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What to do when the person with dementia asks the same questions

by Monica Heltemes on 9/24/2014 to Dementia Activities

new resource, "Ask the OT". Caregivers often have questions or situations that come up in dementia care. Although one answer never fits all situations, having different perspectives on the issue can help - in this case the perspective of an occupational therapist (OT).

Why does the person with dementia say the same things over and over?

The easy answer, but one that can be hard to keep in perspective, is that the person does not remember that he or she already told you that piece of information or story. Yes, in literally seconds, the person can have forgotten what was just discussed. The diseased brain is like a sieve with holes in it. The information just leaks right out instead of staying in the brain as it should.

Sometimes the person may be doing it to get attention. I don't mean to say that the person is purposely doing it to get attention, but rather the person may be bored or even frightened and may be seeking conversation or reassurance.

Another possibility is that the person is having a strong memory of a past event. The fact that the person is experiencing memories is a good thing, but perhaps it is not a happy memory or an unresolved memory, that is worrying the person. In either case, the caregiver understanding that the dementia illness is causing this behavior, is important.

Is there a way I can reduce the dementia behavior of repetitive questioning?

Yes, there are strategies to try. If one does not work, try another. The repeating may not go away completely, but it likely can be reduced.


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Alzheimer's Care Training - Help for Alzheimer's Families

Alzheimer's Care Training - Help for Alzheimer's Families: Free Family Caregiver Alzheimer’s Training

Learn how to better care for a loved one with Alzheimer’s by taking advantage of free family caregiver training opportunities available from Home Instead Senior Care.

HIPAA - Individually Identifiable Information: Know the Rules! ,,,,,, from Harmony Healthcare International, Inc.

 Privacy Rule. One such policy includes incidental use and disclosure of confidential health information (also known as Protected Health Information or “PHI”). Per the requirements in the HIPAA Privacy Rule (See 45 CFR 164.530), protect the confidentiality of individually identifiable patient health and financial information from any unauthorized intentional or unintentional use or disclosure.

For clarity,  Protected Health Information (PHI) is defined as any information in the medical record or designated record set that can be used to identify an individual and that was created, used, or disclosed in the course of providing a health care service such as diagnosis or treatment.

The HIPAA Privacy Rule specifies the following pieces of “Individually Identifiable Information” that, when linked with health or medical information, constitute PHI (45 CFR 164.514):

    Names of the individual, and relatives, employers or household members of the individual
    Geographic identifiers of the individual, including subdivisions smaller than a state, street addresses, city, country and precinct
    Zip code at any level less than the initial three digits; except if the initial 3 digits cover a geographic area of 20,000 or less people, then zip code is considered an identifier
    All elements of dates, except year, or dates directly related to an individual including birth date, admission date, discharge date, date of death and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older
    Telephone numbers
    Fax numbers
    Electronic mail addresses
    Social security numbers
    Medical record numbers
    Health plan beneficiary numbers
    Account numbers
    Certificate/license numbers
    Vehicle identifiers and serial numbers, including license plate numbers
    Device identifiers and serial numbers
    Web Universal Resource Locators (URLs)
    Internet Protocol (IP) address numbers
    Biometric identifiers, including finger and voice prints
    Full-face photographic images and any comparable images
    Any other unique identifying number, characteristic, or code

Failure to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) can result in Civil and Criminal penalties. These civil and criminal penalties can apply to both Covered Entities and Individuals.

If you have questions regarding HIPAA or need help maintaining compliance, please click here to contact Harmony Healthcare International or call them at (800) 530-4413.

Feds delay enforcement of home care wage rule - Modern Healthcare

Feds delay enforcement of home care wage rule - Modern Healthcare: Feds delay enforcement of home care wage rule
By Lisa Schencker | September 11, 2015
The U.S. Labor Department won't start enforcing its new rule requiring higher pay for many home healthcare workers just yet, despite a recent court decision upholding the rule.

The new rule won't go into effect until 30 days after the District of Columbia Circuit Court of Appeals issues a mandate making its opinion effective. It's unclear when that mandate will come because industry groups have asked the court to wait until after they try to appeal the matter to the U.S. Supreme Court.

The rule was slated to go into effect Oct. 13.

Online Tools | Caregiver Center | Alzheimer's Association

A diagnosis of Alzheimer's raises many questions. The Alzheimer's Association has several free, online tools to help you find answers, local resources and support.
Alzheimer's Navigator®
ALZConnected® (Message Boards)
Caregiver Stress Check
Care Team Calendar
Comfort Zone®
Community Resource Finder
E-Learning Workshops
essentiALZ Individual Certification
Virtual Library

Read more: http://www.alz.org/care/alzheimers-dementia-online-tools.asp#ixzz3ST9Bt8Q1

Stephanie Z's link list

Stephanie D Zeman MSN RN
This is an updated list of links about information care givers will need. Most helpful will be "Understanding the dementia experience" which will give you an idea of what your LO is going through; and "Communication skills" Which will help you to communicate in ways which will avoid or decrease her negative behaviors.

It is also important for you to use the 800 number at the National Alz. Assoc. if you run into problems we can't help with. The 24/7 Helpline is: 1.800.272.3900

Here are some very helpful links on dementia care:

Guide to diagnosing and treating dementia


Anosognosia explains why dementia patients are unaware that they are ill:


Understanding the dementia experience


Communication Skills:


Selecting a home health caregiver:


Elder abuse and neglect:


Bathing and Showering


Help with dental care (PDF fine from Aust. Alz. Ass.)


