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Immunization and the Elderly

Immunization and the Elderly

As National Immunization Month comes to a close, it is important to remember that seniors need to make sure they are keeping up on what immunizations they should have to protect themselves. A weak immune system can lead to serious health problems. All adults should get vaccines to protect their health. Even healthy adults can become seriously ill, and can pasFacebooks certain illnesses on to others. Immunization is especially important for older adults and for adults with chronic conditions such as asthma, Chronic Obstructive Pulmonary Disease (COPD), diabetes or heart disease. Immunization is also important for anyone who is in close contact with the very young, the very old, people with weakened immune systems, and those who cannot be vaccinated.

• All adults should get the influenza (flu) vaccine each year to protect against seasonal flu. Every adult should also get the Td or Tdap vaccine once if they did not receive it as an adolescent to protect against pertussis (whooping cough), and then a Td (tetanus, diphtheria) booster shot every 10 years. 
• If you are age 60 or older: Get a shot to prevent shingles. Shingles causes a rash and can lead to pain that lasts for months. Learn about the shingles vaccine.
• If you are age 65 or older: Get shots to prevent pneumococcal (“noo-muh-KOK-uhl”) disease. Pneumococcal disease can include pneumonia (“noo-MOHN-yah”), meningitis, and blood infections. Learn about pneumococcal shots.
• The need for vaccination does not end in childhood. Vaccines are recommended throughout our lives based on age, lifestyle, and occupation, locations of travel, medical conditions and vaccines received in the past. Some vaccines can help prevent cancer. Hepatitis B vaccine can prevent liver cancer that can develop after developing chronic hepatitis B. The HPV vaccine can prevent cancers caused by HPV infection, including cervical, vaginal, vulvar and anal cancer.
• Vaccination is important because it not only protects the person receiving the vaccine, but also helps prevent the spread of diseases to others –especially those who are most vulnerable to serious complications, such as infants and young children, the elderly, and those with chronic conditions and weakened immune systems. The single best way to prevent the flu is to get a flu vaccine each season. A yearly flu vaccine is recommended for everyone age 6 months and older.
•  While everyone should get vaccinated, certain people are at greater risk for serious complications if they get the flu, including: people 65 years and older, young children, pregnant women, people with certain health conditions such as asthma, Chronic Obstructive Pulmonary Disease (COPD), diabetes or heart disease, and people living in facilities like nursing homes.
• Annual flu vaccination is also important for anyone who lives with or cares for people at high risk for developing flu-related complications.

Make sure you and your loved ones are current on all important vaccines and immunizations. It will help everyone stay happy and healthy!

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UTI and Seniors

For an adult aged twenty to sixty, a UTI (Urinary Tract Infection) can be a painful, uncomfortable experience, but with proper medication and treatment  it will be gone within a few days. For a senior, it is a very different experience; an elderly UTI rarely causes such clear symptoms and might not involve pain or discomfort at all. “As you get older your immune response changes; it’s part of normal aging,” says Anna Treinkman, a nurse practitioner at the Rush Alzheimer’s Disease Center in Chicago and president of the National Conference of Gerontological Nurse Practitioners. 

The population most likely to experience UTIs is the elderly. Elderly people are more vulnerable to UTIs for many reasons, not the least of which is their overall susceptibility to all infections due to the suppressed immune system that comes with age and certain age-related conditions. According to the National Institutes of Health (NIH).

Younger people tend to empty the bladder completely upon urination, which helps to keep bacteria from accumulating within the bladder. But elderly men and women experience a weakening of the muscles of the bladder, which leads to more urine being retained in the bladder, poor bladder emptying and incontinence, which can lead to UTIs.

Symptoms of UTIs

The typical signs and symptoms of a UTI include:

• Urine that appears cloudy
• Bloody urine
• Strong or foul-smelling urine odor
• Frequent or urgent need to urinate
• Pain or burning with urination
• Pressure in the lower pelvis
• Low-grade fever
• Night sweats, shaking, or chills

Elderly people with serious urinary tract infection don’t exhibit the hallmark sign of fever because their immune system is unable to mount a response to infection due to the effects of aging. In fact, elders often don’t exhibit any of the common symptoms – or don’t express them to their caregivers.

