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Ask Kurt, Home Care 101: How to cope with Sundowning

Ask Kurt: Is a new column by Professional Homecare expert Kurt Leggard, a registered Nurse Chief Clinical Officer -Director of Patient Services for a Licensed Home Care Services Agency in NYS. Each week Kurt will be answering your questions regarding Home Care.

Home care, is supportive care provided in the home. Teamed with physical alterations to the home such as having mobility wet rooms fitted, it’s a great way to allow your dependent relatives to stay in the comfort of their own home while still getting the help they need. Care may be provided by licensed healthcare professionals who provide medical care needs or by professional caregivers who provide daily care to help to ensure the activities of daily living(ADL’s) are met. Also, very similar to RIGHT ACCORD HOME HEALTH CARE, In-home medical care is often and more accurately referred to as “home health care” or formal care. If you’re looking for an elderly care facility, The Hermitage of Northern Virginia has very nice assisted living facilities in Alexandria VA.

This weeks question is from Stephanie in Sag Harbor, NY

Question: My question is this: What do you recommend to cope with “sundowning” , a condition of extreme irritability of older people between 5pm and 7pm…hard time for caregivers to handle.

ASK KURT:

Kurt: Thank you for the question Stephanie. As defined, ‘Sundowning’ is characterized as a spectrum of behaviors of individuals with a diagnosis of Instant Coupons!“>Alzheimer’s Disease or other dementias with the individual presenting as agitated, extremely confused and sometimes combative beginning toward the end of the afternoon to early evening sometimes extending through the entire night. Basically, when the sun goes down.

I tend to begin any recommendations with addressing ‘Sundowning’ as a condition that is very stressful for the caregiver as well as a potential safety risk for the sufferer. It is imperative that the caregiver takes care of their own health care and emotional needs and gets appropriate rest and respite to handle the rigors of caring for the individual suffering with ‘Sundowning.’ Please get support if you can.

The immediate things you can do for the sufferer is to ensure that a recent medical examination has been conducted to determine if there are any medical conditions that may be the underlying cause for the ‘Sundowning.’ If an individual is in pain, this may cause ‘Sundowning’ to start or become more pronounced as will severe constipation, Urinary Track Infections, poor nutrition, dehydration and many other conditions.

If the sufferer tends to wander (a possible secondary affect), it is very important to conduct a complete environmental review of the client’s home. Remove safety hazards (loose carpets or rugs, telephone or lamp wires, use night lights, etc) to prevent falls. If the client is at risk for wandering out of the home, safety door locks should be installed out of the reach of the client but easily accessible to the caregiver. Visible signs inside and outside of the door to identify where the lock is located can be helpful if there is a need for an emergency evacuation, as in the case of fire.

There is nothing more frightening than a love-one wandering outside and lost. Safety locks can prevent this. Do not lock a sufferer indoors without appropriate supervision. If a lock is needed, then there is a great chance that ongoing supervision is indicated (consider the many Homecare options available but be cautious to consider caregiver compatibility and costs).

The following are my recommended interventions: Maintain a routine for the sufferer. Stress will exacerbate ‘Sundowning’ and routines reduce stress. Maintain or increase the activity status of the sufferer during the day and avoid naps if possible. Naps can tend to disrupt the clients nighttime sleeping pattern. As the sun light in the sufferer’s home decreases through the afternoon to the evening, increase the amount of lighting used in the home. The use of lights will reduce one of the triggers of ‘Sundowning.’ Reduce foods that have caffeine and sugar during dinner and snacks. Keep snacks light prior to going to sleep. Ensure that the sufferer has had adequate hydration during the day (the elderly are prone toward dehydration) but reduce fluids at night to minimize nighttime urination (nocturia). Minimize disturbances during the night This seems pretty reasonable but is sometimes difficult to manage, depending on outside traffic, neighbors, etc.

I read in Healthline.com (http://www.healthline.com/ ) that each sufferer has triggers that lead to ‘Sundowning’ and they recommend keeping a journal, recording all triggers to be avoided. Great recommendation!

