Helping Someone Move to a Long-Term Care Facility

Moving to a long term care facility is often difficult for an older adult. But there are many things family members and friends can do to reduce the physical and emotional stresses involved. They can help plan the move, participate on the day of the move, and provide love and support after the move.

Moving to a nursing home is an important long term care option for many older or disabled adults. Sometimes, a person moves to a nursing facility because the care they need just isn’t available or practical at home. Or, they may have special rehabilitative care needs after leaving the hospital, but before they return home.

Whatever the circumstances, there are a few simple steps you and other family members and friends can take to help the person you care for make a smooth, hassle-free transition to new surroundings.

Before the Move

Moving to a long-term care facility usually means making do with less space than the person is used to. Long-term care residents have the right to keep and use items of personal property, to the extent space permits. But space is almost always in short supply. So choices may have to be made about what to take along…and what to leave behind. Friends and family can help by:

  • Learning from the facility exactly what space limitations apply
  • Helping prepare for the move, including arranging for storage or other disposition of items left behind
  • Discussing the facility’s policies for safeguarding resident property; for example, you may be advised to mark all clothing and personal belongings with the person’s name, and to make (or helping the resident or facility make) a list of the resident’s things
  • Anticipating and responding to special concerns, such as care for a pet.

On the Day of the Move

Moving to a new home is always stressful. You can help minimize feelings of disorientation and dislocation by:

  • Helping your loved one unpack…and making sure that pictures, personal mementos and other similar items are placed where they will create a feeling of home
  • Sharing a meal at the new facility
  • Getting to know staff members  and learning about all the various programs, services, and activities the facility has to offer
  • Spending some quiet time after everything is unpacked to make sure your family member or friend is as comfortable, relaxed, and reassured as possible.

After the Move    

When people move to a care facility, they often fear that the move will come between them and people and activities they love. They may worry about being alone and out of touch. It may take some time and effort to get over these concerns, to be reassured by the support of loved ones, to make new friends, and to settle into new and interesting patterns of living. You can help by:

  • Staying in touch right from the beginning…communicating frequently and positively
  • Working closely with your loved one and staff to make sure any difficulties are ironed out
  • Establishing regular visiting times so your loved one can plan ahead for them
  • Making a few surprise visits as well
  • Visiting individually or as a family group for special occasions, such as birthdays and anniversaries
  • Attending care conferences and family support groups
  • Working with your loved one and staff to make the new living situation a happy, successful one.

15 Great Ways to Help Your Loved One Feel Connected

  1. Send flowers or balloons on a special day.
  2. Write frequent cards, notes or e-mail.
  3. Give a prepaid, senior-friendly cell phone or calling card.
  4. Set up Skype chats with your loved one
  5. Visit as often as you can.
  6. Send pictures or videos of family events, grandchildren, or friends.
  7. Bring a card or small gift when you visit.
  8. Get to know the resident’s new friends and care providers, and greet them during your visits.
  9. Check to see what types of food items would be appropriate as a gift, and include them occasionally when you visit.
  10. Remember to acknowledge and thank members of staff whenever appropriate.
  11. Offer to take along other long-time friends, so they can visit also.
  12. Go for a stroll outside if weather permits.
  13. Take the resident on a day trip, or come along on a resident outing.
  14. Inform friends, family and your loved one’s faith community of their new contact information.
  15. Become a volunteer in your loved one’s new home.

Health Law Requires Medicare to Cover Dementia Evaluation

Provided by Kaiser Health News (www.kaiserhealthnews.com)

For the millions of seniors who worry that losing their keys may mean they’re losing their minds, the health law now requires Medicare to cover a screening for cognitive impairment during an annual wellness visit.
But in a recent review of the scientific research, an influential group said there wasn’t enough evidence to recommend dementia screening for asymptomatic people over age 65.

What’s a worried senior to think?

Dementia screening tests are typically short questionnaires that assess such things as memory, attention and language and/or visuospatial skills. One of the most common, the mini-mental state examination, consists of 30 questions (such as “What month is this?” and “What country are we in?”) and may be completed in about 10 minutes.

In its review, the U.S. Preventive Services Task Force, an independent panel of medical experts, evaluated the evidence of the benefits, harms and clinical utility of various screening instruments for cognitive impairment. It concluded that the evidence for routine population-based screening was insufficient. While declining to  recommend the practice for everyone older than 65, the reviewers noted that some screening tools can be useful in identifying dementia.

