Last year, the members of the Expressive Arts team with whom I work in a long-term care facility for older adults organized a fashion show in conjunction with the annual fall art show. Over the course of four months, we met weekly with interested residents who planned the show, chose clothing to model that best expressed their personalities, and practiced their moves down the runway.

The Expressive Arts team, including another art therapist, a dance/movement therapist, and a music therapist, collaborated with the residents to ensure the show met its intended purpose: to provide a moment for the participants to feel proud in front of family members, staff, and other residents while challenging conventional ideas of age and beauty.

As the participants practiced their moves down the runway for the first time, we watched each person’s transformation as he or she took the spotlight. Chins lifted, smiles spread wide, and arms floated through the air. One of the participants commented as she reached the end of the runway, “Bubbles! I feel bubbles inside!” We could all feel it.

The Rise of Arts & Aging

This year, Chicago Bridge members started a Creativity and Aging Special Interest Group and Deborah DelSignore presented on the connection between creative arts therapies and the culture change movement.  Nationally, the success of programs like Meet Me and films like I Remember Better When I Paint have demonstrated the use of creative arts programming with older adults.

What Does It Look Like?

Who are the professionals using the arts in their work with older adults? What is the difference between expressive arts therapies, arts education, and other types of arts programming? Are you a professional who uses the arts in your practice? Do you know someone whose life has been changed through art? What questions do you have about expressive arts’ connection to aging? Let me know! I will be posting about expressive arts therapies throughout the year on the Chicago Bridge blog, following the lead of previous post topics such as dance/movement therapy for people experiencing symptoms of Parkinson’s Disease.

Thank you to Elyse Baylis for editing this post, and thank you to Sarabbit for allowing us to use her photo.

The Obliviousness of the Federal Government

Yet, despite this growing epidemic of abuse, approximately 6 million cases nationally every year, the government seems to be neglecting offering any support, research, or progress- burying their heads in the sand under budget crisis and campaign promises. Although Obama passed the Elder Justice Act almost two years ago, congress has still failed to provide ANY funding, leaving another empty promise on the table. According to Robert Blancato, of the Elder Justice Coalition in a Huffington Post article, older voters represent about 23% of the voting population, a segment that politicians cannot afford to ignore. Mr. Blancato also states that the amount of funding needed to ignite the Elder Justice Act is just “5% of what was recovered last year by the federal government in fraud and waste in Medicare and Medicaid.”

Chicago’s Response

Despite the national stalemate, locally, elder abuse was addressed in 2011. The Circuit Court of Cook County announced the formation of a new division known as Elder Law and Miscellaneous Remedies to specifically address cases of elder abuse. Cook County State’s Attorney, Anita Alvarez, created an Elder Abuse Task Force to investigate cases of elder abuse as well. Also, due to rampant financial exploitation, Illinois revised the powers of attorney forms, to expand protection for the principal (often seniors) from financial exploitation and elevate the standard of care and expectations of the agent. Elder aaw attornies are taking a lead in informing older adults about their rights and protecting them from abuse.

Looking Forward

Although the nation is cutting back due to a shaky economy and an overwhelming budget deficit, we cannot push aside such a prevalent issue that is affecting each and every family. Even with the terrifying statistics I stated above, Dr. Mark Lachs, Director of Geriatrics for the New York Presbyterian Healthcare System, points out in an article in AARP, “For every case that is reported, some two dozen go undetected.” The only way we can begin to combat these cases and get the funding, staffing, education and legislation we need is through Federal support and recognition that this IS an issue that must be addressed, and before 2013 rolls around.

On November 16th, Marta Pereyra, Executive Director of CLESE (Coalition of Limited English Speaking Elderly), presented on “Multiculturalism and the Field of Aging,” at the Chicago Bridge monthy event.  Marta discussed the state of older adult immigrants in our county at the present time and explained that America is in the midst of massive social and demographic transformation. Due to transformation, first-generation immigrants (foreign born) and their immediate families comprise 1 out of 7 Americans. In the mid 1970’s, it was 1 out of 20.

What is CLESE?

