Alzheimer’s Disease Communication Tips

September 13, 2018September 13, 2018
by Richard Chace

Coping with symptoms of Alzheimer’s disease or dementia can be difficult for everyone. Frustration when messages are not understood, a lack of awareness of time and place or a diminishing sense of self can lead to feelings of frustration, anger and fear by both the individual suffering from the disease as well as by the care giver.

Keep in mind that early-stage individuals with Alzheimer’s or dementia are often easily frustrated because they are aware of their limitations. As the disease progresses, those individuals may then experience every day as a new day, every person as a new face and every activity as a new experience.

Tips:

Introduce yourself. This does not have to be a formal introduction but by providing some context for your relationship as well as your name, it will help reduce anxiety and awkwardness in case you are not immediately recognized.
Treat the person with respect, like an adult, not a child. Although some symptoms of Alzheimer’s and Dementia may rob individuals of memories and knowledge of basic skills, they are still an adult and will likely be able to sense your mood and attitude.
Try to speak calmly, slowly and positively. Start your sentences on a positive note, such as “let’s do…” and then explain whatever it is you would like to do, rather than using a negative tone of “don’t do, or let’s not do….”
Use complete direct sentences to express yourself. For example, “Let’s sit on this bench for a little while and enjoy the view.”
Provide a few options if the individual is having difficulty making a decision. For example, an open-ended question, such as, “what would you like to eat for lunch,” may cause confusion or frustration. If that happens, try providing more specific choices, such as, “would you like tomato soup and a turkey sandwich or a small salad with grilled chicken and some chicken noodle soup for lunch?”
Validate, acknowledge and empathize feelings. Let the person know that it is okay to feel sad, upset, confused, lonely or whatever emotion they may be expressing. Everyone has emotions and being able to share them and feel understood may even help diffuse a difficult or overly emotional situation.
Give compliments, praise and cues to reinforce positive feelings, sense of accomplishment and independence. Depending upon your relationship, hugging and affectionate touches between you is also important and helps maintain both a physical and mental connection.

There are many resources available for anyone dealing with Alzheimer’s or dementia, starting with your family doctor. The Alzheimer’s Association, the National Institute on Aging and the National Alzheimer’s and Dementia Resource Center also provide a wealth of information.

If the time has come when you or your loved one can no longer live independently, please contact CalRegistry for help finding the best elder care options for your family.

Support Circle: Family Caregivers Share Stories And Tips To…

August 1, 2018
by Richard Chace

by Blake Farmer, Nashville Public Radio | Kaiser Health News

Vicki Bartholomew started a support group for wives who are caring for a husband with Alzheimer’s disease because she needed that sort of group herself.

They meet every month in a conference room at a new memory-care facility in Nashville called Abe’s Garden, where Bartholomew’s husband was one of the first residents — a Vietnam veteran and prominent attorney in Nashville.

“My husband’s still living, and now I’m in an even more difficult situation — I’m married, but I’m a widow,” she tells the group one day.

These women — who are roughly 50 to 75 years old — draw the shades and open up to each other in ways they can’t with their lifelong friends.

Vicki Bartholomew’s husband, Sam, has been at Abe’s Garden in West Nashville since it opened in 2015.

“They’re still wonderful friends, but they didn’t know how to handle this. It was hard for them, and as you all know, your friends don’t come around as much as they used to,” Bartholomew said. “I was in bad shape. I didn’t think I was — I did have health problems, and [now] I know I was depressed.”

As the number of Americans afflicted with Alzheimer’s disease continues to swell to an estimated 5.7 million, so do the legions of loved ones caring for friends and family members. The toll on Bartholomew’s own mental health is one of the reasons the Alzheimer’s Foundation of America focuses on the nation’s estimated 16 million unpaid caregivers.

With no cure on the horizon, the foundation has been highlighting the necessity of better support for those caregivers through a national tour. It stopped in Nashville earlier this spring, was in Milwaukee in June and heads to Fairfax, Va., in September.

At the live events, Alzheimer’s researchers and clinicians offer guidance on a number of topics, including how to ensure safety for patients at home, care planning and even how to entertain someone with memory loss.

The organization promotes in-person and telephone support groups, since being a caregiver is often a barrier to getting out of the house alone. Virtual support systems showed effectiveness at reducing loneliness, stress and depression in a small 2014 study.

“We have to do everything we can to educate a caregiver, to provide them with the best practices on caring for somebody,” said Charles Fuschillo Jr., the AFA’s CEO.

For example, the AFA recommends that family members:

Feed Alzheimer’s patients one food at a time. “A busy plate can be confusing,” the group says.
Mark rooms in the house with signs to avoid unnecessary confusion.
Remind a person with Alzheimer’s to use the toilet; don’t wait for them to ask.
When traveling, stick with familiar destinations.
Watch for a cough while eating; it can signal a swallowing disorder in people with dementia.
Schedule overnight stays at a memory-care facility so the caregiver gets some respite.

