Meeting Notes 2002

“Ask Your Pharmacist”

Most of us remember to take our medicines, but few realize that drug interactions could easily occur when we ingest certain foods, minerals, or herbal remedies.

“You need to check the paperwork that accompanies your prescription medicine for updates and warnings,” explained Mr. Tom Lynch, RPh, Pharmacy Manager, Longs Drugs Ewa Beach, one of our guest pharmacists. Lynch and Ms. Betty Iwai, RPh, Longs Drugs Sand Island Refill Center, stressed that we should never hesitate to ask pharmacists questions about any over-the-counter or prescription medications. The two recently participated in a week-long, state-wide medications assessment program administered by several local pharmacies and sponsored by HMSA, Health Plan Hawaii, and the Hawaii Pharmacists Association. “We’re still receiving inquiries,” explained Betty Iwai, referring to the high degree of interest and numerous requests for information.

Four members had submitted their personal medication lists for evaluation. Tom Lynch, a pharmacist for 30 years (most spent in Mililani), began the presentation by reviewing the regimens. Of general interest, he noted that anyone taking diuretics should drink lots of water. Potassium should be taken with food; otherwise, stomach irritation could occur. Routinely, pharmacists check newly prescribed drugs with those already on file for possible interactions.

By member request, Tom Lynch discussed a number of possible interactions, including the following:

Grapefruit. Recent studies indicate that a strong drug interaction could occur when eating grapefruit or drinking grapefruit juice and taking certain high blood pressure, heart, cholesterol-controlling, and other medications. “One glass of the fruit juice could stay in your system for four days,” explained Lynch. The interaction apparently occurs in the liver, where a component in the fruit inhibits an important metabolic pathway and prevents the medicine from being eliminated from the body, essentially causing an overdose without the patient taking extra medications. The popular fruit pomelo (jabong) could also cause similar interactions.

Calcium. May interfere with the proper absorption of some antibiotics, antifungal medicines, and beta-blockers used for the treatment of high blood pressure or heart disorders. If you regularly take calcium, ask your doctor or pharmacist about interactions.

Iron. May interfere with some antibiotic, high blood pressure, and cholesterol-lowering medications. Check your vitamins for iron and mention to your doctor that it is part of your daily regimen.

Ginkgo Biloba. Ginkgo possibly can increase the effect on blood-thinning medications and affect the body’s production and use of insulin. It may also interact with certain diuretics.

St. John’s Wort. Could significantly reduce the effectiveness of many medicines, including Coumadin, a blood thinner, and heart medications such as digoxin. Migraine and depression medications could also be affected.

Interactions do not occur in all situations, but individual precautions should be taken, as personal medication regimens and tolerance to substances differ. Betty Iwai and Tom Lynch stressed being informed. “Check the information sheets provided by your pharmacies, ensure that your doctor knows about any vitamins, minerals, or herbs that you regularly take, and don’t take any medications indiscriminately.”

“I have peace of mind knowing that we made a difference by helping someone. It’s the best reward,” said Lynch.

St. Francis Hospice

The St. Francis Hospice Program began in 1978, brought to Hawaii by Sister Maureen Keleher.

Elizabeth “Liz” Nelson, R.N., M.P.H., Hospice Liaison Nurse, has worked at St. Francis Hospice for 14 years. She described that St. Francis Hospice, the oldest and largest hospice program in the state, provides care for the terminally ill through home care, residential care, and inpatient care. The 12-bed Sister Maureen Keleher Center in Nuuanu opened in 1988 and the 24-bed Maurice J. Sullivan Family Hospice Center in Ewa Beach opened in 1997.

Ms. Nelson described that every situation, each person is different. “Forgiveness, thanks, love, goodbyes all become part of the process.” To help with issues of mourning and grief, hospice staff follow up with survivors for about a year. “We shouldn’t tell someone how to grieve, just support them. People deal with sorrow in many ways.”

If grief becomes debilitating or interferes with daily living, Ms. Nelson suggests that a physician, grief counselor, or other professional be immediately contacted. A bereavement network of professional counselors, physicians, and support groups is ready to help.

Several members expressed their profound appreciation for hospice programs and the help given their loved ones.

Healing Touch

Healing Touch at Wahiawa General Hospital began in the latter months of 2001. Since that time, the program has expanded to include a number of trained volunteer practitioners, weekly sessions, a course of study, a scholarship program, and more.

