Midge watches cows being milked on a dairy farm.

Donna paints watercolor masterpieces with just one touch.

Frank belts out tunes on the karaoke machine.

All call the Woodside Neighborhood, a dementia-specific personal care community at the Presbyterian SeniorCare Network Washington campus, home. Each has a different interest that sparks special moments in their lives – many of these moments they do not recall on a daily basis.

With the help of It’s Never Too Late (iN2L), an interactive computer system that engages residents regardless of their cognitive level, the Woodside team is able to rekindle passions like painting, and bring back lost memories of the days on the farm.

Photo Caption: Donna, a resident in the Woodside Neighborhood, enjoys “painting” on the iN2L

“iN2L doesn’t just impact one of our residents, it impacts all of them,” says Susan Lawrence, lifestyle engagement coordinator at Presbyterian SeniorCare Network. She reminisces, “I remember one of our residents who was a ‘War Bride’ from England. She moved to the U.S. and never got to go back home. We received this information from her family and pulled up the Earth view of the town on iN2L. She couldn’t remember the name of her hometown, but when she saw the local Post Office, she leaned in to get closer to the screen. We watched her eyes light up in a moment of recognition and she began sharing stories about her father and her time ‘at home.’ Talk about an impactful moment of remembrance – and all because of the iN2L.”

iN2L provides an element of engagement that you can’t get from anywhere else.

“We have fun with the iN2L. But what’s most important is that we engage. They remember; even if it is just for one moment,” says Susan.

Midge watches cows being milked on a dairy farm.

Donna paints watercolor masterpieces with just one touch.

Frank belts out tunes on the karaoke machine.

All call the Woodside Neighborhood, a dementia-specific personal care community at the Presbyterian SeniorCare Network Washington campus, home. Each has a different interest that sparks special moments in their lives – many of these moments they do not recall on a daily basis.

With the help of It’s Never Too Late (iN2L), an interactive computer system that engages residents regardless of their cognitive level, the Woodside team is able to rekindle passions like painting, and bring back lost memories of the days on the farm.

Photo Caption: Donna, a resident in the Woodside Neighborhood, enjoys “painting” on the iN2L

“iN2L doesn’t just impact one of our residents, it impacts all of them,” says Susan Lawrence, lifestyle engagement coordinator at Presbyterian SeniorCare Network. She reminisces, “I remember one of our residents who was a ‘War Bride’ from England. She moved to the U.S. and never got to go back home. We received this information from her family and pulled up the Earth view of the town on iN2L. She couldn’t remember the name of her hometown, but when she saw the local Post Office, she leaned in to get closer to the screen. We watched her eyes light up in a moment of recognition and she began sharing stories about her father and her time ‘at home.’ Talk about an impactful moment of remembrance – and all because of the iN2L.”

iN2L provides an element of engagement that you can’t get from anywhere else.

“We have fun with the iN2L. But what’s most important is that we engage. They remember; even if it is just for one moment,” says Susan.

Meeting with a physical therapist and educating yourself before you have joint replacement surgery can help you to have a quicker, less stressful recovery.

Patients who meet one-on-one with a physical therapist (PT) and educate themselves prior to knee or hip replacement surgery feel better prepared to leave the hospital and report less pain and joint stiffness during recovery compared to those who did not, according to a study by Hospital for Special Surgery (HSS). The study evaluated the effect of a face-to-face counseling session coupled with web-based education on patient satisfaction and functional outcomes.

The goal of the education session was to manage patient expectations of the surgery and recovery before undergoing the surgery—rather than after the surgery, when they might be dealing with fatigue, pain or anxiety—so they were able to better absorb and retain the information. Researchers followed 126 patients who underwent knee or hip replacement for osteoarthritis.

All patients attended a group education class before surgery—the standard of care for those scheduled for joint replacement at HSS. They were then randomized into two separate groups. In group one, 63 patients attended the one-on-one education session with a physical therapist in addition to the group class and were granted access to an informational web portal featuring videos. The control group of 63 patients attended the standard group class and received a booklet about what to expect after joint replacement—with no further education.

Using patient satisfaction and patient-reported scores to measure pain, joint stiffness and function both before and after surgery, researchers determined that the patients who attended the extra one-on-one PT counseling session indicated they were better prepared to leave the hospital after surgery and were overall more satisfied with the preoperative education they received. Almost 97 percent of these patients accessed the informational web portal, and all of them said they would recommend it for patients undergoing the same procedure.

Almost 70 percent of patients from the group that did not receive the supplemental educational session or web portal access believed they could have benefited from additional education before surgery. Patients who received one-on-one counseling also needed fewer physical therapy sessions in the hospital before discharge and met PT discharge measures sooner, including being able to get out of bed, walk with or without an assistive device and go up and down stairs independently.

The upshot of this research is that, if you are considering joint replacement surgery, ask to meet one-on-one with a physical therapist BEFORE your surgery if that is not your doctor’s standard approach. And take advantage of any and all learning materials your doctor may give you—specifically online videos and information.

The more you know, the better your recovery may be.

Meeting with a physical therapist and educating yourself before you have joint replacement surgery can help you to have a quicker, less stressful recovery.

Patients who meet one-on-one with a physical therapist (PT) and educate themselves prior to knee or hip replacement surgery feel better prepared to leave the hospital and report less pain and joint stiffness during recovery compared to those who did not, according to a study by Hospital for Special Surgery (HSS). The study evaluated the effect of a face-to-face counseling session coupled with web-based education on patient satisfaction and functional outcomes.

The goal of the education session was to manage patient expectations of the surgery and recovery before undergoing the surgery—rather than after the surgery, when they might be dealing with fatigue, pain or anxiety—so they were able to better absorb and retain the information. Researchers followed 126 patients who underwent knee or hip replacement for osteoarthritis.

All patients attended a group education class before surgery—the standard of care for those scheduled for joint replacement at HSS. They were then randomized into two separate groups. In group one, 63 patients attended the one-on-one education session with a physical therapist in addition to the group class and were granted access to an informational web portal featuring videos. The control group of 63 patients attended the standard group class and received a booklet about what to expect after joint replacement—with no further education.

Using patient satisfaction and patient-reported scores to measure pain, joint stiffness and function both before and after surgery, researchers determined that the patients who attended the extra one-on-one PT counseling session indicated they were better prepared to leave the hospital after surgery and were overall more satisfied with the preoperative education they received. Almost 97 percent of these patients accessed the informational web portal, and all of them said they would recommend it for patients undergoing the same procedure.

Almost 70 percent of patients from the group that did not receive the supplemental educational session or web portal access believed they could have benefited from additional education before surgery. Patients who received one-on-one counseling also needed fewer physical therapy sessions in the hospital before discharge and met PT discharge measures sooner, including being able to get out of bed, walk with or without an assistive device and go up and down stairs independently.

The upshot of this research is that, if you are considering joint replacement surgery, ask to meet one-on-one with a physical therapist BEFORE your surgery if that is not your doctor’s standard approach. And take advantage of any and all learning materials your doctor may give you—specifically online videos and information.

The more you know, the better your recovery may be.

How to ensure your loved one will receive good care after the move
By Cari Shane

If you have a parent or other loved one who will soon be released from the hospital after an injury or surgery, he or she might not yet be well enough to return home, even with the assistance of in-home care. That likely will mean a transition to a short-term rehabilitation facility or nursing home.

If you’ve never had this experience, you may not know what to expect. The following are some important tips, and a few cautionary tales, from caregivers and a patient who have been through the hospital-to-rehab transition.

Before You Leave the Hospital

Don’t let your loved one leave the hospital without being “admitted.” Without the word “admitted” stamped on hospital papers, the stay at the rehab facility is not covered by Medicare. It’s this semantics loophole that left Cat Stone’s mother in severe debt after a 2012 hip fracture.

“Medicare didn’t just abandon my mother — she went to her grave ashamed and afraid knowing they’d stolen her life savings, her security and her dignity with an undisclosed loophole,” says Stone, of New Jersey, whose mother was living in a Florida nursing home. Stone wrote about what happened to her mother and family for The CoveyClub.

