Returning Home: Nutrition and Hydration

Good nutrition is important for everyone, but proper diet is a necessity for seniors home from the hospital or a facility. Sometimes older adults don’t feel like eating when they arrive home. Some medications can impact appetite and even the way food tastes. Other older adults – particularly those with dementia – are no longer able to cook fro themselves wile some cannot, or should not., drive to get the groceries they need.

If a senior is home alone recuperating with no one to prepare nutritious meals, consider either a supplemental meal program or caregiving support. Most communities have programs, such as “Meals on Wheels,” that can provide an older adult nutritious meals. However, those programs are not usually available for each meal, every day of the week. So you and your senior will want to develop a plan that takes into account the daily nutritional needs of a senior.

Proper hydration is as important as good nutrition. Older adults can be vulnerable on two counts, according to experts. As we age, the brain may be unable to sense dehydration and send the signals for thirst. In addition, those who are sick or have certain medical conditions may be unable to get the fluids they need during the day, or must be encouraged to drink.

The warning Signs Associated with Nutrition

As your older adult is recovering, keep in mind these warning signs that a senior could be at nutritional risk. As you can see, a recent illness and multiple medications are, in and of themselves, risk factors:

1.  Loss of appetite
2. Little to no interest in eating out
3. Depression
4. Sudden weight fluctuation
5. Expired or spoiled food
6. Skin tone
7. Lethargy
8. Cognitive problems
9. More than three medications
10. A recent illness

Returning Home: Doctor Follow-Up

Considering all the activity that goes with a senior’s return home, follow-up doctors’ appointments can be easily overlooked – especially if a senior feels well. But, according to experts, missed appointments are among the biggest pitfalls of a successful transition home.

As life returns to normal, you or a senior may be temped to forgo these appointments altogether. Or they can be easily forgotten. That would be a mistake. Medical appointments are important benchmarks in the recovery process.

Prescriptions may have been updated while your senior was sick or recovering. Perhaps they need to be changed again. Your senior’s doctor may want to run some blood work (which can reveal issues not obvious to the eye) or order follow-up X-rays and CT scans (which can help ensure your senior is on the right track). And incisions and wound care must be carefully monitored.

Another common concern for seniors and their family caregivers is transportation. With so may working family caregivers, getting that older adult to and from doctors’ appointments can be a challenge. You may need:

• Someone to make an appointment if your senior is unable to do so.
• Transportation for your senior to attend follow-up appointments and someone to listen to the physician’s recommendations, clarify for the senior, if necessary, and communicate to the family caregiver.
• Attention to detail while at the doctor’s office also is important. When he or she is with the doctor, the National Transistions of Care Coalition advises that your senior loved one should know these things:
  • Why am I meeting with a health-care provider today?
  • What medical conditions do I have?
  • Do I have a list of all the medicines I take?
  • Besides taking my medications, what else do I need to do (such as get blood tests or other medical tests, change bandages, etc.)?
  • Is there more than one doctor or health-care provider that I must see?
  • Has the doctor who discharged me sent my discharge plan or other information about my health to the doctor I am seeing?
  • Who should I call before my next appointment if I have questions or problems managing my care or dealing with my condition?

If you are unable to be there to provide transportation and support at the doctor’s office, look to other resources to help.

Returning Home: Medication Management

Medication mismanagement is one of the leading problems that sidelines a senior’s successful recovery.

Nearly 120,000 patients each year need to be hospitalized for treatment after emergency visits for adverse drug events, reports the Centers for Disease Control. As more people take additional medications, the risk of adverse events may increase.

Why Seniors Are Vulnerable

Although many seniors take regular medications, a recent hospital stay could result in new and unfamiliar prescriptions. Taking the right medication at the proper time and in the correct dosage is important to keeping an older adult on the road to recovery.

