Preventing Falls in an Elderly Home: Review

preventing elderly fallsAccording to the CDC, one in three seniors experiences a fall. Of those that fall, 20 percent have a serious injury, such as a broken bone or head trauma. Therefore, preventing falls in seniors is extremely important. Although this is a topic we have discussed in the past, it is important enough to review again, as it affects so many people. Consider the following ways to make the home of your senior loved one safe.

Stairways

Stairways are dangerous because a fall can easily cause serious injury. Implement these tips to make the stairway safe.

  • Install handrails on both sides of the stairs. Most stairways only have handrails on one side.
  • Be sure the handrails are sturdy. Tighten down any that are wobbly.
  • Clear the stairway of all clutter. No items should be stored on the stairs.
  • Check that the lighting is adequate, so the stairs can be seen when it is dark outside.
  • Take the above steps for all stairways, including those outside that are used to enter the house.

Bathrooms

Falls in a bathroom are so dangerous because of all the hard surfaces. The tile floors and fixtures have no give and the edges of the sink and tub can cause injury. A few changes will make the bathroom much safer.

  • Install a night light for nighttime trips to the bathroom.
  • Install grab bars by the toilet and tub.
  • Ensure the toilet seat is at the right height. Consider buying an elevated seat if the existing seat is too low.
  • Remove trip hazards such as loose carpets, and install non-skid mats.

Living Area

A dark, cluttered home is a trip hazard. Consider the following tips to reduce the risk in the living area.

  • Remove any loose carpeting.
  • If lighting is not adequate, install new lighting. It is difficult to avoid tripping on items you cannot see. Bright light is beneficial.
  • Make sure wires do not run along walkways. Relocate wires to the edges of the room and tack them along the walls.
  • Remove clutter from rooms and walkways. If you must, put items in storage. Clear paths are critical.

Learning More

If you have an elderly loved one living at home, it is important to take steps to reduce the risk of falls. Implementing the above safety tips will help keep your loved one from being injured. For additional information on preventing senior falls, check out our handout and our resource page.

David York Agency can help you elder-proof your home. For more information about David York Agency’s services and their qualified, compassionate caregivers, contact us at 718.376.7755. A free phone consultation can help you decide what services might be best to provide you and your loved one with the assistance they need.

If you’d like to hear more from us, please like us on Facebook or follow us on Twitter, Google+, or LinkedIn.”

Senior Care: Art, Creativity & Dementia

art therapy

Dementia affects millions of Americans each year, but doctors have yet to find a way to prevent the onset of this disease. However, studies have shown that the use of art and creativity often provide solace to seniors and caregivers alike.

Art Therapy

Art therapy benefits seniors tremendously. Creative activities, such as painting, craft making, or collaging, provide a positive creative outlet to seniors living with dementia. They often recall pleasant memories from their past and feel joy in those moments. And, since loneliness and depression are common emotions for seniors both with and without dementia, the joy derived from a creative endeavor can be a powerful force for positivity in their lives.

Collaging

One of the best artistic activities for seniors is collage-making. Collages often expose parts of someone’s world and their perspective. Magazines contain images that can evoke emotions and memories. When one chooses an image to use in a collage, it reflects inner machinations of his or her world, inside and out. Consciously or unconsciously, seniors create more than a collage. They create both a window to their world – past, present and future – and a safe haven for themselves.

Naturally, assistance will be necessary for this activity. Seniors may have difficulty using supplies such as glue and scissors. But materials that stimulate sight and touch prove therapeutically beneficial to participants, so it is worth it to help with this activity.

It is highly recommended that caregivers be part of the creative process with their loved ones. It proves rewarding for everybody involved. When you create art with the special person in your life who has dementia, you not only help them create something new, you give them a way to connect to their past. When that happens, you can be on the spot to catch a glimpse. This will help you build a stronger bond with them and memories of your own for years to come.

Getting Help

At David York Agency, we understand the fears and challenges that dementia can bring, not just for the person diagnosed, but for everyone in their life. We provide families with the support and care they need during this particularly difficult time.

For more information about David York Agency’s qualified, compassionate caregivers, contact us at 718.376.7755. A free consultation can help you decide what services might be best to provide you and your loved one with the assistance they need.

If you’d like to hear more from us, please like us on Facebook or follow us on Twitter, Google+, or LinkedIn.

