How to Avoid Elderly In-Home Care Accidents, Part II: The Checklist

Friday, August 1, 2014 by peter mangiola

In Part I, we talked about the importance of home safety checkups in avoiding elderly in-home care accidents. We promised the checklist in Part II -- and here it is:

In The Bedroom:

  • Is the floor safe to walk across? Are throw rugs, torn carpeting, electrical cords, or height changes making it dangerous to cross the room?
  • Is the room cluttered with furniture or personal items that make it unsafe to navigate?
  • Does the bed have easy access to a phone (cellphones count)?
  • Is the bed the appropriate height for easy ingress and egress?
  • Is there enough light in the room?
  • Does all of the furniture in the room offer proper support for the senior's muscle and bone density?

In The Bathroom:

  • Are there adequate grab bars around the toilet, shower and/or tub, and sink?
  • Does the floor have a mat or some other way of preventing it from being overly slippery?
  • Are the bathtub and toilet the appropriate height for easy ingress and egress?
  • Is the water heater tuned so that the senior cannot accidentally scald themselves?
  • Are medications and other vitals stored within easy reach?

In The Living Room:

  • Is the floor safe to walk across? Are throw rugs, torn carpeting, electrical cords, or height changes making it dangerous to cross the room?
  • Is the room cluttered with furniture or personal items that make it unsafe to navigate?
  • Is there enough light in the room? Can the senior easily reach the light switch?
  • Does all of the furniture in the room offer proper support for the senior's muscle and bone density?
  • Do the windows allow for too much glare or otherwise prevent the senior from seeing?

In The Hall:

  • Is there adequate light in the hallway at night?
  • Is there a functional smoke detector and carbon monoxide detector in place?

In The Kitchen:

  • Are all vital items stored within easy reach?
  • Are the countertops clear enough for easy work?
  • Are all pathways through the kitchen clear enough to allow for easy mobility?
  • Are any dangerous chemicals properly secured?
  • Does the floor have a mat or some other way of preventing it from being overly slippery?
  • Are the food storage areas clean?
  • Are emergency phone numbers posted near the phone and easy for the senior to read?

There may well be other rooms in the senior's house, including a laundry room, study, or basement -- but this list should suffice to cover those rooms as well: treat the laundry room/basement as a kitchen and anything else like a second living room. Perform this check once a year, and minimize the elderly in-home care accidents your loved one will experience.

How to Avoid Elderly In-Home Care Accidents

Thursday, July 31, 2014 by peter mangiola

Upwards of 5 million people over the age of 65 visit the emergency room every year because they were injured while in their own home. As a matter of fact, according to a study by Home Instead, almost two-thirds of all homes with a senior citizen in them have at least one potential safety hazard -- and almost half of all home accidents that occur to seniors could have been avoided.

This is particularly troubling since the same study indicated that an amazing 85 percent of seniors surveyed hadn't taken any steps to prepare their homes for their own changing needs. The place that they should be the most comfortable and safe becomes dangerous not because it has changed, but because they have changed.

The recommendation from leading experts is simple: take one day a year to go through your home (or your loved one's home, if you're a family caretaker -- or have your caretaker go through your home with you, if you need to) and perform a thorough safety check. We'll talk about exactly what to look for in Part II.

There are times when waiting until the yearly appointment has arrived is unwise, as should be obvious. Any time the senior in question experiences a notable loss of ability -- physical or mental -- perform the safety check. Any time the senior goes to the hospital on an inpatient basis, be it for injury, illness, or otherwise, perform the safety check.


To perform the check, use the list provided in Part II and simply move slowly through the home, room by room, and examine each of the places listed on the checklist. If you have to, have the senior navigate around that element of the home and display any difficulties it presents. Don't check it off of the list until any potential issues have been dealt with and the senior is certain that it will not become a problem in the near future. It might seem like a lot of time and effort, but it's well spent if it avoids elderly in-home care accidents that could otherwise lead to hospitalization or worse.



The Two Major Kinds of Elderly Assistance, Part II: In-Home

Tuesday, July 29, 2014 by peter mangiola

Becoming a senior is a stressful experience, and quite often there's little that the senior wants more than to know that his family is still there for them. That's why so many modern American families are turning inward for their elderly assistance, with children caring for their elderly patients.

