About Aging Parents

More Information About End of Life Decisions

noreply@blogger.com (Kathy Quan) — Thu, 26 Apr 2012 22:03:00 +0000

Learn more about speaking with your loved ones about comfort care and end of life decisions...

Be Careful How You Say It

noreply@blogger.com (Kathy Quan) — Fri, 23 Mar 2012 20:41:00 +0000

Communication is an art. It’s a two-way process that involves speaking as well as listening. Perhaps nine out of 10 people may hear the same sentence and understand it the way the speaker meant it; the 10TH person will hear something entirely different.

Recently, I was speaking with a group of nurses at our weekly hospice meeting. One of the nurses discussed how one of her home health patients had totally misunderstood his physician.

The patient, whom I’ll call Sam (for confidentiality reasons), was very sick with cancer. He had undergone major surgery and some chemo and radiation treatments. At a follow-up visit the physician ordered more tests. After those results came back, the physician told Sam that they had “done everything we can do for you.”

The physician was very fond of Sam, and it was quite difficult to deliver this news. He didn’t elaborate, thinking Sam understood that his treatment had not been successful and there were no more options. The doctor told Sam that he should prepare himself for an eventual death and get his affairs in order. He shook his hand and quietly left the room.

Sam was elated. He thought the news was great. His take on this was that his healthcare team had done everything they can. The treatments had worked and his cancer was cured. Now he didn’t need any more treatments and could get on with his life, and yes prepare for that eventual death down the road.

Sam went home to celebrate. He called his home-health nurse and conveyed what the doctor said. She knew it was a misunderstanding and her heart sank for him. She called the physician and told him what had happened, who then called Sam to explain. The news was certainly not what Sam wanted to hear, but his prognosis was poor and he had decisions to make about his short-term future and end-of-life care.

This story gives us pause to be careful how we say things, and even when the conversation is painful, we should make sure the listener understands.

Wear Your Green Today!

noreply@blogger.com (Kathy Quan) — Sat, 17 Mar 2012 21:53:00 +0000

Enjoy a safe and Happy St. Patrick's Day.

Important Terms Affecting End-of-Life Decisions

noreply@blogger.com (Kathy Quan) — Sun, 19 Feb 2012 23:57:00 +0000

When a diagnosis is bad and the prognosis perhaps even worse, the ability to cope and deal with a new set of terms and tasks can be overwhelming.

End-of-life care choices will be some of the most important decisions of a lifetime for anyone choosing to control how and where they will die. Choices made will guide and drive the matters that are most important to ensuring a peaceful, comfortable death with dignity and maximizing the quality of life up until the end.

Some of these decisions can be made long before end-of-life care ever comes into play. If these choices no longer fit they can be changed or revoked anytime. Understanding some important terms used in end-of-life decision making is vital to making appropriate choices.

Advance Directives
Advance directives or healthcare directives are general end-of-life care terms describing:

A Healthcare Proxy or Durable Power of Attorney for Health Care (DPOAHC) is a person (such as your spouse or adult child) you appoint to act on your behalf in the event you are unable to make decisions for yourself.
A list of instructions regarding your medical care wishes such as resuscitation (CPR) or inserting tubes i.e. to help you breath with artificial help (ventilator) or a feeding tube in the event you cannot swallow. These instructions can be as detailed as desired. Beware that advance directives can be treated differently by individual states or provinces. They do help to reduce the burden on family members.

Withdrawing Care
When everything possible has been done, the physician or nurse may mention the term “withdrawing care.” This important term means that the current course of aggressive care and treatment will end. For instance, treatments such as chemotherapy and radiation will be stopped. In advanced stages of illness or dying this can mean withdrawing various levels of life support measures such as ventilators, artificial feedings and dialysis.

What withdrawing care does NOT mean is that these measures should ever be abruptly ended and the patient sent home to die without any support systems in place. Hospice or palliative care should be brought in to help make this transition. For instance, even patients who have been on a ventilator won’t usually die immediately upon its withdrawal. They may experience some air hunger, which is a subjective experience of not being able to breathe in enough air. Comfort medications, such as low doses of morphine can help with the breathing difficulty, or Ativan to control the anxiety and panic associated with not being able to breathe adequately. These medications need to be available to ease these symptoms and allow the natural dying process to take its course.

