The New York Times had an incredible article about the difficulty in taking care of someone with Alzheimer’s Disease.  Ms. Jeneen Interlandi wrote the article and is a member of the editorial board. Her father was diagnosed in 2016.  This year, his doctor told the family that he needed a nursing home.  Well, that journey was fraught with problems.

“By then, he had been expelled from the local senior center for wandering off too much and was refusing to attend the adjacent, slightly-higher-security dementia day care. The strain of caring for him without one of those support programs was too much for our mother to bear, the doctor said. And who could disagree?

“Medicare does not generally cover long-term nursing home care. Medicaid does, but only when it deems those services “medically necessary” — and that determination is made by insurance agents, not by the patient’s doctors. The state of New Jersey, where my parents live, recently switched to a managed care system for its elderly Medicaid recipients. Instead of paying directly for the care that this patient population needs, the state pays a fixed per-person amount to a string of private companies, who in turn manage the needs of patients like my father. On paper, these companies cover the full range of required offerings: nursing homes, assisted-living facilities and a suite of in-home support services. In practice, they do what most insurance companies seem to do: obfuscate and evade and force you to beg.”

We would like to savor our time with him, but we’re often consumed by the work of keeping him safe. There are nine of us — one wife, three adult children and their spouses, two grandchildren — and just one of him. And still, we scramble. Last week, he disappeared off the front porch without a word, sending my younger niece into a tear-streaked panic.

“He was literally right here two minutes ago,” she told my brother over the phone. She had searched the yard and the street, and checked with the neighbors on either side, all to no avail. It was getting dark, the temperature was dropping, and my parents’ neighborhood is not totally safe at night. They were debating whether to call the police when my father emerged from a stranger’s car and ambled onto the porch with a fresh pack of cigarettes. (We probably owe somebody 10 bucks for those.)

 

Alzheimer’s disease is a growing problem especially with the Silver Tsunami or the graying of America.  The neurodegenerative disease that leads to brain cell degeneration and a decline in cognitive functions is estimated to kill a third of seniors and Alzheimer’s-related fatalities have increased nearly 150%.

Several of the world’s largest and most successful pharmaceutical companies have sought to tackle the disease. Researchers have focused on creating a drug that will effectively treat or cure Alzheimer’s when the disease has already manifested itself and progressed too far. However, new research suggests that preventative care may be best.  Changing how we interact with patients and detect traditional signs of the disease well before it takes hold may lead to early detection and create opportunities to develop new treatments or determine which drugs may help if given to patients earlier.

The prevailing theory behind the cause of Alzheimer’s has been the amyloid hypothesis, which asserts that the disease evolves from a build-up of a protein fragment called beta-amyloid in the brain. Researchers who subscribe to this theory believe that the disease ultimately stems from biological problems related to production, accumulation, or disposal of this protein.  But now the amyloid hypothesis has come under scrutiny and even abandoned by some researchers.

A team of researchers at the German Center for Neurodegenerative Diseases (DZNE) led by neurologist Mathias Jucker found a link between the blood biomarker neurofilament light chain (Nf-L), a protein that collects in the body, and early signs of Alzheimer’s.  In the center’s study, Jucker and his colleagues detected increases in Nf-L 16 years before symptoms of Alzheimer’s were present in a cohort of patients with familial Alzheimer’s disease. Nf-L has already demonstrated success in facilitating the early detection and/or prognosis of a variety of neurodegenerative diseases, including multiple sclerosis, Parkinson’s disease, and Lewy body dementia.

While preliminary, the results mark a significant advance toward a blood test that could detect the disease well before symptoms. Early detection would completely change the equation for companies developing new therapies by enabling trials using drugs on early-stage disease when the drug has a better chance of being effective. This also gives patients more resources, including time, to make choices when it comes to treatment or preventative care.

A nursing home resident at Oxford Rehabilitation and Health Care Center allegedly beat his roommate to death with a walker Oct. 5. The tragic incident is getting a lot of attention but attorneys who specialize in nursing home abuse and neglect are not shocked because we know these types of assault happen often especially when short-staffing prevents sufficient supervision and monitoring of easily agitated residents.

When police arrived to find Jose Veguilla swinging a bloody walker at staff, Veguilla responded to an officer’s request to drop the walker. Veguilla has dementia and was speaking incoherently. He had not been given his medication that day.

Police then found the victim, Robert Boucher, unresponsive in his room. He had a large cut on his forehead, among other defense wounds. Boucher had been living at the Oxford Manor nursing facility since April after having a leg amputated. He was engaged to be married. He was pronounced dead soon after.

A judge ordered Veguilla to undergo a competency evaluation after he pleaded not guilty to murder on Oct. 7.  The suspect suffered a traumatic brain injury during a fall at his home last year. A court psychologist questioned Veguilla’s competency at his hearing.

Veguilla’s son Henry said his father had not been taking his medicine and that he felt it was the facility’s duty to ensure the health and safety of all their patients.

