April 16 is National Healthcare Decisions Day. For those who have been named as health care proxies, we offer tips on making decisions in an emergency, just in case. This month we also look at strategies for supporting your personal relationship with the individual you care for. It’s far too easy—and not healthy for either of you—to let the to-do list take over. And finally, on the prevention side, we continue our series on pneumonia with a look at aspiration pneumonia. This lung infection is especially common near the end of life.
- Making medical decisions in a crisis
- Visits: more than just business
- Preventing aspiration pneumonia
- Making a Home Senior Friendly
Making medical decisions in a crisis
If you are named as health care decision maker for your loved one, you may be called upon to make very important decisions on very short notice.
At a time like this, it’s easy, and very human, to get caught up in fear. Fear does not make for the best decisions. If you can, call a friend and have them join you. You don’t have to do this alone.
Vicki Kind, ethicist and author of The Caregiver’s Path to Compassionate Decision Making, suggests these steps to promote your clearest thinking:
- Prepare a 911 list. Before a crisis—why not today?—create a reminder list to draw upon before rushing out the door. Do you have a child or pet you will need to arrange care for? An employer to inform? Do you have your necessary medications, food, and water? Maybe a sweater and a book, and paper for note taking? Phone charger? Your wallet?
- Steady your mind. Give yourself a few minutes to use a calming strategy: pray, call someone, walk around the block. Focus on the positive, “I can stay clear-headed and do what’s needed.”
- Clarify the timeline. You may hear that a decision is needed “now.” Ask what “now” really means. In the next hour? Or by 5:00 pm tomorrow?
- Gather information. Ask about all the options. In addition to the benefits for each one, ask about risks and possible negative outcomes. Find out about the long-term consequences.
- Review and decide. Reread your notes. Consider the options next to your loved one’s values and priorities. Talk things through with a friend or trusted professional. Perhaps create a spreadsheet of pros and cons for each option. Confirm for yourself the logic of your thinking, and go forward with your decision.
Visits: more than just business
Stretched for time? No one knows that feeling better than family caregivers. There’s so much to do and so little time to do it.
Although productive and practical, a task-focused visit can inadvertently demean the person you care for. No one wants to be reduced to an item on the to-do list! For the receiver, there’s a big difference between feeling cared about and being cared for.
These suggestions may help you make your visits more than just business:
- Slow down. Take a tip from Dr. Dennis McCullough, author of My Mother, Your Mother: Embracing “Slow Medicine,” the Compassionate Approach to Caring for Your Aging Loved Ones. Elders operate at a different pace than the work world. Before you walk in the door, take a few deep breaths and intentionally move out of the fast lane. Make “savoring the moment” one of the highest priorities on your to-do list.
- Break up the routine. Convenient as it is to have a standing date, it can make both of you feel obligated. Aim for some flexibility and choice. If you always take Mom shopping on Saturday morning, consider setting up a bonus Wednesday visit for dinner. Or a video. “Date night” with a parent can do much to preserve their self-esteem and remind you both that there’s a relationship there beyond the realities of elder care.
- Allow them their dignity. Humans have a strong need to reciprocate when given to. Otherwise they feel like a “freeloader” or “burden.” Consider ways your loved one can give back. It does not have to be material gifts. Let them know you value their stories, humor, wisdom, or other treasures they can share over tea or coffee.
Whether you visit once a week or once a year, remember that the reason you are there is much larger than the things that have to get done.Return to top
Preventing aspiration pneumonia
People with advanced and end-stage dementia are prone to pneumonia. A lot.
This is not the kind of pneumonia you can get a vaccine against.
With advanced dementia, the body does not reliably close off the esophagus to prevent inhalation of particles of food or drink. When food or liquid slip into the lungs instead of the stomach, it can lead to aspiration pneumonia.
Ways to prevent aspiration pneumonia:
- Rest for 30 minutes beforehand
People who have been active before eating have more trouble swallowing.
- Sitting up to eat
Make sure your loved one is sitting up at 90°. Preferably at the table.
- Calm, leisurely meals
Rushed eating is more likely to result in food going down the wrong pipe.
- Reduce distractions
Present one food at a time. Smile encouragingly, but minimize conversation. Talking is distracting. It increases the risk of aspiration.
- Small bites and sips of water
Food goes down more easily when cut into small pieces, especially if alternated with sips of water.
