A Caregiver’s Guide to Arthritis- Physical Challenges: How You Can Help

The range of physical challenges from arthritis can be extensive: The person may have difficulty walking, trouble with household tasks like opening jars and turning doorknobs, or even problems with dressing and combing his or her hair. And pain pay make sleep hard to come by. But there are ways you can help easy physical restraints and discomforts.

• Arrange for physical and occupational therapy. A physical therapist can develop an exercise routine for your family member that will likely include range-of-motion exercises that will make it easier for him to do things like comb his or her hair, or stand up or sit down; strength training that will strengthen the muscles that support the joints; and some cardiovascular exercise like walking or swimming that will help him maintain overall fitness. An occupational therapist will assess what your family member can and can’t do, and address ways to help make difficult tasks easier. For instance, she may suggest small household changes like door latches instead of twist knobs that won’t stress the joints.
• Employ heat and cold. Heat works by stimulating blood circulation, which can reduce muscle spasms and relieve pain. Encourage your family member to take a warm shower each morning to relieve morning stiffness. Applying heating pads or patches to painful areas for 15 minutes at a time can help as well.
• Try massage. Research shows that regular massage can reduce pain and stiffness and improve range of motion and joint function. An added bonus is that massage also reduces anxiety, a common accompaniment to chronic pain. Researchers have found that massage lowers stress hormones and increases feel-good neurotransmitters like serotonin. Make sure the doctor thinks it’s a good idea and get a referral to a massage therapist familiar with arthritis.
• Address sleep difficulties. Pain robs sleep. And fatigue increases pain. Talk with the doctor about ways that your spouse or parent can sleep more soundly. Try to persuade your family member to avoid caffeine and alcohol, which disturb sleep. And share some minutes of soft music, deep breathing, and warm milk before going to sleep in a cool, dark room.
• Prepare nutritious meals. Some foods can help fight inflammation, while others may trigger arthritic flares (increase in symptoms). And maintaining a healthy weight can also help manage joint pain. Fruits and vegetables, fish, fiber and whole grains can help fight inflammation. High fat foods may trigger arthritic flares.
• Evaluate housing. If you are caring for a parent, you may want your parent to live with you. Evaluate all the options with your parent first. Your parent may want to stay where she is, move to a nearby apartment or a skilled facility with assisted living.

A Caregiver’s Guide to Arthritis: Understanding Your Loved One’s Needs

People handle pain and discomfort in all sorts of ways. Some people keep a stiff upper lip, feeling embarrassed or uncomfortable with complaints. Others may complain indirectly by acting out of sorts or grouchy. Others may get down in the dumps. Below is a roadmap to some of the challenges.

Emotional Challenges: How You Can Help

People with arthritis may also experience depression, anxiety and/or a feeling of helplessness because they are no longer able to do things they used to do. They can also feel isolated, like no one quite understands what they are going through. And stress from chronic pain can stalk them as well. You can help by doing the following:

• Listen and Empathize – You may feel like you need to solve everything when in fact what your loved one may want most is to express their emotions of sadness and loss. Encourage them to talk about how they are feeling, and any concerns or fears.
• Make a date – Plan some outings like lunch out, or a short shopping trip, or just a time to read together. That can help your loved one feel less isolated and alone.
• Practice relaxation together – Chances are you could both use some R&R. Practice deep breathing together. Or run your family member a warm bubble bath where he can listen to music and relax.
• Encourage some movement – if your spouse or parent is able, ask him or her to go for a short walk with you outside. Exercise can lift spirits and lessen pain. Ask the doctor what kind of exercise would be helpful.
• Ask for help – Tell the doctor that your family member seems depressed and anxious. The doctor may be able to prescribe an antidepressant or anti-anxiety medication that can help. Some antidepressants also help with pain.

A Caregivers Guide to Arthritis: Common Arthritis-Related Diseases

While OA and RA may be the most commonly recognized types of arthritis, there are other related conditions that are often found in older adults. They include:

• Fibromyalgia
  • A condition that causes pain in the muscles and soft tissues and is often accompanied by fatigue, poor sleep and sensitivity to touch, especially in certain tender points on the body.
• Gout
  • A condition that occurs when the body produces too much of a substance called uric acid, which can lead to the development of uric acid crystals in the joint (typically the big toe) and causes severe pain and swelling.
• Osteoporosis
  • One of the most common arthritis-related diseases, this condition causes bone to lose mass and become thin and brittle, which can lead to painful fractures, rounded shoulders and loss of height.

Returning Home: Time to Go Home

It’s the day you and your senior have undoubtedly waited for: time to go home! All hospitals and facilities have their own patient discharge procedures but, regardless of their policies, you can be better prepared by ensuring that you have all you and your senior need to be ready when you step out the door.

