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We All Walk For Alzheimer’s.

 

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Last Saturday, Springfield held its Walk to End Alzheimer’s at Erin’s Pavilion in South Wind Park. The Alzheimer’s Association has come a long way; I know because I volunteered when they began these walks at Washington Park in 2008.

This year, the crowd was much larger. The opening ceremonies included singers as well as speeches. Most of all I was impressed with the family teams. Three daughters who had lost their Mother to Alzheimer’s came to the walk. Some family teams wore the photo of their loved one lost to Alzheimer’s. Other families had Tee shirts imprinted with their team’s name, referencing their lost member. One family designated their toddler as “#1 Coach” for their family team. He was named for their lost loved one.

This tragic disease impacts all ages. These teams illustrate, honor the impact and recognize those departed.  As the crowd embarked on the walk, they formed a sea of purple. I wish everyone every one could have seen that “wave of purple”; it’s always the right time to give to the Alzheimer’s Association.

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The Super Bug Scourge & Senior Care

The following article appeared on msn 9- 2-16:

Special Report: ‘Superbug’ scourge spreads as U.S. fails to track rising human toll

 

WHO just issued another report on 9-22-16 on the same subject:

United Nations high-level meeting on antimicrobial resistance

Antimicrobial resistance summit to shape the international agenda

 

The WHO reports are large, and multi-faceted. They refer to seniors but don’t dwell on them. Their reports are worth reviewing to better understand the extent of the problem.

Unfortunately, both of these articles related general information about all age groups, not seniors. Yes, all of us should be aware. However, seniors use the healthcare system more frequently than younger people (exclusive of infants). Thus, seniors stand a greater chance of requiring a hospitalization; where the super bugs live.   Senior tend to have weakened immune systems which can open them to infections. I recommend that caregivers be especially alert to what’s bugging their seniors.

An internet search for (super bugs seniors) revealed 10 references and 12 more pages!  6 of those articles on the first page referred to 1 in 4 seniors bringing superbugs to aftercare facilities or home with them.   Of those references, the one by Interim Healthcare, 3-16-16; How to control infection rates in the elderly after a hospital stay, had the clearest discussion on the topic.

Many articles encouraged senior patients as well as their caregivers to wash their hands thoroughly, with soap and water. We might be sure to wash our hands before and after our visit with the senior; how many of us help the senior to wash their hands? We should. Washing hands before preparing food is common practice. How many of us wash our hands after cleaning up? We should. Lately, washing hands has been replaced with the use of anti-bacterial soaps. Studies show these many contribute to breeding superbugs: back to soap and water. Some articles pointed out that certain superbugs live in the nose. Therefore, washing hands after blowing the nose or catching a sneeze sends these bugs down the drain. That goes for the senior as well as the caregiver. After all, what anyone touches, once contaminated, becomes a superbug haven. Some superbugs, such as MRSA, transmit through skin-to-skin contact. If the caregiver is treating a post-surgical site or a wound, clean hands and cleaned patient skin are a must.

Here are some other, practical ideas for caregivers moving a senior to post-hospital care or home recuperation:

  1. Bag it. Put personal effects in bags; then carry them. All kinds of surfaces can become contaminated. Bagging reduces that.
  2. Do not put personal items in the patient’s room until they have been sanitized. Even if those slippers look clean it doesn’t mean they are clean.
  3. There are many ways to get things de-bugged: sprays, alcohol, thorough laundering, (sometimes) exposure to strong sunlight and freezing. The CDC or your local Public Health Department has guidelines on their websites for proper sanitation procedures.
  4. Have the patient take a shower or wash and change clothes once they arrive (IN A SEPARATE SPACE). Bring them to the bathroom to wash, then to the bed. Bag those clothes and take them to the laundry and right into the washing machine. Handle as little as possible.
  5. Clean yourself as well. Once they’re in bed, shower and put your clothes in the wash. You’ve been to the hospital, lugged the bags to their destination, handled the senior and their belongings; you’ve got superbugs on yourself.
  6. Visits require three sets of hand washing, yours, the senior’s and the visitor’s. You do not need to give your visitors any superbug gifts. They should not expose the newly-released senior to contaminants.
  7. MONITOR the senior. Bowel issues, diarrhea or a temperature spike require an immediate call to the doctor.
  8. No small children as visitors for a couple days. Children are two-legged Petri dishes; heaven knows what they carry. They can say hello to their grandparents via Skype; it’s still resistant to superbugs. Children could also succumb to superbug infections, or carry contamination home to smaller siblings. Both are bad outcomes.

