Choosing Hospice

Carol R. Anderson, RN, BSN is the Director of Quality Improvement & Staff Development at Long Term Solutions. She frequently writes information for our Provider Knowledge Center, a resource for our field clinicians. Here is a post she wrote about hospice care.

"In our careers, most of us have cared for someone who is terminally ill and facing his/her end of life. With the exception of accidents and homicides, dying is a process. It is a journey. Many things affect how the dying and their loved ones work through this process: culture, age, religion, family position, the illness itself, and formal and informal support systems are just some of them. There are many considerations, all of which need to be addressed.

Presenting hospice as an alternative can be difficult, depending on the disposition of the client and their loved ones. One way to think of hospice is as an alternative to traditional care. Hospice is appropriate for the clients who wants to spend his or her final time at home, with the goal of the hospice care being improving the quality of this time with comfort and dignity. It can be provided to a client in a wide variety of settings. It could be in their private home and in a facility, and many hospitals have hospice beds.

Hospice care is provided by specially trained teams. Hospice teams are multidisciplinary with a variety of trained professionals able to provide a unique type of care. They plan the care to address the bio-psychosocial needs of the client and family. Not only will the team address the symptoms of the disease, with focused attention on pain, but they will help to guide the client and family through the social, emotional and spiritual impact of the end of life process.

Understanding Hospice -- Facts and Fiction

Fiction: People are typically referred to Hospice when life expectancy is six months or less. 

This is not to say that this is always the case, but a client can remain on hospice for longer than six months with physician certification.

Fact: A client can choose to decline or discontinue hospice at any time, or they can change hospice agencies if the hospice team doesn't feel like the right fit for the family.

Fact: Life is not prolonged with hospice care, and it is not hastened.

Fact: Bereavement and counseling services are available before and after the client passes.

Fact: Hospice has coverage 24/7, but does not provide 24/7 care. Additional resources may be needed to provide additional client care.

Fact: When Hospice is called in, they connect with the client’s physician and meet with the client and his/her family or loved ones.

Who constitutes the Hospice Team?

As we noted before, the hospice teams are multidisciplinary. A typical hospice team can include physicians, nurses, home health aides, chaplains, social workers, nutritionists, and trained volunteers. If necessary, specialty clinicians can be brought in, such as wound and ostomy nurses, physical therapists and occupational therapists.

Who pays for Hospice?

Hospice is a covered benefit under Medicare, and most states offer hospice under Medicaid or Public Aid. Furthermore, many private insurance companies have hospice benefits"

How Does WeCare+ Help?

Mr. Bob is an 85-year-old male who is the primary caregiver for his spouse Mrs. Bob. She was recently diagnosed with Alzheimer’s Disease. However, the disease began much earlier and progressed very quickly. Within three years he was spending his entire day caring for her. Mr. Bob does this with little or no help, as their children are all out of state and can only offer assistance during the holidays. Also, as with many Alzheimer’s and Dementia patients, most of their friends stopped coming around.

Fortunately, Mr. Bob’s financial advisor was knowledgeable about elder care issues, and he recommended WeCare+. That is where Long Term Solutions stepped in. After an initial in home assessment, Long Term Solutions clinician Sue called Mr. Bob. First, they addressed the activities of daily living. Could she dress herself? Was she able to use the toilet independently? What about independent activities – could she use the phone? These are the types of question Bobby Sue and Mr. Bob worked through. Next, they determined what adaptive equipment would help Mr. Bob properly care for Mrs. Bob. Finally, they discussed safety issues, such as wandering. Mrs. Bob had just started wandering, and recently had been turning on the stove. Sue had many suggestions, from a new lock on the door, GPS transmitting sneakers, to removing the knobs on the stove. They developed a plan to ensure the safety of Mrs. Bob, and then Sue focused on the well fare of Mr. Bob.

With the duties of primary caregiver entirely on the spouse, there is always concern for caregiver burden. Caregiver stress is a multi-dimensional issue, with physical, emotional and intellectual components. Frequently, caregivers don’t realize that caregiver burden and stress is even an issue. Mr. Bob admitted he was having a tough time dealing with the guilt about some of the feelings of anger and frustration he was experiencing while caring for Mrs. Bob.

