Catharine's Quality of Life Homes: 303-373-6780
Resident families are invited and encouraged to attend Catharine's Quality of Life Home's staff-training courses. These courses are the same courses that Dick Page teaches at the Alzheimer's Learning Institute, at nursing homes, other assisted living facilities, and at public forums in the Denver metro area.

Alzheimer's Association Colorado Chapter: 303-813-1669; www.alzco.org

For twenty-five years, the Colorado Chapter has lead the fight against Alzheimer's disease and related disorders by increasing the understanding of dementia and its impact on family and community, providing information and support for those affected, and promoting the advancement of research.

The demand for the incredible support that the Alzheimer's Association Colorado chapter provides the community is far from over. Unfortunately, we will see the incidence of Alzheimer's disease continue to rise dramatically. In fact, Colorado could experience a 124% increase in Alzheimer's cases by 2025, bringing the number from 63,000 individuals with the disease today to over 140,000. The Chapter will continue to increase access to service for all those living with this disease.

The Chapter will continue offering a continuum of superior programs and services to Coloradoans affected by Alzheimer's disease and arm them with critical skills and knowledge so they may live empowered and hopeful lives. Some of these programs and services include:

Alzheimer's Learning Institute: Provides caregivers with the tools and information necessary to provide quality care to persons with Alzheimer's disease and their families.

Savvy Caregiver Course: The Savvy Caregiver program is about the "what" and "how" of care giving. It is built around the ideas that you probably never expected to become a caregiver. And, you never trained for the role. The course provides practical information and critical education for family caregivers to become more knowledgeable and effective caregivers for their loved one.

Alzheimer's Family Support Groups: For caregivers, family and friends to get additional help and encouragement. There are 87 Support Groups throughout Colorado including all Denver metro area counties.

24/7 Helpline: 1-800-272-3900: 24 hour a day, seven days a week helpline for caregivers. Knowledgeable and empathetic volunteers provide information, referrals and support.

Is It Alzheimer’s ? – Ten Warning Signs

1. RECENT MEMORY LOSS THAT AFFECTS JOB SKILLS
It's normal to occasionally forget assignments, colleagues' names, or a business associate's telephone number and remember them later. Those with a dementia such as Alzheimer's disease, may forget things more often, and not remember them later.

2. DIFFICULTY PERFORMING FAMILIAR TASKS
Busy people can be so distracted from time to time that they may leave the carrots of the stove and only remember to serve them at the end of the meal. People with Alzheimer's disease could prepare a meal and not only forget to serve it, but also forget they made it.

3. PROBLEMS WITH LANGUAGE
Every one 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 sentence incomprehensible.

4. DISORIENTATION OF TIME AND SPACE
It's normal to forget the day of the week or your destination for a moment. 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 JUDGEMENT
People can become so immersed in an activity that they temporarily forget the child they're watching. People with Alzheimer's disease could forget completely the child under their care. They may also dress inappropriately, wearing several shirts or blouses.

6. PROBLEMS WITH ABSTRACT THINKING
Balancing a check book may be disconcerting when the task is more complicated than usual. Someone with Alzheimer's disease could forget completely what the numbers are and what needs to be done with them.

7. MISPLACING THINGS
Anyone can temporarily misplace a wallet or keys. A person with Alzheimer's disease may put things in inappropriate places: an iron in the freezer, or a wristwatch in the sugar bowl.

8. CHANGES IN MOOD OR BEHAVIOR
Everyone becomes sad or moody from time to time. Someone with Alzheimer's disease can exhibit rapid mood swings - from calm to tears to anger - for no apparent reason.

9. CHANGES IN PERSONALITY
People's personalities ordinarily change somewhat with age. But a person with Alzheimer's disease can change drastically, becoming extremely confused, suspicious, or fearful.

10. LOSS OF INITIATIVE
It's normal to tire of housework, business activities, or social obligations, but most people regain their initiative. The person with Alzheimer's disease may become very passive and require cues and prompting to become involved.

Source: Alzheimer's Association Colorado Chapter

Diagnosis

Dementia is the loss of intellectual functions, memory deficits and/or confusion. Because there are over 60 dementing disorders, a thorough diagnostic work-up is strongly recommended for anyone experiencing these symptoms. A comprehensive evaluation can be conducted by a family doctor, geriatrician, internist, neurologist, psychiatrist, or memory disorder clinic. A complete evaluation should include:

• a detailed medical history
• a thorough physical and neurological examination
• a mental status test
• a psychiatric assessment
• routine laboratory tests, including blood work-up, urinalysis, chest x-ray, EEG, EKG, and CT or MRI
• other tests as necessary

Alzheimer's disease is by far and away the most common cause of dementia. However, other diseases can cause dementia. They include:

• Multi-infarct dementia
• Lewy body dementia
• Parkinson's disease
• Fronto-terporal lobe dementia
• Less common causes such as: Huntington's disease, Pick's disease, Korsakoff's (alcohol dementia)
• Rare causes such as Creutzfeldt-Jakob, and Binswanger diseases.

Diagnosis is important to rule out all other possible causes of memory impairment, some of which are reversible. Reversible causes of dementia-like symptoms include:

• Delirium
• Emotional illness
• Metabolic disorders
• Endocrine disorders
• Nutritional/neurological
• Tumors/trauma
• Infections
• Arteriosclerosis/Anemia

Source: Alzheimer's Association Colorado Chapter

Stages of Symptom Progression in Alzheimer's Disease

Symptoms of Alzheimer's disease generally progress in a recognizable pattern. These stages provide a framework for understanding the disease. It is important to remember they are not uniform in every person, and the stages overlap

First Stage: 2-4 years leading up to and including diagnosis: (Symptoms)

• Recent Memory Loss
• Progressive forgetfulness; difficulty with routine chores
• Confusion about directions, decisions and money management
• Loss of spontaneity and initiative
• Repetitive actions and statements
• Mood/personality and judgment changes
• Disorientation of time and space (Examples)
  • Forgets if bills are paid
  • Loses things and/or forgets they are lost
  • Arrives at wrong time or place
  • Constantly checks calendar
  • Forgets frequently called phone numbers

Second Stage: 2-10 years after diagnosis (longest stage):

• Increasing memory loss, confusion and shorter attention span
• Difficulty recognizing close friends and/or family
• Wandering
• Restlessness, especially in late afternoon and evening (Sundowning)
• Occasional muscle twitching or jerking
• Difficulty organizing thoughts or logical thinking
• May see or hear things that are not there (Hallucinations)(Examples)
  • Sleeps often - awakens frequently at night and may get up and wander
  • Perceptual - motor problems - difficulty getting into a chair, setting the table
  • Can't read signs, write name, add or subtract
  • Suspicious - may accuse spouse of hiding things or infidelity (Paranoia)
  • Loss of impulse control - may undress at inappropriate times or places
  • Huge appetite for junk food - forgets when last meal was eaten; may lose interest in eating

Third Stage: 1-3 years (Symptoms)

• Unable to recognize family members or self in mirror
• Loss of weight even with proper diet; eventually becomes emaciated
• Capacity for self-care diminished
• Oral communication disappears, eventually becomes mute
• Tries to put everything in mouth; compulsion for touching
• Bowel and bladder incontinence
• May experience difficulty with swallowing, respiratory problems skin infections or seizures (Examples)
  • Looks in mirror and talks to own image
  • Needs total care with bathing, dressing, eating and toileting
  • May groan, scream or make grunting noises
  • Sleeps more, becomes comatose; eventually dies

Source: Adapted by the Alzheimer's Association - Detroit Area Chapter, Credit to Lisa P. Gwyther, ACSW

How to Select a Care Facility

Residential Facility Checklist
Look at daily life:

• Do residents seem to enjoy being with staff?
• Are residents clean and well groomed?
• Are most residents dressed for the season and tome of day?
• Do staff members address residents by name?
• Do staff members respond quickly to residents' calls for assistance?
• Are activities tailored to residents' individual needs?
• Are residents involved in a variety of appropriate activities?
• Do staff makes a concerted effort to interact socially with residents?
• Are personal food likes and dislikes or special diets taken into consideration?
• Are snacks available? Does the facility serve food attractively?
• Does the residence use care in selecting roommates?
• How are :difficult" behaviors handled?
• Does the facility have a family council? If it does, how does the council influence decisions about resident life?
• Does the facility provide special activities; music, art, pet therapies, etc.?
• Are religious services offered?
• Are cultural needs met?
• Is transportation provided for outings/medical appointments?

Look at the care residents receive:

• Do various staff and professional experts participate in evaluating each resident's needs and interests?
• Does the facility allow you to make "special requests"?
• Does the resident or his or her family participate in developing the resident's care plan?
• Are family members able to participate in daily care?
• Does the facility offer programs to restore lost physical functioning (for example: physical therapy, occupational therapy, speech and language therapy)?
• Is there an additional cost? If so, how much?
• Does the residence have any special services that meet your needs? (Is there effective Alzheimer's Care?)
• Is a registered nurse available for nursing staff? If there enough staff?
• How are medications administered and safeguarded?
• Does the residence have an arrangement with a nearby hospital?

Look at how the facility handles finances:

• Is the facility certified for Medicaid?
• Is the resident or the resident's family informed when charges are increased?
• Is the cost comparable to other facilities in the area?

Look at the environment:

• Is the outside of the residence clean and in good repair?
• Are the outside areas accessible for residents to use? Are they secure?
• Is the inside of the facility clean and in good repair?
• Are there handrails in the hallways and grab bars in bathrooms?
• When floors are being cleaned, are warning signs displayed or areas blocked off to prevent accidents?
• Is the facility free from unpleasant odors?
• Are toilets convenient to bedrooms?
• Do noise levels fit the activities that are going on?
• Is it easy for residents in wheelchairs to move around the residence? Inside and out?
• Is the lighting appropriate for what residents are doing?
• Are there private areas for residents to visit with family, visitors, or physicians?
• What are the visiting hours?
• Are residents' bedrooms furnished in a pleasant manner? Are residents encouraged to furnish rooms with their own furniture?
• Do the residents have some personal items in their bedrooms (for example: family pictures, souvenirs, and a favorite chair?
• Do the residents' rooms have accessible storage areas for personal items?
• How are the residents with dementia treated compared to other residents?
• Is the outside of the residence clean and in good repair?
• Are the outside areas accessible for residents to use? Are they secure?
• Does the facility have a good reputation in the community?
• Does the residence have a list of references?
• Is the residence convenient for family or friends to visit?
• Does the local ombudsman visit the facility regularly? When was the last state or local inspection? What were the results?
• What is the facilities autopsy policy?
• What are the facility's policies for transfer and discharge?
• Are residents' rights discussed?
• How long can an Alzheimer's resident remain in the Special Care Unit? What additional impairments necessitate a move?
• Where in the facility are advanced Alzheimer's residents cared for?
• Tour the entire facility.

Source: Alzheimer's Association Colorado Chapter

How to Select a Care Facility

Residential Facility Checklist
Look at daily life:

• Do residents seem to enjoy being with staff?
• Are residents clean and well groomed?
• Are most residents dressed for the season and tome of day?
• Do staff members address residents by name?
• Do staff members respond quickly to residents' calls for assistance?
• Are activities tailored to residents' individual needs?
• Are residents involved in a variety of appropriate activities?
• Do staff makes a concerted effort to interact socially with residents?
• Are personal food likes and dislikes or special diets taken into consideration?
• Are snacks available? Does the facility serve food attractively?
• Does the residence use care in selecting roommates?
• How are :difficult" behaviors handled?
• Does the facility have a family council? If it does, how does the council influence decisions about resident life?
• Does the facility provide special activities; music, art, pet therapies, etc.?
• Are religious services offered?
• Are cultural needs met?
• Is transportation provided for outings/medical appointments?

