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Cheat Sheet

Planning For Long-Term Care For Dummies

Planning for long-term care can be overwhelming. However, with a bit of forethought and a little investigation, you can breakdown long-term care planning into more manageable segments. Learn how to compare online information on long-term care planning, get ready to set in motion an advanced directive plan, find what types of benefits are available to older adults, quickly identify warning signs for older drivers, and handle safety issues in order to prevent falls for older adults.

Tips for Comparing Online Information about Long-Term Care

When researching online information about long-term care, you want to know that what you're viewing is quality information. Websites offer comparative rankings and user reviews of everything from restaurants to electronic products to colleges. And long-term care is no different. Dozens of sites offer comparisons of hospitals, nursing homes, and doctors. But how much weight should you place on any of these sites? And how do you compare the comparisons? What are their strengths and what do they lack?

The website of the Informed Patient Institute (IPI) can help. IPI is an independent, nonprofit organization created to provide unbiased information about health care quality online report cards from both governmental and private sources. It does not rate individual healthcare providers. The ratings are based on 15 criteria in six areas: the site's content, timeliness, presentation, ease of use, information to help make decisions, and special features.

IPI rates websites for nursing homes, hospitals, and doctors. The ratings range from "Recommended," including A (Outstanding), B (Very Good), and U (Recommended for Unique Content). Sites that are designated "Use with Caution" are ranked as C (Fair) or D (Poor). Finally, the really bad grade of F is "Not Recommended" or "Not Worth Your Time."

Checking how the rating system works

Start by entering your state and the type of provider you are investigating. For example, you live in Colorado and are looking at nursing homes. Eight websites are rated, with rankings from B to D. Each rating has sections called "What we like" and "What we don't like" and a link to each website so you can make your own judgment.

Medicare's site Nursing Home Compare gets a grade of "B." IPI likes its nationwide database, its inclusion of many different types of information, including results of state surveys, and quality of care. Nursing Home Compare uses a 5-star quality rating system, points out nursing homes with persistently poor performance, and makes the information available in Spanish. On the negative side, Nursing Home Compare does not have information on resident or family satisfaction with the homes, cost, or resident demographics. The rating of Nursing Home Compare is the same for every state.

Colorado's state website also gets a "B," but with different likes and don't likes. On the positive side, there is clear information about complaints, state inspection surveys, and other required reports. But it provides limited other information and "makes it hard to determine which nursing homes are best." The rest of the sites have different like/don't like profiles but there is a pattern in the "don't likes" of failure to provide information about costs, resident and family satisfaction, and outdated information. Many sites are disliked because they are difficult to navigate.

Websites with doctor ratings are generally prepared by specialty organizations or local physician organizations. For example, Michigan has 12 sites in this category, with no A rankings, three Bs, four Cs, and one each ranked U and D. In general, IPI doesn't like magazine sites that proclaim "100 Best Doctors in Your City" because they become popularity contests rather than quality measures.

Not all states currently have specific hospital ratings online, but all states will eventually be included. The states with current online hospital rating comparisons are: Alabama, Alaska, Arkansas, Arizona, California, Connecticut, Colorado, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, North Dakota , and South Carolina.

California, for example, lists 13 websites ranking hospitals — all Bs and Cs, with two Us (one a website on infections). The review of HospitalCompare, a Medicare site, likes its wide range of information, patient satisfaction results, and quality measures on treatment for diseases such as pneumonia and heart attack. But some information is too technical for the average user, and it's hard to determine which hospitals do better overall.

Looking at additional features

The website also has a series of tip sheets for handling quality problems in selected states. The first states on this list are California, Maine, New York, Pennsylvania, and South Carolina. And there are links to news reports about report cards, quality measures, and other topics, as well as a list of other resources.

IPI's website is easy to navigate and makes clear the strengths and limitations of websites that compare health providers. Users can comment on the site (but these comments are not published) and suggest other websites to be reviewed. One area that is missing, and may be included in time, is assisted living. Although you may disagree with some of the ratings, and will still need to do much more research, looking at the websites for nursing homes, hospitals, and doctors will prepare you to be a much more critical user.

