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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

Moving to a new place is never easy, and it is even harder for our elders. The thought of leaving their home and familiar surroundings can be overwhelming. However, sometimes, its necessary for them to move into an independent living community to ensure their safety, comfort, and well-being. There are multiple independent living communities in Florida, making it challenging to choose the best one for your loved one. This blog post guides how to choose the right independent living community in Florida that meets your loved ones needs.An Initial Step: Identifying Your Loved Ones Personal NeedsAssess Your Loved Ones Needs: Before choosing an independent living community, assess your loved ones needs, including their health, mobility, social life, and budget. Speak to their doctor and caregiver to get a clear understanding of their medical needs. Find out how independent they want to be and what activities they are interested in.Importance of Location: Proximity and ConvenienceThe next crucial thing to consider is the location of the independent living community. Ensure the communitys location is convenient for you and your loved one. Inquire about the communitys proximity to hospitals, grocery stores, and other essential services. The availability of transportation services is also an important consideration.Variety of Amenities: Catering to Specific PreferencesDifferent Independent living communities offer varied amenities. Its essential to compile a list of amenities crucial to your loved ones well-being and compare different communities offerings. These amenities may range from a fitness center, spa, swimming pool, and wellness programs. Ensure that the community can cater to all your loved ones needs.Staff Quality and Services: Ensuring Professional CareThe quality of staff and services offered in the community is also an important consideration. The community should have professional caregivers who are available 24/7 and a personalized care plan for each resident. Its essential to inquire how the community ensures the safety and security of its residents. Check on the ratio of staff to residents to ensure they provide adequate care.The Power of Reviews: Leveraging Experiences of OthersFinally, research and read online reviews of each independent living community you are considering. These reviews can help you gauge how happy the residents are, the standard of care and professionalism, and other critical aspects. A community with multiple positive reviews is likely to be a good fit for your loved one.Conclusion: Navigating the Selection Process with Confidence and AssistanceThe process of finding the perfect independent living community in Florida for your loved one can undoubtedly seem daunting. However, its crucial to remember that the primary goal is ensuring their happiness, security, and well-being. With a clear understanding of their needs, preferences, and the essential factors to consider, such as location, amenities, staff and services, and reviews, youre well-equipped to make an informed decision.But you dont have to navigate this challenging process alone. Involving an experienced elder law attorney can provide invaluable assistance, from long-term care planning to estate planning. They can guide you on leveraging government benefits like Medicaid Long-Term Care to cover nursing home costs, preserving your loved ones assets for their heirs, and avoiding probate. Armed with all these resources and knowledge, you can help your loved one transition seamlessly into a new stage in life that offers comfort and security and caters to their specific needs and preferences.At Mortellaro Law, we practice elder law and offer personalized services designed to provide peace of mind to you and your family. We will take the time to understand your unique situation and help you meet all of your needs. Our team of experienced attorneys and staff can help; schedule a free consultation today to learn more.If youre in the Tampa Bay area and are interested in estate planning, long-term care planning, or asset protection, consider joining our free monthly seminars. While part of our focus is on guiding you in finding the ideal independent living community in Florida for a loved one, we also provide valuable insights into a wide array of topics. These include general estate planning, strategies for long-term care, and effective methods for asset protection. Dont miss this chance to broaden your understanding and make informed decisions. Click here to sign up for our next seminar.