Frugal Eldercare Part 3: How I dealt with the specifics of eldercare costs: Transporation and Utilities

Transportation

Although Dad generates significantly more trips each week with medical appointments and social activities, after we reviewed our transportation needs we determined that we did not need to purchase a second car. We saved $20,000 by choosing to continue living as a one-care family.

Seattle is blessed with decent mass transit options, car-sharing programs, and bicycle lanes. We were also fortunate to have been able to purchase a house 4 blocks from the Link Light Rail station. A grocery store, public library, and other amenities are within walking distance. We both purchased Orca cards for mass transit trips and Car2Go memberships for those times when we both needed a car. We feel fortunate to live in an area that allows us to safely walk many places. We are healthier for the exercise, and the cost of transportation is much lower than it would have been if we had to drive everywhere.

We have a weekly meeting every Sunday morning to review our schedules and negotiate use of the car. My husband is able to work from home one day per week, curtailing the need for commuting that day. Other strategies to save on transportation costs include combining trips, forgoing unnecessary trips, and carpooling.

https://quicken.intuit.com/support/help/saving-smart/save-money-on-transportation/INF16201.html

http://www.youcandealwithit.com/borrowers/managing-money/saving/reduce-transportation-costs.shtml

http://cashmoneylife.com/living-without-a-car/

https://www.car2go.com/en/austin/what-is-car2go/

Utilities

Incontinence and poor coordination are common problems for the elderly, and we wash 7-8 loads of laundry per week because of Dad. As I mentioned in a previous post, our first full water bill after Dad moved in was nearly $400! Ouch! With some simple changes, we were able to reduce that bill by 50%.

  • First, I checked the manuals for my washing machine and dish washers. It turned out that both had quick cycles on them that used less water and still got our clothes and dishes clean.
  • I have our dog, Lainie, “help” me in the kitchen by licking plates clean instead of rinsing them before putting them into the dishwasher. She loves her job.
  • Use water twice.
    • When I have to soak dishes to get stuck food off, I save the water and reuse it for other similar dishes. We keep a mesh filter in the sink to filter out the bits of food.
    • We flush our toilets on the “If it’s yellow, let it mellow. If it’s brown, flush it down” philosophy using gray water we save from the sinks and shower.
  • I purchased a new ultra-low flow shower head with a 1.0 gpm setting to replace our older 2.0 gpm fitting. We took shorter showers also.
  • I checked the CDC’s website for recommendations on the length of time between washings for linens to see if I could wash sheets and towels less frequently without sacrificing hygiene. It turned out that the weekly bed linen washings could be done every 2 weeks. Towels should be washed every 4 days.
  • I also aired out clothing more to refresh for wearing again. This didn’t work with my husband’s shirts however, because he wears moisture-wicking synthetics which do not shed odors without washing.
  • We installed rain barrels to harvest rain from our roof for watering the garden in the dry season. I also found a way to hook them up to the washing machine for use during winter but have not had time to install the system yet.
  • Although we don’t qualify, Seattle Public Utilities has a nice program to help low-income home-owners afford more efficient bathroom fixtures. This is a great opportunity for seniors on fixed incomes to lower their utility bills.
  • Dad often wears an apron while eating now to preserve his garments from food spills.

http://wateruseitwisely.com/100-ways-to-conserve/

http://www.goodhousekeeping.com/home/cleaning-organizing/when-should-you-wash-clothing-and-linens

http://www.seattle.gov/util/EnvironmentConservation/MyHome/ReduceWaterUse/index.htm

http://www.graf-water.com/rainwater-harvesting/general-information/questions-and-answers.html

http://www.youtube.com/watch?v=dQxIsugw8wI

We weren’t able to lower our electric bill by as high a percentage as the water bill, but we still managed to lower by a third. To save on electricity, we tried the following savings strategies:

  • We hung clothes to dry, and air-dried dishes in the dishwasher.
  • I followed Dad around and turned off lights when he forgot to turn them off.
  • We installed Belkin conserve sockets on appliances in the kitchen to save on phantom electrical costs. The boxes turn off the electricity to the appliances after 30 minutes. It turned out that this was a good safety feature as well because Dad doesn’t always remember to set appliance timers properly.
  • We used power strips on electronics.
  • We switched out the last of the incandescent and CFL bulbs for LED bulbs.
  • We turned off the hot water heater when we were going to be gone for a weekend.
  • We relaxed together in the same room to use fewer lights.
  • I waited until full daylight to shower so I could take advantage of natural lighting in the bathroom.
  • I wash all the laundry in cold water unless someone is sick.
  • Rooms which are infrequently used are not heated in winter.
  • The thermostat is set to 66F. The elderly lose their internal heat-generating capacities, so be sure to dress them warmly in winter and don’t set the heat so low they get mildly hypothermic.
  • We cook soups in the crockpot frequently. In fact, we own 2 crockpots and use them at least once a week!
  • I have a wash and wear haircut, and only use the hairdryer for special occasions.
  • We requested a subsidized home energy audit, and added insulation to the attic afterward. We were losing an incredible 70% of our home’s heat through the attic. The insulation project reduced our energy loss by 25%. Because our house is 100 years old, we were not able to lower the energy loss further without significant structural changes that were not in our budget.
  • We take care of the trees on our property so they will provide shade in the summer.
  • We use dried foods when possible instead of fresh to limit the size of fridge we need.
  • Some foods can be eaten cold or room temperature instead of cooked or chilled.
  • We did not purchase a fridge with an ice-maker. We make ice cubes in the summer with old-fashioned trays.
  • We use a solar oven in summer to cook some foods.

http://www.seattle.gov/light/conserve/

http://www.belkin.com/us/Products/Power/c/WSPWRCSR/

http://www.seattle.gov/light/printdocs/savingelectricity.pdf

http://www.seattle.gov/light/printdocs/ac5_hibill_appchrt.pdf

http://www.aceee.org/topics/retrofits

Other utilities savings strategies exist. What works for each family will depend on the nature of the utilities in their area. Here’s what I was able to do:

  • I checked our phone and data usage with Verizon and realized I could lower our data usage, saving $30 per month.
  • We do not replace our phones, or electronics, until they breakdown from wear.
  • I wasn’t able to reduce our Internet costs without moving to a slower system because Comcast has a near monopoly in our area. However, when I was single, I did not purchase Internet service at home. I went to the public library or an Internet café. If was able to do this now, we would save $88 per month.
  • We do not watch TV, so we there is no need to purchase cable. We watch Amazon Prime streamed movies, movies from the library, read books, or play board games instead.
  • Our large dog makes a good burglar alarm system.
  • We use the smallest trash can available from Seattle Public Utilities. Instead of paying for a larger can after Dad moved in, I worked to reduce the amount of trash our family produces.
    • Dad’s incontinence was producing 1 full bag of soiled, disposable undergarments per week, so we are trying out washable undergarments. We also are working with Dad’s doctors to improve his situation.
    • We reduced the amount of plastic packaging by making more food from scratch and reducing packaged snack foods.
    • We purchased bulk recycled toilet paper and tissues because they were not wrapped in plastic.
    • We use cloth napkins and handkerchiefs as much as possible .

Stuffed Jack-O-Peppers Recipe

This fun recipe uses bell peppers with Jack-O-Lantern faces cut into them. Kids of all ages will enjoy carving their own pepper’s faces. The filling is easy to prepare. Any color of bell pepper can be used, however, if it is in your budget, choose orange bell peppers so they look more like carved pumpkins.

If we have fresh herbs on hand I use them, otherwise I resort to dried herbs. Herbs that work well in this dish are basil, thyme, tarragon, or rosemary to complement the sweetness of the raisins. We use brown rice because whole grains are higher in fiber and nutrients and appropriate for a diabetic diet. If you choose to use brown rice, note that you will need to increase the water you cook it in to 3 cups.

