Dakota Travel Nurse Home Care

Keeping home an option!

PRESS RELEASE: DTN Home Care Partners with Proximal 50 for In-Home Physical Therapy

Proximal 50Dakota 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!

New Medicare Laws May Affect Your Access to Home Oxygen Equipment

oxygen tank with face mask and pressure gauge isolated on whiteMy 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



Strategies to Prevent Dehydration in the Elderly

Drinking waterMy 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.

  1. Include foods with high water content in your diet, e.g., fresh fruits and vegetables, soup, dairy products.
  2. Keep a water bottle or glass of water within easy reach.
  3. Drink a glass of water or another beverage with every meal. Offer a choice.
  4. Schedule other consistent times when a glass of water is offered, e.g., after going to the bathroom or brushing teeth.
  5. Drink more than just a swallow or two of liquid with medications.
  6. Avoid getting overheated. Drink more when you do.
  7. Drink small amounts frequently throughout the day and less at bedtime.
  8. Drink liquids regularly, even when you’re not thirsty.
  9. Consume caffeinated drinks in moderation. Too much can be dehydrating.
  10. 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.

  1. Low urine output or dark-colored urine
  2. Constipation
  3. Dry mouth
  4. Inability to sweat or produce tears
  5. Dizziness or difficulty walking
  6. Headaches
  7. Confusion
  8. Rapid heart rate
  9. Low blood pressure
  10. Sunken eyes

Dangers of dehydration:

These and other health problems can be the result of dehydration.

  1. Urinary tract infections
  2. Pneumonia,
  3. Bedsoresin bed-ridden patients
  4. Kidney stones
  5. Medicine toxicity
  6. Increase in falls
  7. Longer stays in rehab facilities.

Risk Factors for Elderly Dehydration:

Some of the risk factors that heighten the chance of developing dehydration include:

  • Swallowing disorderscaused by aging, stroke, Parkinson’s disease or dementia
  • Obesity
  • Patientsover 85 years old
  • Beingbedridden
  • 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


Tips for Receiving VA Benefits You Might Not Know About

Hands holding an American flagYour experience with the VA might be easier, but a friend of mine has been frustrated to tears several times while trying to find out what the VA would do for her almost-95-year-old father as he progressively needed more care. Initially, he lived with his 91-year-old wife, who also has progressively lost the ability to care for him. My friend was able to get coverage for home health care to come in and shower and dress her dad 3 days a week, and for physical therapy off and on, but she was told that he didn’t qualify for “long-term care” (the term she used), which his wife desperately needed him to have. When a stroke qualified him for admission to the VA hospital, he was evaluated onsite, and over several weeks qualified first for VA rehab and then for “end-of-life contract” (room and board paid for by the VA) and hospice (paid for by Medicare). He will be evaluated again after 6 months.

Dakota Travel Nurse Home Care (DTNHC) is eligible to accept VA Benefits. Veterans who meet the clinical need for home care services provided by DTNHC can now apply for VA Benefits to cover them. In order to qualify, vets must be enrolled in the VA and have a VA provider who they see at least once a year. A copay may be charged based on your VA service-connected disability status.

Following a referral from the VA, a registered nurse makes a home visit to determine the level of care required and the frequency of visits recommended for each service. The RN will also develop a written plan of care. C.N.A.s (Certified Nursing Assistants) provide personal care and assistance with activities of daily living. Therapies are provided by licensed therapists. Live-in care is also available for qualified vets.  (See our blog and our website for a complete list of services available to vets.)

Making arrangements with DTNHC may be the easy part. Knowing who talk to at the VA and the right questions to ask is the hard part for many vets and caregivers. Sometimes it seems like the VA has a language of its own, and if you don’t know their word for the type of care you think you or your loved-one needs, you may not be given alternatives to what you asked for. At least, that was my friend’s experience. She started with a VA Social Worker, but it wasn’t until someone told her about the Patient Advocacy Program and she contacted them that she was steered in the right direction.

