Category: Silver Lining

We need and want to keep you up to date on all the information we have regarding the Coronavirus, or COVID-19. On March 12th, we had a meeting with the State of Delaware, and we are staying apprised of all updates through the Delaware Home Care and Hospice Association, the trade associations, the Delaware Office of Health Care Quality, and the Delaware Office of Health and Human Services.

The Coronavirus (or COVID-19) can have far-reaching impacts, health included. We know that uncertainty causes stress, and that you may have concerns about the virus. Our goal with this blog post is to ensure you are up to date on all the steps we’re taking to keep our team and community safe.

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We’re going to cover 5 things:

1. Preparation in the case of the need for self-monitoring or an active virus situation
2. What to do if you have symptoms
3. What Silver Lining Home Healthcare is doing for our staff and team, how we’re limiting exposure to you
4. How to ask questions
5. Planning for the what is next

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PREPARATION IN CASE OF THE NEED FOR SELF-MONITORING OR IF YOU GET THE VIRUS

We recommend preparing just like you already do for an emergency: Purchase and store two weeks worth of medications, food, water and basic supplies. We have included a list of items to make an EMERGENCY PREPAREDNESS KIT for your convenience. Ideally, you won’t need to use all your supplies but it is better to have it and not need it, than need it and not have it.

We are working on having a solution for those individuals that can’t/don’t want to go out to get the basics (like toiletries, paper towels and food) and will communicate that out to you in the coming weeks, should the need for it arise.

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WHAT TO DO IF YOU HAVE SYMPTOMS:

Symptoms are very similar to the seasonal flu and include:

• Fever
• Cough
• Shortness of breath

If you have mild symptoms:

1. Call your Primary Care Doctor and make them aware; they’ll direct next steps. Be aware that in Delaware, your doctor is NOT allowed to have you come into the office if you have symptoms of COVID-19 and will ask you to remain in your car so as to not contaminate or expose others.
2. Limit your exposure to others. Do not go anywhere with large crowds and in fact, don’t go out of the home unless you absolutely need to.
3. Wash your hands frequently.
4. Use treatment as prescribed. Do not panic
5. Tell Silver Lining. We need to ensure our staff are ready!

If you have severe symptoms (difficulty breathing, no ability to catch your breath):

1. Call 911 or go to your nearest emergency room

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OUR FOCUS ON WELL-BEING FOR OUR TEAM AND FOR YOU:

Here are a few ways that we’re limiting exposure.

• We are educating our team with up-to-date and timely information multiple times per week and holding Q&A sessions so that constant communication and education is a reality.
• We have set up weekly ongoing scheduled Q&A sessions via Google Hangouts that you can join (more information below).
• We are preparing for a variety of contingencies. We want this virus to simply go away. Since a chance of that happening is minimal, we are being sure to proactively consider the best ways to continue delivering services.

The guidelines currently show that treatment for COVID-19 is still administered at home and is mostly symptom management, unless signs and symptoms worsen. And like with any sickness, avoiding large crowds (including hospitals, where more sick people are) is advisable. We can and will still care for you at home if you are diagnosed with COVID-19. We will only stop caring for clients if the State of Delaware mandates it or our staff are unable to physically be present to provide care due to unavailability. Why might unavailability become an issue when we have a stellar record of no missed visits?

Anyone that exhibits any symptoms has to be tested quickly in order to rule out COVID. In the instance that tests are unavailable to confirm COVID-19, precautions have to exist as if COVID-19 is there, to ensure minimal risk of exposure to others. If we don’t have that practice in place, then we could put you more at risk. We also acknowledge that staff availability may be limited by situations out of our control, such as school and daycare closures, which result in our staff being unable to go to work since they have to care for their family. Additionally, the personal protective equipment that staff need in order to care for our clients in the case of you having the virus is in limited supply, so should the COVID-19 spread in our community, we’ll have to ensure the protective equipment is used for the most urgent of cases.

Again, please know that we’re having this discussion early to set the expectation of what may happen; at this point, NONE of these hypothetical situations have occured. We’ll continue to plan for the worst and hope for the best.

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HOW TO ASK QUESTIONS:

• Call us!  302.359.5661
• Email [email protected]
• Visit our website: silverlininghealthcare.com

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PLANNING FOR WHAT IS NEXT:

In the instance that services need to be reduced to protect you, consider what hours can be reduced temporarily. We will keep you up to date if and when the time comes to have this discussion. Because we are constantly aware of the most current recommendations, you do not need to proactively cancel services. If you are an essential services client, we will be actively working on a plan to ensure services go uninterrupted. We’ll continue to send out information as it becomes available to us; you can head to our website and click the “View Information Regarding COVID-19” to for the most up to date information.

