Start Up Stretching

Regular stretching reduces pain, improves flexibility and quality of life

Flexibility, or the lack thereof, is probably the single most important factor affecting our quality of life as we age. Don’t assume that with aging you will automatically lose your flexibility. You can counterbalance the effects of aging so that your physiology is quite a bit younger than your chronology. When you stay flexible, you’ll be able to live with vibrancy, energy, and independence.

Over the years, we develop habitual ways of using our muscles to move and position ourselves. Poor posture and a lack of flexibility may be the result of a legitimate medical problem or may be the result of limited stretching and improper body alignment. When muscles get tight and stay tight, they cease to be elastic and they restrict movement. That sense of restriction, or stiffness, often leads to disuse. Disuse causes weakness and tightness, which in turn causes a vicious cycle of more disuse, weakness, and tightness.

You have to “lube your chassis” to ensure a smooth ride. Regular stretching activates fluids in your joints, thereby reducing the wear-and-tear caused by friction. Increased water intake is also believed to contribute to increased mobility for tissues and joints that have become less supple.

It is easy to take your physical capabilities for granted, until there is a problem. Your long-term goal should be to maintain your range of motion so that you can continue to accomplish everyday tasks, pain-free. This goal is totally realistic if you are willing to commit to a regular schedule of careful stretching. The benefits of a stretching program will be readily apparent, and you will experience increased comfort as your body moves with fluidity and balance.

Stretching should be peaceful, both physically and mentally. Quiet your mind, breathe deeply, and r-e-l-a-x.

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Six Easy Stretches

To begin with, try walking for five to ten minutes beforehand to warm up the muscles. Warming up is extremely important to prevent injury to joints and muscles. For each stretch, hold it for 10 to 30 seconds and repeat one or two times.

Stretch One: In this stretch try sitting down with a chair in front of you.

Put one leg up on the chair and lean forward, keeping the back straight.

Stretch Two: For this interlace your fingers and extend them in front of you.

Put your head down and extend your arms further until you can feel the stretch in your back.

Stretch Three: For this sit with your arms up, fingers interlaced and palms

facing up. Slowly and gently lean to one side. Hold when you feel the stretch.

Then, lean to the other side and repeat it 2-3 times.

Stretch Four: For this bend the left elbow behind your head and use the right

hand to gently pull the left elbow in further until you feel a stretch in the back of your arm.

Switch sides and repeat.

Stretch Five: Clasp your hands together in front of you and round your

back towards the floor, pressing your arms away from your body to feel

a stretch in your upper back. Do all this in a slow manner.

Stretch Six: Now for this stand with hands on the wall for support in split stance-one

leg forward and one leg back .Press the back heel towards the floor and lean the body

forward until you feel a gentle stretch in your calf. Repeat the same with the other side

Depression is not a normal part of aging, but when older adults do have depression, it may be overlooked, according to the National Institute of Mental Health. Seniors may show different, less obvious symptoms and may be less inclined to experience or acknowledge feelings of sadness or grief. The winter months can be especially challenging because some seniors experience seasonal affective disorder (SAD), a depressive illness triggered when there is less natural sunlight.

The Geriatric Mental Health Foundation says that an elderly person who may be depressed should see a medical professional. Talk to a client’s family or doctor if you suspect a senior is depressed.

For others, keep the winter blues at bay by using these ideas to inspire ways you can cater to each client’s interests with your personal spin:  

• Eat something new – Tackle a new recipe or re-invent a traditional one. Invite family and friends once a week for dinner and take turns preparing meals. Host a potluck dinner or an evening with international cuisine.
• Exercise the mind – Try a jigsaw puzzle or solve riddles. Discuss our question of the week
• Indulge – Enjoy a healthy dessert or sip a hot drink.
• Go for a walk – Invite family members and friends for an evening stroll. During bad weather, complete laps inside a local mall or community center.