Look at the care residents receive:

• Do various staff and professional experts participate in evaluating each resident's needs and interests?
• Does the facility allow you to make "special requests"?
• Does the resident or his or her family participate in developing the resident's care plan?
• Are family members able to participate in daily care?
• Does the facility offer programs to restore lost physical functioning (for example: physical therapy, occupational therapy, speech and language therapy)?
• Is there an additional cost? If so, how much?
• Does the residence have any special services that meet your needs? (Is there effective Alzheimer's Care?)
• Is a registered nurse available for nursing staff? If there enough staff?
• How are medications administered and safeguarded?
• Does the residence have an arrangement with a nearby hospital?

Look at how the facility handles finances:

• Is the facility certified for Medicaid?
• Is the resident or the resident's family informed when charges are increased?
• Is the cost comparable to other facilities in the area?

Look at the environment:

Is the outside of the residence clean and in good repair

• Are the outside areas accessible for residents to use? Are they secure?
• Is the inside of the facility clean and in good repair?
• Are there handrails in the hallways and grab bars in bathrooms?
• When floors are being cleaned, are warning signs displayed or areas blocked off to prevent accidents?
• Is the facility free from unpleasant odors?
• Are toilets convenient to bedrooms?
• Do noise levels fit the activities that are going on?
• Is it easy for residents in wheelchairs to move around the residence? Inside and out?
• Is the lighting appropriate for what residents are doing?
• Are there private areas for residents to visit with family, visitors, or physicians?
• What are the visiting hours?
• Are residents' bedrooms furnished in a pleasant manner? Are residents encouraged to furnish rooms with their own furniture?
• Do the residents have some personal items in their bedrooms (for example: family pictures, souvenirs, and a favorite chair?
• Do the residents' rooms have accessible storage areas for personal items?
• How are the residents with dementia treated compared to other residents?
• Is the outside of the residence clean and in good repair?
• Are the outside areas accessible for residents to use? Are they secure?
• Does the facility have a good reputation in the community?
• Does the residence have a list of references?
• Is the residence convenient for family or friends to visit?
• Does the local ombudsman visit the facility regularly? When was the last state or local inspection? What were the results?
• What is the facilities autopsy policy?
• What are the facility's policies for transfer and discharge?
• Are residents' rights discussed?
• How long can an Alzheimer's resident remain in the Special Care Unit? What additional impairments necessitate a move?
• Where in the facility are advanced Alzheimer's residents cared for?
• Tour the entire facility.

Source: Alzheimer's Association Colorado Chapter

Additional Checklist Items

Source: Dick Page: Catharine's Quality of Life Homes

• What is the staff to resident ratio during the day? At night? Does the ratio include nurses?
• Are staff awake at night? What is their schedule for checking residents?
• If staff sleeps at night, where do they sleep? How do they hear residents?
• What dementia specific training does the staff receive? On what topics?
• What on-going dementia training does the staff receive? On what topics?
• Who supervises the staff that is interacting with Alzheimer's persons? What is the supervisor's background and/or training?
• After a formal tour of the facility tell the marketing person that you would like to sit quietly in a corner and observe staff/resident interactions. Do it by yourself and with no distractions.
• When starting a conversation, do staff look the resident directly in the eyes and call them by name?
• Do staff speak s-l-o-w-l-y and softly to residents with dementia?
• Do staff seem relaxed or rushed in interacting with dementia residents?
• Do staff smile when interacting with dementia residents?
• Can residents go outside without supervervision or does a staff member accompany them?

Relevant Web Links

• National Alzheimer's Association
• Alzheimer's Association Colorado Chapter
• Information for physicians and the general public
• Web based resources for researchers and a discussion forum to speed the dissemination of new ideas
• Alzheimer's Disease Education and Referral Center (ADEAR) National Institute on Aging site: Research, information and publications on AD

Unfortunately, as persons with Alzheimer's move through the disease process, their physical and cognitive condition deteriorates. Caregivers must adapt to these changes by seeking new and creative ways to enhance the person's quality of life.

As the disease progress, different caregiving skills are necessary. Persons with Alzheimer's change and so do their needs.