A Registered Nurse is the best insurance and peace of mind a senior living community can offer their residents. With seniors experiencing health issues, taking a number of medications and interfacing with many health providers simultaneously, having a nurse to manage all the aspects of a resident’s health eases the burden on residents and their families. A nurse keeps a bead on an individual’s health and needs, consults with pharmacists, specialists, therapists, and physicians, then communicates between all the disciplines to insure all are working towards the senior’s wellbeing. Most senior living communities have one Registered Nurse on staff or a part-time consultant. The Lincoln Home has three RNs; the Executive Director, Lynn Norgang, the Director of Nursing, Millie Jones-Farnham and the RN Nurse Manager of Harbor View Cottage, Linda Morrison. The three RN’s work together as a team to insure that each resident’s care and wellness needs are met every day of the year. The Lincoln Home RN team offers an integrated approach to providing extraordinary care and peace of mind.
My friend and colleague Mary Ellen Crowley received the diagnosis of cervical cancer this past year. She has gone through three rounds of treatment with radiation and chemotherapy. Cervical cancer is a tough diagnosis to begin with, but we all held out a hope that she would beat the odds. But then it spread to her lymph nodes, and now it has made its way into her lungs.
Mary Ellen is just 62. She made the decision to stop treatment and enjoy the life she has left. As I write this, Mary Ellen is leaving within the hour to head south to Massachusetts to live with her sister Pat, who will take care of her during this final passage of her life.
Mary Ellen looks remarkably good right now. She has been working in the LCTV studio to help with the transition of the management to Bristol resident Abby Ingraham. A bunch of us helped with packing belongings over the weekend, with laughs and sadness and food and the kinds of things friends can share in these circumstances. I shared more laughs and conversation at the studio yesterday with Mary Ellen, and goodbye hugs, and appreciation and acknowledgment of each other we have developed over the last couple of years.
Mary Ellen has been with LCTV for better than 10 years. She first became involved as a member of the board of directors, and her interest in production drew her quickly into a hands-on role, and for better than nine years now, she has been the station director, which has meant basically doing almost everything.
When I first arrived in my position with the Lincoln Home, I realized what a wonderful educational resource LCTV can be for this community. I approached Mary Ellen with the idea for the “Spotlight on Seniors” show, and within a short time, she provided the training for our production crew, and we have gone on to produce more than 50 shows.
Mary Ellen has a personal passion for giving a voice to people who might not otherwise have a say in community matters. She says, “The most important aspect of LCTV’s mission is to educate people about how to express themselves with video and then give them a place to air their productions.”
With her support and guidance, we were able to produce shows to inform our local community on issues such as food insecurity and our local Meals on Wheels program and food pantries; affordable housing; legislative issues such as the “Keep ME Home” initiative; proponents on each side of the “Death with Dignity” legislation; senior exercise and fitness and preventing and treating diabetes; hospice and end-of-life care; elder law issues; and looking at the broader demographic and social issues affecting seniors throughout our state.
Throughout all of our work together, Mary Ellen has always shown herself to be a great human being … simple, practical, humble and humane.
And in my view, this is how she has approached her illness and now her terminal diagnosis. She has shown great equanimity, living in the present moment, and making decisions about her treatment, and then her decision to stop treatment, with an open heart and practical presence of mind. She is choosing to live her final time with quality of life instead of chasing an ephemeral quantity of time.
Mary Ellen and I got on camera together to film a “goodbye and farewell” video to all of her friends here in Lincoln County.
Because of the poignancy of that show, I decided to set up a GoFundMe campaign to benefit Mary Ellen. I hope you can see your way to contributing a few dollars to help give Mary Ellen a beautiful send off from Lincoln County, Maine, the place she loves as a home, and now which she must leave all too soon.
You can see Mary Ellen’s goodbye video and, only if you wish, make a small contribution to her benefit, at www.gofundme.com/the-mary-ellen-crowley-care-fund. A donation is not required to view the video.