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TurkeyNoodle Soup

• 5 quarts water
• 1 cup celery, chopped
• 1/2 cup celery leaves, chopped
• 1 cup onion, chopped
• 7 chicken bouillon cubes
• 1 tablespoon salt
• 1/4 teaspoon black pepper, ground
• 1 bay leaf
• 1/2 cup fresh parsley, chopped
• 1 cup fresh peas or 1 cup frozen peas
• 1 cup carrot, sliced
• 1 cup cut green beans, fresh or frozen
• 4 cups fine egg noodles (8 Oz)
• 1/4 cup butter or 1/4 cup margarine
• 1/4 cup flour
• turkey carcass, from a 15-20 pound turkey

Directions:

In an eight quart kettle or Dutch oven place turkey bones, water — down through to and including the bay leaf.  Heat to boiling; reduce heat, cover and simmer for 1 hour.  Remove the bones to a platter and let cool.

Add the parsley through to green beans.  Heat to boiling; reduce heat and simmer for 10 minutes.  Meanwhile, scrape meat from carcass and return meat to soup pot. Add liquid if required.  Heat to boiling; add noodles and cook uncovered for 10 minutes.

Melt butter in a small frying pan; stir in flour.  Cook over low heat, stirring constantly, until the flour browns.  Stir into boiling soup.  When the soup returns to a boil; reduce heat and simmer for 5 minutes.  Serve hot.

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Holiday Card Project

Pressed Flowers/Leaves –

Pick fresh flowers or leaves from a walk. Remove any wilted petals and leaves. Try not to let flower parts overlap. Leaves should lay flat. Choose a heavy book and line the inside pages with 2 or 3 sheets of paper to protect the book. (Using paper towels might turn the whole thing to mush). Carefully lay the flowers/leaves on the paper, and cover with another 2 sheets. After closing the book I stack another couple of books on top. Or you can also place the book in your microwave and “cook” it for 30 seconds. You’ll have to repeat it a few times, checking to see if the flowers/leaves are almost dried. Then I let the book sit for at least another two weeks before opening.

Use the dried flowers and leaves to make holiday greetings for family and loved ones. Take a moment to arrange the flowers on your card, taking note of how and where you want to position them.  The pressed flowers can be mounted directly on the card itself, or you may want to adhere a background of fabric, or handmade paper to the card stock first before gluing the flowers down.  Hold the pressed flower, apply a very small amount of glue to the back of the flower, position it on the card, and gently press down.  Do the same with the stems and leaves.  Once you’ve finished adhering your pressed flowers/foliage, it’s a good idea to place the card under a heavy book for a few minutes.  The firm pressure will ensure that your pressed flowers will dry flat.

Hope you enjoy our holiday kick off of fun things to enjoy this  time of year!

By Emily P. Walker, Washington Correspondent, MedPage Today
Published: August 16, 2011

The researchers expected that seniors, when faced with mounting out-of-pocket costs, would switch to cheaper generics. In fact, that was one of the main arguments behind the coverage back when Medicare’s drug benefit was created in 2006. If seniors saw how much drugs cost, they’d be more thrifty consumers and seek out cheaper drugs, some reasoned.

But the current study shows that hasn’t been the case.

Rather than seeking cheaper alternatives to prolong entry into the doughnut hole, some seniors just stop taking their prescriptions once they reach the coverage gap or alter their dosing regimen to make their medication last longer.

The Affordable Care Act (ACA) will eliminate the doughnut hole by 2020 and until then, the law takes measures to help seniors defray the costs of the coverage gap.

For example, in 2010, many seniors received $250 checks in the mail, and this year 900,000 Medicare beneficiaries have already received a 50% discount on prescription drugs while in the doughnut hole.

But until the doughnut hole is truly closed in 2020 “beneficiaries may still be at risk of decreased drug utilization and adverse clinical consequences,” the authors wrote.

“In contrast to blunt cost-sharing approaches such as the coverage gap feature, more nuanced, clinically informed insurance strategies that specifically promote the use of drugs with high benefit and low cost may hold the most promise for governments and insurers seeking to improve the health of their citizens while reining in drug costs,” they concluded.

One alternative strategy, the authors wrote, would be to encourage the use of generic drugs from the outset in order to forestall entry into the coverage gap.