There is a lot of fear and confusion involved, as there is so little known about the disease. There’s also a lot of confusion. Mr. Bob and his wife were always focused on nutrition, health, and exercise, so why did this disease had affect them? There’s a lot of anger. Mr. Bob sees studies about Alzheimer’s Disease, possible causes, possible treatments, but he knows none of them will help his wife. There’s also resentment. What happened to his freedom? They used to be so involved in their community, but now they spend their days together alone in the house.

Sue suggested that with this level of dementia Mr. Bob should consider 24 hour care. He was hesitant, so she suggested he would benefit from having a home health for aide at least 4-5 hours, 7 days a week. That way, the aide can foster a relationship and develop trust with Mrs. Bob, and Mr. Bob can decide whether or not he is comfortable with it. Either way, it would free up some time for him during the day.

Sue let Mr. Bob know that he was welcome to call her anytime with any new concerns, and she provided him with community resources for caregivers, like himself.

Happy Thanksgiving, from Long Term Solutions

With Thanksgiving just a day away, we would like to take some time to express our gratitude and appreciation for all of the incredible healthcare professionals that we work with, our amazing administrative and clinical staff, and all of the families and caregivers who we are able help through their eldercare process. At Long Term Solutions, we’re passionate about elder care, and we’re thankful that we have been able to help so many families in the process of graceful aging.

Furthermore, we would like to extend our thanks and appreciation to the 65.7 million caregivers who care for ailing or aging loved ones. Sadly, caregiving is usually a silent issue, so many of these caregivers don’t receive the praise and recognition that they deserve. It’s incredibly difficult to care for someone who is continuing to get worse and worse, but these caregivers continue to selflessly provide care and support through all of these emotional ups and downs. Caregivers are amazing and deserve thanks and praise for the amazing care they continue to provide. This year, remember to express your thanks and appreciation to any caregivers that you know.

With that said, we would like to wish everyone a safe and happy Thanksgiving!

How Can WeCare+ Help? Part II

Brian contacted WeCare+ and Leanne, a registered nurse and a care coordinator with Long Term Solutions, became his primary resource for helping his mother. He felt comfortable disclosing all of his concerns with her as she was a registered nurse. He wasn’t sure his mother was being completely honest with him on the phone, and he was concerned there was a bigger issue going on. He knew eventually her dementia would worsen, but he hadn’t planned for this yet. She had been successfully living independently up until now, and he had become comfortable with that. He came to the conclusion that he hadn’t planned appropriately. After their conversation, Leanne contacted a local RN in Florida named Ashley to go to conduct an onsite assessment. She advised the RN that she needed to keep three goals in mind: assess her current living situation, make recommendations for her current care needs, and anticipate her future care needs.

Ashley conducting the assessment quickly realized that Brian’s concerns were genuine. What Brian wasn’t able to discern from a distance Ashley saw in an instant. Like many other people with cognitive impairments, Linda had been able to camouflage many of her symptoms. As an eldercare expert, these discrepancies were something that Ashley was trained to pick up on. She was quick to discern that Linda’s objections as an indication of something more: ‘oh I can’t recall that right now,’ ‘my son already knows about that,’ or ‘of course I take my medications.’ However, when Ashley looked at her medication box she noticed that the only pills missing were Saturday’s. These incongruities in her stories and the conversation with Brian indicated that the dementia had progressed.

Ashley provided Leanne with her assessment, and Leanne followed up with Brian within 24 hours of the visit to discuss Linda’s current and future care needs. Leanne recommended home health aide services on a daily basis, as his mother needed help with medications, bills and other house tasks. There were also safety concerns that a home health aide would be able to address. For the future, Leanne encouraged Brian to consider some different types of facilities for his mother that would offer increased supervision and assistance. Together they put a plan in place for if her dementia worsened, and they successfully gave Brian comfort in knowing he was taking care of his mother. Leanne’s correspondence with Brian didn’t end there. They agreed to follow up every few months to see how his mother’s dementia was progressing, and alter her caregiver services if necessary.

Rising Cost of Nursing Homes

This year, Genworth Financial released their 9^th annual Cost of Care Survey. The results serve as a perfect microscope to examine the cost of care state by state, and to understand emerging trends in the cost of care. One of the most striking figures is the cost of a nursing home and their expected increase in price.

In the study, the facilities are broken down into three categories: assisted living facility, nursing home(semi-private room) and nursing home (private room). For this article, we are just focusing on nursing home stays in a semi-private room. Nationwide, the average nursing home costs $200 a day. This figure has increased 3.63% in 2011, and over the next five years it is expected to grow 4.5%.