How Hospital Social Workers Ease the Transition from Hospital to Home

Discharge planning

After a hospital stay, plans upon being discharged involve careful consideration of the patient’s medical issues and development of a plan of care for that patient’s return home. This critical area is called discharge planning and it arranges the logistics so that the patient can recover safely in the comfort of their own home.

Discharge planners are usually hospital social workers that work with the patient and their family to determine how to make the transition from the hospital to the home as smooth as possible.

Transitioning your loved one from the hospital to home can be a scary time since there is a lot to plan for and consider. This is especially the case when the patient is faced with diminished capacities, even temporarily. However, a discharge planner can help smooth this transition and get your loved one back home safely again.

They do the following:

  • Discuss plans for discharge with the patient and/or their family based on the recommendations of medical professionals treating the patient. The social worker may also visit several times toward the end of the hospital stay in order to ensure the discharge plan is appropriate.
  • Assess the needs of the patient and make necessary referrals to ensure he/she will have access to any medical treatment that may be needed after returning home. This may include arranging in-home nursing, in-home therapies, and/or arranging for necessary medical equipment to be delivered to the home.
  • Provide information on resources  within the community as well as any contact information for any state or federal resources that may be needed to assist with the needs of the patient.
  • Possibly contact insurance companies in order to ensure coverage and may also assist with finding alternate payment options for anything not covered.

Once home, a qualified compassionate caregiver from the David York Agency can provide the extra in-home assistance the patient’s needs. For more information about David York Agency’s home health care services, contact us at 718.376.7755. A free consultation can help you decide what services might be best to provide you and your loved one with the care they need. From geriatric social work to advice on how to deal with a diagnosis, David York Agency can help.

If you’d like to hear more from us, please like us on Facebook or follow us on Twitter, Google+, or LinkedIn. For more information on discharge planning, contact us.

Danger of Polypharmacy in the Elderly by Anita Kamiel, R.N., M.P.S.

Definition

Polypharmacy is a term used for taking five or more drugs concurrently and this trend is on the rise. While this is a cause for alarm in the young, in the elderly, who usually take a panoply of medications prescribed to them by their stable of specialists along with their internist or geriatrician, the effects can be extremely serious. With so many doctors and healthcare professionals managing the patient, it is easy to both rack up the number of drugs at play as well as fall into the “prescribing cascade” where drugs are prescribed to counteract the side effects of another prescribed drug.

Risks in the Elderly

As with most things, the problem of drug interaction is more acute in the elderly than their younger counterparts. If dizziness is a side effect, as it is with beta blockers, and a fall occurs, the results can be catastrophic as compared to someone younger. In fact, higher medication use in the elderly has been cited as responsible for some falls and doctors have been advised to avoid medications that have been linked to falling.

Older patients seem to use their own discretion when taking their medications. They don’t easily cede their independence and it extends to this area of their lives as well. The senior patient may also be loath to tell the doctor about a complementary therapy or remedy having experienced a closed-minded or judgmental reaction it in the past.

Rising Trend...

According to a Harvard study, polypharmacy has seen a 70% increase over the last 12 years. A longitudinal study in JAMA Internal Medicine found that more than 33% are taking five or more medications, 66% are taking dietary supplements and 40% are taking over the counter drugs.

In 2006, 8% of seniors were at serious risk for drug interaction, but that number rose to over 15% in 2011. Adverse drug interactions include combining aspirin with the blood thinner Plavix. Taken together there is an increased risk of abdominal bleeding. Taking fish oil for heart health combined with the blood thinner Coumadin can also cause bleeding.

Most elderly patients don’t bother to tell their doctors about the non-prescription drugs or supplements they are taking for the simple reason that their doctor often neglects to either ask them about it or inform them that there could be risks of drug interaction. If the elderly will be choosing which medication they want to take (or can afford – a whole other topic), it is important to educate them about the purpose of each and the possible interactions, so they, their families and doctors can make informed decisions.

Communication & Follow-up Is Key

A serious problem is that medications are very often prescribed by specialists who don’t necessarily communicate with each other. A clinical pharmacist specializing in geriatric care can help. They are often the repository for all the prescriptions for the patient and can be a central clearinghouse. They can perform a drug reconciliation to make sure the patient is not combining substances with negative interactive effects. Consult Beer’s List put out by the American Pharmacists Association for drugs not to use in older adults. There is a handy list of “Tips on Polypharmacy Management” available through the ClevelandClinic.org.

