South Carolina Nursing Home Blog : South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

The Hartford Courant had an article about the use of a robotic seal to help dementia patients. Sea Sea, a white-furred robotic baby harp seal, was introduced to the residents and staff at McLean, a state-of-the-art care facility in Simsbury, Ct.. The seal is used primarily to calm patients with dementia in nursing homes and long-term care facilities. There are only 40 in the country today, according to Freddi Hoffmann, vice president of marketing at McLean.  Using animals to calm patients in a nursing-home setting is not a new idea. But only recently have advances in technology made it possible to replace living animals with their robotic counterparts.  Hopefully, these will become standard in most nursing homes.

The seal purrs and paddles its flippers when petted and opens its eyes and moves its head toward you when you talk. It has significant weight to it and when held against your chest you can feel it vibrate, simulating a heartbeat.

One of the most dramatic effects of Sea Sea's therapy was seen in Eileen, a non-verbal patient who often doesn't respond to verbal stimulation or acknowledge those around her. "She was lying in bed for about half an hour talking to her and stroking Sea Sea," Cookson said. "Eileen seemed calmed by the noise Sea Sea was making, she sat there laughing and talking with her the entire time."

It is through two microprocessors underneath her fur that Sea Sea is able to interpret and react to her environment. Cookson said that over time Sea Sea will learn to respond to her name and other phrases.

McLean was able to purchase Sea Sea through funds from the Sorenson Technology Center.  McLean is already looking to purchase more of the robotic seals.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

Amarillo Globe News had an interesting article about new technologies at Texas long term care facilities to help care for Alzheimer's patients and give them more freedom.  The article mentions The Garden at Childers Place and its "plush accommodations".  The 20-bed "neighborhood," preferred over the term "unit," was built in 2007 and recently became a state-certified facility for Alzheimer's patients.

Childers Place is now one of four Amarillo facilities that are state-approved for Alzheimer's patients. The other three are: Ussery-Roan Texas State Veterans Home, Ware Memorial Care Center and Windflower Nursing, a part of Craig Methodist Retirement Community. All four combined have capacity for 155 patients.

Alzheimer's disease is a progressive and fatal brain disorder affecting 5.3 million Americans, the majority of which are 65 or older. The disease also is the most common cause of dementia, a mental disorder characterized by loss of memory and other intellectual abilities, according to the Alzheimer's Association. More than 80 percent of dementia cases are attributed to Alzheimer's.

Childers Place is operated by the Bivins Foundation. Residents living in one of the neighborhoods can move into The Garden if their condition deteriorates or they need more assistance. The layouts of the three communities are the same, allowing for as smooth a transition as possible.

The facility can only be entered by key-card access, required by the state. The wing is divided into two sections, with 10 rooms down each hallway. Each room has its own bathroom and shower, and residents are encouraged to outfit it with their own furniture.  Each section has its own communal living room, immaculately set with furniture and a fireplace. A communal kitchen also is available and equipped with staff-operated safety features to avoid any harm to residents.

The use of technology is likely the facility's greatest asset. Motion sensors in the room alert the nurses' station and pagers can notify staff members if a resident leaves a room. A resident who needs to use the restroom at night need only get out of bed, and a weight sensor placed in the bed gradually turns on lights in the room and bathroom. The lights turn off whenever the patient returns to bed. Residents who need help getting to the restroom are a fall risk, and staff members are quickly alerted so they can come to help.

"The smart-room technology keeps staff from hovering over a patient, and it gives them more freedom," Hendley said. "It really cuts down on (patient) anxiety."

• Email This
• Print
• Comments
• Trackbacks
• Share Link

Recent study out of University of Iowa showing that even if an individual with dementia, specifically Alzheimer's, cannot remember what happened, the associated emotion (positive or negative) lingers.   People with memory loss can still "remember" feelings associated with happy and sad experiences.  The findings, published in the Proceedings of the National Academy of Sciences, have implications for Alzheimer's disease patients, their families and caregivers.

University of Iowa researchers showed clips of happy and sad movies to five patients with memory loss. The patients couldn't remember what they had watched, but they did retain the emotions triggered by the movie clips.

