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Live Life On Your Own Terms

Which is safer during the pandemic:
assisted living facilities or living with family?

coin flip optAmerica’s very first COVID-19 outbreak took place at a long-term care facility. At Life Care Center of Kirkland, in Washington State, two-thirds of the residents and dozens of staff members were infected, and at least 35 people lost their lives due to the coronavirus.

The Centers for Medicare and Medicaid Services later fined the nursing home $611,000 for deficient detection and protective procedures.

But for the more than 1.7 million Americans living in nursing homes and assisted living facilities – even those facilities that maintain scrupulous detection and protection measures – there are risks.

One of those risks results simply from housing members of the demographic group most vulnerable to the coronavirus – seniors, many of whom already have underlying conditions such as diabetes or cardiovascular issues – under the same roof. They share the same air, food and water. Planned group activities – communal meals, exercise groups, classes, etc. – are good for social interaction but defeat the purpose of social distancing. And even when there’s not a pandemic, Centers for Disease Control data show that nursing homes, skilled nursing facilities, and assisted living communities are fertile breeding grounds for one to three million serious infections a year. These infections include not only garden-variety influenza, but also pneumonia, respiratory syncytial virus, norovirus, and methicillin-resistant staphylococcus aureus (MRSA), and others.

So does it make sense to temporarily move a parent or other senior relative out of a long-term care facility and into your home?

It’s a tossup, really, because each alternative has its own pros and cons, which vary from family to family – because your home can pose its own risks, too, of a different nature. That’s why the answers to these questions are so important.

About your family member:

  • Specifically, what kind(s) of care does (s)he need? Ask the long-term care facility for a written list. Many of those services – particularly help with eating, dressing, toileting, and medication management – can be provided at home. But some, like Alzheimer’s care, can’t.

About your home:

  • Do you have a separate bedroom and bathroom for your family member?
  • How accessible is your home? Are there too many stairs? Do you have ramps that people with walkers or in wheelchairs can negotiate? Is there at least one bathroom with grab bars? Have you “seniorproofed” your home by removing things that can cause tripping and falls?
  • Will you be able to control infection risk with frequent hand washing and cleaning household surfaces? In anyone in your family going out to work or other places where they can bring home infection from? Will you have enough washable facemasks? Will any home aides you engage wear masks, gloves, and other personal protective equipment and change their clothes between home visits, as our do?
  • Is your whole family up for this? Will everyone be informed in advance and be prepared to take on new responsibilities?

About the facility:

  • What’s your current quarantine policy?
  • What, specifically, are you doing to reduce infection risk?
  • Are you screening staff members for signs of infection? Training them to reduce their exposure from pother health care facilities and the community? Do they have enough personal protective equipment, and do they know how to use it properly?
  • Are you allowing visitors?
  • Are you practicing social distancing? How?
  • When older adults become infected, is transferring them to a hospital or ICU easier from my home or your facility?
  • If my family member becomes infected after moving out and then recovers, will he be allowed to move back in?
  • If my family member doesn’t become infected, will she be allowed to move back once the pandemic is over?

If you have any questions about coping with the Coronavirus outbreak, or your retirement years in general, please feel free to call or email us. Just as we always have, we’ll be happy to give you honest, objective answers.

Coronavirus makes caregiving more difficult. But not impossible.

coronavirus caregivingThere’s good news and bad news about the COVID-19 pandemic.

The good news is that infection and death numbers are starting to drop in New York and other cities. The bad news is, they’re still near their peaks.

So whether you’re a family or a professional caregiver, your duties just became even more exacting.

How do you give hands-on care from a social distance of six feet away? And without either you, your elder, or your client infecting each other?

There’s bad news and good news about that too.

The bad news is, it’s not easy. The good news is, it’s possible – provided you take certain precautions.

First, prevent the spread of germs throughout the home. If you can, use a separate bedroom and bathroom from your family member. Clean all the surfaces that people touch often – counters, tabletops, doorknobs – with household cleaning sprays or wipes. Avoid sharing household items like dishes, towels and bedding. Make sure there’s access to food and other necessities, and that there’s a supply of disposable gloves on hand.

Prevent person-to-person infection. At least one of you, preferably both, should wear a cloth face covering. If N95 masks aren’t available, tightly woven cloth that covers the nose and mouth is the next best thing.

Wash your hands often with soap and water for at least 20 seconds, particularly after face-to-face contact. Or use a hand sanitizer containing at least 60% alcohol. Cover all of your hands’ surfaces, then rub them together until they feel dry.

