Planning a Dignified Death for our friend Claire at New Beginnings
Download PDF Version
Transcript
Decision making at the end of life is a critical challenge for the patients, families and physicians involved.1 In the not-too-distant past, families and physicians were often complicit in hiding information from terminally ill patients. Studies show that this practice is much less frequent today. However, physicians in a 2001 study were found to understate the severity of a terminally ill patient's prognosis 63 percent of the time2, and there is general agreement that physicians and health institutions continue to overuse technology and under-use communication when dealing with terminally ill patients. To reinforce this point, an examination of hospital records of 164 patients with significant dementia and terminal metastatic cancer shows that nearly half of the patients received aggressive non-palliative treatments and a quarter received cardiopulmonary resuscitation.3
While it's easy in retrospect to critique such behaviors, the reality is that managing the progression toward death is highly complex. The physician is often asked to bridge the chasm between life-saving and life-enhancing care. Guidance must be highly personalized and must consider prognosis, the risks and benefits of various interventions, the patient's symptom burden, the timeline ahead, the age and stage of life of the patient, and the quality of the patient's support system.
Considering all these, the physician, patient, and family are expected to explore all curative options, provide clear and honest communications, invite family input, provide their best recommendations, and ultimately affirm and support a patient's decision.1
Walking the road of terminal illness carries special burdens for all involved. For the patient and family, shock gives way to a complex analysis that often intersects with guilt, regret and anger. Fear must be managed and channeled, and loss and its implications for family and loved ones cannot be avoided. On top of this, there are multiple complex decisions that must be addressed within specific time constraints.
While all this is extremely difficult for patients and families, it's also demanding of physicians.4,5 The sheer complexity of individualizing and humanizing each passage is complicated by a heavy emotional burden that comes with accepting responsibility for the care of others. Physicians struggle to balance hopefulness with truthfulness. Determining "how much information," "within what space of time," and "with what degree of directness for this particular patient" requires a skillful commitment that matures with age and experience.
Managing both physical and mental health and distinguishing between normal grief and clinical depression add to the challenge.
Finally, incorporating the unique culture and spiritual context that can help define the right course of action for each individual demands a special set of eyes and ears and an ability to reach out and touch.
Studies confirm that 85 percent of terminally ill patients desire as much information as they can get, good or bad. Prognostic information is the most important. Only 7 percent of terminally ill patients seek "good news" exclusively and only 8 percent want no details.4,5
When a diagnosis is first made, everyone's focus is on life preservation. But a sharp decline, results of diagnostic studies, or an internal awareness can signal a transition and lead patients and families to recognize that death is approaching. Once acceptance arrives, end-of-life decision-making naturally follows. Denying that death is approaching only compresses the timeline for these decisions, adds anxiety, and undermines the sense of control over one's own destiny.
With acceptance, the goals become quality of life and comfort. Physicians, hospice, family, and other caregivers can focus on assessing physical symptoms, psychological and spiritual needs, quality of support systems, estimation of prognosis, and defining a patient's end-of-life goals.2 How important might it be for a patient to attend a granddaughter's wedding or see one last Christmas, and are these realistic goals to pursue?
One issue that often gets confused in the process of planning a death with dignity is hope. It is possible to die with hope, with self-control, and with dignity, but it requires some time and planning. Physician participation is critical. End-of-life care expert Dr. David Weissman offers this counsel: "Physicians are often reluctant to provide specific information largely out of fear of destroying hope …. Dying patients can still have hope for system control, of resolving personal relationships, and for a dignified death."1
In order to plan a death with dignity, we need to acknowledge death as a part of life - an experience to be embraced rather than ignored when the time comes. Recognizing when that time has arrived is a critical challenge for each of us.
Thursday, August 30, 2007
Tuesday, August 28, 2007
caregivers use technology
Caregivers use technology to help faraway family
06:52 PM CDT on Sunday, August 19, 2007
By BOB MOOS / The Dallas Morning News bmoos@dallasnews.com
Becky Bashor lives 800 miles away, but she can still look into her mother's eyes every night and tell whether she's had a good day or a bad day.
Ms. Bashor sits down at her computer and signs on to AttentiveCare, an Internet-based service that connects caregivers with their loved ones. She can initiate a videoconference with her mother or just watch unnoticed.
"I can see in an instant how she's feeling," Ms. Bashor said. "One evening, I noticed she was limping around her place, and I asked her why. If I had simply called her, she might not have mentioned she had fallen."
As Americans struggle to look after a growing older population coping with the chronic illnesses and frailties of advanced age, they're turning more to new technology – including Web cameras, pillbox monitors, bathroom sensors and fall detectors – to complement their hands-on care.
Baby boomers' longtime fascination with high-tech gadgets has merged with their elder care responsibilities and created a burgeoning market for such in-home devices and services.
"The technology revolution that's already transformed our lives in many ways, from e-mail to cellphones, is about to transform aging, too," said Majd Alwan, director of the Center for Aging Services Technologies, a national coalition of technology companies, senior care providers and universities.
The technology has moved well beyond "I've fallen and I can't get up" buttons.
Today, sensors can collect information about eating, medication use, sleeping and toilet habits and transmit it to the adult children or professional caregivers via the Web.
Other systems detect nighttime wandering and check blood pressure, body temperature and pulse. Bed sensors can even measure whether someone has gained or lost weight.
The systems raise inevitable questions about privacy, but Ms. Bashor's mother, at least, welcomes the videoconferences with her daughter and doesn't mind the camera in her living room.
"The fact that my family can see me and how I'm doing gives me a sense of security," said Esther Coker, who's 86.