Just as important, Fuschillo said, “we want to do everything we can to avoid caregiver burnout.”

The breaking point sneaks up on even the most committed caregiver, say Alzheimer’s advocates, especially as the nights grow more sleepless. Alzheimer’s patients can tend to pace, or wake up their partner every few minutes. They can become violent. Or, perhaps worse, they can leave the house.

“And I’ve had some issues at night that I had to take care of alone,” Pam Hawkins, who cares for her husband with Alzheimer’s, said during a support session. “But I’m not ready to have anyone there at night.”

For now, she said, her husband usually sleeps all night. And if there’s a problem, her son-in-law is 15 minutes away.

She’s had to hire caregivers during the day. Knowing how to find and hire the right person is a shared concern by Alzheimer’s family members that inspired a checklist for navigating the process. Tips include these: Interview the aide in the home. Over-share information about the patient. Ask what kind of quality control a supervisor would provide.

Hawkins is adamant about keeping her husband at home, whatever the cost.

“He’s not going anywhere,” she said. “He’s staying at our home until he moves to heaven. We made that decision a long time ago.”

But many caregivers have no choice.

April Simpkins said tending to her husband became all-consuming, and she’s young enough that she still needs to keep her job; she works at a local university.

“It was not possible for us to keep Joe at home,” she said.

Simpkins found she’d often have to call her husband’s siblings to settle him down over the phone. One night, she had to dial 911 when he kept yelling in the hallways of their condo building.

And yet she felt some societal pressure that she wasn’t doing enough.

“There’s a lot of … glory given to the whole idea of someone being long-suffering and staying at home and giving up their life, basically, to care for their loved one,” Simpkins said. “It makes it harder for people who can’t do that.”

Everyone around the table nodded in agreement. Whatever stage of illness their loved one is experiencing, these caregivers understand the complicated existence that many have dubbed “the long goodbye.”

April and Joe Simpkins at Abe’s Garden, the Nashville memory-care facility where Joe moved as his Alzheimer’s advanced.

Along with sharing the sorrow, they find a way to share in the humor of it all — one woman said her husband wears a laundry-basket’s-worth of shirts and pants because he forgets he’s already gotten dressed. Even tips on how to reduce the odor from incontinence are offered with a loving laugh.

The support group ends with hugs. Some women head for the parking lot. Others buzz through the locked doors to see their husbands.

Simpkins, 54, sits down for lunch with Joe, who is a former state employee and a youthful-looking 66 years old. She drapes an arm around his slumping shoulders and assists him as he spears a cold strawberry with his fork.

“You know, there are some days,” she said, interrupted by a random reflection from Joe. “Yeah, some days are clearer than others.”

Simpkins tries to stop by to see her husband every day. But it’s a wicked kind of blessing, she said, that when she misses a visit, Joe no longer notices.

This story is part of a partnership that includes Nashville Public Radio, NPR and Kaiser Health News.

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

Hear Well and Stay Well

May 26, 2018September 13, 2018
by Richard Chace

Getting older comes with many challenges and hearing loss is one of the more common challenges. In addition to the frustrations associated with difficulty hearing, it may result in mental health issues, physical health issues and safety concerns.

Hearing loss can lead to:

Feelings of isolation, which may lead to depression
Balance issues, which may result in significant increase in risk of failing
Inability to hear environmental sounds and cues, which may increase safety concerns
Increased stress from struggling to understand

Therefore, it is important to keep tab on how well we can hear as we age. Age-related hearing loss happens gradually and typically occurs over duration of decade or more. Unfortunately, it is often unnoticed until it becomes significant.

Although it cannot be reversed, hearing loss is often treated successfully. It may also be easier for patients to adapt to hearing aids or other assistive devices the earlier hearing loss is discovered. The functionality and look of hearing aids and other listening devices have greatly improved over the years.

Signs you may be experiencing some age-related hearing loss are:

Difficulty following a group conversation
People often seem to be mumbling
Frequently asking people to repeat things
Trouble understanding women and children (they have higher voices)
Difficulty understanding conversations on the phone
Become stressed at or avoid large gatherings
Ringing in your ears
Experiencing dizziness, loss of balance or suffering from vertigo
Other people comment that your TV or radio is loud
Your ears itch, have pain or leak fluid

A family history of hearing loss, diabetes, heart disease and circulation as well as thyroid issues may also contribute to hearing loss.

