Holidays can be both a joyful and a stressful time for all of us, no matter what stage of life we’re in. But as a family member ages, it can become more and more difficult to continue the family traditions everyone expects, and at the same time ensure that our elderly loved one’s physical and emotional needs are taken into account. Caregivers often struggle with how to juggle events that can be highly stressful, confusing and even depressing for an elderly family member with the needs and expectations of others.
Situations will vary based on the health issues and mobility of your elderly family member, but these 10 tips could help all families and the elderly person they care for find more joy in the holiday season:
- Simplify your holiday. Caregivers of an elderly family member with younger families of their own have a lot on their plates during the holidays. Over-the-top expectations and an “I want to do it all” attitude can bring on a lot of stress. Simplify routines and modify traditions to reduce stress by making a list of all of your chores and then eliminating those that aren’t truly necessary. Figure out how to continue traditions but perhaps in slightly new ways.
- Plan ahead. If older family members tire easily or are vulnerable to over-stimulation, limit the number of activities they are involved in or the length of time they are included. The noise and confusion of a large family gathering can lead to irritability or exhaustion, so consider designating a “quiet room” and schedule time for a nap, if necessary.
- Modify festivities to accommodate individual limitations. Be conscious of potential difficulties with an event or holiday plans for someone with physical or other limitations
- Ask your loved one about their memories. Holidays often bring back memories. Older people whose memories are impaired may have difficulty remembering recent events, but they are often able to share stories and observations from the past. Use picture albums, family videos and music to help stimulate memories and encourage seniors to share their stories and experiences.
- Create new memories. In addition to familiar traditions, seniors need new things to anticipate. Add something new to this year’s holiday celebration. Enjoy activities that are free, such as taking a drive to look at holiday decorations, or window-shopping at the mall or along a festive downtown street.
- Plan how you will pass along holiday traditions. Use the time together for new ways of storytelling and recording family traditions. Step back from simply celebrating the holidays, and think of new ways to record the stories and memories that your parents hold dear.
- Find ways to celebrate long-distance holidays. Circumstances may prevent you from being with your aging parents for the holidays. Be creative and use your imagination for celebrating holidays with elderly parents. For example, hold a “virtual get-together” using Skype, com or FreeConferenceCall.com.Give everyone a chance to talk or even sing together. Reaching out to older relatives who are alone is something all of us can do.
- Acknowledge feelings of grief. Your parents might have new stories about long-time friends that have died. You may have feelings of sadness because they are aging and things are slowing down. If this is the first holiday after one of your parents has died, grief will be very real for everyone. Get a sense of where everyone is emotionally, and what they fear, dread or look forward to about the holidays. Don’t expect immediate agreement about what should be done. Grieving is personal and takes different forms for everyone.
- Avoid embarrassing moments. Try to avoid making comments that could embarrass an older family member who may be experiencing short-term memory problems. If an older person forgets a recent conversation, for example, don’t make it worse by saying, “Don’t you remember?” Just repeat what was said and go on.
- Monitor medications and alcohol. Help seniors adhere to their regular schedule of medications during the chaos of the holidays. Also, pay attention to their alcohol consumption during holiday parties and family gatherings. Alcohol can illicit inappropriate behavior or interfere with medications.
If you need extra help with your loved one during the holidays, give DTN Home Care a call at 701.663.5373. We have staff who can help.
If you’ve been a parent, you’ve surely heard “I’m bored!” countless times. Children often have difficulty thinking of something to do or initiating an activity or a get-together with a friend. The responsibility often falls to parents to suggest the obvious activity or call another parent to arrange a “play date.” If you are the caregiver of an elderly parent or spouse, you may have experienced the same thing. Boredom that leads to depression is a major factor in many homes, senior health care facilities and assisted living homes. The responsibility now may fall on you to keep your loved one busy and involved with other people. Aging is a process, but boredom can be a danger to seniors.
When my husband was first diagnosed as being in the early stages of Alzheimer’s disease, I was told to expect that something with which he would gradually have more difficulty was planning and initiating a healthy variety of activities. I was also told that it would help his emotional health and mental abilities to interact with other people. Knowing this has helped me to take the initiative when it comes to suggesting and planning things we can do together, and also to suggest opportunities for him to call or do things with friends and acquaintances.
Why does keeping seniors busy and social matter?