UTIs in the elderly are often mistaken as the early stages of dementia or Alzheimer’s, according to NIH, because symptoms include:

Confusion, or delirium-like state

Agitation

Hallucinations

Other behavioral changes

Poor motor skills or dizziness

Falling

Sometimes, these are the only symptoms of a UTI that show up in the elderly—no pain, no fever, no other typical symptoms of a UTI.

According to NIH, the following conditions make the elderly more susceptible to UTIs:

Diabetes

Urinary retention (unable to empty the bladder, even if your loved one has just used the bathroom)

Use of a urinary catheter

Bowel incontinence

Enlarged prostate

Immobility (for example, those who must lie in bed for extended periods of time)

Surgery of any area around the bladder

Kidney stones

How to Reduce Risk of UTIs

People with incontinence are more at risk for UTIs because of the close contact that adult briefs have with their skin, which can reintroduce bacteria into the bladder. Some recommendations to help reduce this risk include the following:

Change the briefs frequently

Encourage front-to-back cleansing

Keep the genital area clean

Set reminders/timers for those who are memory-impaired to try to use the bathroom instead of the adult brief

Other ways to reduce the chance of UTIs:

Drink plenty of fluids (2 to 4 quarts each day).

Drink cranberry juice or use cranberry tablets, but NOT if your elder has personal or family history of kidney stones.

Avoid caffeine and alcohol, because these irritate the bladder

Do not douches or use other feminine hygiene products

Always wipe from front to back (for women)

Wear cotton-cloth underwear, and change them least once a day

There are great kits you can buy at the drug stores, such as, Walgreen’s, CVS, and RiteAid between $10 and $20 that will give you an accurate reading and if it does show positive, see your doctor right away.

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Cholesterol Awareness Month

September is National Cholesterol Awareness Month and it is important for everyone to be aware of what cholesterol is, how it works in your body, and what foods to avoid and what foods to eat to keep the bad cholesterol away and the good cholesterol here to stay!

Too much cholesterol in the blood is one of the main risk factors for heart disease and stroke and is the leading cause of death in the United States. One way to prevent these diseases is to detect cholesterol and treat it when it is found. And yet, most adults with high cholesterol don’t have their condition under control. Two out of 3 adults have high cholesterol—or high LDL “bad” cholesterol.

Cholesterol is a fatty chemical which is an important part of the outer lining (membrane) of cells in the body. Cholesterol is found mainly in foods that come from animals. LDL lipoprotein is the major carrier of cholesterol in the blood. LDL cholesterol is called “bad” cholesterol, because elevated LDL cholesterol is associated with an increased risk of coronary heart disease. LDL lipoprotein deposits cholesterol on the artery walls, causing the formation of a hard, thick substance called cholesterol plaque. Over time, cholesterol plaque causes thickening of the artery walls and narrowing of the arteries, a process called atherosclerosis.

Your blood cholesterol level is affected not only by what you eat but also by how quickly your body makes LDL (“bad”) cholesterol and disposes of it. In fact, your body makes all the cholesterol it needs, and it is not necessary to take in any additional cholesterol from the foods you eat.

 Only 25% of blood cholesterol is actually ingested as dietary cholesterol. The other 75% is produced in the liver and, once linked with carrier proteins known as lipoproteins, flows throughout the body in the bloodstream along with dietary cholesterol.

Many factors help determine whether your LDL-cholesterol level is high or low. The following factors are the most important:

• Heredity
• What you eat
• Weight
• Physical activity/exercise
• Age and sex
• Alcohol
• Stress

Before the age of menopause, women usually have total cholesterol levels that are lower than those of men the same age. As women and men get older, their blood cholesterol levels rise until about 60 to 65 years of age. After the age of about 50, women often have higher total cholesterol levels than men of the same age.

Screening is the key to detecting high cholesterol. High cholesterol does not have symptoms. As a result, many people do not know that their cholesterol is too high. Doctors can do a simple blood test to check patients’ levels.

The National Cholesterol Education Program (NCEP) recommends that adults aged 20 years or older have their cholesterol checked every 5 years.

Some of the above information has been provided with the kind permission of the National Institutes of Health (www.nih.gov)

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September is Healthy Aging Month and it is important no matter what your age that you are living a healthy lifestyle, and if you are not, TODAY is the day to start!

