Dementia Patients Victims of Slippery Prank

(08-03) 18:48 PDT UKIAH — Six employees of a Ukiah nursing home coated dementia patients with ointment as a prank, leaving them slippery for workers on the next shift, authorities said Tuesday.

The employees, after a probe by the state Bureau of Elder Abuse, were charged last week by Mendocino County District Attorney Meredith Lintott with four misdemeanor counts, including elder abuse.

The workers allegedly put ointment on the patients at the Valley View Skilled Nursing Facility from “head to foot,” said the office of Attorney General Jerry Brown. Because of their condition, the patients were unable to object.

“As part of a cruel and shocking prank, these caregivers abused defenseless elders,” Brown said in a written statement.

Charges were filed against Jenny Bido, 26; Christina Guerrero, 30; Jared Buckley, 29; Jennifer Burton, 33; Kathleen Phillips, 23; and Monica Smith, 51.

Bail was set at $7,500 each. The six workers were also fired.

E-mail Jill Tucker at jtucker@sfchronicle.com.

This article appeared on page C – 3 of the San Francisco Chronicle

All of these worries and concerns translate into symptoms of stress in our bodies.  Some of these symptoms include anxiety, irritability, muscle tension, sleeplessness, tearfulness, headache, stomach ache, irregular heart beat, and even asthma.

One easy way to combat worry and stress is by walking. 

Before you stop reading and think to yourself “this is ridiculous; I have no time for walking”, ask yourself this: do I have time to be sick myself and possibly end up hospitalized?  Remember that almost 50% of caregivers die before the one for whom they are caring. So please indulge me by reading the rest of the article and consider whether this is an activity that you might enjoy.

There are several reasons that walking helps to reduce worry:

• it triggers the release of endorphins which relieve pain and help to promote relaxation and a feeling of well-being.  The higher your level of endorphins, the greater your sense of well-being.
• it increases blood flow to the brain which helps with mental sharpness
• it helps to relieve tension in muscles by utilizing correct posture thus “unknotting” them
• it gives time to get away from the stress-inducing activities and allows other (calming) thoughts to enter the mind
• it utilizes rhythm (swinging the opposite arm  to the leg) which exercises the right-left brain connection (Carolyn Scott Kortge, author of The Spirited Walker, says ” movement in the body brings movement in the mind.  It’s just natural alchemy”).
• it allows the walker to see that there is more to life than just their own problems
• it allows for a sense of gratitude to enter the thoughts (for the flowers, the trees, the pretty store fronts, etc.)
• it gives a time for the mind to go deeper (what is the purpose of life, why am I here, and WHAT IS THE BEST WAY TO LIVE THE REST OF MY LIFE?)

Ways to Begin and Things to Consider:

• If your loved-one can’t be left home alone for 30-45 minutes, schedule a respite care worker, a family member or even a neighborhood teen (who might austensibly be there to dust or vacuum) so that you can be free of worry during your walk.
• DON’T walk with the person for whom you are caring.  This is your time.  If they like to walk, schedule an additional walk later in the day or week.
• Recruit a “walking partner”.  In my neighborhood, there are a group of 4 of us who walk the community together (although I must confess, they are much more dedicated to it than I am. I DON’T do 7 a.m. walks.)  Our 3.2 mile walks talk approximately 45 minutes at a slightly brisk pace.
• Walking partners are good because laughing and chatting with them will cause even more stress reduction.  You will also find that you’ll hold each other accountable to the committment of walking. 
• Some walkers practice meditation and/or listen to mp3 players while walking.  I would caution you to be aware of your surroundings for safety’s sake.
• When walking, to get the most benefit for muscle tension relief, walk tall, with shoulders back, keeping your eyes forward.  Try not to slouch.

My request to you is that you consider  incorporating this activity into your schedule if it feels like a good fit.  Try it for a month and let me know how it goes.

 Some people are very good at “going to their happy place”.  I am not.  I am much too much a realist – it’s probably the nurse in me.

