Department of Geriatrics and Supportive Care

KP Napa-Solano

Memory Center

Table of Contents

Memory Center Overview 1

Our Team2

The 3 Types of Memory Changes4

10 Warning Signs of Dementia 5

Compassionate Communication

with the Memory-Impaired 7

Living and Home Care Options 9

Driving 13

Caregiver Bill of Rights18

10 Ways to Love Your Brain 19

Physical Activity 20

Eating Healthy 22

Planning for Your Future 24

Resources 26

Presentation Slides 28

Memory Clinic - Vallejo

Monday - Friday

830 am to 1230 pm

130 pm to 5 pm

(707) 651-2474

Memory Clinic - Vacaville

Monday - Friday

830 am to 1230 pm

130 pm to 5 pm

(707) 624-3248

Visit our web site at kporgNapaSolanoMemoryCenter for more information

Overview of the KP Napa-Solano Memory Center

Step 1 Memory Class (No Co-Pay)

This is a 2-hour class for patients who have memory loss andor their family members Information about causes of memory loss treatments community resources and legal issues is presented Family membersindividuals who are close to the patient with memory loss should attend Patients may also attend unless they have a significant hearing deficit wonrsquot be able to sit through a 2-hour class or wonrsquot understand the information

Step 2 Individual evaluation appointment (Co-Pay applies)

This is a 1-hour evaluation appointment with a Nurse Practitioner or Geriatrician The patient may also see a Social Worker if needed The purpose of this appointment is to do a complete memory evaluation and provide a diagnosis make any needed medication changes and provide community resource information

The patient and a family member should attend

Step 3 Ongoing Support (No Co-Pay for email or telephone appointments)

The Memory Center is available for ongoing consultation We will continue to provide support for memory-related issues via clinic visits as well as telephone and e-mail correspondence We can address many behavioral social and medication issues by telephone or email

Additional Support Caregiver Lecture Series (No Co-Pay)

This is an 8 week course for caregivers to review the stages of dementia and discuss common behaviors and strategies for dealing with these issues

1

Memory Center Team

We would like to introduce the providers that work in the Memory Center at Kaiser Napa Solano You may see one or several of these providers when you have an appointment at the Memory Center

Saad Basheer MD CMD FAAFP Dr Basheer is a specialist in Geriatric Medicine who completed his medical training at Quaid-e-Azam Medical College Bahawalpur Pakistan in 2002 He completed his Family Medicine residency at UMDNJ RWJUH-Rutgers University New Brunswick NJ in 2008 and completed his Geriatric fellowship at Saint Louis University Hospital St Louis MO in 2009 He is board certified in Family Medicine and in Geriatric Medicine by the American Board of Family Medicine and is a Certified Medical Director by the American Board of Post-Acute and Long-Term Care Medicine Dr Basheer is a member of the American Academy of Family Medicine the AMDA The Society for Post-Acute and Long-Term Care Medicine and the American Geriatrics Society He previously acted Medical Director for Geriatrics in Tulsa Oklahoma before he joined Kaiser in 2016 His focus is on the care of the patients in the Memory Center skilled nursing facilities and in the My Care My Home program

Chandra Keebler MD Dr Keebler is a specialist in Geriatric Medicine and Palliative Medicine She completed her medical education in 2012 at University of California San Diego School of Medicine in La Jolla CA She completed Internal Medicine residency in 2015 at University of California Los Angeles in Westwood CA and stayed at UCLA to complete separate fellowships in Geriatric Medicine and Hospice and Palliative Medicine She is board certified in Internal Medicine Geriatric Medicine and Hospice and Palliative Medicine Dr Keebler joined Kaiser Permanente in 2017 and cares for patients in skilled nursing facilities Memory Clinic and the My Care My Home program

Michael Mason MD Dr Mason is a specialist in Geriatric Medicine who graduated as a Deans Scholar from The University of Southern California School of Medicine Los Angeles CA in 1994 He completed his residency at the UCLAKFH program in Woodland Hills CA and fellowship training in Geriatric Medicine at the UCLAKFH program in Los Angeles CA He is board-certified in Family Medicine and Geriatric Medicine He served as faculty at the UCLA School of Medicine teaching residents and fellows for many years Dr Mason worked at Kaiser Woodland Hills from 1998 to 2014 then moved to Northern California and joined us here at the Kaiser Hospital in Vallejo He is currently is the APIC of Geriatrics and is part of the faculty of the Family Medicine Residency Program in addition to his other work with caring for our patients in local skilled nursing facilities the hospital and in the My Care My Home Program

Maya Kahwagi MD Dr Kahwagi is excited to join the Memory Center at the Kaiser Permanente Vacaville Medical

Center She received her medical degree from the Universite Saint-Joseph Faculte de

Medecine in Beirut Lebanon in 2002 In 2009 She completed residency at the Vidant Medical

Center in Greenville NC The following year she completed a fellowship at the same venue

She is board certified in both Family and Geriatric Medicine by the American Board of Family

Medicine

2

Sari Fredrickson MS RN FNP-BC NP Fredrickson is a board-certified Family Nurse Practitioner She received her Nurse Practitioner training at the University of California San Francisco and was awarded a Master of Science degree NP Fredrickson has many years of experience in outpatient inpatient and home settings and has worked in Medicine Primary Care Neurology and Psychiatry Over the past decade NP Fredrickson has focused on the care of the elderly In Memory Clinic Palliative Care and Home-Based Primary Care She has served in NP leadership roles and has authored two chapters in a nurse practitioner textbook NP Fredrickson joined the Napa-Solano Memory Center in 2019

Elizabeth McCoy MSW Elizabeth McCoy is a Medical Social Worker who received her bachelorrsquos degree in Psychology from San Francisco State University and a masterrsquos degree in Social Welfare with a health concentration from UC Berkeley Since joining Kaiser in 2014 Elizabeth has supported patients and their families through planning as well as medical crises in the emergency inpatient clinic and hospice settings She is dedicated to taking a strength-based approach to care -- with an emphasis on meeting patients and their families where they are -- to support their efforts to cope effectively through care planning as well as emotional and resource support She joined the Napa-Solano Memory Center in 2019

Emerciana Powell Rodgers Medical Assistant Vallejo Emerciana Powell Rodgers is a Medical Assistant in the Memory Clinic and Palliative Care clinics She completed her education at Boston Reed College in December 1998 Emerciana started with Kaiser Permanente in April 2000 in Walnut Creek and worked in Adult Medicine for 14 years She then transferred to Vallejo Kaiser with the Neurology department in February 2014 Soon after Memory Clinic and Neurology partnered together and she supported both departments In 2017 Memory Clinic then partnered with Palliative Care and Emerciana continues to be an outstanding asset to these departments

Marissa Yamamoto Medical Assistant Vacaville Marissa Yamamoto is a Medical Assistant in Geriatric Medicine and Palliative Medicine She completed her medical assisting course in 2015 at Contra Costa Office of Education in Antioch CA Marissa joined Kaiser Permanente in 2015 and assists patients and her team in Memory Clinic and Palliative Care

3

The 3 Types of Memory Loss

Normal Aging Itrsquos normal to expect some memory loss with age With all the information your brain collects over a lifetime it is logical that recalling certain details take more time and effort Examples include occasionally forgetting where you put your keys or glasses or blanking on the name of an acquaintance This type of ldquomemory problemrdquo is more often annoying than serious Other factors can affect how your mind functions including medication side effects or interaction depressionanxiety and medical problems

Mild Cognitive Impairment (MCI) MCI is a step beyond age-associated memory changes A person with MCI has more memory problems than would be expected for their age but they are able to complete their basic functions When tested they may have difficulty with one area of cognition Research has noted that some patients with MCI improve some are stable over time and some progress to dementia

Dementia When difficulty with memory and other mental abilities interferes with daily life this is called dementia There are several types of dementia that have different characteristics and causes No matter the type dementia is a progressive disease meaning the problems will worsen over months to years There are different stages of dementia mild moderate and advanced The stages are based on the personrsquos function and they will have different needs at different stages Family and caregivers are essential to meet the needs of a person with dementia

4

10 Warning Signs of Alzheimerrsquos

If you notice any of these signs take action Use this form to note your concerns so you can address them with a friend family member or doctor

1 MEMORY LOSS THAT DISRUPTS DAILY LIFE One of the most common signs of Alzheimerrsquos disease especially in the early stage is forgetting recently learned information Others include forgetting important dates or events asking the same question over and over again or increasingly needing to rely on memory aids (eg reminder notes or electronic devices) or family members for things the person used to handle on their own Whatrsquos a typical age-related change Sometimes forgetting names or appointments but remembering them later

2 CHALLENGES IN PLANNING OR SOLVING PROBLEMS Some people living with dementia may experience changes in their ability to develop and follow a plan or work with numbers They may have trouble following a familiar recipe or keeping track of monthly bills They may have difculty concentrating and take much longer to do things than they did before Whatrsquos a typical age-related change Making occasional errors when managing fnances or household bills

3 DIFFICULTY COMPLETING FAMILIAR TASKS People living with Alzheimerrsquos disease often fnd it hard to complete routine tasks Sometimes they may have trouble driving to a familiar location organizing a grocery list or remembering the rules of a favorite game Whatrsquos a typical age-related change Occasionally needing help to use microwave settings or to record a TV show

4 CONFUSION WITH TIME OR PLACE People living with Alzheimerrsquos can lose track of dates seasons and the passage of time They may have trouble understanding something if it is not happening immediately Sometimes they may forget where they are or how they got there Whatrsquos a typical age-related change Getting confused about the day of the week but fguring it out later

5 TROUBLE UNDERSTANDING VISUAL IMAGES AND SPATIAL RELATIONSHIPS For some people vision problems are a sign of Alzheimerrsquos They may also have problems judging distance and determining color or contrast causing issues with driving Whatrsquos a typical age-related change Vision changes related to cataracts

5

6 NEW PROBLEMS WITH WORDS IN SPEAKING OR WRITING People living with Alzheimerrsquos may have trouble following or joining a conversation They may stop in the middle of a conversation and have no idea how to continue or repeat themselves They may struggle with vocabulary have trouble naming a familiar object or use the wrong name Whatrsquos a typical age-related change Sometimes having trouble fnding the right word

7 MISPLACING THINGS AND LOSING THE ABILITY TO RETRACE STEPS A person living with Alzheimerrsquos may put things in unusual places They may lose things and be unable to go back over their steps to fnd them again He or she may accuse others of stealing especially as the disease progresses Whatrsquos a typical age-related change Misplacing things from time to time and retracing steps to fnd them

8 DECREASED OR POOR JUDGMENT Individuals may experience changes in judgment or decision-making For example they may use poor judgment when dealing with money or pay less attention to grooming or keeping themselves clean Whatrsquos a typical age-related change Making a bad decision once in a while like neglecting to change the oil in the car

9 WITHDRAWAL FROM WORK OR SOCIAL ACTIVITIES A person living with Alzheimerrsquos may experience changes in the ability to hold or follow a conversation As a result he or she may withdraw from hobbies social activities or other engagements They may have trouble keeping up with a favorite team or activity Whatrsquos a typical age-related change Sometimes feeling uninterested in family or social obligations

10 CHANGES IN MOOD AND PERSONALITY Individuals living with Alzheimerrsquos may experience mood and personality changes They may be easily upset at home at work with friends or when out of their comfort zone Whatrsquos a typical age-related change Developing very specifc ways of doing things and becoming irritable when a routine is disrupted

WHATrsquoS NEXT If yoursquore concerned that you or someone you know is displaying any of these signs take action

Talk to someone you trust It can be helpful to confde in a friend or family member For tips on how to have a conversation visit alzorgmemoryconcerns

See a doctor Get a full medical evaluation to determine if itrsquos Alzheimerrsquos or something else Early diagnosis gives you a chance to plan for the future access support services and explore medication that may address some symptoms for a time Visit alzorgevaluatememory to learn what an evaluation may include

Get support and information Call the Alzheimerrsquos Association 247 Helpline (8002723900) or visit alzorg10signs

Note This list is for information only and not a substitute for a consultation with a qualifed medical professional This is an ofcial publication of the Alzheimerrsquos Association but may be distributed freely and without charge by unafliated organizations or individuals Such distribution does not constitute an endorsement of these par ties or their activities by the Alzheimerrsquos Association

copy2019 Alzheimerrsquos Associationreg All rights reserved Rev Jun19 TS-0066

6

Compassionate Communication with the Memory Impaired

Donrsquot Donrsquot reason Donrsquot remind them they forget Donrsquot argue Donrsquot question recent memory Donrsquot confront Donrsquot take it personally

DO bull Give short one sentence explanations bull Allow plenty of time for comprehension and then triple it bull Repeat instructions or sentences exactly the same way bull Eliminate lsquobutrsquo from your vocabulary substitute lsquoneverthelessrsquo

bull Avoid insistence Try again later bull Agree with them or distract them to a different subject or activity bull Accept the blame when somethingrsquos wrong (even if itrsquos fantasy) bull Leave the room if necessary to avoid confrontations

bull Respond to the feelings rather than the words bull Be patient and cheerful and reassuring Do go with the flow bull Practice 100 forgiveness Memory loss progresses daily bull My appeal to you Please elevate your level of generosity and graciousness

Remember You canrsquot control memory loss only your reaction to it Compassionate communication will significantly heighten quality of life They are not crazy or lazy They say normal things and do normal things for a memory impaired dementia individual If they were deliberately trying to exasperate you they would have a different diagnosis Forgive themhellipalways For example they donrsquot hide things they protect them in safe placeshellipand then forget Donrsquot take lsquostealingrsquo accusations personally

Their disability is memory loss Asking them to remember is like asking a blind person to read (ldquoDid you take your pillsrdquo ldquoWhat did you do todayrdquo) Donrsquot ask and donrsquot test memory A loss of this magnitude reduces the capacity to reason Expecting them to be reasonable or to accept your conclusion is unrealistic (ldquoYou need a showerrdquo ldquoDay care will be funrdquo ldquoYou canrsquot live alonerdquo) Donrsquot try to reason or convince them Give a one sentence explanation or search for creative solutions Memory loss produces unpredictable emotions thought and behavior which you can alleviate by resolving all issues peacefully Donrsquot argue correct contradict confront blame or insist

Reminders are rarely kind They tell the patient how disabled they arendashndashover and over again Reminders of the recent past imply ldquoI remember Irsquom okay you donrsquot yoursquore notrdquo Ouch Refer only to the present or the future (If theyrsquore hungry donrsquot inform them they ate an hour ago offer a snack or set a time to eat soon) They may ask the same question repeatedly believing each time is the first Graciously respond as if itrsquos the first time Some days they seem normal but theyrsquore not They live in a different reality Reminders wonrsquot bring them into yours Note For vascular dementia giving clues may help their recall If it doesnrsquot work be kindhellipdonrsquot remind

Ethical dilemmas may occur If for instance the patient thinks a dead spouse is alive and truthful reminders will create sadness what should you do To avoid distress try these ways of kindness 1) distract to another topic or 2) start a fun activity or 3) reminisce about their spouse ldquoI was just thinking about ___ How did you meetrdquo or you might try ldquoHersquos gone for a while Letrsquos take our walk nowrdquo

Open ended questions (ldquoWhere shall we gordquo ldquoWhat do you want to eatweardordquo) are surprisingly complex and create anxiety Give them a simple choice between two items or direct their choice ldquoYou look great in the red blouserdquo

They are scared all the time Each patient reacts differently to fear They may become passive uncooperative hostile angry agitated verbally abusive or physically combative They may even do them all at different times or alternate between them Anxiety may compel them to shadow you (follow everywhere) Anxiety compels them to resist changes in routine even pleasant ones Your goal is to reduce anxiety whenever possible Also they canrsquot remember your reassurances Keep saying them

copy1995 2001 2005 2007 2008 Liz Ayres Alzheimerrsquos Support Group Leader former Caregiver Orange County CA 7

Examples Donrsquot argue Patient ldquoI didnrsquot write this check for $500

Someone at the bank is forging my Donrsquot reason signaturerdquo

Patient ldquoWhat doctorrsquos appointment Therersquos nothing Donrsquot (argue) ldquoWhat Donrsquot be silly The bank wrong with merdquo

wouldnrsquot be forging your signaturerdquo Donrsquot (reason) ldquoYoursquove been seeing the doctor every

DO (respond to feelings) ldquoThatrsquos a scary thoughtrdquo three months for the last two years Itrsquos written (reassure) ldquoIrsquoll make sure they donrsquot do on the calendar and I told you about it yesterday thatrdquo(distract) ldquoWould you help me fold and this morningrdquo the towelsrdquo

DO (short explanation) ldquoItrsquos just a regular checkuprdquo (accept blame) ldquoIrsquom sorry if I forgot to tell yourdquo

Donrsquot remind them that they forget

Donrsquot confront Patient ldquoJoe hasnrsquot called for a long

Patient ldquoNobodyrsquos going to make decisions for me You can go time I hope hersquos okrdquo

Donrsquot

nowhellipand donrsquot come backrdquo

(confront) ldquoIrsquom not going anywhere and you canrsquot remember enough to make your own decisionsrdquo

Donrsquot (remind) ldquoJoe called yesterday and you talked with him for 15 minutesrdquo

DO (accept blame or respond to feelings) ldquoIrsquom sorry this is a tough timerdquo (reassure) ldquoI love you and wersquore going to get through this

togetherrdquo (distract) ldquoYou know what Don has a new job Hersquos really

excited about itrdquo

DO (reassure) ldquoYou really like talking with him donrsquot yourdquo (distract) ldquoLetrsquos call him when we get back from our walkrdquo

Donrsquot take it personally Donrsquot question recent memory Patient ldquoWho are you Wherersquos my

Patient ldquoHello Mary I see yoursquove brought a friend with yourdquo husbandrdquo Donrsquot (question memory) ldquoHi Mom You remember Eric

Donrsquot (take it personally) ldquoWhat do you donrsquot you What did you do todayrdquo mean ndash whorsquos your husbandrdquo I amrdquo

DO (short explanation) ldquoHi Mom You look wonderful DO (go with the flow reassure) ldquoHersquoll

This is Eric We work togetherrdquo be here for dinnerrdquo (distract) ldquoHow about some milk and cookies Would you like chocolate chip or oatmealrdquo

Do repeat exactly Patient ldquoIrsquom going to the store for a newspaperrdquo

Donrsquot (repeat differently) ldquoPlease put your shoes Do eliminate lsquobutrsquo onrdquohellipYoursquoll need to put your shoes onrdquo substitute lsquoneverthelessrsquo

DO (repeat exactly) ldquoPlease put your shoes onrdquohellip Patient ldquoIrsquom not eating this I hate chickenrdquo ldquoPlease put your shoes onrdquo

Donrsquot (say lsquobutrsquo) ldquoI know chickenrsquos not your favorite food but itrsquos what we are having for dinnerrdquo

DO (say lsquoneverthelessrsquo) ldquoI know chickenrsquos not your favorite food (smile) nevertheless Irsquod appreciate it if yoursquod eat a little bitrdquo

If you need suggestions on handling challenging situations call the Alzheimerrsquos Association at 8002723900 8

LIVING AND HOME CARE OPTIONS FOR SENIORS

HOME CARE Home care allows older people to remain in their own homes while receiving the assistance they need to help them remain independent Typically home care involves providing assistance with Activities of Daily Living (ADLs) such as bathing dressing and meal preparation or Instrumental Activities of Daily Living (IADLs) such as transportation paying bills making appointments and simply being there to provide companionship and emotional support Home care services range from once a week to 24 hours a day depending on the needs of the client

Also Known As Home Health Care Home Care Aide In-Home Personal Care

Payment Sources Private Pay MedicareMedicaid via certified home health agencies

Price Range $25 hr and up Resources below

RESPITE CARE ADULT DAY CARE Respite care provides a temporary break for caregivers by allowing a resident to have a short-term stay in a community that can meet their needs Many assisted living communities and nursing homes have a respite care program Residents typically stay from a week to a month depending on their situation They receive all of the services of the community Respite stays may also serve as a get acquainted period for the senior Many residents find that they enjoy their stay and decide to move in soon after the short-term visit Respite programs are available for assisted living and Alzheimers residents Normally adult day care is used to relieve the caregiver or his or her duties for the day while ensuring that the care recipient will still receive the proper care in a safe friendly environment These centers usually operate during normal business hours five days a week and some centers also offer additional services during evenings and weekends In general there are three main types of adult day care centers those that focus primarily on social interaction those that provide medical care and those dedicated to Alzheimerrsquos care Many of these facilities are affiliated with other organizations including home care agencies skilled nursing facilities medical centers or other senior service providers

Also Known As Short-Term Stay Programs Adult Day Care

Payment Sources Private Pay Medicaid

Price Range $75-$150 per day

9

INDEPENDENT LIVING COMMUNITIES Senior independent living communities cater to seniors who are very independent with few medical problems Residents live in fully equipped private apartments A variety of apartment sizes are available from studios to large two bedrooms Fine dining services are offered with custom-designed meal packages Often residents can choose to pay for a specified number of meals per day Frequently there are numerous social outings and events to choose from for entertainment

Also Known As Retirement Communities Congregate Care Retirement Villages 55 + Communities Senior Apartments Continuing Care Retirement Community

Payment Sources Mostly private pay Some US government funded through Section 202

Price Range $1500 and up per month

ASSISTED LIVING Assisted Living communities are designed for seniors who are no longer able to live on their own safely but do not require the high level of care provided in a nursing home Assistance with medications activities of daily living meals and housekeeping are routinely provided Three meals per day are provided in a central dining room Residents live in private apartments which frequently have a limited kitchen area Staff is available 24 hours per day for additional safety Most assisted living communities provide licensed nursing services The hours vary greatly so be sure to ask when you visit Social activities and scheduled transportation are also available in most communities A special unit for Alzheimers residents is available in some but not all communities

Also Known As Assisted Care Community Personal Care Home

Payment Sources bull Mostly private pay Some take Medicaid

Price Range $3000 and up per month depending on the size of apartment and level of assistance required

10

NURSING HOMES Nursing homes provide around-the-clock skilled nursing care for the frail elderly who require a high level of medical care and assistance 24-hour skilled nursing services are available from licensed nurses Many nursing homes now provide short-term rehabilitative stays for those recovering from an injury illness or surgery Long-term care residents generally have high care needs and complex medical conditions that require routine skilled nursing services Residents typically share a room and are served meals in a central dining area unless they are too ill to participate Activities are also available Some facilities have a separate unit for Alzheimers residents

Also Known As Convalescent Care Nursing Center Skilled Nursing Long Term Care Facility

