Falls in the Home
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Living alone as an Elder can be stressful for families and the Elder themselves. With some prevention you can be aware of the ways to remain safe, and alert others to times you need help for an emergency. Remaining safe in your home can be done with a few small steps. Making sure others know you are alright can also be easily accomplished. Falls are one of the most common concerns of Elders at home alone and their loved ones. Falls can lead to serious injury or death and we suggest you look at your home critically to make sure you have taken safety measures to prevent injury.

Preventing falls at home takes planning, just as we do for all of the other possible episodes in our lives. A good Safety Plan to remove obstacles in your home and alert others that you need help are part of planning for safety.

Make sure you check your home for possible hazards such as scatter rugs, cluttered walkways in your home or outdoors and remove them before something bad happens. Add grab bars in and around your tub/shower or toilet, and ensure that railings around steps are secure.

Develop a daily calling circle and set a time to talk each day. A calling circle to check on an elder every day is a way to chat and keep in touch as well as make sure they are alright. Your calling circle could include friends, family, church members, or others and those calling should know that if they cannot reach the person being called for a day or two it may mean that something is wrong that needs to be checked on.

Other persons set up a special alert system with neighbors or family using cues such as opening the blinds by a certain time and watching for lights in the house each evening. If the blinds are closed or the light is not on, their loved ones or friends stop and visit. That way, someone is checking on the elder alone every day, and it gives another chance to spend time with a loved one while allowing you piece of mind.

Lifeline www.lifelinesystems.com is another excellent option for the Elder living at home alone. This allows the elder to contact assist persons in the case of a fall by pushing a button. Talk to your physician to see how to access this option.

Preventing the fall is the best way to remain safe and the Safety Plan is one way to make sure the Elder at home keeps in touch with those around them while remaining independent and happy at home.

If a fall occurs:
REMAIN CALM!
Stay where you are for a minute and take a few deep breaths to quiet yourself. Then check yourself to see if you are hurt.

If you ARE hurt:
1. If you have a phone right there, call for help. If you have Lifeline use it, and stay where you are until help arrives.
Crawl, roll, or drag yourself to the phone if not near you
2. If you cannot move, look for things to cover yourself with that are within your reach such as blankets from your bed, afghans, newspapers, pillows or cushions. Keep as warm as possible until someone comes.
3. If you hear someone coming such as the mail man, paperboy, or a relative, call out or bang on something to make as much noise as possible.

If you are NOT hurt:
1. Sit for a minute and MAKE SURE you are alright. Try to relax.
2. Roll, scoot, or crawl to a piece of furniture that will not move, such as a sofa, solid chair, or your bed.
3. Pull yourself onto that object if able.
4. Call someone to let them know your have fallen or use your lifeline if you haven't done so.
5. Sit and relax quietly.










Applying for Medicaid for Long Term Care
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You may not need to apply for Medicaid now, but it may be a pay source you need to consider at a later time. If you think you have been, or think you will be, in a hospital or nursing home for 30 continuous days and have questions, you can contact your county Medicaid agency for help to identify whether you are eligible for Medicaid. You may apply for Medicaid at any time.

What is Medicaid?
Medicaid is a federal/state program that pays health care providers to deliver essential healthcare and long term care services to frail elderly, people with disabilities and low-income families with dependent children, and certain other children and pregnant women.
The Medicaid programs in Wisconsin include Medical Assistance, BadgerCare, and SeniorCare. Medicaid, BadgerCare, and SeniorCare are essential to the safety and well being of the citizens of Wisconsin to protect our seniors, the poor and those most vulnerable.
In Michigan, Medicaid programs include Medical Assistance, MiChild, Healthy Kids, and WIC.

What information will I need to apply for Medicaid?
Whether applying in Wisconsin or Michigan the agency will need you to provide them with some very specific information so they can determine your eligibility for the program. This includes:
• Social Security Number
• Date of Birth
• Marital Status
• Household Members’ relationship to the applicant
• Residence
• Citizenship
• Employment
• Income
• Health Insurance coverage

Where Do I Go to Apply for Medicaid?
Wisconsin residents should contact their Medicaid agency based on which county they live in. Marinette County residents should call 715-732-7700 and will talk to someone in Marinette. Florence County residents should call 715-528-3296 and they will speak to someone in Florence. Visit http://longtermcare.state.wi.us for additional information.