Since becoming a caregiver, I have had an opportunity to revisit meditation.  What I didn’t know back then is that there are different types of meditations.  Along with the visualization meditations there are some that simply concentrate on breathing; some that concentrate on just “being”;  and some that deal with a specific subject such as how to take anger and turn it into positive motivation. 

Meditation is important for caregivers.  As caregivers, we are often filled with stress and negative feelings (not necessarily towards our care recipient, but perhaps towards physicians, hospitals, siblings, insurance companies, etc.)

We are also often overwhelmed and the thoughts in our heads are running around like a chipmunk gathering seeds for the winter.  We MUST slow down.  Meditation is a good way to do this and it doesn’t take much time.

Colin Allen, in Psychology Today, April, 2003, states that  Neuroscientists have found that meditators shift their brain activity to different areas of the cortex – brain waves in the stress-prone right frontal cortex move to the calmer left frontal cortex. This mental shift decreases the negative effects of stress, mild depression and anxiety.

Here are 4 of the daily benefits that meditation can give us:

1.  Reduced Stress

Meditation helps us to switch off the worries that can plague us throughout the day.  It quietens the mind and allows us to clear our heads of all that mumbo jumbo.

2.  Improved Health

Lowered blood pressure, less headaches, improvement in other stress-related ailments and even pain relief have all been proven to be part of the benefits of meditation.

3.  Detachment

As busy caregivers, it is easy to get distractions by small irritations such as having to wait in lines at the pharmacy or having to deal with things like adult diapers that have not been placed where they should have been placed.  The solution is not to avoid these small problems because they will inevitably reappear.  The solution is to develop a detachment in order to keep things in perspective.  Meditation helps with this by clearing the head of these irritating thoughts.  The purpose is not to develop an indifference but to see the situation for what it really is…a minor occurence.

4. Happiness and peace of mind

I remember a time when I was in college and in the middle of mid-terms.  I had just purchased a small condominium and had many boxes remaining to be unpacked after the move AND my best friend was getting married.  My mother asked me what I wanted for Christmas and I remember writing her a poem instead of a Christmas list.  I don’t recall the entire poem but the last line was “ALL I want is some peace of mind.” 

Most of us are seeking happiness and peace of mind in one way or another.  It may be through a spiritual journey, or simply by trying to live a better life.  Meditation helps with increasing our happiness by taking us directly to the source of happiness, which can be found in simply “being”.  When you are simply being, there are no worries, past, present or future because they are all shut out.  This is not to say that they won’t return once our meditation is finished but for that few moments, we can be at peace and tap into the happiness that is available to us.  According to Tejvan Pettinger ” Meditation shows us that happiness is not dependent on outer circumstances, but on our inner attitude.”

The benefits of meditation are real but they will not occur with just one or two sessions.  It may take some time for you to relax and allow the meditations to work.   They should be practiced at least once every day for best results. 

You can find some good meditation CDs at your local bookstore or on iTunes.  The iPhone has some meditation aps available, as well.  Two that I like are called “Simply Being” and “Meditation Oasis”.

Because of our belief in the goodness of meditation for caregivers, when we launch our new membership program in September (Team C.A.R.E. – Caregiving Activities Resources and Education), a monthly downloadable meditation will be included along with 6-8 other meditations to get you started.

I hope that you’ll give the practice of meditation a try and let me know how it works for you.

• 65.7 million Americans (29% of the U.S. Population) are family caregivers for an adult child with disabilities, an elder or a child under the age of 18 with special needs.
• Out of those, 48.9 million are caring for someone over the age of 50.
• The average length of time for a caregiver caring for a person over the age of 50 is 4 years. 
• Caregiving is still mostly a woman’s job with many women having to put their career and financial future on hold because of caregiving duties.
• 25% say that they spend 21-40 hours per week caring for a loved one over age 18.
• Only 1 in 10 say that if they have siblings, they split the care equally. 
• 10% are caregiving for loved ones with either  Alzheimer’s disease or another type of dementia.
• The programs that caregivers support most are the $3000.00 per year tax credit, respite service scholarships, voucher programs that some states offer that pay them a minimum wage to be a caregiver and transportation services.

