“]”]A fascinating article in the Montreal Gazette describes how people living in Health Central Park nursing home in Florida have had their brains, mobility, and social lives jump-started by a simple gadget: the iPad. The hope is that the iPad and other digital tablets could become a mainstream treatment device for people with Alzheimer’s disease and other types of dementia.

“It came to us as a happy accident,” said Judy Skilton, Health Central Park’s director. “What started out as one resident’s curiosity about … an iPhone turned into something that is helping them spell, track items, make choices and read words. It’s amazing.”

How can the iPad help nursing home residents? Let me count the ways:

1. The iPad’s swipe and touch-screen capabilities makes it accessible to people whose hands have atrophied, or who have disorders such as arthritis or Parkinson’s disease, which can make it difficult or even impossible for the individual to type or even use a mouse.
2. It is small, lightweight, and looks like a piece of paper, which makes it nonthreatening for those who might be unwilling to use a computer.
3. It is small enough to be used by people with even severe mobility problems.
4. It has applications that allow individuals to communicate visually with family members who live far away.
5. It has game apps that test a person’s memory, cognitive skills, and hand-eye coordination.
6. It has iTunes capability, which allows an individual to play familiar music, or to watch television shows in the privacy of one’s room.
7. It has a camera and photo albums, which can allow a resident to take pictures to share with others…and to look at pictures of family functions that they may not be able to attend. In that way, nursing home residents can remain a part of family.
8. It has calendar and timer applications that can remind a person to take medication, or time a particular activity.
9. It can be used to test a person’s functioning and mobility, which help residents and their caregivers understand how they are progressing in terms of daily living skills and general movement abilities.

According to the article:

Recreation-therapy assistant Marian Yandle said the Talking Tom Cat app, which features an animated feline that repeats what it is told, encouraged a 99-year-old resident to drink her fluids.

“She watched the cat drink a cup of milk. Then she took her own cup and drank her fluids. We were very excited,” Yandle said. “She also likes the music app and sings to Shirley Temple’s ‘On the Good Ship Lollipop.’ She knows all the words.”

Something so simple…an animated cat helped an elderly nursing home resident drink her own fluids. That’s as close to a magic as we get in real life!

To read the full article in the Montreal Gazette, click here: iPad helps elderly remember, socialize

Today, September 21, 2011, is World Alzheimer’s Day. Every year on September 21st, Alzheimer associations across the globe unite to recognize World Alzheimer’s Day, and this year is no exception.

World Alzheimer’s Day is a day that unites opinion leaders, people with dementia, their carers and family, medical professionals, researchers and the media from all around the world.

Having a globally coordinated awareness day sends a strong message to governments and policy makers alerting them to the fact that dementia is a serious health issue that will have serious implications for services and health systems around the world as the world’s population grows older. In addition, by focusing on a different message each year, the day can be used to educate and challenge people’s misconceptions about dementia.

Plus, having a special day  provides an opportunity for Alzheimer associations around the world to gain recognition and credibility for the work they do, placing themselves in a stronger position to influence opinion leaders and governments.

The theme of World Alzheimer’s Day for 2011 is “Faces of Dementia.” People with Alzheimer’s disease don’t look “crazy” or “out of their minds.” They look like your next door neighbor…your grandmother…or someone at the grocery store.

Today is a day to pay tribute to those who represent the “Faces of Dementia” in all parts of the world.

For a larger version of the “Faces of Dementia” poster, click here: World Alzheimer’s Day 2011

Here in North Carolina, as in many other southern states, we have a higher-than-average risk of cardiovascular disease, leading medical experts to call the band of high-risk states “the Stroke Belt.” Why? Well, no one really knows for sure.

There are a few theories: That people in the south share some genetic susceptibility… that southerners don’t recognize or treat hypertension… that the rural nature of the south means fewer doctors and less-available medical care… that southerners have a distinctive high-fat, fried-food diet that contribute to cardiovascular disease. Regardless of why, the fact remains that stroke is a greater risk for southerners.

Now, a new study suggests that in addition to stroke, people in the stroke belt may also have a greater risk of memory loss and general cognitive decline. Even when all other factors are taken into account, people in the Stroke Belt show an 18 percent greater risk of

According to an article in The New York Times:

None of the people with cognitive decline in the study had had detectable strokes. But some experts believe their memory problems and other mental issues could be related to the same underlying risk factors, including lifestyle patterns that contribute to hypertension, high cholesterol, diabetes and obesity…..

