Seniors and Snow Removal

Winter Storm Linus dragged its blanket of snow across the North and Northeast portions of the United States earlier this week. Many spent long hours digging out and when, as we here in Chicago experienced, city snowplows couldn’t get to side streets, many of us were trapped in the middle of the road, tires spinning. It’s then that we had to rely on the kindness of strangers to help shovel us out of a mess.

Even for the hale and hearty, navigating treacherous sidewalks, getting from point A to point B, prove to be quite a challenge. Major municipalities like Boston, Chicago have city ordinances that make it a finable offense to neglect clearing snow and ice from property sidewalks.

Most city ordinances require snow removal within a certain period of time (usually within 3-4 hours of snowfall ending) and for a minimum path size in order to accommodate pedestrians, people in wheelchairs, strollers, students walking to and from school, individuals with assistive devices and, ironically, seniors.

These senior homeowners are the same who are compelled to clear their own sidewalk or face considerable fines. The snow that Linus dropped was wet and heavy and fell intermittently all day. Shoveling is hard work and can take a quick toll on the body at any age, but especially if that body is older.

According to a study that appeared in the January 2011 issue of the American Journal of Emergency Medicine, cardiac-related injuries accounted for only 7 percent of the total number of cases, but they were the most serious. More than half of the hospitalizations and 100 percent of the 1,647 fatalities occurred while shoveling snow  Patients 55 years of age and older were 4.25 times more likely than younger patients to experience heart attack symptoms while shoveling snow, and men were twice as likely as women to exhibit cardiac-related symptoms. With that in mind, Consumers Advocate has an extensive list of reviews for medical alert devices. When used properly, they can alert the proper authorities whenever it detects a medical emergency.

The City of Chicago provides a volunteer snow-shoveling service called the Snow Corps, which seniors and those with disabilities can contact by calling 311, filling out an online Service Request, or by contacting their Ward office.

Some programs like the Snow Sergeant program in Lansing, MI pair screened and pre-approved High School students needing community volunteer hours with local seniors who need snow removal services.

The Chore Corps Program in Madison, WI is operated by Independent Living, Inc., a local not-for-profit multi-service organization. Following snow storms, volunteers shovel sidewalks and driveways for seniors, allowing the seniors to safely enter and exit their homes.
The volunteers also provide a meals-on-wheels service for independent living seniors.

Caregivers are urged to discourage seniors from clearing their own sidewalks when it would be dangerous for them to do so. Instead, keep them safely inside, warm and well-fed, and contact local authorities for needed support in order to prevent incurring any fines. Living independently is preferred by most seniors, but there’s nothing wrong with getting a little assistance.

CDC Reports Record High Flu Hospitalizations of Elderly

It’s a well-known fact that people 65 years and older are at greater risk of serious complications from the flu than their younger counterparts. According to the Center for Disease Control and Prevention, it's estimated that between 50 and 60 percent of seasonal flu-related hospitalizations in the United States occur in seniors.

The CDC release the new flu numbers on Friday showing a record high amount of flu hospitalizations among the senior population. In fact, the numbers are the highest since the agency started tracking the numbers nine years ago.

About 198 out of every 100,000 people 65 and older have been hospitalized with flu-related illness this season. The next highest rate was for the 0-4 year old group with about 38 out of 100,000. Compare that to last year’s numbers, when, at the same time in the year, only about 40 out of every 100,000 elderly were hospitalized with flu-related illness.

Click on image for larger, interactive view

Because immune defenses weaken as we age, the flu can be a real danger; seniors comprise an estimated 90 percent of all seasonal flu-related deaths. On average, about 24,000 Americans die each flu season, according to the CDC. While flu vaccinations don’t guarantee a flu-free season, (the CDC reported that the flu vaccine is only 23 percent effective this winter,) Fluzone, a higher-dose flu shot developed specifically for older adults, is designed to give people a better immune response, thereby providing better protection against flu.

