Deciding when is the right time to find senior care for your kupuna can be an intimidating task. You want to provide the best care possible for them, but how do you know if it’s the right time; where do you start? First, understand and identify the level of care your senior needs to conduct day-to-day activities and care for themselves. Identifying your senior’s needs early in your search will help you understand the options available. Keep in mind that the level of care can change over time as conditions change.
There are two main categories for long-term care solutions for seniors: senior communities and residential care homes. In senior communities, kūpuna live together in an apartment-like setting and interact with one another through daily, scheduled activities. They dine with other residents. In residential care homes, three to five seniors are cared for in a home-like setting. Residents get more individualized attention and all of their needs are taken care of.
Finding great healthcare for your loved ones is hard to do on your own. Each year, we see hundreds of seniors in Hawai‘i finding themselves incapable of living independently at home.
How do we get Mom and/or Dad out of the home when they don’t see the need, even though they have fallen multiple times?
After a fall, your senior is feeling fearful and may be resistant to change. During gentle conversations over time, explain that finding care comes from a place of love and wanting them to live a safe and healthy life.
What about dementia care?
Questions to ask a care home or facility about a patient’s dementia care include:
• Is the staff experienced in working with residents with dementia/Alzheimer’s?
• What approaches are used to diffuse a situation with an agitated dementia/Alzheimer’s resident?
• What kind of activities are available to help stimulate a resident’s mind and body?
• Are they open to working with the resident’s geriatric team and family?
Deciding when is the right time to find senior care for your kupuna can be an intimidating task. You want to provide the best care possible for them, but how do you know if it’s the right time; where do you start? First, understand and identify the level of care your senior needs to conduct…
Hiring a home care aide represents a major transition in family caregiving, especially when the care recipient is a person with dementia (PWD), less able to express his or her needs. Initial encounters may stress both sides.
Family members may feel uncomfortable letting a “stranger” into their home and feel guilty relinquishing caregiving tasks, and may feel uncertainty about the trajectory of dementia.
The home care worker may feel anxious entering a work situation with many unknowns regarding expectations, demands and personalities. These suggestions can help families develop partnership relationships with home care aides:
Clearly define expectations and duties:
• Identify activities of daily living (dressing, toileting, eating) the PWD can’t do alone.
• Agree upon a schedule of care and tasks.
• Identify caregiving tasks a PWD (or family) prefers the care worker avoid, either because the PWD might feel uncomfortable or family members want to continue to provide it.
• Provide important phone numbers and emergency procedures.
• Develop backup plans for substitutes if the care worker cannot work.
• Develop a system of communication, e.g., leave instructions in writing, develop checklists of completed tasks or problems, maintain a daily log of the day’s events.
• Identify dietary requirements and restrictions, allergies, meds, exercise and endurance levels.
• Agree on policies (smoking, eating, using the phone on the job, payment and benefits).
The more the care worker knows about the PWD’s background, history and preferences, the better able he or she will be to converse, develop rapport and treat the PWD as a unique individual.
Information family members might share with the home care worker:
• Life history highlights
• Persons who hold influence with the PWD (a physician, favorite child)
• Pet peeves; ideas of appropriate behavior, habits and routines; food, entertainment and activity preferences; favorite conversation topics, e.g., pets, possessions, grandchildren
• What upsets or triggers challenging behaviors
• Special phrases or behaviors that may signal a need, signs of pain and other symptoms
For more information about what you should know in order to develop a successful partnership relationship with a home care aide, go to this address.
Hiring a home care aide represents a major transition in family caregiving, especially when the care recipient is a person with dementia (PWD), less able to express his or her needs. Initial encounters may stress both sides.
Memory care communities that first began appearing in the 1990s are an important care option today for the growing number of families caring for a person living with Alzheimer’s disease or other dementia. When considering memory care, look for a community with a rich and lively activity program, and staff who are well-trained in dementia care, and exemplify a caring and kind spirit.
When should a family consider memory care? It’s a good option when a loved one:
• Can no longer manage their own health (not taking their medications, poor nutrition or diet) • Is wandering away from home or physically unsafe (leaves the stove on, fall risk) • Demonstrates poor judgement and is at risk for elder or financial abuse (giving money to fraudulent charities, individuals) • Stops managing their personal hygiene and self-care (not changing clothes, not bathing) • Is lonely, isolated or in need of valuable, brain-healthy stimulation and socialization
Families considering this move often feel guilt. But a person living with dementia can thrive in a memory care environment rich with friendship, meaningful activity and engagement, with well-trained staff providing quality personal care.
