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Aging in Place Tips

Many seniors prefer to stay in their own homes as they age – or “age in place” – but not all homes are set up to accommodate the physical challenges of aging adults. If you or your loved one would like to remain in your home, there is good news. Often just several small changes can have a big impact on successfully aging in place and by utilizing the principles of Universal Design (UD), homes can be adapted to be more accessible, more functional and safer.

Small changes in the home can actually make a big difference, such as changing lighting to reduce glare, installing handrails on staircases or smoothing thresholds. These changes make the living environment easier and safer for all ages, from toddlers to seniors.

Depending upon the current set up on the home, some changes may involve select remodeling, such as updating a bathroom with roll-in shower or removing loose rugs and installing wall-to-wall carpeting instead. These types of Universal Design elements require a monetary investment but it would be less expensive and less disruptive than moving into an assisted living facility.

If you planning on building a home, consider incorporate UD elements in your new space no matter what your current age and physically ability is. With the aging populations, incorporating features such as hallways wide enough for wheelchairs or walkers, low light switches, higher electrical outlets and installing blocks behind walls to accommodate grab bars later can add great resale value to the home.

You may also want to consult with interior designers and home builders who are Certified Aging in Place (CAP) specialists. These professionals can help determine which UD elements to bring into your current home or incorporate into your new home’s blueprints.

Helpful Universal Design Elements:

  • Motion detector lights
  • Reduced or no-glare lights for general lighting, task lighting for tasks
  • Handrails on both sides of stairs
  • Electric outlets that can be reached from a wheelchair
  • Lowered light switches that can be reached from a wheelchair
  • Programmable thermostats
  • Drawers instead of cabinets in kitchen
  • D-shaped cabinet and drawer pulls
  • Wall-to-wall carpet instead of rugs
  • Wires neatly managed, off floors or behind walls
  • Grab bars by toilets and in showers
  • Roll-in showers and room for shower seat
  • Hand-held shower heads on glides
  • Non-slip, low-maintenance floors in bathrooms
  • Kitchen, bedroom, bathroom and laundry on same floor (ground level or accessible by elevator)
  • Side-by-side refrigerator/freezer
  • Accessible from wheelchair/counter height dishwasher, microwave, stove and oven
  • Flat cook top/range with front controls
  • Varied counter heights so cooks can sit or stand
  • Beveled corners on counters, furniture and walls
  • Front-load, front-control washer and dryer
  • 36-inch-wide doorways and hallways

Visit the National Aging In Place Council to learn more about how you can age in place and visit The National Association of Home Builders to find a Certified Aging in Place (CAP) specialist.

If the time has come when your aging loved one is no longer able to live independently, please contact the knowledgeable staff at ElderLink to help you find elder care services or an assisted living facility within California that is customized for your family.

Understanding Home Health Care Part II

In Part One of Understanding Home Health Care, we explained the most common differences between home health and home care. In this second part of the series, we will provide brief summaries of the trained professionals that you may encounter when working with a home health care agency.

It is important to remember that unlike home care agencies, home health agencies provide services and treatment that are prescribed by a doctor and are usually part of a transition from a hospital stay back into a home environment. Therefore, home health agency fees are usually covered by medical insurance, Medicare or Medicaid.

The type of care provided by health care professional will depend on the needs of each individual and may occur in-home through a home health agency or may occur on an outpatient basis.

HOME HEALTH AIDES/ASSISTANCE ADLS

Individuals trained to assist with personal care needs and activities of daily living (ADL). ADL are the essential self-care tasks, such as bathing, ability feed oneself, dressing, toileting, transferring from a bed to a chair, etc. Additional tasks and responsibilities may be assigned to aides depending upon the agreement between the home health aid agency and the family. Home health aide’s assistance may range from a few hours per week up to 24-hour care, either on a temporary or long-term basis.

SKILLED NURSING

Skilled nursing refers to the services performed by a licensed Registered Nurse (RN) or Licensed Practical Nurse (LPN) and these nurses are registered with the State Board of Nursing in their respective state. Skilled Nurses provide medical care as prescribed by physician and may also provide patient assessments, performance of prescribed medical treatments and administration of prescribed medications. Additional services may also include education for the patient and the caregiver to the disease process as well as treatment options, health measures and medication management.

PHYSICAL THERAPY (PT)

Physical therapists assess and treat large motor function skills when prescribed by a doctor. Depending upon the needs and mobility of the patient, PT may be conducted on an outpatient or in-home basis. Physical therapists will create a treatment plan with goals and utilize rehabilitative techniques, which may include exercise, gait training, prosthetics and heat to restore the highest functional level of strength, range of motion and mobility based on the individual abilities of the client.