No one likes to be bored, at any age. Senior citizens are no different, but when they reach their later years, they begin to experience some significant changes in their physical and mental health that tend to limit their activity. We may think of difficulty with memory as the first mental symptom to appear, but often the first noticeable changes are more related to cognitive abilities—the ability to make plans and carry them out, the ability to follow directions, the ability to use language as effectively—all changes that affect a person’s ability to participate in stimulating activities. This means that they need support in more ways than just help with remembering words and upcoming events. Meaningful activities and opportunities to socialize are vital in helping seniors maintain their ability to live independently and even live longer, happier lives, no matter what their physical problems may be.
Community help for seniors and caregivers
As long as a senior’s physical health doesn’t limit their mobility to the point of keeping them homebound, helping them to get involved in community-based programs that promote social interaction and physical activities can be a win/win for both senior and caregiver. Your community may have a Senior Center that offers free exercise programs, various classes geared to older learners, or other skill-building activities like art and music that allow seniors to interact with others, at the same time as filling their days with something other than boredom. Activities and interactions like these can lead to better cognitive, mental and physical health, as well as less anxiety and depression and an increase in happiness and sense of self-worth. A social network and a sense of community with other seniors helps to prevent a feeling of isolation and not fitting in.
In July of 2016, DTN Home Care began a unique collaboration with Proximal 50, a comprehensive wellness center committed to making positive changes in health and quality of life for clients. They provide customizable health and wellness services, including physical therapy in the home for DTN Home Care clients who are homebound. They are our exclusive, recommended provider of in-home physical therapy. You can find more information about our partnership in our blog here.
Alleviating feelings of isolation
My 97-year-old father lives in a very nice assisted living center that plans many activities for its residents, and yet he often reports feeling lonely. Research reveals that nearly 20 percent of seniors feel isolated. The causes for feelings of loneliness and isolation can vary widely, but there are some we can be aware of and help to alleviate. Not having access to transportation may prevent traveling to activities outside the home. For as long as your loved one is able to move about, arranging for or providing transportation to activities in the community or church may be all he or she needs to become involved. Even a short scenic drive can be a big boost to morale. Many organizations can use senior volunteers to perform tasks that are neither too mentally nor physically taxing.
When a person’s physical health limits their mobility and makes it difficult to leave their home, arranging regular visits from family, friends or even professional in-home aides who will read, play games, do puzzles or simply visit and reminisce can be a big boost to mental health. Reminding a senior resident of in-facility activities may be all it takes for them to get involved. Research has also discovered that men tend to have fewer social networks than women and are more likely to experience isolation. Men might need more encouragement and ideas of how to keep busy and be social than women do.
Senior isolation is a social and health issue that affects everyone
Healthy seniors can contribute to communities by bringing a sense of energy, wisdom and experience, and by lending a hand in a variety of meaningful ways. Preventing feelings of boredom and isolation should be a major concern of health care providers and caregivers to the elderly – as high on the list of importance as adequate medical care and supervision. Boredom leads to multiple physical and emotional issues, including:
- Feeling worthless
- Feeling that life is no longer worth living
- Feeling intense restlessness
- Feeling unloved or uncared about
- Feeling suicidal
The National Institute of Aging has identified regular stimulation as a major factor in quality of life between groups of seniors. Those who are mentally stimulated and enjoy social interaction are less likely to suffer from chronic illness and physical limitations. The fight against boredom and depression should be at the top of your senior’s treatment plan.
PRESS RELEASE: Dakota Travel Nurse Home Care is pleased to announce we recently hired Nicole (Nikki) Kinn, Registered Occupational Therapist, to do Home Safety Assessments and give recommendations that will help “Keep Home an Option” for you or your loved one.
During a Home Safety Assessment, Nikki will assess and provide recommendations for issues such as:
- Fall risks and hazards
- Kitchen and cooking safety
- Medication management
- Safe bathing/showering techniques and equipment
- Dressing made easier
- Transfer status throughout living space
- Mobility and related adaptive equipment
- Front-wheeled walker
- Four-wheeled walker
- Grab bars
- Toilet frame
Nikki is a registered occupational therapist and is licensed to practice in the state of North Dakota. She has worked with the geriatric population for the past 10 years. Her primary focus is increasing her clients’ quality of life and the safety in their home environment.
Nikki completed the Masters Program in Occupational Therapy at the University of Mary and has had additional training in accident and fall prevention, interventions for the cognitively impaired and maintaining good nutrition in the elderly population.
If you or your loved one wants to schedule an in-home safety assessment, please call our office at 701-663-5373. We will be happy to answer any questions you have regarding the scope and benefits of this service.
