The Alzheimer’s Association has recommendations for End of Life Care for People With Dementia. This is the 3rd part of a series.
I read through this, and although long, it is well worth the time. In PDF form, I recommend printing it before reading.

Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes

Some Highlights of interest:

• It is important that residents and families consider the following care decisions and the relationship of each of them to the resident’s care goals during planning for the end of life:

Cardiopulmonary resuscitation
Invasive medical procedures and tests (e.g.,surgery, blood tests, dialysis)
Hospitalization
Use of intensive care units and ventilators
Artificial nutrition/hydration
Use of antibiotics
Use of preventive health screenings, medications and dietary restrictions

EXAMPLE: Colonoscopies and mammograms may not be advisable for residents who are at the end of life and cannot benefit from or understand these sometimes uncomfortable procedures.

EXAMPLE: Risks and benefits of medications may change when a resident has a limited amount of time to benefit from the positive effects.

EXAMPLE: Dietary restrictions may be modified when residents have difficulty swallowing or are not eating
enough to maintain their weight.

EXAMPLE: Forgoing weighing the resident when he or she is actively dying.

About Staff Training:

• Staff education and training is an essential part of the delivery of quality end-of-life care for individuals with dementia. It is important for staff members to adopt an attentive, anticipatory and investigative approach to caring for very vulnerable individuals who can no longer manage their own care.

NOTE: Residences that have contracts with hospices or palliative care services may request the hospice to provide palliative care training to staff.

• Good preparation for the unique challenges of providing quality end-of-life care requires that staff have training in caring for people with dementia, which covers:
Dementia as a terminal illness
Effective communication with residents who have dementia

Communication with the resident, proxy decision maker and family regarding advance care planning,end-of-life decisions and when the resident has begun the dying process or has a prognosis of death

Culturally appropriate communication and care for residents and families

Need to honor advance directives and the treatment choices of proxy decision makers for legal and ethical reasons, despite one’s personal beliefs about the appropriateness of care decisions

Physical and behavioral symptom assessment as well as pharmacological and nonpharmacological approaches to care at the end of life.

Wander Guard type devices have been in nursing homes for years now. The tech is just catching on for the other markets- esp. family caregivers. This might be a good thing since wandering is one of the top reasons people with Alzheimer’s are placed into nursing homes.

HAINESPORT, N.J. (AP) - It looks like a toy, but the bracelet locked around Bob Melnick’s wrist gives his wife some peace of mind: If this Alzheimer’s patient wanders off and gets lost, he’s wearing a tracking beacon to help bring him home.

“I’m a marked man,” joked Melnick, of Hainesport, N.J. “The police can pick me up anywhere.”

Wandering is one of the most frightening symptoms of advancing dementia, and the Alzheimer’s Association estimates it will happen to nearly 60 percent of patients.

A mini-industry of technologies promises to find lost Alzheimer’s patients - from simple radio-wave beacons that cost $10 a month for batteries, to more-sophisticated GPS devices that can cost hundreds of dollars.
[...]
Radiofrequency “tags” are a hot topic for assisted-living facilities. Patients wear a sensor read by receivers on doors that sound an alarm when someone strolls too far.

Then there’s the more traditional beacon like Melnick’s, which emits a radiofrequency signal for rescue workers to hunt.

“That kind of technology is the most flexible, because it doesn’t require GPS or infrastructure. But it doesn’t work if you don’t notice the person is gone,” Kautz said.

Whatever the transmitter, there’s the question of how to ensure the patient doesn’t wander off without it. Some systems require carrying cell phones; others come in hard-to-remove jewelry; one company sells sneakers implanted with a GPS chip.

The best technology will alert caregivers as to when they’re loved ones/patients exit, and then send signals as to where they are.
And the devices must be subtle and barely noticeable to the person since they will try to remove them.

A word of caution, from those of us who work or have worked with these devices: Don’t become too reliant upon them. Don’t have too much peace of mind…one breakdown in the system is all it takes for an elopement to occur. And they occur often.

A study is being done on the effects of certain dietary supplements on Alzheimer’s Disease.

The University of Michigan is seeking volunteers to participate in a national study to determine whether taking supplements like fish oil or omega-3 capsules slows the onset of Alzheimer’s disease.

Millions of Americans spend money on the daily supplements. While there’s some evidence that they work, they’ve never been evaluated in such a rigorous, scientifically controlled study.

A total of 51 health centers across the country are part of the study, funded by the National Institute on Aging, which is part of the National Institutes of Health. U-M is the only health center participating in eastern Michigan.

Men and women who are at least 50 years old and have been diagnosed with mild to moderate stages of Alzheimer’s disease are being recruited for the study. Sixty percent of study participants will be randomly assigned to take capsules of DHA daily for 18 months, while the rest of the participants will take an inactive placebo.

DHA is a specific type of omega-3 fatty acid thought to protect cells in the brain from an amyloid protein that is a leading culprit in the progression of Alzheimer’s disease.

The participants’ health will be assessed during the study period. Neither the participants, nor the researchers, will know who gets which substance until the end of the study.

Determining whether the supplements really work is important because five million Americans have Alzheimer’s, and that number is expected to increase rapidly in the coming decades.

“It’s a devastating disease,” said Dr. R. Scott Turner, associate professor of neurology at the U-M Medical Center who is leading the study. “Millions of people are affected and our goal is to try to, first, prevent further decline in someone who has memory problems, to keep them out of nursing homes, and to determine whether all the money spent on (the supplements) is really money wasted or money well spent.”

For more information or to take part, call 734-647-7760 or follow the link to the DHA study at www.med.umich.edu/alzheimers.

One of the problems with placing a loved one into an assisted living facility.

Bettie Carey’s dementia had worsened to the point that she needed to move to a center offering full-time care.