OCCUPATIONAL THERAPY (OT)

Often prescribed along with physical therapy (PT), occupational therapists (OT) assess and treat small motor function. Occupational therapists will design a treatment plan designed to increase the client’s ability to carry out their regular day-to-day activities, such as feeding, dressing, grooming and performing household tasks. Using rehabilitative techniques such as exercise, splinting and assistive devices, the OT guides the client through specialized regimes, exercises and activities to increase function, sensory and muscle strength.

SPEECH THERAPY (ST)

If an individual has difficulty with speaking or swallowing, a speech therapist will be called in to assess and treats speech and swallowing disorders that may have been caused by a stroke, head injury, laryngectomy, voice disorders or cognitive deficits. Individually designed treatment programs will be created by the speech therapist to maximize communicative effectiveness for the client.

These are the most common types of agencies to provide in-home or outpatient care. In case of injury, such as a broken hip or knee replacement, in-home care may only be needed for several weeks. Navigating the system of elder care services and agencies can be confusing for anyone. Sometimes it can be overwhelming. Finding the appropriate level of care and caregivers you can trust can take time but it is time well spent.

If the time has come when your aging loved one is no longer able to live independently, please contact the knowledgeable staff at ElderLink. We will help you find elder care services or an assisted living facility within California that is customized for the requirements of your family.

Understanding Home Health Care

One of the most confusing elements of securing care for seniors is deciphering the difference between home health versus home care. Although it might seem like a minor difference, the distinction between the two terms is more than splitting nouns to professionals in the industry – especially for insurance providers.

One of the most important differences is that care provided by home health agencies are usually covered by medical insurance because these services are prescribed by a doctor and are often part of a transition from a hospital stay back into a home. Home care services are not usually covered by medical insurance but may be covered by long term insurance. The main reason why medical insurance covers one and not the other? Home health services require a trained professional, such as a physical therapist, occupational therapist, registered nurse or certified nurse assistant, while home care services generally not to require professional training or education.

The type of care and the insurance coverage that will be provided depend on each individual but these are some of the key terms you should know.

HOME CARE/ASSISTED LIVING/COMPANION OR RESPITE CARE
This type of care is often provided by friends or family members and includes assistance with daily living tasks. When looking for an extra pair of hands outside your immediate circle, Home Care Agencies can offer assistance. The types of services provided may include light housekeeping, shopping, cooking, laundry, medication reminders, companionship and even transportation to doctor’s appointments, shopping or recreational activities. These agencies usually charge by the hour and may require a minimum number of hours for each shift. Beyond any minimum shift requirements, these types of agencies may offer services for up to 24 hours, allowing the primary caregiver (often a spouse) the opportunity to get away for a few hours or even for several days. Benefits of using a home care agency include care coverage in the case the regular agency care provider is unavailable, employment taxes and fees are handled by the agency and agency caregivers often have some related training. Depending upon your policy, these services may be covered by long term insurance.

HOME HEALTH (AGENCY)
Generally licensed by each state, home health agencies primarily provide skilled care, although some may also provide companion and home care services. Common services provided by home health include nursing care, physical therapy, occupational therapy, speech therapy and respiratory therapy. Some agencies may also provide medical equipment and supplies as well as home health aide services, such as assistance with bathing, dressing and eating. In addition to providing services to patients in private homes, home health agencies may also be able to provide services to patients in assisted living facilities and adult family care homes. Scheduling the services of the medical professionals, including the nurses and therapists, is not as definite as with home care staff as home health professionals are usually going from one patient home to another. The services for skilled home heath care are usually paid in part or entirely by an array of health insurance and long term care insurance, depending upon the policy. Services may also be paid out of pocket or on a fee-for-service basis.

MEDICARE HOME HEALTH AGENCY
These agencies provide skilled care in a person’s home and paid for by Medicare if the following conditions are met: the patient must be under the care of a doctor and you must be receiving services under a care plan established and reviewed on a regular basis by a doctor. As part of this process, a doctor must certify that the patient needs one of more of the following: intermittent skilled nursing care, physical therapy, speech-language pathology services and/or occupational therapy. The agency must be approved by Medicare (aka Medicare certified) and doctor must also certify that the patient is homebound. If these conditions are met, Medicare is likely to pay for your covered home health services for as long as the patient is eligible and the doctor certifies that the services are necessary. Usually homebound patients are still permitted to leave home for medial appointments or procedures as well as brief non-medical reasons, such as a haircut or to attend religious services. Please consult your doctor and agency for specific requirements and eligibility.

