Senior Safety

Elder Care During Emergencies

August 28, 2017 By Jim Reynolds

Home Care > Main Office > Senior Safety

Hurricane Harvey brought many harrowing images - none more stirring than a group of nursing home residents sitting waist-deep in water, awaiting rescue. Elder care during emergencies presents challenges best met in advance. Plan ahead, and your chances of real disaster drop dramatically. But dealing with a patient with Alzheimer's or a related dementia is difficult. Stroke patients with limited mobility, senior citizens who use oxygen or may be confined to a wheelchair, and other elderly family member who may simply be slower to respond is fraught with peril. Wait, assuming everyone will do the right thing (and besides, changes of a true disaster are fairly small), and deep trouble or even tragedy can strike.

Here in New England, we rarely deal with hurricanes, but elder care during emergencies usually means we have good, old-fashioned nor'easters and blizzards to contend with. Seniors living alone are especially vulnerable at those times. We have earlier posted about Caring for Elders during Emergencies, but given recent events, this bears repeating.

Most weather emergencies allow us to plan ahead. For Hurricane Harvey, one of the few saving graces (if we can call it that) was that at least it was not a surprise. When we face a New England blizzard with risk or a power outage or of limited travel, we also usually have a chance to arrange care in advance. Family, friends, or professional caregivers can arrive in advance of the weather and be on hand during the worst times. Meals, medications, and emergencies supplies can be checked. Flashlights, blankets, heating oil, and other critical items can be stocked in advance.

But sometimes even those preparations do not save us. After the Boston Marathon bombing, we had dozens of clients in areas where travel was prohibited and everyone was on edge. At those points, we often had caregivers walking some significant distance to reach elderly clients living alone who needed help. It was an inspiring display of staff who were dedicated to their clients and profession.

Signs that Home Care is Needed

June 8, 2017 By Jim Reynolds

Home Care > Main Office > Senior Safety

Summertime vacations always bring an increase in calls from concerned adult children with some flavor of this question: “During vacation, we noticed Dad is slowing down. We think he might need help at home, but we aren’t sure. How can we tell?” The decision is not always clear; here are some signs that home care is needed.

The easiest decisions follow events that show clear and present danger: traffic accidents or dangerous driving, falls, or home safety hazards caused by inability to mange the home (stove left on, unaddressed plumbing problems, roof leaks, etc.). If this is happening, then it is time to step in, even if “nothing bad happened yet.”

Rationalizing – “It could have happened to anybody; could have happened when I was 40.” – is often deployed by someone resisting care, but the point is that you don’t want to wait until something bad happens; the near-miss is a gift and an opportunity. It shows, with little to no cost, a need for change. Take the gift, and do what is needed. Even if there is resistance, be persistent.

(The caveat: all competent adults have a right to self-determination; this is not an excuse to force a parent to live the way you’d prefer. Yes, fender-benders happen to younger drivers, too. If you are unsure of where you are in the spectrum, keep reading.)

Even clearer signs include early or moderate dementia, incontinence or poor hygiene, and poor medication management. These are not debatable: if this is present, your loved one is unsafe living alone and needs help.

The more difficult decisions arise when warning signs are present but not determinative and you are the closest family member responsible for safety. The best approach, if at all possible, is to open an honest discussion with the person. You can keep it hypothetical if that helps – “Uncle Albert, while you’re still healthy, I wanted to talk about what to do in case something happens. What do you think we should do if your driving skills fall off, or if it gets too hard to manage the house?” Often times, people do not know how to ask for care and a discussion of hypotheticals may allow preferences to emerge that would otherwise have remained unstated.

As you consider whether the time has come to step in, focus first on physical skills: how well does the person drive? Can your loved on walk and get up a flight of stairs easily? Is it still a reasonably simple task to get proper daily nutrition daily, take meds, manage the home, and maintain personal hygiene? The next consideration is how the elder would handle an urgent or emergency situation: what would happen if Dad were alone and cut himself with a kitchen knife, or there were a gas leak, or he fell? Do not focus on what is optimal or what you prefer; he is entitled to handle these his own way, provided he can keep himself safe. If you are concerned about these matters, however, this is a sign that it might be time to start the discussion about extra help.

