How to Tell When It’s Time for Professional Home Health Care

As they grow older, most people want to continue living independently in their own homes. They want to remain self-sufficient in their familiar surroundings. That’s certainly expected and natural. But all too often the very fact of aging affects people’s ability to care for themselves and manage their daily living, and this creates health and safety concerns. Many adult children become their parents’ primary caregivers, taking on all the responsibilities that go with keeping up the quality of their parents’ lives. When caring for themselves becomes progressively too difficult, or when the responsibilities of the adult children become overwhelming, it is time for both seniors and their families to consider professional home health care.

Here Are 20 Signs That Signal the Need for Professional Home Health Care:Inability to manage personal care:

  1. The person does not bathe, groom, and perform oral hygiene.
  2. The person does not dress appropriately.
  3. He or she becomes incontinent and is unable to cleanse properly.
  4. The person forgets to eat, does not eat nutritious meals, and loses weight.
  5. He or she forgets to take medication, is confused about what to take and when, or is unable to administer injections or change bandages.
    Inability to manage functional activities of daily living:
  6. The person doesn’t do laundry, or doesn’t change his or her clothes or linen.
  7. He or she lets dirty dishes and garbage pile up.
  8. The person leaves the stove and other appliances on, creating a safety hazard.
  9. He or she is unable to do grocery shopping.
  10. He or she is unable to use the telephone.
  11. The person doesn’t pay bills or manage money properly.
    Change in emotional, mental or physical condition:
  12. The person has difficulty understanding others.
  13. The person has difficulty remembering names, situations, and locations.
  14. He or she gets lost easily.
  15. The person starts to wander.
  16. The person has sudden mood swings, becoming angry or depressed.
  17. He or she falls down often.
  18. He or she becomes isolated, cutting off social contacts.
  19. The person is incapable of making decisions.
  20. He or she suffers a stroke, loss of limb, or other major physical impairment.

Patient Care Advocacy Organizations

State and Private Agencies Investigate Complaints of Poor Treatment

What if you are not satisfied with the quality of care?

One of the most difficult challenges for caregivers occurs when problems arise with the facility or heath care professionals who are supposed to help the senior. If you are not satisfied with the quality of care, discuss your concerns with the facility’s director. You might also want to speak with the senior’s physician, facility medical director or other appropriate staff member.
Misunderstandings rather than poor intentions cause many problems, and talking with staff and managers can frequently resolve them. Moreover, federal and state laws require facilities to investigate complaints about treatment. However, if directly approaching those involved does not produce results, you may have to turn to one or more advocacy organizations. These include:

·          Ombudsman programs, which investigate complaints against long-term care facilities
·          Peer review organizations (PROs), which oversee quality of care for Medicare patients
·          State survey agencies, which conduct reviews of nursing homes
·          Professional licensing boards, which can sanction their members
·          Law enforcement agencies, which can investigate criminal activities

Ombudsman Programs

If you have a complaint about a nursing home or other facility you cannot resolve with the staff, try the local ombudsman program. Ombudsman programs are independent nonprofit agencies mandated by law to protect the rights of residents in long-term care facilities and investigate complaints. Every state has an ombudsman program; most of the programs maintain local branches in different parts of the state.

State and federal laws require facilities to post contact information for the ombudsman program in their area. Ombudsmen can meet with residents and their caregivers and families to discuss quality of care, financial issues, dietary matters and other areas of concern. Ombudsmen can also mediate disputes between facilities and residents or their representatives.

Ombudsmen have no enforcement authority. However, ombudsmen refer their findings to the state survey agency, which is mandated to regulate nursing homes. Since neither the facility nor the state employs them, their recommendations carry special weight with state survey agencies.

Peer Review Organizations

If you have a complaint about a doctor, hospital, managed care plan or nursing home that you cannot resolve with that physician or organization, try contacting your state’s Peer Review Organization. These organizations — also known as Quality Improvement Organizations — investigate complaints about any care a patient has received under Medicare.However, like ombudsmen, they have no enforcement authority. If enforcement is necessary, the PRO may refer a complaint to the state survey agency or the relevant licensing board.

State Survey Agencies

If neither the ombudsmen nor the PRO is able to help you, you can turn to the state survey agency, also sometimes known as a state licensing agency. These agencies enforce federal guidelines regulating nursing homes and have the power to issue sanctions and impose penalties against facilities with substandard practices.

The possible penalties vary widely, from monetary fines to bringing in a temporary management team to even — although this is rare — closing down a facility. These agencies also conduct annual inspections of every Medicare- or Medicaid-certified nursing home.

