Alzheimer's Care at Home | LinkedIn

Alzheimer's Care at Home | LinkedIn: Alzheimer's Care at Home

Community Transportation Programs- Helping with Dignity and Caring

Community Transportation Programs- Helping with Dignity and Caring : Community Transportation Programs -
Helping with Dignity and Caring
By Sandra Ray, Staff Writer
(Page 1 of 2)



 There are a multitude of programs available to help the elderly and disabled reach appointments, go shopping, and perform other tasks associated with daily living. Not all of these are easily accessible or easy to find. The requirements often range from proof of age or disability, to income, as well as stating that no other transportation means are available. It is easy to become discouraged with the process and give up interacting with the community at large.

Independent Transportation Network (ITN):

The Independent Transportation Network (ITN) has
developed a viable model program that can be readily
duplicated across the United States, helping to solve
some of the transportation woes that communities are
facing today. Started in 1999 as a result of research
sponsored by the Federal Transit Administration, AARP,
and the Transportation Research Board, the Maine-based
non-profit offers the program to seniors and individuals
with vision impairments.

Nursing Home Costs Covered by Medicare and Medicaid - AgingCare.com

Nursing Home Costs Covered by Medicare and Medicaid - AgingCare.com:





Medicare coverage of nursing home costs



In order for Medicare to cover a person's nursing home stay, the person must:



Have been hospitalized for medically necessary inpatient hospital care for at least three, consecutive days, not counting the date of discharge,

Be admitted to the nursing home within 30 days after the date of discharge from the hospital,

Require skilled nursing or rehab care on a daily basis for a condition for which the patient was hospitalized, and

Receive a physician's order that such care is needed.

While the other person is talking

Do not formulate your answer while the other person is talking.

People who don't listen decide how they are going to respond before you even stop talking. Don't be afraid to pause for five or ten seconds to consider, validate,  the what the person is saying.

Doing so demonstrates that you listened carefully and that you are giving them the courtesy of a thoughtful reply. If you actually give a thoughtful reply, no one will remember that it took you nine seconds to start talking.

 Repeat what the person is saying before you answer.
Never make the mistake of taking five minutes of a {person's} time answering a something s/he did not say. First, validate  the point by saying, "If I understand you correctly, you want to know (Repeat, validate, what the person is saying) Is that right?"

If necessary, allow the other person to clarify what they are saying. Only start your answer when you are 100% certain you understand what the person is saying.

It may seem like a waste of time to do this, but you will be demonstrating your ability to obtain and understand feedback.

Respecting Different Approaches to Caregiving is Important - AgingCare.com

Respecting Different Approaches to Caregiving is Important - AgingCare.com: Respecting Diverse Approaches to Caregiving is Important



There is no one-size-fits-all approach to caregiving.



Short of neglect or abuse of the care receiver, nearly every family caregiver must be free to make choices that work best for their unique situation. Even then, the available choices aren't always ideal.



You simply have to try and acknowledge what it really means to just do your best.

Tips for Coping with Symptoms/Alzheimer's and Sundowning | alzcompend.info

from  alzcompend.info/?p=268



1. WHAT IS SUNDOWNING?
Surprisingly, that's not an easy question to answer. Sundowning is a descriptive term rather than a diagnosis. Different researchers have different definitions -- which has complicated attempts to study the symptom, determine what causes it, and find ways to treat it.



Broadly speaking, sundowning is a cyclical increase in agitation (which may include restlessness, confusion, disorientation, wandering, searching, escape behaviors, tapping or banging, vocalization, combativeness, and/or hallucinations) that takes place at roughly the same time every day. Despite its name, and the wide-spread belief that sundowning occurs in the late afternoon and early evening, studies have found that the peak of sundowning activity is more likely to occur in the early- to mid-afternoon (e.g., around 1:00pm), while in some patients, it may occur late at night. It may even peak in the early morning in a fairly high percentage of patients.



For those of you struggling to cope with sundowning -- whenever it peaks -- take heart: many researchers have reported that it tends to occur in the middle stages of dementia, and to disappear as the dementia progresses.





2. WHAT CAUSES SUNDOWNING?



Many researchers consider sundowning to be a type of agitation, called "spontaneous agitation", that is caused by two factors, i.e.:

(1) Confusion, over-stimulation, and fatigue during the day, which results in increased disorientation, restlessness, and insecurity at night. And

(2) Fear of the dark, perhaps because of the lack of familiar daytime noises and activity and the lack of visual cues. The loved one may not be able to see as well in the gathering dusk, and/or be disturbed by strange shadows or reflections in window glass.



Others consider it to be a type of sleep disturbance that is "characterized by nocturnal wandering and confusion". Sundowning and sleep disturbance may appear to be related to each other since a sleep disorder, such as sleep disordered breathing, can be associated with a daytime behavior disorder.



However, more recent studies have concluded that sundowning is a chronobiological phenomenon that is unrelated to sleep disturbances. It is thought to be caused by a disturbance in the normal circadian rhythms, i.e., the "internal clock". Human circadian rhythms are biological cycles of ~24 hours that include sleep/wake, body temperature, and melatonin secretion cycles. They are regulated, in large part, by the suprachiasmatic nucleus (SCN), a cluster of neurons in the anterior hypothalamus. The SCN deteriorates significantly in Alzheimer's disease, contributing to disruption of circadian rhythms.



Decreased exposure to bright light has been suggested as a factor that contributes to the disruption of the circadian clock in dementia patients. Bright light (≥2,000 lux) is one of the most powerful synchronizers of circadian rhythms and directly influences secretion of melatonin, sleep/wake patterns, and body temperature cycles. Young adults and healthy older people are, on average, exposed to one hour of bright light a day, whereas Alzheimer's patients living at home are exposed to only 30 minutes a day, and Alzheimer's patients living in nursing homes are typically exposed to little or no bright light above 2,000 lux and only 10-20 minutes a day to light above 1,000 lux. However, it should be noted that the circadian rhythm disturbances in frontotemporal dementia (FTD) patients differ significantly from those in Alzheimer's patients. For example, in one study, Alzheimer's patients showed increased nocturnal activity and a significant phase-delay in their rhythms of core-body temperature and activity compared with FTD patients (and controls); whereas the activity rhythm of FTD patients was highly fragmented and phase-advanced in comparison with controls and apparently uncoupled from the rhythm of core-body temperature. The implication is that environmental factors such as exposure to bright light could not have caused differences between the two groups of dementia patients, suggesting a neurobiological basis for the time-dependent changes in activity.



Some studies have found no clinical evidence for the existence of sundowning per se. Studies that monitored agitated behaviors throughout the 24-hour day have repeatedly found that roughly the same number of patients exhibited cyclical agitated behavior in the early morning as those exhibiting it in the late afternoon/early evening. One conclusion was that disruptive behaviors which occur in the evening simply are noticed and reported much more frequently because they have a greater impact on caregivers. By the end of the day, the caregivers (whether at home or in a nursing facility) are too tired and irritated to cope with the loved one's behaviors as easily and effectively as they could when they were fresh and rested, and are also likely to be distracted by shift changes, family returning home from work/school, and evening chores such as preparing/serving dinner. Although often noticed, the "sunrising" phenomenon has rarely been studied, in and of itself, since cyclical early morning agitation has been dismissed as a symptom of depression, which is often worse in the early morning. However, a study designed specifically to determine whether there is a correlation between "sunrising" and depression did not find one.





3. HOW COMMON IS SUNDOWNING?



Reports of sundowning in Alzheimer's patients are typically in the 10 - 25% range, but have been as low as 2.4% and as high as 66%. Not surprisingly, the prevalence that is reported depends on the definition of "sundowning" that is used, and the type of population involved in the study (e.g., the type and level of dementia and the environment in which the patients live).





4. WHAT CAN BE DONE TO MINIMIZE SUNDOWNING?



Conventional recommendations for treating sundowning behavior revolve around trying to establish "good sleep hygiene", a reflection of the widely-held belief that sundowning is a sleep disorder. However, there are a number of other approaches to consider, as well.





4.1. Is it really sundowning?



First, be sure that what you are observing actually is "sundowning". Is the behavior new and did it appear suddenly? Have the doctor check for infections (especially urinary tract infections, UTIs) and dehydration. Perhaps your loved one recently had a new stroke or was hurt in a fall. Flare-ups of chronic diseases such as diabetes or heart, liver, or kidney disease can also cause agitation or delirium.



Pain is undiagnosed or undertreated in a staggeringly high percentage of dementia patients, and is a major cause of agitation and sleeplessness. Could your loved one be suffering from arthritis, constipation, gastroesophageal reflux, or sitting all day in an uncomfortable position? Tools to help you evaluate whether your loved one is in pain can be found at the University of Alberta and AlzBrain websites:

http://www.painanddementia.ualberta.ca/

http://www.alzbrain.org/pdf/handouts/2049.%20MANAGEMENT%20OF%20PAIN%20IN%20PERSONS%20WITH%20DEMENTIA.pdf



Perhaps your loved one takes a medicine that would control some source of discomfort, and that is wearing off at the time when the "sundowning" behavior appears.



Conversely, a medicine might be causing the symptoms you're seeing. Medicines that are commonly prescribed for dementia patients often have side effects that negatively affect sleep and wakefulness, or cause agitation or discomfort. Aricept, for example, can cause dream disturbances and/or insomnia. Antidepressants (especially SSRIs) can induce or exacerbate periodic limb movements in sleep (PLMS). Atypical antipsychotics increase daytime fatigue and somnolence, and may induce restlessness or akathisia. Check any medicines that your loved one takes -- even those he has been taking for a long time -- for possible adverse effects. ( http://www.rxlist.com ) Also, consider the possibility of drug interactions that can exacerbate adverse effects or make one or both of the drugs less effective. ( http://www.drugs.com/drug_interactions.php ) Talk with the doctor or pharmacist about the possibility that your loved one is on the wrong dose, possibly due to kidney or liver problems, or weight loss or gain.



