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CAREGIVING IN AMERICA is a monthly magazine published by Minnesota publisher Kay Sauck, premiered in December 2009 to address the needs and concerns of the 50 million caregivers of family and friends. 

The magazine and website, www.CaregivingInAmerica.com, will draw on a stable of experts in health and aging and two organizations devoted to caregiver support: the Rosalynn Carter Institute for Caregiving and the Aging with Dignity organization.

The Green House nursing care center for seniors is a relatively new concept in "home-like" care for seniors requiring nursing care. Traditional nursing homes are based on a medical model. The Green House projects are based on a home model -- with a smaller, more homelike building with private space and shared community facilities.

Staffing is also different. Each project is based on 24/7 care, but the duties have shifted from highly specialized care to more family-like care provided by a core team, and supplemented with appropriate medical teams from outside.

Clinical Support Team

The clinical support team is comprised of a Medical Director, Director of Nursing, nurses, therapists, social workers, dietician, and activities coordinator to provide skilled care for the residents as required in the care plan. The Shahbazim are certified nursing assistants with additional Green House training) by developing close relationships with the elders, provide the Clinical Support Team with valuable information to assist in developing the care plan.

Licensed nurses are available to and responsible for clinical care in Green House homes on a 24-hour basis. If the nurse is not in the home and is needed, is available to the Shahbazim and elders via pager and other communication technologies. The Shahbaz

The Shahbaz (plural: Shahbazim) is a universal worker who provides personal care, meal planning and preparation, light housekeeping, and laundry for 7-10 elders. Shahbazim core training as Certified Nursing Assistants receive about 120 additional hours of specialized training to cover The Green House philosophy of care, person-directed care for persons with demenia, household operations, building self-managed work teams, policies and procedures for their project, communication skills, culinary training, safe food handling, and certification in first aid and CPR.

The Guide

The Green House Guide serves as coach and supervisor the the Shahbazim, and is responsible for the overall operations and quality of services in the home. The Guide may be responsible for more than one home, depending on the size of the community.

The Sage

The Green House Sage is a resident elder who acts as a coach or mentor, assists facilitating the development and continued growth of the self-managed work team and to serve as a trusted advisor to the Shahbazim. This is a volunteer position.

Extended Nursing Care Residents

Residents in the Green House are encouraged to participate in shared home activities such as cooking, self care and cleaning, as well as hobby activities and participation in the surrounding community.

Family

Family participation is encouraged and welcomed in The Green House home, from sharing meals to participating in activities and volunteering time and services to help their loved one decorate personal space. Well-behaved family pets are also welcome visitors!

Only projects accepted through the application process and developed in cooperation with The Green House Project team are authorized to provide long-term care services under the licenses service mark: THE GREEN HOUSE®.

A five year pilot project ending in 2010 is reaching its goal of 50 projects across the country. Check the website for locations in your region. These nursing care facilities are often developed by nonprofit groups, churches and even municipalities.

I've been thinking about the future...and what changes I'll see in the next 20 years or so.

Remember Gordy on Star Trek?  Eyeglasses combined with brain implants?  That could be possible.  Implants are being developed to help spinal cord injuries recover movement, and visual sensors and monitors are increasing in capability.  I can see the possibilities of visual implants and optical visors coming about...

And today, I read about another step forward in the research into human genomes."

Complete Genomics, a Mountain View startup, announced Tuesday that it had deciphered 14 full human genomes for customers that include pharmaceutical giant Pfizer and leading medical research institutes, a significant step for an industry whose work could revolutionize health care.  "This is just the beginning. The real action starts later next year. Then you'll start to see important medical results come out."

All life-forms carry a genome, a full strand of chromosomes that is a reflection of its hereditary traits. Deciphering, or "sequencing," a genome generates a vast amount of raw data that researchers are trying to decode in a quest to understand how heredity influences various maladies. Reid said he expects the company to produce 10,000 sequenced genomes by the end of 2010, greatly enhancing the potential for meaningful discovery.

