Listed below are some resources that might help you in caring for your elder loved one. Let me know if you have others you wish to share and I’ll update the post.

Arkansas Department of Human Services
Division of Aging and Adult Services
PO Box 1437, Slot S-530
Little Rock, AR 72203
501-382-2441
Director: Herb Sanderson
http://www.arkansas.gov/dhs/aging

Arkansas Geriatric Education Center
4301 W Markham Street, #798
Little Rock, AR 72205
501-257-5543
http://www.agec.org

AARP Arkansas State Office
1701 Centerview Drive, Suite 205
Little Rock, AR 72211
866-554-8379
http://www.aarp.org/states/ar/ar-about/a2004-01-26-ar-stateoffice.html

Arkansas Area Agencies on Aging:
AAA of Southeast Arkansas                                              www.asea.org
Age with Dignity – AAA of Southwest Arkansas      www.agewithdignity.com
AAA of Northwest Arkansas                                            www.aaanwar.org
CareLink – AAA of Central Arkansas                            www.care-link.org
East Arkansas AAA                                                               www.e4aonline.com
West Central Arkansas AAA                                             www.seniorspecialists.org
Western Arkansas AAA                                                     www.agingwest.org
White River AAA                                                                 www.wraaa.com

Have you ever had the difficult task of convincing your senior person they need assistance with their daily life.  Typically these conversations don’t go over very well.  It is a difficult decision to make when a family member is no longer able to live alone without assistance in order to ensure safety and maintain quality of life.  In my family full of stubborn folks, (see, I get it honestly) I have seen first hand the resistance in bringing in a home health aide. When my grandmother finally agreed, several persons were brought in, but she disliked each one.  She found fault in what was done, and even accused one aide of stealing things she herself misplaced. Worrying about a senior loved one can take a toll on everyone. 

Take responsibility by looking out for the signs that can help indicate it is time to bring in a trained certified home health aide either part time or for more severe cases full time.   For example, does your family member:

1. Gets lost while driving their car in their community
2. Misplace or continue to lose things
3. Require frequent hospitalizations
4. Mix up medications
5. Battle with depression
6. Isolate themselves from friends and family
7. Fall and hurt themselves
8. Have a fear of being robbed when they are not
9. Have difficulty with travel
10. Have trouble preparing their own food
11. Becoming confined to a wheelchair or walker
12. Failure to properly care for their own personal/ hygiene needs
13. Wander

A certified home health aide can provide companionship for your senior loved one, assist in daily activities such as cooking, dressing, bathing, cleaning, bathroom, administering the proper medication, as well as accompanying or driving a senior person to a doctor, and laundry.   The ideal way to attain a home health care aide is to contact an accredited and insured agency.  Do your research and make sure the agency is accredited and insured.  Check to see what training the employees providing care for your loved ones have had as well as what type of background checks were completed. 

There is no easy way to tell your senior loved one that they require a home health aide, though you can make it as painless as possible by working with a patient advocate.  Case Managers can act as a third party and mediator to  determine when they might require some extra help.  Losing your independence is difficult.  With a caring family and a well trained and insured aide the transition can help prolong a senior person’s quality of life.

*adapted from American Care Manager

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No matter where you are or what you are doing advertisements for smart phones such as the iPhone or Blackberry are everywhere.  Most likely you would expect these smart phones to offer music, games, email, phone calls, Internet, address book, etc., but did you ever think that you would be able to use a phone to facilitate senior medical care?

Apple through the iPhone, revolutionized the application market, generating more than $1 billion in revenue each year from unique applications that other companies create to be used on their phones.   Recently applications have been created to take the iPhone to a whole new level in geriatric care.

There are now applications that let caretakers keep track of a geriatric person’s health no matter where they are.  These new applications allow family members/friends to track doctor’s appointments, weight, prescriptions, insulin schedule, hospital stays, emergency calls, etc.  People who download these applications and are able to: input the senior person’s data into their phone to keep track, send notes to other family members, set up alerts, and even send doctors the information they request straight from their phones without having to sort through thousands of paper documents and folders anymore.