These are the most common types of agencies to provide in-home or outpatient care. In case of injury, such as a broken hip or knee replacement, in-home care may only be needed for several weeks. Navigating the system of elder care services and agencies can be confusing for anyone. Sometimes it can be overwhelming. Finding the appropriate level of care and caregivers you can trust can take time but it is time well spent.

If the time has come when your aging loved one is no longer able to live independently, please contact the knowledgeable staff at ElderLink. We will help you find elder care services or an assisted living facility within California that is customized for the requirements of your family.

These Preventive Measures Might Help Delay Dementia Or Cognitive Decline

In a landmark report, scientists have endorsed three strategies for preventing dementia and cognitive decline associated with normal aging — being physically active, engaging in cognitive training and controlling high blood pressure.

This is the first time experts convened by the National Academies of Sciences, Engineering and Medicine have deemed scientific evidence strong enough to suggest that preventing dementia and age-related cognitive decline might be possible.

Seven years ago, in a separate report issued by the Agency for Healthcare Research and Quality, scientists said they couldn’t recommend any interventions to forestall or slow cognitive deterioration because state-of-the-art science at that time didn’t offer enough support.

Now there’s a considerably larger body of research to draw upon. And while findings are still far from definitive, “we found encouraging evidence that supports the value of several interventions,” said Story Landis, vice chair of the 17-member panel that prepared the report and director emeritus of the National Institute of Neurological Disorders and Stroke.

That doesn’t mean the strategies are guaranteed to protect brain health. “You can do everything right and still get dementia in later life,” said Dr. Kenneth Langa, a panel member and professor of internal medicine, gerontology and health management and policy at the University of Michigan School of Public Health.

Nor does it mean these are the only interventions that offer promise. Managing depression, controlling diabetes and high cholesterol, engaging in social activities, getting adequate sleep, eating a healthful diet, taking disease-modifying treatments for dementia (if and when they become available) and getting enough vitamin B12 and folic acid also appear worthwhile, though more research is needed before those tactics can be formally recommended, the NAS report said.

Addressing lifestyle factors that raise the risk of cognitive impairment could help prevent more than one-third of dementia cases across the globe, according to a separate comprehensive analysis published in The Lancet on Thursday.

The NAS panel proposed that its findings be shared with the public and physicians, but stopped short of proposing a major public health campaign, citing the need for further research.

Here are insights from the report, based on interviews with panel members and outside experts:

Strategies Work In Some Cases, Not Others

As people age, mental processing becomes slower and memory becomes less reliable — a normal condition known as age-related cognitive decline.

Two of the interventions recommended in the NAS report — cognitive training and physical activity — appear to have the potential to delay age-related cognitive decline. But there’s no evidence that they can prevent dementia or mild cognitive impairment, an intermediate condition that sometimes progresses to dementia.

Managing high blood pressure is the only strategy thought to have the potential to prevent or delay the onset of Alzheimer’s disease. But it wasn’t shown to have an impact on age-related cognitive decline.

Once the hallmarks of Alzheimer’s are detected — notably amyloid beta plaques and tau tangles in the brain — some interventions might not be effective, said Dr. Ronald Petersen, a member of the NAS panel and director of the Mayo Clinic’s Alzheimer’s Disease Research Center.

Start Early

It’s now known that biological changes associated with Alzheimer’s and related dementias begin a decade or more before any symptoms become evident. So it’s best to make recommended lifestyle changes early and sustain them over time.

“Prevention really needs to start in people who don’t show any sign of the disease — probably when people reach their 40s,” said Jeffrey Keller, director of the Institute for Dementia Research and Prevention at Louisiana State University, who was not involved in the NAS study.

Controlling high blood pressure, a strategy that helps preserve the health of blood vessels in the brain, is most effective if begun in middle age, the NAS report explained. But if you’ve reached age 65 and your blood pressure isn’t well managed, you’re still well advised to bring it under control, Landis said.

The same applies to physical activity: It’s best if you start in middle age, but becoming more active in later life is still good for your health. While it’s not yet known which type of activity is most effective, for what duration and how often it should be pursued for maximum brain benefit, walking briskly for 150 minutes a week or about 20 minutes a day is a good idea, Petersen said.

