Not all aged care facilities are created alike. Some offer memory care options, while others do not. Independent living facilities, for example, are geared toward older adults who are able to live an active lifestyle. Assisted living facilities and skilled nursing facilities (also known as nursing homes) may offer memory care options for people with dementia. Before choosing a care facility, ask the facility director if the institution provides specialized care or not.
What is the cost?
Caring for a person with dementia is expensive. According to an analysis conducted in 2016, the cost of health and residential care of people living with dementia can reach up AU $88,000 annually. Before committing to a facility, ensure that the facility and their services are up to or above par. Check the facility’s basic daily fee, plus its means-tested care fee and accommodation cost. Some facilities also charge fees for additional services.
What activity programs are available?
Mental stimulation can have physical benefits for people with dementia. Thus, an ideal aged care facility should provide inclusive programming, as well as specific recreational activities for residents with dementia. Some examples of activities include:
Reading and solving puzzles
Exercise and meditation
Playing a musical instrument/ listening to music/ sing-a-long
Movie screenings
Painting and crafts
What kind of training has the nursing staff received?
Thoroughly check ALL nursing staff credentials to make sure that they are adequately trained. Observe how the staff deals with the residents. Do they treat the residents with compassion and respect, or do they raise their voices or are rude when they communicate? Do you see signs of abuse or neglect? What is the staff-to-resident ratio per shift?
Also, make sure that a registered nurse is on duty 8 hours a day, and the facility is operated by licensed nursing staff 24 hours a day. Many dementia patients are unable to eat or drink by themselves, so check whether the staff is willing to assist residents who are unable to do so.
Montessori in Aged Care is a fairly new concept that is picking up momentum in Australia. It revolves around the idea of maintaining independence rather than creating excess disability. Excess disability simply means to increase the dependence of the individual when they can independently complete the activity or task. For example, if an elderly woman can brush her hair, often a staff worker will do it for them with the impression that they are helping, when in actuality they are taking away the resident’s independence. Imagine living in a nursing home away from the comfort of your own home and not being allowed to do the things you enjoy.
Montessori in Dementia Care enables individuals to maintain that independence, make choices and boost their self-esteem. It also empowers people to make important contributions and have a meaningful place in their community. The impact of dementia affects the resident in various ways including perception, attention, planning, insight, language, emotions, apathy, behavior, physical function and memory.
Therefore, the Montessori Method offers more choices and opportunities that promote self-determination and individuality to provide the best quality care for all. Here are strategies to provide relevant activities for people with dementia:
Take advantage of the known and remembered and use it to create meaningful activities for residents.
Offer more social interaction opportunities with people of all ages.
Provide more physical activity to keep residents, even those in wheelchair, active such as indoor bowling or ball games.
Provide mental stimulation for residents such as crosswords, word games, etc.
Utilize music therapy to play familiar music and trigger well-preserved memories and improve quality of life.
Delegate roles for different residents, if possible. Responsibility gives residents a sense of purpose.
Prepare resources ready to be used to minimize noise and distractions.
Know the residents individually: This involves personal history, employment, hobbies, interests and culture.
Always have a plan B, C, D, E, F, G because things never go as planned.
In conclusion, I think this new concept of dementia care focuses on the strengths and abilities of people with dementia rather than their condition. Montessori programs provide individuals the opportunity to engage the five senses, such as touch, sight, smell, taste and sound, and stimulate their minds. As success is easily achieved, people are encouraged to focus on tasks at hand. This creates a sense of security and high self-esteem, which contributes to the attainment of a life full of purpose and meaning.
Hazel Dompreh is currently a Diversional/Recreational Therapist at a nursing home in New South Wales, Australia.
For Australians aged 65 and older, dementia has been identified as the third leading cause of disability and its prevalence is expected to rise as the population ages. Among this age group, roughly nine percent are living with dementia and among those aged 85 and older, the percentage increases to nearly 30 percent. As a disorder, the risk for dementia increases as an individual ages and it is expected that cases may increase to as many as 900,000 among older adults in Australia by the year 2050.
Dementia is not considered a single specific disease, but rather describes a series of symptoms associated with more than 100 different diseases.The symptom most commonly associated with dementia is impaired brain function, which often manifests as problems with language, memory, perception, personality, and/or cognitive skills. Typically, the decline in brain function that is the hallmark of dementia is significant enough to create challenges in daily living.
