Category: Brand Specific

In our last blog post, we looked at the differences between palliative care and hospice. Generally speaking, palliative care describes a type of care provided in association with a chronic illness; hospice care is provided at end-of-life. Insurance only covers a portion of these services. This is where home care and home health companies can come in to play, as it relates to the total care plan whether it be palliative or hospice care.

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CASE STUDY

David and his sister have been caring for their Dad and were just told that he now qualifies for hospice care. After contacting several hospice companies, they chose one and were looking forward to the additional care their Dad would be receiving. Care for Dad had increased to several hours a day and even though they shared the responsibilities, it was beginning to take a toll on them. Housekeeping, cooking, bathing, dressing and medication management were surpassing the full-time job mark. You can imagine their shock to learn that insurance would only cover a home health aide 45 minutes a day, 3 days a week. Moreover, the aide will only be able to assist with Activities of Daily Living (ADLs). They expressed their concerns to the hospice company who suggested they consider supplementing Dad’s care with a home care or home health agency.

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CREATING A CARE TEAM

Hospice and Palliative care can be provided by several different people and agencies that work in conjunction to provide patient care. Think of it as having a Primary Care doctor who oversees and guides the care, but uses specialists (a cardiologist, a gastroenterologist, etc.) when needed to address very specific needs. Supplementing palliative or hospice care with a home health agency is very similar; the palliative care or hospice team oversees the care plan, but companies like Silver Lining Home Healthcare can be part of the team to provide services that will enhance your loved one’s care. Does your Mom or Dad want a massage? Do you want someone with them 24/7 at end-of-life? In the case study above, David and his sister welcomed support so they could be present simply as a son and a daughter and not worry about things like repositioning, suctioning and mouth care. That’s what Silver Lining Home Healthcare can do. Depending on the type of care you want (medical or non-medical) will determine what type of supplemental company you go to: A home health company can do everything (medical care, ADL care, IADL care) and a home care company can only do ADL and IADL care. Note: Make sure for ADL care, you ensure you have a home health aide or CNA.

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CARE CAN VARY AND CHANGE

Different palliative and hospice care companies may offer different levels of service. While they all get reimbursed by the same insurance companies, different business models and focuses may change the way that they’re able to care for you or a loved one. For instance, Delaware Hospice has a hospice house in Milford, Delaware where your loved one will go if he/she has uncontrollable pain or symptoms. Seasons Hospice has a hospital wing that they use for this. Vitas Hospice was trialing a system where they would provide 24/7 nursing care in the home if they had clients with uncontrollable pain. So different companies have different resources and models that change how they deal with your loved one.

As a patient’s symptoms change or progress, so too should their care plan. You know how you make changes to your lifestyle to get a certain result? Like working out and eating healthier if you want to feel better? Care is like that, too; the care plan constantly changes to achieve a desired result. Your Mom or Dad’s needs will be constantly evolving. Sometimes they’ll need the same resources for months, and sometimes the care plan will need to change every few days. Understanding this will help you not get frustrated every time something needs to change or you are given a care recommendation that is new.

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4 QUESTIONS TO ASK WHEN LOOKING FOR CARE

If you’re looking at palliative or hospice care for your loved one, remember that the amount insurance covers will be minimal. When putting together your care team, here are some great questions to ask to help guide your decisions:

1) What is the prognosis? If it’s short and death is imminent, it is easier to handle the cost of 24/7 care. If it’s a longer time-frame, finances may impact your decision. BUT always think “investment” instead of straight cost. There are loan options, reverse mortgage options, and insurance policies that may be able to contribute to covering costs.

2) What does Mom or Dad need help with to maintain a quality of life? Use our Level of Need calculator as a starting point.

3) What are my priorities when choosing a hospice and palliative care company? If keeping your loved one at home is at the top of your list, consider asking a few more questions:

1. How many hours will they be scheduled for?
2. How often will a nurse come out?
3. What else needs to be coordinated? Silver Lining Home Healthcare has a great Case Management program just for you, assisting to arrange things like medication delivery, lawn care, and transportation to doctor’s appointments

4) What level of home care and supplemental care do I need?

1. Make a schedule of friends and family who want to be involved in your loved one’s care. Who can help often depends on prognosis. If care is needed for a week, it may be easier for family and friends to cover certain hours. If it’s weeks or months, then asking for long-term commitments is more difficult and additional supplemental care from an outside source may be necessary and/or preferred (read about why an agency is a great thing in your life!).
2. Add home care or home health company based on needs. Silver Lining Home Healthcare Delaware is a home health company and can offer everything from administering medication to ensuring your Mom’s lawn is cared for. Finding a company like this can give you great peace of mind.
3. Add additional services such as Meals on Wheels, therapy visits, and grocery delivery. Consider using a pharmacy that has a free delivery service.

Caring for an elderly family member who is facing a chronic illness or end-of-life is never easy. We want you to make the most of your loved one’s last days and to be truly present. There are professionals ready to walk with you to ensure the best care for your loved one and for you. Want to read more on the topic of end-of-life care? We love Atul Gawande’s Being Mortal.

Palliative Care and Hospice often get confused with each other, and they also have a lot of negative connotations. We break down what you need to know, and help you figure out how to use each service to the fullest.

