Long toenails and associated issues

pedicureRecently I visited an elderly gentleman in his home. After talking to him for a few minutes, I was just taking my leave when I noticed his toenails. They were long and uncut.

I pointed them out to him and requested him to cut them down to size. Apparently he had been wanting to do that for a long time, but because he was unable to bend, he had not gotten around to doing them for a while. He also seemed very reluctant to ask family members for help. I asked him to bring his nail clipper, thinking I would do his toenails. He brought a pair that turned out to be useless against his thick and long toenails.

I am sending across a toenail clipper to him today. Additionally, I am looking for a salon/spa that provides pedicure and grooming services at home for elders. Believe me, it seems to be easier finding grooming services for pets than for the elders. Such is the state of affairs here!

Anyway, coming back to the topic, here are some of the reasons why you should ensure that the elders in your house have their toenails trimmed regularly.

1. Long toenails can curl up and cut unto the skin.
2. Thickened toenails can become hard and difficult to cut.
3. Toenails harbour a lot of bacteria and other harmful germs. If one were to scratch oneself with their toenails, chances of infection are high. These infections can lead to complications and in some cases even septicemia and death.
4. Long toenails can cause people to trip or stub their toes more often.
5. They are unsightly.

As they say, a stitch in time saves nine. So arrange a pedicure today.

The importance of (not) sitting

sitting is good

I read an article recently where it states that sitting for long periods is the new smoking.

Till recently, say till about 2 generations ago, people were more actively involved in manual work involving standing, walking and running. However, with more work moving to the desk, we are finding most people spending at least 9 hours a day sitting at their desk.

These prolonged periods of inactivity, according to health experts, can lead to obesity, heart diseases, muscular issues including back problems, as well as dementia. The WHO has identified lack of physical activity as one of the biggest killers on this planet.

While most of these articles and TED talks are focused on the young, this is true for the ageing population as well. Especially because many elders spend even longer hours sitting. So, if you notice that you are sitting for long periods of time, please change your life style as soon as possible. Go for short walks more often, join an elder yoga class, stand around for longer periods or join a gym. This should help keep at least some of the problems at bay.

Having said that, there is at least one time when sitting is of paramount importance. And that is when you are trying to put on your underwear and trousers. Most of us, especially the men, do this while standing. As your flexibility decreases, the chances of your foot getting caught inside and making you trip increases quite rapidly. So, always, always sit down before your wear your clothes.

Now, if you are in the habit of wearing your clothes in the bathroom, the situation is even more dangerous. Yes, I know, you have been doing it for several years, practically since you started dressing yourself. Nevertheless, times have changed and you have become older.

Get a shower bench or shower chair for your bathroom. After you wipe yourself, quickly wipe the showerchair as well and then sit on it to wear your clothes safely.

Remember, a fall can lead to a lot of complications and additional dependency on others.

Sometimes, sitting is good.

This is what happened to me when my parents moved in

parents-moving-inJoy, frustration, irritation, adjustment, finally happiness! Getting your parents to move in with you is a tough proposition. When they finally agree to move in, it requires a change in the mindset of everyone. The initial euphoria on both sides slowly moves through difficult periods of adjustment leading both sides to question the decision. But if you persevere and remain true to the reason as to why you want them to be with you, it is very rewarding in the end.  It is far more difficult for our parents to adjust since it means giving up ostensibly their independence.  Giving the limited space in our homes, it also means giving up prized possessions so as to accommodate everyone. It also meant making the home more secure, safer and comfortable for seniors.

Many conflicts arise during the initial phase – things to keep and throw away, finance, medical, the list goes on. When there are kids involved, the demands that are placed on us as parents often lead to what we perceive as interference from our parents. To them, we are still their kids who need to be spared physical and emotional demands. This often makes them intervene directly in delicate situations which make the grandchildren resent them and us. They miss their independence and their life and substitute that with trying to be a part of what happens at home. They constantly tell us when to be home, what to cook, how to buy our groceries and how to save. The conflict arises in how we raise our kids because of very different schools of thought about food, schooling and discipline.

Three generations of mood swings happen at the same time – old age, menopause and teenage. And you have to deal with the aftershocks. You navigate your way through treacherous waters filled with obstacles.