Your loved one may be getting tired and irritable due to a sleep disorder. There are many different sleep disorders that may develop in dementia patients, such as sleep-disordered breathing, PLMS, restless legs syndrome (RLS), obstructive sleep apnea, nocturnal myoclonus, and parasomnias (e.g., REM sleep behavior disorder, RBD.) The treatments that are most likely to be helpful depend on the specific type(s) of sleep disturbances involved. For example, patients suffering from sleep apnea have difficulty breathing; depending on the cause of the apnea, treatment may be, e.g., a change in diet, simple devices to encourage sleeping in a different position, an oral appliance which prevents airway blockage, or a CPAP (continuous positive airway pressure) machine. RLS is caused by a functional disturbance in the dopaminergic system, and so the treatment of choice consists of dopaminergic drugs or dopamine agonists such as pergolide or pramipexole.



Depression is very common in dementia patients. Diurnal mood variation, a pattern of mood variability in which a person’s worst and best moods vary in a predictable fashion, is a symptom of major depression. Mood is most commonly worse in the morning and better in the early evening, but the opposite pattern occurs as well. As noted elsewhere, variability in mood associated with depression is not sundowning (or "sunrising"), and may be responsive to an antidepressant.



Specific interactions with other people might be the culprit. For example, a dementia patient in a nursing home might become upset by visitors they don't recognize or don't like, or by strangers who are visiting other residents of the facility. Because visiting hours are time-regulated, this reactive agitation might appear to have a temporal association.



Your loved one's behavior might even be due to something as simple as hunger and/or thirst. Try serving dinner earlier, or offering a snack or something to drink until dinner is ready.





4.2. Good sleep hygiene



Conventional wisdom for treating sundowning has been to try to help re-establish a "normal" sleeping pattern, coupled with taking steps to minimize factors that might trigger fear or confusion:

• Increase your loved one's daytime activities, particularly physical exercise, and discourage inactivity and napping during the day. If fatigue is exacerbating the sundowning, try a brief (one hour) nap, early afternoon or just before the usual sundowning time. If the loved one won't nap, an hour of quiet time -- sitting quietly and talking together, for example, or listening to soothing music -- may help.

• Since an Alzheimer's patient is usually better able to tolerate outings, activities and increased stimulus during the earlier part of the day, plan trips to the grocery store, involvement with kids, visits to day care and so forth during the morning.

• Even during the earlier part of the day, an Alzheimer’s patient can tolerate only so much stimulation and commotion. Take steps to eliminate over-stimulation such as noisy television or radio, boisterous children, quick movements, and many things going on at one time.

• Sometimes excessive stimulation cannot be avoided. Make sure that there is a private "time out" place where your loved one can retreat for peace and quiet. Make it off-limits to children and general traffic; even the caregiver should try not to intrude unless absolutely necessary.

• Don’t physically restrain the loved one. Let him pace where he is safe. A supervised walk outdoors can help reduce restlessness. Indoors, clear all clutter and obstacles (e.g., low coffee tables and foot stools) from your loved one’s walking paths. Keep knickknacks to a minimum and the tops of tables, shelves, and other surfaces as clear as possible. Mirrors and pictures may be interpreted as unfriendly visitors; complicated, noisy appliances can be frustrating. Avoid making changes once you have things simplified.

• Give diuretics and laxatives early in day.

• Plan for the afternoon hours to be quiet and calm, to allow your loved one to unwind and relax. However, structured, quiet activity is important. Perhaps take a stroll outdoors, play a simple card game, or sing favorite songs together.

• Early evening activities that are familiar from an earlier time in the person’s life may be helpful, for example, walking the dog, a pre-dinner drink, or assisting with preparing dinner or setting the table.

• Physical discomfort -- hunger, being wet or soiled, or feeling cold/hot -- can play a part in sundowning. Light snacking during the day can be helpful. Apples and other fruits can help replace lost energy; even a loved one who is pacing back and forth does not have an endless supply of energy.

• Turning on lights well before sunset and closing the curtains at dusk will minimize shadows and may help diminish confusion.

• Discourage drinking stimulants (e.g., caffeine) or smoking near bedtime.

• Set a quiet, peaceful mood in the evening to help the loved one relax. Keep the lights low, and try to reduce the noise levels, e.g., from television and radios. Some loved ones are comforted by soft toy animals, pets, hearing familiar tunes, or an opportunity to engage in a favorite pastime.

• Have a bedtime routine. Try to have the loved one go to bed at the same time each night. Have a routine for getting ready for bed, such as taking a bath and having some warm milk, a back rub, or perhaps reading out loud.

• Make sure the loved one gets enough rest at night. Provide a comfortable bed. Create a calm atmosphere for sleeping. Reduce noise and light. Stuffed animals or a pet may soothe the loved one and allow them to sleep. Soothing music may help, or a recording of ocean waves or a mountain stream, or even "white noise" from, e.g., a fan.

• Have the loved one use the toilet right before bedtime, to minimize the need for nighttime toileting. Place a commode next to the bed for nighttime urination. Walking to the bathroom in the middle of the night may wake the loved one up too much, making it difficult to get back to sleep.

• Close the curtains and leave night lights on in the bedroom, hall, and bathroom if the darkness is frightening or disorienting.



Most of these recommendations appear (to me) to be based on common sense. A few, however, might be somewhat controversial, as will be discussed later.



Such recommendations have rarely been studied in clinical trials. I did find one, called "NITE-AD" (McCurry et al 2005), which was focused primarily on sleep disturbances. At the end of six months, loved ones whose caregivers were trained in a combination of sleep hygiene, daily walking, and light exposure interventions were found to have fewer nighttime awakenings, less total time awake at night, and less depression. The researchers noted that, given the design of the study, it was impossible to determine whether an individual intervention or some combination of interventions had the greatest effect on the outcomes.



I found it curious that the paper did not present any data on "secondary outcomes" other than depression, such as disruptive behaviors -- even though the data was collected -- and ignored the worrisome (to me) observation that NITE-AD patients exhibited a trend toward more-rapid cognitive decline over time. Granted, the trial was very small and the data might have been skewed ... but that is true of all the data, not just the rates of cognitive decline.





4.3. Support a "normal" circadian rhythm



As sundowning is being established more firmly as a chronobiological phenomenon, measures intended to help re-establish a "normal" circadian rhythm are being suggested more often for treating it. These include:



- Designing ChEI therapy to support, rather than disrupt, the circadian rhythm



Deterioration of the brain's cholinergic system is a hallmark of Alzheimer's, with degeneration of cholinergic neurons in the basal forebrain being one of the first biochemical changes that is seen. The cholinergic system comprises the neurotransmitter acetylcholine, the enzyme cholinesterase (whose function is to destroy excess acetylcholine), and cholinergic receptors. The Alzheimer's brain does not produce adequate acetylcholine for optimum neurotransmission. Drugs such as Aricept/donepezil, Razadyne/galantamine, and Exelon/rivastigmine are cholinesterase inhibitors (ChEIs), i.e., they prevent the enzyme from destroying as much of the acetylcholine as usual, thereby effectively increasing its levels in the brain and increasing cholinergic activity.



The cholinergic system has a pronounced circadian rhythm upon which sleep, waking, and fundamental aspects of learning depend. For example, in general, the healthy brain has low levels of acetylcholine during slow-wave sleep, and high levels during wakefulness. ChEIs have the potential to either mitigate disease-induced disturbances of the cholinergic rhythm by raising acetylcholine levels (increasing cholinergic activity) during the day, or to exacerbate sleeplessness and agitation by preventing the normal fall in acetylcholine levels (and thereby interfering with the normally reduced cholinergic transmission) at night.



The ChEI drug that is used and the time of day at which it is given can determine whether the normal cholinergic transmission and rest-activity cycles are supported or undermined. For example, Aricept/donepezil has a very long half-life (70 hours) in the body. Since its concentration in the blood doesn't vary much over the course of a 24-hour day (once the loved one has reached steady state, i.e., has been taking a given dose of the drug for a couple of weeks), it maintains high levels of acetylcholine in the brain at night, even if the drug is given in the morning. Aricept therefore has the potential to disrupt sleep and trigger insomnia. Razadyne/galantamine, on the other hand, has a much shorter half-life (7 hours). The extended-release formulation administered in the morning, in particular, helps support the normal circadian cholinergic rhythm, maintaining higher levels of the drug in the blood (and thereby higher levels of acetylcholine in the brain) during the day and lower levels at night.



- Bright light therapy



Since exposure to light plays a major role in regulating the phase relationships among core body temperature, melatonin rhythm, and the circadian rest-activity cycle, bright light therapy is frequently suggested as one simple way to help treat sundowning.



There is evidence that bright light can be used to change the timing of circadian rhythms (the circadian "phase") or, when administered at certain times of the day, may increase the amplitude of circadian rhythms without necessarily affecting the phase. Some -- but not all -- studies have found that circadian rhythms in older adults are phase-advanced, that is, the rhythms are shifted to an abnormally early time, resulting in the adults falling asleep and waking up earlier than usual. Conversely, some Alzheimer's patients have phase-delayed activity, that is, sleep onset and morning rising are shifted to abnormally late times. Evening bright light has been shown to delay circadian rhythms, whereas early morning light has been shown to advance circadian rhythms. As a result, advanced rhythms, such as those seen in healthy older adults, might be beneficially delayed with exposure to evening light, whereas a phase delay such as that seen in Alzheimer's may be beneficially advanced with exposure to morning light.



Results from clinical studies on dementia patients, however, have been inconsistent -- quite possibly due to differences in the type of light that was used, the length of exposure, and the time of day the therapy was implemented. Some researchers have suggested that more consistent results might be obtained if only one type of dementia were included in a study, or if the studies did not focus on severely impaired institutionalized patients who are likely to have incurred more marked SCN degeneration. Women show different patterns of sleep and circadian physiology during aging than men, so perhaps the genders should be studied separately. Some researchers suspect that other factors are likely to have been involved, that were not detected due to lack of appropriate controls. One wonders whether more consistent results might have been seen if subjects were screened to eliminate dementia patients who suffer from sleep disorders and other common causes of agitation (e.g., pain), for example.



In any event, some of the largest and best-designed studies found no improvement in nighttime sleep or daytime alertness from bright light therapy, and/or no improvement in agitated behavior, and one study actually reported an increase in behavioral problems. (Note: bright light can contribute to eyestrain and headaches, and can cause glare and reflection off polished surfaces which, in turn, can cause confusion, agitation, and anger.)



