Sunday, June 30, 2019
The Executive Suite: Why you need to integrate behavioral health into y...
The Executive Suite: Why you need to integrate behavioral health into y...: March 23, 2019, marked the ninth anniversary of The Patient Protection and Affordable Care Act (ACA) being signed into law. These past nine...
Thursday, June 27, 2019
The Executive Suite: How to discuss cognitive screenings with your Medi...
The Executive Suite: How to discuss cognitive screenings with your Medi...: Most clinical screening tests are designed to give providers a heads up on the potential development of a disease. While most patients readi...
Monday, June 24, 2019
The Executive Suite: 6 common myths about cognitive decline
The Executive Suite: 6 common myths about cognitive decline: No one likes to talk about dementia. It encompasses disturbing images of the loss of control, the loss of self and, of course, the frighteni...
Tuesday, October 23, 2018
Sandra Day O’Connor’s farewell letter is a plea for country before party
By Ephrat Livni22 minutes ago
Sandra Day O’Connor is not an average American, and there’s plenty of evidence to support this contention.
For one, she was the first woman to serve on the US Supreme Court, appointed in 1981 by Ronald Reagan. And she’s remained active in public life even after her retirement in 2006, committed to advancing civic learning and sharing her passion for the US Constitution and the government it lays out. Today (Oct. 23), she announced she’s stepping out of the limelight because she’s been diagnosed with the beginning stages of dementia and probably has Alzheimer’s disease.
In a sort of farewell letter to the nation (pdf), she urges the rest of us to take up the cause of active citizenship that she can no longer devote herself to entirely, writing:
I feel so strongly about the topic because I’ve seen first-hand how vital it is for all citizens to understand our Constitution and unique system of government, and participate actively in their communities. It is through this shared understanding of who we are that we can follow the approaches that have served us best over time–working collaboratively together in communities and in government to solve problems, putting country and the common good above party and self-interest, and holding our key governmental institutions accountable.
O’Connor, 88, is a pioneer in more ways than one. In 2010, she started iCivics, a non-profit institution that provides free civics games and tutorials to students online and creates lesson plans for teachers in classrooms. On the site, she explains the project, saying, “The practice of democracy is not passed down through our gene pool. It must be taught and learned anew by each generation of citizens.”
In her letter today O’Connor called on all Americans to commit to the project of democracy by engaging in their communities and participating. “It’s not enough to understand, you’ve got to do something,” she writes.
If anyone is in a position to say this, it’s O’Connor, who as a self-described “young cowgirl from the Arizona desert” never could have imagined becoming the first woman on the high court. “I hope that I have inspired young people about civic engagement and helped pave the pathway for women who may have faced obstacles pursuing their careers,” she writes. “While the final chapter of my life with dementia may be trying, nothing has diminished my gratitude and deep appreciation for the countless blessings in my life.”
In response to O’Connor’s announcement, chief justice John Roberts issued a brief statement (pdf), writing that he is saddened by the news but “not at all surprised” that she used the moment “to think of our country first, and to urge an increased commitment to civics education, a cause to which she devoted so much of her time and indomitable energy.” He called her “a towering figure in the history of the United States and indeed the world” and “a role model not only for girls and women, but for all those committed to equal justice under law.”
Roberts concluded, that “no illness or condition can take away the inspiration she provides for those who will follow the many paths she has blazed.” It’s a sentiment that everyone can agree with—whatever their political affiliation.
Sandra Day O’Connor is not an average American, and there’s plenty of evidence to support this contention.
For one, she was the first woman to serve on the US Supreme Court, appointed in 1981 by Ronald Reagan. And she’s remained active in public life even after her retirement in 2006, committed to advancing civic learning and sharing her passion for the US Constitution and the government it lays out. Today (Oct. 23), she announced she’s stepping out of the limelight because she’s been diagnosed with the beginning stages of dementia and probably has Alzheimer’s disease.
In a sort of farewell letter to the nation (pdf), she urges the rest of us to take up the cause of active citizenship that she can no longer devote herself to entirely, writing:
I feel so strongly about the topic because I’ve seen first-hand how vital it is for all citizens to understand our Constitution and unique system of government, and participate actively in their communities. It is through this shared understanding of who we are that we can follow the approaches that have served us best over time–working collaboratively together in communities and in government to solve problems, putting country and the common good above party and self-interest, and holding our key governmental institutions accountable.
