Ageing

Helping Veterans age well after military service

Published in Military Times by Sherman Gillums Jr. and Andrew Greene

When you think of hearing aids, canes, knee pain, memory issues, and heart problems, you might envision a grandparent or elderly person. But these indicators of aging may also describe a military veteran in their late 30s or early 40s who served on numerous deployments, worked on a flight line, or parachuted from aircraft for a living.

While new military inductees are typically some of the healthiest people in our society, many find themselves anything but healthy by the time they end their careers. In fact, many find themselves coping with an accelerated aging process that combines natural aging with the service-related wear and tear on their bodies and minds.

There has always been a national interest in ensuring that veterans receive retirement benefits for serving their country. What hasn’t been emphasized are the specific challenges veterans face as they age. A 2019 study, published in the International Journal of Environmental Research and Public Health, found that Persian Gulf War veterans suffered chronic conditions — such as high blood pressure, heart attacks, diabetes, stroke, and arthritis — about 10 years sooner than non-veterans the same age. This results in lower quality of life, higher mortality rates, and shorter life expectancies, especially for women veterans.

Compared to the overall population, veterans are more likely to be male, older, retired, widowed, educated, and living in the South, according to a report prepared by the LTSS Center in Boston. They also are more likely to report fair or poor health, limitations with activities of daily living, obesity, depression, and chronic conditions. This is despite the fact that there are not stark differences in financial wealth, and veterans pay less out-of-pocket for health care than civilians.

This raises the question: What is the best way to serve aging veterans who report a higher number of health and daily living issues during a greater portion of their lives than civilians?

To answer this, American Veterans (AMVETS) and the National Council on Aging (NCOA) are partnering to understand the specific needs of the nation’s 12.4 million veterans aged 65-plus and ensure that those who served have as fair a shot at aging well as those they defended. The partnership builds on two successful efforts: AMVETS’s HEAL Program and NCOA’s Aging Mastery Program® (AMP).
HEAL — which stands for healthcare, evaluation, advocacy, and legislation — encompasses all necessary steps to intervene directly on behalf of veterans, service members, families, and caregivers to reduce veteran unemployment, homelessness, and hopelessness, particularly for those who are at the highest risk of suicide.

The suicide rate among middle-aged and older veterans remains high, with approximately 65 percent of all veterans who died by suicide being aged 50-plus. Currently, the program has assisted over 600 veterans and families in crisis, with zero suicides following intervention, primarily by coordinating access to care and assisting with VA benefits. AMP helps older adults build their own playbook for aging well. Nearly 25,000 people have taken part either through classes in their community or by using the at-home Aging Mastery Starter Kit. Participants in AMP classes have achieved meaningful, measurable, and enduring changes in their health, finances, life enrichment, and advance care planning. The classes also serve as a gateway to encourage and lead older adults to participate in other community offerings.

An understanding of the aging process — both as a matter of acceleration among younger veterans and ways to make aging more of a comfort than a hardship — is essential to promoting good quality of life for those who served. The AMVETS and NCOA partnership will promote timely access to care and benefits for veterans with unique needs, along with customizable programs that support positive aging.
In addition to active support with obtaining VA benefits, veterans will have access to educational materials through Aging Mastery Starter Kits if they don’t live near an in-person class, are physically or socially isolated, or are caregivers. And with accredited representation and support from AMVETS, AMP will add a session on helping veterans coordinate their veterans benefits with Medicare.
From the time we’re born, we are educated and trained for the next phase of life. There is elementary school, high school, college, and military training. But there is no boot camp for aging. Veterans’ needs are unique, and the AMVETS-NCOA partnership provides a model for helping them age well.

Sherman Gillums Jr., chief advocacy officer, AMVETS, and Andrew Greene, managing director, Aging Mastery Program, National Council on Aging.

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Financial Assistance for Assisted Living in Texas

The following post contains helpful resource information from assistedliving.org/Texas

 

STAR+PLUS
STAR+PLUS is a multifaceted program which provides reimbursement for people seeking assisted living. The STAR+PLUS Home- and Community-Based Waiver is a part of the program that helps seniors who are assessed as nursing home-eligible continue receiving their Medicaid benefits without being institutionalized. Eligible applicants are reimbursed for services that promote independence, such as assistance with personal grooming tasks, basic mobility, and caregiver respite. Services may be provided by direct care aides at an assisted living facility or by home health contractors.

