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Peace of Mind

Allison Baker

Allison Baker says the Atrium at Cardinal Drive aims to both give residents a high quality of life and take stress away from their loved ones.

It’s a moment so many families dread — until they come out on the other side.

“There’s a lot of anxiety. There’s a lot of guilt,” said Allison Baker, director of Community Relations at the Atrium at Cardinal Drive in Agawam, about the decision to move a loved one — usually a parent or spouse — into the assisted-living facility, which specializes in memory care.

“Families can feel like they might be giving up on their loved one by moving them to a setting like ours. And I think our challenge is to show that you’re not placing your loved one in a place just to live out the rest of their life. The point of our community is to give them the best quality of life.”

Cathy Ballini, executive director of Mason Wright Senior Living in Springfield, agreed.

“I always tell families, ‘nobody shops for this until they have to shop for this.’ And there’s a lot of guilt involved when you take parents out of their home. But you have to look at the bigger picture of what’s best for them.”

What often precedes that discussion, especially with individuals with Alzheimer’s disease or another dementia, is large quantities of “caregiver burnout,” Ballini added.

“When one or two people are caring for someone, there comes a time when something is sacrificed or suffers because you’re not providing this level of care. There’s only so much one person can do to keep someone entertained. There’s only so much the television can do.

Cathy Ballini

Cathy Ballini

“That time they have left should be quality time. You’re taking the business end of the relationship and putting that on us so that you can truly enjoy your time with your with your parent, with your brother, with your spouse.”

“Coming here, they’re building friendships and trust with us so their relationship with the parent becomes what it should be,” she went on. “That time they have left should be quality time. You’re taking the business end of the relationship and putting that on us so that you can truly enjoy your time with your with your parent, with your brother, with your spouse.”

But what makes it quality time, and how does memory care differ from traditional assisted living?

Since it opened 26 years ago, the Atrium has featured two buildings with 22 apartments each, both dedicated to a memory-care model.

“We don’t divide residents based on their care level or their cognitive functioning,” Baker said. “With residents with memory loss or cognitive impairment, huge crowds can be overwhelming or overstimulating, so limiting the number of people is better for a resident. That’s why we have two neighborhoods. They have the same amenities — they both have a courtyard, they both have dining rooms, they both have the atrium area, they both have living rooms and sitting-room areas; they’re identical to one another.”

The Atrium aims to provide a level of care often associated with skilled-nursing facilities — such as two-person transfer assistance, feeding assistance, medication administration, and total care with all aspects of daily living — but in a home-like, assisted-living environment, she added. “It’s a little bit different model than most other communities, but the hope is that our residents can remain here in their home through end of life and not have to move to another setting.”

Mason Wright, like many assisted-living residences, has a neighborhood, called Reflections, dedicated to memory care on its third floor. There, “the caregivers build consistency and trust with the same people,” Ballini said. “The caregivers who are helping them out of bed in the morning are doing activities throughout the day and are serving meals to them. The routine is very important.”

That daily routine includes an extensive roster of activities that actively engage the mind. Residents in Reflections are able to join the rest of the Mason Wright community for events like entertainers, baking sessions, and other activities that anyone can enjoy, but also engage in activities exclusive to their neighborhood that are aimed at preserving cognition.

Laura Lovoie

Laura Lavoie

“Some people contact me when they’re almost at the end of their rope and they just need somebody to say, ‘it’s OK. You’ve done a great job, but there needs to be more support around them 24/7, and you need to sleep.’”

At the Atrium, Baker said, “we’re often able to pique new interest with our residents or encourage them to try something that they haven’t done, like our art therapy program, for example. Residents who have never had an interest in art or painting may be willing to try, and we have seen them partake in that and do an amazing job.”

The Atrium infuses music into many activities, she added, from bringing in professional musicians to utilizing the baby grand pianos in both neighborhoods to playing instrumental music during mealtimes.

“In memory care, music is something that resonates with pretty much the entire population, all of our residents. Not necessarily the same song or same genre, but music is something they can relate to, regardless of what stage someone’s at with dementia, Alzheimer’s, or any cognitive impairment.”

 

Helping the Helpers

Laura Lavoie straddles both the world of family caregiving and residential senior-care facilities through her consulting business, Our Dementia Life, which offers assistance to families dealing with the challenges of memory care and workshops and training to assisted-living facilities and other settings.

