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Understanding the Types of Rehab for Stroke Therapy

February 15, 2019

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.

Losing Herself in Art and Finding Joy

February 12, 2019

A lifetime of challenges has never slowed the author's spirited mother
By Donna Trump

Part of the Vitality Arts Special Report

My mother, Anne Pols, celebrated her 87th birthday in November. In that same month, she also made her art show debut, exhibiting a half-dozen freehand colored pencil drawings at the Long Island Museum in Stony Brook, N.Y.

She and six other residents of her assisted living program at Jefferson’s Ferry contributed 25 pieces to a show called “Through Our Eyes.” The accomplishment is particularly sweet for my mother for several reasons. She has lived with a physical disability for most of her life. She took up drawing at 86. And six months prior to the show, she lost, in a single instant, most of the vision in her left eye.

One of my sisters said that days after the eye failed, my mother told her she was working on regaining her appetite. “Well, you’ve been though a lot in the last few days,” my sister said. To which our mother replied, “That’s history.”

She returned to her art classes a few weeks later.

Through Her Eyes

In our youth, my three sisters and I were never far from seeing a somewhat terrifying childhood through our mother’s eyes. At six, she nearly died from a ruptured appendix. In the hospital, she was forced to lay on her belly for a month to allow infected fluids to drain from the open surgical incision. A well-meaning relative doused the wound with perfume to diminish the odor. “That hurt,” our mom told us with a whistle.

At nine, she suffered a stroke — likely a burst aneurysm. There were no CAT scans or MRIs then, so the diagnoses ranged, she told us, from cerebral palsy to polio to some kind of infectious disease. In any case, she lost the use of the right side of her body and her speech as well. Her Irish immigrant family didn’t have much, so she was treated at public hospitals. She recalled for us the times she was paraded, naked or partly clothed, across a stage for a roomful of doctors-in-training. “I’d rather do that than go to the dentist any day,” she’d tell us.

When she was 12, her mother died of her own cerebral hemorrhage. Her father followed her mother to his grave within months, succumbing either “to the drink” or tuberculosis or a broken heart, depending on the telling. It didn’t matter why, we learned. What did matter was that her beloved Aunt Mary (barely a decade older than my mother at the time) and Uncle Bill took my mother and her siblings in after they were orphaned. These fine people supported my mother through years of physical therapy and multiple orthopedic surgeries in her teens, and, in fact, for the rest of their also tragically brief lives.

Mild but persistent right-sided weakness and a tendency of her right arm to tighten in spasticity kept my mother from nothing but learning to drive. An occasional word-finding problem showed up most often in calling her four sons-in-law by the wrong names, errors over which she was frequently the first to laugh out loud.

Learning to Draw

At the exhibit, my mother’s drawings are small in scale but realistic, colorful and expertly shaded. In some, she uses a brush to wash over the pencil for a watercolor effect. The subject is generally still life: a cornucopia, a parrot, a bowl of fruit, daffodils.

The daffodil drawing was one of my mother’s first, and when I saw it, it took my breath away. Not only was it was expertly drawn, it reminded my sisters and me of one of my father’s favorite poems. He was the love of her life but is gone nearly six years now, yet another in a series of losses which our mother appears, most times, to take in stride.

My mother started Saturday morning art classes about a year ago, with an accomplished Long Island artist she knows only as Jill. The class is one of many offered by the fine recreational therapy staff at my mother’s assisted living home. She enrolled in part because there wasn’t a lot of other programming on weekends: “It was something to do on a Saturday morning,” she said, adding, “something I was interested in.”

Although she writes with her weaker right hand (assisting with a steadying grip on the wrist with her left hand) she draws with the left. “It’s easier to control,” she said.

The class started with simple coloring of already-drawn designs, which my mother enjoyed, but soon prompted her to tell Jill, “Let me see if I can copy that.” She did. “Then I colored it and watercolored it, too,” she said with satisfaction.

Jill is a constant source of expertise, support and encouragement. “She taught me all about the shading,” my mother said. “That’s what makes it 3-D.”

I do not recall one incident in my mother’s life up to now where she made art for its own sake. She cooked just about every meal we ate, crocheted hats and blankets and sewed some of our clothes — surely artistic endeavors — but always in service to her family.

Not this time. Not with this pursuit of drawing. One of my favorite things about the exhibit was watching my mother, now unable to stand or walk independently and so using a wheelchair for mobility, crane her neck upwards toward exhibit attendees (mostly strangers) to respond to their comments and questions. Her face is animated. She laughs often. Her hands fly up in enthusiasm. She is an artist discussing her work, her process. Her self.

Self and Others

Contrary to much of today’s advice about being one’s own biggest advocate, my sisters and I were raised (in a fairytale compared to our mother’s childhood) with the understanding that “Self-praise is no praise at all.”