John Carey, a retired thoracic surgeon from Oklahoma City who once worked at the Mayo Clinic, chose Alterra Clare Bridge in Oklahoma City because it had a dementia unit.

He was thrilled with the results.

“They treated my wife just like she was their parent. They comb her hair, dress her up and rouge her face,” Carey said. The two have been married 31 years.

So when the center said it was under pressure from the state to transfer Bettie Carey and three other residents, John Carey said, he decided to fight.

The state Health Department cited the center during a July 2006 inspection with housing four patients whose care was in excess of what the center could offer, records show.

Read what happened, here.

Nursing Home Abuse. Resident to resident. It happens all the time.

Physical abuse in a nursing home is not always perpetrated by staff. According to a Cornell University Study, resident-on-resident violence in long-term-care facilities is far more prevalent than previously thought. But the authors of the study concede that they really don’t know how widespread this problem is because nursing home abuse is still woefully understudied.

The new study, funded by the National Institutes of Health (NIH), is only the second published report to look at patient-to-patient violence. Cornell University examined the records of 747 nursing home patients over the course of the study. Of those, 42 where involved in 79 incidents at nursing homes that actually required police intervention. The finding surprised researchers, especially because the study was not even focused on nursing homes. Rather, it looked at overall community crime, and nursing homes where just one area that was examined.

The report states that “abuse” might not be the correct term for these types of patient-related incidents. Many nursing home patients suffer from varying degrees of dementia, and this often plays a factor in the violence. The violence is not usually malicious, but often is the result of confusion on the part of residents. More often than not, these incidents involve a fight between two patients. Common triggers can be unwanted touching or disputes over television.

And whose to blame?

Even though this type of violence does not fit the classic definition of nursing home abuse, it is often the byproduct of a neglectful staff. Conflicts are far more likely to escalate to physical violence when patients are unattended. However, attentive staff can take steps to separate feuding patients before the situation deteriorates.

And if we had adequate staffing we might see less resident-to-resident abuse. But, when an aide is assigned to 10 or 12 residents there is NO way this one person can be attentive to even one at any given time- except for the one getting the direct care at the moment. What many nursing homes do is simple. They have activities going on during am and pm care times- those hours where the aides are too busy. The activity staff locate themselves wherever the residents are, not always in the activity areas.

Residents with dementia are a special challenge and do need some sort of activity to distract them. Housing them together may or may not be a good thing, but it’s the reality of most nursing home environments. I have seen much success and very few behaviors when the activity program runs at different hours- I like to call it “Resident Centered Hours” and not the typical 9 to 5.
Some activity staff might start working at 7am and the others might be scheduled from 11am to 7pm, to cover many hours.

This offers another choice on how to administer a common drug used to treat Alzheimer’s Disease:

WASHINGTON (AP) - The first skin patch to treat the dementia that can plague Alzheimer’s patients gained federal approval, a drug company said Monday.

The drug in the patch, called Exelon or rivastigmine, is the same as that now available in capsule form but provides a regular and continuous dose throughout the day, according to Novartis Pharmaceuticals Corp. Since the drug enters the bloodstream directly, the patch also eliminates some of the gastrointestinal side effects associated with the drug when swallowed.

The drug is meant to treat the symptoms of mild to moderate dementia in patients with Alzheimer’s disease. It also won Food and Drug Administration approval to treat patients with mild to moderate Parkinson’s disease dementia, Novartis said.

About 4.5 million Americans have Alzheimer’s. As the disease progresses, it robs patients of their memories and changes how they both think and behave. It’s ultimately fatal.

Rivastigmine isn’t a cure. It inhibits the breakdown of a chemical in the brain called acetylcholine, thought important for both learning and memory.

Several months ago we wrote many posts here about the case of Mabel Taylor, the woman with Alzheimer’s Disease, who eloped from her nursing home and was found dead outside. The owner of the home, Martha F. Bell, was recently convicted of covering up the death of Mrs. Taylor. Now the nurse who was on duty that fateful night has also been convicted.

As the son of two doctors who practiced medicine from home offices and treated sick people around the clock, Allegheny County Common Pleas Judge David R. Cashman said he knows what constitutes good patient care.

“That’s not what happened here,” the judge told former nursing home supervisor Kathryn Galati yesterday before sentencing her to five years of probation for her role in a failed plan to cover up how a former resident died in 2001.

Judge Cashman also barred Ms. Galati, a registered nurse, from working in health care during that time. Ms. Galati, 61, of the North Side, in March pleaded guilty to perjury, false swearing, conspiracy and tampering with evidence.

Ms. Galati was the supervisor at the defunct Ronald Reagan Atrium I Nursing, Research and Rehabilitation Center in Robinson when resident Mabel Taylor died on Oct. 26, 2001. Mrs. Taylor, 88, who had Alzheimer’s disease, was trapped overnight in an outdoor courtyard in 40-degree weather.

Investigators accused Ms. Galati of conspiring with former Atrium administrator Martha F. Bell to deceive Mrs. Taylor’s family by directing employees to drag the victim’s body inside, wash and place her in bed and claim she’d died peacefully in her sleep.

Mrs. Taylor’s daughter, Jane Baczewski of Hopewell, testified yesterday of her horror after discovering the “elaborate scheme to conceal” the truth.

“I will live with that picture of my dear mother being dragged on that pavement for the rest of my life,” she said, her voice cracking.

Ms. Galati did not speak yesterday. Her attorney, Leslie Perlow, said she is “not the greatest communicator,” but is remorseful and knows “what she did was wrong.”

A sentence of probation seems a little insufficient to me in this case. A woman died due to the lack of good supervision this nurse failed to provide; and the actions after are just horrible. But I am not a judge or jury in this case.

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