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Tips for Seniors (and their Families) on Downsizing Their Home
Sometimes seniors leave a big house to move to a senior community or assisted living. This new home may be more secure, healthier, and happier, but it’s also likely to be smaller.During this process, a family has two main tasks to focus on: helping their senior loved ones settle comfortably with valued possessions and preparing a house for sale. Downsizing with respect and practicality is important to both goals. Here are some transition to assisted living tips that you may find helpful during the process:
Downsizing Made Easy
Cherished Possessions
It can be hard to separate possessions that truly matter from things that need to be let go. Be patient with anyone who lived in the house and feels attached to it, and expect difficult feelings as natural to the process. Just don’t let objects take priority over anyone’s well-being: the bottom line is that not everything can stay. If there’s not enough time to sort through everything with sensitivity, temporary storage may be the answer. Families can rent a unit or offer some home storage space so that no one feels stressed by any rush.
If there is time to sort through belongings, have seniors choose what goes to the new residence, what they would like distributed to family or friends, and what can be donated to charity. If children or grandchildren are just starting out in a new home themselves, seniors may be glad to contribute necessities they no longer need. Donations can also be satisfying when an item will help a stranger in need. Some charities will pick up goods and furniture by appointment.
It’s true that homes sometimes collect material things over decades, if homeowners don’t purge periodically. No family member should face exhaustion, or neglect their own family or livelihood, over each and every thing in a crowded house. Make sure the downsizing plan is appropriate for everyone. If the house is going on the market, sellers must declutter it of most contents and deep-clean. It must be staged to attract buyers. Seniors and their families need to commit to being understanding with each other, and also to getting the house sold efficiently.
There are tools that use local sales data to help you find the best time to sell in Atlanta. Statistics for 2014-2016 show that June and July are the best months for closing if you want the highest price possible on the home sale. Thus, listing in April or May, and having the house ready to show then, reaps sales about 7% over the yearly average. If your priority is to sell your house quickly, the data says you should aim for the same two months, since homes closing in June or July spend 1-2 weeks less on the market than those closing in other months of the year.
If you’re debating when to sell your house, find and ask an experienced local agent about the current state of the market and how you can maximize your home sale.
Written by Lin Nulman.
The Need for Dementia Sensitive Primary Care
What was the Inspiration behind this post?
Last week I had a doctor’s appointment with my primary care doctor. It was a 3 pm appointment. Here it was almost 4 pm and I was just getting called. When my doctor saw me, she immediately apologized and told me the reason for the delay. She said that today many of her patients had dementia, and those appointments take longer than the other appointments, yet they are scheduled for the same amount of time. My doctor knows I work in senior living, so she felt comfortable telling me her feedback of her experience with dementia patients. My Doctor told me that she spends a large part of the appointment counseling her dementia patients and their families. She also told me, the most frustrating part of her appointments with those with dementia, is explaining to them, that there is little she can do medically to alleviate the symptoms caused by dementia. She said many family members for instance notice their loved one with dementia has suddenly lost weight, and they want a prescription to combat that. She then has to give them the disappointing news that weight loss caused by dementia is a comprehensive symptom and can’t be fixed over night with a prescription. Needless to say, she was very excited to hear about Orchard’s Brand New 4 Tier Nutrition Therapy Program coming in 2018. For more information about Nutrition Therapy for Dementia please visit: http://stage-osl.daveminotti.com/final-stages-of-nutrition-therapy-development-for-dementia-residents/, as well as http://stage-osl.daveminotti.com/nutrition-therapy-at-each-level-of-dementia-care/
What Does Dementia Sensitive Primary Care Mean?
Dementia Sensitive Primary Care, are primary care services that are provided solely to individuals living with dementia. These services are provided by professionals that specialize in dementia, and in many cases only treat those with dementia. This type of care can be provided in a clinic or by a mobile service, by a medical professional ranging from a Nurse Practitioner to a Doctor. This clinic and or professional is designed to replace a person’s primary care provider that they had prior to the dementia.
