Pharmacists and Home Visits

An article in the Vancouver Sun by reporter Pamela Fayerman on January 25 talked about a wonderful, innovative programme under the auspices of Faser Health ( yes, the ones whom it is so difficult to find the right contact, which shows that you shouldnever throw out the baby with the bathwater).

Anyway, it is a pilot programme where pharmacists have beee going to the homes of seniors who have been prescribed more than six medications . They talk to the client, look in the medicine cabinet, see how the medications are being taken. The results-- fewer hospital readmissions and shorter stay where there is a readmission. Also, fewer trips to emergency departments.

"...medication related problems...cause as many as 25 percent of hospital admissions in seniors. Up to three quarters of those admissions could be prevented with the kind of intervention from community based medication management program..."

From what I have seen, medication problems--undertaking, overtaking, taking at the wrong times, is also a strong predictor of nursing home or care admissions. The results of medication problems include falls, delirium, and death, none of which are very pleasant, from w hat I have been told.

Anyone who has some good ideas on cost effective ways to help seniors manage medications at home, beyond bubble packing, and hired home help, I would like to hear from.

And congratulations to Fraser Health on this programme.

How Do You Fold Your Towels?

One of my favourite 96 year olds has her daughter from the Prairies visiting her this week in the nursing home where she live. She told me one of the things that is nice about having her daughter visit, is that she can ask her to do things that other wise noone does for her. Concerned, because that meant she is not asking me or anyone else to do them, I asked her what she meant.

"Well," she said. "When they bring back my laundry they just hang them anywhere in the wardrobe. I like everything to be in place, the skirts with the skirts, the blouses with the blouses. When J-- is visiting , she can put things in order for me."

I asked her why she didn't say that to the person hanging the clothes. She smiled and shook her head. "They are so busy, and they don't listen, I would have to tell them every time. "

I know we need to talk more about assertiveness, and what she has a right to ask for. And the staff is really busy, and to think that they will remember that about every resident is a lot. So I started by making a sign for the wardrobe. It says 'Please: Skirts on the Right, Blouses on the Left.'

It reminded me of a friend of my family who recently died of Muscular Dystrophy. She had become disabled and had to have homemakers come in. She told me one day about telling one of them how to fold her towels. "I fold my towels in a certain way. That is how I want it done, " I remember her telling me. She didn't do it in a mean way, but she spoke up.

This isn't about towels, or skirts and blouses. It is about being disabled, and being dependent on others, and feeling that you want some control in your life. It is also about how sometimes, when someone's life is very restricted, as it can be in a nursing home, the little things take on more significance.

But more than that, it is about listening, it is about not making assumptions about people, it is about people feeling safe enough to say how they want their skirts hung, or towels folded. It is about the nature of relationships in nursing homes.

And it is about feeling empowered enough and important enough to say something.

Personally, I keep my pants to the right. Shirts to the left. The socks are often left, folded and not, in the laundry basket.

The older you are, the more you move, the sooner you will die.

First, let me say, regarding the title, those words did not come out of my mouth, (or my pen or computer).

They are a quote from a newspaper article from someone who speaks and somehow seems to think they are an expert on eldercare. To be gracious, I assume that he was misquoted, and that there was more to it than that. The trouble is how many people will read it and get frightened or upset.

Nowfor the bad news: there does seem to be a connection between moves and morbidity in the elderly. I don't have the studies, so I can't comment on them.

Now for the good news: Hopefully, if eldercare is done right, and planning is done right there will a) not be a bunch of moves and b) they will have good results, not bad ones. The move to appropriate housing housing , where the care and service are good, can lead to an improved quality of life and life satisfaction.

How do you insure that there are good results when looking at seniorcare/eldercare/seniors housing?

1. Do long term planning with knowledge of what may come, of what present conditions are, and what the housing you are looking at offers.
2. Include the person who is being moved in the planning, as much as possible.
3. Provide support before, during, and after the move, especially.

"Parenting Our Parents"

I saw another article in the Vancouver Sun Friday , talking about parenting one's parents.

Well, I know that is how it feels. But...........

It is important to remember that one is not "parenting our parents"when we do eldercare. We are caring for people who are becoming frail, who are perhpas losing memory, who are, well, becoming disabled. They are adults with disabilties.

What does one versus the other do?

The first concept leads to infantilzation. It leads to "making decisions for," rather than "making decisions with." It leads to talking about someone when they are in the room, as if they are not there.

The latter means including someone in care planning. It means making sure they have the dignity that all adults have. it is about approach. It means appropriate boundaries, a difficult thing at the best of times.

323 Years Old? You Don't Look a Day Over 90

I was talking with a woman in one of the nursing homes I contract to. She told me she used to live downtown in the West End, at Davie and Pendrell.

"Did you now?" I said.

"Yes," she told me. "I lived there for 323 years."

I don't know about you , but I think 323 years is a long time to live in one apartment. "Wow, " I responded, "You must have seen a lot of changes in that time."

This was actually the end of the conversation. Earlier, she told me she was paying $1900.00 dollars a day to stay in the home. I tried to tell her that it was much less than that, that it is about $!300 for the month.

"No," she had insisted, "It is nineteen hundred a day, my son told me that"."

"Mrs. S. would you like me to go find out exactly? We could go to the business offfice."

"No, "she shook her head. "I know what it is."

"Nobody pays that much, " I said.

"I do, " she told me emphatically.

We were at a standstill. I looked at her a minute, and thought to myself, why am I arguing. That is not the point. So then I said, "That's a lot of money to be paying, isn't it?"

"Yes," she said, but my son helps me out, so it's okay."

"Your son is very good to you, isn't he?"

She smiled with pride. "He is,"she said.

It was a good review lesson for me.

So who cares--323 years in the West End? She must have seen a lot of interesting things during those years.