Here are 10 Tips for Reinventing Yourself during September Is Healthy Aging® Month:

1. Do not act your age or at least what you think your current age should act like. What was your best year so far? 28? 40? Now? Picture yourself at that age and be it. Some people may say this is denial, but we say it is positive thinking and goes a long way toward feeling better about you. (Tip:  Don’t keep looking in the mirror, just FEEL IT!)
2. Be positive in your conversations and your actions every day. When you catch yourself complaining, check yourself right there and change the conversation to something positive. (Tip: Stop watching the police reports on the local news.)
3. Ditch the downer friends. Have negative friends who complain all of the time and constantly talk about how awful everything is? Drop them. As cruel as that may sound, distance yourself from people who do not have a positive outlook on life. They will only depress you and stop you from moving forward. Surround yourself with energetic, happy, positive people of all ages and you will be happier too. (Tip: Smile often. It’s contagious and wards off naysayers.)
4. Walk like a vibrant, healthy person. Come on. You can probably do it. Analyze your gait. Do you walk slowly because you have just become lazy or, perhaps, have a fear of falling? (Tip: Make a conscious effort to take big strides, walk with your heel first, and wear comfortable shoes.)
5. Stand up straight! You can knock off the appearance of a few extra years with this trick your mother kept trying to tell you. Look at yourself in the mirror. Are you holding your stomach in, have your shoulders back, chin up? Check out how much better your neck looks! Fix your stance and practice it every day, all day until it is natural. You will look great and feel better. (Tip: Your waist­line will look trimmer if you follow this advice.)
6. How’s your smile? Research shows people who smile more often are happier. Your teeth are just as important to your good health as the rest of your body. Not only is it the first thing people notice, but good oral health is a gateway to your overall wellbeing. (Tip: Go to the dentist regularly and look into teeth whitening. Nothing says old more than yellowing teeth!)
7. Lonely? Stop brooding and complaining about having no friends or family. Do something about it now. Right this minute. Pick up the phone, landline, or cell and make a call to do one or more of the following: Volunteer your time, take a class, and invite someone to meet for lunch, brunch, dinner, or coffee. (Tip: Volunteer at the local public school to stay in touch with younger people and to keep current on trends, take a computer class or a tutorial session at your cell phone store to keep up with technology, choose a new person every week for your dining out.)
8. Start walking not only for your health but to see the neighbors. Have a dog? You’ll be amazed how the dog can be a conversation starter. (Tip: If you don’t have time for a dog, go to your local animal shelter and volunteer. You will be thrilled by the puppy love!)
9. Get a physical. Make this month the time to set up your annual physical and other health screenings. Go to the appointments and then, hopefully, you can stop worrying about ailments for a while. (Tip: For a list of recommended annual health screenings, a great resource is the My Health Finder.  http://healthfinder.gov/myhealthfinder/
10. Find your inner artist. Who says taking music lessons is for young school children? You may have an artist lurking inside you just waiting to be tapped.  Have you always wanted to play the piano, violin, or tuba? Have you ever wondered if you could paint a portrait or scenic in oil? What about working in wood? (Tip: Sign up now for fall art or music classes and discover your inner artist!)

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Alzheimer’s and Music

Melody vs. Malady: The Benefits of Music for Alzheimer’s Patients

In the world of Alzheimer’s research, a wide range of methods of treating the disease have been tested, ranging from the logical to the unorthodox. Falling somewhere in the middle of that spectrum is the activity of listening to music, which has recently been shown to benefit Alzheimer’s patients in a noticeable way. Read on to find out more about the connection between music and Alzheimer’s patients’ health!

Study Shows Music Can Boost Memory in Alzheimer’s Patients

A group of neuroscientists conducted a study with Alzheimer’s patients and dementia to see how they responded over several months to the introduction of music to their weekly routine. Their test group attended “music sessions” where they either listened to or sang along with childhood favorite tunes. The familiarity of the songs could be a key to the successes of the experiment that were documented; because singing along with them required recalling lyrics and tunes from years ago, it helped to stimulate the participants’ memories and thus their overall cognitive function.

