Know Your Rights About Health Care

Did you know there is a Patient Bill of Rights? The Patient Bill of Rights that was adopted by the U.S. Advisory Commission on Consumer Protection and Quality in the Health Care Industry in 1998. Virtually any organization that provide services and bill Medicare and Medical Assistance are required to inform patients of these rights when they start providing services to the individual.

So what does the Patient Bill of Rights say?

Information Disclosure: You have the right to accurate and easily-understood information about your health plan, health care professionals, and health care facilities. If you speak another language, have a physical or mental disability, or just don’t understand something, help should be provided so you can make informed health care decisions.

Choice of Providers and Plans: You have the right to a choice of health care providers who can give you high-quality health care when you need it.

Access to Emergency Services: If you have severe pain, an injury, or sudden illness that makes you believe that your health is in serious danger, you have the right to be screened and stabilized using emergency services. These services should be provided whenever and wherever you need them, without the need to wait for authorization and without any financial penalty.

Participation in Treatment Decisions: You have the right to know your treatment options and to take part in decisions about your care. Parents, guardians, family members, or others that you select can represent you if you cannot make your own decisions.

Respect and Non-discrimination: You have a right to considerate, respectful care from your doctors, health plan representatives, and other health care providers that does not discriminate against you.

Confidentiality of Health Information: You have the right to talk privately with health care providers and to have your health care information protected. You also have the right to read and copy your own medical record. You have the right to ask that your doctor change your record if it is not accurate, relevant, or complete.

Complaints and Appeals: You have the right to a fair, fast, and objective review of any complaint you have against your health plan, doctors, hospitals or other health care personnel. This includes complaints about waiting times, operating hours, the actions of health care personnel, and the adequacy of health care facilities.

Some practical advice to assure that you are adequately informed:

Speak up if you have questions or concerns, ot if you don't understand information provided to you. It's your or your loved one's body and you have a right to know.

Pay attention to the care you or your loved one is receiving. Makre sure you/they are getting the right treatments and medications. Don't assume anything.

Make sure staff providing care are introducing themselves and you know what their credentials are.

Notice whether or not the staff is washing their hands. Hand washing is the most important way to prevent the spread of infections. Don't be afraid to gently remind the caregiver.

Makre sure the health care professional confirms your/ your loved one's identity before giving medications or treatments.

Educate yourself about the diagnosis, services provided and the care plan. Gather information. Write down important information the doctor tells you and ask if the doctor has any written information you can take with you to look at later.

Thoruoghly read all forms and make sure you understand them before you sign anything. If you don't understand something, ask for a better explanation.

Make sure you understand how to use any equipment that is being used.

Know the medications and why they are prescribed. Ask about the purpose and ask for written information which can be provided by the pharmacy. Know both the brand and generic names of the medications. Know the possible side effects to watch out for.

Whenever a new medication is prescribed, tell the doctor about any allergies and other medications prescribed to be sure that it is safe to also take the new medication.

Ask for a list of providers for services recommended. The hospital or nursing facility should not automatically assign providers for on-going care. You get to choose who you want for continuing care needs.

TRANSITIONS Reduces Re-hospitalization

Hospitals are dangerous places for patients due to frequent medical errors. Almost 25% of all patients have an adverse event related to processes typically used to discharge a person home. A new program is helping avoid problems associated with discharge. This innovative program includes a predischarge history and physical tailored to the special needs of geriatric patients, with emphasis placed on communication and teamwork among providers from different disciplines, a detailed medication review with a pharmacist, and a predischarge meeting among the patient, the patient's caregiver, and a clinician. The program was tested in general medicine wards run by hospitalists at 3 hospital centers in different states. At 3 days postdischarge, 88% of the study group described their health as better than it was before their hospital stay compared with 79% of those who did not have this process used as part of the discharge planning process. Improving the transition from hospital to home with more information and better communication about care needs after discharge to home improves overall health. While this process is not used in all facilities at this time, Health Calls is implementing these services to assist patients In the transition to home. There are things that you can do to help your loved one in the hospital:

• Visit frequently and ask questions about your loved one's progress.
• Keep notes about what is discussed.
• Provide the doctor and staff with a list of the medications he/she was taking prior to hospitalization.
• Review your loved one's medical history with the clinical team. Ask about the current status of each medical condition.
• Ask questions about signs or symptoms your loved one is experiencing in the hospital.
• If you ask to speak to someone and no one comes to address your concerns within one hour, assertively ask to speak to someone again. If the doctor is unavailable ask to speak to the nursing supervisor or RN assigned to your loved one's care.
• Before discharge, ask for a printout of the list of medications that your loved one will be taking at home. Compare it with your list and determine any changes in the schedule. Ask questions about anything you do not understand.
• Ask about any changes needed in your loved one's diet, activity, or treatments.
• Ask about your loved one's ability to care for him or herself. Does he or she need help with walking or dressing, bathing safely? Medication management?
• Request home therapy and nursing visits if there are any changes in his or her ability to care for self.
• If he or she is unable to walk safely without help, consider a rehabilitation hospital or skilled nursing facility stay before returning home with home services.
• Ask about follow-up care needed after discharge.
Ask for Health Calls Home Health Agency to reduce the risk for re-hospitalization. Health Calls Home Health Agency's re-hospitalization rate is below the national average, ranking in the top 25 percent of all home health agency's nationally.

Reducing Medical Stroke Risks

May is National Stroke Awareness Month. The National Stroke Organizations has published the following guidelines.

Medical stroke risk factors include:
Previous stroke, previous episode of TIA or mini stroke, high cholesterol, high blood pressure, heart disease, atrial fibrillation and carotid artery disease. These medical risk factors can be controlled and managed even if you have already had issues with any of them in the past. Talk with your doctor about what will work best for you.
 
Lifestyle stroke risk factors include:
Smoking, being overweight and drinking too much alcohol. You can control these lifestyle risk factors by quitting smoking, exercising regularly, watching what and how much you eat and limiting alcohol consumption.
 
Public Stroke Prevention Guidelines
1. Know your blood pressure. If it is elevated, work with your doctor to keep it under control. High blood pressure is a leading cause of stroke. Have your blood pressure checked at least once each year—more often if you have a history of high blood pressure.  
 
