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Home Safety Tips for Loved Ones with Alzheimer’s Disease and Dementia by Lorena Romo

Dementia and Alzheimer’s disease can be easier to cope with if you have the right help. Our guide explores how to make the home safe and enjoyable for loved ones who may be coping with these issues.

 According to the National Institute on Aging, Alzheimer’s disease has a significant impact on a large portion of the elderly population. If your family member or loved one is coping with the signs of Alzheimer’s or dementia, it’s important to create a safe place for them at home. With a few easy updates and some positive reinforcement, you’ll discover some helpful ways you can make simple changes to ensure a safer environment.

The Importance and Benefits of Elder-Proofing

More of the elderly population are choosing to “age in place,” which means they’d rather stay in their homes instead of going to a nursing home or assisted living facility. You can keep your loved one safe by making some easy changes in their home. The term “elder-proofing” refers to things you can do to ensure that your loved one is safe and secure while living at home. These simple safety tips include minor updates to the home so they’ll be able to live in a safe and enjoyable home into the future. When you elder-proof a home, you’ll get peace of mind knowing you’ve taken as many precautions as possible to make sure they’re safe.

 Besides peace of mind and improved safety, elder-proofing a home is usually much less expensive than paying for in-home care or a nursing home. Many older Americans have already paid off their mortgages, which means it’s significantly less expensive to allow them to stay at home. Putting a few safety precautions in place can ensure that the patient is secure and able to handle an unexpected emergency. With a few simple home safety upgrades, your Alzheimer’s disease or dementia patient can stay in their home, resulting in a happier, healthier life.

What to Expect

When you prepare to elder-proof a home, make sure that your loved one understands what you’re doing and why. Explain to them that you’re making these changes for their safety and that you want them to be able to enjoy their home for as long as possible. While you certainly want them to maintain a certain level of independence, it’s important to note that many dementia patients may tend to wander or leave their homes without supervision, so you’ll need to take this into consideration when creating your safety plan.

Be prepared to remain on alert and have your contact information posted somewhere prominent in the home in case of an emergency. A monitoring system can help your loved one alert health officials in the event of an emergency. No matter what you do to elder-proof the home, make sure it doesn’t interfere with their routine. Sticking to a schedule may help your loved one feel calm and safe even if you make a few changes to their home.

Adapting Each Room

There are several things you can do to every room of the home that will make it safer and more enjoyable. Here are some suggestions for how you can improve home safety to protect the well-being of your loved one:

Bedroom 

  • Remove space heaters and heated blankets to reduce the risk of fire.
  • Add a nightlight in the bedroom as well as in the bathrooms and hallway so your loved one can see better at night.
  • Get rid of excess clutter in this room so that the patient can easily walk around and avoid tripping over items on the floor.
  • Install a lock on the bedroom windows when applicable so that your loved one does not try to open it. Window locks may also help prevent accidents.

 Kitchen

  • Make sure all smoke detectors are working properly, particularly in the kitchen and bedroom.
  • Move items that are high up in cabinets down to the lower level so your loved one doesn’t have to strain to reach items that are too high.
  • Consider adding an area rug to the kitchen and attach it to the floor using a strong double-sided tape to provide better traction on smooth floors.
  • Prominently display emergency phone numbers on the refrigerator and make sure there is a telephone nearby.

 Bathroom

  • Install grab bars in the bathtub and shower to help the patient get in and out of these areas more easily.
  • Use a bathtub tread or a non-slip tub mat to help your loved one stay safe from falls in the tub and shower.
  • Consider adding an elevated toilet seat and install a grab bar next to the toilet.
  • Unplug any small appliances in the bathroom and use childproof outlet covers to prevent fires.

Cover faucets with a soft material like a sponge or foam to avoid accidents.

Stairs

  • Make sure there is a light switch at the top and bottom of any stairs so your loved one can see as they walk up and down the stairs at night.
  • Add stair treads, even if the stairway has carpet since this will improve traction.
  • Ensure that the stairs have a railing and that it’s tightly secured to the wall.
  • Clearly label the doors to each room at the top of the stairs to help your loved one avoid confusion.

Living Room

  • Eliminate extension cords to reduce the risk of trips and falls.
  • If there is a fireplace, consider disconnecting the gas line.
  • Remove throw rugs and repair or replace damaged carpet.
  • Ensure that all lighting is bright and use overhead lighting instead of a table or floor lamp to prevent the possibility of a fire or broken light bulbs.

 Backyard/Patio and Other Outdoor Areas

  • Check any steps leading to the inside of the home and make sure they’re structurally sound and secure. Mark the edges with bright, reflective tape.
  • Install a ramp with handrails to help your loved one enter the home without having to use the stairs.
  • Check walkways and garden areas to make sure that everything is even and level. Remove or replace buckled concrete or warped wood.
  • If there is a pool in the backyard, surround it with fencing, and use a locked gate. Cover the pool so your loved one is not tempted to go in it without supervision.
  • Remove grills and any other heat sources including propane tanks, lighters, torches, and outdoor candles.

Make Living at Home Enjoyable

It’s easy to support and encourage positive mental well-being by doing a few simple things that may improve the outlook and daily routine for your loved one. Start by adding some cheerful decorations, artwork, or even houseplants that will help to boost their mood. Look for something that’s personal to the patient, such as a landscape painting of a place they’ve traveled to in the past. Family photos are another great suggestion that can keep people with Alzheimer’s disease or dementia familiar with the faces of the people they love.