- Melatonin supplements, alone and in combination with bright light therapy



As noted above, circadian rhythm disturbances have been linked to abnormalities in the SCN. Rhythmic nocturnal melatonin secretion from the pineal gland is directly generated by the circadian clock located in the SCN. Because several studies suggest that melatonin levels are either low or dysregulated in Alzheimer's, oral melatonin supplements have been proposed as a treatment for sundowning.



However, clinical trials on the use of melatonin for treating sundowning or sleep disorders have failed to show that the approach will be broadly beneficial for dementia patients. A recent multicenter, placebo-controlled trial of melatonin for sleep disturbance in Alzheimer's disease found, on average, no significant improvement in objective measures of sleep. Some patients showed improved sleep quality (less interrupted sleep and reduced daytime sleepiness and agitation), some showed no effects on sleep, and some patients became more aggressive. Three double-blind, placebo-controlled studies with objective assessment criteria for measuring sundowning behavior itself -- not sleep per se -- produced conflicting results. Two concluded that there was a small but statistically significant improvement in sundowning/agitated behavior, although one of these noted that melatonin was less effective than morning bright light therapy. The third controlled study concluded there was no improvement.



The stage of dementia may affect the potential benefit of melatonin. For melatonin to have an effect, it must be able to bind to melatonin receptors. Since the numbers of melatonin MT1 receptors in the SCN are extremely low in late-stage Alzheimer's patients (i.e., only 10% of those found in age-matched controls), supplementary melatonin in the late stages may not have a discernible effect on circadian rhythm disorders. Moreover, the sleep/circadian timing systems are the product of complex interactions among multiple brain regions, neurotransmitter systems and modulatory hormones. The rhythmic levels of many other hormones besides melatonin (e.g., cortisol, vasopressin, pulsatile luteinizing hormone, testosterone secretion, dehydroepiandrosterone, beta-endorphine) may be affected in Alzheimer's patients. Since abnormalities in any key neurotransmitter system will impinge on the sleep/circadian timing systems at multiple levels, oral supplements of a single hormone are unlikely to readjust the entire, complex sleep/circadian timing systems as the dementia progresses and more of these neurotransmitter systems are damaged.



Studies on bright light therapy in combination with melatonin supplements have also produced conflicting results. Haffmans et al (2001), for example, found that bright light therapy has a positive effect on sundowning, whereas bright light therapy plus melatonin does not. They hypothesized that the treatment, as designed, "overshot" the chronobiological synchronization of the melatonin supplement. (In healthy people, the density and the sensitivity of melatonin receptors are elevated during the daytime, when endogeneous melatonin levels are low. Hence, a melatonin dose given at a time when melatonin receptor density and sensitivity are lowest may show no effect compared with the same dose given when receptor density and sensitivity are highest.) Others found that the combination reduced agitation and improved several sleep parameters, although some adverse side effects were reported (dysphoric mood, irritability, dizziness, and headache.)



One recent study concluded that melatonin should only be used in combination with bright light therapy. Melatonin by itself shortened sleep onset latency and increased total sleep time; however, it also decreased affect ratings and increased withdrawn behavior, which were counteracted by light therapy. ("Affect" refers to the experience of feeling or emotion.)



All of these were relatively short-term studies. It should be noted that the safety of long-term use of melatonin supplements has never been established. Melatonin can cause a number of serious side effects -- including confusion and depression -- which become more likely as the patient continues to receive it. Supplemental melatonin may exacerbate seizure disorders, which is a concern for Alzheimer's patients since they can develop seizure disorders at any stage. Since melatonin shrinks arteries, it may be contraindicated in loved ones with cardiovascular disease (including vascular dementia). It may also aggravate autoimmune disorders (which can cause dementia symptoms) such as arthritis and severe allergies.



Daily administration of melatonin, even of a low dose (e.g., < 3 mg) can cause the loved one to build up a tolerance, and can eventually disrupt, rather than improve, sleep in some people. Also, melatonin can have serious interactions with a number of medicines, including the antidepressants that are often prescribed for Alzheimer's patients, blood thinners (e.g., warfarin, heparin), blood pressure medications (especially nifedipine), drugs that may affect the immune system (e.g., azathioprine, cyclosporine, prednisone), and fluvoxamine. Anyone considering starting a loved one on melatonin should first discuss it with the doctor and the pharmacist.



- Physical activity



Numerous studies have concluded that exercise can help minimize or eliminate agitated behavior in dementia patients. Exercise also has been linked to phase shifting of circadian rhythms as well as promotion of more restful sleep in older adults, and is considered to be likely to do the same for dementia patients, although no controlled trials that looked at the isolated effects of exercise on sleep in dementia have been done, to my knowledge. Regular exercise also builds muscle mass, improves strength, reduces falls, and improves mood. There do not appear to be any down sides to physical activity, as long as the exercise program is designed for the capabilities and interests of the loved one, whereas there are many potential benefits.





4.4. Let them eat chocolate



Over the past dozen or so years, Alzheimer's care has been undergoing a major paradigm shift, toward "person-centered care". Person-centered care is based on the premise that the personality of the loved one is increasingly concealed rather than lost, and therefore seeks to personalize the loved one's care and environment, to honor who he is and what brings him joy.



This has led to recognition of the fact that the loved ones' behaviors may often be understood as expressions of their individual desires and needs, rather than simply as symptoms of the disease process. As the loved ones' dementia advances, they experience increasing deficits in all aspects of their lives, but most especially and importantly, they lose the ability to verbally communicate their needs -- physiological, psychological, spiritual, social, and comfort needs -- to others. Their behaviors become the conduit for expressing their needs, pleasures, and frustrations. Stress, from fatigue, changes in routine, caregiver, or environment, demands that exceed the loved one's ability to function, multiple and competing stimuli, perceptions of loss, and physiologic factors such as illness, pain, discomfort, and adverse effects of medications, can result in anxiety and increasingly dysfunctional behaviors. In this context, behavioral "symptoms" -- both verbal manifestations such as repetitive questioning or vocalizations and non-verbal ones including withdrawal or physical violence -- can be interpreted as communications meant to convey specific messages and to achieve particular goals relating to unmet needs. Comfortable people do not hit, scream, pound on tables, or call out.



If the loved one's needs remain unmet while the caregivers' energies are directed toward curtailing the behaviors themselves, the likely outcome of this miscommunication is a vicious cycle of further withdrawal and isolation due to perceived inability of the loved one to interact effectively with others, leading to increased depression and anxiety, leading to more dysfunctional behaviors.



Here we get to the crux of it: If the loved one's circadian rhythm is out of whack, and we struggle mightily to force the loved one into wake-sleep patterns that fit our own circadian rhythms instead of his, won't we be in danger of increasing his agitation, as an expression of his stress, fears, and discomfort? And to my way of thinking, this concern is supported by the rash of studies, both recent and not so recent, which have shown that allowing dementia patients to be active when they choose to be active, and sleep when they choose to sleep, may decrease, or even eliminate, serious behavioral problems.



For example, in a study of more than 50 nursing homes (Sloane et al 1998), the proportion of residents who exhibited an agitated behavior varied from "none" in several homes to 38% in one home. Lower rates of agitation were seen in homes that had higher proportions of residents in bed during the day.



More recently, the Parker Jewish Institute in New Hyde Park, NY, implemented a "midnight snack" program, giving wanderers access to food and beverages at will in the middle of the night, instead of insisting that they go back to bed. They report that the program resulted not only in far less agitation among their residents, but also in a sharp decrease in falls and related injuries, and even a huge decrease in pressure sores.



The Hebrew Home at Riverdale in New York established "ElderServe at Night", an "Adult Night Care" program that offers activities and socialization, meals and showers, and even evening trips to the circus or nearby restaurants, for loved ones who are active at night and sleep during the day. Both the patients and their caregivers are enthusiastic about the program. The patients are more alert and happy, and exhibit far fewer behavioral problems, while their families can sleep soundly through the night.



Beatitudes nursing home in Phoenix has gone even further, setting up a person-centered care facility in which residents are allowed to sleep, be bathed, and dine whenever they choose, and eat and drink whatever appeals to them -- even a little alcoholic "nip" now and then. There is a 24-hour restaurant which functions as the primary dining room and snack area. There is an around-the-clock activity program, that offers a balance of sensory-calming and sensory-stimulating activities individualized to each resident. Instead of group activities such as bingo, in which few residents could actually participate, they conduct one-on-one activities -- block-building, coloring, simply conversing -- and use art, music, and exercise to "generate positive emotions", and the outdoors to create connections with the wind, bird song, and sunshine. They have eliminated anything that might be considered restraining, from deep-seated wheelchairs that hinder standing up to bedrails (although some beds are lowered and protected by mats). Bathing is a pleasurable experience and the towel bath method is an option for those who no longer enjoy a shower. Instead of using antipsychotics to treat serious behavioral issues, emphasis is on adequate pain medication and antidepressants. There is no sundowning -- even though the facility is specifically for patients with moderate to severe dementias (of all sorts, including frontotemporal dementia and dementia with Lewy bodies), and accepts those who previously exhibited serious behavioral problems; and even though residents are allowed to stay until they die.



In 2005, Beatitudes instituted a training program for qualified and interested nursing facilities to learn best practices in person-centered dementia care. Those facilities similarly report a reduction in the use of antipsychotic, antidepressant, and sedative medications, decreased use of physical restraints, decreased weight loss, and less hospitalization and emergency department use.



In short, it seems prudent to adjust "conventional wisdom" recommendations to take personal preferences of the loved one into account, including preferences for wake/sleep cycles and napping, to the greatest extent practicable. One caregiver on a discussion forum noted that her loved one was very resistant to staying in bed at night, and was developing behavioral problems. The situation was resolved simply by offering a midnight snack. Beatitudes emphasizes that it is much easier and more effective to anticipate needs rather than wait for a behavior to occur. Caregivers need to be sure to identify discomfort (such as pain, constipation, skin deterioration, malnutrition, physical exhaustion, and adverse drug effects) and manage it effectively. Offer food and drink frequently; anticipate bowel and bladder needs by regularly escorting the loved one to the bathroom (on the loved one’s schedule); and assure other comfort needs are met such as comfortable clothing, room temperatures, and lighting and noise levels. Activities need to be meaningful to the loved one, with the opportunity to make connections to the people and the environment around him; and should be offered to the loved one, not forced on him. Remember that too much stimulation can be just as harmful (if not more so) as too little.



It is one thing for a well-staffed facility to cater to its residents' unique needs, but it may not be practical for the at-home caregiver to adjust the entire household to the rhythms of the loved one. If your loved one simply must be active in the middle of the night, one thing that might be considered is setting up a "safe room" where your loved one can safely pace, which allows you to sleep more soundly. Beverly Bigtree Murphy (if you're not familiar with her website, you should be) describes the "safe room" she set up for her husband -- who paced at night for two years -- at: http://bigtreemurphy.com/Symptoms%20of%20Taking%20Charge%20Stage%20of%20Care.htm#Sundowing,%20Ritualistic%20Behaviors,%20Ccompulsions





5. When all else fails



Learning person-centered care techniques sounds like a lot of hard work and effort. Actually, the sooner the caregiver begins learning "how to speak Alzheimer's", the better off everyone will be, and the less likely that behavioral problems will crop up. Studies have repeatedly shown that caregivers trained in non-drug interventions can not only reduce the frequency and severity of behavioral symptoms and produce higher quality of care for their loved ones, but also reduce their own depression and burden.



Are there medicines that may help? There is some evidence that antipsychotics may help reduce agitation in select patients, but little evidence to support the use of other drugs that are sometimes suggested, such as benzodiazepines, antihistaminics, anticonvulsants, monoamine oxidase inhibitors, or SSRIs. To date, there is no published Class I evidence that any of these drugs are useful for treating sundowning per se. Moreover, there is an increasing reluctance on the part of educated doctors to prescribe medicines for "treating" sundowning because (a) evidence indicates that non-drug interventions are more likely to be beneficial, (b) antipsychotics and benzodiazepines further weaken the already unstable sleep-wake rhythms and further decrease neuronal metabolic activity, and (c) each class of drugs carries considerable risk, ranging from increased likelihood of falls and hip fractures, confusion, psychoses, weight loss, stroke, and/or heart attacks, to increased likelihood of sudden death. Concomitant use of cholinesterase inhibitors (Aricept/donepezil, Razadyne/galantamine, and Exelon/rivastigmine) and antipsychotics may increase the risk of extrapyramidal symptoms by disrupting the acetylcholine/dopamine balance in the striatum. In addition, some drugs are contraindicated for loved ones with some types of dementia, such as the antipsychotics to which Lewy body dementia patients are typically extremely sensitive.



However, each loved one is different. If all else fails, yours might be helped by a drug that is not generally beneficial. Given the risks associated with the candidate drugs, plus possible interactions with other medicines your loved one may be taking, it would be prudent to seek the help of a highly qualified and experienced neuro or geripsych to manage the treatment for your loved one. Be sure to discuss the risks with the doctor, and ask what adverse effects to watch for.



If you are willing to consider trying something outside-the-box, there have been two successful (albeit tiny) clinical trials on using prazosin to treat agitation and aggression in Alzheimer's patients. Two larger trials are now recruiting. Prazosin is a mild antihypertensive with a good safety profile, is inexpensive, and is becoming more and more widely used to treat sleep disruption and agitation associated with PTSD. Given an hour before bedtime, low doses of prazosin reduce light sleep, normalize REM sleep, and increase total sleep time. An additional daytime dose was found to reduce residual daytime agitation symptoms of civilian trauma victims.





Further reading and references



General overviews on sundowning, circadian rhythms, and sleep disturbances



- Volicer L, Harper DG, Manning BC, Goldstein R, Satlin A. Sundowning and circadian rhythms in Alzheimer's disease. Am J Psychiatry 2001;158 (5): 704–11.

http://ajp.psychiatryonline.org/cgi/content/full/158/5/704

- Bachman D, Rabins P. "Sundowning" and other temporally associated agitation states in dementia patients. Annu Rev Med. 2006;57:499-511.

http://cursa.ihmc.us/rid%3D1GM097FD0-1SFSKL8-1FVH/sundowning.pdf

- Kim P, Louis C, Muralee S, Tampi RR. Sundowning Syndrome in the Older Patient. Clinical Geriatrics 2005; 13(4):32-36.

http://www.clinicalgeriatrics.com/article/4013

- Klaffke S, Staedt J. Sundowning and circadian rhythm disorders in dementia. Acta Neurol Belg 2006; 106:168-175

http://www.actaneurologica.be/acta/download/2006-4/03-Klaffke%20et%20al.pdf

- Theison AK, Geisthoff UW, Förstl H, Schröder SG. Agitation in the morning: symptom of depression in dementia? Int J Geriatr Psychiatry 2009 Apr;24(4):335-40.

http://www.gnmhealthcare.com/pdf/09-2008/09/1638914_Agitationinthemorningsymp.pdf

- Wulff K, Gatti S, Wettstein JG, Foster RG. Sleep and circadian rhythm disruption in psychiatric and neurodegenerative disease. Nat Rev Neurosci. 2010 Aug;11(8):589-99.

http://www.ncbi.nlm.nih.gov/pubmed/20631712

- Ancoli-Israel S, Ayalon L. Diagnosis and Treatment of Sleep Disorders in Older Adults. American Journal of Geriatric Psychiatry 2006; 14:95–103

http://www.focus.psychiatryonline.org/cgi/content/full/7/1/98

- Harper DG, Stopa EG, McKee AC, Satlin A, Harlan PC, Goldstein R, Volicer L. Differential circadian rhythm disturbances in men with Alzheimer disease and frontotemporal degeneration. Arch Gen Psychiatry 2001;58:353-360

http://archpsyc.ama-assn.org/cgi/content/full/58/4/353

- Weldemichael DA, Grossberg GT. Circadian Rhythm Disturbances in Patients with Alzheimer's Disease: A Review. Int J Alz Disease 2010; Article ID 716453.

http://www.sage-hindawi.com/journals/ijad/2010/716453/

- Huybrechts KF, Rothman KJ, Silliman RA, Brookhart A, Schneeweiss S. Risk of death and hospital admission for major medical events after initiation of psychotropic medications in older adults admitted to nursing homes.CMAJ 10.1503/cmaj.101406

http://www.eurekalert.org/pub_releases/2011-03/cmaj-omh032311.php

http://www.cmaj.ca/cgi/rapidpdf/cmaj.101406v1.pdf



Nondrug interventions



- Kolanowski AM, Litaker M, Buettner L. Efficacy of theory-based activities for behavioral symptoms of dementia. Nurs Res 2005 Jul-Aug;54(4):219-28.

http://www.nursing-research-editor.com/authors/OMR/5/OMRManuscript.pdf

Note that the patients engaged in the activities for "up to 20 minutes per day", and the authors referenced Kovach and Wells (2002) who found that the daily activity schedule had to be balanced, since over-stimulation as well as under-stimulation can contribute to agitation.

- Teri L, Logsdon RG, McCurry SM. Exercise interventions for dementia and cognitive impairment: the Seattle Protocols. J Nutr Health Aging. 2008;12:391–394.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518041/

- Baehr EK, Eastman CI, Revelle W, Olson SH, Wolfe LF, Zee PC. Circadian phase-shifting effects of nocturnal exercise in older compared with young adults. Am J Physiol Regul Integr Comp Physiol. 2003;284:R1542–R1550.

http://ajpregu.physiology.org/content/284/6/R1542.long

- McCurry SM, Gibbons LE, Logsdon RG, Vitiello MV, Teri L. Nighttime Insomnia Treatment and Education for Alzheimer's Disease: A Randomized, Controlled Trial. J Am Geriatr Soc. 2005;53(5):793-802.

http://www.medscape.com/viewarticle/504709



Person-centered care



- Long CO, Alonzo TA. (2008). Palliative care for advanced dementia: A model teaching unit. Practical approaches and results. Arizona Geriatrics Society Journal, 13(2), 14-17.

http://www.nccdp.org/resources/PalliativeCare.pdf

- Long CO. Palliative care for advanced dementia. J Gerontol Nurs. 2009 Nov;35(11):19-24.

http://www.ncbi.nlm.nih.gov/pubmed/19904852

- Belluck P. Giving Alzheimer’s Patients Their Way, Even Chocolate. New York Times Dec 31, 2010.

http://www.nytimes.com/2011/01/01/health/01care.html

- Buckley C, Estrin J. All-Night Care for Dementia’s Restless Minds. New York Times June 12, 2009.

http://www.nytimes.com/2009/06/14/nyregion/14cover.html

- Girshman P. Midnight Munchies Keep Elderly Safer In NY Nursing Home. Kaiser Health News Mar 16, 2010.

http://www.kaiserhealthnews.org/stories/2010/march/16/midnight-munchies-keep-elderly-safer-in-ny-nursing-home.aspx

- Sloane PD, Mitchell CM, Preisser JS, Phillips C, Commander C, Burker E. Environmental correlates of resident agitation in Alzheimer's disease special care units. J Am Geriatr Soc 1998; 46:862-869.

http://www.ncbi.nlm.nih.gov/pubmed/9670873

http://psycnet.apa.org/?fa=main.doiLanding&uid=1998-04923-004

- Gauthier S, Cummings J, Ballard C, Brodaty H, Grossberg G, Robert P, Lyketsos C. Management of behavioral problems in Alzheimer’s disease. International Psychogeriatrics 2010

http://www.cmrr-nice.fr/doc/IP2010.pdf

- Smith M, Buckwalter K. Behaviors associated with dementia. AJN 2005; 105(7):40-52.

http://journals.lww.com/ajnonline/Fulltext/2005/07000/BEHAVIORS_ASSOCIATED_WITH_DEMENTIA__Whether.28.aspx

- Rader J, Barrick AL, Hoeffer B, Sloane PD, McKenzie D, Talerico KA, et al. (2006). The bathing of older adults with dementia. American Journal of Nursing 106(4), 40-48.

http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=637530

- Whall AL. Changing the care provided persons with dementia -- The role of experiential knowledge and philosophy of science.

http://www2.oakland.edu/oujournal/files/15_changing_the_care.pdf

- McGeorge, S. (2008) Acute Mental Health Issues, in Older People and Mental Health Nursing: A Handbook of Care (eds R. Neno, B. Aveyard and H. Heath), Blackwell Publishing Ltd, Oxford, UK.

http://faculty.ksu.edu.sa/73408/documents/older_people_and_mental_health_nursing.pdf#page=171



Person-centered care at home



- Brackey J. Creating Moments of Joy: A Journal for Caregivers, Fourth Edition. Purdue University Press; (September 1, 2008)

http://www.enhancedmoments.com/

- The Savvy Caregiver training program

http://www.caresprogram.com

(You may be able to get a 20% discount with code AADVD20 .)

