Exercising Mental Muscles During Retirement Makes a Difference

I just read another interesting article about mental fitness. Richard Roche, Ph.D., National University of Ireland, says, "The brain is like a muscle that should be exercized through the retirement years as a defense against dementia, cognitive lapses, and memory failure."

The article, "Rote Learning Improves Memory in Seniors"at Medical News Today is about a study that showed seniors could fight memory loss by practicing memorization. In the study intensive rote memory learning was followed by an equal amount of time to rest. The people in the study showed improved memory and verbal recall.

As people age forgetfulness and difficulty with learning new material often occurs. The study said 40% of the people over 60 have some type of memory difficulty. Loss of brain cells and changes in brain chemistry cause mild memory difficulties.

The people in the study spent 6 weeks using rote memory learning, memorizing a 500 word newspaper article or poem. This was followed by 6 weeks of rest.

Magnetic resonance spectroscopy (MRS) was used to make measurements of chemicals and cells in the brain.

After 6 weeks of learning followed by a 6 week rest all of the people in the study had improved their ability to repeat a short story and a list of words, and to recall events that occurred earlier that day or week.

I will add that today members of the boomer generation are often caregiving for parents or elders who have memory loss. Greater awareness of memory loss is causing a trend of people looking for ways of exercising memory. Boomers and seniors are attending classes, taking up new interests that require learning, and doing puzzles and brain teasers.

Joining clubs, going back to school, starting retirement businesses, and staying mentally active instead of passively watching television are some of the ways people are practicing mental fitness.

At luminosity.com I found a cognitive fitness program for brain health that has brain games and exercises to improve memory, attention, and processing speed. The program was designed by scientists in neuroscience, cognitive psychology, and bioinformatics. You can choose 30 sessions that take 10 to 15 minutes per day, or a varied choice of brain exercises.

Feedback is provided so you can track your progress. Time to start lifting those mental weights.

"Someone Cares" Christian Caregiver Conference Oct. 26-28, 2007

At "Someone Cares Online" you can get a schedule for the upcoming "Someone Cares" Caregiver Conference at the LifeWay Conference Center, Ridgeway, North Carolina. The conference features over 40 workshops and includes music and presentations by celebrity musicians and authors. The conference is titled "Learning to Ask, Thankful to Receive, A Conference for Christian Caregivers."

A quote featured at the website by former first lady Rosalynn Carter says: “There are only four kinds of people in the world—those who have been caregivers, those who currently are caregivers, those who will be caregivers and those who need caregivers.” —former first lady Rosalynn Carter

Some of the speakers and musicians include Deborah Dunn LMFT, Cheryl A. Kuba, Carmen Leal (founder), Robertson McQuilkin, Elizabeth Munoz-Day, Cecil Murphey, Rev. Betsy Ritzman LCPC, Stacie Ruth Stoelting, Beth Vaugan-Wrobel, Debra White-Smith, Steve Siler, Bob Wilis, Scott Kripaynne, and Mike Westen.

The schedule of events highlights important aspects of the caregiving world. Some of the topics include the following:

Listserves, websites and blogs, Oh my! Finding Online Support

Never Enough Time: Caregiving and the Multitasking Monster

Barefoot Joy in the Midst of Life

How to Shamelessly Get What You Need When No One Seems to Care

Addressing Special Behavioral Problems of a Loved One With Dementia

Hiring a Caregiver for In Home Care of Your Loved One

When Someone You Love Has Alzheimer's

Mental Exercises - Create Your Own Crosswords

Looking for some mental exercise? At Crossword Puzzle Games I've found a new hobby to share with caregivers and seniors - creating custom crossword puzzles. Free software on the internet allows you to write your own clues and answers. Memory exercises and word games have been long recommended for seniors, or for anyone who wants a mental workout, and this adds a new aspect to crosswords.

To write a crossword puzzle, first you list the words and clues, and then the software produces the information in a crossword puzzle format. For my own projects I am using trivia from historical eras for creating crosswords. For instance, I'm creating a puzzle now with trivia from the 1950's that includes words like "hoola hoop."

I'm always looking for activities for caregivers or activity leaders to use with elderly seniors. There are many sites on the internet for making your own crosswords, and if you want some ideas for themes you can go to sites for special interests, such as memorabilia, trivia, history and so on.

Book "Elder Rage, or Take My Father... Please!"

When my friends call me, to talk about their problems taking care of their parents, who need help but refuse help, I am going to advise them after this to read Jacqueline Marcell's compassionate and humorous book, "Elder Rage, or Take My Father...Please!". The book, which is about "how to survive caring for an aging parent" asks "Are you at your wit's end with elder care, and coping with an elderly loved one who...

Makes unreasonable demands, wanting all of your time?
Is experiencing memory loss, dementia/Alzheimer's?
Has become depressed, manipulative, distrustful, or hostile?
Refuses any mention of caregiving or eldercare help?"

The list sounded very familiar to me. It reads just like the things my friends say when they call me for help or for a listening ear.

A look at the chapter titles had me lauphing. Chapter 1 is "If It Isn't Ten Things, It's Twenty" and starts with "I've seen fire and I've seen rain drops keep falling on my head".

Jacqueline has had her own radio program for five years and you can hear it at http://wsradio.com/copingwithcaregiving.

Jacqueline Marcell's book is endorsed by a page long list of experts, universities, celebrities, newspapers and so on. The practical information and the true story, uplifted with humor, have been told by Jacqueline at seminars for medical professionals to keep up continuing educational units, on well known televison shows, radio shows, and in personal presentations. She has a busy speaking schedule, and you can check the website schedule to see if she will be in your area.

I felt a little smile coming to me as I read excerpts, and a recognition of familiar situations. How can you help someone who needs help but refuses help? I'm going to read this book.

"Ouch!...it's a disability thing" website from the BBC

Caregivers who assist someone with a disability can gain insight and knowledge from a website at the BBC. The website "Ouch" explains the name comes from the many "ouch" moments experienced by people with disabilities. "Ouch! ...it's a disability thing" is about the lives and experiences of disabled people. Damon Rose editor of the site, came up with the name. One of the typical "ouch" moments happens when "people just see disability as a problem and push it to one side because they're too scared or embarrassed to embrace it or tackle it. ..disability can be the big elephant in the room that no one talks about - "ouch!"

The "Ouch!" website features news, columns, features and more. There is a podcast, a "razor sharp disability talk show"and articles by "Ouch's team of hotshot columnists" .

To gain wisdom and insight about living with a disability you can visit the "Ouch" website. The blogs recommended by the website include bloggers with both physical or mental disabilities.

Caregivers, family and friends of someone with a disability are often uncomfortable, or as mentioned on the website, "scared or embarrassed" and the disability becomes something that they fear discussing. Entering into the world of those who have a disability, and learning to understand the "ouch" moments, can help to overcome the distance and fear that can create isolation.

As a caregiver sometimes I assist people who have had spinal cord injuries, and we become friends. Reading this website helped me to move a step closer to understanding my friends who have disabilities, and to sharing more of their lives and daily experiences.

Fewer in Nursing Homes - Home Health Services Increasing

I read two articles showing trends that are related. "Fewer Seniors Live in Nursing Homes" at USA Today says that about 7.4% of seniors 75 years old and older lived in nursing homes in 2006, down from 8.1% in 2000 and 10.2% in 1990. The other article, titled "In Home Health Care Services Increasing" at Medical News Today discusses "a new kind of medical practice is flourishing nationwide that offers to go where the patients are...to treat ailments."

In 2006 less than 16% of the population aged 85 years or more lived in nursing home facilities, according to the article in USA Today. These statistics refer to nursing homes, but do not include assisted care facilities. A nursing home, or skilled nursing facility, has licensed nurses while an assisted care facility does not require employees to be medically licensed.

According to Met Life Insurance Company said the cost of a nursing home runs from $67,000 to $100,000.

The article said the average resident in a nursing home runs out of money within 6 months and must go on Medicaid, according the CEO of the National Association of Area Agencies on Aging, Sandy Markwood. She explained this will bankrupt the individuals and the Medicaid system.

An article with a related trend discussed the increase in home health care services. At Medical News Today the article discusses a company called Inn House Doctor, founded by Walter Krause, which has 40 doctors who provide appointments in the home.

Rich Kellerman, president of the American Academy of Family Physicians, said in the article, "We have that perfect storm. The current system doesn't work well...More doctors are coming up with home practice models."

In my area, San Luis Obispo County, California, USA, there are not very many doctors who make house calls, but there are a few who are available and specialize in house calls. As a caregiver I have assisted seniors several times who are on programs with local doctors who make house calls. For a frail senior, when leaving the home is very difficult, having a doctor come to the home makes a big difference. I have also known doctors who make calls for appointments with seniors at residential care facilities.

Fewer seniors in nursing homes and an increase in home health care, and in home care (nonmedical assistance) reflect growing trends. Community based services continue to grow, and the majority of seniors say they prefer to avoid going to a nursing home.

With the aging of the population, and boomer generation coming along next, the needs and preferences of the future elderly seniors will continue to change senior care trends.

Utah Lawmakers Propose Freeze of Funds for Long-Term Care Facilities

I just read yet another article from one of this week's newspapers about long term care. Author James Thalman writes about elder care in the Deseret Morning News , Sept. 20, 2007, in an article titled "At Home Elder Care Touted" and a subtitle "Lawmakers propose freeze on state funds for long-term care facilities". This week articles in the The New York Times and the San Luis Obispo Tribune also focused on long term care.

