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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/#   

Selling your house is a significant decision at any stage in life, but for seniors and their families, it can be especially emotional and complex. You may have spent decades in your home, filled it with countless memories, and now face the challenge of moving onperhaps into a smaller space, a retirement community, or closer to family. Whatever your reason, it's important to explore all your options to find the right way to sell that meets your financial and emotional needs.In this article, we will discuss seven different ways seniors can sell their houses, from handling it themselves to working with real estate agents, auctions, or direct home buying companies. Each option has its benefits and drawbacks, so read on to discover which one is right for you.1. For Sale by Owner (FSBO)Selling your home "For Sale By Owner" means you're taking control of the entire process. You are responsible for getting your house ready to sell, marketing it, showing it to potential buyers, and negotiating the sale without the help of a real estate agent. While this method allows you to avoid paying commissions, it also means that you are in charge of every detail, from the paperwork to the closing process.Pros:- No real estate agent commissions to pay, meaning possibly more money in your pocket.- You control the entire process, from pricing to negotiations.- Direct communication with buyers can speed up the process.Cons:- It can be time-consuming and stressful, especially if youre unfamiliar with the real estate market.- Handling all the paperwork and legal aspects of the sale can be complicated.- Limited exposure compared to listing through an agent.For seniors who feel confident in managing a sale and have the time and energy to devote to it, FSBO could be a cost-saving option. However, it does require careful planning and a strong understanding of local real estate laws.2. List with a Real Estate AgentThe traditional way of selling a house is to list it with a real estate agent. This professional helps you market your house, schedule showings, handle negotiations, and navigate the paperwork, making the process much smoother for you. Agents also have access to the Multiple Listing Service (MLS), giving your home more visibility.Pros:- Professional guidance through every step of the selling process.- Greater exposure to potential buyers through MLS and marketing efforts.- Agents can help price your home correctly for the market, potentially leading to a faster sale.Cons:- Youll need to pay the agents commission, typically 5-7% of the sale price.- Less control over the process compared to FSBO.For seniors who prefer a hands-off approach and want expert advice to get the best price, listing with a real estate agent is a reliable and popular choice.3. List with a Real Estate Agent Who Can Provide Cosmetic Updates Before ListingSome real estate agents offer a special service where they not only help sell your house but also arrange for cosmetic updates before it hits the market. These updates, which can include painting, landscaping, or minor repairs, are often done at no upfront cost to the seller and are instead paid for from the proceeds after the sale.Pros:- Homes that are well-maintained and visually appealing sell faster and for higher prices.- You dont have to worry about paying for the repairs upfront.- The agent handles the logistics of hiring contractors and ensuring the work is done.Cons:- The final sale price may be higher, but youll still need to pay the agents commission which also will typically be higher to compensate them for managing the updates, and the cost of the updates will come out of your proceeds.- Some seniors may feel overwhelmed by having work done on their home while still living in it.This option is ideal for seniors whose homes could benefit from some sprucing up to maximize their market value without the hassle of managing renovations themselves.4. AuctionSelling your house through an auction is an alternative to the traditional sales process. Auctions can be fast-paced and competitive, often resulting in a quick sale. However, the final selling price can be unpredictable, as it depends on the number of interested buyers and their willingness to bid and ability to buy.Pros:- Quick processauctions often lead to a sale within a few weeks.- Potential for multiple buyers to drive up the price.- You can set a reserve price, ensuring you wont sell for less than a certain amount.Cons:- No guarantee that the sale price will meet your expectations.- Auction fees can be high, and theres often no flexibility in negotiation.- Requires a significant marketing push to attract potential bidders.For seniors looking to sell quickly and willing to take some risk on the final price, an auction can be a viable option, particularly for unique or high-demand properties.5. Sell to a Direct Cash Home Buying CompanyDirect cash home buying companies like Home Downsizing Solutions offer a quick and convenient way to sell your house. These companies typically buy houses as-is, meaning you dont need to make any repairs or updates. In return for the convenience and speed of the transaction, you may have to accept a lower sale price than you would get on the open market.Pros:- Very fast sale, often within a few days to a couple of weeks.- No need to make repairs, stage your house, or deal with showings.- Simple and straightforward process with no real estate agent fees or closing costs.Cons:- Offers are usually lower than market value.- Beware of wholesalers who advertise they buy houses, but actually just flip contracts once they have a contract to purchase a house.- Beware of companies that make an offer on your house without seeing and inspecting it.For seniors who want or need to sell quickly in its current as is condition and dont want the hassle of preparing their house for sale, selling to a direct cash home buying company can be a good solution.6. Sell to a Direct Home Buying Company on PaymentsAnother option is to sell your house to a direct home buying company that pays you in installments over time rather than offering a lump sum. This option is particularly appealing if you want to turn your house into an income or want to spread out the tax implications of the sale if that is a concern. Because this option makes it easier for the home buyer to purchase your house, they will offer a higher overall price than with just a cash offer.Pros:- Provides a steady income stream over time, which can be helpful in retirement.- No need for immediate repairs or updates before selling.- Can offer more financial flexibility than a one-time payment.- Receive a higher price for your house than with a cash offer.Cons:- Youll need to trust the buyer to make consistent payments.- You may not receive the full value of your home right away.For seniors who arent in a rush to move or need ongoing financial support, this payment plan approach can be a smart way to ensure long-term income.7. Sell to a Direct Home Buying Company and Stay in Your HomeSome direct home buying companies offer a unique option where you can sell your house but continue living in it. In this scenario, you would sell the property and then rent it back, giving you access to the equity in your house while allowing you to stay in familiar surroundings.Pros:- You can unlock the equity in your house without moving.- No need to disrupt your life by moving right away.- Simple process with no need for repairs or showings.- No maintenance, repairs, or updating to perform.Cons:- Youll lose ownership of your house and become a tenant.- Rent payments could increase over time.- Less control over your living situation in the long term.For seniors who want to stay in their home without the worry of repairs and updates but need access to its equity, this can be a comforting middle-ground option.ConclusionSelling your house as a senior can be daunting, but with these seven options, you have a variety of paths to choose from based on your financial situation, lifestyle preferences, and urgency to sell. Whether you decide to take a hands-on approach with FSBO, list with a traditional real estate agent, or explore more creative solutions like selling to a home buying company, the key is to choose the method that aligns best with your needs and goals during this important transition.For additional information for your unique situation, just contact us at www.HomeDownsizingSolutions.com or call us at (855)-291-5005.