Dakota Travel Nurse Home Care is licensed by the North Dakota Department of Health to provide in home healthcare services. We are locally owned and operated in Mandan, ND. We provide in home nursing care, home health aide care and at home companion care. Call (701) 663-5373 today for a free consultation!
My best friend’s father (Bob) died about three weeks ago, just 10 days after his 95th birthday. He left behind three sons, two daughters and his 91-year-old wife. His memory and his ability to walk had been failing gradually for several years, but a few months ago a stroke left him wheelchair-bound and unable to carry on a coherent conversation. Because his wife and my single friend who lives with her parents could no longer care for him, he spent the remainder of his days in a VA care center. Because of their belief in a better life after death, the family considered his death a blessing, but still it is not hard to see that they are each grieving in different ways.
My friend and her mom were Bob’s primary caregivers. Judy Tatelbaum, MSW, says in an article titled After Caregiving Ends, “There is a natural sense of loss when the need for our caregiving is over. We must often face the double sorrow of losing a loved one and our purpose or role in their lives. The aftermath can be a very difficult time that leaves us feeling lost, lonely, and useless…..It is possible that we’ll feel relief that we don’t have to work so hard any longer, and then feel a sense of guilt for feeling such relief…. All of these are natural reactions. It is important to express our sadness, anger, loneliness, regret, and whatever else we may feel. It is also important that we listen to ourselves and appreciate what we feel as we go through the mourning process.” (We will cover the topic of Caregiver Grief more completely in a future blog.)
Stages of Grief
In 1969, psychiatrist Elisabeth Kübler-Ross wrote about the “five stages of grief.”
- Denial:“This can’t be happening to me.”
- Anger:“Why is this happening? Who is to blame?”
- Bargaining:“Make this not happen, and in return I will ____.”
- Depression:“I’m too sad to do anything.”
- Acceptance:“I’m at peace with what happened.”
Authors Melinda Smith and Jeanne Segal said in an article titled, Coping with Grief and Loss, “Contrary to popular belief, you do not have to go through each stage in order to heal. And if you do go through these stages of grief, you probably won’t experience them in a neat, sequential order, so don’t worry about what you ‘should’ be feeling or which stage you’re supposed to be in…. Kübler-Ross, herself, said of the five stages of grief: ‘They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grieving is as individual as our lives.’”
Help for Coping with Grief
Because Grief is made up of many different emotions that can be different for each individual, meaningful advice on how to cope with grief is difficult to give. If you or a loved one is grieving, you will have to pick and choose between a myriad of suggestions. The important thing is to Do Something that helps you. As my friend’s mom wisely said, “I’m trying not to wallow in it.” Here are some widely accepted ideas from a variety of sources. (See Resources below.)
- Acknowledge your pain and actively grieve and mourn. Trying to avoid feelings of sadness and loss only prolongs the grieving process and can lead to depression, anxiety and other problems.
- Look to and accept the support of loved ones and others. Now is the time to lean on the people who care about you, even if you take pride in being strong and self-sufficient.
- Don’t make major decisions while grieving. Don’t decide to do things like move, change your profession, make major purchases or give up possessions until you are more emotionally stable.
- Take care of your physical and emotional needs. If you feel good physically, you’ll also feel better emotionally. Combat stress and fatigue by getting enough sleep, eating right, and exercising.
- Draw comfort from your faith. If you’re questioning your faith in the wake of the loss, talk to a clergy member or others in your religious community.
- Write about your loss in a journal or a letter saying the things you never got to say. Make a scrapbook or photo album celebrating the person’s life.
- Your grief is your own. Don’t let anyone else tell you when it’s time to “move on” or “get over it.” It’s okay to be angry, to cry or not to cry. It’s also okay to laugh and to find moments of joy.
- Plan ahead for grief “triggers.”Anniversaries, holidays, and milestones can be painful. Be prepared for an emotional wallop, and know that it’s completely normal.
- Contact a grief counselor or professional therapist if you:
- Feel like life isn’t worth living
- Wish you had died with your loved one
- Blame yourself for the loss or for failing to prevent it
- Feel numb and disconnected from others for more than a few weeks
- Are having difficulty trusting others since your loss
- Are unable to perform your normal daily activities
Many different aspects of losing a loved one can cause one to experience grief. My friend is grieving for the loss of her father and her role as his caregiver, for her mother as she struggles to cope with the loss of her husband, for the “new normal” of caregiving she and her mother have to work out together, and for the losses that are making change necessary in both of their lives. Your grief also may be coming from a variety of sources. Even though others have not experienced exactly what you are going through, now is the time to put pride aside and reach out for support and comfort from any source that is available.