 Across the United States, it looks like this trend stays true for each state, with some regions being more expensive than others:

•  The North East has some of the most expensive care. In Massachusetts a nursing home stay costs $322 a day, and $117,530 a year. 
•  The cost of care in the West Coast is cheaper than the North East, but is still above the national average. In California a nursing home stay costs $224 a day, and $81,760 a year. 
• Nursing homes in the South are slightly above the national average. 
• In Florida, a nursing home stay costs $215 a day, and $78,475 a year
• The Midwest also is slightly below the national average, with a nursing home in Indiana costing $187 a day, and $68,255 a year.
• The most expensive nursing homes can be found in Alaska, with a nursing home costing $273,750 a year.
• The cheapest nursing homes can be found in Texas with nursing homes costing $47,450 a year.

What does this mean for caregivers? Already, more and more family members are fulfilling the role of caregiver due to the cost of healthcare. With the costs of facility focused care expected to increase at an average of $15,300 a year, more and more family members will become caregivers because facility based care is just too unaffordable.

You can compare costs in your state and others at Genworth’s website, here

Caregivers at LTS: Brenda

“What I really love about working on the administrative side of Long Term Solutions is that at the end of the day I know the work we do is helping someone,” explained Brenda. “At the other end of the phone or on the other end of the assessment is someone who we’re helping. There’s a person behind every claim number.”

Caregiving is something Brenda has been doing full-time since 2000, and, because of this, she is really able to relate to the adult caregivers she talks to on the phone every day.

“Caregiving is very hard, but I’ve found that one line really helps the adult caregivers: 'it’s not easy raising a parent,'” said Brenda laughing.

This lighthearted humor is a part of her family, and she’s incorporated this into her caregiving duties. In 2001, when Brenda was just 36, her mother was diagnosed with sarcoidosis of the lungs, and eventually became wheelchair bound and required constant oxygen. Her father’s vision started failing and he was legally blind by 2001. Between 2001 and 2004, Brenda primarily looked after her mother because her mother continued to help with her father’s care, despite her worsening condition.

“They really complimented each other and that’s why their marriage was so successful. They were best friends. As they aged, their joke was that my mother was my father’s eyes, and my father was my mother’s legs, so together they would be a complete person,” said Brenda smiling.

Unfortunately, Brenda’s mother’s condition worsened in 2004 and she became very ill. Before she passed away, Brenda promised to watch after her mother’s husband and best friend. 

“I said ‘you can go and be at peace, I will always take care of dad. I want you to know that,’” explained Brenda. “I feel like it is an honor to do, as much as it can sometimes be frustrating.”

That is a promise that Brenda has fulfilled two-fold, and in 2004 she became the full-time caregiver for her father. Prior to her mother’s passing, she had moved in with her parents to provide better care for them. They lived in a home in Connecticut, and then together in a ranch house in Florida. After Brenda’s mother passed away, it was very painful for her father to live in the house he had shared with his wife. Brenda decided that they should move back to New England. They moved to Massachusetts in December 2006.

“Now we’re in a condo, and in a condo, you don’t have a lot of personal space,” said Brenda laughing. “It’s difficult at times. For example, if you don’t want to listen to the music my dad is listening to you don’t really have a choice. I’ve listened to a lot of Eva Cassidy.”

With her father’s diagnosis, it can be difficult for him to leave the house. He gave up driving about six months after he realized his vision was failing. Brenda has a difficult time encouraging him to leave the house because he has a natural tendency to be somewhat reclusive.

“He isolates himself at home, so, in a lot of ways, I’m his only social outlet in addition to being his full-time caretaker. I don’t get upset, but sometimes it gets to you.”

Instead of finding activities at the local senior center, he opts to spend most of his time with their miniature schnauzer, Maddie. She is 12-years-old, and also lost her vision this past year. The pair spends their day together, and they’ve worked out quite a schedule. The two go outside walking, and her father will take his seated walker and watch Maddie as she walks around. The two then make their way down the road to the gas station to buy scratch tickets, and then to Dunkin Donuts for lunch. In addition to their outside activities, they spend some of their day watching Home Shopping Network and researching their family tree with a computer that has been adapted to compensate for his reduced vision.

“I never realized that, until my mom passed away, my mom kept my father really in control and grounded. Without her, if left to his own devices, he will really do some silly, silly things,” joked Brenda. 

However, Brenda has worked incredibly hard to help her father maintain a sense of independence.

