Program of All inclusive Care for the Elderly- PACE

PACE is unique. It is an optional benefit under both Medicare and Medicaid that focuses entirely on older people, who are frail enough to meet their State’s standards for nursing home care. It features comprehensive medical and social services that can be provided at an adult day health center, home, and/or inpatient facilities. For most patients, the comprehensive service package permits them to continue living at home while receiving services, rather than be institutionalized. A team of doctors, nurses and other health professionals assess participant needs, develop care plans, and deliver all services which are integrated into a complete health care plan. PACE is available only in States which have chosen to offer PACE under Medicaid.

Eligibility

Eligible individuals who wish to participate must voluntarily enroll. PACE enrollees also must:

* Be at least 55 years of age.
* Live in the PACE service area.
* Be screened by a team of doctors, nurses, and other health professionals as meeting that state’s nursing facility level of care.
* At the time of enrollment, be able to safely live in a community setting.

Services

PACE offers and manages all of the medical, social and rehabilitative services their enrollees need to preserve or restore their independence, to remain in their homes and communities, and to maintain their quality of life. The PACE service package must include all Medicare and Medicaid services provided by that State. In addition, the PACE organization provides any service determined necessary by the interdisciplinary team. Minimum services that must be provided in the PACE center include primary care services, social services, restorative therapies, personal care and supportive services, nutritional counseling, recreational therapy, and meals. Services are available 24 hours a day, 7 days a week, 365 days a year.

Generally, these services are provided in an adult day health center setting, but may also include in-home and other referral services that enrollees may need. This includes such services as medical specialists, laboratory and other diagnostic services, hospital and nursing home care.

An enrollee’s need is determined by PACE’s medical team of care providers. PACE teams include:

* Primary care physicians and nurses.
* Social workers.
* Personal care attendants.
* Dietitians.
* Drivers.

The PACE team has frequent contact with their enrollees. This helps them to detect subtle changes in their enrollee’s condition and they can react quickly to changing medical, functional, and psycho-social problems.

Payment

PACE receives a fixed monthly payment per enrollee from Medicare and Medicaid. The amounts are the same during the contract year, regardless of the services an enrollee may need.

Persons enrolled in PACE also may have to pay a monthly premium, depending on their eligibility for Medicare and Medicaid.

Current Sites

For a listing of PACE organizations nationwide, please visit the following website:
www.cms.hhs.gov

Source: www.medicare.gov, www.LongTermCare.gov
Provided by: The Staff at www.RetirementConnection.com
For more information: www.LongTermCare.gov
Copyright © 2008 RetirementConnection.com. All rights reserved.

Injuries and Mobility Issues Don’t Always End Independence

As people age, they sometimes experience a loss of mobility. Whether it’s arthritis, injuries, respiratory diseases, heart disease or other illness, such conditions can make it difficult to not only move through the home, but also to accomplish the daily tasks of living: dressing and bathing, meal preparation, laundry, grocery shopping and light cleaning, to name a few.

In the past, such conditions would usually mean an end to independence and being able to continue to live at home. But in today’s society, an array of in-home care services and support make it possible for adults with limited mobility to obtain the help they need without leaving their homes.

Families of aging adults and aging adults themselves should know they are not alone in living with mobility issues. In fact, according to the United States Administration on Aging, nearly 10 million Americans live with a physical disability that can hinder mobility on a regular basis.

The following tips can help adults with mobility issues maintain their independence.

* Honestly assess your mobility. Is your condition permanent or temporary? Is it painful/difficult/impossible for you to move? Are you limited in the duration of your activity or limited by obstacles, such as stairs?
* Determine what activities you have difficulty accomplishing because of your condition. Is it now hard for you to bath or get dressed? Do laundry? Shop for groceries? Do certain cleaning tasks?
* Consult a physician on what you can do to increase and/or maintain your activity level.
* Research the types of assistance available in the home, including in-home care services, social services and ambulatory equipment.

It’s no secret that we all will age. However, thanks to advancements in care options and medical equipment, we can get the support we need to continue living at home, even though we may not be as mobile as we once were. This assistance can be tailored to an individual’s exact needs.

Source: Right at Home, 503-574-3674
For more information: www.RAHcares.com, 503-574-3674

Copyright © 2008 RetirementConnection.com. All rights reserved.