 Aside from adding decoration to the home, it’s important that your loved one is able to stay active and engaged. Look for some fun activities they can do at home, such as puzzles, word games, and coloring books that may promote mental stimulation. It’s important for people dealing with these conditions to have plenty of distractions so they’re not engaging in potentially dangerous behavior. Encourage them to try something new like painting, sewing, or crocheting. Arts and crafts can keep idle hands and minds busy while also providing a sense of fulfillment and pride. The key to an enjoyable time at home is to make sure the person has plenty of things to do so they feel like they’re accomplishing something each day. Whenever possible, visit your loved one and play some simple board games so they have in-person contact with people they trust.

 Of course, aside from hobbies and decor, it’s also important that your loved one feels relaxed when they are at home. Encourage them to practice simple daily exercise routines to keep them limber and provide them with a positive energy boost. Some soothing music and a pair of quality headphones are another easy way to help your loved one relax. Avoid using scented candles or essential oil diffusers, as these can pose a possible fire risk. Look for air fresheners that feature their favorite fragrances, so they can enjoy soothing scents at home without worry. If your loved one is able to get outside, consider taking them to their favorite park or a quiet art museum for stimulation and fresh air.

 Coping with Alzheimer’s disease and dementia isn’t easy, but with some simple safety tips, you can ensure that your loved one stays as safe as possible when they’re at home. Follow these tips and make the changes necessary so that you’ll all have peace of mind. Remember to try and make the home environment as enjoyable as possible so that they’ll want to continue living there for years to come.

Threshold Choir

What is Threshold Choir?

August 2020
Debbie Aragon
debaragon5@gmail.com

One Choir, Many Voices
Singing for those at the thresholds of life in over 200 communities around the world.

Vision
A world where all at life’s thresholds may be honored with compassion shared through song.

Mission
Singing for those at the thresholds of life.

Website: www.thresholdchoir.org

History of Threshold Choir:

The inspiration and seed for the Threshold Choir was planted in June of 1990 in California by Kate Munger. She combined some profound personal experiences with death, with her love of singing, and being of service to others. She formed a group and then other groups began forming and spread throughout California. Chapters are now currently in many states in the U.S., as well as in Canada, and in other countries around the world. As of 2018, there were over 200 chapters worldwide, and that number is continually growing. Threshold Choir members are volunteers, who sing with and for all people who are facing death, grief or suffering.

What exactly is Threshold Singing?

The goal of Threshold Singing is to bring ease and comfort to those at the thresholds of living and dying. A calm and focused presence at the bedside, with gentle voices, calming, simple and often lullaby type songs, and sincere kindness, can be soothing and reassuring to clients, family, and caregivers alike. Most importantly, of course, the goal is always to convey compassion and respect for individuals at the threshold.
When invited to a bedside, there are small groups of two to four singers. Some songs are planned ahead while others are chosen to respond to the client’s musical taste, spiritual direction, and current receptivity. Many of the songs are composed by Threshold Choir members specifically to communicate ease, comfort, and presence. The songs are appropriate for all – those who are deeply religious or spiritual, or not at all. A session typically lasts about 20 minutes, sometimes a little longer depending on the individual situation. Using soft, lullaby voices, the voices blend in unison or in harmonies, singing as gentle blessings, not as entertainment. It is absolutely fine when a client falls asleep while listening to the singing. Most of the songs are very short, so their repetition is conducive to rest and comfort. Families have said that Threshold singing helps them to “be more present” with their loved ones.

Music has the potential to be a healing power and can be an instrument for peace and justice. Threshold Choir is committed to creating a harmonious culture of inclusivity, respect, and love, represents and welcomes all backgrounds, is non faith based, and does not tolerate discrimination in any form. Threshold Choir is a 501(c)3 organization, funded and supported by donations. There is great interest and support for Threshold singing from the public, the hospice community, and the choral community. Professional and academic recognition of the significance of this work continues to expand locally, as well as internationally. There are approximately 400 songs in the current Threshold Choir library and that number is growing – the songs are typically lullaby like, calming, short, soothing songs, having melody and 3 part harmonies. Of the many Threshold songs, there are a number of core Threshold songs, ones that tend to be sung more often than others. Each Threshold Choir chapter is firmly rooted in its local community while also being an important part of our shared community as an international organization, singing from the same repertoire and shared experiences at regional and international gatherings. Choir members are always welcome at rehearsals in any location and at Threshold gatherings outside their own home area. 

Who are those that become Threshold Choir members?

Many kinds of people are drawn to becoming bedside singers, and for many reasons. Some join after hearing about Threshold Choir or hearing the unique music, while some come after caring for a family member, or are hospice workers or volunteers. Some are part of traditional religions, some are not religious at all, and some have a personal form of spirituality that has no label. A few are professional musicians; most are not. All members learn to carry their parts and blend their voices, some by reading music and others learning solely by ear. Some have (or have had) careers in all types of fields, and some have focused on home-based work and volunteering. 

Rehearsals, in addition to practicing and learning the music, are also a time to enjoy each other’s company, and an opportunity to have fun and share concerns. Often times, meaningful friendships form within a Threshold group, and those relationships are deepened by the important work that is done together. As Threshold Choir singers, most importantly shared is a repertoire of beautiful, meaningful, and soothing songs and a desire to provide comfort and peace at significant and challenging stages in life. The opportunity to provide comfort and peace is a great motivation for Threshold Choir singers. But as singers we also benefit and are blessed by Threshold singing both in unison and in harmonies.

