The Nine Things You Need for Pre-planning

It can be universally agreed –upon that the two most dreaded things the average person doesn’t want to face are public speaking engagements and their mortality. While public speaking can generally be avoided, your own demise can’t. Make it easy on your heirs by assembling a list with the 9 things they will need once you’re gone so your final wishes can be honored and your friends and family members won’t have to search for valuable paperwork and documents. Start with a simple file folder, marked “Important Information,” and go from there.

1.      If you have a lot of online accounts, whether with banking institutions, mutual funds or even social media, create a document with all of the appropriate passwords and user IDs that can give your durable power of attorney or other designated representative access to the accounts. You may want to create a couple of documents, perhaps one marked “personal” and another “financial,” with the website addresses, screen names and account numbers. For example, the son of a website moderator accidentally stumbled upon a community of friends he had no idea his father had when he looked at his father’s bookmarks. He found his father’s password and logged in to tell the users that his father had passed and was pleasantly surprised to see what an impact his father had made on people he otherwise would never have met. Of course, if you lead a double life, you might just want to leave it to the ages.

2.      If you have a lockbox or portable safe in the house, write down the combination or note the location of the key to open it. Consider putting stock certificates, savings bonds, mortgage information, will or trust documents, your Social Security card and other important paperwork inside. If you have any jewelry that you want to give to certain people, put the items in separate baggies and use a permanent marker to denote which person they’re going to.

3.      Create a document with your bank account information, including the name, physical location, account numbers, any passwords and user IDs. If you have a safe deposit box, note the location of the key.

4.      Compose another document with information regarding your insurance policies, including health, auto, home and life.  Write down the name of your agent(s) if applicable. If you have made burial arrangements, note this information as well, including the location of the plot, the mortuary or where you’d like your remains to go.

5.      Create a document with all of your credit card information, including account numbers. If you get an annual print-out of your credit report, attach it to the document as well. This will ensure that you haven’t forgotten any accounts.

6.      Compose a document with the name of your accountant as well as your attorney, their phone numbers and addresses.

7.      Write up the kind of memorial service you want. Making your wishes known to your friends and family, in terms of how you’d like to be remembered, whether through donations to a charity, the type of music you’d like played or a favorite poem to be read, will help those you left behind remember your legacy and perhaps make the arrangements easier to  manage.

8.      Go through your family albums and write down the names of people on the back of photos. This is a way to preserve your family’s heritage, and you may save one of your descendants the trouble of having to pore through archives for a family tree.

9.     Designate a relative or close friend as your dual power of attorney for health care and fiduciary matters. You should feel that they know your wishes when it comes to end-of-life issues as well as your financial matters.

Preparing for the Holidays with Seniors in Mind

There’s nothing more heart-warming than having generations of family members gathered together, taking pictures, sharing stories and enjoying the holiday festivities. Being mindful of individuals’ limitations, be they a toddler’s or someone suffering from Alzheimer’s, is important, both for safety’s sake and to eliminate any stresses or conflicts that may arise. Keeping in mind some helpful hints, when dealing with an elderly family member, will keep the hectic pace of the holiday season more manageable so you can take it all in stride.

Prior to your family gathering, perform a walk-through of your home to ensure there are no tripping hazards or barriers. Start with the front walkway; if there are a number of stairs or uneven pavement up to the front door, consider entering through the garage. Look for any area rugs that need to be moved away or secured with double-sided tape. Provide seating that is high enough that the senior can easily get up.

If your family member has Alzheimer’s, this presents its own set of challenges. Have a family album or two sitting out on the coffee table. It may be surprising, but someone with age-related dementia may have more acute long-term memory than younger people. Being reminded of past get-togethers and holidays may bring up stories that you’ve never heard and is a chance to engage someone who may otherwise feel left out of the festivities.

Set the mood for the season with traditional holiday music and familiar food. However, be aware that some seniors may have dietary restrictions, in terms of a low-salt or -sugar diet. Be stingy with the sodium; if your guests need more, have salt shakers nearby. The same goes for the sugar: steer away from cake mixes, candy and anything with corn syrup. There are many resources online when it comes to recipes for those with diabetes.

Too much alcohol can turn a light-hearted get-together into a disaster. Those who already need assistance when it comes to balance will only be more impaired after an adult beverage. Moreover, many medications routinely prescribed to seniors, such as Coumadin, definitely do not mix with alcohol. Consider becoming the bartender and offering mixed drinks, substantially diluted with water. Adding a splash of alcohol on top of whatever you’re mixing it with then not stirring it up will make the drink taste stronger.  There are also many non-alcoholic wine, cider and beer alternatives out there; just pour one into a glass to avoid the alcohol altogether.

