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Keeping home an option!

National Home Care & Hospice Month: Keeping Home an Option for Dying Loved Ones

New LogoNovember is National Home Care & Hospice Month. We invite you to join us in honoring the millions of nurses, home care aides, therapists, and social workers who make a remarkable difference for the patients and families they serve. Dakota Home Care is privileged to share the stories of two of our clients for whom home care and hospice made a remarkable difference for them and their dying loved one. 

Todd Kuester & His Wife Terry

In the fall of 2016, My wife, Terry, was diagnosed with terminal brain cancer. She was given only 18 months to live, but with chemotherapy, radiation, and loving care she was able to live for 29 months. With the help of Dakota Home Care and Hospice, she was able to stay in our home—her dream home—until the day she died.

About a year ago, Terry’s cancer, which had been in remission, came back with a vengeance. She became paralyzed on her left side. At that point, we knew we needed help. Terry told me to put her “in a home,” because she didn’t think I could take care of her—it would be too hard. I told her “You live in a home.” I knew she wanted me to take care of her.

A doctor at Sanford hospital, gave me some names of home healthcare companies. I called Dakota Home Care (DHC) first. They sent a Registered Nurse (RN) to meet with us and assess our needs. I asked, “What if my wife doesn’t hit it off with the people you send?” The RN immediately replied, “Let us know, and we’ll get someone else!” I was very impressed by that.

In January, DHC sent us two very kind and loving CNA caregivers, Viola and Shannon. They were God’s angels on earth. They were very good to work with and seemed very knowledgeable. They came in shifts from 8:00 PM – 8:00 AM to help with night care. Terry had bad headaches. I set out her medication and Viola and Shannon gave it to her at night and helped with all of her personal needs. They did everything I asked.

Viola is from Africa, and she would sit and have conversations with Terry about her husband and how she was working to get him here. Shannon was the same way. She had lived in ND all her life, so she and Terry had a lot in common. She loved to hear their stories, and they listened to Terry’s stories, too. It was very important for her to have that interaction with other people

On March 7th Terry decided to stop treatment and go on hospice. The doctor at Sanford Hospital assigned a nurse and an aide, but they only came twice a week for about an hour. DHC worked side by side with hospice, and filled in the gap when hospice wasn’t there. I didn’t know what to expect when someone dies. I was an emotional wreck. Terry was my high school sweetheart. They told us what to expect. That was calming for both of us. It really helped to comfort me while going through the process.

The night Terry died, Shannon was on duty. I was upstairs, and she told me it was time to come down.  I got on Terry’s bed and held her hand. Shannon sat in a chair and held her other hand. After Terry took her last breath, Shannon quietly got up and left the room and gave me time alone with my wife. She came back in when I stopped crying. She sat with Terry while I made calls. When I came back, she was still there holding her hand. She didn’t leave until 4:30 in the morning. Viola would have done the same thing.

Terry passed away at home after being on Hospice for just 19 days. We’re all going to die. DHC and Hospice help people in the process of going from this world to the next, while staying at home. I’m telling my story out of love and respect for my wife. It’s beneficial to me to talk about her, and I hope it helps other people who will go through the same thing. I’m doing what Terry and God would want me to do.

Becky Mahlum & Her Husband Mike

I would not have been able to keep my husband Mike at home had it not been for the good care we received from Dakota Home Care (DHC) and the Hospice Care from Sanford Hospital. Mike died on Sept. 1st from complications of Multiple Sclerosis. (MS) He had been on Hospice care for six months, but I wish I had used it longer. He was considered terminal a year and a half before he died. I tell people that making the decision to go on hospice may feel bad at first, like you’re giving up on the person, but you shouldn’t be afraid of that decision. You can always go off of it. Just say yes to it!

A year and a half before we put Mike on Hospice, I had help from CNAs sent by DHC. Acceptance of home care can be a hurdle to get over. I had to get used to the idea of having someone in my house all the time, but I got over that! They became like family. You get attached. They make it possible for you to do all the things you have to do. Mike needed someone to be at home with him. They came during the day for 7 hours while I was at work. Having their help made it possible for me to go to work without worrying about what was going on at home. I could also arrange to have them there overnight if I had to go out of town.

DHC hires really nice people. They helped Mike with meals, read the paper to him, talked to him. He came to rely on them. His attention shifted from me to them. When they came in, they would say “Hi” to me, but then it was all about Mike. They even took care of the dog, mopped the floor and kept my house clean. And they did everything with such kindness, such loving care. It takes a special person to do that. I don’t know how they do it every day.

The combination of Hospice Care and additional help from DHC was wonderful. During certain days of the week the hospice aide would come in and help the DHC CNAs with Mike’s bathing. They worked together and were respectful of each other.  Hospice CNAs would also come for an hour in the evening, so I could have some down-time after work. It was really nice to talk to them. They gave me emotional support. The DHC and hospice people “have been there before.”