We are in uncharted waters; I can tell you that Allison, Amy, Dorrina, and I are working around the clock (literally) to handle and channel all the information that is coming in and deal with any specific situation that arises. You will ALWAYS get a response to a question, no matter how big or how small. We are here to Make Lives Better through it all.

For More Information:

COVID-19: What Does This Mean for You as a Client?

World Health Organization: Q&A on coronaviruses (COVID-19)

Disclaimer: this blog post is focused on achieving wellness and is not meant to replace any suggestions from your physician or healthcare team.

I struggled with weight during and after both of my pregnancies. It wasn’t until I worked with a registered dietician in Delaware and used a bio-impedance scale that I was able to focus on my overall wellness and take action steps based on my body’s data. After my first pregnancy, I had to go to the dietician’s office to do this. After my second pregnancy, I was able to get my own scale (they’re so affordable now!) and do everything from my own home.

The right scale gives you real data, empowers you to make the right changes for YOUR body, and gives you actionable information for you and your healthcare team to focus on. Does this sound like your experience with a scale? Probably not. Here’s the issue with normal scales: They give you one single number–a weight. You don’t know if it’s good or bad. You don’t know what your body composition looks like, what part of it is muscle mass or what part is water weight.  What does this mean? It could mean that changes you make may not target the true route you need to take to be healthy! This is why I recommend a scale that has a bio-impedance ability to provide you with more data. It’s non-invasive and sends a small current through your body (no, you don’t feel anything) to get measurements.

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WHAT IS BIOIMPEDANCE?

Bioelectrical impedance assessment is a way to measure body fat, muscle mass and a variety of other aspects of body composition.

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WHY USE THIS KIND OF SCALE?

• It gives you real data like muscle mass, visceral fat, BMI, and water percentage, This means it’s specific information directly related to YOUR body
• It gives you actionable information to take to your doctor or Registered Dietician.
• It gives you empowerment on how to change your lifestyle.
• It’s convenient! You can send your information via text or email. Create an accountability group with your sister, share with your doctor or just keep it for you

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A FEW QUICK TIPS:

• ALWAYS use the scale barefoot, or it won’t be able to do anything but take a general weight (i.e., no additional data).
• You WILL need a smart phone if you want to share your information directly via text or email.
• It is NOT difficult. I had mine out of the box and a profile set up in under 5 minutes.
• You CAN use the same scale for multiple people.

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WHAT DO I DO IF I GET A SCALE?

Don’t assume you know what to do with the information. The internet is a beautiful and scary thing, depending how you use it. While degrees don’t make people smart, they DO provide a level of expertise you’re not going to get by searching by yourself on the internet. Request a referral from your doctor for a registered dietician or if you’re in Delaware, contact my gal, Wendy Gibson at Contemporary Nutrition. Don’t be afraid to interview your dietician to be sure they understand what you’re looking for. For instance, it’s important to me that I get real feedback from my dietician on how to adjust my lifestyle for health AND sustainability. I need realistic goals, because I’m going to eat pizza. And who wants to go a lifetime without eating pizza?!

I wish you the best as you find a new “weigh” to wellness!

Kid President‍

‍“Be somebody who makes everybody feel like somebody.”

I keep this framed title and quote on my desk. It’s the first thing I see when I start to work (besides my Anne of Green Gables mouse pad). It’s integral to my personal values, and it’s integral to Silver Lining.  When you care about people, you care about all people. At Silver Lining Home Healthcare, the care we deliver to our clients begins and ends every day with how we care for our own. Internally, we make it a priority to create and maintain a supportive culture in which our caregivers can thrive. When they’re at their best, our service to our clients can be at its best.

You have a lot of options. Why work at Silver Lining Home Healthcare? I’ll give you 5 reasons.

1. Little Things Make a Big Difference
   You CAN do the little things that make a big difference because we give you the resources to make it happen. From giving stipends so you can pick up a cupcake for your favorite client (who is not diabetic, of course) to empowering you to make a favorite meal and giving you the tools to do it, we want you to help our clients Live Life to the Fullest while we do the same.
2. 1 on 1 Care
   It’s 1 on 1 care. Not 10 on 1. Not 5 on 1. 1 on 1. A couple might make it 2 to 1. Our caregivers can focus on their clients and provide highly customized care for them to meet their personal preferences.
3. Autonomy
   It’s not for everyone. In fact, if you require complete structure, this may not be the best environment for you. If you always find ways to improve your work environment, enjoy the ability to affect change, and are proactive, this is a place where you will thrive. Take a look at the 10 Things that require zero talent (a list we talk about regularly and hold our team accountable to).
4. License Oversight
   In order to renew a CNA license, your ‘worked’ hours have to be supervised by an RN. As a skilled home health agency, we have the certification to supervise, so the hours you work support your license renewal. This isn’t the case if you work at a Program Approved Service Agency (PASA), because you are not overseen by an RN. With a career at Silver Lining Home Healthcare, you only need one job to support your professional CNA license.
5. Benefits
   We focus on ways you can make a career with us, so we offer a benefits package to help you create one.

