Today I am responding to a Huffington Post article viewed this morning and written by Anthonia Akitunde with respect to antipsychotic drugs which have been found to be unsafe and ineffective for older adults. Huffington Post author shares the more recent findings on antipshychotic drugs below:
Researchers from the University of California, San Diego and the University of Iowa observed the effects of atypical antipsychotics (Abilify, Zyprexa, Seroquel, and Risperdal) on 332 patients over the age of 40. (These patient all suffered from psychosis caused by dementia, schizophrenia and post traumatic stress and mood disorders.) In the study's first year, one-third of participants experienced metabolic syndrome which includes a number of factors - such as insulin resistance and abdominal weight gain - increasing the risk of heart disease and diabetes. After two years, "nearly a quarter of the patients developed serious adverse effects and just over half developed non-serious adverse effects," according to the study release. According to Dr. Dilip V. Jeste, director of the Stein Institute for Research on Aging at UC San Diego, "The study suggested that off-label use of these drugs in older persons should be short-term, and undertaken with caution. While there were a few significant differences among the four drugs, the overall risk-benefit ratio for the AAPs in patients over age 40 was not favorable, irrespective of diagnosis and drug."
According to the New York Times, 3.1 million Americans were prescribed antipsychotic drugs in 2011 and hundreds of thousands of those persons included elderly patients with dementia. Antipsychotics have been linked to increased risk of death in elderly in past studies yet a recent study found that those with Alzheimer's disease who stop taking Risperdal for agitation and aggression were two times more likely to relapse when put on a placebo than those who continued using the drug. The study found there was no difference between the rate of death or side effects for those who continued taking Risperdal and those on the placebo.
While geriatric dementia patients have been placed on antipsychotic off-label drugs as long as I can remember, many of these same patients also had a dramatic break through in terms of quality of life, especially in those suffering with an Alzheimer's diagnosis. When making home visits to see clients both the nurse and myself noticed a reduction in agitation and a return to quality of life that these clients would not have otherwise. While I am glad there have been recent studies at UCSD, the findings are the same as they were in early 2005 and beyond.
Finally, communication between family, caregivers, and an experienced Geriatric Care Manager working with a client's psychiatrist, reporting any status changes with dementia clients is key. When daily unmanageable crises make it necessary to introduce an alternate treatment method, antipsychotics can sometimes provide the help needed to maintain patient safety and ensure the caregiver's safety as well. This sometimes takes a joint effort of caregivers, nurses and a Geriatric Care Manager monitoring and communicating status updates to clinicians as necessary.
Posted: 20th of March, 2016 by Olga Brunner
Labels: UCSD, antipsychotic drugs, Alzheimers, dementia, geriatric psychiatry, Stein Institute for Research on Aging, Dr. Dilip V. Jeste
Below is a story that I listened to once which broke my heart! It is available on NPR, StoryCorps is a national nonprofit that gives people the chance to interview friends and loved ones about their lives. This conversation was archived at the American Folklife Center at the Library of Congress, allowing participants to leave a legacy for future generations. Visit: storycorps.org
When an assisted living home in California shut down in fall of 2014, many of its residents were left behind, with nowhere to go. The staff at the Valley Springs Manor left when they stopped getting paid - except for cook Maurice Rowland and Miguel Alvarez, the janitor.
"There were about 16 residents left behind, and we had a conversation in the kitchen asking, "What are we going to do?" Rowland says. "If we left, they wouldn't have nobody," the 34 year old Alvarez said.
Their roles quickly transformed for the elderly residents, who needed round the clock care. "I would only go home for one hour, take a shower, get dressed, then be there for 24-hour days," says Alvarez. Rowland, 35, remembers passing out medications during those long days. He says he didn't want to leave the residents - some coping with dementia - to fend for themselves.
"I just couldn't see myself going home-next thing you know, they're in the kitchen trying to cook their own food and burn the place down," Rowland said. "Even though they weren't family, they were kind of like our family for this short period of time."