Those who are considered at high risk of developing serious flu complications are those with:

  • Asthma
  • Blood disorders (such as sickle cell disease)
  • Chronic lung disease
  • Endocrine disorders (such as diabetes)
  • Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)
  • Kidney disorders
  • Liver disorders
  • Morbid obesity (body mass index [BMI] of 40 or higher)
  • Weakened immune system due to disease or medication (such as people with HIV or AIDS, cancer, or those on chronic steroids)

If you see your senior client or care recipient developing any flu symptoms, act fast and get them medical attention. Antiviral drugs can be used to manage and treat flu in the elderly before serious complications develop. Look out for fever, cough, sore throat, runny or stuffy nose, headache, body aches, chills, fatigue, and sometimes vomiting and diarrhea.

Caregivers should take extra precautions as well. The CDC especially recommends that anyone working with older adults get vaccinated to help prevent the spread of influenza, especially if they work in a long-term care facility.

Caregiverlist hopes that seniors and their caregivers stay safe and healthy all year, but especially during this dangerous flu season.

California Enacts Minimum Caregiver Training

Cases of elder abuse and elder neglect can be found everywhere. Abuse can be physical, psychological, and/or emotional. Seniors can be the victims of neglect when caregivers fail to fulfill their duties and obligations to provide even the most basic elder care. Seniors can be the victims of financial exploitation, especially when they entrust their caregiver with their funds and assets. If a caregiver is going to mistreat someone in their care, they’d be hard-pressed to find an easier victim than a vulnerable senior.

Senior care experts agree that there is a correlation between caregiver training and elder abuse. Regrettably, there is no federal mandate for caregiver training. It is up to each state to set its own guidelines for nursing assistant, home health aide, and personal care aide training and supervision. Most senior care agencies have minimum training requirements for their employees, but are not required by law to do so.

California has taken steps to rectify that situation with its Home Care Services Consumer Protection Act. Per Assembly Bill 1217, on and after January 1, 2015, home care agencies would be duty-bound to establish and continuously update a home care aide registry and would require criminal background check clearances for home care aides.

Caregiver training would include a minimum of five hours of entry-level training prior to working with a client. This includes:
(1) Two hours of orientation training outlining the role of a caregiver.
(2) Three hours of safety training, including basic safety precautions, emergency procedures, and infection control.
(3) An additional five hours of annual training. The annual training will include, but not be limited to:

  • Clients’ rights and safety.
  • How to assist a client’s activities of daily living.
  • How to prevent, detect, and report abuse and neglect.
  • How to assist a client with personal hygiene.
  • How to safely transport a client.

The training may be completed through an online training program, as long as that training can be verified.

While this is a great step and in keeping with the many states that require minimum caregiver training, it doesn’t necessarily cover the 400,000 caregivers in California’s $7.3 billion In-Home Supportive Services Program (IHSS) for low-income elderly and disabled residents. Those caregivers are hired, managed and trained by the care recipients themselves. Training requirements for the nation’s largest publicly-funded home care program have been met with resistance because clients want autonomy over their care and how it’s delivered. As a result, only about 12 percent of those caregivers have even basic caregiver training.

Finding official state reports of elder abuse and neglect is a daunting task. The most recent data I could find is from the 2004 Survey of State Adult Protective Services published in 2007. Titled Abuse of Vulnerable Adults 18 Years of Age and Older, a Report of the National Center on Elder Abuse (NCEA), it was prepared by the National Committee for the Prevention of Elder Abuse and the National Adult Protective Services Association. Unfortunately, many states differ in their definitions of what constitutes abuse. For the survey, because states collect very different types of information on the abuse of vulnerable adults, it’s hard to compare apples-to-apples. Thirty two states could provide abuse reports for vulnerable adults aged 18-59 as well as aged 60+; the balance of states don’t collect data by age group, so there’s no telling how many of their reports detailed elder abuse specifically.

