In today's Globe and Mail The Bloomberg Manulife Prize For The Promotion of Active Health was announced. It has been awarded to Dr. Steven Blair who's research shows that as little as 30 minutes of moderate physical activity per day is all it takes to decrease mortality rates by 50 per cent. He says lack of physical activity is the single biggest health issue facing North Americans today.
Unfortunately the headline of this announcement reads:
"No magic pill. No trendy diet. Just 30 minutes of light exercise."
Well, that's going to be a major problem. Who can make money from that kind of advice?
The pharmaceutical companies won't promote it if they can't formulate and sell the next magic pill.
The weight loss companies won't advertise it by hiring famous actors to promote it because there's no trendy diet.
Health practitioners won't become famous and be sought after as highly paid speakers and they will have difficulty selling millions of books with it because it's not trendy or complicated.
Infomercials will not be made because there are no special blenders or pieces of exercise equipment to sell.
Even your family doctor won't give you a medical prescription for it. (Not to mention that doctors are not necessarily experts about exercise anyways.)
I congratulate Dr Steven Blair, but I do have one request: Next time you discover an accessible lifestyle change that might have a significant impact on the health and wellbeing of the entire population, couldn't you make it a little more exotic or mysterious or even sexy? Maybe throw in a secret recipe or two, suggest impossible exercises or even hire a vampire as your spokesperson...seems that's a sure fire way to grab everyone's attention.
Wednesday, December 7, 2011
Monday, December 5, 2011
Depression, Mental Health and Exercise
Here's an interesting statistic; According to the Public Health Agency of Canada, mental illness will be experienced by 20% of the population in any given year.
Depression affects people of all ages. The one treatment that does not involve drugs or specific psychiatric interventions is exercise. All types of exercise have been found to provide some beneficial effect.
Exercise boosts mood, helps reduce stress, improves sleep, and boosts low serotonin levels which are linked to depression. Exercise can reduce blood pressure, assist in weight loss, improve respiratory function, digestion....
Of the thousands of seniors that I have seen in my Practice over the last 25 years, can you take a guess at how many had been advised by their family doctors or psychiatrists to increase or start an exercise program to improve their physical and mental wellbeing? If the answer is not zero, it's pretty darn close.
How many of that same group were given prescriptions for sleeping, anxiety or depression? At least one third. Is it just me, or is there something wrong with this picture?
Depression affects people of all ages. The one treatment that does not involve drugs or specific psychiatric interventions is exercise. All types of exercise have been found to provide some beneficial effect.
Exercise boosts mood, helps reduce stress, improves sleep, and boosts low serotonin levels which are linked to depression. Exercise can reduce blood pressure, assist in weight loss, improve respiratory function, digestion....
Of the thousands of seniors that I have seen in my Practice over the last 25 years, can you take a guess at how many had been advised by their family doctors or psychiatrists to increase or start an exercise program to improve their physical and mental wellbeing? If the answer is not zero, it's pretty darn close.
How many of that same group were given prescriptions for sleeping, anxiety or depression? At least one third. Is it just me, or is there something wrong with this picture?
Tuesday, November 8, 2011
Mental Health and our Nursing Practice
Last night I, along with eight members of the Eldercare Home Health Care team, attended a dinner and presentation featuring John Thomas, who is a member of the geriatric mental health outreach team at Baycrest. John did a great job, as he always does, highlighting the signs and symptoms of depression and anxiety in the elderly. He outlined some commonly prescribed medications and their side effects as well as reviewed the use of ECT.
There's only so much that can be covered in an hour's presentation and by all measures, John's presentation was excellent. However, it was a reminder about the importance of our assessments as Registered Nurses and front line care providers and the scope of interventions possible for the care of older people. The interventions that do not involve medical "treatments".
There are a multitiude of factors that contribute to our mental wellbeing-and absolutely the same is true of people who happen to be over 80 years old. Yes, there may be complicating features, but there are also many very basic healthy interventions that can be addressed;
There are seniors, who, for a variety of reasons, don't eat well. There are those who are chronically dehydrated. Pain, particularly chronic pain, wreaks havoc on a person's mental health.
Research has suggested that many interesting factors contribute to positive mood; exposure to Vitamin D, Vitamin B sufficiency, adequate daily doses of sunlight, an environment with pleasant odours (think lavendar, cinnamon and peppermint), meaningful life activity, pets, the company of others....to mention but a few important findings.
One of the happy coincidences with these kinds of interventions is that they have a distinct lack of serious side effects and many can be very cost effective and accomplished with a minimum of expense.
I know that John did not set out to exclude these important factors from his discussions last night, but I also know that they do not comprise the mainstay of his Practice (I did mention that he only had one hour!!).
But these kinds of considerations should be part of our Practice. I'm absolutely certain, in fact, that if we paid more attention to these basic healthy issues, only people who were truly ill would need medical interventions!
There's only so much that can be covered in an hour's presentation and by all measures, John's presentation was excellent. However, it was a reminder about the importance of our assessments as Registered Nurses and front line care providers and the scope of interventions possible for the care of older people. The interventions that do not involve medical "treatments".
There are a multitiude of factors that contribute to our mental wellbeing-and absolutely the same is true of people who happen to be over 80 years old. Yes, there may be complicating features, but there are also many very basic healthy interventions that can be addressed;
There are seniors, who, for a variety of reasons, don't eat well. There are those who are chronically dehydrated. Pain, particularly chronic pain, wreaks havoc on a person's mental health.
Research has suggested that many interesting factors contribute to positive mood; exposure to Vitamin D, Vitamin B sufficiency, adequate daily doses of sunlight, an environment with pleasant odours (think lavendar, cinnamon and peppermint), meaningful life activity, pets, the company of others....to mention but a few important findings.
One of the happy coincidences with these kinds of interventions is that they have a distinct lack of serious side effects and many can be very cost effective and accomplished with a minimum of expense.
I know that John did not set out to exclude these important factors from his discussions last night, but I also know that they do not comprise the mainstay of his Practice (I did mention that he only had one hour!!).
But these kinds of considerations should be part of our Practice. I'm absolutely certain, in fact, that if we paid more attention to these basic healthy issues, only people who were truly ill would need medical interventions!
Friday, November 4, 2011
A rant about weight measurement in facility settings...
"Accurate weight measuring is a simple yet often neglected aspect of basic care that contributes significantly to determining an individual's overall and nutritional health" (Canadian Nurse October 2011 Volume 107 Number 8 p20)
In an article entitled Taking the Weight, authors report that the lack of weight measurement and documentation in a facility setting were affected by the following issues;
-a lack of time due to workload demands
-confusion about which clinical team member is responsible for weighing a resident
-a lack of understanding of the significance of weight measurement
-inaccessibility of scales and confusion as to which scale was appropriate for the resident
-limited space for documenting weights on nursing flow sheets
-difficulty locating weight data in the medical record
Really? Health care teams made up of professional, caring, intelligent adults cannot figure this one out without studies, multiple meetings and work sessions only made possible with additional money from the Ministry? Imagine if they have to tackle something really difficult!
The team writing the article developed the Bruyere Weight Measuring Protocol and Process. It included education, a protocol guide, a data-fax standardized documentation procedure for collecting and recording data and the production of individualized graphs to track patient weight over time and flag weight loss and gains. (Hope they didn't go to too much effort, because these kinds of tools already exist.)
The authors claim a dramatic improvement in the accurate documentation of weights.
Is it only me or does it strike anyone else that the monitoring of weight within a health care setting is an important, basic indicator of a person's wellbeing? It is a relatively simple procedure in most cases, (no bloodwork required), and can yield important warning signs of impending and/or changing health conditions.
The excuse of workload demand is too often the "go-to" excuse for any and everything in a facility. It's hard to know when the claim is justified, although sometimes there's no doubt that it definitely is.
In this instance, the provision of education and direction regarding when and where to document, as well as the monitoring of compliance, was enough to change Practice. It doesn't sound like workload demands were a factor at all.
The working group that developed the protocol now propose introducing an e-learning weight module to provide more education to staff.
Since they received funding from the Ministry of Health to develop the protocol, it seems to me that the strategies and documentation that resulted should be distributed to all facilities in Ontario, even Canada, where there is a need to monitor patient/resident health.