The last piece of advice is try not to do it all. Consider doing your holiday shopping online, especially for electronic products. Apple, eBay and Amazon offer great deal, especially on “cyber Monday,” right after Thanksgiving when online merchants offer their best deals to compete against brick and mortar businesses. Remember that gift cards make the perfect stocking stuffers and take the guesswork out of shopping for someone who has everything.  If you’re hosting the family gathering, provide the main course and have other family members bring the appetizers, side dishes, drinks and desserts. Keeping it simple will allow you to enjoy your holidays and focus on what’s important: spending quality time with your family.

Prepare for the Worst; Expect the Best

 

Safety, safety, safety: This is the mantra in home care and should always be the primary consideration in your home.  Take some time, print out this handy checklist and do an inspection of your home to keep you and your loved ones safe and sound.

Outside

Are all walkways and entrance areas well-lit?

Would motion detection sensors be a good idea for exterior lights?

Are there any overgrown bushes or trees that need to be cut back? (These can be hiding places for unwelcome guests or offer cover to intruders.)

Are all walkway surfaces even and level to prevent slips and falls?

Consider installing ramps and handrails for easier access to the home.

Inside

·        Hallways: Are they well-lit and free of clutter?

Would a light-activated nightlight be a good idea to illuminate hallways?

If there are wood floors, would a hallway runner prevent potential falls?

Are doorway thresholds a problem for walkers or wheelchairs? Or could they be potential tripping hazards?

·        Living Room: Are there any overloaded electrical sockets?

Are all electrical cords out of the way?

            Are chairs, couches and other seating high enough for ease of use?

Consider putting water bottles on nearby coffee tables to encourage hydration throughout the day.

Are area rugs secured with double-sided tape to prevent uneven surfaces or tripping hazards?

·        Kitchen: Are items that are used often easily accessible?

Is there a fire extinguisher within reach of the stove or a box of baking soda handy?

Is there a stepstool nearby to access items stored in high cabinets?

Is there evidence of droppings around the baseboards or in cabinets from insects or rodents?

·        Bathroom: Is the hot water heater set no higher than 120F?

Are all throw rugs secured to the floor with double-sided tape or have a non-skid backing?

Is there a grab bar near the toilet or an elevated toilet seat if accessibility is an issue? (A towel rack is not the same as a grab bar.)

Is the shower or tub equipped with a grab bar?

Would a bath bench be useful in the shower? What about a hand-held shower attachment?

Is the shower or tub floor slippery? Would a bath mat or appliqués be appropriate?

For nighttime trips to the bathroom, would a nightlight be a good idea?

·        Stairway: Are the handrails sturdy and well-attached to the wall?

Are there working light switches at the top and bottom of the stairs?

Do the stairs have non-skid treads?

Are the stairs free of clutter?

Are the edges of steps marked with a different color of paint or nonskid tape?

Fire Safety

·        Are all smoke alarms and carbon monoxide detectors in working order? A good rule of thumb is to change the batteries annually, perhaps at the first of the year or when you change your clocks.

·        Do you have a plan of escape in case of fire?

Emergency Preparedness

·        Do you have at least three days’ worth of shelf-stable food and bottled water in a storage area, along with disposable plates, utensils and a can opener? (1 gallon of water per person per day is recommended.) Don’t forget about the family pet.

·        Do you have extra medications in the event of evacuation?

·        Do you have a first aid kit that is well-stocked with bandages and antiseptic?

·        Do you have a supply of personal hygiene products?

·        Do you have copies of vital records in a well-secured area, including a list of prescriptions, personal contacts and insurance records?

·        Do you have a flashlight, candles and a portable radio, along with extra batteries and matches?

·        Do you have an extra blanket and a pair of sturdy shoes tucked away?

·        Do you know where the gas shut-off valve is and how to turn it off?

·        If you are on oxygen therapy, do you have portable tanks in case of a power outage?

Being prepared for all eventualities isn’t just paranoid thinking: it assures you and your loved ones peace of mind and can keep you safe and secure in your home. If you have any questions or concerns, please call us at Home Health Care Inc. and we would be happy to answer any questions you may have: (707) 538-0679.

Home Care Now: I Don’t Need it.