Three different senior women I know have suffered accidental falls recently. A broken hip is always a concern with falls, but all three of these women landed on their face and look like raccoons with two black eyes. It is just heartbreaking and scary, and a confidence demolisher if it happens to you.
The Maine CDC says that accidental falls are the leading cause of injury related deaths in Maine for people over 65. It occurs more to women than to men. What is shocking in this statistic is that I have never known anyone to die directly from a fall, but have seen uncountable numbers of people over the years suffer life-changing injuries from falling.
The single most frequent reason that seniors seek either in-home care or assisted living is that there has recently been a fall, and sometimes a few falls. Each year the Lincoln Home welcomes residents who come for a short-term winter stay of a few months. It is a nice way to soften the Maine winter, but more importantly, short-term residents know how easy it is to slip and fall on hidden ice even when you’re being careful.
Even Minor Falls Can Lead to Serious Injury
Even minor fall can results in a severe injury such as a fracture of the hip, pelvis or femur requiring a hospitalization. Recovery from such an injury can be an obstacle course that can lead to other debilitating health problems. According to the Maine CDC, in accidental falls that resulted in death, it is because the fallen person had no way to call for help, and suffered internal bleeding because of the fracture, or suffered from exposure and hypothermia.
Many factors can increase one’s risk for an accidental fall. These include: Impaired hearing and vision; General loss of muscular strength and tone; Arthritis; Osteoporosis (Many people think osteoporosis is only a problem for women past menopause, but it can also affect older men); Vertigo; Cerebrovascular insufficiency; Neurologic disabilities such as a past stroke, Multiple Sclerosis, Parkinson’s Disease, or Dementias; Postural hypotension (sudden decrease in blood pressure). Sometimes a newly prescribed medication may cause dizziness.
Keeping Your Muscle Strength and Balance to Prevent Falls
If you are deconditioned, it is useful to consult with a Physical Therapist to receive an exercise prescription that is suitable for your current state of strength and health. The therapist will identify areas of weakness and imbalance that you are able to strengthen through specific exercises. These are not strenuous exercises! However, they are muscle specific, and receiving guidance can help you strengthen muscles you never think about, such as your foot and lower leg muscles, and the small muscles that support your spine.
Doing things like getting together with friends, gardening, walking, or going to the local senior fitness center are important for staying healthy. The good news is that there are simple ways to prevent most falls. By taking care of your overall health, you may be able to lower your chances of falling.
In general, you should stay physically active within your abilities, but also seek to gently challenge your abilities so that you maintain them. Regular walking improves your muscle strength, and keeps your joints, tendons, and ligaments flexible. Yoga is wonderful anti-aging medicine. Physical strengthening of the muscles used for balance is possible even for those in their 80’s and 90’s if a neuromuscular disorder is not present. We can definitely maintain and improve our strength, balance and flexibility through a variety of functional movement exercises.
Falls can never be completely eliminated. You’d have to wrap everyone in bubble wrap to totally prevent fall injuries. People need to lead their lives, and trying to eliminate all risk is simply not the way we do things in Maine.
However, being a strong and independent Mainer doesn’t mean you can’t take steps to reduce the potential for harm with some common sense measures. Call Valerie Lovelace, One2One Home Care Manager to arrange an in-home Fall Prevention Assessment. To learn more about Short-term Winter Stays at Lincoln Home, call Steve Raymond at 207-563-3350.
“Grey is the New Green” is the newest saying catching hold in Maine and New England. It refers to the growing trend for older workers to continue working and earning income to age 70. This is in part due to a shortage of younger workers.
Social Security is Especially Important to WomenThere is a much more personal reason for women especially to consider working to age 70. More women rely on social security income than men, and they tend to live longer. By delaying taking social security benefits until age 70, you can greatly increase your monthly benefit, as well as the benefits you receive over your lifetime.