How to determine if your LO has pain. Use the Pain Scale:


Picking at skin/scabs


Sexual Consent Guidelines Weinberg Center and Hebrew Home


Finding a Memory Care Unit:

When you start to look at nursing homes or ALFs, begin with a call to your local AD chapter and get a list in your area.

You can also go to: Guide to retirement living

http://www.retirement-living.com/ where you will get free information on nursing homes in your area.

Then go to the government site called Nursing Home Compare and get the results of their last surveys so you can get some idea of the quality of their care.


Also, when you select some, Google them along with the word lawsuit to see if there are or were any significant problems that crop up.

Do select at least 3 to look at. DO NOT expect them to look like an ALF. The decor will be less attractive, but in a good nursing home with a dementia unit, the care will be much better.

Once you have picked one, you will want to visit at least 3 times. Once during meals to see what the residents are eating (see if you can eat there as well), once on the evening shift, and once during activities to see how many people attend or have other things of interest available to do.


Twenty Common Nursing Home Problems and How to Solve Them.


Urinary infections in people with dementia


Eating problems


Caregiver kitchen


Australian Site: Nutrition Matters – Finger Foods:


Hope this helps Stephanie Z

Delirium or Dementia - Do you know the difference?

From   http://www.alz.org/norcal/in_my_community_17590.asp from Northern California and Northern Nevada Chapter Home > Delirium or Dementia - Do you know the difference?

What do we mean by delirium?
Also called the acute confusional state, delirium is a medical condition that results in confusion and other disruptions in thinking and behavior,
including changes in perception, attention, mood and activity level.

Individuals living with dementia are highly susceptible to delirium. Unfortunately, it can easily go unrecognized even by healthcare professionals
because many symptoms are shared by delirium and dementia. Sudden changes in behavior, such as increased agitation or confusion in the late evening, may be labeled as “sundowning” and dismissed as the unfortunate natural
progression of one’s dementia.

When is a change in behavior delirium and not part of dementia?
In dementia, changes in memory and intellect are slowly evident over months or years. Delirium is a more abrupt confusion, emerging over days or weeks,
and represents a sudden change from the person’s previous course of dementia.

** Unlike the subtle decline of Alzheimer’s disease, the confusion of delirium fluctuates over the day, at times dramatically. Thinking becomes more
disorganized, and maintaining a coherent conversation may not be possible. Alertness may vary from a “hyperalert” or easily startled state to drowsiness and lethargy. The hallmark separating delirium from underlying dementia
is inattention. The individual simply cannot focus on one idea or task.

What if you suspect delirium?

..... Secondly, create a safe and soothing environment to help improve the course of delirium: keep the room softly lit at night, turn off the television
and remove other sources of excess noise and stimulation. The reassuring presence of a family member, friend, or a professional often prevents the need to medicate.

And lastly, tread lightly with medications. Sedatives, sleeping medications and other minor tranquilizers play a very limited role in delirium management
unless a patient is experiencing drug withdrawals.

Prevention of Delirium

  Avoid illness through smoking cessation, a balanced diet, regular exercise, adequate hydration and vaccinations to prevent influenza and pneumonia.
  Avoid alcohol in any amount.
  Exercise caution with medication, especially sleep aids, and periodically ask the physician for a “medication review.”
  Eliminate or reduce the use of the following medications:
  Antihistamines (e.g., diphenhydramine)
  Bladder relaxants
  Intestinal antispasmodic
  Centrally-acting blood pressure medicines (e.g., clonidine, methyldopa)
  Muscle relaxants
  Anticholinergics (drugs with atropine-like effects)
  Opioids (e.g., codeine, hydrocodone, morphine)
  Anti-nausea medication
  Benzodiazepine type sedatives

The following interventions appear to reduce the risk of delirium during hospitalization:

  Early mobilization after surgery
  (e.g., walking, getting up in a chair)
  Assisting the individual with eating
  Round-the-clock acetaminophen for surgical pain (may lessen the need for stronger drugs)
  Minimizing bladder catheter use
  Avoiding physical restraints
  Avoiding multiple new medications
  Hydration – encourage and assist with fluids
  Normalizing the environment (e.g., pictures from home, familiar objects, cognitively stimulating activities and reminders, visits from family
  Providing sensory devices if needed
  (glasses, hearing and visual aides from home)
Overview of Delirium and Dementia
by Juebin Huang, MD, PhD

Delirium (sometimes called acute confusional state) and dementia are the most common causes of cognitive impairment, although affective disorders (eg,
depression) can also disrupt cognition.

Delirium and dementia are separate disorders but are sometimes difficult to distinguish. In both, cognition is disordered; however,
dementia affects mainly memory, and
delirium affects mainly attention

 Matching the environment to patients with delirium: lessons learned from the delirium room, a restraint-free environment for older hospitalized adults with delirium.
Flaherty JH1, Little MO.


Delirium is associated with several negative outcomes and is not always preventable. Current practices for the management of older hospitalized adults with delirium, such as one-on-one sitters, antipsychotic medications, and physical restraints, have limited effectiveness or potential health risks. 

