We Need Health Care Reform

Check out this article I wrote, just to let off some steam over the battle to prevent health care reform. I feel that information about hospice and advanced directives is extremely important and here is why:
Death Panel Madness

Take Charge of Your Heatlh

According to AARP writer Mary A Fisher until the mid 20th century more people died of infectious diseases such as diphtheria, polio, meningitis and polio. Now chronic diseases such as diabetes and cardio-vascular disease are killing people and most insurance companies and doctors don't know how to shift the model of care to address needs for improved diet, smoking cessation and exercise to address these conditions. Exceptions are the Chronic Disease Managment Programs first nationally adopted by Kaiser permante in 1998 and spreading throughout the country.Check out this article at: Take Charge of Your Health and nurse Kate Lorig's story and book.

Glasses to help watch television

Seniors and others with low vision may be interested in this video that described two types of special glasses to improve distance vision to watch TV. The Max TV glasses can be adjusted for varied focal distances and provide a larger visual field, the mounted spectacles are stronger, but the visual field will be smaller. Which to use can be determined by severity of acuity loss and doctor recommendation.

Budget-Friendly Exercise Tools for Seniors

Check out these Budget-Friendly Exercise Tools for Seniors written about by Jane Sorensen, PhD, OTR, ND in Advance for Occupational Therapists. I especially like the Chinese hand balls to strengthen hands. Her point, well taken is that with cuts to Medicare, seniors need to look for low cost activities that help keep them fit and active.
BarbaraSmithOccupationalTherapist.com

Sensory gifts

During the late stages of Alzheimer's disease my mother enjoyed listening to music and holding sensory objects. She particularly enjoyed objects that vibrated or were heavy, cuddly or made sounds. Here are suggestions for objects that might make nice gifts:

1. The baby water mat shown at the bottom of this blog. My mother enjoyed the feel of this on her lap.
2. A massaging/vibrating pillow, snake or massager that fits inside the hand.
3. Holiday cards that played music when opened up.
4. Beanie Babies
5. Koosh balls
6. Fidget toys like a chain of Links
7. Stuffed animals that made sounds when squeezed
8. Soft pieces of fabric tied together to fidget with
9. Socks filled with sand or pennies, packing peanuts, marbles. Sew the ends closed.
10. Plastic plants
    

Pilates Training

Here's a nice article:
Pilate Exercises

Strength Training

I started using the weight room at my YMCA after the doctor said I am beginning to have early signs of osteoporosis. From talking to friends this seems to be a common concern after menopause. Although I already roller skate, hike, bike and swim I decided that I needed weight bearing exercises. So after 3 months- I am definitely stronger but have aches and pains I didn't know were waiting to be discovered. I just finished reading the book Strength Training for Seniors- looking for some tips on how to do things better. My goal is not to change my appearance but to have stronger bones. This book would make a nice gift for an older friend or relative who is not used to exercising and/or has some medical issues such as obesity, arthritis or high blood pressure. The author does a nice job of explaining why strength training is important, the relationship between good nutrition and strength, principles of strength training such as how to keep it safe, frequency, intensity, duration, how to select an exercise and pace of progression. The specific exercises look fairly easy for a beginner with exercises done while seated, using the wall, a bench or ball. I personally like the ball the best for home exercises and if I feel lazy just lie on it to stretch and relax.

I purchased my ball at Target a while back and think it was less than 20 dollars. It is not super strong but I don't really abuse it much so it has lasted several years. There are much stronger balls sold in therapy catalogs and websites but they can be quite expensive.


I recently began taking a yoga class to become more flexible and hopefully get rid of the aches and pains just mentioned. I was very surprised that I was able to lie on my back and slowly lower my legs to the floor-a demonstration that my abdominals had strengthened from time in the gym. Aside from that, the yoga class was a lot of fun.
BarbaraSmithOccupationalTherapist.com

Environmental Adaptations

There are many books (including my own) that describe in detail ways to adapt the environment to make a person with Alzheimer's disease more independent and less agitated. Here are 10 simple tips:

1. Use visual cues to guide where the person needs to go. For example, leave the bathroom door slightly open with a big bright picture and printed word "Toilet" on the door. Keep the path clear and easy to walk to with a night light on.
   