Entrepreneurs in action
Giant companies such as Honeywell International Inc., Intel Corp. and Philips are entering the market, but much of the technology has come from entrepreneurs and start-up companies.
The AttentiveCare system, developed by Caregiver Technologies Inc. of Oklahoma City, provides a virtual window into seniors' homes. It also lets family members post photos of grandchildren and reminders about doctor appointments on the senior's video screen. Caregiver Technologies charges $200 for the setup and $60 a month after that.
Ken Nixon, president of the privately held company, designed the computer software to help with his mother, who was in the early stages of Alzheimer's disease at the time. He has since marketed AttentiveCare over the Internet and by word-of-mouth to about 100 other long-distance caregivers, mostly in the Southwest.
Ms. Bashor's home is in Lawrenceburg, Ind.; her mother lives in Fort Smith, Ark. When Ms. Bashor initiates their videoconferences, a bell rings in her mother's home, and the older woman sits down by the webcam.
"The beauty of this system is that it doesn't require the senior to do anything," Mr. Nixon said. "Most caregivers like to observe unannounced, besides doing videoconferences. You might say they're spying, but they do it out of love."
Another entrepreneur, Vestu Brue of San Antonio, heard friends fret that their aging parents weren't remembering to take their medications. Her answer was a "smart pillbox" called MedSignals that beeps at the appropriate times, dispenses the prescriptions, tracks the use and sends the information to a Web site.
Caregivers then can check whether their loved ones have taken their pills. Clinical trials have found that patients using the device are less likely to miss their medication than those who rely on memory.
Ms. Brue's company, LifeTechniques Inc., will ship the first pillboxes to customers this month. MedSignals sells for $200; caregivers will pay from $3.50 to $15 per month for accessing their seniors' medication use.
Aging in place
Older adults' strong preference to "age in place" is largely propelling the development of the in-home technology, said Richard Lusky, chairman of the applied gerontology department at the University of North Texas.
But the technology benefits family members and professional caregivers as much as it does seniors because it eases the strain of caregiving, he said.
As the 65 and older population doubles over the next 25 years and threatens to overwhelm the nation's long-term care system, the technology may also help delay seniors' nursing home use and hold down costs.
Attracted by the prospect of serving 19 million Americans who care for older adults, Intel has formed a separate research and development unit to create and test an array of home health monitoring products.
"All of our tests have shown that seniors are quite capable of learning and using the technology if they understand the benefits of it," said Eric Dishman, manager of the company's health research and innovation group.
Experts predict the most successful companies in this field will be those that bundle their monitoring and measuring devices into a single package. Right now, Living Independently Group Inc.'s QuietCare may be the most developed system on the market.
With wireless sensors placed throughout the home, QuietCare informs authorized caregivers of any atypical activity that suggests a possible health problem. Frequent bathroom visits might signal trouble, for example.
The private company has sold several thousand systems to individuals and professional caregivers in its 2 ½ years.
QuietCare will soon add a fall detection feature that's triggered when there's an unexplained lack of motion in the older adult's home or room.
"Most existing systems depend on a senior pushing a button for help," said George Boyajian, executive vice president of strategy, research and development for Living Independently. "But in three out of four falls, that doesn't happen."
Austin-based Senior Safe at Home will roll out a system in October that emphasizes both "high tech" and "high touch." The new company will combine home health monitoring equipment with home health care aides.
"The technology is just one component," said interim chief executive Sheri Easton-Garrett. "If someone has a fall, we'll install fall sensors, but we'll also do physical therapy in the home to reduce the risk of another spill."
The business venture grew out of a pilot project by Sears Methodist Retirement System Inc. of Abilene. The pilot found that in-home technology can postpone a senior's need for institutional care by an average of 18 to 24 months.
Ms. Easton-Garrett said the cost of the service will start at $35 to $40 per month, which will provide round-the-clock access to a call center staffed by nurses.
The C.C. Young retirement community in the Lake Highlands neighborhood of Dallas plans to partner with Senior Safe at Home early next year to provide care to older adults who want to remain at home, said Ken Durand, C.C. Young president and chief executive.
Mr. Durand sees senior living communities like his becoming testing grounds for technology that promotes independence. "I've learned that it pays to ride a horse in the direction it wants to go," he said.
Competition at work
A number of senior communities are installing home health monitoring systems because they believe the technology gives them a competitive advantage among prospective residents.
Classic Residence by Hyatt will put sensors in the independent-living residences of its planned 3000 Turtle Creek Boulevard building in Dallas, said Chet Phillips, Hyatt's vice president of information technology.
"Residents appreciate a safety system, as long as it's discreet," he said. "We'll place a single sensor between the bedroom and bath. If there's no motion for 24 hours, it'll alert the concierge, who will send someone to check."
Oatfield Estates retirement community near Portland, Ore., is gaining attention for its extensive use of technology. Although many residents have dementia, the facility doesn't rely on locked doors to prevent wandering.
Instead, residents wear lapel pins that let sensors track their movements throughout the six-acre campus. With a resident's permission, family members can sign in at a secure Web site and follow that person's activities.
"Caregivers love it because they feel involved," said Lydia Lundberg, co-owner of Oatfield Estates. "That's especially important if the senior has Alzheimer's disease and can't tell his family what he's done that day."
Ms. Lundberg and her technology team designed the system's software and have begun to market it to other retirement communities through their new company, Elite Care Technologies.
Don Cline lives just minutes from Oatfield Estates, but he visits its Web site several times each day to see what his mother-in-law, 74-year-old Helen Watkins, is doing and what kind of care she's received from the staff.
