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home health physical therapyIf a loved one will be discharged from a hospital or other care facility and require home health services, there are some things to look into in advance.  Home health services typically include skilled nursing services and rehabilitation services such as physical therapy, occupational therapy or speech therapy. Generally, the person who needs the services will be referred to a specific home health provider by their doctor who determines what type of services they will require.

In terms of necessary preparations, doctors, social workers, discharge planners and other health care professionals are a tremendous resource for determining how to prepare.  There are many things to consider and once the person requiring care is at home, it may be more difficult to find the time to take care of these details.  Therefore, consulting with these experts in home health care in advance can be helpful and can help ensure that care is well coordinated with the home healthcare providers.

Some things to find out and address in advance are:

  • Are any special types of equipment or supplies needed?  Who orders them and when should they be delivered?
  • Should a medical alert system be ordered?
  • Is 24 hour care necessary?  Who can help provide coverage?  Is it necessary to find a separate home care agency to fill in any gaps in coverage?
  • Should a handicapped parking sticker be obtained?
  • Does the furniture need to be rearranged?  Will the person be able to use stairs and do accommodations need to be made if bedrooms and bathrooms are not on the main floor?
  • Do any home modifications need to be made such as allowing for wheelchair accessibility, ramps, handrails, or alarm systems to address potential wandering issues, etc.?
  • Are there any special dietary considerations that need to be addressed or supplies needed such as a food processer, blender, grinder or liquid thickener?
  • Are there any local programs that can assist with respite care or transportation, or should the senior be registered with any programs for seniors who may have issues with wandering due to dementia or other conditions?

By asking the right questions and preparing in advance, seniors can improve their recovery and be on their way to better health and quality of life.

senior home health malnutritionSenior home health experts indicate there are many factors that contribute to senior malnutrition.

It may be surprising to some, but senior malnutrition is a significant problem in the United States. Given that senior home health experts indicate that a lack of proper nutrition can lead to a weakened immune system, muscle weakness and a difficult time healing from wounds, identifying the causes of malnutrition and working to correct nutritional deficits is an important part of monitoring senior health.

Before determining how to identify seniors who may be suffering from malnutrition and how to intervene, it is important to consider the reasons why seniors may become malnourished. There is a tendency to assume that malnutrition is a problem that only low income seniors might face, but senior home health experts note that actually senior malnutrition is a far more complex issue and can be impacted by physical, social, emotional factors in addition to economic issues.

Physically, health issues – particularly dementia and dental health issues – can lead to decreased appetite or difficulty actually consuming food.  Other health issues identified by senior home health experts which can contribute to malnutrition include side effects of certain medications and conditions that prevent absorption of certain nutrients. In addition, food can become less appealing due to a decrease in the ability to taste or smell food due to certain medications or conditions, or the dietary restrictions in place to control certain medical conditions which require limiting the amounts of flavor enhancers like salt, fat and sugar in the diet. Alcoholism can affect nutrition as alcohol can interfere with digestion. Alcohol also presents a problem if non-nutritious calories from alcohol are consumed instead of nutritious foods.

Seniors who have found their social lives limited as they age may become more susceptible to malnutrition, especially if food was a social or family activity for them in the past, and they no longer have friends or family with whom to share daily meals.  Finding the energy to prepare meals only for themselves and facing the prospect of eating alone can impact how well a senior is eating, which can impact overall nutrition.

Some of these physical and social factors can impact seniors’ emotional health which can also factor into nutritional health.  Seniors who are depressed due to poor health, grief, loneliness, or isolation due to lack of mobility and few opportunities for social contact may find they do not have the appetite to eat the number of daily calories required to maintain adequate nutrition.  When they do eat, they are more likely to make unhealthy food choices.

Economic issues, of course, do play a significant role in malnutrition, when seniors may be inclined to make less healthy but cheaper choices when buying food due to living on a limited income.  Another significant economic factor is the cost of medications, where seniors may struggle to pay for expensive medications that cut into their grocery budget, forcing them to make difficult choices between medications and nutritious foods.

The complex causes of malnutrition can make it more difficult to identify it in senior adults.  Check back next week for the second part in this series on senior malnutrition, where senior home health experts will help identify ways to spot malnutrition in the senior population.