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4 MAIN DIFFERENCES AT A GLANCE

1. Prognosis – Palliative care does not have a particular prognosis. Hospice requires a prognosis of less than 6 months to live.
2. Qualifying for Care – Palliative care requires a serious illness, acute or chronic, as determined by your physician.
3. Goal of care – Palliative care focuses on quality of life during treatment. Hospice care focuses on quality of life and comfort measures without treatment for a disease or illness (unless that treatment will provide symptom relief)
4. Oversees Care – Palliative care is typically overseen by your normal PCP (primary care physician) while hospice care is overseen by the Medical Director of the Hospice.

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WHAT IS PALLIATIVE CARE?

Palliative care is specialized medical care for those with serious illnesses. The entire focus of palliative care is to increase quality of life, which is different for every person.

MYTH BUSTER: You don’t have to be “end-of-life” and you don’t have to be actively dying to receive palliative care.

• Prognosis (probable outcome because of your diagnosis) –  There is no prognosis qualification for palliative care.
• Qualifying for care – You must have a chronic or acute condition that interferes with quality of life or ability to do Instrumental Activities of Daily Living (IADLs) or Activities of Daily Living (ADLs).

• Goal of care – The goal of palliative care is to provide relief from the symptoms and stress of a serious illness. Palliative care focuses on improving the quality of life during treatment.
• Who oversees the care – Your primary care physician typically oversees palliative care.
• Who provides the care – Palliative care can be provided in hospitals, nursing homes, outpatient palliative care clinics and certain other specialized clinics, or at home.

Medicare, Medicaid, and insurance policies may cover palliative care. Veterans may be eligible for palliative care through the Department of Veterans Affairs. Private health insurance might pay for some services. Health insurance providers can answer questions about what they will cover. Private pay options are available for services that may be incorporated into a palliative care plan like massage, hypnotherapy, hyperbaric therapy, etc.

How to use palliative care to its fullest:

1. Ask your doctor for resources for the best palliative care options in your area.
2. If your doctor or practitioner don’t know of any, do online searches for “Palliative Care <insert your area’s name>” or look at this directory to see if there is anyone in your area. An example in Delaware is Delaware Transitions. Most companies like this have services that are completely free of charge!
3. Call your insurance company and ask for all the services that your insurance covers for palliative care. Some of the services that are often covered by insurance may include: supplies, nursing services, social work services, or spiritual visits.

Examples of when to use Palliative Care:

• Congestive Heart Failure
• Chronic Obstructive Pulmonary Disease (COPD)
• Cancer
• Dementia
• Parkinson’s
• Multiple Sclerosis
• Any diagnosis that can limit your quality of life and/or ability to do ADL’s or IADL’s.

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WHAT IS HOSPICE?

Hospice is a type of care that is enlisted for patients with less than 6 months to live. It offers patients pain relief, nursing care, emotional support and help with everyday tasks.  Hospice can also provide support for family, friends, and caregivers as they too are on this journey with the patient. Hospice does not seek a cure

MYTH BUSTER: You can “graduate” from hospice. In some cases, patients improve and no longer meet the requirement for hospice care. Read more here.

• Prognosis (probable outcome because of your diagnosis) – General guidelines for health providers to qualify an individual for hospice is less than 6 months to live.
• Qualifying for care – An individual must be considered terminally ill, and have less than 6 months to live if the disease runs it’s normal course.
• Goal of care – Comfort measures. When you’re on hospice, all treatment is focused on relief of symptoms, not on finding a cure.

• Who oversees the care – The Hospice Medical Director typically oversees the care
• Who provides the care – Hospice care can be provided in hospitals, nursing homes, outpatient care clinics (or hospice houses, which exist to manage uncontrollable symptoms) and certain other specialized clinics, or at home.

Like palliative care, Medicare, Medicaid, and insurance policies may cover hospice care. Veterans may be eligible for palliative care through the Department of Veterans Affairs. Private health insurance covers some services. Health insurance providers can answer questions about what they will cover. Private pay options are available for services that may be incorporated into a hospice plan like massage, hypnotherapy, hyperbaric therapy, additional home care, grocery shopping, etc.

How to use this service to its fullest:

1. Ask your doctor for resources for the best hospice companies in your area.
2. If your doctor or practitioner doesn’t know of any, do online searches for “Hospice” or look at this directory to see if there is anyone in your area. Examples in Delaware include Compassionate Care Hospice, Delaware Hospice, Seasons Hospice or Heartland Hospice. If your journey of care takes you from one facility to another, these companies can travel with you during the continuum. You will want to ask what the hospice does for uncontrolled symptoms and pain management; some hospices have their own “hospice houses” and some have a wing at a hospital. In our opinion, we have found the hospice houses are typically the best experience for clients and families.
3. Another great research tool is Hospice Compare. It’s a conglomeration of data that helps you find hospices in your area and compare them based on the quality of care they provide.
4. Call your insurance company and ask for all the services that your insurance covers for hospice care. Some of the services that are often covered by insurance may include: supplies, nursing services, social work services, or spiritual visits.

Examples of when to use Hospice Care: Any diagnosis where you may have less than 6 months. You will need a prescription from your physician, so if your doctor hasn’t initiated hospice care, the hospice company can reach out to the physician for you. Hospice consults are free. You can call any hospice company to request one.

You won’t use both palliative care and hospice. You’ll only use one at a time, and any services covered by insurance will only cover one or the other. But by all means, we encourage you to use either of these care services. Most of the services are covered by an insurance, and if you don’t like it, you can always stop. We know experiences vary based on area, company, illness, family dynamics and client needs, but we always encourage you to build up a community that can help deliver quality of life, and palliative care and hospice programs can do just that.

Coming next month, we look at how to pair palliative or hospice care with home care and home health. Until then, we leave you with this challenge: When you hear palliative care and hospice care, think enhanced quality of life, not death.