Who is Eligible?
The STAR+PLUS program has absorbed many Texas Medicaid plans and services, so understanding whether you qualify can be difficult. This is due to the many caveats that may apply if you are eligible for multiple state programs under the STAR+PLUS umbrella, or for other programs like Supplemental Security Income. Eligibility requirements are listed on the Texas Health and Human Serviceswebsite, though understanding what you may qualify for is likely to require the assistance of a dedicated case worker.

Eligible applicants are people who need an institutional level of care and qualify for Medicaid. Medicaid applicants over 65 should have a maximum income of $2,250 and countable assets of no more than $2,000, though eligibility criteria varies with marital status, level of assistance needed, and other factors.

How to Apply
This waiver is a non-entitlement program, which means that it can only support a limited number of active participants. Applying for the waiver is likely to result in one’s name being added to a waiting list for enrollment, so it is advised that interested parties sign up as far in advance as possible. Applicants are encouraged to seek qualified counseling to help them navigate the enrollment process and eligibility requirements of STAR+PLUS. To begin the application process, contact The Office of the Ombudsman at (866) 566-8989, or consult the Texas Area Agencies on Aging by calling (800) 252-9240. Find your local Area Agency on Aging by consulting the directory in this guide.

The Community First Choice (CFC) Program
The Community First Choice program is a lot like the STAR+PLUS HCBS waiver in what it offers, except that CFC is a Medicaid entitlement program, meaning there are no maximum recipient caps and no waiting lists for enrollment. Community First Choice offers Medicaid reimbursement to low-income assisted living residents for the provision of assistance with activities of daily living, such as personal grooming tasks, mobility, and basic house chores. People already enrolled to receive other Medicaid waiver services may elect to switch to the Community First Choice Program.
Services provided under the CFC Program may include:
• Personal assistance with activities of daily living
• Skills education for self-care and independent living
• Emergency response services
• Training for support staff management
• Consumer-directed service options

Who is Eligible?
Applicants for the Community First Choice program must qualify for Medicaid and must be assessed by a physician as nursing home-eligible. Coverage of personal care services through this program is provided based on an assessment of which services an individual requires.

How to Apply
Interested parties can apply online at YourTexasBenefits.com, or call 2-1-1 for guidance and consultation. Your local Area Agency on Aging can also help with Medicaid and non-Medicaid applications. To initiate an assessment and determine your eligibility, consult the directory in this guide to find a nearby Area Agency on Aging.

PACE
Serving the cities of El Paso, Amarillo, and Lubbock, PACE is the Texas branch of the national Program for All-Inclusive Care for the Elderly. It is a Medicaid-administered program intended to provide total coverage of all medical and personal care needs for especially frail seniors, helping them to avoid institutionalization. This program reimburses for a broad array of services that may be provided by assisted living facility staff or home health contractors.
PACE provides these services:
• Personal care services and home healthcare
• Adult day healthcare
• Medical care
• Coverage for all necessary prescription drugs
• Hospital and nursing home care when necessary
• Social services
• Caregiver respite

Who is Eligible?
• Individuals aged 55 and older who are nursing home-eligible
• People who live in an area covered by PACE services
• Those who can live safely at home or in an assisted living community
Private payment is accepted for individuals not receiving Medicare or Medicaid and fees for these participants will not exceed average costs for nursing home care in Texas. However, space in the program is limited, and preference is given to applicants who have greater medical and financial needs. Most recipients of PACE are dually eligible for both Medicaid and Medicare. All applicants must have family or caregivers who can provide limited support during short intervals of respite.

How to Apply
To find out if you’re eligible and to learn about what PACE offers, contact your local HHS office by dialing 2-1-1, or 7-1-1 for the hearing impaired. You can also consult your local Area Agency on Aging for more details and application assistance. Find your local Area Agency on Aging by searching the directory included in this guide.

