This past week the Boston Marathon bombings put parts of the city and suburbs on lockdown, providing an unwelcome example of a type of emergency families rarely plan for: terrorism and police actions. Most people who care for elders think often about the elder’s own health crises, and all of us have to plan for blizzards, power outages, and related events. But reassuing a frightened elder during an act of terrorism? Not so much.

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Probably the single greatest reason we are called to serve families is to provide care following a fall by an elder. Particularly when people have lived in a home for decades, we see that homes and people have not adapted to the extra care needed to prevent falls. These are preventable events, and families with elders will be well-advised to attend Emerson Hospital's free workshop.

Falling - Don't let it happen to you or someone you love

I took a short break this afternoon, and when I tuned back into the world of news, I found that the expected winter storm Friday into Saturday was now being called a BLIZZARD WATCH!  Eighteen to twenty-four inches are being forecast with high winds. My goodness... 

We rolled into action to consider the safety of every shift change Friday and Saturday... will the roads the safe? Will it be snowing too heavily? How can we serve clients Saturday night and Sunday morning safely? We will work with families and caregivers to create a plan for any shift changes that may be made unsafe or impossible by this storm. We will be in touch wiht impacted families and caregivers.

In the meantime, this is the right moment to share two blog posts I wrote from a past winter storm/blizzard. They contain info about prepping clients' and the caregivers' homes, and other important information. Please review this and then get into action to get ready.

Who Will Shelter Your Elder Loved One in an Emergency?
http://www.caringcompanion.net/blog/view/1873-who-will-shelter-your-elder-loved-one-in-an-emergency

First Possible Winter Storm Coming, Eastern Massachusetts 
http://www.caringcompanion.net/blog/view/1163-first-possible-winter-storm-coming-eastern-massachusetts

Easten Massachusetts Winter Storm Forecast Upgraded To a Blizzard
http://www.caringcompanion.net/blog/view/1177-eastern-massachusetts-winter-storm-forecast-upgraded-to-a-blizzard

New technologies to help seniors, the disabled and their caregivers are being launched every day. It's a huge, growing industry worth billions of dollars annually. But there are so many new products and services coming to market that most people feel confused and overwhelmed.  Do these devices mean  real aid for aging in place, or just a new way to part elders with their money?

Learn how to sort out the "toys and gadgets" from the helpful technologies on the market today. "Aging, Disability & New Technologies: Real Hype or Real Help?" Instructors Jim Reynolds and Deborah Bier, PhD will help participants make more wise choices in this bewildering, rapidly expanding marketplace.

The session will review some of the

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Caring Companion Home Care has adopted and trains our caregivers in habilitation therapy when caring for clients with Alzheimers Disease and related dementias (ADRD). This approach was developed at the Massachusetts Chapter of the Alzheimer's Association, and is considered to be the best standard of care for all types of dementia. Sadly, it is not in as widespread use in all aspects of elder care as it should be.

Habilitation therapy is a comprehensive behavioral approach to caring for people with dementia. It focuses

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On Day 4 without power following our recent late-October snowstorm, a woman in her 90s slowly rolled into a municipally-run emergency shelter at a nearby metro-west Boston town.  Leaning heavily on her walker, she looked at the shelter manager wearily and said, "I'm cold. I want to sleep here tonight."  Her caregiver interjected quickly, "I have to get back home,” eyeing the exit.

The shelter manager quizzed them about the elder's ability to function independently.  How much care was needed, and what type?  It turns out that the caregiver came 3-4 days a week; the senior was a bit confused, not fully independent in several of the activities of daily living, nor could she manage her own medications safely. Just not handling her medications independently was enough of a deal breaker, according to the manager. "I'm sorry, but this shelter cannot accommodate you," said the manager. "You'll have to find somewhere else to stay."

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NOTE: Elders, babies and those with certain illnesses are at greater risk for heat stress than others. Please take this information to heart! For people not located in Concord, MA, please contact your municipal fire/police departments to find out what types of services are avaiaable to you for cooling.

By Mark R. Cotreau, Fire Chief/Emergency Management Director, Town of Concord Fire Department

As you are most likely aware, we are in for a few days of extremely hot weather conditions. Please see the below advisory issued by MEMA.  Additionally residents can access a cooling shelter as noted below:

In response to the extreme temperatures forecast for the next few days, the Harvey Wheeler Community Center will be open as a cooling center Thursday and Friday, 12 noon until 9pm. There are no age restrictions. Please feel free to stop by if you would like to escape the extreme temperatures forecast. If transportation is an issue, during business hours please call 978-318-3020 (the COA Office), or after hours please call 978-318-3400 (Public Safety Dispatch).