  • 4 large bell peppers
  • 2-3T oil
  • 1 chopped onion
  • 1C rice, we use brown
  • 2-3C water or broth
  • 3 garlic cloves, chopped or pressed
  • 1T fresh herbs or 1t dried herbs
  • ¼ C raisins
  • 1t salt
  • Optional: ¼ C sliced almonds or parmesan cheese

Remove the tops of the peppers, and pith. Carve the peppers into fun, Jack-O-Lantern faces. Set aside.

Sauté the chopped onions, garlic and raisins in oil over medium heat until the onions are soft. Turn the heat down to medium-low. Add the rice and water/broth and cook until the water is absorbed. Fold in the salt and herbs and heat gently. Remove from heat.

Fill the peppers with the rice pilaf. Top with the almonds or parmesan cheese if desired.

Bake for 30 minutes at 350F.

Low-Cost Breakfast Burrito Recipe

Burritos can be eaten for any meal, and can be taken to work for lunch. This burrito recipe uses up left-over and older bits of food in the kitchen. While we use eggs in our recipe, tofu or meat could be substituted. We often purchase tortillas from the store, but we have also made them at home. The home-made tortillas are time-consuming, but incredibly tasty and very low-cost.

Burrito filling:

  • Chop and sauté in a small amount of oil over medium heat any left-over vegetables in your kitchen. We have used onions, peppers, tomatoes, squash, corn, kale, eggplant, etc.
  • Drain and rinse 1-15 ounce can of beans of any type and add to the vegetables.
  • If you like to eat meat, slice up any left-over meat and add to the beans and vegetables
  • Add some chopped fresh cilantro, basil, or oregano if you have any on hand.
  • Add 2-4 scrambled eggs to the mix if desired.
  • Season to taste with salt, pepper, cumin, coriander, tabasco, or smoked paprika.
  • Scoop some of the filling into a tortilla. Add shredded cheese, salsa, guacamole, or yogurt as desired. Roll the tortilla up and serve.

Salsa recipe:

This salsa recipe uses ingredients that are easy to find and low-cost. Apple cider vinegar can be used in place of citrus for those who are allergic to citrus or wish to eat locally grown foods. Additionally, when the salsa gets close to its end-of-life, I stretch it by using it to prepare a pot of vegetarian chili. This helps prevent food waste and prepares a healthy and economical meal for the  family.

Preparation time is about 15 minutes using a food processor, or 25 minutes cutting by hand. Ours lasts 1 week stored in the fridge.

  • 1 small onion, or half a large onion
  • 2-3 cloves of garlic
  • 2-3 tomatoes
  • 1/4C corn
  • 1-2 small mild jalapeno peppers
  • A few tablespoons of fresh cilantro
  • 1 t salt
  • 2T apple cider vinegar
  • Chop all vegetables and cilantro. Add salt and vinegar. Refrigerate for storage.

Guac Recipe:

This recipe was developed by my husband and is similar to traditional guacamole, except that it adds yogurt, and uses apple cider vinegar instead of citrus. We keep it in the fridge and it lasts about 1 week. All ingredients are added to a food processor and blended for preparation.

  • 1 T of olive oil
  • 2 avocados
  • 2 tomatoes
  • ¼ of a large onion, or half a small onion
  • 2 cloves garlic
  • 1/4C yogurt
  • 2-3T apple cider vinegar
  • 2-3T fresh cilantro, or 1 large squirt of cilantro paste
  • Add salt, pepper, cumin, coriander, and chipotle tabasco to taste.

Frugal Eldercare Part 3: How I dealt with the specifics of eldercare costs: Housing and Food

First, before I offer any other advice, if there is even a remote possibility that your elderly loved one will come to live with you in the future, beef up your emergency fund. If you don’t have an emergency fund, start one now. In the first week that Dad unexpectedly moved in with us, we spent $2000 on moving costs and bathroom assistive devices. And that was just the beginning…

Food, utilities, transportation, over the counter (OTC) medicines, entertainment, etc. were costs that we hadn’t planned for because we never anticipated that Dad would move in with us under crisis conditions. By the end of the first year that he lived with us, we were around the $5000 in unreimbursed out-of-pocket costs that the average American family spends per year on eldercare. Respite care runs about $25 per hour, wheelchairs rented at zoos and fairs cost $10-$25 per day, assistive devices cost from $20-$4000 depending on the item. Medicare does not pay for all assistive devices.

