Visiting Nurses Association

One out of three senior citizens suffers a fall each year. Falls are the most frequent factor in hospitalization admissions for the elderly in Texas. Forty per cent of all nursing home admissions are related to falls.

The effects of falling can also be emotionally debilitating, creating fears about walking or leaving the house. Fear of falling can severely impair independent living, as well as social functioning.

The two most common areas in the home where injuries occur are the bathroom and kitchen. Taking a few precautions, though, can help the elderly avoid many of these accidents, according to Nancy Crowe, a physical therapist and chief operating officer for the Visiting Nurse Association.

Nancy offers the following 10 tips for preventing falls in the home:

· Use non-slip mats or apply textured strips in the bathtub and on shower floors.

· Install grab bars next to the toilet and in the tub or shower.

· Immediately clean up spilled liquids and food from kitchen floors.

· Do not stand on chairs, boxes, or other makeshift items to reach high shelves or to replace light bulbs. Use a stepstool with a handrail.

· Avoid placing small throw rugs on hard wood, linoleum, and tile floors, or apply rubber matting or double-faced adhesive tape to the backs of the rugs.

· Do not rush to answer the door or phone.

· Check lighting on stairs to make sure each step is well lit and that the edge of the steps is clearly visible when going up and down. All staircases should have lights and handrails.

· Make sure hallways and passageways between rooms are well lit and uncluttered.

· Use nightlights to illuminate hallways and rooms.

· Keep a flashlight near the bed.

Family members can help reduce the risks of an elderly relative falling at home by becoming aware of these and other possible hazards, and helping correct them.

It is also important to make sure that phone numbers of the police and fire departments are readily available, along with a neighbor’s number. At least one phone at home should be easily accessible in the event that a person falls and is unable to stand.

“Most of the factors involved in home falls can be fixed, provided you are aware of potential dangers,“ Nancy states. “By making just a few modifications and taking some precautions, it is possible to minimize injuries in the home,” she adds.

The Visiting Nurse Association has joined with other health and wellness providers as part of the Texas Falls Prevention Coalition, created in 2007 by the Texas Association of Area Agencies on Aging. The group’s mission is to “Promote, implement and evaluate evidence-based programs and policies that help reduce risk factors of falls and injuries in older adults; provide education and resources to increase public awareness, mobilize communities and effect policy change for a falls-free Texas.”

The Texas Falls Prevention Coalition is working to establish a statewide network to share information, identify needs in fall prevention services and resources, and advocate for policies that support fall prevention.

As part of this effort to reduce falls by the elderly, physical therapists with the Visiting Nurse Association make assessments and recommendations about safety hazards when they visit the homes of patients. It’s an important part of VNA’s mission to provide the care that makes it possible for the elderly to continue to live independently in the safety and comfort of their homes.

Additional information about VNA rehabilitation therapies and other home care services can be obtained by calling Elaine Harrison, R.N., at (972) 533-4676 or going online at www.vnatexas.org.

– Robert Smith, Director of Public Relations, Visiting Nurse Association

Summer months are the most hazardous time of the year for many Texas residents. The Texas Department of Health reports that there were 40 heat-related deaths in the state last year. In most cases, these were preventable.

Exposure to high temperatures can lead to a severe loss of salt and water in the body, resulting in heat exhaustion. When the body can no longer cool itself by sweating, a life threatening condition called heat stroke may develop.

Elderly individuals with low fixed incomes are especially at risk because they may avoid using air conditioners and fans to cool their homes due to worries about high electric bills. Making the situation worse, doors and windows are sometimes kept shut, cutting off ventilation in the house.

The Visiting Nurse Association has suggestions for reducing the incidence of heat-caused illnesses:

· Drink plenty of fluids each day. Drinking water helps cool the body’s temperature.

· Avoid turning on the stove or large oven. Instead, use a microwave or toaster-type oven to prepare food.

· Stay out of direct sunlight as much as possible. If it’s necessary to go outside, wear a hat or sunbonnet. Avoid being outdoors between 2 p.m. and 4 p.m., when the heat is most intense.

