My mom has been troubled by bedsores on and off for the past two years.  A bedsore forms, gets worse and then very s-l-o-w-l-y heals (as in taking months to completely close up). She presently has three in various sizes, places and stages of breakdown or healing.

Contrary to what most of us believe, I’ve learned bedsores do not occur as a result of neglect.  In my mom’s situation, her skin breakdown is due to the thinness and fragility of her skin, her weight (she’s only 90 lbs.) and the fact that she can no longer walk. The caregivers at her board & care are all top notch and are constantly battling any signs of skin irritation to keep new bedsores from forming.

The Current Medical Treatment

The worst bedsore is on her coccyx and the doctor ordered her to be in bed 99% of the time now.  The caregivers are vigilant about turning her from one side to the other side every two hours and changing her diaper to keep moistness away from all the sores.  She uses an alternating pressure air mattress which is always moving slightly to massage her skin.  The hospice nurse provides specialized wound care every second or third day. I know medically these are correct steps, because with the attentive wound care and the “staying in bed regime” the sore is not getting worse, and is starting to heal.  For that I am grateful.

So What’s My Dilemma?

Why is this medical treatment bothering me?

Because it is also a quality of life issue.

When she’s in bed 99% of the time, Mom misses out on the social activities that go on in the living room and kitchen of the house.  She can’t partake in musical sing-a-longs or arts & crafts sessions three times a week.  She misses mealtime conversations and visits from other residents’ families.  Even though her ability to speak, participate or interact are limited, I still believe she gets stimulation and enjoyment by being in these social situations.  Or just by viewing the changing indoor “landscape” in front of her eyes. When she’s lying in bed in her room, she’s isolated and misses out on this liveliness, except what I bring her during my visits.

If I knew the medical treatment was just for a few days or even for a few weeks, I could live with it.  But based on how long it has taken previous bedsores to heal, I see her staying in bed for months to come.

A Balancing Act

It’s a matter of balancing her medical needs and keeping her quality of life at a decent level.  It’s a balancing act that I’m not sure we’re winning.  Yes, her bedsores are healing, but at what cost?  It’s frustrating and it makes me sad.

Have you found yourself in a similar caregiving predicament?

How have you dealt with it? Let’s discuss . . .

Due to the current economic downturn I worry that senior citizens on fixed incomes could start to neglect their health in order to save money. In fact I even caught myself questioning whether I really needed to go back to the doctor for a recheck blood test he recommended. Yes, I made the appointment and went. Our aging parents’ health (and our own) is just too important and not a place to cut corners in order to save money! Please be certain your Golden Oldies are not putting off necessary doctors visits or laboratory tests, now or ever.

I recently read about a program that can insure our aging parents’ eye health is not neglected. EyeCare America offers a year-round program for U.S. citizens called the Seniors EyeCare Program. It is designed for people ages 65 and older who have not seen an ophthalmologist in three or more years. Eligible patients are matched with a nearby volunteer ophthalmologist, receive a comprehensive medical eye examination and up to one year of care for any disease diagnosed during the initial visit for FREE.

The participating ophthalmologists have agreed to accept Medicare and/or other insurance reimbursement as payment in full, resulting in no out-of-pocket cost to the patient. Seniors without insurance receive care at no charge. It can’t get any better than that!

By age 65, one in three Americans has some form of vision impairing eye disease. Most do not know it because there are often no warning symptoms or they assume that poor sight is a natural part of growing older. By detecting and treating eye disease early through annual, dilated eye exams, seniors can preserve their sight.

To see if your aging parents qualify for this eye care program, call 1-800-222-EYES (3937), or read more about it at EyeCareAmerica.org. The organization also offers programs for glaucoma, diabetes and children’s eye disease detection. Their site is definitely worth a look see.

**********

And while we’re on the subject of eyes . . . . Lions Club International has been collecting glasses for nearly 80 years. Adult and especially children’s eyeglasses are needed. Prescription and nonprescription glasses and sunglassses are gathered from their many donation centers and sent to one of the Lions Eyeglass Recycling Centers here in the U.S. (there are 17 centers worldwide). Volunteers help clean and sort the glasses before shipping them to developing countries, where they are given to those in need.

