Friday, October 23, 2020
Ever find yourself saying, "what was their name again? It's on the tip of my tongue." Then do you worry that you have dementia because you can't remember the word? The Washington Post tackled this in a recent article, Dementia is more than occasionally forgetting a name or a word.
First, it is important to know that dementia cannot be diagnosed from afar or by someone who is not a doctor. A person needs a detailed doctor’s exam for a diagnosis. Sometimes, brain imaging is required.
And, forgetting an occasional word — or even where you put your keys — does not mean a person has dementia. There are different types of memory loss and they can have different causes, such as other medical conditions, falls or even medication, including herbals, supplements and anything over-the-counter.
There is normal age-related memory loss, and the article emphasizes that such memory loss is normal! Let’s distinguish from memory loss that is not normal---“forgetting the name of someone you see every day; forgetting how to get to a place you visit frequently; or having problems with your activities of daily living, like eating, dressing and hygiene….When you have troubles with memory — but they don’t interfere with your daily activities — this is called mild cognitive impairment. Your primary care doctor can diagnose it. But sometimes it gets worse, so your doctor should follow you closely if you have mild cognitive impairment.”
The article offers the CDC's quick bullet-point list of warning signs for specific domains when forgetfulness is more than just normal age-related memory loss:
- Reasoning, judgment and problem solving.
- Visual perception beyond typical age-related changes in vision.
Although Alzheimer’s is the dementia that most often comes to mind, the article reminds us that there are several types of dementia. The article provides a good overview of the issues that arise from dementia and concludes with this thought-provoking observation:
But even more frightening is unrecognized or unacknowledged dementia. You must, openly and honestly, discuss changes you notice in your memory or thinking with your doctor. It’s the first step toward figuring out what is happening and making sure your health is the best it can be.
And, as with any disease or disease group, dementia is not a “character flaw,” and the term should not be used to criticize a person. Dementia is a serious medical diagnosis — ask those who have it, the loved ones who care for them or any of us who treat them.
Thursday, October 22, 2020
When someone retires, three substantial changes take place, said Ken Dychtwald, psychologist, gerontologist and founder and chief executive of Age Wave, a consulting and research company.
“They struggle with their identity, relationships and activity,” he said. “Some people feel unsettled, anxious or even bored, but eventually they realize that relationships, wellness and purpose really matter — perhaps more than ever.”
The reporter asked him if his views of retirement have changed due to his turning 70 and COVID. The short answer-yes. One statement he made resonated with me: "The pandemic this year has given many of us an enormous appreciation for the preciousness of life. I’ve come to realize that I’d like to be useful more than youthful." He notes that many individuals who are retired have made "themselves irrelevant" while recognizing staying relevant takes time and effort.
He responds to several interesting questions, the last of which is notable
What is the biggest mistake retirees make?
Far too many think far too small. I have asked thousands of people from all walks of life over the years who are nearing retirement what they hope to do in retirement. They tell me: “I want to get some rest, exercise some more, visit with my family, go on a great vacation, read some great books.” Then most stall. Few have taken the time or effort to study the countless possibilities that await them or imagine or explore all of the incredible ways they can spend the next period of their lives.
Tuesday, October 20, 2020
The Washington Post recently published an article examining the future of long term care facilities around the world, As covid-19 cases surge, global study paints grim picture for elder-care homes.
There are few easy lessons. In many countries, the trend is hard to escape: The larger the coronavirus outbreak in an area, the more deaths elder-care facilities there can expect to see, according to the results of an ongoing transnational research project, which published new data this week.
Across 26 countries, elder-care home residents have accounted for an average of 47 percent of recorded coronavirus deaths, according to data collected by the International Long-Term Care Policy Network, a global collaboration between academics and policymakers.
With the cases rising again, will the death toll in facilities rise as well? We know that residents of SNFs are more frail, but what causes such a high death rate is the subject of ongoing research according to the article. Because of the lack of or variations in data with various countries, "[t]he only true metric for understanding the impact of covid-19 on elder-care homes is to look at the total number of deaths among residents and compare the change over previous years, but that data is rarely published...."
