Playgrounds aren’t just for kids anymore.
New designs cater to older adults who want to increase their flexibility and balance—as well as have fun.
Playgrounds for older adults are starting to mushroom in cities nationwide, including Miami, Kansas City, Los Angeles and New York City, according to Next Avenue. The latest fitness trend, popular in Europe, features low-impact exercise equipment designed to promote flexibility, balance, speed and coordination.
Adult playgrounds expose us to a new experience, and challenging older brains in such a way can help fight dementia. Plus, playgrounds are fun and provide a chance to interact (play) with others, including children who may have a nearby playground of their own.
Just take it slow on the slide.
“A Fun, New Exercise Trend for People Over 50,” April 4, 2016, Next Avenue.
Blog posting provided by the Society of Certified Senior Advisors
Parkinson’s Disease: 300 Tips for Making Life Easier
By Shelley Peterman Schwarz
An indispensable resource for patients, families, and caregivers
Filled with creative tips and techniques, this updated second edition of Parkinson’s Disease: 300 Tips for Making Life Easier contains a wealth of ideas and shortcuts for working, organizing, simplifying, and conserving time and energy while living with Parkinson’s disease. It includes:
Ways to make your home safe and accessible, your mealtimes more pleasurable, and your communications easier
Unique product suggestions that make daily living tasks less stressful
Extensive resources to help you easily locate items and services
These small dwellings in residential neighborhoods provide a family environment with individualized care for the same price as an institution.
While surveys show that most older people want to live in their homes as they age, for many this is unworkable, as they face loneliness and lack of support for health and physical issues. Often, seniors don’t want to leave their homes because they fear losing their independence if they move into care facilities such as assisted-living or nursing homes.
That’s where the Green House Project comes in. For older adults who can no longer live on their own, this alternative nursing home provides shared living and 24-hour support, but with the ability to live as independently as you desire. A Green House (which is not green in color, doesn’t provide a place to grow plants and doesn’t refer to an environmentally progressive place) is a large house generally shared by seven to 10 adults (although some places have more). Each resident has their own room and bathroom, but shares a communal kitchen and living room.
The Green House Project describes itself as providing long-term and post-acute care. In the words of its founder, William H. Thomas, the Green House Project aims to create “a real home that provides care but also supports those seeking to redefine the worth and meaning of late life. [It] represents a massive shift toward the deinstitutionalization of older people. It generates human warmth, as opposed to institutional coldness, through its commitment to small size (seven to 10 residents in each house), its de-emphasis on hierarchy and its complete dedication to fostering a new expression of elderhood” (fromNext Avenue).
How It Started
Film Documents One Town’s Efforts
With a strong desire to take care of their elderly, a group of citizens in the small town of Sheridan, Wyo., went through a 12-year struggle to establish a Green House project. The effort involved finding land and funding, having to change the local laws to make this kind of care possible and raising millions of dollars during the 2008 economic crisis.
A documentary, Homes on the Range, captured the struggle and ultimate success: the only independent, not-for-profit, purely grassroots skilled nursing facility in the United States, not affiliated with or dependent on a larger corporation or hospital. Four cottages were opened in 2013, with 48 residents and 65 support staff, and plans are to add more houses, including cottages for veterans’ groups.
The film has been shown on PBS stations around the country, and is available as a DVD. A short clip is available from the Media Policy Center
Thomas, a geriatrician, international authority on elder care and author of four books on the subject, cofounded Eden Alternative in the 1990s. The nonprofit organization partners with nursing homes and other long-term care facilities with the aim of deinstitutionalizing them. In 2003, he started the Green House Project, also a nonprofit organization, which puts into reality the philosophy of the Eden Alternative. The Green House Project partners with the Robert Wood Johnson Foundation, which provided a $10 million grant in 2005, and Capital Impact Partners, which provides technical assistance and coordinates financing. The first Green House Project home was constructed in 2003 in Tupelo, Miss. In December 2008, the project reached its goal of completing 50 houses by 2010. As of February 2015 there are 174 Green House homes in 27 states with another 186 in development (Wikipedia).