“That’s one of the things I always think about. How can I provide him with some independence? I always give him options for dinner, for example. I like him to have some control. It’s very hard to feel like you’re losing your independence, especially for men.”

From ensuring that the carpeting in their condo was flush with the walls and level with the hardwood floors so that her father wouldn’t trip, to hunting down a specialized stove to allow her father to cook, Brenda has actively pushed to provide her father with this independence. Brenda is now preparing to remodel their bathroom to make the shower more accessible.

“Well, the most rewarding thing about caregiving is knowing that my dad is happy where he is, and knowing that the quality of life that I’m able to give him is appreciated,” explained Brenda.

It’s this perspective and appreciation that has helped Brenda while working with other adult caregivers.

“My experience with my dad has really helped me. When the caregivers are stressed out, I know it helps just to have someone listening to them and telling them that we are there for them. I always say how lucky their parents are to have them as an advocate, and how wonderful it is that they take the time to be involved in their parent’s care,” explained Brenda. “It’s not easy for them. But, it can help if you put it into perspective – how much your parents did for you, and how much you can give back.”

Caregiving and the Importance of Balanced Eating

Caregivers, you need to take care of yourself! One of the first steps towards doing this is maintaining a nutritionally balanced diet. Unfortunately, eating can be one of the first thing affected by caregiving. Eating an imbalanced diet can lead to malnutrition, erratic blood sugar levels, fat storage, fatigue and more. There are a couple of pitfalls that can impact how and when you eat. Be sure to know how to recognize these and avoid them.

First, most caregivers are guilty of skipping meals. A jam packed schedule and a never-ending to do list can quickly push meal time to last priority. The demands of the feeding schedule of the person you are taking care of can also impact how you support your own eating. When preparing meals and shopping constantly for someone else, it’s easy to forget your own nutritional needs. Try not to fall into the habit of forgetting yourself. It may not be easy, but do try preparing your meals ahead of time. If you can cook several meals for yourself on the weekend, you’ll be stocked and prepared to have well-balanced meals during the course of the upcoming week.

Secondly, eating and emotions are very closely linked. Light stress can induce extra eating, while extreme stress can cause one to avoid eating all together or eating too much. It’s safe to say that caregiving can include varying levels of stress. As a caregiver, you need to learn how to identify when these emotions are impacting your diet. Once you’re able to do so, you can avoid the emotional eating trap.

Remember, you have to take care of yourself in order to fully provide care for the one you love. This is not selfish, it is prudent. By taking care of yourself, you’re able to provide the best care for the one you love.

Elder Care Information

The Bureau of Labor Statistics released the American Time Use Survey this past week, and there are some incredible figures regarding family caregivers.

According to The New York Times, this survey was started in 2003, and the numbers are based on the minute by minute activities of Americans during a specific 24-hour period. This is the first year that elder care data was collected, and here is what they found:

39.8 million people over the age of 15 acted as unpaid caregivers to someone over 65.

22.3 million ( or 56%) of these caregivers were women.

 23% of these caregivers were between the ages of 45 to 54.

22% of these caregivers were between the ages of 55 to 65.

16% of these caregivers were 65 and older.

23% of these caregivers were part of the sandwich generation, and cared for a child under 18 in addition to fulfilling their elder care duties.

This data was taken in 2011. With the first baby boomers beginning to retire, it will be interesting to see which areas increase during the next year. What do you think this means for the future of caregiving? What surprise you most about this data?

You can find the New York Times article here, and more statistics from the Bureau of Labor Statistics here.

Caregiver Stress Relief: Walking

For caregivers, taking a break can be incredibly difficult, and it can be next to impossible to incorporate a workout into the day. Exercising is crucial to stress relief and physical health, and for a caregiver, stress relief is top priority. That’s why walking is a great exercise option for caregivers.

Walking is a great fit for many reasons. First off, it doesn’t require a gym. You can walk anywhere and anytime without having to worry about setting time aside to drive to a gym or fitness class. Secondly, it’s an opportunity to have some time alone, which can be difficult to find as a caregiver. On the other hand, caregivers can walk with a buddy to incorporate some social interaction into their day. Whether walking alone or with a friend, the stress relief and mental health benefits are incredibly important. Lastly, there are numerous physical health benefits. Here are some from the Mayo Clinic:

• Lowers blood pressure
• Increases HDLs and lowers LDLs
• Reduces the risk of type 2 diabetes
• Is good for weight maintenance
• Increases strength

For more information on walking, take a look at this information from the Mayo Clinic by clicking here.

