Caregiver ‘Boot Camp” for Dementia Patients

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Boot camp alzheimer caregiversGary Carmona thought he could do it all. He has headed companies and chaired nonprofit boards. But since his wife was diagnosed with dementia, Gary, 77, has felt exceedingly overwhelmed. 

 

 

“I really see myself crashing at times,” he said. “In my mind, I’m saying, ‘You know, I can’t really handle all this.’”

There was the time his wife, Rochelle, wandered outside and fell down. And the time she boiled water and walked away, leaving the burner on.

“I’m always double-, triple-, quadruple-checking everything that she’s around,” he said.

Carmona was among about 25 people who went to a Los Angeles-area adult day care center on a recent Saturday for a daylong “caregiver boot camp.” In the free session, funded in part by the Archstone Foundation, people caring for patients with Alzheimer’s or another form of dementia learned how to manage stress, make their homes safe and handle difficult patient behaviors. They also learned how to keep their loved ones engaged, with card games, crossword puzzles or music.

Doctors and researchers increasingly recognize that caring for people with dementia compromises the physical and mental health of the caregivers. And that, in turn, jeopardizes the well-being of the people in their care. Some studies have shown that the burden on caregivers may increase the likelihood that the loved ones in their charge will be placed in a nursing home.

“People with Alzheimer’s who have stressed caregivers have been shown to have poor outcomes,” said Zaldy Tan, the medical director of the UCLA Alzheimer’s and Dementia Care Program who created the boot camp. “Their caregivers have essentially thrown in the towel.”

People with dementia are also more likely to visit the emergency room and be hospitalized if their caregivers are not prepared for the task, Tan said.

That’s one of the main reasons why UCLA Health and its geriatrics division started its caregiver boot camps in 2015.

UCLA holds four boot camps a year at community and senior centers in Southern California and hopes to expand over the next year to meet the growing need. About 5 million Americans, 1 in 10 people over 65, have Alzheimer’s disease — a number that could balloon to 16 million by 2050, according to the Alzheimer’s Association.

Similar caregiver training programs have taken place in New Jersey, Florida and Virginia.

Tan started the recent session by explaining the progression of dementia, noting that in its later stages people often do not remember their loved ones.

“Do they all reach that stage?” asked one woman, who takes care of her sister.

“They do, if they live long enough,” Tan said. “I know it’s heartbreaking.”

He also warned the group that their actions can inadvertently provoke anxiety or aggression in their loved ones.

“Many times, when you see someone shift from being calm to agitated, happy to angry, typically there’s a trigger,” Tan said. “A trigger is just like a trigger on a gun. Something is pushed and you get a reaction.” He told them that as caregivers they were in the best position to identify and avoid those triggers.

Leon Waxman, who also attended the boot camp, said he tries not to upset his wife, Phyllis. But sometimes she gets angry, as she did the day he dropped her off for day care while he attended the session for caregivers.

Taking care of Phyllis the past few years has been trying, he said. She can still dress herself, but she gets easily confused and can no longer make decisions.

“The hardest part for me is I don’t have my wife anymore,” said Waxman, who has been married to Phyllis for 58 years. “She’s not the same person she was 10 years ago.”

During the boot camp, recreational therapist Peggy Anderson demonstrated a game caregivers could play at home: music bingo. Each square had the name of a song, and she played music.

“What’s this song?” Anderson asked the group.

“Bye blackbird,” one yelled out.

“If you have that one, mark it off,” she said.

Anderson said that even people with dementia can sometimes recognize songs and read their titles. “There’s a lot of good things that come out of this activity — just listening to music, clapping your hands, reminiscing,” she said.

In another room, occupational therapist Julie Manton explained how to prevent people with dementia from falling. She advised the group to ensure their homes have good lighting and bed rails, as examples. She also urged them to remove throw rugs.

Manton warned the participants that their loved ones might wander off and suggested the use of monitoring devices. “The key thing is to know where your loved one is at all times,” she said.

 

Put The Home In A Nursing Home

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Mealtime. Naptime. Bath time. Bedtime. Everything is on a schedule for residents in a traditional nursing home, leaving little flexibility for personal decision making. But LaVrene Norton is working to make a change.

Norton is founder and president of Action Pact, a national consulting firm. It specializes in helping retirement communities and nursing homes train staff and design their facilities to feel and be more like living at home. Since beginning work on the “household model” in 1984, Norton has helped design hundreds of these communities.

The idea is that residents’ rooms are clustered around a common area, with a kitchen and living room. The size varies from four people in a private home to a bigger building with up to 20 people in “household” groups. Nursing assistants and caretakers help with the more traditional side of things, such as helping residents take their medicine and bathing. Norton says the household model is “the new nursing home” that helps focus on “person-centered care” and helps meet the wave of demand for more quality services from aging consumers.  Five percent of people over age 65 in nursing home-type facilities is more than 1.3 million.

Norton was recently interviewed:

How does your design compare to a modern day senior home?

There is no comparison. A traditional nursing home is institutional. When you move in, you in a way lose your identity. You definitely lose your uniqueness. It’s not like the staff is at fault, it’s the way the system is set-up. It’s very different when you’re in an institutionalized nursing home which most nursing homes are. The thing you’ll hear people talk about is person-centered care and that [means] teaching staff to seek the residents’ suggestions on things, do more at the residents’ timetable and attend to the residents’ needs and wishes. But the truth is, this system fights against all of those things.