And on that topic, be sensitive to how you raise the issue and your attitude. Remember that most adults would love to have a personal assistant, but nobody wants a baby-sitter. If your unstated attitude is, “You are clearly too old to be living alone, and you cannot manage your own affairs,” you are much less likely to have a productive conversation than if you convey, “We love you and want your golden years to be as easy as possible. Let’s get you an assistant so someone else handle the chores.” And if the assistant can be a family member or friend, that’s often more palatable, especially at first.

If you are still uncertain whether it is time for more help, or if your initial discussions meet resistance, it may be best to get a neutral third party to help advise your loved one. If the relationship with the primary care physician is good, ask for an appointment that you can both attend to discuss your concerns. A professional geriatric care manager (check with the National Association of Professional Geriatric Care Managers at http://www.caremanager.org) who specializes in creating care strategies can also be a great aid. We find that those whose backgrounds are in social work or counseling are best in these situations. Many GCMs are nurses, but you want someone whose training makes her a good mediator and facilitator of family discussions in addition to conducting the actual assessment of the elder.

Finally, do all you can to involve other family members in the discussion. The more collaborative the decision-making is, the greater the chance for success and for cooperation from everyone.

Fall Risk Elder Assessment – Hazards and Prevention

May 23, 2017 By Jim Reynolds

Home Care > Main Office > Senior Safety

Falls are the single biggest cause of fatal injuries in people 65 and older, so keeping elders safe in a home where they may have lived for decades is one of a family’s biggest challenges. The familiarity of the surroundings and the history of safety can work against both the recognition in adult children of growing dangers and can build resistance on the part of the elder to any change in a familiar and comforting environment.

There is good/bad news here: fortunately, many factors that contribute to fall risk are under a family’s control; unfortunately, fall risks are sometimes especially difficult to eliminate, because it can require change that generates resistance in the elder to the very actions needed to improve safety. When we visit families, one of our first activities is a review of the home to inspect for these risks; we typically find that a person who recently moved to a condo or other new arrangement has many fewer accumulated hazards than someone who has lived decades in a home and intends to stay.

Many sources are available to help families take action to reduce fall risks. AARP, Mayo Clinic, and the Center for Disease Control, for example, all contain articles on the topic. For those tackling the task at home along, here are some tips culled from our experience.

Physical Health

Regular exercise is probably the single biggest factor that helps reduce falls. If the elder will participate in a class like Tai Chi, which focuses on strength and balance, that is best. But simply walking 20-30 minutes daily at a moderate pace is an enormous help. Studies consistently show that people who remain active walkers later in life fall less often than more sedentary counterparts.

Review meds, and when possible, reduce them. Write down every prescription and non-prescription drug or supplement, including anti-depressants and sleep aids, and take them for review by the senior’s physician. Request a review for side effects and interactions that may increase fall risk.

Limit access to alcohol. Even in safe doses, alcohol makes everyone a bit less steady, and alcohol abuse among elders, who are often lonely and isolated, is surprisingly common.

Check the elder’s health. Poor vision, inner ear problems, urinary tract infections, and other health conditions may be the harbingers of increased fall risk.

Environment

Turn your attention to the environment. Start with the elder himself or herself - be sure the elder wears proper shoes. Flip flops, sandals, and bedroom slippers, even in the home, can cause a stumble or fall. Properly fitting and sturdy shoes are the keys the stable walking.

Next, examine each of the home’s component parts. Consider these questions:

Floors

Is there a clear path through every room? If you have to walk around furniture, or if there are low items like coffee tables or foot stools, these will increase fall risk. Even if items have been present for decades, try to move them; they represent a risk now that they did not in years past. If necessary, consider saying that they need repair or that they are dangerous for a grandchild. Avoid arguments over whether the elder is likely to fall; most likely, the response will be “I’ve lived here 50 years and haven’t fallen, so I want nothing to change.” Your goal is not to get elders to agree that their skills are declining; it is rather to remove the risks, so always try to do it in a way that leaves the person’s dignity intact.

