The sustained presence of COVID-19, including the fluctuating easing and reinstating of restrictions, makes it difficult to feel hopeful. As a result, it is critical to identify ways to support our mental and physical wellbeing. It will help us as we work to keep persevering.

Wishful Thinking

When the shelter-at-home orders were put in place earlier this year, the thought was that life would get back to normal anywhere from a few weeks or months. We thought things could get better in the fall, possibly the summer. At that time, the COVID-19 quarantine felt more like a sprint.

As time progressed, we might have thought that the COVID-19 quarantine was more of a marathon, and not a sprint. At this point, we now know that the COVID-19 quarantine is more of a triathlon, not a marathon.

Planning ahead

Preparing for a triathlon would be daunting at best, to say nothing of actually competing in one. As a result, athletes who compete in a triathlon must prepare in advance, somewhere between three to six months at least. For caregivers, both family members and caregivers in healthcare, having any lead time to prepare  would have been helpful. Unfortunately, there were limits to being able to prepare adequately. Who knew exactly what we needed to prepare for? Moreover, who knows how long this quarantine will continue?

Persevering

How can we persevere during this uncertain time? There are some parallels in training and preparing for a triathlon and persevering during the COVID-19 quarantine. Some of the ways to persevere can be beyond our control, like making sure you have the right equipment for competition. Other ways to persevere include keeping your body fueled and properly hydrated. Another way to persevere is to find someone to support/coach you when you hit a wall. Also, finding what works for you can help refresh and renew your spirit.

According to the Chinese philosopher Lao-Tzu, the journey of one thousand miles must begin with a single step. While we don’t know how many steps we must take until this COVID-19 journey concludes, we know we must keep going.

Kathy Dreyer, Ph.D., is an Advisor at AGE-u-cate® Training Institute, which develops and delivers innovative research-based aging and dementia training programs such as Dementia Live® and Compassionate Touch®, for professional and family caregivers; kathy.dreyer@ageucate.com

Hospital readmissions can be costly, in terms of the effect on the patient being readmitted and the related expenses. The American Health Care Association (AHCA) established a Quality Initiative (Initiative) to support the level of care in both the long-term care and post-acute care settings. The Initiative aligns with programs underway by the Centers for Medicare and Medicaid Services (CMS) to address long-term care challenges and costs related to hospital readmissions.

CMS implemented the Hospital Readmissions Reduction Program (HRRP) to reduce payments to hospitals with excessive readmissions as compared to other hospitals. The program, which started in 2010 and began assessing penalties in 2012, reviews hospital readmissions within 30 days of discharge for six conditions: myocardial infarction, chronic obstructive pulmonary disease, heart failure, coronary artery bypass graft surgery, elective primary total hip arthroplasty and/or total knee arthroplasty and pneumonia.

While a person with Alzheimer’s disease or another type of dementia can experience many health conditions, the incidence of pneumonia can be particularly challenging. According to the National Institute on Aging, persons with Alzheimer’s disease can be prone to pneumonia in the later stages of the disease due to potential food aspiration. A person with Alzheimer’s disease is likely to be hospitalized during the disease.

Hospital stays for both the person with dementia and their care partner can be problematic and a source of agitation for several reasons. Moving a person with Alzheimer’s disease or related dementias from a known environment to one that is unknown will likely be disruptive for that person. If the hospitalization is the result of an emergency, both the person with dementia and the care partner will likely be more stressed. Also, transferring into a hospital setting provides several challenges. Typically the person will not know many of the persons providing care in the hospital. These staff members may not have experience, information, or understanding about the unique needs of a person with dementia related to their care. Information about the best ways to accommodate a person with dementia is needed, but even those accommodations may not be feasible. If a care partner or family member is not be available to stay the night with the person, additional challenges can result. The National Institute on Aging has a tip sheet for care partners preparing for potential hospitalizations. Following the NIA guidelines can help care partners plan, yet if the person with dementia or Alzheimer’s disease must be readmitted shortly after discharge, any challenges that occurred previously may occur again.

The Alzheimer’s Association created a policy brief to address reducing potentially preventable hospitalizations for those with Alzheimer’s disease or related dementias. Based on these guidelines, support for the care partner and the patient is needed, both in the home and community setting. The utilization of the strategies, outlined by the Alzheimer’s Association, National Institute on Aging, the Centers for Medicare and Medicaid Services and the American Health Care Association can have a positive impact on the care of those with dementia and their care partners to reduce potential costs and improve health outcomes related to hospital stays and readmissions.

Kathy Dreyer, Ph.D., is the Director of Strategic Projects at AGE-u-cate® Training Institute, which develops and delivers innovative research-based aging and dementia training programs such as Dementia Live® and Compassionate Touch®, for professional and family caregivers; kathy.dreyer@ageucate.com