Michigan Residents will also contact their local Family Independence Agency (FIA) by county to determine their eligibility and obtain the proper paperwork to complete. Dickinson County residents should call 906-774-1844 and Iron County residents contact their agency at 906-265-9958. To find out more, go to www.michigan.gov/dhs for Michigan Medical Assistance.

Once you make contact you will receive a Medicaid Application which you will need to fill out and return. You may have someone help you fill out this form. Bring or mail the signed form to your local Medicaid agency.
© 2006 mhm




Communicating with the Alzheimer's Victim
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The Alzheimer’s victim often responds in ways you do not expect, and may even become angry or frustrated without cause. The ways we talk with that person, even our tone of voice can lead to a response WE do not understand. We can at times forget that this person is an Adult, and through our concern may say and do things in ways which the Alzheimer’s victim see as upsetting.

When visiting with the Alzheimer’s victim make a conscious effort to remember that they are an adult, interested in adult conversations and adult activities. Be aware of every aspect of how you present yourself, including your voice tone, posture, facial expression, and movements. Speak calmly, in a warm inviting voice, and remain welcoming with your facial expressions and posture.

Eliminate distractions such as radio, TV, or other noisy conversation so they can focus on what you have to say. If their response seems unusual don’t assume the person doesn’t hear you and speak louder, but instead change the wording and keep it simple. Let that person guide your conversation, and bring in subjects slowly which are familiar to them. Take an interest they have and use that as your conversation starter. Don’t be surprised if you rehash things you have heard before, stories from the past, or family long since grown. Allow plenty of time for a response. The Alzheimer’s victim does not process information quickly and it may take a bit of time for them to respond. Be comfortable with that silence.

If they share mistaken information, don’t correct them. These persons have impaired reasoning and it is highly unlikely that you can talk or reason them out of that mistaken idea. Arguing is futile because they truly believe what they are saying, and trying to correct them leads to anger and agitation.

Living with a person who suffers from Alzheimer’s or related dementia can be a challenge, and we highly recommend that care givers find a support group to join. Northeast Wisconsin’s Niagara Alzheimer’s support group meets at Maryhill of Niagara the third Monday of each month. There are other support groups in our area which can provide care givers with much needed information and the support of others who can assist.

Other sources of information include the Internet www.alzheimers.org, and books by Naomi Feil, the recognized authority for Alzheimer’s care giving information. Ms. Feil has written several excellent books about “Validation Therapy” as well as books explaining the process of this disease. Your local Alzheimer’s Association is the place you can start.
©2006mhm




Choosing a Nursing Home
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Many times the decision for admission into a long term care facility is suddenly thrust upon us when our loved one is in the hospital following a fall or acute illness, begins to decline and cannot care for themselves, or their memory fails.

Finding the right place is a difficult and emotional decision for the elder adult and those who are helping them to choose, whether it be for short term recovery or long term care. It is a good idea to look into the facilities in your area to see what services are available before they are needed, so your decision making can reflect the goals you and your family have.

One of the most important considerations is the type of care needed. Different facilities offer different levels of care and are better suited to meet the needs of a particular elder population. You=ll want to tour the facilities in your area to see what services are available at each building. Many times it's not the closest Rehabilitation and Skilled Nursing Center which offers the services you want and need so even though convenience is an issue, the care and treatment options are of greater importance to your recovery.

Here are a few Questions to Ask and Tips to Follow when you are looking at a Long Term Care Facility for either short term recovery or long term care.

1. What level of care will I or my loved one need? Is this for short term recovery after illness or injury or for a longer term stay?
Skilled facilities offer more extensive clinical services, and many times higher level staffing skills, such as 24 hour per day RN coverage, Physical Therapy, Occupational Therapy, and Speech Therapy on-site. You will want to find out what the staffing of the building is as well as the availability of therapies and other ancillary services. Another question to ask is whether the building has an active Restorative Program to help the elders maintain their independence.

