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Does Mom Need Care? Here's How to Tell

Written by James Reynolds

Editor's Note: A version of this blog post recently ran in our monthly column in the Concord Journal.

Summertime vacations always bring an increase in calls from concerned adult children with some flavor of this question: “During vacation, we noticed Dad is slowing down. We think he might need help at home, but we aren’t sure. How can we tell?” The decision is not always clear -- keep reading for tips we have developed working with many families.

The easiest decisions follow events that show clear and present danger: traffic accidents or dangerous driving, falls, or home safety hazards caused by inability to mange the home (stove left on, unaddressed plumbing problems, roof leaks, etc.). If this is happening, then it is time to step in, even if “nothing bad happened yet.”

Rationalizing – “It could have happened to anybody; could have happened when I was 40.” – is often deployed by someone resisting care, but the point is that you don’t want to wait until something bad happens; the near-miss is a gift and an opportunity. It shows, with little to no cost, a need for change. Take the gift, and do what is needed. Even if there is resistance, be persistent.

(The caveat: all competent adults have a right to self-determination; this is not an excuse to force a parent to live the way you’d prefer. Yes, fender-benders happen to younger drivers, too. If you are unsure of where you are in the spectrum, keep reading.)

Even clearer signs include early or moderate dementia, incontinence or poor hygiene, and poor medication management. These are not debatable: if this is present, your loved one is unsafe living alone and needs help.

The more difficult decisions arise when warning signs are present but not determinative and you are the closest family member responsible for safety. The best approach, if at all possible, is to open an honest discussion with the person. You can keep it hypothetical if that helps – “Uncle Albert, while you’re still healthy, I wanted to talk about what to do in case something happens. What do you think we should do if your driving skills fall off, or if it gets too hard to manage the house?” Often times, people do not know how to ask for care and a discussion of hypotheticals may allow preferences to emerge that would otherwise have remained unstated.

As you consider whether the time has come to step in, focus first on physical skills: how well does the person drive? Can your loved on walk and get up a flight of stairs easily? Is it still a reasonably simple task to get proper daily nutrition, take meds, manage the home, and maintain personal hygiene? The next consideration is how the elder would handle an urgent or emergency situation: what would happen if Dad were alone and cut himself with a kitchen knife, or there were a gas leak, or he fell? Do not focus on what is optimal or what you prefer; he is entitled to handle these his own way, provided he can keep himself safe. If you are concerned about these matters, however, this is a sign that it might be time to start the discussion about extra help.

And on that topic, be sensitive to your attitude and how you raise the issue. Remember that most adults would love to have a personal assistant, but nobody wants a baby-sitter. If your unstated attitude is, “You are clearly too old to be living alone, and you cannot manage your own affairs,” you are much less likely to have a productive conversation than if you convey, “We love you and want your golden years to be as easy as possible. Let’s get you an assistant so someone else can handle the chores.” And if the assistant can be a family member or friend, that’s often more palatable, especially at first.

If you are still uncertain whether it is time for more help, or if your initial discussions meet resistance, it may be best to get a neutral third party to help advise your loved one. If the relationship with the primary care physician is good, ask for an appointment that you can both attend to discuss your concerns. A professional geriatric care manager (check with the National Association of Professional Geriatric Care Managers) who specializes in creating care strategies can also be a great aid. I find that those whose backgrounds are in social work or counseling are best in these situations. Many GCMs are nurses, but you want someone whose training makes her a good mediator and facilitator of family discussions in addition to conducting the actual assessment of the elder.

Finally, do all you can to involve other family members in the discussion. The more collaborative the decision-making is, the greater the chance for success and for cooperation from everyone.

Reassuring Elders in Emergencies

Written by James Reynolds

dr-levineEditor's Note: A similar version of this blog post originally appeared in the Concord Journal here: Reassuring elders who live alone during an emergency - Concord, MA

This past week the Boston Marathon bombings put parts of the city and suburbs on lockdown, providing an unwelcome example of a type of emergency families rarely plan for: terrorism and police actions. Most people who care for elders think often about the elder’s own health crises, and all of us have to plan for blizzards, power outages, and related events. But reassuing a frightened elder during an act of terrorism? Not so much.

At least a blizzard or storm comes with some warning; this tested families and caregivers with its sudden and unpredictable course. As we addressed the logistics of the emergency, and got caregivers to everyone, we found ourselves responding also to clients, families, and care staff searching for words to comfort and reassure vulnerable people who may not have fully understood what was happening, but knew enough to realize that an ominous and uncontrollable threat was at hand.

Reassuring people in an uncertain world can be a difficult task. Part of the job is very practical: reduce the risk as much as possible, and be ready to respond if something goes wrong. But once that is done, we have the often-delicate task of reassuring a frail elder whose cognitive skills or memory may be compromised. Although our information is never perfect, emergencies like blizzards are common enough, and their paths well known enough, that we can provide some solid guidance. But the truly unpredictable nature of a terrorist bombing and a manhunt close to home can present challenges we rarely have to face.

At these times, personal trust is your best asset. Reassurance comes in many forms, and telling your loved ones that the door is locked may not comfort them nearly as much as sitting with them to help them feel secure (but lock the door anyway). Here are a few helpful guidelines designed to avoid the onset of stress, or to reduce the stress once it appears:

  • Comfort their fears. Last week, you might have reminded an elder that these are very rare events, and that many, many really good people were there to help, even risking their lives to help the wounded. Ask them about times they remember people who were extraordinarily kind or generous or heroic in times of crisis. Observe that people like that are still with us today.
  • Listen, and allow them to talk about their feelings and memories of the other events this may bring up. This may include stresses from long ago – WWII for example, or a time their home was robbed as a child. Allow those feelings to be voiced and those memories to be recalled, but …
  • ...despite the advice above, try to redirect attention so that no one dwells on the current threat. If at all possible, do not allow someone to sit and listen to the news about this all day, especially when there is really nothing new being said. lnstead, find an activity at home away from the TV or radio, or take them out of the house. Some people can be easily distracted with a favorite activity, and now is a good time to use it.


As we say with all parts of the journey in elder care, these times, if accepted for what they are, can still yield treasured moments. There is little more that we can do for those we love of any age than to be there when needed. And in that sense, if you can provide the support that settles their mind, you might create one of those treasured memories. It may be that providing comfort in a fearful time is an event you will remember years after your loved one is gone.

Emerson Hospital (Concord MA) Fall Prevention Workshop Mon Apr 8 9:30AM

Written by James Reynolds

Probably the single greatest reason we are called to serve families is to provide care following a fall by an elder. Particularly when people have lived in a home for decades, we see that homes and people have not adapted to the extra care needed to prevent falls. These are preventable events, and families with elders will be well-advised to attend Emerson Hospital's free workshop.


Falling - Don't let it happen to you or someone you love

Emerson Hospital Falls Prevention Conference
Monday April 8, 2013
9:30AM - 1:30PM

Holiday Inn Boxborough
242 Adams Place
Boxborough, MA

Learn to prevent dangerous slips, trips, and falls

Falls are the leading cause of serious injury for people over 65. Falls are NOT a normal part of aging; simple steps and information can hep prevent these dangerous accidents.

Emerson Hospital will provide a complimentary lunch, health screenings, and workshops designed to help seniors and their family lead safer, healthier lives.

Screenings and workshops include:

  • Balance assessments
  • Vision screenings
  • Foot screenings
  • Tips to stay safe at home
  • Exercises for better balance
  • Eating for better balance
  • Blood pressure
  • Minding your medications
  • Diabetes screening
  • Neurological changes

Seating is limited and registration is required. Call 1-877-9Emerson (877-936-3776).

