Monthly Archives: September 2014

The American Heart Association states that stroke is the No. 4 cause of death and a leading cause of disability in the United States.

Working with a primarily senior population, the health care team at the 45 year old Staten Island-based, healthcare agency, SafeHarbor HealthCare Services works with many patients who are in need of assistance due to having survived a stroke.

“It is a frustrating and painful process to watch your loved one work their way to a more independent way of life and in some cases the severity of the stroke may never allow for a full recovery” stated Mary Brady RN, Supervising nurse at SafeHarbor.“While our trained healthcare providers are knowledgeable, we also encourage family members living with or occasionally caring for the loved one to know t he possible risk factors and the warning signs.”

Risk factors for many include:

  • having already had a stroke
  • having Transient ischemic attacks (TIAs), a warning stroke that caused no lasting damage
  • having had a heart attack

There are other contributors, but for the caregiver, or person living with someone who has risk factors, it is also important to know the signs of a stroke.  The American Heart Association has an easy way to remember sudden signs called F.A.S.T.

 F.A.S.T. is:

  • F- Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile.  Is the person’s smile uneven?
  • A -Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
  • S-Speech Difficulty – Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like “The sky is blue.” Is the sentence repeated correctly?
  • T- Time to call 9-1-1 – If someone shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get the person to the hospital immediately. Check the time so you’ll know when the first symptoms appeared.

The National Stroke Association cites that one in six strokes is caused by a heart condition called atrial fibrillation (Afib), a condition where the heart beats abnormally resulting in the formation of blood clots.  Medical science has shown that having Afib increases the risk of stroke by 500 percent.

“Recent  studies have concluded that more strokes are attributed to Afib even though a short hospital visit does not indicate its presence.  Patients and their loved ones should relate any known risk factors or behaviors to the treating physician to rule out a heart problem as the cause of a stroke.  Caring for a patient and being knowledgeable and in tune with their risk factors and the latest medical science data on this issue is key to quality care”, added Ms. Brady.

For information about SafeHarbor  call: 718-979-6900.

Responses provided by: Mary Krause Brady RN, Supervising nurse at SafeHarbor HealthCare Services, a family operated, 45 year old Staten Island-based Joint Commission Accredited agency.

What are indicators that you should look for to determine whether your loved one can maintain an independent lifestyle?

When determining if your loved one can safely live independently, there are a few indicators to look for aside from the obvious ones like frequent falls or not recognizing people who are regularly in their lives. Check to see if medications are being taken regularly by discreetly counting them when you are visiting; see if the food in the refrigerator is fresh and being consumed. Is the person having difficulty bathing, keeping clothes clean and not keeping up with personal hygiene? Are they having difficulty with paying bills on time?

After making the assessment do you have a conversation with loved one first or an agency?

Only the one making the assessment will know how their loved one will react to having another person in their home taking care of them. Many may feel their independence is threatened and will not be receptive to the idea at all. Of course the optimum solution, if at all possible, is to have a loving family member or members alternate care. If financial resources are available, suggesting that a non-relative be hired to do some cleaning or shopping once or twice a week may alleviate their anxiety about the situation. This may help to make the loved one more comfortable to having someone in the home; if appropriate the aide could then assist with activities of daily living, i.e. personal hygiene, preparing meals, etc.

Does an agency offer intervention to assist with THE conversation?

If an agency must be utilized, most will aid the family in helping the loved one understand the need for some assistance. The usual procedure is that a supervisory Registered Nurse from the home care agency makes the initial visit to access the situation and put the consumer and family’s minds at ease. Once an agency is selected, typically they will assign a Home Health Aide to the case, if that is the level of care required. The family will meet the Aide when they start working. Of course, we usually try to fill the position with someone who will be compatible to the loved one’s personality and likes. If the loved one is not comfortable with the person we send, someone else is assigned until their needs are met.

Once the decision to use a Home Health Aide service is made what are next steps for family?

