Category Archives: Nursing Care

Caring for the Caregiver-Preventing Caregiver Burnout

Utah Home Health Care ServicesWe all want to provide the best care possible for our loved ones. Yet, sometimes we need to ask the question: Who is caring for the caregiver? Caregiver burnout is a legitimate concern for any family or person who provides ongoing service to physically or mentally dependent individuals.

WebMD lists a few symptoms of Caregiver Burnout:

  • Irritability
  • Loss of interest in usual activities
  • Withdrawal from friends and family
  • Feeling blue, helpless, hopeless
  • Change in sleep patterns
  • Loss of appetite
  • Getting sick more frequently

You might notice these symptoms are similar to symptoms of depression. Counseling and support groups can help lift the emotional burden of a full-time or part-time caregiver who finds herself overwhelmed. And unlike chronic clinical depression, which may require medication in combination with other supportive treatment, caregiver burnout can often be resolved without medication. All we need is a little common sense and willingness to use some of that wonderful, caring energy (that we offer our patients or loved ones) to care for ourselves.

Interestingly, I learned the lesson about how to be a good, healthy caregiver during my years of raising a family as a single parent. I used this knowledge both at home and in my career as a nurse. And I learned the lesson from our family cat. You read that right–a cat.

Midnight was an indoor-outdoor cat, a combination of street cat and diva and I came to love her for this. She was keen, hard-working and a great mom to her kittens. (Stay with me here. I promise you’ll be glad you did.)

One afternoon I retreated to my bedroom to fold laundry on the bed, away from the sounds of TV and whatever else was going on in the house. It must have been a Saturday because it was mid-day and I was at home. Most other days I would have been at work. A few days earlier Midnight had given birth to a litter of kittens in a blanket-lined box in my closet. As I folded towels and matched socks, I watched her caring for her newborn kittens. She nursed them, cleaned them, let them cuddle next to her. Then she did something that surprised me. She left her babies.

She got up from where she was lying, stepped over them, and left those newborn-blind, helpless kittens mewing plaintively in their box. They began feeling around, smelling for her, trembling as they tried to walk on tiny paws. And she just walked away. I stopped what I was doing to watch. I remember feeling sorry for the kittens. But I also felt compelled to follow Midnight to see where she was going.

She went to her food dish. She ate. She drank. She went outside and did her business. Then she came back in the living room, found a spot on the floor where a shaft of light had warmed the carpet and she lay down. She cleaned herself, stretched her legs, laid her head on her paws and closed her eyes.

That’s when it hit me. BAM! This cat instinctively cares for herself. No one has to tell her what to do. She doesn’t buy books about feline co-dependence or how to be a good mommy cat. She doesn’t call her cat sister on her cat telephone to cry about how hard it is to care for her babies by herself. She doesn’t get angry or depressed about the burdens she bears. She leaves her kittens safe and sound and follows her natural instincts to care for herself so she can care for her offspring. Period. End of story. Her cat brain does not allow her to over-ride her instincts like a human brain does.

Midnight’s example of self-care was all I needed to bring more balance to my life of caring for my children. I was doing the best I could. I stopped feeling bad about the time I spent in my garden, which was relaxing and regenerative for me. I made sure to provide regular lunch dates for myself with friends. I joined a writer’s group. I started paying attention to my physical, emotional and spiritual resources and began responding in a more organic, instinctive way to cues of stress and exhaustion. This may be when I began taking routine afternoon naps and saying “no” to some requests for my time. I realized that my own instincts were the landmarks nature gave me to define my mothering and care-giving limits.

We each have our own limits. We can avoid becoming burned out by

  • feeling good about what we CAN do
  • honestly admitting our limits
  • asking for help when we need it
  • being a good caregiver to our self first and foremost – taking time to regenerate

By doing these things, we ensure we will be there to care for our loved ones as long as possible and in the very best possible ways.

If you feel you need help, please call or email us to see if your loved one qualifies for homecare services. We can also help you find community resources that may be available to you.

What has worked for you? What is your greatest challenge as a caregiver?

We’d love to hear from you in the comment section below.

