Horse Therapy/Equine Therapy/Therapeutic Riding

What do horses have to do with therapy? Well, for me, just looking at a beautiful huge gentle horse is enough to relax me as I always stare in awe at the beautiful creature looking at me from his/her huge dark eyes and long lashes. We are lucky in Columbus, Ohio to have so many things at our fingertips, and yet, if we  only knew what was out there to assist those in need, what a difference it would make!

Equine psychotherapy is a type of psychotherapy which provides troubled youth and adults to react when they are otherwise therapy resistant. A licensed Equine therapist works with family, children, and adults to help with most psychological needs. One example of a lesson is to ask a child what he or she believes the horse is thinking. The child most likely will point out the attributes they feel inside and give the feelings to the horse which gives the therapist better insight into the child's own feelings. An example of a lesson for families is to put a horse in the middle of a large circle and then ask the client to try to get the horse to move outside the circle. No amount of screaming, yelling, clapping (which are most likely tried at first response) works. The lesson here is that you cannot force someone to do something by yelling and screaming. Hmmm, great lesson there!

Just a few of the skills learned in Equine psychotherapy are: accountability, self confidence, problem solving skills, self control and emotional awareness.

Another form of horse therapy is called Therapy Riding. The benefits of therapy riding are two fold: therapy riding is often used for those with physical disabilities to strengthen core muscles, and improve balance, but also has the added benefit of the emotional response of just being with the horse and in control. Riding Therapy is used for clients with Cerebral Palsy, Post Traumatic Brain Injury, Spina Bifida, Neuromusular Disorder, Trauma Recovery and Autism. Horse riding has three dimensional movements that relaxes muscles, improves musculature flexibility and balance and also enhances spacial awareness.

We are fortunate to have such wonderful therapies here at our fingertips.The following are the horse therapy places in our area. I will mention they all raise funds for those that do not have insurance that cover the therapy and cannot afford it. As a matter of fact PBJ connnections has a Gala this Saturday, October 25th. Go to http://pbjconnections.org/news.php?newsID=102 for more information!!!

PBJ Connections (Equine psychotherapy)
9735 Jug St. Rd. NW
Pataskala, Ohio 43062
740-924-7543
www.pbjconnections.org

Hope Farms (Therapy Riding)
3738 Grandview Road
Grandville, Ohio 43023
740-321-1387
www.hopefarmgrandville.com

The Shane Center (Therapy Riding)
7908 Myers Road
Centerburg, Ohio 43011
8770815-4042
www.equineassistedtherapy.org

How to choose an aide/caregiver/unlicensed personnel for your loved one....

There are a lot of reasons why someone would need a caregiver. Perhaps they are not as independent as they once were and need some minor support such as help grocery shopping, or help cleaning. Maybe a family is helping to care for another family member and the family caregiver needs to get away for a few hours a week for a break ,or maybe your loved one had a catastrophic event and needs help with changing depends, help ambulating and bathing. A good caregiver can bring a world of change to a person as many times this can be their only socialization they have throughout the week. On the other end, choosing a bad caregiver can have catastrophic consequences from just giving off bad energy and bringing the person down, to not helping and just being a plain waste of money, to abuse, neglect and predatory behavior that can strip a person of their dignity, money and even health and well-being. 

So how do you make a good decision and how do you know who to go to? First, if you can get in touch with an agency that is knowledgeable about what care is needed at what level, what agencies are best, and are able to follow up appropriately, this would be the best way. Companies such as mine, IKOR of Greater Columbus helps to navigate the complex healthcare system and knows the good agencies in the area to help navigate the way. If you choose to find a caregiver on your own.... read on and be knowledgeable about your options. 

What do you mean my aide can't help my mom eat? .... 

There are different levels of care and not all home health aides can provide all care. 

DIFFERENCE IN AIDES

Companion care- This type of caregiver can NOT touch the client. Companions can do chores such as cooking, cleaning, grocery shopping, provide socialization, and sometimes drive the client to activities. 

Custodial care- This type of caregiver CAN touch the client and help more if the client is needed more advanced care such as: help with bathing, dressing, eating, walking, and/or toileting. 

There is not a huge difference in the cost between the two levels of care. If your family member has a condition that they will need increased assistance over time, go with custodial care for continuity. 

ALWAYS interview more than one company for services. Some require a minimum number of hours a week and some do not and just need advance notice before using them. For example, some people just need a ride to a doctors appointment once every few months. Different agencies are a better fit for both of these situations. 

