Wednesday, May 23, 2012

How Caregiver Services Case Managers care and planned things for each and every client they handled:

How Caregiver Services Case Managers care and planned things for each and every client they handled:

As individuals grow older, their needs and lifestyles change. Environmental, social and medical services may need to be reassessed. Case Manager of Caregiver Services can help identify kind of service before a crisis occurs to best meet their needs.

... Case Managers of Caregiver Services assist elderly and disabled adults and their caregivers to decide which services they need in order to remain living in their home.

This service provides an assessment of the individual's environment, social, financial and medical needs. Caregiver Services develop a care plan, coordinate needed services and assist with caregiver issues.

Caregiver Services Case Managers respond when an inquiry or a request for service is made by the individual or someone on the behalf of an individual. These steps include assessment, care planning, monitoring and reviewing.


The assessment process begins when a referral or request is made for services. The Case Managers will begin to gather information with the present problem, the person's condition and what the initial request for service is.

Other information gathered during the face to face assessment may include:

presenting problem or initial request;
the person's present condition and need for services; type of help already provided or tried by family, friends or neighbors; appropriateness of the environment;
eligibility requirements (income, age, level of care, etc.) of programs; and individual's strengths, goals and preferences.

Care Planning

Care planning is the process of developing an agreement between the individual and Caregiver Services regarding problems identified, outcomes to be achieved and services to be pursued in support of goal achievement.

Care planning is based on a comprehensive functional assessment; involves the individual and informal caregivers in the process; is problem oriented and goal directed; plans for a specific period of time; involves planning both formal and informal services; is conscious of costs and results in a written care plan.

Monitoring and Reviewing

Monitoring of a care plan is an ongoing process achieved by regular contact with the individual and caregivers. It is a process by Caregiver Services and the individual reassess the current service plan to determine if it continues to be the best plan possible within the limit of available resources.

Most of the services provided by the Caregiver Services require a formal review of the care plan be done at least every 6 months, or as needed.


When Alzheimer's patient becomes aggressive

When a person with Alzheimer’s becomes aggressive, it is important to try to understand what is causing the person to become angry or upset. Aggressive behaviors may be verbal (shouting, name-calling) or physical (hitting, pushing).

Possible causes
The chief cause of behavioral symptoms is the progressive deterioration of brain cells. However, environmental influences can also cause ...symptoms or make them worse. Aggression can be caused by many factors including physical discomfort, environmental factors and poor communication. Aggressive behaviors can occur suddenly, with no apparent reason, or can result from a frustrating situation. If the person is aggressive, consider the following:

Physical discomfort
Is the person tired because of inadequate rest or sleep?
Are medications causing side effects? Side effects are especially likely to occur when individuals are taking multiple medications for several health conditions.
Is the person unable to let you know he or she is experiencing pain?

Environmental factors
Is the person overstimulated by loud noises, an overactive environment or physical clutter?
Does the person feel lost ?
Poor communication
Are you asking too may questions or making too many statements at once?
Are your instructions simple and easy to understand?
Is the person picking up on your own stress and irritability?
Are you being negative or critical?

How to respond
Try to identify the immediate cause. Think about what happened right before the reaction that may have triggered the behavior.
Focus on feelings, not the facts. Rather than focusing on specific details, consider the person's emotions. Look for the feelings behind the words.
Don't get upset. Don’t take the behavior personally. Be positive and reassuring. Speak slowly in a soft tone.
Limit distractions. Examine the person's surroundings, and adapt them to avoid similar situations.
Try a relaxing activity. Use music, massage or exercise to help soothe the problem.
Shift the focus to another activity. The immediate situation or activity may have unintentionally caused the aggressive response. Try something different.
Decrease level of danger. Assess the level of danger — for yourself and the person with Alzheimer’s. You can often avoid harm by simply stepping back and standing away from the person. If the person is headed out of the house and onto the street, be more assertive.
Avoid using restraint or force. Unless the situation is serious, avoid physically holding or restraining the person. He or she may become more frustrated and cause personal harm.

Alzheimer's Association ...

Thursday, May 17, 2012

National Alzheimer's disease plan unveiled as aging baby boomers' needs drive urgent action

National Alzheimer's disease plan unveiled as aging baby boomers' needs drive urgent action

On the day before he left for Washington to push for a national plan to fight Alzheimer's disease, Roger Bushnell leaned over his mother's wheelchair as always.

"Love ya," the 49-year-old Melvindale man murmured with a quick kiss.

For the first time, there was no answer. Colleen Bushnell, 86, just stared.

On Tuesday, the National Institutes of Health unveiled the first of long-awaited details of the plan, which will focus federal resources to help Americans such as the Bushnells -- both the estimated 5.4 million Americans with the incurable disease as well as their often-exhausted caregivers who, as baby boomers heading toward their retirement years, face increasing odds of developing Alzheimer's and related dementias themselves.

Among the highlights of the plan are two major clinical trials: A $7.9-million effort to test an insulin nasal spray for treating Alzheimer's and a more than $16-million study that focuses on prevention among people at the highest risk for Alzheimer's.

