Are Dementia and Pleasure Mutually Exclusive States?

Chris Laxton expertby Chris Laxton, Executive Director of AMDA, the Society for Post-acute and Long-term Care Medicine

Dementia, including Alzheimer’s disease, confronts us with a challenge: How do we live fully – with dignity, meaning and happiness – in the face of progressive disability and, ultimately, death? Those living with dementia have cognitive and decision-making impairments that often make them unable to answer this question. And when those who provide care and services for them fail to recognize what is meaningful, positive and pleasurable for persons with dementia, they suffer. Furthermore, we need a health care system that fosters dementia-capable caregiving, so that everyone has the opportunity to live fully, with dignity and well-being. Why don’t we have such a system, and what do we need to do to achieve it? Continue reading

In a New York Times editorial last year (“Too Young to Die, Too Old to Worry,” Sept. 20, 2014), Jason Karlawish, MD, a professor of medicine, medical ethics and health policy at the University of Pennsylvania, presented a thought-provoking question: “When should we set aside a life lived for the future, and, instead, embrace the pleasures of the present?” He also offered this challenge: “A national investment in communities and services that improve the quality of our aging lives might help us to achieve this.”

Dr. Karlawish, who will present a keynote address at the 2015 AMDA annual conference in Louisville this month, reminds us that this issue is highly significant for those living with dementia, including Alzheimer’s disease, and their care partners, as they are on the front line in considering the lingering question of how to live fully with the time they have left. Is it an absolute necessity that living with dementia means a life spent “fighting the disease” – or can we posit that a life lived fully is actually a higher value?

“Aging in the 21st century is all about risk and its reduction,” says Karlawish. “Today, 3.6 percent of the [U.S.] population is over 80, and life is heavily prescribed not only with the behaviors we should avoid, but the medications we ought to take. More than half of adults age 65 and older are taking five or more medications or supplements, many of them designed not to treat acute suffering, but instead, to reduce the chances of future suffering.”

Often, families and other care partners think they are doing the right thing for their loved ones by imposing burdensome treatments or interventions. But Dr. Karlawish suggests we ask family members what constitutes a good day even when a person has advanced dementia. “We need to focus on what gives pleasure now, in the present,” he says. This can be a challenge, but it’s an important one. “When individuals have dementia, their lives – their very selves – are constructed by the people around them. We shape their personhood, and that is a tremendous moral responsibility.”*

Taking on this responsibility is at the essence of person-centered care – a concept at the very heart of what we call “dementia-capable” models of care delivery, communities, and caregivers. Let’s work together to bring such a system into being. An entire generation of those living with dementia, and their care partners, deserve no less.

*Excerpted from “Keynoter Puts Patient Pleasure First,” Caring for the Ages, January 2015.

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Dementia: Mental Activity Delays Onset; Accelerates & Compresses the Progression

Dr. WilsonBy Robert S. Wilson, PhD, Rush University Medical Center; Neurology®, the medical journal of the American Academy of Neurology, September 1, 2010

New research shows that mentally stimulating activities such as crossword puzzles, reading and listening to the radio may, at first, slow the decline of thinking skills but speed up dementia later in old age.

“Our results suggest that the benefit of delaying the initial signs of cognitive decline may come at the cost of more rapid dementia progression later on, but the question is why does this happen?” Dr. Wilson.

According to Wilson, mentally stimulating activities may somehow enhance the brain’s ability to function relatively normally despite the buildup of lesions in the brain associated with dementia. However, once they are diagnosed with dementia, people who have a more mentally active lifestyle are likely to have more brain changes related to dementia compared to those without a lot of mental activity. As a result, those with more mentally active lifestyles may experience a faster rate of decline once dementia begins. Continue reading

Wilson noted that mental activities compress the time period that a person spends with dementia, delaying its start and then speeding up its progress. “This reduces the overall amount of time that a person may suffer from dementia,” he said.

For the study, researchers evaluated the mental activities of 1,157 people age 65 or older who did not have dementia at the start of the nearly 12-year study. People answered questions about how often they participated in mental activities such as listening to the radio, watching television, reading, playing games and going to a museum; for this five-point cognitive activity scale, the more points scored, the more often people participated in mentally stimulating exercises.

During the next six years, the study found that the rate of cognitive decline in people without cognitive impairment was reduced by 52 percent for each point on the cognitive activity scale. For people with Alzheimer’s disease, the average rate of decline per year increased by 42 percent for each point on the cognitive activity scale.