The demand for direct-care workers like Personal Care Aides and Home Health Aides will soon outpace the supply. According to the Bureau of Labor Statistics at the U.S. Department of Labor, the projected growth in home health care services from 2012 to 2022 is 67 percent. As the pool of informal caregivers shrinks (family and friends), the demand will need to be filled by a more professional workforce. And in order to to help minimize instances of elder abuse, we believe that workforce should be adequately trained.

Caregiverlist applauds California for taking training initiatives, but is it enough? Should minimum caregiver training be federally mandated? What are the possible downfalls to requiring any senior caregiver to obtain even the most basic caregiver training?

Feel-Good Senior Care and Caregiver News

It’s an occupational hazard. Because I write about anything and everything connected with seniors and eldercare, I come across a lot of depressing stuff. From elder abuse to inequitable caregiver pay, the internet is not lacking in bad news.

In a bit of a departure, certainly for me, here are some stories from around the web about seniors and senior caregivers destined to make you feel good.

  • Two nurses thwart “grandparent scams,” as reported in a story by Steve Coulter of the Connecticut Ridgefield Press. One nurse prevented a senior from wiring $5000 for “bail money” and another stopped a couple from sending $2,800 to a scammer claiming to be their grandson needing money for surgery. Both instances involved bogus claims from grandchildren in trouble and both warned the seniors not to tell anyone about the financial need. Luckily, these two nurses were both highly observant and able to convince the seniors to contact other family members for verification. Of course, they found out their grandchildren were never in trouble.
  • Scotland’s oldest woman, Jessie Gallan, celebrated her 109th birthday and divulged her secrets of longevity to the Daily Mail. “My secret to a long life has been staying away from men. They're just more trouble than they're worth. “I also made sure that I got plenty of exercise, eat a nice warm bowl of porridge every morning.”
  • Men are in the house as well. Yoganonymous posted these life instructions as told by William Snell, 95:

  • In my FB feed: Random Acts of Flowers Chicago delivered 63 bouquets to Waterford Nursing Home and Rehab. RAF recycles and reuses every part of donated flower arrangements including ribbons, wire, foam, buckets, baskets, vases, moss, and stands (and flowers) as part of their “upcycled” floral arrangements.
  • Kitty Nicholson, 100, knits a baby cap a day for the last five years. Every baby born at Waccamaw Community Hospital and Georgetown Memorial Hospital leaves with one of her creations. “It keeps me out of trouble.”

So there’s good out there along with the not-so-good. Caregiverlist invites you to share your feel-good senior or caregiver story in the comments.

Seniors and Bullying

It’s an irony of life that, in many ways, we end as we begin — dependent, spoonfed pureed foods (is Ensure the geriatric Enfamil?), wearing diapers. If it’s true that at a certain point we our lives begin to Benjamin Button, then maybe it’s true that retirement communities are like high school, replete with the ubiquitous resident mean girls.

In a New York Times Op-ed piece this weekend, Jennifer Weiner writes about the bullying behavior her 99-year-old “Nanna” experienced when she first arrived at her new retirement home. In Mean Girls in the Retirement Home, Ms. Weiner describes that Nanna wasn’t allowed to sit at certain dining tables. Nanna wasn’t invited to play bridge. It sounded to Ms. Weiner (and to me) like classic school bullying.

I thought, is senior bullying really a thing? It is.

With more elderly entering senior care centers, retirement communities, assisted living facilities, and nursing homes, the instances of senior bullying is on the rise. It’s estimated that 10-20% of seniors in these types of communities find themselves objects of bullying by the members of the “controlling group.” Sometimes, residents with dementia will act in a bullying manor out of frustration, anger, and confusion.

Senior-to-senior aggression can be overt or passive-aggressive. Studies show that, much like the bullying found in high school, men tend to be openly abusive, challenging other residents both verbally and physically. Women tend to take part in stereotypical behavior, spreading rumors and ostracizing victims.

Why do seniors engage in bullying? The same reason kids bully. A bully, no matter what age, seeks to control and dominate. Perhaps because they lack power in their own situation, they seek to make themselves feel stronger by making others feel weak and fearful. They also have a lack of empathy.