Another problem is once we start medications, we almost never stop them. Money is poured into efficacy tests for a course of drug treatment, but we almost never study how and when treatment is to end. A study out of the Veteran’s Affairs Hospital showed that 44% of elderly patients were actually given at least one unnecessary medication upon discharge.

In the meantime, go along with your senior loved one to the next checkup or doctor visit and bring every prescription and non-prescription over the counter remedy or supplement with you so you can do a comprehensive review. It will be a good time to re-visit the necessity of the medications as well as a time to tweak dosages.

If elderly patients are confused about what to take or are in the beginning stages of dementia, it’s easy to mismanage the arsenal of medications they are prescribed or recommended to take. A caregiver or family member must step in to avert what can sometimes become a life threatening disaster.

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Anita Kamiel, RN, MPS, is the founder and owner of David York Home Healthcare Agency, licensed by the State of New York. She holds a master’s degree in gerontological administration and is fully acquainted with all factors related to eldercare services and the latest guidelines for seniors. Thirty years ago, she realized the need for affordable, quality home health aide services provided and supervised by caring individuals. You can contact her at 718-376-7755 or at www.davidyorkagency.com. David York Agency is also on Facebook, Twitter, Google+, and LinkedIn.

10 Things You Can Do To Prevent Falls by: Anita Kamiel, R.N., M.P.S.

friendly caregiver talking to senior woman outdoors


It used to not be this way.

How many times have you heard someone say their father or mother was fine before he or she fell? For many older adults, an unexpected fall can touch off a series of events that end in serious or fatal complications. It can lead to extended hospital stays and disabling conditions that make living independently more of a challenge.

As we age, we begin to lose our balance. Due to their unsteadiness, the elderly are terribly afraid of falling and tend to view themselves as fragile. This is one of the underlying reasons they avoid commonplace activities like walking, shopping and even socializing. Their physical reality combined with their fears often exacerbates their feelings of isolation and depression, all too common in this group.


May be the most serious concern for the elderly.

The National Institute of Health maintains that “falls are the number one cause of fractures, hospital admissions for trauma, loss of independence, and injury deaths” among those 65 and older in the US making fall prevention in the elderly a high priority. The risk only increases as we age with one in five people 85 and older reporting a fall more than once a year compared to one in 10 of those between 65 and 74. Falls in the elderly are often fatal or have long term consequences for performing their activities of daily living.

Elderly patients must be counseled on how to prevent falls in terms of their surroundings and medications. Certain drugs can affect their already compromised sense of balance. They include:

  • anti-seizure drugs (anticonvulsants)
  • hypertensive (high blood pressure) drugs
  • sedatives
  • tranquilizers
  • anxiolytics (anti-anxiety drugs)
  • aminoglycosides (a type of antibiotic)
  • diuretics
  • vasodilators
  • certain analgesics (painkillers)
  • certain chemotherapeutics (anti-cancer drugs).

Things you can do.

The National Institute on Aging has a handy tip sheet at Go4Life on preventing falls.

Here are 10 things you can do to prevent falls:

  1. Regular exercise, especially those that work on balance like yoga and tai chi, can help steady the elderly adult as can weight-bearing exercises that slow bone loss and lower-body strengthening exercises.
  2. Elderproofing a home where most falls occur while doing mundane tasks is critical. Tripping hazards from carpets, wires, and clutter must be removed. Half of all falls at home happen in the bathroom and a misstep in this room can spell disaster. Grab bars in places like the shower, tub and toilet as well as proper lighting are essential.
  3. Make regular eye and hearing check-ups to ensure properly fitted glasses with the optimal prescription. Wearing bifocals while walking or on steps may blur the vision enough to cause falls. Proper hearing can ensure no cues are missed.
  4. Regular dizziness may indicate an underlying medical condition with respect to blood pressure, circulation, or sensory issues which should be checked out by a physician.
  5. Physical therapy may be useful for improving balance and walking confidence.
  6. Have the doctor or pharmacist review all medications to identify those most likely to cause dizziness and drowsiness.
  7. Stand up slowly from a seated or lying position.
  8. Wear rubber soled shoes to avoid slipping.
  9. Limit the amount of alcohol consumed.
  10. Get enough sleep.

