When a loved one reaches a point in his or her life in which self-care becomes challenging, the next step may be a little overwhelming; particularly when trying to make the best choice for your loved one and your family. Some families struggle with guilt because it may not be financially, emotionally, or physically feasible for some individuals to become a caregiver. Often times a hired in-home caregiver is only a temporary solution until the aging or ill loved one requires more specialized care. Unfortunately, more often than not, many people are hesitant to choose the most common option of a nursing home facility due to the horror stories or bad reputations they can have.

Although a nursing home can be an intimidating next step, if you know what to look for and monitor closely, your elderly loved one can continue to live a healthy and safe life.

Myth #1: Nursing Homes Mark the “Final Days” of an Elderly Individual
While it is true that many elderly individuals may live their final years in a nursing home, it doesn’t automatically mean that an elder is living his or her last days. A nursing home is not a hospital, as it often mistaken for, but does have medically trained staff available 24 hours a day. Nursing home candidates do not need to be in a hospital, but are no longer to be cared for in their home or cannot take care of themselves. Although a majority of nursing home residents are older seniors, some younger seniors have short stays in a nursing home after a lengthy illness or after a surgery.

Myth #2: “If I move my elderly relative into a nursing home, he’ll lose all of his independence.”
When selecting a nursing home, many are fearful to move someone into a facility out of fear that he or she will have no independence. Many facilities respect and even encourage independence as much as possible. Even if one individual may have mobility issues, the staff will encourage other independent activities such as eating, grooming, and participating in activities. When deciding on whether or not to move your loved one into the appropriate care, keep in mind that the need for assistance is not the result of a loss of independence as we all require help sometimes.

Myth #3: “If my loved one moves into a nursing home, she will be mistreated by staff and there will be nothing I can do.”
We’ve all heard the terrible stories of nursing home abuse or elder abuse. Unfortunately, these stories of physical, emotional, and financial mistreatment are true, but they don’t apply to every nursing home facility across the country. First off, the best way to prevent elder abuse from occurring is by being active in your elder’s life. Before you choose a facility, take a tour, look around, and ask questions because this is the time in which you are interviewing facilities in search of the best possible care your loved one can receive. If anything feels or looks wrong, you don’t have to settle for that particular home. Be sure to educate yourself on how to recognize and respond to any sign mistreatment of your loved one.

Once you have found a suitable home for your elder, visit often, communicate regularly with staff, keep track of any changes to physical appearance and his or her emotional or mental state. Changes could be part of aging, but it could also indicate abuse. If you suspect any abuse, contact authorities immediately. This next chapter in your loved one’s life can be a positive transition and an opportunity to feel confident that they are being provided with the best care and surrounded by friends and family.

Dementias are degenerative disorders that develop primarily in the nervous system and selectively damage particular areas of the brain. Some dementias, like Alzheimer’s disease affect all areas of the brain simultaneously, while others, such as frontotemporal dementia, affect the parts of the brain involved in controlling one’s communications and emotions. Still others are caused by vascular disease, brain trauma, or chronic alcohol abuse (Korsakoff’s syndrome)

By 2030, 20% of U.S. population will be older than 65 years of age – about 50 million people. Dementia affects 1% to 6% of those older than 65, and between 10% and 20% of those older than 80 years of age. In the next 30 years, estimated 10-20 million seniors in U.S. will have mild to severe forms of dementia.

Seniors with history of moderate traumatic brain injury (TBI) have a 2-3 times greater risk of developing Alzheimer’s disease – those with a severe TBI have a 4-5 times greater risk. Even healthy seniors are at risk for falls and head trauma, so any fall to the head, however minor, should be seen by a medical professional and documented.

Alzheimer’s disease accounts for 65% of all dementias. There is no direct diagnosis of Alzheimer’s – and while PET scans and other imaging techniques are being studied, none have yet been able to show the presence of Alzheimer’s disease.
Alzheimer’s onset often surprises families because vision, movement, and sensation remain untouched while a senior’s memories begin to slowly decrease. Recent memories are affected first, leading to “senior moments” that appear innocent because all other memories, including those from decades ago, remain intact. Eventually those remote memories begin to fade, and lastly the senior’s “crystallized” memories, such as family member’s names and faces, are compromised.

