Health Insurance Reform Timeline All About Pain:
myths and realities
The Importance of Socialization for Seniors
Helping People with Alzheimerâ€™s Lead Richer Lives
The Facts About
No More Aching Feet
The Importance of Socialization for Seniors............................2 For Medicaid Applications, Having an Attorney Can Be Crucial................................................4 Memory Loss & Aging............................................................................6 Treat Your Vertigo Without Medication.......................................9 Focus on healthy eating habits for healthy eyes.....................................................................10 The Fact about Breast Cancer........................................................11
Publisher/Editor: Seth Auerbach 856-240-5001 firstname.lastname@example.org Advertising Sales: Stefanie Lindner 856-630-9183 email@example.com Creative Director: Michelle Helfrich firstname.lastname@example.org
Don’t Wait to Talk About Hospice..................................................13
Production: Seth Auerbach
Five Questions to ask when choosing a home care agency......................................................15
Advertising Inquiries: email@example.com
No More Aching Feet..........................................................................16
It’s not You, It’s the House...............................................................18
Dana E. Bookbinder, ESQ Dr. Anne Rosenberg
All About Pain: Myths and Realities..............................................19
Dr. Paul G. Vidal, DPT
Health Insurance Reform Timeline................................................20
Dr. Lawrence Levine, DPM
Sharing Across Generations...........................................................22
Dr. Kimberly Friedman Gary Skole
Is It Time To Move?................................................................................23
Holly Alexander, OTR/L, CDRS
Living with home oxygen therapy.................................................24
Janie De Leon-Male, M.S.S., LSW
Regaining Balance After Breast Cancer....................................26
Trip Tip: Older Drivers and Public Safety.....................................27
Marcy Schachinger Sandi Lichtman
What is a Geriatrician?.......................................................................28
Removing fear, promoting joy.......................................................30
Terre Mirsch, RN
The Importance of Medication Management for Seniors.................................................................32 Volunteering – In The Spirit Of Hospice Care.............................33
Thomas A. Cavalieri, DO, FACOI, FACP, AGSF Tori DeAngelis Valerie Esquilla
The Importance of Socialization for Seniors Socialization: The Missing Component to Senior Care By Gary Skole The majority of seniors would prefer to stay at home and age-inplace. However, this may not be the ideal situation for everyone. While home care services allow seniors to remain living independently, they often leave the care recipient isolated without much contact from family and friends. A growing body of evidence is suggesting that the psychological state of a person can have as much to do with successful aging as good genes, diet and exercise. In a study published in Psychology and Aging, it was reported that a low frequency of socializing with relatives and friends was a significant predictor of future institutionalization. Those who spent more time doing social activities and communicating regularly with friends and relatives had a lower
rate of institutionalization later in life. Another recent study coming from the University of Chicago showed that loneliness can play a major role in elevating an individual’s blood pressure. The study, published in the March 2010 issue of Psychology and Aging, found that the loneliest people registered blood pressure 14.4 millimeters of mercury higher than the blood pressure of the most socially contented participants. In Okinawa Japan, where people routinely live healthy lives past
the age of 100, there are several common factors shared by most centurions, which include a strong social community and remaining active throughout their lives. The evidence is mounting about the importance of socialization. Humans are a social species and require human interaction in order to live with optimal health. Remaining at home for as long as possible is the goal for most seniors and incorporating social activities, at any age, needs to receive more attention from family members, friends and the professional senior care community. Seniors are at a much greater risk of suffering from loneliness and isolation due to many factors. • Driving becomes more difficult, which means fewer trips to visit friends, family and trips to the store and other social outings. • Spouse and friends are often outlived, and meeting new people is very difficult. • Using technology to socialize can be scary and uncomfortable. • Scattered families are spread out, often too far away to visit easily. (continued on page 43)
For Medicaid Applications, Having an Attorney Can Be Crucial By Dana E. Bookbinder, Esq. Given the convoluted and ambiguous set of provisions that are our federal and state Medicaid laws, it is a wonder how any lawmaker could expect individuals, especially seniors with compromised health, to apply for benefits on their own. Federal regulations require Medicaid caseworkers to be helpful to those who file for benefits, but state and federal budgetary constraints have created a reality that is much more frustrating than the printed law would suggest. Many individuals file applications unprepared for the minutiae that will delay the processing of their application for several months or cost them tens of thousands of dollars in health care expenses. Fortunately, the public is becoming increasingly aware of the difference that an attorney can make with Medicaid applications. The most common obstacle to obtaining a timely Medicaid approval is the failure to provide the Medicaid office with complete information. The amount of paperwork required with each application is burdensome, and under new federal law, last year it became potentially more burdensome. In addition to compre-
hensive financial information dating back three (soon to be five) years, Medicaid applicants must submit a variety of documents such as marriage licenses, birth records, deeds, affidavits, etc. to support their applications. The documentation required varies somewhat with each case, but the paperwork is oppressive for even the most organized individual. When a senior is dealing with his spouseâ€™s ailing health and his own limitations, the task of applying for benefits becomes overwhelming. The most daunting obstacle to a Medicaid approval is the Deficit Reduction Act of 2005. This Act extended the three-year lookback to five, creating much more homework for anyone seeking benefits. It also changed the rules regarding transfers of assets and created partial month penalties. Whereas the old rules granted Medicaid eligibility for a certain period of whole months, the new laws grant or deny Medicaid for partial month periods. With regard to certain assets such as annuities and promissory notes which may be held by Medicaid applicants, the new law confuses most Medicaid 4
caseworkers rather than guides them. The result is that many more Medicaid applications have to be sent up from the county level, where the applications are originally filed, to central state offices for review. In New Jersey, the Division of Medical Assistance and Health Services in Trenton has been collecting applications that include trusts, annuities, and notes for several months. This is slowing the entire process. To those who do not practice elder law, it is always unbelievable that the counties implement certain Medicaid eligibility policies which are not necessarily written down. Other policies are handed down from the state office to the county supervisors through memos that do not reach the public until after the supervisors begin to implement them. For instance, the firm recently learned that such a memo was disseminated among the counties concerning prepaid funerals and whether the Medicaid eligibility rules permitted prepaying a funeral luncheon. Because much of what affects those applying for Medicaid is not part of (continued on page 34)
Memory Loss By Tanya McKeown
– and even some that are barely into middle age – joke about having “senior moments,” those annoying instances when your brain goes blank and you simply cannot remember something. But getting older doesn’t have to go hand-in-hand with memory loss. While aging brains experience changes in the ability to retain and retrieve memories, these changes usually represent more of a slowing in the ability to absorb and retrieve new information, not a loss.
Memory is the mental activity of recalling information you have learned or experience. And just like muscular strength, your ability to remember is a “use it or lose it” proposition. “Exercising” your brain, along with good health habits, is key to keeping your ability to retain information – and recall it on demand – strong. In addition to simple brain exercises – like brushing your teeth with your non-dominant hand or getting dressed with your eyes closed – there are some basic things you can (continued on page 44)
Treat Your Vertigo Without Medication: The Facts on Benign Paroxysmal Positional Vertigo Dr. Paul G. Vidal, DPT Do you or someone you know experience vertigo? Vertigo, a type of dizziness, is usually described as a sense of spinning or rotating. The presence of vertigo is typical for involvement of the vestibular system (inner-ear). Vertigo may increase an individual’s risk for falling which may lead to serious injury. Timely diagnosis and treatment of vertigo is essential to avoid or limit the detrimental effects that vertigo can have on an individual’s life. Did you know that the most common vestibular disorder is due to displaced microscopic calcium carbonate crystals in the posterior canal located within the inner ear1? Did you also know that successful treatment for this most common cause of vertigo is performed without medication or surgery? This condition is called benign paroxysmal positional vertigo, otherwise known as BPPV. BPPV is responsible for about 20% of all dizziness1. As the name implies, a person will experience vertigo with positional changes, such as lying in bed, rolling in bed, looking up, bending down, etc. Typically, vertigo brought on by positional changes will last no more than sixty seconds1-3. Why does BPPV occur? There are a few causes of BPPV. It can be degenerative, brought on by head injury, after prolonged bedrest (from illness or surgery), or sometimes it can just happen (insidious 9
onset). Other times it can come on after a viral infection1-3. BPPV can occur throughout the lifespan, but peak incidence is between the fifth and seventh decades of life3. In the older adult, 50% of all dizziness is due to BPPV1. Since it is benign vertigo, it is not fatal, yet it can have a significant impact on your ability to function2. People with BPPV tend to limit their physical activity in fear of provoking their vertigo. BPPV can limit a person’s independence. Fear of falling, inability to work, difficulty driving, difficulties picking something off the floor, or difficulty washing your hair (bending head backward to look up) are examples of the detrimental effects that BPPV can have on a person’s life. How is BPPV diagnosed and treated? BPPV can be detected and treated in the office quite effectively and efficiently3. In fact, there is a high success rate in one office visit2,3. A number of healthcare providers can detect and treat BPPV, including otolaryngologists, neurologists, and physical therapists3. BPPV is detected via a Dix-Hallpike Test, the gold standard test for BPPV1-3. The treatment for BPPV is known as a canalith repositioning technique, most commonly known as the Epley maneuver1. The Epley maneuver mobilizes the calcium carbonate crystals out of the posterior canal into the correct (continued on page 37)
Focus on healthy eating habits for healthy eyes The adage “you are what you eat” doesn’t apply only to the waistline. A person’s diet affects every aspect of his or her body, including the eyes.
For people of any age, Friedman notes the following examples of nutrition-related eye problems that merit consideration:
In fact, a balanced diet is essential not only for maintaining daily eye health, but also in helping protect against common ailments such as macular degeneration and cataracts, according to Kimberly Friedman, O.D. FAAO, past president of the New Jersey Society of Optometric Physicians and partner at Moorestown Eye Associates.
• Severe vitamin A deficiency is the major cause of childhood blindness in the world. More than half a million preschool-age children throughout the world lose their sight each year due to vitamin A deficiency.