The genomes, they said, are being studied by customers to validate the company's technology and for small-scale studies of four types of cancer (breast, lung, colorectal and melanoma), HIV and schizophrenia.

The aim is to use this previously unavailable whole genome data to accurately characterize the tumor and identify its vulnerabilities, which in turn can be used to design more effective therapies. The customers include the Flanders Institute for Biotechnology, Duke University, Brigham & Women's Hospital, the HudsonAlpha Institute for Biotechnology, the Ontario Institute for Cancer Research, the Institute for Systems Biology and Broad Institute of MIT, and Harvard.

There will be more radical changes in preventative and emergency care, I feel sure. I anticipate that sensors, monitors and controllers will provide some of the most commonplace changes that benefit seniors. I can see rolling in a diagnostic cart much like we roll in an oxygen cart today.

Can't you?

The Centers for Medicare and Medicaid Services conduct Quality Indicator Surveys of nursing homes.  The same quality factors would be good for families to know about...and ask about before admitting their family member to the facility. 

Here are some of the factors they look for:

• Familiarity of the nursing and licensed staff with individual resident/patient care requirements
• Updated "Care Item" lists
• Diligence with Weight monitoring -- for 30, 60, 90 and 180 days.
• Weekly Weightings.  And alert dietary and the doctor of gains or losses of 3 pounds or more.
• Monitor room Trays.  Weight loss prevention is closely connected to food.  Is the food appealing and easy to chew...are their oral hygiene problems?
• Billing Logs.  Check on "demand billing" and Medicare Denials.  Incomplete forms and information can reduce quality of care available to the patient.
• Audit Medicare Denials.  Check Medicare forms for completeness and professionalism
• Audit the Dining Experience.  Watch the entire dining experience:  room temperatures, lighting, staff  communication, food handling and variety of food choices.  Watch clean up and watch infection control practices.
• Resident Census.  How many residents are away for home visits, or doctors appointments or in the hospital?  Check the list of those admitted and discharged over the last 30 days for trends.
• Specialized Care List.  Check lists of residents who receive ventilators, dialysis, hospice or end of life services.  Compare trends in a number of prospective nursing homes to understand trends and quality of care connectons.

These tips are based on tips provided to nursing home staff to help them cope with Medicare and Medicaid Services inspections.  Some of this information will not be available to individuals, but knowing which care standards are audited can provide you with good questions to ask, and how to observe quality of care before you make important care decisions.

REFERENCE: Ecumen Consulting Services (www.ecumen.org), provides long term care consulting, training, management, development and repositioning services for nursing homes, assisted living, Continuing Care Retirement Communities (CCRCs) and home care and community-based services.

How would you like a coffeehouse or snack bar named for you? 

Vitalize! Wellness Centre, is a state‐of‐the‐art development that opened as part of the Ecumen community Parmly LifePointes in Chicago City, called Ruben's, named for a 94‐year‐old resident, and lifetime swimmer.  Being active in a local community brings many rewards...and a great community will use its own facilities to acknowledge achievements and inspiring people to further their mission -- including naming facilities after key residents!

The Vitalize! Wellness Centre,  features a warm‐water pool, juicing classes and rows of high‐tech exercise machines that boost a goal of helping residents to seize personal responsibility for "aging well." Ruben Berg is a prime example of that accomplishment, says Patricia Montgomery, the center's director.

She defines aging well as "live long, die short."

A 1998 book titled "Successful Aging," based on results of the groundbreaking MacArthur Foundation Study, taught us the powerful role each of us has in shaping our health and well‐being as we age.

Our genes determine only 30% of our destiny! 
The other 70 percent is up to us!

A decade after the book was published, other studies have confirmed and advanced those findings.

