Vrable Healthcare, Author at THE GRAND

The 5 Stages of Grief

The 5 Stages of Grief

Catherine Denlinger
Director of Social Services, MSW, LSW
THE GRAND of Dublin

Given the tragedies that happened over the weekend in El Paso and Dayton, I thought I would briefly talk to you about grief and how to cope with loss in general.

There are 5 stages of grief that one typically goes through and there is no timeline on each stage.  Everyone grieves at their own pace and on their own terms. The important thing to remember is that grieving is a natural and a necessary course of emotions that everyone goes through.

Grief Cycle

Below are the 5 stages of grief:

  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance

 

  1. Denial – Initially we are in shock that this happened. We are telling ourselves that this can’t be real.  I must be dreaming.  Please tell me I’m dreaming.  Numbness takes over our bodies and we seem to be frozen, unable to comprehend what’s happening.  This is a normal reaction to loss, tragedy, trauma, etc.
  1. Anger– We are annoyed easily, blame others, question our faith, and feel very negative about everything and everyone. The underlying feeling of anger is pain.  In order to grieve we need to feel angry.  It’s ok to be mad, to be upset, and to be furious.  We need to look for a reason.  Why did this happen?  Why did this happen to me, to us, to him, to her, to them?  Looking for an answer to explain what happened so that we can understand the why.  This is a normal reaction to loss, tragedy, trauma, etc.
  1. Bargaining – If only…What if…Please God…. This stage is when we try to come up with a plan to fix it.  Trying to figure out how we can give something of ourselves and in return we wake up and this was all just a bad dream.  This is when we are going through the guilt.  Why not me? It should have been me? Let me take his/her/their place.
  1. Depression – Emptiness. The loss is real and we feel it.  It’s the heaviness in our bodies and in our hearts.  This is one of the hardest stages to go through for many people.  The pain and loneliness can feel overwhelming.  This is most definitely when you need support from others.  You don’t have to go through this alone.
  1. Acceptance – We never forget, we find peace within ourselves. As hard as it is to do it is necessary.  We must try to live in a world without our loved one.  Things change, we change and we never replace.  We just learn to live with it day by day, month by month, and year by year.

In summary, be in shock, be mad, be a negotiator, be down and at some point…move forward.  It’s okay to experience these emotions.  It’s necessary to be able to move on, to have good days, to feel happy again, to experience pleasures, and to enjoy life.  If you find yourself unable to have these good feelings then please seek help.  There are many resources to help you with the grieving process. You are not alone.

If you’re ever in the situation that you need long term care, skilled care, any care in a Nursing Center and you are going through struggles in your life please reach out to your social worker.  We can help! We have resources to assist you with managing your feelings and improving your mood.  When in a Nursing Center and the social work administers a PHQ-9 mood assessment (discussed in a previous article) they are asking these questions for a reason.  When answering these mood questions and scoring a lot of points, take advantage of the question, “would you like to talk with someone about how you’ve been feeling?” “Would like to talk with a counselor or our physician?” “Would you like to talk with me about how you’ve been feeling?” Social workers in Nursing Centers are not grief counselors; however, we are trained to have the basic skills that are needed to provide support and encouragement to you.  We want to help you.   If you need help, we are here for you.

Understanding Skilled Nursing

Understanding Skilled Nursing

Jada Palm
Hospital Liaison
The GRAND of Dublin

What is skilled nursing?

Skilled nursing is a type of intermediate care in which the patient or resident needs more assistance than usual. This setting is designated for physical, occupational, and speech therapies, to aide in strengthening the patient who has a goal of returning to their home at baseline. Skilled nursing services are offered to patients who need IV medications administered, who may have wound care needs, or who may need teaching on medication management, an example of this would be newly diagnosed diabetics.

What is the difference between short-term care and long-term care?

Short term care is a temporary solution that may last from a few days to a few months and is typically provided for rehabilitation and allow for recovery outside of a hospital. Long term care is typically utilized for in-house placement for the duration of the patient’s life, providing permanent custodial assistance.

What social activities are offered?