“How does an 83-year-old man have the time to do what he is being accused of doing and no one stepping in to intervene?” his son said.

Athena Health Care Systems operates the nursing home. Oxford Manor receives a much lower than average rating on Medicare.gov and was the subject of a settlement by the Mass. Attorney General earlier this year. They failed to protect patients in the past and now that same state-licensed nursing home is part of an ongoing investigation after an elderly patient is accused of murdering his roommate.

According to state and federal reports obtained by 5 Investigates, the nursing home has a history of problems related to the abuse and care of patients, including patient-on-patient assaults.

The state found the facility failed to protect residents from alleged abuse, including abuse of patients by a resident who was a potential sex offender. In another case, Oxford Rehab waited six months to contact police about an allegation of patient-on-patient sexual assault.

The nursing home even hired back a certified nursing assistant who was previously suspended for verbally and mentally abusing a patient.

 “Based on the interview and record review the facility failed to supervise a male resident with known sexual aggression to prevent resident from having access to female residents on the dementia unit,” the report said.
 On Oct. 27, he was placed on increased behavioral monitoring after sitting on a couch next to a resident and touching her inappropriately across her chest, down her leg and poking her hip.

Last year, a jury compensated a former resident of Renew Saddle Rock $3.6 million after the resident was beaten by another individual who resided there, identified as “Anne B.”  The facility is being sued again for the same resident beating another wheelchair-bounded 92-year-old and failing to report it.  Apparently the facility cannot keep the residents safe or keep Anne B. from harming others.  Anne B. has also been accused of assaulting a third female resident who has had only her first name released, Josephine.  Many of the residents have Alzheimer’s and dementia so the facility knows altercations are inevitable and foreseeable and therefore preventable with adequate staff to supervise and intervene if necessary.

The latest lawsuit accuses the center of putting profits over people and engaging in under-staffing to save money.  Renew regularly staffs just one employee for as many as 28 dementia clients throughout evening and weekend shifts, the lawsuits alleges, and when an attack occurs, the center doesn’t have the resources to report it in a timely manner.

It was filed on behalf of Joanna Dryva whose mother, Maria Pallman, was the elderly wheelchair-bound women assaulted.  According to the lawsuit, Pallman was sitting in the hallway in her wheelchair when the assault occurred.  Now, according to court documents, she suffers from anxiety and other recurring medical complications.  The nursing home refused to hand over surveillance footage Pallman’s family request that they believe documented the incident.

The lawsuit additionally accuses former director, Britny Otto, of violating state law when she denied throughout her testimony in court that Anne B. had assaulted the individual in the first case that was presented.  It says that Otto the facility as having higher levels of staffing than its competitors even though she and the company were well-aware that it was chronically understaffed.  Otto also didn’t report the assault of the first resident to the police or adult protective services, as required by state law.

 

 

New British research suggests that high-tech “robopets” are the next best thing for nursing home residents unable to have a beloved pet or those suffering from loneliness.  The robopets stimulate conversations and trigger fond memories of pets or past experiences.

In the new study, Abbott’s group analyzed data from 19 studies involving 900 nursing home residents, family members and staff at centers worldwide. Five different robopets were used in the studies: Necoro and Justocat (cats); Aibo (a dog); Cuddler (a bear); and Paro (a baby seal).

Many nursing home residents were entertained by the robopet even if they realized it wasn’t a real dog or cat. Of course, “residents’ responses could vary according to whether they were living with dementia and according to the severity of the dementia,” Abbott’s team noted.

Some residents talked to the robopet as if it were, in fact, alive and a real animal. Some even made an emotional connection with the “pet.” For example, one resident told staff, “I woke up today and thought, today is going to be a good day because I get to see my friend.”

For others, just holding and stroking the robopet brought “them back into a space in their life where they feel loved,” as one nursing home caretaker put it in the study.

As to whether the robopet felt “real,” one resident’s family member said that it “doesn’t matter, because I can see that the robotic cat has an impact on my dad’s quality of life.”

Besides their other benefits, robopets appeared to boost social interaction with other residents, family members and staff, often by acting as a trigger for conversation, according to the research.

“Of course, robopets are no substitute for human interaction,” she said, “but our research shows that for those who choose to engage with them, they can have a range of benefits.”

The study, which received no private industry funding, was published May 9 in the International Journal of Older People Nursing.

KWQC had a recent article about the benefits of robot pets which are becoming more common in retirement homes. They’re not as much responsibility as a regular pet, and can bring a lot of joy to the residents.  Where it might have gotten lonely before, now there’s a friend. This can help residents who suffers from agitation or dementia with behavior issues.

“When a person is in a room by themselves basically, it’s nice to have something that you feel is there with you,” said Clair Odell, whose daughter is a resident. “The sounds, the purring, the mewing seems to be very soothing.”

Odell remembers the first time he met his daughter’s pet.