Professional Licensing Boards

If your complaint is with a nursing home, the state survey agency has enforcement authority; however, if your complaint is with a physician, nurse or hospital, you can turn to the professional licensing board. The boards oversee standards for medical professionals and facilities and can exercise disciplinary authority if necessary.

For example, physicians are licensed through a state board of medical examiners which can sanction them or revoke their medical licenses; nurses are licensed through a state board of nursing, and most hospitals undergo accreditation through the Joint Commission on the Accreditation of Hospital Organizations. You can find phone numbers in the state government section of your telephone book.

Law Enforcement Agencies

If you have a complaint about a facility or care provider that is so serious you believe a law has been broken, you should call a law enforcement agency. These agencies have responsibility in cases of criminal misconduct. For example, a licensed medical professional who steals a patient’s pain medication could face both malpractice and criminal charges. Licensing boards deal only with the professional licenses, so the state’s attorney general or the local police would investigate a possible criminal violation.

In serious or life-threatening situations, such as physical or sexual abuse, any individual can call the local police department, the city attorney’s office or the state’s attorney general. You can find the numbers in the government section of your telephone book.

Unhappy With a Nursing Home? Considering a Move?

Despite all your best efforts, you may find that a senior you care for is in a nursing home that is not meeting your expectations. What do you do? This article examines the questions about when, and how, to choose a new nursing home.
Admitting someone in your care to a nursing home may be one of the most emotionally traumatic things you ever do. You and the senior will go through an adjustment period that may last several weeks before you reach some sort of equilibrium.
The same thing happens to all of us when our social situation changes. If you think back in your life you may remember starting school, moving away to college, or starting a new job. You may also remember advice you received from your parents and later gave to your children, such as “stick with it,” or “You don’t want to be a quitter.”
It is also important to recognize that situations where everyone is happy are rare. Be realistic in your expectations. For example, you must have a quality facility that treats people with dignity; but don’t expect rave reviews from the senior. For most people, being in a nursing home is what they had feared and hoped to avoid.

Beware of Judging the Facility Based on Traumatic Reaction to the Move

With that in mind, remember to “Stick with it.” Especially in the beginning, there will most likely be a traumatic initial adjustment to even the best facility. So don’t make the mistake of evaluating a nursing home based on your own emotional state rather than an honest appraisal of the care and attention the senior is receiving. Remember that building a relationship with the staff of the new facility is the best way to assure that they understand the needs of the senior and for you to get timely, honest information back. Also, bear in mind that staff in a nursing home work efficiently because of routines and standardization. This means they may not provide care exactly the way you do. In fact, they probably cannot provide care the way you do.

Keep the Senior Involved in the Decision Making Process

However, there are times when an honest appraisal of your situation demands that you seriously consider moving the senior to a new facility. As we explore this idea we will look at some of the issues and even warning signs that indicate you should consider a change. We will also discuss the down side of moving and the effects that a change may have on the senior. All in all, the placement decision should be dictated by what is in the senior’s best interest, and should be made by those who are most qualified to understand and interpret his wishes. The senior should always be kept informed and involved in the decision-making process unless a physical or mental condition precludes it.
The best advice, of course, is to carefully select the right nursing home for the initial placement. But, even if you did all your homework, some placements may not be permanent for a variety of reasons. What are some valid reasons to consider a move, and how do you go about arranging it?

Improvement in Condition Is a Good Reason to Move

The most positive reason for changing placements is that the senior improves in health to a point that certain skilled services are no longer needed. Many more people enter nursing homes for rehabilitation today than just a few years ago. Many, if not most, placements are seen as temporary because of a physical condition such as a stroke or fracture.

Medical Concerns and Uncaring Staff Can Be Reasons to Move

Of the negative reasons to change placements, quality of care is the most important. Medical signs that are the most telling include:
  • Significant weight loss
  • Dehydration
  • Bedsores
However, you should ask to discuss your concerns with the director of nurses before drawing conclusions since there may be a valid medical reason for all of these conditions becoming unavoidable. You might want to back this up by discussing it with the physician or facility medical director. Other questions you want to ask yourself and the senior include:
  • Does the senior feel comfortable discussing concerns with the staff?
  • Are management staff receptive to your concerns?
  • Do the staff, in general, seem to care about the senior?
Remember, one employee doesn’t represent the whole facility. Report any behavior that does not meet your expectations.