Having the hospice RN come to our house was comforting. She visited while the DHC CNAs were there. They could tell me what symptoms were normal and what showed a progression of his illness. I didn’t have to think about that or wonder if I should be doing something else for him.

I was so blessed to be able to keep Mike at home. That was what he wanted. I was especially glad that I could be there on days when he was scared. He would call out to me, and I could say “I’m here.” Having the help from Dakota Home Care and Hospice was such a gift. They helped us get through a very hard time!

If you think Dakota Home Care could help you and your loved one, call us at (701) 663-5373 to make an appointment for your free assessment.


Physician & Surgical Appointments—Transportation & Advocacy: A new service from Dakota Home Care

Transport serviceIn his 90s, my dad always needed someone to take him to a Dr. visit, not only because he couldn’t drive, but because he couldn’t give vital information about himself, describe what was wrong, ask follow-up questions or remember what he had been told and instructed to do. He needed an advocate. Now, I am going with my 79-year-old husband to most of his doctor visits, because even in early-stage Alzheimer’s, he has similar difficulties.

But what if you can’t be there to transport your loved ones or advocate for them, whether it be for regular Dr. visits or pre- and post-surgery? 

Dakota Home Care now offers services for families that can’t always transport or advocate for a loved one who can’t or shouldn’t be expected to do it for themselves.

Regular MD Appointments

Every elderly, or handicapped person probably has more than the usual number of appointments required to maintain health or to deal with chronic illnesses or pain. Even you might be intimidated during an appointment. You would be relieved to have someone there who knows the pertinent information to give about the patient and the important questions to ask. A Dakota Home Care Nurse has years of experience, will know what to say and will understand what the doctor says, giving you peace of mind and guidance through the whole process.


  • Transportation to and from the doctor’s office
  • Expertly advocating for the patient during the visit
  • Helping describe the purpose of the visit to a medical professional
  • Asking pertinent questions about the patient’s wellbeing
  • Reporting the findings of the visit and care recommendations to the family

Having Surgery

A diagnosis that requires surgery can be frightening and raise many questions about navigating and getting the best results from the whole process. There will be pre- and post-surgery doctor visits, and especially the uncertainty of what will happen on the day of the surgery and at home, and how you will manage it. Ask Dakota Home Care which of their services could simplify the big day and its aftermath for you and/or your loved one.


  • Pre- and post-surgery advocacy with physicians and surgeons
  • Checking in on the patient during the days following surgery
  • Watching for complications and calling the doctor about anything out of the ordinary
  • Making sure the doctor’s orders are being followed
  • Transportation and advocacy for post-surgical appointments

Don’t be overwhelmed by frequent doctor visits or the logistics and aftermath of surgery. Call Dakota Home care at 701-663-5373 for a free consultation regarding which of their services will be most helpful for you and your loved one.

World Alzheimer’s Month: Raise Awareness and Challenge the Stigma

World Alzheimer's MonthDementia is a collective name for progressive degenerative brain syndromes that affect memory, thinking, behavior and emotion. Alzheimer’s disease is the most common type, affecting up to 90% of people living with dementia. Other types include vascular, Lewy bodies and frontal-temporal dementia.

World Alzheimer’s Month is the international campaign held every September by Alzheimer’s Disease International (ADI) to raise awareness and challenge the stigma that surrounds dementia. World Alzheimer’s Day is on September 21st. Two out of every three people globally believe there is little or no understanding of dementia in their countries. The impact of World Alzheimer’s Month is growing, but the stigmatization and misinformation that surrounds dementia remains a global problem requiring global action. World Alzheimer’s Month seeks to unite opinion leaders, people with dementia, caregivers and family, medical professionals, researchers and the media from all around the world. More information about the campaign can be found at https://www.worldalzmonth.org/ .

Raising Awareness

Dakota Home Care is committed to supporting the goals of World Alzheimer’s Month. We respectfully provide specialized care for clients with Alzheimer’s and other forms of dementia. We work with the local Alzheimer’s Association for education and training and facilitate home consults with their specialists. We provide in-house, online and hands-on training for caregivers. Through our blog, we also raise awareness about dementia and caring for those who have it. You can learn more about these 10 related topics by clicking on the links:

Challenging the Stigma

The Oxford dictionary definition of stigma is “a mark of disgrace associated with a particular circumstance, quality, or person.” The Collins dictionary states “If something has a stigma attached to it, people think it is something to be ashamed of.” 

How to deal with the stigma associated with the disease is often a primary concern of people living with Alzheimer’s and their caregivers. The myths and misconceptions, the lack of public awareness and understanding, and the use negative labels to identify a person with dementia all contribute to the stigma.

