Promoting safety and independence in our client’s home is our major goal at SelectCare. When our home care staff identifies a client who may need extra assistance in this area, we contact outside resources to help. Home visits by physical, occupational and speech therapists allow the therapists to see the barriers the client must deal with and create an individualized plan to overcome these challenges.

In addition to the local Visiting Nurse Association (VNS) there are several outstanding companies that also provide these services. SelectCare and Fox Rehabilitation have worked together for several years with outstanding client results.

Fox Rehabilitation is a private practice of full-time physical, occupational, and speech therapists who provide Geriatric House Calls™. Fox was the first to deliver these services to the older population in their home under Medicare Part B, a model that permits providing the correct intensity and duration of care as indicated by need.

Providing house calls allows our patients to relearn in the perfect environment- their home. It is not a simulated environment as you would find in an out patient facility. It is the setting where they “live” on a daily basis. This also allows the therapists to assess for possible hazards as well as make home safety recommendations to reduce the risk of falls.

In addition, treatment sessions are tailored the patient’s personal goals. If the patient wants to be able to safely walk up their stairs to sleep in the bed they have used for 30+ years, the Physical and Occupational Therapist can formulate treatment sessions that progress them to their end goal.

Fox staff members believe in treating patients proactively. Staying well and strong is much easier than rehabilitating after an illness or injury. Here are some clues to look for when determining if the older person you love could benefit from physical or occupational therapy:

• Parts of the home look unused. If your parent is no longer venturing from room to room, and instead isolates himself / herself in one room, this may be a sign of limited mobility or fear of falling
• You find spoiled food in the refrigerator or pantry, which can be a sign of difficulty in the kitchen.
• You see a distinct change in driving skills. Take special notice of dents or scrapes on your loved one’s car, or changes in the way he or she drives.
• You observe that Mom / Dad is using furniture, walls, and door jambs for support.
• Your loved one is noticeably less active. This may be a sign that they are fearful of falling. Falls can be a strong indication of declining function and strength.

For more information about Physical, Occupational and Speech Therapy in the home please call SelectCare or log onto www.fox.rehab.org.

Many of our clients hire SelectCare staff for assistance during the day, however in order to remain independent and safe at night, our clients are encouraged to consider Personal Emergency Response Systems (PERS) should they need help when our staff are not with them. By simply pressing a pendant worn around your neck or a band on your wrist, immediate help is available if needed. There are many organizations that provide this service and one such service is Phillips Lifeline. Giselle Korda represents Phillips Lifeline and has conducted many inservices to our home care staff regarding falls prevention.

Giselle recommends the following regarding preventing falls in your home:

• Talking to your health care provider about an appropriate exercise plan that focuses on balance, strength and flexibility.
• Having your vision checked regularly.
• Reviewing your medications with your healthcare provider to reduce the risk of falling.
• Fixing slip and trip hazards in your home such as improper lighting, excess clutter or unsecured rugs and wires.
  
• Joining a local senior center to take advantage of free health and wellness programming.

Giselle describes Phillips Lifeline as follows:

You are comfortable in your home, but the risk of falls or medical issues can get in the way of independent living. If you experience a fall or other emergency, every second counts. If you’re alone, delays can jeopardize your recovery and your independence. With 13.3 million falls each year, over half of those who fall will not be able to get up without help and that’s where Philips Lifeline can be a possible solution. Medical professionals know this, and that’s one reason why Lifeline is the #1 medical alert service provider, trusted by thousands of hospitals and more than 65,000 healthcare professionals. For more than 35 years and over 6 million subscribers, we’ve focused on creating products to help people live independently at home, but most importantly, to live safely.

This service gets you fast access to trained Response Associates, 24 hours a day, 365 days a year. It’s easy as pushing a button; just explore Phillips Lifeline website at http://www.lifelinesys.com/content/home to get started. Philips Lifeline can offer you independence, but even something more: peace of mind.”

Spouses, children, siblings, neighbors and friends are considered strong support systems for home bound clients, but what supports are in place for the caregivers?

More than just a shoulder to cry on, Caregiver Support Groups offer education, information, guidance and encouragement to people who are facing the challenges of care giving. Participants find inspiration from others and insight to their daily struggles of caring for a loved one.

Many disease specific organizations such as the Alzheimer’s Association, Multiple Sclerosis, American Cancer Association, and American Parkinson’s Associations organize local support groups for people with these diseases as well as care givers.

An excellent example of a Manhattan based caregiver support group is led by Christopher Chin, program coordinator of Project STAR at Lenox Hill Neighborhood House. In the support groups that Christopher offers, the caregivers are able to share the challenges they face in caring for a loved one in a safe and supportive environment.

The discussion can vary each week and topics range from trying to get other family members more involved and finding adequate home care coverage to expressing the sadness of seeing their loved one decline and worrying about who will be around to care for the caregiver when they become frail themselves.

The caregivers in the group are also able to relay their successes and wisdom they have gained from their experience and allowing them to even laugh at times about their situation. Most of all, the group emphasizes the need for self-care and helps caregivers to feel less isolated knowing that there are others who are in a similar situation who can relate to the struggles they are facing.