Medicare covers nursing home care if a person over 65 has been admitted and remained in a hospital for three days, counting admission day but not the day of discharge. Since Medicare only picks up the rehab tab for the first 20 days, a secondary insurance may cover the $170.50/day co-pay for days 21 through 100.

Know you can request a private room. The hospital’s social worker will place your loved one in the facility of your choosing as long as there’s a bed available. Since a private room doesn’t cost extra, you might want to request one to ensure a restful stay. While many temporary roommates can get along just fine, sometimes it doesn’t work out.

“My grandmother[’s] roommate was not a good match,” says Amie Clark, whose grandmother was in a nursing home near Portland, Ore. “Had we not spoken up, she would have had to continue to tolerate a situation that was not healthy for an 88-year-old.” If your loved one ends up in a double room and it’s not a good situation, you can add his or her name to the private-room waiting list.

Plan for a Sunday, Monday or Tuesday discharge time. Since patients do not receive physical therapy from either the hospital or the nursing home on discharge or arrival days, the prime day to transition is a Sunday. At most facilities, Sunday is a typical off day for therapy, so your loved one won’t miss what he or she won’t get anyway.

By that same calculation, being discharged on a Saturday can ratchet up three missed therapy days: no therapy on Saturday (transition day), no therapy on Sunday (off day) and no therapy on Monday because this is the day department heads assess your loved one’s therapy needs. If the rehab facility doesn’t do assessments on Saturdays, a Friday departure would mean four days of therapy missed.

When You Arrive at the Care Facility

Disinfect the room. Studies show that the rails on the bed, over-bed table, bed control wand, nurse’s button and the room’s door handles can be ripe with germs. Get wipes and disinfect.

Get direct phone numbers. It may prove difficult to get a human to answer any of the phone numbers provided in the welcome pamphlet. Since most department heads carry company cell phones, ask for these numbers. Key ones to get: the nursing supervisor, social worker and the doctor assigned to your loved one’s care.

Schedule advocates. Schedule at least one person — a family member, friend or perhaps a paid aide — per day to advocate for your loved one, at least until you feel like everything is going well. An advocate helps draw attention to the person’s needs, especially in an environment where nurses and other care staff often are over worked and in charge of a large number of patients. If you hire someone to be an aide for this, just know the service is not covered by Medicare.

Make sure the staff understands your loved one’s mental condition. When transitioning from a hospital to a care facility, many older adults suffer from some level of hospital delirium. The rehab staff may assume that this is who your loved one is and create a misinformed treatment plan. Some of this is inherent ageism, says Catherine Callahan, 68, who says she tackled head-on the assumptions about her abilities when she arrived at a nursing home in Santa Barbara, Calif., after major surgery. They “may think you are hard of hearing, confused and limited in your determination … I stated up front that I have a keen sense of hearing … and was very committed to doing my program,” she says.

Check with your loved one’s doctor. The facility may require an immediate influenza and/or tuberculosis shot. Since your loved one may already be up to date on these, insist that the facility wait for you to get medical records. And, while you’re on the phone with the doctor, discuss medication changes and contraindications.

Look and ask before your loved one takes medicine. Each time your loved one is given medication, make sure you, your advocate or the patient asks the nurse to state the names of the pills. Lana Wolfe’s 81-year old mother was prescribed oxycodone despite an allergy, which was noted on her chart. “She was given this for two days before I found out,” says Wolfe, of Fort Colins, Colo., whose mother was in a rehab facility near Denver. Also, a few times “the medication was just left with my mom [even though] the nurse is supposed to wait until the patient actually takes the medication,” she says.

Don’t ever accept “we can’t do that” or “you have to do that” as gospel. Patients have the right to turn down treatment. “Many people assume that they have to follow the doctor’s orders and don’t have a choice, but they do,” says Clark, who is also a former long-term care social worker. Also, a family member or other individual who is legally designated can refuse treatment and make other decisions for a person in the hospital or rehab.

While Medicare’s Bill of Resident’s Rights states that patients have the right to be treated with dignity and respect, sometimes it can be a battle. “Nurses aides insisted that my mother wear a diaper even though she could go to the bathroom on her own,” says Dr. Carole Lieberman, whose 101-year old mother spent time in two Los Angeles-area rehab facilities. “Diapers are easier for the staff … but they infantilize the patients.”

Patients also have the right to ask for treatment. “My speech was unclear … [but] my program did not include speech therapy,” says Callahan. “I never gave up asking for it.” She gave doctors specific reasons for why she needed it, “such as therapists not being able to understand me.” By the second week, Callahan was assigned a speech therapist.

You have the right to read all paperwork before signing. Remind your loved ones that they do not need to sign something they don’t understand, haven’t read or for which they do not agree.

If you don’t like how your loved one is being treated, go straight to the top. It may be difficult to get the facility administrator on the phone, but keep trying. If the person remains elusive, demand an internal investigation about your loved one’s treatment from the director of nursing or social work.

By Cari Shane

Cari Shane is a freelance journalist and corporate writer specializing in public relations and social media strategy. She is based in Washington, D.C.@cariinthecity

How to ensure your loved one will receive good care after the move
By Cari Shane

If you have a parent or other loved one who will soon be released from the hospital after an injury or surgery, he or she might not yet be well enough to return home, even with the assistance of in-home care. That likely will mean a transition to a short-term rehabilitation facility or nursing home.

If you’ve never had this experience, you may not know what to expect. The following are some important tips, and a few cautionary tales, from caregivers and a patient who have been through the hospital-to-rehab transition.

Before You Leave the Hospital

Don’t let your loved one leave the hospital without being “admitted.” Without the word “admitted” stamped on hospital papers, the stay at the rehab facility is not covered by Medicare. It’s this semantics loophole that left Cat Stone’s mother in severe debt after a 2012 hip fracture.

“Medicare didn’t just abandon my mother — she went to her grave ashamed and afraid knowing they’d stolen her life savings, her security and her dignity with an undisclosed loophole,” says Stone, of New Jersey, whose mother was living in a Florida nursing home. Stone wrote about what happened to her mother and family for The CoveyClub.

Medicare covers nursing home care if a person over 65 has been admitted and remained in a hospital for three days, counting admission day but not the day of discharge. Since Medicare only picks up the rehab tab for the first 20 days, a secondary insurance may cover the $170.50/day co-pay for days 21 through 100.

Know you can request a private room. The hospital’s social worker will place your loved one in the facility of your choosing as long as there’s a bed available. Since a private room doesn’t cost extra, you might want to request one to ensure a restful stay. While many temporary roommates can get along just fine, sometimes it doesn’t work out.

“My grandmother[’s] roommate was not a good match,” says Amie Clark, whose grandmother was in a nursing home near Portland, Ore. “Had we not spoken up, she would have had to continue to tolerate a situation that was not healthy for an 88-year-old.” If your loved one ends up in a double room and it’s not a good situation, you can add his or her name to the private-room waiting list.

Plan for a Sunday, Monday or Tuesday discharge time. Since patients do not receive physical therapy from either the hospital or the nursing home on discharge or arrival days, the prime day to transition is a Sunday. At most facilities, Sunday is a typical off day for therapy, so your loved one won’t miss what he or she won’t get anyway.

By that same calculation, being discharged on a Saturday can ratchet up three missed therapy days: no therapy on Saturday (transition day), no therapy on Sunday (off day) and no therapy on Monday because this is the day department heads assess your loved one’s therapy needs. If the rehab facility doesn’t do assessments on Saturdays, a Friday departure would mean four days of therapy missed.

When You Arrive at the Care Facility

Disinfect the room. Studies show that the rails on the bed, over-bed table, bed control wand, nurse’s button and the room’s door handles can be ripe with germs. Get wipes and disinfect.