What I found very interesting is that while caregivers often seek out the help of those who have gone before them in the caregiving arena, nearly 1/2 say that they have not gone to a web site in the past year to seek information related to being a caregiver.

Would any of you like to comment on why that might be?

Ironically, I know exactly what I didn’t know in my dream.  I know that I have a lot of guilt over the circumstances of his death .  He wasn’t treated well at the hospital; I HATED seeing him propped up in a chair.  I wasn’t there when he passed away in the middle of the night.  Nobody was.  I wish I could change that and therefore I go over and over it in my mind, trying to rewrite the past but realizing that it is impossible to do so. 

According to Dr. Vickie Rackner, author and keynote speaker, “Guilt is a pain that tells you there’s a mismatch between the person you’d like to be and the person you were in that moment.”  At “that moment”, I would have liked to have been the person who stayed at the bedside 24/7 and the person who KNEW to argue for hospice care and kept my father at home .  I regret that I wasn’t.

Dr. Rackner also states that regret and guilt are distant cousins.  Certainly they are related because regret often leads to guilt.

In the book, “The Emotional survival Guide for Caregivers” by Alexis Abramson, Barry J. Jacobs, PsyD states that when a loved one dies, guilt is the 2nd most predominant feeling in a former caregivers’ experience.  There is guilt that they didn’t do enough, guilt that they are now “free” of the burden of caregiving, guilt that they have their own life back.  This guilt can last 6 months or even longer. It comes and goes but is eventually replaced by the knowledge that the disease process and God’s plan were the biggest factors overall.

Guilt is a part of all aspects of caregiving.  Caregivers are often overburdened and torn between what they need to accomplish for their employer, their spouse, their family and their care recipient.  What was NOT accomplished often leads to feelings of guilt. ( I missed the soccer game; I missed spending quiet time with my spouse; I ran in, dropped off groceries, and ran out of my Mother’s house without stopping to chat at length.)  When I was caregiving for my father, I would often feel bad that I didn’t make the time to sit with him and play cribbage or watch T.V. as often as he wished I would.  There was just too much to do.  We DID play Cribbage at least 2 hours almost every night but as he always said “I have all day !”  He did; I didn’t.

Anger can also lead to feelings of guilt.  We feel badly about being angry that we are stressed, overwhelmed, over-worked, tired, etc., so then we feel guilty which leads to anger back to guilt and more anger….a never-ending circle.  Guilt will also cause us not to take care of ourselves, perhaps because we believe we don’t deserve the care  – which of course, will lead to anger, to guilt…and you get the picture.

In order to get rid of the guilt, it is important to acknowledge that feelings are JUST feelings, nothing more.  You must forgive yourself for your imperfections.  You are only human and no human is perfect.

While you cannot change events or all of the activities in your caregiving role, you CAN change your feelings about them and you may be able to change some of the actual activities themselves.  For instance, if you are finding it difficult to have any quality time with your care recipient because you are too busy doing chores, hire some of them out.  (If expense is a problem, The Area Agency on Aging has a scholarship program for a certain number of hours per month where caregivers can do light housework).  (Meals on Wheels may be available in your area to deliver some hot food to your loved one or perhaps your church may have a program.) When you are able to spend some time with your loved one, you can get to (RE)know them better, and enjoy them.

In the last couple of years, there has been a lot of talk surrounding the book The Secret and the laws of attraction.  Part of that philosophy involves a change in the way you look at the world and your role in it.  You CAN change the way you perceive your caregiving role from one of burden to one of gratitude for the experience.  Changing your perception will cause you to (consciously or subconsciously) change your actions in order to align the two with each other.

You must remember that it is absolutely imperative to take care of yourself and to continue to enjoy life.  Do not feel guilty about those things that you do just for yourself (I’m speaking in moderation, of course).  They will make you a happier person to be around. Do not become a matyr; it does nobody any good. 

