Challenges and Special Circumstances For Care

NO two home bound seniors are exactly alike. Each person presents a unique set of challenges and issues. However, there are a few problem areas that are common. This post will looks at a few of these challenges and offers suggestions for working in a positive ways toward the resolution of the problem.

Lack of Mobility/Deconditioning

Most home bound seniors have some level of mobility. Some get around by doing a "furniture walk," or holding onto furniture for support as they move around their homes. Others use a walker, a cane, or sometimes a pair of crutches. Some home bound seniors are less mobile, and use either a wheelchair or a scooter to get around.

Some of these less mobile seniors can move themselves (transfer) from the wheelchair to the toilet or the bed. Others need the help of one or more caregivers to assist them. Finally, a significant number of people confined to the home are also confined to the bed and require a mechanical lift for transfers.

Seniors who are unable to move their arms and legs easily are likely to experience wasting and weakness of the muscles. This is called of "deconditioning." Deconditioning is sometimes the natural result a disease process, such as muscular dystrophy, and will occur no matter what the caregiver does. Other times, deconditioning can be slowed or prevented by assisting the individual with simple exercises.

Bedsores (Decubitus Ulcers, Pressure Ulcers)

Bed or pressure sores are serious problems for seniors who are bed bound. They grow quickly and can even lead to death if not treated promptly. Bed sores occur when a person with limited experiences damage to the skin and the underlying mobility tissue due to pressure. Pressure sores usually occur in places on the body where the weight rests against a mattress or other surface, such as the seat of a chair or wheelchair. For instance, pressure sores are common on the bottom and on the heels.

Some people, especially those who are severely deconditioned and malnourished—will get bedsores no matter what the caregiver does. However, there are several steps that a caregiver can take to reduce the likelihood of bedsores.

Checking the Skin

Whenever you help, bathe or dress your loved one, carefully check over the skin for red areas or places where the skin appears scabbed over or there are open wounds. Report any of these to your doctor.

Repositioning

Repositioning means helping a bed or chair bound positions every one to two hours. This is accomplished by moving person shift the person from the left to the right side. Pillows can be use for support and to help hold the position. If the senior is in a wheelchair, you can reposition them slightly by having them shift their weight from one buttock to the other using the pillows for support. Because sitting places more pressure on tailbone than lying down, the person in a wheelchair should spend at least part of the day in bed.

Keep the Skin Clean

If your loved one is incontinent, be sure to wash and dry the genital area, the area between the thighs, and their bottom after each episode of incontinence. There are some products that act as a barrier between the skin and moisture and you should consider using one of these. Seniors with urinary incontinence can sometimes avoid bedsores by using an indwelling catheter. Again, this is a decision you should make with your doctor.

"Float" the heels

If the skin on the heels is breaking down, encourage your loved one to lie on their side. If they are unable or unwilling to do so, place a couple of pillows under their calves to elevate their feet off the mattress.

Change Mattresses

Some mattresses, such as low air loss mattresses or egg crate mattresses, reduce the risk of bedsores. These mattresses are provided by medical supply stores and usually require a doctor's order. Medicare will cover the cost of a special mattress in many cases. Some private insurance companies also will pay for these special mattresses.

Maintain Good Nutrition

By adding protein to the diet with special shakes like Ensure or Boost, you can help avoid bedsores. Caregivers should also encourage foods high in protein, like lean meats, fish, peanut butter, cheese, most types of beans, and eggs. Any of these diet changes will help seniors avoid bedsores.

Falls

Falls happen in many ways. A senior who is able to walk, although unsteadily, might slip on a slick floor or trip over a small object or simply lose their balance. If your loved one has severe osteoporosis, their hip might break simply from the weight of the body (this is called a pathological fracture), leading to a tumble. A senior who is confined to a wheelchair or to bed might fall when leaning over to reach for something on the floor or on a nearby table. Some seniors with dementia become confused and try to stand up on their own, believing they can walk.