Moving Can Be Traumatic; Try Every Reasonable Way to Resolve the Problem First

Stability is important for a senior’s sense of well being. When a problem comes up, consider whether you are dealing with a minor annoyance or a real issue. Communicate your concern to a management level person and give them a chance to explain or resolve it. Do what you can reasonably do to try to avoid moving the senior.
The potential burdens of relocation include relocation trauma, which in some cases may be fatal to a frail elderly person, especially someone who has been in one location for a long time or is significantly confused. The very frail do not have the inner reserves to handle physical or emotional stress as well as they did when they were healthier. All moves, even those carefully planned for very good reasons, entail a certain amount of stress. As many as 10 percent of people moved from a skilled care facility will die from a range of causes which can include depression, loss of appetite, and onset of pneumonia.
Another, much less severe side effect of relocation is simply that you and your senior will experience another adjustment period in the new facility. There are times, however, when the potential benefits outweigh the risks.

Moving Will Require Coordination; the Current Facility Should Help You

If, after careful consideration, you and the senior decide it is necessary to move, how do you go about it? The process of relocating is as simple as notifying the current facility that you wish to move. Nursing homes are obligated to assist you in the relocation process, which is usually handled through the social services director.
The amount and kind of help the nursing home provides can vary significantly, depending on your needs and the senior’s needs. You may wish to choose the new facility yourself; however, the discharge planner can also make all the calls and find a suitable new placement. Bear in mind that if the senior entered the current facility as a self-paying resident and converted to Medicaid while there, in searching for a new facility, you will be limited to those which accept Medicaid. The discharge planner can also arrange for an ambulance to move your senior, if necessary, and for someone to pack up and move personal possessions.
When and if you decide to change nursing homes you should be as thorough in your search for a new home as you were in your original search. Involve the senior in the decision-making process and make the move if it is in her best interest.

Nursing Home Rights

State and Federal Laws
Protect Residents From Abuse

What rights do nursing home residents have?

Federal and state regulations offer extensive protections for nursing home residents. The laws address such critical areas as privacy rights, financial matters, personal treatment and medical care.
The federal Nursing Home Reform Law protects the rights of all residents in nursing homes that receive Medicare and Medicaid funds, which includes almost all such facilities. Regulations in every state closely mirror the federal requirements.
You can obtain a copy of these laws by contacting your local long-term care ombudsman program or state survey agency, sometimes called a state licensing agency. Regulations require every facility to post contact information for the local ombudsman program and state survey agency.
The policies on residents’ rights allow for exceptions if authorized medical personnel determine patients’ actions threaten their own or others’ health and safety or if complying with the regulations in particular circumstances would violate other laws. The regulations vary from state to state but generally require the facility to provide:
·          Full notification of patients’ rights, rules of the facility and rules and regulations pertaining to patient conduct and responsibilities. The facility must obtain written acknowledgement from the patient or patient’s representative that they have received this information before or at the time of admission.
·          Complete information about a patient’s medical condition to the patient or patient’s representative.
·          Freedom to choose a personal physician, participate in decisions about treatment options and refuse treatments.
·          The right to refuse participation in experimental research.
·          The right to be treated with respect, dignity and consideration, including the right of residents to set their own schedules, eat meals when they want and engage in activities as they see fit.
·          The right to manage one’s own financial affairs, including the right to know the cost of services and the ones Medicare and Medicaid cover. Residents who choose to have the facility manage their financial affairs have the right to receive a regular accounting of transactions made on their behalf.
·          Confidentality of personal and medical records, including the right to approve or refuse the release of medical records to any individual outside the facility except as part of a transfer to another facility.
·          Equal access to care without regard to whether a resident pays privately or through private or government insurance programs.
·          Freedom from abuse, including physical, sexual, financial, emotional and mental abuse.
·          Freedom from chemical or physical restraints, unless a medical professional with appropriate authority has ordered those restraints in writing for a specified and limited period of time and for specific medical or safety reasons. A facility cannot use restraints simply to punish residents or make it easier to care for a particular patient.
·          Freedom of association with family members, a personal physician or other healthcare provider, an ombudsman or other resident advocate, government representatives or other visitors of the patient’s choice.
·          Freedom to participate in religious, social and community groups.
·          Freedom to use personal clothing, furniture and other possessions as space permits.
·          Personal privacy, including physical privacy during spousal visits and privacy in telephone calls, written communications and personal visits with family members, physicians and other chosen visitors.

Do the laws also cover discharge, transfer and readmission policies?

