With the dramatic growth in the elder population and the staggering number of people with dementia, now more than ever, there is a need to find ways to enhance the quality of life for both the patients and caregivers. On today’s show, Carrie Miller is joined by Rachelle Baum, the Founder and owner of CASA Healthcare to talk about caring for aging individuals. A physical therapist with over 23 years of experience in hospital care, rehab sports, orthopedic, skilled nursing, and home healthcare, Rachelle discusses the needs of someone living at home by themselves and what they need from their healthcare professionals.
Listen to the podcast here:
Caring For Aging Individuals With Rachelle Baum
We’ve got a special guest for you all. She’s the Founder and Owner of CASA Healthcare. She’s a physical therapist with over 23 years of experience in hospital care, rehab, sports, orthopedic, skilled nursing and home healthcare. She owns her own outpatient physical therapy clinic and has over twenty years of experience in home health. She spent her life in a caregiver’s role. We appreciate her and we’re excited to have her here. Welcome, Rachelle Baum.
Thank you so much. It’s great to be here. You said I’ve been a caregiver a lot of my life. It’s true because I have eight children. Plus, caring for these wonderful elderly senior citizens. It’s great being in the caregiver role. I feel like I’m doing a lot of good helping people with their health and being healthy.
Let’s dive right into our discussion about caring for aging individuals. Especially those with some form of dementia, but may not necessarily been diagnosed with dementia. I believe that our readers want to know because you’re that person that totally understands the individual’s needs, someone who’s committed to listening and adapting to the needs of your clients. Most of us know that there’s a dramatic growth in the elder population and a staggering number of people with dementia. We believe in going beyond medicine to find ways to enhance the quality of life for patients and caregivers. I’m sure you’d agree. Let’s first discuss the needs of someone living at home by themselves and what they need from you as a healthcare professional.
This is why you’re going to be effective and great. You focus on nutrition. I’m certified with Medicare. Medicare pays for us to go in the home and we’re the cheapest form of healthcare. We’re on the front line. It’s unfortunate because they’re not treating us as important as are because we see what’s going on in the home. For somebody that lives by themselves, their nutrition is super important. As you and I both have heard from seminars we’ve gone to or doctors that have talked about dementia, being a Type 3 diabetes can cause dementia. People have not talked about that. You have an elderly person that lives at home. Maybe they’re not shopping, they get and they’re eating junk food. It’s not a surprise that they might have dementia, memory problems, especially if they’re taking medications. That’s the other thing. Many of these seniors are prescribed several medications. My mother-in-law came home from the hospital with six different blood pressure medicines.
A lot of them don’t even know what are all these medicines, but they take them because the doctor says you need to take them. Especially if they’re living by themselves, it’s dangerous because they have side effects and if they’re not eating well, they might forget how to take them appropriately or when to take them. Our role as caregivers, especially in the home, is we have nurses and CNAs that go in. We try and get people in there frequently to help them out and communicate if there’s a family member that is overseeing them and let them know how they’re progressing and help them learn how to take their medications appropriately. However, another thing I was going to mention that we were talking about, Medicare does not pay for a nutritionist or dietician. They don’t cover that.
We need to change that.
The agency paid for one of my friends, who is a dietician, to do a consult for feeding tube patients. Nutrition is important. That’s where it all starts and it’s crazy that Medicare doesn’t realize that that’s causing a lot of the health problems and issues that they’re having to pay for. Why don’t we focus maybe on some nutrition, meal planning and some extra community services and support that can help our seniors with their health?
Getting back to medications a lot of times the elderly, an individual has medications that have been prescribed to them from different doctors and there are not enough geriatric doctors is what I hear can go around.
In the home health world, care coordination is the most difficult challenge because when they might be going to a primary care physician because they’re the ones that authorize the home health visits and oversee them. As opposed to a specialist, maybe their cardiologist, neurologist, rheumatologist or endocrinologist. They usually don’t sign for the home healthcare. These patients go to all of these specialists and they prescribe medicine. Are these specialists communicating with the primary care physician what they’re prescribing? Sometimes my patients can’t get in to see their primary care for 2 or 3 months. We require that they go in at least every three months. Ninety days as required by Medicare as well. That care coordination, that’s why they depend on home health agencies, nurses for us to fax that information, call the doctor, let them know what’s going on.