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JOIN OUR TEAM

The care we give to our team ultimately touches the clients for whom we care, that’s why we’re passionate about supporting and nurturing our family of caregivers. Are you or someone you know a kind, caring individual who wants to make a difference in the life of a senior? Let’s connect! Go online today to start your journey with us.

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Racism, sexism, inappropriate sexual comments/advances and bias are complex topics that can create deeply emotional conversations. Our focus in this post is twofold: (1) to provide a son or daughter some tips to use when talking to parents or loved ones about these issues, specifically as it relates to receiving care and (2) to share Silver Lining Home Healthcare’s handling and stance on discriminatory behavior.  As health care professionals, we run into situations all the time where a daughter or son is embarrassed about a parent’s racist tendencies, inappropriate sexual comments towards caregivers, and numerous other behaviors that may invoke feelings of shame. These topics are hard to handle. Know that you are not alone.

*This article is not meant to be inclusive of all good tips. We encourage you to research more on the topic and be prepared to engage using the specifics from your situation, including your own experiences and that of your parents/loved ones.

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TALKING TIPS

As a healthcare worker, I’ve see racism, sexism and cultural bias first hand. I know we all have inherent bias built into our psyche because of the way our society has developed. The idea that not everyone is equal exists in the world, even if we don’t want to talk about it. So let’s dive into some practical ways to approach these important–albeit difficult–conversations with our loved ones. Don’t get frustrated because your parents’ long-held beliefs don’t change overnight. Like many difficult conversations, these will probably be ongoing. Planting seeds and watering them (excuse the cliche) may be the best approach to nurture a shift in beliefs and behavior.

Ask & Listen. Ask genuine, open-ended questions about their life in regards to stereotypes and biases that exist, and how your parents treated these topics. A few suggestions are:

• “You’ve mentioned several times that you don’t want [insert what they’re objecting to]. Tell me more about why.”
• “What experiences have led you to believe [insert belief]?”
• “When you make an inappropriate comment like that, do you feel it is warranted? How would you feel if someone said that to me?”

Be aware of your own prejudices: How do you react when you hear terms like “Jewish”, “Muslim”, “African-American”, “Person of Color”?  What do you think of when you think of someone who is uneducated, poor, or of the LGBT community? How do you feel when someone different than you expresses a different religious opinion? Do you feel defensive? Open-minded? Understanding? Without being aware of your own prejudices, it may be difficult to address them with your loved ones constructively.

Educate. In order to educate someone else, educate yourself. Perhaps you know the key terms when it comes to the topic of discrimination, but a refresher never hurts. Click the terms below for  their definition:

PREJUDICE  | BIAS | STEREOTYPE | RACISM

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HANDLING OBJECTIONS

Prepare for objections. Prepare for some defensiveness. Keep in mind that you may be addressing lifelong beliefs that are considered by your loved one to be truths. Below are some common objections you may hear. Rehearse the best responses so you feel confident in engaging your loved one in a conversation.

Objection: “They’re not trustworthy.”

Best response: “Tell me more about what you don’t trust. Is there something in the house you’re concerned about protecting from strangers? Is there something that has made you feel unsafe?”

It may help to provide some education around the process of hiring for healthcare workers. All healthcare workers are hired using the same criteria. While this differs by state, typical requirements (and the requirements in Delaware) include a background check, fingerprinting, having an adult abuse check and a child abuse check, and completing a motor vehicle record check, as well as a drug screen.

Objection: “They’re uneducated.”

Best response: “What is your goal with education? What is the level of education that you would like to see?”

Education is often standardized for license levels. For a Certified Nursing Assistant, a program consisting of 160 hours plus a final exam is required. For LPN’s and RN’s, the completion of a licensed/accredited nursing school (with passing grades) is required prior to taking the NCLEX.

Objection: “They’re not like me.”

Best response: “Nobody is! Skin color, sexual preferences or religious preferences doesn’t change that. We’re all completely unique. Your uniqueness is why I love you!”

Objection: And sometimes, there may not be a specific reason, it’s just “No way!”

