“We are experiencing an increase in demand for our services, especially from adults age 80 and older,” said Paula Thompson, president and CEO of Fidelity Health Care, an affiliate of Premier Health Partners that provides home health care and home medical, infusion therapy, oxygen and medical equipment needs. “These patients want to continue living in their home as independently as possible, even when they are recovering from an illness or injury. Home health care services assist them in achieving that goal.”
Most home health care patients are older adults returning home from a hospital stay, whether for an acute illness such as pneumonia or an orthopedic surgery. Many of the therapies that these patients receive at home were until recently only offered in the hospital setting, Thompson said.
“New technologies allow our patients to use small mechanical pumps and other equipment to manage their own intravenous medications and nutritional therapy,” Thompson said. “Managing their chronic health problems from home reduces their medical costs and allows them to be more comfortable.”
Safety is key, Thompson added. An assessment by a home health care professional can help determine if a patient or caregiver is capable of using medical equipment in the home. And some therapies that can be performed in the home, such as chemotherapy, must be closely supervised by a nurse.
Health experts anticipate that as the American population ages, the incidence of dementia will rise as well. When patients are experiencing mild to moderate dementia, adult care centers fill an important niche. These facilities typically offer a safe environment where memory-impaired individuals can spend all or part of the day, providing stimulation for them and a respite for their loved ones. Activities might include crafts, chair exercises, games such as Bingo and Scrabble, and outings.
“People who are dealing with memory issues need structure and stimulation, and that’s what a program like ours can provide,’ said Mary Benson-Landau, RN, MSN, program manager for the Adult Care Center at Miami Valley Hospital. “The sandwich generation — those caring for aging parents and their own children — relies on us because they still have to work. An added bonus is that our staff serves as an extra set of eyes and ears, observing any important changes in the participant’s condition.”
Dementia and other illnesses, such as Parkinson’s disease, can take an unpredictable course in older adults, said Nancy Trimble, PhD, RN, CNP, a nurse practitioner with The Hospice of Dayton who specializes in geriatric medicine. “When patients are over the age of 70, they might have multiple medical conditions, such as heart disease and diabetes or lung disease and dementia and, taken together, those conditions can be very debilitating,” she explained. “Very little research has been done on elderly patients, but we do know that you can’t just treat them like you would a younger adult. Their systems work differently, and we have to learn how to account for that.”
Part of the challenge with dementia is that the disease progresses slowly, and caregivers often don’t realize when significant changes in cognition or behavior are taking place. “It’s important for health care professionals to be educated about dementia so that we can help patients and families deal with it,” Trimble said. “Families may not be aware how much their loved one has declined or what interventions may be necessary.”
Trimble expressed concern about America’s ability to care for its aging population in the years to come.
“Right now, insurance companies only reimburse primary care practices for 10-15 minute doctor appointments, and that just isn’t enough time to really see what’s going on with an older adult who has multiple health problems,” she explained. “We also need to encourage more physicians, nurses and other health professionals to specialize in geriatric medicine. Here in the Dayton area, we are seeing improvements. For example, Boonshoft School of Medicine has reestablished its geriatric fellowship program, and several local nursing schools offer geriatric training programs as well.”
For many families, of course, the future is now as they try to care for aging parents and grandparents. Trimble said that, for them, a thorough assessment and support from community resources are essential. “A neurologist or nurse evaluator can perform a standardized assessment of the patient’s condition, which can lead to an understanding of which interventions are needed,” Trimble said. “The resources are out there, but families have to be their loved one’s best advocate.”
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