Your parent is aging and you want to make sure they have the best care possible. Should they be seeing a geriatrician? It has been estimated that 30% of people over the age of 65 should be seeing one. This article will cover this question and more so that you can help make the best decision for your loved one. Let’s start by discussing what a geriatrician is.  

What is a Geriatrician?

Most geriatricians are primary care physicians (PCPs) certified in family or internal medicine who have gone on and completed advanced training in geriatric medicine. These doctors work in a variety of settings. They sometimes work on their own in primary care or inpatient settings. But many are known to be part of a team with other providers who have also had advanced geriatric training. This team of specialists can include geriatrician nurses, social workers, pharmacists, nutritionists, physical therapists, speech and hearing specialists, psychiatrists, and psychologists. It’s the team’s job to manage not only the patient’s medical needs but also the social and emotional. For example, they might evaluate the living situation, social support, balance, memory issues, and ability to perform daily activities such as dressing, bathing, and eating.

Who needs to see a geriatrician?

Just because a person is over the age of 65 does not necessarily mean that they need to see a geriatrician. Consider a consult with a geriatrician when your loved one is suffering from several diseases and or disabilities which can include memory concerns. Another time to consider a consult is when the caregiver is having difficulty keeping up with the care of the loved one and managing multiple healthcare professionals being seen for different health conditions. An 80-year-old who walks a mile every day, is independent, and takes only one or two medications does not require the care of a geriatrician. However, a 66-year-old with multiple co-morbidities taking several medications could benefit from a geriatrician.

What Benefits does a Geriatrician have over a PCP?

Time

One of the greatest advantages of seeing a geriatrician is time. A PCP has a very short appointment time, usually ten minutes, to evaluate their patient. A geriatrician has much longer appointment times, usually an hour, so there is time to discuss all medical concerns.

Considers the Whole Picture

An elderly person who has several health issues, medications, and therapies can be difficult to manage, especially because their bodies give unique warning signs and tolerate treatments differently than a younger person. The geriatrician has the specialized knowledge and ability to look at the whole picture.

Decreases Misdiagnoses and Overmedicating

There are an estimated 49.2 million older adults who are receiving specialized geriatric care from a PCP. Having a PCP manage specialized geriatric concerns such as cognitive assessments, psychological impairments, and other non-normative aging diseases can lead to misdiagnosis and overmedicating. A geriatrician is better able to manage those complex issues and prescribe treatment that will bring a better quality of life.

Decreases Hospitalization

Being misdiagnosed and overmedicated can lead to other complications arising. This scenario is seen frequently in hospitals. Many times, it’s from mismanagement of medication. As a person ages, the body has a harder time metabolizing the medications, and the more medications a person is on the higher the chance of a side effect. A geriatrician will be less likely to prescribe risky medications and is better able to watch for warning signs so adjustments can be made before hospitalization is required.

How to Find a Geriatrician?

Sadly, there is a shortage of this type of physician and the demand for them is increasing. To see if a geriatrician is accepting new patients near you go to HealthinAging.org. Or you can call (212) 308-1414 to have a list mailed to you.

How to Prepare For the Visit

·       Have a list of your parent’s health history, past and present diagnosis, past surgeries, and allergies

·       List of medications

·       List of other doctors your parent is currently seeing

·       Know the goals for your parent’s care

Questions to Ask at the Visit

·       Training- ask if the doctor has received special training or certifications

·       Accessibility- Make sure your insurance is accepted by the practice. Ask about after-hours questions and how emergencies are handled. You can also ask if there are at-home services provided.

·       Communication- Ask how the MD prefers to communicate with you and how the MD communicates with other specialists such as cardiologists, pulmonologists, and neurologists.

·       Philosophy- Make sure you and the geriatrician are on the same page when it comes to the health goals

Conclusion

Watching your parents age can be difficult. You want the very best care for them and maybe that is with keeping their same PCP. However, if the health management is difficult and there are a few medical issues going on, switching to a geriatrician might be in their best interest. Now you understand the role of the geriatrician, when they are used, and how to locate one.

