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What We Dont Know We Dont Know in Health Care: September 24, 2024 -Oral Care, Monitored Meals, and Aspiration PneumoniaProper oral care is crucial for maintaining optimal health. Keeping the mouth clean not only helps maintain the protective properties of saliva but also reduces bacteria in the mouth which can be a source of infection in aspiration pneumonia. In addition, monitoring meals and assisting with feeding for those at high risk for aspiration is also a necessity. The process of swallowing involves dozens of muscles that start in the mouth and include the pharynx, larynx, and esophagus. These muscles can become weakened with age and from various, often age-related diseases.  The aging population is especially at risk for aspiration pneumonia due to comorbidities, frailty, and conditions that can impair swallowing.  As a result, aspiration pneumonia is one of the leading causes of death from infection in individuals over the age of 65. One study shows that 1 in 10 deaths from pneumonia in elderly nursing home residents may be prevented by improving oral hygiene (Sjogren et al., 2008). Unfortunately, proper oral care and monitoring of meals is often overlooked in the health care setting.  Perhaps the greatest reason for this is the challenge that almost every health facility faces today: adequate staffing. When I started working in acute care as an RN over 20 years ago, nursing assistants (these are the staff generally responsible for proving oral care in an acute care setting) were typically responsible for 5-7 patients. Nurses had 3-5 patients (this was on a step down cardiac unit). Between the nurse and the assistant, we were able to provide oral care at every meal and offer one-on-one assistance to any patient that was at risk for aspiration. This is no longer the case.  RNs oftentimes look after upwards of 8 patients, and there is generally either no nursing assistant on the floor or only 1 for a patient load that can exceed 20.  Consequently, proper oral care is neglected.  I have often seen patients that are aspirating during meals, but do not have adequate staffing on hand to provide them with the supervision and monitoring that they need. This presents a hazardous catch-22: the aging individual needs to eat to maintain nutritional needs yet he/she needs assistance with eating to prevent aspirating pneumonia.   How can this be remedied? If the family is present, they can provide oral care and meal monitoring. If meal monitoring is required for an at-risk individual, its recommended to touch base with the health care team to inquire as to what the specific aspiration precautions are (every individual may have a different need and/or recommendation). A care companion can also be hired to provide the needed care. I hired a companion for my father when he was in a skilled nursing facility. He was not getting his teeth brushed or flossed regularly, and I was seeing a decline in his dentition. Having this extra support provided him with much needed assistance and the care companion had the added benefit of encouraging him to eat more at every meal, something that was a bonus as he was not meeting his nutrient needs. Touching base with staff to request that oral care and meal monitoring be done can also be helpful. Having an advocate to ensure necessary care is getting done can also be very effective in the health care setting.  What is proper oral care and effective meal monitoring?  Proper oral care includes brushing the teeth for at least 1 minute after every meal. It also includes using a soft bristle brush, fluoride toothpaste, flossing daily. A final component of oral care that is often not discussed is denture care. Dentures should be cleaned at least once per day and removed at bedtime. Removing them prior to sleeping can greatly reduce the risk of pneumonia (Iinuma et al. 2014). Effective meal monitoring includes adequate supervision during mealtime for those at risk of aspiration. Such supervision includes ensuring the individual is properly positioned for a meal (head of bed as high as can be tolerated and supine position), takes small bites, eats slowly, swallows a couple times in between each bite, and intermittently takes a sip of liquid to clear the mouth of food particles. The use of straws is generally not recommended for an individual at risk for aspiration as it propels the food to the back of the throat and hence can increase risk. I recall when I was working as a Registered Nurse (RN) in acute care that I was constantly removing straws from the bedside of at risk individuals and often reminding them to eat slowly and swallow at least twice between each bite to ensure food clearance. Individuals at risk for aspiration often require a modified texture diet as it can further prevent the aspiration of food and liquids.   This is a brief summary of the attention to detail needed in addressing oral hygiene and meal monitoring amongst the aging population. Both measures can play a significant role in reducing aspiration pneumonia.  If you would like more information on understanding proper oral care or any other questions that you may have regarding aging life care, please feel free to reach out to me.    Sources:1.      Sjogren P, Nilsson E, Forsell M, Johansson O, Hoogstraate J. 2008. A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials. J Am Geriatr Soc. 56:21242130. 2.      Iinuma T, Arai Y, Abe Y, Takayama M, Fukumoto M, Fukui Y, et al. 2014. Denture wearing during sleep doubles the risk of pneumonia in the very elderly. J Dent Res. doi: 10.1177/0022034514552493 3.      F Muller, 2015. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541086/#   

