Category Archives: Caregiving – General

“The Underbelly of Grief”

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This article in the Huffington Post about one woman’s grief at the loss of a spouse (of 47 years) may be of interest to some of you.

There were several thought-provoking things said in this blog post — not all of which I agreed with.  Here are a few excerpts:

* “What fascinates me is that women today are more open about the pain of childbirth than they are about the pain of grief.  Grief is the new taboo. Few people openly talk about the agony of grief.”

* “I get daily calls from well-meaning folks asking how I am. I have learned never to ask a widow or widower how they are doing.”

* “There should be a pain barometer for grief. Doctors inquire about your back pain all the time. Is it a five or a seven today?”

* “I was amazed when a friend said to me, ‘I know exactly what you are going through. My mother died six months ago.’ What people don’t realize is that the loss of a spouse is different. When you lose a parent, you have siblings or family members to comfort you. When you lose a spouse, you lose your life partner and are alone.”

* “No one should look at grief before they must face it. But we should be prepared for its effect on our life. Maybe if we talk about it more, it will lessen the pain when it happens?”

Here’s a link to the article:

www.huffingtonpost.com/laurie-burrows-grad/pain-of-losing-a-spouse_b_8173264.html

DEMOTED TO LUNCH: The Underbelly Of Grief
by Laurie Burrows Grad
Huffington Post
Posted: 09/22/2015 8:00 am EDT

Robin

SF Bay Area Home Health Agencies Rated on Medicare Site

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I recently posted that Medicare now rates home health agencies.  This post is about using the Medicare tool to find the 33 home health agencies in the San Francisco Bay Area that received 4, 4.5, or 5 star ratings.

The Medicare home health agency ratings aren’t super-easy to find but, after digging a layer or two down on the Medicare website, they can be discovered. Start at the Medicare home page of “Home Health Compare”:

www.medicare.gov/homehealthcompare/search.html

In the search box, type in “California,” indicating you want to search in the state of CA. On the right side, “Modify your search” by selecting a county, such as San Mateo County.

I also selected that I wanted to “Filter by” those agencies that provide all six services indicated (RN, PT, OT, ST, SW, HHA). Then I clicked on the green button for “Update search results.”

In that search, 73 agencies came up. Unfortunately you can only compare three at a time. I selected three agencies that I’d heard of previously.

If you select the “Quality of patient care” tab, you can see the star ratings.

Local support group member Dell did all the search work for us and compiled a list of 33 agencies in the SF Bay Area with 4, 4.5, or 5 star ratings.  Below, I’ve copied Dell’s list.

Robin

Wonderfully, local support group member Dell compiled a list of 33 agencies in the Bay Area that have a rating of 4, 4.5, or 5.

(Actually, this list could be longer because a single agency is typically listed in more than one city.  For example, I found CVH in San Mateo County while the list below shows them in San Ramon.  They have more than one office.  Perhaps the cities listed below are their main offices.)

RATING OF 5

INTERIM HEALTHCARE, SAN JOSE
DOMINICAN HOME HEALTH, SANTA CRUZ
ST CLAIRE’S HOME HEALTH, HAYWARD
LIFEGUARD HOME HEALTH, PLEASANTON
ASIAN NETWORK PACIFIC HOME CARE, INC, OAKLAND

RATING OF 4.5

SUNSHINE HOME HEALTH CARE, PLEASANTON
AMERICAN CAREQUEST, SAN FRANCISCO
CVH HOME HEALTH SERVICES, SAN RAMON
PREMIER HOME HEALTH PROVIDERS, SAN JOSE
MERIDIAN HOME HEALTH, NEWARK
TRUEMED, INC, SOUTH SAN FRANCISCO
CARELINK HOME HEALTH AGENCY, BURLINGAME
FARALLON HOME HEALTH CARE, BURLINGAME
MEDICS CHOICE HOME HEALTH, MILPITAS
QUALITY CLINICIANS CARE HOME HEALTH SERVICES, SANTA CLARA
LIFEGUARD HOME HEALTH SOUTHBAY & PENINSULA, MILPITAS
HEALTHFLEX HOME HEALTH SERVICES, OAKLAND
STAFFING HOME CARE, MILLBRAE
ASIAN AMERICAN HOME HEALTH CALIFORNIA, OAKLAND