So, how does a frugalista manage with these costs? Turning off the heat and lights in the winter seems a tad extreme, so I’ll focus on the costs that are easier to live with.

Housing

Housing is the largest expense in most budgets and in eldercare as well. Each family’s home and circumstances are different, but evaluating the existing home is a reasonable first step in deciding whether to move or stay. Although our 1800 square foot house is smaller than average by American standards, we resisted the suggestions that we purchase a larger home to accommodate Dad. A larger home would increase our insurance, maintenance, mortgage, and utility costs. We didn’t know how long Dad would be living with us because his illness is a degenerative disease, and would eventually require nursing home care. We decided that buying a bigger home would be a bad investment if Dad moved out 6 months afterward.

Because we were fortunate the main floor of our home had a small bedroom with attached bathroom, we were able to move Dad into it. We added grab bars, and other assistive devices to Dad’s bathroom. We also got rid of some of our own furniture and a large number of our belongings to make room for Dad. We rearranged our furniture in the house, so Dad’s could be accommodated. While our home now resembles an assisted living facility, the $2000 we spent is far cheaper than a larger home and associated mortgage. By staying in the same home we saved $50,000 to $100,000.

Food

Food is another big expense in most budgets. With an extra mouth to feed, our food costs initially rose by a third. We also had another complication, Dad’s dietary needs were somewhat different than our own and had to be accommodated for health reasons. This required cooking 2 separate sets of meals every day. Unfortunately, Dad’s tastes have changed dramatically, and my cooking didn’t meet his standards which caused some friction in our home.

Not only was cooking 2 sets of meal daily more expensive, it was taxing energy-wise as well. In the first 4 months after Dad moved in, I lost 6 pounds. While this isn’t much for most adults, it was noticeable on my already petite frame. I began to feel stretched, fatigued, and in general more emotionally brittle. Something had to change or I would not survive.

Initially, I worked to reduce overall food costs. I wanted to do this without resorting to the diet of ramen noodles, bananas, cabbage, and beans that I often ate whilst I was putting myself through college. After a while, I was able to reduce our grocery bill by $150 per week compared to when Dad first moved in. This translates to $7800 per year.

With three people living in the house, it now made economic sense to buy staple foods and household items in bulk. I purchased an Amazon Prime membership because I noticed that they had good prices on bulk food items and free delivery. Because my husband and I share a car, I don’t always have access to a vehicle without added expense. An annual $99 Amazon Prime membership was far more affordable than purchasing a new car, or even renting a Car2Go every week for grocery shopping. In addition, some days I can’t go out shopping because Dad is having a lot of difficulty and cannot be left alone. Although Amazon is maligned regarding its business practices, I have yet to see a better alternative for my situation.

I also began making foods like bread, soy milk, and yogurt at home instead of purchasing them at the store, saving $10-15 dollars a week. Because these foods are all “hurry up and wait” items to prepare, I was able to accommodate making them  with my schedule. The one exception was tofu. I tried a recipe in Joy of Cooking and it was a miserable failure. It took over 24 ours to make a batch of bitter, inedible bean curd. I decided that purchasing it at the store was a better option.

We already had a tradition of a weekly menu and shopped with a list to avoid impulse purchases. As vegetarians, my husband and I are careful to construct a menu of 3 dishes each week to be cooked in batches to save time and money. We plan eggs, legumes, and whole grains with various vegetables including dark leafy greens thrown in to ensure a healthy diet. Dad eats a more traditional diet of meat, bread, and vegetables.

We had a small vegetable and fruit garden that provided organic produce during the growing season. We also received fresh produce from other people’s gardens when they had a bumper crop. We tried to purchase in-season foods when possible. We bought dried foods because they last longer and we didn’t want to buy a larger fridge.

