24 7 Care For Elderly – The Caring Generation®

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The Caring Generation® – Episode 87, May 26, 2021. On this caregiver program, expert Pamela D Wilson shares the different meanings of 24 7 care for the Elderly, including insights for family caregivers told by the healthcare system that parents need 24 7 care, plus prevention tips for all adults. Guest. Dr. Joseph Cafazzo from the Centre for Global eHealth Innovation talks about how healthcare technology is allowing adults to manage health and stay out of the hospital.

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What Is 24 7 Care for the Elderly?

0:00:04.0 Announcer: Caregiving can sometimes feel like an impossible struggle. Caregivers may be torn between taking care of loved ones and trying to maintain balance in life. The good news is that it doesn’t have to be that way. The Caring Generation, with host Pamela D. Wilson, is here to focus on the conversation of caring. You’re not alone. In fact, you’re in exactly the right place to share stories and learn tips and resources to help you and your loved ones. So now, please welcome the host of The Caring Generation, Pamela D. Wilson.

Curious About 24 7 Care for the Elderly?

Watch More Videos About Caregiving and Aging on Pamela’s YouTube Channel

0:00:37:23 Pamela D Wilson: This is Pamela D. Wilson, caregiving expert, speaker, consultant, and guardian of The Caring Generation. The Caring Generation focuses on the conversation of caring, giving us permission to talk about aging, the challenges of caregiving, and everything in between.  It’s no surprise that needing care or becoming a caregiver changes everything. The Caring Generation is here to guide you along the journey to let you know that you’re not alone.

0:1:07:26 Pamela D Wilson: You’re in exactly the right place to share stories, learn tips and resources to help you and your loved ones plan for what’s ahead. Invite your family, and friends to listen to the show each week. This week we are talking about 24 7 care for elderly parents. We will talk about how 24 7 care situations arise and result in a need for around-the-clock 24 7 care.

01:39:02 Pamela D Wilson: I’ll share insights on whether 24 7 care is truly mandatory when families hear this recommendation from a hospital, nursing home staff, or a doctor. Then, what is life like for 24 7 caregivers? What happens if you are a family member who took time off work to be with a parent who needed 24 7 care? How do you know when or if you can leave a parent’s home to return to work? There are many, many considerations and decisions to be made around 24 7 care for elderly parents and the goal to return a parent to a level of living independently.

02:25:62 Pamela D Wilson: We will talk about all of these and more. In the second segment of the show, Dr. Anthony Cafazzo joins us. He is a biomedical engineer and Lead of the Centre for Global eHealth Innovation at the University Health Network, a state-of-the-art research facility hosting 70 staff and students devoted to the evaluation and design of healthcare technology. He is based at Toronto General Hospital. If you’re not familiar with healthcare technology, think of blood pressure machines you might have at home, digital thermometers, and other types of devices now available to monitor health and make staying at home and out of the hospital easier.

03:18:84 Pamela D Wilson: Let’s begin with the definition of 24 7 care. The term 24 7 care is the terminology used primarily by individuals working in the fields of home care, home health care, care communities, nursing homes, and hospitals. When an aging parent or another loved one is said to need 24 7 care, this means that the parent may be at risk of injury or safety concerns if left alone for any time during 24 hours. 24 7 care can also apply to the care needed by family members with dementia, Alzheimer’s disease, or another cognitive impairment that makes it unsafe for this person to live alone.

04:10:95 Pamela D Wilson: Family caregivers usually first hear 24 7 care after an elderly parent is hospitalized. Another time that 24 7 care may be mentioned is when a parent is in a nursing home for rehabilitation after a hip fracture or another health issue. Care staff in the nursing home may tell you that an elderly parent can’t go home unless 24 7 care is arranged.  If a parent previously lived alone at home, the individual’s goal or the family’s wish is usually for mom or dad to return home and live independently.

04:54:74 Pamela D Wilson: Depending on the condition of health of your parent before the hospitalization, returning home may be simple or it may involve arranging help in the home and monitoring health conditions. Suppose that your parent is in the hospital or a nursing home. The staff tells you that mom or dad can’t go home without 24 7 care. If you are a son or daughter who works full time, you may be shocked to hear a requirement mentioning 24 7 care, especially if you are new to caregiving.

05:32:22 Pamela D Wilson: You may be wondering how you are going to arrange to hire caregivers or be the caregiver who takes care of a parent 24 7. How do you really know if 24 7 care is necessary? If you are new to navigating your way through the healthcare system of hospitals and nursing homes, know that it may not be. If you are a new caregiver, you may feel intimidated by the care staff telling you and your parent what you need.