By David L. Raffle, PhD
Clinical and Forensic Neuropsychologist
www.RaffleBrainInstitute.com

Holistic nursing care is a concept that moves away from viewing a patient as merely a 'diagnosis'; rather, the patient is viewed and treated as a whole person. In other words, holistic nursing will involve care and support of the person's physical, mental, spiritual, emotional, social and environmental needs. In many cases, holistic nursing may also include alternative therapies that may be seen as beneficial, with the patient's consent. This is not a new concept—even Florence Nightingale advocated holistic nursing:

"Florence Nightingale recognized the importance of caring for the whole person and encouraged interventions that enhanced individuals' abilities to draw upon their own healing powers. She considered touch, light, aromatics, empathetic listening, music, quiet reflection, and similar healing measures as essential ingredients to good nursing care."
- American Holistic Nurses Association (AHNA), Position Statements, 2004

One of the most important aspects of holistic care is the involvement of the patient in making their own decisions, always being allowed to consent or deny a route of care, and a focus on self-care where ever possible.  Holistic nursing not only involves those patients with curable illness but for terminal illness as well. Take any factor within holistic care—physical, psychological and emotional, spiritual and environmental aspects of life—each individual aspect has an effect on the mental and physical health of a patient. They are all interconnected and related to the person as whole. Where one area is not understood or assisted then true healing or care can't take place.A holistic assessment is one that not only identifies the care required for health requirements but the impact that other areas of the patient's life may be impacting on the path of treatment and/or cure.

Holistic nursing assessments are an excellent way to identify the true needs of a patient because they:

• Offer an opportunity for an individual to think about and have a say about what their care needs are and work in partnership with their health support team in making a plan to achieve realistic goals.
• It allows people to self care as far as possible - this gives control back to the individual and helps to raise confidence and self esteem.
• It also helps the health care team to focus support much more efficiently as their decisions are based on more informed information about the patient and their needs and wishes.
• When used properly an holistic assessment focuses on the needs and wishes of the patient not what the health care team assumes the patient's needs are.
• Because it is a team approach working with the one plan, no point of care or support is neglected or left out.
• It encourages consideration of the mind-body aspect of care and also the spiritual aspect. In addition, the patient's social and environmental conditions are also looked at.
• Holistic assessment not only focuses on treating illness but on promoting health and fitness.

Holistic Nursing Care and Alternative Therapies
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Nurses who have received the proper training often incorporate alternative therapies into treatments along with conventional medicine. There are a huge variety of alternative treatments available today - not all suitable for all patients. Therefore during the holistic nursing assessment it may become clear what alternative therapies might be available if the patient is in agreement about trying them.
The table below highlights some of the main therapies and the broad reasons why they are used.


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So what exactly is Holistic Nursing Care?

I hope that this short article has given you a better idea of what holistic care should be about. More importantly I hope that you have realised that, if you ever need health care, you do have a right to make choices, make decisions and be involved every step of the way when it's your health and your life that's involved. Nurses and patients shouldn't be on different sides of the fence. It should be a partnership. A partnership based on mutual trust, respect and honesty.

It has been many years since I stepped foot onto my first surgical ward during my nurse training. The first words I heard were spoken by a trained nurse in front of the patient and his family, speaking to another nurse, she nodded towards the patient and said "Could you admit this 'appendectomy' now". I couldn't help but think at that moment how I would feel if I was addressed as a mere condition to be admitted, sorted and then thrown out. Thankfully, with an holistic nursing care approach this kind of off-hand thinking has no place.

 author - Helen Murphy Howell

The first step to finding the best senior housing for your loved one is to understand what type of care facility is the best fit. There are six main types of residential elder care options:
Independent living facilities are ofen the best senior housing options for active adults who want built-in community without giving up their privacy. Most feature studio or multi-bedroom apartments with kitchens so residents can stay independent as long as possible.
Continuing care retirement communities, or CCRCs, are best for those seeking a continuum of care from independent living to skilled nursing, all in one location. CCRCs generally have studio or multi-bedroom apartments for their most independent residents and private or shared rooms for residents who need more care.
Assisted living facilities are best for for those who need some care and supervision but who don't need skilled nursing care. Most assisted living residents live in private or semi-private rooms within a complex.
Memory care communities are facilities designed specifically for seniors with Alzheimer’s disease or other forms of dementia or serious cognitive impairments. Also known as dementia care, memory care communities are often housed in one part of an existing assisted living community or skilled nursing facility. These communities are best for those with severe dementia or cognitive impairment who are no longer able to live independently.
Board and care facilities, also known as care homes, are best for those who can't live independently due to physical or mental disabilities but who don't require fulltime skilled nursing care. They feature private or semi-private rooms in a complex (often a large home) that usually provides communal dining.
Skilled nursing facilities, also called nursing homes, are residential care facilities that are best for those with illnesses or mental conditions requiring fulltime monitoring and medical care. Most skilled nursing residents live in semi-private rooms, and meals are generally provided.

