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What is Assisted Living and is it Right for You or Your Parent? – Richmond, VA

Joseph Coupal - Friday, March 03, 2017

Spring Arbor, Richmond, VAThere comes a time when senior are consider moving to an assisted living facility. The reasons are often extremely varied. Some are lonely in their homes and want social interaction. Others are having greater difficulty managing and maintaining their own homes. Some often have misconceptions about what an assisted living facility is and the costs of residing there.

While the physical structure and amenities provided in an assisted living facility may vary based on the costs associated with residing in each facility, they all have many similar features and amenities.

Generally, an assisted living facility is a residential option for seniors who require some assistance with their activities of daily living, such as bathing, dressing, cooking, toileting and walking. The care necessitated is greater than what would be provided in an independent living facility; however, for most residents, it is a level of care that is less than that provided in a nursing home, which provides round the clock medical care and skilled nursing. The goal of most assisted living facilities is to provide a safe and secure environment with dining and entertainment options while also providing access to medical care and transportation.

Each resident in an assisted living facility has his or her own private residential unit and can socialize as much as or a little as he or she wants. Some assisted living facilities provide residents with small efficiency kitchens, while others just provide a bedroom and a living area without any kitchen.

Each facility has its own unique characteristics and amenities. Some have fine dining options, as well as expanded social, recreational and entertainment areas and amenities, while others may have more limited amenities and options available.

The most common characteristics found in assisted living facilities are as follows:

  • Either one-three prepared meals served in a common dining room;
  • Assistance with activities of daily living;
  • Medication management;
  • House cleaning services;
  • Laundry services;
  • Transportation services;
  • 24 hour security;
  • Fitness programs; and
  • Social and recreational programs.

Additionally, the cost for each residential unit will vary by a number of factors such as:

  • The size of each unit;
  • Whether it will be provided furnished or not; and
  • Are there one or three prepared meals per day being provided?

One expense that is virtually always extra is the cost for any additional assistance and care with activities of daily living. This is an expenditure that is generally always provided at a charge based on the care required in an amount above the basic room rate.

Another factor that may distinguish assisted living facilities is whether or not the facility has a special unit for its residents that need care because they are suffering from impairment of their memory (a memory care unit). Whether or not the facility has a locked memory care unit is often an important consideration for those that have memory care issues and needs. Again, those needing to be in the locked memory care unit will often find that the cost of each room is greater than in the regular part of the facility as greater care is needed for each resident.

Additionally, if you have a long-term care insurance policy, the policy may provide benefits for the cost of any additional care (an aide) that you may require in the facility.

Finally, whether or not an assisted living facility is the right place for you may depend on your answer to the following:

  • Are you feeling lonely in your home and do you crave daily social interaction and companionship?
  • Are you no longer able to maintain your current residence and are the total costs to reside in your current residence greater than those in an assisted living facility?
  • Do you require greater care at home than you currently have or can be provided to you?
  • Does living at home raise safety and security concerns?
  • Do you need transportation services?

If you have answered yes to any of the above, you may be someone who should consider assisted living as an option or perhaps seek additional care at home. The decision is clearly one that is personal in nature.

For more information on assisted living, contact Spring Arbor.


Assisted Living: What to Ask During Your Search - Greensboro, NC

Joseph Coupal - Friday, February 24, 2017

Spring Arbor Assisted Living, Richmond, VAYou’ve decided that an assisted living residence is the right choice for you or someone you care for. This checklist will help you choose the right residence to meet your needs. Make a copy of this checklist for each of the residences you’re considering. It may make comparing them a little easier.

The Call

Once you have a list of residences to visit, call each one. Think about what is important for you and your loved one: location, size, and types of services offered. Bear in mind that the person you speak with will most likely be a marketing or sales representative whose job is to promote the residence.
Take this checklist with you as you compare different assisted living residences.

The Call Checklist:

  • How many living units are in the residence?
  • Where is the residence located?
  • Are different sizes and types of units available?
  • Do any units have kitchens or kitchenettes?
  • Are all the rooms private?
  • Are bathrooms private?
  • Does the residence offer special care units such as those serving people with Alzheimer’s disease?
  • Is a contract available that details fees, services, and admission and discharge policies?
  • Is there a written care plan for each resident?
  • What role does the resident have in developing the care plan? Are additional services available on the same campus if a resident's needs change?
  • Can residents choose their own doctors, therapists, or pharmacies?
  • How does the residence bill for services?
  • What if a resident runs out of money?
  • Under what conditions would a resident have to leave the residence?