Blizzard Watch -- Keeping Elders Safe Through Homecare

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I took a short break this afternoon, and when I tuned back into the world of news, I found that the expected winter storm Friday into Saturday was now being called a BLIZZARD WATCH!  Eighteen to twenty-four inches are being forecast with high winds. My goodness... 

We rolled into action to consider the safety of every shift change Friday and Saturday... will the roads the safe? Will it be snowing too heavily? How can we serve clients Saturday night and Sunday morning safely? We will work with families and caregivers to create a plan for any shift changes that may be made unsafe or impossible by this storm. We will be in touch wiht impacted families and caregivers.

In the meantime, this is the right moment to share two blog posts I wrote from a past winter storm/blizzard. They contain info about prepping clients' and the caregivers' homes, and other important information. Please review this and then get into action to get ready.

Who Will Shelter Your Elder Loved One in an Emergency?

First Possible Winter Storm Coming, Eastern Massachusetts 

Easten Massachusetts Winter Storm Forecast Upgraded To a Blizzard

Improve Elder Safety and Budgets with Fall-Detection Technology

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Fall detection devices can help maintain both safety and privacy


"A home care agency just showed me how to reduce the cost of home care!  Now, how amazing is that?!"

Families are so grateful (if not surprised!) when we help them develop a cost-efficient plan to keep aging parents safe and comfortable in their homes -- even when it means fewer hours of in-home care by Caring Companion.  Finding effective  and safe ways to stretch the care budget is one of the keys to successfully managing elder care for your family.  People tend to move from crisis to crisis, addressing each problem independently in a fire drill mode. Sometimes it helps to step back and think in an organized way about what's needed. And that's where we always start with each household.

For example, here are the top threats to health and safety of elders living alone:

  1. Falls
  2. Burns
  3. Poisoning (including by medication mistakes)
  4. Wandering
  5. Self-neglect (e.g., poor diet or hygiene, etc.)

In addition to whatever immediate need is required -- say, getting Dad home from rehab after a fall, or getting Mom help and meds after surgery -- preventive action to mitigate these issues should be planned in advance.

For example, let's just take the first item on the list: Falls.  More than half of all falls take place in the home, an ongoing concern for anybody with impaired balance or mobility. This is a particularly significant health risk for the elderly and disabled, as a fall can lead to serious injury, or even death.

At Caring Companion Connections, we don't simply provide outstanding in-home caregivers -- although that is our specialty. We can also equip an elder's or Alzheimer's patient's home with fall-detection technology that will alert 911, us and/or family members when a fall has taken place.  And best of all, the wearer doesn't have to press any buttons -- or even be conscious or oriented for it to operate.  Typically, we choose a pendant-style device that can detect falls using built-in sensors.  Some are even waterproof, and can be used in wet, slippery environments like the shower, bath, garden or pool.

One current client fell prior to being in our care, and although she was wearing a personal emergency response system (PERS), the system had to be activated by her. But in this case, she was bleeding, unconscious, and unable to operate the PERS unit.  The family's response was to ask us to provide 24 x 7 in-home caregivers -- which we can of course do. But instead, we recommended a far more cost-effective solution that is just as safe: in-home caregivers for part of every day to address tasks that require human intervention and to provide life-enhancing activities, combined with  an automatic fall detection monitor that does not require the wearer to actively set it off. If she falls, it will alert 911, the family and/or us immediately. We can have someone on-site within minutes, 24 hours per day.  She lives in a small apartment with her husband, and they prefer to have part of each day without a third person in their space. The solution we recommended is safe and effective; it respects the privacy preferences of the client -- and it's far cheaper.

This type of technology can yield BIG savings on home-care costs. Until now,  when the concern was someone falling at home and no one finding them for a length of time, many families decided that the best option to was to pay a caregiver to be in the home for long hours "just in case."  Using fall-detection technology, elders can enjoy both increased safety AND privacy -- and save their home care dollars for the type of care only humans can provide.

These devices are quite reasonably priced and widely available, but they are not a "one-size-fits-all" solution.  They have a wide range of features, and selecting the right option for the needs of the client and family is important; not all devices meet all needs.  Some require user operation, others do not.  Some have automatic fall detection, and still others offer additional services like medication reminders.  Remote configuration options are convenient but not uniform across all products. We can advise which  features that are best for your particular situation.

We began installing these devices because client families requested it, and we have even begun doing it for families in households even where we are not providing home care services.  We think it is one way that home care has evolved in the early part of the 21st Century.  This is a significant step forward since the days of "I've fallen and I can't get up!"

Hurricane Earl Emergency Planning for Elder Care Clients in Eastern Massachusetts

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Hurricane Earl's will keep us guessing for another 24/48 hours about when and where landfall will occur. But Friday is a possibility, and it's also possible that we are right in its track. Or not!

I spent 10 years with the Concord, MA Emergency Management Agency as a leader in preparedness planning and training for citizens as service to my community. Luckily, I'm able to bring that experience to Caring Companion.  Believe me – it’s far better we think these things through now than to be surprised at the last minute!  And we’ll just hope we don’t have to use our plans.

I want to talk about everyone’s own personal and household protection, as well as how CCC serves our clients.   It's been a very long time since we've had a hurricane pass directly over us, and we don't have the practiced “chops” for preparing for one or weathering it safely.  And with the strangely warm ocean waters, there's a lot of unknowns here.

Loss of electricity and communications, food and water supply contamination, and an inability to move from Point A to Point B due to downed trees and other debris are the usual problems encountered during and following a hurricane. Please talk with your loved ones about the upcoming possibilities.  Let them know that there are people working to keep them safe and sound. Think through the kinds of things you need to make sure are on hand to keep the household running through at least through the weekend. Food, water, a battery-powered radio, new batteries in the flashlight, enough medication to last until next week (eliminate pharmacy runs if possible), enough pet food, etc. In my experience, advanced discussions and planning help people feel more calm and secure, not more upset. (And the stories about other hurricanes our elders have been through that will no doubt be evoked can teach us a lot.  This can be a GREAT way to engage someone in conversation if you have trouble connecting with Mom or Dad – try it!)

As for Friday and Saturday caregiving schedules: if it looks on Thursday like this thing is really going to hit here on Friday, we may need to deploy caregivers early to the households where they are needed the very most, where clients really are not able to spend a day or two without care.  Since traveling to/from shifts is not advised during the hurricane, we would try – depending upon everything’s timing – to get caregivers in place before it becomes too dangerous on the roads, staying on site until it's again safe to travel.  We would ask caregivers who wait to be relieved by next shift personnel to be prepared to stay longer, even overnight if it's unsafe to leave.  I will be in direct contact with families and individuals who cannot manage without care – and their caregivers – to do some specific planning. Which I hope we will not need to use!

In cases where clients can go up to a couple of days without care, if it really looks like this thing is coming right to our doorstep, I will want to reschedule our visit if it is expected right during prime hurricane time.

Please see the info below from MEMA on 8/31 about having a go-bag and preparing your household, etc. I will be in touch again as the weather picture clarifies. Let’s cross our fingers that this is just a drill and – as they say so often about predicted New England weather that didn't happen – it just goes out to sea!

FOR IMMEDIATE RELEASE                                                                    CONTACT: Peter Judge, MEMA PIO

August 31, 2010                                                                                                                                  (508) 820-2002


Threat of Hurricane Earl Reminds Families of Importance of Preparedness

FRAMINGHAM, MA – The potential threat of Hurricane Earl reinforces the importance that everyone take the proper preparedness steps.  Now is a good time to take to heart the three steps being reinforced by the President, as he proclaimed September as ‘National Preparedness Month’: Prepare a Kit, Have a Plan and Be Aware.