More Ways to Finance Assisted Living
Some additional ways to finance assisted living costs include:

Free Assisted Living Resources in Texas
Texas is home to hundreds of nonprofits and government resource providers that assisted living residents can look to for added support. Some of these organizations, like the Area Agencies on Aging, operate in every state across the country, while others are dedicated only to specific regions in the state of Texas. All of these services are free to use. However, some organizations listed here may have income and health-related requirements intended to preserve resources for those who are most in need.

The Aging & Disability Resource Center
This center was opened by the HHS as part of the national No Wrong Door initiative, and it is intended to streamline public access to resources and information concerning long-term services and supports. The Aging & Disability Resource Center helps to reduce confusion and facilitate access to care for long-term care recipients in all 254 counties of Texas. Contact them by calling (855) YES-ADRC, or (855) 937-2372. Find out more online by visiting hhs.texas.gov.

The Long-Term Care Ombudsman Program
Most states have a Long-Term Care Ombudsman program which organizes volunteers to act as advocates for recipients of LTC benefits. Ombudsmen periodically visit residents of ALFs and nursing homes to verify the quality of their care and environment, field complaints and concerns, help them protect their rights, and keep them in touch with the service providers and authorities they may rely on. The services of ombudsmen are always free and confidential, and their organizations avoid conflicts of interest by remaining unaffiliated with service providers and government agencies. The Texas LTC Ombudsman program can be reached via e-mail at ltc.ombudsman@hhsc.state.tx.us and toll-free at (800) 252-2412.

211 Texas
The Texas Health and Human Services Commission provides 211 Texas as an anonymous social service hotline with 25 information centers across the state. They are available to take calls 24/7, and can help citizens understand and gain information on any programs administered by Health and Human Services, which includes long-term care facilities like assisted living and other supports for seniors.
Reach 211 Texas by simply dialing 2-1-1, or visit them online at 211Texas.org.

Area Agencies on Aging
The AAA is a national, federally funded organization. It acts as a central agency, unifying hundreds of community outreach programs and supports for citizens over 60 years of age. Texas hosts 27 Area Agencies on Aging, making this a convenient resource for people in all regions of the state.

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How to Plan, Prepare, and Realistically Pay for Long-Term Care

Published in caringfromafar.com

When you plan for your future, do you include any plans for long-term care? It’s an aspect of life that too many adults fail to properly plan for, and that can leave seniors and family members struggling to find a solution. So, if you really want to prepare beforehand, you need to make some smart plans to cope with and pay for long-term care.

Focus on Your Long-Term Care Strategy First

Use Medicare to Your Advantage

Before you begin setting aside funds for long-term care, it’s important to have a good idea of what that situation may look like for you or a loved one. For many older adults, this means taking a look at how Medicare will offset any long-term care needs. While Medicare and Medicaid offer little long-term care assistance, the former can offer peace of mind through Medicare Advantage plans. These supplemental plans cover more of your future care, but it’s important to know the enrollment dates so you don’t miss out on this opportunity.

Know What Factors Put You at Risk

Another smart way to plan for long-term care is to examine your family history and lifestyle choices. For example, seniors with Alzheimer’s are likely to need progressive long-term care, and this is a condition which tends to be passed on from one generation to the next. But knowing you have a risk of developing dementia or Alzheimer’s also allows you to make changes in your life to potentially halt the impact of these illnesses. You can exercise more, change your diet, and even use puzzles and games to help decrease your need for long-term care in the near future. Cognitive decline is a major risk factor for long-term care, but serious falls can be a culprit as well. Also, dedicate some time to making your home a safe spot to age in place.

Put Together Your Plan to Pay for Care

Photo by Pixabay

Assess Your Insurance Coverage Options

You know that Medicare Advantage plans can help seniors stay better prepared for the future, but do you know how Medicare or health insurance covers long-term care costs? This may be a shock, but Medicare and Medicaid offer minimal long-term care coverage. In fact, the only aspects most health insurance plans will pay for are actions directly related to your health. So, the more routine care that most long-term care seniors need likely won’t be included in your average healthcare coverage. For many seniors, this is where options like long-term care insurance come in handy. If you plan ahead, this supplemental coverage is not as expensive and can offset some of the financial burdens. Understanding this kind of coverage can be a challenge, so make sure you carefully read through and research policies before you commit.

