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August 2017 Caregiver eLetter
 Aging Care Solutions      Vol. 20, No. 4
     The gauntlet was passed to us and we accepted it.
 Therefore we will cope, and in so doing, set an example 
 for our children, and the generations to follow.
Contact Kay at 972-839-0065 or
www.AgingCareSolutions.com or
kay@AgingCareSolutions.com or kay@kaypaggi.com
   “I Want to Go Home”

    I hear this frequently from my clients who are hospitalized or in a long term care community. I was surprised to hear it from my adult daughter while she was in the hospital following spine surgery.
    My daughter is in her 30’s and engaged; she lives in an apartment by herself. She recently had surgery to repair herniated discs in her thoracic spine.  Her surgeon told her she would stay in ICU for 2 or 3 days, then move to the surgical recovery floor for another 3-5 days. On the 4th morning, the surgeon told her she was ready to be discharged home. She was delighted! Her support system (me, her father, and her fiancé) were horrified! 
    We had neglected to get a shower chair or bath bench, a shower hose, and a reacher or grabber before the surgery.  There is not enough space for a portable toilet in her bedroom. She refused to consider having someone stay with her in her apartment. She wanted to go home, sit in her favorite chair, and pet her cat.
    While that seemed desirable, she was not thinking about how many steps she would need to get to the bathroom or how many to get to the kitchen, or how she would carry food from the kitchen to a table or how she would manage a shower. When the social worker suggested a brief stay in a rehab hospital until she could go home safely, she was furious. All she could think about was going home where she could be comfortable. She said the same thing my clients have said:  I Want to Go Home!!
    Most of my clients go into the hospital suddenly with stroke or heart attack or broken hip; they don’t have opportunity to prepare their home with post-hospital equipment. Everyone understandably wants to go back to the place where they last felt safe and in control and comfortable: Home. What they, and my daughter, do not consider is the burden on their primary caregiver of having an invalid at home. The patient needs 3 nutritious meals every day, a way to bathe, someone to help them get to the toilet and back to bed or chair, someone to help them walk or exercise to regain strength, and medication management. It requires a strong caregiver to say NO, you are not ready to go home, and I’m not ready to have you at home.
    The other situation in which I hear “I want to go home!” is when a client has been placed in a long term care community. While there is always a possibility that this client will return home, more time is needed for their recovery, and their caregivers are not able to provide that additional care at this time. These clients are often too confused to understand that home is not a safe place for them. In this circumstance also, it requires a strong person to refuse to take the patient home. Soften it with something hopeful, like, ‘I’ll take you home after you can walk 1,000 steps’ or ‘You can go home when the roof repairs are completed’.
    In both situations, the caregiver must remember that safety is more important than comfort, and that preserving the caregiver's energy and health is necessary for the patient. If you are sick, then you are useless to your care receiver. Sometimes doing the best thing is hard. That is part of being a caregiver; you can make the hard decisions and take the blame while the patient gets good care. They will love you for your strength later.
Understanding Dementia Care

Thursday, August 31, 7:30-4:30
    This is an opportunity to hear Teepa Snow, one of the best known, dynamic and knowledgeable speakers on the care of people with dementia.. She will be the presenter at an all-day conference to be held on August 31 in the McGown Auditorium at Presbyterian Village North. Teepa will talk about how to understand those with dementia and how to care for them properly in the morning session, and how to interpret the body language of those with dementia in the afternoon, 'Giving care without the Fight'. The conference begins at 7:30am with a continental breakfast and concludes at 4;30, with a break for lunch (included).  The cost is $10.00 for family caregivers. You must register in order to have a reserved seat and get a lunch; seating is limited. RSVP to Lilly Adrian at ladrian@prescs.org, or mail her a check at this address:
Presbyterian Village North, 8600 Skyline Dr., Dallas 75243. 
Teepa Snow, A Positive Approach to Care, www.teepasnow.org  

    Centers for Medicare & Medicaid Services (CMS) recently unveiled the  new Hospice Compare website. The site provides a snapshot of the quality of care each hospice agency offers to its patients. CMS is helping individuals and families make informed healthcare decisions  based on objective measures of quality.
    Hospice offers specialized care and support to individuals with a terminal illness and a prognosis of six months or less if the illness runs its normal course. Once a patient elects hospice care, the focus shifts from curative treatment to palliative care for relief of pain and symptom management, and care is generally provided where the patient lives. Additionally, caregivers can get support through the hospice benefit, such as grief and loss counseling. Hospice Compare helps patients and caregivers find hospice providers in their area and compare them on quality of care metrics.
    The Hospice Compare site allows patients, family members, caregivers, and healthcare providers to compare hospice providers based on important quality metrics, such as the percentage of patients that were screened for pain or difficult or uncomfortable breathing, or whether patients’ preferences are being met. Currently, the data on Hospice Compare is based on information submitted by approximately 3,876 hospices.
    For more information please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-08-16.html 
   Nursing home administrators' salaries increased nearly 3% over the past year to an average of $97,401 in 2017.  The Nursing Home Salary & Benefits Report 2017-2018, was released by the Hospital & Healthcare Compensation Service.  Directors of nursing average $91,444 in 2017; assistant DONs also fared well, with average salaries increasing 2.31% to $71,474.
Answers to Mental Aerobics
Caregiver Support  - The regularly scheduled Caregiver Support meetings have been cancelled. I would be pleased to discuss your ElderCare issues with you privately. Send me an email or text, or call me at 972-839-0065 to arrange a time and place.

In This Issue
- Teepa Snow, A Positive Approach to Care
- Hospice Compare website
- Nursing Home salaries
- Mental Aerobics
- Elder Humor 

Contact Kay
Visit Aging Care Solutions for practical, useful information about ElderCare. Kay Paggi is a Licensed Professional Counselor (LPC), National Certified Gerontological Counselor (NCGC), Care Manager Certified (CMC), and an ElderCare Mediator.
Nine first names are hidden in the sentence below. What are they?

Alabama rye bread is dandy, but anglophiles are used to automat toast.

(Answers below)
 As we Silver Surfers know, sometimes we have trouble with our computers. 
I had a problem yesterday, so I called Eric, the 11 year old next door, whose bedroom looks like Mission Control and asked him to come over. 
Eric clicked a couple of buttons and solved the problem. 
As he was walking away, I called after him, 'So, what was wrong? 
He replied, 'It was an ID ten T error.'
I didn't want to appear stupid, but nonetheless inquired,
'An, ID ten T error? What's that? In case I need to fix it again.'
Eric grinned ..'Haven't you ever heard of an ID ten T error before?
'No,' I replied.
'Write it down,' he said, 'and I think you'll figure it out.' 
So I wrote down: 
I used to like Eric, the little shit head. 
PLEASE LET ME KNOW when your care receiver dies or you no longer want to receive the Caregiver eLetter!
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