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Carole Larkin
Certified Dementia Consultant to families with someone who has Dementia
Certified Dementia Consultant to families with someone who has Dementia


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These doctor's comments on the different definition of Alzheimer's for researchers are all over the place. Very interesting reading!

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A NEW WAY TO DEFINE ALZHEIMER'S!! This could start to ACTUALLY begin to take the stigma out of it! All we have to do is make the biological tests available to everyone. That means PET scans or Spinal Taps. Ok, can anyone make those tests affordable, or at least get them covered by Medicare???,%20not%20cognition,%20will%20now%20define%20Alzheimer%27s

Centers for Medicare & Medicaid Services <> 4/2/2018.

I rarely read all the way through this stuff. ( I get this every .) but I did this time. Passing over all the cost reducing things that are being done, I noted with surprise something that could possibly be REAL helpful to older adults and disabled adults who are on Advantage Plans. Many are, you know because of marketing and perceived cheapness of the premiums.

Check out this paragraph:
As part of today’s announcement and guidance, the agency is reinterpreting the standards for health-related supplemental benefits in the Medicare Advantage program to include additional services that increase health and improve quality of life, including coverage of non-skilled in-home supports and other assistive devices. CMS is expanding the definition of “primarily health related.” Under the new definition, the agency will allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.

If that definition means home care companies will be covered by Medicare (and some of the home care companies accept Medicare payment rates).What a bonus for people with a dementia and a co-existing physical issue (and many, many do), that’s a BIG,BIG thing!!!
Let’s see how it pans out.

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As I suspected, computer brain training programs really train people in tasks similar to the exercise they learn to do, rather than really increase working memory. Better to learn a whole new language or take up a new hobby to really improve working memory.

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And now the article on lack of caregivers right now. And folks its going to get worse in the future unless we change some things.

The Common Cause of the Abuse of Neudexta and the lack of Real “Person Centered Care in America.

I’m trying to kill 2 birds with one stone here. This article will be 98% fact and 2% my opinion.


Marie Marley asked in a comments section of my last article “The True Meaning of Person-Centered Care”, so which of the national chains of Residential Care for seniors are good?”

Marie, I’d love to give you a simple answer, but there really isn’t one. There are way too many other influences on any given Assisted Living/Memory Care/Skilled Nursing Care Facility than just the corporate policy dictating how things should run at the community/facility. Granted, Corporate policy is the foundation and the framework that sets the outside parameters of how the community is run. There is no disputing that.

Large corporations of all types depend on “standardization” to ensure consistency of their product going to the consumer, for maximum efficiency of production of the product at the lowest cost possible. It’s the same “assembly line” model that America has used for well over a century, since the era of industrialization emerged from the pre-industrial era. (Yes, I was a history major in college.) It works the same whether its cars or residents in a community/facility. In order for this model to work, people must be viewed as objects on the assembly line, hence the lack of real person-centered care.

But other things also impact how each community/facility runs daily and how they treat their residents. Consider the importance of the community’s/facilities management (the Executive Director or Administrator, the Assistant Executive Director or Administrator, the Director of Nursing and Assistant Director of Nursing) in your assessment of the community/facility strengths and weaknesses. The management’s personalities, their compassion, their love and dedication to their job, and finally how willing they are to “buck” the corporation edicts at any given time on any given issue. Still another factor is how full the community/facility is and how big their profits are (yes, even in “non-profit” communities) at any given time.

But of all the other factors, the biggest factor is clearly if they have enough trained, knowledgeable, caring staff (meaning aides, caregivers or whatever they are called in that community/facility).

Now I live in Dallas TX, a BIG city and we have a shortage of aides available to help care for disabled or demented older adults. Here the demand is too high for the pool of people available to satisfy the need. And I am talking for any caregivers, be they good, bad or otherwise. The demand for “good” aides is even higher, as you can well imagine. I don’t even want to think about smaller cities and “rural” America, where there is way less people in the pool.

