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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“Physicians Choice Private Duty solves the problems families face in finding home health care providers they can trust. Providers who will focus on strategies that keep parents in their homes. To learn more about our health care services, visit http://www.encompass-home-health-care.com.”

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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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Checklist: Recognizing the Signs of Elder Abuse

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.

elder abuse omahaWith an increasing population of elderly as a result of the Baby Boom generation, statistics show that elder abuse is more prevalent than ever. One study recognized that for every case of elder abuse reported to agencies nearly 25 go unreported.

Abuse of an elderly person can be physical, mental or financial and take on a variety of forms. If you observe any blatant signs of abuse — name-calling, threats, intimate contact, unreasonable restraints, withholding of food or medication, etc. — you should take immediate steps to stop it. Elder abuse, however, is rarely that obvious.

Many of the conditions and events listed below may be caused by occurrences unrelated to abuse, but then again maybe your relative is being abused. Use this checklist to quantify possible signs. If you notice the following occurrences or conditions, it is important to carefully monitor your relative’s care or alert the authorities.

Physical or mental abuse may be causing the following conditions:

    • Recurring or unexplained injuries

 

    • A combination of new and old injuries

 

    • Injuries without underlying diseases, or incompatible with medical history, including cuts, lacerations, puncture wounds, bruises, welts or discoloration

 

    • Any injury that looks like it may be have been caused by cigarettes, caustics, acids, friction from ropes or chains or contact with other objects

 

    • Poorly treated or untreated injuries

 

    • Injuries in areas usually covered by clothing

 

    • Poor skin condition/poor skin hygiene/lice

 

    • Absence of hair and/or hemorrhaging below the scalp

 

    • Dehydration or malnutrition that is unrelated to illness

 

    • Loss of weight

 

    • Soiled clothing or bedding

 

    • An environment that is excessively dirty or smells of feces or urine

 

    • Inadequate clothing

 

    • Depression or withdrawal

 

    • Hesitation to talk openly

 

    • Fearfulness of caregivers

 

    • Confusing or contradictory statements by an otherwise competent senior

 

    • Resignation or denial

 

    • Implausible explanations of injuries or conditions

 

    • Unexplained agitation

 

    • Denial of an injured state

 

Financial abuse may be causing the following conditions:

    • A sudden lack of knowledge about financial matters

 

    • A sudden refusal to make financial decisions or pay bills without consulting another person

 

    • Unusual or inappropriate banking activity

 

    • Signatures on your relative’s checks or other financial documents, particularly when your relative can no longer write

 

    • The creation of a power of attorney or will, when your relative is incapacitated

 

    • Numerous unpaid bills and overdue rent when someone is supposed to be handling your relative’s finances

 

    • Lost valuables

 

Caregiver behavior that should raise suspicion of abuse includes:

    • The caregiver does not allow your relative to speak for herself

 

    • The caregiver does not allow your relative to visit with others out of the caregiver’s presence

 

    • The caregiver expresses that your relative’s injuries or undesirable behavior is deliberate or self-inflicted

 

    • The caregiver has a history of abusing others

 

    • The caregiver has problems with alcohol or drugs

 

    • The caregiver is inappropriately affectionate or sexual

 

    • The caregiver restricts the activity of or isolates your relative

 

    • The caregiver’s explanation of an injury or incident conflicts with your relative’s account

 

    • The caregiver is unwilling or reluctant to comply with instructions from other care providers

 

    • The caregiver is inappropriately defensive when asked to explain an injury or occurrence

 

    • The caregiver has unjustified control of your relative’s finances

 

    • The caregiver refuses services that your relative needs

 

    • The caregiver is unusually concerned about the amount of money being expended on your relative’s care

 

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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New York Times: Pope’s retirement a reminder of the ails of old age

pope benedict frailPope Benedict XVI’s unexpected retirement has captured headlines across the world. While this post is in no way going to get into papal politics, a storyline pertinent to the senior care industry is that, as we reach old age, our bodies inevitably become more and more frail — even when you’re the pope.