If your are confused, give us a call! We're more than happy to help.

The decision to help an aging adult move out of a current home is a complex one -- both emotionally and practically. Above all, you want the person to be safe and well. How can you all feel more confident about whether circumstances suggest that your loved one should no longer be living alone?
Although every situation is different, looking at the following 11 signs will give you valuable information to help make the decision.
1. Big-picture signs it might be time for assisted livingKeep the big red flags in mind. Certain situations make it more obvious that it's wise to start thinking about alternate living arrangements.
Look for:

• Recent accidents or close calls. Did your loved one take a fall, have a medical scare, or get in a fender bender (or worse)? Who responded and how long did it take? Accidents do happen, but as people get older, the odds rise of them happening again.
  
• A slow recovery. How did the person you're caring for weather the most recent illness (for example, a flu or bad cold)? Was he or she able and willing to seek medical care when needed, or did last winter's cold develop into untreated bronchitis?
  
• A chronic health condition that's worsening. Progressive problems such as COPD, dementia, and congestive heart failure can decline gradually or precipitously, but either way, their presence means your loved one will increasingly need help.
  
• Increasing difficulty managing the activities of daily living (ADLs) and instrumental activities of daily living (IADLs). ADLs and IADLs are the skills needed to live independently -- dressing, shopping, cooking, doing laundry, managing medications, and so on. Doctors, social workers, and other geriatric experts evaluate them as part of a functional assessment, which is one way to get an expert's view of the situation. Difficulties with ADLs and IADLs can sometimes be remedied by bringing in more in-home help.
  

2. Up-close signs it might be time for assisted livingGive your loved one a big hug. Clues aren't always visible from a distance; especially when you don't see the person every day, you might learn more through touch.
Look for:

• Noticeable weight loss. Does the person feel thinner? Are clothes loose, or has he added notches to his belt? Many conditions, from depression to cancer, can cause weight loss. A person who is having trouble getting out to shop or remembering how to cook (or to eat) can lose weight; check the fridge and watch meal-prep skills.
  
• Seeming more frail. Do you feel anything "different" about the person's strength and stature when you hug? Can your loved one rise easily from a chair? Does she or he seem unsteady or unable to balance? Compare these observations to the last time you were together.
  
• Noticeable weight gain. Common causes include an injury slowing the person down, diabetes, and dementia (when someone doesn't remember eating, he or she may indulge in meals and snacks all day long). Someone with money troubles may choose fewer fresh foods and more packaged goods or dried pasta and bread.
  
• Strange body odor. Unfortunately, a close hug can also reveal changes in personal hygiene habits. Causes range from memory trouble to depression to other physical ailments.
  
• Changes in appearance. Does the person's hair and makeup look all right? Are clothes clean? Someone known for crisply ironed shirts who's now in a stained sweatshirt may lack the dexterity for buttons or may have lost the strength for managing an ironing board and iron. A formerly clean-shaven man with an unkempt beard may be forgetting to shave (or forgetting how to shave).
  

3. Social signs it might be time for assisted livingThink realistically about the person's social connections. Social circles tend to shrink with age, which can have health and safety implications.
Look for:

• Signs of active friendships. Does your loved one still get together for lunches or outings with friends or visits with neighbors, or participate in religious activities or other group events? Does he or she talk about others or keep a calendar of appointments? Lack of companionship is associated with depression and heart problems in older adults. If friends have died or moved away, moving to a place where other people are around could be lifesaving.
  
• Signs that your loved one has cut back on activities and interests. Is a hobby area abandoned? Has a club membership been given up? A library card gone unused? There are many reasons people cut back, but dropping out of everything and showing interest in almost nothing is a red flag for depression.
  
