Medication management is one of the most important tasks you may be providing for your loved one.  You will want to ensure your loved one’s medications are effective. To achieve this you need to be sure of the following:

• They are taking the right prescription, at the correct dose for the reason intended;
• The medication has not expired;
• When a new medication is added to the list (many seniors between the ages of 80-84 take 18 prescriptions per year) a physician or pharmacist needs to review the list so that they are sure that the medications are compatible with each other.

Many seniors are reluctant to dispose of medications (this includes over-the-counter medications) because they feel they may need it someday and they don’t want to waste it.  Eventually it is pushed back into the cupboard and forgotten about.  Taking expired medications or mixing medications without the doctor or pharmacist reviewing your medications with you can be very dangerous and even deadly.

The City of South Portland, supported by agencies and businesses, has begun a Medication Collection event. This year it takes place on October 29^th from 10am-noon.  You can bring unused, expired medications and more (sharps and even pet medications) to this event.  One location is the Community Center on Nelson Road, and the other is the HUB CPPC Trailer at 580 Westbrook Street.  Please call Bob Scarpelli, SPPD at 799-5511, ext. 7221 for more information.

Having these medications out of the home and out of harm’s way will help to give peace of mind knowing that your loved one will not be taking anything that they shouldn’t, and that visitors and children will not be at risk, as well as the community at large, as flushing and disposing of these medications improperly is dangerous for us all.

• Aging is about growth and development (not decline and decay).
• Longevity is about living as well as possible (not as long as possible).
• Health and wellness is about enjoying life and growing no matter your age or condition (not about staying young forever).
• Dementia and Alzheimer’s is about creating a life worth living regardless of memory ability (not about waging a war against memory loss).
• Elderhood is a distinct stage of life and growth (not the dead end of retirement).

I hope this philosophy becomes widespread. Imagine how our society would change….

And, somewhere in my own tapestry are the colored fragments of the lives that have touched mine: the 90 year old gentleman who told me his favorite trees were birch trees because he loved to swing from their flexible branches as a young boy, the 93 year old lady who whispered that her most precious possessions were hidden in a shoe box filled with tissue paper under her bed, and that some of those treasures were sea shells. The 89 year old man who wore a t-shirt that said “older than dirt” and who told me his story of building a pink brick home for his new bride because pink cast off bricks were all he could afford. But that his wife always called it her valentine house and they lived there happily for 55 years.

When I first became a nurse I wondered both to myself and outloud. Would my heart be able to hold and comfort all the new faces that would enter my life? Could my heart stretch enough to give that caring to all of my patients as well as my own family and loved ones. I don’t need to ask that question anymore, now I know the answer is yes. And, if this sounds like a love letter to my patients both past and present, it is.

Written by a VNA Home Health Nurse.

VNA: What exactly is palliative care? Is it the same as hospice?

Jessica: Palliative care and hospice are two different things. Palliative care aims to improve a patient’s quality of life by relieving the pain and anxiety experienced with chronic or life-limiting illness. It’s based on a patient’s goals and the way they want to live their life. Many people feel uncertain about how to handle the changes caused by a serious illness or disease. Palliative care can help set the stage for a continuous conversation between patient, family, physicians, nurses and other caregivers to enhance communication over time, and focus on the patient’s desires.

Hospice is for patients suffering from serious illness with a life expectancy of less than six months, while palliative care can assist patients from their diagnosis onwards – whether they live for a few days or many, many years.

VNA: Who could benefit from palliative care?

Jessica: Patients suffering from cardiac conditions like heart failure, which can be very recurrent, pulmonary diseases, cancer, multiple sclerosis, Parkinson’s or ALS can enjoy relief from their symptoms with palliative care.

For example, a patient may have cancer and want it treated with chemotherapy as much as possible, but also desire excellent control from a symptom, such as nausea. Another patient might experience shortness of breath, which impairs their ability to get around, but is not bad enough for a hospital visit. A palliative care team member can act as a liaison between the nurse provider and the family, and could make suggestions with them, such as having a more specialized nurse visit.

It’s about clarifying a patient’s goals and managing their symptoms – a collaborative process with various health professionals. We work with Mercy Hospital and VNA to make it happen.

VNA: How long do patients need palliative care?

Jessica: This all depends on each patient’s illness and experience, which can vary at different points in time. Once a patient is diagnosed, we work to clarify their goals, explain their treatment options, and discuss what makes the most sense for them.

For instance, a patient could be doing very well after being discharged from the hospital, then have a problem, and the home nurse might suggest that a palliative care person visit the patient in their home. Providers are asked to do so much these days, but with less time and fewer resources – as part of a palliative care team, I know we are all more than happy to offer our support.

For more information on palliative care and how it can help you, contact: VNA Home Heath Hospice.