If you or your loved on experience any of the warning signs mentioned above, consult your primary care physician to evaluate your symptoms and determine if you should see a specialist. Your doctor may recommend visiting one of the following specialists:

Otolaryngologist: A physician specializing in ears, nose and throat, more commonly referred to as an ENT doctor.
Audiologist: A health-care professional who specializes in identifying, treating (with hearing aids or other devices) and monitoring auditory disorders.
Hearing-aid Specialist: A licensed professional who can test hearing as well as select and fit hearing aids.

Your hearing is a major factor in your quality of your life, your health and your ability to remain independent. Having regular hearing check-ups is an important part of aging well.

If the time has come when you or your loved one can no longer live independently, please contact CalRegistry for help finding the best elder care options for your family.

The New Medicare Cards, Everything You Need To Know…

March 25, 2018June 19, 2018
by Richard Chace

In April, the government will start sending out new Medicare cards, launching a massive, yearlong effort to alter how 59 million people enrolled in the federal health insurance program are identified.

Historically, Medicare ID cards have been stamped with the Social Security numbers of members — currently, about 50 million seniors and 9 million people with serious disabilities. But that’s been problematic: If a wallet or purse were stolen, a thief could use that information, along with an address or birthdate on a driver’s license, to steal someone’s identity.

For years, phone scammers have preyed on older adults by requesting their Medicare numbers, giving various reasons for doing so. People who fall for these ruses have found bank accounts emptied, Social Security payments diverted or bills in their mailboxes for medical services or equipment never received.

The new cards address these concerns by removing each member’s Social Security number and replacing it with a new, randomly generated 11-digit “Medicare number” (some capital letters are included). This will be used to verify eligibility for services and for billing purposes going forward.

Such a major change can involve bumps along the way, so there will be a transition period during which you can use either your new Medicare card or your old card at doctors’ offices and hospitals. Both should work until Dec. 31, 2019.

If you forget your new card at home, your doctor’s staff should be able to look up your new Medicare number up at a secure computer site. Or, they can use information that’s already on file during the transition period.

“We’ve had a few people contact us and ask ‘If I don’t have the new card at a doctor’s appointment, does that mean my provider won’t see me?’” said Casey Schwartz, senior counsel for education and federal policy at the Medicare Rights Center. “That shouldn’t be an issue.”

Cards will be sent to people covered by Medicare on a rolling basis over a 12-month period ending in April 2019. Older adults in Alaska, California, Delaware, the District of Columbia, Hawaii, Oregon, Pennsylvania, Virginia and West Virginia will be the first to receive the mailings, between April and June, along with several U.S. territories — American Samoa, Guam and the Northern Mariana Islands.

The last wave of states will be Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio and Tennessee, along with Puerto Rico and the Virgin Islands.

“If your sister who lives in another state gets her card before you, don’t fret,” the Federal Trade Commission explained in a new alert. Since the cards are going out in waves, “your card may arrive at a different time than hers.”

If you think Social Security might not have your current address, call 1-800-772-1213 or check your online Social Security account at https://www.ssa.gov/myaccount/, the FTC advised.

When you get your new Medicare card, don’t throw your old one in the trash. Instead, put it through a shredder or “spend time cutting it up with a pair of scissors” to make sure the part showing your Social Security number is destroyed, said Amy Nofziger, a fraud expert for AARP.

Those numbers remain sought-after by scammers, and AARP and Senior Medicare Patrol groups tell of receiving fraud reports related to Medicare cards since last year.

In one scam, reported by California’s Area 1 Agency on Aging, a caller purporting to represent Medicare or another government agency claims to need your bank account information so Medicare can arrange a direct deposit of funds into your account. The new Medicare cards are used as an excuse for the call.

In another, circulating in Iowa, scammers are threatening to cancel seniors’ health insurance if they don’t give out their current Medicare card numbers. “We’re telling people, don’t ever give someone this number — just hang up,” said Nancy Ketcham, elder rights specialist at the Elderbridge Agency on Aging, which serves 29 counties in northwestern Iowa.

A month ago, Alfonso Hernandez, 65, who lives in Moreno Valley, Calif., received a call from a man who told him, in Spanish, that Medicare was going to issue new cards and that he needed to verify some information, including Hernandez’s name, address and Social Security number.

“I said no, normally, I don’t give my Social Security number to anyone,” Hernandez said. At that point, the caller put his “supervisor” on the phone, who said the government needed to make sure it had correct information. Caught off guard, Hernandez recited his Social Security number and, “as soon as I did that, they hung up.”

“Immediately, I’m like ‘oh my God, what did I do,’” said Hernandez, who quickly contacted credit agencies to have them put an alert on his account. “I just keep praying that nothing happens.”

Just last week, California’s Senior Medicare Patrol program received a report of another scam detected in Riverside County: a caller claiming that before a senior can get a new Medicare card, he or she has to pay $5 to $50 for a new “temporary” card, according to Sandy Morales, a case manager with the program.

