Saturday, January 16, 2016

Loss & The Stages of Grief

Coming face to face with losing someone or something we have come to love may be one of the hardest experiences we face in our lives.  How we deal with loss could make all the difference in how it affects our daily functioning and our future.  Expressing grief when someone we love passes on is a normal response and everyone progresses through the grief process at a different pace.  Total Home Health professionals are familiar with individuals who have dealt with loss, and grief, so we will be a positive addition to your support system and remain by your side to help you through your difficult time.

For your information and to get more technical in our descriptions of what the different types of losses are that people actually experience in their life…take a look below because there actually are differences.

  • Necessary Loss
    • A loss related to change that is part of the cycle of life or that is anticipated, but still may be intensely felt.  This type of loss can be replaced with something different or better.
  • Actual Loss
    • Any loss of a valued person, item, or status…such as loss of a job or spouse.
  • Perceived Loss
    • Any loss defined by the client that is not obvious or verifiable to others.
  • Maturational or Developmental Loss
    • Any loss normally expected due to the developmental processing of life.  These losses are associated with normal life transitions and help to develop coping skills.
  • Situational Loss
    • Any loss caused by an external event.

Losses can be devastating to those individuals who are the survivors.  For some individuals they may cope rather easily, and some may experience a more difficult time.  After a loss obviously comes the process of grieving.  There are 5 different stages of the grief process which may or may not necessarily be experienced in order, and the length of each stage will vary from person to person.  The 5 different stages of this process include:

  • Denial
    • Client has difficulty believing a terminal diagnosis or loss, such as a diagnosis of cancer or the tragic loss of a relative.
  • Anger
    • Client lashes out at other people or things due to being upset related to their loss or terminal diagnosis.
  • Bargaining
    • Client begins to negotiate for more time or for a cure.  For example, an elderly person may say, “Please give me just a few more months to see my grandchild graduate from college.”
  • Depression
    • Client seems to be overwhelmingly sad over their inability to change the situation.
  • Acceptance
    • Client acknowledges what is happening and plans for the future without including what has been lost, such as making plans to travel for their next vacation.

How individuals progress through their grief depends on many things.  If they have experienced loss before, they may have an idea how well they will cope with other losses in the future.  There are other factors that influence loss, grief and the ability to cope, including:

  • Current stage of development
    • People all will cope with loss differently depending upon their age and what they have already experienced.
  • Relationships and social support systems
    • The more positive social support an individual has, generally the better off they are at coping during a loss.
  • Type and significance of a loss
    • Depending upon how the loss happened and what was lost will play a role in how individuals cope.  For instance, coping usually will differ if the loss was either tragic or anticipated…or if the loss was an animal or a spouse.
    • If the individual was exceptionally dependent upon who they lost, there will be an increased chance of dysfunctional grieving.
  • Culture and ethnicity
  • Religious beliefs and practices
  • Socioeconomic status
    • If the individual experiencing loss has greater resources available and a way to get to them...more likely their grieving experience will occur much more smoothly.

Total Home Health encourages you and your loved ones to never hesitate to speak out to express your wishes, ask questions and always ask for help when you need it.  We understand that losing someone or something you love can be such a disheartening experience and each time it will be different.  We will answer your questions to the best of our ability, and with our staff you will never feel rushed.  Our professionals care and will grant you all the time you need to talk and to allow the process of grieving occur so that it does not affect your overall way of life in a negative way.  The support you’ll receive from us will be outstanding; we’ll encourage you to build new relationships, assist you to accept the reality of the loss, and make future plans.  Enroll with us today and you’ll see that we’ll be there for you in every situation to address any of your needs along the way.

Home Safety

Promotion of client safety in the home is of huge importance to Total Home Health and all of our professionals.  We often will collaborate with not only you, as the client, but also your family members, other professionals on your healthcare team and whoever else that may have an impact on any of your daily routines.  Being well prepared is the reputation Total Home Health would like to keep a hold of because we want to provide you with the safest and most effective care possible…at ALL times!