"This is formal recognition that we have a major problem," said Dr. Henry (Hank) Paulson, director of the University of Michigan Health System's Michigan Alzheimer's Disease Center.

According to the Alzheimer's Association, 1 in 8 Americans 65 and older has Alzheimer's, and nearly half of people age 85 and older have the disease.

By 2050, it is estimated that up to 16 million Americans will have it. Or to look at it another way: Someone develops Alzheimer's in America every 68 seconds now; by mid-century, it will be every 33 seconds, according to the Alzheimer's Association.

"I'm a baby boomer, and we're in this tidal wave," said Bushnell, whose father died in 2010 with Alzheimer's and whose mother has been diagnosed with Alzheimer's as well as dementia. "Something has to be done."

Bushnell has spent six years advocating for more awareness of Alzheimer's. In April, he made the more than eight-hour drive to Washington to push for implementation of the national plan, which was required by the National Alzheimer's Project Act (NAPA) passed by Congress last year.

And its goal is ambitious: Prevent and treat Alzheimer's by 2025.

To that end, millions of dollars in new federal money will fast-track research.

For example, a four-month pilot trial at the University of Washington suggests a link between insulin, delivered in a specialized nasal spray, and improved brain function. Fueled by $7.9 million over five years, the expanded study announced Tuesday will recruit 240 volunteers across the U.S. to receive insulin treatment or a placebo.

At the end of the year, researchers will compare cognition, memory and functional performance between the two groups.

A second study, also announced Tuesday, is an international collaboration that focuses on a unique and large family in Colombia whose members share a genetic mutation known to cause observable signs of Alzheimer's disease around age 45.

Researchers want to know whether several years of an antibody treatment, called crenezumab, will clear away abnormal amounts of amyloid -- the telltale protein in the brains of people with Alzheimer's. A smaller group of Americans also is involved in the study, along with the Colombian family, and the National Institutes of Health will contribute $16 million to the effort.

The new plan already has established Unveiled Tuesday, the website offers information on the disease, caregiving and even paying for care and making long-term plans.

Michigan Alzheimer's awareness advocate said they were pleased by the news of the national plan, noting that better understanding of the disease might one day lead to a cure.

In the short run, the plan will help raise awareness, said Dian Wilkins, executive director of the Alzheimer's Association, Greater Michigan Chapter, which is in Southfield. According to the association, as many as one-half of people who satisfy the criteria for Alzheimer's and other dementias have not been diagnosed.

The new website might prompt families to find out more and seek help.

"Hopefully, it (the national plan) has a ripple effect, for families, for practitioners, for social workers," she said.

Bushnell, too, said he was "thrilled" at the announcements Tuesday. But he was sad, as well.

Bushnell's father died with Alzheimer's -- a loving man who grew angry as the disease took hold of his behavior, and he no longer recognized the woman with whom he held hands and whom he showered with kisses.

And these days, Bushnell's mother no longer shows signs of recognizing her son, though sometimes -- if Roger Bushnell catches her at the right time -- she'll sing little bits of an Andrews Sisters song or a Christmas carol with him.

She now stays at Maple Heights Retirement Community, a senior living facility in Allen Park, where her son became executive director after having spent most of his career in the restaurant business. Bushnell said he's lucky -- he gets to see her as part of his job.

Other caregivers wear thin, but get little to no help.

In Michigan, more than 504,000 caregivers contribute to nearly $7 billion in uncompensated care, according to the Alzheimer's Association.

"It's overwhelming -- the extent of the disease," Bushnell said.

By Robin Erb

Detroit Free Press Medical Writer

Tuesday, May 15, 2012

Great caregiver service at work!

Just came from an assessment with a client at City of Commerce referred by one of our Senior Care Resource. Able to finalize a 24/7 personal care service and provided an experienced and reliable caregiver for the client in two hours...Thank you again for the support from Staffing Department Jen... AGN

Strategies to cope with caregiver burnout

Caregiver Burnout

By Dr. M. Ross Seligson

Being able to cope with the strains and stresses of being a Caregiver is part of the art of Caregiving. In order to remain healthy so that we can continue to be Caregivers, we must be able to see our own limitations and learn to care for ourselves as well as others.

It is important for all of us to make the effort to recognize the signs of burnout, I...n order to do this we must be honest and willing to hear feedback from those around us. This is especially important for those caring for family or friends. Too often Caregivers who are not closely associated with the healthcare profession get overlooked and lost in the commotion of medical emergencies and procedures. Otherwise close friends begin to grow distant, and eventually the Caregiver is alone without a support structure. We must allow those who do care for us, who are interested enough to say something, to tell us about our behavior, a noticed decrease in energy or mood changes.

Burnout isn't like a cold. You don't always notice it when you are in its clutches. Very much like Post Traumatic Stress Syndrome, the symptoms of burnout can begin surfacing months after a traumatic episode. The following are symptoms we might notice in ourselves, or others might say they see in us. Think about what is being said, and consider the possibility of burnout.