Further flexibility includes, for example, if a doctor detects an aneurysm at a checkup, they can contact the appropriate family member or a caretaker who has this phone application and find out immediately when this was first diagnosed if at all, by which doctor, action taken, the last recorded size, etc  For doctors that are technically advanced and dedicated., they can actually set up permission to gain direct remote access to the application to view the senior person’s history and records computer-to-phone..

There are many companies and organizations creating application for smart phones, here are a few to take note of:

Ringful.  Their plan is to help users to change their behavior with more transparency and information.  They currently have approximately 19,000 active users using their application to record blood pressure, pulse measurements and workout routines, as well as to find information about local hospitals. The company offers free versions of its application and premium versions for $4.99 with additional charting and analytical capabilities. Ringful will soon release applications for pain management and smoking cessation.

AllOne Health Groupinc.  Caretakers and family members can view their medial history on the go, see prescription history/pharmacy information and receive alerts on medical appointments. It gives mobile access to existing personal-health records maintained by participating health plans and for users of Microsoft’s HealthVault program.

WebMD Health Corp. Will be launching free mobile applications for iPhones and BlackBerrys that enable users to view and update their WebMD online record from their phone.

This is just the start to the mobile medical application market.  But since we are a society that is continually on the go, having mobile applications that can hold and track a senior person’s medical history and information is an invaluable tool giving doctors up-to-the-minute information in the care of a senior person while making life easier and less stressful for the family.

*reprinted with permission from American Care Managers

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I was recently approached about a case involving a fall in an assisted living facility.  Someone suggested that these facilities are not regulated.  This is false.  An information sheet provided by the US Department of Health and Human Services can be found here.  You will see that these facilities are indeed regulated.

Assisted living facilities are less costly than nursing homes, but are still quite expensive.  The national average is $1,800 per month.  When considering this housing option for you or your loved one, be sure to inquire about what is and is not included in the monthly fee.

For more specific information about assisted living, be sure to check out the resources below.

Assisted Living Federation of America
1650 King Street, Suite 602
Alexandria, VA 22314
703-894-1805
http://www.alfa.org/ or email info@alfa.org

Consumer Consortium on Assisted Living
2342 Oak St., Falls Church, VA  22046
(703) 533-8121
http://www.ccal.org/

National Center for Assisted Living
201 L St., NW Washington, DC 20005
(202) 842-4444
www.ncal.org/consumer/index.cfm

American Association of Homes and Services for the Aging 2519 Connecticut Ave., NW Washington, DC 20008-1520 (202) 783-2242  http://www.aahsa.org

The American Seniors Housing Association 5100 Wisconsin Ave., NW Suite 307 Washington, DC 20016 (202) 237-0900  http://www.seniorhousing.org

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The holiday season can be a joyous time of the year for families and friends, near and far.  But the events of the last two years and the aging of the baby boomer genre have placed us all in very unique circumstances.  As joyous as the holiday season can be, it can also be stressful and tiring, especially for our elderly.  We would like to share a few inspirations to help you deal with this holiday season.