The GRAND social activities - skilled nursingSkilled nursing facilities offer a full calendar of social events and activities. Residents are encouraged to join in as many activities and social events as they like. Some examples include; art classes, ice cream socials, bingo and cards, game and movie night, quest performers and church services.

In addition, they offer wellness programs, exercise classes, beauty salons, small dining areas, café and restaurant style dining rooms, and outdoor sitting and walking areas.

What should I bring with me?

It is recommended that you bring comfortable clothing for working out in therapy along with well-fitting shoes. Personal hygiene items (all labeled with your name), photo ID, insurance cards, advanced directive paperwork (Power of Attorney and Living Will paperwork).

The GRAND Skilled Nursing roomWhat are the rooms like?

Some facilities offer both single and double occupancy rooms. Each facility has its own characteristics which make it unique and sets it apart from the other down the street. An example; The GRAND offers single occupancy rooms with walk-in showers, individual heating/cooling units, refrigerators, Wi-Fi and cable. Patient’s medications are locked securely in each patient room and we strive to provide a home like atmosphere.

What does Medicare cover?

Medicare part A covers skilled nursing care under certain conditions for a limited time.

  • You must have a qualifying hospital stay. This means you meet the minimum 3 night inpatient hospitalization requirement.
  • You have part A and days left in your benefit period.
  • Your doctor has ordered skilled services due to a medical condition which requires the need for 24/7 nursing care and therapy services offered 5 to 6 days a week.

Medicare covered services include:

  • A semi-private room
  • Meals
  • Skilled nursing care
  • Physical and Occupational Therapy
  • Speech-Language Pathology Services
  • Medical Social Services
  • Medical supplies and equipment used in the facility
  • Ambulance transportation (when other transportation endangers ones health) to the nearest supplier of needed services that aren’t available at the SNF
  • Dietary Counseling

Medicare part A will pay as follows:

  • Days 1-20 – pays at 100% with no patient responsibility
    (Remains $0 co-insurance for 2019)
  • Days 21-100 – patient responsibility of $170.50 per day co-insurance
    (2019 co-insurance will be $170.50)

Additional information can be obtained through Medicare.gov

How do I find out what my insurance will cover?

Insurance benefits and eligibility will be checked prior to admission to the building, but you may also call the member services number on your card and a customer service representative will provide you with details of your coverage options.

What is the next step and what can I expect once I select a facility?

Once you have selected a facility you will notify your hospital social worker and he/she will send the referral to the building for review. You may choose to tour the building. Your clinical is then reviewed by the admissions and nursing team to make ensure the facility can clinically manage your stay, and then the hospital liaison will visit you in the hospital to answer any questions you may have. If you need an authorization from your insurance to admit, the facility will then start that process. Once authorization has been received the facility will communicate with the hospital social worker.

What are your staffing ratios?

At The GRAND skilled setting, our ratio is 1:12 or 1:13, with an STNA on each hall. Our staffing ratios are significantly above average.

How often is therapy provided and will I have a schedule?

The GRAND therapy - skilled nursingTherapy is provided at the discretion of your ordering physician, the therapy team, and your needs. You can ask for a specific schedule if that works better for you. At The GRAND, the therapy team will meet with you either the day of your arrival or the next day.  An example, some prefer mornings, some prefer afternoons and some prefer to have their therapies separated. Meaning occupational therapy may be planned for the afternoon and physical therapy planned for the mornings.

The GRAND of Dublin Main StreetWhat sets your facility apart from the others?

The GRAND offers several amenities that set us apart from our competitor’s. We have Digger and Finch pub, our ice cream parlor, Movie Theater, beauty salon, pharmacy, chapel, licensed in-house therapy team and team of dedicated nurses and STNA’s and low patient/staff ratios, we offer outstanding service to our residents.

What are your visitation hours and/or restrictions?

Each facility will have set hours of operation. The most common hours of operation most facilities follow are 8am to 8pm, 7 days per week. The GRAND’s hours are 8:30am to 8pm, Monday through Friday and 9am to 8pm, Saturday and Sunday. There may or may not be restrictions on when visitors can be with their loved one. The GRAND does not have such restrictions and provides security 7 nights per week.