According to Friedman, more than 22 million Americans suffer from cataracts (a clouding of the natural lens and the leading cause of visual loss among adults 55 and older) and age-related macular degeneration (AMD), which is a hardening of the arteries that nourishes the retina. Research by the National Eye Institute and countless studies and surveys indicate a positive correlation between good nutrition and prevention of AMD and cataracts. “Simply incorporating healthy foods into your diet can help prevent these two leading causes of visual loss and blindness,” Friedman said. “Especially when you consider cataracts require surgery, and treatment options for macular degeneration are currently limited, it makes sense to take preventive measures to head off potential problems.”
• “Night blindness” is one of the first detectable signs of vitamin A deficiency. Night blindness occurs when the retina doesn’t receive enough retinal to regenerate the light-bleached visual pigments. People lose the ability to recover quickly from a temporary blinding that follows a flash of bright light at night (such as from car headlights) or after a light goes out. Because of the deficiency, recovery takes much longer than a few seconds, which can be dangerous in some situations. “ These are extreme examples of the damage poor nutrition can cause, but they get people re-evaluating their eating habits,” Friedman said. So what types of foods are eye healthy? Friedman said most people are familiar with the link between carrots and good eye health, but there are many other foods that will do the trick. Key nutrients for eye health include: • Vitamin C, which can be found in oranges, grapefruits, strawberries, papayas, green peppers and tomatoes; 10
• Vitamin E, which is more difficult to obtain from food sources because it is found in very small quantities. However, vegetable oils (safflower and corn oil), almonds, pecans, wheat germ and sunflower seeds are good sources; • Beta-carotene, which is present in dark-green leafy vegetables such as spinach, deep orange or yellow fruits such as carrots, mangos, sweet potatoes, cantaloupe, apricots and peaches, and fortified cereals. • Lutein and zeaxanthin, which are found together in many food sources. Dark-green leafy vegetables such as kale, collard greens and spinach are primary sources, but they are also present in lesser amounts in other colorful fruits and vegetables such as broccoli, orange peppers, corn, peas, persimmons and tangerines; and • Zinc, which is found in abundance in meat, liver, shellfish, milk, whole grains and wheat germ. “A healthy diet is as good for your eyes as it is for your entire body,” Friedman said. “Proper nutrition is essential for looking good and seeing well.” Dr. Kimberly K Friedman, FAAO is the past president of The New Jersey Society of Optometric Physicians and practices in Moorestown, NJ. For more information, visit ww.moorestowneye. com.
treatment for early-stage breast cancer. This recommendation was based on the results of prospective randomized trials showing that the survival rates were equal after BCS and mastectomy.
The Facts about Breast Cancer by Dr. Anne Rosenberg
It is estimated that in 2009, there will be 192,370 newly diagnosed breast invasive breast cancers, another 62,280 non-invasive cases, and that 40,170 women will die from breast cancer. Only lung cancer accounts for more cancer deaths in women. In 2009, 1,910 or 1% of breast cancers will occur in men and 440 will be expected to die from disease. High risk factors include: being female, advancing age, inherited
genetic mutations (BRCA), first degree relatives with premenopausal breast cancer, a personal history of breast/ovarian cancer and atypical hyperplasia. Almost twenty years ago, breast conservation therapy or lumpectomy was accepted as an alternative to mastectomy for early stage breast cancer patients. In 1991, a National Cancer Institute Consensus Conference endorsed BCS or lumpectomy as the preferred
Currently, in this geographic area, approximately two thirds of all early stage breast cancer is treated with lumpectomy, radiation therapy to the breast and sentinel node biopsy. Sentinel node biopsy has replaced axillary node dissection as the standard of care for axillary staging. But things are also improved for the 30% of breast cancer patients who undergo mastectomy. First, they have sentinel node biopsy instead of axillary dissection and the pectoral muscles are spared. This minimizes lymphedema and physical disability from surgery. Second, most mastectomies are now skin-sparing. This means that only a minimal amount of breast skin (maybe only the nipple and areola) are removed to perform the mastectomy. This (continued on page 36)
The National Hospice and Palliative Care Organization reports that more than 1.4 million people received care from our nation’s hospices last year.
Don’t Wait to Talk About
Hospice providers can help with information about care options and choices to ensure quality of life is maintained as fully as possible. They will make sure family members receive support as well.
It’s an all too common situation. A family is at the bedside of a loved one who is seriously ill and nearing the end of life. Each member of the family has a different idea of what should be done and what the patient would have wanted.
One of the best ways to make sure you and your loved ones benefit fully from hospice, should you ever need this care, is to talk about it before it becomes an issue.
Far too many people wait until they are in the midst of a health care crisis before thinking or talking about what options are available or what care they or their loved ones would have wanted. Hospice professionals deal with these challenging situations every day – that’s what they are trained to do.
For more information, contact Lighthouse Hospice at 1-888-HOSPICE or www.lighthousehospice.net. This information is provided by the National Hospice and Palliative Care Organization and Lighthouse Hospice.
When a family is coping with a serious illness and a cure is no longer possible, hospice provides the comfort and dignity most people say they want at the end of life. Considered to be the model for high-quality, compassionate care for people with a life-limiting illness, hospice includes specialized medical care, expert pain management, and full emotional and spiritual support. Care is provided by an interdisciplinary team of professionals and trained volunteers who maintain the wishes of the patient and family at the center of care. Most hospice care is provided in the home – where the majority of Americans have said they would want to be at the end of life. Care is also provided in nursing homes, assisted living facilities, and hospice centers. Care is paid for by Medicare, Medicaid, and most private insurance plans and HMOs. However, no patient is denied hospice care for reasons of inability to pay for services. 13
Five questions to ask when choosing a home care agency Dear Readers: There can be no more of an intimate setting than providing care for an individual in his or her home. In our area, we are fortunate enough to be provided with several choices when it comes to choosing an Agency that will provide home healthcare to ourselves or our loved ones. However, I encourage everyone to be diligent in their choices and to not hesitate to ask the representatives of these Agencies the questions set forth below. These questions will lead to intelligent discussions about the type and quality of the Agency and the services it provides. In an industry with very low barriers to entry, it is imperative for you, the consumer, to educate yourself and ensure that you are choosing a reputable provider.
Question # 1
Are your caregivers certified in the State of New Jersey? Unless the request for services is strictly companionship (i.e. meal preparation and conversation), the caregiver is to have no contact with the client in the State of New Jersey without the caregiver having the designated Certified Home Health Aide licensure in the State of NJ. Further, a recipient of the Agency’s services is encouraged to ask the caregiver to see proof of their original license (the caregiver should carry it on them at all times during the workday just like a driver’s license).
Question # 2
Question # 4
Does the Agency conduct criminal background checks on its employees? In order for a caregiver to maintain his or her Certified Home Health Aide licensure in the State of New
All Agencies are required to have this licensure in order to provide any type of homecare service in the State of New Jersey and employ a Registered Nurse in a supervisory role.
Question # 3
Question # 5
Is the Agency fully licensed, insured and bonded? In order to mitigate the consumer’s liability, the Agency should have proper coverage to address any issue that may arise.
• CHAP (Community Health Accreditation Program) and • NAHC (National Association for Home Care and Hospice) While accreditation is not required of an Agency, a governing body can provide an additional measure of quality assurance that protects the consumer and the Agency’s reputation.
Jersey, a background check is conducted every two years by the New Jersey Board of Nursing upon renewal; however, a background check conducted by the Agency themselves at the time the caregiver joins the organization and every year thereafter, is an additional measure of quality assurance.
Does the Agency have a Healthcare Service Firm License?
• JCAHO (Joint Commission on the Accreditation of Healthcare Organizations)
Is the Agency accredited? Many consumers are not even aware that a home care Agency can be accredited. The four Accrediting bodies in the State of New Jersey are: • CAHC (Commission on Accreditation for Home Care) 15
Choosing a Home Care Agency can be a challenging decision. These questions should always be asked but not limited to any other pertinent information you need to obtain to make an informed decision. The good news is you have choices, but please always ensure you choose a reputable and trustworthy Agency that complies with the above referenced. Regards, Kevin Zepp Kevin is the President of Liberty Healthcare Services, Inc. a home care agency that serves all of New Jersey. Further information can be found on the Company’s website at www.libertyhealthnj.com or by calling 1-866-540-1547.
No More Aching Feet By: Dr. Lawrence Levine, DPM
Staying mobile for as long as possible is an important goal for seniors. Obviously, when our feet hurt, our mobility becomes severely hampered. Aching feet can be annoying, but more importantly, may signal serious problems such as arthritis, diabetes, and nerve and circulatory disorders. Regular foot healthcare is the key to staying active, mobile, and healthy. Here are some tips to meet that goal: Soothing Advice • Keep blood circulating to your feet as much as possible. Do this by putting your feet up when sitting or lying down. Also, stretch if you’ve had to sit for a long while or have been walking. A gentle foot massage, or warm foot bath will also keep the blood flowing.
