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Home Care Paradise Valley: Learn to Safely Reposition Your Bed or Chair-Bound Loved One

home care paradise valley - Bed-Bound Seniors

Learn tips to reposition bed-bound seniors safely and correctly.

As providers of the most trust home care Paradise Valley and the surrounding area has to offer, we know working with bed-bound seniors and chair-bound seniors requires much care and attention, and one of the most critical components is repositioning. The primary purpose of repositioning is to improve circulation to the skin and other organs, relieving pressure and preventing skin breakdown. Repositioning also helps in providing comfort to your loved one and ensures movement of the joints and muscles. Although many bed-bound patients often resist turning and will tell you they just want to be left alone, turning will improve comfort over the course of the day and night, and will also give you opportunity to inspect the skin.

Your Loved One’s Individual Repositioning Schedule

Although the current accepted “guideline for care” is to reposition your loved one every two hours, there is much more involved in finding the right solution for your individual loved one. The frequency of turns/repositioning should be individualized to your loved one based on such factors as:

  • Tissue tolerance
  • General medical condition
  • Level of activity and mobility
  • Overall treatment objectives
  • Comfort
  • Skin condition

To test your loved one’s “tissue tolerance” you must observe and document the time it takes the skin to redden over bony prominences (hips, ankles, shoulders). You must gradually increase the amount of time the person is left in the same position until redness is detected. Once the threshold has been established, you must set the turn frequency to 30 minutes less than the time interval, with no more than 2-hour intervals maximum. Repositioning a chair-bound loved one should occur even more frequently.

In addition to determining tissue tolerance and the frequency of repositioning, you will need to move your loved one using proper techniques. Keep these points in mind when repositioning:

  • Make sure the pressure is relieved or redistributed.
  • Avoid positioning over bony prominences that redden easily.
  • Do not drag or pull your loved one while repositioning, which can damage the skin.
  • Alternate between the back, right side and left side on the schedule determined for your loved one, but at least every two hours.

Necessary Equipment for Your Bed/Chair-Bound Loved One

Depending upon your loved one’s condition and activity orders, the use of equipment can make all the difference for a person who is bed/chair-bound. You should talk to your loved one’s physician and health care team about necessary equipment to aid your loved one in repositioning and preventing skin breakdown and other complications.

Some equipment to consider:

  • A hospital bed with bedrails
  • A trapeze, if your loved one has upper body strength to help reposition
  • A Hoyer lift
  • Drawsheets and bedpads
  • Slide sheets
  • Wedges and pillows
  • Low air-loss mattress
  • Wheelchair cushion
  • Geri-chair
  • Heel and elbow protectors
  • Contracture rolls

Always Use a Drawsheet!

Using a drawsheet under your loved one makes it much easier to position the person, and also reduces the possibility of your loved one developing a skin injury/breakdown. If you don’t have one, you can make one by folding a twin-sided top sheet in half. To place the sheet correctly under your loved one, follow these steps:

  • If your loved one has a hospital bed, raise the bed to a level that reduces the strain on your back, and make the bed flat.
  • Roll your loved one to one side and place the half rolled up sheet on top of the fitted bottom sheet so that the top and bottom of the drawsheet go across the bed (perpendicular to the bed). Position the drawsheet so that it will be between the person’s head and knees.
  • Roll your loved one onto the sheet and unroll the sheet out flat under the person.
  • Tuck in the drawsheet tightly on both sides. Smooth out any wrinkles to reduce possible skin irritation.


Basic Repositioning Rules for a Bed/Chair-Bound Person


  • Never lift more than you can manage.
  • Get help when needed.
  • Explain to your loved one the steps involved, and how the person can help.
  • Raise the bed to safe working height and ensure that brakes are applied.
  • Never lift your loved one.
  • Never pull the person by the arms.
  • Never attempt to pull your loved one without a drawsheet; the risk of giving your loved one a skin injury or injuring yourself is very high without one!