"She shows up as an icon on my computer screen at home," said the retired air traffic controller. "I can see where she's at, whom she's having lunch with and how quickly the aides respond when she asks for help."
Though the monitoring is voluntary, most residents choose it because it gives them an added sense of security, Ms. Lundberg said.
Oatfield Estates includes the cost in its monthly service fee, which averages $4,800.
Tricking the system
Mr. Dishman of Intel said seniors generally don't object to the monitoring on privacy grounds because they understand that the technology gives them more independence than they otherwise might have.
"They agree to use it because they prefer to be at home or in their own apartment than in a nursing home, where they'd have no privacy at all," he said.
Still, Sears Methodist chief executive Keith Perry admits that a few seniors sometimes resort to an old-fashioned technique to frustrate the newfangled technology.
"Some of the ladies will occasionally pull out a hanky and throw it over the webcam. I guess there's still a certain level of distrust."
06:52 PM CDT on Sunday, August 19, 2007
By BOB MOOS / The Dallas Morning News bmoos@dallasnews.com
Becky Bashor lives 800 miles away, but she can still look into her mother's eyes every night and tell whether she's had a good day or a bad day.
Ms. Bashor sits down at her computer and signs on to AttentiveCare, an Internet-based service that connects caregivers with their loved ones. She can initiate a videoconference with her mother or just watch unnoticed.
"I can see in an instant how she's feeling," Ms. Bashor said. "One evening, I noticed she was limping around her place, and I asked her why. If I had simply called her, she might not have mentioned she had fallen."
As Americans struggle to look after a growing older population coping with the chronic illnesses and frailties of advanced age, they're turning more to new technology – including Web cameras, pillbox monitors, bathroom sensors and fall detectors – to complement their hands-on care.
Baby boomers' longtime fascination with high-tech gadgets has merged with their elder care responsibilities and created a burgeoning market for such in-home devices and services.
"The technology revolution that's already transformed our lives in many ways, from e-mail to cellphones, is about to transform aging, too," said Majd Alwan, director of the Center for Aging Services Technologies, a national coalition of technology companies, senior care providers and universities.
The technology has moved well beyond "I've fallen and I can't get up" buttons.
Today, sensors can collect information about eating, medication use, sleeping and toilet habits and transmit it to the adult children or professional caregivers via the Web.
Other systems detect nighttime wandering and check blood pressure, body temperature and pulse. Bed sensors can even measure whether someone has gained or lost weight.
The systems raise inevitable questions about privacy, but Ms. Bashor's mother, at least, welcomes the videoconferences with her daughter and doesn't mind the camera in her living room.
"The fact that my family can see me and how I'm doing gives me a sense of security," said Esther Coker, who's 86.
Entrepreneurs in action
Giant companies such as Honeywell International Inc., Intel Corp. and Philips are entering the market, but much of the technology has come from entrepreneurs and start-up companies.
The AttentiveCare system, developed by Caregiver Technologies Inc. of Oklahoma City, provides a virtual window into seniors' homes. It also lets family members post photos of grandchildren and reminders about doctor appointments on the senior's video screen. Caregiver Technologies charges $200 for the setup and $60 a month after that.
Ken Nixon, president of the privately held company, designed the computer software to help with his mother, who was in the early stages of Alzheimer's disease at the time. He has since marketed AttentiveCare over the Internet and by word-of-mouth to about 100 other long-distance caregivers, mostly in the Southwest.
Ms. Bashor's home is in Lawrenceburg, Ind.; her mother lives in Fort Smith, Ark. When Ms. Bashor initiates their videoconferences, a bell rings in her mother's home, and the older woman sits down by the webcam.
"The beauty of this system is that it doesn't require the senior to do anything," Mr. Nixon said. "Most caregivers like to observe unannounced, besides doing videoconferences. You might say they're spying, but they do it out of love."
Another entrepreneur, Vestu Brue of San Antonio, heard friends fret that their aging parents weren't remembering to take their medications. Her answer was a "smart pillbox" called MedSignals that beeps at the appropriate times, dispenses the prescriptions, tracks the use and sends the information to a Web site.
Caregivers then can check whether their loved ones have taken their pills. Clinical trials have found that patients using the device are less likely to miss their medication than those who rely on memory.
Ms. Brue's company, LifeTechniques Inc., will ship the first pillboxes to customers this month. MedSignals sells for $200; caregivers will pay from $3.50 to $15 per month for accessing their seniors' medication use.
Aging in place
Older adults' strong preference to "age in place" is largely propelling the development of the in-home technology, said Richard Lusky, chairman of the applied gerontology department at the University of North Texas.
But the technology benefits family members and professional caregivers as much as it does seniors because it eases the strain of caregiving, he said.
As the 65 and older population doubles over the next 25 years and threatens to overwhelm the nation's long-term care system, the technology may also help delay seniors' nursing home use and hold down costs.
Attracted by the prospect of serving 19 million Americans who care for older adults, Intel has formed a separate research and development unit to create and test an array of home health monitoring products.
"All of our tests have shown that seniors are quite capable of learning and using the technology if they understand the benefits of it," said Eric Dishman, manager of the company's health research and innovation group.
Experts predict the most successful companies in this field will be those that bundle their monitoring and measuring devices into a single package. Right now, Living Independently Group Inc.'s QuietCare may be the most developed system on the market.
With wireless sensors placed throughout the home, QuietCare informs authorized caregivers of any atypical activity that suggests a possible health problem. Frequent bathroom visits might signal trouble, for example.
