Caring For Dementia and Alzheimers Disease Patients

It was the month of June 2006 when My daughters, Janet and June and I began noticing signs that Agnes, my wife of 59 years was not behaving like herself (or former self). She was beginning to forget, people, places, events, etc. and was appearing confused. This caused me to have her evaluated by professionals who confirmed our suspicions of dementia (or early state Alzheimer's).

. The chances of these over age 50 contracting this diseases are rising all the time. This article directs itself to many personal aspects of the diseases and what is required of caregivers. Are you prepared to cope with the personal problems and the enormous expenses involved? I hope our experience which I share with you will help when the need arises.

We first detected the symptoms when daughter Janet (LPN) made her call from Parsippany, NJ to have her weekly chat with Mother. After the call, Janet called me, "Dad, I think something is wrong. Mom is talking about things that make no sense and asking about a house I do not own." A few days later, daughter June, (A nursing home employee), also reported that she too had called Mother. "Mother was forgetting a lot of things." She suggested that Mother be examined as soon a possible. A few days latter we met with Agnes’s physician who referred us to a psychiatrist .

The physiatrist spent time asking questions and performed numerous tests. which Agnes did not pass. This called for a second visit to his little office off small alleyway in New Bern. For the second time the physiatrist kept Agnes waiting for over a half hour while he conversed on the telephone with another doctor on another case. I found that dementia patients do not tolerate waiting . They do not like small enclosures. They want things to happen immediately. Agnes was tired of waiting and protested by walking out of the Doctor’s office never to return again.

Many simply refer to dementia as a loss of memory. I wanted to know however is what it is that cause one to lose one’s mind. There are many different categories of dementia. We do know Alzheimer's Disease patients make up 60% of those with dementia and is the most destructive . Alzheimer's Association spreads some light on this pointing out that there has been progress in research only during the past 15 years. There is an accelerating worldwide effort to find a cure.

In it’s most common form, dementia, is a general term for the loss of memory and other intellectual abilities serious enough to interfere with daily life. Vascular dementia, another common type , causes a reduced blood flow to the memory part of the brain. There are two parts of the brain, one for long term memory and a smaller part dedicated to short term memory. There are 100 billion nerve cells in the brain. Each nerve communicates with many others to form a network. Some are involved with thinking, learning and remembering. Other cells tell our muscles what to do.

To do their work, brain cells operate like tiny factories. They take in supply, generate energy construct equipment and get rid of waste. Cells also store and process information. Keeping everything running requires coordination as well as large amounts of fuel and oxygen.

Initially, the patient does not display any symptoms. It is reported that this disease may lay dormant for as long as 10 years before it begins to show itself. Alzheimer's Disease is the largest in the growth of dementia which affects the lives of over 26 million Americans according to Johns Hopkins University. It is projected that by the year 2050, one in every 65 persons will be infected and unable to care for themselves. Dementia progresses in three stages of Alzheimer’s Disease. ( Early, Middle and Severe).

Prime suspects are Plaques and Tangles. Plaques build up between the nerve cells. They contain fragments of a protein fragment called beta-amyloidal. Tangles are twisted fibers of another protein called tau. They form within dying cells. Though most people develop plaques and tangles as they age, people with Alzheimer’s patients develop far more. The plaques and tangles tend to form a predictable pattern beginning in areas important in learning and memory and then springing to other regions.

Dr, Alois Alzheimer simply stated, Alzheimer's Disease is an advanced version of dementia. which destroy blood cells in the memory portion of the brain. There is no cure at present. Recent articles report some advances where normal behavior has been restored or extended. Alzheimer’s patients normally live five to ten years with some living as long as 20 years. The quality of life however is very poor with a loss of memory and inability to perform normal activities. I recently received an e-mail from a retired military officer who reported being a caretaker for his mother for 31 years. Another e-mail was received telling about care for his sister who was treated for over 34 years.