• Is crafted of over 50 ethnic, community based social service agencies
• Members represent over 35 ethnic groups and speak over 60 languages
• Is nationally recognized as unique coalition of ethnic providers
• Represents a model of service delivery which could be replicated nationally
• Is committed to an equal access to services for all elderly regardless of ethnicity or language

The History of Immigration Issues for Older Adults

Marta reported that, “Current U.S. immigration structure was established as a result of the Immigration and Nationality Act Amendments of 1965. Those amendments abolished the national origin quotas set in the 1920s that had effectively barred immigration from Asia. They also revised permanent‐immigration admission classes. Most permanent visas are distributed to family‐related classes, while about one‐fifth are committed to employment‐based classes.”

Main Issues Older Adult Immigrants Face

One of the main issues they face is that they do not have time to accumulate wealth in America, even though they may have in their country of origin. This poses a great deal of stress on their abilities to finance their housing, nutritional, and medical needs. Not all older adult immigrants are alike, and many of them face different types of problems in different volumes. Some of the factors that may differentiate them from each other are country of origin, age, education level, community, and citizenship status.”

Older Adult Immigration Statistics

Minorities now roughly 1/3 of the U.S. population are expected to become majority by 2050. The number of adults 85 years and older are expected to more than triple from 6 million to 20 million by 2050. In addition the non‐Hispanic, single‐race White population is projected to be only slightly larger in 2050 (from 200 million to 203 million). Hispanics in general will become the largest of the minority groups in the country. The Asian population is projected to climb in the nation from 16 million to 41 million by 2050. Health disparities will continue to be a problem without the country as life expectancy increases. In addition, we are likely to see increase numbers of minorities will age with disabilities.

 Helping Older Adult Immigrants

We can help older adult immigrants by increasing the number of programs/funding which translate materials. In addition, more programs are needed to ethnic elders (immigrant and refugees) learn English and civics to accommodate increasing number of ethnic seniors. As Nan Anderson reported in “When the Written Word is Not Understood” it can be a challenge to serve those with limited English speaking abilities. “As a social service administrator for many years in several settings, part of my success may be attributed to quickly adapting to cultures and language.”

Increase Programs & Funding to Meet Ethnic Elder’s Needs

• Programs should be initiated to combat depression and social isolation among ethnic elderly.
• Providers of services to ethnic elders need to in the language of the elder and cultural sensitivity. This is needed among mainstream service providers to prepare them for the projected increase in number of ethnic seniors.
• Health disparities remain a serious problem and more educational programs are needed to address chronic conditions such as high blood pressure, diabetes, obesity but also mental health and well being issues‐depression, social isolation, substance overuse, etc. To address health disparities it is important to pursue health related research focused on minority populations, which is what University of Michigan is doing for minorities with dementia.
• Public policy must be racially and ethnically inclusive so that changes can be made on a large scale level to assist in improving the lives of ethnic elders. For example, certain Social Security cuts would greatly impact ethnic elders-see this article to learn more.

What can you do to help ethnic elders?

A couple ideas for possible solutions to help an individual level include learning a new language like Spanish or Chinese so that you are better equipped to meet more elder’s needs. Join in on the education of your community about the needs and contributions of ethnic elders.

“Embrace reality! We live in the most racially and ethnically diverse society!” (Pereyra)

***Thanks to United Nations Photo for keepin the picture used in this article open for use.  Thank you Jaimie Robinson and Emily Mysel for editing this article.  http://www.flickr.com/photos/un_photo/4399017050/sizes/z/in/photostream/

Most of us say we want to be in control of our destiny, but do we really mean it? Death is the one outcome we are sure of, yet most of us choose to avoid thinking about it or planning for it until “something” happens. Unfortunately, that is exactly when clear thinking and calm reflection are least likely to be available. In our fear and anxiety, we look to the “experts” to tell us what to do. Yet no matter how well-intentioned or respected, others will never know all the particulars of our unique situation the way we do. Furthermore, if we wait until a crisis to confront the difficult and far-reaching decisions we each must eventually face, we may not even be conscious to make them. They will be forced into the hands of our loved ones, or even complete strangers, who may or may not have any idea what we want. They will be deciding how and where our last days, weeks, and months will be spent.

Who Suffers?

While this may be a burden on others, the person most directly affected by this choice not to make a choice will be us. As terrifying as the unknown nature of death and debilitation can be, even more distressing is giving up the opportunity to approach the end of life on our own terms. Polls have shown that a significant majority of Americans would prefer to die at home, yet only 20-30% do. Why is this? One reason is that not enough people make their wishes known, or put plans in place to insure they are followed when the time comes. Family members as well as health care providers need to be aware of what measures one wants taken when dealing with potentially life threatening diagnosis or situation.

