coordinate in the community
"One of the biggest challenges with the geriatric population is the handoff; the transition of care," says Barbara Looby, administrative director of senior health services at Crozer-Keystone Health System, a five-hospital system based in Drexel Hill, PA, covering 774 inpatient beds. "What happens when patients leave the inpatient hospital setting to go to an outpatient level of care, whether that's home care or another level of care such as nursing home or assisted living?"

Communication is vital, but so is training. The caregiver providing the care to the patient needs very specific training to ensure that the patient doesn’t end up right back in the hospital. Too often the elderly are discharged out of the hospital to untrained, inexperienced family members who are very willing, but not appropriately trained to provide quality follow-up care.

Success Key No. 4: Train physicians

Currently the US has a little over 7,000 geriatricians (specialists in geriatric medicine). It seems that med students see little reward in this field of practice and they’re right – it is one of the lowest paid specializations. The projected need for geriatric physicians to meet increasing demand is estimated at 36,000 by 2030. Making this more attractive to new, young physicians – and compensating appropriately – must begin happening soon for this need to be met.

Wednesday, January 7, 2009

Changing Nursing Homes and culture of care, one person at a time

December is a very busy month in my office. Many administrators of nursing homes and assisted living communities have a December 31 deadline for renewing their licenses. Many of those get to the end of the year only to find that they're lacking just a few continuing education courses they need for license renewal.

And we get really, really busy meeting those last-minute needs for training.

It's a fun time for us, as we get to talk to one person after another, calling us for help in solving their urgent need. Most of the conversations start off something like this,

"This is really embarrassing, but I need to take an online course that I can finish within the next 2 days. Can you help me?"

The typical caller goes on to explain why he or she left it to the last minute, and why the rush is on to finish so they can keep their license.

This December, I got to personally field more of these calls than usual. An extraordinary amount of snow virtually shut down all traffic to our office. Fortunately, I live close enough so that I could put on 6 layers of ski clothes, boots, hat and goggles, grab my ski poles and walk in to work.

That meant that I also answered the phones.

Here's what I heard:

"Thank you so much for helping me. I was afraid that I wouldn't be able to renew my license this year. It's been such a rough year - my husband died, completely unexpectedly, just 3 weeks ago. My job - my residents and staff - are the only things that keeps me going right now."

This caller and I ended up talking for nearly 20 minutes about life's challenges, and how she was handling them with grace and courage. I was humbled by her story, and proud to be able to help.

Then Sherry called:

"I had never been a nursing home administrator before this year. I have no nursing background either, and even though I had worked in a drug store pharmacy and had been involved in placing several families members in nursing homes, the staff didn't think I knew anything about the job. That was hard."

Sherry went on to share some of the changes she had made in the past year in her job:

"Staff were feeding residents in the living room. They had put sheets over all the chairs and had turned the chairs away from the windows. After a meal, staff were busy helping residents and food didn't get cleaned up quickly enough, resulting in flies and ants on the floor. In general, it was horrible, but it was 'the way things were done.'"

Sherry instructed staff to take all the sheets off the chairs, deep-clean the living room and turn the chairs to the windows. No residents were allowed to be fed in the living room; they had to be fed in their rooms or in the dining room only. After a little resistance, but careful monitoring on Sherry's part, here's what happened:

"Staff say that is is easier to feed residents in the dining area. Extra food is available, clean up is faster and the residents have begun to eat more.

"Residents are using the living room more as a living room, too. Families visit longer; residents are calmer and happier."

Sherry makes me proud to be a part of training administrators to manage person-centered care environments. But she also makes me aware of how much farther we still need to go.

"It's an uphill battle working in a nursing home trying to care for residents on the minimal amount of money available."

Sherry's right about that. As we head into a new year and a new economic reality the money is not going to flow any more freely.

But we'll have one person here and another person there, working their hardest to ensure that care is provided to our nation's most vulnerable citizens in a way that is caring, compassionate and dignified.