Most falls can happen in the blink of an eye. Although they can and do occur while the caregiver is out of the house or in another room, many occur right in front of the caregiver, who feels powerless to stop them. Even though falls are not 100% preventable, there are some things you can do to decrease their likelihood. There are also some steps you can take to minimize the damage if a fall does occur.

Keep Walkways Clear

If you have children in the house, make sure they don't leave toys or objects on the floor. Other items that can cause falls include clothes or towels on the floor, accent rugs, and electrical power cords stretched across a hallway or doorway. Always Wipe up spills immediately to avoid slips on a wet surface.

Use Assisted Devices

If the doctor recommends that your loved one get around With a walker or cane, make sure they use it.

Install handrails to reduce the risk of falls while toileting or bathing

Handrails are available at most pharmacies, medical equipment and discount stores. They are easy to install or can be installed through a local contractor or medical supply store.

Check clothing and shoes

Avoid such clothing as long bathrobes that drag on the ground and get caught under feet. Shoes and slippers should fit comfortably and have non-skid soles. Discourage walking around barefoot.

Keep things close at hand

Keep items your loved one uses frequently, like a glass of water, the television remote control, a bell to summon you, and a box of tissues right beside the bed or chair within easy reach.

Consider getting a tray table for the wheelchair

This will prevent your loved one from standing up or leaning out of the chair. Because it is a type of restraint, however, you'll want to discuss the pros and cons of using one with your doctor.

Talk to your doctor about bedrails

Like a tray table, bedrails are considered a form of restraint. If your loved one is determined to climb out of bed, bedrails can actually cause injury if they get tangled or fall. Other options include concave mattresses, which have sides that curve upward to prevent rolling out of bed, and bolster overlays, which provide soft barriers to discourage the your loved one from getting up on their own.

Purchase a bed or chair alarm

There are two kinds of alarms. One senses pressure and alerts if the pressure is removed (i.e., if your loved one gets up). The other is a two part alarm. One part is safety-pinned to clothing and the other part is attached to the chair orb ed. The two parts are then connected by a magnet. If your loved one stands up, he breaks the magnetic connection and a loud alarm sounds.

As mentioned above, in spite of your best efforts, your loved one may still fall. There are a few things you can do to lessen the risk of injury.

Lower your loved one to the ground

If you observe a fall, don't try to stop it from happening. If you do, you're likely to get injured, too. Instead, grab your loved one under the arms or by the gait belt and gently lower them to the floor. Don't hesitate to call 911 for assistance.

Remove furniture with sharp corners

Many falls happen at night, when trying to get out of bed to go to the bathroom. If there is a table with sharp corners beside the bed, your loved one may hit his head on it on the way down, causing a head injury as well as other bumps and bruises from the fall. An alternative to removing the furniture entirely is to tie towels around the corners to cushion them.

Get a personal medical alarm

Popularized by the commercial where a woman cries, "I've fallen and I can't get up," these alarms work through your phone systems Your loved one wears a waterproof bracelet or necklace alarm button. In the event of a fall or other injury, a simple push of a button summons 911, family, friends, or neighbors. This is especially important if your loved one lives alone - remaining on the floor for hours can cause just as much damage as the fall itself.

Discouraging moving after a fall

If your loved one falls, encourage them to lie still while you check for obvious injuries such as bleeding head wounds and limbs that are bent in the wrong direction. If everything looks all right, gently move his arms and legs, and ask him to tell you if anything hurts. Then have him get to his hands and knees and try to lift himself off the floor while you use a gait belt to assist.

Call 911

If your loved one is injured or in pain, or cannot get off the floor easily, call 911. At the very least, they will help you get your loved one back into bed or a wheelchair. They may also recommend going to the emergency room for x-rays and observation.

Notify the doctor, home care agency, or hospice after every fall. Even if your loved one does not appear to be injured, his healthcare team may want to take a second look to be sure.

Burns

Burns can occur when a confused individual attempts to use appliances in the kitchen. A hospice social worker remembers one client who tried to microwave her adult diapers in order to dry them. A fire started in the microwave, and when the woman tried to open the door to put it out, she burnt her hands.

