Phil lives alone unless you count his dog, Clare. Phil now is seventy-three and most people would have considered him in better than average shape. He is not one for exercise but he always has watched what he eats, and was blessed with good genes. However, Phil made some very bad decisions.

It happened on a very nasty night in the Midwest. There was a ugly ice-sleet storm raging outside when Clare needed to go out. Phil did his usual thing at night he took Clare out into the backyard. Too bad his usual thing was to walk Clare in his underwear. So when Phil fell, he was too embarrassed to call out to his neighbors for help.  So there he lay with an injured leg, shoulder and arm, out there on the ice.

Because Phil didn’t want to call for help it took him two and a half hours in the cold, on the ice, to pull himself to his back door and drag himself in.   This experience caused Phil to be hospitalized for five days and is now in a nursing home due to the pneumonia that set in while hospitalized.

What seniors can do to protect against falls:

  • if you live alone (and are even if in very good condition like Phil) wear an alert button
  • think ahead, make good decisions and be proactive – is it really a good idea in any weather to be outside in your underwear
  • prepare for the weather – when in snow, ice, sleet – carry a small bag of salt, sand or gravel to throw out in front of yourself as you walk
  • for those who have to go out in all weather – consider rubber ice cleats that easily attach to the bottom of any shoe or boot – they are easy to put on and off and very in expensive

It really didn’t seem like it would be Phil who would be in a nursing home, at least not until a very old age. Bad weather got him there, and a fall, but more than that it was bad choices.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


The story begins with the senior in his home, which is beautifully decorated for Christmas. He starts to receive the bad news from his children that they won’t be making it home, this Christmas. They appear to be spread all over the world, these high achieving children.  Promises are made that they definitely will be there with him the next Christmas.

There he sits eating a meal alone, at his large family dining room table, next to his decorated tree. Then the children all seem to be receiving a stunning message. Tears flow, grief is written on their faces as they all make a dash for transportation. They arrive together for what they clearly think is a funeral.

Upon entering the family home they see the table set for a holiday dinner. Walking out of the kitchen is their old Dad, saying “How else could I get you here?”

Compared to many commercials now airing, where you end up scratching your head, thinking what was that even about? This one from a German grocery chain couldn’t be more clear. Decorating is good, the meal even nicer, but holidays are about showing up.

This commercial is certainly worth taking a look at, during this hectic holiday season. So many people are alone during the holidays. If you don’t have someone in your immediate vicinity, go to your local nursing home. Many people are in the nursing home because they are alone and have lost their loved ones.

What a wonderful message, whether for a senior, a child, the lonely, anyone in need, just show up.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing



There they sat in their usual places next to the nurses station, in the nursing home. The two of them, good friends, enjoying a warm and deep conversation. Just the way all, old friends enjoy doing. They were deep in discussion about other residents of the home. One by one, they went through the list of people living on their floor.

Talking about Barbie who is so cheerful even though she has had MS now for many years. The friends talk about how sad they feel for her, how hard her life is, how hard it must be for those young nursing assistants to take care of her.

They talk about Lillian who isn’t so cheerful, and even though Lillian has said many a harsh comment to these two old friends. All they can say about her is that she must have had a hard time, something must have happened to her to make her so grumpy. They express as much sympathy for Lillian as they do for the so cheerful and nice Barbie.

And so they go on, talking about each elderly neighbor of theirs in this nursing community. As they talk, what you hear is genuine caring for their neighbors. A total lack of judgement on their part for either difficult personalities or for behaviors that most likely caused the declines in health. Like the parade of neighbors constantly making trips outside to smoke. No judgement here.

When they give kind words of encouragement to others, they don’t expect anything back. They have taken the time to get to know their neighbors families, so they can brighten people’s days by mentioning how smart or cute someone’s grand-kids are. When a neighbor gets bad news, they cry with them as though it is their bad news.

They are the true meaning of benevolence, they live it. What makes it so much more surprising is that one of the friends is only 57 years, living in the nursing home because she has end stage renal disease. She never married, has only one brother living who never comes to visit. She is living on medicaid, clips coupons, goes to dialysis, and looks forward to trips to Walmart.

The other friend keeps waiting for the day when her daughter will arrive to move her to a nursing home closer to her family. She is a very fragile 87 year old, living with the hope that her family will come and get her.

Benevolence – when there is nothing in it for you. So surprising, how much people with nothing can give and continue to be benevolent.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing



THE DEFINITION OF DELIRIUM: A condition of acute and sudden onset of impairment of attention, memory, orientation, language usage, consciousness, perception, behavior and/or emotions that may fluctuate. This is a condition that is directly related to a medical cause and is not due to dementia. It is often called “acute confusion.”