“Clinicians need to use their judgment,” says Albert Siu, professor and chair of geriatrics and palliative care at Mount Sinai School of Medicine in New York, who was co-vice chair of the task force on dementia screening. “The evidence isn’t clear that there is a net benefit to screening for individuals that are asymptomatic.”
The risk of dementia increases with age: its prevalence is 5 percent in people aged 71 to 79, rising to 37 percent of those older than 90. Mild cognitive impairment has many definitions, but the term generally refers to people whose impairment isn’t severe enough to hamper their ability to manage their daily lives. By some estimates up to 42 percent of people older than 65 have it. Mild cognitive impairment is a warning sign, but it may not progress to Alzheimer’s disease, says Dean Hartley, director of science initiatives at the Alzheimer’s Association.

Alzheimer’s is the most common form of dementia, accounting for up to 80 percent of cases. Other types include vascular dementia, many cases of Parkinson’s disease and Huntington’s disease.

Someone without symptoms who does poorly on a screening test may have other medical conditions, such as depression or sleep apnea, that can cause memory or other problems, says Hartley. That’s why it’s important that people take the tests in a medical setting with a trained professional who can evaluate them and take a good medical history from patients and their family members, he says.

One-time screenings at shopping malls or health fairs should be avoided, experts agree. Taking a quick test without any accompanying medical evaluation may raise more questions than it answers.

But seniors may want to consider having an evaluation for cognitive impairment as part of their annual wellness visit with their health provider. It is covered with no out-of-pocket charge.

The Alzheimer’s Association recommends that seniors undergo cognitive impairment screening and evaluation to establish a baseline for comparison, and then have regular follow-up assessments in subsequent years.

There is no cure for Alzheimer’s disease. Some drugs, such as Aricept, may improve memory or other symptoms temporarily, but no medical treatment halts or reverses the disease.

That is a key argument against large-scale routine screening of people older than 65, says Ariel Green, a geriatrician at Johns Hopkins Bayview Medical Center. “We don’t have studies that show that such a screening program improves the care of people with dementia,” she says.

Still, if an individual has concerns about dementia because of a family history of Alzheimer’s or memory lapses, for example, a medical professional should evaluate the person and a screening test may be appropriate.

And although research hasn’t yet shown that large-scale screening is effective at improving dementia care overall, screening may help individuals and their families identify a cognitive impairment or dementia early on. The drugs that are available are most effective in the early stages of the disease. In addition, Green says, “it’s helpful for people to hear a diagnosis of dementia, if it’s an accurate diagnosis, because it can help people anticipate their future needs and plan for that.”

Source: Kaiser Health News (www.kaiserhealthnews.org), an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. This article was produced by Kaiser Health News with support from The SCAN Foundation (www.thescanfoundation.org).

How Are Today’s Seniors Adapting to Disability?

Only about a third of Americans ages 65 and older are fully able to take care of themselves and go about their daily lives completely independently, according to a recent study published online in the American Journal of Public Health.

Understanding that there are different ways older adults adapt to disability is a big step in developing public health policies that maximize the quality of life for all older Americans, said the study’s lead author, Vicki Freedman, a research professor at the University of Michigan Institute for Social Research.

Freedman and colleagues analyzed data on a nationally representative sample of 8,077 older men and women, part of the National Health and Aging Trends Study. The National Institute on Aging, part of the National Institutes of Health, funded the research.

Among the findings:

  • About a quarter succeed in accomplishing what they need to do on their own by using walkers or other assistive devices. Another 18 percent say they have trouble even when using these devices.
  • Six percent cope by reducing their activities—bathing or going outside less often, for example.
  • Twenty-one percent manage by receiving help from others.

The study is the first to provide national estimates of ways the Medicare-age population adapts to limitations in daily life.

“Nearly 80 percent of all older adults find ways to manage on their own without assistance from others,” Freedman said. “The group using devices on their own without difficulty is especially interesting. They seem to be able to participate in activities they enjoy and report well-being as high as those who are fully able to care for themselves.”

The researchers asked about seven activities of daily living: going outside, getting around inside, getting out of bed, eating, getting cleaned up, using the bathroom and dressing.

During face-to-face interviews, study participants were first asked whether they used devices or environmental modifications including canes, walkers, wheelchairs, scooters, grab bars, and bath/shower seats and whether they received help from another person during the previous month.

Then they were asked whether they experienced any difficulty doing any of the activities even when they used modifications, and about whether they had changed how often they performed any basic activities over the last year.

According to Freedman, the proportion of older adults able to function independently varies greatly by activity and by age. For example, 90 percent of older adults are fully able to eat by themselves, while only 54 percent are fully able to bathe by themselves. About 45 percent of those ages 65 to 69 are fully able to carry out all activities independently, compared with only 4 percent of those ages 90 and older.

Women are more likely than men to do things on their own by using devices to assist them (26 percent compared to 23 percent). But African Americans and Hispanics are much less likely than whites and Asians to do so. Older adults with low incomes are also less likely to successfully accommodate declines in their functional abilities.