With the latter, “it’s really focused on relationships between the staff member and the person living with dementia so that they can give them better care,” she explained, adding that facilities are mandated to offer just two hours per year of dementia training, which isn’t nearly enough. “So many people, not only in memory care but in assisted living and independent living, have dementia, and nobody’s taught how to actually work with these people in order to support them and let them be as autonomous as possible and let them feel as empowered as possible, while still asking for help.”

Meanwhile, Lavoie said, “I also deal with families, especially people who have their loved one in their home, who are really struggling with how they can understand what’s happening, what’s going on inside their brain, and how they can communicate better so that they can care for them better.”

Sometimes those conversations lead to a realization that the family simply can’t do it alone. “Some people contact me when they’re almost at the end of their rope and they just need somebody to say, ‘it’s OK. You’ve done a great job, but there needs to be more support around them 24/7, and you need to sleep.’”

Lavoie said she got into this work almost three decades ago. “My grandfather had dementia. He had a brain tumor, and then he developed dementia because of it and lived with us for a couple of years. And I watched my mom care for him 24/7 with zero training, and she did a beautiful job, but I remember the struggles that she had.”

With people living longer and the over-65 population growing, the need for her services is only growing.

“The mindset at many facilities needs to change and grow with it, and we need people to be well-trained to work with these people in order for them to have a really good quality of life,” she told BusinessWest. “Just because you get a dementia diagnosis does not mean you stop living. Some people have dementia for many years, and why do they have to be bad years?”

She emphasized that the crux of her beliefs lies in looking at the person living with dementia and discovering — and cultivating — what they still have, rather than focusing on what has been lost. “There is a mass culture change that has to happen as the Baby Boomers begin to explode into the various realms of dementias, and I hope to be a part of that even more than I am now.”

Baker also wants to cultivate what residents enjoy, which is why residents at the Atrium are encouraged not to spend the majority of their time in their apartments, but rather in the common areas, taking part in activities that range from trivia and conversations about history to physical activities like cornhole or bowling, as well as outings to local restaurants, parks, and community events.

“We’re trying to keep our residents as engaged as possible throughout the day,” she explained, “with the understanding that we know not every single resident enjoys every single activity that we offer, but the idea is to offer such a variety that there’s something that our residents will enjoy.”

 

Being the Problem Solver

Meanwhile, what families enjoy is spending time with their loved ones without the burden of constant caregiving, Baker said.

“I often talk with families and say, ‘our goal is to relieve you of all that caregiver stress.’ We want them to be able to come and visit their loved one and just be their daughter, son, niece, nephew, husband, wife, and not be worried about whether they got their medications on time, did they take a shower, did they get whatever level of personal care that they may need? We want our families to visit their loved ones and let us worry about all of those other pieces.

“Sometimes you can visibly see the stress relieved from somebody,” she went on. “They just look so much more relaxed once their loved one acclimates.”

Ballini said the need for quality memory care is only growing, and most facilities have waiting lists — and, as a result, many people end up in nursing homes before they need to because there’s not enough spots at facilities like Mason Wright that can meet their care needs in a home-like setting. “In this age of medicine, people are living longer, and there aren’t enough beds for people.”

For the families that can access the right care, however, the rewards can be great, especially if they’re burned out on caregiving at home.

“To see someone come in, not knowing what to do with all the stress, walking through, and they’re not sure it’s right for their loved one, but then seeing their loved one a month or two later, it’s so gratifying,” Ballini told BusinessWest. “It’s nice to be the problem solver. You’re taking care of the family as much as the actual resident.”

Lavoie finds her work satisfying as well, both working with families and helping to train facility staff on how to interact with people with dementia, showing them techniques and communication skills that enhance quality of life for everyone involved.

“It’s the best thing in the world. I get these ‘a-ha’ moments all the time, where even really good care workers in facilities that are really dedicated realize they can make this person feel like they can paint again, and they come to you crying, saying, ‘you should have seen her face.’ Or families say, ‘I can’t believe this this is all it took.’ It’s just the most gratifying thing ever, and I’m thrilled to be doing it, and I just want to give more people the opportunity to learn more.”