The study was funded through grants from the National Institute on Aging, the National Institute of Mental Health, the National Heart, Lung, and Blood Institute, Robert Wood Johnson Foundation, and CVS Caremark.

The study authors reported a number of conflicts of interest, including that lead study author is a consultant for a company that contracts with the Centers for Medicare and Medicaid Services; another author is a consultant to United Healthcare, which sells Part D plans, and receives research funding from CVS Caremark, Aetna, and Express Scripts, which all have Part D business. Another author worked at CVS Caremark during the study, and CVS Caremark provided funding and data for the study.

 Primary source: PLoS Medicine
Source reference:
Polinski JM, et al “Changes in drug utilization during a gap in insurance coverage: An examination of the Medicare Part D coverage gap” PLoS Med2011; 8(8): e1001075

Why Seniors are Moving from Institution Back Home

After living for three years in a nursing home following a stroke, Gail, 78, went through his life savings paying for the nursing home and eventually qualified for Medicaid. He had always wanted to and intended to move back home, but his condition required that he stay in the nursing home. His ex-wife, Sue, and a social worker at the nursing home informed him about a program called “Money Follows the Person” (MFP), which supports efforts to move institutionalized individuals back home.

In 2009, MFP enabled Gail to move into Sue’s house because she is his main care provider. The program allotted $1,500 for home services, modifications to the home in the form of ramps and a handicap accessible bathroom, 16 hours of personal care services each month, and attendance at adult day care each day. Gail’s health has remained steady, he is able to enjoy more of a routine life, and he is able to get the care he needs at home while surrounded by friends and family.

The U.S. Congress authorized the MFP as part of the Deficit Reduction Act of 2005. MFP was designed to assist states in rebalancing their long-term care systems and help Medicaid enrollees transition out of institutions and back to their communities.

Since 2008 when the first senior moved back home through the MFP program, an increasing number of states have been making stories like Gail’s a reality for seniors and others with disabilities. As of February 2011, 43 states and the District of Columbia participate in the “Money Follows the Person Rebalancing Demonstration Program.”  The significance of this program for seniors is found in its intention for establishing a strong foundation of person-centered, consumer-directed, and community-based services. Seniors are receiving the services they need in an environment that is more comfortable for their recovery and/or daily living. Ultimately, the service model is no longer provider-driven and institution-based, but rather it is more conducive to successful living because of the personalized approach. (Centers for Medicare and Medicaid Services).

More recently, with the passing of the Affordable Care Act in March of 2010, the MFP received a boost in funding and a time extension through September 30, 2016. Additionally, the MFP program expanded the eligibility requirements to include anyone who is in an institution for more than 90 consecutive days. The old restriction was anyone who had been institutionalized for six months to two years. The longer an individual has been institutionalized the more likely they are to have relinquished a community residence and it is often more challenging for them to again establish a community residence. Individuals who have been institutionalized for a shorter period of time may still have a home to which they still have access. 

States have their own methods for identifying appropriate candidates for the MFP program. Once identified, the individual has access to the designated funds for their case for a period of twelve months and receives assistance in achieving the needed transition services.

After the program is complete, the continuity of care in each state will vary. Generally, MFP participants may be able to access existing waivers. Participants will continue to be served through these waivers as long as they continue to meet the eligibility criteria.  Therefore, there will not be a lapse in services for MFP demonstration participants. Check with your state on the plans the Medicaid office has in place for the post-demonstration period.
 
Challenges that Affect the Program
While each state handles their grant money from the MFP program differently, each is working to gain foothold in providing opportunities for their institutionalized citizens to regain status as community members. Implementing a MFP program involves comprehensive and extensive planning at the state level as well as collaboration with Centers for Medicare and Medicaid Services. The two main challenges to the success of the program continue to be available housing and accessibility of community service providers.

Housing – The number of residential units available for Medicaid dependents is limited in any case, and states recognize the squeeze that the MFP program places on this issue. More and more states have launched a concerted effort in conjunction with other government agencies such as the U.S. Department of Housing and Urban Development (HUD) to increase their chances of creating and locating safe and affordable housing arrangements.