Get direct phone numbers. It may prove difficult to get a human to answer any of the phone numbers provided in the welcome pamphlet. Since most department heads carry company cell phones, ask for these numbers. Key ones to get: the nursing supervisor, social worker and the doctor assigned to your loved one’s care.

Schedule advocates. Schedule at least one person — a family member, friend or perhaps a paid aide — per day to advocate for your loved one, at least until you feel like everything is going well. An advocate helps draw attention to the person’s needs, especially in an environment where nurses and other care staff often are over worked and in charge of a large number of patients. If you hire someone to be an aide for this, just know the service is not covered by Medicare.

Make sure the staff understands your loved one’s mental condition. When transitioning from a hospital to a care facility, many older adults suffer from some level of hospital delirium. The rehab staff may assume that this is who your loved one is and create a misinformed treatment plan. Some of this is inherent ageism, says Catherine Callahan, 68, who says she tackled head-on the assumptions about her abilities when she arrived at a nursing home in Santa Barbara, Calif., after major surgery. They “may think you are hard of hearing, confused and limited in your determination … I stated up front that I have a keen sense of hearing … and was very committed to doing my program,” she says.

Check with your loved one’s doctor. The facility may require an immediate influenza and/or tuberculosis shot. Since your loved one may already be up to date on these, insist that the facility wait for you to get medical records. And, while you’re on the phone with the doctor, discuss medication changes and contraindications.

Look and ask before your loved one takes medicine. Each time your loved one is given medication, make sure you, your advocate or the patient asks the nurse to state the names of the pills. Lana Wolfe’s 81-year old mother was prescribed oxycodone despite an allergy, which was noted on her chart. “She was given this for two days before I found out,” says Wolfe, of Fort Colins, Colo., whose mother was in a rehab facility near Denver. Also, a few times “the medication was just left with my mom [even though] the nurse is supposed to wait until the patient actually takes the medication,” she says.

Don’t ever accept “we can’t do that” or “you have to do that” as gospel. Patients have the right to turn down treatment. “Many people assume that they have to follow the doctor’s orders and don’t have a choice, but they do,” says Clark, who is also a former long-term care social worker. Also, a family member or other individual who is legally designated can refuse treatment and make other decisions for a person in the hospital or rehab.

While Medicare’s Bill of Resident’s Rights states that patients have the right to be treated with dignity and respect, sometimes it can be a battle. “Nurses aides insisted that my mother wear a diaper even though she could go to the bathroom on her own,” says Dr. Carole Lieberman, whose 101-year old mother spent time in two Los Angeles-area rehab facilities. “Diapers are easier for the staff … but they infantilize the patients.”

Patients also have the right to ask for treatment. “My speech was unclear … [but] my program did not include speech therapy,” says Callahan. “I never gave up asking for it.” She gave doctors specific reasons for why she needed it, “such as therapists not being able to understand me.” By the second week, Callahan was assigned a speech therapist.

You have the right to read all paperwork before signing. Remind your loved ones that they do not need to sign something they don’t understand, haven’t read or for which they do not agree.

If you don’t like how your loved one is being treated, go straight to the top. It may be difficult to get the facility administrator on the phone, but keep trying. If the person remains elusive, demand an internal investigation about your loved one’s treatment from the director of nursing or social work.

By Cari Shane

Cari Shane is a freelance journalist and corporate writer specializing in public relations and social media strategy. She is based in Washington, D.C.@cariinthecity

A breakdown of the various offerings and where insurance fits in
By Lisa Fields

After a stroke, only about 10 percent of people recover almost completely without intervention. For everyone else, therapy is a crucial part of the recovery process. Whether you need physical, occupational and/or speech therapy following a stroke depends on your needs, but the goal is the same: to help you regain control of your body and be independent once again. The therapy you receive should be tailor-made to suit your lifestyle.

“Is the goal returning to driving or returning to work, or (is the person) a retiree who needs to take care of their own bodily functions and participate in playing with a grandchild?” says Glen Gillen, professor and director of programs in occupational therapy at Columbia University in New York and a fellow of the American Occupational Therapy Association.

Kinds of Rehabilitation Facilities

Most stroke patients stay in the hospital for five to six days. Their therapy needs are assessed within the first two days, and therapy may begin on the second. Some patients are sent home from the hospital right away. They may receive outpatient therapy sessions three times a week or get therapy at home from visiting nurses or therapists.

“If they’re higher-functioning, they can potentially go to outpatient therapy, if they have the means to get there,” Gillen says. “That is a challenge for many.”

Many stroke patients are discharged from the hospital to inpatient rehabilitation facilities, where they receive therapy at an intensity that’s best for their needs, based on the severity of the disability. Some go to acute inpatient rehab facilities, which offer the most intense therapy for the most responsive patients. Those with a greater degree of impairment may be sent to “subacute rehab” facilities, where the therapy isn’t as intense as acute rehab.

At acute rehab facilities, “people are guaranteed a minimum of three hours of therapy a day, and a physician visits six days a week,” says Dr. Alexander Dromerick, professor of rehabilitation medicine and neurology and chairman of rehabilitation medicine at Georgetown University Medical Center in Washington, D.C. “(At a subacute facility), they may get a few minutes a day, up to two hours a day, of therapy, and a physician visits every few weeks. They’re very different levels of intensity of care.”

Patients who are making great strides in a subacute facility might be moved to an acute facility for more intense therapy. Those who don’t have the endurance to tolerate an acute facility’s therapy, might be transferred to a subacute facility. “A subacute unit can be a way station back to the community,” Dromerick says, “or it can be a way station to go to a nursing home for the long term.”

Types of Therapy for Stroke Patients

Stroke patients often need physical therapy to strengthen their muscles, retrain their sense of balance and coordination and relearn certain movements. They may need occupational therapy to ensure they can do the tasks associated with daily living, like getting dressed, feeding themselves, showering or relearning skills necessary to return to work. Speech therapy also might be required to relearn how to speak or swallow food.

“Sometimes occupational therapists and physical therapists work together, but occupational therapists focus more on mobility activities that have to do with returning to work or returning to their role in their family or community,” says Carolee Winstein, professor of biokinesiology and physical therapy and director of the Motor Behavior and Neurorehabilitation Laboratory at the University of Southern California. “Physical therapists work on fundamental skills that are needed to be functional in their particular life, whatever it is. We work a lot on mobility. We teach people a lot about the importance of remaining physically active.”

Physical therapists help patients overcome physical challenges — this includes when a stroke has weakened or partially paralyzed one side of the body. Medical professionals refer to that side as “paretic.”

“If they’re having trouble reaching and grasping with their paretic side, I have them do it with their less paretic side to remind them what it should feel like,” Winstein says. “A lot of motor skills are implicit — we don’t think; we do it automatically.”

Occupational and speech therapists also address cognitive challenges.

“We consider most tasks physical, like dressing yourself, (but) all tasks that we do across the day have a cognitive component,” Gillen says. “With getting dressed, it’s the sequence of the clothing: which goes on what body part, which goes on first. If cognition is involved after a stroke, it’s a time-consuming process. We know it will take much longer, much more repetition of practice to get them there.”

Insurance Plans Could Limit Therapy

Health insurance may limit how much therapy a person can receive during a single calendar year or during his or her lifetime. If a person can afford to pay out of pocket, he or she may continue therapy without interruption. Otherwise, many therapists offer plans that patients can follow at home or at a fitness center either on their own or with the help of a family member, friend or personal trainer.

“You can keep working on the stroke problems indefinitely,” Dromerick says.

Therapists hope to get stroke patients functioning independently again, even after their sessions are complete.

“They may need a cane and a brace, but (we teach) them how to navigate with their disability so their disability does not become a barrier in their participation of being active,” Winstein says. “If there are certain things they can’t do, we show them what they can do and get them to work on those things.”

To learn more about stroke rehab and recovery, check out the American Stroke Association’s website.

By Lisa Fields
Lisa Fields is a writer who covers psychology and health matters as they relate to the workplace. She publishes frequently in WebMD and Reader’s Digest.

