Suppose you bring your frail loved one or a relative with dementia to the ER because of trouble breathing. The doctors determine it is pneumonia caused by bits of food being swallowed into the lungs.

Rather than stay in the hospital, they suggest your relative use the Hospital at Home (HAH) program.

With HAH, your loved one is immediately set up at home with a hospital bed, an oxygen tank, and IV antibiotics. Your relative’s blood pressure, pulse, oxygen, and temperature are then tracked remotely. A phlebotomist comes to the home several times a day to draw blood so they can monitor how the infection is going.

Nurses are assigned to visit once or twice per day. Consults with the doctor may occur via iPad. Or a doctor may come to the home if needed. A respiratory therapist comes to the home if needed. And a dietitian may visit to talk with you about foods that might be easier for your loved one to swallow.

Studies of HAH programs versus hospital stays show good results. Infections resolve more quickly. Patients with dementia have fewer experiences of confusion. There’s much less risk of COVID exposure or other hospital-acquired infections. Plus, patients get to recover while eating the food they like in the quiet of their home.

HAH programs have been popular in Europe for decades. The home setting is safer and more comfortable for elders. It’s especially used for conditions such as pneumonia, flares of heart failure or COPD, urinary tract infections, or cellulitis.

Your role Most families applaud the HAH approach. It does feel like better care. But they do acknowledge it’s tiring. The stress from 24/7 responsibility. Also, the disruption of having many different people coming into the home with little regularity in the schedule. Every day is different.

You may feel squeezed for space, dealing with the hospital bed, other equipment, and supplies. You also may be all alone as the first to realize there’s a problem if one occurs. Although nursing help is available on call 24/7, it can feel isolating and challenging. If you are working or still have kids at home, HAH may not be a good fit.

Also note that HAH is not typically available for those with original Medicare. But if your loved one is enrolled in a Medicare Advantage program, it’s worth asking if HAH is an option.

Does your relative have frequent infections?
If so, a Hospital at Home program may be the wisest approach. These programs are not stress free for family members, however. As the San Francisco experts in family caregiving, we at Compassionate Community Care can guide and support you through the process. Give us a call at (415) 921-5038.

About 20% of seniors living in communal settings experience bullying in one form or another. Cliques and power hierarchies seem to be a human tendency. If your loved one is the focus of bullying, you might notice withdrawal from others or depressed mood. Or you might hear them say that a particular person is “mean” or notice they avoid certain rooms, routes, or activities.

What is bullying? It’s generally defined as unwanted aggressive behavior against a seemingly less powerful person. Those most at risk are individuals new to a facility, particularly if they are single and/or seem timid or shy. Also, those with dementia. Bullying comes in several forms.

• Physical: Pushing or hitting
• Verbal: Snide or critical comments; bossing someone around
• Relational: Negative gossip or rumors; shunning
• Property: Stealing or vandalizing

Why do people bully? It’s not always intentional. A person with dementia might lash out or say something rude because of confusion or fear. Other people bully due to feeling a loss of control in facility life. Bullying can be an unconscious way to regain a feeling of personal power.

What can you do? Talk to the administration. If you can, relay specifics, especially if you witnessed an event. Ideally, every facility has an antibullying policy and procedure and has trained staff to recognize bullying and intercede. Perhaps staff can encourage a buddy for your loved one, as bullies tend to pick on people who are alone. While moving your relative may be tempting, the truth is that bullying happens everywhere. It may not be better at a new facility. If you do choose to move, be sure there is an antibullying policy in place and that it’s enforced.

If it’s your relative doing the bullying, some counseling may be in order to address the root cause. They may, for instance, have a mild cognitive impairment.

Are you worried about bullying?
Give us a call at (415) 921-5038. As the San Francisco experts in family caregiving, we at Compassionate Community Care know how frustrating it can be. There are strategies to address it, however. You don’t have to do this alone.

Hollywood would have us believe that profound deathbed conversations occur just before the last breath is drawn. Not so! The last few weeks of a person’s life are often marked by extreme fatigue, long hours of sleep, and sometimes distracting levels of pain. Conversations require too much energy.

If someone you care about has been given a terminal diagnosis, it’s best to talk sooner rather than later. Typically, the older adult and their relatives want to have a conversation, but there’s worry that emotions will get overwhelming. And worry about how to start. Look for a time when stamina is good, pain is gone or at a minimum, and try an opening such as, “I was wondering if you had thoughts about …” Once past the initial discomfort, there is usually great relief and greater intimacy ensues.

