Family is biggest influencer of older adult housing and care preferences: study

Author: Lois A. Bowers, Senior Editor, McKnight’s Senior Living

Family support is the biggest influencer of housing and care preferences among older adults, according to a study published Wednesday (March 7, 2018) in the Journal of the American Geriatrics Society.

Often, the authors found, older adults changed their preferences based on the concerns of family members or a wish to avoid “being a burden” to others. This basis was especially true for preferences regarding the places where people wished to receive care — for example, at home or in a residential care setting, they said.

The researchers, all of whom were affiliated with the Cicely Saunders Institute of Palliative Care Policy and Rehabilitation at Kings College London, examined 57 previous studies about the preferences of older adults with advanced illness. They included research that investigated preferences for where people wanted to be cared for, the kinds of communication and decision-making they wanted and the quality of life they hoped to have over time.

Family involvement is key in care decisions

Although support from family was the most important influence on their care preferences, older adults usually formed their preferences based on several other factors, too, including their experiences related to previous illness and caring for others as well as having a serious illness, according to the study.


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Preventing the Flu: Good Health Habits Can Help Stop Germs

From the CDC and

The single best way to prevent seasonal flu is to get vaccinated each year, but good health habits like covering your cough and washing your hands often can help stop the spread of germs and prevent respiratory illnesses like the flu. There also are flu antiviral drugs that can be used to treat and prevent flu.

  1. Avoid close contact.

Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.

  1. Stay home when you are sick.

If possible, stay home from work, school, and errands when you are sick. This will help prevent spreading your illness to others.

  1. Cover your mouth and nose.

Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.

  1. Clean your hands.

Washing your hands often will help protect you from germs. If soap and water are not available, use an alcohol-based hand rub.

  1. Avoid touching your eyes, nose or mouth.

Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.

  1. Practice other good health habits.

Clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

A article by Sallie Jimenez focused on item #4 and shared a study concluding that hand washing decreases chances for the illness to result in deaths. Jimenez writes that “In the midst of what may be one of the worst flu outbreaks in a decade, new research reinforces the importance of proper hand hygiene protocol.”

Her article references the following: A study published in the February issue of the American Journal for Infection Control found hand washing saves lives — not just in hospitals — but all healthcare facilities, including nursing homes. Researchers looked at 26 French nursing homes from April 1, 2014, to April 1, 2015, discovering consistent measures encouraging staff and visitors to wash their hands reduces mortality and antibiotic prescription rates, according to a news release from the Association for Professionals in Infection Control and Epidemiology highlighting the results.

During the course of the study, which included 13 nursing homes randomly assigned to an intervention group and 13 assigned to a control group, a program was implemented targeting nursing home staff, visitors and outside care providers, the news release said.

As part of the program, hand sanitizer became more readily available in both pocket-sized containers and dispensers and the idea of proper hand hygiene was promoted through posters, events, work groups and education.

“The measures resulted in a lower mortality rate of 2.10 deaths per 100 residents, versus 2.65 in the control group, with a notable 30% decrease in the mortality rate during France’s major influenza outbreak in early 2015, according to the news release.”

Although the CDC stresses the single best way to prevent the flu is to get vaccinated, proper hand washing and cleansing — either with soap and water or an alcohol-based hand sanitizer if soap and water are not available — also is recommended.



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Veterans Can Access Mental Health Services

Most Vets Don’t Know What Mental Health Services VA Offers. So Here You Go


Roughly half of all post-9/11 veterans who may need mental health care do not seek it through the Department of Veterans Affairs or in the private sector, according to a recent report by the National Academy of Sciences, Engineering, and Medicine.

Alarmingly, the report also says a significant number of veterans are unaware of the services available to them from the Veterans Health Administration — the VA’s medical arm.

Veterans who need mental health care but haven’t sought VA help cite several reasons, including “that they do not know how to apply for VA mental health care benefits, they are unsure whether they are eligible, or they are unaware that VA offers these benefits,” according to the Congressionally mandated Jan. 31 report.

“I was dismayed to learn how many veterans didn’t know how to access care,” Ralph Bozella, Chairman the of Veterans Affairs and Rehabilitation Commission for The American Legion, told Task & Purpose. “The VA has done a great job advertising their mental healthcare services on the web and via social media.”

But, he added, “At this point, I think the entire veteran community needs to do more to ensure veterans in need link up with the care they require. We all need to play a more active role here.”

To help with that, here’s a list of mental health services the VA provides to recently transitioned veterans.

Are you a combat vet?

