Growing Old Gracefully

Incontinence, it’s an unfortunate occurrence that is very common with advanced age. First step would always be a trip to the Dr to see if there is an underlying cause that needs treated first.
Management: Depending on severity the Dr may refer to the hospital’s continence clinic, but there’s a whole lot of steps before being severe enough.
Supermarkets sell a range of pads and liners for urine, suitable for men and women. Often its not the spilling but the frequency that’s the issue, men can use a bottle or bucket by the bed overnight and both men and women may benefit from a bedroom commode chair. This reduces the time spent out of bed and distance travelling at night when falls frequently occur.
There are Pull Up’s an underwear replica continence product available at supermarkets and Disability stores too. They are disposable and tear down the side to remove if bowel continence is an issue.
“Kylies” or Brolly sheets can be bought to protect beds, chairs and the car seat from leakage and provide some dignity to the person, can be used when visiting so not leaving with a mess to clean up.

Meals and groceries
What do you do if you can’t drive and can’t cook?
Meals on Wheels is a service in most areas and the acceptance criteria differs for each area. It’s usually quite strict, you have to be assessed as long term unable, no able-bodied person in the house. An example of this is Mum usually does the cooking but can’t. Just because Dad is used to having Mum do it doesn’t mean they will qualify for Meals on Wheels. There is a small charge for theses meals and not paying the bill will end the service.
There are usually many community agencies and businesses that will provide and deliver pre prepared meals to heat up. Your hospital Social Worker should be able to give you a list. You don’t need a referral for these services.
There are many supermarkets that deliver with online orders or community agencies that will take a person shopping once a week. Sometimes it’s a neighbour or family member that can support.

Total Mobility Card /Mobility Parking
If you have had a stroke or TIA you automatically shouldn’t drive for ONE MONTH or the term medically assessed, your Dr may give a longer term.
If you have a seizure you shouldn’t drive for ONE YEAR.
There's important information about driving here.https://www.stroke.org.nz/sites/default/files/inline-files/Driving%20%2B%20transport%20after%20Stroke_V2_2022.pdf
To return to driving its important to talk to your Dr. They may ask for an assessment by an Occupational Therapist to assess your driving.
If your Dr suspects you have been driving when advised not to, they may instruct LTSA to formally remove your licence.
If Driving becomes an issue, you can apply for a Total Mobility Card, this is processed through your local council and they can guide you where to get the application form from, there are community agencies that help with the application and they may charge a small fee.
A total mobility Card gives discounted Taxi and bus fares.
A Mobility Parking permit gives you access to Mobility Parks There is a higher fee for this application subject to how long your permit will be for. https://www.ccsdisabilityaction.org.nz/assets/resource-files/Mobility-Parking-Application-Form-Mar2022-FILLABLE2.pdf

Disability Allowance, on a low income your loved one may qualify for a Disability Allowance. This helps with the care of lawns and gardens, Medical Alarms, Non funded prescriptions and general prescription costs, Transport to Doctors visits, Heating costs – power, wood & gas, costs associated with a disability someone may have. The disability can include frailty associated with age.
The DA needs applied for through WINZ and the persons Doctor. It is income tested but if a pension is your main income and a small amount of interest you will qualify.
It is paid into your bank account with a pension or other benefit. It’s the persons responsibility to pay the bills and keep receipts as each year the amount will be reviewed based on receipts.

Isolation. This is a huge issue, many people who have lost loved ones, lost mobility, hearing decline and lost confidence end up with social isolation and this can hasten cognitive decline.
Age Concern and other community organisations have activities and lunches which can create a community of like-minded people to socialise. Encouraging visitors at home, even for just short visits.
Rest Home care can isolate further as family visit less when they know their loved one is being taken care of. Ensure you accompany your loved one to activities programmes and plan visits with them – they need something to look forward to.
Volunteering can be a huge antidote to isolation, reading at a kindergarten, helping with flowers at a rest home, volunteering for events, becoming a caring caller (Phone call on a regular basis) to help others, anything that brings meaning and purpose to life helps with the isolation.

Access and hand rails – These need put in BEFORE they are needed. I know, how do you judge this time? Any unintended falls or instability. Any bathroom renovations, include handrails; in the shower, to get up from the toilet, getting in/out of the bath. Entranceways and anywhere there are staps.
In some cases handrails can be funded by the hospital but there’s a long waiting list and the chance an assessment may have funding declined. Its an investment to have them installed yourself. There are community organisations, mobility stores that will install for a fee or DIY stores sell them.