This will help you compare residences. It’s a real challenge to choose a quality assisted living residence. Remember that it can be expensive and a long-term decision. If you’re searching out a unit for yourself, try not to make the visits and decisions alone. Talk with family members and friends. Learn as much as you can about assisted living and each of the residences you are considering. This will build the confidence and comfort level you’ll need to make the best choice.

The Visit

Take along your checklist and some written questions for the staff when you visit. As you meet with them and tour a residence, pay close attention to how you feel and what is going on around you. Spend time with the staff and residents; ask them what they like and dislike about the place. It’s a good idea to visit more than once; an unscheduled visit on a weekend or in the evening might be very helpful in your decision making.

The Visit Checklist:

  • Is the residence clean?
  • Is the residence cheerful?
  • Do you feel good about it?
  • Are stairs and hallways well lit?
  • Are exits well marked?
  • Do rooms and bathrooms have handrails and call buttons?
  • Are there safety locks on the doors and windows?
  • Are there security and fire safety systems?
  • Is there an emergency generator or alternate power source?
  • Is the floor plan logical and easy to follow?
  • Are rooms large enough for a residents’ needs?
  • Are there kitchens or kitchenettes?
  • Are there enough common areas, such as dens and living rooms?
  • What special services are available?

The Contract:

  • Is the contract easy to read?
  • Do you understand everything in it?
  • Are specific services provided by the residence?
  • Does the contract include all of the services you are looking for?
  • How frequently are services provided?
  • What do additional services cost?
  • Are health care services included? Which ones?
  • When and where are meals served?
  • Are all meals served 7 days a week?
  • Does the contract address levels of care? How many levels?  Who determines level of care? Are there services for each level?
  • Are linens/laundry provided?
  • Are transportation services provided?
  • Is there a parking fee for residents? For visitors?
  • Does the residence offer worship services?
  • Is transportation to worship services provided?
  • What are the entrance fee(s)?
  • What is the monthly rent?
  • What is the security deposit? Are deposits refundable?
  • Are utilities included? Which ones? Is telephone included?       
  • How are rate increases or late payments handled?
  • Does the contract cover transfer and discharge policies?
  • Who makes a transfer or discharge decision?
  • How much notice is given to residents who have to leave?
  • Is the living area held if the resident is in the hospital? For what cost?
  • Can you have a pet?
  • Can you have personal furniture?
  • Does the contract deny your right to bring legal action against the residence for injury, negligence, or other cause?
  • Can personal visitors come and go at will?

For more information on assisted living, contact Spring Arbor.


Is it Time to Look into Assisted Living? - Richmond, VA

Joseph Coupal - Friday, February 17, 2017

Spring Arbor Assisted Living, Richmond, VAThe family gatherings during the holiday season might have left you with more than a few extra pounds to lose. If you’re like many adult children who enjoyed a visit with your parents, you might also have some nagging concerns about their health and safety. These family events are typically when people first notice warning signs that their aging relatives aren’t managing on their own as well as they used to.

A mom once full of energy now seems frail, or a dad who was always on top of his game is now experiencing issues with memory loss.

We all value our independence, so considering assisted living can be a difficult idea to embrace and a tough topic to broach. However, in most instances, the residents experience improvements in their quality of life once arriving in an assisted living community. Some even expressed regret at not having made the move sooner.

As you consider what you witnessed over the holidays, ask others if they noticed the same things you did. Specifically, here are three warning signs to look out for:

  1. Loss of social drive – As our parents and older relatives age, their social circles also get smaller, which can lead to major health and safety issues. That’s where assisted living communities come in, offering companionship and a sense of purpose, which can help combat depression and other health challenges.
  2. Unfinished business – Are there unpaid bills or stacks of unopened mail that have gone unnoticed? It might be a sign that your parent or older relative is physically or emotionally unable to handle the task. It’s important to ascertain if this is a one-time situation or something that has been going on for a while, so it’s important to check in on this frequently. If you live far away, ask a neighbor or friend to check in, and if it’s ongoing, it might be time for assisted living.
  3. Eating habits – If you notice changes in weight loss or weight gain, it may be a sign that your parents or older relatives are either forgetting to eat altogether or forgetting they ate and eating meals twice. It’s important to check for stale, spoiled or expired food as that may be a sign of changed eating habits. It’s also important to check that they’re going to the store or have ample items in stock.

The transition to an assisted living community is challenging for residents and their families alike, so look for places that provide support to everyone involved so that it becomes an empowering change rather than a stressful one. A community where residents have access to outings and programming, art classes and great meals. Through movie nights and game tournaments, they can remain socially active while maintaining their privacy and dignity. It’s not uncommon for people to regain their confidence and zest for life once the daily stress of caring for themselves and their home is removed.