In-Home Elderly Assistance

In-home assistance means that the senior will be staying at a private residence. If their caretaker is a family member, it will usually be that family member's home; if their caretaker is a private worker, they will generally stay in their own home and have the caretaker come to them. As with residential care (see Part I), there are a few different kinds of in-home senior care:

  • Concierge Services are for seniors who are mostly independent, but need occasional assistance from a meal service, a doctor who can perform a house call, or some other serviceperson like a repair man or an exterminator.
  • Homemaker Care a.k.a. Nonmedical Care is when a homemaker comes to the residence to assist the senior with basic life tasks such as cooking, cleaning, laundry, and simple companionship. Homemakers often also come and perform the same duties alongside a medical professional who comes to provide Medical Home Care (below).
  • Medical Home Care involves having a nurse, therapist, or other medical worker come to the senior's home and assist with their health needs. This can be a temporary situation, lasting until the senior has recovered from an illness or injury, or it can be an ongoing one when the senior has every day -- but not continuous -- medical needs. (Seniors with continuous medical needs are better served by residential care.)


Any or all of these professional services can be mixed with family caretaking. Most often, if there is a dedicated family caretaker, these services are used as respite services. That means that they're used long enough for the family caretaker to have some necessary time to themselves, after which the family caretaker steps back into the role.

The Two Major Kinds of Elderly Assistance, Part I: Residential

Saturday, July 26, 2014 by peter mangiola

It's not an easy thing becoming a senior. Decades of self-sufficiency melt away and seniors find themselves suddenly unable to do things they've been doing for as long as they can remember. Many seniors have no clue where to turn -- but with a little perseverance and a little effort, finding the right elderly assistance isn't as overwhelming as it first appears.

Residential Elderly Assistance

Residential assistance means that the senior will live in some form of facility that will provide structure for their lives. They come in a fairly wide variety, but there are four major categories:

  • Independent Living Facilities are for seniors capable of performing all of the necessary activities of daily life on their own. They provide seniors the ability to live with similar people, and offer activities and social programs to keep them occupied and integrated. Some offer housekeeping or other minor assistance services, but that varies by facility.
  • Assisted Living Facilities provide personal care with activities of daily life like getting dressed, using the bathroom, and bathing, but doesn't provide for any but the most basic of medical needs. Assisted living facilities frequently also provide the kind of structured social support that an independent living facility does, though generally at a slower pace. Seniors who need medical assistance beyond a reminder of when to take their medicines don't belong here. They belong in…
  • Nursing Homes are much akin to assisted living facilities, but are staffed with a much denser population of registered nurses, practicing doctors, and other high-level medical staff. Nursing home life is often less socially-oriented than the previous categories, because seniors living here are frequently incapacitated and cannot participate in such programs.
  • Alzheimer's Care/Dementia Care Facilities are a specialized kind of nursing home with high security and staff specially trained to deal with seniors that have impaired mental faculties.

Regardless of which level of need your senior loved one is at, do your best to ensure that the facility they're in is safe, reasonable in price, and has a pleasant atmosphere. Come back for Part II to learn about in-home elderly assistance options.

A Promising New Alzheimer's Treatment? Part II

Wednesday, July 23, 2014 by peter mangiola

In Part I, we discussed the discovery of a team of British scientists that a compound exists capable of preventing neurodegenerative diseases from causing the protective casing around your neurons to fail. While it's only been tested on mice thus far, the team leader of the group said, "We can go forward and develop better molecules and I can't see why preventing this process should only be restricted to mice. I think this probably will translate into other mammalian brains." Now we're going to tell you (more or less) how it works.

In Alzheimer's disease and other similar diseases, the brain begins to create proteins, or 'amyloids,' that are not built correctly. Because they're malformed, the brain's natural mechanisms don't remove them, and they build up -- which triggers a defense mechanism in which the brain stops producing those proteins altogether. The problem is that those proteins are made to protect your neurons, and without them, your neurons are defenseless and die off quickly.

The defense mechanism is triggered by a particular enzyme called PERK. The compound the scientists used to block the PERK enzyme was so effective that it stopped the diseases in their tracks -- and in some cases even restored some of the mice behavior patterns to pre-disease levels.

The compound does have some significant side effects, including damage to the pancreas that was severe enough to cause diabetes in some of the mice -- but the team believes that it will be possible to find a balance that will protect the brain without the pancreatic damage.

Even the scientists behind the study warn that it can take decades to move from curing prion disease in mice to curing Alzheimer's in humans. The important takeaway here, however, is that it is possible to arrest neuro-degeneration caused by the buildup of amyloid in the brain. That knowledge alone is worth celebrating.



