The Wonderful Wizard of Hos-pice

Last week I found myself visiting with the daughter of an aging parent. After reviewing their situation, I mentioned that it might not be a bad idea to contact a hospice organization. As soon as the word "hospice" escaped my lips, I found myself face to face with a hysterical daughter who sobbed uncontrollably at the imminent passing of her father. That wasn't what I said!

At Home Instead Senior Care, we often partner with hospice organizations. Home Instead is dedicated to the mission of helping people live life on their own terms. So is hospice. Home Instead recognizes that there are certain realities that are naturally associated with the aging process that cannot be avoided. So does hospice.

Many people think about hospice as a place but in actuality it is a philosophy of care. Hospice can help patients and their families begin to deal with whatever is happening to them on their own terms and in their own time frame. If life is a journey, think of hospice as a travel agent. Hospice helps coordinate community resources and helps you to know where to go in order to get the very best of everything. While most of us try to cheat death at every turn, there has only ever been one man who has managed to defeat death. That makes the human mortality rate pretty close to 100%. If you are the child of an aging parent and are approaching the point where care is more important than cure then I would highly suggest getting in touch with a hospice organization. They are truly wonderful people and have been a tremendous comfort to to the clients we have partnered with them to serve.

In Case You Missed It!

In case you missed it, i've posted the interview I did regarding the Protect Seniors From Fraud Program on our website. Enjoy!

Home Instead Franchise Owner on UNCTV

It's Not A Toomah!

Don't you just hate armchair physicians? Well intentioned people who roam the streets and speak half-truths into the lives of those around them, usually without being asked, drive me crazy. I generally resent unsolicited advice of any nature but on the healthcare front I find myself especially agitated by pseudo-doctors who feel the need to diagnose and offer treatment suggestions whenever I sneeze, cough, or just feel a little off.

Seniors face a number of challenges with regards to the normal aging process. Certain things just start to wear out after about 70-80 years. When I meet with the family of a prospective client, I take care to question where each claimed illness has been diagnosed. Specifically with regards to dementia, I find that many seniors are living life under the impression that they have Alzheimer's or dementia. Out of all the illnesses that befall the elderly, none is more terrifying than this one. A disease which causes you to lose your memories and any sense of who you are is not a diagnosis that should be lightly made. Yet we see countless examples of this at Home Instead Senior Care. We see huge numbers of seniors who live in fear of Alzheimer's disease because they momentarily forgot where they put their house keys and some well intentioned person mentioned dementia as a reason.

If you happen to be one of those people who feels the constant urge to offer possible explanations to anyone who is suffering from anything at any given time, please pull Alzheimer's and dementia out of your little black bag of non-authorized diagnosis doom. While I appreciate your desire to help it is only fair to point out that you lack the medical training with which to squeeze a pimple and therefore have no business diagnosing a disease that has befuddled the brightest minds in the medical community for over a century. It's not a toomah!

Gimme the Candy!

To say that there are an abundance of children in my neighborhood would be an understatement. Our house sits on the corner of two cul-de-sacs which, in total, represent 32 children. Halloween is kind of a big deal. Nevertheless, I am guilty of two Halloween sins. First, I turn my lights off before the candy is really gone. Once the stash of candy has run down to the dregs, I flip the light off and retreat to my lazy boy (aptly named) where I work to avoid the stomach ache which will undoubtedly follow the consumption of that many Sour Patch Kids. Second, I lie to my children. My oldest son has a peanut allergy and we therefore must screen all of our children's loot to ensure that there are no peanut candies hiding in the mix. Over the years, my wife and I have taken increasing liberties with the screening process. My kids are now convinced that there are many candies that could potentially spell disaster for people with a peanut allergy. Such as: Gummy Savers, the aforementioned Sour Patch Kids, Smarties, Rolo's, Swedish Fish, Airheads, Nerds, Sweet Tarts, Now-n-Laters,  and anything with dark chocolate in it. These are a few of my favorite things. Following the onslaught of our neighbor's goodwill, the kids all come back home and dump their goodies onto the living room floor where I scour the contents of their respective pumpkins, removing all "risky" items. Safety is important on Halloween.

I thought this blog was about seniors?