•Feelings of depression.
•A sense of ongoing and constant fatigue.
•Decreasing interest in work.
•Decrease in work production.
•Withdrawal from social contacts.
•Increase in use of stimulants and alcohol.
•Increasing fear of death.
•Change in eating patterns.
•Feelings of helplessness.

Strategies to ward off or cope with burnout are important. To counteract burnout, the following specific strategies are recommended

•Participate in a support network.
•Consult with professionals to explore burnout issues.
•Attend a support group to receive feedback and coping strategies.
•Vary the focus of caregiving responsibilities if possible (rotate responsibilities with family members).
•Exercise daily and maintain a healthy diet.
•Establish "quiet time" for meditation.
•Get a weekly massage
•Stay involved in hobbies.


Friday, May 11, 2012

Communication to senior with Alzheimer's disease

From Alzheimers Association


Alzheimer's disease can gradually diminish a person's ability to communicate. Not only do people with dementia have more difficulty expressing thoughts and emotions, they also have more trouble understanding others. Here are some tips to help you and the person with dementia understand each other better.
... Changes in communication

The person with dementia may experience changes in communication such as:

Difficulty finding the right words
Using familiar words repeatedly
Inventing new words to describe familiar objects
Easily lose their train of thought
Difficulty organizing words logically
Reverting to speaking in a native language
Using curse words
Speaking less often
More often relying on gestures instead of speaking

Tips for better communication

Let the person know you are listening and trying to understand what is being said.

Keep good eye contact. Show the person that you care about what is being said. 

Let the person think about and describe whatever he or she wants to. Be careful not to interrupt.

Avoid criticizing, correcting and arguing.

If the person uses the wrong word or cannot find a word, try guessing the right one.

If you don't understand what is being said, ask the person to point or gesture.

Focus on the feelings, not the facts. Sometimes the emotions being expressed are more important than what is being said. Look for the feelings behind the words.

Always approach the person from the front. Tell the person who you are.

Call the person by name. It helps orient the person and gets his or her attention.

Use short, simple words and sentences. Talk slowly and clearly.

Ask one question at a time.

Patiently wait for a response. A person may need extra time to process your request.

Repeat information and questions. If the person doesn't respond, wait a moment. Then ask again.

Avoid quizzing. Reminiscing can be healthy, but avoid asking, "Do you remember when...?"

Give simple explanations. Avoid using logic and reason at great length. Give a complete response in a clear and concise way.


Monday, May 7, 2012

Caregivers has wonderful rewards, but can also be very difficult

Caregiving has wonderful rewards, but can also be very difficult.

By Angil Tarach-Ritchey RN, GCM

Relationships can be tested to the limit when there is a caregiver and care recipient within a family relationship.

In a paid caregiving position there are those who have something special within them and those who are just making an income. I think about and meet all types of caregivers on a daily basis.

Not everyone is suited to provide care in a family situation or as a paid position. So what are the characteristics that an excellent caregiver has? I believe there are 5 core qualities an excellent caregiver possesses.


My belief is empathy is the #1 core characteristic of an excellent caregiver. I often question if this is inherent within us or this is something which can be learned?

I tend to believe it’s a lot of inherent and a big mix of environment. I also believe there are degrees of empathy. Some can empathize more than others. If you can totally put yourself in the place of who you are caring for, you will do nothing but provide excellent care.

The question is always how would I want to be treated and taken care of under these circumstances? If that is the core basis for how you provide care you will provide caring, compassionate, and dignified care with a great attitude.


Someone who is in need of care has lost some degree of independence. They have to be able to depend on the person or people providing assistance to them.

Imagine being unable to obtain your own meal, bathe yourself, get dressed, or go to the bathroom independently. Imagine the feelings involved when you lose that independence and have to ask for help. Imagine having no one to count on when you need them.

It is difficult enough for a person to lose independence without having the added burden of finding someone reliable to help them. When you provide care, it is crucial that you are dependable. So many vulnerable seniors’ lives depend on the assistance and care of another to live a safe and happy life.


Besides children, most care recipients are elderly. As we age our bodies no longer move the way they used to. Add an injury, or physical illness and movement is more difficult, slower and may be painful.

Parts of our bodies may not work at all, such as after a stroke, or with a disease such as advanced Parkinsons, or arthritis. With an illness of the brain, such as Alzheimer’s there is memory loss, and loss of the ability to process information.

These are some of the examples that would cause someone to move slowly, respond slowly or repeat conversations. It takes a patient person to provide care when we can move and process quickly, but the person we are assisting cannot.

I often see caregivers contribute to loss of independence because of impatience. We are in a hurried society and typically spend our lives in a fast pace. It can be difficult to slow down to the pace of the person we are caring for, but it is crucial in excellent caregiving.

A good rule is to allow a person to do as much as they can for themselves, and to avoid doing things for a person they can do for themselves. Doing too much contributes to the loss of physical abilities and increased dependence. It can also damage the dignity of a person and this that is an important part of their mental health and quality of life.