On Cognitive Training

Probably the best cognitive training you can get is a good education and ongoing mental stimulation. “There’s growing evidence that the ways in which your brain is challenged all through your life matter,” noted Langa, whose research has documented a decline in dementia rates in high-income countries over the past 25 years.

But the impact of education on brain health is very difficult to quantify. So the NAS panel endorsed cognitive training based largely on a randomized controlled trial known as Advanced Cognitive Training for Independent and Vital Elderly, which studied several thousand older adults over the course of 10 years.

ACTIVE had certified trainers work with seniors in small group sessions on various cognitive exercises for 10 sessions lasting an hour or more over five to six weeks. Feedback was an essential part of the intervention and booster sessions were offered. At 10 years, there was evidence of a positive effect on seniors’ independence and ability to perform daily tasks.

What was responsible for this effect? The training? Social interactions? Feedback? Booster sessions? All or some of the above? It’s not yet clear.

It’s important to note that the panel insisted that commercially sold computer-based brain games can’t be assumed to have the same effect. So far, research about brain games has failed to prove that this type of training improves broad-based cognitive functioning and people’s ability to function independently.

“The data supporting their efficacy just isn’t there,” said Petersen of the Mayo Clinic.

Try Several Things, Not Just One

When scientists examine the brains of people with Alzheimer’s disease, they find amyloid beta plaques and tangles, but also changes in blood vessels, evidence of microbleeds, and lesions in the brain’s white matter. “It’s mixed dementia, due to multiple factors — not just one thing,” Landis said.

The corollary: Mix it up and try several ways to reduce age-related cognitive decline or dementia, not just one.

“If we think of Alzheimer’s as a multifactorial disease, it makes sense to reduce multiple risk factors simultaneously,” said Rong Zhang, associate professor of neurology and neurotherapeutics at University of Texas Southwestern Medical Center. Zhang is also the principal investigator for a five-year study investigating whether aerobic exercise combined with intensive control of hypertension and cholesterol can help prevent Alzheimer’s. That study, the Risk Reduction for Alzheimer’s Disease trial, is currently enrolling participants at six medical centers.

“The brain is complicated and its response to interventions is complex,” Langa said. “Therefore, the more strategies that you use to try to improve the brain’s health long term, the more likely they’re going to work.”

Don’t Bother

The NAS report found no evidence supporting the use of ginkgo biloba and vitamin E, which are widely marketed to people concerned about brain health. And it questioned the value of other supplements, noting that overall dietary patterns appear more important than any single substance.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

The Elderly and Falls

The older you get the harder you fall might be a misquote from the old adage, but has some truth to it. For those aged 65 and older, falls are among the leading cause of death due to injury and it is estimated that in the United States, one out of every three adults 66 years or older falls each year.

Unfortunately, research published in the American Journal of Preventative Medicine found that 60 percent of fatal falls for older adults 65 and older occur at home, 30 percent happen in public places and 10 percent occur in health care institutions. Unfortunately, many falls cannot be foreseen or prevented but there are some risk factors that can be controlled.

Risk Factors
Environmental factors, including slippery surfaces, poor lighting, steps and loose rugs
Use of equipment, such as a cane or walker
Non-adherence to safety practices
Gait and balance impairments
Visual impairment
Physical conditions, such as stroke, arthritis, muscle weakness, glaucoma, cataracts, hearing loss or foot problems
Age
Fall history and fall related injury
Neurological disabilities, including Parkinson’s disease or stroke
Cognitive impairment and/or behaviors
Medication use, side effects, multiple medications or psychotropic utilization

While caretakers cannot necessarily prevent an elderly adult’s fall, they can work to minimize the risk as well as increase the response time of medical assistance should a fall occur. The most common fractures from a fall include pelvis, hip, femur, vertebrae, hand, forearm and ankle.

In addition to the stress and pain, the elderly who have taken a fall are also at a greater risk of complications such as pressure sores resulting from immobility as well as decreased appetite, infections, respiratory issues, pneumonia and incontinence.

So what can you do if your aging loved one does experience a bad fall? Develop a care plan that takes into account your loved one’s age, medical history, risk factors for falling again, mental health, functional abilities, expectations and willingness to follow the plan. Determine whether recovery and rehabilitation should occur in home or in a care facility and work with doctors, physical therapists, occupational therapists and other care givers on developing and following exercise, restorative and/or physical activity programs.

If the time has come when your aging loved one is no longer able to live independently, please contact the knowledgeable staff at ElderLink to help you find elder care services or an assisted living facility within California that is customized for your family.