Dehydration in the Elderly: Know the Signs

It's June, almost summer, and a great time to remember how significant of a risk dehydration is for the dear elderly that we care for. A call from a caregiver reporting a very healthy 84 year old's trip to the hospital today reminds us how quickly things can change. Reviewing the basics will increase awareness and support the power of prevention.

According to Jeannete Y. Wick, RPh, who wrote the article" Prevention and Management of Dehydration," the elderly are at greatest risk for dehydration, and those 85-99 years old are six times more likey to be hospitalized for dehydration than people aged 65-69.  Dehydration is fatal in 18% of these cases, not having been addressed early enough. Most importantly, this problem can be prevented. Knowing the signs and having a plan can help prevent this very common problem.

Signs:

• Confusion - Frequently an early sign. Pay attention to even mild cognitive changes.
• Poor skin turgor-  May be difficult to assess, but skind that feels warm and moist may be a good sign.
• Dry mouth
• Changes in vital signs - Usually a lower blood pressure and an increase in pulse.
• Concentrated urine
• Dizziness or fainting

Risk Factors:

• Increased age - The elderly have lower body water content compared to younger people.
• Cognitive impairment - Difficulty remembering when or how much fluid they have had to drink
• Medications - Diuretics, laxatives, blood pressure medications, some demetia medications
• Dysphasia - Difficulty in swallowing
• Decreased ability to sense thirst
• Increase in activities
• Depression
• Change in schedule
• Diarrhea

Prevention strategies for caregivers:

• Make monitoring fluid intake a priority
• Know the signs and symptoms
• Offer water every hour; even when the elder does not say they are thirsty
• Add lemons, strawberries, orange slices, or cucumbers to make water more appealing
• Offer food like, jello, yogurt, melons
• Make water available at all times especially if going on an outing, walk, or running errands
• Pay attention to temperature changes

Water is a basic nutrient of the body and is critical to human life, supporting digestion, the transport and use of nutrients, and the elimination of toxins and waste from the body (Kleiner, 1999). Let us remember to pay attention, and help prevent this big problem in the lives of the elderly.

Celebrating Nurses

 

National Nurses Week started yesterday, an annual celebration that is planned around the birthday of Florence Nightingale (the founder of modern nursing), on May 12th.

A unique strength of Elder Care Guides' geriatric care management services is our interdisciplinary approach to our work. In addition to nursing, our clinical staff represents the fields of social work, marriage and family therapy, public health, geriatric counseling, and nutritional science. While each of our clients develops a relationship of trust with a professional geriatric care manager who coordinates and monitors their care over time, they also benefit from the expertise of our full team. Our approach is a highly collaborative one, with weekly team meetings, close clinical supervision, and ongoing support and consultation. Our 24-hour on-call system is managed internally, so that clients experiencing a crisis receive a response from a professional who is knowledgeable about their specific needs.

Nursing is a critical component of this collaborative approach, and our nurse care manager Susan Bill, RN, brings invaluable expertise and perspective to the Elder Care Guides team. She earned her nursing degree from the University of South Carolina, and is a licensed Registered Nurse in California. A skilled and knowledgeable advocate for her clients, Susan builds relationships with a warm and empathetic approach. National Nurses Week is a good opportunity for us to publicly recognize her talents and skills, which Susan's clients and her families experience for themselves every day.

Long Term Care Planning: Specialty Community-Based Long Term Care

We were invited to write a series of brief articles for the monthly newsletter of our friends at MDK Insurance Services, describing the continuum of long term care, and how to navigate oneself through it. You can sign up for the newsletter on their website, and each month we provide a copy of the article here as well. Please share the information with someone you know who is thinking ahead about how to plan for (and pay for) their own or a loved one's long term care. 

Volume VII: Specialty community-based long term care

Last month’s issue provided an overview of the basic types of long term care facilities. Here we review a few models of specialty care that are available in the community.

There are several types of specialty Skilled Nursing Facilities (SNFs) in California. A Distinct Part/SNF (DP/SNF) is a hospital-based unit, rather than a freestanding facility. Intermediate Care Facilities (ICFs) provide inpatient care to those who need nursing and supportive services, but who don’t require continuous skilled nursing care.

A Continuing Care Retirement Community (CCRC) is a configuration in which Independent Living, Assisted Living, and Skilled Nursing Facility services are provided on one campus. A resident contracts for care regardless of changing needs, usually for their lifetime. Most CCRCs have a large entrance fee, ranging anywhere from $100,000 to $1 million. CCRCs are regulated by California’s Department of Social Services Continuing Care Contracts Branch.

Some residential care facilities offer specialized services for people with dementia. Dementia Care can be provided within a freestanding facility, or as a separate unit within an Assisted Living facility. Staff are trained to work effectively with people with Alzheimer’s and other types of dementia, and activity programs are tailored to the special needs of the residents. Buildings have secured perimeters to prevent unsafe wandering.

Hospice Care provides comfort and support to patients with terminal illness that is not responding to cure-oriented treatment. Hospice may be provided within the home or in a facility setting, with the goal of maximizing quality of life through effective symptom and pain management. Services provided by an interdisciplinary team address the emotional, spiritual, and social impact of the illness upon the patient and their family.

The Cost of Probate

First, let me say that I am not an attorney or a financial planner, but I am curious. I was given a handout at an estate planning group by Kim Ward, a licensed Realtor with Horizon Real Estate in La Mesa, California. This handout provides a brief rundown on the costs of probate, and the purpose of this post is to state briefly some of its main points.

My purpose here is to increase your awareness of the costs of "going through probate."

