http://www.cnn.com/2009/HEALTH/01/28/memory.research/index.html

http://www.kansascity.com/115/story/954642.html

http://www.nytimes.com/2008/10/21/us/21alzheimers.html

They note that, while Hispanics are not necessarily genetically predisposed to this illness, that they do have an increased number of risk factors including high rates of diabetes, obesity, and stroke. Moreover, financial and language barriers can discourage a family from seeking treatment for a loved one, complicating an already difficult situation.

Music is the “universal language” and can continue to many areas of therapeutic intervention. Most individuals with Alzheimer’s Disease respond well to music. Their responses may depend on the type of music. There is a commonly-held belief that this population will only like “old” music, music from their era. However, any music from the time they were born is now from their era. One downfall we have when working with individuals with Alzheimer’s Disease, or the older population in general, is that we tend to limit their possibilities.

If your loved one is agitated and you try playing music they once enjoyed but it’s not helping, try a different kind of music. Some music, even classical, can be very “busy” and can tend to overstimulate persons with dementia and cause more anxiety or agitation. If they feel overstimulated and become extremely agitated, they may become aggressive and lash out as a response. They can’t always tell you how they are feeling, so they lash out instead.

White noise is often calming to a person with Alzheimer’s Disease. Actual white noise machines can be purchased, but an example of this is the noise a fan makes. Just running a fan may help them to relax. Another example is a water fountain .You may try one of these types of noise to help calm your loved one. There are CDs or cassette tapes that you can purchase with calming noises such as the ocean, birds, and wind. Once again, the birds can be over-stimulating, so if you notice your loved one becoming increasingly agitated, turn it off. Sometimes those with Alzheimer’s need complete silence, so when all else has failed, just try a quiet room!

One Saturday afternoon, a police officer knocked on the door of their home, and Carmen answered.

“I’m investigating a motor vehicle accident,” he said. “Someone ran into the car parked across the street from your driveway. Do you know anything about that?”

Carmen shook her head. “No, I didn’t see anything,” she said. “But I’ve been gone all morning. I went to my hair appointment about 10:30.”

The police officer asked Carmen to accompany him outside. Together, they looked at the rear bumper of her car. The police officer pointed to a large area where the bumper had been scraped. Red paint clung to the scraped area. Across the street, a red Ford Taurus sat, its door panel crumpled by a deep dent.

“Has anyone else driven this car today?” the police officer asked.

“Why, no,” Carmen said. “But I don’t remember hitting anything.”

Jim stood on the doorstep with his hands in his pockets. He was grateful no one had been hurt in the accident. He knew he could no longer postpone the difficult decision to keep Carmen from driving. Even though Carmen treasured the independence her automobile symbolized, Jim knew he had to take away Carmen’s car keys for good.

If you have Alzheimer’s disease, you may someday be faced with a recommendation that you restrict your driving privileges. If you have recently been diagnosed in the disease’s early stage, you may be able to continue to drive. However, at some point, you or your family members may begin to notice effects the disease has on your memory, judgment and attention. Your depth perception may fail and your reaction time may increase. You may find yourself disoriented in once-familiar areas, misjudge the speed of oncoming traffic or fail to notice stop signs.

You may be driving legally…that is, you have a valid driver’s license. But, you might not be driving responsibly. The last thing you’d want to do is cause an accident, which could harm someone else and cause legal problems and financial burdens for you and your family. The independence that driving allows isn’t easy to give up. Some people even feel lowered self-esteem when they can no longer drive. We have all grown up in a culture where driving is important to us. And, no one wants to be a burden on others for transportation. So it’s common for Alzheimer’s patients not to admit difficulty behind the wheel.

However, people with Alzheimer’s disease and their families and doctors have a responsibility to balance a person’s convenience with his or her safety and the safety of passengers and other drivers. Studies have found that, particularly in later stages, a person with Alzheimer’s disease is twice as likely to cause or be involved in motor vehicle accidents as a driver of the same age without the condition.

Recently published American Psychiatric Association guidelines for restricting driving privileges of persons with Alzheimer’s disease say that all severely impaired Alzheimer’s patients pose unacceptable risks on the road. So do some people with moderate impairment. In the early stage of the disease, some people can drive safely for a while. Others, however, cannot drive even short distances without endangering themselves or others. Discuss this issue openly with your family members and doctor. Trust them to tell you when to turn over your car keys.

