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Are generic drugs inferior?

If your relative is taking brand-name prescription drugs, a switch to generic could provide significant savings.

Why are brand-name drugs so expensive?

It takes a lot of money and time to develop a new drug. In particular, it must be tested to show it works and is safe for humans. Patent laws give an innovator company 10 to 20 years to sell the drug with no competition. When the patent expires, any company can develop the generic equivalent. It is less expensive because they don’t have to repeat the testing.

The Food and Drug Administration approves both brand-name and generic drugs. The two medicines are identical in

  • active ingredient(s), strength, quality, safety, and how they work
  • required lab testing to prove they are absorbed 80%–120% as well as the original (the average tends to be 96%–104%)
  • manufacturing standards that ensure consistency and purity

Brand-name and generic drugs are different in

  • inactive ingredients. Think fillers, binders, colors, and flavorings
  • appearance, such as shape, size, and color
  • clinical testing on humans. This is not required for generics
  • name. The generic’s name is scientific as it was not created for advertising

The biggest difference is cost. Generic drugs cost about 66%–85% less than their brand-name equivalents.  

Is there a downside to generics? Not generally. Some consumers in online forums write that the generic has not worked as well. But there is no scientific evidence or study to explain or support these personal reports. Others mention more or different side effects. There may be some validity to this. Pharmaceutical companies are always looking to reduce side effects. Perhaps the latest version has a new twist that is enough to make it easier for your loved one to take. With no generic version available, this brand-name update might be worth the extra cost.

Consult with the doctor or pharmacist if you are considering a switch.

Worried about the high cost of medicines?
You are not alone. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice hear the concerns of many families around this issue. To explore cost-saving options, give us a call at 1-800-897-3052, toll-free.

Keep calm and stay in balance

This is a time of great uncertainty. It’s natural to feel a wide range of emotions, including fear, anxiety, confusion, or loneliness. It is also a time to take extra care to address your feelings and keep them from paralyzing or overwhelming you.

Get the facts. Our emotional responses come from the part of our brain that specializes in survival and gives us extra energy to fight or flee. Very useful! But we need the thinking part of our brain to take charge and analyze the facts for a balanced, healthy perspective. Use reliable sources of information, such as the Centers for Disease Control ( and your local health department (

Give yourself a sensible media diet. Limit the amount of time you consume news each day. Avoid sensational sources that concentrate on what’s going wrong. Feed yourself information that is empowering (what you can do). Verify anything you hear on social media, even from friends.

Focus on what you can do. We are most afraid when things feel out of control. While a global pandemic may feel overwhelming, we do have tremendous power to limit this virus with simple, individual actions, such as handwashing and social distancing.

Stay safely connected with friends and family. It’s good to share your feelings. AND make sure to talk about topics besides Covid-19. If you are “sheltering at home,” use the phone, texting, email, and social media to stay connected. If you have access to FaceTime, Skype, or Google Hangouts, use them! Video visiting is a good alternative to in-person interaction.

Take care of your body. Eat wisely and pay attention to getting good, sound sleep. Avoid caffeine, which is anxiety producing. Take time to exercise, and spend time outdoors. Even “shelter-in-place” communities encourage walking outdoors. Just maintain social distancing of at least 6 feet from others. Keep up with your medications, especially those for depression and anxiety. Avoid increased use of alcohol and recreational drugs.

Replenish your spirit. Prolonged stress has been shown to compromise the immune system. What do you usually do to manage stress and lift up your spirits? Find time to invest in your mental health—and your resistance to viruses—by specifically scheduling activities that help you feel calm and grounded.

Get professional help. If you find you are overwhelmed by your feelings and unable to function very well for 2­–3 days, seek professional help. If you don’t know who to turn to, contact the Disaster Distress Helpline: 1-800-985-5990 or text TalkWithUs to 66746. (TTY 1-800-846-8517)

Can we support you?
At Iowa City Hospice we are the Iowa City, Muscatine and Cedar Rapids experts in family caregiving. We also understand the public health system and are adept at finding solutions. If you are worried about your loved one, give us a call 1-800-897-3052, toll-free.

