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Holiday Visits Can Raise Concerns

When families live far away from one another, the holidays may be their only chance to personally observe their older relatives. Age-related declines can happen quickly. Family members who haven’t seen their loved one since last year might be shocked at what they see – a once healthy father looking frail or a mom whose home was well kept now in disarray.

For those family members who have relied on regular telephone calls, the upcoming holidays might be revealing. When family members visit for the holidays it gives them an opportunity to observe a situation through new eyes. The following changes might indicate the need to act to ensure your aging relatives’ safety and good health.

Weight Loss – One of the most obvious signs of ill health, either physical or due to cognition struggles, is weight loss. The cause could be related to a lack of energy to cook, or it could be more serious. Certain medications and aging in general can change the way food tastes. If weight loss is evident, talk with your loved one about your concern and schedule a doctor appointment to discuss the issue.

Balance – It is important to pay attention to how an older adult moves and walks. An older adult who is reluctant to walk or has pain while they move may have muscle or joint problems. If your loved one appears unsteady on their feet there could be a risk of falling. This is a serious problem and could result in a severe injury.

Emotional well-being – Be cautious of obvious and subtle changes in your loved ones’ emotional well-being. You can’t always gauge someone’s spirits over the telephone, even if you speak daily. Take note of signs of depression, withdrawal from activities with others, sleeping patterns, loss of interest in hobbies, lack of basic home maintenance or personal hygiene. All of these are concerns of depression, dementia or other physical ailments including dehydration. If you notice different behaviors with your loved one, be sure to seek medical attention.

Home environment – Pay attention to your loved ones’ surroundings. For example, your parent might have been a stickler for neatness or for paying bills on time. If you discover clutter or mail piled up, a problem might exist. Keep an eye out for other concerns. Scorched cookware could be an example of a stove that was left on. An overflowing hamper could mean your loved one doesn’t have the energy or desire to do laundry. Check prescription bottles for expired dates and make sure medications are being taken as directed.

If you visit your loved one over the holidays and have concerns, Geriatric Care Management can be of assistance in assessing and developing a care plan for your loved one to help ensure their safety and help with decisions about their future. The more systems you have in place, the better peace of mind you’ll experience as you return home from your holiday and future visits.

Kathleen Weston
Preceptor Home Health Hospice

What do you want at End of Life?

With any important decision comes a frank and open discussion, especially when it comes to medical care preferences. There is always hope this discussion happens before you are unable to make decisions for yourself. These decision are called advanced directives and include your wish for what you want as your health care changes.

Is there ever a good time to talk about this? The holidays might be the right time – when family is together. If you prefer to skip the conversation, record your preferences in a letter, email, or during a routine doctor’s appointment. As long as you are able to communicate your wishes, you can change your mind about how you want to be cared for as your health changes.

Below is a list of questions you might consider to guide the conversation.

– Thinking about your death, what do you value most about your life?
– If you were diagnosed with a terminal illness, would you want to pursue every possible cure?
– Do you want to die at home?
– If not at home, where do you want to die?
– How much pain is acceptable to you?
– Do you want your family with you when you die?
– What decisions regarding care do you want to entrust with others?
– What do you hope for regarding your death?

I believe the most important question is “What do you want at end of life?” I met with a woman who asked her father this, and he said, “As long as I can have chocolate ice cream and watch football, I will be fine.” His answer surprised her, but it also told her what was important to her father and helped guide her when his health changed.

We all have different values. We know that what is important to one person might not be important to another. Spiritual, cultural, social and economics may influence decision-making. Understanding options and what is available is important as these decisions are considered.

Sometimes people do not want to stop curative measures. At some point, however, the person may not be able to physically withstand additional surgery, chemotherapy or other treatment. Palliative care, which helps relieve pain and provides symptom management, can be a relief and an option. Hospice provides care to the patient and entire family. Curative care is stopped and replaced by comfort care to reduce pain and other symptoms associated with the illness. Hospice also supports quality of life while supporting the family helping to care for the patient. Hospice provides a range of services for a variety of illnesses through a team approach that offers support physically, socially, and spiritually. Hospice also offers bereavement to families after the death of a loved one. Hospice does not take away hope – it offers a different kind of hope.

Discussing a care path or change in the goal for care is difficult for family members. However, having the conversations sooner rather than later can ensure you are providing the care your loved one desires.

