ROBOT AND FRANK with Frank Langella and Susan Sarandon takes us to a future where Frank is a man whose increasing memory loss worries his family and they want him to change his lifestyle to keep him safe. Frank is given the choice between “a home” and a new technology – a robot home health aide.  I am shocked and amazed that Hollywood is producing a movie about a man struggling with old age and dementia!  A review by Slate says the movie is charming, sentimental and funny. 

I talked with one of our caregivers about the idea of a robot caregiver. At first she was horrified (she thinks kids watch too much TV and spend too much time interacting with virtual friends on the Internet) about a machine doing her job but said she needed to think about it before condemning the idea. We both know there aren’t enough children, home health aides or facilities to take care of 77 million Baby Boomers.   Is a caregiver robot better than a nursing home?

 Home care counselors at A WAY TO STAY Home Care are available to talk with you about your needs.  A WAY TO STAY is a home care agency providing In-Home Care in Yardley

One of our great joys is to create cards that celebrate caregiving.   We want the reader to smile and connect for a moment with the notion of how Devon and I see what a Home Care agency does.  Devon is a punster and came up with the title of this card!  The caregivers we work with, and the clients and families we work for, are so full of love.  

We use the “occasion” of the card to make a donation to a non-profit we think is the Bomb.  For Valentine’s Day our donation is to the Alzheimer’s Association of the Delaware Valley. They do such important work and are so encouraging to our team. Among many other things the Association helps us direct our dementia clients to resources in the local area as well as having a 24-hour helpline 800.272.3900.

Home care counselors at A WAY TO STAY Home Care are available to talk with you about your needs.  A WAY TO STAY is a home care agency providing In-Home Care in Yardley

• Aides who want cash under the table. It could be because they are working illegally in the U.S., have a criminal record, are working under an alias or are hiding income from Unemployment or the I.R.S.
• Aides who to take over the client’s life until the client relies on them utterly and completely.  We’ve seen adult children try to negotiate with caregivers who are in control of their parent. It’s a terrible situation.

 As the owner of a licensed homecare agency, I come down on the side of hiring through a reputable agency because we are “experts” at finding aides.  Our  extensive screening process helps us select the “gold nuggets” from our many applicants.  

 What do we look for in a caregiver?

 1.       A cheerful, positive, mentally-stable person. No one wants an argumentative nervous personality.

2.       Good work history and wide range of experience. Has worked with a wide range of elders, has experience with Alzheimer’s and other chronic diseases AND gets rave reviews when we talk to former clients.

3.      Communicates effectively and speaks English.  Must be able to communicate on the phone, in writing and in-person so the family, other care team members and our supervisors know what’s going on in the home.

4.       Goes above and beyond all their duties. Someone who is self-directed, is ready to go the extra mile and is always there to help solve problems before they happen.

5.       Trustworthy. Passes a national, state and county criminal background check, drug test and our caregiver quality assessment that evaluates caregivers for dependability, integrity and hostility.

6.       Attentiveness to client’s right to dignity and respect. It’s the client’s agenda, not the aide’s agenda; must be highly sensitive to non-verbal communication and be an active listener. Must be able to “hear” the client’s needs to effectively support them.

7.       Team player. We seek quiet competence not know-it-alls. Care team members who find goodness in others will find and nurture the goodness in their clients.

8.       Maintains personal boundaries. Sensitive to personal & family dynamics and maintains professional boundaries. What goes on in your home stays in your home!

9.       Is confident about her ability to provide exceptional care.  Someone who knows she gives good care in a range of circumstances– “It’s what she does” – and she wants to work with other quality caregivers like herself.

Aides who don’t meet these criteria don’t get through our screening.  

 Home care counselors at A WAY TO STAY Home Care are available to talk with you about your needs.  A WAY TO STAY is a home care agency providing In-Home Care in Yardley.

Devon and I first met Cece while we were doing clinicals for our CNAs. She worked as a CNA in a well-regarded nursing center of a local CCRC (Continuing Care Retirement Community). She had been there for years and was helpful to newbies like Devon and I. Her calmness and confidence were a big boost; her smile, big hug and good advice made her a favorite of ours and residents. Almost all the residents needed total care and didn’t have much in the way of verbal communication skills. Cece carefully worked her way from one to the next always greeting each one with a bright smile, a kind word and a sense of what each resident wanted even though they couldn’t speak clearly about their needs.

It’s not often that you get a chance to hire someone you’ve worked with but we were lucky enough to hire Cece. She epitomizes what we are looking for in an employee. Cece is a team player who knows all about ailing older adults and has managed to retain an amazing sense of humor. Not only is Cece beloved by our clients (and their families) but our 12-year old Hannah has had her as a sometime sitter. She passed all Hannah’s pre-teen tests (surely more challenging the dealing with a sick elder) and is welcome here 24/7. Cece is a modern day Mary Poppins – she loves what she does and it shows. Her clients look forward to her visits and their families feel confident that their aging parents are competently and compassionately cared for.

Cece has a full and complete life. Three grown daughters and a bright and charming grandson, Jonathan, who (if he were older) might sweep our Hannah off her feet someday. Tonight Cece is visiting her 90-year old neighbor who is now at a rehabilitation facility; Cece walks the walk, and talks the talk. We are lucky to have her and are careful to place her with clients who appreciate her special attributes

Home care counselors at A WAY TO STAY Home Care are available to talk with you about your needs. A WAY TO STAY is a home care agency providing In-Home Care in Yardley-Newtown, PA

This New Year’s 2011 card came to life during a brainstorming session in a parking lot at Ann’s Choice.  Devon and I were attending a seminar on Hospice and it made us think about one of our clients whose caregiving for her mother went above- and-beyond the call of duty. Her mom died in early December.  This card celebrates that daughter and other sons, daughters and spouses who do amazing things – often to their own determinant – to care for their loved ones.   

The visual image of recharging the battery of one of our cars by jump starting it was a great metaphor for the renewal of the caregiving spirit. If only it were so easy for human beings to recharge themselves.

We made a donation to the Rosalynn Carter Institute for Caregiving because of the work they do to sustain and enrich caregivers everywhere.  They create evidenced-based programs to help caregivers maintain balance in their lives so they can continue to care for their loved ones instead of burning out.  An interesting factoid is that most sons, daughters and spouses don’t think of themselves as caregivers – they think what they do is what their loved one would do for them if they switched places.

Home care counselors at A WAY TO STAY Home Care are available to talk with you about your needs.  A WAY TO STAY is a home care agency providing In-Home Care in Yardley

Let me simplify and break Home Care into two types, one paid out-of-pocket and the other by Medicare or private medical insurance:

1.  Unskilled Home Care or Non-Medical Home Care does not provide nursing or  skilled care and is sometimes called Private Duty Care. This is the service our agency, A WAY TO STAY provides.

• Who pays? It is out-of-pocket although some clients have Long Term Care Insurance or Veteran’s Benefits “Aid and Attendance” that covers the cost.
• Type of staff? Services are provided by experienced caregivers; many are CNA’s (certified nursing assistants) or HHA’s (home health aides) who have worked in facilities or have other Private Duty experience.  Once assigned to a client the caregiver is generally the same one so the client has consistent care.
• Kinds of services? Caregivers assist clients with eating, bathing, toileting, dressing, transferring, meal preparation, errands, supervision, transportation, medication reminders, and light housekeeping, etc. according to a care plan.
• How long is the visit? The length of the visit depends on the client’s needs, lasting from a few hours to live-in arrangements.
• How is the visit scheduled? The schedule is determined by the client.
• How do clients get referred ? Most clients discover Home Care because a doctor or a discharge planner at a hospital or rehab suggests it.

2.   Home Health Care isskilled care provided in the patient’s home or facility and is sometimes called Visiting Nurses, In-home Health Care or variations of this name!

• Who pays? It is generally paid for by Medicare and private medical insurance.
• Type of staff?  Licensed professionals such as physical, occupational and respiratory therapists, RN’s, LPN’s and HHA’s or CNA’s. Once assigned to a patient the caregiver is generally the same one so the patient has consistent care.
• Kinds of services? Home Health Care is responsible for administering treatments and  medications per a care plan. It is not usual for a caregiver to cook a meal or  provide any non-medical type care because they don’t have the time to do anything other than the procedure they came to do.
• How long is the visit? The visits may be scheduled once or several times a week and last approximately 45 to 90 minutes. The visits are scheduled for a limited period of time and the patient must be home bound.
• How is the visit scheduled? The patient is usually called the morning of the visit so schedules may vary for each visit.
• How do patients get referred? Generally Home Health Care is based on a doctor’s order.  Most patients come from the hospital or rehab.