Now, whether that weight record is reviewed on a regular basis and how the information figures into Client care....that's an entirely different issue and a topic for another day.
In an article entitled Taking the Weight, authors report that the lack of weight measurement and documentation in a facility setting were affected by the following issues;
-a lack of time due to workload demands
-confusion about which clinical team member is responsible for weighing a resident
-a lack of understanding of the significance of weight measurement
-inaccessibility of scales and confusion as to which scale was appropriate for the resident
-limited space for documenting weights on nursing flow sheets
-difficulty locating weight data in the medical record
Really? Health care teams made up of professional, caring, intelligent adults cannot figure this one out without studies, multiple meetings and work sessions only made possible with additional money from the Ministry? Imagine if they have to tackle something really difficult!
The team writing the article developed the Bruyere Weight Measuring Protocol and Process. It included education, a protocol guide, a data-fax standardized documentation procedure for collecting and recording data and the production of individualized graphs to track patient weight over time and flag weight loss and gains. (Hope they didn't go to too much effort, because these kinds of tools already exist.)
The authors claim a dramatic improvement in the accurate documentation of weights.
Is it only me or does it strike anyone else that the monitoring of weight within a health care setting is an important, basic indicator of a person's wellbeing? It is a relatively simple procedure in most cases, (no bloodwork required), and can yield important warning signs of impending and/or changing health conditions.
The excuse of workload demand is too often the "go-to" excuse for any and everything in a facility. It's hard to know when the claim is justified, although sometimes there's no doubt that it definitely is.
In this instance, the provision of education and direction regarding when and where to document, as well as the monitoring of compliance, was enough to change Practice. It doesn't sound like workload demands were a factor at all.
The working group that developed the protocol now propose introducing an e-learning weight module to provide more education to staff.
Since they received funding from the Ministry of Health to develop the protocol, it seems to me that the strategies and documentation that resulted should be distributed to all facilities in Ontario, even Canada, where there is a need to monitor patient/resident health.
Now, whether that weight record is reviewed on a regular basis and how the information figures into Client care....that's an entirely different issue and a topic for another day.
Wednesday, November 2, 2011
Hospital meals gone terribly wrong....
A Client's wife told me of her experience with the delivery of meals to patients in a hospital setting. Mrs "Smith" spent her days in hospital by her husband's bedside. He was elderly, was diagnosed with dementia and had recently had a stroke. Mrs Smith spent long days in that hospital room which housed four patients and had this observation to share about the meals.
She said that the meal trays would be delivered to the patients by the kitchen staff. Sometimes the trays would be placed outside of the reach of the patient in the bed. Often no one came to assist the patients with their meals. She took on that responsibility for the four. The patients in the room could not reach the trays without assistance, nor could they open the containers holding the meal items.
Most days, she said, no assistance was offered to these patients, and very often they did not get to eat the food on the tray. She recalled the day that the four trays arrived, each with a lovely, whole orange. Being that none of the patients could manage to peel and eat an orange without assistance, the unfinished meals, along with the lovely whole oranges, were collected by the kitchen staff, carted off and likely placed in the garbage.
In this scenario, a Dietitian would be overseeing the menu that was supposed to ensure that patients in the hospital get nutritious meals. The Dietitian would have wanted patients to receive the benefit of fresh fruit.
The Nurses, who would have created a careplan to outline the care needs of patients, charted that the patients required assistance with their activities of daily living, and the reports they created for Ministry of Health would have indicated that this was a Unit with patients who had heavy care needs.
The Doctor would wonder why the patients were failing to respond to treatment, why their weights were in decline, (if the monthly weight chart was even consulted), the Physiotherapist would wonder why the patient was so fatigued that they were unable to participate in an excercise program, (and they would soon give up offering a physio session).
The Pharmacist would supply a multivitamin due to the deconditioned nature of the patient, the Dietitian would order an expensive meal supplement....and the fresh fruit on each patient's tray would go uneaten day after day....
I'm sorry to say that this is not a made up scenario. It is a scene played out day after day in various hospital settings, where older adults require more assistance than they are receiving in order to benefit from the treatments offered and even at a more basic level, to avoid other pitfalls of being hospitalized; becoming deconditioned, dehydrated and ill.
A caregiver's role in an acute care setting is to assist Patients with all activities of daily living, to advocate for Patients with the clinical staff and to remind the staff of the particular care needs of the Patient.
Sometimes that means peeling a couple of oranges.....
She said that the meal trays would be delivered to the patients by the kitchen staff. Sometimes the trays would be placed outside of the reach of the patient in the bed. Often no one came to assist the patients with their meals. She took on that responsibility for the four. The patients in the room could not reach the trays without assistance, nor could they open the containers holding the meal items.
Most days, she said, no assistance was offered to these patients, and very often they did not get to eat the food on the tray. She recalled the day that the four trays arrived, each with a lovely, whole orange. Being that none of the patients could manage to peel and eat an orange without assistance, the unfinished meals, along with the lovely whole oranges, were collected by the kitchen staff, carted off and likely placed in the garbage.
In this scenario, a Dietitian would be overseeing the menu that was supposed to ensure that patients in the hospital get nutritious meals. The Dietitian would have wanted patients to receive the benefit of fresh fruit.
The Nurses, who would have created a careplan to outline the care needs of patients, charted that the patients required assistance with their activities of daily living, and the reports they created for Ministry of Health would have indicated that this was a Unit with patients who had heavy care needs.
The Doctor would wonder why the patients were failing to respond to treatment, why their weights were in decline, (if the monthly weight chart was even consulted), the Physiotherapist would wonder why the patient was so fatigued that they were unable to participate in an excercise program, (and they would soon give up offering a physio session).
The Pharmacist would supply a multivitamin due to the deconditioned nature of the patient, the Dietitian would order an expensive meal supplement....and the fresh fruit on each patient's tray would go uneaten day after day....
I'm sorry to say that this is not a made up scenario. It is a scene played out day after day in various hospital settings, where older adults require more assistance than they are receiving in order to benefit from the treatments offered and even at a more basic level, to avoid other pitfalls of being hospitalized; becoming deconditioned, dehydrated and ill.
A caregiver's role in an acute care setting is to assist Patients with all activities of daily living, to advocate for Patients with the clinical staff and to remind the staff of the particular care needs of the Patient.
Sometimes that means peeling a couple of oranges.....
Tuesday, November 1, 2011
Medically proven, but likely not found on a prescription pad....yoga
What has been shown to relieve headaches, insomnia, back pain and fatigue? Furthermore has been shown to relieve stress and mild depression? Helps to prevent osteooporosis and improves digestion?
A miracle cure? No, it's practicing yoga on a regular basis. There are even some claims that it may help regulate heart beat, and lower the risk of a stroke. Research by the University of Kansas Hospital showed that after three months of doing poses, breathing exercises and meditation, patients suffering from atrial fibrilllation reported less anxiety and depression and fewer irregular heartbeats.
This can be a social or solitary activity, may be modified for a beginner or someone with limited mobility. It can be a senior friendly intervention and best of all has no known negative side effects.
A miracle cure? No, it's practicing yoga on a regular basis. There are even some claims that it may help regulate heart beat, and lower the risk of a stroke. Research by the University of Kansas Hospital showed that after three months of doing poses, breathing exercises and meditation, patients suffering from atrial fibrilllation reported less anxiety and depression and fewer irregular heartbeats.
This can be a social or solitary activity, may be modified for a beginner or someone with limited mobility. It can be a senior friendly intervention and best of all has no known negative side effects.
Monday, October 31, 2011
True Story...
There is not doubt that truth is stranger than fiction. And I could never make up the unbelievable "stuff" that we see in our Practice every day. With this one, I shook my head so much - I practically got whiplash!
A client's daughter became concerned with the worsening of a rash on her father's lower back. Being the weekend, and having a strong aversion to a long wait in an emergency or urgent care clinic, she called a visiting Doctor service and booked a housecall. The physician who came to the door was a senior himself (reportedly 80 years old). He stated that he had developed a cold and that he would wear a mask during his assessment so as not to infect the patient. Very commendable-and not often seen. Unfortunately, said doctor also decided not to view the reddened area at all during the visit, due to that same concern with contamination...he prescribed a topical medication without every setting eyes on the problem area!