{snipped} The authors have found that a restraint-free environment can be achieved; "tolerate, anticipate, and don't agitate" (the T-A-DA method) are the core principles of the nonpharmacological approach that go beyond the traditional strategies of management (such as reorientation); based on observational data,

Alzheimer's and Dementia Care Must read books

 Kisses for Elizabeth: A Common Sense Approach To Alzheimer's and Dementia Care (Volume 1) by Stephanie -Large Print Paperback
also available as  Kindle Purchase

 Creating Moments of Joy: A Journal for Caregivers, Fourth Edition (NEW COVER) by Jolene Brackey (Sep 1, 2008) Paperback
also available as Kindle Edition

The 36-Hour Day, fourth edition: The 36-Hour Day: A Family Guide to Caring for People with Alzheimer Disease, Other Dementias, and Memory Loss in Later Life, 4th Edition

Day Trips for Caregivers - Visiting Nurse Service of New York

Day Trips for Caregivers - Visiting Nurse Service of New York: Day Trips for Caregivers
Nature Getaways within 2 Hours of NYC

People who spend time outdoors, particularly around trees and in gardens, have better physical and mental health, and the benefits can be immediate. One recent study at Stanford University found that volunteers who walked in a park-like section of the university’s campus were less anxious, less likely to dwell on negative things, and performed better on short-term memory tests than those who walked near a highway.

Arrange for a day of respite care and plan your escape! Here are day trips in the Hudson Valley, on Long Island, and in New Jersey that can help caregivers recharge. If you can only steal a few hours, we’ve also included ideas for NYC.

Over-Night Care: Night programs serving individuals with Alzheimer's

Over-Night Care: Night programs serving individuals with Alzheimer's: Over-Night Care: Night programs serving individuals with Alzheimer's

Carers often experience chronic sleep deprivation. At the onset of nighttime. The demons of anxiety, anger, fear, hallucinations and paranoia come out. Night time can be unpredictable, up and down cycles.We need All-Night Care all night respite programs. 

Hospice is likely to be the most important health care decision we make. by Joy Loverde

Hospice: I had no idea | Eldercare Blog: Families have a choice in hospice programs.
Hospice is likely to be the most important health care decision we make. For a long time, we could assume that every hospice provided high-quality care. That assumption is no longer safe. Families must shop around. To start the process, request a home visit for patient assessment and a customized Q & A. How receptive a hospice is to the following questions is an indicator of the quality of their program:

What do others say about your organization? Get references.
How long has the hospice been in operation?
Is the hospice Medicare-certified?
What is the expectation regarding the family’s role in caregiving?
Is there anything currently being done for the patient that you would not do?
(Make a list of specific family needs.) How will you address these needs?
What extra services are offered?
Is your availability 24/7?
How rapid is crisis response?
Do patients ever get transferred to inpatient care? Under what circumstances? And where do they go?
Is family respite care available? What kind? Under what circumstances?
Are your MDs/RNs certified in palliative care?
How are family complaints handled?
What kind of emotional support do you provide – now and after?

This is just brilliant! It can help so many people..

This is just brilliant! It can help so many people....Please SHARE, let's make this available for everybody! :)

Posted by Motivational and Inspirational Quotes on Thursday, August 20, 2015

New techniques to move patients safely

 Patient transfer


Medicare System  
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Phone:+34 937 57 00 48

 InnoCare Health Corporation is a leading supplier of AEDs and related products and accessories across the United States. We are a family-owned and operated company and we pride ourselves on our ability to combine the most competitive pricing with outstanding customer service.

The Top Two Misconceptions about ADA Compliance at Your Senior Community | Senior Housing Forum

The Top Two Misconceptions about ADA Compliance at Your Senior Community | Senior Housing Forum: “But our resident units are accessible.”

While your resident units are accessible, you must remember that ADA accessibility is also about accommodating the general public and your employees.

This means all public accommodations at your senior care community, inside and out, should be in compliance.

“What often gets reported are violations that occur outside of the resident dwelling units, such as the lobby, public restrooms or parking lots,” said Greg. “Many senior care providers often forget that these areas need to be compliant, and since they have never received a complaint or violation, they continue to operate under the assumption that nothing needs to be changed.”

And don’t forget, you should also be cognizant of your employees’ work areas, such as the staff break rooms and bathrooms, which also need to be accessible.

How loved ones can help prevent patients developing delirium in hospital | Liz Charalambous | Society | The Guardian

John's Campaign
How loved ones can help prevent patients developing delirium in hospital
In the first of a series by health professionals on the importance of family and volunteers helping with a condition in hospital, we hear from a nurse at Nottingham University Hospital Ward B48

 How loved ones can help prevent patients developing delirium in hospital | Liz Charalambous | Society | The Guardian

What to Do When You Suspect Abuse in Your Parent's Retirement Home - AgingCare.com

What to Do When You Suspect Abuse in Your Parent's Retirement Home - AgingCare.com: What to Do If You Suspect Abuse in Your Parent's Retirement Home

I think most of us approach the idea of sharing the care of an elder with a lot of trepidation. We have cared for them with one-on-one loving attention. We know their history, their preferences, their tempers and their needs. Bringing others, no matter how experienced, into the equation is counter-intuitive.
, Expert
Author, speaker, columnist and eldercare consultant

  1. If
    possible, talk nicely with the CNA or hands-on person you think may
    need some direction. Talk kindly, and take some of the load off by
    saying, "Mom can be sensitive, and I know that. Is there a better way we
    can handle this?"
  2. If you don't get
    anywhere with that (all of this advice only applies if there isn't
    obvious abuse – if that is so, skip to the last step), talk with the
    floor supervisor, often a nurse.
  3. If
    that still doesn't get you a listening ear and some change – and if you
    are being realistic about your requests – then talk with the home
  4. If talking doesn't get you anywhere, write a letter and state the complaint and say that you will be contacting your state ombudsman.
    An ombudsman is an independent advocate who handles consumer complaints
    about government-regulated agencies. Since nursing homes are
    government-regulated agencies, they qualify. Assisted living centers may
    not, but it's worth a try. Then
    do so. You can go online to your state's website and look up aging
    services or you can go to the national site and find the National Long
    Term Care Ombudsman Resource Center at
    You will then type in the location of the home and you will find
    contact information. Carry through, and this person will investigate.
Don't ever be afraid to involve the ombudsman.

