Pacifica Senior Living - LiveWell Blog

Seniors and Oral Health

2015-03-06T10:42:00.000-08:00

At a young age, we're taught that brushing and flossing our teeth everyday is very important. We also learn that visiting the dentist regularly keeps our smiles bright and healthy. However, as we age, these simple oral care habits can become very difficult.

In seniors over the age of 65, the development of arthritis is common and a significant hindrance for brushing and flossing regularly. For a person with arthritis, these simple daily habits can be very painful, if not impossible at times. Even still, seniors with memory related diseases often completely forget about their dental care all together which can lead to a number of health conditions.

As we grow older, keeping ourselves healthy becomes increasingly important, and as our oral health is closely tied to our whole body health; keeping up on our daily oral hygiene practices needs to be a priority. Aging with poor dental care can have a much larger impact on your overall health than you might expect. Bad dental health can you put you at an increased risk for
diabetes and heart disease.

According to seniorsoralhealth.org nearly a quarter of all seniors over the age of 65 have severe gum disease which is often caused by chronic dry mouth. Chronic dry mouth, which can be caused by medications and normal aging, directly contributes to gum diseases and significant tooth decay.

While many people know that regular dental exams are important, few understand that as we age how staying on top of our oral health is paramount to maintaining our overall health. So don't forget to brush and floss your teeth everyday, and make sure to visit your dentist regularly.

Extravagant Romance In Senior Living

2015-02-23T16:05:00.001-08:00

I'm a superficial romantic. I love flowers, nice dinners and all sorts of other things that you see or read about in those great love stories. But I never forget that behind all those enchanting tales real life is just around the corner. Yes, who doesn't like to get swept off their feet, wined, dined and romanced? But in the end, do all those things stand as abiding examples of real romance? To that I offer a very resolute no.

Real People in Real Love

There are a few reasons I think real romance is comprised of much sturdier material than rose petals and caviar, but since this is a blog about senior living, you are right if you guessed that it might have something to do with my vocation.

Over the last 15 years I have had the honor of witnessing some remarkable people who have shown that, even after decades of marriage, extravagant love can still thrive, despite the obstacles of physical, mental and even emotional challenges. They don't include tear-jerking professions of unrequited love or dinners with diamond necklaces as dessert, but they are every bit, if not more, moving than the best romantic cinema you've seen. And because they’ve have had such an impact upon my life, I’d like to introduce you to a few of these love stories.

Heartthrob in Denim Overalls

Pearl was one of the residents in the skilled nursing where I worked over a decade ago. She was in the final stages of the dementia, nonverbal and, for the most part, non-responsive to most outside stimuli. She sat at the "feeder" table because we had to make sure she was fed every day, every meal.I knew virtually nothing about her due to her current state, but we all got to know her husband, because he came to feed her lunch- Every. Single. Day.

She never spoke to him, sometimes pursed her lips so he couldn't get the spoonful of pureed food into her mouth and even took a swipe at him a few times.

Yet day after day he came. He stroked her hair and called her by name. Each day, like clockwork, he'd arrive in his old denim overalls and repeat the ritual of feeding his beloved wife. We all got to know him and, once, he even brought in one of their wedding photos. It was remarkable to see the same woman we cared for each day as she had been in her prime; vibrant, bright and so alive.

I realized then that the woman in that photo was the one he was coming to see; the contracted, silent woman we all cared for wasn't the wife he saw, for he knew her essence and her soul, and that's why he kept coming back even after the outer shell had long deteriorated.

Timing is Everything

Mr. and Mrs. James had resisted moving into the community where I worked for quite a long time despite the fact that they really needed the additional help. Finally they made the decision and, with the help of their adult children, in a whirlwind, they were in the community. Within a few short months he passed away. You see, he knew he was dying and one of the final things he wanted to do was make sure they moved to a community where his wife would be well cared for after he left her.

Holding Hands and Hearts

Bill and Lucille, after getting married within days of the Pearl Harbor bombing and decades of marriage, lived out their final days in a skilled nursing facility. Despite near blindness in one and dementia in the other, one of the most beloved sights to all of the staff was the two of them sitting side-by-side in their wheelchairs, holding one-another's hands and saying they loved each other. The image of Lucille's hand being gently held in Bill's will forever be imprinted in my memory.

Seven Decades of Love

Finally, there was the gentleman, who after 70 years of marriage (no I didn't make an error, it really was 70 years) had lost his wife. I hadn't known her when she was well, but all accounts given reported that even after nearly three quarters of a century they were still like newlyweds. He was talking to me one day and out of the blue he said “Do you tell your husband you love him every day?" I was stopped dead in my tracks and wasn't quite sure how to respond, mostly because I know I don't do that every day without fail.

Most days, yes, but every day? I wasn't so sure I did. He replied “Well, you should because you never know when you won't have him." I left that conversation and went into my office and cried. I wept for the loss that he was feeling from his wife's death, but mostly at the profound truth he communicated to me. It wasn't about flowers or chocolates or having a date night once a week. It was simple; tell my husband I love him every day. And mean it.

Weathering the Storm

So, don't get me wrong, I won't turn away flowers and other sweet trappings, but the real romance I'm moved by isn't found in a sappy movie. Instead it finds breath in the lives of people who have persevered, held on to a faith bigger than one another's shortcomings and, above all, held fast to their commitment through every wave and storm.

That, my friends, is real romance.

Leslie Quintanar — Executive Director at The Meridian at Lake San Marcos

Heat Stress

2015-01-29T09:55:00.001-08:00

As outside temperatures rise, the elderly are more prone to heat stress. Heat stress occurs when the body can't adequately cool itself or maintain a healthy internal body temperature. Normally, we cool ourselves through sweating, but sometimes this just isn't enough and the body's temperature keeps rising. Heat-related illness can range from mild conditions such as rash and cramps to more serious and potentially life threatening conditions like heat stroke. Heat stroke occurs when the body becomes unable to control its temperature, and the body temperature rises to 106F or higher. Heat stroke can happen in as little as 10 minutes and can cause death or permanent disability if emergency treatment is not immediately provided.

Be alert for the following warning signs of overheating or heat stroke:

Very high body temperature
Dry swollen tongue
Nausea
Rapid Pulse
Red, hot and dry skin
Throbbing headache
Confusion or strange behavior

How to protect yourself and your loved one:

Drink cool, nonalcoholic beverages
Rest
Take a cool shower or bath
Wear lightweight clothing
Do not engage in strenuous activities
Limit tea and coffee
If possible, seek an air-conditioned environment

The elderly require extra vigilance. Not only does the aging body have a harder time regulation its internal temperature, but the elderly often have a decreased thirst awareness. Taking certain medications can reduce the skins ability to sweat and may increases health issues like blood circulation problems which can put an elderly person at higher risk for overheating. If you have an elderly friend or relative who is currently living alone, check on them twice a day. Look for signs of dehydration and heat stress. If you see any of these warning signs of overheating or heat stroke, get help immediately.

Keith Ayers — Executive Director at Pacifica Senior Living Modesto

Connect with us on Facebook, www.pacificaseniorliving.com or at Pacifica Senior Living Blog.

Constipation: Cause and Treatment

2015-01-28T09:49:00.001-08:00

Constipation is one of the most common disorders in Western societies, and its prevalence increases with age. Many of the factors that predispose older adults to constipation are not a direct effect of normal aging, but are closely related to it. Fortunately, there are therapies which can improve this distressing condition.

Causes

A majority of people over 65 take one or more medications that effect nerve conduction and smooth muscle function. Medications such as opioids, NSAIDS, calcium supplements, and various others increase the risk of constipation in older patients. Other common risks include low-fiber diets, limited fluid intake, impaired mobility, and cognitive disorders. Studies also show that there are distinct physiological changes which can affect colonic motility in older people.

Treatment

Treatment should focus on education. Informing patients about diet, exercise and bowel techniques, including evacuation timing, breathing, and the way they position themselves on the toilet, can be incredibly effective.

Depending upon the type of constipation, a routine that includes taking a fiber supplement mixed with 2 ounces of water every evening, can be a proven therapy. Additionally, adding a morning routine which begins with mild physical activity- just stretching in bed- a hot, preferably caffeinated beverage and possibly a fiber cereal followed by another cup of a hot beverage- all within 45 minutes of waking can increase the possibilities of effective evacuation.

Having a routine and an organized plan will provide patients with an improved quality of life. It offers more than the band-aide of taking a laxative, as laxatives really do not provide a long term solution, nor do they promote health.

Have You Had Your Residents Poached?

2015-01-27T09:41:00.001-08:00

Few things aggravate me more than a “well-meaning” outside care provider or the like, coming into a community and telling a family or resident that they should be relocated to a different level of care or a different community. This could be skilled nursing, a designated hospice wing, or the classic board and care. I am by no means opposed to their help and services when necessary, but I’m primarily referring to the ill-timed incidences when business appears to be more important than the residents well-being.