06:03:03 Pamela D Wilson: Mom or dad may be saying that she or he doesn’t need any help at home. After all, the word “help” can have a negative connotation. Meaning that a person who needs help is viewed as being incapable of doing something. In this case, taking care of him or herself. Caregivers, more than aging parents, resist the mention of needing help. In evaluating mom or dad’s situation – if they have been in a hospital or a nursing home—they are more likely to be physically weaker than before the hospitalization or nursing home stay. What can you expect?

06:45:81 Pamela D Wilson: Because this situation has never happened before, or maybe it has, you might be unsure how quickly mom or dad will return to their “pre-hospitalization” level of ability or even wonder if this is possible. At this point, it’s best to have a serious talk with an aging parent about the level of independence necessary to return home. The question for caregivers is—how do you know what effort your parents will have to make? What is your involvement and commitment level based on the present situation?

07:26:14 Pamela D Wilson: If your parent is relatively healthy—the effort may be minimal. However, if your parent can’t physically do everything that he or she did before the hospitalization, you are faced with a problem and an opportunity.  Here are a few questions to ask. Will your parent work to do the physical therapy exercises provided by the nursing home staff to avoid or minimize the need for permanent 24 7 care when mom or dad returns home?

08:05:77 Pamela D Wilson: Will or can mom or dad commit to following doctor’s orders and go above and beyond to establish habits that support better health and more physical activity? If not, it’s time to begin conversations about paid-in-home caregivers options or moving to a care community. Talking about being unable to take care of oneself—rather than not talking about it or delaying the conversation about moving—serves a couple of purposes.

08:42:64 Pamela D Wilson: It helps you, the caregiver, set boundaries about the level of time or money you can commit. The primary caregiver frequently overcommits and becomes exhausted and overwhelmed from taking on too much responsibility. While you might feel a commitment to help parents stay at home, the question to ask at this stage is how committed is your parent to return to a high level of physical independence?

09:15:75 Pamela D Wilson: If you have been helping your parent for some time, you might be able to answer this question with a certain degree of confidence. Are you looking at a 50% or better likelihood of independence or less than 10% chance that a parent will have the motivation and the ability to do what it takes to return to live independently? At first, a little extra care can be a good thing. But if this care becomes permanent, what then?

9:50:24 Pamela D Wilson: You want to avoid a parent or a spouse who can do things for him or herself becoming dependent on you or someone else. Caregivers become frustrated when parents or spouses become apathetic and don’t seem to care, but they don’t realize that the caregiver created the situation by being too helpful. Many caregivers don’t realize that a critical decision point exists each time an elderly parent or spouse is hospitalized or has a nursing home stay.

10:29:09 Pamela D Wilson: These events are indeed a physical and emotional battle—for a parent or a spouse—to be tenacious and not to give up. If a loved one has dementia or Alzheimer’s disease, hospitalizations and nursing home stays are usually a step down to permanently requiring more care. Memory loss means that individuals lose the ability to recognize the skills they just lost. Without significant hands-on care, prompting, and direction, it is challenging for people with memory loss to regain their physical abilities. But I can tell you, it is possible.

11:13:28 Pamela D Wilson: I had clients with dementia who did very well when I created a care plan with scheduled daily activities—and I had a caregiver maintain the schedule. For loved ones that don’t have memory loss, establishing equal participation in care is essential so that that caregiver does not become responsible for taking on total responsibility for a 24 7 care situation. As you know, or as you might imagine, there are many decisions and considerations to set up 24 7 care for a parent returning home from a hospital or nursing home stay.

11:55:38 Pamela D Wilson: If you’re not sure what steps to take, if you are unsure what is involved, take a look at my online course. It’s called Taking Care of Elderly Parents: Stay at Home. Included in the online course that is available 24 7 are the processes that I used to make sure that my clients who lived in their homes— including some who had 24 7 care—could remain living in their homes and be as independent as possible. In the third segment of this show, we’ll talk about why parents need 24 7 care after a hospitalization or a nursing home visit.

09:30:00 Pamela D Wilson: Up next, Dr. Joseph Cafazzo, the Lead of the Centre for Global eHealth Innovation at the University Health Network, a state-of-the-art research facility hosting 70 staff and students devoted to the evaluation and design of healthcare technology, based at Toronto General Hospital. As a biomedical engineer, Dr. Cafazzo observes healthcare delivery from the inside out and works on ways to keep people out of the hospital by creating technologies that allow for self-care at home.

13:13:32 Pamela D Wilson: He will share information about up and coming technologies that diagnose chronic disease before the disease occurs—or that helps manage the disease. One example we’ll talk about is the technology for early detection of Alzheimer’s disease. Stay with me to learn more. Check out the podcast page on my website or set up a reminder in your podcast app to listen to new episodes of The Caring Generation each Wednesday. The show is not limited by time zone or location—caregivers worldwide listen.

