Senior Community Without Walls

An Aging Society


Like the rest of the world, the US is an aging society. Between 2000 and 2050, the number of older people is projected to increase by 135%. Moreover, the population aged 85 and over, which is the group most likely to need health and long-term care services, is projected to increase by 350%. Over this time period, the proportion of the population that is over the age of 65 will increase from 12.7% in 2000 to 20.3% in 2050; the proportion of the population that is age 85 and older will increase from 1.6% in 2000 to 4.8% in 2050.

The future strains of population ageing in the US derive not so much from the growth in the elderly population or the 85 and over population, but rather from the slow projected growth in the non-elderly, working age population. Between 2000 and 2050, the population age 16–64 is projected to grow by only 33%. The ratio of people ages 16–64 to those ages 65 and over (the aged dependency ratio) is projected to decline from 5.1 in 2000 to 2.9 in 2050, a 43% decline. The slow growth in the working age population will mean that there will be relatively fewer people to pay the taxes necessary to support public programs for the older population and fewer people to provide the services that older people need.  Medicare currently covers skilled, relatively short-term care provided by home health agencies and nursing homes, not traditional long-term care. 

A.C.A. 2010

The Affordable Care Act of 2010 requires Department of Health and Human Services to establish a readmission reduction program. This program, effective October 1, 2012, was designed to provide incentives for hospitals to implement strategies to reduce the number of costly and unnecessary hospital readmissions. Centers for Medicare and Medicaid Services defines a readmission in this context as “an admission to a subsection(d) hospital within 30 days of a discharge from the same or another subsection(d) hospital.”

When the program was implemented, about 20% of Medicare patients were readmitted to a hospital within one month of discharge; CMS considered this number excessive and believed that readmissions are an indicator of quality of care, or lack thereof. This new program provides an incentive for hospitals to decrease readmissions by coordinating transitions of care and increasing the quality of care provided to Medicare beneficiaries. The program is part of CMS’ goal to transition to value-based purchasing--paying for care based on quality and not just quantity.

These incentives are escalating penalties that decrease a hospital’s payments from all of its Medicare cases.

The purpose of this program is to improve quality and lower costs for Medicare patients. It is meant to help ensure that hospitals discharge patients when they are fully prepared and safe for continued care at home or at a lower acuity setting.   

6 Ways Home Care Can Greatly Reduce Hospital Initial Admission and Readmission Rates

Having a personal service aide or access to home care services upon discharge is a very effective way of improving a patient’s care transition. Studies show that persons who live alone have a 50 percent higher risk of readmission compared to those living with others. Home care can help reduce initial admissions and readmissions by providing a low-cost supplement to medical-based care transitions. In-home caregivers can provide personal care assistance, medication reminders, transportation to appointments, ADL care, and act as the critical link in communicating with other care providers to raise red flags and provide early detection.

#1) Reducing the risk of Falls:

Falls are the most common cause of injuries among seniors and the top reason for a hospital admission for trauma.  One out of every three people over 65 falls every year and a fall was fatal to nearly 8,000 over 65. 

Each year, according to estimates by the U.S. Consumer Product Safety Commission (CPSC), nearly 1 million people over age 65 are treated in hospital emergency rooms for injuries associated with the products they live with and use every day. The death rate from accidental injuries in the home is approximately three times greater for elderly people than the younger population. Specifically, there are 60 deaths per 100,000 persons age 65 and older, while there are only 20 deaths per 100,000 persons under 65.

Slips and falls are the main cause of injury for elderly people in the home. The CPSC recommends the use of grab-bars and non-slip mats in the bathtub, handrails on both sides of the stairs, and slip-resistant carpets and rugs. .

Homecare by Design believes that many of injuries to elderly persons in their homes result from hazards that are easy to overlook, but also easy to fix or correct. By spotting these hazards and taking some simple steps to correct them, many injuries can be prevented.  We have developed our Home Safety Inspection Checklist program to help you identify these hazards. If you choose to participate we will send our safety inspection person to your home to conduct your safety inspection.  In five to seven business days you will receive a full report of our findings and recommendations for your home. We hope you choose to take our recommendations and create a safer environment in your home. Many of the recommended items can be done at home by you, or you may choose Homecare By Design's Handyman services or recommended contractor vendors. 

Here are some general recommendations that you can identify and change to help reduce your risk of falls at home.  These and many others can be identified in your home by participating in our home safety inspection.


General recommendations for items with electrical cords.