My 97-year-old dad has lived in a very nice assisted/senior-living center apartment for nearly two years. Now, when we drive up to it together, he says, “There’s my home!” But he also says, “This is a lovely place, but I’m very lonely.” He has outlived two wives. He married a third time when he was 86 because, he said, “I don’t like living alone.” His current wife is 9 years younger than Dad and doesn’t want to leave her home to live with him. She comes to visit him for a couple of hours four days a week. We make sure that at least one of his children also is there for a visit every day of the week. We often wonder what else we can do!
The center offers several activities each day, and they are good to remind him to participate, but his dementia has kept him from developing any satisfying friendships. Because he aspirates food and chokes if he tries to talk and eat at the same time, mealtime conversations are difficult. I’ve encouraged my four siblings who live out of town to call or write. Sometimes they do, but often Dad doesn’t answer the phone, and when he does, it’s hard for them to know what to say to him. They wonder if a call or a visit is worthwhile, especially when after an hour or two, he can’t remember it even took place. I try to encourage them by saying that even if he doesn’t remember it later, at least for the time he is on the phone or with a visitor, he is happy. Keeping Dad active and trying to prevent him from feeling lonely takes a lot of effort.
A Health Risk of Epidemic-Proportion
Loneliness is said to be an “invisible epidemic” that affects 60 million Americans. A recent New York Times article states, “Researchers have found mounting evidence linking loneliness to physical illness and to functional and cognitive decline. As a predictor of early death, loneliness eclipses obesity.” Dr. Carla M. Perissinotto, a geriatrician at the U. of CA, San Francisco, adds, “The profound effects of loneliness on health and independence are a critical public health problem. It is no longer medically or ethically acceptable to ignore older adults who feel lonely and marginalized.” During 6 years of follow-up, the lonely adults she studied had significantly higher rates of declining mobility, difficulty in performing routine daily activities and death.
John T. Cacioppo, professor of psychology at the U. of Chicago and director of the university’s Center for Cognitive and Social Neuroscience, has been studying loneliness since the 1990s. His research has shown that chronic loneliness can raise blood pressure and decrease blood flow to vital organs. “Loneliness doesn’t just make people feel unhappy, it actually makes them feel unsafe — mentally and physically.” It also affects the production of white blood cells, which can decrease the immune system’s ability to fight infection. An article by Dr. Sanjay Gupta in Everyday Health explains why you should treat loneliness as a chronic illness. It goes on to say, “On the other hand, people who have strong ties to family and friends are as much as 50 percent less at risk of dying over any given period of time than those with fewer social connections.”
What to Do for Yourself or Your Loved One
If you, a loved one or someone you care for is lonely, here are some suggestions that may help, depending on current health and mobility:
- Don’t text. Use the phone and talk to someone.
- If you leave a message and don’t get a return call, call back.
- Plan a low-key activity with someone, like a walk.
- Practice simple acts of social interaction, like saying “hello” to everyone.
- Make the effort to meet new people.
- Check out the resources at your local senior center.
- Contact a friend with whom you’ve lost touch and meet for lunch.
- Volunteer to help others as much as you can.
- Take up a new hobby that fits your current abilities.
- Adopt a pet, if you have the ability to care for one.
- Provide transportation for a short excursion or just a drive.
If You or Your Loved One Is Homebound
Being social can be difficult if you are homebound. Area agencies on aging, places of worship or providers like Dakota Travel Nurse Home Care may be able to offer home-visitation services, companionship or respite care. Help prevent illness by lessening loneliness. Call DTN Home care today for a personal consultation on how we can help. 701.663.5373
Maintaining good oral and dental health can get more and more complicated as your loved one ages. At the same time, it becomes more and more important, and caregivers must assume more responsibility. It should not be neglected, because oral health is necessary for good overall health.
At first, regular trips to the dentist and simple reminders to brush twice a day and to floss daily might suffice. Other tips include drinking tap water that contains fluoride and making smart choices about diet. As dementia or other diseases such as arthritis, Parkinson’s, and movement problems progress, it becomes more difficult physically and mentally for an elderly person to take care of their mouth and teeth on their own. Tasks that were once simple to do become challenging or impossible, and help from a caregiver is required.