Fortunately, the client's primary Nurse was available to intervene, and in discussion with the Pharmacist, and the client's primary care physician, she got the correct treatment in place to heal the reddened site.
Moral of the story? If the medical treatment you're getting doesn't seem right, don't be shy, ask questions. You may need a second opinion. Insist on getting the right treatment for yourself or your loved ones.
A client's daughter became concerned with the worsening of a rash on her father's lower back. Being the weekend, and having a strong aversion to a long wait in an emergency or urgent care clinic, she called a visiting Doctor service and booked a housecall. The physician who came to the door was a senior himself (reportedly 80 years old). He stated that he had developed a cold and that he would wear a mask during his assessment so as not to infect the patient. Very commendable-and not often seen. Unfortunately, said doctor also decided not to view the reddened area at all during the visit, due to that same concern with contamination...he prescribed a topical medication without every setting eyes on the problem area!
Fortunately, the client's primary Nurse was available to intervene, and in discussion with the Pharmacist, and the client's primary care physician, she got the correct treatment in place to heal the reddened site.
Moral of the story? If the medical treatment you're getting doesn't seem right, don't be shy, ask questions. You may need a second opinion. Insist on getting the right treatment for yourself or your loved ones.
Tuesday, October 11, 2011
Parkinsons Society Education Event
Just a reminder that tomorrow, October 12, 2011 we will be on site at the Toronto Botanical Gardens where Dr. Mario Masellis will speak on the topic of Mind, Mood & Memory. The evening runs from 6:30pm-9:00pm and is free to attend. Hoping to see you there!
Wednesday, September 21, 2011
Geriatric Emergency Management (GEM) Conference Sept. 20 to 22, 2011
Geriatric Emergency Management (GEM) Conference Sept. 20 to 22, 2011. The focus is better health outcomes for frail seniors. Eldercare Home Health is pleased to be an exhibitor at the event. See you there!
Tuesday, August 30, 2011
The Most Helpful Prescriptions you will never receive...
We know that it is not inevitable that with advanced age comes physical disability and mental frailty. In fact, we know a lot about strategies for aging well. Somehow, this knowledge seldom passes from the medical and health journals to the health professionals' clinical practices and on to their patients.
For next number of days, I will highlight some well researched, well known, easily accessible, drug-free "prescriptions for health".
First, there is the obvious...If you still smoke, quit.
No smoker should be allowed out of his/her doctor's office without this encouragement. Smoking negatively affects all aspects of health, including boosting your risk of developing Alzheimer Disease.
Then there is the very general advice of "getting more exercise". What does that mean?
Well, findings of the Deptartment of Radiology at the Universtiy of Pittsburgh in Pennsylvania showed that greater amounts of physical acitivity were associated with greater brain volume and that cognitively impaired people needed to walk at least 58 city blocks, or approximately five miles, per week to maintain brain volume and slow cogintive decline. Healthy adults, they suggest, need to walk at least 72 blocks, or six miles, per week to maintain brain volume and signifincatly reduce rthe risk for congitive decline.
Of course, exercise in general, and walking in particular brings with it many other positive health benefits. Stay posted for more on that...
For next number of days, I will highlight some well researched, well known, easily accessible, drug-free "prescriptions for health".
First, there is the obvious...If you still smoke, quit.
No smoker should be allowed out of his/her doctor's office without this encouragement. Smoking negatively affects all aspects of health, including boosting your risk of developing Alzheimer Disease.
Then there is the very general advice of "getting more exercise". What does that mean?
Well, findings of the Deptartment of Radiology at the Universtiy of Pittsburgh in Pennsylvania showed that greater amounts of physical acitivity were associated with greater brain volume and that cognitively impaired people needed to walk at least 58 city blocks, or approximately five miles, per week to maintain brain volume and slow cogintive decline. Healthy adults, they suggest, need to walk at least 72 blocks, or six miles, per week to maintain brain volume and signifincatly reduce rthe risk for congitive decline.
Of course, exercise in general, and walking in particular brings with it many other positive health benefits. Stay posted for more on that...
Tuesday, August 16, 2011
Alzheimer Society: Public Education Series
We often find ourselves with the opportunity to work with Clients who have Alzheimer Disease. For that reason we have our staff complete a certification program through the Alzheimer Society and we keep on top of the latest research developments. In the latest newsletter, I came across a listing of educational events being offered and thought you might find them to be of interest.
| Alzheimer Society: Public Education Series | |
1. Understanding Alzheimer's Disease: Learn the signs, symptoms and risk factors of Alzheimer's disease and related dementias. Discover what services are offered by the Alzheimer Society of Toronto. 2. Brain Health: Learn practical steps that you can take that may reduce your risk of developing Alzheimer's disease and how to maintain or improve your brain health. 3. Caregiver Stress:Learn to cope with the stress of caring for someone with Alzheimer's disease or related dementias. Please note: Registration is required. | |
When: | Mondays, September 12, 19, 26. 6:30 to 8:00 p.m. |
Presented by: | Alzheimer Society of Toronto |
Where: | Upstairs@Loblaws, Scarborough Town Centre (HWY 401 & Brimley Rd). |
To Register: | Call 416-322-6560 or Email contact@alzheimertoronto.org |
For More Info: | |
Heads Up for Healthier Brains | |
This workshop is for anyone interested in learning strategies to keep their brain healthy and to enhance wellness. Please note: Registration is required. | |
When: | Monday, September 19. 5:50 to 7:00 p.m |
Presented by: | Alzheimer Society of Toronto |
Where: | Alzheimer Society of Toronto (Yonge & Eglinton). |
To Register: | Call 416-322-6560 or Email contact@alzheimertoronto.org |
For More Info: | |
Lessoned Learned | |
Family caregivers and people with dementia are the true experts. Come and learn what others found helpful and difficult during their own personal journey. Please note: Registration is required. | |
When: | Thursday, October 13. 5:30 to 7:30 p.m. |
Presented by: | Alzheimer Society of Toronto |
Where: | Alzheimer Society of Toronto (Yonge & Eglinton). |
To Register: | Call 416-322-6560 or Email contact@alzheimertoronto.org |
For More Info: | |
Monday, August 15, 2011
Sponsoring the Parkinson Foundation Speakers Series
We are pleased to announce our participation as a sponsor for the Parkinson Foundation's Speakers series. We will be on site at the Toronto Botanical Gardens on October 12, 2011 where Dr. Mario Masellis will speak on the topic of Mind, mood & memory. The evening runs from 6:30pm-9:00pm and is free to attend.
Monday, August 1, 2011
Shouldn't Care be delivered 7 days per week?
Today is August 1st, a civic holiday (not a stat day). And yes, those of us who work at Eldercare Home Health are working. This includes front line careproviders, the Registered Nurse Case Managers, the Bookkeeper, the Administrative Assistant and me, the President.
You may find it surprising to know that many people in a hospital or facility setting, who have care and other responsibilities, are not at work today. Many of these same people are also not available to their patients on weekends - any weekend.
Last week I was contacted by a family whose father suffered a broken hip. He underwent surgery and was transferred to a rehabilitation setting. The transfer occurred on Thursday. When the family found out that no therapist would be available on Saturday, Sunday or Monday, to work with their father, they took matters into their own hands and hired a private physiotherapist to provide care on each of these three days. They could not bear for their father to sit around idly for three days and wait for the therapy he so badly needed in order to resume his life of independence. They were astonished to find that the hospital operated in this manner and that this practice was commonplace.
I've never understood this organization of care services myself. If a person is in an acute care setting and it has been deemed that they would benefit from therapy services, why are the therapists not scheduled, on a rotating basis, to work on each of the seven days of the week?
We already have examples of this kind of scheduling in an acute care setting. That is how nurses work and dietary staff. Nobody works every weekend, but everybody works some weekends.
If it is important and necessary that a person be in an acute care facility, it is important and necessary that they receive the best care services each day that they are there.
By not scheduling therapy on a weekend, we are literally taking 5 steps forward and 2 steps back every single week!!
You may find it surprising to know that many people in a hospital or facility setting, who have care and other responsibilities, are not at work today. Many of these same people are also not available to their patients on weekends - any weekend.