1. The holiday season is meant for families, but it is also a time for remembrance.  There may be family members that have passed on, and a gentle walk down memory lane can a healthy way in dealing with loss while learning how to move forward into the next, and many years to come.  Remember, grieving is a healthy process for every one of all ages.
2. Some members of your family may be dealing with certain health issues, including memory loss, dementia, or Alzheimer’s.  The holidays and family gatherings can provoke powerful memories, or even inhibit moments of memory.  Be patient.  This can be the right time to remember what is important, and that is your family. Be accepting of change and advent of new, more exciting traditions.
3. Be careful of holiday cheer, as alcohol can have both impassive and passive effects on the elderly due to disease processes, and the medications they may be taking.
4. Provide areas of rest and relaxation.  The elderly may become more fatigued and have shorter endurance levels than last year.  Be cognizant of their needs, and provide space and time for rejuvenation.
5.  Sometimes keeping it small will be more beneficial and the economic challenges of the last two years has made it all but impossible to make this holiday season anything but small.  But small does not have to change the spirit of the holiday season.  What it does mean is more time to spend together and remember the events of Christmas past that have only made us stronger from one year to the next.
6. Have realistic expectations.  The parties and celebrations don’t have to be perfect.  As our families grow and change, traditions may need to change too.  Choose a few to hold on to, but be open to modifying others.
7. Plan ahead.  If an older family member tends to tire easily or if they are easily over-stimulated, limited the time they are included.

Remember, Christmas is not about what or how much is under the Christmas tree.  It is time to be with family, share the joy of the season, and to be thankful for the blessing you and your family experienced over the last year.  Be sure to acknowledge those blessing and pass them on for all Christmas’s to come.

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The National Electronic Injury Surveillance System All Injury Program, supported by the Centers for Disease Control, tracks data from a representative sample of hospital emergency departments (EDs).  This dataset was recently analyzed¹ to reveal the circumstances of injurious falls and the assistive devices that were involved, yielding estimates that:

• Each year in the US there are 47,312 nonfatal fall injury ED visits associated with the use of canes and walkers by people 65+ years of age;  60% of these happen at home.

• The injuries sustained in these falls are serious with one-third of patients requiring hospital admission for fractures, contusions, abrasions & internal injury.  Men are more likely to sustain head and neck injuries while women more commonly injure the lower trunk.

Canes are generally prescribed for a moderate level of gait instability, whereas walkers are recommended for more generalized weakness, limited weight bearing ability or poor balance.  Women are more likely to use walkers than men.  Even though there are twice as many older adult cane-users as walker-users, this analysis found that:

• Walkers are associated with 7 times as many ED fall injury visits as canes.
• Women are 2 ½ times more likely to report to the ED for these walker-fall injuries.
• Those 85+ years of age on a walker are at particularly high risk.

Clinical implications:  Assistive device use is associated with injurious falls that require medical care.  It is essential that older adults receive instruction from qualified therapists who can intervene to reduce intrinsic risk factors (poor balance) as well as maximize the likelihood of  proper fit and safe use of assistive devices.  Particular attention should be given to those helping those aged 85+ master the physical and cognitive skills required for safe walker use.

1.  Stevens JA, PhD, Thomas K, The L, ABJ, and Greenspan AI. (2009). Unintentional fall injuries associated with walkers and canes in older adults treated in US emergency departments.  JAGS 57:1464–1469.

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Below is a list of the top 50 hospitals in America that excel at and focuses on treating geriatric patients developed by US News and World Report.  While Arkansas is not currently listed, the medical center is working to change that with new grant money.  You can read about the project here.

