Most everyone wants to stay out of a nursing facility as they get older. Some people are able to remain at home with support, but many need more help than is available with in-home care.
As our loved ones age, most of them have some combination of chronic illnesses that present constant challenges. Some will need ever–increasing help in managing their health issues. Many are just lonely and unable to meet their basic “activities of daily living” without some assistance.
Whether at their own house or in assisted living, there are some common things that take elders out of their home and to the nearest emergency room. Many of these things can be avoided by doing some simple tasks on a regular basis.
These tasks are referred to by the founder of the nationally respected “Transitional Care Model,” Dr. Eric Coleman, as the “Four Pillars” of transitional care.
Truth be told, there are many more than the “Four Pillars” that Dr. Coleman uses in his framework. However, these are the basic and most common tools used by all geriatric care management professionals in providing excellent chronic disease management at home or in other non-medical environments.
Here’s ashort list and explanation of how important each one is and how easy it is for a family member to get these in place. If you need help, call Grace Care and we’ll assist you in setting these up.
Physician Appointment Calendar:
Ensure the appointments your loved one has with their doctors are made in timely fashion and are actually attended, with full information transferred to all caregivers, whether family members or agency caregivers. If you or a family member is acting power of attorney for health care and you are unable to attend doctor’s visits, you can ask for the visit notes to be faxed to you after each appointment.
Communication with all Medical Providers:
Two–way communication with your loved one’s physicians is critical. Coordination of care between multiple medical providers is an important key to managing chronic illness well at home. Each doctor needs to be kept current on what medications and treatments the other doctors have initiated. Reactions to new medications and all changes in condition need to be reported to appropriate physicians on a regular basis.
Medication List:
Keep a list that documents all medications; when they were started and stopped; what doses and what times they are given. Make several copies so that all routine providers as well as emergency medical providers have access to the current medication list. Include allergies to medications, and the specific reactions to each medication on the list.
Vital Signs:
Keep a record of vital signs taken as often as needed. Vital signs include: Temperature, Heart Rate or Pulse, Respirations and Blood Pressure. These readings are a “snapshot” into your loved one’s real-time medical status.
A digital blood pressure cuff will measure both blood pressure and heart rate. This data is easy to collect and an extremely important window into the medical status of your loved one. For those taking hypertension medications, blood pressure should be taken before blood pressure medications are given to make sure that blood pressure or heart rate doesn’t drop too low. The same is true with diabetes medications. Always check to make sure it is safe to give these powerful medications.
Many falls and adverse events are caused by “over medicating” with the prescribed doses at the prescribed times.
A person’s weight is also an important metric for those with hypertension and cardiac disease. Weights should be taken daily for anyone with congestive heart failure (CHF). Weight gain of over five pounds in one week should be reported to their physician as it can be connected to fluid retention which will directly impact respiratory status. Ask their physician for parameters to use so you will know when to hold off on these medications.
Blood sugars should be checked with a glucometer and documented. Again, ask their physician for medication parameters.
For those with respiratory problems, a pulse oximeter will measure the oxygen level in the blood. This small device fits on the end of a finger and works by monitoring the oxygen saturation by digital read out to notify when oxygen should be used.
(All of the monitoring tools mentioned here are available for purchase from your local pharmacy.)
These measures can be adapted at home or in assisted living facilities. Caregivers, family members or care facility staff can perform these basic assessment techniques.
However they are adapted, it is clear that these functions are critical to good management of an elder’s multiple chronic medical issues.
Make sure that these things are happening on a regular basis and changes communicated to all medical providers. This is the only way to assure your aging loved ones continue to enjoy optimum health and the highest quality of life possible.