QUESTIONS TO ASK DURING INTERVIEW

• Are you licensed? (make sure you check the license and is currently up to date). 
• Do you background check your employees? How far back is the background check? (It should be a minimum of 7 years). 
• Do you hire your own employees or are they contracted? (make sure they are their own employees)
• What is your turnover rate? What do you do to retain your employees? - One of the biggest problems in homehealth services is the turnover rate. Once your loved one gets used to one aide you don't want to have a new aide in every few weeks like a revolving door. And asking about turnover, they will be aware you will be watching for this problem and may match you with a more seasoned aide. 
• How will you communicate with me? Make sure they have a system to keep you up to date with what is happening with your loved one. 
• Other things to keep in mind are: Does the agency return your calls promptly? Do you get along and generally like the owner, case manager you are meeting with? Do they seem receptive and knowledgeable about your loved ones needs? 

WHAT ABOUT NON-AGENCY CAREGIVERS?

I typically recommend against using someone that is not affiliated with an agency. Some issues to keep in mind if you are considering a non-agency caregiver is: 

• Who will be providing oversight? 
• Who will conduct the background search to make sure this person does not have a criminal past? 
• What happens if this person gets injured on the job? Are YOU willing to pay for workers comp insurance so the person does not try to sue you or your loved one if injured while caregiving? 
• Will you document the care for tax reasons? Bills can add up quickly and can make a big difference during tax time if you can write off the expenses, or not write them off if you are not tracking expenses. 
• What about other insurance and bonds to protect your loved one that is provided by reputable agencies. 
• Again- not all agencies have these protections in place, make sure you do your due diligence! 

Functional Medicine

Functional Medicine is a newer term that is grabbing a lot of attention and momentum as people learn more about what Functional Medicine is all about! With the newer emphasis in healthcare on disease prevention, Functional Medicine is a growing field. Physicians time is very limited and they do not always have the time to talk to you about prevention. After all, it seems pretty simple to most: eat healthy, sleep, increase rest, decrease stress and most important is exercise! Functional medicine practitioners take this a step further though and are specially trained to address these areas of prevention and also take into account genetic, environmental and physical attributes and to address the unique health and vitality for each individual.
Traditional medicine focuses on treatment of  disease and  the extension of life, where as Functional Medicine focuses on the underlying cause of the disease and extension of QUALITY of life. The Functional Medicine practitioner addresses the whole person, not the disease or the isolated set of symptoms. When I see a client many times they are on so many medications that after assessing the medications there are almost always contraindications which cause other serious problems and are adversely effecting them. Functional Medicine Practitioners believe in traditional medicine in that they may write prescriptions for medications to improve health or if it is unsafe to come off the medication, but may offer alternative therapies, exercise, or change in eating habits to come off of the medication in the future.
As in any field, there are always good and bad people, I advise you to interview any healthcare professional you are considering going to and making sure they are a good fit for you personally and they align with the values and goals you have.

Click HERE to find a Functional Medicine Practitioner near you.

The Voice of a Nurse is Powerful. The Nurse's Experience and Expertise Provide the Knowledge and Professionalism to Make a Difference.

Advocacy is a broad term used for seniors that confuses both professionals as well as the lay person. “An advocate is one who pleads the cause of another and provides a voice for those who are not heard, making sure that important issues are addressed” (Mason, Leavitt, Chaffee, 2012). I have been a Registered Nurse for over 19 years and when I say “I’m a nurse” people know exactly what I do. I became a patient advocate over a year ago and now when I say “I’m a patient advocate”, people look at me and say “are you an attorney, are you a politician? What do you do? This is a good question and my answer is a lengthy one as this position has many different ways I promote health and independence. I am rare and much sought out for my knowledge, support and peace of mind I give my clients and families.

Not all patient advocates are created equal and we will discuss what exactly an advocate does in detail as well as what to look for in terms of experience and knowledge. Because patient advocate does not have any current regulations, anyone off the streets can call themselves an advocate. So, how do you find a qualified advocate and someone you can trust to take care of your client or loved one?
A good patient advocate should have an assessment process that address all aspects of the client’s needs: medical, physical, psychological, psycho-social and vocational needs. In order for someone to be truly happy all areas of their life need to be optimized. An advocate should have a holistic approach to assessing the person. An assessment of one to two hours is not ideal as it cannot address all aspects of the person’s life and most times cannot get to the root cause of the problem. I have been asked to only address one situation that is the “problem” and this simply cannot be done and should be viewed as a short cut that will ultimately have negative consequences on you or your family member. Some advocates will address the “one problem” just to get the client, but the family soon realizes that after that is addressed a new “problem” arises. This is because the underlying cause of the problem was not addressed.