Comfort Measures
Comfort measures is a term for the care which will be implemented to assist the patient as he moves into the next stages of dying. This may be accomplished with a variety of medications and treatments to manage such symptoms as pain, anxiety, depression, constipation or breathing difficulties. Comfort measures can also include non-medical techniques as massage, therapeutic touch and guided imagery along with spiritual and emotional support for the patient, family and caregivers.

Symptom Management
Hospice and palliative care often get the bad rap of “immediately putting patients on a morphine IV drip so they will die quickly.” Any quality hospice or palliative care organization does not do this. If this is the case for you or a loved one, you have the right to revoke and call in another team.

Over-the-counter medications may be used for mild pain in the beginning; as the pain increases, stronger medications can be used. Stronger comfort medications like Vicodin, Norco, dilaudid and morphine are commonly used for moderate to severe pain and/or advanced breathing difficulties. These medications are carefully titrated (doses increased in small increments) from very minute amounts until effective symptom management is achieved. Symptoms can often be controlled for a long time with very small doses.

For patients who might not be used to anything stronger than aspirin or ibuprofen, changing the strength (dose) of these stronger medications in small increments should be as slow as needed to achieve symptom control while maintaining the desired level of alertness for quality of life. This is just one reason why it is highly recommended to start palliative care or hospice early enough so that symptoms aren’t so far out of control and the patient is the stage of actively dying. It can take some time to reach proper symptom management.

Antidepressants, anti-anxiety medications, anti-nausea medications and bowel regimens (including medications, increased fiber and fluids, and daily habits) are useful in helping control other common end-of-life symptoms, such as depression, anxiety, nausea/vomiting and constipation or diarrhea.

End-of-life care and the dying process have so many unknowns that make it a scary experience for many people. Through knowledge and education many of these unknowns and fears can be conquered. The journey can become a more pleasant time to share the gift of spending the time left in peace and comfort in the company of family and friends.

SOURCES:
Jeanette R. Stevens RN, BSN, CCRN, CHPN, “Care Until the End.” Nurseweek West, October 10,2011.

Mayo Clinic Staff; “End of Life: Caring for a Dying Loved One.” MayoClinic.com
http://www.mayoclinic.com/health/cancer/CA00048

“Pain Control Methods and Standards of Care.” Hospice Patients Alliance. http://www.hospicepatients.org/hospic29.html

Advance Directives Allow Choices and Support Medicare Savings

noreply@blogger.com (Kathy Quan) — Fri, 27 Jan 2012 00:24:00 +0000

All the hoopla about “death panels” during the 2010 battle for healthcare reform spooked too many older adults into thinking they would be deprived of curative healthcare because they were older and the care too costly.

That talk has died down for the most part; however, the idea continues to haunt many when they think about end-of-life choices and hope their wishes will be honored and not limited to palliative care alone.

The results of a recent University of Michigan study, published in the Journal of the American Medical Association, show promise that advance directives and other end-of-life care choices have not had an impact on the quality of care provided. Nor have older Americans been denied curative care if they desired it, according to the study.

In regions of the country where curative care is the norm, the cost of medical care has surprisingly declined (and Medicare savings have increased) because of growth in the number of patients choosing palliative care instead of more costly aggressive care. The Michigan study showed that patients in those regions with advance directives received quality comfort care according to their final wishes. Many died at home instead of in hospitals, as was their wish.

The study’s results may encourage people to strongly consider their quality of life concerns and make their end-of life choices known to their families and their healthcare team. Even many study participants who chose treatment-limiting instructions also allowed for limited trials of intubation (inserting breathing or feeding tubes) and mechanical ventilation if needed. But their instructions also made it easier for their proxy (appointed person who has the legal power to make healthcare decisions if you cannot) to stop the treatments if they weren’t effective.