Alzheimer's disease is a progressive, degenerative disorder that attacks the brain's nerve cells, or neurons, resulting in loss of memory, thinking and language skills, and behavioral changes. These neurons, which produce the brain chemical, or neurotransmitter, acetylcholine, break connections with other nerve cells and ultimately die. For example, short-term memory fails when Alzheimer's disease first destroys nerve cells in the hippocampus, and language skills and judgment decline when neurons die in the cerebral cortex. Two types of abnormal lesions clog the brains of individuals with Alzheimer's disease: Beta-amyloidal plaques—sticky clumps of protein fragments and cellular material that form outside and around neurons; and neurofibrillary tangles—insoluble twisted fibers composed largely of the protein tau that build up inside nerve cells. Although these structures are hallmarks of the disease, scientists are unclear whether they cause it or a byproduct of it. Alzheimer's disease is the most common cause of dementia, or loss of intellectual function, among people aged 65 and older.

According to the Alzheimer’s Disease Research, Alzheimer’s Disease is the seventh leading cause of death among the elderly in the U.S., claiming almost 66,000 lives annually. The disease affects an estimated 4.5 million individuals. Most cases occur after age 65; however some individuals in their 30;s, 40's and 50's are affected. Recent studies indicate that 5% of those age 65 to 74 suffer from Alzheimer’s Disease. The incidence increases greatly in those 85 and over. It is estimated that 1 out of every 8 "Baby Boomers" will come down with this disease which is rated as the 7th largest cause of death in the U.S.

A drug called Namenda which is the first approved drug for the treatment of Alzheimer's Disease is reported to slow down the infection. It does this by slowing up the movement of destructive cells to the brain which cut off the blood supply. This causes the brain memory cells to die. Agnes has been on this drug now for several months with no side effects. She appears to be more alert and does not have personality changes as frequently.

Another drug called Aricept was approved for treatment of severe Alzheimer's Disease. in 2006. It is the approved for all stages of this disease. Agnes’ physician has prescribed a combination of both Aricept and Namenda which appears to be holding her condition stable. More information on these drugs may be found on GOOGLE.

These two drugs have different approaches to slowing down Alzheimer's Disease. Agnes is taking both of them and I believe the drugs are doing what they are supposed to do. My wife's condition has improved whereas when dementia began she threw her meals on the floor, criticized the Staff and kicked and punched them when they were changing her clothes. Two years later and now she assisted the Staff and constantly tells both patients and staff how beautiful they are. She has become one of the favorites in the Assisted Living Community.

US National Institute of Health, National Institute on Aging has produced a chart which describes Namenda, Razadyne, Exaladyne, and Airicept. The manufacturers recommended dosage are included along with common side effects and possible drug instructions. As an example Namenda treatment begins with 5MG per day. It is then increased to 5MG twice and day and then 5MG and 10 MG. You can reach this publication by checking "Medications Fact Sheet.

Papers Hail Alzheimer's Breakthrough July 20, 2008 The discovery of a new drug to treat Alzheimer's Disease makes the lead in the Daily Telegraph and the Daily News.

Daily Pill Said To Stop Alzheimer's
British scientists claim treatment destroys "tangles" in the brain .

Just in time to treat a huge increase in the aging population, British scientists say they have developed a drug that, taken daily in pill form, stops Alzheimer's Disease in its tracks.

The drug is known as Rember, and scientists say it appears to be twice as effective as current Alzheimer's treatments, reducing the effects of the memory-robbing disease by as much as 81 percent. Even patients who have lost memory function appear to recover.

"We appear to be bringing the worst affected parts of the brain functionally back to life," said Dr. Claude Wischik, of the University of Aberdeen, who headed the research team.

The research was presented this week at the International Conference on Alzheimer's disease in Chicago. The trial involved more than 300 people with mild and moderate Alzheimer's disease in Britain and Singapore.