Home Care Later: I’m on the Floor; Now What?

When families get together for the holidays, you might hear stories about the time mom fell and had to get the neighbor to help her up or when she went to the doctor and he told her she needed home care, which made her upset. In person she tells you, “There’s nothing wrong with me; I can handle my own life.” You go over to pick mom up for dinner and notice stacks of unpaid bills jammed in a drawer, and there are full vials of pills in the kitchen that have long expired with conflicting directions on when/if they should be taken. This is especially a red flag since the #1 cause of death after a hospitalization is due to medication not taken as directed. You may notice that mom’s hygiene is not what it once was: her hair appears greasy and unwashed, and her fingernails are long and dirty. The house reeks of urine, from the upholstered chair mom likes to sit in to a closet full of saturated adult diapers crammed away under the bathroom sink. On further inspection, you notice that the dog appears underfed, the cat’s hair is falling out, and there’s no fresh water or food for them anywhere. You open the refrigerator and find last year’s leftovers from dinner right where you left them. If even one of these conditions has you nodding in agreement, it’s time to explore home care options for your mom.

When this subject first presents itself, many adult children react like the children of alcoholics: “I cannot say anything to mom because she’ll get mad at me. If I tell her what I’m seeing, she may never talk to me again. And if I keep it up and continue to point out her problems, she may cut me out of the will.” Contrary to what you may think, this is the point where you must take the bull by the horns and tell mom what the problems are while knowing there is help available. Remember, these living conditions will only get worse. She will either end up falling and breaking a hip, becoming hospitalized, or worse, due to medication mismanagement or starving to death waiting for someone to find her on the floor. Now is the time to make a plan, get information about home care companies and make a list of their pros and cons.

Home care is something of an old concept made new. In the Charles Dickens’ novel Martin Chuzzlewit, the unscrupulous and alcoholic nurse, Sarah Gamp, became the stereotype for the itinerate midwife/hospice nurse who attended needy families at the most critical and life-changing times: birth and death. Indeed, such a poor representative of the nursing profession led to changes in this relatively new field, most notably by Florence Nightingale and the Victorian medical reform movement. 

Historically, home care nurses were necessary for new mothers and babies, as well as working families that contracted infectious diseases. Up until the 1930s these were the most critical patients, at which point chronic degenerative diseases became the primary cause of patient mortality, and the majority of these cases were dealt with in a hospital setting. In the late 1950s hospital costs began to rise, and multiple nurses’ organizations started to bring home care back to the forefront.

The old adage “home is where the heart is” applies nowhere better than to positive patient outcomes, as opposed to the sterile environment of a hospital or skilled nursing facility. Home care is generally preferred when it comes to end-of-life matters, as well as patients with disabilities or those recuperating from surgery. A little help can go a long way to ensure the patient remains safe in the home, no matter the medical issue involved. Home care may be considered if the patient needs pain management, assistance with bathing, activities of daily living, light housekeeping or range of motion therapies. Indeed, home care may be the deciding factor for maintaining an independent lifestyle.

Just remember that home care, like religion, age and politics, is often ignored as a subject in polite company. However, continued denial about the state of a loved one’s health will only cause more upset and guilt when the time comes for action to be taken. Get information ahead of time, understand what your needs may be and make a plan of action. Consider disease conditions and how they may change and the resulting physical limitations so that when that time comes, you have a definite course of action. Work with a home care agency that will make a preadmission assessment and give you more insight and possible referral ideas when that eventuality. Take the time to do your homework so when a crisis occurs, you’re not caught off-guard and working in panic mode, rather than from a calm, well-considered perspective.   

Plan Before Panic

In our 25 years of involvement in home care, we are frequently called by family members who require care for their loved ones after an unexpected illness or injury. In these instances, concerned friends and family members may not have taken the time to explore or understand what is available in terms of home care, and these life-changing decisions may be made in panic mode. Whether or not your family has set up a trust or taken out a long-term care policy, someone needs to take the responsibility for deciding who will care for mom or dad. This individual will need to consider the following:

1.      The need for a dual power of attorney for the patient’s health care and fiduciary matters.

2.      An understanding of the patient’s wishes when they are unable to decide for themselves.

3.      The need to decide which family member will be responsible for paying the household bills when the patient can’t do it themselves.

4.      The need to decide which family member will determine whether the patient will stay in the home, go to assisted living or a skilled nursing facility.