Moving Your Loved One Up in Bed


There are several methods for moving a person up in bed. If your loved one has some upper body strength or is able to use his/her bent legs to push up in bed, this can be helpful. Aids such as trapeze bars, side rails and “slide sheets” can be useful tools when you are moving your loved one without additional help. The goal to moving your loved one up in bed is to not lift, but pull the person up in bed using a drawsheet. Do not slide your loved one up in bed without a drawsheet, as you can create friction or shear skin injury. These are instructions for using a drawsheet and two-person assist for moving a person up in bed:


  • Lay your loved one on his or her back; place the pillow at the head of the bed and against the headboard.
  • Stand between the shoulders and hips of your loved one, with your feet shoulder-width apart. Weight will be shifted from back foot to front foot.
  • Fan-fold the drawsheet toward your loved one and grab the drawsheet at the person’s upper back and hips.
  • Ask your loved one to tilt his/her head toward the chest to protect the neck, and to fold the arms across the chest, bending knees to assist with the movement. Let your loved one know when the move will happen.
  • Tighten your gluteal and abdominal muscles, bend slightly at your knees, and keep your back straight and neutral.
  • On the count of three, gently slide (not lift) your loved one up the bed, shifting your weight from the back foot to the front, keeping your back straight with your knees slightly bent.
  • You may need to do this more than once to get your loved one in the right position.
  • Replace the pillow under the person’s head, and position the person in bed.
  • If your loved one is going to remain on his/her back, raise the foot of the bed enough to bend the knees. In addition, you can place a pillow under the knees to prop the person up to prevent sliding down in bed. This will help reduce friction and shear skin injury as well.

Turning and Positioning Your Loved One in Bed

Repositioning bed-bound seniors is easier to accomplish with help. If you don’t have help, it can be done but will require more steps to accomplish. Here are the steps to repositioning a person in bed without help from experienced providers of home care Paradise Valley families depend on.

  • Move the person to the center of the bed so the person is not at risk of rolling out of the bed.
  • Ask your loved one to look towards you. Position the arm nearest you stretched toward you and the arm farthest from you across his/her chest.
  • Position a pillow next to the person on the opposite side of the bed.
  • Reach over the person and grab the drawsheet on the opposite side, gently pulling the drawsheet toward you.
  • Gently pull the person’s hip and shoulder towards you with the drawsheet as you place the pillow under the drawsheet to prevent your loved one from rolling back.
  • Go around the other side and get your hands, palms up, under the person’s hips to pull him/her back into position.
  • Position the pillow or a foam wedge under the drawsheet at the person’s back. Push the pillow close against the back to help prop the person on his/her side.
  • Make sure the arm under your loved one is pulled out from under him/her, resting more on the shoulders for comfort.
  • Make sure your loved one‘s ankles, knees, and elbows are not resting on top of each other to prevent skin problems.
  • Make sure his/her head and neck are in line with the spine, not stretched forward, back, or to the side.
  • Place a pillow under the top arm of your loved one.
  • Place another pillow or a specially designed foam leg wedge between the person’s knees. This extra bit of support will add comfort by keeping the spine in alignment and by easing pressure on the bony areas of the knees and ankles.
  • Return the bed to a comfortable position with the side rails up. Check with your loved one to make sure he/she is comfortable.

Repositioning Your Seated Loved One

Repositioning chair-bound persons is just part of the care to prevent the development of skin problems, and each person will present different needs. Seated people need to be repositioned more frequently than bed-bound people. Instruct your chair-bound loved one to shift his/her weight every 15 minutes. If your loved one is unable to reposition, you will need to physically move him/her at least every hour. To do this, you will need to use a drawsheet or sling under your loved one’s buttocks and hips to gently pull from side to side. In addition, your loved one who is chair-bound should always use a pressure redistribution cushion, which will distribute the weight of the body without impeding function or increasing the risk of skin damage.

Other factors, such as your loved one’s nutrition, medical condition, skin condition, and tissue tolerance will also determine repositioning needs. Ask your loved one’s health care team what their recommendations are for repositioning. Use of a Hoyer lift, geri-chair and a seated positioning system may be necessary for your loved one who is unable to reposition independently in a chair.