Learn what it takes to become a CAREGiver

The Heart of a CAREGiver    info@homeinsteadinc.com

Caring for seniors is a labor of love that requires a special person with just the right touch.

The Home Instead Senior Care® network is looking for dedicated CAREGiversSM who share its passion for caregiving to provide non-medical in-home care assistance to seniors.


Senior Fall Prevention: Help for Caregivers

Senior Fall Prevention: Help for Caregivers: Caregivers can help seniors reduce their risk of falling and remain independent in several proven ways.

Regular exercise is essential in helping seniors improve balance and gain strength. Check in with local senior centers and community groups to find out about fitness classes, such as Tai Chi, for older adults. Even seniors with limited physical fitness can increase their abilities over time.

It's important for caregivers to offer gentle support if seniors push back against a new exercise regimen. One way to get your aging loved one on board while also deriving benefits for yourself? Join in their routine.

Also, take time to fall-proof your aging loved one's home. Cords, wiring, newspapers, and other debris are hazardous when underfoot. Living spaces should be free of clutter with clear, well-lit pathways between rooms. Grab bars, railings, and other assistive devices further protect seniors against falls.

Event - healing heart houspitality house

Event - healing heart houspitality house: Healing Heart Hospitality House sponsors a Caregiver’s Support Group every third Thursday of the month.

Graciously hosted at Dodge Park Rest Home, 101 Randolph Rd., Worcester, MA from 6:00 p.m. to 8:00 p.m.

A Guide to Coping with Alzheimer's Disease - Harvard Health

A Guide to Coping with Alzheimer's Disease - Harvard Health

 This Special Health Report includes in-depth information on diagnosing
Alzheimer’s and treating its symptoms. Because caring for someone with
Alzheimer’s continues to be one of the toughest jobs in the world, the
report includes help for family members and caregivers, as well as for
the individuals with Alzheimer’s.

Prepared by the editors of Harvard Health Publications in collaboration with John H. Growdon, M.D., Professor of Neurology, Harvard Medical School, and Director, Memory and Movement Disorders Unit, Massachusetts General Hospital. 53 pages. (2015)

Wheelchair to Car Transfers - Getting your patient AND the wheelchair in the car


Wheelchair to Car Transfers - Getting your patient AND the wheelchair in the car: Wheelchair to car transfers and wheelchair management is not exactly what most people think of when they think of home safety or independence ... but...

One of the toughest obstacles patients and caregivers alike face is that of getting in and out of a vehicle and accomplishing this safely for both patient and caregiver. No doubt this IS part of a wise home safety checklist. If attempted without any forethought, disaster can lurk at any point in this sometimes tricky transfer.

Yet, mastering this wheelchair to car transfer can spell freedom and excitement for years to come for those otherwise "stuck" at home. It is my theory that those disabled by stroke or any any other means live longer lives when they can go out with a caregiver. And getting out means getting in the car, going, and getting back out of the car.

Of great importance next to seat belt use and the like is your planning for this essential ability.

You may master the car transfers without a hitch until you turn and see that ole wheelchair. Unless it's truly a window shopping ride, that wheelchair needs to come along too. With so many moving parts, though, it can be tougher than getting mom or dad to get in the car!

Do-It-Yourself Home Health Physical Therapy is a free e-zine that is sent to you when something happens here worth notifying you about. In the future, we will be sending this out on a monthly (and possible weekly) basis. Either way, your Do-It-Yourself Home Health Physical Therapy newsletter keeps you up to date on hot home health care topics that affect your rehabilitation at home.

Beoynd the Video: Home Care—Lifting and Moving Your Loved One

Beoynd the Video: Home Care—Lifting and Moving Your Loved One: beyond the video
Home Care—Lifting and Moving Your Loved One

Video summary
This video demonstrates basic techniques for moving a person with limited mobility, such as after a stroke, from bed to wheelchair and back again.

The steps for each maneuver are simply stated, but these are the things you need to know first:

Help the person to work with you by placing yourself so that his stronger side is on the edge closest to the bed or chair.
Tell the person what you are going to do and that the move will take place when you say "Now" so that he is prepared and can work with you.
Always bend your knees and keep your feet spread about shoulder-width apart so that you can lift with your legs, not your back.
Use a transfer belt that is fastened around the person's waist with room for you to get your fingers underneath it for each lift. You will be reaching both arms around his waist (closer to his back) and putting your fingers underneath the bottom of the belt, with your thumbs at the top of the belt. This makes the transfer easier for you and also helps the person feel more secure.