Drug Class Series: Antidepressants

Andrea Hartley, CPhT
Pharmacy Technician/Central Supply Manager
The GRAND of Dublin

Drug Class Series: Antidepressants

antidepressantsContinuing the series of articles featuring common drug classes, this article will be about antidepressants.

This class of medications is used to treat depression as well as anxiety and other psychiatric or sleep disorders as determined by a physician.  Nearly all antidepressants are taken orally and all require a doctor’s prescription.

There are 4 types of antidepressants within the class, based on how they work in the body:  SSRIs, Tricyclics, MAOIs and Atypical.  Side effects of medications within the same antidepressant group are very similar.

Below are the medications in the antidepressant class along with the most noteworthy facts about them.

SSRIs (selective serotonin reuptake inhibitors):

Paxil (paroxetine), Prozac (fluoxetine), Zoloft (sertraline), Serzone (nefazadone), Luvox (fluxoxamine), Celexa (citalopram), Lexapro (escitalopram), Pristiq (desvenlafaxine), Effexor (venlafaxine), Cymbalta (duloxetine).

SSRIs ease depression by increasing levels of serotonin in the brain. Serotonin is one of the chemical messengers (neurotransmitters) that carry signals between brain cells. SSRIs block the reabsorption (reuptake) of serotonin in the brain, making more serotonin available. SSRIs are called selective because they seem to primarily affect serotonin, not other neurotransmitters.  They are the most commonly prescribed type of antidepressant and generally cause the least amount of side effects.

Tricyclics (TCAs)

Anafranil (clomipramine) Elavil (amitriptyline) Norpramin (desipramine), Pamelor (nortriptyline), Sinequan (doxepin), Tofranil (imipramine), Vivactil (protriptyline),Asendin (amoxipine)

This type of antidepressant was discovered in the 1950s.  TCAs are named after their chemical structure, which contains 3 rings of atoms.  This type of antidepressant impacts several different neurotransmitters in order to change the brain and for that reason can cause many unwanted side effects.

MAOIs

Marplan (isoxarboxazid), Nardil (phenelzine), Emsam (selegiline), Parnate (Tranylcypromine)

MAOI stands for MonoAmine Oxidase Inhibitor.  This was the first variety of antidepressant developed.  They are effective, but are known for causing many side effects; frequently ones that are unsafe.

Atypical or Miscellaneous

Wellbutrin aka.  Forfivo, Budeprion, Aplenzin(bupropion), Viibryd (vilazodone),  Desyrel (trazodone),Trintellix (vortioxetine),  Remeron (mirtazapine), Serzone (nefazodone)

Medications are placed in this category because they don’t fit into the other groups.  This is because they treat depression in a completely different way or they combine multiple characteristics of other groups to work uniquely.  They are each unique medications that work in different ways from one another.

When you stay at The Grand, the knowledge of our doctors, nurse practitioners, nurses and pharmacy technician is at your disposal.  If you have a questions about your medications, just ask!

May is Older Americans Month, Focus on Aging!

May is Older Americans Month!

by Meghan Elliott, RN, Director of Nursing
and Sarah Schubert, LPN, MDS
The GRAND of Dublin

Older Americans Month, AgingAging is something no one can escape. While society frequently reinforces an anti-aging atmosphere, there are many reasons to celebrate and embrace the changes that occur throughout the aging process. Many physiological changes occur during this process, but very important mental aspects change as well. According to the World Health Organization, approximately 15% of those aged 60 or over suffer from dementia and depression; it is important to note that the majority of aging Americans do not. For those aged 65+, a lot of reflection tends to occur. These individuals look at their past and present relationships, and think about what they have accomplished or not accomplished throughout their life. This is a great time to interact with our “older” family members and friends as the insight they have is immeasurable.