Payment Sources Private Pay Medicare Medicaid

Price Range $8000 and up per month

ALZHEIMERSMEMORY CARE Numerous senior housing options for people with dementia or Alzheimers are available With memory impaired it is important to have 24-hour support and structured activities to ensure their safety and quality of life Many families try to care for their loved ones at home which can be extremely difficult given the skill that is required to care for a person with memory problems If you need to consider a community understand that Alzheimers care is delivered in the assisted living setting as well as in nursing homes and occasionally in personal care homes Generally the residents live in semi-private apartments and have structured activities delivered by trained staff members Most of these living environments have secured or locked areas to ensure no one wanders off Many times within the secured areas residents have access to outdoor walking paths or gardens

Also Known As Memory Care Dementia Care

Payment Sources Private Pay Medicaid

Price Range bull $5000 and up per month

11

RESIDENTIAL CARE HOMES Residential care homes are private homes that typically serve residents who live together and receive care from live-in caretakers These homes offer assisted care services for seniors who want a more private home-like community Assistance with activities of daily living such as bathing and dressing are typically provided Amenities and nursing services vary greatly between homes Ask about their services when you tour

Services Comfortable private or semi-private rooms 1-to-3 daily home cooked meals Housekeeping and laundry service Medication management Social programs and activities Transportation to doctors appointments

Also known as bull Board and Care Homes bull Personal Care Homes bull Adult Family Homes

Payment Sources bull Private Pay bull Medicaid

Price Range bull $2500 and up per month depending on the services and level of care provided

PLACEMENT AGENGIES (For assistance in locating local placements for you or your loved one) Aspire 707-514-6074 ABBA In Home Care 707-704-6489 Advance Care for Seniors 707-685-6705 Alternatives Beginnings 707-732-3651 Care Network 707-747-2720 Helping Hands 707-451-8724 Inspired Senior Living Options 707-327-2773 Serving Seniors 415-987-8151

12

Driving and Dementiaby Charles G Warner

Driving provides independence from others It is the freedom to go where you please when you please If however if you have been diagnosed with Alzheimerrsquos Disease or a related dementia at some point you should stop driving

The Position of the California Department of Motor Vehicles

The California Department of Motor Vehicles (the ldquoDMVrdquo) has specifc rules and regulations for persons who have been diagnosed with Alzheimerrsquos disease Mild Cognitive Impairment and a long list of related conditions andor diseases that might afect onersquos ability to drive [httpswwwdmvcagovportaldriver-education-and-safetymedical-conditions-and-drivingdementia]

How would the DMV know what happened between my physician and me

When your physician diagnoses anyone with Alzheimerrsquos disease he or she is required by law to fle a report with the County Health Department of your county of residence The County Health Department then forwards the report with the diagnosis to the

13

Overview of the KP Napa-Solano Memory Center

Step 1 Memory Class (No Co-Pay)

This is a 2-hour class for patients who have memory loss andor their family members Information about causes of memory loss treatments community resources and legal issues is presented Family membersindividuals who are close to the patient with memory loss should attend Patients may also attend unless they have a significant hearing deficit wonrsquot be able to sit through a 2-hour class or wonrsquot understand the information

Step 2 Individual evaluation appointment (Co-Pay applies)

This is a 1-hour evaluation appointment with a Nurse Practitioner or Geriatrician The patient may also see a Social Worker if needed The purpose of this appointment is to do a complete memory evaluation and provide a diagnosis make any needed medication changes and provide community resource information

The patient and a family member should attend

Step 3 Ongoing Support (No Co-Pay for email or telephone appointments)

The Memory Center is available for ongoing consultation We will continue to provide support for memory-related issues via clinic visits as well as telephone and e-mail correspondence We can address many behavioral social and medication issues by telephone or email

Additional Support Caregiver Lecture Series (No Co-Pay)

This is an 8 week course for caregivers to review the stages of dementia and discuss common behaviors and strategies for dealing with these issues

1

Memory Center Team

We would like to introduce the providers that work in the Memory Center at Kaiser Napa Solano You may see one or several of these providers when you have an appointment at the Memory Center

Saad Basheer MD CMD FAAFP Dr Basheer is a specialist in Geriatric Medicine who completed his medical training at Quaid-e-Azam Medical College Bahawalpur Pakistan in 2002 He completed his Family Medicine residency at UMDNJ RWJUH-Rutgers University New Brunswick NJ in 2008 and completed his Geriatric fellowship at Saint Louis University Hospital St Louis MO in 2009 He is board certified in Family Medicine and in Geriatric Medicine by the American Board of Family Medicine and is a Certified Medical Director by the American Board of Post-Acute and Long-Term Care Medicine Dr Basheer is a member of the American Academy of Family Medicine the AMDA The Society for Post-Acute and Long-Term Care Medicine and the American Geriatrics Society He previously acted Medical Director for Geriatrics in Tulsa Oklahoma before he joined Kaiser in 2016 His focus is on the care of the patients in the Memory Center skilled nursing facilities and in the My Care My Home program

Chandra Keebler MD Dr Keebler is a specialist in Geriatric Medicine and Palliative Medicine She completed her medical education in 2012 at University of California San Diego School of Medicine in La Jolla CA She completed Internal Medicine residency in 2015 at University of California Los Angeles in Westwood CA and stayed at UCLA to complete separate fellowships in Geriatric Medicine and Hospice and Palliative Medicine She is board certified in Internal Medicine Geriatric Medicine and Hospice and Palliative Medicine Dr Keebler joined Kaiser Permanente in 2017 and cares for patients in skilled nursing facilities Memory Clinic and the My Care My Home program

Michael Mason MD Dr Mason is a specialist in Geriatric Medicine who graduated as a Deans Scholar from The University of Southern California School of Medicine Los Angeles CA in 1994 He completed his residency at the UCLAKFH program in Woodland Hills CA and fellowship training in Geriatric Medicine at the UCLAKFH program in Los Angeles CA He is board-certified in Family Medicine and Geriatric Medicine He served as faculty at the UCLA School of Medicine teaching residents and fellows for many years Dr Mason worked at Kaiser Woodland Hills from 1998 to 2014 then moved to Northern California and joined us here at the Kaiser Hospital in Vallejo He is currently is the APIC of Geriatrics and is part of the faculty of the Family Medicine Residency Program in addition to his other work with caring for our patients in local skilled nursing facilities the hospital and in the My Care My Home Program

Maya Kahwagi MD Dr Kahwagi is excited to join the Memory Center at the Kaiser Permanente Vacaville Medical

Center She received her medical degree from the Universite Saint-Joseph Faculte de

Medecine in Beirut Lebanon in 2002 In 2009 She completed residency at the Vidant Medical

Center in Greenville NC The following year she completed a fellowship at the same venue

She is board certified in both Family and Geriatric Medicine by the American Board of Family

Medicine

2

Sari Fredrickson MS RN FNP-BC NP Fredrickson is a board-certified Family Nurse Practitioner She received her Nurse Practitioner training at the University of California San Francisco and was awarded a Master of Science degree NP Fredrickson has many years of experience in outpatient inpatient and home settings and has worked in Medicine Primary Care Neurology and Psychiatry Over the past decade NP Fredrickson has focused on the care of the elderly In Memory Clinic Palliative Care and Home-Based Primary Care She has served in NP leadership roles and has authored two chapters in a nurse practitioner textbook NP Fredrickson joined the Napa-Solano Memory Center in 2019

Elizabeth McCoy MSW Elizabeth McCoy is a Medical Social Worker who received her bachelorrsquos degree in Psychology from San Francisco State University and a masterrsquos degree in Social Welfare with a health concentration from UC Berkeley Since joining Kaiser in 2014 Elizabeth has supported patients and their families through planning as well as medical crises in the emergency inpatient clinic and hospice settings She is dedicated to taking a strength-based approach to care -- with an emphasis on meeting patients and their families where they are -- to support their efforts to cope effectively through care planning as well as emotional and resource support She joined the Napa-Solano Memory Center in 2019

Emerciana Powell Rodgers Medical Assistant Vallejo Emerciana Powell Rodgers is a Medical Assistant in the Memory Clinic and Palliative Care clinics She completed her education at Boston Reed College in December 1998 Emerciana started with Kaiser Permanente in April 2000 in Walnut Creek and worked in Adult Medicine for 14 years She then transferred to Vallejo Kaiser with the Neurology department in February 2014 Soon after Memory Clinic and Neurology partnered together and she supported both departments In 2017 Memory Clinic then partnered with Palliative Care and Emerciana continues to be an outstanding asset to these departments

Marissa Yamamoto Medical Assistant Vacaville Marissa Yamamoto is a Medical Assistant in Geriatric Medicine and Palliative Medicine She completed her medical assisting course in 2015 at Contra Costa Office of Education in Antioch CA Marissa joined Kaiser Permanente in 2015 and assists patients and her team in Memory Clinic and Palliative Care

3

The 3 Types of Memory Loss

Normal Aging Itrsquos normal to expect some memory loss with age With all the information your brain collects over a lifetime it is logical that recalling certain details take more time and effort Examples include occasionally forgetting where you put your keys or glasses or blanking on the name of an acquaintance This type of ldquomemory problemrdquo is more often annoying than serious Other factors can affect how your mind functions including medication side effects or interaction depressionanxiety and medical problems

Mild Cognitive Impairment (MCI) MCI is a step beyond age-associated memory changes A person with MCI has more memory problems than would be expected for their age but they are able to complete their basic functions When tested they may have difficulty with one area of cognition Research has noted that some patients with MCI improve some are stable over time and some progress to dementia

Dementia When difficulty with memory and other mental abilities interferes with daily life this is called dementia There are several types of dementia that have different characteristics and causes No matter the type dementia is a progressive disease meaning the problems will worsen over months to years There are different stages of dementia mild moderate and advanced The stages are based on the personrsquos function and they will have different needs at different stages Family and caregivers are essential to meet the needs of a person with dementia

4

10 Warning Signs of Alzheimerrsquos

If you notice any of these signs take action Use this form to note your concerns so you can address them with a friend family member or doctor

1 MEMORY LOSS THAT DISRUPTS DAILY LIFE One of the most common signs of Alzheimerrsquos disease especially in the early stage is forgetting recently learned information Others include forgetting important dates or events asking the same question over and over again or increasingly needing to rely on memory aids (eg reminder notes or electronic devices) or family members for things the person used to handle on their own Whatrsquos a typical age-related change Sometimes forgetting names or appointments but remembering them later

2 CHALLENGES IN PLANNING OR SOLVING PROBLEMS Some people living with dementia may experience changes in their ability to develop and follow a plan or work with numbers They may have trouble following a familiar recipe or keeping track of monthly bills They may have difculty concentrating and take much longer to do things than they did before Whatrsquos a typical age-related change Making occasional errors when managing fnances or household bills

3 DIFFICULTY COMPLETING FAMILIAR TASKS People living with Alzheimerrsquos disease often fnd it hard to complete routine tasks Sometimes they may have trouble driving to a familiar location organizing a grocery list or remembering the rules of a favorite game Whatrsquos a typical age-related change Occasionally needing help to use microwave settings or to record a TV show

4 CONFUSION WITH TIME OR PLACE People living with Alzheimerrsquos can lose track of dates seasons and the passage of time They may have trouble understanding something if it is not happening immediately Sometimes they may forget where they are or how they got there Whatrsquos a typical age-related change Getting confused about the day of the week but fguring it out later

5 TROUBLE UNDERSTANDING VISUAL IMAGES AND SPATIAL RELATIONSHIPS For some people vision problems are a sign of Alzheimerrsquos They may also have problems judging distance and determining color or contrast causing issues with driving Whatrsquos a typical age-related change Vision changes related to cataracts

5

6 NEW PROBLEMS WITH WORDS IN SPEAKING OR WRITING People living with Alzheimerrsquos may have trouble following or joining a conversation They may stop in the middle of a conversation and have no idea how to continue or repeat themselves They may struggle with vocabulary have trouble naming a familiar object or use the wrong name Whatrsquos a typical age-related change Sometimes having trouble fnding the right word

7 MISPLACING THINGS AND LOSING THE ABILITY TO RETRACE STEPS A person living with Alzheimerrsquos may put things in unusual places They may lose things and be unable to go back over their steps to fnd them again He or she may accuse others of stealing especially as the disease progresses Whatrsquos a typical age-related change Misplacing things from time to time and retracing steps to fnd them

8 DECREASED OR POOR JUDGMENT Individuals may experience changes in judgment or decision-making For example they may use poor judgment when dealing with money or pay less attention to grooming or keeping themselves clean Whatrsquos a typical age-related change Making a bad decision once in a while like neglecting to change the oil in the car

9 WITHDRAWAL FROM WORK OR SOCIAL ACTIVITIES A person living with Alzheimerrsquos may experience changes in the ability to hold or follow a conversation As a result he or she may withdraw from hobbies social activities or other engagements They may have trouble keeping up with a favorite team or activity Whatrsquos a typical age-related change Sometimes feeling uninterested in family or social obligations

10 CHANGES IN MOOD AND PERSONALITY Individuals living with Alzheimerrsquos may experience mood and personality changes They may be easily upset at home at work with friends or when out of their comfort zone Whatrsquos a typical age-related change Developing very specifc ways of doing things and becoming irritable when a routine is disrupted

WHATrsquoS NEXT If yoursquore concerned that you or someone you know is displaying any of these signs take action

Talk to someone you trust It can be helpful to confde in a friend or family member For tips on how to have a conversation visit alzorgmemoryconcerns

See a doctor Get a full medical evaluation to determine if itrsquos Alzheimerrsquos or something else Early diagnosis gives you a chance to plan for the future access support services and explore medication that may address some symptoms for a time Visit alzorgevaluatememory to learn what an evaluation may include

Get support and information Call the Alzheimerrsquos Association 247 Helpline (8002723900) or visit alzorg10signs

Note This list is for information only and not a substitute for a consultation with a qualifed medical professional This is an ofcial publication of the Alzheimerrsquos Association but may be distributed freely and without charge by unafliated organizations or individuals Such distribution does not constitute an endorsement of these par ties or their activities by the Alzheimerrsquos Association

copy2019 Alzheimerrsquos Associationreg All rights reserved Rev Jun19 TS-0066

6

Compassionate Communication with the Memory Impaired

Donrsquot Donrsquot reason Donrsquot remind them they forget Donrsquot argue Donrsquot question recent memory Donrsquot confront Donrsquot take it personally

DO bull Give short one sentence explanations bull Allow plenty of time for comprehension and then triple it bull Repeat instructions or sentences exactly the same way bull Eliminate lsquobutrsquo from your vocabulary substitute lsquoneverthelessrsquo

bull Avoid insistence Try again later bull Agree with them or distract them to a different subject or activity bull Accept the blame when somethingrsquos wrong (even if itrsquos fantasy) bull Leave the room if necessary to avoid confrontations

bull Respond to the feelings rather than the words bull Be patient and cheerful and reassuring Do go with the flow bull Practice 100 forgiveness Memory loss progresses daily bull My appeal to you Please elevate your level of generosity and graciousness

Remember You canrsquot control memory loss only your reaction to it Compassionate communication will significantly heighten quality of life They are not crazy or lazy They say normal things and do normal things for a memory impaired dementia individual If they were deliberately trying to exasperate you they would have a different diagnosis Forgive themhellipalways For example they donrsquot hide things they protect them in safe placeshellipand then forget Donrsquot take lsquostealingrsquo accusations personally

Their disability is memory loss Asking them to remember is like asking a blind person to read (ldquoDid you take your pillsrdquo ldquoWhat did you do todayrdquo) Donrsquot ask and donrsquot test memory A loss of this magnitude reduces the capacity to reason Expecting them to be reasonable or to accept your conclusion is unrealistic (ldquoYou need a showerrdquo ldquoDay care will be funrdquo ldquoYou canrsquot live alonerdquo) Donrsquot try to reason or convince them Give a one sentence explanation or search for creative solutions Memory loss produces unpredictable emotions thought and behavior which you can alleviate by resolving all issues peacefully Donrsquot argue correct contradict confront blame or insist

Reminders are rarely kind They tell the patient how disabled they arendashndashover and over again Reminders of the recent past imply ldquoI remember Irsquom okay you donrsquot yoursquore notrdquo Ouch Refer only to the present or the future (If theyrsquore hungry donrsquot inform them they ate an hour ago offer a snack or set a time to eat soon) They may ask the same question repeatedly believing each time is the first Graciously respond as if itrsquos the first time Some days they seem normal but theyrsquore not They live in a different reality Reminders wonrsquot bring them into yours Note For vascular dementia giving clues may help their recall If it doesnrsquot work be kindhellipdonrsquot remind

Ethical dilemmas may occur If for instance the patient thinks a dead spouse is alive and truthful reminders will create sadness what should you do To avoid distress try these ways of kindness 1) distract to another topic or 2) start a fun activity or 3) reminisce about their spouse ldquoI was just thinking about ___ How did you meetrdquo or you might try ldquoHersquos gone for a while Letrsquos take our walk nowrdquo

Open ended questions (ldquoWhere shall we gordquo ldquoWhat do you want to eatweardordquo) are surprisingly complex and create anxiety Give them a simple choice between two items or direct their choice ldquoYou look great in the red blouserdquo

They are scared all the time Each patient reacts differently to fear They may become passive uncooperative hostile angry agitated verbally abusive or physically combative They may even do them all at different times or alternate between them Anxiety may compel them to shadow you (follow everywhere) Anxiety compels them to resist changes in routine even pleasant ones Your goal is to reduce anxiety whenever possible Also they canrsquot remember your reassurances Keep saying them

copy1995 2001 2005 2007 2008 Liz Ayres Alzheimerrsquos Support Group Leader former Caregiver Orange County CA 7

Examples Donrsquot argue Patient ldquoI didnrsquot write this check for $500

Someone at the bank is forging my Donrsquot reason signaturerdquo

Patient ldquoWhat doctorrsquos appointment Therersquos nothing Donrsquot (argue) ldquoWhat Donrsquot be silly The bank wrong with merdquo

wouldnrsquot be forging your signaturerdquo Donrsquot (reason) ldquoYoursquove been seeing the doctor every

DO (respond to feelings) ldquoThatrsquos a scary thoughtrdquo three months for the last two years Itrsquos written (reassure) ldquoIrsquoll make sure they donrsquot do on the calendar and I told you about it yesterday thatrdquo(distract) ldquoWould you help me fold and this morningrdquo the towelsrdquo

DO (short explanation) ldquoItrsquos just a regular checkuprdquo (accept blame) ldquoIrsquom sorry if I forgot to tell yourdquo

Donrsquot remind them that they forget

Donrsquot confront Patient ldquoJoe hasnrsquot called for a long

Patient ldquoNobodyrsquos going to make decisions for me You can go time I hope hersquos okrdquo

Donrsquot

nowhellipand donrsquot come backrdquo

(confront) ldquoIrsquom not going anywhere and you canrsquot remember enough to make your own decisionsrdquo

Donrsquot (remind) ldquoJoe called yesterday and you talked with him for 15 minutesrdquo

DO (accept blame or respond to feelings) ldquoIrsquom sorry this is a tough timerdquo (reassure) ldquoI love you and wersquore going to get through this

togetherrdquo (distract) ldquoYou know what Don has a new job Hersquos really

excited about itrdquo

DO (reassure) ldquoYou really like talking with him donrsquot yourdquo (distract) ldquoLetrsquos call him when we get back from our walkrdquo

Donrsquot take it personally Donrsquot question recent memory Patient ldquoWho are you Wherersquos my

Patient ldquoHello Mary I see yoursquove brought a friend with yourdquo husbandrdquo Donrsquot (question memory) ldquoHi Mom You remember Eric

Donrsquot (take it personally) ldquoWhat do you donrsquot you What did you do todayrdquo mean ndash whorsquos your husbandrdquo I amrdquo

DO (short explanation) ldquoHi Mom You look wonderful DO (go with the flow reassure) ldquoHersquoll

This is Eric We work togetherrdquo be here for dinnerrdquo (distract) ldquoHow about some milk and cookies Would you like chocolate chip or oatmealrdquo

Do repeat exactly Patient ldquoIrsquom going to the store for a newspaperrdquo

Donrsquot (repeat differently) ldquoPlease put your shoes Do eliminate lsquobutrsquo onrdquohellipYoursquoll need to put your shoes onrdquo substitute lsquoneverthelessrsquo

DO (repeat exactly) ldquoPlease put your shoes onrdquohellip Patient ldquoIrsquom not eating this I hate chickenrdquo ldquoPlease put your shoes onrdquo

Donrsquot (say lsquobutrsquo) ldquoI know chickenrsquos not your favorite food but itrsquos what we are having for dinnerrdquo

DO (say lsquoneverthelessrsquo) ldquoI know chickenrsquos not your favorite food (smile) nevertheless Irsquod appreciate it if yoursquod eat a little bitrdquo

If you need suggestions on handling challenging situations call the Alzheimerrsquos Association at 8002723900 8

LIVING AND HOME CARE OPTIONS FOR SENIORS

HOME CARE Home care allows older people to remain in their own homes while receiving the assistance they need to help them remain independent Typically home care involves providing assistance with Activities of Daily Living (ADLs) such as bathing dressing and meal preparation or Instrumental Activities of Daily Living (IADLs) such as transportation paying bills making appointments and simply being there to provide companionship and emotional support Home care services range from once a week to 24 hours a day depending on the needs of the client

Also Known As Home Health Care Home Care Aide In-Home Personal Care

Payment Sources Private Pay MedicareMedicaid via certified home health agencies

Price Range $25 hr and up Resources below

RESPITE CARE ADULT DAY CARE Respite care provides a temporary break for caregivers by allowing a resident to have a short-term stay in a community that can meet their needs Many assisted living communities and nursing homes have a respite care program Residents typically stay from a week to a month depending on their situation They receive all of the services of the community Respite stays may also serve as a get acquainted period for the senior Many residents find that they enjoy their stay and decide to move in soon after the short-term visit Respite programs are available for assisted living and Alzheimers residents Normally adult day care is used to relieve the caregiver or his or her duties for the day while ensuring that the care recipient will still receive the proper care in a safe friendly environment These centers usually operate during normal business hours five days a week and some centers also offer additional services during evenings and weekends In general there are three main types of adult day care centers those that focus primarily on social interaction those that provide medical care and those dedicated to Alzheimerrsquos care Many of these facilities are affiliated with other organizations including home care agencies skilled nursing facilities medical centers or other senior service providers

Also Known As Short-Term Stay Programs Adult Day Care

Payment Sources Private Pay Medicaid

Price Range $75-$150 per day

9

INDEPENDENT LIVING COMMUNITIES Senior independent living communities cater to seniors who are very independent with few medical problems Residents live in fully equipped private apartments A variety of apartment sizes are available from studios to large two bedrooms Fine dining services are offered with custom-designed meal packages Often residents can choose to pay for a specified number of meals per day Frequently there are numerous social outings and events to choose from for entertainment

Also Known As Retirement Communities Congregate Care Retirement Villages 55 + Communities Senior Apartments Continuing Care Retirement Community

