Celebrating the holidays with seniors this year requires careful planning and consideration.
Back in March, when the words “pandemic” and “COVID-19” just began to creep into our vocabulary, we had no idea that by the holiday season, we’d still be right in the thick of isolating, social distancing, and doing whatever we can to keep ourselves and each other safe. Yet here we are, and it’s important to carefully think through the risks associated with celebrating the holidays with seniors this year.
At the heart of the quandary lies the knowledge that both COVID-19 and isolation from loved ones bring serious, potentially life-threatening risks to older adults. Harvard epidemiologist Julia Marcus explains, “There’s no easy answer here, just like with everything else. It’s not about safe or unsafe. It’s about figuring out how to balance various risks and keeping risks as low as possible.”
And while we’ve learned to avoid super-spreader events, experts warn that the recent spike in infections has been attributed in large part to transmissions within home gatherings.
The CDC (Centers for Disease Control and Prevention) recently redefined “close contact” as it relates to the spread of infection to 15 minutes of cumulative exposure during a 24-hour period, within six feet of others (as opposed to the former 15 consecutive minute definition).
Although these guidelines reference maintaining social distancing of six feet, it is believed that aerosol transmission can occur at much greater distances – there’s nothing magic about the six-foot figure.
Family members considering air travel (or other public transportation) are, of course, at a greater risk of exposure to the virus, and can still transmit the virus to others, even if they remain asymptomatic. The safest course to follow would be to self-quarantine for 14 days after arrival, and then get tested – an incredibly difficult protocol to follow.
As a result of these factors, the CDC’s official holiday celebration guidelines encourage people to stay at home with those already living in the same household, which raises the issue of senior isolation and the serious emotional and physical toll it can take on older adults.
Dr. Anthony Fauci explains, “There are some families who are so frustrated with not seeing each other for so long, they’re going to say, ‘Hey, I’m going to take the risk. My mental health of seeing my children or grandchildren is so important to me that I’m going to take the risk.’”
If a senior you love expresses these types of feelings, and is experiencing the negative impact of isolation, you’ll need to carefully consider the risks vs. the benefits of getting together. In that case, face coverings, social distancing, and handwashing are necessary, and time spent together should be limited. Outdoor visits are also preferred.
The holiday season of 2020 may not be the Normal Rockwell celebration we’d wish for, but know that Nightingale Homecare, the leading Phoenix home health agency, is here to help make it as merry and bright as possible for the seniors you love. Contact us to learn more about how we can help alleviate isolation for seniors, coordinate the technology necessary for contactless visits with a senior loved one, and so much more.
Use this COVID-19 self-assessment tool from the home care team at Nightingale.
Nightingale Homecare is dedicated to ensuring our patients’ safety and good health during the COVID-19, or “coronavirus” pandemic. Anyone can get the virus and may have mild or severe symptoms. However, if you are an elder adult with underlying conditions, such as heart disease, lung disease, hypertension or diabetes, you are considered to be at higher risk for developing more severe complications from the virus, and need to be particularly cautious.
Of course, the best way to prevent illness is to avoid being exposed to this virus, so it is important to stay away from people who are sick, or may unknowingly have the virus. The virus is thought to spread mainly from person to person who are in close contact, or through respiratory droplets when an infected person coughs or sneezes.
People with pre-existing conditions are encouraged by the CDC to stay home whenever possible and to go out only for medical care. If you do venture out, do so with a cloth face covering, avoid crowds, and stay at least six feet from others at all times. It is especially important to use hand sanitizer while out and to wash your hands often with soap and water for at least 20 seconds after being in a public place.
While home, you should pay special attention to your hand hygiene, especially after blowing your nose or coughing, and avoid touching your face, nose and mouth. It is also important to clean and disinfect frequently touched surfaces daily: tables, counters, doorknobs, phones, keyboards, toilets, faucets, sinks, and light switches.
