People who live in nursing homes may require help with daily living activities such as getting out of bed, eating, bathing, dressing, and using the bathroom. Your dad’s doctor, as well as other members of the healthcare team, family members, and close friends can help you judge whether nursing home care is best for your loved one. If possible, you also should include your loved one in these discussions.
General
The best way to sort through your options during a healthcare crisis is to talk to those who understand what your grandmother and your family are going through. Your loved one’s doctor can help explain various options for her care. Additionally, admission counselors can help resolve medical and insurance issues. You may want to consult an attorney who is familiar with end-of-life issues and can offer experienced advice on advance directives and wills. You also may wish to consult a financial adviser to clarify issues regarding money matters.
First, talk to your father’s doctor about what kind of care he needs. There are a few options available:
- A private nurse will oversee your father’s medical care at home. The nurse performs such duties as changing bandages, taking vital signs, dressing wounds, and monitoring intravenous (IV) solutions or oxygen.
- If your father lives at home, a personal care attendant (PCA) can help him with light housekeeping duties, prepare meals, bring groceries, help you with routine activities like dressing and bathing – or just offer some companionship. The PCA will also observe your loved one and note for any major changes in his or her condition that might indicate a need for medical attention.
- Your father could be enrolled in a state rehabilitation program. As part of this program, professionals can show your father how to adapt to his disability so he can live at home more comfortably. Simple adjustments include a ramp for easier wheelchair access or raised furniture so he can stand without stressing his legs or back.
Admission to a nursing home does not always require a physician’s order, but the order is a condition of payment for Medicare or Medicaid. Respite care could be provided and paid for privately without a physician’s order. Families usually work with their doctor to decide the right time to admit a loved one to a nursing home. Several factors — including age, diagnosis, medical history and abilities of the primary caregiver — play a part in that decision. Other times, the patient is admitted to a nursing home following a hospital stay. Ultimately, though, the decision to enter a nursing home lies with the patient and the family.
Ask your mother’s doctor or your local hospital about respite care. Respite care offers medical professionals on call 24 hours a day, seven days a week. You might be able to bring your mother to a facility for a few hours, or a nurse or other medical professional could come to your house to give you a break.
Most of us don’t think about how to pay for nursing home care until the need arises. When you visit our LivingCenter, ask to speak with our admissions coordinator. She can help you determine which long-term care benefits your loved one may qualify for. Here are some options.
- Medicare benefits are available to millions of Americans, including those over age 65 and some people under 65 who are disabled or suffer from permanent kidney failure. Visit Medicare’s Web site at Link for more information.
- Medicaid is an option for eligible low-income patients in need of long-term nursing care. Eligibility requirements vary from state to state, and we can help you determine if you qualify. For more information, please visit the Centers for Medicare and Medicaid at Link
- Many insurance companies and employers now offer long-term care insurance.
- Veterans benefits are available at some nursing homes through the Department of Veterans Affairs.
For any eligible beneficiary needed skilled nursing or skilled rehabilitation consistent with Medicare coverage criteria, Medicare Part A coverage will pay for a semi-private room, meals, nursing services, rehabilitation services, medications, supplies and durable medical equipment for up to 100 days. For the first 20 days in a nursing home, Medicare covers 100 percent of skilled care. From Day 21 through Day 100, the resident must pay a daily co-insurance rate. Residents who are eligible for the services covered under Medicare Part B will be responsible for an annual deductible plus 20 percent of the total charges for services such as occupational therapy, physical therapy and speech therapy, as well as medical supplies. For more information on Medicare, please visit their Web site at Link.
Your loved one must have a Medicare card that reads “hospital insurance” and must have spent a minimum of three consecutive days (not counting the day of discharge) in a hospital. The hospital stay must not have occurred more than 30 days prior to entering the nursing home. Further, a physician must certify that your loved one needs skilled nursing or skilled rehabilitation care on a continuing basis, and the need for skilled care must relate to the reason for hospitalization.
Golden Living’s skilled nursing facilities, or Golden LivingCenters, provide skilled nursing and rehabilitation care for those who are recovering from illness, injury or surgery and those who need medical support and supervision that can no longer be provided at home. Our assisted living facilities, or Golden Living Communities, are ideal for those who are able to live independently but may need assistance with certain aspects of daily life. In certain locations, Golden Living also offers therapy through Aegis Therapies as well as home health and hospice services through AseraCare.
To choose a good nursing home for your mother, you need to focus on her needs and wants, take a good look at what facilities are available in your area, and let others with the right knowledge and experience help you get through the insurance questions and paperwork involved. Talk to your hospital’s case worker or your mother’s health insurance representative to find out what nursing home facilities are available in your area. Read the facilities’ inspection report for the facilities, including ratings of health, safety, and quality of life. Tour each facility – preferably with your mother or other family members. During your tour, keep an eye out for features that will make a nursing home safe and comfortable for her. The federal Centers for Medicare and Medicaid Services provides a great deal of information on their internet site Link about the nursing homes that participate in Medicare and/or Medicaid.