Dying Alone

Let me illustrate my point with an experience I had several years ago. A resident who had been in our community for an extended length of time was approaching the end of his life. He was in the hospital and despite the fact that they knew we could do hospice care in our building, the hospice agency told the family that he should go to their specialized wing as we wouldn’t be able to handle the care of their resident.

It was not even close to the truth.

His daughter, who didn’t know the complexities of the senior healthcare system, went along with the agency’s advice and he went to this “specialized” unit. When I found out what happened I called his daughter and told her that we could have taken him back and would have loved to have cared for him in his final days. At that point he was far too frail to move again so he stayed there for the remainder of his days. When he left this world, it was alone, without staff that had cared for him for years, fellow residents with whom he had built meaningful relationships, and the familiar surroundings of his room and our community. And it was precipitated by a suggestion from a staff member of an agency who thought they were doing the “right” thing.

Poaching as a Common Practice

I’ve since had experiences in which others have come into the picture and suggested other living arrangements for our residents; as a matter of fact I don’t think I’ve ever worked in a building where it hasn’t happened at least once. But despite that, each time it happens it is no less infuriating. It is so maddening because in most cases, we as the provider are working hard to ensure our residents are happy; we know not only them, but their families, preferences, and have diligently met their needs from the day they’ve entered our buildings. So when another provider, let’s say a home health or hospice employee, comes in and completely disregards the history, rapport, and well-being of the resident, it makes me feel as though I’ve been betrayed. Yes betrayal is a strong word, but I think it’s an accurate way of describing the experience.

Why do I feel so strongly about this frequent occurrence that happens in nearly all communities?

I can tell you adamantly that is it’s not because of a loss in occupancy or revenue. It is because I firmly believe that as an operator, a large part of my vocation is to ensure that each resident who calls our community home is indeed kept in their home; surrounded by familiar sounds, visual stimuli, people, and routines to which they have become accustomed. To remove someone from that level of comfort when they are dying because we don’t keep a bowel and bladder book is a little silly, isn’t it?

There is Enough to go Around

My point is this; we are all in this business of caring for our seniors together. There is no shortage of people over 65 to care for and thus we need to learn to better communicate and work together instead of against one another. Finally, we need to put the needs of our residents ahead of our sales targets and financial goals.

Just to give this a little more perspective here are a couple facts:

From 2010 to 2050 the numbers of Americans over 65 will more than double; from 41 to 86 million.

By 2050, the number of people age 65 and older with Alzheimer's disease may nearly triple, from 5 million to as many as 16 million.

Based on those two statistics alone it is quite easy to see that we are living in an era where there are an abundance of people who can be classified as seniors. And it is only increasing. Therefore, why not work together with the varied repository of resources to create a strong, unified network of providers who strive to do their best to ensure our elders are given the dignity and respect they deserve?

Calling a Truce

We all know that in today’s business climate it’s often easy to see providers pitted against one another in the name of quality care, but I don’t think we should allow that to become our standard of practice.Instead, let’s call a truce. Let’s remember to look at things on more of a macro rather than micro level.

The next time a provider of any type comes to your community or office, or a family from a competitor comes to see you regarding a possible move, I challenge you to ask the following questions before proceeding:

Is this suggestion because of a genuine concern for the quality of care of the resident?

Do you know the family history and their rapport with the community?

If dissatisfaction with another community is involved, can you share with the other competitor to allow them the opportunity to rectify?

Is it in this resident’s best interest to be able to return to their current community from an emergent occurrence to prevent as little upheaval as possible?

Is the resident at a significant safety risk or is it simply a preferential suggestion to relocate?

If we can all answer these questions each time our paths intersect with regard to our common residents, I am confident that we will all serve our elder population with greater efficacy and increased camaraderie. After all, we are in this together; let’s act like we mean it when we say that we put our residents first.

Leslie — Executive Director of The Meridian at Lake San Marcos, a Pacifica Senior Living community.

AMBROSIA SALAD

2015-01-26T09:34:00.000-08:00

Not long ago, I had lunch with a former Executive Director who now owns her own senior referral agency. During the course of our conversation, I asked her if she ever missed that role which she held so many years ago. Her response was one of the best assessments of the job I’ve ever heard, “When it was good, there was nothing better.”

The Gift of Today

Today wash one of those days for me. After two weeks of holidays, family, sickness and a December full of events and activities galore, I've found it difficult to follow my usual routine, both personally and professionally. Finally this week, things have returned back to normal. One of those routines that I enjoy most is walking through the dining rooms and visiting our memory care neighborhood. This afternoon, I got to spend some time in that special neighborhood, and it was nothing short of magical.

–

Our activity person was in the kitchen with a couple of memory care residents making Ambrosia salad. A mixture of fruit, mini marshmallows, shredded coconut and cool whip that instantly transports you back to summertime family gatherings and happy memories. As we continued working in the kitchen, more residents came in to see what was happening. One was helping at the sink, washing dishes, another comes in to eat some grapes, and a few more came in just to see what was going on. I grabbed a bag of mini-marshmallows, adding them and a few other ingredients to the mixture. Once everything was mixed together, we all tried a spoonful, uttering praises about the yummy creation before turning the conversation to shoes, babies and other topics.

After leaving the kitchen, I walked across that hall to the activity room, and spoke with a resident that I hadn’t seen in a while. Usually quiet and sometimes even withdrawn, she has recently become animated, talkative, and more engaged than she has ever been before. When I sat next to her she leaned toward me saying, “I haven’t seen you in a while” which warmed my heart in a way that is difficult to describe. While there I met one of our newest residents, greeted three other ladies and watched as our newly acquired community pet walked around and gently interacted with the residents.

What’s So Special?

I know that you are probably thinking, what is so magical about salad making and a dog roaming around a memory care neighborhood? Here’s what’s so special. All of those ladies, plagued with dementia had temporary slipped their bounds and were once again engaged, vibrant women. There weren't wracked with anxiety, worried about what they cannot remember, and weren't experiencing sun-downing behaviors. For this brief window of time, they were simply women enjoying themselves, engaged in the simple practices of everyday life that we often take for granted. They were ALIVE.

As I walked back to the main building, I felt as though I had been given a very valuable gift. I had been able to not only witness, but be part of a small time period in which these ladies were once again like their former selves. We laughed and talked, and I was able to envision what it must have been like before they were stricken with this terrible disease. I felt blessed to have to have been a party to something that was so special and beautiful. And then, I thought about my new friend, the former Executive Director, and how her words couldn’t ring truer for me than today: “When its good, there is nothing better.”

Leslie Quintanar — Executive Director of The Meridian at Lake San Marcos

Don't Lose Heart

2014-12-15T15:41:00.005-08:00

I once had a conversation with the President of a senior living organization for whom I worked in which he related that he believed that the Executive Director role is by far one of the toughest in the industry. You’re ultimately responsible for driving occupancy, meeting financial targets, cultivation an engaged workplace, over seeing compliance issues, functioning as the community HR representative, and overall quality assurance. Finally, we are expected to have a resident focus and create a setting that will allow each individual to have a quality of life that is vital and relevant. Piece of cake, right?

Sisyphus in Training

Anyone who has been or is currently an Executive Director wholeheartedly resonates with the laundry list of expectations. We’ve put in the longs days, lain awake at night remembering things not completed that day and thinking ahead to the next day’s challenges. And to be honest, sometimes it’s just exhausting. There are days we could very accurately compare our jobs to Greek tales of Sisyphus—always pushing the rock up that hill only to watch it roll back down and being faced with doing it all over again. Ever. Single. Day. So what do we do when we fell as though we cannot push that boulder up the mountain one more time? When we hit the proverbial wall?

And the answer is…

I got the answer last week when I was talking to a dear friend and fellow senior living warrior. We hadn’t spoken in a while, and as we were catching up she told me about a coworker who recently took her to his office, put some headphones on her to listen to some smooth, mellow music, and told her ” Do not lose heart—what you do has meaning, and even though tit is hard it’s worth it in the end.”

An AHA! Moment

I knew as soon as she spoke those precious words that their impact would be far-reaching and a source of strength I could pull out in some of my most difficult moments. It would be a source of reassurance to me that there is purpose, value, and hope in my role in senior living. In the last week as I’ve had to deal with staff changes, a belligerent resident, an unfortunate communtiy event, licensing complications, and numerous other challenges, that phrase has been my mantra.

Here is what I learned:

Do not lose heart—for every resident who is difficult there are other who are quick to tell you that you are special to them and that you’ve changed their lives.

Do not lose heart—for every staffing change that happens, you’ve got the unique opportunity to bring in someone fresh, new perspective and they’ll see things in ways you’ll need for that advancement of you community.