Moving a loved one to an assisted living situation isn’t the easiest task, but it doesn’t have to be the scariest either. When approached with compassion and understanding, it can make the senior years golden indeed.

For more information on assisted living, contact Spring Arbor.


Work and Caregiving: Finding the Balance - Greensboro, NC

Joseph Coupal - Thursday, February 09, 2017

Spring Arbor, Greensboro, NCThese tips can help you juggle your job responsibilities and your demands at home.

You've got important meetings at the office and projects that are almost due. But you care for your parents and they’ve been waking up every night this week and you would like to take him to the doctor. What should you do?

An estimated 25.5 million Americans face challenges like these every day as they struggle to balance work responsibilities with caring for a relative aged 50 or older. Not surprisingly, they wind up distracted, emotionally drained and physically exhausted.

The good news is that many employers are sympathetic to these demands. Some companies have programs to help caregivers find community services, counseling, respite care, legal and financial assistance, and caregiver support groups. Others have begun offering caregiving leave and flexible work arrangements.

Of course, every caregiver's job is different, and even within the same company, different managers may be more or less supportive. These tips will help you manage your dual roles.

Learn about company policies. Talk to your human resources department or read your employee handbook to ascertain your company's policy regarding caregivers. Find out about any benefits your company may offer, such as an employee assistance program.

Know your rights. Ask your human resources department for information about the Family and Medical Leave Act. Have them send a copy to your supervisor as well, if appropriate. Under the FMLA, eligible workers are entitled to 12 weeks per year of unpaid leave for family caregiving, without the loss of job security or health benefits.

Talk to your manager. Be upfront about your role as a caregiver and the demands that it puts on you. It's better that she or he hear from you why you're coming in late or seem preoccupied. Spell out the concrete steps you can take to juggle your competing demands. For instance, say, "I just found out my mother needs weekly physical therapy on Wednesday afternoons. While I'm looking for other arrangements, I propose that I work late on Tuesdays." Chances are your company will reward your honesty and sense of responsibility toward both your family and your job.

Inquire about flex-time. Even if no formal policies exist, you should ask your boss if he or she would consider an arrangement to help you accommodate your caregiving responsibilities. For instance, you might ask if you could work from home a day or two a week. You could inquire about a part-time job or job-sharing arrangement.

Don't abuse work time. Whenever possible, avoid taking care of caregiving chores when you should be working. If you have to make phone calls or search the Internet for information related to your parent's needs, do it on your lunch break.

Stay organized. Do your best to manage your time efficiently. Use to-do lists and calendar reminders. Set priorities, then tackle the most important items first. Delegate at work and at home.

Seek help. Turn to the community for caregiving resources and services.

Say thanks. Show your appreciation for co-workers and colleagues who pitch in and help you out with your job. Agree to take on extra work when the dust settles, and be willing to help someone else who is suddenly thrust into a situation you may know all too well.

For information on assisted living for your loved one, contact Spring Arbor.


Alzheimer’s Caregivers Can Feel Overwhelmed – Richmond, VA

Joseph Coupal - Tuesday, February 07, 2017

Spring Arbor, Alzheimer's careSometimes, it is easier for a non-family member to care for someone with Alzheimer’s.

The caregivers know the patient as they are now, while a loved one knows them as they were yesterday. Caregivers don’t focus on what your loved ones could do, but on what they can do.

Alzheimer’s affects not only the patient but also the patient’s caregivers, who often become overwhelmed and isolated as the disease progresses in a loved one.

Finding help for caregivers has become more important.

Often caregivers become very isolated, especially as the disease progresses.

In the early stages of the disease, the patient are still able to handle most of his or her day-to-day activities, still understanding what is happening and able to share in the decision-making process.

These partnerships begin to become unequal in the middle stages. At this stage the patient loses certain memories. They may remember how to mow the lawn, but not how to turn on the mower, or completely forget about paying bills. It adds to the frustration for the caregiver, who is taking on more and more roles … there is a significant increase in stress.

As the disease progresses, it can be hugely difficult to leave the house because the patient behaves inappropriately in public. In fact, it is not uncommon for a caregiver to not leave the house in months, relying on others to pick up needed groceries and other items and drop them off.

Social lives change. If a couple used to play cards with friends on a regular basis, but now one person in that couple can no longer remember how to play, behave in public or even who the friends are, the ties to those friends loosen, especially if the caretaker often cannot find, or afford to pay, someone to stay with the affected spouse while the main caretaker leaves to shop or visit with friends.