Interestingly, Ritalin may help prevent falls. In an encouraging breakthrough, Ben Gurion University researchers have found that a single dose of the drug used to treat attention deficit hyperactivity disorder and narcolepsy, helps improve balance during walking reducing the risk of falls among seniors. While they admit the results may be due to the improved focus brought about by the medication, they also feel that Ritalin actually has a direct influence on parts of the brain that deal with motor and balance control.


Prevention is key.

Falls can be prevented and a good caregiver can minimize any negative long term effects if one does occur. The importance of caregivers being familiar with maintaining safe environments and routines for the elderly cannot be overstated. Many geriatric social workers and occupational therapists can help set up a safe living space for an elderly person. If you don’t know of one, a home healthcare agency should be able to refer one to you.


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Anita Kamiel, RN, MPS, is the founder and owner of David York Home Healthcare Agency, licensed by the State of New York. She holds a master’s degree in gerontological administration and is fully acquainted with all factors related to eldercare services and the latest guidelines for seniors. Thirty years ago, she realized the need for affordable, quality home health aide services provided and supervised by caring individuals. You can contact her at 718-376-7755 or at www.davidyorkagency.com. David York Agency is also on Facebook, Twitter, Google+, and LinkedIn.

A Hot Trend: The Internet, Social Media & The Elderly by: Anita Kamiel R.N., M.P.S.

Senior couple using tablet sitting on bed

Many might think that social media is the exclusive domain of the younger generation. However, many of our older adults have enthusiastically adopted it to keep up with the times as well as their old acquaintances and younger family members. Grandparents are becoming proficient in alien things like Skype and Facebook and liking it. It has become a healthy emotional outlet and word of its benefits has spread like wildfire among the elderly.

Statistics on Elderly Internet Use

According to the Pew Research Center, Internet use among those 65 and older grew 150 percent between 2009 and 2011, the largest growth in a demographic group. Furthermore, their 2012 study showed that of those that go online, 71 percent do so daily and 34 percent use social media. The elderly use these tools to bridge the geographic gap between them and their loved ones far away and as a way to re-connect with friends from a far off time. Studies show that the internet has become an important portal for reducing isolation, loneliness and other depressive symptoms.

How the Elderly Use the Internet

Seniors emphasize the informational and educational aspects of the Internet using it in an encyclopedic fashion to visit government sites or research financial issues. Many of the elderly have uncovered the beauty of the digital travelogue and the value of having a book review available through a simple click. This gateway to the outside world is critical once the elderly become homebound. While teens have moved on from Facebook, the older generation has found that it serves them quite well. Seniors have discovered that Skyping is a great way to bring relatives from faraway destinations right into their living rooms. Twitter has become popular for keying into specific news sections they want to follow.

While their younger counterparts use social media in a “selfie” sort of way, the elderly, who are very sensitive to privacy issues, use it to connect with like-minded individuals. They use it for health information and to connect with others experiencing the same challenges. They have recognized that others in their stations in life are also online and have used it to start discussion groups for life and health issues pertinent to them. From dementia to depression to diabetes — all can give and receive support in the comfort and convenience of their home. Doctors and other professionals have keyed into this demographic and set up social media pages to take advantage of this customer and patient outlet. Groups for the elderly experiencing specific ailments as well as groups directed at their caregivers are all set up for those elderly who are increasingly availing themselves of this supportive network.

Computer Classes for the Elderly

Computer classes at senior centers are growing in popularity. Classes on computer basics as well as instruction in using email and other social media platforms such as Facebook have become more common. In fact, the Jewish Council for the Aging in Washington, D.C. offers an entire Senior Tech program. DorotUSA.org has a whole program called University Without Walls specifically designed for seniors who are homebound where they get to participate in stimulating classes and lectures through their computer or tablet. Local AARP chapters also offer computer basics classes and sometimes partner with vendors for discounts on the hardware.

A Tool With Great Benefits

Research shows the Internet has become an important way to exercise the minds of seniors. A new study out of England and Italy finds that when the elderly are trained in the use of social media as well as Skype and email, they perform better cognitively and experience improved health. During a two year period, 120 seniors in the UK and Italy aged 65 and above were given specially designed computer training and were compared against a control group that did not receive any. Among those that used these tools, the mental and physical capacity improved as opposed to a steady decline experienced in the control group. One woman reported feeling “invigorated” rather than “slipping into a slower pace” and caring more about her appearance and losing weight. It seems that satisfying our basic social needs can have synergistic effects for our overall health.