Several lifestyle changes also can make it more difficult to keep teeth healthy. As the number of medications increase, so can the side-effect of dry mouth, which can be damaging to tooth enamel. Teeth can become less sensitive to pain, making it more difficult for the elderly person to detect cavities and other mouth problems. When you’re caring for someone with a number of health problems, it’s easy to overlook oral health. This can be dangerous, because bacteria from the mouth can be inhaled into the lungs and cause pneumonia.
Medications, Dry Mouth and Cavities
As we age, we become more cavity prone. A frequent cause of cavities in older adults is dry mouth. Dry mouth is not a given in aging. However, it can be a side-effect for more than 500 medications, including those for allergies or asthma, high blood pressure, high cholesterol, pain, anxiety or depression, Parkinson’s and Alzheimer’s. Tell the dentist about any medications your loved one is taking. These are some common recommendations dentists make to help relieve dry mouth and prevent cavities:
- Consult with a physician on whether to change a medication or dosage.
- Drink more water. Have water nearby, and don’t wait until you’re thirsty to drink. (The elderly may have trouble recognizing that they are thirsty.) Your mouth needs constant lubrication.
- Use sugar-free gum or lozenges to stimulate saliva production.
- Get a humidifier to help keep moisture in the air.
- Avoid foods and beverages that irritate dry mouths, like coffee, alcohol, soft drinks, fruit juices.
- Ask the dentist about applying a fluoride gel or varnish to protect teeth from cavities.
Many elderly adults develop gum, or periodontal disease, caused by the bacteria in plaque. Gum disease can be painless until the advanced stages. If untreated, gums pull away from the teeth and form pockets where food particles and more plaque collect. Advanced gum disease will eventually destroy the gums, bone and ligaments that support teeth, leading to tooth loss. With regular dental visits, gum disease can be treated or prevented.
People with diabetes are twice as likely to develop gum disease. When blood sugars aren’t well controlled, it is harder to fight infections, including infections in the mouth and gums. Infected gums make it harder to control blood sugar. Oral health, blood sugar control and the ability to fight infections are closely related.
Dementia and Dental Care
In the early stages of dementia, focus on regular care and preventing the need for extensive procedures later on. During the middle and late stages of dementia, oral health becomes more challenging. The person may forget what to do with toothpaste or how to rinse, or may be resistant to help from others. Try these tips from the Alzheimer’s Association:
- Provide short, simple instructions. Explain dental care by breaking directions into steps. “Brush your teeth” by itself may be too vague. Instead, walk the person through the process. Say: “Hold your toothbrush.” “Put paste on the brush.” Then, “Brush your teeth.”
- Use a “watch me” technique. Hold a toothbrush and show the person how to brush his or her teeth. Or, put your hand over the person’s hand, gently guiding the brush. If the person is agitated or uncooperative, postpone brushing until later.
- Keep the teeth and mouth clean. Brush the person’s teeth at least twice a day, with the last brushing after the evening meal and any nighttime liquid medication. Gently place the toothbrush in the person’s mouth at a 45 degree angle so you massage gum tissue as you clean the teeth.
- Try different types of toothbrushes. You may find that a soft bristled children’s toothbrush works better than a hard bristled adult’s brush. Or that a long handled or angled brush is easier to use than a standard toothbrush. Experiment until you find the best choice. Be aware that electric dental appliances may confuse a person with Alzheimer’s.
If the person you are caring for wears dentures, check with the dentist for specific instructions as to their care. Be aware of any signs of mouth discomfort during mealtime. Refusing to eat or pained facial expressions while eating may indicate mouth pain or dentures that don’t fit properly.
This blog is not intended to be medical advice, only to make you aware of the importance of good oral and dental health in yourself and your loved ones. Always consult a dentist or oral specialist if you suspect problems or encounter difficulties with maintaining good oral hygiene.
The assisted living center where my dad lives provides each resident with an emergency alert button that they can push when they need help. It also senses when the person wearing it falls and alerts a staff member to come running. At first, Dad had trouble remembering that he could push the button when he needed help, but after a while he got the hang of it. Now the only problem is he has no sense of how much time has passed since he pushed it, so he’s either unhappy that it “took so long” for help to come, or he forgets why he pushed it in the first place. When he still lived at home, we rented a similar button for him, but neither he nor his wife would push it to summon help! You will have to determine whether the following types of devices, jewelry and related services could be a help to your elderly loved one.
A DTN Home Care client recently purchased a MedicAlert bracelet for her mom through the MedicAlert Foundation featured on the Alzheimer’s Association website. In the event that her mom gets lost, which happened recently, there is an 800 number on the back that the person who finds her can call. The emergency response personnel then calls from a list of loved ones to notify the family.
