Sunday, February 28, 2010

Why the Obsession with the Bowels?!

Does every conversation with your elders involve the state of their bowels? Listen in on the conversations with their friends and you'll find out more than you ever wanted to know about them as well.
Why oh why do they obsess? And then they eat too many prunes or take to many laxatives and end up with diarrhea! They need to understand that as they age and the body slows down, so will the everyday functions. They may not need to go every day and they can cause more problems than good with the laxatives. Fiber can turn to cement if they don't drink liquids. Read more...

I also have a discussion about this issue in my book.... The Everything Guide to Caring for Aging Parents.... click on the link in the sidebar to purchase a copy.

Saturday, February 13, 2010

Happy Valentines Day & Chinese New Year's

Wishing all of you a very Happy Valentine's Day! Feb. 14th this year also marks the beginning of the fifteen day Chinese New Year celebration. It's the Year of the Tiger now. Enjoy!

Thursday, February 4, 2010

Hospice Care for Alzheimer's and Dementia Patients

Did you know that your elder with Alzheimer's or other specific end-stage dementia could qualify for hospice care? Medicare has established hospice guidelines for end-of-life care for patients who have entered a terminal phase of dementia or any other terminal disease.

In the last and most challenging stages of dementia, caregivers can get support through hospice. It is paid through Medicare, as well as most private health insurances for those under 65 who qualify. Intermittent visits from nurses, hospice physicians, health aides, medical social workers, spiritual counselors and trained volunteers can help to reduce the burden of care giving. However, hospice is not meant to be a caregiver substitute.

If your elder has shown a decline in health status such as 10% weight loss in the last six months, is now dependent in at least 2-3 ADLs (the more the better), cannot converse effectively (speaks less than 6 words), is incontinent of urine and stool, and in the last 6 mos. has had a severe health issue such as an infection (urinary sepsis, aspiration pneumonia), stage III or IV bedsores, has lost greater than 10% of their normal body weight, or has had an exacerbation of a co-morbid illness, or recent hospitalization for Urinary Sepsis or Pneumonia, they may qualify for hospice care. Note that Alzheimer's can take 10 years to reach the terminal stage and hospice care is designed solely for the end stage.

The primary care physician has to certify that they have 6 months or less to live. (They can live past six months and as long as they don't show improvement, but rather continue to decline at a slow and steady rate, they will most likely qualify to continue hospice care until they pass away. Please note that some patients will improve substantially under hospice care and be discharged until they once again have a true terminal trajectory.)

Hospice care can help to palliatively control and help prevent issues such as hallucinations and behavior problems like "sundowners," calling out, or yelling at night, and infections from such sources such as the bladder, skin breakdown, incontinence, and aspiration. Any pain and respiratory distress can also be controlled to make for an improved quality of life and  peaceful passing. The earlier the hospice can get involved during the end stages, the better the chances for controlling these issues.

Although end-stage dementia patients will most likely not benefit from most of the emotional and spiritual support that hospice can provide, the caregivers and family members should be able to enjoy this benefit at the time when they can be in the most need of this support.

The hospice agency can assess and help determine if your loved one is eligible for hospice care. An order for a hospice evaluation is needed from the primary care physician. If your loved one is not quite yet eligible for hospice care, the hospice may be able refer to home health or to palliative care until they do meet criteria.

If your loved one is on a managed Medicare aka Medicare Advantage program, they will revert to regular Medicare for the hospice care. If they need medical care for a non-hospice related issue, the managed care remains in effect for this treatment. The hospice agency can explain this.

Don't overlook this valuable resource option. Talk to the physician and arrange for a hospice evaluation. Find an accredited hospice through the National Association for Home Care and Hospice (NAHC) or the National Hospice and Palliative Care Organization (NHPCO).

Medical Supply Depot

Friday, January 29, 2010

Is it Time to Consider Hospice?

When your aging parent reaches a point at which he/she seems to be declining and not able to bounce back, it may be time to consider palliative care. Perhaps hospice is an option. Talk with the primary care practitioner and see if a hospice eval can be arranged. Hospice care can help all of you ease into the next phase and maintain a good quality of life and eventually achieve a peaceful passing for your loved one, with dignity and without pain or discomfort.

