Too Hot for Homecare
A changing climate may disproportionately impact aging adults & those with dementia
By Elsa Lam
Across the country, Americans are feeling the heat this summer, as high temperatures become more frequent and heat waves last longer due to climate change. The Environmental Protection Agency recently reported that the decade between 2014 and 2023 was the hottest on record. Extreme heat is responsible for the most weather-related deaths in the United States.
Environmental factors can have an immense impact on homecare patients who are vulnerable to the elements, given that the majority are over the age of 65 and coping with multiple chronic conditions. One group particularly at risk is the Alzheimer’s and dementia community.
Dementia Can Exacerbate Heat
Dementia affects cognition and can damage the functioning of internal systems that regulate body temperatures. Those suffering from the condition may be less aware of internal temperature changes, putting them at greater risk for dehydration or heat stroke.
Nationally, 32% of all long-term home health agency users have dementia. In addition, 80% of all people with dementia live at home and are cared for by family or professional caregivers. As a result, homecare clinicians are on the frontlines in dementia care. These clinicians have a comprehensive view of outside factors impacting their patients, including heat waves, transportation, safe housing and food.
Laura Chartrand, a homecare nurse at the home-based nonprofit organization VNS Health, has seen how living conditions can exacerbate safety conditions for patients firsthand, especially those who lack cooling systems in their homes.
“We’ve had situations where you come in and you see that the client doesn’t have (air conditioning) or even a fan,” Chartrand said. “In those cases, we’ll immediately talk with the rest of our team, especially social workers, to find ways we can get a patient the help they need.”
Chartrand added that, while nurses should immediately address immediate signs of heat exhaustion and dehydration, it is also important to pinpoint the root causes that lead to hotter apartments and homes for their patients. For example, older apartments and homes may not have proper insulation or ventilation to protect from heat, so adding blinds or additional fans can be beneficial.
Chartrand noted that another challenge for people with dementia, especially older clients, is frequently feeling cold in general. In these cases, she encouraged caregivers to turn on the air conditioning preemptively, as a patient may not notice they’re overheating until it’s too late. In addition, nonverbal dementia patients may have trouble communicating their discomfort to a caregiver. For this reason, it’s recommended that caregivers proactively serve water and remind their patients to take regular sips. Another helpful strategy is to ensure there are cool, damp washcloths on hand to help lower body temperature.
A Team Approach
When it comes to keeping dementia patients safe, nurses, social workers, rehabilitation therapists and home health aides each play an important role. Because many patients at VNS Health are low-income or live below the poverty level, social workers play an integral role in connecting them with available community resources that bring comfort and help them live safely and independently in their homes.
Heat can have a major impact on mood and mental well-being. People with dementia might become more irritable or sensitive when temperatures rise due to physical distress—which then results in patients being less likely to listen to their family caregivers. In these situations, home health aides play a crucial role in maintaining day-to-day health, as they are often the first to notice when something seems off with their patients.
“With dementia patients, mood swings are not uncommon, and changes in things like temperature can trigger different behavior,” said Petra Peters-Charles, a home health aide. “In these cases, you really need to have patience and understanding for what the person is experiencing.”
"Now more than ever, homecare has a significant role to play in helping those most vulnerable & their families navigate environmental pressures. "
Tempers May Fire
Empathy is another major tool in dementia patient care. When family caregivers find themselves frustrated by a loved one’s behavior, stress and anxiety can escalate, as proverbial “buttons” are pushed. This can be frustrating for everyone involved, as well as a serious burden to mental health.
In addition to clinical care, one of the most important aspects of delivering home health care is educating patients and their family caregivers about their illness. Teaching the signs and symptoms of heat stroke and dehydration, as well as the best ways to keep someone comfortable and safe at home are vitally important. During heat waves, homecare teams check on their vulnerable patients to ensure they and their families know what to look for and how to react if symptoms rise to an emergency level.
Research has found an increased frequency of heat waves overburdening hospital systems, with increasing numbers of patients coming into emergency rooms due to heat-related illnesses. Now, more than ever, homecare has a significant role to play in helping those most vulnerable and their families navigate environmental pressures that can trigger life-threatening situations.
Elsa Lam, MSN, RN, PCC, is vice president of regional patient care services at VNS Health, one of the country’s largest home and community-based nonprofits in the country. In her role, Elsa is responsible for planning, directing and evaluating VNS Health’s homecare operations in Manhattan, the Bronx and Westchester, New York. Visit vnshealth.org.
