Wednesday, June 29, 2011

Keeping Cool in the Summer Months

Elderly people (that is, people aged 65 years and older) are more prone to heat stress than younger people for several reasons:

  • Elderly people do not adjust as well as young people to sudden changes in temperature.

  • They are more likely to have a chronic medical condition that changes normal body responses to heat.

  • They are more likely to take prescription medicines that impair the body's ability to regulate its temperature or that inhibit perspiration.

Heat Exhaustion
Heat exhaustion is a milder form of heat-related illness
that can develop after several days of exposure to high temperatures and inadequate or unbalanced replacement of fluids.
Signs and Symptoms of Heat Exhaustion
Warning signs vary but may include the following:

  • Heavy sweating

  • Paleness

  • Muscle Cramps

  • Tiredness

  • Weakness

  • Dizziness

  • Headache

  • Nausea or vomiting

  • Fainting

  • Skin: may be cool and moist

  • Pulse rate: fast and weak

  • Breathing: fast and shallow

What You Can Do to Protect Yourself
You can follow these prevention tips to protect yourself from heat-related stress:

  • Drink cool, nonalcoholic beverages. (If your doctor generally limits the amount of fluid you drink or has you on water pills, ask him how much you should drink when the weather is hot. Also, avoid extremely cold liquids because they can cause cramps.)

  • Rest.

  • Take a cool shower, bath, or sponge bath.

  • If possible, seek an air-conditioned environment. (If you don't have air conditioning, consider visiting an air-conditioned shopping mall or public library to cool off.)

  • Wear lightweight clothing.

  • If possible, remain indoors in the heat of the day.

  • Do not engage in strenuous activities.

Monday, June 13, 2011

My Trip - By Barbara Auten

As a long distance caregiver I struggle with many challenges, even with 7 brothers and sisters to help with my mother’s care. My mom fell in April for no apparent reason. After four days in the hospital the doctors could find no neurological reason and no real physical damage. But a four day stay in the hospital had a huge impact on my mom. She lost 25 pounds that week and was weak after lying in a bed for four days. I cried when my sister described her crawling up the stairs to her bed when they came home. It broke my heart to imagine the scene … this vibrant pillar of a woman who just 3 years ago was hiking in Northern Canada at age 84.
I knew I had to make the trip to see her and could not delay any longer. I made plans to visit for Mother’s Day and invited my daughter, Maureen, so we could all celebrate this special day together. It was a shock to see mom had shrunk. Her height had always towered mine yet now I am 2 inches taller than her. Her clothes hung on her diminished frame yet her feet were so swollen she could only wear slippers. I was afraid to hug her too hard but wanted to hold her in my arms forever. I had four short days to spend with her and help my sister who is her main caregiver.
Mom’s balance was “off” due to her weakened state and loss of weight yet she fought using a walker or cane. She insists she doesn’t need her bedroom moved to the first floor. I was relieved that she allowed me to have an additional railing installed on the stair well so she has adequate support … for now. How long will it be enough?
I anticipated Mother’s Day starting out with Mass and brunch with the family but was heartbroken to hear mom say she wouldn’t be going to church. Church was her life, the parish secretary had just requested her bio for a feature they wanted to do on her. The Bishop’s Committee had recently recognized her for 50 years of service. When I reminded her of the award she looked confused and asked, “What’s Bishop’s Committee?” So … the whole family gathered to celebrate the day and the matriarch, 5 of the 8 children and spouses, grandchildren and great-grandchildren filled the house. She was surrounded by family and for the most part could remember almost everyone. This was her element … family …she loved being surrounded by them and thrived on their presence but after an hour I could see the confusion in her face and knew it was exhausting her. We sat quietly that evening, Maureen, myself and Mom piecing together a puzzle over light conversation. She didn’t remember everyone being there that afternoon.
We saw the Neurologist Monday afternoon after dropping Maureen at the airport. Mom lost another point on her memory screening. The doctor had not received her records from the hospital. We discussed her medications and considered changing to the Aricept 23 but were told the insurance wouldn’t cover it. If we chose to pay privately it could cost several hundred dollars per month. I asked for an extension on her physical therapy as she was still weak after the hospital stay. The swelling in her feet and ankles remained a problem but isn’t going away. The compression stockings were still her best defense. The doctor renewed her prescriptions and we left hoping she wasn’t too tired to shop for shoes that would fit her feet and offer her a solid foundation. We managed to find 2 pair and even got a compression stocking aid to help her get them on. Anyone who has ever had to use them will know what a struggle this can be!
So for 2 more days we cooked and cleaned and talked. She was not happy that we put so much in piles for a garage sale but knowing she wouldn’t remember in a few minutes we kept on. It was obvious she was growing stronger since I’d arrived and she was eating better. My brother who lives with her and is developmentally challenged tries hard but sandwiches just don’t make a healthy meal twice a day, everyday. I filled the freezer with nutritional meals for two hoping they will actually reheat them for dinner. I convinced my sister that it was time to consider outside help, a sitter to relieve her of some of the burden. Even 4 children in town are not able to juggle being there for her. I’d spent nearly every waking hour with her for four and a half days, I’d filled the freezer, I’d installed the railing, I’d seen her doctor, she had new shoes, clean clothes and been bathed. I felt I’d done everything I could in that short time. We’d spent many hours just talking as I cooked or cleaned or drove the car. I hugged and kissed her good-bye trying to remain upbeat more for her sake as I walked to the car. My sister forgot something and ran back in the house giving mom time to walk to the door, to look one more time. She stood there … not with a blank stare … but a forlorn look knowing it may be the last time she saw me. It wrenched my heart … the picture of her standing in that doorway looking so frail and lost will forever be etched in my mind.