The study was supported by the National Institute on Aging & the National Institute of Environmental Health Sciences.

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By Richard Powers: Richard has been teaching historic and contemporary social Senior_dancesdance for 40 years. He leads workshops around the world and is currently a full-time instructor at Stanford University’s Dance Division.

For centuries, dance manuals and other writings have lauded the health benefits of dancing, usually as physical exercise. More recently we’ve seen research on further health benefits of dancing, such as stress reduction and increased serotonin level, with its sense of well-being. More recently we’ve heard of another benefit: Frequent dancing apparently makes us smarter.

A major study added to the growing evidence that stimulating one’s mind by dancing can ward off Alzheimer’s disease and other dementia, much as physical exercise can keep the body fit. Dancing also increases cognitive acuity at all ages.

You may have heard about the New England Journal of Medicine report on the effects of recreational activities on mental acuity in aging. Here it is in a nutshell:

The 21-year study of senior citizens, 75 and older, was led by the Albert Einstein College of Medicine in New York City, funded by the National Institute on Aging, and published in the New England Journal of Medicine. Their method for objectively measuring mental acuity in aging was to monitor rates of dementia, including Alzheimer’s disease.

The study wanted to see if any physical or cognitive recreational activities influenced mental acuity and discovered that some activities had a significant beneficial effect while others had none.
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Cognitive activities such as reading books, writing for pleasure, doing crossword puzzles, playing cards and playing musical instruments were studied; as were physical activities like playing tennis or golf, swimming, bicycling, dancing, walking for exercise and doing housework.

One of the surprises of the study was that almost none of the physical activities appeared to offer any protection against dementia. There can be cardiovascular benefits of course, but the focus of this study was the mind. There was one important exception: the only physical activity to offer protection against dementia was frequent dancing:

Reading – 35% reduced risk of dementia
Bicycling and swimming – 0%
Doing crossword puzzles at least four days a week – 47%
Playing golf – 0%
Dancing frequently – 76%, the greatest risk reduction of any activity studied, cognitive or physical.

What could cause these significant cognitive benefits? Neurologist Dr. Robert Katzman proposed these persons are more resistant to the effects of dementia as a result of having greater cognitive reserve and increased complexity of neuronal synapses. Like education, participation in mentally engaging activities lowers the risk of dementia by improving these neural qualities.

As Harvard Medical School psychiatrist Dr. Joseph Coyle explains in an accompanying commentary: “The cerebral cortex and hippocampus, which are critical to these activities, are remarkably plastic, and they rewire themselves based upon their use.”

Our brain constantly rewires its neural pathways, as needed. If it doesn’t need to, then it won’t.

When brain cells die and synapses weaken with aging, our nouns go first, like names of people, because there’s only one neural pathway connecting to that stored information. If the single neural connection to that name fades, we lose access to it. As people age, some of them learn to parallel process, to come up with synonyms to go around these roadblocks.

The key here is Dr. Katzman’s emphasis on the complexity of our neuronal synapses. More is better. Do whatever you can to create new neural paths. The opposite of this is taking the same old well-worn path over and over again, with habitual patterns of thinking and living. . . We need to keep as many of those paths active as we can, while also generating new paths, to maintain the complexity of our neuronal connections. In other words: Intelligence — use it or lose it.

We immediately ask two questions: 1) Why is dancing better than other activities for improving mental capabilities? 2) Does this mean all kinds of dancing, or is one kind of dancing better than another?

. . .The essence of intelligence is making decisions. The best advice, when it comes to improving your mental acuity, is to involve yourself in activities that require split-second rapid-fire decision-making, as opposed to rote memory (retracing the same well-worn paths), or just working on your physical style.

One way to do that is to learn something new. Not just dancing, but anything new. Don’t worry about the probability that you’ll never use it in the future. Take a class to challenge your mind. It will stimulate the connectivity of your brain by generating the need for new pathways. Difficult classes are better for you, as they will create a greater need for new neural pathways.

Then take a dance class, which can be even more effective. Dancing integrates several brain functions at once — kinesthetic, rational, musical, and emotional — further increasing your neural connectivity.

In social dancing, the Follow role automatically gains a benefit, by making hundreds of split-second decisions as to what to do next, sometimes unconsciously so. As I mentioned on this page, women don’t “follow”, they interpret the signals their partners are giving them, and this requires intelligence and decision-making, which is active, not passive.

This benefit is greatly enhanced by dancing with different partners, not always with the same fellow. With different dance partners, you have to adjust much more and be aware of more variables. This is great for staying smarter longer.