Learn and follow the CDC guidelines for home care. All of our home caregivers do; they even completely change their clothes between caring for one client and another.

Fill out an emergency care plan form covering your family member’s condition(s), medications, healthcare provider(s), insurance, hospital preference, caregiver resources, and emergency contacts. If you don’t know the answers, check with your family member’s primary health provider.

Take frequent temperature readings, and keep an eye out for any of the virus’s early symptoms, which can sneak up on older adults before they notice. If your family member gets sicker, runs a fever that resists medication, or, even worse, develops emergency symptoms –breathing trouble, persistent chest pain or pressure, new confusion or dazedness, and bluish lips or face – call 911and tell the dispatcher there’s a suspected case of COVID-19.

Even under the best of circumstances, social isolation can play havoc with an older adult’s emotional, cognitive, and even physical health. So it’s important to keep in contact. That contact doesn’t have to be physical, though. You can have daily face-to-face “visits” using Face Time for iPhones, Google Duo for Android, Skype, Facebook Talk, and other technology. You can shoot pictures and videos, and text or email them. It’s not the same as being there, but it’s better than just hearing your voice – which, in turn, is better than just reading texts or emails.

And if you’re feeling stressed and isolated, or have any questions about coping with the Coronavirus outbreak, please feel free to call or email us. Just as we always have, we’ll be happy to give you honest, objective answers.

During the Coronavirus outbreak, is exercise good or bad for you? Yes

exercise during coronavirusYou’ve probably read about how good moderate exercise can be for the emotional and cognitive state of seniors sheltering in place during the COVID-19 pandemic. But what about your immunological state?

According to two professors of sports science, the answer depends on three things: What kind of exercise, how long you do it, and how often. “Both too much and too little are bad,” they write, “while somewhere in the middle is just right.”

There are two kinds of exercise immunity, they note. One is a systemic (i.e., whole-body) cellular response to infection, and the other, mucosal, response affects the respiratory tract’s mucous lining – the very part of your body that the COVID-19 virus attacks.

If you were to plot the infection risk and illness severity against the amount of exercise of time, it would show a J-or U-shaped curve. After a moderate amount of exercise over time reduces risk and severity to their minimums, both risks start to increase again – often to greater risk and severity than there’d have been with no exercise at all.

A 1998 Hong Kong study of H1N1 deaths during the Hong Kong flu epidemic compared never/seldom (once a month or never), low/moderate (1-3 times a week) and frequent (4 time a week or more) exercisers. The report noted that frequent exercisers’ risks were just as high as seldom/never exercisers’. It concluded that there was “a U-shaped pattern.” As exercise becomes more frequent, mortality risk initially decreases, but after that point the risk goes way up again.

“The United States recommendation of ‘all or most days of the week’ of doing 30 minutes’ exercise may be more than is appropriate, particularly for older people,” the researchers concluded.

Studies on college athletes also showed that more exercise isn’t better; it lowers the levels of an antibody protein called secretory immunoglobulin A, which reduces upper respiratory infections.

So how much exercise is enough?

  • 20-45 minutes’ moderate exercise.
  • Up to 3 times a week.
  • With the goal of maintaining but not increasing strength and fitness.

And how much is too much?

  • Exercising past exhaustion. Marathon running, for example, heightens illness risk from 2.2 to 13 percent after the race.
  • Exercising more than 5 days a week.
  • Exercising if you have any flu-like symptoms. And any form of team or contact sports.

And be sure to wash and disinfect your equipment after you’re finished.

If you have any questions about coping with the Coronavirus outbreak, or your retirement years in general, please feel free to call or email us. Just as we always have, we’ll be happy to give you honest, objective answers.

What disabled employees can tell you about working from home

working from home optWhen George H. W. Bush signed the Americans with Disabilities Act into law in 1990, one of its provisions required workplaces with more than 15 employees to offer workers with disabilities reasonable accommodation. Twelve years later, in 2002, a federal guidance specifically named remote work from home as a required form of reasonable accommodation.

Today, millions of full-time employees with disabilities or chronic illnesses telework from home, and what they’ve learned can help you be productive during this time of COVID-19 sequestration.

