All posts tagged: safety

How to Safely Lift and Transfer Elderly Adults

When lifting, moving, and assisting elderly adults, you need to use good and proper “body mechanics” to reduce the likelihood of injury to yourself or the other person. Follow these tips to make sure you are safely and correctly moving transferring people.

Proper Body Mechanics When Moving Elderly Adults

Stand with your hold head up, shoulders back, chest high, and back straight. Place your feet hip-width apart. Shift so one foot is in front of the other. With your knees bent, lift using leg muscles rather than pulling with your arms. Do not turn from the waist. Do not reach out when lifting. Allow the person you are assisting to do as much of the moving as possible  

Proper Moves to Turn or Position Reclining Elderly Adults

When moving a person reclining in bed, be aware of your competencies. Communicate with the adult as much as possible as you move around the room and position yourself and the person. First, always wash your hands. Provide as much privacy as possible. Remove pillows from under the older adult’s head Have the older adult bend both legs and put feet on the bed. Ask the person to push down with his/her hands and feet, to help move toward the top of the bed on a count of three. Allow the older adult to do all or most of the work. Pulling the person with your upper body is likely to cause injury to yourself or the elderly adults. Ensure that the older adult has enough room to roll. If needed, have the person bend both legs and put feet on bed to allow them to assist with scooting over. Ask the older adult to help perform the roll by reaching in the direction of the roll. If the older adult’s legs are bent, it will make the roll easier. Put one hand under the older adult’s shoulder. Put the other hand on the older adult’s hip, then gently roll the older adult toward the other side of the bed. Make sure the older adult is comfortable.  

How to Safely Transfer an Older Adult from Bed to Wheelchair

When lifting a person from a bed, be aware of your abilities and limits. Communicate clearly with the person as much as possible as you position yourself and them. First, wash your hands thoroughly. Always make provisions for privacy. Bring the wheelchair close to the bed, positioned so that stronger side of the older adult is closer to the chair you’re moving to. A cushion is best for comfort for most elderly adults when sitting in a wheelchair. Fold the wheelchair’s footrests out of the way. Use proper body mechanics while assisting the older adult to move. A gait belt or pants belt will give you the most control when you’re assisting an older adult to stand. Pulling on someone’s arms during a transfer may cause injury to the adult’s joints or bones. Ask the elderly adult to push up from the surface they are standing from on the count of three ensure the older adult uses their gait device as part of the transfer

Use of Assistive Technology and Specific Adaptive Equipment like Mechanical Lifts

Make sure to have a therapist or equipment company demonstrate the specific lift to you first, so that you will understand the safety steps involved. Position the wheelchair so that there is room to turn and move the lift. Ensure that the wheelchair’s brakes are locked. Always look for obstacles or objects which could cause injury if elderly adults bump into them Explain what you are going to do, so that the person knows what to expect. Move slowly while turning an adult in a lift, to minimize risk for injury and to allow time to spot potential hazards.

How to Assist Elderly Adults with Walking

Ensure that supportive footwear is in place. Discourage slippers or sandals which are not strapped around the heels. Always utilize a gait device, if recommended by a doctor or therapist. Position yourself alongside the person’s weaker side. Use a gait or pants belt if the older adult is not fully steady. Make sure to have the elderly adult turn fully and back up before attempting to sit. Encourage the adult to reach back with one or both arms before sitting.   Making sure that elderly adults are as mobile as possible is a huge part of being a great caregiver. It’s important to keep everyone safe during any process of moving an adult from one position or location to another. Always remember that safety comes first.    

CareAcademy offers online classes to help professionals and family learn to prepare for all aspects of personal care for elderly adults.

Madhuri ReddyHow to Safely Lift and Transfer Elderly Adults
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How to Spot Changes in Older Adults

Caregivers for older adults need to understand when and how to get assistance. In particular, non-medical caregivers should be clear on when to refer to a registered nurse, and when to call 911 in an emergency.

Identifying Changes in an Older Adult’s Condition

When you are a caregiver, things can happen any time and you always need to be prepared with a plan of action in case of emergency. The older adult may stop breathing, have a heart attack, stroke, a diabetic complication or other physical or mental emergency.
If you ever feel that the older adult or you are in any immediate danger, you need to call 911.
You may also consider completing a first aid or CPR course, which can be enormously helpful.