Your social security benefits are calculated by the 35 years where you had the highest earnings. Many women dropped out of the workforce altogether for children and family reasons. A report from Boston College’s Center for Retirement Research found that women are about three times more likely to have a zero-earnings year at some point during those 35 years. That is the case for nearly half of all women. Some chose to raise children, others went off to pursue a Ph.D. or other interests.
These gaps in income years skew benefits downwards. A recent article in the Wall Street Journal reported that “women who delay taking Social Security until 70 increase their monthly payment by 88% over their benefit at age 62.” If a woman had dropped out of work, returning to work (at a decent wage) to fill in the gap years allows her to grow her social security benefit.
For many reasons, it can be very tempting to retire at age 62. NBC news reported that “40.8 percent of the women who were newly awarded Social Security in 2014 were aged 62.” However, you really need to question the wisdom of the decision to collect social security at the young age of 62.
Know Where You Stand
We are believers that there are many positive reasons other than income and social security benefits to stay in or return to the workforce. Nonetheless, social security income is a major factor in basic comforts of living for a very large segment of the population. You will do well to understand what this means to your future by looking at your social security benefit “what if” scenarios. What if you retire at 62 versus 66 versus 70? If you have no pension and not a lot of savings, your social security income will be your lifeline to covering the basic expenses of living. Even though Social Security benefits are modest, the program lifts 14.5 million seniors out of poverty, and provides the majority of income for 61% of all seniors.
The Myth of Social Security Insolvency
There are myths that Social Security is insolvent. These alarmist views undermine faith in the system and cause some people to want to retire early. The Center on Budget and Policy Priorities states that “relatively modest changes will keep social security solvent for the next 75 years,” and that without any changes at all, the system is still solvent until 2034.
You can learn your earnings history and future benefits by going to www.ssa.gov/myaccount/. It is a good exercise for you to know exactly where you stand, especially if you had some low or no earning years.
Steve Raymond is the Director of Community Outreach at The Lincoln Home Senior Retirement Community, and the producer and host for the “Spotlight on Seniors” show.
Are Older Drivers More Dangerous?
Older drivers may or may not become dangerous drivers. An unfortunate truism of aging is that some of our most competent, successful, self-actualized and responsible citizens can become very dangerous drivers. They become dangerous to themselves and dangerous to others. That is just a simple fact that is true in every single community in our car-driven country. The shocking stories are many… I won’t sensationalize them here. The Insurance Information Institute in a March 2017 report states that older drivers have higher rates of fatal crashes than all age groups other than the youngest age group.
Of course, it’s one thing to say “Aging drivers can be dangerous” as social commentary. It’s another thing altogether to say it to an aging individual. The transition from complete autonomy to increasing dependence upon others is challenging. It is always a difficult conversation, but it is a crucial conversation to have at the right time. It is a conversation I have had more times than I can count. I went through it for a few years with my own father. He was a 30-plus years Teamster and long-haul truck driver. You think he gave up his keys very easily?
When to Have “The Conversation”
The problem is, there is no absolute, black-and-white “Right time.” You may have a perfectly competent 94-year old driver, and a menace-on-the-road 69-year old driver. Age is not at all a good indicator. There are many ambiguities and varying circumstances. However, truth be known, by the time most drivers give up their keys, everyone around them would agree that they should have given up their keys a long time sooner than they did.
The loss of driving skills and reflexes creeps up on people unless they have had a suddenly severe health event. There can be deep resistance to giving up driving as driving skills become less competent. There can be very deep levels of denial and covering up of minor accidents. These are early warning signs of a dangerous older driver. The car evolves more unexplained dings and dents and sideswipes and all the family members have raised eyebrows, but feel perplexed about what to do. See the AARP’s list of 10 signs that older drivers should stop or limit driving here—>
We want to intervene, but we don’t want to offend or hurt feelings. Maybe we even have our own levels of denial or conversation avoidance. It’s easy to say, “It doesn’t matter about his feelings… he’s dangerous, what if he kills somebody? Take the keys away!”
Older Drivers’ Sense of Identity
Well, it’s just not that simple and easy for family members, and this is why many turn to an outside third party to have the “Dad-you-can-no-longer-drive” conversation. I have had this conversation with so many people during my many years working in Senior Care and Home Care. Our ability to drive and enjoy the “Freedom of the Road” is a huge cultural value in our country that is popularized around the world. Many tourists from other countries come here specifically for the experience of driving the “American Open Roads.”
The “Freedom of the Road” cultural belief is deeply ingrained in the American identity. The loss of the ability to drive is so hugely symbolic that it can seem to mean, “Your Life is Over.” You might as well be an oncologist telling someone they have cancer when you tell someone they can no longer drive. Except with cancer, you might have a fighting chance! The loss of driving privileges feels like a threshold that once crossed, there is no return. And usually this is true, and because it is true, we can realize that the emotional process of denial in the aging driver is really the desire to stave off feelings of helplessness, hopelessness and despair as autonomy feels like it is slipping away.
I have infinite compassion when I have “Stop Driving” conversations with aging drivers. I also have the sure knowledge that to avoid and delay the conversation potentially places the health and lives of others at risk. And so it is with both genuine compassion and civic responsibility and knowledge that I help an aging driver make the emotional transition to letting go of driving, not because he is forced, but because he sees the wisdom and dignity in doing so.
The Conversation has to start somewhere
The conversation must start with consideration of all the feelings related to identity and autonomy. However, once you have identified that there are problems, you need to begin the conversation with respect and compassion. If you meet angry resistance, you need to come back to it enough times to reach agreement on limits or stopping driving altogether. And if you meet a brick wall, it is time for a direct discussion with your parent’s physician. Ask that a report be made to the DMV so that a driving test and assessment is required. It is the wisest, safest and most compassionate thing you can do.
A dear friend of ours recently developed a rash that turned out to be Shingles. It’s one of those things we don’t think much about until we get it, or if we know someone dealing with it. It is definitely no fun because it can be extremely painful. It is worth knowing about so you receive quick treatment if it ever occurs to you.
Childhood Chickenpox May Lead to Older Age Shingles
Shingles is caused by the same virus that caused chicken pox during childhood. It is called “varicella-zoster virus.” Chickenpox in your childhood creates the risk of developing shingles in your senior years. This is because the virus enters the nervous system and hides away. It can reactivate in seniors into a very uncomfortable rash. In older seniors it can produce severe medical complications. The disease does not transmit from one person to the other. It only arises from within one’s own nervous system if you had chickenpox in your childhood.
The rash usually affects a small area on one side of the body, usually on the torso, but can also begin on the neck or face. Pain symptoms can be extremely sensitive because the virus follows nerve tracts to the skin. First there is pain, burning, numbness or tingling, then a red rash breaks out. The rash develops into fluid-filled blisters that break open and crust over. Other symptoms can include fever, chills, headache or an upset stomach.
Treatment and Risk
Shingles may be successfully treated in two to four weeks. However, it can also progress to severe nerve pain that may last for months. If you develop early symptoms, get treatment immediately. If you have an unusual pain or if you develop an unusual rash, it is definitely wise to check with your physician immediately, especially if you have other symptoms. While shingles cannot be cured, you might limit the outbreak with easy-to-tolerate antiviral medications. Topical creams will reduce discomfort, which can be quite severe if you let the rash get out-of-control.
Age is the biggest risk factor. Starting with age 50, the risk progresses as you get older. There is a 50% risk in people over 85. About 1/3 of all people will develop shingles at some point in their life. If you are 60 years old or older, it is wise to have a discussion with your physician about receiving the vaccine to prevent Shingles in the first place. The vaccine will reduce the chance of developing shingles by about 50%, and will reduce the severity of outbreaks if an outbreak develops.
Vaccine Recommendation for Prevention
The CDC recommends the Zostavax vaccine for adults over 60, with several exceptions. It is a single injection in the upper arm. Consult your physician to see if the shingles vaccine is appropriate for you. Medicare Part D will cover the vaccine as a prescriptive drug, even though it is a preventive vaccine. Paying for Zostavax runs from $215 to $250. Check with your private health insurance carrier to see if the cost is covered. Read more from the Centers for Disease Control on Shingles vaccination.
A Shingles infection is much more dangerous to your health than the vaccine to protect against it. Like any medicine, this vaccine can cause side effects, but the risk of serious side effects is reported to be extremely low. Have this conversation with your physician.
Six Home Care Providers Complete Twenty Hour Excellence in Care-Giving Class
Training came to a close today after twenty hours of training spread over a five week period. Class participants learned a range of handy skills for in-home care-giving. Lincoln Home’s Giving Excellent Care in the Home: From Our Home to Yours curriculum centers on simple but important skills that boost confidence and help home care givers gain insight.
Class topics cover a broad range of skills. Right from the start students jump in with both feet, taking on subjects like personal values, home safety, and how to help granny with her dentures. Learning different skills and techniques help students become more confident providers.
I enjoyed the activities and games that really enhanced learning.
Student feedback helps us know what we’re doing well and what we can do better. It’s exciting to hear how the class was received, and even more exciting to know we’ve made a difference in our community with this class offering.
I gained so much through this class. I now have a different perspective and feel more confident caring for my stepfather.
I liked the way we reviewed chapters after reading them. It felt easier to take in the lessons that way.
I learned about all aspects of daily living. I gained a lot of new information and recognize that every care-giving situation is going to be different. This class is fantastic!
I liked the interaction with other students during activities.
We all got off to a good start that provided ease of sharing information and asking questions.
I learned a lot about care-giving. The biggest lesson I take away from this class is “someone else’s emergency is not my emergency.”
Please stay tuned. Lincoln Home will offer this course again in the fall of 2017.
by Steve Raymond and Jill Wallace
We shared dinner with a friend whose cognitively impaired mother just went into a memory care unit. She is upset because every time she visits she thinks the visit was great, but after she gets home, the staff calls her because her mother is upset… really upset. So much so, that professional staff asked her not to visit for a whole month. “Not visit at all,” she said.”
“Not visiting” is advice that is very difficult for family members to understand. Not everyone needs this therapeutic intervention, but some do. This is because of the way that each person’s brain is uniquely damaged by the disease.
Human beings love to remember our past. It is natural for us to want to share our memories with our loved ones. If our loved one is cognitively impaired, it is easy to think that we are helping them by reminding them of the past and keeping them “reality oriented.”
Our friend thinks she is helping her mother by reminding her of the past memories that connected them. She thinks she is helping her confused mother, who is forgetting things, to hold on to her memories. She thinks she is building connection, and improving their relationship by sharing the good times.
The trouble is that her mother does not remember, and no amount of reminding will make her mother’s brain function again. Her brain is working differently than it used to, and differently from her daughter’s. We don’t really know how it is working differently, but we see the effects. We can see that Mom becomes agitated and anxious after her daughter leaves.
Her mother feels even more confused when her daughter talks about things she should remember, but doesn’t. The daughter was talking about fun summers at the cottage. Happy memories. But the mother is now walking around, agitated and anxious, looking for her children. She has remembered the summer cottage, but for her it is not in the past. In her mind, she is right back there; back in the memory of having small children she is responsible for and she cannot find them. She experiences those memories as if they are Now.
“Where’s my little boy? I have to put him to bed. Where’s the dog? I just let him out and he’s not back yet. Does he need to go out? Has he made a mess somewhere?” These feelings create stress and anxiety and send her thoughts spinning. Rather than an act of kindness in reminding a cognitively impaired person of the past, it can actually be an inadvertent act of cruelty. This can be a hard pill for family members to swallow.
People who work in assisted living homes and memory care units know that confused people do best when they can live in the present. We learn to help our residents be comfortable in their own skins by focusing upon the positive and redirecting conversations from the stressful and anxious. We want families to learn these therapeutic communication skills because it is the most loving way to connect with your spouse or parent who is cognitively impaired.
This is why memory care communities will ask for limited or no visits for some new residents in the first few weeks. It is to provide an adjustment period for the resident. It is loving empathy for the person whose thoughts become disordered and fearful. It is a way to create the feeling of safety without the overuse of medications. It is not just the cognitively impaired who must adjust to a new reality… it is also the family members, and the professionals are there to help.
Veterans in Maine can face many challenges with aging. Wishing to remain independently at home is quite common for any senior. The Veterans Administration at Togus offers a wide variety of services to meet the needs of senior and/or disabled veterans: mobile and satellite clinics, telemedicine, traveling physicians/nurses, and many other services, including home care.
Spoiler Alert: Veterans who ask for help are not, repeat, NOT taking services from other veterans.
If you are a veteran receiving your primary medical care through the Veterans Administration system, you may be eligible for services to support your ability to remain at home with as high a quality of life as possible.
How does that work? Your primary care physician at Togus actually needs to hear if you are having challenges with independent living. That’s a pretty tough thing for any service member to say out loud. You might feel that being a veteran is about being tough, self-sufficient, and able to take care of yourself and everyone around you. You may feel that being a military person is about duty, responsibility, and not asking for help.
Veterans are about self-sacrifice and not asking for anything in return, right? Wrong.
Being a veteran is tough duty, for sure. Many vets believe they are “not sick enough.” They think they should “save the benefits for someone who really needs them.” The truth is, former service members often go without services they truly need. If the services are available and you are eligible for them, you need to know that this kind of thinking is flawed. There is enough to go around. A veteran with the courage to ask for help is not, repeat NOT, taking services from anyone else.
A proud veteran recognizes that after serving his or her country, the country really wants to serve them back. Unsure? Make an appointment with your VA Primary Care Provider to discuss your needs and options.
The State of Maine values its veterans in many ways, some of which may surprise you! Check the Maine.gov website for more information.
Giving Excellent Care in the Home: From Our Home to Yours
Our Giving Excellent Care class started April 11, 2017 at 9:00am. As facilitator, I experienced excitement, anticipation, and just a little bit of anxiety in the weeks leading up to the start of class. I truly want people to have a good experience at Lincoln Home. I want our guests to enjoy what they are learning. Truthfully, I personally want to make and maintain good first impressions that will eventually lead to long-standing relationships with the people in our community.
I am super excited to have gotten everyone through the first day in one piece, and I’m looking forward to what unfolds over the next 4 weeks in our class.
Building Excellent Relationships in Care-Giving
Seven eager faces reflected a variety of emotions as we started.
“What will this class be like?
“Will I know anyone else here?”
“What have I gotten myself in to?”
As an educator, I’m excited that people want to learn. As a human being, I’m thrilled when people want to learn and gain skills that later will enhance their future with other human beings. How we are in relation to others is far more important than what we know or what we do, to my way of thinking. It’s really cool when people are ready to jump into that idea, being willing to explore the many ways they approach life and living in relationship to caring for others.
Day one topics included:
Healthy Care-Giving Boundaries
Stress and Burn-Out
Rights, Abuse, Neglect, and Exploitation
We learned about care-giver ethics. We discovered that excellent means different things to different people. We explored what it means to be a guest in someone else’s home, helping them when they may be feeling vulnerable or at risk. Students inquired into all the reasons they have for not providing self-care, which is a required skill and essential practice for the care-giver’s own long-term health and well-being. The best part is it seems the students are looking forward to how the rest of the class goes.
And so am I.