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Assisted Living and Rehabilitation

North Carolina had 1.1 million people age 65 or older in 2008, an increase of 20% from 1998.  Many of us are living longer but may need some assistance.  By 2020, the average 65-year-old man could live to the age of 82 and the average women to age 85.  This growing segment of our population is producing record demand for all kinds of care services.  Assisted living communities and rehabilitation facilities fill some of those needs.

Assisted living provides a transition from independent living to an independent lifestyle with assistance personalized to each resident’s needs, combining housing, support services and health care. Assisted living offers a unique mix of security and independence, privacy and companionship, care and services for those who are not able to live by themselves but do not require constant care. Assisted living facilities may be part of a retirement community, nursing home, senior housing complex, or may stand alone.

“At Magnolia Glen, ” said Sara Suite, Sales Director, Raleigh, NC, “we look at wellness as part of everything we do, from the relationships we develop and nurture to the services and programs we offer. We strive to take an individualized care approach to our residents and their unique needs, wants and choices; making your experienced focused on maintaining and enhancing your quality of life.”

Assisted living communities support those who need help preparing meals, every day activities, performing household chores, health care management and monitoring, medication management, and transportation. Some communities also have memory care support, for those suffering from Alzheimer’s or other memory disorders.

“Our assisted living becomes home for our residents. We offer help with activities of daily living with the goal of preserving dignity, independence, and the ability to make choices,” said Allison Pait, Wellness Director, Abbotswood at Irving Park, Greensboro, NC.

Rehabilitation is the process of assisting someone to improve and recover lost function after an event, illness or injury that has caused functional limitations. Rehabilitation assists recovery after events such as stroke, orthopedic surgery, or simply recuperation after a serious illness. Skilled nursing rehabilitation facilities may be independent or part of a senior continuing care community. There is a 41 percent chance that those 65 and older will spend an average of 2 1/2 years in a skilled nursing facility.

Regaining strength, relearning skills and finding new ways of accomplishing everyday tasks can be a slow process. Functioning normally may require physical therapy, occupational therapy, treatment of pain and inflammation, and retraining to regain specific lost functions. Recovering from a disabling injury or illness may require temporary custodial care a strength and balance improve.

“It’s rewarding to see our residents discharge home knowing that together as a rehab team we have provided quality care,” said Linda Roberts, Executive Director of Sunnybrook Healthcare and Rehabilitation Specialists in Raleigh, NC. “The resident’s rehab stay allows them to achieve personal goals and return to independence in daily activities.”

Your doctor will prescribe a rehabilitation care team which may include nurses, psychologists, social workers, speech pathologists (to help with speech, language, and voice), occupational therapists (to help with basic self-care activities), physical therapists (to improve standing, balance, and walking with exercise), other health care practitioners, and family members.

Rehabilitation at home can work well for those who require less care and is often a first choice. Family members or friends must be willing to participate in the rehabilitation process, but it can be physically and emotionally draining for all involved. A visiting physical or occupational therapist or nurse can help.

“Our goal is to provide exceptional rehabilitation to allow our residents to strengthen and recondition so that they may return to the home setting as quickly as possible,” said Anna D’Occhio, Director of Nursing, Blue Ridge Health Care, Raleigh, NC.

Choosing the right assisted living or rehabilitation facility should be a carefully thought-out process. A good match between a facility and a resident’s needs depends as much on the philosophy and service of the facility as it does on the quality of care.

Article by Lesley Gray
Reprinted with permission from the June 2010 edition of Boom! Magazine.

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On-Site Home Health Care

Care-giving is providing assistance to another who is ill, disabled, or in need of help. Caregivers often are family members who take on the sometimes daunting task of managing their loved one’s care. 53 million caregivers in the United States provide an estimated $990 billion worth of unpaid care annually. 34 million U.S. adults provide care to adults 50 and over.

Although your loved ones may prefer that you or other family members provide all their care, you have the right to get help.

Most seniors want to stay at home as long as possible. There are many community-based services that can provide solutions to these long-term care needs ranging from doing household chores and assisting with daily activities, to 24-hour care and advanced medical treatments.

Home health care focuses on health care needs, including skilled nursing care, personal care, rehabilitative therapy, medicine management, wound care, and medical help ordered by a doctor and provided by licensed professionals. The most common types of help are skilled care, home health aid, and companionship services.