- Feil N. The Validation Breakthrough: Simple Techniques for Communicating with People with 'Alzheimer's-Type Dementia, Second edition. Health Professions Press (January 15, 2002).

http://www.vfvalidation.org



Bright light therapy



- Forbes D, Culum I, Lischka AR, Morgan DG, Peacock S, Forbes J, Forbes S. Light therapy for managing cognitive, sleep, functional, behavioural, or psychiatric disturbances in dementia. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD003946.

http://www2.cochrane.org/reviews/en/ab003946.html

- Skjerve A, Bjorvatn B, Holsten F. Light therapy for behavioural and psychological symptoms of dementia. Int J Geriatr Psychiatry. 2004 Jun;19(6):516-22.

http://ot.creighton.edu/community/EBLP/Question4/Skjerve%202004%20Light%20Therapy%20for%20behavioral.pdf

- Ancoli-Israel S, Martin JL, Gehrman P, et al: Effect of light on agitation in institutionalized patients with severe Alzheimer disease. Am J Geriatr Psychiatry 2003;11:194-203.

http://luminoterapia.blogdiario.com/img/Luminoterapia-Alzheimer.pdf

- Barrick AL, Sloane PD, Williams CS, Mitchell CM, Connell BR, Wood W, Hickman SE, Preisser JS, Zimmerman S. Impact of ambient bright light on agitation in dementia. Int J Geriatr Psychiatry. 2010 Oct;25(10):1013-21.

http://www.ncbi.nlm.nih.gov/pubmed/20104513



Melatonin



- Melatonin. Alzheimer Research Forum.

http://www.alzforum.org/dis/tre/drc/detail.asp?id=52

- Gehrman PR, Connor DJ, Martin JL, Shochat T, Corey-Bloom J, Ancoli-Israel S. Melatonin Fails To Improve Sleep Or Agitation In A Double-Blind Randomized Placebo-Controlled Trial Of Institutionalized Patients With Alzheimer’s Disease. Am J Geriatr Psychiatry. 2009 February; 17(2): 166–169.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2630117/

- Asayama K, Yamadera H, Ito T, Suzuki H, Kudo Y, Endo S. Double blind study of melatonin effects on the sleep-wake rhythm, cognitive and non-cognitive functions in Alzheimer type dementia. J Nippon Med Sch. 2003 Aug;70(4):334-41.

http://www.ncbi.nlm.nih.gov/pubmed/12928714

- Singer C, Tractenberg RE, Kaye J, Schafer K, Gamst A, Grundman M, Thomas R, Thal LJ. 2003. A multicenter, placebo-controlled trial of melatonin for sleep disturbance in Alzheimer’s disease. Sleep 26(7): 893–901.

http://www.chalmersresearch.com/bmg/docs/t2a3.pdf

- Serfaty M, Kennell-Webb S, Warner J, Blizard R, Raven P. 2002. Double blind randomised placebo controlled trial of low dose melatonin for sleep disorders in dementia. Int J Geriatr Psychiatry 17(12): 1120–1127.

http://www.chalmersresearch.com/bmg/docs/t2a2.pdf



Bright light and melatonin



- Haffmans PM, Sival RC, Lucius SA, Cats Q, Van Gelder L. Bright light therapy and melatonin in motor restless behaviour in dementia: A placebo-controlled study. Int J Geriatric Psych 2001; 16[1]:106-10

http://ot.creighton.edu/community/EBLP/Question4/Haffmanns%202001%20Bright%20light%20therapy%20and%20melatonin.pdf

- Dowling A, Burr Robert L, Van Someren Eus JW, Hubbard Erin M, Luxenberg JS, Mastick J, Cooper BA. Melatonin and bright-light treatment for rest-activity disruption in institutionalized patients with Alzheimer's disease. J Am Geriatr Soc 2008; 56(2): 239-246.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2642966/

- Riemersma-van der Lek RF, Swaab DF, Tiwsk J, Hol EM, Hoogendijk WJ, Van Someren EJ. Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: a randomized controlled trial. JAMA. 2008;299:2642–2655.

http://jama.ama-assn.org/content/299/22/2642.long



Cholinesterase inhibitors (ChEIs)



- Nieoullon A, Bentué-Ferrer D, Bordet R, Tsolaki M, Förstl H. Importance of circadian rhythmicity in the cholinergic treatment of Alzheimer’s disease: focus on galantamine*. Curr Med Res Opin. 2008 Dec;24(12):3357-67.

http://www.ncbi.nlm.nih.gov/pubmed/19032118

- Davis B, Sadik K. Circadian cholinergic rhythms: implications for cholinesterase inhibitor therapy. Dement Geriatr Cogn Disord. 2006;21(2):120-9.

http://www.ncbi.nlm.nih.gov/pubmed/16391473

- Robert P. Understanding and Managing Behavioral Symptoms in Alzheimer’s Disease and Related Dementias: Focus on Rivastigmine. Curr Med Res Opin. 2002;18(3).

http://www.medscape.com/viewarticle/439728



Prazosin



- Wang LY, Shofer JB, Rohde K, Hart KL, Hoff DJ, McFall YH, Raskind MA, Peskind ER. Prazosin for the treatment of behavioral symptoms in patients with Alzheimer disease with agitation and aggression. Am J Geriatr Psychiatry. 2009 Sep;17(9):744-51.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2842091

- Wang LY, Petrie EC, Rohde K, Hart KL, Hoff DJ, Shofer JB, Rasking MA, Peskind ER. P2-277: Prazosin for treatment of disruptive agitation in Alzheimer's disease. Alz & Dementia 2008;4(4):T453

http://www.alzheimersanddementia.com/article/PIIS1552526008015136/fulltext

- Two larger trials are now recruiting.

http://clinicaltrial.gov/ct2/show/NCT01126099

http://clinicaltrial.gov/ct2/show/NCT00161473

- Taylor FB, Martin P, Thompson C, et al. (2008) Prazosin effects on objective sleep measures and clinical symptoms in civilian trauma posttraumatic stress disorder: a placebo-controlled study. Biol Psychiatry 63:629–632.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2350188

- Raskind MA, Peskind ER, Hoff DJ, et al. (2007) A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. Biol Psychiatry 61:928–934.

http://axon.psyc.memphis.edu/~charlesblaha/7705/Papers_10/Aycock%20Rebecca%20-%20Prazosin%20and%20PTSD.pdf

- Raskind MA, Peskind ER, Kanter ED, Petrie EC, Radant A, Thompson C, et al. Reduction of Nightmares and Other PTSD Symptoms in Combat Veterans by Prazosin: A Placebo-Controlled Study. Am J Psychiatry. 2003;160:371–373.

http://ajp.psychiatryonline.org/cgi/content/full/160/2/371

- Taylor F, Raskind MA. The alpha1-adrenergic antagonist prazosin improves sleep and nightmares in civilian trauma posttraumatic stress disorder. J Clin Psychopharmacol. 2002;22:82–85.

http://www.ncbi.nlm.nih.gov/pubmed/11799347

- Taylor F, Lowe K, Thompson C, McFall MM, Peskind ER, Kanter ED, et al. Daytime prazosin reduces psychological distress to trauma specific cues in civilian trauma posttraumatic stress disorder. Biol Psychiatry. 2006;59:577–581

http://www.ncbi.nlm.nih.gov/pubmed/16460691

Alice 105.9 - Timeline Photos

Alice 105.9 - Timeline Photos

Alice 105.9 - Timeline Photos

Options For Elder Care: Anosognosia

Options For Elder Care: There is NOTHING Wrong with Me and I Don’t Need Help! (Tips for dealing with a loved one who deny they have an impairment)

Options For Elder Care

"Expert" Advice on Aging In Place by Advocating the Clinical,

Psycho-Social, and Holistic (mind/body/spirit) Care of the Older Adult.

Bobbi is the President of Options For Elder Care and on the Board of

Directors of The National Society of Geriatric Care Managers (NAPGCM) 

 Anosognosia is not

denial, but the lack of knowing that an impairment, deficit, or illness

exists. It results from physical changes in brain cells most typically

in the right front side of the brain as well as in part of the lobes

directly just behind. Decreased self-awareness results from these brain

changes. To put it another way, “our right brain is wired to detect

anomalies and new information and incorporate these into our sense of

reality. When something happens to damage that part of the brain, the

left brain seeks to maintain continuity of belief, using denial,

rationalization, confabulation, and other tricks to keep one’s mental

model of the world intact” says neurologist Dr. V.S.  Ramachandran of

the New York Times.



The most frequent problem we see in our Geriatric Care Management

Practice is the person is no longer able to perform their activities of

daily living (ADLs) functions such as cooking, bathing, dressing,

financial management, taking medications, or remembering appointments.

When confronted, there is vehement denial anything is “wrong” and may

react with anger and defensiveness.

References

1. Ramachandran , v.s. (1995). Anosognosia in parietal lobe syndrome. Consciousness and Cognition, 4(1)




2. Ott, B.R.Lafleche, G.,Wheliham, W.M., Burongiorno, G.W., Albert,
   
   M.S. % Fogel, B.S. (1996). Impaired awareness of deficits in Alzheimer
   
   disease. Alzheimer Disease and Associated Disorders, 10 (2).