A final or perhaps initial intervention may be to medicate the sufferer based upon their symptoms and behaviors. Interestingly, some medications may themselves be the cause (trigger) for what appears to be ‘Sundowning’ but may actually be causing medically induced insomnia and confusion. Review all medications the sufferer is taking with their physician or nurse practitioner to determine if medication may be the cause of the problem.

Ultimately, this is a very difficult and challenging circumstance for caregivers to handle. It can be very exhausting and frustrating for everyone involved. A combination of the recommendations offered will hopefully provide some answers and work for you. Get plenty of rest and support if possible. (please review Web MD (http://www.webmd.com) and the Alzheimer’s Association ( http://www.alz.org/nyc/ ) for excellent information.

Each week I will be answering your Home Care Questions: Email your questions to HamptonsMouthpiece@gmail.com

Homecare is Expensive! Greeting’s Hamptons Mouthpiece Readers…Most of my Sag Harbor friends know me as a photographer but my profession, I am a Registered Nurse with a background in elder care. My responsibilities include running one of the larger Medicaid Homecare service agencies in NYC. So I thought that I would talk to you about…. Estate Planning.

While I am no expert in this field, I have first hand seen the devastation thatcan impact families that do not plan for the inevitable health declines in our parents and significant others as aging and subsequent health issues arise. It is an important part of life that we all have to contend with soon or later, so a support plan may be worth looking into such as where to find a good homecare, you may want to begin with somewhere similar to GYC Senior Care – see more at gycseniorcare.com. It is imperative that well in advance of these calamities, you seek an Elder Lawyer who can help you prepare your family’s finances to protect your wealth.There are many legal vehicles that will allow you to shelter your loved ones assets such as Pooled Trusts, which will allow for you to provide the care and services that the sick and frail will need in their declining years while simultaneously protecting and allocating assets for this purpose.

elder2Homecare is EXPENSIVE and can quickly overtake any savings that have been accumulated. You should invest in a Long Term Health insurance policy that will provide some limited coverage for homecare if those services are required. Please conduct your due diligence in researching the insurance company that you chose to join. It is imperative that you investigate the financial health of the company you choose. The most unfortunate thing that could happen is that you contribute toan insurance company that goes belly up because THEIR financials were not in order. BEWARE!!! Carefully read your policy to understand what you are entitled to regarding homecare. Some simple math will illustrate what can happen to your finances if you will need homecare from an aide. 8 hours of service per day x 7 days weekly x 52 weeks at $15 per hour for a home health aide will cost $43,680 per year. Multiply this by 5 years and you get $218,400. What you should know is that the risk for health status to decline and the elderly needing more services than 8 hours daily…well, you get the picture. Please take my advice. Plan ahead.

Here’s to your good health!

Kurt H. Leggard, RN**Contributor

Program Director

Personal-Touch Home Health Services

This is a plight of significant proportion and there is of course an impact to neighboring countries in South America and as far as Spain, where Venezuelan immigrants are seeking refuge. But we should make no pretense on what is unfolding here. Our media outlets showed the imagery of Russian jets landing on Venezuelan soil in increasing numbers. The embrace of Maduro by Russian, Turkey and to a lesser degree, North Korea.This is happening in the Western Hemisphere and is seen as a threat (real or contrived and inflated). Interesting that the plight of the Haitian people who are also in our Hemisphere is not considered a priority or ‘humanitarian crisis, but that writing is for another day.

Further, and here is the kicker….Venezuela is OIL RICH (oh… Haiti, now I understand). Let me repeat that. Venezuela is OIL RICH. The ability of many multinationals (in case you were wondering, the 1%) to manipulate OPEC, Russia’s oil dominance and an opportunity to determine Russian economic stability is too great an opportunity for America, especially this administration to squander, or so they may think.

If I were the American tourists, dignitaries and Embassy staff located in Venezuela I would be packing my bags and getting on the next flight out, because they are going to be the pawns used as a simulated pretext for American intervention. Think hostage situation. Think about Maduro’s threats and demand that they leave. Think about Secretary of State, Mike Pompeo’s position that Maduro cannot demand they leave. Is Pompeo kidding???? All the precursors for an invasion…er sorry….INTERVENTION (so much cleaner and sanitized a term).