Anyone who does come into your home should always self-screen, and not come in if they are feeling sick, have a temperature, or have been recently exposed to anyone with, or suspected of having, COVID-19. In addition, your guests should wear a cloth face covering, practice good hand hygiene, and stay at least six feet from you at all times.
All of Nightingale’s patients are asked to self-screen for the virus daily. To self-screen effectively, you must know the symptoms associated with COVID-19. The following is a list of known symptoms of COVID-19:
· SORE THROAT
· SHORTNESS OF BREATH
· NEW CONFUSION
· LOSS OF TASTE/SMELL
· CHEST PAINS
· BLUE COLOR IN LIPS, FACE OR EXTREMITIES
· TEMPERATURE > 100.4
· SHAKING WITH CHILLS
· MUSCLE ACHES
At Nightingale Homecare, we ask all our patients to go through the following self-checks daily. We use a tool called a stoplight self-assessment, and patients are asked to evaluate if they are in the GREEN, YELLOW or RED ZONE.
THE GREEN ZONE
If you can affirm all of the statements below, you would be considered to be in the GREEN ZONE, and would not need to do anything other than monitor for symptoms that may develop and continue taking precautions.
I am breathing easily.
I have no fever or chills.
I am not coughing, wheezing, or experiencing chest tightness or shortness of breath.
I do not have a sore throat.
I am able to maintain my normal activity level.
I am alert without confusion or unusual fatigue.
I have no loss of smell or taste.
I have no diarrhea or stomach upset.
I have no color changes in my face or extremities.
THE YELLOW ZONE
If you note any of the following symptoms, you would be in the YELLOW ZONE, and you would need to contact your health care provider right away.
I am coughing more than usual, or have a sore throat.
I have a fever over 100.4 degrees Fahrenheit when taken orally (or a tympanic recording), or 99.4 under the arm (or temporally).
I have loss of smell or taste.
I have diarrhea or vomiting.
THE RED ZONE
If you affirm any of the following statements, you would be in the RED ZONE and would require immediate, emergency medical attention:
I am experiencing unrelieved shortness of breath.
I have a persistent cough.
I have a fever over 101.4 degrees Fahrenheit when taken orally (or a tympanic recording), or 100.4 under the arm (or temporally).
I have a change in the color of my skin, nails, or lips to gray or blue.
Learn everything you need to know about taking vital signs at home from Nightingale Homecare.
If you are a caregiver for a loved one who has a medical condition that requires monitoring, chances are his or her physician has asked you to keep an eye on a measurement or two in order to detect a change in condition. Learning to monitor vital signs is a necessity for caregivers of people with chronic conditions.
Checking vital signs is an important skill to learn, because it tells us how the person’s body is functioning, helping us to monitor current conditions and alerting us to changes in health status. It can also give us clues to possible medical conditions that have yet to be diagnosed. The four main vital signs that are measured to give us an overview of your loved one’s health status are:
Heart rate (pulse)
Our team of experts in home care Paradise Valley, AZ at Nightingale Homecare shares the following instructions on how to correctly monitor vital signs:
No individual has the exact same temperature reading throughout the day, as body temperature naturally fluctuates. Normal body temperature measured orally ranges from 97.6 to 99.6 degrees Fahrenheit (36.4 to 37.5 degrees Celsius) for a healthy adult. Of course, normal temperature variation depends on recent activity, food and fluid intake, time of day, etc.
Body temperature may be abnormal due to fever (high temperature) or hypothermia (low temperature). According to the American Academy of Family Physicians, a fever is indicated when body temperature rises one degree or more over the normal temperature of 98.6 degrees Fahrenheit. Hypothermia is defined as a drop in body temperature below 95 degrees Fahrenheit.
There are four different ways to measure body temperature:
Orally: At Nightingale, we ask that our caregivers and clinicians use a digital thermometer to measure oral temperature over glass thermometers due to safety reasons. If you do not have this piece of equipment to monitor your loved one’s temperature, you should make the investment; they are inexpensive and reliable.