2. Find out if you have atrial fibrillation (AF). If you have AF, work with your doctor to manage it. Atrial fibrillation can cause blood to collect in the chambers of your heart. This blood can form clots and cause a stroke. Your doctor can detect AF by carefully checking your pulse.
 
3. If you smoke, stop. Smoking doubles the risk for stroke. If you stop smoking today, your risk for stroke will begin to decrease.
 
4. If you drink alcohol, do so in moderation. Drinking a glass of wine or beer or one drink each day may lower your risk for stroke (provided that there is no other medical reason you should avoid alcohol).  Remember that alcohol is a drug - it can interact with other drugs you are taking, and alcohol is harmful if taken in large doses. If you don’t drink, don’t start.
 
5. Know your cholesterol number. If it is high, work with your doctor to control it. Lowering your cholesterol may reduce your stroke risk. High cholesterol can also indirectly increase stroke risk by putting you at greater risk of heart disease - an important stroke risk factor. Often times, high cholesterol can be controlled with diet and exercise; some individuals may require medication.
 
6. Control your diabetes. If you are diabetic, follow your doctor’s recommendations carefully because diabetes puts you at an increased risk for stroke. Your doctor can prescribe a nutrition program, lifestyle changes and medicine that can help control your diabetes.
 
7. Include exercise in the activities you enjoy in your daily routine. A brisk walk, swim or other exercise activity for as little as 30 minutes a day can improve your health in many ways, and may reduce your risk for stroke.
 
8. Enjoy a lower sodium (salt), lower fat diet. By cutting down on sodium and fat in your diet, you may be able to lower your blood pressure and, most importantly, lower your risk for stroke.
 
9. Ask your doctor if you have circulation problems. If so, work with your doctor to control them. Fatty deposits can block arteries that carry blood from your heart to your brain. Sickle cell disease, severe anemia, or other diseases can cause stroke if left untreated.
 
10.​If you have any stroke symptoms, seek immediate medical attention.

National Stroke Awareness Month: Guidelines to Recognize and Act Quickly Can Reduce Symptoms

 
May is Stroke Awareness Month. The following guidelines are Published by the National Stroke Association.

Stroke 101
• Stroke is a brain attack, cutting off vital blood flow and oxygen to the brain.
• In the United States, stroke is the third leading cause of death, killing about 137,000 people each year, and a leading cause of serious, long-term adult disability.
• From 1996 to 2006, the stroke death rate fell 33.5 percent and the actual number of stroke deaths fell by 18 percent.
• Approximately 795,000 strokes will occur this year.
• Stroke can happen to anyone at any time, regardless of race, sex or age.
• Approximately 55,000 more women than men have a stroke each year.
• Men’s stroke incidence rates are greater than women’s at younger ages, but not older ages.
• African Americans have almost twice the risk of first-ever stroke compared with whites.
• Types of Stroke:
o Ischemic stroke occurs when arteries are blocked by blood clots or by the gradual build-up of plaque and other fatty deposits. About 87 percent of all strokes are ischemic.
o Hemorrhagic stroke occurs when a blood vessel in the brain breaks leaking blood into the brain. Hemorrhagic strokes account for thirteen percent of all strokes, yet are responsible for more than thirty percent of all stroke deaths.
• Two million brain cells die every minute during stroke, increasing risk of permanent brain damage, disability or death. Recognizing symptoms and acting fast to get medical attention can save a life and limit disabilities.
• The prevalence of transient ischemic attacks (TIA) increases with age. Up to 40 percent of all people who suffer a TIA will go on to experience a stroke.
• The estimated direct and indirect cost of stroke for 2010 is $73.7 billion.
 
Stroke Strikes Fast. You Should Too. Call 9-1-1.
Few Americans know the symptoms of stroke. Learning them—and acting FAST when they occur—could save your life or the life of a loved one. Remember that: Stroke Strikes Fast. You Should too. Call 9-1-1.
 
Common stroke symptoms include:
• Sudden numbness or weakness of the face, arm or leg – especially on one side of the body,
• Sudden confusion, trouble speaking or understanding,
• Sudden trouble seeing in one or both eyes,
• Sudden trouble walking, dizziness, loss of balance or coordination,
• Sudden severe headache with no known cause.
 
Use the F.A.S.T. test for recognizing and responding to stroke symptoms:
 
F = FACE​ Ask the person to smile. Does one side of the face droop?
 
A = ARMS​ Ask the person to raise both arms. Does one arm drift downward?
 
S = SPEECH ​Ask the person to repeat a simple sentence. Does the speech sound slurred or strange?
 
T = TIME ​If you observe any of these signs, it’s time to call 9-1-1 or get to the nearest stroke center or hospital.
 

Regional Philly Forum Offers Straight Talk on Lupus - May 17

Lupus is a challenging disease that often leaves patients feeling alone and misunderstood, challenging to recognize, diagnose and treat. This chronic autoimmune disorder can affect many organs, including the skin, brain, joints, and other internal organs. Symptoms vary widely, wax and wane and often mimic other conditions. Since the disease manifests itself in numerous different ways, patients often are misunderstood at home and in the workplace.

While many patients might not “look” sick, they may be silently managing the debilitating pain, fatigue and other symptoms associated with lupus. This can lead to a lack of understanding from friends, family members and even physicians. Lupus can be challenging to recognize, diagnose and treat. The chronic autoimmune disorder can affect many organs, including the skin, brain, joints, and other internal organs. Symptoms vary widely, wax and wane and often mimic other conditions. Background materials about the disease are available on the recently launched “the us in lupus” website at www.usinlupus.com.

Doctors and patient ambassadors from “the us in lupus” community at www.usinlupus.com are traveling to cities across the country to offer support, information, and tips for people living with the chronic autoimmune disorder and their caregivers, family and friends.

Two such advocates, Dr. Daniel Kirby and Rena Baldwin, will visit Philadelphia during Lupus Awareness Month in May to help lupus patients discuss their challenging disease – and to help forge new understanding among patients and their caregivers, family and friends.