As you prepare, ask yourself, “What do I need to say?” “What is it that I want out of communicating?” The most meaningful topics usually involve

• expressions of love. These can be verbal. But nonverbal gestures (loving gaze, holding hands, hugging, kissing) are also extremely powerful.
• spiritual or religious affirmations (as appropriate). Following your relative’s beliefs, it may be soothing to talk about the afterlife. You might share expectations of seeing each other again in the future.
• practical communications. Perhaps further discussion about wishes concerning where to die. Or arrangements, such as burial. Or signing legal paperwork.
• difficult relationship talk. This is the most challenging. And also the most meaningful. Again, keep the outcome in mind. If your intention is a positive resolution to unfinished business, focus on efforts to understand, accept, and forgive. Let go of accounting for every past hurt.

Even if it’s late in the process and is only a monologue, your loved one can still hear you. It’s worth the effort to verbally and nonverbally create positive closure.

Has your relative received a terminal diagnosis?
As the San Francisco experts in family caregiving, we at Compassionate Community Care understand how incredibly emotional such news can be. And confusing! Let us help. Give us a call at (415) 921-5038. You don’t have to do this alone.

Make sure your loved one is ready to “take the heat” this summer.

Older bodies are less able to cope with excessive heat, so it’s important to ensure safeguards are in place.

Check in with your relative’s doctor. Certain chronic conditions and medications increase an older adult’s risk of heat stroke. Get advice on optimal fluid intake and medication management for times of extreme heat.

Provide air conditioning. Ideally, your relative has access to air conditioning at home, in at least one room. (Before temperatures rise for the summer, test that the unit works!) Otherwise, identify a place nearby that’s air conditioned to get relief for an hour or two. Perhaps a library, movie theater, or shopping mall. Some cities publicize “cooling stations” for just this purpose. Make arrangements for transportation, if necessary.

Watch the weather. Monitor the weather at your relative’s location. Hot weather in a city is particularly dangerous, because cities trap heat and are slow to cool.

Arrange for contact. Especially if your loved one lives alone, it’s important that someone check in several times a day during a heat wave. This provides an opportunity to catch symptoms of overheating early on.

Plan ahead for shade. Take a look at where your relative’s dwelling gets the most direct sun. Awnings and shutters are more effective than curtains, because the sun’s rays don’t heat up the glass. Trees and bushes are useful, too. Consider adding insulation in the roof and walls to block the heat from entering through these hot surfaces. The government offers financial help for insulation through the Low Income Energy Assistance Program.

Are you worried about heat waves?

We at Compassionate Community Care are keenly aware of how vulnerable older adults are to extreme temperatures. As the San Francisco experts in family caregiving, we encourage you to have precautions in place, even if you live far away. Let us help. Give us a call at (415) 921-5038.

If you are considering a trip with your loved one this summer, do yourself a favor and reflect on the realities of travel when a person has dementia. The disease is likely to be a prominent third guest in your plans, requiring consideration every step of the way. The disruption may make this less of a “vacation” than you had hoped. Changes to routine and not having the usual resources at the ready could prompt upsetting behaviors from your loved one, resulting in greater stress for you.

Consider these questions before buying your tickets:

• Does your relative get easily agitated, disoriented, or wander? If these problems occur at home, they are likely to be worse when traveling.
• How does your loved one do with day trips? How long can they stay seated and belted in? Are they easily distressed in new places? In crowds? Do you know strategies to help soothe them when not at home?
• Has the doctor signed off on the trip? Any reservations or concerns?
• What is the best mode of transportation? A car allows more flexibility for start and stop. A train relieves you of driving, but is public, slower, and difficult if your relative has balance issues. It’s also potentially overstimulating for a person with dementia. Likewise, airports can be distressing, but the airlines have some services to help.
• Can you provide a home base at your destination? Can you retain many of your daily routines, simply in a new location? Will there be a quiet room where you are staying? A hotel room away from the hubbub of kids might be an important refuge.
• Are your plans flexible? If your loved one is having a bad day, can you sit the activities out? Can you build in a gap day between arrival and big events?
• Who is the trip for? You? Your loved one? Friends or family at your destination? Especially if it’s been a while since you traveled together, it could be that the disease has progressed to a point that merits significant reevaluation. Honestly ask yourself, “Is this trip realistic?” Might you be better off planning for someone to stay with your loved one so you can go off on your own? Perhaps it’s better for family to come visit you. Be open to alternate possibilities.

Are you ready to travel?

As the San Francisco experts in family caregiving, we at Compassionate Community Care know how important it is to break from routine and shake things up a bit. Unfortunately, that does not always go over well for persons with dementia. Give us a call at (415) 921-5038 and let’s explore the options. We’d love to help you get the vacation you want.

Exploitation of older adults is an issue none of us likes to think about. But it’s a growing problem. One in 10 Americans age 60 or older has experienced some form of elder abuse. It is estimated that up to 5 million elders are abused each year.

Elder abuse includes intentional acts of malice. Also, simple acts of neglect or ignorance.

