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April 2017 Caregiver eLetter
 Aging Care Solutions      Vol. 20, No. 3
     The gauntlet was passed to us and we accepted it.
 Therefore we will cope, and in so doing, set an example 
 for our children, and the generations to follow.
Contact Kay at 972-839-0065 or
www.AgingCareSolutions.com or
kay@AgingCareSolutions.com or kay@kaypaggi.com
    Palliative care is one of the most misunderstood terms in health care. It is often associated with death and dying but it actually refers to specialized medical care for symptom relief. 
   One definition of palliative care is “specialized medical care for people with serious illness. It focuses on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a specially-trained team of doctors, nurses, social workers, and other specialists who work together with a patient’s doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment” (https://getpalliativecare.org/whatis/).

   Palliative care providers often make recommendations to primary care doctors that improve the patients' comfort. Keeping people comfortable and free of pain should be a national priority across the care continuum — not just at the end of life. Pain is a tricky issue, especially for older adults. Narcotics can cause hallucinations and paranoia; clinicians who don't know the patient often misjudge these symptoms. The family caregiver often recognizes these issues before clinicians do, simply because they are more familiar with their loved ones. Communication among all care team members is key to the success of palliative care;
   Ideally, a palliative care consult should be part of the process following every surgery and before every emergency department discharge for elderly patients. It is no longer acceptable to send patients and family caregivers home with a bottle of narcotics to manage their own pain. For older adults, this often leads to overuse of prescription pain medications (often prescribed by different doctors), reactions with other medications, and increased risk of falling.

    Results from a study published in The Gerontologist in 2013 showed that palliative care led to a significant reduction in emergency department visits and depression among elderly participants. Their 2-year study included 250 elderly long-term care patients, half of whom received palliative care. Recipients had about half as many ED visits and were much less likely to suffer depression, compared with those who didn’t receive palliative care.
   Americans are not using palliative care to its fullest potential. Palliative care can reduce pain and reduce dependence on opioid drugs. Part of the problem is the word: Palliative; it is not well understood for most people, and sounds somehow mysterious. We need a common, user-friendly word to describe the benefits of palliative care, like 'comfort management' or 'quality-of-life care.'  The concept of palliative care needs to be part of medical education, and families need to be educated about what it is and the potential benefits it brings their loved ones. The words 'palliative care'  have been linked to hospice and death, resulting in unnecessarily stressful conversations for families. Some refuse to discuss it because of this negative connotation. 

   I had a wonderful experience with Palliative care this week. One of my clients has been in and out of rehabilitation several times over the past year. She has been increasingly frustrated with the rigors of PT and her inability to perform up to expectations. This week she turned her face to the wall and said, No more. She is not well enough to go home without full time help but was discharged from rehab because she had used all her therapy days. This particular rehab community has a Palliative care unit, with its own team and a physician who specializes in Palliative care. She was offered a bed in this unit. Here she can take a breather. . In this unit she can go to therapy if she feels up to it, or stay in bed, or get up and go to the salon on a good day. She pays for room & board; Medicare pays for her palliative care. If she continues to decline, she can move onto hospice without changing her room. Or, she can get better and go home. This program has been a godsend for her family, allowing them to rest, knowing that she is well taken care of. I hope to see  more palliative care units in rehab buildings and nursing home soon.
  Disadvantages of Retirement Communities
    An Aging Life Care Professional (aka Geriatric Care Manager) does a great deal more than advise families about placement issues. Helping families make that decision is only a part of the services we provide. In this article I explore the negatives about relocating into a retirement community.
   First, Retirement communities are not democracies! Your individual preferences are not the top consideration. The wants and needs of all the residents must be taken into account.Some communities have resident counsels; their recommendations are often ignored by the management.
   Then there is size. Invariably, an apartment in a retirement facility is smaller than a house. Independent living units are the largest, assisted living apartments trade space for more care, and units in memory care and the healthcare areas are smallest. The arrangement of the space varies from one community to another. Sometimes the kitchens are large enough to prepare Thanksgiving dinner, other times there is barely room for one cook. Those with plenty of kitchen space may not have large bathrooms, or the bedrooms may not accommodate a king size bed. Very few communities have additional storage space for luggage or Christmas decorations; few have built-in bookcases, pantries or coat closets.
   Once you have moved, it is beyond your control what happens with the ownership, or the management, or the staffing. All retirement places, including those that are 'not-for-profit' are in business to make money. The owners can decide to sell their property, and the buyer may have different values or priorities. The new owner may decide to take a larger share of profit and turn less of the profits into improvements. The staff may change, and the woman who has been your trusted aide may quit. The chef may move somewhere else and the quality of food service decline, while you are paying the same. The wonderful activities that you enjoyed when you looked at the community may disappear when the budget changes.You are powerless to do anything about any of this.
    Residents change over time; you may like your new neighbors, or not. One woman told me years ago that the emergency sirens were too frequent, and always signaled the loss of another neighbor. Your family may relocate to follow a promotion, so you will have to decide whether to relocate to their new city, or stay behind.