Education and prevention are key to promoting your health and safety within your home.  With every age group of individuals there are different risks and educational information that is provided to them and their families in order to be the most prepared.  In our case we will focus on safety risks and prevention measures for the older adult population.  For instance, some risk factors for falls in older adults may include:

  • Physical, cognitive, and sensory changes
  • Changes in functioning of the musculoskeletal and neurological systems
  • Impaired vision/hearing
  • Frequent trips to the bathroom at night

Total Home Health understands that with age there is obviously bound to be some sort of decline in our level of functioning, so in order to compensate while promoting your safety and independence we will find the best ways to modify your home environment in order to best cater to your needs and make your life easier.  For example, we could possibly make some the following modifications:

  • Removing any items that may cause you to trip in your home, such as throw rugs or any loose carpets.
  • More careful placement of electrical cords and extension cords, such as placing them against a wall or behind furniture instead of in the middle of the floor.
  • Our professionals will take note each visit of your gait and balance, providing interventions with aids as needed…such as a walker, cane, etc.
  • Ensuring any steps and sidewalks are in good shape by placing reflective strips on the edges or non-skid strips where needed, or constructing ramps over stairs to make it easier for you to get in and out.
  • Placement of grab bars near the toilet and in the tub/shower, also possibly recommended use of a raised toilet seat.
  • Recommended using a non-skid mat in the tub/shower.
  • Recommended Placement of a shower chair and/or a bedside commode to decrease the distance to and from the bathroom…especially in the middle of the night.
  • Ensuring all lighting is optimal, both inside your house and outside.

Another danger in the home is that of a fire.  Fire safety is something that honestly probably does not get as much hype as it should even though it is very important, because fires in the home still continue to be a major cause of death and injury for people of all ages.  Total Home Health professionals will go over the plans you have in case of a fire in your home.  We will help you refine your plans and will encourage you to put even more measures in place to be prepared, including:

  • Keeping all emergency numbers near your phones so they can be immediately found and used should an emergency occur.
  • Make sure all smoking alarms are in working order.
  • We will go over your exit plan with you in case of a fire.
  • Remind you that if oxygen tanks are used in your home that you should NOT smoke around them and you should keep all other flammable materials away from the oxygen source too…it is dangerous!

Aside from falls and fires in the home there are other, more indirect, factors that may pose additional risks to your health that you may not ever think about.  These factors may include things such as inhalation of second-hand smoke, carbon monoxide poisoning, and food poisoning.

  • Second-hand Smoke Inhalation
    • This is the unintentional inhalation of tobacco smoke that occurs when someone else around you in your household smokes.
    • Inhalation of second-hand smoke will place you at an increased risk for numerous diseases just as if you were the one smoking.
  • Carbon Monoxide
    • This is a very dangerous gas that ultimately reduces the oxygen that is supplied to the tissues in the body.
    • This process happens silently because the gas has no smell, taste and it cannot be seen.
    • Death may even occur with prolonged exposure if the individual involved is unaware, such as if they are sleeping throughout the night.
    • Carbon monoxide detectors are a must if you have an appliance in your home that may give off this gas, such as a propane furnace.
  • Food Poisoning
    • E.Coli is the major bacteria most people have heard of that causes food borne illnesses.
    • The main way to prevent this is to prepare your food in more sanitary conditions and wash your hands frequently!
    • Food should not be used past its expiration dates and fruits/vegetables should always be cleaned.

Total Home Health professionals understand that we are coming into your home and we will respect your wishes 110%.  However, our job is to ensure that we work to fix any problems we come across that would otherwise compromise your health and safety.  Promotion of your health and prevention of accidents and injuries will help you to continue to lead a happy, healthy life and remain as independent as possible…which is our goal!  Enroll with us today and see for yourself!

Client Safety

When you or your loved one takes the leap and makes the decision to enroll with Total Home Health, you will begin to receive our health care services in the comforts of your own home.  You should feel at ease knowing that among our ultimate priorities is to provide for your safety and prevent injury 24-7-365…day in and day out.  There are several factors within your home that you may not have even thought of that could possibly be harmful to how you live your everyday life.  Total Home Health professionals will work diligently to ensure that your home environment and the care provided to you is the safest and most effective throughout your entire journey with us!