3. Xavier Amador, Anna-Lica, and Ph.D. Johanson, I am Not Sick I Don’t Need Help!Publisher: Vida Pr




4. Antoine C1, Antoine P, Guermonprez P, Frigard B., Awareness of deficits and anosognosia in Alzheimer's disease.  Encephale. 2004 Nov-Dec; 30(6):570-7

How much electricity does your appliances use?

Bartholomew County REMC:

Bartholomew County Rural
Electric Membership Corporation is an electric
cooperative located in Columbus, Indiana.

How much electricity does your appliances use?

 Take a look at what you can do for just a few pennies with the help of electricity:
 Use a 75-watt lamp for 14 hours for about 7 cents
Refrigerate food for a day for about 20 cents
Operate a window fan for about 1 cent an hour
Cook a meal on an electric range -using all the burners and the oven - for about 84 cents an hour.
 Use the self-cleaning feature on your oven for a total of 35 cents.
Wash a load of dishes in a dishwasher for about 7 cents

 What Does it Cost to Run My Appliances?

The appliance use chart above shows the most commonly used appliances and office equipment in homes, the average wattage of that equipment and the estimated average cost.

To calculate the exact use of your appliances, or for those not listed in this chart, use the following formula:

amps x volts = watts
watts x hours = watt-hours
watt-hours / 1000 = kilowatt-hours (kwhs)
kwh x .10 (10 cents) = estimated cost of using appliance.

Look for the serial plate on the bottom or back of the appliance. It lists the power used in terms of watts (120 watts might be written 120 w) or amps and volts.

For a larger appliance such as a water heater, remember that it is only running when it has clicked on and is actually heating water. The time your water heater is on varies according to how much you do laundry, take baths, or run the dishwasher. But, let's say your water heater is on for 3 hours on a particular day (the national average):

4,500 watts x 3 hours = 13,500 watt-hours
13,500 watt-hours / 1000 = 13.5 kwh
13.5 kwh x 10 cents = $1.35

There are several things you can do to use electricity more efficiently.

You will find that your electric furnace, air conditioner and water heater will make up the greatest percentage of your electric bill, so these are the areas in which to concentrate your energy management efforts.

Baypath - Resource Database

DisabilityInfo.org - Resource Database




1:1 Specializing

Personal Touch Home Aides
697 Cambridge ST
Suite 204
Brighton, MA
(617) 783-0700
Program Type(s):Home Health/Personal Care, Respite
Record last updated on:3/19/2012

Adult Day Services

Gardner Visiting Nursing Association
34 Pearly Lane
Gardner, MA
(978) 632-1230
Program Type(s):Outpatient Medical/Allied Health
Record last updated on:3/30/2009

Adult Family Care

Franklin County Home Care Corporation
330 Montague City Road
Suite 1
Turners Falls, MA
(413) 773-5555 - 255
Program Type(s):Adoption/Foster Care, Adult Family Care/Adult Foster Care, Aging, Community Based Residential Services, Day Care, Housing, Information/Referral, Legal/Advocacy, Options Counseling, Outpatient Medical/Allied Health, Respite, Support Groups-Networks, Transportation, Vocational
Record last updated on:5/30/2008

Aging Service Access Point

Boston Senior Home Care
99 South Street
# 500
Boston, MA
(617) 451-6400
Program Type(s):Aging, Options Counseling
Record last updated on:3/25/2009

Aging Service Access Point

Old Colony Elder Services
144 Main Street
Brockton, MA
(508) 584-1561
Program Type(s):Adult Family Care/Adult Foster Care, Aging, Case Management, Food and Nutrition, Home Health/Personal Care, Housing, Information/Referral, Options Counseling, Respite
Record last updated on:7/12/2012

Aging Service Access Point

Elder Services of Worcester Area, Inc.
67 Millbrook Street
100
Worcester, MA
(508) 756-1545
Program Type(s):Aging, Case Management, Community Based Residential Services, Consulting/Training, Day Care, Family Support, Food and Nutrition, Health Insurance, Home Health/Personal Care, Information/Referral, Options Counseling, Respite, Support Groups-Networks
Record last updated on:3/7/2014

Aging Service Access Point

Tri-Valley, Inc.
10 Mill ST
Dudley, MA
(508) 949-6640
Program Type(s):Adult Family Care/Adult Foster Care, Aging, Case Management, Family Support, Food and Nutrition, Home Health/Personal Care, Information/Referral, Options Counseling, Respite
Record last updated on:8/23/2013

Aging Service Access Point

Montachusett Home Care Corporation
680 Mechanic Street
Suite 120
Leominster, MA
(978) 537-7411
Program Type(s):Adult Family Care/Adult Foster Care, Aging, Case Management, Group Adult Foster Care, Information/Referral, Options Counseling, Respite, Support Groups-Networks
Record last updated on:3/7/2014

Aging Service Access Point / Area Agency on Aging

Minuteman Senior Services
26 Crosby Drive
Bedford, MA
(781) 272-7177 - x7064
Program Type(s):Aging, Case Management, Home Health/Personal Care, Information/Referral, Options Counseling
Record last updated on:3/17/2014

Aging Service Access Point / Area Agency On Aging

Springwell
307 Waverley Oaks Road
Suite 205
Waltham, MA
(617) 926-4100
Program Type(s):Aging, Case Management, Family Support, Food and Nutrition, Group Adult Foster Care, Home Health/Personal Care, Independent Living, Information/Referral, Options Counseling, Respite, Transportation
Record last updated on:2/15/2013

Aging Service Access Point / Area Agency on Aging

Elder Services of Berkshire County, Inc.
66 Wendell Avenue
Pittsfield, MA
(413) 499-0524
Program Type(s):Adult Family Care/Adult Foster Care, Aging, Case Management, Food and Nutrition, Group Adult Foster Care, Home Health/Personal Care, Housing, Independent Living, Information/Referral, Options Counseling, Respite, Support Groups-Networks, Transportation
Record last updated on:3/12/2013

Aging Service Access Point / Area Agency on Aging

SeniorCare Inc.
49 Blackburn Center
Gloucester, MA
(978) 281-1750 - (866) 927-1050
Program Type(s):Aging, Case Management, Family Support, Food and Nutrition, Group Adult Foster Care, Home Health/Personal Care, Independent Living, Information/Referral, Options Counseling, Respite, Support Groups-Networks, Transportation
Record last updated on:6/6/2012

Aging Service Access Point / Area Agency on Aging

WestMass ElderCare, Inc.
4 Valley Mill Road
Holyoke, MA
(413) 538-9020
Program Type(s):Adult Family Care/Adult Foster Care, Aging, Home Health/Personal Care, Information/Referral, Options Counseling, Respite
Record last updated on:7/9/2012

Aging Service Access Point / Area Agency on Aging

Mystic Valley Elder Services, Inc.
300 Commercial St.
Suite 19
Malden, MA
(781) 324-7705
Program Type(s):Aging, Case Management, Home Health/Personal Care, Information/Referral, Options Counseling
Record last updated on:3/30/2009

Aging Service Access Point / Area Agency on Aging

Greater Lynn Senior Services
8 Silbee Street
Lynn, MA
(781) 599-0110
Program Type(s):Aging, Information/Referral, Options Counseling, Transportation
Record last updated on:5/17/2012

Aging Service Access Point / Area Agency on Aging

North Shore Elder Services
152 Sylvan St
Danvers, MA
(978) 750-4540
Program Type(s):Case Management, Information/Referral, Options Counseling, Respite, Support Groups-Networks
Record last updated on:6/19/2012

Aging Service Access Point / Area Agency on Aging

South Shore Elder Services
1515 Washington Street
Braintree, MA
(781) 848-3910
Program Type(s):Aging, Case Management, Consulting/Training, Family Support, Home Health/Personal Care, Housing, Information/Referral, Options Counseling, Respite, Support Groups-Networks
Record last updated on:4/4/2014

Aging Service Access Point / Area Council on Aging

Franklin County Home Care Corporation
330 Montague City Road
Suite 1
Turners Falls, MA
(413) 773-5555
Program Type(s):Aging, Case Management, Day Care, Financial Assistance/Planning, Home Health/Personal Care, Housing, Information/Referral, Legal/Advocacy, Respite, Support Groups-Networks, Transitional/Supported Employment, Transportation, Vocational
Record last updated on:5/17/2011

Aging Service Access Point / Home Care / Area Agency on Aging

HESSCO Elder Services
One Merchant Street
Sharon, MA
(781) 784-4944
Program Type(s):Home Health/Personal Care, Options Counseling
Record last updated on:5/17/2012

All Care Resources, Inc.

210 Market St.
Lynn, MA
(781) 586-1610
Program Type(s):Case Management, Home Health/Personal Care, Respite, Transportation
Record last updated on:8/28/2013

All Care Visiting Nurse Association and Hospice

16 City Hall Square
Lynn, MA
(781) 598-2454
Program Type(s):Home Health/Personal Care, Respite
Record last updated on:4/21/2009

AlphaCare Home Health Agency

214 Lincoln St
Ste. 202
Allston, MA
617-600-4547
Program Type(s):Case Management, Group Adult Foster Care, Home Health/Personal Care
Record last updated on:1/3/2013

Always On Call Health Services, Inc.

285 Central Street
Suite 214
Leominster, MA
(978) 537-9900
Program Type(s):Home Health/Personal Care, Respite
Record last updated on:9/4/2012

Ameriken Caring Services Inc

199 Revere Street
001
Revere, MA
781-286-6916
Program Type(s):Adult Family Care/Adult Foster Care, After School Program, Consulting/Training, Counseling, Day Care, Day/Work Activity, Early Intervention, Group Adult Foster Care, Home Health/Personal Care, Independent Living, Information/Referral, Mental Health, Transportation
Record last updated on:5/6/2013

Beverly Outpatient Clinic

800 Cummings Center
Suite 266T
Beverly, MA
(978) 921-1190
Program Type(s):Mental Health
Record last updated on:7/7/2011

Beyond Healthcare

Beyond Healthcare Agency
136 Treble Cove Rd
North Billerica, MA
978-930-9410
Program Type(s):Home Health/Personal Care
Record last updated on:5/18/2012

Braintree Access Center

Habilitation Assistance Corporation
30 Foster Road
Braintree, MA
(781) 848-6466
Program Type(s):Day/Work Activity, Home Health/Personal Care, Social/Leisure, Transportation
Record last updated on:10/24/2011

Bright Care, Inc.

