ScienceDaily (Jan. 10, 2011) — A large proportion of Medicare expenditures for nursing home residents with advanced dementia, a terminal illness, is spent on aggressive treatments that may be avoidable and of limited clinical benefit, according to a new study by the Institute for Aging Research, an affiliate of Harvard Medical School, published in the online version of the Archives of Internal Medicine on Jan. 10, 2011.

The study examined Medicare expenditures for 323 nursing home residents with advanced dementia in 22 facilities in the Greater Boston area as part of the Choices, Attitudes, and Strategies for Care of Advanced Dementia, or CASCADE, study. According to the findings, the largest proportion of Medicare expenditures was for hospitalizations (30.2%) and hospice (45.6%). Medicare expenditures rose by 65 percent in each of the last four quarters before death, primarily due to an increase in both acute care and hospice services. Acute care costs were lower among residents who had either a Do Not Hospitalize (DNH) order, lived on a special care dementia unit, or did not have a feeding tube.

“Our study demonstrates that a large proportion of Medicare expenditures in advanced dementia are attributable to acute and sub-acute services that may be avoidable and may not improve clinical outcomes,” says senior author Susan L. Mitchell, M.D., M.P.H., a senior scientist at the Institute for Aging Research.

An additional 10 percent of Medicare expenditures were for care in a rehabilitation facility after hospitalization. Dr. Mitchell calls the benefits of skilled nursing or rehabilitative care for these patients “questionable,” given that most of them are totally physically functionally and cognitively impaired.

Strategies that promote high-quality palliative care may shift expenditures away from aggressive treatments for dementia patients at the end of life and more toward a comfort care approach, say the researchers.

“The strong association between the lack of a DNH order and higher acute care expenditures supports the notion that advance care planning may be a key step toward preventing aggressive end-of-life care,” says Dr. Mitchell, an associate professor of medicine atHarvardMedicalSchool. Among cancer patients, advance planning lowers costs in the last week of life, and lower costs are associated with a higher quality of dying experience.

Both hospice and palliative care focus on quality of life or “comfort care,” including the active management of pain and other symptoms, as well as the psychological, social and spiritual issues often experienced at the end of life. Unlike hospice, however, palliative care services do not depend on life expectancy and may be used in conjunction with curative treatments.

Estimates peg 2010 total health-care expenditures for dementia at $172 billion, which will continue to rise as the number of people experiencing the end stages of this disease increases. Currently, more than 5 million Americans suffer from dementia, a number that is expected to increase to almost 13 million in the next 40 years. Total Medicare and Medicaid payments (nursing home care is generally paid for by Medicaid after individuals have exhausted their savings) for patients with dementia are roughly three times higher than they are for those without dementia.

Dr. Mitchell’s team looked at Medicare health services used by the nursing home residents over 18 months, culling data from hospital admissions, emergency department visits, primary care provider visits, and hospice enrollment. Roughly one-third of all Medicare costs for dementia were for hospitalizations, which Dr. Mitchell says are burdensome for many of these patients because, among other reasons, they involve a physical transfer and dementia patients often become even more confused and agitated in an unfamiliar environment. Previous studies by Dr. Mitchell and others have shown that most hospitalizations for patients with end-stage dementia are for conditions such as pneumonia that could be treated as effectively and at less cost in a nursing home setting.

Hospice payments accounted for close to half of all Medicare expenditures even though only 22 percent of the nursing home residents received hospice care. Hospice has been shown to benefit residents dying with dementia, but it is greatly underutilized with this population.

Dementia is a group of symptoms severe enough to interfere with daily functioning, including memory loss, difficulty communicating, personality changes, and an inability to reason. Alzheimer’s disease is the most common form of dementia.

A 2009 study by Dr. Mitchell in the New England Journal of Medicine was the first to rigorously describe the clinical course of advanced dementia and to label the disease a terminal illness similar to other incurable diseases, such as cancer.

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.   

10 Senior Mealtime Challenges 

Research conducted for the Home Instead Senior Care^® network reveals 10 mealtime challenges for older adults. The following percentages refer to the number of seniors who believe these are challenges for older people who live alone. After each are tips for how to make the most of mealtimes for older adults who live alone, from the Home Instead Senior Care network and Sandy Markwood of the National Association of Area Agencies on Aging.