Nofziger of AARP said a Medicare representative will never contact an older adult by phone or email about the new cards and will certainly “never ask for money or personal information or threaten to cancel your health benefits.” The new Medicare cards are free and you don’t need to do anything to receive one: They’re being sent automatically to everyone enrolled in the program. Don’t give out any information to callers who contact you by phone, she advised.

If you suspect fraud, report it to the FTC , AARP’s fraud help line, 1-877-908-3360, or your local Senior Medicare Patrol program.

If you’re among nearly 18 million seniors and people with serious disabilities who have coverage through a Medicare Advantage plan, keep the card that your plan issued you. Medicare Advantage plans are offered by private insurance companies, which have their own way of identifying members. Similarly, if you have prescription drug coverage through Medicare — another benefit offered through private insurance companies – keep your card for that plan as well.

Those numbers remain sought-after by scammers, and AARP and Senior Medicare Patrol groups tell of receiving fraud reports related to Medicare cards since last year.

If you suspect fraud, report it to the FTC , AARP’s fraud help line, 1-877-908-3360, or your local Senior Medicare Patrol program.

by Judith Graham | Republished Courtesy of Kaiser Health News

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

Senior Housing: Questions to Consider

January 30, 2018
by Richard Chace

If you have reached the point where you or your loved one may need senior housing, you may be wondering what sort of questions you should ask each facility. Of course, medical conditions, facilities and care are at the top of the list and are the primary consideration when creating a list of potential senior housing facilities but what else might be important to consider?

To learn more about senior care facilities and housing options, please review our two part series in which we provide summaries of the most common long-term and short-term senior care and elder care facilities. Before making a final decision, discuss the medical condition, needs and elder care preferences with your loved one, their doctor and insurance providers.

As part of your decision making process, you may first need to have an assessment to determine the aging individual’s activities of daily living (ADL), such as bathing, dressing, grooming, bathroom assistance, eating and mobility. You should also consider any current medial requirements, prescriptions and the individual’s ability to move about independently.

In part one of this two part series, we’ll cover the most common questions to consider for any senior housing facility. In the second part of the series, we’ll provide some additional questions about health care and living space specifically for independent vs. assisted living & skilled nursing facilities.

THE PROPERTY AND GROUNDS

Are the building and the grounds maintained, well kept and attractive?
Are all areas inside and out handicap accessible – are there handrails, large doorways with wheelchair access and ramps? Are there elevators or any steps or rough ground that could be difficult to navigate with a cane, walker or wheelchair? If there is a pool, is it handicap accessible as well?
Is it well lighted inside and out?
Is it easy to find your way around – is there easy to read signage?
Is there 24/7 security?
Does it smell clean and pleasant?
How far is it from your home?
Are there any restrictions for visitors and do visitors have to sign in or pass through a security point?
Are residents restricted outside access or can they come and go freely? Do residents with Alzheimer’s and dementia live in a separate area with more restricted access to unsupervised areas and/or outdoors?
Are the common areas clean, comfortable and provide a variety of activities?

THE STAFF

Are all the posts staffed – front desk, dinning area, housekeeping, healthcare/nurses station?
Is the front desk staff friendly?
Do you receive a prompt response to your questions (in person, by phone or via email)?
How difficult is it to reach someone?
Are messages returned?
Do the staff members know the residents and interact with them appropriately?
How do the residents contact staff members and how difficult is that to do?
How does the staff assist or identify someone who is experiencing limited mobility or memory issues?
What types of medical professionals are on staff and how often do they visit the residents?
Who would be your staff point of contact if you have a concern, trouble reaching your loved one or there is a medical emergency?

THE RESIDENTS

Do the residents look well, clean and are socializing?
Are they using the common areas?
Are they friendly and willing to talk about the facility and community?
Are they all approximately at the same level of mental and physical ability? If not, what assistance is provided?

DINING/FOOD

Are there multiple dining options available – meals to go or delivered to a resident’s room if the resident prefers not to eat in the dining room? If so, are there fees for those options?
How many meals and/or snacks are available and served in the dining room?
Which meals are included in your monthly fee?
Are their kitchen facilities in the residents’ rooms? If not, are residents allowed to have a select items, such as a microwave, small refrigerator or plug in kettle?
Are there beverages or snacks available to residents throughout the day?
Is there more than one option available for a main course? What foods are available every day?
How are dietary restrictions handled – Kosher, vegetarian, lactose intolerant, diabetic, high cholesterol, etc?
Is the menu publicly posted and is there a monthly menu available for your review?
Is there a private dining room available to the residents for special events?
How are the portions? Does the food look good and fresh? Do the residents seem to be enjoying their meals?
Can you dine there while you are considering the facility?
Can you eat with your loved one if they are a resident? How is that arranged?