A Promising New Alzheimer's Treatment?

Monday, July 21, 2014 by peter mangiola

For the first time in human history, a group of British scientists have created a 'drug-like compound' that was found to halt the death of brain cells in mice who had neuro-degenerative disease. Many doctors are, perhaps preemptively, hailing the discovery as a turning point in the search for a medicine that can conquer Alzheimer's. The miracle pill that will treat (or even merely prevent) Alzheimer's is still a long ways off, but scientists at least have a solid lead on which direction to point their searches.

Neuro-degenerative diseases cause the degeneration by creating a signal inside the brain that tells the brain to stop producing some proteins. Those proteins would, if created, form the sheath around each neuron that protects it from its immediate environment. Without those proteins, neurons will still form, and they may function for some time, but they will be unprotected and they will eventually die.

Mice that had prion disease, which is one of the animal diseases that most closely mimics Alzheimer's disease, were tested. The scientists performing the experiment said they were "confident the same principles" would "apply to the human brain" affected by diseases like Parkinson's disease or Alzheimer's disease.

Team leader Giovanna Mallucci said "It's the first time a substance has been given to mice that prevents brain disease. The fact that this is a compound that can be given orally, that gets into the brain and prevents brain disease, is a first in itself." Traditional oral medicines have had a very difficult time affecting the brain because of the blood-brain barrier, a membrane that prevents most large molecules -- and pharmaceuticals are known for being quite complex and thus quite large in the molecular sense -- from getting into the brain no matter how concentrated they are in the bloodstream.

Come back for Part II to read the rest of this exciting story!

When 'Affordable Care' Isn't: Home Health Care Agencies and the ACA, Part II

Saturday, July 19, 2014 by peter mangiola

In Part I, we detailed some of the potential effects of a decision, made as part of the government's attempt to fund the Affordable Care Act, to slash funding of the Home Health Care Prospective Payment program. The numbers are pretty gruesome: upwards of five hundred thousand home health care agency workers losing their jobs, for example -- but the actual effect isn't yet known, because the cuts never actually happened…and they never actually will.

Instead, the Centers for Medicare and Medicaid Services recently announced an entirely different schedule for cutting back -- that results in a cut of a mere three tenths of one percent (0.3%) to the HHCPP starting on January 1st, 2015.

Why the dramatic change in the plan? Two significant reasons; first, it turns out that the CMMS didn't actually study the matter before they decided to make the maximum possible cut that the ACA rules allowed. Second, people nationwide raised a huge groundswell of concern over the matter -- and got attention.

Fifty-one senators -- 35 Democrats, 15 Republicans, and an Independent -- signed a letter to the head of the CMMS proclaiming that the decision would "raise serious concerns about access to care for vulnerable seniors." Another letter, this one signed by 142 member of the House of Representatives (66 Democrats and 76 Republicans) reminded the head of the CMMS that "home health is a critical service that allows patients to be treated in a cost effective manner in the environment they prefer — their home."

Fortunately, it seems as though the voices of reason have won out in this instance. That the HHCPP is going to get cut at all is unfortunate, though probably necessary -- that the cut is going to be more than 90% smaller than it was originally announced is literally going to save millions of lives.



When 'Affordable Care' Isn't: Home Health Care Agencies and the ACA

Friday, July 18, 2014 by peter mangiola

January 1st, 2014: about 3.5 million senior citizens expected to wake up and find that the government funding they relied on to pay for their home health care agencies had been dramatically reduced. That was the decision that the ACA advisory panel had made: cut Medicare's home health care benefits by 14% over the next four years.

The Centers for Medicare and Medicaid Services whispered the announcement on November 22nd, 2013: the Home Health Care Prospective Payment program was going to lose 3.5% of it's funding each year for four years, starting in 2014, for a total of fourteen percent when all was taken into account. The program is used to pay for home health care agencies to provide workers to assist seniors who are homebound and require assistance with daily life, such as getting dressed or bathing, who are suffering from chronic diseases, or who need physical therapy.

The Centers for Medicare and Medicaid Services’ own calculations are that some 40% of home health care agencies -- about five thousand businesses all told -- will suffer a net loss in revenue due to the cuts, and (again, by their own estimation) many of those will become unprofitable by 2017.