Consider Elder Mediation

Elder mediation is an alternative dispute resolution process that many associate with divorce or foreclosure proceedings, but is growing rapidly in the areas of aging and estate planning. It creates a space and provides a process to make one’s needs and desires known to all interested parties before a crisis, while one is still able to answer questions and make sure personal wishes are understood. It is an opportunity for everyone to get on the same page without the stress and urgency of a crisis getting in the way. Mediators are trained neutrals with no interest in the outcome of the mediation. They facilitate the conversation, but do not direct it. While elder mediation can be very effective for proactive planning, it is also a good option even after a critical incident or mental decline. The opportunity for families to come together, engage in productive conversations that can result in realistic and workable plans, and keep the elderʼs self-determination and best interests at the forefront is extremely valuable. It will have ripple effects into the lives and well-being of all involved.

Costly Decisions

Beyond quality of life concerns, in these frightening economic times, it is worth mentioning the runaway costs of care for the very end of life. 25 percent of Medicare spending goes to the five percent of Medicare patients in the last year of life. The out-of-pocket costs can easily reach into the tens of thousands, with no cure at the end of this massive expenditure. In addition, there is no evidence that continuing active treatment will even prolong life after a certain point. Most people want to leave something for their families, especially in light of the ever-increasing economic inequality in this country. This isn’t about denying Mom or Dad care in order for the kids to cash in. It’s about taking a long look at the amount of money that is spent on futile care. These are delicate and emotionally laden topics that deserve thoughtful consideration, not snap judgments made in a moment of crisis.

Preventative Care

By empowering the individual to make his or her own decisions ahead of time, many of the financial issues that are bankrupting families and the country could take care of themselves. Elder mediation can be the forum where this kind of decision-making takes place. Georgia Daniels gives a clear explanation of what elder mediation can look like in this post at mediate.com. Awareness of our mortality doesn’t have to be terrifying. It can help us appreciate being alive and remind us to make the most of it, up until the very end.

Thank you to Arlene Wanetick for editing this post. And, thank you to squishband for providing the picture.

The first thing you should know about Elder law is that it is an incredibly broad area of law.  It can include any legal issue facing older adults and their families. It includes things like estate planning, probate, guardianship, real estate, nursing home neglect and a dozen other areas of law. In fact, Elder law is such a broad topic that no one lawyer is likely to have expertise in all of the topics. The goal of most elder law attorneys is to know several topics very well and to work with other attorneys who know the others. Small firms often have several attorneys that each handle different categories.

In addition, it is important for elder law attorneys to have some knowledge of the so called “elder network.” For example, a good elder law attorney should be able to guide you to public and private agencies that may be able to assist a client.

In selecting an elder law attorney, it is important to discuss who will be working on your legal matter, and their qualifications in that area of law. It is also important to consider cost. Simply because you are elderly, does not mean that you need an elder law attorney to handle a simple real estate closing. If an Elder law attorney has the experience in real estate law and a competitive cost – that’s great.  If not, a real estate attorney may be a better choice. When it comes to things like Medicaid planning, Elder law attorneys may be a little more expensive, but their knowledge is likely to be worth the cost.

Here are some common things that elder law attorneys handle and a brief description of the area of law:

Estate Planning

This involves the preparation of documents necessary to pass your estate to your heirs.   Typically it involves the preparation of a will or trust agreement.   Common goals of an estate plan are to avoid estate tax and probate and to ensure that assets go to the right people.

Probate

Probate is the court system’s method for processing the estate of a person who has died.  Probate involves gathering all of the assets of the estate, paying all of the debts and distributing the balance to the heirs. It is a useful process, but it can be expensive and time consuming.  As a result, a common goal of estate planning is to avoid probate altogether, which can often be accomplished through a living trust.

Medicaid Planning

Nursing home care is expensive and it is not covered by Medicare. If you run out of money, it can sometimes be paid for by Medicaid. In order to qualify, however, you must be almost completely out of money and you cannot give away your money just to qualify.  The situation can be more complicated if one partner in a marriage is in good health and the other needs nursing home care. The medicaid rules for how much money you can protect and the circumstances under which you can do that, are complex. Elder law attorneys are often able to help families to plan how to get the best possible care for seniors.