Overcoming loneliness is that much easier through the Internet and social media. As more and more of the population ages and sticks closer to home, the Internet as a support and educational tool becomes ever more important. Technology has greatly ameliorated the potential of our seniors feeling isolated and alone. Let’s help them take advantage!

 


Anita Kamiel, RN, MPS, is the founder and owner of David York Home Healthcare Agency, licensed by the State of New York. She holds a master’s degree in gerontological administration and is fully acquainted with all factors related to eldercare services and the latest guidelines for seniors. Thirty years ago, she realized the need for affordable, quality home health aide services provided and supervised by caring individuals. You can contact her at 718-376-7755 or at www.davidyorkagency.com. David York Agency is also on Facebook, Twitter, Google+, and LinkedIn.

Senior Substance Abuse: An Explosion On The Horizon by: Anita Kamiel, R.N., M.P.S.


Elderly Addiction

It’s something that we never associate with the elderly, but it does exist: substance abuse. According to the NYS Office of Alcoholism and Substance Abuse Services (OASAS), this “hidden national epidemic is diagnosed in only 37% of those ages 60+ suffering from addiction. Many organizations have new guidelines for doctors and health professionals to screen every patient for alcohol and drug abuse.


2 Types of Abusers

According to the Hazelden Betty Ford Foundation, there are two types of elderly abusers: those who are continuing their heavy substance use cultivated over their lives, and those who, due to the disappointments and struggles of later years, have turned to alcohol and drugs as a way to cope with their pain—physical and psychological. OASAS calls these groups “hardy survivors” and “late onsets.”


Older Women

Women, who generally live longer, are more likely to fall prey later in life. Alcohol is usually the drug of choice, but prescription medications rank just below that. Many of these prescription drugs include opiates for pain relief for diseases like arthritis and sedatives for anxiety and sleep disorders.

According to Dr. Andrew Kolodny of the Physicians for Responsible Opioid Prescribing, middle-aged women saw an increase of 900% (not a typo!) in addiction to both opioids and heroin since 1997 with a concurrent 450% increase in deaths due to overdose since 1999. The potential to overwhelm the medical system and society is enormous.

The opioids are prescribed for pain, but due to their high acclimation effect, higher and higher doses are needed to get the same result. Doctors, given specious information from drug companies and largely untrained in pain management, prescribe them again and again to improve quality of life, and patients are not educated in alternative methods.


There are acute risks associated with elderly substance abuse.

The elderly use so many prescription and over-the-counter drugs that their adverse interactions with alcohol or narcotics could be disastrous.
Because the way we metabolize alcohol as we age changes, it actually takes much less alcohol for the elderly to become intoxicated. This leads to a greater risk for impaired cognitive functioning, depression, and general confusion. They may even become so confused that they take extra doses of medication resulting in overdose or death.

Already compromised in many seniors, brain cells essential for memory, thinking, and decision-making are destroyed with heavy drinking.
Being sedated by drugs or alcohol combined with its cumulative effects increases the risk of falls and serious fractures to the elderly which are often accompanied by fatal complications.


Not Just for Teens, but Baby Boomers, too!

Up to this point, addiction and substance abuse has primarily been seen as a young person’s affliction, but a whole generation of younger people is aging out. Furthermore, as baby boomers enter the golden years, their exposure to alcohol and drugs as youngsters makes them more open to them now. The Hazelden Betty Ford Foundation estimates that 17% of those 60 and older abuse substances, including prescription drugs. They estimate the number to double by 2020.


The Signs & Signals

Though it is difficult to tease out the symptoms of abuse since they mimic many of the common signs of aging, the Center for Applied Research Solutions recommends watching out for:

  • Memory loss
  • Disorientation
  • Lack of balance
  • Shaky hands
  • Mood swings
  • Depression
  • Chronic boredom
  • The Center for Substance Abuse Treatment adds the following symptoms to the list:
  • Changes in sleeping habits
  • Unexplained bruises
  • Being unsure of yourself
  • Unexplained chronic pain
  • Changes in eating habits
  • Wanting to stay alone much of the time
  • Failing to bathe or keep clean
  • Having trouble concentrating
  • Difficulty staying in touch with family or friends
  • Lack of interest in usual activities

Some suggestions for managing this problem include:

Many doctors and professionals are reluctant to confront this since they feel “you can’t teach an old dog new tricks,” but that is a fallacy. The elderly can be nimble, as proved by their ability to adapt to their personal deficiencies fairly rapidly. They react better to intervention than other age groups and require less-intensive rehab called “brief alcohol interventions.” They recognize the benefits of sobering up since not doing so threatens their independence as well as their cognitive and physical abilities. Early evidence supports the finding that baby boomers are more amenable to recovery since they don’t carry the shame of addiction of previous generations.

