Eldercare Tips | Caregiver Tips

Archive for June, 2010


Posted on June 30, 2010 - by

NEVER EVENT – WHY JUST FOR HEALTHCARE?

“Never Events” refer to a list of 28 inexcusable outcomes, the result of spending some time in a healthcare setting. Of course the most horrendous of the hospital events are on the list. As horrific and newsworthy as these events are:

  • A foreign object left in a patient after surgery
  • Giving a patient the wrong blood
  • Surgery on the wrong body part
  • Surgery on the wrong patient
  • A patient death due to medication error
  • Patient death due to electric shock in the healthcare facility
  • Patient death due to a fall in the healthcare facility
  • Patient death due to a burn sustained in the healthcare facility

These are considered, and rightly so, events that should never happen in a healthcare setting. Medicare started denying payment for eight never events in October of 2009. Insurance companies usually follow Medicare’s lead and of course we can expect everyone to really run with this. At some point, that original list will really seem like small potatoes. Of course as money is saved refusing payment, I doubt the patients will see any savings.

However, when we get into the area of skin breakdown in the elderly, can we be as sure as to where to place blame?  (In-house acquired wounds and infections are on the list) Or, how about infections acquired in a healthcare setting?

I remember an elderly lady who in her last month of life did start to have “in-house acquired” skin breakdown. She had large, very dark areas of skin, that you just knew were going to open up and be ugly. Because the breakdown was happening from the inside out – not from the outside in, (as happens with poor care) we realized this was just part of her body shutting down.  As this wonderful woman was dying the Director of Nursing wanted her sent out of the building, because she didn’t want one of those “in-house” acquired wounds in her building. Fortunately, common sense prevailed and this elderly woman was allowed to stay, and die being cared for by the staff that had gotten to know her so well for her last six years.

Blame is easy to assign, when a blatant mistake is made. But, sometimes it’s not so easy to designate the blame, and playing the blame game, can take the focus away from patient care.

Here’s an idea. How about coming up with a list of “Never Events” for the Oil Industry?  Maybe some “Never Events” for Congress that makes them stop and think before they allow Wall Street to bet against the country? How about some “Never Events” to prevent the real estate industry from falsifying applications so people can buy what they can’t afford? Just a thought.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com


Posted on June 29, 2010 - by

AGITATION AND AGGRESSION IN THE CONFUSED ELDERLY WITH ALZHEIMER’S DISEASE

Aggression on the part of an elderly person with Alzheimer’s disease is usually a reaction, and triggered by a small unimportant incident.

Aggression on the part of a confused elder is typically:
Not planned
Not premeditated
Doesn’t have a long-term goal
Can be explosive with no obvious buildup
Unusually is periodic
Is part of brief outbursts between long periods of calm behavior
More likely to be a burst of aggression and quickly forgotten by the elder
Seen in a married man who is taken care of by his spouse
A confused elder with few social contacts
Is likely to occur during times of direct hands-on care; bathing, toileting, dressing, shaving, eating

We are told that 70-90% of the elderly with Alzheimer’s disease have some behavioral problem. Who wouldn’t? If you don’t understand what is going on around you, what people are saying to you, what’s happening to you, why wouldn’t you become agitated or aggressive.

Leading cause of agitation and aggression -is loss of physical function
When the confused elderly person, wants is to take care of themselves, put their shirt on by themselves and they can’t seem to remember how.  And then someone tries to help them, when they struggle with that shirt. The elder can become agitated. A decline in physical function will lead to aggressive behavior faster, than a decline in cognitive function.. The caregiver many times doesn’t even know what the elder wants or what they are trying to do for themselves.

Aggressive and agitated behavior is one of the leading reasons a confused elderly is admitted to a Nursing Home. The family is able to handle the forgetfulness and confusion in the elder. But the aggression, especially on the part of an elderly man who is still very strong, becomes just too much for the family.

Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance


Posted on June 28, 2010 - by

WHEN AN ELDERLY PERSON HAS A SUDDEN CHANGE – IT’S NOT THE TIME TO PLAY DOCTOR, TIME TO GET A DOCTOR

Sudden, suddenly, all of a sudden, unexpected, immediate – when a change in condition is highlighted by an urgent word like “sudden. “ The response needs to reflect that urgent word with action.

