Happy Thanksgiving. In case you haven’t noticed ~ the holidays have started. Negative political ads have been replaced by holiday “needs” in a nearly-constant bombardment of commercials, while Facebook-ers debated whether or not to shop on Thanksgiving. I think shopping for me would be much more pleasurable if I had a good sense of what each person on my list really wanted. As I was thinking last Friday of the “deals” I was surely missing as work trumped Black Friday, it struck me that you might like a list of ideas for those on your list who are elderly or living in Assisted Living or Nursing Homes. For a complete list of ideas and resources, visit www.agingcareacademy.org and scroll down to “Your Personal Consultant.”
Hobby & Leisure – there are great resources available for everything from adapted puzzles to games and reading. The puzzles should always be age-appropriate (not childlike), and suitable for the current ability – from 4 or 6 pieces to 50 pieces. Magnetic puzzles with stands are great for those with neck problems. For reading, my newest resource is based in solid research from a physician and speech/language pathologist: Reading2Connect.com. This product has adapted graphics and photos, plus reading content tailored to various abilities — people with advanced dementia may still be able to read! Games which spark memories, use contrast and easy to manipulate materials are available at alzstore.com, best-alzheimers-products.com and memoryjoggingpuzzles.com.
Cognitive Fitness – books, activity cards, games and software are available in all shapes and sizes. Attainmentcompany.com offers the Whole Brain Workout series. Resources throughout the web offer products such as “Connect: Memory Enhancing Game” which can be used in a number of ways to improve neuronal flexibility for all abilities.
Physical Fitness – being confined to a wheel chair does not mean you should quit being active. Some of the best exercise videos are now available at very little cost. Enjoying yoga, aerobics and stretching and strengthening is now possible in your own living room or day room. Check out chairdancing.com, gentlefitness.com and the award winning PBS special sitandbefit.org.
Quality of Life – No one should have to watch garbage television, wonder where the family is or be isolated because of changes in communication. A communication book, talking photo album or alternative TV program would improve quality of life for all. Attainmentcompany.com, Alzstore.com and Best-Alzheimers-Products.com can provide ideas for any gift giving budget.
If you order through Amazon, sign up for AmazonSmile and add Hebrew Health Care as your charity: a % of your total will be donated so your gift is twice as nice. Thank you, and Happy Holidays!
By Marichelle B. Cirunay, BSN,RN Infection Preventionist, Hebrew Health Care
A 100oF or higher fever or feeling feverish (not everyone with the flu has a fever)
A cough and/or sore throat
A runny or stuffy nose
Headaches and/or body aches
Nausea, vomiting, and/or diarrhea (most common in children)
Do I have the flu or a cold?
The flu and the common cold have similar symptoms. It can be difficult to tell the difference between them. Your health care provider can give you a test within the first few days of your illness to determine whether or not you have the flu.
In general, the flu is worse than the common cold. Symptoms such as fever, body aches, tiredness, and cough are more common and intense with the flu. People with colds are more likely to have a runny or stuffy nose.
When should I seek emergency medical attention?
Seek medical attention immediately if you experience any of the following:
Difficulty breathing or shortness of breath
Purple or blue discoloration of the lips
Pain or pressure in the chest or abdomen
Severe or persistent vomiting
Flu-like symptoms that improve but then return with fever and worse cough
If you have been diagnosed with the flu, you should stay home and follow your health care provider’s recommendations. Talk to your health care provider or pharmacist about over-the-counter and prescription medications to ease flu symptoms and help you feel better faster.
You can treat flu symptoms with and without medication.
Over-the-counter medications may relieve some flu symptoms but will not make you less contagious.
Your health care provider may prescribe antiviral medications to make your illness milder and prevent serious complications.
Your health care provider may prescribe antibiotics if your flu has progressed to a bacterial infection.
Are there ways to treat the flu or its symptoms without medication?
