Helpful Gadgets for the Elderly

First a confession.  Ask anyone in my family and they will tell you I'm a "gadget guy".  Gadgets and elderly are two words that aren't often seen together, and I believe marketers are missing a lot of potential customers.  While many electronic devices are marketed at kids, teens, and young adults the fact is that many can fill very specific needs for the older adult.

We are all aware of the common place large button remote controls and cell phones (some of us might have actually received them as gifts!)  There are many other devices we see or use every day that can nicely meet a need for an elderly friend or relative living independently.  Below I have tried to identify categories, but you'll notice some items may fit into more than one.

1. Vision - As mentioned earlier, large button devices have been around for a while and all kidding aside, they do meet a need.  Larger buttons are easier to see and they are also easier to use for those with limitations in dexterity.  Talking devices are cropping up in many places too.  You can program your cell phone to read out the number or name of a personal calling you, and you can place a call by saying a name.  There are talking watches, blood sugar monitors, and blood pressure monitors.  Alarms on your pill box can remind you it's time to take your medication.  Electronic organizers can be programmed with alarms to remind you of, well, anything!  Love reading but find the type in books, magazines, and newspapers too small?  Consider a Kindle or similar devise.  Type size can be adjusted to meet your need.  Not only can you get books (you can find many for free) but you can change to an electronic subscription so the magazine or paper is automatically sent to your device.  Computer keyboards can also prove difficult to see for many people.  A keyboard with yellow keys and black letters may be easier to see, or maybe lighted keys solve the problem.  There are numerous accessibility options.  Computers also include accessibility adjustments from a high contrast theme to larger fonts and even text to voice and voice to text.  A quick internet search for a specific problem should produce several solutions.  MP3 players make an excellent device for audio books and of course CD (and sometimes cassette tape) audio books are available for purchase.
2. Transportation - Speaking of things that talk to you, have you spoken to your car lately?  Place a call, get directions, or summon help from your car.  Safety technology in cars is developing at a very rapid rate.  Sensors help you avoid hitting objects while backing up and brakes can automatically be applied if you get too close to the vehicle in front of you.  Sensors in your side mirrors can alert you if someone is in your blind spot and additional sensors on the back can alert you if a car or pedestrian is approaching from the side as you back up.  Yet other sensors will alert you if you are veering from your lane.
3. Monitoring Services - Many of us are familiar with Mrs. Fletcher who's fallen and can't get up.  The options for monitoring have come a long way since then.  There are paid monitoring services that can do anything from monitor the pendant worn around the neck to a complete system to monitor security, fire, and push button devices.  Some also include motion detectors that will alert the monitoring service if there has been no activity in the home for a period of time, if an hour has passed and the person has not come out of the bathroom, and even pressure sensors in the floor to monitor for falls.  Pill reminder alarm hasn't been effective?  Sign up for a service that will place a call (often times an automated call) for medication reminders.  You can also install and monitor your own system with a camera (or 6 or 10) that you can view over the internet any time.  Motion censors and other options are also available for these systems and they do not incur monthly monitoring charges.  Living in the same home and need low tech ways to keep track of Mom or Dad?  Wireless monitors and intercoms can be purchased almost anywhere.  Maybe you need to know when s/he gets up from a chair or out of bed.  Both pressure alarms and pull string alarms should be available at your local medical supply store.  These alarms emit a loud beep or buzz when activated letting you know as soon as the person is trying to get up.
4. Lighting - In my post yesterday about preventing falls I covered the importance of good lighting.  However, if the lights are never turned on they can't help.  Consider motion activated light switches.  When an area is dark the light will be turned on when motion is detected.  The light will remain on for a set period of time (usually up to 30 minutes).  Still in the hall when the light turns off?  Just wave a hand to reactivate.
5. Hearing - Many devices also exist for those with hearing impairments.  Someone missing phone calls or not answering the door because they don't hear it?  Grab a device that blinks a lamp or flashes a strobe when the phone rings or the door bell is pressed.  A phone amplifier can be added to both home and cellular phone.  Wireless headphones can allow a person to watch TV or to listen to music without bothering anyone else in the home.  Some hearing aid manufacturers make hearing aides that are compatible with wireless headphone systems so the sound is broadcast straight to the hearing aid.
6. Physical and mental fitness - The Nintendo Wii has many physical fitness programs available.  Some include progress tracking.  Walking and balance exercises are a few of the offerings.  Traditional games also offer fitness benefits.  Be aware, however, that if mobility issues exist this type of exercise should be done with your physician's consent and with supervision to avoid injury.  There are also many brain exercising titles from riddles to cross word puzzles to math.
7. Convenience - Some other items to consider.  Doors, especially entry doors, can pose difficulty for people using assistive mobility devices (wheel chairs, walkers, etc) or when carrying items into or out of the house.  Automatic door closers will close the door for you.  Your local or big box hardware store should have a few; some that look like their commercial cousins to spring loaded hinges that replace existing hinges.  An Automatic blood pressure monitor can make blood pressure checks easier; remember, though, they are often not as accurate.  Compare your reading with your doctor's when at the office.  A high or low reading with an automatic monitor should be rechecked in the other arm.  If the reading is still high or low don't panic, but get your blood pressure checked with a cuff and stethoscope.  A paper shredder can be an easy way to reduce the risk of identity theft.