  1. Cords stretched across walkways may cause someone to trip.
  2. Arrange furniture so that outlets are available for lamps and appliances without the use of extension cords.
  3. If you must use an extension cord, place it on the floor against a wall where people cannot trip over it.
  4. Move the phone so that telephone cords will not lie where people walk.
  5. Furniture resting on cords can damage them, creating fire and shock hazards. Electric cords which run under carpeting may cause a fire.
  6. Remove cords from under furniture or carpeting.
  7. Replace damaged and frayed cords.


PLEASE NOTE:  Nails and staples can damage cords, presenting fire and shock hazards. Inspect any electric cord of any electrical appliance that is over 20 years after manufacturing and check wiring for damage.


RECOMMENDATION: Wet, soapy tile and porcelain surfaces are especially slippery and may contribute to falls.

  1. Apply textured strips or appliqués on the floors of tubs and showers.
  2. Use non-skid mats in the tub and shower, and on the bathroom floor.
  3. Use hand held shower head, as appropriate
  4. Use stool to sit while bathing, as needed to prevent falls
  5. Use safety bars for a solid grip, as often as needed.


  1. Are all small rugs and runners slip-resistant?
    It is estimated that over 2,500 people 65 and over were treated in hospital emergency rooms for injuries that resulted from tripping over rugs and runners. Falls are also the most common cause of fatal injury for older people.
  2. Remove rugs and runners that tend to slide.
  3. Apply double-faced adhesive carpet tape or rubber matting to the backs of rugs and runners.
  4. Purchase rugs with slip-resistant backing.
  5. Check rugs and mats periodically to see if backing needs to be replaced.
  6. Place rubber matting under rugs. (Rubber matting that can be cut to size is available.)

Purchase new rugs with slip-resistant backing.

These items and many others should be identified and remediated to reduce your risk of falling in your home.

#2) UTI:

Did you know that Urinary Tract Infections are the 2nd most common infection in the body? Urinary Tract Infections (UTI’s) are common in the elderly, and it is important for us to be familiar with the signs and symptoms so that we can help our loved ones get treatment before they become a major problem. UTI’s occur in the elderly more frequently because the bladder loses its elasticity and doesn’t do as well at forcing the entire amount of urine out of the bladder. The urine that remains in the bladder can cause an increase in bacteria…which then causes the infection. Another type of UTI occurs because of a kidney infection. 

Signs to watch for:

  • Foul smelling and cloudy urine
  • Having to urinate frequently, and urination is often painful
  • Decreased appetite
  • Pain in the abdomen
  • With UTI’s caused by kidney infections, pain in the upper back and sides
  • Possible fever
  • Impaired mental state-increased confusion, and level of consciousness
  • Falls
  • ”Just not looking right.” – Doctors are hesitant to check a urine sample each time these symptoms occur, but as we learn our loved one’s personality, we will be able to know when things are “just not right.”

We should always encourage fluids unless the person is on a fluid restriction. This helps push the built up bacteria out of the body.  Encouraging a routine when it comes to toileting is also helpful.

If your loved one has these symptoms, please notify their primary physician. If you feel your loved one is unable to manage their fluid intake or unable to execute proper hygiene on their own a personal caregiver may be a good alternative.  Care Management is another good option too; our Care Manager can assist clients in making any doctor appointments and go with them to their appointment to assure doctor compliance.  It is important that we get the proper care quickly. Our seniors’ immune systems are often already compromised and untreated UTI’s can cause permanent damage to the kidneys and the client can become septic (the built up bacteria enters the blood stream.) 

#3) Memory Loss

What is “normal” age-related forgetfulness? Memory lapses that are considered normal among seniors and are usually not warning signs of dementia may include:

  • Difficulty remembering names of acquaintances or calling somebody by the wrong name.
  • Occasionally forgetting where you have left an object that is used frequently (keys, remote, glasses.)
  • Difficulty remembering details of a previous conversation or details of what you’ve just read.
  • Occasionally forgetting the date/time of an appointment that you scheduled.
  • Walking into a room just to realize that you forgot why you came there in the first place.
  • Distracted very easily and not being able to finish a sentence even though the information is “on the tip of your tongue.”

These memory lapses have little impact on your daily functions and do not keep you from doing the things that you want to do. However, when memory loss does begin to affect your ability to function, and disrupts your work, relationships, and safety it could be a warning sign that you are facing a more serious disease. 

Remember that if you are worried that you or a loved one may have the warning signs for dementia, the sooner you address the problem, the better. Visit your physician as soon as you can get in. At your appointment with the physician your symptoms will be evaluated, personal risk factors will be assessed, reversible causes of memory loss will be removed, and the appropriate plan for care will be established.