After you successfully navigate your way through these treacherous waters and lead your family successfully, it is richly rewarding to see your parents by your side through the joys and sorrows of everyday life. At the end, I am happy they are with me.

Care giving guide for first timers

care-givers-guide

Guide For First Timers

Caregiving is not easy but it’s probably one of the most complicated roles you’ll ever play but you do get the satisfaction of helping someone. Most caregivers experience mixed emotions as they have very little control over what happens and often experience feelings of resentment and frustration about the loss of privacy. This guide is aimed to help first time caregivers, it includes advice, resources and checklists. We hope this guide helps you get organized and make the process easier for both you and your loved one. Finally, remember: Just take it one step at a time.

Step – 1

Anticipate and Plan
When it comes to your parents or anyone close to you; plan a conversation. Don’t wait for a sudden illness or a critical diagnosis to take you by surprise. Plan caregiving at an early stage. Talk to your loved ones about their views and wishes, preferences and finances.

Step – 2

Group Resources
Don’t try to handle all the responsibilities of caregiving yourself. Talk to other family members, friends, and professional caregivers. Assign roles to whoever is willing to help, usually other family members and friends. It is also important to engage an unrelated mediator to manage disagreements and resolve any difficult issues.

Step – 3

Make a Plan
Sit with other members of your family and develop a short term and a long-term plan. This includes financial planning as well as determining role each of you play. Also, gather all medical records in one place as it will help you respond more quickly during an emergency. In case, you have to do everything yourself, consider engaging a part time caregiver.

Sometimes, hands-on caregiving tasks, such as bath or toileting can be uncomfortable. Check if any other member can help or consider hiring assistance.

Tasks that can be shared or delegated:

  • who will take care medical appointments
  • who will prepare meals
  • who will step in when the primary caregiver is away
  • who will keep tabs on all expenses

Set up an email or WhatsApp group to keep everyone up to date, this will help you stay organized and focused.

Step – 4

Care for Your Loved One
Choosing between your own career, children, spouse and taking care of a parent often becomes a challenge for caregivers. Source products that lighten the caregiver’s workload and help your loved one remain safe and independent.

Some products that you might consider:

Step – 5

Get Trained
As a primary caregiver, ask your doctor or medical assistant to train you on day to day procedures such as sugar level tests, nebulization or dressing a wound.

Step – 6

Stay organized
Caregiving can be a complex role but try to be organized with health records, filling prescription and storing all emergency numbers in phone and in a notebook as well. Also, check out sources for ambulances, medicines, doctors who make house calls, medical oxygen suppliers and hospitals near you.

Step – 7

Take care for yourself
Caregiving can be highly stressful. Add loss of sleep, poor eating habits and lack of exercise can affect your health indirectly. Always, take care of yourself first; engage in activities that you find relaxing. Remember, caregiving is a long haul and you’ll need to stay fit physically and mentally to care for others.

Finally, take care of your personal finances, paying for medical expenses, missing out work, passing up promotions, are all going to take a toll. Keep a record of all expenses and share it with others in your family.

 What are the criteria for finding good in-home care services?

What is home health care?

Home health care is the process of providing health care to people in their homes. This could include post-trauma care, post-operative care and elder care, and may range from supporting daily living activities to complete at-home ICU setup.  In this article we will restrict ourselves to home healthcare for elders.

The need for home health care

Of late, India has woken up to the need for home health care.

Firstly, a burgeoning population is putting a lot of pressure on hospitals to treat and discharge patients as soon as possible.  This is extending the post-hospitalization and recovery period where people who have come back home continue to require a fair amount of health care in order to fully recover.

Secondly, the elder population in India is growing steadily and small families are finding it hard to look after the elders at home without professional help.  India today is home to over 120 Million people above the age of 60 and a good 10% require some health care and support at home.

These two together are creating a new market for professional home healthcare services.

Introduction to professional home healthcare services in India

“Home healthcare services” is still a nascent industry in India.  It is also a very challenging space because the requirements and conditions in India are very different from those in developed nations. Which means that we do not have a successful model to emulate or follow.

