Improving elder health care transitions

Check out this insightful article by Carol Bradley Bursack of ElderCareLink. A great way to provide help with the hospital to home transition for your loved one is through a care management agency, such as Lifespan. Check out our hospital to home brochure here.

Fortunately for me and my family, I was able to make myself available to help each of my elders after their many hospitalizations. Typically, however, many families simply don’t have anyone in a position to help, and elders go home only to return quickly to the hospital setting because they didn’t have the community support needed for recovering.
Billions of dollars are spent annually by elders returning home from hospital stays. According to the US Administration on Aging, almost one out of every five Medicare patients ends up back in the hospital within 30 days. Most of these readmissions are due to poor transitions due to poor communication and medical mismanagement.

Slow medicine, decision-making may lead to better care for seniors

Slow down! That message is one we need to hear when it comes to making decisions on health matters for the elderly. In this era of text messages, snap decisions and time limits on doctor’s visits, it really may be beneficial to give elders, caregivers and doctors some time to think about next steps and to make informed decisions.

For example, is surgery really the best option for the elderly? A recent Harvard study published in October in The Lancet, found that almost one-third of Medicare beneficiaries in fee-for-service plans opt for inpatient surgery during the last year of their lives. Furthermore, almost 20% of these elderly beneficiaries had surgery during the last month of their lives while almost 10% had a procedure the week prior to their death.

Treating elders with slow medicine

Additionally, the elderly’s wishes need to be considered and discussed. A recent study out of Switzerland found that 75% of elderly heart failure patients would opt for quantity of life over quality of life. According to Reuters Health, researchers surveyed 555 heart failure patients who were primarily in their 70s and 80s. When the study started, 74% of the participants said they would rather have two more years in their current state as opposed to living one more year in excellent health. That percentage increased to 80% a year later and remained constant six months later when the study ended.
That’s why I think it’s an excellent idea for the elderly, caregivers and doctors to explore slow medicine, a concept developed by Dr. Dennis McCullough, a geriatrician at Dartmouth Medical School. In 2008, The New York Times reporter Jane Gross wrote,

“Grounded in research at the Dartmouth Medical School, slow medicine encourages physicians to put on the brakes when considering care that may have high risks and limited rewards for the elderly, and it educates patients and families how to push back against emergency room trips and hospitalizations designed for those with treatable illnesses, not the inevitable erosion of advanced age.”

The part of slow medicine that I really appreciate is the chance to look at all sides of a health issue in order to make an informed decision. “You need to understand what you face, what you most want to avoid and what you most want to happen,” nurse practitioner Joanne Sandberg-Cook told The New York Times.
Therefore, taking extra time to consider options may end up adding both quantity and quality to an elder’s life.

by Dorian Martin from Eldercare Link

Holidays provide an opportunity to gauge elders’ well-being

Like many young adults, my brother Steve and I moved away from home to follow our dreams. With the exception of a four-year period in the late 1990s, we never lived closer than a three-hour drive to our parents’ house. That wasn’t a problem early on, but as our parents reached their late 70s, Steve and I increasing found it difficult to gauge how they were doing physically and mentally. Like many adult children, we found that the best time to get a handle on our parents’ status was during holiday visits.

Elders and the holidays

Unfortunately, monitoring an elder’s situation during the holidays can be a real challenge. First of all, family members often focus on tales from past holidays when the adult children were still young. And many family members secretly have hopes for one more celebration with everyone joyously gathered together in a setting worthy of a Hallmark card.
So how can you get a good handle on an elder’s status without messing up the holidays for everyone? Here are three suggestions to consider:

1. Check the status of the housekeeping. My mom was always neat and tidy, especially during the holidays when she was expecting us. That changed during Christmas in 2003. When Steve and I arrived home, we found a mess. There wasn’t a clear kitchen counter and several days of dirty dishes were stacked in the sink. The rest of the house was a little better, but not by much. That holiday put us on notice that something wasn’t right. It turns out that Mom was increasingly experiencing mild cognitive impairment and lung disease, and Dad didn’t know how to step in to help.
2. Go on an outing and let the elder drive. Often, adult children grab the car keys when the family travels somewhere. By being a passenger, you can see how the elder reacts in traffic and determine if it’s nearly time to take the keys away from your elder.
3. Check with the elders’ neighbors or friends. If elders have lived in the same place for awhile, they probably have developed numerous relationships. If you can, check with these friends to get their perspective on how the elders are doing.