Please remember that the Concord Public Library -  Main Library and Fowler Branch - are also air conditioned and welcome the public. The Main Library and Fowler Branch summer hours vary somewhat, and are posted on the Library web site at http://www.concordlibrary.org/pages/general.info.html#hours

Remember last winter when we all wished for warmer weather?

With the extremely hot weather the Commonwealth is experiencing, the Massachusetts Emergency Management Agency (MEMA) is advising people to be cautious and is offering some tips to help keep cool and safe.

“A few common sense measures can reduce heat-related problems, especially for the elderly, the very young and people with respiratory ailments, who are more susceptible to the effects of high temperatures,” said MEMA Director Kurt Schwartz. “Here are some tips to follow to stay safe during this hot, humid weather.”

·    Slow down, avoid strenuous activity.  Do not try to do too much on a hot day.
·    Wear lightweight, loose-fitting, light-colored clothing.  Light colors will reflect heat and sunlight and help maintain normal body temperature. Protect your face with a wide-brimmed hat.
·    Drink plenty of water regularly and often, even if you do not feel thirsty. Attempt to stay hydrated.
·    Limit intake of alcoholic beverages.  They can actually dehydrate your body.
·    Eat well-balanced, light, regular meals.  Avoid high protein foods that increase metabolic heat.
·    Stay indoors as much as possible.
·    If you do not have air conditioning, stay on your lowest floor, out of the sun.  Electric fans do not cool the air, but they do help evaporate perspiration, which cools your body.
·    Go to a place where you can get relief from the heat, such as air conditioned schools, libraries, theaters and other community facilities that may offer refuge during the warmest times of the day.
·    Check with your community for information about possible local ‘cooling centers’. You may also want to call 2-1-1 for ‘cooling center’ information or go to <http://www.mass211.org/>www.mass211.org.
·    Cover windows that receive morning or afternoon sun with drapes, shades, awnings or louvers.  Outdoor awnings or louvers can reduce the heat that enters a home by up to 80%.
·    Avoid too much sunshine.  Sunburn slows the skin’s ability to cool itself.  If you are outside, use sunscreen lotion with a high SPF (Sun Protection Factor) rating.
·    Never leave children or pets alone in a closed vehicle.
·    Check on family, friends and neighbors.

In normal weather, the body’s internal thermostat produces perspiration that evaporates and cools the body.  However, in extreme heat and high humidity, evaporation is slowed and the body must work extra hard to maintain normal temperature, which may lead to heat cramps, heat exhaustion and heat stroke.  If you believe you, or anyone you are with, is experiencing a heat-related medical emergency, promptly call 911, and if possible, move to a cooler place.

The Massachusetts Emergency Management Agency (MEMA) is the state agency responsible for coordinating federal, state, local, voluntary and private resources during emergencies and disasters in the Commonwealth of Massachusetts.  MEMA provides leadership to: develop plans for effective response to all hazards, disasters or threats; train emergency personnel to protect the public; provide information to the citizenry; and assist individuals, families, businesses and communities to mitigate against, prepare for, and respond to and recover from emergencies, both natural and man made. For additional information about MEMA and Preparedness, go to www.mass.gov/mema. Follow MEMA updates on Facebook and Twitter.

Challenging Behaviors and the Dementia Patient

June 8, 2011, 8:00am–10:00am
50 W Main St, Hopkinton, MA
Golden Pond Assisted Living
50 W Main St, Hopkinton, MA 01748
Breakfast: 8 am
Presentation & Q&A: 8:30-10 am
RSVP to Golden Pond by June 6 at 508 435-1250

Sleep disturbances… resistance to care… suspiciousness… sundowning… hoarding… rummaging… These challenging behaviors can be frustrating, frightening, and exhausting for families and caregivers of dementia and alzheimers patients.

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The new “Homestead Advantage Program” is being offered by Caring Resources of Norwood, MA. This program provides a cost-effective approach to dementia care and is aimed at helping dementia patients, their families and caregivers create the right environment and enable meaningful relationships.

Homestead Advantage encompasses individual caregiver education, support, guidance, care planning and appropriate referral sources to best meet the needs of the dementia client. This program includes a personalized, at-home assessment by a Certified Dementia Practitioner, a Geriatric Psychiatrist, and a Licensed Independent Social Worker to meet the clinical, social, and environmental needs of the dementia client.

