Category: Giving Care

Are You Prepared?
The American Red Cross, featured in this issue of Generations Magazine, is a historic organization that has served our country for more than 134 years. Not only does Red Cross provide assistance during crises, but it also educates the public on disaster preparedness. The question is: are you, as an older individual or as a caregiver to an elderly relative, prepared for an extended emergency?

If you share your home with an elderly family member, disaster preparedness is paramount. Here are six ways you can prepare your home and your family for emergencies:

Take a moment to look up your local shelter: where it is located, what services does it provide.

Are home emergency kit batteries sufficient for a disaster? If electricity is critical to the care of your elderly family member, be prepared to transport your loved one to an acute care facility.

Put together a “To-Go Bag” with basic care items for your family member. Include extra clothing, diapers, baby wipes, water and medications.

Ensure your family member’s medication will last several days. Have at least one refill available.

Keep medications in a small cooler filled with reusable ice packs.

Plan ahead for civil emergencies, because your home services may be temporarily unavailable.

Natural disasters and other emergencies are incredibly stressful; add caregiving and meeting the medical needs of loved ones on top, and you can be overwhelmed. But if you are prepared for crisis, you can keep your family protected! Aloha.

HiHomeCare, 745 Fort Street, Honolulu, HI 96813
808-356-HELP (4357) | info@hihealthcarehawaii.com
hihealthcarehawaii.com
The American Red Cross, featured in this issue of Generations Magazine, is a historic organization that has served our country for more than 134 years. Not only does Red Cross provide assistance during crises, but it also educates the public on disaster preparedness. The question is: are you, as an older individual or as a…
“I Want to Die Comfortably – at Home”

National surveys say 80 percent of people want to “die in the comfort of their home,” but in Hawai‘i, only 22 percent of families use hospice services. Hawaii also ranks high (number 2 in the U.S.) in emergency room deaths. Are we getting what we want?

Dr. Angelo Volandes from Harvard Medical School recently spoke to health care professionals in Hawai‘i about ways to find out what terminal patients really want. “We don’t live in a patient-centered health care system,” says Volandes.“ As patients, we need to take control and become the center of our care team’s attention.”

Under-utilization of hospice services is a national problem, but worse in Hawai‘i. According to a 2007 study of over four thousand terminal patients, those on hospice lived longer than patients in hospitals who opted for complex procedures to “fight for longer life.”* Obviously, being kept alive in an intensive care unit is not the same as recovering enough to go home — but by the time families figure out their loved one is not coming home, it’s too late. For ten years Dr. Volandes taught doctors how to find out their patients’ end-of-life intentions. Now he is helping educate families to start the conversation early, and to tell their doctors — if they want to die comfortably at home.

Dr. Volandes’ new book, “The Conversation,” tracks seven patients at the end of life. He says that if patients knew that surgical procedures and resuscitation at end of life often do little good, they might turn them down. Such procedures may even increase their loved one’s pain and decrease the comfort of their last days.

HMSA (Hawai‘i Medical Service Association), Dr. Volandes, and Dr. Rae Seitz from John A. Burns Medical School collaborated to make a series of videos on advanced care planning. Videos are available to Hawai‘i hospitals and health care providers in all local languages so they can open the “Conversation” about end of life care and clearly plan for the patient’s true wishes and intentions.

Dr. Volandes urges elders to take the first step — have a conversation with your loved ones — to be sure everyone in the family knows what you want. If you want to die in familiar surroundings at home, pick the person who will honor your wishes when you are no longer able to make your own decisions. For further information contact your health care provider. “The Conversation” is available in bookstores and on Amazon.com.

Theconversationbook.org
* Journal of Pain and Symptom Management
Vol. 33 No. 3 March 2007, pp.238-245

National surveys say 80 percent of people want to “die in the comfort of their home,” but in Hawai‘i, only 22 percent of families use hospice services. Hawaii also ranks high (number 2 in the U.S.) in emergency room deaths. Are we getting what we want? Dr. Angelo Volandes from Harvard Medical School recently spoke…
What Level of Care and Where?

