Meeting Notes 1999

Long-Term Care Insurance: What? Why?

Mr. Gil Sanchez, consultant with John Hancock Insurance and part-time caregiver, gave us a very informative, entertaining presentation on long-term care insurance. In addition to answering insurance questions regarding individuals presently receiving care, he stressed that caregivers, too, need to examine their own options for future care. “We all could use a little bit of our estate to protect a larger part of that estate,” he suggested.

Eligible applicants must be between 18 and 84. Insurance underwriters use various means to evaluate applicants’ eligibility, including the six Activities of Daily Living: (1) bathing, (2) dressing, (3) eating, (4) toileting, (5) transferring, and (6) continence. Note: The editor’s parent would not be able to meet criteria requirements as a new policy holder because of existing dependency on a walker.

John Hancock Long-Term Care Insurance covers all levels of nursing home care (skilled, intermediate, and custodial). It also allows for care to be received in sites other than a nursing home, such as a person’s own home, an assisted care living facility, or an adult day care center. Anyone with questions about qualifications, premium costs, and coverage should call their insurance representative or Gil Sanchez at 979-3350.

As usual, members feasted on an array of delicious snacks during the discussion half of the meeting.

Hospice Hawaii Celebrates 20th Anniversary

Our guest speaker, Reverend John Lunn, like his employer, has been associated with patient care and end-of-life issues for more than twenty years. He has worked as a nursing supervisor, long-term care facility manager, and now ordained Lutheran minister and Spiritual and Bereavement Counselor for Hospice Hawaii.

According to Reverend Lunn, the hospice alternative allows a patient, whose illness has been deemed incurable, to guide his or her final days. Working with the patient’s physician, a team of trained professionals and volunteers can attend to pain relief and offer spiritual and emotional comfort and support.

In addition to at-home care, Hospice Hawaii serves patients in hospitals, nursing homes, or at the organization’s Hawaii Kailua Home, a five-bedroom house equipped to provide 24-hour care for a limited number of patients. Working with the patient’s physician, a team of trained professionals and volunteers can attend to pain relief and offer spiritual and emotional comfort and support. The organization also offers bereavement counseling, a bereavement camp for children, workshops, art and music therapists, educational presentations and videos, and assistance for caregivers.

All members expressed much appreciation for Reverend Lunn’s presence and his very informative, reassuring presentation. Anyone with questions should call Hospice Hawaii at 924-9255. Reverend Lunn’s extension is 237. Hospice Hawaii after hours, weekends, holidays: 945-1101.

WGH Vision for Health Care in the 21st Century

Milton Sagon, caregiver and Vice President for Development and Community Relations at Wahiawa General Hospital, presented the Wahiawa Hospital Association’s vision to bring 21st century health care to Central Oahu and the North Shore. The vision includes continued service in Wahiawa and the development of the Pacific Health Community at Koa Ridge.

Area residents have long been aware of proposals to expand; public discussions have been held, and informational presentations given. Much work has been done to ease the vision toward reality.

Several sites had been considered for the medical mall. But the Koa Ridge location, south of Wahiawa between Waipio Gentry and Mililani, provided the most opportunity for innovative expansion. Through partnering with other health care providers, a medical mall could be developed in phases, with state-of-the-art services and facilities.

Milton explained that several key bills are now before members of the legislature, including one to provide a fast track permit process for health care providers, encouraging them to invest in the medical mall.

In response to an inquiry on groundbreaking, Milton mentioned that the goal is to begin in 18 months. With the support and assistance of many, this timeline could be accomplished. After the presentation, Milton distributed refrigerator magnets illustrated with the hospital logo and the words, “A new health care network. ‘Be Audacious!’ Wahiawa Hospital Association.” For specific information on the hospital’s vision and proposals, call Milton Sagon at 621-4416.

Touring the WGH Long-Term Care Facility

Ms. Becky Canon-Fratis met us at the first floor main lobby located adjacent to the large dining room/multipurpose room. We started our tour with this room, which serves not only as a dining area but also as a gathering place for residents to enjoy performances by visiting entertainers, play bingo, attend Sunday church services, and participate in a number of other scheduled activities. A smaller dining area also exists on the second floor, decorated with framed elaborate puzzles pieced together by residents.