Shedding light on this matter is an article by Paula Span on The New York Times‘ New Old Age Blog. The Vatican recently revealed that the 85-year-old pope has a pacemaker, signifying “long-standing heart problems,” according to the article. Other reported health issues affecting the pope include difficulty walking even short distances and a recent fall in Mexico, leading Span to ask the simple question — is the now-former pope frail?

But what exactly is frailty? According to the Oxford’s Journals of Gerontology, “Frailty is considered highly prevalent in old age and to confer high risk for falls, disability, hospitalization, and mortality.” Still, a standardized definition of geriatric frailty has yet to be established.

The American Academy of Physical Medicine and Rehabilitation states that a person must meet three of the five following criteria to be considered frail:

    1. Weight loss

 

    1. Exhaustion

 

    1. Weakness

 

    1. Slow walking speed

 

    1. Decreased physical activity

 

As Span notes, trying to diagnose the pope from afar is not the point, rather it’s realizing that frailty is a real concern for elders. Encouragingly, in it’s early stages frailty is a condition that is reversible or can be slowed. In the article, Columbia University’s Dr. Linda Fried recommends key exercises to accomplish this, including regular walking and moving to maintain strength and muscle mass.

While the pope will surely live out the rest of his days comfortably and in the best of care provided by the Vatican, millions of aging Americans face a different reality. One that potentially brings about a national crisis unless a workable and affordable system of long-term elderly care is established. But that’s an entirely different story.

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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How to determine caregiver stress

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 omaha dementiaThe following Burden Interview has been specially designed to reflect the stresses experienced by caregivers of dementia patients. It can be completed by caregivers themselves or as part of an interview. Caregivers are asked to respond to a series of 22 questions about the impact of the patient’s disabilities on their life. For each item, caregivers are to indicate how often they felt that way (never, rarely, sometimes, quite frequently or nearly always).

Scoring the test

The Burden Interview is scored by adding the numbered responses of the individual items. Higher scores indicate greater caregiver distress. The Burden Interview, however, should not be taken as the only indicator of the caregiver’s emotional state. Clinical observations and other instruments, such as measures of depression, should be used to supplement this measure.

Norms for the Burden Interview have not been computed, but estimates of the degree of burden can be made from preliminary findings. These are:

    • 0-20 — Little or no burden

 

    • 21-40 — Mid to moderate burden

 

    • 41-60 — Moderate to severe burden

 

    • 61-80 — Severe burden

 

Instructions

The following is a list of statements which reflect how people sometimes feel when taking care of another person. After each statement, indicate how often you feel that way and score accordingly: never (0), rarely (1), sometimes (2), quite frequently (3) or nearly always (4). There are no right or wrong answers.

1. Do you feel that your relative asks for more help than he or she needs?

2. Do you feel that, because of the time you spend with your relative, you don’t have enough time for yourself?

3. Do you feel stressed between caring for your relative and trying to meet other responsibilities for your family or work?

4. Do you feel embarrassed about your relative’s behavior?

5. Do you feel angry when you are around your relative?

6. Do you feel that your relative currently affects your relationship with other family members?

7. Are you afraid about what the future holds for your relative?

8. Do you feel that your relative is dependent upon you?

9. Do you feel strained when you are around your relative?

10. Do you feel that your health has suffered because of your involvement with your relative?

11. Do you feel that you don’t have as much privacy as you would like because of your relative?

12. Do you feel that your social life has suffered because you are caring for your relative?

13. Do you feel uncomfortable having your friends over because of your relative?

14. Do you feel your relative expects you to take care of him or her as if you were the only person he or she could depend on?

15. Do you feel that you don’t have enough money to take care of your relative in addition to the rest of your expenses?

16. Do you feel that you will be unable to take care of your relative much longer?

17. Do you feel that you have lost control of your life since your relative’s death?

18. Do you wish that you could just leave the care of your relative to someone else?

19. Do you feel uncertain about what to do about your relative?

20. Do you feel that you should be doing more for your relative?

21. Do you feel that you could do a better job in caring for your relative?

22. Overall, how burdened do you feel in caring for your relative?

Sources consulted:

    • Brown, JL, Potter JF, Foster BG. Caregiver burden should be evaluated during geriatric assessment. J Am Geriatr Soc. 1990; 38 (4): 455-460.