Payment Sources Mostly private pay Some US government funded through Section 202

Price Range $1500 and up per month

ASSISTED LIVING Assisted Living communities are designed for seniors who are no longer able to live on their own safely but do not require the high level of care provided in a nursing home Assistance with medications activities of daily living meals and housekeeping are routinely provided Three meals per day are provided in a central dining room Residents live in private apartments which frequently have a limited kitchen area Staff is available 24 hours per day for additional safety Most assisted living communities provide licensed nursing services The hours vary greatly so be sure to ask when you visit Social activities and scheduled transportation are also available in most communities A special unit for Alzheimers residents is available in some but not all communities

Also Known As Assisted Care Community Personal Care Home

Payment Sources bull Mostly private pay Some take Medicaid

Price Range $3000 and up per month depending on the size of apartment and level of assistance required

10

NURSING HOMES Nursing homes provide around-the-clock skilled nursing care for the frail elderly who require a high level of medical care and assistance 24-hour skilled nursing services are available from licensed nurses Many nursing homes now provide short-term rehabilitative stays for those recovering from an injury illness or surgery Long-term care residents generally have high care needs and complex medical conditions that require routine skilled nursing services Residents typically share a room and are served meals in a central dining area unless they are too ill to participate Activities are also available Some facilities have a separate unit for Alzheimers residents

Also Known As Convalescent Care Nursing Center Skilled Nursing Long Term Care Facility

Payment Sources Private Pay Medicare Medicaid

Price Range $8000 and up per month

ALZHEIMERSMEMORY CARE Numerous senior housing options for people with dementia or Alzheimers are available With memory impaired it is important to have 24-hour support and structured activities to ensure their safety and quality of life Many families try to care for their loved ones at home which can be extremely difficult given the skill that is required to care for a person with memory problems If you need to consider a community understand that Alzheimers care is delivered in the assisted living setting as well as in nursing homes and occasionally in personal care homes Generally the residents live in semi-private apartments and have structured activities delivered by trained staff members Most of these living environments have secured or locked areas to ensure no one wanders off Many times within the secured areas residents have access to outdoor walking paths or gardens

Also Known As Memory Care Dementia Care

Payment Sources Private Pay Medicaid

Price Range bull $5000 and up per month

11

RESIDENTIAL CARE HOMES Residential care homes are private homes that typically serve residents who live together and receive care from live-in caretakers These homes offer assisted care services for seniors who want a more private home-like community Assistance with activities of daily living such as bathing and dressing are typically provided Amenities and nursing services vary greatly between homes Ask about their services when you tour

Services Comfortable private or semi-private rooms 1-to-3 daily home cooked meals Housekeeping and laundry service Medication management Social programs and activities Transportation to doctors appointments

Also known as bull Board and Care Homes bull Personal Care Homes bull Adult Family Homes

Payment Sources bull Private Pay bull Medicaid

Price Range bull $2500 and up per month depending on the services and level of care provided

PLACEMENT AGENGIES (For assistance in locating local placements for you or your loved one) Aspire 707-514-6074 ABBA In Home Care 707-704-6489 Advance Care for Seniors 707-685-6705 Alternatives Beginnings 707-732-3651 Care Network 707-747-2720 Helping Hands 707-451-8724 Inspired Senior Living Options 707-327-2773 Serving Seniors 415-987-8151

12

Driving and Dementiaby Charles G Warner

Driving provides independence from others It is the freedom to go where you please when you please If however if you have been diagnosed with Alzheimerrsquos Disease or a related dementia at some point you should stop driving

The Position of the California Department of Motor Vehicles

The California Department of Motor Vehicles (the ldquoDMVrdquo) has specifc rules and regulations for persons who have been diagnosed with Alzheimerrsquos disease Mild Cognitive Impairment and a long list of related conditions andor diseases that might afect onersquos ability to drive [httpswwwdmvcagovportaldriver-education-and-safetymedical-conditions-and-drivingdementia]

How would the DMV know what happened between my physician and me

When your physician diagnoses anyone with Alzheimerrsquos disease he or she is required by law to fle a report with the County Health Department of your county of residence The County Health Department then forwards the report with the diagnosis to the

13

Memory Center Team

We would like to introduce the providers that work in the Memory Center at Kaiser Napa Solano You may see one or several of these providers when you have an appointment at the Memory Center

Saad Basheer MD CMD FAAFP Dr Basheer is a specialist in Geriatric Medicine who completed his medical training at Quaid-e-Azam Medical College Bahawalpur Pakistan in 2002 He completed his Family Medicine residency at UMDNJ RWJUH-Rutgers University New Brunswick NJ in 2008 and completed his Geriatric fellowship at Saint Louis University Hospital St Louis MO in 2009 He is board certified in Family Medicine and in Geriatric Medicine by the American Board of Family Medicine and is a Certified Medical Director by the American Board of Post-Acute and Long-Term Care Medicine Dr Basheer is a member of the American Academy of Family Medicine the AMDA The Society for Post-Acute and Long-Term Care Medicine and the American Geriatrics Society He previously acted Medical Director for Geriatrics in Tulsa Oklahoma before he joined Kaiser in 2016 His focus is on the care of the patients in the Memory Center skilled nursing facilities and in the My Care My Home program

Chandra Keebler MD Dr Keebler is a specialist in Geriatric Medicine and Palliative Medicine She completed her medical education in 2012 at University of California San Diego School of Medicine in La Jolla CA She completed Internal Medicine residency in 2015 at University of California Los Angeles in Westwood CA and stayed at UCLA to complete separate fellowships in Geriatric Medicine and Hospice and Palliative Medicine She is board certified in Internal Medicine Geriatric Medicine and Hospice and Palliative Medicine Dr Keebler joined Kaiser Permanente in 2017 and cares for patients in skilled nursing facilities Memory Clinic and the My Care My Home program

Michael Mason MD Dr Mason is a specialist in Geriatric Medicine who graduated as a Deans Scholar from The University of Southern California School of Medicine Los Angeles CA in 1994 He completed his residency at the UCLAKFH program in Woodland Hills CA and fellowship training in Geriatric Medicine at the UCLAKFH program in Los Angeles CA He is board-certified in Family Medicine and Geriatric Medicine He served as faculty at the UCLA School of Medicine teaching residents and fellows for many years Dr Mason worked at Kaiser Woodland Hills from 1998 to 2014 then moved to Northern California and joined us here at the Kaiser Hospital in Vallejo He is currently is the APIC of Geriatrics and is part of the faculty of the Family Medicine Residency Program in addition to his other work with caring for our patients in local skilled nursing facilities the hospital and in the My Care My Home Program

Maya Kahwagi MD Dr Kahwagi is excited to join the Memory Center at the Kaiser Permanente Vacaville Medical

Center She received her medical degree from the Universite Saint-Joseph Faculte de

Medecine in Beirut Lebanon in 2002 In 2009 She completed residency at the Vidant Medical

Center in Greenville NC The following year she completed a fellowship at the same venue

She is board certified in both Family and Geriatric Medicine by the American Board of Family

Medicine

2

Sari Fredrickson MS RN FNP-BC NP Fredrickson is a board-certified Family Nurse Practitioner She received her Nurse Practitioner training at the University of California San Francisco and was awarded a Master of Science degree NP Fredrickson has many years of experience in outpatient inpatient and home settings and has worked in Medicine Primary Care Neurology and Psychiatry Over the past decade NP Fredrickson has focused on the care of the elderly In Memory Clinic Palliative Care and Home-Based Primary Care She has served in NP leadership roles and has authored two chapters in a nurse practitioner textbook NP Fredrickson joined the Napa-Solano Memory Center in 2019

Elizabeth McCoy MSW Elizabeth McCoy is a Medical Social Worker who received her bachelorrsquos degree in Psychology from San Francisco State University and a masterrsquos degree in Social Welfare with a health concentration from UC Berkeley Since joining Kaiser in 2014 Elizabeth has supported patients and their families through planning as well as medical crises in the emergency inpatient clinic and hospice settings She is dedicated to taking a strength-based approach to care -- with an emphasis on meeting patients and their families where they are -- to support their efforts to cope effectively through care planning as well as emotional and resource support She joined the Napa-Solano Memory Center in 2019

Emerciana Powell Rodgers Medical Assistant Vallejo Emerciana Powell Rodgers is a Medical Assistant in the Memory Clinic and Palliative Care clinics She completed her education at Boston Reed College in December 1998 Emerciana started with Kaiser Permanente in April 2000 in Walnut Creek and worked in Adult Medicine for 14 years She then transferred to Vallejo Kaiser with the Neurology department in February 2014 Soon after Memory Clinic and Neurology partnered together and she supported both departments In 2017 Memory Clinic then partnered with Palliative Care and Emerciana continues to be an outstanding asset to these departments

Marissa Yamamoto Medical Assistant Vacaville Marissa Yamamoto is a Medical Assistant in Geriatric Medicine and Palliative Medicine She completed her medical assisting course in 2015 at Contra Costa Office of Education in Antioch CA Marissa joined Kaiser Permanente in 2015 and assists patients and her team in Memory Clinic and Palliative Care

3

The 3 Types of Memory Loss

Normal Aging Itrsquos normal to expect some memory loss with age With all the information your brain collects over a lifetime it is logical that recalling certain details take more time and effort Examples include occasionally forgetting where you put your keys or glasses or blanking on the name of an acquaintance This type of ldquomemory problemrdquo is more often annoying than serious Other factors can affect how your mind functions including medication side effects or interaction depressionanxiety and medical problems

Mild Cognitive Impairment (MCI) MCI is a step beyond age-associated memory changes A person with MCI has more memory problems than would be expected for their age but they are able to complete their basic functions When tested they may have difficulty with one area of cognition Research has noted that some patients with MCI improve some are stable over time and some progress to dementia

Dementia When difficulty with memory and other mental abilities interferes with daily life this is called dementia There are several types of dementia that have different characteristics and causes No matter the type dementia is a progressive disease meaning the problems will worsen over months to years There are different stages of dementia mild moderate and advanced The stages are based on the personrsquos function and they will have different needs at different stages Family and caregivers are essential to meet the needs of a person with dementia

4

10 Warning Signs of Alzheimerrsquos

If you notice any of these signs take action Use this form to note your concerns so you can address them with a friend family member or doctor

1 MEMORY LOSS THAT DISRUPTS DAILY LIFE One of the most common signs of Alzheimerrsquos disease especially in the early stage is forgetting recently learned information Others include forgetting important dates or events asking the same question over and over again or increasingly needing to rely on memory aids (eg reminder notes or electronic devices) or family members for things the person used to handle on their own Whatrsquos a typical age-related change Sometimes forgetting names or appointments but remembering them later

2 CHALLENGES IN PLANNING OR SOLVING PROBLEMS Some people living with dementia may experience changes in their ability to develop and follow a plan or work with numbers They may have trouble following a familiar recipe or keeping track of monthly bills They may have difculty concentrating and take much longer to do things than they did before Whatrsquos a typical age-related change Making occasional errors when managing fnances or household bills

3 DIFFICULTY COMPLETING FAMILIAR TASKS People living with Alzheimerrsquos disease often fnd it hard to complete routine tasks Sometimes they may have trouble driving to a familiar location organizing a grocery list or remembering the rules of a favorite game Whatrsquos a typical age-related change Occasionally needing help to use microwave settings or to record a TV show

4 CONFUSION WITH TIME OR PLACE People living with Alzheimerrsquos can lose track of dates seasons and the passage of time They may have trouble understanding something if it is not happening immediately Sometimes they may forget where they are or how they got there Whatrsquos a typical age-related change Getting confused about the day of the week but fguring it out later

5 TROUBLE UNDERSTANDING VISUAL IMAGES AND SPATIAL RELATIONSHIPS For some people vision problems are a sign of Alzheimerrsquos They may also have problems judging distance and determining color or contrast causing issues with driving Whatrsquos a typical age-related change Vision changes related to cataracts

5

6 NEW PROBLEMS WITH WORDS IN SPEAKING OR WRITING People living with Alzheimerrsquos may have trouble following or joining a conversation They may stop in the middle of a conversation and have no idea how to continue or repeat themselves They may struggle with vocabulary have trouble naming a familiar object or use the wrong name Whatrsquos a typical age-related change Sometimes having trouble fnding the right word

7 MISPLACING THINGS AND LOSING THE ABILITY TO RETRACE STEPS A person living with Alzheimerrsquos may put things in unusual places They may lose things and be unable to go back over their steps to fnd them again He or she may accuse others of stealing especially as the disease progresses Whatrsquos a typical age-related change Misplacing things from time to time and retracing steps to fnd them

8 DECREASED OR POOR JUDGMENT Individuals may experience changes in judgment or decision-making For example they may use poor judgment when dealing with money or pay less attention to grooming or keeping themselves clean Whatrsquos a typical age-related change Making a bad decision once in a while like neglecting to change the oil in the car

9 WITHDRAWAL FROM WORK OR SOCIAL ACTIVITIES A person living with Alzheimerrsquos may experience changes in the ability to hold or follow a conversation As a result he or she may withdraw from hobbies social activities or other engagements They may have trouble keeping up with a favorite team or activity Whatrsquos a typical age-related change Sometimes feeling uninterested in family or social obligations

10 CHANGES IN MOOD AND PERSONALITY Individuals living with Alzheimerrsquos may experience mood and personality changes They may be easily upset at home at work with friends or when out of their comfort zone Whatrsquos a typical age-related change Developing very specifc ways of doing things and becoming irritable when a routine is disrupted

WHATrsquoS NEXT If yoursquore concerned that you or someone you know is displaying any of these signs take action

Talk to someone you trust It can be helpful to confde in a friend or family member For tips on how to have a conversation visit alzorgmemoryconcerns

See a doctor Get a full medical evaluation to determine if itrsquos Alzheimerrsquos or something else Early diagnosis gives you a chance to plan for the future access support services and explore medication that may address some symptoms for a time Visit alzorgevaluatememory to learn what an evaluation may include

Get support and information Call the Alzheimerrsquos Association 247 Helpline (8002723900) or visit alzorg10signs

Note This list is for information only and not a substitute for a consultation with a qualifed medical professional This is an ofcial publication of the Alzheimerrsquos Association but may be distributed freely and without charge by unafliated organizations or individuals Such distribution does not constitute an endorsement of these par ties or their activities by the Alzheimerrsquos Association

copy2019 Alzheimerrsquos Associationreg All rights reserved Rev Jun19 TS-0066

6

Compassionate Communication with the Memory Impaired

Donrsquot Donrsquot reason Donrsquot remind them they forget Donrsquot argue Donrsquot question recent memory Donrsquot confront Donrsquot take it personally

DO bull Give short one sentence explanations bull Allow plenty of time for comprehension and then triple it bull Repeat instructions or sentences exactly the same way bull Eliminate lsquobutrsquo from your vocabulary substitute lsquoneverthelessrsquo

bull Avoid insistence Try again later bull Agree with them or distract them to a different subject or activity bull Accept the blame when somethingrsquos wrong (even if itrsquos fantasy) bull Leave the room if necessary to avoid confrontations

bull Respond to the feelings rather than the words bull Be patient and cheerful and reassuring Do go with the flow bull Practice 100 forgiveness Memory loss progresses daily bull My appeal to you Please elevate your level of generosity and graciousness

Remember You canrsquot control memory loss only your reaction to it Compassionate communication will significantly heighten quality of life They are not crazy or lazy They say normal things and do normal things for a memory impaired dementia individual If they were deliberately trying to exasperate you they would have a different diagnosis Forgive themhellipalways For example they donrsquot hide things they protect them in safe placeshellipand then forget Donrsquot take lsquostealingrsquo accusations personally

Their disability is memory loss Asking them to remember is like asking a blind person to read (ldquoDid you take your pillsrdquo ldquoWhat did you do todayrdquo) Donrsquot ask and donrsquot test memory A loss of this magnitude reduces the capacity to reason Expecting them to be reasonable or to accept your conclusion is unrealistic (ldquoYou need a showerrdquo ldquoDay care will be funrdquo ldquoYou canrsquot live alonerdquo) Donrsquot try to reason or convince them Give a one sentence explanation or search for creative solutions Memory loss produces unpredictable emotions thought and behavior which you can alleviate by resolving all issues peacefully Donrsquot argue correct contradict confront blame or insist

Reminders are rarely kind They tell the patient how disabled they arendashndashover and over again Reminders of the recent past imply ldquoI remember Irsquom okay you donrsquot yoursquore notrdquo Ouch Refer only to the present or the future (If theyrsquore hungry donrsquot inform them they ate an hour ago offer a snack or set a time to eat soon) They may ask the same question repeatedly believing each time is the first Graciously respond as if itrsquos the first time Some days they seem normal but theyrsquore not They live in a different reality Reminders wonrsquot bring them into yours Note For vascular dementia giving clues may help their recall If it doesnrsquot work be kindhellipdonrsquot remind

Ethical dilemmas may occur If for instance the patient thinks a dead spouse is alive and truthful reminders will create sadness what should you do To avoid distress try these ways of kindness 1) distract to another topic or 2) start a fun activity or 3) reminisce about their spouse ldquoI was just thinking about ___ How did you meetrdquo or you might try ldquoHersquos gone for a while Letrsquos take our walk nowrdquo

Open ended questions (ldquoWhere shall we gordquo ldquoWhat do you want to eatweardordquo) are surprisingly complex and create anxiety Give them a simple choice between two items or direct their choice ldquoYou look great in the red blouserdquo

They are scared all the time Each patient reacts differently to fear They may become passive uncooperative hostile angry agitated verbally abusive or physically combative They may even do them all at different times or alternate between them Anxiety may compel them to shadow you (follow everywhere) Anxiety compels them to resist changes in routine even pleasant ones Your goal is to reduce anxiety whenever possible Also they canrsquot remember your reassurances Keep saying them

copy1995 2001 2005 2007 2008 Liz Ayres Alzheimerrsquos Support Group Leader former Caregiver Orange County CA 7

Examples Donrsquot argue Patient ldquoI didnrsquot write this check for $500

Someone at the bank is forging my Donrsquot reason signaturerdquo

Patient ldquoWhat doctorrsquos appointment Therersquos nothing Donrsquot (argue) ldquoWhat Donrsquot be silly The bank wrong with merdquo

wouldnrsquot be forging your signaturerdquo Donrsquot (reason) ldquoYoursquove been seeing the doctor every

DO (respond to feelings) ldquoThatrsquos a scary thoughtrdquo three months for the last two years Itrsquos written (reassure) ldquoIrsquoll make sure they donrsquot do on the calendar and I told you about it yesterday thatrdquo(distract) ldquoWould you help me fold and this morningrdquo the towelsrdquo

DO (short explanation) ldquoItrsquos just a regular checkuprdquo (accept blame) ldquoIrsquom sorry if I forgot to tell yourdquo

Donrsquot remind them that they forget

Donrsquot confront Patient ldquoJoe hasnrsquot called for a long

Patient ldquoNobodyrsquos going to make decisions for me You can go time I hope hersquos okrdquo

Donrsquot

nowhellipand donrsquot come backrdquo

(confront) ldquoIrsquom not going anywhere and you canrsquot remember enough to make your own decisionsrdquo

Donrsquot (remind) ldquoJoe called yesterday and you talked with him for 15 minutesrdquo

DO (accept blame or respond to feelings) ldquoIrsquom sorry this is a tough timerdquo (reassure) ldquoI love you and wersquore going to get through this

togetherrdquo (distract) ldquoYou know what Don has a new job Hersquos really

excited about itrdquo

DO (reassure) ldquoYou really like talking with him donrsquot yourdquo (distract) ldquoLetrsquos call him when we get back from our walkrdquo

Donrsquot take it personally Donrsquot question recent memory Patient ldquoWho are you Wherersquos my

Patient ldquoHello Mary I see yoursquove brought a friend with yourdquo husbandrdquo Donrsquot (question memory) ldquoHi Mom You remember Eric

Donrsquot (take it personally) ldquoWhat do you donrsquot you What did you do todayrdquo mean ndash whorsquos your husbandrdquo I amrdquo

DO (short explanation) ldquoHi Mom You look wonderful DO (go with the flow reassure) ldquoHersquoll

This is Eric We work togetherrdquo be here for dinnerrdquo (distract) ldquoHow about some milk and cookies Would you like chocolate chip or oatmealrdquo

Do repeat exactly Patient ldquoIrsquom going to the store for a newspaperrdquo

Donrsquot (repeat differently) ldquoPlease put your shoes Do eliminate lsquobutrsquo onrdquohellipYoursquoll need to put your shoes onrdquo substitute lsquoneverthelessrsquo

DO (repeat exactly) ldquoPlease put your shoes onrdquohellip Patient ldquoIrsquom not eating this I hate chickenrdquo ldquoPlease put your shoes onrdquo

Donrsquot (say lsquobutrsquo) ldquoI know chickenrsquos not your favorite food but itrsquos what we are having for dinnerrdquo

DO (say lsquoneverthelessrsquo) ldquoI know chickenrsquos not your favorite food (smile) nevertheless Irsquod appreciate it if yoursquod eat a little bitrdquo

If you need suggestions on handling challenging situations call the Alzheimerrsquos Association at 8002723900 8

LIVING AND HOME CARE OPTIONS FOR SENIORS

HOME CARE Home care allows older people to remain in their own homes while receiving the assistance they need to help them remain independent Typically home care involves providing assistance with Activities of Daily Living (ADLs) such as bathing dressing and meal preparation or Instrumental Activities of Daily Living (IADLs) such as transportation paying bills making appointments and simply being there to provide companionship and emotional support Home care services range from once a week to 24 hours a day depending on the needs of the client

Also Known As Home Health Care Home Care Aide In-Home Personal Care

Payment Sources Private Pay MedicareMedicaid via certified home health agencies

Price Range $25 hr and up Resources below

RESPITE CARE ADULT DAY CARE Respite care provides a temporary break for caregivers by allowing a resident to have a short-term stay in a community that can meet their needs Many assisted living communities and nursing homes have a respite care program Residents typically stay from a week to a month depending on their situation They receive all of the services of the community Respite stays may also serve as a get acquainted period for the senior Many residents find that they enjoy their stay and decide to move in soon after the short-term visit Respite programs are available for assisted living and Alzheimers residents Normally adult day care is used to relieve the caregiver or his or her duties for the day while ensuring that the care recipient will still receive the proper care in a safe friendly environment These centers usually operate during normal business hours five days a week and some centers also offer additional services during evenings and weekends In general there are three main types of adult day care centers those that focus primarily on social interaction those that provide medical care and those dedicated to Alzheimerrsquos care Many of these facilities are affiliated with other organizations including home care agencies skilled nursing facilities medical centers or other senior service providers