Sudden changes:
Confusion
Severe headache
Speech
Vision
Paralysis
Disorientation
Hallucinations
Behavior
Attention
Balance/ability to walk
Incontinence
High fever

When you call the doctor or paramedics what they will want to know.
What is normal for this elderly person and what is unusual for this person.
Confusion – if the elder always knows where they are and now they don’t recognize their home, or anything else they normally know.
All of a sudden got “lost” driving, can’t find their house, lost in their own community.
Hallucinations- they are saying they are “seeing things, that aren’t there.”
Behavior – a person who is normally very calm and thoughtful – without provocation is angry, yelling, aggressive, and this is unusual for this elder.
Attention – especially if the person is going in and out of consciousness, has cloudy not clear thinking
Any recent falls or bumps to the elder’s head – even hours or the day before.

Now is not the time to play doctor.
With the elderly an emergency situation can be caused by an infection, side effects of a
new medication, low blood sugar, neurological problem, head trauma, – so many things.

See also blogs: WHEN THE ELDERLY HAVE A SUDDEN ONSET OF CONFUSION – IS IT DEMENTIA OR DELIRIUM? 3/22/2010 and part II 3/23/2010

Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegetoknowme.com


Posted on June 24, 2010 - by

NEWSWEEK ARTICLE GETS CAREGIVING FOR THE ELDERLY RIGHT

Newsweek June 28 & July 5, 2010, has the best article I have read for sometime on caregiving called The Caregiver Boomerang by Gail Sheehy author of ‘Passages.’

Excerpts from article:
Nearly 50 million Americans are taking are of an adult who used to be independent.

It starts with The Call. It’s a call about a fall. Your mom has had a stroke. Or it’s a call about your dad-he’s run a red light and hit someone, again, but how are you going to persuade him to stop driving?

This is a caregiving role that nobody applies for. You don’t expect it. You aren’t trained for it. And, of course you won’t be paid for it. You won’t even identify yourself as a caregiver.

Brothers bury their heads in the sand. The farther away a sister lives, the more certain she will call the primary caregiver and tell her she doesn’t know what she’s doing.

Ailing elders seldom say thank you. On the contrary, they often put up fierce resistance to the caregiver’s efforts.

Once the solitary caregiver gets so stressed out emotionally that her own health declines, she can no longer provide the care. The only option left is to place the family member in a nursing home-the last choice of everybody, the most expensive for taxpayers, and guaranteed to leave the caregiver burdened with guilt.

Right, right and right again. The author touches on the physical tool of care giving, but then Gail goes on to give the reader what she calls “survival strategies.” Her strategies again are right on and worth while taking a look.

See blog for more resources: Caregiver Support

Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com


Posted on June 22, 2010 - by

BEST SHOES FOR ELDERLY – KEDS

10 REASONS WHY I LIKE KEDS FOR THE ELDERLY

  • Elderly don’t tend to pick up their feet when they walk – they may “shuffle.”
  • Thick soled athletic shoes have a “super grip.”
  • Thick soled athletic shoes because of the super grip can “catch” on carpet and tile when an elder doesn’t pick up their feet and many times cause a fall.
  • Thick soled athletic shoes tend to be heavy shoes, the elderly need to wear a lighter shoe.
  • The elderly often lose sensation in the bottom of their feet – maybe due to diabetes or decreased circulation.
  • The elderly need to be able to “feel” the floor through their shoes – to help tell them where they are.
  • The elderly can better feel the difference between a carpeted surface and a tiled surface through a shoe with a thinner sole
  • Keds shoes have a thin and flexible rubber sole so the elderly can feel the floor better through the bottom of the shoe.
  • Keds  – “Champion” is the same shoe as their first design in 1916. Improvements in that original shoe increased the ability of the shoe to absorb shock and protect the foot from jars and jolts. (All with the same thin sole)
  • Elderly with Alzheimer’s disease need as much information as they can get as to what is going on around them. They even need the information they get from the bottom of their feet, through their shoes.

See also blog: March 18, 2010 – GOOD OLD “KEDS” – BEST SHOES FOR CONFUSED ELDERLY

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com


Posted on June 21, 2010 - by

THE AGING GUT – NO MATCH FOR ANTIBIOTICS OR WHY DOES GRANDMA KEEP GETTING DIARRHEA

Grandma is over 65 and therefore her digestion is not what it used to be. Now she has another sinus infection and is beginning on yet another round of antibiotics. She starts to complain about “not being able to control her bowels.” (watery diarrhea) She now starts wearing an incontinent product because she is afraid of having an “accident.”

Antibiotics are a true wonder of the age we live in. Anyone who has suffered from an infection gone wild can fully appreciate living in this time when we have easy and cheap access to these wonder drugs. In 1900, the age expectancy was just 49, and the dramatic increase in life expectancy since then, has been due in large part to the discovery and use of antibiotics.

