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What is Dementia?
Dementia is an umbrella term used to describe the loss of cognitive or intellectual function. Many conditions can cause dementia. Dementia related to depression, drug interactions, and thyroid and other problems may be reversible if detected early. That’s one of the reasons it’s important to obtain a professional assessment, so that the actual cause can be identified and proper care provided. Several other diseases also cause dementia, such as Parkinson’s, Creutzfeldt-Jakob, Huntington’s, and multi-infarct or vascular disease, caused by multiple strokes in the brain.
What is Alzheimer's?
Alzheimer's disease (pronounced Alz-hi-merz) is a progressive, degenerative disease that attacks the brain and results in impaired memory, thinking and behavior. It affects an estimated 4 million American adults. When it was first diagnosed by German physician Alois Alzheimer in 1907, Alzheimer's disease was considered a rare disorder. Today, it is recognized as the most common cause of dementia. Alzheimer's disease is distinguished from other forms of dementia by characteristic changes in the brain that are visible only upon microscopic examination. Another characteristic of Alzheimer's disease is the reduced production of certain brain chemicals, especially acetylcholine, but also including norepinephrine, serotonin and soma-tostatin. These chemicals are necessary for normal communication between nerve cells.
What are the warning signs of Alzheimer’s?
The Alzheimer’s Association has developed a list of warning signs that include common symptoms of Alzheimer’s disease (some also apply to other dementias). Individuals who exhibit several of these symptoms should see a physician for a complete examination.
1. Memory loss that affects job skills. It’s normal to occasionally forget an assignment, deadline, or colleague’s name, but frequent forgetfulness or unexplainable confusion at home or in the workplace may signal that something’s wrong.
2. Difficulty performing familiar tasks. Busy people get distracted from time to time. For example, you might leave something on the stove too long or not remember to serve part of a meal. People with Alzheimer’s might prepare a meal and not only forget to serve it but also forget they made it.
3. Problems with language. Everyone has trouble finding the right word sometimes, but a person with Alzheimer’s disease may forget simple words or substitute inappropriate words, making his or her sentences difficult to understand.
4. Disorientation to time and place. It’s normal to momentarily forget the day of the week or what you need from the store. But people with Alzheimer’s disease can become lost on their own street, not knowing where they are, how they got there, or how to get back home.
5. Poor or decreased judgment. Choosing not to bring a sweater or coat along on a chilly night is a common mistake. A person with Alzheimer’s, however, may dress inappropriately in more noticeable ways, wearing a bathrobe to the store or several blouses on a hot day.
6. Problems with abstract thinking. Balancing a checkbook can be challenging for many people, but for someone with Alzheimer’s, recognizing numbers or performing basic calculations may be impossible.
7. Misplacing things. Everyone temporarily misplaces a wallet or keys from time to time. A person with Alzheimer’s disease may put these and other items in inappropriate places — such as an iron in the freezer or a wristwatch in the sugar bowl — and then not recall how they got there.
8. Changes in mood or behavior. Everyone experiences a broad range of emotions — it’s part of being human. People with Alzheimer’s tend to exhibit more rapid mood swings for no apparent reason.
9. Changes in personality. People’s personalities may change somewhat as they age. But a person with Alzheimer’s can change dramatically, either suddenly or over a period of time. Someone who is generally easygoing may become angry, suspicious, or fearful.
10. Loss of initiative. It’s normal to tire of housework, business activities, or social obligations, but most people retain or eventually regain their interest. A person with Alzheimer’s disease may remain uninterested and uninvolved in many or all of his usual pursuits.
What is Parkinson's disease?
Parkinson's disease (PD) is a degenerative neurological disorder of the brain related to a depletion of a neurotransmitter called dopamine. PD strikes people of all ages and ethnic groups. The average age of diagnosis is 60. However, 10 - 20% of persons with PD develop it before the age of 50. About half of these are diagnosed before the age of 40. The cause of PD is still under investigation, however there may be multiple factors including genetic predisposition and exposure to environmental toxins. Symptoms can include: Rigidity or stiffness of arms, legs or neck Tremors, mostly in the hands (at rest) Instability in posture or balance Slowness in movement Secondary symptoms may include facial "masking", depression, confusion, difficulties in speech or swallowing. PD affects individuals differently, but if managed carefully, each person can live well.
What are our Residential Options?
Independent Living
For seniors able to determine their own activities of daily living (ADL) … this is similar to apartment dwelling for retirees.