So if you’re hanging on to old eyeglasses you no longer can use, go to the Lions Club web site or call the club in your area to find a list of donation centers where you can drop off or mail your old eyeglasses. Helping to improve someone’s eyesight is a simple yet wonderful thing to do!

**********

“The real voyage of discovery consists not in seeking new landscapes but in having new eyes.”

~ Marcel Proust

**********

These items caught my eye in the “Hints from Heloise” newspaper column and I am pleased to share them with you. Thanks, Heloise!

This is Part 3 of a 3 part series on this topic.

Click here to see Part 1.  Click here to see Part 2.

When my Dad had surgery to replace his broken hip at age 95, he spent one week in the hospital recuperating and then almost two more weeks in a rehabilitation facility.  We were all ecstatic when he was told he could go home! 

Then it got rather interesting.  I had to look at many facets of my Dad’s daily living with a new perspective because the rehab nurse handed me a 38 page manual covering the basics of post-operative home care for hip replacement patients.  It included precautions, exercises, transfer techniques (i.e., getting in and out of bed, cars and chairs), walking with a walker, stair-climbing (thankfully he didn’t have stairs at home), dressing and bathing.  Yikes! 

Things I’ve learned from this experience (and also when my Mom was hospitalized briefly) that can help you and your aging parent in this transition from hospital or rehab facility to home are:

• Meet with the doctor, nurses, physical and occupational therapists to get clear written and verbal instructions your Golden Oldie will have to follow at home, and for how long.  Will it be just until a re-check with the doctor in a few days or for weeks, perhaps months, until fully recovered? 

• If possible, attend physical and/or occupational therapy sessions before your parent is sent home.  The more information you can take in about your parents’ physical needs, the easier it will make it at home.  Some people learn best by watching, not just talking with the therapists.  They will be happy to have you “practice” with your parent in front of them to be sure you and your parent understand.  For example, a simple thing we do every day, such as sitting on the edge of a bed, bending over and tying one’s shoes was a definite “no-no” for my Dad after hip replacement surgery.  Another thing I learned was how my Dad should use the walker when getting up or sitting down in a chair.  None of us had ever even owned a walker before.  Some Golden Oldies may need a wheelchair when they first leave the hospital, and properly using one is another learning curve for you all to tackle.  I’m the worst at steering those things (with no reflection on my car driving abilities however!).

• Anticipate how any new medical equipment your parent needs will fit into their home environment.  For example, will the wheelchair be able to roll into the bathroom they use the most, or is the doorway too narrow?  If they need a hospital bed, coordinate with the hospital staff to see that it is ordered, delivered and set up before discharge.   Will they need a commode temporarily near the bed?  Will they be able to go into the kitchen to eat or will they need a tray to eat meals in bed at first?

• Hospitals and rehabilitation facilities are usually very good at going over medications with the patient and family before discharge.  Be sure you are present when this is done, because your Golden Oldie may be weak or unable to concentrate fully at discharge time.  You should be the “technical interpreter” and be clear about the names of all medications, what they are for, dosages, when they are taken, and other special instructions (such as take only on an empty stomach).  There may also be special dietary items and/or restrictions you should learn as well. The staff may  be willing to call in the prescriptions to your favorite pharmacy right before discharge.  You can then pick them up on the way home, and not have to leave your parent alone at home because you need to fill their prescriptions.  It won’t hurt to ask if the nurses can make the phone call for you.

• Sometimes the smallest things make a huge difference!  At the time of my Dad’s hip replacement surgery, our family had a mini-van and a sedan automobile.   I had always used the sedan to take my parents out and about on errands.  However, after the surgery, it was much easier for Dad to get in and out of the mini-van.  Because the seat was higher it was easier to slide onto the seat, plus it met the important post-surgical hip precautions.  The sedan’s seat was 1) too low, and 2) could not be moved back far enough to give him adequate leg room.  You may even need to have someone else drive you and your parent home.

• Your Golden Oldie may be weak when they first arrive home — very happy and relieved, but weak and/or slightly disoriented from their ordeal.  Just as you did when they were in the hospital, if you feel they need extra TLC for awhile, arrange with other family, neighbors and/or friends to spend the first few days with them until you are certain they are able to manage again on their own for longer periods of time. They will hopefully bounce back quickly from whatever setback they had and resume their normal activities.