Open a Dialogue and Ask Questions

This is also a critical time to focus on what that family member or friend may desire in terms of end of life care, or how they envision spending their final days, months, or years. Please take the time to ask your loved one their thoughts and feelings about alternate living arrangements, medical procedures they would want performed and those they would not. Also ask about a plan B, what if that preferred plan isn’t possible, then what? These questions are vital to the comfort and security our older population has when faced with a new or chronic health problem that requires treatment. These types of discussions are critical not only in a medical scenario, but they are also important ways to connect with that individual and appreciate their perspective on life. You may be incredibly surprised by the answers your loved ones will give you. Open, honest, frank discussions about life lessons, goals, failures and successes from the older population can mold and shape how WE live our lives. Those of us in healthcare want to take the time to thank our elderly population. You teach and guide us more than we could ever educate you. Happy Older Americans Month! Your wisdom is appreciated.

What is PHQ-9?

PHQ-9 – Patient Health Questionnaire Depression Module

Catherine Denlinger, DOSS, MSW, LSW
Director of Social Services
The GRAND of Dublin

PHQ-9 stands for Patient Health Questionnaire Depression Module.  It a screen used to assist with identifying a resident’s current and recent mood state and to help determine if any interventions or referrals need to occur.  The 9 stands for the 9 criteria derived from the DSM-IV (now DSM-V) which is a diagnostic manual for those in the mental health field.  The PHQ-9 is a mandatory interviewing tool for skilled nursing centers.  A social worker is usually the one that would be administering the PHQ-9.

The PHQ-9 is administered shortly upon admission and then several times thereafter if a resident is in a center for skilled services.   It is administered after 14 days, 30 days and so forth.  If a resident is receiving long term care, then the PHQ-9 is administered upon admission, quarterly and if there is a significant improvement or decline in a resident’s well-being.

A resident is asked is over the past 2 weeks, has he/she been bothered by any of the following problems.  There are 9 questions to be asked that are answered with a yes or no.  If a question is answered yes, then there is a follow-up question asking the frequency ranging from a 0 to a 3.

  • A 0 is never to 1 day
  • A 1 is 2-6 days (several days)
  • A 2 is 7-11 days (half or more of the days)
  • A 3 is 12-14 days (nearly every day)

The scoring ranges from 00 to 27.  The tally of the scores represents a resident’s tentative mood state for depressive signs/symptoms.

  • A score of 0-4 represents none to minimal depression
  • A score of 5-9 represents mild depression
  • A score of 10-14 represents moderate depression
  • A score of 15-19 represents moderately severe depression
  • A scored of 20 + represents severe depression

Below is the Resident Mood Interview (PHQ-9) found in the MDS Manual used by all skilled nursing centers:

PHQ-9

This questionnaire is a tool to assist with providing a holistic presentation of a resident in order to ensure the most appropriate plan of care.   Here at The GRAND, there are resources available to assist a resident with depression signs/symptoms during their stay with us such as scheduled activities, pet therapy, counseling services, a Medical Director to oversee any medication management needs and an ample amount of caring staff members to talk with.  The Grand has all private rooms for a resident’s comfort and privacy as well as multiple locations throughout the center to engage in socialization or to just have time for oneself.  We strive to make our residents stay both physically and mentally stimulating as well as to have the best possible outcome for their well-being.

Gout diet: What’s Allowed, What’s Not

Gout diet: What’s Allowed, What’s Not

Frank Mackovine
Dietary Manager
The GRAND of Dublin

Gout Diet - what's allowed and what's notStarting a gout diet? Understand which foods are OK and which to avoid.

Gout is a painful form of arthritis that occurs when high levels of uric acid in the blood cause crystals to form and accumulate in and around a joint.

Uric acid is produced when the body breaks down a chemical called purine. Purine occurs naturally in your body, but it’s also found in certain foods. Uric acid is eliminated from the body in urine.

A gout diet may help decrease uric acid levels in the blood. A gout diet isn’t a cure. But it may lower the risk of recurring gout attacks and slow the progression of joint damage.

People with gout who follow a gout diet generally still need medication to manage pain and to lower levels of uric acid.