The agency should help the patient and family feel secure.  It is often requested that a family member not stay the first day but return unexpectedly to see how well the consumer and aide relationship is going. I always suggest that, if possible, the family visit often and unannounced.

No matter who you have working in the home, and even though they are bonded and screened, it is always a good idea to put valuables away and not leave opportunities for any misunderstanding. Install a listening or video device that gives the family some level of comfort. You can decide whether or not to tell the home health agency that it is installed.

Once the type and level of services are needed and determined how do you “shop” for one? How do you compare? What resources are available to fully investigate the options?

Start by researching agencies in your area. Question how long they have been in business and most importantly, how are their employees screened?  Are criminal and background checks done on a regular basis? Other sources for references would be your physician and friends who have had similar services. The family should feel free to interview each agency, and ask for references from others who have used their services.

Once you’ve settled on a service how do you stay involved in the loved ones care? How do you monitor?

Does the agency keep in touch with the family and reassess the client? How often? The family should be assured that the service agency is available 24/7 and that calls will be returned within a reasonable time. Be vigilant by stopping by frequently unannounced, especially if your loved one is incapable of letting you know if there is a problem.

What should an agency provide to loved ones in terms of reporting?

Someone from the service agency should call once a week and a Registered Nurse should visit on bi-monthly basis at a minimum. There should be a receptive voice from the agency for any concerns or questions and you should be confident that messages will be relayed to the Nursing Supervisor.

“Urinary tract infections, as we know from our long time working with elderly, are a very common infection affecting the elderly. The difference is that in the elderly population the symptoms may manifest in ways that mimic other disorders or lead to diagnosis that doesn’t address the primary issue, the UTI,” said Mary Krause Brady RN, Supervising nurse at SafeHarbor HealthCare Services, a family operated, 45 year old Staten Island-based Joint Commission Accredited agency.

The elderly are susceptible due to a lack of hydration. Whether it be a patient with a form of dementia or just the ability or desire to have an adequate intake of fluids, the elderly can develop a UTI yet not experience the same symptoms as a younger individual. They may not have pain or fever but rather are confused or feeling excessively tired.

“We have found that working with the elderly that you can’t look at their symptoms in the same way you would someone half their age,” said Mrs. Brady.

According to the National Institutes of Health (NIH), elderly people are more vulnerable to UTIs for many reasons, not the least of which is their overall susceptibility to all infections due to the suppressed immune system that comes with age and certain age-related conditions.

NIH has cited that younger people tend to empty the bladder completely upon urination, which helps to keep bacteria from accumulating within the bladder. But elderly men and women experience a weakening of the muscles of the bladder, which leads to more urine being retained in the bladder, poor bladder emptying and incontinence, which can lead to UTIs.

UTIs in the elderly are often mistaken as the early stages of dementia or Alzheimer’s, according to NIH, because symptoms include:
• Confusion, or delirium-like state
• Agitation
• Hallucinations
• Other behavioral changes
• Poor motor skills or dizziness
• Falling

We recently had a case where a client presented with increased confusion and had sustained several falls. Diagnosis was delayed because common signs and symptoms such as discomfort on urination and foul smelling urine were not present. After a complete blood work up and vital signs, a urinalysis finally revealed an infection of the urinary tract. A course of antibiotics quickly helped the patient regain her normal mentation and secure mobility.

About Safe Harbor HealthCare Services
Since SafeHarbor’s establishment nearly 45 years ago, this fully licensed by the State of New York and accredited by the Joint Commission on Health Care Organization remains family owned and operated by the founding family of Frank Krause.

Caregivers at SafeHarbor are professionally trained, thoroughly screened, bonded and insured and undergo a complete background check, including fingerprinting under the auspices of the New York State Department of Health. SafeHarbor maintains its credentials by hiring highly qualified and professionally supervised personnel with a team approach which emphasizes total case management and excellent customer service as well as by compliance with agency and governmental regulations.

For information about SafeHarbor call: 718-979-6900.