• The best way to improve circulation is to stop smoking which decreases blood supply and increases the chance of swelling and other circulatory problems. • Wash your feet every day with mild soap and warm water. “Sock” it To Me • Avoid exposing your feet to cold temperatures and wear warm socks and shoes during the winter. Also, wear loose socks to bed. • Choose socks and stockings carefully. Wear clean, dry socks every day. Avoid socks with holes or wrinkles. Thin cotton socks are more absorbent for summer wear. Avoid stockings with elastic tops. Lotions, Potions & Tools • Don’t use antiseptic solutions, drugstore medications, heating (continued on page 29)
It’s not You, It’s the House A Practical Guide for Creating a More Accessible Home
There’s no place like home, but as the years add up home sweet home can become more of a hazard than a haven. In fact, approximately one-third of all falls by the elderly involve environmental dangers in the home. Avoid risk factors by applying a few well-established principles of universal design. Make an Entrance A firm level path into the home should be well lit with plenty of traction to accommodate walkers, wheelchairs, and strollers. Carry the level entry into the house with a stepless threshold when possible. Fumbling with keys, packages, the mail — all can distract and unbalance someone entering or exiting a home. In addition to providing lighting at entryways be sure to have a table, bench, or other surface nearby for setting things down. A covered portico over the door can protect the landing from rain, snow and ice. Plan for Change At least one bedroom and bathroom should be located on an accessible ground floor entry level (same level as kitchen, living room, etc.). To accommodate wheelchairs, doorways should be a minimum of 32 inches wide and hallways ideally 42 to 48 inches wide. Friendly Flooring Slippery surfaces are not the only
danger underfoot, although they’re the most obvious. Trips are as dangerous as slips, so eliminate or reduce the height of trip points like thresholds. Thick plush carpeting is especially dangerous for someone with a walker. Opt for low profile pile instead, a half-inch at the most. Replace shifty throw rugs and mats with modular carpet tiles that can be taped down. Small tiles with thin grout lines are also a good choice, especially non-skid styles. Within Reach For someone in a wheelchair, the optimal reach zone is 20-44 inches above the floor and 20 inches from the body. To improve access, shift outlets a little higher (approximately 15 inches above the floor) and light switches a little lower than usual (about 48 inches from the floor). A remote or switch near the bed can be handy for late night trips to the bathroom. Hands On Turning a doorknob doesn’t usually require much thought, but can be a painful challenge for arthritis victims. Simply replacing doorknobs and faucets with lever-style hardware can make life easier. Illuminated rocker switches would be a great replacement for standard toggle light switches. In addition, knobs and pulls for drawers and cabinets should pass the “closed fist” test. Better Baths Most people would list grab bars as a necessity in the bath but there are other ways to ensure safety and 18
comfort. For instance, when installing grab bars, the walls should be reinforced and the bars should be placed on both sides of the toilet and in the shower. Customize the height for the primary user and pair with a higher toilet to limit the distance arthritic and injured joints have to bend. A curbless shower is a better choice than a bath and should include a seat and hand held showerhead. A recessed niche allows for greater maneuverability than a regular shelf. Small things like hooks near the bathing area allow the user to dry completely before taking any steps out of the shower. Mature skin is less sensitive to heat and reaction time slows with age. Prevent scalding with an anti-scald device or by setting the water heater to 120 degrees Fahrenheit. Be sure to leave enough room around the toilet and sink for a wheelchair. In order to be able to use a sink properly, a wheelchair user needs to have 30 inches by 48 inches of clear floor area. Consider a wall-mounted sink or even a sink that can be raised or lowered depending on the user. Get Cooking Maneuverability is especially important in the kitchen. Try to incorporate multi-level countertops with one level at a height for seated workers and another for those that are standing. As far as appliances go, a side-by-side refrigerator provides better access (continued on page 40)
All About Pain: Myths and Realities
By Terre Mirsch, RN Holy Redeemer Home Care & Hospice
Persistent uncontrolled pain causes suffering and significantly impacts quality of life and physical, “Pain is a normal part of aging.” emotional, social, and spiritual well Reality: Although older adults being. Physically, uncontrolled pain are more likely to experience pain, may lead to other physical symp- it is not a “symptom” of aging, and toms including insomnia, fatigue, should not be considered inevitable. poor appetite and nausea. Uncontrolled pain can even compromise the immune system resulting in an increased risk for infection. Socially, “My loved one doesn’t look like he it is often difficult for pain sufferers is in pain - that must mean that the to interact with others, leading to pain is not that bad.” social isolation. Depression, loss of control, anger, and anxiety are not Reality: Pain research expert uncommon. Spiritually, one may Margo McCafferty defined pain as begin to question the meaning of “whatever the experiencing person says it is, existing the pain and wonder whenever he says “Why is God doing Uncontrolled pain can it does.” We canthis to me?” even compromise the not tell if a person is immune system resulting Living with adhaving pain by lookvanced or life limin an increased risk for ing at them. Only the iting illness does infection. person having pain not mean that knows how it feels one has to live so it is important that we ask the with uncontrolled pain. Pain person if they are having pain and can be controlled by relatively how it feels - and we need to listen simple means utilizing oral medito their answer. cations the majority of the time. However, despite having the ability to control pain, there are many barriers that get in the way of controlling pain effectively. Understanding what “It is best to wait until the pain pain is, how it can be effec- is severe before taking pain tively managed, and alleviating medications.” misconceptions is the first step Reality: It is best to stay ahead towards effective pain of the pain by taking medications management and ensuring optimal around the clock when treating persistent pain. The longer pain goes quality of life. untreated, the harder it is to ease.
If the prescription says to take the medicine at certain times or at certain time intervals (for example, every six hours), make sure this is done.
“People who take strong opiate (“narcotic”) pain medication become drug addicts.” Reality: Opiates (narcotics) are highly effective for many types of pain and can be given safely. Addiction is characterized by compulsive craving and use (continued on page 31)
Health Insurance Reform Timeline In March of 2010, President Obama signed into law two health insurance reform bills designed to make health insurance accessible to more Americans. While many provisions of the new laws focus on reforming health insurance, others focus on paying for the reform. Revenue raisers affecting individuals include: • A stiffer penalty (20%, rather than 10%) for using the savings from a health savings account for unqualified expenses. • A higher income threshold (10%, rather than 7.5%) that must be met before unreimbursed medical expenses can be deducted.
• An additional Medicare tax (0.9%) on the wages of individuals earning more than $200,000 ($250,000 if married filing jointly). • A new 3.8% Medicare tax on the net investment income of individuals earning more than $200,000 ($250,000 if married filing jointly). • A tax penalty for individuals who do not obtain health insurance.
The following timeline focuses on some of the changes affecting individuals; changes that may affect your personal taxes are preceded by a star. Although the timeline is limited to provisions affecting individuals, the new laws also include many provisions affecting businesses. Please consult us about how you or your business may be affected taxwise.
Some provisions in the new laws, such as guaranteed coverage for children with pre-existing conditions, will become effective as early as September 2010. Other provisions will take effect over the next decade.
Morris J. Cohen & Co., (MJC) is a full service CPA firm offering a wide range of tax and accounting services for individuals and businesses.
• Children up to age 26 can remain on their parent’s policy, if their parents choose.
• Health professionals can exclude from their gross income amounts they receive under any State loan repayment or loan forgiveness program that is intended to increase health care services in underserved areas.
Phone (215) 567-8000 Fax (215) 567-5288 E-mail: firstname.lastname@example.org Website: www.mjcco.com
2010 • Uninsured individuals with preexisting conditions gain access to insurance through a temporary high-risk pool. • Children with pre-existing conditions cannot be denied coverage by health plans. • Health plans cannot drop people from coverage when they get sick. • Lifetime limits on benefits are prohibited and the use of annual limits is restricted.
• Medicare Part D enrollees who enter the donut hole (coverage gap) in 2010 will receive a $250 rebate. • $1,000 increase in the adoption tax credit and the adoption assistance exclusion for 2010 and 2011. The credit is refundable for 2010 and 2011.
• 10% tax imposed on indoor tanning services beginning July 1, 2010.
• Medicare beneficiaries receive a free, annual wellness visit and personalized prevention plan services. • Medicare Part D enrollees receive a 50% discount on all brand-name
• Health plans are prohibited from imposing annual limits on the amount of health benefits an individual may receive. • Health Insurance Exchanges open in each state to individuals and small employers.
• Contributions to health Flexible Spending Accounts (FSAs) are limited to $2,500 per year, indexed for inflation. • The income threshold for claiming the itemized deduction for medical expenses increases from 7.5% to 10%. The threshold for individuals age 65 and older remains at 7.5% through 2016.
drugs while in the donut hole. (The donut hole is scheduled to be completely closed by 2020.) • The additional tax on nonqualified withdrawals from a Health Savings Account (HSA) or an Archer
• Premium assistance tax credits are available through the Exchange for people with incomes above Medicaid eligibility and below 400% of the federal poverty level who are not eligible for or offered other acceptable coverage.
• An additional 0.9% Medicare tax is imposed on the wages and selfemployment income of individuals earning over $200,000 ($250,000 if married filing jointly). • A new 3.8% Medicare tax is imposed on the net investment income of individuals earning over $200,000 ($250,000 if married filing jointly).
Medical Savings Account (MSA) increases to 20%, from 10% and 15% respectively. (Individuals age 65 or older are not subject to the additional tax on HSA withdrawals.)
• Most individuals must obtain acceptable health insurance or pay a penalty of $95 for 2014, $325 for 2015, $695 for 2016 (or, up to 2.5% of income in 2016), up to a cap of the national average bronze plan premium offered through the Exchange. Families will pay half of the amount for children, up to a cap of $2,085 per family (in 2016).
*Indicates a change that may affect your personal taxes. SOURCES: Implementation Timeline by the Committees on Ways and Means, Energy & Commerce, and Education & Labor, March 18, 2010. Key Provisions that Take Effect Immediately by the Office of Speaker Nancy Pelosi, March 22, 2010. Copyright 2010 Quinn Communications Inc.
