Would you give your baby adult medication or any drug that you weren’t aware of how it would impact your baby? I think it’s safe to assume that most people would say no. Medications impact everyone differently and some medications are safe for some and not others.
In a recent article on US News, Payton Sy explains how medications can affect the elderly. She explains that as we age, the way the body metabolizes medications changes, which can lead some medications to become stronger and others weaker. Sy explains that the following are reasons why medications react differently in seniors:
Medications that are typically less effective in the elderly include:
Medications that typically have stronger effects in the elderly include:
The reason medications are less effective in the elderly is due to the stomach getting less acidic as people get older; certain medications require an environment with a higher acidity to be metabolized properly. Medications that have stronger effects typically act on the central nervous system. Long term use of these medications can lead to:
Sy also explains that certain health conditions can present differently in older adults. For example, a symptom of a urinary tract infection can be confusion instead of painful urination. I sat down with Twin Lights Home Care Case Manager Donna Chalmers to discuss her thoughts on this topic. I began by asking Donna how common it is for adverse drug affects and health conditions to present differently in the elderly. “Health conditions present differently in older adults a lot. It’s very common.” Donna says. “Many clients I have worked with have gone to the hospital for a UTI without realizing that is what it was.” Donna continues by explaining how families will be concerned when their loved one begins to act confused and agitated with no explanation. “They bring their loved one to the hospital and are told they have an untreated UTI,” Donna explains. “It’s so common, but when your loved one begins acting differently, thinking they have a UTI is not the first thing that comes to mind.” At first, families can be very confused as to why certain health conditions present drastically different in their older loved ones. However, after experiencing it the first time, families and caregivers are better equipped and educated to deal with such things. When caring for older adults and administering medication, it is important to have open communication with the individual’s doctor(s) and to monitor any side effects. If you have any questions about home care for your loved ones, you can contact us. You can also check out the rest of our blog posts on our website. Written by Madison Chalmers
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More than 7 million people in the United States are living with Alzheimer’s disease and other types of dementia. In 2022 alone, Medicare spent over $1 billion dollars on people with Alzheimer’s disease, and Medicaid spent over $60 billion dollars on nursing home care.
Currently, there is no cure for Alzheimer’s disease. When thinking about treatments for Alzheimer’s disease and other forms of dementia, many think about drug therapies. However, Judith Graham of the Philadelphia Inquirer explains that there are dozens of programs that can improve the lives of people living with memory loss diseases. Judith Graham states that these programs are not just support groups, but “comprehensive dementia care” services that seek to assess needs, link families to resources, and create care plans. These programs are not widely known or broadly available due to low funding, especially compared to what the budget is for drug therapies. Additionally, there are low numbers of health care professionals trained in dementia care. In 2021, more than 11 million unpaid and untrained Americans provided more than 80% of the care to family members and friends with dementia. These caregivers have proven to have a higher burden of psychological and physical stress when compared to properly trained caregivers. However, access to “comprehensive dementia care” programs can assist untrained caregivers with caring for their loved ones. Research has also shown that these programs:
The hope in the future is for comprehensive dementia care programs to be widely accessible for those that need them. Currently, dementia advocates are lobbying Medicare to launch a pilot project to test a new model to pay for one of these programs. Additionally, the Alzheimer’s Association is advocating for a pilot project to be adopted “Medicare-wide” where comprehensive dementia care programs would receive between $175 and $225 per month for each patient enrolled. Which over 10 years would save Medicare and Medicaid about $21 billion dollars. A few examples of current programs for dementia caregivers include:
Caring for the elderly and those with dementia is no easy task. Caregiving can be mentally and physically exhausting, especially with how little resources are available. If you have any questions about home care for your loved ones, you can contact us. You can also check out the rest of our blog posts on our website. Written by Madison Chalmers
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There truly is no place like home, which is why many elderly people are opting to stay at home rather than go to a skilled nursing facility. Recently, former president Jimmy Carter chose to begin home hospice care which has become the more a popular choice among aging Americans. Over the last several years WellSky, a healthcare technology company, has seen a 20% increase in referrals for home care. Ron Southwick of Chief Health Care Executive reports that “From January 2019 through September 2021, hospitals saw a 10% increase in home referrals and an 18% drop in referrals to skilled nursing facilities.” Lissy Hu, of WellSky, attributes the growing popularity of home care to the pandemic. During the pandemic, many people were hearing horror stories about things happening in nursing homes. Many people do not want to be away from their families. However, Hu emphasizes the importance of care coordination. In a nursing home, patients can have all their health concerns addressed in one place. When opting for care in the home, it is important to have all members of the treatment team on the same page. Typically, primary care doctors have been used for referrals to other doctors and hospitals, but in the future primary care doctors will need to have more communication with community and home-based services. Hu describes home health services as “very fragmented” components in healthcare delivery. The hope is in the future, primary care providers will fill in the gaps. Additionally, hospitals are going to play a greater role in ensuring that patients opting to receive care in their homes will be able to have all their needs met. Jimmy Carter starting that he is starting home hospice care does not come as a surprise with the growing number of people opting to stay in their homes. There are many moving parts to this (i.e., who will be providing care, how will it be paid for?). However, more acute care programs at home are being developed and companies are beginning to focus more on at-home care (i.e., CVS Health acquiring Signify Health). If you have any questions about home care for your loved ones, you can contact us. You can also check out the rest of our blog posts on our website. Written by Madison Chalmers
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Millennials want to take care of their parents, but at what cost? An article recently posted on Yahoo News explains the financial burden that is placed on millennials taking care of their aging parents.
Living through multiple recessions and bouts of inflation, most millennials are not ready for the extra cost of providing for their parents. The burden of providing financially for aging parents as well as acting as caregivers has left one-third of workers ages 62-66 having no retirement funds. “A Goldman Sachs report found that 79% of millennials expect caregiving to undermine their own progress toward retirement goals, while 72% predict that they will lose earnings and career momentum due to caregiving,” reported Yael Bizouati-Kennedy of Yahoo News. Financial planner Lemar Williams suggests that families get together once a year to discuss finances and plans for aging parents and how to manage their care and bills. RBC Wealth Management suggests five big expenses that come with aging:
Goldman Sachs also found that a third of millennials, on average, have only saved a little over $3,000 to cover the costs of care for their parents. Even with long-term care insurance, the financial burden can be quite impactful on individual goals (i.e., buying a house). With the rising costs of living and home care, it is important to be prepared for the inevitable. Millennials can help prepare themselves, for taking care of their parents, by having discussions with their parents regarding the expectations for financial support. Additionally, for those millennials that have had to begin providing for their parents, 43% reported that they had to take time off work and 64% stopped adding to their retirement fund and had gone through some of their savings. Bizouati-Kennedy explains that millennials can help themselves while assisting with their parents’ expenses by maintaining a good credit score. You can check out the rest of the blog posts on our website and contact us if you have any questions about home care for your loved ones. Written by Madison Chalmers
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I recently read an article on Home Health Care News regarding self-directed care. Patrick Filbin, the author of the article, talks about the pros and cons of self-directed care.