Tony Callaway of Accessible Home Health Care of Mid Carolina, Raleigh told us, “One of the rewards of the home care business is we offer a loving, respectful, competent and trustworthy service that improves the quality of life for our children as well as other family members who are responsible for their care. We give the caregiver their life back.”

Registered nurses and licensed practical nurses provide skilled care ordered by doctors such as monitoring medications and procedure training for patients and their families. Therapists provide respiratory, physical, speech, and occupational therapies in the home.

Certified nurse assistants (CNAs) provide personal care, non-medical assistance with activities of daily living, sometimes referred to as ADLs, such as bathing, dressing, getting in and out of bed or a chair or using the toilet.

Companions provide companionship, household help, telephone support, and friendly visits in person. Homemakers and home-care aides take care of such things as laundry, cooking, errands, and shopping.

“When going into homes our goal is to be an extension of the family. We want to be there to ease the burden, offer relief and comfort but at the same time be seen but not heard. We collect their tears and their laundry, tidy up, run errands—add as much normalcy to their lives as we can” said Amy Martin of Visiting Angels, Raleigh, NC.

It’s very important to analyze and verify the quality of services provided. Get referrals from friends and family. Interview providers, ask about worker education, training, experience, screening and bonding, and get at least two references.

Community services can make a big difference, but it takes work to find the best one for your situation. Compare costs and check limits on Medicare, Medicaid, or other insurance policies. Check with your area agency on aging, organizations offering community services, and your local department of local services. Eldercare.gov (800-677-1116) will list which agencies provide services locally.

Most pay for their home care services out-of-pocket. Some may be able to get help from public funds. Medicare covers limited home-care benefits for people age 65 and up. For information about Medicare benefits, check out medicare.gov or call 800-Medicare.

Medicaid, a state and federally funded program, may help pay for nursing home care and sometimes limited services at home. Private long-term care insurance pays for care in nursing homes, assisted living facilities, and sometimes home care depending on the policy.

“The single most important positive thing about utilizing in-home care is to try to preserve a senior’s independence in life while remaining in their environment,” said Patty Aiken, Home Instead Senior Care of Greensboro. “Helping a senior with the activities that have become more difficult to complete allows this individual to remain, with dignity, in the place they want to be—their homes.”

Article by Lesley Gray
Reprinted with permission from the April 2010 edition of Boom! Magazine.

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Hospice and Palliative Care

Misconceptions about hospice can cause some to dread the entire subject.  For some, signing up for hospice is seen as giving up.

The hospice philosophy treats death as a natural part of life, suffering is not extended and doesn’t hurry the end, allowing nature to simply take it’s course with a single focus on living life to its fullest in those final days. It is a special kind of caring for dying people, their families and caregivers designed to meet their total suffering—physical, emotional, social, and spiritual—in the last days of life. Hospice feels life should be lived fully, with as much comfort and dignity as possible. Quality of life is as important as length of life, with care focused on the patient and family rather than the disease.

Hospice focuses on the alleviation of a terminally ill patient’s symptoms. It is a holistic approach involving a team of trained professionals who provide medical attention, pain management, and support personalized to an individual’s needs and wishes. Teams provide compassion, strength and comfort to grieving caregivers as well as the patient during the illness and beyond.

Hospice helps make the patient as free of pain as possible so they can make the most of each day, focusing on support of the family. Outside of the hospital, patients and families have more control over the final days. Hospice comes to the patient, wherever he or she calls home. Whether in a nursing home, home-like hospice facility, hospital, assisted living, veterans’ facility, hospital, prison, or at home, services are available wherever it is most comfortable and as long as needed, even years. Several hospices in the area have in-patient facilities.

Hospice care is covered by Medicare, Medicaid and most private insurance plans. Hospice is the only Medicare benefit that includes medications, medical equipment, 24/7 access to care and support for loved ones.

Professional staff and trained volunteers on the care team provide expert medical care and supportive services to help meet complex needs, including counseling support for families, short-term respite care, spiritual care and counseling, volunteer support, bereavement care, transitional home health care, palliative care, and end-of-life education. Physicians, spiritual care counselors, bereavement counselors, nurses, nursing assistants, clinical counselors and social workers, trained volunteers, nutritionists, physical, occupational and speech therapists are available.

The goal of hospice care is comfort rather than cure during the terminal illness. Hospice allows patients and families to decide where and how they want to spend their final days. Patients are eligible for hospice care if a doctor determines they have a life expectancy of six months or less, and are seeking comfort care rather than curative treatment.

“We provide innovative, thoughtful care, using an interdisciplinary team approach, to achieve the best possible outcomes for the patients, families and communities we serve. Hospice can bring peace for a lot of patients and their families. This is what we do each and every day, and we are good at it. The hospice team comes in and helps both patients and families come to terms with the end of life, and support them in choosing their own path,” said Diana Mitchell, MSW, Marketing Manager, Duke HomeCare & Hospice.

Hospice care and palliative care are related, but different. Palliative care is the attention to and treatment of symptoms by a professional team, with a goal to prevent and relieve suffering and improve quality of life. Hospice care is for people at the end of their lives, who will not recover. Hospice care is comfort care for the last six months of life, while palliative care can be provided at any time during an illness. Palliative care is often used when chronic diseases such as cancer, heart failure, HIV/AIDS, diabetes, or progressive neurological conditions are being treated and provides a wide range of services.

Emily Pearson, RN, Hospice Clinical Services Coordinator, 3HC, said “Dying is a natural part of life, and each person’s dying experience is unique to them. The compassion of hospice allows one to be cared for in a home setting surrounded by loved ones. When a cure isn’t possible, CARE is. Our goal is geared towards ensuring that the person is given the opportunity to live as fully and comfortably as possible, while at the same time, provide support for the caregiver as they care for their loved one in the final weeks and days of life.

Bereavement services are typically offered free to family members for up to a year or more after the patient’s death. Counselors provide compassionate counseling and support to adults and children who are preparing for, or grieving, a loss. One of the best ways to address grief issues is to talk about them with others who are also coping with the death of a loved one, individually or in a group. Adult, child and teen groups are available as well as workshops and individual counseling.

Michael Blanchard, Vice President of Development, Hospice of Wake County Foundation, told us, “To the casual observer, it might appear that the aim of hospice care is to help patients with a serious illness die peacefully. The truth of the matter is that the goal hospice is not to help anybody die, but to help patients live as fully and comfortably as possible as long as they have life. Likewise, the goal of a hospice’s bereavement program is not to help family members forget the deceased but to help them cope with loss while celebrating the lives and honoring the memories of their loved ones.”

There are many opportunities to volunteer for hospice, suitable for groups and individuals of all ages and backgrounds. Hospices need office helpers, fundraisers, family support and speaking volunteers. It is a most rewarding endeavor, paying back much more than that given.

Article by Lesley Gray
Reprinted with permission from the December 2010 edition of Boom! Magazine.

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Skilled Nursing and Memory Care

We need to start planning ahead!  The 85+ population is projected to increase from 5.7 million today to 6.6 million in 2020.  We are living longer but often with increased disability.  Where are we going to live and who will care for us?

We never think it will happen to us—we’ll never need skilled nursing care! Yet it’s to be expected that some of us will require skilled care as we age. It is comforting to know there are many options available to us.

Nursing homes (also known as skilled nursing facilities or SNFs, long-term care facilities, or custodial care) offer care for those who require ongoing nursing care due to physical, emotional, or mental conditions. Residents may be there temporarily for rehabilitation or may be there long-term for skilled medical and/or custodial care.

Comprehensive care is provided, including medical attention, medication, housing, meals, laundry, and help with personal needs. For those with advanced dementia this may be the most appropriate choice for memory care. Registered nurses are staffed 24/7 and a licensed physician supervises each patient’s care. Skilled medical care includes the services of physical, speech and occupational therapists.

Custodial or personal care includes assistance with what are known as the activities of daily living. These self-care tasks include personal hygiene, dressing, eating, transferring from bed to chair, maintaining continence, and mobility. Many need help with taking medications.

A skilled nursing facility is appropriate for those who cannot take care of themselves because of physical, emotional, or mental problems, can no longer care for their own personal needs, require more care than can be provided by their caregiver, and cannot live alone; might wander if unsupervised; have extensive medical needs requiring daily attention; or are going to be discharged from the hospital and require temporary skilled nursing care or rehabilitation before returning home or to a residential facility.

Chronic or custodial care is covered by long-term care insurance. It is non-skilled and can be provided at home or in an assisted facility. Chronic conditions are treatable but not usually curable and is not covered by Medicare or most health insurance policies.

Ted Smith, Administrator, at Hillcrest Convalescent Center, in Durham, NC, ,told us “Hillcrest is one of North Carolina’s first nursing homes. Our mission is to provide consistent, quality service to our families and residents. With a patient-to-nursing staff ratio exceeding current requirements, Hillcrest delivers quality care through open communication between our qualified staff, residents, and families.”

In 2011, the first baby boomers will reach their 65th birthdays. By 2020, all baby boomers will be at least 65 years old. Totalling an estimated 70 million people aged 65+, they will considerably affect our healthcare system. Those with dementias are high users of health care, long-term care and hospice.

“Spring Arbor promotes dignity and choice within a setting of professional, compassionate care. Assistance is always offered, never imposed, and our lifestyle offers our residents and their families the time to focus on opportunities, not challenges,” said Sandy Gegax, Executive Director, Spring Arbor of Apex. “We assume that regardless of abilities lost, residents still have the capacity and the right to continue to live, love and learn.,”

Memory care, also known as SCUs (skilled care units) and memory care assisting living, is designed for seniors with Alzheimer’s or other forms of dementia. As dementia progresses, the level of care and assistance a person requires increases. SCUs offer a higher ratio of staff to residents and specialized staff training. Scheduled activities designed to enhance memory are offered and common spaces are provided for socialization, meals and activities.

“Long-term care may become necessary when an individual requires more attention than can be given at home or in an assisted living facility. The individual’s stay may be temporary, lasting just a few weeks or months, or the nursing center may become the person’s home,” said Linda Roberts, Executive Director, Sunnybrook Healthcare and Rehab.

Article by Lesley Gray
Reprinted with permission from the October 2010 edition of Boom! Magazine.

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Retirement Communities

Are you interested in a retirement community that offers a wide range of care? A place where you will be able to receive appropriate care as your needs change without having to leave the community?

Continuing care retirement communicites, or CCRCs, are communities for seniors with three levels of residence: active retirement/independent living, assisted living, and skilled nursing.

“St. Josephh of the Pines features two nationally accredited continuing care retirement communities in Southern Pines—Belle Meade and Pine Knoll,” said Ellen McFarland, Director of Sales and Marketing. “Both communities offer superior services and amenities, with the added assurance that, if ever needed, various levels of healthcare are guaranteed. SJP believes in offering our community options, and have designed or communities in ways to satisfy each individual’s lifestyle.”

These days, more Ammericans can expect a longer life than at any other time in hisroty. A key decision that you may face is where to spend your retirement years. Continuing care is a good option for many, allowing them to live in one community throughout their retirement. Each care level can suitably provide for the current needs of the resident and fewer transitions will have to be made as you progress from stage to stage throughout your life.

If you are making long-term plans that include changes in your health, a CCRC is a great option. For instance, you can create an active and healthy lifestyle surrounded by other active seniors and, if changes in your health require help with daily activities, you don’t need to move away from your comfort zone. You simply move to another part of the community,  maintaining as much continuity as possible. An option may be to have additional care services come into your independent living home.

CCRCs are especially appropriate for couples. Many times, one half of a couple has a change in health that requires more support. In a CCRC, a couple can stay together even while one member receives a higher level of care. They can still eat and do many activities together, maintaining the rich relationship they have had over the years.

Many feel that the continuity and security available at a CCRC are worth the cost, which can be substantial. This choice is not for everyone but is an alternative that is perfect for some seniors who can afford it and want to prepare for a smooth transition at every stage of their retirement. 

Most CCRCs establish minimum requirements for incoming residents based on age, financial assets, income level, and physical health and mobility. If possible, it is best to move into the community while you are still independent and able to take care of yourself.

Marthat Grove Hipskind, Director of Senior Living at The Cardinal at North Hills, told us, “The desire at every stage of The Cardinal’s Development is to bring together health and wellness, people and places, and private and public spaces in a way that sets a high standard for well-being and transcends physical health.  It is a vibrant multigenerational neighborhood that combines every convenience into a walkable lifestyle that family and friends enjoy visiting.”

Residents may choose to continue their career, take up hobbies, volunteer, travel or just unwind, socialize and take advantage of the many activities and services.  Residents’ family and friends are welcome to visit anytime—for a meal in the dining room or for a visit in the residence.

CCRCs offer a home to those who simply want to enjoy life without the responsibilities of maintaining their own house.  You can relax with no need to worry about cooking, cleaning, laundry, or maintenance.  Some of the benefits are three full meals a day, professional staff to assist with personal care needs, housekeeping and laundry services, 24-hour security and maintenance, and transportation to medical appointments and shopping.  Multiple activities, events, entertainment, excursions, and religious services are there for everyone.  Does a warm and caring environment with every opportunity for friendships and a variety of activities sound enticing?

“CCRCs are a great choice for retirement living, for both seniors and their families and we encourage seniors to go ahead and make the move to a CCRC while they are young and healthy enough to really enjoy the amenities and services the community offers,” said Kathleen Loescher, Marketing and Relocation Coordinator, Springmoore Life Care Retirement Community.  “Too often, seniors wait too long to make this kind of move and end up being forced to react to a crisis situation, which puts a lot of unnecessary pressure on spouses and children.  By choosing a CCRC, that stress is eliminated because the future is secure, and that benefits both the senior and their family.”

Article by Lesley Gray
Reprinted with permission from the August 2010 edition of Boom! Magazine.

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Aging in Place

Do you want to stay in your own home as you age? Aging in place means not having to move from your present residence in order to be cared for as your needs change.

According to ageinplace.com, as of 2000, the U.S. Census Bureau reports that by 2030 there will be approximately 71.5 million Americans over the age of 65, nearly 20% of the entire U.S. population. AARP commissioned a telephone survey of people age 50+. Eighty-four percent said it was very important to stay in their current home.

Often the quality of life goes down as we age, and everyday life can become a struggle as we get older. When you plan ahead you maintain control of your independence, quality of life and dignity. You can choose how you want to spend your retirement years, health care options and your wishes for events such as sickness, housing transitions and financial decisions.

As we age, many are looking for a smaller, more affordable house which can be built to accommodate or modified to help us age gracefully. The right home or well-done home modifications can make our lives much more comfortable and safer.

One out of three Americans older than 65 will suffer a fall. Improve that statistic by eliminating potential problem spots. Many accidents happen in the bathroom where modifications can provide a safe experience. Area rugs and slippery flooring can cause falls. Bending, reaching and loss of balance can cause falls. Adequate lighting, cabinets within easy reach with “D” shaped handles and ample counter space can help. Roll-out or pull-down shelves make reaching a breeze.

Ellen Whitlock, Executive Director, Senior Resources of Guilford County, Greensboro, NC, says, “Older adults should make sure their homes are free from hanging cords and floor mats kept in the proper place. They should take care of clutter, consider using bars in the bathrooms to prevent falls and use night lights to ensure safety.”

Understanding that our abilities may diminish over time will help you make good choices when making decisions on desired features. Home accessories, kitchen aids and phones that are universally designed (for use by people of all abilities) can be very helpful.

Replace a standard toilet with a higher version. Add grab bars in the shower, tub and toilet areas and install lever-handled faucets, a slide bar shower head and a bench in the shower. Replace smooth, slick flooring with a textured tile for increased traction. For wheelchair access, roll-under sinks and low counters are a must in the kitchen and bathrooms.

It can be a challenge getting safely down and back up again from chairs and beds. It is important that there is plenty of room to maneuver walkers and wheelchairs around the home and in and out of doors. Throughout the house, wider entrance and interior doors will allow access for wheelchairs and walkers. All door knobs should have levered-handles.

Assistive technology is products designed to provide greater independence and increased quality of life. Just a few examples of adaptive devices available today are furniture with lifts for easy standing or sitting, seat lifts; large button phones; special lights on smoke detectors; phones and doorbells, talking clocks, and motion sensors for lights.

Dr. Sarah Kirby, Associate Professor and Housing Specialist, North Carolina State University said, “Universal design is for people of all ages, abilities, and genders, and designed to support you throughout a lifespan. It is all about helping people have mastery over their environment. Universal design supports those changes we all go through in life. What is most important to avoid is having to make a decision during a crisis period. Plan your housing just as you have to plan your financial future. Planning ahead makes a huge difference for your caregivers, whether planning ahead with your finances or living arrangements.”

Article by Lesley Gray
Reprinted with permission from the February 2010 edition of Boom! Magazine.

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