Tuesday, June 7, 2011

Creating Comfort with In-Home Care

It is quite normal for a family caregiver to feel some anxiety when a new person comes into the home to provide assistance, especially so because many caregivers have genuine concerns toward ensuring that the best possible care is provided to their loved one affected by dementia. When considering outside assistance, caregivers should make themselves comfortable in asking some or all of the following questions, prior to selecting an Independent or Agency Provider. This will help to decrease anxiety and promote an overall sense of comfort for everyone, especially for the individual being cared for. Below are some questions that a caregiver may consider.
Questions for an Independent Worker/Caregiver:
1. What kind of work experience do you have in caregiving?
2. What specifically makes you qualified to work with my loved one?
3. Are you comfortable dealing with my loved one’s emotional and/or mental changes?
4. Why are you interested in this type of work?
When asked upfront and respectively, these kinds of questions can create a dialogue for asking and answering all kinds of questions, while also setting an expectation for the kind of care that is sought and deserved.
Questions for an Agency:
1. What kind of background check is performed on the workers?
It's commonplace for employers to do criminal background checks on potential employees. Since trust is critical when hiring someone to help inside of your home setting, a background check can be a valuable screening tool.
2. Do you check your workers' driving record and driver's license?
If you need someone to drive your loved one, even occasionally, it is important to know what kind of driver you may be hiring. Car insurance requirements may differ from state by state. It is advisable to check with your local Department of Motor Vehicles (DMV) to see the requirements of your state. If the worker may be driving yours or your loved one’s car, check with the insurance company to find out how to include new drivers.
3. Are your workers bonded?
If someone is bonded, their work is basically insured and your loved one will be covered, in the event that the worker breaks or steals something. Bonding coverage varies, so you can ask for details. It's a level of reassurance that can make a difference; however, it is not necessarily essential to good care.
Do you provide any training for your workers?
If so, ask the agency whether training is done once or on an ongoing basis.
Are the healthcare workers your employees or independent contractors?
Some agencies function more like job referral services, linking independent workers with jobs, rather than managing their own employees. With independent contractors, you will likely be required to do more paperwork and supervision. It is a good idea to be clear about this from the very start.
What kind of supervision do you provide?
How often does the agency check in with its workers…daily or weekly? Is someone available to provide expertise or extra assistance, if needed?
How do you handle a worker's sick days, vacation days, and holidays? Will you automatically send a replacement worker?
Everyone needs breaks and time off, including yourself and those you may hire. Caregiving can be physically and emotionally demanding. Find out how agencies cover for worker absences and what's required from your end.
What's the turnover rate of your workers?
Do you think your employed caregivers enjoy their jobs? Do you offer benefits? It is hard to be certain that you will receive an honest answer, but it never hurts to ask. But, remember that one simple truth prevails: People who are happy with their work make better employees.
How do you handle conflict between a client and worker?
It helps to know how much support you'll get from an agency, should a conflict arise. Does the agency mediate conflicts, and if so, how? Is the agency flexible about changing workers, if things don't improve?
Do you have other people that I can talk to about their experiences?
It is perfectly ok to ask for several references. This is one of the best ways to get a sense of how an agency has performed over time.
Do you accept payment from insurance companies?
If your loved-one has long-term care insurance that pays for the cost of in-home care, you may want to make sure that the agency accepts this kind of payment. If not, you are likely better off using one that does.
What kind of service agreement is required?
This will help you to learn of any requirements or commitments on your end, as well as flexibility of services provided.
Will you take care of all required payroll paperwork?
A significant amount of paperwork may be involved when employing someone, covering such matters as taxes, Social Security, and disability. One benefit to hiring from an agency (and the reason it's usually more expensive than hiring independently) is that an agency will normally do this for you. However, it never hurts to double-check to see.
Are you Medicare certified?
Medicare certified agencies are eligible to be paid through Medicare, the government's health coverage for persons over 65. To become Medicare certified, an agency must meet federal standards for patient care.
Can my loved one and I interview candidates and give input on the choice?
The more control you and your loved one have over choosing an in-home health worker, the better you will feel about your choice. Agencies approach this differently, so you may need to ask.