1. 1.     Lack of companionship during mealtimes (62 percent) Tip: If you can’t be there to dine with a loved one regularly, look for alterative options such as friends and neighbors. Check out special activities at churches and senior centers as well as the local Area Agency on Aging and Home Instead Senior Care resources.  
2. 2.     Cooking for one (60 percent) Tip: Freeze most any type of leftovers including sliced and seeded fruit by placing it in plastic containers or freezer bags. Buy your senior healthier low-sodium dinners for one.
3.      Eating nutritious meals (56 percent) Tip: Buy fresh, when possible, or frozen foods including fruits and vegetables. Frequent affordable farmer’s markets in season. Your older loved one may enjoy perusing the racks of produce.  If your senior is able, help plant a garden.
4.    Grocery shopping for one (56 percent) Tip: Transportation can be a big issue for seniors. Contact the local Area Agency on Aging and Home Instead Senior Care business, or encourage your loved one to engage neighborhood support systems when possible.
5.     Eating three meals a day (49 percent) Tip: So many seniors are on prescription medications that must be taken with or without food. Coordinate the food plan with the medication plan. “Remember, Dad, to take this pill when you’re eating oatmeal for breakfast.”
6.  High expense of cooking for one (45 percent) Tip: Encourage shared meals when possible – your older loved one will get the benefit of reduced costs of meals as well as companionship. Check out your local senior center, which often offers affordable meals for older adults, as well as the home-delivered meals program, also known as “Meals On Wheels^®.”
7.   Relying too much on convenience food (43 percent) Tip: Encourage your older adult to meet with a nutritionist or talk with the doctor to learn how to read labels. So many older adults don’t know the foods that are good and bad for them.
8.  Loss of appetite (41 percent) Tip: Help older adults make mealtimes an event, which can make dining more appealing. Pull out a favorite recipe, help that older adult prepare a meal, get out the good dishes and decorate the table with real or artificial flowers.
9.    Eating too much food (38 percent) Tip: The bigger issue is eating too much of the wrong types of food. If you’re helping an older loved one with a shopping list or grocery shopping, encourage healthier choices.

10.  Eating too little food (35 percent) Tip: Plan a trip to a favorite restaurant for a special dish. If lack of food is an ongoing problem, check with your senior’s doctor to learn about supplemental products that could ensure an older adult is getting the proper nutrition.

For more information about the National Association of Area Agencies on Aging, go to www.n4a.org. Learn about the Home Instead Senior Care network’s Craving Companionship^SM program at www.mealsandcompanionship.com.

While family caregivers and senior care professionals might recognize that an older adult needs help, seniors often don’t want it, potentially putting their health and safety at risk. Family caregivers may lack the communication skills needed to talk with their aging loved ones about this sensitive subject and the practical knowledge of the options and services that are available for them right here in Sonoma County so they can age in place. It doesnt matter where you call home, Petaluma, Sebastopol,  Santa Rosa to Healdsburg , Home Instead Senior Care can help your love one stay safe & age where all their memories are “at home”.

“Reassuring a senior loved one that you have the same goal in mind will help,” said family caregiving consultant Dr. Amy D’Aprix, author of From Surviving to Thriving: Transforming Your Caregiving Experience (www.DrAmyCaregiving.com). “Start with: ‘My goal for you is to be independent, too. You know I can’t be here all the time.  A little extra assistance will help you stay home.’”

Consider these tips, from the Home Instead Senior Care^® family caregiver support series Caring for Your Parents: Education for the Family Caregiver:

1. Be mindful of your approach and speaking methods.
2. Move toward solutions that provide the maximum amount of independence for the older person.
3. Look for answers that optimize strengths and desires.
4. Remember that you are talking to an adult, not a child.
5. Not everything needs to be solved right away.

Other tips that can help families address sensitive situations such as money troubles, dating or driving are available at www.4070talk.com.

For more information about family caregiving and communicating with a senior loved one, go to www.CaregiverStress.com.

http://www.caregiverstress.com/educational-videos/family-caregiver-training-video-series-senior-communication-issues-part-1-of-5/

We are continuing our series of local senior living and healthcare facilities available in Sonoma County.  This week, we feature Summerfield Healthcare Center.

If your elderly loved one has a stay at Summerfield, they’ll be comforted knowing that there is 24-hour support and a number of social activities. The 58-bed facility has a family-like support system of nurses that are on the clock both day and night.

Nursing services cover a range of areas, such as:

• IV therapy
• Wound care
• Enteral feeding programs
• Restorative nursing programs
• Individualized care plans
• Hospice care

Summerfield also has a number of scheduled activities, too, from religious services to field trips to music…and of course, B-I-N-G-O!

Still, aside from all the activities and in-house rehab, nurses and staff operate with a single goal in mind: Helping residents recover so that they can return safely to their home.

For more information about Summerfield, call them at 707.539.1515.   They are conveniently located at 1280 Summerfield Road, Santa Rosa, California 95405.

Once your loved one gets home, they may need assistance. And Home Instead Senior Care of Sonoma County can help with that. Call us at 707.586.1516 to learn more.

Here at Home Instead Senior Care of Sonoma County, we want to help our readers better understand all the senior living and senior care options available in the area.   So we’ve been highlighting a few of the assisted living centers and nursing homes nearby and this week we’re featuring the Golden LivingCenters, which are conveniently located in both Petaluma and Santa Rosa.