Federal and state laws also address facilities’ policies on discharge, transfer and readmission of patients. Typical guidelines include:
Transfer to another setting. If a facility is transferring a resident to the hospital or another therapeutic setting, it must provide written notice of how long it will hold the resident’s bed open. This time period is called a bedhold.
Priority readmission. If residents want to return to a nursing home from the hospital after the bedhold period has passed, the facility must readmit them immediately when a semi-private bed becomes available.
Discharge. A nursing home can insist residents leave only if:
·          Their condition has improved or worsened and the facility no longer offers the appropriate level of care.
·          They have failed to pay reasonable and appropriate charges.
·          Their presence endangers their own or other patients’ health and safety.
·          The nursing home is shutting down.
If the senior you care for lives in a nursing home and you believe the facility is violating these rights in any way, you should immediately inform the administrator and contact the local long-term ombudsman program or state survey agency, or both. Federal and state laws require the nursing home itself and government regulators to investigate any alleged abuse, and state survey agencies have the power to issue sanctions against facilities with deficient practices.

Health on wheels / Meals on wheels

Grocery and Meal Delivery
Helps Seniors Stay Healthy at Home

Many seniors can take care of themselves at home but have great difficulty shopping for groceries, either because stores are too far away or the packages too heavy to carry. A leading cause of hunger and poor nutrition among the elderly is the trouble they often have obtaining enough food to eat properly.
Tapping into meal and grocery delivery programs becomes essential for many seniors who want to remain healthy and continue to live at home. The good news: The number of such programs, both government-funded and private, has grown in recent years to serve their burgeoning population. Seniors and their caregivers can choose options best suited to their economic and dietary needs.

Delivery options

Meals on Wheels, a government program launched in the 1960s as part of the Older American’s Act (OAA), offers food to homebound seniors regardless of income level, accepting small payments from those who can afford it.
To qualify for OAA Meals on Wheels Service, a client must be:
·          60 or older
·          Unable to leave home without help and unable to shop
·          Without reliable assistance in meal preparation

Many public and private organizations – local agencies, churches, civic groups, senior organizations, supermarkets and food co-ops – also sponsor a variety of low-cost meal and grocery delivery services.The programs offer a range of public and private meal delivery services, so make sure to find out about both types of plans. In many cases, meal delivery is free. However, the sponsoring agency sometimes requests a small donation if a client can afford it. Some refer to themselves generically as “meals on wheels” even though they have no relation to the federal program.

Other possibilities include small grocery stores and food co-ops that have been in the neighborhood for a long time. To compete with larger supermarket chains, many of these stores will deliver orders of $10 or more to homebound seniors. Finally, if you live in a community with a large senior population or an urban area with a lot of apartment dwellers, you may be able to find restaurants or diners that deliver on a regular basis.

Many services and stores allow customers to order meals and groceries – and sometimes pay for them – via phone, fax or Internet. Some companies ship the food to the seniors’ homes, while others deliver.

Ordering online

Ordering groceries via the Internet can be convenient. Several services offer non-prescription drugstore items, pet food, stationery and a variety of other items. Some sites provide calorie counters and ingredient lists to help ensure the foods meet seniors’ dietary needs. Whole Foods Markets sells groceries, meat, seafood, produce, baked goods and more online, along with prepared foods free of artificial sweeteners, colors, flavors or synthetic preservatives – particularly important for those on restricted diets.Internet companies tend to serve major metropolitan areas. Some guarantee same-day service with a couple of hours’ notice, while others require a few days. Most offer supermarket items rather than entire meals, but some deliver deli and prepared foods.

Delivery fees vary among companies. Most charge a flat rate or a percentage of the order cost, while some deliver larger orders free.

Checklist for meal delivery services

·          Can they accommodate special dietary needs?
·          Are deliveries made on a regular schedule? Is the schedule flexible? Can you tailor it to your needs?
·          Can you also purchase meals for a healthy spouse or caregiver?
·          Will the service deliver more than one meal at a time?
·          Are weekly menus provided in advance?
·          If the senior stays in a hospital or with family for a period of time, is it possible to restart deliveries later without reapplying?

Behavior Management Strategies

Caring for a loved one with dementia poses many challenges for family caregivers and health care service providers. Bizarre behaviors and memory problems make it difficult to leave the impaired person alone, even for a short time. These behaviors can cause embarrassment, frustration, and exhaustion in those providing the care. You will probably need to explore what works best for you and your impaired relative.