WHEN
Tuesday, May 17, 2011
Registration: 6:30 p.m.
Program start: 7:00 p.m.

WHERE
Crowne Plaza Philadelphia/ Valley Forge
260 Mall Boulevard
King of Prussia, PA 19406

INFORMATION
To register or learn more about this event log on to www.usinlupus.com or call 1-855-874-6587 to register.

These forums are sponsored by Human Genome Sciences and GlaxoSmithKline.

Ways You Can Help Your Family Prevent Medical Errors

About one in three people in the United States will encounter some kind of mistake during a hospital stay, according to a recent study reported in April. This finding is about 10 times higher than estimates using older methods. Adverse reactions to medications account for nearly 1.1 million emergency department visits annually by elderly patients alone. 33% of these patients end up being hospitalized for further treatment.

Much more work is needed to improve health care quality. Medical errors are mistakes, when something happens with your health care that doesn't work out or when the wrong plan was used. Medical errors can hurt or even kill people. Many, including doctors, hospitals, nurses, and others are working hard on initiatives to prevent medical errors. These can be medicine errors, mistakes with surgery, tests, diagnosis, equipment, lab reports and other aspects of health care delivery. They can happen during even the most routine tasks such as when a hospital patient on a salt free diet is given an high-salt meal.

You can protect yourself and your family from medical errors.
1. The single most important way you can help to prevent errors is to be an active member of your health care team. Talk to you doctor, nurse and other health care workers. Tell them important information about your health. Ask them questions. Make decisions about your health care with them.
2. Make sure that you receive the right medicine. Bring your medicines with you to all doctor appointments or at least a correct current list of your medicines which includes the dose and frequency that you take them. Include on your list medicines that you may buy over the counter including aspirin, cold medicine, vitamins, and herbs. This will help your doctor make sure that your new medicine does not cause problems with the ones that you are already taking. Tell your doctor if you have any allergies. Also tell about any problems your medicines have caused, such as a rash or a stomach ache. When your doctor gives you a prescription, look at the writing. Is it easy to read? If you can't make out the letters, the drugstore may not be able to either. When you pick up your medicine at the drugstore, make sure it is what the doctor ordered. Ask questions before you leave the drugstore. If you receive the wrong medicine from the drugstore, ask about it.
3. Make sure you follow the right schedule and take the right amount of medicine. Ask your doctor: "What time of day should I take this medicine?"; "do I need to take this medicine with food?'; "How much should I take each time?". Make sure you know how to measure your liquid medicine. The label may say teaspoon but do not use the teaspoon you eat with to measure your medicine. These do not hold the right amount. Use a special measuring tool designed to accurately measure the amount. These are available for purchase at the pharmacy.
4. Errors made in procedures performed by health care workers can make you sick. Illness can spread when health care workers don't wash their hands and apply gloves. It is okay to ask anyone who touches you whether they have washed their hands. Some foods can make you ill. Know what foods your doctor doesn't want you to eat.For example, people with heart failure can not have salt in their food, and diabetics receiving a meal with lots of carbohydrates or sugar can become sicker.
5. Make sure that your doctor operates on the right part of your body. Talk to your doctor about the surgery. Ask what will be done. Be sure your surgeon makes a mark with a pen before the surgery on the part of your body where the surgery will happen just prior to the surgery, while you are still awake.
6. When you are discharged from the hospital, ask your doctor to explain the treatment plan you will use at home. This includes learning about your medicines and finding out when you can go back to your regular activities. Research shows that doctors think their patients understand more than they really do about what they should or should not do when they return home.
7. Make sure that those caring for you have all the important health information about you. Do not assume that everyone knows everything they need to know.
8. Ask a family member or friend to be there for you and to be your advocate. Having someone who can help get things done and speak up for you if you can't is important. Even if you think you don't need help now, you might need it later when you are groggy and sedated after surgery, or not able to think clearly if you aren't feeling well.
9. Know that more is not always better. It is a good idea to find out why a test or treatment is needed and how it can help you. You could be better off without it.
10. If you have a test, don't assume that no news is good news. Ask about the results.

Doctors and nurses, other healthcare providers want to offer safe care. They learned to do "no harm" in their training. In spite of that, defects in the health care delivery system result in errors. Teamwork among everyone, including patients, is essential.

5 Tips for Getting the Most of Your Doctor’s Visits When You or a Loved One Is A Patient in the Hospital

You may recognize this common scene that occurs in room after room on any floor in any hospital. A patient has had tests or is waiting to have tests. A doctor has been in to review the findings and has a plan. Or the patient is waiting to see the doctor. In either case, once the doctor leaves, the patient and their loved ones don’t always have a clear sense of what the next step or plan is. I have seen families write notes on the back side of a discarded breakfast menu so that they can be sure that they ask a follow-up question of the doctor the next time he or she visits. Then of course, the family waits until the next visit which may be 24 hours later.
I have been on both sides of this scene. I have been there as a clinician coaching the family to help them understand and interpret what they have heard and then as a daughter anxiously waiting to hear the results of the test and waiting all day with the hope of getting a 2 minute conversation with the doctor.
I recently read an observation that people ask more questions when buying a cell phone than they ask their doctors. Your health and your loved one’s health are more valuable then any cell phone! Use these tips to get the most information to make an impact on the quality of the care your loved one receives in the hospital.
1. Get a spiral bound notebook. Family members are often at a loss as to what to bring in as a gift for someone in the hospital. Use a spiral bound notebook to jot notes down listing details from the hospital staff providing information.
2. Ask more questions, get involved. When you ask questions you get answers that can help you make better decisions and get better quality care. Read that last part again: better quality care. People who are more involved in their health care management receive better quality care. Questions usually don’t appear to you until after the doctor has left the room. Write down all your questions. Remember, there is no dumb question, especially when it comes to your health. Write down the answers offered to you by the doctor to help you remember and sift the information as you think about it later.
3. Ask what all the options are for treatment. There are at least three treatment options for most conditions: a conservative approach, the usual treatment, and more aggressive treatments. Not all treatments may be available to you in the current hospital setting. It’s good to ask anyway. Newer or more aggressive treatment options may not be available in the hospital you are in. Find out where you may go to receive more aggressive treatment if needed.
4. Ask what would happen if you don’t follow the recommended treatment. There are many people who don’t agree with the treatment approach that the doctor has recommended but never tell him/her. Treatment may be started in the hospital, but most often, treatment needs to continue after you leave the hospital. Are you going to realistically follow through with the treatment plan? If you don’t think that is possible, or you know that your loved one will forget or won’t have ability to leave home to get treatment, discuss that with the doctor now so an alternative can be arranged. For example, if the patient is going to need to have therapy and the doctor wants the patient to go to an outpatient clinic but you need to return to work and the patient cannot drive, explain this. Home Health Care is a possible solution in this case. Most of the time, alternatives are available.
5. Ask what follow-up will be required. Follow-up doctor visits, lab work, additional tests, treatments often follow after a hospital stay. Unfortunately, 1 in 5 patients end up being re-hospitalized within thirty days of a hospital stay. Why? Lack of follow-up with a timely doctor office visit and medication confusion and/or mismanagement are the most frequent causes. Leaving the hospital is often a flurry of activity and a lot can get lost or missed in the confusion. Pay attention to discharge instructions provided both verbally and written prior to leaving the hospital. Keep the instructions in a safe, deliberate place, like the spiral bound notebook until you get home and settled. Then, pull out the instructions again and read them carefully. Most of the time, the medications have been listed, follow-up treatments or tests and instructions to call the doctor’s office have been listed. Now is the time to follow through with the instructions. Getting settled can be difficult and these details are often overlooked and result in deteriorating health and re-hospitalization if not promptly taken care of.

