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My mom thinks, after a few sessions, that her doctor-ordered speech therapy is a waste of time. Should we put up with the stress of forcing her to do this if she doesn’t want to? | Chicago Long-Term Care Planning Attorney Anthony B. Ferraro

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August 9, 2012

- Alzheimer's Care, Blog, Elder Law Articles

You better go talk to the physician involved before you assert yourself here. Also, discuss this with the speech therapist to find out what type of therapy work your mother is undertaking. The therapist should have her individualized care plan available to discuss. It should include a goal and various steps for meeting it. Speech therapy does a lot more than most people realize. It is not just about talking more clearly. Some of the most important work may have to do with swallowing issues, which can be quite dangerous if not addressed appropriately. As Alzheimer’s disease progresses, for example, swallowing becomes more difficult, sometimes to the point of being life-threatening. Choking is a big concern. Speech therapists can assess such situations and apply therapies as needed. Rather than just having a person form sounds and letters, speech therapists also conduct swallowing tests on people with dementia — sometimes with the use of X-rays. These can help form care plans. It is easy to see why an Alzheimer’s patient might not understand all of this. You probably will want your mother’s doctor to explain the seriousness of the situation to her, and why the speech therapy is needed. Then, if your mother complains in the future, you can rely on the authority of the doctor. You also will both be more knowledgeable and familiar with the reasons for speech therapy.  For more information from the Alzheimer’s Resource Kit, click here.
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How can you get a loved one with Alzheimer’s disease to eat more? | Chicago Long-Term Care Planning Attorney Anthony B. Ferraro

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August 8, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Often, as Alzheimer’s progresses, a person loses his or her appetite. Getting the person to eat can be a constant struggle. This is, in fact, one of the great challenges that Alzheimer’s caregivers face on a regular basis. It might be helpful to serve Alzheimer’s patients food on brightly colored plates and drinks in brightly colored cups or glasses. A study in a recent edition of Clinical Nutrition magazine revealed that when nursing home Alzheimer’s patients were served food on bright red plates, with red cutlery, they ate 24% more than when served on white plates. Similarly, bright red cups led to 84% more liquid being drunk than out of plain glasses. It’s a little-understood fact about Alzheimer’s that as the disease progresses, the ability to process all types of information is often lost. Outwardly it might seem obvious and easy for a person to recognize food on a plate, but it can be a challenge for an Alzheimer’s patient. So if other strategies for encouraging or cajoling more eating and drinking have failed, try serving food on bright red plates and putting beverages in red cups to encourage greater consumption.  To learn more, try the Alzheimer’s Resource Kit, click here.
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I am going to be president of the new family council at my dad’s nursing home. I plan to have a rep from each department give a description of their duties and responsibilities and then invite questions. What should we do after that? | Chicago, Illinois Elder Law Attorney Anthony B. Ferraro

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August 8, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Having a leader from each department is a very good idea. The more the communication, the fewer the problems, in theory at least. When you hear from the department leaders, it will give you a good picture of their responsibilities, and why they do what they do. It’s not always clear to us and can lead to unanswered questions otherwise. Sometimes, there are health department, state, federal or other regulations in place. It’s easier for you and other resident families to deal with when staff members’ routines make more sense. Work on building relationships between staff members and the residents’ families. Invite different staff members to attend your meetings. Remember that nurses and other direct care personnel are very important — not just the department heads. They are usually the ones doing 90% or more of the hands-on caregiving with your loved one. You better believe their input is important. As a group, a family council can develop a method(s) for more effective communication with facility staff if a complaint or concern arises. When something does come up, it then ought to be less threatening for everyone to sit down and resolve it. The council also should consider developing a good way to deliver compliments to staff members, via proper thank-you notes, for example. Plan for picnics or other get-togethers so staff, residents and family members can spend relaxed time together. Treat everyone as family. The council should not simply become a gossip or complaint forum. The meetings also should be structured and effective since nobody wants to waste time — staffers and non-employees alike. For more ideas on what you might do or include, you can call other facilities and ask how they run their family council meetings. Best of all, speak with the actual officers of the family councils at other places, not just staff members or directors.
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Since my father just wandered from his nursing home, could it be that he’s placed inappropriately? | Chicago, Illinois Elder Law Attorney Anthony B. Ferraro