Five Common Concerns About Flu Vaccine

iStock_000027477011XSmallEvery year I give flu vaccines. While working as a hospital Infection Control Nurse I literally gave hundreds of them. Each year I seem to hear the same basic fears expressed by various people in various ways by those who don’t want to be vaccinated.

We all have fears and concerns that keep us from doing things that are good for us, like getting a flu shot. But thanks to the internet, you can easily find well-informed and reassuring sources to answer your questions. Many sites debunk myths about the influenza vaccine. Here are a few of my favorite sites this year:

From a hipster-mom science blog

From Harvard Medical School

From WebMD

Today I’d like to highlight the five myths or concerns that I hear most often, as a nurse who wants to provide good public health information. (And as a nurse who wants to administer your flu shot!)

  • The flu shot gave me the flu once, so I don’t want to have it again.

Sorry, but this is not true. The flu shot contains no living influenza virus. You simply can’t catch the flu from it. Sometimes you may have flu-like symptoms related to your immune response as it creates antibodies to influenza. But, if you truly contracted influenza, it was because you were exposed to it before you had the vaccine, or during the time your body was producing immunity.

  • It has harmful chemicals and preservatives. I’m more of a “natural medicine” person.

If you’re concerned about these issues, please talk with your healthcare provider.  Influenza vaccine is available in a preservative-free form and exposure to this tiny amount of vaccine serum is relatively free from risks. The benefits to you, your family and community far outweigh the risks.

  • I’m healthy enough that I don’t need the vaccine.

It is impossible to know if or when you will contract influenza. Even the healthiest people have periods of stress that can weaken their immune system. Healthy people can and should protect themselves by being vaccinated. This in turn protects your loved ones and community from exposure to the virus. [Also, if you do happen to catch the flu, you will have a far milder case than your non-vaccinated friends. Many people may not realize that flu vaccine does not guarantee you will not contract influenza virus. It does guarantee a milder case and most people who are vaccinated will be spared the disease entirely.]

  • I’m pregnant. It might harm my baby.

Wrong. In fact, pregnancy is a good reason to be vaccinated. Your unborn child will be able to fight influenza in her early weeks of life via passive immunity from you. [You really should click that link. It’s a short, fun and informative.] If you breastfeed, she’ll be protected even longer!

  • I don’t like shots.

This is a tough one. Some people have legitimate phobias about needles. Your healthcare provider can help you cope with anxiety and fears about getting a shot. And remember: many nurses and doctors use tried-and-true methods to help make injections less painful. We can also help distract you from the source of your fear long enough to give the shot. We care about your fears and we’ll do anything we can to help you get through those few moments it takes to receive an injection. Give us a chance, okay?

Let’s all be brave this year. Protect yourself and your loved ones by being vaccinated.

.    .    .    .    .

Are you or your parent or grandparent home-bound? Do you need a flu shot? Call Envision Home Health and Hospice for a free flu shot today. 1-866-471-5733. We’ll send a nurse to administer the vaccine right in your home!

Visit this Envision blog post for more fun and fascinating flu facts!

Have You Had Your Flu Shot?

IMG_1110Autumn is around the corner. Have you had your flu shot yet? Well, folks, ‘tis the season! I received my vaccine last week. This means in the next few days my body will have developed immunity to this year’s prevalent influenza virus strains. I feel safer already!

Did you know that every year the flu vaccine is custom designed to protect us against specific strains of the virus? Because influenza virus mutates from year to year, we all need to get the vaccine every year. The Centers For Disease Control and Prevention  (CDC) website has wonderful information about protecting yourself and your loved ones from the potentially life-threatening influenza virus. Visit the site if you have time. You won’t be disappointed.

Click here for the website. Flu vaccine is the headline at CDC this time of year.

I could go on and on about the miracle of vaccinations and the benefits of living in a time and place where we can be protected from diseases that plagued our ancestors, but today, I’ll just highlight a few key points. Hopefully, you’ll make an appointment with your healthcare provider or stop by your local pharmacy for your flu shot sooner than later.

First: Who Should Get Vaccinated?

The following is directly from the Center For Disease Control and Prevention website

Everyone is at risk for seasonal influenza.