The subjects were divided into four groups, with three taking different doses of the drug and a fourth group taking a placebo After nearly a year, those with both mild and moderate Alzheimer's who were taking Rember experienced 81 per cent less mental decline compared with those on the placebo.
   Those taking any dosage of the drug did not experience any significant decline in their mental function over 19 months, while those on the placebo got worse.
   The drug reportedly works by targeting what are called "tangles" in the brain. These tangles are what destroy nerve cells and, over time, destroy the patient's memory function.
   Currently, there is no known cure for Alzheimer's, which afflicts mostly elderly patients and eventually is fatal.
   Researchers say the drug could be commercially available within four years, pending the outcome of further trials and the approval of regulatory agencies.

Today, as many as 5.2 million Americans are living with Alzheimer's disease, which includes between 200,000-500,000 people under age 65 with young-onset Alzheimer's disease or other dementias. A report by the Alzheimer's Association projects that as many as 10 million baby boomers in the U.S. will eventually develop Alzheimer's as this large demographic moves into old age.

Experts predict by 2010, there will be almost a half million new cases of Alzheimer's disease each year; and by 2050, there will be almost a million new cases each year. Eventually, the report says, the disease will strike one out of every eight boomers.

Alzheimer's disease is the seventh leading cause of death in the U.S. and the fifth leading cause of death for those over age 65.

Loss of short term memory. Although having lost the short term memory, portion of the brain, patients may recall names of people and events which occurred 50 years ago.

Unable to Walk. There are many patients who are very mobile and have the ability to use walkers, canes and wheel chairs to get them where they want to go, Others however are too weak to propel themselves around in a wheel chair and depend on a caregiver to get them to the dining room and other facilities. Physical therapists try very hard to encourage patients to stand and take a few steps with the aid of a walker. Agnes has refused this treatment apparently for fear of falling. This is a setback to her recovery.
Agnes' used to wander and get lost when she was at home. She contracted bronchitis and was coughing so hard she was rushed to the hospital by ambulance. The constant heavy cough resulted in a tear in the tube that carries food and water from the mouth down to the stomach. This required nourishment by IV. After spending a week in the hospital bed, Agnes was no longer able to stand or walk and was confined to a wheel chair. In addition to the loss of being able to walk, Agnes had become so weak that she could not move the wheel chair without assistance.

Unable to Drive I note that some patients are reported to be able to drive. Agnes got to a point where she was unable to park the car. She needed two parking spaces. She could not back up the car and was frequently lost traveling over streets she had used many times. She had forgotten the locations of many of the stores she had patronized. She used to take her turns so wide that she would be heading into oncoming traffic. She frequently passed STOP signs and STOP lights. It all came to an end when two women reported that she was driving on the wrong side of the road. The Police summoned her for a driving test. She was frightened about this. We discussed it and she agreed to turn in her driver’s license which she did willingly. My advice is to take possession of the car keys and not subject your loved one to the driving perils.

Unable to Feed Themselves Most patients are very tired and spend the day sleeping in their darkened rooms . . They must be wakened at meal time and wheeled into the dining room. Agnes can feed herself but must depend on a caregiver to wheel her into the dining room.. Some patients must have their meal brought to their room and are fed by an aide. Often, they do not eat and the uneaten food is transported back to the diet kitchen.

Unable to Dress Themselves. The early stage Alzheimer patients often lose the ability to dress and undress themselves and must have Caregiver help. Agnes after employment with Lord and Taylor became very fashion conscious . Despite her condition, she insists on being well fashioned coordinated. She can’t stand a spot of dirt on her clothes. or anywhere else for that matter. Most patients will have little or no concern about how they look.

Loss of Urine and Bowel Control. Some patients must wear diapers at all times. Failure to keep patients dry results in "urinary infection" This requires 10 days on anti-biotic s with its attendant side effects. Patients often become sluggish and tired. . Most manuals will suggest that caregivers stay alert to any discomfort the patient may have due to the necessity for toilet use. This may be possible in the home where the caregiver is close by. Agnes is able to control her bowel and urine for a short period of time. However, it is not feasible in a nursing home since the caregivers are most often occupied with as many as 20 pati patients, making up beds, dispensing medications, giving baths and showers and washing ward laundry. The wards are long and by the time the caregiver can reach the patient, it is too late.. Eventually Alzheimer's destroys bowel and urine control completely.