Best response: “What is the biggest reason you don’t want people taking care of you?”

Fear is a big motivator. Care may not be wanted at all, and reasons such as sexism and racism are excuses. The requirement of needing care often brings along feelings of lost independence. At Silver Lining Home Healthcare, we actually focus on care that keeps people independent, not measures that take away independence. But it’s crucial to understand that physical and mental changes, the necessity of having someone assist with IADLs and ADLs, and the emotional state of your parents play a big role in not wanting or accepting care. See more on getting your parents to accept help here.

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HAVE A CONVERSATION WITH YOUR HEALTHCARE COMPANY

Talk to your healthcare company about your situation. Sometimes behaviors and comments are part of a disease process; caregivers can help you understand that. You will also gain an understanding about the boundaries your healthcare company has in place to handle discrimination as it relates to providing care. Ultimately, boundaries are created around what is safe, what is required for a healthcare worker to do his/her job effectively, and what is appropriate based on the situation and disease process.

Safety. If the safety of a healthcare worker is ever in question, discriminatory behavior or comments is never appropriate. Physical aggression in a competent individual (someone who can make decisions for him/herself) will never be tolerated.

Hostile workplace. Boundaries are put in place to ensure that all healthcare workers can do his/her job. Conduct and speech typically considered “hostile” is intimidating, offensive, abusive, mocking, and may reach the level of harassment. Typically, we consider it hostile if any of the above occur AND it is intentional, severe, recurring and/or pervasive. Thus, it’s important to discuss other factors (such as disease) and how they relate to “intentional”. So who decides this? A particular healthcare worker may have a different perception of the situation. Typically, the behavior is viewed how a “reasonable person” would characterize it.  It must be considered “crossing the line” not only on a subjective basis by the person making the complaint, but also on an objective basis by “reasonable people.”

Disease-specific considerations.  Different diagnoses result in different mental and physical manifestations that affect behavior. The easiest one to talk about is dementia. Dementia may make a person say or do things he/she wouldn’t do otherwise. Silver Lining Home Healthcare specializes in dealing with difficult behaviors, and our caregivers and team understand how to appropriately handle difficult situations. If they are in a difficult position or feel uncomfortable, we immediately address it.

• The difference between competence and incompetence in this context is important. Read more about that here.
• Understand that even if a parent has severe dementia as the reason for inappropriate behavior, it may still affect a healthcare worker’s ability to provide effective care, even though it doesn’t qualify as a hostile work environment.
• Effective Communication – Talk about the difference between agreement and respect. I don’t have to agree with you to respect you as a human being. And just because you have the right to say something doesn’t mean it’s the right thing to say. As the son/daughter, attorney-in-fact, or decision maker, it is crucial you are willing to have these conversations with your loved one and abide by the boundaries yourself.

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WHAT IF…

So here’s a question you may have: “What if my dad openly acknowledges his homophobic or racist beliefs and claims his right to express them? Will you still take care of him?”

Answer: We love being able to have conversations around why our care is excellent and we’ll set appropriate boundaries. At no point will we tolerate inappropriate behavior or a hostile work environment for our employees. We won’t discriminate or change our care to accommodate your dad’s discriminatory preferences, so if he is unable to accept the amazing people we send in, then it will be a choice you and he need to discuss. You may be amazed at how acknowledging your dad’s feelings allows him the space to accept help from us and starts changing his perception. We’ve had many times when a favorite caregiver turned out to be someone the client would never have picked themselves.

Know that discrimination in the workplace is illegal and demoralizing. As an employer, we have a high purpose of caring for our people. We also acknowledge that we’re not going to change everyone’s mind. Whether it’s because of a deeply held conviction or because of a disease process, there may not be enough educational conversations in the world to influence a complete change in beliefs. Often, the conversations will be about setting boundaries and defining appropriate behavior. We don’t need everyone to change their beliefs in order to receive care; we do expect all clients and families to treat people with dignity and respect. Healthcare workers care for anyone and everyone regardless of skin type, sexual preferences, religious orientation, background etc. A healthcare company is responsible for giving you a qualified and competent person that can provide the care required. If the issue of requesting specific caregivers based on race or religion is a requirement for you, then Silver Lining Home Healthcare will not be the best company for your needs. If you want the best, customized care by expert Certified Nursing Assistants, Licensed Practical Nurses and Registered Nurses, we’re your people.

Additional Reading:

How Do We Talk To Our Elderly Parents About Race?
Talking About Race and Racism

Pelvic floor health sounds so unsexy, but it can be life-changing, physically and sexually, for both women and men.

