Friday, August 31, 2018

Great Caregiving Book from Tina M Marrelli, RN

I want to bring to your attention a great book, A Guide for Caregiving by Tina M. Marrelli, RN. Marrelli is an RN who has written extensively about home health care nursing for nurses. Her books have been considered as bibles for home health care.

This time around she has written a guide to caregiving for caregivers. Marrelli covers the basics of caregiving and then delves into some specific care issues for diseases such as Alzheimer's, COPD, Cancer, etc., and cargiving issues such as caring for bedbound patients and providing incontinence care.

It's very easy to read and follow and covers all your questions. The American Journal of Nursing awarded the book 3rd place in its 2017 Book of the Year awards. It's truly worth your while!

Thursday, June 28, 2018

Nursing Home Compare

I know that the current administration has made many changes that diminish or limit protections for our aging loved ones in nursing homes. But there are a lot of things you can do to help you find the BEST place for Mom or Dad or other aging loved ones.

Remember that long term care is not covered by Medicare. If skilled care is needed after an acute illness or injury an short term stay in a nursing home will most likely be covered as long as rehabilitation is progressing. Non-skilled care in a nursing home is an out-of-pocket expense, and choosing the best option is of utmost importance. Discuss this with your discharge planner, case manager and MD. has several pages of checklists and information about nursing homes. They even have a comparison site called Nursing Home Compare that provides you specific information about Medicare related information to help you make decisions. Be sure to explore all of the tabs and print information to review as needed.

A wonderful checklist is downloadable from the site and they offer an in-depth description about all of the things you can find on their website to help making the choice for a nursing home a better experience for you and your family.

Not all nursing homes are created equal and will not appear on the list if they are not certified to accept Medicare for skilled nursing care. But you can find out information through state survey information. "Note: Nursing homes are not included on Nursing Home Compare if they are not certified by Medicare or Medicaid. Those nursing homes may be licensed by a state. For information about nursing homes not on Nursing Home Compare, contact your State Survey Agency."

In addition to information about Medicare certified nursing homes, Medicare also provides a well-defined list of alternative long term care living situations for your loved ones. 

Make informed choices and involve family in the decision making process to ease tensions down the road.

Thursday, April 5, 2018

April Is Healthcare Decisions Month

April is National Healthcare Decisions Month and April 16 is National Healthcare Decisions Day. As our loved ones age, and as we age, there are many decisions to be made about health care as well as end-of-life care and they are not comfortable topics of discussion.

What's even less comfortable is having to make decisions when you have not had those discussions with your aging loved ones and every possible relative and friend comes out of the woodwork with a different opinion of what needs to be done, what the loved one said they wanted and carries a strong sense of entitlement to be heard and followed!

Sudden illness and death as well as dealing with a terminal diagnosis are hard enough. Having decisions made ahead of time, allows everyone to relax and enjoy whatever quality time they have left.

Triggers for the Conversation
Starting the conversation can be very hard, but the National Hospice and Palliative Care Organization (NHPCO) offers some important suggestions and literature to read about conversation triggers and how to find the forms to set your goals and plans. Understand that these can be altered at any time and opted out of. But they provide everyone the opportunity to discover for themselves what kinds of decisions they want made for them if they are unable to decide for themselves.

For example is quality of life a priority over just being alive longer? Religion and spirituality can be a huge influence over this matter and it's something that really must be discussed before a crisis happens.

Advance Directives
Advance Directives and Living Wills can spell out very specific parameters of what to do IF..., or they can be a very general guideline as is comfortable. They can be state specific as well. These documents also appoint the spokesperson(s) also known as the Durable Power of Attorney for Healthcare (DPOA-HC) who can make the decisions when the loved one is no longer capable of doing so or defers to them to make the decisions. A Durable Power of Attorney for financial matters should also be considered. Free downloadable printable documents available from AARP.

Advance Directives can also designate organ donation options, which even for the elderly can include things such as corneas and skin, or making a donation to science of the whole body or tissue donations for research purposes.

These documents need to be reviewed periodically. April is a good time to remember to do so. What changes have happened in the past year and how do they affect the decisions and documents. Having things in writing makes everything go smoother.

Discuss with the MD- sign a POLST
Having a talk with healthcare providers and giving them a current copy of the documents is encouraged so that everyone is on the same page. Again, the decisions can be revoked by your loved one at any time, so keep the conversation going. This is especially important if as a healthy individual they opt for being a full code (wanting CPR performed) with everything possible to be done for them. But after an illness or watching a friend or family member suffer through something, they may want to reconsider. The decisions don't have to be black or white. There are many options in the middle. Some states also encourage a POLST document be completed with your healthcare provider.

Burial or Cremation?
Perhaps one of the most important decisions to be made is whether to bury or cremate.  Making arrangements in advance can also be a cost savings. And can relieve some of the burdens for the grieving family and friends.

Consider Hospice Early
Another consideration is where would they prefer to spend their last days? Would they want to be at home or prefer to be in a hospital or nursing home setting? Many people will have very strong feelings about one or the other and others may just want to go with the flow and see how things unfold.

Hospice care can be provided in most settings to help manage symptoms and allow the patient to live out their final months in comfort. Hospice in a hospital setting may be limited in your area so investigate options. Talk to your healthcare provider early on. Hospice care started in the last days or week of life doesn't always have time to capture all of the benefits available. Hospice care initiated when the prognosis is 6 months or less can help improve the patient's quality of life and prepare the family and friends for a peaceful experience.

photo from pixabay