“Two groups that we identified may be especially important targets for public health intervention,” Freedman said. “These are the seven million older adults who have difficulty carrying out activities alone with whatever accommodations they have already made, and the additional 2.1 million who have reduced their activity levels but do not experience or acknowledge that they are having difficulty.”

Source: University of Michigan Institute for Social Research (http://home.isr.umich.edu)

Understanding Frontotemporal Disorders

The National Institute on Aging offers information about these brain disorders that strike middle-aged adults, causing devastating changes in behavior, personality, emotions, language and movement.

Most Americans are familiar with Alzheimer’s disease. But few are aware of the impact of frontotemporal disorders, the cause of up to 10 percent of dementia cases. Unlike Alzheimer’s disease, these devastating disorders usually strike during middle age. Patients and families struggle to cope with changed relationships and the person’s daily needs.

Frontotemporal disorders are caused by changes in the frontal and temporal lobes of the brain.

The frontal lobes control higher-level thinking, such as planning, prioritizing and multitasking. This area of the brain also is involved in language and in motor functions, such as moving the arms, legs and mouth. The frontal lobes help manage emotional responses and enable people to control inappropriate social behaviors.

The temporal lobes play a major role in language and emotions. This area of the brain helps people speak, read, write and connect words with their meanings. It is involved in recognizing recognize objects, including faces, and in relating appropriate emotions to objects and events. When the temporal lobes are dysfunctional, people may have difficulty recognizing emotions and responding appropriately to them.

Depending on which area of the brain is affected, frontotemporal disorders may cause:

  • Physical symptoms—abnormal movement in hands and feet; tremor; loss of coordination.
  • Loss of language—a decline in the ability to speak, understand language, read or write.
  • Emotional changes—apathy; inappropriate emotional responses; lack of social inhibition.
  • Personality changes—problems with thinking; a decline in judgment and insight; embarrassing and uncharacteristic behavior.

The changes may be subtle at first. Families and friends often report that the patient “isn’t acting like himself.” According to the National Institute on Aging, frontotemporal disorders can be hard to diagnose because their symptoms are similar to conditions such as stroke, depression or other types of dementia. But early diagnosis allows patients to get the help they need and plan for treatment and future care. Family caregivers should learn all they can about their loved one’s condition to reduce frustration and cope with the challenges of caring for someone who is gradually losing many of their abilities.

Treatment to control symptoms

At present, there is no cure for frontotemporal disorders. Treatment cannot halt the progression of the disease, but it can help manage symptoms. Several classes of medications are currently used. Physical, occupational and speech-language therapy help patients with movement and speech problems. Physicians, nurses, social workers, and physical, occupational and speech therapists who are familiar with frontotemporal disorders help ensure that patients have the highest possible quality of life and receive appropriate medical treatment.

For More Information

Family caregivers of patients with frontotemporal disorders face a host of challenges, from day-to-day medical care to handling changing relationships. Visit the U.S. National Institute on Aging website to read “Frontotemporal Disorders: Information for Patients, Families and Caregivers” [add link to:  http://www.nia.nih.gov/alzheimers/publication/frontotemporal-disorders] online, or call 1-800-438-4380.

Copyright © AgeWise, 2014

When People With Alzheimer’s Disease Wander

When People With Alzheimer’s Disease Wander

Wandering is one of the greatest challenges faced by family caregivers whose loved one has Alzheimer’s or other memory loss. Over 60 percent of Alzheimer’s patients will become lost at some time. Most are gone only briefly, though long enough to frighten their loved ones.

Others may be lost for an extended period of time, and unfortunately, there are news reports each year of missing Alzheimer’s patients who are never located. It is a sobering fact that if a person with dementia is lost for over 24 hours, he or she is likely to suffer a fall or other serious injury, or even death from injury or exposure. Reports one family caregiver, “The thought that Dad would climb onto a bus at the corner and we would never find him again keeps me awake at night, even on nights when he is getting a good night’s sleep.”

Why do people with dementia wander?

For people with Alzheimer’s or other memory loss, confusion and disorientation make it increasingly difficult to recognize familiar faces and places, even a spouse or child, or a lifetime home. Geriatricians point out that the term “wandering” is something of a misnomer, because many times, in the person’s mind, his or her activity is not purposeless. She may be looking for the bathroom but be unable to find it. He may think it is time to leave for work, even if he retired years before. A great-grandmother might be searching for her children, in the belief that they are still small and in need of her care.

Other factors that contribute to wandering include restlessness, agitation and stress; boredom and lack of a sense of purpose; sleep disorders; physical pain; and the side effects of medications.