Ms. Jan Ching, a physical therapist with Wahiawa General Hospital’s Home Health Section, also coordinates the hospital’s Healing Touch Program. The program, available at several hospitals in the state, is also practiced throughout the mainland and in several foreign countries.

“It is not a religion and we don’t guarantee cures,” Jan explained. “Healing Touch complements traditional medical treatment by facilitating the body’s natural restorative processes. Trained Healing Touch practitioners utilize a gentle, non-invasive, hands-on technique to clear, balance, and align the body’s outer and inner energy fields. The therapeutic approach aims to promote self-healing by reducing pain and anxiety, inducing deep relaxation, and reactivating the mind/body/spirit connection. Jan described that receivers sometimes feel warmth or a tingling sensation. Some fall asleep during the session.

Because of the number of practitioners in attendance, one from as far as Kapahulu, all members had an opportunity to experience Healing Touch. “I could feel the stress leaving my body,” one caregiver described. “I feel so relaxed now,” another member expressed. “I can feel the warmth in my shoulders.”

Members were directed to sit on a chair, with their feet flat on the floor. The session started with a “cleansing” breath, exhaling from the stomach. While music played quietly in the background, practitioners proceeded to lightly place their hands at various Chakra points. “Chakra,” a Sanskrit word for “spinning wheel,” refers to the energy vortices that bring in universal energies to our bodies. Our Chakra system consists of seven major Chakras (crown, brow, throat, heart, solar plexus, sacral, and root, at the end of the spine). Numerous minor Chakras also exist. Practitioners are individuals who have completed at least a 20-hour course and have received approval as hospital volunteers. Course instruction includes Levels I, IIA, IIB, IIIA, IIIB, & IV.

Healing Touch influences the whole person on multiple levels and can promote, among other benefits, relaxation, pain control, healing, and anxiety relief.

Anyone interested in learning more about the Healing Touch program, course schedules, tuitions, or scholarships should call Jan Ching at 621-4289.

The Ponds at Punalu‘u

The senior living community offers rental options for independent and assisted living, short-term overnight stays, a care home for persons with Alzheimer’s or dementia, and a variety of services and amenities.

“The Ponds at Punalu’u will be celebrating its fifth birthday in June,” explained Ms. Angelina Hammond, referring to the senior living community nestled against the Koolau Mountains on the windward side of Oahu. Active seniors as well as those requiring assistance currently call The Ponds home.

Although constructed only five years ago, the architecture and landscaping reflect an earlier time, “old Hawaii, quaint and beautiful, with a country, laidback feeling,” described Ms. Hammond. The four-story structure includes a library, dining room, chapel, lounge/activity room, and 153 rooms, some with lanais that offer ocean or mountain views.

Basic services and amenities include: (1) three meals a day in the dining room; (2) regular housekeeping; (3) complimentary washers and dryers; (4) transportation to physician appointments; (5) social, educational, and cultural activities; (6) 24-hour emergency call system; and (7) utilities (except phone and cable).

Services (in addition to Basic) include: (1) weekly laundry of linen & personal items; (2) Ponds Express Family Connection; (3) wellness clinic; (4) medication administration; (5) personal care services (dressing, bathing, grooming, etc.); and (6) apartment maintenance and repair. Additional services, as listed below for The Gardens residents, may be contracted.

A secure area known as The Gardens has features to promote comfortable living for those dealing with Alzheimer’s and dementia. A figure eight-shaped walking path gives residents of The Gardens a chance to safely enjoy the outdoors. Semi-private suites cost approximately $124 a day. The price for a private suite is $220 a day. In addition to those already listed for Assisted Living, services and amenties include: (1) well-being monitoring, (2) case management; (3) nurse consultation & supervision; and (4) special structured activities to emphasize skills.

All lifestyle choices, services, and activities are offered for respite or short-term stays (ideal for caregivers who need some time off, or for persons recuperating from illness or surgery who need extra support). Daily rates start at:

• Independent Living – $55
• Assisted Living – $84
• The Gardens – $153

Small pets are welcome! The Ponds Express provides islandwide transportation for medical appointments, family visits, and frequent shopping and recreation excursions.

There are certain medical procedures that the nursing staff cannot administer. Please call Angelina Hammond at 293-1100 for more information, eligibility requirements, or to arrange a tour.