It was frightening for all of us but most especially for my mother. To go from an active woman on the go to someone who couldn’t even sit up in bed on her own was terrifying. She started to express fears that she could never go up stairs again or sleep in her own bed. She never saw herself returning to normal. The next day, she had her first visit from her physical therapist. This woman was wonderful. She not only gave my mother the support she needed to regain her health but she also gave her the confidence that she could get her life back. Within three weeks, my mother was up and walking with just a cane and going up and down stairs again. I saw first hand what an important role physical therapists play in someone’s recovery.

As I look back on it, I realize there had been slight changes in my mother this past year. She was still active but once in awhile she would waiver when she walked and didn’t walk in a straight line. With my position at VNA Home Health & Hospice, I should have known better… I’ve heard Bill Anderson explain many times how important it is to work on strength and balance not just after an event but in order to prevent debilitating events. Bill is our Physical Therapist with a specialty in Geriatrics.

When I asked him what signs I should have noticed in my mom, he gave me a list of things to watch for and also to ask in order to identify any potential issues around safety, strength and balance.

Watch:
* Do they take a longer than expected time rising from a chair?
* Do they look like they are straining or struggling to rise?
* Does it take them multiple attempts to stand?
* Do they hold onto furniture/objects while walking?
* Do they walk in a straight line or do they waiver?

Ask:
* Have they fallen in the past year?
* Are they afraid of falling?
* Are they leaving the house less often than they used to?
* Do they need help to leave the home for safety reasons?
* Do they get dizzy or lightheaded when they rise from a bed or walk around?

If you see someone who meets some of this criteria, don’t wait for a fall to happen. Talk to their doctor. She can provide a referral for a physical therapist who can help your loved one stay strong and healthy.

Ruth is 87 and has macular degeneration. She has not been able to drive for a few years. All of her children have moved away but her sister, Bette, lives close by and has always taken her to the grocery store and physician’s office making sure her needs were met. Unfortunately, Bette was recently diagnosed with Alzheimer’s. Her family has decided she can no longer drive. Did Ruth let any of her children know that she was no longer able to get to the grocery store easily? Of course not!

We are now in the process of finding a good non-medical home care company that can provide transportation and support to Ruth. Being a long distance caregiver is challenging. Situations change and can be easily overlooked when you are not physically there to see the impact. Many people are struggling with this so I have decided I will start to blog about my own experiences as a long distance caregiver. I will share all the ups and downs even if it means swallowing my pride and sharing my own mistakes during this process.

Our first step? Interviewing home care companies. I always recommend to clients that if they are long distance, they should consider hiring an agency instead of an individual. There are many reasons for this. If the agency is a good one, their caregivers and management team can become your eyes and ears and let you know if they start to notice any changes in your loved one. They also send replacements if the primary caregiver is sick or can’t be there. They also do criminal background checks, driving checks and reference checks before hiring. If something goes wrong, you have a management team you can speak with who can solve the problem. Because none of us live close by, I feel we need that level of support so an agency is the right decision for us.

Because Ruth does not require any medical care, we are only speaking to companies that provide non-medical companionship care. Here are some questions you need to ask a potential non-medical home care company to be sure you are bringing a reputable agency into your home.

1. What is the background of your company?

Search out the history and ownership of the company. Find out who owns the company and weigh how the ownership affects the company’s service and reliability. Is this agency backed by a nationally strong firm? Is it reputable and in good standing?

2. How long has your company been in business?

The number of years an agency has been in business is not always pertinent to the quality of care given, but it does reflect on the stability and success of the company.

3. What qualifications, certifications, experience and training do you require of your workers?

Find out if caregivers’ credentials are investigated. Plus, determine whether caregivers undergo a thorough, professional testing and screening process.

4. Are your employees insured and bonded?

For your protection, ensure that all caregivers are insured and bonded by the home care agency.

5. How do you supervise your workers to make sure the proper care is given?

Some agencies make scheduled quality assurance calls and visits. To further ensure quality care, see that all caregivers are regularly and closely supervised by a qualified company representative.

6. Will the same employee continue with my case?

It is difficult to receive good care if different people show up every week. A good home care provider will be concerned with continuity of care.

7. Do you conduct a home visit before starting the home care service?

When choosing the home care services that are right for you, it is important that the patient and family members discuss the kind of care needed with a home care representative. This will help you determine whether the home care provider can meet your needs.

9. Can you give me some references from previous and current customers?

Ask for names of people. One good question to ask is “Would you use this company again for yourself or your loved ones?”

10. Do you guarantee customer satisfaction?

Find out if there is a length of time you will be committed to the home care provider even if you are unhappy with the care they are providing. The home care provider should guarantee care and cancel charges for unsatisfactory service.

Thanks to the Area Agency on Aging of Pasco-Pinellas for these questions. More information about non-medical home care companies, including the names of companies in your area, can be found at your local area Agency on Aging.

