For many people, a diagnosis of diabetes seems to bring nothing but limitations and restrictions. But for 82-year-old Sandra, a diabetes diagnosis has translated into a great array of mealtime options. That's thanks to her home health aide, Betty.
Every morning, on her way to Sandra's Manhattan apartment, Betty swings by the supermarket for reconnaissance. "I tell her, apples are on sale today, the cabbage and collard greens look good," explains Betty. "And I ask, 'What do you have a taste for?' She has until noon to decide the menu, then I go shopping for dinner."
By getting Sandra involved in the decision-making and preparation (baking, no frying) and the taste-testing (spices, no salt), Betty finds that her 82-year-old client can be remarkably open-minded about trying new foods and changing her diet. No longer does she skip lunch and fry up chicken or oxtails for dinner. Instead, Sandra chooses a salad for lunch and something along the lines of baked, skinless chicken with spinach or cabbage for dinner. "We talk and commentate," says Betty. "She really participates in the meal, so she enjoys it more."
Living with Diabetes
More people than ever are living with Type 2, or adult-onset, diabetes. According to recent figures from the Centers for Disease Control and Prevention, diabetes affects 25.8 million Americans, or 8.3 percent of the population (including both diagnosed and undiagnosed cases). Nearly two million Americans were newly diagnosed last year. At Partners in Care, the licensed, not-for-profit home care agency that I run, we have many clients with diabetes, and I see the numbers only rising in the near future. The New York Times Magazine recently focused attention on the role sugar plays in America's diabetes epidemic as well.Diabetic patients who need home care tend to fall into two groups:
- those newly diagnosed with diabetes or recently home from a diabetes-related hospitalization, who need extra care at home while they try to get their diabetes under control
- those who have other conditions in addition to diabetes and who need extra help to live safely and independently at home
For both categories of people living with diabetes, the "stuff" of daily life -- eating, walking and even putting on shoes -- must be understood through the lens of the disease, and this is where skilled home health aides play a vital role. Well-trained aides pay close attention to diabetes management while they carry out such daily tasks as shopping and cooking, helping with getting dressed and overseeing and assisting with managing medications and carrying out prescribed exercise routines.
All home health aides who receive their certification from a licensed agency in New York State are required to learn about diabetes care as part of their training. Licensed agencies like Partners in Care often augment that training with in-service education for experienced aides. "That means certified aides have the latest information about the disease, how it manifests, and what exactly are the direct tasks that they have to do that relate to the diabetes," says my colleague Mark Andaya, Director of Education and Quality Assurance at Partners in Care.
As I noted in Part I of this Specialty Care series, home health care is not a one-size-fits-all profession. When you or a loved one chooses certified home care from a licensed agency, you have the advantage of matching a caregiver's experience, expertise or training to your loved one's specific care needs, including diabetes.
Daily Care for Diabetes
Certified home health aides are often part of a larger team, responsible for day-to-day implementation of doctor's orders and a nurse's plan of care. Renata Gelman, RN, BSN, who is a clinical manager at Partners in Care, passes along some information that we give home health aides in their training and in the plan of care we create for our clients with diabetes.1. Nutrition This is the number one issue for someone with diabetes. "When a nurse creates a care plan for the client and the home health aide," explains Renata, "she's going to focus first on diet." When shopping and planning meals for someone with diabetes:
- Exclude all refined sugar
- Add fruits and vegetables to the diet, bearing in mind that, for a diabetic, not all fruits are created equal. Green means "go" for certain fruits: greenish bananas have much less sugar than deep yellow ones; likewise, green apples are better than red ones. Avoid grapes and raisins, which have too much sugar.
- Avoid white flour, choosing brown rice and whole-wheat pasta
- Avoid salt and fat in cooking
- Limit juices and avoid sodas
- Control portions and don't skip meals. Betty says she tells her client, "You can't eat like you're a teenager anymore."
A caregiver should also make sure that a diabetic client has sugary items on hand in case of an emergency. "Always examine the refrigerator," says Renata, "and make sure that orange juice is present, or Coke or chocolate."
Insulin dries out the natural moisture of the skin, so make sure someone with diabetes drinks enough water. Caregivers should check skin for dryness and encourage hydration. Renata suggests filling a pitcher to the maximum daily requirement in the morning, dispensing water by the cupful, and making sure the pitcher is empty by bedtime.
Staying active is a critical part of keeping diabetes under control. While the patient might be resistant at first, caregivers must be persistent. Betty recommends being gentle -- yet firm. "At the beginning," Betty recalls of her client, "she didn't want to walk. She was very used to sitting in her chair. I'd say, Let's just walk around the table then sit back down. Next time, it was, 'Okay, now to the bathroom.' Start with baby steps, then, when they feel comfortable, add a little more."
4. Foot care
Because diabetes can cause nerve damage and numbness, especially in the feet, diabetics should wear comfortable, close-toed shoes to avoid injury, and aides should help patients inspect the feet regularly for damage (which the patient may not feel). Wounds heal slower, so wound prevention is paramount.
5. Vision care
Vision is also affected by diabetes, and aides are trained to "be their client's extra set of eyes," says Mark Andaya. This includes communicating with clients about how they are seeing and reading, and understanding that diabetics can experience fluctuation in their vision.
6. Doctor's orders and warning signs
To monitor and manage the disease, people with diabetes should have a detailed plan of care from their doctor. This includes when and how to check blood sugar and administer insulin, as well as when and how to take medications. Home health aides oversee -- and, under certain limited conditions, can assist with -- a patient's monitoring and managing of his or her diabetes.
Aides are also trained to recognize warning signs, indicating blood sugar is too high or too low. If the patient is unusually thirsty, is confused, or has a blood sugar reading of 200 or above, aides will immediately call the patient's doctor and the nurse managing the case.
Rules to Live By
When it comes to caring for any client -- in this case, one with diabetes -- Betty provides some wonderful words of wisdom. "Be very observant," she says, noting that if someone says they'll take their medication or eat or exercise in five minutes, check in five minutes to make sure it's done. "Be persistent when you need to be. But also be compassionate. Sometimes even those of us in good health don't want to do everything we're supposed to do."
Living with diabetes -- or caring for someone who is -- is an increasingly common story. Tell us your story, and share a tip for monitoring or managing the disease.
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