Each and every person is unique and set in their ways in which they have learned that work the best for them to get through their everyday lives.  Several situations and conditions could play a role in each client’s ability to protect themselves, including:

  • Age
    • Older adults and the elderly fall into this category.  With age, individuals begin to notice declines in their abilities to function and become more prone to accidental injuries.  Special precautions may need to be implemented in the home in order to ensure the environment is as safe as it can possibly be.
  • Mobility
    • How well individuals are able to be mobile and move themselves around can determine how much of a risk they are for injury or how much their safety may be compromised.  For example, those individuals who are immobile (unable to move without assistance), will most likely be at a much greater risk for development of pressure ulcers, constipation, weight loss…and the list goes on. 
  • Cognitive and Sensory Awareness
    • With age individuals may notice they are becoming more and more forgetful.  For instance, they may not notice that something is hot until it has already caused them to burn.  With a decline in this area, individuals may need reminders and/or a more structured environment developed so they know what to do next in order to complete their daily activities.  Also, individuals that fall into this category should always be allotted enough time to finish at their own pace to increase their sense of freedom and independence.
  • Emotional State
    • Emotions can greatly affect safety and may or may not increase the risk for injury to occur.  For example, if an individual is depressed, this could cause them to experience suicidal thoughts, overeat, sleep for extended periods…and more.  Every person is different in how they handle situations and conditions.  Our professionals at Total Home Health will provide you with educational information regarding ways to handle your emotions in a more positive manner.
  • Ability to Communicate
    • Communication is very important, and if individuals cannot communicate appropriately…or if who they are communicating with does not completely understand…their safety could be at risk.  In the elderly population it is especially important that if they are going to be left alone that they have some sort of back up communication if they were to fall and were unable to reach the phone.  Some elderly individuals will use life alert devices that remain on their person, such as by wearing a bracelet or a necklace, so that if an accident were to occur they could initiate an urgent medical response just by pushing a button.
  • Lifestyle and Safety Awareness
    • The lifestyle choices each individual makes may or may not have a negative effect on their safety or risk of injury.  In order to be as safe as possible, individuals should be oriented well to their surroundings and aware of what process to initiate should an accident or injury occur. 

Total Home Health and our professionals understand that each and every single person has their own ways to go about their daily life.  As the professionals come in and out of your home, one of their jobs is to be your advocate.  Being your advocate means that our professionals thrive on making your living situation the best in can be with YOUR wishes at the forefront of the care we provide for you.  We will continually encourage you to speak up and speak out about anything you feel that could make your care better…always!   The last thing we would ever want to do is to walk into your home and just start making changes without discussing your wishes first…that will NEVER happen.

During the initial visit into your home we will assess not only you and the wishes you have regarding your care, but the environment you reside in.  From that point on we will communicate any risk factors that we find that may compromise your safety with you and your family in order to come up with the best way to fix any problems as a team.  Along those lines also we will provide you with education and plans to gradually make any needed changes regarding any health conditions you have or any lifestyle choices you are making that could prove to be detrimental to your health.  Total Home Health has a wide array of programs that will fit into your life just about anywhere you may need the extra help.  Our professionals are ready to help you make positive changes in your life day after day in order to live a long, prosperous, and happy lifestyle surrounded by those you love.  Enroll today to be on your way to a brighter future!

ALS (Amyotrophic Lateral Sclerosis)

Amyotrophic lateral sclerosis (ALS), is also known as Lou Gehrig’s disease after the professional baseball player who died of this disease in 1941.  This condition is a degenerative neurological disorder of the upper and lower motor neurons within your body that results in deterioration and death of these motor neurons.  The death of the affected neurons eventually causes paralysis and muscle weakness, which progresses to cause respiratory paralysis and eventual death of the individual involved.  Functioning of the brain is usually not affected, so the person is aware of what is happening the entire time. 