Memory care communities that first began appearing in the 1990s are an important care option today for the growing number of families caring for a person living with Alzheimer’s disease or other dementia. When considering memory care, look for a community with a rich and lively activity program, and staff who are well-trained in dementia…
Time can stop when memories are lost for a person with Alzheimer’s disease. At certain stages, the brain loses its recent (short-term) memories. The brain — and therefore, the present — is in the past for those with memory loss. Current thoughts are drawn to distant memories. Familiar people and places from long ago are at the forefront of the mind, even though those people may no longer be alive and those places have most likely changed. Because long-term memories can be intact for most Alzheimer’s patients, they often think they are much younger than they are chronologically. For example, it is not unusual for a medical professional to ask the patient what year it is during an exam. The patient’s answer may often reflect a time 20 to 30 years earlier. This question establishes his or her orientation to time. The absence of this orientation is a classic sign of memory issues and could indicate Alzheimer’s or another form of dementia.
Memories from long ago can be triggered while driving through a neighborhood — searching for an old friend’s home can become an obsession. Houses and streets may look different; unrecognizable. This can be upsetting and puts pressure on family members to explain why visual expectations do not match the individual’s recollection. Avoiding the neighborhood is one idea; however, conversations can take a difficult turn when it comes to people who have passed or moved away. Here are some tips to create reassurance when these lapses in memories occur:
• Find a quiet and calm environment, and sit with the individual.
• Speak with compassion. The person may be afraid and appear overwhelmed.
• Understand the timeframe this person is in. This is the reality he or she has chosen to remember.
• Talking about this timeframe will help him or her feel safe.
• Use photos to help them realize that time has passed. Suggest a correction, but do not scold with comments such as “Oh, we moved out of that house over 20 years ago!”
• Offer distractions to encourage his or her brain to move to another topic.
• Be patient and understanding; these memories will come up repeatedly.
Loss of memory also takes away relationships that may have been important. Family and friends need to understand that being forgotten should not be taken personally. Relationships with loved ones who suffer from dementia should not be judged by how well that person can remember the past. Instead, the focus should be on maintaining a personal and heartfelt connection in the present. Try some of t these ideas to foster the memories that remain intact:
• Play familiar music.
• Watch old films with familiar actors/actresses.
• Pull out old photos. You may even learn something new about the people in them!
• Enjoy memories as if you were there with them while you listen to their stories again and again.
We all spend time in the past, reliving cherished memories. The feelings of joy and accomplishment this creates should be valued for the difference they make in the present.
ATTENTION PLUS CARE HOME HEALTHCARE
Accredited by The Joint Commission
1580 Makaloa St., Ste. 1060, Honolulu, HI 96814 808-739-2811 | www.attentionplus.com AGING IN HAWAII EDUCATIONAL OUTREACH PROGRAM
by Attention Plus Care — a program providing resources for seniors and their families, covering different aging topics each month. For class information and upcoming topics, call 808-440-9356.
Time can stop when memories are lost for a person with Alzheimer’s disease. At certain stages, the brain loses its recent (short-term) memories. The brain — and therefore, the present — is in the past for those with memory loss. Current thoughts are drawn to distant memories.
Mom at the Bicol Club of Hawaii’s 40th anniversary.
My mother, Paz Pontillas Celebrado, graduated from college in the Philippines and dreamed of coming to America to start her nursing career. Her dream came true when she fell in love with my father, Felipe Celebrado, a U.S. Navy man. They immigrated to America in 1959 and she adjusted to a new life as a military wife and mother, and as a nurse for the next 40-plus years.
She expanded her traditional nursing role, becoming a home- and community-based case manager. In addition, my mother was one of the first care/boarding home operators in the state.
Mom and Dad in 1959 on their arrival to the states.
Having been exposed to what it takes to be a care manager at a very young age as I watched my mother tend to disabled clients in our home, I followed in my mother’s footsteps. I pursued a social work degree from the University of Hawai‘i at Mānoa and eventually worked at HMSA as a care coordinator, supervisor and manager.
After nearly 20 years at HMSA, I realized that my husband and I had become members of the “sandwich generation,” caring for three children and aging parents. When my father became seriously ill in 2008, my mother embraced her role as his personal nurse until he passed away from lung cancer in 2009.
But after he was gone, my mom began showing signs of mild dementia or cognitive impairment. I left HMSA and looked for a job that would allow me to work from home. I found an opportunity as a community outreach liaison with Urgent Care Hawaii, working alongside a longtime case management colleague Donna Schmidt, owner of the company. Finding employment that allowed remote work provided me the flexibility I needed to earn an income while raising our children and caring for my mother in our home.