I hope it was not only me, among the four of us sisters, whose ego was periodically trimmed by our mother’s quick-tempered, “Who the hell do you think you are?” Let’s just say there wasn’t much discussion about self-actualization.

And yet, the image of her animation at the exhibit stays with me. What is it in drawing that gives her this joy?

In our daily phone calls what I hear most is how time flies — how, in fact, she loses her self — when she’s drawing. “I look up and two hours have passed,” she says. “It relaxes me. It’s like meditation.”

When pressed, she offers just a touch more: “I think that something special came out of me when I started those classes.” I ask her if she feels in any way that she has found herself through this art. “I know who I am,” she informs me, somewhat curtly. “I don’t need to find myself.”

As to the question of what might have come of it all had she started earlier, she is adamant: “I never think about that. My life went the way it did and it was full of love, consideration and respect.”

And now, Saturday morning art classes with Jill.

Donna Trump’s work has been published in december magazine (forthcoming in November 2018), Ploughshares and Mid-American Review, among others. She has received several Pushcart Prize nominations.  Honors include a Loft Mentorship, mentorship with Benjamin Percy, a MN Emerging Writer grant and the selection of her story “Portage” by judge Anne Tyler for first prize in a 2018 contest sponsored by december.

How to Recharge Your Job or Career in 2019

February 6, 2019

A noted life and career coach offers her five-step plan
By Allison Task

Would you like to make 2019 a remarkable year for you?

A new year has begun. It’s is as exciting and fresh as the first day of school and a brand new lunchbox. You’re past those school days, of course, but you aren’t past embracing the new and possibilities to recharge your job or career this year.

As a career and life coach, I help people set — and more importantly — achieve life-changing goals. It’s what I do: identify what isn’t working, clarify what could be better and help people pursue a life they’d rather lead. I’d love to help you make 2019 a remarkable year.

Ready?

What you’ll need:

A 2018 calendar, filled out (or your memories of 2018 fresh in your mind)

A 2019 calendar, fresh and new

Blank paper (or a Word doc if you’re more of a  computer person)

What you’ll get: A remarkable year.

There are five parts to this exercise — reflection, selection, envisioning, planning and sharing. Here’s how it works:

Reflection

For this part, pull out that 2018 calendar if you have it or rely on your memory.

Write down the names of the months on three pieces of paper. Put four months down on a page, in separate quadrants. January, February, March, April on one, May, June July, August on another and September, October, November and December on the last page.

Now, review 2018 month by month. Let’s start with the trips you’ve taken. Where did you go, in which month? Short trips, overnights and longer trips. Write them down on the calendar.

Next: were there any landmark events for you? A new job, a promotion, weddings, graduations, births and deaths? What big events happened in your life, and the life of loved ones?

Sit with this for a while, as you start remembering one thing, which leads to another. As you start filling up the months, you may realize that you need more pages. Enjoy the memory trip.

You’re ready for phase two.

Selection

Once you’ve got a thick set of memories from 2018, take out another piece of paper. On one side, write “coming” and on the other side write “leaving.”

Imagine that you are packing your bag for 2019, and you can choose five things that come with you, and five things you’d like to leave behind. Maybe you hired a terrible contractor last year; leave him or her in the past. More importantly, what incredible things happened? New relationships or experiences that you could pick as the “best of” 2018?

Keep that list of five things you treasured from 2018 and want to bring with you and five things you’d prefer to leave behind.

Envisioning

You’ve just taken stock of 2018 and my guess is that it was more extensive and powerful than you may had remembered. So many things happened. And 2019 will be the same. Right now, you can choose those things.

Look at your top five treasures from 2018. If you were to elevate these, build on the joy they delivered and create even more joy, how could you do that? How could you plan that into the coming year? If you improved your health, how could you celebrate that or take that to the next level? If you became closer to an old friend, is there a new old friend you’d like to connect with this year?

Write it down. Acknowledge and elevate your top achievements from 2018.

Is there something missing that you’d like to be sure to add to this year? Think about what that would be

Maybe you’d like to start meditating more, or get off medications that you think are slowing you down.

Maybe you’d like to travel more, or nest more. This is your life; your choice.

Write it down. Add new goals for 2019.

Next, look at the four seasons and the month at the center of each: February, May, July and October. When you think of these seasons, what do you love most? Is it apple picking in October, and the beach in July? How can you embrace the upcoming season with a new or well-loved experience or person you’d like to have in the center of the season? What is the treasure you’d like to look forward to?

Write it down. Make sure to add your favorite parts of the year to 2019.

Planning

Now take out that 2019 calendar. What is already in place? Have you booked any travel already? When is your birthday? Any upcoming weddings, graduations or other events? Put those on the calendar.