     In my opinion, relocating to a retirement community is the best option for the majority of older people. But there are disadvantages. This is a step that should be researched and a choice made with great care.
Making the Move
   Once you have decided where to move, request a diagram of the apartment floor plan so you can begin placing your furniture in the space. There are websites for purchase that do this, or you can draw your own after measuring your furniture. Go into this knowing that not everything you have now will fit into the smaller space. What comes as a shock to most older adults is that their children do not want their precious antiques! Young couples no longer set a lovely table with china, silver and crystal. They order pizza! As a result of this cultural shift, these items have little value on the resale market. Your grandfather's desk - nope, it isn't worth anything. Your grandson going off to college doesn't want your piano or your loveseat or anything else precious that you have carefully saved all these years. Ouch! An estate sale doesn't make nearly as much as one used to make. Some people rent storage units and pay rent until the next generation finds a way to rid themselves of these undesirable inheritances.
   Move managers are highly recommended. They can help you make difficult choices based on what you need to have in your life and what space is available, and what will be useful in  your new environment. Chairs with arms are best; sofas are not so good because they are hard to get out of. Coffee tables are not great because they are knee height and easy to fall over. Bring lots of lighting to compensate for normal age-related vision loss. Move managers are invaluable on the day of the move. They should arrange it so that by day's end, your clothes are hung, sheets are on the bed, groceries in the refrigerator, coffee is made and the boxes are gone.

    Remember that ALL changes, even good changes, are difficult.Remember your first baby? While the arrival was full of joy, it took lots of readjustment. The same applies to moving from living independently in your house to living in a community. Give it time and believe it was the right decision.
April Calendar
Friday, April 14, Good Friday, 7:00 pm, Come enjoy the beautiful music of John Rutter's 'Requiem' presented by the Church of the Epiphany Adult choir joined by a chamber ensemble with harp and organ. Free
    The Episcopal Church of the Epiphany, 421 Custer Rd, Richardson, 75080
Thursday, April 20, 2:45-4:30, Dallas Area Gerontological Society, presents “Infectious diseases in senior citizens and ways to prevent them” by guest speaker GeorgeAnne Thibodeau, MS, CIC   |  Infection Prevention Coordinator, Medical Center of Plano.
   Overture Plano, 500 Coit Rd., Plano, TX 75075  Valet parking will be available
Friday, April 21, 7:30 AM to 4:30 PM, 6th Annual Compassion Fatigue Symposium  $35
Speakers: Keynote- Francoise Mathiew, Martha Fiddes, Dr. Paul Schneider, Jessica Bluesky, Jane Baldwin and Jule Aguirre.  Topics: Healing, Humor and Harmony
     Lovers Lane United Methodist Church, 9200 Inwood Road, Dallas, TX 75220
RSVP: Register online at https://www.educaredallas.com / or send an email to Sharyn Fein at educaredallas@gmail.com   or call 214-263-2826
Thursday, May 11, 6:30 'Preparing for the Unexpected', a panel with Kay Paggi and Marcie Johnson
   7850 Collin McKinney Parkway, Suite 140, McKinney 75070 (Craig Ranch)
Answers to Mental Aerobics
1. wesson
2. nestea
3. combat
4. advil
5. sprite
6. bayer
7. drano
8. parkay
9. planters
10. pampers
11. crest
12. folgers
13. vaseline
14. unisom
Caregiver Support  - The regularly scheduled Caregiver Support meetings have been cancelled. If you need to discuss your ElderCare issues, I am available to meet with you or your family privately. Send me an email, a text, or call me at 972-839-0065 to arrange a time and place.

