Monday, August 29, 2011

Signs There May Be Trouble at Home

Some tough decisions are required when it comes to adult children of a parent with Alzheimer's or another form of dementia. One of the toughest is admitting when there is a problem. Spouses may try to hide the other's shortcomings for fear of losing independence. Families may have difficulty charting a course of action. But sometimes the most difficult part is coming to terms it's time to intervene.

Here are some signs someone may need help, courtesy of the latest San Diego Eldercare Directory. Thanks to Ginny Wallis for passing these along.
  • Mail piles up
  • Bills go unpaid
  • A previously well tended house falls into disrepair
  • Trash cans no longer get put out or picked up on the proper days
  • More clutter than usual
  • Appliances are misused or ignored
  • Driving and judgement are impaired (inattention, forgetting to get gas)
  • Sudden shift to poor personal hygiene
  • Incontenance
  • Walking or balance problems
  • Difficulty locating familiar places, even at home
Be aware parents may be reluctant to discuss issues happening within the home. But it's important if there are strong enough signs to take action, beginning with a talk, to help them before a situation becomes dangerous.

Friday, August 26, 2011

'Make It Work'

Anyone who's a fan of the reality TV competition Project Runway is familiar with mentor Tim Gunn's trademark expression, "Make it work." It's advice for designers to do the best they can with what resources and time is left.

That expression was underscored this week when University of Tennesse women's basketball coach Pat Summitt announced she had early onset Alzheimer's Disease and intended to continue working as long as she could.

Alzheimer's is a terminal illness, something we sometimes forget because the disease can take up to 20 years before it claims a life. The average, though, is 8 to 10 years and typically 5 or less for those diagnosed before 65. A lot has to do with any other health factors which could undermine or extend life spans.

At 59, Summitt is one of the most successful coaches in college history and said she wants to continue working as long as possible. Many of us derive at least part of our personal worth from our occupations, and it's one reason that it is important to making loved ones continue to feel valued. If they were a lawyer, you might send them into a home office to do "research." If they worked retail, they may enjoy folding laundry and displaying it on a dining room table. If they were a homemaker, a simple meal they can prepare would make their day.

Consider ways that you can help your loved one with dementia continue to feel productive in the early stages, when they still have the cognitive ability to perform simple and maybe even complex tasks. It will go a long way in making their day - and yours.

Monday, August 22, 2011

Wednesday, August 17, 2011

'Is it Normal Aging or Dementia'



We recently posted about this subject, but not in as much detail as this slide show. This is definitely worth a look if you not only want to know the differences but how to maintain a healthy brain as long as possible.

Tuesday, August 16, 2011

When Is Enough Enough?

This morning a report is out showing moderate amount of alcoholic beverages might stave off Alzheimer’s and dementia. This is potentially good news to those who like a glass of wine with dinner or to have a beer with friends on the weekend.

Others studies have proven that those who drink too much are at greater risk of Alzheimer’s and dementia. Here we’re referring to alcoholics who drink (now or at an earlier stage of life) to excess on a regular basis.

What can be confusing is determining what amount of alcohol may carry benefits and what amount may carry risks.

The new Loyola Study suggests heavy drinkers consume 3-5 drinks per day, implying that those in the “safe zone” to actually improve their cognitive longevity imbibe 1-2 drinks per day at most. Though no solid rationale is given for why a little helps, the study suggests smaller amounts of alcohol have health benefits, including opening up blood vessels that allow more blood to flow to the brain.

The opposite effect from heavy drinkers is the result of the alcohol damaging brain cells and therefore raising the stakes for the person to develop dementia.

The Loyola University researchers also do not recommend non-drinkers take up alcohol to help stay mentally active. Instead, they should focus on a sound exercise and diet regime that also keeps the blood flowing and brain in good shape.

Friday, August 12, 2011

Options for Hiring an In-Home Caregiver

Yesterday we mentioned some of the risks of hiring an in-home caregiver, particularly if you opt to privately hire from public sources without doing a proper background check. Today we’re following up that post with one outlining options for the main types of caregivers. As with the last entry, the information is from a Health Care Reform Expo held last week in La Jolla and sponsored by local members of CAHSAH. This information comes from a presentation titled “A Pivotal Year for Health Care” given by Brittnei Salerno, president and CEO of La Jolla Nurses Homecare.


Option 1: Hiring a Caregiver Directly

This includes finding someone using online or newspaper ads or church and community bulletins. The cost to hire is low but risk is high.

• You are responsible for checking references and doing a complete background check. (By law in California, you can request one from the Department of Justice.)

• The patient, as the employer, is responsible for deducting payroll taxes and obtaining Workers’ Compensation Insurance.

• The patient does the hiring and the firing, which can be both awkward and difficult depending on circumstances.

• Be sure to tell the caregiver exactly what you expect of them and how they should be carried out.

Option 2: Hiring Through a Direct Referral Agency

The cost for using an agency is moderate and the risk is high.