Last week I was contacted by a family whose father suffered a broken hip. He underwent surgery and was transferred to a rehabilitation setting. The transfer occurred on Thursday. When the family found out that no therapist would be available on Saturday, Sunday or Monday, to work with their father, they took matters into their own hands and hired a private physiotherapist to provide care on each of these three days. They could not bear for their father to sit around idly for three days and wait for the therapy he so badly needed in order to resume his life of independence. They were astonished to find that the hospital operated in this manner and that this practice was commonplace.
I've never understood this organization of care services myself. If a person is in an acute care setting and it has been deemed that they would benefit from therapy services, why are the therapists not scheduled, on a rotating basis, to work on each of the seven days of the week?
We already have examples of this kind of scheduling in an acute care setting. That is how nurses work and dietary staff. Nobody works every weekend, but everybody works some weekends.
If it is important and necessary that a person be in an acute care facility, it is important and necessary that they receive the best care services each day that they are there.
By not scheduling therapy on a weekend, we are literally taking 5 steps forward and 2 steps back every single week!!
Friday, July 29, 2011
"Nursing Home gave Tylenol..." - discussion point 3
One of the underlying questions that is not addressed in this article is Why did Sylvia Bailey suffer for so long with a fractured leg? Why was she denied investigation and treatment? Her condition was not invisible, there was an incident leading up to her pain and she was able to articulate that she was in pain.
Why did no one act?
The facility had caregivers, a physiotherapist, a doctor and nurses. They all interacted with her.
We have found that this failure to act is not uncommon. Being an advocate for Clients, to assist them to get the care that they deserve, is an important part of our role. The reasons that professionals who are charged with the responsibility to care for others, in fact are getting paid to do just that, don't, are complicated.
From what I have been able to glean from my 30+ years of working and volunteering in health care settings, failure to act is a learned behaviour that is developed in a setting where there is a pervasive culture of not acting.
In these kinds of settings, I often find that there is little or no leadership and no accountability. In some circumstances it is that the medical staff are intimidating and discourage staff from contacting them outside of regular visiting hours-even though they are supposed to be on call. Add to this that many facilities now hire Registered Practical Nurses for roles where they once hired Registered Nurses.
Many "in charge" positions are held by people who are newly graduated. The newer graduate will not have the experience or confidence to suggest to a doctor or administrator that care should be delivered differently. Also, the workloads in a facility setting may be very heavy. Care decisions that allow staff to get their daily assignments done are favoured over those that may take additional hours to complete and have them at odds with an unhappy physician who has been paged in the evening.
If you are a family member who is concerned about the care your relative is receiving in a facility setting, you should speak to the person in charge of the delivery of that care. If you do not feel that the issues are being addressed, document your concerns and ask to talk to the next senior person in the organization. Be polite, be firm, be reasonable, be an advocate.
Why did no one act?
The facility had caregivers, a physiotherapist, a doctor and nurses. They all interacted with her.
We have found that this failure to act is not uncommon. Being an advocate for Clients, to assist them to get the care that they deserve, is an important part of our role. The reasons that professionals who are charged with the responsibility to care for others, in fact are getting paid to do just that, don't, are complicated.
From what I have been able to glean from my 30+ years of working and volunteering in health care settings, failure to act is a learned behaviour that is developed in a setting where there is a pervasive culture of not acting.
In these kinds of settings, I often find that there is little or no leadership and no accountability. In some circumstances it is that the medical staff are intimidating and discourage staff from contacting them outside of regular visiting hours-even though they are supposed to be on call. Add to this that many facilities now hire Registered Practical Nurses for roles where they once hired Registered Nurses.
Many "in charge" positions are held by people who are newly graduated. The newer graduate will not have the experience or confidence to suggest to a doctor or administrator that care should be delivered differently. Also, the workloads in a facility setting may be very heavy. Care decisions that allow staff to get their daily assignments done are favoured over those that may take additional hours to complete and have them at odds with an unhappy physician who has been paged in the evening.
If you are a family member who is concerned about the care your relative is receiving in a facility setting, you should speak to the person in charge of the delivery of that care. If you do not feel that the issues are being addressed, document your concerns and ask to talk to the next senior person in the organization. Be polite, be firm, be reasonable, be an advocate.
Thursday, July 28, 2011
Does the Health Care System really need more money-or does it need to use the money it has more wisely?
Today I received a phone call from a senior who had recently undergone back surgery for degenerative disc disease. She is home from hospital, lives alone in a highrise apartment, and receives two one hour visits each week from the CCAC for assistance with bathing.
She is using a walker now due to poor balance. She is not receiving assistance from a physiotherapist either at home or in an outpatient setting. She has not been given any direction in terms of a follow up exercise program. She still requires medication for pain, and some days are better than others. She does not have children to assist her, although she stated that her neighbors have been very generous with offers to assist with grocery shopping.
What's wrong with this picture?
Back surgery is an expensive, invasive and serious undertaking. As taxpayers, we should consider it an investment in a person's wellbeing. We have the right to expect that the person receiving the benefit of the surgery, actually benefit. This means that once a person is discharged home to the community, some basic care and supervision and support should be offered to keep that person as safe and independent as possible. We don't see this happening very often.
The cost of providing home health care compares very favourably to providing hospital or facility based care. The VIP program offered by Veterans Affairs has demonstrated the tremendous beneficial effect, both financial and psychological, for those receiving even minimal support at home. For those not familiar with this program, it provides housekeeping and in some cases caregiving support to Veterans who wish to live at home. The annual costs are within the $3,000-$5,000 range. This compares incredibly favourably with the approximately $1,000/day to keep someone in an acute care setting. (And yes, there are many seniors who are being "held" in an acute care setting who could safely live either at home or in a long term care setting.)
This way of doing "business" is costing us a fortune and is not providing favourable outcomes for the Client. It doesn't make any sense.
Back to our caller...with continued support and a small investment in her continued wellbeing, we have the opportunity to keep this senior safe, happy and independent at home. It's a win-win situation; makes great economic sense and gives a senior her choice to stay home safely.
She is using a walker now due to poor balance. She is not receiving assistance from a physiotherapist either at home or in an outpatient setting. She has not been given any direction in terms of a follow up exercise program. She still requires medication for pain, and some days are better than others. She does not have children to assist her, although she stated that her neighbors have been very generous with offers to assist with grocery shopping.
What's wrong with this picture?
Back surgery is an expensive, invasive and serious undertaking. As taxpayers, we should consider it an investment in a person's wellbeing. We have the right to expect that the person receiving the benefit of the surgery, actually benefit. This means that once a person is discharged home to the community, some basic care and supervision and support should be offered to keep that person as safe and independent as possible. We don't see this happening very often.
The cost of providing home health care compares very favourably to providing hospital or facility based care. The VIP program offered by Veterans Affairs has demonstrated the tremendous beneficial effect, both financial and psychological, for those receiving even minimal support at home. For those not familiar with this program, it provides housekeeping and in some cases caregiving support to Veterans who wish to live at home. The annual costs are within the $3,000-$5,000 range. This compares incredibly favourably with the approximately $1,000/day to keep someone in an acute care setting. (And yes, there are many seniors who are being "held" in an acute care setting who could safely live either at home or in a long term care setting.)
This way of doing "business" is costing us a fortune and is not providing favourable outcomes for the Client. It doesn't make any sense.
Back to our caller...with continued support and a small investment in her continued wellbeing, we have the opportunity to keep this senior safe, happy and independent at home. It's a win-win situation; makes great economic sense and gives a senior her choice to stay home safely.
Tuesday, July 26, 2011
"Nursing Home gave Tylenol" -Addressing the incidence of Falls
This article sadly states that the resident, Sylvia Bailey, "had fallen from her wheelchair four times in the past year, hitting the floor so hard she had a permanent dent in her forehead."
Nobody, never mind a frail senior, should be falling repetitively and hitting their head. And yet I hear from family members regularly that amongst the other ailments a senior might have, that the senior has fallen, often more than once. People should not be falling. If someone falls, we need to know why. We need to know if they've suffered any harm and we need to do something to make sure that it doesn't happen again.
A fall is not an isolated event. It is the result of a lot of things that have gone wrong. When I conduct an initial assessment for a new Client what I often discover is that someone has not been eating well, that they are not taking medications as prescribed, that they are dehydrated, that their blood pressure is too low or too high.