An example of one common situation is when a family asked me to find a long term care facility for their parent who was becoming increasingly confused and the family was worried they were no longer safe to live at home. After conducting the full assessment it was determined the client was only slightly confused but was prescribed the same medication from different physicians not in communication and then was filling these medications incorrectly in his medication tray. After communicating with his physicians, figuring out correct medication, correcting electrolyte imbalance caused by the medication errors and then providing a medication dispensing tray to properly dispense the medication moving forward, the client was able to stay in his home. The son stated “he is acting like he was two years ago, I can’t believe the difference”. This would never have been caught if we would have just taken the family at their word and “found the parent a nursing home”. By trying to save money the family, it would have cost the family around $7,000 a month by an unnecessary long term care placement long before it was truly necessary.

When looking for a patient advocate look for a Registered Nurse or those companies that employ Registered Nurses as the advocate. R.N.s have been providing care coordination and advocacy since the turn of the century. Nursing defined by the American Nurses Association (2001) states: “Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human responses, and advocacy in health care for individuals, families, communities, and population”. Nurses are natural advocates through their education and training. The nursing process works for patient advocacy. Ask if the patient advocate follows the nursing process of: assessment, nursing diagnosis, planning, implementing and evaluation in addressing all aspects of life, not just one area.

Questions to ask a potential advocate are:
What degrees do you have? You should be looking for an RN or those who employ RNs. Not to say a social worker is not sufficient for some situations, but most seniors have many medical needs including multiple physicians, multiple medications, and chronic conditions that need managed. The Center for Disease Control and Prevention, (2011) cites almost 80% of older adults have one chronic condition and 50% have at least two; infectious disease and injuries take a disproportionate toll on older adults. As the story above proves, a social worker may be able to make an appropriate placement in a nursing home, but if you want to determine if a nursing home is even needed in the first place, an experienced RN is a better fit.
How do you refer to community resources? Some advocates get paid by making referrals to certain companies. If the service is “free” you may ask how they make money. Most people do not work for free. If I would get paid a certain wage by how many people I referred to X nursing home, or X home health agency, I may be swayed to refer a client to these agencies to make more money. Although the agencies where there is no reimbursement from outside agencies for pay are more expensive, they work for only you ensuring the referral they made is for only your benefit, not the benefit of their pocketbook.
Do you follow up after making a recommendation? Our lives and needs are constantly changing and what works best for you or your family today may not work best tomorrow. Ask your advocate if they will make follow up visits at least once a quarter to make changes in the plan of care needed to reach the long term goals set. A diligent advocate will check to make sure all referrals are fully vetted, meaning the advocate will make sure if they refer to a home health agency for aid work, that agency conducts employee background checks, and are fully bonded and insured and have a good reputation in the community.
Who are your employees? If the owner is a RN make sure the employees also have RNs as they are the ones working with you or your family. Ask if the employees are background checked and insured. You can also ask what training the employees have, and ask to meet the employee that will be working with you or your family member. If the company has nothing to hide they would be happy to oblige you in introducing you.
What is your area of expertise? Some advocates only work with people who are having an acute episode in the hospital. Some advocates specialize in geriatrics, or special needs children. Some advocate in finding physicians or coordination of care. Larger organizations may have many areas of expertise to draw from and have a wide array of knowledge and expertise. Just make sure you choose an organization that meets the needs you are looking for.
Lastly, meet the advocate in person and check out the license for restrictions with your state board of nursing. We all have instincts and let that guide you if this is the right person to care for you or your family member. Make sure your personalities are compatible and you can trust this person can work together with you to promote health and wellbeing. Ask about assessment techniques and don’t always go for the cheapest as discussed. You pay a lot for a car that will eventually break down, put priority on your health and well-being, you deserve the best. And, a good patient advocate, even if the up-front cost is more, can help save money by: keeping you or your family out of the hospital, keep out of long term care facilities, and you can’t really put a price on peace of mind.

“The voice of a nurse is powerful. The nurse’s experience and expertise provide the knowledge and professionalism needed to make a difference” (Hearrell, 2011).