In partnership with the Alzheimer’s Association, MedicAlert has created a specialized program to provide 24/7 wandering protection and emergency response services for individuals living with Alzheimer’s or other types of dementia, who are at risk for wandering and becoming lost or having a medical emergency. If an individual with dementia wanders and doesn’t return, caregivers can call the 24-hour emergency response line to report it. A community support network is activated to help find the person who wandered and return them to the caregiver. The service also provides emergency responders with complete medical information. You can learn more about this jewelry and related services here.
If you want to compare providers and services, a list of the 2016 Best Medical Alert Companies can be found here.
Medical ID Bracelets
Another option is an engravable medical ID bracelet with no services included. The person’s name, a phone number and medical condition—for example, diabetes, asthma, hemophilia, dementia—can be engraved on the back. You can search online for “Medical ID Bracelets.” One example can be found here. (DTN Home Care does not recommend a specific provider.)
Emergency Alert Systems
In an article on agingcare.com entitled How to choose an emergency alert system, author Marlo Sollitto informs us, “More than 33 percent of accidents and falls involving people over age 65 occur at home, according to the CDC….There are many devices available that will instantly summon help in the event of an emergency. Sometimes called Personal Emergency Response System, Medical Alert, or Medical Emergency Response Systems, all systems work in essentially the same way: When emergency help (medical, fire, or police) is needed, the senior presses the transmitter’s button. The elderly person wears the transmitter around their neck, on their wrist, belt buckle or wheelchair. In case of emergency, the senior calls for help by simply pressing the alert button, without needing to reach the telephone.”
What to Look for in an Emergency Response System
An article titled “Home Alone” (Nov 2005, Good Housekeeping magazine) lists tips to help you shop for an emergency response system:
- Price: Compare pricing, features and servicing of each system. ask if the price will increase.
- Hidden Costs: The system should be included in the monthly fee with no up-front costs.
- Contracts: Don’t sign a long-term contract.
- Experience: How long has the company been in business?
- Portability: Can the system be used when away from home?
- Ease of Use: Try out the system and make sure it is easy to use and easy to see.
- Waterproof: Can emergency button can be worn in the bath or shower?
- Trained Operators: In an emergency, you need qualified specialists to assist your parent.
- Hours: Make sure the monitoring center is available 24/7 and also has 24/7 customer support.
- Testing: Ask what procedures the center uses to test systems in your home.
- Repairs: Your system should include repair and replacement service.
What Is the Best Option for Your Loved One?
Before you purchase a wearable safety device &/or bracelet, you will have to consider the special needs of your elderly loved one, including whether or not they will remember to wear it and how to use it. Be sure that your service provider allows a trial period, and that you or your loved one’s caregiver will give the user some time to get used to wearing the jewelry or button and to learn how and when to use it. Once that has been accomplished, you will have more peace of mind that your loved one will be cared for when lost or alone.
Dakota Travel Nurse Home Care is pleased to announce that in July of 2016, we began a unique collaboration with Proximal 50, a comprehensive wellness center committed to making positive changes in health and quality of life for clients. They provide customizable health and wellness services, including physical therapy in the home for DTN Home Care clients who are home-bound. They are our exclusive, recommended provider of in-home physical therapy.
This partnership allows us to tailor our physical therapy services more effectively, especially in the area of tools and resources. We also are expanding our combined services to include post-surgical clients and tailored programs for clients with various disease states such as MS, Parkinson’s and dementia. We are excited about the additional support system that Proximal 50 provides, in addition to our blending of services.
DTN HC works with Proximal 50 to ensure that clients get the physical therapy they need. Required documentation and open and easy communication help us work together for the good of our clients. Proximal 50 shares our philosophy of keeping home an option for our clients. “P50 does not have members…we have clients. This means that all clients will get individual attention and guidance throughout their lifelong wellness journey, to ensure safety and effectiveness.” Our collaborative services are a blending of good people providing good services. We also share a common goal of reaching the community through education, wellness programs and advocacy.
VA clients require a physician’s order to receive physical therapy benefits. Clients who choose to participate in therapy classes or to be evaluated by a licensed physical therapist do not need a physician’s referral. When they see a need, our care givers will recommend physical therapy by Proximal 50 to their clients, who should then check with a physician before beginning any exercise program. P50 notifies a client’s physician of their evaluation and provides updates on the care plan, as needed. Their care plans are a part of our overall care plans for patients who can benefit from this kind of therapy.