“This should be a very strong alarm signal,” said Dr. Gustavo C. Roman, who leads the neuroepidemiology section of the American Academy of Neurology and was not involved in the study. The finding suggests that “if you want to keep your marbles, you need to control your blood pressure, excessive weight and other risk factors for stroke.”

The thing all those risk factors have in common is that they can affect blood flow, causing less blood to reach the brain. Without blood, the brain can’t get the oxygen and nutrients it needs to function properly. In the short term, this can mean simple memory loss, but in the long term, it can mean cognitive decline and dementia.

According to a physician quoted in The New York Times, it is a question of taking care of your body and health:

“Those behaviors that prevent stroke likely will prevent some but not all of the things that cause cognitive decline,” said Dr. Joseph P. Broderick, chairman of neurology at the University of Cincinnati Neuroscience Institute, who was not involved in the study. “If you buy a car and you take great care of it, it still ain’t the same 15 years later. But if you don’t ever change the oil and your basic engine grinds down, in five years you can’t drive it and it won’t last very long.”

The goal, then, becomes one of change–changing our health habits for the better, changing the way we take care of our human engine. It’s difficult, but the possibility of living out our final days in a nursing home because of dementia is even more more difficult to contemplate.

To read the Annals of Neurology article, click here:  Incident cognitive impairment is elevated in the stroke belt

To read the article in The New York Times (much more reader-friendly), click here: In the ‘Stroke Belt,’ Erosion of Memory Is More Likely Too

Palliative care is treatment intended not to heal, but to relieve symptoms so that the patient feels better. Despite the fact that it is an important part of treatment, especially for people with incurable disorders, palliative care is not well understood by most people, including those who need it. For people with a terminal illness, palliative care is also known as “hospice care.” That’s one reason why some people don’t even want to talk about the possibility of palliative care, even though it doesn’t mean that a patient is “giving up” or resigning himself to terminal illness. So I repeat:  Palliative care is about helping people feel better and providing them a better quality of life. It can be provided throughout the course of the disease along with regular medical treatment.

What is even less well known is that palliative care is available for people with dementia. Currently, 72% of palliative care programs provide care to dementia patients; just 15 years ago only 21% provided care to dementia patients. These programs can help relieve pain, shortness of breath, fatigue, nausea, eating difficulties, sleep problems, and other symptoms. But according to a study published in the November 2010 issue of the Journal of the American Geriatrics Society, despite the availability of palliative care, dementia patients are not receiving the services that could help them out. The obstacles to receiving this type of care include inadequate insurance coverage, expired home health benefits, and lack of information about when palliative care is appropriate and how to access those services.

“While it is heartening to see that most of these [hospice and palliative care] programs provide care for patients with dementia, there are many, many more who need this care than are receiving it. Education and policy efforts should focus on communicating with families and providers about palliative care, supporting caregivers who often are frustrated in their efforts to improve quality of life for a loved one with dementia, and reforming reimbursement structures to provide coverage earlier in the disease when patients have high needs but are not hospice eligible,” said study author Alexia M. Torke, M.D., M.S., assistant professor of medicine and geriatrics at Indiana University School of Medicine. [as reported in ScienceDaily]

People with Alzheimer’s disease and other forms of dementia have a tough road ahead of them. So do their families. We love the idea that dementia patients are finally getting the kind of care that can make their lives a little easier, but we would like to see this become a standard part of dementia care. Why does it have to be so difficult to get palliative care? Isn’t it a basic human right to have the worst of our suffering relieved as much as possible? We fear that this is another case of agism. The elderly in America are generally treated as though they are disposable, so an elderly person with dementia really has no voice.

It’s sad. But it’s something we, as a society, can change. Studies like this are the first step.

To read the whole ScienceDaily article, click here: ScienceDaily

To read an abstract of the original article, click here: Journal of the American Geriatrics Society

To read more about how HensonFuerst Attorneys work to protect the rights of people in nursing homes and assisted living facilities, visit our website: http://www.lawmed.com/

November is set aside to officially recognize a trio of related causes. It is National Alzheimer’s Disease Awareness Month, National Family Caregiver Month, and Long-Term Care Awareness Month.