Sharing Across Generations by Janie De Leon-Male
A colleague of mine often teases me that I spend too much time with my parents and the elderly members of my family during my weekends and days off from the office. But as a new mom for the first time, it is all the more important for me to spend this momentous time in my life with my parents and the generations of family that have come before me. There are numerous studies that demonstrate the effect that children have on the well being of their senior peers and vice versa. Generations who seem worlds apart often end up teaching each other a new thing or two. If your children are looking to surprise your elderly parents with a unique gift on their birthday, how about encouraging your children to interview your parents and record their oral histories in some type of memoir? Or how about encouraging your children to create your family’s first-ever family tree? Many area assisted living or nursing home communities welcome grade school or high school students to become involved in their communities. Your child could assist in running an art class or teaching a computer science course. Even though your child is volunteering their time with the intent of sharing their knowledge with the residents of these long-term care communities, your child will more than likely walk away with life 22
lessons that cannot be obtained from a classroom textbook. Cooking together is also another way to learn about family or cultural traditions. Discussions about each other’s life experiences will fill the kitchen as naturally as the aromas that arise from the stove or oven. In my family, our discussions center around the dinner table. No, I still haven’t learned how to cook those traditional Filipino dishes, but I have learned that my grandparents originated from Spain and the Philippines, one of my grandfather’s owned a large banana and cocoa plantation, and my other grandfather survived the Bataan Death March during World War II. It is the time that I spend with my parents and elderly members of my family that keep me grounded and remind me about what is important in life. Their stories are stories that I will pass on to my child and hopefully, my child (or children) will continue this tradition for generations to come. Janie De Leon-Male, M.S.S., LSW Director of Care Coordination Law Offices of Jerold E. Rothkoff 911 Kings Highway South Cherry Hill, NJ 08034 (856) 616-2923 (856) 616-2991 fax email@example.com www.rothkofflaw.com Offices in Cherry Hill, Center City Philadelphia, and Trevose, PA Serving Seniors and their Families in South Jersey and Southeastern Pennsylvania
Is It Time To Move? By Sandi Lichtman, Lichtman Associates Real Estate
There comes a time in the lives of many seniors when staying in their current home is no longer a safe or desirable option. But the decision to move is often delayed because of the many powerful physical and emotional issues. The reasons for moving fall into two categories: physical or emotional. The senior who needs assistance with daily living, is at risk for falling, has developed dementia, or simply has achy knees and no longer wants to walk steps on a daily basis all have valid and important reasons for moving. The emotional motivators are just as valid. Perhaps it is time to move near one’s children - even if that means leaving a retirement community. Perhaps the senior is feeling isolated in their home because it is difficult to get out and interactions with friends are rare. Whatever the motivation, the decision is a difficult one, and the execution of that decision is also daunting. Moving is a challenge for young and middle aged people, but it is often overwhelming for seniors. Sometimes this move means giving up independence – and this is a difficult threshold to cross. Although the move may signify the beginning of a new chapter in one’s book of life, it is a difficult time when you make the transition because of
advancing age or failing health. So, the senior’s support people need to understand the difficulty of this transition. Sadness is the word most often used to describe this time in one’s life. I remember a man who was moving into his daughter’s home because of frequent falls. I visited him while the movers were carrying his belongings out of the house, and he simply hung his head and said “It’s so sad.” Once the senior is settled into their new living environment, the sadness should lift as new friends are made and they find many new activities to join.
Sometimes the move is forced on the senior when an event, such as a fall, occurs. Leaving the home may be unexpected, and the path may go from the hospital to a rehab center to an assisted living environment. These seniors need much more assistance to move them from their home – either from family members or professionals. Perhaps they can go back to their home to decide what they want to take with them to the assisted living, but others need to be responsible for the rest of the belongings.
In addition to clearing out the home, Most people (with very few excep- sometimes work needs to be done tions) who have lived in a home to get the property ready for sale. This should be for a number of years left in the hands have an accumulation Moving is a of a competent of “stuff”. That can challenge for professional mean scraps of wood young and middle Realtor. The or fabrics for projRealtor will ofects or repairs, too aged people, fer guidance many serving platters, but it is often whether the china and crystal overwhelming for home should from their wedding, seniors. be staged for collections from sale, repairs various vacations, family photos and so made, or sold on, and so on. Parting with all “as is”. That decision should take this “stuff” can be an emotional into account the senior’s finances, time. Seniors who have the luxury time factors, and market conditions. of taking time to make their move A Seniors Real Estate Specialist should begin finding homes for (SRES) has been trained to be their things as soon as the sensitive to the special needs of the decision to move has been made. senior population. He or she should Children and grandchildren usually talk about the emotional, financial come and take some of the and physical aspects of making possessions. Some furniture and a move. A seniors specialist will collectibles can be sold either likely make sure that wills are in locally or on the internet. And lastly, place, assets are protected, and that there are donation centers and plans are made for the proceeds clean-out specialists to help with of the sale. These areas of concern the home’s contents. Plan plenty of are, of course, above and beyond time for the packing – if you have marketing and selling a home. that luxury. (continued on page 33) 23
Living With Home Oxygen Therapy pulmonary rehabilitation programs. The expectations and needs of each oxygen patient for portability should be part of the evaluation process when determining whether a patient requires long term oxygen therapy. The ease with which the oxygen patient can be mobile not only contributes to the quality of life and mental outlook of the patient, but will also greatly affect how compliant the patient is with the prescribed therapy. The typical American today prides themselves for their ability to multitask, expects results immediately, and wants to be on the move; living life to the fullest. The typical home oxygen patient is no different. It is no longer acceptable for a patient to be confined to their home by an oxygen requirement. Portability and
mobility are required in order that the oxygen patient can participate in family activities and interact with family and friends. Oxygen patients often expect to continue to work or travel. Even for relatively inactive patients, portability is necessary so that the patient can make physician office visits or participate in
There are primarily four different types of portable oxygen systems. These systems are: cylinders with oxygen conserving device, self filling systems, liquid oxygen and portable oxygen concentrators. Each system has its own advantages and limitations. Each system
must be weighed against the needs and expectations of the patient. Factors to be considered include: size and weight of the equipment, flow capabilities, duration of use, and also the abilities or limitations of the patient. Portable oxygen systems are not “smaller but equal” versions of the patient’s home oxygen system. Oxygen delivery may differ significantly even when on “equivalent” settings. Patients are also usually exerting themselves when using their portable systems. Therefore it is essential that patient’s oxygen saturation be evaluated on the portable system with exertion. The most common portable oxygen system in the home is an aluminum oxygen cylinder with an oxygen conserving device. Oxygen cylinders are typically 12 or 24 inches in length and weigh 4 or 9 pounds. They are usually carried over the shoulder in a carry bag or may
be kept in a small wheeled cart. Oxygen conserving devices are screwed onto the valve at the top of the cylinder which requires hand strength. There must be a washer on the conserving device. This gets lost or forgotten frequently, resulting in a loud hissing leak when the cylinder is opened. This can be a little frightening to some patients. Conserving devices sense the patient’s effort to inhale a breath, and deliver a “puff” of oxygen at the beginning of the breath. Oxygen only flows during a small part of each inspiration and there is no oxygen flow as the patient exhales. Therefore an oxygen conserving device can make a cylinder last much longer than if oxygen flowed continuously from the cylinder. Patients must breathe through their nose wearing a nasal cannula. They must also be able to make an inspiratory effort sufficiently strong to trigger the
conserving device. A typical conserving device will not trigger when a patient is breathing through their mouth. Manufacturer’s advertising for oxygen conserving devices needs to be carefully examined. No matter how much or how carefully manufacturers suggest that a number setting on their conserving device is equivalent to a continuous flow of oxygen of the same number, it just isn’t so. A setting of 2 on a conserving device is not necessarily the same as 2 liters per minute continuously. The difference becomes greater as flows increase to 4 and above. The only way to know that a conserving device works for a patient is to measure oxygen saturation during exertion at the time of set up. (continued on page 42)
on bras and breast forms with your fitter. “When I see a woman for the first time, usually she is not sure where to begin when it comes to finding a bra or prosthesis that suits her body and her needs. That is why consulting with a trained fit specialist is so important,” says Denise Hughes, Certified Fitter of Mastectomy. “I enjoy helping women feel like themselves again and in order to do that, I need to be as knowledgeable as possible to help them easily navigate what would otherwise be a very overwhelming experience.”