This fact sheet provides some practical suggestions and strategies for dealing with common behavior problems in dementia patients.
Communication
  • Eliminate distractions. Turn off the TV or radio when talking to the confused person and maintain eye contact to help keep his/her attention.
  • Use short, simple sentences and give only one directive at a time. Avoid sentences phrased in the negative. Instead of saying: “Don’t go outside” say: “Stay inside.”
  • Monitor the tone and level of your voice while talking to the person with dementia. Gestures, pantomime, and pictures can help you get the point across. Use nonverbal cues like exaggerating a smile or a nod.
  • Avoid speaking down to your loved one. Speak slowly and clearly, but in an adult manner. Don’t be afraid to repeat what you say several times.
  • Refrain from discussing topics your relative can no longer remember. Encourage him/her to talk about familiar places, interests, and past experiences.
Wandering
  • You may want to change the locks on your doors. Consider a lock where a key is required for exit and entry. A sliding bolt installed at floor level may be effective.
  • Try a barrier like a curtain or colored streamer to mask the door. A “stop” sign or “do not enter” sign also may help. Another technique is to place a black mat or paint a black space on your front porch; this may appear to be an impassable hole to the dementia patient.
  • Child-safe” plastic door knob covers are available at children’s departments. Special electronic devices also are sold by private companies to prevent wandering.
  • Put away essential items such as the confused person’s coat, purse, or glasses. Some individuals will not go out without certain articles.
  • Have your relative wear an identification bracelet. Maintain a current photo should you need to report your loved one missing. Consider leaving a copy on file at the police department.
  • Tell neighbors about your relative’s wandering behavior and make sure they have your phone number.
  • Allow for regular exercise to minimize restlessness.
Incontinence
  • Establish a routine for using the toilet. Try reminding the person or assisting him/her to the bathroom every two hours.
  • Schedule fluid intake to ensure the confused person does not become dehydrated. However, avoid drinks with a diuretic effect like coffee, tea, cola, or beer. Limit fluid intake in the evening before bedtime.
  • A commode, obtained at any medical supply store, can be left in the bedroom at night for easy access.
  • Incontinence pads can be purchased at the pharmacy or supermarket. A urologist may be able to prescribe a special product or treatment.
  • Use signs (with illustrations) to indicate which door leads to the bathroom.
  • Use easy-to-remove clothing such as elastic waistbands, full skirts, and clothes that are easily washable.
Angry/Agitated Behavior
  • Obtain a doctor’s evaluation to determine if there is a medical cause, or if medications are causing adverse side-effects. Reducing caffeine intake may be helpful as well. In severe cases, medication can be prescribed by a neurologist to keep a dementia patient calm.
  • Reduce outside noise, clutter, or number of persons in the room. Maintain structure by keeping the same routines. Keep objects and furniture in the same places. Help orient the confused person with calendars and clocks. Familiar objects and photographs offer a sense of security and can facilitate pleasant memories.
  • Try gentle touch, soothing music, reading, or walks to quell agitation. Speak in a reassuring voice. Do not try to restrain the person during a catastrophic reaction. Keep dangerous objects out of reach.
  • If agitation increases at night, a night light may reduce confusion.
  • Limit choices to minimize confusion. Instead of asking “What would you like for lunch, soup or a sandwich?” say: “Here’s some soup.
  • Acknowledge the confused person’s anger over the loss of control in his/her life. Tell them you understand their frustration.
  • Distract the person with a snack or an activity. Allow him/her to forget the troubling incident. Confronting a confused person may increase anxiety.
Perseveration (repetitive speech/actions)
  • Reassure or try to distract the person. Avoid reminding the person that he/she just asked the same question. Ignoring the behavior or question may work in some cases.
  • Do not discuss plans with a confused person until immediately prior to an event.
  • You may want to try placing a sign on the kitchen table stating “Dinner is at 6:30” or “Lois comes home at 5:00” to remove anxiety and uncertainty about anticipated events.
  • Learn to recognize certain behaviors. An agitated state or pulling at clothing, for example, could indicate a need to use the bathroom.
  • Check with the demented person’s doctor. Make sure the person is not in pain or suffering any side effects from prescription medications.
Paranoia
  • Check out paranoid behaviors with the person’s doctor. Adjustments may be needed in prescription medications.
  • If the confused person suspects money is “missing,” allow him/her to keep small amounts of money in a pocket or handbag for easy inspection.
  • Assist the person in looking for a missing object. Avoid arguing. Try to learn where the confused person’s favorite hiding places are for storing objects which are frequently assumed to be “lost.”
  • Take time to explain to other family members and home helpers that suspicious accusations are a part of the dementing illness.
  • Respond to the feeling behind the accusation. If the accusation involves hurting or killing someone who has passed away, you might try saying “You really miss your mother; tell me about her.”
  • Try non-verbal reassurances like a gentle touch or hug.
Traveling
  • Do not negotiate an outing with a confused person. Instead of asking, “Are you ready to go out?” Limit what he/she must remember by announcing “Here’s your coat” and “We’re getting into the car now.”
  • Reassure the person. New and different surroundings can be anxiety-producing and disorienting for someone with dementia.
  • Plan your route as carefully as you can, know about parking, elevators, stairs, etc. Leave plenty of time so you will not need to rush.
  • If taking a vacation or weekend away with the dementia patient, consider bringing along another adult to help out.
  • Bring something to help keep the confused person occupied if you must wait somewhere. Try a package of snacks, cards, or a picture book.
Additional Problem Areas
  • If bathing is a problem, realize that you can skip a day, if need be. Be aware that loss of ability to determine temperature may make the water seem too hot or too cold. Safeguard hot water so that the person does not get burned. Supervise showers or baths, particularly if the person’s balance is unsteady. Remove the bathroom door lock for safety. Concern over modesty also may increase agitation, so be reassuring. Try varying the time of day to better suit the person’s prior bathing habits.
  • Loss of control over appetite can occur and the person may not remember just having eaten. Keep food out of sight during non-meal times. Serve food pre-cut, if using utensils becomes difficult. Respond to the emotion by reassuring the person that you will make sure he/she is well fed. Distract the person with a different activity.
  • Dressing is difficult for most dementia patients. Choose loose-fitting, comfortable clothes which have easy zippers or snaps with minimal buttons. Reduce the person’s choices by removing seldom-worn clothes from the closet. To facilitate dressing, lay out one article of clothing at a time, in the order it is to be worn. Remove soiled clothes from the room. Don’t argue if the person insists on wearing the same thing again.
  • If the confused person suffers sleep disturbances or night-time agitation, make sure the house is safe: block off stairs with gates, lock kitchen door or put away dangerous items. Try soothing music or a massage to induce relaxation. If agitation increases after dark, keep the house well lit and close curtains to shut out darkness. If the person remains awake or restless at night, consider hiring someone for the night shift or find a way to share night-time supervision with others so you can get your own rest. Use sleeping medications only as a last resort.
  • When hallucinations are a problem, keep the house well lit to decrease shadow effects which can be confusing. Reassure the person during or after a loud noise such as a storm, siren, or airplane. Give a simple, truthful explanation of the noise, but avoid arguing or trying to convince the person. A distraction may be useful. Check with the person’s doctor.
  • Other problems may include sexually-inappropriate behaviors, driving a car, stubbornness or violent outbursts.