Pros typically include the following:
Cons include the following:
Afterwards, I spoke with Twin Lights Home Case Manager Donna Chalmers regarding her thoughts on where self-directed care fits in home health care. “One of the biggest challenges that families face when taking an aide private is finding a relief aide or someone to take over when the original aide needs time off,” says Donna. Donna explained that with self-directed care, she believes it would be difficult for families to manage their caregiver, even if the person were someone they knew well. Donna continued, “Unforeseen circumstances happen all the time. Your mother is relying on you for care, but maybe you got a flat tire on your way; now your mother is without care. What do you do?” Donna went on to clarify that when utilizing an agency, for your home care needs, it will always be the agency’s responsibility to find coverage if an aide is unable to come to work. There is more security when using an outside resource. Filbin explains that “self-directed care can sometimes lack the resources provided through a traditional setup.” “Just because you need care, doesn’t mean you should lose your autonomy or dignity,” explains Donna. A study conducted at the University of Kansas, found that the self-directed care model focuses on self-determination and choosing care to suit individual needs. Donna pointed out that there is “a science” to matching aides with clients. “It is vital to match the personalities of clients and aides well,” says Donna. “The goal is for the client to have as much control as possible and not to make them feel like they don’t have a say in what’s going on.” Filbin believes that self-directed care is going to continue to grow in home health care. However, it is believed that state regulations will need to become stricter to prevent fraud. Donna sheds light on how it may be comforting to family members to have a caregiver that they know well but warns about burn-out and coverage. You can check out the rest of the blog posts on our website and contact us if you have any questions about home care for your loved ones. Written by Madison Chalmers
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I recently read an article in the New York Times depicting how to make a caregiver plan so that it is ready when needed. Lynya Floyd, the author, describes a couple with a childless friend that needed end-of-life care, and the process was made easier by already having an established plan. The plan’s purpose would be to designate who would cook meals, do laundry, coordinate healthcare, and keep him company.
It is recommended that the caregiving plan include answers to the following questions:
However, even the most detailed caregiving plans will require additional effort to succeed. The New York Times article explains a situation in which a family member was discussing hiring a home health aide but experienced resistance from the ones who needed the care. Maria P. Aranda, a professor of social work and the executive director for the Edward R. Roybal Institute on Aging at the University of Southern California, told the New York Times that “the preferences, likes, and dislikes of the person receiving care should be at the forefront.” I can recount an experience that a close friend had gone through when her grandmother became ill. My friend’s mother became the power of attorney over my friend’s grandmother. From there, they had several conversations about how to continue forward as my friend’s grandmother’s condition worsened. My friend and her mother had to make the difficult decision to move the grandmother in with them, which initially upset the grandmother. I remember my friend telling me she was concerned about all the decisions being made and how they would impact her grandmother and her well-being. Floyd discusses ways that can springboard conversations about creating a caregiver plan. Firstly, Floyd suggests starting with goals and identifying how your loved one would like to be best supported. Secondly, Floyd explains how there will be a need for more than one conversation and how important it is to remember that everyone is on the same team and wants what is best for the one needing care. When having these conversations, it is important to remember the five questions stated above and designate who will be prepared to gather the information needed and implement the plan. You can check out the rest of the blog posts on our website and contact us if you have any questions about home care for your loved ones. Written by Madison Chalmers
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 I started paying attention to statistics and studies on elder care more than five years ago, when my mother was showing signs of dementia and no longer was able to manage life at her condominium in Highlands.
The numbers were scary then. They’re even scarier now. An excellent article in the Wall Street Journal highlights the plight of “sandwich-generation” caregivers: men and women -- mostly women -- who simultaneously are caring for young children and elderly parents who no longer can perform “activities of daily living” such as preparing meals and bathing. The number of Americans shouldering such a burden has swollen to 9 million, according to the Journal. The article points to a number of demographic trends that help explain how we got here. Women are having children later in life. People are living longer, and more are developing Alzheimer’s disease and other forms of dementia. Families are smaller, increasing the burden on the “sandwich generation.” “All these trends are converging and intensifying the demands on those caring for generations on either side of them,” Journal reporter Clare Ansberry writes. A recent study by the National Alliance for Caregiving found most such caregivers are in their 30’s, 40’s and 50’s -- at the peaks of their careers both as professionals and parents. They devote an average of 22 hours a week to caring for an elderly parent, even as they work an average of 36 hours a week, not to mention the time spent raising their children. “It’s not hard to see how we are being squeezed and stretched like never before,” said Sarita Gupta, co-founder of the support group Caring Across Generations. And it’s only going to get worse. Consider that the first baby boomers will turn 80 in 2026. Consider, too, that about 60% of Americans 65 and older have at least two chronic health conditions, according to the Centers for Disease Control and Prevention. “Old age is very different today than it was 15 or 20 years ago,” said Anne Tumlinson, who started