Your loved one’s VA treatment team can include his doctor, nurse, social worker, dietitian, pharmacist, chaplain, therapist and other professionals associated with his medical care. If you feel your concerns are not being addressed by the treatment team, you may contact a VA Patient Advocate. A Patient Advocate is a VA employee who is specifically designated at each VA facility to manage the feedback received from veterans, family members and friends. Patient Advocates work directly with management and employees to facilitate resolutions. They can “translate” the words you are using—in-home care, assisted living, long-term care, hospice—into “VA-speak,” like: VA HealthVet System, respite stay, rehab, residential homes program, medical foster care homes, end-of-life contract and hospice. While you may be told by your Social Worker that your loved one does not qualify for the care you are asking about, your Patient Advocate may be able to tell you about qualifying alternatives.

Some types of care are fully paid for by the VA. Others require that the patient contribute all VA pension and Social Security income to the care, in addition to costs those sources don’t cover. Be sure to ask what will be covered with the type of care you are seeking. Medicaid may help to make up the difference, but you will have to apply for that. Your loved one might have to be evaluated repeatedly to determine what care he qualifies for. For example, after a 4-day hospital stay, he could qualify for 20 days of rehab—or up to 100, if he is making measurable progress.

Care for Veterans with Alzheimer’s or dementia is provided throughout the full range of VA health care services. Depending on the Veteran’s needs, services may include home-based primary care, homemaker and home health aide, respite, adult day health care, outpatient clinic, inpatient hospital, nursing home, or hospice care. Caregiver support is an essential part of all of these services.

The website for the U.S, Department of Veterans Affairs, contains helpful information regarding Home and Community Based Services, as well as testimonials as to the benefits of home care. Another good source of information is http://www.elderlawanswers.com/long-term-care-benefits-for-veterans-and-surviving-spouses-6158

DTNHC Admissions Coordinator/Case Manager and RN, Michele Meske, states that “We want to provide veterans in ND with skilled, reliable, individualized, compassionate home care to enhance their quality of life and well-being. If you or anyone you know qualifies for VA benefits and has a need for PT/OT/ST, CNA care, or other home healthcare services, please contact Dakota Travel Nurse Home Care at 701-663-5373.

Sleep Apnea in the Elderly

Man with sleeping apnea and CPAP machine asleep in bed

Obstructive sleep apnea—when a person briefly stops breathing multiple times during the night—can lead to health and cognitive issues at any age, but it can be even more of a problem in older adults. They are more likely to have obstructed breathing at night, but are less likely to be properly diagnosed.

My husband did not think he had sleep apnea, but in order to rule that out as the cause of some cognitive problems he was having, he spent a night in a sleep lab. He was able to sleep long enough for the technicians to discover that he stopped breathing about 28 times an hour! He was told that he needed to wear a mask to keep his airways open at night—a treatment known as Continuous Positive Airway Pressure (CPAP). He is still struggling to get used to sleeping with the head gear, but when he does have a good night, I think there is an obvious difference in his mood and cognitive abilities. For those who go untreated, often no amount of sleep means feeling well-rested.

According to a 2009 article in the Internet Journal of Internal Medicine and quoted in The Beaver County Times, sleep disordered breathing affects between 20 percent and 50 percent of older adults, and the prevalence of sleep disorders increases with age—adults age 70 to 80 are twice as likely to be affected than those around age 40. Obstructive sleep apnea has been linked to numerous other diseases, including hypertension, congestive heart failure, stroke and coronary artery disease. The dangers of sleep apnea increase with age.

A large neck, obesity, extra tissue in the back of the airway and loss of muscle tone that helps to keep the airways open are only some of the reasons obstructive sleep apnea can occur. Loud snoring or gasping during sleep and issues such as memory loss, daytime fatigue or sleepiness are some of the most common signs.

Without treatment, the blocked breathing of sleep apnea can force the heart to pump harder to get oxygen. Low oxygen levels in the blood can affect the oxygen supply to the brain, causing cognitive issues, stress to the body and a variety of other symptoms:

  • Restless sleep, night sweats, choking, snoring
  • Daytime drowsiness, lack of concentration
  • Headaches
  • Moodiness, anxiety and depression
  • Leg swelling

A 2010 article in the New York Times titled “When Sleep Apnea Masquerades as Dementia,” explains, “Most of the time, cognitive problems won’t evaporate when seniors are treated for sleep apnea. But researchers find that with C.P.A.P., many older patients see marked improvement. ‘They’re not dozing off during the day, they’re not dragging,’ said Dr. Bradley Boeve, a neurologist at the Mayo Clinic. ‘Quality of life improves. 