Most people can recite the wisdom of regular exercise, keeping weight within limits and that smoking is bad for your health, says Robert Kahn, co‐author of "Successful Aging"

He sees progress in Americans' understanding of aging well, he says. But it shows up more in what they know than what they do.  Like obesity -- it's increasing rather than decreasing.

Kahn sees too little about why people are living longer and what longer life means, he adds. "Or what a longer and productive and happy life can be."

He wants to see more information circulated about other findings, too, such as the need to challenge our brains often and in new ways to stay mentally sharp. And he'd like to see more about learning and productivity in older people's lives and less about leisure.

We get the hint :-)  So in this blog ... "Solutions for Senior Health" we're focusing on learning and productivity and healthful living!  Good behavior!

Dr. Roger Landry travels the country to educate audiences about aging well and to promote and train care providers in the how‐to of masterpiece living, a plan for successful living inspired by the MacArthur Foundation Study.

Questions remain about how to make it happen. "One is how to engage older adults. They're smart people with interesting lives." But our broader society tends to push them aside. Changing that, he says, would be a "win‐win" for people of every age.

IDEAS:  crossword puzzles and Sudoko and software such as  [m]Power cognitive fitness technology

Spirituality and Social Connectedness -- Solution for Isolation

Understanding of the value of both spirituality and social connectedness is growing, he says. "If we stay in our homes, almost by definition we stay more and 3
more isolated." Studies show that isolation heightens the risk of cancer, cardiovascular disease, dementia, falling and fractures.

"Alzheimer's disease still terrifies people," Landry says, and many aren't aware there are ways to ward it off.

Americans need to replace high levels of stress, which he calls "our national sickness," with more serenity and soulfulness.

States Are Developing Senior Communities

Cleveland (Ohio) Foundation Successful Aging Initiative (http://www.successfulaging.org), which is developing a three‐year, $4 million plan to create and maintain elder‐friendly communities in the city. Goals include creating lifelong learning and development centers and promoting employment and volunteer opportunities for older people.

Colorado,  (www.silverprintcolorado.org) is developing an independent coalition of individuals, organizations and businesses with a vision  to establish a culture for positive aging and addressing needs, contributions and opportunities for people age 60‐plus.

6 Dimensions of Wellness

• physical
• emotional
• intellectual
• social
• vocational
• spiritual

The hope is that individuals will hold onto an independent spirit. That can mean living one's passion, whether it's a long‐held one, something they've always wanted to try or a new discovery.

SOURCE:  Ecumen, "Senior Housing and Successful Aging in the 21st Century"

When our President was a Senator, Barack Obama worked a day with home health care worker Pauline Beck to learn the inside of the health care system. Interesting...

There is nothing more powerful than having a friend or neighbor make the pitch for change!

I recently discovered a comprehensive website called "Consumer Guide to Dentistry" that includes information about senior dentistry and dental health.

Dental care for seniors involves unique considerations. Seniors are more likely to suffer from a host of oral health issues resulting from the natural aging process, their inability to receive proper oral health care due to financial constraints (no dental insurance) or their inability to provide adequate dental hygiene care for themselves.

These factors, combined with the limited dental benefits provided by state aid programs for the aged, blind or disabled, leave many seniors at risk of ignoring tooth decay and tooth infection until there is no alternative but tooth extraction -- which is the only dental procedure covered by many state aid programs such as Medicaid or Medicare.

Tooth Loss, Periodontal Disease and Other Dental Concerns for Seniors

Prior to tooth loss, seniors may experience tooth sensitivity or discoloration due to a loss of enamel and dentin (hard, calcareous tissue beneath the enamel), or root deterioration caused by gum recession.

Seniors are more prone to periodontal disease (gum disease) resulting from improper dental hygiene practices, poor diet, ill-fitting dental appliances and/or diseases such as cancer or diabetes. In fact, the supporting bone structure for the teeth, including the jaw, may shift, which can play havoc on a senior's bite and may contribute to tooth decay.