This is not the confusion associated with a terminal condition that occurs in the days before dying. This “terminal delirium” is irreversible and often calls for the use of anti-psychotic medications for the comfort of the patient. Sudden onset delirium is reversible and requires testing for possible cause.

Delirium caused by a medical condition is often confused with dementia and requires a clear history from the family. The areas to report to your healthcare provider are;

  • Is the person more confused today than yesterday? Was this a sudden change in the person’s mental status? If the person is more confused and the increase came on suddenly, you need to consider delirium.
  • Is the person more easily distracted, unable to focus his attention or unable to follow what is being said, than previously? A person with mild cognitive impairment can usually say the days of the week backwards or recite the months of the year backwards. The person with delirium is too distracted to focus on a task like this.
  • Is the person’s thinking disorganized or incoherent? Is the person rambling, has an illogical flow of ideas, or engages in irrelevant conversation? Ask the person a few questions to assess their train of thought:
  1. Will a stone float on water?
  2. Are there fish in the sea?
  3. Does one pound weigh more than two pounds?
  4. Can you use a hammer to pound a nail?

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


Some elements in the environment can cause unwanted behaviors in persons with dementia. Unsettling noises, unpleasant people, being constantly directed or told “no,” all of these things can cause agitation in a person with dementia. Thinking about what is pleasant, and comfortable, this is when the term “homey” comes to mind. Everyone knows when a home feels homey.

The feeling of homey can mean pleasant smells. Smells like bread baking, apple or pumpkin pie, roast beef, cookies baking, all of these words can trigger memories of those comforting smells. Having certain smells over the course of a day can help cue a confused person as to what is happening. Greeting an elder in the morning with “good morning” while the smells of bacon frying and fresh brewed coffee are coming from the kitchen helps the elder know it is morning.

Create a homey room with furniture in limited patterns and choosing colors that are warm. Select seating that is comfortable and looks like an invitation to sit and spend some time. Many colors and patterns can make a room look “busy.” Use basic solid color carpet that is a contrasting color from the furniture so the elder can see where the furniture ends and the carpet begins. Reduce clutter on all surfaces, but include familiar items for the comfort they bring.

Throw rugs will become tripping hazards as are small glass tables. Anything that causes a glare or is difficult to see the edges of, are potential safety hazards. This includes shiny dark flooring. Lighting that is too low or creates especially dark areas of the room, can cause paranoia as well as be unsafe.

A safe secure outdoor space that is accessible to the confused elder to use independently is a very positive activity, as well as good dementia care. Giving the elder the chance of more options by choosing to be inside or outside maintains self-esteem and independence. The elder can enjoy safe interaction with nature while rocking in that homey old rocker, and maybe another one of those cookies.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


There are consequences to living a risky lifestyle. The wellness check list tells you what a healthy lifestyle is and isn’t. Taking a close look at the areas that the wellness check targets, tells you what behaviors are ultimately going to cause disease.

Many of the tests check for cancer. Cancer is caused by external factors such as tobacco, infectious organisms, eating an unhealthy diet as well as internal factors such as inherited genetics, mutations, hormones and immune conditions. These factors may act together or in sequence.

What this tells us is that a substantial proportion of the cancers diagnosed could be prevented. All cancers caused by tobacco use and heavy alcohol consumption could be prevented.

Of the over 589 thousand deaths predicted in 2015 from cancer in the United States, 178 thousand will be directly caused by smoking alone. A third of the cancer cases will be directly related to obesity, physical inactivity and poor nutrition.

Seventy-eight percent of all cancers diagnosed are in people age 55 and older. The cost of cancer in 2011 in the United States alone was 88.7 billion.

So what about the wellness check? Will it make a difference? Only, if people are able to make the changes recommended. The best place and most obvious place to start are with smoking and diet.

Increase fiber, vegetables, fruit, (only if you do not have a sugar problem) reduce the use of red meats and eliminate processed foods and meats. And with winter behind us, time to increase that physical activity they talk about.

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing


Part II

Preventative care under the ACA is offered by the insurance provider – but when is it free? When isn’t it free?

There is a list of 15 preventative services that are recommended by the Affordable Care Act. These are things like blood pressure screenings, testing for cholesterol levels, mammograms, colonoscopies, vaccines and so on.

These recommended preventative services require no; co-pay, out of pocket payment or meeting any deductible. The goal here is to offer these screenings/services to catch a disease process before you have any symptoms.

So what isn’t considered preventative and so isn’t free?

