The Ankota Healthcare Delivery Management Blog

Best Practices for Managing Dementia/Alzheimer's in Home Care

  

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I read a piece this morning by a pastor named Anthony Robinson about his experience with his mom's dementia, and it reminded me that home care workers visit daily with people dealing with memory issues.  Here's the anecdote:

My wife and I were nervous about my 94-year-old mother's impending visit to the family cabin this summer. We had spent the weeks before she came remodeling, adding a new bathroom to the nearly 100-year-old structure built by my own grandparents. When my parents were the stewards of the cabin their policy had been to maintain the place as a kind of living museum. No changes.

The first time we steered her to the new bathroom, we held our breath. Pushing her walker across the threshold, she stopped, looked around, then said, "This is nice. This is really very nice." (Because she has short-term memory loss, each subsequent time she used the new bathroom was also the 'first' time, and every time she said, "This is very nice.")

On my mother's last day, we again steered her to the "new bathroom." "We have a new bathroom?" she asked. My wife said, "Well, next year it won't be the 'new' bathroom any longer." My mother stopped, looked up, and with sudden full clarity - and a wry smile - said, "Oh yes, it will be the 'new' bathroom for a very long time."

I learned a lot about Alzheimer's care in a lecture by Dr. Verna Benner Carson who teaches people how to become an Alzheimer's Whisperer.  Here are five tips that your caregivers can use to better deal with Alzheimer's and other forms of dementia:

1. Don't Quiz, Argue or Reason
2. If at first you don't succeed, wait five minutes*
3. To combat repetition, find a "job" for the person you're caring for (such as folding towels or building with Legos(r))
4. If a loved one complains "My mom didn't have breakfast", or "Nobody has been in to see my dad today", calmly explain that that "Your mom/dad can't remember, and fill them in"*
5. Old photo albums and songs from the past are likely to connect with the patient because long-term memory lasts the longest.

*Note: Alzheimer's sufferers generally have less than 5 minutes of short-term memory, so if for example you propose a shower and get a negative response, rather than forcing the issue, you might instead wait 5 minutes and try an approach like "let's go for a nice walk but get cleaned up first."

Do you have any other tips you can share for managing Alzheimer's and other forms of dementia in the home care setting?

Ankota provides software to improve the delivery of care outside the hospital. Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care. To learn more, please visit www.ankota.com or contact Ankota.

Expert Alzheimer's and Dementia Advice for Home Caregivers

  

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Back in December, Ankota co-founder Marc Ottinger shared a great piece on the blog called "Choosing the Best Elder Care for Your Loved One" which pointed readers to some strong guides about assisted living, home care, memory care and more from Assisted Living Today (http://assistedlivingtoday.com/).  Today's post introduces a very powerful series, also by Assisted Living Today that talks about Dementa and Alzheimer's care.  They've assembled a panel of 20 memory experts who have contributed content.  Here's a collage and the list of experts (I've cleverly left out their bios so you can read them all here):

Can Your Home Care Agency Help Prevent Delirium?

  

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Delirium is likely to be the most costly and debilitating disease afflicting the elderly that you never heard of.  We focus lots of attention on dementia, alzheimers and fall-related issues, and we should, but at the same time delirium is hurting the quality of life for elderly people and costing Medicare over $143 Billion per year according to a study this year in The Journal of American Geriatric Society.  The November 2, 2011 New York Times article "Another Hospital Hazard for the Elderly" by Susan Seliger tells a chilling story about the onset of delirium and just how common it is:

Hours before she fell and broke her hip, my mother, 85, lucid and whip-smart, was doing what she always did in the morning: drinking an entire pot of coffee and digesting both The New York Times and The Baltimore Sun.

The next day she came out of the hip surgery just fine. But within 24 hours, a totally different woman seemed to have taken over her capable mind and body.

She was disoriented. “This isn’t a very nice hotel,” she told us in the hospital room. “They haven’t even served cocktails. Let’s go.” My father, sister and I laughed, thinking it was just grogginess from the anesthesia. But then she developed trouble breathing, and the nurses clapped on an oxygen mask and whisked her off to another ward for more intensive monitoring.

Things quickly spiraled out of control. She tried to rip off her oxygen mask and IV tubes. She frantically tugged at the sheets and her skimpy hospital gown. Like the aged Lady Macbeth, she kept saying: “We have to clean this up! Clean this mess!”

They tied her hands to the bed. The medications to calm her down didn’t work. The doctors upped the sedation. Later, the physical therapist could barely rouse her to do the critical rehab on her brand-new hip.

What my family didn’t know at the time, because the doctors did not tell us, was that this frightening transformation was a classic case of hospital delirium — a brain dysfunction characterized by sudden confusion and inattention. It’s one of the most common, dangerous and costly complications of hospital stays for the elderly.