• There typically is a fee to help the patient hire a caregiver

• The patient is the employer and responsible for supervision, payroll taxes and Workers’ Compensation Insurance

• If it doesn’t work out, the patient does the firing and must start the process to find a replacement

Option 3: Hiring Through a Full-Service Agency

The cost is moderate to high and the risk is low.

• The agency is the employer and takes care of the screening, hiring, firing and payroll

• The agency is liable for the caregivers’ actions while employed with them

• The agency finds a replacement if needed

• Caregivers may be eligible for employee benefits, such as health insurance and 401(k) retirement accounts

Thursday, August 11, 2011

The Risks of Hiring a Caregiver

Last week in San Diego, a caregiver was charged with the murder of an 89-year-old Rancho Bernardo man who disappeared last fall. The case once again highlights how important it is to carefully screen and monitor in-home caregivers.

The percentage of seniors in need of ongoing assistance with daily living activities is expected to double by 2025, according to Brittnei Salerno, who spoke at a Health Care Reform Expo sponsored by local members of CAHSAH.

When a parent in particular requires more care than the family can manage on its own, a common course of action is to find an in-home caregiver so Mom and Dad can age in place. More than 50% find family members to help, while others privately hire someone through classified ads, church bulletins, word of mouth and other informal avenues. Still others use referral or employer-model agencies.

Most states, including California, have no licensing requirements for aide-level care.

The California Senate Office of Oversight and Outcomes examined private duty home care and found few Californians who hire caregivers on their own know they have a legal right to request a criminal background check through the Department of Justice.

During the state Senate committee examination they determined:

• More than 25% of caregivers from Craigslist and newspaper ads had previous criminal histories

• Crimes ranged from shoplifting and burglary to assaulting a patient and impersonating a registered nurse.

• Using 7 years’ worth of newspaper ads for caregivers, 64 had legal trouble from transgression on the job

• In 27% of those 64 cases, the caregiver had been previously convicted of a crime

• In 13 of those 17 cases, the old crimes mirrored the new crimes

Something else to consider is if the caregiving situation doesn’t work out. Hiring is easy; firing is not. Some are reluctant because they do not have a backup plan and others are fearful of retaliation.

Next Up: What to consider with various caregiver options

Tuesday, August 9, 2011

'The Unkindest Cut'

Last night we listened online with others as guests on KALW’s “City Visions” discussed what will happen to the 34,000 to 37,000 families impacted by the elimination of Adult Day Health Care in California. From the experts and those who called in to the segment titled "The Unkindest Cut," it’s apparent there’s already some movement.

One hospital ER worker has seen an increase in elderly patients since a nearby adult day health care center closed due to budget cuts. Another noted that there’s now a 4 to 6 months waiting list for skilled nursing homes in her area since the local ADHC closure created sudden demand for a limited number of beds.

To those locally who are wondering about our Glenner Centers: We intend to remain open!

The first half of the live broadcast focused on how we reached this point, with the legislature first voting to eliminate ADHC and then the governor vetoing it’s replacement, Keeping Adults Free from Institutions (KAFI).

Assembly member Mariko Yamada (D-Davis), who chairs Chair of the Assembly Committee on Aging and Long-Term Care, told the audience she never would have voted as she did had she suspected Gov. Jerry Brown would veto KAFI.

“It is a vote that I will regret for the remainder of my career,” she said.

During the show, Yamada noted the “silver tsunami” that’s arrived -- referring to the vast number of Baby Boomers turning into senior citizens and requiring more long-term care options. Even with the large number of ADHC recipients today, she said, “we do not have the capacity to place everyone that would need to be institutionalized.”

Someone who operates an ADHC within the Chinese community of San Francisco called to say 43 percent of residents in his area live alone, do not speak English and do not want to give up their family doctor, let alone move to a facility. “We provide medication management and we remind them to take medicine at hime. If we’re eliminated, I worry they will become confused with medications.”

Michelle Pope, who operates Alzheimer’s Services of East Bay, was more blunt in her predictions.

“I think it’s going to be catastrophic,” she said. Ninety percent of those served at her ADHC have caregivers who work. “It’s short-sighted to throw our seniors and their communities under the bus when they need us most,” she said.

Yamada agreed. “People will have to make a choice between their jobs and taking care of their loved ones, and that is a choice no one should have to make, especially in this economy.”

You can listen to the broadcast later this week when it is posted on at www.kalw.org.

Monday, August 8, 2011

'Planet of the Apes' Stars James Franco ... and Alzheimer's

The new science fiction thriller Rise of the Planet of the Apes opened to great reviews this weekend. While we typically don't endorse movies on our blog, we did want to point to something in this one that might be of interest. A key element of the plot is Alzheimer's.

We won't delve too much into the plot, but do know that the disease and search for a cure plays a vital role in the film. James Franco plays a scientist with both personal and professional reasons for wanting to eradicate Alzheimer's: his father has the disease. Someone did their research because in many ways Franco's caregiver role seems realistic, as does how the disease plays out in his father, played with aplomb by John Lithgow.