Countries tried various approaches, some with success, some without. But what works? "[I]t can be hard to isolate tactics that work. In some facilities in Spain and Britain, having staff live on site and submit to frequent testing appears to have helped keep the virus out. In the United States, rapid response teams that isolate patients and take them to hospitals have been helpful in limiting the virus’s spread." Tactics don't come without tradeoffs, however. For example, restricting visitation may protect residents but the isolation has a negative impact.
Will there be significant and long-lasting changes to the way we provide long-term care? "Elder-care facilities may see significant changes — and not just in the short term. The International Long-Term Care Policy Network predicts higher costs and lower demand for elder-care services may not be a blip but could last for 'many years to come.'"
Monday, October 19, 2020
The New York Times reported recently on a hot topic with the upcoming election: whether an individual with dementia can still vote. Having Dementia Doesn’t Mean You Can’t Vote "tells us that for some, voting is still possible. The key, "he ability to express a preference," citing to a new report from experts on this topic. Even though the person has the right, the exercise of that right may be challenging: "[v]oting can become challenging for many older citizens, who may struggle to reach polling places, stand in lines, use computerized voting machines or read ballots printed in small type."
Further, the article notes, many believe they cannot help the voter in casting the ballot. "A diagnosis of cognitive impairment does not bar someone from voting. Voters need pass no cognitive tests. They don’t have to be able to name the candidates or explain the issues. If they need help reading or physically marking the ballot, they can be assisted, either at the polls or with mail-in ballots. In some states, even people under court-appointed guardianship don’t lose their voting rights."
So you want to help. What do you do? "If you are considering helping someone with dementia to participate in an election, and they have registered to vote, in most cases there are only two real guidelines to keep in mind.
- "After reminding the person that Election Day is nearing, ask whether he or she would like to vote." If the answer is no, you are done.
- If the answer is yes, then "you may read the voter the ballot choices, if he or she cannot read them, but cannot provide additional information or interpretation, although discussions before voting begins are permitted. “Ask them their choices and see if they answer,” ... “If they do, they vote.”
Even in normal times, there are challenges for those who need help with voting, for examples residents of SNFs. In the time of COVID, the challenges are even greater. The article is really interesting and I encourage you to read it. The study findings can be accessed here.
Sunday, October 18, 2020
The New York Times ran a recent story about elders who retired after a long career and then went into business for themselves with elders as their target clients. As They Aged, They Started Businesses for People Like Them, describes these "older entrepreneurs ... [as] turning their lifelong skills into encore careers selling services and products in the booming senior consumer market. In some cases ... their own experiences become catalysts for career moves at a time when others are retiring." The article notes the confluence of two factors driving this trend: the "longevity market and the increasing amount of these "later-in-life entrepreneurs." The article offers some insights regarding the shift to becoming a late-in-life business person and the types of businesses that lend themselves to this model. Check it out!
Friday, October 16, 2020
The Consumer Financial Protection Bureau and the National Alliance for Caregiving are offering a free webinar on Tuesday, October 20 at 2 p.m. eastern on Tools for Financial Caregivers of Older Adults.
The Consumer Financial Protection Bureau (CFPB) and the National Alliance for Caregiving (NAC) will provide a free webinar on Tuesday, October 20, 2020 from 2-3 pm ET. NAC will share findings from its joint study with AARP on caregiving, including ways financial strain can affect caregivers and older adults. The CFPB will share free resources for financial caregivers of older adults, with an emphasis on tips and tools that can be used during the Pandemic to manage someone else’s money.