The article says that Utah senior advocates, government agency representatives, and care providers want a freeze put on government funds spent on public funds that are used for long term care facilities.

Alan Ormsby, director of the state division of Aging and Adult Services is quoted in the article. He said, "This is simply recognizing that the traditional skilled nursing as a care center model of caregiving is on the way out...When you can provide safe and more effective services at home and at a sixth the cost for most seniors, we have to at least begin moving in that direction."

The article goes on to describe the transition that has been taking place for 10 years in Utah, where a variety of in-home services, and day care have been used as part of a nursing home placement diversion program.

I was puzzled by this article. In the article it also said the "average cost of in-home services was $3,700, the average nursing home cost is $72,000." The amount of $3,700 for a year's worth of in-home services seemed pretty low to me, and some other things were also puzzling.

There were eight comments listed that readers had posted. One comment said that "it cost a lot more than $3,700 to care for a loved one at home". I agree, and am wondering what is included in the $3,700.

Another said, "Has anyone given any thought to how much of a burden this puts on the families?"

New York Times Series - Nursing Homes: More Profit, Less Nursing

I just read an article in The New York Times dated Sept.23, 2007 titled "At Many Homes, Less Nursing, More Profit" that describes what happened when a group of investment firms purchased about 48 nursing homes. This article happens to appear during the same week when a front page article in my local paper, the San Luis Obispo Tribune asked "Is the Quality of Elder Care in Jeopardy".

The San Luis Obispo Tribune also had articles on "Finding Quality in Long Term Care" and another titled "County's Worst Residential Homes Are Cited After Repeat Violations."

The New York Times article describes the steps the investors took at one of the homes purchased to reduce costs The residents at the Habana Health Center, in Tampa, Florida saw changes that meant they were "worse off" according to the article.

The article says the number of registered nurses was cut by one-half and budgets for supplies, resident activities and services fell. A series of incidents showed that the residents were suffering, according to the regulators.

The New York Times says the investors did well financially but the situation for the residents went downhill. Regulators "repeatedly warned that staff levels were below mandatory minimums."

The article describes the situation when nursing homes are purchased by investors, costs are reduced, profits go up, and the homes are sold for a profit.

People who are thinking of moving to a nursing home, or of moving a relative to one, need to find out what the options will be if they are not satisfied with the quality of the care. If the home is purchased by investors who reduce spending on staff, supplies and services, will the residents be able to move to another home?

An important question to answer is always "How many aides are on duty for each resident? Not just how many aides are on the schedule. After employees have called in with excuses to be absent, which happens especially often on weekends, how many aides are physically present for each resident?"

Other important questions include the following.

What does the local long term care ombudsman have to say about complaints and violations at the facility? Does the ombudsman, who investigates complaints and resolves them, recommend this nursing home?

Can the staff communicate well enough to read, understand, and follow directions for care and to write notes to keep track of changes?

Can the staff communicate well enough to provide quality companionship and interaction? Is the atmosphere conducive to good emotional health for your loved one, and do you feel comfortable when you visit there?

If a number of staff members cancel, as may happen on a weekend, is there a supply of trained replacement staff available at short notice or does the reduced staff just take on more residents per person?

If you visit the facility, especially on a weekend night, does the staff appear short handed and to be rushing from resident to resident?

If your loved one needs assistance, how long is the waiting time? How much time does the staff have to assist your loved one? Is the assistance accomplished in a hurry?

Dr. Mike Magee - Trends Toward "Home Centered Health Care"

The trend toward Home Centered Health is discussed at Health Commentary by blogger, physician, author, environmentalist, speaker and healthcare leader Dr. Mike Magee. He says the U.S. Administration on Aging has a study that shows 81% of the people over the age of 50 would like to avoid nursing home care in their future. Home Centered Healthcare for seniors as they age is a trend he says will enable them to spend their elderly years at home instead of in a facility.

Dr. Magee predicts that the home health industry, already an area of enormous growth, will skyrocket. Improvements to the home such as grab bars in showers and stair lifts will make homes adapted to the needs of elders. New technology will enable people who are at home to have their health monitored.

He predicts that part of the system of Home Centered Health will be having a home health manager, usually an informal caregiver in the family. Treatment and care will someday take place often at home by physician led, nurse directed networks.

The growth in the number of home care agencies, which provide paid caregivers, is part of the trend that I see for Home Centered Health. Already people are putting together a team of licensed medical personnel from home healthcare agencies and a team of caregivers to enable elders to remain in their home. Making the home safe, getting a medical alert system, and adapting the home are already trends that have arrived.

As mentioned in the study above, people prefer to stay in their homes. Long-term care insurance, mentioned in a recent post, is another trend, and can be used to pay for a facility or for home care, thus providing a choice.

Reverse mortgages, which can be refinanced again later, are on the rise as people use them to pay for care, or other expenses, in their elder years.

We can already see many of the trends Dr. Magee predicts taking shape. He says that with patient empowerment, a home health manager (often a family caregiver) and a team of home health professionals the Home Centered Health Care trend will be in the not so distant future.

I will add that today already many people adapt their homes to be suitable for later years. Going from the hospital to the home, with care from licensed medical personnel, such as nurses, physical therapists, and home health aides, is already often a part of the system.

Family caregivers or paid caregivers are also part of the team. The team leader is the family caregiver who acts as the home health manager or coordinator.

Things You Might Not Know About Reverse Mortgages

These days some seniors say they seem to receive up to fifteen pieces of mail a day advertising reverse mortgages. It's true the ads are everywhere. I'm not on the market for a reverse mortgage, but today I learned some new information when I talked to a Reverse Mortgage Consultant at a Workshop at the Central Coast Seniors Center, Oceano, California.

Suzie Smith, of the Pismo Beach area Wells Fargo, provided statistics showing the leap in the number of reverse mortgages today compared to 5, 10 or 15 years ago. With the aging of the population, and with needs for long-term care in the home or in a facility, medical bills, or other needs, the number of reverse mortgages will continue to climb.

Funds from a reverse mortgage can be used for any expenditure, including food, paying off bills, or taking a long-dreamed-of vacation before getting any older. Sometimes someone uses the money to buy a second home.

A reverse mortgage can be refinanced again later, providing it is worthwhile and not just "churning".

For every reverse mortgage it is a requirement to see an outside mortgage counselor. This third party independent counselor can provide seniors with guidance.

The FHA sets lending limits for each county, with the higher limits being in the most expensive counties. If the property has a mortgage on it, the reverse mortgage can pay that off in addition to providing funds for other expenses.

To get a reverse mortgage someone must be 62 years old, and live in the house as a primary residence.

Long Term Care Insurance - A Reality for Boomers Planning Ahead

As the population ages members of the baby boomers generation are looking at Long Term Care Insurance as they plan ahead for the future. Today's family caregivers will be tomorrow's elderly seniors. A recent article by Gail Sheehy asked the question "Who will take care of the caregivers?"

Long Term Care Insurance is one of the ways the Boomers generation can take care of themselves.

I attended a presentation on Long Term Care Insurance today, held at the Central Coast Seniors Center, Oceano, California, with State Farm of Pismo Beach representative John Stobbe providing information.

Along with insurance for life, property, autos, disability, and medical people are adding long-term care insurance now to help prepare to age in their home if they wish or to pay for assistance in a facility.

Did you know the following:

Medicare Supplement Insurance does not cover long-term care expenses.

A Long-Term Care Insurance policy helps cover costs of long-term care in the setting you prefer, either home care or community care.

It helps you to avoid dependence on family and friends.

It preserves your assets.

Additional benefits included the following:

Coverage for a communication system in the home to summon medical help in an emergency.

Caregiver training for a family member or friend to provide the care you need if you choose to remain at home.

Respite Care to provide relief for a primary caregiver at home.

Patrick Leer's Blog "Caregivingly Yours" - The Many Sides of Caregiving

"Knowing you are not alone is a beacon for any caregiver, anytime, anywhere" says Patrick Leer at his blog Caregivingly Yours. His wife, Patti, was diagnosed with MS 22 years ago. Patrick's blog "Caregivingly Yours" tells the story of his 15 years of caregiving for her at home and 3 years of caregiving for her at a facililty. He writes about multiple facets of caregiving, including financial issues and a caregiver's lost dreams, celebrating and fun on a birthday, and the psychological issues of caring for a person who is mentally and physically dependent.

Recently Patti and Patrick, and their daughter celebrated Patti's birthday with an outing to The Charles Town Races and Slots for a day of gambling and fun. Patti is legally blind and uses a wheelchair. Patrick explains that Patti enjoys the bright, Disneyland atmosphere, plus everyone else is sitting down too, so she is not "lost in a forest of walking people."

Patti lives in a facility now. In a post several years ago while Patti still lived at home titled "The Point of No Return" Patrick at Caregivingly Yours puts into words what many spousal caregivers have experienced. As MS eroded Patti's mental abilities the caregiving situation became one of total dependence.

Patrick writes "You cease to be, in a sense you suffocate...Too often it's like existing simultaneously in parallel universes."

Patti's health decline continued and they lost the "ability to discuss plans and ideas". At that time Patrick says "That was a frightening and lonely point of no return."

Caregivers who assist someone who is about to move to a facility can take heart from the good news that Patti's move enabled her to receive care 14/7 that she needed and the move worked out well.

The complex issues and many sides of caregiving, the ups and downs, and the new roads taken that are discussed in this blog make it inspiring, interesting and full of useful information.