Try these tips:

  1. Paying close attention to the elderly family member’s daily comings and goings.
  2. Getting a drug interaction list of the elderly patient’s medications from the pharmacist.
  3. Raising your concerns with the doctor and having him/her assess and screen thoroughly for the problem.
  4. Increasing the activity level and social activities for the elderly loved one.
  5. Participating in a 12-step program or support group.
  6. Having diplomatic, nonjudgmental conversations with your elderly relative.

The key is to avoid the opioid addiction cycle to begin with. Just as we plan for later years, that could begin as early as middle age.



Anita Kamiel, RN, MPS, is the founder and owner of David York Home Healthcare Agency, licensed by the State of New York. She holds a master’s degree in gerontological administration and is fully acquainted with all factors related to eldercare services and the latest guidelines for seniors. Thirty years ago, she realized the need for affordable, quality home health aide services provided and supervised by caring individuals. You can contact her at 718-376-7755 or at www.davidyorkagency.com. David York Agency is also on Facebook, Twitter, Google+, and LinkedIn.

Hiring A Geriatric Care Manager by: Anita Kamiel, R.N., M.P.S.

Senior woman with her geriatric care manager

Being a caregiver for an elderly adult can be fraught with unforeseen and challenging situations that many relatives are ill equipped to handle. Managing all the details and logistics required for situating an elderly parent either in their home after a hospital stay or in a facility of some kind can be daunting for a child or senior spouse. That is when it is often a good idea to hire a professional geriatric care manager (GCM). But, wait – What is a geriatric care manager?

GCMs are usually social workers, but they could be nurses or psychologists or someone in a geriatric health related field, that specialize in the care and problems associated with the elderly. They are certified through an independent agency to manage all aspects of the aging adult. They are totally familiar with Medicare, Medicaid, hospitals, rehab centers and home care through both private pay and long term care insurance. GCMs can provide the all important continuity of care when there are multiple professionals to manage and/or when transitions need to be made. They can also provide useful input for resources pertaining to a specific health situation.

GCMs work as advocates for the geriatric patient in various settings and visit the client on a regular basis. They and their team are available 24/7 by phone to the patient and family for emergencies, updates and consultation and are always able to take charge when a problem arises. They charge by the hour after an initial consultation fee and are a godsend when the family lives far away.

With the geriatric population aged 65+ set to double from 35 million in 2000 to 72 million in 2030, it is important to start thinking about how to manage them all. This field is rapidly expanding with the Aging Life Care Association, the professional organization of GCMs, reporting that it is growing steadily with 300 new members annually.

The time to consider a GCM is when an aging loved one experiences declining health, questions regarding long term care arise, a discharge from a hospital or facility is imminent, end-of-life planning begins, and if family members can’t agree on caregiving decisions or are not happy with current care providers. Difficult interpersonal relationships often come to the fore at these times and an oft overlooked benefit of involving this type of third party professional is their ability to work through unpleasant family-to-family sticky situations should they arise.

GCMs help with lining up proper housing, home care service, scheduling doctor appointments, as well as suggesting social activities. When close family members live far away, they are essential to oversee the daily care of the client. They can also help with elderproofing a senior’s home from assessment through to installation. They are handy when a move is necessary which is often extremely stressful for an elderly person. They help with all the logistics of such a move including arranging for the physical packing up of all belongings all the way through to shutting off or transferring the utilities.

Starting with a GCM can be costly, but once wheels are set in motion, costs should settle down. In New York City, initial 1.5 hour initial assessments begin at $250 and go up from there. Subsequent hourly rates range from $150-$200 per hour.

Since you will be working closely with this individual on critical personal decisions, personality chemistry is key in this situation. It is important to get references from both the professional and client side to make the relationship successful and happy. Turn to your doctor or allied health professional for a reference and canvas your friends and acquaintances for personal recommendations. You can also consult the credentialing agencies such as the Aging Life Care Association formerly the National Association of Professional Geriatric Care Managers, the National Association of Social Workers, the National Academy of Certified Care Managers or the Commission for Case Managers for certified GCMs in your area. Once you find a few to consider, it would be wise to ask them for a client you can speak to regarding their experiences before you decide whom to engage. Most important, you must hire a flexible and caring GCM that makes the needs and preferences of your loved one paramount.

