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Handbook for successful ageing - 9.4


9.4 Care for housemates as professionally as possible!

When writing this section, I assumed that you live alone with the patient requiring care. If this is not so, then my suggestions are valid for everyone who is involved in care-giving.

If it is clear that your housemate can no longer get up and cannot take care of himself otherwise, search for a course in which you can learn caring techniques. Additionally, you should have your housemate prescribed a height-adjustable conveyor. It is then placed in the bed instead of the sprung slat. According to the requirement of your housemate, when getting up or lying down, or according to the requirement of the physiotherapist or massager, it can be adjusted overall to a higher or a lower level. The individual parts can also be adjusted, particularly the headrest, which can be put up if your housemate cannot get up to eat and drink.

If this is the case you should also look for a hospital nightstand with a care table, a side table or a bed-table (a tray with legs), depending on which is best/ most suitable for your housemate. You shouldn’t be embarrassed to ask him/her to drink from a feeding cup from now on: he/she closes the hole through which the air is flowing with the forefinger, so that he/she can bring the cup to the mouth in the angle in which he/she wants to drink and then lets the air flow sip after sip until he/she has had enough to drink. If your housemate finds it difficult to carry the cup to his lips, hold him, or purch him up so that he can drink from the container with a straw. If your housemate can’t get up by himself anymore or at least finds it hard, you should get a urine bottle for a men and a special urinal for women. For stool a bedpan is suitable, however the usage of this is very uncomfortable.

If your housemate finds it difficult to walk by himself, procure a walking frame for him; if he is completely unable to walk, then procure a wheelchair and a toilet stool. Finally, ask a nurse to show you how you can help your housemate to shift from the wheelchair to the toilet stool and back to bed by protecting your back.

All these and many other tools for providing care are available in an emergency store. Search for all the equipment that could help your housemate yourself.

If your housemate had a fall, learn to lift him up by protecting your back if you are strong enough. Also, allow his family doctor to prescribe him emergency calling equipment ( refer to 9.3.1 and 9.3.2). If you require to leave the house, attach the signal transmitter to his neck. Like this he can call the rescue coordination centre if possible. You can also call them yourself, if you are not strong enough to help your housemate up alone.

If your housemate lies in bed immobile, in those parts where there are no fatty tissues, pressure ulcers - decubitus ulcers can occur. They are difficult to treat. In order to be able to do so you have to turn your housemate several times. You should again have a nurse show you how this is done, and how often it is necessary. It depends on the sensitivity of your housemate’s skin.

If despite all efforts a pressure ulcer has occurred you should consult a nurse that has been further trained to become a wound therapist. You should also do this if your housemate has venous ulcers and can’t take care of himself anymore.

In addition you should have him prescribed an antidecubitus mattress by the doctor; if your housemate already has pressure ulcers it should be an air mattress with an alternating pressure system. The air cells are automatically alternately filled and emptied by a motor, so that the mattress constantly changes its surface, which is however barely noticeable.

If someone is still able to stand up, but in general doesn’t do it anymore and prefers a certain position, he/she should care preventively his/her skin with a 10 per cent urea lotion at spots all spots which lay on the bed permanently such as: the tailbone, the heels, the elbows and the hip bones.

Photograph the back, the hips and heals of your housemate before he is transferred to a home or a hospital to be able to claim compensation for inadequate care if he develops decubitus ulcers. Check from time to time as to whether certain spots on the skin have reddened or developed ulcers. If required, transfer your housemate to another nursing home if complaining does not help.

If your housemate can still forward his interest, he should remind the staff every morning to put cream on the heels, the coccyx area and the elbows. If your housemate lives in a home, you should also make sure that he is taken good care of otherwise. This is of particular importance if he has dementia and can’t speak for himself anymore.

If your housemate is frequently or continuously in bed, he will quickly lose his body energy and is at risk of becoming stiff. Ensure that he is prescribed physiotherapy and massages with the additional condition that both are performed at home.

Also, in this case, have the doctor prescribe BronchoVaxom® for him (refer to 9.1).