Do not lose heart—for every emergency situation you have to deal with you have the opportunity to prove to your residents that they can indeed trust you and you wil do all you can to ensure that they are safe and secure.

Do not lose heart—when you are exhausted and think that you cannot hear one more problem, you find that one resident who shars with you just how happy they are and how you and your staff have made it possible. I’m sure you are seeing a theme here; as leaders in this industry, we often come home emotionallyu spent, physically tired, and mentally drained.

Yet, ask most of us in this business and you’ll find that we cannot imagine doing anything else. Nothing compars to laying your head on you pilow each night and knowing you’ve helped alleviate a families fears, delivered on promised to create a community that exceed their expectiations, and wholeheartedly poured yourself into the lives of those entrust to you care and oversight. So, if you’ve had a tough week, take a few moments to balance the good with the bad, see the blessings in the challenges, and don’t forget to give yourself this piece of advice. Do not lose heart. Leslie

Organizational Culture and 7-Minute Phone Call.

2014-09-30T11:50:00.000-07:00

The other day I was surprised to listen to a voice mail on my cell phone from the owner of our company. It’s not every day that the owner calls to inquire about who is working over the weekend as he could be bringing some folks for lunch.

After listening to the message, I called him back as requested. He was pleasant and friendly, asked me about the community, challenges, updates on occupancy, and even complimented me that though I expressed there is a lot to the job, he has heard that I am up to the task. It was a nice conversation.

He let me know he’d confirm the lunch and tour with me the next day. Saturday evening I got another VM from him saying they wouldn't be coming the following day after all as their plans had changed. He also passed along that he hoped I was feeling better (I mentioned the previous day that I had a cold).

Mission and Values

I share this personal illustration because it’s a great example of company culture in action. I've worked for a few other senior living companies and other organizations that serve the senior populace, and they all have a mission and core values. I’m happy to report that in most of my experiences, those companies were, by and large, seeking to exemplify that mission and put those values into practice.

But in at least one of my experiences, that couldn't have been further from the truth. Senior management would espouse core values at every opportunity, but in practice, especially the further down the management chain things went, it was virtually unrecognizable.

The Ripple Effect

What do a couple of voice mails and short conversation have to do with all this? A lot. As the owner of the company, he could have very easily given a directive and had someone else handle the task. He could have sent an email or called the office, but instead he took the time to call my cell phone and personally connect with me. This from a man who presides over a company with more than 50 senior living properties and nearly as many hotels. The fact that he took time out of his day to do so speaks volumes.

It was encouraging to me, but it also left me with a renewed appreciation for what Jen Shirkani refers to as a leaders downstream impact. In her book “Ego vs. EQ,” she explores the fact that as leaders we often lose sight of just how much our behavior is being watched by others and also how our actions have a ripple effect. My owner’s call was a perfect example of that to me. It was a very ordinary call, but the fact that it was made by the owner of our company made it extraordinary.

A Little Introspection

That same surprise call from the owner of our company got me thinking about my own leadership. If I was so impacted by a simple phone call, how am I impacting those I lead? Am I using my influence for good, or is it lacking?

I asked myself the following questions:

Am I making an effort to connect with my employees? Not just business conversation, but to really get to know them?
Am I striving to be consistent with our companies mission and core values?
Am I seeking to be consistent in my daily practices and subsequent interactions?
Am I alert to potential blind spots and seeking to grow in those areas?

By asking those questions I’m seeking to ferret out areas where I am not as effective as I could be at leading others. In turn, this gives me the ability to have a greater impact within my sphere of influence. The greater my impact, the greater my opportunity at multiplication: that is, grooming and mentoring new leaders to take up the challenge of leading a successful community. This ultimately has the greatest impact upon the most important people of all; our residents.

Passion Isn’t Enough

Many of us got into senior living because we have a passion for the older population. However, most of us probably figured out just as quickly that simply being passionate about seniors isn't enough. You have to know how to lead people and effectively work through others. If you don’t, the results can be disastrous.

That’s why it’s refreshing and inspiring to have a very easily delegated task of a phone call reveal that a leader recognizes the power of a personal connection with his employees. It made me want to follow suit and examine my own leadership practices to find areas where I can continue to mature.

I encourage you to take a few minutes to mull over the questions above and be really honest with yourself. If you find yourself answering unfavorably to even one of them, take it as an opportunity to grow.

Seek ways to improve your emotional intelligence, which will arm you with the tools to be a more effective leader. And who knows, you just may impact one of your employees with a 7-minute phone call along the way.

Leslie

Executive Director of The Meridian at Lake San Marcos

Pacifica Senior Living

Make a Difference

2013-08-07T10:58:00.000-07:00

by Rebekah Martin

How many of you have seen the challenge on the Alz Assn’s website “Do a little BIG thing”?

I took care of my Mother for an entire year and after she passed away, I called our local hospital to provide a change of address as I was still paying down her medical bills. The account manager in their billing dept stated she remembered me from when she set up the payment plan and asked how my Mother was… She wanted to know if everything ended as well as it could or if it was rough.

When I hung up the phone that day, I thought to myself “What a huge difference you can make in a small place”

Do a little BIG thing made me think…

The Walk to END Alzheimer’s is a small part of life that gives more back to you than you invest. For example, when you walk, run, cycle or do other activities, you receive the gift of discovering courage, tenacity and the inner strength you possess

It isn’t what you do that makes you an athlete. It isn’t how fast or how far you go or haw many personal bests you have. Its waking up every day knowing that you will take on whatever life has for you that day. You embrace the challenges – physical, emotional and spiritual – because you know it’s the challenges that make you stronger.

Through your journey you realize you have gained the strength to face it all – the best days and the worst – for what they are: Days, Moments, Experiences

As you set out to walk this morning, remember, Every finish line is a gift.

And because of what you’re doing today, you can expect BIG things!

Walk on, friends.

Contributing Author Rebekah Martin is the Community Relations Director at Pacifica Senior Living in Modesto, CA.

Memory Loss - Like a Stealth Bomber?

2013-07-17T14:04:00.000-07:00

Memory loss is such a strange thing. You can’t see it. You can’t touch it. You can’t hear it. You can’t smell it. You can’t taste it.

Staring into the eyes, ears, nose or throat with the naked eye cannot give you a clue. Palpation and percussion of the head or neck will reveal nothing. Listening to the chest or smelling of the breath won’t work either. The usual tools that Mom used to diagnose our childhood illnesses or that the family doctor or office nurse could employ are worthless.

Memory loss is like a brewing storm- you just don’t know it’s coming if you’re not paying attention. Or, it is like a stealth bomber- you never even saw it coming until the bomb hits. Unfortunately, the disease that will ravage the brain and steal the memory is a pretty sneaky entity.

Those of us who are already touched by this illness have an inside track on new medications, diagnostics, and approaches to diagnosing and treating the memory disorder. Yet still, we are where we are- probably not ever having guessed that we would be here.

Those who have not yet been touched may have a niggling worry in the back of their mind. They may have a family history or a predisposing gene. They may know someone who has dealt with this illness. For the most part, though, these folks walk through their daily routines not suspecting that their lives may change at any moment.

When memory loss begins to become apparent, we can deny, we can rationalize and we can make excuses. But as the loss becomes more pronounced, the disease has already snuck in the back door and has probably been living with us for some time already. The ravaging of the brain cells has already begun- slowly but surely robbing us of the one we knew.

Standing before us is the loved one who looks all the word like the person we have known. Their hair is the same color, their smile the same, their walk and gestures so familiar. Yet, all the while we are looking at that same corporeal body, the essence… the mind… the thoughts… habits… behavior… are slipping away.

By the time we can deal with the early losses, another progression of the disease process has snuck in. We see a subtle, or sometimes, marked change. More and more, the losses take their toll and soon the corporeal body begins to fail as well. Only now can we see it, touch it, hear it so clearly.

Memory loss is indeed a strange thing, an insidious thing, a terrible thing. And still, we are where we are- never having guessed that we would be here. Would that we could change it. Would that we could make it go away. Would that a “cure” can be found.

In the meantime, we support one another with an understanding that no one, no one who has not been touched will know. We hug each other and say, “I know”. We face the inevitable together.

And we understand that we have been blessed- blessed with our friends and family support, blessed for having the chance to remember even though they have forgotten- blessed to have had them in our lives and our love.

Author:

Christine Varner

Executive Director at Pacifica Senior Living Belleair, FL

Memory Care Community

Let Them Eat Cake!