What is an Example of Dementia Sensitive Primary Care Center?
The Integrated Memory Care Clinic, located in Atlanta, is a nationally-recognized patient-centered clinic that provides primary care for someone living with dementia. The clinic provides a variety of services to meet the challenging needs of those living with dementia. Whether the patient living with dementia has a cold, needs a vaccine, or has a change in behavior, the clinic can help. Dementia and other chronic conditions are managed exclusively by nurse practitioners who collaborate with geriatricians and neurologists on the team. The nurse practitioners have advanced training and specializations in dementia, geriatrics, and palliative care. A clinical social worker is also a vital member of the team. I personally know people that are patients at The Integrated Memory Care Clinic, and I know some of the professionals that manage it. I can say this clinic does an absolutely amazing job, and I would recommend it to anyone who is looking for Dementia Sensitive Primary Care.
Can Dementia Sensitive Primary Care be done outside of a clinic?
The answer is yes. I personally work with several medical groups that provide concierge dementia sensitive care in a person’s home. They can go to someone’s home or to their community. The group I work with closest has a team of professionals that provide the care. Their team is made up of a Geriatric Psychiatrist, a Nurse Practitioner and a Doctor trained in dementia care, as well as an Occupational and Speech Therapist. These professionals work as a team to define the patient’s cognitive, functional and behavioral profile, and create a care plan to manage their care. The extent to which each specific professional sees the patient depends on the patient’s needs and their profile. These services are offered in a person’s home, and at the Orchard, or another community.
Why do we need Dementia Sensitive Primary Care for those with Dementia?
Currently, 50-90% of all dementia gets misdiagnosed or gets missed all together until a crisis happens. Even if Primary Care Professionals start to more accurately recognize dementia, the quality of management of the disease after the diagnosis is usually sub optimal. Even if a PCP can diagnose dementia, in many cases they do not have a plan for follow up management. After dementia is diagnosed, there needs to be a plan of care set up to address potentially starting dementia-specific drug treatment to slow the decline, assessment and management of Behavioral and Psychological Symptoms of Dementia (BPSD), safety issues in and out of the home, side effects of psychotropic drugs, as well as the stress of family care givers. Most Primary Care Professionals today are not equipped to provide follow up dementia care. These PCPs are missing the coordination of primary healthcare partners,
as well as the implementation of support for both people with dementia and their caregivers. Hopefully in the next few years, more Integrated Memory Care Clinics will spring up, and more people with dementia will receive the Dementia Sensitive Primary Care they need.
Are Patients with Dementia Smarter than their Primary Care Practitioners?
Are Patients with Dementia Smarter than their Primary Care Practitioners?
The answer is not necessarily, however patients with dementia work much harder to mask and hide their dementia from the PCP, than their PCP works to diagnose their patients’ dementia.
How Has the Role of a Primary Care Practitioner Evolved?
Due to the increasing numbers of people living with Dementia and Alzheimer’s Disease, primary care practitioners, are seeing their patient loads be filled with more and more dementia patients. Primary Care Practitioners are usually the first health professionals that either patients or their families contact if concerned about memory decline. However only 60% of the people who meet the diagnostic criteria receive a formal diagnosis of dementia. Failure/Misdiagnosis rates have been estimated between 50% and 80% for moderate-to-severe dementia and up to 90% for mild cases. PCPs are usually the ones who have a long relationship with patients as well as their families, so patients and their families usually turn to the PCPs for sensitive matters such as memory loss or other signs of dementia.
Why is there such as high rate of Failure and Misdiagnosis? The Too Simple of an Answer…
Most primary care practitioners do not specialize in dementia and therefore symptoms get missed. Most PCPs rush through the appointments and do not take the time to notice dementia symptoms. Another too simple of an answer, PCPs treat dementia like they do other chronic illnesses by prescribing medications and sending the patient home. Although there is some truth in all these answers, the real answer is much more complicated.
The Real-Life Reason there such as high rate of Failure and Misdiagnosis?