Your loved one is aging, and you are concerned for their safety at home, how can you help?

Introduction

An important part of my job as a home health nurse is assessing the home environment for safety issues. Some of the top safety issues for the elderly are falls, fires, and poisoning. I’m also going to include a section on phone safety because of the many scams that target the elderly. Let’s walk through each of these 10 areas you can check for safety issues in the home.

Bathroom Safety

The bathroom is one of the most dangerous rooms for an elderly person. Many falls happen in this room along with scalding.

·       Install grab bars in the shower and next to the toilet.

·       Make sure the floor of the shower/tub is slip-proof with rubber floor mats or anti-slip strips.

·       Set the water temp no hotter than 120 degrees to prevent burns.

·       Place a shower chair in the shower or bathtub.

·       Install a handheld showerhead to make bathing easier.

·       Install a raised toilet seat for help with standing up. The seat should be between 17-19 inches in height.

·       Make sure there is a nightlight to help with middle-of-the-night trips.

·       Remove rugs that act as tripping hazards.

·       Consider replacing the bathtub with a walk-in model instead.

Bedroom Safety

The bedroom may seem like a rather safe place, but I have encountered a few safety issues over the years.

·       Declutter the environment. Too much clutter or cords are a major fall hazard.

·       A sagging or too soft mattress can make it difficult for a senior to get out of bed. Consider a firmer mattress.

·       A bed that is too high or too low is dangerous. Consider replacing the frame with one that is easy to get in and out of.

·       Make sure the lighting is good and easily accessible from the bed.

·       Remove area rugs.

·       Consider installing a telescope grab bar from floor to ceiling next to the bed to help with getting in and out of bed.

·       Make sure items are within easy reach and there is nothing high on a shelf or in the closet the senior would be reaching for.

·       If the flooring surface changes in texture from the hall to the bedroom, make sure it is a smooth transition and is marked so the senior remembers to watch their step.

·       Replace a round doorknob with a lever doorknob which is easier to grab. (Go ahead and do this throughout the whole house.)

Kitchen Safety

The kitchen is the hub of the home. Time needs to go into making sure it is a safe room.

·       Go through the cupboards and decide if everything is still needed. Then store most needed items in easy to reach places to prevent bending or having to use a stepstool.

·       Is a step stool still needed? Make sure to get one with only one or two steps that is very sturdy.

·       Lever handles on faucets are easier for seniors to turn on and off, consider replacing those.

·       Open the fridge and give it a good clean out and wipe down. Discard expired food.

·       Do the same with pantry items.

·       Does your senior need help with meal planning? Grocery shopping? Food prep? Remember that older people don’t eat quite as much. Think about high nutrition content in smaller proportions.

·       They also don’t get thirsty which often leads to dehydration.  Consider a cup that measures how much they have drunk so far and encourages them to drink their daily amount.

·       Have emergency phone numbers posted on the fridge.

·       Other items to post on the fridge are an up-to-date medication list, DOB, allergies, diagnosis, and the seniors POLST for easy access for medical personal in case of emergency.

Living Room Safety

The living room is generally safe. My tips have to do with the general ease of movement and support.

·       Make sure there is a clear walkway. Remove clutter, cords, and area rugs that could be tripped on

·       Get rid of extra furniture that is no longer needed.

·       The lighting should be bright and easily accessible.

·       The furniture should be in good condition and supportive. A saggy couch or chair is very difficult to get out of and can cause falls.

·       Make sure items used daily in this room are easily reached without bending over or stretching high.

·       Encourage your loved one to wear non-skid shoes when they are in the home.

·       Any areas where the flooring surface changes from wood to tile to carpet, make sure the transition is smooth and well-marked as a reminder to slow down.

·       Plugin sensor lights would be a great idea in this room as well.

·       If a pet is in the home, consider having a designated area that the pet stays in to help prevent a tripping hazard.

