Aging parents typically require some kind of outside support as their physical and/or cognitive abilities decline over time. When that day comes, it can be difficult for them to accept a “stranger” in their home. You may encounter resistance to hiring caregivers for help. Your parents may refuse the idea with comments such as, “it’s not necessary,” “it’s uncomfortable,” “it takes away our independence,” “it’s dangerous,” “it violates our privacy,” or other similar rebuttals.

While their questions and concerns may be valid,  this doesn’t mean your aging parents don’t actually need the help. It may take some time for them to warm up to the idea of having caregivers in the home, but the effort is well worth it.  Here are three tips to help encourage your parents to accept help at home:

1. Start Small

Initially, you can hire a trusted caregiver to come into the home to assist your parent with everyday household tasks such as laundry, driving to appointments, or grocery shopping. If needed, you can even suggest it be for a trial period. Eventually, the goal is for your parents to form a trusting relationship with the caregiver and allow them to provide more personal hands-on help over time.

2. Emphasize the Needs of Your Parent who is the Primary Caregiver

When one parent is dependent on the other for day-to-day care, the burden can become heavy for the spousal caregiver. Draw attention to this fact, and help the dependent parent to understand their spouse or partner needs the support for their own well-being.

3. Emphasize Your Own Need

The classic, “It’s not you, it’s me” explanation is appropriate in this situation. Let your parents know that having some outside help will give you peace of mind, and help you manage your personal stress. This tip is particularly potent if your parent lives alone and needs help and you cannot always be there.

Choosing Caregivers for Aging Parents

If you know where to look, finding good help for your aging parents can be easily accomplished. Not sure how? Call Windward Life Care for guidance about your options. Our team of caring professionals is here to help you get the local support you need.

Roughly 15 to 20 years ago, the U.S. Department of Veterans Affairs (VA) noted the number of World War II veterans heading into their sunset years. As these veterans approached the end of their lives, the VA acknowledged they did not have the capacity to care for all of these aging soldiers in a meaningful way. The sheer number was beyond their ability to handle.

Recognizing the problem, the VA began to establish hospice and palliative care in every VA medical center across the country. In time, they also began to partner with private community health providers to offer end-of-life services in local communities far from VA hospitals. This effort remains ongoing as additional collaborative health care partnerships continue to be established. The increased availability of hospice care should help close the low utilization gap that exists between veterans and the general population.

Coalitions for Veteran Care

Commonly referred to as Hospice-Veteran Partnerships (HVP), these veterans’ care coalitions are being set up between VA facilities, State Hospice Organizations, local community hospice providers, and other supporting groups. The HVP initiative is conducted by the VA Hospice and Palliative Care Program. Their objective is to extend the reach of the VA by establishing a network of interested health organizations to meet the end of life needs of our nation’s veterans.

Unique Veteran Needs

Because of the unique stresses of serving in the armed forces, many veterans need special care throughout the course of their hospice experience. For example, if a patient who is a combat veteran has dementia, it is possible for post-traumatic stress disorder to manifest during routine care. This sudden onset can happen even if it was not an issue previously. Other examples revolve around military culture and training that is so engrained in these service men and women, that they may refuse to disclose pain and symptoms in order to not appear weak.

Help to Get You Started

If you are searching for hospice or palliative care options for an aging veteran, call on us here at Windward Life Care. Our team of professionals can provide you with timely information and guidance to the resources that you need.

By Bita Naderi, PharmD, BCGP

Note: This article is intended for informational purposes. It is important that you or your loved one(s) do not make changes to your medication(s) without first discussing with a physician or other prescribing healthcare provider.

Dr. Bita Naderi, PharmD, BCGP

People commonly believe that medications and supplements available to them over the counter must be safe. They are available, after all, without a prescription. However, over-the-counter does not necessarily translate to safe, and people should still exercise caution with these medications. Many factors go into determining safety: dose, duration of use, and interactions with other medications, among many others. Older adults often have multiple medical conditions, are on a variety of medications, and have physiological changes associated with aging that can put them at greater risk of adverse effects from medications. In fact, an outpatient study found people taking 5 or more medications had an 88% increased risk of an adverse drug event.

Considering that older adults account for 40% of all over-the-counter medication purchases, think about the following: Did you know that diphenhydramine (Benadryl®), often used for allergies and insomnia, may increase one’s risk of cognitive impairment, confusion, delirium, and dementia? Did you know that commonly used stomach acid suppressing medications, proton pump inhibitors, such as omeprazole (Prilosec®) when used over-the-counter, should be limited to 14 days of treatment? These medications are associated with increased risk of Clostridium difficile, a life-threatening bacterial intestinal infection, and impaired absorption of important vitamins and minerals such as calcium, iron, magnesium, and vitamin B12. Despite this, people sometimes use these medications indefinitely when not indicated. Did you know that commonly used non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen (Aleve®) and ibuprofen (Advil®), may carry an increased risk of heart failure exacerbations, stroke, heart attack, bleeding, and acute kidney injury?