Currently, there is no regulatory body or umbrella organization for the home healthcare sector that could regulate and set up the rules of engagement.  So, we are pretty much bordering on what can be called an unorganized, unregulated sector.

Also, most home healthcare services organizations are independent organizations not affiliated to any hospital.  This means that, more often than not, the hospital is not aware of what specific services the home healthcare agency is providing for their discharged patient and whether it is in line with what they – the hospital –  has recommended. In fact, most often, the home healthcare services are provided without any supervision or monitoring by a doctor.  This means all the due diligence in the selection process and the supervision of their work with the patient rest solely on the shoulders of family members of the patient.

This is why it is essential to learn how to select the right service partner for you.

  1.  Collect the list of service providers operating in your area.  These could be individuals (freelancers), general manpower agencies, local hospitals’ outreach business arm, or dedicated home healthcare providers.
  2. Select a service partner who meets your current requirements and be prepared to switch to a different partner if the needs become more complicated (or less complicated) as the case may be.  This will give you some flexibility in managing costs.
  3. If you are selecting a freelancer or individual, there are both advantages and disadvantages. The advantages and disadvantages are
  4. (A) The cost will be low.
  5. (A) If you have the space, you can find someone who is a live-in service agent.  This will prevent sudden “no-shows” and unexpected disappearances.
  6. (D) You will have to do all the due diligence starting from the security aspect onwards.  Is this person reliable?  Where do they live?  Do we need to get them to get a police clearance?  Should I get copies of their important documents?   These are all some of the questions you will need to grapple with.
  7. You will be responsible for their personal needs in terms of food, security and shelter (in the case of a live-in).
  8. When they leave for whatever reason, either permanently or for a short/long leave of absence, finding a replacement can be challenging.
  9. If you are selecting a general manpower agency, it should be only for a companion or a nursing assistant (untrained helper).   You should not rely on a general manpower agency for professionally qualified personnel such as nurses, physiotherapists, occupational therapists or doctors.  The advantages of going to a manpower agency over an individual is that you can expect the manpower agency to do some of the due diligence (though we would strongly recommend that you do your own due diligence).  Additionally, finding a replacement for a truant caretaker may be easier.  On the down side, expect “no-shows” and everyone involved, from the agency to the actual personnel, to be “unreachable” at such times.
  10. If your local hospital provides home healthcare services also, that is ideal.  Since all the services are provided by the same organization, one can hope that they all work in unison and provide you with the right level of support whatever your needs are.
  11. Finally, there are a number of independent professional home healthcare agencies that have come up in India recently.  They are expensive, but they provide a wide range of services from house calls by doctors to 24×7 intensive care.

The bottom line in all this is that the quality of service received is, at the end of the day, dependent on the quality of the individual deputed to provide that service.  As a fledgling industry, training of personnel for home health care is still not very advanced and you can expect a lot of rough edges.  Be prepared to spend time on training the deputed personnel on matters such as hygiene, empathy, kindness, caring and pleasant bedside manners.  You will also have a tough time taking them away from their phones!

All the best!

How to handle a parent who has become, bitter, rude and even more stubborn as they have aged?

DementiaThough this may sound pithy, it is true that old people are like children. And sometimes, the older they get, the more child-like and/or childish they become. While this can be endearing at times, it can also be very frustrating and annoying. Not to mention, difficult to manage.

If you feel that your elder loved one is behaving badly, ask yourself this question.
Is this completely new, surprising behaviour or is this their usual inherent traits getting magnified a bit (or a lot)?

If you feel that there is a sudden and drastic change in the personality of the person, then this could be a symptom of dementia. Seek professional help. Take the loved one to a neurologist and have a proper assessment done.

Dementia is a generic term for decline in mental ability of a person. It is not a specific disease. Alzheimer’s is one of the common forms of dementia among elders. Dementia results in a loss of ability to perform even routine tasks properly and the person suffering from this may become frustrated and angry at their own inability which can then manifest itself in the form of bad behaviour.

If on the other hand, the traits exhibited have always been inherent in the person, except that it is coming to the fore more often and more forcefully, then it could be due to other factors.