I find cluttered environments, risky behaviour (like climbing on small ladders to reach a shelf), poor footcare, inappropriate footwear, an absence of assistive devices or misuse of assistive devices, overuse of sedatives , analgesics or other medications, a lack of medical follow up for underlying conditions-and these are just for starters!
Falls are a complicated issue. They happen often. They are not inconsequential. Many are preventable. Falls cause pain, suffering, debilitating injuries and they negatively impact quality of life.
To begin to recognize contributing factors and reduce the incidence of seniors falling, I have the following advice: We need to see falling as unacceptable. We need to see falls as preventable. We need to investigate possible contributing factors each time there is a fall and we need to address these issues to reduce the risk of a fall happening again.
But the first thing that we need to do is to pay attention. If a senior falls, we need to care.
Nobody, never mind a frail senior, should be falling repetitively and hitting their head. And yet I hear from family members regularly that amongst the other ailments a senior might have, that the senior has fallen, often more than once. People should not be falling. If someone falls, we need to know why. We need to know if they've suffered any harm and we need to do something to make sure that it doesn't happen again.
A fall is not an isolated event. It is the result of a lot of things that have gone wrong. When I conduct an initial assessment for a new Client what I often discover is that someone has not been eating well, that they are not taking medications as prescribed, that they are dehydrated, that their blood pressure is too low or too high.
I find cluttered environments, risky behaviour (like climbing on small ladders to reach a shelf), poor footcare, inappropriate footwear, an absence of assistive devices or misuse of assistive devices, overuse of sedatives , analgesics or other medications, a lack of medical follow up for underlying conditions-and these are just for starters!
Falls are a complicated issue. They happen often. They are not inconsequential. Many are preventable. Falls cause pain, suffering, debilitating injuries and they negatively impact quality of life.
To begin to recognize contributing factors and reduce the incidence of seniors falling, I have the following advice: We need to see falling as unacceptable. We need to see falls as preventable. We need to investigate possible contributing factors each time there is a fall and we need to address these issues to reduce the risk of a fall happening again.
But the first thing that we need to do is to pay attention. If a senior falls, we need to care.
Friday, July 22, 2011
Toronto Star report - "Nursing home gave Tylenol to resident with broken leg"
On Thursday July 21, The Toronto Star reported a sad case where a nursing home resident suffered a fall, which resulted in a broken leg which was never diagnosed or treated. The resident suffered terribly. She subsequently died.
I wish that I could say that this was an unusual occurence, that everything that went wrong for this resident was an anomoly and that most Nursing Home residents get superb care. Sadly, I cannot. We have assisted and advocated for many Clients over the years so that they might receive the care that they need and deserve.
So many things went wrong for this resident. Opportunities for improving the lives of residents can be highlighted using this scenario as an example. Over the next week, I will tackle some of the important issues that have been revealed through this sad experience.
Pain
The article begins with "For 24 days, Sylvia Bailey screamed in pain from an untreated broken leg.."
Nobody should be in pain - especially when the pain is excruciating and unrelenting. We have the means to keep people comfortable while we sort out why they are uncomfortable. It is every resident's right to be free of pain to the best extent possible.
In this case, there was a strong possible cause to the resident's pain. It is absolutely unforgivable that an effort to investigate was not made immediately.
If you find yourself in this position, where your loved one is uncomfortable and is not being attended to in a compassionate manner, you must insist that those charged with the responsibility for their care, act. You must make a fuss.
One of the most important roles we have at Eldercare Home Health is as an advocate for our Clients. We ask questions, suggest direction and insist on feedback and action in a timely manner. You need to do the same.
No one cares more for your loved one than you do. When that loved one is a frail senior, and when that frail senior is in pain or is suffering in any way, don't be shy, don't worry about stepping on the staff's or the doctor's toes. Be polite. Be firm. Be an advocate.
I wish that I could say that this was an unusual occurence, that everything that went wrong for this resident was an anomoly and that most Nursing Home residents get superb care. Sadly, I cannot. We have assisted and advocated for many Clients over the years so that they might receive the care that they need and deserve.
So many things went wrong for this resident. Opportunities for improving the lives of residents can be highlighted using this scenario as an example. Over the next week, I will tackle some of the important issues that have been revealed through this sad experience.
Pain
The article begins with "For 24 days, Sylvia Bailey screamed in pain from an untreated broken leg.."
Nobody should be in pain - especially when the pain is excruciating and unrelenting. We have the means to keep people comfortable while we sort out why they are uncomfortable. It is every resident's right to be free of pain to the best extent possible.
In this case, there was a strong possible cause to the resident's pain. It is absolutely unforgivable that an effort to investigate was not made immediately.
If you find yourself in this position, where your loved one is uncomfortable and is not being attended to in a compassionate manner, you must insist that those charged with the responsibility for their care, act. You must make a fuss.
One of the most important roles we have at Eldercare Home Health is as an advocate for our Clients. We ask questions, suggest direction and insist on feedback and action in a timely manner. You need to do the same.
No one cares more for your loved one than you do. When that loved one is a frail senior, and when that frail senior is in pain or is suffering in any way, don't be shy, don't worry about stepping on the staff's or the doctor's toes. Be polite. Be firm. Be an advocate.
Friday, June 10, 2011
Why do Seniors fall?
The answer to this seemingly simply question is very individualized and very complex. The easy answer is: it depends....
I'll touch on some of the more common causes - but be aware, this list is by no means exhaustive.
First there are the true accidents; missing a stair on the way down the staircase, tripping over a toy left by a child in a hallway, slipping on a slick wet floor in a grocery store...these are all scenarios that we have seen in cases where seniors have fallen. Although the cases that we have seen have resulted in serious injuries, like fractures, these kinds of "accidents" have been the exceptions.
Most of the falls that we see are related to impaired mobility, sensory changes, balance disturbances, medication influences, blood pressure fluctuations, dehydration, confusion, agitation, disorientation etc.
There's enough material available to write volumes on each of these causative factors, but in the interest of being useful, each day for the next number of days, I'll touch only on some important highlights.
You might receive guidance to wear "appropriate footwear". What does that actually mean?
Proper footwear may include shoes or slippers with non-skid soles, that are closed back, that have either no heel or a low (1") heel. I have noticed that most styles of slippers, worn by Clients, do not have support around the heel and often do not have non-skid soles. (Socks should also be non-skid).
While we're in the region of the foot in our discussions, other foot related issues include foot and nail care that allow for comfort and fit in the shoe. A podiatrist or foot care nurse might be needed to assist with this. For those with longstanding diabetes, neuropathy may be a contributing factor to falls. A person with neuropathy in the feet cannot feel their foot in their shoe or striking the ground. Swollen extremities caused by poor circulaton, edema, heart failure, infection are problematic because sensation in the foot and leg may be impaired. Also the added weight of edema in the legs, makes it difficult to move the legs normally and easily during walking. Any kind of pain will interfere with a person's gait-and this may be due to arthritis, osteoporosis, fracture, intermittent claudication, knee pain, side effects of medication, poor circulation etc.
Some solutions may include; regular exercises, analgesics, pressure stockings, orthotics, weight loss, leg massage, proper footcare, diabetic control, reduction of edema, etc.
Helpful people may include a physiotherapist, a chiropodist, a footcare nurse, a doctor or specialty footwear professional.
I'll touch on some of the more common causes - but be aware, this list is by no means exhaustive.
First there are the true accidents; missing a stair on the way down the staircase, tripping over a toy left by a child in a hallway, slipping on a slick wet floor in a grocery store...these are all scenarios that we have seen in cases where seniors have fallen. Although the cases that we have seen have resulted in serious injuries, like fractures, these kinds of "accidents" have been the exceptions.
Most of the falls that we see are related to impaired mobility, sensory changes, balance disturbances, medication influences, blood pressure fluctuations, dehydration, confusion, agitation, disorientation etc.
There's enough material available to write volumes on each of these causative factors, but in the interest of being useful, each day for the next number of days, I'll touch only on some important highlights.
You might receive guidance to wear "appropriate footwear". What does that actually mean?