2. Do the opposite to discourage going places- such as keeping the door to the basement a color that blends in with the walls. Consider blocking it with furniture
   
3. Provide simple labels or signs such as "Use soap" near the soap dish and label dresser draws with "shirts" or " underwear".
4. Remove remote controls and most technology that is just confusing and frustrating.
5. Use a large number, simple phone and set number 1 to call a helper. Add a sign next to the phone that says "Press number one to call ________"
6. Set the television to the person's favorite station. Cover the button that changes stations with brown tape. Highlight the button that turns the TV on and off with bright orange nail polish.
   
7. Disconnect the stove and microwave if the person cannot safely use them and fill the refrigerator with prepared cut up vegetables and fruits, cheeses, sandwiches and other finger foods.
   
8. Provide a digital clock with date, day of week and time. Some people obsess over this information and then you can just tell them to check the clock.
   
9. Remove clutter
10. Avoid glare that may contribute to faulty visual perceptions. Use curtains that let in some light, but not enough to cause glare or blinds that can be adjusted according to the outdoor lighting. Position the television so that light does not shine on it. Special low vision lamps are designed to decrease glare. Add lots of good overhead and table lighting.

Visit my Vision Resources page

I'm Still Here Amazon Book Review

I finished reading I'm Still Here by John Zeisel. I heard of this book and the Alzheimer's and Arts program he runs after attending a conference last month. I have mixed reactions because I don't agree with a lot of what he says in terms of people with Alzheimer's being more receptive to art because of their brain changes. Many people are not even interested in art. My mother in law couldn't have cared less but would have enjoyed stimulation related to farming and gardening. In fact, when we visited her we always put on a show watering plants and picking flowers to show her. Every individual responds to stimuli that is meaningful to them. A former tennis star may love batting a balloon around. My mother enjoyed our trips to the North Shore Music Theater until taking her to the bathroom was too difficult for me. Then we spent our time together singing and eventually me singing, her smiling.
I do think that Zeisel did a good job explaining how to set up the environment and behavioral techniques designed to prevent or reduce agitation.
Amazon Book Review
Here is the book. I'm happy to hear other opinions.

Make an Activity Book for Loved ones with Alzheimers

My continuing education course at Salem State College was canceled due to low enrollment. I was looking forward to sharing activity ideas with caregivers. The best activity I made for my mother was an activity book because during the early stages of the disease, when she could still read she loved flipping through the pages of a book all about her life. It included:

• The Story of Sarah Smith made with scanned pictures from her early life and more digital pictures put together to tell the simple highlights of her life.
• Large print songs to sing over and over again
• Simple pictures with captions or brief description
• Nursery rhymes
• Ben Franklyn Adages
• Descriptions of her favorite recipes and foods
• Yiddish words

Creating an individualized, meaningful book such as this for a loved one may be the most appreciated holiday gift for a loved one with memory impairment.

ArtistsFor Alzheimers

There was a presentation at the recent Alzheimer's Partnership Conference I went to in Peabody, Mass-by Artists for Alzheimers - an organization that promotes art, music and theater to help victims of Alzheimer's. The concept is fascinating although I don't understand how anybody can say that abilities to enjoy the arts does not diminish. My mother absolutely lost the ability to understand what she was seeing and spent more and more time with her eyes closed. The circus would have terrified her as did the costumed door man at the Magic Show. However, music remained powerful and much appreciated up until the end.
John Zeisel the president of Hearthstone Alzheimer Care developed the Artists for Alzheimer’s™ program, which involves guided museum tours for people with the disease. Check out his blog with a video demonstration of how a troupe of actors interact and stimulate the residents: I'm Still Here
I think that it is wonderful that the residents are receiving this great stimulation but does it really take professional actors, trained museum guides, etc.? I have found that people in institutions simply crave attention, interaction, the human touch and often times looking at family photos, hearing familiar songs from their youth and being amongst lively people is all that they need to come alive. However, I ordered Dr. Zeisel's book to check out.

Barbara

The Driving Dilemma

I enjoyed the Alzheimer's Partnership conference yesterday. Elizabeth Dugan, author of The Driving Dilemma shared some very scary photographs of accidents caused by elders and discussed the types of assessments available to determine driver safety. Testing assesses the person's vision, cognitive and mobility abilities needed to quickly respond to driving demands. States greatly vary in regulations related to who is responsible to report a dangerous driver.
My own mother's doctor reported her early stage Alzheimers to the Dept. of Motor Vehicles. They suspended her license but that didn't stop her from driving. I called the police near her home in Connecticut and they wouldn't do anything unless she was caught in the act of driving. The transition between respecting the person's rights and taking them away is the most emotionally wrenching stage of the disease. Fortunately, after my husband disabled her car, she forgot about the whole issue and my sister moved it to her own back yard. Technically- did my sister steal? Good material for an ethics class.


Resources:
The Driving Dilemma
Caring and Driving
SeniorDrivers.org
ITN America(transportation alternatives)
thehartford.com/alzheimers/
Driver Rehabilitation Specialists

Multi-Sensory Rooms

I used to bring clients with developmental disabilities into a multi-sensory room such as this when I worked at Hogan Regional Center in Danvers, Massachusetts. I think they can also be helpful for patients in the later stages of dementia who get agitated and need to relax. However, therapists need to think about whether the patients may or may not benefit more from social and movement activities that are familiar, feel purposeful and expend energy. Also, sitting in this room may just put patients to sleep, something they already get plenty of in an institutional setting.

93 year old mom helps little old lady cross the road

I love this "mom" story-
http://otinpublicschools.blogspot.com/2009/02/its-still-christmas-at-my-house.html

Barbara
BarbaraSmithOccupationalTherapist.com

Activities for a Healthy Brain

Will keeping this blog keep my brain healthy? Watch this video about activities to keep your brain young.

Northshore Alzheimer's Partnership Conference

I hope to attend this conference given by Norshore Alzheimer's Partnership in Peabody, Massachusetts on November 7, 2009. I think the lecture about driving and the elderly sounds very interesting. I will be sharing what I learn.....
BarbaraSmithOccupationalTherapist.com

Salem State College Course for Caregivers

I am scheduled to teach this course at Salem State College.
However, it may be canceled due to low enrollment. Please pass this information to anyone whom you think would benefit.
Course Title:
Alzheimer's: A Caregiver's Journey
Course Number: NCHR 314
Where: Salem State College
When: Saturday, November 14, 2009 from 9:00 a.m. to 1:00 p.m.
Call for information; (978) 542-6000

The focus of this session is to share information and provide support for those who are dealing with this disease. You will learn how to relate to the Alzheimer's victim in meaningful and enjoyable ways. Topics will include: Normal memory loss, chooing an adult day care center, home care services or residential facility, legal considerations, ways to integrate cultural identity into the victim's life and care for the caregiver. Related information and resources are provided in the instructor's book and on her web site at: Barbarasmithoccupationaltherapist.com. You will leave this class with a copy of the book: Still Giving Kisses: A guide to Helping and Enjoying the Alzheimer's Victim You Love as well as an understanding of how Alzheimer's disease is diagnosed, its progression and ideas on how to help the person maintain independence and functional skills, as well as many handouts.