Difficulty Understanding Basic Health Information May Lead to Higher Risk For Death

Health literacy is a person's ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor's directions and consent forms, and the ability to negotiate complex health care systems. Health literacy is not simply the ability to read. It requires a complex group of skills including reading, writing, and reasoning to understand concepts inorder to make health behavior decisions.

Medication bottles collected in medicine cabinets across the country simply read: "Take as directed". For those adults who have limited health literacy, or are limited in their ability to make sound health care decisions, this has little meaning. Take Charlie, for example,who has bronchitis and has been taking a swig from that cough medicine the doctor prescribed that has codeine in it. His caregiver discovered he was drinking from the bottle after she found him on the floor in his kitchen. He had been drinking the medicine staight from the bottle without measuring the amount every 2 or 3 hours. If a little is good for you, more is better, right?

More than 75 million English-speaking Americans have limitations in their ability to make health care decisions. Health literacy can be improved. Patient teaching handouts, medical forms, and health web sites make it easier to understand and improve patient-provider communication.However, the most important strategy for people with limited health literacy is to have a person with them to advocate for them at doctor appointments, during short procedures and especially while in the hospital.

What is your biggest concern for someone you love with limited health care literacy who requires health care?

Cooking for the Person With Diabetes

The way you cook for a person with diabetes is the way you should cook for the whole family. By cutting down the fat, sugar, and sodium in recipes, you lower everyone’s risk for diabetes and other chronic diseases.

Use of Sugar and Artificial Sweeteners
In some recipes, sugar can be safely cut by 1/4 to 1/3. Cookies and cakes may not turn out as well when all of the sugar is eliminated.
Artificial sweeteners work best in foods that do not need sugar for color, texture, or moistness.
For the best recipes made with less sugar or an artificial sweetener, use a good diabetic cookbook or recipes from companies that make artificial sweeteners.
You can substitute small amounts of sugar for other carbohydrates in the diet. But use foods high in sugar very seldom, as they only have empty calories.

Cutting the Fat and Sodium
Eat very little fried food.
Bake, broil, grill, boil, poach, and roast.
Trim all meat well. Remove skin and fat from poultry.
Season vegetables with fat-free, low-sodium broth rather than fatback, margarine, oil, or butter.
Cook in a nonstick pan or skillet.
Use a nonstick vegetable spray on pots and pans.
Switch to reduced-fat tub or liquid margarine.
Sprinkle on lemon juice, herbs, and spices instead of salt or fat for flavor.
Use reduced-fat and fat-free foods carefully. Some are high in calories from sugar or other carbohydrates. Many are also high in sodium.
Eat more low-calorie vegetables instead of large portions of meat, poultry, or fish.
Have fruit for dessert.
Use nonfat or reduced-fat milk, cheese, and sour cream.
Use reduced-fat salad dressing and mayonnaise, or cut regular dressing in half with plain nonfat yogurt.
Cut the fat or oil in a recipe by 1/4 to 1/2.

Is It Memory Loss?

Lucy couldn't find her insurance cards. She looked in her wallet. It wasn't there. She looked through her purse. No luck. Finally, she found it on her desk. Yesterday, she forgot where she put her keys. Her memory seems to be playing games with her and she is starting to be worried about itLucy saw her doctor. After a good physical exam and lab work-up, the doctor said that Lucy was fine. Lucy's doctor suggested that take a class, play cards with friends, or help out at the local school to sharpen her memory.

What is mild forgetfulness?
It is true that some of us get more forgetful as we age. Itmay take longer to learn new things, remember familiar names and words, or find our glasses. These are usually
signs of mild forgetfulness, not serious memory problems. If you’re worried about your forgetfulness, see your doctor. You also can do many things to help keep your
memory sharp. Finding a hobby, spending time with friends, eating well, and exercising may help you stay alert and clear-headed.

Here are some ways to help your memory:
• Learn a new skill.
• Volunteer in your community, school, or place of worship.
• Spend time with friends and family whenever possible.
• Use memory tools such as big calendars, to-do lists,and notes to yourself.
• Put your wallet or purse, keys, and glasses in the same place each day.
• Get lots of rest.
• Exercise and eat well.
• Don’t drink a lot of alcohol.
• Get help if you feel depressed for weeks at a time.

Swine Flu: Taking Care of a Sick Person in Your Home

The Swine flu A virus outbreak has reached 91 confirmed cases in the United States according to the CDC update posted April 29th, 2009. Patterns of a more severe illness may emerge in the United States.

