Category: Silver Lining

As I drive between hospitals, rehab centers, and retirement communities across Northern Virginia in my position at Capital City Nurses, I see the real-world impact of specialized care every day. One thing I’ve learned? Parkinson’s care isn’t one-size-fits-all. Our clients living with Parkinson’s and other movement disorders benefit tremendously from our caregivers and nurses who bring years of hands-on experience to the table. Our team members aren’t just familiar with Parkinson’s – they understand how symptoms can change from morning to evening and how to adjust support accordingly. That kind of expertise simply can’t be taught overnight.

My conversations with healthcare partners throughout the day often turn to how we can better serve clients with progressive conditions like Parkinson’s. Whether I’m meeting with a discharge planner at a hospital or chatting with the wellness director at a retirement community, the goal is always the same – helping people maintain their independence and dignity at home. I love being able to say, “Yes, we have caregivers and nurses who specifically understand Parkinson’s care” and seeing the relief on their faces. It’s those moments that bring purpose and meaning to our work.

Of course, my door is always open for a conversation about how Capital City Nurses or any of our other care companies might be able to help. As we were recently reminded during Parkinson’s Awareness Month, this disease affects an estimated 1.1 million Americans, with a further 90,000 being diagnosed each year. While Parkinson’s Awareness Month comes once a year, it is important to keep it front-and-center, and our commitment to providing high-quality care for those living with this condition is year-round. It’s what gets me out the door each morning, ready to connect the right care with the people who need it most.

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The medical field is filled with acronyms and terms that are used frequently among professionals in the field, but can often come across as a different language to those without professional training. With respect to health care for older adults, two acronyms you will often hear are IADLs and ADLs–Instrumental Activities of Daily Living and Activities of Daily Living, respectively. Read on to learn the difference between the two terms and why their difference matters.

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INSTRUMENTAL ACTIVITIES OF DAILY LIVING – IADLS

We like to explain IADLs as “hands-off” care–the type of activities that someone can do for another person without physical contact. Examples of IADLs include:

• Errands – grocery shopping
• Transportation – to appointments, community center, concerts, etc
• Light housekeeping
• Meal preparation
• Managing finances, such as paying bills and managing financial assets
• Managing transportation, either via driving or by organizing other means of transport
• Managing communication, such as the telephone and mail
• Managing medications, which covers obtaining medications and taking them as directed

IADLs may have to be managed by different service providers. Finances, for example, could be handled by an accounting firm, financial management professional or daily money management professional such as Paper Tigress Personal Finance Care. Many IADLs can be handled by a Certified Nursing Assistant, but some may need to be done by a Registered Nurse.

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ACTIVITIES OF DAILY LIVING – ADLS

Now we turn to the “hands-on” care, the ADLs. These are the activities that would require personal contact should someone be assisting with them. They’re those activities we do every day and when we’re capable of doing them, we don’t give them much thought..

• Personal hygiene – bathing/showering, grooming, nail care, and oral care, Catheter/Ostomy care
• Dressing – the ability to make appropriate clothing decisions and physically dress/undress oneself
• Eating – the ability to feed oneself, though not necessarily the capability to prepare food
• Maintaining continence – both the mental and physical capacity to use a restroom, including the ability to get on and off the toilet and cleaning oneself
• Transferring/Mobility- moving oneself from seated to standing, getting in and out of bed, and the ability to walk independently from one location to another

As people age, it is normal to become slower at performing ADLs. Certain health issues such as a stroke or a fall can significantly affect a person’s ability to perform these activities.

WHY DOES THE DIFFERENCE MATTER?

Knowing the difference between IADLs and ADLs helps you understand the reasons behind your loved one’s care plan. Medical professionals will use assessments of IADLs and ADLs to create a care plan and assign the appropriate level of health care worker needed to best care for your loved one.

Secondly, insurance companies care! Insurance companies are very specific regarding what they do and do not cover. For instance, Medicare only covers home care if you have a skilled medical need (something only an RN or Physical Therapist can provide) and will only allow for ADL care to be provided by a Home Health Aide if there is a skilled need present in the home. IADL is not covered at all under Medicare. Most long term care insurance policies require you to need assistance with at least 2 ADLs for benefits to be paid out. The need for assistance with only IADLs will not trigger the benefits of a long term care policy.

I hope this post has helped you understand the difference between IADLs, ADLs so that you can be an active and educated participant in your care or that of your loved one. For more reading on this topic, check out the additional resources below.

For assistance with any level of care, we’d love to talk with you! Our one-stop-shop agency makes it easy to get the quality of care you want no matter the level of care you need.

Additional Reading:

Activities of Daily Living
Roper-Logan-Tierney Model of Living

Home Care can be confusing.

What is it? Why would I need it? Why would I want it? Who pays for it? What is the difference between this and going to a facility?