the support group Daughterhood.org. “Medical intervention keeps people alive long past the point when they can take care of themselves.” The Journal article profiles a number of women and men who are simultaneously raising children and caring for elderly parents -- cases that painfully illustrate the predicament so many of us are in. One example is Deanna Bautti, a 37-year-old small-business owner who drives to her father’s apartment twice a day to make sure he is fed and dressed. Because her toddler Roman accompanies her, Ms. Bautti tries to time the visits around his naps and meal times. “I feel very torn between my child and my dad,” she told the Journal. According to the article, one in three “sandwich caregivers” live in the same home with the parent who needs help. While that may be true nationally, the number is probably far smaller in wealthier areas such as Monmouth County, where many residents commute to high-pressure jobs in and around New York City. In many ways, the pressures on caregivers can be even greater under those circumstances. The Journal piece also powerfully illustrates the boundless love people bring to juggling their responsibilities as parents, professionals and adult children of an ailing mother or father. “My mom was mentally ill and dependent on me the entire time I was bringing up my three kids,” one “sandwich-generation” caregiver said. “I didn’t realize this until years later, but the life-affirming and loving messages my kids got from watching my husband and me care for someone taught them the really big lessons in life -- like the meaning of love. We all learned and grew from the experience.” If you’re a “sandwich caregiver,” the Journal offers some useful advice. Among the most important points: 1. Set boundaries: Be clear about what you can and can’t do and say no when you have to. 2. Prioritize: Drop non-essentials from the list and make sure the essentials really are that. 3. Enlist help: Ask relatives, friends and neighbors for help. Family members who can’t help with primary care can research support options and help manage finances or pay for housekeeping. 4. Plan: Caregiving can stretch into decades. Look into respite care, adult day care and in-home care. If you want to explore home-care options, Twin Lights Home Care is here to help. Written by T.J. Foderaro  The cost of employing a live-in aide can range from roughly $175 to more than $300 per day, depending on the agency and the clients’ needs. But for several of our clients, the out-of-pocket expense is substantially lower because they have so-called long-term care (LTC) insurance.
LTC policies make perfect sense when you consider round-the-clock home care can cost more than $100,000 annually, and a private room in a nursing home can be twice as much. There are tax advantages as well, since the premiums are partially deductible as medical expenses. But as thousands of older Americans have discovered, the cost of maintaining an LTC policy has risen dramatically in the past few years. The headline of a recent New York Times article says it all: “Your Long-Term Care Insurance Spiked. Now What?” The Times cites the example of Karen Herzog, a retired school teacher who received notice from her insurance carrier that her monthly premium was set to double to $550. “Many of us will be forced to drop this policy,” Herzog told the Times’ personal-finance reporter, Tara Siegel Bernard. “This was supposed to be my parachute.” Long-term care policies are designed to cover some or all of the cost of a home-care aide when the policyholder no longer can perform at least two “activities of daily living,” including feeding, bathing, dressing and toileting. Studies show that half of all Americans now turning 65 will require long-term care at some point. Most will need assistance for less than two years, but one in seven will need it for more than five years, according to the Times. That fact helps explain why insurers have aggressively hiked premiums for LTC policies. But there’s more. “Why are premiums swelling so much? There are several factors, but two of the more serious problems involved the predictions insurers made roughly two decades ago. Not only did they underestimate how long policyholders would live, they overestimated how many people would drop their policies, [in which case] insurers would not have to pay claims.” Many insurers -- including the biggest provider of LTC policies, Genworth -- ran into financial trouble. Genworth has agreed to sell itself to a Chinese company, though a deal has yet to be finalized. There are now only a dozen or so insurers offering LTC coverage, down from more than 100 at the market’s peak. Those that are left have petitioned state insurance regulators to increase premiums for tens of thousands of customers. “There is an inherent tension as a regulator,” Virginia’s insurance commissioner told the Times. “You want to protect consumers against rate hikes, but you also want to make sure the carriers remain solvent and are able to pay claims in the future.” Meanwhile, rate hikes are forcing policyholders like Karen Herzog to make difficult decisions -- including whether to drop their coverage. As a general rule, experts advise the elderly to maintain their coverage if at all financially possible. That’s because even with the premium increases, existing policies are both cheaper and more comprehensive than those being written now. “It’s technically still a deal relative to what coverage costs today,” one expert told the Times. If policyholders no longer can afford to maintain their existing coverage, they have several options. For instance, they could elect to reduce their benefits and/or cut the inflation rate for calculating benefit increases in the future. “You can call and sometimes [the insurer] will be flexible with giving you other options that were not in the package sent in the mail,” said Jesse Slome, executive director of the American Association for Long-Term Care Insurance. For more information, check out my Q&A with Tinton Falls insurance agent Toby Stark, which covers the basics of long-term care insurance. Another good resource is AARP, whose website includes a fact sheet titled “5 Things You Should Know About Long-Term Care Insurance.” Written by T.J. Foderaro  One of the nicest things about my work at Twin Lights Home Care is getting to know the women who take care of our clients. While they’re all dedicated to helping elderly men and women continue living in the comfort and security of their own homes, some have an inner strength, dignity and sense of duty that’s nothing short of heroic.