For Alvarez, the situation brought back memories from his childhood. "My parents, when they were younger, left me abandoned," he says. "Knowing how they are going to feel, I didn't want them to go through that."
Alvarez and Rowland spent several days caring for the elderly residents of Valley Springs Manor until the fire department and sheriff took over. This incident led to legislation in California known as the Residential Care for the Elderly Reform Act of 2014.
"If I would've left, I think that would have been on my conscience for a very long time," says Rowland.
This story made me very curious so I searched for more and found this:
REDWOOD CITY, California – The state of California recently revoked the licenses of a Filipino mother and daughter who allegedly committed multiple violations while operating various residential care facilities in the Bay Area.
The state handed down a lifetime ban to Herminigilda Manuel and her daughter Mary Julleah from owning and managing any residential care facility in California.
The Manuels formerly operated Sundial Palms Assisted Living in Modesto, Eden Manor Facility in Oakland, and Valley Springs Manor in Castro Valley.
According to the State Department of Social Services, the Manuels violations included under-staffing, not providing sufficient meals for residents, and failing to supervise seniors.
In their facilities in Oakland and Castro Valley, about 15 residents were reportedly abandoned after it was shut down by the state in October.
While they are both banned for operating residential care homes for life, Mary Julleah can apply for reinstatement or a reduced penalty after one year?
As a State Certified Assisted Living Core Trainer, I have to say that this situation would never have happened in Florida. Here in Florida, we are governed by the Agency for Health Care Administration (AHCA) who not only licenses ALF facilities but governs everything that has to do with eldercare. As trainer of future ALF owners, preparing them for the Competency Exam, I not only teach the Florida Statutes and Administrative Code, I prepare students to follow the law or deal with the wrath of AHCA. I cannot believe that the State Department of Social Services in California allowed this ALF to keep 15 elderly in place until November after revoking licenses in October. Thank God that these two workers had the good sense to continue meeting the needs of these seniors until the fire department and sheriff arrived and took over. These men are Heroes! What these men did is amazing and shows that there is hope in times of need.
Please feel free to comment and let us know how you feel about this situation in California. Thank you.
Posted: 12th of March, 2016 by Olga Brunner
Labels: California aged, disabled, elderly, long term care, assisted living, agency for health care administration, AHCA
Posted on March 3, 2016 by Jim Koewler
This morning's post was borrowed from a post of the Koewler Law Firm found to have substance regarding V.A. applications in terms of an aging adult who wants to stay in his or her home. Today's discussion involved hiring someone to help with activities of daily living (a professional caregiver).
When an older adult is no longer able to perform the routine daily tasks that he or she could easily perform when younger, it is time to consider how to help the older adult. The routine daily tasks that people who work with seniors usually considers are:
Someone who is trying to stay in his or her home but is having difficulties with one or more activities of daily living can hire help. Professional caregivers are available who will help someone with these activities. Such caregivers can be found through a commercial home care agency, and there are many such agencies. Such caregivers can also be hired directly by the aging senior or by his or her family. Commercial home care companies can be expected to provide oversight of the caregivers as well as to manage the business relationship with the caregiver. The caregiver should be an employee of the company, so the company handles long term care insurance, bonding, payroll, taxes, and accident liability. The downside is that the actual person who acts as caregiver may change from time to time. This may happen when the senior has come to rely on a particular individual. Commercial home care companies are bound to a Department of Labor proposal that would force higher pay for the caregivers because of the rules on length of the work day and overtime pay. If a family member or individual chooses to hire a caregiver that is not from an agency, they may have to adhere to the same regulations. When the older adult or family hires the caregiver directly, much of the pay for directly hired caregivers is sometimes done “under the table,” without proper tax and payroll compliance. (I cannot recommend such an evasion of tax and labor laws.) For some older adults, the Medicaid program and/or the Veterans Administration’s Pension (more commonly called Aid and Attendance) program can help pay for such home care services.
"Having worked as a case manager with the Medicaid program, I can say that the amount of care giving hours often provided under the program are greatly reduced and may not meet the needs of someone with greater needs."
