 Welcome to Elderhood, aging gracefully. Think Tecawaii joining together with me, Larry. Looking at Elderhood and what it takes to age gracefully here in Hawaii and around the world, wherever we are. And my question is, we'll look to Puna, our elders. How do we take care of our elders in the midst of a pandemic? How do we take care of elders in the midst of a pandemic? It's a very important question because as of 2018, 18.4% of the Hawaii population was over 65. So it's something that is very much a part of our local life all the time. My more recently, it seemed to me it was closer to a quarter of the population which was about 240,000 over 65 which puts it in another dimension here as we look at our population. How do we take care of our Kupuna in the midst of an elder, in the midst of a pandemic? And I've invited back to continue this discussion. My guest from two weeks ago, Erin Hamilton from Bristol Hospice who is the Area Community Director. Say your exact title for us, Erin. It's the Area Director of Community Education. Thank you very much. I just know her as an excellent cohort and coworker for I too have the pleasure of working with Bristol Hospice, one of several hospice providers on the island of Water but certainly the premier provider. So this is the question, Erin. How do we take care of our Kupuna? What's the best way to take care of our Kupuna in the midst of a pandemic? Those who are over 65 are what we call the vulnerable population, right? Yes, definitely. So I would say the first question is going to be what are the goals? So asking the patient or family member where do they wanna be? What makes them most happy and most comfortable? And if that is remaining at home then it would be to try to stay at home. If the medical care is such at a level that it is not possible for them to be home, there's other avenues that you could look at and that would be typically a foster home or a smaller care home setting or a nursing facility setting as well. I think most of us are accustomed to nursing facilities and thinking about nursing facilities, I'm not sure the general population knows as much about foster homes or care homes. Would you explain that system, that part of the system for us? Yes, so a foster home or a care home is typically going to be anywhere from four to a larger one, maybe about 10 patients in a home. For the most part, it is usually four and less and up at four, it's typically gonna be one person up at four that their level of care or their medical needs are gonna require them to have more assistance with daily living activities such as bathing, eating, cleaning, that sort of thing. And foster homes are going to be more if a home setting they're going to be in your local neighborhood, they could be down the street. The caregiver is living most likely in the home and their employees are either typically nurse or they live in the home or are doing shifts with rotating other persons in and out of the care home setting. It's either gonna usually be a private pay situation or Medicaid would be involved in it versus our nursing facility setting would be a different payment method. So my understanding is Medicaid pays for room and board. Medicare does not during the general care until it's intensive care, is that correct? Some what, so Medicaid typically is going to pay for what we would call long-term care. So the long-term care could be provided in a foster home. However, it has to be a Medicaid certified bed or it could be provided in a nursing facility setting. Typically a person who or the persons in a foster home setting are going to be a little bit more high-functioning. So maybe out of that four, three or ambulatory and they're able to walk on their own versus a nursing facility setting, a good majority of them are either going to be there for rehab or going to have a much higher level need of daily living activity. So there's a little bit of a criteria difference but for the most part, Medicaid will always cover room and board. It's Medicare that would not be covering long-term care. And just the difference between the Medicare and the Medicaid is going to be Medicare is 65 and older. It's a benefit we all would have. And then Medicaid is going to be based on financial criteria. Thanks, Erin. And so the complexities of all of this can be navigated with the help of what person in a hospice say, in our hospice. Sure, sure. So typically in terms of placement, it would be the social worker, but on the subject and the topic of caring for a family member with COVID-19, just being our natural environment, definitely the clinical team is going to be involved in that. So the Department of Health has put out a few different flyers, just kind of easier to read. And they're usually about five steps. So the first one, and we can pull that up, is going to be five steps when caring for a person in a foster or care home setting. So the major difference is going to be that when we're in a foster home setting, typically we're not having registered nurses or a attending physician in the home versus a nursing facility setting. So there's a lot more education that is being brought forward for them as well and for families too. So the first thing that you'll notice is, just making sure that everyone in the home has an infection control protocol or a plan in place. So that would also be a part of recognizing signs and symptoms if a person has or potentially is under suspicion of COVID-19. So coughing, fever and that sort of thing. The second step would be to anticipate challenges. So I think some of the things that is very, very challenging and we're all facing is going to be in a foster home setting. We have a large amount of them available in Hawaii. However, the challenge with it is that the residents that are in the foster home setting are typically also going to be the caregivers. So with that being said, if a patient or a resident becomes positive with COVID-19, most likely the caregiver or the foster home is exposed. So we just have to be really, really careful about following proper protocol and isolation as much as possible in those settings. That would include the third step, which is establishing a routine. So I think having a routine just like for all of us really helps reduce our anxiety and it helps us also to find where we can improve and what we're doing good at. So washing our hands, making sure that if there's any bodily fluids that we are cleaning that up with antiseptic chemicals and making sure we're disposing of that properly. The fourth step would be very much connected to this, which is trying to prevent this spread of disease. So really infection control, social distancing, staying home, limiting the amount of visitors. And we are seeing that now that the foster homes, just because they are of course more at risk, but just because of the