Keeping loved ones safe

When a loved one with dementia wanders, family often decide that a nursing home or other residential memory care is the best choice for the person. However, many patients fare much better at home, in familiar surroundings. How can families keep their loved one safe at home, for as long as possible? Here are some strategies recommended by professionals:

Observe your loved one’s patterns. The first step is to understand as best you can the reason for your loved one’s wandering. What are his “triggers”? Where does he usually try to go? During what time of day is he most restless? Does he seem to be looking for something, someone, or someplace?

Adapt the home to keep your loved one safe. Beyond the usual “aging in place” home modifications, you can add special locks to doors, safety gates to prevent exit, and an alarm that will sound if the front door is open. See the resources at the end of this article for information about other home modifications.

Be sure your loved one always carries ID, and a medical alert to tell others he has memory loss. If he doesn’t consistently carry a wallet, try a bracelet, pendant, or clothing labels. Contact your local Alzheimer’s Association office to learn about their Safe Return program. In addition, more and more families are also using a GPS or other tracking device to help locate loved ones quickly.

Notify neighbors and local merchants about your loved one’s condition. Ask them to contact you if they see your loved one alone when he shouldn’t be. Having this conversation with you makes it more likely that others will recognize the problem and feel comfortable getting involved.

Find out if your state has a “Silver Alert” program, similar to the “Amber Alert” for missing children. As law enforcement agencies recognize the needs of growing numbers of adults with dementia, more states are implementing this broadcast notification system.

Try “behavior modification” strategies. If your loved one expresses feelings of being lost or abandoned, reassure him he is safe. Redirect him to safe activities that fill his need for a sense of purpose. If “sundowning” (restlessness at night) is a problem, limit daytime naps. Dementia-care professionals have found that “correcting” a dementia patient frequently can increase agitation. “Don’t correct—redirect” is their guideline.

Have your loved one’s medications reviewed. A person with Alzheimer’s may take medications for the disease itself, for mood or other behavior changes, and for other medical conditions they might have. It is important to take medicines correctly, and it is just as important to be alert for side effects that might increase wandering and other difficult behaviors.

Provide appropriate activities to reduce boredom and isolation. Boredom is stressful for people with dementia, and increases wandering. Art activities, crafts, household tasks, singing, cooking simple foods and socializing all promote well-being and a sense of purpose, which makes it less likely that your loved one will wander.

Take advantage of respite care for family caregivers. Family caregivers need a break to renew their energy and take care of other responsibilities. Locate resources in your community where your loved one can spend time while you are at work, doing other tasks or just taking a break to recharge your emotional batteries. Many families have discovered the advantages of adult day programs specializing in the needs of people with memory loss, which provide condition-appropriate activities, socialization and supervision for people with Alzheimer’s and related conditions. Some of these organizations even offer after-hours care for participants who wander at night.

For More Information

The Alzheimer’s Association [add link to:  http://www.alz.org/care/alzheimers-dementia-wandering.asp] and the National Institute on Aging [add link to: http://www.nia.nih.gov/alzheimers/publication/home-safety-people-alzheimers-disease/home-safety-behavior-behavior] offer information on creative solutions for managing wandering.

Senate Special Committee on Aging Launches Anti-Fraud Hotline

Senate Special Committee on Aging Launches Anti-Fraud Hotline

If you or someone you know suspects they have been the victim of a scam or fraud aimed at seniors, the U.S. Senate Special Committee on Aging has set up a toll-free hotline to help.

The hotline was unveiled in late 2013 to make it easier for senior citizens to report suspected fraud and receive assistance. It is staffed by a team of committee investigators weekdays from 9 a.m. to 5 p.m. EST. The investigators, who have experience with investment scams, identity theft, bogus sweepstakes and lottery schemes, Medicare and Social Security fraud, and a variety of other senior exploitation issues, will directly examine complaints and, if appropriate, refer people to the proper authorities.

Anyone with information about suspected fraud can call the toll-free fraud hotline at 1-855-303-9470, or contact the committee through its website, located at www.aging.senate.gov/fraud-hotline.

As chairman and ranking member of the committee, Sens. Bill Nelson (D-FL) and Susan Collins (R-ME) have made consumer protection and fraud prevention a primary focus of the committee’s work. This year the panel has held hearings examining Jamaican lottery scams, tax-related identity theft, Social Security fraud and payday loans impact on seniors.

“If you’re contacted about an offer that sounds too good to be true, then it probably is,” Nelson said. “This new hotline will give seniors a resource to turn to for assistance if they think they’ve been victimized or have questions about fraudulent activities.”

“Ensuring that seniors are as equipped as possible to avoid becoming victims of fraud and other scams is among our committee’s top priorities,” said Collins. “This new hotline offered by the Senate Special Committee on Aging will help to identify and put a stop to the cruel scams that hurt seniors and their families.”

Source: United States Senate Special Committee on Aging (www.aging.senate.gov)