• Days spent without leaving the house. This sometimes happens because the person can no longer drive or is afraid to take public transportation alone and lacks a companion to come along. While many older adults fear being "locked away" in a retirement home, many such facilities offer regular outings that may keep them more mobile and active, not less.
  
• Someone who checks in on a regular basis. If not you or another family member, who does this? Is your loved one willing to consider a home-safety alarm system, a personal alarm system, or a daily calling service?
  
• A plan for a worst-case scenario. If there's a fire, earthquake, flood, or other disaster, is someone on standby to assist? Does your loved one understand the plan?
  

4. Money signs it might be time for assisted livingRiffle through the mail. Your loved one's mail can offer an often-overlooked clue to how he or she is managing money, a common early warning sign of cognitive trouble.
Look for:

• Snowdrifts of mail in various places. Finding lots of mail scattered around raises concern about how bills, insurance, and other matters are being managed. (Piles of mail are also a potential tripping hazard.)
  
• Unopened personal mail. Everybody skips junk mail, but few of us can ignore a good old-fashioned, hand-addressed letter.
  
• Unopened bills. This can indicate that your loved one is having difficulty managing finances -- one of the most common first signs of dementia.
  
• Letters from banks, creditors, or insurers. Routine business letters aren't worrisome. But it's alarming if they're referring to overdue payments, overdrawn balances, recent accidents, or other concerning events.
  
• Thank-you messages from charities. Older adults are often vulnerable to scammers. Even those who have always been fiscally prudent are vulnerable if they're having trouble with thinking skills (a common sign of Alzheimer's disease). Some charities hit up givers over and over, and your loved one may not remember having donating the first time.
  
• Lots of crisp, unread magazines. The person may unknowingly have repeat-renewal subscriptions that he or she doesn't need.
  

5. Driving signs it might be time for assisted livingTake a drive -- with your loved one behind the wheel, if he or she is still driving. Often, the ability to drive is practically a requirement for living independently in our culture (or the arrangement of alternate transportation options).
Look for:

• Nicks or dents on the car. Notice the car body as you get in and out. Damage marks can be signs of careless driving.
  
• Whether the person promptly fastens his or her seatbelt. Even people with mild dementia usually follow the rote basics of driving. It's worrisome if he or she is forgetting this step.
  
• "Tension, preoccupation, or being easily distracted. The person may turn off the radio, for example, or be unwilling to engage in conversation while driving. He or she may avoid certain routes, highway driving, or driving at night and in rain -- a safe kind of self-policing but also signals of changing ability.
  
• Signs of dangerous driving. People whose driving ability is impaired are more likely to tailgate, drift from their lane, go below the speed limit, react slowly to lights or other cars, and mix up gas and brake pedals. See 8 ways to assess someone's driving.
  
• Warning lights. Check out the dashboard as you ride along. Does the car have sufficient oil, gas, antifreeze, windshield-wiper fluid?
  

6. Kitchen signs it might be signs for assisted livingGo through the kitchen, from fridge to cupboards to oven. Because people spend so much time in this room, you can learn a lot.
Look for:

• Stale or expired foods. We all buy more than we need. Look for signs that food is not only old but that this is unnoticed -- mold, sour milk that's still used, or expiration dates well past due, for example.
  
• Multiples of the same item. Ten bottles of ketchup? More cereal than can be eaten in a year? Multiples often reveal that the shopper can't remember from one store trip to the next what's in stock at home.
  
• A freezer full of TV dinners. Your loved one may buy them for convenience sake, but frozen dinners tend not to make healthy diet. If there's not much fresh food in the house (because it's too hard to for the person to procure or cook), your loved one might be ready to have help with meal prep or delivery services.
  
• Broken appliances. Check them all: microwave, coffeemaker, toaster, washer, and dryer -- any device you know your loved one uses (or used to use) routinely.
  
• Signs of fire. Are stove knobs charred? Pot bottoms singed badly (or thrown out)? Do any potholders have burned edges? Also look for a discharged fire extinguisher, smoke detectors that have been disassembled, or boxes of baking soda near the stove. Accidents happen; ask for the story behind what you see. Accidental fires are a common home danger for older adults.
  
• Increased use of takeout or simpler cooking. A change in physical or mental abilities might explain a downshift to simpler recipes or food choices.
  