Although there is some truth in the simple answers, they don’t paint the entire picture. Understanding and diagnosing dementia takes more than just being familiar with the typical dementia symptoms and being able to recognize them. There are many symptoms of Alzheimer’s and Dementia that a person exhibits before significant memory loss. Many people and their families discount these symptoms as just general senility or some other problem. These symptoms include personality changes. A warm, friendly person may turn into a bit of a grouch, at first occasionally, and then increasingly. They may start neglecting some of their grooming habits slowly. A person developing dementia may start telling inappropriate jokes in wrong settings. Another symptom is developing a problem with executive functions, such as difficulty with familiar, tasks such as cooking. A person will start having difficulty doing something that involves multiple steps, or following instructions. Word retrieval and getting out the right words can become a problem, and it may be a while before friends and family notice the more common communication problem of repeating stories or questions. Problems with depth perception or visual-spatial coordination can also precede memory problems. Usually these difficulties get blamed on vision problems and not dementia. Apathy and social withdrawal are also common with dementia. All these symptoms often precede memory loss, yet can easily be justified as being caused by something else other than dementia. Until a certain point, these symptoms do not significantly impact a person’s life, and therefore get ignored, and ultimately dementia is not diagnosed. One of the largest culprits of a missed diagnosis is masking by the person that has dementia. People with dementia usually notice something is wrong and they do everything they can to hide it. So even if a PCP asks their patient about one of the above symptoms, the patient easily comes up with a pliable excuse, such as they are tired and don’t 
want to do a hobby, the weather is bad, they are stressed, they need new glasses, they are not sleeping well and therefore their mind is foggy, and on and on. If a person with dementia misses their appointment, they are likely to blame it on the doctor’s office, or someone else, and even avoid making future appointments all together, due to the fear of missing the next appointment. It is very difficult, if not impossible for a PCP that treats a spectrum of patients including those with dementia and without to be able to pick up on these subtle symptoms. They are not focusing on these subtle symptoms, and because many of their patients do not have dementia, dementia and its symptoms are not in the fore front.
Why We Rarely See a Person with Mild Dementia Move to Assisted Living?
Since upwards to 90% of people with mild dementia get misdiagnosed or missed, most people do not realize something is wrong until there are blatant symptoms that usually harm a person in some way. Most people do not notice or get alarmed with a few missed medication doses, until a person either takes to many pills, or takes too few, gets dizzy, and falls. Even in those cases, they go to the hospital and the fall is at the forefront, and not the dementia that caused a person to forget their medications and fall. Rarely do families notice that their loved one is not eating, until there is a significant and visual weight loss. Families usually do not notice that their loved one is neglecting their grooming until they look obviously disheveled. They don’t notice personality changes, until something out of character and usually embarrassing occurs in public, very often in church. Most people with dementia improve their masking abilities over time, and their dementia is not addressed until they are not able to mask anymore, which is usually in the Early Moderate Stage of Dementia. By that time in many cases, substantial damage has been done, such as substantial weight loss, a broken bone due to an avoidable fall, and so much more.
The Take Away….
The solution to the huge percentages of failure/misdiagnosis of dementia, and the damage caused by these misses, is multi-faceted. There is a need for Comprehensive Dementia Education, Dementia Sensitive Primary Care Clinics and Doctors, and Cognitive Care Communities specializing in all levels of dementia from Mild to Severe. To find out more about the importance of a cognitive care community visit; http://orchardseniorliving.com/the-importance-of-a-cognitive-care-community-for-dementia-care/.
The next several posts will detail ideas and solutions to combating dementia caused crisis, and decrease the failure/misdiagnosis rates. Visit http://stage-osl.daveminotti.com/category/blog/
Creating an Enabling Environment is Key to Providing Dementia Care
How does Dementia effect a person’s ability to enjoy their hobbies and participate in activities?