This is by no means an exhaustive list but instead should serve as an illustration that a little creativity can go a long way toward addressing problems the elderly face in living independently.  Look beyond the obvious to better provide a safe environment for your loved one.

Preventing Falls in the Home

Falls are the leading cause of hospitalizations for the elderly in the US and can lead to life changing events including surgery to repair broken bones, rehabilitation in a nursing home, and loss of mobility.  Fortunately the risk of falls can be significantly reduced with observation and some no and low cost adjustments.  Below are some places to start.

1. Medications - Many medications include side effects like drowsiness or dizziness but the combination of several medications may also produce side effects of their own or increase the side effects of certain medications.  Ask your physician to review current medications and to look for combinations that may be of concern.  You can also check with your pharmacist; many times they are more attuned to looking for interactions between medications.  A gerontologist - a physician specializing in geriatric medicine - however, may be the best choice.  As we age our metabolism changes and medication doses may need to be adjusted to produce the desired effect.  It is not uncommon for an elderly patient to require far less of a medication than a younger adult, even if they have been on that medication for many years.  Periodically check medications to see if they are being taken properly; skipped or additional doses can complicate the issue.
2. Limitations - Be aware of any physical limitations that may exist.  Weakness from a stroke or injury, Parkinson's, or other medical condition.  If these conditions are present, talk with your physician, home health nurse, or Elder Care Consultant about what specific dangers are present.
3. Assistive Equipment - Wheel chair, walker, cane, braces, or special footwear can all limit mobility in the home.  Make sure all areas of the home are easily accessible using assistive equipment.  Does the wheel chair or walker fit into the bathroom and to the commode?  Are floor transitions smooth and manageable?  The other concern here is that the needed equipment is actually used.  All the time.
4. Stairs - Stairs may be one of the most frightening obstacles for care givers.  Develop a plan to make the home suitable without using the stairs.  Even if you don't need that limitation today I can guarantee you will at some time, either during short term recovery or because of a permanent change in condition.  Can a bedroom be set up on the first floor?  Is there a bathroom, or at least a commode?  Where are laundry and kitchen facilities located?  Having a plan in place will definitely be worth your while.  Are there hand rails?  It's probably a good idea to have a hand rail on each side to be prepared for any limitations in the future.  The treads of the stairs should be covered in non-slip material.  If the stairs are carpeted, make sure the carpeting is secure.  For wooden and other hard surfaces you can install stair treads made of carpet or vinyl; again, make sure they are securely attached.
5. Outside Access - How easy is it to get in to and out of the home?  Again, this may not be an issue today but I promise you it will be an issue some day.  The ideal is to have ground level access to the outside from the main floor.  If this is not possible a ramp can be built.  There are even portable ramps you can purchase!
6. Bathrooms - Bathrooms, statistically, are the most dangerous room in your home.  Spend some time here to look for potential trouble spots and correct them.  Grab bars are cheap and easy to install around at least the back and one side of the commode and inside and outside of the tub or shower.  Though there are guideline for installation heights, you may need to consider the short or tall person using them and adapt as necessary.  Make sure that non-skid materials are installed in the tub or shower.
7. Lighting - As we age our eyes require more light to see properly.  Diseases of the eye can also reduce visibility.  Look at every area of the home; kitchen, bathroom, bed room, living area, stairs, hallways and entry ways.  Make sure there is good lighting in every area.  A higher wattage bulb or adding a lamp may be all that is required.
8. Reach - Reorganize storage areas and place the most commonly used items within easy reach to eliminate stretching or climbing.
9. Clutter - Remove clutter from frequently used areas and walkways.  Look at the arrangement of furnishings and other items.  Rearrange so there is a clear path to other areas of the home.  
10. Throw Rugs - This is a personal pet peeve (hence the photo).  Loose rugs in any room, including the kitchen and the bathroom, pose a problem for walkers, canes, and yes, even feet.  This is the area where I find the greatest resistance.  
11. Footwear - This is another area where I get resistance.  Safe footwear is a complete shoe, with toes and a heel, and a firm, non-slip sole.  Soft slippers and sandals, though comfortable, tend to fit loosely and do not provide support.
12. Spills - Spills should be cleaned as soon as possible.  Though I know this should go without saying, it may be difficult for an older person to reach the floor to clean up a spill.  Keeping a light mop handy may help remove the bulk until the spill can be properly cleaned.