Your 2019 treasure map is starting to take shape.

And now (drumroll please)… add in those extras: those bigger dreams and seasonal joys. Add in the items you identified in the “envisioning” phase. If you can dream it, you can build it. You’ve dreamt it, so put it on the calendar.

Have fun with this. You may find there’s too much to do in one year; some items may need to wait until 2020. Others that seemed important may not seem as urgent now that you’ve raised your game, so they can be replaced.

Sharing

Onto Sharing. This is where the rubber meets the road. It’s time to share your dreams and your calendar with your friends and family members. Make a list of the top five items you want to do this year (that you’ve always done) and top five new objectives (that you’ve never done). Identify something, each month that you are looking forward to doing.

On the first of the month, announce the thing that you’re excited about. You may be telling your loved ones, but what you’re REALLY doing is telling yourself, reminding yourself how sweet your life is, and then sucking every last bit of sweet off your finger tips.

You have now created a treasure map for 2019 of the things you’d most like to do. Pursue that treasure. You’ve created a powerful vision. It can be as remarkable as you let it be.

Allison Task, is a Montclair, N.J. life and career coach whose business is Allison Task Career & Life Coaching. She is a author of Personal (R)evolution: How to Be Happy, Change Your Life and Do That Thing You’ve Always Wanted to Do.

5 Hidden Causes of Heart Disease

January 25, 2019

What can increase your risk and how to prevent it
By Frieda Wiley, PharmD

Heart disease kills about 610,000 people in the United States each year — 1 in every 4 deaths — more than any other disease, according the Centers for Disease Control and Prevention. It’s commonly known that exercise and eating a healthful diet are keys to keeping your heart in tip top shape. But there are seemingly unrelated conditions and lifestyle habits that can lead to heart disease.

Here are five lesser-known causes of heart disease that you can do something about: Sleep apnea; stress, anxiety and loneliness; sitting all day, influenza and dental disease.

  1. Sleep Apnea

“Sleep apnea is very common, especially as we get older, and it puts enormous stress on the heart,” says Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver.

People who have sleep apnea tend to also have other conditions that are associated with the disease, such as high blood pressure, atrial fibrillation (a kind of irregular heartbeat) or pulmonary hypertension, which Freeman defines as high blood pressure on the right side of the heart.

Symptoms of sleep apnea include daytime sleepiness, memory problems and irritability. Being overweight or obese and even structural features, such as having a big chin or tongue, may also make you more likely to develop sleep apnea, according to the American Lung Association.

Premenopausal women are less likely to have sleep apnea than men, but postmenopausal women and men of any age share similar risks. After reaching adulthood, sleep apnea becomes more common with age until you reach 60, when the chances of developing it begin to taper off.

One way to treat sleep apnea is to use a continuous positive airway pressure (CPAP) machine at night. However, Dr. Mark Peterman, a cardiologist at Texas Health in Plano, says that many people find the machine uncomfortable to use. Other treatment options, depending on the severity of the problem, include weight loss, oral appliances (similar to a mouth guard), nasal decongestants and surgery.

  1. Stress, Anxiety and Loneliness

Stress can have powerful effects on the body that wreak havoc on your health. Some stresses, such as learning a new language or skill, can be positive. But Freeman says the majority of stress people experience, like worrying about children or finances, tend to have negative effects on the body.

While it might be difficult to see the connection, the lack of social interaction and fulfilling relationships also impacts heart health.

“It might sound strange to hear a heart doctor talk about love, but people need what we call social support and connection,” Freeman says. “People don’t talk about it much, but people who lack social support or are lonely are at higher risk for heart disease and depression.”

The American Heart Association says that, while stress can harm the heart, researchers still haven’t quite figured out the role stress plays in causing heart disease. Even for those who manage stress well, keeping up with life in our increasingly fast-paced world can still take its toll.

“Treating stress with medication can be difficult, so it usually requires counseling and lifestyle changes,” Peterman says.

  1. Sitting All Day

We hear a lot about how important exercise is to keep your body and mind in shape. Studies also show that sitting the majority of the day increases your chance of developing heart disease.

In a 2014 study of how a sedentary lifestyle affects blood pressure, researchers found a strong association between a sedentary lifestyle and an increase in blood pressure. This finding was independent of time spent in moderate to vigorous exercise. A 2015 study came up with similar findings: Sitting down the majority of the day can increase your risk for heart disease, stroke and even diabetes — even if you exercise an hour a day.

Luckily, this heart risk factor is easily remedied with increasing physical activity. If you’re having trouble getting started, Peterman suggests technological devices like Fitbits to help you become more aware of your daily movement and motivate you to exercise.

  1. Influenza

If you think the only consequences of getting the flu are having body aches, a runny nose and fever for a week or two, think again. The flu can increase the risk for heart problems stemming from the inflammation it causes.