Dementia gets worse over time. Although symptoms vary, the first problem many people notice is forgetfulness severe enough to affect their ability to function on a daily basis and to enjoy hobbies. One example is playing cards. A person with dementia will likely begin to forget the rules of a card game they have played their whole life. They may mess up during the game, which will usually cause them to avoid a card game they have played their whole lives all together. Aside from general forgetfulness, people with dementia often find that they lack the motivation to do anything. This loss of motivation can be attributed to general apathy or that certain activities have no value if they cannot be carried out as before. Repeated difficulty doing hobbies that used to be easy is also a painful reminder of the progression of the disease. Lastly but in my opinion most importantly, there is the issue of personal pride which causes masking, which is not wanting to show others that one cannot do something well or is forgetful. Even those who carry on with their usual activities sometimes lack the motivation or the incentive to get started due to the brain changes that come along with dementia. Family members often find it difficult to deal with apathy, particularly if the person with dementia has always been a fairly active person. In order to understand how Dementia and apathy are related, please visit my previous blog post http://stage-osl.daveminotti.com/apathy-is-a-main-the-road-block-of-dementia-care-at-home/
What does creating an enabling environment for a person with Dementia mean?
The first step is to know what type of activities or hobbies a person enjoyed prior to the dementia. Activities that are related to or connected with past hobbies are often easily accomplished as they bring a sense of familiarity. The second step is to align the type of activity to the stage of dementia. Over simplifying activities for someone with more capabilities is just as detrimental as not simplifying them at all.
Real Life Example: Lets take a puzzle activity. You are working with Jane who has mild dementia, who loves puzzles, and has done them all of her life. You present Jane with a 25 piece puzzle. She finishes it quickly and wonders why you brought her such a “child like” puzzle. This further effects Jane’s self esteem and reminds her that the world notices her cognitive deficits and has started treating her as a child. On the other hand you are working with John, who has moderate dementia, who also loved puzzles. You bring John a 200 piece puzzle. He struggles and struggles with it and after 10 minutes give up in frustration. The solution would have been to give the Jane the 200 piece puzzle and to give John the 25 piece.
What if you are working with a new person and are not sure of their current abilities?
Lets take the above example of Jane and John and puzzles. If you are not sure of their abilities you bring several puzzles to both. In Jane’s case, if you see her quickly putting it together, you tell her that she is doing a great job, and that you knew that puzzle was too easy, and that you brought another one and put the 200 piece in front of her. In John’s case, as soon as you notice that he is struggling you tell him that it appears that there are pieces missing from that puzzle, and you have one for him that has all the pieces, at which point you take out the 25 piece puzzle. It is very important to say that there is something wrong with the puzzle so that John does not feel that you changed puzzles because he could not do the first one.
What is another example of creating an enabling environment?
Choosing a simplified version of an activity, or an easier game or version are also ways of creating an enabling environment. Simplifying an activity or a game by removing some of the steps.
Real life example: Jenn used to be a chef and has cooked her whole life. She has given up cooking on her own but loves to participate in cooking activities. Jenn is in the moderate state of dementia. You have a cookie recipe that makes cookies from scratch by first making dough and then baking the dough. In order to enable the environment for Jane, you take that same recipe but you remove the more difficult steps such as those steps where the dough is made and you start with the dough being in front of Jenn. You have now created a simplified version of a hobby that Jenn can do and she will get the same final cookie as she would have if the cookie was made from scratch.
Many do not realize that time awareness is part of an enabling environment but it is..
Many people with dementia loose track of time in general. They also have trouble remembering appointments as well as at what time activities take place. Because they start forgetting and missing activities and appointments, many times they stop attempting to go to any of these appointments or activities. To create an enabling environment, you must take the remembering out of their minds. Instead of telling them in advance, scheduling future events or appointments, you tell them in the moment right before the appointment or activity. You also reassure them, that you will get them for the each activity, not because they will forget, but because you want to. This will take the stress of remembering out of the equation and help foster more participation in hobbies and activities.