And don’t forget about dietary supplements. Studies show that 70% of older adults use at least one supplement daily. Many herbs and supplements such as fish oil, garlic, and ginkgo biloba can increase the risk of bleeding, especially when used in combination with other medications that carry a bleeding risk. Some supplements, such as iron, magnesium, calcium, or aluminum, can impair absorption of some medications. You can discuss these drug interactions further with your pharmacist.

Paracelsus, the famous Swiss physician and alchemist of the 16th century, once said, “All things are poison, and nothing is without poison, the dosage alone makes it so a thing is not a poison.” In short, all medications, including those available over-the-counter, have the potential to cause harm if not used appropriately. In fact, we now know that is it not just the dosage alone that can impact safety, but a multitude of other factors. These include the person’s chronic disease states, other medications they are on, length of therapy, their ability to be adherent to a medication, and many others. These factors are unique from person to person. As such, every treatment plan must be individualized.

How can patients know if an over-the-counter medication or dietary supplement is safe for them? Pharmacists can serve as a great resource. Medication Therapy Management (MTM) is a growing field for pharmacists with the goal of improving therapeutic outcomes for patients. MTM aims to decrease the utilization of high-risk medications and medications that are ineffective or no longer indicated. MTM can decrease adverse drug events, drug interactions, and therapeutic duplications. Older adults can benefit greatly from MTM services, as many have multiple chronic conditions, complex medication regimens, and are experiencing growing healthcare costs. Furthermore, these patients often have multiple prescribers and multiple pharmacies. This is even more reason for a pharmacist to oversee and manage their medications as a whole, which when complicated by over-the-counter medications, can put them at greater risk for adverse drug events.

UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) offers MTM services to clients through a program called Partners in Medication Therapy. UC San Diego SSPPS clinical faculty, who are also licensed and credentialed pharmacists, ensure effective and safe use of drug therapies according to recommended guidelines and best practices in order to meet treatment goals.

Windward Life Care clients can access the services of the UC San Diego SSPPS Partners in Medication Therapy program. Just contact us to find out next steps.

Dr. Bita Naderi is a California licensed and Board Certified Geriatric Pharmacist. She completed a UC San Diego geriatric pharmacy postdoctoral fellowship and served as a pharmacy consultant at a local Program of All Inclusive Care for the Elderly (PACE). She currently works as a pharmacist at Southern Indian Health Council and strives daily to optimize medication therapies and improve adherence.

One of the biggest problems facing older adults in the United States is the growing shortage of professional caregivers. San Diego is feeling the pressure along with other cities across the nation. The demand for caregivers is increasing as the Baby Boomers need more services. Something needs to be done to ensure that the support they need is available to them.

Why are We Experiencing a Shortage of Professional Caregivers?

According to the Paraprofessional Healthcare Institute (PHI), the shortage is occurring due to an increase in demand from consumers, as well as turnover because of career changes or people leaving the workforce.

The Bureau of Labor Statistics (BLS) reported that 7.8 million direct care openings are projected from 2016 to 2026:

  • 4 million new jobs created due to growth in the industry
  • 6 million jobs that need to be filled due to employees leaving the labor force
  • 8 million jobs to fill due to employees making a career change to other industries

This $103 billion industry is facing a serious crisis as more people reach retirement age and require care in medical facilities and at home. The health care system is strained and working to keep seniors at home and out of the hospitals. Many of the people in need of care suffer from chronic health conditions and require ongoing assistance.

Finding a Solution

Recommendations have been released by the California Future Health Workforce Commission, to close this gap by 2030. Not only is it anticipated that we will have a shortage of professional in-home caregivers, but there will be additional need for nurse practitioners, primary care physicians, social workers, and physicians’ assistants.

On a positive note for workers, the increased demand for healthcare professionals with geriatric expertise means there is great career opportunity for people with the heart and skill set to work with older adults. Many people choose to have a lifelong career in professional caregiving, while others enter the workforce in this position, then use their valuable experience to move into nursing or other healthcare careers.

Home care agencies looking for qualified, desirable candidates are working harder than ever to attract and retain professional caregivers, competing with other care providers like residential care facilities, as well as employers in other service industries.

The shortage of professional caregivers is a serious issue, but there is hope on the horizon.

Kimberly Torrence, Director of Operations
Kimberly Torrence, Director of Operations

What is Windward Life Care doing to recruit and retain the best professional caregivers? We actively track local, state and national trends affecting recruiting and retention.  We have adjusted to labor force challenges without sacrificing our Home Care Aide skills and experience requirements. Retention of quality employees is one of our highest priorities because it benefits our clients, our company and the community we serve.  Our comprehensive orientation, ongoing training, and professional support from Aging Life Care Managers help our Home Care Aides to thrive in their role at Windward. This training and support, in addition to our competitive pay and outstanding benefits package, enables us to retain experienced caregivers. Understanding our employees’ needs and working with them to create the schedule they desire makes Windward a partner in their career and life satisfaction.  A strong indicator of our success in this area is the fact that our caregiver turnover rate is 28% less than the national average. We are proud to be the employer of choice for experienced and professional Home Care Aides in San Diego County. Contact us if you want to see how our Home Care Aides can enhance your life!

– Kimberly Torrence, Director of Operations

June is Pride Month, which is a great time to celebrate diversity and evaluate how we can better support equality for all older adults. We’d like to highlight an important topic: how discrimination affects the LGBTQ population living in senior living settings, and what needs to be done to fix this problem.

Problems in Senior Communities

It’s a tragedy that many LGBTQ older adults feel they must go “back in the closet” in senior living to avoid harassment/discrimination. Some LGBTQ older adults experience mistreatment from facility caregivers on a one-on-one level, and some facilities have cohabitation policies that discriminate against same-sex marriage and relationships. In addition to facing discrimination and mistreatment from facility staff, LGBTQ older adults may also find that other residents are exclusionary, or even abusive. As a result, older adults sometimes feel that their only option is to conceal their sexual orientation and/or gender identity so they can have a place to live and receive the care they need.

This situation can be difficult to face when a person has for decades of lived openly. It is a step in the wrong direction if seniors need to pretend to be siblings or “just friends.” In addition, LGBTQ older adults should not fear elder abuse in the form of emotional or physical harm from staff or other residents.

While these problems are common across the nation, some providers are looking for ways to accommodate all people. Many forward-thinking senior housing communities see the problem and are opening their doors to the LGBTQ community.

Legal Protections for LGBTQ Adults

If you or a loved one is being discriminated against in a senior housing setting, then it is important to know that legal protections are available. LGBTQ older adults need to be aware of their legal rights and tap into the resources and support that is offered. For example, a U.S. District Court recently ruled that senior housing landlords cannot discriminate based on sexual orientation.

Where should you turn for the legal support and advocacy that is needed? SAGE is a national non-profit organization that advocates for LGBTQ older adults. They have a “National LGBT Housing Initiative” designed to tackle the problems LGBTQ seniors are facing when looking for housing options. The goal is to improve and expand senior living options for older adults, giving them a safe place to live without fear of discrimination or harassment. Elder law attorneys experienced in working with senior housing issues are another good resource.

Windward Life Care is here to help you find the right services and support in San Diego County. A member of the San Diego Equality Business Association, Windward is committed to providing compassionate and inclusive services for older and disabled adults in our community.

Windward Life Care’s professional Aging Life Care Managers provide an array of services that benefit clients and their families. One particularly important function is assisting clients and their support systems in managing medical conditions and related problems. This includes helping clients and their families navigate through often stressful and confusing hospital visits, whether the visits are routine or urgent. Care managers like Windward’s Terry Ehlke, RN, BSN, CMC, serve as the client’s primary advocate to facilitate the entire process. Terry took some time out of her busy schedule to answer questions about some of the essential services a care manager provides at such critical moments in a client’s care.

Terry Ehlke, RN
Clinical Services Manager
Windward Life Care

How can Aging Life Care Managers help when an older or disabled adult is hospitalized?

Care managers function as patient advocates, making sure the client is cared for properly during hospitalization all the way through discharge. Care managers work closely with the client and hospital team to ensure everyone understands the history and special needs of the client, any unnecessary trips back are avoided (such as for tests that can be handled during the current visit), the client is safely discharged, and adequate discharge instructions are provided to the client and caregiver. A care manager can also step in with any appeals to pause or slow down the discharge process if need be. Often clients don’t realize they can say “no,” so they just go along. The ultimate goal is for clients to experience the safest and most effective and efficient hospital stay possible.

What are the risks when the hospital says it’s time for a patient to be discharged?

Unfortunately, the discharge process can often be too fast and disorganized. Without any standard of care for hospital discharge in place, every hospital does their own thing. Hospital staff are under great time pressure and can rely on “cookie cutter” discharge plans that don’t account for the client’s unique circumstances. The very real situation at the client’s home is often overlooked, so failures stemming from not considering certain bigger-picture issues are common. Elderly clients especially are very medically fragile. In addition, communication and referral delays can lead to unsafe situations at home and treatment delays. Instructions to the patient regarding follow-up care, if even provided, can be rushed and inadequate. This is particularly dangerous in the case of a new diagnosis for diabetes or congestive heart failure. There is a significant risk that problems that could have been easily prevented through a better discharge process will lead to readmission.

