You can take steps to protect yourself from developing cardiovascular disease, even if you are at risk. The best way to prevent this condition is by following a healthy lifestyle, which includes not smoking, exercising regularly, eating a balanced diet and maintaining a healthy weight as well as getting enough sleep and regular checkups with your doctor.Continue reading
Planning For The Future
It is important to plan for the future and empower ourselves with options that meet our needs and desires. When faced with a life-limiting or terminal illness, many decisions must be made. These decisions can involve financial matters, advance directives, funeral arrangements, how the last days of life will be spent, and other issues. Even though discussing these issues may bring up feelings regarding difficult losses and changes, it is important to be proactive and to communicate in order to ensure choice and control during difficult times.Continue reading
6 Ways to Make a Home Safe and Comfortable for Seniors
Losing strength and balance can be common consequences of aging, and living with these changes is rarely easy. It is frustrating not to be able to do everything you once could; it can also be dangerous due to an increased likelihood of falls.
Changes in mobility can make your own home seem like a dangerous place. However, there are ways to make the home a safer place for seniors. With a few alterations and upgrades, you can live comfortably in your home again or bring aging loved ones into your home safely. Here are six ways you can bring your home up to snuff for anyone easing into old age.
Avoid Tripping Hazards
Falls are a serious hazard for older adults, often resulting in injury or even death. Fortunately, the necessary adjustments for avoiding trips are simple. Remove throw rugs from the floors as well as cords and other items that can be tripped over. Move furniture around so that there are large pathways that will be easier to navigate. Outdoors, make sure walkways are smooth and kept clear of debris. If possible, remove thresholds between rooms and into the home so an older person does not have to step over the threshold.
Stairs can be difficult for seniors to navigate, whether they are painful for aching joints, cause balance issues, or are just harder to climb than they used to be. If you are looking for a new residence that is senior-friendly, stay away from stairs if possible. When making changes to a home, trade the stairs for a ramp for a wheelchair. Leading up to the home, take out stairs and instead use an inclined walkway. Inside the home, be sure stairs have handrails and add nonslip tread to avoid falls. A stair lift can also be installed to help a person get up and down.
Install Better Lighting
Adequate lighting is critical for seniors, especially when their eyesight begins to worsen over time. Make sure the home is well lit in every room. Good lighting can help a person to get around their home safely and avoid tripping over objects or bumping into furniture. Put bright lights in hallways and stairs and add extra lamps. Outdoors, make sure pathways are well lit. Consider motion-sensor lights that will help keep the area bright at all times and will not need to be turned on.
Provide Easy-To-Use Appliances
One aspect of a senior-friendly home that may not be as obvious are the appliances. Appliances can become more difficult to use as eyesight declines and technology advances. Find simple, easy-to-read appliances, such as microwaves with programmed buttons. Look for appliances with an automatic shut-off, which will ensure they do not stay on if they are forgotten. Find appliances that may be easier for someone with limited mobility, like a side-by-side refrigerator and freezer. Adjust the water heater to avoid scalding injuries.
Renovate the Bathroom
The bathroom is a prime location for falls among the elderly, especially those with poor strength or balance. Several changes in the bathroom can help a person maintain their independence and reduce the risk of getting hurt. Install grab bars in the shower or next to the toilet to help with standing up and exiting or entering the shower. If a tub is being used, a bench or bar can help give support while stepping into or out of the tub. Shower chairs and nonslip mats also help prevent slipping while showering and bathing.
Make It Easy on the Hands
People with arthritis or weakness in their hands may find it difficult or painful to do simple tasks like turning on the lights or opening a door. Some relatively cost-effective changes can make these acts much easier. Change out light switches with a toggle switch and change doorknobs and faucets to levers. These alternatives can lessen the amount of force and grip strength needed. A slip and fall can be life-changing or even life-ending, for a senior. Make your home a safe and comfortable environment by making changes in layout, fixtures, and appliances. The changes are small, but the gains in safety are enormous.
The “Things” Part of Hospice
Hospice provides medications that address symptoms related to the terminal diagnosis. All medications are prescribed by the attending physician and delivered by a courier service to the patient’s home. Medications are available to the patient 24 hours a day. The hospice nurse is responsible for ordering medications and will arrange for delivery at a time convenient to the patient/family. Let the office know if the patient is running low on any medication.