Boomer’s Balancing Act: Juggling Careers and Caregiving

Individuals who are part of the “sandwich generation” are juggling the responsibilities of working, caring for their children, and providing home care for their aging parents, thus causing them to bite off more than they can chew. The United States includes an estimated 34 million unpaid family caregivers for adults, typically older relatives, according to a study released by AARP.

Family members frequently face challenges in the workplace while caring for a loved one at home. Often times they are forced to make the difficult choice between work and family: “Do I go to my 3 o’clock meeting or take my mother to the doctor?” Managing both responsibilities can often increase stress while decreasing productivity in one or both of these tasks.

According to national studies by MetLife Insurance and the National Alliance for Caregiving, nearly 65 percent of family members who worked while caring for an aging parent experienced conflict with their jobs, including tardiness, lost hours or income, and the sacrificing of vacation. The following are other effects caregiving can have on employee relations in the workplace:

PROBLEMS EMPLOYED FAMILY CAREGIVERS FACE:

* Career Stands Still
Home caregiving responsibilities can mean missing out on promotions and training at work, opportunities for job transfers or relocations, and acquiring and keeping up with necessary job skills.
* Loss in Wages
Income can drastically be cut as a result of caregiving obligations. In the national MetLife and AARP study, nearly two-thirds of respondents said that caregiving had a direct impact on their earnings. As a result of caregiving, the average loss in aggregate lost wages, Social Security and lost pension benefits reported was $659,139 over a lifetime.
* Reductions in Savings and Spending
Providing home care for a loved one can cause significant limitations to personal savings and spending, home improvements, vacations and/or investments.
* Toll on Health
Caregiving responsibilities can often take a toll on the health of a family caregiver leading to increases in absenteeism in the workplace, early retirement and job turnover. This can lead to a loss in employee productivity and overall workplace morale.
* Economic Loss for Employers
Employers also lose money due to employees’ caregiving responsibilities. A previous MetLife study estimated that absenteeism, partial absenteeism, workday interruptions, eldercare crises and costs associated with supervising employed caregivers conservatively averages $11.4 billion per year.

TIPS FOR BALANCING WORK WITH HOME CARE:

* Find out if the employer must follow the federal Family and Medical Leave Act. If so, an employee is entitled to up to 12 weeks of unpaid time off annually to care for a parent with a serious health condition.
* Long-distance caregivers shoulder an even greater burden of caring for an aging parent while meeting job demands. Employees should find out if they can work remotely for greater flexibility. For instance, an employee may be able to work from the home of the relative for whom they are caring.
* Employee Assistance Programs, such as WorkPlace Options, are an example of a growing trend in employer-subsidized caregiving programs that employers and employees around the country are embracing. This program enables employees to continue working when they experience a temporary breakdown in their elder care arrangements. WorkPlace Options offers a comprehensive, fully integrated Backup Care Program that features a network of thousands of individually contracted home care agencies, including Right at Home, to provide Backup Caregivers in case of an emergency.
* Hiring a national home care and assistance agency, such as Right at Home, is another solution for many families. Right at Home provides in-home non-medical care, often at a fraction of the cost of moving into an assisted living facility or nursing home. Services offered included companionship, meal preparation, light housekeeping, grocery and errand services, incidental transportation, personal care assistance, and more. Best of all, Right at Home is available 24/7, catering to an employee’s varied work schedules. All Right at Home caregivers are fully screened through professional references, rigorous criminal background checks and are fully insured and bonded.

For more information on support for the family caregiver, and options for receiving home care services, check out the following resources:

The Free 2007 Adult Caregiving Show Me Guide by Right at Home and Secure Horizons

Download a free version of the Show Me Guide on this page from Right at Home
www.rightathome.net

Family Caregiver Alliance
www.caregiving.org

National Family Caregivers Association
www.nfcacares.org

AARP
www.aarp.org

Source: Right at Home Managing Director, www.RAHcares.com 503-574-3674
For more information: www.RAHcares.com, 503-574-3674

Copyright © 2008 RetirementConnection.com. All rights reserved.

Keeping Active Through Your Senior Years: Both Mentally and Physically

Americans are living longer than ever, according to a study by the Centers for Disease Control and Prevention. In 2005, the average American life expectancy reached 78 years-of-age, an increase from 76 years in 1995.

One component of this lengthening life expectancy is the exercising of both the body and mind. Scientific research shows that continuous physical and mental activity during the senior years promotes a healthy lifestyle and, therefore, longevity.