Lack of Physical Hygiene. After two years in three Assisted Living Facilities Agnes' teeth have decayed and must be removed. She used to be very meticulous about caring for her teeth and never had a cavity. Dental bills never exceeded a few hundred dollars. Dental Insurance was considerably more costly and was not obtained. Who would ever believe that a terminal disease would bring about a change. An oral surgeon was hired to do two operations at a cost of $3545. Just one more unanticipated expense.

Changes in Personality. . Patients may experience frequent personality changes which last for short periods of time. Quiet at one moment and fiery for the next five minutes. Some caregivers find this a very difficult time to endure as patients will criticize and call them names or throw food or other objects at them. Inexperienced caregivers may argue with patients, "That such language is not permitted here.". Little do they realize that the patient does not know what they are talking about and will have forgotten the incident within a few minutes." I find the aides who have tended to Agnes several times in the past are much more settling and she responds quickly to their requests without any fuss.

Hallucinations. Alzheimer's patients have vivid hallucinations from time to time and see things that are not actually there. They also frequently imagine things. . I often watched one young lady who wheeled herself into the dining room for her meals. She always carried a little doll dressed like a baby which she held close to her breast. She imagined that the doll was real and she proceeded to feed it with a bottle as if it were alive.

I have noted from personal observation of diseased patients that for the most part they all react very differently to dementia and Alzheimer's Disease. Some are very mobile and tend to wander. . They shuffle up and down the long corridors and in and out of other patients rooms where they empty the refrigerator and drawers of valuables. The severe cases are assigned to a special section of the facility which have all exit doors locked with combinations known only to staff members. Some never go to the dining room. With a patient occasionally yelling out , the Alzheimer unit is quiet.

Agnes had a brother-in-law who passed away at age 93 with Alzheimer's after 10 years of battle with the disease. Sister Alice, (a retired RN) refused to commit her husband to a nursing home for fear he would get lost. He visited with us in River Bend one year and just "wandered" out of the house one day. He quickly became lost on one of the nearby streets. This caused a minor panic. Agnes herself wandered out of our home one day and it was a half hour before we found her on a far away street. She was looking for a house with 302 on it which was our previous address.

I am also aware of another dementia patient of five years who was very mobile and active. He attempted to climb to the roof of his home one day. His wife was in panic and sold their large home to move into a small apartment Most assisted living facilities are equipped with combination locks.

Many early Alzheimer's patients frequently perform normal functions. Agnes continues to have very sharp vision and acute hearing. She still reads the cards she receives. She can conduct normal conversation and handle the big words. At times she remembers things that has to do with short term memory. Take the other day for instance when I asked her who her husband was. She immediately looked and me and responded, "Alexander Kish". It was then I saw a tear come to her eyes. She is usually on time for meals with one of the staff wheeling her into the dining room where she feeds herself. Sometimes however, Agnes falls asleep at the table and does not eat her meal. She loves watching the birds who visit her feeder. She also enjoys artificial flowers. When not asleep in her room, she sits in the lobby with her eyes fixed upon the front door waiting for a visitor. Long before the visitor reaches the front door, she is waving and yelling out a bright and cheery "Hello. I am over here."

Dementia Patients Are People One recent article by a noted psychologist stated her research indicated that dementia patients recognize love. Recent news articles have brought attention to those patients who have been dating women other than their wives. It appears most wives approve taking the position that if their husband is happy than they are glad. Dementia patients also love music and often participate in sing-a-longs. Unfortunately, not all nurses or aides enjoy music. They ban, radios and CD players throughout the nursing home except for the television sets in the patient’s room. Stepping into the lobby of some nursing homes where many mobile patients are held is like entering a funeral parlor. Dead silence with patients staring at each other all day. When my daughter and I visit, we normally take Mom back to her room where she often sings along with the Christmas music and holiday hymns.

