By Theresa Pichelmeyer, EdD, RN, President and CEO of Valley VNA Senior Care

National Health Care Decisions Day is April 16, a day set aside to educate and empower people and their family members about the importance of advance care planning. The Power of Attorney for Health Care, or POA-HC, is a document that any adult, age 18+ (the “principal”) completes and signs, naming another individual (the “agent”) to make one’s health care decisions when the principal might become unable to make those decisions for him or herself.

Most people never plan on becoming incapacitated. Many think a POA-HC is just for old people. However, every adult should think about a few situations where they, at any age, might need a POA-HC: a car, ATV, or snowmobile accident that leaves you in a coma; a prolonged bad reaction to a drug; an injury sustained in a violent crime; or a life-threatening event, like a stroke or progressive disease. Therefore, all adults, or a loved one who is becoming an adult, needs a POA-HC.

There are several important reasons why every adult, age 18 or older, should complete a POA-HC. The “next of kin” idea simply does not apply in modern times. In Wisconsin, a family member is not automatically authorized to make health care decisions for an adult relative unless he or she completes a POA-HC document naming that person as one’s agent. Secondly, it’s not just about end-of-life care. Hopefully the sick or injured person will recover from his or her health crisis. The POA-HC is about receiving the care one needs and wants when he or she can’t speak for oneself. Also, a person’s family may have to go to court to appoint a guardian without a POA-HC in place. This process can be costly, time-consuming, cumbersome, and emotionally draining.  And then, a court-appointed guardian may not be the person the principal would have chosen. The appointed person may have no idea of the person’s wishes or what care he or she might or might not want.

Every adult should choose his or her agent carefully. A person’s health care agent, upon being activated, might make some very important decisions regarding choosing a doctor, treating a medical condition, managing pain, maintaining or refusing artificial hydration and nutrition, and consenting to or refusing surgery. Principals should be confident that their agent will follow their wishes. An agent should be able to resist pressure to influence a person’s choices from friends and family. Nor should the agent make decisions about a person’s care according to his or her own ideas. An agent should be capable of dealing with hospitals, doctors, and stressful health care situations and understand the choices surrounding the principal’s particular injury or condition. A health care agent should be assertive. He or she should be able to ensure that the principal is being treated properly and insist on full, open, and transparent communication with his or her care providers. A chosen health care agent should live nearby or be willing to travel if needed.

To be deemed incapacitated, two physicians must personally examine you and certify that a person can no longer receive, evaluate, and communicate his or her health care wishes. All adults should rest assured, despite creating the document, they keep their right to make their health care decisions as long as they are able. They can also update their POA-HC at any time to change their agent or add specific instructions. If a POA-HC is activated and a person regains his or her ability to make health care decisions, the POA-HC can be rescinded.

How to Prepare and Submit a POA-HC

• Download the POA-HC form from the Fox Valley Advance Care Planning Partnership website. You will need witnesses to your signature, but you do not need a lawyer’s or notary public’s s
• Take time to discuss your wishes. Don’t just fill out the form. The POA-HC is only as good as the effort you put into thinking about your own wishes and communicating them to your agent.
• Talk with your entire family about your wishes. When everyone is on the same page, it prevents family discord in the future. In a chaotic and emotional time, your pre-planning will provide an element of peace.
• Hand deliver your completed POA-HC to your doctor’s office or mail or fax it to your health system’s medical records office. Keep a copy for yourself and send one to your health care agent.
• In Neenah, Valley VNA Senior Care helps people of any age complete their POA-HC and can help with questions regarding Advance Directives. Call to set an appointment at 920-727-5555.

Theresa Pichelmeyer, EdD, RN, President & CEO

Valley VNA Senior Care

In January 2022, Valley VNA will turn 114! We are proud of our steadfast commitment to the health and happiness of older adults in our community and their families.

Steadfast means resolutely or dutifully firm and unwavering; the resolve not to be persuaded or worn down to be something we are not. When I set foot inside Valley VNA each new day, these are some of the things I see, hear, and experience. These things are infused with loyalty, commitment, and devotion to the people and culture of Valley VNA. Put another way, they really show what we stand for:

On December 9, the community of Valley VNA celebrated 30 years of Love Light Angels, the opportunity for residents, families, and community members to dedicate an ornament on our Love Light Angels tree in honor of someone special. Three decades in, and our community remains steadfast in support of Valley VNA’s special Christmas tribute.