Avoiding a sedentary lifestyle during adulthood not only prevents cardiovascular disease, but also substantially expands the life expectancy for men and women, according to a study published in Archives of Internal Medicine 2005.

Living an active life is key to keeping the body and mind in a healthy condition, which has a positive effect on living longer. Maintaining activity can also help prevent or minimize development of Alzheimer’s and other dementia-related illnesses.

For example, a study published in the February 13, 2002 Journal of the American Medical Association reported that, on average, those who said they frequently take part in mentally stimulating activities were 47 percent less likely to develop Alzheimer’s disease than those who rarely do so. The study also concluded that keeping your mind active can slow the rate at which you lose mental ability.

At Right at Home of Portland, we understand the importance of such research, and have developed the following tips for older adults:

Exercising The Mind

What seniors can do to maintain an active, independent and healthy lifestyle:

* Learn new activities and try new hobbies
* Play memory games, such as crossword puzzles
* Read a novel, write in a journal or join a book club
* Practice using your opposite hand over your dominant one
* Stay social, and informed on current events, by interacting with friends and family

Staying Physically Active

According to the U.S. Department of Health and Human Services- Administration on Aging, one in three men and one in two women are not physically active. Researchers know that physical activity promotes good blood flow to the brain and encourages new brain cell growth, which may lower the risk of developing dementia-related diseases.

Remaining physically active could be as simple as using personal strength to rise from a chair rather than using the assistance of a cane or walker. When appropriate, such exercise can be achieved safely with the supervision of a professional caregiver. The following are three suggested forms of basic exercise. Always check with a physician or healthcare professional before participating in any physical activities.

* Endurance Exercises – Endurance exercises are activities that increase heart rate and breathing for an extended period of time. Examples of moderate endurance activities for the average older adult include: swimming and water aerobics; brisk walks; cycling; and even everyday activities such as gardening.
* Strength Exercises – Strength exercises build muscle and allow seniors to do more activities on their own. Strength exercises also increase metabolism, helping to keep a senior’s weight and blood pressure stable. This is very important because obesity and diabetes are major health problems for older adults. Examples of strength exercises include arm raises to strengthen shoulder muscles and chair stands to strengthen the abdomen and thighs.
* Balance Exercises – Balance exercises help prevent a common problem in seniors – falls. According to the National Institute on Aging, U.S. hospitals see 300,000 broken hip admissions every year due to falls- often resulting in disability and loss of independence. Balance exercises include standing on one foot or rising from a chair without the use of hands.

For more ideas on how to stay physically and mentally fit, visit these resource sites:

1. AARP – www.aarp.org
2. Caring News Website: www.caringnews.com
3. National Institutes of Health www.nihseniorhealth.gov
4. Alzheimer’s Prevention Help Guide www.helpguide.org
5. Right at Home www.rightathome.net

Source: Right at Home Managing Director, www.RAHcares.com 503-574-3674
For more information: www.RAHcares.com, 503-574-3674

Copyright © 2008 RetirementConnection.com. All rights reserved.

Key Facts About Seasonal Flu Vaccine

The single best way to protect against the flu is to get vaccinated each year.

There are two types of vaccines:

The “flu shot”- an inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm. The flu shot is approved for use in people older than 6 months, including healthy people and people with chronic medical conditions.

The nasal-spray flu vaccine – a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for “live attenuated influenza vaccine” or FluMist®). LAIV (FluMist®) is approved for use in healthy* people 2-49 years of age† who are not pregnant.

Each vaccine contains three influenza viruses-one A (H3N2) virus, one A (H1N1) virus, and one B virus. The viruses in the vaccine change each year based on international surveillance and scientists’ estimations about which types and strains of viruses will circulate in a given year.

About 2 weeks after vaccination, antibodies that provide protection against influenza virus infection develop in the body.

When to Get Vaccinated

October or November is the best time to get vaccinated, but you can still get vaccinated in December and later. Flu season can begin as early as October and last as late as May.

Who Should Get Vaccinated

In general, anyone who wants to reduce their chances of getting the flu can get vaccinated. However, it is recommended by ACIP that certain people should get vaccinated each year. They are either people who are at high risk of having serious flu complications or people who live with or care for those at high risk for serious complications. During flu seasons when vaccine supplies are limited or delayed, ACIP makes recommendations regarding priority groups for vaccination.

