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Wednesday, November 26, 2014
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Sunday, April 7, 2013
3 Generations Under One Roof
51 million Americans live in multigenerational homes. Is it right for your family?
by Sally Abrahms, AARP Bulletin, April, 2013
Have you noticed more people around your neighborhood? That long-gone college grad is back across the street, and Grandma's moved in, too. The older couple next door has a full house — their son, his wife and two kids. The ranch a few doors down was just bought — jointly — by adult children and their parents.
Three generations under one roof, known as multigenerational housing, is here to stay.
According to a Pew Research Center analysis of the latest U.S. Census Bureau data, approximately 51 million Americans, or 16.7 percent of the population, live in a house with at least two adult generations, or a grandparent and at least one other generation, under one roof. The Pew analysis also reported a 10.5 percent increase in multigeneration households from 2007 to 2009. And a 2012 survey by national home builder PulteGroup found that 32 percent of adult children expect to eventually share their house with a parent.
"It used to be older people whose money had run out who were living with their children, and now it's the next generation that can't keep up," says Louis Tenenbaum, a founder of the Aging in Place Institute, which promotes "multigen" remodeling.
True, multigenerational families bunking together is hardly news in certain cultures. In 2009, 9.4 percent of Asian households, 9.5 percent of African American ones and 10.3 percent of Latino homes were multigenerational (compared with 3.7 percent of non-Hispanic white households).
But strong indications show that multigenerational living is on the rise: The U.S. 65-plus population is expected to more than double to 92 million by 2060. Sixty-one percent of Americans ages 25 to 34 have friends or family who have moved back in with parents or relatives (because they have no job, no money and no other place to live). And the latest census projections show the clear growth in cultures, such as Latinos, that already embrace multigenerational housing (non-Hispanic whites will no longer make up the majority of the population by 2043).
Could this be an idyllic world of built-in child care, elder care and three square meals? A solution for avoiding isolation in old age? A way for pooled finances to go further?
Another Pew report did find that more than three-quarters of "boomerangs" — the young adults ages 25 to 34 who move back in with their parents — were satisfied with their living situation. Almost half paid rent and nearly 90 percent helped with household expenses. And in a 2011 report of multigen dwellers by Generations United, a Washington, D.C.-based advocacy group, 82 percent said the setup brought them closer, 72 percent mentioned improved finances, and 75 percent saw care benefits.
Consider long-term care costs alone. A 2012 MetLife Mature Market Institute survey put the average annual cost of a private nursing home room at $90,520, a semiprivate at $81,030 and assisted living at $42,600. Add to those costs the value of peace of mind knowing a loved one is being cared for by family, and multigenerational housing may be the new assisted living plan.
Designing for multigenerational living
Builders and remodelers are ready to support the growing trend. Want or need to stay put? The number of certified aging-in-place specialists who help older folks remain safely at home has more than doubled to nearly 5,000 since 2008. And the construction of new houses has started to get off the ground again.
Some builders have begun offering two master suites, a den or family room that can be converted into a bedroom and bathroom on the first floor, and other "bonus areas" with flexible space that can change with family needs. A two-car garage might shrink to one car and the extra area morph into living space for a grandparent or boomerang kid. Builders and remodelers are offering universal design features (wider hallways and doors, good lighting, few or no steps) that work for a baby stroller or a wheelchair. Some builders are installing infrastructure for future bathroom grab bars and stacking closets for down-the-road elevators.
In 2011, national builder Lennar introduced its first Next Gen house in Phoenix, geared to more than one generation. Now Lennar offers more than 50 Next Gen floor plans in 120 communities in California, Washington, Arizona, Nevada, Minnesota, Texas, New Jersey, Florida, North Carolina and South Carolina.
Next Gen's concept is two houses in one: The main home has three or four bedrooms, and there's an attached unit with its own front entrance, kitchen, bedroom, living space and garage. Perfect for an aging parent (or lucky nanny or guest, or as a man cave), it's typically one-fifth the size of the main house. An adjoining inner door can be left open so the house can be one big home or, when closed, two residences.
Before Sharing a Multigenerational Home, You'll Want to
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Discuss expectations and responsibilities before the move: Who's going to pay what bills for current and future expenses? Which areas are communal space and which are private? Are there family rules for laundry, TV, cleaning, cooking, opposite-sex sleepovers?