The main way flu viruses spread is from person to person in air droplets from sneezes and coughs. This can happen when droplets of an infected person travel through the air and are deposited on the mouth or nose of people nearby. Flu viruses may also be spread when a person touches respiratory droplets on another person or an object and then touches their own mouth or nose (or someone else's mouth or nose) before washing their hands.

If a loved one you are caring for becomes ill with the virus:
- Check with the health care professional about any special care needed, particularey in individuals with a health condition such as diabetes, heart disease, asthma, or emphysema.
- Check with health care professional about whether they should take antiviral medications which have been found to be very helpful in treating the Swine Flu A Virus.
- Stay home for 7 days after the start of illness; fever must be gone first before venturing out of the home.
- Get plenty of rest.
- Drink clear fluids such as water, broth, sports drinks, electrolyte replacement such as Pedialyte to keep from becoming dehydrated.
- Cover coughs and sneezes with facial tissue. Dispose of soiled tissues immediately into a paper bag.
- Clean hands with soap and water or an alcohol-based hand rub often and especially after using tissues and after coughing and sneezing into hands.
- Avoid close contact with others-do not go to work or school while ill.
- Be watchful for emergency warning signs that might indicate you need to seek medical attention.

Seek emergency medical care right away if a sick person at home:Has difficulty breathing or has chest pain.
- Has purple or blue discoloration of the lips.
- Is vomiting and unable to keep liquids down.
- Has signs of dehydration such as dizziness when standing, absence of urination, or in infants, a lack of tears when they cry.
- Has seizures, or uncontrolled convulsions.
- Is less responsive than normal or becomes confused.

A Season for Sadness?

For as long as she could remember, Mary had bought winter clothes two sizes larger than her summer ones. As soon as the weather turned cold, she found herself craving rich, creamy foods and sweets. By Christmas, she was usually five pounds heavier than she’d been at Halloween. By the end of the holidays, she’d put on another five. "I just can’t control my appetite," she told a friend. "Then I get so depressed about being fat that I feel miserable for months."

In fact, Mary not only looked different in the winter, she acted differently. In the summer she was full of pep, spending as much time as she could out in the sun. In the winter, she holed up inside the house for entire weekends. Her husband once described her as "the original couch potato." It wasn’t that she didn’t want to get up and do things-she couldn’t. She didn’t have the energy. Her nerves also seemed more on edge. "Don’t mind mom," she heard her son tell a friend when she yelled for them to lower the volume on the TV. "She’s just in one of her moods."

As she began her annual countdown to spring, she once told her husband, "I’d rather be off hibernating," She couldn’t wait for the first crocuses to push up through the earth. Whereas she usually didn’t feel like fussing over Christmas, she celebrated Easter in grand style. And even though she cooked up a storm, she usually was able to curb her appetite and start losing weight. "Just getting ready for swimsuit time," she’d laugh.

One winter Mary’s family decided to give themselves a special Christmas present: two weeks in Florida. "None of my clothes will fit," she wailed. But when she got into the sunshine, she started feeling so good she didn’t care. As if it were as easy as taking off a heavy coat, Mary shed her winter gloom. The vacation was one of the happiest times of her life. But after returning home, her spirits sank.

A few weeks later, Mary’s seventeen year old grandson, working on a research paper, came across an article on a specific type of depression that strikes mainly in winter. "Read this, Mom Mom," he said. "It sounds like you." As Mary read the article she had to agree that the description of seasonal affective disorder fit her perfectly. The piece included an address for the National Institute of Mental Health, and Mary wrote away for more information on SAD. She also talked to her doctor, who referred her to a psychiatrist in town. His recommendation: phototherapy, or daily exposure to bright light.

Mary purchased a specially designed light box, which she set up in her kitchen next to the table where she read the newspaper in the early morning. Later in the day, she rearranged her easy chair so that her seat was closer to the window. She took daily walks to get the benefit of whatever sunlight there was. She felt lighter, more energetic and her food cravings diminished. And although she still waited eagerly for the first flowers of spring, she felt relieved that winter had lost its terrible hold on her spirits.

Light therapy has been endorsed by medical circles and therapists worldwide as an effective treatment for the depression associated with SAD. The range of specific application is vast and the research continues.

In addition to treating SAD, light therapy -- also known as phototherapy -- has been found to be helpful to elderly patients with dementia or Alzheimer's syndrome. It is known that melatonin levels decrease as we age and there is a syndrome common in the elderly that is called "sundowner's syndrome." In winter months and summertime alike, when the sun goes down those with Alzheimer's or dementia can become sullen, depressed anxious or morose as darkness approaches.

A spectrum of light appliances designed for use in treating SAD is available on the market today.

In a recent study called the Heart and Soul Study, scientists looked at over 1000 people with stable coronary heart disease, followed for almost five years, measuring depressive symptoms at baseline in relation to subsequent heart failure, MI, stroke, transient ischemic attack, or death.

It has long been known that depression is known to increase the risk of heart disease. The study found that if you increase exercise in depressed patients, you're going to reduce their risk of heart disease. But the thing to remember about depressed patients is that they are that much less motivated to do things, so it takes extra effort to get them to exercise, take their medications, and stop smoking.

Take home points: light therapy and exercise will go far to decrease the winter blues.

Tips and Hints for Choosing In-Home Care Services

• Be Organized. Develop a summary of information about the care needs of your loved one that you want the caregiver to be aware of. Also, when searching for a service provider, draw up a list of questions to ask the agency.
• Ask the Home Care Agency if they have a back-up person on-call in case of caregivers becoming ill, or not showing up.
• Provide the aide with a checklist of duties for EACH DAY.
• The aide should not sleep, or smoke in your home.
• If there is a problem, immediately contact the agency that sent the aide.
• The aides should provide their own lunch/dinner.
• Do not tip. No money should be exchanged with the home health aide
• Do not send your loved one out in a car with the aide unless this situation is prearranged with the agency. Be sure the agency completes driver record checks on all employees.
• Aides should not use the phone for lots of personal calls.
• Make sure you know in advance how payment is expected.
• Some aides are Certified Nurse’s Aides (CNAs) and others are not. Some will take a blood pressure and a pulse, others will not. Ask the agency.
• There should be some consistency after about 1 to 2 weeks regarding the person who is sent to the home. Sometimes it takes a week or so to get the same person on the schedule for your home. Be patient!
• What is the hiring practice of the agency? Have background checks been performed on every caregiver? What about Elder Abuse or Child Abuse database checks? Are they
bonded and insured?
• If there are too many late shows/no shows or inconsistencies, CHANGE AGENCIES (speak to them about the problem first, perhaps they can correct the situation).