Seniors are also more likely to suffer from inflammation of gum tissue, dry mouth syndrome (often caused by medications) or oral thrush (a fungal disease causing ulcers and whitish spots on membranes of the mouth due to its effect on the immune system).

Dental Hygiene for Seniors

• Brush, floss and rinse with mouthwash properly to maintain dental hygiene, as instructed by your dentist.
• Look into special toothbrushes to clean hard-to-reach areas of the mouth.
• Know the warning signs that indicate your mouth, teeth or gums may be in jeopardy, including tooth sensitivity, teeth grinding, pain, mouth sores, bumps (see oral cancer), swelling, loose teeth, jaw popping or clicking, difficulty quenching thirst, swallowing or chewing (dry mouth syndrome).
• Visit your dentist as often as he or she recommends for regular dental hygiene checkups.
• Maintain dental appliances such as dentures and dental bridges properly.
• Consider seeing your dentist before and after surgery.
• Tell your dentist about any medications that you are taking or changes to medication.

This website provides Dental Hygiene suggestions for Seniors, as well as an online dentist LOCATOR:  YourDentistryGuide.com

At the National Alliance for Caregiving's Lotsa Helping Hands website, visitors may create their own caregiving site to coordinate support needed for the caregiver and care recipient.

Most of us have experienced the crisis of a friend or loved one suddenly unable to function as they had for their family or themselves. Perhaps it's a debilitating illness, or post-surgery rehabilitation necessitating weeks or months of bed rest.

In many instances of long-term family caregiving or caring for an aging loved one, those affected must also cope with finding support for meal preparation, grocery shopping, transportation for themselves and their dependent family members.

But it is often difficult for patients and family caregivers to ask for help. And if help is offered, managing that help can be a significant part-time job: coordinating family, friends, neighbors, colleagues, and church or synagogue members who do not all know each other can be complex and time-consuming, with endless phone tag and forgotten commitments.

Private Group Calendar for Sharing Caregiver Tasks

Lotsa Helping Hands is a free caregiving coordination web service that provides a private, group calendar where tasks for which a caregiver needs assistance can be posted. Family and friends may visit the site and sign up online for a task.

The website generates a summary report showing who has volunteered for which tasks and which tasks remain unassigned. The site tracks each task and notification and reminder emails are sent to the appropriate parties.

To sign up for a free Lotsa Helping Hands account or to learn more, please visit the National Alliance for Caregiving's Lotsa Helping Hands website.

During a patient stay in a hospital, nursing home, or other health care setting, the staff will work with you to plan for the patient discharge. The patient and their caregiver are important members of the planning team. This is a checklist of important things you should know to plan for a safe discharge. To view the checklist, click here.

Examples of the items in the checklist include:

1.  Who will you contact to get care after you are discharged?

2. Do you understand your health condition(s)?

3. Do you know what problems to watch for...and how to handle them?

Check the checklist for more details.

Public agencies have resources available such as home-delivered meals and rides to appointments. Ask a social worker at your health care provider for more information about the local community services and support available in your area.

Area Agencies on Aging (AAAs)
Assist adults age 60 and older and their caregivers.  Call the Eldercare Locator at 800-677-1116 weekdays or visit their website at www.ElderCare.gov

Aging and Disability Resource Centers (ADRCs)
Assist people of all incomes and ages in 43 states.  Check the website to see if your area is served:  www.adrc-tae.org

Centers for Independent Living (CILs)
Assist people with disabilities. A state directory can be found at www.ilru.org

State Technology  Assistance Project
Information on medical equipment and assistive technology.  Contact the RESNA - Rehabilitation Engineering and Assistive Technology Society of North America to get contact info for your state.  www.resna.org

State Medicaid Agency
Information about Medicaid. To find your local office visit www.nasmd.org/links/links.asp. It has a clickable map of the US.

Medicare
Call 1-800-Medicare (800-633-4227) or visit www.medicare.gov/LongTermCare/Static?Counseling.asp