"Mothering Mother" Caregiver's Book by Carol D. O'Dell

Both pain and humor are part of award winning author Carol D. O'Dell"s book Mothering Mother . She was adopted at the age of four to southern, fundamentalist parents in their mid-fifties. I read the book excerpt at the website and I loved it. As an adult Carol found herself caregiving for her mother, who had Alzheimer's among other health conditions. She tells the story with humor and love, but the stress and exhaustion of a caregiver's path are part of the tale also.

Carol will be appearing on CNN on October 11 to discuss her caregiving experience, the book
Mothering Mother, and useful information for caregivers. You can read an excerpt from her book at the website. At the website you can also listen to a radio interview with Carol on the subject "Coping with Caregiving" and read an interview.

Carol's blog, also available at the website, had a recent post titled "Tell Your Stories - Ward Off Dementia" about one of her writing workshops. She teaches Journaling and Writing Memoirs at colleges, universities and community centers. She has also been a children's minister for fifteen years.

Carol's schedule is posted at the website and includes many media appearances and workshops so you can catch her on the television, radio or in person.

"Don't Walk the Caregiver Path Alone" on Billboards Now

In Michigan ten billboards with the message "Don't Walk the Caregiver Path Alone" have been placed. The message is the theme for The Caregivers Resource Network, a Michigan based organization. At their website caregivers can take a Self-Check Survey on Personal Well Being, that includes 15 questions to measure physical and psychological problems that caregivers often experience.

The "Don't Walk the Caregiver Path Alone" campaign and the health checklist for caregivers point to the caregivers' needs for resources to help with the often overwhelming job of caregiving.

Examples of problems on the caregivers' checklist include the following:

• Felt completely overwhelmed
• Felt lonely
• Been edgey or irritable
• Had a crying spell
• Felt ill (headaches, etc.)

The "Don't Walk the Caregiver Path Alone" billboards may help alert caregivers and families to the need for resources and support.

Often caregiving is not recognized as having an overwhelming physical and psychological burden on the caregiver. Demands can be seemingly unlimited and exhaustion and stress reach a high level while caregivers try to continue soldiering on as heroes.

The studies and statistics show, as covered in previous posts on this blog, that caregivers' own health often gives out. Lifespan can be shortened, lifting injuries occur, and depression and anxiety are found at high levels in caregivers.

Mobile Fall Prevention Clinic Seeks to Protect Seniors From Injuries

I've taken care of many frail seniors after they have had a fall. In Canada there is a new system to help prevent falls. Healthcare specialists travel with the Mobile Falls and Injury Prevention Clinic, which provides personal custom reports and personal programs for seniors. The assessment and programs are aimed at preventing seniors from falling and injuring themselves. Seniors go to six stations that include a nurse, pharmacist, kinesiologist, biomechanics expert, and a physiotherapist.

Seniors who go to the mobile clinic receive a custom report to reduce their own risk of falling and getting injured. They also receive a custom activity program designed to meet their needs and provide safety.

I will add that having a personal evaluation and a custom tailored program of exercise, mobility, and activities can help seniors to avoid falls. Details such as safely getting in and out of a chair, the height of chairs and whether the chairs have arms on them, and body mechanics are some of the everyday activities that most people don't think about but that can make a difference.

Caregivers can suggest that seniors get fall prevention advice. A personal fall prevention program might include having a physical therapist evaluate and advise seniors about using walkers. For instance, some seniors use a walker by leaning forward, with arms more outstretched, and pushing the walker a little bit ahead of them. A safer method is to stand more upright, with the walker closer to the body, where it can provide balance.

Another example would be when people use the sliding "skiis" for the feet on a walker. For some people this is suitable but the skiis also can make a walker slide faster and for some people it is harder to control the walker then.

If a frail elderly senior falls caregivers can call paramedics who can check for injuries before moving the person, and then lift the person safely.

Home health professionals can come to the house to provide safety checks and tips for avoiding falls.

The article, at CTV.ca said the mobile clinic is sponsored by Fraser Health Authority in Canada.

The United States Department of Health and Human Services says falls are the number one cause of injury deaths among people over 65. Falls are the most common cause of nonfatal injuries and of hospital admissions for trauma.

Their website says that in 2003 in the U.S. 13,700 people died from fall related injuries.

Another 1.8 million in 2003 were treated in emergency rooms for non-fatal injuries related to falls.

To reduce the risk of fall injuries home safety measures can be followed including the following.

Avoid having floors that are slippery.
Put grab bars on tubs, showers and stairways.
Remove throw rugs.
Remove clutter, open up walkways in the house.
Have bright lighting after dark.
Have an evaluation by medical professionals and a custom report and activity program to avoid falls.
Have an exercise program to build strength and balance.
Eat a nutritional diet.
Wear proper shoes that fit well.
Check vision and be sure glasses prescription is up to date.
Have medications checked to avoid overmedicating and dizziness.

Caregivers can go to The United States Department of Health and Human Services website to read about seniors and falls.

Tribune Article: Finding Quality Long Term Care

A third article relating to eldercare in today's San Luis Obispo Tribune is titled "How To Find a Quality Assisted Living Facility". To learn more about assisted living and long term care options for the elderly contacting your local ombudsman service is recommended. The article is relevant for people living outside of the area as well, because issues of finding quality care are universal.

Additional resources for information about long term care options and quality are listed and costs are discussed.

In San Luis Obispo County residential care homes are described as averaging $4,000 per month or more. A residential care home differs from a larger facility because the residential care home often has 10 beds or less and may be in an adapted house.

The residential homes often offer a warm, friendly family style environment. But, another article in the Tribune explains they may only be inspected once in five years unless there are complaints. Some of the homes are recommended as fantastic and others have had serious complaint issues.

The growth of the number of small residential long term care homes in the county shows the popularity of these smaller facilities. People who are looking for long term care can ask questions about the type of training the staff has received, the ratio of aides to residents, and the emergency response procedures. They can also ask questions regarding medication logbooks, daily care notes, care plans, and the amount of experience that the supervisiors and aides have had with caregiving.

If an employee calls in sick, what plan does the home have to provide for staffing the position?

Other questions might include asking how long a resident has to wait for help, and how much time per shift does the aide have for each person. Is this the aide's first job providing personal care assistance?

There is also the option of hiring paid caregivers from an agency to provide assistance in the senior's own home. Independent caregivers are available also, but as discussed in other posts, insurances, background checks, payroll and supervision will be the responsibility of the client.

Local Article Identifies Violations at Residential Care Facilities

Examination of records of violations at residential care facilities for the elderly was part of an investigative report in today's San Luis Obispo Tribune. The story was titled "County's Worst Offending Homes Are Cited After Repeat Violations". Poor medication management, insufficient and unqualified staffing, poor food quality, and inadequate dementia care provisions were listed as the most common violations found by the Tribune.

The local facilities were listed and violations were discussed in the article. Training the staff to use proper emergency response programs was also an issue at one facility, where a resident wandered outside, fell, and broke a hip.

At another facility inspectors found that staff failed to call 911 after a resident fell and suffered broken ribs.

I would like to add the information that when a frail elder falls caregivers can call 911 for rescue workers to come to the house. The fire department provides a free lift assist and the rescue workers can check for injuries. If there is any chance at all that there is an injury caregivers can call 911 for an ambulance to bring paramedics and transport to the emergency room.

Moving someone who has an injury can make the injury worse. Let trained medical personnel check for injuries and lift someone from the floor. The local fire department provides a free lift assist. Call 911 when there is a fall and ask for rescue workers to come to the house for a lift assist.

Front Page Today's Paper: "Is the Quality of Elder Care in Jeopardy"

The front page story today on the San Luis Obispo Tribune asks "Is the quality of elder care in jeopardy?" The article starts with the story of a woman at a local facility who died from complications from a diabetic condition. State officials found the facility had "insufficient and unqualified staff" who failed to monitor a diabetic condition.

The questions about the quality of elder care are being asked all over the world, as this topic grows in importance with the aging of populations and changes in society.

The small facilities, like the one described above, are said in the article to be often less expensive and less restrictive. Many of them are wonderful, home style settings where a house has been adapted for use as a board and care facility.

The less restrictive aspect of the small board and care homes that offer assistance to frail seniors also means they are not inspected regularly. The article said that unless there is a complaint the small homes might only be inspected once every five years.

The article said in 1998 San Luis Obispo County had fewer than 40 small board and care homes and now there are 74 with 10 beds or less. The trend for more facilities to keep up with the growing demand is expected to continue as the population ages.

For information about local facilities, recommendations, and violations you can call the local ombudsman services where you live. The long term care ombudsman, as discussed in other posts at this blog, is a person who investigates complaints and is there to help you find quality care. This official is familiar with the inspections, violations, and quality of local facilities.

Self-Care for the Caregiver - Who Has the Time Or Money?

A good night's sleep, a breakfast of high protein cereal, and a long, slow walk are some of the ways I have been taking steps for self-care of myself, as a caregiver. But, I know that for many caregivers having the time available for self-care is difficult or impossible, like a luxury. The recent article on CNN about Caregiver Syndrome gave a name to the effects of caregiving stress and emphasized how important it is for caregivers to use self-care. The previous post on this blog explains an article and study that shows Alzheimer's caregivers are at risk for a shortened life.

Regarding my own self-care, now that I'm 55 years old I have joined a local seniors group, the Central Coast Seniors, located at 1580 Railroad St., Oceano, California, and the phone is (805) 481-7886. I plan to take some of my caregiving clients with me to the activities. I know they will enjoy the outing. That way I can visit with friends, play Bingo or Bridge, be part of a fun club, and meet more friends. I plan to bring an elderly senior whom I am assisting so that person can watch or participate too. The group also provides health classes for seniors, Friday night group dinners, and health screening workshops.