The Family’s Role

Julianne had watched her widowed father’s mental condition deteriorate in the three years since he’d been diagnosed with Alzheimer’s disease. Despite his illness, he remained relatively independent, doing his own laundry and preparing his own meals. He drove to his Rotary Club meetings and church and ran occasional errands to the hardware store to get supplies for tinkering around the house.

Lately, though, Julianne noticed he’d been having trouble. Several times when she stopped by, she found wet laundry that had sat for several days in the washing machine. And the last time he made beef stew, he had added one-fourth cup of salt rather than one-fourth teaspoon, making it inedible.

Her father had driven the night before when they went out for dinner at a new restaurant in town. They enjoyed roast chicken and simple conversation. (Julianne had become accustomed to his repetitive questions and hardly noticed.) What she did notice, however, was his erratic driving when he took her home. He changed lanes without looking, nearly sideswiping a van. Then he swore at another driver who honked at him for running a red light.

Julianne resolved to keep her father from driving, but she knew from past discussions that he would ignore a plea from her to turn over the keys. Instead, she phoned her father’s doctor and asked him to write “Do Not Drive” on a prescription form and hand it to him at his next appointment.

If you are a family member of someone with Alzheimer’s disease, keeping an impaired driver off the road is your moral responsibility. Because of the independence an automobile represents, many people with Alzheimer’s disease resist giving up their driving privilege. If family members are providing care for the patient, this issue can be divisive. If you try to takeaway your loved one’s car keys, you may face his or her frustration and anger. Helping a frustrated, angry person bathe, dress or perform other activities of daily life adds tension to an already stressful situation. For these reasons, many families turn to their loved one’s doctor or the state motor vehicle department for help.

ACTION POINT!
How do you know when the time has come to stop your loved one’s driving? A good rule of thumb is when you no longer feel comfortable riding with him or her or letting your child go along. Another sign is when you notice your loved one can no longer follow recipes or perform simple household tasks. Mental abilities required for these activities are critical for driving.

Once you decide the time has arrived, you may find several actions helpful. First, consult your loved one’s doctor. An older person may find it easier to hear advice not to drive from a health care professional he or she trusts rather than from a family member. Understanding this role, many doctors are willing to comply with such a request from the patient’s family. In some states, doctors can also file a request for re-examination with the agency responsible for licensing drivers. People authorized to file such a request depend on laws in each state. Those who can ask the state to re-examine a driver’s ability to operate a motor vehicle may include police officers, family members, neighbors or others.

For example, both Kansas and Missouri laws and practices provide for retesting of drivers whose mental or physical impairments may prevent them from driving safely. In Missouri, the law authorizes the director of revenue (who oversees driver’s licensing) to require a road test, medical evaluation or both if there is cause to believe a driver is incompetent or unqualified to keep his or her driver’s license. Under the law, the Department of Revenue can order an examination of driving skills after receiving a written medical report from a physician or a letter from a law enforcement officer, family member or licensed health care worker who presents personal observation or physical evidence of unsafe driving. Reports must be in writing (no action is taken on telephone calls). The report must include the name, address, telephone number and signature of the person making the report.

Kansas law provides for additional tests to determine whether a person with mental or physical disability can keep a driver’s license. Another law authorizes the Division of Motor Vehicles to revoke driving privileges of people who are incompetent to drive.

A doctor, police officer, family member, employer, neighbor or anyone else who questions a driver’s ability can send a letter of concern to the state director of vehicles. Such letter must state a specific reason for the concern. It must also be signed. The letter is kept confidential; the writer’s name can be revealed only by court order.

When the director receives a letter of concern, the driver is contacted and asked to have a doctor complete a medical form. If the doctor says the driver may continue to drive, the state requires the driver to take a road test. If the doctor says the driver may not drive, the state revokes the driver’s license. (Revoked drivers may appeal the decision).

Other states have different rules and practices. In New Mexico, for instance, drivers 75 and older must get a new driver’s license each year. In addition, the state Motor Vehicle Division can require an individual to complete all testing phases if it receives information concerning the driver’s inability to operate a motor vehicle safely. Most often, information comes from a member of the driver’s family.

In some states, such as Illinois, the driver’s license authority cannot act on information that comes from a driver’s family members. Under Illinois law, the state agency must receive official notification from one of four authorized sources: the motorist’s physician, a law enforcement agency, a judge or a state’s attorney. The information must be firsthand knowledge of the condition that may impair driving ability and the reason the authorized source believes the state should take action. Family members who wish to keep a driver from behind the wheel must turn to one of the four authorized sources for a professional analysis of driving skills.