Elder Abuse

Older adults can become more vulnerable to others who may take advantage of them. An elderly person with short term memory problems may open the door to a stranger and allow them in the home. Mental and physical problems may make them more difficult for the people who live with them.

Tens of thousands of seniors across the United States are being abused: harmed in some substantial way often people who are directly responsible for their care. More than half a million reports of abuse against elderly Americans are reported every year, and millions more go unreported.

Elder abuse tends to take place where the senior lives: most often in the home where abusers are apt to be adult children; other family members such as grandchildren; or spouses/partners of elders. Institutional settings especially long-term care facilities can also be sources of elder abuse.

Physical elder abuse is non-accidental use of force against an elderly person that results in physical pain, injury, or impairment. Such abuse includes not only physical assaults such as hitting or shoving but the inappropriate use of drugs, restraints, or confinement.

In emotional or psychological senior abuse, people speak to or treat elderly persons in ways that cause emotional pain or distress.

Verbal forms of emotional elder abuse include

• intimidation through yelling or threats
  
• humiliation and ridicule
  
• habitual blaming or scapegoating
  

Nonverbal psychological elder abuse can take the form of

• ignoring the elderly person
  
• isolating an elder from friends or activities
  
• terrorizing or menacing the elderly person
  
• Elder neglect, failure to fulfill a caretaking obligation, constitutes more than half of all reported cases of elder abuse. It can be active (intentional) or passive (unintentional, based on factors such as ignorance or denial that an elderly charge needs as much care as he or she does).
  

This involves unauthorized use of an elderly person's funds or property, either by a caregiver or an outside scam artist.

An unscrupulous caregiver might

• misuse an elder's personal checks, credit cards, or accounts
  
• steal cash, income checks, or household goods
  
• forge the elder's signature
  
• engage in identity theft
  

Scams that target elders include

• Announcements of a "prize" that the elderly person has won but must pay money to claim
  
• Phony charities
  
• Investment fraud
  

The following are warning signs of some kind of elder abuse:

• Frequent arguments or tension between the caregiver and the elderly person
  
• Changes in personality or behavior in the elder
  

If you suspect elderly abuse, but aren't sure, look for clusters of the following physical and behavioral signs.

Physical Abuse:

• Unexplained signs of injury such as bruises, welts, or scars, especially if they appear symmetrically on two side of the body
  
• Broken bones, sprains, or dislocations
  
• Report of drug overdose or apparent failure to take medication regularly (a prescription has more remaining than it should)
  
• Broken eyeglasses or frames
  
• Signs of being restrained, such as rope marks on wrists
  
• Caregiver's refusal to allow you to see the elder alone
  

Emotional Abuse:

In addition to the general signs above, indications of emotional elder abuse include

• Threatening, belittling, or controlling caregiver behavior that you witness
  
• Behavior from the elder that mimics dementia, such as rocking, sucking, or mumbling to oneself
  

Neglect:

• Unusual weight loss, malnutrition, dehydration
  
• Untreated physical problems, such as bed sores
  
• Unsanitary living conditions: dirt, bugs, soiled bedding and clothes
  
• Being left dirty or unbathed
  
• Unsuitable clothing or covering for the weather
  
• Unsafe living conditions (no heat or running water; faulty electrical wiring, other fire hazards)
  
• Desertion of the elder at a public place
  

Financial Exploitation:

• Significant withdrawals from the elder's accounts
  
• Sudden changes in the elder's financial condition
  
• Items or cash missing from the senior's household
  
• Suspicious changes in wills, power of attorney, titles, and policies
  
• Addition of names to the senior's signature card
  
• Unpaid bills or lack of medical care, although the elder has enough money to pay for them
  
• Financial activity the senior couldn't have done, such as an ATM withdrawal when the account holder is bedridden
  
• Unnecessary services, goods, or subscriptions
  

  
  

If you are know an elder who is being abused, neglected, or exploited, tell at least one person. Tell your doctor, a friend, or a family member whom you trust. Other people care and can help you. You can also call your local Office of Aging.

Insomnia Affects Treatment of Depression

Depression occurs in 5-10% of older adults. Risks for depression include recent loss of a loved one, sleep disturbance, loss of physical abilities, and a history of depression.

Older adults with persistent insomnia were more likely to have depression. Treatment for insomnia is important to overcome depression. Treatment consists of medications and altering behavior that occue with insomnia.

In order for behavioral strategies to work, the patient must be willing and open to change behaviors. Changing habits, or behaviors can be difficult to do. The following behaviors are suggested:

Restrict the time spent in bed.

Establish regular wake up time

Go to bed only when sleepy

Stay in bed only when asleep

Practices that help sleep include:

Regular daily exercise

Daily routines

Treating medical problems such as sleep apnea

Using the bed only for sleep and sexual activity

Practices that hurt sleep include:

Alcohol use

Caffeine use

Worries

Poor sleep environment

Using bed for things other than sleep or sexual activity

Medication Side Effects? What To Do

Taking multiple medications unnecessarily is perhaps the best definition of polypharmacy. Older adults use 34% of all prescription medications and 40% of all over-the-counter medications. According to one study, as many as 28% of hospitalizations in the U.S. were related to medication errors and 2/3 of these could have been prevented. Another study in the Veterans Administration health system focused on patients 65 years and older found that in more than 40% of patients there was inappropriate medication use and underuse for patients taking more than 5 medications per day.

The more medications a person is taking, the risk for mistakes in medication dosing occurs. Also, as the body ages, medications are processed differently. The liver and kidneys are the main organs involved in metabolizing medications and these organs function differently as a person ages. Medications remain in the system longer than they should because absorption rates are slower, medications are highly concentrated due to poor circulation, the liver shrinks and there is decreased hear function, which affects metabolism, and decreased kidney function affects how the drug flushes from the body.