If your housemate is unable to take in adequate liquid, after consulting his doctor, have a PEG (stomach tube) attached; this is a minimally invasive procedure. You then pour warm water via a "drop delivery system", a high mount, from a plastic container through a thin pipe, whose end you turn into a probe input. Do not open the slider in the pipe right from the front, but rather try to open it gradually, depending on How quickly the water should flow without making your housemate sick. Twice a week, place a new slit on the probe input in the abdominal wall and clean the entrance prior to that with a disinfectant and perhaps with an anti-inflamatory ointment.

From the plastic bag filter out the fine particles which could block the pipe or the tube/probe probe input. In order to protect yourselves against surprises, after tightening the lifted container, take the end of the pipe into your mouth, open the pipe valve and suck till water comes out, close the valve again, turn the pipe into the probe input, open the valve into it and again the pipe valve. If no water flows despite that, ensure that you have actually opened both valves. If this applies, the probe input is blocked. Close both valves, turn the pipe out and spray the probe input free with Coca Cola. From experience, this was found to be better suited than water.

If the container could be emptied, as this is what usually occurs, if you have previously sucked out water, hoist the pipe up, so that water flows from the pipe into the stomach, close the entrance valve, turn the pipe out, take it into your mouth again in order to suck out the last drops of water from it and close the pipe valve.

In order to spray cola, you would require a sprayer and a adapter, which should be turned into the sprayer on one side and into the probe input on the other side. If you have rotated the sprayer, open the entrance valve and spray. Afterwards link the container with the tube again. If there is still no water flowing, spray the probe input free again and change the container. Ensure that you always have reserve containers at home for this purpose.

If your housemate is congested and should, according to his doctor therefore take a cough medicine that loosens the phlegm, you should dissolve the medicine in warm water first and then add it to the rest of the liquid.

If your housemate can’t eat anymore, read the explanations in section 9.5.

If your housemate should wear compression socks, but has water in the feet, Against normal practice, ensure that socks which end 6 cm below the hollow of the knee are made for him. This would make it easier for him to wear the socks constantly several days in a row until someone comes who can change it for him.

Request your family doctor to vaccinate your housemate and yourself against flu as soon as he has new serum in September.

When you are outside the hearing distance of your housemate, install a baby phone in his room which works via radio signals and place the receiver at a place where you can hear it best. Such digital devices are manufactured according to DECT standard. You can buy them at online shops a great deal cheaper than in normal stores.

Do not however neglect your own care in the process. Do not assume it to be mandatory to give up your profession. If your housemate would like to stay at home, he should be willing to allow himself to be cared for by friends, paid workers or outpatient service during the day. You can cook the meals beforehand . You can buy frozen or ready-to-eat stuff, which someone cooks or heats up for him at a pre-arranged time or order "Meals on wheels", if you are able to find vendors who can deliver and serve it at noon.

If your housemate suffers from urinary incontinence, read through my explanations in 9.3.16. Advise the doctor to prescribe pads that can absorb the urine. Change his clothes by making your housemate sit on the edge of the bed, you kneel beside him on the carpet, and raise his feet. Both of you should get up if he still can and you pull the pad up. If he is no longer able to stand, have a professional care-giver show you how to change the pads. Collect the used pads in a bin that can be closed tightly in order to dispose of them later.

If your housemate also suffers from fecal incontinence you don’t use pads anymore but a special disposable adult diaper, and also place a disposable drawsheet with the measures 90 x 60 cm on the bed. Have all those care supplies prescribed to your housemate by his doctor. If your housemate can’t change the pad himself anymore and can’t clean himself anymore, and you can’t do it either, you should look for a care service that comes in as often as necessary, but you have to consider the costs for this. Therefore you maybe want to ask a nurse to show you how you can wash your housemate in his bed, clean him from excretions, put on diapers and lay him in the right way.

If you don’t care for your housemate yourself, you should ask the nursing staff from time to time about red spots. Provide the outpatient care-giver a key to your house if they have to come also at night or very early in the morning, so that you don’t have to open the door everytime.

If your housemate is fatally ill, engage the services of a hospis in order to lighten your load. Search the Internet for a hospis close to where you live. Do the same for yourself towards the end of your life, especially if you are alone.

If he toys with the idea of searching for euthanasia abroad, halt his thoughts by assuring that he can choose a palliative center or a hospis where professional care-givers will relieve him of pain and will - especially in a hospis - help him to a peaceful end.




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