“Every home and business should have a stocked basic emergency supply kit that could be used for any emergency, regardless of the time of year,” states MEMA Acting Director Kurt Schwartz. “Everyone should keep certain items around the house and workplace in the event you are isolated for three to five days without power” Each kit will be unique to each family, but should include a portable radio, flashlight, extra batteries, a supply of non-perishable foods, along with bottled water, a first aid kit, extra prescription medication, and extra food and supplies for infants and pets.

“All families should develop a ‘Family Emergency Communication Plan’ with an ‘outside the area’ contact to help ensure everyone is safe. You should reach out to your local authorities to learn about your community’s potential evacuation routes and the location of possible emergency shelters,” said Schwartz. “It is always important to familiarize yourself with your Community’s Emergency Plans before an emergency situation occurs.”

Also, develop a Disaster Supply Kit ‘Go Bag’, with essentials in case you must evacuate quickly.

The Massachusetts Emergency Management Agency (MEMA) is the state agency responsible for coordinating federal, state, local, voluntary and private resources during emergencies and disasters in the Commonwealth of Massachusetts.  MEMA provides leadership to: develop plans for effective response to all hazards, disasters or threats; train emergency personnel to protect the public; provide information to the citizenry; and assist individuals, families, businesses and communities to mitigate against, prepare for, and respond to and recover from emergencies, both natural and man made. For additional information about MEMA and National Preparedness Month, go to <http://www.mass.gov/mema>www.mass.gov/mema and <http://www.ready.gov/>www.Ready.Gov. Continue follow MEMA updates on Facebook and Twitter.
Peter W. Judge
Massachusetts Emergency Management Agency
400 Worcester Road
Framingham, MA 01702-5399

Direct: 508.820-2002
24 hr.: 508.820.2000
Fax: 508.820.2030
<mailto:This email address is being protected from spambots. You need JavaScript enabled to view it.>This email address is being protected from spambots. You need JavaScript enabled to view it.

Massachusetts Home Care - Using Social Media and Web 2.0

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The post below is adapted from an except of our white paper, Re-Imagining Home Care: New Needs, New Approaches. This is the 4th in a series of of 11 posts.

Consider the changes in consumer technology since 1980, and stop to think about how they have changed the way home care agencies can now interact with client families.  In contrast to service providers in other industries, home care agencies offer little more than email, if they offer even that.  There are many reasons for this – e.g., concerns about HIPAA regulations and the slow pace of physicians’ electronic medical record adoption.  But failure to take advantage of the wide adoption of Web 2.0 technologies and social media leaves remote family – a fast-growing component of the senior care environment – in the dark about the status, important changes, and key needs of their loved ones.

Any authorized user, anywhere, can instantly know:

  • Login/logout times to confirm that caregivers are on site
  • Meals & diet info
  • Medications taken
  • Hourly log of activities
  • Photos taken during the visit
  • Quantitative, observable changes
  • Qualitative daily report

This is unnecessary and borders on unforgivable. The technology is inexpensive and widely available.  There is no need for remote family to lack any relevant information on a nearly instantaneous basis.  Furthermore, access to this information can easily, at the request of the client, be provided to physicians, case managers, Geriatric Care Managers, or other members of the care team to support follow up care decisions.

Caring Companion Connections has developed a proprietary system delivering all the functionality discussed here and more. All our caregivers use it, every day. Completing online reports is a job requirement, not an optional service - and it is included at no charge with all client visits.  Upon seeing this system, one of our clients said, "You know, when I leave my dog at the kennel, I know more about what happens to him than I do when I have an aide come to my 84-year-old mother's condo. I know what my dog ate, when he went outside, who he played with, when he pooped. I see pictures. But I just have to hope the aides show up and until I go to her condo again, I don't really know what happened."

In the 21st Century, client families should insist upon web access to daily reports of client visits. Just as they would not choose a bank, an airline, or a retail store that could not provide basic account activity information online, there is no reason to accept this failing from a home care agency.  Caregiving staff should carry smart phones or other mobile devices that enable mobile updates. Family members and authorized users should be able to review reports, ask questions, and communicate among themselves regarding the service plan, independent of location.  The improved information flow allows family decisions to be made more quickly and ensures that data is available to all interested parties.  It reduces anxiety, improves peace of mind, and promotes better care.

Download our paper – Reimaginging Home Care: New Needs, New Approaches

Find out how home care agencies can improve service and outcomes for today's clients.

The passage above is an excerpt from the introduction of a white paper describing our innovative strategy for 21st Century home care. We will publish the remainder of the paper in a series of posts over the coming weeks. This is the 4nd of 11 planned posts.

Readers wishing to read the complete white paper, click here.

Over-Prescribing for Elderly Labeled a "Disease"

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We love working with physicians, registered nurses, geriatric care managers and pharmacists as part of a client's care team.  But it happens far less often than we think is most helpful for the client. Everyone is so busy, few see it as their mandate as healthcare professionals -- though we certainly do.  Inter-disciplinary communication and teamwork isn't just a "good thing" -- it is absolutely vital.

Here is a powerful example of why real teamwork is necessary, and why we at CCC go the extra mile to be in touch, and to put people in contact with other healthcare professionals who can eliminate problems that stem from a lack of teamwork elsewhere. And that is the epidemic of over-prescribing of medications for the elderly. Too many specialists not talking with one another, each prescribing medications that are then not adequately reviewed by the patient's primary care physician result in lots more drugs than are needed.

Now, we at CCC are not in a position to make such judgments about whether any particular person has a problem with over-prescribed medication.  We instead point to both research data and anecdotal information we hear from those who are in a position to investigate such matters. For example: a study recently published in the Archives of Internal Medicine (see the study abstract here) showed that it was possible to safely and significantly reduce the use of medications in elderly patients living in the community (as opposed to in care facilities). In fact, almost all patients in the study had nearly 60% of their medications safely discontinued, with very, very few needing to have these drugs re-prescribed. As a result, 88% of patients reported improved health! "Polypharmacy itself should be conceptually perceived as 'a disease,' with potentially more serious complications than those of the diseases these different drugs have been prescribed for," the authors write.

If you or your loved one are on multiple medications prescribed by multiple physicians, it is worth getting a professional review of their medication list.  You can also sit with the primary care physician and go over every drug with them. Good preparation for such a meeting would also be reviewing the drug list with your pharmacist.

(Thanks to our eagle-eyed caregiver, Mary Ann, who forwarded me the link to this polypharmacy study!)

Creating Lifelong Residences for Aging in Place

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Striking front entries with winding front stairs... luxurious bath suits with rooms for toilet, shower and dressing... inviting sunken living rooms. These residential features add to the interest and drama.  But given the aging of our population, the homes of the future with higher and more sustained value may be ones suited for aging or disabled occupants.

However, a lot of housing stock now is simply unsuitable for people with mobility or memory  issues. If a family member becomes disabled due to age, illness or injury, a move to a safer environment or an often-costly home modification may become inescapable. And you'd see increased costs of home care for seniors and the disabled.

But "assisted living" can start at home: regardless of the age of the occupants, we can start right now making homes more adaptable for aging in place.  This takes a shift in thinking, but it's one that will pay back the homeowner handsomely. Every time you make a lasting change to the interior or exterior of your home, answer these three questions:

1. "How can I do this to increase an aging or disabled person's independence?"
2. "Can this be done so an aging or disabled person could be helped by another person?"
3. "How can this be done now, so that later is can be more simply and inexpensively adapted time for an aging or disabled person?”

Asking these questions repeatedly throughout each new building project, addition, renovation, remodeling, or landscape project can create simple changes you will benefit from in the future.  It can also cause you to re-imagine your entire project to prevent the headache of an unplanned move, or a costly, preventable home modification.  Here are five examples of this type of lifelong residence thinking (also called “Universal Access”).