Rectally: If your loved one’s doctor asks you to take a rectal temperature, you should use a digital thermometer over a glass thermometer for safety reasons. Rectal temperatures tend to be 0.5 to 0.7 degrees F higher than when taken by mouth.
Axillary: Temperatures can be taken under the arm using a digital thermometer. Temperatures taken by this route tend to be 0.3 to 0.4 degrees F lower than those temperatures taken by mouth.
By ear: A special thermometer can quickly measure the temperature of the ear drum, which reflects the body’s core temperature (the temperature of the internal organs). An ear temperature is between 0.5 -1.0 degrees F higher than an oral temperature.
By skin: A special thermometer can quickly measure the temperature of the skin on the forehead. A skin temperature is between 0.5 -1.0 degrees F lower than an oral temperature.
Taking Body Temperature Using a Digital Thermometer:
Wash your hands.
Cover thermometer mouth tip with a clean plastic shield.
Press button to set the thermometer.
Place the thermometer under the tongue and instruct your loved one to close his or her lips around the probe.
Wait several minutes and remove thermometer when beeping indicates the reading is complete.
If you are taking a record for your loved one’s physician, write down the temperature, including the date, time and method used as follows: “O” for oral, “R” for rectal, “E” for ear, “A” for axillary.
Remove the plastic shield.
Clean and sterilize the thermometer following manufacturer’s instructions, or with an alcohol prep pad wiping from the top to the tip.
Note: Oral thermometers are not indicated for some individuals, such as those with a history of seizures, or people unable to close their mouth fully. Digital thermometers can be used to take an axillary temperature by being placed under the armpit, against dry skin, and following the instructions noted above.
Pulse rate, also called heart rate, indicates the number of times the heart beats per minute. As the heart pushes blood through the arteries, the arteries expand and contract with the flow of the blood. Taking a pulse not only measures the heart rate, but also can give us information on the strength and rhythm of the heart.
Normal pulse for healthy adults ranges from 60 to 100 beats per minute. The pulse rate may fluctuate and increase with exercise, illness, room temperature, injury, and emotions. It is not uncommon for athletes, who do a lot of cardiovascular conditioning, to have a heart rate of nearly 40 beats per minute and experience no problems.
Taking a Pulse Rate:
Wash your hands.
Make sure that your loved one is at rest before you begin.
The easiest place to find a pulse to measure is at the radial artery found on the inside of the wrist at the base of the thumb. Alternatively, you can find the pulse on the inside of the elbow (brachial artery), or neck (carotid artery).
Note: If you use the neck, be sure not to press too hard, and never press on the pulses on both sides of the lower neck at the same time to prevent blocking blood flow to the brain.
Use your first and second fingertips (never the thumb, because it has a pulse and will interfere with an accurate assessment of your loved one’s heart rate) to press firmly but gently on the wrist (or otherwise) until you feel a pulse
With an analog clock or watch, wait until the second hand is on the 12 to begin counting.
Begin counting the beats of the pulse
Count pulse for 60 seconds until the second hand returns to the 12. Or, you may also count for 15 seconds and multiply by 4 to calculate beats per minute. Note: The physician may request for you to take the loved one’s heart rate for a full minute, if he/she has an irregular heart rate.
When counting, do not watch the clock continuously, but concentrate on the beats of the pulse.
If your loved one’s physician asks for a record, write down the heart rate, including the date, time, and if you notice any irregularities.
Respiration rate, also referred to as breathing rate, is the number of breaths taken over a minute. This measurement is always taken when the person is at rest and involves how many times the chest rises per minute. One respiration count is equal to the chest rising (inhaling) and falling (exhaling) once. The normal range for an adult is 12 to 20 respirations per minute. Factors like age, fever, agitation, activity, illness and sleeping can alter breathing and therefore the respiratory rate. When a person is acutely ill, respiratory rate fluctuations and patterns are monitored as a warning sign for further decline.
Taking Respiratory Rate:
You can keep your fingers on the radial pulse after you have stopped counting pulse rate, and use the next minute to count the person’s respiratory rate.