ACTION POINT!
Check with your state’s drivers’ licensing agency to see what provisions exist for revoking an impaired driver’s license.

Protecting Insurance Coverage

Unfortunately, even with a doctor’s order not to drive, or a license revocation, no guarantee exists that your loved one won’t drive. He or she may simply forget the admonition not to drive or forget that driving privileges have been revoked. Frustration or stubbornness may also help put an impaired driver behind the wheel.

In short, despite loss of driving privileges, a person with Alzheimer’s disease may drive anyway. Should that person be involved in a motor vehicle accident, serious consequences may result. Depending on the state, these consequences may include a challenged insurance claim or cancellation or denial of motor vehicle insurance.

In some states, for example, state law requires insurance companies to honor claims from a motor vehicle accident that involves an insured vehicle driven by a driver without a license. The insurance company would pay the claim, but may subsequently cancel the insurance policy.

If the state revokes a driver’s license, the insurance company may cancel the policy even if no accident has occurred. That’s because the revocation becomes part of the driver’s driving record. Many insurance companies routinely run periodic driving record checks on their insured drivers. Once the insurance company learns its insured has no driver’s license, especially if no other drivers reside in the home, the company would likely terminate the policy. If that happens,an impaired person who drives without insurance coverage would be at risk. In the event of an accident, the canceled insurance policy would not cover his or her assets from claims of accident victims for property damage or personal injury.

Insurance cancellation would also jeopardize the insurability of an unimpaired spouse, who, because of his or her older age, would likely have trouble obtaining another policy without paying rates far higher than the couple had been paying. Some states do, however, provide a remedy for this kind of situation.

For example, sometimes an impaired driver can submit a letter to the insurance company excluding himself or herself from an insurance policy so the unimpaired spouse can get auto insurance. If a loss results because the excluded driver drives anyway, the insurance company may pay liability claims for property damage or injuries to others. However, it might not pay the full amount of the policy’s limits for personal injury to the driver or damage to the insured’s vehicle. Again, the company would likely then cancel the insurance policy.

WARNING!
State laws concerning motor vehicle insurance vary. If revocation of a driver’s license becomes an issue, consult the insurance department of your state government for information concerning your situation. You may also want to consult an attorney to find out what your responsibilities are.

If the person with Alzheimer’s disease lives alone and should no longer be driving, the best course of action may be to sell his or her car. If the idea of selling the impaired driver’s car meets with objection, families can and should take other steps. For example, you could remove the car’s tires or otherwise disable the car. One way to disable a car is to disconnect the battery. Another is to disconnect the coil wire that leads from the coil to the distributor, which is as easy as unplugging an electrical cord from a wall socket.

The effect of disconnecting the coil wire is similar to the effect of removing the flint from a cigarette lighter. You can flick the lighter all you want, but it won’t fire up. With a car, you can turn the key, but the spark created by the coil cannot reach the distributor to start the car. Replacing the wire when an unimpaired driver wants to use the car is easy, too. Ask an auto mechanic to show you how.

Alternatively, the unimpaired spouse could give the loved one with Alzheimer’s disease a “new” set of car keys that look like the old ones but don’t fit the car. Parking the car out of sight, perhaps down the street, around the corner or in a neighbor’s garage is also a good idea.

ACTION POINT!
If you have a loved one who should no longer drive, for his or her own safety as well as for the safety of others, take action to keep him or her off the road.

Are you caring for a loved one with Alzheimer’s Disease in Kansas or Missouri? Get your FREE copy of our informative report, The Alzheimer’s Survival Guide, and learn the 9 Steps to Peace of Mind for You and Your Loved Ones.

Is your loved one crying? Depressed? Wanting to be alone? Wanting to stay in bed?

We all have a right to our blue days, and at times, the person with this disease just feels deeply sad. They sense the changes in their lives, and they feel their losses. Put your arms around them and say it’s okay to cry, it’s okay to feel sad. Bit by bit, you may coax them up and about. Try old, familiar stories or old familiar prayers. If they refuse still to get up, come back in a little while and try again, or have a different person try. Music can make an extraordinary difference. Play music they once loved; it will help them to reconnect to life.

In this case, you will be involved in a lot of physical care. Use touch. Stroking and rubbing of hands and feet (unless medically not advised for some other reason) will help keep the person “in touch,” and help with circulation to prevent skin breakdown. Your loved one will also need to be turned from side to back to the other side at regular intervals to prevent skin breakdown, commonly called bedsores.

