Tag: Community Foundation

How should you prepare for an in-person appointment in this time of Covid?

If you are living with one or more chronic medical conditions, it may seem you are constantly seeking the help of a medical professional.  The pandemic of COVID-19 has many people concerned about leaving their home and going to a health care facility and many offices have been encouraging virtual medical appointments.  These are helpful but often not as comprehensive as an in-person appointment.

If your doctor recommends an in-person appointment, know that healthcare facilities, such as hospitals, doctors’ offices, surgery centers and all sites of care are taking precautions to ensure your care is safe and that you are protected. Therefore, you should not postpone necessary care or preventative care such as physical exams, immunizations or cancer screening. Do not hesitate to reach out to your provider if you have any questions about when to seek treatment.

When you make an appointment to be seen in the office, check the visitor policy before you go. Because of the pandemic, some offices are limiting who can come inside.  Let the office know if you need special assistance of any kind!

If caregivers are NOT able to be in the room during the appointment, ask if you canjoin the appointment via phone call on “speaker” or videocall (such as Facetime).  This can be extremely helpful especially if there are any medication changes, procedures scheduled, or important questions needing answering.

These are some tips to prepare for the appointment of the person you are caring for:

• Arrive on time and make sure the person you are caring for has their insurance cards and ID. 
• Bring a current list of medications — names, dosages and frequencies, as well as any refills needed.
• Bring the person’s symptom history that includes where they are hurting or having problems, when their symptoms started (with dates), how long they last, what makes them better, and what makes them worse. 
• Bring a list of any changes in their routine such diet, exercise or activity, sleeping patterns.
• Bring their daily monitoring log if you use one (blood pressure/heart rate log, diet log, activity log, blood sugar log).
• Have written list of questions so that you don’t forget a key issue and you can take notes of the answers provided.
• During the appointment, don’t withhold information.  Their physician cannot help if you do not honestly give the whole story of what’s going on.
• Get clarification of anything you don’t understand.
• Write down the physician’s answers and directions. Make sure you can hear and understand what the physician is saying.
• If there is a new test, medication or treatment planned, be sure you understand the risks and benefits.
• Ask for patient education materials if available to read when you get home.

Remember medical providers want to help you to the best of their abilities.  But YOU are your family member’s best advocate and are an important partner in getting the best care possible for them.

You can find more resources on Parkinson’s Disease by visiting Nevada Caregiver’s Chronic Conditions and Diseases resources.

By Mindy Lokshin

Looking for fun ideas to do this holiday season with the person you are caring for? Read on to learn more fun ideas from Deanna Hearn.

Deanna Hearn, President of the Nevada Caregivers Coalition and former family caregiver, shares how she made the holidays a fun time for her mom. She said the biggest thing she kept in mind was to make sure her mom did not feel excluded during the holidays.

Here are a few things you can do with the person you are caring during this holiday season!

1. Christmas Lights

One of the things that Deanna’s mom enjoyed during the holidays was seeing the Christmas lights. They would go out and make an evening of it! Go for a drive and make your rounds in your neighborhood to see festive lights and decorations!

2. Baking

Deanna likes to bake during the holidays. She would invite her mom to bake Christmas bread with her. Her mom loved to help with making any kind of preparations, so this is one of the tasks her mom participated in. If you like to bake or make a special treat for the holidays, ask them to help you to prep! A simple task can be something they enjoy and appreciate being a part of.

3. Meal Planning

As with any big festivities go, meal planning is definitely a necessity for the holidays. Deanna suggests to also include the person you are caring for in meal planning. If there are things they can help with, ask them if they are up to the task, even if it is something as simple as setting the table.

4. Decorating

One of the most fun things about the holidays is decorating to make your home look festive! Ask the person you are caring for to help you decorate the tree and your home!

5. Holiday Party

Every year, Deanna throws a holiday party at her home. “Mom was a big help! She helped with the food prep and decorations. The best part was that she also felt like a guest at the holiday party – interacting with everyone. I could tell she enjoyed herself.”

6. Picking out a Christmas Tree

Do you and the person you are caring for prefer a real Christmas tree? If so, this can be another fun activity for you both to do. It is also a great opportunity to spend time with the person you are caring for.

7. Shopping for Gifts

Shopping for gifts is also something that you can do as a fun holiday activity with the person you are caring for. If they are comfortable, take them with you to go shopping! If the person you are caring for is usually at home, this would be an opportunity for them to get out, get some fresh air, and see holiday decorations outside!

8. Celebrating the end of Hannukah

In honor of the end of Hannukah, there are plenty of fun activities you can do to celebrate. The most classic game being, spinning the dreidel. There are also other activities you can do, like making a cupcake menorah, or a Star of David sculptures out of popsicle sticks.