This is what I learned through my experiences as a caregiver.
My niece, Juliana, graduated from college in 2017. Mom was always proud to attend any of her family’s celebrations.
■ Caregiving is a marathon, not a sprint. It’s a cross-country run with highs, lows and unexpected obstacles. Be prepared and plan for the long course. Read, attend caregiver workshops and join caregiver support groups. Learn what resources are available at every stage of the journey.
■ Plan around your loved one’s abilities. My mom always loved grocery shopping and going to Longs. So when she lost her ability to drive, I signed her up for services through Project Dana, which provided my mom with three volunteers who would take turns taking her shopping. She relished her outings!
■ Identify what brings them joy. Surround your loved one with those whom they are familiar with and those who will bring them comfort. Is there a church group, civic group or volunteer group that your loved one enjoys? For my mom, it was her Filipino club — The Bicol Club of Hawaii. The social connection, and common native language, food and culture provided the comfort my parents needed in their final years. My mother enjoyed attending celebrations and events that would make her feel socially connected and valued. During her final months, members of the Bicol Club would bring her favorite foods that would stimulate her declining appetite. It was great to have the support and respite provided by familiar faces and friends who could bring back memories of better times for my mother. If you have that kind of social connection available, utilize these invaluable relationships.
■ Practice self-care. As a caregiver, you need a break. You cannot be a caregiver 24/7 without experiencing burnout. Schedule time for yourself to recharge your batteries. Find a niche, hobby or interest that will provide that little slice of happiness to escape from day-to-day caregiving. Exercise regularly. I have heard too many stories about caregivers who begin to experience health issues due neglect of their own health after the loved one passes away.
■ Make memories as you provide caregiving. Embrace the time you have with your loved one by including them in celebrations, special occasions and travel plans. My mother was able to travel until a year before she passed away. I became a specialized travel agent, planning all details of the itinerary. Anticipatory planning included identifying urgent and emergent medical services available in transit and at our destination. Packing included durable medical equipment and devices, sufficient medication for the entire trip and packing that extra change of clothes. The memories spent with dear family and friends were priceless and helped my mother feel a sense of completion as she checked off items on her lengthy bucket list.
■ Leverage all the support you can. The last 10 years were not easy. I could not have done it without the support of my family. As the primary caregiver, I controlled the calendar and coordination of schedules. I was the quarterback. But we were a team. Fortunately, there were builtin advantages in our multi-generational home, where we were able to provide 24/7 care for my mother among us all.
■ Cultivate good relationships with each member of your loved one’s healthcare team. My parent’s PCP took care of them for over 40 years. He was always available to help me navigate and coordinate my parents care needs. The supportive services provided by Project Dana, St. Francis Hospice – Bereavement Support Group and Hospice, Kupuna Care Hawaii, Urgent Care Hawaii and Hale Hau‘oli Adult Day Care were the foundational support that allowed me and my family keep my mom comfortable in her own home until the very end.
■ You are your loved one’s patient advocate. If they are no longer able to communicate their needs, then you must. You need to have the conversations early in the caregiving process to understand the care preferences and wishes in order to honor their wishes. There may be conflicts that arise within the family and it is important to remember that the focus should be on your loved one. It is important to consider a good mediator or elder care attorney if you and your family are not able to represent your loved one’s wishes.
Mom passed away in 2019 according to her wishes; peaceful, at home, surrounded by family and dear friends. I can look at the last 10 years of caregiving with no regrets and feel blessed with great memories. I wouldn’t have done it any other way. I hope these reflections on my caregiving journey will help you in yours. You have an incredibly difficult job, but it can be do-able with the right plan, support team and resources.
CAREOPS CONSULT LLC 808-778-2752 | melissacareopsconsult@gmail.com Provides healthcare consultation services to organizations that need assistance with business development, project management, product or program development.
Having been exposed to what it takes to be a care manager at a very young age as I watched my mother tend to disabled clients in our home, I followed in my mother’s footsteps. I pursued a social work degree from the University of Hawai‘i at Mānoa and eventually worked at HMSA as a…
Each year, one in four seniors suffers a fall, leading to injuries and emergency room visits. Although they are preventable, falls can lead to a loss of independence.
Take Control of Your Home
Taking control of your environment is crucial in preventing and reducing your risk of falling.
• Keep all walkways clear of clutter or potential tripping hazards.
• Make sure your home is well-lit.
• Add grab bars inside and outside your tub or shower, and next to the toilet.