”Life gets easier for their caregivers, too, a key concern in trying to keep people out of nursing homes….And, as Dr. Ancoli-Israe, professor of psychiatry at the U. of CA, San Diego, pointed out, ‘If you’re waking up hundreds of times a night and you’re not getting enough oxygen to the brain, of course you’ll see the effect.’ ….But when someone with apnea does stick with the treatment, ‘you’ll see the effects within a month or so,’ Dr. Boeve said. ‘Sometimes even within a week.’

“Now Dr. Ancoli-Israel is investigating whether C.P.A.P. therapy might help reduce the cognitive damage from Parkinson’s disease. ‘This isn’t just Alzheimer’s,’ she said. ‘Any time there are symptoms of dementia, you should think about sleep apnea and discuss it with your doctor.’”

Elderly people may have other medical issues that sleep apnea only makes worse, causing them to not be as independent as they could be or to suffer in other ways. In diabetics, for example, sleep apnea can make it very difficult to control blood glucose levels at night, and like having very high blood pressure or cholesterol, it can even cause death.

If you think you, a loved one or anyone you’re caring for might have sleep apnea, we encourage you to talk to a specialist in sleep disorders. Getting treatment could make life easier and more enjoyable for everyone concerned. 


Diagnosing Dementia—a Personal Story

Dementia Alzheimers Represents Alzheimer's Disease And ConfusionIt’s still not possible to say definitively that an older person’s progressive dementia is caused by Alzheimer’s disease—until they’re dead and an autopsy is performed on the brain. However, specialists are becoming more confident that behavioral symptoms, neurological testing and the results of brain scans (MRI) can be narrowed down enough to diagnose the disease on a living person, even in its early stages. Because of this progress, on March 3, 2016, my 77-year-old husband and I sat with a neuropsychiatrist who felt he could tell us with a high degree of surety that Dennis’s cognitive and neurological issues were characteristic of both early-stage Alzheimer’s and Vascular dementia.

Arriving at this diagnosis had taken more than a year. Because there can be value in knowing early that one has Alzheimer’s and also vascular reasons for cognitive decline, I asked Beverly if I could share a summary of the process with our readers. The hope is that both families and caregivers will learn something that could help put a name to disturbing symptoms and provide some guidance on how to proceed with the highest degree of hope and understanding. At first Dennis didn’t want to know, but now that he does, we’re both glad that he went through the whole process. Every case is different, so please do not take this account as medical advice.


We first started paying close attention to physical and mental changes in February of 2015, when Dennis had 3-4 unexplained falls, after which he had difficulty getting back up. It seemed like for a few minutes the signal to move couldn’t get from his brain to his legs and feet. Other symptoms noticed mostly by me included (not in any particular order):

  • A progressively slower, shuffling, short-stepped gait (observed even before the falls)
  • Slower speech and less participation in conversations
  • More difficulty thinking of specific words and concepts
  • Sometimes talking “around in a circle” while trying to arrive at the meat of a story
  • 2-3 incidents of getting lost when driving by himself in what should have been a familiar area
  • A decrease in driving skills in general
  • Lessened ability to follow instructions, especially those with more than 1 step
  • Decreased ability to perform some household tasks, such as cooking
  • Sleep deprivation

Process of Elimination

Dennis first saw his PCP about the falls. The Dr. recommended that he see a neurologist, which he did in March 2015. He was given a variety of short tests, some related to walking and balance and others to mental acuity. I accompanied Dennis on this visit and was able to report on behaviors that Dennis was not fully aware of. Because several serious diseases begin with falls, i.e., Alzheimer’s, MS, Parkinson’s, ALS, etc., it was determined that additional testing and a process of elimination of possible reversible causes of both physical and mental issues were needed. Over the course of several months, the following took place:

  • An MRI
  • Multiple consultations and short testing with a neurologist
  • Withdrawal from a medication known to affect memory
  • Two rounds of rehab/physical therapy (PT) for balance and walking issues
  • An oral and on-road driving test
  • An overnight sleep test in a sleep lab
  • A 3-hr. neurological/psychological test; results were compared to others his age and education level; my input was sought during the first 30 minutes; test included a variety of combined mental and physical skills