AMENITIES

Is there an activity calendar publicly posted? Is there a newsletter and can you review several issues?
What services are available? Laundry, housekeeping and/or transportation?
Is there transportation available for doctor appointments, shopping or special events? How often, how far and is there a fee for transportation services?
Are there recreation facilities on site? Gym, fitness and educational classes, pool, walking trails?
What special events are available – on site and off site?
Is there a hair salon on site? Is there a nail salon?
Is there Internet service – in resident rooms, common areas?
Are there newspaper delivery and TV available – in resident rooms, common areas only?
Are there any accommodations for overnight guests?
Is there anyone on staff that could help residents to video-conference with out-of-town family or friends?

CONTRACTS/COST

Ask for a comprehensive break down of fees, what is included in monthly fee and what services are extra
Are utilities included in the fees?
Are there any types of insurance that can be used toward payment?
How often and how much can fees be raised?
What happens if you run out of funds?
What conditions or circumstances could result in termination of your contract/agreement?
What is a procedure for a grievance or complaint?
What happens if the resident needs a higher level of care?
Make sure you thoroughly read and understand any contract before you sign it. If you have any concerns, consider consulting an attorney.

Determining the best type of senior living arrangements, the appropriate level of care and caregivers you can trust can sometimes feel overwhelming. If you or a family member is no longer able to live independently, please contact CalRegistry to discuss the options and learn about assisted living services and facilities throughout California.

Senior Care Facilities and Housing Definitions Part II

December 21, 2017December 21, 2017
by Richard Chace

Following up on Part One of our two part series defining senior care facilities and housing options, we provide summaries of some additional care services when your senior loved ones are no longer able to live independently. Many families care for their elderly family members at home but those families may still be eligible and could benefit from some professional assistance.

There are also several different options for long-term and short-term senior care and facilities to care for your loved ones. We suggest you discuss your loved one’s medical condition and needs as well as your elder care preferences with your doctor and insurance providers before making a final decision. As part of the decision making process, there may first be an assessment to determine the individual’s activities of daily living (ADL), which include bathing, dressing, grooming, bathroom assistance, eating and mobility. The term ADL is commonly used by professional caregivers and in assisted living facilities. Not necessarily part of ADLs, but are also factors to consider, include any medications as well as the individual’s ability to move about independently.

The duration and level of care as well as the amount insurance will cover vary upon each individual. Long-term care insurance can also help cover the cost of many types of senior care.

EXTENDED CONGREGATE CARE (ECC)
An assisted living facility (ALF) with this type of license can provide extended congregate care services. In other words, congregate care facilities are a type of senior housing facility between age-restricted independent living and assisted living facilities. The main, and most important difference to know, between congregate care and traditional assisted living facilities is that congregate care homes do not offer assistance with daily living activity services (ALF). However, an assisted living facility with ECC beds may keep residents who become frailer than would normally be permitted in order for the resident to age in place. For example, an AFL with ECC can provide total help with bathing, dressing, grooming and toileting, as well as provide or arrange for rehabilitative services. Although these facilities may also provide other services, this generally does not include 24-hour nursing services.

INDEPENDENT LIVING
These communities are specifically designed for elderly residents and are typically comprised of studio, one bedroom or two bedroom rental apartments with full kitchens and private baths. Services for residents may include meal plans, transportation, wellness clinics, housekeeping, laundry and maintenance but they are not licensed to provide personal/nursing care.

MANAGED CARE
A term to describe any system that manages health care delivery and serves as a gatekeeper for other services, such as specialized medical care, surgery and physical therapy.

LIMITED NURSING SERVICES (LNS)
An assisted living facility (ALF) with a LNS license offers select limited nursing services, as defined by law. However, these facilities do not include 24-hour nursing supervision.

SHORT TERM/RESPITE CARE
For those who are caring for their loved ones at home, there may be still times and circumstances that require a caregiver to seek temporary senior housing. Short-term, or respite care, facilities provide a temporary emergency care environment that supports the wellness needs of seniors who cannot living independently. Whether a caregiver is called away for business or vacation, or just needs a short break from caregiving, these facilities can provide peace of mind that their family member will be properly cared for.

SKILLED NURSING FACILITY (SNF)
Although not as common, this level of care can be found in a nursing center or a transitional care unit in a hospital. Daily rates typically include a furnished bedroom as well as a private or shared bath, meals, activities, transportation, phone service, cable television and all personal/nursing care needs. Medicare, Medicaid, Veterans Affairs benefits, some insurance plans or private sources may cover the costs.

Determining the best type of senior living arrangements, the appropriate level of care and caregivers you can trust can sometimes feel overwhelming. If you or a family member is no longer able to live independently within California, please contact CalRegistry to discuss the options and learn about assisted living services and facilities throughout California.