Auditions are not required of new singers, and yet there is required a certain level and style of vocal skill. Skills required for joining may vary from chapter to chapter, but these are the general guidelines for someone who wants to join with the intent of singing at bedsides:
1) be able to carry a tune,
2) be able to hold your own part (or sincerely want to learn to) while others sing harmony,
3) be able to sing softly and blend your voice with others (or sincerely want to learn),
4) be able to communicate kindness with your voice, and
5) be willing to use self-monitoring and accept peer feedback as we work together to bring the most blended and graceful sound to our clients.

 Threshold Choir Values:

We are committed to these values when we serve our clients. We recognize the privilege of being invited into our clients’ lives at a significant threshold and honor that privilege by maintaining these values at every level of the Threshold Choir organization:

We value honesty, sincerity, care, and respect in all our interactions.
We value each person’s own life path, choices, and experiences.
We value transformative power of love and the healing power of presence.
We value the importance of compassion and kindness.
We value the benefit of listening with more than just our ears.
We value caring for ourselves while being of service to others.
We value diversity with respect to spiritual paths, cultures, and abilities without respect to age, race, color, creed, gender, sexual orientation, or physical ability.
We value dignity, worth, and uniqueness of all people.
We value the sanctity of all life.
We value the rights of individuals to privacy, confidentiality, and self-determination.
We know that we are giving something extremely precious when we sing at the bedside of someone on the threshold. We are aligning our integrity, our gratitude, and our deep generosity with our voices and dancing in the balance
of humility and confidence,
of service and self-healing,
of one singer’s voice blended with others,
of following the breath of our “traveler” with the blessing of our own breath,
of the stranger bringing grace to an intimate moment.
We are making kindness audible.
Of the many occasions when the Threshold Choir has been featured in the media, the following selections have especially captured the essence of what Threshold Choir is all about and does in many communities:

Video and Audio Interviews:

The Washington Post Video
May 2018
“Dying is a part of living: Threshold choir visits hospice patients” (2:54 minutes)
PBS Video
December 2016
“The Threshold Choir” (6:33 minutes)
Great Big Story (CNN) Video
July 2016
“Songs of Comfort at the End of Life” (3 minutes)
KQED Video
June 2016
“Threshold Choir Brings Songs of Comfort to the Dying” by Rachel Berger (6 minutes)
NPR Weekend Edition
August 2014
“At Life’s Last Threshold, Choir Brings Comfort” by Emily Siner (5 minutes)
NPR All Things Considered
December 2013
“Threshold Choir Sings to Comfort the Terminally Ill”, an interview with Kate Munger, founder of the Threshold Choir, by Arun Rath (4 minutes)
Death: the podcast
August 2016
“The Gift of Song”, an interview with Annie Garretson and Sally Rothstein of the Pikes Peak Threshold Singers (34 minutes)
Well Talk Radio Interview
July 2016
Interview with Susan Randazzo, Charlotte Russell, and Suzanne Buell of the Threshold Singers of Indian Hill Music (30 minutes)

The practice began in California and spread to 130 communities around the world. The mission of the Threshold Choir is to bring gentle acapella singing to people who are dying in hospitals and hospices, usually with three or four voices at a time. We accompanied the Washington, DC Threshold group as it comforted a patient during the last stages of his life.
Aired: 12/16/2016

Publications:

“6 Stories That Will Inspire You to Give Back This Holiday Season: A Final Note” by Julia Scheeres, The Oprah Magazine, November 2018
“When someone hovers at the edge of death, these singers step in to ease the passage” by Debra Bruno. The Washington Post. May 2018
“This Choir Sings to People On the Verge of Dying, and It’s Just Beautiful” by Amy Paturel in Reader’s Digest, March 2016
“Threshold Choir: A Legacy of Healing and Peace” by Lynn Pribus in go60.us, June 2014
“Choirs support and comfort those at life’s threshold” by Sharon Sheridan in Episcopal News Service, December 2013
“Singing at the Threshold”
by Kelsey Menehan in The Voice, Spring 2013
“A Choir Rehearsal That Grew into Two” by Karen B. Kaplan in Offbeatcompassion (blog), July 2013

Epidemic of Loneliness

 

Written by Abigail Tillery

ROCHESTER, Minn. (FOX 47)

Suffering from loneliness: It’s becoming a serious epidemic among seniors in the United States.

According to the National Poll on Healthy Aging, chronic loneliness can be fatal. It can affect memory, physical well-being, mental health and overall life expectancy. The symptoms of loneliness vary, but it usually comes during a change in a person’s life. For example: retiring from a career and missing the social contact that came with it, health issues, or the death of a loved one can lead to isolation.

Statistics from Maryville University show that the population of US citizens aged 65 or older grew from 35 million in 2000 to nearly 50 million in 2016. There is an even larger jump predicted in the future – nearly doubling from 52 million in 2018 to 95 million by 2060. Socialization is critical, so if you have an elder family member or friend, simply just spend time with them.

In the Bessie’s Hope blog post on ‘The Importance of Intergenerational Programs’, it stressed how especially important it is for elders in nursing homes and assisted living facilities to interact with people, because they are greatly affected by their drastic change in lifestyle, loss of autonomy, and lack of family members and places to call home. Any form of social contact is vitally important.

