Author – Cyndi Siders, RN, MSN, CPHRM, DFASHRM, CPPS
“Home in Time for the Holidays…”
Mrs. Mary Peterson, fell at home in October while attempting to get out of her bathtub. She fell sideways and fractured her hip. She was hospitalized for surgery, transferred to a rehab unit for a short stay, and then was admitted to your facility for continued rehabilitation. Mrs. Peterson’s goal was to return home to her townhome by the holidays or at least be able to live with her daughter for a few weeks before returning home. Mary’s recovery has not gone as she intended and she has not progressed in therapy to the point of being able to return home. Her daughter works during the day and there would be no one to assist Mary while she is away. Additionally, Mary’s daughter lives four hours away and she has children and grandchildren that will be visiting for the holidays.
Mary has always loved the holidays. She loves to decorate, bake holiday cookies, and send personalized gifts to her family. While her two adult children and grandchildren have not always been able to travel to see Mary for the holidays, she has been able to travel and spend time with each family. Mary’s two adult children have made plans to spend a weekend with her in early December, but will not be able to see her for Christmas. The reality of not being “Home for the Holidays” is real and Mary has lost her enthusiasm in her therapy sessions and she is struggling at meal times. Her care team is working together to create a special holiday season for Mary including making holiday cards and cookies and decorating her room.
The Holiday Experience –
For many, the holiday season is an exciting time with family and friends; things to look forward to including time-off, travel and vacations, parties, favorite foods, and drinks. For many seniors, this time of year can feel very different – the sun doesn’t shine as much, the day light hours are shorter and the temperatures are colder, some of their friends have passed away, and family obligations make “going home” a challenge. Favorite family traditions may no longer be possible. Along with these changes, feelings of loneliness and isolation can accompany the holiday season.
Care providers are in a unique position to recognize changes in behaviors and physical responses that may suggest holiday depression. Managing expectations (e.g., “I’ll be home for the holidays”) on admission and during care conferences, along with understanding social preferences and important family traditions, can help support a healthy transition into what might be a new set of traditions in the senior living community. The holiday activity calendar with card making, cookie baking, special holiday visits from different community groups can be a time to listen, share stories and connect past and new traditions.
Warning Signs of Senior Depression (include, but are not limited to)
• Persistent sadness
• Withdrawal from regular social activities
• Slowed thinking or response
• Lack of energy or interest in things that were once enjoyable
• Excessive worry about finances or health
• Frequent tearfulness
• Feelings of worthlessness or helplessness
• Weight changes
• Pacing and fidgeting
• Changes in sleep patterns (inability to sleep or excessive sleep)
• Inability to concentrate
• Staring off into space (or at the television) for prolonged periods of time1
Individuals that are feeling sad or blue during the holidays can generally function in day-to-day activities. Resident depression that lasts longer than the holiday season or interferes with activities of daily life, such as refusing to get out of bed, get dressed, or eat, may signal clinical depression and should be professionally evaluated.
Provide education and training for clinical care staff to promote early recognition and response to holiday depression. Initiate proactive interventions to support the resident’s emotional and psychological health and well-being. Involve the resident and family in understanding social preferences for the holidays. Share resources with family members to support old and new traditions. One such example is the C.H.E.E.R plan.
• Check – check on your loved one’s well-being. Have a family visitation plan/schedule for the holiday season.
• Help – help your loved one to stay engaged. Include seniors in family activities and events as much as possible, coordinating transportation with other family members. Listen to their stories. Consider a memory book of their stories or a video recording of their most fond holiday memories.
• Empower – empower/encourage your loved one to maintain their independence, including participating in facility and family activities and events.
• Enjoy – enjoy your time together. Make new memories, take pictures, tell stories and enjoy a family tradition together (e.g., hot chocolate with marshmallows and sugar cookies).
• Reminisce – get nostalgic and reminisce about holiday events and traditions. Share favorite pictures and music. “Even seniors with advanced memory loss retain long-term memories, and may be able to speak vividly about a Christmas more than 50 years ago.”2
Holiday Decorating –
A festive holiday environment also helps to support emotional and psychological health and well-being. As part of your holiday planning, consider the following safety reminders:
• Maintain Your EXITs – keep all exits and exit signs free and clear of obstructions and clutter including holiday decorations and trees, rearranged furniture, and equipment. “Rearranged furniture should never partially or totally compromise an exit or other parts of the means of egress. Do not let seasonal design impede on function or code requirements, and always maintain exits in a condition that is free and clear of any obstructions that may impede emergency evacuation (and represent a code violation).”3
• Maintain Detection Systems – Do not hang holiday decorations (e.g., mistletoe, garland, bulbs) from features of fire protection systems (sprinkler heads, smoke detectors, pull stations, etc.). These critical life-saving devices should be clear of all obstructions that can impede performance.4
• Open Flames Cause Fires – According to the National Fire Protection Association (NFPA), “Two of every five home decoration fires are started by candles and nearly half of decoration fires happen because decorations are placed too close to a heat source.”5 Consider battery-operated flameless candles. Candles used within the facility should be placed in a substantial holder, be supervised by staff at all times when lit, be handled by staff and never placed near plants, flowers, decorations or any other combustible materials. Candles should not be used in resident rooms.6,7
• Select Safe Decorations – Decorate with Non-Combustible or Flame Retardant artificial trees and decorations. Use UL approved decorative lighting (use in supervised areas and turn off when not in use) and UL approved outdoor lighting.8
• Moderation in Decorating – Understand the electric capacity of your facility and the proper number of electrical outlets needed for holiday decorations and lighting. “It is critical not to overload electrical outlets or use unsafe wiring arrangements.” “Use good common sense when setting up electric decorations. If it looks unsafe, it probably is.” Also, do not get carried away with extension cords and only use approved sockets strips or surge protectors with built-in circuit breakers to safely expand the use of your building’s electrical delivery system.”9
• Provide Holiday Decorating Reminders – Ensure residents and family members are aware of your holiday decorating policies.