In particular, remove small throw rugs – these are among the most significant hazards. (“We took it for cleaning” or “It was ripped and is being repaired” are handy excuses if needed.) If the rug is so well-loved that it cannot be removed without undue stress, use double-sided tape on a non-stick backing to keep it securely in place.

If there are small objects on the floor, remove them. These include pet toys or pet food dishes, laundry baskets, footstools, shoes, magazines and newspapers, etc. Especially in the bedroom, where people often rise at night in the dark and are disoriented and sleepy, these present significant fall risks.

Get wires and extension cords out of the way. If necessary, have an electrician install a new outlet. Tape or staple cords out of the way.

Examine stairs and hallways. Be sure they are well-lit – often older homes do not have bright lighting for stairways. Be sure the light can be turned on/off from both the top and bottom of the stairs. If not, call to have a new switch installed. Is there loose or torn carpet? Remove it or replace it. Even better: attach non-slip rubber treads to the stairs. Check for sturdy hand-rails on both sides of each stair.

These changes of course will not prevent all falls, but they can go a long way to eliminating the risk of unnecessary injuries.

Our next column will address fall risks in bathrooms and bedrooms separately, because they are so important.

Reassuring Elders Living Alone During an Emergency

May 22, 2017 By Jim Reynolds

Home Care > Main Office > Senior Safety

Families with elders living alone always worry about handling emergencies. In addition to the elder’s own health crises, all of us have to plan for blizzards, power outages, and related events. And of course this past week provided an unwelcome example of another type of emergency, when the Boston Marathon bombers put parts of the city and suburbs on lockdown. As a home care agency with clients and staff living in Watertown and other close-in suburbs, we had some clients we could not reach and caregivers who could not move from their homes. At least a blizzard or storm comes with some warning; this tested families and caregivers with its sudden and unpredictable course.

We have covered the nuts and bolts of emergency preparedness in other articles. But last week, as we addressed the logistics of the emergency – which clients were stranded alone? were staff and clients safe? did everyone have food, power, and medical supplies? – we found ourselves responding also to clients, families, and care staff searching for words to comfort and reassure vulnerable people who may not have fully understood what was happening, but knew enough to realize that an ominous and uncontrollable threat was at hand.

Reassuring people in an uncertain world can be a difficult task. Part of the job is very practical: reduce the risk as much as possible, and be ready to respond if something goes wrong. But once that is done, we have the often-delicate task of reassuring a frail elder whose cognitive skills or memory may be compromised. Although our information is never perfect, emergencies like blizzards are common enough, and their paths well-known enough, that we can provide some solid guidance. But the truly unpredictable nature of a terrorist bombing and a man-hunt close to home can present challenges we rarely have to face.

At these times, personal trust is your best asset. Reassurance comes in many forms, and telling your loved ones that the door is locked may not comfort them nearly as much as sitting with them to help them feel secure (but lock the door anyway). Here are a few helpful guidelines designed to avoid the onset of stress, or to reduce the stress once it appears:

Comfort their fears. Last week, you might have reminded an elder that these are very rare events, and that many, many really good people were there to help, even risking their lives to help the wounded. Ask them about times they remember people who were extraordinarily kind or generous or heroic in times of crisis. Observe that people like that are still with us today.
Listen, and allow them to talk about their feelings and memories of the other events this may bring up. This may include stresses from long ago – WWII for example, or a time their home was robbed as a child. Allow those feelings to be voiced and those memories to be recalled, but …
… despite the advice above, try to redirect attention so that no one dwells on the current threat. If at all possible, do not allow someone to sit and listen to the news about this all day, especially when there is really nothing new being said. lnstead, find an activity at home away from the TV or radio, or take them out of the house. Some people can be easily distracted with a favorite activity, and now is a good time to use it.