Gabriela Prudencio – National Alliance for Caregiving
Lisa Weintraub Schifferle – CFPB, Office for Older Americans
Kate Kramer – CFPB, Office for Older Americans
Wednesday, October 7, 2020
Advancing Action, 2020: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers ranks individual states on the available services, etc. Here's the introduction on this latest scorecard:
This report is a compilation of state data and analysis that is based on a vision of a high-performing system of long-term services and supports (LTSS). By using reliable, consistent, available data, it is designed to spark conversations that can result in actionable solutions at the local, state, and national levels—solutions that help older adults, people with physical disabilities, and their family caregivers live their best lives possible. Making that happen is the responsibility of both the public and private sectors, with advocates playing crucial roles. And consumers’ choices and actions ultimately affect a state’s LTSS system as well.
Of course, COVID changes everything and the introduction addresses that impact on the Scorecard. The purpose of the scorecard
The 2020 Long-Term Services and Supports (LTSS) State Scorecard aims to empower state and federal policy makers, the private sector, and consumers with information they need to do the following:
- Effectively assess their state’s performance across multiple dimensions and indicators.
- Learn from other states.
- Improve the lives of older adults, people with disabilities, and their families.
The Scorecard is guided by the belief that, in order to meaningfully manage and improve performance, one must measure it. Unlike many other rankings that focus on a particular aspect of LTSS system performance, the Scorecard compares state LTSS systems across multiple dimensions of performance, reflecting the importance and interconnectedness each has on the overall LTSS system. The goal is to spark conversations, galvanize broad-based coalitions, and focus stakeholders’ attention on the factors that most directly impact consumers and their families.
Tuesday, October 6, 2020
According to AARP, The United States is an Aging Nation.
Here are the population projections they offer
1. The National Median Age is 38.2 Years Old
2. The Number of Older Adults Will Soon Outnumber Children
3. The 65+ Population Increased During the Past Decade
4. The Population of Older Adults is Getting Larger — and Older
Each of this incudes an interactive graphic that links to a separate page that provides more info about the statistic. The landing page for the projections is here.
Monday, October 5, 2020
The GAO has released a new report, RETIREMENT SECURITY: Older Women Report Facing a Financially Uncertain Future. Here are the highlights:
In all 14 focus groups GAO held with older women, women described some level of anxiety about financial security in retirement. Many expressed concerns about the future of Social Security and Medicare benefits, and the costs of health care and housing. Women in the groups also cited a range of experiences that hindered their retirement security, such as divorce or leaving the workforce before they planned to (see fig.). Women in all 14 focus groups said their lack of personal finance education negatively affected their ability to plan for retirement. Many shared ideas about personal finance education including the view that it should be incorporated into school curriculum starting in kindergarten and continuing through college, and should be available through all phases of life.
Individual women's financial security is also linked to their household where resources may be shared among household members. According to the 2016 Survey of Consumer Finances, among households with older women, about 23 percent of those with white respondents and 40 percent of those with African American respondents fell short of a measure of retirement confidence, indicating their income was not sufficient to maintain their standard of living. The likelihood of a household reporting high retirement confidence rose in certain cases. For example among households of similar wealth, those with greater liquidity in their portfolio and those with defined benefit plan income were more likely to report high retirement confidence.
The full report is available here.
Friday, October 2, 2020
The National Guardianship Association (NGA) has released a September 21, 2020 FAQ for guardians about the pandemic. Frequently Asked Questions by Guardians About the COVID-19 Pandemic.
Here are the top takeaways
• Contact with My Client or Loved One – Maintaining contact is essential, whether remotely or in person.
• Special Considerations for Nursing Home Residents – New federal guidance provides ways you can safely visit a resident in person. While there still may be some restrictions on in person visits, you have a responsibility to maintain contact and monitor well-being through remote access.
• Special Considerations for Residential Groups Settings and Hospitals – While there may be restrictions on in-person visits, you have a responsibility to maintain contact and monitor well-being through remote access.
• Protections and Services for My Client or Loved One in the Community – Maintain contact with your client or loved one in the community, and make sure he or she gets services and supports to maintain health and well-being.
• Access to Courts – Each state determines its own procedures during the pandemic. Courts have made many changes, including implementing or expanding remote hearings, and there may be changes in requirements for timelines, notices, and submission of reports.