Silver Lining Home Healthcare is uniquely positioned to provide supplemental palliative and hospice care with a full team of certified and licensed staff. Contact us anytime with questions!

Sources:

“What Is Palliative Care” https://getpalliativecare.org/whatis/

“What Are Palliative Care and Hospice Care?” https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care

“Hospice Eligibility Requirements” https://www.nhpco.org/hospice-eligibility-requirements

Finding the best living situation for yourself or aging loved ones can be a struggle for many families as they wade through different options. While we are active proponents of happier aging at home, this post is not meant to persuade you to always use home care. We’re here to be a resource for you, to help you (or your loved one) age the way you want—with choice and dignity—in a place where you want to be.

We’ve identified 7 aspects we know to be essential when comparing in-home care vs an assisted living facility (ALF). Let’s take a look:

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SPACE

Consider the space where you or your loved one will feel most comfortable and what their preferred size of living area is.

• In-home Care – Primary place of residence. First floor bedroom or a first floor room to put a bed is highly beneficial, as is first floor bathroom. Home is, of course, as big or small as you have.
• Assisted Living Facility – Square footage generally ranges from 250sq. ft. to 600 sq. ft. for a room. ALFs vary widely in room options (private, double occupancy, multi-room suites).

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MEDICATIONS

Managing medications is a crucial part of a care plan. Both in-home care and assisted living facilities can excel at staying on top of a client’s medications.

• In-home Care – Skilled home health agencies (like Silver Lining Home Healthcare) can provide and administer medications. Additional resources that can verify medications are taken (i.e., like the Livi or a Medication Compliance program from SafeinHome) can help your loved one stay medication compliant at home.
• Assisted Living Facility – Nurses oversee and administer medications. For most assisted living facilities, the more medications your loved one has, the higher the monthly cost of care.

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SOCIALIZATION

Time with friends and family. Exercise classes. Church gatherings. Pursuing a favorite pastime. Socialization opportunities such as these promote physical, mental, and cognitive benefits for seniors.

• In-home Care – Socialization in the home setting is focused on encouraging family and friends to come to your loved one’s home or having your loved one venture out for lunch dates, bus trips, exercise classes or any social event (if physically able).
• Assisted Living Facility – Socialization in the assisted living setting is easy because it’s quite accessible. Most assisted livings have an activities director to coordinate activities ranging from chair yoga to playing games to watching a school choir come and perform. This is a perk to living at an ALF.

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SAFETY

Evaluation, prevention, and early detection are the pillars of safety whether in the home or in an assisted living facility.

– In-home Care – Prevention and early detection are the main focus around safety in the home. Even with a person present 24/7, Mom or Dad could still have a fall related to a variety of environmental and physical factors. In-home care agencies help clients create a safe environment in their homes by:

• Performing a Home Safety Evaluations and making adjustments
• Creating a care plan with physical exercises and the use of adaptive equipment
• Taking advantage of early detection devices that detect and send alerts in the case of a fall (SafeinHome is one example).

– Assisted Living Facility – Just like in-home care, prevention and early detection are the goals of an assisted living facility. An ALF is designed to keep clients as independent as possible, which means they often don’t have any more oversight than an individual would in a home environment. Systems like SafeinHome can work in an ALF just like it can in the home. Something to be aware of: Safety precautions often aren’t as customizable in an ALF as they are in a home environment.

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DEMENTIA CARE

Deciding on care for a loved one with dementia or Alzheimer’s disease can be one of the toughest decisions. In many cases, there is a desire to keep a loved one in familiar surroundings for as long as possible.

• In-home Care – 1:1 personalized care in familiar surroundings is a benefit to home care. In-home care can also be a great support to one’s primary caregiver.
• Assisted Living Facility – Typical ratio may be closer to 5 clients to 1 staff member. Not all ALFs have memory care units or they are best suited for those in the early stages of the disease. A memory care unit is typically a separate wing or residence of a facility that is staffed 24/7 by staff who are specifically trained to care for the needs of dementia patients.

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COST

Understandably, the cost of care is a major consideration. Consider care as an investment into your loved one’s quality of life. Still, we know that sometimes money is the biggest factor into how much care can be obtained. Think about “what is the alternative to this cost?” For example, home care may sound expensive until you see the costs of burnout, losing a job/taking off work to provide the care yourself, or using a facility. Genworth provides a widely used long-term care calculator to help you gauge the cost of care in your area.

• In-home Care – Depends on availability of additional resources and level of care required. To a certain point, home care is cheaper than an ALF; 24/7 in-home care is not. There are multiple options instead of doing 24/7 care (i.e. technology to supplement actual people care). Hourly rates for in-home care range from $18-30 for Instrumental Activities for Daily Living, $20-35 for Activities of Daily Living, and $50-130 for nursing care.
• Assisted Living Facility – Most have a base price or “Level 1” price. Depending on level of involvement required (personal care, medication management, etc.), the price increases. In Delaware, the average monthly cost is $5350.

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CARE COORDINATION

“An ounce of prevention is worth a pound of cure.” And so it is with Care Coordination. Care Coordination exists to help your loved one maintain a normal life while staying on top of health concerns before they snowball into health crises. Scheduling and attending important medical and non-medical appointments, coordinating social activities (loneliness is the biggest contributor to depression in older adults!), and bringing in or recommending additional resources are all functions of Care Coordination and work to prevent issues before they arise.