The holidays offer a time when adult children can quietly get a handle on the well-being of their elders. Use your visit wisely to not only enhance your relationships and build memories with your elders, but to determine if they are starting to need more assistance.
by Dorian Martin from Eldercarelink

Are you or one of your clients in need of a smaller PG&E bill?

Different Behaviors Relating To Alzheimer's

by Judy Kirkwood of Elder Care Link

We used to roll our eyes and laugh when my dad would open his wallet and count his money over and over.

I wish I had known that compulsive behavior is a typical manifestation of anxiety for those withAlzheimer’s. Dad knew at some level it was important to have money on hand, but he didn’t remember why. To a man, the wallet symbolizes being a  provider. In fact, many times, Dad would not only count his money but he would ask if we needed money for gas, a typical worry for a father who had raised three daughters. He never wanted us to run out of gas.

Dealing with Dad’s Alzheimer’s behaviors

Since it was harmless behavior, we didn’t do anything to extinguish it, although we made sure he never had more than $20 in bills. To try to change the behavior would only have created more stress and anxiety. What was helpful was to offer a hug as a sign of appreciation, or some humor: “Thanks Dad,” my sister would say. “I’ll use that for my face lift.” That always cracked him up and he’d stuff his money back in his wallet and say “Never!”

Nataly Rubinstein’s new book, Alzheimer’s Disease and Other Dementias: The Caregiver’s Complete Survival Guide, lists 10 typical compulsive behaviors and how to deal with them. The important thing is that your response not make things worse.

Alzheimer’s and repetition: cherish it

When Dad told the same stories over and over, the son-in-laws used to actually bet on how many times Dad would repeat himself. I guess it made their visits less boring, but I was not a fan of that as it bordered on ridicule even though they would never have hurt Dad’s feelings intentionally.

I grew to love the stories because I wanted to really remember them after Dad was gone–not just the subject– but the way he told them and the words he used. But I can appreciate how tedious it was for my mom to listen to the same things endlessly.

When Dad would repeat “Isn’t your mom the most beautiful woman in the world,” it irritated Mom because he had not said it enough when she was younger and would have appreciated a genuine compliment. But we could see in dad’s eyes–actually he was legally blind, so it was really coming from his heart–that he believed what he said.

Later, we were glad we had all those comments stored up for when Dad began to say “She’s not my wife.” It was abundantly clear that he loved Mom deep inside where it mattered.

Q&A: My mom is balking at moving closer to us.

My brother and I are helping our mom move from out of state into a nearby condo we’re buying. It makes good sense, since she doesn't own her home or have strong emotional ties where she lives now. It will also be good for her to be nearer to us as she gets older and begins to need more care -- and best for her to have some years to feel happy and settled herebefore she becomes more dependent on us.

Our mom agrees in theory that this is a good idea. However, I know she's uneasy. She's pouting over the idea of downsizing. She sometimes tells one of us she doesn't want to move at all, in the same day that she's told the other that she's excited about the change. It seems like she has a new cold or headache every other day -- but she also talks a lot about how much she'll enjoy seeing more of us and her grandchildren.

Her changing moods are hard to keep up with, and I'm afraid that at the last minute she'll refuse to move and sabotage the whole plan. Any advice?

Your mom is freaking because it's such a big change.

Four ways to help elders keep their balance

by Dorian Martin from Elder Care Link

My 86-year-old father fell again recently. These missteps are worrisome since falls account for 70% of accidental deaths in people age 75 and older, according to the American Family Physician. Therefore, Dad’s experiences may provide important insights that can help other elders avoid falling.