Early Identification is Key to Best Response

Early identification of changes in an older adult’s daily routines, behavior, ways of communicating, appearance, general manner or mood, or physical health can save his or her life. When you have spent time with a person, you get to know what is normal and usual for them, and you will be able to tell when something has changed. Some of the changes you can observe yourself, and others the older adult themselves will complain of.
What is most important is a CHANGE in the patient’s condition, or something different than usual.  
Look for changes in their functional ability, body, mental status and environment.

How to Spot Physical Changes in Older Adults

For physical changes, you should first ask yourself:   Are there any changes to any part of the older adult’s body that you notice? Physical changes in older adults to pay attention to include:
  • Overall: fever, lethargy (tiredness), chills
  • Head & Neck: headache, stiff neck, dizziness
  • Skin: redness, swelling, cuts, rash, new numbness or tingling
  • Eyes: redness, drainage, swelling, reports of pain or burning
  • Ears: pulling at the ear,ringing in the ears, diminished hearing, drainage, dizziness or pain
  • Nose: runny discharge, rubbing the nose, congestion
  • Mouth & Throat: eating less, redness, white patches at the back of the throat, hoarse voice, fever, toothache, facial or gum swelling, bleeding, pain when swallowing
  • Muscles & Bones: limited mobility in a leg or arm that the older adult could previously move, stiffness, pain, limb out of alignment with the rest of the extremity, joint swelling
  • Heart & Lungs: chest pain, new or changing cough, shortness of breath, wheezing, new numb or cold hands or feet, swollen ankle
  • Abdomen: abdominal pain, nausea, vomiting, loose stools or diarrhea, constipation, blood in vomit or stools, painful or burning urination, changes in urine color
  • Women: new or changing vaginal discharge, itching, unusual odor, burning, bleeding
  • Men: discharge from penis, pain, itching, redness burning.

Paying Attention to Mental and Emotional Changes in Older Adults

For mental and emotional changes, you  should ask yourself the following questions: Does the older adult appear to be “himself” or “herself”? Has their ability to communicate change? Have they lost interest in taking care of themselves or doing any activities they previously enjoyed? Has their mood changed and do they want to be alone more? Mental & Emotional changes in older adults to pay attention to include:
  • Overall attitude: An older adult who is usually very friendly becomes quiet and to themselves; an older adult who is usually very talkative suddenly wants to be alone more.
  • Behavior: an older adult who is usually calm is more irritated or aggressive than usual.  It could also be the opposite – they may become less active than usual.
  • Ways of communicating: an older adult who usually is talkative stops talking; speech becomes garbled or unclear; the older adult doesn’t seem to understand you, but they usually do.
  • Relationships: The older adult may act distant or afraid when certain family members, visitors or professional caregivers are around.
Changes in the older adult’s home environment to pay attention to:
  • Finances: see if their are any obviously unpaid bills, utilities cut off, and if there is sufficient food available.
  • Cleanliness: Ensure the older adult is able to continue their previous level of housekeeping chores
  • Home maintenance/safety: See if there are any repairs that need to be done that could cause a health or safety hazard.

Top communication skills help caregivers give better care. Check out our online course for Communicating with Older Adults.

Madhuri ReddyHow to Spot Changes in Older Adults
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Senior Care Home Safety Tips to Prevent Falls

As a family caregiver or professional senior care provider, you need to know about how to make any environment safe for the person in your care.

Preventing Falls is a Big Part of Senior Care

Take a look at the environmental safety tip-list we’ve put together for every room in your house. Here’s all the ways we recommend senior care givers prevent falls around a home.

Living Room Safety Tips

Problem areas for falls in this living room include:
  • cords that run across the floor
  • slippery hardwood floors or tiles
  • carpet edges, throws, or rugs that are not secured to the floor
  • sofa or chair that is at an improper height
Prevent falls in the living room
  • Remove clutter, and rearrange furniture to have a clear walking path.
  • Keep mops, brooms, sponges, or other cleanup tools accessible within reach to wipe messes from the floor
  • Either remove throw rugs completely, or tack them down to ensure they don’t slip.
  • If the coffee table is too low, remove it. A coffee table should be at a comfortable height to use while sitting on a chair or sofa.
  • Make sure couches are not too low and enables them to access transfer pole to assist with sitting and standing.
  • Make sure that items the patient commonly uses (the phone, eyeglasses, remote control) or within reach when you leave.
  • Sofas should have armrests to support the individual while standing up.
  • Proper height of a sofa or chair means that the older adult can sit on the edge with both feet resting comfortably on the floor. A sofa or chair that is too high or too low can result in a fall when an elder is either trying to get down on the chair or trying to get up.