The study showed specifically that singing along to music helped with thinking skills, but that is not all. In addition to benefitting the cognitive abilities of Alzheimer’s patients, music has also been linked to stress reduction and mood enhancement. It is a natural way to combat depression-like symptoms and is easily incorporated into a daily routine. You can listen to music while cooking dinner, reading, or as an activity in and of itself to bring a dose of memory-boosting enjoyment to your day!

When used appropriately, music can shift mood, manage stress-induced agitation, stimulate positive interactions, facilitate cognitive function, and coordinate motor movements.

This happens because rhythmic and other well-rehearsed responses require little to no cognitive or mental processing. They are influenced by the motor center of the brain that responds directly to auditory rhythmic cues. A person’s ability to engage in music, particularly rhythm playing and singing, remains intact late into the disease process because, again, these activities do not mandate cognitive functioning for success. Most people associate music with important events and a wide array of emotions. The connection can be so strong that hearing a tune long after the occurrence evokes a memory of it.

If the links with the music are unknown, it is difficult to predict an individual’s response. Therefore, observe a person’s reaction to a particular arrangement and discontinue it if it evokes distress, such as agitation, facial grimaces or increasing muscular tension.

 Selections from the individual’s young adult years—ages 18 to 25—are most likely to have the strongest responses and the most potential for engagement.

Unfamiliar music can also be beneficial because it carries no memories or emotions. This may be the best choice when developing new responses, such as physical relaxation designed to manage stress or enhance sleep.

As individuals progress into late-stage dementia, music from their childhood, such as folk songs, work well. Singing these songs in the language in which they were learned sparks the greatest involvement.

Non-verbal individuals in late dementia often become agitated out of frustration and sensory overload from the inability to process environmental stimuli. Engaging them in singing, rhythm playing, dancing, physical exercise, and other structured music activities can diffuse this behavior and redirect their attention.

For best outcomes, carefully observe an individual’s patterns in order to use music therapies just prior to the time of day when disruptive behaviors usually occur.

How-to of music therapy:

 Early stage—

  Go out dancing or dance in the house. 

  Listen to music that the person liked in the past—whether swing or Sinatra or salsa. Recognize that perceptual changes can alter the way individuals with dementia hear music. If they say it sounds horrible, turn it off; it may to them. 

  Experiment with various types of concerts and venues, giving consideration to endurance and temperament. 

  Encourage an individual who played an instrument to try it again. 

  Compile a musical history of favorite recordings, which can be used to help in reminiscence and memory recall.

Early and middle stages—

  Use song sheets or a karaoke player so the individual can sing along with old-time favorites.

Middle stage—

  Play music or sing as the individual is walking to improve balance or gait. 

  Use background music to enhance mood. 

  Opt for relaxing music—a familiar, non-rhythmic song—to reduce sundowning, or behavior problems at nighttime.

Late stage—

  Utilize the music collection of old favorites that you made earlier. 

  Do sing-alongs, with “When the Saints Go Marching In” or other tunes sung by rote in that person’s generation. 

  Play soothing music to provide a sense of comfort. 

  Exercise to music. 

  Do drumming or other rhythm-based activities.

  Use facial expressions to communicate feelings when involved in these activities.

The information above was provided from the Alzheimer’s Foundation of America. http://www.alzfdn.org

As Alzheimer’s treatments continue to develop, doctors will discover more about the unexpected benefits of listening to music and other activities for Alzheimer’s patients. More and more homes, assisted living facilities, and in-home care companies are using music therapy as part of their daily routine to help those suffering with Alzheimer’s remember their past. One of the tools they are using is an iPod, loaded with the client’s favorite songs so they can listen with headphones on, which helps the listening process as well because it helps to drown out the surrounding noises that can be distracting.

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Budgeting Basics for Seniors Looking to Save!

As we age and our priorities change, our budgets can become a bigger and bigger issue. You may be concerned about saving money to pay for medical bills, putting money into a college fund for your grandchildren, or even paying for trips and entertainment during your retirement. Regardless of what you want to save for, keeping these few budgeting basics in mind will help make managing your money easier. Read on to find out more!

Seniors Save Big with These Budgeting Tips

 Work out weekly expenses. An easy way to break down your average expenses is to see what you spend in a week on groceries, gas, and other expenses. You can even divide up your monthly bills per week to see how much you should be setting aside. Budgeting in small increments like this allows you to get a realistic picture of what an average week looks like for you.

