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Aging Care Solutions
October 2018 Caregiver eLetter
      Vol. 21, No. 4
     The gauntlet was passed to us and we accepted it.
 Therefore we will cope, and in so doing, set an example 
 for our children, and the generations to follow.
Contact Kay at 972-839-0065 or
www.AgingCareSolutions.com or
kay@AgingCareSolutions.com or kay@kaypaggi.com
   In recent months I've received several calls from people who are caring for beloved parents/relatives/friends that are not aging well. In response to these needs I now offer a option for consulting. Some families do not need a complete assessment of the parents' circumstances that would be the basis for geriatric care management, but rather need someone to listen to their particular issues and make a few suggestions for improvement. Consulting can be done on the phone or at a neutral meeting place, and can be done in half hour sessions.
   I have more than 20 years experience dealing with caregiving and working with older adults. I am also a trained ElderCare Mediator. 972-839-0065  Tell your friends about me and encourage them to talk to someone like me before making major decisions about aging loved ones.Call me and let's talk.
In this Issue:
Surgical Recovery - Going Home and Onward
Joys of Old Age
Mental Aerobics: Homonyms
CONFERENCE WITH 12 hours of CEU's, including nursing!
     In the fall of 2017 I had three surgeries to correct several spinal conditions. I have posted the articles from the last three eLetters about rehab and recovery on my website. My intention for writing these articles is to provide information to older adults and their families about recovery from various types of surgeries. Hip and knee replacement surgeries are frequent, as well as falls that require surgery in order to regain function. Knowing what to expect is helpful. http://kaypaggi.com/Portals/0/Surgical_Recovery.pdf?ver=2018-09-27-165341-347
POSTSCRIPT: Coming Home & Outpatient Therapy
    The day a patient is discharged home after rehabilitation can be frightening. Home Health cannot start until the following day in the best case. Most patients will have different medications from the ones taken before their hospital stay; the patient must decide when to take the new afternoon and evening pills without a medication aide.  In the rehab unit there have been aides to answer a call light, wither the patient used it or not, they were there in case there was a need. At home, the patient must depend on him/herself or someone staying with them in the home. If the patient is using a walker, he/she must learn how to prepare a meal and bring it to the dining area.
   Before the patient comes home, the family or support network must do some preparation. While Medicare will pay for a walker or wheelchair, it does not cover bathroom equipment. Some items that may be needed are a raised toilet, with or without handles; a shower seat or bathtub slider; shower grab bars to hold on for safety; a bath hose that reaches long enough to the user in the chair; and a ramp to avoid steps leading into the home entrance. This is when a home visit by the PT and OT is valuable. They can point out if a hall is too narrow for the walker/wheelchair, or the bathroom door is to narrow, or if the tub or shower needs a non-slip mat. They will remind the family to keep a bath rug off the floor when it's not in use, or to purchase one with a heavy non-slip backing. The PT/OT will offer advice about a bedside potty, ways to successfully get in and out of bed, and how to get into the bathroom quickly and safely.
   Some of these items can be borrowed from a 'nurse's closet' or from Lori Nesler at Comfort Keepers. Comfort Keepers has a large selection of Durable Medical Equipment (DME) for loan without charge. All they ask is that you return the item in good condition when you no longer need it. Grab bars can be installed or purchase those that use suction to adhere to the bathroom walls (Home Depot).
  Thank goodness for Home Health. This service is reimbursed by Medicare. It usually includes an aide twice a week to help with bathing and shampooing, an OT and PT and a nurse. The nurse will help the patient, and the family, learn to set up a pillbox with all the medications, as well as monitor wound care and blood pressures, and manage other physical health care concerns. After Home Health, or instead of it, a patient can choose outpatient rehab. This can be done in the same rehab gym used for inpatient care, or another, perhaps closer to home. Most patients do not begin driving until several weeks after discharge from inpatient therapy, so having someone to drive for them is critical for getting to the grocery store, the
pharmacy, and medical appointments.

   Continuing with therapy after discharge is helpful is establishing independence and decreasing reliance on others.  Patients who use walkers or canes become more familiar with them; they learn to use them as they negotiate stairs, both up and down. They learn to use the device as they enter and exit cars or vans. They learn to make meals and carry them to an eating place while using their device, and use the device to get into the shower and out without losing their balance. If they start driving again, therapy helps them learn how to stow the device and get behind the wheel without losing their balance. Continuing with OT helps the patient continue to regain the arm strength needed to manage the walker or cane. 
 The patient needs to see several physicians following discharge, especially a primary care physician (PCP). This physician will decide when to discontinue medications taken in the hospital, and at what levels to keep others. Depending on the surgery, the patient will need to make follow-up appointments with the surgeon and any specialists, such as a cardiac specialist or orthopedist or endocrinologist. During this post-rehab period, the patient may not have much energy; the body is still recovering. The family needs to be available to support the patient to avoid re-hospitalization. 
   There are additional financial burdens on the patient. Home modifications can be expensive, new medications cost money, increased gas is needed for the car to make trips to physicians, or money is needed for taxis or uber.