Valley VNA volunteers are some of the kindest people I know. They remain committed to safely engaging with our clients and residents, from spiritual companionship to rickshaw rides (during the biking season) and other opportunities like gardening or reading. We are especially proud of Valley VNA volunteers who discover the passion we have for our vocation. In fact, two of them of them recently accepted employment at Valley VNA, and we couldn’t be happier:

• Tom Lyons, husband to kind and musical Carol who lived with us before her death in 2020, is also known to all of us as a generous and skillful rickshaw pilot and facilitator of our men’s caregiver support group. Tom has begun caregiver training to become a member of our direct-caregiving staff at Valley VNA.
• Kristi Branchford, also known to Valley VNA as a rickshaw pilot and supportive volunteer, has joined our staff as the new Valley VNA Senior Living Advisor. She takes up a key position to introduce potential new residents and families to Valley VNA.

When there is a call for more hands on deck, especially during this difficult era that combines pandemic precautions and staffing challenges across the health care field, our existing team members consistently step up. I see staff members pitching in to fill open shifts to support one another—and the residents and families we serve.

Many of our community programs are up and running, from Foot Care Clinics to Respite Care Programs and Meals on Wheels. As humans, we know that the need for health and social connections do not dissipate during difficult times—they become more important than ever.

Thank you for your steadfast support of Valley VNA. As we strive to serve, you consistently respond with kind words, staff treats, and support for our mission.  Happy holidays and best wishes for a good 2022—Valley VNA’s 114^th year! Know that the people of Valley VNA remain steadfast in our commitment to our community and those we serve.

By Cami Tesch, Student Nurse

College of Nursing, University of Wisconsin Oshkosh

Alzheimer’s and Dementia

Alzheimer’s and dementia are often used interchangeably. However, think of dementia as a big umbrella with categories underneath it. Alzheimer’s is one of those categories. Dementia is characterized by memory decline, while Alzheimer’s is decreased cognitive ability caused by increased plaques and cell death in the brain.

It was reported that in 2020, 120,000 cases of Alzheimer’s were diagnosed in Wisconsin. There is early onset Alzheimer’s, but the older adult population (65+) is the most common age group to be diagnosed. It is also more common in women rather than men.

How do I know if my loved one is experiencing Alzheimer’s or just common aging characteristics?

There are characteristics of aging that could be mistaken for Alzheimer’s. For example, a common characteristic of aging may be to forget where an object is placed, but remember a couple of hours later. A characteristic of Alzheimer’s is placing an object in the completely wrong place, such as milk in the cupboard instead of the fridge, and not remembering it. Another characteristic of Alzheimer’s would be confusion over a simple conversation. Alzheimer’s tends to progress through stages to where, eventually, a person cannot remember or perform typical daily activities.

What are the stages of Alzheimer’s?

Stage 1: Early Stage (Mild)

In the beginning stage, individuals may still be continuing on with their daily lives. They, along with those close to them, may be noticing slight delays in their memory. It isn’t a huge change but there are some instances such as misplacing an object used daily, getting slightly confused in a conversation, and forgetting a few names here and there.

Stage 2: Middle Stage (Moderate)

This is typically the longest stage in patients with Alzheimer’s. This stage is more prominent to those around the individual. The patient is becoming more forgetful and confused. You may find your loved one wandering around. They may get lost in the house trying to find a specific room. Incontinence or having accidents may become more common. Someone at this stage may need to be watched a little more carefully.

Stage 3: Late Stage (Severe)

This is the last stage of Alzheimer’s progression. While in this stage, the individual will need constant care. They will most likely need to be fed, need total assistance when using the bathroom, and need partial or total help with all daily activities. Confusion is at its peak, there is an increased risk for falls and wandering.

Is there a cure for Alzheimer’s?

Unfortunately, there is no cure for Alzheimer’s, but there are many treatments to help with memory decline and behavior. A physician may be able to prescribe medications for memory decline, mood, sleep disturbances and behavior. There are medications to help, but it is still very important to make some lifestyle changes. For example:

• Keep the same bed time every night.
• Do not eat dinner right before bed.
• Make sure the environment is calming and a comfortable temperature.

Caregiver Burnout

Caring for a loved one on a daily basis puts a lot of stress on the caregiver and their relationships. Respite care can be an amazing resource for caregivers to take times for themselves. There are many care resources within the community that want to help, which will help not only you, but also your relationship with your loved one.