It is important to approach this task with an open mind and objective observation.  If this has been the home for a long time it may be a good idea to have an impartial person with you.  A healthcare professional or an Elder Care Consultant can add a different perspective.  Once you've made the necessary changes to the home make sure to monitor from time to time to ensure everything is still as safe as possible.

Behavior Changes Associated With Alzheimer's and Dementia

A loved one has been diagnosed with Alzheimer's or other type of dementia and lately you notice uncertainty, fear, frustration, periods of greater memory loss, and even anger!  What's causing these changes and how can I manage them?  In order to understand these behaviors, we need to understand the disease.  In basic terms dementia is the development process in reverse.  Reasoning, judgement, and abstract thinking are among the last abilities to develop and among the first to go.  Memories are much the same; more recent memories will be lost quickly while memories from earlier in life will remain intact longer.  This helps to explain why a person might do fairly well in the home they have lived in for the past fifty years but can't manage well at all in an unfamiliar setting.  How does all of this relate to behavior changes?  Early stages of Alzheimer's and dementia are typically the most difficult for the patient.  They realize something is wrong but can't figure out why.  Many times this translates into either frustration or anger.  This is also a period in the disease process where you will notice confabulation - a plausible but imagined memory that fills in gaps in what is remembered.  The person often seems more on edge and may get agitated when asked questions.  As the disease progresses fear becomes more prevalent.  There can be two causes.  First, frustration and anger can become fear as the person feels less control over themselves and their surroundings.  The other relates to memories.  As the disease progresses fewer new memories are available to recall so the brain brings up older memories it can still access that relate to the current situation.  The actual situation, however, may not relate completely to the memory.  In the earlier stages, confabulation helped make the pieces fit.  Now things just don't make sense.  The more things don't make sense, the more fear plays a part.  Every person's reaction to fear is different: Some become protective of themselves, pull away from people and may seem paranoid; some may react with fight or flight - an innate reaction to danger to either stay and fight the danger or run away from the danger to protect yourself - and elopement can become a risk; some may seek protection from others, never wanting to be alone.  You may also begin to notice that anything out of the ordinary will increase the frequency and/or intensity of these behaviors.  While dementia can ultimately affect intelligence it may not occur in the early stages so your loved one will look for solutions to the problem and react.  The problem here is that you may not understand what they are reacting to and the actions will seem irrational or harsh.

