Thursday, August 30, 2012

Special Volunteer

What is an Ombudsman?  Ombudsman means “citizen representative” and is a very special person who is a volunteer advocate for residents of long-term care facilities.  Good Ombudsmen are compassionate through and through, are good listeners and communicators that bridge the interaction between residents of nursing/ adult homes with facility staff, and show concern about the residents’ care.  They are available to nursing/adult home residents to help those residents.  

I’d like to dedicate this article to all of the extraordinary Ombudsmen who exemplify the dedication and caring we look for in our volunteers.  In Niagara County, Ombudsmen serve 15 facilities as advocates for residents of long-term care facilities. Ombudsman is a Swedish word for “mediator”. Responsibilities of an Ombudsman include advocating for residents and their families in resolving problems or complaints, monitoring the residents’ quality of care, helping protect residents’ rights and assuring safety and fair treatment with dignity and respect.  New York State’s Long-term Care Ombudsman program is sponsored in Niagara County by The Dale Association and helps approximately 2300 residents county-wide.  I’ve had the privilege of meeting most of the volunteer Ombudsman; as volunteers, they are an extension of The Dale Association and I am honored to have such a wonderful group of people helping support The Dale’s mission in our community.  We greatly appreciate our Ombudsmen and the wonderful, caring support they provide.

Volunteers are the heart of our services at The Dale Association.  One of the most visible volunteer opportunities is that of a long-term care Ombudsman.  If you are looking for a volunteer experience where you can have a direct impact on the quality of life for people in long-term care facilities, consider becoming a Niagara County Ombudsman.  As a trained Ombudsman, you can have a positive impact on the quality of the residents’ lives, in as little as four hours a week and you’ll set your own hours. Ongoing support and assistance are provided to all volunteers.  The next training session starts October 1st. If you are at least 21 years old and interested in learning more about how to become a Niagara County Ombudsman, please contact Nancy Smith at 433-3344, ext 1.

This is a volunteer experience for compassionate people with good communication skills and a willingness to be of service to the elderly. It is both rewarding and meaningful. Funding for the Ombudsman Program is provided by New York State and the Niagara County Office for the Aging and administered by The Dale Association, Inc.

Thursday, August 23, 2012

Caregiver Coping

Today’s column is from a caregiver’s perspective.  The strategies are written from a caregiver’s experience in an attempt to live a balanced life – juggling work, commitment to children and grandchildren, and an ill spouse.  Already stressed to the max, adding compassionate caregiving demands an incredibly difficult balancing act. The following coping strategies may help. Because caregiving is such a universal task, faced by nearly all of us at one time or another, I hope you find these strategies helpful as well.
Be clear about today’s reality. Don’t imagine things are worse than they are. Enjoy the good parts of today and don’t let worries for tomorrow take over your emotions and thoughts.
Talk honestly to family and friends. Honest, frequent communication with close family and friends from the start of diagnosis is much easier than trying to play catch-up later.
Expect and prepare for tough talks. Family and friends process the news about a serious illness at their own pace. They will not accept the reality of the illness on a schedule that meshes with yours. This means that sometimes family and friends will not understand the tension of your caregiving lifestyle, especially at first. This requires a difficult conversation about what the illness is, how it will be treated, and what kinds of side effects will be expected from the treatment and the disease itself
Learn the medical lingo. It will help you as a caregiver and a medical advocate to learn the lingo surrounding your loved one’s illness. The Internet is a helpful resource, but you need to learn what Web sites can be trusted.  Even with a trusted Web site, don’t believe everything you read. Not all information will pertain to your loved one’s situation and you can worry yourself into a frenzy over some Internet information you have read. Ask questions of the doctors and nurses. Check the accuracy of your information if you are at all troubled or in doubt.
During treatment, pain or pain medication might do some talking. Be aware that pain, stress and pain medications will release the patient from their social “filter” and they can and probably will say some interesting and difficult things at times. Actually, caregivers do this, too, as stress lifts our social filters at unexpected times—forgive yourself as well when this happens. Listen and be compassionate as best you can. Children and teenagers will need help understanding the changes in their loved one’s personality, especially to know that the changes are not permanent.
Control what you can control. Lots of articles about stress-management advise letting go of control; however, I have found that being in control of some areas helps to greatly reduces stress.  For example –
Get help with housework or yard work—paid or unpaid. Help with household chores or yard work can help make your home a sanctuary. 
 Prepare meals in advance and freeze them.
Keep bills and insurance paperwork organized so there are fewer financial surprises. Make necessary phone calls to insurance companies, and pay bills, or call to arrange payments, on time.
Do three things every evening before you go to bed—laundry, dishes and take out the garbage. The morning will be much more of a gift.
You may find other things that give you a sense of control and therefore help reduce stress.
Let go of what you cannot control. – Easier said than done, but important for keeping stress to a minimum.
Nest  Everyone, especially people who are recovering from illness or injury and their caregiver, needs a comfy chair—a place to relax and rejuvenate. Make a comfortable nest for your loved one and for yourself by adding afghans, pillows, fresh flowers, candles, books and great music to your comfy chair area. This is important to do both at your home and at the hospital should there be an extended stay there.
Make comfort food. Think about what your patient is hungry for, and then consider the details—digestibility, comfort, correct textures, temperature and presentation.
Enjoy life today. Remember, your loved one is a person with interests, not just a patient. And, as a caregiver, you are a person with interests; not just a patient’s caregiver.
Take good care of yourself. Eat good food, exercise a little, rest well and learn to say no to outside demands.
Release yourself from expectations for perfection. As humans, we all experience finitude when we do not have infinite energy, wisdom or capabilities to manage our lives. This is normal. Get through each day as best you can, and don’t dwell on mistakes.

