The medical world, families, and patients should all be concerned about the high % of readmissions to hospitals, known as rehospitalization, within the first 30 days of discharge for geriatric patients.  The cost of rehospitalization skyrockets Medicare billing. For senior citizens alone this poses an increased risk of infection, falls, and mental status changes or increased frailty. Families experience added stress and missing work to become caregivers for their elderly loved ones.

Further examining the predicament the 50% of patients being readmitted within 30 days reveals something interesting.  Most had not been seen by their outpatient physician. This raises the question of how patients are following discharge plans and whether or not their families are realizing the importance of reading them and following up on their loved one.

Being responsible for these critical issues is an ominous undertaking for anyone.  Not to mention grocery shopping, medication management, bathing, dressing, and safety in the home.  Figuring out what your parent needs is not easy.  Finding the services they need can be even more challenging. But, stopping the in and out rehospitaliztions is a primary need which will help your parent redevelop his or her resiliency.

HELP IS THE ANSWER. Prevention of these round robin readmissions will make life easier for your loved ones and all of the family members.

Ivory House Health Services is a Geriatric Care Management company which specializes in keeping persons out of the hospital and emergency rooms.  This is accomplished by establishing an accurate Geriatric Care Plan.  This plan of care includes collection of all pertinent information, coordination of all medical services, integration of home care, assessment of needs regarding activities of daily living and instrumental life skills.  The Ivory House staff is highly educated  with a total of 200 years of professional experience. For a phone consultation please call 410-823-3153 or e-mail Hazel Kuchinsky APRN-BC. You can also use this website to ask your questions.

New online Medicare Help for caregivers

Caregivers now have a new resource, the ask Medicare website launched by the centers for Medicare & Medicaid services is designed to provide help with Medicare.

• The site (www.medicare.gov/caregivers) includes information on navigating through Medicare, health care services, link to partner organizations that assist caregivers and personal caregivers’ anecdotes.
• Kerry Weems, CMS acting administrator, says the new site provides valuable one stop resources for caregivers which will help them to better assist Medicare beneficiaries.
• The care that more than 44million Americans provide for  their family members friends or neighbors is valued  at 350 billions annually, according to a recent AARP report. -Rebecca Kern

We know navigating the Medicare System can be challenging for anyone so resources which help with Medicare are extremely useful. “Ask Medicare” provides caregivers with valuable information for Medicare benefits for clients and loved ones.  The site itself is set up in an easy to use fashion with Medicare Basics, Caregiver Support and Care Option sections which are clear and concise.  Ivory House is pleased to share such a wonderful Elder Care resource.

What Causes High Triglycerides?

Triglycerides are a type of fat some come from food and some are made from carbohydrates and other substances. Your body needs some Triglycerides, but high levels can be harmful to your heart.

High levels can be the result of:

• Being overweight
• Not enough exercise
• Drinking alcohol
• Smoking cigarettes
• Certain conditions like diabetes and kidney disease

Triglycerides are measured with a blood test:

• Normal: lower than 150 mg/dl
• Borderline-high: 150-to 199 mg/dl
• High: 200-to 499 mg/dl
• Very high: 500 mg/dl or higher

11 measures for older adults to lower heart risk

1. Daily aspirin (81 mg one baby aspirin) for women over 65 or men of any age.
2. Lower LDL to less than 160 mg/dl in low-risk individuals.
3. Lower LDL to less than 130 mg/dl in high risk individuals.
4. Lower LDL to less than 100 mg/dl in patients with coronary artery disease.
5. Lower LDL to less than 100 mg/dl in diabetic patients.
6. Lower blood pressure to below 140/90 mmhg in non diabetic individuals.
7. Lower blood pressure to 130/ 90 mmhg in diabetic patients.
8. Lower hemoglobin A1C to less than seven percent in diabetic patients.
9. Reduce fasting plasma glucose to less than 110 mg/dl in all older adults.
10. Quit smoking.
11. Reduce weight to a body mass index of less than 30. (Calculate your BMI by dividing your weight in pounds by your height in inches squared and multiplying the result by 703. A BMI between 25 and 29.9 is considered overweight, a BMI of 30 or greater is considered obese.

Signs & symptoms of heart failure:

By themselves, according to the American heart association, the signs of heart failure may not be cause for alarm. But if you have more than one of these symptoms, report them to a healthcare professional and ask for an evaluation of your heart:

• Shortness of breath
• Persistent coughing or wheezing
• Buildup of excess fluid in the body tissues (edema)
• Tiredness, fatigue
• Lack of appetite, nausea
• Confusion, impaired thinking
• increased heart rate

The information in this article is not intended to be substitute for medical care or advice provided by a doctor. Always consult your physician for appropriate examinations treatment and care recommendation .if you have any questions about this information you should call your physician. Specific treatments and therapies may not be covered by your health plan. For questions about your benefits, please consult your health plan. Any references in this material to other  organizations or companies including their internet sites, is not an endorsement or warranty of the services, information or products provided by those organizations or companies  All models are used for illustrative purposes only.