The private company has sold several thousand systems to individuals and professional caregivers in its 2 ½ years.
QuietCare will soon add a fall detection feature that's triggered when there's an unexplained lack of motion in the older adult's home or room.
"Most existing systems depend on a senior pushing a button for help," said George Boyajian, executive vice president of strategy, research and development for Living Independently. "But in three out of four falls, that doesn't happen."
Austin-based Senior Safe at Home will roll out a system in October that emphasizes both "high tech" and "high touch." The new company will combine home health monitoring equipment with home health care aides.
"The technology is just one component," said interim chief executive Sheri Easton-Garrett. "If someone has a fall, we'll install fall sensors, but we'll also do physical therapy in the home to reduce the risk of another spill."
The business venture grew out of a pilot project by Sears Methodist Retirement System Inc. of Abilene. The pilot found that in-home technology can postpone a senior's need for institutional care by an average of 18 to 24 months.
Ms. Easton-Garrett said the cost of the service will start at $35 to $40 per month, which will provide round-the-clock access to a call center staffed by nurses.
The C.C. Young retirement community in the Lake Highlands neighborhood of Dallas plans to partner with Senior Safe at Home early next year to provide care to older adults who want to remain at home, said Ken Durand, C.C. Young president and chief executive.
Mr. Durand sees senior living communities like his becoming testing grounds for technology that promotes independence. "I've learned that it pays to ride a horse in the direction it wants to go," he said.
Competition at work
A number of senior communities are installing home health monitoring systems because they believe the technology gives them a competitive advantage among prospective residents.
Classic Residence by Hyatt will put sensors in the independent-living residences of its planned 3000 Turtle Creek Boulevard building in Dallas, said Chet Phillips, Hyatt's vice president of information technology.
"Residents appreciate a safety system, as long as it's discreet," he said. "We'll place a single sensor between the bedroom and bath. If there's no motion for 24 hours, it'll alert the concierge, who will send someone to check."
Oatfield Estates retirement community near Portland, Ore., is gaining attention for its extensive use of technology. Although many residents have dementia, the facility doesn't rely on locked doors to prevent wandering.
Instead, residents wear lapel pins that let sensors track their movements throughout the six-acre campus. With a resident's permission, family members can sign in at a secure Web site and follow that person's activities.
"Caregivers love it because they feel involved," said Lydia Lundberg, co-owner of Oatfield Estates. "That's especially important if the senior has Alzheimer's disease and can't tell his family what he's done that day."
Ms. Lundberg and her technology team designed the system's software and have begun to market it to other retirement communities through their new company, Elite Care Technologies.
Don Cline lives just minutes from Oatfield Estates, but he visits its Web site several times each day to see what his mother-in-law, 74-year-old Helen Watkins, is doing and what kind of care she's received from the staff.
"She shows up as an icon on my computer screen at home," said the retired air traffic controller. "I can see where she's at, whom she's having lunch with and how quickly the aides respond when she asks for help."
Though the monitoring is voluntary, most residents choose it because it gives them an added sense of security, Ms. Lundberg said.
Oatfield Estates includes the cost in its monthly service fee, which averages $4,800.
Tricking the system
Mr. Dishman of Intel said seniors generally don't object to the monitoring on privacy grounds because they understand that the technology gives them more independence than they otherwise might have.
"They agree to use it because they prefer to be at home or in their own apartment than in a nursing home, where they'd have no privacy at all," he said.
Still, Sears Methodist chief executive Keith Perry admits that a few seniors sometimes resort to an old-fashioned technique to frustrate the newfangled technology.
"Some of the ladies will occasionally pull out a hanky and throw it over the webcam. I guess there's still a certain level of distrust."
Monday, August 27, 2007
computers make life easy for elders
Computers Make Life Better for the Elderly
"There are three signs of old age," the old joke goes. "First is loss of memory. And I forget the other two." That makes me smile -- but what's underlying this common stereotype about seniors is really not so funny. We all know that age-related mental decline takes simple forgetfulness to far more painful levels.
Computers, of all things, can help -- and not just because they store so much information. It's been demonstrated that brain-teasers and games can help keep mental faculties sharp, and in the past, studies have hinted that computer-based brain games can be especially helpful. (I say "hinted" since many were funded or conducted by software companies with a stake in the outcome.) One I found particularly interesting was recently conducted at the Tel Aviv Sourasky Medical Center of Tel Aviv University in Israel, where a clinical trial compared the cognitive improvements of 121 participants age 50 and older. They were asked to use a sophisticated brain-training program called MindFit or classic computer games (such as Tetris or Labyrinth) 30 minutes a day, three times a week for three months.
PICK A GAME... ANY GAME
Yes, this was one of those studies that received funding by a software company to test their products, so I took their conclusions on that front with a grain of salt. But what grabbed my attention was that in this case, regardless of which computer game or program they used, both study groups experienced improvements in areas such as short-term memory, memory recall and focused attention. The very act of focusing -- attentive participation involving higher order thinking, information integration and judgment -- on mental computer tasks appears to be what helps keep the mind sharp... and that is consistent with past research.
Add to that some of the other ways computers can expand horizons -- including building or maintaining social connections, providing access to information on virtually any topic, and even offering the potential to contribute a valued service to a business or nonprofit -- and it seems an excellent idea to encourage computer use by seniors in your life who aren't already connected.
PROVIDING TECH SUPPORT
A common problem is that computers can be frustratingly difficult for people who lack experience with them. Memory issues, lack of confidence and often sensory problems and decreasing motor skills present obstacles that can seem insurmountable -- but they need not be.