We believe in Proximal 50’s philosophy that “Pain is not normal. You shouldn’t have to just ‘live with it’ or ‘work through it.’ Our therapists strive to improve mobility, restore function, prevent injury, and provide less invasive treatment options while reducing overall healthcare expenses and offering an individualized and custom treatment plan.”
If you or your loved one wants to take advantage of in-home physical therapy opportunities made possible by our unique partnership with Proximal 50, please call our office at 701-663-5373. We will be happy to answer any questions you have regarding the benefits of in-home physical therapy.
Dakota Travel Nurse Home Care is licensed by the North Dakota Department of Health to provide in home healthcare services. We are locally owned and operated in Mandan, ND. We provide in home nursing care, home health aide care and at home companion care.
Call (701) 663-5373 today for a free consultation!
My 96-year-old father has had pneumonia 7 times! That is just one of the medical conditions that can result in the pulmonary fibrosis he suffers from now. Because of the condition of his lungs, Dad requires supplemental oxygen 24/7. He has a concentrator that provides oxygen in his room, and he must take a portable oxygen bottle with him whenever he goes more than 50 feet from the concentrator. The refillable bottles must be constantly rotated on to and off of the self-fill portion of the system.
Pulmonary fibrosis is just one lung disease that can require constant or occasional oxygen therapy. One you might hear more about is COPD, a group of lung diseases that includes emphysema, chronic bronchitis, and in some cases asthma. In older people, especially those with memory problems, oxygen use must be closely monitored. Many patients strenuously resist being tethered to an oxygen supply, and loved ones and caregivers sometime have an uphill battle just to keep the oxygen on the patient. If your loved one is able to move around on his own, remembering to change from home to portable oxygen and then back again can be a struggle. As many lung diseases are progressive, the flow of oxygen must be adjusted from time to time. This should only be done under a doctor’s supervision.
Dakota Travel Nurse Home Care serves clients that are on oxygen. They do competency checks with their caregivers to ensure that they know when and how to adjust the oxygen and how to manage the equipment to ensure that there is a steady supply. Family caregivers must also ensure that oxygen equipment is being used correctly and consistently.
2016 Changes to Medicare Laws
A new challenge with my dad’s oxygen needs occurred when I received a letter from his supplier on May 17, 2016, stating: “This is to notify you that changes in the law have altered the way Medicare pays for your oxygen equipment and supplies. The new rules become effective July 1, 2016.” The “bottom line” said in bold, “You have two options: you can continue service with [us] and pay out of pocket for the equipment or you will need to find another supplier….If we do not hear from you, we will be picking up your oxygen equipment on June 30, 2016.”
When I told Dad’s doctor about the letter, his first response was, “Oh, no!” Apparently, he knew something about the difficulties facing us in finding a new “Medicare Competitive Bid” supplier in the ZIP Code where Dad resides. Yes! Your ZIP Code makes a difference. Because the changes are so new, one of the difficulties we encountered was that not everyone at every company knew what equipment they could provide under the new law. The two-page list of suppliers on the Medicare Website was at least 75 percent inaccurate, and when I called Medicare’s direct line, I was read the same list over the phone. On a first call to one company, I was assured that they did provide the Medicare-covered equipment we needed. During a follow-up call, a second person told me that the first person was wrong—that they did not cover Dad’s ZIP Code. We had already sent paperwork from the doctor.
From start to finish, it took more than 6 weeks of continuous effort with 3 different suppliers and many failed attempts to get Dad set up with the prescribed equipment. Even when we got to the point of delivery, the first truck brought the wrong equipment and the next one brought a low-flow concentrator that did not have adequate capacity to also fill portable tanks. I had to accept this one, because the original equipment had already been picked up, and I was desperate. The third supplier I found would not accept the documentation the doctor had provided to the first two, and so we began the whole process again. When all of the documentation had finally arrived and been approved, the company said we had exceeded the 30-day limit from when Dad recertified by the doctor as qualified to received oxygen so we would have to begin again!
With Dad limping along on less oxygen than prescribed and portable tanks we were unable to keep full, I began looking into renting or buying equipment on a self-pay basis. At this point, the low-flow concentrator ceased to function! The supplier reluctantly—because we were trying to replace them—agreed to schedule a next-day delivery of another low-flow system. They told me after the first delivery that they didn’t carry the type of high-flow concentrator Dad needed.