Does Dad “saw logs” all night?

If your loved one snores, this may be a sign of “sleep apnea.”

All snoring jokes aside, sleep apnea is a serious condition that deprives the brain of oxygen. A person with sleep apnea goes without oxygen for at least 10 seconds, five to 30 (or more) times an hour. It happens because the soft tissues of his or her airways collapse and stick together, blocking air. 

What should be restful sleep time is instead mini-suffocations and a nightlong struggle to breathe.

Sleep apnea is more common in men than in women. Aging is a big risk factor. So is nighttime alcohol consumption. Both cause the soft tissue of the airways to lose tone and collapse. Obesity, smoking, and allergies are also contributors (all three narrow the airways).

Sleep apnea has multiple potential consequences.

  • Type 2 diabetes. The chronic nightly jolts to the nervous system affect the body’s blood sugar control.
  • High blood pressure. Sleep apnea is estimated to be a factor in 38,000 deaths from heart-related problems each year. The risk of heart disease increases by 30% and risk of stroke by 60%.
  • Earlier onset of dementia. Those with sleep apnea appear to develop dementia as many as 10 years earlier than their full-breathing peers.
  • Depression, foggy thinking, and irritability. Quality of life definitely goes down when you don’t get a good night’s sleep.
  • Car accidents. Daytime fatigue seems to result in a 2.5 greater risk of falling asleep at the wheel.

Just because sleep apnea is more common in men does not mean that Mom is immune.

If either parent snores, wakes up with headaches or a dry mouth, complains of daytime fatigue, or has trouble with fuzzy thinking or irritability, talk to the doctor about a sleep apnea test. There are more than a few logs at stake.

Concerned about a loved one’s snoring?
At Iowa City Hospice we know that snoring is a condition all too often dismissed. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we can help you make the case and encourage testing and treatment. Give us a call at 1-800-897-3052, toll-free.

Caring for a loved one with COVID-19?

What we know so far is that COVID-19 is spread much like the regular flu—through coughs and sneezes that put droplets in the air and on surfaces. It may be 2–14 days after exposure before a person has symptoms. That means people can spread the virus without knowing it. And many have symptoms that seem much like a cold, so they don’t think to alter their behavior.

The good news is that 81% of those who get COVID-19 seem to have a fairly mild case—between a cold and the seasonal flu. But 14% of those infected have a severe case, involving pneumonia and low blood oxygen levels. About 5% have a critical case involving respiratory failure, septic shock, or multiple organ failures.

So far it appears that only 2%–4% of those who get COVID-19 actually die. Scary as that sounds, bear in mind that means 96%–98% recover fully. Just like the seasonal flu, frail older adults and persons with respiratory problems, such as COPD, are hit the hardest.

The signs of COVID-19

  • Fever
  • Cough
  • Shortness of breath

Call the doctor before you go. The doctor’s office will guide you concerning the need for an office visit. Ask about suggestions for relieving symptoms and guidelines for calling 911.

If someone in your household is sick

Do not leave home except for medical care. The entire household is now contagious.

Care at home

  • Follow viral prevention strategies. (See tips below.)
  • Employ the doctor’s recommendations to improve breathing, reduce fevers, and ease discomfort.
  • Monitor your loved one’s symptoms. If you need to call 911, tell them your concerns about COVID-19.
  • Isolate the patient from others in the house. He or she should stay in a separate room, ideally with a separate bathroom.
  • Wear facemasks—both you and the patient—when in the same room. Throw disposable facemasks away. Do not reuse.
  • Use disposable facemasks and gloves when you touch or have contact with the patient’s blood, stool, or body fluids such as saliva, sputum, nasal mucus, vomit, urine. Throw out the disposables after using them. Do not reuse.
  • Avoid sharing household items with the patient, such as dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items. Wash these items thoroughly after use.
  • Clean laundry thoroughly. Immediately remove and wash clothes or bedding that have blood, stool, or body fluids on them. Wear disposable gloves while handling soiled items and keep soiled items away from your body. Use normal detergent and set the dryer to the highest appropriate temperature.
  • Place all used tissues, disposable gloves, and facemasks in a lined container. Tie off before placing in the trash.
  • Isolate pets from the patient. At this time, it is not known if domestic animals can contract COVID-19.
  • Turn away visitors who do not have an essential need to be in the home.
  • Monitor your own symptoms. Have a Plan B for who will care for you and the patient if you become sick.