Regaining Bala n c e After Breast Ca n c e r Valerie Esqu
What to expect at your fitting: When you arrive, you will be asked several questions by your fit specialist. Who is your insurance carrier? How long has it been since your
illa, Bre Textile Produc ast Form & t Manager, CFM
Whether you’ve undergone a mastectomy or a lumpectomy, your emotional healing following breast surgery is just as important as your physical healing. A breast form or symmetry shaper can help you regain your confidence and positive body image. Breast forms have made significant improvements over the years. Today, breast forms are available in a variety of shapes, sizes, weights and skin-tone colors. Many combine additional features, like temperature control, to meet your individual needs. If you’re in the market for a new breast form, here are some suggestions to help you find the best product for you. Consult With Your Physician For your insurance carrier to consider coverage of your breast prosthesis and post surgical bras, you must have a prescription from your referring physician. While in most cases, women are able to be fit for a breast form six weeks after surgery, your doctor can best determine how long you should wait before trying
on breast forms and what type of form would be best for your stage of healing. Be Fit By an Expert Once you have the prescription, it’s time to find a Certified Fitter of Mastectomy (CFM) in your area. With so many solutions available, a knowledgeable and experienced fit specialist is vital in finding the appropriate breast form for your needs and your body. CFMs are specially trained to help you choose a form that best matches your natural breast. The fitter will also measure you for a post-surgical bra. The post-surgical bras are important to the fit and comfort of the breast form. They are specifically designed with pockets to support and hold the breast form in place. They come in a wide variety of fashionable, feminine styles. It is advised that you call ahead to make an appointment and plan to be at the fitting for about two hours. This will allow ample time for you to learn about your options and try 26
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Trip Tip Older Drivers and Public Safety By, Holly Alexander, OTR/L, CDRS FOX REHABILITATION
Presently, driver licensing among the older adult population is very high, and it is predicted that by 2012, almost every man and more than 90% of women in the United States will enter their retirement years as drivers (Rosenbloom, 1999). Older drivers are reported to make approximately 85% of their trips outside the home in a car as either a passenger or a driver (Rosenbloom, 1999). According to the Centers for Disease Control and Prevention (2009), older drivers are at an increased risk for injury, and possible reasons for this are “visual deterioration and declines in cognitive and motor skills.” Further, “physical frailty increases susceptibility to injury in a crash. Thus, a crash that results in nonfatal injuries to a younger person might result in the death of an older adult driver or passenger.” The CarFit program (www.car-fit.org) was developed in response to this vulnerability for injury and the importance of optimizing the use of vehicle safety devices. Many older drivers usually will moderate and self-monitor their driving. For example, they will deliberately avoid driving during rush hour (Metropolitan Transportation Commission, 2002) and frequently limit night driving due to increased difficulty with glare
recovery. It is projected that most older drivers will outlive their driving abilities by about 7 to 10 years (Foley, Heimovitz, Guralnik, & Brock, 2002). Some drivers know when to restrict or retire from driving, and some do not. Often, individuals demonstrating limited insight into driving impairments may require intervention from other sources. Making your clients aware of self assessments is one way to contribute to safety (see resources on the American Occupational Therapy Association Web site [www.aota.org/olderdriver]). Discussions initiated by family and friends with the older driver may be effective. A survey of 7,200 homedwelling adults 50 years of age and older revealed that more than half followed the suggestions made in conversations about driving (Age-Lab & The Hartford, 2005). Health care providers also play an important part in initiating conversations about older driver safety, with the physician’s role covering public health, medical, and legal and ethical areas (Schwartzberg, 2003). Physicians can have on hand The Physician’s Guide to Assessing and Counseling Older Drivers (American Medical Association & National Highway Traffic Safety Administration, 2003) and may call on occupational therapy practitioners to assist in the 27
decision-making process of determining whether an older driver is safe to remain on the road. Department of Motor Vehicle agencies also can play a vital role in assisting older drivers. Some states have developed driver assessment programs that require individuals to perform vision and physical testing annually after a certain age. A few states have initiated information campaigns on safe driving and developed transportation committees to improve the drivability of roadways. Some states have shortened the time span between renewal periods or issue restricted licenses based on drivers’ abilities. It has been found that states with an in-person license renewal policy had lower fatality rates for drivers 85 years of age and older, and states with vision evaluations before renewal had lower fatality rates for drivers 65 to 74 years of age (Grabowski, Campbell, & Morrissey, 2004). Occupational therapy practitioners can advocate for senior drivers in their state by becoming involved with their state’s medical review board. Driving improvement and refresher programs, such as those offered by The American Automotive Association and AARP, can provide valuable tips on safety to older adults and health care providers (continued on page 40)
What is a Geriatrician? By: Thomas A. Cavalieri, DO, FACOI, FACP, AGSF In a 1963 message to Congress, President John F. Kennedy wrote, “It is not enough for a great nation merely to have added new years to life – our objective must also be to add new life to those years.” At the time, President Kennedy was speaking of the health and welfare of senior citizens in America, shortly before the enactment of the
lion New Jersey residents have already reached age 65 and more than 175,000 residents are older than 85. The impact of boomers as they age will resonate throughout American society. It’s estimated that, ultimately, three million members of this group will eventually live to see their 100th birthday and that by the year 2050, more than one mil-
• 34 percent of all prescription medications; • 35 percent of all hospital stays; and • 38 percent of all emergency medical responses. At the same time, 80 percent of older adults require medical care for at least one chronic medical condition. When children need medical care, parents don’t hesitate to seek out the services of pediatricians because they know that pediatricians are specially trained in the health care needs of life’s early years. The same should hold true for your senior years. Older individuals have many unique medical and health needs. So it only makes sense to consider the services and advice of a medical professional who specializes in recognizing and responding to those needs.
legislation that created the Medicare and Medicaid programs. But he could just as easily have been speaking to the future health care needs of the baby boom generation, the last of whom would be born the following year. Today, 47 years since Kennedy’s message, the first of the baby boomers stands on the cusp of the traditional retirement age. Beginning next year, the oldest of that generation will turn 65. Twenty years from now, nearly one out of every five Americans will be 65 years or older and 8.7 million will be at least 85 years old. Currently, nearly 1.2 mil-
lion will have already reached that milestone. These are incredible numbers that will have a significant impact on many areas of American life, not the least of which will be the health care industry. According to the American Geriatrics Society, adults older than 65 represent just 13 percent of our country’s population, but they account for a disproportionate amount of health services, including: • 26 percent of all physician office visits;
Geriatrics has been a certified medical specialty for only slightly more than 20 years, so it’s not surprising that many people are unclear about the services that geriatricians offer. Geriatricians are physicians – usually specialists in internal or family medicine – who have received additional training in the often complex area of the medical, social and psychological needs of older patients. Growing older doesn’t cause disease, but a number of chronic and acute medical conditions, such as diabetes, cardiovascular disease, osteoporosis and dementia, are related to the aging process, and two or more of these conditions will often occur simultaneously. In fact, the average 75-year-old has three chronic conditions and takes five (continued on page 41)
(continued from page 16) pads or sharp instruments on your feet.
hours or less at a time. Don’t wear the same pair everyday.
• Do use quality lotion to keep the skin of your feet soft and moist, but don’t put any lotion between your toes.
• Don’t lace your shoes too tightly or loosely.
• Trim your toenails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, contact your podiatrist. Functional Footwear • Buy shoes that are comfortable without a “breaking in” period. Check how your shoe fits in width, length, back, bottom of heel, and sole. Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes. • Wear new shoes for only two
“Toeing” the Line • See a podiatrist to assess your gait, foot appearance, and overall foot wellness. Diabetic Footcare According to the American Diabetes Association, about 15.7 million people (5.9 percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands. With a diabetic foot, a wound as small as a blister from wearing a
shoe that’s too tight can cause a lot of damage. Diabetes decreases blood flow, so injuries are slow to heal. When your wound is not healing, it’s at risk for infection. As a diabetic, your infections spread quickly. If you have diabetes, you should inspect your feet daily. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Get someone to help you, or use a mirror. Stop neglecting your feet and give them a little tender love and care. If you pay attention to the well-being of your feet now your whole body will thank you later. For more information visit the Foot Health Centers’ website (www.foothealthcenters.com) or call Dr. Levine at 856-795-1003. Dr. Lawrence Levine founded Foot Health Centers, P.A. in 1972, now encompassing 12 doctors, 29 offices, nursing homes, and assisted living facilities throughout the region. Dr. Levine, who teaches at Temple University and New York College of Podiatric Medicine, was honored by SJ and Philadelphia Magazines as a “Top Doc”.
Removing fear, promoting joy Cameron Camp, PhD, is applying Montessori and other methods to help people with Alzheimer’s disease lead richer lives. By Tori DeAngelis
One Montessori-based skill-building game, for instance, helps people with Alzheimer’s build the muscles and skills they need to continue to feed themselves. The task has residents use a slotted spoon to search for objects buried in a tub of rice. When they find one, the rice falls through the slots and the treasure remains. Each time they find an object, they put it aside until all of them are collected.
Myer Erlich is a bright, loquacious man, a retired radio show host and World War II vet who speaks proudly of a son who lives in China and a daughter who lives nearby. He also has Alzheimer’s disease. But looking at the life he is leading, you’d never know it. At Hearthstone at New Horizons, in Marlborough, Mass., the assisted-living residence where he lives, Erlich hosts book clubs and shares his knowledge of history during a weekly news program that residents watch through an interactive DVD. “It’s fun, let me tell you,” the 84-year-old says. Erlich is the rule, not the exception, in facilities touched by the work of psychologist Cameron Camp, PhD, an applied gerontologist and former University of New Orleans professor, who develops creative, empirically based approaches to helping people with dementia engage in meaningful activities and learn new memory strategies. Camp is director of research and product development at Hearthstone Alzheimer’s Care, a company headed by sociologist John Zeisel, PhD, that oversees several Alzheimer’s assisted living residences in New York and Massachusetts. Camp’s philosophy is to see a client with Alzheimer’s as a person, not a diagnosis. “We want to flip the system on its ear -- to change people’s expectations about what people with dementia are capable of,” he says. “Our job is to allow this person to be present -- to help them, wherever they are in the journey of dementia, to be connected with a community, to contribute to the best of their ability.”
Tapping strengths The team takes a “translational research” approach to its work, where researchers bring lab findings into real-world settings. The trend began in the late 1990s when researchers and the National Institutes of Health began to emphasize the need to look beyond statistically significant effects in lab-based research, and ensure that research findings are applied in real-world settings and produce clinically relevant results, says Camp. In the case of Alzheimer’s patients, the team does this using a half-glassfull philosophy, Camp says. “It starts with saying, ‘What are the abilities that remain? How can we connect with the person who is still here?’” he says. One way is through a method called Montessori-Based Dementia Programming®, which Camp began developing about 15 years ago. He observed that the Montessori method -- which guides children to direct their own learning via tasks, tools and projects that engage all of their senses -- might work for people with dementia, in part because it is based on rehabilitation principles. 30
Just as importantly, the task helps them achieve a concrete goal in the present moment, without having to count or remember, Camp explains. “By creating these cognitive prostheses, we can circumvent deficits in memory and executive function and bolster people’s sense of accomplishment and self-esteem as a result,” he says. Another intervention he helped to develop, called spaced retrieval, lets people with dementia practice recalling information over progressively longer periods of time, using supportive props to help them remember. One common example is a resident who keeps forgetting that her daughter has just visited her, grows anxious, and repeatedly asks staff when her daughter will come back. To help the resident remember, Camp has her daughter write about their visits in a book and date each entry. He then helps staff members train the mother’s memory so she eventually remembers to look at the book any time she gets anxious about not seeing her daughter. The team regularly draws on people’s backgrounds and strengths (continued on page 38)
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bowels regular. Achieving comfort while maintaining optimal level of of a drug, which results in physical, consciousness (wakefulness) is the psychological, and social harm to goal of pain management. Side the user. An addict’s drug use effects of drowsicontinues in spite ness will reduce or Living with advanced or of predictable, disappear within a life limiting illness does consistent harm few days. not mean that one has to (self-destructive live with uncontrolled pain. behavior) Addiction Pain can be controlled by is NOT a problem relatively simple means for people who “Once you start utilizing oral medications take opiate medicataking morphine, the majority of the time. tions for persistent the end is always uncontrolled pain. near.”