Excursions also are often painful and disorienting for the Alzheimer’s patient, who now might not recognize the proper way to use silverware — if they even try to use it.

But caregivers are not alone and are encouraged to form partnerships with others — perhaps even other caregivers — to help handle the burden of caring for an Alzheimer’s patient.

Finding an outlet and finding time to stretch, dance, sing, write or any other relaxing or energizing activity helps.

For more information contact Spring Arbor.


All About Assisted Living Options – Greensboro, NC

Joseph Coupal - Thursday, February 02, 2017

Spring Arbor Assisted living, Greensbor, NCThe number of older Americans (65-plus years) is increasing by the minute. In 2014 they comprised 46.2 million, representing 14.5 percent of the U.S. population. By 2040 seniors are projected to make up 21.7 percent of the population. As these baby boomers retire from full-time careers and become empty nesters, their lifestyles will certainly change. As they age, their health and wellness needs will also change.

Unable or uninterested in living on their own, many will look for a residential senior community—there are many variables to consider. Some have a formal, traditional feel, while others may have a more relaxed, home-like ambiance. Some cater to a particular culture or religious preference. The centers themselves can be towering apartment buildings in urban centers, sprawling complexes in the suburbs, small cottages or more intimate communities catering to a small number. Populations can range from 20 people to hundreds of residents.

These communities offer many different amenities for residents, just as they offer differing levels of health care services. Personal preferences, in addition to an assessment by a medical professional, will help determine the type of community that fits an older person’s needs.

Independent living is perfect for those seniors who are still healthy and active. These residents typically do not need assistance with daily tasks. Instead they are looking to socialize, meet new people, and enjoy their senior years.

Assisted living residents are largely independent, but may need help with personal care such as bathing and dressing. They are mobile, and typically live in a studio or one-bedroom apartment. Their health is generally stable, so they do not need ongoing medical attention. This is a great intermediate step for seniors who need more help than family members can typically provide at home, but who don’t need the continuous medical care.

Nursing home residents are often bedridden. They generally have a single or semi-private room and receive 24-hour assistance from skilled nursing staff.

A Closer Look at Assisted Living

Assisted living centers should provide seniors with an environment that promotes accessibility, independence, quality of life, dignity, and personal choice. An ideal housing option for those in a transitional stage of aging, residents generally have continuous access to personal care, as well as nutrition and wellness services designed specifically for older adults. In these settings seniors can also enjoy social contact, security, and support while maintaining their independence. Common advantages of assisted living communities include:

Physical Fitness Programs
With the latest in gym equipment, swimming pools, group exercise classes like Tai Chi and Zumba, and personal trainers well acquainted with the needs of older adults, assisted living communities frequently offer opportunities for physical fitness that go far beyond what was available when the resident lived at home.

Social Activities
Living alone can be isolating, particularly after an individual retires, or has trouble driving. Getting out of the house is difficult; seniors lose touch with lifelong friends due to health and mobility problems. Social skills can atrophy if they are not used, causing anxiety when seniors do go out. Without meaningful interaction, the elderly can become withdrawn and even depressed.

In assisted living, residents can easily socialize with peers through planned, structured activities like field trips to museums, zoos, farmers’ markets, shopping trips to local malls and stores, and cultural events both on and off-campus. In common areas seniors may meet for game nights, poker or bridge, movie nights, or special interest groups like scrapbooking or gardening clubs.

A Safe Living Environment
For seniors to be safe in their own homes when their physical health begins to decline, the house itself may need significant modifications, such as shower railings, expanded doorways and bathrooms, or medical alert systems. Assisted living facilities are designed for safety and accessibility. They can also provide immediate help in case of an accident.

Intellectual Stimulation
Recent studies conclude that older adults who remain intellectually engaged throughout their golden years —through reading and study—have healthier brains. This can significantly delay and/or reduce the cognitive effects of aging. To serve this need, many assisted living communities provide a wide range of lifelong learning activities, from computer classes and book clubs to art classes. Many facilities even offer lectures from visiting scholars and other professionals.

Supervised Nutrition
Several factors contribute to the problem of poor nutrition in seniors. Living alone, many may find it unappealing to cook for one, and it’s challenging for family caregivers to monitor whether their loved ones are receiving the necessary nutrients.

Some lack transportation to the grocery store. Appetites can also lessen as we age—either naturally, or due to side effects of various medications. And many people simply don’t like eating alone. They may have trouble following specially prescribed diet restrictions and with less interest in meals, they may indulge in unhealthy, ready-made snack food instead of preparing well balanced meals. They then may eat in front of the TV for company.