Peterman says the flu has been linked to increased risk of heart trouble between the months of October and February. One study published in the 2016 found that people who had the flu were six times more likely to have a heart attack within the first seven days of their condition being confirmed with laboratory testing.

Sounds like your doctor may have more than one reason for recommending you get a flu shot.

  1. Dental Disease

Dental health is important for more reasons than a great smile; it can also work wonders for your heart.

Mouth issues like cavities and gum disease can trigger chronic inflammation, which Peterman warns can speed up hardening of the arteries, or atherosclerosis, causing the risk of heart problems to soar.

But not to worry. This problem is easily remedied by maintaining good brushing and flossing habits along with regular trips to the dentist.

How to Reduce Body Inflammation

Freeman says these five hidden causes of heart disease lead to inflammation in the body, which is the root of other common diseases, including cancer, diabetes and arthritis. Luckily, there are four key practices you can adopt to put your body in anti-inflammatory mode and strengthen your heart in the process:

  • Eat a predominantly plant-based diet; limit your consumption of animal-based products.
  • Get at least 30 minutes of brisk activity each day.
  • Make time for a little stress relief each day. Prayer, yoga, meditation or anything else that helps you become more mindful and live in the moment helps.
  • Build a strong social network so you feel connected, supported and loved.

“Switching the body into an anti-inflammatory healing environment is what we’re trying to do to get people to heal,” Freeman says.

Hopefully these extra tips will help you take a load off your heart — and your life.

By Frieda Wiley, PharmD

Frieda Wiley, PharmD, CGP, RPh, is a board-certified geriatric pharmacist and freelance medical writer based in the Piney Woods of East Texas. She enjoys using her background in patient care to empower people with more knowledge about living well.@frieda_wiley

Simple Steps to Keep the Deadly C. Diff Infection at Bay

January 22, 2019

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.

18 Questions to Ask Any Nursing Home

January 14, 2019

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.

8 Reasons You’re Losing Sleep

January 8, 2019

Avoid these culprits to get a better night's rest
By Sheryl Kraft

E-READERS

As if there weren’t enough things keeping you tossing and turning each night, here’s a new one: Using short-wave, blue light-emitting e-readers, like the iPad, iPhone, Nook Color, Kindle and Kindle Fire before bedtime can make it harder to fall asleep, according to a December 2014 study at Brigham and Women’s Hospital in Boston.

“When blue light hits the optic nerve, it tells the brain to stop producing melatonin,” which is “the key that starts the engine for sleep,” says Michael Breus, diplomate of the American Board of Sleep Medicine and fellow of the American Academy of Sleep Medicine. “This is especially problematic, since as you get older, the ability to produce melatonin becomes even more compromised.”

Fixes: Open up a real book instead. (Remember those?) If giving up your e-reader is impossible, look for screens and glasses that can block the sleep-stealing blue light on websites like Lowbluelights.com.(MORE: 6 Habits That Ruin a Great Night’s Sleep)

BEING OVERWEIGHT

Carry extra pounds, especially in the neck and trunk section, and it’s more likely you’ll suffer from sleep apnea, which causes your airway to become blocked or obstructed during sleep, robbing you of quality deep sleep. The condition affects 90 percent of obese men, though it’s not purely a man’s disease. The Cleveland Clinic reports that after menopause, it’s just as likely to affect women. Even more disturbing, it goes undiagnosed in as many as 80 percent of those who get a lousy night’s sleep.

“Sleep apnea can mask itself as fatigue, trouble with concentration, dry mouth or even depression,” Breus states.

Unfortunately, the relationship between sleep apnea and obesity is a bit of a chicken-egg scenario. Do sufferers have problems because they’re obese, or is their obesity stoked by their compromised sleep? No one knows for sure, but what is known is this: Poor sleep makes people less motivated to increase physical activity, which can lead to more weight gain. Additionally, reduced sleep is associated with elevated levels of the hormone leptin, which helps regulate appetite.

Fixes: Among the various treatments for sleep apnea is a continuous positive airway pressure (CPAP) machine, which delivers air pressure via a mask that sits over your nose or mouth while you sleep. Other treatment options include losing weight, oral appliances (that resemble mouthguards), and Inspire Upper Airway Stimulation (USA) therapy, a new FDA-approved implantable device.(MORE: A Good Night’s Sleep Could Ward Off Alzheimer’s)

MEDICATIONS

Many popular over-the-counter pain medications, like Excedrin and Bayer Back and Body, may contain caffeine, which helps the medication get absorbed more quickly, but can cut into your sleep, according to Breus (who suggests always checking the label first). If you’re feeling under the weather, beware of nasal decongestants and daytime cold or flu medicines, as well, which can contain pseudoephedrine; you’ll feel jittery instead of tired.