O’Connor, 88, is a pioneer in more ways than one. In 2010, she started iCivics, a non-profit institution that provides free civics games and tutorials to students online and creates lesson plans for teachers in classrooms. On the site, she explains the project, saying, “The practice of democracy is not passed down through our gene pool. It must be taught and learned anew by each generation of citizens.”
In her letter today O’Connor called on all Americans to commit to the project of democracy by engaging in their communities and participating. “It’s not enough to understand, you’ve got to do something,” she writes.
If anyone is in a position to say this, it’s O’Connor, who as a self-described “young cowgirl from the Arizona desert” never could have imagined becoming the first woman on the high court. “I hope that I have inspired young people about civic engagement and helped pave the pathway for women who may have faced obstacles pursuing their careers,” she writes. “While the final chapter of my life with dementia may be trying, nothing has diminished my gratitude and deep appreciation for the countless blessings in my life.”
In response to O’Connor’s announcement, chief justice John Roberts issued a brief statement (pdf), writing that he is saddened by the news but “not at all surprised” that she used the moment “to think of our country first, and to urge an increased commitment to civics education, a cause to which she devoted so much of her time and indomitable energy.” He called her “a towering figure in the history of the United States and indeed the world” and “a role model not only for girls and women, but for all those committed to equal justice under law.”
Roberts concluded, that “no illness or condition can take away the inspiration she provides for those who will follow the many paths she has blazed.” It’s a sentiment that everyone can agree with—whatever their political affiliation.
Dementia Signage for the Home
Tuesday, July 31, 2018
5 Best Family Caregiving YouTube Channels
We collected a list of helpful family caregiving YouTube channels that every caregiver should check out. The videos available provide expert and crowdsourced tips, meaningful material, demonstrations on ‘how-to’ many actions, and other supporting topics for caring for an aging parent. Keep in mind that these are not a replacement for medical advice from your doctor so always check with your physician if you have any additional questions.
Peruse the channels compiled below and you may be surprised at how much content is available on everything from a 2-minute video on medication management to longer posts about caregiver stress.
Check out the YouTube channels below. You will find a variety of videos on how to take blood pressure, best dental cleaning advice and other general care topics for your aging loved one.
Caregiver Alliance, National Center on Caregiving is a public voice for caregivers. The pioneering programs — information, education, services, research, and advocacy — support and sustain the important work of families nationwide caring for loved ones with chronic, disabling health conditions.
Home Instead Senior Care created the Caregiver Stress video channel, and caregiverstress.com to bring caregivers helpful resources and tips related to caring for a senior loved one. It’s their small way of trying to help you navigate what they know from their own experience can be a trying time.
AARP is a United States-based interest group whose stated mission is “empowering people to choose how they live as they age.” The videos covered are on topics such as highlighting caregivers, learning healthy habits and how to disrupt aging and live independently.
The National Institute on Aging is the U.S. Government’s lead agency on aging research and is part of the National Institutes of Health. NIA supports a broad scientific effort to understand the nature of aging and extend the active, healthy years of life.
Care.com believes in being there for one another. They help families find the care they need and caregivers find the jobs they want. Browse their channel for caregiving stories, advice, recipes, activities, and tips for using care.com.
Peruse the channels compiled below and you may be surprised at how much content is available on everything from a 2-minute video on medication management to longer posts about caregiver stress.
Top 5 Best Family Caregiving YouTube Channels
Check out the YouTube channels below. You will find a variety of videos on how to take blood pressure, best dental cleaning advice and other general care topics for your aging loved one.
Family Caregiver Alliance Family
Caregiver Alliance, National Center on Caregiving is a public voice for caregivers. The pioneering programs — information, education, services, research, and advocacy — support and sustain the important work of families nationwide caring for loved ones with chronic, disabling health conditions.