As many as 5 million people in the United States have Alzheimer’s disease and related dementias. According to the North Carolina Division of Aging and Adult Services, more than 1 million adults in North Carolina are caring for an older person. And more than 40 percent of NC family caregivers take care of someone with a memory disorder, such as Alzheimer’s disease, which is now the fifth leading cause of death in the United States.

This month, state leaders and communities are working to raise awareness of the tremendous burden the disease takes on the person suffering from the disease, as well as their friends and family members.

In addition, November is a time to recognize that about 70 percent of people over age 65 will require some long-term care services at some point in their lives. Because Medicare and private health insurance don’t pay for much of long-term care, it’s important to plan ahead for possible future care needs.

To find out more about these special November recognition topics, check out these resources:

North Carolina’s Project C.A.R.E. (Caregiver Alternatives to Running on Empty)

North Carolina Publications and Resources for Alzheimer’s Disease

North Carolina Family Caregiver Month Events

the Presidential Proclamation of National Alzheimer’s Disease Awareness Month

National Clearinghouse for Long-Term Care Information

Yes, we all know smoking is bad for health. We know that it increases the risk for heart disease, stroke, and many kinds of cancer.

Now, add dementia to the list.

A groundbreaking article published online this week in the Archives of Internal Medicine reported on the results of a long-term study that followed more than 21,000 people between 1978 and 2008. By the end of the study, a total of 5,367 people had been diagnosed with dementia. (That alone is frightening: about one in four people developed some form of dementia.)

After adjusting for other factors that differ from person to person (such as sex, age, race, hypertension, body mass index, diabetes, alcohol use, and others), the study found that compared with nonsmokers, people who smoked more than 2 packs a day had more than DOUBLE the risk of developing dementia. For those who smoked 1 to 2 packs a day, the risk was 43% higher…and for those who smoked less than 1 pack a day, the risk was 36% higher.

The good news is that people who are “former smokers” have the same risk as never smokers. So stopping smoking is not only good for your lungs and heart, it is especially good for your brain!

It’s rare that a study is able to show such strong correlations between a lifestyle choice and a health effect that can change the entire course of later life. There has to be a slogan in here somewhere:  Douse the Butts, Save Your Brain!  Or, Smoke Your Way to Senility.

Okay, they’re not so catchy. But the study speaks for itself.

Read the abstract here:

http://archinte.ama-assn.org/cgi/content/abstract/archinternmed.2010.393?papetoc

There are many different living options for people who are no longer able to live independently, or who require more care than the average family can give. About 70 percent of people over age 65 will require some type of long-term care services during their lifetime. The process of choosing can be overwhelming.

To begin, it’s important to know the differences among various terms. Each type of facility offers different benefits and levels of care, and often must follow different rules and government guidelines in order to maintain its certification and/or funding. The quality of individual facilities varies, as well. Some are wonderful, but many (way too many) are horrific. (On the HensonFuerst website, we provide guidance about how to choose the best-rated care in your area, and we’ll also discuss these topics in detail in future blogs.)

To help ease the confusion, here are some definitions of commonly used terms:

Long-Term Care

“Long-term care” is an overarching term used to describe any service (including many of the services listed below) designed to help people who have chronic illness, disability, dementia, or other condition that requires on-going help. Long-term care services can be provided anywhere, including in the individual’s home or in a residential facility.

Continuing Care Retirement Communities (CCRCs)

CCRCs offer multiple levels of care–Independent Living, Assisted Living, Skilled Nursing Care—housed in different areas of the same community or campus. As the personal and medical needs of residents change, they have the opportunity to move to a different care facility while remaining in the same community—social connections remain in place, friends can stay friends. CCRCs provide residential services (including meals, housekeeping, and laundry), social and recreational services, health care services, personal care, and nursing care.

If you are considering a CCRC, be sure to check the associated nursing home, in person and on the Nursing Home Compare page on www.Medicare.gov. A CCRC contract usually requires you to use the CCRC’s nursing home if you need nursing home care. And some CCRC’s will only admit people into their nursing home if they have previously lived in another section of the retirement community, such as their assisted living or an independent area. CCRCs usually require a large lump-sum entrance fee, and residents must pay a monthly fee. (Licensed as nursing homes/residential care facilities or as homes for the aging.)