Assisted Living
For seniors no longer able to care for themselves in daily needs such as grooming, medication management, continence, feeding or physical movement, assisted living helps with these tasks. Silverado Senior Living communities go far beyond mere ADL care needs by engaging our residents with activities of their choice, surrounding them with sensory experiences, and enlivening them with pets, children, laughter and love.
Skilled Nursing
For those rehabilitating from some kind of medical condition (stroke, operation, etc.), skilled nursing facilities are typically hospital-like settings. Silverado now offers Skilled Nursing units in a few of our communities, allowing those needing rehabilitation services to reside in an uplifting and engaging environment.
Home Care
Home care is a way for families to enable their loved ones to safely remain in their home environment, through the assistance of hourly or live-in caregivers. Silverado At Home brings their Care Plan Program to this option, which includes creating an individualized care plan that collaborates the client, family, geriatric care manager, caregiver, and other invested parties (doctors, lawyers, other family members, etc.)
Hospice
Hospice is palliative end-of-life care. Palliative means comfort care, and the purpose of Hospice is to ease pain, and bring relief to the patient and their family. The process of life includes this journey. Hospice utilizes interdisciplinary teams including medical, spiritual, and psychosocial aspects, each bringing their own level of care and expertise to your loved one. Silverado Hospice additionally offers dementia care expertise to their list of specialties.
Who is eligible to receive hospice care?
All patients whose disease prognosis is measured in months, not years, and who are seeking comfort, not cure.
Who pays for hospice care?
Medicare, Medi-Cal, Champus, and most private insurance carriers cover hospice services.
What is Hospice?
The word “hospice” originated in medieval times, a derivative of the Latin “hospes” meaning host or guest. Travel-weary crusaders on their way to the Holy Land found places of refuge in monasteries. Eventually these places of rest came to be called hospices. Because great numbers of the pilgrims were in ill health, many probably spent their last days there.
During the 1960’s, Dr. Cicely Saunders began a hospice program in England which encompassed home care and an in-patient facility for the terminally ill. The first hospice in the United States was established in 1974.
The Social Security Administration added Hospice Care as a separate voluntary program in 1982. Medicare eligible recipients may elect this special benefit after meeting the Hospice Admission criteria through a Medicare certified Hospice Program. This is a Medicare Part A benefit.
What is a Hospice Philosophy?
Hospice is a special kind of care designed to provide sensitivity and support for people in the final phase of a terminal illness. Hospice care seeks to enable patients to carry on an alert, pain-free life and to manage other symptoms so that their last days may be spent with dignity and quality at home or in a home-like setting.
How does Hospice work?
Hospice services are available to persons who can no longer benefit from curative treatment; the typical hospice patient has a life expectancy of six months or less. Services are provided by a team of trained professionals-who provide medical care and support services not only to the patient, but to the patient’s family and caregivers. The patient is usually referred to hospice by the primary physician. Referrals can also be made by family members, friends, clergy, or health professionals.
How does a patient get Hospice services?
Through a process called Informed Consent. The beneficiary must agree that he/she wishes to receive “palliative, not curative, care”, and to surrender all other Medicare benefits relating to the terminal diagnosis, with the exception of the professional services of his/her attending physician.
Who determines what medications will be administered?
The patient’s primary physician, the hospice physician and the hospice registered nurse work in concert to evaluate medications necessary to control a patient’s pain and symptoms. These decisions are discussed with the family.
What if the patient gets better?
If you, your physician and/or the hospice team feel that hospice care is no longer needed, you can be discharged. If hospice care is needed at a later date, we will be there.
Will Hospice pay for benefits related to other health problems?
No, it is important to note that Medicare will still pay for covered benefits for any health problems that are not related to the patient’s terminal illness.
What is the Medicare Hospice Benefit?
Medicare covers services provided by qualified Hospices which have been certified by Medicare. Under this benefit, Medicare will cover basic costs of Hospice services delivered by a qualified Hospice. The Medicare Hospice Benefit covers services, drugs, biologicals, medical supplies and medical equipment related to the management of problems associated with the terminal illness. This includes palliative (pain reducing) and supportive interventions. When all requirements are met, basic Hospice services include.
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Hospice physician oversight and consultation
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Nursing services
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Medical supplies and durable medical equipment related to the Hospice diagnosis
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Medications for symptom management and pain relief
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Home health aide and homemaker services
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Medical social services for patient and family including bereavement and psychosocial support
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Spiritual support as desired by patient and family
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Volunteer services
The Hospice program is financially responsible for all services covered under the Hospice Benefit.
What does Hospice Care under Medicare consist of?
