Thursday, December 28, 2006

Announcing CareGiver: The Book

I started a new Weblog that is devoted to my Caregiving activites. Caregiver the Book contains a table of contents and is written in the form of a book.

The blog contains a description of the trials, tribulations and wonder of dealing with an Alzheimer's patient, my 90 year old mother. The blog contains our story.


Wednesday, December 20, 2006

Alzheimer's Disease: What is it?

Alzheimer's disease is the most common cause of a condition called dementia. It is named for the German doctor who first described it, Alois Alzheimer. What is it? Who gets it? What causes it?
You can read this information at the  The Caregiver .
Information supplied by the Milton S Hershey Medical center and the CareGiver Weblog.

Tuesday, November 28, 2006

The CareGiver: Dementia

I ran across this factsheet on Dementia from the Milton S Hershey Medical Center. The section entitled, What are the Symptoms, is particularly interesting.

Source Milton S Hershey Medical Center


What is it?

Dementia is the gradual deterioration of mental functioning, such as concentration, memory, and judgment, which affects a person’s ability to perform normal daily activities.

Who gets it?

Dementia occurs primarily in people who are over the age of 65, or in those with an injury or disease that affects brain function. While dementia is most commonly seen in the elderly, it is not a normal consequence of the aging process.

What causes it?

Dementia is caused by the death of brain cells. Brain cells can be destroyed by brain diseases, such as Alzheimer’s disease, or strokes (called vascular or multi-infarct dementia), which decrease blood flow to the brain. Lewy body dementia is another common cause attributed to changes in brain tissue. Other causes can include AIDS, high fever, dehydration, hydrocephalus, systemic lupus erythematosus, Lyme disease, long-term drug or alcohol abuse, vitamin deficiencies/poor nutrition, hypothyroidism or hypercalcemia, multiple sclerosis, brain tumor, or diseases such as Pick’s, Parkinson's, Creutzfeldt-Jakob, or Huntington's. Dementia can also result from a head injury that causes hemorrhaging in the brain or a reaction to a medication.

What are the symptoms?

In most cases, the symptoms of dementia occur gradually, over a period of years. Symptoms of dementia caused by injury or stroke occur more abruptly. Difficulties often begin with memory, progressing from simple forgetfulness to the inability to remember directions, recent events, and familiar faces and names. Other symptoms include difficulty with spoken communication, personality changes, problems with abstract thinking, poor personal hygiene, trouble sleeping, and poor judgment and decision making. Dementia is extremely frustrating for the patient, especially in the early stages when he or she is aware of the deficiencies it causes. People with dementia are likely to lash out at those around them, either out of frustration or because their difficulty with understanding makes them misinterpret the actions of others. They become extremely confused and anxious when in unfamiliar surroundings or with any change in routine. They may begin a task, such as cooking, then wander away aimlessly and completely forget what they had been doing. Dementia is often accompanied by depression and delirium, which is characterized by an inability to pay attention, fluctuating consciousness, hallucinations, paranoia, and delusions. People in advanced stages of dementia lose all control of bodily functions and are completely dependent upon others.

How is it diagnosed?

Dementia is diagnosed through a study of the patient’s medical history and a complete physical and neurological exam. The doctor will speak with those close to the patient to document a pattern of behavior. He or she will also evaluate the patient’s mental functioning with tests of mental status, such as those that require the patient to recall words, lists of objects, names of objects, and recent events. Diagnostic tests, such as blood tests, x-rays, or magnetic resonance imaging (MRI), positron emission tomography (PET), or computed tomography (CT) scans, can help determine the cause of the dementia.

What is the treatment?

In some instances, treating the cause of dementia may successfully reverse some or all of the symptoms. This is the case when the cause is related to a vitamin/nutritional deficiency, tumor, alcohol or drug abuse, reaction to a medication, or hormonal disorder. When dementia is related to an irreversible destruction of brain tissue, such as with Alzheimer’s disease, Lewy body dementia, or multiple strokes, treatment involves improving the patient’s quality of life as much as possible. This includes maintaining a stable, safe, supportive environment and providing constant supervision. While this may be done in the home, people in the advanced stages of dementia may require round-the-clock care in a long-term healthcare facility. It is important to provide the patient with structured activities and avoid disruptions to his or her daily routine. Many patients enjoy therapeutic activities, such as crafts or games, designed specifically for people with dementia. Some medications, such as donepezil and tacrine, have been effective in improving the mental functions of those in the beginning stages of dementia. Patients with hallucinations and delusions may also be treated with antipsychotic drugs, while antidepressant medications are used to treat depression.

Self-care tips

There is currently no known way to prevent dementia associated with Alzheimer's disease. You can decrease your risk of dementia associated with stroke by maintaining a healthy lifestyle, following a heart-healthy diet, and controlling high blood pressure and high cholesterol. Healthy lifestyles, including not smoking and not abusing drugs and alcohol, go a long way in keeping most people in good health. Caring for a person with dementia is stressful. It is important to learn all you can about the disease, seek the help of support groups, and find a responsible caregiver who can give you a break when needed. There are daycare programs specifically designed for patients with dementia that are good for the patient and the family.


This information has been designed as a comprehensive and quick reference guide written by our health care reviewers. The health information written by our authors is intended to be a supplement to the care provided by your physician. It is not intended nor implied to be a substitute for professional medical advice.

The CareGiver Blog

Robert T DeMarco

AllAmerican Senior Care

AllAmerican Senior Care Weblog

Sunday, November 26, 2006

The CareGiver: Americans Fear Alzheimer’s More Than Heart Disease, Diabetes or Stroke

A recent study by the MetLife Foundation found that Americans fear getting Alzheimer's disease more than heart disease, stroke, or diabetes. Alzheimer's ranks second in the minds of American's only to cancer.

MetLife Survey Highlights

The Complete MetLife Survey on Alzheimer's: What America Thinks (36 pages)

The Major Findings of the Study included the following:

Finding 1: Americans fear Alzheimer’s disease.

Finding 2: Americans Know Little or Nothing about Alzheimer’s.

Finding 3: One-third of Americans say they have direct experience with Alzheimer’s disease.

Finding 4: Most Americans are concerned that they will be responsible at some point for someone with Alzheimer’s disease.

Finding 5: Most Americans recognize the need to create a plan to address the possibility of Alzheimer’s disease, but very few have taken steps to do so.


Americans fear Alzheimer’s and the impact that it could have on their lives in the coming years. And although they may recognize the need to look toward the future, the majority hasn’t started making plans.

The downside of living longer has a high price: Nearly 50 percent of those who are 85 or older are affected, and the rate of Alzheimer’s increases exponentially every five years past the age of 65. And with the aging of America’s population these numbers are sure to become even more dramatic in the future, making it imperative that individuals and institutions plan for the future.

The growing number of people with Alzheimer’s will have an impact on every part of society. The vast majority of people know that this disease may someday affect them, either directly or as a caregiver. In addition, many already know a family member or friend who has Alzheimer’s. They strongly support the concept of planning now to cope with the life-changing impact of the
disease – at least in theory.

Despite widespread agreement, few have taken steps to prepare for the possibility of developing Alzheimer’s. Only a few have a solid understanding of the disease. The overwhelming majorityhas done nothing to plan.

The survey reveals a mismatch between fear of Alzheimer’s and acting on that fear to prepare for the future. The findings from this survey suggest that there is an opportunity to build awareness and help bridge the gaps that were identified in knowledge and behavior. Americans should learn all they can about the disease that will touch so many of us and plan for the future.

The CareGiver Blog
Robert T DeMarco
AllAmerican Senior Care
AllAmerican Senior Care Weblog

Thursday, November 16, 2006

All American Senior Care: Immigrants, increasingly, provide elder care in U.S.

Not only are immigrants a major source of employees right now this trend is expected to grow very fast in the future.

Immigrants, increasingly, provide elder care in U.S.

Scripps News

Thursday, November 16, 2006

Wanda Moeller's blue eyes dance when she talks about Franklin D. Roosevelt, the Grand Ole Opry _ and Haydee Carrillo, the Salvadoran immigrant who has helped care for her for six years.

Three mornings a week, Carrillo lifts the partially paralyzed Moeller from bed and gives her a bath, breakfast and oxygen treatment. Then she applies lipstick for her 76-year-old client, and the two run errands or have fun talking or looking at photos of grandchildren.

"She's like a daughter to me," the Oklahoma-born Moeller said, as Carrillo, 60, smiled and wiped a drop of cafe latte from Moeller's chin.

In the same Sacramento, Calif., apartment building, another elderly client also praises Carrillo. "Her mother was killed in El Salvador's war," said Merle Heath, 78, as Carrillo hooked up his oxygen to treat severe bronchitis. "Her English isn't too good. But she's a loyal, good Christian."

As Heath has learned, Carrillo's life began a world apart from the universe she now shares with the American septuagenarians she cares for, at $10 an hour. That they have all crossed paths in the United States, however, is no longer a rare phenomenon.

Immigrants are rapidly taking on prominent roles as American families' caregivers, whether those immigrants are naturalized citizens, permanent residents, undocumented or _ like Carrillo _ in between. They nurture babies, keep house and, increasingly, care for America's surging population of senior citizens.

Immigrants make up nearly 18 percent of the nation's baby sitters and in-home aides for seniors or people with disabilities, according to the Migration Policy Institute, a nonpartisan research center.

At the same time, many involved in senior care are discovering that the U.S. immigration system offers few avenues for recruiting and legally employing caregivers to help meet exploding demand. A job like Carrillo's, that of home health aide, is expected to be the fastest-growing job in America for the next decade.

"Even if you substantially raise salaries, and I'm not sure you can, it's not clear there is enough of a latent native work force," said Michael Fix, the Migration Policy Institute's vice president. "You shouldn't idealize immigration as a solution," he said, but added that it could be helpful "to take this flow and make it a regulated flow."

Undocumented workers, senior advocates say, are filling many of these jobs, in private homes and even in facilities _ such as nursing homes _ where employers are required only to see, not authenticate, a green card.

Families, too, are dismayed to find out that if they try to do "the right thing," as one daughter of a 95-year-old said, and legalize a trusted caregiver, the process is next to impossible. Only 5,000 low-skilled immigrant work visas can be issued annually and waiting times are now up to more than five years.

Escalating demand for senior care is shared by Italy, Austria and other aging nations that already rely on caregivers from poorer countries, according to a 2005 report by AARP, an advocacy organization for older Americans.

That report urges an expansion of U.S. programs to train more American elder-care workers of all levels, but acknowledges that the supply of homegrown applicants for such programs is finite.

AARP's report notes: "Meeting the long-term care needs of the growing older populations in more developed nations requires more engagement across international boundaries."

Heath, who is virtually bedridden, said his own experience shows how much workers like Carrillo are already vital. "We should be helping people like her," he said. "Not a lot of able-bodied American men out on the street want to do this."

Carrillo cites her religious faith and difficult life _ her mother's murder, prolonged separation from her children _ as factors that have strengthened her empathy for "ancianos," as seniors are called in Spanish.

Caregivers like her must be strong and skilled enough to lift immobile adults and help them into wheelchairs, and patient enough to provide companionship and intimate needs, like washing, clipping nails and, for the most frail, changing diapers.

"You can't mechanize taking care of the elderly," said Ken Preede, director of government relations for the American Health Care Association, which has joined other industries in lobbying for an earned legalization of undocumented workers.

Health and Moeller live alone, in assisted-living apartments, while their children live too far away to shoulder the type of care Carrillo provides through California's In-Home Supportive Services program for seniors.

"I trust Haydee with my life," said Heath, who values his independence but is too weak to handle even simple personal tasks.

Carrillo entered the United States in 1983 _ illegally, like many who fled El Salvador's civil war. She worked cleaning houses and taking care of seniors in facilities and homes.

Her 1987 petition for political asylum eventually earned her a work permit, but her asylum was never fully approved. The U.S. government supported the Salvadoran government during the civil war, and many who fled that war were turned down for refugee status.

These days, Carrillo hangs her hopes on being granted legal permanent residency through the 1997 Nicaraguan and Central American Adjustment Act, which was designed to allow law-abiding refugees to finally integrate into the country after years of living in limbo.

"God willing, it will happen," she said in Spanish.

(The Sacramento Bee's Susan Ferriss can be reached at sferriss(at)

All American Senior Care

The CareGiver

Wednesday, November 15, 2006

All American Senior Care: The Silver Tsunami

The Baby Boomers are coming...What looms for this generation?

By Andra Coberly

With a thriving post-World War II economy and soldiers returned from service, the men and women of America did their civic duty.

And they did it again and again and again.

The Baby Boom began 60 years ago when economic prosperity—as it often does—translated into a flood of offspring. By the end of the 1940s, close to 32 million babies had been born, and families of 10 were not uncommon. The “fruit of demobilization,” a term coined by the Washington Post, didn’t end until 1964. Boomer Nation was about 75 million strong—a diverse generation defined by the Vietnam War, sexual revolution and even disco.

What concerns some is that the boom of babies between 1946 and 1964 will become a tsunami of seniors in 15 to 20 years. While Boomers will be the first to tell you how active, healthy and stable they are, the aging of this generation is now considered a looming crisis.

Ten million Americans will be 85 years or older by 2030, and Larimer County’s 75 and older population is expected to surge 48 percent between 2005 and 2020. With a large number of older seniors, some expect serious strains on the programs they often rely upon.

Actually, “strain” is an understatement when describing how these masses will impact the system in 20 years—a system that includes everything from social security to dental care to congregate meals to Medicare.

“Detriment” might be more appropriate.

When one turns 75, the likelihood of being placed in a nursing home or long-term care facility increases greatly. Aging, often, leads to more medical oversight, more medication and more services from federal, state or local entities.

According to Margaret Long of the Larimer County Office on Aging, funding is currently not meeting the needs of the community’s elderly. And when Larimer County’s 75 and older population hits 19,000 in 2020—as it’s expected to do—funding will increasingly fail to help those in need.

“We must keep providing service and we must also plan for the demographics and change in numbers,” Long says. “This is the time we have to start setting the wheels in motion.”

If agencies like Department of Human Services do not plan for this senior tsunami, as Long calls it, they will not be prepared to handle the need. While it is clear that the impacts of the aging Boomer population may not be known for at least 15 to 30 years, Long and others are beginning to prepare so this tsunami doesn’t turn into a disaster.

“It’s going to be a challenge to us all,” says Jill Taylor, manager of Poudre Valley Health System’s Aspen Club, which provides educational and screenings to local seniors. “But it’s a good challenge.”

Issues beyond funding are also expected to arise. Physicians and mental health practitioners who specialize in geriatric care will be in high demand. Senior-care businesses will likely be overrun with clients. And health-care facilities will be forced to change their offerings for a generation that is not afraid to demand its morning latt├ęs and private rooms.

Largely, Baby Boomers will push the definition of what it means to be old. In fact, their maturity has been, and will continue to be, the focus of a certain amount of speculation.

“I don’t know what it will look like but I know the Boomers are not looking like status quo,” says Yvonne Myers, health systems coordinator for Columbine Health Systems.

Gary Sheldon couldn’t agree more that there is no way to pigeonhole the Baby Boomer generation.

“We’re a diverse group,” he says.

But as the 52-year-old talks about himself and his future, he realizes that he is a specimen of his generation.

“I’m the quintessential Baby Boomer, aren’t I?” he says, interrupting himself.

Sheldon is active, an enthusiastic cyclist, and he plans to stay spry and healthy into his older years. He hopes to see his grandchildren grow up, and the orthodontist feels comfortable about his plans for retirement and his aging—though he resists the term “senior.”

“It implies sedentary,” he says.

Sheldon seems to have his future set, like many his age who plan to spend their senior years traveling, doing yoga and taking bike tours of Italy.

But a large percentage of Sheldon’s generation will not be so lucky.

While several studies show the health and quality of life of older adults is steadily increasing, some worry that the growing senior population will translate into sizable numbers living in poverty, without health insurance and alone—requiring health care, nutrition, transportation and others services from government entities.

In a study by The Population Reference Bureau, two sociologists say Baby Boomers will stay employed and active longer. But, they counter, the group is also characterized by huge economic inequalities and a large population without health insurance—many Baby Boomers will be less healthy and less wealthy than seniors before them. Younger Boomers, now in midlife, have the highest poverty levels since before to World War I. Plus, there will be fewer workers contributing to endowments like Medicare and Social Security than there are now.

For Larimer County, that means that Department of Human Services and some non-profits will increasingly struggle to provide. The Office on Aging, a division of Department of Human Services, offers multiple services for the county’s elderly. Long, the program’s director, recently presented its four-year plan, the office’s predicted spending between 2007 and 2011. Simply, the budget holes over the next four years are gaping. The estimated funding shortfall for just the office’s external services could pass $200,000 by 2011.

Long considers her work on the four-year plan the start of preparation for the gigantic wave of feisty, silver-haired seniors.

“The really critical thing when looking at the Baby Boomers is to use the next eight years for planning,” she says.

The potential for a flood of seniors drives several issues for Long and others.

One is the need for more doctors and mental health specialists. Doctors will need to be aware of how medications and treatments affect aging bodies. Mental disorders such as depression and bipolar are increasingly problematic, and according to Long, “There are some real shortages in terms of practitioners who really specialize in the mental health issues of the geriatric population.”

No matter the specialty, Myers says, “if you are in the health-care business, you’ll want to like taking care of old people.”

The Baby Boomers, living longer and healthier, will post new challenges for those doctors. Finding and funding dental care—a new problem since seniors in the past largely didn’t have their teeth and required dentures—is a concern. As is learning to better treat those in their 100s, as that demographic is likely to grow.

Those who run nursing-care and assisted-living facilities expect Baby Boomers to remodel their services. Nursing-home activity directors, Myers says, will have one hell of a time pleasing the musical tastes of this generation—from The Beatles to John Fogerty to Michael Jackson. Nutrition programs, like congregate meals and fixed menus, will also need to be rethought.

“There was a woman in her 50s in here the other day and she said she would starve to death if she lived here,” Myers says. “She said she was a vegetarian, she’ll need her soy milk and tofu. I thought, ‘I’m not moving any place unless there’s an espresso machine.’”

Not all of this anticipation is treated like preparation for Armageddon.

Myers hopes the attention will bring a new appreciation for the elderly.

“It’s awesome when you’re a senior in high school,” says Myers, a Baby Boomer herself. “But not so much when you’re a senior in life. My hope is that we come to value their wisdom and value the roles that older people play.

“It’s an exciting time to be a senior,” she continues. “It’s a blank slate.

“I hope the Baby Boomers do it right.”