Birdwatching with the Alzheimer's Patient

I love this video. It shows how a daughter took a simple and familiar activity that her mother always enjoyed and was able to continue to offer it with some adaptations as they picnicked in the car, watching birds. We all have histories of favorite recreational past times that can be incorporated into activities that are shared and enjoyed with loved ones.
Barbarasmithoccupationaltherapist.com

Occupational Therapy with Clients with Dementia

This week's Practice magazine from the American Occupational Therapy Association has a good article titled Occupational therapy for Clients with Dementia. Monica Heltemes describes the role of OT's in assisted living facilities- since AL is such a fast growing long- term care option for seniors. Residents with dementia and psychiatric disorders are common in ALFs. My mom moved into an ALF with a memory impairmment side when she was in the early stges of Alzheimer's disease. According to the author, the role of OT's is to:

• Perform an evaluation including the Allen cognitive Assessment
• Identify the best ability to function
• Create a plan to maximize and maintain function and safety
• Analyze the triggers of behavior issues and implement strategies to minimize them.
• Provide caregiver education
  
• Provide recommendations regarding the client's driving status

OT services for persons with dementia are covered by Medicare and this may include determining the need for and training to use assistive devices. Heltemes recommends use of the Cognitive Performance Test (CPT).
The article goes on to describe treatment interventions and gives case studies. I was lucky that the staff of the ALF where my mom lived was fantastic at addressing all of these needs. However, it was when she moved int a nursing home - when OT input would have been extremely valuable in addressing her emotional, sensory and behavioral needs during the late stages of the disease. The only therapeutic input I observed was when I complained about her positioning in a recliner where her feet and arms were often hanging off the sides and to evaluate dining and food texture needs.
Barbarasmithoccupationaltherapist.com

Roller Skating is Great for the Brain and Body

I skate Tuesday mornings in an all adult session with people who are are on the older side 60-70 years of age, a few in their 80's and few younger than 50. I am right there in the middle at age 55 and just started dance skating five years ago. I loved skating around the block when I was a little kid with those clumsy metal skates that fit over my shoes and the key that tightened them in place. But skating around the block was about all I did.
Learning a new motor skill such as roller skating really keeps the brain working. I used to fall a lot, like every couple of minutes- its just part of the learning. I wear knee pads and wrist guards since I fall on those body parts the most. Skating is not for everyone but I like how it makes me feel like I am back in the 60's buggying at a rock concert. I hope that wherever I am living when I reach my 80's- they play the Beatles.

Yoga and the Elderly

Paying for a yoga class would be a wonderful holiday gift to give any loved one but especially an older relative. Yoga contributes to healthy bones, balance, mental health and overall strength and flexibility.
There are lots of books available on this topic. I like this one because it has chapters on arthritis, hip replacement surgery, Parkinson's disease, healthy hears and memory impairment.


I also like Peggy Gardiner's book Yoga at the Kitchen Sink. Written from an occupational therapist's perspective. More information at:
Email:
Peggy.gardiner@gmail.com
Here is a good laught!

Visual Stimulation and Alzheimer's Disease

During the early stages when my mother was becoming less active and less able to hold a conversation- she still enjoyed looking at photographs, watching videos of her favorite musicals such as Fiddler on the Roof and looking at interesting visual objects such as an aquarium.
As the disease progressed-she was unable to enjoy actually looking at objects because she had her eyes closed more and more. Whatever she did look at, I needed to hold in front of her face and encourage her to open her eyes. However, when she was still able to look around her nursing home room, I bought and positioned an artificial aquarium near her bed. She enjoyed that for a while until she stopped attending to nearby objects. This fake aquarium is electric and has moving bubbles and fish. I bought mine at CVS for about 12 dollars.

Barbara
Barbarasmithoccupationaltherapist.com
Between now and New Years I am going to focus on objects, services and activities that one might purchase or provide as a holiday gift for a person with memory impairment. If you have one that you find particularly useful-please describe it on my blog.
FYI, I just saw the movie Julie and Julia, loved it and just like the character Julia-would love to know if anyone in the blogosphere is reading this.

Another Country: Navigating the Emotional Terrain of Our Elders

I am reading Another Country; Navigating the Emotional Terrain of our Elders by Mary Pipher. I had heard of her before when she wrote the book about daughters. But since I only have a son did not give her books much thought. Another Country was mentioned in an occupational therapy article and was published in 1999, so as usual I am behind the times. I thought that it would be really depressing, but she is such a good writer that I am able read a little bit each day and think about her ideas.