Examples of what states are doing specifically to address this problem include: Ohio has a housing specialist under the MFP umbrella whose job it is to build partnerships with housing officials. Michigan has 26 housing coordinators throughout the state who identify housing opportunities for MFP recipients (www.kff.org).

Community services – Already stretched thin, service providers who can provide Medicaid supported home- and community-based services (HCBS) are difficult to find. MFP aligns more individuals with service providers, but without enough service providers, the MFP program recipients may not have access to these services. States are working hard to develop HCBS services using MFP dollars because community services are typically more cost-effective compared to institutional care when measured on a per-person basis.

Examples of the most commonly expanded services that states are employing are: case management to coordinate transition; help with home modifications; and one-time housing expenses such as security deposits, use of assistive technology, and transportation (Kaiser Family Foundation). North Dakota has developed a 24-hour back-up nursing service.

All of these efforts are to create more opportunity for community-based service providers that will support the long-term care of seniors and people with disabilities in their homes by providing the care they need.

Successes for Seniors Now and Long-Term
Each year, the numbers of participants transitioning increases as solutions to barriers are identified and significant technical assistance helps states meet transition goals. As of December 2010, almost 12,000 individuals returned to the community as a result of these demonstration programs, with a reinstitutionalization rate of only about 3–4 percent.

The infrastructure that is creating avenues to affordable housing and HCBS continues to be strengthened through plans customized at the state level to provide support for seniors even after MFP is slated to end. This infrastructure is required if states plan to successfully extend the opportunity of transitioning institutionalized individuals for the long-term.

According to the Kaiser Family Foundation, “MFP is likely to continue to help states reorient their long-term services and support systems toward more community-based care. This program in conjunction with other ACA Medicaid policy options has the potential to expand Medicaid home and community-based services for many more seniors and persons with disabilities who desire to live in the community.” Kaiser Family Foundation expects this trend to extend beyond the life of the MFP program demonstration and have a positive long-term impact for seniors.

Resources:
To find out if you are eligible and to apply for MFP, contact the Department of Social Services or related Medicaid office in your state. To get to your state’s official website, most states follow the website address pattern of www.insertnameofyourstate.gov, i.e. www.colorado.gov.

Centers for Medicare and Medicaid Services:
www.cms.gov 

Join the effort to detect Alzheimer’s early

The Home Instead Senior Care^® network has joined the Alzheimer’s Early Detection Alliance (AEDA) in a nationwide effort to educate people about the warning signs of Alzheimer’s disease and the importance of early detection.  The AEDA is a group of corporations, nonprofits and government entities under the leadership of the Alzheimer’s Association dedicated to making a difference in the fight against Alzheimer’s disease.

There is no cure for Alzheimer’s disease and no way to prevent it. Early detection allows those living with the disease – and their families – time to plan for the future. The Alzheimer’s Association created the following list of warning signs for Alzheimer’s disease and related dementias. Every individual may experience one or more of these symptoms in varying degrees:

1. Memory changes that disrupt daily life
2. Challenges in planning or solving problems
3. Difficulty completing familiar tasks
4. Confusion with time or place
5. Trouble understanding visual images and spatial relationships
6. New problems with words in speaking or writing
7. Misplacing things and losing the ability to retrace steps
8. Decreased or poor judgment
9. Withdrawal from work or social activities
10. Changes in mood and personality

If you notice any of these signs in your senior clients, contact the client’s family members immediately.

To learn more about the 10 signs of Alzheimer’s disease, contact the Alzheimer’s Association at www.alz.org/10signs or 877-IS IT ALZ (877.474.8259).

Older adults should guard against over-medication and talk with their doctor about the best ways to manage their health.  Companionship is one.

Q.    As a healthy 75-year-old, I’ve managed without much medication all of my life. My children are always trying to get me to ask my doctors about the newest medications on the market. I think less is more. Am I being unreasonable?  

It’s important to check with your doctor first about any medications you should be on. Never stop taking a medication or reduce your dosage without first consulting your physician.