There are seven types of abuse:

• Emotional abuse. Attacking or humiliating a person verbally. Intimidation. Harassment. Threats of abuse.
• Financial exploitation. The misuse or withholding of the older adult’s financial resources. Taking money. Selling the older adult’s possessions for personal gain. Forging a signature. Or forcing an elder to sign documents.
• Physical abuse. Hitting, shaking, pinching. Any action that causes pain or injury.
• Sexual abuse. Sexual acts or sexual touch when the older adult does not consent or is threatened or physically forced. Also, sexual contact with a mentally confused person who doesn’t understand enough to give consent.
• Passive neglect. Refusing or failing to provide for an elder’s basic needs such as food, clothing, shelter, or medical care.
• Willful deprivation. Denying an older adult medication, medical care. Also shelter, food, or other physical assistance. Exposing them to the risk of physical, mental, or emotional harm.
• Confinement. Isolating or restraining an older adult other than for medical reasons.

Elder abuse is often rooted in family problems. Sixty percent of those who exploit elders are family members. Frequently it is a spouse or adult child. Key risk factors include:

• A relationship with a history of domestic violence.
• Personal problems. Drug or alcohol abuse or mental illness of the family caregiver. An adult child who is financially dependent.
• Isolation of the elder. Blocking contact with others creates a situation ripe for abuse.

To report elder abuse

Call 911 if the person is in immediate, life-threatening danger. Otherwise, if you suspect elder abuse, contact a local Adult Protective Services office.

Are you worried about potential elder abuse?
Let’s talk. As the San Francisco experts in family caregiving, we at Compassionate Community Care understand how distressing it is to realize a loved one may be exploited. It’s especially difficult if you suspect a family member. You don’t have to do this alone. Give us a call at (415) 921-5038.

We all need time away from constant responsibility. Sometimes the best way to care for your loved one is to take an extended break and recharge your batteries.

If your relative is fairly independent, consider these other services that may be helpful:

• A daily check-in call from a friend or nearby relative. Or from a telephone visiting service
• A personal medical alert system (a single-button pendant for summoning emergency help)
• Temporary meal delivery

Also ensure that all bills are up to date or prepaid and that adequate supplies of medications are on hand.

In case of emergency, leave complete information about your relative’s medical insurance, health history, current prescriptions, and doctor and pharmacist contacts. Include a completed advance care directive and instructions about how to reach you or other next of kin.

If your loved one needs lots of help, plan well in advance for care. Options to consider:

• Family members. Whenever possible, ask siblings several months to a year ahead of time. They may need the notice to make arrangements at work. If they live out of town, have them come early so you can orient them to the routines. This is especially important if your relative has memory problems. Familiar routines will help keep your loved one calm.
• Agencies. Allow yourself at least three months’ lead time if you need to hire in-home care. Use the agency for a trial period as training before you go.
• Facilities. Similarly, if you need to find a facility for short-term residential care, start looking three months ahead. Consider taking your relative to the facility for lunch several times before you leave. Your loved one will come to feel more comfortable. Plus, this will keep you top of mind with the staff and administration as they strive to match short-term requests with upcoming vacancies.
• A Care Manager. Ask about “vacation packages.” A Care Manager can find and hire care and provide ongoing supervision while you’re away.

Are you ready for a recharge?

As the San Francisco experts in family caregiving, we at Compassionate Community Care know how vitally important it is to take breaks from the tremendous responsibility of caring for an aging loved one. We can help you arrange things at home so you can just concentrate on filling your own well. Give us a call at (415) 921-5038.

If found early enough, many cancers can be kept in check. Some even eradicated. To encourage early detection, Medicare pays 100% (in most cases) for screening tests. Your loved one may have a copay and/or Medicare percentage for the doctor’s exam to administer a test. Or a  facility fee for a colonoscopy. To get the most insurance coverage for screenings, look for doctors who “accept assignment” (accept what Medicare pays). With Medicare Advantage, they all do.

Remember, a screening test is preventive care. It means no cancer has been found as yet. These tests look for specific indicators. If a cancer diagnosis is made, payment for follow-up treatment, doctor visits, and testing falls within your loved one’s regular Medicare arrangement. Deductibles or copays may apply.

To secure a screening test, get an order from your relative’s primary care provider.