Medical supplies, walkers, wheelchairs, hospital beds, oxygen and other medical equipment that would be of service can be delivered to the patient’s home. Elite Hospice orders this equipment, which is delivered by our supplier. Equipment that is no longer needed will be retrieved by the equipment company at the request of the patient, family, or an IDG member.
Where does Hospice Care Happen?
Hospice is a type of care, not a place. Hospice can happen wherever a patient calls home. This could be in a Skilled Nursing Home (SNF), an Assisted Living Facility (ALF), Independent Living Facility (IL), their home – such as a house or an apartment, even a hotel or homeless shelter.
Hospice Care in a skilled nursing facility is quite similar to home hospice care. Hospice manages all care related to the patient’s terminal diagnosis. In many cases, the staff of the nursing facility acts as the primary caregiver (a role that must be filled by family, friends, or in-home staff when hospice is given at home — see our section on The Caregiver’s Role). Elite Hospice collaborates with each facility in which our patients reside to develop a coordinated Plan of Care, which ensures that all caretakers are working together to meet the patient and family’s needs, wishes, and goals.
It is important that the entire team, staff, and volunteers communicate effectively with facility staff when visiting a patient.
THE MEDICARE / MEDICAID HOSPICE BENEFIT
The following levels of care are available under this benefit.
Routine Home Care
This is the most frequently used level of care. Under a Routine Level of Care, the Hospice Team is available on a scheduled basis and is available for consultation or to make a visit 24 hours a day. Visit frequency is determined by the IDG in response to the patient’s needs and is documented in the Plan of Care.
General Inpatient Care
Short-term inpatient care may be used during times when a patient and/or family has an immediate and apparent need. This level of care is most often needed for pain control or acute symptom management and can only be provided in a Skilled Nursing Facility or hospital that is contracted with Elite Hospice. Once symptoms are well-managed, the patient will be returned to the routine level of care, in the current setting, or at home.
How do patients pay for Hospice?
Most of Elite Hospice’s patients utilize a Medicare or Medicaid benefit. This usually covers 100% of the cost of Hospice. Some patients use private or commercial insurance. These patients often have a co-pay. Because we receive money from the federal government for Hospice services we have to follow their guidelines. Hospice is required to pay for the “people” and the “stuff” as shown above for our patients when it is related to the terminal diagnosis or to comfort. We are also responsible for moving patients to different levels of care if their symptoms require it.
Inpatient Respite Care
Inpatient respite care is available to home patients in order to give the caregiver relief and is limited to five consecutive days. This level of care is provided in a skilled nursing facility.
Continuous Home Care
Continuous care is provided when symptoms need acute management in order to prevent hospitalization. Under the continuous care benefit, a minimum period of eight hours of care is provided during a 24-hour day. Nursing care by either a Registered Nurse (RN) or Licensed Practical Nurse (LPN) must be provided for more than half of this period of care.
Signs and Symptoms of Approaching Death
When diagnosed with a life=threatening illness, a person begins a new journey in life. Each journey is unique, and we all handle death in our own way. As time progresses toward a person’s death, that person will undergo some changes. The person will prepare physically, emotionally, mentally, and spiritually. Few things about death and dying are predictable- nobody knows when it will happen, how it will happen, who will be present, or what feelings it will bring up. A patient and family must be prepared to work through this process as it unfolds, discovering the patient’s own unique journey. The wishes of the patient should be followed whenever possible.
On the physical level, the body begins the final process of shitting down. Usually, these are an orderly and undramatic progressive series of physical changes, which are not medical emergencies. These physical changes are normal and may occur quickly or over a period of time.
Coolness and Mottling (blotches of discoloration of the skin)
The person’s hands, arms, feet, then legs may be increasingly cool to the touch and the color of the skin may change. The underside of the body may become darker and the skin becomes mottled. This is a normal indication that the circulation of blood is decreasing to the body’s extremities and being reserved for the most vital organs. Keep the person warm with a blanket, but do not use an electric blanket or heating pad.
The person may spend an increasing amount of time sleeping, appear to be uncommunicative or unresponsive, and at times, difficult to arouse. This normal change is due in part to changes in the metabolism of the body. Sit with them; hold his or her hand. Speak softly and naturally. Speak to him/her directly as you normally would, even though there may be no response. Never assume the person cannot hear; hearing is the last sense to be lost.