What are the challenges you’ve seen with people wanting to build a household model?

There’s the need to get everybody involved without getting scared. If you say we’re going to do universal workers and all of the housekeepers are going to become CNAs [certified nursing assistants] and everybody in the kitchen is going to become CNAs and CNAs are going to do the cooking, it just freaks everybody out. We promote something that’s called a “versatile worker” instead of a “universal worker.” So we don’t expect everybody to become a CNA. We expect everybody to cross-train in something. From the CEO down, everybody cross-trains in something and that makes them more versatile.

Is this scaleable on the national level?

It is scaleable on a national level and I think it is going to be the new nursing home. My generation of people, and I’m 69 years old, who were born and raised and toughened up in the 60s are not going to tolerate bad service, shared rooms, a bath time that’s scheduled by somebody else. So the market is changing and we have to respond to that market. The neighborhood model is where you have a small group of staff, a very homey kitchen area, living room and dining room for each small group. So either neighborhoods or households are going to be in that new building once it’s built and all buildings will be rebuilt or renovated overtime.

You call it the “new nursing home.” Is this a movement?

It’s a movement because people want it. All of us want a good life for our elders and we’re frustrated by the old nursing home way. We don’t want that. Every CNA and every nurse and every cook and every housekeeper in this country, every activities person, every social worker who works in a traditional nursing home doesn’t want it for the residents they serve. They would so much rather have a good way for them to live. So you have that going for you. That’s the movement part of it. Then you’ve got the market.

Anybody who’s got a household model in their market area knows the pressure of having a decent place to showcase, to attract people to come to your home. You’ve got the customer. People my age, and 10 years older than me for that matter are not wanting the old way. They want to have a say in their life, they want to continue to contribute and give to others, they want to have a good daily life and when they look at this, and they’re much more consumer savvy, they’re not going to put up with the old way.

Is this a long-term solution?

More and more people are able to stay in their assisted-living environments. That goes for residential care as well. Residential care is a lesser life-style than assisted living and people are more able to stay there, in other words, home care keeping people at home. So, really and truthfully, whether or not in the future there are licensed nursing homes or not, there will be some kind of homey household model of community living. That allows [residents] the quality of life of home, that gives them freedom and independence and being in charge of their own life and yet has services that they need. So that’s going to be the ideal world for the future. We’ll never go back to institutionalized, long hallways filled with tons of people and warehousing people again, that’s done.

Who doesn’t this model work for?

I can’t think of a population that this concept does not work for. You use a smaller configuration which allows more interpersonal relationships with the residents to tend to them individually whether they’re severely disabled physically, whether they’re mentally ill, have severe memory loss.

People say “Well what about someone who is really sick, it won’t work for them, will it?” Well, of course it will. If I’m in bed all day I’d much rather live in a homey little space where someone could wheel my bed up to the door or help me into a lounge chair and help me into the living room area and I could just be there, whether I could talk, whether I could even be sure of where I’m at, just being around the clatter of dishes in the kitchen, and the smell of coffee pouring or bread baking, of genuine laughter in the other room. If I’m really, really sick I’m going to love it so much better. The best place to die would be at home, and this is as close to home as possible.

The cost of home care, assisted living and nursing home care has risen in Scottsdale, Arizona according to local planning professional..

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The cost of home care, assisted living and nursing home care in Scottsdale, Arizona has increased over the previous year according to an analysis conducted by Ernie Bobel, a long-term care insurance professional.

 Nationally the average hourly rate for a home health aide is $21, a 4.7 percent increase from the previous year, according to the yearly study conducted by the American Association for Long-Term Care Insurance. The average monthly rate for assisted living communities increased 2 percent to $3,100 and a private room in a skilled nursing facility now averages $220, up $10 from the previous year.

Costs for home care in Scottsdale, Arizona will range from $18 per-hour to $22 depending on the level of care needed explains Bobel.   Most people who require home care pay for several hours of care daily.

Costs for nursing home care in Scottsdale can range from $5400 per month to $7400.   All costs for care locally are rising and people need to prepare today so that a future need for care won’t wipe out a lifetime’s worth of savings.

The national average for one year in a private nursing home is $80,300 according to the Association study. Local skilled nursing home costs will vary but one thing is certain, they never decrease.

People tend to think they will never need long term care. Unfortunately when they do need it they are not prepared. With long term care insurance you can take control and be prepared. It helps you retain your independence, preserve your quality of life, stay at home as long as possible, protect your assets and savings and avoid burdening friends and family.

As life expectancies increase, there is a greater chance that people will require long term care.  According to an AARP study, only half of people say they “feel very or fairly prepared if they suddenly required long term care for an indefinite period of time.” 

If you are among the half that do not feel prepared, knowledgeable long-term care insurance agent, Ernie Bobel offers free, no obligation information that can help you plan and reach a decision regarding your future. 

To learn about ways to reduce the cost for long-term care insurance or to obtain a no obligation quote, contact Ernie Bobel at EHB Insurance Group by calling 602.617.4770 / 877.441.4714. Or visit the EHB Insurance Group website.

Bobel is a member of the American Association for Long-Term Care Insurance the national organization for leading insurance and financial professionals committed to educating consumers on the importance of planning.