I hope these strategies work to help you both in your caregiving work and in reducing the stress that comes from this part of life’s journey.

Thursday, August 16, 2012

Social Capital

Social networks have been shown to influence well-being in many ways. For example, a large, diverse social network can provide access to social support and a wide range of opportunities and resources. At the same time, stressful social relationships can be a source of anxiety or conflict. Social networks high in “social capital” - that is, the economic and other resources made available through social ties - have been shown to have health benefits in older adults, though the exact mechanisms through which this occurs are unclear. In a recent study, researchers used data from the National Social Life, Health and Aging Project to examine the relationship between social networks and well-being.

The study participants were at least 65 years of age, were administered in-depth interviews in their homes, and completed follow-up questionnaires. Using the data, the researchers classified participants as belonging to one of five different network types: Family, Friends, Diverse, Congregant, or Restricted.

Family - having connections primarily within family networks
Friends - having many ties outside of the family and few or none with family
Diverse - having ties to multiple individuals both inside and outside of their families
Congregant - with most social ties being members of the same church
Restricted - with minimal social connections

Of these, friends, diverse, and congregant types had a high degree of “social capital”, while family and restricted networks tended to be lower in “social capital”.

The researchers also assessed to what extent each participant experienced loneliness, which in previous research has been associated with a higher likelihood unhealthy or sedentary behavior among older adults. They hypothesized that loneliness might undermine the likelihood of engaging in healthy behavior.
Future research will help determine whether there is a causal relationship between social networks and health behavior, or whether one’s health behaviors have an influence on the shape of one’s social networks.

Monday, August 13, 2012

The Cost of Caregiving

Family support is critical to remaining in one’s home and in the community.  If family caregivers were no longer available, the economic cost to the US healthcare systems would increase astronomically.

In 2009, about 42.1 million family caregivers in the US provided care to an adult with limitations in their daily activities at any given point in time.  And, about 61.6 million provided care at some time during the year.

The estimated economic value of their unpaid contributions was approximately $450 billion in 2009, up from an estimated $375 billion in 2007.  The report also explains the contributions of family caregivers, and details the costs and consequences of providing family care.

In today’s economic climate, family caregivers remain the backbone of our nation’s long term care system.  Their unpaid contributions, along with those of friends and neighbors, include not only personal care and help with everyday tasks, but also health related activities, like administering medications.

The “typical” US caregiver is a 46 year old woman who works outside the home and spends more than 20 hours per week providing unpaid care to her mother.

The caregivers are improving the quality of life for the ones they care for and reducing the use of nursing home and inpatient hospital care. This is sometimes at a cost to the caregivers themselves, though.

The estimated economic value of caregiving is calculated based on the number of caregivers at a given point in time, providing an average of 20 hours of care per week, at an average value of a little more than $10 per hour. These estimates were from data collected from various surveys.  What ever the figure calculates to be, the estimate is conservative.

Moreover, the “opportunity costs” of foregone wages and non-wage benefits costs the caregivers themselves.  It often creates economic insecurity due to changes in their work patterns.  The loss of wages, health insurance and other job benefits, retirement savings, and Social Security benefits holds serious consequences for caregivers.  More than one-third (37%) of caregivers, to people age 50 or older, reported quitting their job or reducing their work hours.  Another recent study found that midlife women in the labor force who begin caregiving are more likely to leave the labor force than to reduce their hours.

Caregivers are at risk of becoming “patients” themselves. The greater the intensity in the type or quantity of assistance provided, the greater the magnitude of the health effects, which were largely due to chronic stress.