13:45:07 Pamela D Wilson: Install the podcast on app Apple, Google, Spreaker on your cellphone. Add the app to the cellphone of grandma, grandpa, mom, dad, brothers, sisters, friends, and colleagues so everyone can become more informed about health, aging, and caregiving. The more information you have—the better decisions you will make. I’m Pamela Wilson on The Caring Generation. Stay with me; I’ll be right back.


14:40:08 Pamela D Wilson: This is Pamela D Wilson caregiving expert, speaker, and elder care consultant on The Caring Generation. The only program of its kind caring to bring helpful information about aging, caregiving, health, and everything in between to caregivers and aging adults. I’d like you to meet Dr. Anthony Cafazzo.

15:00:57 Pamela D Wilson: Dr. Cafazzo, thank you so much for joining me.

15:02:87 Dr. Joseph Cafazzo: Happy to, thank you, Pamela

15:06:32 Pamela D Wilson: Can you share the priorities of your work at Human Factors since 2004?

15:10:92 Dr. Joseph Cafazzo: Yes, so we were born out of the Center for Global Health Innovation which really its mandate was to look at the hospital because we are located right within Toronto General Hospital in downtown Toronto. Our mandate was to look at what we could do about changing models of care. Perhaps facilitate it through good design and technology about making the hospital the place of last resort. We saw trends in healthcare delivery and you know there was a strong feeling that the idea of traditional acute care facilities—bricks and mortar—and simply waiting for patients to decompensate from their chronic condition, waiting for them and entering our ED, treating them, and then sending them back into the community was not in anyone’s interest. And we really wanted to explore new models of care, better design, better models of care that were facilitated using technology. And that’s how we started.

16:21:10 Pamela D Wilson: Can you talk about how technology is changing the management of health conditions?

16:26:64 Dr. Joseph Cafazzo: Yes. I think the biggest trend. It’s not as if healthcare has been, you know, not using technology. But usually, in fact, some of the most innovative technologies in all sectors are used in healthcare. Some really advanced imaging, advanced therapeutics, and diagnostics, incredible technology that’s used in healthcare. It’s actually not in the hands of patients, however. And so, I think the biggest trend is towards patients having access to technologies that allow them to care for themselves in a more timely way. In their home, at work, where they live. And actually, sort of taking more responsibility for their own care and moving the focus of care away from healthcare organizations.

17:21:12 Dr. Joseph Cafazzo: Because many people who live with chronic conditions—they live with this 24 7. They live with the symptoms and the consequences of chronic illness and the health system, they only interact with the system for very short periods. So how could we use that time, enabling people living with a chronic condition—any health condition—through the use of information and the use of tools, and more timely access? And that could be in the form of over just what we’ve seen since the beginning of the pandemic, is the convenience of being able to visit with your doctor remotely. But more importantly, that’s not as big of an innovation as the use of information, and sensors, and software to help people manage their condition more closely.

18:09:02 Pamela D Wilson: Well, and I agree. I’ve been doing this for twenty years, and I think the more that patients and consumers can be proactive, the better. And so, mobile apps for health are becoming more popular, and I follow you on Linked In. And I saw one of your posts, and it talked about an Apple Watch technology, EKG app, and mention of another app called Medly. Can you talk about those and what the benefits are to consumers and patients?

18:33:18 Dr. Joseph Cafazzo: Yes. I’ll start with Medly because it’s something that we designed and built and is now in clinical use. You know this took almost ten years to do throrugh, a lot of fundamental research and understanding the problem. But people who have—suffer from heart failure—and there’s more than a million people in Canada that suffer from heart failure. And in the U.S., that would be about ten times that amount. And the quality of life is quite poor—can be quite poor— and the median life expectation at diagnosis is only 2.1 years. And so, it’s a very serious chronic condition, and we thought how could we make this better?

19:16:89 Dr. Joseph Cafazzo: And really, we thought about tightening the management and putting more control, not only into the patient’s hand but more recently into the family’s hands as well. So, what this application does—you know—I think one of the things that really makes it difficult having heart failure is the repeated hospitalization. So, you know, the readmission rate for heart failure patients is really, really high—as much as 50% within six months. And so that’s not good for the health system, and it’s certainly not good for the patient and their quality of life.

19:54:84 Dr. Joseph Cafazzo:  So is it possible for us to be able to detect a patient decompensating, deteriorating at home much, much sooner to avoid those hospitalizations? So, we ask of the patients to take home an application, a software application. We might give them the phone, but if they have their own phone, they can download Medly. We’ll give them—this is a prescribed application—so we prescribe it to them. And we either provide them with a blood pressure monitor and weight scale. But they go home with this, and the system prompts them every morning.

20:30:987 Dr. Joseph Cafazzo:  And there’s a reminder call at 10 am if they’ve forgotten. It asks them to take their blood pressure, their weight and asks a series of questions, a very short little survey about their symptoms. And then we have this algorithm that we’ve designed over many years, with the knowledge of cardiologists and experts in the field on an algorithm that is able to detect right on the phone whether or not they’re decompensating. And in most cases—in 80% of the cases—everybody is fine.

21:04:13 Dr. Joseph Cafazzo:  But in 20% of the cases, we start seeing symptoms creeping up. And most of those symptoms, the patient can manage on their own through just adjusting their medication slightly. And the application will tell them to do that. If it’s more serious, it alerts our clinic—and our, the Medly nurse—will reach out to the patient and intervene. And if it gets really serious—and this is only 1 in 200 cases—the cardiologist needs to be involved. And, you know, what we’ve shown over time is that we’ve reduced the incidence of rehospitalization by 50% using this technology.

21:43:88 Pamela D Wilson: How common is it—that patients get this type of technology?

21:49:35 Dr. Joseph Cafazzo: Well, it’s becoming more common. But, in the U.S., there’s some good examples of it too. But unfortunately, it’s not the standard of care right now. And really, it takes quite a long time for the practice to change. It’s being recognized, and quite honestly, there were examples of this type of technology really tried for the last twenty years with various levels of success. And I believe that it was largely because, number one, the technology wasn’t necessarily easy to use. It wasn’t cost-effective because it used expensive technology—it wasn’t based off mobile phone that is quite ubiquitous.

22:37:69 Dr. Joseph Cafazzo: And the bottom line is that it wasn’t an intelligent system. It put actually more burden on the healthcare system than it resolved because when you have all these patients every day generating this data, there’s somebody who has to look at this data. So, you know, we wanted to automate this and actually create sort of the best practice by, you know, creating an algorithm which is based on, you know, the best form of heart failure care. You know, based on a lot of people’s thinking. So, I’m confident in the future that this will get recognized really as the result—the therapeutic effects are shown to be superior to, you know, standard care.

23:20:60 Pamela D Wilson: And you mentioned before the idea of medical sensors. Is there anything in the works besides this Medly product that can help people detect Alzheimer’s or other diseases or even manage other diseases like you’re talking about?

23:35:28 Dr. Joseph Cafazzo: Yes. Well, our relationship with Apple, you know we are doing two studies for Apple. One—their watch technology—and I think Apple is being very bold in some of the applications that they are designing around the watch sensor. And it is perhaps one of the more advanced wearable sensors that are out there. And, you know the Apple watch has the ability to do an electrocardiogram, and it’s able to detect whether or not an individual has a regular sinus rhythm or an arrhythmia known as atrial fibrillation.

24:15:43 Dr. Joseph Cafazzo: So, they launched that a couple years ago, and you know it’s quite an advanced application for a consumer watch. And more recently, they’ve introduced pulse oximetry which measures blood oxygenation on their watch as well. And they have other applications on there like fall detection and that sort of thing. So, I mean, Apple is one of the leaders in this area from a consumer space. I think anyone who is living with diabetes will see the incredible innovations that are happening in the diabetes space over the last few years with blood glucose monitors.

24:56::72 Dr. Joseph Cafazzo: They used to be where you needed to do a finger prick and apply a drop of blood on a strip to and get a measure, a spot check of blood glucose. The technology has improved so much in recent years that you can get through a sensor on your arm or on your abdomen. You can get a measurement every few minutes and see how your blood sugar changes over time and how carbohydrates and your insulin dosing is affecting your blood sugar.

25:25:47 Dr. Joseph Cafazzo: And that’s been made available for people, originally for people with type 1 diabetes. But now even people with type 2 diabetes are using it. And it is by far the most advanced wearable on the consumer market are these continuous blood glucose monitors, also known as flash glucose monitors. So, it’s very exciting for the management of diabetes because it’s making it a lot easier for people to track blood sugars.

25:49:53 Pamela D Wilson: You’ve been in this industry, almost, going on twenty years. Where are we going to be ten years from now? Will a lot of this technology that you’re talking about like Medly, do you think it will be very common by then?