To ensure your loved one is safe from injury – as well as yourself! – call on Nightingale Homecare, providers of the most trusted home care Paradise Valley and the surrounding area have to offer. We can assist with a full range of both skilled and non-medical services for seniors in the home, based on each person’s individual needs. Call us at (602) 504-1555 to learn more.

Posted in Aging Issues, Senior Safety on September 6th, 2019 · Comments Off on Home Care Paradise Valley: Learn to Safely Reposition Your Bed or Chair-Bound Loved One

Seniors and Shingles: Is Your Loved One at Risk?


Learn everything you need to know to protect seniors from shingles.

Back in the day, getting chickenpox as a child was a rite of passage. Parents would often even throw “chickenpox parties” – inviting the neighborhood kids over when one was contagious with the disease! The thinking was that since everyone was going to catch it anyway, why not get it over with?

Thankfully, we now have effective vaccines that allow for the prevention of chickenpox. But for those who were stricken with the disease at some point, the lingering effects can manifest later in life as shingles – a condition that can lead to significant pain and discomfort that can last for weeks. There are also a number of serious complications that can arise in older adults who develop shingles, including:

  • Blindness
  • Infection
  • Neuralgia (nerve pain)
  • Hearing loss
  • Encephalitis
  • Facial paralysis
  • And more

Although contagious, it’s important to note that it is the chickenpox virus that will be passed on from the person infected with shingles – not shingles itself.

Shingles typically displays as a rash of blisters that wrap around one side or the other of the upper body, with pain, burning, tingling, or numbness, sensitivity when touched, itching, and sometimes fatigue, headache, fever, and light sensitivity.

Additional risk factors, over and above being a senior, include taking certain prescription medications (prolonged use of steroids, for instance, as well as medications taken to ensure transplanted organs are not rejected), diseases such as HIV/AIDS and cancer, and any other condition or treatment that leads to a weakened immune system.

There is a silver lining in all of this, however! Two types of shingles vaccines are available and recommended for everyone age 60 and older: Zostavax and Shingrix. Talk with a doctor to determine which is right for your senior loved one, but the basic differences include:

  • Zostavax: A live vaccine that provides protection for five years, given as a single injection.
  • Shingrix: Often preferred over Zostavax, Shingrix is a nonliving vaccine that provides protection beyond the five-year mark. Shingrix requires two injections given six months apart.

Although neither vaccine provides 100% protection, the risk of contracting the disease is reduced, and if a vaccinated senior does develop shingles, it’s typically less severe and of a shorter duration, with fewer complications.

For more information about shingles or any other concerns of aging, contact the Scottsdale senior home care experts at Nightingale Homecare. Our nursing team is always on hand to help provide the resources seniors and their families need to optimize health and wellbeing, and our customized in-home care services ensure that older adults are living life to the fullest, each and every day.

Contact us at (602) 504-1555 to learn more or to schedule a complimentary in-home consultation and discover a better quality of life for a senior you love!

The Role of the Caregiver in Fall Prevention

Fall Prevention

Learn how a caregiver can help with fall prevention for seniors.

According to the Centers for Disease Control and Prevention (CDC), “Each year, one in every three adults age 65 and older will fall. Falls can lead to moderate to severe injuries, such as hip fractures and head trauma and can even increase the risk of early death.” The good news is that falls can be prevented!

With Nightingale’s falls prevention program, Paces, each of our patients is screened for fall risk at the time of admission to care. If the risk is significant, our professional clinicians work together to develop a customized fall reduction plan that addresses all of the unique factors that contribute to that patient’s risk. The family caregiver also plays a significant role in ensuring that his or her loved one is safe at home.   

There are many factors that increase the risk of falling. The more of these risk factors a person has, the higher the chance that he or she will fall. This is why the professional home health Scottsdale providers at  Nightingale Homecare perform a very detailed fall risk evaluation of each patient. We want to uncover every risk factor, so that we can discuss the risk with each patient and his or her caregivers and create the most successful fall prevention plan.