Kathleen Weston
Preceptor Hospice Director of Operations

Suggested Activities for Seniors with Dementia

Keeping aging loved ones active in hobbies and interests that gave them pleasure in the past is important. This is important to stir memories, feel emotionally connected with others, reduce anxiety and irritability, and make them feel more engaged with life. Certain activities may work better at different times of the day or may change as the disease progresses. Give them a try, you may be surprised yourself at how much fun you will have.
* Sing songs or play music from an era when they were younger
* Watch family videos
* Look at family photo albums together
* Make a small hand held photo album and label with the names of family and friends. Leave in resident’s room to look at any time they would like
* Put a simple puzzle together
* Play a familiar game such as UNO, go fish or checkers
* Color or paint pictures
* Look through magazines of interest to resident such as cars, hunting, gardening, etc.
* Ask about memories they have about their siblings, going to school as a child, wedding day (memories from long ago stay intact longer)
* Make birthday or holiday cards together
* Keep a journal in resident’s room and write about visitors or special outings, family gatherings, etc.
* Eat lunch or a snack outside
* Fill a bird feeder together and place outside room
* Look at or count trading cards
* Cut coupons together

Ten Strategies to Communicate Better with Older Adults with Dementia

1. Reduce Distractions: Turn off TV or radio, find quiet place to talk, close the door if possible. This allows the person to focus their energy on the conversation.
2. Get the Person’s Attention: Establish eye contact, smile, use their first name, and identify yourself by name, position, relation. Use a natural voice.
3. State Your Message Clearly: Use simple words and sentences. Speak slowly, distinctly, and in a reassuring tone. Refrain from raising your voice louder.
4. Ask Simple Questions: Those that can be answered with a simple yes or no and one word is best. Avoid open ended questions. Ask only one question at a time.
5. Give Two Choices: Example – would you like to wear the red blouse or white blouse? Show the choices if possible.
6. Give Extra Time for Responses: Be patient in waiting for a reply. Watch for nonverbal cues and body language to help you understand.
7. Give Directions One at a Time: Break down activities into series of steps. This will help them to understand and participate better.
8. Stick to a Topic: Avoid quick shifts from topic to topic or activity to activity.
9. Have Patience: Do not show your frustration and try to to correct every inaccurate statement they make.
10. Remember there will be Good Days and Bad Days: Just like anyone, they will have ups and downs. Just keep trying.

Tips for Talking to your Doctor

How well you and your doctor communicate is one of the most important parts of getting good health care. Talking to your doctor, however, is not always easy. It takes time and effort on your part as well as your doctor’s.

In the past, the doctor typically took the lead and the patient followed. Today, a good doctor/patient relationship is more of a partnership. You and your doctor work as a team, along with nurses, physician assistants, pharmacists and other health care providers, to address your medical problems and keep you healthy.

Talk to your doctor and the nurse
It is not uncommon to visit with your doctor’s nurse first. Be sure to tell the nurse about any current and past health care issues or concerns. It is important to share any information you can, even if you’re embarrassed, including:
– Any symptoms you are having
– Your health history. Keep a journal and bring it to your appointments.
– Personal information, including whether you are stressed or your life is changing
– List all your medications, even those purchased over the counter. Include the medication strength and how often you are taking each.
– Any side effects from your medications
– Any allergies you might have, especially to medications.

Ask questions
Don’t be afraid to speak up. It is important for you to let your doctor know if you don’t understand something. If you don’t, your doctor will think you understand everything you’ve been told. If you have questions before the appointment, be sure to write them down to ask during your appointment. You don’t want to forget anything when you have your doctor’s attention. Tell your doctor if you need more time to discuss something.

Take information home
It’s all right to take notes at your appointment. Sometimes it helps to bring a family member or friend with you to help write down the doctor’s instructions or answers to your questions. Ask for brochures or other written material.

Follow through
Be sure to follow your doctor’s instructions, like taking medication or scheduling a test or another appointment. If you forget something, it is okay to contact your doctor. The following are reasons you may need to call after your appointment:
– If you have questions after the appointment.
– If you start to feel worse or have problems with your medicine.

As we age, it becomes even more important to talk often and comfortably with your doctor. That’s partly because you may have more health issues to discuss. It’s also because your health greatly impacts other parts of your life. Taking an active role in your health care puts the responsibility of good communication on both you and your doctor.

Kathleen Weston
Director of Hospice Operations

Medicare Part D

It’s October – and the time of year when people 65 years of age and older have the opportunity to review their Medicare Part D plan. If you’re just reaching Medicare age, you might be surprised to find out that traditional Medicare doesn’t cover prescription drugs. As drug costs rose, Congress created a Medicare drug insurance program, called Medicare Part D, which went into effect in 2006.

To take advantage of this program, offered by private insurers, individuals receiving Medicare have to choose a drug plan every year, unless they have a Medicare Advantage plan that includes drug coverage or are covered through a former employer.

Plans vary by state, but most Americans have more than 25 plans to choose from, each offering different premiums, agreements with certain pharmacies and varying coverage amounts for the same drugs. This can make choosing the best plan a challenge.

Plans for 2020 will be revealed October 1 on the Medicare.gov website, and participants have from October 15 to December 7 to choose a plan that will go into effect January 1, 2020. Even if you loved last year’s plan, it’s important you shop around from scratch this year.

