Can an Adult Senior Remain at Home? …That is the Question

Can an Adult Senior Remain at Home? …That is the Question

As an eldercare consultant, I am familiar with the statistic that close to 90% of adult seniors, have expressed a desire to remain in their homes for as long as possible. The terminology in the world of eldercare is “aging in place.”

My lack of surprise about aging at home, while corroborated by AARP, has its source in the adult children who visit my office frustrated that their parents feel there is no compelling reason for them to move out of their house. A typical scenario as described by a son or daughter: no bathroom or only a half bathroom on the main floor, stairs that must be ascended or descended to get to the kitchen, no direct access to the outside without holding on to a hand rail that is unstable accompanied by a walkway that is crumbling, nonstop repairs both large and small.

Sitting across from these adult children, I understand their unease. They are often wakeful at night, distracted at work, consumed with the responsibilities of calling the plumber, roofer or making sure a path has been shoveled after a snowstorm.  I also know from talking with adult seniors the comfort that comes with continuing to reside in a lifelong home. Change is never easy or welcomed.  So, what’s an eldercare consultant to do?

For this consultant, the major consideration is safety. There is no compromise on this issue. To ensure this safety there are three necessary requirements. First, the willingness of a parent to agree to whatever modifications should be made to the house. First, the readiness of the parent to accept home care if necessary and first, the financial wherewithal and/or community support services to achieve these outcomes.  Yes, they are all number one priorities.

To this end, I frequently visit the parents in their home. Often, mom and dad need to be heard and understood, with a focus on empathy. Once they know I understand their situation, it is easier to start to effect change. The secret is small steps. With each step, it is validating their willingness to undertake necessary changes. That validation provides the incentive for the next step until a safe living environment is accomplished.

But please don’t think I come with a magic wand. Sometimes the ideal, or even close to it, becomes unachievable. It may be the staunch autonomy of a parent or it is the symbiotic relationship of husband and wife who create such a strong wall (yes, this one is achievable), that adult children, the family favorite, or even this eldercare consultant cannot convince them that they are putting their safety at risk. Then Father Time steps in and removes aging at home as a choice. A fall, noncompliance with medication, or one of those all too frequent storms we’ve been having here in Westchester County, may result in a whole new aging in place definition and destination.

From Hospital to Home:  Post Hospital Syndrome

From Hospital to Home: Post Hospital Syndrome

Recently I addressed the Post-Acute Care Continuum in White Plains, New York. An organization whose goal is to educate and share best practices in post-acute care and care transitions. I was asked to speak about how geriatric care managers can help to ensure that patients return home and remain home beyond the initial 30-day period. Of course, we do not want our clients to return to the hospital at any time, but there is a reason for the specific 30 days.  In 2013, the United States Department of Health started to penalize hospitals for re-admission of patients within thirty days. The Department of Health wanted patients to be discharged responsibly with adequate follow-up care, hence this law was enacted.

Because of this act, the rate of 30-day re-admission has dropped from 20% to 17%. But often, while the reason for hospitalization has been addressed, the consequences of a hospitalization are just being felt when our clients return home. Dr. Harlan Krumholtz, MD of Yale-New Haven Hospital refers to this return as the Post Hospital Syndrome. He attributes this re-admission within 30 days to five major factors:

  1. Sleep deprivation: The patient is in a new environment. The illness combined with being in a different bed, in a different place will impact on cognitive and physical performance. A situation of perpetual jet lag has been created.
  2. Malnourishment: Certain tests and procedures require nothing by mouth for the day or evening prior. And if the test is cancelled and then rescheduled, another period goes by without nutrition. This results in protein-energy malnutrition. The consequences of such a scenario is that wound healing is impaired, there is a chance of increased infection and one’s immune system is compromised.
  3. Pain and discomfort: For any of us, especially those dealing with pain in the hospital environment, pain can lead to sleep disruption, mood disturbance, impaired cognitive functioning and may also impact on the immune system.
  4. Altering medications: Stopping one medication and adding another can have its impact on cognition and physical functioning: too much of a medication, too little, the wrong medication, an allergic reaction to a medication. A patient’s body becomes a roller coaster of experimentation in an effort to cure.
  5. Deconditioning: Time in bed for rest can put a patient at greater risk of accidents and falls. While physical therapy may take place in the hospital, Dr. Krumholtz questions if there is still too much inactivity. The result being once the patient returns home he or she is at greater risk for developing blood clots.

As discharge approaches, what must be done is a TOTAL evaluation of the patient. This evaluation should go beyond the reason for hospitalization. Attention must be given to sleep, nutrition, activity, strength and how all symptoms are treated and managed. As a geriatric care manager, it is my responsibility to observe, question and advocate for clients whose care has been entrusted to me.