Health experts now recommend that everyone 6 months of age and older get vaccinated against influenza. While everyone should get a flu vaccine each flu season, it’s especially important that the following groups get vaccinated either because they are at high risk of having serious flu-related complications or because they live with or care for people at high risk for developing flu-related complications:

  •  Pregnant women
  • Children younger than 5, but especially children younger than 2 years old
  •  People 50 years of age and older
  • People of any age with certain chronic medical conditions
  • People who live in nursing homes and other long–term care facilities
  • People who live with or care for those at high risk for complications from flu, including:       Health care workers; household contacts of persons at high risk for complications from the flu; household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)
  • Some children 6 months to 8 years of age may need 2 doses of the vaccine to be fully protected. Ask your doctor.

For a complete list, see “Who Should Get Vaccinated Against Influenza” at

Second: Who should NOT get vaccinated?

Influenza vaccine is not approved for use in children younger than 6 months so they should not be vaccinated, but their caregivers should be vaccinated instead. And people who are sick with fever should wait until their symptoms pass to get vaccinated. Some people should not be vaccinated before talking to their doctor. This includes:

  •  People who have a severe allergy to chicken eggs.
  •  People who have had a severe reaction to an influenza vaccination in the past.
  •  People who developed Guillian-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine previously.

If you have questions about whether you should get a flu vaccine, consult your health care provider. Once again, for a complete list, see “Who Should Get Vaccinated Against Influenza.”

Envision Home Health is committed to protecting our employees, our patients and their loved ones from influenza virus. If you have any questions or concerns about your flu shot, please talk with your home care nurse or call our office 1-866-471-5733. We care about you and your family!

Check back later for Envision Home Health’s “Influenza Vaccine Myth Busters” where we’ll debunk the myths, show you some cool science and answer more questions about influenza vaccine. Until then, be safe out there and enjoy this beautiful autumn weather!

August is National Immunization Month

Dandelion PhotoAs we enjoy the last days of summer, it’s also good to remember National Immunization Month! Did you even know we had such a thing?

August is a great time to review and update personal immunization records. It’s back-to-school time, so, if you’re a parent of school-aged children, you’ve likely already done this for your kids. If you aren’t sure about which immunizations your children should have, the CDC will help you with that  — right here.

You can go here to find specific recommendations for pre-teens.

Most of us make sure our children are immunized. But, adults need immunizations too. You could make immunization a family affair. Show your kids it’s important, by getting your own vaccination boosters when they get theirs. Why not check with your doctor and find out if you should update any immunizations for yourself? In fact, you can take this quiz on the CDC website and find out right now!

Remember special populations require additional attention with immunization. If you’re over 65, for instance, the CDC recommends getting the pneumonia vaccine. If you have certain health conditions which compromise your immune system, like kidney failure or chronic kidney disease (CKD) you may need more frequent dosing to achieve immunity. Your health care provider can give you all the information you need for your particular situation.

There was a time in history when viruses like chicken pox, whooping cough and influenza took the lives of many thousands of people each year. (Tens of millions in the Great Influenza Epidemic of 1918.) We are fortunate to live in a time when many deadly diseases are preventable. So, regardless of our age or health status, let’s take advantage of August as National Immunization Month to stay healthy and happy by protecting our loved ones and ourselves by getting vaccinated!

The WOW Factor: Wisdom and Wit In Homecare

Envision Home Health and Hospice serves patients of varying ages and with a variety of needs. However, the majority of our patients are older adults. As a result, we have numerous opportunities not only to care for these individuals, but also to learn from their wisdom and wit. Here on the Envision blog, we’d like to share some of these unique and wonderful moments with you from time-to-time. We call them WOW moments.

WOW stands for “Words of Wisdom and Wit.” Home health care is full of them.

Now, for today’s story . . .

James [not his real name] is a gentleman who has passed the eighty-year mark. He is a bright, energetic man who does not look his age. (Of course, the older I get as a nurse, the younger my patients seem to look.) James finds ways to remain youthful in spite of physical limitations and occasional setbacks from health problems. He has supportive family around him and he refuses to allow his difficulties to discourage him. Maybe he is one of the lucky ones who was blessed with the happiness gene. To be honest, he’s not necessarily a smiley or jovial person. He is more of a dry humor type, but his contentment and positive attitude comes across in every interaction I’ve had with him.