After a couple days to a week, if no symptoms appear, you, the senior and the grandchildren will all be in the clear. These precautions are not the way we used to do things. However, today’s superbugs require extra care.

 

 

 

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Keep Dancing

My daughter sent me this photo and caption..

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I don’t know where she got it.  The photo reminded me of a recent senior’s situation which I would like to share:

A recent patient shed tears because she no longer had friends.  Then she listed FOUR symptoms that would prevent her from attending a neighborhood gathering!    I pointed out that her perspective was the problem, not her medical issues.  Decades working with seniors have shown me that one’s medical diagnosis does not determine social engagement.  Some seniors push on taking their aches and pains along for the ride.  Others cite their aches and pains as reasons to withdraw.

Aches and pains are real, so are medical conditions. However, there’s more to life than medical conditions.    I’ve observed that those who engage in life usually have a “youthful perspective”. It begins with a youthful personal decision.  A youthful decision is forward-looking, if not for yourself; then for your children, grandchildren or future generations.  A youthful decision may not embrace all the new technology but agrees to contend with it and find a way to master it.  A youthful perspective becomes the driver helping us (seniors) to get up and dance alongside our aches and pains.  You’ll notice I said “us”.  I have joined the ranks of seniors myself.  I am determined to dance into my future!   Other seniors have shown me that such a decision becomes even more important as years pass.  So keep dancing, even if you must sit down between dances.

 

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Commentary:”More American Are Dying in Poverty”; Bloomberg News, August 2016.

 

While the topic, More American Are Dying in Poverty”; Bloomberg News, August 2016, is important, it raises some interesting questions. Early in the article, it states; “Though no empirical measure can truly illustrate the day-to-day reality of being poor. … When including out-of-pocket healthcare costs, more elderly Americans are classified as living in poverty”. Yes, it’s true.   However, the costs listed do not tell the whole story.

In my decades of experience working with seniors, I noticed that other kinds of out-of-pocket costs are not directly considered healthcare and impact seniors financially. These costs include landscaping, house cleaning and home repairs. In previous years, the senior mowed, painted and cleaned house themselves. Seniors may also need someone to run their errands because they no longer drive.  None of these kinds of costs are considered “staying overnight in hospital” yet they are costs to seniors. Sometimes family takes on these tasks; sometimes they can’t; then it becomes a senior’s out-of-pocket expense.  I therefore request the total senior living expense be re-determined to more accurately reflect expenses by including a senior supportive living cost factor.

The article goes on to describe the 1963 formula which defines the poverty line as the dollar equivalent of three times the cost of feeding a family of four based on the 1955 Household Consumption Survey that is adjusted for inflation each year. REALLY?!   That’s 61 years of successive inflation! No wonder “supplemental measure’s poverty line is consistently 0.5 to 1% point above the official measure”.   That consistently inaccurate percentage is an excellent indicator that those measurements need to change. Why are we still using it? Additionally, the percentage of seniors in our population in 1950 was 5.6%. In 2010 it was 13%. No wonder measurements are off; we are using a yardstick from Donna Reed’s era to measure a country in the digital age!

The article continues by pointing to measures that have helped reduce poverty such as child care tax rebates and SNAP food benefits for children. We have 34.2 million caregivers today; where are their senior care tax rebates? Where’s the senior care SNAP? Studies have shown it’s cheaper to keep seniors with their families or in their own homes? If families take on these responsibilities, is that not as important to maintaining this society as child rearing? Where’s the senior caregiver’s help?