Checklist: Seniors and Driving

Know When to Put the Brakes On Elders Behind the Wheel

Telling seniors it may be time for them to stop driving can be one of the most difficult milestones in the caregiving process. Just as it does for teen-agers, driving represents freedom and independence for seniors ? the ability to visit friends, go to the movies and shop without having to rely on anyone else.

Because of the emotional nature of the issues involved, it is important to include seniors in the discussion rather than dictate a decision to them.

It is also useful to consult with family members, doctors and other health care professionals, and people the senior respects, such as clergy and friends. Seniors might get defensive and even angry when you broach the subject, but safety concerns demand you raise it nonetheless.

How does aging affect driving ability?

Safe driving demands the complex coordination of a host of skills. Many physical and mental changes that accompany aging can diminish the ability to drive. These include:

  • A slowdown in response time
  • A loss of clarity in vision and hearing
  • A loss of muscle strength and flexibility
  • Drowsiness caused by increased use of medications
  • A reduction in the ability to focus or concentrate
  • Lower tolerance for alcohol

None of these changes alone automatically means that seniors should not drive. But caregivers need to regularly evaluate a senior’s abilities and assess whether the person needs to alter driving habits or stop driving altogether.

A checklist on safe driving

Be on the look-out for telltale signs it might be time for a senior to stop driving. When they are behind the wheel, do they:

  • Drive at inappropriate speeds, either too fast or too slow?
  • Ask passengers to help check if it is clear to pass or turn?
  • Respond slowly to or not notice pedestrians, bicyclists and other drivers?
  • Ignore, disobey or misinterpret street signs and traffic lights?
  • Fail to judge distances between cars correctly?
  • Become easily frustrated and angry?
  • Appear drowsy, confused or frightened?
  • Have one or more near misses?
  • Drift across lane markings or bump into curbs?
  • Forget to use left- and right-turn indicators?
  • Forget to turn on headlights after dusk?
  • Ignore signs of mechanical problems with the car?
  • Have difficulty turning head, neck, shoulders or trunk while in traffic or parking?
  • Have too little strength to turn the wheel quickly in case of emergency?
  • Lose their way repeatedly?