Evidence that family caregiver support delays or prevents the use of nursing homes continues to accumulate.  People who have family caregivers tend to have shorter hospital stays, while the absence of a family caregiver has been linked to hospital readmissions.  Informal care by adult children reduces Medicare inpatient expenditures of single older people, as well as expenditures for home health and skilled nursing facility care.

The role of family caregivers as critical partners with professionals in the care of patients with chronic illnesses, along with the need for better communication with and support of family caregivers is essential.   Interventions that focus on the roles of family caregivers during care transitions show positive results, ranging from better patient outcomes in functional status and quality of life to reduced re-hospitalizations.  For example, better discharge planning involving family caregivers during transitions from hospital to home may not only improve quality of care, but also help to avert early hospital readmission.

It is essential to prevent family caregivers from being overwhelmed by the demands placed on them. The cost of funding more services and supports for caregivers is minute compared to the value of their unpaid contributions. Moreover, caregivers help contain health and long term care costs by delaying or preventing the use of nursing home care and hospital inpatient care.

Friday, August 3, 2012

Summer Safety for People with Dementia

The pleasures of summer include longer, warmer and sunnier days, celebrations with family and friends, and backyard BBQs. For the person caring for a loved one with dementia, summer can also bring with it additional safety challenges. By taking a few minutes to learn the safety tips outlined below, families can enjoy a fulfilling and pleasant summertime together.
  • Limit your loved one’s exposure to the sun. Place comfortable lawn chairs in shaded areas. Encourage him/her to stay indoors between 10:00 a.m. and 2:00 p.m. when the sun’s rays are the strongest. Encourage your loved one to wear a hat and sunglasses to protect his/her eyes.
  •  Remind your loved one with dementia to apply and reapply sunscreen when outside for long periods of time. Spray-on sunscreens are now available and may make application quicker and easier. 
  •  During the summer heat it is especially important to drink lots of fluids. Offer the person with dementia a small glass of water to drink hourly, or keep a cool glass of water within arm’s reach as a reminder to him/her to drink. Provide non-alcoholic beer or lemonade for backyard BBQs.
  • Reorganize your loved one’s closet; put away winter clothes and replace them with light clothing appropriate for the season.
  • Noise and crowds of people can cause a person with dementia to become agitated or wander in search of a quiet place. Fireworks displays, parades and picnics in the park on holidays may overwhelm your loved one. Consider watching fireworks from your home or in the quiet of the car and parades on television; picnic during less crowded hours and days.
  • Backyard BBQ’s and fireworks can create a fire and safety hazard for your loved one with dementia  who does not remember the proper use for such items. Never allow unsupervised access to open flames and hot surfaces.
  • Attending a minor or major league ballgame may be something your loved one has always enjoyed. However, large crowds can be overwhelming for the person with dementia. Identify someone in your group to be the designated “buddy” so you don’t lose track of who was supposed to stay with your loved one. Make sure someone always accompanies your loved one to the restroom and the concession stand and stays with them until they are ready to return to their seat. In large crowds the risk of being separated is great and can happen very quickly.
  • Swimming may be a favorite pastime for your loved one with dementia. While the physical exercise should be encouraged, do not allow an individual with dementia to swim unsupervised, and do not leave children in the pool under the supervision of the person with dementia even for a short period of time.
  • Bicycling can be an enjoyable way to exercise in the summer, but traffic and other external stimuli can cause a person with dementia to become distracted, resulting in an accident. If your loved one still enjoys bicycling, consider accompanying him/her  on the ride or ask a trusted companion to accompany him/her. Encourage your loved one to wear a helmet and to ride on trails designated for pedestrians and cyclists.
  • Gardening can be a pleasurable and relaxing activity but can also pose risks for the person with dementia. Keep an eye on sharp gardening shears or tools and closely monitor their use. Use fertilizers that are not harmful if swallowed accidentally and ensure that the plants in the garden are not poisonous.
  • Family reunions can be overwhelming to the person with dementia and may rely greatly on his/her ability to recall names and faces. Consider limiting the amount of visitors and prepare both family members and the person with dementia in advanced for the visit. Have a back- up plan that will allow for a quiet place of rest if things become overwhelming or confusing.
  • Many families plan vacations and trips during the summer time. Remember that new and unfamiliar places can be confusing for the person with dementia. Consider simplifying travel plans or traveling to a familiar destination.
  • When visiting relatives this summer, remember that dementia can have a big impact on every member of the family including children. Each child will react differently to someone who has dementia.
  • The young people in your life might have questions about what is happening. It’s important for you to take the time to answer these questions openly and honestly. It will also help to share with them the changes the disease might bring, now and in the future.
The local Alzheimer’s Association can help answer questions and provide additional information about how the family can work through the changes brought on by the disease and keep your loved one safe.