If coming as a patient from the hospital, it is important to know if the Skilled Facility is Medicare Certified. If you meet the Medicare qualifiers you will then be able to access Medicare benefits as payment for Skilled Nursing and/or Rehabilitative Care.

Knowing if the building has experience in working with certain types of persons is helpful. Check to see if staff is trained in dementia care and care of Alzheimer's clients. Find out if there is a special care unit for Alzheimer's and related dementia cares, if needed for safety. Watch programs and interactions to see how staff respond to persons with mental status declines.

2. When should I tour? What should I look for? How do I get more information from the facility?
To speak with someone about the facility and your or your family member's needs, you can call and make an appointment with the Admissions Coordinator. Often that will be the Social Worker. They will take information from you, show you around the facility, and can tell you about the types of services provided. They can also answer questions you may have about short term or long term stays.

The Admissions Coordinator can also provide you with contact information for county programming to answer questions about costs not covered by Medicare. If you meet certain asset levels, Medicaid may be available to help with the costs of long term care. Maryhill accepts Michigan and Wisconsin Medicaid reimbursement for persons who qualify.

You can visit whenever you are able. Evenings, weekends, mealtimes, special events, or other unscheduled times can give you the flavor of the facility and help you in your decision-making.

When you are in the building look to see how the staff interact with the residents. Are staff helping the elders? Do the elders look happy and relaxed? Are they well groomed and dressed nicely? Are there activities in progress? Is there a full calendar of different types of
events for those living there to join in? Are the Residents involved in the programs offered? Are families welcome and encouraged to be involved?

Check to see whether the building is clean and odor-free. Certain odors may periodically occur, but there should be no lingering odors, and it should appear clean and well-kept.

Visit during mealtimes and you will see how staff assists residents with dining as needed, and how the meals served smell. Do the building and dining areas appear well-lit? Are resident rooms of good size and personalized by the elders living there?

3. Is there any other place I can find out about a particular nursing home?
You can log onto the Internet to the Medicare.gov website and click on Nursing Home Compare to check other statistics about buildings in your area. Information found there is 6-12 months old however, and does not provide detailed explanation about the data listed, so talk with the facility you are interested in so they can answer your questions, give you a clearer idea of what the information means, and how the facility is addressing it.

Another way to find additional information is during your visit. When touring, look for the posted copy of the nursing home's most recent state survey (inspection) and ask about the results.

Choosing the right place to best help you to recover quickly and return home, or give you the piece of mind of knowing that your loved one is
well cared for is difficult. If we at Maryhill can assist you, please call Cindy, our Social Worker, and she will be happy to answer what questions you might have. Maryhill's phone number is (715)251-3172.





Home Medication Use
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As we get older, many times we end up with a problem or two that require us to see a physician. It could be because of an acute illness or a long term condition which needs follow up. The physician often will prescribe medications to treat the problem and we need to take those medications properly to improve our health or cure the condition.
Here are a few tips to follow when taking medications at home.

1. Keep a CURRENT list of all your medications in a place where they are easily found such as on your refrigerator.

2. Write your medications down in PENCIL so you can make changes if your medications change. Include any over the counter medications, vitamins, and herbal preparations you take regularly. Include the dose and times you take your pills.

3. Take your list of medications with you when you visit your physician so they will know what you are taking.

4. Always take the medications as ordered by your physician. For example, even if you feel better take the full treatment of antibiotics. Don't save them for later. The dose and amount is needed to treat whatever infection you have.

5.If medications are ordered Awith meals@ then take them with food. You can take them 2 hour before you eat up to 1 hour after your meal. If medications are ordered Aon an empty stomach@ then take them 2 hours after your meal.

6. If you find it difficult to swallow pills, tell your physician. Many medications are available in liquid form.

7. Store your medications in a cool, dry area out of the sunlight.

8. Tell your physician and pharmacist about ANY ALLERGIES you have and what reaction you had. (Such as hives, rashes, difficult breathing or swallowing).