Berries Delay Memory Decline

Here’s another great reason to incorporate fruit into your diet: berries may delay memory decline. In a recent study, researchers found that consumption of berries slowed cognitive decline in women 70 or older. In some cases, the cognitive decline was slowed for up to 2.5 years.

Blueberries contain an extremely high amount of flavonoids. These flavonoids are able to cross the blood brain barrier into the hippocampus, which is that part of the brain that is responsible for forming memories and learning. Interestingly, many medications aren’t able to cross this blood brain barrier.

So, be sure to put blueberries on your shopping list this week! You can read the full report here.

Caregivers and Social Media

This week, there has been a lot of discussion about the benefit of social media for caregivers. If you’re a caregiver, social media is a great way create a support group made up of caregivers, and to reconnect with friends and family.

There are many amazing websites that are created specifically to support caregivers, and one of the best features of these websites is the opportunity to vent. Talking to your friends and family can be incredibly helpful, and is a lifesaver on many days, but there is something extremely helpful in venting to a virtual group of caregivers. If you don’t feel like writing about your personal experience, you can read the experience of other caregivers and understand that you’re not alone in your feelings.

Social media is also a perfect way to stay connected with your friends and family. You can stay up to date on everything in their lives, and you can keep them posted on your caregiving duties. The best part about social media is that you don’t have to dedicate your entire day to catching up.

Here is a great piece from HealthyMagination.com with online resources for caregivers: http://www.healthymagination.com/blog/social-media-can-help-reduce-caregiver-stress/

Memorial Day: Outdoor Safety Tips for the Elderly

Memorial Day: Outdoor Safety Tips for the Elderly

Traditionally, Memorial Day is usually spent with family and friends around a grill. In order to have a fun, carefree Memorial Day, you have to take some safety precautions: 

Grill Safety: Before you grill, there are some important safety to ensure that the grill is functioning properly and to avoid any fires.

1.Place the grill far away from your home, your deck, trees, shrubs and any flammable items.

2. Scrub the grill! Remove all grease and fat. It can catch on fire if it isn’t cleaned properly

3. If you’re using a charcoal grill, be careful about using starter fluid. Ensure that it is out of the reach of children and pets, and only use starter fluid. Don’t use any other accelerants!

4. If you’re using a propane grill, check the gas tank hose for leaks. The National Fire Protection Association has a great test: apply soapy water to the gas hose. If there is a leak, you will see bubbles. If not, then start grilling!

5.Read the complete list of tips from NFPA here.

Food Safety: Practice extreme caution while handling raw food!

1. While handling raw meat, wash your hands for at least 20 seconds before and after handling food.

2. Ensure that the coals are lightly coated with ash.  Check that hamburgers reach an internal temperature of 160°F, large cuts of beef reach 154°F, and poultry reaches 165°F.

3. Read this list of food safety tips from the USDA here. 

Elderly Safety: Heat stroke and heat related illness can be a serious problem for seniors.

1. Have plenty of water available to keep your elderly loved ones hydrated.

2.When you’re setting up, be sure to place several lawn chairs and tables in shaded areas to keep your senior loved ones cool.

3. Leave the air conditioning or fans on inside a room so that seniors can rest there if needed.

4. Leave bottles of sunblock outside for your guests to use, and ensure that your senior loved one wears light, breathable clothing and a hat.

5. Know the symptoms of heat exhaustion and seek medical attention if any of your guests start showing any symptoms! You can see the full list of symptoms here.

Hope everyone has a safe and fun Memorial Day!

Halting the Stress of Caregiving: Meditation

At Long Term Solutions, we’re constantly examining new techniques to support caregivers in their journey. One great way to manage your wellness is through meditation.  

Now, we don’t mean adding another thing to a list of your ‘to-do’s,’ we don’t mean learning new meditation techniques, and we definitely don’t mean wasting fifteen minutes of your day. We’re talking about meditating on the most basic level possible. It can be as easy as stopping what you’re doing, no matter where you are, and taking five deep breaths. As simple as that! 

One place to try this is waiting for your loved ones during appointments. Caregivers are always shuttling their loved ones to and from doctor’s appointments, so instead of stressing out about the next doctor’s appointment, what’s for dinner, or an overbooked agenda, take some time to meditate. Take five minutes to focus on breathing and not the thoughts scrambling through your head. You don’t have to completely clear your head of thoughts, but just pause them momentarily. 