The Harvard Health Letter points out that with a disciplined lifestyle, seven of the most common senior conditions can be managed without medications. If you’re interested in learning how to continue to keep your meds to a minimum, here’s how. If you’re thinking of incorporating any of these, please discuss first with your doctor:

Arthritis: There’s a good chance that losing weight will make arthritis less painful. Combine weight loss with exercise and you may have less pain and more mobility.

Cholesterol: Your LDL level may drop by 5 percent or so if you keep foods high in saturated fat off the menu. Additional soluble fiber may reduce LDL levels as well. So can margarines fortified with sterols.

Cognitive decline: Memory training and other “brain exercises” seem to help healthy older people stay sharp.

Depression: Studies have shown that regular physical activity can have a potent antidepressant effect.

Diabetes: Regular physical activity is a powerful brake on blood sugar levels as well, because exercised muscle becomes more receptive to the insulin that helps it pull sugar in from the bloodstream.

High blood pressure: Losing weight, getting more exercise, and eating less sodium all lower blood pressure.

Osteoporosis: Weight-bearing exercise puts stress on bones, and bone tissue reacts by getting stronger and denser, fending off osteoporotic processes. Extra vitamin D and calcium top the list of dietary recommendations.

Also, don’t discount the importance of companionship to staying healthy. Make sure that you get out often and socialize with friends. You can make a new friend by hiring a CAREGiverSM from Home Instead Senior Care®. The company’s CAREGivers are often seniors like you who could share many of your hobbies and interests.

For more information about the Harvard newsletter, log on to

www.health.harvard.edu/health

The Loneliness Factor

Loneliness – it’s one of the most serious obstacles to good nutrition that your senior loved one could face. In the United States, approximately 40 percent of the population age 75 and older – 6.7 million people – lives alone, according to the U.S. Census Bureau. These seniors face significant socialization challenges, particularly when it comes to lack of shared mealtime experiences.

“Who likes to eat alone?  Nobody,” says Sandy Markwood, Chief Executive Officer (CEO) of the National Association of Area Agencies on Aging (n4a) – who served as expert source for the Home Instead Senior Care^® network’s Craving Companionship^SM program. “Meals are not just a matter of sustenance, but a social outlet,” said Markwood, whose members coordinate the popular home-delivered meals program, also known as “Meals On Wheels^®.”

“It’s how we come together as a family or a community. When you’re isolated from that opportunity it’s indicative of bigger challenges that person could be facing.”

The far-reaching impact of loneliness prompted the Home Instead Senior Carenetwork to conduct a first-of-its-kind study* to measure mealtime routines, challenges and preferences of seniors age 75 plus who live by themselves in their own homes or apartments. 

This comprehensive study, which involved 600 interviews, provides evidence that increased opportunities for seniors to share meals with others will promote nutritional and emotional well-being. Key findings include:

• Two of five seniors who live alone have at least four warning signs of poor nutritional health.
• One in five seniors says he or she sometimes or most of the time feels lonely when eating alone.
• Seventy-six percent of these seniors eat alone most of the time.
• The biggest mealtime challenge for older people who live alone is lack of the shared family experience, including lack of companionship. 
• Mealtimes last nearly twice as long when seniors who live alone share meals with others compared with when they eat alone.
• A majority of seniors who live alone say they eat more nutritiously and the food actually tastes better when eating with others.
• More than three-fourths of seniors say they wish their families shared more meals together.
• The most common obstacle preventing these seniors from sharing more meals with others is that their family and friends don’t have enough time.  

As a result of this study, the Home Instead Senior Care network launched the Craving Companionship program to encourage extended families to bring back the family meal for the benefit of their seniors, especially those who live alone.

For more information, visit www.mealsandcompanionship.com. The program includes a variety of resources such as recipes and tips to help family caregivers make the most of mealtimes.

*The Home Instead Senior Care network completed 600 telephone interviews with seniors age 75 and older in the U.S. who live alone in their own homes or apartments. The sampling error is +/-4.0% at a 95% confidence level.   

