CareNotes: The Home Care Newsletter Vol 5. Issue 6
CareNotes: The Home Care Newsletter Vol 5. Issue 6
Letter From the Editor:
I would like to start off by saying that on behalf of everyone at Home Care Assistance we send our thoughts and prayers to all of those affected by Hurricane Sandy. Many in the Home Care Assistance family (owners, managers, caregivers, clients) have had their lives disrupted by this storm. There are still millions of people on the East Coast without power, thousands who have lost their homes and possessions and still others who have lost loved ones.
On another note, the second webinar in our 3-Part CEU Series in partnership with the American Society on Aging is just a few days away. It will be held on Tuesday, November 6th at 11 AM Pacific, 2 PM Eastern and led by Dr. Samuel Gontkovsky, Director of Neuropsychology and Dementia Therapeutics in Palo Alto. This series is the ideal opportunity for professionals from a wide spectrum of fields — ranging from social workers to nurses to care managers — to earn free CEUs while simultaneously gaining valuable information that will be beneficial in advancing their careers and strengthening their client relationships.
Participants in this web seminar will:
- Understand the impact of dementia on a person’s life and the importance of recreational and social activities in improving quality of life.
- Learn about recreational activities that are interactive and engaging.
- Receive strategies for making routine activities socially meaningful for individuals with dementia.
Continuing on the topic of best practices for caring for someone with Alzheimer’s, in this issue I will discuss tips to help prepare a loved one with dementia for the holidays. In honor of November as Family Caregiver Month, I will also address ways in which you can safeguard your own mental and physical health to avoid burnout as well as present scientific findings on the potential physical and cognitive benefits of caregiving! Further, I will explore how avoidable hospital readmissions are hurting the economy, the health care system and patients, and what you can do to help prevent this cycle. Lastly, I would like to congratulate Mary Gaynor from Home Care Assistance of Minneapolis for being selected for this month’s Caregiver Spotlight. Thank you, Mary, for your commitment to providing excellent care!
How Avoidable Hospital Readmissions are Hurting the Economy, the Health Care System and the Patient
The United States spends more on health care — $2.6 trillion in 2010 — than any other nation in the world. Despite this enormous investment in our national health, we rank 37th in health-care quality behind Greece, Colombia, Chile and Costa Rica. Among the many causes of this disparity, three stand out: unnecessary care, uncoordinated care and avoidable care.
Among the many causes of this disparity, three stand out: unnecessary care, uncoordinated care and avoidable care. The Economist
estimates that these three inefficiencies alone account for over $300 billion dollars per year in unnecessary spending. We will focus on one area in particular — avoidable hospital readmissions
. According to the Medicare Payment Advisory Committee, almost 1 in 5
Medicare patients will be readmitted to the hospital within 30 days of discharge. Beside the $15 billion in financial costs, these readmissions have another, less obvious cost — a heavy emotional and health toll on the patients and their families.
Avoidable hospital readmissions are typically caused by insufficient post-hospitalization care, failure to adhere to recommended medication or therapy regimens and lack of physical support for the discharged patient. Beginning this year, the Centers for Medicare and Medicaid have changed their reimbursement schedule
to essentially penalize hospitals with high readmission rates. Hospitals and health-care professionals across the nation are teaming up with care facilities, home care agencies and other sources of post-hospitalization support in order to adapt to the new regulations. Ideally, this will mean better long-term care for patients and broader support for recovery at home.
While medical providers are implementing procedures to prevent readmissions, patients and families should take note of a few important tips to facilitate a successful transition from hospital to home. The best thing you can do if your loved one is hospitalized is to gather information — learn about skilled nursing, home health care and private duty home care; consider recovery options at home or within facilities; collect opinions from the doctors, nurses and discharge planners within the hospital. Our Hospital to Home Care website
outlines the full discharge and post-hospitalization care process; we've also included 10 helpful hints for families planning for a hospital discharge in this post. Understand your care options prior to discharge. If your loved one prefers to recover at home, make these feelings known to the hospital discharge team.
- Write a list of your loved one's prescription drugs, over-the-counter drugs, supplements and vitamins, including your regular dosage and medication times. Make sure the medical team is aware of any drugs your loved one was taking prior to hospitalization to prevent unintended complications.