Take advantage of discounted services. For seniors in some states, certain services are offered at a free or discounted rate. Cell phone plans, for instance, are often available to seniors for reduced rates- this could also eliminate your need for a landline and that additional expense.

See what you can do for free. When it comes to entertainment and activities, there are always opportunities for saving money. Instead of going out to a pricey movie, spend the afternoon at a local farmers market or at a church event. Participating in these types of activities can not only save you money, but also boost your spirits by getting you out in the community!

 Create accounts for children and grandchildren. If part of your money-saving plan is to put aside money for your children or grandchildren to pay for certain expenses, create those accounts so that their money is safe and can start to accumulate interest.

Ask for assistance! If budgeting is becoming too difficult for you to manage on your own, seek the advice of an accountant or even a family member with a good head for figures. They can help you create a plan that works best for your needs.

According to AARP.com here are some great tips to help downsize and help to save and even make a little money.

The Big House

Consider making this decision as soon the kids are gone rather than when you’re ready to retire. Even if your home is already paid for, there are still significant costs in owning more space than you really need, including taxes, utilities, insurance and repairs. Plus, it will force you to downsize other belongings, too. You’ll also have an excuse for why the kids can’t move back in with you later!

Clothes

If your wardrobe has outgrown your closet and dresser, start by purging enough pieces so that everything will fit. Get rid of unwanted clothing at yard sales or online, or by donating items to charity.

Anything in Off-Site Storage

According to the Self Storage Association, there are about 50,000 self-storage facilities in the U.S. That’s more than five times the number of Starbucks! Vow to eliminate storage fees by getting rid of enough stuff so that all your possessions fit in your own home.

Exercise Equipment

If the exercise bike or treadmill in your bedroom has morphed into a permanent clothes rack, donate it to a local thrift store or charity.

Kitchen Appliances and Gadgets

Ask yourself: “When was the last time I plugged that in?” If it’s been more than six months since you’ve used the waffle iron or bread maker, it’s probably time to find that appliance a new home. While you’re in the kitchen, eliminate unused culinary gadgets and nonmatching tableware.

Car

Besides downsizing your home and eliminating debt, getting rid of one — or all — of your vehicles could result in the greatest savings. According to AAA, it currently costs an average of $8,698 annually to own and operate a vehicle in the U.S. if you factor in all the costs, including depreciation. If you’re a two-car family, getting rid of one set of wheels might make sense once one or both partners are no longer working. You might be able to get by with public transportation or a car-share program, or at least downgrade to less-expensive vehicles. If you’re planning to relocate in retirement, there are communities where owning a car may not be necessary.

Childhood Memorabilia

If your kids or other family members don’t want keepsakes from their own childhood (or yours) now, they’re not going to want them when you’re gone. Hold on to a few precious, symbolic mementos — those that truly spark memories and joy — and digitize images of the other things.

Furniture

Filling — and too often, overfilling — a room with furniture is a common tendency. Doing so makes the room seem smaller and gives you more places to store and display more stuff. Start by eliminating a couple of pieces from a room and see how much more spacious it feels

Books, Magazines, DVDs

Unless a book has sentimental value or you’re going to read it again, put it back into circulation via a yard sale or thrift store so that others can enjoy it. Or donate it to your library, where you can always get free access to books, CDs and DVDs. You can store countless e-books (many are available for free) on an e-reader that’s smaller than a single print volume, and you can easily digitize your music and movie collections.

Decorations

While holiday decor has some sentimental value, consider getting rid of the decorations you haven’t used in the past five years, particularly bulkier items such as outdoor decorations and holiday tableware you use just once a year.

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Fall Prevention and Facts

According to the Centers for Disease Control (CDC) Each year, one in every three adults ages 65 or older falls and 2 million are treated in emergency departments for fall-related injuries. And the risk of falling increases with each decade of life. The long-term consequences of fall injuries, such as hip fractures and traumatic brain injuries (TBI), can impact the health and independence of older adults. Thankfully, falls are not an inevitable part of aging. In fact, many falls can be prevented. Everyone can take actions to protect the older adults they care about.

