Caregiving For Dementia Patients A Guest Post by Olivia Wolfe

Dementia

Caring for dementia patients can be frustrating and difficult. Because dementia patients are suffering from a brain disorder, basic communication can be a challenge. With that said, we have partnered with Private Home Care in St. Louis to showcase some things that will help you to communicate with people that have dementia effectively. Communication is the key to excellent care.

Get The Patient’s Attention When You Enter The Room

It’s easy for patients with dementia to become disoriented. Even minor surprises can set them on edge. Because of this, it’s important to get the attention of a patient before you interact with them.

Even if the door to the room they are in is open, you should know before entering. You should also call out their name and make sure they see you. If you let them know you are going to be entering the room, they will be prepared to interact with you.

Set A Positive Mood

You should always be pleasant and friendly when you interact with a patient that has dementia. People with dementia often experience significant amounts of anxiety. If you can create a positive environment, you will be able to alleviate that anxiety.

When you greet a patient with dementia, you should greet them with a big smile. Be pleasant and cheerful whenever they ask you questions. If you’re friendly and happy, they will know that they can relax around you.

Keep Things Simple

People with dementia can’t always think quickly. You should use simple words when you are interacting with them. While you shouldn’t necessarily treat a dementia patient like a child, you should try to keep things simple. Work to avoid confusing them.

You don’t need to use medical terminology when talking to them. You should always make your explanations clear and easy to understand. If a dementia patient does not know what is going on, they are going to become anxious. This could cause behavioral issues. Try to keep things simple when you provide care. If the patient can follow what you are doing, they won’t have to worry.

Have Fun With The Patient

While dementia patients may lose some mental abilities, they still have a sense of humor. It’s okay to joke around with a dementia patient from time to time. If you can get them laughing, it will be that much easier for you to get them to relax.

Obviously, you shouldn’t make fun of a dementia patient; you don’t want them to be the butt of your jokes. However, a few simple, lighthearted comments should be enough to set them at ease. You may even be able to get them to make a joke of their own.

Don’t Just Listen With Your Ears

When you’re interacting with a dementia patient, you need to listen to them carefully. It isn’t always easy for people with dementia to express themselves. You need to pay close attention to what they tell you.

However, you shouldn’t just listen with your ears. You should also pay close attention to the way the patient is behaving. If you can see that the patient is anxious or upset, you need to try to address that.

Try to remain focused on the patient you’re caring for at all times. If you pay attention to them, you’ll be able to see what they need. Being receptive to a patient’s needs is an essential part of being a caregiver.

Break Things Down Into Steps

It can be hard for dementia patients to process a lot of information at once. That’s why it’s smart for you to break things down. Instead of overloading them with information, you should present them with one thing at a time.

If you are planning on getting a patient ready for a doctor’s appointment, try breaking down each step of the process. Tell them you are going to brush their teeth, brush their hair, get them dressed, and take them outside. If you handle things one step at a time, the patient will understand what is happening in the moment.

Reassure Your Patient

Whenever you see your patient looking nervous or confused, you should reassure them. A little bit of encouragement can go a long way. Make sure your patient knows that everything is going well.

If you regularly praise or reassure a dementia patient, they will know that they are doing what they are supposed to do. If they are getting praised, they won’t want to panic. It will be easy for them to remain calm as you provide care.

There are a lot of challenges associated with caring for dementia patients. With that said, proper communication will make it easier for you to provide essential care. As long as you’re ready for the challenges associated with caregiving for dementia patients, you should be able to provide high standards of care.

Cardinal Tips For Caregivers of Senior HIV Patients A Guest Post by David Beeshaw

Elderly woman and young female caregiver at home

In 2014, people aged 55+ accounted for 17% of Americans living with a diagnosed HIV infection.

Even if this age group has the same risk factors as young people, they might be less aware of them – especially since most awareness campaigns don’t target older adults. Most of the time, they don’t think HIV is an issue for them and may be less likely to protect themselves. That’s why it’s older Americans that are most likely to learn about their HIV infection later in the course of their disease.  As a result, they start the treatment late and might suffer from more damage to their immune system.

