Index of Activities of Daily Living

Today’s post is part of our series, The Encompass Way. Here, we’ll go over many of the steps involved in setting up a comprehensive care plan, which helps us to provide seniors and their families a complete understanding of the available care options and helps families maneuver through the challenges of the system.

home care omahaPhysicians Choice Private Duty professionals conduct a comprehensive in-home assessment for each of our clients. Each assessment looks at a client’s current psychological, environmental, functionality and medical status, helping us develop a written plan of care and coordinate the health care providers and family members who are responsible for the execution of the plan of care.

Part of determining a client’s functionality status is to index his or her Activities of Daily Living (ADL).

Below is an adaption of Dr. Katz’s ADL index, via The Hartford Institute for Geriatric Nursing, College of Nursing and New York University.

Index of Activities of Daily Living

ACTIVITY

Bowel

    • 0 = incontinent

 

    • 1 = occasional accident (once a week)

 

    • 2 = continent

 

Bladder

    • 0 = incontinent

 

    • 1 = occasional accident (max. once per 24 hours)

 

    • 2 = continent (for over 7 days)

 

Grooming

    • 0 = needs help with personal care

 

    • 1 = independent face/hair/teeth/shaving (implements provided)

 

Toilet Use

    • 0 = dependent

 

    • 1 = needs some help, but can do something alone

 

    • 2 = independent (on and off, dressing, wiping)

 

Feeding

    • 0 = unable

 

    • 1 = needs help cutting, spreading butter, etc.

 

    • 2 = independent (food provided within reach)

 

Transfer

    • 0 = unable (no sitting balance)

 

    • 1 = major help (one or two people, physical), can sit

 

    • 2 = minor help (verbal or physical)

 

    • 3 = independent

 

Mobility

    • 0 = immobile

 

    • 1 = wheelchair independent, including corners, etc.

 

    • 2 = walks with help of one person (verbal or physical)

 

    • 3 = independent (but may use any aid, e.g. stick)

 

Dressing

    • 0 = dependent

 

    • 1 = needs help, but can do about half unaided

 

    • 2 = independent (including buttons, zips, laces, etc.)

 

Stairs

    • 0 = unable

 

    • 1 = needs help (verbal, physical, carrying aid)

 

    • 2 = independent up and down

 

Bathing

    • 0 = dependent

 

    • 1 = independent (or in shower)

 

TOTAL SCORE = ____________ 6 = High (patient independent) 0 = Low (patient very dependent)

Currently serving Omaha and surrounding areas, all Encompass services are directed by registered nurses or social workers with no long-term contracts. Contact us today for help with your senior care needs.

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Elderly Nebraskans target of ‘Jamaican lottery scam’

elderly scams nebraskaIt’s been all over the news recently, and federal officials are confirming that scammers based out of Jamaica are targeting seniors in the U.S., stealing upwards of hundreds of millions of dollars a year. To put it in perspective, complaints about the scam to the Federal Trade Commission spiked from 1,867 in 2007 to 29,220 in 2012, with federal officials saying far more cases are likely never known about, reported CBS News.

The scam works like this:

    • Scammers obtain lists of elderly Americans’ names and numbers.

 

    • Scammers call seniors on the list telling them they’ve won money from an American sweepstakes company.

 

    • Scammers then tell seniors that, in order to get the prize, a fee is required (for processing, taxes, etc.).

 

According to CBS News, victims are apparently falling for the ruse because scammers know exactly what to say and are extremely aggressive.

“They will call 50 times a day, 300 times a week, until you give in,” AARP’s Doug Shadel told CBS. “And the thing that’s most worrisome to me, is these are the most vulnerable people we have. They’re 75- to 80-year-old seniors who are scared to death by these guys.”

Elderly Nebraskans are among those at risk, as Nebraska Attorney General Jon Bruning issued a warning about lottery scams targeting seniors earlier this week. The Lincoln Journal Star reported that Bruning’s Consumer Protection Division received more than 450 calls and complaints about fake lottery letters targeting Nebraskans in the first quarter of 2013.