 

    • Cummings JL, Frank JC, Cherry D et al. Guidelines for managing Alzheimer’s disease: part I. Assessment. Am Fam Physician. 2002; 65 (11): 2263-2272.

 

    • Council on Scientific Affairs, American Medical Association. Physicians and family caregivers: a model for partnership. Council report. JAMA. 1993; 269 (10): 1282-1284.

 

    • Rankin ED, Haut MW, Keefover RW, Franzen MD. The establishment of clinical cutoffs in measuring caregiver burden in dementia. Gerontologist. 1994; 34 (6): 828-832.

 

    • Zarit SH, Reever KE, Back-Peterson J. Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist. 1980; 20 (6): 649-655.

 

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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3 Ways to Keep Track of Medication Regimens

senior care omahaIt’s very common for an elderly person to be taking several doses of prescribed medication each day. And the list of drugs seems to only get longer and longer over the years. This makes it increasingly more difficult for someone to properly manage their medication, which is concerning because a missed or wrong dose can have dire consequences.

According to the National Council on Patient Information and Education, around 90 percent of Medicare recipients take prescription drugs, and two out of five reported having to take five or more medications — and many are non-adherent to doctor’s orders. This non-adhereance all adds up to $1 billion annually in hospital costs, according to the New England Journal of Medicine. Meanwhile the FDA figures that more than two million serious adverse drug reactions occur each year, which are responsible for about 100,000 deaths annually.

If your loved one is taking several medications daily, you may want to take the time to help them better organize their pills, especially if they have poor vision and/or cognition problems. Here are some medication management tips via Caring.org.

There are many reminder technologies that can help, including:

Telephone-based reminders

Telephone-based medication reminders have the lowest cost and least intervention, according to Caring.org. Usually for a monthly fee in the $15-$20 range you can subscribe to an automated calling service that calls your loved one each day to remind them to take their medication. If the person doesn’t answer or acknowledge the reminder, the system will notify the designated contact (likely you) by email and/or telephone. No fancy new telephone required.

Another option is the Pill Phone, which is available through wireless carriers like Verizon an AT&T.

Reminders integrated as part of home monitoring or safety devices

Several personal emergency response systems should be available through your local pharmacy. Caring.org notes that these services are often built around wearable products such as pendants or watches. These vary in degrees of sophistication — from programmable medication reminders to a personalized emergency response system.

Electronic pill-dispensing systems

Electronic pill boxes are a small yet advanced way to offer medication reminders. These may be ideal for seniors who can load and count their own pills, or those with regular support from a caregivers. If you can afford it, there are also lockable electronic pill dispenser systems that cost upwards of $1,000.

Which level of intervention depends on your loved one’s ability to independently take medication. When choosing a medication reminder, Caring.org suggests envisioning your loved one’s ever-evolving need for medication management and intervention, taking into account his or her current needs and what those needs might be in the near future.

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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“Physicians Choice Private Duty solves the problems families face in finding home health care providers they can trust. Providers who will focus on strategies that keep parents in their homes. To learn more about our health care services, visit http://www.encompass-home-health-care.com.”

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3 steps to coping with caregiver stress

caregiving omahaA recent study from the National Alliance for Caregiving confirms what many of America’s 65 million caregivers know firsthand — the responsibilities of caring for a loved one brings on stress and lots of it. What’s most concerning is that this stress can lead to an overall decline in health. The study found that 91 percent of caregivers with declining health report depression. Caregivers are also at risk of turning to bad habits such as smoking and alcohol abuse to cope.

Sherri Snelling, CEO of the Caregiving Club, created a “Me Time” plan to help caregivers effectively turn their lives around and deal with stress in healthy ways. Snelling breaks her plan down into three steps:

1. Create a plan. To make sure positive change happens, you need to establish realistic goals. Maybe it’s finding outside help so you can take one day off per week and find time to relax and do the things you love. Snelling suggests seeking out volunteer networks and/or online communities for help. Leaving yourself “Me Time” reminders — like a sticky note in the car — can help make sure you don’t forget.