People who should get vaccinated each year are:

* People at high risk for complications from the flu, including:
* Children aged 6 months until their 5th birthday
* Pregnant women
* People 50 years of age and older
* People of any age with certain chronic medical conditions
* People who live in nursing homes and other long term care facilities
* People who live with or care for those at high risk for complications from flu, including
* Household contacts of persons at high risk for complications from the flu (see above)
* Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)
* Healthcare workers

Use of the Nasal Spray Flu Vaccine

It should be noted that vaccination with the nasal-spray flu vaccine is always an option for healthy* people 2-49 years of age† who are not pregnant.

Who Should Not Be Vaccinated

There are some people who should not be vaccinated without first consulting a physician. These include:

* People who have a severe allergy to chicken eggs
* People who have had a severe reaction to an influenza vaccination in the past
* People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine previously
* Influenza vaccine is not approved for use in children less than 6 months of age.
* People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms lessen

Vaccine Effectiveness

The ability of flu vaccine to protect a person depends on the age and health status of the person getting the vaccine, and the similarity or “match” between the virus strains in the vaccine and those in circulation. Testing has shown that both the flu shot and the nasal-spray vaccine are effective at preventing the flu.

* Vaccine Side Effects (What to Expect)
* Different side effects can be associated with the flu shot and LAIV.
* The flu shot: The viruses in the flu shot are killed (inactivated), so you cannot get the flu from a flu shot. Some minor side effects that could occur are
* Soreness, redness, or swelling where the shot was given
* Fever (low grade)

Aches

If these problems occur, they begin soon after the shot and usually last 1 to 2 days. Almost all people who receive influenza vaccine have no serious problems from it. However, on rare occasions, flu vaccination can cause serious problems, such as severe allergic reactions. As of July 1, 2005, people who think that they have been injured by the flu shot can file a claim for compensation from the National Vaccine Injury Compensation Program (VICP).

LAIV (FluMist®): The viruses in the nasal-spray vaccine are weakened and do not cause severe symptoms often associated with influenza illness. (In clinical studies, transmission of vaccine viruses to close contacts has occurred only rarely.)

In children, side effects from LAIV (FluMist®) can include:

* runny nose
* wheezing
* headache
* vomiting
* muscle aches
* fever

In adults, side effects from LAIV (FluMist®) can include:

* runny nose
* headache
* sore throat
* cough

Source: Coordinating Center for Infectious Diseases (CCID). www.cdc.gov

Provided by: The Staff at www.RetirementConnection.com
For more information: www.cdc.gov
Copyright © 2008 RetirementConnection.com. All rights reserved.

Know Your Money

U.S. paper money has several special features that can help you identify genuine bills.New bills contain a small embedded strip that can be seen while holding the bill up to light. The strip runs vertically through the clear field to the left of the Federal Reserve Seal. Printed on the strip is a denomination identifier, for example, “USA TWENTY USA TWENTY” on the $20 bill. There are additional details.

How To Detect Counterfeit Money

The public has a role in maintaining the integrity of U.S. currency. You can help guard against the threat from counterfeiters by becoming more familiar with United States currency. Look at the money you receive. Compare a suspect note with a genuine note of the same denomination and series, paying attention to the quality of printing and paper characteristics. Look for differences, not similarities.

Portrait

The genuine portrait appears lifelike and stands out distinctly from the background. The counterfeit portrait is usually lifeless and flat. Details merge into the background which is often too dark or mottled.

Federal Reserve and Treasury Seals

On a genuine bill, the saw-tooth points of the Federal Reserve and Treasury seals are clear, distinct, and sharp. The counterfeit seals may have uneven, blunt, or broken saw-tooth points.

Border

The fine lines in the border of a genuine bill are clear and unbroken. On the counterfeit, the lines in the outer margin and scrollwork may be blurred and indistinct.

Serial Numbers

Genuine serial numbers have a distinctive style and are evenly spaced. The serial numbers are printed in the same ink color as the Treasury Seal. On a counterfeit, the serial numbers may differ in color or shade of ink from the Treasury seal. The numbers may not be uniformly spaced or aligned.