The person may seem to be confused about the time, place, and identity of people surrounding him/her, including those close and familiar. This is also due in part to metabolic and oxygen supply changes. Identify yourself by name before you speak. Speak softly, clearly, and truthfully when you need to communicate something important to the patient’s comfort such as “it is time to take your medication” and explain the reason for the communication such as “so you won’t begin to hurt”.
The person may lose control of bladder and/or bowels as the muscles in that area begin to relax. Discuss with the hospice nurse what can be done to protect the bed and keep the patient clean and comfortable.
You may hear gurgling sounds coming from the person’s throat or chest as though marbles were rolling around inside. These sounds may become very loud. This normal change is due to the decrease of fluid intake and inability to cough up normal secretions. Suctioning usually only increases the secretions and causes sharp discomfort. Gently turn the person’s head to the side to allow gravity to drain secretions. You may also gently wipe the mouth with a moist cloth. The sound of the congestion does not indicate the onset of severe or new pain.
The person may make restless and repetitive motions such as pulling at the bed linen or clothing. This often happens and is due, in part, to the decrease in oxygen circulation to the brain and to metabolism changes. Do not interfere with or try to restrain such motions. Talk to the Elite Hospice team about methods to assist in relaxing the person.
The person’s urine output normally decreases and may become tea-colored, referred to as concentrated urine. This is due to the decreased fluid intake as well as decrease in circulation through the Kidneys.
Fluid and Food Decrease
The person may have a decrease in appetite and thirst, wanting little or no food or fluid. The body will naturally begin to conserve energy for other functions that would otherwise be used in digestion. Swallowing and normal reflexes can become sluggish and nourishment by mouth can carry the risk of choking. Do not try to force food or drink into the person. Doing this only makes the person much more uncomfortable. Although it can be difficult to disassociate food with love, refusal of offered nourishment is a choice that needs to be honored. Small chips of ice, frozen Gatorade, or juice might be refreshing in the mouth. If the person is able to swallow, fluids may be given in small amounts by syringe (ask hospice nurse for guidance). You can try raising the head of the bed to make swallowing easier. Elite Hospice can provide glycerin swabs to help keep the mouth and lips moist and comfortable.
Breathing Pattern Change
The person’s breathing pattern may change becoming more labored, irregular, or noisy. The person may breathe deeply and then pause for a long time – 10 seconds to a minute – before breathing resumes. This is called apnea and causes the person no discomfort. These patterns are very common and indicate decrease in circulation in the internal organs. You may want to elevate the head or turn the person on his/her side. 18
In addition to physical/medical symptoms, the process of dying includes the spirit beginning the final process of release from the body, its immediate environment, and all emotional attachments. This release tends to follow its own priorities, including the resolution of unfinished business, reconciliation, affirmation of close relationships, and accepting permission from family members to let go. Support and encourage this transition.
The person may seem unresponsive, withdrawn, or in a comatose-like state. This indicates preparation for release, a detaching from surroundings and relationships, and a beginning of letting go. Since hearing remains until the end, speak to the patient in your normal tone of voice, identify yourself by name when you speak, hold his/her hand, and say whatever you need to say that will help the person “let go.”
The person may speak to or claim to have spoken to persons who have already died. He/she may see or have seen places or things not presently accessible or visible to you. This doesn’t indicate a hallucination or drug reaction. This person is beginning to detach from this life and is being prepared for the transition. You may hear the hospice team refer to this process as “celestializing.” Affirm his or her experiences—just because you cannot see or hear these things does not mean they are not real to the patient. If they frighten the patient, explain to him/her that these visions are normal and common. The Chaplain may be a good resource in this situation.
Your loved one may want to be alone or with only a few people. This is a sign of preparation for release and an affirmation of whom the support is most needed in order to make the appropriate transition. If you are not part of this “inner circle” at the end, it does not mean you are not loved or important. It means you have already fulfilled your task with him/her, and it is time for you to say goodbye. If you are part of the final “inner circle” of support, the person needs your affirmation, support, and permission.
A Need for Permission
Giving permission to your loved one to let go without making him/her feel guilty for leaving or trying to keep him/her with you to meet your own needs can be difficult. Despite prolonged discomfort, a dying person may hold on to be sure that those who are going to be left behind will be all right. Therefore, your ability to release the dying person from this concern assure him/her that it is all right to let go whenever he/she is ready is one of the greatest gifts you have to give your loved one at this time.