The following services which address the Hospice diagnosis are available when determined by the Care Team and your attending physician to be necessary.
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Regular visits by a Registered Nurse, Home Health Aide, Social Worker and Physician.
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Short-term inpatient care including respite care
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Spiritual support
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Volunteers
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Medications, equipment and medical supplies as needed for comfort.
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Bereavement support for 13 months.
How long can Hospice care continue?
Special benefit periods apply to Hospice care. A Medicare beneficiary may elect to receive Hospice care for two 90-day benefit periods, followed by indefinite 60 day benefit periods.
The benefit periods may be used consecutively or at intervals. Regardless of whether they are used one right after the other or at different times, the patient must be certified by the Hospice Medical Director and care team as terminally ill at the beginning of each period.
A patient has the right to cancel Hospice care at any time and return to standard Medicare coverage, then later re-elect the Hospice benefit if another benefit period is available. If a patient cancels during one of the first three benefit periods, any days left in that period are lost.
In addition to the right to discontinue Hospice care at any time, patients also may change Hospice programs, once in each benefit period.
While individual patients may receive hospice services for periods beyond six months, Medicare has a “global cap” on the total annual monies that a hospice can receive. This “global cap” forces hospices to work closely with community physicians to assure patients’ appropriateness but does not “punish” a beneficiary or his/her physician if a patient is fortunate enough to live beyond six months.
Are other Medicare benefits available?
When a Medicare beneficiary chooses Hospice care, he or she gives up the right to standard Medicare benefits for the terminal illness. If the Medicare Hospice patient(who must have Part A in order to use the Medicare Hospice benefit) also has Medicare Part B, he or she can use all appropriate Medicare benefits for the treatment of health problems unrelated to the terminal illness. When standard benefits are used, the patient is responsible for Medicare deductible and coinsurance amounts.
When a patient elects the Hospice benefit Silverado Hospice does not bill the family for any deductible or coinsurance amounts.
What is not covered?
All services required for treatment of the terminal illness must be provided by or through the Hospice. When a Medicare beneficiary chooses Hospice care, Medicare will not pay for:
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Treatment for the terminal illness which is not for symptom management and pain control;
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Care provided by another Hospice that was not arranged by the patient’s Hospice; and
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Care from another provider which duplicates care the Hospice is required to furnish.
All health care services must be authorized by Silverado Hospice to be covered under the Hospice Benefit. If a patient elects to receive medical or hospital services which are not directly provided or authorized by Silverado Hospice, they may either self pay for that service or they may revoke the Hospice Benefit and have that service covered by standard Medicare.
How do I know when it's time to seek help for the care of my loved one in order to maintain my own health?
A study of elderly spouse caregivers, aged 66 to 96: found that caregivers who experience mental or emotional strain have a 63% higher risk of dying than non-caregivers. Caregivers are often so concerned with care for their relative’s needs, that they lose sight of their own well being.
Please use the caregiver self-assessment questionnaire below to help assess your need for help. Please take just a few minutes to answer the following questions.
Answer Yes or No
During the past week or so, I have…
1. Had trouble keeping my mind on what I was doing |
Yes |
No |
2. Felt that I couldn't leave my relative alone |
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3. Had difficulty making decisions |
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4. Felt completely overwhelmed |
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5. Felt useless and unneeded |
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6. Felt lonely |
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7. Been upset that my relative has changed so much from his/her former self |
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8. Felt a loss of privacy and /or personal time |
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9. Been edgy and irritable |
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10. Had sleep disturbed because of caring for my relative |
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11. Had a crying spell or spells |
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12. Felt strained between work and family responsibilities |
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13. Had back pain |
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14. Felt ill (headaches, stomach problems or common cold) |
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15. Been dissatisfied with the support my family has given me |
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16. Found that my relatives living situation to be inconvenient or a barrier to care |
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17. On a scale of 1 to 10, with 1 being "not stressed" to 10 being "extremely stressful,"
please rate your current level of stress |
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18. On a scale of 1 to 10, with 1 being "very healthy" to 10 being "extremely ill," please
rate your current health compared to what it was this time last year. |
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To determine the score total the number of "yes" responses. Chances are you are experiencing a high degree of distress if your total score is 10 or more; you answered "yes" to questions 4 and 11 or your score on either question 17 or 18 was 6 or higher.
Next Steps:
Consider seeing a doctor for a check-up for yourself.
Consider having some relief from care giving. Contact the Silverado Senior Living community nearest you. Short respite care is also available, and every Silverado community offers support groups with free respite care during the program at no charge to you.
Consider joining any support group!
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