Independent Living Community

Independent living communities typically provide meals in a restaurant setting, housekeeping, transportation and various social activities. While there may be wellness programs, care services may or may not be available for an additional charge. These communities are often part of a Continuing Care Retirement Community. (Not licensed.)

Assisted Living Facility

These communities promote independence in a private residence setting, a kind of “home with services” for people who are generally well but still need help with everyday tasks. There is an emphasis on privacy and choice. Residents typically have private locking rooms (unless shared by choice) and private bathrooms. Personal care services are available on a 24-hour-a-day basis. Residents have access to assistance with meals, bathing, dressing and/or medication as needed. In addition, transportation and social activities may be available (not all facilities offer all services, so ask for a list of services in writing). Assisted Living facilities may stand alone, or they may be part of a Continuing Care Retirement Community. There is usually a monthly fee, plus additional fees for added services. (Licensed as residential care facilities or as rest homes.)

Skilled Nursing Facility

Skilled nursing facilities are nursing homes that are certified by Medicare to provide 24-hour nursing care and rehabilitation services, in addition to other services. Many of these communities offer short term, comprehensive rehabilitation programs on an inpatient and outpatient basis. They may be stand-alone facilities, or part of a Continuing Care Retirement Community. (Licensed and regulated by state public health departments.)

Nursing Home

A nursing home is a facility licensed by the state to offer 24-hour skilled nursing care and personal assistance. For people who don’t need to be in a hospital but still require round-the-clock care, a nursing home provides nursing care, personal care, room and board, supervision, medication, therapies and rehabilitation. Rooms are often shared, and communal dining is common. Some nursing homes have special care units for people with Alzheimer’s disease or other serious memory disorders. (Licensed as nursing homes, county homes, or nursing homes/residential care facilities.)

Alzheimer’s/Memory Care

Alzheimer’s or Memory Care communities are a type of service, not particular facility. They provide specialized services to meet the needs of individuals with dementia, brain injury, or Alzheimer’s disease. These services may be provided by an Assisted Living, Skilled Nursing or Residential Community.

Rest Home

These facilities offer 24-hour supervision and supportive services for people who don’t need on-going medical or nursing care. They provide housing, meals, activities, and medication administration.

Hospice Care

Hospice provides care for individuals who are terminally ill, including health services, volunteer support, grief counseling, and pain management. Although most hospice programs are only allowed to offer services to people who are thought to have less than six months to live, some hospitals are providing hospice to people with a documented terminal illness who need palliative care. These services can be provided in a person’s home, a hospital, or a long-term care facility.

Adult Day Care

Even though the name sounds a bit condescending, Adult Day Care can be very helpful for adults who are functionally impaired, but who want or need an alternative to live-in care. These programs run during the day (much like child day care), and provide variety of health and wellness, social, and related support services in a safe, protective setting.

For More Information…click the links below:

HensonFuerst Attorneys Nursing Home Abuse webpage

National Clearinghouse for Long-Term Care Information

Medicare.gov

Aging isn’t always dignified. That’s especially true for people with dementia. Alzheimer’s disease dismantles a person’s life piece by piece: short-term memory is the first to go, followed by long-term memory, recognition of family members, recognition of self, all cognitive abilities. In addition, a person loses physical capabilities–the ability to walk, to talk, to balance, and even to eat.

Eventually, a person with dementia becomes totally dependent on the care of others. Because the medical needs are intensive, families are generally unable to provide adequate care and a loved one is placed in the hands of a long-term care facility.

We’d like to think that a nursing home that courts families of dementia patients would provide trained and compassionate care. Unfortunately, that’s not always true.

In a letter to the Chicago Tribune, Kim Warchol (of Dementia Care Specialists, Inc.) notes that nursing home residents can’t achieve their best lives unless nursing home staff are properly trained to provide safe, therapeutic care. She states:

“Based on my experience, between 60 to 80 percent of those living in geriatric nursing facilities have dementia, and well over 50 percent of those admitted to assisted living facilities have functional loss due to cognitive impairment. And with a new diagnosis being made every 70 seconds, long-term care facilities must empower their staff for the challenges ahead.” [Kim Warchol, letter to Chicago Tribune]

Her wish is that new laws be enacted to encourage facilities to move from an impairment-based practice to an abilities-based practice, which respects the person behind the disease. What a fantastic idea. Why does it have to even be mentioned as a “revolutionary” concept? It seems basic–dignity for all, but especially for those who lose everything else.