26:00:67 Dr. Joseph Cafazzo: Yes, and I wanted to answer your question about Alzheimer’s’ and some of the aspects of early detection because I see that’s where it’s going so. You know, some of the research that’s happening now is analyzing people’s voice. And one of the earliest applications happens to be in the area of Alzheimer’s. So, through some machine learning and voice analysis, there is the hypothesis that you can detect the early on stages of dementia just by analyzing people’s speech patterns. And so, there’s a company here locally in Toronto, Winterlight Labs, that is working on this.

26:40:81 Dr. Joseph Cafazzo:  And we’re actually looking into it in the context of other chronic conditions. So obviously, I think an intuitive application would be respiratory diseases such as asthma and COPD, and heart failure in that if we can start recording and analyzing people’s voice and be able to relate it to their symptoms—could we find a signal that is indicating that this person is deteriorating? These are things that are not perceptible by you or I or even a trained clinical professional but through the subtleties of the data analysis and machine learning.

27:20:84 Dr. Joseph Cafazzo:  You could perhaps be able to detect it, and you know we have these devices in the home. And I know that some people are wary of the privacy issues. But devices like Google Home, Google Nest, and Amazon Alexa, and even Apple Siri are devices that could potentially be able to detect chronic conditions, deterioration, or general wellness just through voice analysis. And we’re also looking at those devices that maybe in the future the way of interacting with technology is not through a screen—be it a mouse and keyboard or a touchscreen—but maybe through voice.

28:01:64 Dr. Joseph Cafazzo:  It will be much more ubiquitous. Because anyone who has owned those devices and maybe was an early adopter have seen over the years how well they have improved. They’re getting more accurate at understanding speech. They’re getting more sophisticated in that they are now multi-lingual. So you know, I’ve noticed that my in-laws, who are from South America they interact with their device entirely in Spanish. So, I think it bodes well for especially making the technology more accessible in those people who are not comfortable with computers.

28:38:12 Pamela D Wilson: For people for consumers for patients who are interested in keeping up with all of these advances, is there a place that we can go? Is it your website? Is it—where do we find out more about what’s going on with all of this technology and healthcare?

28:51:62 Dr. Joseph Cafazzo: Yes, I think if you want to see the absolute leading edge—and it’s a little bit more on the business-oriented. But it mentions all of the companies that are working on these digital health problems to solve. It’s a site called mobihealthnews.com, and it’s a terrific site because it talks about everything that the FDA is working on with companies trying to bring things to market. But also ensuring that they’re safe and effective.

29:24:95 Dr. Joseph Cafazzo:  Because I think, you know the FDA and other regulators have a responsibility just like they have with you know medical devices and with pharma to be able to ensure that you know what’s coming down the line is going to be safe and effective. And so, you know, what’s really interesting as all, what are known as digital therapeutics is the new buzzword. These are digital applications that have been proven to show that they actually will show a net therapeutic effect that the health outcome will improve if someone uses this app or this digital health application.

30:06:25 Pamela D Wilson: Dr. Cafazzo, I thank you so much for joining me.

30:09:47 Dr. Joseph Cafazzo: Thank you, Pamela

0:30:12:06 Pamela D Wilson: The technology that Dr. Cafazzo and I discussed is becoming more and more available every day with the goal of helping aging adults, aging parents, stay at home, and avoid 24 7 care. If you are a caregiver or an aging adult interested in a plan for aging in place, staying out of the hospital, and avoiding 24 7 care, visit my website pameladwilson.com where you can contact me or request a 1:1 eldercare consultation.

0:30:44:20 Pamela D Wilson:  I invite you to follow me on social media. On Facebook, I’m @pameladwilsoncaregivingexpert, on Twitter @caregivingspeak, Instagram @wilsonpamelad, and Linked In @pameladwilsoncaregiverexpert. We’re off to a break. I am Pamela D Wilson, caregiving expert, speaker, and elder care consultant with you here on The Caring Generation. Stay with me; I” ll be right back.


0:31:36:91: Pamela D Wilson:  This is Pamela D Wilson, caregiving speaker, expert, and advocate on The Caring Generation program for caregivers and aging adults. Whether you are twenty or 100 years old, you’re in exactly the right place to share stories and learn tips and resources to help you and your loved ones plan for what’s ahead. If you’re not sure how to talk to your children or your parents about caregiving issues or if you’ve tried and not been very successful, let me start the conversation for you.

0:32:06:44   Pamela D Wilson: Introduce your parents or your adult children to my YouTube Channel, where there are hundreds of videos. You can also share this podcast on your favorite app or point your parents to the podcast page on my website, where they can read the show transcript. We’re back to talk about why elderly parents may need 24 7 care after a nursing home stay or hospitalization and about the time sensitivity of responding to these concerns to help parents return to become more independent versus becoming more dependent on caregivers.