The scam, which unfolds just like the one outlined above, asks for fees or taxes to be wired or sent as pre-paid charge cards in order for the victim to claim any prize money.

Unfortunately, once the money is sent, it’s nearly impossible to recover, Bruning told the Journal Star.

Related

Protecting elderly from scammers

Study finds brain damage makes elderly susceptible to scams

Physicians Choice Private Duty  currently serving Omaha, Eastern Nebraska and Western Iowa ” provides seniors and their families a complete understanding of the available care options and helps families maneuver through the challenges of the system. All Encompass services are directed by registered nurses or social workers with no long-term contracts. Contact us today for help with your senior care needs.

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The Mini Nutritional Assessment

Today’s post is part of our new series, The Encompass Way. Here, we’ll go over many of the steps involved in setting up a comprehensive care plan, which helps us to provide seniors and their families a complete understanding of the available care options and helps families maneuver through the challenges of the system.

home care omahaFor every client, Physicians Choice Private Duty professionals conducts a comprehensive in-home assessment, complete with a psychological, environmental, functional and medical assessment. This helps us develop a written plan of care and coordinate the health care providers and family members who are responsible for the execution of the plan of care. Once created the plan is then communicated to family members and other members of the care team.

Part of the medical assessment is to determine the nutritional health of the client. Below is an excerpt of how we complete this process — the Mini Nutritional Assessment.

Mini Nutritional Assessment

Has food intake declined over the past three months due to loss of appetite, digestive problems, chewing or swallowing difficulties?

    • 0 = Severe decrease

 

    • 1 = Does not know

 

    • 2 = No decrease

 

Weight loss during the three months?

    • 0 = Weight loss greater than 3kg (6.6 lbs.)

 

    • 1 = Does not know

 

    • 2 = Weight loss between 1 and 3 kg (2.2 and 6.6 lbs.)

 

    • 3 = No weight loss

 

Mobility

    • 0 = Bed or chair bound

 

    • 1 = Able to get out of bed/chair but does not go out

 

    • 2 = Goes out

 

Has suffered psychological stress or acute disease in the past months?

    • 0 = Yes

 

    • 1 = No

 

Neuropsychological problems?

    • 0 = Severe dementia or depression

 

    • 1 = Mild dementia

 

    • 2 = No psychological problems

 

Body Mass Index (BMI)

    • 0 = BMI less than 19

 

    • 1 = BMI 19 less than 21

 

    • 2 = BMI 21 to less than 23

 

    • 3 = BMI 23 or greater

 

Scoring:

12-14 = Normal

8-11 = At-risk

0-7 = Malnourished

Currently serving Omaha and surrounding areas, all Encompass services are directed by registered nurses or social workers with no long-term contracts. Contact us todayfor help with your senior care needs.

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Elderly Care: When to say no to doctors

geriatric care omahaAn elderly person suffering from multiple chronic conditions likely sees several specialists on a routine basis. Oftentimes, these specialists — cardiologists, general practitioners, gastoenterologists, etc. — administer tests that end up confirming what everyone already knows: the patient is elderly and has multiple chronic conditions. Recent coverage from the New York Times’ New Old Age blog and the AARP blog reveal that many of these tests aren’t always necessary. And a patient has every right to tell his or his doctor “no.”

Both articles cite Choosing Wisely, an initiative by the American Board of Internal Medicine (ABIM) Foundation that aims to help doctors and patients understand when certain tests do or do not make sense. One recent list from Choosing Wisely is comprised of recommendations from geriatricians and palliative care specialists.

So what are some of tests and treatments to avoid?

For starters, both the American Geriatrics Society and the American Academy of Hospice and Palliative Medicine agreed that feeding tubes should not be used for people suffering from advanced dementia. Research has shown that feeding tubes don’t prevent pneumonia or prolong a dementia patient’s life but they do cause bedsores and distress. The alternative is simple — spoon feed the patient instead.