In Australia in 2010, dementia was the third leading cause of death overall and among adults aged 65 and over, it was the leading cause of morbidity. From a structural perspective, there are many barriers to the provision of quality care for older adults living with dementia in Australia. It has been estimated that by the year 2029, there could be a shortage of more than 150,000 caregivers for those living with this disorder – a bleak prospect when considering the projected rise in those diagnosed. Additionally, it is estimated that the costs of care to the healthcare system associated with dementia will arise and reach nearly one percent of Australia’s GDP in the next 20 years.
Among Australia’s indigenous groups, the risk for dementia is higher than the general population. Research has suggested that the prevalence of dementia among “remote and rural indigenous people” could be nearly four to five times higher than the general population. For individuals aged 45 and older among indigenous groups, dementia prevalence was 12.4 percent compared to 2.6 percent compared to 2.6% in the broader Australian population. Research has also shown that among indigenous groups, dementia tends to be higher among males while the rate is generally higher among females in the overall population.
The Australian government has recognized the importance of addressing dementia risk among the aging population. In 2012, the Australian Health Ministers included dementia as the ninth National Health Priority Area and it is the newest health issue to be added. By including dementia as a priority area, it is recognized as a significant issue of concern for the Australian population and allows for more concerted, focused efforts to combat its effects. Continued efforts and prioritization will be necessary to ensure older adults in Australia, particularly those living with dementia, may continue to age while experiencing improved quality of life.
Diana Kingsbury is a PhD student and graduate assistant in prevention science at the Kent State University College of Public Health.
Unfortunately, it is impossible to create a standardized time frame regarding end-of-life or long-term care since it varies case by case. While there are signs and symptoms that allow people to predict the direction that someone’s health is going, many individuals begin long term care after a sudden life change that leaves them unable to care for themselves at home. One day, they could be healthy and the next, there could be a stroke or fall. In the best-case scenario for a situation like a stroke or fall, patients return home after successful rehabilitation, but more often than not, patients are unable to fully recover. When this happens, depending upon the severity of the person’s impairment, they are either taken care of by family members or moved into an institutional setting.
About 80 percent of seniors receiving long-term care remain within a private home (either their own or a family member’s), and the remaining 20% are moved into facilities. Each situation has pros and cons and what is best for one individual may not be the right choice for another. Those who remain within their homes are often eligible for home-health services to aid family members in their responsibilities. According to the AARP Public Policy Institute, the elderly population in nursing homes has declined over the past ten years with more people receiving care at home, living in assisted living, or being taken care of in group homes. Nursing homes are generally preferred if a person needs 24-hour supervision.
Long-term care, a general term, refers to the type of assistance provided for people with cognitive or physical limitations. Caregivers provide patients with the care needed to complete daily activities. If patients are unable to remain at home, facilities continue rehabilitation to try and strengthen patients and improve their quality of life. Not only does a more functional patient ease the burden of the caregiver, but the more a resident can do by him or herself (eating, using the bathroom, bathing, and changing), the happier they generally are. As age and illness advance, it is important to not have unrealistic expectations since people start to naturally decline.
Typically, long term care is not paid for by insurance companies so cost is definitely a factor when deciding what is best for your loved one. Even with 80 percent of elders receiving care through informal caretakers such as family members, there is still monetary value attributed to this “donated” care. The time spent caring for a loved one could be spent employed elsewhere with wages. There are also transportation costs to think about since an informal caregiver performs duties otherwise performed by paid healthcare aides. It is therefore important to reach out to a social worker as there are benefits that caregivers may not be aware of in their home state. Some states provide a stipend to informal caregivers while other states grant special benefits. Planning ahead and purchasing long-term care insurance can be a good option for many families. Even without this type of insurance, many facilities, especially hospices, charge on a sliding scale. In some states, there is no fee at all beyond Medicaid coverage. See here for eligibility guidelines and a list of Medicaid rules in your home state.
From long-term care, people unavoidably move toward end-of-life or palliative care, and when a loved one makes the transition, it is not about giving up or hastening death. Rather, it is about making death as comfortable and painless as possible. Many people mistakenly believe that admission to a hospice facility is determined by a life expectancy of six months or less, but this is false. Palliative services exist to relieve emotional or physical pain and to manage symptoms.
Before getting to this stage in life, it is crucial to have a written and notarized document, declaring how your loved one would like the end of their life managed in case they become unable to make decisions for themselves. Without preference information available in one’s medical records, it becomes harder on families in a time when things are already hard enough. Thankfully, people live in a time when long-term care and end-of-life care have made one’s later years more comfortable.
Max Gottlieb is the content editor for the Arizona Long Term Care System (ALTCS) and Senior Planning in Phoenix, Arizona, USA. Senior planning is a free service that has helped many Arizona seniors and their families navigate the process of long term care planning. ALTCS and Senior Planning find and arrange care services as well as help people apply for state and federal benefits.