A breakdown of the various offerings and where insurance fits in
By Lisa Fields

After a stroke, only about 10 percent of people recover almost completely without intervention. For everyone else, therapy is a crucial part of the recovery process. Whether you need physical, occupational and/or speech therapy following a stroke depends on your needs, but the goal is the same: to help you regain control of your body and be independent once again. The therapy you receive should be tailor-made to suit your lifestyle.

“Is the goal returning to driving or returning to work, or (is the person) a retiree who needs to take care of their own bodily functions and participate in playing with a grandchild?” says Glen Gillen, professor and director of programs in occupational therapy at Columbia University in New York and a fellow of the American Occupational Therapy Association.

Kinds of Rehabilitation Facilities

Most stroke patients stay in the hospital for five to six days. Their therapy needs are assessed within the first two days, and therapy may begin on the second. Some patients are sent home from the hospital right away. They may receive outpatient therapy sessions three times a week or get therapy at home from visiting nurses or therapists.

“If they’re higher-functioning, they can potentially go to outpatient therapy, if they have the means to get there,” Gillen says. “That is a challenge for many.”

Many stroke patients are discharged from the hospital to inpatient rehabilitation facilities, where they receive therapy at an intensity that’s best for their needs, based on the severity of the disability. Some go to acute inpatient rehab facilities, which offer the most intense therapy for the most responsive patients. Those with a greater degree of impairment may be sent to “subacute rehab” facilities, where the therapy isn’t as intense as acute rehab.

At acute rehab facilities, “people are guaranteed a minimum of three hours of therapy a day, and a physician visits six days a week,” says Dr. Alexander Dromerick, professor of rehabilitation medicine and neurology and chairman of rehabilitation medicine at Georgetown University Medical Center in Washington, D.C. “(At a subacute facility), they may get a few minutes a day, up to two hours a day, of therapy, and a physician visits every few weeks. They’re very different levels of intensity of care.”

Patients who are making great strides in a subacute facility might be moved to an acute facility for more intense therapy. Those who don’t have the endurance to tolerate an acute facility’s therapy, might be transferred to a subacute facility. “A subacute unit can be a way station back to the community,” Dromerick says, “or it can be a way station to go to a nursing home for the long term.”

Types of Therapy for Stroke Patients

Stroke patients often need physical therapy to strengthen their muscles, retrain their sense of balance and coordination and relearn certain movements. They may need occupational therapy to ensure they can do the tasks associated with daily living, like getting dressed, feeding themselves, showering or relearning skills necessary to return to work. Speech therapy also might be required to relearn how to speak or swallow food.

“Sometimes occupational therapists and physical therapists work together, but occupational therapists focus more on mobility activities that have to do with returning to work or returning to their role in their family or community,” says Carolee Winstein, professor of biokinesiology and physical therapy and director of the Motor Behavior and Neurorehabilitation Laboratory at the University of Southern California. “Physical therapists work on fundamental skills that are needed to be functional in their particular life, whatever it is. We work a lot on mobility. We teach people a lot about the importance of remaining physically active.”

Physical therapists help patients overcome physical challenges — this includes when a stroke has weakened or partially paralyzed one side of the body. Medical professionals refer to that side as “paretic.”

“If they’re having trouble reaching and grasping with their paretic side, I have them do it with their less paretic side to remind them what it should feel like,” Winstein says. “A lot of motor skills are implicit — we don’t think; we do it automatically.”

Occupational and speech therapists also address cognitive challenges.

“We consider most tasks physical, like dressing yourself, (but) all tasks that we do across the day have a cognitive component,” Gillen says. “With getting dressed, it’s the sequence of the clothing: which goes on what body part, which goes on first. If cognition is involved after a stroke, it’s a time-consuming process. We know it will take much longer, much more repetition of practice to get them there.”

Insurance Plans Could Limit Therapy

Health insurance may limit how much therapy a person can receive during a single calendar year or during his or her lifetime. If a person can afford to pay out of pocket, he or she may continue therapy without interruption. Otherwise, many therapists offer plans that patients can follow at home or at a fitness center either on their own or with the help of a family member, friend or personal trainer.

“You can keep working on the stroke problems indefinitely,” Dromerick says.

Therapists hope to get stroke patients functioning independently again, even after their sessions are complete.

“They may need a cane and a brace, but (we teach) them how to navigate with their disability so their disability does not become a barrier in their participation of being active,” Winstein says. “If there are certain things they can’t do, we show them what they can do and get them to work on those things.”

To learn more about stroke rehab and recovery, check out the American Stroke Association’s website.

By Lisa Fields
Lisa Fields is a writer who covers psychology and health matters as they relate to the workplace. She publishes frequently in WebMD and Reader’s Digest.

The contagious bacterial infection can be more serious for older adults
By Mark Ray

When you were a child, did you worry about monsters hiding under your bed or lurking behind your closet door? It turns out one monster — clostridium difficile, or C. diff — may actually be closer at hand, at least in hospitals and nursing homes.

Transmitted via fecal matter, the C. diff bacterial infection can cause severe diarrhea, nausea, fever, dehydration, abdominal pain, kidney failure and even death. Older adults are more vulnerable to it because of naturally weaker immune systems, more likelihood of underlying health issues and more time spent in health care settings.

1. diff is resistant to some antibiotics, but there are some shown to work against it. In serious and recurrent C. diff cases, patients may undergo a fecal transplant or surgery to remove a portion of the colon.
2. diff spores adhere to every imaginable surface, including toilet seats, faucet handles, doorknobs, linens, bedrails, nurse call buttons, chair arms, ceiling vents and even floors. A 2017 study in the United Kingdom detected it in floor corners in 86 percent of hospital rooms that had undergone routine cleaning.

Since its spores resist standard cleaning methods and alcohol-based hand wipes, C. diff is tough to eradicate. “We know those spores can last nine months or more in a room,” says Dr. Kate Mullane, an infectious disease specialist at The University of Chicago Medicine. “It takes a high concentration of bleach to kill the spores: a cup of bleach in a gallon of water.”

And killing the spores is critically important because C. diff itself is a killer. The most common microbial cause of health care-associated infections in the United States today, it causes nearly half a million infections and 15,000 deaths annually — almost as many deaths as drunk driving and HIV/AIDS combined,  according to the U.S. Centers for Disease Control and Prevention (CDC). Eighty percent of C. diff deaths occur among people 65 and older, and one in 11 patients in that age group dies within 30 days of diagnosis.

A two-pronged approach can keep this microscopic, but deadly killer, at bay. Prong one is antibiotic stewardship; prong two is infection control.

Antibiotic Stewardship

You’ve doubtless heard the world uses far too many antibiotics, wasting money and contributing to the growing problem of antimicrobial resistance. The Pew Charitable Trusts reported that 30 percent of outpatient antibiotic prescriptions in the U.S. are unnecessary (antibiotics prescribed for a viral infection, for example).

Doctors are getting more judicious in their use of antibiotics, but Mullane says patients should still talk with their doctors about the drugs they’re prescribing. If you can avoid antibiotics, or at least broad-spectrum antibiotics, you will be less vulnerable to C. diff. This is because, along with the bad bacteria the drugs are after, antibiotics also kill much of the good bacteria in our intestines. This leaves C. diff an opportunity to overwhelm the gut and cause illness.

1. Diff Infection Control

Given C. diff’s persistence in health care environments, it’s also important to prevent transmission between patients, health care workers and visitors — including people who aren’t symptomatic.

“We know at any one time, about 5 percent of the population is colonized with C. diff,” Mullane says. “They may not be sick with it, but they’re at least carrying it.”

The easiest way to stop transmission is with proper handwashing, according to Anna Barker., a researcher in the medical scientist training program at the University of Wisconsin-Madison. “Even with hospital-grade hand sanitizer, which in many cases is pretty similar to what you would buy out in the community, you do still need to use soap and water,” she says.

“It’s not only the soap and water (that gets rid of the germs), it’s the friction and having your hands under the tap water, which you just don’t get when you use (hand sanitizer) gel,” Barker says. A good rule of thumb to make sure you get rid of the germs: Wash your hands for as long as it takes to sing Happy Birthday to You.