Cara had to face it — after 7 years, she couldn’t care for Dad at home any more. He needed 24/7 supervision and care and she was worn out. After calls to five facility managers, and getting no answers she collapsed in tears. Cora needed help right now…

Cara’s story replays every day. Caregivers get beyond the limit of their own strength without even realizing it. Their loved one may not qualify for skilled nursing, but is already well beyond the care limit of assisted living.

Some seniors are much happier in a small care facility that can provide increased care options when needed.

Hawai‘i has two more levels of care between Assisted and Skilled nursing: Adult Residential Care Homes (ARCH) which offers 24/7 supervision for safety and care for clients under the direction of a facility RN. An additional level of care is provided by Intermediate Care Facilities (ICF), with 24/7 care below the level of skilled nursing, but each client’s care is managed by an independent RN case manager, required by Hawaii State Department of Health. Case managers may cost an extra $500–$800 per month. Long-term care costs top out at skilled nursing facilities (SNF), which cost about $10,000/month in Hawai‘i.

Some large care facilities offer independent living and all levels of care in different branches of their complex. A change in a person’s care level would mean moving to another section of the property, away from familiar clients, personnel and surroundings. Clients who choose smaller, friendly care homes without options for increased care services may have to move to a different facility when they require more care. When looking for placement in a small care home, one should try to find one that is licensed to provide intermediate care and has an Expanded Care License for skilled nursing care. Avoid the hassle and distress of moving when the inevitable happens.

Most of all, be looking ahead, and don’t put off transition to a care facility until you are too exhausted to make a good decision. Your loved one and you will be much better off.

_________________________________

Kina ‘Ole Estates: Enriched. Dependable. Senior Living
45-225 William Henry Road, Kaneohe
808-233-4455 | bslaven@kina-ole.com
www.kinaolehomes.com

Cara had to face it — after 7 years, she couldn’t care for Dad at home any more. He needed 24/7 supervision and care and she was worn out. After calls to five facility managers, and getting no answers she collapsed in tears. Cora needed help right now… Cara’s story replays every day. Caregivers get…
The Winter Medication Blues

Do you have so many medications that you feel you can’t manage them all? We call this “the medication blues.” Keeping your prescriptions straight, organizing pills or disposing of unused meds, can be truly overwhelming.

The first step to cure the medication blues is to keep your medications organized. If you have several medications, you or a family member can type out each medication name, why you take it, and the dosage (how much and how often you take it). This list will allow you to clearly see all your medications in one place. Next, buy a pillbox at your local pharmacy. Pick a pillbox that will accommodate the amount of medications and how many times a day you need to take each. Fill your pillbox each week using your medication list as a guide.

If a medication changes or is discontinued, properly dispose of it. There are several ways to dispose of old medications. The simplest way is to call your pharmacy to find out if it has a medication return or “take-back” program. Not all pharmacies have this program, but many do. If you can’t find a return program, follow this plan:

Do not throw bottles of pills in the trash or flush them down the toilet. Instead, it is recommended that you strip the prescription label off the bottle, add some liquid to the bottle to dissolve the pills, reapply the lid, tape the lid with duct tape and throw the taped bottle in the trash.

With these simple actions, you can get your medications organized, ensure you get the treatment you need and soon make the medication blues a thing of the past.

HiHomeCare, 745 Fort Street, Honolulu, HI
808-356-HELP (4357) | info@hihealthcarehawaii.com
hihealthcarehawaii.com

Do you have so many medications that you feel you can’t manage them all? We call this “the medication blues.” Keeping your prescriptions straight, organizing pills or disposing of unused meds, can be truly overwhelming. The first step to cure the medication blues is to keep your medications organized. If you have several medications, you…
Na Hoaloha Elder Volunteers

Na Hoaloha “Go Go” volunteers donate thousands of hours to serve Maui homebound seniors.