Caregiving Costs U.S. Economy $25.2 Billion in Lost ProductivityNearly one-third of working caregivers miss at least six work days each year

by Dan Witters

This is part two in a special series of in-depth articles on what it means to be a working caregiver in the United States. Part one revealed the demographics of working caregivers in the United States. Part three will look at how caregivers report spending their time and specifics of who they are caring for.

WASHINGTON, D.C. — Working American caregivers — those who work at least 15 hours per week and help care for an aging family member, relative, or friend — report that their caregiving obligations significantly affect their work life.
 

The majority of caregivers say that caregiving has at least some impact on their performance at work. Based on a five-point scale, where five is a great impact and one is no impact, 10% of caregivers choose five and 44% pick somewhere between two and four.

Additionally, 24% of caregivers say that providing care to an aging family member, relative, or friend keeps them from being able to work more.

Most caregivers also report missing entire workdays as a result of their caregiving responsibilities. Thirty-six percent report missing one to five days per year because of caregiving duties, while 30% say they missed six or more days in the past year.

Overall, caregivers reporting missing an average of 6.6 workdays per year. With approximately 17% of the American full-time workforce acting as caregivers, this amounts to a combined 126 million missed workdays each year. This absenteeism costs the U.S. economy an estimated $25.2 billion in lost productivity per year. Including caregivers who work part time in the equation would cause absenteeism costs to climb even higher.

These findings are from a special survey of Americans who self-identified as caregivers in Gallup-Healthways Well-Being Index surveys throughout 2010. Gallup recontacted those self-identified caregivers and interviewed 2,805 who were also employed at least 15 hours per week for a Pfizer-ReACT/Gallup poll specifically about caregiving. All respondents answered affirmatively to the question, “Do you currently help care for an elderly family member, relative, or friend, or not?”

Most Working Caregivers in Professional Roles

Nearly one-third of all working caregivers are in a professional occupation, with another 12% each in service and management roles. Less than 5% of caregivers work in other professions such as installation/repair, transportation, and construction.

Most caregivers (71%) indicate that their employer is aware of their caregiving status, but another 28% believe that their employer is unaware. Furthermore, an analysis of knowledge of workplace support programs shows that about one-quarter or less of working caregivers have access to support groups, ask-a-nurse-type services, financial/legal advisors, and assisted living counselors through their respective workplaces.

Implications

Many caregivers face significant physical and emotional challenges on a routine basis. Given the significant effect that caregiving can have on workplace absenteeism, business leaders should be mindful of the unique realities that caregivers encounter.

Ultimately, providing an organized support system for these employees may prove to be a fruitful investment for businesses, given the high percentages of working caregivers who would like to work more if they could. Many working caregivers are likely interested in seeking support in work-life balance to help them meet their responsibilities as caregivers and employees alike, and the accessibility to assistance could potentially go a long way toward greater productivity in the U.S. workplace.

Survey Methods
Results for this Pfizer-ReACT/Gallup poll are based on telephone interviews conducted Dec. 28, 2010-Jan. 9, 2011, with a sample of 2,805 adults, aged 18 and older, who self-identified as caregivers and were working at least 15 hours per week, living in all 50 U.S. states and the District of Columbia. Respondents had previously self-identified as caregivers in Gallup Daily tracking surveys conducted throughout 2010 and were recontacted to participate in this survey.

For results based on the total sample of caregivers, one can say with 95% confidence that the maximum margin of sampling error is ±2 percentage points. For smaller groups, such as full-time employed caregivers, the maximum margin of sampling error is ±2.3 percentage points.

Interviews are conducted with respondents on landline telephones and cellular phones, with interviews conducted in Spanish for respondents who are primarily Spanish-speaking.

Samples are weighted by gender, age, race, Hispanic ethnicity, education, region, adults in the household, and phone status (cell phone only/landline only/both, cell phone mostly, and having an unlisted landline number). Demographic weighting targets are based on the March 2010 Current Population Survey figures for the aged 18 and older non-institutionalized population living in U.S. telephone households. All reported margins of sampling error include the computed design effects for weighting and sample design.

In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.

For more details on Gallup’s polling methodology, visit www.gallup.com.