So how do you cope with these nightmare?  Begin with the realization that all types of dementia are progressive and will get worse with time.  Again, everyone is different.  I've had people who moved slowly through the disease over two decades, and I've had people who progress through the disease in less than two years.  Establishing a time line is nearly impossible but understanding the disease will help you be prepared.  Routines and rituals are your go-to tools.  When each day is like the last and the next, behaviors will be less frequent and less severe.  Awake at 7:00, breakfast at 8:00, lunch at noon, supper at 5:30, bed time at 10:00.  Meds at 8:00, noon, 5:00 and bedtime.  A walk after breakfast, a nap at 2:00.  The routine itself is not as important as having the routine.  The body will develop a natural rhythm.  When you need to break the routine be prepared for increases in behaviors.  Plan to have extra help for the day.  Explain things in small steps and be prepared to repeat yourself.  Try to include something that will bring back a good memory.  Need to go to an appointment?  Stop at a favorite restaurant for lunch or a cup of coffee afterwards.  Appear organized and at ease.  If you are upset, your loved one will be too.  Finally, be prepared to recognize when the situation progresses to the point where you can no longer do it all yourself and need help.  

Top stressors for sibling caregivers

Often times, as parents age and require more help, children become the caregivers and enter the "sandwich" generation; caregivers to their own children and their own parents.  In more than twenty years I can not recall one situation where care giving responsibilities have been equitably divided between siblings.  Please don't misunderstand, some are much more equitable than others but none are truly equitable.  One child often ends up with greater responsibilities than the other(s).  It may be the child believed favored by the parents, one with the most flexible schedule, or it might be the child geographically closest to the parents.  S/he might be self appointed or elected by other siblings.  However, there is almost certainly one sibling carrying a greater share of the responsibility.  This arrangement, though, often times leads to misunderstandings, hurt feelings, and even anger.  Siblings may not understand the level of care needed, or they may question costs for equipment, supplies, or paid caregivers.  So, how does a family cope?  How does every one do their part?  How can you minimize or even avoid hurt feelings?  Below are some suggestions.

1. Dividing responsibilities:  While in many cases is simply makes sense for one child to take the lead in care giving responsibilities duties still can, and in most cases should, be divided among siblings.  Financial and legal issues can be handled from any distance so even a sibling living far away can help with or take over these responsibilities.  Though one or some siblings may have more flexible schedules providing care is a 24/7 responsibility.  Other siblings can offer to offer care giving for a weekend, or use some vacation time to provide the primary care giver a needed rest.  In larger families a schedule can be implemented: Mary will stay over Monday, Bob will stay Tuesday, etc.  Every family is different and no two solutions will look the same.  The key here is to communicate.  Have a family meeting, identify the needs, and divide the work as evenly as possible.
2. Understanding needs:  Though immediate needs may be painfully obvious, other needs may not be initially apparent.  Developing a running list can be helpful to keep track.  Also remember that needs can change over time.  Regular family updates can be an effective way to keep everyone up to date.
3. Financial issues:  Money is frequently an area that can lead to arguments, misunderstanding, and even distrust.  Review assets, cash, and savings.  Identify current expenses, current needs, and consider what care related expenses may be on the horizon.  Preparing a budget can be a very effective tool both to keep you on track and to help other siblings understand finances.  Funeral arrangements, though difficult to discuss, should also be reviewed.  An irrevocable burial trust or other means to prepay is often a wise move.  Also be aware that prepaid funeral expenses are often times not counted as assets.
4. Legal issues:  Is there a will?  Advanced directives?  Living will?  Power of attorney, Medical proxy?  If these documents are in place and executed locate them, review them with the family, and keep them in a safe place.  If they are not in place they should be.  Though hospitals and other providers will routinely ask for a living will or advance directives I always suggest that a medical proxy or medical power of attorney also be in place.  Standardized forms for living wills and advance directives are ambiguous and leave little room to further define a person's wishes.  In addition, you are making medical decisions for a situation that has not occurred yet.  A medical proxy has the legal power to make medical decisions specific to the situation.