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Discuss parental responsibilities with other siblings: What will they do — take Dad to doctors, pay his bills online, offer respite care?
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Include age-friendly and privacy features if renovating or building: Consider wider doorways, brighter lighting, grab bars, low-pile carpeting and a separate space for additional family members. Find out if there are zoning restrictions for attached dwellings.
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Divvy up chores: If possible, let family members choose the ones they want.
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Accept realities: Understand that people's personalities and habits don't usually change.
"Learn About Senior In Home Health Care in Traverse City and Northern Michigan
Senior Helpers Provides Many services in the Traverse City and Northern Michigan area. We provide a full array of Home Care services for seniors and the elderly living in this beautiful area. Our Home Care Services are provided by bonded and insured employees and all employees pass a National Background check.
If you need Home Care services in Alpena, Bellaire, Boyne City, Cadillac, Charlevoix, Cheboygan, Empire, Frankfort, Gaylord, Grayling, Harbor Springs, Houghton Lake, Indian River, Northern Michigan, Petoskey, Roscommon, Suttons Bay, Tawas City, Traverse City, West Branch and the surrounding areas we are an excellent choice with impeccable references. Home Health Care for your elderly loved ones is never an easy choice but we can promise we will do our best to make it as painless as possible. From our family to yours we sincerely thank you for considering Senior Helpers of Traverse City and Northern Michigan Home Health Care Company. "
Monday, April 1, 2013
Three Ways Caregivers Can Use Music Therapeutically
Posted on 3/15/2013 by Amy Goyer | Multigenerational & Family Issues
As a music therapist, I worked for many years with older adults and children with special needs using music as a tool to achieve non-musical goals. I used music to encourage expression and social interaction, physical activity and movement, brain stimulation, healing, verbal expression and communication, expression of emotions, reminiscence and even achieve simple eye contact. I created a hand-chime choir with my adult day services center participants who traveled around performing for their peers at other centers. One of my favorite experiences was the intergenerational choir I conducted. Older adults who attended a senior center joined children from a local school — we performed at the Ohio Governor's Conference on Aging! Talk about a self-esteem builder and instilling a sense of purpose — singers of every age were thrilled.
When my grandparents were living, I used my music therapy skills with them as well. My grandmother Genevieve had dementia, and eventually became blind. She loved music. I have wonderful memories of my visits with Granddaddy CV and her, especially when I fixed their old phonograph and got out those hard, brittle 78 records and we'd play them, singing and dancing together and laughing deliciously at our silliness. When she could no longer dance, I would play piano for her and sing. Even as her verbal skills diminished, she could still sing her favorite hymns. When the words would no longer come, the melodies remained and she could hum along. In the last days of her life, the healing power of music was calming for her. (Read the AARP Bulletin story from Sally Abrahms here.)
Now — 30 years after I got my degree in music therapy — I find myself using my music therapy skills with my own parents, who live with me. My Mom enjoys music, and she had a stroke more than 20 years ago. We've used music therapeutically for her over the years — from melodic intonation therapy to enhance her verbal skills to using music to motivate her to move her body and enjoy exercises.
My Dad now has Alzheimer's disease and glaucoma. As his vision deteriorates, and his cognitive abilities slowly diminish, his activities are becoming more limited. But these four things are the joys in his life — truly his quality of life: his family (especially Mom), physical activity (he loves to walk and exercise,) his dog, Jackson and music. Music is indispensible for those with Alzheimer's. When he sings — his true essence shines through.
These are some of the quick and easy ways I incorporate music into our everyday lives:
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I keep a CD player on the back porch where Dad likes to sit in the sunshine and listen to his favorite tunes — everything from classical to World War II-era music to Josh Groban. It transforms a solitary time into a fun, relaxing or stimulating experience and activity for him.
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I keep a DVD library and I use the DVR to tape musicals (hint: TCM airs them frequently!). We watch them often as the plots are easier to follow, they keep Dad's attention and Mom enjoys them … and Dad and I sing along! Dad and I frequently have spontaneous dance contests as we view them. Seven Brides for Seven Brothers, The Sound of Music and Oklahoma are just a few of our faves.
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Dad likes to take Jackson for several walks every day, and I turn our walks into musical adventures. Physical activity and music are a golden combination for brain stimulation. It's amazing to me the songs that Dad will remember when we're walking — the other day he sang one of his college fraternity songs for me that I had never heard before — see video I shot (above) when we got home as he sang it for Mom. He's so adorable! When we walk, if he begins to drag his feet, I encourage him to play drill sergeant (he's a WWII veteran) and he calls out the march and then we sing patriotic songs. His pace instantly picks up and the shuffling stops.