0:32:43:27  Pamela D Wilson: When a parent has a change in health—especially a significant change in health that requires hospitalization—a window of time and effort is necessary to return to the prior level of physical ability. This time window applies to any person who experiences a physical injury or health event, no matter the age. Suppose you noticed changes in a parent and mentioned these, but mom or dad ignored your concerns.

0:33:16:97 Pamela D Wilson: If you listened to The Caring Generation podcast, Help for Seniors Living Alone, you might remember my interview with Lorraine, who talked about falling, breaking a hip, walking the next day but having to move into an assisted living community. Now, she recovered pretty quickly. The type of quick recovery that Lorraine experienced is not the same for all elderly who fall and break a hip or sustain some other type of injury. Some older adults never fully return to the prior level of physical activity. I want to talk about the body’s ability to recover related to a need for 24 7 care.

0:34:05:51 Pamela D Wilson: When all body systems are high functioning, like in a younger adult, the recovery time is rapid. I remember when I was young. I had a lot of allergies and would get sinus infections that would knock me down. They made me exhausted. But after 24 hours of anti-biotics and some good sleep, I was back to near normal very quickly. An aging adult who has multiple health diagnoses—for example, high blood pressure or other types of heart disease, diabetes, COPD, arthritis or who is physically deconditioned or weak, or overweight will have to put in more significant effort—both mentally and physically—to return to a state of living independently.

034:56:31 Pamela D Wilson: The body doesn’t become sick or weak overnight, although it can certainly seem like this is what happens. Beginning at age 30—yes, 30. How many of you are close to thirty or over thirty? Starting at age 30, muscle mass and strength decline between 16% and 40% in the area of knee flexion. I know that’s a medical speak term but let’s talk about anatomy for a few minutes to make it easy to understand how the body becomes weak and how physical weakness for adults, for elderly parents translates to chronic disease and other health conditions that eventually do result in the need for a caregiver and finally even 24 7 care.

0:35:51:83 Pamela D Wilson: What is knee flexion? Knee flexion is the ability to flex your knee. It determines what the body can physically do. For example, you bend your leg and knee so that you can put your feet on the floor to stand up from a chair without using the chair’s arms. How many of you can stand up from a chair without using the chair’s arms? If you can’t—your leg muscles are probably weak, or you may have another health issue going on. The strength of the quadriceps muscles on the front of your thigh also affects the strength of your knees. Muscles in your hips support the movement of the legs and knees up, down, and forward in the process of putting one foot in front of the other. In the process of walking.

0:36:47:56 Pamela D Wilson: When you walk, you engage multiple muscles: quadriceps, hamstrings, stomach, buttocks, calf, and pelvic muscles. If you’re listening to the show on an app, I visit you to visit the page on my website for this show, and in the transcript, I will share a research article. It’s called  Strength and Muscle Mass Loss With Aging and it’s by Karseten Keller and Martin Engelhardt. I’ll also post a link about the anatomy of walking and all of these muscles that I’m mentioning.

0:37:23:84 Pamela D Wilson: Lower muscle mass and strength result in more aches and pains as we age and eventually issues resulting in the need for 24 7 care. After age 50, muscle losses become more significant—if a person is not physically active and participating in strength training exercises. If before or by the age of 50 you have chronic diseases like COPD, congestive heart failure, IBS, arthritis, or poor leg circulation, these conditions can result in lower physical activity result in a faster rate of muscle mass loss for you.

0:38:13:58 Pamela D Wilson: Then we have unexpected conditions for anyone. Heart attack, pneumonia, any type of surgery, blood clots. Those can also result in muscle mass loss. When we think about things that contribute to the recommendation for 24 7 care—a lack of participation in physical activity is at the top of that list. The elderly who are less active lose muscle mass. Their appetite decreases because of a lack of physical activity. The body starts to waste away and it fails to thrive.

0:38:58:76 Pamela D Wilson: Next in the cascading list of problems is poor nutrition. Many older adults become malnutritioned and don’t eat enough protein. Although by looking at someone you can’t tell if they are malnutritioned or not. There’s a special test for that. The body needs protein to support building and maintaining muscle mass.

0:39:22:13 Pamela D Wilson: When you look at yourself, an aging parent, or a spouse, how many of these issues do you see? Do you see weak or flabby muscles or have you lost strength? How is your physical activity level? Do you have any diagnoses of chronic disease? Have you lost your appetite? Not motivated to do anything? Do you have poor nutrition? One or all of these eventually contribute to needing care and possibly needing 24 7 care.

0:39:22:13 Pamela D Wilson: But, as you can see with your aging parent or the person you care for, these issues don’t automatically show up at once. These concerns accumulate over time> First one and then the next, and then one day—a hip fracture, heart attack, hospitalization, change in health, need for a caregiver, another hospitalization, and the need for 24 7 care.