Stigma can prevent people from:

  • Seeking medical treatment
  • Receiving an early diagnosis
  • Living the best quality of life possible
  • Making plans for their future
  • Benefitting from available treatments
  • Developing a support system
  • Participating in clinical trials
  • Contributing to disease research

Experiencing Alzheimer’s stigma

Stigma and stereotypes are a significant obstacle to well-being and quality of life for those with dementia and their families. Here are some examples of the stigma those living with dementia may experience:

  • Friends may refuse to believe your diagnosis or withdraw from your life.
  • Family members may not want to talk about the disease, or may avoid interacting with you.
  • Others may approach your care partner, rather than asking you directly how you are doing.
  • Associates may not understand all of the things you are still able to do.

Five tips to overcome Alzheimer’s stigma

The following tips are based on the experience of members of the Alzheimer’s Association National Early-Stage Advisory Group, which consists of individuals in the early stage of the disease who help raise awareness about the disease. If you are the caregiver, practice these tips and share them with your loved one who has the disease:

  1. Be open and direct. Engage others in discussions about Alzheimer’s disease and the need for prevention, better treatment and an eventual cure. Engage with others like you.
  2. Communicate the facts. Sharing accurate information is key to correcting misconceptions about the disease. Offer information to help people better understand Alzheimer’s disease.
  3. Seek support and stay connected. Stay engaged in meaningful relationships and activities. Whether family, friends or a support group, a network is critical.
  4. Don’t be discouraged. Denial of the disease by others is not a reflection of you. If people think that Alzheimer’s disease is normal aging, see it as an education opportunity. Click here for some tips for helping family and friends adjust to your diagnosis.
  5. Be a part of the solution. As an individual living with the disease, yours is the most powerful voice to help raise awareness, end stigma, and advocate for more Alzheimer’s support and research.

World Alzheimer’s Month can serve as an incentive to all of us to acquire more information about Alzheimer’s disease and other types of dementia and a reminder to not contribute to the stigma felt by those who live with it. At Dakota Home Care, these are our goals all year long.

Recognizing when Death is Near: How to Plan and What to Expect

End of life signsIt can be just as difficult to predict the exact time that someone will die as it to predict exactly when a baby will be born. However, there are signs you can watch for that will help you prepare mentally, emotionally and physically for this big change in your family’s life.

As you care for your loved who may be near death, look for normal signs like these:

  • Losing interest in and becoming less responsive to what is going on around them
  • Sleeping or seeming drowsy most of the time
  • Eating and drinking less than usual or not at all
  • Irregular breathing, including noisy or gurgling sounds, sometimes called a “death rattle”
  • Talking to someone who has already died
  • A brief surge of energy and clarity of mind

The loved ones of a person who is dying want to know what they can do to make the person more comfortable. Even though a dying person may seem unconscious, many professional caregivers think hearing may still be functional. Continue talking to your loved one. Express your love, hold their hand and reassure them that they can go when they are ready. Take advantage of a brief period of consciousness to say final goodbyes. Even though my father couldn’t talk, we put the phone up to his ear to let out-of-town family members talk to him. He seemed to respond to hearing their voices.

Don’t try to force food or water. Going without food or water is not uncomfortable. Swallowing may also be a problem, especially for people with dementia. A conscious decision to give up food can be part of a person’s acceptance that death is near. If the person’s mouth seems dry, just swab it with water and apply lip balm. A “death rattle” may be helped by turning the person to one side. Pain killers often make breathing easier, as well.

Ask for help when you need it and graciously accept it when it’s offered. Some specific tasks that you could assign to others include picking up the mail or newspaper, writing down phone messages, doing a load of laundry, feeding the family pet, taking children to their activities, picking up medicine from the pharmacy, paying bills, walking the dog, babysitting or bringing in meals. Help with any of these tasks may provide welcome relief for caregivers.

Keeping close friends and family updated can be a big job. Setting up a family blog, a mass-email list, a private Facebook page, or even a group text can reduce the number of calls you have to make. Assigning a family member or friend to make the updates for you can help reduce the emotional burden of answering frequent questions.

If the patient or anyone in the family needs help with religious traditions, funeral plans or other spiritual issues, someone can also be assigned to call the family’s spiritual leader or advisor or even the funeral home that has been selected. Hospice services also provide spiritual counseling and support.

If the loved one or the family hasn’t already decided what is the preferred location for where death should take place, there are three options for patients who are on comfort measures only (CMO):

  1. If the loved one is in the hospital, the family may wish to stay there, either with or without hospice. Staying in the hospital for longer than one day may not be an option, because many hospitals have a 2-3 day time limit for in-hospital hospice or comfort care only.
  2. An inpatient hospice unit staffed by hospice nurses, social workers, and physicians can provide excellent comfort care as well as helping families with psychological and religious needs.
  3. Many people express a desire to die at home, and many families also prefer to bring their loved one home with hospice care. Hospice services provide roughly 2-4 hours of care a day, depending on the patient’s needs. The family will need to provide basic comfort care for their loved one with guidance from the hospice team. Additional in-home services are offered by Dakota Home Care and other in-home-care companies.