Set Long-Term Care Planning in Motion

Advance care planning is one of those topics that tend to get postponed until there is a crisis, when the planning is no longer "in advance" but "right now." It's difficult enough to do without placing all the emphasis on a single momentous conversation. A study by Terri Fried and colleagues at Yale University School of Medicine found that many people go through six stages of change on the path to actually taking action to complete an advance directive and name a health care proxy. These stages are precontemplation ("I've never thought about it") to contemplation, preparation, action, and maintenance (reviewing plans).

Using this framework, Rebecca Sudore and colleagues at the San Francisco VA and University of California, San Francisco, Division of Geriatrics, developed a website called PREPARE to guide older adults and their families through these stages.

The tool guides users through the process of choosing a decision maker (a health care proxy), deciding what matters most in life, choosing flexibility for your decision maker, telling others about your wishes, asking doctors the right questions, and making a plan.

The type is large and each screen has one idea. Each stage of the process includes videos and stories about how individuals have made different choices. You can stop the process at any stage, save the information, and come back to it at a later date. Unlike some other tools, PREPARE starts with selecting a decision maker, which is a critical step, and may make it easier to go on to the next steps. It also includes giving the decision maker flexibility (or withholding that option), which is also seldom part of the process.

Early testing of PREPARE found that it improved the ability of users to move from precontemplation to contemplation and along the scale toward action. And even those who are not regular computer users found it very easy to use.

Long-Term Care: How to Find Benefits for Older Adults

Many older adults are unaware that they may be eligible for a range of benefits, and it's not easy to find them one by one. BenefitsCheckUp, a free tool from the National Council on Aging, is a good place to start. The website asks questions about you (or the person for whom you are seeking assistance) and then directs you to the agencies in your community that may be able to help. Some of the services include help paying for medications or food, legal advice, utilities, housing, in-home services, taxes, transportation, or employment training.

After you complete the survey, you will receive a written report and you can take the next steps by applying online or in person.

Your state or city department of aging may have a similar site that has additional local resources. For example, The New York City Department for the Aging has a guide called "Benefits for Older New Yorkers at a Glance."

Identify Warning Signs for Older Drivers

For older adults and their families, driving is often a flash point. When is it time to give up the keys? Waiting until there is a serious accident is not advisable. Most older drivers are safe drivers, but some monitoring and caution are appropriate. Here are some warning signs for older drivers from "We Need To Talk: Family Conversations with Older Drivers," produced by The Hartford.

The driving behaviors listed here could cause safety problems. They are ranked from minor to serious. Many of the less serious issues may be overcome with changes in driving behavior or physical fitness, while the more serious behaviors may require your immediate action. Since driving ability seldom changes drastically in a short time, you should be able to track changes over time to get a clear picture of overall driving ability.

Here's how to use this list.

  • Observe driving over time, keep notes to help you understand changes in driving ability.

  • Look for a pattern of warning signs and for an increase in the frequency of occurrence.

Consider these warning signs when observing older drivers:

  • Decrease in confidence while driving.

  • Difficulty turning to see when backing up.

  • Riding the brake.

  • Easily distracted while driving.

  • Other drivers often honk horns.

  • Incorrect signaling.

  • Parking inappropriately.

  • Hitting curbs.

  • Scrapes or dents on the car, mailbox or garage.

  • Increased agitation or irritation when driving.

  • Failure to notice important activity on the side of the road.

  • Failure to notice traffic signs.

  • Trouble navigating turns.

  • Driving at inappropriate speeds.

  • Not anticipating potential dangerous situations.

  • Uses a "copilot."

  • Bad judgment on making left-hand turns.

  • Near misses.

  • Delayed response to unexpected situations.

  • Moving into wrong lane.

  • Difficulty maintaining lane position.

  • Confusion at exits.

  • Ticketed moving violations or warnings.

  • Getting lost in familiar places.

  • Car accident.

  • Failure to stop at stop sign or red light.

  • Confusing the gas and brake pedals.

  • Stopping in traffic for no apparent reason.