End-of-life care decisions require careful consideration; they can be as specific as you want or need them to be. Although impossible to address every scenario, it’s imperative to discuss the scope of your wishes with your family; your spokesperson and your healthcare team so that your intentions can be met. For instance, do you want everything possible done or do you want quality of life and freedom from pain and suffering (palliative care) if there is no hope of a cure?

What is Palliative Care?

noreply@blogger.com (Kathy Quan) — Thu, 05 Jan 2012 19:31:00 +0000

Palliative Care is about managing symptoms for those with chronic or fatal illnesses. It's something we're going to hear more about in the next few years.

Quality of life and managing pain and other symptoms instead of just prolonging life will help us all be comfortable in our last days.

Palliative Care also helps those with chronic symptoms of pain, nausea, shortness of breath, etc., from diseases such as Rheumatoid Arthritis, MS, and COPD, to live more comfortable lives with a better quality of life. Here's a great article to help you understand more about Palliative Care.

Happy New Year

noreply@blogger.com (Kathy Quan) — Sat, 31 Dec 2011 23:48:00 +0000

Happy Holidays!

noreply@blogger.com (Kathy Quan) — Fri, 23 Dec 2011 17:29:00 +0000

HAPPY HOLIDAYS!!! Make some good memories.

Relax, Prioritize and Enjoy Your Holiday Season

noreply@blogger.com (Kathy Quan) — Thu, 01 Dec 2011 22:33:00 +0000

I hope everyone had a great Thanksgiving and got to spend some quality time with loved ones. As we move into the major holiday season, stress and panic are two words that come to mind quickly. This is especially true of those involved in caregiving situations and those in the sandwich generation between being son or daughter and mom or dad as well as just being you and all that that entails.

Take time every single day to stop and close your eyes and take a few deep breaths -- in through your nose and out through your mouth. This doesn't take long and can be done several times a day. Deep breathing helps to improve your circulation. It will relax you and help clear your mind. When you feel the stress building or panic sneaking up to overcome you. STOP!! Close your eyes and breath deeply. It will help to stall the stress or panic and allow you to gain control over the situation again.

If you already have a great relaxation routine be sure to practice it regularly. And if you don't, these deep breathing moments can help you to begin to find a way to stop the dreaded stress and panic that can steal time and precious memories.

Make lists and prioritize tasks. As you cross them off your list, re-prioritize as the importance of some items may have changed. See which items you can delegate to someone else or work together to accomplish. Look at you list with an eye to how important in the long scheme of things this matter will be five years from now...that just might change how urgent it can seem right now. And then again it may add importance to the matter, but remember to prioritize things.

Another important tip to remember is to figure out which things you pushed to the bottom of the list because you really dread doing them. Sometimes if you get some of these things done first, the rest of your To-Do list seems much easier and less stressful. The more we procrastinate doing something we dread, the more it weighs us down knowing we have to get to it eventually. We don't really have a chance to enjoy the things in between because we have this nagging task lurking out there somewhere. Just do it and move on. It will take a huge load off your shoulders when you do. Or see if someone is willing to share the burden and work with you to get it done.

Caregiving can be a very thankless job. So be sure to build in some little rewards for yourself on a regular basis. Look for silver linings, but also make sure you get a little time to enjoy something you like to do too. Take time to read, watch TV, or rent a movie. Hire some respite care if needed and get out for a meal.

As the holidays approach, it's a time for reflection. Encourage family members who may be gathering to bring a list of questions fro your elder(s) to discuss. These may be directly related to your family, or just things in general. The population in their 80's plus has seen a lot in their lifetime. They didn't grow up with television, they listened to the radio. They saw air travel develop. They lived through the Great Depression. How did it compare to our economic situation now? They lived through several wars and may have been in the armed services. There's no better source of history than first hand information. Take the opportunity to fill in a few gaps. Record your conversations. And perhaps if you have several elders present you'll get a collection of history to pass on.

Most of all take time to enjoy the holiday season!!

photo from morguefile.com

Only Four Kinds of People in the World...

noreply@blogger.com (Kathy Quan) — Thu, 13 Oct 2011 17:12:00 +0000

I was reminded of this quote when reading my ezine from The Intentional Caregiver today...