Not only do the dementia patients recognize love and affection they also know when you are angry with them. The nurses and aides who are more attentive and caring are the ones patients admire.

Patients enjoy having visitors although most relatives and friends rarely find the time to visit patients. Some never come to the nursing home leaving their relative abandoned forever. Visitors are important to people with dementia and AD. They present a ray of hope. They may not always remember who the visitors are, but just the human connection has value. When visiting, bring along some kind of activity such as a book, photo album or something similar. Agnes likes snacks. Be prepared to abandon the gift if patient is not in right frame of mind to receive it. Patients do not like being forced to do anything. They must operate at their own speed.

Agnes has lost millions of very tiny brain cells causing memory loss. Although seriously handicapped by this loss she struggles valiantly with what is left to remember her friends most of whom have already forgotten her.

Be quiet and calm. Avoid using a loud tone of voice or talking to the person as if he or she were a child. Try to establish eye contact and call the person by name to get his or her attention. Remind the person who you are if he or she doesn’t seem to recognize you.

If the person is confused, don’t argue. Respond to the feelings you hear being communicated, and distract the person to a different topic if necessary..

If the person doesn’t recognize you, is unkind, or responds angrily , remember not to take it personally. He or she is reacting out of confusion

Since Jan and I visit the nursing facility every day, several of the patients have come to know us. They look forward to our coming and hold out their hands for us to hold. .They are very appreciative that someone cares about them.

When I visit with Agnes sitting in her wheel chair each evening , I give her a reassuring hug, several more hugs and I tell her, "I love you." She smiles, takes my hand in hers and responds, "I love you too. You are more important to me than life itself." No greater love has any man.

Response to Visitors As I pointed out, visits to Assisted Living Facilities are important to patients. Jan and I have developed an excellent report with many of them.. We normally meet Agnes in the lobby and wheel her to the outdoor porch. We usually have three or four patients follow us. . We bring along Agnes’ CD player and we all enjoy listening to Daniel O’Donnell. He is a world renown Irish tenor who sings soothing and familiar music..

One evening when walking thru the lobby to leave the building there were fifteen patients sitting around in the chairs as they normally do each day. Suddenly, they all started singing, "Happy Birthday". They all knew the words and they sounded very good. Believe me, it was quite a surprise and evidence of our reception. I thanked them all as I waved goodnight and they waved back with a smile on their faces.

Entertainment is Part of Treatment Entertainment helps to keep patients from constantly having to think about their plight which is quite dull. Agnes and other patients often say, "I am lonely here. When am I coming home?" A gospel singing group of four from Cherry Point entertains for an hour each week at one of the nursing homes. The piano player, herself disabled by blindness does an excellent job. It is indeed very heart warming to see and hear one who disabled donate her time to improve the quality of life for others.

Jan joined them one day singing a popular solo number called, "Climb Every Mountain". You recall that this was one of Kate Smith’s favorites which she sang at a Carnegie Hall performance.

Mother Agnes was bursting with pride. She could hold back no longer and kept telling others around her, "That's my Daughter.": Jan received a big round of applause from the patients.

Some Assisted Living Facilities Support Spiritual Well Being. Independent volunteers often contribute an hour each Sunday to provide Sunday School or Church Services. One of the Assisted Living Facilities has a small beautiful Chapel where patients could come to meditate. and hold a religious service. Every Sunday services attracted 20 or more patients. to hear the word of the Lord. Two other facilities had no provision for spiritual services. Preacher are forced to use Activity Rooms sparsely furnished with no evidence of spiritual activities. For many patients, the Church provides support and a ray of hope in a world where they have been doomed.