Also Known As Short-Term Stay Programs Adult Day Care

Payment Sources Private Pay Medicaid

Price Range $75-$150 per day

9

INDEPENDENT LIVING COMMUNITIES Senior independent living communities cater to seniors who are very independent with few medical problems Residents live in fully equipped private apartments A variety of apartment sizes are available from studios to large two bedrooms Fine dining services are offered with custom-designed meal packages Often residents can choose to pay for a specified number of meals per day Frequently there are numerous social outings and events to choose from for entertainment

Also Known As Retirement Communities Congregate Care Retirement Villages 55 + Communities Senior Apartments Continuing Care Retirement Community

Payment Sources Mostly private pay Some US government funded through Section 202

Price Range $1500 and up per month

ASSISTED LIVING Assisted Living communities are designed for seniors who are no longer able to live on their own safely but do not require the high level of care provided in a nursing home Assistance with medications activities of daily living meals and housekeeping are routinely provided Three meals per day are provided in a central dining room Residents live in private apartments which frequently have a limited kitchen area Staff is available 24 hours per day for additional safety Most assisted living communities provide licensed nursing services The hours vary greatly so be sure to ask when you visit Social activities and scheduled transportation are also available in most communities A special unit for Alzheimers residents is available in some but not all communities

Also Known As Assisted Care Community Personal Care Home

Payment Sources bull Mostly private pay Some take Medicaid

Price Range $3000 and up per month depending on the size of apartment and level of assistance required

10

NURSING HOMES Nursing homes provide around-the-clock skilled nursing care for the frail elderly who require a high level of medical care and assistance 24-hour skilled nursing services are available from licensed nurses Many nursing homes now provide short-term rehabilitative stays for those recovering from an injury illness or surgery Long-term care residents generally have high care needs and complex medical conditions that require routine skilled nursing services Residents typically share a room and are served meals in a central dining area unless they are too ill to participate Activities are also available Some facilities have a separate unit for Alzheimers residents

Also Known As Convalescent Care Nursing Center Skilled Nursing Long Term Care Facility

Payment Sources Private Pay Medicare Medicaid

Price Range $8000 and up per month

ALZHEIMERSMEMORY CARE Numerous senior housing options for people with dementia or Alzheimers are available With memory impaired it is important to have 24-hour support and structured activities to ensure their safety and quality of life Many families try to care for their loved ones at home which can be extremely difficult given the skill that is required to care for a person with memory problems If you need to consider a community understand that Alzheimers care is delivered in the assisted living setting as well as in nursing homes and occasionally in personal care homes Generally the residents live in semi-private apartments and have structured activities delivered by trained staff members Most of these living environments have secured or locked areas to ensure no one wanders off Many times within the secured areas residents have access to outdoor walking paths or gardens

Also Known As Memory Care Dementia Care

Payment Sources Private Pay Medicaid

Price Range bull $5000 and up per month

11

RESIDENTIAL CARE HOMES Residential care homes are private homes that typically serve residents who live together and receive care from live-in caretakers These homes offer assisted care services for seniors who want a more private home-like community Assistance with activities of daily living such as bathing and dressing are typically provided Amenities and nursing services vary greatly between homes Ask about their services when you tour

Services Comfortable private or semi-private rooms 1-to-3 daily home cooked meals Housekeeping and laundry service Medication management Social programs and activities Transportation to doctors appointments

Also known as bull Board and Care Homes bull Personal Care Homes bull Adult Family Homes

Payment Sources bull Private Pay bull Medicaid

Price Range bull $2500 and up per month depending on the services and level of care provided

PLACEMENT AGENGIES (For assistance in locating local placements for you or your loved one) Aspire 707-514-6074 ABBA In Home Care 707-704-6489 Advance Care for Seniors 707-685-6705 Alternatives Beginnings 707-732-3651 Care Network 707-747-2720 Helping Hands 707-451-8724 Inspired Senior Living Options 707-327-2773 Serving Seniors 415-987-8151

12

Driving and Dementiaby Charles G Warner

Driving provides independence from others It is the freedom to go where you please when you please If however if you have been diagnosed with Alzheimerrsquos Disease or a related dementia at some point you should stop driving

The Position of the California Department of Motor Vehicles

The California Department of Motor Vehicles (the ldquoDMVrdquo) has specifc rules and regulations for persons who have been diagnosed with Alzheimerrsquos disease Mild Cognitive Impairment and a long list of related conditions andor diseases that might afect onersquos ability to drive [httpswwwdmvcagovportaldriver-education-and-safetymedical-conditions-and-drivingdementia]

How would the DMV know what happened between my physician and me

When your physician diagnoses anyone with Alzheimerrsquos disease he or she is required by law to fle a report with the County Health Department of your county of residence The County Health Department then forwards the report with the diagnosis to the

13

Sari Fredrickson MS RN FNP-BC NP Fredrickson is a board-certified Family Nurse Practitioner She received her Nurse Practitioner training at the University of California San Francisco and was awarded a Master of Science degree NP Fredrickson has many years of experience in outpatient inpatient and home settings and has worked in Medicine Primary Care Neurology and Psychiatry Over the past decade NP Fredrickson has focused on the care of the elderly In Memory Clinic Palliative Care and Home-Based Primary Care She has served in NP leadership roles and has authored two chapters in a nurse practitioner textbook NP Fredrickson joined the Napa-Solano Memory Center in 2019

Elizabeth McCoy MSW Elizabeth McCoy is a Medical Social Worker who received her bachelorrsquos degree in Psychology from San Francisco State University and a masterrsquos degree in Social Welfare with a health concentration from UC Berkeley Since joining Kaiser in 2014 Elizabeth has supported patients and their families through planning as well as medical crises in the emergency inpatient clinic and hospice settings She is dedicated to taking a strength-based approach to care -- with an emphasis on meeting patients and their families where they are -- to support their efforts to cope effectively through care planning as well as emotional and resource support She joined the Napa-Solano Memory Center in 2019

Emerciana Powell Rodgers Medical Assistant Vallejo Emerciana Powell Rodgers is a Medical Assistant in the Memory Clinic and Palliative Care clinics She completed her education at Boston Reed College in December 1998 Emerciana started with Kaiser Permanente in April 2000 in Walnut Creek and worked in Adult Medicine for 14 years She then transferred to Vallejo Kaiser with the Neurology department in February 2014 Soon after Memory Clinic and Neurology partnered together and she supported both departments In 2017 Memory Clinic then partnered with Palliative Care and Emerciana continues to be an outstanding asset to these departments

Marissa Yamamoto Medical Assistant Vacaville Marissa Yamamoto is a Medical Assistant in Geriatric Medicine and Palliative Medicine She completed her medical assisting course in 2015 at Contra Costa Office of Education in Antioch CA Marissa joined Kaiser Permanente in 2015 and assists patients and her team in Memory Clinic and Palliative Care

3

The 3 Types of Memory Loss

Normal Aging Itrsquos normal to expect some memory loss with age With all the information your brain collects over a lifetime it is logical that recalling certain details take more time and effort Examples include occasionally forgetting where you put your keys or glasses or blanking on the name of an acquaintance This type of ldquomemory problemrdquo is more often annoying than serious Other factors can affect how your mind functions including medication side effects or interaction depressionanxiety and medical problems

Mild Cognitive Impairment (MCI) MCI is a step beyond age-associated memory changes A person with MCI has more memory problems than would be expected for their age but they are able to complete their basic functions When tested they may have difficulty with one area of cognition Research has noted that some patients with MCI improve some are stable over time and some progress to dementia

Dementia When difficulty with memory and other mental abilities interferes with daily life this is called dementia There are several types of dementia that have different characteristics and causes No matter the type dementia is a progressive disease meaning the problems will worsen over months to years There are different stages of dementia mild moderate and advanced The stages are based on the personrsquos function and they will have different needs at different stages Family and caregivers are essential to meet the needs of a person with dementia

4

10 Warning Signs of Alzheimerrsquos

If you notice any of these signs take action Use this form to note your concerns so you can address them with a friend family member or doctor

1 MEMORY LOSS THAT DISRUPTS DAILY LIFE One of the most common signs of Alzheimerrsquos disease especially in the early stage is forgetting recently learned information Others include forgetting important dates or events asking the same question over and over again or increasingly needing to rely on memory aids (eg reminder notes or electronic devices) or family members for things the person used to handle on their own Whatrsquos a typical age-related change Sometimes forgetting names or appointments but remembering them later

2 CHALLENGES IN PLANNING OR SOLVING PROBLEMS Some people living with dementia may experience changes in their ability to develop and follow a plan or work with numbers They may have trouble following a familiar recipe or keeping track of monthly bills They may have difculty concentrating and take much longer to do things than they did before Whatrsquos a typical age-related change Making occasional errors when managing fnances or household bills

3 DIFFICULTY COMPLETING FAMILIAR TASKS People living with Alzheimerrsquos disease often fnd it hard to complete routine tasks Sometimes they may have trouble driving to a familiar location organizing a grocery list or remembering the rules of a favorite game Whatrsquos a typical age-related change Occasionally needing help to use microwave settings or to record a TV show

4 CONFUSION WITH TIME OR PLACE People living with Alzheimerrsquos can lose track of dates seasons and the passage of time They may have trouble understanding something if it is not happening immediately Sometimes they may forget where they are or how they got there Whatrsquos a typical age-related change Getting confused about the day of the week but fguring it out later

5 TROUBLE UNDERSTANDING VISUAL IMAGES AND SPATIAL RELATIONSHIPS For some people vision problems are a sign of Alzheimerrsquos They may also have problems judging distance and determining color or contrast causing issues with driving Whatrsquos a typical age-related change Vision changes related to cataracts

5

6 NEW PROBLEMS WITH WORDS IN SPEAKING OR WRITING People living with Alzheimerrsquos may have trouble following or joining a conversation They may stop in the middle of a conversation and have no idea how to continue or repeat themselves They may struggle with vocabulary have trouble naming a familiar object or use the wrong name Whatrsquos a typical age-related change Sometimes having trouble fnding the right word

7 MISPLACING THINGS AND LOSING THE ABILITY TO RETRACE STEPS A person living with Alzheimerrsquos may put things in unusual places They may lose things and be unable to go back over their steps to fnd them again He or she may accuse others of stealing especially as the disease progresses Whatrsquos a typical age-related change Misplacing things from time to time and retracing steps to fnd them

8 DECREASED OR POOR JUDGMENT Individuals may experience changes in judgment or decision-making For example they may use poor judgment when dealing with money or pay less attention to grooming or keeping themselves clean Whatrsquos a typical age-related change Making a bad decision once in a while like neglecting to change the oil in the car

9 WITHDRAWAL FROM WORK OR SOCIAL ACTIVITIES A person living with Alzheimerrsquos may experience changes in the ability to hold or follow a conversation As a result he or she may withdraw from hobbies social activities or other engagements They may have trouble keeping up with a favorite team or activity Whatrsquos a typical age-related change Sometimes feeling uninterested in family or social obligations

10 CHANGES IN MOOD AND PERSONALITY Individuals living with Alzheimerrsquos may experience mood and personality changes They may be easily upset at home at work with friends or when out of their comfort zone Whatrsquos a typical age-related change Developing very specifc ways of doing things and becoming irritable when a routine is disrupted

WHATrsquoS NEXT If yoursquore concerned that you or someone you know is displaying any of these signs take action

Talk to someone you trust It can be helpful to confde in a friend or family member For tips on how to have a conversation visit alzorgmemoryconcerns

See a doctor Get a full medical evaluation to determine if itrsquos Alzheimerrsquos or something else Early diagnosis gives you a chance to plan for the future access support services and explore medication that may address some symptoms for a time Visit alzorgevaluatememory to learn what an evaluation may include

Get support and information Call the Alzheimerrsquos Association 247 Helpline (8002723900) or visit alzorg10signs

Note This list is for information only and not a substitute for a consultation with a qualifed medical professional This is an ofcial publication of the Alzheimerrsquos Association but may be distributed freely and without charge by unafliated organizations or individuals Such distribution does not constitute an endorsement of these par ties or their activities by the Alzheimerrsquos Association

copy2019 Alzheimerrsquos Associationreg All rights reserved Rev Jun19 TS-0066

6

Compassionate Communication with the Memory Impaired

Donrsquot Donrsquot reason Donrsquot remind them they forget Donrsquot argue Donrsquot question recent memory Donrsquot confront Donrsquot take it personally

DO bull Give short one sentence explanations bull Allow plenty of time for comprehension and then triple it bull Repeat instructions or sentences exactly the same way bull Eliminate lsquobutrsquo from your vocabulary substitute lsquoneverthelessrsquo

bull Avoid insistence Try again later bull Agree with them or distract them to a different subject or activity bull Accept the blame when somethingrsquos wrong (even if itrsquos fantasy) bull Leave the room if necessary to avoid confrontations

bull Respond to the feelings rather than the words bull Be patient and cheerful and reassuring Do go with the flow bull Practice 100 forgiveness Memory loss progresses daily bull My appeal to you Please elevate your level of generosity and graciousness

Remember You canrsquot control memory loss only your reaction to it Compassionate communication will significantly heighten quality of life They are not crazy or lazy They say normal things and do normal things for a memory impaired dementia individual If they were deliberately trying to exasperate you they would have a different diagnosis Forgive themhellipalways For example they donrsquot hide things they protect them in safe placeshellipand then forget Donrsquot take lsquostealingrsquo accusations personally

Their disability is memory loss Asking them to remember is like asking a blind person to read (ldquoDid you take your pillsrdquo ldquoWhat did you do todayrdquo) Donrsquot ask and donrsquot test memory A loss of this magnitude reduces the capacity to reason Expecting them to be reasonable or to accept your conclusion is unrealistic (ldquoYou need a showerrdquo ldquoDay care will be funrdquo ldquoYou canrsquot live alonerdquo) Donrsquot try to reason or convince them Give a one sentence explanation or search for creative solutions Memory loss produces unpredictable emotions thought and behavior which you can alleviate by resolving all issues peacefully Donrsquot argue correct contradict confront blame or insist

Reminders are rarely kind They tell the patient how disabled they arendashndashover and over again Reminders of the recent past imply ldquoI remember Irsquom okay you donrsquot yoursquore notrdquo Ouch Refer only to the present or the future (If theyrsquore hungry donrsquot inform them they ate an hour ago offer a snack or set a time to eat soon) They may ask the same question repeatedly believing each time is the first Graciously respond as if itrsquos the first time Some days they seem normal but theyrsquore not They live in a different reality Reminders wonrsquot bring them into yours Note For vascular dementia giving clues may help their recall If it doesnrsquot work be kindhellipdonrsquot remind

Ethical dilemmas may occur If for instance the patient thinks a dead spouse is alive and truthful reminders will create sadness what should you do To avoid distress try these ways of kindness 1) distract to another topic or 2) start a fun activity or 3) reminisce about their spouse ldquoI was just thinking about ___ How did you meetrdquo or you might try ldquoHersquos gone for a while Letrsquos take our walk nowrdquo

Open ended questions (ldquoWhere shall we gordquo ldquoWhat do you want to eatweardordquo) are surprisingly complex and create anxiety Give them a simple choice between two items or direct their choice ldquoYou look great in the red blouserdquo

They are scared all the time Each patient reacts differently to fear They may become passive uncooperative hostile angry agitated verbally abusive or physically combative They may even do them all at different times or alternate between them Anxiety may compel them to shadow you (follow everywhere) Anxiety compels them to resist changes in routine even pleasant ones Your goal is to reduce anxiety whenever possible Also they canrsquot remember your reassurances Keep saying them

copy1995 2001 2005 2007 2008 Liz Ayres Alzheimerrsquos Support Group Leader former Caregiver Orange County CA 7

Examples Donrsquot argue Patient ldquoI didnrsquot write this check for $500

Someone at the bank is forging my Donrsquot reason signaturerdquo

Patient ldquoWhat doctorrsquos appointment Therersquos nothing Donrsquot (argue) ldquoWhat Donrsquot be silly The bank wrong with merdquo

wouldnrsquot be forging your signaturerdquo Donrsquot (reason) ldquoYoursquove been seeing the doctor every

DO (respond to feelings) ldquoThatrsquos a scary thoughtrdquo three months for the last two years Itrsquos written (reassure) ldquoIrsquoll make sure they donrsquot do on the calendar and I told you about it yesterday thatrdquo(distract) ldquoWould you help me fold and this morningrdquo the towelsrdquo

DO (short explanation) ldquoItrsquos just a regular checkuprdquo (accept blame) ldquoIrsquom sorry if I forgot to tell yourdquo

Donrsquot remind them that they forget

Donrsquot confront Patient ldquoJoe hasnrsquot called for a long

Patient ldquoNobodyrsquos going to make decisions for me You can go time I hope hersquos okrdquo

Donrsquot

nowhellipand donrsquot come backrdquo

(confront) ldquoIrsquom not going anywhere and you canrsquot remember enough to make your own decisionsrdquo

Donrsquot (remind) ldquoJoe called yesterday and you talked with him for 15 minutesrdquo

DO (accept blame or respond to feelings) ldquoIrsquom sorry this is a tough timerdquo (reassure) ldquoI love you and wersquore going to get through this

togetherrdquo (distract) ldquoYou know what Don has a new job Hersquos really

excited about itrdquo

DO (reassure) ldquoYou really like talking with him donrsquot yourdquo (distract) ldquoLetrsquos call him when we get back from our walkrdquo

Donrsquot take it personally Donrsquot question recent memory Patient ldquoWho are you Wherersquos my

Patient ldquoHello Mary I see yoursquove brought a friend with yourdquo husbandrdquo Donrsquot (question memory) ldquoHi Mom You remember Eric

Donrsquot (take it personally) ldquoWhat do you donrsquot you What did you do todayrdquo mean ndash whorsquos your husbandrdquo I amrdquo

DO (short explanation) ldquoHi Mom You look wonderful DO (go with the flow reassure) ldquoHersquoll

This is Eric We work togetherrdquo be here for dinnerrdquo (distract) ldquoHow about some milk and cookies Would you like chocolate chip or oatmealrdquo

Do repeat exactly Patient ldquoIrsquom going to the store for a newspaperrdquo

Donrsquot (repeat differently) ldquoPlease put your shoes Do eliminate lsquobutrsquo onrdquohellipYoursquoll need to put your shoes onrdquo substitute lsquoneverthelessrsquo

DO (repeat exactly) ldquoPlease put your shoes onrdquohellip Patient ldquoIrsquom not eating this I hate chickenrdquo ldquoPlease put your shoes onrdquo

Donrsquot (say lsquobutrsquo) ldquoI know chickenrsquos not your favorite food but itrsquos what we are having for dinnerrdquo

DO (say lsquoneverthelessrsquo) ldquoI know chickenrsquos not your favorite food (smile) nevertheless Irsquod appreciate it if yoursquod eat a little bitrdquo

If you need suggestions on handling challenging situations call the Alzheimerrsquos Association at 8002723900 8

LIVING AND HOME CARE OPTIONS FOR SENIORS

HOME CARE Home care allows older people to remain in their own homes while receiving the assistance they need to help them remain independent Typically home care involves providing assistance with Activities of Daily Living (ADLs) such as bathing dressing and meal preparation or Instrumental Activities of Daily Living (IADLs) such as transportation paying bills making appointments and simply being there to provide companionship and emotional support Home care services range from once a week to 24 hours a day depending on the needs of the client

Also Known As Home Health Care Home Care Aide In-Home Personal Care

Payment Sources Private Pay MedicareMedicaid via certified home health agencies

Price Range $25 hr and up Resources below

RESPITE CARE ADULT DAY CARE Respite care provides a temporary break for caregivers by allowing a resident to have a short-term stay in a community that can meet their needs Many assisted living communities and nursing homes have a respite care program Residents typically stay from a week to a month depending on their situation They receive all of the services of the community Respite stays may also serve as a get acquainted period for the senior Many residents find that they enjoy their stay and decide to move in soon after the short-term visit Respite programs are available for assisted living and Alzheimers residents Normally adult day care is used to relieve the caregiver or his or her duties for the day while ensuring that the care recipient will still receive the proper care in a safe friendly environment These centers usually operate during normal business hours five days a week and some centers also offer additional services during evenings and weekends In general there are three main types of adult day care centers those that focus primarily on social interaction those that provide medical care and those dedicated to Alzheimerrsquos care Many of these facilities are affiliated with other organizations including home care agencies skilled nursing facilities medical centers or other senior service providers

Also Known As Short-Term Stay Programs Adult Day Care

Payment Sources Private Pay Medicaid

Price Range $75-$150 per day

9

INDEPENDENT LIVING COMMUNITIES Senior independent living communities cater to seniors who are very independent with few medical problems Residents live in fully equipped private apartments A variety of apartment sizes are available from studios to large two bedrooms Fine dining services are offered with custom-designed meal packages Often residents can choose to pay for a specified number of meals per day Frequently there are numerous social outings and events to choose from for entertainment

Also Known As Retirement Communities Congregate Care Retirement Villages 55 + Communities Senior Apartments Continuing Care Retirement Community

Payment Sources Mostly private pay Some US government funded through Section 202

Price Range $1500 and up per month

ASSISTED LIVING Assisted Living communities are designed for seniors who are no longer able to live on their own safely but do not require the high level of care provided in a nursing home Assistance with medications activities of daily living meals and housekeeping are routinely provided Three meals per day are provided in a central dining room Residents live in private apartments which frequently have a limited kitchen area Staff is available 24 hours per day for additional safety Most assisted living communities provide licensed nursing services The hours vary greatly so be sure to ask when you visit Social activities and scheduled transportation are also available in most communities A special unit for Alzheimers residents is available in some but not all communities

Also Known As Assisted Care Community Personal Care Home

Payment Sources bull Mostly private pay Some take Medicaid

Price Range $3000 and up per month depending on the size of apartment and level of assistance required

10

NURSING HOMES Nursing homes provide around-the-clock skilled nursing care for the frail elderly who require a high level of medical care and assistance 24-hour skilled nursing services are available from licensed nurses Many nursing homes now provide short-term rehabilitative stays for those recovering from an injury illness or surgery Long-term care residents generally have high care needs and complex medical conditions that require routine skilled nursing services Residents typically share a room and are served meals in a central dining area unless they are too ill to participate Activities are also available Some facilities have a separate unit for Alzheimers residents

Also Known As Convalescent Care Nursing Center Skilled Nursing Long Term Care Facility

Payment Sources Private Pay Medicare Medicaid

Price Range $8000 and up per month

ALZHEIMERSMEMORY CARE Numerous senior housing options for people with dementia or Alzheimers are available With memory impaired it is important to have 24-hour support and structured activities to ensure their safety and quality of life Many families try to care for their loved ones at home which can be extremely difficult given the skill that is required to care for a person with memory problems If you need to consider a community understand that Alzheimers care is delivered in the assisted living setting as well as in nursing homes and occasionally in personal care homes Generally the residents live in semi-private apartments and have structured activities delivered by trained staff members Most of these living environments have secured or locked areas to ensure no one wanders off Many times within the secured areas residents have access to outdoor walking paths or gardens