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Recently, I was honored to be part of a four-person panel at the Wayland Public Library speaking on the topic "What's New in Aging?" We discussed navigating the new terrain of aging in the 21st century, followed by a question and answer session from the audience. Juergen H. Bludau, MD (photo at right), Harvard University and Brigham and Women's Hospital geriatrician, and Carol Sneider Glick, Esq, elder law specialist with Squillace & Associates of Boston, were wonderful fellow panelists. (Part 2 of this talk is scheduled for April 6, 7pm at the same location - register here)

I want to note here high points of the evening, including the excellent questions the audience brought. I felt very much at home in the company of these speakers, all on the front lines of bringing best-quality care in a quickly changing landscape. My fellow panelists as well as the audience of about 45 from Wayland, Weston and beyond were enthusiastic and engaged with every presenter's points.

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This is a very difficult and emotional topic: what do you do if you suspect (or know) an elder is being abused or neglected? This would include emotional, physical, sexual and/or financial abuse or neglect; self-neglect is also included.  If you're not sure what might be considered elder abuse or neglect, here are some guidelines from the US Administration on Aging.

I always strongly encourage the person with the suspicions or knowledge to report them -- but often the next questions are: how and to whom? Here are four approaches, each based upon my working in Massachusetts. I will also include general info for those reading this concerned about elders living elsewhere in the US.

The most vulnerable members of our community need help from every one of us.  Overwhelmed and frustrated caregivers need help too, which is often what happens when elder abuse or neglect is report. Your report might just be what turns the situation around for everyone.

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Topics in this just-published snailmail newsletter:

• Better Care - Lower Cost - Improved Health! Elder Care Remote Activity Monitoring Technology Pilot
• Want to Participate in One of Our Pilots - Free!
• Caring Companion Awarded Home Care Agency Accreditation
• Optimism Connected to a Stronger Immune System

Download this newsletter here: CCCnewsletterv2.1 (if you would like to receive our next newsletter  by email or snailmail -- or to have it sent to a friend, client or family member -- This email address is being protected from spambots. You need JavaScript enabled to view it. with the name contact info).

Being able to stay in the home we've lived in as we've aged is a real blessing, and almost always preferred by elders.  But some homes are just not set up for aging in place -- too many stairs, bathrooms and bedrooms in the wrong part of the house to fit the elder's needs and mobility.  Home modification is an option, and the Commonwealth of Massachusetts makes low- and no-interest loans to modify the homes of elders and individuals with disabilities where there is income qualification.

Monday, January 31 at 7PM at the Gleason Library in Carlisle, MA, there is a meeting about this program. I just noticed it in the Boston Globe, following a Facebook pointer from our State Representative, Cory Atkins (isn't life in 2011 strange??!) -- you can fit in this meeting before the next snow storm starts. Download a program brochure here.

(This message was just sent out via email to our caregivers, clients, and client families)

Winter is just not going to quit, is it?!  This time, it's not more snow (we've had "only" 3 storms this past week!), but extreme cold temperatures.  This is of particular concern with elders and people who are disabled due to their lower activity levels. If there is dementia, they might not be able to know how to keep safe.  The below alert from the Massachusetts Emergency Management Agency (MEMA) contains important safety info about extreme cold weather.

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At Caring Companion, we already do far more than the industry standard to reduce the costs of health care and improve the quality of life for elders and the disabled. We provide real-time information and reports to health care professionals and families via our unique online system -- we are the only agency in the country doing this.  We already place appropriate technology in homes to help reduce the number of care hours needed.   Our guiding model combines our outstanding on-site caregivers with with the appropriate technology to improve care and reduce its cost.

Throughout 2011, we will demonstrate this in a series of public pilots.  In partnership with some Massachusetts Aging Services Access Points (ASAPs) and Councils on Aging (COAs), we will pilot promising technologies that we have identified to help at-risk elders and the disabled.  Testing such technologies in elders' homes has not been done before in our region; in fact, it's seldom been done around the country. In these carefully crafted pilot studies, we will demonstrate that we can:

• significantly reduce care costs
• reduce hospitalizations
• reduce falls
• identify problem areas before they fully develop
• proactively intervene to prevent crises
• reduce stress, increase efficiency for care partners
• allow elders to live longer in their homes
• delay or prevent entry into higher levels of care
• increase elder safety
• maintain elder privacy

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(Email sent this evening to Clients, Families and Caregivers)

I hope you are having a lovely Christmas holiday today!

