“Home-based care is increasingly seen as a legitimate and less costly alternative to nursing home care. The Patient Protection and Affordable Care Act, signed into law by President Obama in March 2010, includes provisions to assist people who want to stay in their homes longer.” This act has been praised from many in the medical field as being “one of the most important reforms to long-term care since Medicare and Medicaid”.
For many, nursing homes are not an appealing place to live. It is generally true that people like where they are currently residing as a recent study found that of adults aged 50+, “86% of them want to stay in their homes”. This makes private at-home nursing care a preferable option for those who lack the financial resources to move permanently to a nursing home or need social support because their families are busy.
According to recent research, the cost of staying at a nursing home ranges from $40,000 to $85,000 a year whereas the average cost of a home aide is only $37,000. With money becoming tighter and tighter with the economic slide, many are hoping the provisions of the Affordable Care Act will help retiring baby-boomers pay for at-home care. The most important provision is the Community Living Assistance Services and Supports Act (CLASS) which is a voluntary, consumer-paid insurance idea to cover long-term care expenses. Dee Mahan, deputy director of health policy at FamiliesUSA, called the plan “a really different and new way of looking at the delivery and financing of long-term care in the U.S…[it] is really, really important”.
Hopefully this new legislation will finally give patients the flexibility they have always wanted in terms of long-term care and open up all possible avenues. Companies and nursing homes are ready to serve when your decision is made.
 Tammy Worth. “Helping seniors live at home longer”. June 19, 2011. http://articles.latimes.com/2011/jun/19/health/la-he-long-term-care-20110612
 Report by John Hancock Financial Services, Inc.
Alzheimer’s disease is a growing concern in modern society as over 26 million people globally are affected by it each year. It is known as the incurable, terminal brain disorder that slowly steals the minds of its victims. The emotional and financial costs for families experiencing this disease with a loved one can be enormous. There has recently been an increase in research relating to this disease in an effort to help slow the effects and find a cure.
This is where a nutritious diet comes in. A healthy diet has been proven to be important for your body but recent studies say it is good for your brain and can help prevent Alzheimer’s as well. The study concluded that “diet may be a powerful environmental factor that modulates Alzheimer disease risk”. The results are only preliminary but definitely seem to indicate a connection between eating healthier and reducing your risk for Alzheimer’s.
Similarly, another study isolated fruits, vegetables and omega-3 fatty acids as specific dietary elements that were beneficial in reducing the risk of Alzheimer’s. This study discovered that people who followed the diet above were “38 percent less likely to develop Alzheimer's disease”.
Overall, it is clear that diet has some effect on reducing Alzheimer’s but more research is necessary to confirm the correlations described in the studies above.
 “About Alzheimer's Disease”. http://www.ahaf.org/alzheimers/about/
 LiveScience, “Can Changing Your Diet Decrease Your Risk of Alzheimer's?”. June 14, 2011. http://news.yahoo.com/s/livescience/20110614/sc_livescience/canchangingyourdietdecreaseyourriskofalzheimers
 Todd Neale. April 13, 2010. “Alzheimer's and Diet: Good for Heart May Be Good for Brain”. http://abcnews.go.com/Health/Alzheimers/alzheimers-diet-foods-lower-dementia-risk/story?id=10359869
By Arjun Vellayappan / Hotel Recovery, Inc.
As time passes, our parents and grandparents age and several questions arise. Should I advise them to join a nursing home? Do they need long-term care at home? When will they retire? Will I have to take care of them?
One question that should be thought about more carefully than it currently is regards when the elderly should stop driving motor-vehicles. As coordination, eye-sight and other motor skills decline with older age, there can be several warning signs that should indicate it is time to stop driving.
The National Highway Traffic Safety Administration lists the following warning signs:
- “Becoming lost when taking a familiar route
- Appearance of new scratches and dents on the car
- Getting ticketed for a driving violation
- Getting into a car accident, or having a near-miss
- Receiving a recommendation from a doctor to stop or reduce driving, having health problems that impact driving, or taking medications that affect driving
- Finding that road signs and road markings are suddenly overwhelming
- Driving too fast or too slowly for no apparent reason.”