Front Entrance Safety

Getting in and out of cars and climbing steps to the front door can be very difficult and there are many areas in which an accident can happen.

·       If your senior is still driving, make sure they can get in and out of their car easily.

·       Are there steps leading up to the front door? Install a handrail next to the stairs. Should there be a ramp instead of stairs?

·       Make sure the front door has a peephole in it so your senior can check to see who is at their door.

·       Post a reminder note next to the door, “Do you know who is at your door? If not, do not open the door.”

·       Is the mailbox an easy walk to get to? Would a mail slot in the front door be better?

·       Install motion detector lights from the driveway to the front door so the walkway is well lit.

·       Always keep doors and windows locked.

Stair Safety

Along with getting generally weaker with age, many diseases that come in the elder years make stairs very difficult and are a major safety hazard.

·       Consider getting a stairlift. I once had a patient who lived in a three-level home. She had a stairlift on each level and a walker at each landing so she could transfer. She made it work great!

·       Test the railings and make sure they are firmly in place.

·       With poor vision it can sometimes be difficult to differentiate stairs from each other, consider colored duct tape on the edge of each stair to make it easier to see. Also, consider a different color for the top and bottom stairs.

·       Make sure there is no clutter on the stairs.

·       If living in a cold environment, make sure you, a hired local service, or neighbor regularly clear ice and snow off outside stairs.

Fire Safety

Checking for fire hazards and removing them is another key area for making the home safe.

·       Make sure smoke and carbon monoxide detectors have new batteries in them and change them regularly.

·       Check all electrical cords of appliances and lamps and replace any frayed or damaged ones. Make sure to limit the number of cords plugged into power strips.

·       Remove all candles from the home, a forgotten candle can start a fire.

·       Review fire safety drills with your loved one. Remind them to stay low when exiting the home if there is a fire to reduce smoke inhalation. Plan with them for the best escape routes from each room in case a fire broke out.

·       Discourage the use of space heaters but if it is insisted upon, make sure it is at least three feet away from bedding, curtains, or furniture. Remind them to turn it off when leaving the home and before going to bed.

Phone Safety

We’ve all heard of the phone scams that target the elderly. My own grandfather was almost caught up in one. Talking about them with your loved one can help prevent them.

·       Do not believe any stranger claiming a family member is in danger over the phone. If there is an actual emergency a police officer will come to visit you.

·       Never agree to telephone offers.

·       Never give out your Social Security number over the phone or any of your financial information.

·       The IRS and credit card companies communicate by mail and don’t make phone calls demanding money. Do not speak to anyone claiming you owe them money.

·       Let your loved one know there are many scams out there and they should always use caution when speaking with a stranger.

Medication Safety

I saw many horrifying medication issues when seeing my home health patients. This is an area that requires careful attention.

·       First, make sure to have an updated medication list from the doctors overseeing your loved one’s care.

·       I suggest typing up this list in an easy-to-read format as this can be helpful for doctor visits, hospitalizations, and in case of emergency.

·       The easiest way to organize medications is a week-long pill box divided into morning, afternoon, and evening. (You can get some with more slots available as well.)

·       Make sure the pill box you get can be opened easily by your senior, (some of them are tricky!)

·       Educate your senior on how to fill the weekly pill box and have them show you how to do it. If you see it’s too difficult, then you will need to come weekly and fill it for them or have someone trustworthy assigned to this task.

·       Go through all the cupboards and medicine cabinets in the home. Check the dates on all medications and dispose of expired medications.

·       Organize medications according to their use for easy access.

Back Yard Safety

While keeping up with gardening can have many health benefits for the elderly, it also has its fair share of risks.

·       Avoid all ladders when working outside, make sure everything is within reach and anything requiring climbing up a ladder should be done by a younger person.

·       I once had a patient who had banged himself up pretty good after tripping over his hose. Wrap bright-colored duct tape around the hose so it’s easily seen when laying in the grass and always have it wrapped up when not in use.

