Wednesday, September 26, 2012
Caregiver Services stands for our employees who are:
Posted by Caregiver Services at 6:44 PM
Thursday, September 13, 2012
Studies: Alzheimer drug may stabilize brain plaque
By MARILYNN MARCHIONE | Associated Press – Tue, Sep 11, 2012
An experimental drug that failed to stop mental decline in Alzheimer's patients also signaled potential benefit that suggests it might help if given earlier, fuller results of two major studies show.
Some patients on the drug had stable levels of brain plaque and less evidence of nerve damage compared to others who were given a dummy treatment, researchers reported Tuesday.
The drug is called bapineuzumab (bap-ih-NOOZ-uh-mab), made by Pfizer Inc. and Johnson & Johnson. The new results suggest it might work if given sooner, before so much damage and memory loss have occurred that it might not be possible to reverse, experts say.
"We're very disappointed that we were not able to come up with a treatment to provide to our dementia patients in the near term," said Dr. Reisa Sperling, director of the Alzheimer's center at Brigham and Women's Hospital in Boston and leader of one of the studies.
But brain imaging and spinal fluid tests are "very encouraging" and suggest the drug was "doing something to the biology of the disease."
"We've got a path forward" now to test it in people with mild mental impairment or those who show plaque on brain imaging but have not yet developed symptoms of dementia, Sperling said. Of people with mild cognitive impairment, about 15 to 20 percent a year will develop Alzheimer's disease.
About 35 million people worldwide have dementia, and Alzheimer's is the most common type. In the U.S., about 5 million have Alzheimer's. Current medicines such as Aricept and Namenda just temporarily ease symptoms. There is no known cure.
This year researchers had been hopeful of major progress in treating the disease, but study after study has proved disappointing, including results reported earlier on bapineuzumab. The drug failed to slow mental decline or improve activities of daily living for patients with mild to moderate Alzheimer's in two studies in the United States and Canada.
Bapineuzumab is designed to attach to and help clear amyloid, the stuff that makes up the sticky plaque that clogs patients' brains, harming nerve cells and impairing memory and thought. Doctors don't know whether amyloid is a cause or just a symptom of Alzheimer's, but many companies are testing drugs to try to remove it.
Sperling's study involved people with a gene that raises the risk of developing the disease. Dr. Stephen Salloway, a neurologist at Brown Medical School in Providence, R.I., led the other study of people without the gene. Both researchers have consulted for the companies that make the drug and presented results Tuesday at a neurology conference in Stockholm.
Brain imaging on a subset of patients in Sperling's study found 9 percent less amyloid in those on bapineuzumab compared to those on a dummy treatment. The drug group had stable levels while the others developed more plaque. Spinal fluid tests on some participants also showed the drug group had less of another substance called p-tau that is released when nerve cells are damaged.
There were potential safety concerns, including six deaths from various forms of cancer among those on bapineuzumab and none in the placebo group. But a wider review of all studies of the drug found that cancer was not more common among users.
"That's not raising any red flags," said an independent expert, Dr. Maria Carrillo, a senior scientist at the Alzheimer's Association. She said the biological changes suggest the drug is helping, so if it's used sooner, "we can perhaps affect cognition."
Salloway's study produced less evidence of benefit. Too few participants had brain imaging to make definitive conclusions about amyloid, and there was just a trend toward less of the nerve-damage substance in the group receiving the higher of two doses tested.
The hopeful signs on biomarkers are "the silver lining" in studies that failed to show the drug was helping patients, said Dr. Eric Yuen, head of clinical development for J&J's Janssen Alzheimer Immunotherapy unit.
Bapineuzumab is given as periodic intravenous infusions, and the companies have said they are stopping development of that form but continuing to test a version that can be given as a shot.
More results on this drug and a similar one — Eli Lilly & Co.'s solanezumab — will be presented at a conference in Boston next month. Lilly recently announced that combined results of two large studies of solanezumab suggested some benefit on cognition.
Posted by Caregiver Services at 7:45 AM
Saturday, September 8, 2012
The Four Phases of Resolution for Alzheimer cases as role played by Naomi Feil (Speaker & author of Validation Therapy for Alzheimer's)
Phase 1 Mal-Orientation
Phase 2 Time-confusion
Phase 3 Repetitive Motion (becomes non-verbal)
Phase 4 Vegetation (minimum movement & no speech) ---> Click & watch:
Posted by Caregiver Services at 9:39 PM
Tuesday, September 4, 2012
A great reading for ‘Baby Boomers’ with parents living in Los Angeles area, Orange County, San Bernardino County and Ventura County area to help them make a decision how they can hire an At-home or In-home Caregiver for their family members.
How to Hire an At-Home Caregiver
By Lisa Trottier, Caring.com
When your parents start struggling with everyday tasks, hiring a home care aide can help them remain in their home -- and take some pressure off the rest of the family. Here's help on finding the best care possible.
What is a home care aide?
At-home caregivers fall into three categories: certified nursing assistants, home health aides, and personal care attendants. Certified nursing assistants (CNAs) have some medical training and must pass an exam to get a license. They generally work under the supervision of registered nurses. CNAs can check vital signs, care for wounds, and help your parents with everyday activities like bathing and eating (you'll often hear these referred to as "activities of daily living," or ADLs). Home health aides generally assist with ADLs. And personal care attendants (PCAs), also sometimes called personal companions, assist with household chores like cooking, cleaning, and shopping. The job descriptions of these caregivers can overlap considerably, and they're often referred to interchangeably.