During the course of a year of tests and therapy, MS, Parkinson’s and ALS were eliminated as possible causes. The MRI results were typical of a mild cognitive decline: Dennis’s brain was smaller than other men his age and also showed micro-vascular changes, possibly due to mini strokes. The PT greatly improved balance and walking issues and has prevented recent falls. The driving test was passed by a small margin. The sleep test revealed moderate to severe sleep apnea, currently being treated with C-PAP and on-going evaluation. All of the tests and their results were analyzed by the University of Utah Neurological team and the neuropsychiatrist we met with on March 3, 2016. He showed us slides of Dennis’s brain, and he explained the results of the MRI, as well as the scores on the neuro/psych test. The overall test performance was judged to be poor (worse in some areas than others). The combined MRI and test results determined the diagnosis of early-stage Alzheimer’s and vascular dementia. He was prescribed the drug Aricept to increase the brain chemicals involved in storing memories, and he was told that because of the early-stage diagnosis he could also participate in clinical drug trials.

Because Dennis’s symptoms seem to have progressed minimally over the past year, and because of his improvement in some areas, we were told that with regular physical and mental exercise and social interaction, his mental abilities could possibly stay close to the same for several years. A repeat of the neuro/psych test is recommended in a year to judge degree of decline, if any. We were told to watch for changes in the following common symptoms:

  • cognitive ability (both memory and reasoning)
  • ability to initiate/plan activities
  • inability to recognize abnormal behavior (not the same thing as denial)

I was also given some good advice to help me cope with the above-noted changes in behavior (some easier said than done!):

  • Give him time to form and verbalize his thoughts; don’t speak for him.
  • Don’t say “I already told you that.” Just repeat without comment.
  • Only repeat things that are important for him to understand and to stay safe.
  • Give help with everyday tasks only as needed.
  • Initiate and plan activities, especially those that may slow the progression of the disease.
  • Do most of the driving and encourage him to only drive to familiar destinations—not at night or on the freeway.
  • Take over the finances.
  • Take advantage of available written information and counseling/support group opportunities.


No one wants to hear the words Alzheimer’s or dementia as part of a personal diagnosis. It is a lifestyle change that affects the whole family. We were told to tell our children so that they can plan for who will care for Dennis if I should pass on first, and so that they will be able to react to his changing behavior in the most positive ways. You may think YOU don’t want to know, but remember that an early diagnosis can be a very good thing that helps the whole family to cope and prepare for the future. New discoveries are being made about Alzheimer’s every day. Taking part in trials can not only help you and your loved ones, but also the many others who have or will have the disease.

by Marti Lythgoe, NL Editor

When Is It Time to Give Up the Car Keys?

Senior woman holding car key and smiling, selective focusMost of us think we know when an aging loved one should stop driving, but most elderly people think they still can drive safely, and they strongly resist giving up the keys to the car. Well into his 90s, my father kept saying, “My kids took my car away from me!” He thought he could drive safely, even though he had trouble walking (poor reflexes and reaction time), he needed hearing aids but seldom wore them (couldn’t get cues from road sounds), had trouble turning his head very far to either side (couldn’t look over his shoulder to back up or change lanes), was easily distracted, and couldn’t always remember or recognize where he was. At 96, he’s stopped saying that, but I know he still misses the freedom and mobility that a driver’s license and the keys to the car gave him.

Will YOU know when it’s time for you to stop driving? The chances are good that the answer is “No!” Besides being the basis of our independence—something we are loathe to give up—one of the symptoms of the early stages of any type of dementia is to not be able to recognize that our driving skills or other physical and mental skills are not as good as they used to be. It’s not denial. It’s actually Not Knowing! My 77-year-old husband was told this by the geriatric neurologist who, after a series of tests, gave him the diagnosis of being in the early stages of dementia.