Another concern for the elderly is adverse drug reactions. Oftentimes, adverse drug reactions are mistaken for normal signs of aging such as loss of appetite, unsteadiness, falls, confusion, and urinary incontinence. However, these symptoms are not just connected to aging. It's the combination of age, multiple medications, and adverse drug reactions is cause for concern.

It is important to explore alternatives to medication to solve the problem whenever possible. For example, some drugs may cause dizziness when first taken, but this reaction subsides once

A person has been on the medication for a few weeks. The doctor may instruct your loved one to get up slowly from a seated or lying position or take the medication with food, or he may recommend another nondrug therapy until this effect subsides. If the reaction is severe, one solution could be switched to another medication that doesn't have the same effect. But prescribing another medication to combat dizziness shouldn't be the first action taken.

 

It's important when helping your loved one with the medications and possible side effects to go to the doctor with them. It's difficult to remember instructions and all the details of the dialogue with the doctor.

• Take a list of all the medications he or she currently is using, even if another doctor prescribes that medicine, or even if it is an herb or over-the-counter medication.
  
• Take a list of your questions with you to the appointment. This will help make sure all of your questions are addressed as conversation can cause you to be side-tracked and forget something you thought was important.
  
• Ask the doctor to write the brand and generic name of the drug on the list and why it is prescribed.
  
• Double check how often and when it should be taken and whether it should be taken with a meal, whether or not she or he should avoid alcohol or any particular foods and if there are any over-the-counter medications to avoid.
  
• Find out what side effects to watch for
  
• Ask when to call the doctor if adverse effects develop.
  
• Ask the doctor what medicine your loved one can stop taking, especially if the doctor wants to prescribe a new medication
  

When filling new prescriptions, ask the pharmacist for a printout of instructions. At home, write out a medication schedule for your loved one to follow at home. It may also be important to use a medi-set, or medi-planner to be sure that the drugs are taken when prescribed.

Medications help older people to overcome life-threatening acute illnesses and to live successfully with chronic diseases. But with the benefits can come risks. By knowing what drugs your loved one is taking and their potential dangers, watching carefully for untoward effects, communicating your concerns to the doctor, and taking the time to check how the medications are working, you can help your loved one get the better part of the medication bargain.

Tips for Choosing an Adult Day Care Center

• Identify services in your area. For names and phone numbers of the adult day centers, try: • Yellow Pages (“Adult Day Care;” “Aging Services;” Senior Citizens’ Services,” etc.)
• Area Agency on Aging (AAA) Call 1-800-677-1116 for the AAA in your area, or search for them online. See the “Aging Answers Rolodex”.
• A local senior center
• Your family doctor
• A Geriatric Care Manager
• Call first! Call adult day centers and ask for a flier or brochure, eligibility criteria, a monthly activity calendar,a monthly menu and application procedures.

• Know what to ask. Look for the following information:
• Owner or sponsoring agency.
• Years of operation.
• License or certification (If required in your state).
• Hours of operation.
• Days open.
• Transportation
• Cost – Hourly or daily charge, other charges,financial assistance.
• Conditions accepted – such as memory loss,limited mobility, and incontinence.
• Staff credentials.
• Number of staff per participant.
• Activities provided – Is there variety and choice of individual and group activities?
• Menu – appeal, balance.
• Tour. After reviewing materials, make an appointment to visit two or more centers that might meet your needs.
• Check references. Talk to two or three people who have used the center you are considering. Ask for their opinion.
• Try it out. Select a day center. Try it for three to five days. It sometimes takes several visits for new participants to feel comfortable in a new setting and with a new routine. If you have questions or are experiencing any problems, ask for a conference. The staff may have suggestions to make the transition easier both at home and at the day center.

Assistive Devices that Prevent Falls

Each year, thousands of older adults fall and this often results in injury, including broken bones. A broken bone for the elderly can be the start of more serious problems. These accidents can lead to a lasting disability and loss of independence.

Aging in itself does not cause falls. There are however, a number of chronic health problems that can result in falls. For example, diabetes and heart disease, circulation, thyroid and nervous system problems all may affect balance. Some medications may make a person dizzy. Eye problems or alcohol affect steadiness. Any of these may make a fall more likely.

Osteoporosis makes bones thin and easier to break. This disease can make any fall more dangerous and a major reason for broken bones in women and men as they age. When a person's bones become fragile, even a minor fall can cause one or more bones to break. People with osteoporosis must be very careful to avoid falls.

Accidents seldom "just happen". Taking care of health by exercising and getting regular eye exams and physicals may help reduce the change of falling. Getting rid of tripping hazards in the home and wearing non-skid shoes also may help. To reduce the chances of breaking a bone in the event of a fall, one should be sure to get enough calcium and vitamin D each day.

Use of assistive devices can prevent harmful falls. These devices include canes, walkers, and reachers. A physical or occupational therapist can help your loved one decide which devices might be helpful and how to use them safely. Ask the doctor for a referral for an evaluation.

Canes can help one fell steadier when walking especially when in unfamiliar places or where walkways are uneven. Different types of canes are available. They can be purchased from medical suppliers, local pharmacies, and even stores that provide equipment for mountain climbers.

There are many styles of cane handles. Some have grips made of foam or that fit the shape of the hand. There are canes that fold up, have adjustable lengths, and even those with spikes on the bottom to aid walking on icy surfaces. Sand or salt spread on icy surfaces around the home will help reduce the risk of a fall.

Be sure the length of the cane fits your loved one. The elbow should ne at a comfortable angle when using the cane. A cane that is too short may make the person unsteady. A cane that is too long is harder to use. A physical therapist can help your loved one learn how to use the new cane properly. Some users like to decorate their canes to make them seem less utilitarian.

For a person who is at risk for falling, a doctor or physical therapist might suggest using a walker, which aids balance by giving a wide base of support. Different types of walkers are available. Some have two wheels so the walker can't roll away. These work well for those who need to put weight on the walker when walking. Other walkers have four wheels and brakes for going down inclines. These can sometimes roll out of control, so be sure that your loved one knows how to use the walker safely.