These are the basic facts every caregiver should know before starting to provide care for senior patients with a diagnosed HIV infection.

However, that’s not everything. Here are 4 critical tips for caregivers of senior HIV patients.

Be aware of the stigma

Patients diagnosed with HIV often face social stigma and might be suffering from lack of support from others in their circle of family and friends who in turn might lack knowledge about HIV. Older people might already feel isolated because of their illness or loss of friends and family.

Social stigma might affect their self-image and quality of life. It often discourages these patients from seeking care or disclosing their status to others. Adults diagnosed with HIV are 5 times more likely to experience depression and be at risk of suicide than HIV-negative adults.

HIV and aging

Aging with HIV infection is challenging because the disease increases the risks that come with aging: particular cancers, thin bones, or cardiovascular disease.

That’s why care providers should make sure to maximize their efforts to prevent these conditions and look for signs of illness early on. Caregivers should also pay attention to the potential interactions between medication used to treat HIV and those used by the patient to treat common age-related conditions such as obesity, elevated cholesterol, diabetes, or hypertension.

Antiretroviral treatment allows patients diagnosed with HIV to achieve a near-normal life expectancy. However, senior patients are more vulnerable to infections and illnesses because of their age. Caregivers should minimize their exposure to common illnesses such as the flu that could bring about complications (like pneumonia) for patients with a compromised immune system.

Research the disease

Caregivers should educate themselves about HIV and AIDS. Knowing how the HIV infection is spread is a helpful measure against social stigma. Caregivers should also know how an HIV infection develops and when it might lead to the patient developing AIDS. Being aware of what different treatment regimens entail is helpful as well.

Follow these rules while providing care

Caregivers who provide care to senior patients diagnosed with HIV should know how the infection is spread and what they can do to prevent it.

Here are some tips on how to prevent the spread of HIV infection while taking care of a diagnosed patient:

  • Always wear vinyl or latex gloves if you might have contact with bodily fluids or blood from a person infected with HIV. Wear such gloves when cleaning articles soiled with vomit, feces or urine to avoid infection with other germs. Remember to wash your hands after any contact with blood, even if you wore gloves.
  • Flush all liquid waste that contains the patient’s blood down the toilet.
  • Items that aren’t flushable (sanitary pads, paper towels, wound dressings) need to be placed in a plastic bag. Close the bag securely before throwing it out. Remember to check in with your local health department about the disposal of such items.
  • Cover all breaks, cuts or sores in your exposed skin.
  • Wash all clothing and linens together – those worn by the patient don’t need to be separated.
  • Dishes used by the patient don’t need to be separated and can be cleaned using regular methods.
  • Be positive!

Follow these 4 tips and you’ll be on your way to providing top-quality care to a senior patient who has been diagnosed with an HIV infection.

Author’s Bio:

David Beeshaw is a staunch advocate of regular exercise and leading a healthy lifestyle. He is also a writer at raTrust, a non-profit organization dedicated to helping those at risk of STIs and HIV. Verify raTrust on BizDb.

Navigating Medicare – Understanding Medical Supplies vs. Durable Medical Equipment A Guest Post by Rodger Sims

Medicare

Medicare is a health insurance program that covers people who are over 65 and can cover younger people with disabilities and people suffering from kidney failure, known as end-stage renal disease (ESRD). With over 71.3 million people enrolled, Medicare is one of the largest insurance providers for seniors in the United States. If your loved ones are enrolled in Medicare, it is important to know how to navigate your options.

There are four different parts to Medicare:

Medicare Part A

Part A covers your hospital insurance. This coverage includes inpatient hospital stays, care in a nursing facility, hospital care and even some home health care. If you’ve worked over ten years and have paid into social security taxes, this coverage is free to you. In 2015, Medicare Part A had served 7.7 million patients.

Medicare Part B

Part B covers medical insurance and includes certain doctor’s services, outpatient care, medical supplies and preventative services. In 2015, Medicare Part B had served over 33.8 million seniors.