Another recent study concluded that older drivers are more likely to make crucial driving mistakes, even when they are healthy. “The oldest people in the study, who were between ages 85 and 89, made four times as many critical errors in a driving test”. The Center for Disease Control and Prevention had the following advice for older drivers:
- “Review medications with your doctor or pharmacist to make sure there are no side effects that can impair your driving ability
- Get your eyes checked at least once a year, and always wear glasses or contact lenses while driving, if needed.
- Plan your driving route before you start driving.
- Don't tailgate; leave a large distance between you and the car in front of you
- Avoid distractions such as cellphones, loud radios and eating
- Consider public transportation if you don't feel safe driving"18
By taking the time to understand concerns like this one you can ensure that you enjoy the years with your loved ones for a long time to come.
 Yahoo News. “Health Tip: Is It Time to Stop Driving?”. June 2, 2011. http://news.yahoo.com/s/hsn/20110603/hl_hsn/healthtipisittimetostopdriving
 Amanda Chan. My Health News Daily. May 17, 2011. “Older drivers make mistakes, even when healthy”. http://www.msnbc.msn.com/id/43065601/ns/health-aging/
In the United States more than 700,000 people suffer a stroke every year, and about two-thirds of these individuals survive and require rehabilitation. Rehab aims to help these survivors reach the best quality of life and become as independent as possible. Reaching this goal requires an understanding of the important elements of recovery at home which will be discussed here.
As briefly mentioned in a previous post, therapy at home has recently been found to be a more effective treatment method than high-tech intervention. Duncan’s 2011 study regarding stroke patients concludes that “patients given the treadmill intervention were also found to be at higher risk for falls when started early, making in home therapy safer”. Another study directed by Nancy E. Mayo (PhD, associate professor at the school of physical and occupational therapy at McGill University) decisively concludes that “home is the best place for stroke rehabilitation” and “going home…empowers the survivor and the family to take charge of the care”. Given these facts, patients need to understand the steps they can take to even further improve their rehabilitation process.
Here are a few tips for improving your post stroke recovery at home according to the National Stroke Association:
- Ask your doctor to arrange a home visit by an occupational therapist, who is trained to help you regain your independence
- Adjust or add lighting throughout your home to decrease glare and help you see better
- Keep telephones within easy reach
- Write out emergency phone numbers in large font and keep them in several easy to find locations
- Accept help with chores such as cleaning, making meals and errands
- Install sturdy handrails and grab bars in your bathroom to prevent injury
- 40% of stroke survivors suffer serious falls within the first year of recovery at home, use these tips to prevent that:
- Move extra furniture out of the way
- Clear paths to important rooms like the kitchen, bathroom and bedroom
- Move electrical wires out of walkways
- Wear non-skid shoes and avoid slippery surfaces
- Install handrails for support when going up and down stairs
Following this advice in addition to consulting an occupational and physical therapist can make post-stroke recovery an easier process for those faced with the circumstances.
 National Institute of Neurological Disorders and Stroke. “Post-Stroke Rehabilitation Fact Sheet”. http://www.ninds.nih.gov/disorders/stroke/poststrokerehab.htm
 Kathleen Blanchard, RN. “At home physical therapy safer than high tech stroke rehabilitation”. http://www.emaxhealth.com/1020/home-physical-therapy-safer-high-tech-stroke-rehabilitation
 ”Home Is the Best Place for Stroke Rehabilitation”. May 5, 2000. Medscape Medical News. http://www.medscape.com/viewarticle/411846
 National Stroke Association. “Recovery After Stroke: Managing Life at Home”. http://www.stroke.org/site/DocServer/NSAFactSheet_ManagingLifeatHome.pdf?docID=994
Physical therapy is centered on identifying and maximizing the quality of life and movement potential of patients in treatment, prevention and rehabilitation. There are many different settings where physical therapists can treat their patients including hospitals, schools, nursing homes and private homes. This article will focus on the home setting and outline the benefits of taking that approach.