Incorporating five minutes of meditation into your day will have incredible benefits! Here are six steps to quieting your mind from Huffington Post.  

Caregiving and the Importance of Getting Outside

Caregivers are constantly being bombarded with things they should and shouldn’t do to help process the incredible amount of stress involved with caregiving. One thing is frequently overlooked, and it is probably one of the easiest things to do: get outside!

The health benefits of sun exposure and fresh air are incredible. First, it’s important for caregivers because sunlight is a necessary part of the production of Vitamin D. Vitamin D has been credited with reducing the risk of cancer, increasing bone health, reducing the risk of developing osteoporosis, and it is associated with better moods and increased happiness.

Aside from the health benefits, going outside will give you an opportunity to take a break from caregiving. If you incorporate 15-30 minutes of alone time outside, you will see both mental health benefits as well as physical health benefits! As always, be sure to wear sunscreen while outside, and only moderate amounts of sun exposure is recommended!

Click here for a list of 25 health benefits of sun exposure.

Caregivers and Mother's Day

As we’ve mentioned, caring for an aging parent is one of the most challenging tasks a caregiver can face. Caregiving is incredibly stressful and it is even more difficult for women caring for their mothers.  They can face frustration, anger and depression, and with all of the daily tasks, medications and doctor’s appointments it’s easy to forget about the person being cared for.

Mother’s Day is a wonderful opportunity for caregivers caring for their mothers to reconnect and to spend time remembering their childhood. If you are a caregiver caring for your mother, here are some ideas for a more meaningful Mother’s Day:

- Spend time together talking about your childhood, and what it was like when you were growing up.

- Look at old pictures together and see what stories the photographs inspire.

- Ask about your mother’s mother, and spend time talking about her family and experience growing up.

- Talk about your mother’s favorite activities when she was young. Did she like baking? Playing tennis? What did she do with her free time?

- Ask your mother about her favorite things – favorite memory, favorite vacation, favorite song.

Happy Mother's Day!

LTS Weekly News Roundup

Caregiving in the News:
NPR: One Roof, Three Generations, Many Decisions
In the first of a series of broadcasts, NPR has begun examining how the recent recession has forced many into multi-generational homes. As a result, they will discuss issues of elder care, the costs of caregiving, and the costs of long-term care insurance.

McKnight’s:Caregivers for Medicaid recipients often live in poverty, study finds
UCLA released a study this past week revealing that caregivers providing services to adults using Medi-Cal earn less than $11 an hour and have monthly incomes of $1,970. This is 200% below the federal poverty level.

Elder Health News:
The New York Times: Too Many Pills for Aging Patients
With more than 40% of people over age 65 taking five or more medications, there has been an increasing trend of over medicating seniors which leads to hospitalizations.

TIME: No Regrets! Successful Aging Means Letting Go of ‘What Ifs?’
Research from Science has indicated that adopting a‘no regrets’ philosophy will lead to emotional health later in life. Through a series of chance games, researchers determined that the elderly who readily blamed themselves for circumstances beyond their control were more likely to be depressed.

LA Times: You’re never too old to reduce Alzheimer’s risk with exercise
A recent study tracked 716 elderly people, and the results indicated that the participants who spent the least amount of time partaking in physical activity were more likely to develop Alzheimer’s Disease.

Long-Term Care Industry News:
US News & World Report: Long-Term Care Needs Demand Your Attention Now
A combination of shrinking financial resources and fewer health-care workers is creating an unprecedented health care crisis.

LTS Weekly News Roundup

Caregiving in the News:
New York Times: Reconnecting Through Art
The Rubin Museum of Art in Manhattan has been hosting “Mindful Connections” once a month, which is an opportunity for caregivers caring for loved ones with Alzheimer’s or dementia to bring them to a 90-minute art discussion. This is part of a larger trend to use art as a way to stimulate conversation and communication in people with Alzheimer’s or dementia related illnesses.

CNN: Caregiving for loved ones the ‘new normal’ for boomers
43.5 million Americans care for someone older than 50, and with more and more baby boomers retiring, this number is expected to grow exponentially.

Elder Health in the News:
World Health Organization: Dementia cases set to triple by 2050 but still largely ignored 
In a press release issued on Wednesday, the World Health Organization has indicated that by 2050 70% of the population will be living with dementia. This number roughly translates to 115.4 million people, which is three times the current number.