There are many accessories to make walkers more convenient. A basket, tray, or pouch can be added to carry items from place to place. These add-ons can be purchased or, less expensively, fashioned at home. For example, a child's bicycle basket fastened safely on the front of the walker makes a handy carrier. Homemade pouches made ofpretty fabric can drape nicely over the front bar and can be fastened with simple snaps, buttons, or Velcro.

Rechers are special grabbing tools that can be purchased at many hardware and most medical supply stores. A reacher, or grabber, also can help to prevent falls. This simple tool lets one take, or replace, lightweight items from high shelves. By using one, a person can avoid standing on a stool or chair, which may be unstable. The reacher also can be used to pick up dropped items. Many are equipped with a magnet on the tip for picking up small metal objects.

Cordless or cell telephones also can help prevent falls. Encourage your loved one to carry the phone from room to room. When it rings, he or she won't have to rush to answer it. Not rushing could avert a harmful fall. These phones are also handy if your loved one is lying down. Rising suddenly to answer a fall can cause a drop in blood pressure and result in dizziness.

If your loved one is often alone at home, suggest that she or he check out a home monitoring service. Usually, the person wears a button on a chain around the neck. In the event of a fall or emergency, the person just pushed the button to alert the service. Emergency staff is then sent to the home. You can find local "medical alarm" services in the phone book. Be warned, however, that these systems often are not covered by Medicare or medical insurance.

For the half of Americans who take more than one prescription daily, life is about to change for the better, thanks to new onePAC^TM prescription packaging from Parata Systems.

 

onePAC prepares a person's medications by day and dosing time in a sealed, clear plastic packet that is arthritic-approved for easy opening. Each onePAC dose is custom-printed with the person's name; day and time of dose; medication names, strengths and descriptions; and other details to help them take the right medications at the right time, every time.

 

onePAC Helps Your Pharmacist Help You

Consumers request onePAC from their local pharmacy, so they keep that important care touch point with their local pharmacist. onePAC packaging is filled right at the pharmacy using Parata's automated technology, and verified by the pharmacist, who is most familiar with the patient's medication needs.

 

"If you or a loved one have faced the stress of missed doses of an important medication, or struggled to use a pillbox, the peace of mind and ease of onePAC packaging is immediately appealing," said Tom Rhoads, executive vice president for customer and market strategies at Parata Systems. "From caregivers and their family members, to parents whose children must take medications at school, to busy travelers — onePAC helps people know when and how to take their medicines, reducing risk and ultimately helping them live healthier lives."

 

How it Works

Rendering the "SMTWTFS" pillbox obsolete, a 30- to 90-day onePAC supply comes to patients as a perforated strip of individual onePAC packages, one for each dose, prepared in a convenient dispensing box that displays the next dose to be taken. 

 

And it all happens right behind your pharmacy counter. Parata's new PACMED technology makes it affordable and efficient for local pharmacies to provide this valuable service to consumers. It automatically and accurately prepares up to 50 multi-dose packages per minute; a big improvement over traditional med-prep programs, which can be very time-consuming for pharmacy staff to administer.

 

Request Free Sample at www.myonepac.org or 1-888-onePAC1

onePAC packaging is available now at pharmacies across the United States and Canada. Interested consumers can visit www.myonepac.org or call 1-888-onePAC1 to learn more and to request a sample, which can be passed along to local pharmacists who don't currently offer onePAC packaging.

 

Better Adherence Improves Health, Lowers Healthcare Costs

Nearly one-quarter of long-term care admissions occur because someone is no longer able to safely and independently follow a medication regimen. Failure to take medication as prescribed impacts the effectiveness of the medication. It also contributes to an estimated $100 billion in additional healthcare costs annually, from increased hospitalizations, doctor visits, lab tests and nursing home admissions, according to the National Community Pharmacists Association.

 

Companies that work in the long-term care sector, such as LTC Solutions, Inc., are rallying behind this new technology and its implications for people who take medications, whether at home or in residential settings. "When it comes to helping people who take multiple medications take them consistently and safely, onePAC packaging is the wave of the future," says Patty Crawford, president of LTC Solutions. "The impact of the nursing shortage is forcing senior health care providers to seek safer and more effective ways to administer medications. Whether in long-term care settings or at home, onePAC packaging is a timely innovation in how medications are dosed. The impact on improved health and extended independence is incalculable."

 

About Parata Systems

Durham, N.C.-based Parata Systems, LLC, was founded in 2001 to offer industry-leading technology that improves consumers' safety and convenience at the key touch points in the circle of pharmacy care: fill, serve and adhere. Parata's solutions include: Parata RDS (Robotic Dispensing System) to improve the speed and reduce prescription errors in retail pharmacies; Parata eXpress APM to expand convenience, safety and privacy with self-service prescription pickup; and onePAC packaging, which improves patient safety by promoting adherence with customized, convenience packaging for medications. To learn more call, click or visit Parata Systems, www.parata.com, info@parata.com, 1-888-PARATA1 (727-2821

Recognizing Dehydration

Dehydration can be a serious matter with symptoms including lethargy, headache, and even hallucinations. A person may die if the case is extreme.

Elderly people are less likely to be able to tell if they are getting enough to drink and therefore are at greater risk of becoming dehydrated. This is because an area of the elderly person's brain underestimates how much he or she needs to drink.

The part of the brain that indicates to a person how much water she or he needs is called the mid cingulated cortex. In elderly people, this region of the brain malfunctions.

Researchers at the Howerd Florey Institute in Melbourne, Australia studied two groups of people, one group made up of people age 65-74 and the other group of people age 21-30. The participants were given salty water through their vein and then allowed to drink as much water as they wanted. Even though both groups got equally thirsty, the older group drank half as much as the younger group/

Through imaging with a PET scan, the researchers found that the mid cingulated cortex turned off much earlier in the older people than the younger ones. Much smaller amounts of water were needed for the older person's brain to signal "enough".

This is important information for caregivers to keep in mind. Your elderly family member may feel that they have plenty of fluid when they are actually becoming dehydrated. This is especially true in warmer weather.

Remind your loved one to keep drinking those liquids. Adults should drink at least 8 glasses of water per day to prevent dehydration and physically active people may need to drink more.