Advance Directives

Advance directives are documents that state what you would like done if you become unable to make decisions during your lifetime. The most common advance directives are known as Durable Powers of Attorney and they allow an individual to name an agent who can make health or financial decisions for them if they became unable to do so.

Guardianship

When a person becomes unable to make decisions, the courts will look to their advance directives to see who should make decisions for them.  If the person has not prepared an advance directive, the court must appoint somebody to do it and they are called a guardian. The probate courts appoint guardians who monitor the care of disabled people. The best way to avoid guardianship is to prepare advance directives. Unfortunately, many people never get around to doing this, and guardianship becomes a necessity. Elder law attorneys can assist families and older adults who find themselves in this situation.

Nursing Home Neglect

Providing care for the elderly is a huge responsibility, and many nursing homes take it seriously.  However, when a nursing home does not properly care for a resident medical errors, bed sores, fractured bones, overwhelming infections and death can be the result. Nursing home neglect cases are handled by litigation attorneys, but they are different than routine personal injury cases. In order to effectively handle these cases, the lawyers need to be familiar with common illnesses and ailments of the elderly as well as the many regulations that apply to nursing homes.

Housing Transitions

There are a variety of living arrangements available for the elderly today. They include independent living, senior communities, assisted living, skilled care and a variety of other permutations. What they all have in common is that they involve a transition from a house or apartment. The transition involves many personal, medical, and financial intricacies. Under ideal circumstances, this transition may occur when everybody is healthy and sound. Often, though, the decisions happen in a rush and after dementia or other issues have crept into the picture. A good elder law attorney can successfully guide you through this delicate process.

The one essential skill that elder law attorneys must possess is an ability to listen to their clients. The issues that elder lawyers address are very personal and their ability to cater to the needs of older adults makes them a more suitable choice. Another type of lawyer may be able to solve these legal matters, but the process would be completely different. Elder lawyers not only know how to take care of the legal matters presented above, they know how to take care of older adults.

Thanks to Alixandra Burns for her help editing this article.

What is Long-Term Care and What are Long-Term Services and Supports?

A brief primer on long-term care (LTC):

• LTC covers a broad range of services and supports for individuals requiring medical and/or social care over an extended period of time.
  • This includes activities of daily living like feeding and bathing; and instrumental activities of daily living like grocery shopping and doing laundry.
  • Long-term supports and services (LTSS) can be delivered in two main areas: institutions (like nursing facilities) or the home and community based setting.
  • Currently there is a focus in the United States to ‘balance’ the LTC system; historically long-term care has been institutionalized. We are moving towards a more balanced LTC system, and eventually towards a primarily home and community based LTC system.
    • Over time through technological advances, people are living longer and care is able to be provided in a home and community based setting (HCBS).
    • It is also worth noting that, in addition to most individuals preferring to receive HCBS care, the cost of providing HCBS care is often less than institutional care.

How Does Illinois fare?

The good news is that Illinois ranked, overall, in the 2^nd quartile.  On the four main categories of measure here is how Illinois measured up:

• Affordability and Access: 1^st Quartile, ranking 12 out of 50 states
• Choice of Setting and Provider: 3^rd Quartile, ranking 33
• Quality of Life and Quality of Care: 2nd Quartile, ranking 24
• Support for Family Caregivers: 3^rd Quartile, ranking 27

These rankings were achieved by looking at several indicators per category; for the full explanation for how they computed these findings check out the methodology site here.  For example, if you look at the Affordability and Access category for Illinois, you see Illinois’ measurements for 6 indicators.  From median cost for a private-pay nursing home stay to the ability to access LTSS through a single point of entry like the Aging and Disability Resource Center.

Specific Findings for Illinois: What Did You Find?

One thing that I found interesting is that Illinois ranks the lowest for providing nursing home care for people with low-care needs.  Illinois measured at providing low-care needs for 25.1% of the nursing home population, as compared to Maine who ranked the highest at 1.3%.  This is one area that Illinois can improve it’s long-term care system.  On the main “Raising Expectations” website, there is a great interactive function where you can compare different states on a variety of different indicators; it’s labeled “Browse the Score Card” on the right hand side of the screen.

I recommend checking it out yourself and sharing what you find here.  Is there anything else that Illinois has ranked at the top or bottom? What have you found where Illinois is a leader to follow, or has room to reform?

Special thanks to Bridget Murtha for editing this article; and to pjern on flickr.com for the photo.