Proper footwear may include shoes or slippers with non-skid soles, that are closed back, that have either no heel or a low (1") heel. I have noticed that most styles of slippers, worn by Clients, do not have support around the heel and often do not have non-skid soles. (Socks should also be non-skid).
While we're in the region of the foot in our discussions, other foot related issues include foot and nail care that allow for comfort and fit in the shoe. A podiatrist or foot care nurse might be needed to assist with this. For those with longstanding diabetes, neuropathy may be a contributing factor to falls. A person with neuropathy in the feet cannot feel their foot in their shoe or striking the ground. Swollen extremities caused by poor circulaton, edema, heart failure, infection are problematic because sensation in the foot and leg may be impaired. Also the added weight of edema in the legs, makes it difficult to move the legs normally and easily during walking. Any kind of pain will interfere with a person's gait-and this may be due to arthritis, osteoporosis, fracture, intermittent claudication, knee pain, side effects of medication, poor circulation etc.
Some solutions may include; regular exercises, analgesics, pressure stockings, orthotics, weight loss, leg massage, proper footcare, diabetic control, reduction of edema, etc.
Helpful people may include a physiotherapist, a chiropodist, a footcare nurse, a doctor or specialty footwear professional.
Friday, June 3, 2011
Home Safety - general considerations
There are so many elements to consider in a home safety assessment. The priority will always depend on the abilities and the wishes of the individual Client. Below are some commom themes and issues that need to be addressed in any home safety assessment. Also, a long distance home safety assessment is not ideal. This is the kind of exercise that needs to be accomplished onsite.
The issues that are addressed will vary depending on whether home is a house, apartment, condominium, bungalow or multi-storey dwelling.
Challenges in balance, gait and the need for assistive devices such as a walker or wheelchair need to be taken into consideration. A stairlift, handrail or ramp may be needed for those with strength, balance and other mobility impairments. The width of doorways, hallways and stairways may have an impact.
For all rooms of the house it is advised to reduce clutter and remove throw rugs. Smoke detectors should be present. If the resident smokes, are they doing so safely? If there are pets in the home, can the resident ake care of the needs of the pet such as litter box changes, daily walks, feeding, provision of fresh water, fish bowl cleaning etc?
Memory affects safety. Will the resident remember to eat and drink adequately? Can they safely manage the stove? Can they learn how to use a microwave?
How are medications organized? Perhaps a blister pack would be appropriate, or a dossette. Meals on Wheels delivery might be helpful for some - for others, a visit from a caregiver or companion each day might be suitable.
These are some general thoughts with regard to home safety. The abilities, personality and wishes of the individual will dictate which ones are the best choice.
The issues that are addressed will vary depending on whether home is a house, apartment, condominium, bungalow or multi-storey dwelling.
Challenges in balance, gait and the need for assistive devices such as a walker or wheelchair need to be taken into consideration. A stairlift, handrail or ramp may be needed for those with strength, balance and other mobility impairments. The width of doorways, hallways and stairways may have an impact.
For all rooms of the house it is advised to reduce clutter and remove throw rugs. Smoke detectors should be present. If the resident smokes, are they doing so safely? If there are pets in the home, can the resident ake care of the needs of the pet such as litter box changes, daily walks, feeding, provision of fresh water, fish bowl cleaning etc?
Memory affects safety. Will the resident remember to eat and drink adequately? Can they safely manage the stove? Can they learn how to use a microwave?
How are medications organized? Perhaps a blister pack would be appropriate, or a dossette. Meals on Wheels delivery might be helpful for some - for others, a visit from a caregiver or companion each day might be suitable.
These are some general thoughts with regard to home safety. The abilities, personality and wishes of the individual will dictate which ones are the best choice.
Wednesday, June 1, 2011
Home Safety in the News and always on our minds
There's a terrific series in the paper this week that brings to light the huge number of seniors experiencing falls. Falls experienced by seniors are important and often life threatening events. I am always amazed when someone casually mentions that a senior has had a fall. To me it's a tragedy, a red flag, a message that there are already a number of risks that need attending.
Falls are rarely an isolated event. They are almost always the outcome of a long series of events, that culminate in a fall. We should take it as a given (and we do in other age groups) that it is not normal to be falling down! It's dangerous and painful, debilitating and inconvenient and puts one at risk for all sorts of other related negative events.
Falls may happen anywhere and there are a great number of possible contributing factors. One place that we can hope to reduce the incidence of falls is the Client's home. A home safety assessment, conducted by a knowledgeable and experienced care provider, is the first step to improving safety at home for seniors.
Over the next number of days I will publish aspects of a home safety assessment commonly used to improve safety in the home. I'll share some creative and uncommon strategies that we have used to improve safety and I will provide practical advice and give examples from the homes of Clients that we have visited.
Falls are rarely an isolated event. They are almost always the outcome of a long series of events, that culminate in a fall. We should take it as a given (and we do in other age groups) that it is not normal to be falling down! It's dangerous and painful, debilitating and inconvenient and puts one at risk for all sorts of other related negative events.
Falls may happen anywhere and there are a great number of possible contributing factors. One place that we can hope to reduce the incidence of falls is the Client's home. A home safety assessment, conducted by a knowledgeable and experienced care provider, is the first step to improving safety at home for seniors.
Over the next number of days I will publish aspects of a home safety assessment commonly used to improve safety in the home. I'll share some creative and uncommon strategies that we have used to improve safety and I will provide practical advice and give examples from the homes of Clients that we have visited.
Thursday, April 21, 2011
A call from a distressed family
A woman called me today. Her husband, age 95 years, lives in a Toronto Nursing Home and she fears for his comfort, safety and wellbeing. Her husband suffered a stroke and as a result has difficulties swallowing safely. The speech-language pathologist who assessed him in hospital gave specific direction about how to prepare his meals; the food should be minced and the fluids should be thickened. The patient, now living in a Nursing Home, has a sign over his bed that reminds staff about how to safely give him food and fluids.
This is the incident that the caller relayed to me: She arrived at the Home at 5:20pm and found her husband lying down flat in bed, he had vomited and was now coughing and gasping for breath. His colour was poor. She raised the head of his bed and waited for the coughing to subside, she called the Nurse to come to the bedside. The Nurse confirmed that she had fed the husband, she had not noted any difficulties.
So what's wrong with this picture?
The wife noted that feeding her husband safely is time consuming and takes some degree of patience and skill. It could not have been accomplished in 15 minutes. Also, the patient should not have been left lying in a flat position, without his head elevated, immediately after eating. The patient would be at high risk for aspiration pneumonia.
What to do? The floor has 38 high need residents, but only 3 Personal Care Assistants, 1 Registered Practical Nurse and 1 Registered Nurse. The wife visits with her husband daily and feeds him but cannot be present for every meal.
The patient's wife, understandably, is frantic with worry. She is making inquiries with her insurance company to see if additional services can be covered. She is trying to involve the Home's doctor. She is trying not to alienate the Home's staff - but she has already had angry words with them and talked about suing them for poor Practice.
My advice: Have a conversation immediately with the Nurse in Charge, report the incident, express your concerns. Get a commitment from the Nurse that a care provider will be dedicated to assist the patient during mealtimes. Ask the Nurse to reinforce the direction of the speech-language pathologist with all of the staff. Document the incident, document your conversation. Send a copy to the Nurse in Charge, to the Home's doctor and a copy to the Director of Nursing. I recommended putting together a schedule and assigning who it is who will feed the patient; the wife, staff, a paid caregiver, even a Nursing student completing a practicum, if appropriate.If the wife is not satisfied with the response of the Home and does not see an improvement in the way her husband is cared for, she can contact the Ministry of Health, Long Term Care and make her concerns known. Finally, she may want to consider a transfer to a Home where she has more confidence in the quality of care provided.
This is the incident that the caller relayed to me: She arrived at the Home at 5:20pm and found her husband lying down flat in bed, he had vomited and was now coughing and gasping for breath. His colour was poor. She raised the head of his bed and waited for the coughing to subside, she called the Nurse to come to the bedside. The Nurse confirmed that she had fed the husband, she had not noted any difficulties.
So what's wrong with this picture?
The wife noted that feeding her husband safely is time consuming and takes some degree of patience and skill. It could not have been accomplished in 15 minutes. Also, the patient should not have been left lying in a flat position, without his head elevated, immediately after eating. The patient would be at high risk for aspiration pneumonia.