A case in point is Cynthia, who started working with our clients earlier this year. So far, Cynthia mostly has performed “relief” duty –- filling in on a case when the regular aide takes time off to spend with her family. While my partner Donna always speaks very highly of Cynthia, I didn’t have a chance to meet her myself until this week, when I picked her up at the Red Bank train station and drove her to the home of a client in Middletown whose regular aide was going off for a week. It’s about a 15 minute ride from Red Bank to the Navesink section of Middletown, so I asked Cynthia a little about herself. I learned that she lives in North Jersey but originally is from Jamaica, as are many of the aides who work with our clients. I also learned she has three grown daughters still living in Jamaica, and several grandchildren. That’s not uncommon: Many home-care workers help support family members in their native countries, often in the Caribbean or the Philippines. I wanted to ask Cynthia how she felt about living apart from her family … but I didn’t. I knew that she had helped care for the client in Navesink once before, so I asked Cynthia how she got along with the woman and her family. “Oh, very good,” she said. “They’re very nice.” I was curious to know how the client, who is in her 80s, was doing both physically and mentally. “Oh, pretty good,” Cynthia said. “She can’t get out of bed, and she’s very tall. And she can’t move her legs, which makes it difficult to clean her.” “That must be challenging,” I said. Cynthia continued: “She can only eat pureed food. Everything has to be finely pureed. It takes her a long time to eat. She sips her food with a straw, but sometimes it can take 15 minutes for her to swallow.” “Wow, that sounds very challenging,” I said. “No, not really,” Cynthia said. “They just need love. That’s all this job is about. Love.” I was speechless for a moment, then continued. “It sure is tough getting old. That’s something my father always used to say.” “No, I want to get old,” Cynthia said. “My family will know how to take care of me. As long as you have love, that’s all that matters.” After I dropped her off, I felt very appreciative for the opportunity to spend a few minutes with a woman who, despite significant personal sacrifice, gives her heart and soul to help the most frail and vulnerable among us –- people she never knew before -– live out their lives in comfort and dignity. When I called Donna to confirm that Cynthia was on the case, I told her about my conversation in the car and asked whether we could use Cynthia in a full-time capacity, rather than for relief. Donna explained that for now, Cynthia would prefer to work part-time. If that ever changes, I would be the first to recommend Cynthia to any client who needs a live-in aide. They would be very lucky to have her. -- Written by T.J. Foderaro  There were times when I was caring for my mother in the final years of her life that I thought I was going to lose my mind. Many times. And quite literally. Although we employed part-time aides to look after my mom at her condominium in Highlands, I was constantly dealing with calls from the building manager, grocery shopping, doctors’ appointments, prescription pick-ups, bills and taxes. As my mother grew frailer in body and mind, there were phone calls at all hours of the day and night. Her door was wide open. She tried to walk out of the building. She was confused. She had fallen. There were days when I felt like I couldn’t go on anymore, had no idea how I’d continue juggling the responsibilities of helping my 82-year-old mother while meeting my obligations at work (two jobs) and home (three children). There were moments when the stress literally made me feel nauseous. I also felt angry, sad, frustrated, guilty. It didn’t occur to me at the time that other people — millions of them — were going through the same thing. “It’s hard,” said Linda Schulman, a New Jersey resident who first cared for her dying husband and then for her elderly mother. “It’s like having a second full-time job. It’s very time-consuming.” Schulman’s testimony is all the more telling because she’s a professional. Her title is director of community relations at Daughters of Israel, a nursing home and rehabilitation facility in West Orange. “It is