This two part story in the New York times continues by teaching us the signs of delirium and how it can be prevented.  The following items in particular caught my attention:

1. Once delirium occurs, the patient has a 62% chance of dying in the next year
2. Delirium can be prevented in 30 - 40% of cases
3. The best people to detect and counteract delirium are caregivers who know the person well and are able to detect when they're not normal
4. Home Care Caregivers can greatly assist in the prevention and recovery from Delirium with steps as simple as getting the person up to walk a little bit each day

This topic is too important to stop here, so here are the next steps:

• You should all read the two part series right now by clicking on the titles.  The first part is entitled "Another Hospital Hazard for the Elderly" and the second (published November 11, 2011) is entitled "Preventing Hospital Delirium"
• Ankota will do a deeper dive into the prevention and cure in the coming weeks.

Can your agency put an awareness and education program in place to help prevent and recover from delirium?  Can you offer hospital companion services with caregivers who can advocate for your clients, alert hospital staff when something's not right, and make sure that the hospital is doing the right things?

Ankota provides software to improve the delivery of care outside the hospital. Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care. To learn more, please visit www.ankota.com or contact Ankota

A Home Care Checklist for Good Dementia Care

  

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Aging in Place Technology Update for Home Care

  

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We often blog about "Aging in Place Technologies" and the reason is that we beleive that these technologies represent an opportunity for home care companies to do two things: 1) keep abreast of what's available (and often marketed direct to consumers and their families) and 2) Look for ways to grow your businesses with this technology.  As an example, two weeks ago we did a blog post entitled Wired Homes for Tracking the Elderly: A private Duty Differentiator that you can read here.  That post talked about home monitoring solutions that families are considering in lieu of private duty care, but then outlined a way that you can in fact grow your business by embracing the technology.

Today we bring you an update from Laurie Orlov, who is an expert consultant in all matters related to aging in place.  She publishes a blog at http://ageinplacetech.com.  Below is a sample of her research and writing with information to connect you to her site.

Aging in Place Technology Watch August Newsletter

by Laurie Orlov

August was a bonanza of buzz, buzz, buzz.  Usually August is a snoozer (and a slow news month) in the business world, what with vacations and organizational regrouping. But beginning with the August 3 Intel-GE Joint Venture announcement that fueled hope and speculation about accelerating intentions, more activity and media tracked right behind. During August, Great Call announced a new Jitterbug medication reminder service, Healthsense received a round of investment led by Radius Ventures, a $1.3 billion M-Health market sizing got Qualcomm and AT&T excited. Or maybe that that was 'mHealth' -- Best Buy (re)surfaced with health-related stuff in stores. Within the general what's-it-all-mean confusion, more press followed last month's NY Times series -- this time NPR offered up a series on aging and technology as well. Never one to shut up, I offered my own 'bah humbug' assessment of the assessment.

Alzheimer's hype, hope, oops...reality. Speaking of saturated media coverage, August was a month in which the unsuspecting might actually think an Alzheimer's revolution was at hand. Following July's news of amending (expanding) criteria as to what consitutes the disease, next came identification of biomarkers as possible early warning indicators. But stay cautious about remedies and prevention: see yesterday's NY Times published the NIH jury and Duke 'meta' study -- a study of all previously published studies about what's proven and what's not. The short answer about the various prevention and remedies studied to date -- the answer: NOT PROVEN. Implication? New criteria potentially broadens the population beyond the current 5 million, diagnosis is potentially going to be at an earlier age, and nothing has been proven to work at staving off or curing the disease. To me, this signals an opportunity to create or re-purpose smarter GPS and geo-fencing apps (not just technologies) to prevent wandering, not just find those who are lost -- and while we're at it, let's see some studies that prove which ones work best and under what conditions. We're going to need them.

And how long before the iPad solves everything? Ah well, sigh, I guess it will be just a bit longer, judging from the Nielsen study noting that only 15% of iPad buyers are over age 56. I bet that even those (no demographics to prove) are not that much over, either. And will the smart phone be the remote monitoring and fall detection device of choice, meaning all others rest? Not in the near term -- seniors aren't buying or using them either. So for all those who ask about this -- I doubt it. Remember, Apple doesn't even want admit to marketing to baby boomers!. And carriers express interest and even dabble a bit here and there, but invest little or nothing in marketing. So in the meantime, keep on keeping on with solutions for the foreseeable future. When there's a big change, you can read it on this site early and often.

And for those who might be running around here and there like I will be in the fall -- look on the left side of the website at http://www.ageinplacetech.com for a list of events.

For any of you who are interested in aging in place technologies and who will be in the Boston area on September 23rd, Ankota helped organize a great event featuring Laurie.  You can learn more and sign up at http://silvertsunami.eventbrite.com/.

Ankota provides software to improve the delivery of care outside the hospital.  Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care.  To learn more, please visit www.ankota.com or contact Ankota.