For those who like to cook once in a while, many assisted living centers offer kitchenettes, so residents have the option of preparing an occasional meal in their apartments. But in general, communities provide three nutritionally balanced meals, served in a communal environment. They also offer healthy snacks throughout the day. With good company for meals residents generally eat better, keeping them healthier. Dietitians in senior living communities can also design meal plans specifically for those with medical restrictions.

Home Maintenance and Housekeeping
Mowing the lawn, climbing a ladder to change light bulbs, shoveling snow, pulling weeds, vacuuming—caring for a home is a lot of work. As we grow older, routine maintenance becomes more difficult, repairs are delayed, and general housekeeping needs are sometimes overlooked.  Living in a senior community, residents are not only assured that their surroundings will be clean and well cared for, they decrease the risk of injury in trying to keep up with these tasks. (To satisfy a green thumb, residents are often invited to adopt a small garden plot.)

Even renters have to be proactive about their homes if something goes wrong. They need to contact a landlord if there are plumbing, electrical, or other problems in their apartment, and often they must follow up on repairs. For homeowners, it can be more complicated because in aging homes there are more systems and appliances that can break down. In assisted living, residents don’t have to worry about repair responsibilities. If something doesn’t work properly, they simply need to alert a caregiver or member of the maintenance staff and the problem will be addressed, at no extra cost. There’s no worry about the senior letting in a stranger to fix a leaky sink, or being taken advantage of by unscrupulous contractors and repair people.

When an elderly person begins to struggle with driving, the loss of transportation can be a hardship. Not only are they losing their independence, they must rely on friends and family to shuttle them back and forth to appointments. Fortunately, most assisted living facilities provide transportation services for shopping, routine outings, as well as special appointments.

Help with Activities of Daily Living
Family caregivers are often responsible for assisting with the tasks of daily living for an elderly relative, such as bathing, dressing, general hygiene, ensuring medications are taken on time. In other cases, the family employs a home care aide to assist with these activities. Both of these options can place emotional and financial strain on the family. In contrast, one of the basic cornerstones of assisted living is helping older adults with these activities, so that they can continue to live as independently as possible.

The Rewards of Independence
Being able to maintain one’s independence is tremendously valuable—and sometimes that requires accepting help from caring professionals. Assisted living gives seniors access to an active and rewarding lifestyle while meeting their specific physical and medical needs.

For more information on assisted living, contact Spring Arbor.


The Stages of Alzheimer ’s Disease – Greensboro, NC

Joseph Coupal - Monday, January 30, 2017

Spring Arbor assisted living in Greensboro, NCAfter we find out that a loved one has Alzheimer's disease (AD) or any other disease, it is only natural to explore the subject with some research. What can we expect and when can we expect it?

The national Alzheimer's Association (AA) has developed a very useful tool, or "staging system," to use as a frame of reference when coping with AD. But people are not programmed to follow these stages in a direct line. No matter how much we would like to "know" what stage someone is in, we cannot. With that in mind, let's look at the stages to better understand the progression of this disease.

Stage 1: No Impairment
Research now reveals that AD begins years, if not decades, before we have a clue that anything is wrong with ourselves or our loved ones. Genetic research and much more sophisticated technology will no doubt make this an important and focused area of study as we march into the future. But, for now, most of us will never know if we are in the beginning stages of the disease. Unfortunately, doctors can only diagnose probable AD due to the fact that a definitive diagnosis is only made through the post-mortem examination of brain tissue.

Stage 2: Very Mild Cognitive Decline
This stage may be indicative of normal age-related decline or the very earliest signs of Alzheimer's disease. At this time, you or your loved one may have a sneaking suspicion that something questionable is on the horizon. A little more forgetfulness could be due to natural aging. But what about increased irritability when that forgetfulness occurs? Maybe we should chat with a doctor. Still, we are not likely to get the satisfaction of a definite yes or no either way. We will most likely hear something to the effect that it is just normal aging and perhaps we should do more crossword puzzles or take a class to learn a new skill. And eat more chocolate. Chocolate has antioxidants in it that are good for the brain.

Stage 3: Mild Cognitive Decline
This is a tricky point in the disease. Early-stage AD can be diagnosed in "some, but not all," individuals with the symptoms recognizable to family and others close to the person having problems. These symptoms include difficulty with words and names and a decreased ability to remember names of newly introduced people. Unusual performance issues at work or in social settings, reduced retention of recently read material, losing or misplacing items, and a decline in the ability to plan and organize are strong indicators of a deeper issue. This is especially true if all or a few of these symptoms are occurring simultaneously.