We followed Becky as a group, stopping to learn about the tub room, employee lounges, and the various available services. Staff offices occupy rooms on both floors, creating easy interaction between employees and residents. The 93-bed facility contains rooms with four, two, and one-bed accommodations. Families often provide private television sets for in-room viewing. Laundry services for personal clothing are also available.

At tour’s end, members gathered at the second-floor lobby to ask questions about admittance, length of stay, number of residents, and methods of payment. Becky explained that some of the residents receiving physical therapy or other rehabilitative treatment return home after a temporary stay.

Infrequently, when living space becomes available and no hospital patients are awaiting transfer, those living in the community, whose names have been placed on the waiting list, can be accommodated. Methods of payment for residency include private pay, cost-sharing, Medicare, private insurance, and Medicaid.

After the tour, members gathered in the hospital’s board room for snacks and additional discussion. We all appreciated the warm welcome we received and agreed that we had gained much from the time spent with Becky. Anyone with questions on the Skilled Nursing Facility should call Becky Canon-Fratis at 621-4389 or 621-8411 (switchboard).

Time Out Options for Caregivers

For Lance Evers, Director of Respite Nanea, and Rosanna Evers, Director of Social Services, Waianae Coast Comprehensive Health Center, helping caregivers and their families has become a way of life.

Rosanna has been with the Waianae Coast Comprehensive Health Center since 1986. The Center also manages Hale Kako‘o Respite Center in Alewa and, since May 1, 1999, Hale Pekelo in Wahiawa. At present, the latter program can accept only a few individuals, but efforts are underway to enlarge the program to accommodate more clients.

The Waianae Coast weekday program provides a protective environment, personal care, and supervision for frail elderly, disabled, or memory-impaired adults. Program activities provide opportunities for participants to socialize with peers and members of the community. Anyone interested in the services offered or or application procedures may call 696-4944. The center is located at 86-260 Farrington Highway. The program receives clients from 8:00 a.m. to 4:00 p.m. Monday through Friday.

The Hale Kako‘o Respite Center provides day care services for adults with impaired memory associated with Alzheimer’s disease and related disorders. The program operates Monday through Friday from 9:00 a.m. to 5:00 p.m. A written application, face-to-face screening interview, TB clearance, and doctor’s form and letter are required for admittance. Call 595-0556 for more information.

Lance Evers can be reached through the Physicians Exchange (524-2575). Created in 1986, Respite Nanea distinguishes itself from other programs by its flexibility, fast response, and availability of private respite homes located throughout the island. Trained personnel can also be sent to the client’s home to assist families on an as-needed basis. According to Lance, “Respite Nanea is designed to help families by offering 24-hour care on a flexible basis.” Leave a message with Physician’s Exchange (524-2575) and Lance will call you back.

Interim Health Care

Ms. Leilani Wagner, RN has worked in the home health business on the mainland and in Hawaii. She has been with Interim Health Care for about two years.

The national agency, headquartered in Florida, has been providing services in Hawaii since 1977. They are presently the largest home health agency in Hawaii, with offices on Maui, Molokai, Kauai, and the Big Island. The organization is Medicare and Medicaid certified, state licensed, and JCAHO accredited. Their health care professionals are insured and bonded. The agency provides a number of services:

Questions during the presentation included: Can Interim provide 24-hour assistance? What are the charges for private pay?

According to Ms. Wagner, Interim does provide assistance on a 24-hour basis. This is accomplished by having two or three rotating shifts. Charges, in general, are $20 an hour for nurse’s aide services and $15 an hour for choreworkers. Don’t hesitate to discuss costs. Once a call is received, a free patient assessment is scheduled to determine the extent of services required.

Anyone interested in receiving more information should call 955-1102. The statewide services are available 24 hours a day, seven days a week.

Caring for Our Elders

Ms. Kathy Komori, Director of the Waipahu Hongwanji Mission Adult Day Care Center, has been working with Hawaii’s elderly since 1983. Her experience includes positions at two Kuakini Hospital day centers (Hale Pulamamau and St. Timothy’s Adult Day Care Program) and at Hale Kako‘o Respite Center. The latter respite center provides day care services for adults with Alzheimer’s disease and related dementias.