Any change in your health that is found through the preventative screening, requiring follow up testing and treatment, is not free. This could include lab work or other testing to manage or treat a condition. Medical treatment for a specific health condition and any on-going care is not included in “preventative” care. Any future diagnostic care or treatment is not part of preventative care.

Once a condition is identified, that will require any on-going or future treatment, it now is covered under your health care policy with the deductibles you selected.

Wellness checks serve an even greater purpose through organizing your healthcare. Instead of the burden being placed on the patient, to always know what is significant to report to the doctor. The wellness check will now ferret out those facts. If you are uncomfortable bringing up unusual bowel movements with your doctor, the wellness check will bring it up for you.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


Part I

Several seniors have asked me lately about the “wellness check form” they have received from their health insurance provider. This wellness check is a direct result of the Affordable Care Act (ACA/Obama care) under “preventative care”.

Why is this coming from the insurance company instead of the doctor?

You would think that a health insurance company would want to catch a disease process early when it is not only easier to treat but cheaper to treat. But this hasn’t been the case. Standard medical practice has put a large burden of medical care in the hands of the consumer. A person would need to know that they have a problem and then seek out the physician.

Once at the doctors the individual would have to be a good communicator as well as historian to recount their symptoms. Now with ACA the first move to identify a disease could come from the insurance company, through a screening process. The screening might be a questionnaire as well as some routine lab tests. The burden of identifying illness then rests with the check list and starts with your insurance provider.

The thinking behind creating the wellness check, assumed that people are slow to contact their doctor for financial reasons. This is why the screening for many disease processes are considered preventative and are free. This could be true, based on the many seniors who once on Medicare, spend a considerable amount of their time visiting a round of doctors.

But for the people who are in denial about their health, it has been easier to avoid thinking about the consequences of a risky life style, by just not going to the doctor. For these people the check list might also make a trip to the doctor easier. After all, you received this form from your insurance company and “they” want you to see your doctor.

Part II – Preventative care is free? When does it stop being free?

Part III – How does the check list tell you what is a healthy life style?

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


Please, please can’t you open the ice cream parlor now?” the elderly woman begged the activity aide. Once again the young activity aide explained to Hannah, that it was 8 o’clock in the morning, and they don’t open the ice cream parlor till 2 in the afternoon.

The pain was easy to see in the elderly woman as she was turned away. Anyone who has experienced cravings can understand how she felt. Sugar craving is nothing new to millions of people with diabetes and pre-diabetes.

The craving for sugar is physical and so mental. For the elder with dementia and sugar cravings the time of day doesn’t matter. The fact that she had just had breakfast doesn’t matter. The fact that this tiny old lady just couldn’t be physically hungry doesn’t matter.

Hannah doesn’t remember that breakfast she just had. She will clearly tell you that no body feeds her at the nursing home. Because she believes it. Hannah knows what it feels like to be hungry and right now she is craving some ice cream and so she must be hungry.

For persons like Hannah it might have been the toast loaded with “sugar free” jam that triggered this craving. Or the large bowl of corn cereal she had with the toast. Maybe the 5 packets of sugar substitute she insists on putting in her morning coffee.

Loading up on a breakfast with empty carbs and sugar free products – served up by kind hearted nursing assistants, wanting to make all those Hannah’s happy is her problem.

Would she go back to her unit in the nursing home angry? Of course she did.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing



(Four things to notice when visiting an elder in a nursing home, cont.)

2. Observe the elder’s skin. Skin is the largest organ of the body. In the average person, the skin stretches about two square yards and is about 15 percent of the individual’s weight. We consider the skin the first line of defense against environmental factors. Skin is also a barometer of health. We want to be aware of any redness, warmth, or swelling. It is perfectly appropriate for family members to ask the nurse or nursing assistant “Does Mom have any skin breakdown?”

When elder sit for hours in a wheelchair or are unable to move themselves independently, they may be at risk for skin to break down because of decreased circulation. Nursing homes may provide special pressure-relieving mattresses to prevent skin breakdown. A special pressure-relieving gel cushion is an excellent aid for wheelchair-bound elders.

3. Report any significant change. The rule of thumb is that a dramatic change in any body system must be reported to the physician immediately. This includes an abrupt change in:

  • Behavior
  • Difficulty arousing the elder
  • High fever
  • Dizziness or unsteadiness
  • Sight or hearing
  • Ability to communicate or speech pattern
  • Personality
  • Eating
  • Difficulty swallowing
  • Weakness or decreased use of an extremity

Book excerpt from: Please get to Know Me – Aging with Dignity and Relevance Available on Amazon.

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing