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News Roundup: July 15, 2013

Research Shows Sensors Lead to Aging-in-Place Success

Published by Home Health Care News
Elizabeth Ecker
July 10, 2013

Aging in place with the help of in-home care is getting a major boost from technology, writes the Associated Press. From motion sensors to mattress monitors, home care is becoming more viable with the help of new gadgets.

Researchers at the University of Missouri are ramping up efforts to test some of the devices in the homes of seniors who are utilizing them to alert family members as to their activities—or lack thereof. Currently, they are being tested in a university-affiliated senior apartment complex as well as another local senior community.

The research has proven to foresee possible falls from two weeks to 10 days prior, the AP reports.

‘‘We were blown away that we could actually detect this,’’ nursing professor Marilyn Rantz, an aging-in-place specialist who is leading the research, told the AP.

By monitoring heart rate and vital signs of sleeping subjects and then tracking their movement through the use of a camera technology most often used in video games, the team has been able to recognize when a person is at risk of falling, shortness of breath and infection.

But the presence of the devices can be a stop-point, the researchers found, with the level of obtrusiveness in a senior’s home being a considerable factor. The sensors must be embedded rather than worn, for example, Rantz told AP.

‘‘When we started this team, I said we are not going to make anybody wear anything or push any buttons, because my mother refused and I don’t think she’s any different than a lot of other people in this world,’’ Rantz said.

Fixing Up Seniors' Homes To Help Them Age In Place

Published by NPR News
The Associated Press
July 8, 2013

Alberta Hough struggles to feed herself a snack, her arms shaking badly from Parkinson's disease. Days earlier, the 84-year-old fell while eating, sliding off her kitchen chair.

The rest of Hough's day isn't much easier to navigate. She wobbles into a bathtub with no grab bar. Her feet catch on damaged floor tiles. Part of the banister she needs to steady herself on the stairs has pulled out of the wall. At the back door, a rickety wooden ramp no longer supports the scooter that helps her get around.

The environment in which you live can be as disabling as a disease, and too often, older Americans wind up in a nursing home not because they're super-sick but because they can't get through their days safely at home.

Now a major research project will bring handymen, occupational therapists and nurses into the homes of 800 low-income seniors in Baltimore to test if some inexpensive fix-ups and strategies for daily living can keep them independent longer, and save millions in taxpayer dollars spent on nursing home care.

"Very small changes can make a big difference," said Sarah Szanton, a Johns Hopkins University associate nursing professor who leads the project. "We're not saying, 'What's your blood pressure?' We're focusing on function: What do they want to do?"

Losing independence is a leading fear as people age. But a recent poll shows that too few comprehend the changes in lifestyle needed to offset the chronic illnesses and gradual slowdown that hit just about everyone in the 70s, 80s and beyond.

Asked about their choice of living situation when they're older, Americans 40 and over say their top priorities are a one-level home with no stairs, that's close to their children and medical care, according to the poll by the AP-NORC Center for Public Affairs Research.

Chances are, that won't be enough.

For Hough, No. 1 is feeding herself without everything tumbling off the fork.

"I'm shaking all the time," she quietly told Hopkins occupational therapist Allyson Evelyn-Gustave.

Hough's other priority is not falling, and stairs are only one of her home's hazards.

To Hopkins' Szanton, bridging the gap between what older adults are able to do and what their homes allow them to do is key to maintaining independence.

The Capable study aims to prove how. During 10 home visits over four months, the Hopkins team is tailoring interventions — including about $1,100 in home repairs or modifications provided for free — to help low-income seniors who are having trouble caring for themselves.

Drills buzzed in Hough's house as carpenters installed a new banister and added grab bars and a raised toilet seat in the bathroom. They replaced patches of flooring to prevent trips and prepared to tackle the ramp.

As for eating, Evelyn-Gustave recommended a little-known tool: utensils and cups that are specially weighted to counter Hough's tremors.

"It'll be easier for you to hold," she promised.

The set of utensils costs only about $20, one of the affordable tips the study is generating. Hough's daughter had thought the only solution was an aide to feed her mother, which the older woman hates.

"I always said I wouldn't let my mom go to a nursing home," said Gloria J. Hawks, 66, who is determined to care for her mother in the house the two share.

The Capable project — it stands for Community Aging in Place, Advancing Better Living for Elders — is being closely watched by Medicaid officials in other states as a way to coordinate care and improve the functional problems that lead to pricey, and sometimes preventable nursing home admissions. Today, it's difficult for Medicaid patients to get these services.

With more than $8 million in research money from the National Institutes of Health and the Centers for Medicare and Medicaid Services, the project goes beyond home repair for health. It starts with a full-scale assessment of each participant's needs.

In one home, a Hopkins nurse discovered that an 82-year-old woman was taking all of her 26 daily medications at once instead of staggered throughout the day, leaving her disoriented and sedentary until she became too weak to get out of bed without help.

First the nurse fixed the medication schedule. Then the occupational therapist taught the woman leg-strengthening exercises and installed $30 steel risers to make it easier for her to get in and out of bed. Add new banisters, and soon she was moving around on her own.

Whether it is the cost or emotional ties, many people grow old in the same home where they spent their younger, more agile years. An AARP survey in 2010 found nearly 90 percent of seniors wanted to remain in their current home for as long as possible.

Yet government figures show nearly 1 in 5 seniors living in the community have trouble with at least one activity of daily living, such as walking or bathing.