"A simple visit or phone call from family members might have a lingering positive influence on a patient's happiness even though the patient may quickly forget the visit or phone call. On the other hand, routine neglect from staff at nursing homes may leave the patient feeling sad, frustrated and lonely even though the patient can't remember why,"  lead author Justin Feinstein said in the news release.

"What this research suggests is that we need to start setting a scientifically informed standard of care for patients with memory disorders," Feinstein added. "Here is clear evidence showing that the reasons for treating Alzheimer's patients with respect and dignity go beyond simple human morals."

• Email This
• Print
• Comments
• Trackbacks
• Share Link

NY Times had an interesting article about wandering among residents with dementia.  Many people with dementia do not fit the textbook definition of wandering, "To move about without a definite destination or purpose."  It is a serious problem in long term care facilities.  The article discusses the public safety concerns and the sad case of Freda Machett.

"Ms. Machett, 60, suffers from a form of dementia that attacks the brain like Alzheimer’s disease and imposes on many of its victims a restless urge to head out the door. Their journeys, shrouded in a fog of confusion and fragmented memory, are often dangerous and not infrequently fatal. About 6 in 10 dementia victims will wander at least once, health care statistics show, and the numbers are growing worldwide, fueled primarily by Alzheimer’s disease, which has no cure and affects about half of all people over 85."

“It started with five words — ‘I want to go home’ — even though this is her home,” said Ms. Machett’s husband, John, a retired engineer who now cares for his wife full time near Richmond. She has gone off dozens of times in the four years since receiving her diagnosis, three times requiring a police search. “It’s a cruel disease,” he said.

Searching for them often also means learning a patient’s life story as well, including what sort of work they did, where they went to school and whether they fought in war. Because Alzheimer’s disease, the leading cause of dementia, works backward, destroying the most recent memories first, wanderers are often traveling in time as well as space.

Advanced age can compound health risks of exposure.   Nursing homes should have a locked unit, enough staff to supervise, and alarms on all residents with dementia,

• Email This
• Print
• Comments
• Trackbacks
• Share Link

The Star Tribune had an article about another disturbing incident of abuse at a nursing home.  An aide at a nursing home crammed a sock in the mouth of a screaming resident because the woman wouldn't be quiet.  The investigative report quotes a co-worker as saying, "What the hell are you doing?" as the incident  took place in the resident's room at  the Sunnyside Care Center.

The co-worker told an investigator that the nursing assistant "chuckled" and responded
that the resident "wouldn't quit hollering," the report added. The co-worker then removed
the sock from the resident's mouth. The nursing assistant was hired in October 2009 at the care center.  He denied putting the sock in the resident's mouth and said some of his colleagues were trying to force him out.   A claim by the resident that the assistant also slapped her that evening could not be substantiated. 

• Email This
• Print
• Comments
• Trackbacks
• Share Link

The Dallas Morning News had an article about a new study that proves that feeding tubes in nursing-home patients with advanced dementia are used in for profit facilities more often than government-owned hospitals.  The feeding tube is used whether it helps the patients live longer or not, the researchers from Brown and Harvard universities say.

Researchers analyzed more than a quarter-million admissions at thousands of acute-care hospitals from 2000 to 2007. Feeding tubes were used far less frequently at smaller, rural hospitals not affiliated with medical schools. Decisions are based more on hospital practices than on patients' or families' wishes, says lead study author Dr. Joan M. Teno, from Brown University's medical school.

The results were published Feb. 10 in the Journal of the American Medical Association.
 

Feeding tubes generally save nursing homes time and money.  It is another way that the industry places profits over the best interest of their residents.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

Mary Fridley at Gero-Resources wrote the following for The Capital. 

DEAR MARY: I just lost my dear husband of 65 years to Alzheimer's disease. Mary, you would hardly believe the many times I thought about you during his stay in the hospital and nursing home. I am so glad we had the experiences of the wealth of knowledge you shared through the many workshops and seminars we attended together.