Also Known As Memory Care Dementia Care

Payment Sources Private Pay Medicaid

Price Range bull $5000 and up per month

11

RESIDENTIAL CARE HOMES Residential care homes are private homes that typically serve residents who live together and receive care from live-in caretakers These homes offer assisted care services for seniors who want a more private home-like community Assistance with activities of daily living such as bathing and dressing are typically provided Amenities and nursing services vary greatly between homes Ask about their services when you tour

Services Comfortable private or semi-private rooms 1-to-3 daily home cooked meals Housekeeping and laundry service Medication management Social programs and activities Transportation to doctors appointments

Also known as bull Board and Care Homes bull Personal Care Homes bull Adult Family Homes

Payment Sources bull Private Pay bull Medicaid

Price Range bull $2500 and up per month depending on the services and level of care provided

PLACEMENT AGENGIES (For assistance in locating local placements for you or your loved one) Aspire 707-514-6074 ABBA In Home Care 707-704-6489 Advance Care for Seniors 707-685-6705 Alternatives Beginnings 707-732-3651 Care Network 707-747-2720 Helping Hands 707-451-8724 Inspired Senior Living Options 707-327-2773 Serving Seniors 415-987-8151

12

Driving and Dementiaby Charles G Warner

Driving provides independence from others It is the freedom to go where you please when you please If however if you have been diagnosed with Alzheimerrsquos Disease or a related dementia at some point you should stop driving

The Position of the California Department of Motor Vehicles

The California Department of Motor Vehicles (the ldquoDMVrdquo) has specifc rules and regulations for persons who have been diagnosed with Alzheimerrsquos disease Mild Cognitive Impairment and a long list of related conditions andor diseases that might afect onersquos ability to drive [httpswwwdmvcagovportaldriver-education-and-safetymedical-conditions-and-drivingdementia]

How would the DMV know what happened between my physician and me

When your physician diagnoses anyone with Alzheimerrsquos disease he or she is required by law to fle a report with the County Health Department of your county of residence The County Health Department then forwards the report with the diagnosis to the

13

The 3 Types of Memory Loss

Normal Aging Itrsquos normal to expect some memory loss with age With all the information your brain collects over a lifetime it is logical that recalling certain details take more time and effort Examples include occasionally forgetting where you put your keys or glasses or blanking on the name of an acquaintance This type of ldquomemory problemrdquo is more often annoying than serious Other factors can affect how your mind functions including medication side effects or interaction depressionanxiety and medical problems

Mild Cognitive Impairment (MCI) MCI is a step beyond age-associated memory changes A person with MCI has more memory problems than would be expected for their age but they are able to complete their basic functions When tested they may have difficulty with one area of cognition Research has noted that some patients with MCI improve some are stable over time and some progress to dementia

Dementia When difficulty with memory and other mental abilities interferes with daily life this is called dementia There are several types of dementia that have different characteristics and causes No matter the type dementia is a progressive disease meaning the problems will worsen over months to years There are different stages of dementia mild moderate and advanced The stages are based on the personrsquos function and they will have different needs at different stages Family and caregivers are essential to meet the needs of a person with dementia

4

10 Warning Signs of Alzheimerrsquos

If you notice any of these signs take action Use this form to note your concerns so you can address them with a friend family member or doctor

1 MEMORY LOSS THAT DISRUPTS DAILY LIFE One of the most common signs of Alzheimerrsquos disease especially in the early stage is forgetting recently learned information Others include forgetting important dates or events asking the same question over and over again or increasingly needing to rely on memory aids (eg reminder notes or electronic devices) or family members for things the person used to handle on their own Whatrsquos a typical age-related change Sometimes forgetting names or appointments but remembering them later

2 CHALLENGES IN PLANNING OR SOLVING PROBLEMS Some people living with dementia may experience changes in their ability to develop and follow a plan or work with numbers They may have trouble following a familiar recipe or keeping track of monthly bills They may have difculty concentrating and take much longer to do things than they did before Whatrsquos a typical age-related change Making occasional errors when managing fnances or household bills

3 DIFFICULTY COMPLETING FAMILIAR TASKS People living with Alzheimerrsquos disease often fnd it hard to complete routine tasks Sometimes they may have trouble driving to a familiar location organizing a grocery list or remembering the rules of a favorite game Whatrsquos a typical age-related change Occasionally needing help to use microwave settings or to record a TV show

4 CONFUSION WITH TIME OR PLACE People living with Alzheimerrsquos can lose track of dates seasons and the passage of time They may have trouble understanding something if it is not happening immediately Sometimes they may forget where they are or how they got there Whatrsquos a typical age-related change Getting confused about the day of the week but fguring it out later

5 TROUBLE UNDERSTANDING VISUAL IMAGES AND SPATIAL RELATIONSHIPS For some people vision problems are a sign of Alzheimerrsquos They may also have problems judging distance and determining color or contrast causing issues with driving Whatrsquos a typical age-related change Vision changes related to cataracts

5

6 NEW PROBLEMS WITH WORDS IN SPEAKING OR WRITING People living with Alzheimerrsquos may have trouble following or joining a conversation They may stop in the middle of a conversation and have no idea how to continue or repeat themselves They may struggle with vocabulary have trouble naming a familiar object or use the wrong name Whatrsquos a typical age-related change Sometimes having trouble fnding the right word

7 MISPLACING THINGS AND LOSING THE ABILITY TO RETRACE STEPS A person living with Alzheimerrsquos may put things in unusual places They may lose things and be unable to go back over their steps to fnd them again He or she may accuse others of stealing especially as the disease progresses Whatrsquos a typical age-related change Misplacing things from time to time and retracing steps to fnd them

8 DECREASED OR POOR JUDGMENT Individuals may experience changes in judgment or decision-making For example they may use poor judgment when dealing with money or pay less attention to grooming or keeping themselves clean Whatrsquos a typical age-related change Making a bad decision once in a while like neglecting to change the oil in the car

9 WITHDRAWAL FROM WORK OR SOCIAL ACTIVITIES A person living with Alzheimerrsquos may experience changes in the ability to hold or follow a conversation As a result he or she may withdraw from hobbies social activities or other engagements They may have trouble keeping up with a favorite team or activity Whatrsquos a typical age-related change Sometimes feeling uninterested in family or social obligations

10 CHANGES IN MOOD AND PERSONALITY Individuals living with Alzheimerrsquos may experience mood and personality changes They may be easily upset at home at work with friends or when out of their comfort zone Whatrsquos a typical age-related change Developing very specifc ways of doing things and becoming irritable when a routine is disrupted

WHATrsquoS NEXT If yoursquore concerned that you or someone you know is displaying any of these signs take action

Talk to someone you trust It can be helpful to confde in a friend or family member For tips on how to have a conversation visit alzorgmemoryconcerns

See a doctor Get a full medical evaluation to determine if itrsquos Alzheimerrsquos or something else Early diagnosis gives you a chance to plan for the future access support services and explore medication that may address some symptoms for a time Visit alzorgevaluatememory to learn what an evaluation may include

Get support and information Call the Alzheimerrsquos Association 247 Helpline (8002723900) or visit alzorg10signs

Note This list is for information only and not a substitute for a consultation with a qualifed medical professional This is an ofcial publication of the Alzheimerrsquos Association but may be distributed freely and without charge by unafliated organizations or individuals Such distribution does not constitute an endorsement of these par ties or their activities by the Alzheimerrsquos Association

copy2019 Alzheimerrsquos Associationreg All rights reserved Rev Jun19 TS-0066

6

Compassionate Communication with the Memory Impaired

Donrsquot Donrsquot reason Donrsquot remind them they forget Donrsquot argue Donrsquot question recent memory Donrsquot confront Donrsquot take it personally

DO bull Give short one sentence explanations bull Allow plenty of time for comprehension and then triple it bull Repeat instructions or sentences exactly the same way bull Eliminate lsquobutrsquo from your vocabulary substitute lsquoneverthelessrsquo

bull Avoid insistence Try again later bull Agree with them or distract them to a different subject or activity bull Accept the blame when somethingrsquos wrong (even if itrsquos fantasy) bull Leave the room if necessary to avoid confrontations

bull Respond to the feelings rather than the words bull Be patient and cheerful and reassuring Do go with the flow bull Practice 100 forgiveness Memory loss progresses daily bull My appeal to you Please elevate your level of generosity and graciousness

Remember You canrsquot control memory loss only your reaction to it Compassionate communication will significantly heighten quality of life They are not crazy or lazy They say normal things and do normal things for a memory impaired dementia individual If they were deliberately trying to exasperate you they would have a different diagnosis Forgive themhellipalways For example they donrsquot hide things they protect them in safe placeshellipand then forget Donrsquot take lsquostealingrsquo accusations personally

Their disability is memory loss Asking them to remember is like asking a blind person to read (ldquoDid you take your pillsrdquo ldquoWhat did you do todayrdquo) Donrsquot ask and donrsquot test memory A loss of this magnitude reduces the capacity to reason Expecting them to be reasonable or to accept your conclusion is unrealistic (ldquoYou need a showerrdquo ldquoDay care will be funrdquo ldquoYou canrsquot live alonerdquo) Donrsquot try to reason or convince them Give a one sentence explanation or search for creative solutions Memory loss produces unpredictable emotions thought and behavior which you can alleviate by resolving all issues peacefully Donrsquot argue correct contradict confront blame or insist

Reminders are rarely kind They tell the patient how disabled they arendashndashover and over again Reminders of the recent past imply ldquoI remember Irsquom okay you donrsquot yoursquore notrdquo Ouch Refer only to the present or the future (If theyrsquore hungry donrsquot inform them they ate an hour ago offer a snack or set a time to eat soon) They may ask the same question repeatedly believing each time is the first Graciously respond as if itrsquos the first time Some days they seem normal but theyrsquore not They live in a different reality Reminders wonrsquot bring them into yours Note For vascular dementia giving clues may help their recall If it doesnrsquot work be kindhellipdonrsquot remind

Ethical dilemmas may occur If for instance the patient thinks a dead spouse is alive and truthful reminders will create sadness what should you do To avoid distress try these ways of kindness 1) distract to another topic or 2) start a fun activity or 3) reminisce about their spouse ldquoI was just thinking about ___ How did you meetrdquo or you might try ldquoHersquos gone for a while Letrsquos take our walk nowrdquo

Open ended questions (ldquoWhere shall we gordquo ldquoWhat do you want to eatweardordquo) are surprisingly complex and create anxiety Give them a simple choice between two items or direct their choice ldquoYou look great in the red blouserdquo

They are scared all the time Each patient reacts differently to fear They may become passive uncooperative hostile angry agitated verbally abusive or physically combative They may even do them all at different times or alternate between them Anxiety may compel them to shadow you (follow everywhere) Anxiety compels them to resist changes in routine even pleasant ones Your goal is to reduce anxiety whenever possible Also they canrsquot remember your reassurances Keep saying them

copy1995 2001 2005 2007 2008 Liz Ayres Alzheimerrsquos Support Group Leader former Caregiver Orange County CA 7

Examples Donrsquot argue Patient ldquoI didnrsquot write this check for $500

Someone at the bank is forging my Donrsquot reason signaturerdquo

Patient ldquoWhat doctorrsquos appointment Therersquos nothing Donrsquot (argue) ldquoWhat Donrsquot be silly The bank wrong with merdquo

wouldnrsquot be forging your signaturerdquo Donrsquot (reason) ldquoYoursquove been seeing the doctor every

DO (respond to feelings) ldquoThatrsquos a scary thoughtrdquo three months for the last two years Itrsquos written (reassure) ldquoIrsquoll make sure they donrsquot do on the calendar and I told you about it yesterday thatrdquo(distract) ldquoWould you help me fold and this morningrdquo the towelsrdquo

DO (short explanation) ldquoItrsquos just a regular checkuprdquo (accept blame) ldquoIrsquom sorry if I forgot to tell yourdquo

Donrsquot remind them that they forget

Donrsquot confront Patient ldquoJoe hasnrsquot called for a long

Patient ldquoNobodyrsquos going to make decisions for me You can go time I hope hersquos okrdquo

Donrsquot

nowhellipand donrsquot come backrdquo

(confront) ldquoIrsquom not going anywhere and you canrsquot remember enough to make your own decisionsrdquo

Donrsquot (remind) ldquoJoe called yesterday and you talked with him for 15 minutesrdquo

DO (accept blame or respond to feelings) ldquoIrsquom sorry this is a tough timerdquo (reassure) ldquoI love you and wersquore going to get through this

togetherrdquo (distract) ldquoYou know what Don has a new job Hersquos really

excited about itrdquo

DO (reassure) ldquoYou really like talking with him donrsquot yourdquo (distract) ldquoLetrsquos call him when we get back from our walkrdquo

Donrsquot take it personally Donrsquot question recent memory Patient ldquoWho are you Wherersquos my

Patient ldquoHello Mary I see yoursquove brought a friend with yourdquo husbandrdquo Donrsquot (question memory) ldquoHi Mom You remember Eric

Donrsquot (take it personally) ldquoWhat do you donrsquot you What did you do todayrdquo mean ndash whorsquos your husbandrdquo I amrdquo

DO (short explanation) ldquoHi Mom You look wonderful DO (go with the flow reassure) ldquoHersquoll

This is Eric We work togetherrdquo be here for dinnerrdquo (distract) ldquoHow about some milk and cookies Would you like chocolate chip or oatmealrdquo

Do repeat exactly Patient ldquoIrsquom going to the store for a newspaperrdquo

Donrsquot (repeat differently) ldquoPlease put your shoes Do eliminate lsquobutrsquo onrdquohellipYoursquoll need to put your shoes onrdquo substitute lsquoneverthelessrsquo

DO (repeat exactly) ldquoPlease put your shoes onrdquohellip Patient ldquoIrsquom not eating this I hate chickenrdquo ldquoPlease put your shoes onrdquo

Donrsquot (say lsquobutrsquo) ldquoI know chickenrsquos not your favorite food but itrsquos what we are having for dinnerrdquo

DO (say lsquoneverthelessrsquo) ldquoI know chickenrsquos not your favorite food (smile) nevertheless Irsquod appreciate it if yoursquod eat a little bitrdquo

If you need suggestions on handling challenging situations call the Alzheimerrsquos Association at 8002723900 8

LIVING AND HOME CARE OPTIONS FOR SENIORS

HOME CARE Home care allows older people to remain in their own homes while receiving the assistance they need to help them remain independent Typically home care involves providing assistance with Activities of Daily Living (ADLs) such as bathing dressing and meal preparation or Instrumental Activities of Daily Living (IADLs) such as transportation paying bills making appointments and simply being there to provide companionship and emotional support Home care services range from once a week to 24 hours a day depending on the needs of the client

Also Known As Home Health Care Home Care Aide In-Home Personal Care

Payment Sources Private Pay MedicareMedicaid via certified home health agencies

Price Range $25 hr and up Resources below

RESPITE CARE ADULT DAY CARE Respite care provides a temporary break for caregivers by allowing a resident to have a short-term stay in a community that can meet their needs Many assisted living communities and nursing homes have a respite care program Residents typically stay from a week to a month depending on their situation They receive all of the services of the community Respite stays may also serve as a get acquainted period for the senior Many residents find that they enjoy their stay and decide to move in soon after the short-term visit Respite programs are available for assisted living and Alzheimers residents Normally adult day care is used to relieve the caregiver or his or her duties for the day while ensuring that the care recipient will still receive the proper care in a safe friendly environment These centers usually operate during normal business hours five days a week and some centers also offer additional services during evenings and weekends In general there are three main types of adult day care centers those that focus primarily on social interaction those that provide medical care and those dedicated to Alzheimerrsquos care Many of these facilities are affiliated with other organizations including home care agencies skilled nursing facilities medical centers or other senior service providers

Also Known As Short-Term Stay Programs Adult Day Care

Payment Sources Private Pay Medicaid

Price Range $75-$150 per day

9

INDEPENDENT LIVING COMMUNITIES Senior independent living communities cater to seniors who are very independent with few medical problems Residents live in fully equipped private apartments A variety of apartment sizes are available from studios to large two bedrooms Fine dining services are offered with custom-designed meal packages Often residents can choose to pay for a specified number of meals per day Frequently there are numerous social outings and events to choose from for entertainment

Also Known As Retirement Communities Congregate Care Retirement Villages 55 + Communities Senior Apartments Continuing Care Retirement Community

Payment Sources Mostly private pay Some US government funded through Section 202

Price Range $1500 and up per month

ASSISTED LIVING Assisted Living communities are designed for seniors who are no longer able to live on their own safely but do not require the high level of care provided in a nursing home Assistance with medications activities of daily living meals and housekeeping are routinely provided Three meals per day are provided in a central dining room Residents live in private apartments which frequently have a limited kitchen area Staff is available 24 hours per day for additional safety Most assisted living communities provide licensed nursing services The hours vary greatly so be sure to ask when you visit Social activities and scheduled transportation are also available in most communities A special unit for Alzheimers residents is available in some but not all communities

Also Known As Assisted Care Community Personal Care Home

Payment Sources bull Mostly private pay Some take Medicaid

Price Range $3000 and up per month depending on the size of apartment and level of assistance required

10

NURSING HOMES Nursing homes provide around-the-clock skilled nursing care for the frail elderly who require a high level of medical care and assistance 24-hour skilled nursing services are available from licensed nurses Many nursing homes now provide short-term rehabilitative stays for those recovering from an injury illness or surgery Long-term care residents generally have high care needs and complex medical conditions that require routine skilled nursing services Residents typically share a room and are served meals in a central dining area unless they are too ill to participate Activities are also available Some facilities have a separate unit for Alzheimers residents

Also Known As Convalescent Care Nursing Center Skilled Nursing Long Term Care Facility

Payment Sources Private Pay Medicare Medicaid

Price Range $8000 and up per month

ALZHEIMERSMEMORY CARE Numerous senior housing options for people with dementia or Alzheimers are available With memory impaired it is important to have 24-hour support and structured activities to ensure their safety and quality of life Many families try to care for their loved ones at home which can be extremely difficult given the skill that is required to care for a person with memory problems If you need to consider a community understand that Alzheimers care is delivered in the assisted living setting as well as in nursing homes and occasionally in personal care homes Generally the residents live in semi-private apartments and have structured activities delivered by trained staff members Most of these living environments have secured or locked areas to ensure no one wanders off Many times within the secured areas residents have access to outdoor walking paths or gardens

Also Known As Memory Care Dementia Care

Payment Sources Private Pay Medicaid

Price Range bull $5000 and up per month

11

RESIDENTIAL CARE HOMES Residential care homes are private homes that typically serve residents who live together and receive care from live-in caretakers These homes offer assisted care services for seniors who want a more private home-like community Assistance with activities of daily living such as bathing and dressing are typically provided Amenities and nursing services vary greatly between homes Ask about their services when you tour

Services Comfortable private or semi-private rooms 1-to-3 daily home cooked meals Housekeeping and laundry service Medication management Social programs and activities Transportation to doctors appointments

Also known as bull Board and Care Homes bull Personal Care Homes bull Adult Family Homes

Payment Sources bull Private Pay bull Medicaid

Price Range bull $2500 and up per month depending on the services and level of care provided

PLACEMENT AGENGIES (For assistance in locating local placements for you or your loved one) Aspire 707-514-6074 ABBA In Home Care 707-704-6489 Advance Care for Seniors 707-685-6705 Alternatives Beginnings 707-732-3651 Care Network 707-747-2720 Helping Hands 707-451-8724 Inspired Senior Living Options 707-327-2773 Serving Seniors 415-987-8151

12

Driving and Dementiaby Charles G Warner

Driving provides independence from others It is the freedom to go where you please when you please If however if you have been diagnosed with Alzheimerrsquos Disease or a related dementia at some point you should stop driving

The Position of the California Department of Motor Vehicles

The California Department of Motor Vehicles (the ldquoDMVrdquo) has specifc rules and regulations for persons who have been diagnosed with Alzheimerrsquos disease Mild Cognitive Impairment and a long list of related conditions andor diseases that might afect onersquos ability to drive [httpswwwdmvcagovportaldriver-education-and-safetymedical-conditions-and-drivingdementia]

How would the DMV know what happened between my physician and me

When your physician diagnoses anyone with Alzheimerrsquos disease he or she is required by law to fle a report with the County Health Department of your county of residence The County Health Department then forwards the report with the diagnosis to the

13

10 Warning Signs of Alzheimerrsquos

If you notice any of these signs take action Use this form to note your concerns so you can address them with a friend family member or doctor

1 MEMORY LOSS THAT DISRUPTS DAILY LIFE One of the most common signs of Alzheimerrsquos disease especially in the early stage is forgetting recently learned information Others include forgetting important dates or events asking the same question over and over again or increasingly needing to rely on memory aids (eg reminder notes or electronic devices) or family members for things the person used to handle on their own Whatrsquos a typical age-related change Sometimes forgetting names or appointments but remembering them later

2 CHALLENGES IN PLANNING OR SOLVING PROBLEMS Some people living with dementia may experience changes in their ability to develop and follow a plan or work with numbers They may have trouble following a familiar recipe or keeping track of monthly bills They may have difculty concentrating and take much longer to do things than they did before Whatrsquos a typical age-related change Making occasional errors when managing fnances or household bills

3 DIFFICULTY COMPLETING FAMILIAR TASKS People living with Alzheimerrsquos disease often fnd it hard to complete routine tasks Sometimes they may have trouble driving to a familiar location organizing a grocery list or remembering the rules of a favorite game Whatrsquos a typical age-related change Occasionally needing help to use microwave settings or to record a TV show

4 CONFUSION WITH TIME OR PLACE People living with Alzheimerrsquos can lose track of dates seasons and the passage of time They may have trouble understanding something if it is not happening immediately Sometimes they may forget where they are or how they got there Whatrsquos a typical age-related change Getting confused about the day of the week but fguring it out later

5 TROUBLE UNDERSTANDING VISUAL IMAGES AND SPATIAL RELATIONSHIPS For some people vision problems are a sign of Alzheimerrsquos They may also have problems judging distance and determining color or contrast causing issues with driving Whatrsquos a typical age-related change Vision changes related to cataracts

5

6 NEW PROBLEMS WITH WORDS IN SPEAKING OR WRITING People living with Alzheimerrsquos may have trouble following or joining a conversation They may stop in the middle of a conversation and have no idea how to continue or repeat themselves They may struggle with vocabulary have trouble naming a familiar object or use the wrong name Whatrsquos a typical age-related change Sometimes having trouble fnding the right word

7 MISPLACING THINGS AND LOSING THE ABILITY TO RETRACE STEPS A person living with Alzheimerrsquos may put things in unusual places They may lose things and be unable to go back over their steps to fnd them again He or she may accuse others of stealing especially as the disease progresses Whatrsquos a typical age-related change Misplacing things from time to time and retracing steps to fnd them