Once diagnosed with ALS, your prognosis includes a time frame of approximately 3 to 5 years.  Death usually occurs due to respiratory failure within 3 to 5 years after the initial manifestations of the disease become apparent.  The cause of ALS is unknown…and currently there is no cure.  ALS tends to affect more men than women and it often develops between the ages of 40 to 70.  Signs, symptoms and findings of ALS may include:

  • Fatigue
  • Twitching and cramping of muscles
  • Muscle weakness that usually begins in one part of the body
  • Muscle atrophy
  • Difficulty swallowing
  • Difficulty/unclear speaking
  • Laboratory results will show an increased creatine kinase (CK-BB) level
  • An electromyogram (EMG) will reveal a reduction in the number of functioning motor units in the peripheral nerves…or in your extremities.
  • A muscle biopsy will also reveal a reduction in the number of functioning motor units of peripheral nerves, along with atrophic muscle fibers.

Total Home Health has a program that is right for you or your loved one who is suffering from ALS.  Due to there being no current cure, our focus will be on promotion of your current health and prevention of complications.  Keeping you comfortable and in good spirits will be of great importance to us.  To promote your health and depending on your condition, any of the following interventions may be carried out, including:

  • Maintaining an open airway.
  • Monitoring oxygen status and use of oxygen therapy if needed, or other measures such as a CPAP or BiPAP while sleeping to help maintain adequate oxygenation.
  • Encourage clients to turn, cough and deep breathe at least every 2 hours so that pneumonia is less likely to develop.
  • Encourage incentive spirometry in order to facilitate proper inflation of the lungs to allow for the most adequate air exchange to occur. 
  • Facilitate communication if there is notable changes or unclear speech patterns.  We will use communication boards or refer you to a speech language therapist.
  • Total Home Health professionals will assess you for any depression or difficulty coping with your diagnosis.
  • Your ability to swallow will be monitored to ensure safety with oral intake.  Fluids will be thickened as needed.
  • Measures will be implemented in order to conserve your energy.

Our professionals will always be attentive to your condition and provide client-centered care at all times to promote health, comfort and safety.  In addition to all the non-pharmacological interventions as mentioned above, there are certain medications that may aid in controlling your symptoms depending on how you are affected.  Your medical provider will go more into detail regarding the medication regimen that is right for you, then Total Home Health professionals will ensure that you receive your medications as prescribed. 

ALS is a rather quick disease…the time from diagnosis to when individuals pass away may only be a handful of years.  Counseling services may be recommended also for both the individual involved and their family in order to better cope with ALS, including a referral for hospice services due to the terminal phase of the illness in order to maintain optimal levels of comfort.

Respiratory status tends to be the main focus if you suffer from ALS, because after all…if you cannot breathe, you cannot supply your vital organs with the oxygen demand they need in order to function.  Therefore, our priority will be on maintenance of your airway and prevention of respiratory conditions that could hasten worsening of how ALS affects your respiratory system.  Enroll with Total Home Health today and let us work hard to promote your health with ALS and bring with us positive vibes and reassurance for both you and your family all the way until the end. 

Urinary Elimination

Urinary elimination is a precise system of filtration, reabsorption, and excretion of the wastes that have accumulated in your body.  All of those processes help to maintain the fluid and electrolyte balance within your body, while filtering and eliminating the wastes.  The primary organs involved in this process are the kidneys.  Want to hear a fun fact?  Well, most adults produce between 1,500 and 2,000 milliliters (mL) of urine per day…that’s like two 2-liter bottles full!

Here’s how the urinary elimination process works:

  1. Once filtered, your urine passes through the ureters and into the bladder.
  2. The bladder stores the urine…it usually will store up to 200 mL at a time.
  3. The bladder then sends a signal to the brain to tell you to go urinate!
  4. The person then will relax both the internal and external sphincters.
  5. Urine will pass from the bladder through the urethra…where it exits the body!