By Pamela Atwood, MA, CDP, Director of Dementia Care Services, Hebrew Health Care
(NOTE: The subject of this blog post may be uncomfortable, but we offer it as a way to open real discussions about a subject which needs consideration. Although you will quickly understand my biases through some sarcastic words below, let me disclose that I believe the state and federal governments are wrong in their current positions, and need to be open to discussing these issues in a reasonable debate about aging, health and memory disorders.)
Despite the millions of insensitive jokes, there are serious concerns about sexuality and people with dementia. A Bloomberg article this week highlighted issues of individual rights, facilities’ responsibilities, lost jobs, licenses and more because of complex issues which most people don’t think about or discuss.
At Hebrew Health Care, we have spent many years talking about these subjects, training our staffs and other organizations, and developing guidelines for appropriate responses when people with dementia express their sexuality or seek companionship.
Now, if you don’t work in healthcare, you’re probably thinking, “What?!? Why is my sex life any of your business?” Let me break it down.
1) The government (federal and state surveyors and licensors) charge health care organizations with the responsibility to protect our clients. For instance, if we do not ensure you are hydrated, we have failed to protect you from the risk of dehydration. That may make sense if you have ever seen some facilities or home care situations where neglect is a serious issue. The logical next step is that we need to protect people from all kinds of harm, including harm from themselves and others, and that includes sexual assault. (Now, you’re thinking, “Okay, the first part makes sense, but Pam, isn’t there a difference between intimacy and assault?”)
2) The next issue is, I believe, related to our culture’s biases about sex and youth. Many of us believe our parents only had sex the # of times that there are children in the family. Even very progressive families have a difficult time imagining grandparents, or great-grandparents remaining sexually active. (The one exception is about YOUR sex life as an older person. What we want or expect for our own intimacy in later years is different than what we think about for others.) If it wasn’t for commercials about medications which treat “ED” or “low T” there would still be intense reluctance to even discuss these issues in mainstream media. (I know, I know; you’re now saying to your computer screen, “Pam, you’re making me uncomfortable, but how is this related to nurses losing their licenses? Don’t you in health care know how to deal with these issues?” – so glad you asked.)
3) The only people allowed to have sex are married people. That’s proven fact, right? NO? Huh. Well, according to the State it is. Well, maybe not in society, but in nursing homes. And well, maybe not married, but they both have to be consenting adults. This makes sense really – the problem is really one’s capacity to consent. The most serious issue about sex/intimacy and dementia is consent. How do we determine your right to consent? If you don’t consent, then it’s rape, right?
What if you DO consent – in fact, you seek out the partner – but you have dementia. Are you still consenting? That is the core issue here. There are no good tools to assess one’s ability or legal cognitive capacity to consent. People with serious mental illness, to the point where they have legal guardians to make all of their health and financial decisions, still retain the right to get married and have sex. Older adults with dementia (who have previously had normal sex lives) need to be PROTECTED (according to regulators) from what others would easily otherwise determine to be consensual relations.
This leads to all sorts of grey areas (fifty maybe? – sorry, I couldn’t resist the connection).
A – if two people with dementia kiss, is that assault? And who committed the assault? B – if one person has dementia and the other doesn’t, and they are married, why isn’t that marital rape (by state definitions – and no, I don’t believe in “implied marital consent”)? C – if one person has dementia and has forgotten the spouse, and resists the spouse, shouldn’t THAT be an issue to address? D – what if the residents (one or both with dementia) are so distressed about our preventing the relationship that they have agitation, crying or anxiety as a result? Should we put them on medications to treat these new symptoms?
There are many more issues, and in good facilities these are debated and staffs are trained how to respond with compassion and fair consideration. What do you think? Do you think health care professionals should be determining (along with your adult children or other “decision makers”) whether or not you develop intimate relationships if you get dementia? At what point should others be involved? What are some ways that facilities can protect people from abuse/exploitation but allow people to express their normal human instincts? Let us know what you think (with decency and taste please…).