What to do? The floor has 38 high need residents, but only 3 Personal Care Assistants, 1 Registered Practical Nurse and 1 Registered Nurse. The wife visits with her husband daily and feeds him but cannot be present for every meal.
The patient's wife, understandably, is frantic with worry. She is making inquiries with her insurance company to see if additional services can be covered. She is trying to involve the Home's doctor. She is trying not to alienate the Home's staff - but she has already had angry words with them and talked about suing them for poor Practice.
My advice: Have a conversation immediately with the Nurse in Charge, report the incident, express your concerns. Get a commitment from the Nurse that a care provider will be dedicated to assist the patient during mealtimes. Ask the Nurse to reinforce the direction of the speech-language pathologist with all of the staff. Document the incident, document your conversation. Send a copy to the Nurse in Charge, to the Home's doctor and a copy to the Director of Nursing. I recommended putting together a schedule and assigning who it is who will feed the patient; the wife, staff, a paid caregiver, even a Nursing student completing a practicum, if appropriate.If the wife is not satisfied with the response of the Home and does not see an improvement in the way her husband is cared for, she can contact the Ministry of Health, Long Term Care and make her concerns known. Finally, she may want to consider a transfer to a Home where she has more confidence in the quality of care provided.
Thursday, March 10, 2011
Best Practice Approaches to Responsive Behaviours in Dementia Care
Last night at a meeting of the Gerontological Nursing Association, Toronto Chapter, we had the opportunity to hear John Thomas, Psychogeriatric Resource Consultant speak about Responsive Behaviours in Dementia Care. John shared some useful information and approaches. He has a favoured way to describe the way that dementia is related to Alzheimers. He asserts that Dementia is to Alzheimers as Sneezing and Coughing is to the cold virus. In other words, dementia in and of itself, is not a disease.
On a very important note he reminded the audience of some of the often overlooked but possible reversible causes of dementia; medications,poor nutrition, low B12, low iron, electrolyte imbalance, brain tumour, depression, and delirium to mention a few.
We know that medications used to help with agitation and aggression are not more important than, and will never take the place of, getting to know the person suffering from dementia and really discovering the ways to provide care for each person in a meaningful and personalized manner.
We are ever hopeful, but always concerned as to whether the good done by these medications outweighs the often serious side effects that accompany them.
The audience was composed of Registered Nurses, Registered Practical Nurses and Personal Support Workers. For us the topic is more than academic, it's personal. The issues arising from the care of persons with dementia challenge us everyday in our Practices.
We appreciate the opportunity to get together with colleagues, to discuss the challenges of our daily work, to share ideas and to brainstorm. A serving of lasagna, eggplant parmagiana and salad, a slice of lemon meringue pie, a fruit platter and a cup of tea to fuel the discussion certainly don't hurt either!!!
On a very important note he reminded the audience of some of the often overlooked but possible reversible causes of dementia; medications,poor nutrition, low B12, low iron, electrolyte imbalance, brain tumour, depression, and delirium to mention a few.
We know that medications used to help with agitation and aggression are not more important than, and will never take the place of, getting to know the person suffering from dementia and really discovering the ways to provide care for each person in a meaningful and personalized manner.
We are ever hopeful, but always concerned as to whether the good done by these medications outweighs the often serious side effects that accompany them.
The audience was composed of Registered Nurses, Registered Practical Nurses and Personal Support Workers. For us the topic is more than academic, it's personal. The issues arising from the care of persons with dementia challenge us everyday in our Practices.
We appreciate the opportunity to get together with colleagues, to discuss the challenges of our daily work, to share ideas and to brainstorm. A serving of lasagna, eggplant parmagiana and salad, a slice of lemon meringue pie, a fruit platter and a cup of tea to fuel the discussion certainly don't hurt either!!!
Monday, January 31, 2011
When is a cold more than a cold?
We received a phone call from a concerned daughter. Her 82 year old mother was seemingly suffering with a cold and had absolutely no energy. As a result, she was neither eating nor drinking reliably. The daughter thought it would be wise to have a caregiver spend some time with her mother, reminding her to eat and drink, to keep her company, and generally assist her with household tasks until the mother recovered.
With this information in hand, I visited her mother. I found a pale, pleasant woman, still in her pajamas in the middle of the morning. Her son in law was present. He said she looked better this day than the previous day. I checked the Client's medications and noted that she had prescriptions for Lipitor, apo-hydro, lisonopril, amlodipine and entrophen. Other, over the counter medications that she was taking included tylenol arthritis, aspirin and tylenol with caffeine and codeine.
Blood pressure was 112/60 (low), heart rate 82 (high), and client complained of fatigue and general achiness. She wondered if she might have the "flu". I told her that I did not think so.
I asked if her physician was aware of all of her medications, including the over the counter group. She said that she wasn't sure. She said that she saw her family doctor regularly.
With her permission, I called the family doctor and informed him of the client's condition and I expressed my concern over the excessive aspirin intake. I asked about recent bloodwork results, including hemoglobin and INR values. I told him I was extremely concerned that the Client might have an internal bleed. The doctor suggested she come to see him immediately and that she bring all the medications that she was currently taking.
I told the family and the Client of my concerns and the doctor's request.
The next day I received a call from the family, thanking me for my visit. They called for an ambulance immediately after I left the Client's home. The Client was admitted to hospital due to a gastrointestinal bleed.
Sometimes, a cold is more than a cold!
With this information in hand, I visited her mother. I found a pale, pleasant woman, still in her pajamas in the middle of the morning. Her son in law was present. He said she looked better this day than the previous day. I checked the Client's medications and noted that she had prescriptions for Lipitor, apo-hydro, lisonopril, amlodipine and entrophen. Other, over the counter medications that she was taking included tylenol arthritis, aspirin and tylenol with caffeine and codeine.
Blood pressure was 112/60 (low), heart rate 82 (high), and client complained of fatigue and general achiness. She wondered if she might have the "flu". I told her that I did not think so.
I asked if her physician was aware of all of her medications, including the over the counter group. She said that she wasn't sure. She said that she saw her family doctor regularly.
With her permission, I called the family doctor and informed him of the client's condition and I expressed my concern over the excessive aspirin intake. I asked about recent bloodwork results, including hemoglobin and INR values. I told him I was extremely concerned that the Client might have an internal bleed. The doctor suggested she come to see him immediately and that she bring all the medications that she was currently taking.
I told the family and the Client of my concerns and the doctor's request.
The next day I received a call from the family, thanking me for my visit. They called for an ambulance immediately after I left the Client's home. The Client was admitted to hospital due to a gastrointestinal bleed.
Sometimes, a cold is more than a cold!
Monday, January 17, 2011
Interview by TheDailyPlanet.com
Woman freezes to death in city's northeast end...
We were contacted today by a reporter at Thedailyplanet.com to provide advice to the public on how to avoid a tragedy like this one; a 66year old woman, suffering from dementia, wandered out of her home at 2am and was found dead of hypothermia at 5am in a neighboring driveway.
Here are some of the ideas we shared:
*Register your loved one with the Alzheimer Society and Police through the Wandering Registry. This gives the Police a headstart should they be called upon to help find a missing person with dementia. The Registry also provides the potential wanderer with a medical alert bracelet which will help neighbors and others realize that there is a medical issue and that the confused person that they have encountered may be in need of immediate assistance.
*Alert your neighbors to the possibility that your relative may wander from your home. People are sometimes embarrassed to talk to others about dementia. Most people will gladly help out.
*Try the following strategies to prevent the confused person from exiting the house in the middle of the night: Use a motion detector device that alerts others in the house when the confused person has crossed the threshold of their bedroom; place windchimes on the inside of the door, alerting other residents of the home that the family member is trying to leave the home; place bright yellow hazard tape across the door threshold - this will discourage some people from attempting to exit.
*Remember that being a primary caregiver to a person suffering from dementia is an exhausting job. Sometimes the primary caregiver needs time off. Consider hiring a caregiver in order to give that person a break. Alternatively, there are respite settings available where the person with dementia can stay for a period of time, allowing the primary caregiver a much needed break and a chance also to catch up on their sleep.
