Oct. 24, 2011
On Saturday, Mom and I went back to her home in Clinton Township after two weeks of her staying with me. She slowly rolled her walker through the chilly living room headed straight for Dad's room, the sunniest room in the small condo. She put on her brakes and looked around. Then, still leaning on the walker, she looked straight at me with a heavy saddness: "I never knew that once someone died, we'd never see them again."
I started to say the thing about heaven. But I knew at that moment Mom, even though she's a devout Catholic, could not be comforted. In the couple weeks she had been with me and my family, she had asked to go home every few days. So we made a date to return there on Saturday, to clean out the refrigerator, to pick up a few things, to make sure everything was in order. That's what I said. But Mom had a different idea. She went looking for Dad.
In the 18 months since Dad died, it has become harder and harder for me to enter the condo. Even during the months that Mom had a 24-7 live-in caregiver or when we gathered for a family dinner, I wanted to leave almost as soon as I arrived.
Now, packing up Mom's clothes and emptying out the pantry was more than I could bear. Though nothing definitive was in the works, we all understood that Mom likely wasn't going back to the condo to live.
After Dad died, she had been adamant about staying in her own home. We did what we could to grant her that. But as her dementia progressed and she became more fragile, staying with one of us made more and more sense. And, this time, Mom didn't oppose. Almost too readily, she agreed to leave her home of 25 years, the home she and Dad had "downsized" into after the last of us had left them empty-nesters in a house that was too big and becoming increasingly unmanageable.
Dr. Cathy Lysack of Wayne State University's Institute of Gerontology recently completed research on the phenomenon of downsizing, the act of moving from one's long-time home into a smaller, more manageable space. She says the move is especially poignant because the elderly know it's likely their last. And she cautions well-meaning adult children to slow down, listen to their parents and make accommodations for whatever they want to take.
When it was time to leave, Mom asked only to take only a couple of photos of her and Dad.
Two hours earlier, Mom walked into the house sad, confused and looking for Dad. Now, as she left, she was lucid and present and reasonable.
Perhaps having the luxury of easing out of one’s long-time home rather than making a quick and final move, is a blessing. We can’t know for sure. But given that these are our circumstances, I choose to look at it that way. A blessing. What else can it be?
-- Anne Marie Gattari, 586.279.3610, am.gattari@brightstarcare.com
Sunday, October 23, 2011
Sunday, October 16, 2011
Moving Mom, or Not
Oct. 17, 2011
Her advice to adult children: Slow down, listen and be honest with yourself about who the move is really for. "Moving one's parents goes well beyond the simple taks of packing up her set of dishes," Dr. Lysack said. "And sometimes the solution may be to not move at all and provide the assistance they need in their own homes."
Dr. Cathy Lysack spent much of this year sitting in the living rooms of Detroit's elderly listening to their stories as they prepared to move out of their long-time homes into smaller, more manageable, quarters.
What she heard will be the subject of a compelling speech entitled, "Moving Mom Means More than Packing the Dishes," on Thursday, Oct. 20, at 4:30 p.m. at the Grosse Pointe War Memorial.
Dr. Lysack, a researcher at Wayne State University's Institute of Gerontology, is presenting her findings at my grand opening celebration of my new senior home care business, BrightStar of Grosse Pointe / Southeast Macomb. The event is free and open to the public.
"What makes downsizing in late life unique is that it could be their last move," Dr. Lysack says. "Thinking about it in this way brings the distant horizon of their end of life closer into view and they ask: 'How much future do I have, and do I want to have it in a new place?'"
Often the move is more traumatic than it needs to be because well-meaning adult children inadvertantly create emotional crises. The family may be pushing for the move out of love and caring. "But from the older person's point of view, it just doesn't always feel right," Dr. Lysack said.Her advice to adult children: Slow down, listen and be honest with yourself about who the move is really for. "Moving one's parents goes well beyond the simple taks of packing up her set of dishes," Dr. Lysack said. "And sometimes the solution may be to not move at all and provide the assistance they need in their own homes."
Are there ways to "downsize" in place? If the home is too large and upkeep too much, can a Certified Aging in Place Specialist remodeler make sensible modifications?( http://www.capsremodeling.com )
If your parents need help with some of their daily activities, can you give yourself the gift of peace of mind by finding compassionate home care professionals? The answer may very well be 'no' to both and moving is the best decision. In that case, Dr. Lysack says, consider what makes your mother or father feel like a whole person -- not necessarily what makes the most sense.
Dr. Lysack likes to tell the story of a woman whose new home was too small for her sofa and her piano. She took the piano.Good for that woman's family. It appears they were really listening to their mother.
Anne Marie Gattari, 586.279.3610, am.gattari@brightstarcare.com; http://www.brightstarcare.com/grosse-pointesoutheast-macomb
Thursday, October 13, 2011
Stopping the Hospital Revolving Door
In a year from now, in October 2012, Medicare will begin penalizing hospitals when their elderly patients, once discharged, are readmitted within 30 days. The penalty will be equal to 1 percent of their total Medicare billings and will rise to 2 percent in 2013 and 3 percent in 2014.
A report on hospital readmission rates released last week by the Dartmouth Atlas Project found that readmission rates haven’t improved since 2005, due in large part to uncoordinated and inadequate follow-up care by physicians and the discharging hospital.
The report, “After Hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries,” says 1 in 5 Medicare patients return to the hospital within 30 days of discharge. www.dartmouthatlas.org/downloads/reports/Post_discharge_events_092811.pdf
The annual cost of avoidable readmissions stands at $17 billion, according to the U.S. Centers for Medicare and Medicaid Services (CMS).
“Hospitalized elderly are some of the nation’s sickest patients, and they enter the hospital with the hope for not only short-term improvement, but also long-term benefit,” the report states.
As a country, we need the cost savings, and we’ll take it. But what does this mean to each of us individually? I hope it means the hospital revolving door stops spinning for our parents.
Skeptical, are you? I don’t blame you. The healthcare industry has been trying to reduce what it calls “readmits” for many years.
My own experience exemplifies the lack of success: Between October 2009 and January 2010, my mom was shuffled back and forth between one hospital, two rehab centers and her own home eight different times.
But I believe this time might be different. I want to believe. Financial incentives aside, hospitals and other healthcare providers are beginning to work in tandem on “care-transitions” programs as outlined by the CMS.
The CMS’s Community-based Care Transitions Program is funding pilot programs around the country designed to improve care transitions for high-risk Medicare patients. This effort is part of the Partnership for Patients, a public-private partnership to reduce harm and improve care transitions.
The Dartmouth authors believe that these programs can positively affect short-term outcomes. But there's more. “The greater question is how they can contribute to, and be effectively aligned with, broader efforts to improve care integration, coordination and accountability across the full continuum of patient care.”
It’s a question I have as well. These care-transitions programs all contain the same elements: follow-up telephone calls from hospitals, better care coordination between physician, hospital, rehab center, nursing home, and Medicare-paid home healthcare services, and better record-keeping.
That’s a good start.
But what’s missing as far as I can see is a commitment to on-going home care services that provide companionship, help with daily activities, and medical assistance for meaningful periods of time.
These are the type of services that BrightSar provides, with qualified, compassionate caregivers who make sure your parent makes and keeps the follow-up doctor’s appointment and is taking his or her medication. Our caregivers also make sure your parent is eating right and getting the right kind of exercise or activity.
In short, private duty agencies like BrightStar can coordinate all aspects of the post-hospital care plan and make sure it is followed. But what gives us the most joy is knowing your mother or father is on the mend and looks forward to his or her day.
And in the best-case scenarios, private-duty home care assistance will already be part of your parents’ daily regime, which can, in fact, prevent that unfortunate and unexpected hospital stay. With each of our cases overseen by a long-time Registered Nurse, BrightStar is looking at our clients holistically. In many cases, we are the care coordinator.
“Care coordination needs to be a continuous process that begins before illness warrants hospitalization, continues when hospitalization is necessary, and seamlessly moves back into the community,” according to the report. “For many patients, particularly for those with chronic illness, the episode of care has no definite end. Innovations in care coordination need to further develop lifelong models of longitudinal care.”
I couldn’t agree more.
am.gattari@brightstarcare.com; 586.279.3610
A report on hospital readmission rates released last week by the Dartmouth Atlas Project found that readmission rates haven’t improved since 2005, due in large part to uncoordinated and inadequate follow-up care by physicians and the discharging hospital.
The report, “After Hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries,” says 1 in 5 Medicare patients return to the hospital within 30 days of discharge. www.dartmouthatlas.org/downloads/reports/Post_discharge_events_092811.pdf
The annual cost of avoidable readmissions stands at $17 billion, according to the U.S. Centers for Medicare and Medicaid Services (CMS).
“Hospitalized elderly are some of the nation’s sickest patients, and they enter the hospital with the hope for not only short-term improvement, but also long-term benefit,” the report states.
As a country, we need the cost savings, and we’ll take it. But what does this mean to each of us individually? I hope it means the hospital revolving door stops spinning for our parents.
Skeptical, are you? I don’t blame you. The healthcare industry has been trying to reduce what it calls “readmits” for many years.
My own experience exemplifies the lack of success: Between October 2009 and January 2010, my mom was shuffled back and forth between one hospital, two rehab centers and her own home eight different times.
But I believe this time might be different. I want to believe. Financial incentives aside, hospitals and other healthcare providers are beginning to work in tandem on “care-transitions” programs as outlined by the CMS.
The CMS’s Community-based Care Transitions Program is funding pilot programs around the country designed to improve care transitions for high-risk Medicare patients. This effort is part of the Partnership for Patients, a public-private partnership to reduce harm and improve care transitions.
The Dartmouth authors believe that these programs can positively affect short-term outcomes. But there's more. “The greater question is how they can contribute to, and be effectively aligned with, broader efforts to improve care integration, coordination and accountability across the full continuum of patient care.”
It’s a question I have as well. These care-transitions programs all contain the same elements: follow-up telephone calls from hospitals, better care coordination between physician, hospital, rehab center, nursing home, and Medicare-paid home healthcare services, and better record-keeping.
That’s a good start.
But what’s missing as far as I can see is a commitment to on-going home care services that provide companionship, help with daily activities, and medical assistance for meaningful periods of time.
These are the type of services that BrightSar provides, with qualified, compassionate caregivers who make sure your parent makes and keeps the follow-up doctor’s appointment and is taking his or her medication. Our caregivers also make sure your parent is eating right and getting the right kind of exercise or activity.
In short, private duty agencies like BrightStar can coordinate all aspects of the post-hospital care plan and make sure it is followed. But what gives us the most joy is knowing your mother or father is on the mend and looks forward to his or her day.
And in the best-case scenarios, private-duty home care assistance will already be part of your parents’ daily regime, which can, in fact, prevent that unfortunate and unexpected hospital stay. With each of our cases overseen by a long-time Registered Nurse, BrightStar is looking at our clients holistically. In many cases, we are the care coordinator.
“Care coordination needs to be a continuous process that begins before illness warrants hospitalization, continues when hospitalization is necessary, and seamlessly moves back into the community,” according to the report. “For many patients, particularly for those with chronic illness, the episode of care has no definite end. Innovations in care coordination need to further develop lifelong models of longitudinal care.”
I couldn’t agree more.
am.gattari@brightstarcare.com; 586.279.3610
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