I recently attended a session with Agnes and 20 other patients. The service at 9:30 AM began with the singing of familiar hymns. The hymns come from a hymnal called "Sunshine Songs and Scriptures" produced by the Sunshine Society in extra large type. Two volunteers on their own provided the piano player, (also the songstress) and a gentleman named Steve who acted as the Preacher. Patients sang hymns for nearly half hour and they enjoyed it . This was followed by a five minute session in acknowledgment of those recently hospitalized.

The preacher was very down to earth and spoke in a language most patients could understand. For this session, the subject was the meaning of words, very important to those with memory loss. He frequently asked questions to which patients responded indicating that they knew what the preacher was talking about. His sermon lasted half an hour during which time not a single patient left the chapel.

One prominent Doctor previously published an article in which he stated that nursing homes were licensed and assured the public of proper care. After receiving much flak on the subject, he rescinded this statement.

We found the nursing home Agnes was originally assigned by the hospital to be inefficient and extremely costly. We began our own search for a less expensive and more caring nursing facility.

A residential care setting that combines housing, support services, and health care for people typically in the early or middle stages of Alzheimer’s disease.

Assisted Living facilities differ in size and furniture included. While one facility may have rooms which measure 14 feet by 14 feet, other may be larger or smaller. Two bureaus containing eight drawers are typically provided for storing clothing for each patient. A good sized closet is also provided . A bed provided with side bars and a wheel chair is provided by Medicare. in addition to medication. Restraints are installed on the wheel chairs of weaker patients to keep patients from falling out. TV is available at caregiver expense. There is also a large TV room available. A small refrigerator may also be installed at caregiver expense. No telephone service in rooms. in some facilities. There may be one located in the hall.

I recently read an article about a patient who rolled out of bed without side bars causing severe bone damage. She died a few weeks later. Remember, Medicare pays for a hospital bed with side bars.

A bathroom usually adjoins the bed room which is equipped with toilet, sink and mirror. A larger bath room across the hall is equipped with bath tub shower, toilet, sink and scale. Also has special bars to assist the handicapped.

Prior to entering an Assisted Living facility, Agnes had been confined to the local hospital where she was treated with anti-biotic for ten days due to bronchitis which caused a tear in her esophagus The hospital Discharge Nurse has the responsibility for locating an appropriate assisted living facility. After several days she reported that only one such facility had a room available for Agnes. Upon arrival by private ambulance we noted that Agnes’ room was not ready for occupancy. We also noted several empty rooms.

Checking GOOGLE, you will find information on at least a dozen assisted living facilities in the New Bern are. I have visited and toured seven of them. Entrance to the service of these facilities is not automatic. A representative from the facility will first interview the patient to determine his or her needs and whether the facility is in a position to provide them. . My daughter Jan (LPN) and I took a tour of a prospective assisted living facility. Some of the things we observed: The staff including the administrative personnel were friendly and eager to have us inspect their facility. We were particularly interested in the housekeeping where the halls were free of cleaning equipment, hundreds of feet of electrical wires and beds temporarily stored while rooms were being repainted. Very difficult to get a wheel chair through in the event of a fire. At one facility, the dining room floors were frequently cleaned at dinner time. Patients were diverted to the TV room which was not too pretty and used folding chairs and tables. I believe dining rooms should have pleasant and comfortable looking surroundings..

Dietician One of the most difficult jobs in the nursing home is the preparation of meals three times a day for 100 patients. Having spent hundreds of hours in four different assisted living facilities where I regularly had meals with the patients. I note these observations where the quality of food differs dramatically. Many patients are afflicted with diabetic, kidney, liver, blood problems and other diseases which require special foods As am example one nursing facility puts a label on each patient’s food tray. The dietician then serves the foods which that person is allowed to eat. For those with no diet afflictions, seasoning and condiments to flavor the food and make them more edible. Apparently to cut costs,in one facility every patient in one facility is served what those with diabetes are required to eat. No seasonings, no condiments, no fats. Soda biscuits and corn meal muffins are server without butter. Vegetables, the mainstay of all diets are boiled in water. Fish is served without tartar sauce. Lean meats are served without any sauces to flavor them. The result is that at least 25% of this bland food is untouched by patients and returned to the garbage.