These are just a few ways I use music, and you can too. Music really is a unique and special tool and you don't have to be a professional music therapist to utilize it in your daily routines to enhance yours and your loved ones' lives. I use music therapeutically for myself too - to calm, relax, energize and express my caregiving experience.
http://blog.aarp.org/2013/03/15/amy-goyer-music-therapy-as-a-tool-for-caregiver/
"Learn About Senior In Home Health Care in Traverse City and Northern Michigan
Senior Helpers Provides Many services in the Traverse City and Northern Michigan area. We provide a full array of Home Care services for seniors and the elderly living in this beautiful area. Our Home Care Services are provided by bonded and insured employees and all employees pass a National Background check.
If you need Home Care services in Alpena, Bellaire, Boyne City, Cadillac, Charlevoix, Cheboygan, Empire, Frankfort, Gaylord, Grayling, Harbor Springs, Houghton Lake, Indian River, Northern Michigan, Petoskey, Roscommon, Suttons Bay, Tawas City, Traverse City, West Branch and the surrounding areas we are an excellent choice with impeccable references. Home Health Care for your elderly loved ones is never an easy choice but we can promise we will do our best to make it as painless as possible. From our family to yours we sincerely thank you for considering Senior Helpers of Traverse City and Northern Michigan Home Health Care Company. "
Sunday, March 24, 2013
Caregiving Conversation Between Your Heart and Your Head
March 08, 2013
By: Sherri Snelling
I recently attended a salon event hosted by The Judy Fund, an Alzheimer's Association donor sponsored effort created by Marshall Gelfand and his family now lead by daughter Elizabeth Gelfand-Stearns who lost both her grandmother and her mother, Judy (the fund's namesake), to Alzheimer's disease. Elizabeth's heartfelt passion is finding a cure for the disease that took her loved ones. To date, the family has raised almost $5 million to fund research and advocacy efforts for the Alzheimer's Association in support of the more than 5 million Americans who have Alzheimer's as well as the 15 million family members nationwide who are caring for them.
What made this evening special were the headliners: two rock stars in their respective medical specialties, Dr. Jill Kalman, a noted cardiologist at Mount Sinai Medical Center in New York, and Dr. Maria Carrillo, vice president of medical and scientific relations for the Alzheimer's Association. Together, they addressed the twin terrors many women in the audience are concerned about: heart disease and Alzheimer's disease.
The American Heart Association has done a superb job raising public awareness that heart disease is the No. 1 killer for women (and for men). Although one in three women still die from heart disease, education about prevention is on the rise.
As the red dress-clad Dr. Kalman told the audience, "The brain gives the heart its sight and the heart gives the brain its vision." Insightful words as the message for the evening was a dialogue about how Alzheimer's advocates can take heart and follow the blueprint that heart disease (which has now evolved to heart health) has provided on how to combat an epidemic.
Dr. Carrillo was riveting as she outlined recent research being done, particularly in the area of familial Alzheimer's disease also known as autosomal dominant Alzheimer's disease (ADAD). A comprehensive study is being conducted in families who carry a gene for Alzheimer's, which, if inherited, guarantees they get the disease at a young age—30s, 40s or early 50s. ADAD is very rare and the families who are affected by this type of Alzheimer's usually are aware of the gene in their families.
I was astounded to learn that ADAD family members who do develop Alzheimer's disease do so at the exact same age their parent developed the disease. If a parent was diagnosed at age 42, then a child who carries the gene also develops Alzheimer's at age 42. Dr Carrillo also discussed recent updates in the early diagnosis of sporadic Alzheimer's disease, the most typical form of Alzheimer's affecting more than 5 million Americans. This set off a skyrocket of hands in the audience and much discussion around whether families want to know and should know (if a test ever becomes widely available) how to predict your future Alzheimer's diagnosis years ahead of your first warning signs. Both doctors agreed – it is better to be informed than to be living in denial or ignorance.
While much debate always follows any exciting news, the results of this study are still years away.
Where does that leave us today? According to the docs, what we do know is that healthier lifestyle behaviors (exercise, nutrition, good sleep), knowledge of our family health histories, and reduction of stress in our lives will improve both heart health and brain health.