2. Take baby steps. If you want to run a 5k but are not in shape like you used to be, you have to train slowly, day by day and week by week. The same goes for your “Me Time” plan. If you want a week off to visit your new grandson in Texas, plan it out well in advance and take little steps along the way to make sure it happens.

3. Track and celebrate your progress. Snelling says that tracking your progress will allow you to celebrate it. Pick a day each week and reflect on your recent “Me Time” moments. Having a support network of people who know about your goals can also help immensely. Plus you’ll have someone to celebrate with.

Read more about Snelling’s “Me Time” plan on Huffington Post’s Post 50 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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Is your elderly mother at risk for falls?

Today’s 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.

elder fallsThe following test — which we call the “Get Up and Go Test” — is an assessment that should be conducted as part of a routine evaluation when dealing with older persons. Its purpose is to detect “fallers” and to identify those who need evaluation.

Senior care professionals should be trained to perform the “Get Up and Go Test” at check-in and query those with gait or balance problems for falls. Below is what they’ll be looking for.

Initial Check

All older persons who report a single fall should be observed in the following exercises:

    • From a sitting position, stand without using their arms for support.

 

    • Walk several paces, turn, and return to the chair.

 

    • Sit back in the chair without using their arms for support.

 

Individuals who have difficulty or demonstrate unsteadiness performing this test require further assessment.

Follow-Up Assessment

 

In the follow-up assessment, ask the person to:

    • Sit.

 

    • Stand without using their arms for support.

 

    • Close their eyes for a few seconds while standing in place.

 

    • Stand with eyes closed while you push gently on his or her sternum.

 

    • Walk a short distance and come to a complete stop.

 

    • Turn around and return to the chair.

 

    • Sit in the chair without using their arms for support.

 

While conducting the test, pay attention to any abnormal movements. As you observe, answer the questions below.

Follow-Up Assessment Observations

    • Is the person steady and balanced when sitting upright?

 

    • Is the person able to stand with their arms folded?

 

    • When standing, is the person steady in narrow stance?

 

    • With eyes closed, does the person remain steady?

 

    • When nudged, does the person recover without difficulty?

 

    • Does the person start walking without hesitancy?

 

    • When walking, does each foot clear the floor well?

 

    • Is there step symmetry, with the steps equal in length and regular?

 

    • Does the person take continuous, regular steps?

 

    • Does the person walk straight without a walking aid?

 

    • Does the person stand with heels close together?

 

    • Is the person able to sit safely and judge distance correctly?

 

The more you answer “no” to the above questions, the greater your loved one’s risk is for falling.

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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Executor’s guide to wills and estates

nebraska probateServing as executor of a loved one’s estate is a more difficult job than most people realize. There’s the paperwork, finding an attorney to help with the probate process, following through with the requests in your loved one’s will, paying bills — the list goes on and on.

To help streamline the process, you can refer to the many online guides and checklists out there (or you could always consult with your attorney, who will bill you for the time). Even so, you should consider picking up a copy of the latest edition of the American Bar Association’s “Guide to Will and Estates,” because, as Paula Spin writes in a post for The New York Times’ New Old Age blog, anyone in charge of settling an estate should expect things to be 30 percent more complicated than initially planned.

Spin notes the A.B.A. guide is “written with surprising clarity” (quite a feat for a bunch of lawyers) and offers thorough explanations to common scenarios like divvying up property and real estate between heirs and how to best deal with taxes and trusts. Since you’ll likely be working with an estate lawyer to get things settled, the A.B.A.’s guide will help you better understand what exactly is going on throughout the entire process. And, as many of us have experienced when a loved one’s affairs and assets were disorganized at the end of his or her life, the guide will help you to prioritize getting your own estate in order, something your likely unprepared heirs will certainly appreciate.

You can pick up a copy of the American Bar Association’s “Guide to Will and Estates” at your local bookstore or order it online via Amazon.com.

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.

“Physicians Choice Private Duty solves the challenges families face in caring for aging parents, with a focus on strategies that keep them in their homes. To learn more about our solutions, visit us today..”

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