How To Get Up After a Fall – A Short Video from Learn Not to Fall

How To Get Up After a Fall – A Short Video from Learn Not to Fall: LEARN HOW TO GET UP
Review Your Risk Now
How to get up
How to call for help

In this short video, Dr. Dorothy Baker, RN PhD, explains the importance of knowing how to get up if you fall, and shows a senior demonstrating these techniques.A  printable copy (PDF) of illustrated instructions on how to get up is available

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Registrar Abuse Contact Email: abuse@web.com
Registrar Abuse Contact Phone: +1.8003337680:
Registrant Name: Lifeline Systems
Registrant Organization: Lifeline Systems
Registrant Street: 111 Lawrence Street
Registrant City: Framingham
Registrant State/Province: MA
Registrant Postal Code: 01702
Registrant Country: US
Registrant Phone: +1.5089881000

Alzheimer's Safety Proofing Households, Devices and Equipment

Follow : Dave's Knowledge Networks  http://tinyurl.com/ny62zh3
“The beautiful thing about learning is nobody can take it away from you.”   B.B. King

Hidden Costs of Assisted Living - AgingCare.com

Hidden Costs of Assisted Living - AgingCare.com:

, Expert
Author, speaker, columnist and eldercare consultant

The strong suit for in-home care agencies is their flexibility. During my years of caregiving for multiple elders, I used the services of two different in-home care agencies in the traditional manner, which was to fill the gaps in home care that I couldn't provide for my loved ones.

One of the reasons that assisted living centers are appealing to many people is that they offer a relatively high level of independence. If your parent is in good health and doesn't require much assistance with everyday tasks, assisted living is a terrific option. In fact, residing in an assisted living center is similar to having a private apartment, complete with private bathroom and kitchen, but you can rest easy with the knowledge that trained staff is on hand to help your loved one when necessary.

However, assisted living centers are not all cut out of the same mold. Depending on what part of the country you live in, what you get at assisted living may cost more.

Assisted living facilities provide a safe environment with convenient meals and social opportunities in their "base package." They are generally set up so that an elder can obtain help if he or she falls or has another emergency. Many also offer transportation by bus or other means for group outings or to specific locations.

But what about the basics of personal care: help with dressing, bathing, keeping track of prescription refills, setting up daily doses, injecting medications such as insulin, and a companion for trips to doctor appointments? Many assisted living facilities don't provide it in the "base" package. The services are add-on pricing.

So make sure you understand what services they do and don't offer per the contract, and what services may be available, but would cost extra. You might get some services you are expecting, but not all.

It works differently at different communities. At Emeritus Senior Living in Bonita Springs, FL the base rent is for what is called independent living. Any room could become an assisted room if the resident has a health care need. A caregiver goes to the room to help with showering, medication management and more. But, there's a fee for that.

Confabulating and Confabulations

Everyone and particularly medical personnel and caregivers must understand!
Confabulating and Confabulations

In psychology, confabulation (verb: confabulate) is a memory disturbance, defined as the production of fabricated, distorted or misinterpreted memories about oneself or the world, without the conscious intention to deceive.
Key factors in confabulations are there is no intent to deceive, second the person being unaware that the information is blatantly false. Confabulating is distinct from lying because there is no intent to deceive, and the person being unaware that the information is blatantly false.

Carers challenge: is what they say true? Confabulations become a far greater concern in the later stages, because confabulations are much more likely to be acted upon.

It is difficult for everyone to accept a mind is damaged.
Not only is memory damaged their ability to process thoughts and conversations is impaired.

Confabulations are a major annoyance and can be dangerous- when we the take everything in a discussion at face value. Confabulating is very frequently observed in people with Alzheimer's.

We all Confabulate when we make..verbal statements and/or actions that inaccurately describe history, background and present situations unintentionally. We must be aware of information that is blatantly false yet are coherent, internally consistent, and appear relatively normal.


The Truth About Hospice | Author- Kathryn Watson

"Hospice is about living not about dying."

The Truth About Hospice - Kathryn Watson

Independent Elder Care Consultant-Kathryn WatsonLike many today, Kathryn Watson was thrust into the world of Eldercare with little knowledge or understanding of the industry.

  Podcast- Listen to A Hospice Social Worker Explain  “What is Hospice” 

 The challenges Kathryn Watson overcame led her to write Help! My Parents Are Aging  Five steps to help you make the right decision regarding their care Paperback
Help! I Can’t Do This Alone   When caring for your spouse becomes too hard Paperback

3 Factors to Help You Compare Nursing Home Care - AgingCare.com

, Expert
President and CEO, eHealth Medicare
 3 Factors to Help You Compare Nursing Home Care

Chances are, at some point you or a loved one may need to spend time in a nursing home.

 In fact, about 70 percent of Americans will need a form of long-term care at some point in their lives. As more baby boomers continue to turn 65 — seniors are expected to comprise 19 percent of the population by 2030 — a growing number of people will be looking for the right place to receive the care and services they need.