• In-home Care – Varies based on agency. Having the right agency that can actually manage all of your care and coordinate the details can be the key to success for aging in place.
• Assisted Living Facility – Typically streamlined and overseen by an on-site Director of Nursing.

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CHOOSING BOTH

Did you know that home care could actually be provided at an Assisted Living Facility to supplement one’s care? It is yet another option to consider. Like most options, in-home care and assisted living can both be the right option for you. And that can be a good “problem” to have. If your family is struggling with this decision, know that you are not alone. A Care Specialist at Silver Lining Home Healthcare can take your unique situation into account, help you weigh the options and design a care plan for your loved one.

Seasonal depression is real and it can be intensified with age as we face health challenges, loss of loved ones, and changes to daily routines that don’t serve us like they once did. Seasonal depression, better known as Seasonal Affective Disorder or SAD (the irony of the acronym is not lost of me!), affects millions of people. While no one confirmed cause leads to SAD, there are a few factors that could increase your chances of having SAD. There could be special circumstances or varying degrees of factors, so be sure to consider these in the context of your own situation. According to the National Institutes for Health,  common risk factors for SAD include:

• Being female. SAD is diagnosed four times more often in women than men.
• Living far from the equator. SAD is more frequent in people who live far north or south of the equator. For example, 1 percent of those who live in Florida and 9 percent of those who live in New England or Alaska suffer from SAD.
• Family history. People with a family history of other types of depression are more likely to develop SAD than people who do not have a family history of depression.
• Having depression or bipolar disorder. The symptoms of depression may worsen with the seasons if you have one of these conditions (but SAD is diagnosed only if seasonal depressions are the most common).
• Younger Age. Younger adults have a higher risk of SAD than older adults. SAD has been reported even in children and teens.

In addition to having common risk factors for SAD, there are other reasons that seasonal depression may be amplified for you:

• Situational – As we get older, life changes happen in our relationships. Beloved friends and family pass away and memories of great times make us nostalgic. Acknowledge why you might be sad or depressed and don’t feel bad about it. Know that you can make different memories today. Situational depression is usually short-term.
• Physical and Mental – I pair these together because our physical health affects our mental health and our mental health affects our physical health. If you can’t get out of bed because you’re feeling depressed, then your physical body starts to decline. Without moving around, muscles atrophy. We don’t eat right, we don’t sleep well, we don’t stay hydrated, we become isolated. And these fuel our depression.
• Genetics – There is a difference between genetic depression and situational depression brought on by environment or life events. Situational depression usually starts as something acute (short-term) but can grow into something long-term if not addressed. While genetic depression may be worsened by a change in season, it is not something that can be cured simply by changing an outlook. It may be something you were born with and may require some extra assistance, i.e. medication, so that you can achieve a great quality of life.

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WHAT TO DO

If you’re recognizing a seasonal pattern in your mental wellness, you may suspect that you’re suffering from SAD. Here are some steps you can take:

1) Get your hormone levels checked. Low testosterone levels are a huge factor when it comes to feelings of depression. Also, a key contributing factor to SAD may be an overproduction of melatonin.

2) Ask yourself what kind of depression you may be dealing with; self-assess, but don’t self-diagnose (there are doctors and nurse practitioners for that). By self-assessing based on the information above, you can be prepared to have an effective conversation with your primary care provider the next time you see them. Being familiar with what kind of depression you may be dealing with can help you be an engaged participant with your care provider in developing a plan to address it. Here is a tool to help you prepare.

3) Don’t do anything in a vacuum. While any step is better than none, thinking that any one step is going to make you feel 100% better isn’t realistic. Look at your situation holistically and then make a plan (Or have someone else make a plan for you! Call us!). What do I mean? Something like this:

• Physical Goal – Take a 10 minute walk 3 times per week
• Mental Goal – Meditate once a week
• Sleep Goal – Go to bed by 11pm Some of the biggest factors to effective sleep are how long you sleep, a consistent wake up time, how much time it takes you to fall asleep, and how long it takes you to leave bed.
• Eat Goal – Eat at least 1 serving of fruit and vegetables every day for starters. For guidelines on what you should work up to, ChooseMyPlate.com is a fun and easy tool to use.
• Medication Goal – If I need medication, I will take it consistently. I will ask my doctor about any interactions my medications may be having that contribute to my feelings of depression. (We are huge believers in not jumping to medications, but they do have a time and place and when used effectively, are irreplaceable. But make sure you don’t go right from “I’m depressed” to taking meds without addressing the root causes or other contributing factors, as it may have a much more limited effect and cause unnecessary side effects.)
• I will get my hormone levels checked.
• I will TELL SOMEONE about my plan! If there is no one checking on me or holding me accountable, will I get it done? A superhuman it might, but for the rest of the world, we need someone to check on us and encourage us.
• I will put on some music. Music has a lot of power. I may not want to be around anyone, so I will welcome the positive vibrations that come from music.
• Some other ideas for goals: Learn how to use social media, visit a place that you love, find a new kind of routine with small pleasures (i.e., a new kind of tea you can drink every morning).

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WHAT TO DO IF YOU SUSPECT SAD IN A LOVED ONE

You can tell them to cheer up, but it probably won’t be well received. We all have bad days. And the platinum rule (“Treat others the way they would like to be treated.”) is probably the best approach. Some good questions you could ask them:

• Do you want to talk about it?
• What makes you feel happy?
• If it can change your quality of life and make you feel better, would you consider creating a game plan? (Then use the goals template above to create some goals for them.)