·       Before gardening, encourage a gentle warm-up stretch to prevent injury.

·       Make sure to be hydrated before gardening to decrease getting dizzy.

·       Wear protective clothing like long sleeves, a hat, and gardening gloves.

·       Have a garden seat for frequent rests.

·       Consider raised beds or vertical gardens to decrease bending over.

·       Long-handled tools can also help decrease bending. Just like the hose, wrap the long handles in bright-colored tape so it doesn’t get lost in the grass.

·       Invest in a wagon instead of a wheelbarrow. A wagon is much more stable, and this will keep your loved one from carrying too much in their arms.

Conclusion

Now that you have walked through these ten areas of home safety, your loved one will be in a much safer environment. Always remember that frequent check-ins are essential. Consider an alarm necklace or bracelet that your senior can wear if they do have a fall so that emergency services can get to them quickly.

You know the time is coming when you or your loved one will require assistance, what is the best option for that care? 

Introduction

Aging, while it happens inevitably to all of us, is no easy task. Losing the ability to perform tasks we used to do with ease can lead to fear and frustration. Knowing your options for assistance in the future can help smooth the transition for both the person requiring the assistance and the loved ones in their life. The following is the comparison of nursing homes versus in-home care. The differences, the benefits of each, the costs associated, how it’s typically paid for, and the different impacts Covid-19 has had on each.  Having this knowledge can help you choose the route that will best fit your needs and desires.  

What is a Nursing Home? 

A nursing home is a facility for individuals who require assistance with daily tasks, in healthcare we call it activities of daily living or ADL’s. Nursing aids and skilled nurses are on staff in most nursing homes 24 hours a day. The living quarters can be shared or private rooms. Usually, there are organized activities for the residents, and meals are provided in a dining room or to the private quarters. The arrangement or feel of each nursing home varies from home-like to hospital-like. Some nursing homes also have specialized units that care for seniors with memory problems, these units are usually locked down to help keep the residents safe from wandering. 

What is In-Home Care? 

Home care services (which should not be confused with home healthcare services) are when a home care aid comes into the home to help with ADLs. They are not usually medical professionals and do not provide medical treatment or care. They do help with hygiene, meal planning/prep, transportation, medication reminders, general housekeeping, and are a friendly companion. The home care aide is scheduled according to the needs of the person, a few hours a day or week up to 24 hours a day. This type of service can be organized privately or through an agency.  

Home healthcare services are when a physician orders a skilled medical professional, such as nurses, physical therapists, occupational therapists to provide medical services in the home such as wound care, IV changes, feeding tubes, catheters, injections, and physical needs beyond the level of basic ADL’s and mobility.  This is generally arranged through a home health company.

Benefits of Nursing Homes

Nursing home benefits revolve mostly around being in an organized community with many things available in-house. There is usually 24/7 medical assistance by a nurse available and around-the-clock help with ADLs by aides. Meals being planned, prepared, and served to the residents can be a huge positive. Also, there is the social aspect, most nursing homes have organized activities such as game times, movie times, craft times, music times, trivia times which many residents participate in and have great fun. There is also the ability to make friends and have a social life. 

Benefits of In-Home Care 

In-home care benefits revolve mostly around being able to keep the person in their familiar environment. With age and especially with dementia, being in familiar surroundings are key to reducing anxiety. Having one-on-one care customized to the individual and based on a comfortable routine can be very reassuring. There is also the encouragement of independence that comes with in-home care.  With a home aide’s attention being only on one person there is the ability to know their client better, see the strengths and weaknesses, and know when to promote independence. According to statistics, those who receive in-home care also have 50% fewer doctor visits annually. 

The Cost of Nursing Homes Vs. In-Home Care

Nursing Home Costs

The cost of staying in a nursing home varies from state to state. There is also the difference between using a private room or a shared room. The national average for a shared room is $93,075 annually and for a private room $105,850. 