Body Mechanics I

The study of body mechanics combines a general knowledge of human anatomy, principles of posture, and body movement. Proper application can produce more efficient, energy-conserving, safe movement for the patient and the caregiver. “Good posture and an understanding of body mechanics can help anyone avoid injury and take advantage of body parts best suited for lifting, moving, and positioning,” explained Ms. Jan Ching, Physical Therapist at Wahiawa General Hospital.

Jan started the session by demonstrating the importance of good posture. “Don’t tip your bowls,“ she expressed while extracting three saimin bowls from a basket. “Your head, shoulders, and chest should be centered in a neutral position over your hips for best balance and least strain.” Slouching in a low soft couch or recliner can result in stretching the muscles of the back, shortening the stomach muscles, and placing a strain on the back and neck.

“Your head can weigh as much as a 15-pound bowling ball,” Jan described. “Imagine the pull it can have on the upper part of your body. Try to keep your back straight when getting off a chair or toilet.” Several members assisted the demonstration by holding a bowl over Jan’s head, another at her rib cage area, and a third at her stomach. Stooping caused all of the bowls to tip. “Our muscles have memory, so don’t be discouraged. Your old habits can be retrained by repetition and practice,” Jan explained in response to a member who mentioned that leaning forward while sleeping in a chair had left her husband with a hunched gait.

Getting patient into car:

• Patient’s back should be facing the car seat.
• Patient should walk back until they feel the seat against back of their legs.
• Patient should place hand on seat back, while caregiver stabilizes open door.
• Patient should squat and lower self into car seat.
• Patient should scoot back and slowly bring legs into car; caregiver carefully assists as necessary.

Body mechanics tips:

• Instruct patient to walk inside walker “box” to prevent stooping.
• Move close to patient or object to be lifted, keep back straight, use leg and arm muscles.
• When assisting patient to stand, caregiver should bend knees and instruct patient to place hands around caregiver’s hips — not neck or shoulders!

Always check with your doctor or physical therapist before initiating any new physical or exercise procedures. Stand up straight and your bowls won’t tip!

Body Mechanics II

By using proper movement, safe techniques, and assistive aids, caregivers and patients can minimize injury, described Ms. Jan Ching, PT, and Ms. Myra Nishimoto, OT, both with Wahiawa General Hospital’s Home Health.

As an Occupational Therapist, Myra instructs patients and their families on the best aids and techniques to increase, if possible, the patient’s independence and ability for self-care (grooming, bathing, warming food, cooking, etc.). Jan Ching, Physical Therapist, works to strengthen and increase a patient’s mobility through appropriate exercises and safe movements, using proper body mechanics. With other members of the Home Health team, the duo assists home-bound patients attain maximum mobility.

At times, a patient’s fear of falling or reinjury can affect their progress; Jan and Myra suggested that their physician should be contacted and a therapist assigned. Step-by-step instruction and practice should gradually instill confidence.

Our guest speakers presented (with visual aids) techniques of getting patients in and out of bed, in and out of the shower, and off and on wheelchairs. But as individual situations vary, only safety tips and a few methods will be listed. Also, some of the caregivers in attendance offered techniques they have used to make their daily routines a bit easier.

Getting off the bed. Don’t attempt to rise straight up from the bed; instead, roll patient on their side, if appropriate. Lower legs over the edge of the bed. Assist to a sitting position or have patient push up with their elbow. A bed rail, if available, can be used for leverage. Once upright, the patient should scoot toward the edge of the bed until feet are flat on the floor. Caregivers should stand close, with their knee placed lightly against the patient’s knee to provide a barrier of support, to avoid accidental movement off the bed, or to prevent knee buckling during patient’s attempt to stand. This “knee-to-knee” position should be used whenever patient is attempting to stand from a sitting position.

Getting on the bed. If using a hospital-type bed, sit where the bed creases to be in the proper position to lie down. On a regular bed, sit at the top third. This will avoid having to reposition patients once they are lying down.

Too low on the bed? A bed sheet should routinely be placed across the width of the bed for ease of repositioning the patient. This sheet can be used to pull the patient up toward the head board. Have the patient assist (if possible) by bending their knees and pushing up with the heels of their feet. Remove pillow from under the head before the maneuver. One caregiver mentioned that to reposition her father, she placed a pillow at the head board, then lowered the head of the bed. She would then use the draw sheet to pull her father “down hill.”