So how does this all relate to my dream and my feelings of guilt ?  As I thought it through, I decided that I did the best that I could with the knowledge that I had at the time, so I forgave myself .  I had cared for my father in my home up until the last week and a half of his life and I am proud and grateful that I was able to do that.

With the holidays approaching, I wanted to mention something else that Dr. Vicky Rackner stated.  “Consider giving yourself a holiday gift.  Forgive yourself for one choice that brought you guilt.  Forgive one other person for one action that disappointed you.  Forgive the world for the bolt of unfairness that stood between you and an old dream.”

I hope that you can do that.

Gary’s article can be found immediately below.

“Coumadin^®, available generically as warfarin, has been widely used to reduce the risk of stroke for well over 50 years. Dwight Eisenhower, Richard Nixon and George Bush senior were all taking Coumadin during their active years of former Presidency. Despite millions of prescriptions written annually for this medication, practical, easy to use information remains a challenge.

One of the most common and historical needs of managing warfarin is diet, specifically, dietary vitamin K. Physicians use warfarin to increase the bleeding time in patients at risk for developing unwanted blood clots. The goal is to prolong the bleeding just time enough to prevent clot formation where it isn’t needed (the heart and lungs for example) but allow clotting to take place for normal blood vessel bleeding repair. While warfarin prolongs your bleeding time, dietary vitamin K increases the body’s natural ability to form clots.

The simple blood test called an INR test measures that active anti-clotting effect of warfarin. The higher the dose of warfarin, the more potent or longer the blood takes to clot. A diet high in vitamin K can reduce the effect of warfarin and lower the number of the blood test result. For this reason, it is important for patients to keep a consistent intake of dietary vitamin K to help maintain safe levels of protection warfarin provides without interfering too much.

It is difficult to monitor vitamin K intake when food and beverage labels do not provide this information and the FDA does not require it. While professionals teach vitamin K is abundant in leafy green vegetables – there are many hidden sources patients and their care givers need to know about. Salad dressings and some mayonnaise are good examples.

The vitamin K registry

An easy to use, extensive vitamin K database is available for patients and their family. The vitamin K diary allows you to simply type the first few letters of a food or beverage you’re interested in and a menu of products is displayed listing the serving size and the amount of vitamin K. The vitamin K registry can help you keep balance and choice in your diet. A printable version is also available to assist in creating grocery lists for the Coumadin patient.

The vitamin K diary

The vitamin K diary is an interactive resource for patients or caregivers to keep track of vitamin K intake. While using of the vitamin K registry as a source guide, the vitamin K diary allows the user to record the vitamin K (listed in micrograms) consumed for each meal. The diary, offered as a word document, calculates the total daily and weekly intake of vitamin K. The vitamin K diary is best used 7 days prior to the patient’s blood test to best evaluate the effect of diet and shared with the patient’s healthcare provider.

For other helpful resources on maintaining your quality of life, visit www.PTINR.com  ”

Registration for the ceremony was offered several weeks ago, but no one was turned away for not having registered previously.  Upon arriving, we were given the chance to choose an ornament to place on the Christmas tree in honor of the loved one being remembered and a marker to write on it.  There were 2 different shapes of ornaments: round and heart shaped.  There was also an assortment of colors from which to choose.  I hadn’t thought of it before, but the colors would be very important to some people, for instance, my nephew passed at the tender age of 6 (hit by a car) and his very favorite color was green. His siblings wrote messages on green balloons at his funeral and “sent them up to him”.

I chose a red heart for my father ( I think because my heart is still bleeding for him) and a white heart with sparkly green swirls for my nephew.

After enjoying a wonderful brunch in the foyer of the church, we went into the worship area for prayers, hymns and a presentation by author and grief support facilitator, Joanne Petrie.  She was a wonderful speaker and stressed that grief may come not only from the loss of a person, but the loss of a situation – divorce, the loss of a job, the loss of a home, (and I’ll add, in the case of many caregivers, the loss of freedom or the life once lived).  She also stated that recovering from grief does not put you back to “normal” but leads you to accept a “new normal”.  How profound.