“The side effects of opiate pain medications make people too sleepy and can stop their breathing.” Reality: Most side effects are mild, tolerable, treatable and fade with time. The most common side effect is constipation which can be controlled with a regular routine of medications aimed at keeping
Reality: Morphine does not initiate the final phase of life or lead directly to death. Morphine provides not only relief of severe, chronic pain; it also provides a sense of comfort. It makes breathing easier. It promotes relaxation and sleep. Morphine does not cloud consciousness or lead to death. Morphine does not kill. Good pain management improves quality of life. It is important that
the treatment of pain be individualized to each person according to their diagnosis, stage of disease, response to pain and treatments, and personal likes and dislikes. Unfortunately, many people with chronic pain do not get the help they need, and the effects may be devastating for the patient and the entire family. The Holy Redeemer Palliative Care and Hospice team assesses and manages pain and symptoms associated with advanced or life limiting illness, ensuring comfort and quality of life for patients and their families. Holy Redeemer Home Care and Hospice can be reached at 1.800.818.4747 or www.holyredeemer.com.
The Importance of Medication Management for Seniors By Marcy Schachinger
Approximately 20% of seniors are using about 50 prescriptions every year! More than two thirds of those over 65 take prescribed medications regularly. Keeping up with the multiple medications can be very challenging for anyone, especially seniors. It is also a concern for family members and other caregivers. All seniors or caregivers should know the following when taking medications: • What is the name of the medication? • Why am I taking it? • How many times a day should I take it? • Should I take this medication before, during, or after meals? • What does “as needed” mean? • When should I stop taking the medication? • If I forget to take the medication, what should I do? • Exactly how do all of my medications work and how do I take them properly? • What side effects can I expect?
• Be sure that the label of the medication indicates that it is the correct medication/dosage you were prescribed and displays your name. • Have a list of medications; include the doctor who prescribed it, the name of the medication, the reason you take it, and the directions for use. Bring this list to every doctor’s appointment. • Take your medication exactly in the way that it is meant to be taken. • Let your doctor know immediately if you experience any unexpected side effects from the medication. • Use charts, calendars, or weekly pillboxes to help you remember
Although modern medicines have many benefits for senior citizens in treatment of age-related disease, extreme caution needs to be taken when using a combination of medicines. It is very important to practice safe habits with medication as many drugs can be lethal if taken in the wrong way. Senior citizens, companions or caregivers should use the following tips to ensure, facilitate, and encourage safe use of medication. • Check that you can open the container the medicine is in. 32
which medications to take on a daily basis. • Make sure companions or caregivers know when and how you are supposed to take your medication so that they can remind you. • Take medication until it is finished or your doctor instructs you to stop. • Check expiration dates on your pill bottles in case a medication should be replaced. Contact Home Helpers and Direct Link at 856-812-0626 or 856-264-7936!
VOLUNTEERING – IN THE SPIRIT OF HOSPICE CARE In order to maintain Medicare certification, all hospices must provide care through a team of professionals comprised of the Medical Director, the patient’s physician, RN’s certified in Hospice and Palliative Care, Licensed Social Workers, Chaplains, Certified Home Health Aides, bereavement support and trained volunteers. Volunteers are vital to the spirit of hospice care. When hospice began, all care was provided by volunteers both professional and lay. In the early 1980’s hospice care became a Medicare Part A benefit and the federal government mandated that the volunteer aspect of hospice be maintained. To achieve this, it is mandated that volunteers MUST provide 5% of all patient/family care. This is achieved through visits with patients, providing respite for their care givers, and other services such as administrative office support. All hospices are in need of volunteers who will visit our community patients and families. Patients who are in their own home or the home of a loved one can, at times, feel isolated and alone. Providing them with a friendly visitor who cares enough to give 2 hours a week reassures and reaffirms their value as a person and as a caregiver. Hospice volunteers receive extensive training in the physical, emotional and spiritual components of hospice care. Please help us support our patients and families and to meet our Medicare mandates by becoming a volunteer. For more information, please call Pat Concannon, Volunteer Coordinator of Masonic Hospice Services at 609-589-4072.
(continued from page 23) Anyone who works with seniors as they move understands that the process can be a long one. It can take years to make the decision to move. It is important to consider, however, what the situation would look like if the move is a forced one and not a voluntary one. How much harder would it be to pack up and move when sitting in a wheelchair recovering from a fall? Making the move before it is a necessity is certainly the best idea. The support of family goes a long way to making the process of moving more comfortable and smoother.
This can even turn into an important bonding time in families – as the younger generation shows their love and support for the senior in their lives. Sandi Lichtman is the Owner of Lichtman Associates Real Estate, LLC, THE place to call when a senior makes a move. She is a Seniors Real Estate Specialist, and she makes seniors’ moves as simple and painless as possible. Sandi can be reached at 856-795-7890
(continued from page 4) the written law, different county Medicaid offices enforce different procedures for filing applications. Certain eligibility requirements also vary from county to county. Some counties permit applications by mail, some permit non-lawyers to represent the applicant at the meeting to file the paperwork, and others are stricter, only permitting certain family members or attorneys to represent the individual applicant. Partial month penalties as required under the Deficit Reduction Act have begun to be imposed by Burlington County, for instance, yet not by the other local counties as of this writing. Counties also vary in the levels of proof they require to permit a child of a Medicaid applicant to retain his or her parent’s house in his own name with no Medicaid penalty. Finally, another difficulty in obtaining Medicaid approval is the public benefit numbers themselves. These figures on which Medicaid eligibility hinges change each year. Certain figures are updated each January and others in July. They include income and asset caps. To many seniors’ surprise, they also include strict limitations on the amount of assets that spouses of Medicaid recipients may retain. The Medicaid application process and eligibility laws may be designed for the public’s use, but they are complex and burdensome. They are especially daunting for the population they are designed to assist. Especially in a time when our government is tightening the budget and implementing restrictive laws such as the Deficit Reduction Act, it is crucial for families to obtain legal counsel. Failure to plan ahead can severely impact a family’s financial status, especially if there is a spouse involved who wishes to maintain his or her home. Dana E. Bookbinder practices elder law with Begley, Begley & Bookbinder, P.C., in Moorestown, Princeton, and Stone Harbor, New Jersey. Call 800-533-7227.
(continued from page 26) surgery? Are you currently wearing a breast form? When did you last purchase a breast form? How many bras did you purchase yearly before your surgery? What are your favorite activities? Please be sure to discuss your needs and options with your fitter. Be sure to bring your prescription and a well-fitting garment with you so you can see how the forms look in clothes. You are welcome to bring someone for support and know that your fitting will be conducted with the utmost privacy in a special fitting room.
you have arthritis, osteoporosis or lymphedema. “As the daughter of a breast cancer survivor, I’ve seen the primitive versions of breast forms of yesteryear,” says Renee Davis, breast cancer survivor and model for
equalizing technology patented by Amoena, helps alleviate overheating issues. If you are an avid swimmer, talk to your fit specialist about swim forms and pocketed swimwear. Some women experience an irregular chest wall following surgery, but forms with a silicone gel back will easily mold to the unique contours of your body ensuring a snug fit and natural feel. After you’ve chosen a breast form, be sure to discuss with your fit specialist how to best care for and clean the form. Medicare guidelines and thus, most insurance plans, deem the useful lifetime expectancy of breast forms to be 2 years, but proper care is necessary.
Options to Discuss at Your Consultation Whether you need a shaper to balance your silhouette or a full breast form, you will likely have no problem finding one that fits your lifestyle and that you feel comfortable and confident wearing. For example, you may choose an attachable breast form — which adheres to your body — or one that slips into a pocketed bra.
Amoena. “Today’s forms offer comfort and come in colors to match different skin tones—something my mother’s generation never had.”
Did you know there are lightweight breast forms that are 35% lighter than standard silicone breast forms? Lightweight forms may help alleviate strain on the chest wall or pressure from the shoulder strap of a bra and may be a good choice if
Some breast forms also have added benefits that address specific issues or lifestyles. For example, if you are active or experience hot flashes, ask your fit specialist what she recommends. You may find that a breast form with Comfort+, a temperature-
Know When to Buy a New Form In addition to the initial fit following surgery, it is important to have check-up fittings regularly as our bodies and lifestyles continue to change and you may need to update your breast forms every so often. Even though a breast form can last up to two years, sometimes longer, it is recommended that you see a Certified Fitter of Mastectomy every six months to re-evaluate your fit. For more information, please call 856-854-3100
(continued from page 11) dramatically improves the cosmesis post-operatively since there is less scarring and the breast shape is better maintained, and there has not be any increase in local failure with this modification to the surgery. Third, there are significant changes in reconstructive options. Most reconstruction is done immediately, meaning that at the same time as the mastectomy, a breast mound is created. One or two more operations are needed to refine and complete the reconstruction including creation of a new nipple. Reconstructions can be performed using only an implant (initially a tissue expander) or a tissue flap. Tissue flaps include latissimus dorsi flaps, TRAM flaps and DIEP flaps (both of these last two use the abdominal fat and skin to create the new breast). In our experience, over 70% of women opt for immediate reconstruction and this is almost 80% for women under the age of 70. Another interesting trend is the increase in the rate of contra-lateral prophylactic mastectomy (CPM), or removing the opposite uninvolved breast. In the late 1990â€™s, the rate for CPM was 4% and within the next 5 years, this more than doubled. And the rate has continued to increase in the past 5 years and may be as high as 20% in some institutions. When women with unilateral breast cancer are faced with mastectomy, an increased number will choose CPM. This is seen more frequently with young patient age, non-Hispanic white race, lobular histology, and previous cancer diagnosis (locally recurrent disease). We also found that CPM rates were significantly higher for patients with a previous history of other cancers. Favorable prognostic factors (smaller tumor
size, negative lymph node status, and lower tumor grade) were associated with a significantly higher CPM rate; such patients are probably more likely to benefit from CPM because their survival time is longer and thus their subsequent risk of contralateral breast cancer is greater. Thus, patients are increasingly choosing between minimal surgery (BCS) or more aggressive surgery (bilateral mastectomy) instead of unilateral mastectomy.
cancer concern compared with patients who did not undergo CPM. Prospective studies are needed to understand the decision-making processes that have led to more aggressive breast cancer surgery.