“The National Alzheimer’s Project Act (NAPA)  (Public Law 111-375) requires creation of a national strategic plan to address the rapidly escalating Alzheimer’s disease crisis and will coordinate Alzheimer’s disease efforts across the federal government.” (source www.alz.org)

To find out what should be a part of NAPA, the federal and state government’s are holding “Listing Sessions.” The listening sessions held throughout the country are designed to let the community members tell state and federal representatives what they feel is important to include in the plans for the Law. I was able to attend one of the few federal held listening sessions at the Swisotel in Chicago on August 9th.

What is a listening session?

Although there are some provisions of the National Alzheimer’s Plan (NAPA), the details of what it will achieve are what are being considered now at listening sessions around the country. We all know the very popular Town Hall meetings that had been held in the past years around our country to address elections, the economy, etc. However, this type of community forum is different. It is exactly what is says it is — a listening session, which meant there were two people from the Federal government there to sit on a stage and listen to what you, that guy over there, and the young lady in red had to say about their experience with dementias, such as Alzheimer’s disease. There were no responses from the people on the stage. They nodded their heads, and on rare occasion took notes.

Who were those people on stage? White House Senior Advisor on Disability Policy, Jeffrey Crowley, HHS Don Moulds, Health and Human Services Assistant Secretary for Planning and Evaluation. Chicago’s Listening Session is one of the few sessions held on a national level. There are many statewide sessions planned so that citizens can tell their state representatives their experience as well. Here is a blog article in which this writer attended a local listening session.

Hearing from those living with Alzheimer’s and related disorders

I think is a great idea to help those working in our government learn how this disease is impacting lives of people around the country. I thought in this article I would share with you what some of the feedback was from those who spoke. Twenty-five people stood up and walked to a microphone in front of 100 people and told their short tale. Some were patients, teenagers, spouses, grandchildren, adult children, partners and friends, all affected by Alzheimer’s and related dementias.

What I Heard while I Listened

Those who spoke mentioned many different topics related to their own experience. I heard some themes, and some very realistic reflections that I have listed below:

1. The need for better methods of early detection
2. Programs to help support the patient who is already living with the disease, especially those in the early stages
3. More professional training on symptoms and interventions for dementia – especially behavioral changes
4. Acknowledgment of the many others living with a non-Alzheimer’s type of dementia, like Lewy Body disease, Frontotemporal Dementia, Primary Progressive Aphasia, Vascular Dementia, etc.
5. More community interventions that bring people with dementia together at all stage.
6.  Let’s find a cure!
7.  Financial support to cover costs of the expensive long-term care options
8.  More outlets to locate supportive information for families
9. More resources for those under the age of 65 with a diagnosis of dementia
10. Access to methods to intervene with agitation caused by dementia impairments and prevent over medication
11. Culturally competent services
12. Additional support for family caregivers, including job security, financial support and respite

Amazing Moments

Some amazing moments at the Listening Session included a 17-year-old daughter of a young onset Alzheimer’s disease mom, who stood up and stopped the show with her insightful, heartfelt comments about what her mom and her family needed. When the persons affected by the non-Alzheimer’s disease spoke up, showing that they were affected too and the plan should include their needs as well. When early stage persons currently living with Alzheimer’s disease and related dementias spoke their mind about needs and considerations to be made.

Share your voice

I hope that from these sessions and other methods of sharing the needs of our Alzheimer’s and dementia community, NAPA is successful in assisting families currently living with a diagnosis, finding better treatment, earlier detection and of course a cure. Share your thoughts for what you think NAPA should include

** Thanks to BloomKitty for the picture used in this article

One Medication Error Per Hosptial Patient

Medication errors are an even bigger problem among older adults. According to a study by the Food and Drug Administration (FDA), almost half of the fatal medication errors occurred in people over the age of 60.   One theory is that older people are at greater risk for medication error because they often take multiple medications.

The medical industry is gradually taking steps to address this problem. Still, it is likely to remain a problem for many years to come. Here are some things that you can do to avoid being the victim of a medication error.

1. Keep a list of your medications and dosages:

In an emergency many people don’t have time to gather their prescriptions and dosages before going to the hospital. In theory, your doctors and hospital should communicate to get you on the correct dosages. In practice, that communication can be flawed and could take days. If, for example, you are supposed to be taking blood thinners – that lag time can be fatal.