Why is preventing readmission such a big deal?

I recently read a study that revealed up to 27% of rehospitalizations were preventable. While it’s true that many readmissions are simply not avoidable, medical issues that are not resolved prior to discharge or failures in the transition to home can often result in an otherwise unnecessary return to the hospital or emergency department. Readmission has a huge impact on the client’s quality of life and safety. Each hospital visit poses that much more exposure to potentially lethal complications (medication errors, hospital-acquired infections, blood clots, etc.) while putting added stress on the client who is once again away from the comforts of home in an unfamiliar environment. Worsening cognition, including delirium, can result from being in the hospital environment. Ultimately, readmission delays recovery, possibly introducing new complications.

Who is most at risk for recurring hospitalizations/readmission?

There are myriad factors that increase the risk of repeat hospitalizations. These include taking certain medications, such as antibiotics, glucocorticoids, anticoagulants, narcotics, antipsychotics, and antidepressants to name a few, as well as certain chronic health conditions, like advanced chronic obstructive pulmonary disease, diabetes, heart disease, stroke, cancer, and depression, among many others. Prior recent hospitalizations and premature discharges also increase risk, as does low health literacy, a limited social network, and low socioeconomic status.

A key advantage of working with a care manager is that we have detailed knowledge of a client’s daily life, health, diet, medication regimen, and other circumstances that can impact his or her health and well-being when it comes to hospital readmission.

Medications can be confusing and the risks of taking them incorrectly are high. What can families do to help reduce errors and complications in this area upon hospital discharge?

The client and/or family caregiver must be clear on all medication instructions. Families and caregivers need to determine who will set up and manage the medications, as the client may not be the best person to do this for him- or herself. All medications, including pre- and post-hospital meds and over-the-counter meds, should be reconciled. Be sure to update and consult with the primary care physician as soon as possible following a hospital discharge. Due to the complexity of managing the administration of multiple medications at multiple times of day, enlisting the services of a home health nurse may be the best option. Pharmacists can also be an invaluable resource.

What are some of the issues where multiple healthcare providers are involved?

There are often many providers involved after a discharge. Inadequate hand-offs and communication problems between them are major impediments to a smooth transition to home. Home health providers, including nurses and therapists, may get incomplete information from the discharge planner’s referral. Equipment is ordered (or maybe not) and does not arrive on time. Home care aides are often not provided with basic information prior to working with a new client. There’s the potential for no one to follow up on hospital lab results after discharge if the discharge papers didn’t indicate any were pending. Pharmacies are also known to transcribe orders incorrectly, or not know some medications were discontinued or changed at the hospital, and then they don’t fill them correctly or at all.

Do doctors ever talk to each other about their shared patients?

Hospital doctors, or hospitalists, do not talk to primary care doctors as a general rule. This often comes as a surprise to our older clients who were used to a different system for most of their lives. Doctors may share computer records, but those are sometimes incomplete. Up to 50% of patients do not see their primary MD following a hospital stay, though this is essential to the success of ongoing care and is usually included in the “to do” list in discharge instructions. The hospital discharge planner typically does not make this appointment for the client. Referrals are mostly made to specialists, but if the client does not follow up to make an appointment, the specialist may never see the client.

What steps does a care manager take to ensure a smooth transition to home when a client is leaving the hospital?

This is often the time when we first get involved with a new client because the family or involved professional realizes they need an advocate. The Aging Life Care Manager conducts a full assessment that starts with a review of the discharge instructions. Particular attention is paid to any signs that require medical attention, medication changes, any restrictions on physical activity and diet, and any treatments that are needed. The care manager also follows up with the primary care physician and specialty providers while making sure the client and family have a complete understanding of all of the above and consults with them regarding possible needs for home healthcare assistance.

The care manager also discusses with the client and family meal preparation, physical and social activities, transportation needs, financial resources, and client preferences, because a care plan that does not align with the client’s preferences cannot be effective.

The care manager then develops a customized care plan based on this thorough and holistic assessment of the client. The plan addresses both immediate needs and long-term care goals, and it clearly identifies who is responsible for each service. The care manager communicates the completed plan with the client, family, caregivers, and other professionals who may be involved in the client’s care. The care manager then supervises the plan’s implementation.

 

Terry Ehlke recently presented on the topic of hospital discharge planning best practices at the San Diego Regional Home Care Council Spring Symposium in May 2019. Terry was recently promoted to the position of RN Clinical Services Manager at Windward Life Care and is available for assessments and consultation.