Mary Pipher points out how each generation differs in values and ways of thinking and that baby boomers became all me me me whereas the World War II generation was forced to accept poverty, be willing to compromise and create their own fun rather than depend on the television. Actually I like the change that came with educational and career options for women and the fact that I didn't have the full time job of caring for my mother when she had alzheimer's disease for 8 years.
But I do wish I had the support of a large family instead of being the only one in my mother's life who loved her. My sister lived far away and like so many adult children couldn't cope with the dementia and avoided interacting with her.
Right now I am reading about how the generations view "dependency " differently. These days people are ashamed to be "dependent". In the past it was a way of life for family to care for a dependent. I'll keep you posted as I learn more about that other "country" which is what Pipher calls being old old, the state of being ill and dependent- which even healthy people in their 60's and 70's can imagine but not truly understand.

Allen Cognitive Levels

Occupational therapists evaluate patients with memory loss to determine what cognitive level they are functioning at. This helps in planning the patient's level of support and what settings his needs can best be met. The Allen Cognitive Levels Screen is commonly used to do this. The screen consists of learning three visual-motor tasks (leather-lacing stitches) with increasingly complex activity demands. Completion of the three tasks requires that the person attend to, understand, and use sensory and motor cues from the material objects (leather, lace, and needles), the administrator’s verbal and demonstrated instructions and cues, and feedback from motor actions while making the stitches.

The occupational therapy students in the following video will give you an idea of how the screening is performed.

Creative Alternatives

Here is an article in Advance for Occupational Therapists that I think has some very clever, inexpensive and creative ideas of interest to home health occupationa therapists:
Creative Alternatives, Part 2

Still Giving Kisses- A New Book Review on Amazon

Check out this recent book review on Amazon:
An Occupational Therapist Loves this Book

Dancing Hands Taps

I think that this is a very clever activity!

Low Vision Occupational Therapy

Occupational therapists are trained to work with patients who have low vision. These patients are usually elderly and commonly diagnosed with macular degeneration and glaucoma, although patients with other diagnosis such as diabetic retinopathy also benefit from low vision occupational therapy.
People with low vision have limitations that cannot be corrected with standard eye glasses or contact lenses. In the United States low vision is commonly considered 20/70 or worse in the better eye with best correction or have a decreased visual field that impacts function.


I work for the agency Visions of Independence (in Massachusetts and surrounding areas) providing home care to low vision patients. The goal is to help patients be as independent as possible and just a few of my job duties are to provide:

• A home safety assessment to make the environment safer
  
• Adaptations with touch and visual cues such as tactile bumps to feel settings on an oven or bold lined paper to make writing easier.
  

• Assistance in using low vision glasses, magnifiers and techniques to make reading and writing easier
• Ways to adapt the environment to decrease glare and increase color contrast

Services are paid for by Medicare after a doctor's referral. For more information, please visit the Visions of Independence web site or contact the owner Eliot Feldman at (781) 784-3320 or email : EFELDMAN@visionsofindependence.com.
As an occupational therapist doing low vision work I found the following text book to be most helpful. Also, please check out the information and many resources on my web site at:
Barbarasmithoccupationaltherapist.com/lowvisionelderly
Barbarasmithoccupationaltherapist.com/vision

One of the most helpful books I read when first learning about Alzheimer's disease was "Your Name is Hughes Hannibal Shanks by Lela Shanks. I really learned a lot about not only what it is like to be the spouse of a person with memory impairment but how optimistic, creative and clever a caregiver can be when rising to the occasion. I particularly appreciated the author's adaptations to her husband's clothing and the environment to make life easier for both of them, how she handled behavioral issues and the video she made to help her husband remember his past.