Give the care recipient ample time to comfortably be assisted with their activities of daily living (ADL’s), and to complete as many tasks as possible on their own. If you aren’t patient, you will end up providing more care, not less. Use the time to slow down your hurried life and enjoy the process of caregiving.

Persons with memory loss will repeat questions, and comments. This can be enough to test anyone’s patience when you’ve heard the same question 30 times that day.

Here again, empathy is needed. EVERY single time a person with dementia asks a question, they truly believe it is the very first time they have asked it. You MUST respond as if it’s the first time you heard the question askeded.

I cringe when I hear a caregiver tell a care recipient with dementia, “I just told you”, or “don’t you remember?” This vulnerable person affected by this horrible disease truly doesn’t remember you just told them, and they honestly cannot remember.

These responses typically come with a frustrated tone of voice, and sometimes anger. Again, empathy counts! Imagine asking someone a question for the very first time, and they respond in an angry voice and scowl, and you know you never asked them before. Rather than getting to this point of frustration become a pro at redirection!

Sometimes redirection can take awhile to start working because dementia can cause someone to get fixated on something, but the better you get at it, the less your patience will be tested. Direct the care recipient towards something they enjoy, or change the conversation to a joyful time earlier in their life. Photo albums are always helpful in redirection.

If the care recipient is angry, and uncooperative, give them space, and a bit of time. If they are not in danger of hurting themselves or others remove yourself from the situation. Give everyone time to breathe and calm down. Wait 15 or 20 minutes and reproach in a calm and loving manner. If the source of the frustration is a task that can be put off -- put it off. If it’s something that needs to take place as soon as possible, like changing an incontinence brief, try a different approach.


As I mentioned above, caregiving can be very difficult. Whether you are paid or unpaid there will be days and times when you feel like you are at your limit.

You may be having a bad day yourself, the care recipient may be having a bad day, or you are just burned out. Times like these call for strength.

You must be strong enough to recognize when you are in need of time off, when you need to adjust care, when you need to dig deep within yourself for patience.

Caregiver’s seem to be in a frequent battle with the outside world regarding advocacy and fighting for services, or through red tape of insurance, or healthcare bureaucracy. It takes a lot of patience and strength to advocate for your care recipient.

Recognize what your weaknesses are and when to get additional assistance. If you get frustrated and exhausted it will not only affect you, but it contributes to the person you’re caring for feeling like a burden, and everyone loses.

Take time off, get additional assistance, and again put yourself in a place of empathy. Caregiving is not for sissy’s!

5. Flexiblity

Caregivers have to be some of the most flexible people I know. Things can change in an instant when you are caring for someone.

Family members can be called home from work, need to get their loved one to the doctor, or hospital. The health situation can fluctuate, and personality and behavior can change on the drop of a dime.

Paid caregivers can lose a client to a hospital admission, have to stay on their shift longer because of a health crisis, or get a new patient at the last minute. There are constant schedule changes, and client changes. You must be open to change because whether you like change or not, it will happen.

People who value strict schedules and sticking to a routine have a lot of difficulty in the caregiving role. I have spent my career knowing that as soon as I have my day planned out something is sure to change and I will have to tend to whatever has become the priority. Caregiving is best for people who can adapt quickly, and accept change easily.

There are other qualities and characteristics I could talk about, but I believe those stem from the core 5. Being kind, and gentle stems from empathy and patience. Obtaining the best healthcare possible is a result of empathy and strength. Keeping the care recipient safe comes from empathy, dependability and strength. Every situation and every caregiving moment spent will require empathy.

Whether you are providing care now or will be in the future, you have to ask yourself if you are able to put yourself in the shoes of the person, or people you care for.

This requires you to be judgment free of their situation, and have the ability to understand what it must feel like in their place.

If the person has advanced Alzheimer’s, take yourself to the place it would be like when they were healthy, and then started to realize they couldn’t remember things, or lost their way. Understand how it felt to receive the diagnosis of Alzheimer’s, knowing there is no cure and your abilities will most likely diminish. Think about what it would be like to have a stranger bathe or dress you.

If you can do those things, you will always provide care that is of the best quality possible. If you cannot, I recommend alternative care for a family member or another choice of career.

Care recipients deserve no less than the best we have to offer.

Angil Tarach-Ritchey (RN GCM) has over 30 years of experience, and is a nationally known expert in senior care and advocacy.