The study made another important suggestion: do it often. Seniors who did crossword puzzles four days a week had a measurably lower risk of dementia than those who did the puzzles once a week. If you can’t take classes or go out dancing four times a week, then dance as much as you can. More is better. And do it now, the sooner the better. It’s essential to start building your cognitive reserve now. Some day you’ll need as many of those stepping-stones across the creek as possible. Don’t wait — start building them now.

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A Plea for Better End of Life Care

Dr. Atul Gawande, bestselling author of Being Mortal: Medicine and What Matters in the End.
In order to provide better medical care to the seriously ill, physicians must ask patients about their goals of care and end of life wishes.

Gawande, a general surgeon at Brigham and Women’s Hospital in Boston, addressed hundreds of medical students and physicians at the University of Chicago Medical School… He asked that they listen to patients’ concerns and recognize that prolonging life may not always be the best medical option for the dying.

“We have failed to recognize in medicine and society that people have priorities besides just living longer, that they have aims and goals,” he said. “The most effective way to find peoples’ priorities is to ask. But we don’t ask.” In the hospital setting, the physician often speaks more than the patient, Gawande added.

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Some terminally ill patients wish to remain mobile or mentally competent enough to walk their dog or eat at a favorite restaurant; others wish for enough time to say goodbye to loved ones.

“At the end of life, people want to still participate, have a role and make memories,” he said. Because aggressive, often unnecessary, treatments can stymie mobility and cognitive ability, Gawande recommends that doctors familiarize themselves with the benefits of hospice and palliative medicine.

We have failed to recognize in medicine and society that people have priorities besides just living longer, that they have aims and goals.

Gawande urged physicians and nurses to ask their patients if they truly understand the nature of their disease. Only with this understanding can a physician begin to provide guidance, he added. Patients and families would be more comfortable enrolling in earlier palliative treatments if they are told about the benefits soon after diagnosis.

Throughout his new book, Being Mortal, Gawande tackles the negative impacts of some relatively new life-prolonging treatments on the seriously ill.

“I never expected that among the most meaningful experiences I’d have as a doctor — and, really, as a human being — would come from helping others deal with what medicine cannot do as well as what it can,” he writes.

Unfortunately, many medical students avoid pursuing careers in geriatrics – care for the aged and ill – often due to the lower pay and the difficult, often emotional, nature of the work.

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Alzheimer’s Claims One Half of Click & Clack

Click & ClackOn Monday, November 3rd, Tom Magliozzi, one half of Car Talk’s Click and Clack, succumbed to complications due to Alzheimer’s. Tom and his brother Ray were experts in soul-cleansing, captivating humor. In honor of what they have brought us for over 35 years, we dedicate this “Featured Expert” space to the joy they brought.  Click on their photo and enjoy.

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Staying One Step Ahead of the Mortician

Martin Bayneby: Martin Bayne a journalist, Buddhist monk, MIT graduate, and well-known advocate for the aging. In the nineties, at the peak of his professional career and personal eldercare advocacy, Bayne was diagnosed with Parkinson’s Disease. For the past ten years he has lived in an assisted living facility.

Prior to my diagnosis of Young Onset Parkinson’s Disease in 1994, just before my 44th birthday, the concepts of morbidity and mortality were statistical anomalies; ignored, for the most part, like unwanted relatives. That would change, however, in ways I could not fathom.

Three weeks ago I was taken by ambulance from the Assisted Living Facility (ALF) I now call home, to an acute care hospital ER where I presented with a 103o fever, delirium and difficulty breathing. After eight hours of poking, prodding, blood work and X-rays, I was diagnosed with pneumonia and exacerbation of congestive heart failure. I waited for a bed on an ICU step-down unit to open, and three hours later was admitted to the sixth-floor unit, where a broad-spectrum antibiotic (the first of sixteen IVs) was started in my left antecubital vein.

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A week later and pneumonia-free, I was transferred to a Skilled Nursing Facility for rehab – a move mandated by my ALF. Finally, after two weeks of physical and occupational therapy, I returned home yesterday, closing the circle, and once again cheating the Grim Reaper.

After twelve years of life in an ALF, I’d like to report that going toe-to-toe with death has become just another fact of life. But it hasn’t. In fact, the older I get (now 64), the more I dig in with all the tenacity I can muster to stave off what I know is natural and inevitable.