In addition to caregiver support groups, Project STAR also offers individual counseling, information and referral and workshops for family caregivers.

For more information on Project STAR or other services and programs sponsored by Lenox Hill Neighborhood House please call Chris Chin at 212-744-5022 or visit their website: www.LenoxHill.org

Sometimes, home health care assistance is not quite enough support for seniors who want to maintain a quality lifestyle at home. Throughout 26 years of business, SelectCare has collaborated with many local community organizations to enhance our clients’ care while they remain in the comfort and familiarity of their home.

Some community resources are able to provide services at little or no cost to the client and can be started with a simple phone call; others may require a home visit by the organization’s representative. SelectCare staff is always available to be part of the home visit and will help coordinate the services. The list below highlights just a few of the types of services SelectCare is able to coordinate with other community services.

• Pet groomers and dog walkers
• Hair stylists, manicurists
• Podiatry services
• Art Volunteers
• Volunteer readers
• Physician Home Visits
• Physical Therapy, Occupational Therapy, Speech Therapy
• Yoga and Stretching
• Volunteer Shoppers
• Low Vision Rehabilitation Services

SelectCare has developed wonderful relationships with many organizations that cover the New York City area. One such organization, DOROT, is one of New York’s premier multi-service agencies. DOROT (which means “generations” in Hebrew) serves older people of all backgrounds and interests, and offers programs and services proven to reduce social isolation. It promotes a model that helps seniors improve their lives and honors them as valued members of the community. While bringing elders, volunteers and professionals together in a mutually beneficial way, DOROT also brings younger and older people together through Friendly Visiting in the comfort of a senior’s home and has created a new social community through teleconferencing calls on “University Without Walls” where people – who are included via telephone from many geographic regions — can socialize and find new support through topics and discussion groups presented by professionals in areas as diverse as the arts, current events, history, cinema, and health promotion.

To find out more about University Without Walls or other resources in New York, call Carla Holub, VP, SelectCare, and she will work with you in locating appropriate ancillary services for you or your loved one.

Field Nurse Supervisor, Kelly Shearer, RN is one of SelectCare’s four nurses who administers the flu vaccine to SelectCare’s field staff. HHA, Ina Leach, made sure she was ready for the flu season by receiving her vaccine during 4th Quarter Inservice. During our 4th Quarter Inservice, Janet Stofkoper, RN, Director of Nursing, makes sure that our staff is well educated on Flu Prevention.

The flu is spread from person to person when someone who has the flu virus sneezes, coughs or even talks. The flu virus is put into the air and may be inhaled by anyone close by. Occasionally a person may become infected by touching something with the virus on it and then touching their nose or mouth.

To Protect You and Your Family From the Flu:

1. Wash your hands often with soap and warm water. Carry hand sanitizer when soap and water is not available.
2. Cover your mouth when sneezing or coughing. Dispose of the tissue in a trash bin, not your pockets for another use.
3. Keep hands away from your face.
4. Clean shared space more often such as phone receivers, keyboards, steering wheels and office equipment, bathrooms.
5. Do not share personal items such as eating utensils, towels, pillows and toothbrushes.
6. Try to avoid large crowds during the flu season.
7. Eat healthy, drink lots of fluids, make sure you get adequate sleep and stay home if you get the flu.
8. Get a flu vaccine.

For more information visit www.nyhealth.gov and www.cdc.gov

SelectCare receives many letters of acknowledgement of our field staff and we want to share a special note with you.

Laverne Brown has been working as an aide for my 95 year old husband. We love her and think she was born to be a nurse.

Among the qualities she displays are calmness, competence, intelligence and caring.

My husband, who usually displays anxiety when someone he’s not familiar with comes on the scene, responded immediately to Laverne.

My own daughter is a nurse and I have met many in the course of various surgeries and illnesses and I heartily recommend Laverne for other clients.

Mrs. SK

Part of  SelectCare’s  services is to ensure our clients are prepared in the event natural or man-made emergencies prohibit or delay services from reaching them.  When home care services are initiated, our Field Nurse Supervisors review a list of items that should be in the home and assists the clients, families and home care staff in obtaining those items.  A list of items that all clients should have on hand is kept in the Client Communication Binder for review.  Each home care staff member works with the clients and their families to ensure the emergency supplies are updated and restocked as necessary.

SelectCare Nursing and Administrative staff practice emergency procedures twice a year which includes staff communication, triaging patient care and coordinating services with community resources.  We put our plans into action this summer during the heat waves and in preparation for the hurricane season.

SelectCare trains and reviews emergency preparedness practices with home care staff members during orientation and through out the year with inservices, newsletters and on site visits.  We base our training on materials supplied by the Office of Emergency Management and the NY State Department of Health regulations.

To learn more about how you can prepare yourself, your family, your community, visit the NYC Office of Emergency Management website:

New York City Office of Emergency Management

I had the honor of meeting Rosemary Bakker, developer of  www.thiscaringhome.org.  Ms. Bakker guided a group of professionals through her website designed to assist families who need to modify homes so that their loved ones, especially those with dementia, are able to remain independent and safe in the comfort of their familiar surroundings.   I invite you to visit this website and learn about how simple strategies can make a big difference with your loved ones.