Is your loved one bedfast (i.e. unable to get out of bed at all, or only with great effort)

Even if the person cannot move on their own, they can be repositioned — such as moved to an upright chair, or a recliner if available. They can therefore be involved in the social activity going on around them and can be a part of it, too. Don’t forget pet therapy or music.

A home health nurse can give instructions on how to do exercises that are appropriate for your loved one.

• Offer snacks or liquids. A person with Alzheimer’s may have missed a meal or forgotten they had one.
• Suggest that your loved one help with simple and repetitive tasks, like folding and unfolding laundry. Bring out the familiar pieces of games they once enjoyed, such as Monopoly, Parcheesi, or other board games. Also try giving them playing cards or crossword puzzles. It doesn’t matter if they do any of it well, or even at all. The object is to keep them occupied with familiar items and tasks.
• Restless and wandering patients need a safe place to wander and pace. They may just move around, or they may need a purpose, like carrying the newspaper from one part of the house to another, or going through old mail. Pet therapy can also work wonders. Be sure the animal is a calm breed, such a golden retriever. Or a smaller, lap dog may work better for others.

Is your loved one tense? Refusing to move? Irritable? Worried? Afraid?

• Always first ask or observe if your loved one is in pain. If not, remember these behaviors are often about feeling unsafe. Recall that persons with Alzheimer’s have lucid times that come and go. Try to imagine how frightening they must feel. Do comforting things. One is always to approach the person from the front. Hold their hand if they will let you, or just touch a shoulder and tell them they are in a safe place. Reduce any noises from a radio or television that may be creating confusion or anxiety for them. Try calming music from years ago. Tell them they are in a safe place. If they will allow you, hugs can do wonders!

Care Program Provides Friends and Fun - Kansas City Star

When someone is faced with the overwhelming job of finding a nursing home for a loved one in Kansas or Missouri, the question often asked is, “Where do I begin?” Although this is a job that no one wants to do, it can be done with forethought and confidence that the best decision was made for everyone involved.

When nursing home placement in Kansas City or surrounding areas is necessary, it is crucial that the family and/or potential resident decide what’s most important to them in looking for a facility. It is important that the resident’s needs and wants be included in the evaluation. Things such as location of the facility, if a special care unit is necessary and type of payer source should be considered when beginning this process.

The next step is to identify the facilities in your area which meet the criteria you established above. Beyond this guide, listings of facilities in the Kansas City Metropolitan area can be obtained from:

• Missouri Long Term Care Ombudsman, (816) 474-4240
• Kansas Area Agency on Aging, (913) 894-8811
• Alzheimer’s Association, (913) 831-3888
• Kansas and Missouri Alzheimer’s Resource Center of the Elder & Disabilty Law Firm, (913) 338-0959

If placement is “down the road” and you have time, call the nursing facilities and ask them to send you their information packet including an activity calendar and a menu.

Get ready to tour the facilities you have chosen. Don’t schedule your tours. Just show up during regular business hours. You will be able to meet with the administrative staff who will answer all your questions. Next, you will want to tour a second time in the evening or on the weekend just to see if there is a drastic difference in the atmosphere of the facility or the care being provided. It is important to tour at least two facilities so you can see the difference in the physical plant and the staff.

When you are touring, pay attention to your gut feeling. Ask yourself the following questions… Did I feel welcome? How long did I have to wait to meet with someone? Did the admission director find out my family member’s wants and needs? Was the facility clean?

Were there any strong odors? Was the staff friendly? Did they seem to genuinely care for the resident? Did the staff seem to get along with each other? Listen and observe. You can learn so much just by watching and paying attention. When touring a facility, ask any questions that come to mind. There are no “dumb” questions. Here are a few examples of questions you will want to ask to make sure that the administration of the facility is giving proactive care instead of reacting to crisis.

• How do you ensure that call lights are answered promptly regardless of your staffing?
• If someone is not able to move or turn him or herself, how do you ensure that they are turned and do not develop bedsores?
• How do you make sure that someone is assisted with the activities of daily living like dressing, toileting and transferring?
• Can residents bring in their own supplies?
• Can residents use any pharmacy?
• How many direct care staff members do you have on each shift? Does this number exceed the minimal number that state regulations say you have to have or do you just meet the minimum standard?
• What payer sources do you accept?
• How long has the medical director been with your facility?
• How were your last state survey results? (Ask to see a copy)
• How did you correct these deficiencies and what process did you put in place to make sure you do not make these mistakes again?
• Has the state of Kansas or Missouri prohibited this facility from accepting new residents at any time during the last 2 years?
• What is your policy on family care planning conferences? Will you adjust your schedule to make sure that I can attend the meeting?
• Do you have references I can talk with?
• Can my loved one come in for a meal to see if he/she fits in and likes the facility?