Diuretics, water pills for heart disease and high blood pressure, and ADD medications like Adderall and Ritalin can also disrupt sleep, says Dr. Hrayr Attarian, a neurologist at Northwestern Memorial Hospital in Chicago, Ill. Other culprits include steroids and some medications for depression or asthma. “As with any new medication, always check with your doctor first,” Attarian says.

Fixes: If your meds are causing sleep problems, “First, I’d suggest talking to your physician to see if your medication can be changed or the dose adjusted,” Attarian says. “If that doesn’t work, you can go to a sleep clinic to discuss treatment options that may or may not include sleep aids. Taking a sleeping pill is not always the right thing right away, especially if you are taking other medications to manage health conditions.”

(MORE: 6 Foods and Medications That Don’t Mix)

A WARM BATH

Body temperature naturally begins to drop before bedtime, preparing us for sleep. Although a warm bath can relax and calm you, taking one too close to bedtime will not give your body enough of a chance to cool sufficiently to bring on slumber.

Fixes: To reap the full benefits of your bath, the National Sleep Foundation recommends finishing up your soak at least an hour before climbing into bed. While you’re at it, keep your room cool. “We sleep better in cool rooms,” says Dr. Patrick D. Lyden, chairman of the Department of Neurology at Cedars-Sinai Medical Center in Los Angeles, Calif..(MORE: Can’t Sleep at Night? Look at Your Day)

THE WRONG FOODS

If you like to snack before bed, watch what you eat. Loading up on foods that contain excessive salt or fat can stimulate brain waves, bringing on nightmares instead of sweet dreams, says the National Sleep Foundation. Choose foods that contain tryptophan (an amino acid linked to sleep quality), whole-grain carbs (which help boost serotonin production) and certain minerals (like calcium and magnesium, which can have a calming effect). Examples include half a banana and a handful of almonds, whole-grain crackers and peanut butter, a mug of warm milk, or half a turkey sandwich on whole-wheat bread.

Fix: In general, stick to a routine of eating early in the evening and try to avoid sugar at night. “Late meals are more likely to make it harder to sleep; snacking in the middle of the night can worsen insomnia,” says Dr. Andrew J. Westwood, a member of the American Academy of Neurology and American Academy of Sleep Medicine. Additionally, eating too much can make you feel physically uncomfortable when you lie down, and may cause heartburn, contributing to wakefulness.(MORE: 6 Healthy Foods to Put in Your Grocery Cart)

CLUTTER

The ideal bedroom should be simply furnished and decorated, so there’s not much to distract you from the primary reason you’re in there — to sleep. Excess clutter and mess can often cause anxiety, and remind you of all your unfinished business, making it harder to fall — and remain — asleep.

(MORE: Take the 30-Day Declutter Challenge)

EXERCISE

Sure, being physically active can make you tired, promote sleep and improve the quality of your rest, but exercising vigorously too close to bedtime can rev you up instead. “Aerobic exercise can raise your core body temperature long after you’ve finished,” says sleep specialist Rubin Naiman.

Fixes: Naiman suggests completing exercise at least three hours prior to bedtime. However, gentle exercise like yoga, he says, can be helpful to promote relaxation and sleepiness.(MORE: The Best Exercise to Protect Your Bones)

STRESS

When you’re stressed, your body secretes cortisol, a hormone produced by the adrenal gland. This can disrupt the body’s natural rhythm, says Naiman. “Cortisol is naturally produced in the morning. It peaks at around 8 a.m., when it can be helpful to naturally energize us,” he explains. “But at the wrong time—like nighttime—it can make us hyper-aroused and disrupt our sleep.”

Fixes: In addition to yoga for relaxation, a new study in adults over 55 finds that practicing a popular form of meditation known as mindfulness meditation can reap improvements in sleep quality and reduce insomnia and fatigue. Mindfulness meditation can also help reduce stress, according to a 2009 Massachusetts General Hospital study. Visit Mindful.org to learn some basics.(MORE: 6 Health Risks of Poor Sleep)

If meditation is not your thing, there’s always a good old-fashioned belly laugh; laughter actually induces physical changes in your body, says the Mayo Clinic. It cools your stress response and can increase positive thoughts, which, in turn, causes your body to release neuropeptides to help fight stress.

By Sheryl Kraft

Sheryl Kraft is a freelance journalist, essayist and writer of non-fiction based in Fairfield County, Conn. Her writing covers all areas, with a concentration in health, wellness and fitness.@sherylkraft

What Can You Do to Ease a Caregiver’s Burden?

January 4, 2019

Giving thought to what she or he needs makes the help more meaningful
By: Debbie Swanson

When a friend or family member is knee-deep in caring for a loved one, a common gesture is to drop off a casserole, or remind him or her to “let me know what you need.” But as genuine as your intentions may be, they may not be the best ways to ease the caregiver’s load.