If there’s any new medicine that they’re issued, we have to ask them every visit, “Are you taking any new medicine? Did you go to the doctor?” That’s the challenge. They might not even remember. You have to coordinate with the family members. It’s very important to be comprehensive and communicate. Some doctors, places you can’t talk to the doctor. You have to try and click on three to get to so-and-so and then you have to leave a message because they’re not available. Remembering that when you’re going through a busy day, seeing all your patients, it’s difficult and not that easy that people don’t understand that.
What I don’t understand sometimes is when I’ve seen the elderly on 15, 16, 17-plus meds and you wonder how in the world and does the doctor even look at that list?
They don’t make soapboxes that big for seventeen pills in one little box.
It’s sad to me because there are some issues, the side effects and the interactions of drugs.For somebody that lives by themselves, their nutrition is super important. Click To Tweet
For instance, one of my patients I was prescribed a medicine for over-reactive bladder, which causes dry mouth. The urologist is like, “Take this medicine. This will help you with your dry mouth.” They have to take another medicine to try and mitigate the effects of the other medicine. They keep adding extra. How do you know the long-term effects of these anyway with many new medicines coming out? You see commercials try this med and that, but how long are these longitudinal studies and all the different issues?
The research and the reporting is biased. That’s a whole other stuff. Going back to the needs of someone living at home by themselves. You do a lot of physical therapy?
Yes, I am a physical therapist and I believe a lot in physical therapy because of the health benefits of it. For one of my patients, she got off her blood pressure medicine because she was walking and I got her on a walking program and not just when I came because that’s a key to that. You get these patients to also do their exercise program safely. If you’re training a family member to help them be accountable and do that but do it safely and continue to do that. She was faithfully walking every day, doing a training program. She’s going through chemotherapy and she’s done so well with her cancer. Also, she lowered her blood pressure and she doesn’t take her blood pressure medicine. Everybody needs physical therapy, especially women. Also, one quick thing with many of these diabetic patients that we have. I don’t know how many readers know, but if you go walking for twenty minutes, it’s the same thing as if you’re injecting yourself with insulin. You walk for twenty minutes, your muscles are going to take that glucose from your blood and use it. Instead of taking an injection of insulin, walk for twenty minutes. Exercise is effective.
How about hygiene? Do you all go over hygiene and feeding?
Yes, because many of our patients are incontinent. One, that’s a safety issue because sometimes they wait too long and they run to the bathroom and they can fall if they’re in a hurry. If they soil themselves sometimes, that’s frustrating. They might soil themselves and stay in a wet pad for too long and that can because urinary tract infections, which affect their mental status. I had a patient, she is amazing at cooking. There’s pumpkin bread sometimes. Her son texted me a picture that she had put a plastic bowl in the oven and it was completely melted with food. He texted me a few days later. It’s like, “Mom needs to have a dementia test because she put a metal pot in the microwave and it almost caught on fire.” I was like, “This is so unusual. This is not typical of this patient.” I told him, “You need to take her to the doctor. She might have a urinary tract infection.” I confirmed that with the nurse. She thought the same thing. It causes altered mental status or confusion and things that they have. If you notice things they don’t normally do, who would ever know that might be urinary tract infection? It affects seniors and their mental state. Hygiene is very important.
What about home delivery of meals, especially in the elderly? A lot of times they don’t cook. I suppose there are all kinds of meals on wheels and things like that around.
I do have patients that have meals on wheels and I will say, they’re not that healthy. I went to see a patient one time and they’re in a Styrofoam thing. It was cold and I couldn’t imagine her being very healthy with that food, but it is food. Instead of them not eating or instead of eating a box of cookies. Generally, they deliver pretty warm.
They’ve got family members too, I’m sure they could help out.
I do have a friend who was a chef and so he would do meal deliveries. There’s a lot of new businesses where if family members could work with them where they could order. I’d given menus to several of my patients. Some of them did order these healthy menus, but again it’s a little bit cost-prohibitive. Some of these elderly people that don’t have that much money, it’s very difficult for them. It would be great to have some good community resources for meal planning and nonprofits, volunteers, helping them at your church.