The Take Away…Creating an enabling environment takes on many forms. Some of these forms are tangible activities and some are communication styles. It is important to know that creating an enabling environment is not a skill that most people naturally have. It is not a skill that you make up as you go. It is imperative to surround a person with dementia with those who understand dementia, and have received specialized training and have experience with things such as creating an enabling environment and communicating with a person with dementia. Continuing dementia education is a great way to learn the skills to engage a person with dementia. Join us at the Orchard at Tucker, 2060 Idlewood Rd, Tucker GA 30084 on Thursday, January 4th at 6:00 pm for our monthly Live & Learn Dementia Education Forum. For more information call 404-775-0488 or download http://stage-osl.daveminotti.com/wp-content/uploads/2017/12/Live-Learn-Dementia-Educational-Forum.pdf
Elevated Emotions Even Without Memory while Living with Dementia
Which last longer for those with Dementia or Alzheimer’s Disease? Memories or Emotion?
Have you seen long lasting emotions in a loved one with Dementia or Alzheimer’s after the memory causing the feelings have faded? I have on many occasions. Although I have seen it live on so many occasions, there is now science behind it. It’s no surprise that people with Alzheimer’
s have trouble recalling memories. It is, after all, the hallmark symptom of the disease. However, a new study has found that events can have a longer term and profound effect on how they feel even if they do not remember the particular event.
The Study..
A new University of Iowa study further supports an inescapable message: caregivers have a profound influence—good or bad—on the emotional state of individuals with Alzheimer’s disease. They may not remember a recent visit by a loved one or having been neglected by a loved one, but those actions can have a lasting impact on how they feel. University of Iowa researchers also showed individuals with Alzheimer’s disease clips of sad and happy movies. The patients experienced sustained states of sadness and happiness despite not being able to remember the movies.
The Emotional Life of those with Dementia and Alzheimer’s Disease….
These studies confirm that the emotional life of those with dementia and Alzheimer’s disease last far beyond the tangible memory of an event, regardless if the event was good or bad. “This confirms that the emotional life of an Alzheimer’s patient is alive and well,” says lead author Edmarie Guzmán-Vélez, a doctoral student in clinical psychology, a Dean’s Graduate Research Fellow, and a National Science Foundation Graduate Research Fellow.
The Take Away…
Despite the considerable amount of research aimed at finding new treatments for Alzheimer’s, no drug has succeeded at either preventing or substantially influencing the disease’s progression. Against this foreboding backdrop, the results of this study highlight the need to implement new care giving techniques and care models aimed at improving the well-being and minimizing the suffering for the millions of individuals afflicted with Alzheimer’s. These studies prove that traditional thinking about the emotional life of someone with Dementia and Alzheimer’s Disease is lacking immensely. Traditional thinking still tries to convince people that if they don’t remember it does not matter. At the Orchard at Tucker, we feel it Not Only Matters, but it Matters More. Although these studies are wonderful, we see the importance of emotion based care each and everyday by watching our residents.
The Subtle Signs of Swallowing Problems for Those with Dementia and Other Diseases
How does swallowing actually occur?
The oral phase of swallowing requires a complex interplay of chewing, food bolus formation, and push of the bolus to the back of the throat for the process of swallowing and movement to the esophagus and stomach. Multiple facial and oral muscles, such as the tongue, are responsible for this phase. Once the food bolus is to the back of the throat a series of muscular contractions occur to move the bolus into the esophagus and away from the airway. The airway is temporarily closed as the food bolus is pushed past the tracheal opening and into the esophagus. The food bolus then makes its way to the stomach through another series of coordinated muscular contractions within the esophagus.
Sounds Complicated Right? It is and lots can go wrong..
Due to the complexity of the swallow mechanism, a multitude of problems that can arise. The most common cause of oral dysphagia (swallowing trouble) is stroke, with up to 45 percent of stroke patients develop swallowing problems following the stroke. Other neurological diseases such as Parkinson’s disease, Multiple Sclerosis, Dementia, and Alzheimer’s disease are known to cause swallowing difficulties. Lesions, re flux conditions, and cancer have also caused swallowing troubles but to a lesser extent.