If it's not obvious, businesses that become unprofitable generally don't remain in business for very long. And that's the numbers the CMMS will admit to. According to the National Association for Home Care and Hospice, the real numbers will be closer to 75% of all home care agencies being affected. That would equate to about half a million home care workers becoming un- or under-employed over the next four years.

Now note that in the beginning, we said that all of this was 'expected' -- that's because all of those cuts haven't actually gone into effect…yet.  Come back in Part II for the rest of this outrageous story.

Paid Senior Care Services Are Vital To Family Caretakers, Part II

Wednesday, July 16, 2014 by peter mangiola

Time for some statistics and analysis on the study of in-home senior care services mentioned in Part I. First, the statistics:

  • 78% of family caregivers that took advantage of paid in-home care services rated their health as 'good' or better.
  • Only 72% of family caregivers that tried to go it alone gave the same rating.
  • 10% of family caregivers that utilized paid in-home care services said their health was worse than it had been a year before.
  • But 14% of family caregivers that didn't use any paid services made the same claim.
  • 19% of family caregivers that had paid caretakers working alongside them had used any form of outpatient hospital care in the previous year…
  • But 25% of family caretakers that did it all by themselves had been through the outpatient hospital care system in the last year.

Now, these numbers might not seem dramatic to you -- what does a 4% increase in the number of 'worse health' claims mean? Well, let's take a look at some numbers: there are upwards of 65 million family caretakers in the US. (A 'family caretaker' is someone who spends at least an hour each day providing caretaking services for another family member, most often a senior.)

10% of that number is 6.5 million; 14% of that number is 9.1 million. So that 4% increase represents 2.6 million people whose health is worse this year. Now, it's true that there is no proof that their health is worse because they didn't take advantage of in-home senior care services -- correlation is not causation -- but statistically speaking, it's a large enough number that the chances are very good that there's a connection.


Similarly, that's 3.9 million people who didn't rate their health as 'good' who might have if they had used paid senior care. And 3.9 million people who went to the hospital who might not have. The impact of paid senior care services on family caretakers shouldn't be underestimated.


Paid Senior Care Services Are Vital To Family Caretakers

Monday, July 14, 2014 by peter mangiola

A senior care research group recently studied the use of paid in-home senior care services and found that the use of non-medical senior care has significant personal and employment benefits for family caretakers -- and to the seniors they care for.

A non-medical senior care service provides workers that help seniors who have reached a point in life when they need help with their activities of daily living (ADLs); including toileting, bathing, getting dressed, eating, and getting around the home. They take such seniors to see the doctor, remind them to take their medications on schedule, prepare meals, keep the pantry stocked, and provide light housekeeping services. In short, they allow these seniors to feel independent and safe as they age in place.

Normally, all of these functions are performed by a family member, but because a family member isn't compensated for their efforts, the dynamic is notably different. A family caretaker still has to work in order to make ends meet, which means they either have to have a job that can bend around the senior's needs, or they have to hire someone to care for the senior while they work, be it an in-home caretaker or an adult day care service.


As it turns out, however, according to the study, there are several reasons why even a family member whose job is that flexible might want to take advantage of in-home senior care services. We'll get into the exact statistics in Part II, but suffice it to say that millions of Americans who care for their senior loved ones would find themselves with better health and a better relationship with their loved ones if they even (at least occasionally) utilized the services of an agency that provided skilled in-home care for their seniors. Come back next time for the exact numbers!



The "Grey Market" In Home Care for Elderly Loved Ones, Pt II: The Downside

Monday, July 14, 2014 by peter mangiola

In Part I, we introduced the notion of the 'grey market' -- an informal network of providers that give in-home care for elderly folks at discounted prices, but don't have basic legalities like a license to do business or a certification in caregiving. Today, we're going to talk about why you should avoid those people at all costs.

The Economics of The Grey Market

The grey market works on a simple principle: the agency that organizes most home care workers takes a big cut of their pay. It may be that the caregiver only sees $9/hour out of the $20/hour that you pay them to take care of your loved one. If you hired the same caregiver through the grey market for $12/hour, you could save $8/hour while giving them a 33% raise. But there are some very good reasons that home care agencies charge that much money -- some of those reasons benefit you, and others benefit the caregiver

What an Agency Does For the Caregiver

A caregiver that works through an agency does make less money per hour than one hired directly – but for good reason:

  • Most agencies put a significant amount of time and money into ensuring that their caregivers are trained to respond correctly to emergency situations.
  • Most agencies provide insurance for their caregivers, which can save them a huge amount of money and hassle if something catastrophic happens.
  • All agencies provide placement services for their caregivers, ensuring that they can find as much work as they care to take on.