• Protecting the Rights and Well-Being of My Client or Loved One – The rights of your client or loved one have not changed, but the pandemic makes it more difficult to exercise certain rights. Take actions to ensure the person receives fair health care treatment, facilities follow safety protocols, and support the individual during this difficult time.
• Protecting the Medical Decisions for My Client or Loved One – Work with health care
providers to ensure that the health care choices and values of your client or loved one are
• Protecting the Finances of My Client or Loved One – As guardian of the estate or conservator,
ensure that your client receives all COVID-19 and other benefits for which he or she is eligible; develop and implement a financial plan that is flexible enough to accommodate demands due to COVID-19; and manage investments and financial affairs with increased vigilance during the pandemic.
• Safety Precautions – Take steps to make sure you are not exposed to or transmitting illness, and to respond if your client or loved one is exposed to COVID-10, shows symptoms, or is hospitalized. Be alert to COVID-19 frauds or scams.
The 20 page FAQ with detailed explanations is available here.
October 2, 2020 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)
Thursday, October 1, 2020
We encourage the use of these best practice tips to aid your communication efforts:
• When anticipating a need to hire a new role on your team, screen for bilingual or multilingual candidates.
• Identify members among your team who speak other languages who you know can assist with outreach when connecting with people who speak different languages.
• Establish a list of translated basic phrases, such as “Do you speak English?”.
• If someone is contacting you by phone and has reception issues (Are they trying to reach you from somewhere remote or out of the country?), try to obtain as much information as possible to contact the person back, in the hopes of establishing a clearer second communication attempt.
• For people requesting information with language barriers or who may be hard-of-hearing, slow down your speaking pace, pronounce words clearly, and repeat phrases when necessary.
The full list of tips is available here.
Wednesday, September 30, 2020
There have been lots of discussions about the impact of isolation necessitated by COVID, especially on elders. We have previously written about robot pets, and now the New York Times has examined the role of these robots in lessening the impact of isolation during the pandemic: In Isolating Times, Can Robo-Pets Provide Comfort?
Such devices first appeared in American nursing homes and residences for seniors several years ago. A Japanese company began distributing an animatronic baby seal called PARO in 2009, and Hasbro started marketing robotic cats in 2015.
But the isolation caused by the coronavirus, not only in facilities but also among seniors living alone in their homes, has intensified interest in these products and increased sales, company executives said. It has also led to more public money being used to purchase them.
The article discusses the adoption of the robots by various facilities, and then the interest individuals have shown in having the robots as their companions.
Of particular interest is the Joy for All brand sold by Ageless Innovation, a spinoff of Hasbro, and available from retailers like Walmart and Best Buy for about $120.
One of the largest studies, underwritten by United HealthCare and AARP, distributed free Joy for All robots to 271 seniors living independently.
All the seniors suffered from loneliness, according to a screening questionnaire. At 30 and 60 days, “there was improvement in their mental well-being, in sense of purpose and optimism,” said [the] chief medical officer of AARP’s business subsidiary and a study co-author. The study also found “a reduction in loneliness,” ... although the questionnaires showed that participants remained lonely.
Armed with such findings, Ageless Innovation has been offering discounted robots to state agencies working with seniors. (Both Joy for All and PARO robots can be sanitized to prevent viral transmission, the companies said.)
One Medicare Advantage plan covers them and Ageless Innovation is working to get other MA plans to also cover them. The article also discusses the views of fans and critics of the use of these robot pets. Of course, nothing beats human interaction! What do you think?
Tuesday, September 29, 2020
Mark your calendars now for a free webinar on ABLE accounts on Tuesday October 13 at 2 eastern.
The ABLE Act offers the opportunity for 8 million individuals with disabilities to save without affecting means tested benefits. The ABLE Act builds on the Americans with Disabilities Act (ADA), recognizing the extra, significant costs that come with living with a disability. This training will cover how ABLE accounts empower people to save and invest their funds in a tax-advantaged savings vehicle to cover a wide range of qualified disability expenses, providing for a better future and enhanced quality of life.