• Take into account the need for living only on the first floor.  A full bath with a walk-in (or wheel-in) shower, or that could be easily adapted to include one, is a necessity.  Laundry on the same floor is also crucial.  Could a room you are adding for another purpose later be adopted for a bath and/or laundry room? How can you make it easier for future plumbing needs?

• Make doorways wide enough for a wheelchair or walker, or for a person being aided by someone walking beside them.  Thinking about the swing direction of doors will  unblock areas that might be vital real estate for a walker, wheelchair or home health aide.

• When remodeling a bathroom, are the toilet, sink and shower/tub areas accessible for wheelchair or walker access? How about for a person who needs to transfer from wheelchair to toilet or shower/tub?  Is there room for a person to stand beside to help with the transfer to any of these facilities?

• Outdoors, regrading projects can either greatly enhance or detract from a future need for ramp or lift access.  Keep in mind that the minimum recommended ramp length for a one-foot rise or drop in elevation is 12 feet (16 feet is better).  That means that entering a front door with a 3-foot elevation requires a 36-48-foot ramp (add a 6x6-foot area for every switch-back used).  Thoughtful grading could help eliminate some of the elevation at the doorway level.

• A change in elevation within a residence accomplished by even a half-step can become a prison wall for a person with mobility issues.  Floor plans that feature multiple levels on a single floor add visual interest, but they can become dangerous or impossible to navigate.  Be aware you may not be able to age in place should you adopt this type of housing style.

First Possible Winter Storm Coming, Eastern Massachusetts

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A note emailed earlier today to our clients, their families and our caregivers.

I am writing because  we may/may not have our first winter storm in eastern Massachusetts, Sunday night into Monday. Who can say? This is after all, New England!

But this is a perfect time to review plans for clearing driveways, steps and walkways of snow and ice at your loved one's/our client's homes.  Everyone wants to prevent falls due to snow and ice, and to keep people from being trapped inside the house -- or outside unable to get in!

Do you have a plow service set up? How about someone to shovel the sidewalks? Is there sand and de-icer stationed both inside and outside the doors? A small shovel and/or broom near the door?

To review what our caregivers are able to do to help: if we are on site during the storm, we keep the egress to/from the house open as much as possible so that in an emergency, safe exit can be made.  Or emergency personnel can get into the house if needed.  If CCC is there during a large storm, we ask caregivers to sweep, sand and salt doorways, walkways and stairs regularly so no heavy shoveling is needed -- unless it is too dangerous to be outside.  We are unable to do heavy snow clearing on walking areas, or to clear the driveway.

Families need to make arrangements with a service to keep the driveway plowed and the walks and stairs clear.  It's important that your service know when our caregivers would need to come and go, so that we can serve you without interruption or delay.  These service are used to such requests -- and if not, they're maybe not the right one for you!  They are also open to being phoned by caregivers in anticipation of arrival/departure, and are generally able to make a pass beforehand so things go smooth and safe.  Please let our caregiver(s) know the contact info for your service.

In the event of an expected severe storm that might make roads impassable, we would work to position caregivers where they are needed most before the roads become dangerous, and keep them there until they can safely leave.  This might mean getting them to the client's home before usual, or having them stay later.  We would consult with families about this whenever we anticipate this could happen.

All that aside: have a warm, safe, wonderful, healthy and peaceful holiday, with many blessings to you and your family!

Eastern Massachusetts: Winter Storm Forecast Upgraded to a Blizzard!

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(Email sent this evening to Clients, Families and Caregivers)

I hope you are having a lovely Christmas holiday today!

After yesterday's early storm"heads up", I'm back to encourage you in your plans to prepare households and our clients for what is now being talked about as a blizzard: up to 20" of snow and 50-60mph winds, beginning Sunday afternoon and into sometime Monday. This is being predicted to be "heart attack snow" -- meaning it's so heavy that people have heart attacks exerting themselves while clearing it. This kind of heavy snow might be hard to keep cleared from roads and driveways, and street plows when they pass by will deposit "cement-like" snow and ice at the ends of driveways.  High winds with heavy snow can also bring down power lines; power outages should be prepared for.

These are the kind of conditions where we should all be hunkering down before it gets bad and waiting for the roads to be opened afterward. I'm starting to position caregivers in households for Sunday overnight where the occupants will be the most in need if we can't get there Monday, or if there should be a power outage at any point.

I have a few preparedness recommendations to make, and they're based on my 10+ years as a volunteer doing emergency planning and response with the my town's public safety departments (caregivers: please consider these instructions from me if you are working during the storm).

1) Locate and find available flashlights and battery-operated radios.  Change batteries now if needed and have spare ones easily available. This is a great time to set the radio to local news. Caregivers: you might bring any extra flashlights, radios and batteries you have at home. These may not be easy to find in clients' homes, or at stores as they can be quickly sold out. Put batteries on the client's shopping list for next week to replace any used from your own supply.

2) Please do NOT provide light with open flames like candles should power be lost. Candles can be sweet and romantic, but it's too easy to start a fire with them.

3) Do NOT use bbq's and other propane or gas devices for heating inside should we lose power, unless the device is designed specifically to provide space heating.  They can be deadly sources of carbon monoxide.

4) Does the house have natural gas or propane heat? It's VERY IMPORTANT to check where the flue/vent is -- they are supposed to be no lower than 4-feet above the ground, but I've seen lower -- also, snowy shrubs in front of vents can interfere with them.  In heavily drifting snow, these flues can become blocked, sending dangerous carbon monoxide gas into the house. Caregivers, please find out the source of heat for the house you'll be in and if it's natural gas, find where that flue is located. This must be kept unblocked during any storm with high snow drifts. (Older natural gas heating systems will -- they are generally vented through the chimney. The type of vents/flues to worry about during snow are high-efficiency, newer models)

5)  Caregivers: be VERY careful clearing egress to/from homes. I know you want to help as much as possible (and we love you for that!), but if you become injured, chilled or exhausted from too much shoveling of heavy snow, you can't fully care for your client. Go easy... go slow!

6) Best to prevent hypothermia if heat is lost. If the stove is electric, find some thermoses you can fill with boiling water, and keep them filled for use if the power goes out.  Serve hot drinks regularly, which warm the hands when held and the body when consumed.   Don't wait until the client feels chilled to have them put on extra layers of clothing, including hats and gloves. Encourage the client to do some moving around regularly to keep their blood flowing and their hands and feet warm.

7) Caregivers: charge your cell phones NOW, and keep them charged in case landline communication is lost.  Data services like texting and email take a lot less power than voice phone; use this info to conserve power.  If it gets too cold, you may need to call that city/town's police department for info on warming shelters or other ways they are helping at-risk citizens -- why not program in their business number?   (warming shelter info might also be found on local news radio) Also client family phone numbers and email addresses. Keep an eye on your smartphone's email more than usual as it may be easier for us to communicate that way.

8) Start talking about the weather forecast with clients immediately. Be calm, but don't brush it off as a nothing: psychological preparedness is important and sets the groundwork for resilience and lower anxiety.  Ask them to recount experiences they've had in bad weather, and how they handled it.  Tell them about some of your stories! Talk together about some of the suggestions I've put down here, plus any that might be special to their particular situation. If they are anxious,  let them know that there are plans being put into place, and that everyone will be working to keep them safe and comfortable.  Caregivers: please speak with their family members, care managers and other members of their care team to make sure you get info about plowing services, any medication refills that MUST be picked up before the storm, and any other info needed. For example: are there neighbors with alternative heating sources (like wood stoves)? Might they have overnight space for an elder who is at high risk for hypothermia?

When all is said and done: I would prefer to find out that this storm system has "gone out to sea" and that we only get a dusting with light winds!  IF YOU HAVE ANY CONCERNS AT ALL: CONTACT ME! Everyone, please take extra good care!