Veterans who served in a combat zone can receive medical services — including mental health care — for five years through the VA, beginning the day of their discharge. This isn’t the same as having a service-connected disability rating; instead, think of it as free health insurance. Eligible vets will have free care and medications for any condition that might be related to their service; there’s no enrollment fee or premium, but you do have to cover copayments. This also opens you up to the VA’s CHOICE program, which means you can receive care through a private-sector specialist at the VA’s expense, not yours.

Soon, every transitioning vet can receive a year of mental health care through the VA.

Last month President Donald Trump signed the executive order “Supporting Our Veterans During Their Transition from Uniformed Service to Civilian Life.” It expands VA mental health care services to the 60% of recently separated vets who were previously deemed ineligible — usually because they lack a verified service-connected disability or service in a combat zone. Beginning in March, all transitioning service members with an honorable discharge will be eligible for 12 months of mental health care through the VA. Though the details of the program are still being worked out, veterans will be eligible to receive care at VA facilities — or in the private sector through CHOICE, if a local clinic can’t meet their needs.

Related: Here’s What We Know About Trump’s Executive Order To Combat Veteran Suicide »

Emergency mental health care is available for veterans with OTH discharges.

Though the executive order provides a year of care to many veterans, it doesn’t cover those with “bad paper” discharges — punitive discharges that preclude access to Veteran Affairs benefits, like education and health care. But last March, the VA launched a separate program offering emergency mental health services for veterans with other-than-honorable discharges. Though not all vets with bad paper are eligible, those with an OTH discharge in need of emergency mental health care can receive treatment through the Veterans Health Administration for up to 90 days — inpatient, residential, or outpatient care.

The VA offers much more if you’re enrolled in their system, though.

Veterans who qualify to register with the Veterans Health Administration enjoy a variety of mental health services. These include counseling, therapy, and, often, a treatment plan that includes prescribed medication. The range of coverage is fairly expansive, with experts able to offer support to veterans suffering from post-traumatic stress disorder, anxiety, depression, substance abuse, and stress, among other concerns. Additionally, the VA offers short-term inpatient care for vets suffering from life-threatening mental illness; outpatient care to a psychological rehabilitation and recovery center; video conferencing with a care provider; and residential rehab programs.

If you need immediate help, or just someone to talk to, resources are always available.

For those in need of immediate support, responders with the Veterans Crisis Line can be reached by calling 1-800-273-8255 and pressing 1; via text, by sending a message to 838255; or online. The conversations are confidential and the line is open 24 hours a day, 7 days a week year-round, and the staff is trained to assist veterans of all ages and circumstances.

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Are Baby Boomers Changing the Way We Die?

Quality of life. Hope. Living before leaving.

The nature of death and dying has evolved dramatically over the past century, driven in great part by Baby Boomers.

“A Good Death: How Boomers Will Change the World a Final Time” asserts that many in this generation are embracing the idea that quality of life should be the most important issue for patients and families facing terminal illness.

Think You’ve Covered the Bases? Better Check Again.

Tom Brokaw felt confident that he was prepared until this TED Talk. Here his doctor daughter interviews the NBC journalist about his future health care wishes.

Get Started (Hint: You Don’t Have to Be a Boomer)

Call 713-677-7118 or email to request an Advance Planning Packet filled with information about how to write a Life Review, how to talk to your family, and necessary legal forms such as Medical Power of Attorney and Texas Directive to Physicians and Family or Surrogates. You may also download Advance Directive forms here.

—Karla Goolsby, Houston Hospice Communication Specialist

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Report: Senior Health Care Misses the Mark

Report Details Senior Health Care That Misses The Mark

By Michelle Andrews

Quality over quantity. As people get older, their health care goals may shift away from living as long as possible to maintaining a good quality of life. In key areas, however, the medical treatment older people receive often doesn’t reflect this change, according to a new study.

The wide-ranging report from the Dartmouth Atlas Project uses Medicare claims data to examine aging Americans’ health care. Among other things, it identified five key areas where too many older people continue to receive treatments that don’t meet established guidelines or, often, their own goals and preferences.

Two of the five have to do with preventive care that may not benefit seniors: screening for breast and prostate cancer. The other three address care at the end of life: late referral to hospice care, time in the intensive care unit in the last six months of life and placing feeding tubes in patients with dementia.

While the measures themselves are quite different, they each highlight the need for better communication and shared decision-making among patients, their families and their medical providers.

“Where there are harms and benefits and people judge them differently, that’s where the shared decision-making comes in,” said Dr. Julie Bynum, an associate professor at the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H.