This is the first article in a series on senior malnutrition. The second article will offer information on how to spot malnutrition in seniors, and the final article will address recommendations from senior health experts on steps to take if malnutrition is suspected.

home healthcare agency nurseFor seniors who have a medical condition or recently suffered an injury, a home healthcare agency can mean the difference between staying in their own home for many years or having to turn to long term nursing home care.

The services offered by a home healthcare agency will vary depending on the specific home health provider.  Services offered may include occupational therapy, physical therapy, speech therapy and skilled nursing.  These services are provided on-site in the comfort of the senior’s own home.

Home health care is different from home care. Home health care is medical health care, whereas home care typically includes housekeeping, companionship and personal care assistance services to seniors. Many seniors who require home care assistance with cooking, cleaning or getting dressed do not require the specialized services of a home health care provider. In contrast to a home care agency that will provide services to seniors as they age or are simply in need of additional assistance, a home healthcare agency usually helps seniors recover from an illness or injury. Home healthcare agencies will generally have licensed practical nurses, occupational therapists, physical therapists, speech therapists or home health aides on staff.

Depending on the variety of services offered, a particular home healthcare agency may also offer services that are generally considered home care services, including assistance with bathing, dressing, eating and other activities of daily living.  Other home care type services that a home healthcare agency may offer include cooking, cleaning, housekeeping and medication monitoring.

If both home health and home care services are needed, it is important to determine if the agencies you are considering offer both services, or if two agencies will need to provide the different types of services.  Obtaining the right kind of assistance for a senior can help keep a senior in their home for many additional months, or even years, which usually leads to greater happiness and better health.

home heath care provider exerciseAccording to home health care provider experts, seniors should participate in mobility exercises on a regular basis.  A home health care provider can assist seniors with performing mobility exercises, which can lead to an improvement in overall functioning.

Mobility exercises should be part of every senior’s physical activity regimen.  Doing mobility exercises on a regular basis can help seniors maintain joint flexibility, decrease their risk of falling, reduce pain, increase self-confidence.  In addition, these exercises allow seniors to remain independent longer by enabling them to continue everyday activities that involve bending, lifting, walking and tasks like opening jars. Before beginning any exercise program, it is always best to check with a doctor or home health care provider about appropriate activities given the specifics of one’s health and mobility.

There are several different types of activities that can improve senior mobility.  Seniors may wish to consider the following:

Water Activities

Exercising in the water is a gentle form of exercise that is usually easier and less painful for people with joint pain or inflammation due to arthritis or fibromyalgia. Since water makes individuals naturally buoyant, there is less chance of falling, and weight and pressure is taken off the joints. If the water is warm, water exercise can improve blood circulation by dilating blood vessels and raising the senior’s body temperature.  The water level can be adjusted according to fitness level, with chest deep water offering a more strenuous work out than waist deep water.   Start by walking across the pool or around the perimeter, increasing repetitions as strength increases.

Chair Activities

Excising while seated in a chair can help mobility impaired or wheelchair bound seniors improve their mobility and can also be used as a warm up for individuals with greater mobility. In addition to activities done while seated, more able-bodied individuals can do exercises using the chair for balance or stability. Different types of chair exercises can be guided by specifically designed videos or TV programs, during classes for older adults provided at facilities like the YMCA, or by a home health care provider.

Stay Safe

It is important to be cautious when beginning an exercise program.  Begin gradually and increase the intensity and duration after building up stamina and skill. Dress in clothing that allows for unrestricted movement, with properly fitted shoes. Drink lots of water while exercising to avoid dehydration.  If exercising outside, beware of hazards like uneven surfaces, traffic, and obstacles like rocks and branches.  Make sure to exercise in a safe area and do not exercise outside if temperatures are extreme. In addition, all individuals – and particularly those with conditions including shortness of breath, irregular heartbeat or heart palpitations, rapid unexplained weight loss, blood clots, hernia, pneumonia or other infections, or joint inflammation or pain should consult with a doctor or home health care provider before beginning an exercise program.  In addition, seniors should use extreme caution while exercising and individuals who experience dizziness, nausea, sudden pain or break out in a cold sweat while exercising should stop immediately.

By integrating mobility exercises into seniors’ regular routines, senior adults can expect to see improvement in their mobility and overall quality of life.