Dad went without any oxygen for more than 24 hours, but when the truck finally arrived, miraculously the high-flow concentrator we’d been searching for was on it! I don’t know where it came from, and I didn’t ask. I was able to tell supplier #3 that we wouldn’t be starting the documentation process again, and we have able to meet Dad’s oxygen needs once again!
If you have a loved one or a client who is on oxygen that is currently covered by Medicare, and you receive a letter like I did, consider these things that I had to find out the hard way:
- The list of medical equipment suppliers who provide oxygen equipment on a Competitive Bid basis, if required in your area, might be short. Don’t wait to start looking for one.
- Save time by first telling the companies you call what the delivery/use Zip Code is and by asking if they service Medicare patients in that area.
- The documentation suppliers require from the doctor is extensive, but they might not tell you exactly what that documentation needs to be until you’ve failed to provide all of it more than once.
- The documentation must contain the exact wording required by Medicare for such things as the type of equipment and the reasons why it is needed. One of my forms was rejected because I left out the word “system.”
- Anything handwritten, such as a date, must be deemed legible by the supplier. I had one document returned as illegible because the bottom part of a 6 was not completely closed.
- The doctor’s oximeter test and the resulting report and all other documentation must be returned to the supplier and approved by Medicare within 30 days of the required testing.
- You may think your doctor and the suppliers you talk to will know everything they need to know about what to provide and how, but because of the recent changes to the law, they might not.
There is some very detailed information online about Medicare requirements that you might not want to read but you probably should. Some links you can follow are at the bottom of this blog. If you know a professional who can help you wade through all of this bureaucracy, take advantage of their expertise!
We all need the right amount of oxygen for our minds and bodies to function at their full capacity. The difficulty of getting that oxygen from a mechanical source that is covered by Medicare just might take Your breath away!
by Marti Lythgoe, Writer/Editor
My 96-year-old father easily aspirates liquids, unless they are thickened. Keeping him hydrated is a challenge. He will eat fruit and ice cream, but he refuses most vegetables and soup, so he doesn’t get a lot of water from his food. His lack of mobility is also an issue. You may have other difficulties hydrating your elderly loved one or client.
Dehydration can be difficult to detect, especially in older people. However, its effect on your client or loved one’s health can be dramatic and even life-threatening. Usually, humans can’t survive more than four days without water. Because body water content decreases with age, especially in women, dehydration can occur fairly quickly. Although knowing the symptoms of dehydration and its damaging effects can be important (see below), having a strategy for prevention is the most important thing for the elderly and their caregivers to focus on.
10 strategies to prevent dehydration in yourself and others:
Staying hydrated is more difficult the older you get. You can’t rely on feeling thirsty and it’s often more difficult to get up and get something to drink.
- Include foods with high water content in your diet, e.g., fresh fruits and vegetables, soup, dairy products.
- Keep a water bottle or glass of water within easy reach.
- Drink a glass of water or another beverage with every meal. Offer a choice.
- Schedule other consistent times when a glass of water is offered, e.g., after going to the bathroom or brushing teeth.
- Drink more than just a swallow or two of liquid with medications.
- Avoid getting overheated. Drink more when you do.
- Drink small amounts frequently throughout the day and less at bedtime.
- Drink liquids regularly, even when you’re not thirsty.
- Consume caffeinated drinks in moderation. Too much can be dehydrating.
- Monitor weight loss. A sudden loss of 2 pounds or more signals dehydration in people over 60.
Signs that you or your loved one might be dehydrated:
Keeping an elderly person hydrated requires constant monitoring. Some of these symptoms my signal other serious conditions. Check with your doctor.
- Low urine output or dark-colored urine
- Dry mouth
- Inability to sweat or produce tears
- Dizziness or difficulty walking
- Rapid heart rate
- Low blood pressure
- Sunken eyes
Dangers of dehydration:
These and other health problems can be the result of dehydration.
- Urinary tract infections
- Bedsoresin bed-ridden patients
- Kidney stones
- Medicine toxicity
- Increase in falls
- Longer stays in rehab facilities.
Some of the risk factors that heighten the chance of developing dehydration include:
- Swallowing disorderscaused by aging, stroke, Parkinson’s disease or dementia
- Patientsover 85 years old
- Diarrhea,vomiting or excessive sweating
- Having5 or more chronic diseases
- Taking5 or more prescription medications
- Diminished drinking due tofear of incontinence
Learning more about staying hydrated, or how to keep your patient or loved one hydrated, and then developing a strategy to prevent dehydration can be very important to overall health and even longevity.
by Marti Lythgoe, DTNHC Writer/Editor