Senior Planning

Six Indications It Might Be Time for Memory Care

By Arbors Assisted Living

 

Memory care is a special kind of long-term care designed to meet the specific needs of people with Alzheimer’s and other forms of dementia or types of memory problems. Often housed within an assisted-living community, a memory-care program offers a more structured environment that comes with set schedules and routines to create a stress-free lifestyle, safety features to ensure the health of the residents, and programs designed to cultivate cognitive skills.

Five Symptoms of Dementia to Look Out For

1. Memory loss that disrupts daily life.

One of the most common signs of dementia involves trouble with short-term memory. From forgetting recently learned information to asking for the same information over and over, your aging loved one may be able to remember events that took place years ago, but not what they had for breakfast.

2. Difficulty handling complex tasks.

You might notice a subtle shift in your loved one’s ability to complete normal tasks, such as driving to a familiar location, managing a budget at work, or remembering the rules of a favorite game — or when they start having difficulty handling more complex tasks, such as balancing a checkbook.

3. New problems with words in speaking or writing.

Maybe your mom has always been a stellar conversationalist, and you notice that now she may have trouble following or joining a conversation. Or perhaps your dad struggles to find the right word or calls things by the wrong name.

4. Apathy and withdrawal or depression.

Changes in mood can be an indication that your loved one has dementia. Perhaps they avoid being social because of the changes in their brain. They may also have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby, so they may start to withdraw from things they previously enjoyed.

5. Increasing confusion and disorientation.

Someone in the early stages of dementia may often lose track of dates, seasons, and the passage of time. Confusion may arise as they can no longer remember faces, find the right words, or interact with people normally.

When to see a doctor:

If your aging loved one exhibits several of these signs, consult a doctor. A general practitioner will typically refer you to a neurologist who can examine your loved one’s physical and mental health to determine whether the symptoms result from dementia or another cognitive problem.

One of the goals of a memory-care community is to keep seniors with dementia engaged and active in a safe, home-like environment and to promote the highest quality of life by adapting the staff, environment, and daily routine to the needs of each individual.

Because of this, there is no downside to placing a loved one in a memory-care community too soon. However, there are many drawbacks to waiting too long.

So, how do you know when it’s the right time to consider moving your loved one to a specialized memory care community? The following questions may be helpful when determining if a move to memory care is a good option.

 

1. Is My Loved One Becoming Unsafe in Their Current Home?

As dementia progresses, your loved one will have a harder time functioning independently. Maybe you used to be able to help your mom by writing out a daily to-do list and a schedule of when she should take her medications. But now, she needs reminders to shower and help choosing appropriate clothes for the season.

Bathing, toileting, dressing, and other activities of daily living all come with risks. Safety should always be considered, and if there are any tasks that your loved one cannot perform safely on their own, assistance should be provided.

How often each day you worry about her, check on her, or make a call regarding her safety or whereabouts? If your loved one has fallen, had a driving accident, or suffered an unexplained injury, these are safety signs it’s time to consider moving your loved one to a memory-care community.

 

2. Is the Health of My Loved One or My Health as a Caregiver at Risk?

Dementia will affect your loved one’s ability to remember to take prescribed medications at the right time or the right dosage, which can lead to serious health problems. For example, chronic health conditions such as COPD and heart disease may worsen rapidly if dementia interferes with your loved one’s ability to manage their treatment. You might also notice that your loved one starts to look different. Maybe your dad is losing weight because he forgets to eat or gaining weight because he forgets he’s eaten and eats again.

When you look in a mirror, you might notice that you are starting to look different, too. Caring for someone with dementia is mentally draining and physically exhausting. If the stress of caregiving is left unchecked, it can have an impact on your health, relationships, and state of mind, eventually leading to burnout.

Is dementia preventing your loved one from taking care of their health? Are you and your other family members exhausted? It’s important to be honest with yourself about your emotional and physical limits while caregiving. Sometimes placement in a memory-care community is best for both the caregiver and the loved one’s overall health and well-being.

 

3. Are My Loved One’s Care Needs Beyond My Physical Capabilities?

In the later stages of dementia, your loved one may require assistance getting in and out of bed and moving from the bed to a chair. Additionally, dementia physically damages the brain, which can affect your loved one’s personality and behavior.