Viral prevention strategies

Because there is no cure for COVID-19, your best protection is to follow these guidelines put out by the Centers for Disease Control and Prevention (CDC).

  • Avoid close contact with people who are sick (stay at least 6 feet away).
  • Avoid touching your eyes, nose, and mouth.
  • Stay home if you feel unwell.
  • Cover your coughs and sneezes with a tissue. Throw tissues away immediately. Do not let them collect on tables or chairs around the house or at work.
  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom, before eating, and after blowing your nose, coughing, or sneezing. Be sure to clean the backs of your hands as well as the palms. Also clean between your fingers and under your nails. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol.
  • Clean and disinfect frequently touched objects and surfaces such as tables, countertops, light switches, doorknobs, cabinet handles, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables. Use a household cleaning spray or wipe. Follow instructions for safe and effective use of the cleaning product, including precautions to take such as wearing gloves and making sure you have good ventilation while using the product. If you do not have cleaning spray, make a solution of household detergent and water.
  • Facemasks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others. People who are well do not need to wear a facemask unless they are in active contact with someone who is sick.

Dad can’t brush his teeth

Is dementia making oral care difficult?

Unfortunately, this isn’t a task to let go. Poor mouth care leads to cavities and gum disease, and then to toothaches, sore gums, and a disinterest in food. It can also contribute to a deadly infection, “aspiration pneumonia.” Even if the person you care for is no longer eating, bacteria in the saliva slip down the throat into the lungs.

Toothpaste and brushes

Avoid fluoride toothpaste. And mouthwash. These are not healthy if swallowed. Instead, use just water or a baking soda–based toothpaste. For a better grip, look for a large-handled toothbrush or use an electric one.

Tips for brushing teeth

  • Prepare their toothbrush for them.
  • Model tooth brushing. Put your toothbrush in your mouth. See if they can follow along. If not, have your loved one sit while you sit or stand behind them. Put your hand on top of theirs to help them brush. Explain each step as you go.
  • Try to also brush his or her tongue and the roof of the mouth. Mucus here can harbor harmful bacteria. (Even people with dentures need to have their gums and tongue—and dentures—cleaned.)
  • Rather than cleaning teeth in the bathroom, consider sitting at the kitchen table with a bowl and water. It’s a friendlier, more spacious room. You might add calming music or a special toy to hold.

If brushing doesn’t work

Don’t force your relative. Try just wiping the teeth and gums. A cotton swab, a “toothette” (sponge on a stick), or a cloth wrapped around your finger and dipped in water can be very effective. Use this approach only if you are sure your loved one won’t bite! Call the dentist for further ideas if none of these works.

Is basic hygiene a challenge?
If so, give us a call. At Iowa City Hospice, we have a lot of experience working with people in the advanced stages of dementia. You don’t have to do this alone. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we can guide you to get the help you need. Phone us at 1-800-897-3052, toll-free.

The myth of self-reliance

As a society, we value independence. The self-sufficient super-achiever. When it comes to family caregiving, however, this mind-set can backfire, resulting in stress and burnout for you, not to mention greater risk for your relative. (Imagine if something happened to you and no one else has really been part of the team, sharing the tasks!) 

Your mind may be the culprit. When you think about asking others for help, does your mind immediately come up with reasons why they can’t? Those are thoughts and beliefs trapping you, not reality or facts. It is time to question your assumptions.