All links below provide excellent resources on facts of Alzheimer’s and support programs:

https://www.alz.org/alzheimer_s_dementia

https://www.dhs.wisconsin.gov/aging/caregiver.htm

References:

Wisconsin family caregiver support programs. (2021). Wisconsin Department of Health Services. Retrieved from: https://www.dhs.wisconsin.gov/aging/caregiver.htm

Alzheimer’s and dementia. (2021). Alzheimer’s Association. Retrieved from: https://www.alz.org/alzheimer_s_dementia

Normal ageing vs dementia. (2021). Alzheimer’s Society. Retrieved from: https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/how-dementia-progresses/normal-ageing-vs-dementia

By Cami Tesch, Student Nurse

College of Nursing, University of Wisconsin Oshkosh

What is Congestive Heart Failure?

Congestive heart failure is when the heart is not able to pump a sufficient amount of blood through the body. The left side of the heart is responsible for pumping oxygenated blood to the body. When someone has heart failure, fluids begin to pool and back flow to the lungs, causing the congestive portion. The right side of the heart is responsible for pumping blood from the body to the lungs. If the lungs are already backed up, there is going to be a back flow to the rest of the body.

If there is a back flow of fluids into the lungs, a person may be having symptoms such as a productive cough with tinted mucus, and shortness of breath or wheezing. A main sign of right sided heart failure is edema in the lower legs, ankles, and feet. Edema is when there is a substantial amount of fluid pooling in a certain area. It may or may not become painful. Because there is a lot of fluid pooling in the lower extremities and not going back to the heart, becoming very dizzy when standing up from a seated position is common.

Is there a way to prevent Congestive Heart Failure?

There are several ways to help prevent heart failure. One important thing to remember is to eat healthy which includes a low sodium diet. Keeping sodium intake low helps to decrease any retention of fluids. Reducing fat intake is also important in the prevention of heart failure. Exercise is a good way to keep weight at a healthy level. A main factor associated with heart failure is high blood pressure. Smoking increases blood pressure, which is why quitting smoking is a way to help prevent heart failure.

How can medical professionals tell if I have heart failure?

There are several tests that can be conducted if someone is suspected of having heart failure. One test is an EKG, or electrocardiogram, which includes putting several electrodes over the chest to see how the heart is beating. Another test, called an echocardiogram, is an ultrasound of the heart. This allows medical professionals to see if heart muscles and valves are working properly and if they are pumping the sufficient amount of blood. More information can be found here.

What is the next step?

If someone is diagnosed with heart failure, the doctor may prescribe some form of medication(s). Some of these may include antihypertensives, diuretics, or blood thinners. Each case of heart failure may be different. There are several different ways to begin treatment, so be sure to talk with a doctor about any concerns.

References:

Cleveland Clinic Medical Professional. (2021). Heart failure. Cleveland Clinic. Retrieved from: https://my.clevelandclinic.org/health/diseases/17069-heart-failure-understanding-heart-failure

Healthwise Staff. (2020). Right-sided heart failure. Frankel Cardiovascular Center: University of Michigan Health. Retrieved from: https://www.umcvc.org/health-library/tx4093abc

John’s Hopkins Researchers. (2021). Congestive heart failure: prevention, treatment and research. John’s Hopkins Medicine. Retrieved from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/congestive-heart-failure-prevention-treatment-and-research

By Cami Tesch, Student Nurse

College of Nursing, University of Wisconsin Oshkosh

Unravelling the stigma of depression

Depression isn’t something that you can get over with the snap of your fingers. The condition is a chemical imbalance in the brain. The three main chemicals that are deficient are serotonin, dopamine and norepinephrine, or, the happy hormones. It can be just the way the body is wired, and every single person is different. So, a person isn’t to blame if they are diagnosed. What a lot of people don’t know is there is a high rate of depression in the older adult population. Many people mistake depression for a common aging characteristic, but it’s not. Some people may have a slight decrease in energy, but depression is not a natural part of aging, and there is much a person can do to battle depression.

Is sadness the only symptom of depression?

One symptom of depression is decreased mood, and there are many more, including:

• Loss of interest in things that gave you joy in the past
• Decreased energy
• Loss of appetite
• Weight loss
• Sleep disturbances
• Emotional outbursts on a frequent basis
• Isolating yourself from others
• Thoughts of harming yourself
• Irritability

Is medication necessary for depression?