We can chat with a doctor and even request the cognitive tests at this point, but will they be conclusive? This is still a point where a diagnosis could be a tough call. If someone is very concerned, he or she should see a team of physicians uniquely qualified to diagnose dementia because this a point where some medications can help maintain better brain function longer into the disease. If we brush off worries too long and then decide to go for help, we may have lost valuable time. Still, this is not the time to panic. Schedule a general physical and perhaps see a qualified neuropsychologist that has experience with diagnosing dementia.

Stage 4: Moderate Cognitive Decline
This point in the progression is considered to be mild or early-stage AD and by now there are clear-cut indications of the condition that a careful medical examination can detect. This includes an obvious decrease in knowledge of recent events, both personal and concerning the local community or world. There would be a decrease in the performance of the standard test where they ask someone to count backward from 75 by sevens. Less scary, perhaps, is testing the person's capacity to perform tasks such as planning dinner for several people or balancing a checkbook.

Again, remember that it is important to know how well the person performed similar tasks at an earlier time. Some people do not do well with numbers or do not exhibit high levels of reading comprehension, but that doesn't mean dementia is present. They are looking for changes in these abilities. They conduct many different kinds of tests to account for the fact that some people struggle with certain things like math or organizational skills. These are consistent characteristics that have been with us all of our lives and do not indicate an illness or neurodegenerative condition.

Stage 5: Moderately Severe Cognitive Decline
Also known as moderate or mid-stage AD, this is where things become pretty obvious and serious. This is when the going gets rough for the caregiver and frustrations mount for most patients. A great deal of agitation occurs. People are aware that they are not functioning normally, and it understandably makes them angry and possibly even more confused. They often take it out on the person or people they feel safest with, such as their spouse or their adult children; those that are their caregivers.

The afflicted person will have major memory gaps, and people at this stage often need some help with activities of daily living (ADLs).

People in this stage are often unable to recall their current address or telephone number. They may not remember where they graduated from school and can become confused about the date and even the current season. They have trouble with easier arithmetic such as counting backward from 20 by twos. They often need help choosing appropriate clothing for activities, occasions, and the season.

Although memory and daily function may be somewhat impaired in stage 5, people usually retain "substantial knowledge about themselves," such as their own names and those of their children. They also, generally, do not need help eating or using the toilet.

Stage 6: Severe Cognitive Decline
This moderately severe mid-stage is where really significant personality changes can emerge. That sweet person you used to know is suddenly combative, volatile and possibly violent at times. At this stage, people lose "most awareness of recent experiences… as well as their surroundings."

Individuals in this stage can be very inventive when trying to outwit their caregiver. They are also prone to wandering, so keeping them safe can be a constant challenge. Patients may find ways to undo several locks on doors and enable a supposedly disabled car. Caregivers have been known to remove and hide car batteries to prevent this. Family members sometimes install an alarm system that is meant to alert homeowners if someone is breaking in, but use it to keep track of whether their loved one is trying to break out. During this wandering-prone stage, the patient must be watched carefully.

Stage 6 is also a phase where, "(People) lose most awareness of recent experiences and events as well as of their surroundings."

They often do not remember their own histories and can forget the names of people they love (although they usually recognize faces). They need help dressing and toileting. This, too, is the stage where the sleep cycle is greatly disturbed for this person. Unfortunately, this means that the caregiver's sleep habits suffer as well.

Late day or early evening confusion called "sundowning" can trigger additional agitation and confusion. This phenomenon is thought to have to do with changes in lighting and/or activity changes that trigger the patient's need to do something important, but they don't know what. For example, they may have the impulse to go home from work or begin cooking dinner. Whatever the cause, this is a difficult time of day for many caregivers and dementia patients.

This is also the phase where the caregiver will witness increased paranoid or suspicious behavior. Hallucinations are not at all uncommon, and compulsive behaviors such as picking at skin or nails, tissue shredding, scratching and hand-wringing can occur.

At this point the patient may need to be moved to a secure environment where they are both stimulated and safe. This minimizes or completely eliminates the dangers associate with wandering and provides the caregiver with some needed relief from their 24/7 responsibilities.

Stage 7: Very Severe Cognitive Decline
This severe late stage of AD is the sad time when the patient's speech is often unrecognizable, there is general incontinence, eating is difficult or refused, and swallowing can be impaired. They usually need assistance and support with walking and even sitting. Falls can be a dangerous complication at this stage.