On any given day throughout the year, there are Na Hoaloha volunteers driving a homebound senior, making a visit or helping family caregivers — with a mission to help Maui’s kupuna remain independent and stay in their homes for\ as long as possible.

Growing old in Hawai’i can be a positive experience. Life expectancy is greater than in any other state, and we stay healther longer. For those embedded in the ‘ohana way of life, volunteering is natural part of growing old. A Hawaii Community Foundation says that 57 percent of adults ages 50 to 75 volunteered in the past six months statewide. In the past year, Na Hoaloha volunteers on Maui have contributed approximately 28,000 hours and have driven 61,000 miles — services valued at approximately $620,000.

Na Hoaloha’s “Neighbors Helping Neighbors” brings volunteers and the homebound together. “Our volunteers are “Go Go” seniors,” explains Candice Carter, executive director. “More seniors are healthier than ever before and continue to remain active, so we affectionately group people\ by activity level: ‘Go Go’ are healthy and active, ‘Go Slow’ are ones beginning to slow down and ‘No Go’ are homebound that need substantial assistance to remain in their homes.”

Executive Director, Candice Carter (left) with 83 year-old Volunteer, Irene Oficial. Photo courtesy of Na Hoaloha.

The majority of Na Hoaloha “Go Go” volunteers are 60 and older; some are in their 80s and helping others who are much younger. At 83, volunteer Irene Oficial is full of life, energy and kindness. She is helping younger seniors get to their doctor appointments, pick up medications and buy food.

Irene came to Na Hoaloha when she was 80 and had never before volunteered. When asked why she reached out to Na Hoaloha, Irene said she didn’t want to stay home. She enjoys being around people and wants to help others. At first, she volunteered as a caregiver, giving respite for families who provide around-the clock-care for their loved ones. Irene is no stranger to caregiving; she took care of her own mother.

Because she loves to drive, today Irene is a Na Hoaloha “Aloha Cruisers” driver (10 of whom are in their 80s) and on the road two or three days a week driving a homebound elder couple. When she talks about her volunteer work, she sparkles.

If you have a few hours a week to help keep our Maui kupuna in their homes, please volunteer with Na Hoaloha. Helping your neighbors can make a world of difference in someone’s life — ESPECIALLY YOURS.

Na Hoaloha — Wailuku, Maui
808-249-2545 | www.nahoaloha.org

Na Hoaloha “Go Go” volunteers donate thousands of hours to serve Maui homebound seniors. On any given day throughout the year, there are Na Hoaloha volunteers driving a homebound senior, making a visit or helping family caregivers — with a mission to help Maui’s kupuna remain independent and stay in their homes for\ as long…
Preserving Dignity and Happiness
Dignity is vital to self worth throughout our lifetime; in the later stages of life, preserving a sense of respect and honoring the individual is especially important. Rarely will anyone argue this point. However, unless careful planning and clear communication is established early on, issues with regard to health, living situation and end of life decisions can often result in family arguments — that could have been avoided.

It is crucial that we take the time to think about what is truly important to us concerning our health, where we want to live and how we want to die — some simple, straight-forward tips:

Family: it’s our greatest asset but their love for us can be the biggest roadblock when it comes to discussing our wishes with them. When facing chronic illness or cancer, it is important that your family thoroughly understand your illness and how it is affecting your well-being. Always allow your family to express their fears, but be firm with your decisions and take the time to explain your decisions and why they’re important to you.

Advance Directive: having it is strongly recommended and should be discussed with your doctor. The Advance Directive is a simple form that must be signed by you and your physician. Once established, it provides clear instruction for your doctor should you be unable to speak for yourself during a health crisis. It also removes the pressure for your family on making critical decisions.