SENIOR CARE FACILITIES AND HOUSING DEFINITIONS

October 19, 2017December 21, 2017
by Richard Chace

There are many types of care options as your loved ones age and are no longer able to live independently. While many people and their families prefer to care for their elderly family members at home, with or without professional assistance, the time may come when that option is no longer the best option.

Fortunately, there are many options for both long term and short-term senior care and facilities, though it would be advisable to discuss your options with your doctor and insurance providers before delving too deeply in the process. One of the first assessments will be to determine the individual’s activities of daily living (ADL), which include bathing, dressing, grooming, bathroom assistance, eating and mobility. This term is most frequently used in assisted living. Medication and ability to move about independently are also factors to be considered but are not necessarily part of ADLs.

The level of care and the insurance coverage that will be provided depend on each individual but these are some of the most common types of senior facilities that you might explore.

ASSISTED LIVING
Many assisted living communities are designed like apartments, with kitchenettes and private bathrooms. Some may also offer companion accommodations. Amenities vary among facilities but usually include meal plans, cable television, landline telephone, housekeeping, maintenance and transportation. ADL assistance is provided and some skilled nursing services may also be available.

CONTINUING CARE RETIREMENT COMMUNITY/LIFECARE (CCRC)
A retirement community that also offers assisted living and skilled nursing services. Residence options may include villas, apartments or condos and a usually a large endowment fee is required prior to moving in. This fee usually entitles residents the opportunity to use the assisted living or skilled nursing skills throughout the time living there. Generally, residents also pay a monthly maintenance fee.

MEMORY CARE
Specializing in patients with dementia or Alzheimer’s, these communities may be licensed assisted living facilities or a dedicated section within a skilled nursing facility. Residences are often an en suite bedroom with limited or no kitchen facilities for the patient’s safety. Dining and activities in are usually held in common areas. Staff should be trained for the special needs of memory care patients and amenities vary by facility but generally include meal plans, cable television, landline telephone, housekeeping, laundry, transportation and assistance with ADLs. Rates may range from all-inclusive to a base rate with additional rates based upon the level of care needed.

ADULT DAY STAY PROGRAMS
There are usually two types of adult day care programs; one based upon medical care and the other on socialization. Both types of programs do not include overnight care and are often limited to service hours between 9 am and 5 pm. Medical programs provide comprehensive medical, therapeutic and rehabilitation treatment for a limited number of hours during the day. Social programs may offer supervised activities, companionship, peer support, recreation and dining options. Both types of programs are designed to assist senior citizens and individuals with chronic conditions to remain as independent as possible for as long as possible.

Navigating the care and housing options for older adults can be confusing for anyone. Finding the best type of living arrangements, the appropriate level of care and caregivers you can trust can sometimes feeling overwhelming.

If you or a family member is no longer able to live independently within California, please contact CalRegistry to discuss the options and learn about assisted living services and facilities throughout California.

JUMP-STARTING HARD CONVERSATIONS AS THE END NEARS

August 15, 2017December 21, 2017
by Richard Chace

Frederick Bannon Jr. was by his mother’s side in intensive care as she fought a rare form of muscle cancer in late 2014. She was heavily sedated, but he felt confident making medical decisions for her, thanks to his family’s advance care planning.

Bannon had difficult end-of-life-care conversations with his parents, both in their mid-80s, before his mother’s diagnosis. During those discussions, held at Bannon’s urging, his parents decided how far they wanted doctors to go to keep them alive should they become too sick to communicate. Bannon then documented their wishes.

“That helped so much, because you knew at least one thing was going to be taken care of,” said Bannon, 65, of San Francisco, whose mother survived and lives with Bannon’s father in Wethersfield, Conn.

Most Americans avoid end-of-life decisions, although some people may be more likely to make them if a doctor or social worker starts the discussion. In California, the state’s attorney general’s office offers an end-of-life planning checklist on its website. In the past few years, other websites have encouraged those conversations, with their own suggestions on how to get started.

Rebecca Sudore, a geriatrician at the University of California-San Francisco, created prepareforyourcare.org, which provides step-by-step instructions and video stories to help people navigate the care they want at the end of their lives. She built the site in 2013 for families unsure how to broach sensitive questions. In a study published in JAMA Internal Medicine in May, she and other researchers found that the website — combined with the use of an “advance directive” form — prompted participants to plan ahead.

The website is free, and Sudore makes no money from it. She said she created it as a public service with the idea of studying its effectiveness.

The site guides patients in drafting a “summary of wishes” to help families and other caregivers decide whether their loved ones should undergo life-sustaining medical interventions such as feeding tubes and ventilators.