“When we went to see her and her new cat, the excitement and the joy that she had when she was showing it off and showing off its antics,” he said.

Officials at Ridgecrest Village say the next step is getting pets with reminders in them for residents – letting them know about appointments and when to take their medicine.

WHAS11 had an incredible story about two friends who really made a difference in the lives of nursing home residents.  Sandy Cambron and Shannon Blair provide baby dolls to nursing residents suffering from dementia.

It began as a gift to Sandy Cambron’s mother-in-law.  “We would buy her a TV, buy her stuffed animals and nothing would work and one day, we were out shopping and I told my husband, maybe we should get her a baby doll,” Sandy Cambron said.  It made all the difference.

“She loved it. She took that baby and slept with it, had meals with it. You could see the biggest difference with her. She would not leave that baby. It was always by her side. When she passed away, we buried the baby with her,” Cambron said.

Then, last year, when her friend, Shannon Blair, was going through a similar experience with her own mother, Sandy offered a baby doll.

“It was actually my mom’s roommate’s response. She immediately reached out and started crying. I went back to Sandy the next day and I said, I get it. I get why you wanted to give my mom a baby,” Blair said.

“300 babies later, we are boomin’. We are visiting as many places as we can,” Blair said. They hand out baby dolls, stuffed puppies and kittens. Each doll is color coordinated and wrapped in the softest of blankets.  They’re changing lives one baby doll at a time.

“It is just a baby doll, but whatever emotions it stirs up, it’s all happy. It takes them back to a joyful time. It’s happy and it’s sad at the same time,” Blair said.

Pearl’s Memory Babies runs purely on donations. Shannon and Sandy buy the baby dolls and shop all the bargains they can find to get the outfits, blankets, and even the diapers. If you’d like to donate or learn more, you can visit their Facebook page or website.

Texas has slowly reduced the misuse of antipsychotics in nursing homes in recent years, but experts and advocacy groups say more can and should be done. Texas legislators are considering a pair of bills that would require the written consent of a patient or a family member before an antipsychotic drug is given to a nursing-home patient.

Amanda Fredriksen, associate state director at AARP Texas, explained about 12,000 nursing home residents are being given antipsychotic drugs for no legitimate reason, perhaps other than the convenience of staff in caring for patients who otherwise might be difficult. She said these medications are intended to treat schizophrenia, bipolar disease and Tourette’s syndrome, but are dangerous for those with Alzheimer’s and dementia.

“These drugs can increase the risk of falls, increase blood glucose levels, they dramatically increase the risk of stroke – all these risks are well known,” Fredriksen said. “We outlawed physical restraints many, many years ago and now we’ve moved to chemical restraints. It’s fairly barbaric. ”

Fredriksen noted there are other alternatives to antipsychotics, including music and memory therapies and safer medications.

“There are also behavior techniques that can be used to know how to anticipate some of the reactions from residents and intervene with different kinds of behavior techniques that don’t require any drugs at all,” she said.

Tulsa World reported on a bill pending in the Oklahoma House to crack down on the administration of antipsychotic drugs to nursing home residents. Oklahoma ranks first in the nation in giving antipsychotic medication to nursing home residents, according to AARP Oklahoma, which is backing Senate Bill 142, by Sen. Stephanie Bice, R-Oklahoma City.

This legislation will provide a stop to this immoral practice of drugging our seniors,” said Sean Voskuhl, AARP Oklahoma director.  “We rank No. 1 in the country in this category with the high use of antipsychotic drugs,” Voskuhl said. “We owe it to our most frail and vulnerable citizens to provide dignity and care.”

The measure defines antipsychotic drugs as a “drug, sometimes called a major tranquilizer, used to treat symptoms of severe psychiatric disorders, including but not limited to schizophrenia and bipolar disorder.”

Bice said the legislation requires written informed consent from the patient or legal representative.

If the nursing home resident is given the antipsychotic in an emergency situation, a physician would need to do a follow-up exam to ensure the proper diagnosis, according to the measure.

The medications are being prescribed for nonpsychotic reasons, Bice said.

“We want to ensure that if there is a medical diagnosis and they need it, they get it,” she said.

But if a patient doesn’t need it, caregivers must be careful about over prescribing, she said.

Some of the medications have negative side effects, such as sedation, which can increase the risk of a fall, Bice said.

There is a high occurrence of nursing homes giving antipsychotic medication when it is not necessary.

Nico Gomez is president and CEO of Care Providers Oklahoma, which represents about 200 nursing homes. Gomez said his organization is not opposed to the measure.

“It is an issue we have been working hard to improve for a number of years,” Gomez said. “We can understand that people who care for our residents like we do are getting frustrated with the lack of progress that other states have made.”

He said his organization is working to educate its members and with physicians to make sure “we are prescribing the right medications to the right person at the right time.”

Gomez said he didn’t have an answer as to why the state ranks first in the nation on administering the drugs to nursing home residents.