If your elder doesn't yet meet hospice criteria, the hospice nurse may be able to recommend other options such as home health care. Perhaps some PT to strengthen muscles and increase safety would be advised, or an OT eval for some assistance with energy conservation techniques.

Thursday, December 31, 2009

Happy New Year!

Wishing everyone a very Happy New Year!!! Hope this new year and new decade brings you happiness and the strength and courage to continue your journey with your aging parents, spouse, or other loved ones.

Remember to take time for yourself, accept help as needed and to remember only to sweat the big stuff and let the small stuff go.
Have a safe and health New Year's Eve and a terrific 2010!!

Wednesday, December 23, 2009

Wishing everyone the merriest of Christmases. Even if it's not your holiday, I hope you have a great end to this week. Next week brings us a New Year with lots of hopes and wishes for better things for all as we enter a new decade. Celebrate, have fun, take time to enjoy and make memories. Be safe!

Peace on Earth, Good will Towards ALL Men (Women and children too!)

Tuesday, December 15, 2009

When the Unexpected Happens....

I'm a bit behind the 8 ball now..... Hope your holidays are coming along and that you are taking time to ENJOY them.

Thanksgiving in our house was a little overwhelming as we found my 82 year old mom had spent the night before in the tub and couldn't get out. She was in remarkably good shape despite this. Spent a couple of days in the hospital (without an answer to why she fainted) and we had our turkey in the ER.

I spent a few days and nights with her and we figured out some things....

Now we have a web cam (granny cam) installed so we can "spy" on her (even works from my smart phone) and make sure she doesn't do that again! (We chose the Panasonic model.) We didn't opt for the typical answer of the little necklace life alert mechanism because it would be in the bedroom or the kitchen or somewhere, and she'll be down somewhere else in the house. Her income is VERY FIXED and even $30/mo for this service would be too much esp. if she doesn't use it right.

There are similar systems that don't have installation fees and a monthly cost. They don't connect to a live person; they simply dial programmed numbers until it get's a response. Some only dial 911. That isn't always what you need and can prove costly for non-urgent issues. We're investigating them. I'll let you know if they work out. I've added several to the Aging Parents Amazon Store if you want to check them out.

She has cordless phones and we have placed them in better access areas. One sits on the bath bench in the bathroom gets swapped out daily so it's always charged and ready. It's not waterproof of course and so she moves it away from the spray, and (hopefully) keeps it within easy reach. We keep a reacher in the tub area too.

We're in more frequent phone contact. Most of all she has been given a new set of exercises to do every day forever now by the home health PT to help strengthen her muscles. This has made the biggest difference. (Thanks Charlene!!!) The few visits she was allowed worked wonders!!!

The shower water has to be cooler so it doesn't make her BP drop. (She loves it way too hot!) She HAS to eat! And she has to drink more liquids. No coffee doesn't count, in fact it dehydrates you. (Dehydration and not eating much that day contributed to her fainting and falling. Perhaps a heart problem, but nothing has been detected as yet. )

She tried to tell me one day she had drunk 2 (16 oz.) glasses of water in the kitchen plus her 2 cups of coffee. Well the web cam told me there had been no glass on her TV tray, and no dirty glasses in the kitchen told rest of the story..... caught ya Mom!!!! So now she knows she can't get away with that!

We know that this isn't the perfect solution and things WILL change again sooner than we like, but she still has her independence for now. Moving to my house wouldn't solve it. Assisted living is out of the financial picture.

Like giving up driving, it would be another big step towards dependence and she would again decline rapidly. That isn't essential just yet. Might be one day soon, or maybe not for awhile. We'll take it one day at a time and be prepraed to make more changes as we have to. Meanwhile Mom has her dog and her TV as loud as she wants it.... CNN all day long and OLD movies when she tires of the same old news stories.

God love her she's healthy and that helps and hinders the situation in various ways. The economy sucks and we don't have many choices. Everyone's story will be different, and yet in so many ways the same.......

It's holiday time and we may only have this one left with Mom so we will make the most of it. Make memories with your loved ones this year. Take some time for yourself too!!!!