I remember the Iranian hostage CRISIS. I see this devolving into a situation that may be reminiscent of that malady. 

I am no military planner, I am not Nostradamus, I have no other concern other than to say, I have seen this movie before. A high level American politician setting the stage for intervention by preparing the American public about ‘humanitarian’ or ‘geopolitical’ crisis forming “right off our shores”. A President with sagging popularity looking for an ‘October Surprise.’ Military threat from….The Russians. And….get ready…… ITS ABOUT THE OIL. ITS ABOUT THE MONEY! 

Who will get rich at the expense of some other nation’s citizens?

I will remind you of the Shah of Iran and American intervention that gave rise to the Ayatollah Khomeini. Iran Contra Affair. The Domino Theory. The Iraq War (take your pick which one) giving rise to ISIS.  I know, I know, these are all disparate ‘adventures’ with unrelated precursors save one. MONEY. Look and see what was at the root of these interventions by our government. Oil, land, territory and a geopolitical chessboard that makes dominance over other people’s land the prime directive. But make no mistake, if you seek out the root cause analysis of the adventurism, it was about the MONEY! Its ALWAYSabout the money!

I don’t want to see anymore American treasure lost in the pursuit of fleeting gains and assuaging fragile egos and image.

Be cautious America, Be on your guard.                          I think we have seen this movie before.

Hamptons Teen: CALL ME OLD-FASHIONED, but I’m Just a DAD
I have become increasingly aware and worried about the relaxed attitude of illicit drug use among teens in the Hamptons and beyond. But what are our teenagers to think? They see a more relaxed and accepting attitude regarding the use of marijuana due to the reduction of legal penalties and the sale of marijuana for recreational use in multiple states. This is in the news and has become a part of their realities.Happy Group Of People
What our teenagers do not realize is the increased documentation about the effects of marijuana on the teenage brain. We know that the development of the brain is very fluid until or between the ages of 21-25 years old. The way in which the brain is wired is open to impact by this and other drugs. I am not a prude nor am I unaware of the opportunities, interest, curiosity and pressure to smoke weed. A lot of us did it when we were young. But this isn’t our father’s (and mother’s) weed no more. Things like the juicy fruit strain are a lot different to what was being smoked back in the day. The THC (active ingredient that produces the high) content is many times more concentrated in today’s marijuana than in the weed our generation smoked. Many ‘brands’ of weed are genetically improved to the form of designer status. I’ve also recently heard that there are different ways that you can smoke weed these days, like through a helix pipe for example. Apparently it’s a cool thing to do. Consenting adults should have the option of doing whatever they want to do but it is imperative to fully inform our teenagers of the risks inherent in smoking pot.
I have the same concerns about smoking cigarettes and underage drinking that I have towards smoking weed and I feel to some extent, these are a more insidious and risky behavior that is impacting our teenagers. I cannot tell you what is the percentage of teenagers smoking and drinking but I feel it is over 50% of the population. Maybe I’m old-fashioned but if you were to ask both of my daughters (18 and 25), I still harp on the need to show restraint and to use some forward thinking concerning their future plans and how use and abuse can derail their goals. Believe me, they get tired of ‘the talk’ but I continue just the same. Am I being successful… I don’t know but I hope so. They lead their own lives, much of the time out of my view but I do what I do anyways because I must! I have no illusions, I can’t protect them all the time, nor should I or will I try. I will tell them the real deal, give them the tools to make good decisions and pray for the best.
EVERYONE has my permission to warn me if they think my child’s behavior is a risk to them and I do not care if they don’t like it. If your kids have come to my house, they may have heard some rendition of ‘the talk’ as a natural inclination of mine to be protective and proactive towards the friends of my children. My kids have probably warned them to expect it sometimes. AGAIN, I don’t care. I will not preach or teach but this is a part of the way we conduct business in our home. I will not stop!
Now don’t get me wrong, I remember being a teenager and doing LOTS OF STUFF. I will not be a hypocrite and tell them to ‘do as I say and not as I do’. But the risks of life long impacts secondary to social media and ‘selfies’ of illicit behavior that can follow them FOREVER…there are no do-overs anymore. Society can be very unforgiving. We did not have to face these risks. Remember, the definition of a teenager is filled with doing DUMB THINGS. But it is this risk taking and feelings of invincibility that makes them so powerful and dynamic. It will be hard to convince them of the dangers because they LIKE danger!
One more trend that I am seeing; the use of illegal performance enhancing drugs (PED’s). The use of Human Growth Hormone and steroids among teenage athletes has increased exponentially. Kids want to look better and perform better and they are getting access to and using these drugs more and more. The lifelong effects of these PED’s and the health impacts are so pronounced and damaging that it is imperative that parents and adults of teenage athletes inform them of the risks. Encourage your school teams to educate their athletes of the dangers and make it part of their athletic curriculum.
From me to you….JUST BEING A DAD