After yesterday's early storm"heads up", I'm back to encourage you in your plans to prepare households and our clients for what is now being talked about as a blizzard: up to 20" of snow and 50-60mph winds, beginning Sunday afternoon and into sometime Monday. This is being predicted to be "heart attack snow" -- meaning it's so heavy that people have heart attacks exerting themselves while clearing it. This kind of heavy snow might be hard to keep cleared from roads and driveways, and street plows when they pass by will deposit "cement-like" snow and ice at the ends of driveways.  High winds with heavy snow can also bring down power lines; power outages should be prepared for.

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A note emailed earlier today to our clients, their families and our caregivers.

I am writing because  we may/may not have our first winter storm in eastern Massachusetts, Sunday night into Monday. Who can say? This is after all, New England!

But this is a perfect time to review plans for clearing driveways, steps and walkways of snow and ice at your loved one's/our client's homes.  Everyone wants to prevent falls due to snow and ice, and to keep people from being trapped inside the house -- or outside unable to get in!

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Striking front entries with winding front stairs... luxurious bath suits with rooms for toilet, shower and dressing... inviting sunken living rooms. These residential features add to the interest and drama.  But given the aging of our population, the homes of the future with higher and more sustained value may be ones suited for aging or disabled occupants.

However, a lot of housing stock now is simply unsuitable for people with mobility or memory  issues. If a family member becomes disabled due to age, illness or injury, a move to a safer environment or an often-costly home modification may become inescapable. And you'd see increased costs of home care for seniors and the disabled.

But "assisted living" can start at home: regardless of the age of the occupants, we can start right now making homes more adaptable for aging in place.  This takes a shift in thinking, but it's one that will pay back the homeowner handsomely. Every time you make a lasting change to the interior or exterior of your home, answer these three questions:

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We love working with physicians, registered nurses, geriatric care managers and pharmacists as part of a client's care team.  But it happens far less often than we think is most helpful for the client. Everyone is so busy, few see it as their mandate as healthcare professionals -- though we certainly do.  Inter-disciplinary communication and teamwork isn't just a "good thing" -- it is absolutely vital.

Here is a powerful example of why real teamwork is necessary, and why we at CCC go the extra mile to be in touch, and to put people in contact with other healthcare professionals who can eliminate problems that stem from a lack of teamwork elsewhere. And that is the epidemic of over-prescribing of medications for the elderly. Too many specialists not talking with one another, each prescribing medications that are then not adequately reviewed by the patient's primary care physician result in lots more drugs than are needed.

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The post below is adapted from an except of our white paper, Re-Imagining Home Care: New Needs, New Approaches. This is the 4th in a series of of 11 posts.

Consider the changes in consumer technology since 1980, and stop to think about how they have changed the way home care agencies can now interact with client families.  In contrast to service providers in other industries, home care agencies offer little more than email, if they offer even that.  There are many reasons for this – e.g., concerns about HIPAA regulations and the slow pace of physicians’ electronic medical record adoption.  But failure to take advantage of the wide adoption of Web 2.0 technologies and social media leaves remote family – a fast-growing component of the senior care environment – in the dark about the status, important changes, and key needs of their loved ones.

This is unnecessary and borders on unforgivable. The technology is inexpensive and widely available.  There is no need for remote family to lack any relevant information on a nearly instantaneous basis.  Furthermore, access to this information can easily, at the request of the client, be provided to physicians, case managers, Geriatric Care Managers, or other members of the care team to support follow up care decisions.

Caring Companion Connections has developed a proprietary system delivering all the functionality discussed here and more. All our caregivers use it, every day. Completing online reports is a job requirement, not an optional service - and it is included at no charge with all client visits.  Upon seeing this system, one of our clients said, "You know, when I leave my dog at the kennel, I know more about what happens to him than I do when I have an aide come to my 84-year-old mother's condo. I know what my dog ate, when he went outside, who he played with, when he pooped. I see pictures. But I just have to hope the aides show up and until I go to her condo again, I don't really know what happened."

In the 21^st Century, client families should insist upon web access to daily reports of client visits. Just as they would not choose a bank, an airline, or a retail store that could not provide basic account activity information online, there is no reason to accept this failing from a home care agency.  Caregiving staff should carry smart phones or other mobile devices that enable mobile updates. Family members and authorized users should be able to review reports, ask questions, and communicate among themselves regarding the service plan, independent of location.  The improved information flow allows family decisions to be made more quickly and ensures that data is available to all interested parties.  It reduces anxiety, improves peace of mind, and promotes better care.

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