Here’s the deal. The healthcare system is complex.Every individual is different, which makes generalizations something we just don’t like. Here are some answers to common questions.

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What  is it?

Home care is a broad term that means any medical  or non-medical care provided in a primary place of residence. That means you may see home care in a single-family home, at an in-law suite, in an assisted living or at a skilled nursing facility. Home care is generally divided into two main areas: home health  and home care. Home health includes medical care like medication management and organization, PEG tube care, trach care, wound care, etc. Home care includes both Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) like dressing,  bathing, check-ins, reminders, errands, transportation, cleaning, and cooking. For a peek into the difference between ADL’s (bathing/dressing etc) and IADL’s (cooking/cleaning), take a look at this post.

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Why Do Our Clients Need it?

Two main overarching reasons:  acute care (short-term) and chronic care (long-term). The biggest reasons for short-term home care include a hospitalization, wound care, or surgery. The biggest reason for long-term home care include a change to the primary caregiver (i.e. the passing of  a spouse), chronic disease management (like diabetes or dementia) or a decline in ability to do things (like cook, clean or drive).

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Why  Would Our Clients Want it?

Home care exists to make  our clients’ life easier and provide him with a better quality of life, keeping him independent at home as long as possible. That doesn’t mean it’s any easier to get older, or for him to feel like he needs help. Home care does allow our client to stay home  longer. It lets him continue to do things he wants to do (like go shopping, eat the meals you want to eat) and have control over his environment. It may keep him safer longer. We know we’re caring for our clients in the most private of spaces: their primary  residence.

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* National Alliance for Caregiving and AARP. (2015). Caregiving in the U.S

Medication compliance is a key factor in well-being. If you’re thinking that a medication “should be skipped”, “isn’t important” or “they have too many medications,” then be an advocate and talk to the prescribing physician(s) about it, but never modify a prescription on your own accord. The importance or significance of a medication and its dose or frequency should always be discussed with the prescribing physician(s). Write down your concerns ahead of your discussion so that you can be thorough in talking about side effects, any new symptoms, or whatever the reason is for wanting to make a change. Even if an individual does end up going off of a medication, there are often specific ways of doing this to prevent side effects (i.e., weaning).

We have a robust Medication Management Checklist made just for you that you can view or download here, as well as an in depth video on how to maintain Medications here.

If your loved one needs a little extra prompting with meds and lives on their own, look into something like the Livi. The Livi is a smart home medication dispenser that simplifies managing multiple medications for patients while giving caregivers support.

Visit our YouTube channel for talks around aging topics and to watch our Coffee Chats with Tiffany where RN Tiffany Rubin talks about matters you care about.

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* National Alliance for Caregiving and AARP. (2015). Caregiving in the U.S

By Brittany Stoltzfus, RD, LDN, owner of Simply Nutrition LLC in Pennsylvania

Being a caregiver of a loved one involves multiple responsibilities. This role can be stressful at times, especially when meal and snack times arrive. As people age, different medications, disease states and emotional health can influence one’s ability to eat. How can you as the caregiver know if your loved one is eating enough? Every person is unique in their exact nutrient needs so overall goals can vary person to person. A person can show physical signs of not eating enough through increased weakness, increased fatigue, and a high level of weight loss. While working with your loved one, patience is helpful. Remember, your loved one will have good days and challenging days with food intake and that is okay. Read the tips below to aid with increasing your loved one’s food intake.

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NO RESTRICTIONS

When your loved one has a decreased appetite, allow them to choose what foods sound good to them. If they are interested in seconds, offer another portion. If your loved one is on a restricted diet, speak with your physician first before loosening restrictions.

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AMBIANCE

Creating an enjoyable eating experience for your loved one is key. This can include eating together at the table, playing soothing music, and presenting the food in an appealing manner.

MEAL SCHEDULE

Offer 4-6 small portions throughout the day versus 3 meals. This approach provides manageable portions and variability based on individual’s needs.  

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FOOD CHOICE

On days your loved one is not as hungry, offer high calorie options such as nut butters mixed in yogurt or oatmeal, avocado toast or smoothies to boost calories.

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SIMPLE FLAVORS

Prepare foods with few spices or flavors. Choosing bland food such as bread, applesauce, rice, or bananas can be helpful or protein with limited seasoning.

If you notice your loved one is struggling to eat most days (4 out of 7 days), working with a registered dietitian or the team at Silver Lining Home Healthcare can be helpful for a personalized plan for your loved one.

Simply Nutrition LLC is a registered dietician-owned nutrition and wellness company focused on bettering every client’s relationship with food. They focus primarily on remote interactions (through Telehealth) to enable access to anyone. If you’re interested in learning more, visit their website.