How do you know if a senior is experiencing bullying? Here are some telltale signs:

  • Isolation
  • Depression
  • Avoidance of certain communal areas
  • Taking circuitous, out-of-the-way routes to get to and from areas
  • Complaints that they are not liked and are not included in activities

Bullying is a form of elder abuse and should not be tolerated. In these instances, a third-party has to get involved. Alert the staff  or on-site social worker if you suspect bullying. If they don’t intervene, contact your state’s long-term care ombudsman to report the abuse. Everyone deserves to live their life with respect in a caring community.

Have you ever experienced senior bullying? What did you do about it? Tell us in the comments.

Home Care Workers are "Companions" Judge Rules

For the million+ home care workers in the United States, the dream of finally receiving the respect and pay equality their profession so richly deserves was struck down with one judge’s decision to block a Department of Labor regulation that would force third-party employers to provide them minimum wage and overtime, just days before it was to be enacted.

Judge Richard J. Leon, U.S. District Court for the District of Columbia sided with the Home Care Association of America, the International Franchise Association, and the National Association for Home Care and Hospice who oppose the exemption from the Fair Labor Standards Act's minimum wage and overtime requirements.

The new rule, scheduled to go into effect in early January, would have guaranteed a national baseline minimum wage and overtime under the Fair Labor Standards Act (FLSA) for all direct care workers.

Congress originally excluded home care workers from the FSLA when, in 1974, they defined all in-home care services as “companionship” services. However, today’s in-home care worker is generally more professional and better trained. They provide much more than mere companionship, many times providing vital services such as help with the activities of daily living that are so important in helping seniors to live independently in their own homes.

Quality home care agencies should (and many do) pay their workers more than minimum wage and overtime for the invaluable services they provide. However, the national median wage for home health aides is less than $10 per hour and that’s why, many argue, federal mandates need to be in place. Opponents of the regulation believe if 3rd-party agencies are forced into paying more to their hourly wage workers, the cost will be passed along to the consumer — seniors and their families who are already struggling with the high cost of senior care.

Judge Leon, who was appointed to the United States District Court in February 2002, came into prominence in December of 2013 when he ruled the NSA’s collection of all Americans’ phone calls most likely violated the Constitution (specifically, the Fourth Amendment). The judge also had historically and infamously sided with the tobacco industry against the FDA.

The home healthcare industry is facing a looming shortage of qualified home health aides and senior home caregivers. Those caregivers are the ones who make it possible for the elderly to age at home in dignity and not in nursing homes, thereby saving Medicare millions of dollars. Senior care experts agree that the only way to draw a trained workforce and stem the high-turnover rate is to provide a decent living wage. For those senior caregivers who do so much more than provide “just companionship” (although that, in and of itself, is a great service), we don’t think it’s too much to ask that they are protected and guaranteed to make at least as much as the teenager who flips burgers at McDonald’s.

Medicare Pays Doctors for Integrated Senior Care

Eleanor is 85 years old and spends many of her days in various doctors’ offices. Her osteopath checks her progress after a recent hip replacement. Her rheumatologist helps manage her arthritis pain. She sees her cardiologist after a mild heart episode and her primary care physician treats her hypertension. No one has yet addressed her depression. With each visit, Eleanor receives prescriptions, instructions, and tests — so many that she feels overwhelmed and underinformed. 

Many seniors seeking medical care have multiple chronic conditions. In fact, it’s estimated that three in four older Americans live with MCC. That figure is only going to increase as baby boomers age. This challenges has been recognized by the U.S. Department of Health and Human Services. They are initiating federal programs to prevent and manage MCC.

As one of those programs, Medicare is now paying primary care doctors to coordinate care for their elderly patients. Typically, when seniors see so many different doctors, their care is quite fragmented. MRIs and x-rays can be duplicated (and costly) and results aren’t shared between the various specialists. Dangerous drug interactions can adversely affect patient, leading to more doctor visits and deteriorating health.