I read about food waste in the grocery industry and spent time when I was at a store looking for mark-downs on foods that would otherwise be deposited in a dumpster at the end of the night. I reasoned that one way for Americans to reduce food waste was to simply purchase food before it outdated and stores felt compelled to toss it for safety and litigation reasons. Dad cannot be a vegetarian for health reasons, and I wanted to purchase meat for him at an affordable price. I scored lamb shanks for him the other day that were cheaper than chicken because they would be outdating that night. I cooked them with onions, potatoes, and tomatoes and oregano from our garden when I got home.

We also reduced our restaurant meals. When we do go out, we mostly go out for brunch or lunch which is cheaper. Take-out is also a cheaper option. Although convenience foods are expensive, an organic pizza from the frozen section at the grocery store is cheaper than a restaurant meal when you are too busy to cook from scratch. Dress it up with some more ingredients at home, and you have a fairly satisfying dinner.

Finally, we found out about Meals on Wheels for Dad. This non-profit organization delivers healthy meals to disabled adults to assist families with the cost and time involved in meal preparation. Dad gets 10 meals per week from them with a surprising amount of variety. They are able to accommodate his dietary needs too. It had made a tremendous difference to have this generous service. I stopped losing weight, and nightly disagreements at the dinner table have dropped off.

http://www.webmd.com/food-recipes/guide/10-ways-save-money-food-shopping

http://www.stretcher.com/food/

http://www.eatingwell.com/healthy_cooking/budget_cooking/15_tricks_to_save_money_on_food_but_still_eat_well

http://www.mowaa.org/

Solving the Sleep Deprivation Problem

For the last several months, Dad has needed help with medication and toileting during the night most of the time. Some nights he only needs help once, other nights it is several times. Surgery to remove his bladder tumor did not help with the incontinence. A new medication has improved the problem, but not eliminated it.

Last night was one of the more difficult nights with Dad getting me up every 2 hours for a 6 hour stretch. Needless to say, I’m a bit of a zombie today. I have been invited to a Halloween party this evening with a few friends, and I hope to be able to attend. I’m considering dressing as a zombie.

When Dad doesn’t get enough sleep he has difficulty during the day. His Parkinson’s disease symptoms are made worse, and he also has daytime somnolence. No surprise there. However, when he is struggling, he requires more hands-on care and this contributes to fatigue for the entire family because my husband attempts to assist me. Based on conversations I have had with other former caregivers, this is not an uncommon problem.

Social workers, physicians, and guides on caregiving stress the importance of getting enough rest. They suggest respite care to prevent caregiver burnout. Most suggestions center on hiring respite care or asking family and friends for support. While experts are correct about the link between sleep and good health, their well-intended suggestions fall short of reality.

http://www.helpguide.org/articles/caregiving/caregiving-support-and-help.htm

http://www.helpguide.org/articles/stress/caregiving-stress-and-burnout.htm

Most Americans do not save enough money during their working years to pay for their infirmity, although there is some evidence that this is due more to an overly expensive for-profit infirmity industry than lack of thrift. The US also does not have a very comprehensive social support system. The result is that seniors can burn through their retirement savings fairly quickly enjoying retirement and paying medical bills. When this happens, they rely on Social Security to cover living expenses, which typically is not enough to cover the cost of professional care facilities. This point is when parents move in with their children and the caregiving cycle with its domino effect on the family begins.

http://www.bankrate.com/brm/news/retirement/Oct_07_retirement_poll_results_a1.asp

http://www.ssc.wisc.edu/~scholz/Research/Optimality.pdf

http://www.dol.gov/ebsa/publications/10_ways_to_prepare.html

With professional respite care costing $25 per hour, most families and seniors are not in a position to purchase much of it. Relying on family and friends is difficult because they may be working when you need help, or sleeping at the same time you wish to do. In a large country like the US, family and friends are often spread out over large geographic distances. While I have family who might be willing to help, most of them live out-of-state and it simply isn’t practical to ask them for assistance. Also, it seems a bit much to ask others to help change soiled undergarments in the middle of the night for free while I sleep.