Following are key tasks that older adults returning home often need assistance with to ensure they remain safe and on track:

• Picking up prescriptions from the pharmacy
• Ensuring medication is taken
• Refilling prescriptions. (It’s best to go to a senior’s regular pharmacy to avoid adverse reactions from a combination of drugs prescribed by different sources such as hospital and primary care physician.)
• Organizing pills to ensure that confusion doesn’t lead to a medication mishap. A pill box can help track whether a senior has taken his or her medications. Some pharmacies will fill a pill box and others offer a service that seals each day’s medications in a blister pack.
• Tracking medications to hep older adults more easily manage their health

Make sure your senior has the support he or she needs to manage the tasks above.

Senior Emergency Kit

Whether accompanying your loved one to a doctor’s appointment or in response to a medical crisis, it’s critical to have your loved one’s medical information easily and quickly accessible.

The Senior Emergency Kit features several worksheets that family caregivers can complete with the help of a senior loved one. This toolkit can be kept in an easy-to-reach location, such as a nightstand, to allow easy access to information.

Returning Home: A Rested Caregiver

During the early days of your senior’s recovery, you will want to make sure you’re taking care of yourself.

Family caregivers often suffer from debilitating stress that can endanger their own health and place the person they care for at risk as well. Anger anxiety, sadness, exhaustion and guilt are just a few of the signs that you will need assistance and support as a caregiver.

Make sure you’re doing the following:

• Work out: Exercise and enjoy something you like to do (walking, dancing, biking, running, swimming, etc.) for a minimum of 20 minutes at the least three times per week.
• Meditate: Sit still and breathe deeply with your mind as “quiet” as possible whenever things feel as if they are moving too quickly or you are feeling overwhelmed by your responsibilities as a caregiver.
• Ask for help: According to a national survey by the Home Instead Senior Care network of adults who are currently providing care for an aging loved one, 72% do so without any outside help. To avoid burnout and stress, you can enlist the help of other family members and friends, and/or consider the services of the Home Instead Senior Care network’s Returning Home Care Program.
• Take a break: Make arrangements for any necessary fill-in help (family, friends, volunteers or professional caregivers.) Take single days or even a week’s vacation. Talk about different things, read that book you haven’t been able to get to, take naps, whatever relaxes you and makes you happy.
• Eat well: Eat plenty of fresh fruits, vegetables, proteins, including nuts and beans, and whole grains. Indulging in caffeine, fast food and sugar as quick “pick-me-ups” also produce a quick “letdown.”

Caring for you, the caregiver, ultimately provides your senior loved one with the support needed to make a successful transition home.

Returning Home: The First Few Days

The Warning Signs

Regardless of your older adult’s situation and conditions, you will want to know the warning signs that could signal trouble when your senior is discharged from a hospital or facility.

Each senior’s situation will be unique, but some general warning signs will help determine whether your older adult is in trouble.

According to the Visiting Nurse Service of New York*, general problems to watch for include:

• No bowel movements in three days
• New skin problems
• Change in balance, coordination or strength
• Change in mental status or behavior
• Nausea or vomiting
• Running out of medication
• Dizziness
• Diarrhea
• Fever

Be sure to call the doctor if any of the problems above appear to be an issue for your senior. The Visiting Nurse Service of New York advises to call 911 if your senior is experiencing any of the following:

• Fall and is bleeding
• Fall and has a broken bone
• Severe or prolonged bleeding
• Severe or prolonged pain
• You are unable to wake the senior
• New onset of slurred speech
• Sudden weakness in arms or legs
• Chest pain that medication does not help
• Increased Difficulty breathing not relieved by rest or medications

For more information about the symptoms and problems of chronic conditions, such as congestive heart failure and heart attack, visit www.ReturningHome.com/conditions

Returning Home: Preparing a Safe Home-Pt. 2

Stocking the Refrigerator and Cupboards, Changing the Linens

While you’re getting everything together, don’t neglect the refrigerator and cupboards. If your senior has been gone long, there may be spoiled and outdated food to replace and important staples to replenish.

Gear the type of food you restock the refrigerator and cupboards to the condition that your loved one will be in when returning home. If cooking will be a challenge and he or she doesn’t have adequate help, buy or arrange for nutritious and easy-to-prepare preferably fresh or frozen, if necessary, alternatives. Or consider asking the social worker or case manager to help arrange signing up for a home delivery meal program such as “Meals on Wheels.”