Presenters will share:
- How an ABLE account can increase financial independence
- ABLE account basics and the interaction with SSI and Medicaid
- Resources and tools
- Miranda Kennedy, Director, ABLE National Resource Center
- Marlene Ulisky, Disability Benefits Expert, ABLE National Resource Center
- Pshon Barrett, Esquire, ADA Group, LLC, Attorneys for Disabled Americans and ABLE account owner and 2020 ABLE NRC Ambassador
Closed captioning will be available on this webcast. A link with access to the captions will be shared through GoToWebinar’s chat box shortly before the webcast start time.
This training will be presented in a WEBCAST format to accommodate more participants. Due to the high volume of participants, computer audio will be the only option to listen to the presentation. No telephone call-in number will be provided. Please plan accordingly. Thank you.
This webcast will be recorded and available on our website shortly after the presentation. The recording and training materials will also be emailed to all registrants within a few days after the training.
To register, click here
Monday, September 28, 2020
Two researchers are collecting data on court monitoring involving conservatorships and guardianships.
The National Center for State Courts would like to learn about your experiences with court monitoring practices of guardians and conservators.
This survey is part of the research that [two researchers] are conducting in preparation for the 4th National Guardianship Summit to be held in May 2021, at the Syracuse University Law School.
Please answer the questions with reference to the jurisdiction you are most familiar with. Responding to the survey will take less than 15 minutes of your time. You will not be identified in any manner, as findings from the study will be presented only in the aggregate.
The researchers acknowledge the assistance of the State Justice Institute in conducting this survey.
September 28, 2020 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Thursday, September 24, 2020
Not a day goes by, or so it seems, that thee isn't some new article or announcement or data released about SNFs. Here, in no particular order, is some of the recent ones that I've collected in my inbox.
New York Times: Inside a Nursing Home Devoted to Treating Those With Covid-19
Wednesday, September 23, 2020
The ABA Commission on Law & Aging, along with the Penn Memory Center, has announced the release of a new voting guide, Assisting Cognitively Impaired Individuals with Voting: A QUICK GUIDE.
Here's the intro to the guide
Difficulties in communication can occur when interacting with a person who has cognitive impairment. The techniques and tips described in this guide will help make sure that your communication is as effective as possible and within the limits of assistance permitted by election laws.
These techniques and tips are especially important when interacting with persons who are diagnosed with Alzheimer’s disease or another brain illness or disorder such as stroke or head injury.
The guide discusses capacity to vote, communication challenges, and listening skills. The guide offers 10 case studies with suggestions for those who may be assisting such voters.
An underlying principle here is that people should not be treated any diferently in voting rights based on any perceived impairment or other personal characteristic. People whose mental capacities are clearly intact may vote for candidates based on any whim or reason, rational or irrational. Similarly, for persons with some level of cognitive impairment, if they can indicate a desire to participate in the voting process and they can indicate a choice among available ballot selections, their reasons for such choice are not relevant.
The full guide is available here.
Prohibiting visitors to SNFs has hopefully helped limit the spread of COVID. But what is the impact of those in isolation? According to the Washington Post article, Pandemic isolation has killed thousands of Alzheimer’s patients while families watch from afar, for some the impact has been profound. According to the Post's research, the article states that
Beyond the staggering U.S. deaths caused directly by the novel coronavirus, more than 134,200 people have died from Alzheimer’s and other forms of dementia since March. That is 13,200 more U.S. deaths caused by dementia than expected, compared with previous years, according to an analysis of federal data....
Overlooked amid America’s war against the coronavirus is this reality: People with dementia are dying not just from the virus but from the very strategy of isolation that’s supposed to protect them. In recent months, doctors have reported increased falls, pulmonary infections, depression and sudden frailty in patients who had been stable for years.
This is an important consideration as states begin to allow visits to residences of LTC facilities. Data is also showing increased deaths not specifically from COVID but "occur from causes such as hypertension or sepsis. But they are occurring at much higher levels than in the past, experts say, in part because of the pandemic’s indirect effects — hospitals being overrun or care being delayed."