With an analog clock or watch, wait until the second hand is on the 12 to begin counting.
Count breaths (inhale + exhale = 1 respiration) for one minute. You may also count for 15 seconds and multiply by 4 to calculate breaths per minute.
If your loved one’s doctor wants a record, write down respiration rate, noting any observations (such as irregularity, increased effort or wheezing).
Blood pressure is the force of the blood pushing against the artery walls during contraction and relaxation of the heart. Each time the heart beats, it pushes blood into the arteries, resulting in the highest (top) number of pressure reading. This is called “systolic.” The bottom number, lowest reading or “diastolic” is when the heart is totally relaxed before the next beat. The blood pressure measurement is recorded in millimeters of mercury or mm Hg and written as systolic/diastolic.
A blood pressure reading identifies how effectively the oxygenating blood is moving through the blood vessels of the circulatory system. In healthy adults, the systolic pressure should be less than 130 and the diastolic pressure should be less than 85. High pressure is called hypertension and low pressure is called hypotension. Many health conditions can affect blood pressure. Cardiac patients, and those afflicted with hypertension, are instructed to monitor their blood pressure, as it can directly lead to life-altering conditions like heart attack, heart failure and stroke.
At Nightingale, all of our staff use manual or android cuffs, as electronic blood pressure machines can be unreliable and false readings could lead to devastating consequences for your loved one. You will need to have a stethoscope, blood pressure cuff with inflatable balloon (sphygmomanometer) with a numbered pressure gauge called a digital monitor or aneroid monitor.
Before you measure your loved one’s blood pressure:
The American Heart Association recommends the following guidelines for home blood pressure monitoring:
Have your loved one refrain from smoking or drinking coffee for 30 minutes before taking blood pressure.
Have your loved one go to the bathroom before the test.
Your loved one should relax for 5 minutes before taking the measurement.
Taking Blood Pressure
Have your loved one sit with the back supported (he or she shouldn’t sit on a couch or soft chair). Your loved one’s feet should be on the floor and uncrossed.
Wash your hands.
Place your loved one’s arm on a solid flat surface (like a table) with the upper part of the arm at heart level.
Place fingers on the underside of the elbow to locate the pulse (called the brachial pulse).
Wrap and fasten the deflated cuff snugly around the upper arm at least one inch above where you felt the strong and steady brachial pulse.
Position the stethoscope diaphragm directly over the brachial pulse and insert the earpieces.
Turn the knob on the air pump clockwise to close the valve.
Pump air, inflating the arm cuff until the dial pointer reaches 170.
Gently turn the knob on the air pump counter-clockwise to open the valve and deflate the cuff.
As the dial pointer falls, watch the number and listen for a thumping sound.
Note the number shown where the first thump is heard (systolic pressure).
Note the number shown where the last thump is heard (diastolic pressure).
Deflate and remove cuff.
If your loved one’s doctor asked you to take multiple readings during one sitting, take the readings one minute apart and record all the results.
It is best to take blood pressure at the same time every day.
If your loved one’s doctor asks for a record, write down the date, time, and blood pressure reading.
When blood pressure reaches a systolic (top number) of 180 or higher OR diastolic (bottom number) of 110 or higher, this could require emergency medical treatment, so call your loved one’s doctor for further instruction.
Properly monitoring vital signs can be a challenge, which is why we recommend letting Nightingale Homecare’s professional home health care staff take care of it for you! Our team of experts in home care Paradise Valley, AZ is highly skilled in a wide range of both medical and non-medical home care services, ensuring that older adults live their safest and healthiest lives possible, in the comfort and familiarity of home. Contact us at (602) 504-1555 to learn more and to find out if our services are available in your area.
Learn the 7 main types of elder abuse and how to keep seniors safe.
Elder abuse is a serious issue that involves the abuse or neglect of people age 60 and older. The signs of abuse are often not recognized, leading to gross under-reporting of the problem. In fact, the limited research available suggests that only one in 14 cases of abuse are actually reported to the authorities. Sometimes the abuse is a continuation of existing dysfunctional family dynamics. More often, however, the abuse is a result of changes brought about by the stress of illness, dependency and need for increased care.