In This Issue
- the downside of downsizing
 - April calendar
- Sleep Aids
- Mental Aerobics
- Elder Humor 'Life in 1917'

Contact Kay
Visit Aging Care Solutions for practical, useful information about ElderCare. Kay Paggi is a Licensed Professional Counselor (LPC), National Certified Gerontological Counselor (NCGC), Care Manager Certified (CMC), and an ElderCare Mediator.
   Change one letter in each of the following words to make a well-known brand name.
Example: Skimpy - change the 'm' to 'p' for Skippy
1. lesson
2. nested
3. wombat
4. anvil
5. spritz
6. buyer
7. drank
8. parlay
9. plasters
10. campers
11. crept
12. folders
13. baseline
14. unison
(Answers below)
Sleep Aids
   Most of the over-the-counter (OTC) sleep aids contain diphenhydramine. It can cause constipation, confusion, dizziness, and next-day drowsiness. These are particularly bad side effects for older adults. OTC sleep aids also lead to impaired balance and coordination and poor driving performance the next day. The long time use of these drugs is linked to an increased risk of dementia.
   The packaging says it is not 'habit forming.' But long term use of diphenhydramine can create psychological dependence. Psychological dependence is what happens on the night you do not take it and lie there for hours trying to sleep; your mind is convinced that you have to take a pill in order to sleep. How else are you to get to sleep?
   A geriatric psychiatrist recently recommended playing yoga tapes. At the end of  most yoga sessions, there is a cool down period in which you consciously relax. Counting sheep and reading the phone book are substitutes, of course. But listening to relaxation tapes is safe and effective. Amazon has plenty.
The year is 1917 "One hundred years ago." What a difference a century makes! 
Here are some statistics for the Year 1917:

-The average life expectancy for men was 47 years.
-Fuel for cars was sold in drug stores only.
-Only 14 percent of the homes had a bathtub.
-Only 8 percent of the homes had a telephone.
-The maximum speed limit in most cities was 10 mph.
-The tallest structure in the world was the Eiffel Tower.
-The average US wage in 1910 was 22 cents per hour.
-The average US worker made between $200 and $400 per year.
-A competent accountant could expect to earn $2000 per year.
-A dentist $2,500 per year.
-A veterinarian between $1,500 and $4,000 per year.
-And, a mechanical engineer about $5,000 per year.
-More than 95 percent of all births took place at home

Ninety percent of all Doctors had NO COLLEGE EDUCATION!  Instead, they attended so-called medical schools, many of which were condemned in the press AND the government as "substandard."

Sugar cost four cents a pound.
Eggs were fourteen cents a dozen.
Coffee was fifteen cents a pound.

Most women only washed their hair once a month, And, used Borax or egg yolks for shampoo.

The Five leading causes of death were:
1. Pneumonia and influenza
2. Tuberculosis
3. Diarrhea
4. Heart disease
5. Stroke

The American flag had 45 stars ...

Two out of every 10 adults couldn't read or write. And, only 6 percent of all Americans had graduated from high school.

Marijuana, heroin, and morphine were all available over the counter at local corner drugstores. Back then pharmacists said, "Heroin clears the complexion, gives buoyancy to the mind, regulates the stomach, bowels, and is, in fact, a perfect guardian of health!" (Shocking?)

Eighteen percent of households had at least one full-time servant or domestic help...

There were about 230 reported murders in the ENTIRE U.S.A. !

(I have not fact checked this. You are welcome to do that)
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