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June 2009 Your Partners in Home Care Volume 2, Issue 2
In This Issue HCP Update Medicine Use and Older Adults
HCP Profile Neil Alfeche, PTA
Article of the Month Our Patients Are People Who Have Much to Teach Us
Mental Health Managing Caregiver Stress Successfully
A Note from Melanie West MBA, MT (ASCP)
Administrator/COO
Technology Improves the Care Rendered in Home Medical Visits
Beware of Burning Feet
Suggested Reading Thank You Quick Links Contact Us!
Email us
Linda Jones, RN
CEOJulianne Stroud
Director of EducationMedical Social Work Manager
Medical Director
Dear Friends & Relations, Health Care Partners is very happy and glad to be part of the world’s cures with you! We are proud of our Telehealth and Anodyne Therapy services which are helping to decrease re-hospitalization and relieve pain. We have launched our Electronic Medical Record Software last fall ahead of much of the country, our talented IT department deserves waves of applause for their impressive dedication and commitment to implementation, training, and utilization.
As we age we will experience first hand the truth of some of the comments we’ve been hearing from many of our clients and patients regarding old age: Find out about age related changes and medications; not all seniors love being wired to the Internet, but those that do, will never turn back; burning feet is a newly recognized disorder affecting the elderly. How do family caregivers manage stress? They need to pay close attention and act on the philosophies of The National Family Caregivers Association, read below.
Health Care Partners is here for you whenever you need any information pertaining to home health care and community resources. Enjoy!
Joyfully,
Linda Jones, RN
Owner, Health Care Partners, Inc.
HCP Update: MEDICINE USE AND OLDER ADULTS
by Julianne Stroud, RN, Director of Education Older adults are at increased risk of serious adverse drug events for a number of reasons: age-related physiological changes, use of multiple medicines, drug interactions, inappropriate prescribing and monitoring of drug therapy.
Medicines (Prescription and OTCs), dietary supplements, herbal remedies and certain foods can interfere with one another and, in turn, heighten or reduce the intended effect/purpose of the drug(s). For example, Warfarin, a blood thinner to prevent blood clots, in combination with aspirin, ibuprofen or other NSAIDS greatly increases the risk of serious gastrointestinal problems. Supplements such as iron and calcium, can interfere with thyroid medicine.
Age related changes can impact how a drug works in the body, for example, reductions in liver and kidney function can affect the way a drug is broken down and removed from the body; this means medications may stay in the body longer and cause more severe side effects if doses are not properly adjusted. Certain ingredients found in some OTC sleep aids and cold and allergy medicines are typically well-tolerated in younger people, but can cause falls and confusion in older adults in whom the drug’s sedative properties can circulate longer. Declines in body weight, loss of body fluid and more fatty tissue can alter the way drugs are distributed and concentrated in the body. Age related changes include increased sensitivity to many drugs, especially those targeting the central nervous system.
Older adults may not adhere to drug regimens (also called nonadherence) due to forgetfulness or decisions to limit medication(s) due to bothersome side effects, perceived non-efficacy, or cost. Up to 40% of older patients who decide to skip doses or stop taking their medicine do not tell their provider. One-third of patients, and many with three or more chronic conditions, have not talked with their provider about all of their medications within the last year.
Nearly half of all American adults – 90 million people – have difficulty understanding and acting on health information. Almost 40% of seniors are unable to read prescription labels; 76% are unable to understand information given to them.
Those who cut back on prescribed medications because of cost are 76% more likely to have a significant decline in overall health than those who take their medications as prescribed. Source: www.mustforseniors.org
For a complete listing of drugs that are best avoided in older patients, visit http://www.dcri.duke.edu/ccge/curtis/beers.html.
WIRED SENIORS
Adapted from The Pew Internet & American Life Project and SeniorNet
by Jane Cortez, Executive Administrative Assistant
-47% of Americans 65 and older use the Internet, the number of seniors online jumped by 67% between 2000 and 2004.
-More than 50 million U.S. adults over the age of 50 have Internet access, and this number continues to grow rapidly.
-Women outnumber men but more senior men than senior women use the Internet.
-Nearly 3 in 5 online senior citizens (56%) say that the Internet has improved their connections with family.
-Wired seniors are devoted Internet users – 69% of wired seniors go online on a typical day, compared to 56% of all Internet users.
-The top Internet activities among seniors who go online: 93% of wired seniors have used email; 58% have gotten hobby information online; 55% have read the news online; 53% have searched for health and medical information online; 53% have browsed the Web “just for fun”; and 53% have checked weather updates.
-68% of wired seniors say they would miss the Internet if they could no longer use it.
Email is the #1 draw for seniors. Seniors have fallen in love with email as much as any other group of Internet users. On any given day millions of seniors are using email; email is popular with every group of seniors – men, women, those with advanced educations and those with a high school education only. Hobbies. The second most popular online activity among seniors is seeking out information on hobbies. Health. Since senior citizens are more likely to suffer health problems many wired seniors search the Web for medical advice and health information. According to a study in the Proceedings of the National Academy of Sciences, health education is one of the factors that have decreased the number of senior citizens who are chronically disabled and require nursing-home care. Seeking health information is one of three activities in which online senior women outdo the men (58% vs. 51%). Neither income level nor educational attainment makes much difference in whether or not seniors seek out health information.