Signs Your Older Family Members May Need Help

Activities for Seniors

Listed below are ideas for activities to do with Senior Citizens or encourage them to do on their own or in a group settings.  Engaging in activities such as these helps keep individuals active and social.  This goes a long way in keeping Seniors happy, healthy and enjoying life.

Sittercise – Encourage gross motor functions.  Sittercise includes having seniors while sitting  kicking legs, lifting legs, lifting hands above head and making circles with hands.  May adapt the hokey pokey to sittercise.

Devotional time – May read a passage from the Bible and sing  hymns.  Must be non-denominational.

Reminiscing Group – Seniors through reminiscenceing recalling memories review them and recapture the moments that went with them.  Seniors enjoy talking about the old days as it gives them a feeling of well-being and raises self-esteem.  Use Reminiscing Book and Magazine

Games - May be gross motor games where resident is moving arms/legs, i.e., basketball, cards, bingo, dominoes and checkers.

Baking Group – Seniors may assist in mixing ingredients, putting dough on cookie sheets, cake in cake pan, icing and decorating cookies, and icing and decorating cakes.  The purpose is not to have the cookies and cake perfect, but have seniors socialize, participate and enjoy the end product.

Reading Club – Consists of reading a short article and discussing it.  May also be looking through magazines and discussing what is in the magazine.  Try to help seniors apply, if appropriate what they read to their lives, i.e. Music boxes relate this to seniors like music boxes; cooking what did the seniors like to cook?  The newspaper can be used.

Current Events – Take an article from the newspaper, current magazine or news from television.  Encourage seniors to talk about the information.  If material is from newspaper or current magazine, may read highlights from article, then discuss.

All movies – Make comments throughout film as to what is happening as well as which stars are in movies.  Try to get residents to talk about what they liked about the films.

Documentary – May be on countries, sports, special events.

Oldies But Goodies – Maybe I love Lucy comedies, Jack Benny, ect…

Sing-A-Long- Play musical tape and help seniors to sing. You may want to repeat a song that that particularly enjoyed.

Creative Arts Group- This group involves the art project that are “free lance art” i.e.. clay, finger painting, paper mache and watercolors. Collages may be made from outdoor gathering and cloth ect…

Letter writing – Encourage seniors to write letters, notes to family members.  You may need to assist them in formulation of thoughts and what to write to family member. Suggest to senior that they tell the family member what they have been doing. ie. cartoonist came and did the presidents; we made cookies today and they were good; or arts and craft project.

Arts and crafts – This may be theme oriented based on what is happening during the month: St. Patrick’s Day, Easter, and July 4^th. May start art and craft one day and finish the next.

Nature Group- This may be a walk, painting flowers or vegetables. May also be a film on nature or watching the Discovery Channel.

Musical Tapes- Have senior listen to quiet music. Let senior select the tape talk a little about the performer before or after the song or tape.

Word Puzzles / Number Games- Do encourage seniors to do word puzzle and number games.

Call Ivory House Health Services if you need assistance
Phone: 410-823-3153
Toll Free: 1-800-704-3536
www.ivoryhouse.net

Depression in the elderly is a problem that largely goes unnoticed.  When caring for the elderly it is important to be on the look out for the signs of depression. Statistics show that depression among seniors is a growing problem in elder care, and elderly caregivers need to understand that life changes for seniors can trigger depression. Qualified geriatric care managers are equipped to deal with these issues and should be utilized by family members, friends or seniors themselves who may be dealing with elderly depression.  Managing life changes with professional assistance should be part of every one’s elder care plans.

Risks of Depression in the Elderly

Bereavement is a common factor of depression in the elderly.  The death of a spouse who has been a support system can be devastating for a senior even though we often see this as a normal stage of life.  The fact is people rarely talk about impending death with family members, have sufficient end of life plans and even plan for life after a the loss of a spouse. Sudden changes without adequate planning can alter the mental health of the elderly

Social Isolation is another risk for depression. Again we often think of the solitude which many seniors face as a normal part of the life process at that stage, but it doesn’t mean that everyone is equipped with proper coping mechanisms. Family moving away, loss of career or the simple fact that a social circle may began to suffer due to the death of friends can bring about social isolation leading to depression.