Those physical limitations become more difficult with doorways too narrow for walkers, toilets that are lower than chairs, and kitchen counters too tall to sit while cooking. Plus, nearly one-third of older adults experience a fall every year, and most who are injured fell inside the home, according to the Centers for Disease Control and Prevention.

"You don't think about that stuff," said Hattie Watties, who can't imagine leaving her Baltimore home of 36 years, that's near children and grandchildren. "You just do what you have to."

For Watties, 74, that meant climbing onto kitchen counters to reach too-high cabinets. Steep, dark stairs to the basement laundry only had a partial railing, so she threw clothes down and inched her way after them.

No more: Carpenter Tyrone White lowered Watties' cabinets to a comfortable reach, installed railings, and showed how an energy-saving compact fluorescent light bulb provided more light than a regular bulb in the dim stairway.

In homes where it's even darker, White sticks motion-sensing lights by each step to show where to aim your foot. They're less than $15 for a two-pack and run on batteries, so no rewiring is needed.

The work that perhaps has the biggest impact seen so far is a double railing for stairs lets people rest their weight on both sides.

The handymen, employed by the urban service corps Civic Works, also insist on installing carbon monoxide monitors, which have detected leaking gas stoves in some homes.

Do these solutions really save money?

The four-month intervention costs about $4,000 per participant, including the home modifications and specialists' salaries. The average cost for nursing home care in the U.S. is $6,700 a month, so even a modest delay could add up fast. Szanton will track participants long term and, based on results from an earlier pilot test of 40 high-risk seniors, hopes to delay nursing home entry by up to a year in this frail population.

For families, perhaps the bigger question is how long the solutions will last. Evelyn-Gustave teaches families to brainstorm options as new challenges crop up.

"We can't be there forever. They need the skill to carry on," she said.

Are We Underestimating How Much Help Aging Parents Need At Home?

Published by Forbes
Carolyn Rosenblatt
July 8, 2013

Lots of people think of the possibility that their aging parents might need a little help. The parents may be struggling, but don’t want anyone coming into their home. They say “I’m fine” when their children suggest a helper. So, they all wait.

No one calculates the actual cost of help until a crisis hits. Like a fall and broken hip. After the hospital and then the rehab facility, it’s back home. Then the adult children are shocked to discover that Medicare does not cover a home care worker to be there to help mom with her bath and meal preparation. Medicare does not cover anything else that is categorized as help with “activities of daily living”.

The concern is whether the adult children are going to have to pay for that help out of their own pockets. Many aging parents do not have the income to cover this help.

We all just got a reality check in a report from the Congressional Budget Office about how many hours of daily assistance an aging person is likely to need.

The report tells us about our aging parents who have trouble functioning independently in their activities of daily living (ADLS), which include bathing, dressing, eating, toileting, walking, and transferring from bed to chair.

People with functional limitations who receive assistance from others primarily rely on informal care to obtain the assistance they need. Generally, this means family caregivers. The number of hours of paid care is highest for people who have difficulty with three or more activities of daily living and who are 85 or older. Many are widowed and thus without a spouse to care for them.

People under age 85 with limitations in three or more ADLs who live at home rather in a care facility receive an average of 9 hours of assistance per day.

People age 85 or older with that degree of impairment typically receive about 11 hours of assistance per day, mostly informal.

And for those whose aging parents 85 and up who have limitations with three or more ADLs and who also have cognitive limitations (this includes dementia) receive an average of more than 14 hours a day of informal and paid care.

The cost of an unlicensed home care worker who provides basic care is paid out of pocket for those who are not eligible for public benefits. According to the 2012 Met Life study of costs of long term care, including home care workers, the average national cost is $20 per hour.

If you pay a worker to come to your 85 year old parents’ home to care for them with three functional limitations and dementia, the cost will be an average of $102,200 per year for daily, 14 hour a day help. Since most elders cannot afford this, the writing is on the wall. Family members provide much of the needed help themselves. Will this be you?

Long term care insurance is the only private benefit that covers home help with activities of daily living, the kind of help most elders need. But most people in the U.S. don’t have it. The Congressional Budget Office report cites statistics from America’s Health Insurance Plans, Who Buys Long-Term Care Insurance in 2010–2011 (report prepared by LifePlans, March 2012), www.ahip.org/ WhoBuysLTCInsurance2010-2011/. Among the adult U.S. population only about 3 percent had LTC insurance in 2011.

It is prudent to consider the long term picture even if your aging parents are just fine at the present. Most of us are going to need some help at some time in the future if we live to be that old. Aging parents need to see their financial planners to be sure their assets are available to cover these potential costs. And if they do not have that kind of assets, be prepared for the alternatives. It may be up to you to pay or provide care on your own.

ND Sees Surge In Demand For Home Health Workers

Published by WDAY 6 News
The Associated Press
July 6, 2013

Grand Forks-based Altru Health System is seeing an increase in demand for home-health aides in North Dakota, matching a nationwide surge in demand for those health care workers who visit senior citizens and patients in their own homes.

Kari Jensen, Altru's home health and hospice manager, tells the Grand Forks Herald (http://bit.ly/14yiTvW ) that the demand is growing the most in rural areas.

In addition to Grand Forks, Altu's home health program has branches in the northeast North Dakota towns of Cavalier, Devils Lake, Grafton, McVille and Park River, and also in Warren, Minn.

Jensen says people want the services to stay in their homes longer so they don't have to move to other living arrangements. She says patients going home from the hospital also benefit from home health services.