2013-04-10T11:59:00.001-07:00

I read an article in McKnight's Long Term Care News in regards to the effectiveness of dietary restrictions in people over the age of 75 and I'd like to share some thoughts on it. Based on a study conducted by Penn State & Geisinger Healthcare, the conclusion was that after a person reaches 75 years old, changes to diet are not likely to be effective. The damage has already been done and trying to eat "healthy" is not going to change the likelihood of acquiring Cardiovascular Disease, Diabetes, and Hypertension. Eating healthy throughout your early lifetime is the first line of defense, keeping yourself happy, in my opinion, is the second.

Our residents health and nutrition is very important to us, that is why we spend quite a bit of time with families at our round table meetings when a new resident is joining us asking about preferences, allergies & special dietary needs. Hearing what our new resident has been eating since a diagnosis of dementia is just as important as hearing about what they grew up eating and allowing our residents to have a choice in what they eat. I am in no way suggesting cotton candy as a steady diet for a diabetic, I am simply re-applying the age old saying "you are what you eat." By allowing our residents to be happy with the quality and presentation of the food they are served, we are giving them additional moments of happiness.

While some foods may have a higher value than others, nutritional value can be found in almost all foods. We strive to encourage the foods that do the most good, however, as taste buds change and diminish the list of those foods will also change. A resident who once ate only bland oatmeal throughout most of his life for breakfast now prefers brown sugar and cinnamon added in or will now only eat french toast with strawberries and bananas on top. It is not our intention to over-sugar or super saturate foods with salt, but if that simple addition keeps your loved one consistently taking in some nutrition that in itself is far better than not receiving any nutrition at all. At the end of the day what it all comes down to is a variation of the age old saying "Let them eat cake" - which in our setting means that when bread is refused, it may be better to let your loved one eat cake rather than eat nothing at all.

About the Author:

Stephanie Muhlbach is the Activity Director at Pacifica Senior Living Paradise Valley in Phoenix, AZ.

World Health Day 2013 - Take Control of Your Blood Pressure

2013-04-08T12:05:00.000-07:00

Yesterday was World Health Day. World Health Day is celebrated every year on April 7^th to mark the anniversary of the establishment of the World Health Organization. Each year a new theme is chosen to raise awareness of the world’s major health issues. This year’s theme is focused on addressing the problem of Hypertension, also known as high blood pressure. High blood pressure and other related conditions (such as obesity, poor nutrition, and lack of physical activity) are risk factors for chronic diseases, including cancer.

It is important on this World Health Day to raise awareness of the growing burden of non-communicable diseases (NCDs) on the world population. NCDs kill more than 36 million people each year, and almost 80% of these deaths occur in low and middle-income countries. In 2012, the World Health Assembly decided to adopt the target to reduce premature deaths from non-communicable diseases by 25 percent by 2025. The Member States are finalizing global targets for 2025.

“Early detection of high blood pressure and lowering heart attack and stroke risk is clearly far less expensive for individuals and governments than heart surgery, stroke care, dialysis, and other interventions that may be needed later if high blood pressure is left unchecked and uncontrolled,” says Dr Shanthi Mendis, Acting Director of the World Health Organization Department for Management of Noncommunicable Diseases.

Cut the risks of high blood now pressure by:

-Eating a balanced diet incl. consuming less salt

(This following link provides some great tips on Lowering your Salt Intake )

-Engaging in regular physical activity

-Avoiding tobacco use

-Avoiding or minimizing harmful use of alcohol

According to the WHO, the prevalence of hypertension is highest in Africa with 46% of adults being affected, while the lowest prevalence it found in the Americas with 35% of adults affected. Overall, high-income countries have a lower prevalence of hypertension (35% of adults) than low -and -middle income groups (40% of adults) – thanks to successful multi-sectoral public policies, and better access to health care.

Source: World Health Organization

Nutrition for a Healthy Brain

2013-01-30T10:54:00.000-08:00

You are what you eat. Who hasn’t heard this old saying? Our diet affects every bodily function including brain function and health. Certain foods such as refined sugars, increase inflammation and reduce blood flow to the brain. World renowned neurologist Dr. Majid Fotuhi said “Food can affect the brain in minutes”, during interviews with CNN and the Dr. Oz show. The “Superfoods” and supplements listed below do the opposite, reducing inflammation and increasing blood flow to the brain helping keeping it strong:

Brain Superfood 1: Elderberries

Elderberries are packed with quercetin, a flavonoid that’s critical to your brain’s health. Like blueberries and strawberries, the flavonoids found in elderberries help reduce harmful inflammation at a cellular level. Additionally, quercetin increases the activity of your cells’ mitochondria, which you can think of as the “powerhouses” within each of your cells. By boosting your mitochondrial activity, you’ll boost your overall energy level, too.

Brain Superfood 2: Pecans

Pecans are high in omega-3s, which are vital for a healthy brain. In fact, pecans are the most antioxidant-rich tree nut, and are ranked by the USDA among the top 15 foods with the highest antioxidant capacity. A brand new study shows consumption of omega-3 rich foods like pecans can dramatically reduce the risk of neural degeneration.

Brain Superfood 3: Chicken Giblets or Clams

Most of us make the mistake of throwing chicken giblets (the neck, kidneys, gizzard, heart and liver that come bundled inside a whole chicken) directly into the trash. Even though they may not look appealing at first, fight the urge to toss them! Not only can the giblets be delicious as an addition to a chicken stock or prepared on their own (you’ll find plenty of recipes online), but they’re a great sources of vitamin B12, which is crucial for brain health. In fact, just a cup of giblets provides 228% of your recommended daily dose of B12. If you can’t bring yourself to eat them, however, clams are another terrific source. They also contain zinc and iron, which have been associated with the brain’s ability to stay focused and recall information.

Brain Superfood 4: Vegetable Juice

Vegetables are like heath gold mines, providing all the vitamins and antioxidants our hearts and brains need. Juiced vegetables are a convenient and delicious way to get all those vital nutrients. If you’re buying vegetable juice at the market, look for bottles labeled all-natural with no added sugar. Of course, the best way to enjoy vegetable juice is freshly juiced at home, with no added sugar or preservatives. Whether store-bought or homemade, be sure to limit your intake to 8 ounces a day to avoid excess sugars.

Brain Superfood 5: Beets

Nosh on this root vegetable to boost your brainpower. As we age, poor blood flow contributes to cognitive decline. Research has determined, however, that the natural nitrates found in beets (as well as cabbages and radishes) can actually increase blood flow to the brain, thereby improving mental performance. Be sure to make beets and all the superfoods listed above a part of your diet. You’ll send your brain capacity through the roof, and tip the scales in the battle against Alzheimer’s.

Brain Booster Supplement: DHA

If you’re only going to take one supplement, DHA is the one you need. DHA, or docosahexaenoic acid, is an omega-3 fatty acid that makes up a significant portion of your brain tissue. Lower DHA levels are associated with a smaller brain size, so it’s important to supplement your natural DHA intake (which comes primarily from cold-water seafood). Taking a DHA supplement reduces inflammation, combats the plaque buildup associated with Alzheimer’s, and increases blood flow to your brain. In fact, studies have shown that taking 600mg of DHA supplement daily for 6 months boosts your brain so much that it functions as though it were 3 years younger!

(Source)

Traveling with Food Memories

2012-11-16T13:51:00.000-08:00

By Steven Mattingly

I’ve created a BIG problem for myself in a couple of weeks. Our community throughout 2012 has participated in something we call the “Passport Dining Series”. Each month we have created a unique dining experience by visiting different parts of the world. Among others we have had Breakfast in Paris, dined on the varied cuisine of Italy, and celebrated Bosnian cuisine. Bet you didn’t see that one coming now did you?

The next place that we will visit doesn’t exist in the real world and that is the problem that I have created for myself. Many who read this blog know that I am a former chef who realized early in his career that I wasn’t going to be the next Wolfgang Puck or even a mediocre executive chef. I left the 90 hour work week of food and beverage when I came to my senses and began a career in the world of senior housing. But the urge to prepare food for the masses never really leaves you. My family will attest to that as does my expanding waistline. So every now and then (it’s usually around the holidays) I have the hair brain idea that I will cook a meal for the community and that is what I am doing in two weeks. The place I want to visit doesn’t exist anymore; it’s mealtime at my mother’s kitchen table located in the house that she and my father built on Rural Route 2, Saint Mary’s Road, Lebanon, KY 40033 more than 50 years ago.

How can I tell the story of that place in the foods that I prepare? Do I cook the fried chicken that my wife recalls my Mother lovingly showed her how to make when she was a very new bride more than 30 years ago or do I make the Sunday Dinner Pork Chops that she made just like her mother, my Memmaw. I could make the Cincinnati style chili that was a cold night favorite or my all-time favorite of beef hash with fried cornpone (who knew she was ahead of her time frying polenta cakes). I could make the 60’s favorite tuna Noodle Casserole from which I picked out all those little bits of mushrooms or the other 60’s dish of Macaroni and Cheese made with Velveeta. I remember orange Jell-O cubes served as dessert with real whipped cream as much as I remember the chocolate birthday pies that she made for me each year. Or the divinity fudge that was a Christmas staple along with the regional black walnut cake made with black berry jam. I could make her most famous disasters, the pickled bologna that eventually sat in the refrigerator until it truly turned green. So many ways I could get to that special place. It’s overwhelming to consider it all.