“They think they are elderly and it is a normal consequence of ageing to be in bed,” says Dr Al Suwaidi.
The United Arab Emirates (UAE) is a small country in the Middle East, nestled between Saudi Arabia to the West, Oman to the East and Iran to the North. A cross-sectional study reported that 95% of its participants, all adults over the age of 65 years, rated their health as satisfactory or higher. There is a general perception of good health among the elderly. Despite this fact, the UAE has the 2nd highest incidence of diabetes in the world, and 4th highest rate of glucose intolerance in its population. Very little in known about elderly health in the UAE and even less is known about elderly health beliefs in this population.
Dubai, United Arab Emirates. Photo by Paolo Margari.
Dr. Al Suwaidi, Director of Geriatrics at Dubai Health Authority, provides insight into what elderly health could be. She suggests the norm to be a passive acceptance of poor health during aging. Religion also plays a significant role in health care seeking behavior. A recurrent theme is the idea that ‘Health is from God‘, discouraging individuals to take action for better health which can imply going against the will of God. Another factor influencing health care seeking behavior is the presence of symptoms. Good health is equated with lack of visible disease, making it less likely to seek care for silent or underlying cases such as diabetes and hypertension.
There is a high regard for elders within the family structure. Common features of the family structure include a practice of traditional values, religion and high economic resources. Understanding the role of elders within the family is essential to providing adequate geriatric care. Dr. Al Suwaidi suggests that there is a greater need for day care centres than long term nursing homes since families would not be receptive to placing their elders in old-age living facilities. This shows the importance of encouraging families and increasing geriatric care that focuses on home-based elderly care.
Geriatric care is a relatively new branch of medicine in the UAE. There is a high disparity of geriatric care provided between the seven emirates, or regions, of the country. The emirates of Umm Al Quwain and Fujairah have relatively poor geriatric care facilities. This is because different governmental bodies govern and offer different services to their respective elderly population. In addition to disparity by location, there is also disparity by citizenship. UAE has one of the world’s highest proportions of an expatriate population, accounting for close to 90% of the country’s total population. This vast majority have limited access to health insurance and social welfare programs.
Current government initiatives include the Elderly Happiness Initiative (EHI) and Weleef. EHI aims to improve the quality of life of elders living alone by providing funding for health care workers to visit and provide home-based care. Weleef is a program that imparts knowledge on best practices to health care providers on a regular basis. Both programs operate in the Emirate of Dubai and are accessible only to UAE nationals or Emiratis. In Dubai, the elderly population, constituting 0.5% of the total population, accounts for 5% of out-patient visits. In addition to improving health, revisiting the current situation of elderly health can also help defray the costs of aging. The UAE needs an inclusive geriatric care model that incorporates local ideas on elderly health. The UAE needs an inclusive geriatric care model that takes local models of elderly health into account
Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.
A growing trend in long-term care delivery has sparked the redesign and re-engineering of senior living centers. This trend includes the integration of plants, gardens, and greenhouses within communities. For instance, assisted living homes and skilled nursing facilities nationwide have adopted horticultural programs in order to improve psychological health and serve as a therapeutic comfort for older adults. Mere exposure to living plants and flowers have also shown to increase activity levels in the elderly as well as influence health outcomes for seriously ill patients.
Redesigning homes range from developing community plots or atria that encourage active teamwork and participation through gardening to “meditative labyrinths” or aromatherapy gardens. In fact, the Robert Wood Johnson Foundation-supported “Green House Project” takes advantage of greeneries, natural light, gardens, and therapeutic outdoor spaces that drastically improve the environment and ambience of care settings. The Foundation has called the project a “catalyst for significant social change in how frail older adults are cared for in this country” and the initiative is being adopted at sites nationwide.
Green House Project homes may qualify as assisted living centers or nursing homes and can be funded through Medicaid or Medicare. Medicaid provides free or low-cost health coverage for families and individuals with low income and limited resources in the United States. Medicare is the federal health insurance program for Americans age 65 and older, certain younger people with disabilities, and people with end stage renal disease and amyotrophic lateral sclerosis (ALS). The widespread growth of the Green House Project and other pilot programs represent a movement towards person-centered, comfort-based care. These programs also reflect a broader paradigm shift in the delivery system towards non-medical needs, personal comfort and well-being.
Raca Banerjee works in health care policy and consulting. She has conducted research on a wide variety of policy and legislative issues related to the Affordable Care Act, Medicare, long-term care, health IT, and more. Raca is an active participant of Rotary Club International. In her free time, she enjoys volunteering, performing music, playing tennis, and learning new languages.