The available options will vary depending on the patient’s condition, the insurance, and the family’s situation.

A dying person may have some specific fears and concerns. He or she may fear the unknown or worry about those left behind. Some people are afraid of being alone at the very end, while others want to wait until their loved ones are not there before they let go. Remember that a dying person may still be able to hear you, so you can continue to express your love and give comfort until the last breath.


End-of-Life Comfort Care

Comfort careWhen a patient can no longer benefit from curative treatment, comfort care allows them a better quality of life. Comfort care does not seek to cure or aggressively treat illness or disease. It focuses on relieving symptoms and optimizing comfort as patients near the end of life.

Comfort care can be given at home and nursing facilities. Most patients and family members prefer home to hospitals. Hospice care is one source of comfort care delivery. Comfort care is sometimes called palliative care, but the terms “palliative care” and “hospice care” cannot be used interchangeably. Hospice can be provided in the last six months of life. Palliative care can be offered anytime in the course of an illness.

Loved ones with a wide range of health conditions can benefit from comfort care. This includes cancer, heart disease, chronic obstructive pulmonary disease, and dementia or Alzheimer’s disease. Sometimes loved ones oppose stopping aggressive treatment for a condition and moving to comfort care. They may feel that there is still hope and not realize how much discomfort the treatment is causing their loved one. It to know and ensure the patient’s needs and wishes are honored. Many people approaching death make their own choice to stop treatments that cause significant side effects, preferring treatments that improve comfort. Your loved one also may prefer to die free from the life-support, such as ventilators and dialysis.

Choosing Where to Die In Comfort

Your loved one might have preferences for end-of-life care and where to receive it. Try to clarify which type of care your loved one wants. Options might include:

  • Home care — Most people prefer to die at home or in the home of a family member. You can assume the role of caregiver or hire home care services for support.
  • Hospice care — services that help ensure the highest quality of life for whatever time remains , can be provided at home as well.
  • Inpatient care. Some people might prefer round-the-clock care at a nursing home, hospital or dedicated inpatient hospice facility.

Comfort Measures for Specific Types of Discomfort:

If your loved one:

  • Feels tired and has little or no energy, keep activities simple. A bedside commode can be used instead of walking to the bathroom. A shower stool or switching to sponging off in bed can save a person’s energy.
  • Is no longer eating or drinking but wants to eat, you can help with feeding. Try offering favorite foods in small amounts. Or, serve frequent, smaller meals rather than three big ones.
  • Has shortness of breath or labored breathing, turn the head to the side and place pillows beneath it. Open a window or turn on a fan. Oxygen or a cool-mist humidifier also might help. Ask the medical team if medication is indicated. Sometimes, morphine or other pain medications can help relieve the sense of breathlessness.
  • Is agitated or confused, try to be calm and reassuring. Remind the person where they are and who also in the room.
  • Seems to be in pain, ask the medical team to adjust medication. Focus on relieving pain without worrying about possible long-term problems of drug dependence or abuse. Pain is easier to prevent than to relieve, and severe pain is hard to manage. Don’t wait too long to give medication. Try to make sure that the level of pain doesn’t get ahead of pain-relieving medicines.
  • Has skin irritation, gently applying alcohol-free lotion can relieve dry skin. Dryness on parts of the face, such as the lips and eyes can be eased by a lip balm, a damp cloth placed over closed eyes, ice chips, or a specially treated swab. A heavy cream can be used on heels and elbows.
  • Has bed sores or pressure ulcers, turning the person from side to back and to the other side every few hours may help prevent more sores or heal existing ones. Try putting a foam pad under an area like a heel or elbow to raise it off the bed and reduce pressure. Ask if a special mattress or chair cushion might help. Keep the skin clean and moisturized.
  • Has cold hands and feet, make sure there isn’t a draft in the room. Turn up the heat and provide warm blankets .People who are dying may not be able to tell you that they are too hot or too cold, so watch for clues. Someone who is too warm might repeatedly try to remove a blanket. A person who is hunching their shoulders, pulling the covers up, or even shivering is giving signs of being cold. Avoid electric blankets because they can get too hot. 

Mental and Emotional Needs

End-of-life comfort care also includes helping the dying person with mental and emotional distress. Depression and anxiety are common. Conversations about their feelings or medication may help. Holding hands, a touch, or a gentle massage can be soothing and make a person feel connected to those he or she loves. Just being present and listening can make a difference. Music at a low volume and soft lighting can improve mood, help with relaxation, and lessen pain. Listening to music might also bring back memories that the person can share with those who are there.