Wandering, agitation, repetitive speech or actions, paranoia, and sleeplessness may pose many challenges for families and caregivers. However, it’s important to remember that these behaviors are often coping tactics for a person with deteriorating brain function.

Is your petite, 70-year-old mom trying to get your 180-pound dad to the bathroom two or three times each night? Is your dad’s aggression triggered by something — physical discomfort, being in an unfamiliar situation, poor communication — on a regular basis? If continuing to care for your loved one at home puts both of you in danger, that’s a telltale sign that it’s time for memory care.

 

4. Am I Becoming a Stressed, Irritable, and Impatient Caregiver?

Stress arousal is the first sign that you’re not getting the physical and emotional support you need as a caregiver. Maybe you’re frustrated or disappointed over your loved one’s deteriorating condition or lack of progress. It can be hard to accept that the quality of your care and effort have nothing to do with the actual health-related decline or mood of the care recipient. This frustration can lead to caregiver stress.

If you are so overwhelmed by taking care of someone else that you have neglected your own physical, mental, and emotional well-being, it will not be long before you are experiencing caregiver burnout. When you are burned out, it is tough to do anything, let alone look after someone else.

 

5. Am I Neglecting Work Responsibilities, My Family, and Myself?

You might be struggling to maintain a sense of purpose in working so hard to provide care, which leads to neglecting responsibilities, withdrawing socially from friends and family, and having much less energy than you once had.

Family caregivers often have to take time off, either paid or unpaid, while some have to reduce their work hours. Others leave the workforce entirely in order to provide full-time care for a loved one. Additionally, caregivers don’t have as much time to take care of themselves, and they can often feel cut off from the outside world. Social isolation leads to higher levels of both caregiver stress and depression.

“There is no downside to placing a loved one in a memory-care community too soon. However, there are many drawbacks to waiting too long.”

Are you feeling irritable or hopeless, struggling with emotional and physical exhaustion, or getting sick more often? Do you have heightened anxiety or trouble making care decisions? If your loved one’s need for care is wearing you out, it may be time to start considering your memory-care options.

 

6. Would the Structure and Social Interaction at a Memory-care Community Benefit My Loved One?

Somewhere in the middle and late stages of dementia, your loved one will no longer be able to drive, and communication with others will become increasingly difficult. Your loved one may lose track of their thoughts, be unable to follow conversations, and/or have trouble understanding what others are trying to communicate.

Maybe it’s become too challenging to take your mom out to eat, shop, or exercise because her behavior is unpredictable. Or perhaps your dad can no longer drive, so he rarely goes out and is restless and lonely.

Is dementia shrinking your loved one’s world? Memory-care programs are equipped to provide activities and stimulation — including trips and outings — that can keep your loved one engaged and active in a safe, homelike environment.

If you answered yes to any of these questions or if you have reached a point where you feel like you cannot fully meet the needs of a loved one struggling with memory impairment, it is time to start visiting memory-care communities, which offer specialized environments where your loved one can not only live, but even thrive. Plus, knowing that your loved one has trained, 24-hour care can help relieve the caregiving burden and give your family peace of mind.

Business of Aging

When Memory Falters

By Mark Morris

 

As we age, the occasional struggle to find a word, or a sporadic lapse of memory, is hardly a cause for alarm. It becomes a concern when short-term memory or trouble finding words becomes a constant battle, because those are often signs of dementia.

Memory loss is usually observed by others and not the person who is afflicted. According to Lori Todd, executive director of Loomis Lakeside at Reeds Landing, a person tends to lose their short-term memory — such as not remembering what they had for breakfast — while their long-term memory stays sharp, and they can tell you all about what happened in 1950.

“We also see the person ask a question, get an answer, and then, 10 minutes later, ask the same question,” Todd said.

Understanding the difference between benign memory loss and early stages of dementia can be difficult for families of aging parents because confronting dementia often comes with lots of fear and denial.

“They know you are an important person in their life, and they know there is an emotional connection. Words aren’t as important as the emotions.”

Beth Cardillo, executive director of Armbrook Village in Westfield, works with families to better understand what is happening with their loved ones. Overcoming their fear and denial is the first big hurdle.

“Family members might admit that mom has a little dementia, but not Alzheimer’s,” Cardillo said. “They treat Alzheimer’s like it’s a dirty word.”