Deterioration of personal health or the health of a spouse can also lead to depression in the elderly because of the new challenges they face. Loss of mobility, reduction of independence and the need for assistance are things that can seriously change the mindset of a person and in some cases turn a happy person into someone who may feel like giving up.

All of these things can have attitude changing affects on seniors and the solutions often do not help the situation. Learning to go out and be social can cause anxiety for seniors who are used to a set life, and facing the facts regarding assisted living care or other geriatric care management can be stressful without proper guidance. Even drug therapies used for common chronic illnesses can have side effects which lead to or cause depression.

Symptoms of Elderly Depression

Symptoms of elderly depression are not unlike the symptoms of depression among other individuals. Changes in sleep patterns, irritability, loss of appetite and changes of physical appearance regarding weight and grooming are all signs a caregiver should look for.

Internal symptoms of depression can be extreme sadness, confusion, feelings of hopelessness, feelings of worthlessness and thoughts of suicide.

These actions and feelings are quite normal during periods of grief due to loss.  Loss can include the death of a spouse, a job, health or anything mental or physical which has been removed from a person’s life. However, as grief is normal, it is worked through in a reasonable amount of time. Depression lingers and requires action to cure it.

Treating Elderly Depression

Treating Elderly Depression is a very important part of elder care because depression will affect the quality of a senior’s life. The whole idea behind assisted living, geriatric care management and senior care services is to maintain or improve the quality of an individual’s life. So recognizing and treating depression is necessary.

Treatments may include drug therapy, counseling and possibly crisis management. Qualified mental health professionals can make the call regarding the most effective treatment or combination of treatments to best serve the patient.

Depression in the elderly is on the rise due to many factors. In fact, the suicide rates of individuals as they age is increasing at alarming rates. Suicides for people beginning at age 64 are higher than the numbers indicating for the general population. This increases further when people reach their 80’s.

Recognizing the existence of elderly depression and paying attention to it is paramount to any form of care management. It is part of the job of qualified geriatric care managers to asses the mental state of their clients and monitor changes over time or in crisis. This is one of the main reason involving professional senior care is so important when caring for aging parents. Geriatric care managers are available to help families with important decisions regarding in home care, assisted living care, end of life planning and maintaining the quality of life of loved ones.

Elder Care Clients Receive Exemplary In Home Care and Quality of Life

Sandy, Power of Attorney for Mary, contacted Ivory House Care Management in February 2007. Mary, at age 88 years, had sustained a very large stroke and was hospitalized at an acute rehabilitation center for the brain injured. She was paralyzed on her left side, had difficulty swallowing and was incontinent. Her diabetes and hypertension also presented complications. Mary’s long term prognosis was poor. Her physician had told Sandy that she would be lucky to live six months.

Since she had never married, Mary had no close family to care for her. Other than her nephew in Virginia, she had two close friends, Sandy and Clara, who shared responsibilities as Power of Attorney. Also there was Wilbur, a handy man who lived on her property. None of her friends had senior care experience. When the rehabilitation center notified Sandy and Clara that Mary was ready to be discharged, they contacted Ivory House about assisted living care. Mary wanted in home care to be with her cats and friends.

Prior to Mary’s discharge, a geriatric care manager from Ivory House went to visit and reviewed her medical history and progress at the center. She met with the social worker and arrangements were made to have medical equipment and a hospital bed delivered to Mary’s in home care even before she left the center. The geriatric care manager also met with Sandy to review the assisted living care for Mary and discuss several elder care services. Round-the-clock in home health care services were provided.

Pam was the aide from Ivory House who cared for Mary from 7 A.M. to 3 P.M. She and Mary developed a close relationship. Every day Pam would make Mary’s favorite breakfast which included eggs, bacon and fried tomatoes. After breakfast she would bathe and dress Mary and get her up in her chair to watch the “Price is Right” or Animal Planet. Pam also monitored Mary’s blood sugars, blood pressure, level of awareness and general well being. If there were changes, she would immediately call the care manager at Ivory House and have her assess the situation.

Because Mary was incontinent and wore diapers, skin care was especially important. Mary’s senior care manager would visit every 1-2 weeks to assess her skin and general condition. She would then discuss with Pam the best approach to maintaining Mary’s skin. This helped prevent skin breakdown and ulcers from occurring.

After several weeks at home, Mary’s physical condition continued to improve. With exercise and good nutrition Mary was able to go visit the hairdresser and antique business located on her property. By summertime she was strong enough to take short excursions with Pam to the grocery store, farmer’s market and fruit farm in Pennsylvania. Eventually Mary became a “fixture” again at the antique shop and made flower arrangements with Pam during the Christmas holidays.