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August 6, 2012

- Alzheimer's Care, Blog, Elder Law Articles

This depends on a number of factors. If he is considered a high-risk case for wandering and the provider is admittedly not suited to deal with it, then, yes, he may be incorrectly placed. But if this was a first or “one-time” incident and staff members say they can handle it from here on out, try to keep your father where he is. It’s good for him to remain in familiar surroundings. (If you think the facility simply is not living up to its care obligations or has been derelict in its duties, then looking for a different facility would be advised.) Having a person with Alzheimer’s disease move can often be traumatic. What makes this predicament particularly difficult is you can’t typically determine if your father is going to wander until the first time it happens. A facility can be caught off-guard by this but then can recover by ramping up supervision to responsibly take care of him. The facility might, in fact, have a very good resident monitoring system available or in place but did not think to tell you about it because your father wasn’t yet deemed a wandering risk. You can do a little research to help determine the next step. Speak with the facility’s activity director to learn whether your father takes part in activities. If he doesn’t or doesn’t take part much, ask the director to get him more involved in either group of individual activities. This will help keep his body active and his mind stimulated, diverting some of the energy that would be used for wandering. Exercise is a good way to spend excess energy You also can look into engaging private duty or sitting services. Consult facility staff about having someone come in to spend one-on-one time with your father. This would still not guarantee against wandering (due to the nature of the disease) but it would be another proactive measure against it. Have all caregivers track whether your father tries to leave the facility, and if staff members are able to prevent or counteract it. If they can’t prevent it, you might need to explore other options. Also consider: Does your father seem anxious or extremely agitated? His doctor might be able to do something about this with an appropriate intervention. There is also the chance that your father may remain agitated enough to wander no matter where he is. Be sure to keep his doctor up to date on the situation. For more information, go to our Alzheimer’s Resource Kit by clicking here.
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How will we know when it’s appropriate to move my dad from adult day care to a nursing home, or an assisted living facility? . | Chicago Long-Term Care Planning Attorney Anthony B. Ferraro

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July 26, 2012

- Alzheimer's Care, Blog, Elder Law Articles, Estate Planning, Medicaid and Paying for Nursing Home Care

The answer is simple: When you no longer can care for him at home. Adult day care is just a day service, so it occupies only part of the time. Care at home is still needed for nights and weekends. There are some adult care centers that offer evening and weekend services, but often it is not enough. Some people “package” services from a home care agency with the time spent at adult day care. In addition, a home care agency can assist with evening and weekend care to reduce the strain on you, and keep your father at home longer. But as you can see, that takes quite a bit of coordination, and still a fair amount of resources, to do properly. Everyone’s situation is different and everyone has a different threshold, so you have to figure out what is appropriate for you and your loved one. It is time to consider a nursing home or assisted living facility if you are feeling overwhelmed and the quality of life at home has fallen. You need to remember that it isn’t fair to either of you if your time with your father is so strained it diminishes your quality of life. If he were to go to an eldercare facility, your time together would likely be decreased, but then your time together could be that much more focused on doing things you like together, and in a lower stress environment. Some assisted living facilities have staff members who are trained and equipped to work with Alzheimer’s residents. But many do not. You must research any long-term care operator’s limitations before making a decision. Some will accept Alzheimer’s residents until they become incontinent or require some other type of skilled care. In that case, you must consider what an extra move might mean to your father’s well being and sense of orientation. This is a decision that you, as primary caregiver, must make. Everyone has different limitations and goals. When you know you have reached your limit, make the most appropriate, effective decision for everyone involved.  Realize you have done your best and that that is good enough. Let go of any guilt, for it can only destroy you.  For more information about Alzheimer`s, click here for our Resource Kit.  
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I’m scouting nursing homes for my mother, who has Alzheimer’s. Can they ever kick her out if she runs out of money? ? | Chicago, Illinois Elder Law Attorney Anthony B. Ferraro

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July 25, 2012

- Alzheimer's Care, Blog, Elder Law Articles, Medicaid and Paying for Nursing Home Care

This is a good question that you need to sort out before making a final decision about specific living arrangements for your mother. Medicaid is for individuals who have little or no means to pay for their own care. Eldercare facilities must be certified by the appropriate government entities to serve Medicaid beneficiaries. Some nursing homes and other eldercare facilities simply are not certified to accept Medicaid funding once a resident runs out of his or her own money. And those facilities that do accept Medicaid could have a long waiting list for the beds designated for that type of care. That is why it is so important to figure out the lay of the land and your options before you initially settle your mother into a facility. Find out the monthly cost of a nursing home that interests you and project how much you think you will ultimately be needed. If you think your mother will outlast her funds, you can ensure you choose a provider that will accept Medicaid, when and if the need arises. Families of individuals with Alzheimer’s usually do not want to move their loved ones if they don’t have to, especially not after they have adjusted to their surroundings. Changing locations can be very stressful for a person with dementia.  To learn more about Medicaid, click here.
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How can I get a family council established at my husband’s nursing home? | Chicago Elder Law Attorney Anthony B. Ferraro

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July 20, 2012

- Alzheimer's Care, Blog, Elder Law Articles

When done right, family councils can be very beneficial. Their goal is to discuss issues with staff members in a constructive, non-threatening setting. They are not supposed to be forums for constant complaining or berating of staff. At these meetings, ideas, concerns and possible solutions are shared. It is also an opportunity for bonding with staff members. If you want to establish a council, speak with the nursing home’s administrator. These councils are common so you might not face much resistance. Establish a place, day and time to meet, as well as a format for how meetings will run and what will be addressed. You’ll also need to determine who will run such meetings, and create a way of informing all residents, family members and staff about them. The meetings can be informal, or quite formal — complete with minutes being taken. It’s up to everyone to decide. The structure isn’t as important as getting information out and distributed. One big function of family councils is to help arrange activities that involve both residents and their families. By this, we’re mainly talking about picnics held at the facility. These can help promote a sense of unity among residents, family members and staff.  For more information, look into our Alzheimer’s Resource Kit.  
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My father lives in a nursing home and we need to know how to deal with him constantly losing things such as his wallet, glasses, dentures, etc. | Chicago Long-Term Care Planning Attorney Anthony B. Ferraro

