Toileting Assistance: 2ND MOST FREQUENT MOVEMENT TASK

In a report sponsored by the National Alliance for Caregiving to identify ways technology can support family members and friends who help sustain elderly, disabled, sick and recovering patients, a panel of national experts and government officials used a "task matrix" to understand the frequency of demand for assistance with movement. HELP TO/FROM THE TOILET was the SECOND MOST FREQUENT TASK, only behind "Help in/out of bed/chair." Perhaps another indication of the need to improve the bedside commode, a common toilet substitute for the mobility impaired? Catalyzing Technology to Support Family Caregiving, http://www.caregiving.org/wp-content/uploads/2010/01/Catalyzing-Technology-to-Support-Family-Caregiving_FINAL.pdf

Dropping Caregiver Ratio: Who Will Provide all the Anticipated "Aging at Home" Care?

A new study released by the Bankers Life and Casualty Company Center for a Secure Retirement, "Retirement Care Planning: The Middle-Income Boomer Perspective," found that U.S. unpaid caregivers provide approximately $450 billion worth of care to someone who is ill, disabled or aged. Among middle-income Boomers, four in ten have been a caregiver to a parent or spouse. Among these caregivers, 77% cared for a parent, and nearly one-fourth (23%) cared for a spouse.

Although they primarily relied on doctors and nurses to perform medical caregiving, Boomer caregivers found themselves quite involved in personal caregiving needs, such as:

• Assistance with eating (79%)
• Assistance with getting in and out of bed (78%)
• Assistance with using the toilet (69%)
• Assistance with dressing (68%)
• Assistance with bathing (56%)

Our thanks to Grand Villa of Delray Beach East for making this information generally available via Twitter!

Insights into Measuring Activities of Daily Living

In his article, "Life and Death After Hip Fractures in Older Nursing Home Residents," Eric Widera describes how Activities of Daily Living (ADLs), which include eating, dressing, bathing, toileting, and mobility, are measured in a typical nursing home setting:

" . . . but when is someone independent or dependent in ADLs? In nursing homes, . . . locomotion on the nursing home unit, is described . . . as: “how the resident moves from place to place in the room or hall using whatever device is appropriate or needed.” The device can be a thing like a wheelchair, walker, cane, feet, prothesis, or scooter. So if the nursing home resident did the activity completely on their own without cueing or supervision, then they are described as “independent”. If they need just some oversight or cueing then they are described as needing “supervision”. More help than that is “limited assistance” where the staff do some of the activity, and more help than that is “extensive assistance” where the staff do most of the activity. Lastly, complete dependence is where staff do all of the activity for the nursing home resident.

The other important thing to know is that functional status in this study is based on self-performance as observed across all nursing shifts over a 7-day period. So a resident is independent in an ADL if the resident is able to perform that activity “without help or oversight or requiring help or oversight only 1 or 2 times over 7 days”. The same thing goes with total dependence, the resident needs to require staff to do all of the ADL for all 7 days to be described as dependent.

Why is all of this important? Although these definitions are standardized, a nursing home resident’s self-performance can change shift-to-shift, day-to-day, and week-to-week based on things like their mood, an acute illness, or even just their relationship to their nurse. So one week you may be “dependent” and another week you may be “limited assistance.”

http://www.geripal.org/2014/07/Outcomes-of-Hip-Fracture-in-nursing-homes.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+Geripal+%28GeriPal%29

The way it has been: TIME FOR A CHANGE??

Home medical equipment for many people needing toileting assistance consists of using a transfer board to move from wheelchair and/or bed to a commode and back again. Height cannot be adjusted, and the picture below depicts the design solution for keeping a transfer board from shifting. It does not appear that the average care recipient will be able to position this equipment without assistance from others.

Time for a change?

Innovating Home Medical Equipment: Who experiences the burden of poor design?

I've been struck by the fact that improving home medical equipment is not as easy as it would seem it should be. Have come to think that this might be partially explained by the fact that the world of HME falls into the domain of low-paid workers and unpaid family/friends, which means the burden of poor design is experienced by those with the functional limitations and their caregivers. Improving the design of HME has not been seen as yielding any value to a hospital or a physician's practice. That means that is it very hard to persuade existing HME companies to take on any risk for introducing such innovations.

Yet, seems like the environment is changing in ways very favorable to getting a toileting improvement to market.

The Accountable Care Act is changing the incentives for providers and health plans. The smart ones will realize that HME is their "last mile" for reaching patients to avoid unnecessary hospitalizations and ED visits, support telemedicine and remote patient monitoring, and keep the mobility challenged with chronic conditions well and at home. Improved HME design will also provide respite to both paid and unpaid caregivers as users are better able to manage their assistive devices for themselves. And there will be plenty of work to go around as we baby boomers age; in fact, we will need this type of self-managed equipment to be able to handle the growing demand for caregiving.

Over the next weeks and months, I'll be posting short reports of our progress. Stay tuned,