Better Care - Lower Cost - Improved Health for Massachusetts Elders!

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At Caring Companion, we already do far more than the industry standard to reduce the costs of health care and improve the quality of life for elders and the disabled. We provide real-time information and reports to health care professionals and families via our unique online system -- we are the only agency in the country doing this.  We already place appropriate technology in homes to help reduce the number of care hours needed.   Our guiding model combines our outstanding on-site caregivers with with the appropriate technology to improve care and reduce its cost.

Throughout 2011, we will demonstrate this in a series of public pilots.  In partnership with some Massachusetts Aging Services Access Points (ASAPs) and Councils on Aging (COAs), we will pilot promising technologies that we have identified to help at-risk elders and the disabled.  Testing such technologies in elders' homes has not been done before in our region; in fact, it's seldom been done around the country. In these carefully crafted pilot studies, we will demonstrate that we can:

Want to Participate? If you, a family member, or your agency would like to participate in any of our free pilots, please fill in the information requested on this page or phone us at 800 869-6418.
  • significantly reduce care costs
  • reduce hospitalizations
  • reduce falls
  • identify problem areas before they fully develop
  • proactively intervene to prevent crises
  • reduce stress, increase efficiency for care partners
  • allow elders to live longer in their homes
  • delay or prevent entry into higher levels of care
  • increase elder safety
  • maintain elder privacy

A pretty heady list of goals, isn't it?  But in our experience, with the right combination of human care and remote technology, they can be accomplished! We are partnering with a variety of manufacturers and local area agencies on aging to demonstrate in the field just how different technologies and services combined with the right type of care and caregivers can help meet these goals. The first pilot involves technology that's been tested in assisted living and showed that care costs were reduced by 75% as compared to a control group.

This is not a "bake-off" where we expect one product or one service to be best in all cases.  Instead, we normally find that each product has its strengths and weaknesses, and we want to provide concrete data that will help us -- and our pilot partners -- to develop clear guidelines for creating optimal blends of technology options and human care.

Our first two pilots will begin this winter, and we will continue through spring and summer with follow-on studies.  The technologies we have selected to pilot are all commercially available now and offer the following benefits:

  • remote activity monitoring
  • capability to spot problems in changes to day-to-day behaviors
  • alerts for advance intervention to prevent crises
  • real-time alerts for certain high-concern events, such as possible falls, wandering, and gross changes from normal behaviors

All of our pilots are free to participants!  And more pilots are coming through the rest of the year.  If Aging Services Access Points, Councils on Aging, Senior Care Option, other elder agencies, or members of the public would like to participate in this free pilot, please fill out the information requested on this page or phone us at 800 869-6418.

Extreme Cold Warning - Massachusetts Elders at Risk

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(This message was just sent out via email to our caregivers, clients, and client families)

Winter is just not going to quit, is it?!  This time, it's not more snow (we've had "only" 3 storms this past week!), but extreme cold temperatures.  This is of particular concern with elders and people who are disabled due to their lower activity levels. If there is dementia, they might not be able to know how to keep safe.  The below alert from the Massachusetts Emergency Management Agency (MEMA) contains important safety info about extreme cold weather.

Also, extreme cold is of concern for households where we work.  Caregivers, family members and homeowners: the below message also contains important info about getting the home through this cold safely. Pharmacy and food supplies should be checked so everyone can stay inside and keep warm! Please encourage warmer clothes even indoors if the house is drafty -- preventing hypothermia is the best course of action.

Website: www.mass.gov/mema

January 21, 2011


FRAMINGHAM, MA – “According the National Weather Service forecast, we can anticipate extremely low temperatures throughout the region for the next few days.  Therefore, we all should consider taking precautions to minimize the dangers presented by such severe weather,” stated Massachusetts Emergency Management Agency (MEMA) Acting Director Kurt Schwartz. “To that end, MEMA presents these cold weather safety tips.”

  • Continue to be aware of extreme weather conditions by monitoring Media reports.
  • Make sure you always have a well-stocked Winter Home Emergency Supply Kit that includes flashlights, portable radio, extra batteries, a first aid kit, bottled water, non-perishable food and a manual can opener.
  • Minimize outside activities, particularly the elderly and very young.  Also, consider your pets.
  • If outside, dress in several layers of loose fitting, lightweight clothing, rather than a single layer of heavy clothing.  Outer garments should be tightly woven and water repellent.  Wear a hat, mittens and sturdy waterproof boots, protecting your extremities.  Cover your mouth with a scarf to protect your lungs.
  • Ensure you have sufficient heating fuel, as well as emergency heating equipment in case you lose electricity.
    When utilizing alternate heating sources, such as your fireplace, wood stove or space heater, take the necessary safety precautions.  Keep a fire extinguisher handy; ensuring everyone knows how to use it properly. Test smoke alarms and Carbon Monoxide (CO) detectors.
  • If you lose your heat, seal off unused rooms by stuffing towels in the cracks under the doors. At night, cover windows with extra blankets or sheets.
  • Food provides the body with energy for producing its own heat.
  • Be a good neighbor. Check with elderly or relatives and friends who may need additional assistance to ensure their safety.
  • To keep pipes from freezing, wrap them in insulation or layers of newspapers, covering the newspapers with plastic to keep out moisture. Allow a trickle of warm water to run from a faucet that is farthest from your water meter or one that has frozen in the past.  This will keep the water moving so that it cannot freeze.  Learn how to shut off your water if a pipe bursts.
  • If pipes freeze, remove insulation, completely open all faucets and pour hot water over the pipes or wrap them with towels soaked in hot water, starting where they are most exposed to the cold.  A hand-held hair dryer, used with caution, also works well.
  • Make sure your car is properly winterized.  Keep the gas tank at least half-full.  Carry a Winter Emergency Car Kit in the trunk including blankets, extra clothing, flashlight with spare batteries, a can and waterproof matches (to melt snow for drinking water), non-perishable foods, windshields scraper, shovel, sand, towrope and jumper cables.

The Massachusetts Emergency Management Agency (MEMA) is the state agency responsible for coordinating federal, state, local, voluntary and private resources during emergencies and disasters in the Commonwealth of Massachusetts.  MEMA provides leadership to: develop plans for effective response to all hazards, disasters or threats; train emergency personnel to protect the public; provide information to the citizenry; and assist individuals, families, businesses and communities to mitigate against, prepare for, and respond to and recover from emergencies, both natural and man made. For additional information about MEMA and Winter Weather Preparedness, go to the MEMA website at www.mass.gov/mema. Follow MEMA updates on Facebook and Twitter.

Home Modifcation Load Program in Carlisle, MA Jan 31

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Being able to stay in the home we've lived in as we've aged is a real blessing, and almost always preferred by elders.  But some homes are just not set up for aging in place -- too many stairs, bathrooms and bedrooms in the wrong part of the house to fit the elder's needs and mobility.  Home modification is an option, and the Commonwealth of Massachusetts makes low- and no-interest loans to modify the homes of elders and individuals with disabilities where there is income qualification.

Monday, January 31 at 7PM at the Gleason Library in Carlisle, MA, there is a meeting about this program. I just noticed it in the Boston Globe, following a Facebook pointer from our State Representative, Cory Atkins (isn't life in 2011 strange??!) -- you can fit in this meeting before the next snow storm starts. Download a program brochure here.

New Issue of Our "21st Century Homecare" Newsletter

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Topics in this just-published snailmail newsletter:

  • Better Care - Lower Cost - Improved Health! Elder Care Remote Activity Monitoring Technology Pilot
  • Want to Participate in One of Our Pilots - Free!
  • Caring Companion Awarded Home Care Agency Accreditation
  • Optimism Connected to a Stronger Immune System

Download this newsletter here: CCCnewsletterv2.1 (if you would like to receive our next newsletter  by email or snailmail -- or to have it sent to a friend, client or family member -- This email address is being protected from spambots. You need JavaScript enabled to view it. with the name contact info).

