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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.

The Changing Face of Parkinson’s Disease

Parkinson's Disease - respite care sun city az

Discover the 5 stages of Parkinson’s disease and the changes that may occur in each from the Phoenix senior care team at Nightingale Homecare.

According to the Parkinson’s Foundation, the number of Americans diagnosed with Parkinson’s disease is predicted to cross the one million mark by next year – impacting more than those with MS, muscular dystrophy, and Lou Gehrig’s disease combined. In fact, there are already more than ten million people with the disease worldwide.

As such, it’s likely that most of us either already are or will be closely acquainted with someone managing the disease; so it’s important for all of us to better understand how the disease progresses, and what changes might be encountered in each stage. Our Phoenix senior care team has the information you need:

Stage 1

In the beginning stage of Parkinson’s disease, patients typically begin to experience mild tremors on one side of the body, as well as barely perceptible changes to posture, ambulation, and/or facial expressions.

Stage 2

As the disease begins to progress to Stage 2, tremors may become apparent on both sides of the body, along with rigidity and more noticeable changes to posture and ambulation. During this phase, patients can usually still manage daily life independently, although with a bit more difficulty.

Stage 3

Balance and coordination issues are common in this stage, leading to slowed movements and increased risk of falls. Activities of daily living (ADLs) such as getting dressed and eating may require a little assistance – or may simply take more time to complete independently.

Stage 4 

In the fourth stage of the disease, there is a markedly greater level of impairment, and many daily tasks will require assistance, including help with walking and other forms of movement.

Stage 5

In the fifth and final stage of Parkinson’s disease, many patients will need a wheelchair for mobility, as impairment of motor skills advances and there is increased difficulty with standing, walking, and managing daily activities. Hallucinations are also common in this stage.

If you or a senior loved one is managing the effects of Parkinson’s disease, our Phoenix senior care team is on hand to help with personalized services adapted to meet needs both now and as the disease progresses in the future.

Our Journeys Parkinson’s and Movement Disorder program is staffed by BIG and LOUD certified therapists with specialized expertise in improving quality of life for those challenged by movement difficulties such as those experienced in Parkinson’s disease.

  • Our BIG program utilizes a proven exercise approach in which patients learn techniques to make bigger movements that lead to more normalized movement patterns; and
  • Our LOUD program helps patients improve quality and volume of speech, leading to more confident and effective conversation abilities and socialization.

We also work with Parkinson’s patients to improve swallowing, facial muscle control, balance, fine motor skills, fall prevention, and much more.

Contact Nightingale Homecare, the best providers of respite care Sun City, AZ and the surrounding areas depend on for quality care, any time at (602) 504-1555 to learn more about our specialty Parkinson’s care program, or any of our other in-home senior care services.

Eating Challenges with Alzheimer’s and Dementia

Phoenix, AZ home care

Overcome the challenges of getting proper nutrition with dementia with these tips.

Alzheimer’s and dementia often present numerous eating challenges. Regular, nutritious meals are important to maintain, as poor nutrition and eating habits can aggravate confusion and lead to physical decline. These tips will help you understand what causes eating challenges in your loved one with Alzheimer’s/dementia, and how you can encourage good nutrition in each stage of the disease.

In the early stages of Alzheimer’s/dementia, your loved one may forget to eat and lose the skill needed to plan for and prepare nutritious meals. As the disease progresses, your loved one may experience a diminished sense of smell and taste, which can cause a loss of interest in eating. Your loved one may also lose the ability to effectively use utensils necessary to eat. Agitation and distraction may affect mealtime greatly, so it will be important to plan for a distraction-free and consistent mealtime. In the later stages of the disease, your loved one will experience difficulty chewing and swallowing, which will challenge your ability to ensure proper nutrition.

Tips to Improve Nutrition

  • Maintain familiar routines.
  • Don’t rush mealtime.
  • Don’t worry about messes!
  • Offer favorite foods and drinks.
  • Check food temperature before offering.
  • Offer vegetables, fruits, whole grains and lean proteins.
  • Cut down on refined sugars, high saturated fats, high salt and cholesterol.
  • Provide foods that are calorie-dense and dementia-friendly: peanut butter sandwiches, milkshakes with added protein supplement, pudding cups, ice cream, pureed fruit and sweetened yogurt.
  • Keep distractions to a minimum; use a soothing voice and turn off the TV and cell phones. Calming music may be helpful.
  • Be sure your loved one is in a seated position at 90 degrees to prevent choking.
  • Serve meals on bright, solid-colored dishes. A color contrast between the tableware or placemat and the dinnerware serves as a visual cue for self-feeding.
  • Your loved one may need assistance at meals to increase caloric intake. If she says that she does not want to eat more, allow her to rest, and then try to get her to eat more with your assistance.
  • Be mindful of textures that she is most responsive to.
  • Place a beverage directly in front of your loved one, not off to the side.
  • Be sure dentures are in place for all meals and secure with denture adhesive if necessary. If your loved one is refusing to wear his or her dentures, it may be dental issues or it may be necessary to modify the diet.
  • Bowls are easier than plates. Spoons are easier than forks.
  • Bowls with suction cups are helpful.
  • Use straws or lidded cups for liquids.
  • Offer one or two types of food at a time, in small portions.
  • Offer three meals and snacks, or smaller meals throughout the day.
  • Provide the major caloric meal early in the day.
  • Add butter, syrup and dipping sauces to increase calories.
  • Offer foods that are easy to chew and swallow. Avoid popcorn, nuts, raw vegetables and other foods that are difficult to chew.
  • Remind your loved one to thoroughly chew and swallow carefully throughout the meal.
  • Cut food into bite-sized portions. Finger foods are even easier: pieces of fruit, cheese, crackers and other snacks.
  • Eating your meal with your loved one often improves intake.
  • Your loved one’s physician may add supplements if weight loss and nutrition are a problem. You may consider adding an instant breakfast drink mixed with ice cream.