Liberate yourself
For each obstacle statement your mind produces, challenge your limiting thoughts with alternate possibilities:

  • “They are too busy.” This is an assumption. I won’t know until I ask.
  • “I should be able to do it all.” The situation is more than anyone could foresee or do alone. It’s reasonable to ask for help.
  • “I’m emotionally the closest.” That may be; however, that doesn’t mean that others don’t have a role to play. It is an opportunity for them to learn and participate, and also for the person I care for to have greater security and feel supported by more than just me.
  • “They live too far away.” Even if they can’t help with hands-on activities, there are other ways they can contribute that will make my load lighter.
  •  “It’s more work to teach them than to do it myself.” That’s true at first. But then they will know how and can do it again. This is a vote for the long haul.
  • “They won’t do it right.” I can teach them. And maybe it’s okay if it’s not perfect (the way I would do it).
  • “They don’t want to help. If they did, they would have already.” This is an assumption. They won’t know what’s needed or how to help unless I express the need.

Do you have trouble asking for help?
As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice see this often. A dedicated family member who just can’t bring themselves to ask other relatives to pitch in. Sometimes it’s easier to turn first to someone outside the family. No history. No baggage. Give us a call at 1-800-897-3052, toll-free. You don’t have to do this alone.

Early signs of heart failure

Too often, older adults assume that fatigue and trouble breathing are just a natural part of aging or being out of shape. They aren’t. In fact, these can be early signs of heart failure.

Heart failure means the heart is having difficulty pumping effectively. As a result, fluids build up, especially in the lungs and lower body. This makes it harder for necessary oxygen to get to all the cells. In a vicious cycle, the heart becomes overworked and enlarged trying ever harder to circulate more oxygen.

Catching symptoms early is key to engaging treatments that prevent this condition from getting worse. A visit to the doctor is in order if you notice the symptoms below. 

Check for “F-A-C-E-S”

  • Fatigue. Tiredness and lack of stamina.
  • Activity limitation. Inability to do usual tasks without becoming tired or out of breath.
  • Congestion. Coughing and wheezing may be a sign that the heart and lungs are building up fluid.
  • Edema. Edema is swelling in the ankles, legs, and abdomen. It can be a sign that the heart is not pumping at full strength.
  • Shortness of breath. Fluid in the lungs can make it difficult to exhale and inhale fully. This results in shorter, quick breaths that are much less effective.

It may not be heart failure, but testing is advised. The doctor may order blood work and an ultrasound to see the heart in action (echocardiogram).

Depending on the severity of any damage in the heart, treatment may include medication, surgery, or devices that assist the heart.

There are lifestyle changes, too, that can help prevent further damage: Quitting smoking. Monitoring weight. Restricting salt.

Also ask the doctor or pharmacist about over-the-counter medicines. Certain pain relievers, cold remedies, and heartburn drugs are especially hard on the heart. And herbs such as green tea, ginseng, or St. John’s wort can interfere with heart medications.

Does your loved one seem tired and out of breath?
We at Iowa City Hospice can help you work with your relative to pace activities and encourage lifestyle changes that support heart health. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we can help you, too, through this journey. Give us a call at 1-800-897-3052, toll-free.


Caring for your marriage, also

With Valentine’s Day on the horizon, it’s a good time to consider strategies to prevent your partner from getting overlooked because of your caregiving.

Caring for an aging relative definitely affects your ability to nurture your significant other. A poll at revealed that 81% of family caregivers say caregiving tested their marriage in ways they never imagined.

In that light, we draw upon suggestions of family caregivers and the research of noted couples counselor Dr. John Gottman to suggest ways to maintain the health of your marriage as you care for the health of your aging loved one.


  • Review family values and goals. Establish a sense of shared purpose. How does eldercare fit with your values? Having a shared vision makes it easier to accept inconveniences.
  • Discuss fears, concerns, and expectations. You and your partner may have strong memories and assumptions based on watching your parents care for—or not care for—your grandparents.
  • Show interest when your partner shows signs of stress. Demonstrate that his or her emotional and physical needs are also a priority.
  • Stay positive. Even when there are problems between you, notice and point out the good things.

