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Senior Assisted Living Blog

The Common Behaviors of Alzheimer's and How to React

Joseph Coupal - Monday, August 26, 2019
Spring Arbor - VA, NC, TN, SC

Confusion is a common behavior starting in Stage 1 of Alzheimer's Disease. The person may call you by a different name, forget their address, a phone number or forget what their toothbrush is for. It's easy to get frustrated with this behavior, especially if it happens day after day.

  • Stay calm and remember that it's part of the disease. Some days may be better than others.
  • Give a brief explanation but don't overwhelm with a lot of information. Keep it simple.
  • Try to jog their memory with pictures of important places and relationships.

Sundowning is late-day confusion caused by a number of factors: mental and physical exhaustion; disturbed internal body clock; reduced lighting and increased shadows; less need for sleep.

  • Keep the person busy throughout the day with both mental and physical activities.
  • Limit caffeine and sweets and only serve them in the morning.
  • Serve dinner early
  • Keep their bedroom partially lit to lessen confusion by the dark surroundings.

Aggression—in addition to the effects by the disease—can be caused by several other factors: poor communication, physical discomfort and their environment.

  • Being tired because of poor sleep
  • Side effects from medication
  • Being in pain and unable to let you know
  • Feeling overstimulated or overwhelmed by an environment because of loud noises, clutter, or lighting (glare, too dark/too light, flashing lights of TV)
  • Feeling lost
  • The caregiver's poor communication such as hard to follow instructions, asking too many questions, being negative and/or critical.

Agitation often occurs when the person is in an unpleasant environment, a new environment and their frustration trying to remember things.

  • Be aware of the same reasons above that can prompt aggression.
  • Modify the environment; get to a known comfortable environment like their bedroom.
  • Ask them what's causing the agitation.
  • Go for walk to take their mind off the agitation
  • Don't become agitated yourself; they'll recognize this.

Suspicion is caused by the brain perceiving things in new, sometimes unusual ways, leading them to make accusations of friends, spouses and caregivers.

  • Listen and find out what's bothering them.
  • Don't argue
  • Offer a simple explanation
  • Engage them in an activity to change their focus..

Hallucinations can be terrifying for the individual or they can simply be non-threatening images from their past. Causes of hallucinations in addition to Alzheimer's include: schizophrenia, dehydration, intense pain, alcohol/drug abuse, medications and eyesight/hearing problems.

  • Be supportive and respond in a calm manner.
  • Ask them to take a walk into another room, preferably one that is better lit.
  • Re-focus their attention with their favorite activity.
  • Make sure the environment doesn't have distracting lights, shadows or noises that can be misinterpreted.

If you are an Alzheimer's caregiver, and are considering Memory Care for your loved on, contact Spring Arbor.


Questions to Ask Regarding Memory Care Services

Joseph Coupal - Monday, August 19, 2019
Spring Arbor, NC, VA

When it comes to finding the right memory care community for your loved one, questions about the costs and services provided may come to mind. But, memory care communities offer a range of services, some of which might be more important to your loved one than others.

If you are considering memory care for your loved one, understand that many assisted living communities offer a special memory care unit (SCU) on a separate wing or floor. Or, you can choose an independent memory care community – just remember that memory care is specialized skilled nursing distinct from assisted living. Care costs are generally higher at these communities, even if the memory care unit is part of an assisted living facility.

Regardless of whether you choose a memory care facility or SCU, know that staff members have received special training to assist people with dementia or impaired cognition. Common services include 24-hour supervised care, medical monitoring and assistance with daily living tasks, in addition to a pleasing environment that is easy for residents to navigate.

Questions to Ask Before Choosing a Memory Care Community

As 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 assisted living and senior care, contact Spring Arbor


Must-Ask Questions When Choosing Assisted Living

Joseph Coupal - Monday, August 12, 2019
Spring Arbor, NC, VA

Speak to all sorts of staff members – and residents – to get the real scoop.

Questions to ask

Obviously, you can't just rely on facility tours or promotional brochures to make this crucial decision. First, get your ducks in a row. When you're ready to visit in person, turn to administrators, staff members and residents for answers to pivotal questions.

Consider Before You Visit:

Is the location realistic? Lengthy drives, not to mention flights, will affect visits and add barriers to relationships with friends and family members, including spouses still living at home.

Many families face a tough conundrum. Sometimes it's a matter of choosing between top-ranked but distant facilities versus more accessible locations for loved ones to visit regularly and monitor care.

Ask Administrators and Nursing Directors:

What are the staffing ratios? Bolster your question with research.

What is your staff turnover? Stable staffing is a good sign. In addition, consistent assignment – when the same caregivers are assigned to the same residents on a daily basis – is critically important. That way, staff members really get to know residents, anticipate their needs and can recognize and address problems early.