Feeding Dementia Patients with Dignity

A related article in the New York Times this week talks about the “revolutionary” concept of feeding dementia patients with dignity. After a person loses the ability to eat, the family typically is asked whether they would prefer to have a gastric feeding tube inserted so nourishment can be forced, or not…which is the equivalent of withholding nourishment. The decision is always heartbreaking.

But get this…some social workers are suggesting that there is a third option: to feed the patient carefully and slowly by hand, stopping when the person has enough, starts choking, or becomes agitated.

Doctors are calling this new option in palliative care “comfort feeding only.” In a recent paper in The Journal of the American Geriatrics Society, the authors argue that feeding tubes do not necessarily prolong life in patients with advanced dementia, and that surveys indicate that a vast majority of nursing home residents say they would rather die than live with a feeding tube.

“Just imagine someone interacting with the patient, talking to them, cueing them into eating,” Dr. Teno [Joan Teno, professor of community health at Brown University's medical school] said, “as opposed to someone walking to the bedside and pouring a bottle of Ensure down the feeding tube.” [from New York Times article]

Dignity…who knew it could be so revolutionary. At HensonFuerst, every day we fight for the basic dignities of people in nursing homes. We agree that special training should be required of everyone who treats dementia patients, but we would like to take that one step further. Let’s require compassion, caring, and, yes, dignity for our parents and grandparents when they live their days in a nursing home.

HensonFuerst Attorneys provide a voice for people in long-term care, and their families. If you have questions about how your loved one is being treated and suspect neglect or mistreatment, feel free to contact us. If you have questions, HensonFuerst has answers.

An article on the WRAL webite today reports that an excessive amount of morphine contributed to the death of a patient in the Alzheimer’s unit of Britthaven of Chapel Hill nursing home.

In February, patients were drug tested when managers expressed concern about the way the patients were acting. Of 25 Alzheimer’s patients, nine tested positive for opiates. (Morphine is a type of opiate.)  Three of the patients were removed from the nursing home and hospitalized, and one of those patients–Rachel Holliday–died on February 16, 2010. On autopsy, the medical examiner found extremely high doses of morphine in Ms. Holliday’s system, even though she was not scheduled to receive that medication at all.

The North Carolina State Bureau of Investigation (SBI) is still analyzing evidence in the case; the medical examiner did not rule out homicide.

Everyone at HensonFuerst is outraged and heartsick at these findings, and our prayers go out to the family members affected. Britthaven of Chapel Hill has been providing substandard care for a long while, as evidenced by its Medicare rating: an overall 1 out of 5 stars. It is also a “Special Focus Facility,” which means that they have a history of persistent poor quality of care. Every patient deserves the best possible care, and Britthaven of Chapel Hill has not been keeping up with the implicit promise made by every special care facility: That they will take care of your loved one.

Obviously, there has been a serious disconnect somewhere along the way. Is the staff undertrained or incompetent?  Do the corporate heads not care enough improve the facility?

HensonFuerst is also investigating cases involving Britthaven of Chapel Hill nursing home patients receiving opiates. If you are concerned about a loved one who resides in this or any other facility, please give us a call. We want to help.

You can reach our nursing home abuse team by calling 1-800-4-LAW-MED.

Will your loved one end up with a feeding tube? According to an article in a recent issue of JAMA (Journal of the American Medical Association), the answer may depend more on money than on desire.

In patients with advanced dementia, doctors know that careful feeding by hand is safer and more comfortable for the patients. But because it takes more time, some nursing facilities decide to insert a feeding tube instead. Here’s the kicker–they do it even if patients had previously signed directives asking not to be tube-fed.

Hospitals were more likely to use feeding tubes if they were for-profit hospitals, or if they had a large number of patients. The authors of the study compiled a list of hospitals and feeding tube usage (view it here), so you can look up your facility. In 2003, the New York Times published an article that detailed race also plays a role: Feeding tubes are more likely to be used if the nursing home resident is black or Asian.

Both these articles clearly illustrate how some nursing homes pursue profits at the expense of our most defenseless family members. They are trading compassion and humanity for dollars. This is what we find ourselves fighting against every day.