2. Monitor the Dose:

 According to a study by the FDA 41% of fatal medication errors involved patients receiving an improper dose of the medication. At home, this means knowing the difference between a teaspoon and a tablespoon – for liquid medicines. It can also mean following the medication directions and checking to make sure your pills look the same when you receive them from the pharmacy. In a facility, this means checking the doses and asking questions. If you can’t do it you may need a friend to keep an eye on things.

3. Always have an advocate:

Patient advocates suggest that you always have a friend or relative who can keep an eye on your care when you go into a hospital or facility.

4. Recognize when you need help:

For patients who suffer from memory loss, dementia, or Alzheimer’s, medication management can become a big issue. If you or a loved one are struggling with forgetting to take medications, the results can be serious. Interventions can range from a simple pillbox, to a home care nurse to assist with medications.

5. Discuss prescriptions with your doctor:

In this age of specialization, many of us see more than one doctor. When a doctor prescribes medication to you, make sure you tell them all of the other medications you are taking. Also, don’t leave the office until you have a good understanding of what the medication is intended to do, and if there are any special instructions.

6. Don’t Forget About Non-Prescription Medicines:

 Herbal supplements, Tylenol, Advil and other over-the-counter products may be perfectly safe on their own, but they can still have interactions with your prescription drugs. Ibuprofen, for example, can have blood-thinning properties that make it dangerous after surgery.  Be sure to tell your doctor about everything you are taking – not just the prescriptions.

7. Know your drug allergies:

Your family physician may know that you are allergic to penicillin, but that doesn’t mean that the hospital knows. Write the allergies on your list of medications that you bring with you to the hospital. For severe allergies, consider getting a bracelet that identifies your allergies. In any event, you need to know them and communicate them to each doctor you see.

8. Always ask questions: 

Don’t assume that your medical providers know best. No competent professional should be offended by a question. If something doesn’t seem right – ask about it.    According to the Mayo Clinic, these are some of the most common causes of medication errors:

• Poor communication between health care providers
• Poor communication between providers and patients
• Sound-alike medication names and medical abbreviations
• Illegible prescriptions or confusing directions

 Lawyers often investigate medication errors after the fact.  Although it can be important to find a remedy after the injury has occurred – it would be better to avoid the problem altogether. Preventing medication errors is an important issue for our health system to address. Until then, you can improve your chances of staying safe by advocating for yourself.

Meditation is a practice of familiarizing oneself with one’s own mind, of cultivating awareness and insight. Mindfulness refers to resting the mind in the bare awareness of thoughts, feelings and sensory experiences. Simply put, it is the practice of resting in the present moment. This can be more challenging than it sounds. That’s why they call it “practice”. But learning to rest in the present moment serves us well through all our days, up to and including the final ones.

Meditation as anti-inflammatory

The inevitable changes and losses we experience as we age can be stressful. Stress leads to inflammation throughout the body. Meditation has been shown to reduce inflammation, a condition involved in any number of diseases, including arthritis, diabetes, cancer, multiple sclerosis, depression and stroke, just to name a few. As Shelly Young mentioned in her post on meditation and inflammation, Emory University researcher Charles Raison, M.D. found that compassion meditation diminished the inflammatory response to psychosocial stress.

Meditation for brain health

A recent study in the Journal of Alzheimer’s Disease showed that meditation improved cognition in people with memory loss and increased brain activity in areas central to memory.  With so few options currently available to slow, much less prevent memory loss, anything that can help individuals and reduce our already overburdened health care system should be considered. Meditation is free; no co-pays, no insurance necessary. You can’t lose it. There are no negative side effects.

Dr Sara Lazar of Harvard University found an increase in the thickness of the prefrontal cortex of people who practiced meditation, a finding contrary to previously held beliefs about the brain and aging. As a result, Dr Lazar said she believes, “The effects of meditation can counter the effect of age.”

How to do it

There are many different meditation styles and techniques. It is important to have a qualified teacher. Yongey Mingyur Rinpoche is a Tibetan meditation master who has a fresh and accessible approach to meditation that makes the practice very easy for modern people to understand and apply to their daily lives. His book, The Joy of Living, is a New York Times bestseller. Pema Chodron’s amazing book, The Places That Scare You: A Guide to Fearlessness in Difficult Times, is especially relevant in the context of aging. Jon Kabat-Zinn established Mindfulness Based Stress Reduction (MBSR) at the University of Massachusetts Medical School, a complementary medicine program that uses mindfulness to promote physical and emotional well-being. His books, such as Wherever You Go, There You Are and Full Catastrophe Living have introduced many Americans to the practice of mindfulness.