Senior Care Professional’s Safety Tips for Steps and Staircases

Even though the bathroom is the most common place for falling in the home, the stairs are the most common place for serious injury from a fall. Several areas on these stairs are common risk factors in most homes:
  • Lack of handrails
  • Low or lack of lighting
  • Poor carpeting, hanging edges
Prevent Falls on the Steps or a Staircase
  • Install handrails on both sides of the stairwell. Handrails should be round to ensure good grip. Rails should extend beyond the last step to help the older adult recognize they are on solid ground.
  • Remove any stair runner rugs
  • Fix broken steps or coverings.
  • Convince the older adult to move their bedroom to a room on the first floor.  This minimizes the threat of suffering a fall by– for instance – walking up or down a flight of stairs in the dark, or even using stairs while exhausted and barely awake

Senior Care Truths & Myths About Preventing Falls

Here are a few practices that do not effectively prevent falls and may, in some cases, increase the risk:
  • Wearing socks that do not have a grip or shoes with no tread.  Instead, make sure the older adult is wearing proper shoes, even in the house. Shoes should fit well and have some non-slip tread on the bottom. Older adults should avoid going barefoot in the house, wearing shoes with a heel, or wearing slippers. Shoes that tie or have velcro to close stay on snugly and are ideal.
  • Wearing bifocals while on stairs.  This can also cause problems because bifocals can impair the eye’s ability to judge depth and detect obstacles. We recommend most older adults use single-lensed glasses while on stairs.
  • Hip protectors are hard plastic shields or soft foam pads usually fitted in pockets in specially designed underwear to provide padding on the hips. Hip protectors probably reduce the risk of hip fractures in older people living in nursing homes, but unfortunately have not been shown to reduce hip fractures in older people that live at home.

Additional Locations for Falls

Quality senior care also involves attending to two additional locations in the home where falls frequently occur:
  • Transitional Areas:  Fall injuries occur frequently at the edge where the carpet meets the floor. These so-called “transitional areas” are often at different heights or textures and may pose a problem for the rubber tips of canes or crutches.  Transitional areas also frequently occur in areas where there is a difference in lighting.
  • Car:  It is actually very common for older adults to fall when getting out of a car.  Why?  Well, car seats are usually soft, cushy and low to the ground. This can make it hard for an older adult to get up from sitting in one. If this is the case, they should see a physical therapist.  Occupational therapists can help to assess other physical issues that can impede someone from using their car.

Professional senior care involves making every space safe for the adult you care for. Check out the CareAcademy online class for preventing falls in older adults.

Madhuri ReddySenior Care Home Safety Tips to Prevent Falls
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How to Make Your Home Safer for Seniors

If you need to make a place safer for seniors that you care for, follow these general guidelines for safety precautions and eliminating risks.

Potential Risks for Seniors in the Bathroom

The bathroom is the most hazardous room in the home for falls!  Most bathrooms tend to have:
  • Wet & slippery tub surface
  • Lack of support handles/grab bars in the tub or near the toilet
  • Slippery towels or rugs on floor
  • A low toilet, which makes it difficult for an older person to sit down and get up

Making the Bathroom Safer for Seniors:

  • Ensure that the toilet is at a proper height. When an older adult is sitting on toilet, it should feel comfortable. They may need a toilet riser placed if the toilet is too low.
  • Grab bars may need to be placed for assistance into/out of the tub and when using the toilet.
  • Use non-slip mats, and decals in the shower to prevent falls.
  • A shower chair and transfer bench may be really beneficial.
  • Encourage elders not to hurry to the bathroom, especially at night, as this can increase the chances of a fall. For men who urinate frequently at night, consider offering a urinal near the bedside to avoid frequent bathroom trips.
  • Encourage the use of a night light. Ensure proper lighting between the bedroom and bathroom.