We always welcome families into our home and encourage you to call your local nursing home to arrange a tour today. We can accommodate your schedule because we’re open 24 hours a day, 7 days a week.
Part of the admission process is to evaluate the resident for a risk of wandering. If our care team determines that a resident may have a tendency to wander, the care plan will include interventions to reduce the likelihood that the resident will wander. In some instances, a bracelet-type device is worn by the resident and an alarm system alerts the staff if the person tries to leave the building. Some of our nursing homes feature enclosed courtyards so that every resident can enjoy the outdoors. This type of courtyard is either enclosed by the building’s exterior or a safety fence blocks the exit. We encourage our residents who tend to wander to participate in activities to keep them focused on an agenda other than wandering.
To make each room feel as much like home as possible, we encourage residents to bring personal items with them when moving into our home. We do not limit any kind of furniture in resident rooms unless it invades the space of the resident’s roommate or poses a safety hazard to other residents, visitors or our employees. Many of our residents have brought their own recliners, end tables, plant stands and television sets.
Resident room hookups are available in the locations that offer cable television service. At some of the locations that offer cable, the resident is charged a monthly fee for this service.
Pay phones are available for use throughout the building for residents and visitors alike. Residents may have private telephone service in their rooms, but the expense of the connection and the monthly bill may be charged to the resident.
Before your father is accepted for admission into a nursing home, our social services director will try to locate a room with someone who either shares his interests or has a similar background. If your father later wishes to move to another room, we will try to accommodate him as rooms become available.
Our home is open 24 hours a day, 7 days a week, and you are always encouraged to visit. However, it’s important to consider your mother’s special needs — for medications, rest, medical treatment, etc. — when planning your visits.
There is no limit on visiting hours for family members and friends, but we have found the most convenient hours for residents are between 9 a.m. and 9 p.m.
Before you bring your father’s favorite foods into the nursing home, check with the nursing staff or dietary manager because many of our residents must follow a special diet for health reasons. Anytime you bring in food from home, be sure to store it in an air-tight container. Also, plan to arrive at mealtimes or snack times, when the food can be eaten, because our nursing homes have very strict guidelines for storing perishable food.
Ask your loved one if he or she has completed any advance directives, which are documents that provide clear instructions about what medical care he wants (or doesn’t want). The most commonly recognized types of advance directives are the living will and the durable power of attorney for healthcare. A living will is a document that contains all of your loved one’s wishes concerning medical treatment. A durable power of attorney for healthcare enables your loved one to appoint someone to make medical decisions when he or she cannot do so. If your loved one does not have any of these documents, talk to her about her wishes and the need to get them in writing. Be sure to discuss his wishes with other family members, and perhaps with important people outside the family such as a family friend, religious leader, or social worker.
Healthcare Needs
- Ask her why she is falling. Your grandmother may be able to tell you what circumstances lead to her falls, which can help you address the problem.
- Talk to her doctor. Consult with your grandmother’s physician about medicines and over-the-counter drugs she is taking to see if any may be making her dizzy or lightheaded. Make sure she sees the doctor on a regular basis to check for any other health problems that could cause her to fall.
- Make the house safer. Add railings to any problem areas in the house, such as stairs, hallways, and bathrooms, and install non-glare lighting. Also make sure that the traffic areas are dry and clutter-free, and ensure that there are no loose rugs that could be tripped over.
- Give her the right tools. Shoes that are more stable or have better traction could help your grandmother avoid falls. Talk to her and her doctor about the possible need for a cane or walker.
- Make sure she’s getting enough calcium and vitamin D. These vitamins will help prevent the weakening of bones, or osteoporosis. Calcium supplements, including calcium phosphate and calcium nitrate, are just as effective as calcium from food.
- Be sure she’s exercising on a regular basis. With a doctor’s guidance, have your grandmother participate in a regular exercise program for agility, strength, balance, and coordination.
If your father loses weight, becomes constipated, and/or starts to have trouble walking, consult his doctor immediately. Also ask the doctor how much water and other fluids your father should drink each day and discuss dietary considerations that apply to your father’s condition.
If your mother spends a lot of time in bed, she may be more susceptible to pressure ulcers, or bedsores. You can prevent bedsores by encouraging your mother to get up and walk around if she can. Or have her recline a position that does not irritate the area of the current bedsores. If she is unable to move on her own, help her change positions every two hours or less. She is also less likely to get bedsores if she drinks plenty of fluids and sticks to a nutritious diet. Be sure to tell your mother’s doctor if she keeps getting bedsores and ask for further suggestions on how to prevent and care for them.