For the study, Sudore approached 414 San Francisco-area military veterans — including Bannon — who were split into two groups: One received a simplified advance directive, a legal document allowing a patient to consent to or decline specific medical procedures well before they occur. The other group was given the directive but also was pointed to prepareforyourcare.org, which is publicly available in English and Spanish.

Almost none of the participants had documented their wishes in the six months before the study. But nine months after the study began, 35 percent of those who received access to the website and the directive had updated their medical record, while 25 percent who received just the directive had done so.

Sudore sees stark contrasts between “deer-in-headlights” families who arrive at the intensive care unit with outdated directives and no specified plans, and those who have had ongoing conversations.

Bannon, a Vietnam War veteran, X-ray technician and colon cancer survivor, praised the site’s simplicity and accessibility and said it persuaded him and his parents to document their wishes before his mother’s cancer treatment.

The website appears to be a useful tool, according to Dr. VJ Periyakoil, associate professor of medicine and director of Stanford University’s Palliative Care Education and Training Program. (Periyakoil is friends with the UCSF researchers but was not involved in the study.)

“Clinicians are so hard-pressed for time, so when the patients get activated by web-based tools, I think it’s a wonderful thing,” she said.

Seventy percent of Americans lack an advance care plan, according to the U.S. Centers for Disease Control and Prevention, and lack of preparation can have undesirable effects, Periyakoil said.

Family members who have not gone through this process sometimes choose life-sustaining options for their loved ones that may cause unnecessary suffering, Periyakoil said.

Children “might be more lured by, ‘I really love Mom. I can’t allow anything bad to happen to her and I want to keep doing whatever I can to extend her life,’” she said. “And by doing so, they might end up subjecting Mom or Dad to a lot of measures that are ineffective and burdensome.”

Periyakoil, who has studied barriers to end-of-life care among eight ethnic groups, does not believe there’s a single solution to encouraging end-of-life conversations, because different groups have different approaches to discussing death. She suggested the website might be one of many strategies to consider.

Prepareforyourcare.org has logged more than 1.7 million page views and 85,000 users in 115 countries since its 2013 launch.

For Bannon, the site worked. “Now [my parents are] even more relaxed, because when they do face their final exit, everything’s in place,” he said.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation, coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation, and coverage of aging and long-term care issues is supported by The SCAN Foundation.

AGING SKIN, HOW TO CARE FOR IT.

July 1, 2017June 19, 2018
by Richard Chace

Did you know that as we age, our skin is at greater risk for injury due to reduced blood supply and thinning of the outer layer of the skin (epidermis)? Many people over 70 years old may experience between one and four skin disorders, which is impacted by family history, genetics and lifestyle. The skin of elderly adults may be up to 7 times more permeable than a young adult. Bruises or tearing can occur more easily as we age and healing may be 4 or 5 times slower for elderly individuals compared to young people.

Skin breakdown and pressure sores can lead to other potentially life threatening conditions, such as sepsis, osteomyelitis and other infections. Unfortunately, there are some circumstances and conditions where skin breakdown and pressure sores are unavoidable. For example, pressure sores may develop as part of a disease progression. In a debilitated individual, a pressure sore could be a sign of physical decline and mortality similar to signs of heart, lung and kidney disease.

Risk Factors for Skin Problems and Injury
Age
Nutrition changes, including vitamin and/or protein deficiencies
Prolonged bed rest or decreased activity
Insufficient fluids
Medications
Incontinence
Poor hygiene
Smoking
Medical conditions, such as factures, circulatory problems, diabetes, edema, infections, cancer or renal issues
Changes in sensation, such as pain or lack of pain

If you notice pressure sores developing or increased injury to your skin, consult a doctor for care and treatment options as soon as possible. For those elderly adults receiving in-home care or residing in an assisted living facility, you and your family members should talk with your primary caretakers about the protocols for care, including developing a plan that takes into account medical history, expectations and willingness to follow the plan.

When the time comes that you or a family member is no longer able to live independently, contact CalRegistry to discuss the options and learn about assisted living services and facilities within California.

ALZHEIMER’S, HOW TO HELP WARD IT OFF, THINK BEFORE…

May 21, 2017June 19, 2018
by Richard Chace

Diets designed to boost brain health, targeted largely at older adults, are a new, noteworthy development in the field of nutrition. The latest version is the Canadian Brain Health Food Guide, created by scientists in Toronto. Another, the MIND diet, comes from experts at Rush University Medical Center in Chicago and Harvard T.H. Chan School of Public Health.

Both diets draw from a growing body of research suggesting that certain nutrients — mostly found in plant-based foods, whole grains, beans, nuts, vegetable oils and fish — help protect cells in the brain while fighting harmful inflammation and oxidation.