- Obtain a list of home medical equipment, such as a walker or hospital bed, to facilitate recovery at home. You should plan to acquire and install this equipment prior to discharge.
- If regular therapy, testing or medical check-ups are required, write down a schedule of the appointments, including relevant contact information.
- Ask the hospital staff to demonstrate any tasks that require special skills, such as changing a bandage. Try to understand and master these tasks before you leave the hospital environment.
- Ask the discharge team about common issues for patients in similar circumstances, what you can do to reduce your loved one's risk and what you should do in the event of emergency.
- Understand your loved one's physical limitations and areas where he or she will need support. For example, mobility issues may prevent your loved one from safely walking around the house or up and down the stairs.
- Create a regular schedule with your loved ones and any professional care providers involved in your loved one's post-hospitalization care. Regular check-ins are critical in order to monitor progress and catch minor issues before they become major complications.
- Ask to speak with a social worker if have concerns about coping with your loved one's illness. A social worker can provide you and your family with information on managing the condition, available support groups and other resources.
- Request written discharge instructions and a summary of your loved one's current health status.
Bring this information and the medication list with you to any follow-up medical appointments.
Planning for discharge is the first step of the post-hospitalization recovery process, but the road to recovery can be long and trying. The stress of recovery takes its toll on the entire family; individuals who care for a loved one suffer from fatigue, exhaustion and weakened immune systems. Over half of all family caregivers
have some clinically significant symptoms of depression. Take advantage of the free information and resources available to you and contact a professional if you need further support.
Dr. David Carr, clinical director of the Division of Geriatrics and Nutritional Science at Washington University School of Medicine, agrees:
Hospital readmissions are not only detrimental to a patient's mental and physical health and expensive, but they can result in hospital penalization. Readmissions are often the result of inadequate support and supervision following the patient's discharge orders upon returning home. Having a structured, professional Hospital to Home program like the one offered by Home Care Assistance
promises benefits to the patient and the hospital by working in conjunction with the patient's medical team to ensure discharge orders are followed and intervention occurs before a readmission is necessary.
We often mistakenly assume that we can't play a role in the efficiency of our institutions. We can prevent thousands of avoidable hospital readmissions by being proactive and availing ourselves of the resources in our communities. Together, we can help create a healthier America and a more cost-efficient health care system.
The Benefits of Being a Caregiver
It is a well-known fact that taking on the role of primary caregiver for a loved one is often so stressful and draining that it can take a toll on your well-being, increasing your risk for chronic stress, burnout and illness. The idea that caregiving could actually provide health benefits seems counterintuitive. However, Dr. Lisa Fredman, a Boston University epidemiologist, and her colleagues, have found that caregivers do reap real physical and cognitive rewards. Using a sample of caregivers and non-caregivers from Baltimore, Pittsburgh, Minneapolis and Portland, Dr. Fredman and her team found that while caregivers are indeed more stressed than non-caregivers, they also tend to have lower mortality rates on average. Looking at 900 women from this sample, even those classified as high-intensity caregivers (e.g. those who assist their loved one with the majority of their ADLs and IADLs) were found to be more physically fit than non-caregivers, performing better on tests like walking pace and grip strength. In addition, caregivers performed significantly better on memory tests than non-caregivers over the two years they were followed; both groups were about the same average age, but caregivers scored at the level of individuals 10 years their junior!
While her results suggest that caregivers may be stronger and stay stronger than women of the same age who don’t take on such a role, we must take study limitations into account. For one thing, Dr. Fredman’s definition of a caregiver includes anyone who performs just one instrumental activity of daily living, lumping together those who may help a loved one with cooking and those who may provide more hands-on help with bathing or around-the-clock care for someone with Alzheimer’s. In addition, because randomization is impossible in such a study, the results may be attributed to natural differences between the groups: women who are healthier may feel more able to take on the role of caregiver. In any case, most caregiving activities do require a lot of movement and the physical and cognitive benefits of exercise are well documented. Moreover, caregiving often involves complex thought—balancing medications, finances and appointments—keeping the mind stimulated. Overall, the burdens and benefits of caregiving likely depend on the individual situation.