Gout diet goals

A gout diet is designed to help you:

  • Achieve a healthy weight and good eating habits
  • Avoid some, but not all, foods with purines
  • Include some foods that can control uric acid levels

A good rule of thumb is to eat moderate portions of healthy foods.

Diet details

The general principles of a gout diet follow typical healthy-diet recommendations:

  • Weight loss. Being overweight increases the risk of developing gout, and losing weight lowers the risk of gout. Research suggests that reducing the number of calories and losing weight — even without a purine-restricted diet — lower uric acid levels and reduce the number of gout attacks. Losing weight also lessens the overall stress on joints.
  • Complex carbs. Eat more fruits, vegetables and whole grains, which provide complex carbohydrates. Avoid foods and beverages with high-fructose corn syrup, and limit consumption of naturally sweet fruit juices.
  • Stay well-hydrated by drinking water.
  • Cut back on saturated fats from red meat, fatty poultry and high-fat dairy products.
  • Focus on lean meat and poultry, low-fat dairy and lentils as sources of protein.

Recommendations for specific foods or supplements include:

  • Organ and glandular meats. Avoid meats such as liver, kidney and sweetbreads, which have high purine levels and contribute to high blood levels of uric acid.
  • Red meat. Limit serving sizes of beef, lamb and pork.
  • Some types of seafood — such as anchovies, shellfish, sardines and tuna — are higher in purines than are other types. But the overall health benefits of eating fish may outweigh the risks for people with gout. Moderate portions of fish can be part of a gout diet.
  • High-purine vegetables. Studies have shown that vegetables high in purines, such as asparagus and spinach, don’t increase the risk of gout or recurring gout attacks.
  • Beer and distilled liquors are associated with an increased risk of gout and recurring attacks. Moderate consumption of wine doesn’t appear to increase the risk of gout attacks. Avoid alcohol during gout attacks, and limit alcohol, especially beer, between attacks.
  • Sugary foods and beverages. Limit or avoid sugar-sweetened foods such as sweetened cereals, bakery goods and candies. Limit consumption of naturally sweet fruit juices.
  • Vitamin C. Vitamin C may help lower uric acid levels. Talk to your doctor about whether a 500-milligram vitamin C supplement fits into your diet and medication plan.
  • Some research suggests that drinking coffee in moderation, especially regular caffeinated coffee, may be associated with a reduced risk of gout. Drinking coffee may not be appropriate if you have other medical conditions. Talk to your doctor about how much coffee is right for you.
  • There is some evidence that eating cherries is associated with a reduced risk of gout attacks.

Sample Menu

Here’s what you might eat during a typical day on a gout diet.

Breakfast

  • Whole-grain, unsweetened cereal with skim or low-fat milk
  • 1 cup fresh strawberries
  • Coffee
  • Water

 Lunch

  • Roasted chicken breast slices (2 ounces) on a whole-grain roll with mustard
  • Mixed green salad with vegetables, 1 tablespoon nuts, and balsamic vinegar and olive oil dressing
  • Skim or low-fat milk or water

Afternoon snack

  • 1 cup fresh cherries
  • Water

Dinner

  • Roasted salmon (3 to 4 ounces)
  • Roasted or steamed green beans
  • 1/2 to 1 cup whole-grain pasta with olive oil and lemon pepper
  • Water
  • Low-fat yogurt
  • 1 cup fresh melon
  • Caffeine-free beverage, such as herbal tea

Results

Following a gout diet can help limit uric acid production and increase its elimination. A gout diet isn’t likely to lower the uric acid concentration in your blood enough to treat your gout without medication. But it may help decrease the number of attacks and limit their severity.

Following a gout diet, along with limiting calories and getting regular exercise, can also improve your overall health by helping you achieve and maintain a healthy weight.