Start small. If you have never worked out in your life and decide to go to the gym every day, you’ll burn out and most likely revert back to where you started. But if you start with one day a week, it’s more manageable for your body to adapt. In the same way, start small with how you help someone. This month, maybe it’s fresh flowers once a week. Next month, maybe it’s sharing a meal with them and eventually taking them out to an event. Be genuine. Be authentic. No one wants to feel like a charity case.

**Depression is not normal. Seek change and go to your primary care provider for help. If you had or are having suicidal ideation, call 1-800-273-8255. Don’t stop yourself from getting help because you feel ashamed, feel bad, or don’t want someone to think there is something wrong with you. You’re here, and you matter. If there is ever a time when you are not ‘taken seriously’, we will help you find a provider who can assist you.

Whatever season find yourself in, I hope you will use all the tools and people in your life to make it one of happiness and joy so that tomorrow it will be worth remembering. “Happy Season” to you and your loved ones from all of us at Silver Lining!

Additional Reading:

“Seasonal Affective Disorder”- National Institute of HealthDr. Colbert’s Hormone Health Zone: Lose Weight, Restore Energy, Feel 25 Again! by Don Colbert, M.D.

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Wondering whether your home health care will be covered by insurance? Here’s a clue: Do you have a skilled need and are you homebound? “Skilled need” and “homebound” are two words that go hand-in-hand when an insurance company is considering home health care coverage. Many insurance companies follow Medicare guidelines when it comes to coverage for home care. For that reason, we have found that understanding Medicare’s definitions is a great help in understanding how the majority of insurance companies define certain terms.

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WHAT IS A SKILLED NEED?

A skilled need refers to something that someone with a license is required to provide. For most purposes, this means a Registered Nurse or a Physical Therapist. Some examples of skilled needs include:

• Intravenous or intramuscular injections and intravenous feeding
• Wound care
• PEG tube care
• Medication management, administration and education
• Physical therapy, due to a fall or post-surgery rehab, for example

Once a skilled need has been identified and approved, then services from a speech therapist, occupational therapist, social worker and home health aide can be provided. If you don’t have a skilled need, then most insurance companies, including Medicare, will not provide coverage for these services (occupational therapy, social work, or home health aide) on their own.

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WHAT IS HOMEBOUND?

By Medicare’s guidelines, you are homebound if:

1. You need the help of another person OR medical equipment to leave your home. This could include a wheelchair, walker, or crutches.
2. Your doctor believes that your health or illness could get worse if you leave your home.
3. You typically cannot leave your home OR it’s difficult for you to leave your home (requires taxing effort)

The MedicareIntertactive.org site continues to further explain homebound status:

“Your doctor is the final say in whether you are homebound. Even if you are homebound, you can still leave your home for medical treatment, religious services, and/or to attend a licensed or accredited adult day care center without putting your homebound status at risk. Leaving home for short periods of time or for special non-medical events, such as a family reunion, funeral, or graduation, should also not affect your homebound status. You may also take occasional trips to the barber or beauty parlor.”

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HOME CARE VISITS: WHAT TO EXPECT

So you have the skilled need, the homebound status, and the doctor’s order for home care services. What can you expect next? At your first visit, the nurse or therapist will review your information, the doctor’s orders and the plan of care. They’ll review your medications, talk with you about your goals, and discuss the role of any family members who may be part of your care.  After these introductory steps have been completed, the visit will follow the protocol of a “normal visit”–a check of your blood pressure, temperature, heart rate and breathing and of course, the therapy or nursing care that has been prescribed. Education is also part of the visit, so you and/or your caregiver will be taught how to perform exercises, care for a wound, or how to control symptoms of your ailments.

All insurance policies limit the number of home care visits they will cover in a given year, so check with your insurance company for the specifics of your plan. When coverage ends or if the coverage provided isn’t enough, you may want to opt for out-of-pocket coverage. Silver Lining Home Healthcare is very uniquely positioned for any gaps in care that insurance doesn’t cover. As a skilled home health agency, Silver Lining Home Healthcare can provide care for patients who have skilled needs AND non-skilled needs, regardless of homebound status. Two companies can’t be billing insurance at the same time; since Silver Lining Home Healthcare focuses on private home care, we can actually be present in the home at the same time as an insurance-covered option. We can also continue care after discharge from another program, offering clients the comfort of familiar faces and uninterrupted care.

*Note: Silver Lining Home Healthcare provides private home care and charges a fee for our services. We are not affiliated with any government programs. We do not accept Medicare or Medicaid.

Resources:

Home Health Basics – Medicare Interactive

The Homebound Requirement – Medicare Interactive

Medication management is a hot topic. And it should be. Medication confusion and home medication errors account for additional health expenses, hospital readmissions and even falls at home. Researchers at Brigham and Women’s Hospital (2012) noted that half of the people who go home from the hospital have medication errors and problems within the first month of discharge. According to an article in Drugs & Aging (2005), as many as 200,000 people may die of medication-related problems each year in the United States.

Managing medications can be a real headache for some clients and families, as it requires time and attention to detail. And the headaches are no surprise when we consider the following circumstances that can contribute to the confusion:

• Pharmacy substitutions – Pharmacies may change the brand of pill they dispense for your prescription (for example, substituting a generic brand). This usually means you’ll receive pills of a different size, color or shape even though you’ve been on the “same” medication for a long time.
• Doctor to doctor communication – A cardiologist may reduce a medication from twice a day to once a day, but the primary care doctor has no idea.
• Stop that. Start this. Medication changes are almost inevitable if you’ve been at the hospital or at a rehab facility. Additions or deletions from your daily med lineup can be confusing to a newly discharged patient. And if old medications are not disposed of or stored away, the confusion can be compounded.