We are fortunate to receive 6 hours of sliding scale respite care per week provided by Senior Services and Washington State. We elected to use that on Sunday afternoons so my husband and I can have time off together. This relieves some of the stress on our marriage. Dad is also generously provided 20 hours of respite care per year by the American Parkinson’s Disease Association. These services are very welcome, but cannot hope to provide the amount of relief necessary to prevent sleep deprivation.

http://www.apdaparkinson.org/

http://www.udel.edu/cds/downloads/respitecarereport.pdf

http://www.dads.state.tx.us/taketimetexas/summit/documents/joycepohlman.pdf

http://www.kccaregiver.org/what-we-do/about-us/

Moving an elderly relative to a facility that can offer them the 24 hour care they require ends up being the only realistic option over time. However, this is horribly expensive. Assisted living facilities run $3500 per month and nursing homes cost $7500 per month in the Seattle area. Medicaid ends up being the only option for care, which limits the number of facilities a family can choose from to place their parent. In addition, as the number of Medicaid recipients rise, the available slots in nursing homes decrease. In some areas, the wait list for a nursing home slot is 1-2 years. This means that even if a family needs to move an elderly relative, it won’t happen for an extended period of time.

http://www.payingforseniorcare.com/medicaid-waivers/wa-copes-waiver.html

http://www.payingforseniorcare.com/longtermcare/paying-for-nursing-homes.html

Medicare will pay for 60 days’ worth of nursing home care if the patient is transferred directly from a hospital for rehabilitation. But again, many of these slots are also filled. The result in this situation is that hospitals “board” the patients for a month or two, sometimes in corridors due to space restrictions.

http://www.medicare.gov/what-medicare-covers/part-a/health-care-and-drug-coverage-in-nursing-home.html

http://www.physiciansweekly.com/ed-boarding-problem/

In every instance, providing care for the indigent elderly is a challenging problem. States that provide Medicaid nursing home care are struggling with cash problems, and are apt to be resistant to moving the elderly to care facilities. As one social worker told me, “our mandate is to keep people out of nursing homes. That’s why we place people with family whenever possible”.

The federal government is heavily in debt. Entitlement programs like Social Security and Medicare already eat up 20% of the federal budget and will continue to rise in the future, squeezing out other federal budget money. These programs are also set to go bankrupt in the near future without Congressional intervention to overhaul the federal budget and rescue the entitlement programs. With a current Congress that excels at stalemates, it seems an unlikely bet that the entitlement programs will be addressed until the last possible minute and possible only with a band aid approach.

http://www.ssa.gov/oact/trsum/

Despite the gloomy predictions, I do not believe that the problems are intractable. What society needs is a reassessment and reworking of existing strategies. Policy makers, welfare experts, and taxpayers are reluctant to try new approaches because they fear of expending precious monies on an uncertain outcome. In such a case, it might be better to try a series of pilot studies to determine strategies that will work for the long term benefit of the country. Here’s a few ideas that lend themselves to pilot studies:

  • Develop respite care coops similar to preschool coops
  • Retrain long term unemployed workers to work as respite care givers
  • Test out AI and robotic technologies that can relieve caregivers for short periods
  • Set up caregiver education programs in developing countries, and provide 5 year visas to graduates to provide care in the US

Frugal Eldercare Part 2: Overall Savings Strategies

Saving money to make ends meet during eldercare is not impossible.  It can even be fun as evidenced by these creative stuffed peppers dressed up to look like Jack-o-Lanterns for our dinner last Halloween. Here’s how:

Brainstorm with the family on how to reduce expenses, including asking your elderly parent if possible. Ask what can be substituted to reduce expenses or what people are willing to give up. You might be surprised by their ingeniousness. For example, my husband swapped fresh milk with dried milk for his morning coffee, saving several dollars every week. When my husband was growing up, his mother cut the family’s fresh milk 50:50 with dried milk to save on grocery costs. Today, my in-laws are comfortably retired.

Elderly parents are often fonts of willing knowledge because they want to contribute to the family and be useful. My father has been reading the 500 page manual for our car, and introduced me to an economy mode which increases gas mileage. He also has many ideas on how to repair things cheaply rather than replacing them.