Relax, I'll get there.
One of the parts of the natural aging process is the reduction in the body's ability to taste things. This is due to a number of factors such as a reduction of saliva production as well as a reduction in the actual number of taste buds. Frequently, you will see older people dumping unholy amounts of salt, pepper, vinegar, Tabasco, etc. onto everything they eat. They don't decide to begin bathing their food in hot sauce because they have suddenly gone cajun at the ripe old age of 65. They do this because it is the only way they can taste the foods. The reduction of a senior's ability to taste their food has a couple effects which merit words of caution. First, it is no fun for older adults to eat so they don't. The only thing worse than eating by yourself is eating a meal you physically can't enjoy by yourself. Proper nutrition is important at every stage of life but probably most of all for seniors, some of whom are managing chronic conditions. These conditions can be greatly exacerbated by poor nutrition. At Home Instead Senior Care, our caregivers pay special attention to the nutritional needs of seniors and work to make meals more enjoyable. They do this not only through companionship but also by working to make mealtime more of an event. Eating out of microwaveable cardboard container stinks even with good conversation. Setting a nice table goes a long way toward making meals more palatable even if it is only for the eyes.

Ok. But how does this have anything to do with Halloween and your crimes against children?

Hold on to your hats because I'm about to bring it all home.
Riddle: If you are unable to taste anything except for things that are exceptionally salty or sweet and suddenly find yourself with an abundance of Halloween candy, what will you probably eat?
Answer: All of the leftover Halloween candy.
The days following Halloween are great times to visit the senior in your life and check in on the nutrition front. Look to make sure that there isn't a ton of candy left over which could pose a significant health threat in the absence of other foods. Plan a trip to the grocery store to provide nutritious companions if not alternatives to the belly full of Snicker's Minis that will represent the first thing your senior has been able to taste in weeks.

If the senior in your life is unreceptive to this kind of assistance then I would encourage your children to be more insistent about that second or third treat in the basket. Arm them with kind words like: 'It's for your own good,' and 'Because we care.'

Have fun and be safe tonight, dear readers. Happy Halloween!

How Does Your Garden Grow?

I find some of my greatest life lessons in my garden. Last year, I built two raised bed gardens in my backyard. I had grand dreams of the food we would grow there. Initially, the garden I made was a thing of beauty. Rich black soil, the smell of fresh mulch, bees buzzing busily as they pollinated my crops. Each morning and evening I would water and preen by hand. In short order, my garden began to blossom. Then life happened. I got busy. I got too busy to continue to spend the amount of time that I had initially spent cultivating my garden. As a result, weeds and bugs began to invade. Before long, the fantastic thing I built was no longer.

So much of in-home care is a garden. Initially, we utilize a ton of resources to ensure that we are recruiting and training the very best caregivers available. The background check we run on all our applicants continues to be the most thorough available, the reference checks and drug screening we insist upon have set the standard for in-home care. But that isn't enough. We must continue to water and preen our garden lest the weeds and bugs should invade. This is the new battlefield for in-home care providers.

One of our two core values at Home Instead Senior Care in Chapel Hill is to exceed the expectations of everyone that we encounter. We call it our 4E's. Sadly, the expectations from seniors and their families are fairly low. They have become accustomed to a certain amount of tardiness, a certain amount of apathy, a certain amount of absenteeism when dealing with in-home care. Their experience with the industry has taught them what they can realistically expect. From day one, we fight against this "assumed reality" with our clients and our caregivers. From birthday and anniversary cards, to our P.E.A.Q. program, to our quality assurance visits, to our on-call policy, to our community involvement-Home Instead Senior Care is working to exceed the expectations of everyone that we encounter. As anyone who is happily married can tell you, relationships do not build themselves. Like gardens, relationships require constant effort if they are to grow.

Engaging the Lost Causes

When caring for people who are suffering from Alzheimer's and other forms of dementia, there comes a time when the person suffering loses the ability to communicate. During typical late stage Alzheimer's, a person may be bed or chair-bound, unable to speak, and in some cases completely unresponsive. Sadly, the temptation is to disengage from the person we love at this point. Why bother talking with them when they can't talk back? Why ask them questions to which they can no longer respond? While this approach is understandable to anyone who has dealt with this disease firsthand, it misses a huge opportunity to continue to connect with the people we care about.

During our Alzheimer's and Other Dementia training at Home Instead Senior Care, we deal specifically with late stage clients. We address the fact that just because the people for whom we are caring aren't able to verbally validate our attempts, we shouldn't be discouraged from continuing to interact with them. We should, however, amend the techniques we use in order to give them the maximum benefit of our involvement.