We can make lifestyle choices that keep both the heart and the brain healthy. For instance, we know that a higher BMI (body mass index) and higher cholesterol (particularly the bad LDL kind) is certainly a risk factor for heart disease and may be a risk factor for Alzheimer's disease. We also know inflammation is bad – it is connected to the brain abnormality typical of Alzheimer's patients and it is a common problem for victims of stroke and heart attack. This is why it is so important for family caregivers to pay attention to both the heart and the head.
Often caregivers neglect themselves. Studies show caregivers are twice as likely as the general population to develop chronic illness – heart disease, diabetes, asthma and other health problems – because of prolonged stress. Both doctors agreed family caregivers typically become more ill or even die before the demise of their loved one for whom they are caring. Becoming a caregiver should be added to the list of risks for heart disease and a whole host of other health ailments.
As a caregiver, you use your heart to provide compassionate comfort and support to a loved one. Now use your head – if you become ill or too exhausted to continue to care, what will become of your loved one and of you? Avoid what I call the Caregiver Achilles heel – the inability to ask for help and accept the help offered. Try creating an online volunteer help community such as the Alzheimer's Association Care Team Calendar where friends and family can give you a break with the kids, help with your mom, or perform every day chores such as making a meal or raking the leaves when you are too overwhelmed to manage it all.
Judy Gelfand was a Juilliard-trained pianist diagnosed with Alzheimer's at age 62. Her family cared for her for almost 10 years before she lost her battle with the disease. And although she is gone, her legacy lives on in her family's efforts to find the clues on how to stop Alzheimer's in its tracks. It is her daughter, Elizabeth, who created an evening to show how much our hearts and brains are connected in this fight.
The message is simple: Find the balance between caring for your loved one and caring for yourself. Your heart and your head will love you for it.
Sherri Snelling, CEO and founder of the Caregiving Club, is a nationally recognized expert on America's 65 million family caregivers with special emphasis on how to help caregivers balance "self care" while caring for a loved one. She is the former chairman of the National Alliance for Caregiving and is author of A Cast of Caregivers, a book about celebrities who have been caregivers.
http://blog.alz.org/caregiving-conversation-between-your-heart-and-your-head/
"Learn About Senior In Home Health Care in Traverse City and Northern Michigan
Senior Helpers Provides Many services in the Traverse City and Northern Michigan area. We provide a full array of Home Care services for seniors and the elderly living in this beautiful area. Our Home Care Services are provided by bonded and insured employees and all employees pass a National Background check.
If you need Home Care services in Alpena, Bellaire, Boyne City, Cadillac, Charlevoix, Cheboygan, Empire, Frankfort, Gaylord, Grayling, Harbor Springs, Houghton Lake, Indian River, Northern Michigan, Petoskey, Roscommon, Suttons Bay, Tawas City, Traverse City, West Branch and the surrounding areas we are an excellent choice with impeccable references. Home Health Care for your elderly loved ones is never an easy choice but we can promise we will do our best to make it as painless as possible. From our family to yours we sincerely thank you for considering Senior Helpers of Traverse City and Northern Michigan Home Health Care Company. "
Sunday, March 17, 2013
New Push For Early Testing, Treatment for Dementia
by Laura Landro
The Informed Patient, Updated February 25, 2013, 8:06 p.m. ET
A new push is under way to improve screening and follow-up care for patients with dementia, the devastating loss of brain function that impairs memory, thinking, language, judgment and behavior.
With no cure and little in the way of treatment, experts have long debated the value of screening for the condition. But newer research suggests that the benefits of routine dementia testing in older patients may outweigh any potential harms. Identifying the problem at a milder level of impairment—and enacting a care regimen—may stave off a crisis that can disrupt patients' lives, prevent them from putting their affairs in order and levy extreme burdens on caregivers.
Under the new U.S. health law, Medicare will cover an annual wellness visit that includes detection of "cognitive impairment," or a measurable change in thinking abilities—especially memory—that signal a dementia risk. Once diagnosed, patients can be helped with family support, medication management and brain games to help delay further declines.
The U.S. Preventive Services Task Force, a government advisory body, is currently reviewing its 2003 guidance that there is insufficient evidence to recommend for or against routine dementia screening in older adults.