Potential Risks for Seniors in the Kitchen

Notice the following risky areas that are also common in many kitchens. Remember – we are talking about someone who may be a little off balance to begin with. But it’s simple to make any kitchen safer for seniors. Look for:
  • Shelving that is too high to reach or too low to bend over
  • Slippery floors
  • Unstable stools/chairs
  • Unsecured rugs

Making the Kitchen Safer for Seniors:

  • If mats are used in the kitchen, ensure that they are non-slip
  • Keep mops, brooms, sponges, or other cleanup tools within reach to wipe messes, so no unnecessary reaching has to take place and so any wet areas can be cleaned up quickly
  • Never use chairs with wheels in the kitchen. And always ensure the chairs have arms.
  • Make sure the kitchen table and chairs are sturdy, stable, and not too high or low.
  • Make sure shelves are between shoulder and waist height.
  • Encourage elders to ask for help when things are out of reach.

Common Hazards for Seniors in the Bedroom

Even bedrooms can have some problem areas. For example:
  • Poor lighting
  • Clutter
  • High bed
  • Walking aids, telephone or other necessary items (eg. glasses) that are out-of-reach

Making the Bedroom Safer for Senior Citizens:

In any bedroom, check a few simple things to make sure that the room is safe for adults of all ages.
  • Make sure no loose cords are laying across the floor.
  • Keep the area neat and free from clothes on the floor.
  • Encourage the use of night lights. Lighting is very important all over the house. (Imagine a sleepy older adult walking around in the middle of the night – they are more likely to fall if they can’t see well.)
  • Check for proper bed height. When sitting on the edge of the bed, both feet should be on the floor.
  • Ensure the nightstand is within arm’s reach.
  • Ensure walking aids such as canes and walkers are within reach of the bed.
  • Make sure that items the person commonly uses (the phone, eyeglasses, remote control) are placed within their reach when you leave.

Safety Risks for Seniors in a House’s Hallway

In a hallway, issues that can lead to falls include:
  • Poor lighting
  • Clutter
  • Cords that run across the floor
  • Carpet edges, throws, or rugs that are not secured to the floor
  • Obstacles such as lamps or furniture

Making the Hallway Safer for Elderly Adults:

  • Ensure lighting is proper and high wattage.
  • Rearrange any furniture so that it is not in the walking path for an elder.
  • Make sure no loose cords are laying across the floor
  • Secure throw rugs or carpets, either by nailing them down or using non-slip backing underneath the rug.
  • Consider installing handrails for balancing

Eldercare professionals are responsible for keeping environments safer for seniors. Find out more with online eldercare classes from CareAcademy.

Madhuri ReddyHow to Make Your Home Safer for Seniors
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Personal Safety & Managing Aggressive Behavior

  Caregivers need to learn about keeping themselves and the older adult safe while in their care. In today’s blog,  we will discuss personal safety  and what to do when managing aggressive behavior from an upset adult.  

Managing Aggressive Behavior

  You may be involved in situations where the older adult, particularly if they have cognitive impairment, becomes verbally abusive or combative.  These can be very difficult and stressful situations for you and the older adult. Here are three key tips on how you can manage these situations:

1 – Don’t use force.

It can often backfire. Physical restraints should not be used indiscriminately.

2 – Stay calm, quiet, and rational.

If you allow the person to verbally express their anger, the possibility of physical violence can be avoided many times. Try and remember that the person who is acting aggressively is not doing so to harm you. They are trying to protect themselves. Don’t give them another reason to feel threatened. Act calmly and composed, even if you don’t feel that way. Never shout or yell or try to grab or hold the older adult. This will only escalate the situation.

3 – Take personal safety precautions.

When an older adult is out of control, your primary concern when managing aggressive behavior is safety. Remember, violent behavior is usually not planned and may not be under their control. To help make sure that everyone is safe, you should:
    • Get something such as a table between you and the aggressive older adult.
    • Try to get any potential weapons out of reach.
    • Call for extra help if you need it.

Specific tips on how to alert someone about what has happened.  

If you are a family caregiver, be sure to tell the older adult’s health care provider once the situation has been handled. If you are a professional caregiver, tell your supervisor. If you feel threatened in the moment, call 911.  

Personal safety and managing aggressive behavior can be vital as an eldercare professional. Learn how to be prepared for any emergency. Register for an online course.

Madhuri ReddyPersonal Safety & Managing Aggressive Behavior
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Senior Abuse: What Signs to Look For

1 in 10 seniors are abused – so chances are you as a caregiver have met at least one.