Research Other Viable Ways to Pay for Care

Medicare may not help, and long-term care insurance is not the perfect option for everyone. So, how can seniors find other ways to make sure they get the long-term help needed? Thankfully, there are some smart solutions to help give seniors and their families financial peace of mind. If you have served in the military, you may be eligible for more comprehensive VA coverage for your future care needs. It’s a benefit many veterans and loved ones forget, but this assistance is priceless for those struggling to find ways to afford long-term care. For adults who are not veterans, there may still be tools to help with costs. Financial assistance is available for seniors and family caregivers, but you can also reduce the expenses of care by carefully researching facilities and care providers. In essence, you can cut down your expenses by planning ahead.

Long-term care doesn’t have to be stressful, expensive, or, most importantly, an afterthought. It’s an essential step most adults will likely face at some point in the future. So, you should plan for long-term care just like you do any other important aspect of life and give yourself and your family some needed peace of mind in the process.

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How to Help Your Loved One Stay in Touch with You

During the holidays, relatives will especially rely heavily on two-way communication to stay connected.

Published in caringfromafar.com 

Technology makes communicating with your loved one as easy as the push of a button, which is a true blessing for long-distance caregivers. However, your loved one might not be as tech-savvy as you are, or they may have trouble communicating due to vision or hearing deficiencies. The following are simple ways to make staying in touch a breeze:

Start with the Basics

You might have gotten rid of your landline phone years ago, but for older adults, this is the phone they grew up using and are most comfortable with. Technology is confusing, and trying to teach your loved one how to use it could be more stressful than it is helpful. In fact, a landline phone may even be the safest option, as it reduces time spent routing the call to the correct emergency response center. In addition, calls from landlines automatically show emergency responders the address, name of the residence, and a map, which could be a lifesaver should your loved one call for help and be unable to talk or get confused about where they are.

Depending on your loved one’s needs, you can switch out the landline for something more feasible such as a phone with larger buttons or a high ringer volume. Keep in mind that getting your loved one a cell phone, and teaching them how is use it, is still a good idea, as they can take it with them when they are out of the house. To really ramp up the communication measures, install a medical alert system that makes communication with emergency services quick and simple.

Set a Schedule

Once you choose the preferred communication, set up a time each day to check in and stick to it. This not only gives you peace of mind that your loved one is okay, but even simply hearing a familiar voice could be the daily pick-me-up they need. If your loved one is tech-savvy, use video chat such as Skype or FaceTime, or have a local family member or in-home caregiver assist them.

In addition to communication with your loved one, it is imperative that you chat regularly with their primary caregiver to get details and information your loved one might not feel comfortable sharing with you. If you chose to hire an in-home caregiver, check in with them daily, and don’t be afraid to request a log of what they did each day. Don’t forget to ask your loved one how they feel – sometimes caregivers aren’t the right match.

Staying in touch with your loved one will take a continued effort on your end, but it is just one of the many responsibilities that come along with being a long-distance caregiver. With the right technology and a consistent schedule, you can make the miles between you seem far less.

 

 

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5 advantages of early election of hospice benefits in assisted living and skilled nursing

Published in McKnight’s Senior Living by Rhea Go-Coloma, LMSW

For many, hospice care is associated with care received in the home. When provided early enough for residents in assisted living facilities and nursing homes, however, hospice care can provide important benefits for the resident and facility operator alike.

Hospice care, which is covered by Medicare and most private health insurance plans, eases pain and alleviates discomfort when a resident’s illness no longer is responding to treatment.

In fact, about one-third of assisted living residents receive end-of-life care at the community they have made their home. When residents become terminally ill, however, operators must provide care that may go beyond their capabilities.

When this happens, residents may be better served in a hospital or nursing home setting, but frequently it’s in the best interests of the resident to remain in the assisted living community. This is largely because residents have grown accustomed to the people and environment and feel the most at home.

When an assisted living community resident opts for hospice care, he or she also may be able to remain in the facility during the last months of life. This is best achieved when the assisted living community operator partners with an outside hospice provider. In this situation, it’s important for both organizations to work closely together to provide the best possible care for the resident.

Whether the hospice care is being provided in an assisted living community or nursing home, good communication between the family, staff, hospice staff and caregivers is important. Equally critical for success is early adoption of hospice care.