· Wear light-colored cotton clothing or cotton blends that are loose fitting. Avoid both outer and undergarments that are tight.

· Close blinds and window shades during the day to block out sunlight.

· In addition to an air conditioner, electric floor and ceiling fans can be used to circulate air that will help cool the body.

· Instead of turning off air conditioners and fans because of fears about high electric bills, individuals should contact their utility company to learn about assistance that may be available to low-income customers during the hot summer months.

· Individuals 65 years of age and older should have a friend or relative check on them or call twice a day during a heat wave.

“These recommendations are particularly important for those most at risk – the homebound elderly,” advises Shelley Dodd, R.N., branch supervisor of the Visiting Nurse Association’s Tarrant County office in Fort Worth. “Taking a few precautions is key to staying well,” she adds.

– Robert Smith, Director of Public Relations, Visiting Nurse Association

When illness requires medical care, oftentimes treatment can be done in the home instead of in hospitals. Home care nursing began in the 1880s when public health nurses traveled to patients’ homes to care for the ill, teach family members how to provide care, suggest ways to improve health, and comfort the dying. The arrival of the trained nurse eased the family’s burden of caring for the sick at home.

Today, home care plays an even greater role in the health and well being of patients of all ages and is an integral part of America’s health care system for the elderly.

Highly trained nurses and other health professionals, using advanced health care technologies and skills, make it possible for patients to now receive care at home that once required traveling to clinics and hospitals. Cardio-vascular disease, lymphedema, dysphasia, diabetes, Parkinson’s, and other disease can be treated by skilled home care professionals.

Through the use of telehealth home monitors, nurses are able to electronically check up on patients at home between visits and reduce the need for emergency room admissions and hospitalizations.

Electronic clipboards allow nurses to chart vital patient health data during home visits, which can be relayed quickly to patients’ physicians for decisions about their care. These and other new technologies make it possible for many patients to be cared for in their homes, reducing the burden on hospitals and nursing facilities.

Home care is less expensive than other forms of health care. The average Medicare charges per day in a hospital and skilled nursing facility are estimated at $1,500 and $475, respectively. The average Medicare charge per home care visit is estimated to be $150.

As a cost-effective means of providing high quality health care and supportive services in the dignity and comfort of a patient’s home, home care also helps keep families together.

Many patients, though, are unaware that home care services, including hospice, are Medicare and Medicaid covered benefits. Many private insurance policies also cover these services.

Medicare pays for in-home care for patients who are homebound and under the care of a physician. These services include skilled nursing; physical, occupational, and speech therapies; and personal care assistance, as well as medical supplies and equipment. Except for hospice care, health services received in the home are covered only for short periods of time and not on an on-going basis. Most often, the care is provided to patients recovering from acute illness, injury, or surgery. The services must be authorized and periodically reviewed by the patient’s physician, and be provided by a Medicare-certified home health agency.

Many individuals purchase “Medigap” insurance to cover expenses not paid by Medicare. Medigap insurance usually pays for certain personal care services when the policyholder is receiving Medicare-covered skilled home health services. The patient’s physician must order the services as part of a plan of care. As with Medicare, Medigap insurance is not designed to cover long-term care.

Medicare also covers in-home hospice services for terminally ill patients who have a life expectancy of six months or less. Services include palliative care nursing, medications, medical social work, and personal care assistance. Hospice care must be authorized by the patient and the patient’s physician.

Medicaid also covers home care services, which can be of longer duration than what is provided by Medicare. Skilled nursing, rehabilitative therapies, and medical social services, in addition to medial supplies and equipment must be authorized by the patient’s physician. In Texas, Medicaid also covers the same range of hospice services that Medicare does.

Coverage of home care services by private insurance varies from policy to policy. Home care services are typically covered for acute needs on a short-term basis. Usually there are deductibles and co-pays made by the patient for the services. Long-term care insurance policies are also available for purchase to cover extended home care, if needed.

Most private insurance plans also cover comprehensive hospice care. Individuals should review their health insurance plans to be certain what home care services they are eligible for.