In both cases, a lot of patience, tolerance, love and care are needed. Here are few tips for handling such situations:

1. Try and identify the cause(s) for their frustration.

2. Help them in tasks they are having difficulty with.

3. Where possible assist them in finding ways by which they can remain independent, rather than taking up those tasks yourself. For example,

  • If they are constantly forgetting things, get them a board on which they can write things they need to remember and allow them to use it to supplement their memory.
  • If they are forgetting dates and seasons, get them a big calendar that they can refer to regularly.
  • If they are misplacing things, help declutter their living environment and designate places for the things they misplace. For example, a decorative and distinct keyholder can ensure that they hang all the keys there. A spectacle stand kept within ready reach can help them remember to leave their specs in the same place most of the time.
  • If they are getting lost, buy them a wearable GPS tracker. This may not help them but will help you ensure that they don’t wander away and get lost.

4. If they are abusive or physically threatening, then get them to sit down and explain why such behaviour is disturbing to you and ask them how you can make them happier. If that does not work, you can switch to expressing your displeasure at being abused and take certain actions to ensure that they get the message that you will not tolerate bad behaviour. For example, you can move out of the room saying “I am not going to come back till you calm down and behave properly”. If they get physically violent, get support.

5. If they are suspicious of you, don’t take it personally. Many times, you are the only person they are interacting with and so you become the easiest target to vent out all their frustration, anger and suspicion. If they are worried about monetary issues, keep their bank passbooks and other asset related papers somewhere close to them, so they can go through them whenever they want and reassure themselves.

Each case is unique. The main thing to remember is that you don’t have to face it all alone. Get help. Talk to your friends and family. Enlist their support. Talk to fellow caregivers. Join a self-help group. Approach NGOs that are working with elders.

Above all, tell yourself that their behaviour is not a reflection of their opinion of you. Don’t let your self-esteem suffer. All the best!

Transitioning from the saree to the nightgown

Cocoon adaptive clothingMost elderly ladies, especially in South India, have worn nothing but sarees all their lives.  While the saree is an elegant dress, it is quite a handful to drape, even for a normal person.  But to have to drape it on another person, that too someone who is confined to their bed is not only tedious but also difficult to manage for multiple reasons.  Just imagine having to change the saree every time there is a diaper ‘accident’ and you will understand some of the problems faced in such situations.

One such story involves an 89-year-old lady. This lady had been very active until she fell and fractured her hip a few months ago.  One thing led to another and now she is confined to her bed, and dependent on her daughter for everything.  A feisty lady, the perceived loss of control of the household and having to depend on others made her very difficult to deal with.

One of the things she refused to compromise on, in the beginning, was the saree.  She insisted that she had to be in a saree all the time.  And not just any kind of saree but one of the starched and iron cotton ones that she was used to all her life.  The daughter tried gamely for a few days but was unable to take on the additional burden of changing her mother’s saree two or three times a day.

She then bought nightgowns from us, but her mother refused to even consider them, even after she was given a wide choice of designs to choose from.  Finally, the mother and daughter had a big showdown at which time, the daughter reduced the choices to grey hospital gowns and our special design Cocoon nightgowns.  The mother finally relented and decided to go with the nightgowns, for she abhorred the dowdy hospital gowns, which she felt made her look and feel even sicker than she actually was.  Needless to say, the mood in the house subsequently went downhill.

We came to hear about this story when the daughter, the primary caregiver came to buy some more of our specially designed back-open nightgowns for her mother.

With dark circles around her eyes, hunched shoulders and a resigned look, she appeared to be at the end of her tether.  On gentle probing, she confided that she felt that she had let her mother down as she could not even meet the simplest of her wishes.

Once she narrated her story, we took a leaf out of another customer’ story (similar beginning, but a different ending), and suggested the following:

  1. Have specific visiting hours for her mother during which time her friends and relatives can come and visit her.
  2. Get the mother dressed in a saree for the those visiting hours, so she can receive her visitors the way that she liked – prim and proper in a starched cotton saree.

A few weeks later, the daughter came back for a few more of our nightgowns.  She seemed to be in a much better mood and was happy to share with us that our suggestion had worked very well and both mother and daughter were very pleased with the arrangement.