All of this sound too overwhelming?  It can be.  Planning in advance can make the process much easier and allows the family to discuss these issues without the emotions stress of making immediate plans.  Be aware too that help is available.  An Elder Care Consultant or Geriatric Care Manager can assist you in through the entire process from assessing current needs and projecting future care to getting legal affairs in order.  The consultant also acts as an unbiased third party who can provide a written report of current needs and suggestions for planning, allowing less involved family members true picture of the situation.

Need caregivers?

It is commonplace for individuals or families to hire caregivers to go into the home to provide assistance.  Needs can vary widely from person to person but common needs include housekeeping, laundry, shopping, meal preparation, and bathing.  Most, if not all, of these tasks allow a caregiver access to sensitive information, valuable property, money, and even banking information.  It is of the utmost importance to find a caregiver who is skilled and patient.  It is equally important to find a caregiver who is also discrete and honest.  Add in someone willing to work for the wage you can afford to pay and you find yourself with a difficult task to say the least.  Word of mouth from others in your community can be a good start but be sure to personally interview a candidate before you hire; your expectations may be different.  Also check with your local Area Agency on Aging.  Many keep a current list of caregivers who have been successful providing care for others.  Family members and close friends can be caregivers but proceed very carefully if they want paid for their work.  If you want to alienate a family member or lose a close friend, hire them.  Don't be afraid to check in while a caregiver is working, it's beneficial for them to know you are watching.  Also check valuables in the home and review purchases and banking statements if caregivers have access.  Don't forget to check with the person receiving care, it is they who often have the best insights.  Finally, don't hesitate to fire a caregiver if you are uncomfortable or if you suspect they may be taking advantage.  While it may be inconvenient as you look for someone else, it is much less inconvenient than if your loved one is injured, not cared for, or if you find an empty bank account.

Will Medicare (or other health insurance) pay for long term care?

The short answer is no.  Let me explain.  Medicare and other health insurances pay only for medical care but they will not pay for ongoing long term care.  Need rehabilitation in a nursing home?  That's covered.  Need skilled nursing care for an acute condition?  That's covered too.  If, however, you need to stay long term in a care center neither Medicare nor you health insurance will cover the cost.  All medical plans will cover up to 100 days of skilled nursing care.  This does not mean you will get 100 days, it means 100 days is the maximum they will cover.  Every insurance is different and co-pays may also apply.  With Medicare only, co-pays may begin on day 21.  Medicare is the only insurance that allows the facility to determine what length of stay is necessary, as long as it is justified.  Most insurances will authorize a skilled stay  for a week or two at a time, some only a day or two at a time.  If continued progress is demonstrated most, though not all, insurances will continue to authorize additional time.  An insurer will decide to stop paying once they believe there is no additional improvement to be gained from additional time in the facility.  If you believe additional time will be beneficial you do have remedies.  You can appeal the decision, and the insurer will review the case and make a determination.  This typically happens within a day or two of your appeal as the company pays for care while the appeal is reviewed.  If an appeal is not successful you can request a "peer review".  This requires cooperation and action from your physician, who will make a case for continued care.  The request is reviewed by a panel of physicians to determine if your physician made a good case to continue care.  Neither of these remedies is guaranteed to be successful, but they can buy you an extra day or two even if they are denied.  Also remember that once an insurance company decides to discontinue skilled care they must give notice to the facility, usually 48 hours, to allow the facility to put a discharge plan in place.  Not sure what your insurance covers or if there are co-pays?  Once you provide all of the insurance information to a facility they should be able to tell you exactly what is covered and what co-pays apply.  Typically they can provide you with this information in a few business hours.  Still have questions?  Call the customer support telephone number on the back of your insurance card.