Spiritual Issues

Many people nearing the end of life have spiritual needs as important as their physical concerns. Spiritual needs might include:

  • Finding meaning in one’s life
  • Ending disagreements with others and resolving unsettled issues with friends or family
  • Struggles with their faith or spiritual beliefs

Praying together, talking with someone from one’s religious community (such as a minister, priest, rabbi, or imam), reading religious texts, or listening to religious music may bring comfort. Family and friends can talk about the importance of their relationship and share memories of good times. Those who can’t be present could send a recording of what they would like to say or a letter to be read out loud. Your loved one might also find it comforting to have help with leaving a legacy — such as creating a recording about his or her life or writing letters to loved ones, especially concerning important future events.

Comfort care isn’t just about tending to a patient’s physical needs but to a patient’s mental, emotional and spiritual needs as well. Successful comfort care providers find ways to offer emotional as well as physical support. They also know when to ask for help.

Every situation is different. Dakota Home Care assigns an experienced registered nurse to visit your home, to evaluate and assess the patient’s and family’s needs. We work with the patient, family and home care staff to draft and implement an individualized plan of comfort care, including hospice care, for your loved one. Call us today at 701.663.5373 to schedule an appointment.


Ardys Olson, RN, Reaches 50-Year Milestone in Her Nursing Career

ardysDakota Home Care is proud to announce that one of our skilled nurses, Ardys Olson, RN, has reached a milestone of 50 years dedicated to the profession of nursing! She recently was recognized in a North Dakota nursing publication, and we are thrilled to recognize her as one of our own!

 Becoming a Nurse

As a high school graduate, Ardys first thought she would go into accounting. Then a bout of appendicitis and a stay in the hospital to have her appendix removed helped her to change course and decide that nursing was her calling. She had always been interested in nursing, but actually being in a hospital setting peaked her interest even more. That and knowing that she wanted to help people turned her life around.

Ardys attended what was then Bismarck Hospital School of Nursing for a 12-months-a-year, 3-year program. (Nursing is now a 4-year program with summers off.) Too far from home to commute, she lived in the dorms and “had a blast.” She started dating her husband, Gerald, during her last year, graduated in May and got married in September. They recently celebrated their 50th wedding anniversary with a trip to Tahiti. Ardys and Gerald have 3 children and 6 grandchildren.

Raising a Family

Not long into her career, Ardys became a military wife. Gerald was drafted into the Vietnam War. When he left for basic training, she stayed in North Dakota and worked. After that, she went with him whenever she could. “Wherever we were, there was always a job,” Ardys said. They were married for three years before they started a family. When the children came along, nursing gave her the flexibility to take a 6-month maternity leave each time and then work part-time.

“It’s a beautiful thing for mothers to have a nursing career. I was able to work evening hours while my husband worked days. We required minimal child care. As a mother, it also helped to understand injuries and sickness and how our bodies function. I can’t imagine going through life not thinking how a nurse thinks or understanding what a nurse does!”

Thriving on Chaos

The majority of her career, Ardys worked in Emergency Care. She started her emergency career in a small hospital in a small South Dakota town, but for 30 years she managed the Emergency Department in MedcenterOne, a 200-bed hospital in Bismarck. “I thrive on chaos and the unknown”, Ardys said. “My job was always interesting and never routine. I had a very good staff. We were like a family.” The patient load varied from 40 – 80 patients a day, keeping Ardys and her staff of nurses very busy.

Specializing in Everything

Ardys explained that emergency departments specialize in “everything,” and there is a lot of on-the-job learning. “It’s only been about the last 15 years that nurses are required to have continuing education as part of licensing renewal. “The practice of nursing is overwhelmingly different now. When I started, nursing was mostly about comfort care. Nursing practice is now assessment, intervention, and planning.  Nurses coordinate with other disciplines such as social services, nutritional services, and the therapies to provide patients the best opportunity for a positive outcome and a return to their home environment.”

Challenging and Rewarding

When asked what was the most challenging part of her fulltime job, without hesitating Ardys replied, “The weather! The weather in ND can be difficult! Even in a big snowstorm or below zero temperatures, somehow the patients managed to show up and we had to be staffed!  Our department had to be available for emergency care.”

One memory that stands out in her career is when 8 patients who had been in a car accident in the middle of the night came to that small hospital where she first worked. “That put us in disaster mode!” She also remembers life-threatening events where things went well, patients with end-of life issues that could be helped to feel a little better so they could attend a special event, and an ill groom-to-be who was made well enough to attend his wedding.

Retiring—for a Year

Ardys retired from her full-time job in 2012 and didn’t work for a year. “I didn’t realize how stressful my job was until after I’d retired. It took me a year to recover!” After a year, Ardys started back to work part-time. “It’s healthy for me to feel like I can help other people and that I still have a purpose in life. I would like to continue to help others as long as I’m able to do the job and enjoy it. I like the in-home environment and the relationships.”

Going Beyond 50 Years

Currently, Ardys works partime doing pediatric nursing for Dakota Home care. She goes into the home to care for a child with identified medical needs. “It makes me feel good to help the parents and give them the freedom to go out from time to time. Parenthood is a 24/7 commitment. I feel like I’m helping the family as well as the child.”