The Caregivers Network at caregiverresource.net lists time off, sleep, keeping a sense of humor, educating yourself, and making realistic commitments as some of the important parts of self-care for the caregiver. Isolation for caregivers is an important problem, and getting together with relatives and friends can be difficult if a caregiver does not have any time off.

Recent articles discussed Alzheimer's caregivers who were visited once a week by a social worker who provided training and coping skills. The caregivers who received this training experienced less stress when compared to caregivers who did not receive training. The problem is that many caregivers do not have time to find training and go to classes because life is a daily struggle with multiple demands.

The lack of time for the caregiver to devote to self-care is a big part of the problem that needs to be solved. Support groups can provide sharing and counseling. But, finding someone to affordably step in to provide caregiving can be difficult. Lack of financial resources to hire paid assistance means a family caregiver has multiple ongoing demands without rest, recreation, or time for friends.

Most people are familiar with the steps for self-care, but there is simply no time for themselves.

Some of the possible options for assistance might include checking with local agencies, such as the Area Agency on Aging, to find out about programs they have for providing outside caregivers to help out with housecleaning and other tasks.

Adult Day Care provides a way for a caregiver to have some time to rest and renew. The adult who goes to day care can have social time and activities in a safe place with assistance available.

A part-time outside caregiver can be hired but this can be too expensive for many people. In my area, San Luis Obispo County, California, USA, agencies charge from $17 per hour to $25 per hour. A registry that does criminal background checks has caregivers for $10 to $15 per hour, but the employer must then get the necessary insurances, do payroll, and supervise. Independent caregivers start at around $10 per hour, but background checks, insurances, payroll and supervising are duties of the employer. For seniors who live alone and need help, there are 24 hour, stand-by-assist caregivers. A month can run from about $7,000 to $12,000.

Often caregiving is very customized to meet an individual's needs, and it is not possible to have a well meaning neighbor stop by for awhile to help a family caregiver have time for self-care. Toileting, dealing with Alzheimer's or dementia, and helping people who are using walkers or wheelchairs are activities that require skills and knowing the individual's routine.

Family caregivers and paid caregivers often are unable to take time for themselves. As Gail Sheehy asked in a recent article at parade.com, "Who will take care of the caregivers?"

Study Shows Caregiver Stress Includes Depression and Shorter Lifespan

The exhaustion and stress of caregivers for elders with Alzheimer's makes the caregivers' own health suffer. A recent study from Ohio State compared non-caregivers with caregivers for Alzheimer's sufferers. The caregivers for people with Alzheimer's had much higher rates of depression and of changes in the immune system. The article, at Medical News Today, titled "Stressed Caregivers Had Decreased Lifespan" explains a three decade long study between the effects of psychological stress and the immune system, showing genetic and molecular changes in the immune system from stress. Lifespan was shortened by the effects of the stress.

The three decade long study has also included medical students, newlyweds, divorced spouses, widows and widowers, and married couples. The recent study on caregivers of Alzheimer's sufferers included a professor of immunology, a professor of psychiatry, and the National Institute on Aging.

The symptoms of depression for the caregivers of people with Alzheimer's were twice as severe as for non-caregivers.

What can be done to help the caregivers for people who have Alzheimer's?

Articles and studies say that doctors refer to caregivers as the "hidden patients". The studies and numbers keep adding up to show that caregivers are exhausted, stressed, suffering more depression, and living a shortened lifespan when compared to non-caregivers.

A recent article at parade.com by author Gail Sheehy asked "How can we help our nation's caregivers?" With the population of elderly people who have Alzheimer's rising the topic of caring for the caregiver is becoming a crisis.

Recent studies have proved that providing training for caregivers made a difference in caregiver stress. An article titled "Training Helps Alzheimer's Caregivers" in the Associated Press on August 12, 2007 discussed the proven stress reduction for caregivers who received training. The problem is that most Alzheimer's caregivers don't have any spare time to spend finding and getting training. Daily life is an ongoing struggle to balance all of the demands.

Exercise, Gingerbread, and Visits for a Senior with Alzheimer's

One of my favorite activities with a senior who had Alzheimer's was when we combined a walking exercise routine with a trip to bring gingerbread (with whipped cream) to the neighbors for visits. Who said exercise had to be dull? This way an elderly senior had a pleasant recreational time that provided motivation. Cooking the gingerbread, interacting socially with the neighbors, and enjoying companionship made it a good day for a senior who might otherwise have sat alone at home in front of a television. The gingerbread visits became part of the weekly activities, and the elderly neighbors recipricated.

Some of my favorite times assisting seniors who had Alzheimers have been when we went walking in the neighborhood or for outings. Apart from the relaxation and pleasure there are many benefits to exercise for the person who has Alzheimer's, and the caregiver can enjoy the exercise too. Understanding the activities recommended and following directions from medical personnel are important when assisting someone with Alzheimer's or Dementia. At alzinfo.org you can read about the benefits of light exercise and walking. Exercise helps with the following : (1) maintaining independence (2) reducing wandering, aggression, and agitation (3) increasing mobility. It also can be part of the recreational activities that add pleasure to the day.

When paid caregivers provide care at the home for someone who has Alzheimer's and who lives alone, medical professionals can recommend exercise types and amounts. Often a frail elderly person who lives alone watches television for much of the day. A daily routine that includes light exercise, as recommended by medical professionals, can be part of the caregiving.

Some of my favorite activities with seniors include going outside for a walk on a nice day and looking at the neighborhood gardens. In my area there are a lot of fruit trees and the climate is mild. Going out to pick oranges, apples, persimmons or figs from trees in the backyard has been something I've done with many seniors, depending what fruit trees they have planted.

Sometimes seniors with Alzheimer's or Dementia have lost interest in getting up from their chair to go for a walk, but I try to think of something that will appeal to their personal interests to provide motivation.

With another senior, who was 96 years old and on a walker, I used to walk down a long driveway in the countryside to the mailbox and to pick up the newspaper each day. We also went out for shopping trips, visits to the beauty parlor, scenic drives, errands, and church activities.

Physical therapists have hand-outs and leaflets available of exercises that non-ambulatory people can do while sitting in a chair. The physical therapist can make an evaluation and recommend a routine of walking, and other exercises.

For example, sometimes it is recommended that a person who watches television from a recliner be encouraged to get up once per hour and walk around the house a little bit. It is easy for elderly people to get involved for hours at a time with television, and varying the activities also has more mental stimulation.

The agitation, tension, and sundowners wandering can be alleviated by having some exercise, and many articles, studies and websites explain more about this.

It's important to get directions from medical personnel, especially physical therapists. Home Health Agencies who send nurses and therapists to the house, or physical therapists in a facility can give directions to the caregiver regarding the exercise.

If the person uses a walker or wheelchair we can still go for an outing and get exercise. I pull the wheelchair along behind someone who is using a walker if there is a chance the person will get too tired to walk. Sometimes a person who uses a wheelchair will have the footrests taken off for awhile and ride in the chair while pushing with the feet and pushing the wheels with their hands. Caregivers need to get directions and exercise routines from medical personnel.

The exercise routine time can be a relaxing and pleasant time for the frail elder and the caregiver. Combining exercise with outings can reduce stress and add a recreational activity to
the day.

Caregivers and Companionship for People with Alzheimer's and Dementia

A program in Chicago, Illinois in an article on CNN provided an enriched environment for people with early stage Alzheimer's by pairing them up as "buddies" with Alzheimer's scientists. The people with Alzheimer's shared discussions, trips, visits to museums, just visiting and talking, and going to local activities.

The article is titled "Program Pairs Alzheimer's Scientists With Patients."

Caregivers who assist someone who has Alzheimer's or Dementia can get activity ideas from the article. Having a "buddy system" provided people with companionship and interaction while sharing activities.

The program was at Northwestern University, but the University of Chicago had a similiar "buddy system" program.

Companionship and shared activities are ways to make life more pleasant and rewarding for someone who has Alzheimer's. Becoming passive, losing interest and being isolated are some of the behaviors that can occur. An enthusiastic caregiver can help by being a buddy for someone and encouraging activities.

The goal was to see if providing social support, mental stimulation, and education would provide "indirect therapy" that would help people with Alzheimer's remain independent longer.

The article provides additional support for the idea that activities and companionship are important for people who have Alzheimer's or Dementia.

Doing crossword puzzles, taking classes and using memory stimulation programs were some of the other activities mentioned in the article that might help those diagnosed with early stage Alzheimer's.

Caregivers, Adult Day Care, Personal Care Aides, and others who interact with a person who has Alzheimer's can use this information by being "buddies" and companions.

Team Style Solitaire for Alzheimer's and Dementia

I play a type of team style Solitaire with people who have early or mid-level dementia which pits two of us, or more, as a team against the cards. At one of our "Card Parties" a question like "Can you find a red queen or a black nine" helps a person with Alzlheimer's start to look for the needed cards. Then, "Hurray! we've got it!". People with Alzheimer's or dementia often respond well to images and visuals, and the cards don't need to be remembered, just found or matched.

Having an enthusiastic caregiver can help get the game rolling. The caregiver can offer suggestions, if needed, about what cards to look for next.