However if you are one of those who have over used antibiotics or are old enough, like this Grandma, to have a more delicate balance of colon bacteria. Exercising caution by being aware of the side effects of using antibiotics, might be a smart investment in health.

The bacteria responsible for the diarrhea are “normal” to the colon but are held in check by other bacteria that are easily destroyed by antibiotics. These normal bacteria, then go out of control because this balance has been disturbed. A good protection is for the elderly to routinely take a probiotic product, especially when experiencing an infection and subsequent antibiotic treatment.

TV commercials are full of Ads for digestive aids especially yogurt with probiotics. The problem is that these products have very little live culture, or the amount necessary to replenish the lost healthy bacteria killed by the antibiotic. These products have undergone pasteurization which kills the live bacteria.  Probiotics are readily available at the drug store in capsule form. Because these products are live bacteria, they have expiration dates that are important to note.

Probiotics help in:
Eliminating toxins
Preventing allergic reactions
Digesting and absorbing food
Producing vitamins and absorbing minerals
Supporting the immune system

Probiotics may be a little pricey compared to other supplements. But since 80% of your immune system is located in the gut, protecting this fragile environment, especially in the elderly is so important.

Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com


Posted on June 18, 2010 - by

HOW TO HELP THE ELDER WITH ALZHEIMER’S DISEASE OR A RELATED DEMENTIA EAT SAFELY

Whether it is eating non-food items, using utensils incorrectly or having difficult behaviors during meals, solving mealtime problems for the elder can be challenging.

CODE IS AS FOLLOWS: Problem is stated and suggested correction follows in bold type.

PROBLEMS WITH USING DINING EQUIPMENT

  • Uses knife/fork/spoon incorrectly   – Using hand-over-hand, demonstrate use of utensil, if unsuccessful remove.
  • Eating non-finger foods with hands – Wash elder’s hands before the meal, and cut food in bite size pieces.
  • Elder is using cup or glass incorrectly – First demonstrate by using hand-over-hand – if unsuccessful remove.

PROBLEMS WITH FOOD

  • Elder mixes inappropriate foods together – If the elder eats less than 50% of the food – start serving just one item at a time.
  • Elder eats pieces of food that are too large for safe intake – Cut the food into bite size pieces before serving.
  • Elder just wants to eat sweets or deserts and neglects other foods – Don’t have anything sweet in sight, and just bring deserts out after the meal has been eaten.
  • Elder will only eat certain food groups or only liquids – Remove that food group – and serve at the end of the meal.
  • Elder eats too fast for safety – Keep reminding elder to slow down and chew (don’t leave unattended while eating) give the elder only small amounts of food at a time.
  • Elder eats everything and anything – even non-food items – Give the elder small meals more frequently (6 times a day) check the elder’s living area for unsafe items that may be ingested.

PROBLEMS WITH DINING BEHAVIORS

  • Impatient behavior before meal is served – Bring the elder to the table when the food is ready to be served.
  • Impatient behavior during the meal (fidgeting) – Take the elder to the bathroom immediately prior to the meal.
  • The elder stares without eating – Touch the elder’s arm, say the elder’s name, put a utensil in the elder’s hand and do some hand-over-hand to get them started.
  • Elder routinely gets up from the table and walks away without eating enough – Experiment with finger foods that can be eaten “on the run.” Many food items can be eaten rolled up in a piece of soft bread, pita pocket – anything that can hold food items.
  • Elder is always searching for food – Keep on hand small food items – individual jello containers, pudding containers or protein shakes.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com


Posted on June 17, 2010 - by

HOW TO SHAVE AN ELDERLY MAN WHO IS BEDRIDDEN

Safety concerns before you begin – is the elderly man on any blood thinners? If so you will want to use an electric razor. When using an electric razor – it should not be shared with other men for infection control reasons.

Assemble all of your equipment before you start getting the elderly man ready for the shave. Equipment you will need:
Razor – electric or safety razor (use the best/safest razor possible)
Shaving lather for safety razor or pre-shave lotion for electric razor
Towels – 2 small hand towels
1 large towel -to go under the man’s head and cover the pillow
Basin of warm water
Washcloth
After shave lotion