Some of the Factors That Can Increase the Risk of Falling

  • Problems walking or moving around, regardless of the cause
  • Weakness
  • Balance problems
  • Vision problems
  • Sensory problems, including lack of sensation in the feet (neuropathy)
  • Medications that cause drowsiness, dizziness or low blood pressure
  • Urinary urgency or incontinence
  • Uncontrolled pain
  • Wearing certain types of shoes
  • Low blood pressure
  • Problems with thinking, problem solving or decision making
  • Improper use of walkers, canes or other assistive devices
  • Not having the house set up to allow safe activities of daily living; for example, having to reach too high or stoop too low for frequently used items
  • Having cluttered stairways and walkways, poorly lit rooms, unsecure carpets, damaged floors and other issues within and outside the home

Caregiver Observations: Your Loved One

The following is a list of observations to watch for in your loved one while you are caring for him or her.

  • State of Mind
    • Is your loved one confused, anxious or depressed?
    • Does your loved one make decisions that jeopardize his/her safety?
  • Vision and Hearing
    • Is your loved one using glasses and/or hearing aids consistently and appropriately?
  • Strength, Mobility and Balance
    • Does your loved one get up safely?
    • Does your loved one lean on furniture and walls while walking?
    • Does your loved one wear long robes or other clothing that could be tripped on?
    • Is your loved one wearing safe footwear?
    • Does your loved one get dizzy or light-headed when getting up?
    • Does your loved one have to hurry to get to the bathroom to avoid having an “accident”?
    • Does your loved one move too quickly?
    • Does your loved one reach for objects that are too low or too high or seem to lose his/her balance when reaching?
    • Does your loved one have any new bruises, scrapes or skin tears?

Caregiver Observations: The Environment

Pay special attention to your loved one’s environment, and note the issues that may lead to a fall.

  • Is there enough light for your loved one to see effectively?
  • Is there anything on the floor your loved one could trip on?
    • Scatter rugs
    • Wires/electrical cords
    • Oxygen tubing
    • Furniture
    • Pets
    • Clutter
  • Are there uneven surfaces, loose tiles, torn carpet?
  • Is your loved one sitting on a firm chair that has arms?
  • Is your loved one using his/her walker/cane at all times and in a safe manner?
  • Does your loved one have frequently used items within reach in the kitchen, bedroom and bathroom?
  • Does your loved one have grab bars, non-skid bathmat and a shower/tub chair?

What to Do with Your Observations?

When you notice problems that will increase your loved one’s fall risk, there are things you can do immediately to help reduce the risk and keep your loved one safe in his or her home.

When problems are observed, take the following actions:

  • Notify your loved one’s physician about your concern
  • Remind your loved one to wear his/her glasses and hearing aids – make sure the glasses are clean and find out if the hearing aids work
  • Remind the person to do his/her exercises, and provide assistance
  • Remind the person to use assistive devices and show him/her how if reinforcement is needed (an occupational and physical therapist evaluation can help with this)
  • Remind your loved one about which footwear is safest and help him/her choose and apply the safest footwear
  • Remind your loved one of the risk for falling if clutter, cords or other trip hazards are visible; move these items out of the way
  • Remind your loved one that a sturdy chair with arms is safest for him/her to sit in; help the person select the safest chair available and make sure it is accessible
  • Consider an occupational therapist evaluation to determine any supplies that your loved one needs but does not have, such as incontinence products, non-skid slippers, non-skid bathmat, etc.
  • Report any changes in behavior, ability or status to your loved one’s physician immediately, including:
    • Eating habits
    • Changes in ability to move around
    • Increases in shortness of breath
    • Skin changes

At Nightingale Homecare, providers of the highest quality home health Scottsdale families trust, we’re always on hand to perform an in-home safety evaluation, to provide you with additional resources and recommendations to enhance safety, and to improve overall health and wellbeing with our personalized, professional home care services for seniors. Contact us at (602) 504-1555 any time to learn more!