Finding ways to pass the time and provide stimulating activity can be a challenge for a caregiver assisting a senior with Alzheimer's or Dementia. If the senior lives alone at home there may be family caregivers or paid caregivers 24 hours a day. Adding pleasant, relaxing, but mentally stimulating activities can make the day a better one for both the caregiver and the senior.

The studies showing the positive effects of playing cards or board games for people with Alzheimer's or dementia are common knowledge. Studies of comparing the use of mental challenges and mental exercises versus mostly watching television shows that games and puzzles are the winner by far. Mostly watching television has been connected in many studies with losing mental skills. Television is passive, card games, board games, and puzzles are active.

If you are playing Solitaire, Go Fish, or other card games that a person with early or mid-Alzheimer's can share with you, there are also extra large playing cards for people with low vision. If arthritis has made handling the cards difficult the caregiver can turn and move the cards.

Sitting in a comfortable chair with arms is often a favorite place for frail seniors, and a TV table can be placed in front, plus a chair for the caregiver. Dining tables also provide the right height but the chairs might not have arms or be comfortable enough for a long session.

A real "card party" means snacks, beverages, and perhaps soft background music. If a senior with Alzheimer's or Dementia has lost interest in many activities, the caregiver can try starting a game and "asking for some help" finding the cards. Sometimes the elderly person will watch for awhile and then tentatively begin to join in. Just watching and cheering someone else on is enjoyed by some people.

Games of cards like Concentration are easier than Solitaire and may be suitable for people in more advanced Alzheimer's or Dementia. In Concentration each player turns over two cards, and if the cards match the player gets another turn. You can buy Concentration with various pictures, or make your own cards from scratch and use themes that mean something special or relate to someone's interests.

Study Shows Soothing Music Calms Elders with Alzheimer's

I plan ahead when assisting a senior with Alzheimer's and soft background music is one of the things I've tried that seemed to help the agitation and restlessness. An article from Reuters, "Music Therapy Helps Alzheimer's Patients" by Jane Vail, pub. in 1999, explained a study that proved soothing music can be effective. Aggression and agitation, as well as sleep patterns, were better after a month of music therapy for a group with Alzheimer's.

Blood tests proved that levels of chemicals changed in a positive manner after listening to calming music. The article said the people with Alzheimer's who received music therapy were more active, slept better and were more cooperative.

Sometimes I've assisted elders who have Alzheimer's sundowners syndrome, and I start creating a calming environment as the afternoon progresses to keep the agitation and wandering minimized. Relaxing games, soft music, an easy-going pace to the day's activities, and avoiding tension all seem to help.

The soothing music is nice for relaxing the caregiver too!

Caregiving and Learning About Alzheimer's, Art, and Memory

Studies show there is a connection between art and memory for people with Alzheimer's. Caregivers may have noticed that when people with Alzheimer's color or paint pictures they sometimes respond to the images by remembering things. I don't know if it was just chance, but many people whom I have assisted who had Alzheimer's have been enthusiastic about making or coloring pictures. In fact, they were more enthusiastic than the other elderly seniors about it. Their walls were decorated with pictures they had colored with paints, crayons, colored pencils or markers.

I noticed recently that Amazon.com has adult coloring books, even one full of paintings by the artist John Constable, ready for someone to color. This could be another source for art projects for people with Alzheimer's.

Many studies say that memories are stored as images. In an article at ABC News, John Ziesal, director of Hearthstone Alzheimer Care, explained why Alzheimer's patients respond to looking at images and art. "It's as if you...put the memories in the glove compartment and you lost the key...and the art unlocked it."

As a caregiver, have you ever noticed how visuals help people with Alzheimer's to start remembering? For instance, photos in an album can trigger reminiscing. Some seniors with Alzheimer's like to color pictures with paints, markers or pencils, and the pictures often seem to help get a conversation started and to trigger memories.

In the article at ABCnews.com, 2006, titled "Art Awakens Alzheimer's Patient's Minds" a visit to an art museum and its effects are discussed.

The article explains that Alzheimer's patients may develop four "A's" of anxiety, aggression, agitation and apathy. Nurses and families of Alzheimer's patients say that after a visit to an art museum the four "A's" fade and people are calmer.

Sometimes I've gotten out the art supplies, pictures to color, and colored markers or crayons at the time when sundowner's often seems to start with people whom I've assisted. Coloring the pictures and talking about them seemed to calm people and soothe agitation. They seemed to be less apt to start wandering and more apt to sit and make pictures. Adding some healthy snacks helped too.

Using a coloring book with subjects that the person might relate to due to past interest seemed to help. For instance, themes of animals for someone who likes pets.

When caregiving for someone with Alzheimer's some people like to share a magazine full of pictures, a history book with a lot of photos, or an art book. This can be a pleasant activity for caregivers and senior's with Alzheimer's and a way to bring back memories.

Scientists say perhaps the memories are not actually forgotten but the access to the memory is not working. When seeing the art at a museum the images bring back memories.

A family photo album or scrapbook can be a source of images to help memory. Sometimes when someone is agitated a caregiver can get out a photo album for a calming activity.

Short term memory loss occurs in Alzheimer's but images seem to help memory retrieval. Caregivers can use images and artwork to aid memory for people with Alzheimer's.

5 Things You Didn't Know About Jigsaw Puzzles for Elders

I had a great time doing a puzzle of a black cat with a senior over the age of 95, who had her own black cat sitting on her lap. We used one of the puzzles with large pieces and easy vision pictures. Our snacks and beverages helped to make it a "puzzle party". Because arthritis in the hands is so common, as well as poor vision, the puzzles with large pieces and easy pictures to see are helpful for elderly seniors.

The puzzle had 100 pieces, which makes it quick and fun. Below is a list of five things caregivers might not know about doing jigsaw puzzles with seniors. With snacks and beverages a caregiver can start a "puzzle party" to add a highlight to the day for someone.

1. Choose a puzzle with extra large pieces that are easy for people with arthritis to handle.

2. A puzzle with a picture suited for people with low vision, that avoids small, intricate details will be easier to see.

3. A puzzle with only 100, or even 50 or 30 pieces will be easier for someone who has Alzheimer's or dementia to enjoy and finish.

4. Caregivers and seniors can start by separating the pieces with similar colors and designs into groups on a table. This step makes it easier for anyone, and especially for elderly seniors with Alzheimer's or dementia.

5. Choose a picture of something that will spark interest. One senior I assisted collected antique style dolls and she did a victorian dolls picture. Another did one that looked like her own cat. An elderly gentleman did one of vintage cars.

You can go to seniorstore.com to get ideas about puzzles. In my area the local "Dollar Store" always has a selection of puzzles in the games section, and for only a dollar each I can get several for variety.

Alzheimer's and the Dominoes Champion

I bring a lot of games with me when I assist elderly seniors, and the Color Keyed Dominoes or the Number Dominoes are favorites for people with Alzheimer's and dementia. The colors stand out for easy matching . You can get dominoes that are extra large and these are easier for people with arthritis to handle and easier to see. One elderly senior with Alzheimer's won so often she was clearly the "Dominoes Champion". Seniors with Alzheimer's or dementia can match the colors, not just the dot patterns.

The Number Dominoes have a large color keyed number instead of a pattern. For ideas you can go to dominoes.com. For a group of people you can try Mexican Train Dominoes. A central hub is used and the domino trains branch out from it.

Dominoes, you might recall, have different numbers of dots arranged in patterns. The goal is to match patterns. The old dominoes were black and white. Now you can get dominoes that are white with each pattern of dots in a different color.

The game comes with a booklet of variations, too. Caregivers can set up the same type of game for elderly seniors who prefer this, or use some of the other dominoes games to change things around sometimes.

Book at AARP Covers Crossword Puzzles, Gridlock, and Geniuses

Caregivers and seniors, would you like to have some fun? Here is a puzzle to solve - Who is competitive, funny, "punny" and inventive? Answer: Crossword puzzle writers. At AARP Magazine.org you can read a review about an interesting book "Gridlock: Crossword Puzzles and the Mad Geniuses Who Create Them" by Matt Gaffney. Did you know that no more than one-sixth of the puzzle can be filled with black squares? Or that when the puzzle is turned upside down the pattern of black squares remains the same?

It's all in the book along with the interesting psychology about the kind of puzzling people who write crossword puzzles. The stories about crossword authors as hypercompetitive and obsessive make them sound like "type A" personalities.

The trivia behind the crosswords and the writers might help those of us who do crosswords to picture the authors as they devise themes, design grids, and write clues.

Caregivers and seniors can enjoy reading the review or get the book. Some of the seniors I've assisted have difficulty with vision but I do crosswords with them by reading the clues and number of letters in the word out loud.

For instance, "What's a nine letter word for a square that has a design of black and white squares inside of it, with a list of clues?"

Home and Garden TV Website Has Senior Crafts

Caregivers who want to find creative craft ideas for seniors can go to hgtv.com . Homemade toys, birdhouses, totebags, memory boxes, paper bag crafts, shoebox crafts and craft businesses are some of the topics covered in HGTV crafts.

My aunt, who uses a walker, has turned her spare room into a crafts studio. She started by making handmade keepsake greeting cards. Now she makes keepsake and heirloom items for craft bazaars.