When You Suspect Elder Abuse or Neglect

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This is a very difficult and emotional topic: what do you do if you suspect (or know) an elder is being abused or neglected? This would include emotional, physical, sexual and/or financial abuse or neglect; self-neglect is also included.  If you're not sure what might be considered elder abuse or neglect, here are some guidelines from the US Administration on Aging.

I always strongly encourage the person with the suspicions or knowledge to report them -- but often the next questions are: how and to whom? Here are four approaches, each based upon my working in Massachusetts. I will also include general info for those reading this concerned about elders living elsewhere in the US.

The most vulnerable members of our community need help from every one of us.  Overwhelmed and frustrated caregivers need help too, which is often what happens when elder abuse or neglect is report. Your report might just be what turns the situation around for everyone.

4 Ways to Report Elder Abuse and Neglect

  1. If you are concerned that the person is in immediate danger, call the police local to the elder' municipality. Tell them what you're worried about and ask them to do a welfare or wellness check.
  2. Call the elder's closest Area Agency on Aging. In Massachusetts, you can search by town; ask to speak with Protective Services.  Here's a national search capability from the US Administration on Aging.
  3. Call the elder's city or town and ask about their elder services. Here is a list of the 348 municipal Councils on Aging in Massachusetts.
  4. Call the elder's state Elder Abuse Hotline. In Massachsuetts, that's 800 922-227. Here is a national list of such hotlines.

Important Lessons from Our Wayland, MA Panel Discussion

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Recently, I was honored to be part of a four-person panel at the Wayland Public Library speaking on the topic "What's New in Aging?" We discussed navigating the new terrain of aging in the 21st century, followed by a question and answer session from the audience. Juergen H. Bludau, MD (photo at right), Harvard University and Brigham and Women's Hospital geriatrician, and Carol Sneider Glick, Esq, elder law specialist with Squillace & Associates of Boston, were wonderful fellow panelists. (Part 2 of this talk is scheduled for April 6, 7pm at the same location - register here)

I want to note here high points of the evening, including the excellent questions the audience brought. I felt very much at home in the company of these speakers, all on the front lines of bringing best-quality care in a quickly changing landscape. My fellow panelists as well as the audience of about 45 from Wayland, Weston and beyond were enthusiastic and engaged with every presenter's points.

Dr. Juergen H. Bludau, MD (photo, above right), a Harvard University and Brigham and Women’s Hospital geriatrician, built a powerful case for why geriatricians are so vital for elders. Despite the enormous demographic change of aged and aging people in our society, the need for geriatricians is not universally accepted. "Older people are biologically different from people of other ages," said Bludau, "this must be understood to treat them correctly." During their standard training, physicians receive very little information about treating elders. Because symptoms of serious conditions like pneumonia or a heart attack often present very differently in elders, it takes a specially trained eye to not brush off what may otherwise appear to be insignificant conditions. Though children now are widely understood to benefit from specially trained pediatric practitioners, there is still a long way to go for such general acceptance to extend to physicians specially trained to treat elders.

Bludau pointed out that even among aged individuals who are enjoying good health and vitality, they may be living very close to the edge of their their ability to rebound from an illness or injury. "Homeostenosis, the point at which a person has used up all their inner reserves and resilience, may be close to the daily functional level of many elders," he said. This is why once an elderly person who was healthy becomes ill or has an injury, one problem after another may develop, and they may not be able to regain their health. Seemingly small health events may appear to have disproportionately negative effects on elders if they are viewed through a non-geriatrician's lens.

Aging is Complicated

Attorney and Wayland resident Carol SneiderGlick (photo, right), elder law specialist with Squillace & Associates, P.C., in Boston, made it clear that being an elder lawyer isn't just about preparing documents like a will and power of attorney. While these are important to have, the attorney has to get to know much more about the elder's life and goals, as well as their financial situation, and should be a specialist in elder law, including Medicaid and tax planning, in order to be able to prepare the correct documents so that the client can be adequately protected and that the documents serve them as intended. "Many aspects of elder law are complex, such as tax planning," said SneiderGlick, who holds an advanced law degree in this area. "It's heartbreaking to see a client who thought they were all set with their asset protection and tax planning, to find that they haven't even come close to meeting their goals."

I spoke about how dramatically aging has changed in the last 40 years, with people living substantially longer with many more complicated medical conditions, with family often no longer nearby, or nearby but so busy with work and raising children that they can't consistently help. But also in the past 40 years, many of the ingredients for successful aging have become available, but that they are not being put together and used nearly as frequently as they should be. The audience and my fellow speakers warmly received the messages I offered about bringing home care into the 21st century: the importance of choosing caregivers who perform up to modern care standards, reducing at-home care costs by bringing in monitoring technology, how teamwork is vital, and the way we are keeping the family and care partners informed about care in the home through our one-of-a-kind online system.

Audience Questions

The audience was very attentive, and had a wide range of questions the panelists answered.  In the final analysis we can see that regardless if they were asking about lawyers, medicine, physical therapy or other disciplines, many questions were touching the same point: "How can family and professionals know that others on the care team know what they are doing, are making the right decisions, and carrying out the right care?"

In general, the panel said it was important to make sure there is proper credentialing of professionals, that when possible you choose care team members from institutions or private practices that specialize in your area of need, and that if necessary you get a second opinion from some other institution or practitioner.

After continuing to think about this question, I would add that this underscores the need for a fully integrated team approach with great communication: it's likely that team members have worked with similar circumstances to your or  your loved one's, and have also worked with other professionals in many different disciplines. Periodically check in with those seasoned practitioners to get their take on how the team is performing.  If they are all from the same practice or institution, my experience is that it's likely you may not get straight answers as politics may overwhelm an urge to speak frankly.  However, if you watch their body language, listen to their voices, to what they say and especially to what they won't respond to, you will get clues to what they really think. More direct questioning may or may not bring out their true opinions.  Do your best to be uncritical, non-blaming and calm, and try to elicit their best recommendations for improvements without pointing fingers at any particular team member.

SneiderGlick concurred. "A good, caring professional is going to notice if something isn't going right, even if it's in an area that isn't their specific expertise," she said. "I was just referred a client by a financial planner who had an instinct that her client's trusts weren't set up correctly, although she didn't know enough about it to know exactly what was wrong." Upon review, Sneider-Glick found several deficiencies in that client’s estate planning client’s estate planning documents that if left uncorrected, would have defeated that client’s goals. Fortunately in this instance she was able to correct them before it was too late.  "Talking fully with the client and talking among professionals is vital -- there is no substitute for working together as a team," she concluded.

The second part of this series is scheduled for April 6 at 7pm at the Wayland Public Library, and focuses further on 21st century care essentials, helpful to both elders and adult children looking for help with aging parents.  Both presentations are a free service to the community, and are sponsored Caring Companion Connections of Concord.  To reserve a seat, sign up at http://info.caringcompanion.net/21st-century-caregiving/.

Cost-Effective Dementia Care Program Comes to Boston Area

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The new “Homestead Advantage Program” is being offered by Caring Resources of Norwood, MA. This program provides a cost-effective approach to dementia care and is aimed at helping dementia patients, their families and caregivers create the right environment and enable meaningful relationships.

Homestead Advantage encompasses individual caregiver education, support, guidance, care planning and appropriate referral sources to best meet the needs of the dementia client. This program includes a personalized, at-home assessment by a Certified Dementia Practitioner, a Geriatric Psychiatrist, and a Licensed Independent Social Worker to meet the clinical, social, and environmental needs of the dementia client.

