Hospitals, Seniors, and Safety

I have had a influx of people calling and seeking advice after an elderly relative was sent home from a hospital into what the family viewed as an unsafe situation. Over and over I heard, why would the staff kick my relative out when they are sick and weak to go home and be alone. It's cruel.

Today I want to address this from multiple sides.

First, let's look at the hospital's role. They have a patient that does not need to stay in the ER or in a room any more. There is nothing more the hospital can do for them. And keeping them in the hospital increases the risk of new infections. They ask the patient if they feel ready to go home and the patient says yes. So the hospital releases the patient to go home. The system works great for most everyone. Who would want, at age 40, to get the second degree from the hospital staff when you are ready to go home. New York State law says if the patient says they are safe to go home, then they can be sent home.

Second, let's look at your elderly relative's role. If they can live at home safely before they went into the ER, they should be safe when they go home afterwards. Frequently, they were not really safe at home alone to begin with. The illness or the fall or whatever sent them to the hospital was a result of the fact that they were not safe at home alone. But if the senior refuses to see that or act on that fact, then they will be discharged from the hospital back into the unsafe environment. We live in a state that allows elderly people to make their own decisions, even if they are totally the wrong, highly unsafe decisions.

Third, is there a role for the family in this mess? When your elderly family member entered the hospital, is there a reason a family member didn't take him/her and stay? No one would send a five year old to the ER alone and no senior should go either. The family must be proactive in sharing their concerns with their elderly loved one so that when he/she decides to seek treatment, the family knows and someone is headed to the hospital with him/her.  This would allow the family to ensure that their senior is cared for, understands what is going on, and has a safe way to get home and be cared for.

From now on, let's try to stay calm when dealing with the health care system. No one went into medicine to put people into danger. Medical staff try their best to make sure everyone who comes in and out of the ER or hospital is safe, healthy, and treated with respect. While insurance companies don't want to pay for unnecessary time or treatments, they also don't want a senior returned to an unsafe environment where they will get injured or sicker. But they don't even get to talk to your loved one. They are relying on the hospital, senior, and family to make sure all is well. 

One of the key pieces to this puzzle is the reality that, at some point, seniors are more concerned with being independent than with their safety and health. When "I'm independent" is all the family member hears, they need to put into existence a game plan to ensure health and safety needs are being met. Because the loved one is now incapable of making that call for him/herself. This includes having a plan for when something happens that sends the senior to the hospital.

The earlier people can begin to make a plan, the more likely the senior is to follow it when the brain says "I'm ok, I don't need my family right now." Use this blog post as a starting point in your family to have this discussion. Some of the questions you might need to answer are: who will the senior call when he/she needs to go to the hospital, are health care proxies and other forms filled out, does everyone understand what the priorities are for your senior's long term goals on life, and how often do we need to review these plans and have these discussions to ensure the right decisions are made in an emergency.

Aging is a tough reward for not dying. It comes with constant ever-changing challenges that need the most open lines of communication possible. Illnesses, safety issues, healthcare systems, and insurance providers don't make any of this easier. In fact, those problems often take a mild situation and turn it upside down, sideways, and inside out. Don't get caught in the blame game, it doesn't help anything. Make a plan. Be prepared. Help your senior live out the rest of their live in peace, comfort, and safety, but also make sure they are LIVING their life to the fullest.

Breast Cancer, Prostate Cancer and AIDS Vaccine All Now!!!

OK. I lied. None of them are available now. And if they were, I hope I am not the first place you are hearing about them.

But what if it were true? What if the CDC and National Institutes of Health announced breakthroughs in these vaccinations and that they would be available in your doctor's office starting Feb 1, 2015? Would you be calling your doctor for a chance to be the first to get the breast or prostate cancer vaccine? Would you be lining up at your favorite drug store for the AIDS one? Or would you wait until your next annual exam for them?

Or would you tell your doctor you are not interested in them? That they will probably not help, come with side effects, or be generally unsafe to take? Probably not. Why? Because you see the devastation that these diseases cause. Because you know personally someone who has been impacted by these illnesses.

And thus is the problem with the measles, polio, or rubella vaccinations. They have worked so well in the US, you may have no experience with how horrendous these diseases are. So when people who are not medical doctors (just because they have the title Dr. in front of their name, does NOT make them a medical doctor) tell you the vaccines are not safe, you have no reference for how unsafe being un-vaccinated is. All treatments have side effects and risks. And there is nothing wrong with knowing what they are. But use reputable medical reports and websites to get your information. Not a website sponsored by a celebrity or vitamin company.

