Long-distance caregiving is easier with these tips.
During holiday visiting, families often uncover concerns with a senior loved one that hadn’t been apparent through shorter visits or over the phone. And for family members who live at a distance, it can be quite a challenge to head back home, feeling helpless to know exactly how to help.
If this describes your situation, Nightingale Homecare, your trusted Phoenix home care agency has some helpful suggestions to provide you with peace of mind, and your loved one with the help he or she needs.
When it’s not possible to simply drive across town to help an older loved one, it’s helpful to hold family meetings regarding the potential “what ifs” that might arise, such as:
Living preferences according to who may be able to help in the event of an injury or illness. Roleplay some scenarios, such as if the senior experienced a broken hip following a fall and needed rehabilitative care.
Determining factors that will indicate that it’s time to consider care options. What might that look like?
Finances and other resources required and available for caregiving, including how much time family members can afford to miss from work for caregiving tasks.
Advance directives and wills: it is important that all paperwork is in order, and that family members impacted maintain a copy.
Living at a distance from a senior loved one makes it easy to put off the uncomfortable task of assessing the older adult’s health and wellbeing; yet, it is important to ensure these things are evaluated on a regular basis.
Obtain the name and contact information for your loved one’s primary care physician, and stay in touch with the office.
Ensure that there is a signed HIPAA Release of Information Form filed at each of your loved one’s doctors’ offices so you can communicate freely with each physician (and keep a copy for yourself).
Call your loved one regularly to check in and offer help with resolving or preventing any problems.
Maintain a list of other potential resources in your loved one’s neighborhood: neighbors, friends from church, other local family members who can be part of the support network. Make sure these contacts know that you are part of the long-distance caregiving team and have your contact information.
Difficult issues are bound to occur, and often at a moment’s notice. It may not be feasible to travel home for each issue, so determine in advance when you will travel and when to call on other resources for help.
Determine if a situation is a true medical or care crisis. In your decision-making process, consult with your loved one’s doctor, social worker, or nurse for details and to get their opinions on whether you should be there.
Is there someone locally available who can help resolve the problem, or check in on the situation?
It’s perfectly fine if you prefer to visit just to put your mind at rest. If staying at home will cause you to worry, then it may be best to go.
Nightingale Homecare Can Help
Engaging the services of Nightingale Homecare, the top-rated Phoenix home care agency, is the perfect solution for long-distance caregiving needs. Providing as much or as little assistance as needed, and offering a full range of both medical and non-medical care, families know they can trust our care professionals to pay close attention to their loved ones’ needs, and to catch any concerns immediately, allowing them to be addressed before they become a more serious problem. Call us at (602) 504-1555 to learn more.
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.
Discover how urinary tract infections can display differently in older adults.
Chances are, your elderly parent or grandparent has experienced a urinary tract infection, or “UTI,” at some point during his or her life. In a healthy adult, a UTI can be an annoyance, but is generally pretty straightforward in symptoms and in treatment. The hallmark signs of a UTI are burning pain with urination, frequency of urination, back pain, fever, and cloudy, foul-smelling urine. When UTIs are diagnosed early, antibiotics and fluids are prescribed and recovery lasts just a few days. Yet, the presence of a UTI in an elderly, frail person can be deceptive, and left undetected, can potentially lead to hospitalization and even death.
A UTI generally refers to a bacterial infection in any of the four parts of the urinary tract system: urethra, bladder, ureters or kidneys. An un-checked UTI can eventually migrate into the circulatory system, resulting in sepsis. This is why early detection is so critical.
In the elderly population, UTI’s are the most common, yet often most hidden infection they can suffer from. Because elders often lack the normal symptoms of a UTI, the infection may become septic before an infection is even suspected or diagnosed. This is why a UTI in an elder requires immediate attention and treatment. So, if you are caring for an elder loved one, it will be important to differentiate a UTI from other illness and get your loved one immediate medical attention in order to eliminate the infection.
Causes and Risk Factors
Most often, about 85% of the time, a UTI is caused by Escherichia coli, or E. coli bacteria. This bacteria is naturally found in the GI tract, but especially for women, E. coli can easily sneak into the urinary tract. Although women have a higher risk for developing UTIs and generally acquire them much more frequently, men are much more likely to develop severe UTIs, requiring hospitalization. It is important to note the common causes and risks associated for developing a UTI:
Poor hygiene habits
Wiping back-to-front after a bowel movement
Wearing soiled underwear
Wearing incontinent briefs
Not urinating frequently enough
Not relaxing and emptying the bladder with urination
Post-menopausal thinning and weakening of the urinary tract (in women)
Enlarged prostate, leading to retention of urine in the bladder (in men)
Seniors in general are more susceptible to UTIs due to the above mentioned factors; however, the biggest culprit to developing UTIs is a weakened immune system. Your loved one may also have a diminished ability to take care of herself/himself for physical and cognitive reasons. These factors lead to decreased attention to hygiene overall. Seniors also tend to limit their fluid intake in an effort to avoid the embarrassment and inconvenience caused by bladder control issues. As urine pools in the bladder longer, it leads to urinary retention and a greater incidence of infection.