1. Probate costs are very high. Maximum statutory fees that attorneys can charge for probate, per the California Probate code section 10810, are 4% for the first $100,000, 3% for the next $100,000, 2% of the next $800,000, 1% of the next $9,000,000 and 1/2% of the next $15,000,00. A separate fee is established by the courts for anything over $25,000,000.

2. If executors are part of the probate, both the attorney and executor will receive fees, thereby doubling the costs.

3. The estate's value is determined by the inventory and debts are not included. An example: If a house is appraised at $1,000,000 and it has a mortgage of $800,000 the assets for determining the probate attorney's fee is considered on the $1,000,000.

4. Estates are appraised by probate referees who are appointed by the State Controller. These probate referees also receive a fee based on 0.1% of the assets appraised.

5. It usually takes longer to probate an estate than to administer a trust.

If nothing else, I hope these statements will lead you to contact an attorney to review probate costs and consider the less costly alternative, establishing a TRUST.

November is National Home Care & Hospice Month

Elder Care Guides joins our colleagues in the California Association of Health Services at Home (CAHSAH) in celebrating National Home Care and Hospice Month during the month of November.

"During National Home Care and Hospice month, we take time to honor the thousands of individuals in home care and hospice who, on a daily basis, provide remarkable care in people's homes. Thank you for all that you do."
-- CAHSAH President Joe Hafkenschiel

Every day, Elder Care Guides' geriatric care managers and caregivers are actively engaged in our mission to better the lives of elders living with physical and cognitive impairments, providing services that center on the goals of the individual, and foster within them a lifelong sense of purpose. We see firsthand the impact of our team approach, of finding "the right match" and seeing a client transformed -- whether it is through healthier eating, more physical activity, opportunities to connect socially, or just a hand to hold in the last hours of life.

We're proud of the time, care, and attention to the details that matter most to our clients that our Human Resources department expends in selecting skilled and qualified professional in-home caregiver employees. Day in and day out, they work hard to enhance the quality of our clients' lives, and they have our full support, 24-hours a day, 7 days a week. We take this commitment to a highly professional and well-supported staff very seriously, as they are key to fulfilling our mission.

As such, we strongly support AB-899, the Yamada Home Care Services Act of 2011. This legislation will require California's Department of Social Services to license and regulate home care agencies, holding the agencies responsible for ensuring that their professional caregiver employees are qualified and reputable. For information about this legislation and how to support it, please visit: California's Legislative Information page at: http://www.leginfo.ca.gov/bilinfo.html

Long Term Care Planning: Community-Based Care Settings

We were invited to write a series of brief articles for the monthly newsletter of our friends at MDK Insurance Services, describing the continuum of long term care, and how to navigate oneself through it. You can sign up for the newsletter on their website, and each month we provide a copy of the article here as well. Please share the information with someone you know who is thinking ahead about how to plan for (and pay for) their own or a loved one's long term care.

Volume VI: Community-based care settings

Previous installments of this series have described the resources available to those planning for care at home, and the goal of this issue is to describe the basic options for community-based long term care. Those who choose to move out of a private home and into a "senior living" setting do so for a variety of reasons. For some, it is a financial decision, while for others it is a lifestyle choice - freedom from the day-to-day responsibilities of managing a household, or the opportunity to interact socially with more people on a daily basis.

Independent Living communities are also sometimes referred to as "retirement communities." Some amenities such as communal dining, light housekeeping, transportation services, and planned activities may be available, but no personal care is provided. In these communities, residents must usually be able to ambulate independently.

Residential Care refers to a range of different housing providers that are licensed (in California by the Department of Social Services' Community Care Licensing division) to provide assistance with activities of daily living such as bathing, dressing, and medication management. A Board and Care home is a small residence (usually a single family home) with between six and twelve residents and a small staff of attendants. An Assisted Living facility is a larger community that usually offers several different levels of care and more supportive services.

Skilled Nursing Facilities are sometimes referred to as "nursing homes." They are licensed (in California by the Department of Public Health) to provide skilled nursing and supportive services for those who require assistance with most - or all - of the activities of daily living.

Next month we'll explore some additional specialty community-based residential services that are available, and then we will move on to a discussion of fees and funding sources for each level of care.

Are Your Employees Orange?

We have spoken earlier about the great research done by Chester Elton and Adrian Gostick in The Carrot Principle, a book about employee engagement and the effects of recognition in the workplace. The authors have done it again, this time in The Orange Revolution, which discusses teamwork. The book encompasses what makes a great team, and how an "orange" team, or one with a high sense of unity in a common goal, achieves breakthrough, positive results.

Teams exist in almost every organization, in every arena. The elder care industry is no exception, especially when you consider geriatric care management, and the team it takes to care for an elder in their home. Elton and Gostick found that once an initial level of basic competence is met, there are 5 key factors every team needs in order to achieve "orange" status and be effective:

• Goal Setting (knowing where the team is going)
• Communication (wise use of your voice and ears)
• Trust (believing in others and being trustworthy)
• Accountability (doing what you say you will do)
• Recognition (appreciating others' strengths and contributions)

A geriatric care manager and an organization that employs caregivers to the elderly has a key responsibility to ensure their employees are humming the same tune when it comes to those five factors. Supervisors who set clear goals, encourage and provide detailed communication, build trust, hold team members accountable, and recognize great work will undoubtedly have an engaged team environment built around the client.

Since October brings us lots of orange in pumpkins, Halloween, and harvest colors, I encourage you to survey your employees and client care teams to see if they are engaged and orange, too.