5.      An understanding of what resources are available to the patient: an acute care hospital, a skilled nursing facility, assisted living, memory care, hospice care or a home care agency.

A POLST (Physician Orders for Life-Sustaining Treatment) form is available from a health care provider and specifies what kind of care a seriously ill patient desires. This document is signed by both the physician and patient and goes with the patient, whether in the home or to a facility.  A POLST form indicates the treatment options chosen by the patient. These may include:

·         Resuscitation, including CPR, a defibrillator, intubation or a ventilator;

·         DNR (Do Not Resuscitate) order;

·         Comfort Measures, including pain management;

·         Antibiotics to fight off infections, including pneumonia;

·         Intravenous (V) Fluids;

·         Artificial Nutrition/Tube Feeding.

An Advance Health Care Directive specifies who speaks on behalf of the patient (i.e., power of attorney), general health care decisions, organ donation information and the choice of a primary care physician.  The primary difference between the two documents is that a POLST deals with end-of-life issues and brings up the difficult decisions that many patients and family members may want to avoid. These decisions need to be made well before the need arises so that all parties involved are operating from a calm, clear and rational perspective as opposed to crisis mode.

Feel free to call our office at (707) 538-0679 and talk with our case management team to explore the options available in a home care setting.

Managing Medications

Any drug that a patient takes will cause a series of chemical and physical effects in their system. All drugs have the following properties:

• absorption
• distribution
• metabolism and
• excretion.

Properties describe a drug's

•  onset
•  dosage
•  length of action and
•  availability.

All of these properties impact the body's ability to metabolize the medication.

Before a drug can get into the system, it needs to be absorbed into the bloodstream. Only after it dissolves can the drug be absorbed and produce an effect.

Doses must be based on the patient's:

•  body weight
•  age and
• condition.

The rate at which a drug is metabolized varies from person to person. The patient's age is an important factor. Elderly patients usually have decreased liver and kidney function. Underlying disease conditions may also affect drug action and effect. Body weight is another important factor.

The storage of drugs can alter their potency. Drugs should be stored in tight-fitting containers and kept out of direct sunlight. Some medications must be refrigerated. Many drugs should not be stored in bathrooms because of constantly changing humidity.

The timing of drugs is very important. Some medications are given either before or after a meal. If you're taking a large quantity of vitamins, it is often preferable to eat a small meal beforehand. Also, with the current popularity of herbal supplements and vitamins, it is important for the prescribing physician to know about these over-the-counter products to avoid any adverse interactions.

Drug interactions occur when a medication is given with or shortly after another drug and alters the effect of either or both drugs. For example, one drug may stimulate the metabolism or excretion of another. Not all interactions are beneficial.

Adverse Reactions can be hazardous or even fatal. Drug hypersensitivity or allergies are the result of an immune response that occurs in the body when a drug is given to a susceptible patient. One of the most dangerous of all drug hypersensitivities is penicillin allergy. In the most severe form it can become fatal. To be alert to adverse reactions, you need to be aware of minor changes/symptoms in the patient's status. Such minor changes may be an early warning sign of toxicity. Your ability to recognize the signs and symptoms of drug allergies and to report them to the prescribing physician immediately is of utmost importance.

In order to ensure the continuous action of prescribed medications, you can use a mediset that divides the medication doses into morning/evening slots by the day of the week. This is the best way to eliminate confusion and potential overdose or under-dosing, particularly with the elderly or those with dementia.

The five rules for drug administration are:

1. The right person
2. The right drug
3. The right route
4. The right dose and
5. The right time.

Remember, 60% of all hospital admissions are from taking incorrect medication. This includes recently discharged patients.

Know why the doctor is prescribing the drug and take it as ordered. If there seems to be a problem, please consult your physician. Never get the attitude that you (the patient) know more than 6your physician. 
  

  

What if Mom Doesn't Think She Needs Home Care?

Your mom may live down the street from you, across town, in the same state or many miles away. You may visit her a few times a week, a month or see her on the holidays with the grandkids, but you always keep in touch with her over the phone. She enjoys her independence, or at least she tells you that. But you may be seeing some things that just don't seem right. 

For instance, her car may have some dings or dents that you didn't notice before or she can't explain how they got there, or the wheel alignment may be off due to running over curbs because of poor depth perception. The house may not be as clean and picked up as you're accustomed to: there are spider webs in the corners that she may not have noticed, and the pots and pans may have burnt-on food because she left them on the stove too long. 