Another indication for prophylactic surgery is when women are found to have genetic mutations that predispose them to breast cancer. This testing has become more popular over the past 5 years as we have better understanding about the BRCA mutations. Those women The potential benefit of CPM is found to have BRCA mutations greatest for patients who have the frequently elect bilateral prophyhighest risk of contralateral breast lactic mastectomy with immediate cancer. Although absolute indica- reconstruction, and prophylactic tions for CPM are not established, laparoscopic oophorectomy because the Society of Surgical Oncology they have extremely high risks of has published criteria that developing breast and/or ovarian physicians should consider for cancer, particularly at a young age. mastectomy of the contralateral, Looking forward, surgery remains a intact breast. The decision to mainstay in the diagnosis and treatundergo CPM is complex, and ment of breast cancer. One third of many factors likely contribute to its women with breast cancer will increased frequency. In a review of undergo mastectomy and will be the National Prophylactic Mastec- faced with complex decisions tomy Registry, it was reported that regarding management of the the most common reason for CPM contra-lateral breast, type and was physiciansâ€™ advice regarding timing of reconstruction and risk of contralateral breast cancer. indications for adjuvant radiation Patient satisfaction and psycho- and chemotherapy. Better underlogical and social outcomes after standing of lifestyles and behaviors, CPM have been examined by several biomarkers and molecular mechainvestigators. Investigators reported nisms will hopefully lead to a cure. that 83% of patients were either satisfied or very satisfied with their decision to undergo CPM at a mean of 10 years after surgery. The most common reasons for regret after CPM were a poor cosmetic outcome and diminished sense of sexuality. Patients who underwent CPM were less likely to express breast 36
(continued from page 9) place of the inner ear, called the utricle1-3. Once the crystals are successfully mobilized into the utricle, BPPV resolves. Many patients will experience long-term resolution, but due to the nature of BPPV it may return1-3. When BPPV exacerbates patients will typically respond well to another Epley maneuver. Sometimes a home exercise is prescribed to address residual symptoms following the Epley maneuver. This is known as BrandtDaroff exercises1. What can you do if you suffer from vertigo? If you suffer from vertigo, communicating with your physician is
recommended. Always tell your physician exactly how you feel and how your vertigo behaves, as this will guide your physician on the proper course of action. Remember that BPPV is defined by vertigo with positional changes that lasts less than sixty seconds. However, keep in mind that there are several causes of vertigo. Consultation with a specialist, such as an otolaryngologist, neurologist, or physical therapist may be necessary, especially for BPPV. Specialized Physical Therapy, LLC, 1919 Greentree Road, Suite B, Cherry Hill, NJ 08003. To learn more about BPPV or other treatments for dizziness and balance
problems, please feel free to call us at 856-424-0993 or visit our website at www.specializedphysicaltherapy.com References: 1. http://www.tchain.com/otoneurology/disorders/bppv/bppv.html. Accessed on May 31, 2010. 2. Helminski J, Zee D, Janssen I, Hain T. Effectiveness of Particle Repositioning Maneuvers in the Treatment of Benign Paroxysmal Positional Vertigo: A Systematic Review. Phys Ther. 2010; 90(5): 663-678. 3. Bhattacharyya N, Baugh R, Orvidas L, Barrs D, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo. Otolaryngology-Head and Neck Surgery. 2008; 139: S47-S81.
(continued from page 30) as well -- an approach that squares with Montessori programming by helping to create environments that challenge people but also let them succeed, Camp explains. Michelle Boiardi, program director at Hearthstone at New Horizons, says she recently enlisted the aid of a Chinese-American resident to help her and other residents develop a Chinese New Year’s celebration. “He felt very empowered and important because he had something to offer that others didn’t have,” she says. “That’s just a human need for any of us.”
“So, if someone gets up and walks, no one says, “You can’t do that,” Zeisel says.” “They will always be going somewhere where something is going on.” Relatedly, they work to ensure patients have meaningful social roles, Camp adds. For example, residents create welcoming committees for new residents and put on their own comedy clubs and musicals. Not surprisingly, the approach has a powerful effect on families as well as residents. Following the lead of Camp and Zeisel, families continue to see their ailing members as whole
manity, you’re able to connect on a really meaningful level,” she says. Spreading the word The methods Camp and Hearthstone use are catching on internationally. Camp has conducted training across the United States and in Australia, Greece, Taiwan, Canada and France. Manuals on his Montessori methods and spaced retrieval are available in Japanese, Mandarin, Spanish and Greek, and will soon be printed in French. In the research realm, Camp -- who has been funded by NIMH, the National Institute on Aging and the National Alzheimer’s Associa-
Overall, the methods demonstrate that psychological interventions can effectively treat people with Alzheimer’s and boost caregiver morale, says George Niederehe, PhD, branch chief of the Geriatrics Research Branch at the National Institute of Mental Health, which has funded Camp’s work. “Cameron’s work has made people aware that there are psychological methods that can be useful in treating cognitive disability in older people,” Niederehe says. “As a result, it’s created a sense of therapeutic optimism, giving caregivers a method of working with people that they can see has benefit.” Nurturing community The team infuses its techniques with relevant research on memory, social connections and other pertinent topics. Zeisel, for example, has developed and implemented what he calls a “naturally mapped” environment, where all of the information a person needs to navigate is self-evident. For instance, Hearthstone facilities all have pleasant destinations at the end of every corridor – a reading room, a peaceful garden, a kitchen – rather than closed doors.
people. Staff members further encourage family members to engage their loved ones in meaningful conversations, and to collaborate with Alzheimer’s patients’ on projects, such as food and toy drives.
tion, among others -- has published a number of small-scale studies showing that his interventions help people with dementia lead fuller lives.
A 2004 study in The Gerontologist “These are very different visits from, (Vol. 44, No. 3), for instance, ‘How ya doin’, how are they treating found that people with early-stage ya?’” Camp says. Alzheimer’s who were trained to Likewise, using these techniques lead group activities with peers with helps staff see residents with new advanced dementia -- such as Erlich eyes, Boiardi notes. leading the book group -- were more “Instead of getting burned out and satisfied than when they engaged seeing someone as a problem to in standard activities. The findings solve, you’re able to see the hu38
suggest that such interventions can provide people with Alzheimer’s with meaningful social roles, a tack Camp is pursuing on a broader scale with NIMH funding. Camp also is hoping to conduct a larger randomized controlled trial comparing his interventions with standard nursing home care.
has taken developmental theory and applied it in meaningful ways to people with moderate to severe Alzheimer’s disease.”
standing of the Hearthstone Affiliate Network (HAN)TM. Hearthstone Affiliates represent a network of professionals associated with a brand that has
Tori DeAngelis is a writer in Syracuse, N.Y. Her specialties include psychology, health, culture and spirituality.
become synonymous world-wide with excellence in caring for the memory impaired.
Given the increasing prevalence of Alzheimer’s disease due to America’s aging population, Camp’s research is more important than ever, says Peter Lichtenberg, PhD, chair of APA’s Div. 20 (Adult Development and Aging) and director of Wayne State University’s Institute of Gerontology. “Cameron’s work is viewed nationally by different chains, homes and projects as the cutting-edge way of engaging people with dementia intellectually, as well as assessing them,” Lichtenberg says. “As much as anyone in the country, he
CareOne Harmony Village in Moorestown, New Jersey is a member in good
(Continued from page 27) and may allow drivers to receive discounts from their insurance companies. Although no one study has found classes to prevent crashes, they do help to keep older drivers current on the rules of the road and offer tips to identify warning signs of impairments and possible ways to stay fit for driving. A frequently overlooked component to public safety regarding driving and driving cessation can be the amount of community resources available, especially for persons living in rural areas. Alternative means of transportation and community mobility help to maintain independence, mobility, and quality of life. Johnson (1995) reported that persons who had to give up driving had feelings of regret, loss, and isolation due to the loss of community mobility. Educational toolkits are available for occupational therapy practitioners interested in informing older drivers in their community. The Drivewell speaker’s toolkit (www.asaging. org/drivewell) offers speaker-ready seminars and downloadable handouts, and The Hartford has free support group leader kits on Alzheimer’s disease, dementia, and driving (www.thehartford.com/alzheimers/support_group_leader_ brochure.html) for family members. When driving is no longer an option, it is important for the driving team
(Continued from page 18) than a top/bottom model. This is also true for raised dishwashers and ranges with front controls, but the latter may be inappropriate for use in households with small children. Commonly used household items should be placed in low cabinetry and drawers when possible. Leave
to establish referrals that will enable continued involvement in meaningful roles, habits, and routines while maintaining the recommendation of retiring from driving and, thus, ensuring public safety. Holly Alexander, OTR/L, CDRS is a practicing occupational therapist and the Driving Program Coordinator for Fox Rehabilitation, the largest private practice of geriatric physical, occupational, and speech therapists in the United States. For more about how physical therapy, occupational therapy and/or speech at home can help seniors, visit www.foxrehab.org or call 1-877-407-3422. References Age-Lab & The Hartford. (2005). Family conversations with older drivers.Retrieved January 25, 2010, from http://www.thehartford.com/talkwitholderdrivers/driversatrisk.htm American Medical Association & National Highway Traffic Safety Administration. (2003). The physician’s guide to assessing and counseling older drivers. Chicago, IL: American Medical Association. Retrieved January 25, 2010, from http://www.nhtsa.dot.gov/people/ injury/olddrive/OlderDriversBook/pages/ Preface.html
Driving life expectancy of persons aged 70 years and older in the United States. American Journal of Public Health, 92, 1284–1289. Grabowski, D. C., Campbell, C. M., & Morrissey, M. A. (2004). Elderly licensure laws and motor vehicle fatalities. JAMA, 291, 2840–2846. Johnson, J. E. (1995). Rural elders and the decision to stop driving. Journal of Community Health Nursing, 15, 217–224. Metropolitan Transportation Commission. (2002). San Francisco Bay Area older adults transportation study: Final report. San Francisco: Author. Rosenbloom, S. (1999, November). The mobility of the elderly: There’s good news and bad news. Paper presented at the Transportation in an Aging Society: A Decade of Experience, Washington, DC. Schwartzberg, J. G. (2003, March 13). The physician’s role in older driver safety. Paper presented at the Joint Conference of the American Society on Aging and the National Council on Aging, Chicago. Holly Alexander, OTR/L, CDRS, is Director of Fox Driving Program, Fox Rehabilitation, 7 Carnegie Plaza, Cherry Hill, NJ 08003; Holly.firstname.lastname@example.org. Alexander, H. (2010, June). Trip tip: Older drivers and public safety. Physical Disabilities Special Interest Section Quarterly, 33(2), 3–4.