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* National Alliance for Caregiving and AARP. (2015). Caregiving in the U.S

Getting safely in and out of bed, or doing transfers of any kind, can be physically taxing. Our resident nurses, Tiffany and Amy, offer these steps in learning the ropes:

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STEP 1: DETERMINE WHAT KIND OF ASSISTANCE YOUR LOVED ONE CAN PROVIDE YOU. TYPICALLY, IT’S ONE OF THE FOLLOWING:

• Independent – no assistance is needed
• Partial assist – light assistance is needed (i.e., to get the feet to the edge of the bed, to get them sitting up)
• Dependent – your loved one can’t get out of bed without someone helping the entire time

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STEP 2: DETERMINE WHAT KIND OF WEIGHT-BEARING CAPABILITY YOUR LOVED ONE HAS.

• Full weight-bearing – able to fully stand on their own feet/own accord
• Partial weight-bearing – able to stand but not able to put all their weight down (common in hip and knee surgeries)
• No weight-bearing – unable to stand or bear weight on their own

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STEP 3: DECIDE ON YOUR METHOD:

For someone who is dependent or non-weight-bearing, you MUST use an assistive device to safely get them out of bed. A hoyer lift is the type of equipment you will need. They come in manual or electric options as well as  floor or ceiling options. If the hoyer device will be temporary, renting a it may be most beneficial. Go through your insurance company first. If the hoyer lift will be permanent, then adapting the floor layout, home modifications and adjusting the type of lift is necessary.

For someone who is a partial assist, there are a variety of options. If you can safely get them to the edge of the bed on your own, there are sit-to-stand lifts, transfer boards and walkers that can safely allow them to pivot to a chair. A transport chair or light wheelchair is a preferred type of seating to transfer to in these cases.

If you can’t safely get your loved one to the edge of the bed on your own, then look at adjustable bedframes/hospital bed options (for two-person beds, there are adjustable beds that offer different settings for both sides) so you can elevate the head of the bed prior to turning your loved ones legs to hang over the side of the bed. This eliminates you lifting them up and straining your back.

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STEP 4: LEARN PROPER BODY MECHANICS!

You can’t care for your loved one if you are hurt. Always bend your knees/hips and keep your back straight. Lift with your legs (not your back), and keep your loved one as close to your body as possible (pretend you’re dancing!). NEVER twist. Here are some additional resources that offer direction on proper body mechanics:

Body Mechanics During Transfers for Caregivers

Prevent Injury! Use Proper Body Mechanics for Lifting and Transferring

ALWAYS TALK TO YOUR PHYSICIAN

If you anticipate your loved one will have issues getting out of bed, ask your physician for a Physical Therapy home health referral. A trained professional can assess your situation, provide recommendations, and discuss appropriate exercises. This should be covered by most major medical insurance policies.

Visit our YouTube channel for talks around aging topics and to watch our Coffee Chats with Tiffany where RN Tiffany Rubin talks about matters you care about.

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* National Alliance for Caregiving and AARP. (2015). Caregiving in the U.S

Getting the right durable medical equipment or DME (which is the official umbrella term for any medical equipment like walkers, wheelchairs, canes, etc.) can be cumbersome and difficult. Why? Because in order for an insurance company to approve DME, they need information from your physician (and sometimes this includes backdated notes/information). If your insurance company approves the DME, then the DME company needs to get you what you need and submit a reimbursement claim to the insurance company. Medicare, through which a lot of individuals over 65 get their DME, has a list of approved DME. They’ll cover 80% of the allowable cost. You cover 20% plus your Part B deductible.

You can typically get equipment in two main ways:

1. Pay for it out of pocket. This makes it easier to pick what you want and you typically can get it faster because the insurance company doesn’t have to be involved..
2. Use your insurance. This usually means it’s free or you have a low co-pay. It may take more time to get it, but not having to pay for it is a plus, especially if it’s something expensive like a hoyer lift.

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RESOURCES

Tomorrow Health is an excellent resource in helping you find the right medical equipment and in navigating your way through the insurance process. They’ll work with your doctor and your insurance to get you the right products at the right prices.

DME Supply USA is an online DME store through which you can view, sort, and purchase DME.

Visit our YouTube channel for talks around aging topics and to watch our Coffee Chats with Tiffany where RN Tiffany Rubin talks about matters you care about.

While safety precautions have always been part of the way we deliver care, we want to make sure our clients know exactly how we’ve augmented our precautions during COVID-19. We’re taking extra steps to make sure we’re keeping our clients, their loved ones, and our vulnerable population safe. Here are some of the key steps we’ve implemented, plus the “Why” behind them.  We’re also providing cautionary steps you can take and resources you can use for getting tested for COVID-19, symptomatic or not symptomatic!

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WHAT CAN YOU DO TO HELP?