To make sure you’re choosing the best Medicare Part D plan for you, start with the medications you take. On the Medicare.gov website, you can enter your medications (including dosages and quantity) and the site will rank the plans by which would be cheapest for you, showing your medication costs on each plan and how much you’ll pay in premiums. You may need to search multiple times since the cost varies by pharmacy and you can compare only two pharmacies at a time.

Once you’ve narrowed your search to a few choices, you also want to check whether there are any restrictions on your medications. Certain plans, for example, may require prior authorization or step-up therapy, where you have to try and fail with one drug before the plan will approve another.

Those fortunate enough not to need any prescription medication may still want to sign up for a basic drug plan because Medicare charges a penalty if you don’t enroll when you’re first eligible. The penalty is based on how long you go without coverage.

Once you choose a plan, you can’t change it until the next open enrollment period unless you meet special circumstances, such as moving to an area where your plan is no longer offered or losing employer-based coverage. If you’re prescribed an expensive drug midyear, you’re stuck and can’t shop around for a new plan until the open enrollment period at the end of the year.

There are other opportunities within the State of Wisconsin when choosing a Medicare D plan. Have you heard of Senior Care or the State Health Insurance Assistance Programs?

YES, this process can be extremely challenging, especially if you are not Internet savvy. Help is available. The Medigap Helpline is a free, confidential counseling service for all Medicare beneficiaries, including disabled individuals and those age 65 and over. The insurance counselors at the Medigap Helpline can help you with questions about various health insurance topics:
• Medicare
• COBRA
• Medicaid
• Medicare Advantage Plans
• Guarantee Issue / Open Enrollment
• Medicare Prescription Drug Coverage (Part D) • Medicare State Health Insurance

Assistance Program (SHIP)
Medigap Helpline Telephone Counseling Service
1-800-242-1060

Medigap Part D and
Prescription Drug Helpline
1-855-67PARTD (1-855-677-2783)

You can reach out to your local ADRC (Aging and Disability Resource Center) for additional assistance.

Kathleen Weston
Director of Hospice

Assessing Home Safety

Question: My parents live in Wisconsin; I live out of state and will be visiting them soon. They have experienced some struggles that resulted in hospitalizations. They are living independently. While I am visiting, what can I look for to be sure they are still safe in their home? How can I offer assistance and share concerns?

Answer: When families live away from one another, vacations and holidays may be your only opportunity to personally observe our parents. Family members who haven’t seen their aging loved ones in a while might be shocked at what they see: A formerly healthy father looking frail, or a mom whose once well-kept home is now in disarray. Absence, even for a short period, allows us to observe a situation through new eyes. The following may indicate the need to take action to ensure your parent’s safety and good health:

Weight Loss: is one of the most obvious signs of ill health. The cause could be an array of health issues or it could be a lack of energy to cook. Certain medications and aging in general can change the way food tastes. If weight loss is a concern, schedule an appointment with the primary doctor.

Balance: Pay close attention to the way your parent moves or walks. Reluctance to walk or pain during movement can be a sign of joint or muscle problems. If they are unsteady on their feet, they may be at risk of falling, which could cause severe injury or worse.

Emotional well-being: You can’t always gauge someone’s spirits over the phone, even if you talk daily. Take note of signs of depression including withdrawal from activities, changes in sleep patterns, loss of interest in hobbies, lack of basic home maintenance or personal hygiene. The latter can be an indicator of not only depression but also dementia or physical ailments including dehydration. If you notice a change in behavior, be sure to seek medical attention.

Home environment: If your parent has been a stickler for neatness, for paying bills promptly, or if you discover excess or unsafe clutter and mail that has piled up, a problem may exist. Keep an eye out for less obvious indicators: scorched cookware could be a sign your parent is forgetting to turn off the stove. An overflowing hamper could mean they don’t have the strength or desire to do laundry. Be sure to check prescription medications and medication bottles for expiration dates. Make a list of medications and place it in their wallet.

Assessing Home Safety
If you notice these problems or others, here are some steps to take:
– Share your concerns through a heart-to-heart conversation with your parents.
– Contact the local aging department and ask about geriatric care management services that can help direct the many issues associated with aging and health care. Learn about in-home services to assist your parent with laundry, meal preparation, transportation, and other tasks.
– Identify local resources that can assist your parents, including friends, neighbors and clergy. Take time to contact those friends and ensure you have their phone numbers and e-email address.
– Compile a list of medical information about your parents’ prescriptions, doctor’s names and phone numbers.
– Obtain access to all your parent(s) vital documents including their will, power of attorney, birth certificate, social security number and insurance policies.

Remember to give your loved one the power and permission to be in control of his or her own life, as much as is reasonable. The more systems you have in place the more your loved one can remain independent and safe in their home.

