Holiday Caregiving Tips

Holiday Caregiving

By Scott Morrison, Certified Senior Advisor,President, BrightStar LifeCare in Duluth and North Georgia.

     The holidays can be a fantastic time of year full of family events, reflections on what we have and the spirit of giving.  Just turn on the television and there are many shows and special programs demonstrating relationships and families coming together.

     However, the holidays can also be a time of stress and sadness for those who provide care for loved ones that are struggling with health problems, dementia or recent loss of a loved one. Those who provide care for these individuals may feel frustrated, overwhelmed, depressed or even resentful as they watch “perfect” families enjoying the holidays.  There are many published studies of surveys that show that caregivers are highly susceptible to these feelings. If you or someone you know is a caregiver, there are measures you can take to avoid this.

First; remember that you are not alone!

     The perfect family on television is not reality for many Americans.  A recent study by the National Alliance for Caregiving and AARP found that 44.4 million Americans age 18 or older are providing unpaid care to an adult.  According to the National Family Caregiving Association:

  • The typical caregiver is a 46 year old Baby Boomer woman with some college education
  • 69% say they help one person
  • The average length of caregiving is 4.3 years
  • Many caregivers fulfill multiple roles. Most (62%) caregivers are married or living with a partner and most have worked and managed caregiving responsibilities at the same time (74%)

Second; find help

     There are many resources available to a caregiver. Some of these include family members, friends, a local religious group, and professional caregiving agencies like BrightStar Lifecare.  BrightStar will offer free consultations and provide paid aides to help you with your loved one with such things as bathing, dressing, shopping, household chores, transportation, companionship and much more.  

Lastly, it is important to take care of yourself first in order to give effective and loving care.

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Thanksgiving- A Good time for Family Planning

Thanksgiving—A Good time for Family Planning

By Scott Morrison, Certified Senior Advisor

     Long distance family members will often travel to gather together and celebrate Thanksgiving. It is also the perfect time to do some planning for the future. With parents aging and their lifestyles and health changing, children need to discuss some changes and decisions that will be needed in the near future.

     For the children who live away, the changes they see in their parent’s health and mental capacity can be alarming. For the siblings that have daily contact, the changes are propagating issues that require constant attention. Here is a chance to compare notes and work together as a complete family in the long term care planning process.

     In its book, “The 4 Steps of Long Term Planning,” the National Care Planning Council, provides guidelines and checklists for family planning meetings. Here is an excerpt from the book:

“ The first step to holding a meeting, and perhaps the most difficult one, is to get all interested parties together in one place at one time. A family gathering…could be used as a way to get all to meet…

After a thorough discussion of the issues and the presentation of solutions to the problems that will be encountered, there should be consensus of all attending to support the plan. GET IT IN WRITING. All good intentions seem to be forgotten with time. It may be years after this meeting before the long term plan begins. If there are vocal commitments to help with transportation to doctors, give respite to the caregivers or other commitments, write them down on the care agreement. You can even have each person put their signature to his or her commitment if you think that is important.”

     The U.S. Department of Health and Human Services states: ( http://www.longtermcare.gov ) “no one wants to think about a time when they might need long term care. So planning ahead for this possibility often gets put off. Most people learn about long term care when they or a loved one need care.  Then their options are often limited by lack of information, the immediate need for services, and insufficient resources to pay for preferred services. Planning ahead allows you to have more control over your future.”

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November is National Diabetes Month

November is National Diabetes Month

It’s estimated that 23.6 million people in the US have diabetes.  17.9 million Americans have been diagnosed with the disease and another 5.7 million are unaware that they are diabetics.  November is National Diabetes month.  The American Diabetes Association has a national movement this month to Stop Diabetes. In recognition of this, The Aging Suite will be discussing issues that affect older individuals with diabetes.  Diabetes impacts the entire body including a person’s sensation and vision.  The Aging Suite hopes to help empower people by educating them about diabetes and its effects on the body.  While having diabetes can impact someone’s ability to age in place, it doesn’t have to stop it.

Type I Diabetes:

Insulin is a hormone needed to change carbohydrates and other foods into energy.  When someone has diabetes, their body doesn’t produce or correctly use insulin.

It’s estimated that 5-10% of the US population has Type I Diabetes.  Type I Diabetes is a chronic condition that occurs when the body does not produce insulin.

Symptoms of type I diabetes can include:

  • § Blurred vision
  • § Fatigue
  • § Weight loss
  • § Extreme Hunger
  • § Increased thirst and urination

Type II Diabetes Mellitus

Type II Diabetes is a chronic condition and the most common form of diabetes.  It occurs when there is an excess of sugar in the bloodstream and the body becomes resistant to insulin or when the pancreas doesn’t produce sufficient amounts of insulin to maintain a normal glucose level.  Diabetes can impact all of the body’s organs.