In September 2008, Mary had her 90^th birthday. Sandy and Clara helped Mary arrange a reception at the L’Hirondelle Club which included Mary’s favorite foods, drinks and a dance band. Pam took Mary shopping at Nordstrom’s for a new silk suit and “strappy” sandals. Although she was wheelchair bound, Mary wanted to look her best for this event.

January 2009 Mary suffered a second massive stroke. After 3 days in the hospital she came home on hospice care. Over the next week family and friends came to visit and say goodbye. Mary died quietly in her sleep and all agreed that she had lived the last two years, as a gift, with quality.

When Do You Need Elder Care for Aging Parents?

Barbara and Emma’s Story

In April of 2006, Barbara’s children contacted Ivory House regarding elder care for aging parents and assisted living care, because they were concerned for their mother Barbara and their aunt.  Both women were in their eighties.  Barbara had experienced a small stroke that affected her sight and was placed on a blood thinner that the doctor was having trouble regulating.  In addition, Emma had begun to have lapses in her memory and was diagnosed with early dementia.  The family thought that both women would benefit from the services of a geriatric care manager.

Barbara and her sister Emma had been close, only 18 months separated them in age, until Barbara married and moved away from Prince Georges County.  Emma stayed at home giving up her hopes of a theatrical career and worked for the State Department in Washington D.C.  Barbara moved to Ruxton and with her husband and raised two children. After Barbara’s husband died, Emma came to live with her sister in an apartment in Ruxton.  Barbara was known as a gardener and both she and her sister loved to cook and bake items for others.

After a thorough assessment which included physical findings, social data, mental health status, and medical record review the geriatric care manager from Ivory House compiled a list of assisted living care recommendations based upon the findings and wishes of all parties.

Elder Care Services Role in Assisted Living Care

Since the sisters’ goal was in home care and neither of them was able to drive a car, transportation was arranged for an aide to be present for four hours on Wednesdays and County Ride applications were completed for transportation to appointments that were scheduled for other days of the week.

On Wednesdays Barbara and Emma were able to go to their favorite places which included Trader Joe’s and the Library, as well as run any other necessary errands.  As much as possible, doctors’ appointments were scheduled for Wednesday.

The Ivory House geriatric care manager also made recommendations for medical care which included, at the client’s request, a physician who specialized in Senior Care and a clinic which was able to get Barbara’s blood thinning medication into control within a few weeks.  An elder care wellness plan was developed for both sisters, and the care manager accompanied them to their physician visits.

Over the next two and a half years, the Ivory House geriatric care manager visited the sisters at least every two weeks to monitor their health and quality of life.  Minor illnesses, such as shingles, colds and urinary tract infections were recognized early and treated without the need for emergency room visits or hospitalization.

Geriatric Care Managers Remain Involved

Both Barbara and Emma remained active and content, living in their apartment.  They enjoyed gardening in the spring and summer months.  When Barbara’s daughter visited from California in June, they would travel to a local orchard to pick cherries and blueberries.  During the summer these fruits would be turned into pies and jams for neighbors and loved ones.  In 2007 Barbara celebrated her 90^th birthday with family and friends.

During the fall of 2008, Barbara began to experience unexplained falls.  Her geriatric care manager from Ivory House arranged for increased aide services to assist with ambulation, laundry, cooking, and light housekeeping.  On an early January morning in 2009, Emma found Barbara lying on her bedroom floor, unresponsive.  She called her neighbor from the apartment across the hall, who in turn called 911 and the sister’s care manager from Ivory House.  The care manager met Barbara, Emma and their neighbor at the emergency room.  She was able to provide the emergency room staff with important health information, medications, and advance directives.

While waiting for the emergency room physician to complete his evaluation, the Ivory House care manager contacted both of Barbara’s children to tell them what had happened.  As they were frantically making arrangements to fly in from California and Puerto Rico, the emergency room physician talked with Emma and the care manager regarding Barbara’s condition.  She had sustained a large stroke that was incompatible with life.

After a discussion with the family, life support measures were discontinued.  Since Emma was emotionally not able to do so, Barbara’s care manger stayed with her until she passed away peacefully.  Barbara’s daughter arrived from California later that evening and her son arrived from Puerto Rico the next morning.  Both were grateful, knowing that their mother had received the best of care and had not been alone during her death.

Emma continues to live in the apartment that she shared with her sister.  Her Ivory House care manager visits weekly and she has an aide who assists her on Mondays, Wednesdays, and Thursdays.  Next month Emma will be ninety and a party is in the planning stage.  Her niece and nephew continue to frequently visit.  Friends often have Emma over for dinner and her neighbor checks in with her on weekends.  Last week she and her aide planted Pansies to welcome Spring.