Other questionable tests and treatments include prescribing medications to elderly diabetics to achieve “tight glycemic control” (i.e., control their blood sugar) and prescribing antibiotics when a test indicates a urinary tract infection but the patient shows no signs of discomfort.

The list from the palliative care doctors warns of delaying palliative care, as it can relieve pain and control symptoms in patients — patients who can still seek treatment for their diseases.

For more lists, visit the Choosing Wisely website.

Physicians Choice Private Duty currently serving Omaha, Eastern Nebraska and Western Iowa provides seniors and their families a complete understanding of the available care options and helps families maneuver through the challenges of the system. All Encompass services are directed by registered nurses or social workers with no long-term contracts. Contact us today for help with your senior care needs.

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Be prepared for your aging parent’s home care needs

senior home care omahaWhile an unforeseen stroke, heart attack, fall or other debilitating incident will surely send your aging parent to the hospital, beyond that his or her long-term care needs are uncertain. Best-case-secenario, your parent swiftly recovers and goes on living independently with little or no help. More realistically, he or she will require substantial care at home or in a facility for the best chance at recovery. With this in mind, a USA Today article encourages those with aging parents to be prepared for their parents’ future needs, because the results of being caught off guard could be devastating — both emotionally and financially.

Below are some tips from the article, from what paperwork you’ll need to get started to the ins and outs of long-term care to the role family caregivers play throughout the journey.

All that paperwork

The most basic and important step your parent can take is creating an advance care directive, according to the article. The directive includes creating important designations like who will be the power of attorney and your loved one’s health care proxy.

Without this advance directive, family members will have to petition the court to be appointed as the legal guardian of their loved one — not a fun or easy undertaking, to say the least. That’s why talking long-term care with your parent in advance will make the process easier for all involved, especially since everyone will know the preferences of the senior, AARP caregiving expert Lynn Feinberg told USA Today.

The long-term care system

The long-term care options are many and, far and wide, expensive. In the article Feinberg notes that many families are unprepared to make quick decisions once they find out Medicare doesn’t cover long-term care. Remember, health care professionals are there to help a family make the proper decisions for their aging loved one’s care, whether in the form of in-home care, a nursing home or another option.

Whatever option is best, however, may not be your parent’s preference, as AARP research found that 90 percent of elderly parents prefer to stay at home as long as possible. And, no matter what, long-term care is not cheap. The article reported that the national median cost of long-term care was nearly $40,000 in 2011.

Family caregivers

The responsibilities of family caregivers are many, from overseeing day-to-day care to managing a parent’s finances. In some cases, a family member may even take a substantial amount of time off from work (or even quit) to take on full-time caregiving duties.

For more information, read the full article or find related posts on the Encompass blog.

Physicians Choice Private Duty “ currently serving Omaha, Eastern Nebraska and Western Iowa ” provides seniors and their families a complete understanding of the available care options and helps families maneuver through the challenges of the system. All Encompass services are directed by registered nurses or social workers with no long-term contracts. Contact us today for help with your senior care needs.

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Confusion Assessment Method (CAM)

Todays post is part of our ongoing series, The Encompass Way. Here, we’ll go over many of the steps involved in setting up a comprehensive care plan, which helps us to provide seniors and their families a complete understanding of the available care options and helps them maneuver through the challenges of the system.

home care omahaWhen applicable, Physicians Choice Private Duty uses the Confusion Assessment Method (CAM) to identify possible delirium in a patient. This is an important test because, according to research, around 15-60 percent of elderly patients experience some form of delirium prior to or during hospitalization, but sadly this goes undiagnosed 70 percent of the time. If you’re a caregiver and notice that your loved one seems confused, inattentive or even a little off, it’s important to make note of the symptoms and report them to a healthcare professional.

INSTRUCTIONS

This form assesses the following factors:

Acute Onset

1. Is there evidence of an acute change in mental status from the patient’s baseline?

    • Yes

 

    • No

 

    • Uncertain

 

    • Not applicable

 

Inattention

(The questions listed under this topic are repeated for each topic where applicable.)