If the answer to one or more of these questions is “yes,” you should explore whether medical issues are impacting their driving skills.

Medical issues to consider

Caregivers need to know:

  • Have seniors had their vision and hearing tested recently?
  • Have they had a physical examination within the past year to test reflexes and make sure they do not have illnesses that would impact their driving?
  • Are they taking medications or combinations of medications that might make them drowsy or confused?
  • Have they reduced or eliminated their intake of alcohol to compensate for lower tolerance?

Adapting to changes

Driving is not necessarily an all-or-nothing activity.
There are many ways for seniors to adjust their driving so they do not pose a danger to themselves or others. Among them are:

  • Avoiding nighttime driving
  • Driving only to familiar locations
  • Avoiding drives to places far away from home
  • Avoiding freeways and rush hour traffic
  • Leaving plenty of time to get somewhere
  • Foregoing driving alone

Other forms of transportation

You might encourage the senior to rely more on public transportation. This will reduce their time behind the wheel and help prepare them for when driving may no longer be an option. Many cities offer special discounts for seniors on buses and trains, and senior centers and community service agencies often provide special transportation alternatives for seniors.

How to get them to stop

If you feel strongly that a senior cannot drive safely, you have little choice but to get them to stop. If they agree without an argument, wonderful. If not, you have several options:

  • Stage an intervention. This approach, commonly used with substance abusers, involves confronting the senior as a group of concerned caregivers. The group should include family members, health care workers and anyone else respected by the senior. The intervention needs to be handled firmly but with compassion in order to break through the senior’s denial on the issue.
  • Contact the local Department of Motor Vehicles and report your concerns. Depending upon state regulations and the senior’s disabilities, it may be illegal for them to continue driving. The DMV may do no more than send a letter, but this may help convince the senior to stop.
  • Take the keys, disable the car or move it to a location beyond the senior’s control. Leaving the headlights on all night or disconnecting the battery are good ways to disable the car. But if the senior is likely to call AAA or a mechanic, you have no choice but to eliminate all access to the car. While these measures may seem extreme, they can save the lives of seniors, other drivers and pedestrians.

Home modifications and repairs

Home Modification and Repair includes adaptations to homes that can make it easier and safer to carry out activities such as bathing, cooking, and climbing stairs and alterations to the physical structure of the home to improve its overall safety and condition.

Why Is Home Modification And Repair Important?
Home modification and repair can help prevent accidents such as falls. Research suggests that one-third to one-half of home accidents can be prevented by modification and repair.

Typical Problems:

  • Difficulty getting in and out of the shower
  • Slipping in the tub or shower
  • Difficulty turning faucet handles/doorknobs
  • Access to home
  • Inadequate heating or ventilation
  • Problems climbing staffs

Possible Solutions:

  • Install grab bars, shower seals or transfer benches
  • Place non-skid strips or decals in the tub or shower
  • Replace with lever handles
  • Install ramps
  • Install insulation, storm windows and air conditioning
  • Install handrails for support

Home Care’s range of services

Home care services cover a wide range of health and social services for individuals recovering from surgery or an injury, those with disabilities and chronic conditions, or people with terminal illnesses.

Because of the extensive range of home care services it?s important to have your care manager complete a comprehensive assessment to help determine the best home care services to meet your specific needs and budget.