I committed to taking our community to this special place more than a month ago. It’s only a couple of weeks away and I still am trying to decide on the perfect menu that will be transport our community to the place that I called home. What I have to remember is that just like when we all were growing up, the meal will happen, the warm hands and hearts of our care giving team will make sure that we get where we need to be at just the right time, and I will somehow just like my Mom did each and every day I ate at her table, create a memory for the community albeit a fleeting one for many.

As I get older and my vision of my life as a senior become clearer, I see how those little journeys that we have taken this year really are important to our community. If even for a brief moment a special smell or taste or atmosphere provokes a memory, it’s a good thing.

Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro, CA.

Winter Holiday Season Caregiving Tips for Families with Loved Ones with Dementia

2012-11-14T15:35:00.002-08:00

'Tis the season to be jolly. Or is it?

While those facing Alzheimer's disease or a related illness in their family might question the sentiment, experts say that it is possible to not only keep the cheer in the holidays, but also to savor them.

Some suggestions you might want to consider from the Alzheimer’s Support Organization:

· Communicate concerns. In advance of the holidays, be candid with family and friends about your loved one's condition and your concerns, and enlist their support. In cases where resentment brews because one family member assumes the primary caregiving role, use this season of giving as an opportunity to discuss sharing family responsibilities and to strive for family togetherness.

· Set realistic expectations. Consider both what the individual with dementia is capable of and what you, as a caregiver, can handle given your demanding role. Then, put celebrations into manageable proportions. This can help decrease stress and head off feelings of depression that stem from unrealistic expectations, both for you and your loved one.

· Select appropriate activities. Be mindful of the individual's current mental condition and do special things that they can still appreciate. Engage your loved one in singing and dancing since these abilities tend to remain intact longer. Involve them in some rituals—whether it is lighting the menorah, decorating the tree or baking cookies. Try to spark memories by bringing out family photographs or heirlooms. But do not demand mental performance by asking them to name people, places or other facts. Rather, help stimulate memories by offering descriptions as you present each object.

· Pare down traditions. With round-the-clock caregiving, it may not be feasible to juggle all of your religious and ethnic observances. You can still keep traditions alive; just reduce their number to avoid feeling overwhelmed and frustrated. Ask your loved one which traditions to choose; it is another way to involve them. Even though they may not recall later on, making the effort reinforces the fact that you care what is important to them and will make you feel better as a caregiver.

· Adapt family gatherings. Since crowds, noise and altering routines can aggravate confusion and other behavioral problems, revising your get-togethers may be in order. For example, instead of entertaining the whole clan, limit the number of attendees at a holiday dinner or spread out several smaller gatherings on different days. Mark a calendar with upcoming visits to make your loved one feel special.

· Stick with familiar settings. Because new environments can increase disorientation and pose safety concerns, discard restaurants or relatives' houses in favor of your own home. Likewise, if Mass is still important to your loved one, consider how they can participate. For example, take your loved one to an earlier, less crowded service; if they are unable to go to church, watch a Mass on TV or ask clergy to make a house call.

· Head off problems. Avoid alcohol, which may cause depression, increase the risk of falls and add to the loss of brain cells. Try to schedule holiday activities or visits earlier in the day before the potential for sundowing - behavioral problems that typically occur toward dusk among those in the middle stages of dementia. And, in preparing for holiday celebrations, do not re-arrange furniture or create obstacles-both are accidents waiting to happen.

· Limit holiday decorations. Decorations can still adorn your home, but in moderation. Hang cheerful ones that recall memories and family traditions. Do not overdo the ornaments on a Christmas tree. Remember that hauling out a lifetime of garlands, religious items and wall decorations can clause clutter and over stimulation, which can intensify disorientation and agitation. Ensure, even more than usual, that decorations do not block pathways or pose potential fire hazards.

· Re-think gift giving. Devise ways to include your loved one, depending on their capabilities. You might take them to a store to buy presents, and offer extra guidance. Or, you can buy the gifts for them and wrap them together since many individuals with dementia like handling paper. In giving presents, pick ones appropriate for someone with the disease. Instead of something material, try things that are simple, personal and sentimental. For example, photographs and heirlooms provide the opportunity to reminisce—a gift in itself.

· Welcome youngsters. While it is important to include children, it is just as vital to consider their feelings. Address the fear factor by helping them have special moments with their relatives. If their loved one uses inappropriate language or easily becomes angry during the visit, explain that this behavior is not personal or intentional; it is part of the disease. Youngsters' excitement about the holidays can be contagious. Singing songs together can strike a chord for someone with dementia. Or having an elder teach dominoes to children is a good way to foster interaction and make your loved one feel they have something to offer.

· Join a support group. A forum to express feelings and socialize can help overcome sadness for both caregivers and individuals in the early stages of dementia. Unfortunately, the incidence of depression ranks high during and after the holidays. Consult with a healthcare professional if you detect warning signs of depression: tearfullness, poor eating habits, withdrawal, inability to sleep, and physical complaints.

· Enjoy yourself. The greatest giftat the holidays: time. Ask a family member, friend or healthcare professional to keep your loved one company so you can relish some respite—time for some holiday shopping, a walk in the park, checkers with an old friend or whatever present you want to give yourself.

Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro, CA.

Mother Most Often Knows Best

2012-10-11T12:10:00.000-07:00

By Steven Mattingly

Our community hosted an event this week titled “Don’t Be Afraid of the H Word; Hospice 101”. An element that made the event very personal was a touching video tribute put together by Annemarie Lorenzini and her sister in honor of their late grandmother. Annemarie has for the past couple of weeks asked me to review the tribute because she felt it had a message that was important to the subject of the program that night. I repeatedly avoided doing so which frustrated my co-worker. It’s time for me to come clean to Annemarie and myself as to why I put off watching her tribute for so long.

It’s been over twenty years since my father died and over five since my mother died. My father was diagnosed with lung cancer fifteen years after successfully beating cancer of the larynx. He and my mother were told that he had between eighteen months to two years to live as the cancer was not treatable. My father died in less than three months. At that time I lived more than a 10 hour drive from my family home. My wise mother kept me informed of my father’s rapid decline but she also knew me much better than I thought. In the southern community where I grew up there is a long standing custom of the gathering of the family whenever there is an imminent death. I recall when each of my grandparents died there were between thirty and forty people present at the hospital waiting for death. My mother remembered how much I struggled as a small child and even as a teenager with this custom. She did not allow my older sister to call me until she knew that I could not get there in time due to the travel time needed. Once I got the call, I immediately headed to the airport to get a flight to the airport nearest to my family’s home. When I arrived, my younger sister and her husband met me and I knew by the look on their faces my father had died while I was in transit. It was a somber and mostly silent ninety minute drive to what was now my mother’s home.

My mother was unable or perhaps once again was a wise woman as she allowed her four children to make the funeral arrangements. We were somewhat surprised that knowing the cancer was fatal that my parents had not made any plans. While we have often been discordant as adults we were able to discuss the things that we felt would be important to honor my father’s wishes as well as provide the quiet dignity that we knew would be comforting to my mother. Simple little details became extremely important all of a sudden. The casket had to be a certain kind, the flowers had to look a certain way, and we all knew that my father would be buried with his favorite putter. All of this was accomplished without a raised voice or even a harsh word between the four of us. While each of us had a very different relationship with my father we realized that this was a time to put aside all the jealousy and individual anger that usually swirled around my father and put the family first.

As is often said about southern funerals, it was a lovely service. Perhaps the most painful thing about the entire sequence of events occurred after the funeral service. My very emotionally strong and dignified mother came back to her home, retired to what had been my parent’s bedroom and for almost an hour we listened to her cry. We assume she then fell asleep. After a couple of hours we heard the bedroom door open, my mother appeared and immediately asked if we had eaten and she went about putting a meal together from all the food that had been brought to the house. She never again slept in what had been my parent’s bedroom just as she never again mentioned my father’s death.

My mother spent the next fifteen years doing all the things that she felt my father would want done such as refurbishing the interior of their home for what she labeled the last time, buying a smaller and dependable car, and after many years of unpleasantness with his family that was directed to her, became friends with most of my father’s surviving siblings. She sewed, made great dresses for her granddaughters, cross stitched quilt tops for each of her children, and made Raggedy Ann and Andy dolls for an increasing number of great nieces and nephews, and all the while, consistently losing at cards.