residents there are that vulnerable population. They have, a lot of them have kind of reverted to the nursing facility model where they're not having or having limited amount of visitors coming in. So this is a challenge and just a really tough part about this whole situation, which is, people not being able to visit their loved ones in a care setting. And a lot of family members have kind of gone to the foster homes because they wanted more of a home feeling. They wanted to be able to have more one-on-one interaction with their family members and visit them. And this is another challenge that we're kind of going through right now. And then the fifth step would be monitoring the, monitoring safely. So dry cough, fever, difficulty breathing, they're all gonna be signs of an infection. So making sure that if that worsens over time and also wearing PPE. So PPE is gonna be our personal protective equipment. So that'll be our masks, our gloves, our face shields, that sort of thing. And just making sure that everybody in the home has those things as well to protect the resident as well as themselves and contact spread. So those are the five steps. For a person who's in foster home and in a care, hospice care, will the hospice program monitor all of this, do you think? Oh, sure. You mean the symptoms of the patient? Yes. Yes, definitely. So anybody who is caring about for their elder can trust, can know that they have the confidence that they have a professional onlooker all the time who will be monitoring this kind of care, even in a foster home and care home, smaller versions of care. Right. And then also, I think that added benefit of it as well is that in a foster home, there may not necessarily be a registered nurse doing symptom management. They have case managers, but they're not in this frequently and a registered nurse for hospice. So the RN case manager for hospice is also gonna be communicating with the physician, the attending physician. So if there's any sort of status change or medication needs for symptom management, that's gonna be communicated as well. Good. So how about keeping my elder mother or father at home? It wouldn't be mine because they'd be mine or not a lot, but if we're keeping our elder mother or father or auntie or uncle at home, what are we looking at? What's the best thing for us to be responsible to? What kind of criteria of prevention do we need to follow? Sure. So again, the Department of Health does provide, again, kind of the five quick steps to kind of recognize this and preventative measures. So the first one really is gonna be, I think we've all been hearing it, which is preventing the spread of disease. So having a person stay in a separate bedroom, if a person has any signs or symptoms themselves, also staying away from others that are more susceptible and are more a compromised population like the elderly. Utilizing their own bathroom, I think that that is probably overlooked a lot because not everybody is cleaning their bathroom after every single use in between every single person. And then also in Hawaii, we're just in a very unique situation which makes us wonderful culturally. I think with that being said, we have typically multiple generations living in a home. So with that, there's also gonna be a risk of exposure for potentially somebody who's younger, who is asymptomatic or not showing any symptoms to be a carrier of the virus and then coming home to grandma, grandpa, mom, dad and potentially getting them sick. And I think the challenge about this entire situation that we're in is this is pretty much an invisible war that we're fighting except it's an invisible war of us having contact with the people we love. So it's an even more difficult challenge. The second step for the caring for a person in your home is going to be the periodic symptoms and monitoring that. So if there is support staff coming in making sure that everybody is being monitored for a fever, cough, shortness of breath and then any sort of muscle pain, flu-like symptoms, sore throat, a new symptom that has come out that I think a lot of people have not necessarily heard about is gonna be a loss of taste or smell. And that's something that has been correlated with COVID-19. And then of course, if you're recognizing or seeing any of these symptoms to definitely call your healthcare provider, call your physician and let them know. The third would really just be providing symptom treatment. We do not have a cure yet for COVID-19. So it's really your healthcare provider, your physician is going to be trying to control symptoms. So trying to make sure that if you have a fever, reducing your fever, if you're having shortness of breath using whatever medications they're gonna be recommending at that time to help with that symptom management. And then of course, if your symptoms become worse at home you can call 911 if you're having any sort of extreme shortness of breath, trouble breathing, new confusion and then also just making sure that you're keeping everyone informed. So if you have multiple people in the home and you find that one person is confirmed or under investigation for COVID-19 just making sure that you keep everybody in the loop too as well just so that they can be a little bit more proactive whether that means isolation or self-quarantine electively or going out and getting tested themselves. So those are the five steps when caring for a person with COVID-19 in your home. Larry, you're on mute again. I had another thought just as you were talking. Sure. As we approach, as the discussion heightens about the children, what is your concern about opening the schools? Well, I'm a mother of a five-year-old so I can say of course there is concern. We have the Department of Health definitely working in close contact with the Department of Education trying to come up with parameters to make sure that just like we are talking about right now with distancing, isolation, symptom recognizing any sort of changes, they're trying to implement that as well in the school system. So I know that they have talked about cutting the classes in half basically and then doing half days and spreading the children so that there's not as many in a classroom setting. But of course there's always concern, but I think that there's definitely been some proactive measures put in place. Aaron, some are talking about the disease, the virus spreading by droplets. Can you explain what that means for a lay person like me? Sure. So I think that we've been hearing that a lot so like they say, droplet precautions. So if you or I right now are maybe less than six feet within each other and I sneezed, my droplet precautions from my body would be in the air and even if you were not able to see it, it would kind of be like a mist and whether that got on you, whether that got in your nose, your