Take Control of Your Health
Taking control of your health is another important step. Keep yourself safe by being proactive regarding your health.
• Talk openly with your doctor about fall risks and prevention. Have your doctor or pharmacist review your medications.
• Consult with your doctor about an exercise program to improve your leg strength and balance.
• Get an annual eye exam. Replace eye glasses or contacts as needed.
MDX HAWAI‘I
500 Ala Moana Blvd., Ste. 2200, Honolulu, HI 96813-4993 808-522-7500 | www.MDXHawaii.com MDX Hawai‘i has over 35 years of experience serving the people of Hawai‘i. Our physician network represents over 630 top primary care physicians, and 2,200 leading specialists and hospitals. MDX Hawai‘i contracts with Humana HMO, Humana PPO and AARP/UnitedHealthcare PPO Medicare Advantage Plans.
Each year, one in four seniors suffers a fall, leading to injuries and emergency room visits. Although they are preventable, falls can lead to a loss of independence.
Forty years ago, medical exercise specialists Debbie and Norm Compton met in Hawai‘i and made fitness the key element in both their personal and professional lives. Personal training, stunt work, injuries and their continual quest for excellence compelled them to write Stacking: Your Skeletal Blueprint for Posture. In their book, the Comptons share techniques for regaining posture as you age.
Learning to develop a strong skeletal “stack” and the ability to keep your bones in their intended places allows us to know the feeling of neutral and true posture, they say. “When you’re strong in neutral, you’re strong everywhere.”
Using a construction theme, the Comptons take all 206 of your bones and teach you how to build your frame from the bottom up, beginning with your feet. Moving up the body, they describe which parts serve as the glue that keeps your body together.
They also explain what can go wrong if your bones aren’t aligned correctly, and have first-hand knowledge regarding misalignments and injuries. Deb has scoliosis; Norm was a Hollywood stuntman for 27 years.
Now in their mid-60s, the Comptons continue to practice the fitness principles they preach, illustrating living proof of the old axiom “if you don’t use it, you lose it!” They still have it!
Forty years ago, medical exercise specialists Debbie and Norm Compton met in Hawai‘i and made fitness the key element in both their personal and professional lives. Personal training, stunt work, injuries and their continual quest for excellence compelled them to write Stacking: Your Skeletal Blueprint for Posture. In their book, the Comptons share techniques for…
I love sugar! Sugar makes desserts, candies and drinks taste wonderful! The bacteria in our mouth love sugar, too. Eating foods that contains sugar instantly activates bacteria for 20 minutes. As bacteria devour the sugar, their waste is acid.
Acid is one of the few things that can destroy your enamel and may contribute to dementia.
While sipping on a soda, sweet tea, a cup of coffee with cream and/or sugar for an hour, you have exposed your teeth to over an hour of enamel-eroding acid. Be aware that sugar-free diet drinks, and starchy foods like rice, chips and bread also activate bacteria.
To lessen acid exposure, eat your dessert or sugary treat right after meals, rinse with water after consuming candies and sweet drinks, and brush and floss — especially before bedtime.
Do not constantly tuck cough drops or hard candies on the side of your cheek! Not only is it a dental disaster, studies have shown that sugar may have a role in the progression of Alzheimer’s disease. Researchers found that people with high blood-sugar levels are prone to dementia.
Enjoy your sweets but take steps to keep your teeth and mind intact.
I love sugar! Sugar makes desserts, candies and drinks taste wonderful! The bacteria in our mouth love sugar, too. Eating foods that contains sugar instantly activates bacteria for 20 minutes. As bacteria devour the sugar, their waste is acid. Acid is one of the few things that can destroy your enamel and may contribute to…
Seniors are less likely to attend community fitness classes and participate in face-to-face networking due to social distancing mandates put in place for our safety during the pandemic.
Enter virtual training!
If asked about attending an online class before COVID-19, seniors’ likely response may have been “heck no.” Now, if they have an underlying medical condition which makes it risky to attend in-person classes — even with rigorous safety protocols in place — it may be the only way.
COVID-19 has forced many seniors to become more tech savvy and open-minded to new ways of doing things. With someone to assist in the setup, more seniors are exploring and enjoying the benefits of working virtually with a professional trainer in their home.
Les and Shirley were initially hesitant about having someone come to their home; but when offered a virtual exercise session, they agreed. Assisted by their daughter, they started with individual sessions because of the difference in their physical abilities, but quickly moved to working out together. They seem to enjoy ribbing each other when one of them is having difficulty perfecting their form. They even showed us their dance moves at the end of one session! Virtual training: Think about it!