Paper

Genuine currency paper has tiny red and blue fibers embedded throughout. Often counterfeiters try to simulate these fibers by printing tiny red and blue lines on their paper. Close inspection reveals, however, that on the counterfeit note the lines are printed on the surface, not embedded in the paper. It is illegal to reproduce the distinctive paper used in the manufacturing of United States currency.

Source: http://www.secretservice.gov/data/KnowYourMoneyApril08.pdf
Provided by: The Staff at www.RetirementConnection.com
For more information: www.SecretService.gov
Copyright © 2008 RetirementConnection.com. All rights reserved.

Life after Driving

Transportation can be a critical issue for older adults as well as caregivers. Planning ahead and understanding the available options can give older adults and their caregivers peace of mind knowing that there are alternatives available to address their changing needs.

A good place to start learning about these resources is the Eldercare Locator. Administered by the National Association of Area Agencies on Aging, the Eldercare Locator is dedicated to connecting older adults to local resources that enable them to live independently in their communities. Area Agencies on Aging (AAAs), Aging and Disability Resource Centers (ADRCs). And Indian Tribal Organizations can provide information about transportation options specific to local communities. Older adults and their caregivers can call the Eldercare Locator at 800-677-1116 or visit its web site at www.Eldercare.gov to identity these resource in their area.

The Eldercare Locator recently published a new brochure, “Transportation Options for Older Adults: Choices for Mobility Independence” designed to help older adults and their caregivers with transportation needs and concerns. The brochure describes various types of transportation services for older adults, such as volunteer drivers, paratransit, door-through-door, public transit, travel training and funded transportation vouchers. There is a list of key questions to ask transportation providers to determine the best option to meet individual needs.

The free brochure can be acquired from the Eldercare Locator by calling 800-677-1116. Service providers that work with adults can have multiple copies shipped to them so they can provide the brochure to their clients.

Editor’s Note: RetirementConnection.com has posted a copy of the brochure mentioned in this article on this website. Visit this link: Transportation Options for Older Adults

Article Source: National Center on Senior Transportation, NCST Today, January 2008
Provided by: The Staff at www.RetirementConnection.com
For more information: www.SeniorTransportation.net
Copyright © 2008 RetirementConnection.com. All rights reserved.

How to Encourage Parents and Older Adults to Get Help

If you do not see your parent often, changes in his or her health may seem dramatic. In contrast, the primary caregiver might not notice such changes, or realize that more help, medical treatment, or supervision is needed. Sometimes a geriatric care manager or other professional is the first to notice changes. For families dealing with Alzheimer’s disease and other dementias, it can be easier to “cover” for the patient-doing things for him or her, filling in information in conversations, and so on-than to acknowledge what is happening.

A few good conversation starters are:

If you thought there might be a change in Aunt Joan’s condition, whose opinion would you seek? or I didn’t notice Dad repeating himself so much the last time I was here. Do you remember when it started?

Some changes may not be what you think. Occasional forgetfulness does not necessarily indicate Alzheimer’s disease. Before you raise the issue of what needs to be done, talk to your parent and the primary caregiver about your concerns. Try not to sound critical when you raise the subject. Instead, mention your particular worry, for example, “Mom, it looks like you don’t have much food in the house-are you having trouble getting to the store?” and explain why you are concerned. Listen to what the primary caregiver says about the situation, and whether he or she feels there are problems.

Discuss what you think needs to be done: “Do we need to get a second opinion about the diagnosis? Can you follow the medication schedule? Would you like some help with housework?” Try to follow up your suggestions with practical help, and give specific examples of what you can do. For example, you might arrange to have a personal or home health aide come in once a week. You might schedule doctors’ appointments or arrange for transportation.

In some cases you may have to be forceful, especially if you feel that the situation is unhealthy or unsafe. Do not leave a frail adult at risk. If you have to act against the wishes of your parent or the primary caregiver, be direct and explain what you are going to do. Discuss your plan and say why you are taking action.

Source: National Institute on Aging, www.nia.nih.gov, Long Distance Caregiver
Provided by: The Staff at www.RetirementConnection.com
For more information: www.nia.nih.gov
Copyright © 2008 RetirementConnection.com. All rights reserved.

How to Choose Assisted Living

Assisted living facilities and personal care boarding homes are referred to as assisted living residences. There are three types of assisted living residences: private pay, alternative care facilities (assisted living residences that are Medicaid certified) and residential treatment facilities for persons with severe and persistent mental illness. Any assisted living residence caring for 3 or more residents must be licensed.