When she’s not working, Ardys enjoys cooking, baking, reading and taking care of a 3-year-old granddaughter. She and her husband go to a warmer climate for a few weeks in the winter. We’re very happy that she enjoys spending a little time being part of the Dakota Home Care family and that she will continue her career beyond 50 years by working for us!

Congratulations Ardys!

Facing a Hard Choice: Saying Yes or No to Artificial Nutrition & Hydration (ANH)

accounting series- confusing tax formsIt can be difficult to have a conversation with your family about whether or not an elderly family member should be put on artificial nutrition and hydration (ANH) when he or she is nearing the end of life. However, it’s usually much easier to make that decision while the elderly person can still give informed consent and include their wishes in an advanced health directive. Providers need to be aware of the goals of all concerned and families must be informed as to whether ANH can realistically achieve these goals.

Have the Conversation

A few months before my 97-year-old father died, he and I sat down with a kind doctor who explained the risks and benefits of ANH. Dad was able to state unequivocally that he did not want ANH or any other extreme measures, including hospitalization, if he developed a life-threatening illness. We made contact with a hospice service that sprang into action immediately when he developed aspirational pneumonia. Within three days, he died peacefully in his own bed.

For some families the choice is not so easy. Each situation is different. Some people consider it an ethical matter and feel they must prolong life as long as possible. Others worry that their loved one will suffer needlessly without nourishment or fluids. Your spiritual advisor and doctor can help you make the decision that is right for the patient and family, including informing you of the risks and benefits of ANH and alternative treatments and interventions.

Possible Side-Effects of ANH

When a person has a curable illness and can’t swallow, ANH can help him or her recover. For a patient who has a life-threatening illness and is dying, ANH may not be beneficial. These patients may live a little longer with ANH, but not always. In either case, there are side-effects to consider.

  • Requires the patient to undergo uncomfortable, and at times painful, procedures when the treatment is started
  • Serious infections,
  • Nausea, vomiting and diarrhea
  • Skin breakdown due to constant moisture from urine and/or feces on the skin
  • Electrolyte and mineral imbalance

Dehydration and Poor Nutrition Common in the Elderly

According to the Journal of the American Geriatrics Society, the elderly are at a high risk for dehydration due to a decreased sense of thirst, fear of being incontinent, swallowing difficulties and gastrointestinal disorders, etc. See our blog on Strategies to Prevent Dehydration in the Elderly. They also often suffer from a loss of appetite or for other reasons don’t want to eat, putting them at risk for nutritional deficiencies. See our blog on Why Seniors Don’t Want to Eat and What you Can Do About it.

 Alternatives to ANH

ANH does not prevents aspiration pneumonia in a person who has difficulty swallowing; it may actually increase episodes. There also is evidence that ANH actually causes more harm than good in people with advanced Alzheimer’s disease. In both cases, careful feeding by hand is a better alternative.

Dehydration in dying patients is not painful. Increased sleepiness and less mental alertness occur without other signs of distress. The majority don’t experience thirst, and any initial thirst that occurs can be alleviated by small amounts of fluids or ice chips given by mouth, and by lubricating the lips.

When a person with advanced age or a terminal illness stops eating, usually it is because they are no longer able to process food and fluids. Forcing this person to eat, or starting artificial nutrition and hydration usually does not help the person to live longer or feel better. For those who experience hunger, small amounts of food and fluids, offered whenever the person wants, will relieve the hunger.

We often think of giving food and water as a form of comforting or nurturing. For a dying person, more helpful forms of nurturing can be expressed by gentle presence, touch, talking with the person (regardless of his/her ability to respond), keeping the person’s lips and mouth moist, gently massaging the skin using lubricants, praying with the person, or playing favorite music.

Call Dakota Home Care for assistance in managing the care of a loved one who is facing this difficult choice: 701.663.5373.


It’s spring! Why is my elderly loved one still depressed?

sad senior womanEven though spring flowers are starting to bloom, cool, rainy or even sunny spring days still can bring on feelings of sadness, depression and a lack of desire to do much of anything. While the rest of us can start doing some favorite outdoor activities and more easily get out to see family and friends, our loved ones may still feel homebound and missing the increased mobility they used to look forward to in spring. Consider one of these as a possible causes of depression in your loved one:

Less Socializing & the Technology Gap: During any time of the year, depression can be caused by social isolation. Help your senior to spend more time with family, friends and neighbors, and when unpredictable spring weather makes visiting difficult, call them for a chat or write a letter that can be read over and over.

While the younger generations are staying well connected with all of today’s high tech gadgets, the elderly are often left out. Older family members need to feel connected, wanted, and loved, too. Some training in electronic ways to connect may help bridge the gap, but many elderly people are incapable of mastering email, Facebook or Skype. Friends can play a vital role in socialization, and new friends can be found at senior centers, church activities or even the library.