Advance Directives.
These are decisions you can make to let your medical professionals know what treatment you want if things go wrong, and you can’t say. These fit in with EPOA. They are limited to what is legally and ethically allowed. You can advise your Family Doctor to what lengths you want resuscitated or not as an example.
Theres a wealth of information here Advance Directives & Enduring Powers of Attorney - Health and Disability Commissioner (hdc.org.nz)

Enduring Power Of Attorney – often shortened to EPOA
This is put in place through a lawyer while cognitively intact and healthy. You decide who will make decisions when you can’t. Once in place nothing happens until the time you aren’t cognitively intact and healthy and can no longer make decisions for your self as assessed by a Dr. You need two, one for health decisions, one for financial decisions. They can be the same people.
Just because you select people to make the decisions doesn’t mean they are solely able to decide. They should know and respect your wishes and make decisions along your advance directives. Your loved ones should be kept informed and consulted if your EPOA doesn't know what you would have wanted.
It can take several months to put and EPOA in place through the courts when a person can no longer make decisions, so it is important to do while in good health. Most people choose a younger family member.

Services.
Sometimes on discharge from hospital or after discussion with a Dr there might be “Services put in place” sounds ominous but its really just another way to keep people safe at home.
Services are usually government funded and many are not asset/income tested they include...
Personal Care assistance, help with washing, dressing, support stockings etc.
Safety Check, someone who calls in around mid-morning just checking everything is ok and the person is up and about independently and no assistance needed, many people don’t have family support and this helps them feel safe.
Medication support, someone to check, measure if needed and assist with taking of medications. Sometimes its not easy to see the dose or open the package and someone will call in for 15 mins to support this.
Domestic Assistance. Sadly there’s very few agencies able to offer this currently but the plan is for one hour a week someone comes in and changes the bed, cleans the floors including vacuuming, shower floors and mopping vinyl floors. It’s just the basics and the things where falls are likely to occur. There just isn’t enough funding for things like dusting, cleaning the fridge, guest bedrooms or pet care so they have to be self-funded.
If you feel your loved one needs help talk to their family Doctor

Equipment
This can be bought from Disability Supply stores, Kmart, The Warehouse, or Issued by an Occupational Therapist (OT) through your hospital after an event or via referral from a Dr.
Band one (The first to be issued) equipment is fairly basic but makes a lot of difference.
Band Two or higher requires a full OT assessment and sometimes needs funding applied for, this can take some time.
Some common band one equipment includes…
Over Toilet Frame – (Pictured) This is a frame that raises the seat of the toilet and provides arms to help a person get up.
Shower stool, something to sit on while showering, it has arms to help a person get up.
Chair raiser, a frame that attaches to the base of common armchairs raising them a few cm (Between 5 and 15) to make it easier to get up.
Bed Lever (Bed loop) this is L shaped and sits under the mattress providing a vertical arm that provides leverage needed for getting in and out of bed.
Bath board, this sits firmly across the bath for a person to sit on while lifting their legs in and out of a bath, once in they can stand up or remain seated. This is used in a shower over bath situation.

Deconditioning
If someone has been in hospital for some time they will start deconditioning, losing strength, balance and mobility.
There are exercise programmes in the community and online to help get them back to where they were previously. This isn’t for everyone though. There’s also equipment that can be put in to make things easier while they get back to their baseline, where they were before the hospital stay. BUT if the equipment makes things too easy it can prevent rehabilitation. An example is raising a chair, it might take a person a few attempts and grunts to get out of their chair but if it was easy before they were injured/deconditioned, and the injury isn’t likely to be permanent its going to slow recovery to raise the chair long term. But if a partner is having to pull at the person, risking injury to both, or they are choosing not to do things because of the effort required to get out of a chair then it’s important to make things easier. I’ll talk about chair raisers in equipment.
When you visit, don’t just sit there and chat, suggest a walk around the garden, or down the street. Assisting someone to regain mobility is important in keeping them safe at home.

Showering assistance.
I’m often sent out to help people have a shower, often they are completely independent and its about the security of knowing someone is there until the get their confidence back.
I love it when the bathroom is uncluttered, warm, ventilated, there’s 3 towels for the person I’m assisting. 3 might seem excessive but It’s important for modesty and dignity that the person holds their own towel and they can dry and cover what they feel comfortable covering, usually ge****ls. They sit on one or it covers their shoulders keeping them warm while I dry their feet and legs. They don’t have to be big and plush but plenty of towels is important.
An obvious facecloth/flannel/sponge to use.
Obvious products, soap/bodywash.
There’s lots of equipment needed for a bathroom but I’ll cover that later.