Commuting to an office, store, or other place of business to work creates a psychological separation between work life and home life. Disabled teleworkers can’t commute, so they create this kind of separation at home. Here’s how you can too:

  • Establish regular working hours – a standard start time, lunch break, and quitting time. And stick to them.
  • Take some time to do a stretching routine or take a walk before your workday starts, as a replacement for your commute.
  • Don’t work in the pajamas you slept in. If you want to work in pajamas, that’s okay so long as you change into a fresh pair.
  • Pick a home workplace. If you and your spouse are both teleworking, agree to set boundaries and work in separate rooms, space permitting.
  • Grow something green in your workroom, and open the curtains or blinds and the windows to bring in natural light and fresh air.
  • Structure and schedule your work day – when to check in with your supervisors, when to tackle time-sensitive tasks, which goals to achieve for the day and the week, which deliverables are due when,
  • Take advantage of technology: Trello to organize and prioritize your projects, Zoom for face-to-face meetings and chat, Slack for teamwork, file-sharing, conversations and as a digital water cooler.
  • Quit at quitting time. Log out of your work email, and do something that tells your brain you’re not working anymore. Read a book, listen to music, watch TV, start on a personal project, start dinner, or use your phone, Facebook or Twitter account to check in with family and friends – secure in the knowledge that the day’s productive work is done.

If you have any questions about coping with the Coronavirus outbreak, or your retirement years in general, please feel free to call or email us. Just as we always have, we’ll be happy to give you honest, objective answers.

See the doctor without having to go see the doctor

See the doctor optThere’s a demographic group that’s even more susceptible to COVID-19 infection than elders, and that’s doctors and other health workers.

In Italy, where actual cases outnumber those reported by China, the Ministry of Health reports that at least 2,629 health care workers – roughly 8.3 percent of all cases in Italy – have contracted COVID-19 from working with inadequate equipment or being exposed to asymptomatic carriers. And sitting in a doctor’s waiting room, surrounded by people with symptoms, isn’t exactly a good example of social distancing. “When somebody has symptoms, they may be the last people who should go to a doctor’s office or emergency room,” says Dr. Andrew Diamond, chief medical officer of primary care provider One Medical. “They may be exposing other people – or themselves.”

That’s why a provision of the CHRONIC (Creating High-quality Results and Outcomes Necessary to Improve Chronic) Care Act, which President Trump signed into law in 2018, is a potential lifesaver for the 19 million Americans enrolled in Medicare Advantage Plans. It includes telehealth doctor visits in Advantage Plan coverage, so patients can get answers and care advice from their doctors without exposing themselves to flu germs or traveling to the doctor’s office for a face-to-face visit.

And last week, the Trump administration loosened some federal rules to make it simpler for doctors to get paid for Medicare patients’ telehealth visits.

Apps like the CVS MinuteClinic serve telehealth patients for as little as $60 per visit, and the New England Journal of Medicine found that more than 50 major US health systems – including Jefferson Health, Mount Sinai and Cleveland Clinic – have telehealth programs.

Historically, only about 18 percent of Americans take advantage of telemedicine, but that’s rapidly changing.

Teledoc Health reports that video appointments were up 50 percent last week, with some 95 percent of cases completely resolved online. HMO Kaiser Permanente says that telehealth reduced in-person visits to specialists by 40 percent. And more and more providers and provider groups are adopting independent secure telehealth systems.

Telehealth apps are about as easy to use as Face Time or Duo (which, incidentally, don’t meet the HIPAA privacy requirements), but there are a few things you should do to make your virtual visit as productive as possible:

  1. Check your connection for at least 1.2Mbps download bandwidth. Use for your phone or tablet, or for laptops and desktops. And make sure to shut down your Skype or Face Time, which may be eating up some of the bandwidth.
  2. Check yourself. The very first part of a face-to-face visit is checking your vital signs. At the very least, you should use a thermometer to check your temperature, since fever is one of the early Coronavirus symptoms. If you wear an Apple Watch or similar device, write down your other vitals too.
  3. Check your audio and video. Many proprietary telehealth software packages include a way to test your video and audio beforehand. Or if your doctor uses a teleconferencing system such as VSee or Zoom, make sure you have it installed. Some systems have a pop-up box asking permission to use your video or audio; just click yes.
  4. Pick a quiet, private, well-lit area. In-person doctor visits take place in a quiet room with the door closed. So should virtual ones. Make sure you have a light source – like a lamp or window – directly in front of you. That way, when you see the doctor, the doctor can see you.
  5. Use headphones or ear buds. That way, you’ll be able to hear clearly – and nobody else will.
  6. Write down your problems and questions ahead of time. And have any relevant pictures or reports ready for uploading.

If you have any questions about coping with the Coronavirus outbreak, or your retirement years in general, please feel free to call or email us. Just as we always have, we’ll be happy to give you honest, objective answers.