Early adoption of hospice makes all the difference

When adopted early, hospice care offers significant benefits for residents and families. Significantly, hospice healthcare specialists help residents and their families prioritize wishes and goals, creating a greater sense of ease and comfort.

Team-oriented hospice healthcare specialists work with the staff members of the assisted living community or nursing home to coordinate and plan care. Here’s a look at the five most important advantages of early election of hospice care for residents, families and facilities striving to meet the needs of these individuals:

Family support. Early involvement of an interdisciplinary team of hospice specialists helps families on many fronts: teaching family members how to care for the person who is ill, providing support and counseling to family and friends, offering education about the care process.

The hospice team also is there to help families clarify patient wishes, establish physician and patient relationships and balance family dynamics during this stressful time. Bottom line: hospice provides a way for residents to have a diverse group of committed professionals advocating for their needs.

Care goals. Hospice gives families the time they need to discuss goals of care, including an advance directive, a legal document that spells out end-of-life care ahead of time. The hospice team — including doctors, nurses, therapists, healthcare aides, clergy and social workers — addresses every aspect of a resident’s illness, with emphasis on controlling and reducing pain and discomfort. Team members provide symptom management and pain relief, increase quality of life and relieve patient suffering.

Family counseling. Guidance and support are a crucial feature of hospice, helping families deal with the range of emotions that surround this difficult time, offering guidance from social workers and chaplains. Hospice also offers bereavement and grief counseling after a loved one has passed, and it helps with some of the after-death tasks that need to be completed. Ultimately, choosing hospice care early makes end-of-life a calming and successful experience during a difficult time.

Dignity for the resident. Hospice offers the resident a chance to die with dignity. Hospice patients are not hooked up to loud machines, their vital signs are not constantly checked by medical personnel and they do not undergo invasive procedures to prolong life. It’s about respecting patient wishes.

By making arrangement to provide hospice care, operators of assisted living communities and nursing homes can make it possible for residents and families to focus on spending time with their loved one and not dealing with the red tape and medical procedures associated with hospital care.

 

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Suggestions for adult children caring for aging parents

Published in OA Online By Raylene Weaver, LPC of Centers for Children and Families

The Beatles will always be one of my favorite groups. One of their songs that has hit home with me while thinking about this particular article is, “When I’m Sixty-four”.

People want to be needed and appreciated especially when approaching a time in life when it’s easy to be disregarded or forgotten. The aging process can be stressful, causing some to suffer anxiousness and sadness. Several of my clients and friends have faced or are facing tough decisions that are affecting their parents and themselves. I would like to pass on a few suggestions regarding the physical, emotional, mental and financial aspects of AGING that might alleviate some of the stress that can definitely arise for all concerned.

A…ASK parents specific questions concerning their health. Do family members know their medical history, names of their doctors, any medications they might be taking or appointments they are scheduled on a regular basis? If on Medicaid or Medicare, do they also carry supplemental insurance? Are all financial papers, investments, bank account information, bill payment procedures, updated will, computer passwords and any other important documents or information easily accessible? Do they have a bereavement plan?

G…GUILTY feelings about wanting to be prepared by creating a plan for a parent’s future? Questions concerning the private aspects of their lives might seem like prying but this can hopefully be of some consolation for parents, knowing that they will be taken care of “when the time comes”. The objective for the children is to be “in the know” not to be “nosey”.

I…INDEPENDENT lifestyle is what one wants for aging parents. Parents hope to be independent for as long as possible. They want to continue to travel, take care of their own bills, shop, visit friends and attend worship services. Children sometimes become too “helpful” when parents are capable of handling chores and projects and making decisions for their future. Parents do need family members visiting and checking in on them, showing care and concern, just not insisting on control.

N…NECESSARY intervention will be inevitable for many parents. Knowing when to step in and offer the appropriate type of care and assistance can be stressful. Emotions will surface that might not have been seen or experienced before. When going thru matters for instance, pertaining to insisting a parent not drive any longer, taking over their physical and financial aspects of daily life or ultimately moving them into a facility for mental or physical issues or children becoming caretakers of parents in their own homes, professional agencies might be considered. Seeking assistance from those in the medical field, state/local agencies and counseling professionals might become necessary. But until this time arises…

G…GIVE the gift of respect, love and kindness to parents. They are experiencing and living life to the best of their abilities like their children. One article I came across by Evan H Farr, “What Aging Parents Really Want from Their Adult Children”, stated that adult children should: 1) make suggestions instead of giving orders, 2) pick your battles about what parents can and cannot do, 3) reframe, don’t blame and 4) stop and think how you would want to be treated.