3 Factors to Help You Compare Nursing Home Care - AgingCare.com

Today's Geriatric Medicine - Alzheimer's/Dementia

Today's Geriatric Medicine - Alzheimer's/Dementia

    Dementia and Inappropriate Sexual Behavior
    Cognitive Evaluation for Memory Concerns
    Lifestyle Influences Brain Health
    Alzheimer's Research Comes of Age
    Music and Art in Memory Care
    Behavioral Expressions in Dementia Patients
    Alzheimer's Diagnosis in Primary Care
    Cognitive Decline Screening and Resources
    Gait Speed Reflects Cognitive Function
    Interventions Slow Brain Atrophy
    Lighting Affects Dementia Patients’ Sleep
    Therapeutic Options in Alzheimer’s Disease
    Holistic and Creative Arts Therapies in Alzheimer’s Care
    Fish Oils and Cognitive Function
    Alzheimer’s Disease and the Blood-Brain Barrier
    Evidence-Based Memory Preservation Nutrition
    New Target for Therapy in AD Patients
    Memory Maintenance
    Pharmacological Prospects for Alzheimer’s Treatment
    Medications Target Alzheimer’s Disease
    What Should You Tell Patients About Alzheimer’s?
    DBS to Treat Alzheimer’s Patients?
    The Gait-Cognitive Decline Connection
    Can You Recognize Lewy Body Dementia?
    Recruiting Patients for Alzheimer’s Clinical Trials
    Dementia and DSM-5: Changes, Cost, and Confusion
    Alzheimer’s Staggering Financial Impact
    12/15-Lipoxygenase’s Role in AD Prevention
    New Technology to Detect, Diagnose AD
    Dementia Care Model Facilitates Quality Outcomes
    Integrating Palliative Medicine With Dementia Care
    Dementia-Related Behavior Management
    Combating Dementia With Infrared Light?
    Deep Brain Stimulation
    Becoming ADEPT at Predicting Mortality
    New Biomarkers for Alzheimer’s Disease
    MMSE vs. MoCA: What You Should Know
    Vitamins and Dementia — Delaying Cognitive Decline?
    Dealing With Dysphagia
    New Molecular Tools Developed in Alzheimer’s Research
    Hope for an Alzheimer’s Cure?
    Alzheimer’s Cure on the Horizon?
    Imaging Alzheimer’s Disease
    Cognitive Camouflage — How Alzheimer’s Can Mask Mental Illness

How the Invention of Alzheimer's World Changed My Life Alzheimer's Reading Room

How the Invention of Alzheimer's World Changed My Life Alzheimer's Reading Room: How the Invention of Alzheimer's World Changed My Life

 Alzheimer's Reading Room    The best way to find Solutions to the Problems that Alzheimer's and dementia caregivers face each Day

The best way to find Solutions to the Problems that Alzheimer's and dementia caregivers face each Day
- See more at: http://www.alzheimersreadingroom.com/2011/07/why-i-invented-alzheimers-world-and.html#sthash.xGvr50v3.dpuf

The best way to find Solutions to the Problems that Alzheimer's and dementia caregivers face each Day
- See more at: http://www.alzheimersreadingroom.com/2011/07/why-i-invented-alzheimers-world-and.html#sthash.xGvr50v3.dpuf

Dealing With Angry Seniors Under the Same Roof By Sarah Peterman on July 8, 2015

Angry & Elderly: Dealing With Angry Seniors Under the Same Roof   http://tinyurl.com/oqc8g56

By on July 8, 2015 under Aging in Place as a Family, Process of Aging, Senior Care Advice
Every experienced family caregiver knows that seniors have their good days and bad days. Mood swings resulting from dissatisfaction, poor health, stress, pain, and a loss of dignity can easily lead to your loved one to lash out against you and others that they care about. Being a family caregiver under these conditions can be particularly stressful for the sandwich generation, who are “sandwiched” between living with an elderly parent and caring for their own children.

While dealing with these feelings and the emotional strain they cause can require a considerable amount of patience and empathy, there’s much more you can do than simply hope for more good days than bad ones. Below you can learn about several simple steps you can take to help those you look after to be less cranky, and help preserve your own wellbeing as a family caregiver in the process.

Download A Free Guide to Dealing with Elderly Anger

Emotional Turmoil in the Elderly

Getting older can magnify our character traits, often in undesirable ways. Someone who was crabby in their younger days may be prone to full-on bouts of rage in old age. Unfortunately, caregivers are often the target of these outbursts, and it may seem at times as though there may be no simple solution to deal with this type of behavior. After all, when outbursts are not caused by serious problems like chronic pain or difficulties in memory, they’re often the result of serious illnesses like Alzheimer’s or dementia, over which your loved one has no control.

How to Handle Anger

The first step to dealing with these problems is to understand that you shouldn’t take these negative emotions and their associated behavior personally. Pain and disease can cause us to act in very inappropriate ways, and it’s important to take any opportunity for a break from your caregiving duties that you can get. In the long term, you’ll likely want to spread caregiving amongst as many friends and family members as you can to make the possibility of these breaks more frequent.

The best solution to dealing with difficult elderly parents is almost always communication. Unfortunately, parents can be generally uneasy talking with their children about fears of the future, finances, and their mortality. If your loved one seems increasingly frustrated, anxious, or otherwise emotionally disturbed, it’s your responsibility to find out why if you want to help fix the problem. The next time both of you are in a pleasant mood, try warming them up to the conversation, and be ready to try several times before you’re successful.{END QUOTE}

Read more: http://www.griswoldhomecare.com/blog/dealing-with-elderly-anger/#ixzz3fUK21wz9

Legal Issues – Revoking prior Powers of Attorney

From Jim Koewler's The Koewler Law Firm website
The agent named in a now-revoked POA may not be happy about being
replaced.  That deposed agent may use the authority in the old POA to
take actions with the principal’s assets.  The bank or investment office
or real estate agent (or anyone else, for that matter) has no way to
know that the POA has been revoked.  (Not many former agents would act
out in this manner, but those few that would certainly can hurt their

To avoid an old POA being accepted as current, there are practical steps (in addition to the legal steps) to revoke an old POA.

The principal should try to retrieve all of the copies of the prior
POAs.  Retrieving all of them can be a daunting task if there are a
number of copies.  (Most POAs have a statement that a copy is to be
honored just like an original, so retrieval of copies is important.)