Early Alzheimer's sign - loss of smell

Loss of Smell, an Early Alzheimer’s Sign, Reversed in Lab

A poor sense of smell may be one of the earliest signs of Alzheimer's. Now, researchers have shown that the offending culprit may be beta-amyloid, a protein that builds up in a toxic form in the brains of those with the disease.
Working with laboratory mice that had been bred to develop a disease that resembles Alzheimer's in people, the scientists from Case Western Reserve University School of Medicine showed that removing the plaque-forming protein restores the animals' sense of smell. Researchers believe that the smell centers of the brain may be among the first areas affected by toxic beta-amyloid, followed by brain areas critical for memory and thinking.
“Understanding smell loss, we think, will hold some clues about how to slow down this disease,” said Daniel Wesson, assistant professor of neuroscience at Case Western Reserve and lead investigator for the study, which was published in The Journal of Neuroscience.
Loss of the sense of smell can be caused by many conditions other than Alzheimer’s, including medications, viral illnesses or injuries to the olfactory systems. But a poor sense of smell has also long been recognized as an early sign of Alzheimer's. It may also be an early sign of mild cognitive impairment, a form of memory loss that sometimes precedes Alzheimer's. Not all people with Alzheimer’s lose their sense of smell.
The new research shows how and where in the brain this happens, and that the impairment is likely to be treatable.
Mice exposed to a very minute amount of beta-amyloid lost their ability to detect odors. Plaques made up of the toxic proteins appeared in the rodents' brain areas responsible for smell long before they showed up in areas important for memory. The mice spent more time sniffing than usual but became incapable of remembering smells or telling the differences among odors in lab experiments.
The research team then sought to reverse the effects. The mice were given a drug that clears beta-amyloid from the brain. After two weeks on the drug, the mice could process smells normally. After withdrawal of the drug for one week, impairments returned.
Like the mice in the study, people with Alzheimer's may have a poor sense of smell and be unable to detect common odors like natural gas or roses. But no drugs are currently available that clear beta-amyloid from the brain, though scientists continue to test new candidates.
“The evidence indicates we can use the sense of smell to determine if someone may get Alzheimer’s disease, and use changes in sense of smell to begin treatments, instead of waiting until someone has issues learning and remembering,” Dr. Wesson said. “We can also use smell to see if therapies are working.”
The researchers are continuing their research to determine how beta-amyloid spreads through the brain, and to find new ways to slow its spread and stop the progression of disease.
By, The Alzheimer’s Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer’s Disease Research at The Rockefeller University.
Source: The Journal of Neuroscience, Nov. 2, 2011. Case Western Reserve Medical School.

A New Type of Brain Scan to Detect Alzheimer’s Early

A New Type of Brain Scan to Detect Alzheimer’s Early

A new type of brain scan may help to detect Alzheimer's early, using no radiation and at less cost than other techniques, researchers report. Doctors at the University of Pennsylvania's Perelman School of Medicine have developed a form of magnetic resonance imaging, or MRI, that detects brain changes that signal Alzheimer's disease. The doctors have developed a modification to the technique called arterial spin labeling, or ASL-MRI. Small studies show, this may be a useful way to diagnose probable early dementia.

MRI scans are routinely used in hospitals to check for tumors and other issues, and seniors with memory problems may undergo the procedure to rule out brain tumors, strokes or other problems that may be causing the deficits. If Alzheimer's is suspected, they may then undergo another scanning procedure, such as a PET scan.

The advantage of the new ASL-MRI technique is that someone could undergo brain scanning in a single session to help determine whether Alzheimer's may be present. The technique looks for changes in blood flow and the uptake of blood sugar, or glucose, in the memory centers of the brain. It requires about an additional 20 minutes compared to standard MRI scans.

"Increases or decreases in brain function are accompanied by changes in both blood flow and glucose metabolism," explained Dr. John Detre, professor of Neurology and Radiology at Penn, who has worked on ASL-MRI for the past 20 years. "We designed ASL-MRI to allow cerebral blood flow to be imaged noninvasively and quantitatively using a routine MRI scanner."

Studies show that the MRI method is similar in effectiveness to current PET scans that inject a radioactive dye to measure these brain changes. However, the ASL-MRI method uses no radiation and costs one-fourth as much.

"If ASL-MRI were included in the initial diagnostic work-up routinely, it would save the time for obtaining an additional PET scan, which we often will order when there is diagnostic uncertainty, and would potentially speed up diagnosis," said Dr. David Wolk, Assistant Director of the Penn Memory Center and a collaborator on the research.

The studies compared the MRI technique and the specialized PET scan results using flurodeoxyglucose, or FDG, a radioactive tracer. In one, published in the journal Alzheimer's and Dementia, doctors compared images from 13 patients diagnosed with Alzheimer's and 18 age-matched controls. Both methods proved equally effective in detecting signs of early Alzheimer's. In the second study, published in the journal Neurology, data from 15 AD patients were compared to 19 age-matched healthy adults. The patterns of reduction in cerebral blood flow were nearly identical to the patterns of reduced glucose metabolism by the PET scan and showed reductions in brain gray matter typical of Alzheimer's disease.

"Given that ASL-MRI is entirely noninvasive, has no radiation exposure, is widely available and easily incorporated into standard MRI routines, it is potentially more suitable for screening and longitudinal disease tracking than FDG-PET," said the Neurology study authors.