For example, ten craft ideas caregivers could use for seniors include:

1. rubber stamps today include artistic themes, pictures and borders
2. scrapbooking helps preserve photos and keepsakes to nudge memories
3. memory boxes provide storage for family memorabilia
4. hand decorated picture frames add a home style touch to family photos
5. handmade holiday cards become instant keepsakes and can be framed
6. handpainted "suncatchers" are colorful plastic faux stained glass to hang in the window
7. hand decorated birdhouses with themes, for gifts or a business
8. using fabric paint to decorate towels, pillowcases, and table runners
9. dried flowers and leaves can be used for decoupage
10. photo collage with memorabilia

Defining Quality Care - The Rosalynn Carter Institute for Caregiving

Ten measurements of quality care are listed by Richard C. Birkel, Ph.D., at The Rosalynn Carter Institute for Caregiving . In "Defining Quality Care in Long Term, Home and Community Settings" Dr. Birkel starts with discussing care that is (1) safe, (2) effective, and (3) personalized.

Safe Care provides care that avoids injuries to the care-receiver or to the caregiver. I will add some examples for you:

• clearing the home of unsafe conditions
• safe lifting procedures and lifting devices when needed
• caregiver notes, emergency medical information, emergency contacts available
• training for caregivers
• emergency procedures for home caregivers re: calling 911, rescue workers, ambulances

Effective care is based on scientific knowledge. Again, some examples I might add include:

• caregiver training from the Red Cross in their new program
• caregiver support groups that provide education and other local city and state programs
• formal and informal training, books, internet

Personalized care respects the preferences, needs and values of the care-receiver. My additions of examples include:

• respecting preferences if someone wishes to remain in the home vs. facility
• treating care-receivers with respect for their values
• caregivers offering options and choices to the care-receiver when possible
• designing a customized care program specially tailored for the individual's satisfaction

For more about the other seven topics covered in Dr. Birkel's paper you can visit the RCI website.

Rosalynn Carter Institute for Caregiving Offers "Lotsa Helping Hands"

At Lotsa Helping Hands, developed by The Rosalynn Carter Institute for Caregiving, caregivers can create a free, easy to use website for volunteer caregiver helpers, schedules, updates for family and friends, messages, calenders and more. The Former First Lady Rosalynn Carter established the Institute, RCI, in 1987 on the campus of Georgia Southwestern State University. The mission of the RCI is to meet the challenges of the caregiver crisis in America.

The Rosalynn Carter Institute for Caregiving website has a wealth of online resources to help caregivers.

Some of the topics covered at the website include :

• Development of quality care in home,community and long term care
• Common characteristics of effective caregiver programs
• Interventions to create desirable outcomes (such as reducing caregiver depression)

Board and Care Residential Facilities Offer Homelike Setting for Seniors

Seniorresource.com explains that one of the long term care options is a board and care facility, which often is a converted or adapted home that has 5 or 6 residents who receive care. A residential board and care home may specialize in the type of care provided, for instance, early stage Alzheimer's.

The number of residents depends upon the zoning for the home. When a facility has room for a larger number of residents it is called an assisted care facility.

The homelike family style atmosphere of a converted house and the small number of residents appeals to those who do not wish to move to a larger facility. Caregivers or aides provide assistance in a group home and many people enjoy the warm, friendly atmosphere and shared social interaction. Often everyone becomes like a part of the "family" and the residents and aides may develop close friendships.

To find Residential Care or Board and Care in your area you can search the internet, check with the local ombudsman services, browse the yellow pages, and ask local consultants and care coordinators.

In the San Luis Obispo area Hillside Villa Retirement Home is located in Arroyo Grande. I visited several times around Christmas and the warm, friendly family style atmosphere was wonderful. There are a number of residential homes in San Luis Obispo County, and if you live elsewhere you can check for similar homes in your area.

Website Offers Facility Match and Nursing Home Inspector Tools

At carepathways.com you can use a Facility Match knowledge base and a tool called Nursing Home Inspector to help you make decisions before moving from home to a facility. There is also a Home Care and Facility Checklist and a Needs Assessment tool.

You can ask an RN questions about Home Care or Long Term Care or ask a gerontologist about Alzheimer's care.

There is also an enormous base of resources for every topic that caregivers and seniors might need, even links to help for "4-legged seniors" for those who have pets.

Finding Local Support for Family Caregivers

When family caregivers are feeling overwhelmed and exhausted there are support groups locally and on the internet that provide shared experiences, advice, and information. The isolation of caregivers is part of the "Caregiver Syndrome" as discussed in a CNN article recently, and joining a group can reduce the stress and loneliness that caregivers often experience.

To search your local area on the internet use your town followed by the words caregiver support. You can also call your local ombudsman, search for a senior consultant, call the local Area Agency on Aging, or browse through the yellow pages.

There's a support group for every condition these days, and from the other group members you can get informal personalized guidance for the issues you are facing. There's nothing like talking things over with another person who has had a similar experience to relieve stresses. When your regular friends are not able to relate to the stresses you are feeling from caregiving then a support group is a place to meet friends you can talk to who will understand.

Caregiver blogs are popular on the internet and caregiver forums provide a place to interact with others.

Free Senior Living Consultations RE: Long Term Care

Making decisions about moving from home to a facility can be made easier by using a consultant who has experience and information about the facilities in your area. Matching the needs of elderly seniors with the type of care and setting offered by facilities can avoid making a mistake that is regretted after moving. To read about consultants and what they offer you can go to seniorlivingconsultant.com or search for consultants in your own area on the internet.

After seniors have made a deposit at a long term care facility and moved from home it can be disapppointing to find that the facility is not a good match for their needs and preferences. The consultants I spoke to said they match seniors with care facilities. They will visit the facilities with you so you can make an informed decision. The consultation is free because the facilities pay a finders fee to the consultants.

Because they have current information about available space at the long term care facilities, and familiarity because they visit them regularly, the consultants can give you their impressions and recommendations.

You can check the internet and phone book for your area. In San Luis Obispo County, California, there is a company called Senior Living Consultants. They are located at 3164 S. Broad St., Suite 114, San Luis Obispo, CA 93401. The number is (805) 545-9501. Their Santa Barbara office is located at 18 W. Micheltorena, Suite C, Santa Barbara, CA 93101, and the numnber is (805) 963-6045. Whether you live in this area or elsewhere you can get some ideas about what a consultant can offer by going to seniorlivingconsultants.com.

Memory Improvement Steps at newscientist.com

You can read about ways to improve memory at newscientist.com. Did you know that in a 2003 study kids who ate a junk food breakfast performed on tests with reduced memory and attention? Lifestyle habits, studies of memory, and techniques to improve memory that caregivers and seniors might find interesting can be found at newscientist.com under 11 Steps to a Better Brain. The way memory works, what triggers memories, and the steps to improvement are topics covered by the writers.

The article discusses the Mozart and memory connection, and how listening to background music makes people feel relaxed and stimulated so they may perform better in memory activities.

A good night's sleep was also found to improve memory, and exercise improves mental functioning, such as learning, concentration and reasoning. Being able to pay attention and cut out distractions was also among the memory tips.

To read the entire article go to newscientist.com.

Got Questions about Senior Care? Ask a Long Term Care Ombudsman

When people are thinking of moving to a long term care facility they ask "Where do you go for help?" , "Who will answer your questions?", "How do you proceed if something just doesn't seem right?" For answers you can call your local ombudsman. This person is there to help.

The ombudsman is a person who visits the local long term care homes, talks with the residents, investigates complaints, resolves safety issues, and is an advocate for quality care. Counseling and assistance for families are available from the local ombudsman. Referrals to resources and community support groups as well as information about local nursing homes are some more services provided by an ombudsman.

I went to the website for my local ombudsman in San Luis Obispo County, California, but you can search for an ombudsman in your area by going to ltcombudsman.org.

The page for local services in my area said "Long Term Care Ombudsman Services are available to help. Give us a call."

When friends and acquaintances call me to ask what to do involving long term care for their parents I refer them to the local ombudsman. In San Luis Obispo the number is (805) 785-0132, and the office is located at 3232 S. Higuera St., #101 B, San Luis Obispo, CA 93401.

1950's Reminiscing for Caregivers and Elderly Seniors

Reminiscing about historical trivia and events is fun and if you want to start a conversation with an elderly senior you can always ask about the 1950's. Hoola Hoops, the Willys Woody Car, the first Kentucky Fried Chicken, Humphrey Bogart and Audrey Hepburn in The African Queen, poodles on everything, the beginnings of rock and roll, and the new thing called television were part of the 50's. You'll find this at thepeoplehistory.com.

Agatha Christi's play "The Mousetrap" became the longest running play in history. Movies included "Singin in the Rain" and John Wayne in "The Quiet Man." The first Holiday Inn opened in Tennessee.

In 1952 in the United States the average cost of a new home was $9, 050, average yearly wages were $3,850, the cost of a gallon of gas was 20 cents, and the average cost of a new car was $1,750. Average rent was $80 per month.

In 1956 Prince Ranier married Grace Kelley, black and white portable television sets hit the market, and teflon frying pans came out. Pepsi Cola and Post Raisen Bran were new products.

You can go to the website at thepeoplehistory.com for trivia on any year you choose, and find some good conversation topics to share.

Caregiver's Enthusiasm Can Spark An Elderly Senior's Interests Again

As a paid caregiver on rows of 24 hour stand-by-assist shifts, sometimes for weeks at a time, I've tried to make the days interesting for elderly seniors I assist. An enthusiastic caregiver can be the spark and the friend who starts activity rolling again if a senior is confined at home and has lost interest in usual activities. A "Beauty Parlor Day", a "Health Spa Day" , or a " Restaurant or Cafe' at Home" day can be activities for a caregiver and a senior to share for enjoyment.

