ComForCare Home Care Serving Somerset & Northern Middlesex Countries

Archive for June, 2019

Celebrate National Park and Recreation Month With Your Older Adult

Monday , June 24 , 2019

Celebrate National Park and Recreation Month With Your Older Adult

As we age, our bodies and minds may change in ways that we don’t like. We see these difficulties often in our clients, many of who rely on others to assist them with routine activities like driving to appointments and outings, helping them up the stairs, or even using the toilet.

Many of them feel ashamed of their weaknesses or like they’re a burden on others. They minimize their requests for help in order to not ‘annoy’ their friends and family, or simply because receiving assistance makes them feel uncomfortable.

As a result, they often end up homebound, watching hours of television every day, even though they enjoy getting outside and being physical. Recreation is just too difficult for them without relying on others.

For older adults, even the most basic of leisure activities, like going to a public park and taking a stroll, may require overcoming multiple barriers. Transportation may not be available, affordable, or accessible. Once they arrive, they may require assistance that isn’t available without the help of a caregiver. And even if they do have help, facilities, programs, trails, and more may not be accessible to those with special needs.

Leisure activities and health in older adults

The link between leisure activities, positive social relationships, and health in the elderly has been well documented. According to a 2014 study from the US National Library of Medicine:

“The narrowing of social networks may be problematic for health in older age and lessen subjective well-being, life satisfaction, and quality of life. Thus, identifying modifiable factors that may aid in more limited establishing social relationships is important: Health-promoting behaviors, such as leisure activity, may strengthen the link between social relationships and health.”

Why is recreation so important? Because it offers opportunities to gather with friends, meet new people, and develop relationships. These interactions help ward off countless problems common to older adults, such as loneliness and isolation. In addition, increased physical activity can help improve issues such as poor flexibility, weak muscles, and even depression.

The value of public parks

Urban and suburban parks provide critical space for physical and mental health promotion among older adults. In fact, research shows that people of all ages are three times more likely to achieve recommended levels of physical activity when they visit them.

Those in charge have been taking notice. According to a recent survey from NRPA, nine in 10 park and recreation agencies now dedicate facilities, amenities and programming to older adults, with 91 percent offering exercise classes, 53 percent offering group walks, and 48 percent offering volunteer and employment opportunities in recreation centers.

One example? NRPA’s Healthy Aging in Parks initiative, which encourages local park and recreation agencies to implement evidence-based arthritis intervention programs to help individuals maintain physically active lifestyles while reducing arthritic symptoms and pain.

Helping your older loved one get outdoors

Every July, municipalities across the country take part in Park and Recreation Month. In celebration, it’s the perfect time to help your older adult get outdoors. Things you can do to help include:

  • Help find reliable (and affordable) transportation (Somerset County offers transit services to senior citizens and adults 18+ with disabilities)
  • Find a park that offers senior-friendly exercise programs, such as Tai Chi or walking groups
  • Arrange for a companion, if necessary, to help adults with limited mobility or mental impairments
  • If your loved one isn’t able to make it to a park or other outdoor facility, arrange for them to spend time sitting on the porch at home or set up a bird feeder in the back yard so they can still enjoy nature and receive some much-needed mental stimulation

Locally, there are dozens of outdoor programs that can be enjoyed by people of all ages. One we especially love? Robert Wood Johnson University Hospital Somerset’s SAIL program. The Fit Body, Fit Bones series, offered at TD Bank Park, is designed to reduce the risk of fractures from osteoporosis by strengthening muscles and bones through exercise. Benefits include:

  • Instruction from a certified exercise physiologist for performing strength-building exercises that focuses on balance, flexibility, strength and overall wellness
  • Continual disease education from health care professionals
  • Personalized attention, varied and advanced exercises
  • Receive a manual of exercise

Tell us: What’s your favorite local park? Do they offer any programs specifically geared towards older adults?

Posted in: Aging

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Diogenes and Hoarding Disorder in Older Adults

Monday , June 10 , 2019

Diogenes and Hoarding Disorder in Older Adults

Walking into the home of a hoarder can be a bizarre experience. Most of us think of our homes as places to shelter us, to keep us safe and comfortable. But to a certain percentage of the population (estimated to be around 4%, and more prevalent in older people) the home becomes a place to safeguard precious possessions. And for these individuals, every possession is precious, from twenty-year-old mail, to every plastic bag they have brought home since 1978. In extreme cases, even rotten food and toe-nail clippings can be impossible to part with.

 I remember one client we had briefly who couldn’t shower because the bathroom was filled with old papers and mechanical devices. To get through his front door, you had to turn sideways to navigate the stacks of stuff. He had to sleep sitting upright in a chair because his bed was covered with piles of debris. Storing his things was more important to him than is safety or comfort.