Rather than one disease, dementia refers to a group of symptoms severe enough to interfere with daily life. Most commonly caused by Alzheimer's disease, which affects 5.4 million people in the U.S., it is also linked to other age-related problems such as stroke or Parkinson's disease. According to the Alzheimer's Association, the annual incidence of all dementias is expected to double by 2050 as the population of older adults expands.
Yet studies show that up to 81% of patients who meet the criteria for dementia have never received a diagnosis. A 2009 review of research on missed and delayed diagnosis of dementia, led by researchers at Baylor College of Medicine, found that doctors may not focus on memory issues while treating older patients with other health concerns. They may even knowingly withhold a diagnosis of dementia to avoid burdening patients.
The Alzheimer's Association recently published recommendations to help doctors assess cognitive impairment during checkups. These include asking patients and caregivers about whether confusion and memory loss are worsening and using widely available cognitive screening tests that take less than five minutes. Doctors can use the results to determine whether patients need a more complete evaluation.
Studies also show that continuing, individually tailored care-management programs can improve quality of life for both dementia patients and their caregivers. One model gaining attention, which takes a team approach to care management, is the Healthy Aging Brain program, developed at Indiana University Center for Aging Research, in conjunction with the nonprofit research organization Regenstrief Institute. A pilot program at two university-affiliated health systems reduced emergency-room visits by 45% and hospitalizations by 54% for dementia patients receiving a year of care management, compared with those not in the group.
In 2008, following the pilot, Wishard Health Services, affiliated with Indiana University, opened the Healthy Aging Brain Center, where patients can receive a full diagnostic work-up, including neurological exams and brain scans. If dementia is confirmed, the center's nurse practitioners, social workers and care managers work closely with family caregivers and primary-care physicians to customize care plans, reviewing medications to reduce the use of drugs that can be harmful to older brains. They also use aging-brain software to collect data on symptoms, track the stress level of family members and monitor how well patients' goals and needs are being met.
With a grant from the Centers for Medicare and Medicaid Services last year, a team led by Indiana University and Regenstrief's researcher Malaz Boustani expanded the program to about 2,000 patients at 11 facilities operated by Wishard. Dr. Boustani, who is also associate director of the Healthy Aging Brain Center, says he is working with health-care systems in other states to duplicate the program, with an aim to affordably scale up the model to a national level.
"The care for dementia patients right now in this country is suboptimal," says Dr. Boustani. "This model puts less emotional and financial burden on the individual, family members and the system paying for health care."
But simply screening for dementia isn't enough, Dr. Boustani cautions. At least 20% of those who screen positive on questionnaires may have normal cognition, which would only be apparent with more testing. And for those who do have dementia, counseling and care management are necessary to prevent anxiety and depression and keep patients healthy.
One big hurdle to success, says Dr. Boustani, is getting patients and families to overcome some of the stigma and fear associated with dementia. Families may be in denial or assume that memory problems are just a normal part of aging, while patients may be terrified of losing their ability to live independently. But his studies show the majority of older adults are willing to undergo screening when offered the chance.
Betty Crowe's three adult children began noticing in late 2010 that their mother, now 81, was having problems with short-term memory and often repeated herself. The former teacher and counselor from Indianapolis has her own apartment in an independent living facility, and says she didn't think she had a problem, but agreed to see Dr. Boustani in May 2011 after a family friend suggested the Healthy Aging Brain Center. After a comprehensive assessment—including interviews with her and her family, neurological and psychological tests, a brain scan and blood tests—she was diagnosed with mild cognitive impairment due to the earliest form of Alzheimer's. A plan was made to re-evaluate her in a year.
To reduce the risk of the disease accelerating, the recommendations included 60 minutes of brain exercises daily, 15 minutes of moderate-intensity physical exercise and avoidance of medications that might worsen the condition. In May 2012, she returned, and after more tests and interviews, was diagnosed with Alzheimer's and enrolled in the center's home-based program to help manage her symptoms and provide support for her family.
Her children visit often, stay in touch with the medical team and divvy up responsibilities: Larry Crowe, an Indianapolis police officer, gets her to doctor's appointments, while Lloyd Crowe, a deputy police chief, works on her finances. Their sister Linda Crowe-Knight, a receptionist, keeps track of medications.
Ms. Crowe receives regular home visits from occupational and physical therapists, who work with her on puzzles, problem-solving games and exercise, including walking, stretching, leg exercises and light weights. Lloyd Crowe says his mother also dances around the apartment "whenever the mood strikes her."