90 Madison Street
303
Worcester, MA
508-796-5302
Program Type(s):Home Health/Personal Care, Independent Living, Respite
Record last updated on:6/13/2013

Caring for the Elderly and Disabled

Griswold Special Care
490 Shrewsbury St.
Piccadilly Plaza Suite F
Worcester, MA
(508) 797-0400
Program Type(s):Home Health/Personal Care
Record last updated on:3/9/2012

Caring for the Elderly and Disabled

Griswold Special Care
124 Crescent Road
Needham, MA
(781) 449-0402
Program Type(s):Home Health/Personal Care
Record last updated on:7/20/2010

Community Based Day Program

Triangle, Inc
420 Pearl Street
Malden, MA
(781) 322-0400
Program Type(s):Community Based Residential Services, Day/Work Activity, Transitional/Supported Employment, Vocational
Record last updated on:8/13/2013

Community Services Department

Franklin County Home Care Corporation / Area Agency on Aging
330 Montague City Road/ Suite 1
Turners Falls, MA
(413) 773-5555 - x2215
Program Type(s):Adult Family Care/Adult Foster Care, Aging, Case Management, Community Based Residential Services, Counseling, Day Care, Equipment Funding Assist/Consult, Equipment Loan, Equipment Technical Assistance, Family Support, Financial Assistance/Planning, Food and Nutrition, Group Adult Foster Care, Health Insurance, Home Health/Personal Care, Home Modification, Housing, Independent Living, Information/Referral, Legal, Legal/Advocacy, Options Counseling, Outpatient Medical/Allied Health, Relationships/Friendships, Respite, Support Groups-Networks, Transportation
Record last updated on:8/23/2013

Congregate Housing

Franklin County Home Care Corporation
330 Montagne City Road
Turners Falls, MA
(413) 773-5555
Program Type(s):Housing
Record last updated on:9/4/2012

Coolidge Program

ServiceNet, Inc.
129 King Street
Northampton, MA
(413) 586-6432
Program Type(s):Housing
Record last updated on:4/7/2008

DPH Northeast Regional Health Office

Massachusetts Department Public Health
365 East Street
Tewksbury, MA
(978) 851-7261 - 4011
Program Type(s):Advocacy, Case Management, Community Based Residential Services, Diagnosis/Evaluation, DPH Certified Early Intervention, Early Intervention, Family Support, Family Support birth to 3, Food and Nutrition, Outpatient Medical/Allied Health, Respite
Record last updated on:9/19/2011

Family Home Visiting Program

Pernet Family Health Service
237 Millbury Street
Worcester, MA
(508) 755-1228
Program Type(s):After School Program, Case Management, DPH Certified Early Intervention, Early Intervention, Family Support, Family Support birth to 3, Food and Nutrition, Home Health/Personal Care, Information/Referral, Social/Leisure, Support Groups-Networks
Record last updated on:8/23/2013

Family Support Program

Bay Cove Human Services, Inc.
66 Canal Street
2nd Floor
Boston, MA
(617) 371-3000
Program Type(s):Community Based Residential Services, Family Support, Housing
Record last updated on:11/27/2007

Family Support/PCA Services

Toward Independent Living & Learning
20 Eastbrook Road
Suite 201
Dedham, MA
(781) 302-4600
Program Type(s):Mental Health, Respite, Support Groups-Networks
Record last updated on:10/24/2012

HHA & PC/HM Services

VNA of the Berkshires
165 Tor Court
Pittsfield, MA
(413) 447-2862
Program Type(s):Home Health/Personal Care, Respite
Record last updated on:11/8/2011

Home Care Assistance Program

Massachusetts Rehabilitation Commission
600 Washington St.
Boston, MA
(617) 204-3853
Program Type(s):Home Health/Personal Care
Record last updated on:5/16/2013

Home Care Program

Gentiva Health Services
1 Arch Place
Greenfield, MA
(413) 774-7045
Program Type(s):Home Health/Personal Care, Respite
Record last updated on:2/26/2009

Home Care Program

Ethos
555 Amory Street
Jamaica Plain, MA
(617) 522-6700 - ext 341
Program Type(s):Aging, Case Management, Food and Nutrition, Home Health/Personal Care, Independent Living, Integrated Community Program, Options Counseling
Record last updated on:11/13/2012

Home Care Services

Family Services of Central Massachusetts
31 Harvard Street
Worcester, MA
(508) 756-4696
Program Type(s):Home Health/Personal Care
Record last updated on:8/17/2010

Home Care Services/Elder Protective Services

Franklin County Home Care Corporation
330 Montague City Road
Suite 1
Turners Falls, MA
(413) 773-5555
Program Type(s):Aging, Information/Referral, Legal/Advocacy
Record last updated on:9/6/2013

Home Care, Inc.

360 Merrimack Street
Bldg 9
Lawrence, MA
(978) 552-4701
Program Type(s):Home Health/Personal Care
Record last updated on:9/6/2013

Home Health / Personal Care

Griswold Special Care
490 Shrewsbury ST
#F
Worcester, MA
(508) 797-0400
Program Type(s):Home Health/Personal Care
Record last updated on:3/6/2012

Home Health Care

Partners Private Care
70 Everett Ave. Suite 505
Chelsea, MA
508-879-7070
Program Type(s):Home Health/Personal Care
Record last updated on:6/22/2012

Home Health Care Program

Gardner Visiting Nursing Association
34 Pearly Lane
Gardner, MA
(978) 632-1230 - x3044
Program Type(s):Home Health/Personal Care, Support Groups-Networks
Record last updated on:3/15/2011

Home Health Care Program

Visiting Nurses Association of the Berkshires
75 South Church Street
Pittsfield, MA
(413) 447-2862
Program Type(s):Home Health/Personal Care
Record last updated on:5/29/2013

Home Health Care Services

Home Staff
40 Millbrook St
Ste 1
Worcester, MA
(508) 755-4600
Program Type(s):Home Health/Personal Care, Respite
Record last updated on:8/16/2013

Home Health Care Services / Youth and Family Support

Supportive Care
15 Union Street
#410
Lawrence, MA
(978) 686-1300
Program Type(s):Advocacy, Case Management, Home Health/Personal Care, Respite, Support Groups-Networks
Record last updated on:11/8/2011

Home Health Services

Chicopee Visting Nurses Association, Inc.
2024 Westover Road
Chicopee, MA
(413) 533-6733
Program Type(s):Home Health/Personal Care
Record last updated on:4/6/2009

Home Health Services

Partners Homecare
200 Ledgewood PL
Rockland, MA
(781) 290-4000
Program Type(s):Home Health/Personal Care
Record last updated on:3/15/2011

Home Health/Personal Care/Home Modification/Heavy Cleaning

HouseWorks
One Gateway Center
Suite 902
Newton, MA
(617) 928-1010
Program Type(s):Aging, Case Management, Equipment, Family Support, Home Health/Personal Care, Home Modification, Information/Referral, Respite, Support Groups-Networks, Transportation
Record last updated on:9/28/2011

Home Hospice Care

Gardner Visiting Nursing Association
34 Pearly Lane
Gardner, MA
(978) 632-1230
Program Type(s):Home Health/Personal Care, Support Groups-Networks
Record last updated on:7/10/2012

Home Instead Senior Care

440 Totten Pond Road
Suite 300
Waltham, MA
617-229-7962
Program Type(s):Home Health/Personal Care, Respite, Transportation
Record last updated on:5/17/2012

Home Modifications

Building Matters Inc.
563 Mammoth Road
Pelham, NH
978-490-9966
Program Type(s):Home Modification
Record last updated on:1/10/2014

Homemaker/Personal Care/Home Health Aide

Home Staff
40 Millbrook Street
Worcester, MA
(508) 755-4600
Program Type(s):Home Health/Personal Care, Respite
Record last updated on:4/2/2012

In Home Care Services

Griswold Special Care
24 Adam ST
Quincy, MA
(617) 770-0707
Program Type(s):Home Health/Personal Care
Record last updated on:7/2/2009

Independence Health Care

100 Grove Street
Worcester, MA
(508) 767-1776
Program Type(s):Home Health/Personal Care, Respite, Transportation
Record last updated on:3/9/2012

Independent Living Social Services

Massachusetts Commission for the Blind - Region II
390 Main Street
Suite 620
Worcester, MA
(508) 754-1148 - V/TTY
Program Type(s):Home Health/Personal Care, Information/Referral, Support Groups-Networks
Record last updated on:3/9/2012

Individual Support Services

Cooperative for Human Services, Inc.
17 New England Executive Park
3rd Floor
Burlington, MA
(781) 273-2123 - x 230
Program Type(s):Advocacy, Aging, Case Management, Club Houses, Communication, Community Based Residential Services, Consulting/Training, Counseling, Equipment Funding Assist/Consult, Family Support, Financial Assistance/Planning, Food and Nutrition, Home Health/Personal Care, Home Modification, Housing, Independent Living, Information/Referral, Legal/Advocacy, Mental Health, Relationships/Friendships, Respite, Social/Leisure, Support Groups-Networks, Transportation, Travel
Record last updated on:11/19/2012

Inhome Care

Comfort Keepers
67 Federal Ave
Quincy, MA
617-890-1075
Program Type(s):Aging, Day Care, Home Health/Personal Care, Respite, Transportation
Record last updated on:12/9/2009

Intercity Home Health Care, Inc.