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July 19, 2012

- Alzheimer's Care, Blog, Elder Law Articles

First, talk to the person in charge of his unit and ask if there are any known reasons why these items are continually being lost. Then go from there. If your father is a hoarder or hides things on purpose, that is one issue; but if the items are disappearing “on their own,” that is another matter you might want to pursue with facility managers. If it comes down to the cost of replacing certain items, you might want to ask whether they are truly making a difference in your father’s life. Are they causing more strain or stress than the quality of life they bring? Replacing a wallet is probably easier to do than more expensive items. A wallet can give a person a sense of security. Therefore, purchasing a new, inexpensive wallet (or several, just to be prepared) can add to quality of life. Getting new glasses or dentures is quite different. If he still likes to read and needs his glasses to do so, then by all means replace them. Less expensive frames are widely available, and maybe inexpensive reading glasses (that can be bought at a local drug store) might be sufficient. Dentures obviously can play a big role in nutrition so they should be taken care of. Fixing them will be more economical than replacing them in most cases. Unfortunately, often a pattern emerges where once one set of dentures disappears, you know others also will get lost. Your father might be taking his dentures out due to discomfort. Also, if they are shifting in his mouth, he could develop sore gums, which could lead to a loss in weight. Check with a dentist for adjustments that can make your father’s dentures more comfortable.
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I think my mom’s medication is affecting her negatively. How can I get her nursing home to adjust it? | Chicago, Illinois Elder Law Attorney Anthony B. Ferraro

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July 18, 2012

- Alzheimer's Care, Blog, Elder Law Articles

I recommend documenting what you have seen since your mother started the medication in question. You can also start out by directly calling the physician who prescribed it and asking about your concerns. Your mother could be experiencing a transition period, which might be expected. If you think you are getting resistance from nursing home staff members, you should speak with the facility’s administrator. You may also ask to sit in on the next care-planning meeting for your mother. This is where various members of the nursing home caregiving staff collectively discuss a resident’s health status and plan of care. By rule, you are to be informed of these meetings and allowed to attend them. If you are not satisfied with what you hear, then you have to make a further decision. There is the option of calling your state’s long-term care ombudsman. Ombudsmen have been trained to advocate on behalf of nursing home residents. This person can work as a mediator to help you and your mother’s facility work out any differences. You should feel comfortable enough that she is in a safe environment, with people who care for her around her. If this isn’t the case, you might have to move her to another nursing home. This is a difficult decision to come to because moving is hard, especially on a person with Alzheimer’s. Weigh the pros and cons. But the bottom line has to remain whether you are comfortable with the facility where your mother is living. If you’re constantly worried, then your qualify of life could go down. If all else fails in a situation like this and you are your mom’s power of attorney for healthcare, you can request a change in her medication. Just be sure to have spoken with her physician ahead of time to ensure that this is the best thing for her.  For more information, sign up for the Alzheimer’s Resource Kit here.
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The nursing home changed my father’s medications and now wants to evict him and have him checked him for possible inpatient admission because of aggression. Should I have him assessed if the odds are he won’t be taken back by this facility?

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June 29, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Extreme agitation is typically the source of aggression. If the agitation is under control, the aggression should lessen, if not stop altogether. If you believe the nursing home’s staff members did not handle this the best way possible, you can meet with the facility’s director of nursing and the care-plan team to discuss the situation. If that doesn’t bring satisfaction, you can take it further, to the state’s long-term care ombudsman program. Ombudsmen are trained volunteers who, upon request, advocate for nursing home residents and their families when there are problems with a facility. If you are confident that staff members did all they could, your father needs to be assessed. Outbursts of aggression are not only difficult on the people around the Alzheimer’s patient, but also on the individual himself or herself. There is little quality to life when one is agitated all the time. There are various good assessment programs throughout the country. You can learn about some at the Alzheimer’s Association website (www.alz.org). Look for a program near your area. One good thing about an inpatient assessment is the 24-hour-a-day observation. Its value is evident because there can be additions, deletions or changes to medications — and observation of any effects of these changes. You could learn that his medication is causing his agitation. Be sure to keep his doctor informed of what you’re doing and what is happening. When he is being assessed, you have an excellent opportunity to meet with discharge coordinators or social workers. They can help you find the right facility. They may not recommend any one facility but they can give you guidance. Another thing to remember is that environment can play a huge role in how comfortable a person is. If your father is not comfortable where he is, a move might be the best idea for him. Even though moving a person with Alzheimer’s can create confusion and possibly setbacks, the odds are he will recover. Your father needs an environment that feels loving and accepting to him. Staff members are usually the key in this regard. So if/when you wind up looking for another nursing home, be sure to meet staff and observe their interaction with residents. Additionally, if your father didn’t live on an Alzheimer’s unit before, look for one now. Their staff members are specially trained to deal with symptoms and issues that accompany Alzheimer’s.    
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