Dr. Boustani told the family that Ms. Crowe is still in the "green" zone, meaning she could still manage many activities of daily life, and Larry Crowe says their goal "is to keep her there as long as possible." For her part, Ms. Crowe says she still thinks she is fine without help and is upset she can't drive her car anymore. "The one thing I'd like to have is my independence, and I still haven't come to grips with that," she says.
But she is happy to be living in her own home and appreciates the program. And, she adds, she is doing much better than some of her peers who have the same diagnosis.
Write to Laura Landro at laura.landro@wsj.com
http://online.wsj.com/article/SB10001424127887324503204578320032854013890.html?KEYWORDS=dementia
"Learn About Senior In Home Health Care in Traverse City and Northern Michigan
Senior Helpers Provides Many services in the Traverse City and Northern Michigan area. We provide a full array of Home Care services for seniors and the elderly living in this beautiful area. Our Home Care Services are provided by bonded and insured employees and all employees pass a National Background check.
If you need Home Care services in Alpena, Bellaire, Boyne City, Cadillac, Charlevoix, Cheboygan, Empire, Frankfort, Gaylord, Grayling, Harbor Springs, Houghton Lake, Indian River, Northern Michigan, Petoskey, Roscommon, Suttons Bay, Tawas City, Traverse City, West Branch and the surrounding areas we are an excellent choice with impeccable references. Home Health Care for your elderly loved ones is never an easy choice but we can promise we will do our best to make it as painless as possible. From our family to yours we sincerely thank you for considering Senior Helpers of Traverse City and Northern Michigan Home Health Care Company. "
The Informed Patient, Updated February 25, 2013, 8:06 p.m. ET
A new push is under way to improve screening and follow-up care for patients with dementia, the devastating loss of brain function that impairs memory, thinking, language, judgment and behavior.
With no cure and little in the way of treatment, experts have long debated the value of screening for the condition. But newer research suggests that the benefits of routine dementia testing in older patients may outweigh any potential harms. Identifying the problem at a milder level of impairment—and enacting a care regimen—may stave off a crisis that can disrupt patients' lives, prevent them from putting their affairs in order and levy extreme burdens on caregivers.
Under the new U.S. health law, Medicare will cover an annual wellness visit that includes detection of "cognitive impairment," or a measurable change in thinking abilities—especially memory—that signal a dementia risk. Once diagnosed, patients can be helped with family support, medication management and brain games to help delay further declines.
The U.S. Preventive Services Task Force, a government advisory body, is currently reviewing its 2003 guidance that there is insufficient evidence to recommend for or against routine dementia screening in older adults.
Rather than one disease, dementia refers to a group of symptoms severe enough to interfere with daily life. Most commonly caused by Alzheimer's disease, which affects 5.4 million people in the U.S., it is also linked to other age-related problems such as stroke or Parkinson's disease. According to the Alzheimer's Association, the annual incidence of all dementias is expected to double by 2050 as the population of older adults expands.
Yet studies show that up to 81% of patients who meet the criteria for dementia have never received a diagnosis. A 2009 review of research on missed and delayed diagnosis of dementia, led by researchers at Baylor College of Medicine, found that doctors may not focus on memory issues while treating older patients with other health concerns. They may even knowingly withhold a diagnosis of dementia to avoid burdening patients.
The Alzheimer's Association recently published recommendations to help doctors assess cognitive impairment during checkups. These include asking patients and caregivers about whether confusion and memory loss are worsening and using widely available cognitive screening tests that take less than five minutes. Doctors can use the results to determine whether patients need a more complete evaluation.
Studies also show that continuing, individually tailored care-management programs can improve quality of life for both dementia patients and their caregivers. One model gaining attention, which takes a team approach to care management, is the Healthy Aging Brain program, developed at Indiana University Center for Aging Research, in conjunction with the nonprofit research organization Regenstrief Institute. A pilot program at two university-affiliated health systems reduced emergency-room visits by 45% and hospitalizations by 54% for dementia patients receiving a year of care management, compared with those not in the group.
In 2008, following the pilot, Wishard Health Services, affiliated with Indiana University, opened the Healthy Aging Brain Center, where patients can receive a full diagnostic work-up, including neurological exams and brain scans. If dementia is confirmed, the center's nurse practitioners, social workers and care managers work closely with family caregivers and primary-care physicians to customize care plans, reviewing medications to reduce the use of drugs that can be harmful to older brains. They also use aging-brain software to collect data on symptoms, track the stress level of family members and monitor how well patients' goals and needs are being met.