What an Agency Does For You

  • All agencies will switch caregivers for you if the one you're currently working with turns out to be a mismatch for your loved one.
  • Almost all agencies will provide a back-up caregiver for you if your normal caregiver gets hurt, goes on vacation, or otherwise can't make it.
  • Most agencies provide bonding for their caregivers, which can save you a huge amount of money and hassle if something catastrophic happens.

In short, the grey market for in-home care for elderly folk does improve the economics of the home care transaction in the short term -- but you can be virtually guaranteed that some unexpected situation will crop up and complicate things enough that you'll wish you spent the extra money.

Grieving For The Living: Losing A Loved One To Dementia By Peter Mangiola Rn Msn

Saturday, July 12, 2014 by peter mangiola

If you have never had a loved one look at you without recognizing who you are, the idea of grieving the loss of someone that is standing right in front if you might seem counterintuitive. In fact, even those who have a loved one with profound dementia often have trouble resolving their own emotions. There may even be multiple times when you may grieve, recover, and then see your loved one slip even further away from you and experience that loss all over again. LossOne of the most powerful emotions you may experience when caring for a loved one withdementia is loss. You may feel like you lost the person you knew, you lost the future you believed you had with them, you lost their companionship…or you may quite rightfully feel the pain of losing the lifestyle you once had (because you are going to have to take care of them 24/7). None of these emotions are any more or less valid than the others. Coping with loss starts by recognizing that loss is a process and not an event. There will be ups and downs; sobbing despair is more common than wild optimism that a cure will be found, but both are perfectly normal. Denial of the problem and suppression of your feelings is also entirely normal. Eventually, you will accept the truth of the situation and feel like you can cope; and then you'll find one day that you're overwhelmed again with pain, anger, sadness, and loss. Accepting this cycle is the key to coping with the feelings of loss. ResentmentCaregivers who attend to people with dementia often find themselves resentful for the literally constant demands on their time and attention. You may be forced to cut back on work or stop working altogether; at the very least, you will have dramatically less self-directed time on your hands. The most important thing you can do if you experience feelings of resentment is realize that they do not make you a bad person; they are a perfectly natural result of an incredibly stressful situation. Who doesn't wish, when stressed out, that whatever was causing the stress would simply vanish? If these thoughts become commonplace, you may want to seek emotional support from friends, family, a support group, or a psychologist. But when they are infrequent, scary asthey might be, these thoughts are simply normal. Inability to CopeIt may seem strange to talk about 'coping with an inability to cope', but it is nonetheless a very real and necessary part of dementia care. The human mind is only capable of handling so much responsibility before it desperately wants to stop. The act of caretaking for someone with dementia is an ongoing responsibility and involves endless small 

decisions; even if it is not taxing physically, the sustained mental effort can leave you completely exhausted. To cope with an inability to cope, you need what everyone who operates under immense stress needs: a break. Start by getting your loved one set up doing something they do not need constant supervision for, and use this time to take a break and do absolutely nothing. If thoughts pop up in your head, take a moment to recognize them for what they are, and then drop them. Just breathe, let your mind wander, and relax. On a longer term, if you find yourself waking up in the morning already unable to make decisions effectively, it may be time to call a home health aide for some respite care. Having someone come in and care for your loved one a few days a month might cost a couple hundred dollars, but spending those few days just attending to your own needs cando a huge amount to enable you to continue effectively caretaking for the long term. Taking care of someone you love as they slowly lose themselves in dementia is one of themost painful and demoralizing experiences that many oof us will have to go through. The emotions it can trigger are real, legitimate, and above all they are okay. Do what you can to cope, do what you need to get by, and do not be afraid to call for some help.

The "Grey Market" In Home Care for Elderly Loved Ones, Pt I

Thursday, July 10, 2014 by peter mangiola

The term "grey market" isn't new, but it's never been terribly popular. It's just not as dramatic and shadowy as a "black market", and it's not as patriotic as a "free market" -- but grey markets are very real, and they affect most areas of our lives, from the books we read to in home care for elderly loved ones, in ways we'd never suspect.

What Is a "Grey Market"?