Families often become frantic when their loved ones refuse to eat. We get hungry. We think they must be starving and are compelled to try to provide comfort and sustenance through food. However, as the body prepares to die, it often does not want food. The organs are shutting down.

Patients also become increasingly weak and susceptible to bacterial infections such as pneumonia or urinary tract infections (UTIs). The adjustment to the final stage, which will bring death, is one where hospice can support the caregiver and family members, as well.

From stage 3 on, this disease is a mind-bender to deal with. Each stage puts new demands and strains on both family and professional caregivers. Education can help immensely throughout this process, so it is important for family members to conduct research in order to be as prepared as possible. Going through this alone should not be an option. Caring for someone with AD takes a super-human effort. This is a disease where community support can make all the difference. Be sure to get help for your loved one and get help for yourself.

For more information on caring for a loved one with Alzheimer’s Disease, contact Spring Arbor.


The 10 signs of Alzheimer’s Disease Are… - Richmond, VA

Joseph Coupal - Thursday, January 26, 2017

Spring Arbor, Memory Care, Richmond, VAForget what day it is? Lost your keys? Can’t think of the word? Could be typical, related to age – or not.

Alzheimer’s is a progressive disease with no cure. The biggest risk factor is age, and since women tend to live longer than men, it occurs in more women.

Before seeing a doctor – choose one with experience with diagnosing Alzheimer’s – the spouse or family members should keep a log of specific symptoms that have occurred. Also, bring all medication to the appointment and a list of current and previous health problems.

The 10 signs of Alzheimer’s Disease are:

  1. Memory changes that disrupt daily life, like not remembering phone numbers or addresses.
  2. Challenges in planning or solving problems.
  3. Difficulty completing familiar tasks, such as setting the table or following a well-used recipe.
  4. Confusion with time or place.
  5. Trouble with visual images and spatial relationships, interpreting a sequence of instructions.
  6. New problems with words in speaking or writing.
  7. Misplacing things and losing the ability to retrace steps.
  8. Decreased or poor judgment, like giving money to charities or to anybody who asks.
  9. Withdrawal from work or social activities, because they realize something is wrong.
  10. Changes in mood and personality, often becoming more bitter, just not like themselves.

For more information on Alzheimer’s Care, contact Spring Arbor.

The Daily Courier

Signs of Alzheimer’s Disease and Demetia – Greensboro, NC

Joseph Coupal - Thursday, January 19, 2017

Spring Arbor, Greensboro, NCHow do you know if your parent has Alzheimer's disease (AD) or dementia? If dad continually forgets where he puts his keys, or mom seems to get easily confused these days, does it mean they have a progressive neurodegerative disease? Not necessarily. Only a doctor can diagnose the condition. Every person experiences different symptoms with different severity, but there are some main warning signs you can look for.

Early Indicators of Alzheimer's Disease and Dementia:

Forgetfulness and Memory Loss

The most common symptom of most types of dementia is memory loss. However, just because Dad cannot remember where he put his shoes or calls the grandkids by the wrong names does not mean he has Alzheimer's. We all forget the details of a conversation from time to time, but early onset of this disease can cause a person to forget entire conversations that took place only moments ago. AD usually affects short-term memory first, meaning the person forgets information that they recently learned. They have trouble remembering important dates and events and they ask for the same information over and over again. They may even lose the ability to recognize their family members.

Lack of Concentration and Increased Confusion

Getting confused about times and places is a common indicator. Your mom or dad may have difficulty concentrating and take much longer to do things than they did before. Individuals may forget where they are or how they got there. They might have difficulty understanding that an event happened in the past or will be occurring in the future, versus something that is happening in the present. They can lose track of the seasons and the general passage of time.

Losing Things

A person with AD may begin to put things in increasingly unusual places. Car and house keys tend to elude everyone from time to time, but finding lost keys in the freezer could indicate a more serious problem. They may lose things and be unable to use the simple method of retracing their steps to find the items. This situation can even escalate into accusations of theft when they cannot find a personal belonging that they have unknowingly misplaced. This can lead to paranoia, and they may react by placing their things in even more unusual "hiding spots" to foil the perceived thief.

Difficulty Doing Familiar Tasks

This condition also affects the ability to do normal, everyday tasks. People may have trouble remembering how to drive, cook a favorite recipe, or play a familiar game. They may start relying more on a spouse or family member to do things for them that they once enjoyed doing themselves. Symptoms can affect one's abilities related to vision as well, such as depth perception, judging distance and seeing colors. This can lead to an increase in perceived clumsiness, accidents and other uncharacteristic mishaps.