Local daycare programs. Those are so vital, especially those who are caring for them.
In fact, I have two patients in adult daycare. I went to do a reassessment for a patient and saw it was great because they were playing games and interacting and not sitting in the house watching TV all day long.
Where was that?
It’s down in Manville, the adult daycare that I went to.
I’ve visited an amazing place. It’s called Amazing Place.
I would love to go there. They are very important for social interaction. I have a patient and she’s 87. She goes to Whataburger almost every day. She stays until 1:00 or 2:00 in the morning. She’s one of those night owls. She goes to bed at 5:00 in the morning, but she does it regularly. It helps her mental status because she has relationships. Studies have shown that people that have very good relationships with others are more resilient and retain their memory and retain their mental functions longer and better if they have that social interaction. Those are very important.
I wanted to ask you about prescription meds. I don’t know if you have control over the client’s meds at all. Do you?
For home health, the rules are very strict that you keep track of every medicine they’re taking. The dosage, if they’re going to be discontinued, the discontinue date. If they’re new, the effective date that they’re new when they were received. If they’re taking an appropriately. We had a state survey and if you don’t have every single med that they’re taking documented, then you get a citation. It’s very strict. However, as a physical therapist, that’s not necessarily my domain. The nurses are in charge of the medicines, but I’ve done it for twenty years. I know to ask my patients, “Have you had any new medicine?” Because sometimes the nurse might only come once a week or once every other week and if I’m there 2, 3 times a week, I’m there more often. I try and train my therapists, “Make sure if they have new medicine, text a picture of it to the nurse. Let the nurse know so everybody can know.”
You can’t make recommendations to the nurse of maybe they’d had several falls?
All that comprehensive is important. We talk about that like, “This blood pressure medicine is not working or they’re not doing well on this medicine that they’ve had.” We’re the frontliners in the home of noticing subtle changes from a medicine or the stomach GI issues that they have. They might think they ate something wrong or have food poison when it could be their medication.
Overseeing sometimes your clients’ meds, are the anticholinergics prevalent, the list of their meds?
If they’re on pain medicine, especially if they’ve had surgery or something, they’ll usually transition to Tylenol or Benadryl if they have some rash. I don’t know all the top ones that are frequently prescribed. My nurses would know better, but they do prescribe them quite frequently. Also, for helping allergy relief, helping with their muscle spasms, pain relaxants. They do that quite a bit if they’re in pain. Some of my patients that have a difficult time sleeping or insomnia, they give them a lot of those, the sleep aids. That’s very dangerous if you’re taking pain medicine and a sleep aid at the same time. My husband told me it’s a 600% increase in the chance of death. It’s big. Plus your depression medicines, your anti-psychotics, those things, they’re generously prescribed.
They have side effects that can worsen in Alzheimer’s or dementia symptoms. If they don’t have dementia, it can cause dementia-like symptoms, even without someone having cognitive impairment.
Maybe my patient, that was the first question I asked her son, “When you went to the doctor, did the doctor give her a new medicine?” Because when they have those weird changes, all of a sudden they have a rash that they’re breaking out with. That should be the first question that goes through your mind like, “What’s changed?”
You see a lot of antibiotics.
It’s a killer for their GI. They start getting yeast infections or other infections, rashes they break out with and that also affects their mental status.
You give home healthcare, is that correct? You go into the home or do you see people in memory care homes, assistant living as well?Being in a group is powerful because you learn more together. Click To Tweet
That’s correct. One of the challenges is that Medicare does pay a little bit for the nursing home. They pretty much take anything that you get from social security but depending on the level of care. People that want to live in an assisted living or independent living. It starts a minimum $3,000 to $5,000 a month. That is a low end, especially for memory care. Memory care, it’s even more. It’s $8,000 to $10,000 because there’s a lot more supervision level required. We do go into those places as well. It’s not limited to the home because those places don’t have usually a physical therapist on staff that they pay or can bill for doing physical therapy as well as nurses. Unless it’s a nursing home, which has that usually as part of their billing for Medicare, we usually don’t go to nursing homes but we do assisted livings, memory cares, especially if there’s any private pay involved.