Early diagnosis of Alzheimer's in the doctor's office has long been a goal for those who treat dementia. Increasingly, experts believe that Alzheimer's is a disease that begins many years before symptoms like memory loss and personality changes become apparent. Treatment of the disease may be most effective in these early stages, before damage to the brain has become extensive. In addition, a simple test to measure brain function would be useful for researchers to test and monitor new treatments.

Additional studies of this new MRI technique will focus on larger sample sizes, including patients with mild cognitive impairment and other kinds of brain problems.

By, The Alzheimer's Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer's Research Foundation at The Rockefeller University.

Source: American Academy of Neurology. Musiek ES, Chen Y, Korczykowski M, et al: "Direct Comparison of Flurodeoxyglucose Positron Emission Tomography and Arterial Spin Labeling Magentic Resonance Imaging in Alzheimer's Disease." Alzheimer's and Dementia, Oct. 20, 2011, epub ahead of print.

Sunday, May 6, 2012

Communicating in Alzheimer's World

After repeatedly correcting my mother, telling her she just ate, and watching her get frustrated or angry, I finally realized something had to change -- this something was me. I had to change.

By B. DeMarco
Alzheimer's Reading Room

It takes a lot of energy, learning, and patience to deal with Alzheimer's disease.

In order to begin the process of dealing with communication in a world filled with Alzheimer's you first need to make a simple important decision -- you want to decrease both your stress as caregiver, and the stress of the person suffering from Alzheimer's.

Read that carefully, you want to reduce stress. You want to change the dynamic. You want to change for the better -- you want and need to change the way things are.

You might be wondering why I just repeated myself. Why? Because I believe it is necessary to get focused on what you want to accomplish, if you ever expect to accomplish. It must become a deep and strong desire within you.

A goal.

For example, my mother, Dotty, continually tells me she is hungry. She does this repeatedly, just minutes after she has finished eating lunch or dinner. When a person says something that doesn't make sense the natural tendency is to correct them. In this case, I would remind my mother over and over that she wasn't hungry because she just ate.

Ever done that or something similar raise your hand?

We do this because we have a problem accepting that a person suffering from Alzheimer's does not remember. In the case of my mother, she does not remember that she just ate. She can't remember she just ate, so she says she is hungry.

After the thousandth or so time of correcting my mother, telling her firmly she just ate, and watching her get frustrated or angry, I finally realized something had to change -- this something was me. I had to change.

I want to interject here that my mother even after seven years still tells me she is hungry right after eating. She frequently tells me after breakfast and lunch that she hasn't had a thing to eat all day. She tells people on the telephone at night -- I haven't had a thing to eat all day. She -- honestly -- believes that what she is saying is true.

Why is it so hard to understand that a person suffering from Alzheimer's forgets?

Why is it so hard to understand and accept they can no longer store the memory of what just said, or what they just asked -- in their brain? They cannot store the answer to the question you just answered in memory, so they just keep on asking the same question over and over.

Like you and me, they ask questions. The questions come from a different part of the brain then the part that is sick.

My guess is that you experience the frustration of hearing your loved one repeating words that you believe to be untrue over and over. You see and experience the same crazy behaviors over and over.

What you believe to be true and what the person suffering from Alzheimer's believes to be true are often diametrically opposed. The exact opposite.

Here is the one thing you need to understand. Your view of reality and your loved one's view of reality might be very different. This occurs because their brain is sick and they can't remember simple things that are easy for you to remember.

Ask yourself, what are you doing and how are you reacting when someone suffering from Alzheimer's says something you know to be incorrect or untrue?

What are you feeling when this happens?

Are you constantly correcting them?

If you are constantly correcting a person suffering from Alzheimer's are you also experiencing enormous feeling of frustration and stress?

When you correct them do you start to feel angry, stressed, and/or disconcerted?


Sooner or later you must make a decision.

Do I want to do this for the next ten years? Do I want to feel like this for the next ten years? Or, is there an alternative?


This isn't simple to do, but it is necessary -- you need to start accepting that when a person suffering from Alzheimer's says something they believe to be true it is in fact a reality. It is their reality. When they continually repeat themselves they do it because they can't remember. There is no sinister plot here. Brain sick, Brain not functioning properly.

Welcome to Alzheimer's World.

Don't be afraid or reluctant to step into this new and very different world.

In Alzheimer's World, reality takes on a different shape.

Reality in Alzheimer's World is a reflection of what the person suffering from Alzheimer's thinks and believes. It is this reality that you must focus on, not the way YOU think things are, or should be.


I feel confident when I say this -- you won't be able to convince a person suffering from Alzheimer's that they are wrong, and you won't be able to convince them that your reality is the true reality. They can't remember like you or me, so they really cannot comprehend your point of view.

When you do this you are asking the person suffering from Alzheimer's to come back into your world. They cannot do this.


Think about what I am saying here. I am asking you to develop a frame of reference, a new and different behavior that is one hundred percent diametrically opposed to the way you think and act -- the way you think and acted for your entire life.

This isn't easy. It could be one of the hardest things you ever try to accomplish.