This is the focus area for the Bessie’s Hope programs, shining a light on the forgotten segment of our society: nursing home elders. Over sixty percent receive no personal visitors, so if you would like to start off the new year by being a light for one or more of these special elders, contact Bessie’s Hope at 303-830-9037 or linda@bessieshope.org. Whether it is you, your family, your workplace, your club, your church, your children’s school or scout troop – there are volunteer programs designed for you. Education, training, coordination with elder homes, facilitation of visits – all provided by Bessie’s Hope.

Here are other examples of how some places are showing care for the elderly:

Rider companion programs

The United Community Action Partnership’s rider companion program assists lone riders who need help getting home safely, making it to appointments and waiting until they end, or even waiting with them to catch their bus. Their Assisting Seniors on the Go program will offer discounted rates for seniors in the coming year. Willing volunteers just have to go through a brief registration and orientation process before they are matched with someone in need of help.

Get physical programs

In Wisconsin, where over half of the nation’s deadly falls among the elderly occur, the Wisconsin Institute for Healthy Aging and Safe Communities Madison and Dane County has created the Stepping On program. This seven-week program helps the elderly prevent fatal falls by offering practical tips and exercise regimens. These classes also include home assessments and medication reviews, and give the elderly the confidence and support that they need to continue living healthy and independent lives. The program is now available in over twenty states, and statistics show that it’s reduced falls among the older population by thirty-one percent.

Spreading needed cheer

Come Christmastime where loneliness can really set in, Elves for Elders in Prince George aims to brighten up the holiday season for community elders by partnering with organizations to determine those most in need. Volunteers in this group spread Christmas cheer by acting as secret Santas who fulfill wish lists and also donate stockings filled with goodies. 274 seniors received gifts last year, and the numbers are expected to grow with every coming year thanks to generous donors and volunteers.

There are a number of ways you can take part in helping the elderly fight the epidemic of loneliness. You may get involved with any of these programs, find others, or create your own to show the beloved senior citizens in your area that you care – and that they matter.

Content intended only for the use of bessieshope.org by Abigail Tillery.


What is Ageism? Part II

Helping Break the Cycle of Ageism Can Lie in the Hands of Today’s Youth

In today’s society there is a prominent focus on ageism, healthy aging and improved quality of life for the aging population; however, the focus does not extend to those who are living in nursing homes. Six out of ten Americans would rather die than to have to live in a nursing home; however, hundreds of thousands of the 65+ population do reside in a nursing homes. The resistance of not wanting to live there could be that the perceptions of nursing homes is that they are just places people go to die, and are populated with those who have little left to give. That simply is not true.

Society must realize just because someone lives in a nursing home, it does not mean that they have given up the desire to learn, feel valued, contribute to society, and live the rest of their lives with dignity and a sense of meaning.  Just because they have a roof over their head, are fed and receive health care, doesn’t mean that society should assume that their needs are being met.

In a research study titled “Does Intergenerational Contact Reduce Ageism?” the authors, Julie Christian, Rhiannon Turner, Natasha Holt, Michael Larking and Joseph Cotler, found evidence that “youth who have contact with the elderly can break stereotypes and instill positive attitudes toward aging and the elderly. Participants need to have time to get to know one another so that there is potential for empathy, to disclose personal information and to work on communication so that the interactions are comfortable.”  This description of successful intergenerational programs perfectly.

The Bessie’s Hope youth are taught that the elders with whom they will be cultivating relationships are the individuals upon whose knowledge, skills, talents and hard work our communities were built. Also that the elders have amazing life stories to share, but there is no one to listen. Our youth are eager to listen and learn from them, because of our training.  This is important because the residents like telling stories from former times again and again because they live in a world of memories from the past. These stories, which stabilize identity, are important as the elders generate their sense of living from their reflection of the past.

The following are quotes from Bessie’s Hope youth participants:

  • “When I learned I had to go visit nursing home residents, I was really frightened and anxious.  But after our first visit I saw that they were just people like us and were actually fun!”
  • “I love these residents. They are my inspiration.”
  • “I didn’t think I would have anything in common with the elders, but it turned out that wasn’t true.
  • “I though the nursing home residents would be boring and dumb. But they are really smart and fun. I look forward to my visits with them.”
  • “Participating in Bessie’s Hope has helped me have more respect for the elderly and that we need them and they need us.”

What is Ageism? 

 Ageism is the stereotyping, prejudice, and discrimination against people on the basis of their age. Ageism is widespread and an insidious practice which has harmful effects on the health of older adults.  

 

In America, ageism is prevalent because western cultures tend to be youth-centric, emphasizing attributes like individualism and independence. However, many other cultures are less prone to ageism.  For instance, respecting the elders is part of the actual law in China. The Japanese culture values the elders. Appreciation for elders has been ingrained in families and their children, making Japan one of the kindest places in the world for seniors. Older people are valued as assets in Scotland. Their voices are heard, and they are supported to enjoy full and positive lives in family settings. 

 

How does ageism affect older adults? 

 

Age discrimination can be very hurtful to the self-esteem of aging individuals and can even take a toll on their health. Many seniors are treated like second-class citizens by younger generations. They are often talked down to or even made to feel invisible because of their age.  