- Tucked chin when swallowing
Lowering the chin toward the chest seems to line up the throat in a favorable angle.
- Regular oral hygiene
Brushing teeth twice a day removes food particles and bacteria. The use of nonalcohol mouthwash can also help.
Thickened juices seem to cause fewer swallowing problems. But many people dislike the texture. As a result, they reject fluids altogether. That can lead to dehydration, which brings other problems, such as bladder infections. Instead of thickening, try high-liquid foods, such as jello, watermelon, and sorbet.
Consider a palliative care consult
If your loved one has trouble with aspiration pneumonia, you might ask for a palliative care consult. These specialists can help with strategies and treatment decisions.
Making a Home Senior Friendly
Aging in place describes how many of us would prefer to spend our senior years. We’d like to continue to live in our home and neighborhood, with adequate support services nearby and with the ability to move around the house safely. The National Aging in Place Council (NAIPC) says more than 90 percent of older adults would prefer to age in place rather than move to senior housing. But the group acknowledges that a gap exists between their desire and the reality of the modifications their home may require. If your loved one wants to live at home for as long as possible, it’s a great idea to discuss with them the modifications to it and their lifestyle that will enhance their quality of life.
To get started, talk to your parent or loved one about three general categories: “You, Your Home and Your Neighborhood.” Thinking about these three separately will make it easier to isolate issues and find practical solutions to current or future problems.
First, talk about “You”, meaning your loved one’s health and mobility, and desire to maintain independence. They may be more isolated as they age, especially if they no longer go to work or drive. As a result, they may not be getting the exercise they need to maintain good flexibility, balance and strength. Talk with them about starting an exercise program they can do at home. They can purchase exercise videos, borrow from the library, or follow along on TV or Internet exercise shows. It’s especially important to focus on strength training, flexibility and balance. These can also be fun stress relievers, and lead to new hobbies such as hiking or visiting outdoor attractions.
Make sure your loved one is keeping up with doctor appointments, and can be in charge of their own medications. Ask about their eating habits. It’s easy to fall into bad eating habits when you’re cooking for one, especially if you’ve been used to cooking for a family for years. Make sure your loved one has plenty of vegetables (fresh or frozen), fruits, healthy proteins and fats. And encourage them to drink plenty of water. Many health problems begin with mild dehydration as the cause.
Next, talk about “Your Home”, meaning the ability to move around the house easily, access everyday items and notice when things need repair. Some things to check for include:
- Stairs: Increase stair visibility by adding floor lights or making sure overhead lighting is bright with easy to reach switches. Make sure handrails are installed for all stairs, even when there are only one or two. Adding handrails on both sides of the stairs is a safe and easy addition.
- Bathroom: Grab bars in the shower, tub and next to the toilet make life easier for many seniors. Study the different choices before purchasing to make sure you get the right fit for your loved one, and have them professionally installed.
- Rugs: Throw rugs are warm and beautiful, but can be deadly. If your loved one has them, make sure they are backed with a non-slip material, and they don’t curl up on the sides.
- Kitchen: Many new products are available to help in the kitchen, including varying counter heights, open shelving for easy access to everyday items, rocker switch light switches, ergonomic faucet handles, open counter space for seating, and many more. If your loved one is having a problem with any activity in the kitchen, assure them that solutions exist, and they just need to let you know what the issue is.
Then, talk about “Your neighborhood”. Does your loved one have access to public transportation? Or, can they rely on neighbors for rides and other assistance? Many park districts offer programs geared toward seniors, and are worth checking out. How close is the doctor or hospital? Do they have a plan in place in case of an emergency? Ask your loved one if they feel comfortable taking a walk around the neighborhood. Is it easy to do? Is someone available to accompany them? Does your loved one have help with the yard work? If they love gardening, consider the many gardening products available designed with seniors in mind, including ergonomic gardening tools, raised garden beds to reduce the need to bend or kneel when caring for plants, and garden carts to move equipment around the yard.
Having these discussions will give your parent or loved one the information they need to adapt their home to their changing needs. Many seniors find they can also use some help from day to day as they age. Senior Life Solutions provides as much or as little extra help to seniors as they need, from meal preparation to housekeeping or personal care, as well as companionship. We can provide the help your loved one needs to maintain independence, comfort and security. Call us at 630-474-0849 to speak with a home care advisor today.Return to top