As an adult child, the emotional and practical challenges of moving a parent into a senior care facility can be overwhelming. The process often requires juggling your own responsibilities while ensuring that your parents transition is smooth and dignified. One of the biggest hurdles in this journey is the sale of your parents house, a place filled with memories, personal belongings, and decades of accumulated life. What if there was an easy button you could press to make this daunting task more manageable?Thats where the concept of a direct cash home buying company, like Home Downsizing Solutions, comes into play. These companies offer a streamlined, stress-free solution that can ease the burden on your family during this emotional time. Lets explore how this easy button can benefit you and your loved ones as you navigate this significant life transition.Understanding the Emotional WeightBefore diving into the logistical benefits, its essential to acknowledge the emotional weight of selling a parents house. This is not just a piece of real estate, its a place where your parent has built a life, raised a family, and created countless memories. For many adult children, the thought of selling their childhood home can evoke feelings of guilt, sadness, and anxiety.However, its important to remember that moving your parent to a senior care facility is a step toward ensuring their safety, health, and quality of life. By finding a solution that makes the sale of their house easier, you can focus more on their well-being and less on the stress of real estate transactions.The Solution: Direct Cash Home BuyersWhen selling a house the traditional way, there are several steps involvedpreparing the house for sale, finding a real estate agent, staging the house, hosting open houses, negotiating offers, and dealing with potential buyer demands for repairs or concessions. This process can take months and often feels like a full-time job, which is especially challenging when youre already managing your parents transition to senior care.Direct cash home buying companies like Home Downsizing Solutions offer a different approach. These companies purchase houses directly from homeowners, often as-is, for cash. The process is quick, straightforward, and eliminates many of the hassles associated with traditional house sales. Heres how they can be the easy button you need:1. No Need for Repairs or Renovations: One of the most daunting tasks when selling a house is preparing it for the market. This often involves repairs, renovations, and staging to attract potential buyers. With a direct cash home buyer, you can sell the house as-is, in any condition, with or without any unwanted stuff. Whether the roof needs fixing or the kitchen is outdated, you wont have to invest time or money into getting the house ready for sale. This can be a huge relief, allowing you to focus on your parents transition rather than home improvement projects.2. Fast and Flexible Closing: The traditional home selling process can drag on for months, leaving you in a state of uncertainty. Direct cash home buyers, on the other hand, can close the deal in as little as a week or less, or on a timeline that works best for you. This quick turnaround can be incredibly beneficial if your parent needs to move to the senior care facility quickly. The faster the house sells, the sooner you can complete the transition and move forward.3. No Realtor Commissions or Hidden Fees: Selling a house through a real estate agent typically involves paying a commission, which can eat into the proceeds from the sale. Direct cash home buyers dont charge commissions, and most cover the closing costs, meaning more money in your pocket to help cover your parents care expenses.4. Simplified Process: The process of selling a house to a direct cash buyer is straightforward and involves fewer steps. After contacting the company, they will typically schedule a quick inspection of the property. Once the inspection is complete, theyll make a cash offer or offers, which you can accept or decline. If you accept, the sale moves forward with minimal paperwork and hassle. This simplicity can significantly reduce the stress and time commitment involved in selling the house.5. Certainty of Sale: In a traditional house sale, even after accepting an offer, theres always the risk that the sale could fall through due to whole house inspections, financing issues, buyers remorse, or other unforeseen circumstances. A legitimate direct cash home buyer offers certainty. Once you accept the offer, you can be confident that the sale will go through, giving you peace of mind during this challenging time.Focusing on What Matters MostOne of the most significant benefits of using a direct cash home buyer is that it allows you to focus on what truly matters: your parents well-being. The transition to a senior care facility is a major life change that requires your full attention. By choosing the easy button of a direct cash sale, you can free up time and energy to be present with your parent, helping them adjust to their new environment and providing the emotional support they need.This approach also minimizes the disruption to your own life. If youre juggling work, family, and other responsibilities, the last thing you need is the added stress of a lengthy house sale process. Direct cash buyers provide a way to simplify the situation, reducing the burden on you and your family.A Positive Step ForwardSelling your parents house and moving them into a senior care facility is a significant step, but selling their house doesnt have to be a painful part of that transition. By choosing a direct cash home buyer like Home Downsizing Solutions, you can make this transition smoother and less stressful for everyone involved. The easy button of a cash sale allows you to bypass many of the challenges associated with traditional house selling, giving you more time and energy to focus on your parents needs.While the decision to sell a family house is never easy, the benefits of a direct cash sale can help you navigate this emotional journey with greater ease and peace of mind. In the end, its about finding the right balancehonoring the past while making practical decisions for the future. By pressing the easy button, youre taking a positive step forward in ensuring your parents comfort and security in their new living arrangement.If youd like more information on how Home Downsizing Solutions can provide the easy button benefits when selling your parent or loved ones house, just go to www.HomeDownsizing.com or call (855)-291-5005.