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Date: Wed, 19 Oct 1994 22:58:34 +0000
To: lind_don/hpatc2
From: [log in to unmask] (R. A. Schomburg)
Subject: Case Managers and Home Health Aides
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Hello, Don:
Saw your post of Oct 5th on the Parkinsons list ... we are in a similar
situation, each having an elderly father with PD. Mine has fallen on
several occasions, but fortunately never has broken anything. Here are a
couple of things I've learned, which might possibly apply in your Dad's case
as well:
The home health arrangement supported by Medicare has a time-limit. You
need to know how long it will last in his situation, and try to plan ahead
for "afterwards" in the event that he still needs additional levels of
assistance.
Within the framework of Medicare home health is a setup for providing
"durable" medically-indicated healthcare items. On his md's signature, my
Dad just received an in-room commode (saves trips to the bathroom when the
walking gets difficult) and a nice push-button bed (raises at head or foot,
convenient, and smaller than the standard "hospital-size" behemoth !)
In my Dad's case, chronic low blood pressure was the main cause of his
falls. His bp was in the range 70/40 when seated, and would drop from there.
He was hospitalized after the most recent fall, and a smart MD suspected
(and found) Shy-Drager Syndrome, which is apparently not too rare among
elderly PD patients. In Dad's case this was due to inadequate amounts of an
adrenal hormone called aldosterone, causing inadequate sodium retention, in
turn causing inadequate fluid retention, to the point that there was
insufficient blood-volume to sustain his blood pressure. (His heart is
fine.) The fix for the moment is easy: a daily tablet of flourinef acetate
adresses the sodium retention issue, and his bp's are back in the 120/70
range ... tho they still drop when he gets up. I mention this solely on the
odd chance you might be into something similar with your Dad ... not trying
to play doctor (I'm an engineeer) ... but Shy-Drager is not well known to
the typical MD, and in this case that knowledge made a big difference !
Yesterday received a copy of "Beat the Nursing Home Trap: A Consumer's Guide
to Choosing and Financing Long-Term Care". I have skimmed it, not yet read
it, but it looks very worthwhile. Published by Nolo Press, Berkeley. Author
is Joseph Matthews. ISBN 0-87337-230-1. $20 or so. 2nd edition. It talks
about things one can do in advance of actual need to smooth the way ...
financially and otherwise. I'm about in that stage of things for my Dad ...
may in fact have waited somewhat too long ... it's so easy to go from day to
day, eh ?
Best of luck. I would have posted this, but <groan> have forgotten how !
Feel free to do so if you think others might benefit.
Dick Schomburg [Portland, Oregon area]
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