Symptoms of type 2 diabetes can include:

  • § Weight loss
  • § Excessive thirst and urination
  • § Blurred vision
  • § Fatigue
  • § Frequent infections and/or slow healing sores

Having a family history of the disease, excessive body weight, and inactivity increases the likelihood of getting the disease.  Also, American Indians, Asian Americans, African Americans and Hispanics, have a higher incidence of the disease as do adults over the age of 45.

According to the American Diabetes Association:

  • § There is a greater risk for stroke among people with Diabetes, as much as 2 to 4 times higher
  • § Diabetes is the leading cause of blindness for adults ages 20-74
  • § Diabetes is the leading cause of kidney failure
  • § Diabetes can result in  nerve damage
  • § The incidence of amputations is 10 times greater for individuals with diabetes than for non diabetics
  • § Its estimated that  one-third of people with diabetes have severe periodontal disease
  • § Having diabetes makes you more susceptible to other illnesses

People with diabetes may face challenges to aging in place, but they can still do so successfully and safely.

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Medicare cuts in health care law will hurt seniors

Medicare ‘cuts’ in the health care law will hurt seniors, says 60 Plus Association

Guess which member of Congress “betrayed” seniors by voting in favor of the 2010 health care law, a vote for “Nancy Pelosi’s health care bill which will cut $500 billion from Medicare” and “hurt the quality of our care.”

Which member is it? Well, lots of them, according to the 60 Plus Association. The advocacy group bills itself as “a conservative alternative to the American Association of Retired Persons (AARP)” and supports” a free-enterprise, less -government, less-taxes approach to seniors issues.” It has created substantially similar ads to run against Democratic members of Congress in districts around the country.

In Florida, the group is targeting Rep. Allen Boyd, who represents the Panhandle area,  and Reps. Alan Grayson and Suzanne Kosmas, both from central Florida. It is also running ads against Wisconsin members Steve Kagen, representing Green Bay and Appleton, and Ron Kind of western Wisconsin.  Another target is John Boccieri of Canton, Ohio. Still other ads target House members from Arizona, New York, Indiana and Pennsylvania.

It’s true that all of these members of Congress voted in favor of the new health care law when it came up for a vote on March 21, 2010. But the ad gives a highly misleading impression about funding for Medicare.

Here’s the text of the ad running against Boyd, the Florida congressman who represents the northwest Panhandle area:

“Alan Boyd has betrayed Florida’s seniors. Instead of voting to protect us, he supported Nancy Pelosi’s liberal agenda. Boyd voted for Nancy Pelosi’s health care bill which will cut $500 billion from Medicare. That will hurt the quality of our care. … Florida’s seniors can send Alan Boyd a message. He betrayed us, and this November, we’ll remember.”

Because of our previous fact-checks on the health care law, we knew this ad was leaving out important details on how the health care law, formally known as the Patient Protection and Affordable Care Act, changed Medicare.

Medicare, a government-run health insurance program, provides health care coverage for the vast majority of Americans over age 65. It accounts for about 12 percent of the federal budget.

It’s important to note that the law does not take $500 billion out of the current Medicare budget. Rather, the bill attempts to slow the program’s future growth, curtailing just over $500 billion in future spending over the next 10 years. Medicare spending will still increase — the nonpartisan Congressional Budget Office projects Medicare spending will reach $929 billion in 2020, up from $499 billion in actual spending in 2009.

Next, we wanted to address how those reductions are expected to affect the quality of care.

“Some (changes) increase Medicare spending to improve benefits and coverage,” said Tricia Neuman, director of the Medicare Policy Project at the nonprofit Kaiser Family Foundation. “Other provisions reduce the growth in Medicare spending to help the program operate more efficiently and help fund coverage expansions to the uninsured in the underlying health reform legislation. Other provisions are designed to improve the delivery of care and quality of care.”

Neuman walked through the changes in an easily digestible tutorial on the Kaiser Family Foundation’s website, a good non-ideological explanation for people interested in changes to Medicare under health care reform.

Some of the savings are for relatively minor programs, such as $36 billion for increases in premiums for higher-income beneficiaries and $12 billion for administrative changes. The law directs a new national board to identify $15.5 billion in savings, but the board — the Independent Payment Advisory Board — is prohibited from proposing anything that would ration care or reduce or modify benefits.