Loneliness: Older people are particularly vulnerable to loneliness. Loss of a spouse, friends, family, mobility or income can all play a part. Studies show that being lonely is a leading cause for poor physical and mental health among the elderly and can even lead to early death. When loneliness sets in, it can increase the risk of high blood pressure, over-eating, under-eating, excessive drinking, depression, heart disease and other debilitating diseases, such as arthritis, osteoporosis and glaucoma. People who are lonely are twice as likely to become less involved in daily activities. Alleviating loneliness often can be achieved by more one-on-one contacts of any kind—with friends, family, community &/or assisted living activities and other group services.

Lack of Exercise: Exercise has proved to be almost as effective as medication for some in relieving the symptoms of depression. It produces natural endorphins that act like a drug to increase happiness. Even a short walk or chair exercises can give an elderly person a feeling of accomplishment and self-esteem. Exercise is one of the few things that has been proved to slow the advance of some forms of dementia, such as Alzheimer’s.

Sometimes just a reminder to exercise or being part of a group that exercise regularly can help to create a habit. A family member or home health aide can “spot” an elderly person to be sure that there is no danger of falling or hurting oneself. Exercise is so good for our bodies in so many different ways that everyone should be encouraged to do what they can. Exercise has so many positive effects that we can see how lack of exercise can contribute to depression anytime of the year. Sometimes, Dr. prescribed in-home physical therapy can get your loved one moving again.

Boredom: Often, the elderly gradually have more difficulty planning and initiating a healthy variety of activities. Caregivers may have to take the initiative when it comes to suggesting and planning things to do and opportunities to be with friends and family members.

Boredom that leads to depression is a major concern and can be a danger to seniors. No matter what their physical problems may be, meaningful activities and opportunities to socialize are vital in helping them to maintain their ability to live independently and even to live longer, happier lives.

Summary: Isolation and loneliness, lack of exercise and boredom pose health challenges for seniors all during the year, but with planning and some help, they can be healthier and happier when spring finally arrives.

Dakota Home Care helps aging adults maintain their emotional and physical health and their independence by providing companionship and transportation services. Visits with family, lunch with a friend, an evening out, or being able participate in running errands can be a real mood elevator. For more information, call 701.633.5373. Also see our blog on Courier and Transportation Services.

Is It Spring Yet? Weather-Related Depression in the Elderly

An elderly woman sadly looking out the window.Winter weather can keep seniors homebound and isolated. After all, biting cold and snowy days can make anyone want to stay in a warm bed or just sit all day wrapped up in a quilt. A day or two of the “winter blues” can be normal, but when symptoms of depression become debilitating for more than a week or two, caregivers should start looking for a deeper or treatable cause.

Although falls and hypothermia are likely to top the list of caregiver concerns during winter months, seniors are also at risk for these health hazards:

Seasonal Affective Disorder (SAD) 

A lack of natural light can cause depression in both young and old alike. We don’t know for sure why less sunlight causes depression. One theory is that the seasonal changes interfere with an important amino acid in our bodies called Melatonin, which regulates our sleep-wake cycles and may play a role in mood and appetite.

The main difference between SAD and general depression is that SAD only occurs during certain times of the year. Signs of SAD include a loss of energy, changes in appetite and sleeping habits, irritability, and loss of interest in socializing and other activities. These changes in behavior can be worse if a person cannot or does not want to regularly spend time outdoors. This especially impacts the elderly, who are more likely to be housebound or want to stay indoors.

Like other forms of depression, SAD can be treated with antidepressant medications. A drug-free option is light therapy. It requires a “light box,” a fluorescent lamp that emits a spectrum of light that simulates natural sunlight. A more natural alternative to light therapy is daily exposure to sunlight. If time, physical health, and weather conditions permit, it is beneficial for a person with SAD to go outside for a few minutes on sunny days. In any case, keep lights on, open curtains and blinds to let in natural light, and encourage the person to sit close to a window.

Vitamin D Deficiency

Our skin needs direct contact with the ultraviolet rays of the sun to make one type of Vitamin D. A deficiency of this important nutrient is related to both depression and obesity. Seniors are more likely to have a Vitamin D deficiency for three reasons: 1) elderly skin is less efficient at producing this nutrient, 2) they are usually outside less during cold weather and 3) aging bodies have more difficulty converting and absorbing vitamin D from foods. Also, certain medications, such prednisone, can inhibit the ability to produce and metabolize vitamin D.

A simple blood test can diagnose vitamin D deficiency. The safest way to treat or prevent it is to ensure a senior eats food naturally high in vitamin D, like beef liver, egg yolks, cheeses, mushrooms and fatty fish like salmon. Certain varieties of milk, yogurt, cereals and juice are fortified to contain extra vitamin D. 

Check with a Doctor

If you believe an aging loved one may be experiencing something more serious than a short case of the winter blues, encourage them to meet with their doctor to determine if SAD or vitamin D deficiency may be to blame. The physician will work with you both to consider all possible causes and devise an appropriate course of treatment. This may include light therapy, a change of diet or Vitamin D supplements.