8 DECREASED OR POOR JUDGMENT Individuals may experience changes in judgment or decision-making For example they may use poor judgment when dealing with money or pay less attention to grooming or keeping themselves clean Whatrsquos a typical age-related change Making a bad decision once in a while like neglecting to change the oil in the car

9 WITHDRAWAL FROM WORK OR SOCIAL ACTIVITIES A person living with Alzheimerrsquos may experience changes in the ability to hold or follow a conversation As a result he or she may withdraw from hobbies social activities or other engagements They may have trouble keeping up with a favorite team or activity Whatrsquos a typical age-related change Sometimes feeling uninterested in family or social obligations

10 CHANGES IN MOOD AND PERSONALITY Individuals living with Alzheimerrsquos may experience mood and personality changes They may be easily upset at home at work with friends or when out of their comfort zone Whatrsquos a typical age-related change Developing very specifc ways of doing things and becoming irritable when a routine is disrupted

WHATrsquoS NEXT If yoursquore concerned that you or someone you know is displaying any of these signs take action

Talk to someone you trust It can be helpful to confde in a friend or family member For tips on how to have a conversation visit alzorgmemoryconcerns

See a doctor Get a full medical evaluation to determine if itrsquos Alzheimerrsquos or something else Early diagnosis gives you a chance to plan for the future access support services and explore medication that may address some symptoms for a time Visit alzorgevaluatememory to learn what an evaluation may include

Get support and information Call the Alzheimerrsquos Association 247 Helpline (8002723900) or visit alzorg10signs

Note This list is for information only and not a substitute for a consultation with a qualifed medical professional This is an ofcial publication of the Alzheimerrsquos Association but may be distributed freely and without charge by unafliated organizations or individuals Such distribution does not constitute an endorsement of these par ties or their activities by the Alzheimerrsquos Association

copy2019 Alzheimerrsquos Associationreg All rights reserved Rev Jun19 TS-0066

6

Compassionate Communication with the Memory Impaired

Donrsquot Donrsquot reason Donrsquot remind them they forget Donrsquot argue Donrsquot question recent memory Donrsquot confront Donrsquot take it personally

DO bull Give short one sentence explanations bull Allow plenty of time for comprehension and then triple it bull Repeat instructions or sentences exactly the same way bull Eliminate lsquobutrsquo from your vocabulary substitute lsquoneverthelessrsquo

bull Avoid insistence Try again later bull Agree with them or distract them to a different subject or activity bull Accept the blame when somethingrsquos wrong (even if itrsquos fantasy) bull Leave the room if necessary to avoid confrontations

bull Respond to the feelings rather than the words bull Be patient and cheerful and reassuring Do go with the flow bull Practice 100 forgiveness Memory loss progresses daily bull My appeal to you Please elevate your level of generosity and graciousness

Remember You canrsquot control memory loss only your reaction to it Compassionate communication will significantly heighten quality of life They are not crazy or lazy They say normal things and do normal things for a memory impaired dementia individual If they were deliberately trying to exasperate you they would have a different diagnosis Forgive themhellipalways For example they donrsquot hide things they protect them in safe placeshellipand then forget Donrsquot take lsquostealingrsquo accusations personally

Their disability is memory loss Asking them to remember is like asking a blind person to read (ldquoDid you take your pillsrdquo ldquoWhat did you do todayrdquo) Donrsquot ask and donrsquot test memory A loss of this magnitude reduces the capacity to reason Expecting them to be reasonable or to accept your conclusion is unrealistic (ldquoYou need a showerrdquo ldquoDay care will be funrdquo ldquoYou canrsquot live alonerdquo) Donrsquot try to reason or convince them Give a one sentence explanation or search for creative solutions Memory loss produces unpredictable emotions thought and behavior which you can alleviate by resolving all issues peacefully Donrsquot argue correct contradict confront blame or insist

Reminders are rarely kind They tell the patient how disabled they arendashndashover and over again Reminders of the recent past imply ldquoI remember Irsquom okay you donrsquot yoursquore notrdquo Ouch Refer only to the present or the future (If theyrsquore hungry donrsquot inform them they ate an hour ago offer a snack or set a time to eat soon) They may ask the same question repeatedly believing each time is the first Graciously respond as if itrsquos the first time Some days they seem normal but theyrsquore not They live in a different reality Reminders wonrsquot bring them into yours Note For vascular dementia giving clues may help their recall If it doesnrsquot work be kindhellipdonrsquot remind

Ethical dilemmas may occur If for instance the patient thinks a dead spouse is alive and truthful reminders will create sadness what should you do To avoid distress try these ways of kindness 1) distract to another topic or 2) start a fun activity or 3) reminisce about their spouse ldquoI was just thinking about ___ How did you meetrdquo or you might try ldquoHersquos gone for a while Letrsquos take our walk nowrdquo

Open ended questions (ldquoWhere shall we gordquo ldquoWhat do you want to eatweardordquo) are surprisingly complex and create anxiety Give them a simple choice between two items or direct their choice ldquoYou look great in the red blouserdquo

They are scared all the time Each patient reacts differently to fear They may become passive uncooperative hostile angry agitated verbally abusive or physically combative They may even do them all at different times or alternate between them Anxiety may compel them to shadow you (follow everywhere) Anxiety compels them to resist changes in routine even pleasant ones Your goal is to reduce anxiety whenever possible Also they canrsquot remember your reassurances Keep saying them

copy1995 2001 2005 2007 2008 Liz Ayres Alzheimerrsquos Support Group Leader former Caregiver Orange County CA 7

Examples Donrsquot argue Patient ldquoI didnrsquot write this check for $500

Someone at the bank is forging my Donrsquot reason signaturerdquo

Patient ldquoWhat doctorrsquos appointment Therersquos nothing Donrsquot (argue) ldquoWhat Donrsquot be silly The bank wrong with merdquo

wouldnrsquot be forging your signaturerdquo Donrsquot (reason) ldquoYoursquove been seeing the doctor every

DO (respond to feelings) ldquoThatrsquos a scary thoughtrdquo three months for the last two years Itrsquos written (reassure) ldquoIrsquoll make sure they donrsquot do on the calendar and I told you about it yesterday thatrdquo(distract) ldquoWould you help me fold and this morningrdquo the towelsrdquo

DO (short explanation) ldquoItrsquos just a regular checkuprdquo (accept blame) ldquoIrsquom sorry if I forgot to tell yourdquo

Donrsquot remind them that they forget

Donrsquot confront Patient ldquoJoe hasnrsquot called for a long

Patient ldquoNobodyrsquos going to make decisions for me You can go time I hope hersquos okrdquo

Donrsquot

nowhellipand donrsquot come backrdquo

(confront) ldquoIrsquom not going anywhere and you canrsquot remember enough to make your own decisionsrdquo

Donrsquot (remind) ldquoJoe called yesterday and you talked with him for 15 minutesrdquo

DO (accept blame or respond to feelings) ldquoIrsquom sorry this is a tough timerdquo (reassure) ldquoI love you and wersquore going to get through this

togetherrdquo (distract) ldquoYou know what Don has a new job Hersquos really

excited about itrdquo

DO (reassure) ldquoYou really like talking with him donrsquot yourdquo (distract) ldquoLetrsquos call him when we get back from our walkrdquo

Donrsquot take it personally Donrsquot question recent memory Patient ldquoWho are you Wherersquos my

Patient ldquoHello Mary I see yoursquove brought a friend with yourdquo husbandrdquo Donrsquot (question memory) ldquoHi Mom You remember Eric

Donrsquot (take it personally) ldquoWhat do you donrsquot you What did you do todayrdquo mean ndash whorsquos your husbandrdquo I amrdquo

DO (short explanation) ldquoHi Mom You look wonderful DO (go with the flow reassure) ldquoHersquoll

This is Eric We work togetherrdquo be here for dinnerrdquo (distract) ldquoHow about some milk and cookies Would you like chocolate chip or oatmealrdquo

Do repeat exactly Patient ldquoIrsquom going to the store for a newspaperrdquo

Donrsquot (repeat differently) ldquoPlease put your shoes Do eliminate lsquobutrsquo onrdquohellipYoursquoll need to put your shoes onrdquo substitute lsquoneverthelessrsquo

DO (repeat exactly) ldquoPlease put your shoes onrdquohellip Patient ldquoIrsquom not eating this I hate chickenrdquo ldquoPlease put your shoes onrdquo

Donrsquot (say lsquobutrsquo) ldquoI know chickenrsquos not your favorite food but itrsquos what we are having for dinnerrdquo

DO (say lsquoneverthelessrsquo) ldquoI know chickenrsquos not your favorite food (smile) nevertheless Irsquod appreciate it if yoursquod eat a little bitrdquo

If you need suggestions on handling challenging situations call the Alzheimerrsquos Association at 8002723900 8

LIVING AND HOME CARE OPTIONS FOR SENIORS

HOME CARE Home care allows older people to remain in their own homes while receiving the assistance they need to help them remain independent Typically home care involves providing assistance with Activities of Daily Living (ADLs) such as bathing dressing and meal preparation or Instrumental Activities of Daily Living (IADLs) such as transportation paying bills making appointments and simply being there to provide companionship and emotional support Home care services range from once a week to 24 hours a day depending on the needs of the client

Also Known As Home Health Care Home Care Aide In-Home Personal Care

Payment Sources Private Pay MedicareMedicaid via certified home health agencies

Price Range $25 hr and up Resources below

RESPITE CARE ADULT DAY CARE Respite care provides a temporary break for caregivers by allowing a resident to have a short-term stay in a community that can meet their needs Many assisted living communities and nursing homes have a respite care program Residents typically stay from a week to a month depending on their situation They receive all of the services of the community Respite stays may also serve as a get acquainted period for the senior Many residents find that they enjoy their stay and decide to move in soon after the short-term visit Respite programs are available for assisted living and Alzheimers residents Normally adult day care is used to relieve the caregiver or his or her duties for the day while ensuring that the care recipient will still receive the proper care in a safe friendly environment These centers usually operate during normal business hours five days a week and some centers also offer additional services during evenings and weekends In general there are three main types of adult day care centers those that focus primarily on social interaction those that provide medical care and those dedicated to Alzheimerrsquos care Many of these facilities are affiliated with other organizations including home care agencies skilled nursing facilities medical centers or other senior service providers

Also Known As Short-Term Stay Programs Adult Day Care

Payment Sources Private Pay Medicaid

Price Range $75-$150 per day

9

INDEPENDENT LIVING COMMUNITIES Senior independent living communities cater to seniors who are very independent with few medical problems Residents live in fully equipped private apartments A variety of apartment sizes are available from studios to large two bedrooms Fine dining services are offered with custom-designed meal packages Often residents can choose to pay for a specified number of meals per day Frequently there are numerous social outings and events to choose from for entertainment

Also Known As Retirement Communities Congregate Care Retirement Villages 55 + Communities Senior Apartments Continuing Care Retirement Community

Payment Sources Mostly private pay Some US government funded through Section 202

Price Range $1500 and up per month

ASSISTED LIVING Assisted Living communities are designed for seniors who are no longer able to live on their own safely but do not require the high level of care provided in a nursing home Assistance with medications activities of daily living meals and housekeeping are routinely provided Three meals per day are provided in a central dining room Residents live in private apartments which frequently have a limited kitchen area Staff is available 24 hours per day for additional safety Most assisted living communities provide licensed nursing services The hours vary greatly so be sure to ask when you visit Social activities and scheduled transportation are also available in most communities A special unit for Alzheimers residents is available in some but not all communities

Also Known As Assisted Care Community Personal Care Home

Payment Sources bull Mostly private pay Some take Medicaid

Price Range $3000 and up per month depending on the size of apartment and level of assistance required

10

NURSING HOMES Nursing homes provide around-the-clock skilled nursing care for the frail elderly who require a high level of medical care and assistance 24-hour skilled nursing services are available from licensed nurses Many nursing homes now provide short-term rehabilitative stays for those recovering from an injury illness or surgery Long-term care residents generally have high care needs and complex medical conditions that require routine skilled nursing services Residents typically share a room and are served meals in a central dining area unless they are too ill to participate Activities are also available Some facilities have a separate unit for Alzheimers residents

Also Known As Convalescent Care Nursing Center Skilled Nursing Long Term Care Facility

Payment Sources Private Pay Medicare Medicaid

Price Range $8000 and up per month

ALZHEIMERSMEMORY CARE Numerous senior housing options for people with dementia or Alzheimers are available With memory impaired it is important to have 24-hour support and structured activities to ensure their safety and quality of life Many families try to care for their loved ones at home which can be extremely difficult given the skill that is required to care for a person with memory problems If you need to consider a community understand that Alzheimers care is delivered in the assisted living setting as well as in nursing homes and occasionally in personal care homes Generally the residents live in semi-private apartments and have structured activities delivered by trained staff members Most of these living environments have secured or locked areas to ensure no one wanders off Many times within the secured areas residents have access to outdoor walking paths or gardens

Also Known As Memory Care Dementia Care

Payment Sources Private Pay Medicaid

Price Range bull $5000 and up per month

11

RESIDENTIAL CARE HOMES Residential care homes are private homes that typically serve residents who live together and receive care from live-in caretakers These homes offer assisted care services for seniors who want a more private home-like community Assistance with activities of daily living such as bathing and dressing are typically provided Amenities and nursing services vary greatly between homes Ask about their services when you tour

Services Comfortable private or semi-private rooms 1-to-3 daily home cooked meals Housekeeping and laundry service Medication management Social programs and activities Transportation to doctors appointments

Also known as bull Board and Care Homes bull Personal Care Homes bull Adult Family Homes

Payment Sources bull Private Pay bull Medicaid

Price Range bull $2500 and up per month depending on the services and level of care provided

PLACEMENT AGENGIES (For assistance in locating local placements for you or your loved one) Aspire 707-514-6074 ABBA In Home Care 707-704-6489 Advance Care for Seniors 707-685-6705 Alternatives Beginnings 707-732-3651 Care Network 707-747-2720 Helping Hands 707-451-8724 Inspired Senior Living Options 707-327-2773 Serving Seniors 415-987-8151

12

Driving and Dementiaby Charles G Warner

Driving provides independence from others It is the freedom to go where you please when you please If however if you have been diagnosed with Alzheimerrsquos Disease or a related dementia at some point you should stop driving

The Position of the California Department of Motor Vehicles

The California Department of Motor Vehicles (the ldquoDMVrdquo) has specifc rules and regulations for persons who have been diagnosed with Alzheimerrsquos disease Mild Cognitive Impairment and a long list of related conditions andor diseases that might afect onersquos ability to drive [httpswwwdmvcagovportaldriver-education-and-safetymedical-conditions-and-drivingdementia]

How would the DMV know what happened between my physician and me

When your physician diagnoses anyone with Alzheimerrsquos disease he or she is required by law to fle a report with the County Health Department of your county of residence The County Health Department then forwards the report with the diagnosis to the

13

6 NEW PROBLEMS WITH WORDS IN SPEAKING OR WRITING People living with Alzheimerrsquos may have trouble following or joining a conversation They may stop in the middle of a conversation and have no idea how to continue or repeat themselves They may struggle with vocabulary have trouble naming a familiar object or use the wrong name Whatrsquos a typical age-related change Sometimes having trouble fnding the right word

7 MISPLACING THINGS AND LOSING THE ABILITY TO RETRACE STEPS A person living with Alzheimerrsquos may put things in unusual places They may lose things and be unable to go back over their steps to fnd them again He or she may accuse others of stealing especially as the disease progresses Whatrsquos a typical age-related change Misplacing things from time to time and retracing steps to fnd them

8 DECREASED OR POOR JUDGMENT Individuals may experience changes in judgment or decision-making For example they may use poor judgment when dealing with money or pay less attention to grooming or keeping themselves clean Whatrsquos a typical age-related change Making a bad decision once in a while like neglecting to change the oil in the car

9 WITHDRAWAL FROM WORK OR SOCIAL ACTIVITIES A person living with Alzheimerrsquos may experience changes in the ability to hold or follow a conversation As a result he or she may withdraw from hobbies social activities or other engagements They may have trouble keeping up with a favorite team or activity Whatrsquos a typical age-related change Sometimes feeling uninterested in family or social obligations

10 CHANGES IN MOOD AND PERSONALITY Individuals living with Alzheimerrsquos may experience mood and personality changes They may be easily upset at home at work with friends or when out of their comfort zone Whatrsquos a typical age-related change Developing very specifc ways of doing things and becoming irritable when a routine is disrupted

WHATrsquoS NEXT If yoursquore concerned that you or someone you know is displaying any of these signs take action

Talk to someone you trust It can be helpful to confde in a friend or family member For tips on how to have a conversation visit alzorgmemoryconcerns

See a doctor Get a full medical evaluation to determine if itrsquos Alzheimerrsquos or something else Early diagnosis gives you a chance to plan for the future access support services and explore medication that may address some symptoms for a time Visit alzorgevaluatememory to learn what an evaluation may include

Get support and information Call the Alzheimerrsquos Association 247 Helpline (8002723900) or visit alzorg10signs

Note This list is for information only and not a substitute for a consultation with a qualifed medical professional This is an ofcial publication of the Alzheimerrsquos Association but may be distributed freely and without charge by unafliated organizations or individuals Such distribution does not constitute an endorsement of these par ties or their activities by the Alzheimerrsquos Association

copy2019 Alzheimerrsquos Associationreg All rights reserved Rev Jun19 TS-0066

6

Compassionate Communication with the Memory Impaired

Donrsquot Donrsquot reason Donrsquot remind them they forget Donrsquot argue Donrsquot question recent memory Donrsquot confront Donrsquot take it personally

DO bull Give short one sentence explanations bull Allow plenty of time for comprehension and then triple it bull Repeat instructions or sentences exactly the same way bull Eliminate lsquobutrsquo from your vocabulary substitute lsquoneverthelessrsquo

bull Avoid insistence Try again later bull Agree with them or distract them to a different subject or activity bull Accept the blame when somethingrsquos wrong (even if itrsquos fantasy) bull Leave the room if necessary to avoid confrontations

bull Respond to the feelings rather than the words bull Be patient and cheerful and reassuring Do go with the flow bull Practice 100 forgiveness Memory loss progresses daily bull My appeal to you Please elevate your level of generosity and graciousness

Remember You canrsquot control memory loss only your reaction to it Compassionate communication will significantly heighten quality of life They are not crazy or lazy They say normal things and do normal things for a memory impaired dementia individual If they were deliberately trying to exasperate you they would have a different diagnosis Forgive themhellipalways For example they donrsquot hide things they protect them in safe placeshellipand then forget Donrsquot take lsquostealingrsquo accusations personally

Their disability is memory loss Asking them to remember is like asking a blind person to read (ldquoDid you take your pillsrdquo ldquoWhat did you do todayrdquo) Donrsquot ask and donrsquot test memory A loss of this magnitude reduces the capacity to reason Expecting them to be reasonable or to accept your conclusion is unrealistic (ldquoYou need a showerrdquo ldquoDay care will be funrdquo ldquoYou canrsquot live alonerdquo) Donrsquot try to reason or convince them Give a one sentence explanation or search for creative solutions Memory loss produces unpredictable emotions thought and behavior which you can alleviate by resolving all issues peacefully Donrsquot argue correct contradict confront blame or insist

Reminders are rarely kind They tell the patient how disabled they arendashndashover and over again Reminders of the recent past imply ldquoI remember Irsquom okay you donrsquot yoursquore notrdquo Ouch Refer only to the present or the future (If theyrsquore hungry donrsquot inform them they ate an hour ago offer a snack or set a time to eat soon) They may ask the same question repeatedly believing each time is the first Graciously respond as if itrsquos the first time Some days they seem normal but theyrsquore not They live in a different reality Reminders wonrsquot bring them into yours Note For vascular dementia giving clues may help their recall If it doesnrsquot work be kindhellipdonrsquot remind

Ethical dilemmas may occur If for instance the patient thinks a dead spouse is alive and truthful reminders will create sadness what should you do To avoid distress try these ways of kindness 1) distract to another topic or 2) start a fun activity or 3) reminisce about their spouse ldquoI was just thinking about ___ How did you meetrdquo or you might try ldquoHersquos gone for a while Letrsquos take our walk nowrdquo

Open ended questions (ldquoWhere shall we gordquo ldquoWhat do you want to eatweardordquo) are surprisingly complex and create anxiety Give them a simple choice between two items or direct their choice ldquoYou look great in the red blouserdquo

They are scared all the time Each patient reacts differently to fear They may become passive uncooperative hostile angry agitated verbally abusive or physically combative They may even do them all at different times or alternate between them Anxiety may compel them to shadow you (follow everywhere) Anxiety compels them to resist changes in routine even pleasant ones Your goal is to reduce anxiety whenever possible Also they canrsquot remember your reassurances Keep saying them

copy1995 2001 2005 2007 2008 Liz Ayres Alzheimerrsquos Support Group Leader former Caregiver Orange County CA 7

Examples Donrsquot argue Patient ldquoI didnrsquot write this check for $500

Someone at the bank is forging my Donrsquot reason signaturerdquo

Patient ldquoWhat doctorrsquos appointment Therersquos nothing Donrsquot (argue) ldquoWhat Donrsquot be silly The bank wrong with merdquo

wouldnrsquot be forging your signaturerdquo Donrsquot (reason) ldquoYoursquove been seeing the doctor every

DO (respond to feelings) ldquoThatrsquos a scary thoughtrdquo three months for the last two years Itrsquos written (reassure) ldquoIrsquoll make sure they donrsquot do on the calendar and I told you about it yesterday thatrdquo(distract) ldquoWould you help me fold and this morningrdquo the towelsrdquo

DO (short explanation) ldquoItrsquos just a regular checkuprdquo (accept blame) ldquoIrsquom sorry if I forgot to tell yourdquo

Donrsquot remind them that they forget

Donrsquot confront Patient ldquoJoe hasnrsquot called for a long

Patient ldquoNobodyrsquos going to make decisions for me You can go time I hope hersquos okrdquo

Donrsquot

nowhellipand donrsquot come backrdquo

(confront) ldquoIrsquom not going anywhere and you canrsquot remember enough to make your own decisionsrdquo

Donrsquot (remind) ldquoJoe called yesterday and you talked with him for 15 minutesrdquo

DO (accept blame or respond to feelings) ldquoIrsquom sorry this is a tough timerdquo (reassure) ldquoI love you and wersquore going to get through this

togetherrdquo (distract) ldquoYou know what Don has a new job Hersquos really

excited about itrdquo

DO (reassure) ldquoYou really like talking with him donrsquot yourdquo (distract) ldquoLetrsquos call him when we get back from our walkrdquo

Donrsquot take it personally Donrsquot question recent memory Patient ldquoWho are you Wherersquos my

Patient ldquoHello Mary I see yoursquove brought a friend with yourdquo husbandrdquo Donrsquot (question memory) ldquoHi Mom You remember Eric