RATING OF 4

SUTTER VISITING NURSE ASSOCIATION AND HOSPICE, SANTA CRUZ
SUTTER VISITING NURSE ASSOCIATION, NOVATO
PATHWAYS HOME HEALTH AND HOSPICE, SUNNYVALE
ACCENTCARE HOME HEALTH OF CALIFORNIA, SAN RAMON
VN HOME HEALTH CARE, SAN JOSE
PROHEALTH HOME CARE, SAN JOSE
AMEDISYS HOME HEALTH CARE, CAMPBELL
MARE ISLAND HOME HEALTH, VALLEJO
HOME HEALTH ALLIANCE, MILPITAS
ST JAMES HOME HEALTH, SAN JOSE
EMERITUS HOME HEALTH, SAN JOSE
AMITY HOME HEALTH CARE, HAYWARD
SAN BENITO HOME HEALTH CARE, HOLLISTER
INCARE HOME HEALTH SERVICES, SAN FRANCISCO

 

New Medicare Quality Ratings of Home Health Agencies

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This email may be of interest to those with Medicare.

“Home health” is a Medicare benefit that few people seem to know about — unless you or a loved one ends up in the hospital or a rehab facility, and are then ready to be discharged to home again. If there’s a skilled need — RN, therapy (PT, OT, ST), or social worker — Medicare pays for a skilled professional to go to someone’s home to provide services. The person must be unable to leave their home, except to see an MD or attend a gathering in their faith community. When the “skilled need” is resolved or when a therapy cap is hit, the benefit ends. An MD must authorize “home health.”

As of July 2015, Medicare has started to provide quality ratings — one to five stars — to home health agencies in the US. Nine thousand home health agencies around the US were rated. Only 239 agencies in the US received five stars. In California, 1004 agencies were rated, with 42% receiving 4 or 5 stars.

The Medicare home health agency ratings aren’t super-easy to find but, after digging a layer or two down on the Medicare website, they can be discovered. Start at the Medicare home page of “Home Health Compare”:

www.medicare.gov/homehealthcompare/search.html

A Kaiser Health News (KHN) article notes:

“Medicare applied the new quality measure to more than 9,000 agencies based on how quickly visits began and how often patients improved while under their care. Nearly half received average scores, with the government sparingly doling out top and bottom ratings. … The ratings are based on agencies’ assessments of their own patients, which the agencies report to the government, as well as Medicare billing records. The data is adjusted to take into account how frail the patients are and other potential influences.”

“There was a wide variation in scoring among types of providers, a Kaiser Health News analysis found. Visiting nurse associations and agencies with religious affiliations tended to get the most stars. Home health agencies run out of skilled nursing homes and agencies run or paid for by local governments tended to perform poorly.”

“The star ratings were designed to capture overall quality by summing up the results of nine of 27 measures Medicare already publishes on its Home Health Compare website. Agencies were evaluated by how quickly they started visiting a patient, whether they explained all the drugs a patient was taking either to the patient or their caretaker and whether they made sure a patient got a flu shot for the season. The agencies also were judged on how much their patients improve in skills like walking, getting in and out of bed, bathing, breathing and being able to move around with less pain. Finally, the agencies were rated on how many of their patients ended up going to the hospital. The current star ratings are based on performance from the fall of 2013 through the end of last year. Medicare will reassess the stars quarterly.”

“Some in the home health industry are welcoming the ratings, but there is concern that consumers will interpret the scores differently than Medicare intends. The government considers three stars to be solid performers, but in rankings for restaurants, hotels and other common services, three stars are often interpreted as mediocre. … Another concern is that many of the quality results are self-reported by home health agencies.” 

You can find the full Kaiser Health News article (July 16, 2015) here:

khn.org/news/home-health-agencies-get-medicares-star-treatment/

A more recent KHN article notes that the ratings have another limitation:

“Bill Dombi of the National Association for Home Care and Hospice says that for one, they emphasize improvement. ‘The population in home health tends to be fairly aged with multiple chronic illnesses, where stabilization may be the goal rather than improvement,’ he said. Dombi said it’s unrealistic for a patient with Parkinson’s disease, for example, to get much better. But home health can help that person maintain some independence.”

Here’s a link to the more recent article (September 18, 2015):

khn.org/news/how-one-home-health-agency-earned-five-stars/

Robin

“5 ways to care for yourself while caring for a loved one”

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Here’s a very short message from Harvard Medical School’s HEALTHBeat enewsletter.  The message addresses five ways to care for yourself while caring for a loved one —

  • recruit help
  • quell guilt
  • stay active
  • stay connected
  • relax and enjoy yourself

Certainly attending a local Brain Support Network caregiver group meeting can help you quell guilt and stay connected!