So let’s do this! Let’s go from muddled to methodical and get those medications under control for yourself or for someone in your care. Below are 3 easy, but important, steps you can take to gain better peace of mind and #happieraging when it comes to dealing with meds.

1) Make the Mother List – Make one list identifying all medications that you and everyone in your circle (including your doctor) can reference. Keep it updated. Here is a printable one that Silver Lining Home Healthcare might use. If you’d like to complete a form on-line, you can find one here . Whether you use a template or create your own, these are the essentials of a complete medication list:

• Medication Name(s)
• Medication Dose (i.e. 10 mg, 5 mL 1 tsp, etc.)
• Medication Amount (i.e. 1 tab or ½ tab) – This is the amount that you are supposed to take.
• Frequency – How often and when?
• Route – How is it taken (orally, sublingually, intravenously, etc.)?
• Purpose – Some medications are used for different things

Keep your list with you in a wallet or purse when you leave home and especially when you travel.  And remember, keep your list updated!

2) Commit to one pharmacy. Find one you like and stick with it. All your prescriptions should be dispensed from here. Get to know the pharmacists and don’t hesitate to ask questions, even if it concerns an over-the-counter medicine. Your pharmacy may also deliver prescriptions right to your door. Just ask!

3) Choose a medication pillboxor automated dispensing system – Visit your pharmacy and purchase a medication planner, also called a pillbox. If your medication doesn’t change often, go for the monthly one. If your medications are changing frequently, a two-week box may be better to get you started. Tips for choosing a medication planner:

• Look for one that has big enough tabs for you to see and operate. Ezy Dose® Pill Planners and Medtime Planners® come in a variety of sizes. The Jon Locked Pill Dispenser adds another layer of convenience and assurance by locking all the tabs until it is time to dispense the medications. No more worries about spilling a planner and getting mixed up!
• The first time you set these up, you may need to reorder some medications so you have enough to fill all your boxes and get all your meds on the same ordering cycle. Some medications will run out earlier than others and you don’t want to start getting confused about what medications are in the planners and which ones aren’t.
• Always get a medication planner that has the correct time slots for you. For example, if you take medications three times a day, don’t get a pill planner that only has morning and night! This will cause more confusion.

You may want to consider an automatic pill dispenser. With a little bit of time invested up-front, these work great and can even let a caregiver know via text messaging when medication is dispensed or if a dose was missed. It’s still a good idea to keep a pillbox on hand for vacations or times you’ll be away from home. Read more about automated dispensing systems in one of our past posts, Medication Management Tips and Tools.

4) Talk, talk, talk to your doctor – Did you  know that the more medications you take, the bigger the chance you have of developing side effects related to those medications? Polypharmacy (when you take more than one medication) significantly contributes to medication-related issues, especially in the elderly. Talk to your doctor about:

• Consolidating or even discontinuing some medications
• Minimizing the times you have to take medications. Taking meds with less frequency during the day makes it easier to remember to take them. Instead of taking medications 4 or 5 times a day, see if you and your doctor can work to get your schedule down to 1 or 2 times a day.
• Whether medications are appropriate for someone your age. You can do a little homework by reviewing the Beers Criteria for Geriatric Medication Safety to see if any medications you take could be cause for concern. Ask your doctor if he/she uses the Beers Criteria.

As you talk to your doctor or the doctor of a loved one, be the advocate. Be the advocate by asking questions, sharing ideas, relaying symptoms and possible side-effects and by talking about anything that is concerning to you. Talk, talk talk!

Get to it! Make your list, choose your medication planner (and use it consistently,) commit to one pharmacy, and stay in communication with your doctor. If you need assistance with medication management, call us! We can help! To look at our Medication Management plan and other services, visit our website here.

Sentiments of cheer and goodwill are certainly heart warmers at this time of year, but how about ways to literally give the gift of warmth? The team at Silver Lining Home Healthcare put on their (warm) thinking caps to come up with gift ideas to help friends and family stay warm; some will even battle the aches and pains that can worsen in colder months. Happy gifting!

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ARTHRITIS GLOVES

They’re basically fingertip-less gloves that you can wear indoors as you go about your daily activities. They provide mild compression for warmth and help promote circulation. 5 top-rated brands are here for your perusal. Take them off only to wash your hands!

Heated Slippers

Give some toe-tickling comfort! Heated slippers can bring increased circulation and soothing relief to achy feet. Unlike socks, these slippers have flexible rubber soles, so you’re less likely to slip. And they can be worn indoor or outdoor, perfect for a dash to the mailbox.

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CHAIR YOGA

Achy joints? Stiff knees? While it’s important for everyone to be active, it’s even more so for people who suffer from arthritis. Cold weather can hamper exercise routines, so having options for indoor activity is key. Give the gift of gentle movement and stretching. Chair yoga is a gentle way to warm up muscles and fend off stiffness. Check out 5 Chair Yoga DVDs developed for seniors. With the convenience of DVDs, these exercises can be done any time of day within the comfort of home-sweet-home. Namaste!

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WARM MEALS

Cooking can become more difficult as we age, especially if you use a walker or can’t stand for long periods of time. Buy a slow cooker or dust off the one from the cupboard and introduce your loved one to some new recipes. Offer to help with grocery shopping and meal prep or ask your home health aide for assistance. Consider a meal delivery service as a great holiday gift, or connect with your local Meals on Wheels program to be sure nutritious and warm meals are a staple.