Winter can be a hard time to find fun things to do. Anything you can do to help your senior socialize or laugh a little will help fight depression. Arranging visitors may help. If health and mobility allow it, small outings or mini-trips to regional attractions are also a way to break up the monotony of a long winter. The doctor may prescribe companionship care to help your loved one feel more like themselves again.

Winter poses challenges for seniors, but with awareness and planning they can stay healthy and be ready for spring. Dakota Home Care can help aging adults maintain health and independence by providing companionship, meal preparation and personal care. For more information, call 701.633.5373.

10 Tips for a More Heart-Healthy Diet

Healthy food in heart shaped bowlFebruary is Heart Health Month. Though heart disease risks increase with age, it doesn’t have to be an inevitable part of getting older. A more heart-healthy diet is an important step you can take to help your elderly loved one minimize those risks. February is a great time to take an inventory of the foods you and your loved ones are eating.

It is always wise to check with a doctor before starting a whole new way of eating. However, anyone is more likely to succeed with gradual diet changes, making meals healthier, but still appealing. It’s also okay to occasionally treat yourself or your loved one to a favorite but not-so-healthy food.

In March of 2017, we wrote a blog titled, “Why Seniors Don’t Want to Eat & What You Can Do About It.” If your loved one doesn’t want to eat, no matter what is on the menu, you should check out the causes and strategies discussed there. If bad habits or simply lack of awareness are the problem, consider these 10 tips:

10 Heart-Healthy Guidelines Almost Everyone Can Follow

  1. Eat more colorful fruits and vegetables. Low in calories, high in vitamins, minerals and fiber older adults should eat at least five servings per day. Colors indicate a concentration of a specific nutrient, so try to choose a variety. Some ideas are to eat salads every day; make snacks of raw veggies like carrots, celery, pepper strips, and cucumbers; make a meal of a vegetable soup, especially if it is low in sodium.
  2. Select Whole Grains. Avoid overly-processed foods made from white flour. When you have a choice, go for the whole grain version in pastas, breads, and other types of foods. When possible, skip the bread and eat grains whole, for example oatmeal or brown rice.
  3. Eat less high-fat dairy or meat. Look for skinless cuts of lean meat with the least amount of visible fat. Ground meats should have less than 20% fat, whether it’s chicken, turkey, pork or beef. Foods like bacon or cheeseburgers should be eaten infrequently and in small portions. Yogurt, milk, cheese and other dairy products should also be low in fat — 2% “reduced fat” or less. Consider replacing butter with a more healthful spread that has healthy fats that may help lower bad cholesterol.
  4. Have two servings of fish a week. The one kind of fat you and your loved ones should get plenty of is fatty fish: two servings a week of salmon, trout, or other oily fish can help lower the risk of heart disease and increase your body’s level of healthy omega-3s.
  5. Add high fiber foods to meals. You can find fiber in fruits, vegetables, beans, whole-grains and nuts. A study at the Loma Linda University School of Medicine found that Seventh Day Adventist patients who ate nuts at least five times per week cut their risk of heart disease in half.
  6. Choose Dark Chocolate. The darker and more pure the chocolate, the better it is for your heart. Chocolate is high in other not-so-good things like fat, so limit intake to an ounce or so a day.
  7. Replace sugary drinks like soda or fruit juice with herbal teas. The jury is out on caffeine. Some studies show that high caffeine intake can cause heart rhythm issues and other studies show it has a protective effect. Green and black tea may be a good choice since they contain flavinols that are believed to protect and maintain a healthy heart.
  8. Limit salt intake. “Most seniors need around 500 mg of sodium per meal, or 1500 mg per day. If one serving of any particular item has more than 250 mg of sodium, you may want to search for a product that has less.
  9. Stock the kitchen with healthy items. Don’t even buy tempting junk food.
  10. Stay Hydrated. Often, seniors don’t feel thirsty, and it may be a big effort to get up and get a drink of water. Keep a water glass or bottle within reach of where he or she frequently sits. It’s still a good rule of thumb to try to drink eight 8-oz glasses of water a day. Soups or juicy fruits can also help with hydration.

Your senior can be heart healthy no matter what their age, but it does take effort. By maintaining a healthy diet along with regular physical exercise and other good habits, seniors not only feel better, but can live longer, too. Everyone wants to stay healthy and vital for as long as possible. It’s never too late to start living a healthy lifestyle and get heart disease risks in check.

For seniors who live alone and find it difficult to prepare nutritious food for themselves, there are services available to help ensure they’re getting the foot they needs. For example, Dakota Home Care provides aides who can shop and cook and sit with your senior during meals. Services can be for as little as one hour per visit or up to 24-hours-per-day. Home Health Aides can assist with meals and companionship and a whole list of other things. Call us today at 700.663.5373 for a free consultation.