Source: The Mayo Clinic

Dance Your Way To Fitness!

by Sara Katula
Activity Director
The GRAND of Dublin

Regular exercise can help older adults stay independent and prevent many health problems that come with age.  Reduced physical activity is one factor that contributes to reduced strength and stamina in the elderly.  Physical activity not only benefits us physically but emotionally as well.  Exercise reduces the symptoms associated with anxiety and depression and can lead to improved moods and increased feelings of well-being.

fintess

The GRAND of Dublin adds many different types of exercise programs into our activities calendar. Some of the different types of exercises we offer are morning stretch, walking club, exercise bingo, and chair exercises. We also incorporate other physical activities such as balloon volleyball, bowling, corn hole, and basketball to keep our seniors active while having fun at the same time.  

In January of this year, we started a new exercise program called Zumba Gold. Zumba is a new dance fitness program that has become popular over the years across the globe.  Zumba Gold is a new version of the program that is tailored to the needs of the elderly. The design of the class is to introduce easy to follow choreography that focuses on balance, range of motion, and coordination.  Zumba is also a good way to socialize and have fun! Trained Zumba fitness instructors at more than 2,000 locations nationwide, including fitness clubs, community centers, YMCAs, rehabilitation centers, and retirement communities, offer the program. Cindy, our Zumba fitness instructor for The GRAND will be teaching a 30 minute class twice a month for any resident who would like to participate.

Fitness GRAND of Dublin

Every time Cindy has taught this class we have had a full room and positive feedback. Many residents state they enjoy the music and learning the dance moves. “Zumba is fun and does not feel like exercise!” states one of our long term residents.  

Home Evaluation

Home Evaluation

Home Evaluation
By Jeanne R. Seliskar, MA, CCC/SLP
Corporate Director of Rehabilitation
Vrable Healthcare Inc

Home Evaluation completed by a Physical Therapist or Occupational Therapist is a necessary component of the treatment plan of care in a Skilled Facility.  It is essential to ensuring a safe and successful return to the patient’s prior living situation.  A home evaluation is usually scheduled 1-2 weeks prior to discharge and can easily be misunderstood by the patient and family as a signal that we are discharging.  Careful education about the timeline and how goals can develop from seeing the person function at home, need to be reviewed.  It is offered to everyone within a reasonable distance from the facility and helps to dispel the misconception that “when I go home, I will be able to things”.  It presents a realistic picture of current levels of functioning.

Evaluation Areas

The therapist covers various areas which can be divided into the following areas with the patient performing tasks and mobility in each part of the home:

Exterior and Access to the Home:  This section covers lighting, steps, handrails, locking/unlocking doors, opening/closing doors, getting the mail and other outside obstacles, tasks or barriers. This allows the therapist to assess the patient’s ability to enter/exit the home and manage assistive device in case of an emergency. Recommendations may be made regarding the addition of handrails or other safety features such as a ramp.

Foyer and Hallways: This particular part of the evaluation assesses lighting, throw rugs, width of the hallways for walker/wheelchair, managing switches and other possible trip hazards.

Kitchen:  In this area, the flooring condition, accessibility of items to cook or eat with, storage/counter space, operation of the faucets/garbage disposal, dining space, retrieval of items from the stove, oven, microwave and refrigerator are examined. Therapists may recommend that items be placed between knee and shoulder level to improve safety and decrease risk of falls during kitchen tasks/IADLs. Additional equipment such as a walker tray or basket may be recommended at this time.

Living Areas:  the condition of the carpeting, any throw rugs present, sturdiness of the furniture as well as the height of seating for transfers are the foci of this part of the visit.

Interior Stairs or Steps:  Important factors include height of the step, presence of handrails, clutter on the steps, and carrying items when navigating the stairs.

Bedroom:  The therapist notes the condition of the carpeting or flooring, stability of the bed and other furniture, transfers on/off the bed, accessibility of clothing from drawers and the closet and the use of the blinds or window coverings.

Bathroom:  Components include lighting/presence of a night light, throw rugs, presence of grab bars, availability of supplies and ability to safely navigate throughout bathroom with reduced risk of falls. Therapists will assess ability to get on and off the toilet and into/out of tub or shower, recommending equipment as necessary.

Basement/Laundry Area: Lighting, throw rugs, flooring and tripping hazards are assessed. Therapists observe the patients ability to reach and transport laundry items, retrieve clothing from washer/dryer and safely operate machinery.