Seniors are less likely to attend community fitness classes and participate in face-to-face networking due to social distancing mandates put in place for our safety during the pandemic. Enter virtual training!
It’s no secret that poor oral health can lead to many overall health issues, such as heart disease, diabetes and other ailments. But studies show poor oral health may also lead to an increased risk of dementia. People who have gum disease for 10 years or more are 70 percent more likely to develop Alzheimer’s disease than those who have healthy gums.
When sticky plaque on your teeth combines with sugars, the bacteria release acid that attacks your tooth’s enamel. The same plaque and bacteria can escape into the bloodstream and affect major organs, such as your heart and brain, which can increase risk for early onset dementia. And the side effects of gum disease (inflamed and receding gums) may make it difficult for you to eat, preventing your body from getting nutrients.
The presence of gum disease and tooth decay can be treated by brushing twice a day, flossing daily and by visiting your dentist regularly.
It’s important to maintain a healthy smile as you get older. Good oral health not only ensures you get to enjoy delicious and nutritious food during your retirement years, but also limits the health issues you’ll come across later in life.
Protect yourself from Alzheimer’s disease and dementia by maintaining a healthy smile and diet so you can live well and smile more!
It’s no secret that poor oral health can lead to many overall health issues, such as heart disease, diabetes and other ailments. But studies show poor oral health may also lead to an increased risk of dementia. People who have gum disease for 10 years or more are 70 percent more likely to develop Alzheimer’s…
According to the Journal of the American College of Cardiology, chronic heart disease factors like high cholesterol, high blood pressure, diabetes and obesity can quicken the pace of cognitive decline.
High blood pressure and diabetes can accelerate shrinkage of the brain, especially affecting the brain’s memory center, the hippocampus. When combined with other cardio risk factors, the rate at which cognitive decline advances, leading to dementia and Alzheimer’s.
Improve your brain’s processing, memory and overall health by making heart-healthy lifestyle changes. Think of your heart and brain as good buddies who are on this journey of life with you. Each of you supports one another, and you, as the leader, will be the one making decisions that are based on everyone’s best interests.
Daily exercise and meditation have the biggest impacts on improving heart and brain conditions, thinking and verbal skills in older adults. Exercise helps the gut create serotonin, which helps manage stress, and melatonin, which helps to improve sleep. Meditation helps lower blood pressure and relax tension in the brain and body.
Make healthy decisions to lower your risk for heart disease and improve your cognitive functions daily. Your good buddies — your heart and brain — are counting on you.
According to the Journal of the American College of Cardiology, chronic heart disease factors like high cholesterol, high blood pressure, diabetes and obesity can quicken the pace of cognitive decline. High blood pressure and diabetes can accelerate shrinkage of the brain, especially affecting the brain’s memory center, the hippocampus. When combined with other cardio risk…
One would expect that an effective treatment for Alzheimer’s disease (AD) would be pharmacological. And yet, 99 percent of AD drug trials fail. The last time the FDA approved an AD drug was 2003.
Acupuncturists might focus on neuroregeneration using neuroacupuncture. In a similar fashion, a new modality — photobiomodulation (PBM) — has been building its case as a credible treatment alternative for AD. Rather than targeting a single biological mechanism, it helps the brain repair itself.
Photobiomodulation uses near-infrared light to stimulate, heal, regenerate and protect brain cells and tissues that have been injured, are degenerating or are at risk of dying. A high-quality PBM device sends photons of light through the skull, stimulating brain cells to increase metabolic energy, and increase cerebral blood flow and neuroconnectivity.
Many studies have used photobiomodulation for cognitive decline and dementia/AD. Currently, there is a large clinical trial being run at eight sites across North America.
Using light is easy. It’s noninvasive and unlike medication, it is able to affect multiple neural pathways, which may make it an elegant solution to a very complex problem.
One would expect that an effective treatment for Alzheimer’s disease (AD) would be pharmacological. And yet, 99 percent of AD drug trials fail. The last time the FDA approved an AD drug was 2003. Acupuncturists might focus on neuroregeneration using neuroacupuncture. In a similar fashion, a new modality — photobiomodulation (PBM) — has been building…
There are two main categories for long-term care solutions for seniors: senior communities and residential care homes. In senior communities, kūpuna live together in an apartment-like setting and interact with one another through daily, scheduled activities. They dine with other residents. In residential care homes, three to five seniors are cared for in a home-like setting. Residents get more individualized attention and all of their needs are taken care of.