HCP Profile: Mr. Neil Alfeche, Physical Therapy Assistant
Name: Leonilo Alfeche, PTA
Born: Cebu, Philippines
Childhood Dream: To be a pilot. I went to Aeronautical School and became an Aeronautical Engineer. PT is my second degree. I flew for the Air Force for 6 years. The rigid training helped with my work in Physical Therapy.
Graduated: 1998 from Professional Skills Institute, Ohio, as a Physical Therapy Assistant.
Joined HCP: I've been with HCP since its inception in 2000.
Passion: Aside from flying, tinkering with machines and home remodeling.
Greatest job demand: Doing therapy with the geriatric population requires time and patience. If you don’t have them then you are in the wrong field and especially without them you won’t achieve your set outcomes, so you must have patience and take your time.
Greatest impact in your life: Seeing good results when outcomes are really good, that impacts me and makes me do more than what I thought I could do.
Greatest invention ever: Electricity, it powers everything.
What makes your heart soar? Simple things like knowing everything is working like I want it to; free time; going on vacation with family even for a weekend outing.
Telephone: 248-358-1186, ext. 638
OUR PATIENTS ARE PEOPLE WHO HAVE MUCH TO TEACH US
by Tom Barbas, Spiritual Care
For many years I have learned much from the many seniors I have visited. Recently, the lesson came from a man we’ll call Rocky. After trauma to the brain, Rocky was left partially paralyzed and unable to speak, only grunt. Despite his impairment, he’s as alert and as sharp as anyone ever, and what a sunny outlook!
He’s an active part of our discussion group, even though he can only shake his head “no” or nod and grin “yes”. Somehow the rest of us manage to build our conversations to include many yes(s) and no(s), and Rocky cheerfully participates, knowing that he has an active part.
The lesson to me is that someone who has such a “handicap” CAN CHOOSE to be so much alive. That’s the point: HE CHOOSES to be bright and cheerful and involved.
What’s more, as a special bonus, every group conversation which includes Rocky ends with a miracle.
Yes, a miracle. We always sing “God Bless America” when we close. He joins in with a beautiful voice and a clear pronunciation of every word of the song. That’s right: A CLEAR PRONUNCIATION OF EVERY WORD IN THE SONG. Rocky can’t utter a single understandable word when he speaks, but he can clearly and distinctly sing many, many songs. How can that be? Who knows? Am I inspired by him? You bet.
Email: tombarbas@aol.com
MANAGING CAREGIVER STRESS SUCCESSFULLY
by Joanne Corbo Cruz, MSW, LMSW
There are over 54 million family caregivers in the United States, 40% are women. Caregiving costs $357 billion nationwide in “free” services. Family caregivers are their loved one’s greatest dependence. It is crucial that family caregivers take care of themselves so that they don’t become sick or injured.
Successful family caregiving is not simple but the National Family Caregivers Association encompasses and succinctly delivers 4 very powerful messages to family caregivers:
-Believe in yourself -Protect your health
-Reach out for help -Speak up for your rights
The first philosophy simply states that having the confidence that you are able to do this job is an essential element. The attitude of “I can do this” helps set the stage for future challenges.
The second philosophy which is to protect one’s health is also very important. It is not unusual for a caregiver to sometimes have more medication than the loved one they are caring for; taking the time to see their physician for regular check ups; taking medications as prescribed and making sure to take respite is immeasurably essential in alleviating caregiver burnout and breakdown.
The third philosophy is to reach out for help. Caregiving is never meant to be a “solo job” and if possible should never be done alone -- just imagine the emotional and physical isolation! Ask for help -- ask for specific help -- as in picking up prescriptions, sit with my mom from 2:00 until 4:00 next Tuesday. Delegation of small tasks does wonders to help reduce stress levels.
The fourth philosophy is to speak up for your rights. NFCA stresses that you arm yourself with the necessary information about your loved one’s diagnosis and treatment options. Knowing this information allows you to advocate for quality healthcare.
Technology Improves the Care Rendered in Home Medical Visits
by Melanie West, MBA, MT (ASCP)
Administrator/Chief Operating Officer
The miniaturization trend in society today contributes to using more medical equipment in the home to improve care. Small items such as cell phones and laptops allow us to carry more equipment with us and use our time more efficiently. Medical equipment manufacturers are following this trend with electrocardiogram (ECG) units and x-ray units that can be brought to someone’s home.
Health Care Partners is also following this miniature technology trend. The nurses bring a small device into the home to measure the effectiveness of blood thinning medication called Coumadin, also known as Warfarin. With just a finger stick, the nurses can test someone’s blood during the home visit and save the patient a trip to the laboratory. This is very important when the doctors usually like the test to be done every two weeks to monitor the medication levels.