Lela Shanks was kind enough to write the foreword to my book: Still Giving Kisses: A Guide to Helping and Enjoying the Alzheimer's Victim You Love. She is an inspiration.
Barbarasmithoccupationaltherapist.com

Health Care Reform

Older people have a lot at stake with health care reform and the AARP is working hard to improve access, dispel myths and make health care affordable. Here is their list of Myths Vs Facts.
In the November/December AARP magazine , president Jennie Chin Hansen explains that a House bill provision would allow Medicare to pay doctors for voluntary counseling sessions. This counseling would include getting information about living wills, named a friend or relative you trust as your health care proxy and learning about he benefits offered by hospice care.
I wish someone had told me about hospice when mom was in the nursing home. I only found out because I happened to see a Rabbi walking around (an unusual event) and I asked him what he was doing there. He was there providing counseling and some of his patients had Alzheimer's disease. Once I joined the program the Rabbi visited, held her hand, sang to her. A specially trained and loving aide dressed, fed and did activities with mom for 2 hours a day. A special nurse recommended no more blood drawn to test the Depacote toxicity levels (which could be judged based on her behavior). Mom hated those needles that made her agitated.
Now here is an interesting story about the Death Panels myth.
Catchy phrase isn't it.......

Animal-Assisted Therapies

Animal assisted therapies may involve many different types of animals including- dogs, cats, bunnies, horses, llamas and even elephants. It is well documented that nursing home residents perk up and alzheimer's patients receive wonderful sensory stimulation from small, specially trained animals. These animals typically receive many months of training. Some prisons have instituted rehabilitation programs that involve prisoners caring for and training the animals. Read more about animal assisted therapies at this link:
http://www.barbarasmithoccupationaltherapist.com/Pettherapy.html
If your are in the Massachusetts area check out Animal Assisted Interventions, a resource for consultation, education and therapy services.

Isn't this tooooo cute!

Adorable Photographs of Our Baby

As individuals with memory loss gradually lose the ability to read, looking at familiar and easy to interpret photographs becomes an increasingful enjoyable and important recreational activity. The simple pictures on the following page can be printed, inserted inside page protectors and used to make a book with a 3 ring binder. Some individuals will be able to read the simple large print captions; whereas, other may benefit more from a 2-3 word title written below each picture to identify what it is.
Home Made Picture book
Susan Berg's boook Adorable Photographs of Our Baby makes looking at simple photographs fun and easy. Berg is an occupational therapist and activities director in a nursing home and used her expertise to create a book that can be used by staff and family members to stimulate the patient with memory impairment. Her book includes:

• Tips on how to relate to someone with memory impairment
• Suggestions on how to use the photographs as part of games, to stimulate conversation and calm a person down
  
• Ways to use the photographs in an activity group
  

Learn more about this book and Susan Berg's work at: Alzheimer's Ideas

Music and Movement for Dementia Patients

I found that my mother responded to music and could sing long after losing the ability to speak or understand questions. The songs from the World War II era that she grew up seemed to be retained in her long term memory the best. I compiled a list of large print song into a book, fitting them into page protectors inside a 3 ring binder. You can print out 28 songs from my web site at:
http://www.barbarasmithoccupationaltherapist.com/sarahsongs.html
During the early stages of the disease my mom was able to read these lyrics and sing independently. Later on I prompted her by singing most of the songs and letting her complete familiar phrases such as "Let me call you (Sweetheart)."
Eventually, I did all the singing but she shook a tambourine or I helped her to shake it and I set up her CD player to repeat her favorite songs. Here is another site with songs to print: http://geocities.com/dferg5493/songfiles.htm

Still Alice

I recently learned of and read the book Still Alice although it has been a best seller for several months. I can see why the book rose so quickly in popularity. It is very eloquently written, offering a realistic (quite the challenge, I think) look into the interior world of a 50 year old brilliant Harvard professor who has early onset Alzheimer's disease.
Please check out my Amazon review
I was so moved by this book- I joined the Still Alive forum.

I will be adding lots more links to this blog over time. Please share any thoughts if you have read Still Alice. As an occupational therapist, I feel that the character could have greatly benefited from OT services that could have included a great deal of environmental adaptations and patient education. But as the book stood, the reader develops an increasing urgency and awareness of Alice's suffering precisely because not only was the loss of cognitive ability devastating but no professional was there to guide, support and educate.
Barbara