Pamela Atwood, MA, CDP, Director of Dementia Care Services, Hebrew Health Care
4 Reasons Dental is Linked to Health
One of the most challenging aspects of caring for older adults is oral care. Recently, one of our caregivers asked, “Does she still need to brush her teeth now that she’s in the end stage?” I asked our geriatric-dentistry expert, Dr. Ruth Goldblatt, for her ideas. She confirmed that oral health remains a top priority throughout life, for a number of reasons:
No. 1: Oral pain can decrease food intake;
No. 2: Poor oral hygiene affects the self-esteem of the patient;
No. 3: Poor oral care/hygiene is uncomfortable for friends/family/caregivers and may result in social isolation; and most importantly,
No. 4: Poor oral health can lead to serious infection, including pneumonia.
Top 3 Tips to Maintain Oral Health
No. 1:Get baseline dental data and X-Rays for the patient.
No. 2: Get the best dental health as soon as you get a diagnosis of Alzheimer’s or other form of dementia – that doesn’t have to be the most expensive or most elaborate.
No. 3: Establish a routine of completing dental care at the same time every day – preferably 2 times/day after meals if possible.
Dr. Goldblatt also shared the newest resource for oral care – a training video designed for professionals but helpful for families too. It’s available for a modest fee at www.mouthcarewithoutabattle.org; and there is a free video preview on the website. I will warn you – don’t watch it while eating. The pictures are real and relatively graphic to those of us with weaker stomachs. But the information is superb. Tips on brushing, alternative products and techniques for working with resistive persons are available.
Still think aluminum causes AD? Were you taught to use reality orientation? Always wondered what Snoezelen is? At a loss when someone asks you about “respite”? Think behaviors are expected and only fixed with medications?
There are dozens of resources, facts, approaches and research updates in the world of dementia care. To some, these are not news. For people new to the field or new to needing the information, these updates are not always included in Alzheimer’s 101 sessions.
I’m always amazed when I read a “doctor” who has a newspaper column referring to risks of aluminum or mercury amalgam as causes of Alzheimer’s. And although I feel like I speak about it all the time, I’m continuously amused when people say “I heard we’re supposed to use reality orientation” – it’s amusing because it’s so counter-intuitive. The people saying that are seeking confirmation because they know it feels wrong.
Here are some basics you won’t hear about in Alz 101:
According to the Alzheimer’s Association, the National Institutes on Aging & Health, there is insufficient evidence to indicate any causative effect from aluminum or mercy amalgam fillings. Some studies exist but the science has yet to be validated and replication of research yielded different results.
Reality orientation should only be used for non-emotional subjects, such as “when is Bingo.” People with Alzheimer’s should not be “reoriented” when asking where their parents are – telling someone their parents are dead is unpleasant any time. Retraumatizing a person with dementia is complex and cruel.
Snoezelen is a term for multisensory environments. It’s originally a Dutch concept from their words for rest/relax (doezelen) and explore (snuffelen). Now it is also a brand name (like Kleenex is to tissues). In a multisensory environment we use aromatherapy, fiber optic lights, water tubes and sound machines, depending on the person’s interests and reactions.
Respite (pronounced Res-pit) means support for a caregiver to get a break. Services may be provided routinely to get the caregiver to a social event or just to rest, or intermittently for him/her to get to a doctor or family special event.
Behaviors are common, and usually the result of coping with stress (including from the environment) or pain. My favorite behavior meds are PAIN MEDS. Please don’t let me be in pain when I have dementia! Most of the time, behaviors can be managed through prevention by knowing the individual’s triggers. Our motto is ALL BEHAVIOR HAS MEANING.
Learn about more Alzheimer’s updates by following this blog, following us on Facebook & Twitter and joining our newsletter lists at www.agingcareacademy.org and www.hebrewhealthcare.org. You can also request specific educational information from us. Contact us for resources or training options.