Warning signs. My husband had to take an on-road driving test. He passed it with a 4-point margin and still has a Utah license, but his geriatrician later told him that if he lived in California, his scores on the Neuro Psych test he took would cause the DMV to forbid him from driving. He advised him to be careful! Of course, I was not happy with my husband’s diagnosis, but I was fortified in my belief that, whenever possible, I should take over the driving, because the person administering the driving test gave advice related to some of the same problems I had observed, including:

  • Stay in the middle of the lane
  • Enter right-turn lanes as soon as possible
  • Accelerate more quickly when merging onto the freeway
  • Limit freeway driving, when possible
  • Watch the signs and don’t drive above or below the speed limit
  • Only drive in areas where you are familiar with both main roads and side streets
  • Don’t drive at night

State laws. A 2012 Kiplinger article reports, “Only 19 states make seniors renew their licenses more often than younger drivers. Half of those states cut eight- to ten-year renewal periods down to four to six years — only Illinois and New Mexico require annual renewal. Illinois is the only state to mandate that drivers retake the road test as they age.” In Virginia, the state where the author lives, “the only nod toward aging drivers’ safety is a required vision test after age 80, but licenses are good for eight years.” Because most states “sidestep the issue, it’s up to families to act when a loved one is no longer a safe driver.”

North Dakota drivers who are 70 years of age or older at the time their current driver license expires are generally required to renew their license in person at a local DMV office. There are no other restrictions on senior drivers in North Dakota. All licensees must take a vision test (see below) before renewing license. You may in certain situations be asked to take a written knowledge test, as well. 

The right approach. If there’s a problem, “Address it head-on,” says Jake Nelson, director of traffic safety advocacy and research at AAA. “Most people wait until after a crash and it’s too late, but you should act before an accident occurs.” Miriam Zucker, a geriatric care manager, suggests starting with the positives, emphasizing safety and perhaps the need to back off driving because of a medical condition. She suggests saying something like, “Dad, you’ve been a safe driver for 60 years, but with your cataracts, I know it’s harder for you to drive at night. If you got hurt or hurt someone else, that would be awful.”

Rather than disabling the car or hiding the keys, “Let the physician be the bad guy,” says Sharon Brangman, chief of geriatrics at Upstate Medical University, in Syracuse, N.Y. Rules governing physicians, however, vary from state to state. In some, including New York, doctors can’t contact the DMV regarding a patient without the patient’s permission. In others, such as New Jersey, doctors are required to report patients they don’t believe should be behind the wheel anymore. (To see the laws in your state and more information about elder driving safety, go to SeniorDriving.AAA.com.)

Good Luck!

How to Recognize & Report Elder Abuse

No Elder Abuse buttonUnfortunately, as the elderly population increases, so do incidents of elder abuse. “Elder abuse is an umbrella term that may include physical, sexual, or emotional abuse; financial exploitation; and neglect, abandonment or self-neglect.” As we age, we often become less able to make wise decisions or to defend ourselves against abusers of all types, including a family member who may have run out of patience with all that the caregiving process involves.

It may be difficult to imagine that a loved one or any elderly person you are acquainted with could be the victim of abuse. Even if you suspect something is wrong, your first thought might be that changes in behavior or unexplained injuries are the result of dementia or the infirmities of old age. You don’t want to erroneously report a family member or caregiver. Even if you’re sure that abuse of some kind—it could be financial—is taking place, you might not be sure how to go about filing a report or what will happen if and when you do. If the person who is taking care of your loved one is the source of the abuse, you might worry about who will care for your loved one if this person is forced to stay away. It’s even possible that your loved one will deny that abuse is taking place and make it almost impossible for you to change his or her circumstances. In spite of all these potential roadblocks, it’s critical to do something!

What to do?

Step 1: Learn more about the symptoms and signs that elder abuse is taking place. Probably physical abuse is the easiest to recognize, but other forms of abuse can be more difficult pin down. This blog space is too short to list all of them, but there are excellent resources online that you can go to. Here are just three that will give you advice on how to recognize the signs of many types of abuse:

Step 2: Write down the signs of abuse that you observe and the dates on which they occur. Take photos or videos to substantiate claims. When reporting abuse, it’s important to be as specific as possible about why you are concerned. Talk to the person who you think is being abused and include what they say in your report. If you are the person who is being abused, it’s important to report the same things.