In-Home Care Costs

The cost of in-home care likewise varies from state to state. The total is additionally dependent on how many hours a week the home care is needed which can be customized according to the need rather than a flat 24/7 rate like a nursing home. The national average for home care is $4290 a month or $51,480 annually. 

Who Pays? 

Private Insurance 

Regular insurance policies typically do not cover home care, however, there are cases in which an individual has long-term insurance which is designed to cover senior care. The coverage does depend on the insurance provider, the specific policy, and the age of the person when they signed up for the policy. Usually, the insurance will not begin to cover care until assistance with at least two ADL’s is needed. 

Medicaid

Home care can be covered by Medicaid for seniors who qualify both financially and medically. The senior will need to be evaluated medically to prove that they need the level of care they are receiving. The qualifying factors for receiving coverage of care vary from state to state. 

Medicare

Medicare does not cover long-term care. There are circumstances in which it will cover short-term nursing home care. However, it maxes out at 100 days. In-home healthcare will be covered with some limitations and only as long as some requirements are met. For example, the senior must be considered homebound, must be under the care of a physician who has a home health care plan, and must receive services from a Medicare-certified home health care agency. 

Aid and Attendance Benefit

This is a benefit that is available to eligible veterans and their spouses. It is an extra monthly payment that veterans may receive in addition to their regular monthly VA pension. The intention is not to directly cover the cost of care but is an added monthly income for those who require the extra help. 

Life Insurance 

Although most think of life insurance as a policy intended to assist the loved ones of the beneficiary following their death, there are cases in which it can be used to pay for long-term care, in-home care included. The policies are typically referred to as a hybrid and the specifics of what is covered varies. 

Depending on the insurance company’s rules, a person with standard life insurance can sometimes surrender their policy for a cash payment. Or there is sometimes an option to sell a policy to a third-party group. With both options, the cash payment will be less than the original death benefit.

Reverse Mortgage Loans

A reverse mortgage is an option to finance long-term care for adults aged 62 and older. It’s converting part of the home’s value to cash. Most of the time the money is not taxed. This is an option for seniors who are not ready to leave their homes and are wanting in-home care. Keep in mind the loan does need to be repaid when the last surviving borrower passes away or moves out of the home. 

Private Funding

Private pay is always an option for those who have the means to do so. For someone who only needs a few hours of care a week, this option could be much more feasible than someone who requires full-time care. When moving toward requiring 24/7 care a nursing home would be more financially affordable. 

What Impact Has Covid-19 Had on Nursing Homes and In-Home Care?

Covid and Nursing Homes 

Unfortunately, nursing home residents were hit particularly strongly from Covid-19.  Most nursing home residents are elderly and have underlying health care conditions putting them at higher risk. Living in a community environment also increased spread. Family members of loved ones in nursing homes were in most cases unable to visit. Many had concerns about their loved one’s physical health, mental health, and quality of care. Shockingly, statistics say 40% of covid deaths were from nursing homes and other assisted living-type facilities. Sadly, most residents had to be quarantined in their rooms, many times alone with very limited interaction with staff members. This led to loneliness, increased confusion, and depression. Those with memory issues could not understand the process going on and why they could no longer see their family. 

Covid and In-Home Care

In-home care faced a different set of challenges but had some positive changes as well. In some cases, families, or the seniors themselves refused caregivers to come to decrease contact with outside people. Other times it was the caregiver who was afraid and wouldn’t show up to work. For the most part, however, patients receiving in-home care were healthier and safer due to quarantining at home. The desire to decrease the load on the hospital system encouraged physicians to seek in-home care for their patients more than in the past. This led to increased attention on in-home care and has created a desire to grow the industry and make it stronger. 

Conclusion 

It is best to start early when planning for your future care. Aging will have stressful moments and those who have planned tend to transition much smoother. Even if it’s not quite time for their services, start reaching out to nursing homes or in-home care agencies; meet some of the staff, take a tour, find out their process of getting started, and get yourself comfortable with your decision. You and your family will be very glad that you did.