 

A 20-year study on perceived age discrimination, by Becca Levy, PhD, found that 63% of participants over age 53, reported feeling discriminated against, with the main cause cited being their old age. The study also found that age discrimination quickly leads to feelings of depression and stress and causes lowered mental health as well as lower self rated health, and when older individuals were exposed to positive stereotypes about their age they showed significantly better memory and balance than those exposed to negative views. What is even more astonishing is that seniors with positive perceptions of aging live 7.5 years longer than those with negative views.  

 

How to recognize ageist comments? 

 

If left unchanged, ageist comments can erode the self-confidence of older people and make them feel ostracized.  So how can we learn to recognize ageism and how do we avoid it? Here are some ageist words, phrases and non-verbal cues that should be avoided. 

  1. Offensive Descriptions and adjectives. Avoid these words because they are plain mean and hurtful. 

Old hag, old-timer, little old lady, old coot, over the hill, old foggy, decrepit, ancient, biddy, codger, crone, fossil, geezer, old fart, old goat, prune, senile old fool, eccentric, feisty, spry, feeble, grandmotherly, grandfatherly and vegetable. 

  1. Seemingly kind but still offensive endearments. Older people don’t like being treated like babies. They are still mature individuals who deserve respect. Instead of calling them sweetie, honey, dear or young lady, call them by their names Ms. Smith or just plain Judith. 

 

  1. Generalization. As much as we don’t want to be stereotyped by our race, ethnicity or our gender, or be lumped into one description such as “all millennials are apathetic” or “all baby boomers are junkies”, we shouldn’t generalize older people by what other older people can and cannot do, what they have and don’t have. 

“Old dogs can’t learn new tricks.”
“Old people are perpetually out of touch” 

 

 

 

 

 

 

  1. Uncharacteristic for their Age. Though sometimes it may be hard for them, older people can still learn and do new things. When they are treated like they shouldn’t be able to do some things, it’s also ageist. 

 

“A quick-witted 85-year-old”,
“An agile 75-year-old”,
“Feisty old lady”,
“Wow! She’s 78 and still takes online classes.”
“This little old lady still parties like a college kid.”
“He is 80 years young.”
“Can you believe she’s 60 years old?”
“60 is the new 30.” 

 

  1. Assuming they’re weak. Comments like the following, though said with good intentions, suggest they shouldn’t be able to do certain things because they’re supposed to be fragile. Not all older adults are weak. Some even maintain physical fitness up to a hundred. Saying something like this just reminds them of the imminent decline of their health. 

 

“I’m so glad you’re still up and around!”
“You’re still agile! How’s your health?”
“You shouldn’t be doing that.” 

 

  1. Lying in good faith. We are all aging and everyone is older than someone. It someone says they’re not old when they are relatively older to others, instead of it being a compliment, it becomes a reminder o the stigmas that aging bring. Deceiving older people won’t make them any younger. 

 

“You could pass for much younger.”
“Oh, you’re not old.” 

 

  1. Oversimplifying words. This is when we assume that all older people have problems with understanding so we tend to speak in very simple words, like teaching a child how to talk. At times, we also over explain things that don’t need explaining.  Remember that older people are not mentally slow. According to Gerontology Society of America (GSA), we don’t need to change our speech and vocabulary to communicate with older adults. “Older adults maintain their existing vocabulary or continue to improve it,” wrote GSA. “They have no problem understanding complicated words that members of other groups, there is no need to simplify words to use.” 

 

  1. Speaking to others about an older person’s situation when he or she is in the same room. Aside from being plain rude, people assume that older people cannot understand their own situation and that another person (maybe younger) is required. Doctors and health care providers usually commit this mistake. If there is someone else accountable in the area, doctors pretend older adults are not there. 

 

 

  1. Jokes. Every time when a person is joking about older people, he or she is actually disguising emotions and thoughts, deliberately or subconsciously about the horrors of aging.  

“Grandma is so wrinkled she needs a bookmark to find her mouth.”
“My old Uncle Ed still whistles at girls but can’t remember why.” 

 

There Are Not Enough Personal Care Aides To Care For Frail Seniors. What Will We Do?

Howard Gleckman, Senior Contributor, Forbes (AND Bessie’s Hope solution below)

Workforce challenges have grown substantially over the last several years and health care providers will continue to see increasing staffing challenges, workforce shortages, wage and benefit costs, and employment law enforcement. To survive these changing dynamics and become more predictive in people strategies, health care providers will adopt a variety of workforce analytic technology. For example, regular employee pulse surveys for employee engagement or real-time labor management systems which allow staffing to be quickly and accurately adjusted on a per-patient-day (PPD) basis will become essential for managing labor costs and productivity

Health care organizations will also need to ensure deliberate talent acquisition strategies and an engaged workforce to increase employee retention, allowing them to better drive the level of quality, customer satisfaction, and financial performance. Due to the talent shortage, health care providers and even competitors will share staff and centralize back-office functions, allowing care centers to focus on what they do best – high quality patient care and service.

The role of leadership will be more important than ever. Developing cultures of continuous learning and ensuring an agile organization will be crucial with the changing demands of an organization’s shift to meet consumerism demands.

Post-Acute and Senior Care Asset Repurposing

From 2010 to 2017, the senior population aged 65 years and older increased nearly 26 percent, resulting in an increased need for senior care services. However, during this same time, the average daily census at skilled nursing facilities declined over four percent due to declines in utilization, length of stay, payment reform, alternative options, and client preference. Total licensed beds declined approximately one percent, and occupancy declined from 82 percent in 2010 to 79 percent in 2017. To adapt to the changing landscape, more SNFs will convert to senior housing alternatives, such as low-income or market rental apartments, specialized units like traumatic brain injury or mental health units, assisted living, or memory care assisted living, all of which have experienced increasing consumer demand.