Which services do you offer? If you're undergoing rehab to recover from a hip fracture, you'll need a higher level of care than some nursing homes can offer. With medical conditions like chronic obstructive pulmonary disease, or COPD, residents may need help managing supplemental oxygen.

Do you provide special care for people with dementia? Memory care means much more than just a locked unit to prevent residents from wandering. Staffing ratios should be no more than five residents per caregiver, including nurses and aides, around the clock. Caregivers should have special training in dementia care, and the awareness and sensitivity to best address these needs.

Ask Dietitians:

What kind of food do you serve? Residents rely entirely on nursing homes to meet their nutritional needs. Healthy, tasty food improves everyone's quality of life.

How do you satisfy cultural and individual food preferences? People in nursing homes still want to enjoy meals that evoke family traditions and tastes they've developed over their lives.

Do you accommodate special diets? Residents come in with their own dietary preferences and restrictions. Some also may have medical orders for soft or puréed diets, for example.

Can residents eat when they want? Some people prefer to eat outside routine schedules.

Ask Residents:

After the formal tour, explain that you'd like a chance to speak with several residents. Drop in at the activities room or a lounge, introduce yourself, say you're considering a move there and ask what it's like for them.

Are you happy here? "Do you enjoy living here?" "What do you like best about living here?" and "If you could change one thing, what would that be?" are positive ways to frame your questions and make residents more likely to respond.

Do you have freedom of choice? Does the facility offer resident-centered care? Are you able to get up when you want? Do you go to bed at the time you want?

When you ask for help, how long do you have to wait? If you always have to wait beyond five minutes for help, you're likely to try doing things on your own, which could set you up for falls.

Ask Activity Directors:

What about activities? How do you keep residents engaged? Ask to see monthly activity calendars. Offerings should be varied and appealing.

Does the facility have a resident or family council? These self-determined groups can provide a strong voice for quality care.

Is reliable transportation available? Sometimes nursing homes only provide transportation for certain medical appointments – and they don't provide transportation for social purposes. Is there staff to help residents get to a granddaughter's play?

Can residents easily spend time outdoors? Attractive courtyards are sometimes the first thing visitors notice. But how often can residents, particularly those with mobility issues, actually go outdoors? Does staff encourage and help them to do so?

For more information on assisted living and senior care, contact Spring Arbor.


Considerations When Choosing Memory Care

Joseph Coupal - Friday, August 09, 2019
Spring Arbor - VA, NC, TN, SC

Choosing a memory care facility for your loved one requires time and effort. Research several facilities before making a decision, and visit your top options armed with knowledge and good questions. Preparation ensures the decision ultimately benefits your loved one.

Familiarity with Alzheimer’s Disease / Dementia

Some assisted living communities may have specialized dementia care units, and entire facilities exist whose specific purpose is to care for individuals with AD/dementia. When scouting a dementia care facility, get a sense of how knowledgeable the staff is about the needs and care of persons with Alzheimer’s disease or other types of dementia, and consider if the facility is designed to handle the requisite challenges.

  • Are there special measures for security or supervision to prevent wandering (or other behaviors associated with dementia)?
  • Is rehabilitative or therapeutic support offered, and does the staff encourage residents to be active?
  • How often does the staff update its training and education?
  • Does the staff help with cleaning and dressing after instances of incontinence?
  • What is the protocol for behaviors like wandering and aggressiveness?
  • Can a resident be expelled for bad behavior?
  • What is the staff-to-patient ratio, and does it change during nights, weekends, and holidays?

Quality of Care

Anxiety can come with wondering how high-quality the care is at the facility. When you visit, make sure to talk not only to the administration and staff, but also to some of the residents and their family members. Visit the residence multiple days, at different times each day, to get a feel for the overall experience. Eat meals there, and participate in activities with residents. Try to understand how things operate when you are not around. Check for cleanliness, especially in shared common areas. Get a feel for whether the residence is warm and tranquil. Keep notes on likes, dislikes, and features or characteristics that distinguish one residence from others.

  • What kinds of staff or health professionals are available on a daily or semi-daily basis?
  • Time outside has been demonstrated to alleviate symptoms of AD / dementia, so does the residence provide activities to enjoy safely outdoors?
  • Because everyone with Alzheimer’s or dementia experiences it differently, are there organized activities throughout the day for those who require more structure?
  • Can a resident’s loved ones hire supporting caregivers from outside the facility for supplemental help? This can be crucial for extending the stay and / or getting financial assistance from Medicaid.

Practical Matters

Remember to ask the practical questions.