- A lack of interest in food or sleep
- Facial grimaces
- Mood changes
- Physical movements that indicate pain
- Oral or dental problems
- Apparent depression or sadness
- Grinding teeth
- Guarding or rubbing a body part
- Restlessness
- Increased agitation
- A change in activity level
- Resistance to being moved
- Unintentional weight loss
Watch for any of these signs, and talk to your grandmother’s doctor if you observe any of them: If your grandfather is not eating, start by discussing it with him. He might be able to help you understand why. It’s important to discuss his reluctance to eat with his doctor, who may have some advice for you. There are several reasons that contribute to older people’s waning eating habits. Reasons may include the following:
- Adverse reactions from medications can cause older people to avoid certain foods. Some medications alter the sense of taste, which can affect appetite. Talk to your grandfather’s doctor about his medications.
- If your grandfather’s dentures don’t fit properly, it might cause him difficulty when eating.
- Your grandfather might be cutting back on food because he experiences constipation, diarrhea, or heartburn when he eats.
- If your grandfather has had a stroke or has been diagnosed with Alzheimer’s disease, he could have chewing or swallowing problems.
- Your grandfather may have a decreased sense of taste and smell (common among the elderly) that makes food less appetizing.
Your grandfather and his doctor are good sources of information on this topic. Here are some additional tips:
- Encourage your grandfather to eat small, frequent meals whenever possible. It may help him to consume more food if you eat with him.
- Offer him foods that you know he will eat.
- Make sure your grandfather is getting some exercise or activity each day.
- If he has trouble swallowing, ask the doctor about exercises that will help strengthen his throat muscles.
- Be sure that your grandfather receives an annual checkup. Some conditions, like depression and thyroid disorders, might affect your grandfather’s appetite. He might need medication to help him eat well.
Alzheimer’s
Scientists do not fully understand what causes Alzheimer’s disease, or AD. There probably is not one single cause, but several factors that affect each person differently. Age is the most important known risk factor for AD. The number of people with the disease doubles every five years beyond age 65. Family history is another risk factor. Scientists believe that genetics may play a role in many AD cases. Scientists are studying education, diet, and environment to learn what role they might play in the development of this disease. They are finding increasing evidence that some of the risk factors for heart disease and stroke — such as high blood pressure, high cholesterol and low levels of the vitamin folate — may predispose people to AD. Evidence for physical, mental and social activities as protective factors against AD is also increasing.
AD begins slowly. At first, the only symptom may be mild forgetfulness. In this stage, people may have trouble remembering recent events, activities or the names of familiar people or things. They may not be able to solve simple math problems. Such difficulties may be a bother, but usually they are not serious enough to cause alarm. However, as the disease goes on, symptoms are more easily noticed and become serious enough to cause people with AD or their family members to seek medical help. For example, people in the middle stages of AD may forget how to do simple tasks, like brushing their teeth or combing their hair. They can no longer think clearly. They begin to have problems speaking, understanding, reading or writing. Later on, people with AD may become anxious or aggressive, or wander away from home. Eventually, patients need total care.
An early, accurate diagnosis of AD helps patients and their families plan for the future. It gives them time to discuss care while the patient can still take part in making decisions. Early diagnosis also offers the best chance to treat the symptoms of the disease. Today, the only definite way to diagnose AD is to find out whether there are plaques and tangles in brain tissue. To look at brain tissue, however, doctors must wait until they do an autopsy, which is an examination of the body done after a person dies. Therefore, doctors can only make a diagnosis of “possible” or “probable” AD while the person is still alive. At specialized centers, doctors can diagnose AD correctly up to 90 percent of the time. Doctors use several tools to diagnose “probable” AD, including:
- Questions about the person’s general health, past medical problems, and the history of any difficulties
the person has carrying out daily activities
- Tests of memory, problem solving, attention, counting and language
- Medical tests, such as tests of blood, urine or spinal fluid
- Brain scans
Some of these test results help the doctor find other possible causes of the person’s symptoms. For example, thyroid problems, drug reactions, depression, brain tumors and blood vessel disease in the brain can cause AD-like symptoms. Some of these other conditions can be treated successfully. Recently, scientists have focused on a type of memory change called mild cognitive impairment (MCI). Some researchers believe that MCI is always early stage AD, while others believe that you may have MCI and never be diagnosed with AD.