The techniques we use for late stage clients all revolve around the five senses: smell, touch, taste, sight, and hearing. These senses unlock a world of memories for the clients that we serve that we may never truly realize. For all of us, there are certain things which take us to another time and place.

-If I smell Cinnamon Butter Cake, I am transported back to my grandparent's house in Woodward, OK. I can see the large front door they had swinging open as my brother and I bound out of the car after a long drive up from Texas and into their waiting arms.
-The feel of a saxophone in my hands brings back memories of long band bus trips and cold competition mornings.
-The taste of tamales paints a portrait of Christmas in San Antonio that no artist could ever come close to rivaling.
-The sight of pictures of my kids in their toddler years brings smiles to my heart that last all day.
-If I hear the song "Two Princes" by the Spin Doctors, I find myself sitting in the back seat of Jana Davis' car on the way to school. She was a beautiful flute player in the high school band who as a senior agreed to give me a ride as a freshman so that I wouldn't have to ride the bus.

None of these journeys you can go on with me. For our dementia clients in their late stages, you can't go where they are headed either. You may never get the validation of knowing that you have given them the memory tool to take that mental trip. But we do not care for those in our lives in order to attain some personal validation, we care for them in order to provide them with the best possible quality of life. And on that mission, we never give up.

A Turn For the Worse

If I had a nickel for every time I heard the phrase "Since she has been at the hospital, Mother's dementia has taken a turn for the worse," I would be a very wealthy man. The idea that hospitals cause dementia is an amazing phenomenon to me that way too many people accept at face value as a universal truth of aging. Hospitals do not cause dementia. Granted, with the size and confusing layout of most hospitals even I forget how to get back to the parking garage from time to time. The fact that so many seniors never have the opportunity to return home from a hospital stay due to the mysterious "dementia monster" attacking them upon admission is troubling. The fact that this absurd logic is never even challenged is downright maddening.

What causes dementia is, in fact, a mystery. Scientists know that the greatest risk factor is advancing age but beyond that the entirety of medical knowledge on the subject resorts to what can be most aptly described as a "best guess scenario."The sudden, rapid progression of dementia is a far less complicated matter to investigate than actual dementia. So allow me.

In the normal aging process, senior's bodies begin to function differently than they did  in younger years. Kidneys do not function as efficiently as they once did. This particular facet of aging, I believe is responsible for a huge percentage of the post hospital rehab admissions today. Imagine this scenario:

A woman, age 94, has lived independently since her husband's death two decades ago. She continues to be fairly engaged in the community and has a caregiver who comes in twice a week to keep her company and assist her with errands and chores around the house. At times, she has troubling recalling certain things but the things she forgets will generally come back to her and do not interfere with her daily life. She is a model for aging with independence. One day she slips and falls while retrieving the mail. Due to the brittle nature of her bones, she fractures her left hip requiring surgery. The surgery goes extremely well, especially considering her age, and the doctors all say that after some quick rehab she should be fine to return home with limited assistance as before. Not so strangely, she begins to show confusion following surgery. It is gradual at first and then increases rapidly. The doctor's offer a simple explanation. Sometimes in a hospital situation, a senior's dementia takes a turn for the worse. AAAAAAAAAAAAAGH!! With respect to the kind hearted medical professionals, allow me to postulate another theory. This particular 94 year old has avoided medications for most of her life wherever possible. She takes a baby aspirin every morning and a multivitamin because an episode of Donahue told her that doing so might reduce her risk of certain cancers. Suddenly, due to her hip fracture, she is being given an anesthetic for the actual surgery, a sedative to help her sleep at night, a medication to prevent constipation, and Oxycodone to ease the pain. When you combine that cocktail with the knowledge that her kidneys are not filtering these drugs effectively, another possible diagnosis presents itself. She isn't suddenly demented. SHE IS HIGH!!

I wish I could tell you that this woman eventually stabilized and was able to return home. I wish I could tell you that she wasn't discharged to a skilled nursing facility where she was administered a daily dose of instant-dementia for the rest of her days. Most of all, I wish I could tell you that her's was a unique story. But alas, I am unable to make any of these statements and instead sit here at the keyboard typing, collecting a nickel for every time that I hear that someone's dementia has taken a turn for the worse.