Another client, one of the first I had after launching my agency, had lived in a large apartment for forty years. Financially, she was extremely well off. She had held an administrative position with a large company for many years and was still working there past retirement age. In her free time, she traveled extensively and brought back souvenirs from all her trips.

When I was called in by a geriatric case manager to help her move to an assisted living, I found her living in squalor. Her expansive apartment was filled to the gills, making the place a hazard for her. In addition to the danger the piles of stuff both old and new presented, the apartment was overrun with cockroaches—they were on the walls of her kitchen, in her laundry basket, in the drawers of her bedroom furniture.  Yet her clothes were pretty, and in conversation she seemed quite mentally competent.

I worked with this client for months to gradually persuade her to allow us to throw things out, fumigate her remaining possessions, and move her to a place that would be healthful for her. I am delighted that we succeeded, but I know that for many hoarders the change would have been unthinkable.

People of any age can suffer from hoarding syndrome, but for many older adults Diogenes and elderly hoarding disorder pose very serious problems, to both themselves and others.

What is Diogenes Syndrome?

Researchers have described Diogenes syndrome as “a special manifestation of hoarding disorder.”

According to Psychology Today, “hoarding is often a consequence of having DS, but (DS) is associated with self-neglect and much of the items excessively hoarded are typically items of trash with little or no value.” People with DS often live in severe domestic squalor and unsanitary conditions. The syndrome is characterized by poor personal hygiene, extreme filth in the home, social withdrawal, compulsive hoarding of trash, indifference, and lack of shame.

DS can occur in anyone but is most often seen in people over the age of 60. In combination with other common ailments of age, DS can lead to illnesses such as pneumonia, or accidents like falls and broken bones.

Symptoms of Diogenes Syndrome

Symptoms of DS can vary, and usually appear over a period of time. Often, by time diagnosis occurs, a cluster of signs are present, including symptoms of self-neglect. Others include:

  •  Withdrawal from social situations
  • Poor judgement
  • Changes in personality
  • Paranoia or general suspiciousness
  • Skin conditions caused by poor hygiene
  • Unkempt hair and fingernails
  • Body odor
  • Unexplained injuries
  • Poor nutrition or diet
  • Lack of shame regarding their unkempt appearance

 In addition, the person’s home will also likely display some signs, including:

  • Rodent or insect infestation
  • Unsanitary or unsafe living conditions
  • Overwhelming amounts of household items and waste
  • An intense, unpleasant smell

Often, symptoms are difficult to distinguish from those of other conditions such as schizophrenia and frontotemporal dementia – and, in fact, dementia is present in up to 15% of people affected by DS.

Causes and Diagnosis

Research is still being done to improve understanding of Diogenes Syndrome, but there are certain conditions that are known to be risk factors. Often, a specific incident will trigger symptom onset. Examples include:

  •  Death of a spouse or loved one
  • Retirement or divorce
  • Stroke
  • Loss of mobility due to injury
  • Dementia
  • Depression or anxiety

Experts suggest that at least half of the time, symptoms occur in individuals with no prior history of mental illness. Paired with the fact that affected individuals rarely reach out for help, diagnosis can be difficult. Often, it occurs only after a family member seeks intervention or neighbors repeatedly complain.


There is no official treatment for Diogenes Syndrome, but ongoing care is important. People with the disorder may be at risk for life-threatening illness or injury if left untreated. In addition, those around them are at risk of environmental harm.

Doctors may order imaging to rule out similar disorders or personality assessments to shed light on the root cause. Behavioral therapies, such as those used for anxiety or depression, often help — and if the person is able and willing to take part, support groups can be useful. In addition, having a caregiver come to the home to check up on the individual is often recommended.

In extreme cases, the person may need inpatient treatment. Each case needs to be handled on an individual basis and with extreme care, as individuals are often distrustful of others (especially the medical establishment).

If all else fails, referring people to Adult Protective Services (APS) is an option. Within 72 hours of referral, a face-to-face meeting with the adult by a trained social worker will occur.


Posted in: Aging, Dementia

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The Value of Home Care: Don’t Discount the Critical Support a Well-Run Home Care Agency Can Provide to Both Seniors & Home Care Workers

Monday , June 3 , 2019

The Value of Home Care: Don’t Discount the Critical Support a Well-Run Home Care Agency Can Provide to Both Seniors & Home Care Workers

Since 2005, I’ve been the owner and director of an agency providing in-home care to help seniors stay safely and comfortably in their homes. I got into this business because of my personal experience needing to help care for a parent who lived alone, hundreds of miles away from me. She passed away in 2004, and the following year I opened my business in the hopes of helping families facing challenges similar to the ones my family had experienced.