With a grant from the Centers for Medicare and Medicaid Services last year, a team led by Indiana University and Regenstrief's researcher Malaz Boustani expanded the program to about 2,000 patients at 11 facilities operated by Wishard. Dr. Boustani, who is also associate director of the Healthy Aging Brain Center, says he is working with health-care systems in other states to duplicate the program, with an aim to affordably scale up the model to a national level.
"The care for dementia patients right now in this country is suboptimal," says Dr. Boustani. "This model puts less emotional and financial burden on the individual, family members and the system paying for health care."
But simply screening for dementia isn't enough, Dr. Boustani cautions. At least 20% of those who screen positive on questionnaires may have normal cognition, which would only be apparent with more testing. And for those who do have dementia, counseling and care management are necessary to prevent anxiety and depression and keep patients healthy.
One big hurdle to success, says Dr. Boustani, is getting patients and families to overcome some of the stigma and fear associated with dementia. Families may be in denial or assume that memory problems are just a normal part of aging, while patients may be terrified of losing their ability to live independently. But his studies show the majority of older adults are willing to undergo screening when offered the chance.
Betty Crowe's three adult children began noticing in late 2010 that their mother, now 81, was having problems with short-term memory and often repeated herself. The former teacher and counselor from Indianapolis has her own apartment in an independent living facility, and says she didn't think she had a problem, but agreed to see Dr. Boustani in May 2011 after a family friend suggested the Healthy Aging Brain Center. After a comprehensive assessment—including interviews with her and her family, neurological and psychological tests, a brain scan and blood tests—she was diagnosed with mild cognitive impairment due to the earliest form of Alzheimer's. A plan was made to re-evaluate her in a year.
To reduce the risk of the disease accelerating, the recommendations included 60 minutes of brain exercises daily, 15 minutes of moderate-intensity physical exercise and avoidance of medications that might worsen the condition. In May 2012, she returned, and after more tests and interviews, was diagnosed with Alzheimer's and enrolled in the center's home-based program to help manage her symptoms and provide support for her family.
Her children visit often, stay in touch with the medical team and divvy up responsibilities: Larry Crowe, an Indianapolis police officer, gets her to doctor's appointments, while Lloyd Crowe, a deputy police chief, works on her finances. Their sister Linda Crowe-Knight, a receptionist, keeps track of medications.
Ms. Crowe receives regular home visits from occupational and physical therapists, who work with her on puzzles, problem-solving games and exercise, including walking, stretching, leg exercises and light weights. Lloyd Crowe says his mother also dances around the apartment "whenever the mood strikes her."
Dr. Boustani told the family that Ms. Crowe is still in the "green" zone, meaning she could still manage many activities of daily life, and Larry Crowe says their goal "is to keep her there as long as possible." For her part, Ms. Crowe says she still thinks she is fine without help and is upset she can't drive her car anymore. "The one thing I'd like to have is my independence, and I still haven't come to grips with that," she says.
But she is happy to be living in her own home and appreciates the program. And, she adds, she is doing much better than some of her peers who have the same diagnosis.
Write to Laura Landro at laura.landro@wsj.com
http://online.wsj.com/article/SB10001424127887324503204578320032854013890.html?KEYWORDS=dementia
"Learn About Senior In Home Health Care in Traverse City and Northern Michigan
Senior Helpers Provides Many services in the Traverse City and Northern Michigan area. We provide a full array of Home Care services for seniors and the elderly living in this beautiful area. Our Home Care Services are provided by bonded and insured employees and all employees pass a National Background check.
If you need Home Care services in Alpena, Bellaire, Boyne City, Cadillac, Charlevoix, Cheboygan, Empire, Frankfort, Gaylord, Grayling, Harbor Springs, Houghton Lake, Indian River, Northern Michigan, Petoskey, Roscommon, Suttons Bay, Tawas City, Traverse City, West Branch and the surrounding areas we are an excellent choice with impeccable references. Home Health Care for your elderly loved ones is never an easy choice but we can promise we will do our best to make it as painless as possible. From our family to yours we sincerely thank you for considering Senior Helpers of Traverse City and Northern Michigan Home Health Care Company. "
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