*Try organizing a person with dementia's day to include physical exercise, fresh air and stimulating activities so that they will be tired by end of day and more likely to require a night's rest - and less likely to awaken to wander.
There is no one solution that works for everyone. These suggestions are sample interventions from our own experiences for those who have the primary care responsibility for someone with dementia.
We were contacted today by a reporter at Thedailyplanet.com to provide advice to the public on how to avoid a tragedy like this one; a 66year old woman, suffering from dementia, wandered out of her home at 2am and was found dead of hypothermia at 5am in a neighboring driveway.
Here are some of the ideas we shared:
*Register your loved one with the Alzheimer Society and Police through the Wandering Registry. This gives the Police a headstart should they be called upon to help find a missing person with dementia. The Registry also provides the potential wanderer with a medical alert bracelet which will help neighbors and others realize that there is a medical issue and that the confused person that they have encountered may be in need of immediate assistance.
*Alert your neighbors to the possibility that your relative may wander from your home. People are sometimes embarrassed to talk to others about dementia. Most people will gladly help out.
*Try the following strategies to prevent the confused person from exiting the house in the middle of the night: Use a motion detector device that alerts others in the house when the confused person has crossed the threshold of their bedroom; place windchimes on the inside of the door, alerting other residents of the home that the family member is trying to leave the home; place bright yellow hazard tape across the door threshold - this will discourage some people from attempting to exit.
*Remember that being a primary caregiver to a person suffering from dementia is an exhausting job. Sometimes the primary caregiver needs time off. Consider hiring a caregiver in order to give that person a break. Alternatively, there are respite settings available where the person with dementia can stay for a period of time, allowing the primary caregiver a much needed break and a chance also to catch up on their sleep.
*Try organizing a person with dementia's day to include physical exercise, fresh air and stimulating activities so that they will be tired by end of day and more likely to require a night's rest - and less likely to awaken to wander.
There is no one solution that works for everyone. These suggestions are sample interventions from our own experiences for those who have the primary care responsibility for someone with dementia.
Thursday, January 6, 2011
Help us find a terrific RN
Employment - Registered Nurse Case Managers
We're always interested in talking with bright, energetic people who share our values and interest in working with the elderly. We currently have openings for 2 Registered Nurse Case Managers. These are full time positions.
If you or someone you know is interested in the Registered Nurse case Manager position posted below, please contact (or have them contact) Lisa Wiseman by phone, fax or e-mail.
Lisa Wiseman RN BScN
Phone: 416 482-8292
Fax: 416 482-8278
e-mail: wiseman@EldercareHomeHealth.com
Registered Nurse Case Managers:
Eldercare Home Health is a Registered Nurse owned and operated home health care service specializing in the care needs of seniors. Since 1995 Eldercare Home Health has been providing Registered Nurse supervised care in the community to seniors who wish to remain healthy, safe and independent at home.
Registered Nurse Case Managers - must have supervisory experience and experience working with the elderly.
Job Description:
At Eldercare Home Health we take a holistic approach to providing care for our elderly clients.
Registered Nurse Case Manager positions:
As a Registered Nurse Case Manager you’ll have and opportunity to practice Nursing in a way you may not have thought possible. You’ll be able to put the skills and judgement you’ve developed through practical experience, to use, improving the lives of seniors in our community.
You’ll be responsible for case management - including liaising with Family Members, Physiotherapists, Pharmacists, Doctors, and other medical and support professionals. You will have a key role in selecting and scheduling the staff you feel are most appropriate for the clients you are working with, supervising their practice to ensure that our clients receive the best care possible.
Your workday activities will be varied; visiting clients in their homes, supervising caregivers, meeting with healthcare professionals, researching care options for clients or meeting with your Nurse colleagues at our office.
We offer a competitive salary plus benefits, a 9am - 5pm workday (on-call responsibilities are rotated among the staff, with a day off in recognition for weekend on-call), mileage reimbursement, paid parking, and an office conveniently located at Eglinton and Mount Pleasant . We have an office mascot, Tia, a friendly four year old Golden Retriever (Tia also occasionally visits with clients in the community).
We encourage and support continuing education and professional development, and are continually evaluating technology and how it can assist in managing and improving care.
With the Founder and President of the company being a Registered Nurse, you can also count on an understanding, supportive and professional environment.
You are an RN, have supervisory experience, excellent assessment skills, are energetic, self motivated and have a positive attitude toward aging. You enjoy front-line contact with clients and caregivers and have a great sense of humor. If you're looking for a rewarding position with a growing company where you really can make a positive diļ¬erence in older people's lives, we'd like to hear from you (you'll need a car).
Great reasons to consider working with Eldercare Home Health:
Competitive salary
9am-5pm work day (on-call responsibilities are rotated among the staff, with a day off in recognition for weekend on-call)
Health Benefits
Mileage reimbursement
Convenient location
Growing company
President is a Registered Nurse
Since founded over 15 years ago, company has never laid off a Registered Nurse. If you’ve been there and done that, and are ready to practice Nursing the way it should be practiced, contact us today.
Lisa Wiseman RN BScN
Phone: 416 482-8292
Fax: 416 482-8278
e-mail: wiseman@EldercareHomeHealth.com
We're always interested in talking with bright, energetic people who share our values and interest in working with the elderly. We currently have openings for 2 Registered Nurse Case Managers. These are full time positions.
If you or someone you know is interested in the Registered Nurse case Manager position posted below, please contact (or have them contact) Lisa Wiseman by phone, fax or e-mail.
Lisa Wiseman RN BScN
Phone: 416 482-8292
Fax: 416 482-8278
e-mail: wiseman@EldercareHomeHealth.com
Registered Nurse Case Managers:
Eldercare Home Health is a Registered Nurse owned and operated home health care service specializing in the care needs of seniors. Since 1995 Eldercare Home Health has been providing Registered Nurse supervised care in the community to seniors who wish to remain healthy, safe and independent at home.
Registered Nurse Case Managers - must have supervisory experience and experience working with the elderly.
Job Description:
At Eldercare Home Health we take a holistic approach to providing care for our elderly clients.
Registered Nurse Case Manager positions:
As a Registered Nurse Case Manager you’ll have and opportunity to practice Nursing in a way you may not have thought possible. You’ll be able to put the skills and judgement you’ve developed through practical experience, to use, improving the lives of seniors in our community.
You’ll be responsible for case management - including liaising with Family Members, Physiotherapists, Pharmacists, Doctors, and other medical and support professionals. You will have a key role in selecting and scheduling the staff you feel are most appropriate for the clients you are working with, supervising their practice to ensure that our clients receive the best care possible.
Your workday activities will be varied; visiting clients in their homes, supervising caregivers, meeting with healthcare professionals, researching care options for clients or meeting with your Nurse colleagues at our office.
We offer a competitive salary plus benefits, a 9am - 5pm workday (on-call responsibilities are rotated among the staff, with a day off in recognition for weekend on-call), mileage reimbursement, paid parking, and an office conveniently located at Eglinton and Mount Pleasant . We have an office mascot, Tia, a friendly four year old Golden Retriever (Tia also occasionally visits with clients in the community).
We encourage and support continuing education and professional development, and are continually evaluating technology and how it can assist in managing and improving care.
With the Founder and President of the company being a Registered Nurse, you can also count on an understanding, supportive and professional environment.
You are an RN, have supervisory experience, excellent assessment skills, are energetic, self motivated and have a positive attitude toward aging. You enjoy front-line contact with clients and caregivers and have a great sense of humor. If you're looking for a rewarding position with a growing company where you really can make a positive diļ¬erence in older people's lives, we'd like to hear from you (you'll need a car).
Great reasons to consider working with Eldercare Home Health:
Competitive salary
9am-5pm work day (on-call responsibilities are rotated among the staff, with a day off in recognition for weekend on-call)
Health Benefits
Mileage reimbursement
Convenient location
Growing company
President is a Registered Nurse
Since founded over 15 years ago, company has never laid off a Registered Nurse. If you’ve been there and done that, and are ready to practice Nursing the way it should be practiced, contact us today.
Lisa Wiseman RN BScN
Phone: 416 482-8292
Fax: 416 482-8278
e-mail: wiseman@EldercareHomeHealth.com
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