The article compares various factors and offers an interactive. “Acs concludes that if the same poverty rate that existed between 2000 and 2010 were in place today, 11 million fewer (italics mine) people would be considered poor”. That description separates the “historical rate for different age groups” from their percentage of total population. In 1955, the Baby Boom, was just reaching school age. Now, all the Boomers are reaching senior age. Thus, our population is completely reversed in percentages to that of 1955! I believe that the aggregate of an unsupported and growing senior percentage diminishes society’s capacity to absorb these senior supportive living/caregiving costs. Therefore, I suggest that what we need today is a new yardstick which includes current realities, as a basis for true determination of where we are now. Only with an accurate basis can we make solidly supportive public policy that will help our society survive the Age Boom and its consequences leading to senior end-of-life poverty.

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I Don’t Want To Talk To You!

That’s what an adult child recently told me. That feeling is not unusual. News of a parent’s decline is often unexpected. It may come from many sources: The police call because the parent went to their usual grocery store and got lost. They call because the parent had a car accident or fell. Some adult children react with denial. It isn’t helpful for either parent or adult child. The parent’s situation will get worse if ignored. When first-responders can’t elicit help from family, they are required to report a senior at risk to authorities. Confronting authorities usually makes the adult child feel worse and complicates the family situation.

Why deny? Some adult children don’t know what to do. Some worry about making adjustments in their lives to provide caregiving. Old issues such as sibling rivalry, marital frictions, and work pressures show up and seem to rip the child’s social fabric just as they become caregivers. One of the “stickiest” situations is that of the previously poor parent-child relationship. What person from a negative childhood looks forward to becoming that parent’s caregiver? Those are a few reasons they turn away.

Why is it more helpful to face this change?

When the parent’s situation worsens, the adult child can look bad. In the case that prompted this comment, the parent is a heavy smoker, a drinker, and is on medications. What if an ash ignites the mess of papers around the easy chair as the parent falls into a pills-alcohol-induced slumber? House fire! How would the adult child feel like to get that call?

We need to become more flexible. Making changes helps us to develop mastery over our situation.   No couch potato can run a mile; it takes practice. Mastery of adjustment develops our ability to make other adjustments.

What you do now will help you later. When the adult child makes changes in order to care, they show others the way to care. Children or other young people will be our caregivers one day; show them how now.

When the adult child faces the caregiving role, others come to aid. There are many services and supports available to those who ask. No one needs to go through the caregiving phase of life alone. Denial is resistance that makes others resist helping; break the negative cycle; face it.

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In Praise Of Caregivers; Part II

On Saturday August 13th, Senior Sidekicks welcomed caregivers to our booth at the 14th Annual Conference for Caregivers sponsored by the Lincolnland Area Agency on Aging. We enjoyed listening to Caregivers. One caregiver returned to the conference even though her loved one had died. She said she “felt at home” at the conference. She explained that only other caregivers knew what she had experienced. She did not always find such sensitivity in other parts of society. Several caregivers said they had felt alone in their caregiving role. Another caregiver expressed surprise at the number of errands she was still running for her parent recently moved to a facility. Her comments became the topic for my weekly blog; “A Senior Moment”.

Senior Sidekicks views these expos as a chance to affirm caregivers’ great contribution to caring for our aging population. The Caregiving in the US 2015 Report estimates that 34.2 million provided unpaid caregiving in the previous 12 months. They provide an average of 24.1 hours of unpaid care each week. That is 1029 hours per caregiver per year! Now multiply that by 34.2 million people.   Think about the cost to taxpayers if all those hours were paid! Some may stay in the caregiving role for 3.6 up to 4.6 years and a few even longer. Caregivers may need to forego career advancement opportunities, reduce their working hours, or leave the workforce altogether! Such sacrifices deserve our society’s support.