But hand hygiene is just the beginning. In the April 2018 issue of the journal Clinical Infectious Diseases, Barker and two colleagues reported their research on the effectiveness of nine discrete C. diff hospital interventions, including everything from patient hand hygiene to terminal cleaning (deep cleaning of a room after a patient is discharged).

Using computer models, Barker and her colleagues found that daily room cleaning with a sporicidal cleaner plus screening for C. diff at the time of admission reduces hospital-associated infections by roughly 82 percent and asymptomatic colonization by about 91 percent.

“When hospitals try to combat their C. diff rates, they’ll end up doing lots of things at once,” Barker says. “This paper showed you can get a considerable reduction in C. diff with only those two interventions.”

What Patients Can Do

While patients don’t have much control over infection-control practices in a hospital or clinic, they can take two concrete actions.

The first is to ask health care providers if they’ve remembered to wash their hands.

“That’s easier said than done given everything we know about power dynamics and the patient-doctor relationship, but I think that really has a potential to make a big impact,” Barker says.

The other action, perhaps surprisingly, is to reduce the clutter in hospital patient rooms.

“One of the things we hear from the cleaning staff is that it’s very difficult to clean a patient’s room effectively if there are newspapers everywhere or books or food or other items throughout the room,” Barker says. “They can’t, at least at our institution, move the patient’s things for them.”

While decluttering your hospital room may not be quite as simple as switching on the lights to banish an under-bed monster, it can go a long way toward keeping you safe from C. diff.

Mark Ray is a freelance writer who has written for Scouting, Eagles’ Call, Presbyterians Today, Kentucky Homes & Gardens and other publications. He has also written, edited and/or contributed to a dozen books for the Boy Scouts and the Presbyterian and United Methodist churches.

The contagious bacterial infection can be more serious for older adults
By Mark Ray

When you were a child, did you worry about monsters hiding under your bed or lurking behind your closet door? It turns out one monster — clostridium difficile, or C. diff — may actually be closer at hand, at least in hospitals and nursing homes.

Transmitted via fecal matter, the C. diff bacterial infection can cause severe diarrhea, nausea, fever, dehydration, abdominal pain, kidney failure and even death. Older adults are more vulnerable to it because of naturally weaker immune systems, more likelihood of underlying health issues and more time spent in health care settings.

1. diff is resistant to some antibiotics, but there are some shown to work against it. In serious and recurrent C. diff cases, patients may undergo a fecal transplant or surgery to remove a portion of the colon.
2. diff spores adhere to every imaginable surface, including toilet seats, faucet handles, doorknobs, linens, bedrails, nurse call buttons, chair arms, ceiling vents and even floors. A 2017 study in the United Kingdom detected it in floor corners in 86 percent of hospital rooms that had undergone routine cleaning.

Since its spores resist standard cleaning methods and alcohol-based hand wipes, C. diff is tough to eradicate. “We know those spores can last nine months or more in a room,” says Dr. Kate Mullane, an infectious disease specialist at The University of Chicago Medicine. “It takes a high concentration of bleach to kill the spores: a cup of bleach in a gallon of water.”

And killing the spores is critically important because C. diff itself is a killer. The most common microbial cause of health care-associated infections in the United States today, it causes nearly half a million infections and 15,000 deaths annually — almost as many deaths as drunk driving and HIV/AIDS combined,  according to the U.S. Centers for Disease Control and Prevention (CDC). Eighty percent of C. diff deaths occur among people 65 and older, and one in 11 patients in that age group dies within 30 days of diagnosis.

A two-pronged approach can keep this microscopic, but deadly killer, at bay. Prong one is antibiotic stewardship; prong two is infection control.

Antibiotic Stewardship

You’ve doubtless heard the world uses far too many antibiotics, wasting money and contributing to the growing problem of antimicrobial resistance. The Pew Charitable Trusts reported that 30 percent of outpatient antibiotic prescriptions in the U.S. are unnecessary (antibiotics prescribed for a viral infection, for example).

Doctors are getting more judicious in their use of antibiotics, but Mullane says patients should still talk with their doctors about the drugs they’re prescribing. If you can avoid antibiotics, or at least broad-spectrum antibiotics, you will be less vulnerable to C. diff. This is because, along with the bad bacteria the drugs are after, antibiotics also kill much of the good bacteria in our intestines. This leaves C. diff an opportunity to overwhelm the gut and cause illness.

1. Diff Infection Control

Given C. diff’s persistence in health care environments, it’s also important to prevent transmission between patients, health care workers and visitors — including people who aren’t symptomatic.

“We know at any one time, about 5 percent of the population is colonized with C. diff,” Mullane says. “They may not be sick with it, but they’re at least carrying it.”

The easiest way to stop transmission is with proper handwashing, according to Anna Barker., a researcher in the medical scientist training program at the University of Wisconsin-Madison. “Even with hospital-grade hand sanitizer, which in many cases is pretty similar to what you would buy out in the community, you do still need to use soap and water,” she says.

“It’s not only the soap and water (that gets rid of the germs), it’s the friction and having your hands under the tap water, which you just don’t get when you use (hand sanitizer) gel,” Barker says. A good rule of thumb to make sure you get rid of the germs: Wash your hands for as long as it takes to sing Happy Birthday to You.

But hand hygiene is just the beginning. In the April 2018 issue of the journal Clinical Infectious Diseases, Barker and two colleagues reported their research on the effectiveness of nine discrete C. diff hospital interventions, including everything from patient hand hygiene to terminal cleaning (deep cleaning of a room after a patient is discharged).

Using computer models, Barker and her colleagues found that daily room cleaning with a sporicidal cleaner plus screening for C. diff at the time of admission reduces hospital-associated infections by roughly 82 percent and asymptomatic colonization by about 91 percent.

“When hospitals try to combat their C. diff rates, they’ll end up doing lots of things at once,” Barker says. “This paper showed you can get a considerable reduction in C. diff with only those two interventions.”

What Patients Can Do

While patients don’t have much control over infection-control practices in a hospital or clinic, they can take two concrete actions.

The first is to ask health care providers if they’ve remembered to wash their hands.

“That’s easier said than done given everything we know about power dynamics and the patient-doctor relationship, but I think that really has a potential to make a big impact,” Barker says.

The other action, perhaps surprisingly, is to reduce the clutter in hospital patient rooms.

“One of the things we hear from the cleaning staff is that it’s very difficult to clean a patient’s room effectively if there are newspapers everywhere or books or food or other items throughout the room,” Barker says. “They can’t, at least at our institution, move the patient’s things for them.”

While decluttering your hospital room may not be quite as simple as switching on the lights to banish an under-bed monster, it can go a long way toward keeping you safe from C. diff.

Mark Ray is a freelance writer who has written for Scouting, Eagles’ Call, Presbyterians Today, Kentucky Homes & Gardens and other publications. He has also written, edited and/or contributed to a dozen books for the Boy Scouts and the Presbyterian and United Methodist churches.

How to find a place that wants to be a real home
By Denise Logeland

Part of the Transforming Life as We Age Special Report

What makes a nursing home a good place for you or your parents? While “good” can mean a lot of things, it should include qualities like dignity and self-determination for the people who live there. The Pioneer Network offers tips on how to check for those qualities.

Formed 20 years ago, the nonprofit Pioneer Network is made up of professionals who work in long-term care, people who live in long-term care and families who advocate for them. The network, active nationally and through coalitions in 36 states, belongs to a broad-based movement in long-term care that is sometimes called simply “culture change.” That is a movement away from generic, system-based care and toward more individual, person-directed care. With culture change, residents have a large voice in the care they get and have as many of the freedoms they had in their earlier homes as possible.

You can find out if a nursing home is guided by the principles of culture change by asking specific questions when you visit to take a tour. A few examples:

• Can residents wake up when they want to in the morning?
• How do you get to know the people who live here?
• How do you build a sense of community and give those who live here a voice in how things are done?
• What is the turnover rate for the direct care workers on your staff?