I spoke with Scott Rains, senior advisor to with-tv.com (a television station serving people with disabilities) and former director of programs and services at SeniorNet.org, a nonprofit organization that specializes in computer and Internet education for older adults and seniors. He offered advice on how to help computer-wary seniors get started and/or become more comfortable with the computer...
Focus on their interests. Rains suggests starting with a conversation to assess how a computer can (and actually will) be used, prior to buying equipment and software. For instance, says Rains, grandparents may be interested in staying in touch with family through e-mail or receiving regular digital photo updates, while people who enjoy travel may like the convenience of the many travel resources on the Internet. A benefit for housebound seniors may be that they can let their "fingers do their shopping."
Get the right equipment. Seniors with physical disabilities such as arthritis or poor eyesight, may believe these barriers stand in the way of using a computer. That's not usually the case, as specialized equipment is available to adapt computers for just about any disability or challenge. For example, arthritis sufferers can benefit from large-key keyboards, such as those made by BigKeys Keyboards (http://link.dhn.bottomlinesecrets.com/h/2MWE/HF93/CM/IEIFY) and also specialized "mice" like those from the SmartSolutionPartners (http://link.dhn.bottomlinesecrets.com/h/D9RH/HF93/CM/IEIFY). People with poor vision do better with large-print keyboards, such as those made by ZoomText or screen magnification programs, like BigShot (both at http://link.dhn.bottomlinesecrets.com/h/BES1/HF93/CM/IEIFY).
Take a class. For most inexperienced computer users, success depends on learning how to use the hardware and software. Fortunately there are many resources. "You can find classes at continuing education centers, adult education centers, senior centers, community colleges, libraries and more," says Rains, noting that there are more than 200 SeniorNet Learning Centers across the country, as well. The best senior-oriented computer classes are small, use lots of visual aids, provide a handbook for use at home, work at a pace that allows for plenty of questions and repetition, and are focused on personal enrichment -- not speed, competition or job certification, he says. Ask questions about what classes emphasize before signing up.
Enlist a friendly expert. There are plenty of resources for people who need in-home help setting up computers or solving problems -- including national franchises such as Best Buy, which has partnered with Geek Squad. There is also geeksontime.com. But, says Rains, for computer beginners it can be best to enlist the help of a tech-savvy friend or family member. "You're going to get the best results through an interaction between friends," Rains says. "There's a level of comfort and trust, and a shared culture and language that helps them relate to one another."
Source(s): Scott Rains, senior advisor to with-tv.com and former director of programs and services, SeniorNet.org.
"There are three signs of old age," the old joke goes. "First is loss of memory. And I forget the other two." That makes me smile -- but what's underlying this common stereotype about seniors is really not so funny. We all know that age-related mental decline takes simple forgetfulness to far more painful levels.
Computers, of all things, can help -- and not just because they store so much information. It's been demonstrated that brain-teasers and games can help keep mental faculties sharp, and in the past, studies have hinted that computer-based brain games can be especially helpful. (I say "hinted" since many were funded or conducted by software companies with a stake in the outcome.) One I found particularly interesting was recently conducted at the Tel Aviv Sourasky Medical Center of Tel Aviv University in Israel, where a clinical trial compared the cognitive improvements of 121 participants age 50 and older. They were asked to use a sophisticated brain-training program called MindFit or classic computer games (such as Tetris or Labyrinth) 30 minutes a day, three times a week for three months.
PICK A GAME... ANY GAME
Yes, this was one of those studies that received funding by a software company to test their products, so I took their conclusions on that front with a grain of salt. But what grabbed my attention was that in this case, regardless of which computer game or program they used, both study groups experienced improvements in areas such as short-term memory, memory recall and focused attention. The very act of focusing -- attentive participation involving higher order thinking, information integration and judgment -- on mental computer tasks appears to be what helps keep the mind sharp... and that is consistent with past research.
Add to that some of the other ways computers can expand horizons -- including building or maintaining social connections, providing access to information on virtually any topic, and even offering the potential to contribute a valued service to a business or nonprofit -- and it seems an excellent idea to encourage computer use by seniors in your life who aren't already connected.
PROVIDING TECH SUPPORT
A common problem is that computers can be frustratingly difficult for people who lack experience with them. Memory issues, lack of confidence and often sensory problems and decreasing motor skills present obstacles that can seem insurmountable -- but they need not be.
I spoke with Scott Rains, senior advisor to with-tv.com (a television station serving people with disabilities) and former director of programs and services at SeniorNet.org, a nonprofit organization that specializes in computer and Internet education for older adults and seniors. He offered advice on how to help computer-wary seniors get started and/or become more comfortable with the computer...
Focus on their interests. Rains suggests starting with a conversation to assess how a computer can (and actually will) be used, prior to buying equipment and software. For instance, says Rains, grandparents may be interested in staying in touch with family through e-mail or receiving regular digital photo updates, while people who enjoy travel may like the convenience of the many travel resources on the Internet. A benefit for housebound seniors may be that they can let their "fingers do their shopping."
Get the right equipment. Seniors with physical disabilities such as arthritis or poor eyesight, may believe these barriers stand in the way of using a computer. That's not usually the case, as specialized equipment is available to adapt computers for just about any disability or challenge. For example, arthritis sufferers can benefit from large-key keyboards, such as those made by BigKeys Keyboards (http://link.dhn.bottomlinesecrets.com/h/2MWE/HF93/CM/IEIFY) and also specialized "mice" like those from the SmartSolutionPartners (http://link.dhn.bottomlinesecrets.com/h/D9RH/HF93/CM/IEIFY). People with poor vision do better with large-print keyboards, such as those made by ZoomText or screen magnification programs, like BigShot (both at http://link.dhn.bottomlinesecrets.com/h/BES1/HF93/CM/IEIFY).