0:40:30:43 Pamela D Wilson: Chronic disease and needing care seem like they sneak up on us. One day they’re here, the next day they’re not. The truth is that we probably haven’t noticed the signs, if we don’t know what to look for—or if we don’t even know what we should do to stay healthy. Older adults who are trying to regain strength can be impatient. It’s not possible to rebuild body strength and muscle mass in a day.

0:41:00:99 Pamela D Wilson: It can take weeks and months of day in day out consistent effort. What happens is, most people get impatient. They just give up. When these unexpected health events happen, they can change our lives permanently to degrees that we can’t even imagine when they first happen. The truth is that many of these concerns are preventable. The problem is—most people don’t’ know to seek information about health until it’s too late and health issues become a problem.

0:41:39:59 Pamela D Wilson: Elderly parents who need 24 7 care. We know now a little bit more about how it happens. Next what? The effects of lying in a hospital bed or a nursing home bed further deconditions the body. For those who do exercise, the effects of lying in bed for the elderly are similar to you taking a few days off of exercise. You notice when you start exercising again that you’re not as strong as you were or your endurance is not as long as it once was. The body is truly a “use it or lose it” wonder.

042:21:95 Pamela D Wilson: After this break, we’ll talk about the effects of hospitalizations on the elderly related to 24 7 care, what to do if a parent needs 24 7 care? Who provides the care? Is it you or someone else? And how much does 24 7 care in the home cost? This is Pamela D. Wilson, caregiving expert, speaker, and consultant on The Caring Generation. Stay with me. I” ll be right back.


0:43:18:65 Pamela D Wilson: This is Pamela D. Wilson, caregiving expert, speaker, and consultant on The Caring Generation. Hospitalizations have a significant adverse effect on the elderly for many reasons that can relate to needing 24 7 care. For persons over the age of 60, research confirms that more than 50% of aging adults hospitalized can lose up to 50 to 55% of their ability to perform activities of daily living, including the ability to walk that creates a path to nursing home placement or a need for 24 7 care.

0:44:01:42 Pamela D Wilson: One week of bed rest is associated with another 12% loss of strength and significant muscle mass. It’s also important to recognize that elderly parents who need care have changes in their daily conditions that will necessitate more of the caregiver’s time. Let’s turn our attention to the costs of 24 7 care. If you are an aging adult, the cost of 24 7 care to you is your life.

0:44:32:88  Pamela D Wilson: Many children become 24 7 caregivers thinking it will only be for a short period of time. How many of you have done this? This rarely happens. Your parent’s health isn’t going to get better with age unless mom or dad makes very significant efforts in all aspects of life. While we all want to think and hope for the best—and we should—not talking about the reality of the situation, the need for 24 7 care and the costs doesn’t allow us to plan.

0:45:09:78 Pamela D Wilson: Now you may be in a situation where your parent suffered a hip fracture, and you are taking a couple of weeks off work to be the 24 7 caregiver. How do you know when it’s safe for you to go back to work? The answer is when mom or dad is doing as much for themselves as possible and they are safe. This means that 24 7 care by you has the goal of helping a parent become independent. The goal is not for you to be overly helpful and to wait on mom or dad.

0:45:44:26 Pamela D Wilson: That level of help will ensure that 24 7 care will always be needed and that you going back to work will take other discussions about making other care plans like hiring 24 7 care into the home or moving a parent to a care community where access to care is available 24 7.  Families debate when is the best time to move a parent into a 24 7 care community? The answer is different for all situations. It could be the point where the cost of in-home caregivers equals the monthly rate of 24 7 care access in an assisted living community.

0:46:29:32 Pamela D Wilson: What is that? The concern may be that many older adults or their families might not have money to pay $5,000 a month for in-home care or for a care community. If you’re wondering about the total cost of 24 7 care in the home, think about this. The cost is $20 to $30 per hour times 24. You’re looking at between $480 to $720 a day. How many of your families can afford this? Caregivers in these 24 7 care situations,  usually work in shifts of 12 or 8 hours. Meaning that a parent will have 2 or 3 caregivers in the home each day and sometimes not the same caregiver all the time.

0:47:28:69 Pamela D Wilson: Managing 24 7 care in the home takes a lot of effort and oversight by family members. Parents who need 24 7 care are really not physically or mentally capable of managing all of the details involved. It’s up to the primary caregiver or the primary caregiver can hire a local care manager to supervise and oversee the care. How do I know this? It’s because I was that care manager. I managed 24 7 care for families in the home for many of my clients who had the money to pay for this type of care either on a short-term basis until they recovered and returned to being independent or familes who could pay for this type of care for a period of time and permanently.