“The person who offers help almost has to be a detective to figure out what the caregiver actually wants or needs,” says Marty Schreiber, a former governor of Wisconsin, advocate and caregiver. Once you do break through, he adds, the resulting respite will be truly appreciated.

But just how do you decipher the caregiver’s needs when he or she is hesitant to share – or maybe doesn’t even know – what could help? Here are some tips on how to analyze the situation. Then, combine creativity with common sense to formulate a warm and welcoming suggestion.

What Brings The Caregiver Joy?

Browsing an antique shop, pruning in the garden, hiking with the dog — everyone has those little things they relish doing from time to time. Enabling those activities to happen is one area where you can really make a difference.

If you knew this person pre-caregiving, you can probably think of things he or she has now put on the back burner. Your direct offer to sit with the caregiver’s loved one while the carer goes out to enjoy a specific activity may be met with surprise. It may also be hard to resist, particularly if you offer a gentle reminder, should your first attempt be ignored.

Of course, this can be difficult if you’re unfamiliar with the caregiver’s hobbies or interests. Try taking a cue from the seasons: Suggest he or she go browsing at the local farmers market or help the person “put up, or take down, holiday decorations,” adds Leslie Koc, coach and speaker on spousal caregiving from Bend, Ore.

If the caregiver is reluctant to leave home, find a way for the person to enjoy interests at home. “Share a list of best movies to watch, and help them create a Netflix online list. Schedule a time to watch a movie with them,” Koc says.

How Can You Give a Caregiver a Break

Escape from routine worries or chores can go a long way toward recharging a weary caregiver. However, suggesting leaving the loved one for an entire afternoon or evening may seem overwhelming. Instead, think of ways to add small breaks to the caregiver’s day.

“Bring lunch ‘in a box’ to enjoy indoors or outdoors,” Koc says. “Include everything, so that when the lunch is finished, there are no dishes to wash.” Pack a few extras, enabling the caregiver to enjoy a few days of no-effort lunches over the week.

An indulgence is another type of break. “Deliver a dessert that is made or sliced in portion sizes that can be frozen after the first pieces are eaten,” Koc adds.

Something else that may be welcome, but is less often extended, is arranging to take the care recipient out of the house (provided he or she is physically able). The caregiver may relish a brief interlude of time alone at home.

For the best results, approach this with a specific plan, like this: “I’d like to take Jane out for a walk — do you want me at 1:30 or 2?” Schreiber suggests.

How Can You Fill In?

When couples have been together many years, it’s common that each partner has settled into certain areas of responsibility: One does the shopping and cooking, another does taxes and budgeting. Now, the caregiver may be anxious about those things his or her partner used to take care of, so, if you can help in some way, it could mean a lot.

Here are a couple of examples: “I’m pretty good with technology, if your computer or programmable thermostat gives you grief” or, “I know just the person who would love tending to Joan’s lovely gardens; what day is best for you?”

If you aren’t familiar with the couple or don’t know what the household needs are, try asking family members. Or ask the caregiver: “What doesn’t work or needs attention? Caregivers can make up a list if asked that specific question,” Koc says.

Does The Caregiver Have Someone To Talk To?

Caring for someone else usually leads to a plethora of feelings — worry, resentment, fear, exhaustion. One simple way to help is to just listen. Call or text the caregiver at a time when you think the person might be less busy. Or drop by with coffee or a cool drink and be willing to step inside if invited. If the caregiver begins to talk about his or her problems, try to be non-judgmental and focus on listening rather than offering advice.

I Don’t Know You That Well, But…

When a less-familiar acquaintance or coworker suddenly lands in a caregiving role, it can be harder to figure out the best way to help. Try connecting the person to a resource, perhaps an organization focused on the disease or condition the loved one is dealing with, suggests C. Grace Whiting, president and CEO of the National Alliance for Caregiving in Bethesda, Md.

“Information about patient advocacy groups can be a great way to get them connected to a network of caregivers,” notes Whiting.

Don’t be surprised if the individual doesn’t talk much about the particular caregiving role. “People may not feel comfortable talking about their situation (in the workplace) for fear that it will negatively impact their career,” Whiting says.

One way to help with that concern is to supply the person with some pertinent facts. If you are in a position to do so, “share information about workplace protections with all of your coworkers, rather than singling one out; programs like paid family leave, the federal Family and Medical Leave Act, telework and flextime,” Whiting says.

If you’re part of a group including the caregiver, such as coworkers or members of a club, you could pool your money to provide gift cards for, say, gasoline, food or coffee. Another great way a group can help is by creating a monthly calendar of care, distributing days for meal deliveries, snow or leaf removal, grocery pickup or someone to check in for a list of needed errands.