There are 18 questions in all to ask at nursing homes, and a similar set of 16 to ask when looking at assisted living facilities. You can see the questions and the answers to listen for on the Pioneer Network website, where they are also available as downloads.

Denise Logeland is a writer and editor in Minneapolis who has covered business, health and health care. She is the author of Next Avenue's ebook, 10 Things Every Family Should Know: Aging With Dignity and Independence.

How to find a place that wants to be a real home
By Denise Logeland

Part of the Transforming Life as We Age Special Report

What makes a nursing home a good place for you or your parents? While “good” can mean a lot of things, it should include qualities like dignity and self-determination for the people who live there. The Pioneer Network offers tips on how to check for those qualities.

Formed 20 years ago, the nonprofit Pioneer Network is made up of professionals who work in long-term care, people who live in long-term care and families who advocate for them. The network, active nationally and through coalitions in 36 states, belongs to a broad-based movement in long-term care that is sometimes called simply “culture change.” That is a movement away from generic, system-based care and toward more individual, person-directed care. With culture change, residents have a large voice in the care they get and have as many of the freedoms they had in their earlier homes as possible.

You can find out if a nursing home is guided by the principles of culture change by asking specific questions when you visit to take a tour. A few examples:

• Can residents wake up when they want to in the morning?
• How do you get to know the people who live here?
• How do you build a sense of community and give those who live here a voice in how things are done?
• What is the turnover rate for the direct care workers on your staff?

There are 18 questions in all to ask at nursing homes, and a similar set of 16 to ask when looking at assisted living facilities. You can see the questions and the answers to listen for on the Pioneer Network website, where they are also available as downloads.

Denise Logeland is a writer and editor in Minneapolis who has covered business, health and health care. She is the author of Next Avenue's ebook, 10 Things Every Family Should Know: Aging With Dignity and Independence.

What person-centered care means and how you can get it

By Patricia Corrigan

The way patients and health care providers think about health care delivery is changing, with an increasing desire to involve patients in decisions and planning. Today, many providers also work to meet patients’ needs that go beyond medical treatments. This philosophy is known as person-centered care.

The SCAN Foundation, an independent public charity (and funder of Next Avenue), defines that philosophy as putting older adults “at the center of the decision-making process” by making use of a care team “that considers the full range of needs of individuals and their families.”

Rebecca Kirch, executive vice president of health care quality and value at the nonprofit National Patient Advocate Foundation in Washington, D.C., is a proponent of the philosophy. “So often in our health care system, when we are asked what’s the matter, the provider’s response to our answer doesn’t always align with what matters in our lives to us or to our families,” Kirch says.

What does person-centered care look like, and how can you get it? Here are some examples and advice to help you start a conversation with your doctor about a broader range of care for yourself or a loved one:

‘We Listen to What Patients Need’

Sharp Rees-Stealy Medical Group in San Diego has committed itself to person-centered care, with the goals of improving communication channels and offering more support services.

“Medical groups across the country are paying more attention to what patients need and want because patient involvement produces the best outcomes,” says Janet Appel, Sharp Rees-Stealy’s director of population health. The organization serves some 220,000 patients who make more than a million doctor visits each year.

Appel added, “If people are not engaged in how they receive care, their health goals will most likely not be met.” The medical group practices person-centered care in several ways, including:

• Phone or video appointments
• Webinars on topics such as diabetes education
• Expanded evening and weekend hours
• Case management services
• Support programs
• Nurse navigators to help with difficult diagnoses
• Texting to receive reminders and health tips

“The texting program is especially popular,” Appel says. “Patients choose how often to receive texts with tips for healthy living, reminders about appointments or information on where and when flu shots are available. They can also text us with questions, and texting answers back to them helps us stay connected at the patients’ convenience.”

Appel noted that Sharp Rees-Stealy actively seeks feedback so it can make changes that will help communications and practices evolve based on what patients want. “We listen to what patients need in order to improve patient engagement to improve healthy outcomes,” she says.

Delivering Care Where Patients Are Is ‘Critical’

At Inland Empire Health Plan (IEHP), a not-for-profit Medi-Cal (California’s Medicaid program) and Medicare health plan, the focus on person-centered care extends to individuals who may need it the most. Based in Rancho Cucamonga, IEHP is a network of more than 6,000 providers and 2,000 team members who serve more than 1.2 million people.

Through the Affordable Care Act, a large pilot program called the Behavioral Health Integration and Complex Care Initiative allows IEHP to provide person-centered care for its low-income plan members at locations convenient to them.

Working with a dozen agencies, IEHP has staff at 30 sites. “We’ve put nurses, behavioral health specialists and care coordinators at primary care offices, behavioral health clinics, substance abuse treatment clinics, adult day care centers, assisted living centers and pain management clinics,” says Dr. Bradley P. Gilbert, IEHP’s chief executive officer.

“Many people we serve face many complicated issues, including with their health, housing, transportation and other challenges, so making sure they are part of the planning and then delivering care to them where they are is critical,” Gilbert says.

The project has made significant improvements in people’s health, based on measurements regarding depression, anxiety, blood pressure and more, Gilbert says. “We’ve had great feedback from members, and providers also say they like the structure of the health care delivery.”

Currently, the pilot program is in transition. The number of sites is increasing, and nurse care managers, social workers and community health workers are being added at each. Plus, IEHP is working to house high-risk members who are homeless.

Ask Your Doctor About Person-Centered Care

What about your needs?

Is it a hardship to arrange transportation for X-rays, screenings or blood tests done across town from your primary physician’s office? Maybe you see specialists in two separate health care systems and you want them to better coordinate your care. Could you benefit from a talk with a social worker about local agencies that help pay some living costs?

Speak up, the experts advise.

“Let your voice be heard,” Appel says. “Ask what patient-centered care means at your doctor’s office, and if it’s not available, ask how you can help get that started.” You may be surprised, she adds, at the doctor’s willingness to listen.

“The medical world has gotten into what retail has done all along — listening to the consumers and then drawing them in by offering what the consumers want,” she says. “Today, there is a lot of competition, with many places to go for health care.”

Person-centered care can be especially important when individuals are coping with serious illness. Kirch, at the National Patient Advocate Foundation, gave this example: “Palliative care, now part of mainstream medicine, presents a bullet-proof case for person-centered care that aligns treatment with the goals and the specific needs of the person and the family affected, rather than focusing only on the disease. Providers must ask about those goals, document them and honor them.”

‘What We Need Now is More Public Demand’

Like Appel, Kirch encourages speaking up for what you want from your provider. “Public demand makes medical practices change faster than any policy or payment incentive,” she says.

How would Kirch assess the status of person-centered care in the U.S. today? “We have more than a toehold, but not yet a foothold,” she says. “We have demonstration programs in place in some pockets of the country, but it’s not yet scaled to where it needs to be. Still, I’m optimistic. What we need now is more public demand.”

© Next Avenue - 2018. All rights reserved.

What person-centered care means and how you can get it

By Patricia Corrigan

The way patients and health care providers think about health care delivery is changing, with an increasing desire to involve patients in decisions and planning. Today, many providers also work to meet patients’ needs that go beyond medical treatments. This philosophy is known as person-centered care.

The SCAN Foundation, an independent public charity (and funder of Next Avenue), defines that philosophy as putting older adults “at the center of the decision-making process” by making use of a care team “that considers the full range of needs of individuals and their families.”

Rebecca Kirch, executive vice president of health care quality and value at the nonprofit National Patient Advocate Foundation in Washington, D.C., is a proponent of the philosophy. “So often in our health care system, when we are asked what’s the matter, the provider’s response to our answer doesn’t always align with what matters in our lives to us or to our families,” Kirch says.

What does person-centered care look like, and how can you get it? Here are some examples and advice to help you start a conversation with your doctor about a broader range of care for yourself or a loved one:

‘We Listen to What Patients Need’

Sharp Rees-Stealy Medical Group in San Diego has committed itself to person-centered care, with the goals of improving communication channels and offering more support services.