While there are more than 100 types of dementia, Alzheimer’s disease accounts for nearly two-thirds of all dementia diagnoses. Cardillo noted that it’s not unusual for someone to have Alzheimer’s as well as one or two other types of dementia.

On the last Wednesday of each month, she runs a caregiver support group that gives families a chance to hear what others are going through while caring for an aging parent.

Beth Cardillo

For loved ones of individuals with dementia, Beth Cardillo says, overcoming fear and denial is often the first challenge.

“I don’t say much; I’m simply there as a resource,” she said. “Most of the talking is done by group members who help clear up misconceptions and help others realize they are not alone.”

Cardillo called it a true support group, one that has been active for 10 years, the last two years via Zoom, and she welcomes any caregiver to join the group. “And I mean anyone because it’s a virtual group. We have family members from all over the country who join in the discussion.”

 

Keep Talking

Open communication with families can help them overcome some of the fear and denial that comes with seeing a loved one losing their cognitive abilities. This can also lead to better interactions.

One past practice which is now discouraged was to try to reality-orient an individual with dementia. For example, if a 95-year-old asks to see her mother, the natural tendency is to point out that her mother would have to be 130 years old. Todd recommends, instead of a rebuttal, just going with it.

“It’s an opportunity to engage and say, ‘let’s talk about your mother and all the wonderful things about her,’” she explained. “By going on that journey, it makes them feel good and improves their quality of life.”

Often, a son or daughter will insist on asking the parent with dementia to say their name and then, if they can come up with it, assume they are having a good day. Cardillo said knowing their children’s names doesn’t really matter and can cause embarrassment for the parent if they don’t succeed.

“They know you are an important person in their life, and they know there is an emotional connection,” she added. “Words aren’t as important as the emotions.”

At Reeds Landing, people with dementia live among the other residents. While resident assistants are there to help when needed, those with dementia have a daily routine and feel more included.

Lori Todd

“Concentrate on what makes them happy. Their long-term memory is still there, so it’s an opportunity to encourage talking about good memories they have.”

“We try to keep them at their highest level of functioning in more of a home-like setting rather than an institutional one,” Todd said.

People with dementia are capable of learning and in many ways remain the person they have always been, Cardillo added. “There are still moments of lucidity. Just because you have dementia, does not mean you are stupid.”

Programs that encourage a fail-free environment tend to work well for those with dementia, such as the painting program at Armbrook Village called Memories in the Making.

“Lots of conversation comes out during these sessions,” Cardillo said, recalling one resident who painted a summer scene. When she asked what that meant to the artist, she reminisced about vacations in Maine many years ago. “It doesn’t matter what they are painting; it’s really an opportunity to share their feelings and tell their stories.”

While staff at local senior communities are trained to look for signs of dementia in residents, it can be more difficult for seniors living at home. Todd usually sees an increase in phone calls after someone comes home for Thanksgiving, assuming their mom or dad is doing fine, only to discover things are not going well.

“We encourage people to talk with their parent’s physician when there has been a change in behavior,” she said. “The physician is a good resource because they know the baseline health of the parent.”

 

Past Meets Present

Helping people understand dementia is a constant activity for Cardillo. Seven years ago, she started the Dementia Friendly movement at Armbrook. Through a partnership with the city of Westfield, Armbrook staff train city employees, first responders, local businesses, and the public on how to recognize the signs of dementia and to better communicate with those afflicted with it.

Both Cardillo and Todd acknowledged that dementia can be frustrating for the person and their family. Because there is no cure for dementia, the emphasis then becomes on the person’s quality of life.

“Concentrate on what makes them happy,” Todd said. “Their long-term memory is still there, so it’s an opportunity to encourage talking about good memories they have.”

Music can also be an effective way to promote good memories. Cardillo referenced a study of a group of people with dementia who were suffering from depression. Researchers asked their families what music the person enjoyed when they were young and made a playlist of that music to play on headphones.

“It woke up their brains and changed their moods,” Cardillo said. “We all hear music and it brings us back to a certain time.” Because music gives most everyone fond memories, she added, it’s no surprise that music brings pleasure to those with dementia as well.

Whatever the milestones along the journey, once family members can move past their denial and fear, she noted, they can really make a difference for their parents.

“When people understand that dementia is not something to be feared, they can begin to accept it and be there for their loved ones.” u