Home care counselors at A WAY TO STAY Home Care are available to talk with you about your needs.  A WAY TO STAY is a home care agency providing In-Home Care in Yardley.

One part of the interview lacks clarity:  Dr. Salamon’s answer to the question “Is memory loss the biggest fear of aging?”   She says, “We probably will see more and more people with this problem (memory loss) and many doctors will say that’s normal with aging.  And lots of time that is true.  

I was rankled by this because it appears that doctors are saying memory loss is a normal part of aging. Let me say loud and clear: dementia is not a normal part of aging.  If you have Alzheimer’s, part of the disease process is memory loss.  The mistaken belief of many Americans is that ALL seniors become senile and forgetful. This contributes to the negative stereotyping of older adults in our culture called ageism which it affects the physical and mental well-being of older adults.

The reality is that a small percentage of older adults develop incapacitating cognitive disorders. At 65, the prevalence of dementia is 5 to 7 percent, with the risk almost doubling every five years of life until age 90, when rates level off to approximately 40 percent (Ficher, Schroppel, & Meller, 1996; Graves et al., 1996; Sadock & Sadock, 2000). 

Some cognitive changes do occur as we grow older. The most common is a decline in speed of mental processing (Ratcliffe & Saxton, 1998).  Age-related change in cognitive processing speed has practical implications. First, seniors can process information about as well as younger adults if given adequate time to absorb the information. Second, since learning new information is stored more slowly into memory by seniors, they may be less able to “store” new material presented rapidly. This process may also be responsible for a slight decline in ability to learn new information in late life. Similarly, it may take seniors longer to recall information. Third, reaction time is slower, which may have implications for performance of activities that require rapid shifts in attentions, such as driving – for some seniors. It is important to note that these changes are minimal in normal aging and do not general impair the daily function of seniors.  

Since normal aging is accompanied by declines in vision and hearing which may be mistaken for cognitive deficits. A senior who cannot hear or see cannot store or recall information accurately. Thus it is important that seniors maximize the comprehension and retention of information by using any glasses, hearing aids, or other assistive devices they need.

The information and citations in the three paragraphs are courtesy of the Society of Certified Senior Advisors (of which I am a member) “Working With Seniors.”  

Home care counselors at A WAY TO STAY Home Care are available to talk with you about your needs.  A WAY TO STAY is a home care agency providing In-Home Care in Yardley Newtown PA

Her caregivers made certain that the hospital gave her the best care…

• Prevented her from drinking liquids that were missing the required thickener so she didn’t choke (the thickener order went to the patient in the next bed)…
• Made sure she continued to drink fluids so she wouldn’t end up on an IV due to dehydration (the hospital aides don’t have time to make sure that elders are reminded to drink, drink, drink) …
• Slowed down aides from doing personal care at the speed-of-light and explained to our client what was being done (it’s difficult for an elder to have strange men doing your personal care AND not understand a word that person is saying because they speak too quickly or with an accent)…
• Maintained a log of tests run and doctor’s visits (making certain that the family care team knows every move the hospital makes)…
• And most of all our client always had someone with her with whom she was comfortable (when she woke up every morning there was a familiar face to make her less anxious about being in a place where people talk too quickly and  strangers sometimes  touch you without permission)…

Being alone in the hospital is a scary place for an older adult for all the above reasons but this hospitalization was positive and our client didn’t lose ground during her hospital stay.  An anxious time for our client, her family and her A WAY TO STAY care team.   Our caregivers – Becky, Kim, Kyleen get major kudos for their dedication, caring and eye- for- detail.

Home care counselors at A WAY TO STAY Home Care are available to talk with you about your needs.  A WAY TO STAY is a home care agency providing In-Home Care in Yardley

 A warning – Gross’ mother’s choice to die by refusing to drink or eat may make be upsetting to some people. The topic is fraught with emotional landmines and Gross walks you through some of the conversations that occurred before her mother’s death. It makes for difficult reading but will hopefully remind family how important quality-of-life issues are and promote discussion between aging parents and their children.