Many recent studies have described the home-based therapy approach as safer, more efficient and more effective in comparison to other strategies. According to Dr. Pamela Woods Duncan’s (PhD, PT, professor in the Doctor of Physical Therapy Division at Duke University) 2011 NIH-funded study about stroke patients, “home-based intervention is more accessible, more feasible, and it was also associated with fewer risks”. In a similar study, “Young and Forster found that home physiotherapy [was] more effective and resource-efficient than day hospital-based rehabilitation”.
Outside of stroke patients, the benefits of in-home therapy are also clear for the elderly. Researchers from the Yale School of Medicine concluded that “the decline of frail elderly people living at home can be slowed, if not prevented with a home-based physical therapy program”. This makes sense because favorable treatment outcomes depend to some extent on patients following therapy instruction and the elderly are more likely to do so with one-on-one care at home.
Other benefits of physical therapy in the home include:
- “Improved compliance by not missing treatment sessions
- Therapists can evaluate a patient in their real natural environment
- Patient's don't have to travel to a clinic thus making it more time efficient
- Privacy for the patient and their family
- Eliminate disruptions from other clients, phone calls, etc.
- Following surgery, having a therapist come to the home may eliminate complications of driving a car or having to negotiate dangerous obstacles on your way to an outpatient clinic.”
Although in-home physical therapy is not for everyone, it is an option that merits consideration. If you’re the type of person who wants to stay close to home with your friends and family while still receiving quality care, then this may be the perfect option for you.
 Kathleen Blanchard, RN, “At home physical therapy safer than high tech stroke rehabilitation”, http://www.emaxhealth.com/1020/home-physical-therapy-safer-high-tech-stroke-rehabilitation
 Jau-Hong Lin, Ching-Lin Hsieh, Sing Kai Lo, Huei-Ming Chai, and Long-Ren Liao, “Preliminary Study of the Effect of Low-Intensity Home-Based Physical Therapy in Chronic Stroke Patients”, Kaohsiung J Med Sci 2004;20:18–23
 “Physical Therapy Benefits Elderly”, The New England Journal of Medicine, 2002;347:1068-1073, http://www.selecthomecare.net/index.php/our-services/physical-therapy/therapy-benefits.html
 Brad Gilden, DPT, MSPT, CSCS has been practicing orthopedic and sports physical therapy over the past six years, “Benefits of In Home Physical Therapy”, http://ezinearticles.com/?Benefits-of-In-Home-Physical-Therapy&id=82678
Picture from: http://www.smarterlivingestate.com/physical-therapy-treatment-for-chronic-low-back-pain/
Patient compliance with medication post-hospitalization is a vital concern to all hospital personnel because it can dictate the final outcome of treatment. There have been a variety of studies on this subject which all indicate a growing gap between patient compliance and original discharge orders.
One study among the elderly (age 65+) concluded that “64% used at least one medication that was not ordered by the physician at discharge, and 73% failed to use at least one medication according to the way it was ordered. Of all drugs ordered at discharge, 32% were not taken at all”. From these statistics it is clear that medication compliance is one aspect of healthcare that currently needs improvement.
Another more recent study suggested that: “patients do not feel adequately prepared to participate in their post-hospital care. The brief period immediately before discharge may not be an ideal time to convey new and complex information to older patients, as pain, anxiety, sleep deprivation, or delirium may limit receptivity or new learning”. This study concludes that medication compliance can be improved by system quality improvement activities such as receiving more feedback from patients after discharge or having nursing care outside the hospital. Similarly, a recent New York Times article citing Michael Wolf, an associate professor of medicine at Northwestern University, suggested a universal medication schedule. Wolf called it a “ridiculously simple [and] incredibly basic idea” which could solve medication compliance problems for good.
Improving medication compliance after discharge should be a larger focus for healthcare professionals because it directly affects patient safety, quality of care and cost.