Pamela Atwood, MA, CDP, CLL Director, Dementia Care Services Hebrew Health Care, Inc.
I had the great opportunity to meet with our local Parkinson’s Disease (PD) support group yesterday. The group is affiliated with the American Parkinson’s Disease Association, and meets monthly (2nd Tuesdays at 3:30) in West Hartford. We are honored to host this terrific, supportive, knowledgeable group of patients and friends & family. Yesterday we welcomed the new APDA CT Chapter Executive Director, Mary Ellen Thibodeau. She’s amazing, and she let us in on the newest treatments for PD. Some of the members had never heard of them ~ and we’ll let you in on the secret too!
DBS – Deep Brain Stimulation – many PD patients have heard about this before. DBS is like a pacemaker for your brain. It is considered when medications are less effective, and helps patients have symptom free hours in their days. In our area, there are fewer centers which offer this treatment than there were 5 years ago. However, the eligibility has changed. If you were told in the past you were “too old” ask again! There is no longer an age requirement, but doctors do consider functional ability/potential, ability to utilize Sinemet, and medical feasibility.
LSVT Loud – This is a speech-therapy-based program that helps patients with their voice. PD patients lose the strength in their voices, and to them, they feel as if they are yelling when people ask them to speak up. This program is a Medicare/insurance covered intervention, which is intensive but with dramatic results. Therapy is given 1 hour a day, 4 days a week for 4 weeks.
LSVT Big – This is a physical-therapy-based program, also covered by Medicare and insurance, for functional movements. It also has dramatic results, but is a newer program, and not many PTs are certified yet.
Hebrew Health Care will continue to host the PD support group monthly. For more information or to be added to our invite list, email us at email@example.com today!
For more information on these interventions or other information & supports for Parkinson’s Disease, visit www.apda.org and contact your local chapter.
By Joan Carney, Vice President, Hebrew Life Choices and Executive Director, Hoffman SummerWood Community and Valerie Bartos, Director of Community Relations, Hoffman SummerWood Community
What are Assisted Living Communities and are they alike?
Assisted Living Communities provide rental housing for older adults. In addition to housing, they also provide personalized care and supportive services. Examples of personalized care include assistance with bathing or dressing and medication management. Among the supportive services that are offered are meals, housekeeping, transportation, and activities. In the state of Connecticut, assisted living communities must be registered as managed residential communities (MRCs), with an assisted living services agency (ALSA) providing personal care services. The ALSA is licensed and regulated by the Department of Public Health.
How are Assisted Living Communities different?
Assisted Living Communities can be owned by for-profit organizations or by service-driven entities. Some communities are one of many, while others are unique and one of a kind. Assisted living communities can vary greatly with regard to pricing, amenities, staffing, services offered and overall philosophy. Some communities provide specialized services for memory care. Though most assisted living communities are private pay, some communities participate in a Connecticut pilot project which pays for some of the cost through Medicaid.
How do I know if Assisted Living is right for my loved one?
If your loved one is having difficulty with preparing meals, bathing or dressing, managing medications, shopping or getting to medical appointments, or just having trouble taking care of their home, assisted living may be the answer. Often, the real question is not so much “Is assisted living the solution?” but rather “Which assisted living community is the right one for my loved one?” Here are some helpful tips:
Visit more then one community during your search, and on different days, to learn what programs and services are offered at each.
Ask what makes the community different from other communities and ask about the longevity of their key staff, as this is a good indicator of level of commitment.
Meet other residents who live there and ask to speak with family members of residents; they can be a very helpful resource.
Inquire about having your loved one spend an afternoon, dine with the members, and participate in some programs to get a better feel for the community.
In addition to utilizing Hoffman SummerWood Community (www.hoffmansummerwood.org) as a resource in your search for assisted living, The Connecticut Assisted Living Association ( www.ctassistedliving.com) and the Assisted Living Federation of America (www.alfa.org) offer a wealth of information for the consumer.