Both have yielded preliminary, promising results in observational studies. The Canadian version — similar to the Mediterranean diet but adapted to Western eating habits — is associated with a 36 percent reduction in the risk of developing Alzheimer’s disease. The MIND diet — a hybrid of the Mediterranean diet and the DASH diet (Dietary Approaches to Stop Hypertension) — lowered the risk of Alzheimer’s by 53 percent. Researchers responsible for both regimens will study them further in rigorous clinical trials being launched this year.

Still, the diets differ in several respects, reflecting varying interpretations of research regarding nutrition’s impact on the aging brain. A few examples: The MIND diet recommends two servings of vegetables every day; the Canadian diet recommends five. The Canadian diet suggests that fish or seafood be eaten three times a week; the MIND diet says once is enough.

The MIND diet calls for at least three servings of whole grains a day; the Canadian diet doesn’t make a specific recommendation. The Canadian diet calls for four servings of fruit each day; the MIND diet says that five half-cup portions of berries a week is all that is needed.

We asked Carol Greenwood, a professor of nutrition at the University of Toronto and a key force behind the Canadian diet, and Martha Clare Morris, a nutritional epidemiologist at Rush University Medical Center and originator of the MIND diet, to elaborate on research findings about nutrition and aging and their implications for older adults.

Nutrition And The Brain

It’s not yet well understood precisely how nutrition affects the brains of older adults. Most studies done to date have been in animals or younger adults. What is clear: A poor diet can increase the risk of developing hypertension, cardiovascular disease, obesity and diabetes, which in turn can end up compromising an individual’s cognitive function. The corollary: A good diet that reduces the risk of chronic illness is beneficial to the brain.

Also, what people eat appears to have an effect on brain cells and how they function. “I don’t think we know enough yet to say that nutrients in themselves support neurogenesis (the growth of neurons) and synaptogenesis (the growth of neural connections),” Greenwood said. “But pathways that are needed for these processes can be supported or impaired by someone’s nutritional status.”

Essential Nutrients

“Several nutrients have been shown to have biological mechanisms related to neuropathology in the brain,” Morris said. On that list is Vitamin E, a powerful antioxidant found in oils, nuts, seeds, whole grains and leafy green vegetables, which is associated with slower cognitive decline, a lower risk of dementia, and reduced accumulation of beta-amyloid proteins — a key culprit in Alzheimer’s disease.

“The brain is a site of great metabolic activity,” Morris said. “It uses an enormous amount of energy and in doing so generates a high level of free radical molecules, which are unstable and destructive. Vitamin E snatches up those free radicals and protects the brain from injury.” Also on her list is vitamin B12 — found in animal products such as meat, eggs, cheese and fish — and vitamin B9 (folate), found in green leafy vegetables, grains, nuts and beans.

Because aging affects stomach acids that facilitate the absorption of B12, “everyone who gets to middle age should have a doctor check their B12 levels,” Morris said. A deficiency of this vitamin can lead to confusion and memory problems, while folate deficiency is associated with cognitive decline and an increased risk of dementia. Omega-3 fatty acids found in fish and nuts oils, especially DHA (docosahexaenoic acid), are highly concentrated in the brain, where they are incorporated in cell membranes and play a role in the transmission of signals between cells.

“A primary focus has to be maintaining healthy” blood vessels in the brain, Greenwood said. “So, heart health recommendations are similar in many ways to brain health recommendations, with this exception: The brain has higher levels of Omega-3s than any other tissue in the body, making adequate levels even more essential.” Other studies point to calcium, zinc and vitamins A, C and D as having a positive impact on the brain, though findings are sometimes inconsistent.

Foods To Avoid

For the most part, the Canadian and MIND diets concur on foods to be avoided or limited to once-a-week servings, especially saturated fats found in pastries, sweets, butter, red meat and fried and processed foods. As for dairy products, “there’s no evidence one way or another. If you like your yogurt, keep eating it,” Morris said. Greenwood adds a caveat: Make sure you consume low-fat dairy products as opposed to whole-fat versions.

Other Helpful Diets

Randomized clinical trials have demonstrated that both the Mediterranean diet and the DASH diet have a positive impact on various aspects of cognition, although neither was created specifically for that purpose.

“At the end of the day, our [Canadian] diet, the MIND diet, the Mediterranean diet and the DASH diet are not that different; they’re all likely to be helpful,” Greenwood said.

The Pattern Counts

Studies promoting the cognitive benefits of drinking tea or eating blueberries have garnered headlines recently. But a focus on individual foods is misguided, both experts suggested. What matters instead is dietary patterns and how components of various foods interact to promote brain health.

The bottom line: Concentrate on eating an assortment of foods that are good for you. “As long as people are eating a healthful diet, they shouldn’t have to worry about individual nutrients,” Greenwood said.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

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