1. Availability of caregivers – Many people count on friends and family to meet their needs as they age. Initially, they might just need a little help around the house with cooking and cleaning. As they progress, their needs will also include more personal care including bathing and transferring them from one location to another or on and off the toilet. Every family caregiver needs to ask themselves if they can be there for their loved ones as their needs grow. Are you comfortable helping a parent bathe or dress? If not, do you have the finances needed to hire professional caregivers?  These are difficult questions that only you can answer. What is most important is ensuring your loved one has support around them for all of their needs. If this isn’t possible, aging in place would not be a safe option.
2. Accessibility – It is important that the home be as accessible as possible for someone who is aging. Are doorways wide enough for a wheelchair? Are there grab bars in the bathrooms and are they positioned properly? Are all major living areas on one floor? If the answer is no, the home can be modified to fit your needs. It is important to bring in someone who is familiar with “universal design” so they can help you to determine what needs to be changed. Then compare the cost of home modification to the costs of assisted living. This will help you to determine if modifying the home is a realistic option for your family.
3. Transportation - As people age, there comes a time when it is no longer safe for a person to drive. Many people count on their friends and family to drive them where they need to go. This works well but what happens when you are not available? Are there services in the area (including buses, cabs, etc.) they can use to get to the store or the doctor’s office?  If not, can you create a team of individuals who can take turns with the driving? If a person cannot get out to do their errands or to go to the doctors, and there are no support services in the area, then aging in place would not be a good option for them.
4. Socialization – Everyone wants to age in place but many people don’t realize that it can be a lonely option. If a person is alone most of the time and counts on weekly visits by family for their socialization, then they might become very lonely and depressed. It is important that people have activities and people to share them with. Having friends their own age to speak with is very important. Setting up times for them to get together and making transportation easy, will go a long way to having a successful aging in place experience.

I hope that by focusing on these four items, you and your loved ones will have a safe, rewarding aging in place experience.

The Paradox of our Time

The paradox of our time in history is that we have taller buildings, but shorter tempers; wider freeways, but narrower viewpoints. We spend more, but have less; we buy more, but enjoy less. We have bigger houses and smaller families; more conveniences, but less time. We have more degrees, but less sense; more knowledge but less judgement; more experts, yet more problems; more medicine, but less wellness.

We drink too much, smoke too much, spend too recklessly, laugh too little, drive too fast, get too angry, stay up too late, get up too tired, read too little, watch TV too much, and pray too seldom. We have multiplied our possessions, but reduced our values. We talk too much, love too seldom, and hate too often.

We’ve learned how to make a living, but not a life. We’ve added years to life, not life to years. We’ve been all the way to the moon and back, but have trouble crossing the street to meet a new neighbor. We conquered outer space, but not inner space. We’ve done larger things, but not better things. We’ve cleaned up the air, but polluted the soul. We’ve conquered the atom, but not our prejudice.

Remember, spend some time with your loved ones, because they are not going to be around forever.

Remember, say a kind word to someone who looks up to you in awe, because that little person soon will grow up and leave your side.

Remember, give a warm hug to the one next to you, because that is the only treasure you can give with your heart and it doesn’t cost a cent.

Remember, say “I love you” to your partner and your loved ones; but most of all, mean it. A kiss and an embrace will mend hurt when it comes from deep inside of you.

Remember, hold hands and cherish the moment for someday that person will not be there again. Give time to love, give time to speak, and give time to share the precious thoughts in your mind.

Remember, Life is not measured by the number of breaths we take, but by the moments that take our breath away.

Understanding that aging is a continuum requiring some adjustments is the first step in assuring that elders can maintain the independence they so desperately want. In most instances, a decline in their ability to perform small, daily activities is usually the first sign that a person’s needs are changing. Here are some warning signs that an aging loved one may need some help.

• Grocery Shopping and Meal Preparation
  • Is the refrigerator empty? Is food old or moldy? Is basic nutrition being ignored? Are meals being skipped?

• Housework
  • Is there a change in the way the house is being kept? Is the once clean and tidy home showing signs of neglect?

• Transportation
  • Is the individual having “close calls” or accidents? Are people honking? Do they act confused in traffic? Do they drive too slowly?

• Personal Hygiene
  • Is the person wearing the same clothes day after day? Are clothes clean? Does he/she still care about grooming – showering, washing hair, etc.

• Money Management
  • Are bills piling up? Are they being paid on a timely basis?

• Medication
  • Does your loved one remember to take daily medication on schedule and as directed?

These very common signs of aging are, in and of themselves, not cause for alarm. Yet once the number of signs starts to increase, family members should develop a strategy for making sure their loved ones needs are being met. Assistance with any of these tasks is widely available – whether it be from family, friends, neighbors or professional caregivers. It is comforting to know that the majority of people, with just a little bit of help, can retain their independence and continue to age in place.

Being mindful of the first initial signs of aging allows families and loved ones to help the elderly maintain their independence and quality of life at home – right where they want to be.