If you haven’t had time to ask the questions in the beginning, do it now. Likewise, this could be your last chance before your older loved one departs from the hospital or facility to address his or her equipment needs.

Following is a checklist adapted from the Centers for Medicare and Medicaid Services* that can help ensure that you and a loved one haven’t forgotten anything:

• Confirm where your loved one will be going – back home or to a rehabilitation facility or care community.
• Ask staff what your loved one can do to get better.
• Ask about problems to watch for and what to do about them. Write down a name and phone number to call if you have problems.
• Review with medical staff the list of drugs, vitamins and herbal supplements your senior loved one will be taking. Write down a name and number to call if you have problems.
• Confirm the medical equipment your senior will need. Write down a name and phone number to call if you have questions about the equipment.
• Ask if your senior will need help with the following:
  • Bathing, dressing, using the bathroom or climbing stairs.
  • Cooking, food shopping, house cleaning, laundry, and paying bills.
  • Getting to doctors’ appointments, picking up prescription drugs.
• Ask staff to show you and your senior any task that requires special skills such as changing a bandage or taking medication.
• Ask the social worker any final questions about what insurance will cover. If you need help with costs, ask about your options.
• Ask for written discharge instructions and a summary of current health status. Bring this information and list of medications for follow-up appointments.
• Write down any appointments in the coming weeks
• Get prescriptions and any special diet instructions.

Being prepared will help make you a more confident caregiver and put your loved one at ease.

The Home Care Solution: Questions to Ask a Home Health Care Provider

• Is the home health care agency Medicare-certified? That means it is approved to provide services to patients with Medicare.
• Does the home health care agency offer a full range of home health care services including skilled nursing, physical, occupational and speech therapies, IV therapy and home health aides?
• How do I receive home health care agency services? A referral can be made by anyone involved in a patient’s care – physician, family or others. If someone other than a physician makes referrals, many home health care agencies contact the patient’s physician to approve orders for service.
• Does the hospital discharge planner, doctor or social worker recommend the home health care agency? Those recommendations can serve as a second reference.
• Does the home health care agency have the staff available at night and on weekends for emergencies?
• Where else could I find information about Medicare-Certified home health care agencies?
• Does the home health care agency have staff available to provide the type of hours of care as prescribed by the physician?

Information about Medicare-certified agencies in your geographic area are available online at www.medicare.gov, including Home Health Compare, which allows you to compare the home health care agencies in your area. You can also call 1-800-MEDICARE for more information.

The Home Care Solution: Who to Call for Home Health Care

When hiring home health care, seek out a licensed medical caregivers designated as ‘home health agency,’ advises James Summerfelt, chief executive officer of the Visiting Nurse Association. “The term often indicates the provider is Medicare-certified and has met minimum federal requirements for patient care and management.”

Eligibility for Home Health Care Under Medicare is Determined By the Following:

• You must require intermittent skilled nursing care, physical therapy or speech therapy.
• You must be homebound.
• You must currently be under a physician’s care. All home health services must be ordered by your physician.

Services are delivered at home to recovering, disabled, chronically or terminally ill persons in need of medical, nursing, social or therapeutic treatment and/or assistance with the essential activities of daily living.

When interviewing an agency make sure you understand exactly what services it will provide and those it will not provided, including those it is forbidden to provide by state law. Families are allowed to proved any care for a family member, but professionals have to abide by state law. For instance, in many states, invasive procedures such as injections and maintenance of feeding tubes may not be administered by non-skilled professionals. You may need a doctor or a nurse to perform these procedures.*

The Home Care Solution: Home Health Care

It used to be that a medical crisis could spell the end for seniors in their own homes. But today, even older adults who suffer from chronic conditions of life debilitation illnesses can still remain at home. Advances in technology and life-saving equipment have kept many seniors at home.

What’s more, home health care agencies can also provide licensed medical professionals to go to an older adult’s home, offering a wide range of medical and therapeutic services.

Convalescing at home can actually help some seniors not only survive but thrive. For instance, seniors with dementia may be less confused at home where they will more likely know where everything is located.

As is the case with non-medical care, there are signs in a senior that can signal when it’s time to call for help:

• Post-op Rehabilitation
• Skilled Assessments and Teaching
• Occupational Therapy
• Speech Therapy
• Wound Care
• Mobility Training
• Pain Management
• IV therapy/Injestions

According to the Visiting Nurse Association (VNA), a home health agency is likely to employ a range of professionals, including physicians, registered nursed, licensed practical nurses, physical therapists, social workers, speech language pathologists, occupational therapists and certified aides.