Young & Old

The WOW moment came when I commented on his youthful appearance and his generally pleasant mood – even when his physical therapy is demanding or when he gets bad news about the need for yet another doctor’s visit.

His response was, “No matter how long I live, I’m determined to die young.”

Thank you, James. I’m saving that one for a rainy day. Or even a sunny day! May we all stay young for the rest of our lives!

WOW moments are one of many reasons why Envision is among the best places to work. If you are interested in joining the Envision team, please call us at 1-866-471-5733 or visit this link. We’d love to hear from you! Maybe you have your own WOW moment to share. Feel free to write about it in the comment section below.

Sunshine, Skin Cancer, and Vitamin D

Sunflower 1I’ve heard alot lately about how Vitamin D helps protect us from heart disease and other health problems and that spending time in the sun helps our body produce Vitamin D. I also know that exposure to UV radiation from sunlight (or tanning beds) is the number one risk factor for developing skin cancer.[1] We all love the sunshine. It helps plants grow, lifts our spirits, warms the planet and literally keeps the earth alive. How do we enjoy the sun, meet our body’s need for Vitamin D and protect ourselves from cancer at the same time? I’ve asked myself these questions many times before. Today I went looking for answers.

What I discovered while researching the subject is that our need to protect ourselves from skin cancer far outweighs our need for sunlight to generate Vitamin D. Extensive reviews of research by Deon Wolpowitz, MD, PhD, and Barbara A. Gilchrest, MD from the Department of Dermatology, Boston University School of Medicine, concluded that “The tradeoff of vitamin D production today for photoaging and skin cancer decades hence may have made sense millennia ago, when life expectancy was 40 years or less, but it’s a poor exchange when life expectancy has doubled, skin rejuvenation is a $35 billion/year industry, and one in three Caucasians develops skin cancer.” [2]

Here are few reminders from the CDC about UV exposure:

  • Avoid sun exposure during the hours of 10 a.m. and 4 p.m.

If you must be in the sun (and who doesn’t love a mid-day dip in the pool or spending time in the garden during this wonderful summer weather?) remember the following:

  • Seek shade, especially during midday hours.
  • Wear clothing to protect exposed skin.
  • Wear a hat with a wide brim to shade the face, head, ears, and neck.
  • Wear sunglasses that wrap around and block as close to 100% of both UVA and UVB rays as possible.
  • Use sunscreen with sun protective factor (SPF) 15 or higher, and both UVA and UVB protection.
  • Avoid indoor tanning. [3]

From the same source noted above [2], to maintain adequate Vitamin D levels, James Spencer, MD, clinical professor of dermatology, Mount Sinai School of Medicine, New York City suggests, “Drink vitamin D-fortified orange juice or milk or other enriched products. Eat salmon and other fatty fish. Or take a daily multivitamin containing 600 units of vitamin D. It’s so easy. And it’s a lot safer than lying in the sun or climbing undressed into a tanning booth and frying your whole body.”

That settles it for me. This summer I’m going to enjoy a little less sun and a little more salmon.

What do you think? Are you a sun-loving person? Can you give up an afternoon tanning session in favor of taking a vitamin supplement? We’d love to hear from you in the comments below.


Preventing Dehydration in the Elderly

If you are a caregiver for an older adult, you probably know that preventing dehydration in the elderly can be a major challenge. Several factors contribute to why older adults may become dehydrated. For example: thirst sense becomes less acute, the body’s ability to conserve water diminishes, certain medications (such as diuretics) contribute to water loss, and as we age, we tend to eat and drink less. [1]

What can caregivers or healthcare workers do to help prevent dehydration in our aging family or patients? The answers to this question may seem like common sense, but when we are overwhelmed with caring for an aging family member or busy with our case-load of patients, we may overlook these simple but important steps to preventing dehydration.

First: Take time to really listen to your elderly family member or patient. Find out what she likes to drink, how often she eats meals, when she takes medications. This information can give clues to ways you might help her stay hydrated. With these things in mind, consider the following suggestions.