Our physical therapists have medical equipment for therapy treatment in the home. One unit is for Anodyne Therapy and another unit is for electronic stimulation of the muscles. This equipment helps to increase the blood flow to an injured area of the body. The blood brings oxygen and nutrients that help the healing process.
More treatment can be done in the home now because of improved technology. By using this medical equipment in the home for homebound seniors and the disabled, we bring medical care to chronically ill people who may otherwise not get the care they deserve.
Information Technology and Information Systems
Health Care Partners clinical staff uses an electronic medical record to complete their visit notes. Information is typed into a small laptop computer and the data is sent wirelessly to the main computer in the office to complete the medical record. Tight security measures are in place keeping patient medical information confidential.
The Information Technology (IT) Department supports the hardware and the software to help us improve the efficiency and productivity of the nurses, therapists, social workers, and administrative staff. Data is backed up on the server every night in case of an electrical failure or emergency. We have frequent training sessions so everyone can learn how to use these new tools.
BEWARE OF BURNING FEET
A newly recognized disorder affecting the elderly can be a serious problem.
by Pedro V. Caing, MD
Medical Director, Health Care Partners, Inc.
Dr. Pedro V. Caing is the Medical Director of Health Care Partners, Inc. He is an active staff member of Oakwood Hospital in Dearborn, Michigan, maintains a private practice in Internal Medicine at 3735 Monroe Street, Dearborn, MI 48124. telephone: 313-277-6560, email caing62740@comcast.net.
An estimated 15 million people in the United States past age forty experiences some kind of discomfort in the lower extremities consisting of pain, burning, tingling and numbness.
The most bothersome sensation is burning pain in the feet often accompanied by stabbing electric shock-like/pins and needles sensation or cramping in the feet and calves. Patients sometimes describe the feeling as if they are walking on pebbles, sand or golf balls. The feet can feel exquisitely painful; they cannot bear the bed sheets touching the skin.
These symptoms are mild initially but get worse especially at night typically interrupting sleep. Oftentimes the disorder is mistaken for poor circulation, a pinched nerve in the spine or inflammation of the tendons and fascia. Because the large and medium size nerve fibers are not affected, results of neurologic exams and diagnostic tests appear normal.
The underlying problem, known as small nerve fiber neuropathy can be identified with certainty by a simple skin biopsy. This disease has been associated with medical conditions, most commonly diabetes mellitus, Vitamin B12 deficiency, AIDS, hepatitis C infection, autoimmune diseases and thyroid disorders. It is also seen in Celiac sprue disease (intestinal malabsorption caused by intolerance to gluten, the protein in wheat and rye), restless leg syndrome and the deadly cancer of the lungs and kidneys. Hereditary causes of small fiber neuropathy are rare.
Once the diagnosis is established on skin biopsy, the doctor will order a battery of tests to find the underlying cause after which the appropriate treatment is started; most patients will require chronic pain management. It is predicted that the prevalence of small fiber neuropathy will rise with the development of metabolic disorders and malignancies associated with the aging population.
A team of well trained nurses, dietitians, physical therapists and caregivers at Health Care Partners will work closely with the doctor to ensure optimum treatment modality compliance. These professionals will provide dietary education and make certain that medications are properly taken. They will monitor clinical progress and watch for adverse effects should any arise during the course of treatment. Trust them with your care and tell your doctor to ask for their services.
The physical and psycho-social benefits of skilled touch for the confined elderly and ill are elucidated, providing the reader with a greater understanding of how to use touch as a tool to communicate with individuals living with Alzheimers and other types of dementia. Massage therapy students, doctors, nurses, nursing home and extended care facility workers, chaplains, social workers, grief counselors, and all volunteer and family caregivers will benefit from this physical, emotional, and spiritual guide to hands-on comfort and healing.
"Here are the tools for geriatric care and utterly transforming the experience of aging."
Deane Juhan —author, Job's Body
"A treasure that every caregiver and health professional should read."
Dr. Bernie Siegel —author, Love, Medicine and Miracles
"To be the recognized standard home health care organization that exceeds the expectations of our patients and clients, by utilizing skill, knowledge and expert resources; to provide homecare that is meaningful, safe and respectful."
Thank You... to all of our referring physicians, nurses, social workers, rehab staff and office staff for providing excellent care to our patients -- Health Care Partners continues to provide compassionate quality care to all of our patients and communicates their progress to all of our referring physicians!
Quick Links www.healthcarepartnersinc.com www.professionalparentcare.com www.thefamilycaregiver.org www.healingdoc.com www.senioroptionsmi.com www.banananose.com http://groups.google.com//MIfamilycaregivers
Contact Us For more helpful information, contact Health Care Partners, Inc.
Health Care Partners, Inc.
18000 W. Nine Mile Rd. Suite 400
Southfield, MI 48075Phone: 248-358-1186
Fax: 248-784-3919
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The Health Care Partners e-news team Douglas Jones Jane Cortez Arnel Doreza email Doug email Jane email Arnel