At Senior Sidekicks, we’ve made our support tangible.  We write a weekly blog, A Senior Moment, directed to caregivers about practical issues. We have published 7 articles, most of them about caregiving situations. All our services focus on both senior and caregiver. We coined the term “Caregiver Emerita” to describe those who’s loved one has died because believe that the discussion of caregiving needs a vocabulary.

The only way our society can negotiate this demographic dilemma is by recognizing and offering tangible support through our communities, churches and other institutions. Does your organization have a recognition day for caregivers? Does your church devote a Sunday service to caregiver recognition the way many celebrate Mother’s Day? The Family Medical Leave Act policies do not cover all employers, nor are they designed for on-going care situations. Why not? We already have 34.2 million caregivers.    Employers, would you hire a Caregiver Emerita? Do you view her as “dropping out of the workforce” or do you view her as having acquired additional management skills?   Would you provide training to enable a Caregiver Emerita’s re-entry?

These annual Conferences for Caregivers are the only local recognition event. Isn’t it time there were more? We must realize that failure to support today’s caregivers puts them at a financial disadvantage for when they will need care. While our society might survive one generation’s care needs, we cannot afford to assume the consequences of two generations’ care! Please consider ways to support the caregivers in your neighborhood, church, and job. Want ideas; contact Senior Sidekicks.

 

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Senior Sidekicks had a booth at the Conference for Caregivers our first year, 2008. Each booth staff received a bag.   This year we received another bag.   We show both bags in this photo. They represent our eight years of service to caregivers. Thank you!

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Why Am I Still Running Errands?

At a recent conference a caregiver asked me; “Why am I still running errands for my Mother; she now lives in a supportive living facility”?   This not the first time an adult child believed they would have fewer errands if the parent was moved. Not quite; it depends on the facility.

Supportive living facilities can be very helpful for some things; home maintenance is now someone elses responsibility. Meals are prepared by the staff. Nursing care is available in an emergency or for medication dispensing. However, it is as important to know what the facility will not do as it is to know what they will do. Here is your question list:

  1. Who does personal laundry? Does the staff do it for the senior? With the senior’s involvement? Is help automatic or by family request?   Is there a charge?
  2. Does the facility offer a minibus to take residents shopping? How often? [Some facilities reserve their transportation for medical appointments. Others prioritize transport for medical errands and put shopping behind medical needs.]   Ask. Is there a charge?
  3. Where does the minibus go? Your senior is used to certain stores. Adapting to a new store may require you to take them a couple times. Knowing where they will be shopping will help your senior adjust.
  4. How mobile must the senior be to use these shopping trips? (Is your senior able to walk around stores that much?) Do these stores have scooters? (Can your senior operate one without your guidance?)
  5. Must the senior sign up for these trips in advance? (Can your senior remember the shopping trip and get ready?) (Can they create a shopping list?)
  6. Does the facility send a staff member with the senior when they attend medical appointments? Is this service automatic or by family request? Is there an additional charge?

These answers better prepare you to evaluate facilities. If facility charges for certain services, that is part of the total cost of care. If they don’t offer such help; you return to errand-running. Make an informed decision; ask.

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Praise For The Conference For Caregivers

This week, the Lincolnland Area Agency on Aging will hold its 13th Annual Conference for Caregivers on Saturday, August 13th at The Northfield Inn Conference Center in Springfield Ill from 8:00 am to 2:00 pm. In addition to lectures and lunch, there will be exhibit booths from various supportive services for caregivers. This event has been financially self-sustaining despite Illinois’ budget problems. Register through the Lincolnland Area Agency on Aging; 217-77-9234 or 1-800-2523-2918. We hope you can attend. Your $20 registration fee will be refunded to you on the day of the conference.

Why hold such a conference? The Caregiving in the US, 2015 conducted a detailed analysis…”more than 8 in 10 who cared for some one 50+ say they could use more information on help on caregiving topics …keeping their loved one safe at home (43%) [and] …managing their stress (42%).” Is it any wonder? As caregiving duties become heavier, the time for socializing, worship and even personal time gets shorter.   When caregivers get together it demonstrates to each other that they are not alone.