Back in the 1990’s, I was a regular reader of The Tightwad Gazette emails. While the author is now retired, you can pick up her book, The Complete Tightwad Gazette at your local library or used bookstore. This tome has literally hundreds of frugal ideas to choose from.

http://www.thesimpledollar.com/an-interview-with-amy-dacyczyn-the-author-of-the-tightwad-gazette/

http://www.thesimpledollar.com/review-the-complete-tightwad-gazette/

Other people have since taken up the tightwad cause in a variety of flavors. Here’s a few of them:

http://www.ultimatecheapskate.com/blog/index.cgi

http://www.mrmoneymustache.com/

http://www.stretcher.com/

http://www.financialintegrity.org/index.php?title=Category:Spending/frugality

Resources on budgeting and saving abound. This little blog cannot list them all, and each family’s circumstances vary so not every savings tactic will be applicable. Basically, however, they all revolve around the idea that by reducing purchases, we can reduce expenses and save to improve our financial security. Here are a few other ideas of the many available:

While the minimalistic movement may be grounded in using and owning a minimal number of resources and belongings for a variety of reasons, it also stresses financial security. Some of the more radical examples of minimalism may not be realistic for eldercare, but taking an inventory of what is required for a good standard of living vs. what is simply desired may be helpful for caregivers in sorting out some of the more confusing feelings surrounding eldercare.

http://www.dailyfinance.com/on/minimalism-live-small-save-big/

http://www.theminimalists.com/money/

http://www.becomingminimalist.com/benefit-1-simple-dollars-and-sense/

http://www.rowdykittens.com/2010/07/guide-to-saving-money/

Collaborative Consumption, also call the Sharing Economy, saves money by sharing resources instead of purchasing them individually. Public libraries are the original example of this strategy. Other options include tool libraries, car and bike sharing programs, clothing memberships, etc. Many of these options are available via the Web.

http://www.forbes.com/pictures/eeji45emgkh/airbnb-snapgoods-and-12-more-pioneers-of-the-share-economy/

http://www.npr.org/series/244583579/the-sharing-economy-a-shift-away-from-ownership

http://www.thepeoplewhoshare.com/blog/what-is-the-sharing-economy/

http://www.spl.org/

https://www.car2go.com/en/seattle/

http://localtools.org/find/

Finally, I like to remember my Depression-era grandparents’ advice:

  • “The best way to save money is not to spend it in the first place”.
  • “Your belongings are meant to be used”.
  • “If you get hard up, sell the family heirlooms to make ends meet”.
  • “Take care of your belongings. Fix them when they wear out”.
  • “Don’t gamble your hard-earned money away”.
  • “Use both sides of the paper”.
  • “Put on a sweater”.
  • “Dogs have been eating table scraps for thousands of years. If it was really bad for them, they’d be extinct”.

Next post will be about specific savings strategies that come with eldercare. Remember my $400 water bill? I’ll tell you how I cut it by 50%, and some of the other strategies I did to bring our budget back in line. Stay tuned!

Fall Risks in an LTC Population

Elderly patients with dementia face certain risks when treated in a long term care (LTC) facility. The most common risks to patient safety for this patient population are injuries and deaths related to falls, which are about 75% preventable according to experts, result in excess of $170 billion annually, and create 15% of the re-hospitalizations which occur within a month after discharge (Currie, 2008). Thus, addressing the problem of falls in elderly patients with dementia would improve the longevity of LTC residents, reduce the burden of care on families and the healthcare system, and save large sums of money annually on re-hospitalization costs.

The Joint Commission publishes the National Patient Safety Goals every 2 years on a variety of healthcare settings, with the goal of improving patient safety through focusing on solutions to problems in healthcare delivery. The 2014 National Patient Safety Goals for LTC facilities are listed generally as follows: identify residents correctly, use medicines safely, prevent infection via proper hand hygiene, use best practices in preventing central line infections, prevent residents from falling, and prevent bed sores (www.jointcommission.org). While all of these goals are important, dementia is a significant factor in falls among the elderly and can be mitigated through the use of best practices (Varkey, 2010, p. 57).