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REUSABLE WOOL DRYER BALLS AND ESSENTIAL OILS

Bundle up some reusable wool dryer balls and essential oils with the suggestion that they be used any day of the week, not just on laundry day. Warm up blankets or sweaters for a few minutes in the dryer with this dynamic duo before wearing. The soothing warmth and relaxing, all-natural scent will chase away any winter chill. Dryer balls are a cost-saving alternative to dryer sheets, so they’re a gift that will keep on giving throughout the year.

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NOT-YOUR-EVERYDAY BLANKETS

Sure, a blanket seems like such an obvious gift but we have three that stand out in our book:

• Cabeau Fold ‘n Go Travel and Throw Blanket Plus Compact Case – Besides being so soft and plush, this blanket folds into a convenient carrying case for easy travel. Attach a carabiner to the handle and it’s ready to be attached to a walker. While the blanket is in the case you can also use it as a pillow, seat cushion, or lower back and lumbar support.
• Electric Heated Throws – For those times that call for total body warmth, turn on an electric heated throw and snuggle in with a movie or a good book. Today’s heated throws come in so many styles and colors that it’s easy to match them to any décor.
• Custom Photo Blankets – These blankets do double duty, warming hearts as they warm bodies. Family pictures, a family tree, or a family name are just some of the ideas to have imprinted on a blanket. Look for them at retailers such as Costco, Walmart or Shutterfly.

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HEATING PADS

The options for heating pads are many–disposable, microwaveable, and electric. When that deep ache sets in, have the perfect one on hand.  ThermaCare disposable heating pads are great for those hard-to-reach spots and an adhesive keeps them in place. Microwaveable ones offer unlimited number of uses and many can be worn while you move through your day. We like the ones with velcro straps, like this lumbar and abdomen one or this one for your wrist. And don’t rule out an electric heating pad. In addition to the flat style (great for backs), they also come in a variety of designs for different body parts. Side note: We always encourage our clients to take advantage of the time with an electric heating pad to elevate their feet to help maintain positive blood and lymph flow!

From all of us at Silver Lining Home Healthcare, may your aches be few and your warmth be plentiful this holiday season!

Additional Resources:

13 Arthritis Pain Relief Tips for Winter Weather

Different medications. Different dosages. Different times of day. It’s no wonder medication management can be a challenge for seniors. An effective plan for managing the medications of your loved one begins with 2 considerations–people and tools. Ask the questions (1) Who is the right person to oversee a loved one’s medications? and (2) What tools are available to assist in the correct delivery of medication?

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WHO’S IN CHARGE?

Who comes to mind when you think of someone who is organized, competent, and trustworthy? The person you put in charge of managing someone’s medication should possess these traits. You might think of a daughter, a spouse, or a neighbor. You might think of a nurse.

Nurse’s Note: If you decide to hire a nurse for any type of home care, make sure it is a nurse with an active license in your state. A Google search can help with license verification. Simply use your state in your search string, for example, “professional nurse license verification Delaware”.

You can also choose a skilled home health agency (like Silver Lining Home Healthcare) for medication management. A skilled home health agency will ensure all their nurses are trained and licensed. They will also have backup nurses if your regular nurse is unavailable. Silver Lining Home Healthcare specifically offers a Medication Management program – book services today at our website: silverlininghealthcare.com.

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MEDICATION REMINDER AND DELIVERY TOOLS

There are so many products on the market today that help ensure the accurate and timely delivery of medication. From simple pill boxes to more technological gadgets, there are delivery tools to suit many different needs.

• Whether taking daily supplements and vitamins or prescription medications for specific conditions, many of us can appreciate a little help with planning and remembering to do so.  A pill box like the EZY Dose One-Day-At-A-Time at Walgreen’s makes it simple. We love the easy open tabs, the 2x and 4x per day options and the large bins for more medications. At under $10, this pill box is a great tool!
• Consider a cell phone app. Most people have a cell phone and it’s something they usually have within close reach. Here are the top 5 medication apps that can help you or a loved one take the right medication at the right time.
• A MedCenter Talking Alarm Clock is a timed voice prompt that can enhance the pill box method. A pre-recorded message (“Dad, time to take your pills.”) is scheduled to play throughout the day when it’s time to take medications.
• The MedCenter Reminder System combines the talking alarm clock with a pill planner system that’s a bit more elaborate than a pill box. We love this system because there are separate compartments for each round of medications.

Nurse’s Note: Many talking alarm systems come with a pill box system that opens one main lid to reveal all the individual compartments. Even though all the medications are separated and labeled for day and time, there is a greater chance of taking the pills from the wrong slot, forgetting what day it is,  or even spilling the entire container. We prefer separate closures for each day.

The MedCenter Talking Alarm Clock and the MedCenter Reminder System work well for people who are competent, but, like many people, can be forgetful. If you are caring for someone who is not competent, you can still use these systems but we recommend having someone monitor them and watch for signs that indicate it is time to advance to a more sophisticated system. Some suggestions:

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• Livi is an automated pill dispensing machine that can hold up to 90 days of medications and dispense up to 15 pills at at a time. A caregiver can receive text alerts when medication is dispensed or if a dose is missed.
• Phillips Automated Medication Dispensing Service is another option for complex medication management. Medication is loaded by a caregiver who provides the dispensing schedule to Phillips. Phillips programs the dispenser. An alert is sounded when it is time to take medication. At the push of a button, the pills are dispensed. The dispenser is connected to the telephone line, so if a dose is missed, the dispenser can contact you or another family member. You can then check on your loved one to make sure they are getting their medication.