A Home Fall Prevention Checklist for Older Adults

Long-term care planning has so many facets that it’s sometimes difficult to know where to start. One useful approach is to start with prevention. And in that broad category preventing falls is critical. Falls are not only harmful in themselves but they often lead to declines in independence and function. Most falls happen at home, so that’s where you should start.

Each year, thousands of older Americans fall at home. Many of them are seriously injured, and some are disabled. In 2002, more than 12,800 people over age 65 died and 1.6 million were treated in emergency departments because of falls.

Falls are often due to hazards that are easy to overlook but easy to fix. The following tips are from the Center for Disease Control and Prevention’s checklist for preventing falls at home. Use this checklist to help you find and fix those hazards in your home.

The checklist asks about hazards found in each room of your home. For each hazard, the checklist tells you how to fix the problem. At the end of the checklist, you’ll find other tips for preventing falls.

Floors

Look at the floor in each room.

Q: When you walk through a room, do you have to walk around furniture?

Ask someone to move the furniture so your path is clear.

Q: Do you have throw rugs on the floor?

Remove the rugs or use double-sided tape or a non-slip backing so the rugs won’t slip.

Q: Are there papers, books, towels, shoes, magazines, boxes, blankets, or other objects on the floor?

Pick up things that are on the floor. Always keep objects off the floor.

Q: Do you have to walk over or around wires or cords (like lamp, telephone, or extension cords)?

Coil or tape cords and wires next to the wall so you can’t trip over them. If needed, have an electrician put in another outlet.

Stairs and steps

Look at the stairs you use both inside and outside your home.

Q: Are there papers, shoes, books, or other objects on the stairs?

Pick up things on the stairs. Always keep objects off stairs.

Q: Are some steps broken or uneven?

Fix loose or uneven steps.

Q: Are you missing a light over the stairway?

Have an electrician put in an overhead light at the top and bottom of the stairs.

Q: Do you have only one light switch for your stairs (only at the top or at the bottom of the stairs)?

Have an electrician put in a light switch at the top and bottom of the stairs. You can get light switches that glow.

Q: Has the stairway light bulb burned out?

Have a friend or family member change the light bulb.

Q: Is the carpet on the steps loose or torn?

Make sure the carpet is firmly attached to every step, or remove the carpet and attach non-slip rubber treads to the stairs.

Q: Are the handrails loose or broken? Is there a handrail on only one side of the stairs?

Fix loose handrails or put in new ones. Make sure handrails are on both sides of the stairs and are as long as the stairs.

Kitchen

Look at your kitchen and eating area.

Q: Are the things you use often on high shelves?

Move items in your cabinets. Keep things you use often on the lower shelves (about waist level).

Q: Is your step stool unsteady?

If you must use a step stool, get one with a bar to hold on to. Never use a chair as a step stool.

Bathrooms

Look at all your bathrooms.

Q: Is the tub or shower floor slippery?

Put a non-slip rubber mat or self-stick strips on the floor of the tub or shower.

Q: Do you need some support when you get in and out of the tub or up from the toilet?

Have a carpenter put grab bars inside the tub and next to the toilet.

Bedrooms

Look at all your bedrooms.

Q: Is the light near the bed hard to reach?

Place a lamp close to the bed where it’s easy to reach.

Q: Is the path from your bed to the bathroom dark?

Put in a night-light so you can see where you’re walking. Some night-lights go on by themselves after dark.

Other things you can do to prevent falls

Here are a few more tips to prevent falls:

  • Exercise regularly. Exercise makes you stronger and improves your balance and coordination.

  • Have your doctor or pharmacist look at all the medicines you take, even over-the-counter medicines. Some medicines can make you sleepy or dizzy.

  • Have your vision checked at least once a year by an eye doctor. Poor vision can increase your risk of falling.

  • Get up slowly after you sit or lie down.

  • Wear shoes both inside and outside the house. Avoid going barefoot or wearing slippers.

  • Improve the lighting in your home. Put in brighter light bulbs. Florescent bulbs are bright and cost less to use.

  • Maintain uniform lighting in a room. Add lighting to dark areas. Hang lightweight curtains or shades to reduce glare.

  • Paint a contrasting color on the top edge of all steps so you can see the stairs better. For example, use a light color paint on dark wood.

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