A grey market is a market that isn't illegal, but nonetheless takes place 'off the books,' in environments that don't have basic legal backdrops like licenses to do business or certifications in whatever service is being offered. For example, most freelance work in the world takes place through a grey market -- some gets paid to do something, but they don't necessarily ever have a title or a contract of employment, and the only evidence they have of their skill is a portfolio of previous successes.

The Grey Market in Home Care

There was a story in the New York Times seven years ago about how one geriatrician ('doctor of senior care') was planning on accessing the grey market to find a caretaker for her elderly father. It describes the market as "an over-the-back-fence network of women…usually untrained, unscreened and unsupervised…hired through personal recommendation." Not much has changed in the last seven years; if you don't know who to ask to find a good under-the-table worker, you'll never find one, plain and simple.

But Would You Want To?

Therein lies the rub. The grey market is as fraught with risks as it is with opportunity to save money. When you hire someone to give in-home care to your elderly loved ones, and they tell you up front that they come uncertified, without an agency, and that they charge half of what the market normally asks, you have to recognize that there's some downside there. We'll talk in more detail about those downsides in Part II.

Getting In Home Senior Care Services at a Good Price, Pt II

Monday, July 7, 2014 by peter mangiola

The question for those looking to get their in-home senior care services at the best price is simple: who is going to charge me the least to take care of my elderly loved one? In Part I, we discussed a few options, from Medicaid to volunteer groups, but it's time to get to the nitty-gritty: how to find the most cost-effective care in your area.

Beware of the Difference between 'Low Cost' and 'Cost Effective'

This shouldn't even be something you need to be told, but just in case: keep in mind when you're looking for care that 'least expensive' and 'most cost-effective' are two very different things. You don't want to pay $18/hour for a homemaker that doesn't have a CPR certification and doesn't particularly like elderly people when you could be paying $20/hour for one that does both.

This is not to say that a higher price equates to better care -- but to be honest, a very low price is far more likely to equate to sub-standard care than a very high price is to equate to superior care. Determine a standard for your area, and look for someone with rock-solid credentials that is on the low end of that standard; that's how to get cost-effective care.

Ask Around

In Part I, we mentioned that the local Area Agencies on Aging tend to give excellent referrals for in-home senior care services; they're a good place to start -- but only to start. If you're determined to do thorough research (and you should be), you should also ask around at:

  • Senior Employment Services
  • Churches
  • Temp Agencies
  • Hospitals
  • Veteran's groups
  • Senior groups
  • The local Rotary
  • And the local Chamber of Commerce.

Ask first for high-quality caregivers -- then go through that list and look for people offering decent prices. If you start from the price angle, you're risking the safety and happiness of your loved one, and that's not a gamble you want to take.

Getting In Home Senior Care Services at a Good Price

Saturday, July 5, 2014 by peter mangiola

If you have an elderly loved one that requires care for more than a few hours each day, the chances that you'll be able to afford in-home senior care services is slim unless they have significant insurance. Fortunately, there are services out there that can help you get skilled help at lower rates. 

A senior who was just released from the hospital, yet needs to receive skilled medical services like physical therapy or "just" nursing care while they're at home, may be eligible for several programs that can help them pay for those medical services. The most obvious is Medicare, which will reimburse post-hospital home care for a period after each hospitalization.

If Medicare's reimbursement expires before your loved one's needs do, they may be able to obtain services through the local Area Agency on Aging, which often will provide homemaker, home health aide, meal delivery, transportation, and even legal services at steeply discounted rates for low-income seniors. They can also often direct you to other low-income senior-oriented programs such as:

  • Subsidized housing
  • SSI
  • The Qualified Medicare Beneficiary program
  • The Supplemental Nutrition Assistance Program (SNAP/food stamps)
  • And more.

The AAA can also often direct you to other mid-cost options if your low-cost programs are unavailable. They can point you toward volunteer groups, inexpensive home care agencies or private home care contractors, or even adult day care programs that can keep your loved one active while you're at work and allow you to look after them personally once you're at home.

The 'fallback' option for those who are caregiving for their own elderly loved ones in-home is Respite Care, a short-term program that can give you a week or so 'off' -- or even give you a regular day off each week -- to handle your own life so it doesn't suffer because you're trying to be responsible to your loved one. Respite care is often available inexpensively through the AAA as well.

We're not quite done yet -- come back next time for more in-home senior care services at reasonable costs.