Best Geriatric Care Hospitals

1. Ronald Reagan UCLA Medical Center, Los Angeles, CA
2. Johns Hopkins Hospital, Baltimore, MD
3. Mount Sinai Medical Center, New York, NY
4. Massachusetts General Hospital, Boston, MA
5. Duke University Medical Center, Durham, NC
6. Mayo Clinic, Rochester, MN
7. Yale-New Haven Hospital, New Haven, CT
8. UPMC-University of Pittsburgh Medical Center, Pittsburgh, PA
9. University of California, San Francisco Medical Center, CA
10. Cleveland Clinic, Cleveland, OH
11. Johns Hopkins Bayview Medical Center, Baltimore, MD
12. New York-Presbyterian University Hospital of Columbia and Cornell, NY, NY
13. Emory University Hospital, Atlanta, GA
14. University of Washington Medical Center, Seattle, WA
15. University of Michigan Hospitals and Health Centers, Ann Arbor, MI
16. University of Alabama Hospital at Birmingham, Birmingham, AL
17. Beth Israel Deaconess Medical Center, Boston, MA
18. NYU Langone Medical Center, New York, NY
19. Northwestern Memorial Hospital, Chicago, IL
20. Hospital of the University of Pennsylvania, Philadelphia, PA
21. Boston Medical Center, Boston, MA
22. Barnes-Jewish Hospital/Washington University, St. Louis, MO
23. Brigham and Women’s Hospital, Boston, MA
24. Rush University Medical Center, Chicago, IL
25. Shands at the University of Florida, Gainesville, FL
26. Washington Hospital Center, Washington, D.C.
27. Clarian Health, Indianapolis, IN
28. Methodist Hospital, Houston, TX
29. St. Louis University Hospital, St. Louis, MO
30. Hackensack University Medical Center, Hackensack, NJ
31. St. Francis Hospital, Roslyn, NY
32. Mount Sinai Medical Center, Miami Beach, Fl
33. Cedars-Sinai Medical Center, Los Angeles, CA
34. University of Chicago Medical Center, Chicago, IL
35. University of Miami, Jackson Memorial Hospital, Jackson, FL
36. Beaumont Hospital, Royal Oak, MI
37. Sarasota Memorial Health Care System, Sarasota, Fl
38. Aurora St. Luke’s Medical Center, Milwaukee, WI
39. Franklin Square Hospital Center, Baltimore, MD
40. University Hospitals Case Medical Center, Cleveland, OH
41. St. Luke’s Episcopal Hospital, Houston, TX
42. Union Memorial Hospital, Baltimore, MD
43. Mayo Clinic, Jacksonville, Fl
44. Lehigh Valley Hospital, Allentown, PA
45. Sentara Norfolk General Hospital, Norfolk, VA.
46. Christ Hospital, Cincinnati, OH
47. Tampa General Hospital, Tampa, FL
48. Stanford Hospital and Clinics, Stanford, CA
49. Abbott Northwestern Hospital, Minneapolis, MN
50. Loyola University Hospital, Maywood, IL

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The Agency for Healthcare Research and Quality (AHRQ) reports results from analyses of the Healthcare Cost and Utilization Project-Nationwide Emergency Department Sample regarding ED visits among elderly adults who were coded as sustaining both a fall and an injury.  Starting from the vantage point of the ED these analyses highlight the importance of our efforts to reduce falls and illuminate how injurious falls contribute to human suffering, ED overcrowding, hospital costs, admission to long term care facilities as well as private and government health care spending.  Having sustained a fall injury requiring a trip to the ED could trigger efforts to identify, track, assess and intervene with these high risk individuals in order to reduce the risk of sustaining another fall. Having fallen is one of the strongest predictors that one will fall again.

In the United States in calendar year 2006:

Injurious falls accounted for 10.5% of all ED visits among adults aged 65+, totaling over 2.1 million visits.

• The rate was 57.4 ED visits for injurious fall injury per 1000 people 65+ years of age.

• Females accounted for 70.2% of the ED visits.  Those aged 75-84 had the highest number of visits (40.3%), followed by those 85+ (32.4%) and finally those 65-74 (27.3%).  Nearly 1 in 7 women and 1 in 10 men aged 85+ had an ED visit for an injurious fall.

• The most common injuries resulting in an ED visit were fractures (41%); superficial contusions (22.6%); open wounds (21.4%), sprains and strains (10%); internal organ injuries (4.6%) and dislocations (1.5%).

• Hip fractures accounted for about 1 in 8 ED visits among adults aged 65+.

• Nearly 30% of the injurious falls treated in the ED resulted in hospital admissions and these admissions (while not longer) had a higher average cost ($10,800) relative to older adults admitted from the ED for other reasons ($9,900).

• The aggregate national cost of hospital care for older adults who came in through the ED for an injurious fall was $6.8 billion.