Bathing safety. Suggestions included replacing towel bars with safety grab bars and removing tub soap dishes that could be pulled from the wall. Install hand-held shower nozzles. Place grab bars horizontally inside the stall and vertically right outside the stall wall. Use tub benches and shower chairs to create a safer bathing environment. One caregiver mentioned that she purchased and attached a simple lever to the handheld shower to temporarily start and stop water flow. “Otherwise I would have to adjust the temperature whenever I turned off the faucet.”

For questions regarding Wahiawa General Hospital’s Home Health, please ask your physician or call the hospital at 621-4438.

Caregiver Resource Initiatives Project

Caregivers do not fall into any one clearly defined group. They are not just seniors, not just baby boomers. Some are young, some are elderly. They are men, women, working, not working. They run the breadth of our population.

“Our present long-term care system could not exist without all the services being provided by our family caregivers,” explained Ms. Gwen Ouye, Coordinator, Caregiver Resource Initiatives Project, State Executive Office on Aging. Ms. Ouye went on to say that, nationwide, family caregivers provide as much as 80% of long-term care or $200 billion a year in services.

Hawaii’s recently formed Caregiver Resource Initiatives Project coincides with the creation of the National Family Caregivers Support Program and federal legislation, which directs states to develop support systems, services, and products for caregivers. Ms. Ouye described that state agencies introduce legislation, draft policy, and disburse funds to the counties. In turn county agencies prioritize needs and provide services to the general public. Recently, federal funds received by Hawaii from the National Family Caregivers Support Program went to the four Hawaii counties. Honolulu County provided funds to: (1) Ohana Care, (2) Project Dana (Caring for the Caregiver), (3) Kalihi Valley Support Group, (4) Franciscan Adult Day Care, (5) Caregiver Respite in Kalihi, and (6) Alzheimer’s Association.

Ms. Ouye emphasized that creative solutions must be developed to address the variety of challenges and needs presented by our growing senior population. She described the many “first steps” being undertaken by the Caregiver Resource Initiatives Project. Perhaps most formidable is the effort to identify Hawaii’s diverse, sometimes hidden, group of family caregivers. “Many do not identify themselves as caregivers. Many are unfamiliar with the term.”

Ms. Ouye has been attending caregiver-related meetings throughout the state, gathering information, and circulating membership sign-up sheets for the Hawaii Family Caregivers Network. Enrollment data will serve as a valuable resource for locating caregivers, drafting legislation, proposing projects, and determining needs, but certainly will only offer a glimpse into the numbers of caregivers that exist locally. Members will also receive free newsletters on family caregiving issues. The first newsletter is scheduled to be released in August 2002. Ms. Ouye expressed that her office is currently developing a web site that will provide caregivers with information on who to call for services, legislative actions, helpful tips, timely news, and, possibly, a caregiver chat group.

In an effort to better understand the needs of caregivers, the Executive Office on Aging has funded a “Caregivers of the Elderly” survey. “We hope that this will also help determine some of the general needs. We know that caregivers have enough to do. Participation in the survey or the network will not involve attending meetings or any type of intrusion,” Ms. Ouye explained in response to an individual’s reticence to take on “more work.”

In addition to a number of other tasks, Ms. Oyue has been researching legislation and actions of other states. “We have a lot of challenges ahead of us,” she remarked. “I want to stress that your personal stories mean a lot to us. Your situation will help us identify the critical needs of Hawaii’s caregivers.”

Anyone interested in being included in the caregivers mailing list or learning more about the Caregiver Resource Initiatives Project should call Gwen Ouye at 586-0100.

‘Ohana Care: Attending to the Needs of the Caregiver and Care Receiver

“We work to assist the entire family (‘Ohana), all those involved in providing and receiving care,” explained Ms. Emeline “Eme” Kim, coordinator of Honolulu Gerontology Program’s ‘Ohana Care. “Because each situation requires dealing with people of different ages, schedules, and needs, we have to be creative, flexible, stretch our thinking to find workable solutions.”

The program, which began in January of this year, receives federal funding through Title IIIE of the Older Americans Act and National Family Caregivers Support Act as administered by the Elderly Affairs Division, City and County of Honolulu. It is one of a variety of programs available at Child and Family Service (CFS), a private nonprofit organization that has existed in Hawaii since 1899.