As we say with all parts of the journey in elder care, these times, if accepted for what they are, can still yield treasured moments. There is little more that we can do for those we love of any age than to be there when needed. And in that sense, if you can provide the support that settles their mind, you might create one of those treasured memories. It may be that providing comfort in a fearful time is an event you will remember years after your loved one is gone.

Editor's Note: This article was posted originally after the Boston Marathon bombing in 2013. We have kept it here because the discussion is relevant to any emergency.

Tips for Visiting Home for the Holidays

May 21, 2017 By Jim Reynolds

Home Care > Main Office > Senior Safety

Whether returning home to Massachusetts to visit aging parents for summer vacation, the "Holiday Trifecta" (Thanksgiving and year-end holidays), or at other important milestones throughout the year, holidays can be especially stressful for those of us whose parents may be declining. In some cases, this decline can be as simple as realizing that you need to devote regular efforts to help a loved one manage daily life; in others, we might face the grief of knowing, or fearing, that this may be one of the last holidays together.

Because remote family members visit so often during the summer vacations and holidays, we often receive requests at this time of year to help assess whether someone is still safe, and to identify the kinds of help available and what might be needed. We also notice enormous stress in uncertain adult children hoping to do the right thing with their parents while navigating uncharted waters. We find that it helps to use these holiday and vacation visit guidelines, from how to manage taking a dependent elder a short trip away from home to considering whether a senior can continue to live alone, safely and unaided.

1. Treasure and be present with the person before you

First, it is always good to stop and remember those things that cannot be changed: aging, the effects of some illnesses, the progress of dementia, and other factors. “Old age,” as Betty Davis said, “is not for sissies.” Sometimes we see families whose holidays would improve if they paused briefly to realize that a parent will never again have the health and energy of past times. However, treasured holiday memories can still be created with person before you. Honor that person; try to make him or her comfortable; ask to hear a story, or tell one yourself. Even in advanced stages of illness, holiday experiences can be joyous if accepted for what they are. It is good advice for life in general, and especially with aging loved ones.

2. Assign someone the task to be sure your elder is not over-stimulated

Especially for elders who are not used to being active, and have their own hopes for a holiday experience “like old times”, the temptation to try to keep too fast a pace during a holiday can lead to exhaustion. Be sure that every day someone is prepared to stay at home, or leave an event early; your elder will be happier not trying to keep up with the most energetic members of the family. Try to rotate this responsibility so no one misses too much. It can be an adult child, a younger family member, family friend, or regular caregiver. This is simple, but easy to forget.

3. If the elder is traveling, plan extra time

Whether it is security scans at airports or long car rides, the pace and distractions that many of us take in stride as part of travel can be exhausting, confusing, or frightening for elders. If you are in a rush, the problem is exacerbated. Plan ahead, allow for a slow pace and leisurely pace, and explain what is going on. This can relieve pressure on everyone.

4. If you visit home, be on the lookout for signs that help may be needed

People who visit home after an absence of several months sometimes can see the signs of decline in the condition of the home or the elder. It is important to be on the lookout for these, especially if family is not regularly present. Signs include a poorly-stocked kitchen, plumbing or appliances that do not function and have not been repaired, clutter that may be the initial stages of hoarding, or poor hygiene. Rarely to our elders call and say, “I cannot manage alone and I need help to continue living here.” Far more often, the signs appear without a request for help. If you have concerns about whether someone is safe at home, an assessment by a geriatric care manager or local senior citizens’ service center is called for. One good list of criteria to use to determine whether an assessment is called for was created by Professors Hall, Bossen, and Specht at the University of Iowa College of Nursing. It is available here for those interested: Assessing the Risk of Living Alone.

The holidays with aging parents can be bittersweet. But with proper planning and the right attitude, the emphasis can be on the sweet. Do not try to do too much; find ways to enjoy the person as he or she is today, and to help him or her enjoy the day as much as possible. Grieve if it is called for, laugh when you can, ask for help when you need it. It is all part of life’s pageant.