Community-funded care, paid for by charitable donations and state and local taxes, may also provide home health and supportive services. Based on eligibility criteria, including the patient’s financial circumstances, all or part of needed home care services may be covered. Information about community-funded care can be obtained from hospital discharge planners, social workers, local offices on aging, and the United Way.

Information about receiving home care services from the Visiting Nurse Association can be obtained by calling 1-800-225-5862 or going online at www.vnatexas.org.

– Robert Smith, Director of Public Relations, Visiting Nurse Association

Physical functioning often declines with advancing age and can result in deterioration of health and the ability to care for one’s self. Key to physical functioning is muscle strength, which declines by 15 percent each decade after age 50 and 30 percent for each decade after age 70. This is mainly the result of muscle loss, which occurs more often in older women than men. Forty-five percent of women older than age 65 and 65 percent of those older than age 75 cannot lift 10 pounds.

Seniors, though, can regain strength with the help of a physical therapist. Physical therapists are known to work with patients recovering from illness or surgery and those with neuromuscular disorders such as cerebral palsy, Parkinson’s disease, multiple sclerosis, Lou Gehrig’s disease, among others. Physical therapy has been used successfully to treat lymphedema, a painful swelling of the extremities.

Physical therapy can improve the functional ability of older adults through strength and balance training. Strength training helps prevent the loss of bone density and muscle mass that leads to frailty and physical disability. When combined with balance training, it can significantly reduce the high risk of falls for the elderly. Between one third and one half of the senior population falls at least once a year, often causing hip fractures, other injuries, or death. Falling is the number one cause of injury in the home for the elderly.

Research funded by the National Institute on Aging and published in The New England Journal of Medicine provides additional evidence that physical therapy can reduce and even prevent the functional decline of frail elderly individuals who receive a program designed to improve their balance, strength, and movement.

Dr. Thomas M. Gill, associate professor of internal medicine and geriatrics at the Yale School of Medicine and principal author of the study, looked at whether activities necessary for independent daily living – walking, bathing, using the toilet, grooming, dressing, getting up from a chair, and eating – improved with physical therapy. Results of his research showed that frail elderly individuals who followed a six-month physical therapy program and continued with exercises saw a 45 percent reduction in disability compared with others who did not participate.

Patients who received a program in physical therapy also had fewer fall-related injuries and were less likely to move into nursing homes. Dr. Gill concluded that “prehabilitation” or preventive physical therapy for the elderly could reduce health care expenses and nursing home admissions.

”Many elderly and their families often do not know that physical therapy can help an aged relative maintain independent living,” states Valerie Turner, a physical therapist with the Visiting Nurse Association.
“Seniors gain not only balance and strength, but also a renewed sense of confidence in their level of functioning, which results in a safer home environment,” she adds.

Before starting an exercise program, it’s important to first consult with a physician.

For additional information about the benefits of physical therapy for the elderly, as well as career opportunities available for physical therapists at the Visiting Nurse Association, contact Nancy Crowe at (214) 689-2224 or crowen@vnatexas.org

– Robert Smith, Director of Public Relations, Visiting Nurse Association

Meals on Wheels drivers with the Visiting Nurse Association will no longer have to worry about keeping meals warm if stuck in traffic or delayed by bad weather.  Drivers will soon be transporting meals in new thermoelectric containers that will keep food as hot as if it had just came out of the oven. 

The thermoelectric containers operate by being plugged into a vehicle’s cigarette lighter.  This can be a tremendous help for the drivers who deliver more than 3,600 meals on 210 routes each weekday for the Visiting Nurse Association. 

Purchase of the heated thermoelectric containers by the Visiting Nurse Association was made possible in part by a Walmart Foundation Impact Grant.  “We’re glad to receive funding for this,” notes Katherine Krause, managing director of community nutrition programs for the Visiting Nurse Association.  “And so are the homebound elderly, sick, and disabled individuals who receive Meals on Wheels in Dallas County,” she adds.

Information about becoming a volunteer driver with the Visiting Nurse Association’s Meals on Wheels program can be obtained by contacting Betsy Cox, director of volunteers, at 214-689-2210 or coxbe@vnatexas.org.

– Robert Smith, Director of Public Relations, Visiting Nurse Association