Golden LivingCenters are located in both Petaluma and Santa Rosa

The Golden LivingCenters in Petaluma and Santa Rosa encourage residents to participate in regular activities and outings, from bingo to spiritual services, if the residents are in good enough health to do so.

Needs for residents could be short-term respites or long-term living situations.  Either way, Golden LivingCenters are well-equipped to handle every patient’s unique needs with individualized care.

They have plenty of amenities like recreational social activities, and skilled services such as licensed nursing, physical therapy, speech therapy, occupational therapy, stroke rehabilitation and more.

The Santa Rosa facility is located less than five minutes from Sutter Medical Center, while the Petaluma center is just across the street from Petaluma Valley Hospital – and a park for feeding the ducks!

For more information, contact the Golden LivingCenter in Petaluma at 707.763.4109 or Santa Rosa at 707.546.0471.

And if you are in need of non-medical care in your own home (wherever that may be), contact Home Instead Senior Care of Sonoma County at 707.586.1516. We’re available at anytime.

Apple Valley Rehab is conveniently located in beautiful Sebastopol

Every so often, we feature one of the local assisted living or skilled nursing facilities in the Sonoma County area on our blog.  This time, we’re profiling Apple Valley Care and Post-Acute Rehabilitation.

Apple Valley Rehabilitation strives to make its residents feel like they’re living in the coziness of a hotel during what is, hopefully, a short-term stay.

The 24-hour skilled care and rehabilitation services facility in Sebastopol offers a comfortable and friendly environment for residents, helping patients recover from surgery, injury or serious illness.

Experts there specialize in physical, occupational and speech therapy.

Among the amenities?

• Select dining program with two sous chefs
• Electric high/low beds
• Over-bed tables and nightstands
• Flat screen LCD/DVD private satellite TV with wireless headsets
• Wireless Internet access
• Camera security
• Award-winning activity program
• Yamaha Disklavier grand piano

Oh, and lest we forget that Apple Valley brews Starbucks coffee.

Contact Apple Valley Rehabilitation at 707.823.7675.   They’re located at 1035 Gravenstein Highway South, Sebastopol, CA 95472.

And once your elderly loved one gets back home and needs assistance in the home, contact Home Instead Senior Care of Sonoma County at 707.586.1516 anytime.  We’ll be glad to help you with your senior home care needs.

Choosing a nursing home for a loved one is a daunting task. Let Home Instead help make it easier.

For a reasonably healthy senior, a nursing home still is probably not the right choice.  But for the senior who truly needs skilled medical care and intense supervision, a nursing home may be exactly the best place to live.

If your elderly parent or loved one – perhaps a mom, dad or aunt — is in the stage of senior care in which they need a nursing home in Sonoma County, there are a few things to remember when choosing one over another.  The important thing is to do your research and homework to find the one that best suits your senior’s needs. 

Here are 12 things to look for in choosing the right nursing home for your elderly parent or loved one in Sonoma County:

• Visit, observe, ask and try
• Check ratio of nurses and nursing assistants to residents
• Determine staff tenure and turnover
• Ask about physician availability:  full-time or part-time?
• How close is the closest hospital?
• Review the most recent oversight-agency survey
• Look for activities offered by the facility
• Check the food by inviting yourself to meals
• Check exercise and entertainment offerings – do residents participate?
• Determine if speech and physical therapy services are offered
• Consider proximity to family
• Understand the cost and financing options

And don’t forget to ask people for referrals.  At Home Instead Senior Care of Sonoma, we work with many senior care facilities including independent living, assisted living, retirement homes, retirement communities and nursing homes.  Our caregivers provide non-medical care such as companionship services and individual transportation — those are things that nursing and medical care facilities don’t always provide.

Many of the best nursing homes in Sonoma County are staffed with teams of well-trained, professional registered and practical nurses as well as certified nursing assistants.  In case of an emergency, physicians and psychiatrists are close at hand to deal with medical crises, which should give you and your family greater peace of mind.  So nursing homes continue to serve a very important role on the spectrum or continuum of care for the elderly.

Keep in mind that when people are in a nursing home, companionship is the one thing that is often left out.  Our Home Instead CAREGivers often visit our clients to reminisce about the past, to play their favorite game, to read an inspiring book to them and simply to be there on a regular basis when family cannot.

For a free, no-obligation home care consultation, simply call our home care Rohnert Park office at 707.586.1516.  Or, if you’d like to view our digital brochure, you can do so at this link:  Home Instead Sonoma Digital Brochure.  We serve all of Sonoma County including Petaluma, Santa Rosa, Sebastopol, Sonoma, Windsor and more. 

And remember, “To us, it’s personal.”