One of the wonders of our generation is now that we have eliminated these killer diseases, we have gone on to create vaccines for illnesses that are serious but only life-threatening to some people. Chicken pox, the flu, and the HPV vaccines are some of these examples. These diseases haven't shown  the same destructive capabilities as rubella, small pox, or the mumps, and so we tend to think it's ok not to take those vaccines, so it's ok not to use the others. But it's not. If you choose not to vaccinate yourself or your child, you need to know the full truth about the disease you are choosing to leave yourself vulnerable to. Especially in this age where people (and diseases) can spread quickly and easily among continents (think about the chaos from just a few people reaching our country in wake of the Ebola virus.) Think about the number of people complaining that not enough was being done to create a vaccination against the Ebola virus.

Let's try to be consistent people. If you are complaining the drug companies aren't working hard enough to find vaccines for our deadliest known illnesses of today, why would you risk exposing yourself or your kids to the deadliest known diseases of yesteryear by refusing the vaccines?

Think it through.... and play it safe. Vaccinate yourself and your kids. For their healthy future.

Robin Williams, John Pinette, Comedy and Tragedy

           I posted a few days ago in LinkedIn that if the US didn't start treating our mentally ill as well as we treat our physically ill, we would just see more and more reports about deaths like Robin Williams. Then someone today quoted a line from John Pinette, and I realized I was seriously wrong.
           Public health officials will tell you that only 1 in 10 Americans can handle their own health well (are proficient at health literacy skills) and only 1 in 33 are able to handle their mental health.  I will say that mental health care across the country did make some giant leaps forward with the Affordable Care Act, but we have now probably reached the point were they are both handled the same.
           Follow my logic here for a minute. Smoking is the leading cause of preventable death in the US. What do we tell smokers? Just stop smoking. Here's a patch. Why can't you quit. What do we tell the depressed like Robin Williams? Cheer up. It's all in your head. Here's a pill. Obesity is the number two cause of death in the US with malnutrition being the leading cause worldwide. What do we tell the obese, like John Pinette? Stop eating. Move more. Sorry there isn't a pill for that.
          Want more objective facts (thanks CDC). 1 in 4 Americans will suffer with a mental illness in their lifetime. 1in 3 Americans are obese (not just overweight), with almost 1/2 of all Hispanic Americans being obese. Approximately 1 in 5 adult Americans smoke tobacco.  1 in 10 Americans will struggle with depression in the lifetime. 1 in every 4 deaths in the US is related to cancer. The only disease that kills more Americans is heart disease.
         Our medical community has great solutions to physical health problems.... eat a well balanced diet, exercise daily, see your doctor for screening tests, with medications and surgery often correcting what does go wrong. Yet physical health problems are the number one and two causes of death. We have less interventions for mental health problems (which cause fewer deaths), but are the leading cause of disability in both the US and Canada. We need to figure out how to improve care and get people to live healthier lives in both realms of health.
         So as you can see, we don't really treat our mentally ill any worse than our physically ill. The problem is that we really aren't doing a good job of treating either. And that can be born out in the tragic deaths this year of these two comedians. Robin and John had plenty of money and access to the best health care in the world and still died way too early. We need to be better at teaching people how to handle their health in general..... physically and mentally. Socially and spiritually as well. But that's a topic for another blog. 

Health and Pets

        Health encompasses so many pieces of your life. There is your physical health- how your body operates within the world, mental health- how you think and learn, social health- how you relate to the people around you, and spiritual health-where your strength comes from when you are struggling.  These four areas of health feed into a cycle of improving your overall health or slowly destroying it.

         Your health can also be impacted by things beyond your control.  Animals, and especially pets, are a part of nature that can really impact your health and your outlook on life. And nowhere is that more apparent than when we look at animals within use of the medical field. Service animals are trained to assist the blind, the deaf and epileptics function within our world.  Therapy dogs are used to help children learn to focus in school, with seniors to provide love and affection, and for those in rehab to talk to when they are stressed. Therapy horses are being used to help people who struggle with depression, anxiety, and communication skills. Doctors’ offices often have fish tanks within the waiting rooms in part because watching fish lowers blood pressure and is calming. Senior housing providers (nursing homes and assisted living centers) have become pet-friendly in the last few years as research showed the health benefits of having pets is often intensified with seniors.

          Recently, I took a tour of a local memory center that has taken pet-friendly to a new level. And it thoroughly impressed me. The center had had a fish tank, and allowed residents to bring in their own personal pets for a few years.  In the last few months, they have invested in their own pets as a health benefit to their residents. As of my visit they had a dog, 2 cats, 2 rabbits, 2 hamsters, 3 birds, the fish tank, and a beautiful indoor butterfly garden.  I could see the change in the residents as I walked in. They were calmer and more focused. There was laughter as they watched the bunnies. Most didn’t notice the butterflies, but they enjoyed the different flowers within the garden. 