9. Tell your physician and pharmacist about any over the counter medications you take. Even tylenol, vitamins, and dietary supplements have side effects.

10. Try using a pill box to set up your medications so you can easily take the proper medication at the proper time. There are many available on the market to meet your needs.

Ask questions about your medications. Your physician or pharmacist will be happy to help you understand what the medication is and why you need to take it. You need to be informed about your health and the treatment you receive.
©2006mhm



Medicare & Long Term Care
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Medicare benefits are available to provide payment for post hospital care at a skilled nursing facility if you meet some basic qualifiers. Many times there is confusion over how you qualify and the length of time Medicare will pay.

Here are guidelines for Medicare payment for your post hospital Skilled Care and Rehabilitation in a Skilled Facility.

- You need a 3 day hospital stay to access Medicare benefits in a post hospital Skilled Facility.
- Your Doctor must certify that you require Skilled Nursing or Skilled Rehabilitative Care upon admission.
- If qualified, Medicare will pay entirely up to the first 20 days of care. If you were in a Swing Bed at the hospital, some of these days are used there.
- After the initial 20 days, Medicare will continue to pay the majority of the stay, with the beneficiary responsible to make co- payments. Your Medicare coverage continues AS LONG AS YOU QUALIFY for Skilled Services, up to 100 days per spell of illness.
- The nurses and therapists will work with you and will complete assessments of your condition to determine your needs, and your Doctor will need to continue to certify your care as SKILLED for Medicare to pay for care.
- Many people do NOT qualify for the entire 100 days of Medicare payment. At the time you no longer qualify, the Nurse will provide you with the reasons (usually you've gotten much better) and will let you know that you will need to review other payment sources available to you.

If we can help to answer your questions about Medicare in the post-hospital Rehabilitation and Skilled Nursing Care Facility, For information on Medicare or Medicaid go to www.cms.hhs.gov or contact Cindy, cdonahue@maryhillmanor.org , our Admissions Director, Carrie, ckaldor@maryhillmanor.org ,our Business Office Manager, or Amy, our Medicare Coordinator here at Maryhill Manor. Our phone number is 715-251-3172.




Summer Food Tips
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With all the outbreaks recently with food borne illness it is now more important than ever to practice proper food preparation and storage. To avoid heat fluctuations and cross contamination keep cold food cold and hot foods hot. Hot foods should be above 140 degrees F when served, and cold foods need to be at or below 40 degrees F. Keep foods out of the temperature danger zone when prepared, stored, and while serving.

Temperatures from 41 to 139 degrees F allow harmful bacteria the ability to survive, grow, and make you sick. Temperatures from 70 to 120 degrees F allow bacteria to grow more rapidly, and this can lead to food borne illnesses. Do not save foods you have served at a picnic for later unless they have been kept at safe temperatures. When in doubt, throw it out.

Food preparation can also create hazards that could lead to food borne illness. Fresh fruits and vegetables must be washed thoroughly, especially vegetables and fruits that mature above ground. These items have the potential to be covered in pesticides, fertilizers, and raw sewage. For example, take the time to wash the outside of melons, apples, citrus, tomatoes, or peppers before you cut them so bacteria don't get into the fruit or meat of the vegetable. When working with meat and poultry, avoid cross contamination. Do not allow raw foods to have contact with ready to eat foods. Clean and sanitize work surfaces and utensils after each use, between foods being prepared, and keep your meat and poultry in a separate cooler when preparing for a picnic.

It is a common myth that mayonnaise in salads is the cause of many food borne illnesses. It is not the mayonnaise. When pastas and potatoes are cooked, there are changes within them which promote food borne illness growth. Whether part of a hot or cold dish, they need to be within the safe serving range. When storing foods use an airtight see through dated container so you can tell what is in it. Food items over a week old, even stored properly, should be disposed of. Take a little extra time when preparing, serving, and storing food items to stay healthy.




Maryhill Manor, Inc. 501 Madison Avenue Niagara, Wisconsin Tel. 715-251-3172 Fax 715-251-1200

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