Private pay assisted living residences are licensed. Alternative care facilities have Medicaid clients, and are licensed and certified. Residential treatment facilities are mental health facilities and are licensed. They are operated by the local mental health center.

Assisted living residences range in size from 3 to 274 beds. The most common reasons for admission to assisted living residences are medication management, bathing and dressing assistance, and the need for protective oversight and supervision.

Assisted living residences provide a range of services including room, board and at least the following: personal services, protective oversight, social care and regular supervision available on a 24-hour basis.

Personal services include a physically safe environment, supervision, assistance with activities of daily living such as medication administration, bathing, dressing, eating, laundry, recreational activities and arrangements for transportation. Protective oversight includes monitoring the needs to ensure the residents receive the services and care necessary to protect their health, safety and well-being.

The Health Facilities and Emergency Medical Services Division ensures that assisted living residences meet established standards for health and safety which include resident rights, protection from abuse, quality of residents’ lives and quality of residents’ care through unannounced annual surveys and complaint inspections.

How to Choose an Assisted Living Facility

The following tips assist consumers in choosing the most appropriate assisted living facility for themselves or their loved ones. Remember to use all five senses when visiting and making your selection. Trust your initial feelings and reactions. The following questions are meant to assist you in your decision making process.

Provider Agreement and Policies:

* Do the admission criteria match my needs?
* Have I reviewed the terms of the financial/provider agreement?
* Is the unused portion of the rent refunded upon transfer/discharge?
* Do I have a choice in the selection of medical/health care providers if additional services are needed?
* Are the specific services offered clearly identified in the agreement?
* Have I reviewed the house rules?
* Have I reviewed all of the reasons for which I may be transferred of discharged?

License and Certification:

* Is the facility licensed by the state and in good standing?
* Is the facility Medicaid certified?

Space:

* Is the bedroom private or shared?
* Is the bathroom private or shared?
* Are the shared areas clean?
* Is there space for personal belongings?
* Does the floor plan allow for easy mobility for me?
* Are there private areas other than the bedroom for visits?

Safety:

* Is bathroom safety equipment installed or available if needed? (grab bars, raised toilet seat)
* Is there a call system?
* Are walkers/wheelchairs permitted?
* Are hallways and doorways wide enough for wheelchairs?

Care Plans:

* Am I involved in the care planning process?
* Is my family/responsible party involved?
* Is my physician or other health provider involved?
* Are the care plans updated to reflect changes in care needs?

Personal Services:

Does the facility provide:

* Assistance with dressing?
* Assistance with bathing?
* How many times per weeks is bathing provided?
* Assistance with toileting?
* Assistance with incontinency? Does this include assistance with bowel and bladder?
* Assistance with transfers from wheelchair to bed, etc.
* Assistance with medications?

Staff:

* What is the operator/administrator’s training?
* Do staff receive training to work with special needs or behaviors, such as dementia?
* Is there high staff turn-over?
* What is the ratio of staff to resident?
* Are staff awake at night?

Meals:

* Are specialized diets available?
* Are cultural or ethnic preferences considered?
* Are residents involved in menu planning?
* Can residents help with meal preparation and have access to the kitchen?
* Are snacks/beverages readily available between meals?
* Are extra helpings and substitutions available?

Socialization:

* Are activities available within the facility?
* Does the facility take residents on outings?
* Is somebody designated to conduct activities?
* Would my interests match the level/type of activities provided?
* Are there residents I can socialize with?
* Is there a written schedule of activities?
* Does the facility provide transportation?

Communication:

* Does facility inform family/physician when an unusual event occurs?
* Do you feel comfortable talking with the:
* Administrator/Operator
* Manager/Billing
* Staff/Caregivers
* Is the grievance procedure easily understood?
* Is telephone use accessible and conducive to privacy?

Facility Tour and Observations:

* Have I toured the entire facility?
* Have I observed the kitchen and pantry?
* Have I observed a meal?
* Does the atmosphere seem pleasant?
* Does there seem to be enough staff available?
* Are pets allowed?
* Do residents seem happy and engaged?
* Do residents appear to be clean, groomed and odor-free?
* Have I observed for staff/resident interaction?
* Have I observed for cleanliness and odors?