More significantly, there’s also $136 billion in projected savings that would come from changes to the Medicare Advantage program. About 25 percent of Medicare beneficiaries are enrolled in a Medicare Advantage plan.
Let’s back-up for a minute and explain Medicare Advantage: There are two basic ways most people get Medicare coverage. They enroll in traditional Medicare and a prescription drug plan through the government and maybe buy a supplemental policy to cover most out-of-pocket costs. Or they enroll in Medicare Advantage programs (they include drug plans), which are run by private insurers. Medicare Advantage programs typically have more generous benefits such as dental and vision coverage. Some plans even pay the patient’s monthly Medicare premium, which can amount to about $100.

The Medicare Advantage program was intended to bring more efficiency from the private sector to the Medicare program, but it hasn’t worked as planned. A June 2009 analysis from the Medicare Payment Advisory Commission said that the Advantage programs costs taxpayers on average of 14 percent more than the traditional Medicare plan. President Barack Obama has said repeatedly that the Medicare Advantage plan wastes public money that could be put to better use.

The health care law that President Obama signed in March phases out extra payments for Medicare Advantage programs over the next three to six years to bring their costs in line with traditional Medicare and institutes other rules for the program.

“How these payment changes will affect beneficiaries remains to be seen — but is expected to vary across the country,” Neuman said. “The Congressional Budget Office projects the law will result in fewer enrollees in Medicare Advantage plans, and fewer extra benefits for Medicare Advantage enrollees, on average. It is also possible that the number of plans available to beneficiaries will decline — which may or may not be a concern. On average, Medicare beneficiaries have 30 plans available to them in 2010.”

PolitiFact has waded into this argument about whether the adjustments to the Medicare Advantage option constitute a cut before. Most experts we talked to had the same answer: yes and no.

On one hand, they might not be considered cuts because nowhere in the bill are benefits actually eliminated, experts said. And other parts of the bill expand coverage for seniors and ultimately make some components of Medicare less expensive for patients. (More on this in a bit.)

Still, changes could be in store for Medicare Advantage participants, especially the extra benefits that people receive under Advantage, experts said. But basic benefits that mirror regular Medicare will stay the same.

Finally, there’s $220 billion in Medicare savings achieved by reducing annual increases in payments health care providers would otherwise receive from Medicare. The reductions are part of programs intended to improve care and make it more efficient, such as reducing payments for preventable hospital re-admissions. These adjustments are aimed at hospitals, skilled nursing facilities, and home health agencies.

The Office of the Actuary for Medicare and Medicaid Services questioned in an April 2010 report whether these levels of savings are realistic, saying that some health care providers would become unprofitable if payments were reduced. (The 60 Plus ad cites this report in its fine print.) The actuary’s report suggests that Congress will intervene to change the payment formula to avoid health care providers dropping out of Medicare.

The report also includes this caveat about how difficult it is to project the effects of the health care law: “The legislation would result in numerous changes in the way that health care insurance is provided and paid for in the U.S., and the scope and magnitude of these changes are such that few precedents exist for use in estimation. Consequently, the estimates presented here are subject to a substantially greater degree of uncertainty than is usually the case with more routine health care legislation.”

Finally, the 60 Plus ad also fails to mention new benefits for seniors under the health care law, such as a $250 rebate for prescription drugs purchased through Medicare Part D. (A statement on the 60 Plus website calls the drug rebate “the senior suckup.”) Currently, after an initial benefit period, enrollees are required to pay 100 percent of their prescription drug costs until they reach a level of catastrophic coverage. The rebate is meant to begin to close what is often called the doughnut hole in prescription drug coverage for beneficiaries. By 2020, Medicare will pay 75 percent of the total cost of generic prescription drug coverage in the gap, a marked improvement to the current program.

Getting back to the Truth-O-Meter, the 60 Plus ad says that the new health care law “will cut $500 billion from Medicare. That will hurt the quality of our care.” The ad loses points for accuracy because the $500 billion aren’t actual cuts but reductions to future spending for a program that will still grow significantly in the next 10 years. The ad also says those cuts will “hurt the quality” of seniors’ care. But we find that to be a highly contentious subject, and the 60 Plus ad doesn’t hint at any of the ways that the reductions are ways to make Medicare more efficient. Finally, the ad doesn’t mention any of the benefits to seniors, such as improved prescription drug coverage. The ad seems more intent on attacking the health care law than accurately describing this complicated piece of legislation. Because it leaves critical facts out of its description in a way that gives a misleading impression, we rate the statement Barely True.