By identifying additional resources that patients need, such as recommending environmental accommodations, training caregivers and family members, specialized dementia care can be provided within the community setting.

Claire Henry, Masters level clinician and Certified Dementia Practitioner, is principal at Caring Resources.  Ms. Henry is well known in the elder care community for advocacy on behalf of clients with dementia and for providing specialized services to dementia clients and their families.  Additionally, she has worked with organizations and facilities that serve this population by designing programs and developing specialized training programs.

Caring Resources embraces the philosophy that a consistent and safe environment with regular medical care and appropriate environmental cues can reduce dementia symptoms. This allows the dementia client to maintain meaningful interpersonal relationships within the most appropriate home environment.  Caring Resources’ core values include providing the highest level of care for loved ones with dementia, ensuring families and caregivers learn cutting-edge practices in training and support. Caring Resources follows a holistic care model focusing on client-centered care and behavior management strategies, creating safe home environments and strengthening family relationships.  For more information, call 781-540-9357 or see here for more information.

Free Dementia & Alzheimers Lecture Hopkinton, MA

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Challenging Behaviors and the Dementia Patient

June 8, 2011, 8:00am–10:00am
50 W Main St, Hopkinton, MA
Golden Pond Assisted Living

50 W Main St, Hopkinton, MA 01748
Breakfast: 8 am
Presentation & Q&A: 8:30-10 am
RSVP to Golden Pond by June 6 at 508 435-1250

Sleep disturbances… resistance to care… suspiciousness… sundowning… hoarding… rummaging… These challenging behaviors can be frustrating, frightening, and exhausting for families and caregivers of dementia and alzheimers patients.

But there are effective, gentle methods for dealing with such behaviors. Through presentations, case studies and discussion, this event will help you develop some of the skills needed to achieve better outcomes with dementia patients. Learn:

  • Common behavior symptoms exhibited by dementia patients
  • Environmental cues that trigger challenging behaviors
  • How to tweak an environment to reduce challenging behaviors
  • Troubleshoot your relationship with dementia patients
  • Choose and evaluate caregivers for dementia patients

This event offers CEU's for Social Workers and is free of charge.

Meet the Presenters
Claire Henry, M.Ed., CDP, is well known in the elder care community for advocacy on behalf of clients with dementia, and for providing specialized services to dementia clients and their families.  Additionally, she has worked with organizations and facilities that serve this population by designing programs and developing specialized training courses. Ms. Henry is a master’s level clinician and a Certified Dementia Practitioner working with elders for over twenty years. She is the principle of Caring Resources of Norwood, MA, specializing in dementia care solutions. (CaringResourcesInfo.wordpress.com)

Deborah Bier, PhD, has helped individuals with significant physical or psychological disabilities and their families for over 20 years. She understands the impact that one person’s chronic or degenerative disease creates for the entire family, and utilizes a wide range of innovative approaches to help reduce their stress, and reconnect them living again. Dr. Bier has a doctorate in therapeutic counseling. She is a director of Caring Companion Home Care, headquartered in Concord, MA, a innovative home care agency.

Heat Advisory Tips, Metro Boston, Massachusetts

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NOTE: Elders, babies and those with certain illnesses are at greater risk for heat stress than others. Please take this information to heart! For people not located in Concord, MA, please contact your municipal fire/police departments to find out what types of services are avaiaable to you for cooling.

By Mark R. Cotreau, Fire Chief/Emergency Management Director, Town of Concord Fire Department


As you are most likely aware, we are in for a few days of extremely hot weather conditions. Please see the below advisory issued by MEMA.  Additionally residents can access a cooling shelter as noted below:

In response to the extreme temperatures forecast for the next few days, the Harvey Wheeler Community Center will be open as a cooling center Thursday and Friday, 12 noon until 9pm. There are no age restrictions. Please feel free to stop by if you would like to escape the extreme temperatures forecast. If transportation is an issue, during business hours please call 978-318-3020 (the COA Office), or after hours please call 978-318-3400 (Public Safety Dispatch).

Please remember that the Concord Public Library -  Main Library and Fowler Branch - are also air conditioned and welcome the public. The Main Library and Fowler Branch summer hours vary somewhat, and are posted on the Library web site at http://www.concordlibrary.org/pages/general.info.html#hours

Remember last winter when we all wished for warmer weather?


With the extremely hot weather the Commonwealth is experiencing, the Massachusetts Emergency Management Agency (MEMA) is advising people to be cautious and is offering some tips to help keep cool and safe.

“A few common sense measures can reduce heat-related problems, especially for the elderly, the very young and people with respiratory ailments, who are more susceptible to the effects of high temperatures,” said MEMA Director Kurt Schwartz. “Here are some tips to follow to stay safe during this hot, humid weather.”

·    Slow down, avoid strenuous activity.  Do not try to do too much on a hot day.
·    Wear lightweight, loose-fitting, light-colored clothing.  Light colors will reflect heat and sunlight and help maintain normal body temperature. Protect your face with a wide-brimmed hat.
·    Drink plenty of water regularly and often, even if you do not feel thirsty. Attempt to stay hydrated.
·    Limit intake of alcoholic beverages.  They can actually dehydrate your body.
·    Eat well-balanced, light, regular meals.  Avoid high protein foods that increase metabolic heat.
·    Stay indoors as much as possible.
·    If you do not have air conditioning, stay on your lowest floor, out of the sun.  Electric fans do not cool the air, but they do help evaporate perspiration, which cools your body.
·    Go to a place where you can get relief from the heat, such as air conditioned schools, libraries, theaters and other community facilities that may offer refuge during the warmest times of the day.
·    Check with your community for information about possible local ‘cooling centers’. You may also want to call 2-1-1 for ‘cooling center’ information or go to <http://www.mass211.org/>www.mass211.org.
·    Cover windows that receive morning or afternoon sun with drapes, shades, awnings or louvers.  Outdoor awnings or louvers can reduce the heat that enters a home by up to 80%.
·    Avoid too much sunshine.  Sunburn slows the skin’s ability to cool itself.  If you are outside, use sunscreen lotion with a high SPF (Sun Protection Factor) rating.
·    Never leave children or pets alone in a closed vehicle.
·    Check on family, friends and neighbors.

In normal weather, the body’s internal thermostat produces perspiration that evaporates and cools the body.  However, in extreme heat and high humidity, evaporation is slowed and the body must work extra hard to maintain normal temperature, which may lead to heat cramps, heat exhaustion and heat stroke.  If you believe you, or anyone you are with, is experiencing a heat-related medical emergency, promptly call 911, and if possible, move to a cooler place.

The Massachusetts Emergency Management Agency (MEMA) is the state agency responsible for coordinating federal, state, local, voluntary and private resources during emergencies and disasters in the Commonwealth of Massachusetts.  MEMA provides leadership to: develop plans for effective response to all hazards, disasters or threats; train emergency personnel to protect the public; provide information to the citizenry; and assist individuals, families, businesses and communities to mitigate against, prepare for, and respond to and recover from emergencies, both natural and man made. For additional information about MEMA and Preparedness, go to www.mass.gov/mema. Follow MEMA updates on Facebook and Twitter.

Who Will Shelter Your Elder Loved One in an Emergency?

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Note: The following was published in our monthly column "Living and Loving: Elder Care in the 21st Century" in Gate House News' Concord Journal.  We will continue this theme of elders and emergency preparedness in this blog with periodic articles on the subject.

On Day 4 without power following our recent late-October snowstorm, a woman in her 90s slowly rolled into a municipally-run emergency shelter at a nearby metro-west Boston town.  Leaning heavily on her walker, she looked at the shelter manager wearily and said, "I'm cold. I want to sleep here tonight."  Her caregiver interjected quickly, "I have to get back home,” eyeing the exit.