9. Dance!

In honor of Kwanzaa, it is tradition to dance! Ask the person you are caring for to join you! If your family member is not up to it, you can ask them to drum, instead.

10. Invite a fellow caregiver and their loved one to spend a holiday together.
Plan an activity and include a meal/potluck.

For any questions on caregiving resources, call the Community Foundation at 775-333-5499.

Special thanks:
Deanna Hearn

Interview conducted by:
Luiza Benisano

Falls are a major threat to the health and independence of older adults. Each year, one in three older adults aged 65 and older experiences a fall, and people who fall once are two to three times more likely to fall again. Every second of every day, an older adult (age 65+) falls in the U.S. Falls can be devastating, I know firsthand. Several years ago, my sister at age 50 fell down her stairs and died. Then, last year I fell, which resulted in brain surgery, a 5 week stay in rehab, and about a year to fully recover. Falls are the leading cause of nonfatal injuries among older adults. One out of ten falls causes a serious injury, such as a hip fracture or head injury, which requires hospitalization. Due to falls, every 11 seconds an older adult is treated in the emergency room; and, every 19 minutes an older adult dies. In addition to the physical and emotional pain, many people need to spend at least a year recovering in a long-term care facility. Some are never able to live independently again. I was lucky and have been able to recover.

Falls can be deadly. Among older adults, falls are also the leading cause of fatal injuries. Each year, many older adults die as a result of falls. The rate of falls and related deaths among older adults in the United States has been rising steadily over the past decade. Falls result in more than 3 million injuries treated in emergency departments annually, including over 800,000 hospitalizations and more than 32,000 deaths. Each year about $50 billion is spent on medical costs related to non-fatal fall injuries and $754 million is spent related to fatal falls.

Falls are preventable. People are living longer and falls will increase unless we make a serious  commitment to providing effective fall prevention programs. Falls are not an inevitable consequence of aging. However, falls do occur more often among older adults because fall risk factors increase with age. A fall risk factor is something that increases a person’s chances of falling. This may be a biological characteristic, a behavior, or an aspect of the environment. These risk factors include: Muscle weakness or balance problems; Medication side effects and/or interactions; Chronic health conditions such as arthritis and stroke; Vision changes and vision loss; Loss of sensation in feet; Behavioral risk factors; Inactivity; Risky behaviors such as standing on a chair in place of a step stool; Alcohol use; Environmental risk factors; Clutter and tripping hazards; Poor lighting; Lack of stair railings; Lack of grab bars inside and outside the tub or shower; Poorly designed public spaces.

Usually two or more risk factors interact to cause a fall (such as poor balance and low vision). The more risk factors a person has, the greater their chances of falling. These shocking statistics highlight the importance of preventing falls by taking deliberate precautions. Age related losses in muscle strength, flexibility, or balance reactions can be addressed through balance, strength assessments, or rehabilitation therapy.

Some issues associated with falls:

• When an older adult falls, their hospital stays are almost twice longer than those of elder patients who are admitted for any other reason.
• The risk of falling increases with age and is greater for women than men.
• Annually, falls are reported by one-third of all people over the age of 65.
• Two-thirds of those who fall will do so again within six months.
• Alcohol or substance use;
• Socioeconomic factors including poverty, overcrowded housing;
• Among people aged 65 to 69, one out of every 200 falls results in a hip fracture. That number increases to one out of every 10 for those aged 85 and older.
• One-fourth of seniors who fracture a hip from a fall will die within six months of the injury.
• The most profound effect of falling is the loss of functioning associated with independent living. A growing number of older adults’ fear falling and, as a result, limit their activities and social engagements. This can result in further physical decline, depression, social isolation, and feelings of helplessness. 

Areas that we need to pay attention to:

Low vision: Many elders have vision problems like macular degeneration and glaucoma, making it hard for them to see obstacles or hazards when walking.

Weakness and Balance Issues: Without consistent efforts to improve strength and balance, older adults will become weaker, losing muscle mass, flexibility, and endurance. Balance deteriorates due to inactivity, which may increase the odds of a fall. 

Poor Lighting and Accessibility Features: Nighttime is a prime time for falls. Low lighting along the pathway to the bathroom, in particular, can increase risk. Missing bathroom accessibility features like a shower chair or grab bars make it difficult for a weaker person to bathe or use the bathroom safely. Adding adequate lighting to the bathroom and throughout the home is a cost efficient and easy update that will greatly improve the safety of the home.

