Veterans, home health care and technology

Mountain Empire Legal firm logoThe Department of Veterans Affairs (VA) has become an unlikely and innovative pioneer in the quest to provide cost-effective, quality home health care for veterans. Although the agency has long been mired in controversies surrounding its programs, particularly arbitrary caregiver dismissals, the home health services sector of the VA has long been touted as an overall success story. As Thomas Edes, director of comprehensive geriatrics and palliative care programs for the VA puts it “We’re working in this environment of challenging budget constraints, and at the same time, we’re a very mission-driven organization. Put those together and what happens? That really pushes us to innovate.”

This innovation has seen home-based primary care for veterans quadruple since 2000, and all VA medical centers throughout the US now have a palliative care program as well. The VA Medical Foster Home program care has expanded from a pilot to a national program, recognized in at least 45 states and providing veterans housing as well as in-home care. These success stories are great news for veterans and a must for the Veterans Administration in part because the median age of a veteran is now 64 and the US aging veteran population is growing even faster than the senior civilian population.

It is not just the “new-comer” seniors straining the VA health care system. Nationwide the 85 plus population is on track to increase 70% from 2000 to 2020 according to the US Department of Health and Human Services. The overall unsustainability of the US health care system has forced the hand of the VA, and there is no more cost-effective way than through subsidized, at home family and community-centered health care and technology to meet veterans’ care needs.

The Official Blog of the U.S. Department of Veterans Affairs reports that Telehealth is revolutionizing veteran care and providing high-quality treatment for them. The VA Video on Demand is delivering convenient, accessible health care particularly to those 24 plus percent of veterans who live in rural and remote access locations. Telehealth is also important for those veterans who are disabled. Although a veteran might live in a city they might be unable to get themselves to a medical center for an appointment.

Assisted living technologies for veterans include assistive mobility equipment – an ever-expanding category including wheelchairs, all-terrain vehicles, exoskeletons and in-home ceiling track mobility systems. Each of these continue to be refined and specialized to meet the individual veteran’s needs. The Veterans Administration awards grants to develop technology to assist veterans and service members in modifying their homes. Adapted computer access and electronic aids to daily living and environment control units (personal assistants) provide customized interactive abilities for veterans.

Electronic cognitive devices help veterans who struggle with activities of daily living (ADL). These devices include personal digital assistants (PDAs), smartphones, pocket personal computers (pocket PCs) and other handheld devices, global positioning systems (GPS), reminder watches, pagers with reminder features, and digital voice recorders. The use of these devices helps a veteran stay on schedule with medications as well as stay connected with family, friends, and their medical monitoring community. Those veterans with Post Traumatic Stress Disorder (PTSD) are further helped with their ADLs when robots with artificial intelligence (AI) are introduced into their environment. These AI “tech bots” are capable of reading human facial expressions and can identify when a veteran is feeling particularly stressed, isolated, angry, or depressed. The robot can upload the information to the veteran’s caregivers thus alerting them to the need for human intervention. Wearable sensors can also alert a caregiver or medical professional when vital signs are outside of a normal, healthy range.

The VA will provide a payment to disabled veterans toward the purchase of a car or other transportation and additionally will pay for adaptive equipment, repair, reinstallation or replacement of necessary equipment due to disability. If a veteran has lost the use of at least one foot, hand, or has a permanent impairment to their vision or severe burn injuries or immobile joints that their limit mobility, the VA will help to fund the adaptation of the vehicle to make it fully operational to the veteran.

While the latest technology brings benefits to all seniors opting to age in place, the veteran community is especially helped. Many veterans would like the luxury of aging without combat or noncombat injury so inherent to military service. Some of the aging in place obstacles they must overcome are extreme, commensurate with the injuries (psychological and physical) they have endured. Navigating the benefits that are available to a senior veteran is complicated if you are not well versed in the process. Getting enrolled in the correct program and receiving benefits can also be a lengthy process, so it is best to seek help before wasting valuable time.

If you have questions or would like to discuss your particular situation, please don’t hesitate to contact us.

Seniors and Drug Abuse

Many seniors are from a generation that, on the whole, still scorn drug abuse and stigmatize those people who engage in such activities. However, as the baby boomer numbers increase in senior living environments, they bring with them a more freewheeling attitude about drug use and misuse rooted in the culture of the 1960s and onward. Many of the senior baby boomers have experienced illegal drugs first hand, and because of a sense of nostalgia, their views may be more tolerant to the overuse or abuse of drugs.

The opioid epidemic in America is now firmly rooted in the senior population. Statistics indicate that opioid addiction has been growing as fast or even faster among seniors compared to other age groups. The National Institute on Drug Abuse (NIDA) estimates 115 Americans die every day from overdosing on opioids and according to 2014 report by the government Agency for Healthcare Research and Quality, the rate of hospitalization for opioid overuse among those people 65 and older has increased over five-fold since 1993, and continues to worsen.

The crisis has grown mainly from doctors prescribing opioids like OxyContin much more frequently beginning in the mid-1990s under guidelines and assurances from pharmaceutical companies that opioid pain relievers were not as addictive as previously reported. However, this opioid class of drug is highly addictive, and many patients prescribed the medication end up abusing their prescriptions. Based on controversial research in 2009, the American Geriatric Society (AGS) announced that they were in favor of prescribing opioids, asking doctors to consider opioids for any senior with moderate or severe pain. Since seniors often have multiple chronic pain conditions, it is easy to see how addiction rates can skyrocket among the senior population. But, it is more than just opioids.

According to the Drug and Alcohol Dependence Journal, of the 63% of senior study participants who had an alcoholic drink over the course of one month, 13% had engaged in binge drinking, which is defined as having five or more drinks in a single session of imbibing. Bars and pubs are becoming one of the new normal amenities in life plan communities, and it can put seniors at significant risk. Stumbling and falling after having too much to drink or driving a small golf cart while impaired can have disastrous consequences. There is also a danger of mixing prescription medications with alcohol, which can be fatal.

Beyond opioids and alcohol, there is marijuana. As more and more states legalize medicinal (and recreational) marijuana and provide them in edible forms, more seniors are turning to pot as a painkiller and anti-nausea treatment. Contrary to what many believe it is not harmless, especially in a geriatric patient. The strains of marijuana available are potent and can create confusion, delirium, and even psychotic episodes in seniors and its interactions with legally prescribed medications are often hard to assess.

Professional staff in the aging services industry are trained to look for signs of drug misuse and abuse. The Center for Disease Control (CDC) is now recommending doctors to opt for short-term, fast-acting medications instead of long-lasting drugs and prescriptions.  But seniors who experience multiple, chronic pains may find this means they take more pills as their conditions are usually degenerative.

The best way to solve the problem is through education. As a senior, one should be aware of their medications and the proper doses to take. Encourage each doctor to prescribe the lowest necessary dose and look to alternative options to address pain. Never exceed the recommended dose as prescribed and follow the instructions given by the doctor.  Do not take prescription medication with alcohol. If a senior is having trouble understanding their medications or gets confused with the dosage, encourage them to talk to a trusted family member. Consider drafting a medical power of attorney document that will allow someone the senior trusts to be their advocate for a safe and happy senior life.  Contact our office today and schedule an appointment to discuss how we can help you with your planning.

 

 

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