While it’s nice to come up with the perfect way to help a caregiver catch a break, remember that what matters most is simply stepping up and letting the person know you are there.

Being a caregiver is a challenging role, and one that can easily result in isolation or despair. But being a caring friend can help create a bright spot in what could be a difficult time.

By Debbie Swanson

Debbie Swanson (www.swansonwriting.com) is a freelance writer living north of Boston. She often writes about pet care, senior living and family topics.

The Second Year After a Loved One’s Death

December 7, 2018

Moving forward while learning lessons about grief and living with the loss
By Jackson Rainer

For more than 25 years, I served as a psychology professor and researched grief and bereavement. I consulted and taught individuals, couples and families to meet the demands that chronic illness exacts, to build safety nets and resilience in the presence of stress, and to create space for the problems that the loss of a loved one brings. I was widely published, including a well-received book (Life After Loss:  Contemporary Grief Counseling and Therapy), and produced professional audio and video recordings on end-of-life and palliative care.

Throughout, I struggled with the truth that my wife lived with a genetic cancer syndrome causing chronic health concerns, including multiple presentations of vicious cancers over the course of 33 years. She was as well-educated as I; we met the challenges of her illness with state-of-the-art treatment and care, including two decades of participation with the National Institute of Health’s research projects related to Lynch Syndrome.

Then She Died

In the summer of 2016, she began to fail for no apparent reason. Her research teams and physicians had no explanation, nor could they offer any further course of treatment. As she lost energy and strength, I became more alarmed.

The principal investigator of her study told me, “Jack, she has outlived this disease longer than any of us ever expected. She is a medical marvel and there is nothing further that we have to give. It may be time to call in hospice.”

One of her gifted practitioners, a neurologist, suggested that her body “just had enough,” which he termed idiopathic metabolic myopathy, diagnosed when the body unexpectedly stops translating nutrients into chemical energy.

They were right. Her body was exhausted and said “No more!” She died over the course of five weeks as an in-patient in a local hospice, attended to by personal and loving friends with whom we had worked over the years.

The Process of Grief

I arrogantly thought I was ready for my wife’s death. But it took me no time to realize that the experiential nature of grief is very, very different from academic study or clinical facilitation of others through the process. My spouse, lover and favorite playmate was gone. For years, I had taught that the process of grief does not change a person as much as it reveals another part of the self. What I quickly learned is the understanding of myself as student, professor and scholar had little relevance to living as a 61-year-old man whose wife of 38 years had died.

There Are Benchmarks

Much has been written about the natural process of grief. Those in the presence of loss are taught to stay in motion, however that looks personally, and to talk about their feelings of the impact caused by the absence of the deceased. Much is made of the first year following the death of a loved one. There is such focus to understand and explain the loss and come to terms with voids created by the absence of the deceased.

Meeting the markers of the “firsts” such as holidays and birthdays are places for attention, coupled with the erroneous belief that getting over such hurdles will lead to an easier acceptance of the loss.

Little is discussed of the second year, when those who grieve begin to assume a new identity reflecting new circumstances of life. The second-year experiences surprise us in that our loved one will always be absent, yet somehow present. Personally, I became uncomfortably aware of the discrepancy between the world that is now and the world that was.

The Sadness of the Second Year

Sadness is more than an abstract feeling. It penetrates the source of a person’s being and emerges when there is nothing, nothing, nothing to do except live with the loss. It is about resignation and invites one to turn attention inward, to take stock and to adjust.

For me, sadness continues to fine tune my memory in order to tolerate the good, bad, and ugly of my marriage. Over time, sadness has become a bass note to the day-to-day music of my life.

Time has a different meaning. Like all of us, I rely on chronological and sequential time to stay in the rhythm of the day (I have a young friend who calls this “the default world”), but in this second year, I live in what I’ve learned is kairos time, when an hour can be forever, a year a moment. I don’t understand this very well, but trust that time as we typically know it is not real. It is neither an event nor a thing, but a human-mind interpretation of a sense.

For some strange reason, I believe that I can simultaneously grasp the past in memory, the present by attention and the future by expectation. This is the oddest experience and more than a little squirrely.  Life goes on in a linear way, so for many of us grieving the loss of a loved one, the second year forces us to face the harshness of loneliness because the social support of others fades.

What to Do?

In grief, it is never a good idea to curl up into a ball and wait for the will to live to pass away, as appealing as this thought may be. Better, acknowledge the loss and the truth that things do change.

Companionship counters loneliness. While I miss the companionship of my wife, I want the company of others. Such proximity allows an honoring of her spirit, rather than focusing on my intellect. The presence of others bears witness to the struggles of life.