As a Geriatrician (an MD that has special training in the care of people over the age of 65 years), senior abuse is something that I am sorry to say I have seen more than once. The victims are by definition a vulnerable population, who in some cases lack decision-making ability due to Alzheimer’s or other dementia, and/or have put their trust in someone who takes advantage.

In children, we may be more on alert to the signs of abuse – bruises that shouldn’t be there, strange behavior – but when we see the same in a senior, we are more likely to think of medical issues – they probably fell, they are just confused. Seniors with Alzheimer’s or other dementia are at the highest risk of being abused. It important for a caregiver to have a high degree of suspicion when you see certain important signs, so you can call the proper authorities in a timely way.

As a caregiver, you can help a vulnerable person just by knowing what to look for. As they say – if you see something, say something. Call your state’s Elder Abuse Hotline immediately.

Do you know exactly what Senior Abuse (also called Elder Abuse) looks like? What should you, as a family member, friend or caregiver be on the lookout for?

There have been numerous attempts to define senior abuse, which has sadly been documented for thousands of years. Over the last 10 years, though, there have been several improvements in medical research on senior abuse that have taught the medical community quite a lot. For example, financial exploitation has been noted recently to be practically an epidemic in our society.

In long-term care (otherwise known as nursing homes), studies have shown abuse of older residents by other residents. In fact, this is more common than physical abuse by the nursing home staff caregivers.

There are 5 main types of senior abuse (elder abuse):

  1. Physical abuse – carried out with the intention to cause bodily injury. The signs a caregiver should look out for: You might notice bruises, use of restraints, burns, multiple injuries in various stages of healing.
  2. Psychological or verbal abuse – carried out with the intention of causing emotional injury. The signs a caregiver should look out for: You might notice  a caregiver/family member yelling, threatening or signs of intimidation such as preventing the older person from seeing someone they wish to see.
  3. Sexual abuse – nonconsensual sexual contact. Commonly, a resident in a long-term care facility with dementia may in fact assault another resident who may or not have dementia. The signs a caregiver should look out for: This is hard to notice unless you care or know the person intimately, but signs of sexual abuse are similar in older adults as they are in younger adults.
  4. Financial exploitation – misappropriation of an older adult’s property or money. The signs a caregiver should look out for: You may notice weight loss without a medical cause, firing of home care by the abuser, inability to pay for medicine.
  5. Neglect – the failure of a caregiver to meet the dependent older adult’s needs. The signs a caregiver should look out for: You may notice malnutrition, poor hygiene, pressure ulcers, confusion. Neglect may be intentional or unintentional.

Of course, sometimes it is the primary caregiver themselves who are abusing a senior. If you are a caregiver feeling overwhelmed, you need help . Providing care for a senior, particularly one that has Alzheimer’s or other dementia, is immensely difficult and you can’t do it alone. Call someone and tell them you need help – for example, your doctor, or the senior’s doctor. You can also check the Alzheimer’s Association and AARP websites for other caregiver resources and supports. Most importantly, do not suffer it alone. It is important to know that as a concerned caregiver, you play an important role in identifying a senior who is or has been abused. So keep a look out for the signs.

We’d love to hear any comments you have so far. Do you know or suspect any seniors that have been abused?



Lachs MS, Pillemer KA; Elder Abuse, N Engl J Med, 373;20 November 12, 2015
Madhuri ReddySenior Abuse: What Signs to Look For
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How to Find a Compatible Doctor For Seniors

An elder can easily get discouraged with all the research coming out about doctors for seniors. Doctors provide unrealistic prognoses, not discussing hospice, ignoring advance directives and generally setting the stage for a traumatic and painful death. Not all doctors will disappoint you in your elder years, you just have to know how to find the right doctor for seniors. This article comes in praise of physicians who put the “care” in healthcare. As I write this blog, I think of icons such as Dr. Timothy Quill, who wrote A Midwife Through the Dying Process, and all those who came under his magnificent mentoring. I think of the gentle doctor who sat at my mother’s knee and cried as he broke the news that her husband of 60 years was gone. I think of the researchers and practitioners at Dartmouth Medical School who lead an emerging “slow medicine” movement to put the brakes on aggressive, intrusive procedures for frail elderly. I think of those who know “truth” and “hope” are not mutually exclusive and a doctor’s job is to share both. Don’t despair; medical professionals such as those listed above ARE out there. There are many wise, forthright and compassionate doctors prepared to be your companion and ally. You will find them eager to offer cure, care and expert advice, but also willing to let you direct the last scene of your life, when it comes to that.