Staying Hydrated

Staying hydrated can be one of the bigger challenges in your loved one with Alzheimer’s/dementia. Offering small cups of water and fluids throughout the day is very important. Be sure adequate amounts of liquids are consumed at meals. Generally, your loved one may not request something to drink—you need to provide it to her. A health shake between meals may be a way to hydrate her as well as provide added calories. Offer other foods with high water content, such as fruit, soups and smoothies. It may be necessary to offer fluids every two hours to maintain hydration.

Watching for signs of dehydration will be imperative in maintaining your loved one’s overall health: 

  • Weight loss of two pounds or more in a 24-hour period
  • Increased confusion
  • Dizziness or headaches
  • Dry mouth
  • Sunken eyes
  • Inability to sweat or produce tears
  • Rapid heart rate
  • Low blood pressure

Staying Alert for Swallowing Difficulty

“Dysphagia,” or difficulty swallowing, often occurs in the late stages of Alzheimer’s disease when the patient loses the gag reflex and has decreased levels of consciousness. Ensure that your loved one is sitting up straight with her head slightly forward when eating. At the end of every meal, be sure and check your loved one’s mouth to ensure that all food has been chewed and swallowed. Aspiration pneumonia is a leading cause of death in those with Alzheimer’s, so it is critical you watch for the signs of dysphagia and refer to a speech therapist when you notice these signs:

  • Coughing or choking at meals
  • Wet vocal quality during or after meals
  • Decrease in the amount of food eaten
  • Increasing time and effort spent at mealtime
  • Food, liquids or saliva leaking out of the mouth
  • ‘Cheeking,’ or holding foods in the mouth instead of swallowing them
  • Spitting out food
  • Difficulty swallowing medications
  • Unexplained weight loss
  • Excessive drooling
  • Eating too fast, or cramming food into the mouth
  • Extended chewing before swallowing
  • Clearing throat frequently during a meal
  • Dehydration
  • Chest congestion
  • Aspiration pneumonia

Combating Swallowing Challenges

Using all of the techniques mentioned above will help combat swallowing challenges in your loved one. In the later stages, offering pureed foods and a soft diet will help aid in swallowing. Using a commercial thickener like “Thick-It” in thin liquids may also be recommended for your loved one with swallowing challenges. Thickened liquids won’t trickle down the throat as readily as thin liquids and are less likely to cause coughing, choking and aspiration. Your loved one’s physician, speech therapist or nurse will recommend the thickness necessary, depending upon the patient’s ability to chew and swallow. If your loved one is on thickened liquids, then ALL liquids provided must be thickened to the recommended consistency.

The clinician will recommend the minimal level of thickness needed for swallowing safety. As with anything, there are benefits to these thickening agents, but there are also risks. These preparations don’t work for everyone, and in some cases, they can lead to dehydration. They may also reduce the effectiveness of medications when taken together with the thickening agent.

Things to be Alert to When Feeding Your Loved One

In the later stages of the disease, it may become necessary for you to feed your loved one in order to maintain safety and nutrition. When it comes to this, be sure to follow the above pointers on eating and maintain a relaxed, comfortable environment, sticking to a routine. It will be very important for you to take your time with feeding, to avoid choking and agitation. Never rush your loved one when it comes to feeding.

Follow these additional pointers to ensure feeding success!

  • Be sure that the last bite has been swallowed before the next is provided.
  • Give only small bites of food on a spoon.
  • You may need to be prepared to give the next bite after your loved one swallows the last bite, to maintain her interest in eating.
  • If your loved one has difficulty opening her mouth for food entry, you may brush a spoon against the lips, to aid in opening her mouth.
  • You may gently brush her cheeks and neck to encourage swallowing.
  • Place food well into the mouth to assist with chewing.
  • Frequent cueing may be necessary, i.e.: “Open your mouth, chew the food, and now swallow.”
  • Alternating liquids with solids may assist with swallowing each bite.
  • Check for pocketing. Food must be cleared before adding the next bite.
  • It’s best to end with liquids.

For more helpful resources to assist in caring for a loved one with Alzheimer’s, or to learn more about our highly specialized Connections Dementia Care Program, contact the Phoenix, AZ home care experts at Nightingale Homecare at (602) 504-1555.