Donrsquot (take it personally) ldquoWhat do you donrsquot you What did you do todayrdquo mean ndash whorsquos your husbandrdquo I amrdquo

DO (short explanation) ldquoHi Mom You look wonderful DO (go with the flow reassure) ldquoHersquoll

This is Eric We work togetherrdquo be here for dinnerrdquo (distract) ldquoHow about some milk and cookies Would you like chocolate chip or oatmealrdquo

Do repeat exactly Patient ldquoIrsquom going to the store for a newspaperrdquo

Donrsquot (repeat differently) ldquoPlease put your shoes Do eliminate lsquobutrsquo onrdquohellipYoursquoll need to put your shoes onrdquo substitute lsquoneverthelessrsquo

DO (repeat exactly) ldquoPlease put your shoes onrdquohellip Patient ldquoIrsquom not eating this I hate chickenrdquo ldquoPlease put your shoes onrdquo

Donrsquot (say lsquobutrsquo) ldquoI know chickenrsquos not your favorite food but itrsquos what we are having for dinnerrdquo

DO (say lsquoneverthelessrsquo) ldquoI know chickenrsquos not your favorite food (smile) nevertheless Irsquod appreciate it if yoursquod eat a little bitrdquo

If you need suggestions on handling challenging situations call the Alzheimerrsquos Association at 8002723900 8

LIVING AND HOME CARE OPTIONS FOR SENIORS

HOME CARE Home care allows older people to remain in their own homes while receiving the assistance they need to help them remain independent Typically home care involves providing assistance with Activities of Daily Living (ADLs) such as bathing dressing and meal preparation or Instrumental Activities of Daily Living (IADLs) such as transportation paying bills making appointments and simply being there to provide companionship and emotional support Home care services range from once a week to 24 hours a day depending on the needs of the client

Also Known As Home Health Care Home Care Aide In-Home Personal Care

Payment Sources Private Pay MedicareMedicaid via certified home health agencies

Price Range $25 hr and up Resources below

RESPITE CARE ADULT DAY CARE Respite care provides a temporary break for caregivers by allowing a resident to have a short-term stay in a community that can meet their needs Many assisted living communities and nursing homes have a respite care program Residents typically stay from a week to a month depending on their situation They receive all of the services of the community Respite stays may also serve as a get acquainted period for the senior Many residents find that they enjoy their stay and decide to move in soon after the short-term visit Respite programs are available for assisted living and Alzheimers residents Normally adult day care is used to relieve the caregiver or his or her duties for the day while ensuring that the care recipient will still receive the proper care in a safe friendly environment These centers usually operate during normal business hours five days a week and some centers also offer additional services during evenings and weekends In general there are three main types of adult day care centers those that focus primarily on social interaction those that provide medical care and those dedicated to Alzheimerrsquos care Many of these facilities are affiliated with other organizations including home care agencies skilled nursing facilities medical centers or other senior service providers

Also Known As Short-Term Stay Programs Adult Day Care

Payment Sources Private Pay Medicaid

Price Range $75-$150 per day

9

INDEPENDENT LIVING COMMUNITIES Senior independent living communities cater to seniors who are very independent with few medical problems Residents live in fully equipped private apartments A variety of apartment sizes are available from studios to large two bedrooms Fine dining services are offered with custom-designed meal packages Often residents can choose to pay for a specified number of meals per day Frequently there are numerous social outings and events to choose from for entertainment

Also Known As Retirement Communities Congregate Care Retirement Villages 55 + Communities Senior Apartments Continuing Care Retirement Community

Payment Sources Mostly private pay Some US government funded through Section 202

Price Range $1500 and up per month

ASSISTED LIVING Assisted Living communities are designed for seniors who are no longer able to live on their own safely but do not require the high level of care provided in a nursing home Assistance with medications activities of daily living meals and housekeeping are routinely provided Three meals per day are provided in a central dining room Residents live in private apartments which frequently have a limited kitchen area Staff is available 24 hours per day for additional safety Most assisted living communities provide licensed nursing services The hours vary greatly so be sure to ask when you visit Social activities and scheduled transportation are also available in most communities A special unit for Alzheimers residents is available in some but not all communities

Also Known As Assisted Care Community Personal Care Home

Payment Sources bull Mostly private pay Some take Medicaid

Price Range $3000 and up per month depending on the size of apartment and level of assistance required

10

NURSING HOMES Nursing homes provide around-the-clock skilled nursing care for the frail elderly who require a high level of medical care and assistance 24-hour skilled nursing services are available from licensed nurses Many nursing homes now provide short-term rehabilitative stays for those recovering from an injury illness or surgery Long-term care residents generally have high care needs and complex medical conditions that require routine skilled nursing services Residents typically share a room and are served meals in a central dining area unless they are too ill to participate Activities are also available Some facilities have a separate unit for Alzheimers residents

Also Known As Convalescent Care Nursing Center Skilled Nursing Long Term Care Facility

Payment Sources Private Pay Medicare Medicaid

Price Range $8000 and up per month

ALZHEIMERSMEMORY CARE Numerous senior housing options for people with dementia or Alzheimers are available With memory impaired it is important to have 24-hour support and structured activities to ensure their safety and quality of life Many families try to care for their loved ones at home which can be extremely difficult given the skill that is required to care for a person with memory problems If you need to consider a community understand that Alzheimers care is delivered in the assisted living setting as well as in nursing homes and occasionally in personal care homes Generally the residents live in semi-private apartments and have structured activities delivered by trained staff members Most of these living environments have secured or locked areas to ensure no one wanders off Many times within the secured areas residents have access to outdoor walking paths or gardens

Also Known As Memory Care Dementia Care

Payment Sources Private Pay Medicaid

Price Range bull $5000 and up per month

11

RESIDENTIAL CARE HOMES Residential care homes are private homes that typically serve residents who live together and receive care from live-in caretakers These homes offer assisted care services for seniors who want a more private home-like community Assistance with activities of daily living such as bathing and dressing are typically provided Amenities and nursing services vary greatly between homes Ask about their services when you tour

Services Comfortable private or semi-private rooms 1-to-3 daily home cooked meals Housekeeping and laundry service Medication management Social programs and activities Transportation to doctors appointments

Also known as bull Board and Care Homes bull Personal Care Homes bull Adult Family Homes

Payment Sources bull Private Pay bull Medicaid

Price Range bull $2500 and up per month depending on the services and level of care provided

PLACEMENT AGENGIES (For assistance in locating local placements for you or your loved one) Aspire 707-514-6074 ABBA In Home Care 707-704-6489 Advance Care for Seniors 707-685-6705 Alternatives Beginnings 707-732-3651 Care Network 707-747-2720 Helping Hands 707-451-8724 Inspired Senior Living Options 707-327-2773 Serving Seniors 415-987-8151

12

Driving and Dementiaby Charles G Warner

Driving provides independence from others It is the freedom to go where you please when you please If however if you have been diagnosed with Alzheimerrsquos Disease or a related dementia at some point you should stop driving

The Position of the California Department of Motor Vehicles

The California Department of Motor Vehicles (the ldquoDMVrdquo) has specifc rules and regulations for persons who have been diagnosed with Alzheimerrsquos disease Mild Cognitive Impairment and a long list of related conditions andor diseases that might afect onersquos ability to drive [httpswwwdmvcagovportaldriver-education-and-safetymedical-conditions-and-drivingdementia]

How would the DMV know what happened between my physician and me

When your physician diagnoses anyone with Alzheimerrsquos disease he or she is required by law to fle a report with the County Health Department of your county of residence The County Health Department then forwards the report with the diagnosis to the

13

Compassionate Communication with the Memory Impaired

Donrsquot Donrsquot reason Donrsquot remind them they forget Donrsquot argue Donrsquot question recent memory Donrsquot confront Donrsquot take it personally

DO bull Give short one sentence explanations bull Allow plenty of time for comprehension and then triple it bull Repeat instructions or sentences exactly the same way bull Eliminate lsquobutrsquo from your vocabulary substitute lsquoneverthelessrsquo

bull Avoid insistence Try again later bull Agree with them or distract them to a different subject or activity bull Accept the blame when somethingrsquos wrong (even if itrsquos fantasy) bull Leave the room if necessary to avoid confrontations

bull Respond to the feelings rather than the words bull Be patient and cheerful and reassuring Do go with the flow bull Practice 100 forgiveness Memory loss progresses daily bull My appeal to you Please elevate your level of generosity and graciousness

Remember You canrsquot control memory loss only your reaction to it Compassionate communication will significantly heighten quality of life They are not crazy or lazy They say normal things and do normal things for a memory impaired dementia individual If they were deliberately trying to exasperate you they would have a different diagnosis Forgive themhellipalways For example they donrsquot hide things they protect them in safe placeshellipand then forget Donrsquot take lsquostealingrsquo accusations personally

Their disability is memory loss Asking them to remember is like asking a blind person to read (ldquoDid you take your pillsrdquo ldquoWhat did you do todayrdquo) Donrsquot ask and donrsquot test memory A loss of this magnitude reduces the capacity to reason Expecting them to be reasonable or to accept your conclusion is unrealistic (ldquoYou need a showerrdquo ldquoDay care will be funrdquo ldquoYou canrsquot live alonerdquo) Donrsquot try to reason or convince them Give a one sentence explanation or search for creative solutions Memory loss produces unpredictable emotions thought and behavior which you can alleviate by resolving all issues peacefully Donrsquot argue correct contradict confront blame or insist

Reminders are rarely kind They tell the patient how disabled they arendashndashover and over again Reminders of the recent past imply ldquoI remember Irsquom okay you donrsquot yoursquore notrdquo Ouch Refer only to the present or the future (If theyrsquore hungry donrsquot inform them they ate an hour ago offer a snack or set a time to eat soon) They may ask the same question repeatedly believing each time is the first Graciously respond as if itrsquos the first time Some days they seem normal but theyrsquore not They live in a different reality Reminders wonrsquot bring them into yours Note For vascular dementia giving clues may help their recall If it doesnrsquot work be kindhellipdonrsquot remind

Ethical dilemmas may occur If for instance the patient thinks a dead spouse is alive and truthful reminders will create sadness what should you do To avoid distress try these ways of kindness 1) distract to another topic or 2) start a fun activity or 3) reminisce about their spouse ldquoI was just thinking about ___ How did you meetrdquo or you might try ldquoHersquos gone for a while Letrsquos take our walk nowrdquo

Open ended questions (ldquoWhere shall we gordquo ldquoWhat do you want to eatweardordquo) are surprisingly complex and create anxiety Give them a simple choice between two items or direct their choice ldquoYou look great in the red blouserdquo

They are scared all the time Each patient reacts differently to fear They may become passive uncooperative hostile angry agitated verbally abusive or physically combative They may even do them all at different times or alternate between them Anxiety may compel them to shadow you (follow everywhere) Anxiety compels them to resist changes in routine even pleasant ones Your goal is to reduce anxiety whenever possible Also they canrsquot remember your reassurances Keep saying them

copy1995 2001 2005 2007 2008 Liz Ayres Alzheimerrsquos Support Group Leader former Caregiver Orange County CA 7

Examples Donrsquot argue Patient ldquoI didnrsquot write this check for $500

Someone at the bank is forging my Donrsquot reason signaturerdquo

Patient ldquoWhat doctorrsquos appointment Therersquos nothing Donrsquot (argue) ldquoWhat Donrsquot be silly The bank wrong with merdquo

wouldnrsquot be forging your signaturerdquo Donrsquot (reason) ldquoYoursquove been seeing the doctor every

DO (respond to feelings) ldquoThatrsquos a scary thoughtrdquo three months for the last two years Itrsquos written (reassure) ldquoIrsquoll make sure they donrsquot do on the calendar and I told you about it yesterday thatrdquo(distract) ldquoWould you help me fold and this morningrdquo the towelsrdquo

DO (short explanation) ldquoItrsquos just a regular checkuprdquo (accept blame) ldquoIrsquom sorry if I forgot to tell yourdquo

Donrsquot remind them that they forget

Donrsquot confront Patient ldquoJoe hasnrsquot called for a long

Patient ldquoNobodyrsquos going to make decisions for me You can go time I hope hersquos okrdquo

Donrsquot

nowhellipand donrsquot come backrdquo

(confront) ldquoIrsquom not going anywhere and you canrsquot remember enough to make your own decisionsrdquo

Donrsquot (remind) ldquoJoe called yesterday and you talked with him for 15 minutesrdquo

DO (accept blame or respond to feelings) ldquoIrsquom sorry this is a tough timerdquo (reassure) ldquoI love you and wersquore going to get through this

togetherrdquo (distract) ldquoYou know what Don has a new job Hersquos really

excited about itrdquo

DO (reassure) ldquoYou really like talking with him donrsquot yourdquo (distract) ldquoLetrsquos call him when we get back from our walkrdquo

Donrsquot take it personally Donrsquot question recent memory Patient ldquoWho are you Wherersquos my

Patient ldquoHello Mary I see yoursquove brought a friend with yourdquo husbandrdquo Donrsquot (question memory) ldquoHi Mom You remember Eric

Donrsquot (take it personally) ldquoWhat do you donrsquot you What did you do todayrdquo mean ndash whorsquos your husbandrdquo I amrdquo

DO (short explanation) ldquoHi Mom You look wonderful DO (go with the flow reassure) ldquoHersquoll

This is Eric We work togetherrdquo be here for dinnerrdquo (distract) ldquoHow about some milk and cookies Would you like chocolate chip or oatmealrdquo

Do repeat exactly Patient ldquoIrsquom going to the store for a newspaperrdquo

Donrsquot (repeat differently) ldquoPlease put your shoes Do eliminate lsquobutrsquo onrdquohellipYoursquoll need to put your shoes onrdquo substitute lsquoneverthelessrsquo

DO (repeat exactly) ldquoPlease put your shoes onrdquohellip Patient ldquoIrsquom not eating this I hate chickenrdquo ldquoPlease put your shoes onrdquo

Donrsquot (say lsquobutrsquo) ldquoI know chickenrsquos not your favorite food but itrsquos what we are having for dinnerrdquo

DO (say lsquoneverthelessrsquo) ldquoI know chickenrsquos not your favorite food (smile) nevertheless Irsquod appreciate it if yoursquod eat a little bitrdquo

If you need suggestions on handling challenging situations call the Alzheimerrsquos Association at 8002723900 8

LIVING AND HOME CARE OPTIONS FOR SENIORS

HOME CARE Home care allows older people to remain in their own homes while receiving the assistance they need to help them remain independent Typically home care involves providing assistance with Activities of Daily Living (ADLs) such as bathing dressing and meal preparation or Instrumental Activities of Daily Living (IADLs) such as transportation paying bills making appointments and simply being there to provide companionship and emotional support Home care services range from once a week to 24 hours a day depending on the needs of the client

Also Known As Home Health Care Home Care Aide In-Home Personal Care

Payment Sources Private Pay MedicareMedicaid via certified home health agencies

Price Range $25 hr and up Resources below

RESPITE CARE ADULT DAY CARE Respite care provides a temporary break for caregivers by allowing a resident to have a short-term stay in a community that can meet their needs Many assisted living communities and nursing homes have a respite care program Residents typically stay from a week to a month depending on their situation They receive all of the services of the community Respite stays may also serve as a get acquainted period for the senior Many residents find that they enjoy their stay and decide to move in soon after the short-term visit Respite programs are available for assisted living and Alzheimers residents Normally adult day care is used to relieve the caregiver or his or her duties for the day while ensuring that the care recipient will still receive the proper care in a safe friendly environment These centers usually operate during normal business hours five days a week and some centers also offer additional services during evenings and weekends In general there are three main types of adult day care centers those that focus primarily on social interaction those that provide medical care and those dedicated to Alzheimerrsquos care Many of these facilities are affiliated with other organizations including home care agencies skilled nursing facilities medical centers or other senior service providers

Also Known As Short-Term Stay Programs Adult Day Care

Payment Sources Private Pay Medicaid

Price Range $75-$150 per day

9

INDEPENDENT LIVING COMMUNITIES Senior independent living communities cater to seniors who are very independent with few medical problems Residents live in fully equipped private apartments A variety of apartment sizes are available from studios to large two bedrooms Fine dining services are offered with custom-designed meal packages Often residents can choose to pay for a specified number of meals per day Frequently there are numerous social outings and events to choose from for entertainment

Also Known As Retirement Communities Congregate Care Retirement Villages 55 + Communities Senior Apartments Continuing Care Retirement Community

Payment Sources Mostly private pay Some US government funded through Section 202

Price Range $1500 and up per month

ASSISTED LIVING Assisted Living communities are designed for seniors who are no longer able to live on their own safely but do not require the high level of care provided in a nursing home Assistance with medications activities of daily living meals and housekeeping are routinely provided Three meals per day are provided in a central dining room Residents live in private apartments which frequently have a limited kitchen area Staff is available 24 hours per day for additional safety Most assisted living communities provide licensed nursing services The hours vary greatly so be sure to ask when you visit Social activities and scheduled transportation are also available in most communities A special unit for Alzheimers residents is available in some but not all communities

Also Known As Assisted Care Community Personal Care Home

Payment Sources bull Mostly private pay Some take Medicaid

Price Range $3000 and up per month depending on the size of apartment and level of assistance required

10

NURSING HOMES Nursing homes provide around-the-clock skilled nursing care for the frail elderly who require a high level of medical care and assistance 24-hour skilled nursing services are available from licensed nurses Many nursing homes now provide short-term rehabilitative stays for those recovering from an injury illness or surgery Long-term care residents generally have high care needs and complex medical conditions that require routine skilled nursing services Residents typically share a room and are served meals in a central dining area unless they are too ill to participate Activities are also available Some facilities have a separate unit for Alzheimers residents

Also Known As Convalescent Care Nursing Center Skilled Nursing Long Term Care Facility

Payment Sources Private Pay Medicare Medicaid

Price Range $8000 and up per month

ALZHEIMERSMEMORY CARE Numerous senior housing options for people with dementia or Alzheimers are available With memory impaired it is important to have 24-hour support and structured activities to ensure their safety and quality of life Many families try to care for their loved ones at home which can be extremely difficult given the skill that is required to care for a person with memory problems If you need to consider a community understand that Alzheimers care is delivered in the assisted living setting as well as in nursing homes and occasionally in personal care homes Generally the residents live in semi-private apartments and have structured activities delivered by trained staff members Most of these living environments have secured or locked areas to ensure no one wanders off Many times within the secured areas residents have access to outdoor walking paths or gardens

Also Known As Memory Care Dementia Care

Payment Sources Private Pay Medicaid

Price Range bull $5000 and up per month

11

RESIDENTIAL CARE HOMES Residential care homes are private homes that typically serve residents who live together and receive care from live-in caretakers These homes offer assisted care services for seniors who want a more private home-like community Assistance with activities of daily living such as bathing and dressing are typically provided Amenities and nursing services vary greatly between homes Ask about their services when you tour

Services Comfortable private or semi-private rooms 1-to-3 daily home cooked meals Housekeeping and laundry service Medication management Social programs and activities Transportation to doctors appointments

Also known as bull Board and Care Homes bull Personal Care Homes bull Adult Family Homes

Payment Sources bull Private Pay bull Medicaid

Price Range bull $2500 and up per month depending on the services and level of care provided

PLACEMENT AGENGIES (For assistance in locating local placements for you or your loved one) Aspire 707-514-6074 ABBA In Home Care 707-704-6489 Advance Care for Seniors 707-685-6705 Alternatives Beginnings 707-732-3651 Care Network 707-747-2720 Helping Hands 707-451-8724 Inspired Senior Living Options 707-327-2773 Serving Seniors 415-987-8151

12

Driving and Dementiaby Charles G Warner

Driving provides independence from others It is the freedom to go where you please when you please If however if you have been diagnosed with Alzheimerrsquos Disease or a related dementia at some point you should stop driving

The Position of the California Department of Motor Vehicles

The California Department of Motor Vehicles (the ldquoDMVrdquo) has specifc rules and regulations for persons who have been diagnosed with Alzheimerrsquos disease Mild Cognitive Impairment and a long list of related conditions andor diseases that might afect onersquos ability to drive [httpswwwdmvcagovportaldriver-education-and-safetymedical-conditions-and-drivingdementia]

How would the DMV know what happened between my physician and me

When your physician diagnoses anyone with Alzheimerrsquos disease he or she is required by law to fle a report with the County Health Department of your county of residence The County Health Department then forwards the report with the diagnosis to the

13

Examples Donrsquot argue Patient ldquoI didnrsquot write this check for $500

Someone at the bank is forging my Donrsquot reason signaturerdquo

Patient ldquoWhat doctorrsquos appointment Therersquos nothing Donrsquot (argue) ldquoWhat Donrsquot be silly The bank wrong with merdquo

wouldnrsquot be forging your signaturerdquo Donrsquot (reason) ldquoYoursquove been seeing the doctor every

DO (respond to feelings) ldquoThatrsquos a scary thoughtrdquo three months for the last two years Itrsquos written (reassure) ldquoIrsquoll make sure they donrsquot do on the calendar and I told you about it yesterday thatrdquo(distract) ldquoWould you help me fold and this morningrdquo the towelsrdquo

DO (short explanation) ldquoItrsquos just a regular checkuprdquo (accept blame) ldquoIrsquom sorry if I forgot to tell yourdquo

Donrsquot remind them that they forget

Donrsquot confront Patient ldquoJoe hasnrsquot called for a long

Patient ldquoNobodyrsquos going to make decisions for me You can go time I hope hersquos okrdquo

Donrsquot

nowhellipand donrsquot come backrdquo

(confront) ldquoIrsquom not going anywhere and you canrsquot remember enough to make your own decisionsrdquo

Donrsquot (remind) ldquoJoe called yesterday and you talked with him for 15 minutesrdquo

DO (accept blame or respond to feelings) ldquoIrsquom sorry this is a tough timerdquo (reassure) ldquoI love you and wersquore going to get through this

togetherrdquo (distract) ldquoYou know what Don has a new job Hersquos really

excited about itrdquo

DO (reassure) ldquoYou really like talking with him donrsquot yourdquo (distract) ldquoLetrsquos call him when we get back from our walkrdquo

Donrsquot take it personally Donrsquot question recent memory Patient ldquoWho are you Wherersquos my

Patient ldquoHello Mary I see yoursquove brought a friend with yourdquo husbandrdquo Donrsquot (question memory) ldquoHi Mom You remember Eric

Donrsquot (take it personally) ldquoWhat do you donrsquot you What did you do todayrdquo mean ndash whorsquos your husbandrdquo I amrdquo

DO (short explanation) ldquoHi Mom You look wonderful DO (go with the flow reassure) ldquoHersquoll

This is Eric We work togetherrdquo be here for dinnerrdquo (distract) ldquoHow about some milk and cookies Would you like chocolate chip or oatmealrdquo