What makes the perfect doctor for seniors?

A positive upbeat declaration is a great starting point. Share that you feel healthy, you love life and you intend to savor its fullness as long as humanly possible. However, you also believe in preparedness, and you’d like to make sure the two of you would be on the same wavelength in an end-of-life situation. Interview Your Doctor: At Compassion & Choices, we often tell people to interview their doctor. The day you start wondering about end-of-life options is no time to discover your doctor’s values and beliefs don’t match your own. You might like some clues now to what your doctor’s approach might be later. What kind of questions would get your doctor to open up?
  • Doc, if I had an illness that looked pretty grim, how would you feel if I wanted to take a pass on the heroics and let nature take its course?
  • I wouldn’t want my family fighting over keeping me alive if I were in the condition of Terri Schiavo, with no chance of recovery. How would you handle a situation like that?
  • What if I were dying and really struggling with pain or other agonies? Would you prescribe enough pain medication and sedatives to keep me comfortable, even if it meant my life might be a little shorter?
Value Humility in doctors for seniors. Above all. Find a doctor who utters the words, “I don’t know” and you’ve found true gold. Happily, the time is gradually passing when the doctor’s only source of pride lies in “doing everything” possible to prolong life. Some also take pride in serving as midwife to a good death.

Share the Value of What Family Means: Find a doctor who cherishes the love and bond of families, whose greatest need at the end is for a little quiet time and the caress of their beloved. Treasure the doctor who might respond to a family asking that “everything” be done, in the way suggested ten years ago by Duke University physician David Pisetsky:

I would like to say, ‘Family, only you can do everything. Only you can talk of your love and give kisses before the skin is cold. Only you can talk of the future and of dreams to be fulfilled. Only you can talk of the past when life was resplendent because time seemed infinite. Family, only you can oppose the flow of time and enjoy one last day together. Only you can give peace and sustenance for the next journey. Family, only you can do everything. I am only a physician. I can do nothing at all.’

Take a stand in your end of life choices and help find the perfect doctor for seniors that you care for.  

Find out what it means to be a Professional Care Giver. Certifications for Eldercare from CareAcademy.

Barbara CoombsHow to Find a Compatible Doctor For Seniors
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The Three Best Ways to Prevent the Flu

We are in the throes of flu season now. This illness—a really, really bad cold along with fever and sometimes vomiting and diarrhea—can be not only miserable, but dangerous. Every year thousands of people end up in the hospital with complications, and some die. prevent the flu in eldersLuckily, there are things you can do to protect yourself and your family—and your community. This is an important point, because for some peers in your community the flu is especially dangerous. The very young, the very old and those with health problems that affect their immune system can get extremely sick with the flu. It may be true that you or your family members would weather the flu just fine—but your grandmother, your neighbor’s newborn, or the child at school being treated for cancer might catch it from you and not do fine. We need to work together to prevent the flu from spreading.

Three Ways that all of us can prevent the flu in ourselves and others:

  1. Wash your hands.This sounds so simple, but honestly, it makes a huge difference. The flu virus can be passed when sick people (who have touched their nose or coughed into their hands) touch surfaces or other people. Just washing your hands (with soap and water or with hand sanitizer which is easy to carry around) can stop you and others from getting sick.
  2. Stay away from sick people (as best you can)—and stay home when you are sick. During flu season, it’s fine to cancel a playdate if the playmate is sick, or ask about the health of others before inviting them into your home. It’s equally important that you not spread any germs you have; although missing work or missing school can be very inconvenient, if you are sick it simply isn’t fair to others to spread your germs.
  3. Get vaccinated. The flu vaccine—either the shot or the nasal spray—can be extremely helpful in preventing the flu. It’s not perfect—sometimes people still get the flu after getting vaccinated—but it cuts the chances substantially. The vaccine is safe and widely available from September (or earlier) until spring every year.
If you have any questions, talk to your doctor. And for more information on influenza and how to prevent the flu, visit www.
Claire McCarthyThe Three Best Ways to Prevent the Flu
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