In Chicago, we are very fortunate to have many places where meditation is being practiced and taught. The Tergar Meditation Community, under the guidance of Mingyur Rinpoche, meets on the Northwest side in the Irving Park neighborhood. Shambhala Meditation Center in Rogers Park offers a wide variety of meditation programs. Chicago KTC has a meditation center in Cicero, where they often host Tibetan masters and have regular sitting groups and teachings.

Imagine

New research on the physical and mental health benefits of meditation seems to come down everyday, but perhaps the greatest benefit of older people learning this most basic skill could be much more far reaching. Imagine the impact on families and on our health care system if each individual was able to turn toward the inevitabilities at end of life with conscious awareness. Imagine planning proactively with calm centeredness, instead of unconsciously waiting for a crisis that puts the responsibility for making these very important decisions in the hands of others.

Though hardly a topic for breakfast conversation, pressure sores (or otherwise referred to as bed sores, pressure ulcers or decubitus ulcers) are generally the culmination of two factors, prolonged time when unrelieved pressure is applied to bony parts of the body (buttocks, tailbone, hips, and heels) and extended time when human waste is left in contact with the skin. These are two factors known to put patients— and particularly immobile patients— at a heightened risk for developing pressure sores.

When a patient is left in one position for extended periods, the blood flow becomes restricted to healthy tissues and the area slowly begins to decay. When contact with urine and feces is involved the process is accelerated as the caustic nature of the waste products. The culmination of pressure and caustic agents encourages skin breakdown and an open wound may form.

Once pressure sore develops, the individual may immediately be faced with pain and embarrassment. Though perhaps more concerning is the fact that an advanced pressure sore may contribute to serious medical problems such osteomyelitis, an infection in the surrounding bones, or a systemic infection known as sepsis. In drastic circumstances, pressure sores can indeed be fatal.

A duty prevent pressure sores

Though we really don’t hear much about it, nursing homes are some of the most closely regulated facilities around. By accepting governmental funding, nursing homes are forced to comply with a lengthy list of government-imposed regulations— some of which squarely address the prevention of pressure sores.

The burden to prevent pressure sores unequivocally puts the responsibility on the part of nursing homes to prevent the development of the wound. Government regulations state that:

Based on the comprehensive assessment of a resident, the facility must ensure that:”
(1) A resident who enters the facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable; and

(2) A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing. [See F-Tag 314 (codified as 42 C.F.R. 483.25(c))]

An emblem of neglect?

Given the clear-cut governmental guidelines to prevent pressure sores, nursing homes (and medical facilities of other types) need to create and adhere to a pressure sores prevention plan for each patient. The most common types of preventative measures include:

• Repositioning patients at regular intervals
• Ensuring patients remain clean and dry
• Encouraging patients to eat healthy diets and consume adequate fluids
• Use pressure relieving devices: such as mattresses or cushions with patients who are at a heightened risk for developing pressure sores

The above safeguards have been well known by the medical community for decades. However despite the universal acceptance of pressure sore safeguards, today it is estimated that many nursing home patients are more likely to develop pressure sores during their admission today than they were ten years ago.

The reason for the up tick in pressure sore prevalence is likely multifaceted, but a leading factor is believed to be related to under-staffing and inadequate training of staff regarding pressure sore prevention. As some facilities look for ways to improve their profitability, some have looked to reduce their largest fixed cost—labor. When staffing levels are reduced, there may not be sufficient staff to tend to the needs of patients— and some of the preventative measures may get ignored or compromised.

An ounce of prevention goes a long way

As family members and patient advocates it is important to acknowledge that pressure sores are a serious problem that can quickly put our loved ones well being at risk for a long and painful injury. As the saying goes, an ounce of prevention is worth more than a pound of cure—particularly when dealing with an older adult or frail person.

While we hope for advancements in the medical community regarding solutions for this ongoing problem, there is some good news for families. In many situations, simple preventative measures that can greatly improve the quality of life of a person during an admission to a medical facility.

Family members wish to:

• Ask family members if they are in pain when they visit
• Look for early signs of pressure sore—redness
• Make sure fluids are within reach
• Ask staff about pressure sore preventative measures

***Thank you to the editor, Emily Langendorf, and to ulrichkarljoho for the photo.