Because of the extensive range of home care services it?s important to have your care manager complete a comprehensive assessment to help determine the best home care services to meet your specific needs and budget. They will know which services are covered by Medicare, your Long Term Care Insurance policy, or which are considered custodial type services that will need to be paid for privately.
Home care services cover a wide range of health and social services for individuals recovering from surgery or an injury, those with disabilities and chronic conditions, or people with terminal illnesses.
Because of the extensive range of home care services it?s important to have your care manager complete a comprehensive assessment to help determine the best home care services to meet your specific needs and budget. They will know which services are covered by Medicare, your Long Term Care Insurance policy, or which are considered custodial type services that will need to be paid for privately
Registered Nurse (RN) – An RN is typically supervised or prescribed by a physician. An RN has two or more years of training and is licensed by the state. This highly skilled level of care includes trained professional services for individuals recovering from surgery or an accident, or with more complex medical needs which can be addressed in a home setting (such as wound care, injections, intravenous therapy, disease treatment and patient assessments).
Licensed Practical Nurse (LPN) / Certified Nurse Assistant (CNA) – LPNs has one or more years of nursing training. A certified nurse assistant (CNA) has a certain number of hours training in both hands on service and classroom work. Both these categories usually work under the supervision of an RN.
Home health aide – These home care workers assist people with activities of daily living such as getting out of bed or up from a chair, walking, dressing, bathing and toileting.
Homemaker / Companion – This category of home care worker typically performs light housekeeping duties including meal preparation, shopping, laundry, and clean-up. Depending on the level of training, this person may assist with organizing paperwork, or making phone calls. Such individuals are hired to help complete household tasks and generally do not perform personal, hands on care.
Occupational Therapist (OT) – An OT is trained to help individuals learn ways to cope with or compensate for limitations in performing activities of daily living. Often prescribed by a physician, an OT can help teach someone to use a walking device or other rehabilitative equipment. OTs can help train both the care recipient and caregiver in techniques to improve mobility or make household routines easier.
Physical Therapist (PT) – A PT is usually prescribed by a physician to assist a person with a disability or physical injury to improve physical functioning. PTs have extensive training in anatomy and musculature and can teach exercises designed to promote or restore strength. PTs may use equipment, training materials, massage or other techniques. A PT may also be useful in training caregivers in safe lifting or bending practices.
Speech Therapist – These rehabilitative therapists assist individuals with communication disorders resulting from disease, injury, surgical intervention or a stroke. Speech therapists help their clients regain lost speech, cope with aphasia, and learn special techniques to aide in swallowing, breathing, and muscle control.
Dieticians – These health care professionals provide nutritional counseling and guidance to help individuals manage the relationship between nutrition and illness (e.g., diabetes, heart disease, etc) or disability.

Checklist: Home Alone….. Are they Ok?

At some point in many caregiving situations, a moment arises when you must consider whether it is still possible to leave the senior in your charge alone for an hour, an afternoon or an entire day. Will they be safe? Will they wander off? Will they let strangers into the house? Will they turn on the stove and forget to turn it off?
Making this decision can be a complicated and emotionally wrenching experience for both caregiver and senior. For caregivers, it can be heartbreaking to recognize that the strong, self-sufficient adult they have known for years is no longer capable of taking care of the most basic tasks.

It also means a real loss of freedom and flexibility and may require you to develop creative strategies to accomplish daily errands and tasks. For the senior, it can be equally difficult to acknowledge and accept that physical, emotional or mental changes have reduced their independence.

Checklist on being home alone

You have numerous factors to consider when making this determination. Because of the importance of balancing the safety of the senior with the need of both senior and caregiver to retain as much independence as possible, you should include as many people as you can in the decision-making. In addition to the senior, you might want to consult with other primary caregivers, such as family members and friends; paid caregivers who know the senior’s abilities and limitations; and elder care professionals such as doctors, nurses, and social workers.

These questions can guide you in making the decision. If the answer to any of them is “no,” it might be time to consider the possibility the senior should no longer be left alone even for a short period of time.

  • Do they understand how to leave the home if necessary? Do they know where the door is located and how to exit the building?
  • Will they stay home or near the house rather than wander off?
  • If they go outside, do they know where they live and how to get back inside?
  • Can they identify signals, such as smoke from the kitchen or fire alarms, that would alert them to potential dangers?
  • Do they know how to access emergency services? Do they know how and when to dial 911? Would they be able to communicate over the phone? Can they physically get to a phone no matter where they are?
  • Do they have frequent life-threatening medical emergencies that require immediate intervention? Do they know where any medication they might need is located? Can they reach it?
  • Do they have the judgment to identify who they should and should not let into the home? Will they know to allow family, friends and emergency personnel into the home?
  • Can they prepare themselves something to eat if they get hungry? Do they know how to use the stove, and will they remember to turn it off?
  • Can they get to the bathroom and use the toilet on their own? If not, have alternatives been worked out?
  • Are they afraid to be alone for an hour or more? Do they become clingy when caregivers depart and make frequent telephone calls if they are alone?

If you determine through this checklist and other means it is still safe to leave the senior at home alone, you should regularly reassess the situation. Caregiving is a dynamic process, and you need to be aware of any and all changes in the senior’s condition and abilities. Even if you think the senior can be left home by themselves, pay attention to their desires; if they fear being alone, it is often a sign that at some level they know they are not capable of coping with any emergencies that might arise.