Language and Speaking Problems

AD affects how sufferers create and process language. They typically have trouble recalling the right words in conversation or while writing. For example, they say "what-cha-ma-call-it" instead of eyeglasses, or call a watch a "hand-clock." This confusion can cause them to stop abruptly in the middle of sentences or conversations as well.

Problems with Simple Math

People in the early stages may have difficulty working with numbers, including simple math problems they have done their entire lives. They may struggle when balancing their checkbook or performing simple addition and subtraction calculations.

Poor Judgment

Look for changes in their decision-making abilities, rational thought processing and judgment skills. A person who has made poor or risky decisions all of their life probably does not have a medical condition causing these behaviors. But dementia could be the culprit in a situation where a once logical decision maker who carefully weighed all the options and made informed decisions suddenly begins exhibiting poor judgment.

Personality Changes and Mood Swings

Individuals might exhibit changes in personality and sudden mood swings. They could become fearful, suspicious, depressed or anxious. A once confident person might become tentative and shy. They may be easily upset at home and in new or public places where they are out of their comfort zone.

Changes in Grooming and Personal Hygiene

Sudden or steadily declining attention to personal care, such as infrequent bathing, wearing the same clothes over and over again, and not their brushing teeth, can point to this disease. If a person kept their home immaculate all their life but suddenly stops cleaning and allows clutter to accumulate, it could be a cause for concern.

Withdrawing from Friends and Family

Finally, withdrawal from social opportunities and activities they once enjoyed can be a red flag. Affected individuals tend to dodge situations where they have to be around others in order to avoid drawing attention to their memory lapses or communication difficulties. They are typically embarrassed by their inability to converse or perform tasks as they once did. Depression related to this change in abilities can also cause withdrawal from social situations.

Doctors will only diagnose dementia only if two or more brain functions, such as memory and language skills, are significantly impaired without loss of consciousness. If you think someone you love may have Alzheimer's disease, contact your doctor immediately.

For information on memory care, contact Spring Arbor.


Weighing the Options for Assisted Living, Part II - Greensboro, NC

Joseph Coupal - Friday, January 13, 2017

Spring Arbor, assisted living in Greensboro, NCAssisted living residences are aimed at helping residents remain as self-sufficient as possible with the assurance of assistance when needed. Assisted living facilities are a great choice for those who can’t live on their own, but do not need nursing care.

If assisted living sounds like the right choice for your loved one, we offered the first steps to beginning your search in an earlier blog post. Here are the rest of the steps to help begin your search:

Plan to Visit

First, it is imperative that you involve your loved one in the choices about his or her care. Take them with you on the tours of each facility and let them handle as much of the talking and decision-making as possible.

Second, take these questions, along with the residence-specific questions that arose while reviewing the mailed materials, with you. As you and your loved one meet with staff and take a tour, pay attention to how you feel and your surroundings. Spend time with the staff and residents. Ask them what they like and dislike about the place. Make a second, unannounced visit on a weekend or in the evening. You may find out important information by dropping by unannounced.

Signing the Contract

After reviewing all the materials, visiting each prospective residence, and getting all questions answered, singing a contract is the final, and most important, step. This is the legal document that states what arrangements are agreed to, regardless of anything promised verbally or in marketing materials. The more specific the contract, the greater your loved one’s legal protection. Compare information in the sales brochure with that in the contract, paying close attention to fees, level of care, health care services and discharge policies. Benefits that a residence promotes in a brochure should also appear in the contract.


  • Make sure you understand what the contract says. Get any and all questions you have answered before signing.
  • Ask that any information not included about care, rights, costs and services be added — and don’t sign a contract until you see these additions have been made (a residence can promise anything in a brochure, but it is only bound legally by what is in the signed contract).
  • Never sign on the day you visit.
  • Before making a decision about a residence, take the contract home and review it with family members.
  • Consider reviewing the contract with a financial adviser and a lawyer.

The Cost of Assisted Care

Assisted living can be costly. About four out of five people pay for it out of pocket. Medicare does not cover assisted living. While more states are starting to cover some services under Medicaid or other government programs, public payment is not common in the assisted living industry. State Medicaid agencies can provide information about eligibility and covered services. Before you seriously consider assisted living as an option for your loved one, decide whether you and your loved one can afford it long-term. Keep in mind that the cost will rise over time because of standard cost-of-living increases. Also, expect monthly price hikes for extra services as needs change.

Promotional materials for these residences commonly present fee information in general terms, so it’s crucial that a contract detail all of your payment obligations. Consider running the contract by a lawyer before signing.

For more information, contact Spring Arbor.