Make the best senior care decision

Uncontrolled diabetes can cause circulation problems that severely damage feet and eyes, impair sexual health, and can lead to heart and kidney disease.

Senior living communities can offer help managing diabetes in elderly adults — and peace of mind for loved ones.

“As a person ages with Diabetes, the prevention of illness and infection, meeting care needs, and monitoring for changes in health condition can become ever more important in maximizing health and wellness,” says LuAnne Leistner, senior director of clinical policy and programs at Brookdale Senior Living.

Providing opportunities for an active and healthy lifestyle, making sure glucose levels are stable, and spotting easily overlooked symptoms and complications are important ways long-term care communities can ensure proper diabetes management in seniors.

Most senior living communities are experienced in managing diabetes in the elderly. After all, one in four people over the age of 60 has diabetes, according to the American Diabetes Association. The American Geriatric Society recommends that communities provide an individualized care plan that considers the senior’s life expectancy, cognitive status, functional status, and social support.

To determine the level of care your loved one needs, the community’s health care team will use an evaluation tool to assess your senior’s health, the severity of their diabetes, and how much care they will need. A higher assessment score indicates the need for a more intensive diabetic care plan. For example, in some communities, a Level 1 care plan encompasses basic needs, such as help with activities of daily living (ADLs). As the levels of needed care increase, the plan becomes more intensive and specialized.

As you evaluate communities for a loved one, ask the community’s health care team how they will work with you and your loved one to create a diabetes management plan. A well-rounded plan should be based on your senior’s lifestyle, preferences, health goals, and any other existing health conditions.

Ask specific questions to the nurse leader or executive director about how the community nurses and clinical team will met the needs of you or your loved one living with diabetes, Leistner says. Here are some initial questions to ask:

• What diabetes management education and training does the staff receive and how often?
• Does the community have a special focus on diabetes care and/or programs for individuals living with diabetes? Does the community offer diabetes support groups?
• What health care services does the community provide and how will staff coordinate care for health services not provided on site, such as physician visits?

More specifically, you’ll want to explore how the community promotes a healthy lifestyle, how blood-sugar levels are monitored and stabilized, how the team will ensure diabetes symptoms are in check, and how much diabetes care will cost. Here’s a guide to those four important areas, with questions to ask to give you a full picture of how senior living communities approach diabetes care for the elderly.

Promoting healthy living

One of the biggest benefits of a senior living community is access to nutritious, well-balanced meals and physical activities that help keep diabetes symptoms at bay.

“Senior living communities provide programming and activities that can help to enhance a healthy lifestyle,” Leistner says. “Exercise programs, getting active, being socially engaged with community residents, and outside community activities become an integral part of helping to attain a healthy life style physically, emotionally, spiritually, and socially.”

Fitness programs

The American Diabetes Association recommends 30 minutes of aerobic exercise five times a week and at least two sessions of strength training each week. Some senior care communities have a designated program director or exercise coach who customizes fitness programs to fit the needs of individuals. Communities may feature on-site amenities like a fitness center, swimming pool, golf course, or outdoor walking paths to encourage an active lifestyle.

Let our care assessment guide you

Meal plans

Many senior living communities have a dietician or nutritionist on staff who can customize meal plans for seniors who have diabetes or other special dietary needs. These plans incorporate heart-healthy meals that keep saturated fats, sodium, and portions in check.

A dietician might also collaborate with the community’s chef or kitchen staff to create a full menu of healthy options for the entire community to enjoy. Many communities also offer flexible dining schedules and private room service, and these amenities may help ease the stress of a diet change.

When assessing how a community may support a healthy lifestyle for your senior loved one, ask these questions:

• What activities are offered?
• What kinds of exercise facilities are available?
• Is there access to nature and walking paths?
• What are the meal policies and procedures for diabetic residents?
• Is there a dietician on staff?
• Are there meals available that are specifically designed for diabetic residents?
• What is the dining schedule, and is it flexible?
• Is room service available?

Monitoring blood sugar levels

Tracking blood sugar levels is an important part of managing diabetes. Blood-sugar levels can become too high when diabetes is not properly controlled. High levels can cause complications such as circulation problems, heart disease, and kidney disease. Sometimes, a patient’s insulin or diabetes pills push levels too low, causing tiredness, shakiness, dizziness, anxiety, and irritability. According to the American Diabetes Association’s guide to health living for those 55 and up, even seizures are possible.

Your loved one’s care team will determine if the resident is able to monitor their own blood sugar levels and administer insulin as needed or, if not, how levels will be monitored and kept stable. Each community will have policies for monitoring and stabilizing residents’ blood-sugar levels and for administering and tracking medications. These policies are often dependent on state regulations and a community’s clinical capabilities.

For example, most assisted living facilities will provide help with taking medications. Some states require a third-party home health service to monitor levels and give insulin, but most communities provide this service through nurses or medical technicians.

Your loved one’s care plan should clearly state who will monitor blood sugar levels, who will administer necessary medications  including insulin, and the role of the resident’s physician.

When assessing how a community develops diabetes care plans, ask these questions:

• What is the process to create a plan to monitor and stabilize blood-sugar levels?
• Who monitors residents’ blood-sugar levels?
• How is blood sugar monitored? Is a glucometer or an under-the-skin method, such as a continuous glucose monitoring system, used?
• Who administers insulin and other medications?

Tracking uncontrolled symptoms

An important part of a care plan is making sure a resident’s diabetes is controlled. Care staff at senior living communities check for changes in residents’ health and work to prevent preexisting complications from getting worse. When choosing a community, ask about resources to help educate the resident and family members about symptoms and make sure the staff is well-trained to note complications, Leistner suggests.

When assessing how a community monitors diabetes symptoms, ask these questions:

• Does the community have education resources for both staff and residents to learn to how to check for diabetes complications?
• What is the plan for annual wellness visits?
• How often are foot and eye exams conducted and by whom?
• What is the plan for dental hygiene and for dental checkups?
• What access to mental health care is available?

As with all senior living care, the cost of diabetes care depends on the level of help needed. The evaluation tool used to assess your loved one’s level of care will determine the cost.

Talk with a Senior Living Advisor

For example, a resident who independently manages, stores, and administers their insulin and medication may not incur any diabetes care costs, Leistner says.

On the other hand, more hands-on assistance from the community, such as developing a special diet or monitoring blood sugar levels, may incur a higher cost.

“Understanding the community’s cost method is important as the needs of the resident may change over time,” Leistner says.

Be sure to ask about pricing and payment plans when determining your loved one’s care level, and ask the following questions:

• What will my loved one’s diabetes care cost?
• Does providing a special diet add to the cost? How much?
• Does glucose monitoring incur a cost?
• How will the cost change if my loved one’s level of care increases?

Sources:

American Diabetes Association. “Caring for Community-Dwelling Older Adults with Diabetes: Perspectives from Health Care Providers and Caregivers.”

American Diabetes Association.“Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association.”

American Diabetes Association.“Living Healthy with Diabetes: A guide for adults 55 and up.”

American Geriatrics Society.“Diabetes Support Groups Improve Health Care of Older Diabetic Patients.”

Centers for Disease Control and Prevention.“5 Questions to Ask Your Health Care Team.”

Cleveland Clinic.“Diabetes: An Overview.”

Mayo Clinic.“Type 1 Diabetes.”

National Institute on Aging.“Diabetes in Older People.”