Adult children and spouses are the most frequent abusers of the elderly, followed by other family members. The National Center on Elder Abuse defines the following seven different types of elder abuse:
Physical abuse involves the use of physical force that may result in bodily injury, physical pain, or impairment. Persons who have been physically abused may have bruises, welts, lacerations, rope marks, black eyes, wounds, cuts, or untreated injuries in different stages of healing. Dislocations, sprains, internal injuries, broken eyeglasses or frames, and medication overdosing or under-dosing can also be the result of physical abuse. The elder being physically abused is often withdrawn, anxious, depressed, and fearful around a family member or caregiver. A red flag that physical abuse may be occurring is a caregiver’s refusal to let the patient have visitors without the caregiver being present.
Sexual abuse includes non-consensual sexual contact of any kind with another person. Bruising around the breasts or genital area, sexually transmitted diseases, vaginal or anal bleeding, and torn or bloody undergarments are signs of sexual abuse.
Emotional or psychological abuse involves infliction of anguish, pain, or distress through verbal or non-verbal acts. Emotionally abused persons may appear agitated, upset, withdrawn, non-communicative, or unresponsive. Emotional abuse often accompanies other types of abuse. In the elderly, unusual behavior often attributed to dementia, such as sucking, biting, or rocking behavior, can also be signs of emotional or psychological abuse.
Financial exploitation is a common form of abuse that occurs in the elderly and involves illegal or improper use of an elder’s funds, property, or assets. Financial abuse can include cashing an elder’s checks without permission; forging an elderly person’s signature; stealing money or possessions; coercing or deceiving the elder into signing a contract or will; or improperly using a power of attorney, guardianship, or conservatorship. Other indications of financial abuse include the disappearance of financial papers, checkbooks, and legal documents; a sudden change in banking habits or a change in banking locations; the withdrawal of large sums of money by a person who accompanies the elder; additional names added to an elder’s bank signature card; unauthorized use of an ATM or credit card; the unexplained transfer of assets to a family member or person outside the family; or the unexplained disappearance of funds or possessions.
Additionally, substandard care, even though financial resources are available, can be an indication of financial abuse. Exploitation may also occur in the form of fraud schemes by strangers.
Neglect is the most common type of elder abuse. Neglect may be intentional, such as withholding nourishment, or it may be unintentional, resulting from ignorance or from a genuine inability to provide care. Neglect can also take the form of failure to fulfill an obligation, such as failing to pay for necessary home care services or the failure of a caregiver to provide necessary care. Persons who have been neglected may appear dehydrated and malnourished, have untreated bedsores, lice, a flea infestation, a urine or fecal smell, be inadequately clothed, or live in hazardous, unsafe, or unsanitary conditions.
Abandonment is an extreme form of neglect that involves desertion of a person by an individual who has physical custody or by a person who has assumed responsibility for providing care to the individual. An example would be a caregiver who leaves a dependent elderly person alone for several days while traveling.
Self-neglect abuse primarily occurs in the elderly and includes behaviors or absence of behaviors that threaten a person’s health or safety. This definition does not apply to a mentally competent person who makes the voluntary decision to engage in behavior that threatens his or her safety and who understands the consequences of that decision. Self-neglect can include behaviors such as:
Failure to take essential medications or refusal to seek medical treatment for serious illness
Leaving a burning stove unattended
Not wearing suitable clothing for the weather
Poor living conditions or the inability to attend to housekeeping
Self-neglect accounts for the majority of elder abuse cases reported to adult protective services. Oftentimes, the problem is paired with declining health, isolation, Alzheimer’s disease or dementia, or drug and alcohol dependence. In some of these cases, self-neglecters will be connected to support systems within the community that can assist the person to continue living independently. Conditions like depression and malnutrition may be successfully treated through medical interventions. If the problems are severe enough, a guardian may be appointed or alternate living conditions arranged.