This conference will have information sessions on topics such as: Caregiver Stress Relief, Advanced Care Planning, Understanding/ Responding to Dementia-Related Behavior, Get Physical-Activity & Health, Advanced Planning for End-of-Life Rituals; a Caregiver’s Perspective, and Spirituality in Caregiving. This Conference allows caregivers to benefit from experts’ and others experiences; why reinvent the wheel?

This conference also reaches out to grandparents raising grandchildren who find they are caregivers; again. There are special topics for the unique needs of relatives raising children such as Nutrition- Balancing Diet and Treats and much more. When other people find themselves in the parental role it means major adjustments in their lives. For example, grandparents are older and may have their own health problems.

Join the conference and visit Senior Sidekicks exhibit booth; we’re here for you!

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THE CASE OF THE ACCIDENTAL MUTUAL PATIENT

Dr. M. and I are members of the same congregation. At the coffee hour after services, I mentioned to her an incident in which I took an elderly patient to a doctor appointment and found she had been there two days before!   I expressed my concern about the implications of this confusion for the patient, her treatment, the clinic system reimbursement, and its effect on outcomes.   Dr. M. said these situations had occurred in her practice as well. As we discussed my case further, we realized we both had the same patient!   This patient had been seen at two different branches of the same medical system! Neither branch’s staff knew who brought her. In both appointments, the patient could not describe why she was seeing the doctor or how she got there. In the visit I arranged, I came in (our policy) and reported the reason for the appointment. However, I discovered that there were at least two state agencies involved with this family and both denied making the first appointment. One state agency had even asked me to make (the second) appointment. This is good example of the limits of reliance on elderly patient self-reporting.   It has implications for the health care system and reimbursements.

Dr. M. indicated that she had also seen nursing facility patients with poor self-reporting. In my years of practice as a Medical Visit Companion, I have continued to take to patients to visits after they entered nursing homes.  I noted that each facility sends a copy of medicines and treatments but does not always include the reason for the visit. The staff might tell me why; the patients never did.

One of my nursing home cases, I had to drive to the appointment separately. I left after seeing the patient loaded into the transport van. I told the driver I would be there to meet them. 45 minutes later, my patient was missing! I called the transport company; they had taken her to the wrong office! Thus, relying on transport drivers is not a dependable plan for patients who cannot self-report or self-direct.

An increasing elderly population will increase this incidence of patients who poorly self-report. I believe it will have a direct bearing on outcomes, and on reimbursement for all sectors of healthcare.  Identifying problems like this case will help us make modifications.  Our healthcare system needs a method to compensate for inadequate patient self-reporting.  I have some ideas about how to fill that niche; stay tuned.

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Happy Birthday OAA! (Older Americans Act)

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The Older Americans Act, (OAA), Title IIIE turned 50 this month. It was enacted in 1965 and signed by President Lyndon Johnson. The OAA covers persons over age 60. Over the years, its mandates to protect and provide care for elders have been enlarged. In honor of this birthday, the OAA has a variety of free publications, audio, and visual files. For more information, please go to The Older Americans Act: Aging Well Since 1965

One of the programs dear to my heart is the National Family Caregiver Support Program (NFCSP), section 71 of OAA, administered by the Administration for Community Living under the Department of Health and Human Services (HHS).

The NFCSP offers education, training counseling and some forms of respite for family caregivers. For more detailed information go to the ACL – Administration For Community Living website.

Did you know that you may be eligible for support services?
  1. Are you over 18 & providing caregiving to a person over age 60?
  2. Are you 18 providing caregiving to an Alzheimer’s patient of any age?
  3. Are you a grandparent, age 55+, caring for children younger than 18?
  4. Are you a grandparent or other relative (not the parent) caring for a disabled person between the ages of 18-59?

If so, contact your local Area Agency on Aging for these free services.  NFCSP’s goal is to “explicitly recognize the important role that family caregivers occupy in our nation’s long term services and supports system”.

 

 

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