After the presentation, there was another song and then the names of all loved ones represented on this day were read one by one.  As the name was read, the family members came up to the tree and placed the ornament there.  Many stood for a moment of silence or placed a kiss on the ornament.  Many cried.

The ceremony ended in prayer for those we had lost and for those who will carry on.  Hugs abounded. 

I am now a fan of Ceremonies of Remembrance.  It was a wonderful experience and something that a family member or friend could do each year without traveling to a graveside which might be a long distance away.  I hope that many churches, temples and synagogues will adopt this kind of ceremony if they have not already done so.

I must add that the ornaments were given back to the family members at the end of the ceremony and now my father’s ornament rests on our tree at home in a place of honor.  (I will send my nephew’s ornament to my sister.)

With that in mind, we must be proactive in trying to reduce the odds of delirium occurring when our aging parent or loved-one becomes a hospital patient.

By taking the following ten steps, you may be able to reduce the risk of delirium:

1. Bring  a complete list of all medications (and their dosages), as well as a list of all over-the-counter medicines to the hospital with the patient.  It may help to bring the medication bottles as well.
2. Prepare a “medical information sheet” listing all allergies, names and phone numbers of physicians, the name of the patient’s usual pharmacy and all known medical conditions. If you have any reports such as CT scan results, recent lab tests or notes from a recent doctor visit, bring those too.
3. Bring glasses, hearing aids (and extra batteries), and dentures to the hospital. Older persons do better if they can see, hear and eat.
4. Bring in a few familiar objects from home. Things such as family photos or favorite photos in an album, a pillow, a favorite comforter or blanket for the bed, rosary beads, a beloved book and relaxation tapes can be quite comforting.
5. Help orient the patient throughout the day. Speak in a calm, reassuring tone of voice and tell the patient where he is and why he is there.
6. When giving instructions, state one fact or simple task at a time. Do not overwhelm or over stimulate the patient.
7. Massage can be soothing for some patients, but remember that for others, it can be over-stimulating. 
8. Stay with the hospitalized patient as much as possible. During an acute episode of delirium, relatives or perhaps friends should try to arrange shifts so someone can be present around the clock.  If family is not close, and it is affordable, ask about having a “sitter” present. 
9. If you detect new signs that could indicate delirium — confusion, memory problems, personality changes — it is important to discuss these with the nurses or physicians as soon as you can. Family members are often the first to notice subtle changes.
10. Find out more about delirium. The American Psychiatric Association’s “Patient and Family Guide to Understanding and Identifying Delirium” is available on line.

Adapted from The Hospital Elder Life Program 2007

I also wanted to introduce you to the QAS website because they have some great teaching articles about vitamin K (a vitamin that should be limited when receiving Coumadin therapy) and also about some other medications that should be avoided during therapy.  He will discuss those more in later posts.

So without further adieu……

There is good news for patients taking Coumadin^® (warfarin)!

The good news for patients, family members and those who care for a loved-one taking Coumadin® (warfarin) came March 19, 2008 when Medicare announced coverage for patients to test their blood in the privacy of their home. The policy extends benefits to Medicare beneficiaries who have been taking warfarin for at least 90 days for any of the following reasons: atrial fibrillation, mechanical heart valve replacement, or venous thromboembolism (DVT/ PE).  

What is patient self-testing?

Patient self-testing allows patients taking warfarin to test their blood at home with a small finger-stick sample of blood – not too different for diabetic patients who check their blood for insulin levels.

Coumadin^® is a medication that requires a small sample of blood to measure the effect of prolonging the bleeding time designed to prevent dangerous blood clot development. Medicare and many private insurance company’s provide reimbursement for up to, but not more frequent, than weekly home testing to reduce bleeding risks.

Home INR testing however, requires a physician’s prescription for one of the FDA-approved, small, hand-held monitors and for testing supplies. The monitor and testing supplies are not available in retail pharmacies but can be obtained through specialty distributors such as Quality Assured Services, Inc. (QAS).  QAS is a Medicare and private insurance company that distributes, trains, and communicates patient’s home test results to the patient’s physicians.   