How a Green House Works
Unlike traditional nursing homes, which can be huge institutions, Green Houses are literally homes, usually situated in a neighborhood. They are centered on a large living room, dining room and kitchen in one great room, which encourages communication and community. Rather than residents eating at different, smaller tables, they share one large table, emphasizing the sense of a family or community eating together. Each resident, called “elder,” can furnish and decorate their room and bathroom how they want (unlike institutionalized rooms with largely bare walls).
Residents can get up in the morning and to go to sleep when they want, which provides a lot of freedom and flexibility. In contrast, nursing homes enforce a strict sleeping and eating schedule. In Green Houses, residents can eat when they want, although meals are often shared.
To ensure quality, Green House homes are trademarked and built to strict certifications. These dwellings meet federal and state licensing requirements and operate within existing regulatory and cost frameworks.
How the House Is Staffed
Green House homes are staffed by a nurse 24 hours a day. Other staff include certified nursing assistants who perform all the duties found in a traditional nursing home, including dressing, bathing and toileting. Green Homes also provide physical, occupational and speech therapy, but often in a Green Home dedicated for that purpose. For example if an organization built six green homes, it would dedicate one to short-term rehabilitation, in order not to disrupt the routine of the main homes, according to Scott Brown, director of the Green House Project.
Residents with Alzheimer or other forms of dementia are integrated into the home, although some organizations have built homes specifically for those with Alzheimer’s. Although Brown was unable to provide a figure for the staff-resident ratio, he said the “time dedicated to direct care exceed ratios in traditional nursing homes.”
The relationship between the staff and residents is viewed as a partnership rather than the traditional nursing-home role of caretaker and patient. For example, the Eden Alternative’s definition of care is “that which helps another to grow. . . . It acknowledges that opportunities to give and receive are abundant and experienced by everyone involved in the care relationship.” Residents are encouraged to interact with staff and even develop personal relationships.
To emphasize the more informal relationship with residents, staff members are given playful names. The Shahbaz works with the clinical support team of nurses, therapists and dietary professionals to provide individualized care for each elder. The Guide is responsible for the operations of the home, while the Sage is a local elder who volunteers to be a mentor and adviser.
How Much It Costs
Despite the smaller residences, independent research has found that Green Houses cost the same or less to operate than traditional nursing homes, while delivering four times more personal and social contact (Next Avenue). One study found Green Houses cost $1,300 to $2,300 less in total Medicare and Medicaid costs per resident over 12 months than traditional nursing homes. At a Green House in Grand Rapids, Mich., a monthly stay is $10,230, comparable to a good nursing home (New York Times).
Organizations are making an effort to help low-income seniors get into Green Houses. Thanks to a $2.2 million loan through Age Strong, an initiative of the AARP Foundation, Capital Impact Partners and Calvert Foundation, a new Green House in Akron, Colo., plans to have 60 percent low-income residents who are covered by Medicaid. The Green House, expected to open this year, will replace an outdated traditional nursing facility.
Green House Project homes that are licensed as traditional nursing homes are eligible for the same Medicaid and Medicare reimbursements as a traditional nursing home. If the facility is licensed as assisted living, Medicaid reimbursement depends on the state’s assisted-living provisions. For Medicaid, the expenses are equivalent to the traditional Medicaid costs for nursing homes. For private pay, each facility determines its own cost structure.
What Research Has Shown
Several studies have favorably compared Green Houses to traditional nursing care. The Robert Wood Johnson Foundation Green House Workflow Study found that nursing home residents were hospitalized more often (more than 7 percentage points higher per resident over a 12-month period) than Green House residents. As such, annual Medicare hospitalization expenditures per resident were less in the Green House unit relative to traditional units.
A 2009 evaluation of the Green House Project’s care found it provided higher direct care (23–31 minutes more per resident per day) than traditional nursing homes and more than four times as much staff engagement with elders outside direct-care activities (Wikipedia). In a 2004 report presented to Congress, researchers from the University of Minnesota School of Public Health found that elders in a Green House Project home were able to perform daily functions longer than those in traditional nursing facilities. Among those living in Green House homes, there have been increased reports of mobility and social interaction, and fewer reports of weight loss and depression.