“Medical groups across the country are paying more attention to what patients need and want because patient involvement produces the best outcomes,” says Janet Appel, Sharp Rees-Stealy’s director of population health. The organization serves some 220,000 patients who make more than a million doctor visits each year.

Appel added, “If people are not engaged in how they receive care, their health goals will most likely not be met.” The medical group practices person-centered care in several ways, including:

• Phone or video appointments
• Webinars on topics such as diabetes education
• Expanded evening and weekend hours
• Case management services
• Support programs
• Nurse navigators to help with difficult diagnoses
• Texting to receive reminders and health tips

“The texting program is especially popular,” Appel says. “Patients choose how often to receive texts with tips for healthy living, reminders about appointments or information on where and when flu shots are available. They can also text us with questions, and texting answers back to them helps us stay connected at the patients’ convenience.”

Appel noted that Sharp Rees-Stealy actively seeks feedback so it can make changes that will help communications and practices evolve based on what patients want. “We listen to what patients need in order to improve patient engagement to improve healthy outcomes,” she says.

Delivering Care Where Patients Are Is ‘Critical’

At Inland Empire Health Plan (IEHP), a not-for-profit Medi-Cal (California’s Medicaid program) and Medicare health plan, the focus on person-centered care extends to individuals who may need it the most. Based in Rancho Cucamonga, IEHP is a network of more than 6,000 providers and 2,000 team members who serve more than 1.2 million people.

Through the Affordable Care Act, a large pilot program called the Behavioral Health Integration and Complex Care Initiative allows IEHP to provide person-centered care for its low-income plan members at locations convenient to them.

Working with a dozen agencies, IEHP has staff at 30 sites. “We’ve put nurses, behavioral health specialists and care coordinators at primary care offices, behavioral health clinics, substance abuse treatment clinics, adult day care centers, assisted living centers and pain management clinics,” says Dr. Bradley P. Gilbert, IEHP’s chief executive officer.

“Many people we serve face many complicated issues, including with their health, housing, transportation and other challenges, so making sure they are part of the planning and then delivering care to them where they are is critical,” Gilbert says.

The project has made significant improvements in people’s health, based on measurements regarding depression, anxiety, blood pressure and more, Gilbert says. “We’ve had great feedback from members, and providers also say they like the structure of the health care delivery.”

Currently, the pilot program is in transition. The number of sites is increasing, and nurse care managers, social workers and community health workers are being added at each. Plus, IEHP is working to house high-risk members who are homeless.

Ask Your Doctor About Person-Centered Care

What about your needs?

Is it a hardship to arrange transportation for X-rays, screenings or blood tests done across town from your primary physician’s office? Maybe you see specialists in two separate health care systems and you want them to better coordinate your care. Could you benefit from a talk with a social worker about local agencies that help pay some living costs?

Speak up, the experts advise.

“Let your voice be heard,” Appel says. “Ask what patient-centered care means at your doctor’s office, and if it’s not available, ask how you can help get that started.” You may be surprised, she adds, at the doctor’s willingness to listen.

“The medical world has gotten into what retail has done all along — listening to the consumers and then drawing them in by offering what the consumers want,” she says. “Today, there is a lot of competition, with many places to go for health care.”

Person-centered care can be especially important when individuals are coping with serious illness. Kirch, at the National Patient Advocate Foundation, gave this example: “Palliative care, now part of mainstream medicine, presents a bullet-proof case for person-centered care that aligns treatment with the goals and the specific needs of the person and the family affected, rather than focusing only on the disease. Providers must ask about those goals, document them and honor them.”

‘What We Need Now is More Public Demand’

Like Appel, Kirch encourages speaking up for what you want from your provider. “Public demand makes medical practices change faster than any policy or payment incentive,” she says.

How would Kirch assess the status of person-centered care in the U.S. today? “We have more than a toehold, but not yet a foothold,” she says. “We have demonstration programs in place in some pockets of the country, but it’s not yet scaled to where it needs to be. Still, I’m optimistic. What we need now is more public demand.”

© Next Avenue - 2018. All rights reserved.

From FaceTime to iPods, residents at senior living spaces embrace technology

By Mike King
September 10, 2018

Connected technology in our homes is fast becoming part of our daily routine. For good reason: it offers entertainment, convenience, connection to others, improved security and increased comfort. It’s also becoming routine in senior living communities. According to a survey by Pew Research, four in 10 older adults now use the internet and own smart phones — up 50 percent from four years ago.

As the president and CEO of Jewish Senior Life, a continuing care retirement community in Rochester, N.Y., I can say that our team’s experience has given us a strong understanding of how technology can help enrich the lives of those we serve.

From email and webcams that connect with family and friends, and games and puzzles that stimulate minds, to technology-enhanced rehabilitation programs that improve hand-eye coordination, residents with a wide range of physical and cognitive abilities are now enjoying technologies adapted just for them. Even those who’ve never used a computer before.

Through technology, they’re able to continue learning, socializing and doing the things they enjoy doing, which helps them stay engaged, informed, in touch and in control.

These technologies also help foster relationships between staff and residents, who enjoy using them together.

Keeping Lines of Communication and Connection Open

Older adults are increasingly adept with laptops, tablets and smartphones. Many of our residents enjoy using platforms like Skype and FaceTime to keep in touch with family members and longtime friends. Video chatting is more personable than a phone call and allows our residents to be “present” at milestone occasions, such as birthday parties, school performances, graduation ceremonies and weddings.

Whether they’re taking a lifelong learning course, engaging in social media, listening to podcasts or paying bills, today’s older adults want ready access to all that the internet has to offer. Just like they did at home.

Hey Google, When is My Therapy Appointment?

One of the many technology devices we rely on at Jewish Senior Life is Google Home. It’s a voice-activated smart speaker. Our transitional care (short-term rehabilitation) patients enjoy using it during their stays to get instant access to information such as the weather forecast, history and current events, as well as where they need to be when. In short, it helps them stay connected to their hobbies and interests, and on top of their schedule.

Other devices that are increasingly common in assisted living centers, retirement communities and medical facilities include:

• iPads preloaded with medication reminders or “face-to-face” check-ins
• Automated pill dispensers, useful for anyone with a complex pill regimen or a memory disorder
• Wireless pendants that activate a phone if a client has a fall
• Health-monitoring devices that can be applied to a parent’s unit as a motion-detector
• Devices that monitor vital signs, or even manage medications

At Jewish Senior Life, we also utilize the It’s Never 2 Late® (iN2L) system. It’s an adaptive computer system with a picture-based, touch-screen interface that allows users to “touch” their way to find all kinds of engaging content for a variety of interests and uses, and it can be personalized for each resident.

Music, the Universal Language

Many people living in a long-term care residence face cognitive and physical difficulties and have left behind their familiar surroundings, familiar faces and even their favorite music.

We have 65 iPods loaded with MUSIC & MEMORY®, a personalized music software program, which helps them find renewed meaning and connection in their lives in the present and helps them reconnect with their past.

We find it also helps residents relax during sundowning — a symptom of dementia in which an individual experiences late-day confusion or agitation. Hearing pieces of music they know gives them a sense of calm, a sense of peace, puts them at ease. It reminds them of what they were like before they had dementia. And since music is the universal language, the MUSIC & MEMORY program also helps eliminate communication hurdles.

Smart Technology Isn’t a Luxury, It’s a Must-Have

Given the rapid pace at which today’s older adults are embracing technology, and all that it enables them to do, from connecting with grandchildren to playing Scrabble and solitaire to reconnecting with their best selves, the role of connected technology in senior living communities will only increase in prominence.

It can be a wonderful companion and a way to keep the mind stimulated and engaged. Technology can also be a great distraction and source of comfort and help older residents cope and adapt to cognitive and physical challenges.

If you’re considering a move to senior living for yourself or a family member, be sure to ask what technologies are available to the residents and staff. The benefits they bring are immeasurable.