So remember, don’t worry about the things you cannot change, make changes that are needed, then live life to its fullest!

HiHomeCare, 745 Fort Street, Honolulu, HI 96813
808-356-HELP (4357) | info@hihealthcarehawaii.com
hihealthcarehawaii.com
Dignity is vital to self worth throughout our lifetime; in the later stages of life, preserving a sense of respect and honoring the individual is especially important. Rarely will anyone argue this point. However, unless careful planning and clear communication is established early on, issues with regard to health, living situation and end of life…
When Hiring Private Caregivers…
The first thing that many families face in hiring a private caregiver is whether to use someone referred to them by a friend or to hire from an agency.

The questions are: How well do you know the person? Who is responsible if there is an untoward incident? How has the caregiver been screened? Were professional references verified? Clinical skills competency testing is generally conducted by the agencies. Some agencies use nationally accredited and validated skill tests.

Factors to consider on hiring a private caregiver:

Carefully examine licenses and certifications. Agencies should be conducting prime source verification with the proper authorities: U.S. Office of the Inspector General (OIG), Racketeer-Influenced and Corrupt Organizations (RICO) and State Boards documentation should be readily available to you, the client.

Ask for a criminal history background check (CHBC) or documented drug clearance. Federal law requires nationally certified agencies to conduct CHBC tests. Drug screening is done according to employer or agency policy.

Ask for proof of insurance. Professional and Commercial General Liability Insurance is important protection for the patient, family and their personal valuables.
The management of an agency should be readily available 24/7 when problems arise.

An agency with a professional Registered Nurse or Nurse Practitioner in charge will have well established quality control of services rendered. And an agency can replace a caregiver who becomes ill or unable to work.

Kahu Malama Nurses, 1357 Kapiolani Blvd., Suite 850
808-951-0111 | www.kahumalama.com
The first thing that many families face in hiring a private caregiver is whether to use someone referred to them by a friend or to hire from an agency. The questions are: How well do you know the person? Who is responsible if there is an untoward incident? How has the caregiver been screened? Were…
Elder Advice Day: What Can We Learn?
Let’s make Thanksgiving the day we celebrate Elder Wisdom by asking older people to tell us their advice for living.

Our society portrays older persons as sick, frail, unproductive, and even the culprits for busting the federal budget.

We have become segregated by age such that young people’s contact with elders is almost exclusively within the family. It’s time to make a change. Our elders’ multitude of life experience is a unique source of advice for younger generations. What’s truly valuable are the many lessons our elders have learned in life and their desire to impart their knowledge to younger generations.

Here are some questions that might be great to ask elders you know:

What are some of the most important lessons you feel you have learned over the course of your life?

As you look back on your life, do you see any turning points, key events or experiences that changed the course of your life?

What are the secrets to a happy marriage?

What important choices or decisions have you learned from?

What do you know now about living a happy and successful life that you didn’t know when you were thirty?

What are the major values or principles that you live by?

Let’s declare Thanksgiving ‘Elder Advice-Giving Day.’ Our elders won’t be here forever, so start this year!

HiHomeCare, 745 Fort Street, Honolulu, HI 96813
808-356-HELP (4357) | info@hihealthcarehawaii.com
hihealthcarehawaii.com
Let’s make Thanksgiving the day we celebrate Elder Wisdom by asking older people to tell us their advice for living. Our society portrays older persons as sick, frail, unproductive, and even the culprits for busting the federal budget. We have become segregated by age such that young people’s contact with elders is almost exclusively within…
We Have To Stop Falling…!
Senior fall injuries are serious and deadly. One senior will be taken to the ER every hour — for injuries from a fall. Many of these patients will die or never return home to resume a normal life. The pity is that most falls are preventable.

As we age we lose muscle strength, reaction time is much slower, and balance is compromised. Seniors must take personal responsibility for our own safety.

Broken hips may set off heart attacks and strokes. Preventing a fall prevents a host of subsequent injuries, so there are big reasons to get serious and prevent falls.