Here’s who is competing for the same pool of people: hospitals and rehabs, nursing homes, assisted livings and memory care communities, home health companies, home care and personal assistant companies and private employers (think families). Not to mention non-health care related companies like fast food and other restaurants, retail stores, etc. And, except for private employers, the non-health care related companies pay more per hour and sometimes offer health insurance benefits. Now which would you rather do, clean up a spill in aisle 3 or clean up a mess in somebody’s incontinence wear?

Any wonder why there’s a shortage now and a crisis looming in the near future as the baby boomers “mature” into consumers of care?

So how can assisted livings, memory care communities and nursing homes cope with a lack of staff to service their needs?
One way is to make the consumers/residents less “needy”, in this instance, users of less time to need the aide’s attention, so that the aide can help more people per shift. How can you accomplish that? Restrain the residents that are “acting out” and causing a ”ruckus”, which usually demands more than one aide to quieten/calm them down. In the old days, they were physically tied down to their bed or wheelchair. Well, that was outlawed so the industry had to look for another way to solve the problem of “needy/disruptive” residents.

The answer? Chemical restraints to put the residents to sleep so that they are less of a problem. Conveniently, the use of antipsychotic drugs (drugs originally meant to calm people with a mental illness called Psychosis), worked just fine on people with dementia. This use was/is off label, meaning the drug wasn’t developed for them anyway. Never mind the side effects of some of these drugs can harm people with dementia and others, they worked. Well, eventually the Federal Government (FDA, CMS, Medicare) figured this out and have started penalizing communities/facilities for using these drugs in that way. The penalty is taking away money from their reimbursements for the care of the residents. That got the communities/facilities attention. Buy the way, this penalization has just started happening within the last year or two.

Now the communities/facilities backs are against the wall again. What to do? TA DA!!! Neudexta (a drug that is NOT technically classified as an Antipsychotic) is invented and comes on the market. Neudexta is really a combination of Quinine (tonic water) and Dextromethorphan (an ingredient in some cough medicines to help quiet coughing). It was approved by the FDA for a specific condition called Pseudobulbar Affect (PBA). Danny Glover of the Lethal Weapon movies advertises it. Maybe you’ve seen some of the ads. Apparently, it has the same effect as the now penalized antipsychotics on some dementia patients.
Anyways, the federal government hasn’t gotten wind of it yet, and hasn’t addressed it’s use off label yet, hence, no penalties for its use, and fair game for chemically restraining users of aides’ time and energy. Therefore, communities/facilities being able to get by with less staff.

See the connection?


To me, all this dodging the law is just putting Band-Aids on a cut that needs sutures. How about trying to really fix it by making the aides jobs more attractive so that people want to do the job rather than run away from it? Yes, doing that involves money. Lots of it. To raise salaries, to give health care and other benefits and to give significant training to aides.

And there’s the rub.

The general public doesn’t want to do that. Why? Because the prevailing view is that old people are not “worth” it. In academia it’s called “ageism”. Whatever it’s called, it’s basically saying old people (and disabled people including those with dementia) have no value because they are not contributing to the USA’s economy. So, until that attitude changes the real “fix” won’t happen. We’re going to just keep putting on Band-Aids and complaining about lousy care for our elderly family members.

What was it that Pogo (the cartoon character) said?
“We have met the enemy, and he is us”

Just wrote an article about precisely the issue that the suit on Brookdale is about. Will publish that article shortly, but first read this.

I want to let women under the age of 74 know about this NIH Study getting ready to start. If a location where it will be done it'd be crazy not to try and participate. /

The Purple Angel Project in Dallas Texas is slated specifically towards hospitals and other acute care institutions. It is a way for hospitals and other acute care facilities to identify patients who have dementia, delirium, Traumatic Brain Injuries and other forms of "altered mental status" quickly. A sticker of the "Purple Angel" is placed on the wrist band of the patient, and the Purple Angel sign is placed on the white board in the patients hospital room, or on the patients hospital room door, just like a fall risk sticker and sign are currently used. This immediately notifies the hospital staff that the patient must be handled differently than one with no cognitive issues. A 5 section, 15-20 minute per section training program accompanies the provided logo JPEG. This program is free of charge. To know more about the Program contact me.
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