Additional Resources:

Your State Ombudsman Program: Serves as advocate for residents and families

Your State’s Health Department

To review …

We realize that making the decision to place a loved one in a care facility can be difficult. When making your final selection keep these tips in mind:

* Trust your initial feelings and reactions.
* Try not to make a hasty decision. There are many homes from which to choose.
* Consider the location of the home. Your presence and involvement in the facility is important to the care your loved one receive.
* Make an unannounced visit after your initial tour.
* Talk to residents.
* Ask for references.
* Ask to take home copies of the admission packet and house rules.
* Take the time to review the materials and, ask lots of questions.

Source: Colorado Department of Public, Health & Environmental Health Facilities Division, www.cdphe.state.co.us
Provided by: The Staff at www.RetirementConnection.com
For more information: Visit your state’s Department of Public Health
Copyright © 2008 RetirementConnection.com. All rights reserved.

Hospitalization for Loved Ones with Memory Disorders

A trip to the hospital with a loved one who has a memory disorder can be stressful for both of you. This article can relieve some of that stress by helping you prepare for both unexpected and planned hospital visits. In it you will find steps you can take now to make hospital visits as easy as possible, tips on making your loved one more comfortable once you arrive at the hospital, and advice on working with hospital staff and doctors.

Hospital Emergencies: What You Can Do Now

Planning ahead is the key to making either an unexpected or a planned trip to the hospital easier for you and your loved one. Here is what you should do now:

* Register your relative for a SAFE RETURN bracelet through your local Alzheimer’s chapter. People who are lost may be taken to an emergency room. The bracelet will speed the process of reconnecting you and your loved one.
* Know who you can count on. You need a family member or trusted friend to stay with your loved one when he or she is admitted to the emergency room or hospital. Have at least two dependable family members, neighbors, or friends you can call on to go with you or meet you at the hospital at a moment’s notice so that one of you can take care of the paperwork and the other can stay with your loved one.
* Pack an “Emergency Bag” containing the following:

o A sheet of paper listing: the person’s name, nickname, address, insurance companies (include policy numbers and pre-authorization phone numbers), Medicare and Medicaid card numbers, doctors (include addresses).

o A list of important phone numbers such as doctors, key family members, minister and helpful friends.

o A list of all current medicines and dosage instructions. This list should be updated when there is any change.

o A list of medicines taken that have ever caused a bad reaction and a list of any allergies to medicines and foods.

o Copies of important papers such as Durable Power of Attorney, Health Care Power of Attorney, Living Will.

o Extra adult briefs (i.e. Depends) if the person usually wears them. These may not be easy to get in the emergency room if you need them.

o A change of clothes in case the person’s clothes become soiled or torn and a plastic bag for the soiled clothing.

o A card that says, “Please Understand – My companion has a memory disorder. Let me help with specific questions.” You should avoid talking about your relative’s memory changes or behaviors in front of him. This can be upsetting and embarrassing to your relative.

o Moist hand wipes such as Wet Ones.

o A reassuring object, a Walkman with a favorite tape or a portable radio.

o A writing pad and pen so that you can jot down information and directions given to you by hospital staff. You will also want to write down your loved one’s symptoms and problems. You might be asked the same questions by many people. Show them what you have written instead of repeating your answers.

o Pain medicine such as Advil, Tylenol or aspirin. This is for you, the caregiver. A trip to the ER may take longer than you think. Stress can lead to a headache or other symptoms.

o A sealed snack such as a pack of crackers and a bottle of water or juice for you and your loved one. You could wait for quite a while.

o A small amount of cash.

o If you have a cellular phone, put a note on the outside of the “Emergency Bag” to take the phone with you.

By taking these steps in advance you will greatly reduce the stress and confusion that can often accompany a hospital visit particularly if the visit is an unplanned trip to the emergency room.

At The Emergency Room

A trip to the emergency room may tire or even frighten your loved one. There are some important things to remember:

* Be patient. It could be a long wait if the reason for your visit is not life-threatening.
* Know that results from lab tests take time.
* Offer physical comfort and verbal reassurance to your relative. Stay calm and confident.
* Realize that just because you do not see staff at work, does not mean they are not working.
* Be aware that emergency room staff often has little training in Alzheimer’s disease so help them understand your loved one.
* Do not assume your loved one will be admitted to the hospital.

Do not leave the ER to go home without a follow-up plan. If you are sent home, make sure you have all instructions for follow-up care.