"There are only four kinds of people in the world - those who have been caregivers, those who are currently caregivers, those who will be caregivers and those who will need caregivers". ` Rosalyn Carter.

Medicare Open Enrollment 2011

noreply@blogger.com (Kathy Quan) — Thu, 06 Oct 2011 21:22:00 +0000

Open Enrollment for Medicare in 2011 is coming up very soon. The dates this year are from October 15-December 7, 2011. This is an earlier time frame than in the past so please take note. You don't have until Dec. 31 to decide as was the case in past years.

If you need to enroll or change Medicare plans, it must be done during this time open enrollment frame. All changes take effect January 1, 2012 and cannot be changed again until Open Enrollment in 2012.

For unbiased information about Medicare and all of the options to be considered such as Gap coverage, Part D Prescription Drug coverage and whether or not to enroll in an HMO plan is available from the source itself...Medicare.gov. There are differences in the various plans and comparisons are available from this site. Specific Open Enrollment instructions are available: Click Here

Choose carefully the plan that meets your needs now. Understand that your needs can change over time and what was best in the past may not be best for your future health care.

Consider Scrubs When Caregiving

noreply@blogger.com (Kathy Quan) — Thu, 22 Sep 2011 22:50:00 +0000

For anyone providing care to an elderly relative, friend or patent, scrubs are a great option for attire. They are comfortable, allow for ease of movement, and they are designed to live through being beaten up by frequent laundering. Street clothes can hamper the caregiver, and run the risk of being ruined in the course of a normal day of care giving. Blue Sky Scrubs has been a loyal sponsor of this blog. I encourage you to check out their lines. They offer a variety of great scrubs and even provide custom made scrubs.

Understanding the High Cost of Medical Care

noreply@blogger.com (Kathy Quan) — Thu, 15 Sep 2011 18:32:00 +0000

Here's a great article explaining why medical care can cost so much. What it neglects to explain in detail is that the negotiated insurance rates are usually SO LOW that the MD office has to increase the cost just to make enough to stay afloat in the office and pay each of these people. (Same with any medical office or facility.)

Some of the procedures could be shortened and made more cost effective of course, but then someone has to consult with the doctor or his medical group to set up a more efficient office practice, and that costs lots of money too that has to factor into your bill. Interesting.....

Never Forget 9-11-01

noreply@blogger.com (Kathy Quan) — Sun, 11 Sep 2011 17:06:00 +0000

In September 2004 I stood at Ground Zero with my husband and oldest daughter. There is nothing that compares to the feeling looking in to that destruction and realizing how the world was changed that day. Never Forget!

Keeping Aging Parents Hydrated and Cool this Holiday and Summer

noreply@blogger.com (Kathy Quan) — Fri, 01 Jul 2011 17:18:00 +0000

Hope everyone has a safe and happy Fourth of July! This can be a terrific holiday because it's more low key than some of the others. Picnics, BBQs, potlucks, pool parties. Time to relax and enjoy the summer that stretches out before us. Take time to enjoy yourselves and refresh yourselves.

This is also a time to take note of the HOT weather we can expect over the next few months. Older people tend to "run cold" and may not notice that it's really HOT until they are overheated. I've visited many an elderly patient who kept the heat on in the summer with a median temperature of 80+ degrees inside! So make note of your aging parent's habits and have them turn down the heat and step up the fluid intake to stay hydrated.

Watch for signs of dehydration such as increased confusion or forgetfulness, slurring of words and increased fatigue. Most older people are resistant to increasing fluids as then they have to urinate more often and sometimes this keeps them up at night. Encourage them to start drinking fluids when they wake up and decreasing them late afternoon and to slow intake after 6 PM. This will help with the "up all night" aspect.

Coffee and tea are dehydrating and if 8 cups of coffee is Mom's idea of increasing fluids, you might see more dehydration. Juices, flavored waters and of course plain water are best. Ice chips, frozen ices, popcycles and jello are also excellent sources of fluids and may be more palatable than plain water. They can also be a great way to sneak in extra fluids without alerting them to the process.