The Mission’s center opened its doors to applicants for the first time in December 1998. Located on Kuhaulua Street in Waipahu, the newly built facility is less than a mile from the Waikele Shopping Center. It is the first Honpa Hongwanji Mission facility of this type statewide. The center is licensed by the State of Hawaii, Department of Human Services to accommodate 35 persons a day.

Kathy stated that applicants do not have to be affiliated with the Hongwanji Mission and do not have to reside in Waipahu to be eligible for the program. Anyone who is at least 55 years old and meets the criteria for adult day care service may apply. The cost is $600.00 a month for full-time enrollment and $35.00 a day for part-time. The fee includes lunch and snacks. Participants may arrive at 6:45 a.m. and remain until 5:00 p.m.

According to Kathy, the facility provides a safe place for those who may be disabled or frail and need some type of assistance. The Monday through Friday program offers activities, conversation, and entertainment with “a very hardworking, caring, and compassionate staff” of certified nurse’s aides and/or activity assistants experienced in working with the elderly. In addition to snacks and lunches, the daily schedule includes range of motion exercises, entertainment, arts and crafts, “talk story” sessions, rest periods, sometimes guest speakers, and sing-a-longs.

Kathy displayed, among other crafts, a bright red, expertly crocheted pot holder and a multicolored drawing prepared by clients of her day program. She expressed, “Our long-term goal is to have people want to join our program and be part of our group because they have heard from others that it is a good place to be.”

Bathing Strategies for Patients with Dementia

The Alzheimer’s Association sponsored an instructional session on “Bathing Strategies.” Two occupational therapists conducted the seminar held at the Rehabilitation Hospital of the Pacific.

Why a session on bathing?

For the frail, elderly, and those with dementia, bathing can become a major event that requires bathroom renovations, installation of safety equipment, and learning safe ways to get in and out of the tub/shower.

Those with dementia may no longer understand the concept of bathing. Fears and confusion become part of the activity in addition to loss of privacy and lack of control. Attempt to understand the fear. Does it stem from earlier memories associated with drowning, cold or scalding water? One male patient’s lack of self-recognition led to fears of the “man” always in the bathroom. Once the mirror was removed, the situation improved. It was explained that a step-by-step approach works best. Examples given include: (1) “Let’s get clean now,” (2) “Let’s walk to the bathroom,” (3) “Let me help you undress, so you can wash.” Allow the person to maintain as much independence as possible. Try to keep bathing a pleasant experience. For those with dementia, bathroom renovations and changes should be made as early as possible.

Bathroom safety.

Never leave a frail person or someone with dementia alone in the bathroom! Remove scatter rugs that can cause falls. Remove anything that can be swallowed or cause injury. Add grab bars and transfer benches. Change towel bars to grab bars ensuring they are secured on studs! Devices such as hot water thermostat adjusters and handheld flexible shower hoses with on/off switches are available for purchase.

Getting in and out of the tub.

Never pull arms! Dislocations can easily occur. Someone frail can assist by ensuring that their feet are tucked back to have “toes under knees,” which creates a leaning forward, “nose over toes.” Once in this position, the caregiver should place one hand under a buttock and the other at the back to lift and transfer to a wheelchair or shower bench. If there is hesitancy lifting or transferring, do not do it alone! Seek advice from therapists to avoid injury.

Call the Association for their schedule of upcoming classes at 591-2771.

Caregiving from a Husband’s Point of View

In 1980, Tom noticed changes in his wife’s behavior. At the time she was 55 years old. Tasks she had previously done with ease seemed to bring struggle; commonplace chores caused difficulty.

“I think there is something wrong,” Tom would repeatedly state to various physicians, whose examinations revealed nothing. In 1986, almost six years after his initial concern, testing indicated that Tom’s wife, Evelyn, probably had Alzheimer’s Disease.

Tom retired from his career and for the next few years, he and Evelyn traveled together to Japan, China, Europe, and throughout the mainland, places they had always intended to visit, to view the leaves of fall and mingle for a time in other cultures. Fellow travelers assisted, when necessary, but increasingly Tom’s responsibilities grew.

To keep up with the changes wrought by the disease, Tom and family members read, studied, and learned not only about the disease but also topics that no caregiver ever imagined would be necessary. Trial, error, and lots of study produced more efficient ways to handle daily care from toothbrushing to sitting upright in a chair. “Friends helped and family provided support and assistance.”