Tips for coping with memory loss include:

  • Tracking your symptoms by listing all concerns that you have personally and that your family has observed. Be sure to track detailed information such as the frequency, setting of your memory, and behavior concerns.
  • Learn as much about memory loss as you can. Being able to recognize the symptoms of dementia and knowing what to look out for can go a long way in helping you plan for the future and make necessary adjustments that will allow you to live a full life as independent as possible.
  • Allow others to help you for your own safety. If safety becomes a concern, family, friends, and even professional caregivers can assist with daily activities to make sure that you remain safe at all times. While difficulty remembering names and details can be frustrating and make socialization difficult, it is important not to become socially isolated. The brain needs stimulation. Caregivers can be excellent companions as well!

Before you experience a game changer, such as memory loss, consider legally establishing a Power of Attorney for your affairs. A Power of Attorney (P.O.A.) is a legal document that you personally setup to give someone that you trust the authority to handle your personal affairs when you are incapable of doing so.

  • Financial P.O.A. is somebody that you trust to access your money and financial records to settle financial needs when you cannot.
  • Medical P.O.A. is somebody that you trust to make official medical decisions for you when you cannot. It is important that you discuss your wishes with your Medical P.O.A. in order to avoid any doubts in what care you would want in emergency situations.

Remember that your Medical and Financial P.O.A. will be making decisions for you when you are unable to. It is wise to have specific people appointed by yourself to speak for you. When you have decided to take this step in your care, contact your lawyer or and Elder Care Attorney to get the process started.

#4) Doctor Compliance

An estimated half of those for who have treatment regimens prescribed, by a medical professional, do not follow them as directed.  This includes medications, therapy, diet, exercise, rest, or many other recommendations your medical professionals request. 

“Are you taking your medications?” There may be many reasons someone does not take their medications as prescribed, remembering, high cost, difficulty swallowing, just to name a few.  

  • If cost is an issue for medication compliance, please speak with your doctor or pharmacist regarding programs available.
  • You should also not share medications.  Sharing medications could be quite dangerous and lead to serious medical problems. 
  • Keep all medications in the correct container and be sure that they are labeled properly.  It becomes easier to confuse medications once they have been taken out of their original container. 
  • If a medication has expired it should be thrown away, expired medications lose their effectiveness, and many cause additional side effects and may have a toxic effect.  This includes over the counter medications.
  • Certain medications must be continued whether you feel better or not.  This is especially true of antibiotics, high blood pressure medication and cholesterol medication.  Although you may not feel badly, the underlying disease still exists. 

The goal of any prescribed medical therapy is to achieve certain positive healing outcome for the patient.  Your health care professional desires an outcome for your wellbeing and the management of the diseases or conditions. However, despite all the best intention and efforts on the part of the healthcare professionals, those outcomes might not be achievable if the patients are non-compliant. This shortfall may also have serious and detrimental effects from the perspective of disease management.  There are many way to help those who struggle to follow their health care professional’s recommendations.  A Care or Case manager can follow a patient through the medical system and provide the guidance needed for compliance.  There are many medication dispensing units available on the market to remind and dispense medication.  Personal caregivers can aid with reminders and compliance of medications.  

#5) Ambulation

Many reasons may inhibit you from being physically active.  These reasons may be due to stiff joints, illness, boredom, lack of energy, weather, etc.  The problem with being inactive is that it causes an overall deterioration in one’s health. Things like obesity, strokes, hypertension, diabetes and heart conditions are all side effects of a sedentary, inactive lifestyle.  Risks for these diseases increase dramatically if a person sits still for more than 5 hours per day on a regular basis.

Movement supplies the body’s tissues and organs with oxygen and improves muscle flexibility. Physical activity keeps lymph fluid circulating and boosts the immune system to fight infections. More rigorous exercise produces perspiration, which rids the body of toxins. Consistent activity also fuels mood-elevating hormones that sharpen thinking and decrease depression. Seniors who keep moving also lower their number of doctor visits and reduce healthcare costs.

Ambulation & Exercise Benefits Include:

  • Strengthening of abdominal and leg muscles
  • Joint flexibility, especially that of the hips, knees, and ankles
  • Circulation, which helps prevent the risk of blood clots
  • Prevents constipation due to movement of abdominal muscles
  • Prevents Osteoporosis by not losing mineral content from sitting too long
  • Appetite stimulant
  • It helps prevent urinary incontinence and infection
  • Relieves pressure on the body and skin, helping to prevent pressure ulcers
  • Improves self-esteem and the feelings of independence
  • Great way to go out and socialize with others


Personal hygiene may vary to some extent but as a general rule, that bathing daily, a good dental care regimen at least once a day, and proper grooming are all important components of good personal hygiene. Sometimes a person’s concept of personal hygiene suddenly changes; this can be caused by many factors, here are a few examples. 