The long-predicted shortage of personal care aides is here. And it is creating enormous challenges for frail older adults and people with disabilities living at home as well as for operators and residents of nursing homes and assisted living facilities.

This shortage inevitably will drive up costs for services that already are unaffordable for many consumers. They will increase financial pressures on Medicare and Medicaid and force older adults and others with disabilities to rethink how they receive care. At the same time, labor shortages will drive innovation and new technologies that could remake supports and services.

The US has known this was coming for years. As the aging population grew, the number of personal care aides to provide care at home or in nursing or assisted living facilities was not keeping up. But now the shortage is here.

A tight labor market

The long-term problem is all about demographics: The Baby Boomers are aging and, because they had relatively few children, there won’t be enough people of caregiving age—either relatives or paid aides– to help them. But even before we hit the demographic wall, the US is facing more immediate short-term problems.

The biggest may be the strong economy and the very tight labor market. The unemployment rate was 3.7 percent in October, the lowest in a half century. And with lots of other available jobs, it is increasing hard to recruit low-paid aides.

According to the advocacy and research organization PHI, home care workers earn a median wage of $11.03 an hour while nursing assistants in nursing homes earn $12.84 an hour. And their injury rates are among the highest of any occupation in the US.

By contrast, veterinary technicians make more than $16 an hour. A society that pays more to workers who look after pets than those who care for parents should not be surprised when people gravitate to easier and better-paying jobs.

How tight is the current market for direct care workers? The newsletter Home Health Care News reports that home care companies increasingly are requiring non-compete agreements that limit the ability of aides to move to other agencies or to work directly for their clients, who would then avoid paying the agency fees.

According to the newsletter, a lawyer who represents agencies said, “They don’t have enough of a labor force to satisfy their client demands.”

Regulatory answers

Government is looking to regulatory answers, including new rules to require higher staffing levels and more disclosure of facilities that are chronically short-staffed.

Last summer Jordan Rau of Kaiser Health News reported that many facilities have fewer staff than they report to the government. In response, the federal Centers for Medicare and Medicaid Services announced last week that it would urge states to boost inspections in an effort to end the practice. At the same time, some states have moved to mandate specific minimum staffing rules for nursing homes. Last spring, the New Jersey legislature tried.

But requiring minimum staffing won’t solve the problem. Many nursing homes will respond to these mandates by closing beds or otherwise changing their business models. This is a particular problem in long-stay nursing facilities where wages are largely driven by Medicaid. It makes little sense for the government to demand facilities hire more staff if its payment rates won’t support a decent wage for the workers they have.

Home care

But nursing homes are only a small piece of the problem. Fewer than 10 percent of those who require long-term supports and services live in those facilities. About another 8 percent live in assisted living facilities, which are unregulated by the federal government. But more than 80 percent live at home. How will they find aides?

Technology

How about technology? It undoubtedly will help. Facilities increasingly will install devices to monitor the well-being of residents. And some gizmos even are finding their ways into private homes. But caregiving remains a high-touch personal job and we are a long way from the time when human caregivers are replaced by robots.

The bottom line is that the law of supply and demand ultimately will win out, as it always does. The only way to increase the supply of aides is to pay them more, give them more benefits, make their work more rewarding, and give them opportunities for advancement.

Bessie’s Hope has created a solution to help—-

Twenty-five years ago, Bessie’s Hope created a solution to help with the unimaginable statistic that 60% of nursing home elders receive NO personal visitors. The solution: Relationship-driven volunteer programs that provide education and training to volunteers from preschool to adult ages. With the training, and with Bessie’s Hope facilitating elder care group visits for adult groups and youth groups and assisting families and individuals to be matched with elders who have no one, hundreds of elders DO have someone—the Bessie’s Hope volunteer. Compassion, empathy and respect for the elders are key.

The solution to help with the work force shortage is one that introduces high school students to the vast array of jobs and career paths in long term care. This introduction comes only after the training, the participation in the group visits, and the demonstration from the youth that they have respect, compassion and empathy for the elders. In addition, they have the awareness that the elders are resources of vast knowledge and wisdom, with so much to teach all younger generations on so many levels. They have a fondness for the elders, and they genuinely enjoy their company. All of these qualities are essential to being a good elder care provider.

The youth may participate in the Bessie’s Hope School-to-Career Work Force Development for Long Term Care. See the page of the same name on www.bessieshope.org.

Your Relationship to Sound & Music, Part II

Since the beginning of humankind, there has been music-making.  The first instrument was the human voice.  Second came things to beat on and things to shake or rattle to produce sounds.  For centuries, it has been known that music has the power to soothe and calm or to incite into action.

As a Board Certified Music Therapist and a presenter on the therapeutic and healing powers of sound and music, I had the wonderful opportunity to study for a number of years with Don Campbell.  A world renowned author and speaker, Don has written many books, such as The Mozart Effect, from which I’d like to share the following:

“What is this magical medium that moves, enchants, energizes, and heals us?  In an instant, music can uplift our soul.  It awakens within us the spirit of prayer, compassion, and love.  It clears our minds and has been known to make us smarter.

Music can dance and sing our blues away.   It conjures up memories of lost loved ones.  It lets the child in us play, the monk in us pray, the cowgirl in us line dance, the hero in us surmount all obstacles.  It helps the stroke patient find language and expression.

Music helps plants grow, lulls children to sleep, and marches men to war.”

Part I of this blog on our relationship with sound and music touched on vibrations, sound, and making sounds and music with our own voices.

Part II deals with recorded music and suggested applications with primarily instrumental music.   For a nurturing “sound bath” that can be taken in  3 – 5 minutes at your desk, select a piece from the Baroque period, such as the popular, Pachelbel Canon in D.  This style of music is at 60 – 65 beats per minute,  repetitive, predictable, no extreme changes in volume, and always resolves to the awaited home in the key structure.

Move your chair back from your computer and desk, sit with both feet on the floor, hands resting in lap, and close your eyes.   Allow the music to flow over and through you, as though you were sitting in a natural hot spring.  Music has the ability to entrain our biorhythms, so with this piece of music, our breathing becomes deeper to better oxygenate all our cells.  Our heart rate slows, and so does our frantic mind.  One or two such sound baths each day can also lower blood pressure, just as excessive noise can raise it.

Since we are bombarded with noise and chaotic frequencies sometimes 24 hours a day, our bodies are constantly subjected to the release of adrenalin and norepinephrine, which raise the heart rate and ready us for “fight or flight”.  Sound baths are the perfect antidote.

In caring for elders, Part I dealt with humming to create a more soothing presence.  Part II suggests allowing the elders the same opportunity for “sound” baths.  While helping someone dress or bathe, this genre of music lessens the anxiety and discomfort they feel from having another person doing these things for them.

Another suggested application for this music is in the dining room at care centers.  The entire dining experience is enhanced, because the music creates a calm spaciousness.  People can chew, swallow, savor and enjoy eating.  The music is also a nice background for table conversation.

Time to read, concentrate, to memorize, to learn—–the suggestion is playing instrumental music from the Classical period, such as compositions by Mozart.  Music fires more neurons than any other single stimulus, and with the structure and theory throughout this style of music, the brain is awake and alert.

Crossword puzzles and other mentally stimulating games can be nicely paired with this music.  In using this musical stimulation with stroke patients, it is a good background for re-establishing language patterns.

Mozart’s compositions are also suggested for individuals with Alzheimer’s Disease in completing various tasks, and for those with Cerebral Palsy, Parkinson’s Disease, stroke, and other neurophysiological disorders, the music has assisted in regaining control over neuromusculoskeletal functioning, such as gait in walking.

Of course, marches are also excellent for regaining this type of control.  For individuals in rehab or at home with a physical therapy regimen, marches assist in leg strengthening and endurance exercises.

Exercising and working to the rhythm of instrumental “big band” music and to other eras’ popular music pieces that have a steady beat, not erratic, and that is not too loud or too fast also create a pleasurable sound environment.

Singing along to favorite musical selections is advantageous for everyone, when it is time to relax, unwind, oxygenate our bodies, walk, etc.   However, we do need to be mindful when involving lyrics in our musical experience that the brain can only focus or concentrate on one thought or task execution at a time.  Recalling and singing lyrics while simultaneously entering data into a computer will most probably result in misspelled words and miscalculations of numbers.

This is a wonderful tool to use when working with individuals to train or retrain task execution, such as adding melody to “this is the way I tie my shoes, tie my shoes, etc”.   Singing lyrics in this mode assists in accomplishment.

Time to create, or just be—–use again the spacious Baroque music or meditation music.  In caring for others, or just caring for ourselves, we need to give our beta self a rest and spend time with our alpha self.  In caregiving, facilitating activities with someone, or ones, this type of musical background allows space to paint, sew, do crafts, cook, bake, etc.

Recorded music can be used to enhance our daily lives and to share positive, inspired frequencies and energy with our world.  Our bodies are soaking up the music on a molecular level—so nourishment or hazardous? —  A question to ask individuals who drive up beside us or behind us, polluting the environment with a mixture of discordant sounds, erratic beats, and negative, disrespectful words—-

Linda Holloway, Board Certified Music Therapist

 

“Feeling Better/Feeling Sound” – Being aware of our relationship with sound and music—Part I

Being mindful of the impact of our “sound environment” is important to our health.  In caregiving settings, we also control the sound environment for those for whom we are providing care.

Sound affects us on a cellular level at all times.  Silent vibrations also affect us, but this blog will deal primarily with sound and music, with references to the other sources of vibration.  Sound waves are constantly interacting with our bodies and minds.  Often, it is as though sounds are competing for our attention, and without even knowing, this is producing a stressful effect emotionally, mentally and physiologically.

As we know, people have varying degrees of sensitivity to sound frequencies.  There is an engagement with these frequencies.  Our brains and psyches are constantly filtering the information, eg the furnace comes on and creates its sounds, and we peacefully sleep through it.  The alarm on the clock awakens us.  We enter the kitchen, and the refrigerator hums its greeting.  If we begin the day with deep breathing to oxygenate our cells, and exhale with a simple, calming vocalized humming or “Ahhh”, we can welcome the day feeling relaxed and calm.

The meanings of words have their own frequencies, and these words vibrating throughout body produce a nurturing response, such as a mother humming or singing to her baby.  So, we exhale “Peace”,  “Love”, “Joy” to create our own internal, cleansing shower.  Our brain, in turn, like switching on the lights, begins the bio/electrical/chemical response to the sounds and frequencies of those words.  Try “I am peace—I am love—I am joy.”

The brain is like a computer, which will give the reports based on the information we put in.  Thus, our day is begun with peace, love and joy.  In the education we provide to the Bessie’s Hope youth and adult volunteers, we explain that the brain can be tricked.  It doesn’t know the difference between a happening right now and the memory of the happening.  It gets busy dispersing the chemicals, as per above.  When our volunteers help create a happy memory for the elders we serve in nursing homes and assisted living communities, the bodies and minds are showered with the same “feel good” chemicals as when the “real” event happened, eg dancing 60 years ago with their first love.

Likewise, the brain can be programmed to begin our day with the good vibrations we sing or speak.  Our volunteers sing “The Wonderful Song” with the elders, and we suggest to the elders that they begin their day by singing, “I am wonderful, and this is a wonderful day.”

This has been a brief introduction of using our own voices for “sounding”, or “toning”, which was coined by Laurel Elizabeth Keyes in the 1960s.   These are sounds we are creating ourselves with our own intentions to nurture ourselves.  What if we use this in our care providing for elders in our homes, or their homes, or in elder care communities in which we work?  We enter the bedroom or the workplace with a smile.  Remember, the brain is putting out what we put in.  So, our smile comes out of our body in a vibration that the elder will feel as “I am happy to be here with you.”

Also, we are quietly, gently humming or singing a positive, slow to moderate tempo song.  Then, it will be from this smiling, “good vibrations” place that we say “Good morning, ___.  I hope you slept well last night.  Today is going to be a good day.” We have been given the sacred honor of caring for elders, those wonderful beings who have reached the time of ultimate respect.  They have so much to teach all younger generations.

What are some of their favorite songs you could sing with them? Remember what this will do for them—the nurturing vibrations within their bodies.  By the way, it doesn’t matter how you think you sing.  If it’s done on purpose from the heart with the intention to be of service—your voice will be received as though it came from an angel.

For those of you entering the elder care community but not providing the hands-on care, you are still contributing to the vibrational environment.  Before you enter, sing or speak, “I am peace, I am love, I am joy.  I am vibrating at these frequencies.”  Then, as you enter know that you have the honor to share the sacred space with elders.

While focusing on elder care, this also applies to anyone of any age for whom we have been called to serve.  We smile and make a positive difference in the lives of all with our good vibrations.

Next blog will address the use of recorded music.

Linda Holloway, Board Certified Music Therapist

The Brain VS Hydration

Why am I not remembering, thinking as clearly or tired in the middle of the day?

Water is essential for the efficient functioning of your brain!  Dehydration equals Brain Shrinkage!

Even a 2% drop in body water can trigger short-term memory loss, trouble doing basic math and difficulties focusing.

Your brain is comprised of 75% water!!

Did you know that 75% to 90% of seniors are in the ER for Dehydration!!!  Remember from my last article that seniors lose their thirst sensation to let them know they need water!

Drinking adequate water is just as important for the health of the brain as it is for the health of our bodies.  Your brain needs plenty of glucose, oxygen, water and other essential nutrients to function well.  If your brain doesn’t get enough of water, you might feel dizzy, fatigued and get a headache, and you’ll start to lose your ability to concentrate.  Studies have shown that a glass of water every hour while studying prevents fatigue and headaches.

Because your brain is 75% water, ample hydration is an absolute must.  When the water in your brain decreases, stress hormones are released.  These hormones block glucose, which is the primary fuel of the brain, from entering brain cells.  This in turn results in memory problems.

It is important to understand that even a minor amount of dehydration can raise stress hormones in the brain and damage your brain over time.

Excerpts from “Brain Tune Up” By Arnold Bresky, M.D.

Iva Lou Bailey, Founding Trainer of Dr. Bresky’s 9 Point Brain Tune Up System.

Weight VS Hydration

Do you think you are hungry??  Why the hunger pains and so much fat?  How would you like to stop your hunger pains and release the fat?

37% of Americans have such a weak thirst mechanism that they mistake it for hunger!

Nearly 100% of dieters had hunger pangs satisfied by drinking a glass of water.  Drinking 1 glass of water before a meal will help digestion.

Mild dehydration can slow down your metabolism by 3%.  Imagine what chronic dehydration does.  75% of Americans are chronically dehydrated.

NOW ABOUT THAT FAT!

Our Blood is made up of 83% water.  This is important because blood transports nutrients throughout our bodies and moves waste products to be excreted.  So without adequate water, our bodies not only starve, but are poisoned with the waste products that cannot be expelled.

Our blood carries waste products to our kidneys, after which are expelled from the body through our urine.  If the body senses there isn’t enough water available, however, it reacts by retaining what water it has already.  What happens next is that this stored water gets contaminated with waste.  Why?  Because the Kidneys have no way to release the toxins.

When this occurs, the job of clearing waste shifts to the liver, which is already working hard to clean out our blood.  When it takes on some of the work of the kidney, the liver can’t work as efficiently.  And guess what one of the liver’s most important jobs is?  BURNING FAT!  So when it is overloaded the stored fat can’t be burned and the body will hold onto what water it has.  Thus, WEIGHT GAIN OCCURS.

Iva Lou Bailey
Owner/President
Argus Home Health Care
ivalou@argusofcolo.com