Centers for Disease Control and Prevention. (2009). Research update: Motor vehicle-related injuries among older adults: A growing public health concern. Retrieved January 25, 2010, from http://www.cdc.gov/ MotorVehicleSafety/ Older_Adult_Drivers/ motorolder.html Foley, D. J., Heimovitz, H. K., Guralnik, J., & Brock, D. (2002).
the upper cabinets for seldom-used items. From roll-in showers and multilevel countertops to step-free entries, there are many ways for homeowners to take control of their own safety and incorporate injurypreventative measures into their homes. 40
Founded in 1987 and based in Bryn Mawr, award-winning design/build firm Gardner/Fox employs 65 local residents and operates both a residential and commercial remodeling division. In addition to architecture and construction, the firm also provides landscape and interior design services. For more information about Gardner/ Fox please visit www.gardnerfox.com or call 610-525-8305.
(Continued from page 28) different prescription drugs daily. When a patient has multiple chronic diseases, symptoms of one illness can mask those of another. Acute infections, drug interactions or inappropriate dosage levels can cause illness, confusion or delirium in older patients. A geriatrician will not only be able to recognize how multiple conditions or medications are affecting an individual patient, but will also be trained to look for social and psychological factors that could also affect an older individual’s health. Older individuals also face many obstacles beyond medical conditions that can impact their health. Many lack easy access to transportation, have limited financial resources and must rely on someone else to help them with the activities of daily living. Often, they are unfamiliar with community resources and don’t know where to turn for assistance. Geriatricians are experts at understanding these needs and knowing the community-based resources available to older adults. A geriatrician will work closely with patients and their families to develop individualized plans of care based on the patient’s abilities and priorities. The mission of geriatric medicine isn’t only to care for individuals when they become too frail to care for themselves. The goal of geriatricians is to help their patients maintain a healthy lifestyle that will allow them to continue living independently in their communities for as long as possible. Successful aging means more than adding years to your life. It means adding life to your years. If you have reached your mid-50s or are older, you may want to consider contacting a geriatrician to help you make and follow the lifestyle and medical choices that will enable you to remain healthy, active and independent. Dr. Cavalieri is a geriatrician and the dean of the UMDNJ-School of Osteopathic Medicine. He is also the founding director of the medical school’s New Jersey Institute for Successful Aging, in Stratford. 41
(Continued from page 25) A full oxygen cylinder has 2000 pounds of pressure. This high pressure makes some patients nervous, especially the thought of having multiple cylinders in the house. They are very safe however when respected and prevented from falling or dropping. Many home care companies, as their reimbursement decreases, are attempting to reduce delivery costs by limiting the number of cylinders or number of deliveries a patient may receive per month. A second type of home portable oxygen system is a self filling system which consists of an oxygen concentrator and a compressor. The oxygen concentrator is an electric machine which separates the oxygen out of room air and can therefore provide oxygen as long as there is electricity without fear of it running out. Cylinders are available in a variety of sizes but are expensive and the number of cylinders patients receive may be limited. The cylinder may be used with an oxygen conserving device and can be carried in a bag over the shoulder. The patient is freed from the need to maintain a large number of cylinders in their home, and there is no need to wait for or rely on deliveries of cylinders. Liquid oxygen systems are the third portable system. Patients often notice other patients receiving oxygen from rectangular units shaped like a lunch box worn around their waist. A small quantity of liquid oxygen can be the equivalent of a number of oxygen cylinders in one container of a much smaller size and weight. Portable liquid oxygen units come in two sizes. Both units need to be filled from larger stationary reservoirs of
liquid oxygen. These larger liquid reservoirs must also be refilled regularly. The location of the reservoir in the patientâ€™s house should be chosen with consideration for safe delivery of these full stationary units weighting approximately 150 pounds. Narrow doorways and long stairways may make liquid oxygen deliveries impossible.
power, or batteries, and usually can be plugged into the cigarette lighter in the car. Internal batteries in the concentrators can power the unit. Duration of use from the internal battery varies by manufacturer and flow rate required. Higher flow rates shorten the duration of battery power. Many manufacturers offer external batteries, often worn around the waist or over the shoulder.
Liquid oxygen evaporates, turns into oxygen gas, and is lost if not used regularly. Therefore liquid oxygen is ideal for patients who are very active and wish to be mobile for longer periods of time and for patients requiring higher flows of oxygen. As liquid oxygen evaporates, these reservoirs may hiss intermittently. Some patients may find this a little un-nerving. Some patients also find the process of filling the portable unit from the large stationary reservoir, which may be loud and release vapor, to be intimidating. The process also requires strength in the hand and arm.
Long term oxygen therapy is the only non-surgical therapy demonstrated to prolong survival in patients with chronic hypoxemia and advanced COPD. Careful consideration of a patientâ€™s needs for mobility and selection of a portable system which best meets those needs not only improves quality of life but also makes it likely that the patient will actually use the oxygen as prescribed.
Portable oxygen concentrators, like the larger concentrators, extract oxygen from room air, and therefore can provide an endless supply as long as there is electrical power. Some portable concentrators operate only as oxygen conserving devices. Other concentrators operate as conserving devices or can provide a continuous flow of oxygen. The oxygen conserving device allows a battery to power a portable concentrator for 2.5 hours at 2 LPM. Concentrators capable of delivering a constant flow of oxygen are larger and heavier than those which are solely conserving devices. One model, the Sequal Eclipse weighs 17.4 pounds. The ability to produce a continuous flow of oxygen allows these concentrators to be used at night during sleep or with CPAP machines. Both types of concentrators operate off AC 42
For more information, go to www.Pro2.net.
(Continued from page 2) • Moving to a new location can be traumatic.
skipping meals or forget to take medicine.
• Physical discomfort and disabilities make it difficult to get out.
• Anxious behavior. Restlessness, panic, worry and being irritable or demanding can all be signs.
• Fear of falling often makes traveling without a companion a stressful experience.
• Mental changes. Confusion, memory loss or not being able to concentrate can signal depression.
There are several signs to watch out for with seniors who may be at risk for isolation and loneliness.
• Minimal communication. Less communication with family and friends.
• Withdrawal. Lack of social activity is blamed on not feeling well, not having energy or being too much trouble. Invitations for activities they once enjoyed are rejected.
When care is provided in the home, incorporating a social and mental component should be part of a care plan when appropriate. In addition to providing services which address ADL’s such as personal care, light housekeeping and meal preparation, they should also provide more social interaction with activities, using the internet and social outings if possible.
• Persistent, unexplained physical complaints. It might be joint pain, stomach upset, backache or headaches. • Change in habits. They may neglect personal grooming, start
Addressing loneliness and isolation takes some effort, but can be easily accomplished as long as it is part of the overall plan of health. Focusing on a senior’s interests and providing them with assistance to participate in activities they enjoy allows them to socialize in an environment in which they are comfortable. If you notice that a loved one is becoming lonely, depressed or isolated, don’t wait to take action. The sooner socialization begins, the better. If professional caregivers are involved, make sure the company is addressing these needs with their staff. Everyone wants to live a good, long life. With a little help, seniors can thrive and live a life they truly enjoy. To learn more, contact Assisted Living at Home at 856-273-6440.
(Continued from page 6) do to improve your ability to retain and retrieve memories: • Pay attention. You can’t learn something — that is, encode it into your brain — if you don’t pay enough attention to it. It takes about eight seconds of intent focus to process a piece of information into the appropriate memory center. This means no multitasking when you need to concentrate! • Get information that works with your learning style. Most people
are visual learners; they learn best by reading or otherwise seeing what it is they have to know. Others are auditory learners, who learn better by listening. Know what works for you. • Involve as many senses as possible. Even if you’re a visual learner, read out loud what you want to remember. Try to relate information to colors, textures, smells and tastes. The physical act of rewriting information can help imprint it onto your brain.
Other ways to help you remember things include: • Keep lists • Follow a routine • Make associations in your mind to help you “connect” things, such as remembering landmarks. • Keep a detailed calendar. • Put important things, like your house and car keys, in the same place every time! • Repeat names when you meet new people. • Run through the alphabet in your mind to help you think of
words you’re having trouble remembering. Sometimes hearing the first letter of a word can jog your memory! On the medical side, research has also shown that certain nutrients can stimulate brain function and improve memory. They include: • B Vitamins, especially B6, B12 and folic acid found in dark leafy greens, broccoli, asparagus,
• Relate information to what you already know. Connect new data to information you already remember, whether it’s new material that builds on previous knowledge, or something as simple as an address of someone who lives on a street where you already know someone.
strawberries, melons, black beans and other legumes. • Antioxidants, like vitamins C and E, and beta carotene, found in blueberries, sweet potatoes, red tomatoes, spinach, green tea, nuts and seeds. • Omega-3 fatty acids, found in cold-water fish such as salmon and tuna; walnuts; flaxseed and flaxseed oil. A memory problem is serious when it affects your daily living. If you sometimes forget names, you’re probably okay. But you may have a more serious problem if you have trouble remembering how to do things you’ve done many times before, getting to a place you’ve been to often, or doing things that require various steps (such as following a recipe). Please join us quarterly for the Kennedy “Memory Challenge,” and learn how you can sharpen your memory in an easy, fun way! Tanya McKeown is Kennedy’s Community Wellness Program Manager. The “Memory Challenge” is held the third Tuesday of each quarter (January, April, July, October). Call 800-522-1965, or visit www.kennedyhealth.org