Medication Problems: You probably think we can manage medications appropriately, just follow the prescription directions. Medication mismanagement is a huge problem leading to multiple issues for older adults.  Approximately 30 percent of hospital admissions are drug-related due to mismanagement and interactions. Here are some of the common medication issues that contribute to falls:

• Even with proper medication management, many medications cause dizziness and lightheadedness. 
• Mixing several different medications can cause balance problems. More than half of people age 65 and over report taking four or more drugs.
• Most importantly, consult a “geriatric trained pharmacist” for drug interactions with other medications and over the counter meds.

Poor Hearing: This may not seem like a fall risk, but even mild hearing loss can increase falls. According to the American Speech and Language Association, the risk of a fall increases by 140 percent for every 1 decibel of hearing loss.

Doctor visit: Request a medication review (perhaps eliminating some medications is possible) and a hearing and eye examination. Check for dehydration, a common problem for elders. Dehydration can lead to low blood pressure and dizziness. 

‍Exercise: Gradual increase of activity is critical. The safest way to approach this idea is to ask for a physical therapy evaluation. A physical therapist can “start low and go slow” by evaluating your medical condition and making recommendations to increase balance, strength, and endurance. A healthier, stronger person is less likely to fall, and recovery will be faster if they do.

‍Grab Bars and Accessibility Additions: Waiting for a fall or some other crisis will leave you scrambling at the last minute, so be pro-active and have a physical therapist work with you to make your home safe.  At a minimum, think about installing grab bars in the bathroom, a toilet riser, stair rails, and a shower chair with a handheld shower nozzle. There are now plenty of beautifully designed grab bars and accessibility products that will blend right in while providing safety.

And lastly, stairs are hazardous, and many older homes are multi-level, requiring some significant renovations to eliminate the use of stairs. While this may be a larger change, it may be well worth it. At least, always have a hand free walking up and down stairs in case you need to grab on to the railing. 

‍Eliminate Clutter:  We are very attached to our home environments and we may not even realize that we have clutter. Start by making small, achievable steps. Get rid of throw rugs or make sure they have non-skid backing or a non-skid underlayment and that they don’t have edges that curl. Clear pathways to common areas like the kitchen and bathroom. Clutter is likely to return, so this needs to be made an ongoing effort. 

There are four essential components of a complete Fall Prevention program:

• Education;
• Behavior change;

• An initial exercise intervention designed to improve to a certain baseline level those physical attributes that affect fall risk (balance, gait, strength and flexibility); and
• An ongoing exercise program that you take part in indefinitely, and which is designed to maintain and improve the physical attributes that relate to falls.

There is no question that we all have to be aware of the impact that falling has on all of our lives and the community. Each one of us, as well as community organizations and government programs have to open our eyes and work on fall prevention. Prevention pays off in many ways.

Falls are preventable. Click here for more resources on Home Modifications and Medical Equipment.

For more information on other resources, please call the Community Foundation at 775-333-5499.

By

Lawrence J. Weiss, Ph.D.

End of life is inevitable. We all die, whether it is expected or not. When we prepare for our own death in advance, we are able to relieve the decision-making burden on those whom we love and create the opportunity for end of life and death that maintains self-control. If you are reading these words, the day will come when you will die, perhaps “pass on” depending on your spiritual beliefs, but let us use the word death, because that is what it is. Usually death comes expectedly, at the end of a long, well-lived life or at the end of a terminal illness. But, on occasion, death arrives without warning. Accidents, sudden illness, even becoming the victim of a crime can cause you to die without notice, without time to plan. Therefore, do not be caught unprepared. Your take home message here is to plan your death!

How do we plan for end of life and death? First, give someone close to you the durable power of attorney to manage your affairs if you become sick and unable to do for yourself. Who is going to pay your bills, deposit your checks and manage your financial affairs? Second, write a will and communicate this information to those involved, including family and friends. Third, write an advanced-care directive or living will, and give someone medical power of attorney to carry out your wishes about medical treatment at the end of your life if you cannot. Finally, ease the trauma of your death for survivors by preplanning your funeral or service. My mother spelled out exactly what, who, and where she wanted her service, down to the hymns to sing. It made it so easy for us children. In summary, plan!

Experts explain the steps you should take to make sure your family knows your wishes on everything from funeral plans to end-of-life care. The important thing is to start planning sooner rather than later. Only one-third of us have plans like our advance directives and only one-third of those are used. Why? We do not talk about “death” and our end of life wishes. We may fill out the legal form but we file it away somewhere. So, not only do we need to do our own planning through Advance Directives, Durable Power of Attorney, Living Will, POLST (Physician Order of Life Sustaining Treatment), and Five Wishes, but we have to discuss it with our family and friends.