Medicare, as well as private insurance, will pay for some services, such as visits by nurses, and speech and occupational therapists.** If a senior is discharged from a hospital, Medicare will pay for a nurse, occupational and speech therapists for the client at home, but only according to a doctor’s prescribed plan of care.*

The Home Care Solution: Non-Medical Home Care

Just because a senior is having more problems at home does not mean it’s time to recommend a move elsewhere. Such a circumstance could, however, signal the need for more help at home.

The first step in determining if care is warranted is to take a senior’s needs and desires into account. Sometimes these are difficult conversations to have with an older adult how is convinced he or she does not need help. The best way for a family caregiver to start these conversations is to acknowledge the senior’s desire to stay at home:

“You know, Mom, I want you to stay at home, too, however that might be more difficult if you fall or get sick. A little extra help could keep you safe and independent at home for a longer time.” (For more tips about talking with seniors about sensitive subjects, go to www.4040talk.com.)

Non-medical home care might be ideal for an older adult who is recovering from an illness or a surgery, such as a knee replacement, and does not need medical assistance, but rather help around the home with ADLs and IADLs. The need can be just as much for emotional and mental support, as well as physical assistance. A senior who loses a spouse can become depressed and lonely to the point her own health suffers. Or a widower’s increasing forgetfulness can put him at risk of forgetting to pay the bills, or worse, to take his medications.

Enhancing Lives

The companionship component of a professional caregiver’s job can be just as vital as the physical assistance a professional will provide. Seniors need conversation and one-on-one contact to keep their minds alert. They can thrive with someone to participate in their favorite activities such as gardening, baking or woodworking, or someone to go to the grocery store or attend a concert.

Many seniors need help to get their day started with assistance showering, preparing breakfast and taking their medications. Likewise, help before bedtime, or even overnight, can be an important safety net for seniors at home who often are more apprehensive at nighttime. A reputable non-medical caregiving company will provide caregivers who can meet all of those needs.

Let’s say a senior does eventually need to make the move to a care community. If so, in-home non-medical care can continue with that older adult into any community, from independent to skilled.

When Non-Medical Care is Needed:

• Eating
• Dressing
• Bathing
• Toileting
• Transferring
• Continence
• Companionship
• Meal Preparation
• Light Housekeeping
• Medical Management
• Errands
• Shopping
• Transportation
• Hobbies
• Laundry

While more and more long-term care insurance companies are covering this option, it is still primarily paid for by the family or the seniors themselves.

Most care of this kind is provided for just a few hours a week. In fact, a Home Instead Senior Care study indicates that 22 percent of their clients employ caregiver services four and eight hours per week.

There’s also the issue of a senior’s preferences. If a parent or loved one is happiest at home, the cost of additional care may be very well worth it.

Diabetes

Uncle Charlie has diabetes, and the 79-year-old widower landed in the hospital with a foot sore. The doctor was great, and so were the nurses and the treatments. Then it came time for Uncle Charlie’s nephews to take him home. Before the departure, a doctor and hospital caseworker spent a considerable amount of time talking to Uncle Charlie and his nephews about the “transition” back home.

They told Uncle Charlie they hoped to keep him from returning to the hospital for as long as possible. They restated something that he already knew: Foot complications are the most frequent reason for hospitalization in patients with diabetes, accounting for up to 25 percent of all diabetic admissions in the United States and Great Britain.*

They also told Uncle Charlie that recent research showed that weight-bearing exercise does not increase the risk for foot ulcers, and that those people who were the most active actually reduced their risk for ulceration.

“Charlie,” his medical team summed it all up, “please eat better, make sure you take your medications, use your exercise bike or walk more and don’t forget to arrange for rides to your follow-up doctors’ appointments.” Uncle Charlie’s nephews, who run a busy restaurant about 100 miles away, began to look for a way to help him on a daily basis.

So they contacted the local Home Instead Senior Care office to assist Uncle Charlie in trying to recover at home from the effects of diabetes. Home Instead Senior Care can help a senior transition safely home from a hospital or facility through the organization’s Returning Home Program.

To Us, It’s Personal: Ask 5

This is a list of 5 key questions that everyone should ask when interviewing a Home Care Company:

1. Is your company SC DHEC compliant and licensed?
2. Does your company conduct National Background Checks and routine Drug tests on each Caregiver?
3. Does your company Bond and Insure each Caregiver individually?
4. Does your agency answer their phones 24/7 with a live staff member?
5. Does your company provide continuous Education for their Caregivers.. ie: Basic Care giving, Advanced Care giving, Personal Care series and specialized Alzheimer’s training?

For Free consultation, Call 843.357.9777