Time together

  • Set aside time for your partner. Whether it’s a walk, a movie, a weekend away, make sure to have fun together. Consider date nights, just the two of you.
  • Make it quality time. Pay attention to your partner. Be “present” for your moments together. No talking about your caregiving!
  • Avoid discussion of marital problems. Separate your problem-solving time from time together spent nurturing your relationship.

This Valentine’s Day consider starting a tradition of getting together weekly, just the two of you, for some light fun. Help yourselves remember why you became a couple in the first place.

Is caring for your loved one affecting your marriage?
As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice speak from experience: Even though your parent was crucial to your past, you also need to nurture your relationship as it is your future. Give us a call at 1-800-897-3052, toll-free. Let us help you find a balance.

When is your loved one “too isolated”?

When caregiving draws us closer to a family member’s routines, we’re sometimes surprised by what we find. Perhaps you’ve noticed that Dad only leaves the house once or twice a week.

Social isolation has been shown to be a risk factor for many conditions. Depression. Heart disease. Obesity. Dementia. Should you be concerned? Not necessarily.

Although 28% of older adults live alone, not all of them feel lonely. Similarly, a person may be surrounded by others but still feel isolated. Before becoming alarmed, consider if your loved one is an extrovert or an introvert.


  • like to be out and about in the world
  • get energized by doing things with others and often initiate activities
  • like to “think out loud” about decisions and want others’ feedback
  • find routine, such as solitary housework, unappealing


  • are naturally quieter and keep thoughts to themselves
  • enjoy an active inner world
  • get energized by contemplating ideas and memories
  • like people but typically have a few close friends rather than a big social circle

Mom may have always been an introvert and happily so. A solitary lifestyle is only a problem if your loved one wishes things were different. Is your loved one’s pattern in later life different from their earlier pattern? Common causes of isolation include death of a partner, friends getting sick or moving, loss of a driver’s license, or increased difficulty getting around.

More important than having become isolated is whether your relative seems distressed by the change. He or she may or may not talk openly about feeling lonely. But depression from loneliness may show itself in other ways. Confused thinking. Irritability. Loss of appetite. Or difficulty sleeping.

If loneliness is a concern, consider making social activity a higher priority. And ask the doctor to do a depression screening. The hazards of stressful isolation are too risky to ignore.  

Is loneliness a concern?
If so, give us a call at 1-800-897-3052, toll-free. As the Iowa City, Muscatine and Cedar Rapids experts in aging well, we at Iowa City Hospice are quite familiar with the issues that lead to distress and depression. Let us help you come up with a plan.

Immediately after a death

Upon a loved one’s last breath, you may find yourself a little disoriented. Respect that otherworldliness. Families often just sit in silence for a while. Or share chuckles and sweet memories, tears and hugs. There is no need to rush to call the funeral director. A body can safely remain at home—or in a facility’s bed—for several hours.

Two things to do immediately

  • Write down the time of death. This is essential for a death certificate.
  • If your loved one is an organ donor, follow the instructions of the institution involved. Time is of the essence.

Within the first 30 minutes

  • Close the eyes and straighten the limbs. (Before the joints start to stiffen.) Place a rolled towel under the jaw to keep the mouth closed.
  • Call hospice if your loved one is enrolled in this service. 
  • Call 911 unless you are already in a facility or working with hospice.

Before you call the funeral home. Contact those who might want to pay last respects. You may want to wash or dress the body. If there are after-death faith traditions, contact clergy to come perform those rituals.

Call the funeral home only when you are ready for the body to be taken. They will come fairly quickly and things will move very fast. This call is the first step into your new life without your relative. Say your final goodbyes before they come. You may or may not want to witness the body’s removal in a body bag.

Once the body is gone

  • Divide up the phone calls. Split the list so you call only those friends and relatives who were closest. Others can contact more-distant relations.
  • Provide for dependents. If your loved one tended to someone else, make interim arrangements until a long-term plan for their care is mobilized. This goes for pets, too.

Is the death of a loved one in your near future?
You don’t have to go through this alone. Give us a call at 1-800-897-3052, toll-free. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice can help your loved one stay comfortable through the end, and help you prepare. Let’s start the conversation.