Do You Know a House-Bound Senior? Help Them Out(side!) Pt. II

Wednesday, July 2, 2014 by peter mangiola

If you have a senior loved one that is stuck at home, getting them outside isn't always easy. You have to offer your senior help that is relevant to the reasons why they're stuck inside, and that isn't always an easy determination to make.

Disability is one of the more obvious reasons; if your loved one has trouble walking or seeing any significant distance, getting outside requires significant assistance. In these cases, they're not so much a shut-in as they are stuck -- and in most of these cases, they would love to get outside! Going for a drive to familiar, scenic locations might be ideal, particularly if those locations have handy places to rest.

Fear is often hidden in the guise of disability or simply a contentment with an 'inside' routine -- but shows when you try to get your loved one outside. It may be as "straightforward" as agoraphobia or as complex as social anxiety based on forgetting friend's names. The critical element in addressing this kind of fear is that you absolutely cannot force the issue; the only result will be a complete breakdown of their trust in you. Instead, help them explore their fear -- talk about it calmly in a safe setting, and try to reach an understanding of the roots of their fear. You might not ever actually get them outside -- but at the minimum, understanding why not will help you empathize with their need to stay in.

Routine is a reason that non-seniors rarely seem to consider, but the simple fact is that many seniors, especially those with mild cognitive impairment, prefer to have a rock-solid, dependable routine to their daily lives. It helps them understand what's supposed to come next and plan ahead. But if they develop a routine that never includes going out, they'll never go out -- simply because they'll never think to. This reason is hard to discern sometimes, but it's fairly easy to overcome: ask them to include your visits in their routine, and to make time for you…then take them outside.

It doesn't have to be awkward or embarrassing to offer your loved senior help; just be straightforward and honest with them, and let them guide what happens next.

Do You Know a House-Bound Senior? Help Them Out(side!)

Monday, June 30, 2014 by peter mangiola

When you're taking on the role of caretaker for a loved senior, knowing where your job as caretaker ends and your job as loving relative begins can be a challenge. One of those grey areas in understanding when you need to encourage your loved one to get out of the house -- and when you need to insist, for medical reasons, that they do.

Many seniors become shut-ins, some because they are unable to leave because of physical pain or emotional disabilities and others because they simply develop a routine that doesn't include going out. But as we all know, being a shut-in isn't good for your body, your mind, or your soul. How can we help them out -- outside? Not necessarily -- but you don't necessarily need to, either. Instead, start with these steps:

  • Empathize with them. If you don't put the effort into understanding why they choose to stay in, you don't ever be able to solve the problem. In many cases, they will feel like staying inside is their only option -- in others, it may feel like it's the best one. Ask questions, listen without thinking about how you will respond, and repeat what they say back to them in your own words. Then have them validate that you understand what they are trying to say before you bring any new ideas to the table.
  • Visit with them. When a senior doesn't feel like they can get out, it's important that someone get in. Make it a habit to, once a week, stop by. You can watch their favorite TV show with them, cook together, play a game they enjoy, or just chat -- the content of the visit is less important than the fact of the visit.
  • Lift the Mood. Even if you can't make it over for a visit, get in touch via Internet, snail mail, or phone call, and share uplifting tidbits. Funny stories, photos of the grandkids, or simply reminiscing about the moments you most remember from your youth are all great ways to remind them that there's a world out there, and it includes people that love them.

If you want to offer a house-bound senior help, start by helping them enjoy their life. Then -- in Part II -- we'll talk about helping them get out a bit.

Classic and Predictable Dementia Symptoms Part II: Pre-Dementia

Saturday, June 28, 2014 by peter mangiola

In Part I, we discussed the dementia symptoms that classically indicate the onset of dementia and the feared extremes dementia can reach. Today, we're going to talk about "pre-dementia" -- those symptoms that tell you maybe you need to do something now to help stave off future dementia.

The Earliest Signs You May One Day Have Dementia

Many people aren't aware that there is a medical condition between 'normal' forgetfulness that happens as we age and full-on dementia. It's called "mild cognitive impairment", and it's the closest diagnosis we have to 'pre-dementia.'  Not everyone with MCI will get dementia, but almost everyone who has dementia started with mild impairment.