A combination of individual, relationship, community, and societal factors contribute to the risk of becoming a victim or perpetrator of elder abuse. In many situations, the same risk factors may be shared by both the perpetrator and the victim.
In the elderly population, studies suggest that those at risk are most likely to be female, widowed, frail, cognitively impaired, and chronically ill. Social isolation and mental impairment, such as dementia or Alzheimer’s disease, are two factors that may make an older person more vulnerable to abuse. A history of domestic violence may also make a senior more susceptible to abuse. Particularly in the case of adult children, abusers often are dependent on their victims for financial assistance, housing, and other forms of support. Frequently, these individuals need this support because of personal problems, such as mental illness, alcohol or drug abuse, or other dysfunctional personality characteristics. The risk of elder abuse is particularly high when these adult children live with the elder.
Home care clinicians, such as the professional Sun City home health care staff at Nightingale Homecare, are in an ideal position to detect situations for potential abuse and to connect the patient and caregiver with community resources that may prevent escalation of the problem. Stressed caregivers can be put in contact with social organizations and support groups and connected with referrals for adult day care, delivered meals, and respite care. Providing resources for caregiving assistance can be a lifesaver. Clinicians should also teach family caregivers to recognize situations that cause increased stress, as well as appropriate ways to handle difficult patient behaviors like violence, combativeness, and verbal abuse. Identifying actions that can deflate stressful situations is critical to preventing abuse.
Home health providers are mandated to report suspected abuse. Mandated reporters are required by law to report allegations of abuse to law enforcement and regulatory agencies. In most states, Adult Protective Services are the public agencies responsible for investigating reports of elder abuse and for providing victims and families with treatment and protective services. In most situations, the suspicion of abuse is grounds for reporting. Proof is generally not necessary, and the reporter has the option to remain anonymous. Even if a situation has already been investigated, circumstances that seem to be getting worse should continue to be reported and documented by the clinician. If the patient is in immediate danger or a life-threatening situation, it’s important to call 911 or the local emergency authorities.
A trusted home care team, like Nightingale Homecare, is instrumental in reducing the chance for elder abuse and neglect. Contact our Phoenix home care experts to learn how we can help a senior you love stay safe, healthy, and well, in the comfort of home.
Occupational therapy can a great addition to the care team when managing diabetes.
Those with diabetes, and those who provide care for them, know the importance of proper management of the disease: routine monitoring of blood glucose levels, carefully adhering to dietary restrictions, exercising and maintaining regular checkups with the doctor. But what might come as a surprise is the role occupational therapy can play in diabetes management.
Occupational therapists can – and should – be a vital part of a diabetic’s care team, bringing a full range of knowledge and expertise in addressing all of a patient’s needs: emotional, social, sensory and cognitive, as well as physical.
The American Association of Diabetes Educators has compiled the AADE 7TM Self-Care Behaviors, all of which can be enhanced through occupational therapy services:
Monitoring the disease
Healthy coping skills
Here are just a few of the many ways a professional occupational therapist can improve diabetes management as well as the overall health and wellbeing for the person diagnosed:
Provide recommendations for safe, appropriate physical activity
Educate on appropriate meal choices and cooking techniques
Assist with medication tracking and organization
Share tips for effective blood glucose monitoring
Utilize strategies and compensations for those with sensory loss
Help alleviate anxiety and depression through daily lifestyle changes
Whether the need is simply for a little extra help with housework, meals, and personal care, or if a chronic disease calls for skilled medical care, Nightingale Homecare is on hand with the right level of care at the right time. Contact us at (602) 504-1555 for a free in-home consultation where we’ll listen to the challenges being faced and create a plan of care to address those needs, monitoring over time as needs change. Discover how our home health in Phoenix and the surrounding areas can improve quality of life and make each day the very best it can be!
A Nightingale representative would be happy to answer your questions or help you arrange for home care that is custom-fit to your needs.