mouth or on your hands or in your eyes and your mucus membranes and it went there, that would expose you to those so-called droplet precautions. So that's why having a mask is important, washing your hands, wearing gloves, when having any sort of exposure to any sort of bodily fluids is important. Or you're seeing a lot more with face shields or goggles and that's just because our eyes are also mucus membranes and can absorb droplet precautions too. Well, particularly important for family who are doing care in their own home and anything can be transferred by droplets but particularly to be aware of the face coverings and in my home care for my kaboona. What else would you wanna share with us, Erin, right now? I think the most important thing that we have been dealing with is really education. And I think that we are seeing any of us go and drive down the street, you're gonna see people who are not wearing masks or just maybe not necessarily following the Department of Health guidelines for this. And I think that the difficult thing about this entire situation again is it is a invisible, basically it is an invisible war that we are kind of going through. And so when you say droplet precautions, it really is at that point, we don't know if something you're touching, if you're at the gas station, if you're going grocery shopping, they've found that with the cruise ships, some things actually still had the virus on it for multiple weeks. So we don't know enough, this is new to us as a virus. And so I think it's important to just really do our best to protect not only yourself because I think that there is a preconceived notion that I'm not sick, I'm not feeling symptoms and or I'm not seeing anybody with these symptoms. But I think what a lot of people are not seeing is that there are a lot of people that are undergoing this and are at risk for it, it's just that it's indoors and they're behind closed doors that they're undergoing it. And so it's just not open to the public eye, but it is important that we wear a mask and do all of those things to protect those. Thank you. And you had another sheet that you wanted to share with us, I think. Sure, so we talked about how to prepare if you're in a foster or care home setting or if you're an individual caregiver and then what to do if you are a caregiver with COVID-19. So making a plan because I think what we've noticed is let's say you are the sole caregiver or your mom, your dad, grandma, grandpa and then you yourself are positive for COVID-19. What is your plan gonna be? So definitely identifying a backup caregiver in your family when you get sick or if you get sick, this could be a family friend, it could be a neighbor, a substitute caregiver, maybe looking into different agencies, private, hire-contacted agencies that would be able to assist during that time, looking at your insurance and would they cover something like a respite period for mom or dad where they could be in a nursing facility for a few days and then definitely communicating with your backup person on a for daily support and noticing if there's a service coordinator. So some people, you know, whether you have, depending on your insurance type, whether you have Medicaid, you have HMSA, there's typically gonna be a service coordinator who's attached to you and they are a wealth of knowledge. Everyone has a service coordinator that you can reach out to through your insurance company and can kind of help and guide you through what your insurance can offer you through these sorts of situations as well, taking care of your mom, your dad, your grandma, your grandpa and then of course, creating a list of emergency contacts and sharing it with your backup caregiver because if, you know, in the event that you become sick and you're short of breath and you go into the hospital and for whatever reason, you know, worst case scenario, you are intubated and are not able to speak for yourself and talk about your backup plan for mom or dad at home, at least that's all set in place. And then definitely also, you know, we really wanna support the emotional wellbeing of everyone right now. So I think that a part of just like this is an invisible disease that we're fighting. It's also emotionally very, very difficult for a lot of people because we have gone into isolation. We are now doing social distancing, which I think in itself has changed everything in our world and our social interaction. So having someone to talk about that too and what you're going through and what can you do to get more support. Definitely also, you know, the second step would be preventing the spread of disease. So we kind of talked about that, just being proactive, whether it be washing hands, wearing gloves, if you're sick, going and making sure that you're isolating if you start to have symptoms that you think could potentially be COVID-19 calling your healthcare professional, your physician and then monitoring safely. So if you have, you know, a cough, a fever, difficulty breathing, signs of infection that may worsen with time, just be mindful of that, keep track of that and wear your PPE as indicated. So if you have no signs or symptoms of, you know, infection or the person you're taking care of has no signs of infection or any sort of COVID-19 symptoms, you know, when they say wear PPE or personal protective equipment is indicated, that would be a time when, you know, there's not a lot of gloves and masks and N95s out in the community just because we were planning to open up. So there's a lot of businesses, schools that have had to buy a lot of the PPE. So there's a limited amount available to us as well. So just being mindful of that and then contact your physician, of course, if you have any concerns or symptoms. Aaron, this has been wonderful to hear from you again and have this guidance and direction. If anybody needs any kind of consultation on this matter, please know that resources are available, simply call Bristol Hospice, ask for Aaron Hamilton or anybody who is on the staff that is designated, you know, a social worker or one of our highly qualified people there and certainly any other hospice service on the island would do the same. Thank you so much, Aaron. There was another question that came in, we'll not be able to get to it. Thank you all who asked questions and thank you so much for this opportunity to join together in truly a deep concern for the wellbeing of our whole community. When we consider what we do with the most vulnerable in our midst, then we are, that is a value, that demonstrates the value that we hold for one another when we take care of the most vulnerable. Aaron, you have helped us immensely. Thank you very much. Thank you, I appreciate it. And thanks to ThinkTek Hawaii. We're going through our donation time. 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