AD is a slow disease, starting with mild memory problems and ending with severe brain damage. The course the disease takes and how fast changes occur vary from person to person. On average, AD patients live from 8 to 10 years after they are diagnosed, though the disease can last for as many as 20 years. No treatment can stop AD. However, for some people in the early and middle stages of the disease, the drugs tacrine (Cognex), rivastigmine (Exelon) or galantamine (Reminyl) may help prevent some symptoms from becoming worse for a limited time. Donepezil (Aricept) has been approved by the FDA as effective in treating all stages of AD. Another drug, memantine (Namenda), has been approved for treatment of moderate to severe AD and is usually used along with other medications. Also, some medicines may help control behavioral symptoms of AD such as sleeplessness, agitation, wandering, anxiety and depression. Treating these symptoms often makes patients more comfortable and makes their care easier for caregivers. Developing new treatments for AD is an active area of research. Scientists are testing a number of drugs to see if they prevent AD, slow the disease or help reduce symptoms. There is evidence that inflammation in the brain may contribute to AD damage. Some scientists believe that drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs) might help slow the progression of AD, although recent studies of two of these drugs, rofecoxib (Vioxx) and naproxen (Aleve), have shown that they did not delay the progression of AD in people who already have the disease. Now, scientists are studying the NSAIDs celecoxib (Celebrex) and naproxen to find out if they can slow the onset of the disease. Research has shown that vitamin E slows the progress of some consequences of AD by about 7 months. Scientists now are studying vitamin E to learn whether it can prevent or delay AD in patients with MCI.
First, manage your numbers — your blood pressure, cholesterol, blood sugar and body weight — to stay healthy as you age. Feed your brain with nutrients by eating foods high in vitamins E and C, taking a multivitamin that includes folic acid, and including salmon, mackerel and other foods high in omega-3 fatty acids in your diet. Also, exercise both your body and brain. Work out, take a class, converse with others, read, play cards or work on crossword puzzles or Sudoku.
Almost everything we know about AD we’ve learned in the past 15 years, and scientists are making great strides in better treatments and preventions that one day may lead to a cure. The joint efforts of government agencies, research centers and pharmaceutical companies have uncovered many secrets of the disease, and AD can now be diagnosed with 90 percent accuracy. So, yes, there is progress, hope and great momentum toward ending AD.
There are many ways the average citizen can help in the fight against AD. Join an Alzheimer’s Association Memory Walk™ or spend a few hours at your local chapter. Lobby your legislators to increase federal funding for Alzheimer’s to $1 billion each year, and talk to them about supporting local Alzheimer’s initiatives. You can also donate money to the Alzheimer’s Association to advance research and enhance support — and to make Alzheimer’s a part of our past, not our future.
Dementia itself is not a disease, but a set of symptoms that accompany certain diseases, like Alzheimer’s disease and Parkinson’s disease. Symptoms include difficulty remembering, learning, and communicating. It’s important to visit a doctor if you think a loved one might have dementia or Alzheimer’s disease, so he or she can benefit from treatment and plan for the future.
You can be at higher risk for developing this disease if your parents have it. Be sure to get regular checkups from your doctor, exercise regularly, and maintain a healthy diet.
Talk to your mother’s doctor. People who get lost on their own street, forget where they are or how to get back home are displaying symptoms of the memory problems associated with Alzheimer’ disease. To prevent your mother from wandering, make sure she’s supervised. Get her involved in activities so she doesn’t feel a desire to leave, and make sure she is as comfortable as possible. If your mother is in a nursing home, make sure to let the staff know that she wanders.
Talk to a doctor. Sudden changes in personality are associated with many disorders, including dementia and Alzheimer’s disease.
Talk to your family and a doctor about treatment options. You may be able to care for him in your own home, especially if he is in the early stages of the disease. If you feel as though you can’t care for him, discuss care options with your family, including a nursing home or an assisted living facility. Many places have excellent Alzheimer’s care programs that are dedicated to people with the disease.
Those with Alzheimer’s disease may dress with no regard for the weather. They may wear shorts in the winter or bundle up in the summer. If your mother suddenly seems confused about getting dressed, make and appointment for her to see the doctor.
People with Alzheimer’s disease may have trouble balancing checkbooks. They sometimes even forget what numbers are or what they should do with them. The loss of such abstract thinking is a warning sign, so you should discuss your father’s problem with a doctor.
It’s normal for people to occasionally tire of housework and social obligations, but a sudden loss of interest or initiative could be a symptom of a more serious medical problem, such as Alzheimer’s disease. Talk to a doctor to schedule an evaluation.
Maybe. We’re all a little absent-minded some of the time. And if your husband has reason to be particularly preoccupied lately, it could be nothing more than that. But it’s definitely a symptom to keep an eye on. If it persists or there seems to be no reason for being so absent-minded, talk to a doctor. It may be a sign of Alzheimer’s disease.
Alzheimer’s disease does not have to mean a complete loss of independence. However, it is important that people with the disease have appropriate supervision to be sure that they don’t hurt themselves. A nursing home with special Alzheimer’s services can provide the right balance of independence and supervision.