Systems Errors and Human Factors

In recent years, the fall rate among the elderly in LTC settings has increased 40% with a high proportion of this increase among the mentally compromised. Additionally, up to 55% of falls are associated with an injury, underscoring the need for identifying systems errors or human factors which have contributed to this rise. Patient health conditions are known to be contributing factors, but other factors include environmental hazards, toileting problems, certain medications, altered mental states, poor footwear choices, reckless wheelchair use, and inability to adapt to a changing environment (Currie, 2008).

Medical errors can be broken down into both human and system errors. While human errors are attributed to cognitive failures, they do not occur in isolation because a well-designed system would prevent a human error from occurring via the use of safety checks. Therefore, most medical errors are really rooted in poor system design which allow errors to occur (Galt & Paschal, 2011, p.109).

An estimated 78% of falls can be anticipated in LTC residents, and therefore can be prevented (Currie, 2008). Like other medical errors, the high rate of falls occurs because of poor awareness and understanding of the causes, and the failure to address these causes is due to inherent traits in the medical culture, which traditionally has not been patient-centered (Galt & Paschal, 2011, p.109).

Strategies and Tools to Reduce Fall Risk

Happily, resources are available to assist LTC facilities in reducing the fall rate amongst their residents, such as the long-term care minimum data set (LTCMDS) which documents the susceptibility to and history of falls in LTC residents. Another tool is the Nursing Home Quality Initiative, which offers a more sophisticated measure of the probability of fall risk in LTC residents because it tracks both physical and cognitive decline over time.

Additionally, exercise programs have been shown to be helpful in reducing the rate of falls, along with improved nutrition, corrected eyesight, regular fall assessments and cardiac pacing. Handrails, secured rugs, stair tread tape, and thin-soled shoes are effective environmental strategies (Curries, 2008), In their publications Check for Safety: A Home Fall Prevention Checklist for Older Adults and What You can Do to Prevent Falls, the CDC recommends many of the same preventive measure for patients and families as those used in LTC facilities, demonstrating that fall prevention in the elderly is achievable with relatively simple steps.

However, the CDC recommends a multidisciplinary team approach which espouses the above practices (cdc.gov). When designing systems, LTC facilities should plan for human error in order to develop effective safety checks similar to those used in high reliability organizations (HROs). This requires understanding the conditions in which healthcare workers provide care, and the ways in which they assimilate and communicate information (Jenks & Gelinas, 2010). Future research and strategies into fall prevention are likely to improve this problem.

References:

2014 Long Term Care Medicare/Medicaid Certification-based Option

National Patient Safety Goals, (2014). The Joint Commission. Retrieved from:

http://www.jointcommission.org/assets/1/6/2014_LTC2_NPSG_E.pdf

Currie, L. (2008 April). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Section III: Patient-Centered Care. Hughes RG, editor. Rockville (MD): Agency for Healthcare Research and Quality (US). Chapter 10 “Fall and Injury Prevention”. Retrieved from:

http://www.ncbi.nlm.nih.gov/books/NBK2653/pdf/ch10.pdf

Falls in Nursing Homes, (2012, February). The Centers for Disease Control and Prevention. Retrieved from: http://www.cdc.gov/HomeandRecreationalSafety/Falls/nursing.html#prevent

Galt, K. A., & Paschal, K. A. (2011). Foundations in patient safety for health professionals. Sudbury, MA: Jones & Bartlett.

Jenks, S. & Gelinas, L., (2010). Laureate Education, Inc. (Executive Producer). Quality assessment and improvement. Baltimore: Author. “Patient Safety”.

Improving Patient Safety in Nursing Homes: A Resource List for Users of the AHRQ Nursing Home Survey on Patient Safety Culture, (2010, June). Agency for Healthcare Research and Quality, Publication No. 11-0012-1-EF. Retrieved from:

http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/nursing-   home/resources/nhimpptsaf.pdf

Varkey, P. (2010). Medical quality management: Theory and practice. Sudbury, MA: Jones & Bartlett.