Who is a candidate for home INR testing?

Patients who are motivated, with a desire to improve their control of warfarin and reducing the risk of side effects are good candidates for home INR testing. The test is simple to perform by the patient or a caregiver.

How home INR testing works

Home INR testing enables patients to test more frequently than monthly, in the comfort of their home, resulting in better warfarin control and therefore improved safety. Home testing results may be phoned in through a secure 800# provided through the distributor of the monitor. Testing strips are shipped directly to the patient’s home at no additional charge.

Weekly testing is a testing frequency that has been proven superior in clinical studies. Testing weekly evaluates the effect of patients: diet, overall health, metabolism of Coumadin^® and interaction of other medications. Patients or care providers simply phone each home test result into their physician’s office or online service.

How to get started

Patients or caregivers can have many of their questions answered by visiting home INR testing. Specialty pharmacy providers such as QAS, Inc. provide full-service assistance including insurance, clinical and technical support at no charge to the patient.

I am copying verbatum a flyer that is distributed by the Alzheimer’s Association entitled “Principles For a Dignified Diagnosis” because although it was published earlier in 2009, I had never seen it and thought maybe many of you had not seen it either.  It’s important.

“Principles fro a Dignified Diagnosis is the first statement of its kind written by people with dementia on the subject of the Alzheimer diagnosis experience.

In the 2008 report Voices of Alzheimer’s Disease: A Summary Report onthe Nationwide Town Hall Meetings for People With Early Stage Dementia, the Alzheimer’s Association identified diagnostic challenges and dissatisfying interactions with the medical community as two major challenges articulated by people living with the diseases.  These principles are their insights on how to make that experience better.

* Talk to me directly, the person with dementia.

    I am the person with the disease, and though my loved ones will also be affected, I am the person who needs to know first.

* Tell the truth.

Even if you don’t have all the answers, be honest about what you do know and why you believe it to be so.

* Test early.

Helping me get an accurate diagnosis as soon as possible gives me more time to cope and live to my fullest potential and to get information about appropriate clinical trials.

* Take my concerns seriously, regardless of my age.

Age may be the biggest risk factor for Alzheimer’s, but Alzheimer’s is not a normal part of aging.  Don’t discount my concerns because I am old.  At the same time, don’t forget that Alzheimer’s can also affect people in their 40s. 50s and 60s.

* Deliver the news in plain but sensitive language.

This may be one of the most important things I ever hear.  Please use language that I can understand and is sensitive to how this may make me feel.

* Coordinate with other care providers.

I may be seeing more than one specialist – it is important that you talk to my other providers to ensure you all have the information so that changes can be identified early on and that I don’t have to repeat any tests unnecessarily.

* Explain the purpose of different tests and what you hope to learn.

Testing can be very physically and emotionally challenging.  It would help me to know what the purpose of the test is, how long it will take and what you expect to learn from the process.  I would also appreciate the option of breaks during longer tests and an opportunity to ask questions.

* Give me tools for living with this disease.

Please don’t give me my diagnosis and then leave me alone to confront it.  I need to know what will happen to me, and I need to know not only about medical treatment options but also what support is available throught the Alzheimer’s Association and other resources in my community.

* Work with me on a plan for healthy living.

Medications may modify some of my neurological symptoms, but I am also interested in other recommendations for keeping myself as healthy as possible through diet, exercise and social engagement.

* Recognize that I am an individual and the way I experience this disease is unique.

This disease affects each person in different ways and at a different pace.  Please be sure to couch your explanation of how this disease may change my life with this in mind.

* Alzheimer’s is a journey, not a destination.

Treatment doesn’t end with the writing of a prescription.  Please continue to be an advocate – not just for my medicial care for my quality of life as I continue to live with Alzheimer’s.

For more infomation and support, contact the Alzheimer’s Association: http://www.alz.org or call 1-800-272-3900.

Many of these principles would apply to other diagnoses as well.

I wanted to add