So I guess that brings me back to the Beatles. A couple of the lines from Paul and John’s song says, “Will you still need me, will you still feed, me when I’m sixty-four?” Can I just ask…when I’m 74, 84, 94?

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Tips to cope when you’re juggling several chronic health issues

Be proactive by learning about and tracking your conditions and medications, and by speaking up when you have concerns.

Published in Harvard Health Letter

We don’t want our golden years to be spent juggling a long list of health issues. But that’s the reality for most older adults in the United States.

The CDC reports that 75% of Americans ages 65 or older have several chronic health problems. And a 2013 analysis of Medicare claims published online by Preventing Chronic Disease found that 68% of beneficiaries had two or more chronic conditions and 36% had at least four.

“Having multiple chronic diseases is common because people are living longer. The older we are, the more chronic diseases we accumulate,” says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center.

The challenges

Advances in medicine have improved treatment for many diseases and lengthened life. But those same advances mean that today’s medical care often involves seeing more types of doctors, having more tests, and getting more treatments than in earlier times. In other words, medical care in our golden years is better, but also more complicated.

“People take more medications, both prescription and over-the-counter, to manage these conditions. That’s because there are more effective medicines now than there used to be. However, medications can interfere with each other,” Dr. Salamon explains. In addition, treatment for one problem may make another problem worse. “For example, if you have high blood pressure and a history of falls, and lowering your blood pressure makes you feel lightheaded, your fall risk will increase,” says Dr. Erin Stevens, a geriatrician and palliative care physician at Harvard-affiliated Massachusetts General Hospital.

Doctors do their best to avoid prescribing medicines that are likely to cause problems, but the risk cannot be perfectly predicted. Bad things that are unlikely still can happen. “Another problem is that people get tired of taking medications, or find them too expensive — and so they don’t take them. This can lead to problems of untreated hypertension, diabetes, and other conditions,” Dr. Salamon explains.

Why do we accumulate chronic conditions?

Many factors play a role in the accumulation of health problems. Most diseases involve a combination of genetics and lifestyle. Being born with certain genes can make you more vulnerable than other people to certain diseases. An unhealthy lifestyle can further increase the risk.

Some genes, and some lifestyle factors, influence the risk for multiple diseases. And having one disease can increase your risk for another. “One disease can affect an organ system which then affects another. For example, diabetes can damage nerves, which can lead to loss of sensation in the extremities, which can lead to imbalance, a fall, and disability,” explains Dr. Erin Stevens, a geriatrician and palliative care physician at Harvard-affiliated Massachusetts General Hospital. Or you may have high blood pressure that damages blood vessels, which leads to a stroke.

And sometimes health conditions just go hand in hand, and we don’t know why. For example, depression often accompanies heart disease, diabetes, or Parkinson’s disease. Autoimmune diseases also can run in clusters. “So if you have thyroid disease, you may be predisposed to another autoimmune disease, like rheumatoid arthritis,” Dr. Stevens says.

Taking back control

To avoid missteps, be proactive in your health care with these strategies.

Get educated about your conditions. Talk with your doctor about what you can do (like exercise or eat a healthy diet) to take to control of any conditions you already have and to prevent conditions you worry about getting.

Become a medication expert. Find out what each of your medications does, why you need it, what side effects you should particularly watch for, and how it may interact with other drugs. You can get such information from your pharmacist or from online sources (such as the AARP website).

If you see many doctors, be sure each of them knows what medicines the other doctors have prescribed (they will, if they are all part of a hospital or health care system that shares electronic health records).

To be safe, Dr. Stevens recommends bringing all of your medications to each doctor appointment, including over-the-counter pills. “Then we can be sure the medication list on the computer matches the pills and doses that you’re taking,” Dr. Salamon says.