Sometimes home caregivers may be nurses. In Palm Beach County there are some very good Nurse Caregivers who charge $40/hour minimum if working privately. Nurses provide medical care (in the way that “medical” is used by hospitals, doctors, and health insurance companies.) Home health aides provide more personal care or “custodial” care. While nurses in the home are more highly paid than aides, their costs are usually covered by some long term health insurance. Home health aides through an agency are usually covered by long term care insurance as well. I try to call nursing services “skilled care” and call home health aides “non-skilled care.” I do not want to imply that home health aides are not skilled. They are great! Often, people who work with seniors call them “medical home care” and “non-medical home care.” I try to avoid the “non-medical” label because of the rules for the VA Pension.
The VA Aid and Attendance program covers “medical” costs for certain veterans and surviving spouses of certain veterans. The rules for VA Pension defines “medical” costs in a way that includes the services of home health aides. Some Elder Law Attorneys providing help with VA Pension applications have encountered difficulties with the review of applications if the home care provider describes itself as a “non-medical” provider. (This description has most often been in the letterhead of the care provider.) The care provider or VA Pension applicant must provide a letter explaining the services provided. A reference to “non-skilled” care does not seem to trigger the same difficulties in the application process.
The bottom line is this....If the older adult has funds available to pay for home care services and is willing to accept a “stranger” coming to the house, home care support can allow the older adult to stay in his or her home.
If a family caregiver is interested in having a referral to experienced agencies with good staff, please feel free to contact me directly at: email@example.com As a geriatric care manager I have worked with some of the best agencies within the Palm Beach area.
Posted: 5th of March, 2016 by Olga Brunner
Labels: aged, disabled, elder law attorneys, long term care
The non-profit organization formerly known as the Alzheimer’s Association, New York City Chapter has now re-branded as CaringKind, The Heart of Alzheimer's Caregiving. What does Caring Kind do? According to their website, CaringKind provides free information, assistance and support for those with Alzheimer's disease and related dementias.
Their mission is to create, deliver, and promote comprehensive and compassionate care and support services for individuals and families affected by Alzheimer’s disease and related dementias, and to eliminate Alzheimer’s disease through the advancement of research. Their mission is achieved by providing programs and services for individuals with dementia, their family and professional caregivers; increasing public awareness; collaborating with research centers; and informing public policy through advocacy.
According to Lou-Ellen Barkan, President of CaringKind these are the reasons why this change happened: "In December, when we broke away from the National Alzheimer’s Association to return to our roots as an independent charity, we knew we would need a new name that exemplified the very core of who we were: an organization with more than three decades of experience developing and implementing innovative, creative and leading-edge caregiving initiatives. So, we stepped back and assessed what we did best. And what we do best – where we have always excelled – is understanding the needs of New York City caregivers and providing them with the support they need to care with confidence today and, just as important, to plan for tomorrow. We then asked ourselves, What kind of person does it take to be a caregiver for someone who has Alzheimer’s or dementia? The answer was very clear. It takes a special kind of person to rise to the challenge. It takes the courageous kind. The listening kind. The loving kind. It takes the caring kind. As soon as we said this, we knew we had it. Choosing a meaningful name for our organization – one that would resonate with New York’s dementia caregiving community, "CaringKind, The Heart of Alzheimer's Caregiving."
Because of the amount of visitors from New York visiting Palm Beach County this time of the year, I believe posting this information is helpful. As a former New Yorker myself, I wasn't even aware of this change. I thank Bob DeMarco of The Alzheimer's Reading Room, for sharing this piece of information on his blog today. For more information, here's a link to his site: http://www.alzheimersreadingroom.com/2016/03/caringkind.html
Posted: 3rd of March, 2016 by Olga Brunner
Labels: Alzheimer's, Alzheimer's caregiver, CaringKind, dementia care, family, health, New York, Senior care
I Have worn many hats in my day: Nursing Home Assistant Admin and Activities Director, Assisted Living Admin, Case Management for the State-wide Medicaid Program, and Trainer for Dept of Elder Affairs.