Learn How to Prevent Financial Abuse in Seniors

at home care Scottsdale - prevent financial abuse

Prevent senior financial abuse with these tips.

Elder abuse is a serious problem in Arizona, affecting more than 14,000 elders every year. The elderly are at risk for many different kinds of abuse, but it is estimated that over 33% of all elder abuse cases involve financial abuse or financial exploitation.

Obviously, families have many concerns when they hire a caregiver to help vulnerable elders in their home. One of the biggest concerns is that the senior will be taken advantage of, or abused in some way. Many elders have both the desire and the financial means to remain living in their homes for as long as physically possible, which gives more opportunity for financial abuse by a devious caregiver.

One of the primary reasons that seniors and their families hire caregivers through an agency is to avoid hiring a caregiver with a criminal record and to provide the supervision and necessary oversight in order to keep their loved one safe. At Nightingale Homecare, each of our caregivers not only undergoes an extensive background check, but is screened for, and trained on understanding professional boundaries.

Whether you happen to hire a caregiver privately, or through an agency, there are things to be alert for in order to keep your elder loved one safe from financial exploitation.

Who Is at Risk?

Financial exploitation occurs when a person takes the assets of a vulnerable adult for his or her own personal benefit. This can occur with or without the knowledge of the vulnerable adult, depriving the person of his or her own financial resources.

Older adults may be vulnerable to financial exploitation for a number of reasons, including:

  • Having financial assets available and presumed unguarded by a malicious caregiver.
  • The elder individual’s often trusting nature, particularly with a caregiver.
  • Forgetfulness or cognitive impairment that keeps the senior from being aware that he or she is being financially abused.
  • Unhealthy dependence on a caregiver. This can lead to the elder offering things of value to the caregiver in order to win favor and keep the caregiver around.
  • Caregivers may be given or can create access to the elders’ assets, documents, or financial information, or be able to exercise significant influence over the elder person.
  • Social isolation, which shields the caregiver perpetrator from scrutiny and insulates the elder victim from those who can help.
  • Malicious caregivers intimidate and manipulate the elderly and convince them that they “owe” the caregiver money or property.

Signals of Financial Abuse 

Financial abuse can occur when a caregiver or other trusted individual steals from a senior. Often, these malicious individuals take advantage of their relationship with the elderly person to gain access to money and valuables. It can start with the caregiver accepting money for a meal, or other small item, then progress to forging signatures on checks or manipulating the elderly person into giving away money, property or other valuables to benefit the fraudulent caregiver at the expense of the senior.

A number of indicators can signal that an elderly person is the victim of financial abuse. Fraudulent caregivers will work hard to create the illusion to the family and the senior of earned trust and competence. Often, financial exploitation and other forms of elder abuse begin with boundary violations, so be on the alert for these early signals, and do not ignore them:

  • Missing money, medications or property.
  • The elder person giving gifts to the caregiver.
  • Caregiver accepting donations or payment for different causes, asking the elder to donate to schools, charities, Girl Scout cookies, etc.
  • Words or actions to the effect that the caregiver makes the older adult believe that he or she is special or lucky to be chosen by the caregiver to receive care.
  • The elder person’s unawareness of, or confusion about, recently completed financial transactions.
  • Caregiver taking money for a purchase that doesn’t arrive.
  • Unusual purchases for items that the elder has never made in the past.
  • More frequent use of credit cards, increased cash and ATM withdrawals, especially when the elder is accompanied by a caregiver.
  • Caregiver who claims to be “best friends” with the elder, particularly those who spend a lot of time, or take up residence, with the elder.
  • The elder person relies on a caregiver completely, to the exclusion of others.
  • Caregiver over-involved in the elder person’s life and lacks professional boundaries.
  • A promise of lifelong care by a caregiver may be accompanied by an expectation that the elder person’s funds will be transferred to the caregiver.
  • Suspicious or forged signatures on checks, credit cards or other documents.
  • The inclusion of additional names on an elder person’s credit card or bank signature card.
  • Legal documents or arrangements, such as powers of attorney, by the elder who is confused or who does not understand or remember the transaction.
  • Defensiveness or hostility by the caregiver when questioned about financial arrangements with your loved one.
  • An unwillingness by the caregiver to leave your loved one alone during appointments, or isolating the senior from family and friends.