Caregiver Stress
Home Instead Senior Care created the Caregiver Stress video channel, and caregiverstress.com to bring caregivers helpful resources and tips related to caring for a senior loved one. It’s their small way of trying to help you navigate what they know from their own experience can be a trying time.
AARP
AARP is a United States-based interest group whose stated mission is “empowering people to choose how they live as they age.” The videos covered are on topics such as highlighting caregivers, learning healthy habits and how to disrupt aging and live independently.
National Institutes on Aging
The National Institute on Aging is the U.S. Government’s lead agency on aging research and is part of the National Institutes of Health. NIA supports a broad scientific effort to understand the nature of aging and extend the active, healthy years of life.
Care.com
Care.com believes in being there for one another. They help families find the care they need and caregivers find the jobs they want. Browse their channel for caregiving stories, advice, recipes, activities, and tips for using care.com.
Dementia Signage for the Home
5 Tips for Communicating with Someone with Alzheimer’s
Did you know that 5.5 million Americans are currently living with Alzheimer’s disease? Communicating with someone diagnosed with Alzheimer’s can be challenging and often create frustration. However, communication is possible if you remain patient, avoid distractions, avoid pointing out mistakes, utilize nonverbal communication, and keep it simple. Read about these tips in more detail below.
When communicating with someone with Alzheimer’s, make sure to prepare yourself before entering into a conversation. You need to be remain patient and know that it may become challenging. Do not raise your voice, show stress, or demonstrate frustration. Allow your loved one to take their time. Remember to listen and do not interrupt.
Take away the distractions by having the conversation away from competing sights and sounds. You can do this by using a quiet room in the house (like a den or bedroom) so the attention is focused on you and not the T.V., the cars driving by, or other background noise. Doing so will at least create a clear pathway for talking.
You can easily get off topic or lose someone’s attention if you point out a mistake or correct something he or she said. Avoid this mistake and avoid arguing with your loved one.
Communication uses both verbal and nonverbal messaging. Try to use visual and nonverbal cues (i.e. hand gestures, facial expressions, etc.) to get your message across.
Depending on where the disease is in its progression, you may need to keep your sentences short and to the point. Eventually, as it progresses, you may need to keep your questions to yes or no answers. In addition, breakdown larger concepts into smaller, easier-to-understand talking points. For example, if you need to discuss a new medication – consider all of the items you need to communicate: the name of the medication, its purpose, why it’s happening, when it needs to be taken, how often, etc. Break down each of this and take time messaging it.
Remember not to take any issues or comments said personally. By being patient and showing respect to your loved one you can set the tone for the conversation.
5 Tips to Communicate Effectively
Be Patient
When communicating with someone with Alzheimer’s, make sure to prepare yourself before entering into a conversation. You need to be remain patient and know that it may become challenging. Do not raise your voice, show stress, or demonstrate frustration. Allow your loved one to take their time. Remember to listen and do not interrupt.
Avoid Distractions
Take away the distractions by having the conversation away from competing sights and sounds. You can do this by using a quiet room in the house (like a den or bedroom) so the attention is focused on you and not the T.V., the cars driving by, or other background noise. Doing so will at least create a clear pathway for talking.
Avoid Pointing Out Mistakes
You can easily get off topic or lose someone’s attention if you point out a mistake or correct something he or she said. Avoid this mistake and avoid arguing with your loved one.
Utilize Nonverbal Communication
Communication uses both verbal and nonverbal messaging. Try to use visual and nonverbal cues (i.e. hand gestures, facial expressions, etc.) to get your message across.
Keep the Conversation Simple
Depending on where the disease is in its progression, you may need to keep your sentences short and to the point. Eventually, as it progresses, you may need to keep your questions to yes or no answers. In addition, breakdown larger concepts into smaller, easier-to-understand talking points. For example, if you need to discuss a new medication – consider all of the items you need to communicate: the name of the medication, its purpose, why it’s happening, when it needs to be taken, how often, etc. Break down each of this and take time messaging it.
Remember not to take any issues or comments said personally. By being patient and showing respect to your loved one you can set the tone for the conversation.
Dementia Signage for the Home
Thursday, April 12, 2018
How to Hire In Home Care for A Loved One
Family caregivers cannot do all things all the time. Recognizing when you need outside help is good for you and your loved one.