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Family Caregivers Need to Protect their own health

Family Caregivers Need to Protect Their Own Health

By Scott Morrison, Certified Senior Advisor

      The Center for Disease Control and Prevention (CDC) states that over 34 million unpaid, informal caregivers are providing care to someone over the age of 18 who is ill or has a disability. There are an estimated 10 billion caregivers for Alzheimer’s disease alone.  The National Alliance for Caregiving (NAC) believes that 21% of households in the United States are involved in caregiving responsibilities.  Over half of caregivers who claimed a decrease in their own health due to their caregiving activities also stated that their decline in health had affected their ability to provide care.

     The decline in health of caregivers is often linked to stress which can lead to depression.  In addition, the burden of caregiving reduces the ability of the caregiver to get routine care for their health according to John Crews, DPA with the CDC.   A decline in the caregivers health can lead to institutionalization of the care recipient.

     While many caregivers start out with a feeling of well being because they are helping a loved one and learning new skills, it is difficult to maintain that attitude over time.  A NAC survey in 2006 found that 82% of caregivers say their sleep is worse than before they were caregivers, 72% did not go to the doctor as often as they should, 63% said that their eating habits are worse and 58% said their exercise habits had declined.  The NAC recommends that caregivers take breaks from caregiving to attend to their own health, join a support group and exercise.  Respite care services allow caregivers to take the necessary breaks by substituting another caregiver to stay with the care recipient for a brief period of time.

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Caring for your aging parents when you have a difficult sibling

It seems that every day I have a similar conversation with friends and colleagues.  “I can’t get our family on the same page about our elderly parent.  It’s like my brother came in from another planet.”  I laughed the first time I heard that statement but realize that’s exactly how I felt about my brother!

Why is it so hard for a family to listen to Mom or Dad, consider the options and then, in a unified way, make the right decision in Mom or Dad’s best interest?  I’ll share some of the reasons I believe to be true and then a few possible strategies.

First of all, we siblings often live hundreds of miles apart and only get together a couple times a year, limiting any kind of relationship building.   Mom and Dad have managed very well on their own since we left home so we just hope and pray they will continue to do so.  It’s hard to accept any change in them or to envision them living any other way.  Besides, they don’t seem to want to talk about it.  And, then we fall back into our old roles, re-enacting family dramas of the past.   While my mother still lived in her own home (even though it was a home I had never lived in), as soon as I walked in the door, I felt as if I was swept back in time and was a child again.  Feelings, emotions and defenses suddenly surfaced.  Because my time was often short there and filled with tasks and responsibilities, I would take the path of least resistance and respond, as if on auto-pilot.  It was like an out of body experience.  Once I got started, I had no idea how to stop.

You see I was the first-born, the over-achiever, the good girl who did everything right, and my brother was the goof-off, the one you couldn’t rely on.  As soon as we got back together, we slipped right back into those roles.  It was terribly dysfunctional but in, an odd way, it was comfortable.

It wasn’t until our elderly mother had a major health/life crisis that my brother and I had to come to terms and work together.  At first, he was on vacation and unreachable, so I went into my “control mode” and handled everything.  But. once he returned, we had to work together.  It was one of the hardest and messiest things I’ve ever had to do.

I wish I had known to contact a Certified Senior Advisor or an Eldercare Attorney. It would have definately been easier to transistion mom to the next stage if we had a third party mediator.

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The Role of Caregiving to prevent RE-admission to the hospital

THE ROLE OF CAREGIVING TO PREVENT RE-ADMISSION TO THE HOSPITAL

By Scott Morrison, Certified Senior Advisor and owner of BrightStar LifeCare of Duluth and North Georgia 

    One in five Medicare hospital departures results in a re-admission within one month according to a healthcare survey by The Remington Report.  Once discharged from the hospital, it becomes incumbent upon the individual and their care-giving family member to closely manage the ongoing medical condition.  Quite frequently, family members are challenged to fill the role of active caregiver.  Sometimes, the challenges are created by the distance between the caregiver and their loved one. Other times, with the current economic state, family members cannot afford to take time off from work to assume the role of caregiver.

     There are some technological advances in the form of video-phones, sensor based home monitoring, electronic medication reminders and disease status monitoring equipment to help family caregivers with the tasks at hand.  However, these devices are only an adjunct to the care-giving and do not replace the one-on-one, human to human interaction that is a key component to successful recovery.  The rapid recapture of the Activities of Daily Living (ADLs)and improvement of quality of life help tremendously in preventing a readmission to the hospital.

     BrightStar Healthcare, in Duluth, GA is poised to assist families with the care-giving dilemma. All of their employees are insured, bonded and have undergone a criminal background check and drug screen. All Plans of Care are developed by a Registered Nurse. Please call BrightStar Healthcare at 678-646-5400 for a complimentary consultation and nursing assessment and get the help you need for your loved one!

