Mom needs more Care. Is It Time for a Move?

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Feb 24, 2021

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Is It Time For A Move?
Knowing when and if its time for a loved one to move to a personal care home or assisted living is not easy. Ideally most people want to age in place for as long as possible.
However, if ones independence and well-being start to decline and the practicality, safety, and the benefits of aging in place also falter, a change may be needed. Some older adults recognize and may even welcome this need for change. But more often families struggle with the timing of a move, which is compounded with feelings of guilt and uncertainty, and sometimes sheer resistance from their loved one about moving.
So how do you know when its time for a change? Below are some key indicators that can help you determine if a move may be necessary:

Caregiving is significantly interfering with work, relationships and other responsibilities.
Healthcare professionals recommend a change.
The loved one asks for a change.
Despite your best efforts, things worsen (increased falls, illness and/or hospitalizations).
The loved one is in danger of harming themselves or others, especially those with dementia.
The caregivers physical and mental health and wellness are worsening.
The caregiver is depleted, becoming angry, neglectful, resentful, frustrated.
The caregivers coping methods become destructive (i.e. substance abuse).

Furthermore, youre not alone in determining whether your loved one needs care. A medical evaluation and written order from their physician is required. Plus the residence will assess your loved to determine the right level of care.
Other Considerations
Aging in place can have its limitations. In some cases, it can lead to caregiver burnout and can be overwhelming and unsafe if not well planned. Isolation, boredom and inactivity can also be problematic, especially if the person has stopped driving, has limited mobility and/or their health is on the decline.
Making this choice is not just about the need for care. Personal Care not only provides hands-on care and peace of mind, but it can also foster an improved and more active lifestyle. Socialization and peer activity strengthen the mind, body and soul with a wide range of activities, clubs, events and amenities.
Appreciating the value of proactively moving to personal care or assisted living can be comforting and well-paced. It lends itself to a more positive transition, rather than a power struggle compounded by critical need and hurried placement.

Editors Note: This article was submitted by Nancy Iglesias, Admissions Director at Northland Heights Senior Living. She can be reached at 412-223-3100 or at NIglesias@HamisterGroup.com.

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For instance, in-home care may be more affordable than nursing home care but can still add up if ongoing daily assistance is necessary. Assisted living facilities offer different levels of support and amenities, while nursing homes typically provide the highest level of care at a higher cost. Nationally, costs can range from around $4,500 per month for assisted living to over $9,000 per month for nursing home care, depending on location and the level of care. Understanding these factors is key to ensuring that senior loved ones receive the best care within the familys financial means.Assessing Your Loved Ones Financial SituationFor family caregivers, understanding the financial situation of an elderly loved one is a critical step in planning for long-term care. Its essential to evaluate current assets such as savings, pensions, and Social Security income to determine how these resources align with future care needs. 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Oral Care, Monitored Meals, and Aspiration Pneumonia: What We Dont Know We Dont Know in Health Care:

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/#