The Role of a Geriatric Care ManagerThe share of the United States population over the age of 65 has risen to 16%, and it is expected to climb further to 23% by 2060. People are living longer, and that means that people also have more specialized health care needs.Aging life care calls for a different kind of attention, as various conditions and syndromes begin to present themselves. Depending on which conditions those are, the situation can get complicated pretty quickly. In some cases, it might be worthwhile to consider hiring a geriatric care manager.As we and our loved ones age, we usually end up needing support from the people around us to make sure our needs are met. Family members in particular tend to shoulder this responsibility. But there are many reasons that might make it difficult to have a good support network in place. The most common reason is that family caregivers simply live too far away to provide reliable senior care management.In this context, geriatric care managers can be thought of as "professional relatives." If a family member is not able to provide long term care, geriatric care managers can help provide any and all services related to elder care. They are usually licenced nurses or social workers who are trained in aging life care, and they organize care plans and advocate for their patients needs.If you hire a geriatric care manager, you will be able to count on them to navigate the complexities of the health care system. It can also be helpful to have someone who can make decisions from a neutral point of view, as family caregivers sometimes have to make difficult decisions that are deeply personal.The primary responsibilities of a geriatric care manager are:Coordinating elder care between multiple service providersDeveloping both short and long term care plansHelping manage emotional concerns, stress, and anxietiesHelping manage transitional careHiring additional caregivers as necessaryMake home visits and evaluate living conditionsOngoing assessment of aging life care needsAll of this helps take the pressure off family members and ensures that geriatric care management is always under control.When to Seek Support With an Aging Life Care ExpertThere are many cases in which families are perfectly capable of managing aging life care for someone they love. But it can be challenging to know when you might be taking on more than you can reasonably expect to handle. As discussed above, one of the most obvious challenges is that family members do not live near the person who needs their care. But other complications are not as straightforward.You should consider hiring a geriatric care manager when:You need help with a complex issue. Lots of medical conditions can lead to the kinds of behaviors that should really be handled by aging life care professionals. Issues related to dementia, verbal abuse, or physical violence are among these.Your loved one will not talk to you about their health. Whether it is out of concern for privacy, a soured relationship, or an inability to describe what they are experiencing, older adults sometimes do not let relatives help them. A geriatric care manager gives them someone they feel comfortable talking to about their health. You are having trouble communicating with service providers. Geriatric care managers have a better understanding of where other aging life care professionals are coming from, so if you have run into a wall in negotiations or are not able to get the information you are looking for, your care manager is in a position to communicate more effectively.You do not know what to do. Caring for a loved one can be complicated for reasons beyond their health. We always want the best for them, but sometimes there are multiple pathways and it is not clear which one will be best. Geriatric care managers can provide their objective point of view to help your loved one receive the senior care that is right for themFinding Geriatric Care ManagersA geriatric care manager does not have to hold a state level license. But because many of them come from fields in health care, they elect to maintain their credentials. Care managers who come from social work often have to have active licensure in order to practice in their state.So on the one hand, a lack of certification or licensure is not necessarily a deal breaker. On the other hand, it is important that they can demonstrate their experience as aging life care professionals. If you are hiring a geriatric care manager, be sure to ask about the following:Do they have direct experience with managing issues specific to your loved one? This is especially important to cover in cases of severe injury or cognitive decline.Do they have experience with crisis care management? If your loved one is prone to seizures or is at high risk for falls or heart attacks, aging life care professionals need to know how to handle this type of emergency situation. Also ask them if they are available to respond around