“New Homes on the Range: Better Care for Elders,” Dec. 1, 2014, Next Avenue
“Homes on The Range–Change our elder care!“, Indiegogo
“GreenHouse in Akron, CO will offer homelike care,” Age Strong
“A Revolution in Life Beyond Adulthood,” July 31, 2012, Next Avenue
“Green House Project,” Wikipedia
“Culture Change Goes Mainstream,” May 2010, Robert Wood Johnson Foundation
“The Green House Project: The Next Big Thing in Long-Term Care?,” July 30, 2015, A Place for Mom
“Small Residences for the Elderly Provide More Personal, Homelike Care,” Nov. 20, 2015, New York Times
Blog posting provided by Society of Certified Senior Advisors
According to new research, stereotypical views on aging can negatively affect our hearing and memory skills, according to University of Toronto researchers. In a study of 301 adults ages 56-96, scientists assessed each person’s view on aging, the perception of one’s memory and hearing abilities, and actual hearing and memory performance on tests. Those with negative views about aging who believed they had hearing and memory challenges performed poorly on tests. Dispelling stereotypes about aging could improve confidence in hearing and memory abilities, researchers say.
Decreased fluid intake can exacerbate age-related problems, such as declining kidney function, causing seniors’ health to worsen and sometimes landing them in the hospital.
When Walter, 94, got the stomach flu, he became so weak from vomiting that he was taken to the hospital, where he received fluids. A week later he was back in the hospital after falling in his assisted-living apartment. After the second hospital visit, unable to stand on his own, he entered a nursing care facility. It’s likely that, in the intervening week between hospital visits, Walter, who suffers from early dementia, didn’t know to keep drinking water or other fluids and stay hydrated. In a two-week period, he lost 20 pounds and had to start using a wheelchair.
Dehydration, which occurs when someone loses more water than they take in, is a serious problem, and a frequent cause of hospitalization, especially for the elderly. Depending on the definition of dehydration, between 6 and 30 percent of people aged 65 years and older who are hospitalized are dehydrated (International Journal of Preventive Medicine). In a related study, researchers found that 48 percent of older adults admitted into hospitals after treatment at emergency departments showed signs of dehydration (Parent Giving).
Causes of Dehydration
As we age, several bodily functions decline that make us more susceptible to dehydration. When you add in other outside factors, such as the stomach flu, the combination can turn an otherwise healthy person, like Walter, into someone suffering from various medical issues. Causes of dehydration include:
Water loss. As we age, the body doesn’t hold as much water because we lose muscle mass, while our fat cells increase. By the time we’re 80, we have 15 percent less water than when we were 20, making our bodies more vulnerable to dehydration from even minor fluid loss.
Kidney decline. Starting around age 50, and becoming more serious around age 70, the kidneys begin to lose some of their ability to remove toxins from the blood. Because kidneys are less able to concentrate urine, we expel water more quickly as we age.
Less sensation of thirst. Older people lose the sensation of being thirsty, much as our taste buds decrease as we age. Also, some seniors may drink less because they fear incontinence.
Medications. Drugs such as diuretics, laxatives and angiotensin-converting enzyme inhibitors (used to treat high blood pressure, among other conditions) can cause more frequent urination or perspiration, which interferes with fluid balance. Psychotropic medications, such as antipsychotics, cause dryness of the mouth, constipation or urinary retention, which can affect hydration. Additionally, older adults are often taking several medications at once, further complicating the problem.
Illness. Vomiting is a major cause of dehydration, because of fluid loss. A fever has the same effect, and generally the higher your fever, the more dehydrated you may become. A combination of diarrhea and vomiting, as in Walter’s case, can increase the risk of serious health issues.
Older adults also tend to eat less, which can also mean less liquid intake. Nursing homes present their own challenges for hydration of elderly residents (see sidebar).
Severe Consequences of Dehydration
Dehydration can lead to serious complications, including (from the Mayo Clinic):
- Swelling of the brain (cerebral edema). Sometimes, when you’re getting fluids after being dehydrated, the body tries to pull too much water back into your cells. This can cause some cells to swell and rupture. The consequences are especially grave when brain cells are affected.