Keep water within reach – in a pitcher or drink-cup – whichever works best for your patient or family member.

water glass.lemonIf plain water is not palatable to the patient, consider adding small amounts of flavoring, such as lemon juice, honey or sugar free sweetener like Crystal Light. Even small amounts of flavoring can encourage more water intake in some patients.

Offer verbal prompts throughout the day. Some older adults don’t remember to drink due to cognitive impairment and since thirst is less acute, they really may not think about drinking. You can help remind them.

Allow adequate time at meals to eat and drink. An older adult may take longer to consume his meal. If we rush him, we miss this natural opportunity to increase fluid intake. (Remember: many foods contain water, so encourage eating as well as drinking.)

Encourage taking medications with plenty of water. Some studies have shown that people who take medications, drink significantly more water than their cohorts who do not take medications. [2] This is an ideal way to provide small but potentially significant amounts of fluid. Especially if your patient takes medications more than once during the day.

Talk together about the importance of preventing dehydration. Many older adults are interested and involved in their own health management. For these people, education may be all that is needed to prevent dehydration. 

We’d love to hear about your experiences with helping older adults avoid dehydration. You can share in the comment section below.



How to Choose a “Nursing Home” for Your Elderly Parent

Elderly hands held in younger handsAdministrator’s Note: Welcome to the Envision Home Health and Hospice Blog. This post is the first of many to come on a variety of health topics.

At some point it’s bound to happen: your elderly mother or father is no longer safe to live at home. It may be because they’ve had a long illness that has left them debilitated—or they keep falling and hurting themselves—or they just need a little help to take a shower and get dressed.

Whatever the reason, if your parents live long enough (and let’s hope they do!), it’s likely that at some point you’ll have to decide where they can safely live.

And it doesn’t help that there are many types of facilities with very specific titles and purposes—yet most people lump them together as “nursing homes.”

Yet, if you understand, 1) why you shouldn’t feel guilty about “putting Mom in a nursing home”, 2) what your parent needs, 3) the technical names for the different facilities—and what they offer, 4) how they are paid for, and 5) how to choose a good one, the task becomes a little easier.

Step 1: Don’t Feel Guilty

I’ve seen some people struggle for years with the idea of moving their elderly parent into a healthcare facility—all while their parent struggled physically or emotionally in a home that compounded all the problems.

If your mom or dad can’t participate fully in today’s busy world—they may be isolated and left alone far too often.

And “home alone” for an elderly person can mean risk of accidents and depression.

There’s a reason why modern healthcare facilities for the elderly have steered away from calling themselves “facilities” for the more friendly title of “communities”. Why? Because elderly care is much more community-oriented and home-like than what it used to be.

These days, the best “communities” are designed for a more neighborhood-like experience—including cozy rooms, more gathering places, better food, engaging activities, regular entertainment, real socializing with other seniors, etc.

So, as much as you think that your dad or mom will be happier in your home—or their own home—it’s quite possible they will be more content (and safer) in a more stimulating environment with their own age-group.

Step 2: Identify What Your Parent Needs

Healthcare facilities for the elderly are tiered in a hierarchy based on how much assistance the person needs.

Is your mom or dad generally in good health and basically independent—but wants to be around other seniors? Then an “independent living” (IL or ILF) community may be perfect.

Does your mom or dad simply need some help with bathing, dressing, and meals? Then an “assisted living” (AL or ALF) facility would fit the bill.

Maybe your parent has some complex health issues that need monitoring—or recently had a hospital stay for an illness or surgery. In that case, he or she may need a “skilled nursing facility” (SNF) with 24-hour nursing care and daily therapies.

Does your parent have serious dementia, e.g., Alzheimer’s or other dementia? And are they safest when they’re in a controlled and monitored environment? Then you probably need to choose an assisted living or skilled nursing facility with a “memory care unit” with strictly-controlled access so your mom or dad can’t wander off.

Or maybe you can see that your parent is likely to experience all of these needs—perhaps in slow, chronological order—and you don’t want them to switch facilities every time they have a greater need. Then you might consider a “continuing care retirement community” (CCRC) where all levels of care are offered.