         The director confirmed that her residents were happier, healthier, and calmer as well. And as a benefit so was her staff. The staff no longer ran through the halls. Residents and staff stopped and laughed with each other over the antics of the animals. The discussion I heard that morning over and over was about the intro of the new bunny to the existing bunny. It did not go well! Bunny fights are nasty! But it created an environment of talking about stressors, and the reality of pet ownership, and life. Coworkers were bonding together with each other and their residents. The pets encouraged better social health within this environment.  Talking to the pets helped with emotional health. Walking the dog, petting the cats, watching the fish improves their physical health. The gentleness of their pets contributes to spiritual health and resiliency.

        So what should you take away from this blog? That animals help make us healthy. If you have a pet take a minute to recognize how he/she helps you be healthier. If you don’t have a pet, maybe consider getting one. Do some research before you buy a particular animal. If you are going for a cat or a dog, consider adopting from a local humane society or rescue group. If you want to “try out” dog or cat ownership, consider becoming a foster home for a rescue group, where you keep the animal only for a short period of time. Even a beta fish in a small bowl on your kitchen counter can make you smile and bring you peace. It really doesn't matter your age, pets improve your health. What type of pet would you get to bring a little life into your world? I'd love to know. 

What does Low Health Literacy Look Like in Seniors?

·                       Health Literacy is the ability to make healthy choices, navigate the health care system, and respond appropriately in a public health crisis. Our federal government estimates that only 1 in 10 Americans are proficient at health literacy skills, with that number dropping to 1 in 33 for mental health literacy.

·                   Seniors are known to lose their health literacy skills as they age.    Having two or more chronic illnesses (and mild hearing loss is considered a chronic illness) is linked to losing health literacy skills as well. People who have low health literacy skills are at much higher risk of serious injury and premature death than people whose health literacy skills are better.

             While I usually dislike blogs with lists, in this case, the list below is designed to help you see whether or not you or your aging loved one is risking their health and safety unnecessarily.  If you can see these behaviors in yourself or your loved ones, please contact me at info@healthliteracyforall.org to learn how to live a healthy future.

·          So what are some of the behaviors that are linked to low health literacy, especially in seniors?

o   Inability to understand or follow the doctor’s orders

o   Forgetting to take their medication, or taking it wrong. Even when they are justifying their reasons for not taking it

o   Inability to judge their own driving skills

o   Unable to make decisions based on safety and health issues. They often argue independence over safety and well being

o   Cannot read expiration dates on products. Especially hazardous as they often lose their sense of taste/smell as well.

o   Does not know what medications they are taking or why they are taking them.

o   Cannot operate tv, remote, cell phone that they could use previously

o   Not prepared to deal with bad weather. When it snows, they expect you to be there now to shovel them out.

o   Doesn’t keep up with personal care as they did a few months/years ago.

o   Doesn’t maintain their home as they did. Hoarding or throwing out important things.

o   Refuses to discuss the future, wills, life insurance, housing options, what the doctor is telling them.

o   They shove mail places rather than dealing with the paperwork as it comes in. if you look, you may find late notices and cancellations.

2 Health Literacy Skills and Growing Up

Health Literacy is (in English) the ability to make healthy choices and to navigate the health care system whether you are healthy or ill. There are 22 core skills and pieces of knowledge that go into making a person proficient at health literacy. And to some extent, those skills vary as you age.

When you are a child, your parents handle your health care needs and make most choices for you. No 4 year old has ever chosen to grow up un-vaccinated, in a smoking home, using an emergency room as a primary care doctor's office. (All, I hope you know, are low health literate behaviors.) Because we do not yet have comprehensive health literacy classes in schools and colleges, sadly what you learned at four is likely to follow you through to 14, 24, 44 and beyond. But in those few areas of the country where health literacy skills are being taught, children can learn to be their own health advocates.

One of the key skills to develop in health literacy training is the ability to communicate with your doctor. This is a skill that should be developed from toddlerhood on. I know what you are thinking! Toddlerhood? She's crazy! But stop and think for a minute. If your child is old enough to say "my finger has a boo-boo" to you, (s)he is old enough to say it to the doctor. You may have to give further explanations, "he slammed it in the car door," or "she burnt it on the stove." But learning from toddlerhood to talk to the doctor is a key skill to getting your child used to being able to give all their information to the doctor.