- Seizures. Electrolytes—such as potassium and sodium—help carry electrical signals from cell to cell. If your electrolytes are out of balance, normal electrical messages can become mixed up, which can lead to involuntary muscle contractions and sometimes a loss of consciousness.
- Low blood volume shock (hypovolemic shock). This is one of the most serious, and sometimes life-threatening, complications of dehydration. It occurs when low blood volume causes a drop in blood pressure and a decrease in the amount of oxygen in your body.
- Kidney failure. This potentially life-threatening problem occurs when your kidneys are no longer able to remove excess fluids and waste from your blood.
- Coma and death. When not treated promptly and appropriately, severe dehydration can be fatal.
- Heat injury. If you don’t drink enough fluids when exercising vigorously and perspiring heavily, you may end up with a heat injury, ranging in severity from mild heat cramps to heat exhaustion, or potentially life-threatening heatstroke.
One researcher compares dehydration to a pump trying to work with less fluid, which puts a greater strain on the heart. For older adults with serious medical conditions, dehydration has been linked to increased rates of death. Despite what seems a trivial matter, the costs of not treating dehydration early can be high: a U.S. study in 1999 evaluated the avoidable costs of hospitalizations due to dehydration at $1.14 billion (from Hydration for Health).
How to Avoid Dehydration
To make sure you or someone you’re caring for is staying hydrated, the most important factor is to drink plenty of fluids. Standard advice is to drink at least five 8-ounce glasses of water daily. One formula is to drink the number of ounces of water daily that is equivalent to one-third of the person’s body weight in pounds. For example, a 150-pound woman would need 50 ounces of water daily, or about six 8-ounce glasses of water.
Although water is the best beverage choice, to motivate someone to drink, you may need to cater to their preferences, such as fruit juice. (However, if the individual is diabetic, caution should be used because of blood glucose values and dietary restriction of sugars) or decaffeinated coffee and tea. Avoid alcohol and caffeine, which have a diuretic effect, causing the kidneys to excrete more water. Caregivers should ensure the older person they are caring for has water by their side at all times—for example, on a bed stand or next to their favorite chair—especially if they do not walk much.
In addition, if the individual has a swallowing problem and needs thickened fluids, this needs to be watched carefully to avoid aspiration of liquids into the lungs. If dehydration is suspected, because the person is not drinking or does not have a normal urine output, a temporary solution could be a sports drink, which has electrolytes needed by the body. However, caution needs to be taken to not over-consume because of the sports drink’s higher sodium content.
Eat high-water-content fruits such as watermelon, berries, grapes and peaches. Water-rich vegetable options include tomatoes, lettuce and summer squash. Soups are also a good way to sneak extra liquid into a diet.
Check urine color to make sure it is clear or pale yellow. Dark urine or infrequent urination is a classic sign of dehydration, as is decreased urination and urine output.
Other signs of dehydration to watch for are:
- Dry and sticky mouth
- Dry skin
- Confusion and irritability
- Sunken eyes
- Unconsciousness or delirium
- Difficulty walking
- Dizziness or headaches
- Inability to sweat or produce tears
- Rapid heart rate
- Low blood pressure
“Oral Hydration in Older Adults: Greater awareness is needed in preventing, recognizing, and treating dehydration,” June 2006, American Journal of Nursing
“Hydration and the elderly,” Hydration for Health
“Prevention of Dehydration in Independently Living Elderly People at Risk: A Study Protocol of a Randomized Controlled Trial,” Oct. 19, 2015, International Journal of Preventive Medicine
“Dehydration,” Nursing Home Abuse Guide
“Dehydration: Risk factors,” Mayo Clinic
“Dehydration: A Hidden Risk to the Elderly,” Parent Giving
“Elderly Dehydration: Prevention & Treatment,” April 21, 2015, A Place for Mom
Blog posting provided by Society of Certified Senior Advisors
In tribal societies, older adults are valued because they have useful skills. A scholar suggests ways we can appreciate seniors in the modern world.