  • Is the facility licensed and certified?
  • How many rooms and beds are there, and what is the availability of rooms within the facility?
  • If a waiting list exists, how soon would your loved one gain entrance?
  • Does the residence provide transportation to doctor’s appointments?
  • Do residents get opportunities to shop and run errands? How are they transported?
  • Are there any important policies regarding equipment like wheelchairs or oxygen tanks?
  • How are medications managed?

Costs of Memory Care

Be crystal clear on exactly how much a residence will cost, including placement fees and what kinds of payment they take.

  • What is the cost per month?
  • What do monthly payments cover, and are there additional benefits for more money?
  • Is insurance or Medicaid accepted? State-run Medicaid or long-term care insurance may be able to help finance your loved one’s stay. And while Medicare will not pay for extended stays in nursing facilities, the definition of “supplemental benefits” under Medicare laws is expanding in 2019 and 2020, so aspects of assisted living, like health equipment and safety upgrades, may be included. More on Medicare Advantage expansion for assisted living.

Family Involvement

Finally, when talking to residents and their families, ask whether they are satisfied with the level of involvement and interaction in the facility. As a caregiver, you have a lot of knowledge and experience that is valuable to the continued care of your loved one, even in a long-term care facility.

  • How open is the facility to visits from family members and friends?
  • Are there certain hours when you can or can’t visit your loved one? Do appointments need to be made for visitations?
  • Does the facility ask for or allow the input of family members in designing a care plan and activities for their loved ones?
  • How, and how often, does the facility communicate with family? Under what conditions would staff reach out?

For more information on memory care, contact Spring Arbor.


Tips for Visiting Aging Parents During Summer Vacation

Joseph Coupal - Thursday, August 08, 2019
Spring Arbor, NC, VA

Whether returning home to visit aging parents for summer vacation or at other important milestones throughout the year, vacations can be especially stressful for those of us whose parents may be declining. In some cases, this decline can be as simple as realizing that you need to devote regular efforts to help a loved one manage daily life; in others, we might face the grief of knowing, or fearing, that this may be one of the last holidays together.

Because remote family members visit so often during the summer vacations and holidays, we often receive requests at this time of year to help assess whether someone is still safe, and to identify the kinds of help available and what might be needed. We also notice enormous stress in uncertain adult children hoping to do the right thing with their parents while navigating uncharted waters. We find that it helps to use these vacation visit guidelines, from how to manage taking a dependent elder a short trip away from home to considering whether a senior can continue to live alone, safely and unaided.

1. Treasure and be present with the person before you

First, it is always good to stop and remember those things that cannot be changed: aging, the effects of some illnesses, the progress of dementia, and other factors. “Old age,” as Betty Davis said, “is not for sissies.” Sometimes we see families whose holidays would improve if they paused briefly to realize that a parent will never again have the health and energy of past times. However, treasured memories can still be created with person before you. Honor that person; try to make him or her comfortable; ask to hear a story, or tell one yourself. Even in advanced stages of illness, holiday experiences can be joyous if accepted for what they are. It is good advice for life in general, and especially with aging loved ones.

2. Assign someone the task to be sure your elder is not over-stimulated

Especially for elders who are not used to being active, and have their own hopes for a vacation experience “like old times”, the temptation to try to keep too fast a pace during a holiday can lead to exhaustion. Be sure that every day someone is prepared to stay at home, or leave an event early; your elder will be happier not trying to keep up with the most energetic members of the family. Try to rotate this responsibility so no one misses too much. It can be an adult child, a younger family member, family friend, or regular caregiver. This is simple, but easy to forget.

3. If the elder is traveling, plan extra time

Whether it is security scans at airports or long car rides, the pace and distractions that many of us take in stride as part of travel can be exhausting, confusing, or frightening for elders. If you are in a rush, the problem is exacerbated. Plan ahead, allow for a slow pace and leisurely pace, and explain what is going on. This can relieve pressure on everyone.

4. If you visit home, be on the lookout for signs that help may be needed

People who visit home after an absence of several months sometimes can see the signs of decline in the condition of the home or the elder. It is important to be on the lookout for these, especially if family is not regularly present. Signs include a poorly-stocked kitchen, plumbing or appliances that do not function and have not been repaired, clutter that may be the initial stages of hoarding, or poor hygiene. Rarely to our elders call and say, “I cannot manage alone and I need help to continue living here.” Far more often, the signs appear without a request for help. If you have concerns about whether someone is safe at home, an assessment by a geriatric care manager or local senior citizens’ service center is called for.

Vacations with aging parents can be bittersweet. But with proper planning and the right attitude, the emphasis can be on the sweet. Do not try to do too much; find ways to enjoy the person as he or she is today, and to help him or her enjoy the day as much as possible. Grieve if it is called for, laugh when you can, ask for help when you need it. It is all part of life.

For information on assisted living, contact Spring Arbor.