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Maybe 90% Of Older People Don't Want To Live At Home

Joseph Coupal - Thursday, April 19, 2018

Spring Arbor, Richmond, VAResearchers keep producing articles and reports saying that older people want to live at home. Well, duh! If you ask anyone about living at home you’re going to get the same response. What I really want to know is, of those people who are infirm, that is, cannot make it to the bathroom on their own, feed themselves, go to the store, or bathe themselves safely (all the Activities of Daily Living), how many of them want to live at home, especially if it means living by themselves? That’s the really important piece of information needed to make real decisions and policies.

I find it curious that when you ask these same older people about whether they'd want to live at home if they knew their family would have to take care of them, they respond “No.”

What’s also curious to me is, what is the real question these respondents are answering? When my mother-in-law was living in an assisted living facility she kept repeating to us, “I want to go home.” We kept wondering what she meant and asked, “Where do you mean?” Turns out, she didn’t mean the last place she had lived in before moving into the facility. Or even to the house she and her husband lived in for 40 years. She meant the past. She wanted to go back to the time when she was living in her wonderful home with her family and most of her life was ahead of her.

I’m in the demographic group that researchers survey. That is, I’m “over 65.” (According to a widely cited study by the AARP, almost 90% of those 65 and older want to stay in their current homes for as long as possible.) And of course I want to live at home. If I didn’t, I'd move. And if could afford it, I’d move myself into a hotel or, better yet, a full-time resort. Or if I didn’t like my current home, I’d move to another one. The key here is that I know I’m perfectly capable of living by myself.

I also want to know the feelings people would have about living "at home" if they knew they'd be living alone. I think we know the answer to that. After my stepmother died, my father lived in the apartment by himself and had a caregiver live there with him. The apartment was far from me and from my brother. My father wasn’t mobile, he had few friends since he had outlived most of them, and the few that were left never came to visit. Plus, he needed someone to live with him — to prepare his meals, clean, get him to and from the bathroom, etc., all the activities of daily living. Still, he said he wanted to stay in the apartment. And so he did. After a few months he told us that it was getting too hard for him and he was feeling too lonely being by himself all the time, even with the caregiver we had hired. So then he told us he wanted to move, and it was with our blessing. He moved into an assisted living facility closer to my brother, and there my father lived out the rest of his life. He was much happier there and had frequent visits from the family. He didn’t have a lot of friends at the facility. But meals were with other people and sometimes they talked with each other. He went to a few activities and again, he interacted with people, not just the one caregiver he would have had access to at home. He told me, close to the end of his life as it turned out, that he was happy there. He used the word “content.” Moving to the facility was definitely the right thing to do. And had researchers asked him about whether he wanted to live at home, he would have said, “No, I didn’t want to live at home.” For one, he had too many bad memories of what it had been like for him at home after his wife died. But really, he would have said, “I couldn’t manage by myself and, frankly, I was lonely.”

So I challenge researchers to sample the right population before making sweeping comments about how “older people” want to live in their homes. Also, researchers, be sure you define what the word “home” means to the people you’re surveying. “90% want to live at home” makes a great headline. But it’s a meaningless statistic.

For more information on assisted living, contact Spring Arbor.

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Forbes


Choosing the Right Assisted Living Community

Joseph Coupal - Tuesday, April 17, 2018

Spring Arbor, Greensboro, NC Lack of oversight and caregiving shortfalls could put residents at risk. Here's how to avoid problems.

For many frail older Americans, assisted living has become an increasingly popular alternative to remaining in their homes. You can live in a comfortable residence, receive the services that you need, such as help with bathing and dressing, as well as avoid the institutionalized setting of a nursing home.

But finding the right residence can be a daunting challenge. It's also difficult to judge the quality of care you will get.

Many more people going into assisted living facilities today have high care needs. But many of the facilities aren’t set up for high levels of care.

Smart Questions to Ask

For families seeking assisted living for a loved one, there are ways to find a facility that delivers quality care in a comfortable setting. The key is to do careful research.

Start by asking these five key questions:

1. What Kind of Help Do You Need?

Think about what kind of help you or your family member needs now and in the future. Are you looking to help your loved one enjoy more social interaction, or get help with memory loss, or more medical care? Different facilities offer varying levels of care—not all have memory units, for example. The social activities vary as well, so check to see if the book clubs or trips to the symphony fit in with your loved one’s interests.

It’s also a good idea to have your family member evaluated by a physician to have a better understanding of the level of care required and how that might change. That way, you can judge whether the facility will meet your loved one’s needs over the long term.

2. What Is the Quality of Care?

Check into the residence’s licensing and inspection records to see if there are reasons for concern. Depending on your state, you may find this data online—a good starting point is your state Agency on Aging. You can also contact your state ombudsman about the facility’s complaint record. (Go to ltcombudsman.org; use the map tool to find links for your state.

You should also ask if the facility has a registered nurse on staff. If the facility doesn’t have one, your loved one may end up going to the ER more frequently.

To get a feel for the quality of life, make multiple visits to the facility. Go for meals and during the weekends, when fewer staff are on duty. And speak with residents and their families about their experiences.

3. What Are the Real Costs of Care?

As noted above, the typical cost of care is high. And add-on fees could push those costs even higher, which will stretch, or exceed, many retirees' budgets. (Read this story for tips on affording assisted living care.)