Keep track of your symptoms and treatments. If you’re having symptoms you think may be side effects of a medicine or an adverse interaction between drugs, use a notebook or a computer to record when you take medications, when symptoms develop, and how long the symptoms last.

Get a good CEO. Just as a corporation needs a chief executive officer to oversee its many departments, you may need a primary care physician to look at the big picture and help you make sure treatment for numerous conditions is well coordinated.

Consider palliative care. It’s a misconception that palliative care is only for the end of life. When you have serious degenerative illness — like heart failure, Parkinson’s disease, or a breathing disorder — your quality of life suffers. A palliative care physician can help you manage those conditions, maximize your function, and preserve as much quality of life as possible. “We want to meet people early on, not in crisis mode,” Dr. Stevens says. “Maybe we can prevent a fall or address pain. We can talk about what to expect, so when something happens over time, it won’t be a surprise.”

Be your own advocate. Finally, remember that no one understands how you’re feeling better than you do. Ask questions about your treatment, and don’t be afraid to speak up if you’re having trouble managing your conditions or if you’re concerned about the way your doctors are doing the job.

 

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How will population ageing affect future end of life care?

By Anna Bone

Increasing population ageing means that deaths worldwide are expected to rise by 13 million to 70 million per year in the next 15 years. As a result, there is an urgent need to plan ahead to ensure we meet the growing end of life care needs of our population in the future.

Understanding where people die, and how this could change in the future, is vital to ensuring that health services are equipped to support people’s needs and preferences at the end of life. As researchers at the Cicely Saunders Institute, King’s College London, we investigated trends in place of death in England and Wales, and found that deaths occurring in care homes could more than double in the next 25 years if recent trends continue.

Using official records on over five and a half million deaths, as well as population forecasts, we estimated the number of people who will die in a range of different settings in years to come. The intention behind this study is that it will help to guide future planning of health and social care. From 2004 to 2014, the proportion of deaths occurring in care homes increased from 17% to 21%, with numbers rising from 85,000 to 106,000 per year. If this trend continues, the number of people dying in care homes will double to over 220,000 per year by 2040, and care homes will overtake hospitals as the most common place to die. Home deaths are also projected to increase over this period to over 216,000 deaths a year. Together, this means that deaths in the community are expected to account for over two-thirds of all deaths by 2040.

We also know that, increasingly, people are living and dying with multiple illnesses and frailty, which adds complexity to their care needs. The rising number of people with complex illness in the community is a challenge for end of life care. A recent study has shown that palliative care needs are expected to increase by 42% by the year 2040. We need greater integration of specialist palliative care into primary care services, as well as more training in palliative care for general health professionals, to ensure that those with palliative care needs can access services they require.

The projected rise of deaths in care homes and in peoples’ own homes is striking. We must ask care home and community services whether they are equipped to both support such an increase in demand and provide high quality end of life care. How can we provide the workforce needed to care for this growing patient group? To enable people to die in their preferred place in future, we need to ensure adequate bed capacity, resources, and training of staff in palliative and end of life care in all care homes in the country. These projections warn of the urgent need to invest more in care homes and community health services. Without this investment, people are likely to seek help from hospitals, which puts pressure on an already strained system and is not where most people would prefer to be at the end of their lives.

The time has come to test new approaches to care in order to ensure that we address this growing need of our population in the years to come. There are promising examples of innovations in care to increase the reach of palliative care services in community settings, for example project ECHO, which facilitates knowledge-sharing between specialist palliative care services, such as hospices, and general health care professionals such as those in care homes. In an era of increasing need alongside constrained health and social care budgets, developing and testing innovative ways to provide high quality care with minimal resources is imperative.

In the words of Cicely Saunders, the founder of the modern hospice movement, “how people die remains in the memory of those who live on.”The inevitable population changes described here will affect all of us, directly or indirectly, in the years to come. It is time for us as a society to have an open discussion about how we want health services to be delivered to people towards the end of life. Crucially, we need better evidence on how we can best support a growing number of older people as they reach the end of their lives.

Anna Bone is a PhD Training Fellow at the Cicely Saunders Institute, King’s College London. The themes from this blog post come from The Changing Face of Volunteering in Hospice and Palliative Care, published by Oxford University Press.

 

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