Kathleen Weston
Director of Hospice Operation

Memory Tips for You and Your Loved Ones

1. Have a special place for important things. EXAMPLE: Always keep your purse and keys in the same place.
2. Write down things you need to get done in a notebook.
3. Cross off things after you do them.
4. Stay in the kitchen when you are cooking so you do not forget about the stove and oven.
5. Use timers to help you remember to take pills or to do things.
6. Write down ideas or information that you want to remember right away, before you forget it.
7. Keep a small notebook and pen in your pocket, purse, and/or tote bag to use when you are not at home.
8. Write down the names of people that you want to recall later.
9. Write down instructions or information doctors, nurses, or therapists tell you.
10. Check your calendar every day for appointments.
11. Check your “to do” list every morning.
12. Do not try to do a lot of things at once. Do big jobs in parts, one step at a time.
13. Stay calm. If you forget something, do not get upset.
14. Plan ahead. Check your schedule for tomorrow.

Stay Positive

My mother was diagnosed with Alzheimer’s dementia when she was in her late 60’s. I am like many adult children who have a parent who was diagnosed with dementia – I wonder at some point if this will be me. At 58 I find myself being very conscious about remembering people’s names and paying close attention to everything said during a conversation. When I can’t remember, I think “oh boy, here it comes.”

I read an article in “Science Daily” titled: Think Memory Worsens with Age? Then Yours Probably Will. A team of researchers from North Carolina University did a research project with older adults. The study showed older adults who think they will perform poorly on memory tests actually scored much worse than seniors who don’t buy into the stereotype about aging and memory loss. What this means is an older adult’s ability to remember suffers when negative stereotypes are “activated” in certain situations.

When older adults were preparing to take a test for their memory they actually performed poorly when they were told in advance ‘they shouldn’t be surprised if the outcome would not be good.’ Memory suffers if older adults feel they are being looked down on because of their age. Unfortunately, this situation might be a part of an older adult’s everyday experience. Being concerned about what others think can have a negative effect not only on test performance but how we live our lives.

The positive side is older adults who felt good about aging and didn’t buy into the stigma of aging performed well on the test. In other words, if you are confident aging will not ruin your memory, you are more likely not only to perform well on a memory-related test, but to live in the same manner.

While there is no guarantee I will not inherit the disease my mother suffered, I can live my life in a positive manner by not letting the stigma of aging interfere with how I live my life. These wellness steps certainly cannot hurt – in fact; they may help quite a bit.

Kathleen Weston
Director of Hospice

STARTING THE CONVERSATION

Have you seen the bumper sticker that reads: “Be nice to your children, they’ll pick your nursing home?” Although this saying might seem funny to our young grandchildren or other family members, it’s not so funny to older adults or caregivers. However, when you notice your parents or loved ones need more help than you ever imagined, you need to know how to start the conversation.

There is a long list of red flags that can tip you off when the time has come to have the conversation. A few of them are as follows: A gradual or sudden change in mood or behavior, a decline in health or increased trips to the doctor or emergency room, not enough food or rotting food in the house, a change in personal appearance or increased confusion.

This is the time to call a family meeting. It is important to have everyone involved with your parents at this meeting. Have an agenda and appoint someone to take notes. Ask questions and find out what others might be concerned about. Their responses might surprise you.

After the meeting, pick a spokesperson to lead the conversation with your parents. Explain it is your responsibility as an adult child to see that they are safe and healthy. Be respectful and explain you’re being realistic while being loving and practical, trying to avoid a crisis.

Talk about your feelings. Look for body language and facial expressions – are you hearing your parents? Are you reading them correctly? Encourage them to share their own feelings. Many older adults feel a loss of independence and are worried about their declining health and the emotional changes they are experiencing. Maybe they don’t want to be a burden to their children or caregiver. Be a good listener and be patient. Do your best to hear what they are saying – and not saying. Expect there might be some negativity in the conversation.

Take small steps. Don’t overwhelm them with too much action at once. Tackle one or two small issues such as helping around the house, gathering their important documents or offering assistance with paying their bills. Allow them to participate in the solution to whatever is going on that causes concern.

Once they accept help, do your homework. Knowing available resources is important. In the past I have stressed the importance of knowing your parent’s doctors and other vital information (Social Security number, life insurance, Medicare, bank accounts, financial investments, power of attorney documents). Start a notebook or file with this information.

You can also get expert advice from a professional geriatric care manager who can help you navigate through the system. Collaborating with a geriatric care manager can save you time and provide you with information, recommendations and serve as an advocate for you and your parents. Geriatric care management is privately paid, but also cost efficient when you think of the decreased stress and anxiety, and time away from work or your own family, while at the same time providing a valuable service to the family.

Kathy Weston
Director of Hospice Operations