Even though I was well aware of what I needed to accomplish, trying as hard as I could, it still took years to get there -- to get into and comfortable with Alzheimer's World.

Once I made it into Alzheimer's World I reaped rewards that are hard to describe.

When you make it to Alzheimer's World you begin the process of redefining reality. Instead of trying to brow beat your loved one back into your reality, you start to interact with them based on their view of reality.

For example. When my mother says, I am hungry, I'm starving -- I say OK, we will eat in a little while. Instead of telling her -- you just ate, you can't be hungry.

If she asks how long before we eat, I don't say in two hours -- I say, in half hour or soon. The soon in this sentence means when it is time to eat. Either half hour, or when it is time to eat.

Instead of an argument, my mother now reacts positively to this response.

Over time, my mother started saying something she never said before, instead of saying I'm hungry, I am starving, she sometimes says -- Bobby, what did I eat today?

When I answer by recounting our meals, she still makes a funny face, the face of disbelief, but she doesn't get angry or upset, and neither do I.

When I answer my mother I am in Alzheimer's World. I'm calm, and my voice is calm, I am not showing her that I am exasperated by these questions. Why? Because I am not. This is how you learn to communicate in Alzheimer's World.

When I recount to her what she has eaten I have to be very careful. Careful to tell her with a smile on my face, and in a low calm voice. Not like a lecture. If she gets that bewildered look on her face -- confusion -- that is OK because I can then change the topic.

On the other hand, if I allow my mother to get angry and disconcerted then she will start going into the black hole of Alzheimer's World.

When my mother goes into the black hole, I can feel the Alzheimer's trying to drag me into the black hole. If this happens, I am the one that end up with a sore heart or stomach ache.

By listening to her lament -- I am hungry, I'm starving -- and by responding to her reality rather than correcting her -- the communication between my mother and me has improved. The amount of anger, stress and angst is greatly reduced. On both sides.


This new form of communication leads to stress, anger, and angst reduction. It seems to have a cumulative effect. Less stress build up across a series of situations, leads to less anger and nutty behavior from my mother.

Less conflict, fewer explosions. More happiness.

Better caregiving result.


The goal in all communications with a person suffering from Alzheimer's disease should be to connect with the patient in a positive, constructive, effective way.

So instead of telling my mother -- you just ate. I accept her reality that she is hungry and respond in a positive proactive way.

What you want to be doing here is trying to establish a positive pattern of communication?
This requires you to develop calm, effective responses that are easily accepted by the person suffering from Alzheimer's disease.

By establishing positive patterns of communication over a series of situations you learn how to deal with the new reality that is at the core of what I call Alzheimer's World.

The more you practice the better you get at it.

Before you know it, Alzheimer's World becomes another dimension in your life. You learn how to operate effectively in this world. Instead of a sinister, confusing world it becomes a parallel universe.

The place you go to when you want to communicate with someone suffering from Alzheimer's disease.

Once you learn how to do this you start communicating in a way that works for both parties -- the caregiver and the patient.


I feel very confident when I say this. While a person suffering from Alzheimer's can't remember, they are full of feelings and emotions.

As a caregiver, when you try to correct a person with Alzheimer's you are likely to bring out a negative emotion in them. How would you like to be told over and over -- you are wrong?

How would you act?

What emotion would you be likely to express?

Would you like the person that is constantly telling you -- you are wrong?

I'll let you decide the answer.


Effective communication with someone suffering from Alzheimer's requires you to identify the emotion behind the person’s words. To learn ways to address what they are feeling and to validate those feelings.

Right now, it is likely that when a person suffering from Alzheimer's says something that is opposed to reality -- as you understand it -- that you immediately feel an urge to correct them (or worse).

Is this you?

You aren't listening when you do this. You are making the situation about you and your feelings -- not about them. You are trying to drag the person into your world -- this is unlikely to happen and it rarely, if ever, works.

You want to avoid any and all situations that lead to an argument.

When an argument ensues it is likely that the person suffering from Alzheimer's gets agitated and says those mean and angry words you dread.

Instead of creating a secure, safe, calm environment you are perpetuating a state of agitation and angst. When you do this it only gets worse over time.

Ask yourself, is this what you want to accomplish? Who is at fault? How can this dynamic be changed?

If you are caring for someone with Alzheimer's you will need to go into their world -- Alzheimer's World.

The first steps are to start listening to what they say. To accept what they are saying as a "reality". They believe it to be true, why can't you?

Understanding that Alzheimer's World's reality is different -- is a big and important step. A necessary step to communicating effectively with someone that suffers from Alzheimer's.

While you are at it try and remember this. They have Alzheimer's. You are the caregiver. It really is up to you to change. It is up to you to adjust.

The person suffering from Alzheimer's would adjust if they could -- they can't.


I want to close by giving you this construct.

I often think of my mother and myself as two magnets. Every magnet has two fields -- a north pole and a south pole.

If you put the two north poles together (or south poles) the two magnets will repel each other.