There are obvious and less obvious signs of swallowing difficulties…
Everyone knows that if a person coughs up food or gags while eating, they likely have swallowing troubles. However there are other more subtle signs that can go easily unnoticed such as long breaks between bites, being horse, drooling, frequent heartburn, and acid re-flux.
What can happen if these subtle signs are ignored?
If subtle signs are ignored they can result in choking, where food partially or fully obstructs a person’s airway, aspiration or inhalation of food or liquids, oral secretions or gastric secretions into the airway and lungs. Also gastric secretions may be inhaled without bacteria causing aspiration pneumonia. A person may aspirate not only food or fluids that are introduced into the mouth but also their own saliva or any gastric secretions, which may be re-fluxed into the airway.
What can be done?
In a community setting, all care partners must be trained to carefully observe each resident for not blatant signs such as chocking, but for the subtle signs such as drooling, and long pauses and usually get confused for something other than swallowing challenges. When a person lives alone, the signs of swallowing trouble usually go ignored until they end up in the hospital. In many setting, little attention is paid to dining room observation. Orchard at Tucker understands the importance of monitoring these subtle symptoms and finding the problem while it is minor,
and before it causes a resident irreversible harm.
Mom Needs Memory Support not Memory Care
Does mom need Memory Support or Memory Care? Good Question
I would first like to start with saying that appropriate Memory Support prolongs the need for Memory Care. In a traditional community setting, those with moderate dementia are either not thriving in Assisted Living or have to move to Memory Care too soon. In my opinion providing the right amount of memory support is the toughest area of senior care because it is not strictly defined.
Can Memory Support ever be Strictly Defined?
The answer is No. 
Providing Memory Support to someone with Alzheimer’s & Dementia is like providing a step stool for someone who needs a boost to see over a ledge. The difference is there are different ledges so different step stools are needed. Providing the right amount of support will enable a person to function as independently as possible. Providing too much support will further disable a person and result in a cognitive decline, and providing too little will hinder a person’s abilities to function and thrive. Cognitive Care is another way to describe Memory Support. Memory Care is a specialized care unit/section/or building where maximum cognitive assistance is provided and independence is limited. Memory Care is also usually a small, secure section, where activities and daily interactions are done in a group setting.
Types of Memory Support
- have duplicates for commonly lost items, and also knowing the hiding places (for this group of folks, the less space they have the better)
- know their schedule and guide the person through the day, personally guide to appointments and events
- anticipate needs and provide assistance without being asked
- explain tasks by breaking them into parts, with easy to understand sentences
- know and understand the daily routine and provide assistance in a way that does not make a person feel that they need assistance
- do not assume a person ate if you did not see them eat.
- while providing additional assistance, make it seem like you are providing a regular service.
- keep an eye on someone from 10-20 feet away so they don’t feel like you are hovering over them, but you are watching for safety.
Specific Examples
Jan is 78 and has Alzheimer’s Disease. She missed her last doctor’s appointment, hair appointment, and her favorite church concert. While living at home alone, Jan did not eat for 2-4 days, passed out and found herself in the hospital suffering from malnutrition and hydration. What could have been done to avoid these scenarios?
- Keep track of Jan’s appointments, by helping her make them at a time when transportation is available, if transportation is necessary. Remind Jan earlier that day, make sure she is ready, and personally take her to the appointment.
- Bring Jan to breakfast, make sure she gets it in front of her. After breakfast, tell Jan the next meal is lunch and you will get her for that meal. This will put her at ease.
- Everyday at 2 pm come to Jan with a pretty glass of water, encourage her, and then watch her drink it. Make sure Jan has a beverage in front of her for her meals and that she is drinking. Replace the beverage with an alternative option if needed.
The Take Away……
Many people are not getting the right amount of Memory Support in their current environment. I have found that there is a large percentage of those impaired with Dementia and Alzheimer’s that need more than Assisted Living, but less than Memory Care. These folks need another option. What they need is Memory Support/Cognitive Care in Assisted Living.