Procedure for shaving a bedridden elderly man: (encourage elder to participate as much as he is able to do)
Place all the assembled equipment on a bedside table close to elder
Raise the head of the bed so the elder is sitting up as much as possible.
Place the large towel under the elder’s head covering the bed pillow.
Place one hand towel over the elder’s chest.
Moisten face with warm water from basin with washcloth to soften beard. (heat, moisture and lather help to reduce surface tension and soften the beard)
Apply shaving lather (or pre-shave lotion)
Starting in front of elder’s ear, hold skin taunt with one hand, (during any part of the procedure if you are able to make the skin taunt you will get a closer shave) take razor and shave from ear down cheek towards chin.
Use firm, short strokes.
Shave in the direction of the hair growth.
Rinse safety razor in warm water after every stroke.
Repeat shaving cheek until all the shaving lather is removed.
Continue shave with other cheek.
Using short strokes, shave from under nose to lip.
Shave from under lips in downward strokes to chin in short strokes.
On the neck area the strokes go from the base of the neck -upward towards the chin. If the elderly man is able to put his head back this will help considerably in tightening up the skin and making it easier to shave.
Remove all remaining shaving lather with moist washcloth.
Apply after shave lotion.
If the man is nicked during shaving, applying pressure with a small piece of tissue will stop the bleeding. Several nicks will mean that you are not using the correct razor. Maybe the razor you are using is too inexpensive, look for a higher quality razor.

For shaving the elderly man with Alzheimer’s disease or another disease with agitated behaviors, please see blog:
January 22, 2009 – Assisting the Confused Elder with Alzheimer’s Disease to Shave

Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com


Posted on June 15, 2010 - by

HOW TO HELP AN ELDER CHANGE DEMANDING AND MANIPULATIVE BEHAVIOR

(Part II)

When you help an elderly person control or change their demanding or manipulative behavior, it is called “an act of caring.” It is so much easier to give in and give any demanding person what they want or just avoid the complainer. When the staff in a Nursing Home gives in to demanding behavior they may make other people resent the elder. Doing everything for the elder will make the elder more dependent than they need to be. By helping the elder, control or change their demanding behavior, through this “act of caring” you can help the elder to be more self- sufficient.

The act of caring or how to help an elder change demanding / manipulative behaviors:

  • Set limits for what the staff will do and will not do. Set limits on what is acceptable behavior on the part of the elder and what is not. Give the elder clarity when you speak about the limits. “I really can’t discuss another resident with you.” “If you have a concern, I can get the supervisor for you but you don’t need to keep a report on the other shifts.”  “I know you have told me several times how you don’t like the food, is there anything different you would like to talk about?”
  • Expect the elder to be unhappy with the change and the setting of limits. The elder may be even more insistent than usual to get their way. The caregiver may need to keep reminding themselves that this is in the best interest of the elder.
  • Help the elder who needs to be in control make as many decisions as possible. Give choices in what to wear, what activities to go to, “Would you like to take your shower now or after breakfast?” Build into your daily care ways to offer choices to everyone you care for. (Person Centered Care)
  • Reduce the elder’s fear of loss of control by managing the elder’s behavior through action not re-action. Be pro-active in giving opportunities, instead of avoiding the demanding elder.
  • Don’t get caught up in an argument with the demanding/manipulative elder. Say what you need to say, make sure your meaning is clear and fair (that you aren’t coming from a point of anger) and then move on.
  • When you are setting limits, work as a team caring for the elder. Everyone needs to react in the same way and follow through with the setting of limits on the demanding behaviors.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com


Posted on June 14, 2010 - by

WHEN THE ELDER IN THE NURSING HOME HAS DEMANDING AND MANIPULATIVE BEHAVIORS

(Part I)

Sometimes an elderly person just doesn’t want to do anything for anyone else or themselves anymore. They may even become demanding and want to be “waited on” by the staff members of a nursing home. Maybe the elder has always been “given into” but it was never enough for them, so they keep trying to get more and more.

Or maybe the elder has suffered so many losses that they now only focus on themselves and are unaware of their effect on others. They may feel powerless due to their losses and because of that, being demanding or manipulative makes them feel more “in control.”

Types of elderly demanding and manipulative behaviors:

  • Playing one staff member against another. “She (your co-worker) said she always does all the work and you are lazy” or “I heard the nurse say they are going to fire you.”
  • Monopolizing the time of a caregiver so they can’t get to their other residents.
  • “Reporting” on staff or other resident’s behaviors.
  • Telling others that they have special privileges.
  • Threatening the facility or staff with calling the state or police if they don’t get what they want.
  • Threatening to sue the facility.
  • Being the “help” rejecting complainer. No matter how many helpful suggestions have been made to the resident’s complaints, all are rejected.
  • Starting all demands with “I know my rights.”

The answer for demanding and manipulative behavior is to set limits. For the person who has lived a life with few limits this can be especially difficult. For the elder who is acting out because of their recent losses, limits will help them feel more in control again.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com


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