Below (courtesy of the publishers’ blog) are a few the high points distilled from Gross’ experience:

• Slow down: The collision of fear and ignorance leads to bad decisions and most don’t have to be made as quickly as it may seem.

• As painful as the role reversal between parent and child may be for you, assume it is worse for your mother or father, so take care not to demean or humiliate them.

• Denial, more often on your part than theirs, is the biggest obstacle to thoughtful planning. Talk to them, no matter how uncomfortable it makes you, about the future—medically, financially, residentially and in terms of end-of-life choices.

• Do not assume that a parent who reaches the age of 85 is going to die quickly or easily. He or she will likely need years of help with simple tasks like bathing, dressing, eating and toileting, which is not covered by Medicare. Only the very wealthy or the indigent get through this without spending enormous sums of money.

• Be sure your parent has a trusted internist, or, better yet, a geriatrician, to quarterback his or her care, explain that not every medical procedure that can be done should be done and constantly reassess your mother or father’s views on longevity vs. quality of life. Specialists often treat body parts not human beings.

• Avoid hospitals and emergency rooms, as well as multiple relocations from home to assisted living facility to nursing home, since all can cause dramatic declines in physical and cognitive well-being among the aged.

• Lie if you must to keep a parent safe. Examples of this might include disabling a car if your parent will not relinquish the keys and is a risk to himself or herself, or others, or having a college student look in on a parent under the guise of doing a school project.

• Keep with you at all times an updated list of your parent’s health conditions and medications, a cell phone charger, a spare pair of eyeglasses, a credit card or wad of cash or anything else you might need if summoned without notice to deal with an emergency.

Home care counselors at A WAY TO STAY Home Care are available to talk with you about your needs.  A WAY TO STAY is a home care agency providing In-Home Care in Yardley

Last week I took Mrs. Z to a local branch of a big Philly hospital. We walked up to the receptionist and my client identified herself as”Mrs. Z.” It was like watching a slow motion car crash; as the intake person completed the paperwork necessary for her visit, Mrs. Z was addressed as “Honey” several times.  Mrs. Z had introduced herself as “Mrs. Z” and the intake person totally missed her gentle reminder of how she wished to be addressed; she was on auto-pilot and was completely unaware of how disrespectful she was to my client under the guise of being warm and fuzzy.  Mrs. Z knows that if she corrects her and says she wants to be addressed as “Mrs. Z” she risks alienating her.  Mrs. Z relies on the “kindness of strangers” to give her good care and can’t afford to be “pushy.”

This name-calling habit which seems too common in the health profession is called “elderspeak.”  I found a great article in the New York Times, “In ‘Sweetie’ and ‘Dear,’ A Hurt for the Elderly” which explains the impact of elderspeak.   The author, John Leland, describes it as “the sweetly belittling form of address that has always rankled older people: the doctor who talks to their child rather than to them about their health; the store clerk who assumes that an older person does not know how to work a computer, or needs to be addressed slowly or in a loud voice. There are those who address any elderly person as “dear.””

Devon and I grew up in a household that trained us to always address our elders by Mr. or Mrs. or Miss so we innately understood the disrespect engendered by this name-calling habit.  After reading about these studies we weren’t surprised to find out that elderspeak isn’t just annoying or disrespectful — it can have an adverse effect on an elder’s views toward aging, relationships with caregivers, health, and even longevity. Our caregivers are trained to address clients by Mr. or Mrs. or Miss. When we are invited be on a first name basis we say “no” and use it as an opportunity to explain our philosophy and the science that backs us up!

UPDATE – July 25, 2011

NEWS FLASH… I just spoke with Mrs. Z and the 80-year old delivery man who made her squirm by talking down  to her quit his job!!

Mrs. Z is thrilled –“Thank God, I couldn’t take it anymore. The woman who took his place is lovely, respectfully and calls me, Mrs. Z.” 

I bet that drug store has lots of happy customers who feel the same way Mrs. Z does!  

Home care counselors at A WAY TO STAY Home Care are available to talk with you about your needs.  A WAY TO STAY is a home care agency providing In-Home Care in Yardley