For advice, representation and peace of mind through these difficult issues, contact Jim Koewler of The Koewler Law Firm. Legal Issues when someone has Dementia – Revoke prior Powers of Attorney |

CMS will modify—not scrap—two-midnight' rule - Modern Healthcare

 Under the two-midnight rule, the CMS directs its payment contractors to assume a hospital admission was appropriate if a patient's stay spanned two midnights and otherwise should have been billed as an outpatient observation visit.

 The rule was conceived to address a spike in observation stays attributed to hospitals' fear that Medicare audit contractors would challenge their admissions.

 Many patients, as a result, found themselves ineligible for skilled nursing after spending days in the hospital because their stay had been billed as observation.

 CMS will modify—not scrap—two-midnight' rule - Modern Healthcare

5 Steps for Dealing with Anticipatory Grief - Visiting Nurse Service of New York

5 Steps for Dealing with Anticipatory Grief - Visiting Nurse Service of New York: It might be the hardest part of caregiving: Watching your loved one slip away step by terrible step, knowing you can’t stop the decline and grieving the loss of the person you once knew, long before they’re actually gone. Psychologists call this process anticipatory grief, and it’s very common among caregivers and family members of those suffering from Alzheimer’s disease, cancer and other terminal illnesses.

“As a disease progresses, there is so much frustration and sadness associated with watching the person you once knew go away,” says Vince Corso, M.Div, LCSW, CT, Manager of Hospice Psychosocial Services, VNSNY. “It can be overwhelming.”

What Goes Into a Life Care Plan? | Hill Law Group, PA

Data gathering Forms  | Hill Law Group, PA

 These  planning questionnaires are worth their weight in gold! Everyone should, IMCO, have a family records notebook built from these forms.

Dave M.

Personal Support Workers, or PSWs, are starting to fight back, but their wage increases equate to worry for clients, families and service provider agencies.

THE CAREGIVERS' LIVING ROOM A Blog by Donna Thomson: A Fight Between PSWs, Clients and Agency Service Providers Spells Trouble For All
an article by always erudite Howard Gleckman  He wrote in Forbes:

Should the aides who provide home care for frail elders and younger people with disabilities receive a living wage and decent benefits?  If they do, how can families, who often are unable to afford care today, be expected to pay those higher wages and benefits?  Should the market be allowed to set these prices, or should government intervene through minimum wage and mandatory overtime laws? …. These questions have set off an enormous, but largely unnoticed, political firestorm.  In some states, they have pit states against the federal government, people receiving care against their aides, and large home care agencies against independent direct care workers.

In Ontario, exactly the same questions are being asked. This time last year, the then Ontario Liberal Health Minister Deb Matthews and Finance Minister Charles Sousa announced an election promise of an increase in the minimum wage for 34,000 publicly paid Personal Support Workers to $16.50 an hour by April 1, 2016, up 32 per cent from the current rate of $12.50.  Implementation of that promise hasn’t been easy.   According to the Canadian Union of PublicEmployees (CUPE), some home and community care agencies have chosen not to implement the wage increase or they exclude sick leave, vacation and training hours in the new hourly wages.  The sum total effect, says a CUPE spokesperson, is that most Ontario PSWs have yet to receive a wage increase.

The real lives of personal care workers are documented in a new film titled CARE, due for release later this year.   The trailer is riveting and I recommend watching it HERE for a clear picture of the human side of our crisis in home and community care.

The care workers depicted in the film are all women.  They are mothers and daughters who have left their own families behind in more impoverished countries in order to care for more affluent strangers in the United States. 

Many care workers in Canada, the UK, Australia and New Zealand match this description.  Eva Kittay drills down into the issues surrounding immigrant care workers and the role they play in a larger, profit driven dynamic.

The migration of care workers is caused both by a pull, the need for care workers, and a push, the need of these women to provide for their families.

Eva Feder Kittay‘From the Ethics of Care to Global Justice

The truth is that people need care and care workers must be able to earn a living wage. 

New LinkedIn Group
Canadian Caregivers United is a new group on LinkedIn.

Palliative Care for Caregivers | Get Palliative Care

Palliative Care for Caregivers | Get Palliative Care
Mayo Clinic

Top 10 Things Palliative Care Clinicians Wished Everyone Knew About Palliative Care

August, 2013   By Jacob J. Strand, MD, Mihir M. Kamdar, MD , Elise C. Carey, MD

 Today, family caregivers provide about 80 percent of elder care, delivering meals, taking loved ones to doctor’s visits and managing medications and family conflicts. This results in lost work hours or lost jobs, high stress and serious declines in physical and mental health. Palliative care is a solution.

Get Palliative Care

Get Palliative Care

What Is Palliative Care

Learn more about adult and pediatric palliative care, refer to the glossary and get answers to some frequently asked questions.
How to Get Palliative Care

Talk to your doctor, find a hospital and meet with your palliative care team. Just two simple steps to get palliative care.
Is Palliative Care Right for You

Take a quiz to determine if palliative care is right for you or a loved one.

Home Health Aide Certification and Certificate Programs

Home Health Aide Certification and Certificate Programs

 Each state has its own requirements for home health aide certification. Some states only require that the employing agency be certified, while others require home health aides to pass a certification exam following completion of an educational program. Besides a skills assessment examination, certification may also require a state administered criminal background check. Some states maintain a registry database of certified home health aides that can be accessed by the public


Home Health Aide Training Requirements in MA

Massachusetts does not require a State issued certification, nor is there a State exam required to be eligible to work as a Home Health Aide.  Instead the State recommends national certification through the National Association for Home Care and Hospice. The NAHC requires a 75 hour training course and a competency test before you are eligible to apply for their certification.