Step 3: Know the Technical Names of Elderly Care Facilities

The term “nursing home” has become a vague, generic term used to describe any facility that provides elderly care. It’s too vague to be useful when you’re making decisions, so it’s important to know the real names.

From the lowest amount of care to the highest, here are the names that are normally used in this industry:

“Senior Community” or “Independent Living Community” is the name for a facility (or sprawling campus!) that is designed for active seniors who are in relatively good health and who don’t need assistance with anything. They are designed to enhance quality of life by grouping seniors together who may have common interests or needs for socializing. Normally, these communities feature individual apartments or townhouses, have lots of recreational and socializing activities and have a cafeteria or restaurant for meals if the residents don’t want to cook.

An “Assisted Living Facility” is designed to help those who have trouble with “activities of daily living” (ADLs). What are ADLs? Think about what you did this morning…you got yourself out of bed, bathed, groomed yourself, and got dressed. Those are ADLs. An assisted living facility has the personnel (certified nursing assistants or CNAs) to help each resident who has challenges with ADLs. Assistance can also include medication reminders, transportation, and meals.

“Skilled Nursing Facility” is the name for facilities that provide true, 24-hour healthcare for patients with fairly complex health issues. These facilities staff nurses 24 hours a day and provide rehabilitative therapies like physical, occupational, and speech therapy. They are staffed with a social worker and have a medical doctor assigned as the house physician (although you can use your own doctor if you prefer). I like to think of these facilities as one step down from a hospital—in fact, many elderly patients who have a hospital stay for an illness or surgery are discharged from the hospital directly to a skilled nursing facility to get “rehabbed” before they eventually return to their home. However, many of these facilities also have a “long-term” group of patients that will live there—receiving care—indefinitely.

A “Continuing Care Retirement Community” (CCRC) is a facility that usually includes all of the above. Within a large CCRC can be an independent living community, an assisted living facility, and a skilled nursing facility.

Be aware that most of these facilities are not exclusively for the elderly—but could include some younger patients or residents.

Step 4: Know How to Pay for the Care at Each Facility

Costs of these facilities will vary significantly by area and amenities.

Facility Provider of Funds and General Cost
Senior Community or Independent Living Community Normally private pay. Some limited Medicaid funds for low-income seniors. Often starts at $3,000 per month but could be much higher.
Assisted Living Facility Normally private pay, but sometimes covered by long-term health insurance and Medicaid. Can start at $1,500 per month but could be much higher.
Skilled Nursing Facility Medicare pays for up to 100 days of care after a qualifying hospital stay. Medicare HMOs also pay for care. Long-term care can be funded by private pay, Medicaid, or long-term care insurance. Care often costs $300 or more per day.
Continuing Care Retirement Community Different levels of care can be funded as described above—but some CCRCs require private pay only.

 Step 5: Choose a Well-Run Facility

The internet is a great resource for reviews and ratings of specific facilities. Try a search for “assisted living facility ratings [name of city]”, or search for the specific name of the facility you’re considering. For skilled nursing facilities, Medicare provides detailed statistics and ratings at their website: Nursing Home Compare. At the website look for facilities with 5-star ratings and/or high staff hours per resident.

Healthcare professionals who visit multiple facilities on a regular basis—like nurses and therapists from home health agencies—will have excellent insight about the quality of specific facilities. Consider calling a home health agency and asking to talk with one of their professionals. Doctors and hospital discharge planners are also good sources of information.

Finally, nothing beats a tour of the facility. Visit the facility with someone you trust so you get their impressions—and take Mom or Dad along if possible. A good tour will include all areas of the facility, including bedrooms, activity areas, and dining rooms. Ask about the menu, how often activities are held, and what kinds of activities are provided. Don’t be afraid to introduce yourself to some of the residents and ask their opinions of the facility—most seniors will be happy you asked and they’re not afraid to give you an honest opinion.

I’d love to hear about your own experience, so please leave a comment in the comments box.

Blog posts at this site will cover many other aspects of senior care, nursing, and therapy. I invite you to subscribe to this blog.