2A. Did the patient have difficulty focusing attention (for example, being easily distractible or having difficulty keeping track of what was being said)?

    • Not present at any time during interview

 

    • Present at some time during interview, but in mild form

 

    • Present at some time during interview, in marked form

 

    • Uncertain

 

2B. (If present or abnormal) Did this behavior fluctuate during the interview (that is, tend to come and go or increase and decrease in severity)?

    • Yes

 

    • No

 

    • Uncertain

 

    • Not applicable

 

2C. (If present or abnormal) Please describe this behavior.

______________

Disorganized Thinking

3. Was the patient’s thinking disorganized or incoherent such as rambling or irrelevant conversation, unclear or illogical flow of ideas or unpredictable, switching from subject to subject?

    • Yes

 

    • No

 

    • Uncertain

 

    • Not applicable

 

Altered Level of Consciousness

4. Overall, how would you rate this patient’s level of consciousness?

    • Alert (normal)

 

    • Vigilant (hyperalert, overly sensitive to environmental stimuli, startled very easily)

 

    • Lethargic (drowsy, easily aroused)

 

    • Stupor (difficult to arouse)

 

    • Coma (unarousable)

 

    • Uncertain

 

Disorientation

5. Was the patient disoriented at any time during the interview such as thinking that he or she was somewhere other than the hospital, using the wrong bed or misjudging the time of day?

    • Yes

 

    • No

 

    • Uncertain

 

    • Not applicable

 

Memory Impairment

6. Did the patient demonstrate any memory problems during the interview such as inability to remember events in the hosptial or difficulty remembering instructions?

    • Yes

 

    • No

 

    • Uncertain

 

    • Not applicable

 

Perceptual Disturbances

7. Did the patient have any evidence of perceptual disturbances such as hallucinations, illusions or misinterpretations (for example, thinking something was moving when it was not)?

    • Yes

 

    • No

 

    • Uncertain

 

    • Not applicable

 

Psychomotor Agitation

8A. At any time during the interview did the patient have an unusually increased level of motor activity such as restlessness, picking at bedclothes, tapping fingers or making frequent, sudden changes in position?

    • Yes

 

    • No

 

    • Uncertain

 

    • Not applicable

 

Psychomotor Retardation

8B. At any time during the interview did the patient have an usually decreased level of motor activity such as sluggishness, staring into space, staring in one position for a long time or moving very slowly?

    • Yes

 

    • No

 

    • Uncertain

 

    • Not applicable

 

Altered Sleep-Wake Cycle

9. Did the patient have evidence of disturbance of the sleep-wake cycle such as excessive daytime sleepiness with insomnia at night?

    • Yes

 

    • No

 

    • Uncertain

 

    • Not applicable

 

SCORING

For a diagnosis of delirium by CAM, the patient must display:

1. Presence of acute onset and fluctuating discourse

AND

2. Inattention

AND EITHER

3. Disorganized thinking

OR

4. Altered level of consciousness

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Adapted from these sources:

Inouye SK, van Dyck CH, Lessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method of detection of delirium. Ann Intern Med. 1990; 113(12): 941-948.

For a the Confusion Assessment Method (CAM) Diagnostic Algorithm, or to download a printable copy of the CAM, click here.

Currently serving Omaha and surrounding areas, all Encompass services are directed by registered nurses or social workers with no long-term contracts. Contact us today for help with your senior care needs.

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Foods that reduce the risk of Alzheimer’s

brain health home care omahaResearch suggests that filling your day with brain-healthy activities may reduce your risk of Alzheimer’s. Naturally, nutrition is an important part of the equation. Paul Nussbaum, Ph.D., a clinical neuropsychologist and also a member of the Alzheimer’s Foundation of America, told the Huffington Post that, “[n]utrition is very, very important to brain health. Surprisingly, the brain is made up of 60% fat. Without that fat we slow down mentally.”