   The main message about returning home after discharge is that the patient is NOT back to pre-surgery normal. Just because the patient is no longer in a hospital, he/she is not ‘well’ or recovered. There are many adjustments to be made to create a new normal. Support from the family, neighbors, and friends is vital.

Medical Insurance
   I have traditional Medicare with a supplement from AARP. I have not been billed for any hospital, rehab, or therapy in the year since my initial surgery. This would not have been the case with an advantage plan or HMO. If you are able, now is the enrollment time to switch from any other medical insurance onto traditional Medicare. If you need care in the future, traditional Medicare will save you money and heartache. Yes, the monthly cost is high but not near the cost of paying privately for rehabilitation.
   Mental Aerobics is a program of cognitive exercises that I developed in 1994 for use in group settings. It has been studied on three occasions by researchers and found to increase cognition in the participants. These studies have been published in academic journals that are sited on my website. I have posted examples of exercises used in Mental Aerobics, along with the answers, on my website.  http://agingcaresolutions.com/Mental-Aerobics
   I do a one-hour weekly class of Mental Aerobics in various communities. If you have family in a community, or are employed in one, and are interested in having Mental Aerobics in your facility, please contact me. I always give a free one-hour session before adding Mental Aerobics to a community's calendar, to see if residents will find it interesting.
Homonyms are worlds that have the same sound but different meanings and different spellings, such as hare and hair. Find the pairs of homonyms for the clues below:   
 1. Money/ Hiding place     __________/ __________
2. Gazes / Steps
3. Sober and steady/ Remained
4. Fewest / Hired or rented
5. Easy going / Needs
6. Peel/ Fruit
7. Tiresome person/ Pig
8. Bend at the waist/ Branch
9. Circular ditch / Tiny speck
10. Manner / Cut  

(Answers below)      
CONFERENCE with 12 hours of CEU's including Nursing!
South Central Chapter of Aging Life Care Presents
Conference begins Thursday November 8 at 6:30 with Opening Reception
Continues Friday, Nov. 9 at 8:30 and Saturday Nov. 10 at 8:30
Venue: Omni Mandalay Hotel Las Colinas, 221 E. Las Colinas Blvd, Irving, TX 75039
Sessions include:
 - Dealing with Difficult Clients
 - Pain Management in the Elderly
 - Benefits for Low-Income Clients
 -  Neuro-circuitry of Touch, Social Impact (Alexander Peralta)
 - Robots, A.I. and Innovative Tech
 - Making Social Media work for your small business

Non-Member registration $200, Student Registration $35/ One day registration is available
You can register on line or download the registration form and mail it to National. Here is the link
The Surprising Joy of Old Age
adapted from TIME by Jeffrey Kluger

   In the September 17 issue of TIME magazine, there is an amazing article about a positive part of growing old. Not only is the content accurate and well written, but the fact that Mr. Kluger has found anything positive worth writing about regarding aging is amazing.  I completely agree with this article, as does my mentor at UNT, a researcher into aging, Dr. Bert Hayslip.
   Mr. Kluger points out that older adults may well be happier than younger ones. WOW! Kluger bases some of his article on the research of psychologist Alan Castel of UCLA in his book Better with Age: The Psychology of Successful Aging. In fact, researchers into aging have long suspected that old age may be a time defined by peace, gratitude and fulfillment. I well understand that you, the caregivers of loved ones in later life, may find this startling as well as perhaps unbelievable.  Think about it. These older grumpy older adults have lived a long time and survived many crises. Researchers believe this "happy senescence" may be attributed to lessons learned about how to live life when they were in middle age.
   The counterpart of late life happiness is middle age, when life satisfaction is at its lowest point, according to research by Jonathan Rauch in his book The Happiness Curve. Middle life is full of challenges, both in work and home life. There are lot of pressures to succeed, to make money, to live up to ideals. While your life may appear happy, you may not feel happy because of all the pressures. As you age and begin to realize that you may never fulfill your dreams, that realization may come as a relief. You can stop worrying about it and do  more living.
   In late life, older people have learned to survive the storms of life's crises; they know that although you don't make department head, you are still alive and there is much to be happy about. As part of extended families, grandparents give back more than they consume materially. They provide a calm center to the life storms swirling around them. CEO's tend to be at least aged 50-70, and many of them run financially successful companies using the benefit of life's experiences.
Answers to Mental Aerobics
1. Cache / Cash
2. Stares / Stairs
3. Staid / Stayed
4. Least /Leased
5. Lax / Lacks
6. Pare / Pear
7. Bore/ Boar
8. Bow / Bough
9. Moat / Mote
10. Mode / Mowed
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