Anita Kamiel, RN, MPS, is the founder and owner of David York Home Healthcare Agency, licensed by the State of New York. She holds a master’s degree in gerontological administration and is fully acquainted with all factors related to eldercare services and the latest guidelines for seniors. Thirty years ago, she realized the need for affordable, quality home health aide services provided and supervised by caring individuals. You can contact her at 718-376-7755 or at www.davidyorkagency.com. David York Agency is also on Facebook, Twitter, Google+, and LinkedIn.

Consider A Geriatrician For Your Senior Loved Ones by: Anita Kamiel, R.N., M.P.S.


Geriatrician -- Another Specialist

As specialists go, we have all heard of cardiologists, gastroenterologists, endocrinologists, but how many of us really consider or have even heard of geriatric specialists or geriatricians when we think about care for someone 60 and older? As we age, the health challenges we face become more complex and the list of medications quickly grows, a more holistic view of the geriatric patient may be warranted.

A geriatrician is a board-certified family or internal medicine physician with an additional 1-2 years of fellowship training in geriatric medicine for separate board certification. A geriatric care physician offers a unified framework for issues such as adult-onset diseases, incontinence, dementia, depression and changes in mobility. Their focus is on enhancing quality of life and helping older adults remain independent for as long as possible.


Coordination of Care

One of the most important benefits of a geriatrician is to coordinate care. They help the elderly patient when:

  • It is necessary to coordinate too many specialists.
  • The physical and mental health management of senior adults becomes too complex for a regular internist.
  • The list of medications becomes complicated and implications for drug interactions become serious.

Geriatricians use a “whole-body” approach in patient care as their paradigm. During a first visit, you can expect an extremely comprehensive geriatric assessment with a number of components. These include a thorough physical examination after a full recording of the patient’s medical history including a pain assessment. The workup will also include cognitive testing, osteoporosis and arthritic evaluation, a nutritional assessment as well as vision, hearing and dental screening. Additionally, inputs from a geriatric social worker and the family are often important components of the evaluation.

Geriatricians are adept at working closely with the multiple specialists who may be currently managing chronic illnesses of the elderly patient. Also, there is often a team of specialists with specific geriatric certification that the physician calls upon to help with the total care of the patient including registered nurses, physician’s assistants, social workers, physical therapists, occupational therapists, nutritionists, pharmacists and psychiatrists all focused on the prevention and treatment of the diseases and unique challenges that face older adults. They all are trained to take special note of the frailty and mental capacity of the patient while managing their multiple medications. These health care providers nationally are members of the American Geriatric Society.


Selective Testing & Procedures

Geriatric physicians are selective when it comes to ordering certain tests and performing procedures weighing the costs and benefits of each as they can be physically and mentally stressful for aging patients. Routine or preventive testing done in younger people may be counterproductive or risky in certain older adults. Additionally, you will find that a geriatrician is extremely sensitive when listening to the concerns of the elderly patient and in helping them deal with end-of-life issues. They realize the importance of incorporating the unique psycho-social issues related to the elderly into their care plan. As such, geriatricians can be important resources for both the individual patient and their families.

A geriatrician pharmacologically monitors all of the patient’s illnesses and evaluates the therapeutic efficacy and dosage of medications. Polypharmacy, which is managing multiple medications, can unintentionally and needlessly result in dangerous drug interactions. As we age, our metabolism changes and medications are absorbed differently than when we are young. A geriatrician is uniquely qualified to recognize and avoid the problem of over-medication even factoring in any over-the-counter meds or supplements that find their way into the mix.


Emerging Field in Medicine

Geriatric medicine is poised for growth as our population ages and the 85+ segment continues to be the fastest growing. There are only about 9,000 certified geriatricians in the U.S., thus finding one that has room on their roster might be challenging. To try and address this anticipated shortage, a greater emphasis has been placed on applying skills to the elderly population during medical residencies and training. Aside from consulting with your current primary care physician, the American Geriatric Society might be a good first stop for finding a geriatrician you can trust. Lifescript Doctor Review has an interactive portal to help you find a qualified doctor in your area with the expertise you and your family need as you transition into this new phase of life. We owe it to our elderly to make sure they are properly cared for.