Home Health Aide AssistanceAlthough there are many things to get done before having hip or knee surgery, an important aspect of getting ready is preparing the house where recovery will occur. Far in advance of going to the hospital for surgery, it is crucial to prepare the home to make recovery and life easier afterwards.

Consulting with a doctor, nurse, physical therapist or home health aide that knows the specifics of the individual’s situation and can make recommendations about home preparations in advance is critical.  Generally, there are a number of important preparations to consider:

Accessibility:

If possible, plan to have everything needed for recovery on the same floor.  While it is preferable not to use stairs at all initially, their use will need to be limited to once a day if they cannot be avoided entirely. In addition:

  • The bed used during recovery should have a firm mattress and be low enough that one’s feet touch the floor while sitting on the edge of the bed. Ideally, the bed will be on the first floor of the house.
  • A bathroom or a portable commode should be located on the same floor where most of the day will be spent.
  • Food and other supplies should be in a cupboard between waist and shoulder level.
  • Phone and charger should be easily accessible.
  • Frequently used items should be placed on the kitchen counter or another location that is between waist and shoulder level.
  • Chairs with a firm back should be located in each frequently used room, including kitchen, bedroom and bathroom, to enable sitting while doing daily tasks.

Supplies

There should be sufficient supplies at home to last several weeks, or as long as the doctor recommends.  In addition to regular supplies, there may be other items to consider purchasing with can be particularly helpful during recovery.  Items to consider include:

  • Canned or frozen food
  • Shampoo, toilet paper and other personal items
  • Medications
  • Crutches, a cane or a walker
  • A shower sponge with a long handle
  • A long-handled shoehorn
  • A sock aid to help put on socks
  • A reacher to help pick up things from the floor and assist with putting on pants and taking off socks

Bathroom Preparation

The bathroom presents many hazards so it is important to consider the following preparations:

  • Raised Toilet Seat: There are several ways to raise the toilet seat to help prevent excessive flexing of the knee.  Options include adding a seat cover or an elevated toilet seat, utilizing a toilet safety frame or using a commode chair instead of a toilet.
  • Safety Mats: Non-slip suction mats or rubber silicone decals should be put on the floor of the tub to help prevent falls.  A non-skid bath mat should also be placed outside the tub.
  • Bath or Shower Chair: A bath or shower chair with rubber tips on the bottom should be used for bathing. A seat without arms should be used in a bathtub.
  • Safety Bars: The doctor may recommend installing safety grab bars in the bathroom.  It is important to remember that towel racks cannot substitute as grab bars as they are not designed to withstand the weight of a person.
  • Placement of Essential Items: Items like soap and shampoo should be easily accessible and should not require twisting, standing up or straining to reach.  Towels and wash cloths should also be within easy reach.

Home Safety Preparation

To minimize the risk of tripping the following precautions should be taken:

  • Remove loose wires or cords in walking areas.
  • Remove loose throw rugs.
  • Fix any uneven flooring, especially in doorways.
  • Make sure there is good lighting in place.
  • Place night lights in hallways, bathrooms and other dark rooms.
  • Arrange for fast-moving or small pets that can cause falls to stay elsewhere during the first few weeks.

Other preparation

Other preparations to consider are:

  • Prepare or purchase single serving meals that can be frozen and reheated later.
  • If a health care professional recommends using a walker, attach a small basket or strong bag to it to hold important items such as a cell phone, notepad, pen, eyeglasses etc. Alternatively, a fanny pack may be used.  Nothing should be carried in one’s hands when walking after surgery as they may be needed to provide balance.
  • Practice using a cane, walker, crutches, or a wheelchair to correctly sit down to use the toilet and stand up afterwards, get in and out of the shower, use the shower chair and go up and down stairs.

Arrange for Home Care Assistance during Recovery

Unless someone lives at home and can help for the first 1 or 2 weeks after surgery, it is important to arrange to have someone come in who can assist with bathing, using the toilet, cooking, running errands, shopping, doctor visits, and exercising as needed. If a family member or friend cannot help, a health care professional may recommend having a trained caregiver or home health aide come to the home to help.  A home health aide or trained caregiver can also check the safety of the home and help with daily activities.