We especially need to discuss your wishes and desired medical treatment at end of life; since we may not be able to make our own decisions. Physicians, EMTs, and other acute care health professionals are trained to provide all means of life sustaining treatment regardless of the outcome. In addition, I have seen many fights and disagreements among family about what Mom or Dad needs for medical care because their parents had never had the discussion with the family about what their wishes were for end of life care. In short, we need to fill out the legal forms and discuss them fully with our loved ones.

There are many benefits to having a discussion about end of life and death. Awareness of your personal choices regarding end of life arrangements gives you and your loved ones a better perspective. By taking the time to discuss your wishes in advance, your loved ones will not need to make difficult choices for you in a time of crisis, when emotions cloud our decision-making abilities. Having the talk with your loved ones can also save you money if you choose to not receive major medical care. Additionally, many families find that sharing their wishes with their loved ones actually strengthens their relationships and brings peace of mind. Something we all strive for.

Recently, the federal Medicare program instituted funding for physicians to receive reimbursement for providing information and discussion about Advanced Directives; which is really a good move. Unfortunately, it only covers information and a discussion. It does not actually include help in filling out the legal documents. They could provide the POLST if the person was close to death, but all other Medicare recipients need to do the planning and develop the legal documents. A website “theROYL.com” (ROYL = Rest Of Your Life), which I helped create, provides information about what legal forms are needed and what needs to be discussed. Clearly, our professional educational institutions need to incorporate better education and techniques for the communication and creation of the documents for the Advance Directives. In addition, since people turn to their friends and family before professionals, public education has to be addressed.

In a survey on end of life that I crafted several years ago, we found that Nevadans have taken some significant steps toward improving care at end of life.  This statewide survey indicated that the Nevada’s public perception and practice of advance planning, as well as palliative care and pain management, are above some national averages.  These measures still have a long way to go to fulfill the many issues facing us at end of life.  One-third of Nevadans have advance directives, higher than the national average, but clearly more need to have their wishes known and enforced.  Pain management and palliative care were generally well handled by our health care professionals, but one-fourth still needed significant intervention to have a good death.  People perceived hospice care much better than traditional health care for pain management, concerns about the illness, and symptom management.  Our public policy makers and health care professionals need to pay attention to these public perceptions and experiences of end of life care.  By doing so, perhaps we all can benefit by improving the quality of life, even at the end which will “add life to years”.

For more tips on planning for end of life, please visit washoecaregivers.org.

By
Dr. Larry Weiss
Center for Healthy Aging

When do friends become too much? Following yesterday’s blog, “Authentic Independence,” I mentioned being cautious of certain individuals. 

Though they may be friends, be aware and beware of individuals who suck you dry emotionally.  Take inventory of who you are around and what they are doing to you, as well as what they are doing to your time.  Their presence in your life may very well be fine, I’m just saying to take a look.  They can help or hinder our energy that helps us take care of our own daily chores (in addition to caring for your loved one with dementia).  

If you are left drained, either think about limiting your time with them, or letting them go altogether. Is this a tough thing to do? Of course. Absolutely. But our time is too precious to be robbed on any level. Iyanla VanZant said it well, “We meet people where they are, and sometimes we have to leave them there.” 

Secondly, if you have trusted friends who give their support and offer their help, accept it.  Early on in my caregiving days/daze, I made the mistake of allowing the past to dictate my present. I didn’t have help navigating my husband’s alcoholism, therefore my current thought process with Alzheimer’s was, ‘Why in the hell would I have help with this?’  And to a degree, it was true, I didn’t have help, so I continued to do everything myself. I didn’t reach out, even when I was taking classes on dementia and included myself in support group.  

In a way, I was setting myself on fire to either save face, or not bother anyone, or I assumed they wouldn’t, or couldn’t, help. It absolutely was not the right thing to do because caregiving did almost kill me. The silver lining in finally asking and accepting help was that it allowed me to know how it feels to have someone truly stand by my side while I save myself and being able to do the same for others. 

If you find yourself in a friendship or relationship that is out of balance (excluding dementia and their inability to take care of themselves), be discerning about what it is costing you to be around them emotionally and spiritually, as well as what it’s costing you with your time.  If we stand by their side and help them on their “path,” and they take (in) your advice and support so they may save themselves, just be aware some will take and take and take, then do nothing to help themselves. Our path is just as important as anyone else’s, and it is up to us to have boundaries and self-respect to protect it.  It is a commodity we will never get back. 

WHAT IS TRUE FOR ME: I have let many people go in order to grow or do the things I have to do. “Caregiving” made that abundantly clear.  Of course there are people we have no choice in being around; co-workers, bosses, family members, etc.  I can be civil and kind, but I keep them at arm’s length. The people who hinder or who have sucked me dry emotionally, are gone – out of my life.  Funny thing is, not only does the Universe support me every time I have had to make this decision, these people seem to go on just fine without me. 

By

Vic Railton