In her last summer my mother undertook painting the second story deck on her home. While painting she fell off the ladder and ended up in the hospital. She went into sepsis shock from what we later learned was an undiagnosed bleeding ulcer and died three days after her fall.

This time the harmony my siblings and I found when my father passed away was nowhere to be seen. This instance it seemed even the smallest things caused tension. We were indeed grateful to find out that my mother once again in her wisdom had left little to be done insofar as her funeral arrangements were concerned. The casket, the flowers, the music at church, even the outfit in which she was buried was all outlined and to protect the fragile family unit we followed it without exception. We even took the daring and controversial step to honor her request for a closed casket, something that was just not done in the small town that we all had called home.

Over the next few months the estate was settled, the house was sold, and our family unit slowly came unglued. From my somewhat distance outpost, the telephone calls stopped, the updating on our children’s successes and failures were not shared, and we all mourned our loss. As the family member that everyone referred to as the cruise director I still don’t know what to do to find a connection with my siblings. My older sister and I stay in touch sporadically (I do wish it were more often). I haven’t heard much from my younger sister or brother other than what I see about them or their children on Facebook or what my older sister tells me.

I find some reassurance in knowing that for both of my parents their siblings drifted away when the last parent died but in each family there was a coming together again once the various cousins were out of the house and on their own. Perhaps it is the normal ebb and flow for any child to have a certain period of adjustment to being the head of their own families. It’s tough to find the right balance. I hope that my siblings and I find a point in time where we once again can converge as a family and provide that support we found when my father died.

So Annemarie - I knew that your video would be a reminder of a lot of things, many of which still make me uncomfortable. I was right. When I saw your short family tribute I didn’t see your Nona, I instead was picturing my parents who were contemporaries of your Nona. The grainy pictures, snazzy bathing suit poses, and other funny looking clothing were all too familiar reminders for me of similar things for my own parents. I think that the message of grace and acknowledging a life well lived for your Nona and her loving family is absolutely the right tone to set before a discussion of hospice. Had I had the benefit of hospice for either of my parent’s death I believe I would not feel as strongly something wasn’t whole following their deaths.

Death is inevitable for everyone, it’s how we and the loved ones who surround us near or far, face it that can make turn it into a positive setting for the one who is dying and their loved ones. Bravo for a job well done last night and thank you for not noticing or at least pretending not to notice how emotional I became.

Contributing author Steven Mattingly is the Executive Director for Pacifica Senior Living in San Leandro.

Music For The Ages

2012-10-03T15:36:00.001-07:00

By Steven Mattingly

In our community, we regularly have a gentleman who sings the standards of the heyday of most of our residents accompanied by a karaoke machine. My office is in a space adjoining our main floor living room and whenever he performs I have to close my door as his performance grates on my ears. For the most part I am not able to carry a tune but with guidance from my wife who sings in two choral groups I have learned what a well-trained voice can do. This particular performer sings up to the notes most often but I have to say his performances are always well attended and he just exudes charm. He’s a big hit with the ladies; he uses his vocal stylings to shamelessly flirt in the innocent way of the 1950’s.

There has been an array of articles in recent weeks about the benefits of music for seniors and in particular those with more advanced dementia. I’ve seen firsthand the benefits that music therapy can provide to individuals with more advanced dementia. It goes beyond the calming effect that everyone assumes will happen, in the right setting with the right music choice and the right encouragement. I’ve seen even the most withdrawn residents exhibit what I can only describe as the greatest of human emotion - a simple smile. Increasingly the many experts in dementia research are telling us that even though we are unable to discern a visible or verbal response, studies of brain waves before during and after musical programming clearly indicate the resident is processing the information. They have compared that response against voices of loved ones, normal sounds of daily life, and even sounds from a favorite pet and the studies consistently show that the greatest response is to music. An interesting facet is that it's music overall, not to a specific genre. Does that translate to suggesting that you play Led Zeppelin when you visit mom or grandmom? That I think is more of a personal choice but hearing some old fashion rock and roll or some twangy country music would be interesting and perhaps more appropriate for some of our residents. Not everyone loves Glenn Miller or Tommy James. My mother was a big Elvis fan.

In our community when I come in first thing in the morning I put on my favorite classical station to get us off to what I see as a gentle and easy start in the morning. About mid-morning we change to a Singers and Swing station that plays songs that many of our residents listened to when they were growing up or dating that is more up tempo. Can you imagine in a few years when assisted living communities program the songs that the next generation grew up listening to or when they were dating. Are we ready for “Let’s Get Physical” by Olivia Newton-John, or “Bohemian Rhapsody” by Queen? Can you picture a spandex clad, baggy sweatshirt and leg warmer wearing 70+ year old demanding more Disco music at 7:00 a.m. Or does the image of an 80 year old tattoo covered deadhead make you sit upright?

What do you listen to on a regular basis? Can you imagine the faces of your children when you are in your 80’s and they chide you for still listening to Phil Collins or even worse Donny and Marie?

Contributing Blog Author Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro, CA.

The Art of Finesse

2012-09-28T10:18:00.001-07:00

By Steven Mattingly

At our daily meeting recently our team was reviewing our staff’s concerns about a particular resident’s behavior. We discussed various strategies and different approaches that we might use to help this somewhat new resident more easily adjust to the daily rhythm of our community. Our Culinary Service Director chose an unexpected and interesting word to describe his suggestion. That word was finesse.

I was amazed to observe how quickly our discussion took on a totally different tone. Prior to this brilliant word use, the focus had been on preventative and outcome driven strategies. By thinking how we might finesse our interactions with this individual, a much more caring attitude was immediately apparent. The team began to examine how our approach and actions would affect the resident’s response. Instead of taking actions that we thought would give the desired result quickly; we began to think in terms of building a multi-step process with individual small results. The small successes would allow us to build toward the bigger goal that we hoped to achieve. When we thought about it even more we realized that this approach would offer continual positive reinforcement to the resident. As we all have heard more than once, success breeds success.

I recently downloaded a dangerous new “app” for my smart phone that may take over my life as it once did when I was in college, Bridge. Why could that happen? Both my mother’s and my father’s families whenever they gathered for any family event, inevitably a card game of some type would break out. Eucher (sp), Hearts, Canasta, Spades, Tripoli, numerous Poker variations, or Buckpitch were just a few of the games I learned to play. It seemed perfectly normal at both of my parent’s funerals to have extended family members playing various card games in the side rooms of the funeral home. I think it may be a Southern thing.

When I arrived at college I was introduced to Bridge and for a good portion of my freshman year I along with other card playing friends from my college days, ate dinner early and retired to Parrish Parlors for an hour or two or three of competitive bridge. We used rotating dummies so you learned to play various styles of bridge quickly. I found that my card playing days with my family pre-college served me well. If you are a regular reader, at this point you are asking yourself “where is he going with this?”.

Back to the art of finesse. When our Culinary Director used finesse to describe a resident care strategy it just seemed so obvious. Card games like Bridge use finesse to overcome missing trump or face cards in order to win the required number tricks to meet the bid amount. It was the classic “aha” moment. Using a bit of finesse when working with residents allowed us as well as the resident to overcome missing trump cards and make the bid.

This meeting also produced a flood of memories for me that included the places and the faces of my past bridge playing time so many years ago. It is after that meeting that I searched out the Bridge app that now seems to have taken over my spare time. Each and every time I celebrate a Bridge finesse I am reminded of how one simple but out of context word produced a significant change in thought for our team.

There are obvious challenges for those of us who care for seniors face on a routine basis. I can see now how using a little finesse every now and then can produce great results.

Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro CA.

That's Amore

2012-09-19T17:23:00.005-07:00

By Rebecca Weitzel

Pacifica Belleair was entertained and delighted by the Fun Time Singers who came to perform for us a couple of weeks ago. Singing many songs including Patsy Cline’s “Crazy” and Elvis’ “Love Me Tender”, our residents and care givers alike were clapping and tapping along with the music. The highlight for me was when one of our residents opened up and belted out the refrain to “That’s Amore”. Perhaps this isn’t so exciting, but when you consider that this lady hardly speaks anymore, it was quite a surprise to hear her lovely voice belting out “When the moon hits your eye like a big pizza pie, that’s amore”! Her face was beaming, her hands were waving in expression to the words and when I asked her if she liked the music, she lit up into a big smile and said, “Yes, I was remembering!” It made me think of how hearing a certain song can sweep us all back in time. Pat Benatar whisks me back to my freshman year in college, The Eagles, well that’s high school and of course there is that special song that takes me back to my minivan, loaded with my school age kids, all of us singing at the top of our lungs to Billy Ray Cyrus’, “Achy Breaky Heart”! Even today, when that song comes on, each of us will start singing (yes, at the top of our lungs!), inharmoniously, but loudly and enthusiastically nonetheless. Now, thanks to the Fun Time Singers and a lovely lady, another memory has been cemented; from now on, when I hear “That’s Amore”, I will be reminded of the sweet woman who lives at Pacifica and wonder what memory she relives as she’s transported back in time and hears “When the moon hits your eye like a big pizza pie….that’s amore”!