During this difficult period there were many times I thought how much the staff would benefit from your depth and detail of knowledge of dementia care. I was horrified by how they handled him; like he was a piece of meat. One time two aides were moving him up in the bed and slammed his head into the headboard. No one talked to him like he had any sense at all. Even the doctor dismissed him as if he should just die.

He was capable of following directions if they took the time to tell him what to do. Instead, they just did things without warning, which frightened him. I think they could learn a lot by being in bed for a day and having someone tend to all their needs. They would discover how humiliating and degrading an experience it is.

My husband was a person and the love of my life, and I would do anything to have him with me today - even in his Alzheimer's state. He was a gentle, loving soul who would never hurt anyone. I am heartbroken over this experience.

DEAR READER: Please accept my sincere condolences on the loss of your husband. And I am sorry your final days together were so dreadful. No matter how often I hear this story (and I've heard it many times), it never fails to outrage me. The staff broke the most basic rule of care: to see the person, not just the disease.

It should be required that people take a sensitivity course before they work with the elderly. They should be put through the rigors of daily care, such as you suggested, experiencing first hand what it's like to be on the receiving end. I hope your letter sparks discussion among staff to do better.

I know you are grieving, but I encourage you to write a letter to the administrators of the offending facilities. They need to know about your experience. Peace be with you.

___________

I like that.  See the person, not just the disease.  Nursing home employees especially unqualified CNAs do not get enough training on how to take care of demented residents.  It is a shame and a disgrace.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

Reuters had an article discussing the overuse of feeding tubes with demented residents. Whether or not a person with advanced dementia winds up with a feeding tube  have more to do with economic concerns than his or her wishes, suggests a new study out in JAMA (Journal of the American Medical Association).  Dr. Joan M. Teno of Brown University in Providence, Rhode Island, and her colleagues found that hundreds of patients who had specified, in writing, that they did not want a feeding tube received one anyhow.

Feeding tubes don't extend survival for people with advanced dementia who can no longer swallow, and provide no other apparent benefits to these patients, according to two reviews of the medical literature, Teno and her team note in their report.

Tube feeding can also cause harm, the researcher added in an interview; demented patients who are bothered by the tube and try to remove it may be physically restrained or placed on heavily sedating drugs.

Up to a third of nursing home patients with advanced dementia have a feeding tube, Teno and her colleagues note in their article. In two-thirds of these cases, the tube was inserted while a patient was in the hospital.

To investigate what factors might influence whether or not a hospital would use feeding tubes in people with advanced dementia, Teno's team looked at 2000-2007 records for nearly 2,800 hospitals, all of which had admitted at least 30 patients who were 66 or older, had advanced dementia, and were living in nursing homes. Their analysis included Medicare claims for 163,000 patients and nearly 281,000 hospital admissions.

Twelve percent of the hospitals didn't insert a feeding tube in a single patient with advanced dementia throughout the eight-year study period, the researchers found. But at one quarter of the hospitals, patients had a 1 in 10 chance of feeding tube insertion; hospitals with the highest rate of feeding tube use inserted them nearly 40 percent of the time.

For-profit hospitals were more likely to use feeding tubes, as were larger hospitals and those with the highest level of intensive care unit use for patients in their last six months of life.

Recognition is growing that dementia is a terminal illness that affects the body as well as the mind, Teno told Reuters Health. And when a patient with dementia begins having trouble eating, she said, this indicates the final stage of the illness has arrived. For these patients, she added, careful hand feeding can offer a safer and more comfortable alternative to feeding tube insertion, "but it takes staff time and effort."

According to Buchman, the amount of caregiver time and effort to work with patients and try to feed them by mouth and to do it safely is "substantial."

Emory University Hospital's 2006-2007 rate of feeding tube insertions for patients with advanced dementia was 24 per 100; Buchman said he did not want to comment on those figures, given that he has only been working at the hospital since July 2009.

The hospital had one of the highest rates of feeding tube use in patients with advanced dementia, according to Teno's study, with 37.5 insertions for every 100 admissions of such patients in 2006-2007.