Making a special event out of "Jeopardy" time, with snacks and beverages adds to a "party" atmosphere. Watching old movies on the Turner Classic Movie station with "we're at the movies popcorn" makes it an event to brighten up the day.

There can also be "Life History" time and Genealogy time. Hearing about someone's ancestors can start both of us making family trees and sharing stories.

If the weather is nice then sitting on a porch, patio or deck is an option. If an elderly senior uses a walker or wheelchair the porches and patios are still accessible and this outdoor time can make the day more pleasant. Breakfast with a newspaper, or one of the other meals outdoors as a "picnic" can be a treat.

When a 24 hour caregiver is on long rows of shifts without a break it can be helpful to make each day a little different for the elderly person. Keeping a calender of upcoming activities has helped me plan and provides an upbeat anticipation from day to day. Sunday afternoon might be oldies but goodies movie time, Saturday might have a favorite show on, and the middle of the week might have other special events.

Listening to audiobooks of interesting autobiographies and biographies has been an activity some people have enjoyed also. When audiobooks are not available sometimes I get one of the person's favorite books and read out loud. Listening to musical classics, often from the 40's and 50's is another activity some seniors enjoy.

Some of my favorite times assisting seniors have been when we have joined up to start a project together. Several have joined with me in creating their own private version of a "university" at home, and naming it after themselves, too. Of course, everybody graduates.

On rows of 24 hours shifts it helps to make each day have some variety for both the senior and the caregiver. Looking ahead in the TV Guide for shows and movies that an elderly person would enjoy helps create a schedule days ahead of time to look forward to and the shows can be marked on the calender.

One person in her 90's told me she used to like creative writing. She started thinking of writing again, and had a poem published in the newspaper's poetry feature. It was exciting for both of us to see her name in print, and the poem was beautiful.

Home style cooking and preparing meals to freeze for the upcoming week is sometimes "Cafe' (insert senior's last name) the Famous Restaurant." Some of this might sound silly, but often we turn ordinary days into days with a "party" this way. As a paid caregiver on rows of 24 hour shifts I have always been trying to think up new ideas for activities.

Asking questions led to a project with one senior that included studying religious and philosophical material from a university that we found in the storage room. She remembered the professors from long ago and told me about the classes. We also found some newspapers that were 50 years old and we had a great time reading those and discussing them.

Another told me some hilarious escapades that included climbing the town water tower as a young rambunctious redhead, and she made a recording of the story.

Alone, they did not have the motivation to start these projects, but with an interested caregiver providing enthusiasm they got old interests revived, and I had an enjoyable time too.

Asking people questions about their life history helps them to remember things that trigger more memories. Questioning and listening can lead to digging up favorite interests that have been long forgotten. Sometimes seniors have been alone and isolated.

The caregiver can be the spark and the friend who gets enthusiasm rolling again.

Long Term Care Insurance Becoming a Necessity

As families become separated more and more often by distance from those needing daily care the need for long term care insurance is becoming a necessity. At longtermcarelink.net and longtermcarewiz.com the statistics show that the time has come to include long term care insurance along with the other usual insurances that we buy.

Who will take care of the family caregivers of today when they need care in the upcoming years?
Sociological factors show that each generation of families has had a tendency to be more separated by distance, more consumed with employment and work schedules, and less likely to become caregivers for elders.

A recent article at Parade.com by Gail Sheehy asked "What can we do for the nation's caregivers?" With the social security crisis looming, the boomers retiring, and the health costs rising it is time to take responsibility for our own care that might be needed someday and invest in long term care insurance. Waiting for the government to help is not the answer.

The time is coming when long term care insurance will be another part of our insurance necessities along with property insurance, car insurance, and so on. How else can people pay for long term care? Today, reverse mortgages are paying for long term care for many people, but they worry about what to do if they outlive the funds obtained that way.

Longtermcarewiz.com explains how long term care insurance is rated. The limits of Medicare for long term care and the rapid pace that one's assets can be spent are discussed, along with what to expect regarding Medicaid.

At longtermcarelink.net The National Care Planning Council provides information and links on everything from reverse mortgages to family conflicts to care management and nursing homes.

Hospital Discharge Planners Discussed at aahsa.org Consumer Information

The AAHSA, American Association of Homes and Services for Aging, at aahsa.org, offers Consumer Information that explains that hospital discharge planners operate under "tight restrictions...arrange discharges at a rapid pace...and how Medicare reimbursements stop when a doctor clears someone to leave" so the hospital is motivated to fill the bed with a paying patient.

The AAHSA provides consumer information under "How to Choose" on the page titled "Crises Planning, When You Need Aging Services Now" and says "you may want to seek advice from someone other than the hurried discharge planner" and discusses the option of also using a private care coordinator.

The AAHSA says that for a fee you can hire a private care coordinator who can provide you with additional assistance. Contacting friends, relatives, pastors, the local ombudsman and the local Area Agency on Aging are also recommended.

The AAHSA recommends making short term plans if you are not satisfied with the options from the hospital discharge planner.

The website has information also on planning ahead, paying for services, choosing, and family caregiving. If you are not in a crisis they offer a list of ideas to consider for planning to be prepared.

The website recommends that you may want to check with the local ombudsman for help, as mentioned in a previous post. Visiting facilites that offer nursing services, physical therapy or assisted care, or talking to home care agencies, and sorting out the choices, can be daunting.

You may have the option of deciding between nursing facilities and home care. You can get detailed information by checking with home health agencies who send licensed nurses and other professionals to the home.

The types of care and providers after discharge can be researched. Facilities can be visited and interviews with home health agencies and caregiver agencies may be helpful.

The website at aahsa.org also provides lists and descriptions of the many types of care available. Understanding the consumer information at the site can help people to make decisions during a crisis or for long term planning.

Caregiver Training Offered by American Red Cross

At redcross.org you can read about a Family Caregiving Program offered by the American Red Cross that covers hands-on practical caregiving skills such as positioning people in bed, personal care, and providing healthy eating for someone who is elderly, has a chronic illness or is disabled.
The American Red Cross website says that 44 million American families are providing in-home care for a loved one.

A Family Caregiving Reference Guide is also available that covers hands-on practical basics such as assisting with bathing, positioning and helping someone to move, safety, and caring for the caregiver.

There is also a program for people who would like to become a Family Caregiving Leader or Provider.

You can contact your local chapter of the American Red Cross for more information, or go to the website and read about the training in detail.

Newer, Easier, More Comfortable Patient Lifts for Home Care Use

If you are taking care of someone at home who needs to be lifted, there are modern lift devices available that are easier to use and more comfortable for the patient than the devices of a few years ago. At just-patient-lifters.com you can read about the newest developments in patient lifters, which are different from the older styles of hoyer lifts.

Articles at the website explain that making patient transfers with the newer types of lifts is much easier than it was with the older types of lifts that were used before.

The website explains OSHA (Occupational Health and Safety Association) concluded that "injuries in nursing homes alone will reach 200,000 with a cost of almost 1 billion dollars. Injuries to care givers in the home care setting are estimated to be even higher...most of these injuries are directly related to patient transfers."

The just-patient-lifters website goes on to explain that mechanical lifters have improved and the slings are comfortable and easier to use now.

Electric lifters allow the caregiver to remain at the patient's side and to use a push buttom to operate the lift.

In a skilled nursing facility and in home care I have used hoyer lifts and electronic lifts. Sometimes people are not accustomed to lift devices, and may view the lift devices with nervousness.

For in-home care, licensed professionals can provide training and practice for caregivers until the caregivers feel comfortable using the lifts.

This may involve the caregivers experiencing the role of being a patient while someone else operates the lift. Having the experience of being lifted by a device, and practicing lifting others with the device, while an expert provides training, helps caregivers to become more comfortable with using it.

In my nursing classes we used to practice lifting each other until we were able to operate the lift smoothly, and relate to how the person being lifted felt. As we became comfortable and experienced using the lifts we were more able to reassure others until they were accustomed to it.

It can be a new experience but I saw many patients in the facility where I worked become accustomed to being lifted by lift devices.

Gail Sheehy at Parade.com Writes About Caregivers

Gail Sheehy writes about her husband's cancer and how she became a caregiver. I, too, became a caregiver the same way. In 1996 my husband, Frank, died from cancer, when I was 44 years old. The words "It's cancer" seemed to come out of a bad dream somewhere, but it was real.

Many of us who have lost a spouse have taken our experience and we try to use it to give something to the world. We had an experience that we would never choose, but now we try to make use of that experience to care for others.

Carmen Leal, at the Someonecaresonline.com website, is an example of a caregiver who helps others after her own loss. Carmen was her late husband's caregiver, and now she provides caregiver conferences, writes books, and provides resources to support other caregivers.

Safety for Seniors and Caregivers

Some websites about safety for seniors and caregivers include the following: (1) Stopfalls.org has a website devoted to fall prevention, includes articles on legislation, the National Council on Aging, reducing bed falls, and more. (2) Medicinenet.com has an article about what to do after calling 911 for any emergency (3) Osha.gov has a section about lifting and caregiver injuries (4) Just-patient-lifters.com explains the new lifting devices that are easier to use and have slings that are more comfortable than the ones used in the past

The fire department in my local area provides free lift assists when a senior has fallen and you can check with your local fire department and rescue workers for more information.

Print a Free Form for Emergency Medical Information

You can print out a free Vial of Life form that is recommended by fire departments and rescue workers from your computer to provide emergency information. At elderlawanswers.com an article explains the Vial of Life and the importance of having emergency medical information. The form includes history, medications, allergies, doctors, and telephone numbers.