Contributing author Rebecca Weitzel is the Community Relations Coordinator for Pacifica Senior Living Belleair in Clearwater, Florida.

Age In Place....Really?

2012-09-19T12:47:00.000-07:00

by Rebecca Weitzel

When introducing families to our community, I explain that our residents enjoy "Aging in Place". This is a popular buzz phrase that’s currently misused, misunderstood and incorrectly offered by many assisted living providers. Saying that mom can “Age in Place”….sounds nice, but what exactly does it take to make (and keep) this promise?

Regrettably it is important to understand and anticipate that a person suffering from dementia declines over time. As conditions worsen, care levels increase, frequently to the point of becoming acute.

Most Tampa Bay AL’s operate with a Standard License and provide routine personal care services to their residents. Florida guidelines specifically define these services, which are quite limited in scope, as they do not permit delivery of the higher care needs required of more progressed residents.

Pacifica Senior Living Belleair has earned and been awarded a Specialty License called an Extended Congregate Care License (ECC License). This permits us to legally give and manage higher acuity care needs than can other communities. Having this designation allows residents to live here without the threat of one day having to move into a skilled nursing home. Therefore when speaking to families, I legitimately offer “aging in place, here in our cottages, because we are licensed to provide for the increasing healthcare needs of our residents.

We are one of few dementia care communities in Pinellas County to hold an ECC license. Having been awarded this specialty license by the State of Florida, Pacifica Senior Living Belleair offers "Aging in Place" ....really! From the earliest stage of memory care need through the entire journey, our residents remain here, at home, with us. This is one more promise we make (and keep) that makes Pacifica “just the right place” for many Bay Area families.

Contributing author Rebecca Weitzel is the Community Relations Coordinator at Pacifica Senior Living Belleair in Clearwater, Florida.

The Value of Saying Thank you!

2012-09-17T13:13:00.000-07:00

By Steven Mattingly

This past week, September 9-15 was a special one in the world of Assisted Living Communities. It was National Assisted Living Week. Our community used a large poster to say thank you to our staff and encouraged staff members, residents, and family members to personalize it with notes and encouraging words. It was great to see as the week went along the growing and glowing tributes that appeared. We also used this week to honor two members of our staff for their “above the call of duty” care giving skills. They were honored at a Happy Hour event in which all members of the community participated. I felt that we had hit a home run in the thank you game for the week.

It was with a concerned ear this past week that I listened to one of our healthcare vendors tell our concierge how glad they were to see our poster since in their visits to most assisted living clients they serve, they saw nothing in observance of National Assisted Living Week. I made a point of seeking out that vendor during their visit and ask them if that remark was really accurate. Sadly they said yes. We commiserated about what the caregivers in locations where there was no observance might feel. The buzz words of under-appreciated, un-feeling, and we need to do more were tossed about and we both felt better afterwards or was it perhaps our smugness showing.

This incident in so many ways forced me to reflect on how I as a manager perceived my staff. Were they worthy of some special acknowledgement during National Assisted Living Week; absolutely. But are they also worth my time and energy to say thank you each and every day; again the answer should be absolutely. Do I say thank you each and every day? I have to admit to my shortcomings and say no I don’t. I mean to, I really do! But then that report comes due, I get a call from my boss, a family member needs answers, a resident walks into my office with concerns, etc. I think you get the picture. Like everyone else I have constant distractions from my good intentions. To quote my now infamous mother “the road to hell is paved with good intentions”.

Lots of business schools graduates and experts have spent lots of time coming to the conclusion that the one thing managers can do that motivates employees the most is show real and genuine appreciation. Public appreciation like the poster we used, the recognition in front of the community for some, and happy hour for all certainly were signals and signs of appreciation. But those same experts have told us that quiet moments and simple words of appreciation have an even greater effect. In my upbringing we were reminded regularly to say our please and thanks yous. I can remember all too well my parents at the dinner table not serving us food until we used the “magic” word please and we often heard the phrase did you forget something when we didn’t say thank you. Now I understand and appreciate those gentle and even not so gentle urgings of my parents all the more when I think about saying thank you and asking staff members in an appropriate way to work harder and do more. The phrase “how much more our parents know as we get older” keeps coming to mind.

There has been a general (do I dare used the in-the-news-word) bounce in good feelings around and about the community following last week. I hope our tracking polls show it as more than a bounce and something that we can continue to build. I hope that my good intentions don’t send me to hell but I do have a plan to say thank you more to our care giving team in some way every day I am in the community. Little did I know that my parents were as smart as or perhaps even smarter than the business school crowd when they taught us good manners?

Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro, CA.

Our Aging Parents Continue to Change

2012-09-12T13:12:00.000-07:00

By Steven Mattingly

One of the most difficult tasks you face as an Executive Director of an Assisted Living Community is talking with family members about changes you and your staff see in their loved ones. It’s never easy for family members to see the changes or as is more often the case, to process how the changes are affecting their loved ones daily life.

I’ll give you an example from personal experience. All other members of my family are located near our ancestral home in Kentucky. I moved to California more than 15 years ago and as a result I didn’t see my mother regularly the last 12 years she was alive. Unlike my siblings I didn’t get to enjoy her Sunday fried chicken, watch her consistently lose at cards, or for the umpteenth time ask “which hand are we on” in Shanghai (a rummy type card game). The image I instead saw during my semi-annual visits was how much my mother was changing as she aged. When I tried to talk to my siblings about the things that I saw they were always either surprised or defensive. I was the person who informed my younger sister that our 80 year old mother could no longer safely provide free childcare for her two children after school. You can imagine how well that was received. I added a different and at times not welcomed perspective to the family dynamics, not unlike what I often do with family members of residents of our community.

Perhaps the most important role of an Executive Director and his/her team is to be the objective viewpoint in the family dynamics that envelope every single resident in a community. I often tell family members that we are the people who now live with their loved one 24/7/365. We are better suited to know a resident needs because we see and experience the difficulties their loved one encounters each day. Family members sometimes tell me that their loved one saves all their complaints and sad stories to share when they visit; I think that is not the case in most instances. What our team most often observes is the “gearing up” for the visit phenomenon. Residents, even those with advanced dementia, go into a different functionality when loved ones visit. They are more engaged, more alert, participate in the conversation more, and exhibit their “best” behavior when families visit. What happens when the visit is over I describe as the “crash”. Even residents who normally have great coping skills when dealing with their daily challenges experience, albeit small in some instances, some diminishing of their coping skills. That’s when my staff sometimes tells me “I wish their son/daughter/friend could be here now”. The implication is the family needs to see and hear what they are experiencing after a visit.

A few years ago I worked with a family who adamantly maintained that their mother was not incontinent and how could we charge them for that level of care and the accompanying undergarments. After many rounds of discussion I finally in a moment of great exasperation told the family fine, take Mother to live with you for a week and if you don’t come back with an understanding that she is incontinent, I’ll not charge you rent for a month. It took less than 24 hours and mother was back in the community. As much as I wanted to feel a sense of triumph I couldn’t. What I had done was remove one more element of the dignity that Mother had in the eyes of her children. It was needed to make sure their mother got the care she needed and we were correctly paid for providing that care, but it was hardly something that I saw as a victory in any sense.

Many of you by now have realized that I often use my own family to illustrate situations or problems. I find it is often easier to talk with a family about a problem or concern if you use a third party to illustrate the point. But I also think I use my own family stories so that our resident’s families can know my empathy is real. I too have had to face a world with aging parents.

Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living Assisted Living in San Leandro, CA.

Senior Fraud Hits Home

2012-08-29T12:39:00.001-07:00

By Steven Mattingly

We all hear about and read about fraud committed against seniors and it’s exactly that, something that we hear and read about. Most of us pay little heed to the discussion most of the time. Even though I work with seniors each and every day like most of us I tuned out the various commercials and internet pop ups thinking them little more that auditory and visual pollution.

I have changed my nonchalant attitude rather quickly in the past couple of weeks when our community was called upon to assist one of our own residents fight an ongoing case of identity theft and financial fraud. A former business acquaintance of the resident had gathered enough information ranging from bank statements that were altered to included additional names, copies of a state issued ID, and other personal information. This individual was using the information to represent herself as the caretaker of the resident and was attempting to lease an expensive home in the bay area in the resident’s name.

The good news is that an alert property manager for the potential rental property sensed something out of the ordinary and reached out to our community for help. Because of privacy laws we do not respond to questions asking if a resident or staff member is part of the community. Our standard response is that we cannot confirm or deny that information. Fortunately in this situation the property manager was persistent and a manager on staff made the appropriate decision to cooperate once she learned a bit more about the nature of the inquiry.