Realize, with “real eyes,” as Rockland, Maine spiritual director Deirdre Felton says, “Doors are opening. Doors have closed. Take a breather and spend time with the new chrysalis that will hatch in its own time, with a new version of yourself, still who you are, but now somehow different.”

By Jackson Rainer

Jackson Rainer is a board certified clinical psychologist who practices psychotherapy with individuals and couples at the Care and Counseling Center, Atlanta.  He is a Professor Emeritus of Psychology with the University System of Georgia.




 

When You Are Shamed for Moving a Parent into a Care Center

November 30, 2018

How to cope when other relatives don't understand your decision

By Rachael Wonderlin

Beth came up to me, tears in her eyes.

“My cousins came into town,” she lamented. Normally this would not seem like a big deal, but Beth’s cousins were diametrically opposed to the idea of her moving her mother — their aunt — into a long-term dementia care community.

“They think I shouldn’t have moved Mom…they think I should have just kept taking care of her at home,” Beth sighed, dabbing at her eyes. “Maybe they’re right. Maybe I should just take Mom back home with me.”

More3 Surprising Things That Raise Your Dementia Risk

I would love to tell you that this was the first story of a family member getting shamed for moving their loved one into a care community, but it is not. I am the director of Memory Care at an assisted living community, and I’ve been working in dementia care for five years. I hear this kind of thing all the time.

Harsh Judgment

We’ve all heard of “shaming,” a phrase that seems to have picked up more popularity recently. We have seen everything from “body shaming” to “middle class shaming” in articles online. I’ve become very familiar with another type of shaming: shaming people for moving their loved ones into long-term care communities.

Although it would be very nice if everyone could take care of their aging loved ones at home forever, this is just not the case for many families. There are many factors involved: where the family lives, what jobs and responsibilities the family members have, what type of care the aging adult needs, financial concerns, nutrition and health concerns.

Most complicated are mental health concerns for the aging adult. Taking care of anyone at home is challenging. Taking care of an adult with dementia at home is particularly difficult. For example, if you are caring for someone with dementia in your three-story house, you cannot explain to that person that he or she should not attempt to use the stairs if they are home alone. People with dementia have trouble remembering facts, following directions, or understanding risks.

I cannot tell you how many people have had to move their loved ones with dementia into an assisted living or skilled nursing facility because of a major fall.

A Limited View

I explained all of this to Beth. I also reminded her that, no matter what her cousins from out of town had to say, they were not the ones caring for her mother. They didn’t come visit her every single day. They hadn’t been taking care of her at home for the past two years, watching her dementia progress and her falls become more frequent.

These cousins hadn’t retired early, just so they could help care for this aging woman in her own home. They weren’t taking time away from friends, other family, and vacations to bathe, clothe and feed this woman.

More3 Ways to Work From Home and Be a Caregiver, Too

Beth’s cousins had absolutely no idea what it was like to take care of another human being at home without much in the way of other help.

It’s Different With Kids

When you are raising children at home, there’s a community that rallies around you. You host big birthday parties, invite other parents and their children over to your house, plan nights out, call up babysitters, and, although you are probably exhausted, you feel joy in watching your children learn and grow.

From what I have seen, caring for an aging parent is the complete opposite. There is no sense of community. There is no joy in watching them grow and learn. There is only guilt, sadness and panic as you watch them descend deeper into physical and mental disability. There aren’t birthday parties, family gatherings and babysitters to lend you a hand.

A Common Theme

I offer a phone call service for caregivers who have questions about dementia care. While I always help these caregivers troubleshoot their dementia-related issues and provide advice about care communities or care at home, we always end up talking about guilt. All of these caregivers feel guilty, even the ones who are taking care of their loved ones at home.

They don’t give themselves time off, they don’t get paid, and they certainly don’t let themselves off the hook about mistakes they feel that they have made.

“Mom fell the other day,” one told me. “I left the room for 20 minutes to do her laundry, and I should have put the phone next to her — she could have called me for help! This was all my fault.”

‘Clean, State-of-the-Art’

Choosing to move a loved one into a care community is a personal decision. Care communities are also not the awful places we read about decades ago. “Putting someone in a home” does not carry the painful weight it used to carry.

Many of the care communities I’ve visited are clean, state-of-the-art buildings that offer social activities and outings. Sure, care communities are not perfect, but caring for people is an imperfect science. Choosing to move a loved one into assisted living or skilled nursing should not be a worst-case scenario. Sometimes it’s the best-case scenario for aging adults and their families.

My hope is that, as our population continues to age, our society will begin to understand the need for all types of care. The U.S. prides itself on being made up of many types of people and families. Yet we lack the progress and understanding that comes with accommodating different types of caregiving. You can care for a loved one from across the country and still be a fantastic caregiver. There is no shame in choosing the best possible care situation for you and your loved ones.

 
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