If your loved one wears incontinent briefs, there’s a very high probability of developing a UTI. No matter how often briefs are changed, fecal matter can enter the urinary tract very easily, even with minimal contact.
Signs and Symptoms
Detecting the symptoms of a UTI in an elder can be tricky. Your loved one may show all of the classic signs, yet often, because the immune system is not functioning optimally, the normal symptoms we have all come to know are not exhibited. Along with the more typical signs, be alert for these signs and symptoms:
Poor motor skills
Shortness of breath
Blood in urine
Fever and chills
Nausea and vomiting
Confusion and UTIs
The symptom of confusion deserves special mention, as this is a frequent sign in an elder suffering from a UTI. Confusion will usually come on abruptly with a UTI, or for those already experiencing memory challenges, will increase dramatically. An infection will weigh down the immune system and lead to an increase in temperature and brain inflammation, which then leads to dehydration. The combination of these factors leads to mental changes in an elder with a UTI. The most important take-away from this: if your elder loved one show signs of a sudden increase in confusion, seek urgent medical attention to rule out a possible UTI or another cause.
UTIs and Dementia
As noted, with the onset of a UTI, confusion can increase rapidly in your loved one living with dementia. It can also worsen other behaviors such as agitation, hallucinations, insomnia and aggression. You may also notice sundowning symptoms becoming worse. It may be even more difficult to narrow down the cause when your loved one has difficulty communicating other symptoms. If you notice your loved one’s symptoms suddenly accelerating, it is better to be safe than sorry, and seek immediate medical attention.
Treatment and Prevention
The good news is, once diagnosed by a simple urine test, treatment of a UTI in an elder is relatively straightforward. The majority of UTIs are treated with fluids and antibiotics. Once the infection is cured, prevention should be the primary focus. Here are some simple tips to encourage urinary tract health:
Stay hydrated: water is best, but any fluids your loved one enjoys should be offered
Bladder training: encourage toileting to empty the bladder every two hours
Offer a bedside commode or bedpan, if the person is worried about incontinence
Practice good perineal hygiene: wipe from front to back, clean the perineal area with soap and water and pat dry
If incontinence briefs are used, change frequently and clean the perineum between each change
If a catheter is necessary, clean around the insertion site twice daily, and after each bowel movement, with soap and water and pat dry
Wear and change loose, breathable cotton underwear daily and when soiled
Provide clean linens and towels; even a drop of urine or stool on linens should be changed
Avoid perfumed soaps, deodorants, toilet papers and douches
Provide wet wipes to make clean-up easier after toileting
The Scottsdale senior home care professionals at Nightingale Homecare are always on hand to provide education, helpful resources, and hands-on assistance in the comfort of home to help older adults remain healthy, comfortable, safe, and thriving. Call us any time at (602) 504-1555 to learn more!
Discover the roles of each home health care team member.
You may have questions about the home health care professionals sent to your senior loved one’s home and the role that each one plays in his or her recovery. While not every senior will receive every type of service, allhome care professional services are ordered by the doctor who is overseeing care at home, and all professional home visitors will be in close communication with each other and with the doctor. Nightingale Homecare, providers of the top rated senior care Phoenix AZ families need, breaks down the details on each of the types of home health care professionals who may visit your senior loved one:
What is the role of the nurse?
If a registered nurse is involved in your loved one’s care, you can expect him/her to do a thorough review of any medications the senior is on, and provide instruction regarding those medications. If necessary, the nurse might organize medications in a medication cassette or “pill box” to make it easier to keep things straight. Nurses will also monitor and treat any wounds, change wound dressings if necessary, administer intravenous (IV) medications or certain injections, change catheters, help manage pain, and evaluate vital signs and disease symptoms. The RN will also teach the senior and family members how to provide self-care. Nurses play a big role in helping provide understanding of specific illnesses and how to best manage these illnesses to prevent hospitalizations.
What is the role of the physical therapist?
If a physical therapist is part of your senior loved one’s home health care team, she/he will evaluate how the senior is moving and functioning in the home and develop an exercise program designed specifically to help the senior regain mobility and function. Physical therapists can work on strength, mobility, balance and coordination. They also play a big role in looking at the home environment and making recommendations to prevent falls and injuries. They make sure the senior is using the correct mobility equipment, such as walkers or canes, and that the way the senior is moving around is safe. They teach both the senior and his or her caregivers how to safely transfer if help is needed in going between the bed and a chair. Therapists are also required to check vital signs to make sure the senior is well enough to receive therapy.
What is the role of the occupational therapist?
The occupational therapist will evaluate how the senior is doing with activities of daily living, such as bathing, getting dressed, getting meals and tending to the home. They take a close look at how any problems with movement, muscle weakness, sensation, vision, hearing, breathing and thinking might be affecting activities of daily living. They have a lot of knowledge about special devices that can make activities of daily living easier for those experiencing challenges. They also make recommendations for how minor changes at home, such as moving things around, can make activities of daily living manageable.
What is the role of the speech therapist?
A speech therapist will focus on problems the senior may be having with memory, problem solving, swallowing, speaking, and/or understanding speech. She/he will develop a personalized plan to address specific problems in these areas.