‘Ohana Care’s “big picture” approach combined with their flexible, innovative application offers clients a variety of options, including training, subsidies, case management, a support group, and counseling for those who call in desperation seeking assistance. Much time is spent on the telephone talking to caregivers or meeting them at various locations. Ms. Kim explained that no fees are required, but donations are appreciated. “Services do not vary based on donation,” she explained.

With a background in psychology, program development, and case management, Ms. Kim and her staff have taken the project, in just six months, from a no-client, in-development phase to one with a waiting list. The project has recently been renewed for the next fiscal year.

Caregivers must be 18 years or older and provide regular, ongoing, unpaid care to an individual 60 years or older, who requires assistance to continue living independently (not in a foster home, care home or nursing home). Caregivers do not need to be related to the individual.

An interview is conducted with the care receiver and caregivers to determine issues, areas of need, qualifications, and to gather information for federal funding requirements. A flexible care plan is then developed. One caregiver needed transportation for a week of patient doctor visits; an elderly, non-English speaking individual required a translator to understand details of a medical procedure; some caregivers need help with house cleaning and other chores. “We help the caregiver find solutions best suited to preserving their caregiving situations.”

For those interested in employing nurses aides or others to help with caregiving, ‘Ohana Care will assist by making a referral to Honolulu Gerontology Project’s Caregiver Respite Program (CRP), which maintains a roster of aides. Criminal checks and other screening have been conducted, but Ms. Kim strongly recommends that caregivers do their own checking, as no guarantees are made by Honolulu Gerontology Program. The caregiver is expected to be the employer, responsible for obtaining a general excise license, insurance, creating a schedule of federal and state tax withholdings, and other requirements. “An accountant would be able to help you set up a system,” Ms. Kim responded when asked about the complexity of establishing the employment position. “We just help you get started by providing you with an initial list of persons to interview.”

‘Ohana Care also conducts a support group, jointly with CRP (543-8405), for two hours, twice a month. Guest speakers present information on a variety of topics. Anyone interested in learning more about ‘Ohana Care or talking to a case manager should call 543-8468.

Catholic Charities Hawaii

Joyann Yoshikawa has worked at Catholic Charities Hawaii for nearly 20 years, most recently as the organization's Elderly Services Service and Respite Unit supervisor. As a former primary caregiver, she has a keen understanding of caregiver issues.

Catholic Charities Elderly Services (CCES) was established in 1985 as an affiliate agency of Catholic Charities of the Diocese of Honolulu, a private, nonprofit agency. The agency's goal is to delay or prevent institutionalization of our growing elderly population by providing supportive services to prolong independence for individuals 60 and older. "Many people still think that we only service Catholics. But our service extends to all," Ms. Yoshikawa expressed. We make no religious, ethnicity, disability, nationality, or gender discriminations."

The Service Unit provides in-home and community based services which include:

• Chore/housekeeping
• Shopping
• Escort
• Letter writing/reading
• Interpreting/translation
• Advocacy
• Para-professional counseling

Ms. Yoshikawa explained that a wait list currently exists, but individuals should not hesitate to inquire about services or to put their names on the list.

The Respite Unit provides the following services for caregivers of any age who are caring for elders:

• Information and referral on respite and other services
• Respite linkages
• Para-professional counseling to caregivers on how to hire a respite worker

Catholic Charities Hawaii began providing caregiver respite services in the late 1980's, one of the first organizations in Hawaii to offer such options to caregivers. The organization also maintains a list of nurses aides, RNs, and chore workers for private hire. Criminal checks and preliminary screening have been conducted. Ms. Yoshikawa or a member of her staff will assist caregivers with interviews and provide some monitoring of worker performance to ensure "a proper fit between the care receiver and care provider." She stressed caution and the need for strict supervision by family members, guardians, or other trusted individuals to ensure that frail, vulnerable elderly do not experience any type of abuse or neglect by hired care providers.

The organization has prepared a pamphlet, "Respite Connection," which provides general information on respite worker qualifications, legal requirements, benefits, hiring and keeping the worker. Pamphlets are available at our library at 823 Olive Avenue for anyone interested in a copy.

For questions on services, charges, or just to learn more, call Catholic Charities Hawaii at 595-0077, ext 104/105.

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