I want to go back to the overmedicating of the elderly. Is there a solution to this madness?
I have a 100-year-old lady patient. She has the most amazing memory. I had seen her once, twice in a week and she went to the hospital. It was not a serious condition, but she lived by herself. The daughter-in-law is like, “Let’s make sure everything’s okay.” She came back to stay at her daughter-in-law’s temporarily. I had told her I had kids and I told her some details about my personal life. She had told her daughter-in-law everything. When I went to see her after she got home from the hospital like, I couldn’t believe that she remembered all these details about me. I was like, “This lady is 100 years old. She uses a cell phone. She exercises every day.” Most patients probably think that they don’t have to exercise except when you get here. I like to do it every day and it shows. She doesn’t take that many medicines. The people that I’ve seen, several are in their 90s. We had a patient live until he was 107. Generally, they don’t take a lot of medicines, maybe 1 or 2. My healthier patients that live longer are the ones that are not taking so many medicines. All these years, it’s true.
When it comes to an individual caring for someone with dementia, it’s a 24/7 job with lots of changes. Caregivers are at risk for depression and declining health themselves. What do you recommend to the caregivers? There’s a lot out there where they could stay healthy in mind, body and spirit. Do you have any suggestions for them?
As a physical therapist, I would say they need to do their own exercise program themselves. They have to eat well. Patients ask me, “How do you keep up?” I said, “I have to practice what I’m preaching.” That is important as well for them. If they’re also working and being overloaded coming home with trying to care for somebody, it’s important that they look at their nutrition as well as their exercise that helps them deal with stress. Also, I have a wonderful marketer who’s great educating and we’re setting up a family support group. Family members can meet around a certain area. Maybe we can do it where they need to meet where it’s not too far to travel on a regular basis where they can ask questions.
When there’s more than one-person care caring for somebody, somebody might ask a question that’s very important for somebody else that they hadn’t thought of. When there’s more of a group, you learn more together and it’s more powerful. Also, be informed. Don’t be afraid to ask questions or reach out to local home health agencies. Many of our nurses been nurses for 40 years and they have a wonderful experience. We try and be up on all the new resources in the community to help you like counseling. It’s difficult to go through these things when you are not used to it.
It’s difficult to reach out sometimes.
Not look like you need help or we all try and look like we’re strong.
It’s easier for women than men.
Also, men caregivers are not used to doing bathing or hygiene things. I’ve had a few men caregivers where they’re like, “I can’t do this.” A lot of people want to put their elderly members into a home if they can’t handle it. That usually increases their chance of mortality or they don’t last as long, but they have no choice because they can’t. There needs to be more help and resources if we can.
That’s where long-term care comes in.
I was telling my husband, “We need to get this because most people don’t know how important it is.” Long-term care insurance is helpful.
Rachelle, you’ve spent your life caring for the elderly and we are grateful to you. I know you’re one busy lady and we’re going to wrap it up here because I know that you’ve got to get back to work. We appreciate the time that you’ve taken out of your schedule to visit with us and shed some light in this world about the world of dementia and caregiving. Thank you so much for caring and loving the way you do every single day. We are grateful to you and the service that you provide to others in need.
Thank you so much for having me and I would love to do it again. If we want to explore another topic, there’s so much that we can explore and I’d love to help out. If anybody needs any help, you can reach out to me at CASA Healthcare. Let us know.
Are there any other social media?
We’re on Facebook, CASA Healthcare. I’m bilingual. I’m Spanish, so I can help in any way. That’s why I named it CASA because any gringo knows what Casa means. It means home.
Go follow her and her business. Thank you again.
About Rachelle Baum
She’s a geriatrician and former pharmacist. Her research and clinical interest focus on the appropriate use of medications in older patients, particularly those approaching end of life. She’s the director of the Division of Geriatric and Palliative Medicine, joined McGovern Medical School in 2015 and is the Joan and Stanford Alexander Chair in Gerontology.