Genworth Financial: Cost of Care Across the United States
Genworth has released their 9th annual Cost of Care survey. The cost of facility based care has increased steadily, and it is expected to continue to grow by an average of $15,300 yearly. Rates for home care providers have seen almost no increase over the past five years.

Long-Term Care Industry News:
InAudit: Long-Term Care Insurance and Three Ways of Buying It!
This article discusses the different LTCI policies and encourages readers to view LTC policies in the same context as home insurance.

Caregiver Ideas: Music Therapy Playlist 1957

In past posts, we have discussed incorporating items from the past to help soothe people with Alzheimer’s. Here at LTS, we’re always trying to find innovative ways to provide some relief to caregivers and to their loved ones, so we thought that incorporating music from the past would be a great tool for caregivers to use while caregiving. Like items, and possibly even more so, music can bring up memories of the past. It can open up opportunities to talk to your loved ones about their past, and also free up some down time for you!

We put together a playlist of the top Billboard hits of 1957:

1. “Singing the Blues” – Guy Mitchell

2. “Don’t Forbid Me” – Pat Boone

3. “Young Love” – Tab Hunter

4.“Butterfly” – Andy Williams

5.“All Shook Up” – Elvis Presley

6.“Love Letters in the Sand” – Pat Boone

7.“Teddy Bear” – Elvis Presley

8.“Tammy” – Debbie Reynolds

9.“Honeycomb” – Jimmie Rodgers

10.“Wake Up Little Susie” – Everly Brothers

11.“Jailhouse Rock” – Elvis Presley

12."You Send Me” – Sam Cooke

13.“April Love” – Pat Boone

LTS Weekly News Roundup

Caregiving in the News: 
New York Times: The Caregiver’s Bookshelf: A Law Guide for Seniors 
The New York Times New Old Age Blog frequently recommends books for caregivers. In this post, they recommend “Everyday Law for Seniors” by Professor Lawrence Frolik and Professor Linda Whitton.

Huffington Post: Corporate America’s Looking Caregiver Crisis 
U.S. companies lose $33.6 billion a year in lost productivity due to caregiving, but eldercare benefits in the workplace still remain unaddressed.

Elder Health News:
Huffington Post: Will New DSM-5 Diagnosis End ‘Dementia’ Stigma? 
The mental health experts helping to update the DSM-5 have proposed changing the diagnosis of “dementia” to “major neurocognitive disorder.” The reasons for this vary, but one primary goal is to stress a decline as opposed to a deficit.

Long-Term Care Industry News: 
Wall Street Journal: Medicaid Gets Harder to Tap 
State by state, Medicaid program regulations vary, and some states are becoming stricter. It’s becoming increasingly more difficult for families to use Medicaid to help pay for long-term care.

Caregivers at LTS: Karen

“The greatest joy is watching him smile, when he smiles,” said Karen about her father-in-law. “I tell my husband – I just live for that.”

Laughter is one thing about caregiving that brings joy to Karen. Another is taking her father-in-law out to eat fried clams at Red Wing Diner just down the street from her house. The third is having conversations with him.

“He loves having conversation. He has a great sense of humor. If I can just banter back and forth, that makes him laugh. It makes it all worth it for me,” she explained.

Karen’s father-in-law lives with her and her husband in their split level home. They live in the top level and he lives in the bottom level. He has a family room, a living area, a bathroom and a small dinette in his make shift home.

“He’s got everything he needs down there,” explained Karen.

Karen and her husband are the two primary caregivers for her father-in-law, Harvey. He moved in after being diagnosed with vascular dementia and Alzheimer’s disease, and it took a lot to get her father to this point.

Harvey had been successfully living independently in his home since his wife’s death 13 years ago. He had been able to maintain his independence at home for so many years with the help of his eldest daughter. She did his grocery shopping, prepared his meals, did his laundry and helped him with housecleaning. However, his family started to notice a decline. He had memory lapses and frequently repeated the same story. He stopped changing his clothes and caring for his personal hygiene. Things he had been using for years, like the TV remote, became too complicated. The pedals in the car were too close together. He fell frequently and couldn’t help himself up without assistance. The warning signs were all there, and the family knew that he was no longer safe to live alone.

“There were so many indicators that something really needed to change, but that’s such a complicated thing,” she explained. “We knew it was going to end up taking an event to get him out of his home because he was so unwilling to do anything else.”