Take a class. For most inexperienced computer users, success depends on learning how to use the hardware and software. Fortunately there are many resources. "You can find classes at continuing education centers, adult education centers, senior centers, community colleges, libraries and more," says Rains, noting that there are more than 200 SeniorNet Learning Centers across the country, as well. The best senior-oriented computer classes are small, use lots of visual aids, provide a handbook for use at home, work at a pace that allows for plenty of questions and repetition, and are focused on personal enrichment -- not speed, competition or job certification, he says. Ask questions about what classes emphasize before signing up.
Enlist a friendly expert. There are plenty of resources for people who need in-home help setting up computers or solving problems -- including national franchises such as Best Buy, which has partnered with Geek Squad. There is also geeksontime.com. But, says Rains, for computer beginners it can be best to enlist the help of a tech-savvy friend or family member. "You're going to get the best results through an interaction between friends," Rains says. "There's a level of comfort and trust, and a shared culture and language that helps them relate to one another."
Source(s): Scott Rains, senior advisor to with-tv.com and former director of programs and services, SeniorNet.org.
Saturday, August 18, 2007
Retirement cost USA
This is a frightening reality of the high cost of aging - this is a universal problem that must be addressed.
Long-Term Care Insurance
Download PDF Version
Thinking about getting older may not be one of your favorite pastimes. But planning for it is essential.
The average cost of one year in a nursing home now exceeds $70,000, but the average net worth of 65 year olds is only $110,000.1,2 This means you could blow through everything you have, including your home, in 18 months or less.
Maybe you’re only in your 40s now and hardly think of your golden years? That’s trouble – the estimated average cost for one year in a nursing home in 2030 is $190,000.3
Now, many of you might be saying to yourselves, “But I don’t want to go to a nursing home” … and you’re not alone there. No one wants to think of themselves as incapable of their own care or consider having someone else run their lives. But the reality is that 60% of current 65 year olds will require some kind of long-term care in their lifetime – either at home, in an assisted living facility, or in a nursing home.4
That’s why so many people are looking with renewed interest at long-term care insurance, a safety-net concept for seniors that has been around for quite some time, but is now suddenly more relevant than ever.
What is long-term care, exactly? It’s different from what most Americans think of as health care, and it usually isn’t covered by health insurance policies, HMO plans or Medicare supplemental policies. Long-term care can range from basic help with tasks around the house to more essential assistance with activities of daily living – like bathing, eating or getting dressed.
Of course, when you’re in your 40s, 50s, or 60s, it’s difficult to predict how much care you’re going to need down the line. But you shouldn’t let that stop you from making financial plans. Currently, only 7% of American seniors have enough saved to cover even one year of nursing home care.2 Thus, 70% of single people and 50% of married couples who require long-term care become destitute.4
You’re not alone, either, if you think you’ll be able to fall back on family members or friends if you get into trouble, and you’ll be able to age in place at home. This might work for some -- if you’re lucky and aren’t disabled or markedly ill, if you don’t have Alzheimer’s or dementia, and if your family is supportive. In fact, nearly 70% of seniors currently receive volunteer care from their family and friends. But looking ahead, this safety net is likely to weaken. With the size of the American family getting smaller, there are fewer adult children to do the caregiving. Also, children live farther away from their parents than they did a generation ago. And lastly, many more women are a part of the workforce now. This changes the future landscape because, out of the current 23 million unpaid caregivers in the U.S., 70% are women. When you consider the unpaid caregivers who provide 40 or more hours of care a week, 80% are women. Given all these factors, it’s obvious that the percentage of seniors who can fully depend on informal caregiving until they die will shrink. 4
In addition to family and friends, Medicaid has traditionally been another fallback for long-term care. Through a variety of legal loop holes, a failing senior or his/her family can “spend down” their assets, basically causing themselves to go broke on paper and then qualify for government payments to a nursing home. But as our society has aged and costs have risen, Medicaid, a partnership between state and federal government, is feeling the strain. Medicaid expenditures now account for about 25% of the average state budget.4 In response, the Deficit Reduction Act of 2005 modified the rules, making it somewhat more difficult, though not impossible, to qualify for Medicaid coverage.5
Are you getting the picture yet? Unless you can afford to pay $70,000 a year now, or an estimated $190,000 per year in 2030, you need to think about long-term care insurance. The policies are increasingly common and flexible, but, of course, they’re not free. It can cost a 55 year old $5,000 per year for a plan that provides $200 per day for a lifetime with an annual 5% inflation adjustment and an initial 60-day waiting period. That probably puts this type of insurance out of reach for a good number of people. But here are a few things you can do to bring down the cost.
Limit the benefit period. Only 8% of seniors require coverage for more than five years. If you go with 5 years of coverage versus lifetime, you’ll save $2,000 per year.3
If you’re married, consider a shared policy. Plans now allow couples to buy two policies almost for the cost of one, and you can share the years. Two six-year policies with a $150 daily benefit can be had for $3,300 a year. So for $1,650 a person, you get 12 years of total coverage that can be split as needed. If a husband requires three years of coverage before passing away, his wife still has nine years of protection in front of her.3
Don’t be penny wise and dollar foolish on key benefits. Since costs can be unexpectedly enormous, be careful with waiting periods. Going from a 90-day to a 180-day waiting period will save you about $200 per year. But if you are unlucky enough to have a debilitating stroke, those first 6 months of uncompensated care in a nursing home will cost you $36,000. Also, be sure to purchase some inflation protection that at least upgrades benefits to match increases in the consumer price index. 3
If you’re in your 50s and healthy, look for an individual policy versus a group policy. Otherwise, you’ll be factoring in the actuarial cost of individuals who are less well than you. And compare prices from a few insurers, including name brands like Genworth Financial, John Hancock, MassMutual, MetLife, New York Life, and Prudential.