Even though there are several medications to help with depression, there are additional strategies that can help:

• Exercise more to release endorphins that elevate mood.
• Change diet to include more lean meats, fruits and vegetables to keep energized.
• A consistent sleep routine helps with sleep disturbances.
• Talk with someone: a family member, friend, or certified counselor.

The great thing about working with a certified counselor today is there are many ways to have your sessions. If you are not comfortable going into a facility, there are options to have a video chat session. You can have a counselling session in the comfort of your own home and may even feel more comfortable to share information.

Substance abuse and mental health services administration: 1-800-662-HELP (4357)

This helpline is 100% free and confidential. You can call any time, day or night. https://www.samhsa.gov/find-help/national-helpline

For more information on depression:

https://www.psychiatry.org/patients-families/depression/what-is-depression

References:

National helpline. (2021). Substance abuse and mental health services administration. Retrieved from:

https://www.samhsa.gov/find-help/national-helpline

Torres, F. (2020). What is depression. American Psychiatric Association. Retrieved from:

https://www.psychiatry.org/patients-families/depression/what-is-depression

How do I know if I have a UTI?

A urinary tract infection, also known as a UTI, is just as it sounds: an infection anywhere throughout the urinary tract. These infections are a result of bacteria entering the urethra, most commonly E. coli.

Who is at risk?

Anyone is at a potential risk for getting a UTI. However, women are more commonly diagnosed. Women have a shorter urethra, which allows bacteria to travel much quicker to the bladder. Men have a longer urethra making it  more difficult for bacteria to reach the bladder. The older adult population is also at a slightly higher risk for developing a UTI due to causes stated below.

What are symptoms?

The typical symptoms you may see in an individual with a UTI are:

• Burning or pain during urination
• Flank pain/pain in your mid back near your kidneys
• Increased thirst
• Increased frequency of urination
• Cloudy urine
• Urine having a foul odor
• Slight blood in the urine

Those with symptoms should see a physician.

The older adult population (65+), may be showing some symptoms that were stated above, but older adults may develop significant cognitive impairments. Why is this? There are many theories to why this is, but one factor includes a decreased immune system, which is a characteristic of aging. Another factor is that many older adults do not drink enough water throughout the day, causing dehydration. Some common symptoms you may see in older adults with a UTI include:

• Confusion
• Hallucinations
• Delirium
• Increased irritability
• Increased falls
• Incontinence

Those with symptoms should see a physician.

What is the doctor going to do?

If the doctor suspects a UTI,  a urine specimen will be requested. This test will check  the amount of bacteria in the urine. If a UTI is diagnosed, the doctor will most likely prescribe an antibiotic and probiotic. The antibiotic will allow the bacteria causing the infection to be killed, while the probiotic will allow the good bacteria in your body to remain.

Preventing a UTI

There are many ways to help prevent a UTI, including drinking plenty of water. Another thing to remember is to wipe the correct way: front to back. This way, bacteria is less likely to reach the urethra. When cleansing, make sure to use the proper pH balanced soap. Soaps that have strong scents or are perfumed could change the natural environment of the genital area. Another way to help prevent a UTI is toileting frequently. This will help to clear the urethra.

For any other questions, visit the links provided below:

https://my.clevelandclinic.org/health/diseases/9135-urinary-tract-infections

https://www.urologyhealth.org/urology-a-z/u/urinary-tract-infections-in-adults

References:

Cleveland Clinic Medical Professionals. (2020). Urinary tract infections. Cleveland Clinic.

Retrieved from: https://my.clevelandclinic.org/health/diseases/9135-urinary-tract-infections

Rotolo, C. (2021). UTIs cause unusual behavior symptoms in elders. Aging Care. Retrieved from:

https://www.agingcare.com/articles/urinary-tract-infection-symptoms-151547.htm

Urinary tract infections in adults. (2019). Urology Care Foundation. Retrieved from:

https://www.urologyhealth.org/urology-a-z/u/urinary-tract-infections-in-adults

By Christy Feuerstahler, CDP, Music Coordinator, Valley VNA Senior Care

For people with Alzheimer’s disease or dementia, music therapy is powerful because a person’s rhythmic response is tied to the motor center of the brain that requires little or no cognition or mental processing. Human response to music, particularly drumming or singing, is essentially primitive. People with Alzheimer’s disease or dementia who engage in music therapy often respond positively, even in the late stages of disease. I’ve been playing and teaching music most of my life, and now bring music’s therapeutic benefits to older adults and caregivers.