“Now that my mother has got used to wearing nightgowns, she finds them very comfortable and elegant.  She has sent me here to get some more, with clear instructions to get pastel shades because that is what complements her complexion”, she said with a throaty laugh.

On our part, we are very happy to have contributed in making the life of another care recipient and that of the care giver just a little bit better.

What qualifies someone for hospice?

hospice

Definitions:

Hospice:  A home that provides care for the terminally ill.  Cancer patients in their last stages and others who have six months or less to live, benefit from moving into a hospice as the hospice is geared to take care of their needs and ensure comfort and care.

Palliative care:  Palliative care refers to treatment given not towards curing an illness, but towards keeping the patient comfortable and pain free.

Looking after a loved one who is terminally ill is one of the toughest assignments one can have.  Firstly, unless one is a nurse or a doctor, one is not fully qualified for the task at hand.  Secondly, if the loved one is suffering, watching them from close quarters can be really traumatic and both emotionally and physically draining.

Under such circumstances, opting for hospice care may be the best thing one can do, for oneself and for the patient.  A hospice is geared to look after the terminally ill and will be able to keep your loved one as comfortable as possible.  In addition, many times, they will have licenses to procure and prescribe pain killers such as morphine, that are not available to others.  On top of that, this will give you the opportunity to spend quality time with the loved one rather than constantly worrying whether one is doing enough for the loved one.

In India, there are quite a few charitable organizations that run palliative centres.  Most of these however cater to the poor and destitute. They do the best that they can but given that they are charity run and are invariably filled beyond capacity, they may not be suitable for those that are willing to pay for better quality services.

Searching on google for “hospice”, “palliative care”, “terminally ill care” and similar words along with the name of one’s city will give one a quick overview of the available options.

It is important to remember that considering the option of hospice care for a loved one is not an act of abandonment, a sign that one is relinquishing one’s responsibilities or dereliction of duty.

Under such circumstances, it may be the right thing to do for one’s loved one.

Humanitarian Award for Probus Club Of Chennai

The Probus Club of Chennai received the Humanitarian Award from the Thakkar Bapa Vidyalaya Samithi in recognition of  the yeoman service that they did during the floods in Chennai in the year 2015.  The award was presented by Hon’ble  Vice President of India, Shri Venkaiah Naidu and received by Probian President RT Namasivayam.
Award to probus by VP
“Probus Club of Chennai,apart from fellowship among members,undertake projects for the benefit of the society.
During the floods in Chennai in the year 2015, the club collected contributions from members and donated the following.
1.1000 saris to slum dwellers in Mylapore.
2.Rs.70000 to Thakkar Bapa Vidyalaya Samithi, T.Nagar for purchase of machinery.
3.Rs.70000 to M P Aanandh Matriculation HSS for purchase of computers.
4.Rs.45000 to a NGO to construct a thatched house in a village in Cuddalore District.
5.Blankets to an old age home and an orphanage in Nanmangalam.
6.Free medical check up to senior citizens in Mylapore.
Apart from the above,Probus Club has revamped toilet facilities in Gopalapuram Boys’ HSS.
This Humanitarian Award from Thakkar Bapa Vidyalaya Samithi.The foundation for this school was laid by Mahatma Gandhiji.”

Are we any close to a cure for Parkinson’s?

parkinson-TAThere is an article in Wired about 23AndMe’s quest for Parkinson’s.  23AndMe, as you know is a company that is decoding the human genome in search for patterns to help us understand diseases.

Parkinson’s is an incurable neurodegenerative disease that affects 1 million Americans. The biggest risk factor is age, but certain genetic mutations can increase risk too. 23andMe reports two of them to its customers, which each increase the chance of developing Parkinson’s between about 30 and 75 percent. (Sergey Brin, the Google cofounder and ex-husband of 23andMe founder and CEO Anne Wojcicki, carries one of those mutations, called LRRK2.)

But scientists don’t know how the disease works or even how much genetics play a role in its development and progression. Unlike Huntington’s or hemophilia, there’s no single genetic signal for Parkinson’s. 23andMe is betting that through brute-force pattern matching, it can map the constellation of genetic causes—and potentially inform new treatments.

To read the entire article go here.