Do repeat exactly Patient ldquoIrsquom going to the store for a newspaperrdquo

Donrsquot (repeat differently) ldquoPlease put your shoes Do eliminate lsquobutrsquo onrdquohellipYoursquoll need to put your shoes onrdquo substitute lsquoneverthelessrsquo

DO (repeat exactly) ldquoPlease put your shoes onrdquohellip Patient ldquoIrsquom not eating this I hate chickenrdquo ldquoPlease put your shoes onrdquo

Donrsquot (say lsquobutrsquo) ldquoI know chickenrsquos not your favorite food but itrsquos what we are having for dinnerrdquo

DO (say lsquoneverthelessrsquo) ldquoI know chickenrsquos not your favorite food (smile) nevertheless Irsquod appreciate it if yoursquod eat a little bitrdquo

If you need suggestions on handling challenging situations call the Alzheimerrsquos Association at 8002723900 8

LIVING AND HOME CARE OPTIONS FOR SENIORS

HOME CARE Home care allows older people to remain in their own homes while receiving the assistance they need to help them remain independent Typically home care involves providing assistance with Activities of Daily Living (ADLs) such as bathing dressing and meal preparation or Instrumental Activities of Daily Living (IADLs) such as transportation paying bills making appointments and simply being there to provide companionship and emotional support Home care services range from once a week to 24 hours a day depending on the needs of the client

Also Known As Home Health Care Home Care Aide In-Home Personal Care

Payment Sources Private Pay MedicareMedicaid via certified home health agencies

Price Range $25 hr and up Resources below

RESPITE CARE ADULT DAY CARE Respite care provides a temporary break for caregivers by allowing a resident to have a short-term stay in a community that can meet their needs Many assisted living communities and nursing homes have a respite care program Residents typically stay from a week to a month depending on their situation They receive all of the services of the community Respite stays may also serve as a get acquainted period for the senior Many residents find that they enjoy their stay and decide to move in soon after the short-term visit Respite programs are available for assisted living and Alzheimers residents Normally adult day care is used to relieve the caregiver or his or her duties for the day while ensuring that the care recipient will still receive the proper care in a safe friendly environment These centers usually operate during normal business hours five days a week and some centers also offer additional services during evenings and weekends In general there are three main types of adult day care centers those that focus primarily on social interaction those that provide medical care and those dedicated to Alzheimerrsquos care Many of these facilities are affiliated with other organizations including home care agencies skilled nursing facilities medical centers or other senior service providers

Also Known As Short-Term Stay Programs Adult Day Care

Payment Sources Private Pay Medicaid

Price Range $75-$150 per day

9

INDEPENDENT LIVING COMMUNITIES Senior independent living communities cater to seniors who are very independent with few medical problems Residents live in fully equipped private apartments A variety of apartment sizes are available from studios to large two bedrooms Fine dining services are offered with custom-designed meal packages Often residents can choose to pay for a specified number of meals per day Frequently there are numerous social outings and events to choose from for entertainment

Also Known As Retirement Communities Congregate Care Retirement Villages 55 + Communities Senior Apartments Continuing Care Retirement Community

Payment Sources Mostly private pay Some US government funded through Section 202

Price Range $1500 and up per month

ASSISTED LIVING Assisted Living communities are designed for seniors who are no longer able to live on their own safely but do not require the high level of care provided in a nursing home Assistance with medications activities of daily living meals and housekeeping are routinely provided Three meals per day are provided in a central dining room Residents live in private apartments which frequently have a limited kitchen area Staff is available 24 hours per day for additional safety Most assisted living communities provide licensed nursing services The hours vary greatly so be sure to ask when you visit Social activities and scheduled transportation are also available in most communities A special unit for Alzheimers residents is available in some but not all communities

Also Known As Assisted Care Community Personal Care Home

Payment Sources bull Mostly private pay Some take Medicaid

Price Range $3000 and up per month depending on the size of apartment and level of assistance required

10

NURSING HOMES Nursing homes provide around-the-clock skilled nursing care for the frail elderly who require a high level of medical care and assistance 24-hour skilled nursing services are available from licensed nurses Many nursing homes now provide short-term rehabilitative stays for those recovering from an injury illness or surgery Long-term care residents generally have high care needs and complex medical conditions that require routine skilled nursing services Residents typically share a room and are served meals in a central dining area unless they are too ill to participate Activities are also available Some facilities have a separate unit for Alzheimers residents

Also Known As Convalescent Care Nursing Center Skilled Nursing Long Term Care Facility

Payment Sources Private Pay Medicare Medicaid

Price Range $8000 and up per month

ALZHEIMERSMEMORY CARE Numerous senior housing options for people with dementia or Alzheimers are available With memory impaired it is important to have 24-hour support and structured activities to ensure their safety and quality of life Many families try to care for their loved ones at home which can be extremely difficult given the skill that is required to care for a person with memory problems If you need to consider a community understand that Alzheimers care is delivered in the assisted living setting as well as in nursing homes and occasionally in personal care homes Generally the residents live in semi-private apartments and have structured activities delivered by trained staff members Most of these living environments have secured or locked areas to ensure no one wanders off Many times within the secured areas residents have access to outdoor walking paths or gardens

Also Known As Memory Care Dementia Care

Payment Sources Private Pay Medicaid

Price Range bull $5000 and up per month

11

RESIDENTIAL CARE HOMES Residential care homes are private homes that typically serve residents who live together and receive care from live-in caretakers These homes offer assisted care services for seniors who want a more private home-like community Assistance with activities of daily living such as bathing and dressing are typically provided Amenities and nursing services vary greatly between homes Ask about their services when you tour

Services Comfortable private or semi-private rooms 1-to-3 daily home cooked meals Housekeeping and laundry service Medication management Social programs and activities Transportation to doctors appointments

Also known as bull Board and Care Homes bull Personal Care Homes bull Adult Family Homes

Payment Sources bull Private Pay bull Medicaid

Price Range bull $2500 and up per month depending on the services and level of care provided

PLACEMENT AGENGIES (For assistance in locating local placements for you or your loved one) Aspire 707-514-6074 ABBA In Home Care 707-704-6489 Advance Care for Seniors 707-685-6705 Alternatives Beginnings 707-732-3651 Care Network 707-747-2720 Helping Hands 707-451-8724 Inspired Senior Living Options 707-327-2773 Serving Seniors 415-987-8151

12

Driving and Dementiaby Charles G Warner

Driving provides independence from others It is the freedom to go where you please when you please If however if you have been diagnosed with Alzheimerrsquos Disease or a related dementia at some point you should stop driving

The Position of the California Department of Motor Vehicles

The California Department of Motor Vehicles (the ldquoDMVrdquo) has specifc rules and regulations for persons who have been diagnosed with Alzheimerrsquos disease Mild Cognitive Impairment and a long list of related conditions andor diseases that might afect onersquos ability to drive [httpswwwdmvcagovportaldriver-education-and-safetymedical-conditions-and-drivingdementia]

How would the DMV know what happened between my physician and me

When your physician diagnoses anyone with Alzheimerrsquos disease he or she is required by law to fle a report with the County Health Department of your county of residence The County Health Department then forwards the report with the diagnosis to the

13

LIVING AND HOME CARE OPTIONS FOR SENIORS

HOME CARE Home care allows older people to remain in their own homes while receiving the assistance they need to help them remain independent Typically home care involves providing assistance with Activities of Daily Living (ADLs) such as bathing dressing and meal preparation or Instrumental Activities of Daily Living (IADLs) such as transportation paying bills making appointments and simply being there to provide companionship and emotional support Home care services range from once a week to 24 hours a day depending on the needs of the client

Also Known As Home Health Care Home Care Aide In-Home Personal Care

Payment Sources Private Pay MedicareMedicaid via certified home health agencies

Price Range $25 hr and up Resources below

RESPITE CARE ADULT DAY CARE Respite care provides a temporary break for caregivers by allowing a resident to have a short-term stay in a community that can meet their needs Many assisted living communities and nursing homes have a respite care program Residents typically stay from a week to a month depending on their situation They receive all of the services of the community Respite stays may also serve as a get acquainted period for the senior Many residents find that they enjoy their stay and decide to move in soon after the short-term visit Respite programs are available for assisted living and Alzheimers residents Normally adult day care is used to relieve the caregiver or his or her duties for the day while ensuring that the care recipient will still receive the proper care in a safe friendly environment These centers usually operate during normal business hours five days a week and some centers also offer additional services during evenings and weekends In general there are three main types of adult day care centers those that focus primarily on social interaction those that provide medical care and those dedicated to Alzheimerrsquos care Many of these facilities are affiliated with other organizations including home care agencies skilled nursing facilities medical centers or other senior service providers

Also Known As Short-Term Stay Programs Adult Day Care

Payment Sources Private Pay Medicaid

Price Range $75-$150 per day

9

INDEPENDENT LIVING COMMUNITIES Senior independent living communities cater to seniors who are very independent with few medical problems Residents live in fully equipped private apartments A variety of apartment sizes are available from studios to large two bedrooms Fine dining services are offered with custom-designed meal packages Often residents can choose to pay for a specified number of meals per day Frequently there are numerous social outings and events to choose from for entertainment

Also Known As Retirement Communities Congregate Care Retirement Villages 55 + Communities Senior Apartments Continuing Care Retirement Community

Payment Sources Mostly private pay Some US government funded through Section 202

Price Range $1500 and up per month

ASSISTED LIVING Assisted Living communities are designed for seniors who are no longer able to live on their own safely but do not require the high level of care provided in a nursing home Assistance with medications activities of daily living meals and housekeeping are routinely provided Three meals per day are provided in a central dining room Residents live in private apartments which frequently have a limited kitchen area Staff is available 24 hours per day for additional safety Most assisted living communities provide licensed nursing services The hours vary greatly so be sure to ask when you visit Social activities and scheduled transportation are also available in most communities A special unit for Alzheimers residents is available in some but not all communities

Also Known As Assisted Care Community Personal Care Home

Payment Sources bull Mostly private pay Some take Medicaid

Price Range $3000 and up per month depending on the size of apartment and level of assistance required

10

NURSING HOMES Nursing homes provide around-the-clock skilled nursing care for the frail elderly who require a high level of medical care and assistance 24-hour skilled nursing services are available from licensed nurses Many nursing homes now provide short-term rehabilitative stays for those recovering from an injury illness or surgery Long-term care residents generally have high care needs and complex medical conditions that require routine skilled nursing services Residents typically share a room and are served meals in a central dining area unless they are too ill to participate Activities are also available Some facilities have a separate unit for Alzheimers residents

Also Known As Convalescent Care Nursing Center Skilled Nursing Long Term Care Facility

Payment Sources Private Pay Medicare Medicaid

Price Range $8000 and up per month

ALZHEIMERSMEMORY CARE Numerous senior housing options for people with dementia or Alzheimers are available With memory impaired it is important to have 24-hour support and structured activities to ensure their safety and quality of life Many families try to care for their loved ones at home which can be extremely difficult given the skill that is required to care for a person with memory problems If you need to consider a community understand that Alzheimers care is delivered in the assisted living setting as well as in nursing homes and occasionally in personal care homes Generally the residents live in semi-private apartments and have structured activities delivered by trained staff members Most of these living environments have secured or locked areas to ensure no one wanders off Many times within the secured areas residents have access to outdoor walking paths or gardens

Also Known As Memory Care Dementia Care

Payment Sources Private Pay Medicaid

Price Range bull $5000 and up per month

11

RESIDENTIAL CARE HOMES Residential care homes are private homes that typically serve residents who live together and receive care from live-in caretakers These homes offer assisted care services for seniors who want a more private home-like community Assistance with activities of daily living such as bathing and dressing are typically provided Amenities and nursing services vary greatly between homes Ask about their services when you tour

Services Comfortable private or semi-private rooms 1-to-3 daily home cooked meals Housekeeping and laundry service Medication management Social programs and activities Transportation to doctors appointments

Also known as bull Board and Care Homes bull Personal Care Homes bull Adult Family Homes

Payment Sources bull Private Pay bull Medicaid

Price Range bull $2500 and up per month depending on the services and level of care provided

PLACEMENT AGENGIES (For assistance in locating local placements for you or your loved one) Aspire 707-514-6074 ABBA In Home Care 707-704-6489 Advance Care for Seniors 707-685-6705 Alternatives Beginnings 707-732-3651 Care Network 707-747-2720 Helping Hands 707-451-8724 Inspired Senior Living Options 707-327-2773 Serving Seniors 415-987-8151

12

Driving and Dementiaby Charles G Warner

Driving provides independence from others It is the freedom to go where you please when you please If however if you have been diagnosed with Alzheimerrsquos Disease or a related dementia at some point you should stop driving

The Position of the California Department of Motor Vehicles

The California Department of Motor Vehicles (the ldquoDMVrdquo) has specifc rules and regulations for persons who have been diagnosed with Alzheimerrsquos disease Mild Cognitive Impairment and a long list of related conditions andor diseases that might afect onersquos ability to drive [httpswwwdmvcagovportaldriver-education-and-safetymedical-conditions-and-drivingdementia]

How would the DMV know what happened between my physician and me

When your physician diagnoses anyone with Alzheimerrsquos disease he or she is required by law to fle a report with the County Health Department of your county of residence The County Health Department then forwards the report with the diagnosis to the

13

INDEPENDENT LIVING COMMUNITIES Senior independent living communities cater to seniors who are very independent with few medical problems Residents live in fully equipped private apartments A variety of apartment sizes are available from studios to large two bedrooms Fine dining services are offered with custom-designed meal packages Often residents can choose to pay for a specified number of meals per day Frequently there are numerous social outings and events to choose from for entertainment

Also Known As Retirement Communities Congregate Care Retirement Villages 55 + Communities Senior Apartments Continuing Care Retirement Community

Payment Sources Mostly private pay Some US government funded through Section 202

Price Range $1500 and up per month

ASSISTED LIVING Assisted Living communities are designed for seniors who are no longer able to live on their own safely but do not require the high level of care provided in a nursing home Assistance with medications activities of daily living meals and housekeeping are routinely provided Three meals per day are provided in a central dining room Residents live in private apartments which frequently have a limited kitchen area Staff is available 24 hours per day for additional safety Most assisted living communities provide licensed nursing services The hours vary greatly so be sure to ask when you visit Social activities and scheduled transportation are also available in most communities A special unit for Alzheimers residents is available in some but not all communities

Also Known As Assisted Care Community Personal Care Home

Payment Sources bull Mostly private pay Some take Medicaid

Price Range $3000 and up per month depending on the size of apartment and level of assistance required

10

NURSING HOMES Nursing homes provide around-the-clock skilled nursing care for the frail elderly who require a high level of medical care and assistance 24-hour skilled nursing services are available from licensed nurses Many nursing homes now provide short-term rehabilitative stays for those recovering from an injury illness or surgery Long-term care residents generally have high care needs and complex medical conditions that require routine skilled nursing services Residents typically share a room and are served meals in a central dining area unless they are too ill to participate Activities are also available Some facilities have a separate unit for Alzheimers residents

Also Known As Convalescent Care Nursing Center Skilled Nursing Long Term Care Facility

Payment Sources Private Pay Medicare Medicaid

Price Range $8000 and up per month

ALZHEIMERSMEMORY CARE Numerous senior housing options for people with dementia or Alzheimers are available With memory impaired it is important to have 24-hour support and structured activities to ensure their safety and quality of life Many families try to care for their loved ones at home which can be extremely difficult given the skill that is required to care for a person with memory problems If you need to consider a community understand that Alzheimers care is delivered in the assisted living setting as well as in nursing homes and occasionally in personal care homes Generally the residents live in semi-private apartments and have structured activities delivered by trained staff members Most of these living environments have secured or locked areas to ensure no one wanders off Many times within the secured areas residents have access to outdoor walking paths or gardens

Also Known As Memory Care Dementia Care

Payment Sources Private Pay Medicaid

Price Range bull $5000 and up per month

11

RESIDENTIAL CARE HOMES Residential care homes are private homes that typically serve residents who live together and receive care from live-in caretakers These homes offer assisted care services for seniors who want a more private home-like community Assistance with activities of daily living such as bathing and dressing are typically provided Amenities and nursing services vary greatly between homes Ask about their services when you tour

Services Comfortable private or semi-private rooms 1-to-3 daily home cooked meals Housekeeping and laundry service Medication management Social programs and activities Transportation to doctors appointments

Also known as bull Board and Care Homes bull Personal Care Homes bull Adult Family Homes

Payment Sources bull Private Pay bull Medicaid

Price Range bull $2500 and up per month depending on the services and level of care provided

PLACEMENT AGENGIES (For assistance in locating local placements for you or your loved one) Aspire 707-514-6074 ABBA In Home Care 707-704-6489 Advance Care for Seniors 707-685-6705 Alternatives Beginnings 707-732-3651 Care Network 707-747-2720 Helping Hands 707-451-8724 Inspired Senior Living Options 707-327-2773 Serving Seniors 415-987-8151

12

Driving and Dementiaby Charles G Warner

Driving provides independence from others It is the freedom to go where you please when you please If however if you have been diagnosed with Alzheimerrsquos Disease or a related dementia at some point you should stop driving

The Position of the California Department of Motor Vehicles

The California Department of Motor Vehicles (the ldquoDMVrdquo) has specifc rules and regulations for persons who have been diagnosed with Alzheimerrsquos disease Mild Cognitive Impairment and a long list of related conditions andor diseases that might afect onersquos ability to drive [httpswwwdmvcagovportaldriver-education-and-safetymedical-conditions-and-drivingdementia]

How would the DMV know what happened between my physician and me

When your physician diagnoses anyone with Alzheimerrsquos disease he or she is required by law to fle a report with the County Health Department of your county of residence The County Health Department then forwards the report with the diagnosis to the

13

NURSING HOMES Nursing homes provide around-the-clock skilled nursing care for the frail elderly who require a high level of medical care and assistance 24-hour skilled nursing services are available from licensed nurses Many nursing homes now provide short-term rehabilitative stays for those recovering from an injury illness or surgery Long-term care residents generally have high care needs and complex medical conditions that require routine skilled nursing services Residents typically share a room and are served meals in a central dining area unless they are too ill to participate Activities are also available Some facilities have a separate unit for Alzheimers residents

Also Known As Convalescent Care Nursing Center Skilled Nursing Long Term Care Facility

Payment Sources Private Pay Medicare Medicaid

Price Range $8000 and up per month

ALZHEIMERSMEMORY CARE Numerous senior housing options for people with dementia or Alzheimers are available With memory impaired it is important to have 24-hour support and structured activities to ensure their safety and quality of life Many families try to care for their loved ones at home which can be extremely difficult given the skill that is required to care for a person with memory problems If you need to consider a community understand that Alzheimers care is delivered in the assisted living setting as well as in nursing homes and occasionally in personal care homes Generally the residents live in semi-private apartments and have structured activities delivered by trained staff members Most of these living environments have secured or locked areas to ensure no one wanders off Many times within the secured areas residents have access to outdoor walking paths or gardens

Also Known As Memory Care Dementia Care

Payment Sources Private Pay Medicaid

Price Range bull $5000 and up per month

11

RESIDENTIAL CARE HOMES Residential care homes are private homes that typically serve residents who live together and receive care from live-in caretakers These homes offer assisted care services for seniors who want a more private home-like community Assistance with activities of daily living such as bathing and dressing are typically provided Amenities and nursing services vary greatly between homes Ask about their services when you tour

Services Comfortable private or semi-private rooms 1-to-3 daily home cooked meals Housekeeping and laundry service Medication management Social programs and activities Transportation to doctors appointments

Also known as bull Board and Care Homes bull Personal Care Homes bull Adult Family Homes

Payment Sources bull Private Pay bull Medicaid

Price Range bull $2500 and up per month depending on the services and level of care provided

PLACEMENT AGENGIES (For assistance in locating local placements for you or your loved one) Aspire 707-514-6074 ABBA In Home Care 707-704-6489 Advance Care for Seniors 707-685-6705 Alternatives Beginnings 707-732-3651 Care Network 707-747-2720 Helping Hands 707-451-8724 Inspired Senior Living Options 707-327-2773 Serving Seniors 415-987-8151

12

Driving and Dementiaby Charles G Warner

Driving provides independence from others It is the freedom to go where you please when you please If however if you have been diagnosed with Alzheimerrsquos Disease or a related dementia at some point you should stop driving

The Position of the California Department of Motor Vehicles

The California Department of Motor Vehicles (the ldquoDMVrdquo) has specifc rules and regulations for persons who have been diagnosed with Alzheimerrsquos disease Mild Cognitive Impairment and a long list of related conditions andor diseases that might afect onersquos ability to drive [httpswwwdmvcagovportaldriver-education-and-safetymedical-conditions-and-drivingdementia]

How would the DMV know what happened between my physician and me

When your physician diagnoses anyone with Alzheimerrsquos disease he or she is required by law to fle a report with the County Health Department of your county of residence The County Health Department then forwards the report with the diagnosis to the

13

RESIDENTIAL CARE HOMES Residential care homes are private homes that typically serve residents who live together and receive care from live-in caretakers These homes offer assisted care services for seniors who want a more private home-like community Assistance with activities of daily living such as bathing and dressing are typically provided Amenities and nursing services vary greatly between homes Ask about their services when you tour

Services Comfortable private or semi-private rooms 1-to-3 daily home cooked meals Housekeeping and laundry service Medication management Social programs and activities Transportation to doctors appointments

Also known as bull Board and Care Homes bull Personal Care Homes bull Adult Family Homes

Payment Sources bull Private Pay bull Medicaid

Price Range bull $2500 and up per month depending on the services and level of care provided

PLACEMENT AGENGIES (For assistance in locating local placements for you or your loved one) Aspire 707-514-6074 ABBA In Home Care 707-704-6489 Advance Care for Seniors 707-685-6705 Alternatives Beginnings 707-732-3651 Care Network 707-747-2720 Helping Hands 707-451-8724 Inspired Senior Living Options 707-327-2773 Serving Seniors 415-987-8151

12

Driving and Dementiaby Charles G Warner

Driving provides independence from others It is the freedom to go where you please when you please If however if you have been diagnosed with Alzheimerrsquos Disease or a related dementia at some point you should stop driving

The Position of the California Department of Motor Vehicles

The California Department of Motor Vehicles (the ldquoDMVrdquo) has specifc rules and regulations for persons who have been diagnosed with Alzheimerrsquos disease Mild Cognitive Impairment and a long list of related conditions andor diseases that might afect onersquos ability to drive [httpswwwdmvcagovportaldriver-education-and-safetymedical-conditions-and-drivingdementia]

How would the DMV know what happened between my physician and me

When your physician diagnoses anyone with Alzheimerrsquos disease he or she is required by law to fle a report with the County Health Department of your county of residence The County Health Department then forwards the report with the diagnosis to the

13