Some additional summer safety and preparedness tips from the Red Cross for all adults: As our bodies age, skin and fat tissue, the body's insulators, tend to thin. Because of that change, seniors regulate temperature less efficiently, putting them at greater risk than others from heat-related health problems. Signs of dehydration or heat exhaustion are less pronounced in seniors, who:
·         Tend to perspire less than younger people—so their bodies don’t shed heat as easily as they once did.
·         May lose some of their sense of thirst and not feel thirsty until severe dehydration has set in.
·         May take high blood pressure and heart disease medications that remove salt and fluids from the body. These medications, coupled with heat, can cause a senior to become dehydrated—leading to confusion, organ damage and even death.
The following tips can help seniors beat the heat.
·         Slow down. Strenuous activity in extremely hot weather adds strain to the heart. If you must be active, choose the coolest part of the day.
·         Take regular breaks when engaging in physical activity on warm days. If you think that you, or someone else, show signs of heat-related illness, stop your activity, find a cool place, drink fluids and apply cool compresses.
·         Stay cool. If you don’t have air conditioning, spend time at an air-conditioned shopping center, senior center, library, movie theater, restaurant or place of worship.
·         Plan outdoor activities in the cooler early morning or evening hours
·         Stay in the shade. A covered porch or under a tree are good choices.
·         Wear a wide-brimmed hat and umbrella to protected yourself from sun overexposure
·         Use U/V skin protection
·         Stay cool in your home. If you must be at home without air conditioning:
·         Stay in the coolest part of the house—usually the lowest floor.
·         Close curtains or shades on sunny windows to keep out heat and light.
·         Use portable and ceiling fans, and/or battery-operated hand-held fans and misters.
·         Install outdoor awnings or sun screens.
·         Use wet washcloths or ice cubes wrapped in a washcloth to pat your wrists, face and back of the neck.
·         Take cool baths or showers.
·         Stay hydrated. Carry water or juice with you and drink continuously even if you do not feel thirsty. Avoid alcohol and caffeine, which dehydrate the body.
·         Eat small meals and eat more often. Avoid foods that are high in protein, which increase metabolic heat. Sandwiches, salads, fresh fruit and vegetables are good choices.
·         Avoid using salt tablets unless directed to do so by a physician.
·         Dress for the heat. Wear lightweight, light-colored clothing. Light colors will reflect away some of the sun's energy. Wear a hat or use an umbrella as well.
·         Discuss with your doctor how medications and/or chronic conditions may affect your body's ability to manage heat.
·         Take the heat seriously. Rapid heartbeat, dizziness, diarrhea, nausea, headache, chest pain, fatigue, clammy skin, mental changes or breathing problems are warning signs that you should seek immediate medical attention.
Frail seniors who live alone should be looked in on often during hot weather by family members, neighbors or friends.
I hope you enjoy the summer, but stay safe doing so.

Wednesday, August 1, 2012

Beat the Summer Heat

Whew, we’re off to a hot start to the summer season! As I’m writing this, we have just had a couple of days of 90 degrees.   With summer upon us, the heat is more than a cause for discomfort – it can be a health risk.  Older adults are more susceptible to heat related illnesses including heat stroke and sun poisoning.  Because their cardiovascular system cannot with stand heat related stress or illness they are at greater risk and more susceptible to the heat.  During periods of extreme heat and humidity, family members and friends living near older adults should check in on them periodically.  There are several precautions that should be taken to help older New Yorkers avoid being over come by the heat, including:

            Drinking plenty of water and non-alcoholic beverages.
            Staying indoors, especially in well ventilated or air-conditioned rooms.

            Closing blinds or curtains to keep direct sunlight from entering windows.

            Staying in the shade and wearing a hat when outdoors.

Wearing loose fitting, lightweight and light colored clothing and choosing fabrics such as cotton or silk, which allow the body to release heat.

Taking cool showers or baths.

Eating light meals of salads and fruit that help replenish fluids to the body.

Heat affects us all differently, but our older citizens are at greatest risk and are encouraged to protect themselves from the consequences heat can have on their health. And, right here in our own community is one of the best resources for avoiding the heat and remaining healthy during the height of the summer season – fun activities with friends in the comfort of an air-conditioned building. Men and women both benefit from social activity at older ages.  Those that interact with others tend to be healthier, both physically and mentally. Additional types of social interactions include participation in recreational and educational activities such as visits to movie theaters, sports and recreational events, traveling, participation in groups, etc.  Seek out a cool spot if you do not have air at home.