Lessons learned in the past 20 years have been many. To assist others in similar situations, Tom agreed, for the first time, to publicly discuss the knowledge he has gained. The most important lesson? “I needed to understand that any negative reactions I experienced came from my own attitude. She can’t help it.”

Also important is that all caregivers must “take care of themselves, they must have their own time.” For Tom, playing golf with friends or a short trip to another locale is made possible by family members “stepping in” as primary caregivers.

The presentation inspired members to reveal their own intense situations and concerns. “I have to understand my own attitudes,” stated one member, “and remember she can’t help it.” Everyone agreed that much insight had been gained from Tom’s presence.

Editor’s note: Our first shelf at the lending library will be dedicated to “Tom and Evelyn.”

Project Dana - Selfless Giving

Project Dana places no age or income requirements on the people they help, according to our guests, Cyndi Osajima, Project Volunteer Coordinator; Rusty Nakagawa, Wahiawa Coordinator; and Harumi Nakatani, intern from Japan.

This year, members of Project Dana celebrate ten years of providing service to the community. The Sanskrit word Dana (pronounced “Donna”) refers to selfless giving of time and energy with no expectation of anything in return.

The project emphasizes the concept of caring and began with the ideas of two civic-minded women and the efforts of members from the Moiliili Hongwanji. Calls for assistance are received in the main office, assessed, and referred to site coordinators or other agencies.

The interfaith cooperative effort includes members from 21 temples and churches statewide. Volunteers offer social support to the frail elderly, homebound, and disabled. Rusty Nakagawa explained that after receiving a referral, he will schedule an assessment visit and, if appropriate, assign a volunteer for once-a-week visits or other tasks. “We try to match people of similar interests, hobbies, and occupations,” explained Nakagawa. Often friendships form through the arrangement and visits continue for years.

In addition to home visits, the project offers telephone visits, caregiver relief, minor home repairs, light housekeeping, and hospital and care home visits. Volunteers do not handle money, dispense medications, provide personal care, or remain overnight.

All who participate in the project receive training and education on various topics, including being a “caring presence.” The oldest volunteer is 96 years old. The youngest, a four-year-old, accompanies her volunteering mother.

Also, Project Dana has been contracted by the State of Hawaii, Executive Office on Aging to locate eligible families for a one-time $600 “service subsidy” grant to be used expressly for the purchase of respite services, medical treatment, or medication for individuals diagnosed with Alzheimer’s Disease or related dementia.

Anyone interested in receiving more information on Project Dana’s services or one-time subsidy should call the project office at 945-3736.

Skin — Our First Line of Defense

Sometimes pressure ulcers occur despite our best efforts.

Pressure ulcers, also referred to as bedsores, pressure sores, or decubitus ulcers, are places on the body where the skin and tissue have started to die. Prolonged pressure from immobility cuts off the skin’s blood supply, which could result in the skin’s death followed by a pressure ulcer.

Patients that spend a lot of time in bed or in a chair, especially if they cannot move or turn themselves, are at greatest risk for ulcers. Shearing or friction of fragile skin against bed sheets can also cause skin breaks.

Check daily for warning signs of beginning ulcers which include: (1) skin that stays red longer than 30 minutes; (2) skin that feels warm or firm to the touch; (3) skin that is blistered or broken.

For those confined to bed, pressure ulcers can often form at the shoulders, tailbone, hips, ankles, and heels. Buttocks, elbows, and the area between the knees are prone to ulcers for those who spend a lot of time in a chair.

A few prevention tips include:

• Keep bodily fluids off the skin.
• Change the person’s position at least every two hours to relieve pressure. Wiggle arms, boost up in the chair, move legs to keep blood flowing.
• Reduce friction and shear on the skin by using a turn sheet and keeping the head of the bed under 30 degrees.
• Provide nutritious food and ample fluids.
• Make a tight, wrinkle-free bed, absent of crumbs and other irritants.
• Use moisture-absorbing clothing.
• Use a moisturizing lotion. Note: Members report using Moisturelle, Vaseline Intensive Care, and other lotions to keep skin supple.

The visible ulcer could be just the tip of the problem. At the first signs of skin problems, contact your doctor or nurse. Do not use heat or drying agents — it could worsen the situation.