This project was funded by grants from several foundations to Weill Cornell Medical College, a top ranked clinical and medical research center located in New York City. Rosemary Bakker, MS, ASID is on academic staff at Weill Cornell Medical College and is the Director of ThisCaringHome.org. All materials on ThisCaringHome’s website have been reviewed by select members of the Advisory Board, composed of a wide variety of professionals, including nurses, dementia specialists, physical and occupational therapists, safety experts, social workers, and recreational therapists.

HEALTH RISK FACTORS:

Although anyone can suffer from heat related illness, some people are at greater risk such as those who are in the following categories:
Age 65 or older and/or have one or more of medical conditions including:

• Heart disease
• High blood pressure
• Psychiatric or cognitive disorders
• Diabetes Mellitus
• Respiratory conditions
• Obesity

Certain prescribed medications that can increase the risk of heat-related illnesses include:

• Tricyclic antidepressants
• Antipsychotic or neuroleptic medications
• Certain tranquilizers
• Some medications for Parkinson’s Disease
• Diuretics
• Beta blockers
• Calcium channel blockers
• Antihistamines

Helping People Prepare for Extreme Heat:

Air Conditioners

Encourage at-risk individuals to use their air conditioners during periods of extreme heat. Many people do not like to use air conditioners either to save money or because they do not like cold air. Suggest tips to conserve energy and keep the climate comfortable such as setting the temperature at 78 degrees or higher. Make sure the air conditioners are in good working order and insulate any spaces between the air conditioner and window to make sure there is a tight fit.

If an at-risk individual does not have an air conditioner, discuss options they may have during extreme heat periods. If they are able to relocate, suggest locations that have air conditioning including:

• Libraries
• Shopping Malls
• Cooling Centers (located by calling in NYC by calling 311 or visit www.nyc.gov/oem for more information)
• Senior Centers
• Friends or neighbors that have air conditioners

Fans

Be careful about relying on FANS. When the room temperature is in the high 90’s fans will not prevent heat- related illnesses because they just blow hot air around. Fans may be useful at night, to help circulate cooler air from open windows or when used in conjunction with air conditioning.

Shades

Shades, draperies or awnings should cover windows that receive morning or afternoon sun.

Remind at-risk individuals about the following general tips:

Outside Activities

• Limit strenuous activities during an extreme heat period
• Dress in loose-fitting, light weight clothing
• Wear a wide brimmed hat
• Use sunscreen of SPF 15 or higher
• Schedule outdoor activity during morning or evening hours when temperatures are cooler

Fluids

• Drink plenty of non-alcoholic and non-caffeine beverages
• Avoid overly sugary drinks (sports drinks)
• Avoid hot foods and heavy meals
• Try cool (not cold) showers for relief
• Consult your doctor if you are on a fluid restricted diet or have heart, kidney, liver diseases or have a problem with fluid retention.

Air Quality and Respiratory Illnesses

Be aware of air quality-related respiratory problems. High levels of air pollutants including high levels of ozone can occur during heat waves. Ozone can cause breathing problems, especially among those with respiratory conditions. If you have a respiratory illness, limit outdoor activity when ozone levels are high especially in the afternoon and early evening hours. Staying in an air conditioned environment reduces ozone exposure.

This information is not intended to provide medical advice. Always seek the advice from a health care provider.

For more tips on preventing heat-related illnesses, visit www.fema.gov/areyouready/heat.shtm or
www.bt.cdc.gov/disaster/extremeheat/heat_guide.asp

Care for your body by attending to your basic needs for nourishment and nurturance. Healthy foods, consistent meals and snacks, hydration, regular exercise, and sufficient quality sleep and rest are important factors that can reduce the negative effects of the chronic stress of caregiving and promote resilience. Monitor and moderate your intake of caffeine, sugar, alcohol, and nicotine. Don’t forget to focus on your own healthcare needs. Discuss your caregiver status with your physician and other healthcare professionals.

Care for your mind by identifying the positive aspects and rewards of caregiving on a regular basis. Ask yourself the question:”What am I learning from this experience?” Acknowledge and recognize your efforts, commitment, and contributions. You may not be able to change the reality of the caregiving situation; but you can change your perception of it and your response to it.

Care for your emotional and psychological self by cultivating awareness and acceptance of your changing feelings and moods. Share your feelings and struggles with others. Reach out to your family, friends, and community. Consider joining a support group for caregivers or seeking professional counseling.

Care for your Spiritual Self in a way that is most meaningful to you. A spiritual or religious community may provide comfort, compassion, and support.  Engaging in practices such as reflection, prayer, contemplation, or meditation may be helpful. Creating your own meaningful rituals may also provide solace.

SelectCare would like to acknowledge Sarah Waxse, LCSW, Caregivers Services, HealthOutreach, 212-746-4365 for the contribution of this article.