In home senior care for a loved one with multiple chronic conditions

Over the last decade, there has been a significant increase in the number of seniors living at home with multiple chronic conditions (MCC). Patients with MCC are defined as those who have two or more chronic conditions at the same time.  There is a wide range of MCCs such as Diabetes, Hypertension, Heart disease, Stroke, Alzheimer or other Dementias, respiratory illnesses like Asthma or COPD, vision impairment challenges like Macular degeneration, and bone related conditions like Osteoporosis or Arthritis. Of people aged 65 years and older, 50% have two or more chronic diseases. For more than a decade, Care Mountain has had the privilege to provide in home care support for numerous clients with MCCs. This article outlines important ideas to keep in mind as you plan in home care support for a senior with multiple chronic conditions:

Higher Complexity of caring for MCCs

The complexity level for taking care of a loved one with MCCs is SIGNIFICANTLY higher! The risk for becoming disabled or dependent increases with the number of diseases present, and combinations of diseases synergistically increases risks. For example, arthritis and heart disease coexist in 18% of older adults; while the odds of disability increase 3 to 4-fold with either disease alone, this risk for disability increases 14-fold if both these chronic conditions are present! Let’s takes an example of a 72-year-old person – a poorly controlled Diabetic patient who also has vision impairment due to macular degeneration and reduced renal function. Balancing these 3 conditions is like a carefully balanced tripod on 3 legs – any deficiency in the attention to detail of rigorous, daily care for any of these three can bring the whole person crashing down.

Live in or 24/7 care is much better for MCCs – both from a quality and cost point of view

The higher complexity of care needs for people with MCCs leads to them being more frequently hospitalized due to the higher risk of health complications. For such clients based on our experience:
  1. Arranging for a 24/7 care model at home is the best practice and proactive approach. There are 2 key models for 24/7 care at home – Model A where say a team of 2 caregivers tag team with each other on two 12 hour shifts across the day, say 8 AM – 8 PM and 8 PM – 8 AM. Model B would be where one live in care stays in your loved one place for say 3 consecutive full days and is followed by another live in caregiver who stays for 4 full consecutive days with your loved one. Both models have their pros and cons but both ensure the consistency of professional caregiving round the clock to track and deliver multiple and varied aspects of care for a person with MCCs – e.g., water intake, urine output, BP levels, checking sugar levels, 1-1 engagement, dietician compliant meals, safe but regular exercise, regular sleep cycles, prevention of daily challenges like sundowning in dementia or hyper/hypoglycemia (high/low blood sugar level) for diabetes.
  2. A loved one with MCCs usually has three to four doctor appointments every one to two weeks across multiple specialties for example a Neurologist, an Endocrinologist and an Ophthalmologist. If family members are busy with work or personal commitments, these doctor appointments are possibly missed and lead to a downhill spiral or deterioration in health with not picking up early signs of progression or deterioration
  3. By partnering with a high quality and experienced home care company and provide 24/7 in home care, you can help improve your loved one’s health and clinical progress. It can help avoid unnecessary, painful and expensive hospitalization and is actually less expensive in the long run. For example, at $18-22/hour, you will spend approx. $10-15k/month on your loved one’s home  care. One of the largest evidence-based studies by the Agency for Healthcare Research and Quality found that for patients with MCCs hospital stays are 20-30% longer for seniors with four or more chronic conditions. In our experience, clients in DFW have typically spent $3-4K/day or $25-30K for each Hospital stay for a loved one with MCCs. By avoiding one hospitalization per month, it pays for your entire month’s in home care.
  4. The research efforts of organizations like the Partnership to Fight Chronic Disease (which includes member organizations such as American Hospital Association, American College of Preventive Medicine and American Heart Association) indicate patients with chronic disease can cost seventeen times more than other users, making it critically important to streamline help so such patients receive 360 degree care to slow progression of disease and lower overall costs over time.

Higher attention to detail in day to day care for MCCs

When caring for a loved one with MCC, a much higher attention to detail is required across multiple activities of daily living. For example:
  1. Personal care assistance – For assistance with daily activities like bathing, grooming and toileting, one may need to track amount and frequency of urine output.
  2. Meal planning – Your loved one’s dietary needs are usually very specific if there are chronic care complications of the eye, heart and kidney. Accordingly, this has to be very closely followed.
  3. Medication reminders – For patients with MCC, there are usually very specific guidance from your cross functional team of doctors on what can or cannot be eaten before or after which other medicine, with or without food, and with or without the flaring up of one chronic condition. Therefore, medication reminders and supporting your loved one while balancing say three to six chronic conditions with three to four meds for each condition leading to almost ten to twenty-five daily medication reminders requires a high discipline and high attention to detail through the day.
  4. Injury prevention – Preventing fall risk and avoiding injuries that may come from self-neglect or unsafe living conditions is paramount for patients with MCC. For example, if your loved one has arthritis or osteoporosis and neuropathy of the foot due to diabetes, providing overnight care across med reminders (like insulin), safe transfer in and out of a wheelchair when using the toilet late nights is critical.
  5. Track, track, track multiple metrics – For clients with MCCs, your clinical team of interdisciplinary doctors will need you to track many clinical and lifestyle metrics rigorously and meticulously that are critical for your loved one’s physical and mental health to slow down progression of chronic conditions.
Do you live in Dallas Fort Worth area?  Care Mountain provides award-winning in-home care. We are a high quality in home care provider with 16 years of experience providing personalized care for 3,000+ DFW families. We have high quality, experienced caregivers available to support you and your loved one’s care needs across hourly, 24 hour care, and live in care, and have significant experience in supporting clients with multiple chronic conditions.

Give us a call to discuss your in home care needs. 

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