11 Dartmouth Street
Malden, MA
(781) 321-6300
Program Type(s):Home Health/Personal Care, Respite
Record last updated on:8/19/2009

Juniper House Community Residence

Newton Wellesley Weston Committee
1301 Centre ST
Newton, MA
(617) 964-6860
Program Type(s):Advocacy, Aging, Case Management, Community Based Residential Services, Consulting/Training, Counseling, Family Support, Food and Nutrition, Home Health/Personal Care, Housing, Independent Living, Information/Referral, Integrated Community Program
Record last updated on:7/18/2011

Living Assistance Services

Visiting Angels of the South Shore
475 School ST
Marshfield, MA
(781) 834-6355
Program Type(s):Aging, Home Health/Personal Care, Respite
Record last updated on:11/17/2011

Movement Disorders Clinic

University of Massachusetts Medical Center
55 Lake Avenue N
Worcester, MA
(508) 334-2527
Program Type(s):Diagnosis/Evaluation, Outpatient Medical/Allied Health
Record last updated on:5/23/2012

Multicultural Home Care

599 Canal St.
Lawrence, MA
978-689-8666
Program Type(s):
Record last updated on:2/24/2010

Nashoba Nursing Service & Hospice

Nashoba Nursing Service &Hospice
2 Shaker Rd
Suite D225
Shirley, MA
(978) 425-6675
Program Type(s):Home Health/Personal Care, Respite
Record last updated on:8/3/2010

Partners HealthCare at Home

281 Winter Street
Suite 240
Waltham, MA
(781) 290-4000
Program Type(s):Home Health/Personal Care
Record last updated on:9/10/2012

Pediatric/Parent Child Health Program

VNA of Eastern MA
259 Lowell ST
Somerville, MA
(617) 776-9800
Program Type(s):Home Health/Personal Care, Respite
Record last updated on:5/6/2008

Personal Care Assistance

Franklin County Home Care Corporation
330 Montague City Road
Suite 1
Turners Falls, MA
(413) 773-5555
Program Type(s):Aging, Home Health/Personal Care, Independent Living, Information/Referral
Record last updated on:4/2/2010

Personal Care Attendant Services

Boston Center for Independent Living
60 Temple Place
5th Floor
Boston, MA
(617) 338-6665
Program Type(s):Home Health/Personal Care
Record last updated on:3/6/2012

Premier Home Health

657 Quarry St
Ste 107
Fall River, MA
(508) 679-8796
Program Type(s):Home Health/Personal Care, Respite
Record last updated on:7/5/2011

Premier Home Health Care of Massachusetts

Premier Home Health Care of Massachusetts, Inc.
300 W Main Street
St 5
Northborough, MA
(508) 393-8570
Program Type(s):Home Health/Personal Care, Respite
Record last updated on:9/30/2011

Private Duty Nursing, Nursing Services

Centrus Premier Home Care
770 W Boylston Street.
#A
Worcester, MA
(508) 754-8205
Program Type(s):Home Health/Personal Care
Record last updated on:3/26/2009

Programs, Services,Information, and Referrals

Charles River Center
59 East Militia Heights Road
Needham, MA
(781) 972-1000
Program Type(s):After School Program, Case Management, Community Based Residential Services, Day/Work Activity, Family Support, Independent Living, Information/Referral, Respite, Social/Leisure, Support Groups-Networks, Transitional/Supported Employment, Vocational
Record last updated on:7/10/2012

Rehabilitation Teaching

Massachusetts Commission for the Blind - Region I
436 Dwight ST
Springfield, MA
(413) 781-1290
Program Type(s):Home Health/Personal Care
Record last updated on:12/8/2011

Rehabilitation Teaching

Massachusetts Commission for the Blind - Region II
390 Main Street
Ste 620
Worcester, MA
(508) 754-1148
Program Type(s):Home Health/Personal Care
Record last updated on:10/27/2011

Rehabilitation Teaching

Massachusetts Commission for the Blind
48 Boylston Street
Boston, MA
(617) 626-7579
Program Type(s):Home Health/Personal Care
Record last updated on:12/13/2007

Residential Programs

Newton Wellesley Weston Committee For Community Living, Inc.
1301 Centre Street
Newton, MA
(617) 964-6860
Program Type(s):Community Based Residential Services, Housing, Independent Living, Information/Referral, Social/Leisure, Transportation
Record last updated on:2/24/2012

Residential Programs ID/DD

Bay Cove Human Services, Inc.
66 Canal Street
Boston, MA
(617) 371-3000
Program Type(s):Community Based Residential Services, Housing
Record last updated on:9/21/2010

Respite Care

Molari Health Care
80 Center Street
Pittsfield, MA
(413) 499-4562
Program Type(s):Home Health/Personal Care, Respite
Record last updated on:2/17/2012

Respite Care Program

Personal Touch Home Aides
697 Cambridge Street
Suite 204
Brighton, MA
(617) 783-0700
Program Type(s):Respite
Record last updated on:8/19/2009

Respite Care Program/Private Duty Agency

Home Staff
40 Milbrook Street
Ste 1
Worcester, MA
(508) 755-4600
Program Type(s):Respite
Record last updated on:5/3/2012

Right At Home

19 Front Street
Ste 301
Salem, MA
(978) 744-5151
Program Type(s):Aging, Home Health/Personal Care, Information/Referral, Respite, Transportation
Record last updated on:7/6/2009

Roxbury Comprehensive Community Health Center, Inc.

435 Warren Street
Roxbury, MA
(617) 442-7400 - x 228
Program Type(s):Adult Family Care/Adult Foster Care, After School Program, Case Management, Outpatient Medical/Allied Health
Record last updated on:8/25/2008

Social Rehabilitation

Massachusetts Commission for the Blind
48 Boylston Street
Boston, MA
(617) 626-7579
Program Type(s):Home Health/Personal Care, Support Groups-Networks
Record last updated on:12/13/2007

Social Rehabilitation & Vocational Rehab

Massachusetts Commission for the Blind - Region I
436 Dwight ST
Room 109
Springfield, MA
(413) 781-1290
Program Type(s):Advocacy, Case Management, Information/Referral, Vocational
Record last updated on:10/9/2012

South Bay Early Intervention

1563 N Main ST
Ste 202
Fall River, MA
(508) 324-1060
Program Type(s):Diagnosis/Evaluation, DPH Certified Early Intervention, Family Support birth to 3
Record last updated on:7/24/2009

Support Services Programs

Massachusetts Commission for the Blind - Region I
436 Dwight ST
Room 109
Springfield, MA
(413) 781-1290
Program Type(s):Respite
Record last updated on:5/29/2012

Support Services Programs

Massachusetts Commission for the Blind - Region II
390 Main St
# 620
Worcester, MA
(508) 754-1148
Program Type(s):Respite
Record last updated on:10/6/2011

Supportive Community Living & Shared Living

The Arc of Opportunity
564 Main St.
Fitchburg, MA
(978) 345-6301
Program Type(s):Case Management, Community Based Residential Services, Housing, Independent Living
Record last updated on:2/3/2012

The Ledges, Inc.

PO Box 38
Hopedale, MA
(508) 473-6520
Program Type(s):Aging, Case Management, Community Based Residential Services, Consulting/Training, Counseling, Day/Work Activity, Employment, Holistic Health, Housing, Independent Living, Integrated Community Program, Respite, Social/Leisure, Transitional/Supported Employment, Travel, Vocational
Record last updated on:3/30/2012

Transportation Program

John F. Kennedy Family Services
10 City Square
Ste 4
Charlestown, MA
(617) 241-8866
Program Type(s):Transportation
Record last updated on:3/6/2009

Upper Cape Access Center

Habilitation Assistance Corporation
25 Barlows Landing Road
Pocasset, MA
(508) 564-5101
Program Type(s):Day/Work Activity, Home Health/Personal Care, Social/Leisure, Transportation
Record last updated on:10/24/2011

Visiting Angels, Living Assistance Services

34 Robbvins Road
Springfield, MA
413-733-6900
Program Type(s):Home Health/Personal Care, Respite
Record last updated on:6/15/2010

VNA Care Network

120 Thomas Street
Worcester, MA
(508) 751-6860
Program Type(s):Home Health/Personal Care, Respite, Support Groups-Networks
Record last updated on:7/15/2011

VNA of Cape Cod, Inc.

255 Independence Drive
Hyannis, MA
(800) 631-3900
Program Type(s):Home Health/Personal Care
Record last updated on:8/10/2010

Vocational Rehabilitation

Massachusetts Commission for the Blind
48 Boylston Street
Boston, MA
(617) 727-5550
Program Type(s):Vocational
Record last updated on:12/13/2007

Welch Home Health, Inc.

52 Accord Park Drive
Norwell, MA
(781) 878-5020
Program Type(s):Home Health/Personal Care, Respite
Record last updated on:11/8/2011

WestMass Elder Care State Homecare

WestMass Elder Care
4 Valley Mill RD
Holyoke, MA
(800) 875-0287 - TTY
Program Type(s):Adult Family Care/Adult Foster Care, Aging, Case Management, Information/Referral, Options Counseling, Respite
Record last updated on:7/16/2012

Coordinating Care on the Rise | Federal Telemedicine News

Coordinating Care on the Rise

Apr.9,2014



Telehealth is enabling improved patient care transitions, care coordination, and chronic disease management to take place in many communities. This can take place when a patient leaves the hospital to go home or to a skilled nursing facility and sometimes even back to the hospital. Poorly managed transitions can affect the patient’s health and at the same time increase costs that can result in billions of dollars in wasteful spending.





--





Vickie O. Morgan, RN, Clinical Director of Operations for the Home Care Division within the Riverside Health System at www.riversideonline.com

works mainly with older adult patients unable to access regular medical

care. Physicians and nurse practitioners trained in primary care are

working together to develop and design a plan for the care. They are

determining if telemonitoring can be used effectively so that a smooth

transition from the hospital to the home can be achieved.










“Technology used such as a watch device or a tablet can acquire

health data by the minute”, notes Loretta Schlachta-Fairchild, PhD, RN,

retired U.S Army and now President and CEO of iTelehealth Inc. at www.itelehealthinc.com

Personal Senior Advocates | Huntington Beach, CA

 Personal Senior Advocates

In Home Care Program Allows AD Dementia Patients to Stay Home Longer | Alzheimer's Reading Room

In Home Care Program Allows AD Dementia Patients to Stay Home Longer | Alzheimer's Reading Room: Dementia and the Eight Types of Dementia

 Learning How to Communicate with Someone Suffering From Alzheimer's Disease

Ten Tips for Communicating with an Alzheimer’s Patient

Alzheimer's, Urinary Incontinence, Urinary Tract Infections

Alzheimer's Caregiving Dealing with Behavior

Rewiring My Brain and Stepping into Alzheimer's World

Original content Bob DeMarco, the Alzheimer's Reading Room