I’ve heard nothing but joy and appreciation from participants in the Lyrics & Laughter community programming at Valley VNA. It is an offshoot of a program from the U.K. called Singing for the Brain, a weekly music program for people with dementia and their caregivers that goes beyond passive listening by incorporating singing, instruments, and action. We gather in a circle, and that cue helps focus our participants, followed by a session of warm-ups, hello songs, rounds, rhythms, and thematic tunes on topics like the Old West, patriotism, and Irish folk tunes. Caregivers enjoy sharing in the songs, too, because it’s a wonderful way to bond with one another.

An iPod listening program is another great idea for older adults whose families can help develop playlists of favorite songs. The personalized collection helps those in need of sensory stimulation, and earphone splitters can allow an older adult and family member to experience music together. I’ve seen people hold hands, dance, smile, and sing or simply get a sparkle in their eyes when the music starts.

Songs from a person’s young adult years, from about age 18 to 25, are the most likely to elicit engagement, such as dancing, toe tapping, and happy facial expressions. People with late-stage dementia often respond to childhood folk songs, especially when sung in the language in which they were learned. I was once sitting with an otherwise nonverbal resident who began speaking to me once she heard her songs, even complimenting me on my blouse. Music can help elicit speech in people with advanced dementia, if even for a short time.

 Facilitated drum circles brighten moods, encourage social interaction, and allow the release of pent-up emotions. People who typically sit with their heads down may perk up and move their eyes around when group drumming starts. Drum circles are very good for those who can tolerate the loud drumming because it taps into their rhythmic instinct. It’s also an affordable participatory program because drums can be handmade with simple wooden frames and duct tape, and sticks can be used for mallets.

Everyone deserves music in their lives, and for those with Alzheimer’s or dementia, it can be a portal to past feelings of happiness and contentment, and build connections with people in their current social circle. It might even help them express themselves with words and smiles, which puts a song in anyone’s heart.

By Angela Franz, Valley VNA Senior Care Administrator of Independent & Assisted Living

I recently read an article about how the role of physical therapy has changed in recent years and physical therapists are on a mission to help referring providers understand the “wait-and-see” approach is old-school thinking. They report that a patient who falls or pulls a muscle or tendon should be seen by a therapist within days, not weeks. There is so much that can be accomplished by getting help early, avoiding a crisis, and teaching people valuable skills for healthy movement.

I was struck by the similarities in my work as an administrator in long-term care for older adults. The old-school “wait-and-see” approach to aging often morphs into watching a person’s decline without a plan to help, and that’s a sad situation for everyone. If you aren’t sure how to get started planning for life in older age for yourself or a loved one, consider these ideas:

Research. If you are an older adult, or you love someone who is, get familiar with the senior living communities in your area or the older person’s community, if that is where they want to stay. Visit web sites, talk with friends and community members, and subscribe to social media channels. Arrange for a tour, attend a public event at the places that interest you, or become a volunteer so you can experience their organizational culture.

Plan like it’s a big deal. After all, we save for college, plan elaborate weddings, and decorate our babies’ nurseries before they are even born. You or your loved one deserves an equally attentive plan for choosing a new home when he or she is older.

Do the hard things. Older adults who have decades of memories in their homes and neighborhoods will rightfully go through a grieving process when they move. But just because it’s hard does not mean it’s wrong. Through your communication and planning, you will have arrived at the right time to move, before a rush or a crisis happens. High-quality senior living communities also employ compassionate people who understand this grief process and help older adults navigate their feelings.

Let the sun shine in. Although grief is natural, so are happy surprises. I often hear a new resident greet an old acquaintance at Valley VNA with, “I haven’t seen you in years! How are things?” and then they settle in for a good talk. Isolation is real. Quality long-term care for older adults is an antidote to loneliness and lack of engagement and can even slow the decline of aging. A whole new world opens up for people who need people—and we all do.

I encourage you to have good talks and make calm and thoughtful plans about long-term care. When the day comes to move, you can say something like, “We talked about this. Remember the gardens in the courtyard? And our friend from church really likes it there. I’m so proud of you— and I’m so proud of us.”