How to Prepare Someone with Alzheimer's for the Holidays
The holiday season is steadfastly approaching with stores already full of lights and decorations. Preparing for family gatherings is hectic for everyone, but this time of year can be especially stressful for those with Alzheimer's disease or dementia.
Share these useful tips with your loved one to ensure the holidays don’t overwhelm him or her.
- Show him/her pictures of people who will be visiting and talk about them.
- Play some of his/her favorite holiday tunes and serve favorite holiday foods.
- Get your loved one involved in preparations — ask him/her to help you decorate, set the table, etc.
- Consider creating name tags for your guests — people with Alzheimer's may recognize faces but be unable to recall names, so this can be a helpful cue.
- Designate a room the "quiet area" where your loved one can retreat if things get too overwhelming. Ask a familiar person to stay with him/her to prevent feelings of abandonment.
- Have distractions prepared in case problematic behaviors occur (e.g. have him/her fold some napkins, count name tags, etc.)
If you are a family caregiver, remember to take care of yourself as well!
- Plan ahead and set limits as to what you are able to do.
- Don't be afraid to ask for help from friends and family.
- Take breaks regularly (look into in-home care if needed) — preparing for the holidays and caring for a loved one with Alzheimer's or dementia can be overwhelming.
- Consider joining a caregiver support group for tips and insight
- Buy yourself a holiday gift as a reward for your dedication!
Many times, the holidays are when the adult son or daughter notice that their mom, dad, or other loved one needs additional assistance to remain safely in their home. If you live far away and are worried that your loved one cannot manage on their own, contact a reputable home care agency such as Home Care Assistance. Schedule an in-home assessment with a care Manager, your loved one and any family members that would like to be involved in the process and determine the level of care you parent needs. Hiring a caregiver to come in on an hourly or live-in basis will provide you with peace of mind knowing that your loved is in good hands.
Caregiver of the Month Spotlight: Mary Gaynor
This month’s Caregiver Spotlight honors Mary Gaynor from Home Care Assistance of Minneapolis. Mary’s dedication, compassion and willingness to go above and beyond enable her to provide exceptional care with the utmost professionalism.
We wanted to hear directly from Mary what it was that contributed to her outstanding care and strong bond with her clients. She shared the words below:
“Caregiving is my calling. Employed by Home Care Assistance since March, I've been a professional caregiver for nine years. In fact, I was hired on my birthday; what a gift! The things that impress me about Home Care Assistance are the genuine nature of the staff and their concern for their clients. Since March I have had the opportunity to work with nine clients; I consider it an honor to be able to care for and comfort people in this time of their lives. What I enjoy most about caregiving is the challenge. I love taking the time to get to know each client and how he/she likes things to be done. It's important to understand their worries and relieve them of stress when need be. Once I understand their expectations I can better serve their needs and ensure they remain as independent as possible for as long as possible.
I chose caregiving as an occupation after being self-employed as a house cleaner for 20 years (which could be classified as caregiving!). Not only did I clean, but I cooked, grocery shopped and took clients and their pets to doctors’ appointments. After two decades of this career I was looking for something new and got hired as a PCA for a former governor of Minnesota. At this time, I was also caring for my parents until they passed away. These early caregiving experiences, particularly caregiving around the clock for the former governor, reinforced this was a role I loved and was good at. Caring for my parents as their health declined wasn't easy. However, that experience made me realize that hopefully someone will be there to care for me when I reach a point where I can no longer live independently. This realization has fueled my desire to care for people to the best of my ability and become a compassionate companion to anyone who needs a friend. Discovering caregiving was my calling, I went to school and got my medical terminology certificate and my CNA certification.
When I'm not working I enjoy spending quality time with family and friends, traveling, reading, playing cards, hiking, watching movies and volunteering for Allina hospice. Even though I could retire, I plan to work as long as I can, take classes relating to my field, learn to fly a plane and be a wonderful grandmother!”
The Minneapolis office shared that among the many glowing qualities Mary possesses, it is her constant willingness to help out and desire to be a positive presence in her clients’ lives that makes her an outstanding caregiver. Mary, a mother of two and a grandmother of four, is an inspiration to all of us. Thank you for your hard work and dedication, Mary. We are honored to have caregivers like you on our team!