If your loved one has been diagnosed with Alzheimer's disease or another form of dementia, do not leave them in the kitchen alone. Supervise any use of the stove or oven, just as you would do with a child who didn't know how to cook safely. If you and your loved one cook meals together, make sure you are the last one to leave the kitchen. Don't go until you are sure all the appliances are turned off.

Some people with Alzheimer's continue to live alone or stay alone for a time. All too often, caregivers report arriving home to find the gas stove on or food burned to a crisp in the oven or toaster. You can help avoid incidents like this by disabling the stove and oven and unplugging other appliances like the toaster and the microwave. Then make sure to leave meals that your loved one can enjoy without heating them up, like a peanut butter sandwich or a fruit salad. You may also want to arrange for Meals on Wheels or a similar group to deliver nutritious food.

Pain and Physical Symptoms

Seniors may experience pain or discomfort from many sources. People who have been injured in an accident may continue to experience pain from their injuries for a long time. Illnesses like cancer or HIV are often responsible for pain. People with lung and heart diseases may not have a lot of pain, but they may have trouble catching their breath, which is just as unpleasant. In addition, some people suffer from pain that has nothing to do with their primary diagnosis. Many seniors, for instance, suffer from old injuries, chronic arthritis, and neuropathy (nerve damage that causes a tingling sensation) in the extremities.

You should feel free to ask about pain yourself. Ask your loved one, "Do you hurt anywhere?" If the answer is yes, ask where the pain is and have them describe it (sharp, dull, pinching, burning, etc.) and rate it on a scale of one to ten, with one being almost no pain and ten being the worst pain.

Because your loved one might be reluctant to admit to being in pain, also watch for nonverbal signs and symptom: facial grimacing, moaning, restlessness, limping, gasping with sudden movement, crying out, etc. Keep your doctor informed any pain your loved one reports or exhibits, and as what you can do to make the symptoms better. There are many kinds of gentle medications, some narcotic and some not, that can be used to treat pain. Some doctors also prescribe home remedies, like massage for stiff muscles, a hot pack to an aching neck or ice to dull the pain of a sprained wrist. Follow your doctor's treatment instructions and report back with the results.

If your loved one continues to exhibit pain or discomfort, has a life-limiting condition like cancer or end-stage Alzheimer's, and has stopped curative treatment for the illness, consider a referral to hospice for symptom management. A senior who does not have a terminal condition may be referred to a pain management clinic if their Primary care doctor can't get the pain under control.

Abuse, Neglect and Exploitation

Abuse is a behavior directed against another person that is intended to cause harm. Abuse can be physical, like slapping, kicking, whipping, or burning; it can also be emotional, such as name-calling, making threats, or telling lies to frighten someone; finally abuse can be sexual, such as fondling the genitals of a person who does not or who cannot give consent, rape, and making inappropriate sexual remarks. Neglect means failing to provide care that a person needs to survive and thrive. It can involve failure to provide food, failure to provide recommended medical care, and failure to provide assistance with personal hygiene. Finally, exploitation means misusing another person's resources to benefit oneself, such as stealing a family member's pension check, or convincing a demented person to write out a large check from their bank account

According the the National Center of Elder Abuse, between one and two million Canadian seniors are mistreated or exploited by a caregiver each year. Of these cases, only about one in 14 come to the attention of a police officer or social service agencies.

Home bound individuals are uniquely vulnerable to abuse, neglect, and exploitation for several reasons. First, because they are not mobile, they may have little contact with the outside world and no ability to tell a sympathetic person that they are being mistreated. Second, home bound seniors are likely to have psychological conditions such as depression, anger, and anxiety. An inexperienced caregiver may respond with anger or negligence. Third, many home bound seniors require extensive care that their caregiver doesn't know how to provide or is physically unable to provide. Finally, home bound seniors often live with family members who are barely getting by financially. The family may need the senior's social security check to make their house payment. In fact, this situation constitutes elder abuse.


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