Older Adults Enjoy Better Relationships - FamilyConnect can help

  

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Recently published research in the June edition of Current Directions in Psychological Science concludes that Older Adults have better relationships with friends and their family.  The study, conducted by Purdue University shares the following:

• Older Adults can better regulate their emotions and become upset less
• Older adults report better marriages and more supportive friendships
• There is a perception that older people have less time in a relationship, and therefore wish to make that remaining time as pleasant as possible

More than attitude, it's about how all people interact, according to report author Karen Fingerman, professor of Gerontology, Developmental and Family Studies.  Picking up on this point, a concern is raised when the older person becomes less able to communicate effectively on their own.   If they desire to remain independent, there are solutions that assist with this task, such as home monitoring and Ankota's FamilyConnect.  FamilyConnect is a simple software product that allows care givers to report information to family members of someone under their care.  More information is available at our FamilyConnect page.

We're thrilled with the results of the research showing that Older Adults enjoy better relationships and we're glad that we can assist in the process.

Ankota provides software to improve the delivery of care outside the hospital.  Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care.  To learn more, please visit www.ankota.com or contact Ankota.

How will Home Care Change with Life Expectancies over 100?

  

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Scientists in Denmark recently published a report in The Lancet indicating that half of babies born today in the developed world will live past 100 years of age.  There was a good deal of coverage of the report and you can choose your favorite news source below for more complete coverage.

I find this research to be extremely thought provoking.  Here are the top questions that come to mind for me:

• How long will people be able to work if they live 100 years?  My understanding is that the retirement at age 65 was established at a time when average US live expectancy was 72.
• Does a longer life mean a longer healthy and productive life?  Will a 90 year old person in 100 years have a comparable life to a 65 year old person today from the perspective of mobility, vision, etc.?
• How will healthcare be paid for? We've all seen projections about how Medicare will run out of money in the not too distant future.  What will this mean?
• Will we be able to cure Alheimer's by then? So far the cure to Alzheimer's has been elusive, but this projection would seem to raise the urgency to find a cure
• Will this trend continue? Will the babies born in 100 years live to age 125?

If nothing else, this should convince us that we need to keep the innovation coming in the delivery of care.  Maybe it will stimulate our imaginations and accelerate our progress.

Ankota provides software to improve the delivery of care outside the hospital.  Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care.  To learn more, please visit www.ankota.com or contact Ankota.

NIH Alzheimer's Care Guide: A Home Care Must Read

  

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One of our most popular posts on this blog was "Five Tips for Providing Better Alzheimer's Care" inspired by the work of and the keynote speech delivered by Dr. Verna Carson-Benner at the NAHC 5th Annual Private Duty Conference and Exhibition (PDHCA).  In this inspiring presentation, Dr. Carson Benner explained the stages of Alzheimer's in an easy to understand manner and shared tips on providing better care using analogies from caring for children.  Her moving presentation made a great impact based on its content alone, and in addition Dr. Carson-Benner shares her own passion.  In fact, she said that she was honored to be able to present at PDHCA, but that this is a topic she's so passionate about that she'd scream it from street corners.

For those of you who haven't been able to take advantage of one of Dr. Carson-Benner's classes on "How to Become an Alzheimer's Whisperer", the NIH has released a wonderful resource for providing care to a person with Alzheimer's.  It's easy to read, beautifully photographed and free.  In fact, you can download the PDF version by clicking here and you can order free print copies online at this link.  If you have further questions, you can call the NIH toll free and they can answer your questions in English or Spanish on 800-438-4380.

Ankota provides software to improve the delivery of care outside the hospital.  Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care.  To learn more, please visit www.ankota.com or contact Ankota.

Five Tips for Providing Better Alzheimer's Care

  

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We would love to believe that everyone came to PDHCA in Phoenix to learn about the great Non-Medical Home Care Software Solution that Ankota provides, but of course they came (and so did we) to learn so much more.  This post offers a few takeaways from an awesome keynote address by Dr. Verna Carson Benner from her training on "Becoming an Alzheimer's Whisperer." 

In her training, Dr. Carson Benner describes a concept that they call the "Theory of Retrogenesis" which draws parallels between the way a child develops function and the way an Alzheimer's patient loses function.  This concept, depicted in the slide below (slide courtesy of C&V Senior Care Specialists who reserve all rights), helps you to draw parallels between the first stage of Alzheimers and the behavior of a 5 year old child, then between phase-2 and a toddler, and between phase-3 and an infant.

Five Tricks for Providing Better Alzheimer's Care

1. Don't Quiz, Argue or Reason
2. If at first you don't succeed, wait five minutes*
3. To combat repetition, find a "job" for the person you're caring for (such as folding towels or building with Legos(r))
4. If a loved one complains "My mom didn't have breakfast", or "Nobody has been in to see my dad today", calmly explain that that "Your mom/dad can't remember, and fill them in"*
5. Old photo albums and songs from the past are likely to connect with the patient because long-term memory lasts the longest.

*Note: Alzheimer's patients generally have less than 5 minutes of short-term memory, so if for example you propose a shower and get a negative response, rather than forcing the issue, you might instead wait 5 minutes and try an approach like "let's go for a nice walk but get cleaned up first"

This post merely scratches the surface of what you can learn from Verna and her team.  For more information, click on the banner below.