Primary care physicians are ideally situated to oversee their patients overall health. Services include non-face-to-face planning and management for patients with two or more chronic conditions. To collect the new fee, doctors would have to create a care plan for their MCC patients and spend time each month working with their various specialty physicians.

"We're hoping to spur change, getting physicians to be much more willing to spend time working on the needs of these patients without necessitating the patient to come into the office," Sean Cavanaugh, deputy administrator at the Centers for Medicare and Medicaid Services told The Associated Press.

Critics of the plan say the proposed $40 per qualified patient per month is not enough to entice doctors to take on the extra work involved. They suggest it opens the door for even more Medicare fraud. But many doctors, especially those in smaller communities, have for years coordinated care for their senior patients with no compensation. "Quite honestly, I just didn't get paid for it," said Dr. Robert Wergin, president of the American Academy of Family Physicians told the AP. Dr. Wergin spends about 2 hours a day calling on his older patients who can’t make it into his office.

Many times, caregivers also play the part of care coordinator, especially if they accompany their senior to many of their doctor visits. However, it is no doubt helpful if a professional oversees medication prescriptions, possible test duplications, and the coordination of specialists. It’s the hope of Medicare to not only increase the quality of life for patients by strengthening primary care but also, let’s face it, save money on hospital stays, emergency room visits, and post-acute care.

Do you as a caregiver coordinate any of the care for your senior? If so, how involved are you? Do doctors welcome your care coordination? Have you utilized the Caregiverlist Care Consierge to create your own Senior Care Plan?  We’d love to hear from you in the comments.

Foods that Could Lower (or Raise) Your Risk of Dementia

I’m at that age where misplaced keys or a forgotten word gives me pause. I write so much about Alzheimer’s, dementia, and other memory loss diseases, I know the havoc they wreak, not only on the patient, but on their entire family. That’s why I take a proactive approach in decreasing my odds of developing dementia or Alzheimer’s.

Keeping activeboth mentally and physicallycan go a long way in keeping those diseases at bay. Research now shows there are certain foods that can also help or hurt brain health.

The Good
AARP suggests the following foods may lower your risk of dementia. Remember, whole foods are better than supplements for nutritive value, but supplements are better than nothing, so I’ve listed the foods and their corresponding vitamins/minerals. Time to stock up your fridge and pantry with these goodies:

  • Beans and green peas (vitamin B-1 and folic acid)
  • Citrus fruits and berries (vitamin C)
  • Almonds (vitamin E)
  • Fatty cold-water fish like salmon, cod, mackerel, and herring (omega-3 oil)
  • Spinach (flavonoids, vitamins A and K, folic acid and iron)
  • Coffee and chocolate (caffeine)

The Bad
From the Alzheimer’s Association, here are some foods that contain toxins. The resulting inflammation can lead to a build-up of plaques in the brain resulting in impaired cognitive function. They should be avoided as we age.

  • Processed cheeses such as American cheese, mozzarella sticks, Cheez Whiz and spray cheese (causes protein and plaque build-up)
  • Processed meats like bacon, smoked meats, hot dogs (nitrosamines)
  • White foods like white bread, white rice, pasta, white sugar (causes insulin spikes)
  • Microwave popcorn (diacetyl)
  • Beer (nitrates)

If you are a caregiver to someone with Alzheimer’s or dementia, have you seen a change in the disease severity when you’ve altered their diet? We’d love to hear your stories in the comments section.

Also, be sure to watch the Golden Globe Awards, for which Julianne Moore is nominated as Best Actress in a Drama for her star turn in “Still Alice”, the story of a woman, a brilliant professor, wife, and mother, who is diagnosed with early-onset Alzheimer’s disease.

Senior Safety During Extreme Cold

Last year today, my blog post was about Senior Care during the Polar Vortex. Here we are once again in the grips of an extreme cold snap and it’s time, say senior care professionals, to revisit how best to keep seniors safe during frigid weather.