For safety's sake, you sign her up for a Life Line service in case she falls and can't reach the phone to call for assistance. You install grab bars in the shower and buy a bath bench so she has more stability while she's bathing. You accompany her to her doctor's appointments when you can and make sure she knows how often to take her medications. But you still notice some things that just aren't right. Mom's friends may be asking why she's not showing up to her weekly bridge games, or she may be calling you up repeatedly, unaware of the last time she called or repeating the same information to you. At this point, it may be time to broach the subject of home care.

Ask mom about the dents in the car, the missed bridge games and the cluttered house. These may be hard questions to pose, like asking a child why he hasn't done his chores, but at this stage of life, many adult children do indeed take on the parenting role with their parents. In fact, there's even a name for this demographic: the sandwich generation. Many couples waited well into their 40s to have kids due to the economy, which has led to a dual set of responsibilities: caring for their own children and their elderly parents. You want the best for both your kids and your parents, but you can't always be there physically for the latter.

You can gradually introduce the idea of a home care companion for your mom by asking her, "Wouldn't it be nice if you could get out more and have someone drive you to bridge club, your doctors' appointments and the grocery store?" If mom has stopped cooking for herself and instead uses the microwave all the time, explain that someone could come in a few times a week, make up a batch of home-cooked meals and put them into zip-lock bags in the freezer so she can warm them up at dinner time. A home care companion can see the out-of-the-way spots that mom might've missed while cleaning and do the chores that might be too much for her to handle, such as setting out the trash cans curb-side or changing the litter box. 

We all need help as we get older; and when age keeps us from doing the things we love, such as socializing, or simply doing the things we need to do, including bathing and self-care, we may be too embarrassed to ask for assistance. You want mom to thrive at home, and you need to know that the person who's helping her is a trusted, bonded and reliable individual. We at Home Health Care Inc. know how important this is; and as a state-licensed agency with 27 years' of experience, we can answer all of the questions you may have and address your concerns. Contact us for a free, in-home evaluation of your mom's needs; we will assess the level of care your mom requires and match her with one of our experienced and compassionate caregivers to give you both peace of mind. 

Why You May Need Home Care for Mom and Dad

You may live far away from mom and dad or work full-time, and signs that they could need home care may go unnoticed until one of them ends up in the emergency room. For instance, mom or dad may have been diagnosed with congestive heart failure and may not know which foods to avoid. They may have been prescribed a diuretic for swelling and edema and may not know how important to is to drink lots of water with the medication. They may have COPD, and rescue inhalers just aren’t working as they used to, or they may trip on the tubing if they’re using oxygen therapy. They may have incontinence issues and are just too embarrassed to ask for help, leaving them homebound and increasingly isolated. Or they may be fearful of forgetfulness or frustrated with memory loss due to the aging process or a more organic condition, such as Alzheimer’s or incipient dementia. These are the issues faced by many adult children, who want the best for mom and dad in terms of treatment, care and independence.

Your mom may just need help around the house with meal preparation, light housekeeping and friendly reminders to take her medications. Or she may need more specialized care after recovering from surgery after leaving a skilled nursing facility. Or mom may have been diagnosed with Alzheimer’s, and dad can’t keep up with her needs and diminished capacity. You want to know there is a trusted individual you can turn to who has the skills necessary to keep your mom thriving at home.

It may be difficult to convince mom or dad that they need someone in the house to help with meals and the laundry. Gradually introducing a caregiver into the home for a few hours a day to lighten the burden of housework will make the transition easier as they become more accustomed to the extra help around the house which, in turn, makes life easier for them.  At the initial intake, a geriatric nurse meets with mom or dad to assess their  physical condition and limitations; then based on that evaluation,  mom or dad’s primary care physician will be notified and a plan of care established. As needs change, there may be more help needed in the home, and all efforts are made to ensure continuity of care through familiar caregivers.  Ideally, a home care agency gives the elderly  the best opportunity to lead a normal and active life within their capacity in  the comfort and security of their home with trusted and reliable staff.

Each of our CNAs, LVNs, RNs, Home Health Aides and Home Care Companions is checked and rechecked for their applicable certifications and licensures; and at hire, they are tested to ensure their knowledge of the pertinent medical, safety and psychosocial care-giving appropriate to their job. From meal preparation and transportation to doctors’ appointments, to wound care and skilled nursing services, our staff can provide a wide range of services, and you have the assurance of a state-licensed agency providing this care to your loved one.