If your aging parents have pets, be sure they give the pet more water during the summer months as well and a shady place to rest.

Close draperies and blinds, use fans to circulate the air. And cool damp rags or a baggie of crushed ice on the head, neck or even in the lap can help to keep them cooler and replace or cut down on air conditioning.

Keep activities to a minimum during the middle of the day when it is the hottest. And remind them to eat. Cool foods such as fruits and fresh veggies may be most appetizing on a hot day. Small frequent snacks or meals work well with hot summer days as opposed to large heavy meals, but remind them to not skip meals.

Have a great holiday weekend and enjoy this time with your aging parents.

Some Stylish Aids for Daily Living

noreply@blogger.com (Kathy Quan) — Thu, 23 Jun 2011 18:38:00 +0000

photo: Omhu.com

One of the hardest problems is getting our loved ones to use devices to keep them safe with their activities of daily living such as canes and walkers. They just won't use them! Grrr!!!

If they could have a cane with some flair and style perhaps they would be more likely to use it. Here's a site that offers some stylish canes as well as other great ideas to assist with everyday living.

Avoiding Financial Scams with Your Aging Parents

noreply@blogger.com (Kathy Quan) — Fri, 04 Mar 2011 19:55:00 +0000

One of the scariest things you might not even consider as a risk in caring for an aging loved one or friend is the ramifications of financial scams. The elderly are so very vulnerable. And so many of them still believe in get rich schemes.

Too often we easily dismiss this because our aging parents or loved ones are intelligent, strong individuals who won't fall for some hair brained scheme. But look at all the people who have been hurt by the likes of Bernie Madoff! That set off a world of trouble for almost everyone.

So here are 10 Scary Financial Scams That Target the Elderly. I hope this article gives you good food for thought and opens a healthy discussion with your aging parents and loved ones so that you can avoid financial scams with your aging parents and loved ones.

New Fall Prevention Guidelines

noreply@blogger.com (Kathy Quan) — Fri, 14 Jan 2011 22:05:00 +0000

The American Geriatric Society has published new guidelines to help prevent falls.

Falls are a leading cause of death in the elderly. Prevention can be a huge compliance issue especially if it entails a lifestyle change such as removing throw rugs. One of the proposed ideas here includes adjusting medications. This can be another issue especially for those who depend on sleeping medications, anxiety and anti depressant meds. Slow progressive changes may be needed in order to accomplish the goal and achieve compliance.

A Senseless Murder

noreply@blogger.com (Kathy Quan) — Tue, 11 Jan 2011 01:34:00 +0000

Our thoughts and prayers are with all of the victims of the recent Tuscon AZ shooting. We wish for a speedy and full recovery for those who were not fatally wounded, and for compassion and empathy for the families who lost loved ones in this senseless murder. May they be laid to rest in peace!

It's 1/1/11

noreply@blogger.com (Kathy Quan) — Sat, 01 Jan 2011 19:14:00 +0000

•°*”˜˜”*°•.¸☆ ★ ☆¸.•°*”˜˜”*°•.¸☆
╔╗╔╦══╦═╦═╦╗╔╗ ★ ★ ★
║╚╝║══║═║═║╚╝║ ☆¸.•°*”˜˜”*°•.¸☆
║╔╗║╔╗║╔╣╔╩╗╔╝ ★ NEW YEAR ☆ 2011
╚╝╚╩╝╚╩╝╚╝═╚╝ ￥☆★☆★☆￥

Merry Christmas!

noreply@blogger.com (Kathy Quan) — Sat, 25 Dec 2010 14:00:00 +0000

To all who celebrate-- Have a very Merry Christmas!!

Happy Holidays! Resources for Caregivers

noreply@blogger.com (Kathy Quan) — Thu, 23 Dec 2010 21:34:00 +0000

Take time for you!! Don't forget to spend some quality time with YOU over the next couple of weeks. The holidays can be very stressful for anyone, add in caregiving responsibilities and you might find yourself over the edge with caregiver burnout or caregiver fatigue. So take time to recharge your own batteries and relax!!