Prevention Tips

–              Get some exercise. Lack of exercise can lead to weak legs and this increases the chances of falling. Exercise programs such as Tai Chi can increase strength and improve balance, making falls much less likely.

–              Be mindful of medications. Some medicines—or combinations of medicines—can have side effects such as dizziness or drowsiness. This can make falling more likely. Having a doctor or pharmacist review all medications can help reduce the chance of risky side effects and drug interactions.

–              Get vision checked regularly, and keep glasses clean and scratch free. Poor vision can make it harder to get around safely.

–              Eliminate hazards at home. About half of all falls happen at home. A home safety check can help identify potential fall hazards that need to be removed or changed, such as tripping hazards, clutter, and poor lighting.

Home Safety Checklist

1. Remove things you can trip over (such as papers, books, clothes, and shoes) from stairs and places where you walk.
2. Install handrails and lights on all staircases.
3. Remove small throw rugs or use double-sided tape to keep the rugs from slipping.
4. Keep items you use often in cabinets you can reach easily without using a step stool.
5. Put grab bars inside and next to the tub or shower and next to your toilet.
6. Use non-slip mats in the bathtub and on shower floors.
7. Improve the lighting in your home. As you get older, you need brighter lights to see well. Hang lightweight curtains or shades to reduce glare.
8. Wear shoes both inside and outside the house. Avoid going barefoot or wearing slippers.

Facts About Falls:

• Fall injuries are among the 20 most expensive medical conditions.
• The average hospital cost for a fall injury is $35,000.
• The costs of treating fall injuries goes up with age.
• Medicare pays for about 78% of the costs of falls.
• One out of five falls causes a serious injury such as broken bones or a head injury.
• Each year, 2.5 million older people are treated in emergency departments for fall injuries
• Over 700,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.
• Each year at least 250,000 older people are hospitalized for hip fractures.
• More than 95% of hip fractures are caused by falling,6 usually by falling sideways.
• Falls are the most common cause of traumatic brain injuries (TBI).

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The Do’s and Don’ts of Discharge

The primary goal of discharge planning is to ensure a patient’s smooth transition from the hospital to her home or another facility. Patients must be humanely and appropriately discharged when they are medically ready to leave the hospital. Senior patients who are unable to care for themselves cannot be sent home, if proper care is not in place; medically incompetent adults cannot be brought to homeless shelters; and patients in need of vital medications or medical equipment should have them. The discharge planner (DP) must work with all parties involved in their patient’s care to make sure that she is cared for while also facilitating as expedient a discharge as possible to prevent a potential increase in hospital costs.

The Importance of Discharge Planning

Medicare mandates that all inpatient facilities that bill the program provide discharge planning services. The way discharge planning is performed and whose job it is varies in every state and community. Hospitals that employ qualified and experienced discharge planners may see the numerous benefits of their service, including:

–              Shorter length of patient stay

–              Fewer readmissions to the hospital

–              Improved patient outcomes

–              Higher reimbursement rates

–              Strong advocates who ensure that patients’ rights and choices are respected

–              Patients who are better connected to any needed resources or assistance

–              Improved connections between the hospital and relevant community services

–              The education of fellow staff members

–              Assistance with complicated and potentially problematic situation

It is a scary situation being sick and in the hospital. Most people do not know the steps or understand what your responsibility is, and what responsibility the hospital has regarding your discharge and follow up. Here is a discharge planning checklist for you to have in case you or a loved one ever find yourself/themselves in the hospital for an extended stay and will need some direction during discharge.

MEDICAL CASE MANAGEMENT DO’S AND DON’TS

 DO:

 –              Be inclusive of all parties involved in the medical recovery process, especially when working with the elderly and their family.

–              Include goals and timeframes when creating the care plan, and allow for updates as needed.

–              Determine if treatment is appropriate.

–              Determine if funding for case management services is secured before proceeding.

–              Determine what is needed for successful return home, or if home is no longer an option, offering alternative solutions.

–              Provide client advocacy and support at all times, and provide input and guidance on treatment services…

               BE A LIAISON BETWEEN PARTIES.

–              Use valid disability duration guidelines, and use them as GUIDELINES.

–              Always obtain and maintain appropriate releases of information prior to beginning case management services.

–             Understand that there are many players in the case management process, but that your main client should always be the patient you are helping.