With cooperation from our community, the resident affected, and the property manager, the police with jurisdiction over the case set up a “sting” operation to apprehend the individual. It was somewhat surreal. It was like being involved in a scene from “Law and Order”. The good news is that the sting worked, the individual attempting the fraud was apprehended and will be prosecuted. The bad news is that our resident has to do the leg work to restore her good credit status with the various with the credit bureaus, no small feat, but she is determined to put things right.

There are numerous sources where you can get information about how to prevent senior financial fraud. Most of it is simply good common sense. Here are some suggestions you might want to consider:

· Identity thieves love aging parents because they think they are so vulnerable. Social isolation, loss of a spouse, early dementia, general memory loss or confusion set up our elders and aging parents an easy mark. Add to that, seniors tend to be friendly and trusting, and you have a combination that can make your aging parent a sitting duck.

· How can we help them protect themselves? We need to educate our aging parents that trusting strangers on the phone is very dangerous. We need to warn our aging parents that even their own children can rip them off if they are desperate. Drug and alcohol abuse, serious financial trouble and mental illness can lead an adult child to steal account numbers when visiting and later raid his own parents' bank account and steal from the ones most likely to trust him or her. Can we thwart the attempts at stealing our aging parents' identities? We can at least take protective measures. Some of the simplest protections are the best.

· First, buy a cross-cut shredder. Shred or have your aging parents shred sensitive mail, credit card solicitations, and outdated personal documents such as bank statements, rather than throwing them in the trash. Thieves go through the trash looking for anything they can use to steal.

· Guard credit cards. Watch sales people, staff in restaurants, and anyone who asks for your credit card. Thieves use tiny scanning devices called skimmers to steal the numbers and then use the cards. Get rid of any rarely used or unused cards. The fewer your parent has, the better.

· Mail letters at a mail box or the post office, rather than leaving outgoing mail in the mail box in front of the home. Thieves steal checks and payments slips, taking the information and using it to attempt to steal the entire identity. They take out new credit cards in the victim's name and rob them of everything they can.

· One should never, ever give out personal information or financial account information over the telephone. Telephone solicitors offer prizes and rewards to trick the person into telling the solicitor his bank account number, social security number, and mother's maiden name. With that, the thief can wipe out a bank account in minutes.

· Don't let anyone copy your aging parents' driver's license. Anyone doing this can get access to bank accounts, personal data, and anything else you would want to protect. Getting the license number to verify a check is one thing. Letting someone take the entire license and have the other information on it is rarely necessary.

Senior identity theft and fraud are crimes perpetrated by individuals who see seniors as easy prey. It is estimated that 1 in 7 seniors at some point is a victim of fraud. You’ve been warned!

As a footnote to this recent incident, the resident involved has just gotten her fourth “check” from the Nigerian Lottery, all she needs to do to cash the check is call a listed number. Our wise and cautious resident has given this information to the police.

Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro, CA.

Exercise for Seniors

2012-08-20T16:15:00.001-07:00

There is a fountain of youth: Millions have discovered it - the secret to feeling better and living longer. It's called staying active. Finding a program that works for you and sticking with it can pay big dividends. Regular exercise can prevent or delay diabetes and heart trouble. It can also reduce arthritis pain, anxiety and depression. It can help older people stay independent.

There are four main types of exercise and seniors need some of each:

Endurance activities - like walking, swimming, or riding a bike - which build "staying power" and improve the health of the heart and circulatory system
Strengthening exercises which build muscle tissue and reduce age-related muscle loss
Stretching exercises to keep the body limber and flexible
Balance exercises to reduce the chances of a fall

It is safe for most adults older than 65 years of age to exercise. Even patients who have chronic illnesses such as heart disease, high blood pressure, diabetes and arthritis can exercise safely. Many of these conditions are improved with exercise. If you are not sure if exercise is safe for you or if you are currently inactive, ask your doctor.

It is important to wear loose, comfortable clothing and well-fitting, sturdy shoes. Your shoes should have a good arch support, and an elevated and cushioned heel to absorb shock.

If you are not already active, begin slowly. Start with exercises that you are already comfortable doing. Starting slowly makes it less likely that you will injure yourself. Starting slowly also helps prevent soreness. The saying "no pain, no gain" is not true for older or elderly adults. You do not have to exercise at a high intensity to get most health benefits.For example, walking is an excellent activity to start with. As you become used to exercising, or if you are already active, you can slowly increase the intensity of your exercise program.

If your muscles or joints are sore the day after exercising, you may have done too much. Next time, exercise at a lower intensity. If the pain or discomfort persists, you should talk to your doctor. You should also talk to your doctor if you have any of the following symptoms while exercising:

Chest pain or pressure
Trouble breathing or excessive shortness of breath
Light-headedness or dizziness
Difficulty with balance
Nausea

Sources: NIH: National Institute on Aging, FamilyDoctor.org

Musings On Wine and Getting Old

2012-08-20T14:23:00.003-07:00

This past weekend I went to a 40^th anniversary party for Cakebread Cellars, one of my favorite wineries in the Napa Valley. It was a wonderful event with great wines (the 2001 Chardonnay Reserve was my favorite wine) and great food (the crab salad on top of a fried green tomato slice was my favorite food).

As is the nature of this type of event, my dinner companions and I made polite small talk and talked about the type of work that we do. The mix consisted of a CPA who did personal accounting, a CPA who worked for a large accounting firm, a professional banker, a school teacher, an Information Technology Officer for a startup healthcare provider, a contract management officer for the University of California San Francisco, and me, an Executive Director for Assisted Living, (insert punch line here). I was a little surprised when the work that I did for a living became the focal point for the evening’s dinner conversation. But perhaps I shouldn’t have been surprised since everyone at the table was of the sandwich or “tweener” generation. Sandwich or “tweener” families are providing support for their own children, but as we see more and more often, are also providing support for aging parents. The support is certainly emotional but for many “tweeners” it is also financial.

We talked at length about how many from our parent’s generation even as their resources are dwindling, are obsessed with making sure they leave something behind, a final bequest to either their children or their grandchildren. Whereas the tweener generation at the table indicated they felt no obligation to leave something behind for anyone. One person said they would spend every last dime and that seemed to be the sentiment for most. This sentiment signals a clear change in attitude from one generation to the next. Perhaps equally surprising is that it has happened in such a short time span, a single generation. A generation is usually thought to represent roughly a twenty year period. Sociologist and psychologist who study such things are scratching their heads in wonder at this rapid change. While the experts pontificate various explanations, I think the “me” generation had spoken, perhaps prodded along that evening by the various wines that were being sampled.

Trying to appear as innocent as possible, I pushed the conversation to what those at the table had done to prepare for their aging process. After the usual I’m not going to get old comments and twitters of laughter got out of the way, I sensed a very real underlying fear among my dinner companions. I didn’t see it as simply fear of aging but more likely a combination of many fears. The fears of changes we expect as we get older are there for everyone to see but there are other fears that we as “tweeners” feel. The term “tweeners” certainly indicates the position my generation has socially but it also references the push and pull we get from the generations before and after us. The fear of not having the resources to support our children and also to support our parents can’t be hidden behind puffed out chests and driving the brightest and newest car(s). Isn’t the question really if I meet those obligations how will I be in a position to provide for my own later years? What I see is a disconnect promoted perhaps unknowingly by “me” generation. We haven’t instilled the same sense of respect, responsibility, and even obligation from one generation to the next that our parents did with us. Somewhere in the back of our minds is the fear that we’ve done something wrong that is going to suddenly come to light.

Perhaps using the illustration of the inheritance obligation felt by our parent’s generation and the lack of that same sense of obligation for our generation sidesteps a lot of the issues that surround the future of senior care. But I do think it albeit for a brief fleeting thought represents one of the fears we as “tweeners” have about getting older.

There has been a sort of running joke in my family about making sure that one of my children became that pinnacle of the American success story, a doctor. The undercurrent of that joke was that child or children would be the financial reserve that I could tap as I got older. I’ve not been silent about expressing that thought out loud somewhat jokingly. Alas, none of my children as of yet are doctors nor look to be on track to being the next Bill Gates. Like many others of the next generation they are struggling with their own types of pressures made all the more complicated by a society that doesn’t at present offer the wide array of opportunities that faced me in my twenties and thirties. Midlife I’ve had to change gears and re-examine my retirement plan. I’m not sure that my children will feel the same sense of obligation but I’ve also come to increasingly having to face they most likely will not have the resources to help even if they wanted to help. I would be willing to bet that I’m not alone in having that discussion with myself. Like the majority of “tweeners” I approach getting older with many fears.

Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro, CA.