  • Fear in the bathroom, hard surfaces and slick floors
  • Decrease in ability to smell or poor vision   
  • Depression
  • Discomfort
  • Unable to reach some areas of the body
  • Medications

Apart from the social impact of poor personal hygiene and being isolated from friends and families, there are also the medical consequences caused by poor hygiene. Poor personal hygiene can lead to skin infections with bacteria. This can be transmitted to others in close contact with the person.  The consequences are not isolated to the outside of the body.  Unclean hands, utensils and crockery can increase the chances of diseases like gastroenteritis and food poisoning.

If you or someone you know has changes in grooming or hygiene there could be underlying reasons that need to be addressed. In the case of a loved one, you may need to speak with them or look for someone to assist them with grooming and bathing.  Be candid but sensitive and understanding in your discussions when having this talk. Despite your best efforts, your friend or loved one may need professional help. You should encourage them to see their physician if their personal hygiene doesn’t improve.

#6) Loneliness and Depression

As people age they become more vulnerable to loneliness. Loneliness may lead to depression which can have a serious effect on health. Become aware of signs that loneliness may be affecting you or a loved one. Sadness, fatigue, losing interest in hobbies, social withdrawal and weight loss or loss of appetite can be saying someone is lonely.
Roughly 25% of people age 65 or older suffer from depression. More than half of doctor’s visits by the elderly involve complaints of emotional distress. According to a recent report in the Journal of the American Geriatrics Society, depression is one of the major causes of decline in the health-related quality of life for senior citizens.
Why all the depression?
Disabilities, decline in health, diminished quality of life, loss of independence, needing help from family or caregivers, dementia, and loss of loved ones and friends. There are many more factors that can lead to loneliness and depression. Any one of these reasons can lead someone down the road to depression; many people experience multiples of these factors as they grow older.
Here are some tips that can help to combat loneliness.

  1. Separate illness from depression.
  2. Treat any insomnia.
  3. Distinguish grief from depression.
  4. Carry positive uplifting photos.
  5. Make new friends.
  6. Exercise.
  7. Join an interest group.
  8. Remove obstacles, reasons not to go out or participate.
  9. Volunteer.
  10. Teach.

Loneliness and depression does not happen to us over night. It is rare that one day we are participating in activities, enjoying family, running errands, exercising and happy, and the next day wake up alone and sad. Loneliness will usually be progressive over time slowly creeping up on us unexpectedly.

Recognizing signs of depression;
Bouts of loneliness and depression can occur in later life—retirement, the death of loved ones, unable to drive, increased isolation, medical problems—can all lead to depression. It is important to recognize and distinguish between grief or life changes and depression.
Depression prevents you from enjoying life like you used to. But its effects go far beyond mood. It also impacts your energy, sleep, appetite, and physical health. However, depression is not an inevitable part of aging, and there are many steps you can take to overcome the symptoms, no matter the challenges you face. First recognize signs of loneliness and depression.

  • Sadness
  • Fatigue
  • Abandoning or losing interest in hobbies 
  • Social withdrawal and isolation
  • Weight loss or loss of appetite
  • Large mood swings • Sleep disturbances 
  • Loss of self-worth 
  • Increased use of alcohol or other drugs
  • Fixation on death
  • Not taking prescribed medication
  • No desire for bathing and grooming

Unfortunately, if we are affected by depressed feelings we often fail to recognize the symptoms of depression, or don’t take the steps to get the needed help right away. There are many reasons why depression in older adults and the elderly is so often overlooked:

  • You may assume you have good reason to be down or that depression is just part of aging.
  • You may be isolated—which in itself can lead to depression—with few around to notice your distress.
  • You may not realize that your physical complaints are signs of depression.
  • You may be reluctant to talk about your feelings or ask for help.
  • You may not have anyone close to you that you can tell.

Where can you turn for help?
Ask your family doctor for a recommendation for a social worker or counselor. Although your primary care doctor can prescribe antidepressants, ask your doctor if you should work with an expert, like a psychiatrist. They have more experience with depression medicines and with psychotherapy.
You also can ask friends or family for recommendations. There are many opportunities in our community to get plugged into people, places, and things. Homecare By Design would love to help, with care management, social and exercise activities, and personal one to one caregivers opportunities all available to you through our agency.

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