. . Meals are scheduled for 8:00 AM, Noon and 5:00 PM and are normally on time.

Your Diet may prevent Alzheimer’s. Bring on Fatty Fish. Eating oily fish rich in DHA (a particular omega3 fat) cuts your odds of Alzheimer’s and other dementia nearly in half , says a researcher from Tufts University. Salmon is especially rich in DHA. Drink the Right Stuff. A Vanderbilt University study finds that drinking fruit or vegetable juice at least three times a week cuts the risk of Alzheimer’s 76% while compared with at least once a week. Coffee drinkers are 30% less apt to get Alzheimer’s than coffee abstainers says a Spanish study. Possible reason: caffeine.

The maintenance of accurate records is extremely important particularly where medications are administered. When Agnes was transferred to one nursing facility, she was in good spirits and joking with the two ambulance attendants while being wheeled into the nursing home. They immediately administered a tranquilizer which put her into a sound sleep for two days. During this time she was completely out cold and ate nothing and drank nothing. We protested to this treatment and in a few days she came back to a near normal condition. It is important that you check with your doctor to ensure your patient is receiving proper medication and not being sedated when not necessary.

The monthly cost of patient care at an Assisted Living Facility varies greatly and no matter how you slice it, the expense is tremendous. Nursing home facilities here in New Bern range from $1350 to $5,000 per month. You will find the costs in other cities and States may cost thousands of dollars more. Some may furnish very expensive furniture, family visiting rooms, exercise rooms etc. Add to this the cost of medications, supplies, Doctor visitations, etc.. Long Term Health Care Insurance will normally pay or help to pay the cost of services. However, once you pick up any of the symptoms of these diseases you will no longer be able to acquire or use long term health insurance.

The high cost of Assisted Living Facilities frequently wipes out the savings of the elderly within a year or two and once on the verge of bankruptcy many apply to Medicaid for assistance. I also find that the authorities responsible for administering Medicaid benefits are reluctant to discuss it and actually avoid direct interviews.

There is a wide variance in management styles between assisted living facilities. Whereas one facility will employ a large number of LPNs and a lesser number of nursing aids, another facility will employ a lesser number of LPNs and more nursing aids. Many of the Assisted Living Facilities operate with as many as 20 patients per staff member. This makes a difference on the workload which results in a very high personnel turnover resulting in a large shortage of trained personnel. The atmosphere in the up-scale Assisted Living Facilities are quite a bit different. Personnel are always well trained, very pleasant and attentive, the service and food served are equivalent to that found in upscale restaurants. Salaries paid and benefits provided contribute to a much lower turnover rate.

Some assisted living facilities boast of the fact that they have emergency call buttons available 24 hours a day. They are useless. With a large number of patients to care for, there is no way the aids can handle a prompt response to a call for help. . Complain and the aides will remind you that you are not the only patient they have to care for... Heavy workloads frequently result in numerous resignations. Again the better Assisted Living Facilities are equipped with two-way voice communications.

This is a subject about which very little has been written since there is no cohesive Federal Health Care Plan to meet the expenses of these diseases. Each State governs it’s Medicare and Medicaid facilities. Craven County is governed by the Division of Medical Assistance, North Carolina Department of Health and Human Services.

Medicare benefits and eligibility , vary according to a person’s financial circumstances. Following is a brief example of eligibility for Medicaid, Medicare -Aid and North Carolina Health Choice for Children.

Medicaid. There are several groups of individuals who qualify for Medicaid benefits. All have income limits and some have resource limits.

Medicaid for Aged (65 or older) , Blind and Disabled Persons. The income limit is equal to 100% of the poverty level.