To protect your vulnerable loved ones:

• If you live with them, do the minimum CDC recommendations at ALL TIMES, no exceptions.
• If you’re sick, get tested immediately and maintain distancing when possible. It’s inconvenient but it could save a life.
• ALWAYS alert Silver Lining if you’re getting tested for COVID-19 or if you’ve developed symptoms. This will ensure we can protect our team members and prevent transmission to others. We’ll do full-droplet precautions (use of PPE with goggles, mask, gown, and gloves) until COVID-19 is ruled out.

If you’re visiting a vulnerable loved one:

• Never go if you’re sick.
• Always wear a mask the whole time (so as to not infect commonly touched spaces).
• Wash hands prior to entering, before and after eating, after toileting and after exiting

HOW TO GET TESTED:

Testing is FREE by federal mandate. You will not have a copay to use your insurance. For the mail-order option, you can choose to either go through your insurance or pay out of pocket. Different testing options have different results time. The primary reason to get tested if you’re not symptomatic is because you’ll be in an area where maintaining social distancing is not possible.

Know Your COVID-19 Status – Order a mail order kit – Want to go on vacation? See family? Get tested before and/or after!

Access COVID-19 Testing at Home – You can go through your insurance and the testing is free. Or you can pay out of pocket.

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Most clients don’t want to call a home care agency for assistance. After all, we don’t want to need help as we age. And most of us don’t want to pay for it. More often than not, a match between a client and a home care agency starts with a referral from a professional source (like your doctor), a family member (usually a son or daughter), or a close friend or neighbor. People who are close to the client usually take the first step in researching care options.

So when do you know if someone close to you would benefit–and even enjoy–having home care?  You educate yourself on key indicators of help. Our Level of Need Calculator looks at some key factors that contribute to someone needing assistance. Being aware of recurring scenarios is also important. Some scenarios that indicate it’s time to acknowledge the need for help are:

• Frequent falls
• Frequent doctor appoints
• Increase in urinary tract infections
• Forgetfulness
• Trips to the emergency room
• Increase in medications

When these indicators are not acknowledged, health outcomes are usually poor. Ignoring them increases the likelihood of a lifestyle change being forced rather than chosen (i.e., a broken hip from a fall means moving to a a rehab hospital).  If you or your loved one wants to stay home and age in place, it is critical to be alert to these scenarios. Keep in mind that home care doesn’t have to be permanent, invasive, or even from a professional company.

What do I do if I need help or someone I know needs help?

1. Call, or email. Even if we’re not the right fit, we’re happy to answer questions and get you connected with the right resources. We can go as fast or slow as you or your loved one needs to go.
2. Plan. Call an elder law attorney. We have three that we highly recommend. Take a peek here. They can help you protect what you have and plan for the quality of life you want to have. The sooner the better. We recommend this step for any client. For some clients, an elder law attorney will meet with you and you won’t need any services. For others, an elder law attorney can be the difference between staying at home as long as you want to or being forced to leave your primary home and move to a facility.
3. Take a look at our Resource Center for more information like Payment Options, Veterans Benefits, and Who we Are at Silver Lining.

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Home Care can be confusing.

What is it? Why would I need it? Why would I want it? Who pays for it? What is the difference between this and going to a facility?

Here’s the deal. The healthcare system is complex. Every individual is different, which makes generalizations something we just don’t like. Here are some answers to common questions.

‍

WHAT IS IT?

Home care is a broad term that means any medical or non-medical care provided in a primary place of residence. That means you may see home care in a single-family home, at an in-law suite, in an assisted living or at a skilled nursing facility. Home care is generally divided into two main areas: home health and home care. Home health includes medical care like medication management and organization, PEG tube care, trach care, wound care, etc. Home care includes both Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) like dressing, bathing, check-ins, reminders, errands, transportation, cleaning, and cooking. For a peek into the difference between ADL’s (bathing/dressing etc) and IADL’s (cooking/cleaning), take a look at this post.

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WHY DO OUR CLIENTS NEED IT?

Two main overarching reasons: acute care (short-term) and chronic care (long-term). The biggest reasons for short-term home care include a hospitalization, wound care, or surgery. The biggest reason for long-term home care include a change to the primary caregiver (i.e. the passing of a spouse), chronic disease management (like diabetes or dementia) or a decline in ability to do things (like cook, clean or drive).

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WHY WOULD OUR CLIENTS WANT IT?

Home care exists to make our clients’ life easier and provide him with a better quality of life, keeping him independent at home as long as possible. That doesn’t mean it’s any easier to get older, or for him to feel like he needs help. Home care does allow our client to stay home longer. It lets him continue to do things he wants to do (like go shopping, eat the meals you want to eat) and have control over his environment. It may keep him safer longer. We know we’re caring for our clients in the most private of spaces: their primary residence.

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