the clock, or if they have set hours.How will they communicate information to you? It might seem like a tedious question, but being on the same page about communication methods and styles can save everyone a lot of frustration and confusion.Can they provide references? It can be hard to really understand who you are working with based on their resume alone. Talking to people who know them well is a good way to corroborate your first impressions.How are their costs and fees structured? Senior care can be expensive it is typically not covered under Medicare or most other insurance plans so it is important to understand how much things will cost up front. Geriatric care managers charge by the hour, typically within a range of $75200 per hour.When families turn to aging life care professionals for care management services, they need to know as much as possible about the roles and responsibilities of the people they are bringing into the fold. Geriatric care managers help families navigate the complexities of elder care and relieve them of the stress and anxiety that so often comes along with it. They are experienced in working with a variety of national and local resources, care providers, and care services to ensure the highest quality of life possible.Give me a call for a FREE 20 minute consultation at 714-403-7040. source: Keystone Health, 2024. https://keystone.health/geriatric-care-manager-role-responsibilities#table-of-contents

When deciding on the best senior living residence for your loved one, you may have questions regarding which type of facility is most appropriate to address their current health and desired autonomy. Your physician can hep in this determination, and most assisted living and memory care centers will perform their own assessment both to determine if their facility is equipped to help the individual and to determine a probable path for ongoing care. As time goes on, your loved one will be regularly assessed to ensure that their care plan is beneficial for their evolving needs. ADLs and IADLs are the most common measurement guidelines for the required care level.The six activities of daily living (ADLs) and the eight instrumental activities of daily living (IADLs) are the standard guidelines used to assess whether senior adults can or should continue living independently, or if assistance is needed. In some cases, insurance companies may also require ADL or IADL assessment to clinically identify needs before agreeing to pay for additional care.What Are the 6 ADLs?Bathing. The individual is fully capable of bathing themselves, or may just need help with one part of the body because of injury.Dressing. The individual chooses their own clothes from a dresser or closet, get dressed, and adds appropriate outer clothing such as a sweater on cool days.Toileting. The individual goes to the bathroom without assistance, including getting on and off the toilet, taking off and putting on clothes, and cleaning themselves.Transferring. The individual can gets themselves in and out of a chair or bed on their own.Continence. The individual has complete control over urination and defecation.Feeding. The individual can feed themselves without assistance. (Food may be prepared by someone else.)Effectively Assessing ADLsIf senior adults can perform all six of these activities without any assistance or prompting, they are deemed to have full function, and can care for themselves. A score of four out of six indicates  moderate impairment and that they may need additional care, while one or two out of six indicates severe functional impairment and therefore, they need others to care for them. Many seniors lose these abilities gradually and progressively. Certain tasks may become more challenging as they ag, while others may remain their entire life.What are the 8 IADLs?Using the telephone. The individual can answer the phone, and knows how to call family and friends on their own.Shopping. The individual can purchase everything they need without assistance.Food preparation. The individuals has the capacity to plan, prepare and serve their own food.Housekeeping. The individual can perform home maintenance duties such as washing dishes or making the bed.Laundry. The individual can do their own laundry, at least in part.Mode of transportation. The individual can either drive, or understands how to arrange for their own transportation.Responsibility for own medications. The individual correctly self-administers their medication without prompting.Managing finances. The individual manages their personal finances with little (or limited) help, including paying bills and keeping track of balances.Considerations When Assessing ADLs and IADLsWhile ADLs and IADLs can be helpful in assessing autonomy, they arent a perfect tool. An individuals unique physical and cognitive abilities can change from day to day, or decline gradually over time. Because of this, ADLs and IADLs should be evaluated routinely to identify if any changes in living and care arrangements are needed.At My Care Finders, we help families to navigate the complexities of understanding all of their care options. Our knowledgeable senior care experts can help you to collect the necessary information to make an informed and appropriate decision for your loved one. Call today to learn more about our FREE services.