7. Around-the-house signs it might be time for assisted livingLook around the living areas. Sometimes the most obvious sign is hard to see because we become so used to it.
Look for:

• Lots of clutter. An inability to throw anything away may be a sign of a neurological or physical issue. Obviously it's more worrisome in a neatnik than in a chronic slob. Papers or pet toys all over the floor represent a tripping hazard.
  
• Signs of lax housekeeping. Spills that haven't been cleaned up are a common sign of dementia -- the person lacks the follow-through to tidy. Keep an eye out for cobwebs, bathroom mold, thick dust, or other signs of slackness. Physical limitations can mean your loved one needs housekeeping help or a living situation where this is taken care of for him or her.
  
• Bathroom grime and clutter. A common scenario: Your loved one makes an effort to tidy up living areas but overlooks the bathroom. Or the guest bath is clean, but not the one the person uses all the time (the one off a bedroom, for example). Here you may see a truer picture of how your loved one is keeping up.
  

8. Pet-care and plant-care signs it might be time for assisted livingBe sure to check out how the other living things are faring. An ability to take care of pets and plants goes along with self-care.
Look for:

• Plants that are dying, dead, or just gone. Most of us have seen plants go brown sometimes. Keep an eye out for chronic neglect, especially in a former plant-lover's home.
  
• Animals that don't seem well tended. Common problems: dogs with long nails, cat litter boxes that haven't been changed lately, or dead fish in the fish tank. Poor grooming, overfeeding, and underfeeding are other red flags.
  

9. Home-maintenance signs it might be time for assisted livingWalk around the yard. Yard maintenance -- or lack of it -- can yield clues that your loved one isn't faring as well at home alone anymore.
Look for:

• Signs of neglect. Look for discolored siding or ceilings that might indicate a leak, gutters choked with leaves, broken windows or fences, dirty windows.
  
• Newspapers in the bushes. Are papers being delivered but ignored? Sometimes people pick up those they can see on a driveway but not those that go off into the yard.
  
• Mail piled up in the mailbox. Go out and check -- it's an indication that your loved one doesn't even retrieve it regularly.
  

10. Get help looking for signs it might be time for assisted livingGet the input of others who know your loved one in order to collect a fuller picture of reality. Gently probing about what others think isn't nosy; you're being loving, concerned, and proactive.
Look for:

• Input from those in your loved one's circle. Talk to old friends and close relatives to get their sense of how the person is faring. Listen for stories that hint that the person doesn't get out much ("She doesn't come over anymore." "She quit book club."). Pay attention to comments that indicate ongoing concerns ("Has he had that heart test yet?" "We were worried the day the ambulance came.").
  
• Medical insight. With appropriate permission, your loved one's primary doctor may share your concerns about his or her patient's safety at home -- or may be able to alleviate those concerns or suggest where to get a home assessment.
  
• A second opinion. A social worker or professional geriatric care manager visits older adults' homes and does informal evaluations. While your loved one may initially resist the notion of a "total stranger" checking on them, try pitching it as a professional (and neutral) second opinion, or ask the doctor to "prescribe" it. Some people wind up sharing doubts or vulnerabilities with a sympathetic, experienced stranger that they're loathe to admit to their own children or family.
  

11. Caregivers' signs it might be time for assisted livingFinally, realize that some of the information you collect is intangible -- it has to do with feelings and emotions, and the stress levels of everyone involved.
Look for:

• How you're doing. While this decision to remain in one's home is not primarily about you -- the son, daughter, grandchild, caregiver -- your own exhaustion can be a good gauge of a decline in older adults' ability to care for themselves. Keeping someone at home can require lots of hands-on support or care coordination, and this is time-consuming. If your loved one's need for care is just plain wearing you out, or if a spouse or children are feeling the collective strain of your caregiving activities, these are major signs that it's time to start looking at other options.
  
• Your loved one's emotional state. Safety is crucial, of course, but so is emotional well-being. If someone living alone is riddled with anxieties or increasingly lonely, then that may tip the scales toward a move not solely based on health and safety reasons.
  

If your loved one has a full life, a close neighborhood and community connections, and seems to be thriving, it's worth exploring as many in-home care options as possible before raising stress levels by pressing a move from a beloved home.
If, on the other hand, your loved one is showing signs that living alone is a strain, it may be time for a talk. Broach the subject of where to live in a neutral way and you may find that your loved one harbors the same fears for current and future safety and security that you do. Find out what your loved one fears most about moving and about staying before launching into your own worries and what you think ought to be done.