On January 11, you might like to tune in to an online chat sponsored by the Chicago Tribune. They will be chatting with the authors of The Care Organizer. It looks interesting, I haven't had time to review it yet, but might me a good present for yourself!!

Add it to your shopping list along with The Everything Guide to Caring for Aging Parents.

Happy and Safe Holidays!!!

Enjoying the Holidays with Loved Ones

noreply@blogger.com (Kathy Quan) — Fri, 19 Nov 2010 22:22:00 +0000

The holidays are almost upon us and they can be stressful in the best of times. If you're also caring for aging parents, there are many other things to think about such as how to safely get them to and from your celebrations. They may tire out quickly and have to be taken home early. Be prepared. If they have diaper issues, you'll need to make sure you have plenty and bring a change of clothing along-- just in case.

Make sure you plan for toileting every couple of hours and if someone has to assist, add that to the to-do list to enlist someone to help. Perhaps they will need some assistance with eating or need their food cut up, chopped or even pureed. Allow time for this and assign someone to assist with this. Make sure you have any medications that need to be taken during their outing. And plan for bad weather causing you to get shut in.

The holidays can also be a time to reminisce and make sure that stories and traditions get handed down. Ask them about their childhood, where they lived and went to school. When did they marry? What kind of work did they do? Where did they live? what did they do for entertainment (before television, video games and the internet!!)? Maybe have a video camera running in the background to capture some of these moments. And be sure to always take lots of family group photos. Make lots of memories, as they help keep loved ones alive in our hearts when they are gone.

Take time for yourself, and remember that there is NO SUCH THING as a perfect holiday. Being with the ones we love and enjoying their company and a few laughs is the perfection you can expect. The best holidays are the ones that everyone remembers, and they often stand out for their imperfections! So relax and enjoy!!

Photo by monmart

Finding Resources

noreply@blogger.com (Kathy Quan) — Sat, 25 Sep 2010 00:16:00 +0000

While it would be nice to be prepared for any event in life, sometimes it's just not possible to be that well organized and prepared. Part of the problem when dealing with aging parents or spouses or other relatives is that we really don't want to face the fact that they are aging and having challenges and struggles. It would be great to keep everyone young and active. But the fact is, age creeps up on all of us and lifestyles take a hit.

So when you need to find some resources to help meet the needs of your aging loved ones, one of the best places to start is with your friends who are experiencing the same process. Then the Internet can offer lots of information.

A good place to begin your online search would be with the Area on Aging Agency in your state or county. I usually use Google as my search engine of choice so this example is what I got using Google. You can enter the search term "Area on Aging Agency San Francisco" for example and you'll receive information on the agency in San Fransisco along with an number of similar sources. Plug in the name of your local area and see what you get. Then search their site for the kinds of resources you need.

Another good search term is "caregiver resources _______" Fill in the blank with your city or county and see what comes up. Search their sites and contact the sources to find help with additional resources in your location.

Start a file folder and keep copies of the information or write down the web addresses of the places you've found helpful.

Johns Hopkins' Nurse Makes a Difference for the Aging

noreply@blogger.com (Kathy Quan) — Fri, 13 Aug 2010 18:00:00 +0000

The population continues to age because we have better health care and more interventions to help keep the elderly safe as well as healthy. This also presents many new challenges each day to keep this population safe and as independent as possible. An associate nursing professor at Johns Hopkins' University School of Nursing has made a difference in Baltimore, MD with a pilot program.

If your aging parents or spouse needs some suggestions for safer living, contact the PCP (primary care practitioner) to discuss the possibility of a home health safety evaluation. A visiting nurse, PT, OT and Medical Social Worker can be made available to assess their needs to keep them safe and as independent as possible in their own home. This service is paid through Medicare as long as there is a skilled need and the physician orders the evaluation. The skilled need can be issues such as a fall risk, safety with performing activities of daily living, taking medications appropriately, and pain control.

Image:Microsoft.com