Personal Care Assistants (PCAs) are not licensed and have varying levels of experience and training. They serve as helpers and companions — providing conversation, bathing and dressing, neighborhood walks, light housekeeping and meals. They can offer transportation to shopping and appointments, as well as prescription pickup. Training requirements vary by state, and some states do not have formal requirements. PCAs are the least expensive care providers, but they are typically not covered by Medicare or other types of health insurance. The median hourly wage is $10.54, according to the Bureau of Labor Statistics (BLS), but the hourly charge for this and other in-home health service can be considerably higher in tight markets and urban areas. Expect PCA services to be an out-of-pocket expense.
Home Health Aides (HHAs) monitor the patient's condition, check vital signs and assist with the necessary parts of daily living, including bathing, dressing and using the bathroom. HHAs also provide company, do light housekeeping and prepare meals. HHAs are trained and certified, and requirements differ from state to state. The median hourly wage is $10.87, according to the BLS.
Licensed Nursing Assistants (LNAs) and Certified Nursing Assistants (CNAs) observe and report changes in the patient, take vital signs, set up medical equipment, change dressings, clean catheters, monitor infections, conduct range-of-motion exercises, offer walking assistance and administer some treatments. All medical-related tasks are performed as directed by a Registered Nurse (RN) or Nurse Practitioner (NP). CNAs also provide personal patient care — such as feeding, dental help, bathing, bathroom assistance and home tasks that include changing bed linens and serving meals. Median hourly wage for LNAs is $12.78, according to the BLS.
Skilled Nursing Providers meet federal standards for health and safety and are licensed by the state. They manage, observe and evaluate your family member’s care, and provide direct care that nonmedical and home health aides cannot — including administering IV drugs, tube feedings and shots; changing wound dressings; providing diabetes care; and providing caregiver and patient education. Some are trained in physical therapy, occupational therapy and speech therapy. Medicare covers home health skilled nursing care that's part time and intermittent, and arranged by a Medicare-Certified Home Health Agency (CHHA). Median hourly wage is $21.20, according to the BLS.
Registered Nurses (RNs) hold a nursing diploma or associate degree in nursing (ADN), have passed the NCLEX-RN exam administered by the National Council of State Boards of Nursing (NCSBN) and have met all the other licensing requirements mandated by their state’s board of nursing. They provide direct care, can assist doctors in medical procedures, offer guidance to family members, operate medical monitoring equipment and administer medications.
Step 1.
With your loved one, write down needs and limitations, level of assistance needed, likes and dislikes, expectations and doctor recommendations. If your family member is covered by long-term insurance, Medicare or Medicaid, you’ll need a doctor’s report confirming that the need for in-home care. Medicare does not cover personal care if it is the only care needed.
Step 2.
Find a trustworthy, compassionate and responsible caregiver. Do you feel best going through an agency? Friends? A registry?
If the answer is:
An agency
Regardless of whether your family member is Medicare-eligible, compare and research agencies in your area by using the Medicare guide to patient-rated agencies and arrange a consult. Before you sign an agency contract, review our checklist of important questions. Ask them.
Upsides:
Prescreened workers. Caregivers have undergone and passed a background check.
Relevant experience. Agencies are likely to have some caregivers with experience in caring for people struggling with the same illness or condition affecting your loved one.
Backup care. If the caregiver is sick or doesn’t work out, an agency usually can find a replacement quickly.
Addressing problems. Concerns and complaints are reported to and handled by a supervisor.
Fast upgrades. If care level or diagnosis changes, most agencies can quickly provide a worker with more training.
No paperwork. You pay the agency. They take their percentage, pay the worker, and handle payroll, taxes and scheduling.
Liability protection. If a caregiver is injured on the job, the agency covers the cost.
Downsides:
Expense. You pay more — sometimes substantially more — for an agency-provided caregiver.
Limited negotiation. Individuals are generally more flexible about hours, overtime and duties than agencies.
Minimum hours. Many agencies do not allow a part-time schedule.
Little choice. The agency chooses the worker, who may or may not mesh well with you or your family member.