Robin

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www.health.harvard.edu/staying-healthy/5-ways-to-care-for-yourself-while-caring-for-a-loved-one

5 ways to care for yourself while caring for a loved one

Caring for an aging parent or a loved one who is ill or disabled is often deeply rewarding. But it can also consume a lot of time, as well as physical and emotional energy. You may feel overwhelmed by myriad responsibilities — home, work, other family needs, and caregiving. But it’s just as important to care for yourself before you burn out. Try our five tips below to help rejuvenate yourself.

1. Recruit help: You don’t have to “do it all” yourself. In fact, it’s best to have more than one person involved in caregiving. Whether it’s accompanying your loved one to appointments, helping with housework, or cooking dinner one night a week, ask other family members to lend a hand. And if someone asks if he or she can pitch in, don’t be afraid to say yes!

2. Quell guilt: At times, you may feel like there’s something more you should be doing, or something you should have done differently. Rather than ruminate on what could or should be, give yourself credit for all that you do. If feelings of guilt are especially strong, it can help to talk them over with a counselor or social worker.

3. Stay active: Frequent exercise delivers proven health benefits, such as lowering cholesterol and blood pressure — and it can be a powerful energy- and mood-lifter, too. Try to get 30 to 60 minutes of exercise on most days of the week. If that amount doesn’t seem doable, don’t worry — some exercise is always better than none.

4. Stay connected: Catch up with friends by phone or email, or plan weekly walks or a regular lunch or movie. Ask people to drop by and visit with you, or the person you’re helping, so that you can take a break and feel connected with the world outside your caregiving role.

5. Relax and enjoy yourself: Listen to music you like, take a luxurious bath, dabble in creative pastimes, or even splurge on a massage. You can also learn meditation or other relaxation techniques through a class, tape, or book (yoga is a great relaxer as well).

Coping with cognitive changes – some suggestions

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Tonight I’ve been looking over the “Help Sheets” from Alzheimer’s Australia. Though the help sheets are on Lewy Body Dementia (called “Lewy body disease”), I think the sheet on how caregivers can cope with cognitive changes applies to all of the disorders in our group. I’ve copied an excerpt below.

See: https://fightdementia.org.au/sites/default/files/helpsheets/Helpsheet-LewyBodyDisease02-CognitiveChanges_english.pdf
Cognitive Changes in Lewy Body Disease
Alzheimer’s Australia
2012

Excerpts follow:

A person with dementia associated with any of the Lewy body disorders is often described as being in a muddle or not quite right. Early in the course of the disease a partner or colleague may notice that papers are being moved around a desk or tasks previously completed easily are left unfinished.

  • Recognise significant changes in behaviour. Suggest a medical assessment.
  • Encourage the person to ask for assistance and develop strategies to ensure important tasks are completed.
  • Ensure legal documents such as powers of attorney and wills are in place.

An early indication that a person has attentional, visuospatial and executive function problems is often a lack of confidence when driving. Passengers comment that roundabouts and busy intersections pose significant challenges.

  • • If the person wishes to cease driving, accept their decision, rather than suggest that they are OK.
  • If, as the passenger, you have concerns discuss it openly with your GP and ask for a driving assessment.

Shopping, outings and social functions, particularly when there are crowds or the venue is noisy, can be disturbing and result in the person becoming agitated or withdrawn.

  • Learn to recognise the ‘good days’ and be flexible with arrangements.
  • Organise meals with one or two friends or family rather than a large number.
  • Select outings where you have some control over noise levels and crowd control.
  • Attend important family celebrations for part of the time rather than not go at all. Go to other people’s places so you can leave early or organise respite for part of the day.

Partners may perceive that the person has become disinterested in the relationship and more self-absorbed. There may be changes in both conversation and non-verbal communication or gestures.

  • Be patient and give the person plenty of time to interpret and respond.
  • Irony and non-verbal gestures such as raised eyebrows and shoulder shrugs are difficult to understand – speak directly.
  • Involve the person in decision making and life choices.

A person may appear to lose interest in pursuing hobbies and activities that require hand-eye coordination. Rather than being disinterested, this may be because of visuospatial deficits or the ability to plan and
execute the task.

  • Accept the loss and do not put unrealistic expectations on the person.
  • Choose other activities that are achievable and that involve you or a friend.
  • Discuss news, current affairs and the local gossip, even if it appears to be a one way conversation.

Robin