That event came in October 2011, when Harvey’s daughter found him on the floor of his home. He had suffered a stroke which put Harvey into a Boston area hospital for a week and into rehab for two more months. It was there he finally received an official diagnosis. A CT scan and an MRI revealed the tell-tale amyloid deposits that indicated Alzheimer’s disease, and he was given an additional diagnosis of vascular dementia.

Her spouse assumed the role of Power of Attorney and Health Care Proxy, and they began to transition her father-in-law into their home, despite objections from people who advocated for an assisted living facility or a nursing home. For Karen and her husband, it had been an easy decision. Before the dementia and Alzheimer’s disease had set in, the family had agreed to take her father-in-law into their home if he ever lost his ability to live independently. This was a conversation that her father-in-law had actively agreed too.

“Years ago my husband and I had offered to have Harvey come and live with us if the time ever came that he was no longer able to live alone. It became very evident to all of us that he could not go home by himself, and that he needed to come live with us,” she said.

Eventually, with help from the rehab employees and her family members, Harvey agreed to move in with them That’s where her work experience at Long Term Solutions became incredibly useful. Karen is a nurse care coordinator at LTS, so she works all day long helping families address the care needs of their loved ones.

“My experience at LTS helped me in so many ways,” she explained. “I knew exactly what needed to be done in order to have Harvey come live with us. I knew what equipment we needed, what adaptations would need to be made to provide safety in bathing and toileting, and I knew the questions to ask and where to find resources.”

She credits her colleagues at LTS with helping her find lists of local agencies to provide her with home health aides to help care for her father. They provided her with contact information and email addresses to multiple aides in the area.

“I was even able to find a geriatric nurse practitioner who would come to the house… the employees at LTS were so helpful,” she said.

Her husband went to work measuring assistive equipment, putting up grab bars, and making the downstairs as accessible as possible for her father-in-law. They had almost everything in place, when were told that Harvey didn’t have the appropriate diagnosis for insurance to cover a hospital bed.

“The care coordinators in rehab, a lot of times, they don’t know all of the answers. For instance, I was led to believe if the physical therapists ordered the hospital bed, it would be covered. I found out about a week before he was discharged that he didn’t have the diagnosis for that,” she said.

Another physical therapist suggested looking on Craigslist.

“Our daughter who I lovingly refer to as the ‘Craigslist Queen’ was able to locate a used hospital bed for us within 15 minutes,” she said laughing.

With the hospital bed in place, they were ready to bring Harvey home.

“That first day arriving at our house, Harvey was all smiles, and he was so glad to be with us. That lasted about 48 hours. He slept all night the first night. He was so pleased with his caregivers, the food, our dog, and he even liked our cat! I remember coming to work that first day after Harvey moved in saying how smooth the transition had been.It was amazing! However the next day I came to work singing ‘the party’s over’.”

Harvey was no longer so pleased. While experiencing sun-downing, he gets angry and lashes out at Karen’s husband. He can say many hurtful things about being kept a prisoner in his home. Harvey has moments of confusion and agitation, and he can feel lonely and fearful. He needs help with almost everything, toileting, changing his Depends, showering, and walking. His left foot was affected by his stroke, and the dementia and Alzheimer’s make it difficult for him to remember how to walk. Harvey rarely sleeps through the entire night, and Karen and her husband monitor him with a baby monitor. However, there are things he can do himself, and Karen is working hard to allow him the dignity of doing what he can do on his own.

Karen and her husband have two caregivers for 12 hours during the morning, and they manage caring for him at night. To avoid stress, Karen and her husband go on a date once a week. They make sure they have an aide for every Friday night. They take vacation when they need to. They just took a two week vacation in January, but it’s difficult for her husband to take time off.

There is still an amazing amount of stress involved, even with these breaks. It’s a combination of financial stress, selling her father-in-law’s house, family dynamics, and other things.

“These past three months since Harvey came to live with us have been filled with adjustments for him and for us. Harvey no longer talks about going home to his house, he feels safe with us. He seems to be more settled being in our home. My husband and I have learned so much. This journey, traveling deeper into the world of Alzheimer’s is full of the unknown, it’s dynamic. Just when we think we understand it, it changes. It’s full of fearful moments and joy-filled moments. Whatever it is, we are traveling the road together, supporting and loving one another. To provide care for him is a privilege we would never want to miss. My payment you may ask? It’s Harvey’s smile! ” she concluded.