Option 1: Ask friends and neighbors who have employed caregivers for recommendations, names, phone numbers and hourly rates of those they found to be outstanding. Get specifics. Your neighbor’s priorities might not be yours.
Option 2: Consult the community. Leave your name and number and the particulars of the job — including needs and hourly wage — with the receptionists at nearby houses of worship, senior centers, local gyms, yoga studios and community centers.
Option 3: Call your Area Agency on Aging and ask if they have recommendations.
A registry
Local — and sometimes state — employment registries will have lists of available nurses and aides in your area. You call the person directly.
Upsides:
Flextime. It is more likely you will find a part-time caregiver or one who can work an unusual schedule.
Spend less, pay more. Without the higher agency fee, you may be able to pay more for a more skilled or experienced provider.
Your rules. Agency caregivers must follow agency rules. With a nonagency caregiver, the two of you and the person needing care can figure out what works for everyone.
Better fit. You may be more likely to find a caregiver who speaks a second language, shares interests with the care recipient or has personality traits your loved one will appreciate.
Downsides:
Time. A DIY search and screening can take days to weeks. Agencies often can arrange next-day care.
Emergency coverage. Sick days, vacation or a fast departure for a new job can upend everyone’s schedule. There’s no fallback plan unless you arrange it.
You investigate. You will need to screen and verify credentials.
Paperwork. You are responsible for getting an Employer Identification number (EIN), and for withholding and paying Social Security, Medicare and unemployment taxes. You also must confirm that the applicant can work legally in the United States.
Protection. Agencies insure their own. You may be held liable for an on-the-job accident unless you buy liability insurance that covers the caregiver. Workers’ comp — which covers lost wages and medical care — is required by some states and recommended in all by some legal experts.
Training. Agency health aides are trained. You may want to pay for a training class or refresher.
You’re the boss. The person who handles your complaints is you.
Step 3.
You — and your loved one, if possible — should interview applicants together. Prepare written questions. Be clear and honest about job requirements.
A major consideration when hiring a caregiver is the associated cost. In some cases, you may be able to get help paying for in-home care.
What’s the difference between types of in-home care workers?
Personal Care Assistants (PCAs) are not licensed and have varying levels of experience and training. They serve as helpers and companions — providing conversation, bathing and dressing, neighborhood walks, light housekeeping and meals. They can offer transportation to shopping and appointments, as well as prescription pickup. Training requirements vary by state, and some states do not have formal requirements. PCAs are the least expensive care providers, but they are typically not covered by Medicare or other types of health insurance. The median hourly wage is $10.54, according to the Bureau of Labor Statistics (BLS), but the hourly charge for this and other in-home health service can be considerably higher in tight markets and urban areas. Expect PCA services to be an out-of-pocket expense.
Home Health Aides (HHAs) monitor the patient's condition, check vital signs and assist with the necessary parts of daily living, including bathing, dressing and using the bathroom. HHAs also provide company, do light housekeeping and prepare meals. HHAs are trained and certified, and requirements differ from state to state. The median hourly wage is $10.87, according to the BLS.
Licensed Nursing Assistants (LNAs) and Certified Nursing Assistants (CNAs) observe and report changes in the patient, take vital signs, set up medical equipment, change dressings, clean catheters, monitor infections, conduct range-of-motion exercises, offer walking assistance and administer some treatments. All medical-related tasks are performed as directed by a Registered Nurse (RN) or Nurse Practitioner (NP). CNAs also provide personal patient care — such as feeding, dental help, bathing, bathroom assistance and home tasks that include changing bed linens and serving meals. Median hourly wage for LNAs is $12.78, according to the BLS.
Skilled Nursing Providers meet federal standards for health and safety and are licensed by the state. They manage, observe and evaluate your family member’s care, and provide direct care that nonmedical and home health aides cannot — including administering IV drugs, tube feedings and shots; changing wound dressings; providing diabetes care; and providing caregiver and patient education. Some are trained in physical therapy, occupational therapy and speech therapy. Medicare covers home health skilled nursing care that's part time and intermittent, and arranged by a Medicare-Certified Home Health Agency (CHHA). Median hourly wage is $21.20, according to the BLS.