However, it’s the kinds of fats you consume that is the thing crucial to know — trans fats and sugars do not promote brain health. Rather, stick to foods rich in Omega-3 fatty acids, vitamins and antioxidants. Here’s a list of brain-healthy foods via the Huffington Post:

Walnuts, almonds, pecans and hazelnuts

Nuts are filled with Omega-3 fatty acids, i.e. the good kind of fat your brain craves. Walnuts in particular also contain vitamin E and flavonoids — a natural protectant of the brain.

Salmon, mackerel, sardines and other fatty fish

Like nuts, fish is also high in Omega-3s. Salmon can lower beta-amyloid levels in the blood (beta-amyloid is a protein thought to play a role in Alzheimers).In the article, Dr. Nussbaum recommends eating 8 oz. of fish per week. A fish oil supplement may also be an option.

Berries

Berries are ripe with antioxidants, which help stop inflammation and allows for optimal brain cell activity. Research has shown that berries can even reverse a slowdown in the brains ability to process information.

Spinach, kale and other leafy greens

Dark, leafy greens are chockfull of antioxidants and fiber and should be a staple in any healthy diet. They also have high levels of vitamin C, which has been linked to dementia prevention.

Turmeric

Turmeric, commonly found in curries, has a main active component of curcumin, which can help prevent Alzheimer’s. A study by researchers from UCLA found that when vitamin D3 is taken with curcumin, it may help the immune system flush plaque-forming amino acids in the brain associated with Alzheimers.

Coffee

University of South Florida and University of Miami researches concluded that people over the age of 65 who consumed three cups of coffee per day developed Alzheimer’s disease two to four years later than those with lower caffeine levels. The research also found that caffeine had a positive impact in seniors with the early signs of Alzheimer’s, according to the article.

Chocolate

Chocolate (more specifically dark chocolate) contains flavonoids which can help combat heart disease. Flavonoids have also been linked to the slow down of dementia.

Are there any other brain healthy foods we missed? Let us know in the comments or on Twitter.

Physicians Choice Private Duty  currently serving Omaha, Eastern Nebraska and Western Iowa ” provides seniors and their families a complete understanding of the available care options and helps families maneuver through the challenges of the system. All Encompass services are directed by registered nurses or social workers with no long-term contracts. Contact us today for help with your senior care needs.

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Geriatric Depression Scale

Todays post is part of our ongoing series, The Encompass Way. Here, we’ll go over many of the steps involved in setting up a comprehensive care plan, which helps us to provide seniors and their families a complete understanding of the available care options and helps them maneuver through the challenges of the system.

geriatric depressionDepression among the elderly affects upwards of six million Americans. While the causes and symptoms vary case by case, it’s important to determine if an individual is suffering from depression so their care needs can be met. A routine part of Physicians Choice Private Duty’ comprehensive in-home assessment is the Geriatric Depression Scale (GDS). The GDS is a serious of “yes” or “no” questions that are simple enough to be used with even moderately cognitively impaired individuals.

Geriatric Depression Scale (short form)

Instructions:

Answer each questions with a “yes” or a “no.” Score 1 point for each underlined Answer. A score of 5 or more suggests depression.

1. Are you basically satisfied with your life?

Yes No

2. Have you dropped many of your activities and interests?

Yes  No

3. Do you feel that your life is empty?

Yes   No

4. Do you often get bored?

Yes  No

5. Are you in good spirits most of the time?

Yes  No

6. Are you afraid that something bad is going to happen to you?

Yes  No

7. Do you feel happy most of the time?

Yes  No

8. Do you often feel helpless?

Yes    No

9. Do you prefer to stay at home, rather than going out and doing things?

Yes    No

10. Do you feel that you have more problems with memory than most?

Yes    No

11. Do you think it is wonderful to be alive now?

Yes  No

12. Do you feel worthless the way you are now?

Yes    No

13. Do you feel full of energy?

Yes  No

14. Do you feel that your situation is hopeless?

Yes    No

15. Do you think that most people are better off than you are?

Yes    No

Download/print a copy of the GDS.

Currently serving Omaha and surrounding areas, all Encompass services are directed by registered nurses or social workers with no long-term contracts. Contact us today for help with your senior care needs.