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Help BrightStar walk to find a cure for Alzhiemer’s

By Scott Morrison, Certified Senior Advisor (CSA)

According to the Alzheimer’s Association, the most common form of dementia is Alzheimer’s disease, accounting for 60-80% of cases. Dementia is defined by the decline or loss of memory and other cognitive abilities. It is a repercussion of various diseases and conditions that result in damaged brain cells. In the year 2008, one in 8 (13%) of people age 65 or older had Alzheimer’s disease. In 2006, Alzheimer’s was the 7th leading cause of death across all age groups in the United States. It is estimated that in 2010, someone in America will develop Alzheimer’s every 70 seconds and that by the year 2050; someone will develop the disease every 33 seconds. In Georgia alone, there is projected to be a 45% change in the percentage of people who develop the disease between the years of 2000 and 2025. Unless medical breakthroughs identify ways to prevent or more effectively treat Alzheimer’s, there are few among us who will not be affected either directly or through a friend or loved one by this detrimental disease.

BrightStar Lifecare employs caregivers that specialize in providing care to individuals with all forms of dementia, including Alzheimer’s. Care is provided in the home, wherever home may be. BrightStar is proud to be a Platinum Sponsor this year for the Alzheimer’s Association’s Memory Walk. The Memory Walk is a fund raising effort to raise awareness of the disease, create assistance for families afflicted by all forms of dementia and support research into a cure. If you have a loved one afflicted with Alzheimer’s and you would like more information or would like to help out either financially or by joining our team for the Memory Walk, please e-mail me at Scott.morrison@brightstarcare.com. I can also be reached at 678-646-5400. Together, we can work to create a world without Alzheimer’s disease.

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Safe at home….Medication use among Elders

Safe at home…Medication Use Among Elders
The elderly-representing 13% of the U.S. population-account for 34% of all dispensed prescriptions. The risk of adverse drug events increases with the number of medications taken. Compliance is also an issue among elders; more medications make compliance more challenging, and lack of understanding contributes to noncompliance. Estimates of adherence to long-term medication regimens among seniors are in the 40-60% range.

 Key facts about medications and elders:
*   An annual estimated 530,000 medication errors occur each year among elders who live at home.
*   Non-prescription drugs also cause adverse drug events.
*   Seniors take an average of 5.2 prescription medications and 3.7 non-prescription medications each day.

 The following are some findings from studies on medication use in elders-and what can help.
*   Among patients over the age of 80 who were seen in the emergency room after a fall, polypharmacy was the most common risk factor after age.
*   Care for elders is often provided by numerous health care providers, increasing the risk of polypharmacy.
*   One study found that 78% of elders were taking over-the-counter medications; less than 1% of those medications were recorded in the patient’s chart.
*   The most common types of non-prescription medications used by elders include analgesics, laxatives, and nutritional supplements.
*   Two of every five elders don’t take medication as prescribed due to cost, side effects, a belief that the medicine isn’t needed, or a desire to avoid more pills. They also may take medications longer than prescribed.

The Institute for Healthcare Improvement supports medication reconciliation as a key step in preventing adverse drug events. 
Medication reconciliation compares an elder’s actual medication usage with prescribed and recorded use.
Patient education, promoting compliance, and simplifying medication regimens can all help, too.
 
Points to remember
*   Elders are at risk for adverse drug events and noncompliance.
Medication reconciliation compares prescribed and recorded drugs with actual use.

*   A home health nursing visit is the first step.

 

How a Home Health Nurse Can Help with Medications

A home health nurse can compare prescribed and recorded drugs with the prescription and non-prescription drugs an elder is actually taking. By creating a complete and accurate list of medications, a home health nurse helps elders avoid adverse drug interactions and the negative consequences of noncompliance with prescribed therapy. A home health nurse can also help elders simplify their medication regimen and create administration systems that make taking prescribed medications easier 

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Risk of Frailty increases in Older Adults with Unusually High Blood Sugar Levels

Risk of Frailty increases in Older Adults with Unusually High Blood Sugar Levels

By: Scott Morrison, Certified Senior Advisor and President of BrightStar LifeCare of Duluth and North Georgia.

     Frailty is a condition that increases risk of poor health, falls, disability and death. According to the Journal of the American Geriatrics Society, frailty involves “dysfunctions” in many body systems. Research shows that heart disease, obesity and diabetes all boost the risks of frailty.

     People with diabetes have dangerously high levels of glucose, a form of sugar in their blood because their bodies cannot use sugar properly. Type 2 diabetes is the most common and frequently diagnosed disease among aging adults. Unhealthy eating habits, obesity and a sedentary lifestyle can boost the odds of developing Type 2 diabetes.

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