I love what I do, but over the past year or two I’ve become increasingly aware of a media narrative about my business that is both false and detrimental to our nation’s urgent need to find better and more affordable solutions for senior care. This narrative paints a picture of overcharged seniors and families, underpaid and exploited caregivers, and fat cat agency owners in the middle who exploit both sides while offering very little in the way of service.

It’s a compelling story because it touches on some very real problems. One problem is that the vast majority of American seniors want to stay in their homes, but many find it difficult to pay for the support needed to make this possible—despite the fact that seniors can be cared for far more cheaply at home than in a facility. Another real problem is that the amazing people who do the day-to-day, skilled and loving labor of caring for our seniors deserve better pay and support for the important work they do.

I have no quibble with either of these points. I am even sure that there are some unscrupulous agencies who truly are in the business to make money and not to provide service. But that is not true of my agency, and I believe it is not true of most professional agencies, especially those in a highly regulated state like New Jersey.

Please let me explain why a good, well run home care agency is decidedly not a “middleman,” i.e., someone who buys from a seller and sells to a buyer with no value added. Those of us in the home care business are in a unique position to understand the needs of seniors in a way no one else on their health care team can. We know our clients over the long term. We know them in their home environments. We know if they have adequate family support or not. We know what they are not telling their doctors. We can help them.

If you were a fly on the wall in our office for a day, you would see seven full-time and two part-time health care professionals working as a team with one another and with other community care providers to protect the health and safety of our clients. We are often in these clients’ lives for years, and every one of us takes their care personally.

Here are just a few of the ways that a professional agency can contribute to client health in a way that no other health care professional in their lives is in a position to do:

  • We perform comprehensive assessments of each client and their environment. We get to know each client’s health history and medications, of course, but also what their home is like (and how safe), what their daily habits and preferences are, who helps them on a regular basis and what their goals are.
  • This assessment results in a detailed, individualized plan of care for the home health aide(s) to follow, right down to how best to help the client out of a chair, or what is the safest, most comfortable way to bathe them.
  • We always ask, “What are this client’s goals, and how can we make them possible?”
  • Our RNs reassess clients every 60 days to look for changes in health status and to be sure the plan of care is still appropriate. We adapt to our clients’ changing needs.
  • We instruct our home health aides about dementia and teach them methods for succeeding with challenging clients.
  • Because we catch problems early, and because we keep an eye on our clients’ chronic conditions, we reduce unnecessary hospitalizations. This early intervention preserves health and saves the health care system money.
  • We listen to our caregivers’ reports about their clients. They tell us when a client’s blood pressure gets out of control, when they see signs of a developing pressure sore, or when their client’s appetite is off. That’s when we spring into action making sure that families and all caregivers of the client are aware, that appropriate instructions are given, and doctors are consulted.
  • We refer clients to other services to improve their health, safety or quality of life—podiatrists who make house calls, emergency response systems, resources for free or low-cost medical equipment, Meals on Wheels, and physical or occupational therapists. Often families tell us they had no idea these services were available or accessible to them.
  • Teaching is a constant part of what our nurses do. Hospital or rehab instructions given prior to discharge often go in one ear and out the other. Our nurses review these instructions with patients in the home and ask them to “teach back,” so we know they’ve got it.

All of these things and more are part of what our clients receive for the hourly rate they pay for their caregiver. We are hardly acting solely as a “middleman.”

But what about the employees? Wouldn’t they earn more money if they worked directly for the client?

Well, yes, maybe. Especially if they are not paying payroll tax deductions. But there is a great deal they would lose, as well, and a great deal of added risk they would bear.

  • Those thorough RN assessments I mentioned above are not only to protect our clients; they protect the safety of our home health aides as well. Clients and families will frequently ask for, or even demand, services or procedures that are unsafe for the aides to perform. Our RNs will not permit the health or safety of the aides to be jeopardized.
  • We also stand up for our employees when clients of sound mind are rude or abusive, verbally or otherwise. We troubleshoot problems and help find solutions.
  • We provide our aides the support, guidance and encouragement of licensed professionals. They don’t have to worry if they are doing the right thing or not. We are there to ask.
  • Our employees have paid sick time, and access to dental/vision insurance, AFLAC, and a 401k plan to which we contribute.
  • Medicare, social security and unemployment contributions provide a safety net.
  • Employees who are injured on the job are covered by workers’ compensation, both for medical care and lost wages.
  • We pay our home health aide for the work they do like clockwork, whether the client or payer source is in arrears or not. The risk is ours, not the home health aide’s.

Our society needs to give serious thought to the aging of our population and the nation’s growing need for support for seniors. We need creative solutions for meeting these needs, for helping families pay for care, and for supporting our front-line care workers.

Professional home care agencies will surely continue to play a critical role in our care network. The journalists, politicians and pundits who shape our discussions around senior care should take care to understand what we do and represent our work accurately.

Posted in: Aging, Home Care

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