my day and night,” Schulman said of her work in the nursing home. “I lived it. I breathed it. And then it became my life.” Schulman is among a number of New Jerseyans featured in a lengthy expose that recently appeared in the Asbury Park Press. The series, titled “‘Consuming and Isolating’: Why the Caregiver Crisis Could Strain Public Health Care,” reveals that 1.7 million people in New Jersey — nearly 20% of the men, women and children in the state — “live the life of an unreimbursed caregiver.” “Every day, compassionate Americans devote time, energy and resources to ensure that family members who are disabled, elderly, chronically ill or injured can remain in the stability and comfort of familiar surroundings,” reporter Cheryl Makin wrote. “ These Americans are caregivers -- a growing group who often sacrifice much in their own lives for their loved ones.” Are you a caregiver? If you devote some of your time each week to caring for a spouse, parent or other family member who needs help with “activities of daily living” and/or medical treatment, then you qualify as a caregiver. While there are professional caregivers who get paid for their work, most are family members who are unpaid. A recent study by the United Way found the vast majority of caregivers (86%) are women, mostly between the ages of 50 and 64. Nearly half provide care for a parent. Unlike professionals who work regular schedules, unpaid caregivers can be on call 24/7. Numerous studies show that such responsibility can take a serious toll, both mentally and physically. The United Way study, for example, found caregivers often neglect “their own mental and physical health ailments as they put themselves last in their desire to care for another. Caregivers may feel stress, grief and other difficult emotions while providing care.” It’s no wonder that nearly 20% of caregivers exhibit signs of moderate to severe depression, versus less than 7% of the overall population, according to the United Way. Lucille Deutsch, who runs a geriatric-care agency in Morris County, said many family caregivers “end up more ill than the person they are caring for. They don’t keep their doctors’ appointments, they are not eating right, they are not getting enough sleep, they don’t exercise because they are so focused on caring for this person that they love.” In many cases, family members don’t even realize they’re filling the role of a caregiver, Deutsch added. “I’ve met so many sons and daughters over the years who say, ‘No, I’m not a caregiver, I just go food shopping for my mom and do her laundry or I’ll run to the bank,’” she said. “Those are caregiving activities.” In retrospect, I never thought of myself as a caregiver either. As my mother’s condition worsened, we felt it necessary to hire a live-in aide through an agency. We went through a half-dozen aides before we found someone who was right for my mother. But even then I was often on duty, from stocking my mother’s refrigerator to managing her finances to relieving the aide when she went to church on Sundays. I guess I was a caregiver after all. What can caregivers do to manage the stresses and strains of their “second job”? The Family Caregiver Alliance offers the following tips: 1. Recognize warning signs early. These might include irritability, sleep problems and forgetfulness. Know your own warning signs, and act to make changes. Donʼt wait until you are overwhelmed. 2. Identify sources of stress. Ask yourself, “What is causing stress for me?” Sources of stress might be that you have too much to do, family disagreements, feelings of inadequacy or the inability to say no. 3. Identify what you can and cannot change. Remember, we can only change ourselves; we cannot change another person. Ask yourself, “What do I have some control over? What can I change?” 4. Take action. Taking some action to reduce stress gives us back a sense of control. Stress reducers can be simple activities like walking and other forms of exercise, gardening, meditation and having coffee with a friend. Identify some stress reducers that work for you. 5. Take a break from caregiving. Get help with caregiving tasks either by recruiting other family members or hiring a professional caregiver. Written by T.J. Foderaro |
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