Paid caregivers are mandated reporters in ND. A mandated reporter must report if in an official or professional capacity, he or she:

  • has knowledge that a vulnerable adult has been subjected to abuse or neglect; or
  • observes a vulnerable adult being subjected to conditions or circumstances that reasonably would result in abuse or neglect.
  • Important:A mandated reporter is required to report as soon as possible.

Step 3: Find out to whom abuse should be reported in your location and do it:

  • If this is an emergency, i.e., the person’s life is in danger, call 911.
  • If you have the authority to do so, remove the person from the abusive situation.
  • Tell the family. Sometimes family members are not aware that their loved one has been abused or is in an abusive situation. If you are the victim, you can also tell your doctor or a friend who you can trust.
  • In North Dakota, call Vulnerable Adult Protective Services. This link also other information about vulnerable adults.
  • Call the Adult Protective Services (APS) agency in your state. They are usually the “first responder.” To find the number, visit:
    • The Eldercare Locator website or calling 1-800-677-1116. Trained operators will refer you to a local agency that can help.

What happens next?

The APS or VAPS agency screens calls for potential seriousness. It keeps the information it receives confidential. If the investigators find abuse or neglect, they arrange for services to help protect the victim. Elder abuse doesn’t go away. If you suspect abuse, armed with information make that call as soon as possible.

Dakota Travel Nurse Home Care employees are committed to fighting elder abuse through education and raising awareness in our community. 

10 Strategies to Help the Elderly Overcome Resistance to Home Care

Senior womanOne of the most challenging issues you are likely to face when caring for an aging loved one is resistance to additional help, especially when they get to the point of needing in-home care. At the end of one of Dad’s periods in rehab, we were told he couldn’t go home without 24/7 care. He wanted to go home, so he didn’t object, but his wife kept it to herself that she was adamantly opposed to having someone else in the house until after Dad was home. Then she made it perfectly clear how she felt by not letting the caregiver come upstairs to help. Needless to say, we had to make other arrangements.

How do you get help for a loved one who doesn’t want it or strongly resists it? At first, it might not be an absolute necessity, but it could progress to the point where there is no other alternative. Dad’s situation came up suddenly. Hopefully, you will have more time to consider some of these strategies and gradually ease your loved one into a situation that is helpful to all concerned.

  1. Communication: If you suspect that your loved one will be resistant to care — whether from family or a service — you might be hesitant to bring up the topic. Start communicating with her about her need for care while you still have time to discuss it.
    • Try to understand the source of the resistance. Some people value independence, some are scared, and some see accepting help as a sign of weakness or loss of privacy.
    • Ask about your loved one’s preferences. Even though you might not be able to fulfill all of her wishes, it’s important to take them into consideration.
    • Describe care in a positive way. Refer to respite care as an activity she likes. Talk about a home care provider as a friend.
  1. Timing: If possible, schedule a time to talk in advance. Let mom know that the topic will revolve around getting more help. Choose a time when you can both be relaxed. Avoid being in a rush.
  1. Focus: Everyone wants to feel useful. Focus on why you need help. Help your mom see how she will be helping you. Consider asking her to accept care to make your life a little easier. She might find it easier to accept outside care if she thinks she is doing it to help someone she loves.
  1. “We” Solutions: Involve your loved one in the solution process as much as possible. Use “We” when you are negotiating. For example, “How can we manage?” vs. “What am I going to do about you?” No one wants to be labeled a problem. We all want to feel we are part of a solution.
  1. First Things First:Bring up immediate safety or care issues first, and let the rest go. If your mom agrees to home modifications that will help with her mobility but does not want to talk about in-home care, drop it for now. Tell her she’s made a wise choice, and be prepared to bring up the idea of in-home care later.
  1. Independence: Explain how in-home care might prolong your mom’s independence.Knowing that accepting some assistance might help her remain in her home for as long as possible might be a mind changer.
  1. Trial Periods: Don’t ask your mom to make a final decision about the kind of care she receives right away. Ask her to try receiving care for a short period of time. A trial run gives a hesitant loved one a chance to experience the benefits of assistance. If the trial period is a positive experience, the help can continue uninterrupted. 
  1. Professionals:Professionals that are respected by your elderly loved one can have a strong role in providing support and perspective. Bring in your family doctors, clergy or other professionals to provide validation, support and encouragement. If your mom is putting herself in danger by resisting care, seek the counsel of an elder-care lawyer to ensure safety and legal boundaries are being met. (Learn more about Elder Abuse in our next blog.)
  1. Coping: Accepting care might mean relinquishing privacy and adjusting to new routines. Your loved one might feel frightened and vulnerable or angry. Help her cope with the loss of independence. Explain that this isn’t a personal failing. Help her to stay active, maintain relationships with caring friends and family, and develop new physically appropriate interests.
  1. Memory Loss: Dementia or Alzheimer’s disease might make it difficult for your loved to understand why she needs help. Keep in mind that the above strategies might not be appropriate when dealing with a loved one who has dementia.