Before A Hospital Stay

If your loved one is going to the hospital for a planned stay, you have time to prepare and ask your doctor questions. Ask your doctor if the procedure can be done as an outpatient visit. If not, ask if tests can be done before going to the hospital to shorten the hospital stay. Ask if your doctor plans to talk with other doctors. If so, find out if your relative can see these specialists before going into the hospital.

You should also ask questions about anesthesia, catheters, and IVs. General anesthesia can have side effects. Ask if local anesthesia is an option and if you will be allowed in the recovery room.

Before Going to the Hospital

* If your insurance allows, ask for a private room if possible. It is more quiet and calm.
* Let your loved one take part in the planning for the hospital stay as much as possible.
* Don’t talk about the hospital stay in front of your relative as if s/he is not there.
* Plan ahead. Make a schedule with family and friends to take turns sitting with your relative during the entire hospital stay.
* Shortly before going to the hospital, decide the best way to tell your loved one that the two of you are going to spend a short time in the hospital.
* When packing, include a copy of important papers such as a living will and health care power of attorney.

Pack comfort items. Things to help your loved one feel safe and secure such as favorite clothes or blankets and photos.

During The Hospital Stay

* Have someone with your loved one at all times if possible – even during medical tests. This may be hard to do, but it will help keep your loved one calm and make the hospital stay easier for him.
* Ask doctors to limit their questions to your relative who may not be able to answer. Instead, answer questions from the doctor outside your relative’s room.
* Ask the staff to avoid using physical restraints.
* Help your relative fill out menu requests.
* Open food containers and remove trays.
* Talk with your loved one in the way he will best understand.
* Remind your relative to drink fluids. Offer fluids and have him make regular trips to the bathroom.
* Know that a strange place, medicines, tests and surgery will make a person with Alzheimer’s disease more confused. S/he will need more help with personal care.
* Assume your relative will have problems finding the bathroom and using his/her call button.
Sudden confusion can be caused by a medical problem. Ask the doctor if your loved one seems suddenly worse.

If Anxiety or Agitation Occurs

Try some of the following:

* Remove street clothes from sight.
* Post reminders or cues if this comforts your relative.
* Turn off the television, the telephone ringer and the intercom.
* Talk in a calm voice and offer reassurance. Repeat answers to questions.
* Give a comforting touch or distract your loved one with offers of snacks.
* Listen to soothing music or try comforting rituals.
* Slow down, try not to rush your loved one.

Working With Hospital Staff

Remember that not everyone in the hospital knows the same basic facts about memory loss and Alzheimer’s disease. You may be their best teacher of what works with your family member.

You can help the staff by giving them a list of your loved one’s normal routine; personal habits; likes and dislikes; possible behaviors, what might cause them and how you handle them; and signs of pain or discomfort.

You should:

* Make the list easy to read with headings and short, simple statements. Have a copy with the chart and at the nurse’s station.
* Decide with the hospital staff who will do what for your loved one. For example, you may want to be the one who helps your family member get a bath, eat or use the toilet.
* Think about placing a poster above the head of the bed with key information, including names of people important to your loved one and the relationship (spouse, cousin, friend).
* Tell the staff about any unusual behaviors, hearing problems or communication problems your relative may have and offer ideas for what works best in those instances.
* Make sure your family member is safe, tell the staff about any previous problems with wandering, getting lost, suspiciousness or falls.
* Not assume the staff knows your loved one’s needs. Tell them in a nice, calm manner.
* Ask questions when you don’t understand hospital procedures, tests or when you have a concern.
* Realize that hospital staff are caring for many people and practice the art of patience.

Make Contact With National Resources

The following agencies can provide you with information about Alzheimer’s disease assist you through caregiver support groups or connect you with community resources:

Alzheimer’s Association: 1-800-272-3900 www.alz.org

Eldercare Locator: 1-800-677-1116 www.eldercare.gov

For educational and training materials, contact the Alzheimer’s Disease Education and Referral (ADEAR) Center at 1-800-438-4380 or visit us on the Web at www.alzheimers.nia.nih.gov

Source: www.nia.nih.gov, North Carolina Division of Aging in conjunction with the Joseph and Kathleen Bryan Alzheimer’s Disease Research Center through the Administration on Aging grant #90AZ2246.
Provided by: The Staff at www.RetirementConnection.com
For more information: www.nia.nih.gov
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