American Nursing Association (2001). Code of Ethics for Nurses with Interpretive Statements. Retrieved from http://nursingwolrd.org/mainmenCategories/EthicsSTandards/CodeofEthicsforNurses/Code-of-ethics.pdf
Centers for Disease Control and Prevention (2011). Helping People to live long and productive lives and enjoy a good quality of life. Retrieved from http://www.cdc.gov/chronicdisease/resources/publications/aag/aging.htm

Hearrell, C.L. (January, 2011). Journal of American Nursing. Advocacy: Nurses Making a Difference. 37.1 (p. 71-73).

Mason, D.J., Leavitt, J.K., Chaffee, M.W.. Policy and Politics in Nursing and Healthcare (6th ed.). A framework for Action in Policy and Politics. Elsevier, St. Louis, 2012.

Don't Let Hospitalization get you DOWN

People go to the hospital for acute illness, surgery, or chronic conditions to get better. But, many times people who are treated take a step back in strength and independence. 'Functional decline is considered one of the top complications of hospitalizations in older adults" (King, 2006).
"One of the most important moves a hospitalized patient can make is to simply get moving again as quickly as possible, to whatever extent possible. Older people are at an increased risk typically because they start at a lower base line, so there is less reserve" (Mayo Clinic, 2012).
Hospital staff and physicians can be focused on the acute episode happening in the hospital, so it is important to be proactive and address activity with your physician. If you or your family member is on bed rest ask what activities you can do in bed to keep up strength.. Find out why you are on bed rest and if it is possible and safe to  get into a chair with assistance. Many times aids do not have the time to walk people as far as they can. Ask if it is safe for family to walk the patient. Take note of how far you or your family walked and try to walk a little farther with time.  Ask for physical therapy early in the process. Do not wait days to begin physical therapy upon discharge, by then it may be too late. It is always easier to maintain strength than to get it back.
Falls are another risk in hospitalized patients. So make sure it is safe to get out of bed or to get your family member out of bed. Actively advocate for them to get up as soon as safely possible and walk, walk, walk. it could be the single best thing to increase the immune system, increase strength, combat constipation, and put you or your family on the road to recovery!

Who's ready for SUMMER CAMP!!

The weather has warmed to a balmy 40 degrees today. Even though it is still cold out, spring IS coming, followed by summer! I see the promise of spring in the buds on my magnolia tree. I can now see the grass, dead as it is, it is now visible after too long. It is time to begin planning our summer fun!! It will come before we know it! I promise. 

Begin planning your summer activities now so you can begin the countdown to warm weather, fun and sun! Summer camp is a great way for children to have fun and feel a sense of independence. Summer camp can also be a great respite for parents who do not have the structure of school and need a little break of their own. Parents can take a vacation, actually get the house clean and errands done, or plain just rest and relax!

Camp for children with special needs in particular can be a wonderful experience. Children can connect with peers that have the same challenges they have, they can learn more about their disability or ideas from others on how to cope, or can just be themselves and be a kid. 

There are wonderful camps out there for children of all ages and special needs such as: asthma, autism, allergies, blindness, diabetes, behavior or social challenges, cancer, deafness, learning disabled and the list goes on. Most camps have registered nurses, older children with the same disability as leaders and mentors, and as much support your child needs to make you and your child feel safe. I have talked with many children that are not only excited to see old friends year to year, but look forward to hitting the magic age they themselves can be mentors and leaders. What a great way to empower your child! 

Check out this camp guide to find a camp that may fit your child's needs. Visit the websites listed in the guide for a camp near you. And ask as many questions as you can to feel comfortable it is the right camp for your child. 

Sign up for a camp. Make a paper chain. And count the days to sun, fun and freedom. The 2014 camp summer guide IS out, so summer WILL come! 

What is Power of Attorney and Advance Directives? Why do I need this?

I have heard it before.... "I don't need a Power of Attorney because if something happens to me my spouse will make decisions for me". Or I sometimes hear "I don't want to name someone Power of Attorney, they may take advantage of me". I hope we can understand better the importance of Power of Attorney as well as an understanding of advance directives.

Advance Directives - Umbrella term for the following:
Living Will- A written statement that shares your end-of-life wishes shall you become unable to make your own medical decisions.
Durable Power of Attorney- A person appointed to handle financial affairs including things such as: bill payment and handling of property.
Healthcare Power of Attorney - A person appointed to make healthcare decisions for you.
Do Not Resuscitate (DNR) - Must be signed by a physician that states you do not want CPR to save your life should something happen.

To answer the question of why you need a Power of Attorney if you have a spouse that can make decisions for you?