• Lung cancer. Low-dose computed tomography (like a low-radiation X-ray). Medicare will pay for a yearly test for persons ages fifty-five to seventy-seven who don’t currently have signs of lung cancer. (Remember, this is for screening, not treatment.) They must also be a current smoker or have quit smoking within the past fifteen years.
• Colon cancer. Occult blood tests once a year for people age forty-five and older. A flexible sigmoidoscopy or a colonoscopy is covered once every two to ten years. (They involve a look inside the colon.) The frequency depends on your loved one’s risk factors and any precancer findings on previous tests. If the procedure is done in a hospital setting, there is no deductible required for the hospital, but the facility may bill for a copay amount. If a polyp is discovered and removed, this goes from “screening”—no problems yet—to an actual medical procedure. Your loved one may then owe a copay and, for original Medicare, the percentage that is the patient’s responsibility.
• Breast cancer. Mammogram once a year for women age forty and older.
• Cervical and vaginal cancer. Pap smear and pelvic exam, typically once every two years. If your relative is high risk for these cancers or had an abnormal Pap smear in the past three years, Medicare covers the test and doctor’s exam once a year.
• Prostate cancer. PSA blood test and/or a digital exam once a year for men age fifty and older. The blood test is covered 100%. There may be a charge if the doctor does a digital exam to look for an enlarged prostate.

Is your loved one resistant to screenings?
Who wants bad news? On the other hand, it’s great news if the screening shows no cancer. And if there is cancer, the earlier it’s caught, the better. Plus, cure rates are much higher than people think. Breast cancer, for instance, is the second leading cancer cause of death for women, yet current treatments result in a 90% survival rate. As the San Francisco experts in family caregiving, we at Compassionate Community Care can help you work with your relative to encourage them to get these screening tests. Give us a call at (415) 921-5038.

Tinnitus is often described as a ringing in the ears. But it can also be more of a clicking sound, a humming sound, or buzzing, hissing, or roaring. Ninety percent of people with the condition also have hearing loss.

Tinnitus is not a disease. Instead, it is thought to be the brain’s response to a lack of input from the ears. The brain then “tries harder” to catch the sound stimulation it expects. The result is internal noise. For many people, tinnitus is simply annoying. For roughly 10%, however, it can be quite distressing, interrupting sleep and concentration and bringing on depression and anxiety. Nearly one in four adults ages sixty-five or older experiences tinnitus.

If tinnitus interferes with daily life, talk to the doctor. There are several possible approaches.

• Address the underlying cause (if there is one). The culprit may be a buildup of earwax, which can be removed. Or, over 200 medications list tinnitus as a side effect. Aspirin and ibuprofen, for instance. Also, certain antibiotics, anticonvulsants, cancer drugs, antidepressants, and diuretics. Switching to a different prescription may help. Or hearing aids, because they deliver to the brain the auditory information it’s seeking.
• Mask the noise. A quiet room can make the buzz of tinnitus more distressing. “White noise” can provide neutral sounds to override the tinnitus. There are ear devices, even hearing aids, that can deliver white noise. If your relative has trouble sleeping, a white noise machine at night can help. A fan or air conditioner can sometimes do the same thing.
• Manage the reaction to it. Cognitive behavioral therapy can help your loved one live better with tinnitus. By learning new ways to think about the ringing, as well as relaxation and other coping strategies, your relative may feel less affected by the constant sound.

Does your relative struggle with tinnitus?
As the San Francisco experts in family caregiving, we at Compassionate Community Care often notice that hearing issues go unaddressed. Hearing problems frequently result in an older adult withdrawing from social interactions, which can then cascade into depression and poor quality of life. We can help. Give us a call at (415) 921-5038.

Once you decide memory care is the wisest path, the next step is choosing a facility and creating a smooth moving day. Many memory care communities have a “move-in coordinator” or other family liaison. Rely on this professional for guidance.

Ease the change with these tips:

• Involve your loved one in the choice of facility. Without saying why, visit each one with your relative. Have lunch there, perhaps engage in an activity. Watch how they respond and let that guide your choice.
• Wait to tell your loved one about the move. Avoid prolonged anxiety and confusion. Some experts advise that you wait until the day of the move to tell them, or when you are at the facility. Others advise no more than twenty-four to forty-eight hours before.
• Agree on “the story.” Everyone—family and staff—should say the same thing. For example, “The doctor says you need more than home care for your illness right now.” Even a fib (“The house is being tented for termites”) may be the most compassionate way to ease the transition. Imply it’s for a week or two, not a permanent move.
• Prepare logistics ahead of time. Ask the move-in coordinator what to expect, how the facility will greet your loved one, and how you will make your exit. Have a friend or family member bring photos and belongings over and set up the room before you arrive. You might want that person to spend time with you afterwards, as leaving can bring up a lot of emotions.
• The day of the move. Stick to routines as much as possible. When your relative understands what’s happening, stay calm and positive. Empathize. “This is hard for all of us. We just have to put up with it for now.” Stick to the message. Enlist the help of staff—usually a distracting activity—so you can exit quietly.

Is a move in your future?
As the San Francisco experts in family caregiving, we at Compassionate Community Care can help with insights and practical tips to smooth the way on this next step of your caregiving journey. Give us a call at (415) 921-5038.