As your child ages, parent should allow their child to get the first chance to answer all the doctor's questions. When a child has told his parent that his throat hurts, and he is clearly running a fever, the parent is likely to assume strep throat and call the doctor. When the doctor asks if the child's ears hurts, or if his stomach is also upset, the parent really doesn't know. By answering for the child, usually with a "he didn't complain about that," the parent shuts down the child's ability to tell the doctor what he is feeling. What 6 year old is going to say, "well actually doctor my ears really are killing me, my throat is just even worse," when mom has already said no?

By the time you child is a pre-teen, the doctor should be asking you to leave the room for a few minutes. This is not so your child can be harmed, but for privacy as the doctor checks for hernias or asks "have you tried drinking alcohol?" There are just some things a teen will not say in front of their parent, but the questions still need to be answered truthfully to the doctor. Don't take it personally, be glad you taught your teen to trust their doctor and they have someone they trust who will take the time to ask the tough questions, and give correct answers to your teen's most personal questions.

Another key skill is the ability to fill out paperwork. By the time they can write their name on the little lines, you can begin to give your child their paperwork to fill out. At first, it might just be their name and phone number, but year after year, they will be able to fill out more and more of it with less and less of your help. Obviously, until they are 18, the parent will still need to sign all the forms, but they gain invaluable real world experience by filling out the forms as soon as possible. It will certainly make it easier for them to fill out their first job application, when they are already familiar with the medical forms. Also, there is a lot of questions on the intake forms on health history. This becomes a great chance for the parent to talk about the family's medical history (your grandmother had breast cancer, your Grandpa Charlie died of a heart attack when you were 2) that might not get discussed anywhere else.

As always, if you have any questions about the information contained within this blog, feel free to email me at Info@healthliteracyforall.org.

Health Literacy: The Aging Process, Dementia, and Loving Your Loved One

Part of being fully health literate is understanding the aging process. Whether you are in your 80's and leading your family through the end of your life, in your 60's and learning about retirement, in your 50's and stuck in the sandwich generation, or in your 20's and watching your parents and grandparents try to navigate the aging process, this is a process that is often fraught with heavy disagreements, guilt,and independence vs safety issues. Yet there is also a very clear process.

Depending on how one has taken care of themselves earlier in life, somewhere between 60 and 70, aging begins to take it's toll. Vision and response times slow, hearing begins to deteriorate, muscles lose mass faster than the best weightlifters can add it back. Slowly but surely, seniors begin to need a little help with small things. Chronic health problems, multiple medications, and long standing family discord can make the entire journey even more unpleasant. Add dementia in any of it's forms to the mix and the result can be absolute chaos.

So how does someone deal with all of this? By trying to remember that everyone is doing their best. By opening lines of communication as early as possible. By showing respect while keeping safety the ultimate priority.

So let's take a quick look at some questions you will eventually need to answer when dealing with a loved one who has been diagnosed with dementia.
1. How do the children really judge the daily safety of a parent who has dementia and still lives alone or with their spouse.
~~Are they taking their medication correctly?
~~Are they likely to forget something on the stove and risk causing a fire?
~~Can they really safely drive? (How many fender benders are allowed before one takes away their driving privileges?)
2. At what point in your family does safety for others and your loved one top the need for independence? Every family has different values in this area (think child rearing), but at some point in the dementia process, safety must top independence.
~~When do you look at home care support or a great out of home day program (with locked doors for wandering protection)?
~~How do you keep your loved one safe when you are away from home?
3. When is it time to move the loved one out of their house? And to where?The dementia diagnosis of any form will keep your loved one out of most senior housing options, as they are not equipped to deal safely and securely with the sudden changes that can occur.
~~Child's or grandchild's house?
~~A memory care center? A high security nursing facility?

4. And then maybe the toughest questions of all.
~~Do you ask them to sign a DNR when they are still competent enough to do so. (It's not legal once a certain level of dementia is noted in the medical files, a level that varies from state to state.)
~~Do you treat medical conditions like cancer or mental health conditions like bipolar disorder when the treatments can make the dementia worse?

These are tough decisions. Every family is going to answer them different. But if you can talk the questions out early in the journey, you can simply rely on the fact that you already decided what to do in the calm, when the storms of life make the answers necessary. As a country, we are aging. More and more families are facing these tough decisions every day. And ignoring the problems now, do not make them better later. This I know from personal experience. My mom has dementia. We have had to move her into my home, and then slowly lock it down and make it safer for her. Some days she is so weak, she needs a walker to balance. Some days, she wanders away. Someone in my house is always on Grandma duty. But my family isn't fighting with each other over her care. We know what our family lines are that make it unsafe for her to live with us and we have already been looking at options.  Because we love her, dementia and all.