Medicare Part C

Part C is a health care plan offered by a private company that can help you with both Part A and B benefits. Known as a Medicare Advantage (MA) Plan, services offered include health maintenance organizations (HMO), preferred provider organizations (PPO), private fee-for-service plans, special needs plans and Medicare Health Savings Account (HSA) plans. Most of the Medicare Advantage Plans offer coverage for prescription drugs.

Medicare Part D

Part D of Medicare adds prescription coverage to the original Medicare, as well as to some Medicare cost plans, Medicare HSA and some private fee-for-service plans. In 2015, 38.9 million Americans utilized Part D of Medicare. Original Medicare is the tradition fee-for-service Medicare. The government pays directly for the health care services the patient receives.

Durable Medical Equipment vs. Medical Supplies

With all that in mind, it is also important to know that there are two main types of products: medical supplies and durable medical equipment (DME). Both DME and medical supplies are used to make meeting the basic needs of the elderly, ill or disabled patients at home.

Durable Medical Equipment

As suggested by the name, durable medical equipment is meant for long-term use. Medicare defines DME by the following criteria: durability, ability to be used in the home, not usually useful to someone who isn’t sick and must have a life span of three years of use. Examples of DME include hospital beds, mobility aids, prostheses (artificial limbs), orthotics (therapeutic footwear) and other supplies. Medicare pays for DME partially under Part A if the patient qualifies for home health benefit.

To qualify for home health benefit, the patient must be unable to leave his/her home, require care from a skilled nurse and does not require custodial care, such as bathing and toilet-usage. If the patient is eligible for home health benefit, Medicare will cover 80% of the allowable amount for DME.

An example of the allowable amount is the following: a patient needs a walker that costs $200. The allowable amount for the walker in that state is $100. Since Medicare will cover 80% of the allowable amount, the patient will then have to pay $120 for the walker. Under Medicare’s Part B coverage, the co-pay is the same at 20% of the allowable amount and any other additional expense after that.

For Medicare Part B, the patient does not need to qualify for home health benefit to be eligible for coverage. If a doctor or medical professional considers the product medically necessary, Medicare will partially reimburse the patient for it. One benefit of this is the ability to rent the product being needed and still be eligible for reimbursement.

Some DME products that are not covered by Medicare include hearing aids and home adaptation items like bathroom safety and ramps. Additionally, to be reimbursed, your product supplier must be enrolled in Medicare and adhere to their guidelines. If they are not, Medicare can refuse their claims.

Make sure your providers are eligible before purchasing any products.

Medical Supplies

Medical supplies are made for short-term use. They are typically used once then thrown away. Examples of medical supplies include diabetic sugar testing strips, incontinence products (diapers, catheters, etc.) and items like bandages and protective gloves. Generally, medical supplies are not covered by Medicare, though there are a few exceptions for patients with diabetes, ostomy patients and those currently using feeding tubes. These items, however, are limited.

Ostomy products can be limited to a certain number a month. If necessary, a patient can appeal to increase the number of products received a month but must go through a process to do so. This process includes re-approval through Medicare and by a doctor.

Your Options

If you can provide insurance for your loved ones and cost isn’t a large factor, it is useful to know that Medicare can be paired up with other private insurance companies. Doing so can help get over some of the limitations that are imposed by Medicare and ensure your senior has an overall health coverage. If this is not an option, then medical supplemental health insurance, known as Medigap, can help provide funds for expenses Medicare doesn’t cover.

To qualify for the Medigap program, you must be enrolled in both Medicare Part A and Medicare Part B. Medigap can cover excess costs, like co-insurance costs such as stays in the hospital or nursing home, and deductibles in Part A and Part B plans. Costs will vary according to coverage.

Medigap is available through private insurances or organizations that cater to the elderly.

Final Thoughts

Medicare covers durable medical equipment primarily under Part B, but also for DME for people under Part A with the home health benefit plan. Most medical supplies are not commonly covered by Medicare, and those that are covered tend to have limitations. Other options to ensure your senior has all their needs covered including pairing Medicare with a private insurance company or enrolling them in medical supplemental health insurance to help cover excess costs.

With the introduction and popularity of the internet, finding the supplies you need at the right cost is easier than ever before. Different websites offer low-cost medical supplies to help ensure the basic needs of your seniors are met. It is also easier to find the right insurance company for them with all the information available online.