–              Always identify clearly your role as a case manager to the patient at the start of the relationship.

 DO NOT:

 –              Give legal advice at any time.

–              Schedule IME appointments.

–              Change employee’s doctor appointments just to fit YOUR schedule.

–              Withhold information crucial to the success of the patients’ recovery.

–              Perpetuate disability by failing to address doctor recommendations and health concerns.

–              Become personally and/or emotionally attached to the client.

–              Assume that you have an absolute right to attend all doctors’ appointments despite client wishes against it.

–              Initiate cost services prior to obtaining carrier authorization.

–              Provide legal direction to the claims adjuster, or engage in claims investigative or adversarial activities.

By having the patient aware of their rights and expectations, and giving them a better understanding of the role of the case managers and discharge managers, leaving the hospital does not need to be a daunting and confusing experience.

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Choosing A Good Nursing Home

When making the decision to move a loved one into a nursing home there are many questions and it can become overwhelming! There are some basic questions you can ask and signs to look for to ensure your loved one will be in a safe, friendly, caring environment.

1. How does the food look and taste?

Dining with your parent in the nursing home cafeteria is a great way not only to bolster your parent’s spirits, but also to give you an idea of how well he or she is eating. It is hard to know if your parents are not eating because they have no appetite or if the food is no good unless you are eating it every so often.

2. What sounds do you hear?

Do you hear residents yelling or begging for care, or are there people laughing and enjoying themselves? There will be some residents who have dementia or Alzheimer’s that may act out, which is to be expected, but look for residents that seem cognitive but unhappy. Make sure the staff is addressing the residents by their names, “Good morning Ms. Mary” not “Hey there mamma, or pops”.

3.     What does is smell like?

Unfortunately, as we get older we do not have the control of our bodily functions as we did when we were younger, so walking into a nursing home you may get a whiff here or there of a foul odor, but it is nothing to cause alarm. However, if everywhere you go there is a foul odor, or strong smell of urine it could mean they do not properly clean their facility. 

 4.     Is the staff overworked?

 Talk to the nurses and orderlies; are there a lot of employees working double shifts or overtime? Do they mention they are always looking for staff? Does the staff look tired? Do you hear them complaining about too many residents per staff member?

 5.     How do the residents spend their afternoons?

 Are the residents in their rooms or are they participating in activities? Are they hanging around the nurses station, or sitting together having coffee? Does the nursing home offer entertainment, such as, bingo or old movies played in the rec room? Even the residents that are room bound, does the staff take them games and interact?

 6.     How does the staff interact with each other?

 You can tell a lot about how a facility is run by the interactions of the staff with other staff, and with the heads of departments and of the company. If there is visible tension or very little interaction this is not a good sign. A good sign is when you see people smile at one another and say please and thank you and address each other in kind and respectful tones, and when the boss is around people continue to do the job they were doing and not start acting like they are working.

 7.     Do you see bruising on the residents?

 As we age our skin is not as strong and the medications we take can cause easy bruising, but does the bruise look like a finger or hand? That is when you want to take a closer look. Also bruises on the stomach or back are not typical of a fall, so be skeptical about bruises in those areas.

 8.     How do they handle a slip and fall?

 Even under the best circumstances people sometimes fall, it is sometimes unavoidable. But, how the staff and the facility handle the fall is very important. Do they help the patient up? Do they notify the families immediately? Are they checking on the resident a few hours later to make sure there are no signs of an injury that were not present at the initial fall?

 9.     Are there unexplained bedsores?

 If the resident is bed bound it is easy to get bedsores if they are not properly turned and kept clean and dry, and even then sometimes the paper thin skin breaks apart. If there is a bedsore, is it being addressed and taken care of? If the resident is active and there is a bed sore there needs to be a conversation with the staff as to why the resident is not up and active.

 10.    Are personal care needs being met?

 The residents that are incontinent should be changed at a minimum every two hours. Does this facility have a maximum times number of diapers they will give a resident? If so, that is not a good sign, a person left in an unclean diaper can have skin breakdown and wounds.

 There are a lot of questions to ask and things to think about when placing your loved one in a Nursing Home. Make sure you take the time to look at each place and ask the hard questions to guarantee you find the best fit for your loved one.

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