Dad first fell two years ago while living alone. He was carrying groceries into his apartment when his foot caught the door’s threshold. Dad didn’t hurt himself, but he couldn’t get up or reach the phone. Fortunately, he subscribed to a home medical alert system. He pushed an alert button on a necklace provided by the company that notified first responders and me. Within a few minutes, Dad was helped to his feet.

Shortly thereafter, Dad stumbled three more times. Although not physically injured, Dad’s confidence became increasingly shaky. I encouraged Dad to consider trading his cane for a walker, but he refused. We also talked to his doctor about Dad’s instability. The doctor determined that these falls coincided with an increase in one medication. After the prescription was reduced, Dad’s falls ended–until recently.

Elders and falling: four tips to remember

This most recent stumble was due to the environment. I noticed Dad experienced difficulty in maintaining his balance while getting out of a rocking chair in the living room. I replaced the rocker with a sturdy chair from Dad’s bedroom and then moved an dining room chair into his bedroom. One evening, Dad leaned on the dining room chair as he bent to retrieve something from the bedroom floor. Unfortunately, the chair was not as stable as the other chair and Dad lost his balance. I heard his calls for help and, with our neighbor’s aid, we got Dad back on his feet unharmed. The fall made Dad wary and prompted him to enroll in a balance course.

Here are four things I learned through Dad’s falling issues.

1. Use a medical alert service. Subscribe to a service that will alert you and emergency responders when an elder falls.
2. Medications may affect balance. Consult a doctor if your loved one suddenly experiences balance issues to see if a recent prescription change is the cause.
3. Choose an appropriate walking aid. Select appropriate walking aids (a cane or a walker) that can help the elder maintain balance.
4. Review the environment. Check the environment for potential hazards, such as rugs, dim lighting, rocking chairs, and chairs that aren’t sturdy. Make appropriate changes.

Why Elderly Friendships Can Fade

Mom was lucky to have several friends who lived as long as she did. So, it was frustrating that my mother didn’t make an effort to see or talk to them when she seemed to be capable of doing so. Even before her stroke, we would suggest mom make a date to meet an old friend from church, or a woman whom we had called “Aunt” whom mom met way back when Dad was in the service.

We had a Certified Nursing Assistant (CNA) coming to look after dad so mom could have some spare time, but mom often preferred to sit and talk with the CNA. It was hard to understand what was stopping her from spending precious time with those who had known her and dad practically their whole married lives.

Then an odd thing happened. Mom began enjoying new friends. I had never witnessed her make a new friend but everyone at the nursing home and Circle of Friends daycare seemed to “get” her humor and appreciate her personality. They talked about things in the moment mostly, but occasionally she reminisced, looking at dad’s picture.

Surgery Late in Life

Surgery is surprisingly common in older people during the last year, month and even week of life, researchers reported Wednesday, a finding that is likely to stoke, but not resolve, the debate over whether medical care is overused and needlessly driving up medical costs.


The most comprehensive examination of operations performed on Medicarerecipients in the final year of life found that nationally in 2008, nearly one recipient in three had surgery in the last year of life. Nearly one in five had surgery in the last month of life. Nearly one in 10 had surgery in the last week of life. 


Read the full article from the NY Time Aging Blog here.

1 In 4 Adult Caregivers Suffers From Depresssion

One in four caregivers for ill or elderly relatives and friends said in a survey released on Tuesday that they suffer from depression, a figure far higher than for the U.S. population in general.

By comparison, 9 percent of all Americans are estimated to suffer from depression, according to a study released last year by the U.S. Centers for Disease Control and Prevention in Atlanta.

The California-based company Caring.com, a website for caregivers that commissioned the online survey of 400 respondents, said the high level of depression reported by those attending to a loved one comes as many face their own health issues.

The survey also found that a third of family caregivers spend more than 30 hours a week in that role, and 77 percent are concerned about the impact of their duties on their savings.

Most of the caregivers were attending to an infirm parent, while the rest were caring for a spouse, relative or friend.

(Reporting by Alex Dobuzinskis: Editing by Steve Gorman and Jerry Norton)