Be sure to get a written list of fees and charges from the residence, and check to see that they’re included in the contract. While some facilities have all-in costs for room, board, and a particular level of care, others have a point system or charge à la carte. Find out what circumstances might lead to more fees, such as needing help walking to meals or falling ill for a week or so.

Given the high costs involved, it can be a prudent move to hire an elder law attorney who is familiar with local facilities to review the terms of the contract.

4. Can Your Loved One Age in Place?

One of the biggest risks for assisted living residents is involuntary discharge, or eviction, which can happen through lack of payment or when the care required exceeds the facility’s ability to provide services. These circumstances might include cognitive decline, lack of mobility, or complex medical needs.

Find out what situations might trigger a discharge, and whether you could hire private aides if more care is needed. Also ask what assistance the facility would be able to provide if a move is required.

Some nonprofit facilities, for example, may help a resident running low on funds to qualify for Medicaid, which could pay for nursing home care, or funds that may help your loved one stay in place.

5. Will Your Family Member Have an Advocate?

Once you’ve found a residence for your loved one, it’s important to have family and friends drop by regularly. That way, you will be able to spot any lapses in care quickly, which is especially important if your family member is ill or confused and cannot advocate for herself.

If you or your family are not able to visit regularly, consider hiring an aging-life-care expert or asking a friend living nearby to check in on your family member. Spotting issues early may help prevent more costly problems later. And if the assisted living management knows you’re keeping a close eye on your loved one, that can help ensure the quality of care.

For more information on assisted living, contact Spring Arbor.

#HowYouLive

Consumer Reports


Traumatic Brain Injuries Linked to Dementia

Joseph Coupal - Thursday, April 12, 2018

Spring Arbor, Richmond, VAIn one of the largest studies on the association, researchers found people who suffered traumatic brain injuries were more likely to develop dementia and Alzheimer's disease. A traumatic brain injury can occur when there is a bump, blow or jolt to the head.

People who have suffered a traumatic brain injury have a significantly higher risk of dementia, including Alzheimer's disease, than people who have no history of injury.

In one of the largest studies on the subject, researchers studied 2.8 million patient records. They found people with a history of brain injury had a 24 percent higher risk of dementia than those who did not.

The Centers for Disease Control and Prevention defines traumatic brain injury as "a disruption in the normal function of the brain that can be caused by a bump, blow or jolt to the head, or penetrating head injury."

Approximately 50 million people worldwide experience such injuries per year, a press release from the University of Washington School of Medicine reported. About 47 million people worldwide suffer from dementia.

According to the study, a single traumatic brain injury defined as "severe" increased the risk of developing dementia by 35 percent. A single incident of a "mild" case or concussion increased the risk by 17 percent.

The number of brain injuries greatly increases the chances of developing dementia or Alzheimer's disease. People who suffered two or more traumatic brain injuries had a 33 percent increased chance. People who had suffered four or more had a 61 percent increased chance, and people who suffered five or more had a 183 percent increased chance.

"What surprised us was that even a single mild TBI was associated with a significantly higher risk of dementia," lead author Jesse Fann said in the press release. Fann is a professor of psychiatry and behavioral sciences at the university.

"And the relationship between the number of traumatic brain injuries and risk of dementia was very clear. ... Similarly, a single severe brain injury seems to have twice the risk associated with dementia as a single mild traumatic brain injury." 

When a person suffers a traumatic brain injury also affects the likelihood of developing dementia. If someone suffers a brain injury in their 20s, they are 60 percent more likely to develop dementia or Alzheimer's disease in their 50s.

This is concerning because traumatic brain injuries are more common in younger people.

While not every person who suffers a single traumatic brain injury or concussion will eventually develop dementia, the findings may prompt those with histories of such injuries to alter their lifestyles and take control of other risk factors for dementia, including limiting alcohol and tobacco use, increasing exercise, preventing obesity and treating diabetes.

For more information on dementia care, contact Spring Arbor.

#HowYouLive

US News


Questions to Ask Before Choosing a Memory Care Community

Joseph Coupal - Monday, April 09, 2018

Spring Arbor - VA, NC, TN, SCAs you search for memory care communities, you will eventually come up with a list of your top choices. It is important to take time to tour each one, if possible. Ask questions of staff and other families whose loved ones reside at the community, to determine if the community is the right fit for your loved one.

Here are some questions that you may want to ask memory care communities you’re considering:

  1. What level of care does the community provide?
  2. What type of training has the staff received?
  3. What is the monthly rate for housing and care? What services does that rate include?
  4. Are rooms private or semi-private? How do prices vary for each?
  5. What level of personal assistance can residents expect?
  6. What is the policy for handling medical emergencies?
  7. How is the community secured?
  8. What meals are provided? Are special dietary requests, such as kosher meals, accommodated?
  9. How often are housekeeping and laundry service provided?
  10. What programs (exercise, physical therapy, social and other activities) does the facility offer?
  11. Does the facility accommodate special care needs, such as diabetic care, mobility issues, physical aggressiveness or wandering?
  12. Are residents grouped by cognitive level?
  13. What is the ratio of staff to residents during the day/night?
  14. How does the facility communicate with families about a resident’s well-being?
  15. What is the discharge policy?

Families making care decisions about loved ones far away may want to make sure they know where a community is located and perhaps consider travel costs. For more information on memory care, contact Spring Arbor.

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alzheimers.net