Stan Cohen – Senior Wellness

Archive for November 2009

Sonya Mittelman, founder and principal attorney
The Law Office of Sonya Mittelman

Tips for the Caregivers

As we all age, we are facing the inevitable.   Many of you are probably dealing with caring for your parent or other loved one. . As one who   has recently experienced this, I can offer some advice.  Here are my nuggets; Read the rest of this entry »

Article authored by

Sheri Samotin
Life Bridge Solutions

While no two family situations are the same, there are several common scenarios that baby boomers face as their parents come to the point where it is no longer possible for them to live in their own home without assistance. The first is to have the parent move in with one of his or her children or another relative. The second is for a caregiver (family or paid) to provide in-home assistance. And the third is for the parent to move to another living situation entirely. We will focus on the third scenario.

Let’s assume that someone has decided that it is time for your parent to move to a retirement community. Sometimes, your parent will come to this conclusion on his or her own. That is probably the best case scenario, and also the less frequent one. More often, the adult children have reached the decision, but their parent doesn’t see things quite the same way. Under each of these situations, what are the steps that you need to take to make that move happen?

Perhaps the most difficult aspect of helping your aging parent transition to retirement living when they don’t see the need to do so is overcoming your own guilt. It is natural for you to ask yourself if you are doing the right thing, but if you are convinced that you are, then the most important action is to ACT! The longer your parent stays in his or her current living situation, the more likely it is that a crisis such as a fall will occur, making the move ever more urgent. It is always better to transition calmly than to do so in crisis mode. So, what can you do to help your parent accept the decision that you have made?

One of the best ways to help your parent to see the benefits of a move is to allow them to see what they are moving to. Many communities will allow short stays for prospective residents (and others). If your chosen community allows this, it can be a great way to introduce your parent to the new environment, while still letting them “come home again” before making the move permanent. A week or so is a good length of time for a short stay. Perhaps you can do this if you will be away for a vacation of your own or have a business trip planned. I’ve actually heard of aging parents who decide not to return to their former residence once they’ve tried out their new community!

Another possibility is to engage your parent in the process of choosing what furniture, household items, and personal treasures to take to their new home. One of the hardest things for your parent is parting with all of those things he or she has accumulated over a lifetime, and moving to a retirement community usually means downsizing and parting with some of those things. Perhaps there is a favorite chair or dresser that will make the new space feel more like home and help your Mom or Dad get over having to get rid of the rest. Maybe some special window treatments or new bedding can be made for the new space that will make it feel fresh. Hanging favorite photos or art on the walls and making sure the place is all set up for your parent will help to make the whole move less overwhelming. If you are good at imagining an empty room as a home and have the time and energy to set up the new space, then by all means you should take this project on yourself. If not, you might consider engaging a senior move manager who can coordinate the entire project.

Senior move managers specialize in helping people downsize their homes and transition to retirement living. A senior move manager provides services ranging from coordinating the move itself (selecting, negotiating, and supervising the packing and moving staff) to helping decide what to take to the new home and where to put it once it’s there. In addition, many senior move managers will unpack and set up your parent’s new home and help address the items that are not moving along with them through sale, auction, consignment, or donation, as appropriate. The National Association of Senior Move Managers ( http://www.nasmm.org ) provides more detailed information about these professionals including where to find one. For more information about LifeBridge Solutions’ household transition services, check out www.LifeBridgeSolutions.com/Household-Transitions.

I have been following a post on one of my Linkedin groups and felt I needed to repost this excellent reply on the topic from Angil Tarach, director of the Visiting Angels:

Good Morning Lynn,

What caught my attention in your email was Morphine was used in your “mom’s last days”.  I am thinking your mom was on hospice?

Although we all know there is definite over use of drugs on the elderly it’s important to understand when drugs are appropriate or not.  As a nurse with over 30 years in senior care, and as a previous hospice nurse, there is a definite difference in what drugs may be given to a dying patient that wouldn’t be frequently given to a person that isn’t in the process of dying.  Not to say there is never a reason to give an elderly person who is not dying, those same drugs.