Neat huh!  It’s a pretty complicated process that goes on in your body over and over again…thank goodness it is not that complicated to explain in words!  Of course, there are factors that affect normal urinary elimination, which include:

  • Age (Older Adults)
    • Enlargement of the prostate will begin to occur after age 40 in men which will lead to urinary frequency, hesitancy, retention, incontinence, and urinary tract infections.
    • Gravity, and history of childbirth that a woman may have experienced may lead to a weakened pelvic floor which could cause bladder prolapse that will most likely result in stress incontinence.
    • Loss of muscle tone in the bladder, leading to urinary frequency.
    • Inefficient emptying of the bladder will cause residual urine to be left behind which is a reservoir for infection…leading to urinary tract infections.
    • Increase in getting up in the middle of the night to urinate.
  • Diet
    • An increase in sodium levels will lead to decreased urination, which may lead to swelling, heart problems, etc.
    • Intake of caffeine and alcohol lead to increased urination, which may lead to dehydration, etc.
  • Immobility
    • May lead to incontinence if an individual is unable to get up and go to the bathroom or is unable to gain assistance to use the bedpan/urinal as needed.
  • Psychosocial Factors
    • Emotional stress and anxiety can result in holding the urine, or becoming incontinent at times.
    • Individuals may not be given enough time to urinate completely.
  • Pain
    • There could be an obstruction, such as a kidney stone that results in abnormal and/or painful urinary elimination.
    • Having arthritis or painful joints may cause immobility and delays in urination.
  • Surgery
    • Lower abdominal surgery may create edema and inflammation, delaying the process of urination.
    • Medications used for pain relief may slow the urinary processes resulting in a decreased urine output.
  • Medications
    • Diuretics will prevent the reabsorption of water.  For example, “Water pills” work to get rid of all your excess fluid.
    • Antihistamines and anticholinergics lead to a decrease in urine.
    • Take note that some medications you may be on may change the color of your urine, such as:
      • Pyridium – orange
      • Amitriptyline – green/blue
      • Levodopa – brown/black
    • Chemotherapy tends to be toxic to the kidneys.

In the older adult population, it seems as if urinary incontinence, or the inability to make it to the bathroom on time, is more common.  Urinary incontinence significantly contributes to altered skin integrity and places individuals more at risk for falls.  Believe it or not, there are 6 major types of incontinence and Total Home Health wants to you be aware…so let us simply and quickly explain:

  1. Stress – Loss of small amount of urine when coughing, sneezing, laughing or lifting mainly due to weak pelvic muscles.
  2. Urge – Inability to stop the flow of urine long enough to reach the bathroom.
  3. Overflow – Retention of urine due to the bladder enlarging and frequent loss of small amounts of urine due to impaired muscles.
  4. Reflex – Involuntary loss of a moderate amount of urine usually without warning, usually from altered spinal cord activity.
  5. Functional – Inability to get to the bathroom in time due to physical, cognitive, or social decline.
  6. Total – Unpredictable, involuntary loss of urine that does not generally respond to treatment.

Total Home Health understands that any deviation in your normal urinary elimination patterns could cause you embarrassment and take a shot at your dignity.  Our professionals will deliver high-quality, client-centered care and we will take measures in order to give your confidence a boost and try to get your urinary elimination pattern back on the right track.  Depending upon your situation we may encourage you to do the following tasks:

  • Establish a toileting schedule and allow yourself enough time to completely get finished.
  • Monitor your fluid intake during the day and decrease your fluid intake prior to bedtime to help eliminate those nighttime trips to and from the bathroom.
  • We will provide you with the correct incontinence products to maintain your dignity and to keep your skin clean and dry to avoid any breakdown.
  • Educate you on how to correctly perform peri-care to decrease your risk for urinary tract infections…for example, women will be taught to clean themselves from front to back.
  • Instruct you on proper way to take medication that may help with incontinence.

Total Home Health has a program that is just right for you if you are suffering from urinary elimination problems.  We will continually encourage you to express your feelings and will always be at your side to offer you the positive emotional support you need to keep your confidence up where it should be.  Don’t wait any longer!  Contact us for enrollment as soon as possible so we can help you get back in the way of life you used to lead.