• Last but not least — food!  If you can stock your parent’s refrigerator with the staples that will also save you both a trip to the grocery store that first day home.  Even better, if you have time, prepare some of their favorite foods to fill the frig.  Classic comfort foods, such as meatloaf, mashed potatoes, pot pies, chicken noodle soup, beef stew, macaroni and cheese or other pasta, and casseroles may appeal.  Of course, be sure your Golden Oldie doesn’t have any dietary restrictions to follow, and if they do, be sure the foods you prepare or buy follow all of the requirements. 

The key to making this transition go smoothly is for you to anticipate as much as you can.  As I mentioned in Part 1 of this series, thoughtful planning makes everything less stressful when faced with family emergencies or challenges.  You’ll usually have an idea when your Golden Oldie will be discharged, so use that time to your advantage. 

And remember, being home and surrounded by familiar people and things is great medicine for our Golden Oldies!

Warmly,

Linda

This is Part 2 of a 3 part series on this topic.

Click here for Part 1.  Click here for Part 3.

Being in the hospital can be scary for people of all ages.  If your aging parent is hospitalized for even a short time, here are some things you can do to make it easier for them. 

• Bring some favorite things from home to decorate the stark hospital room.  This can include family photos to be put near the bed where they can easily see them, a special throw blanket or pillow(s), and flowers or plants.   Have your children, nieces or nephews make Get Well cards to display.  An iPod or small CD player may also be brought in loaded with their favorite music.
• Many hospital rooms have a combination bulletin board/white board on the wall facing the patient’s bed.  If so,  write messages to your parent to read while you’re away.  Use a thick black or dark marker and write in large print on the white board because often times they don’t wear their eyeglasses when in the hospital.  I would write something like “Dad, Follow doctors’ orders and keep getting well fast.  I will be back at 6:00 pm today with Jeff and Robbie to visit.”  When I left in the evening I would write, “Have a good sleep and sweet dreams.  I will be here in the morning at 9:00 am to visit.”  The bulletin board side is perfect to hang Get Well cards on, so bring some thumbtacks from home.
• Along with creating a friendlier and more interesting physical environment, I believe it is vital to create a positive-thinking environment when visiting.  Try your best to be positive, upbeat and calm in front of your parent, because I truly believe they read and pick up on our “vibes.”  They are probably already scared by just being the hospital, so by your staying calm and in control it won’t increase their level of anxiety and may even decrease it.  Even if the diagnosis is serious, I believe it is important to stay positive in front of the patient and share your worries or concerns with the hospital staff and doctors when you are sure your parent won’t hear the conversations, either behind closed doors or far down the hall from their room.
• Be a patient extender, the person who helps your parent fully explain him- or herself to the doctors, nurses or other providers.  This goes beyond their medical history or current condition; it includes the “every day” things, such as letting the nurses know they aren’t wearing their hearing aides, but if the staff faces them and speaks slowly the patient can read their lips.  Or, their glasses are for distance, not for close up reading.  Or, they’d prefer apple sauce instead of water to take their medications with.
• Be your aging parents’ advocate.  Write down what the doctors and nurses tell you each time you have a conversation.  Then, write down follow up questions as you and your parent think of them, so that you can be sure to get them answered the next time either MD or RN returns to the room.  Be persistent in getting all of your questions answered clearly and completely! 
• Become a technical interpreter, the person who helps doctors and other providers explain themselves to your parent.  While communicating with the hospital staff and even family members who are visiting, do not talk in front of your parent as if they’re not there and aware of what’s going on!  Even if you think they are asleep or sedated from medication, they may be conscious.  As long as they have the ability to comprehend and participate in the health care decision, include them in the discussions as best as you can.  They may be ill, but they are still alive and have the right to understand and have input about their health care decisions.
• If you are unhappy with something that occurs, speak up in an assertive way.  Remember, your parent probably cannot handle a difficult situation themselves at the moment, so you are representing them and their best interests.  Being assertive yet firm will yield a better result than being unpleasant or aggressive in your approach to the hospital staff.  (As the old saying goes, you get more flies with honey than with vinegar.)  And if you do have a complaint, state it away from your parent’s room so as not to upset them further.  They might not have even realized something upset you, so keep it that way! 
• Depending upon your parent’s age, medical condition and your own daily responsibilities, you may want to hire a companion/health aide/licensed vocational nurse (LVN) through an outside agency to stay with your parent when you or other family members can’t be with them.  Many Golden Oldies may have a decline in their normal level of functioning or get confused temporarily when they are in an unfamiliar environment, and having someone with them (especially during the night) may help.  If you have a large family, try to arrange a schedule for your siblings, their grown children, and/or other family and friends to be with your parent during their stay.  Hopefully any confusion or decline in functioning will return to normal once your aging parent is back in their own home.