Motivations and Characteristics of Caregiver Perpetrators

Certain tell-tale characteristics and motivations have been identified in the caregiver perpetrators who prey financially upon on the elderly. The more frequently identified motivations include substance abuse, mental health issues, gambling, or financial problems. These dysfunctional caregivers often have low self-esteem.

The caregiver perpetrator may be motivated by a sense that he or she should be further rewarded for caring for your loved one, or may conclude that your loved one has more assets than needed and the caregiver has too few, and thus the caregiver is entitled to a share of your loved one’s assets.

Older people, who may no longer place as great a value on their material possessions, may attempt to give gifts as a means of maintaining a power balance in their relationship with the caregiver. At the same time, the caregiver may indicate that such gifts are necessary if your loved one wishes to retain the caregiver’s attention and assistance.

Some devious caregivers will methodically identify their victims and accept a role as caregiver for this purpose. They will then establish power and control over the elder person in their care, and obtain the elder’s assets by using deceit, intimidation, and other forms of psychological abuse. Such individuals may have an antisocial personality disorder and have little regard for the rights of others.

The good news is, partnering with Nightingale Homecare for your senior care needs ensures that your loved one is safe from exploitation. Each member of our caregiving staff is thoroughly screened, background-checked, bonded and insured, as well as trained in all facets of appropriate in-home senior care. Contact us at (602) 504-1555 for the at home care Scottsdale families can trust.

Fostering Freedom: How to Help Seniors Stay Independent Throughout Aging

Sun City home health care

Discover how to help seniors stay independent and safe.

It’s a common struggle among family caregivers: deciding when to step in and help, and when to step back and allow an older loved one to accomplish as much as possible independently. It requires a delicate balancing act. On the one hand, we need to ensure safety is never compromised; yet on the other hand, we never want to do anything to damage a senior’s self-worth and self-esteem.

So the question becomes, how can we help seniors stay independent, while ensuring safety? The Sun City home health care experts at Nightingale Homecare have several key recommendations:

  1. Remember: You’re a team! Changing the mindset from working for a senior to working with a senior can make a world of difference in your approach. Talk with the older adult in an open and honest way about the challenges and concerns he or she is facing, and how you can best provide needed support. Naturally, these needs will change over time; and when cognitive issues come into play, communication strategies will need to be modified as well. But we all appreciate being asked for our input, and to know that value is placed on our feelings.
  2. Allow time before jumping in to help seniors. It may seem more efficient to take care of tasks yourself, but doing so may be at the expense of your loved one’s self-image. Instead, factor in plenty of extra time for tasks, allowing the senior ample opportunities to tackle them independently whenever possible.
  3. Focus on the senior’s strengths. If certain tasks prove to be too challenging for your loved one, shift the focus to those he or she is able to manage more easily. For instance, if preparing an entire meal is too difficult, ask the senior to manage creating her special dessert recipe while you work on the main course.
  4. Remind the senior that helpful workarounds are a positive. A senior may balk at the idea of using a walker or wheelchair initially, or in having grab bars installed in the bathroom. And many times older adults are resistant to the idea of needing someone to help with everyday activities that they’ve been managing their entire lives. Providing a reminder that assistance and home modifications are empowering, allowing the senior to accomplish more independently and to remain in the comfort of home throughout aging, can be beneficial.

At Nightingale Homecare, it’s our mission to deliver the highest quality in-home care help for seniors with the respect and dignity that allow for maximum independence and autonomy at all times. Never coming in and taking over, we work together with seniors and their families to develop a plan of care that addresses all needs – including those for personal freedom. Contact our Sun City home health care team at (602) 504-1555 to request a free in-home consultation and discover how we can improve life for a senior you love.