Despite the simplicity of a mammogram or a blood test to check for prostate cancer, if the screening is positive for cancer, that can set off a cascade of further testing and treatment. Those efforts could cause harm to older patients, whose health may be fragile or who have multiple medical conditions.

In addition, older people may well die from something else before a cancer progresses, said Dr. Richard Wender, chief cancer control officer at the American Cancer Society.

“The single hardest concept for the public to understand is the natural history of finding a cancer through a screening process,” Wender said. “Many people have the sense that had it not been found that cancer would have threatened their life within a couple of years or maybe even a couple of months.”

Experts have cautioned older patients about both tests. The U.S. Preventive Services Task Force, an independent panel that weighs evidence and makes recommendations about prevention services, has concluded that prostate cancer screening isn’t beneficial at any age and said that there’s not enough evidence to know whether women benefit or risk harm by undergoing breast cancer screening after age 74.

Medical treatment older people receive often doesn’t reflect their wishes.

Still, the Dartmouth Atlas analysis found that 20 percent of male Medicare beneficiaries age 75 and older got a PSA test to screen for prostate cancer in 2012, and 24 percent of female beneficiaries that age had a mammogram to screen for breast cancer that year.

We Need To Make Decisions Based On The Patient’s Values

Guidelines aside, clinicians and their patients need to discuss the pros and cons of testing and make a decision based on the patient’s values and preferences, experts say.

For example, a 75-year-old woman who is willing to accept that she might actually die of breast cancer within 10 years but wants to avoid the anxiety and harms of treatment, might choose not to be tested.

“I ask people, ‘Do you think you’re going to be around in 10 years? Help me decide’ whether to order a mammogram,” said Bynum, whose work focuses on geriatrics.

As people near the end of their lives, it’s especially important for patients and their family members to discuss their goals and wishes with clinicians. Patients often want to be kept comfortable rather than undergo medical interventions, but physicians and nurses are still trained to do everything possible to prevent death, said Dr. Diane Meier, director of the Center to Advance Palliative Care and professor of geriatrics at Mount Sinai’s Icahn School of Medicine in New York.

The three end-of-life criteria that the Dartmouth researchers cited are areas that geriatrics experts agree are critical but have proven difficult to get providers, health systems and the general public to accept, said Bynum. Late referral to hospice and spending time in a hospital intensive care unit can adversely affect terminal patients’ health, result in higher costs and run counter to their hope for a peaceful death. Feeding tubes in patients with advanced dementia can lead to other complications.

Lost Opportunity: Hospice Comfort Care Services That Are Available For Months Are Not Utilized

The Dartmouth study found that in 2012, 17 percent of Medicare beneficiaries who died were enrolled in hospice only during the last three days of life. Medicare, however, will approve hospice benefits, which generally include comfort care rather than curative treatment, when the physician certifies that someone is expected to live for no more than six months.

The study also found that people spent an average of nearly four days in intensive care during the last six months of life, a figure that is trending upward.

Finally, even though it doesn’t prolong their lives to place feeding tubes in patients with dementia, who naturally lose interest in food and their ability to swallow in the final stages of the disease, 6 percent of Medicare beneficiaries with dementia received them in their last six months of life in 2012.

Communication is key, but the skills that are needed to counsel patients aren’t being taught, said Meier.

“If you unleash an oncologist who does not know how to say, ‘Your cancer has progressed,’ but they know how to say, “I know what we can try,’ that’s why people end up in the ICU and with feeding tubes” at the end of life, she said. “It’s easier than having a difficult conversation.”

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

KHN’s coverage of aging and long term care issues is supported in part by a grant from The SCAN Foundation.

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Interfaith Blessing of Hands for Texas Medical Center

Interfaith Blessing of Hands

Houston Hospice Cockrell Chapel
1905 Holcombe Blvd., Houston, Texas 77030
Wednesday October 28, 12 p.m. and 3 p.m.

A Tradition in Many Cultures

Blessing of Hands is a tradition among many cultures and religions as well as in many medical institutions. The Texas Medical Center’s Houston Hospice believes this voluntary, nondenominational act recognizes and unites health care employees, volunteers and caregivers who have chosen the shared journey of caring for patients, directly and non-directly. Blessing of Hands is a spiritual exercise and prayer to honor those who give of themselves each day. Affirming their work through this blessing is meant to strengthen and renew their efforts.

Services are for all Texas Medical Center staff, volunteers and caregivers and last about 15 minutes. For more information about Blessing of the Hands services, contact Chaplain Gordon Robertson at 713-677- 7220.

—Karla Goolsby, Houston Hospice Communication Specialist

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