When the person is ready to die, then it is time to say goodbye. Saying goodbye is the final gift of love to the patient, for it achieves closure and makes the final release possible. Family members may find it helpful to lie in bed with the person and hold him/her or to take his/her hand and say everything they need to say. It may be as simple as saying “I love you.” It may include recounting favorite memories, places, and activities you shared. It may include saying, “I’m sorry for whatever I contributed to any tensions or difficulties in our relationship.” It may also include saying “Thank you for…” Tears are a normal and natural part of saying goodbye. Tears do not need to be hidden from the patient or apologized for. Tears are an expression of love and may assist in “letting go.”
Elite Hospice Social Workers and Chaplains can be available to provide additional support during this time. It may also be helpful to seek a spiritual advisor with whom the patient has a relationship to come and provide reassurance and support during the last days. In addition, some volunteers specialize in what is called “11th hour support,” and are there to serve the patient and family may have throughout the dying process.
How will you know when death has occurred?
Signs of death include no breathing, no heartbeat, release of bowel and bladder matter, no movement of arms and legs, fixed eyes, no blinking, relaxed jaw, and slightly open mouth.
If you are with the patient at the time of his/her death:
- Call Elite Hospice — there is no need to call the coroner or police.
- DO NOT CALL 911.
- Turn off any electrical equipment attached to the patient’s body, but leave any tubes or attachment devices in place.
- Follow any religious observances that were requested by the patient.
- Call any friends or family members who may wish to spend some private time with the patient before the body is taken by the mortuary.
- When the family is ready, the nurse will call the mortuary.
Death comes to us all and most of us will experience numerous deaths of loved ones. Each one will affect us in different ways. After the patient’s death, be sure to express your needs with the Elite Team and your family and friends. Find some alone time to reflect if you need to. This will be a period when you start the grieving process, which is necessary in healing. The Elite Hospice team will be there to assist during this process.
Five Tips to Help Your Loved Ones Pare Down Their Belongings
As your loved ones enter their golden years, their home becomes their sanctuary. But if they’ve kept all the tokens of love over the years, their home is probably too cluttered for them to navigate safely. This can be a health hazard, both physically (tripping and falling over things) or mentally (hoarding).
Here are some tips to declutter your loved ones’ homes and help them lessen their belongings so that they can remain safe and happy in their living spaces.
Put Safety First
Your elderly loved ones have spent decades with their belongings- especially if they’ve remained in the same home- and they have created an emotional attachment to many of the items in the house. Although each item may have a special place in their hearts, the more items in the house, the more dangerous navigating between the clutter becomes. Help them see the safety benefits of organizing and decluttering so that they will change their attitude about the decluttering process.
Sometimes extreme clutter means that your loved one has developed a hoarding problem. Healing a hoarding issue takes time and patience, so we recommend you find a good support system for you, your loved one, and the rest of the family. Love, support, and patience are key in decluttering the house. Whether your loved one has a hoarding problem or not, groups like the IOCDF (International OCD Foundation) offer great suggestions and tips for those struggling with clutter.
Take It Slow
Always remember to start small. You don’t want to overwhelm your loved ones by renting a dumpster for a weekend and completely gutting their house. Be satisfied with baby steps in the right direction. Try starting with one room- or even a cupboard- so that your loved one can work through the process of decluttering with you. Remember: Patience is always important in these situations.
Put it in a Box
Persuade your loved one to handle an object only once. Allow him or her time to look at the object and make a conscious decision about whether to keep it or not. The more the object is handled, the harder it is to make a decision. Make three piles (or have three boxes) in each room: one for keeping, one for throwing away, or one for donating. If your loved one can’t decide whether to throw it away, put the item in a box for up to six months. Then, he or she can revisit the item and decide what to do with it.
Share heirlooms with those who want them
To help your loved ones in the process of decluttering, gather the family together and distribute any cherished heirlooms. Your loved ones will feel secure knowing that the item isn’t going to waste, and you will get to keep something special.
The process to declutter your parents’ home can be long and difficult. But if you remember to keep safety at the top of your priority list, find a good support system, go slowly and steadily, put everything in a box, and keep the heirlooms, the level of stress and hardship will be minimized.