Consult the Life Safety Code, CMS and local and state fire regulations for facility specific requirements
Winter Weather –
“Oh the weather outside is frightful, but the fire is so delightful….”10 “Let it Snow” a favorite holiday classic certainly can represent the holidays in North Dakota, Minnesota and South Dakota. Keeping in mind the following weather and snow-removal reminders can help to reduce injuries and accidents and support participation in outdoor activities for seniors.
• Hypothermia – Seniors are more susceptible to hypothermia.
o Certain health disorders affect the body’s ability to regulate body temperature. “Examples include underactive thyroid (hypothyroidism), poor nutrition or anorexia nervosa, stroke, severe arthritis, Parkinson’s disease, trauma, spinal cord injuries, burns, disorders that affect sensation in your extremities (for example, nerve damage in the feet of people with diabetes), dehydration, and any condition that limits activity or restrains the normal flow of blood.”11
o “A number of drugs — including certain antidepressants, antipsychotics, narcotic pain medications and sedatives — can change the body’s ability to regulate its temperature.”12
• Being Prepared for the Elements – Proper outdoor footwear, appropriate weight clothing, scarfs, hats, and mittens and being aware of current temperature and wind-chill conditions are important considerations for care staff, residents and family members.
• Ice and Snow Removal – to reduce slip and fall injuries, the following procedures are recommended by GuideOne:
o Designate someone to monitor snow and ice conditions. This individual will be responsible to coordinate snow and ice removal operations.
o During the months when snow and ice will be a concern, monitor weather reports daily. This will give you advanced warning of approaching weather.
o Snow and ice removal equipment should be available and ready to go, including shovels, ice melt, snow blowers, etc.
o Snow removal should occur when one inch or more of snow has fallen or if ice conditions are present. Walkways in front of entrances should have de-icing products applied.
o Snow and ice will melt and water can accumulate inside the building at the entrances from foot traffic. These areas should be monitored closely for wet conditions. Make sure mats are in place and replaced if they become water logged.
o Look for ice conditions that could develop on walking surfaces from runoff from roofs, downspouts and other areas. Isolate problem areas by closing them to the general public, or install signs warning of the potential slip hazard. Make sure that by closing an area off, you are not redirecting foot traffic to other slip and trip hazards. (For example, re-routing sidewalk traffic that requires a user to step off the curb into a parking lot.)13
1. Senior PsychCare. Coping with Depression and the Holidays. http://www.seniorpsychiatry.com/articles/coping.html
2. Jeff Anderson. Senior Living Blog. CHEER Plan for Managing the Holidays with Aging Parents. Posted On 22 Dec 2015. http://www.aplaceformom.com/blog/happy-holidays-seniors-and-families-12-19-2012/
3. 5 holiday life safety tips you might have overlooked. Stan Szpytek, president of Fire and Life Safety, Inc. (FLS) based out of Mesa, Arizona and is the Life Safety/Disaster Planning Consultant for the Arizona Health Care Association and a consultant for the California Association of Health Facilities.http://www.ltlmagazine.com/article/5-holiday-life-safety-tips-you-might-have-overlooked.
5. National Fire Protection Association, Winter Holiday Safety.http://www.nfpa.org/public-education/resources/safety-tip-sheets
6. 5 holiday life safety tips you might have overlooked. Stan Szpytek, president of Fire and Life Safety, Inc. (FLS) based out of Mesa, Arizona and is the Life Safety/Disaster Planning Consultant for the Arizona Health Care Association and a consultant for the California Association of Health Facilities. http://www.ltlmagazine.com/article/5-holiday-life-safety-tips-you-might-have-overlooked
7. Holidays and Decorating.http://health.mo.gov/blogs/ltcblog/category/life-safety-code/
9. 5 holiday life safety tips you might have overlooked. Stan Szpytek, president of Fire and Life Safety, Inc. (FLS) based out of Mesa, Arizona and is the Life Safety/Disaster Planning Consultant for the Arizona Health Care Association and a consultant for the California Association of Health Facilities.http://www.ltlmagazine.com/article/5-holiday-life-safety-tips-you-might-have-overlooked
10. Let it Snow Lyrics, lyricist Sammy Cahn and composer Jule Styne written in July 1945.https://en.wikipedia.org/wiki/Let_It_Snow!_Let_It_Snow!_Let_It_Snow!
11. Mayo Clinic. Hypothermia Risk Factors.http://www.mayoclinic.org/diseases-conditions/hypothermia/basics/risk-factors/con-20020453.
13. GuideOne. Slip and Fall Prevention: Snow and Ice Removal. http://www.goriskresources.com/Docs/Shared/ps_falls_snow.pdf
This blog, which does not reflect any official policy or opinion for Vaaler Insurance, Inc. or Siders Healthcare Consulting, LLC, is provided for informational purposes only. It is not intended to provide legal or medical advice, nor is it intended to be an exhaustive list of all risks that need to be addressed for a healthcare organization. While every effort is made to provide accurate information, changes may occur and inaccuracies happen despite best efforts. This information is not a substitute for individual consultations with professionals in these areas and should not be relied on as such. Please work with your legal counsel and business advisor(s) for a plan that is specific to your organization. © 2016 Vaaler Insurance, Inc.