Traditional hunter-gatherer societies treat their elderly better than modern society does for several reasons, says Jared Diamond, a “civilization scholar.” In tribal societies, elders continue to perform useful services such as producing food and babysitting grandchildren, which frees the adults to hunt and gather. In our modern culture, we have books and Google that serve as our sources for knowledge, but in tribal societies, elders serve as the repository for information about medicine, politics and food, among other topics. Their knowledge can mean the difference between survival and death.
In the modern world, older adults are devalued in a Puritan-based culture that places worth on self-reliance, work and youth. Diamond offers suggestions for how to improve seniors’ lives in a youth-based culture. Listen to his informative talk on “How Societies Can Grow Old Better.”
Blog provided by Certified Senior Advisors (www.csa.us)
by Erika Walker
Retirement today isn’t what it used to be. More and more older adults, including boomers, are choosing to work longer because they enjoy it, or are creating new careers and businesses during retirement.
Gone are the days when individuals worked for one organization for 40 years until they were 65 years old, received a pension and a gold watch, had a retirement party, and then went off to the golf course. Seniors are looking for new ways to use their skills and talents.
Why is this happening?
- Working helps avoid social isolation and keeps them connected to their communities
- Working gives meaning to their lives
- Working allows them to use their knowledge and experience
- Working helps older people stay physically and mentally healthy
- Working is a source of pleasure
So if you are interested in an “Encore” career, you are not alone! There are lots of benefits, so Go For It!
Under a new law, patients can discuss their medical options and goals in order to make an informed decision on the type of care they want.
For the first time, Medicare will pay this year for a conversation with your healthcare provider about your end-of-life care. When Congress attempted this coverage six years ago, it was met with charges that such conversations would result in “death panels.” Yet polls show that a majority of Americans want to talk to their doctors about their options and preferences as they approach the end of their lives. A recent Kaiser Family Foundation survey found that about 9 in 10 adults say doctors should discuss end-of-life care issues with their patients, yet only 17 percent of adults say they have had such a discussion.
Even though most adults (90 percent) say they would prefer to receive end-of-life care in their home if they were terminally ill, only about one-third of Medicare beneficiaries (age 65 and older) died at home (Kaiser Family Foundation). Conversations with healthcare provider about such wishes could guide you and your doctor to the kind of treatment that would ensure you die where you want.
Under the new rule, Medicare pays $86 for the first 30 minutes of “advance care planning” in a doctor’s office and $80 for the service in a hospital. In both settings, Medicare will pay up to $75 for 30 additional minutes of consultation. If the discussion takes place during your annual wellness visit, it is considered a preventive service and the patient’s coinsurance and deductible are waived. These voluntary discussions can take place at any time, not just when a patient is facing a serious illness or death.
Ideally, end-of-life conversations would cover a range of concerns, including understanding the patient’s prognosis and goals. Do you want everything done that would keep you alive—chemotherapy, CPR, tube feeding—even if it doesn’t meet your wishes for your end of life? Be specific about treatments and interventions you do and do not want.
Benefits of the Conversation
Far from forcing people to accept treatments that would shorten their lives, communication with your healthcare provider can help ease your fears, minimize pain and suffering and enable you and your family to experience a peaceful passing. Those who are dying often have many fears—of pain, indignity, abandonment and the unknown. By talking to your healthcare provider, your end-of-life care can become an experience of choice rather than passivity, of empowerment rather than powerlessness, experts say.
An end-of-life conversation allows your loved ones to know what to expect and know that you are receiving the care you desire. The new policy will help seniors “make important decisions that give them control over the type of care they receive and when they receive it,” the Centers for Medicare and Medicaid Services stated.
Studies have shown that advance-care planning improves the patient’s quality of care because it’s targeted to what the person wants. Directed treatments can reduce the costs of medical interventions that the patient either doesn’t want or doesn’t need.
This article comes from the Certified Senior Advisors March 2016 blog. Corinne Auman with Choice Connections is your local Certified Senior Advisor.
The 2016 Senior Games are happening April 5th-May 13th. The games include Olympic style events, such as archery, billiards, bocce, bowling, cornhole, croquet, cycling, golf, swimming, and much more! There will also be a SilverArts showcase.
Visit www.greensboro-nc.gov/seniorgames for more information!