Having a parent in the hospital isn’t easy on any family, and not all problems can be prevented.  But hopefully the steps above should help make it an overall more positive experience for everyone involved.  In Part 3 I will cover issues regarding hospital discharge and the transition from hospital to home. 

Here’s to more Tender Loving Eldercare!

Warmly,

Linda

This is Part 1 of a 3 part series on this topic.

Click here for Part 2.  Click here for Part 3. 

Last week a friend’s Mom, Golden Oldie age 80+, was taken to the emergency room unexpectedly and  was then admitted to the hospital for a few days.  Luckily, it was nothing serious and she will be going home soon. 

An unexpected emergency like this can be much less stressful for you as a family caregiver if you prepare a few things in advance.  Emergency Kits traditionally include bandaids, ointment, gauze pads, scissors, etc.  The Aging Parents Emergency Kit I created has different contents, but is something I could grab and be out the door with in no time flat.  Kind of like the suitcase I packed when I was expecting my first baby!

Prepare a folder, envelope or accordion file with the copies of the vital information the hospital will need upon your parent’s arrival in the ER, including but not limited to:

• Advance Health Care Directive.  This legal document appoints a person to make health care decisions for the patient as well as instructions for future health care.
• Power of Attorney for Health Care.  Depending on your state of residence, this may be a separate legal document or it may be incorporated into the Advance Health Care Directive (above). 
• Durable Power of Attorney.  This legal document may or may not be requested, but it deals with the patient appointing an Attorney-in-Fact regarding financial matters in general.  Again, each state could have different documents, so please check with your attorney in advance as to what your state requires.  The hospital may not need all of these, but it is better to have them handy then to have to go home, find them, copy them and then bring them back.
• List of Medicines, Vitamins and/or Supplements.  The exact name and dosage of each as well as when they were last taken by your parent. 
• Copy of Medicare Card, Secondary Insurance Card and any Pharmacy Plan.  It is good to have the pharmacy phone number handy for when your parent goes home, too, so the hospital can order in advance any prescriptions for medication that may need to be continued at home.
• Medical History.  Including major illnesses, surgeries, current medications being taken and any recent medical conditions.  Writing this down in advance is very helpful and then easy to add to and keep current.  Create the record with your parent so that you can get the dates as accurately as possible.
• Current doctors’ names, addresses and phone numbers.

I also recommend you include some comfort items for yourself.  Waiting in Emergency Rooms can be much longer than expected.  I’ve found it helpful to have on hand:

• Snacks and/or Beverages.  You may not be able to  get to the hospital cafeteria, or the cafeteria could be closed.   (Do not give any food or beverages to your parent unless the hospital staff gives their OK.)
• Sweater or jacket.  Hospitals and ER’s are generally cold.  You may also want to bring a warm jacket or sweater for your parent.  Seniors in general feel colder than the average person, so if you’re feeling cold, they probably are as well. 
• Something to do while waiting.  This is both for you and your parent.  For example, a newspaper, magazines, books, or crossword puzzles you can do together.  The patient might not feel good enough to do anything, but it is nice to have a few things handy just in case.
• Cell phone.  So you can call relatives and/or friends to keep them updated.  Or you may need to call a doctor’s office to let them know your parent is in the ER.

Have you had to take your aging parent/Golden Oldie to the ER?  Is there anything else you can suggest I add to my Aging Parents Emergency Kit?  I’m all ears!

Warmly,

Linda