The article highlights a number of individuals' stories and compares reopening of SNFs in other countries to that of the US. "Countries like the Netherlands have safely reopened their nursing homes without any increase in coronavirus cases by providing ample protective equipment, testing and rigorous protocols. ... But in the United States, little of the trillions in emergency funding has gone to nursing homes. For months, the Trump administration has talked of getting more testing into nursing homes, but the effort continues to be plagued with problems."
The article includes information about the methodology used for this study. This is a helpful article to use as a basis of class discussion. I'm assigning to my students!
September 23, 2020 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations | Permalink
Tuesday, September 22, 2020
Remember when you went to the movie theater (I know, it's been a while) and before the movie, there would be displayed on the screen that the movie would be in Dolby sound. Well, guess what. Dolby is more than sound. Dolby is the man who invented it, Ray Dolby to be exact. Mr. Dolby died a few years back from Alzheimer's. It's only fitting that his son has released a new movie, The Artist's Wife, abut Alzheimer's, New Film "The Artist’s Wife" Tells the Story of a Family Navigating an Alzheimer’s Diagnosis.
The film, described as "show[ing] the difficult and often raw dynamics of a family facing an Alzheimer’s diagnosis ... stars Lena Olin and Bruce Dern, and [Dolby's] own family’s experience facing the disease." An interview with the filmmaker about the film and his family experiences is available here.
The Alzheimer's Association is doing an advance screening of the film. "Visit this link to register to watch “The Artist’s Wife” before it is released in theaters and virtual cinemas on September 25. Access is limited, so please reserve your spot today. The film is currently only available to U.S. viewers."
Monday, September 21, 2020
A recent article in The Guardian highlighted a housing experiment in Sweden that combats loneliness, 'It's like family': the Swedish housing experiment designed to cure loneliness. (If you don't have an account with The Guardian, you need to register, but there is no fee).
The project, known as Sällbo, is
[A] radical experiment in multigenerational living in Helsingborg, a small port city in southern Sweden. Its name is a portmanteau of the Swedish words for companionship (sällskap) and living (bo), and neatly encapsulates the project’s goals – to combat loneliness and promote social cohesion by giving residents incentives, and the spaces, for productive interaction.
Sällbo, which opened last November, consists of 51 apartments spread over four floors of a refurbished retirement home. More than half of the 72 residents are over 70s, like Ahlsten and Bacharach; the rest are aged 18-25. All were selected after an extensive interview process to ensure a mix of personalities, backgrounds, religions, and values, and all had to sign a contract promising to spend at least two hours a week socialising with their neighbours.
Not only was this project designed to combat isolation amongst Sweden's elders, it also was designed to respond to "the 2015 refugee crisis [which] meant organisations like Helsingsborgshem were under pressure to house growing numbers of people who were struggling to integrate with – and win acceptance from – Swedish society. So a plan was hatched to mix the two, with younger Swedish people acting “as a bridge." So far the reports of the project's success have been positive despite the hurdles of starting a new endeavor in these times (think COVID). Information about the services, costs, etc. are available here.
Thanks to my colleague and dear friend, Professor Bauer, for bringing this article to me.
Friday, September 18, 2020
Here's a cool idea from the National Long-Term Care Ombudsman Resource Center: Ombudsman Safety Bags! As states begin to allow visits for residents of LTC facilities, ombudsmen, among others, need to keep themselves, and others, safe. The safety bags include "an Ombudsman imprinted face mask, hand sanitizer, sanitizer wipes, and resources specifically for Ombudsman programs. The resources include tips for Ombudsman program communication, a tip sheet about self-care, NORS FAQs related to COVID-19, 25 Ombudsman program promotion postcards, and COVID-19 Recovery and Reentry Resources." It seems that these bags would be helpful for any professional who interacts with others, especially in cases where attorneys make home visits to their clients.
I just wanted to share something positive with you, so there you have it!