Registered Nurses (RNs) hold a nursing diploma or associate degree in nursing (ADN), have passed the NCLEX-RN exam administered by the National Council of State Boards of Nursing (NCSBN) and have met all the other licensing requirements mandated by their state’s board of nursing. They provide direct care, can assist doctors in medical procedures, offer guidance to family members, operate medical monitoring equipment and administer medications.
Step by Step: Hiring a Caregiver
Step 1.
With your loved one, write down needs and limitations, level of assistance needed, likes and dislikes, expectations and doctor recommendations. If your family member is covered by long-term insurance, Medicare or Medicaid, you’ll need a doctor’s report confirming that the need for in-home care. Medicare does not cover personal care if it is the only care needed.
Step 2.
Find a trustworthy, compassionate and responsible caregiver. Do you feel best going through an agency? Friends? A registry?
If the answer is:
An agency
Regardless of whether your family member is Medicare-eligible, compare and research agencies in your area by using the Medicare guide to patient-rated agencies and arrange a consult. Before you sign an agency contract, review our checklist of important questions. Ask them.
Upsides:
Prescreened workers. Caregivers have undergone and passed a background check.
Relevant experience. Agencies are likely to have some caregivers with experience in caring for people struggling with the same illness or condition affecting your loved one.
Backup care. If the caregiver is sick or doesn’t work out, an agency usually can find a replacement quickly.
Addressing problems. Concerns and complaints are reported to and handled by a supervisor.
Fast upgrades. If care level or diagnosis changes, most agencies can quickly provide a worker with more training.
No paperwork. You pay the agency. They take their percentage, pay the worker, and handle payroll, taxes and scheduling.
Liability protection. If a caregiver is injured on the job, the agency covers the cost.
Downsides:
Expense. You pay more — sometimes substantially more — for an agency-provided caregiver.
Limited negotiation. Individuals are generally more flexible about hours, overtime and duties than agencies.
Minimum hours. Many agencies do not allow a part-time schedule.
Little choice. The agency chooses the worker, who may or may not mesh well with you or your family member.
Option 1: Ask friends and neighbors who have employed caregivers for recommendations, names, phone numbers and hourly rates of those they found to be outstanding. Get specifics. Your neighbor’s priorities might not be yours.
Option 2: Consult the community. Leave your name and number and the particulars of the job — including needs and hourly wage — with the receptionists at nearby houses of worship, senior centers, local gyms, yoga studios and community centers.
Option 3: Call your Area Agency on Aging and ask if they have recommendations.
A registry
Local — and sometimes state — employment registries will have lists of available nurses and aides in your area. You call the person directly.
Upsides:
Flextime. It is more likely you will find a part-time caregiver or one who can work an unusual schedule.
Spend less, pay more. Without the higher agency fee, you may be able to pay more for a more skilled or experienced provider.
Your rules. Agency caregivers must follow agency rules. With a nonagency caregiver, the two of you and the person needing care can figure out what works for everyone.
Better fit. You may be more likely to find a caregiver who speaks a second language, shares interests with the care recipient or has personality traits your loved one will appreciate.
Downsides:
Time. A DIY search and screening can take days to weeks. Agencies often can arrange next-day care.
Emergency coverage. Sick days, vacation or a fast departure for a new job can upend everyone’s schedule. There’s no fallback plan unless you arrange it.
You investigate. You will need to screen and verify credentials.
Paperwork. You are responsible for getting an Employer Identification number (EIN), and for withholding and paying Social Security, Medicare and unemployment taxes. You also must confirm that the applicant can work legally in the United States.
Protection. Agencies insure their own. You may be held liable for an on-the-job accident unless you buy liability insurance that covers the caregiver. Workers’ comp — which covers lost wages and medical care — is required by some states and recommended in all by some legal experts.
Training. Agency health aides are trained. You may want to pay for a training class or refresher.
You’re the boss. The person who handles your complaints is you.
Step 3.
You — and your loved one, if possible — should interview applicants together. Prepare written questions. Be clear and honest about job requirements.
A major consideration when hiring a caregiver is the associated cost. In some cases, you may be able to get help paying for in-home care.
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