• The elderly who were treated in the ED for an injurious fall and then hospitalized were more likely to be discharged to long term care (65.7%) than elderly ED patients hospitalized for other reasons (28.4%). Fractures or internal injuries were most likely to require hospital discharge to a long term care facility.

Owens PL, Russo CA, Spector W and Mutter R. Emergency department visits for injurious falls among the elderly, 2006.

HCUP Statistical Brief #80.  October 2009.  Agency for Healthcare Research and Quality, Rockville, Maryland.

http://www.hcup-us.ahrq.gov/reports/statbriefs/sb80.pdf

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Today we have more and more of our senior population using computers and cell phones.  My own parents are on Facebook *gasp*and enjoy computer games, checking email and the like.  I applaud our parents and grandparents for embracing this technology.  I know in my own family this is a primary way for all of us to keep in touch with one another.  If it weren’t for phones and computers we would rarely know what was going on since we are spread across the country.

As a nurse who cares for the needs of older Americans, I see the struggles that must go through when it comes to technology.  Even my own spouse struggles with the inability to see small print and has to chose his cellphone very carefully to insure that he can work it if the lighting is low or if he fails to have his reading glasses with him.

Luckily this population has not been forgotten.  Just this week I saw two ads directed toward our seniors.  One is a cellphone while the other is a computer system.

The Jitterbug is a cellphone that has large, colored displays and is designed to reduce background noise.  It is very simple with no camera, internet, or other susription based services.  It is a phone; pure and simple.  It does have Bluetooth and Caller ID!

First Street (also the maker of Jitterbug) has designed the GO computer.  It has a big, bright screen and even magnifies the image up to 200% with the touch of a button.  It also hosts a large over-sized keyboard with colored buttons to help with navigation.  These systems were originally targeted to retirement homes and Senior Centers, but now you can purchase them for individual use.

So Mamaw, which would you like for Christmas?

ABLEDATA: Provides information on assistive technology and rehabilitation equipment, including how to find and purchase it.  Also offers an online forum for consumers, caregivers and others to submit and read reviews of products and classified ads of equipment for sale. (800) 227-0216

http:/ / www.abledata.com

Able Project.org: A nonprofit organization with an online directory that allows people to research, compare, locate and obtain mobility and assistive products, such as wheelchairs, canes, walkers, bars and rails. (408) 263-8000

http:/ / www.ableproject.org

Alzheimer’s Association: Provides reliable information, care consultation and supportive services for dementia caregivers through state and local chapters. The website also includes an interactive tool, CareFinder, which helps families to:
• Recognize dementia care
• Plan and pay for care
• Communicate with care providers
• Find local support and resources

(800) 272-3900
http:/ / www.alz.org

AssistiveTech.net: Government-sponsored website with a directory of assistive devices and other products, which includes information about cost and vendors. (800) 726-9119

http:/ / www.assistivetech.net

Association of Jewish Family & Children’s Services (AJFCS): An online directory of AJFCS  member agencies throughout the country. Services include:
• Care management
• Chore services
• Adult day services
• Kosher meals on wheels
• Respite care

(800) 634-7346

http:/ / www.ajfca.org

CancerCare: Provides support services for anyone affected by cancer including limited financial assistance grants for:
• Transportation
• Child care
• Home care

Patient must currently be receiving treatment for cancer (800) 813-4673

http:/ / www.cancercare.org

Catholic Charities: Provides social services to individuals in need, including family support, respite care and home care services.

Eligibility varies by program (see website)

http:/ / www.catholiccharitiesinfo.org

Easter Seals: Assists children and adults with disabilities and their families by providing adult day services, including medical and social services. Children and adults with disabilities. (800) 221-6827

http:/ / www.easterseals.com

Faith in Action: Network of interfaith volunteer caregiving programs across the country. Volunteers shop, cook, drive or just check in on those with long-term health needs.