Caregiving Criticism and Unsolicited Advice From Family - AARP

AARP Home » Home & Family » Caregiving »How to Handle Criticis...
How to Handle Criticism While Caregiving
Well-meaning advisers try to help but some can cause hurt
by Barry J. Jacobs, PsyD., AARP, December 29, 2014

Take it from whence it comes

Caregivers would be well-advised (there's that word again) to not
just react to the message being given but to consider the background and
intentions of the messenger. Advisers often have a sincere desire to
help, because they truly are caring and invested. They just don't have
enough information and understanding to know how to actually be helpful.
They are also unaware that their good ideas may come across as
critical. If you express appreciation for their caring, they will
usually feel satisfied that they are making a difference and stop
pressing specific recommendations.

Some people, though, use pieces of advice as thinly veiled barbs. Out
of competitiveness or their own misery, they consciously or
unconsciously mean to take caregivers down a peg. They should be kept at
arm's length. It is seldom worth debating them or giving them the
satisfaction of having caused hurt.

 Caregiving Criticism and Unsolicited Advice From Family - AARP

staff scheduling and labor management

OnShift  provides staff scheduling and labor management software

They are focused entirely on the long-term care and senior living industry, software and services are built upon an in-depth understanding of how providers work day-in and day-out, and how industry regulations and issues affect their every move.

{ staff scheduling and labor management is of interest to the world of Caregiving}

Jan 26, 2015 Mark Woodka posted the following to their  Long Term Care & Senior Living Blog

For some strange reason we encourage ourselves to prognosticate about the future annually as one year recedes and another begins.  These projections might not always be correct, but I think they nicely balance out our attempts at New Year’s resolutions and give us something to aim for. (I hope this list goes more smoothly than those resolutions usually do…)

I’d like to outline my predictions for long-term care and senior living in 2015 – the big things that may change how you run your communities and provide care for your residents.  So without further ado, here we go:

    Affordable Care Act Penalties: The Employer Mandate began January 1 after two years of delays, and we must now be very, very cautious in managing our workforces to ensure we do not get penalized.  There was a bill proposed to exclude certain industries from having to participate due to large populations of lower-wage hourly workers and low margins.  Guess what?  One of the original intents of the ACA was to get these very workers healthcare benefits.   Therefore, this bill is a non-starter, and we will not see our industry excluded.   The Affordable Care Act will remain the law of the land until and unless we have a new party in the White House in 2016, so tracking employee hours will be key.
    More Doc Fix Activity: The game of kick-the-can that has been the Doc Fix for the past decade will continue.  However, in an effort to kick the can as far as possible, Adam Vinatieri will be the kicker, and he will kick it 21 months into the future.  This will nicely coincide with the new administration taking office in January of 2017.  (I don’t think Congress will want to deal with this again in 12 months.)  Ideally, our friends at AHCA will be able to focus the pay-fors to other segments or maybe even help them find a permanent solution if in fact there is an appetite for one.

- See more at: http://www.onshift.com/blog/5-game-changing-predictions-senior-care-2015#sthash.36ZATwXG.dpuf


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Next Generation Educators blog

Dealing with a “Code Brown”

Dealing with a “Code Brown” | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles
by Ani Burr, RN • October 22, 2010
When you are doing your best to get your client cleaned up, there is still that smell issue that can get in the way of your ability to focus and get in and out of there quickly! While it’s not guaranteed, you can try these tricks to protector your olfactory senses:

Caregiving MetroWest a program of BayPath Elder Services, Inc

Caregiving MetroWest is a program of BayPath Elder Services, Inc. for MetroWest caregivers.
The site offers Information on all aspects of caregiving; "Caregiving is a complex and demanding undertaking. There are many elements involved in the caregiving role, and we’ve assembled some helpful information on a variety of areas of importance to caregivers.

BayPath Elder Services, Inc
BayPath Elder Services, Inc. administers programs offering  home care and related services enabling people to live independently and comfortably in their homes while promoting their well-being and dignity.
Many BayPath services are free, others are based on one's ability to pay, and some are offered on a fee-for-service basis.

 “This non-profitcorporation is organized to plan, develop and implement the coordination and delivery of services and supportive programs   for persons sixty years of age and over unless otherwise restricted by conditions of grants or contracts, in the City of Marlborough, and the townships of Ashland, Holliston, Hopkinton, Dover, Sherborn, Natick, Framingham, Wayland, Sudbury, Hudson, Northborough , Southboro ugh and Westboro ugh , Massachusetts. The corporation shall endeavor to assist older persons to obtain services including but not limited to information and referral, homemaker and chore assistance, housing services, health maintenance and rehabilitation, nutritional services, legal and advocacy assistance, transportation, emergency assistance, and whatever medical or supportive services may be needed to prolong the life and well - being of older persons in the community and to prevent premature institutionalization."

Talking with a person with Alzheimer's guidelines: five basic ones

Marie Marley is the award-winning author of Come Back Early Today: A Memoir of Love, Alzheimer's and Joy. Her website  contains a wealth of information for Alzheimer's caregivers.

When relating to a person with Alzheimer's there are many guidelines to follow. 

five basic ones:
1) Don't tell them they are wrong about something,
2) Don't argue with them,
3) Don't ask if they remember something,
4) Don't remind them that their spouse, parent or other loved one is dead 
5) Don't bring up topics that may upset them.

Marie Marley author of Come Back Early Today