What can you do to be proactive?

Review your medications. Ask your doctor or pharmacist about over-the-counter drugs and supplements too — medications can cause dizziness.

Maintain good vision. This helps with balance and safety. Have your eyes checked at least yearly.

Balance and strength are essential. Plan exercise activities and do simple movements every day: walk, garden, yoga, swim, dance, Tai Chi.

Make your home safer. Things underfoot cause us to trip and fall. Remove fall hazards by keeping pathways open and free of objects.

For further information call the Department of Health Injury Prevention Program in Honolulu at 808-733-9202. Or go to www.nogethurt.Hawai‘i.gov for educational videos, home safety checklist and a listing of tai chi classes and fall prevention services near you.
Senior fall injuries are serious and deadly. One senior will be taken to the ER every hour — for injuries from a fall. Many of these patients will die or never return home to resume a normal life. The pity is that most falls are preventable. As we age we lose muscle strength, reaction time…
Independence Starts at Home!

When we celebrate the 4th of july with family, friends, food and fireworks, it is a time to remember what it means to be free.

With many of our aging, recuperating or ill ‘ohana, independence means being able to receive quality care in the privacy and comfort of their own homes. Home healthcare is not just about doctors, nurses, aides and companions providing safe, quality care in the home; it’s about the right to remain independent as long as possible, even to the end of life.

Home is familiar. Home is comfortable. Home is where most of us want to be when ill. The ability to age and get well in the comfort of your own home surrounded by family and friends helps keep the spirit of independence alive.

Fourth of July is also about patriotism. Being patriotic is not just about pledging allegiance to the flag and believing in American values, it is about being proactive in our community, and making things better for the young and the old.

Nurses, home health aides and companions emulate patriotism by caring for their fellow citizens and providing quality health services rain or shine, most likely without glory or recognition. These caregivers give back by providing all our seniors access to quality home care.

Let’s commend all the caregivers who are committed to our ‘ohana and by supporting the value and dignity of home healthcare, we are protecting our most vulnerable citizens, our fellow Americans!

HiHomeCare, 745 Fort Street, Honolulu, HI 96813
808-356-HELP (4357) | info@hihealthcarehawaii.com
hihealthcarehawaii.com

When we celebrate the 4th of july with family, friends, food and fireworks, it is a time to remember what it means to be free. With many of our aging, recuperating or ill ‘ohana, independence means being able to receive quality care in the privacy and comfort of their own homes. Home healthcare is not…
Better Support for Family Caregivers

Hawaii’s family caregivers are starting to get the support they need. These caregivers are among the 247,000 sons, daughters, husbands and wives who help loved ones stay independently at home for as long as possible — providing help with everyday tasks.

In mid-April nearly 500 Hawaii residents joined elder advocacy groups and resource providers in paying tribute to family caregivers at an event at the Japanese Cultural Center. The event was to recognize the extraordinary contributions they make, highlight helpful community resources and provide an update of recent legislative efforts to support caregivers and their families.

During the 2014 legislative session AARP supported a measure that would allow family caregivers be more involved in the patient healthcare process. Senate Bill 2264 (the CARE Act) was a Kupuna Caucus bill backed by many House and Senate legislators and community groups. It was intended to give caregivers the instruction needed to safely care for loved ones when they’re discharged from the hospital.

AARP believes caregivers should be informed and recognized for their role in coordinating the care of loved ones transitioning from hospitals to home. Research found that family caregivers are under pressure to provide increasingly complex medical tasks — like wound care, injections, and medication management — when loved ones return home from the hospital. Caregivers often receive little or no training to provide care and are often the only option available to families, who may not be able to afford professional home care.