For more information about Medicare and what it covers, got the Medicare website at Medicare.gov.

Images

https://www.shutterstock.com/image-photo/medicare-enrollment-form-glasses-398418109?src=YZoPqz-O9WK3A8VVD8TyZg-1-2

https://www.shutterstock.com/image-photo/empty-bed-on-hospital-ward-247358674?src=Q9ck6CAXE6czGlRyWlBoZA-1-2

https://www.shutterstock.com/image-photo/diabetes-test-blood-medical-equipment-506370463?src=jqL9R3jY1Q44pQysfDM6NQ-1-4

Sources:

https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/whats-medicare/what-is-medicare.html

https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/cms-fast-facts/index.html 

 

Hospice: The Gentle Goodbye A Post by Phyllis

Angel Wings 2
Pair of angel wings on heavenly blue background

Just after dawn on December 11, 2007, my mother went to God. There was a beautiful peacefulness that fell over that bright, winter morning that seemed perfect. Mom had battled several chronic, debilitating diseases that slowly robbed her of her energy and physical function. Her mind was always clear and her determination to live to see her grandchildren grow and to be with her husband of 59 years was intact. Unfortunately, her body had betraying her. Mom and I were very different. Our life’s journey together could best be described as rocky but the journeys end was her last gift to me.

It began one Thursday evening when I went to visit my parents. Mom had just come home from yet another unavoidable hospitalization. She was out of immediate danger but the likelihood of a relapse and perhaps a challenging surgery was weighing heavy on her mind. She looked tired, frail and was having difficulty speaking. I could sense she was in pain although she characteristically denied it. As I sat down next to her, she looked me right in the eye and in a clear voice said, “I’m too weak to live and too strong to die. I want to go to God.” She went on to explain that she was done taking her medications, had seen her last doctor, and had been to the hospital for the last time. If those declarations weren’t enough she asked me, “What are you going to do?” I knew immediately what she meant. She wanted me to take control of this out-of-control situation. She was entrusting me to help her live her last days in comfort and dignity. She wanted me to ensure that her transition from this life would be as gentle on her husband, children, grandchildren, and family as possible. The best solution was to arrange for hospice services.

I was the nurse in the family and I tried my best to collaborate with mom’s private doctor. We spoke so often that we were on a first name basis for many years. Dr. Bob had grown very fond of my parents and their relation. Our common goal was to keep mom comfortable and out of the hospital. Once my mom’s wishes were clear, my role was then to ensure that those wishes were carried out. First, I helped my dad understand and accept her decision. Next, I call Dr. Bob and explained her request. He was very supportive. We both knew that the only treatment he could offer her was palliative. Clearly, in his medical opinion, mom had less than six months to live. He made all the arrangements from his office. Finally, it was now time to call my sister.  The inevitability of losing our mom to death was here. Thankfully, as in all things pertaining to our parents, we would do this together.

The next twelve days were exceptional. Mom was peaceful with her decision. She enjoyed her days with dad, her visits with her grandchildren, and her messages from family and friends. Although she refused to take any more medication, she did allow the hospice nurse to obtain an order for pain meds so she could be truly comfortable. The hospice team arranged for a priest to come to the house. She received the sacraments of Holy Communion and the Anointing of the Sick. Mom prayed her rosary daily and in a few days slipped into a coma.

For twelve days the angels from hospice supported my family through the process of letting go. They immediately responded to phone calls and answered endless questions. Nurses came daily with supplies, understanding, and support. Their presence and professionalism allowed me the opportunity to be a daughter and not a nurse. On the day that mom died, it was the hospice nurse that we called first. She came right away, pronounced her and walked us through the next step.

The Value of Choice

I have been a nurse for 30 years now. For the majority of my career I practiced in critical care and emergency trauma units. I fought death constantly with knowledge, skill, medications, and technology. I had limited success. During the last 10 years however, my focus has shifted from the length of one’s life to a profound appreciation for the quality of one’s life. High tech healthcare has its place when lives need to be saved. However, death does come to us all.