Once you’ve chosen a medical reminder and delivery system, our Medication Management Checklist is the perfect tool to help you get started. Use the steps we’ve outlined for you and you’ll be on your way to a streamlined and organized delivery system of your meds.

Medication management is a critical component of a total care plan. According to an article in Drugs & Aging (2005), as many as 200,000 people may die of medication-related problems each year in the United States. There are so many options to help seniors and caregivers manage a safe and consistent medication plan. Call us today to learn more.

Thank you to special contributor Amy Clark. Amy Clark is a Registered Nurse who is Silver Lining Home Healthcare’s Clinical Director. She has over 12 years in the healthcare field and excels at finding the resources her clients need to age happily at home.

A fall or a medical emergency is a concern in and of itself as we age. Being alone in such a situation is even more worrisome. Fortunately, today’s technology provides a myriad of options to monitor and respond to medical emergencies. Medical alert systems–also referred to as a personal emergency response system (PERS), a medical emergency response system (MERS) or a fall monitor–can provide increased independence and peace of mind. We believe they are an important part of a total care plan.

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RESEARCHING MEDICAL ALERT SYSTEMS

So, where do you begin? For starters, AARP suggests you begin with these 5 considerations:

1. What do you need the system to do? Today’s devices offer many capabilities. They can call for help at the push of a button, offer medication reminders, and use GPS tracking to monitor a person’s location, to name a few.
2. What type of equipment would work best? A wearable device that’s comfortable and unobtrusive should be your first consideration.  Beyond that you’ll want to consider technological features such as battery life, connectivity, remote access by family members, and the logistics of setting it up.
3. How are calls responded to and monitored? You’ll want to know what response times are (think seconds, not minutes), if call routing can be customized, and how does a company’s ongoing customer service measure up.
4. How much will it cost? With the total cost of a system, expect to pay for the device, installation, and monthly fees (which range from $25 to $45 per month or about $1 per day). Discounts may be available for multiple family members in the same household, veterans, or low-income clients.
5. Is the service available in your area? Make sure national companies offer service in your area. If a home security is already in place, your provider may offer medical alert services.

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4 SYSTEMS AT A GLANCE

We’ve collected some information on 4 well-known brands of medical alert systems to help you start your search. In addition to using this table to assist your research, you’ll also want to ask the following questions:

1. What is the length of a contract?
2. Are sound alerts loud enough for someone who is hard of hearing?
3. Will mom or dad actually push the button? Look for a brand that can monitor activity, provide activity information and reports, and set custom alerts. This allows you to be proactive and eliminate the need for a button to be pushed. SafeInHome is one brand we have found that offers this feature.

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SILVER LINING HOME HOME HEALTHCARE DELAWARE CAN HELP

We recently installed a home monitoring system for a client who had mild dementia. The system allowed the daughter to see where mom was by using motion and pressure sensors (no cameras). It also allowed her to set parameters for when to get alerts. For example, if mom left the house between 10pm and 6am, the daughter would get an alert. All alerts were customized for different situations and the daughter was able to give us access to the system as well. This system, along with Silver Lining Home Home Healthcare caregivers being present 3 hours a day, allowed Mom to stay home for months longer than anyone thought possible.

Home monitoring systems, in coordination with other resources and hands on care that Silver Lining Home Home Healthcare provides, are all part of an effective plan to age in place. At Silver Lining Home Home Healthcare Delaware, we can assist in selection and implementation of a system that works best for our clients’ needs. As caregivers, we pride ourselves on the personal, human touch that we give to our clients. But we would be remiss if we didn’t acknowledge–and promote–the important role technology plays in caregiving.

Aging in place, while happy, is all about resources. What is the custom care you or your loved one needs to stay happy at home?

Additional reading:

How to Choose a Medical Alert System – A comparison of systems by Consumer Reports

How to Choose a Medical Alert System – by AARP

10 Fall Prevention Tips for Seniors – by Silver Lining Home Home Healthcare

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Perhaps you’ll notice the brevity in this month’s post. What I hope you will take away after reading is the heartfelt sentiment from which I write, hoping to encourage you to document your life story or that of a loved one.

About 3.5 years ago, my husband and I came across a company called StoryCorps. StoryCorps has expertly crafted their skill in helping people—you guessed it—tell their stories. They facilitate conversations between all kinds of people—brothers and sisters, parents and children, best friends, grandparents and grandchildren. Their mission is, in their own words:

“…to preserve and share humanity’s stories in order to build connections between people and create a more just and compassionate world.

Over Mother’s Day weekend in 2016, we decided to enlist the help of StoryCorps to document the words and memories of my mother-in-law as she was battling cancer. We chose to do an audio and a video recording, so her grandchildren (her first was only 2 months old at the time) would get to hear her voice and see her expressions as she answered questions such as, How do you want to be remembered? What was your favorite trip you ever took?  Where did you grow up? These are questions we had not once thought to ask. She passed away 2 weeks later. We used excerpts from the StoryCorps recordings at her memorial service. Not a day passes that we aren’t grateful and comforted by them.

Imagine having a connection to a grandparent you never met. Imagine the feeling of watching your loved one talk to grandchildren they will never know. And beyond all of these warm feelings of connection, there are actual health benefits to documenting your life story.

Write it down, Dictate it. Record it. However you choose to document a life story, please make the time to do it. A simple internet search will uncover a variety of products that can offer prompts and formats to assist you. Capture the words of wisdom, the treasured memories and the irreplaceable sentiments that all too often slip away after a loved one is gone.

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