Medicaid for Long Term Care. Medicaid pays for medically necessary nursing home care for patients in skilled or intermediate care nursing homes or in intermediate care facilities for the mentally retarded. The patient’s income must be less than the cost of care in the facility at the assets or sells them for less than market value, a patient may be eligible for payment of the cost of care. The sanction period is based upon the value of the assets transferred away.

Medicaid May be Obtainable for Certain Conditions. These include Pregnant Women, Infants Up to Age 1, through age 20, Caretakers, and Medically Needy. These categories may be subject to income and resource restrictions.

Automatic Eligibility for Medicaid. Individuals who qualify for certain cash assistance programs automatically qualify for Medicaid without a separate application. If cash assistance ends, the Medicaid may b continued if the individual meets the eligibility criteria for another type of program.

Medicare Aid. Individuals who have Medicare coverage may be eligible to have their Medicare premium paid by Medicaid if the income is between 100%E and 135% of the poverty level. There is also a limit on resources.

For More Medicaid Information. The foregoing brief is from the web site of the North Carolina Health and Human Services. located on Neuse Blvd in New Bern.

This is a subject that is very seldom discussed which has tremendous import on both patients and caregivers alike. For the past 100 years scientists have committed themselves to longevity of life as the primary goal in the research of Alzheimer’s Disease. Some are not sure but they believe their research has resulted in prolonging the lives an additional ten years.

Normally, Alzheimer's patients will live for fire to ten years. I have had Caregivers inform me of patients living with the disease for as long as thirty years.

This may account for the fact that millions of patients are moving into the SEVERE stage of Alzheimer's. Patients in this stage, are unable to feed themselves, take baths, change their clothes, unable to go to the toilet, have no knowledge of time or the place they are in, unable to speak, or understand what others are saying, unable to walk, remember relatives, friends and others they have known for many years unable to put themselves to bed. In short there is nothing they can do for themselves.

On January 10, 2009 my wife Agnes passed away. We had just moved to a new Assisted Living Home and found Agnes had dehydrated. She was immediately transprted to the Intensive Care area of the Craven Regional Medical Center.She was there one day before being moved to a private room where all life support systems were removed.

Physicians had determined that her body was now loaded with sodium rating an extremely high rating of 176. Her brain had given the order to expel all water from her system. She had passed the point of no return. Physicians felt that to try to reverse the dehydration would result in serious brain damage. They predicted that my wife of sixty years would pass away within a week. She was injected with a slow medication of morphine to kill the pain and make her comfortable. She continued to pass urine for the next three days before being fully drained it stopped. Her fingernails had turned blue.

I held her warm hand as I kissed her on her cheek. I then said, "I Love You". She heard what I said She slowly opened her eyes and looked directly at me. She responded in a very clear voice, "I Love You". No greater love hath any man.

Agnes breathing became more and more pronounced as she struggled for her last breath. Finally her heart stopped at 3:43 PM January 10, 2009 and her body began to cool.

A warm bright sun filled her hospital room with sunshine. The Lord had arrived to deliver her to Heaven. That evening, a full moon lit up the sky to guide her way.

It has been stated that Nursing is the largest industry in the New Bern area. From what I have observed I suspect that it is also the industry with the highest labor turnover. More and more medical facilities are under construction. Salaries and benefits paid in this area are about half of what they are in other major cities. Salaries are frequently the same as that paid to restaurant waitresses, gas station attendants etc. Often, no benefits are provided. . Long twelve hour shifts operating shorthanded shifts are just too much for most nurses and aides.

There is a large shortage of qualified personnel help although there are many leaving the profession to take other better paying and less demanding jobs. This situation will worsen as more people age and thousands of retirees continue to move into the Craven County area.

I find that many of the Assisted Living facilities are understaffed with 20 patients for each aide to care for. It is just "Mission Impossible".

This article is written in layman’s language It is informative to you and the result of my experience spending many hours in the nursing facility with my dear wife each day.