Telephone: The therapist will assess the availability of telephones and other emergency devices to assure that the patient can get help from emergency response personnel if needed.

Fire Safety: During this portion of the home assessment, alternate exit routes are examined, fire sources are observed and smoke detectors are located. Recommendations are made to facilitate safety in case of a fire or other need to evacuate the home.

The importance of the home evaluation should not be taken lightly or dismissed.  It can be the difference between a successful, happy and safe return to home life for a long period of time or possible re-hospitalization from a fall or inability to manage essential components around the house.

Drug Class Series: Analgesics and NSAIDs Medications

Opioid - analgesics-medications
Andrea Hartley, CPhT
Pharmacy Technician/Central Supply Manager
The GRAND of Dublin

This month I’ll begin a series of articles focusing on some of the common classes of medications. I chose analgesics for this article.  Analgesics are one of, if not the most common class of medications around the world.  This class includes both prescription and over-the-counter medications, and opioids.  Some references list NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) as a separate class, but for our purposes NSAIDs will be included with analgesics.

Please note that some medications are in multiple drug classes because they have multiple/different uses.

Analgesics are medications that relieve pain, also called pain killers. They are distinctly different from anesthetics, which temporarily affect, and in some instances completely eliminate, sensation.  Below are the medications in the analgesic class along with the most noteworthy facts about them.

Acetaminophen (aka Tylenol; APAP) is sold over-the counter both alone and in formulations such as Nyquil.  It is also sold as a prescription with codeine, hydrocodone and oxycodone. Over dosing on this medication can cause serious liver disease.  Acetaminophen works by changing the way the body senses pain.  Adults with healthy livers should take no more than 4gm (4,000mg) from all sources in a 24-hour period.  People with liver problems should take even less.

Aspirin (aka Ecotrin; Bayer) is sold over-the counter.  Some also consider it to be in the NSAID class.  Upset stomach is common when taking aspirin.  Children shouldn’t take aspirin or any related medications (pink bismuth, loperamide etc.) because it is thought to play a role in causing a serious condition known as Reye’s syndrome.

Opioids (narcotics), such as Avinza, Kadian, or MS Contin (morphine),  Ultram (tramadol), Oxycontin (oxycodone), Dolophine or Methadose (methadone), Dilaudid (hydromorphone), codeine, Demerol (meperidine), Duragesic or Actiq (fentanyl), Lortab or Norco (hydrocodone),  and others. Opioids reduce the pain signals sent by the nervous system and the brain’s reaction to those pain signals.  If you take an opioid for a long time, you could develop dependence as your body gets used to the drug. Some people also become addicted to opioids. Talk to your doctor if this is a concern.  One of the most common side effects when taking a narcotic is constipation.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin (Ibuprofen), Aleve or Naprosyn (naproxen), Cataflam or Voltaren (diclofenac), Celebrex (celecoib) and others. NSAIDs are available as OTC and prescriptions, oral and topical. 

At The Grand we will make sure you have all of your medications available to you as quickly as we can; especially pain medications.  It’s important to use them wisely to maximize your recovery time here!

Valentine’s Day Messages

Send a Special Valentine’s Day Message to a Resident at The GRAND of Dublin

February and Valentine’s Day are about love, whether it be family, romantic, or platonic. As Valentine’s Day approaches, The GRAND would like to make it easy for you to send our residents a special message to let them know someone is thinking about them on this holiday of love.

For seniors who may feel isolated and lonely, it can be a difficult day. While many people think of the elderly at Thanksgiving and Christmas, Valentine’s Day might be overlooked as an opportunity to make a person’s day feel special. We would like to invite you to send a Valentine’s Day Message to your loved one or to our residents who may no longer have family.

Send a message to one of our residents letting them know someone is thinking about them by filling out the form below. If you do not a have a specific resident you want to reach, simply leave the Resident Name field blank.

The Valentine’s Day Message form is now closed. Thank you to everyone who sent messages to our residents.