The bottom line? You’re not going to be young forever. Set aside some time and money to ensure you’ll have the care you need when the time comes.
For Health Politics, I’m Mike Magee.
Long-Term Care Insurance
Download PDF Version
Thinking about getting older may not be one of your favorite pastimes. But planning for it is essential.
The average cost of one year in a nursing home now exceeds $70,000, but the average net worth of 65 year olds is only $110,000.1,2 This means you could blow through everything you have, including your home, in 18 months or less.
Maybe you’re only in your 40s now and hardly think of your golden years? That’s trouble – the estimated average cost for one year in a nursing home in 2030 is $190,000.3
Now, many of you might be saying to yourselves, “But I don’t want to go to a nursing home” … and you’re not alone there. No one wants to think of themselves as incapable of their own care or consider having someone else run their lives. But the reality is that 60% of current 65 year olds will require some kind of long-term care in their lifetime – either at home, in an assisted living facility, or in a nursing home.4
That’s why so many people are looking with renewed interest at long-term care insurance, a safety-net concept for seniors that has been around for quite some time, but is now suddenly more relevant than ever.
What is long-term care, exactly? It’s different from what most Americans think of as health care, and it usually isn’t covered by health insurance policies, HMO plans or Medicare supplemental policies. Long-term care can range from basic help with tasks around the house to more essential assistance with activities of daily living – like bathing, eating or getting dressed.
Of course, when you’re in your 40s, 50s, or 60s, it’s difficult to predict how much care you’re going to need down the line. But you shouldn’t let that stop you from making financial plans. Currently, only 7% of American seniors have enough saved to cover even one year of nursing home care.2 Thus, 70% of single people and 50% of married couples who require long-term care become destitute.4
You’re not alone, either, if you think you’ll be able to fall back on family members or friends if you get into trouble, and you’ll be able to age in place at home. This might work for some -- if you’re lucky and aren’t disabled or markedly ill, if you don’t have Alzheimer’s or dementia, and if your family is supportive. In fact, nearly 70% of seniors currently receive volunteer care from their family and friends. But looking ahead, this safety net is likely to weaken. With the size of the American family getting smaller, there are fewer adult children to do the caregiving. Also, children live farther away from their parents than they did a generation ago. And lastly, many more women are a part of the workforce now. This changes the future landscape because, out of the current 23 million unpaid caregivers in the U.S., 70% are women. When you consider the unpaid caregivers who provide 40 or more hours of care a week, 80% are women. Given all these factors, it’s obvious that the percentage of seniors who can fully depend on informal caregiving until they die will shrink. 4
In addition to family and friends, Medicaid has traditionally been another fallback for long-term care. Through a variety of legal loop holes, a failing senior or his/her family can “spend down” their assets, basically causing themselves to go broke on paper and then qualify for government payments to a nursing home. But as our society has aged and costs have risen, Medicaid, a partnership between state and federal government, is feeling the strain. Medicaid expenditures now account for about 25% of the average state budget.4 In response, the Deficit Reduction Act of 2005 modified the rules, making it somewhat more difficult, though not impossible, to qualify for Medicaid coverage.5
Are you getting the picture yet? Unless you can afford to pay $70,000 a year now, or an estimated $190,000 per year in 2030, you need to think about long-term care insurance. The policies are increasingly common and flexible, but, of course, they’re not free. It can cost a 55 year old $5,000 per year for a plan that provides $200 per day for a lifetime with an annual 5% inflation adjustment and an initial 60-day waiting period. That probably puts this type of insurance out of reach for a good number of people. But here are a few things you can do to bring down the cost.
Limit the benefit period. Only 8% of seniors require coverage for more than five years. If you go with 5 years of coverage versus lifetime, you’ll save $2,000 per year.3
If you’re married, consider a shared policy. Plans now allow couples to buy two policies almost for the cost of one, and you can share the years. Two six-year policies with a $150 daily benefit can be had for $3,300 a year. So for $1,650 a person, you get 12 years of total coverage that can be split as needed. If a husband requires three years of coverage before passing away, his wife still has nine years of protection in front of her.3
Don’t be penny wise and dollar foolish on key benefits. Since costs can be unexpectedly enormous, be careful with waiting periods. Going from a 90-day to a 180-day waiting period will save you about $200 per year. But if you are unlucky enough to have a debilitating stroke, those first 6 months of uncompensated care in a nursing home will cost you $36,000. Also, be sure to purchase some inflation protection that at least upgrades benefits to match increases in the consumer price index. 3
If you’re in your 50s and healthy, look for an individual policy versus a group policy. Otherwise, you’ll be factoring in the actuarial cost of individuals who are less well than you. And compare prices from a few insurers, including name brands like Genworth Financial, John Hancock, MassMutual, MetLife, New York Life, and Prudential.
The bottom line? You’re not going to be young forever. Set aside some time and money to ensure you’ll have the care you need when the time comes.
For Health Politics, I’m Mike Magee.