If you put the two opposite poles of a magnet together they will attract each other. They will stick together (like glue).

Once you learn to put these two opposite poles together your life as an Alzheimer's caregiver will change. On the other hand, if you keep trying to put the same poles together they will continue to repel each other.

Once you accept Alzheimer's World and learn how to operate in Alzheimer's world you'll learn how use your opposite pole. You learn that opposites can indeed attract. And, stick together like glue.

This is a very pleasant and rewarding way to feel.

I'm not the only one that knows this.

My name is B. DeMarco, I am an Alzheimer's caregiver. My mother Dorothy, now 94 years old, has Alzheimer's disease. We live our life one day at a time.

Saturday, May 5, 2012

"Caregiver University" continuing to train & develop quality caregivers

Another batch of trainees finishing Phase 1 Training during "Caregiver University" training May 4. Positive feedback from participants learning new skills that will help them provide the best senior care and compassion needed by elder clients. Caregiver Services & Homecare Inc. offers a unique advantage of providing inductive training in its homegrown "Caregiver University" that have changed paradigm of trainees in relation to how best they can perform senior care at its highest standard. No other Homecare company offers such benefit to their employees. It becomes so compelling to this organization to continously search for learning modules that will further help our people face the challenges of the ever changing condition of Alzheimer, Dementia, Parkinson's and other debilitating disease that warrants help from our caregivers. The company is committed to build a strong and efficient 'Operating System' and 'business process' while continuing to search & hire caregiver employees and managers equipped with both good "Character & Competence" set at a highest standard that can never be equalled by any existing Homecare company. Visit our site and see how you can benefit from its unique offering whether you are a senior or a qualified caregiver.

Wednesday, May 2, 2012

Helping senior clients

A feeling of fulfillment and confidence when you know you are supported by the Head Office- Staffing Department -Jen- who has helped and assisted me in staffing our senior clients in Santa Monica area with experienced and reliable caregivers...Salute to Caregiver Services Group...AGN

Tuesday, May 1, 2012

The most common issues of aging.

What are the most common issues of aging?

Q: What are some of the most common issues facing the elderly?

A: Thanks to new medications and surgical techniques, people are living longer. However, the body we had at 55 will be a very different body than the one we have at 75. Many issues, both genetic and environmental, affect how we age.

The most widespread condition affecting those 65 and older is coronary heart disease, followed by stroke, cancer, pneumonia and the flu. Accidents, especially falls that result in hip fractures, are also unfortunately common in the elderly.

A lot of our elders are coping with at least one of the following conditions, and many are dealing with two or more of the following:

·         Heart conditions (hypertension, vascular disease, congestive heart failure, high blood pressure and coronary artery disease)

·         Dementia, including Alzheimer's disease

·         Depression

·         Incontinence (urine and stool)

·         Arthritis

·         Osteoporosis

·         Diabetes

·         Breathing problems

·         Frequent falls, which can lead to fractures

·         Parkinson's disease

·         Cancer

·         Eye problems (cataracts, glaucoma, Macular Degeneration)

As the body changes, other things to be aware of are:

·         A slowed reaction time, which is especially important when judging if a person can drive.

·         Thinner skin, which can lead to breakdowns and wounds that don't heal quickly

·         A weakened immune system, which can make fighting off viruses, bacteria and diseases difficult

·         Diminished sense of taste or smell, especially for smokers, which can lead to diminished appetite and dehydration

The list can seem daunting. However, with proper care, elders have a life filled with joy.

Susan Levy, M.D., is the Vice President of Medical Affairs and Medical Director at Levindale Hebrew Geriatric Center and Hospital in Baltimore, Maryland.

Elderly population and data trend

AC Shared good article:
Care for the Elderly
Ethics at the Twilight of Life: Our Obligation To The Elderly
Michael McKenzie

Did you know that:
■ Some 20 percent of all people who have ever lived past age 65 are alive now!
■ In 1860, half the population of the United States was under age 20, and the vast majority of the population was not expected to live to age 65.
■ From 1990 to 1996, the number of Americans 65 or older increased elevenfold (from 3.1 million to 33.9 million). The overall percentage of the population 65 and older increased from 4.1 to 12.8
■ In 1940, just 7 percent of those age 65 would survive to age 90; by 2050, the number will climb to an astonishing 42 percent!
■ In just 30 years, the number of people in the United States over 65 will more than double to reach 70 million people!
■ Such growth means that nearly 1 in 5 Americans will fit this category, up from 1 in 100 in 1900.

The significance of our aging population goes far beyond seeing more gray hair in the supermarket checkout lines. Elderly people often fall prey to chronic diseases that, more often than not, don’t kill outright, but leave the sufferers with pain, difficulty in performing routine tasks, and in need of health care that calls for both increased dollars and specialized personnel. As our society becomes more “gray,” who will foot the increasing medical bills for the elderly? Furthermore, such longevity has steadily increased the gap between retirement and death. Designed for a time when death followed quickly on the heels of leaving one’s job, will Social Security be there for future generations?