What is the role of the social worker? The social worker will evaluate whether there are any community programs or services that could assist the senior with any physical, financial or emotional challenges. Social workers are skilled at helping people cope with stress and improve difficult family situations. They are also very knowledgeable about different types of housing and how much support is available in different housing environments. They are available to help in figuring out how to plan for the future needs of someone whose health is declining.
What is the role of the dietician?
A dietician will look closely at the senior’s medical diagnosis, eating patterns and nutritional status. She/he will develop an eating plan that works for the senior and that follows any medical instructions. She/he will also help with planning meals and provide tips for shopping and cooking. Sometimes dieticians are called in to work with patients who have severe issues with weight gain or weight loss, diseases that affect their nutritional status or dietary needs, and patients that have to be fed through a tube.
What is the role of the home health aide?
Home health aides work under the strict direction of the nurse or therapist, following a care plan that is developed by the professionals involved in the senior’s care. She/he will help with personal care, such as bathing/showering and getting dressed and ready for the day. The home health aide can also tidy up after providing personal care and help with any exercises that the therapist has ordered. Home health aide visits are limited to the amount of time it takes to provide personal care services. Home health aide visits usually are provided one to three times a week, depending on each individual’s circumstances. The number of visits your senior loved one receives is determined by Medicare criteria and will be explained by the nurse or therapist. If the senior needs more help than what the home health aide can provide under Medicare guidelines, Nightingale will be happy to talk with you about options to consider. We are experts with in-home supportive care services and have helped many people that are having difficulty managing at home.
Medications that are capable of affecting the mind, emotions and behaviors are called psychotropic medications. These include commonly used pain medications called opioids as well as medications used to treat depression, anxiety, mood disorders, sleep problems, dementia and other mental illnesses. When given to older adults, psychotropic medications are typically intended to improve quality of life and ability to function. The doctor must assure, however, that the patient is accurately diagnosed, that the dose is correct, that harmful side effects don’t occur and that the psychotropic medication doesn’t interact badly with other medications that the patient is taking.
The use of psychotropic medications and opioids has increased steadily in older adults over the last ten years. In the United States, people over the age of 65 represent just 13 percent of the population, yet this age group takes over one-third of the drugs prescribed in this county. What is even more disturbing is that a recent study found that the number of older Americans who take three or more brain-affecting medications has doubled in the last ten years. For adults age 65-80, nine out of ten have prescriptions for psychotropic medications written by a doctor that is not a psychiatrist.
Although they can be beneficial at times, psychotropic and opioid medications can also be dangerous when taken by older adults, especially when taken long-term. The elderly are more sensitive to the effects of these medications because most drugs are eliminated from the body through the kidneys and liver, both of which may work less efficiently in later years. Another age-related change is an increase in the amount of body fat. Seniors are at high risk for “drug toxicity,” or the result of drugs accumulating in the body because the drugs are often stored in fat. Drug toxicity is very serious and can be fatal.
Even though there is a well-known connection between the use of psychotropic medications in older adults and the potential toxicity from them, health care professionals often do not recognize what is happening. More than likely, they attribute the symptoms of medication toxicity to some sort of new health condition or worsening of an existing health condition.
Side effects from psychotropic drugs are more frequent and severe in older adults, especially feelings of sleepiness or being “out of it.” Memory and movement problems are also very common and can lead to falls, fractures and other accidents.
Most older adults who take psychotropic medications also take other prescribed and over-the-counter medications. Because of this, careful evaluation is needed to make sure that unwanted, uncomfortable or dangerous side effects and interactions are not occurring. Bad medication reactions commonly include: hallucinations, confusion, dizziness, constipation, drowsiness, weakness, slurred speech, lack of balance or coordination, slow and shallow breathing, poor judgement, falls with broken bones, addiction and even death. In addition, a recent study found that use of benzodiazepine (or anti-anxiety medication) results in a higher risk of developing Alzheimer’s disease.
Hospitalization due to bad drug reactions occurs about four times more frequently in older patients than in younger ones – and, these bad reactions could have been prevented in almost 90% of cases!
Due to the risks involved, psychotropic medications should only be prescribed by a senior’s doctor after very careful consideration, and only after trying medications or treatments that pose a lower health risk.
When considering treatment foranxiety, depression, psychological distress, sleep disorders and chronic pain,non-pharmaceutical strategies are often considered preferable to drug options in the elderly. These include:
Cognitive behavioral therapy
Progressive muscle relaxation
Hot and cold treatments
When it comes to pain management, there is a perception that opiate pain medications are the best treatment, but studies have determined that there is no advantage to using opioid pain medications for the treatment of chronic pain in older adults when the pain is not caused by cancer. For non-cancer pain, opioids are recommended for a maximumof 3-7 days, and some over-the counter pain medications may actually be more effective.
Nightingale Homecare is committed to keeping seniors safe and well through trusted in-home care services, skilled nursing care, and more. Contact us today at (602) 504-1555 for further information on psychotropic medications or for set up a consultation for home care in Paradise Valley and the surrounding area.
A Nightingale representative would be happy to answer your questions or help you arrange for home care that is custom-fit to your needs.