Americans rarely talk openly about death — the hospice movement is trying to change that, but the chronology of genuine change is more likely to be measured in generations than years.

According to The National Hospice and Palliative Care Organization (NHPCO), the name “hospice” was first applied to specialized care for dying patients by physician Dame Cicely Saunders, who began her work with the terminally ill in 1948 and eventually went on to create the first modern hospice—St. Christopher’s Hospice—in a residential suburb of London. Considered the model for quality compassionate care for people facing a life-limiting illness, hospice provides expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient’s needs and wishes. Support is provided to the patient’s loved ones as well.

I’ve witnessed a significant number of my fellow residents — in three ALFs, over a twelve year period — drop their bodies and move on. Some transitioned quickly, with no fanfare or goodbyes; often in their sleep, while still others appeared to slowly enter a deep and silent hibernation.

When possible, and the family deemed it appropriate, I would spend time with the dying resident, often holding their hand and reading from an inspirational book or web page ( Other times I would merely sit quietly next to their bed, in meditation – never a “pity party,” just a proper Bon Voyage from a fellow human being.Holding Hands 300×195 Staying One Step Ahead of the Mortician

I was particularly moved by “Charles,” a man in his mid-nineties who sat by himself in the dining room, conversed with none of the other residents, and always wore the same faded-grey trousers and blue cardigan sweater. One day I walked over to his table after lunch and extended my hand. He starred at me for what seemed like an eternity. Then, slowly and cautiously he raised his hand to meet mine. When our hands touched, I was moved beyond words, and I watched as a smile spread across his face. After that day, at the end of every meal, I would make my way across the dining room to shake his hand. Neither spoke; but volumes could have been written about the change in each of our lives.

The grey trousers and cardigan sweater? He threw them away and began to wear colorful outfits – and one day walked into breakfast with a muted pink shirt and dark pink sweater. Something inside me said it was his last day on earth, and after his meal was finished, he broke tradition and walked over to my table, taking my hand in his. Tears were already streaming down my cheeks. “Don’t worry,” he said, a smile playing at the corners of his mouth. “Everything will be all right.” That night, Charles died, taking a part of me with him.

Will I have the grace and courage to look death in the eye and smile when it’s my time to pass?

Hard to say. But in the interim, there are hands to shake and lives to touch.

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In the End, It Is About Life

Salwitz 2by James Salwitz, MD, Oncologist: He has  been listed as a Top Doctor in U.S. News & World Report and Top Doctors: New York Metro Area.

The Institute of Medicine of the National Academies has released their long anticipated 500-page report, titled Dying in America – Improving Quality and Honoring Individual Preferences near the End of Life. This is a critical addition to the ongoing conversation about health care in the United States and makes observations and conclusions, which we need to consider and understand. They conclude, as has been said before, that we waste precious resource’s as we fail to give good end-of-life care, millions suffer needlessly, and that we can and must do much better; it is time we opened ourselves to the conversation and our obligation to one another.

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The report is a remarkable achievement which, like other IOM reports, will be sited during debates, research and planning. They note that with the aging of our population our reluctance to address final planning is a crisis, which affects in disproportionate numbers, not only the elderly, but also any group receiving marginal healthcare. Paradoxically, in the most technologically advanced medical centers, the futile focus on treatment in terminal situations not only wastes dollars it wastes life and causes suffering. As the result of “knowledge gaps, structural problems and financial disincentives,” our poor and painful approach to end-of-life care is perhaps the most perverse result of our fragmented health system.

IOM emphasizes education in end-of-life choices and planning, perhaps starting with organ donation on teenage driver licenses, and continuing through all healthcare contact during a person’s life. Patients and families need to be engaged and educated to discuss and plan long before they are consumed actually fighting disease or making wrenching last minute decisions. To this end, American citizens, doctors and all health care providers need to learn the alternatives, treatment possibilities and confront the challenging topic of dying. While the IOM was encouraged by the expansion of the medical specialty of Palliative Care, they note that there will always be too many people near the end of their lives to be cared for by just a few specialists, rather there is the need for all doctors who serve patients with life threatening disease to be skilled in giving quality end-of-life counseling and care.

The report focus on “person-centered, family oriented End-of-Life Care” is to be applauded. Nonetheless, there will be those that will interpret the emphasis on “compassionate, affordable, sustainable” treatment as suggesting that the hidden agenda is to save dollars at the expense of lives. Such an analysis would corrupt the truth and miss the critical goal of empowering each individual to make decisions regarding how they wish to live their lives and what quality means to each of us. This is a matter of personal freedom; the opportunity and right to live, at every moment of life, as we desire, and to decide what medical care is right for each. Ignorance and confusion about realities and limits, especially in those with terminal disease, combined with a national discomfort about discussing death, results in many Americans losing the opportunity to make vital personal choices.