Eligibility varies by program (see website) (866) 839-8865

http:/ / www.fianationalnetwork.org/

Hospice Foundation of America: Provides information about end-of-life care. Its website includes a “Locate a Hospice” search which allows the user to search for hospice and palliative care programs, and a “Caregiver‘s Corner” that offers publications and tips on caregiving for persons near the end-of-life. See website for local contact information.

http:/ / www.hospicefoundation.org

Lutheran Services: Provides services ranging from health care to disaster response, as well as services for children and families and care for older adults. Eligibility varies by program (see website)

http:/ / www.lutheranservices.org

Meals on Wheels Association of America (MOWAA): Offers online directory of local meal programs across the country for adults who are elderly, homebound, disabled, frail, or at risk.

http:/ / www.mowaa.org

National Adult Day Services Association (NADSA): Online directory of NADSA member agencies throughout the country (including adult day services and adult day health programs).

(800) 558-5301

http:/ / www.nadsa.org

National Association for Home Care and Hospice (NAHC): Online “Agency Locator”  helps consumers to find and choose a home care provider in their state and local area to match their specific needs. Database consists of NAHC members, more than 20,000 home care and hospice agencies.

http:/ / www.nahc.org

National Association of Professional Geriatric Care Managers: Online directory of its members, who provide services throughout the country at varying fees. These professionals (nurses, social workers, etc.)  specialize in aging and elder care and can help families assess needs and plan suitable care.

http:/ / www.caremanager.org

National Center on Senior Transportation: Provides online directory of transit agencies and community transportation providers for older adults. A toll-free line is available to answer questions regarding transportation services for older adults. (866) 528-6278
http:/ / www.seniortransportation.net

National Hospice and Palliative Care Organization: Provides information about end-of-life care. Its online “Find a Provider” search allows the user to search for member hospice and palliative care programs for individuals who have advanced illness or have been considered terminally ill by a physician. (800) 658-8898
http:/ / www.nhpco.org

National Private Duty Association (NPDA): Online directory of home care agencies, both medical and non-medical, in 44 states.  Database consists of NPDA members.

See website for local contact information

http:/ / www.privatedutyhomecare.org

National Resource Center on Supportive Housing and Home Modification: Sponsored by the University of Southern California, the website features a section entitled “Home Modification for Caregivers” and an online national directory of home modification resources geared to help older persons remain independent.

http:/ / www.homemods.org

Senior Corps- Senior Companion Program: Provides assistance to frail older persons and adults with disabilities so they can live independently in their own homes or communities. Volunteers offer:
• Respite for caregivers
• Companionship to care recipients
• Help with various tasks and chores

Frail older adults and adults with disabilities

http:/ / www.seniorcorps.org

Shepard’s Centers of America: Some centers hold monthly meetings of education and support for those who care for older adults. Centers also provide:
• Respite care
• In-home visitors
• Home health aides
• Support groups
• Adult day care
• Information and referral

(800) 547-7073

http:/ / www.shepherdcenters.org/ memberCenters.aspx

United Way: Over 1,350 programs operating throughout the country to promote increased access to health care for disease prevention and treatment, and medical rehabilitations for people with disabilities. Services focus on under- and uninsured populations.

http:/ / national.unitedway.org

Visiting Nurse Associations of America (VNAA): Online resource helps consumers locate a VNA in their area. VNAs offer comprehensive home health care or personal care to individuals in their respective communities for a fee. The website includes tips on choosing a home health agency and information about insurance coverage. Services vary by agency but may include:
• Skilled nursing
• Home health aide services
• Rehabilitation therapies: physical, occupational and speech-language
• Medical social services
• Hospice and palliative care services

• Anyone requiring care – medical orders from a physician are usually required for care
* Individuals must pay privately. Medicare, Medicaid or private insurance may pay for the service if the care is medically necessary, depending on each payer’s eligibility requirements http:/ / www.vnaa.org