We could go on and on, but we hate spoilers. So we'll leave with just one other interesting tidbit that may or may not have influenced the story line: The wildly popular 1968 original of the Planet of the Apes starred Charleton Heston, who died of Alzheimer's Disease in 2008.

Friday, August 5, 2011

Upcoming Radio Program on ADHC Elimination

We wanted to pass along information on an upcoming program that is of interest to all of us in California, whether your loved one is currently enrolled in Adult Day Health Care or not.

This is from the California Association of Adult Day Services:

Tune in Monday August 8th from 7:00 to 8:00 PM for a live radio program on KALW in the Bay Area on City Visions hosted by Joseph Pace on ADHC elimination.

CAADS member Micheal Pope, Executive Director of Alzheimer's Services of the East Bay, and Elizabeth Zirker, Staff Attorney with Disability Rights California will be interviewed along with Assembly Member Mariko Yamada, Chair of the Assembly Aging and Long Term Care Committee.

The tentative title of the show is "Unkindest Cuts: The Threatened Closure of California's Adult Day Health Centers."

I encourage you to tell friends, colleagues, and interested constituencies about the show and that they are invited to call in or e-mail questions. I am aiming to send you a more detailed description of the show by tomorrow that you may forward.

For your information, the studio call-in line is (415) 841-4134, and comments and questions can be emailed in advance or during the show to feedback@cityvisionsradio.com.

You can listen live on www.kalw.org (click listen live, then click either windows streaming or mp3). You can also listen live at the time
the show airs on cityvisionsradio.com. A day or two after the show there will be a link to listen to the program which in turn you can link to
any other website.

Normal Aging vs. Alzheimer's

A hot topic at yesterday's Caregivers Town Hall Forum in Carlsbad was how to distinguish a normally aging brain from one with dementia, particularly Alzheimer's. Dr. Daniel Sewell, a UCSD geriatric psychiastrist and member of the George G. Glenner Alzheimer's Family Centers Medical Advisory Board, offered these examples to help you tell the difference:

Normal Aging: Being more outspoken.
As we accumulate more life experiences, we can feel more compelled to share those experiences and particularly lessons learned from them with others. We can at least appear more opinionated because, again, we have many years of keen observations upon which to draw conclusions.
Dementia: Being inappropriate when speaking.
Those with brain cell damage say things that violate rules of etiquette and/or are deemed socially inappropriate. They do not filter their thoughts before speaking them, regardless of the need for sensitivity.

Normal Aging: Being less concerned about what others think.
As we age, we become more competent -- and confident -- in our decisions and less dependent on approval or validation from others.
Dementia: Being disrespectful of others' rights and boundaries.
Someone with dementia may use another's property or possessions without permission and be confused and hostile when confronted.

Normal Aging: Becoming hypochondriacal.
The more aware of our bodies, the more we consider suggestive symptoms of illnesses we hear or read about.
Dementia: Becoming preoccupied or delusional about non-existent illnesses.
These people become so convinced of an illness despite medical evidence to the contrary that it becomes a major preoccupation or they become delusional.

Normal Aging: Becoming more vigilent.
As we age, we become more aware of the need to adapt our lifestyles or environment to avoid hazards that can produce, say, falls that can have dire consequences. An example is taking more time going down steps and always using a handrail.
Dementia: Developing disabling anxiety.
While normally aging people will take steps to reduce risks, those with dementia begin to altogether avoid people and places for fear of something that may not ever happen. For example, rather than taking more precautions going down stairs, this person refuses to use stairs out of an abnormal fear.

Normal Aging: Worrying about becoming a victim of fraud.
We constantly hear of criminals who exploit the elderly, and it makes seniors more aware of such situations.
Dementia: Becoming excessively paranoid of people.
Someone with dementia is not just wary but suffers from paranoid delusions that limit their quality of life.

Normal Aging: Coping with loss.
As we age, we start to outlive people important to us. Healthy-brained seniors acknowledge the loss and over time replace lost members of their social network.
Dementia: Becoming socially withdrawn.
Those with an abnormal brain isolate and withdraw from their social networks many months following a loss.

Tuesday, August 2, 2011

Free Event: The Aging Brain & Maintaining Wellness

The George G. Glenner Alzheimer's Family Centers and ActivCare at Bressi Ranch is holding a Town Hall Forum for caregivers on Thursday in Carlsbad.

Join us for a morning sesion with Alzheimer's disease experts and learn more about the impact of memory loss on the family. Here are more details:


"The Aging Brain & Maintaining Wellness"

10 a.m. to Noon
Thursday, Aug. 4
Boys & Girls Clubs at Bressi Ranch (Courtyard)
2730 Bressi Ranch Way
Carlsbad CA 92009

Topics include:
Normal memory loss vs. dementia
Defining dementia and the various types
Environmental factors related to behaviors
Nutrition's affect on brain health and general wellness
Helpful tips for family caregivers on daily routines

Speakers:
Daniel Sewell, M.D. - Board-Certified Geriatric Psychiastrist
Neil Levine, M.D. - Board-Certified Internist

To RSVP, call 760-603-9999.