 Beers MH, Sliwkowski J, Brooks J. “Compliance with medication orders among the elderly after hospital discharge”. Hosp Formul. 1992 Jul;27(7):720-4
 Eric A. Coleman, MD, MPH; Jodi D. Smith, ND; Devbani Raha, MS; Sung-joon Min, PhD. “Posthospital Medication Discrepancies”. Arch Intern Med. 2005;165:1842-1847
 Paula Span. Author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.” NYT. “A Dose of Confusion”. http://newoldage.blogs.nytimes.com/2011/06/15/a-dose-of-confusion/#more-9327
Image from: http://www.senior.com/health/prescription-drugs/medication-safety-for-seniors/
Anxiety can be an important factor in determining outcomes of recovery both during and post-hospitalization. Several studies suggest that there is a direct correlation between increased anxiety and poorer treatment outcomes.
This is especially true in the context of cardiac cases as “studies show that anxiety is independently associated with a higher risk of in-hospital complications in patients”. Moser’s study concludes that “interventions that increase patients' perception of control may help diminish the link between anxiety and poorer outcomes”. Some interventions will require the one-on-one care of a nurse and many companies stand ready to provide those services to those who need it. In addition, there are many common methods for reducing anxiety including:
- Talk to a friend or family member. These people are not replacements for professional help, but they can be there to listen when you need them. Sometimes letting off a little steam can help.
- Exercise. Taking a walk or riding your bike allows your body to release endorphins, which contribute to feeling good and reducing stress.
- Reduce your caffeine intake. Caffeine is a stimulant and that is the last thing a person suffering from an anxiety disorder needs.
- Laugh. Nothing reduces stress like laughing. If you walk around feeling miserable, you will be miserable, but if you laugh life seems better.
- Take ten minutes and relax. Do something relaxing: take a hot bath, read a book, listen to music, anything to make you forget for a few moments about your anxious feelings.
In order to increase the chances of a future event-free survival (especially in the context of heart conditions), reducing patient anxiety is a must. The ideas above should aid in this process but for serious concerns, please get in contact with a doctor.
 Debra K. Moser, RN, DNSc, “’The Rust of Life’: Impact of Anxiety on Cardiac Patients: Relationship Between Anxiety and In-Hospital Complications in Patients With AMI”, American Journal of Critical Care. 2007;16(4):361-369
 “What are some steps for reducing anxiety?”, http://www.allaboutlifechallenges.org/reducing-anxiety-faq.htm
It is well known that nurses play a pivotal role in the success of hospitals around the world. Physician Lewis Thomas put it perfectly in The Youngest Science, when he said: hospitals are “held together, glued together, enabled to function…by the nurses and nobody else” (Thomas, 1983: 66-67). Currently over 1.5 million registered nurses work in hospitals across the United States, yet the recent economic downturn and other unforeseen pressures have created a massive nursing shortage. This has brought up new concerns regarding the decrease in the quality and quantity of nursing care and its effects on patients’ recovery.
Several recent studies have found correlations between decreased nursing care and higher rates of adverse outcomes for patients. Needleman conclusively states that “in a large sample of hospitals from a diverse group of states…we found an association between the proportion of total hours of nursing care provided by registered nurses…and…length of stay and the rates of urinary tract infections, upper gastrointestinal bleeding, hospital-acquired pneumonia, shock or cardiac arrest, and failure to rescue”. Needleman’s conclusion was that as the total hours of nursing care increased, the length of stay and rate of infection decreased.
Similarly, Sochalski finds that there is a causal relationship between quality of care and patient workload. She states: “the attenuation of its effect suggests that workload affects quality of care both directly as well as through its effects on patient safety and unfinished work”.
These findings suggest a compelling reason to limit the duration of time spent in a busy and understaffed hospital to what is medically necessary. One can take advantage of care outside hospitals which guarantees extra nursing help while recovering in a familiar and calming environment.
 “RN (Registered Nurse) Salary Statistics”, http://onlinelpntorn.org/rn-registered-nurse-salary-statistics/
 Jack Needleman, Ph.D., Peter Buerhaus, Ph.D., R.N., Soeren Mattke, M.D., M.P.H., Maureen Stewart, B.A., and Katya Zelevinsky. “Nurse-Staffing Levels and the Quality of Care in Hospitals”. N Engl J Med 2002; 346:1715-1722
 Julie Sochalski, PhD, RN, FAAN. “Is More Better? The Relationship Between Nurse Staffing and the Quality of Nursing Care in Hospitals”. Med Care 2004;42: II-67–II-73