Although her study didn't investigate why hospitals opted for feeding tube insertion, Teno said it's likely that cost concerns are a factor. Most of these older patients are on Medicare and Medicaid, and the way that reimbursement works means nursing homes tend to ship them to hospitals when they get sick. Then, hospitals will try to discharge these patients back to the nursing home as quickly as possible. Inserting a feeding tube allows the hospital to discharge a patient faster, Teno added, while for nursing homes, tube feeding is less time consuming than hand feeding.

It's questionable, Teno noted, whether hospitalizing these patients in the first place is helpful. "It can be very disruptive and very stressful to take someone who is in the throes of dementia and put them in an acute care hospital," Teno said. "I'm really concerned that the financial incentives now are aligning with hospitalizing these people rather than trying to keep them in a less restrictive environment and treat them in a nursing home."

For a person with advanced dementia, the onset of eating difficulties should be "a stop sign to say listen, we need to talk about what are the patient's wishes and values for future medical care," she added. "Helping people make the best decision for their loved one is very important."

Teno and her team have compiled a list of hospitals and their rate of feeding tube insertion in patients with advanced dementia, which is available online here

SOURCE: Journal of the American Medical Associations, February 10, 2010.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

Long term Living Magazine had an interesting article on the increase of dementia based on the 2009 World Alzheimer Report.  Perhaps the increase is caused by better diagnostics and understanding of the condition.  According to the World Alzheimer Report, released by Alzheimer's Disease International (ADI), an estimated 35.6 million people worldwide will be living with dementia in 2010. This is a 10% increase over previous global dementia prevalence reported in 2005. According to the new report, dementia prevalence will nearly double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050.

"The information in the 2009 World Alzheimer Report makes it clear that the crisis of dementia cannot be ignored," says Debbie Benczkowski, Interim CEO of the Alzheimer Society of Canada. "Unchecked, dementia will impose enormous burdens on individuals, families, healthcare infrastructures, and global economy."

The report also focuses on the impact of dementia. For example, statistics cited in the new report suggest that 40% to 75% of caregivers have significant psychological illness as a result of their caregiving, and 15% to 32% have depression.  This article is interesting because it states that 40-75% of caregivers for people with Alzheimer's have significant psychological illness as a result of their caregiving. This statistic is a good explanation when nursing homes try to claim that the resdient's family should have cared for the person at home despite their lack of education and expertise. It is also indicative of the need for additional staffing for dementia residents so burn-out, turnover, abuse, and neglect do not occur.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

The New England Journal of Medicine recentl published a study on how to handle dementia in the elderly.  The conclusion was that dementia may lead to complications that may lead to death.  The problem with the study is that they did not determine the cause of the complications or the ability to prevent these foreseeable complicatons.  Could it be caused by abuse, self-neglect, negligent care?

The study's conclusion is that pneumonia, febrile episodes, and eating problems are frequent complications in patients with advanced dementia, and these complications are associated with high 6-month mortality rates. Distressing symptoms and burdensome interventions are
also common among such patients. Patients with health care proxies who have an
understanding of the prognosis and clinical course are likely to receive less aggressive
care near the end of life.

The last line is scary.  It implies that if a residents' "proxy" (which in many situations is the government) was aware of the study, they would decide not to provide care to someone with dementia.  Also, the study did not consider falls a significant complication in dementia residents.

Time Magazine had an article stating the study was "redefining" dementia as a terminal illness.  "Dementia is not a single illness but a collection or consequence of many, including Parkinson's disease, vascular dementia and Alzheimer's disease (which accounts for some 70% of all dementia cases). In the advanced stages of dementia, it is often impossible to tell which disease the patient had at the outset, as the end result is the same, according to Mitchell's study: a syndrome of symptoms and complications — eating problems (86%), pneumonia (41%), difficulty breathing (46%), pain (39%) and fever (53%) — caused by brain failure. "Dementia ends up involving much more than just the brain," says Dr. Claudia Kawas, professor of neurology at the University of California, Irvine. "We forget the brain does everything for us — controls the heart, the lungs, the gastrointestinal tract, the metabolism."

• Email This
• Print
• Comments
• Trackbacks
• Share Link