The shelter manager quizzed them about the elder's ability to function independently.  How much care was needed, and what type?  It turns out that the caregiver came 3-4 days a week; the senior was a bit confused, not fully independent in several of the activities of daily living, nor could she manage her own medications safely. Just not handling her medications independently was enough of a deal breaker, according to the manager. "I'm sorry, but this shelter cannot accommodate you," said the manager. "You'll have to find somewhere else to stay."

The manager was not without pity: she found neighbors with power the elder knew slightly. With reluctance, they took the senior into their home.  The only other options were to send the woman back home, and/or call the daughter in California and strongly recommend she fly out to take care of her mother.

Are you surprised this happened? I’m not. In my 10 years as a volunteer with disaster sheltering, I've become familiar with Red Cross and town shelter operation.  I would have expected this outcome, but of course the general public would not.

Most people do not realize that only medical shelters accept someone not fully independent. Since 90% of shelters opened are not medical shelters, this means that very few will take in anyone who regularly needs assistance in activities of daily living, or who has a medical condition that requires ongoing care the person cannot perform for his/herself. Yes: the very people who are most vulnerable during a disaster may be the ones who cannot find a safe place to shelter.  Ill, elderly, and the disabled dependent upon ongoing help would need other options.

If you know someone elderly, ill, or disabled who depends upon family, friends, neighbors or professional caregivers to make it through the day, then you should be prepared to deal with both local and widespread emergencies – and it is especially vital for these groups. At a presentation by the Massachusetts Office on Disability I attended, the message was clear: if you are ill or disabled, you should be putting into place the ability to deal with emergencies, including by making your home ready to shelter you during any disaster – should it be safe to remain there.  Do not expect emergency shelters to be ready or able to meet your special needs. Staying home may be the most comfortable place for you.

With the cold upon us (and given how wacky our weather has been), here are some questions I believe every family with an elder or disabled loved one should be asking themselves – questions for which you need realistic, sensible answers. (I provide brief suggestions of how I would begin to address such issues.)

Maintaining Ongoing Care:  Who is caring for the elder? What is the caregiver's plan to cover emergency contingencies? Before each storm, if your loved one cannot go without care for a day, a caregiver may need to be dispatched ahead of the storm and outside normal schedules so that dangerous or impossible driving during storms is eliminated.  Depending upon how nearby other family members are, there may need to be back-up caregivers placed on call.

Managing Without Power: How would your elder loved one get through a period of no electricity? How could they stay warm or cool? What would they and their caregiver eat, drink, and how would they cook? (For reference, you may want to see preparedness instructions to our caregivers and client families such as these: http://blog.caringcompanion.net/?p=649)

Keeping Lines of Communication Open: How would you communicate with your loved one to know if they were ok? Can they reach neighbors easily without leaving the house in bad weather, or if they have mobility problems? If you have a landline phone that is not a hand-held or internet-dependant, consider a hard-wired, line-based phone. Plan to keep cell phones charged and use texting or email as they are more likely operational in an emergency.


It seems difficult to fathom that ill, frail or dependant elders would not be accepted into 90% of emergency shelters during a disaster. Changes to this situation need to happen at a systemic level where the realities of the probably are truthfully and fully embraced. Federal, State and municipal priorities, practices and funding will need to be thoroughly reconsidered. In the meantime, you will need to make and be ready to carry out realistic plans for your elder loved ones.

Deborah Bier, PhD, is director of Caring Companion Home Care's Metrowest Boston office, headquartered in Concord, MA (www.CaringCompanion.Net).  She holds a doctorate degree in counseling, and is certified to both educate dementia caregivers and coach families of dementia patients.  She can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it.. To find more emergency information for households with elders, subscribe this blog, as we will have periodic articles on this topic.

Habilitation Therapy for Alzheimers Disease and Related Dementias

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Caring Companion Home Care has adopted and trains our caregivers in habilitation therapy when caring for clients with Alzheimers Disease and related dementias (ADRD). This approach was developed at the Massachusetts Chapter of the Alzheimer's Association, and is considered to be the best standard of care for all types of dementia. Sadly, it is not in as widespread use in all aspects of elder care as it should be.

Habilitation therapy is a comprehensive behavioral approach to caring for people with dementia. It focuses not on what the person has lost through their illness, but on their remaining abilities, aiming to create and maintain a positive emotional state through the course of each day. Their capabilities, independence and morale are thoughtfully engaged to produce greater psychological wellbeing. In this way, difficult symptoms can be reduced or eliminated, despite the disease’s progress.

We had been using this technique for several years, but when the Alzheimer's Association and the Massachusetts Executive Office of Elder Affairs offered a curriculum based on Habilitation Therapy, we jumped at the chance to become certified Habitliation Therapy coach.  This method emphasizes validating the client’s emotions, maintaining dignity, creating moments for success, and utilizing all of the patient’s remaining skills. Habilitation therapy helps caregivers have positive and successful interactions with their loved ones by optimizing and maximizing the care recipient’s strongest skills. The goal is not to re-habilitate the client to an earlier state of functioning, but to “meet them where they are” with the remaining skills they possess.

Every interaction with the person with dementia, every task performed for or with the client, and every aspect of the environment around the client needs to be thoughtfully selected or adjusted with habilitation in mind. Habilitation therapy can be applied in the home or institutional setting, and can be learned by family, friends and professionals alike.

Habilitative therapy also benefits caregivers, be they family, friends, or professionals. The ability to enjoy time together and to share a relationship, activities, and feelings with a person with dementia can be uplifting for everyone involved. The satisfaction we at Caring Companion get from forming warm bonds with our dementia clients, and to help them have satisfying, peaceful days is what keeps us excited about this work.

Aging & New Technologies Lecture, Bedford, MA

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433128 grandmas birthdayNew technologies to help seniors, the disabled and their caregivers are being launched every day. It's a huge, growing industry worth billions of dollars annually. But there are so many new products and services coming to market that most people feel confused and overwhelmed.  Do these devices mean  real aid for aging in place, or just a new way to part elders with their money?

Learn how to sort out the "toys and gadgets" from the helpful technologies on the market today. "Aging, Disability & New Technologies: Real Hype or Real Help?" Instructors Jim Reynolds and Deborah Bier, PhD will help participants make more wise choices in this bewildering, rapidly expanding marketplace.

The session will review some of the high tech tools available today, highlighting ones with the ability to help keep elders, the disabled and their families stay connected, happy, safe and healthy.  The focus will be on consumer technology for fall prevention and alert, technologies to help care for those with Alzheimer's disease and other dementias, and to help with timely and accurate medication use.

Reynolds has been a National Practice Leader for IBM in the area of mobile and wireless technology, and is the owner of Caring Companion Home Care in Concord. Bier has been a health care educator, author, and wellness coach for over 20 years, and is the director of the Concord, MA office of Caring Companion Home Care.

This lecture will be held on April 13 from 2-4pm, through the MILES program at Middlesex Community College on their Bedford Campus. MILES (Middlesex Institute for Lifelong Education for Seniors) offers intellectual stimulation, interaction, and friendship for adults ages 50+. Some of the topics explored through MILES include history, politics, arts, fitness, health, safety, music, computers, internet, travel, business, psychology, law, poetry and opera. Courses have no term papers, exams or grades, and are held at their Bedford campus. They are facilitated by individuals with expertise in topics based on professional, educational or personal experience. Semester membership fee of $95 includes access to all MILES courses. MILES is an affiliate of the Elderhostel Institute Network.

For more information or to register, call 781-280-3570 or e-mail Chris Lindsey at This email address is being protected from spambots. You need JavaScript enabled to view it..