Anita Kamiel, RN, MPS, is the founder and owner of David York Home Healthcare Agency, licensed by the State of New York. She holds a master’s degree in gerontological administration and is fully acquainted with all factors related to eldercare services and the latest guidelines for seniors. Thirty years ago, she realized the need for affordable, quality home health aide services provided and supervised by caring individuals. You can contact her at 718-376-7755 or at www.davidyorkagency.com. David York Agency is also on Facebook, Twitter, Google+, and LinkedIn.

Care Transition From Hospital To Home by: Anita Kamiel, R.N., M.P.S.

Transition home

Returning home from the hospital can be stressful for the older adult for many reasons. In most cases, the patient has been 100 percent dependent on hospital staff and the shift to life at home with less help can be cause for anxiety. While it is a relief to be going home, they may be afraid of how they will manage alone. The trauma of the illness coupled with the care transition can be frightening to both the patient and their loved ones. Their children might be afraid to let them suddenly fend for themselves and they may be too proud to admit to needing the additional help. Fortunately, hospitals do not discharge anyone without the discharge planning social worker ensuring that arrangements are made.

Whether it was a fall that has left them with reduced mobility or just recuperating from surgery, assistance with moving a patient and catering to their needs is essential for preventing additional injuries. Unfortunately, one in five Medicare recipients is re-admitted to the hospital within 30 days of discharge. A hospital re-admission is costly physically, emotionally and financially and a trend is long underway to avoid this at all cost. Proper planning and education can help.

The discharge planner works with the family to ensure continuity of care in terms of any home care, treatments and therapies. While many of the elderly can be independent with respect to a certain amount of care, they may need assistance with some of the activities of daily living such as bathing and dressing. A home health aide is great for the transitional stage. You can hire one for more hours at the beginning and lessen them once the patient is stronger and more independent.

The family and the patient must be fully involved in the discharge planning process. It is crucial that there be a point person in the family for care during the transfer who has knowledge of actual transportation arrangements and any home care set in place. They must have a list of all medications and dosages and the reason for each as well as an understanding of any possible side effects. They must be knowledgeable of any symptoms that are warning signs of anything more serious in order to be able to contact the doctor before a situation gets serious. The patient must realize that their regular doctor may not be aware or have access to the medical information pertaining to their hospital stay. The patient must update the doctor and transmit any medical records pertaining to the stay. Finally, the patient and their family must make the recommended follow-up appointments with specialists in order to treat any chronic condition uncovered or the one which led to the hospitalization. They may also need a registered nurse or physical therapist for some follow-up care.

It is important to consider the physical landscape upon returning home. Places like the bathroom and kitchen will need elder-proofing to make a safe living environment, taking into account new physical limitations. Certain items make home care easier. The installation of a raised toilet seat in the bathroom can prove essential. A portable toilet containing a bucket, grab-rails and raised seat in the bedroom may be necessary and the use of adult diapers can help alleviate accidents. When taking a shower or bath, make sure the levers or knobs are clearly labeled and elongated for easy use and rubber mats and shower chairs will help prevent falls. For the bedroom, a light switch or lamp near the bed will make illuminating a dark room easy. Make sure area rugs are removed as they are tripping hazards. Handrails on stairs should be checked and, if you use the stairs multiple times in the day, consider adding a stair-lift. This would also be a good time to check that the smoke and carbon monoxide detectors in the home are in good working order. Lastly, in lieu of changing any locks, a lock box commonly used by real estate agents is a handy item. These are boxes that hold a key and go around the handle of the front door. They are opened via a combination lock which the patient can give to whomever they wish so they need not be bothered to get up and answer the door while they are recuperating. It is also an affordable safety device should someone who normally would not have a key need immediate emergency access into the senior citizen’s home.

Transitioning from the hospital to home can seem daunting, but consulting the right professionals can make the process seamless and as stress-free as possible.

Anita Kamiel, RN, MPS, is the founder and owner of David York Home Healthcare Agency, licensed by the State of New York. She holds a master’s degree in gerontological administration and is fully acquainted with all factors related to eldercare services and the latest guidelines for seniors. Thirty years ago, she realized the need for affordable, quality home health aide services provided and supervised by caring individuals. You can contact her at 718-376-7755 or at www.davidyorkagency.com. David York Agency is also on Facebook, Twitter, Google+, and LinkedIn.