Remember to change the linens and restock important personal and hygiene products that a loved one could need.

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 of this guide, 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.

If you can’t be there when an older loved one goes home from the hospital, a CAREGiver from the Home Instead Senior Care network’s Returning Home program can assist.

Returning Home: Preparing a Safe Home

Home safety is important for any older adult, but becomes more urgent when a senior who is recuperating returns from a hospital or facility.

Keep in mind that some medications will make a senior weak or dizzy. Think about the layout of your older adult’s home and what obstacles could get in your loved one’s way at home. This home safety assessment can help:

• Examine dark pathways, corners and other areas where seniors regularly walk or read. Make sure all areas of the home have adequate lighting. Timed and motion-sensor lights outdoors can illuminate potentially dangerous pathways. Inside consider OttLites – which provide a high-intensity beam for doing detail work. Make sure that hallways and stairs are properly lit.
• Look for ways to make entries safe. Make sure that railings leading into a home are in good repair and that steps and sidewalks are not damaged. Or eliminate steps altogether. Install remote control locks.
• Think contrast. Large red and blue buttons over hot and cold water faucet controls will help prevent dangerous mistakes for seniors who might be weak and confused after a hospital stay. A dark green or brown toilet seat and vinyl tape around the shower will make those fixtures more easily distinguishable.
• Look for ways to reorganize. Mom always put the black stew pot under the stove to keep the kids from breaking it. Perhaps now it belongs on a shelf beside the stove. And who says the eggs must go in the egg tray of the refrigerator? Perhaps it’s easier for your dad to reach them if they’re stored in the meat tray. If that hallway table, which has been a permanent fixture, is becoming a dangerous obstacle, relocate it.
• Install safety devices. Make sure your loved one has assistive devices in key areas of the home, including grab bars in the bathroom and sturdy railings on the stairs.
• Look for damage. Look for towel bars or window sills that are separated from walls, or shower curtains that have been torn by seniors using them to grab onto.
• Consider security. Think about the potential dangers that lurk within you loved one’s home. Lock-in switches on thermostats and stoves will keep seniors who may be confused from harming themselves when they return home.
• Look behind closed doors. Many seniors will close off parts of a house they no longer use. Be sure to check those areas regularly for mold or water damage, especially if you senior has been away from home for awhile. Don’t close vents to crawl spaces.

Your older adult will be glad to be home, and making sure that everything is in order will help a loved one feel more secure.

A Caregiver’s Guide to Arthritis: Avoiding Caregiver Burnout

A danger or caregiving, whether you are a spouse or grown child caring for a parent, is offering care at your own physical and emotional expense. You are no help to your family member if you are burned out. Below are tips for managing caregiver stress and fatigue.

Take time to exercise. Exercise is not only essential to maintain the physical stamina you need to care for your spouse or family member, but also provides a bread in your day. And the endorphins-feel-good hormones-that exercise induces will also help boost spirits that can get a beating as a caregiver.

Ask for help. Don’t hesitate to ask other family and friends to share your care-taking duties. Disperse tasks like driving to doctors’ appointments or picking up prescriptions. You don’t have to do everything. If no one is available, consider hiring regular help that can offer you a chance for a respite. Talk to other friends and acquaintances who have also been caregivers, or join a caregiver’s support group where you can get empathy and information.

Check employer benefits. Your employer may offer a plan that helps families who are caring for loved ones.

Monitor your won spirits. It’s not unusual for caregivers to become depressed from stress, exhaustion, and from seeing someone they love in pain. If you feel blue for two weeks or longer, ask your doctor if you could be depressed and what remedies such as antidepressants he might suggest.

Stay social. Isolation is a difficulty for caregivers. Schedule regular outings with friends, even if they are brief.

Get a handle on finances. Money may be an issue. Talk about who will be responsible for what costs with your parent and siblings.

Enlist other family. Talk to other family members about how they would like to help. Try to be realistic about what you can manage and what others need to help you with.

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.