The present reality is that excessive, invasive medical treatment is often given without patients and families having the educated possibility of living their final days, weeks or months in comfort, at home, with dignity, held by the ones they love, while other patients languish without any care, in pain, alone in the cold and dark.

The end-of-life is not about being dead. It is a precious, irreplaceable, part of life. Our goal, our obligation, as a society and as individuals, must be to find peace, quality and love until our very end.

Perhaps, then, the title of this report should be: Honoring Life in America.

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In Pursuit of the Tipping Point

by: Laura Beck – developer of Eden at Home. Today, as Learning and Development Guide, she coordinates management of the Eden Alternative brand and packaging of the organization’s message in promotional and educational content. Laura also supports design of new and existing Eden Alternative curricula and educational products, coordinates and facilitates the Eden Alternative’s webinar-based education, and serves as a public speaker and an educator of designated educational offerings.
laura-beckLast week, someone asked me to clarify some things about our Dementia Beyond Drugs training that made me realize that there are still some misconceptions floating around out there regarding the vision behind it. I’d like to share some of my thoughts on this, while noting that Dr. Al Power, the award-winning author of the book by the same name, may have a few of his own. Continue reading

For some folks, the expression “dementia beyond drugs” is perceived as an all or nothing proposition. What the training really emphasizes is how to move beyond merely reacting to so-called “behaviors” and, instead, learn to identify and respond to the unmet needs that are likely their underlying cause. Gone unchecked, unmet needs lead to distress and subsequent medication use for those who live with dementia. Ultimately, then, the goal is to tackle the cause, not just treat the symptom.

Does this mean that all drugs are bad when it comes to supporting the needs of those who live with dementia? As the daughter of two parents who lived with two different forms of dementia, I can clearly say “no.” In both cases (Alzheimer’s disease with Dad, and Lewy Body dementia with Mom), optimization (not maximization) of pharmaceutical support was key to achieving balance.

Yet, we’ve all heard stories (and Dr. Power shares some eye-popping ones in his book) of lives compromised needlessly by a slew of unnecessary medications. Fortunately, this reality is becoming more of a mainstream, regulatory concern. CMS’ National Partnership to Improve Dementia Care in Nursing Homes, for example, has advocated for reducing the prescription of antipsychotic medications, limiting use to only those cases that involve “a valid, clinical indication and a systematic process to evaluate each individual’s need.”

Specialized training, like Dementia Beyond Drugs, is really the only way to reach the tipping point needed to effectively reduce the use of antipsychotic medications by those who live with dementia. Employee care partners require education that demonstrates practice-based, individualized approaches focused on improving overall well-being and facilitating growth and meaningful engagement. Dr. Power’s “Experiential Model” reminds us that when communication, as most of us know it, isn’t possible, the human spirit finds a way to make its needs known.

Our job, as fellow human beings, is to heed this call… to reject any recourse that attempts to silence it pharmaceutically and make every effort to eek out the message behind challenging reactions or “behaviors.” Doing so honors our common need to fulfill our sense of identity, security, connectedness, and autonomy, as well as our need to experience meaning, joy, and never-ending growth… whoever we may be.

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We Are A Long Way From An Alzheimer’s Cure

expertfrom 23 July 2014
By: Howard Gleckman – Resident Fellow at The Urban Institute; a member of the Board of Trustees, Suburban Hospital (Bethesda, MD) and co-chair of its Medical Quality Committee; member of the Board of The Jewish Council for the Aging of Greater Washington; senior advisor to Caring from a Distance, a non-profit that provides Web-based and telephone assistance to long-distance caregivers. A veteran journalist, Mr. Gleckman was senior correspondent in the D.C. bureau of Business Week, covering health and elder care, as well as tax and budget issues, for nearly 20 years. He was a 2003 National Magazine Award finalist for a series of Business Week articles entitled The Coming Revolution in Health Care. Mr. Gleckman is the author of Caring for Our Parents

Two take-aways from the recently concluded Alzheimer’s Association International Conference in Copenhagen: First, after years of research, we still know remarkably little about what causes dementia or how to prevent or delay it. Second, the dementia establishment, including the Alzheimer’s Association and the White House’s National Plan to Address Alzheimer’s Disease, is so focused on a cure that it pays too little attention to the immediate needs of those who already have dementia and those caring for them.