Resistance to care is a challenge that many caregivers face. Spending the time to involve your elderly loved one in the decisions and solutions and emphasizing the benefits of care will improve the care experience, your loved one’s sense of independence and quality of life, and your peace of mind.

by Marti Lythgoe, DTN Home Care Writer/Editor







Why a Daily Routine Is Important for the Elderly & Others with Dementia

senior man with glasses and alarm clock above his head looking upMy 96-year-old father has practically no short-term memory, but he can remember when it’s time to go to the care center dining room, because meals are served at the same time every day. Anything that causes him to deviate from his daily schedule of waking, dressing, eating, showering or napping can result in confusion. “Where am I?” “What are we doing now?” For example, a Dr.’s appointment that causes him to have a late nap might result in him waking up not knowing whether it is morning or afternoon.

Even elderly people without dementia feel safer and less anxious when they don’t have to worry about “the unknown” or what’s coming next. Things that are done repeatedly on a schedule become like “body memory,” and don’t require much thought to act upon. Sometimes we say we know elderly people who are “set in their ways.” This is usually a good thing. It’s easier to cope with memory and cognitive issues when as many activities as possible are predictable. Even though a person with dementia might not be aware of the routine or even of time passing, having a routine helps them feel more grounded and secure.

The importance of routines for people with dementia

Routines are especially important for people in the beginning stages of any type of Dementia.  It gets harder for them to remember new things, but routines are often ingrained into their memory without conscious thought. Daily routines can be helpful for both the caregiver and the elderly person with dementia. The caregiver can spend less time trying to figure out what to do and more time on meaningful and enjoyable activities with their loved ones or clients. Caregivers should also remember to put time for themselves into the schedule. Some activities, like taking a walk, also could include the person with dementia.

Routines also help those with Alzheimer’s to stay calm. They recognize things that they have done all of their lives longer than new items added to their routines. That is why they remember how to eat and get dressed longer than where they put something yesterday. Often when faced with something new, they become fearful and can act out by becoming angry or uncooperative. However, if the function is part of their routine, they more often respond quietly and calmly.

Organizing the day

A person with Alzheimer’s or other progressive dementia will eventually need a caregiver’s assistance to organize their days. Structured activities can often reduce agitation and improve mood. When planning a schedule and activities for a person with dementia, you will need to experiment and adjust according to their changing abilities and interests.

Before making a plan, also consider:

  • What times of day the person functions best
  • Ample time for meals, bathing and dressing
  • Regular times for waking up, napping, going to bed; for creative, intellectual, physical, social and spiritual activities
  • Including enough flexibility within the daily routine for spontaneous activities and time for yourself. Don’t be concerned about filling every minute with an activity. The person with Alzheimer’s needs a balance of activity and rest, and may need frequent breaks and varied tasks.

More on sleep: Having a regular daily routine–doing the same basic activities like eating, dressing and bathing at the same time every day—helps older adults sleep better. This can be especially helpful if the person with dementia experiences sleep issues like sundowning. Creating a predictable daily routine is a simple, non-drug way to improve sleep.

The bottom line

Three major benefits the elderly and those with dementia get from routines include: 1) Reduced stress and anxiety, 2) Increased feelings of safety and security, and 3) Better sleep. Something as basic as sticking to a daily routine can significantly improve the quality of life for a loved one or client with dementia and for the caregiver, as well. Reducing stress, increasing the feeling of security and improving sleep will make everyone happier and healthier

by Marti Lythgoe, DTN Home Care Writer, Editor



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