Your first hiring decision: agency versus independent
Hiring a home care aide through the classifieds or word of mouth is usually the least expensive option. But you should know that it might create unexpected liabilities for your family, which legally becomes the employer. For example, you'd be held liable for any costs related to an injury that happens on the job, including medical expenses and disability payments. This may not apply if you hire your worker as a contractor, but having a "freelance" aide rather than an employee may not create the long-term solution you're hoping for -- high turnover plagues this industry. That said, hiring someone on your own can be a good idea if you have a personal connection or a strong endorsement from a friend.
If you hire an at-home caregiver through an agency, hourly rates tend to be higher (often significantly higher), but the agency will pay the FICA taxes, cover the worker's liability insurance, and fill out the W-4 and W-2 forms. "Once you factor in taxes and insurance, it really comes out to close to the same price," says Jacqueline Dollar, a geriatric care manager in Des Moines, Iowa.
Also, because an agency has a stable of caregivers, you might be able to try out a few and find just the right aide for your parents. "With an agency, you also have the right of refusal," says Anita Silverman, a geriatric care manager in Lake Worth, Florida. "The agency can replace the person if the arrangement doesn't work out." An agency may be able to provide a substitute caregiver if your primary home aide is out sick or on vacation, which can save you a lot of frantic last-minute phone calls.
Keep in mind that agency caregivers are bonded and insured, and they're trained in the basics of care, and usually in CPR and first aid as well. Agency employees are expected to abide by an ethics policy and company rules. And agency CNAs may also have nurses checking in on them to make sure all is well and to offer advice.
Particularly if you live far from your parents, or don't want to get involved with supervising an at-home caregiver day-to-day, an agency can do some of that for you.
Finding a gem of an at-home caregiver
Whether you choose to hire independently or go through an agency, doing some homework on your candidates will help ensure that you hire a reputable worker.
An excellent way to find a high-quality agency is Medicare's new Home Healthcare Compare tool, which allows you to search for agencies in your area that have met with Medicare's approval. The site gives a summary of statistics on the quality of each agency, such as "percentage of patients who get better at walking around," that you can use to guide your decision.
Also look for an agency that's licensed (if state law requires it) and that has liability insurance. Check to make sure the agency's caregivers are bonded and insured and that they're screened for communicable disease like tuberculosis, since the elderly are especially vulnerable to these.
If you hire someone yourself, it's a good idea to find an individual who has (or who once had) a home health aide license, so you know a registered nurse has trained the person in the basics of care. Also get a criminal record check from a service such as Intelius or SentryLink and always call references. There are always a few bad apples who'll take advantage of vulnerable clients -- make sure you don't unwittingly hire one. "If the person doesn't want to submit to a reference check, that's not the person you want -- it's a big red flag," says Dollar.
It's important to find an at-home caregiver your parents are comfortable with. When you're interviewing caregivers, include your parents and make sure they interact well with the aide. Do they communicate well with each other? Are there language barriers? Do your parents enjoy the person's company? "Having shared interests can make a big difference," says Dollar. "One of my clients loved NASCAR and found a home health aide who did, too. They immediately hit it off."
Navigating the paperwork
If you choose to hire an at-home caregiver independently, the first thing you need to decide is whether to treat the person as an employee or as a contractor. If you hire an employee, you'll be legally responsible for paying taxes and benefits such as Social Security and Medicare (FICA), income tax withholding, and unemployment tax. Payroll preparation agencies such as Paycycle and SurePayroll can help you with the accounting and paperwork.
If you hire the worker as a contractor, you'll still have to file a 1099 form with the IRS on any wages you pay over $600 per year. However, the aide would be responsible for paying her own taxes.
If you choose to hire independently, you may want to consult a lawyer and an accountant to make sure you're meeting your legal and financial obligations to the employee and to the state and federal governments.
Forming a tag team
If your parents need full-time care, you'll need to hire at least two caregivers. Nobody wants to work seven days a week, complications will arise in any aide's schedule, and turnover is really high in this field, so if you hire two at-home caregivers, they can trade off and you can protect yourself from being left in the lurch with no help. One way to ensure a smooth handoff is to schedule a half hour of overlap between their shifts so that they can debrief each other on any issues that may have come up during the prior day or shift. If they work on different days, ask them to keep notes in a designated notebook about changes in routine or any concerns.
If you hire the caregiver through an agency, ask about backup provisions for when your aide is sick or on vacation -- or if he quits the agency. Does the agency provide an alternate? Is there an extra charge for this service?
Setting clear expectations
"One big mistake people make when hiring an aide is to say, 'Your job is to take care of Dad,'" says Dollar. "That's not good enough -- you need a detailed job description." Do you expect the aide to cook? Clean? Do laundry? Pick up medications from the pharmacy and run errands? Will she bring her own lunch or cook and eat with your parents? You need to make your expectations clear. You also need to tell the aide when her routine evaluations and raises will occur. If you put all these details in writing, you won't run the risk of disappointment once you've hired your aide, and you'll have better luck keeping her on board.
"You should also enlighten your parents about what they should -- and shouldn't -- be asking for," says Silverman. If the contract doesn't say the aide will wash the floors, your parents shouldn't demand it.
Setting clear rules about food and cooking is also important, says Silverman. "One problem I often see is that the way the aide eats may not be the way the parents eat. You need to make sure an aide will shop and cook for your parents' dietary needs, not according to her own habits."
Keep in mind that aides are employees; don't try to make them your friends. "People are so happy to have help that they often treat the employee like a friend, and that creates problems down the line," says Dollar. If your employee thinks of herself as your pal, she may be more likely to take liberties such as bringing her kids or pets to work, or she may bridle when you assert your authority and request a change. The bottom line: keep it professional.
Posted by Caregiver Services at 7:18 PM
Saturday, September 1, 2012
Caregiver Services stands for our employees who are:
Posted by Caregiver Services at 10:10 PM