How serious are the challenges facing Hawaii’s caregivers? The answer may be found in personal stories of caregivers like Keri Yamamoto, a caregiver and occupational therapist, whose uncle was admitted twice last year to a local hospital. She was “highly dissatisfied” with the discharge procedure. She testified in Support of SB 2264. On Maui, caregiver Michele Paularena, also supported the bill when her husband was discharged from the hospital without adequate instructions on how to administer the medications prescribed.

While SB 2264 did not survive this session, the House Finance Committee passed a concurrent resolution (HCR 78) that calls for the establishment of a family caregiving working group to examine and assess the role of caregivers in the hospital discharge process. AARP welcomes the opportunity to work with hospitals and community stakeholders to ensure caregivers are properly instructed in the care of loved ones at discharge.

Hawaii needs coordinated care putting patients and families first. As our population ages, it’s essential that family caregivers are supported and our community recognizes the limits of what they can do on their own.

AARP Hawai‘i state office:
808-545-6024 | Toll-Free: 866-295-7282
www.aarp.org/hi | facebook.com/AARPHawaii
twitter.com/AARPHawaii

Hawaii’s family caregivers are starting to get the support they need. These caregivers are among the 247,000 sons, daughters, husbands and wives who help loved ones stay independently at home for as long as possible — providing help with everyday tasks. In mid-April nearly 500 Hawaii residents joined elder advocacy groups and resource providers in…
Doc, Follow My Orders

Momi and Roland are a retired couple living in Central O‘ahu. Last year Roland learned he has incurable lung cancer and has been in the hospital several times. The couple has had many conversations together and with the doctors. Because of his short life expectancy and desire for quality of life, he has decided to forgo aggressive life-prolonging treatments although he still wants hospitalization if needed. His doctor recommended that he put his wish to let nature take its course in writing in a document called POLST (Physicians Orders for Life-Sustaining Treatment). This form, signed by his doctor, will ensure that his healthcare wishes be carried out if he is not able to speak for himself at anytime. It also helps put Momi at ease, since she is the one who will be called on to make decisions for Roland if he is unable.

One night, Roland has problems breathing. Momi calls 911 and the paramedics arrive. Knowing her husband’s wishes, Momi wants to be sure that if her husband’s heart or breathing stop en route to the hospital, he can have the natural death he desires. She runs to the kitchen, grabs the completed and signed POLST form hanging on their refrigerator, and hands it to the paramedics. Momi can now feel a sense of relief that her husband’s treatment wishes will be followed, even if she’s not around to tell his medical providers.

So, what is a POLST, and how does it work? A POLST is a portable doctor’s order that makes you or your loved one’s wishes for treatment known. Portable means that it is valid wherever the patient is, whether it is at home, in an ambulance, in an emergency department or anywhere in the hospital or a nursing home. It is for people with a chronic debilitating illness or a life-limiting disease, such as end-stage lung or heart disease, a terminal cancer or anyone who may be approaching the end of their life.

How is the POLST different from an Advance Healthcare Directive (AD)? POLST is completed by you and your doctor and turns your healthcare wishes into orders for healthcare providers and ambulance personnel to follow. An AD is a form that you and everyone over 18 should have to document your values and future wishes for healthcare, and allows you to appoint an agent to act as your health care power of attorney in the event you are unable to speak for yourself. The combination of the POLST and AD will help make sure your wishes are known even if you cannot speak for yourself.

Be just as prepared as Momi and Roland! By talking about these issues ahead of time, you can prevent crisis, relieve stress and ensure that your family’s healthcare wishes are honored. Take action and start the conversations today. To learn more about the POLST and AD or to download forms, visit www.kokuamau.org.

Kokua Mau
Hawaii Hospice and Palliative Care Organization
808-585-997 | info@kokuamau.org
www.kokuamau.org

Momi and Roland are a retired couple living in Central O‘ahu. Last year Roland learned he has incurable lung cancer and has been in the hospital several times. The couple has had many conversations together and with the doctors. Because of his short life expectancy and desire for quality of life, he has decided to…