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Political Opinion: Donald Trump’s Exit Strategy

I think everyone has it wrong, Donald Trump has an Exit Strategy. Donald Trump has never wanted to be president. He has wanted the notoriety of running for the presidency but never the responsibility of the office. He has wanted the attention and to be placed on the same stage as those who would assume the office but he never assumed that he could win the office. Donald Trump’s ego forces him to seek the stage, the limelight but he could never risk not winning. If Donald Trump loses in a ‘fair’ fight or election, it would diminish his brand. Donald Trump could never have that.
Indeed, Donald Trump has expanded his domain. He has expanded the Trump brand. His brand is bombast, entitlement, pugnacious temperament and an air of never retreating from a fight. He has acquired a constituency of older white men who will forever be in his debt for making them feel empowered and in the right, as they see ‘their America’ fading due to a relentless demographic change in the American landscape. They will forever buy the Trump brand of goods for the ‘virile,’‘powerful’ man. Trump Cologne, Trump clothing, Trump real estate, golf course membership and so on.
Donald Trump has succeeded in positioning his business interests among those who he feels will continue to support him and purchase his goods and services for the foreseeable future. The Trump business empire will expand. Watch for the announcement of his next reality television show and see how the networks and cable television executives will fawn over him and enter into armed combat with each other for the ‘privilege’ of producing his show. The network executives will assume that his ratings will be beyond belief because, that older white male demographic will be sure to tune in. The ratings will be ‘HUGE.” Brilliant!
Trump has succeeded in capturing an entire constituency of the Republican Party. Notice you don’t hear much about the Tea party these days, to the chagrin of Ted Cruz and others. We now have the Trump wing of the Republican Party. He could be a Kingmaker. He now has political power to go along with his considerable social media and traditional media acumen. Trump knows how to manipulate the media and expertly leverage the combination of media and political power. We have all been seduced and co-opted by his magnificent illusion. Watch how many of the Republican candidates come to kiss his ring as they mount a bid to become the 45th President of the United States. Trump has won! Regardless of which party wins the White House, Trump will have a voice and a seat at the table because he has his following. I repeat, Trump has won.
Now he has to escape the birdcage of campaigning. Trump has repeatedly stated that he would consider running as an Independent if the Republican Party did not “treat him fairly.” He has now artificially created a crisis of American identity by proposing the unfair and unconstitutional premise of barring Muslims from entering the country. Trump in one fell swoop has coalesced the opposition to him by every candidate and the entire Republican leadership establishment. I guess he will consider this as ‘unfair treatment’ and decide to pick up his marbles and leave the candidate stage. white-blank-space
The Exit Strategy is revealed. He will threaten an Independent run but will decide against this for the ‘good’ of the party; only to remain in the conversation as an outside element. A VERY powerful position that he will be able to continue to drive the conversation and terms of this election. If the Democrats win he will assume no blame because it will be another candidate’s loss. If the Republicans win, he will assume some of the responsibility for victory for having the ‘brass appendages’ for creating the environment for success. The Republican president will owe him favors and he will have unprecedented access. Trump wins.
We have all been witness to the genius of Donald trump. I am very impressed.