0:48:18:76 Pamela D Wilson: For families who cannot provide that 24 7 care for elderly parents, the options are to hire in-home caregivers or look at a care community and eventually one that accepts Medicaid. Medicaid communities at the assisted living or memory care level are really few and far between and usually require two years of private pay before allowing an individual to remain on Medicaid. Nursing homes that offer Medicaid rooms may have long waitlists.

0:48:52:46 Pamela D Wilson: An elderly parent who needs 24 7 care usually requires some type of planning. Financial planning, care planning, and planning to apply for Medicaid. Medicaid is not Medicare. Medicaid applications take time to be processed. Care communities do not always have available rooms.  Then there is the idea of 24 7 care for persons with dementia or Alzheimer’s. An elderly parent or a spouse may be in relatively physically good shape but may have progressive memory loss to a degree that it’s not safe for a parent or a spouse to be home alone.

0:49:38:61 Pamela D Wilson: The same three options exist, a family caregiver providing 24 7 care, hiring in-home caregivers to provide 24 7 care, or finding a care community to provide access to 24 7 care.

Let’s talk about the emotional aspects of 24 7 care. Remaining calm in situations where parents are hospitalized, placed in a nursing home, and then return home to need 24 7 care can be challenging. When caregiving situations spin out-of-control situations, remaining calm can mean the difference between flying off the handle emotionally or remaining calm so that you can be considerate, and respond constructively to the situation.

0:50:31:12 Pamela D Wilson: It’s not possible for anybody to have a crystal ball to predict a 24 7 care situation unless you are already a highly involved caregiver watching a parent decline over time. Those declines can be managed. In all circumstances, families can avoid responding to crises by creating a care plan today. Loved ones who become dependent and need 24 7 care can become defensive, especially when caregivers express concerns of feeling exhausted by the ongoing demands of being a caregiver. You may hear a parent may say something like, “I’m the one who is suffering and has to have help, not you.” The problem is a parent may not realize or recognize or even appreciate everything that an adult child or a spouse has given up to provide 24 7 care.

0:51:35:50 Pamela D Wilson: In caregiving relationships and really all relationships in life if we can avoid taking other people’s behaviors personally. If we do this it may be easier to gain a perspective about a situation and figure out how to solve the problem. We can control our behaviors and how we react to others. We can’t control what elderly parents and spouses say to us or how they act. Rather than being dragged into another person’s emotions or drama, if you can do your best to observe the situation kind of like an outside viewer, and think about it for what it is.

0:52:18:96 Pamela D Wilson: Is mom or dad furious or angry today because they don’t feel well and all they want to do is yell. You happen to be the person they’re yelling at. You can think about not responding to those behaviors. Because it’s really not about something that you’ve done or even something you said even though your parents may be using that as an excuse to yell. Or to be angry. Or to be nasty. Having to make decisions about the 24 7 care needs of an elderly parent can add a lot of emotion and a lot of guilt that the caregiver feels responsible but can’t do everything.

0:53:04:38 Pamela D Wilson: It’s important to realize that everyone creates their life situation—even the caregiver—and has the opportunity to seek information, learn, and do something about the information you receive. Earlier in the program, we talked about all aspects of life that eventually result in a need for a caregiver and possibly 24 7 care. If your parent needs care and you are that caregiver, and you are watching this care situation, what steps can you take today to talk about the what if’s of needing more care with your parent?

0:53:45:22 Pamela D Wilson: How can you share the importance of being physically active and managing health issues to prevent further health declines? Having these conversations today can change the future of care situations and the relationship that you have with your elderly parents and with your children who may one day become your caregivers.

0:55:16:52 Pamela D Wilson: I thank you all for joining me on The Caring Generation it is truly the only program of its kind connecting caregivers and aging adults worldwide to talk about caregiving, health, and everything in between. Invite your family and friends to listen each week. I am Pamela D. Wilson, caregiving expert, advocate, and speaker. I look forward to being with you again soon. God bless you all. Sleep well tonight. Have a fabulous day tomorrow and a great week until we are here together again.

0:54:42:29 Announcer: Tune in each week for The Caring Generation with host Pamela D Wilson. Come join the conversation and see how Pamela can provide solutions and peace of mind for everyone here on Pamela D Wilson’s The Caring Generation.



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About Pamela Wilson

PAMELA D. WILSON, MS, BS/BA, NCG, CSA helps caregivers and aging adults solve caregiving problems and manage caregiving needs through online programs, live support groups, and an extensive caregiving library that includes articles, podcasts, videos, and webinars.

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