Hospice services allow for the care of loved ones to take place in safe, familiar surroundings with those they love close by. It empowers the patient through their last days, offers them the respect of honoring their choices and the dignity of privacy. Hospice care assists the family during horrific moments of anger, regret, and grief that under less supportive circumstances could seriously challenge the family’s unity.

It’s important to understand that hospice is a philosophy of care rather than a specific place. It is an option for people whose life expectancy is six months or less. Treatment outcomes are based on pain and symptom relief rather than pursuing curative measures. This approach enables the person to live his/her last days with dignity, grace and support. Hospice affirms life and does not hasten or postpone death. Hospice care focuses on all aspects of physical, social, emotional, and spiritual well-being. There is no age restriction. Anyone in the last stages of life is eligible.

Hospice Care Services

  1. The Interdisciplinary Team: Team members include doctors, nurses, social workers, counselors, home health aides, clergy, therapists, and trained volunteers who offer support based on their areas of specialty. The team provides a comprehensive palliative plan of care aimed at relieving symptoms and giving social, emotional, and spiritual support.
  2. Pain Management and Control of Symptoms: The goal of these services is to help the patient to achieve comfort while allowing them to remain alert enough to make important decisions and remain in control.
  3. Spiritual Care: Since people differ in their spiritual needs and religious beliefs, spiritual care is individualized and never forced.
  4. Home Care and In-patient Care: Hospice care is typically centered in the home. However, it may be necessary to admit the patient to a hospital, extended-care facility, or a hospice in-patient facility. The hospice team can then facilitate this transfer and stay involved in the patient’s treatment. The team can also facilitate resuming in-home care when appropriate.
  5. Family Conferences: These conferences are facilitated by the hospice nurse or social worker. They serve to help family members stay informed about the patient’s condition and what to expect. Family conferences also provide an opportunity and safe forum to share fears, feelings, talk about expectations, and learn about the process of dying.
  6. Bereavement Care: Bereavement is the time of mourning following a loss. The hospice team works with surviving family members to help them through the grieving process. The team can refer family members and friends to other professional services if necessary. Bereavement follow-up services are provided for at least a year after the loved one’s death.

Hospice Care Settings

Approximately 80 to 90 percent of hospice services are provided in the home. But, it is important to know that if the patient’s lives in a nursing home, hospice services can be offered there as well. Hospitals that treat seriously ill patients often have a hospice program too. Some hospitals have a dedicated hospice unit, while others have hospice teams who visit patients in any unit. Lastly, many communities have independently owned hospice centers that feature in-patient care as well as home care hospice services. Independent hospice center can benefit individuals who do not have family caregivers.

Who is eligible for Hospice Care?

  1. You are eligible for hospice care if your doctor has certified your prognosis as not longer than six months. This applies to anyone of any age. Should you be blessed with improved health and no longer need hospice care, you will remain eligible to reapply for hospice care if it is necessary in the future.
  2. While the majority of hospice referrals are cancer related, hospice is not exclusively for cancer patients. People with terminal neuromuscular diseases or any end stage disease can also benefit greatly from the services. It is not uncommon for people with Alzheimer’s to be referred to hospice when they are in the final stages of the illness.

Are Hospice Services Expensive?

Hospice care customarily costs less than conventional care in a hospital or nursing home. This is because with home hospice, you pay only for the specific care that you need. In addition, volunteers may often provide many services at little or no cost, such as telephone support, meal preparation and running errands. Most private insurance plans, Medicare and Medicaid cover the services.

While patients usually pay out-of-pocket for any services not covered by insurance, hospice services can be provided without charge if you have limited funds. If you are unable to pay, most hospices will try to provide care using funds raised from community donations and charitable foundations.

Closing Thoughts

Hospice care truly provides for the gentlest of goodbyes. It allowed me the space and time to be able to cherish my last moments with my mom. I look back on those days in peace not pain and I will always be grateful for the last gift my mom gave me, her trust.

References

National Hospice & Palliative Care Organization

http://www.nhpco.org/custom/directory/main.cfm

Center for Medicare & Medicaid Services

http://www.cms.hhs.gov/center/hospice.asp

National Association for Home Care & Hospice

http://www.nahc.org/