Friday, August 17, 2007
Trend:Mexican nursing homes see U.S. influx - FierceHealthcare - Healthcare industry, Healthcare news, Healthcare company, Healthcare trend
Trend:Mexican nursing homes see U.S. influx - FierceHealthcare - Healthcare industry, Healthcare news, Healthcare company, Healthcare trend: "Here's a new example of medical tourism, or at least the export of U.S. medical needs. Increasingly, patients needing nursing care are taking up residence in Mexican nursing homes, particularly patients who live near the border. Not only are Americans coming in and moving straight into nursing homes, the approximately 40,000 to 80,000 American retirees already living in Mexico are trickling into the nursing homes as well. Patients in Mexico typically get dramatically cheaper rates--as little as a quarter of what they pay in the U.S.--along with additional perks like satellite TV, laundry and cleaning service, plus beautiful landscapes and warm weather. They also get access to medical care from the Mexican Social Security Institute, which runs clinics and hospitals across Mexico and allows foreigners to enroll in its program even if they've never worked in the country. Because nursing and assisted-living facilities are a new phenomenon in Mexico, they're not well-regulated as of yet. Smaller facilities run out of homes are a particular risk, according to some critics. However, most facilities seem to be meeting patients' expectations. Look for this to be a huge phenomenon over the next decade, as baby boomers look at local nursing home prices, choke and head for the border."
nursing home trends -usa
Nursing Homes Luring Short-Term Patients
By MARC LEVY, Associated Press Writer
Sunday, March 25, 2007
Back to Health
sfgate_get_fprefs();
(03-25) 16:11 PDT Hatboro, Pa. (AP) --
John Smyth needed more than the big flat-screen TV, towel warmers and homelike furniture offered at the Willow Ridge Center to persuade him to stay in the nursing home's rehab unit following knee-joint replacement.
What sold the 70-year-old retired plumber was the ability to sleep, eat and exercise in space separate from the suburban Philadelphia home's long-term patients — "the really older people," he calls them.
"Both parents died in a nursing home and I guess that sort of put me against it a little bit," said Smyth, a six-inch stripe of metal staples still adorning his garishly swollen right knee.
With billions of dollars at stake, nursing homes across the nation are rushing to reinvent themselves to compete with hospitals and affiliated rehabilitation facilities for short-term, higher-paying patients like Smyth. They are spending hundreds of millions of dollars on renovations and additions and new features like aromatherapy, brightly colored decor, spacious therapy gyms and Internet cafes to try to create a new, warmer, less institutional image.
Most often, they are providing postoperative rehabilitation for knee- and hip-joint patients, but heart attack and stroke victims are also coming in for therapy. Though many are retirees, others are still in the work force and some patients are as young as their 20s.
Offering treatment at lower costs, nursing homes are undeterred by criticism that they do not have the expertise that hospitals do, and that some data show a decline in the quality of their rehab care.
One of the nation's largest nursing-home chains, Toledo, Ohio-based Manor Care Inc., has been among the most aggressive in seeking out short-term patients.
Several Manor Care nursing homes, including one in Boca Raton, Fla., now handle primarily rehab patients and about half of all the patients in the company's 280 nursing homes are now discharged in under a month, said chief operating officer Stephen Guillard.
In its 2005 annual report, Manor Care credited its shifting focus to rehab patients for its revenue growth, which exceeded 6 percent that year.
The prospect of bigger payments has spurred a pace of building unusual for an industry with many properties dating to the 1970s, and which has seen home-based care and assisted-living facilities compete for the older, sicker patients who, while less profitable, have been their core customers for decades.
By MARC LEVY, Associated Press Writer
Sunday, March 25, 2007
Back to Health
sfgate_get_fprefs();
(03-25) 16:11 PDT Hatboro, Pa. (AP) --
John Smyth needed more than the big flat-screen TV, towel warmers and homelike furniture offered at the Willow Ridge Center to persuade him to stay in the nursing home's rehab unit following knee-joint replacement.
What sold the 70-year-old retired plumber was the ability to sleep, eat and exercise in space separate from the suburban Philadelphia home's long-term patients — "the really older people," he calls them.
"Both parents died in a nursing home and I guess that sort of put me against it a little bit," said Smyth, a six-inch stripe of metal staples still adorning his garishly swollen right knee.
With billions of dollars at stake, nursing homes across the nation are rushing to reinvent themselves to compete with hospitals and affiliated rehabilitation facilities for short-term, higher-paying patients like Smyth. They are spending hundreds of millions of dollars on renovations and additions and new features like aromatherapy, brightly colored decor, spacious therapy gyms and Internet cafes to try to create a new, warmer, less institutional image.
Most often, they are providing postoperative rehabilitation for knee- and hip-joint patients, but heart attack and stroke victims are also coming in for therapy. Though many are retirees, others are still in the work force and some patients are as young as their 20s.
Offering treatment at lower costs, nursing homes are undeterred by criticism that they do not have the expertise that hospitals do, and that some data show a decline in the quality of their rehab care.
One of the nation's largest nursing-home chains, Toledo, Ohio-based Manor Care Inc., has been among the most aggressive in seeking out short-term patients.
Several Manor Care nursing homes, including one in Boca Raton, Fla., now handle primarily rehab patients and about half of all the patients in the company's 280 nursing homes are now discharged in under a month, said chief operating officer Stephen Guillard.
In its 2005 annual report, Manor Care credited its shifting focus to rehab patients for its revenue growth, which exceeded 6 percent that year.
The prospect of bigger payments has spurred a pace of building unusual for an industry with many properties dating to the 1970s, and which has seen home-based care and assisted-living facilities compete for the older, sicker patients who, while less profitable, have been their core customers for decades.
Subscribe to:
Posts (Atom)