The first consideration in keeping the elderly safe is to keep warm. The CDC (Centers for Disease Control and Prevention) said people over the age of 65 make up nearly half of all hypothermia deaths. As we age, our metabolism slows. Couple that with decreased physical activity and seniors are especially susceptible to low body temperature that can drop to a dangerous degree.

Here are some signs of hypothermia in older adults: shivering, exhaustion, memory loss, slurred speech, confusion, drowsiness. If you notice any of these signs, check their body temperature. If it’s below 95°, seek medical attention immediately. Don't hesitate to call 911.

You can prevent hypothermia in seniors by keeping the home heated safely. Place an easy-to-read thermometer in a room where the most time is spent and make sure the temperature doesn’t get below 65°. Close off rooms that are not in use to conserve heat. Also, put a carbon monoxide detector near the sleep area.

Power outages during peak usage times are always a risk. Keep extra blankets on hand. Seniors should dress in several layers of loose clothing. And of course, the elderly should not go out unless it is absolutely necessary.

In order to keep trips outside in the cold to a minimum, the CDC suggests making sure seniors have these are on hand:
Food that needs no cooking or refrigeration, such as bread, crackers, cereal, and canned foods—canned soup is a great warmer-upper.
Water that is stored in clean containers, or purchased bottled water (5 gallons per person). Keep alcohol intake to a minimum.
Medicines that any family member may need.

Check on older family and neighbors who are at risk from cold weather hazards. As always, if you or a senior in your care needs special help, contact your state's Area Agency on Aging. Caregiverlist hopes all caregivers and their seniors stay warm and safe.

New Year's Resolutions for Senior Caregivers

It’s about that time of the year. The time when we look at our lives and think “How can I make next year better than this one? Am I leading the life I want to lead?” Some people absolutely hate New Year’s resolutions. What better way to heap more stress on yourself than setting unrealistic goals?

What if we don’t call them New Year’s Resolutions? What if we refer to these ideas as hopeful plans to achieve goals that will help both caregiver and care recipient? Start them in January if you’d like, but they’ll be just as relevant in July. Bookmark or print this page and use it as a reminder that life is a balancing act and just as you give (care), you must also take.

Take Care of Yourself
This is the biggest challenge facing both family and senior caregivers. Senior care is exhausting at best, so there is little time to look after your own well being. Don’t make that mistake. You know how in an airplane emergency, you must place the oxygen mask over your own face before you can help those around you? It works the same way with your health. You are an athlete and senior care is your event. Make sure your body is in its best condition by exercising, eating right, and taking some quiet meditative time to regroup.

Take a Respite Break
You just can’t do it all yourself. Nor should you. If you are a family caregiver, consider hiring a professional caregiver to provide a few hours (or days) break for you. If money is tight and you have a community of givers nearby, programs like Lotsa Helping Hands were created to provide friends, family, and colleagues a place to come together and coordinate needed support through a group calendar. Volunteers can provide a meal, furnish transportation, or plan a visit. But most of all, they can give you a break.

Take Some Training
Whether you are a family caregiver looking to learn how to maintain a clean, safe, and healthy environment specifically geared toward seniors, or a companion caregiver who wants to begin a path to professional senior care, formal training is a great place to start. Online training (like the kind Caregiverlist offers) allows you to learn at your own pace, on your own schedule. If you are a seasoned caregiving professional, maybe it’s time to take that next step and study to become a C.N.A. — and very much in demand.

Take Advantage of Technology   
There are a host of programs and applications that can help with self- or elder-care. From exercise and nutrition, to crafting, to ideas for caregiver stress relief, every Friday, Caregiverlist’s own Paige Krzysko reviews all things Tech to help with your senior caregiving. Be sure to give her a read.

Well, that’s my last post for the year 2014 — thanks for reading. From everyone at Caregiverlist, have a happy, healthy, safe New Year and I’ll be back with senior care news, advice, opinions (and sometimes just some general nonsense) in 2015.

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