The conference was filled with academic papers based on small, preliminary studies. Researchers are testing every possible variable in older people’s lives to determine if it could be the key to dementia. And the results were all over the place.

The trick is to ignore the breathless accounts of this research that appeared in the popular media. There is no silver bullet. In fact, the conference made clear that we don’t even quite know what we are shooting at.

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One paper found that mental activity could slow the onset of Alzheimer’s. Another concluded that moderate physical activity in middle age might help. Yet another reported that people over 90 with high blood pressure were less likely to suffer from dementia (older research found that hypertension might be a positive indicator). Another suggested that widowhood in old age might slow cognitive decline (I’m not even going there).

Note that all of these suggest environmental or behavioral responses. They largely ignore the complex genetic questions raised by dementia. Are some of us doomed by our genes to suffer from dementia? The best answer is, once again: maybe.

Importantly, three new studies showed that dementia rates may be slowing in the developed world. This research confirms some important earlier work that reached the same conclusion. The reasons for this are much less clear. It may be about better cardiovascular health or perhaps even better education. Researchers are also focusing on earlier detection. A raft of experimental drugs aimed at slowing the progression of dementia have turned into costly, high-profile flops. By now, most have been abandoned.

But the latest theory making the rounds is that perhaps they were administered too late. If only we could identify likely candidates for dementia even before they begin showing symptoms, these drugs—or others—might be more effective.

One reason for all this uncertainty is that dementia is actually many diseases. While Alzheimer’s has the highest profile, others are related to Parkinson’s Disease, stroke and other vascular diseases, and the like. Many diseases will likely require many different treatments.
But meanwhile, in the U.S. alone 5 million people already suffer from cognitive impairment and 10 million family members are struggling to care for them. At this conference, which brought together researchers from around the world, there was barely a mention of caregiving issues. It was mostly about big bucks medical research.

Nothing wrong with that research, though there is so much money to be made it seems the drug companies ought to be financing it themselves, and without taxpayer help.

In the meantime, let’s acknowledge the painful reality: We are making only slow, incremental progress in the war against Alzheimer’s and other dementias. We are far from prevention or cure. For now, we should increase our focus on living with dementia and caring for those with this condition.

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Enhancing Person-centered Home Care

JTBy Jennifer Tucker, Vice President, Homewatch CareGivers International

Home care is first and foremost about the people we serve, not just the illness or disability that the individual is currently experiencing.  Our principles are in complete alignment with national organizations like CCAL and The Eden Alternative, which is why our caregivers have always been trained in person-centered, relationship-based care.

“From the time it was founded, more than 34 years ago, Homewatch CareGivers has been focused on promoting independence, dignity and choice for elders and their families,” said Homewatch CareGivers International President Leann Reynolds.

For those of you who may not be familiar with the ten-principle philosophy of The Eden Alternative, it promotes person-directed care. This type of care is structured around the unique strengths, needs and desires of people who need home care. Non-medical home care can assist people who for a variety of reasons may not be capable of executing their basic daily activities, such as bathing or preparing food, and need help remaining safe from falls or other hazards in their home environment.

“Even someone’s home can feel like an institution,” said Eden Alternative Co-Founder and geriatrician Dr. Bill Thomas. “Person-directed care changes this by putting the individual first.”

Homewatch CareGivers is pleased to be partnering with The Eden Alternative to bring person-directed care to caregivers across the country through our blended-learning Certified Eden at Home Associate Training for the home care industry.

Our country is facing ever-escalating numbers of families who want to age in place.   We are committed to listening to “the voices and choices of consumers” who are seeking well-trained in-home caregivers and interactive e-learning tools to better engage with their loved ones and improve the quality of life for everyone in the family.

The Eden Alternative has expanded its reach across the full continuum of care to include the needs of those living at home, where “more than 80 percent of care services are now being provided,” stated Chris Perna, Eden Alternative’s CEO.

“We selected Homewatch CareGivers as a partner because we have aligned values and well-trained professionals. This partnership offers us an opportunity to improve quality of life for more families with elders receiving care at home,” Perna added.  Homewatch CareGivers is the first home care company to roll out a focused company-wide strategy to bring these proven principles and practices to elders living at home.   This means that the enriching care provided by Homewatch CareGivers will go beyond addressing the immediate needs of elder clients, to supporting the continued growth and development of the elders in their care

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