The Vial is a form that provides the information that rescue workers and emergency rooms need in order to enable them to act as quickly as possible. The form can be attached to the refrigerator so that rescue workers can find it easily. If someone is taken to the hospital it provides the insurance information as well as the medical information.

Sometimes people have their information kept in phone books and files but this is a way to group the information where it is instantly available.

"Someone Cares" Caregiver Conference To Be a Major Event

At someonecaresonline.com you can read about the upcoming Caregiver Conference featuring New York Times Best Selling author Cec Murphy, radio host Cheryl Kuba, author, singer and actress Stacie Ruth Stoeling and best selling author Debra White-Smith. The conference is scheduled by Someone Cares for October 25-28, 2007 in Ridgecrest, North Carolina.

Over 40 concurrent workshops, multi-media presentations, daily praise and music from Nashville based Music for the Soul, and a concert by Dove award winner Scott Krippayne are among some of the activities.

For more information go to someonecaresonline.com, email info@someonecares.com, or contact Carmen Leal at (808) 372-0274.

Learning opportunities for caregivers include practical topics, legal and financial issues, Medicaid and Medicare issues, respite options and caring for the caregiver.

"Someone Cares" provides Christian Caregiver Conferences and Resources. A ministry from the heart and soul, Someone Cares has a "mission to help churches and caregivers focus on the One who cares for them as they care for those they love."

Founded by Carmen Leal, who had been her late husband's caregiver for 12 years, the goals of "Someone Cares" include the following: (1) Serve the Caregiver, (2) Pray for the Caregiver, (3) Learn from the Caregiver, (4) Care for the Caregiver, and (5) Grieve with the Caregiver.

Carmen has authored nine books, is in demand as a speaker, and has written for many popular publications such as Guideposts.

At someonecaresonline.com you can get information about conference schedules, caregiver devotions, and information about hosting a Someone Cares Caregiver Conference where you live.

There actually will be two conferences at that time. One is the conference for caregivers and will focus on "Learning to care for the terminally, critically or chronically ill or developmentally disabled."

The other conference is a Caregiver Symposium for Church, Staff and Lay Leaders.

The website explains that fifty-four million caregivers live in the United States, and with the aging of the population that number is expected to rise.

Supplies for Care in the Home

Health supplies and equipment can be complicated until you can picture what is needed and where you can find it. Often people are not aware of the many inventions that can make taking care of someone at home safer and more comfortable for the patient and the caregiver.

I looked at the website at valuemedicalsupplies.com to see pictures recently of some of the new equipment for someone I was assisting. If you are a caregiver trying to solve some problems for someone you can get a lot of good ideas by researching supplies.

The home health professionals, as mentioned in the previous post, provide training and you can ask for advice about supplies and equipment.

Home Health Services - Nurses, Physical Therapy

Home health services include licensed professionals such as registered nurses, home health aides, licensed physical therapists, or speech therapy. The nurses and professionals visit your home to provide care and teach the patient and caregivers how to provide the care routine that is needed.

For example, at the webpage for bestcarehomehealth.org, which has offices in many locations in California, there is information about who is eligible. The services need to be prescribed by a physician,the patient must need skilled nursing or rehabilitation therapy, and the patient must be homebound. Homebound means it is difficult or taxing to leave home.

You can also search the internet or yellow pages for additional home health organizations.

Medicare, Medi-Cal, Workers Compensation, Private Insurance or Personal Pay are the options listed for paying for the services.

The nurses provide training for family or paid caregivers so that someone can remain in the home instead of going to a long term care facility.

Understanding What a Long Term Care Ombudsman Does

If you need to find out how to choose a facility for long term care, and how to get good quality care, then contacting your local Ombudsman is a good place to get help. On the Internet you can go to ltcombudsman.org to use a locator to find the ombudsman in your area.

You can also contact the Administration on Aging, which is the agency that administers the Ombudsman Program. The website is at aoa.dhhs.gov

Sometimes the need for long term care comes up unexpectedly, and having information from your local ombudsman will help you know where to start looking for a home that will suit the circumstances.

Knowing your local ombudsman can be helpful in other ways too. A long term care ombudsman resolves complaints made by residents who are in long term care facilities.

The ombudsman can advise the senior and the family caregivers about the person's rights and provide education about what constitutes good care. Part of the ombudsman's duties are also to provide information about nursing homes, board and care homes, and assisted living other facilities to seniors and caregivers.

When you discuss your issues or questions with an ombudsman the information is confidential unless you give the ombudsman permission otherwise.

Website Lists Nursing Home Ratings, Violations, Complaints

Memberofthefamily.net is a website that says on its homepage has information on 16,000 Medicare/Medicaid certified nursing homes in the United States, including the National Watch List of homes with violations and substantiated complaints.

They also have a list of nursing homes that are "deficiency free" on an Honor Role.

The website explains the reports are based on recent government surveys, and describes the reports on the website as easy to understand. I agree the information was presented so that the average person could easily read it, and it was in regular language, not medical terms or technical terms.

The states are listed so you can search your own. There is a Nursing Home Annual Survey Rating System which includes four color codes. The codes include red for "Actual Harm or Immediate Jeopardy", yellow for "Potential for More Than Minimal Harm", blue for "Potential Harm", and green for "No Violations Reported."

There is also a place for "Repeat Violations" for "same violation on two or more of the survey dates listed.

The Nursing Home Watch List shows warnings, the name of the facility with a hyperlink to its page, and the address. You can read the list of ratings, violations, and scope/severity codes for each home on the Watch List.

Nursing Home Quality Trends and Staffing includes Quality Indicators developed by the University of Wisconsin. Again there are four color codes to identify the number of quality measures that do not meet standards or to show there is no more than one quality measure not meeting standards.

Reading the lists of violations shows activities such as "Provide services to meet the needs and preferences of each resident".

Depression Is Not a Normal Part of Aging

Caregivers can be alert for signs of depression in the elderly, and the website at psychologyinfo.com explains that depression is not normal at any age. Sometimes people think depression is part of the aging process. Understanding causes and treatments shows that the elderly have options for treatment of depression.

The symptoms of depression in the elderly, related medical illnesses, psychotherapy, and medication are explained.

The website explains that signs of depression might be mistaken for other medical conditions. For instance, depression can include loss of interest, fatigue, and difficulty concentrating.

An evaluation with a healthcare professional is needed when signs of depression are present in the elderly.

Book "How To Say It To Seniors "

"How to Say It to Seniors - Closing the Communication Gap with Our Elders" by David Solie, M.S., P.A. says in the introduction that it "explores the reasons why communicating with the elderly is sometimes so frustrating and offers strategies and skills."

The book explains that seniors may have different phrases, vocabulary, and personal agendas that cause a communication gap when adult children, professionals and workers try to talk to them.

This sounded to me like the books about communicating with teen-agers, but it makes sense that each age group has its own way of talking, its own style of communicating.

The world of seniors is uniquely different from the world of young adults or the middle-aged and they react differently.

Chapters include "Different Missions, Different Agendas," and "The Need for Control".

Insight into the world of seniors can be gained by reading the chapter "Legacy, The Need to be Remembered".

Those of us who work with elderly people as caregivers could improve the way we listen to seniors by knowing what to listen for, and what motivates them. Seeing the world through their eyes, sensing their feelings, is one of the ways we caregivers can learn to communicate with seniors.

The book is available at amazon.com.

Caregivers and Seniors Take a Look at the 20th Century

Looking at the 1900's through the eyes of seniors who experienced the historical events, and whose lives were often impacted by them, can help caregivers to relate to seniors. For instance, a 90 year old person, born in 1917, would have been a ten year old child in 1927. This person might remember hearing adults discussing World War I, the Scopes Monkey Trial of 1925, and Charles Lindbergh, who made the first solo transatlantic flight in "The Spirit of St. Louis," in 1927.

The book "The Astonishing Century" by Robert Joyce is one of the good books for nudging someone's memory of the 20th century.

Some of the people I've assisted have been over 95 years old and they remember the roaring 20's and the flappers.

A person who is 80 years old in 2007 was born in 1927, and would remember the impact of The Great Depression of the 1930's in America. Growing up during the depression era included the stock market crash, the dust bowl, migrations of people moving from the midwest to California, and poverty.

Some of the seniors tell me that to this day they collect objects they no longer need because they grew up with so little that they can't bear to part with hard earned possessions.

Someone who is 70 years old in 2007 was born in 1937, and would remember a childhood growing up during World War II. In 1958 the Explorer I, the first American satellite, was launched and the space program was on its way. This person would have been 20 years old when Elvis Presley, hoola hoops, poodle skirts, and rock'n around the clock was "in".

I know one senior who still has a huge collection of records from that time, and hopes to get a record player to listen to them for old times sake, even though the music is available in other formats now.

A 60 year old person, born in 1949, was a teen-ager when the Beatles were popular and may remember their debut on the Ed Sullivan Show singing "I Wanna Hold Your Haaaaand." This person was a teenager or young adult during the Viet Nam war, the demonstrations, hippies, flower children, and the first man on the moon.

I am in my 50's so I really did grow up with the hippies, the musical "Hair", and Viet Nam.

Some time when you are caregiving, and feel the need to start a conversation, try asking a senior citizen about one of these historical events and ask what he or she was doing at that time.
You can go to infoplease.com or any number of websites for history timelines.

For instance, you could ask a person who is in the 70's what it was like when Elvis first came on the scene, and whether this person ever tried a hoola hoop!