Morphine, Ativan and a few others are commonly used in hospice care for the comfort of the patient.  Morphine is not only used for pain, but is also used to relax respirations when someone is having difficulty breathing.  There can be a lot of anxiety in the dying process that Ativan helps tremendously.  Families of hospice patients worry about the drugs used, and are very concerned when their loved one sleeps a lot, especially when first placed on those drugs.  Many times the dying patient has been very uncomfortable, and has lacked appropriate rest and sleep, because of the discomfort.  Initially it may be the first time in awhile they are comfortable so they sleep a lot, because they can.  Most will resume more awake time as they get adequate rest, sleep, and comfort.  I have also heard from a lot of hospice patients and their families that they are worried about addiction.  This should never be a concern.  Generally patients who actually need pain management don’t get addicted, and when it’s at the end of life, I say, so what?

Although we all need to advocate for less use of drugs like antipsychotics on the elderly, there are some patients that benefit greatly from those drugs.  I just don’t want to see us push and advocate so hard on less drug use that it gets to the point where patients needing those drugs are not getting them, and suffering.  It can be easy to assume that anyone we see on these type of drugs shouldn’t be and are being overmedicated, when there are appropriate uses.  There is a lot of depression in the elderly, which actually may be undiagnosed.  The question is whether the depression is situational or of an organic brain disorder.  Two very separate issues.  Who wouldn’t be depressed sitting day after day in a nursing home with little activity and meaningful attention?  This has nothing to do with a chemical imbalance.  Situational depression needs to be addressed environmentally.  Brain disorders need to be addressed chemically.  You cannot fix situational depression with a drug, just as you can’t fix a chemical imbalance with therapy or environmental change.

I guess the best is to educate the elderly, and their families to find a geriatric specialist that is very conservative when ordering meds.  Pressure needs to be put on nursing home docs that find it easy to just prescribe before they look into the possible causes of behavior problems and depression.  I believe a lot of those issues can be resolved by how nursing home residents are worked with and treated.  There needs to be much more training for the staff of long term care facilities, and use of techniques that are effective.  Judy’s ranch is a perfect example.  They get to the root of the behavior and use effective techniques to reduce, and/or eliminate the behavior.  I think Judy’s techniques ought to be used in every long term care facility.  If they were, there would be a huge decrease in drug use.

There is a lot of financial benefit in drug use.  There needs to be advocacy against gifts and “perks” to doctors and hospitals from drug companies.  When I worked for the State of Michigan as an Infection control Coordinator I was in a state psychiatric hospital.  The numbers of drug reps that came in on a daily basis offering lunches, gifts, etc, was ridiculous!  Easily there were no less than 6 drug reps a day visiting.  These people are biased and push the advantages of the drug with little attention to appropriate use, and side effects.  Doctors get on a band wagon about a new drug and you see it being prescribed left and right, until a new and supposedly better drug is pushed enough.  I don’t know about any specific cases of docs being paid for prescribing a specific drug or from a specific drug company, but I will bet it happens more than anyone can imagine.

We need to put pressure on state surveyors.  There are regulations about chemical restraints, which I am sure differ by the state.  First, and I have always thought this is crazy, facilities are aware of when the surveyors come to visit.  Every facility I have ever worked in goes crazy trying to clean things up right before and the day the surveyors arrive.  I always said, if they did it right all the time, they wouldn’t have to worry and go crazy trying to get things right.  When they visit, they randomly choose charts and patients to survey.  Many times they ask the administration to pick out the charts.  So, of course the administration will pick out the patients and charts they are not worried about getting reviewed, and the surveyors don’t see the total picture of what is going on there.  Each year they seem to choose one issue they will focus on.  One year it may be falls, another it may be bed sores, etc.  If they looked at psychotropic drugs one year, it may be years before that issue is again on the radar.

As you can see there are many areas that need pressure and tightening up before we could see a decrease in the amount and type of drugs ordered for our vulnerable elderly.  It’s almost like there needs to be several groups, each focusing on pressuring a different group of people at the same time for anything to change.

I hope I have helped some of you with what I have shared here.  I hope it gives a clearer understanding of drug use, and the problems that contribute to overuse.

Have a beautiful Sunday!

Angil Tarach RN
Director
Visiting Angels

2860 Carpenter RD. Suite 300
Ann Arbor, MI 48108
Ph. (734) 929-9201
Fax. (734) 929-9202


Visit www.maturitymatters.net

We have created MaturityMatters.net to help Seniors and their families live joyful and independent lifestyles.

Visit our Facebook page

Home Study Tai Chi and Qigong

We have found the most effective home study course on the market. Check out the program.

Guide to Assisted Living

Check out Ryan Malone's Book The By Families, For Families Guide to Assisted Living: A Step-by-Step Guide to Evaluating and Transitioning to an Assisted Living Community
Blog Directory for New Jersey
Performancing Metrics