Do you get up to pee (pardon us, urinate) several times a night? Do you leak when you cough or hit a golf ball? Do you leak when you’re simply laughing with friends? Could being intimate be more enjoyable? Allow us to introduce you to the wonderful muscles of the pelvic floor. Whether you’re 25 and had a few kids or 75 and just want to stop getting out of bed several times at night, read on.

Do you get up to pee (pardon us, urinate) several times a night? Do you leak when you cough or hit a golf ball? Do you leak when you’re simply laughing with friends? Could being intimate be more enjoyable? Allow us to introduce you to the wonderful muscles of the pelvic floor. Pelvic floor health sounds so unsexy, but it can be life-changing, physically and sexually, for both women and men.Whether you’re 25 and had a few kids or 75 and just want to stop getting out of bed several times at night, read on.

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WHAT IS PELVIC FLOOR HEALTH?

For an expert explanation on pelvic floor health, we turn to Occupational Therapist and pelvic floor rehab specialist, Kourtney Randsdorp, MOT, OTR/L.

Pelvic health refers to the functioning and management of the bladder, bowel, and reproductive system. When one of these systems is out of whack, a person is considered to have “pelvic floor dysfunction”. Pelvic floor dysfunction may present as urinary leakage, chronic constipation, or pain during intercourse, among many other diagnoses correlated with bladder, bowel and reproductive anatomy. Often times, the disorders are due to the muscles and connective tissue in the pelvic cavity, called “pelvic floor muscles”, not working correctly.

The good news is that, just like any muscle of the body, there are steps a person can take to better strengthen, coordinate and heal the muscles of the pelvic floor. Pelvic floor rehabilitation can provide a restorative approach to improve functioning, in addition to behavioral modification strategies such as positional changes during toileting and ensuring proper water and fiber intake to improve ease with voiding (peeing).

Many people know about Kegel exercises as a way to strengthen pelvic floor muscles, but if not done properly Kegels won’t provide their maximum benefit. Let us give you an example: Make a muscle in your arm right now. That’s right–flex it! Hold it there. Your muscle is tightened. If you just exercise it towards your body but keep it flexed, your muscle will only strengthen so much. In order to fully strengthen your bicep muscle, you have to relax it by fully extending your arm down.(extend your own all the way), then perform the exercise again. And so it is with Kegels. The relaxation of the muscle is an integral part of the exercise. And let us tell you, we’ve never had someone who can just come in and relax their pelvic floor muscles! It takes work and training. That’s where a pelvic floor specialist can help. True pelvic floor specialists are trained in the use of multi-modality systems (it’s a big term that just means all aspects) that allow them to evaluate how the muscles are behaving. With this biofeedback, training can begin.

So does it actually work? Here’s a real success story that Kourtney shared with us:

A beautiful lady, 68 years old, has been experiencing several falls over the last few months. She gets up 4-6 times at night to urinate. She participates in 4 weeks of pelvic floor training that includes altering her food and beverage choices to reduce bladder irritation and learning how to coordinate her pelvic floor muscles. Muscle coordination is achieved by adjusting her movements using biofeedback, a computer program that allows her to “see” these movements much like a person can “see” how they are completing bicep curls when looking in a mirror. She learns what the correct movements should feel like and is able to reproduce them without biofeedback for her home exercise program. After 4 weeks of training her symptoms improve dramatically–she doesn’t get up at all anymore in the middle of the night to urinate and has had no more falls!

Talk about an example that shows you how pelvic floor training can change your quality of life. Women, men, young and old can all benefit. Here are a few reasons to seek out a pelvic floor expert:

Constipation | Frequent Urination | Frequent Leaking | Stress Incontinence | Unpleasurable Intercourse | Urinary incontinence | Pelvic pain | Prolapse of Pelvic Organs | Interstitial Cystitis | Vulvodynia | Prostatitis | Chronic Pelvic Pain Syndrome | Postpartum Changes

Pelvic health may not be a popular dinner conversation, but it is a concept that can have a tremendous effect on our quality of life. If you are experiencing symptoms of pelvic floor dysfunction, don’t suffer in silence! Talk to your doctor about pelvic floor rehabilitation or search for a specialist to start work towards your better quality of life.

Functional Freedom LLC was founded by Justin and Kourtney Randsdorp in 2018. Both Occupational Therapists, their vision for Functional Freedom was inspired by the eminent need they see for Occupational Therapy to return to its roots: function in a person’s natural environment. They believe that a person can benefit from consistency with their therapist, a concept lacking with larger rehabilitation companies. Functional Freedom seeks to assist people in regaining function which can ultimately set them free and ensure the greatest quality of life!

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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