Symptoms of mild cognitive impairment include:

  • Having a harder time making decisions, and making the right decisions
  • Finding it hard to keep track of multiple tasks or items at once
  • Losing track of a conversation
  • Forgetting recent events or things you were told
  • Taking a particularly long time to perform challenging mental activities
  • Losing regular objects like keys or kitchen knives on a regular basis

As with dementia, MCI moves through stages. The later stages of mild impairment can produce effects like:

  • Difficulty learning new routines or sets of rules (such as a new game)
  • Getting lost when taking a normally-familiar route
  • Forgetting the names of familiar objects
  • Inability to enjoy things you previously enjoyed; a "flat" mood
  • A rapid slide into inappropriate behavior; personality changes

Dementia and it's little brother MCI form a spectrum -- there are definitely cases out there where one doctor would diagnose a "severe mild" cognitive impairment, while another would diagnose dementia's earliest stages. There is no solid rule for 'you're no longer in MCI, you now have dementia'; it's up to each individual doctor to look at each individual patient's MCI/dementia symptoms and decide as they feel is appropriate.


Classic and Predictable Dementia Symptoms Part I: Onset Symptoms

Thursday, June 26, 2014 by peter mangiola

There are two sets of dementia symptoms that most people are interested in: the symptoms that tell you that dementia is setting in, and the symptoms that tell you it might set in sometime down the road. We'll cover that second set of symptoms in part II; for now, let's talk about how you can tell if the symptoms you're experiencing right now are dementia or otherwise.

Defining Dementia

Before we get into the symptoms themselves, let's be clear on what we're talking about. Dementia is defined as:

  • Difficulty correctly using language
  • Difficulty recalling events and assessing the time (hours and/or decades)
  • Difficulty exercising judgment
  • Difficulty recognizing perceived objects and situations
  • Difficulty recognizing and/or controlling emotions

Onset Symptoms of Dementia

By far the most common symptom of dementia is forgetfulness, though there are many causes of forgetfulness and as a standalone symptom, it's unwise to assume that forgetfulness is a sign of dementia. More damning symptoms include:

  • A change in sleep patterns, particularly waking up in the middle of the night
  • Difficulty with daily tasks such as cooking, dressing, or driving
  • A failure to recognize current events
  • A failure to recognize events in your own life history
  • Suddenly feeling violent, argumentative, or depressed
  • A significant decrease in reading or writing ability
  • A failure to recognize danger
  • Suddenly using the wrong words, or stringing sentences together ineffectively
  • Suddenly pulling away from social contact

Signs of Severe Dementia

As dementia worsens, the symptoms reach the level that sufferers fear most:

  • A failure to care for oneself; needing another person to eat, bath, or use the toilet
  • A failure to recognize family members or loved ones
  • A failure to understand language

Needless to say, this list is not comprehensive, but it is a list of the most commonplace symptoms of onset and worsening dementia. How do you know if you are at risk for this crippling condition? In the next post, we'll talk about the dementia symptoms you might see in yourself before the doctor would diagnose you with the disease.

Choosing Your Senior Care: In Home or Adult Day Care? Pt: II: In Home Care

Wednesday, June 25, 2014 by peter mangiola

In Choosing Your Senior Care: In Home or Adult Day Care? Pt I, we discussed some of the traits and advantages of planning your day around adult day care. Today, we're going to talk about why you might consider in-home senior care a better option.

Senior Care: In Home

Caring for a loved senior in your home is a huge sacrifice in some ways, and extremely convenient in others. On the one hand, you are either volunteering to have someone with them all day, or you're trusting them to be home and safe by the time you get home from work. The most effective way to deal with the dilemma is to hire a caregiver to come in and visit them while you're gone, making sure that they get everything they need to make it through the day. Depending on their needs, that may include:

  • Personal hygiene
  • Cooking and diet monitoring
  • Light housekeeping
  • Offering companionship
  • And if you pay for a nurse rather than a homemaker, minor medical services as well.
  • With a wide range of other services available depending on the agency.

In-home care is available in a wide variety of variations. You can get your caretakers to come into your home at almost any time of day, unlike with adult day care. If you work the night shift, swing shift, or even particularly long shifts, you may actually not be able to use adult day care as intended and in-home care may be your only option.

As mentioned, you can also get your home care for seniors in both medical and non-medical form, depending on the needs of your senior and your budget. You can expect to pay as much as double the per-hour cost for the services of a registered nurse vs. a homemaker, but fortunately there are also nurses' assistants that form a decent halfway mark between the two.

Being a caregiver for a loved senior is a huge responsibility, and arranging to care for them while you're absent at work is a challenging part of that. Whether you do so with adult day care or by providing your senior care in home, your willingness to care for your loved senior yourself is praiseworthy already.