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Is it better to be an only-child caregiver?

home care omahaMany people might think that being an only-child caregiver is about as difficult a duty as there is. There’re no siblings offering physical, emotional or financial support. There’s no one with a similar understanding of who your parents are and how they operate. There’s no one to consult with about pressing matters or to bounce around care ideas with. On the other hand, there’s also no one to butt heads with, leaving you able to make quick decisions. Could it be that it’s actually easier to be an only-child caregiver?

Psychologist Susan Newman tends to think so.

Newman, author of The Case for the Only Child: Your Essential Guide, told the AARP blog,When people think of only-children they think of having no one to turn to, but that’s not usually the case. Rather, Newman says an only-child caregiver has plenty of people to turn to for help and consultation, including spouses, friends and professionals — the type of people an only-child has become used to reaching out to his or her entire lives.

Newman goes on to share three tips for only-child caregivers.

1. Shore up your support system. Friends, spouses and your own children can help with Grandma (even if it’s just phone calls).

2. Don’t try to go it alone. Ask docs and other caregivers for advice and resources. Reminder: Many caregivers try to do everything themselves and get sick. No one can afford that, especially an only child.

3. Hire a sibling. A professional geriatric care manager will be able to guide you, hook you up with programs, agencies and specific needs. She will be able to steer you to volunteer transportation initiatives, for instance, a bookkeeper, or in-home aide.

Are there any more benefits to being an only-child caregiver? Let us know in the comments or on Twitter.

Physicians Choice Private Duty currently serving Omaha, Eastern Nebraska and Western Iowa provides seniors and their families a complete understanding of the available care options and helps families maneuver through the challenges of the system. All Encompass services are directed by registered nurses or social workers with no long-term contracts. Contact us today for help with your senior care needs.

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When is home care needed for my elderly father?

home care omahaWatching an elderly family member — be it your mother, father or aunt — slowly lose independence as they age is a scenario millions of family caregivers live with each and every day. Whether this dependance is due to increased frailty or the progression of a chronic condition such as Alzheimer’s, the family of an elderly person should be diligent to make sure their loved one is receiving the proper care. With this in mind, PBS’s Caring for Your Parents resource center has a comprehensive guide as to help you determine what type of care may be needed, from professional home care to a skilled nursing facility. Below is a sampling of some of PBS’s assessments, which can be carried out by the family caregiver or a professional senior care agency.

Activities of Daily Living (ADL)

This assessment gathers information on your elder’s ability to manage ADLs, such as personal care and house work. It also answers questions about physical limitations and memory problems:

    • Is your loved one able to do housework, laundry, shopping and cooking?

 

    • How well does your loved more maintain personal care (bathing, dressing, using the toilet, etc.)?

 

    • Does your loved one manage medical appointments and medications?

 

    • Is your loved one able to handle personal finances and legal issues?

 

Physical Health Considerations

Consult with your loved one’s primary care physician or a geriatric specialist to evaluate his or his physical capacities. Things to consider:

    • Mobility — Can your elderly father safely maneuver around his home or neighborhood?

 

    • Vision — Many elders do not report their vision problems to health care providers, reports PBS, even though trouble with seeing commonly leads to reduced social interaction, depression and injuries from falls.

 

    • Hearing — Like poor vision, hearing deficits can also affect one’s quality of life. Many people are surprised to find out just how advanced modern hearing aid technology is, so be sure to report any problems with your elder’s hearing problems to a specialist.

 

Other assessment areas include mental health considerations, nutrition considerations and putting all the information together to create a clear picture of the capabilities of the elderly person. PBS notes that answering these questions with a home care agency will make the conversation more useful and productive. And, most importantly, it will lead to the best elderly care possible for your loved one.

Physicians Choice Private Duty “ currently serving Omaha, Eastern Nebraska and Western Iowa ” provides seniors and their families a complete understanding of the available care options and helps families maneuver through the challenges of the system. All Encompass services are directed by registered nurses or social workers with no long-term contracts. Contact us today for help with your senior care needs.

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