If you are incapacitated for a long period, example if you had a car accident that causes you to become brain damaged and either hospitalized for a long time or in need of long term care due to confusion due to a hit on the head. If a person does not have Power of Attorney, the spouse will have difficulty selling property in your name such as a car or selling a home (perhaps one income is not enough to keep up the home anymore) you will have difficulty if the house is in both names. In this case if Power of Attorney is not in place you may have to go to the courts to request guardianship which can be costly, can take away a lot of rights, may cause fights or disagreements in families and the disabled person (maybe you) must attend court and will be emotionally difficult for all parties involved.

I don't want to name someone Power of Attorney and have them take advantage of me.

I hope if you are naming someone to make important health or medical decisions for you, you are naming someone you trust! Absolutely trust! Otherwise you may not want to name that person as your POA. You can make special provisions in your documents and have what is called a Springing Power of Attorney that only "springs" into place when you become incapacitated. You can request either one or two physicians to state you are incapacitated. The only issue I see with this is if you are incapacitated you may be combative or disagreeable and not want to go with family to the doctor. Family has a hard time on determining how to get two physicians to sign the form if you are not hospitalized and you don't want to be taken to the doctor. This may land you in the Emergency room in order to get these two signatures or a call to adult protective services by family who knows you need help and not sure how to proceed. So, again, if you are going to name a POA, have someone you trust. If you cannot trust them when you are of sound mind, they are not someone you can trust when you are incapacitated.

When you name a Power of Attorney share with them your account information and draw up your living will so they can handle your affairs and end of life decisions in a way you want. It is extremely hard to make end of life decisions for someone else. If you make your wishes known you will not only have peace of mind your wishes will be followed, but you will take great burden off the person love as your POA in knowing they are doing what you want to have done and not having to "guess" at what you would want.

POA forms can be downloaded online. I recommend talking with an estate planning attorney to do this to guide you, give options, and answer questions. Your health and money are usually top priorities for people. Make sure you are prepared, you have planned for the unexpected and are knowledgeable about these matters that are paramount.

Health care POA information and forms for Ohio

Durable POA forms and information

What is a Professional Guardian? Why would you use a Professional Guardian?

A guardian is a person who has the authority to care for another person and/or the person's estate (guardian of person or guardian of estate or both). Guardianship is granted by the courts. In Franklin county this is the probate court. The National Guardianship Association noted that "three major groups of people often come under the authority of a guardianship. These groups include older adults with decisional disabilities, persons who have a developmental disability, and those who are mentally ill. Others who may also require the intervention of guardianship in their lives are people who have a head injury, or a physical challenge that causes the individual to be unable to make or communicate reasonable decisions". 

Alternatives to guardianship include: Power of Attorney, living wills, trusts, case management services, or representative payee. 

Many times family members are awarded guardianship to care for their loved ones. So, you may ask WHAT IS A PROFESSIONAL GUARDIAN and WHY WOULD ANYONE USE A PROFESSIONAL GUARDIAN  ? 

Lets start off by answering the question of what a professional guardian is. A professional guardian is someone who is not a family or friend who has the duty to care for another person or their estate. Through the Center for Guardianship Certification, professional guardians can be Nationally Certified (Nationally Certified Guardian, NCG). What this means is the person has worked for at least one year in a guardianship role, has studied and passed an exam on the standards, process, and ethics of guardianship and has passed a background check. 

Why would anyone use a professional guardian?

A professional guardian can be used for many different reasons. Some reasons include: 

• The person has no family or friends
• The family or friends live at a distance
• The family or friends want to continue being the family and friends and not take on the "guardianship role". This is an important reason and one many don't think of. When you love your family member and want to continue being the child, niece, brother or sister, parent, the ward can have a professional and knowledgeable guardian and the family member can just be the family and not have the difficult role of making major decisions for that person which can be very difficult. Think of your parent incapacitated in a nursing home. Wouldn't you like someone checking in on them and making informed decisions, so when you visit as a child, you can still be their child and not the guardian which can also preserve the parents dignity. 
• An aging parent is worried about who will care for their disabled child if something should happen to them. IKOR can assess and document the needs of the person before there is an emergency, so the parent or current guardian can have peace of mind that the person can be well cared for and have a plan in place shall something happen to them. 

If the family or friend wants to be the guardian but does not have the time, expertise, or live near enough to make the day to day decisions another option is to use an agent to guardian. This means another person can be the guardian, but the professional guardian is acting as the eyes and ears and using their experience and expertise to help the guardian make the best decisions for the person. IKOR of Greater Columbus has knowledgeable, experienced RNs on staff to help enrich the lives of wards and support family in this role.