From FaceTime to iPods, residents at senior living spaces embrace technology

By Mike King
September 10, 2018

Connected technology in our homes is fast becoming part of our daily routine. For good reason: it offers entertainment, convenience, connection to others, improved security and increased comfort. It’s also becoming routine in senior living communities. According to a survey by Pew Research, four in 10 older adults now use the internet and own smart phones — up 50 percent from four years ago.

As the president and CEO of Jewish Senior Life, a continuing care retirement community in Rochester, N.Y., I can say that our team’s experience has given us a strong understanding of how technology can help enrich the lives of those we serve.

From email and webcams that connect with family and friends, and games and puzzles that stimulate minds, to technology-enhanced rehabilitation programs that improve hand-eye coordination, residents with a wide range of physical and cognitive abilities are now enjoying technologies adapted just for them. Even those who’ve never used a computer before.

Through technology, they’re able to continue learning, socializing and doing the things they enjoy doing, which helps them stay engaged, informed, in touch and in control.

These technologies also help foster relationships between staff and residents, who enjoy using them together.

Keeping Lines of Communication and Connection Open

Older adults are increasingly adept with laptops, tablets and smartphones. Many of our residents enjoy using platforms like Skype and FaceTime to keep in touch with family members and longtime friends. Video chatting is more personable than a phone call and allows our residents to be “present” at milestone occasions, such as birthday parties, school performances, graduation ceremonies and weddings.

Whether they’re taking a lifelong learning course, engaging in social media, listening to podcasts or paying bills, today’s older adults want ready access to all that the internet has to offer. Just like they did at home.

Hey Google, When is My Therapy Appointment?

One of the many technology devices we rely on at Jewish Senior Life is Google Home. It’s a voice-activated smart speaker. Our transitional care (short-term rehabilitation) patients enjoy using it during their stays to get instant access to information such as the weather forecast, history and current events, as well as where they need to be when. In short, it helps them stay connected to their hobbies and interests, and on top of their schedule.

Other devices that are increasingly common in assisted living centers, retirement communities and medical facilities include:

• iPads preloaded with medication reminders or “face-to-face” check-ins
• Automated pill dispensers, useful for anyone with a complex pill regimen or a memory disorder
• Wireless pendants that activate a phone if a client has a fall
• Health-monitoring devices that can be applied to a parent’s unit as a motion-detector
• Devices that monitor vital signs, or even manage medications

At Jewish Senior Life, we also utilize the It’s Never 2 Late® (iN2L) system. It’s an adaptive computer system with a picture-based, touch-screen interface that allows users to “touch” their way to find all kinds of engaging content for a variety of interests and uses, and it can be personalized for each resident.

Music, the Universal Language

Many people living in a long-term care residence face cognitive and physical difficulties and have left behind their familiar surroundings, familiar faces and even their favorite music.

We have 65 iPods loaded with MUSIC & MEMORY®, a personalized music software program, which helps them find renewed meaning and connection in their lives in the present and helps them reconnect with their past.

We find it also helps residents relax during sundowning — a symptom of dementia in which an individual experiences late-day confusion or agitation. Hearing pieces of music they know gives them a sense of calm, a sense of peace, puts them at ease. It reminds them of what they were like before they had dementia. And since music is the universal language, the MUSIC & MEMORY program also helps eliminate communication hurdles.

Smart Technology Isn’t a Luxury, It’s a Must-Have

Given the rapid pace at which today’s older adults are embracing technology, and all that it enables them to do, from connecting with grandchildren to playing Scrabble and solitaire to reconnecting with their best selves, the role of connected technology in senior living communities will only increase in prominence.

It can be a wonderful companion and a way to keep the mind stimulated and engaged. Technology can also be a great distraction and source of comfort and help older residents cope and adapt to cognitive and physical challenges.

If you’re considering a move to senior living for yourself or a family member, be sure to ask what technologies are available to the residents and staff. The benefits they bring are immeasurable.

Throughout the month of May, Presbyterian SeniorCare Network will be embracing the Engage at Every Age theme and will utilize the power of Facebook to publicize our inspiring resident and team member stories. We’ll keep the buzz going all month, so be sure to check Facebook often and be sure to share our posts with your friends and family!

Each May, the Administration for Community Living leads our nation’s celebration of Older Americans Month. The theme for 2018 is Engage at Every Age. This powerful theme emphasizes that you are never too old (or young) to take part in activities that can enrich your physical, mental, and emotional well-being. Participating in activities that promote mental and physical wellness, offering your wisdom and experience to the next generation, seeking the mentorship of someone with more life experience than you—those are just a few examples of what being engaged can mean.

No matter where you are in your life, there is no better time than now to start!

Throughout the month of May, Presbyterian SeniorCare Network will be embracing the Engage at Every Age theme and will utilize the power of Facebook to publicize our inspiring resident and team member stories. We’ll keep the buzz going all month, so be sure to check Facebook often and be sure to share our posts with your friends and family!

Each May, the Administration for Community Living leads our nation’s celebration of Older Americans Month. The theme for 2018 is Engage at Every Age. This powerful theme emphasizes that you are never too old (or young) to take part in activities that can enrich your physical, mental, and emotional well-being. Participating in activities that promote mental and physical wellness, offering your wisdom and experience to the next generation, seeking the mentorship of someone with more life experience than you—those are just a few examples of what being engaged can mean.

No matter where you are in your life, there is no better time than now to start!

Do you take daily medications? Have trouble remembering to take your pills? A pill dispenser may be just what you need. 

Ten percent of all admissions to hospitals and 23 percent of all admissions to nursing homes can be traced to faulty medication administration, such as failure to take the prescribed dose. This forgetfulness costs the United States an estimated $50 billion each year. 

To avoid medication errors in the homes of elderly individuals, it is a good idea to dispense pills and capsules from a tray with compartments for one or more doses for a particular day or specified time.

These trays are designed to simplify drug rounds for home-care providers and reduce the risk of medical errors, and studies have proven their effectiveness. Medication errors are twice as likely to occur with pills or capsules that are not in dispensers compared those from a dispenser. Pill dispensers are inexpensive tools that prove their worth many times over in an age when more elderly individuals rely on daily medications than ever.

The benefits of using a pill dispenser include significant monetary savings, peace of mind and avoiding medication errors. Patients and caregivers feel better when a pill dispenser ensures that the patient will take his or her medication in the prescribed doses and at the correct times.

As most dispensers only need to be filled once a week or less, they can easily be filled by a caregiver or relative for a forgetful senior. Also, filling the dispenser once a week is a great way to keep on track with refills and ensure that the elderly person has all the pills they need for the week (and next week, too).

Tap into our additional Senior Experience here.

Do you take daily medications? Have trouble remembering to take your pills? A pill dispenser may be just what you need. 

Ten percent of all admissions to hospitals and 23 percent of all admissions to nursing homes can be traced to faulty medication administration, such as failure to take the prescribed dose. This forgetfulness costs the United States an estimated $50 billion each year. 

To avoid medication errors in the homes of elderly individuals, it is a good idea to dispense pills and capsules from a tray with compartments for one or more doses for a particular day or specified time.

These trays are designed to simplify drug rounds for home-care providers and reduce the risk of medical errors, and studies have proven their effectiveness. Medication errors are twice as likely to occur with pills or capsules that are not in dispensers compared those from a dispenser. Pill dispensers are inexpensive tools that prove their worth many times over in an age when more elderly individuals rely on daily medications than ever.

The benefits of using a pill dispenser include significant monetary savings, peace of mind and avoiding medication errors. Patients and caregivers feel better when a pill dispenser ensures that the patient will take his or her medication in the prescribed doses and at the correct times.

As most dispensers only need to be filled once a week or less, they can easily be filled by a caregiver or relative for a forgetful senior. Also, filling the dispenser once a week is a great way to keep on track with refills and ensure that the elderly person has all the pills they need for the week (and next week, too).

Tap into our additional Senior Experience here.