Once a facility has been chosen, there are some definite steps you can take to make the process less traumatic on the resident. First, plan the admission carefully. If you know the resident becomes very difficult to deal with in the late afternoon, plan the admission for midmorning.

Next, complete the admission paperwork before your loved one actually moves into the facility. This will allow you to spend the first few hours that they are there with them getting them settled and making them feel secure in their new living environment.

Some practical things you want to be sure to do … mark every piece of clothing with a permanent laundry marker. When a facility is washing the clothes for 120 people, it is common for things to occasionally end up in the wrong room; however, you can help ensure getting the item back if it is properly marked. If you are going to do your loved one’s laundry, post a sign on the closet door to notify staff and provide a laundry bag where dirty clothes can be placed.

Also, bring in familiar things for the resident so that there is a feeling of home. However, realize that space is limited, especially in a semi-private room.

A very important thing for you to remember is that the staff of the facility is just meeting your loved one for the first time. They do not know his or her likes or dislikes, or those little nuances that make providing care go smoother. The best way you can help your loved one is to tell the staff, in writing, as much information as possible about your loved one … his/her likes and dislikes, typical daily schedule, pet peeves, and so on.

It is important that you get to know the people who are caring for your loved one. Most importantly, stay involved. Let everyone know how much you care and how committed you are to your loved one’s care. Also understand you will not help your loved one by becoming anxious or emotional. Assure them that although this is not an ideal situation, you will be there to assist them in making it as pleasurable as possible.

Although it is a national program, it is administered by each state. The rules and regulations are constantly changing and can vary widely from state to state. So, it’s no wonder there are many myths and inaccuracies surrounding the program.

Today, we are taking a look at the common misconceptions we hear frequently about Kansas and Missouri Medicaid.

“My mother heard about someone who…”

All too often, we meet people who have heard horror stories about Medicaid from well-meaning friends or family members. These stories are often filled with inaccuracies and half-truths that frighten people into spending every last dime on nursing home care for themselves or a loved one before turning to Kansas or Missouri Medicaid for help.

Similar stories have also prompted people to assume that what worked for a friend will work for them as well. So, they may give their house or all of their assets to a child in hopes that impoverishing themselves will immediately qualify them for benefits. Unfortunately, they soon find out that these transfers mean they are unable to receive benefits for several months or even years after the money is gone.

That’s why it is important to contact an attorney who concentrates his or her practice in elder law. With a clear picture of your specific situation, an elder law attorney can explain those laws that should allow an individual or married couple to preserve their house and enough of their assets to live comfortably for the rest of their lives.

“My father is already in the nursing home so there’s nothing we can do now.”

It’s true that a family can wait longer than they should to contact an elder law attorney, but it’s rarely ever too late to establish a good plan. A good rule of thumb is that the earlier a plan is put in place, the more assets can be preserved. So, when is the right time to call an elder law attorney?

You should pick up the phone right now if you or a loved one does not have a Power of Attorney in place for financial and health care decisions. It’s important these documents are put in place before a gradual or sudden decline in mental competency occurs. It’s also important to make sure the financial Power of Attorney contains the right language so Medicaid planning is possible.

You should also call right now if you think that nursing home care will be needed by a loved one. This may be due to a diagnosis of a terminal or debilitating illness, such as Alzheimer’s, Parkinson’s or ALS. It may also be that your loved one is being discharged from the hospital and told he or she will be unable to care for themselves at home. All of these situations should be reviewed by an elder law attorney to determine what type of planning can be done.

“The Kansas or Missouri Medicaid office can just give me the paperwork.”

Those who work in the Medicaid office cannot offer you legal advice. You may not learn about laws that may allow you to receive Medicaid and still keep part or all of your spouse’s income as well as your own. Nor can they represent you or give you advice on the laws that, depending on your specific situation, may allow you to keep all of your assets without spending down a single penny. Medicaid has rules and regulations in place to ensure families don’t lose everything to nursing home costs. An elder law attorney can explain how those laws may benefit you and your family.