6 Steps for a Successful RCFE

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Starting your first Resident Care Facility or RCFE can be exciting, fulfilling and daunting all at the same time. Between securing a location and getting your certifications it can be easy to overlook some of the important basic ideas that will help ensure your first RCFE is a success.

Over the years we have worked with hundreds of newly minted RCFE administrators to make sure their facilities, policies, and business strategies are setting them and their residents up for the best possible experience. In that time, we’ve learned a thing or two (or six) on some of the foundational elements of what makes a successful RCFE. Here is what we would say 0ur 6 most important tips for building a successful RCFE facility are…

1. Spend Time Creating Your Team

More than just a team, you are creating a culture. And where that culture starts is you and your employees. Those first several hires are vital to any new venture, regardless of the industry, and especially in a care-oriented industry like this one. The people you choose and personalities they bring set the tone and precedent for all that is to come.

With everything in flux, you might be tempted to “fire drill” the hiring process in a rush to hit the ground running. This is never a good idea. We’ve all heard the phrase beggars can’t be choosers. In hiring, no matter the circumstances, that should never apply. Give yourself permission to spend time creating your team. Yes, your team. You have a vision, and it is okay to be selective on who will join you on your path to seeing it through.

2. Choose Your Residents Wisely

Just as you are creating a culture with your first employees, so are you building a RCFE community. Your first resident is your benchmark and will set the tone for your facility in ways you might not expect. For example, if your first resident has Alzheimer’s and has repetition tendencies, then it might be difficult to admit residents who are cognitively with it.

Remember, just as you have a choice, so do your residents — and there’s a lot of factors that go into their decision to go with your RCFE facility. As facilities grow in size, culture and community are becoming increasingly important. If a resident-to-be doesn’t see a community they can engage with (even if one exists), they might very well pass. Whether it’s bound in fact or not, perception is reality.

3. Know All of Your State’s Regulations, Codes, and Policies — And Comply with Them

These laws exist for a reason, both for the protection of your residents and for yours. The quickest way to have your facility shuttered is to be out of compliance with your state’s RCFE regulations. You went into caregiving to do just that:  give care. How can you adequately do that if you’re out of compliance, or don’t even know what codes and policies your facility is supposed to be complying with?

Moreover, having a firm grasp of your state’s regulations could very well be crucial down the line. Don’t be afraid to wield them like a shield — the first line of defense towards any future liability claims.

Need to brush up on your policy? You can always turn to experts like Assisted Living Education to help make sure you are up to date.

4. Communicate Regularly

Not only is communication vital so that everyone on your team can always be on the same page, but it’s also a regulatory requirement. The law mandates that any change of condition in the resident — say, they have a urinary tract infection or they’re more confused than usual — must be communicated to their physician and responsible party (i.e. a family member), if any.

This makes sense, of course. A change in an individual’s condition can have life or death consequences, and a lapse in communication could prevent a resident from receiving critical treatment. Shift changes present a particular challenge in this regard. There’s a potential for information to get lost in the mix in the transition between your facility’s day and night teams. Certain symptoms, such as insomnia — a potential indicator and risk factor of depression — might only present themselves at late in the evening, so it’s imperative everyone is kept in the loop, and that changes are noted in writing.

And let’s not forget your duty as an RCFE Administrator to maintain communication with your State Regulators. Any time a resident experiences an unusual incident — such as a fall, an injury, or a medical emergency requiring a 911 out to the hospital — a report must be made to your Licensing Program Analyst at the Department of Social Services with within 1 business day via telephone, and within 7 days via a written report. This takes us into our next tip.

5. Document, Document, Document

Any time there is a resident incident, such as a fall, it must be documented — either internally, if it isn’t that serious, or on a State-provided form to be submitted to the DSS if it triggers a 911 call or something similar. Like the above, incidents need to be reported to the resident’s physician and responsible party, and it’s best to do this in writing so you have a paper trail.

Liability, though you might not want to think about it, should always be a concern. Thus, it’s wise to perform internal audits and random record reviews on a routine basis. You always want to be able to certify compliance if the need arises. This is where the term “defensive documentation” comes into play. When you document incidents, or anything really, specificity, precision, and descriptive detail are all musts.

Resident records (appointments included), personnel records, administrative records, dementia records — these are all things you are required to keep, keeping in mind that certain records must be secured in a HIPAA compliant fashion. As a guideline, take a look at the list of documents and records that must be kept at residential care facilities in California. Remember that every state is different, so unless your facility is located in California, what you are required to retain might be different.

6. Don’t Be Afraid to Say No

The words “this is my island” spring to mind. This facility is yours, and as an RCFE Administrator, you cannot be afraid to say no. We covered this in part in Tips #1 and #2, what to do in the beginning, but there’s a corollary on the other end of the spectrum:  what to do when an end is inevitable.

If an employee misbehaves, routinely underperforms, or puts your residents or facility in any modicum of risk (health, liability, or otherwise), then it is your duty to fire them promptly. With the safety and wellbeing of those in your care on the line, they must be your first primary concern.

But what if an individual’s medical needs exceed your facilities abilities?

It’s sad to say, but this is a quandary you will likely face dealing with residents suffering from advanced Alzheimer’s and dementia. Much as you might want to keep them in your care, your licenses might not permit it. The care they require might go beyond the scope of what you can supply. In these situations, or in cases of residents who exhibit violent behaviors or a flagrant disregard for community rules, letting go of a resident might be a necessary course of action as well.

The Essential Component of Success

Looking back on the six tips we just shared, you might notice that at their core they are all about the same thing:  Care. Caring enough to do things right. Providing the best care. Taking time to assure your level of care by maintaining compliance, and by communicating. Although there is a lot more to running a successful RCFE facility than just these 6 things, mastery of these will give you a great foundation to build your business on. And in the event that you need additional support or training, the experts here at Assisted Living Education is always here to lend a hand.

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Assisted Living Education is the premier provider of RCFE classes, licensing, products and services for assisted living. Our teachers are industry professionals with many years of experience that are engaging, entertaining and highly informative. They offer RCFE consulting services and share real RCFE experience that will help you be successful in this fast growing career industry.

Holiday Depression and Seasonal Affective Disorder is a Painful Reality for Many Seniors (Part 2)

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Joyous as the winter season can be for some — with fresh blankets of snow, a warm hearth, and the love of family surrounding them — for others it can be a time of struggle. Not only do the holidays and cold months often counterintuitively bring some people down, perhaps in part the result of past psychological drama, but they can also trigger persistent depression.

The Holiday Blues and Seasonal Affective Disorder typically manifest in similar ways, but their origins and treatment are different. In our last post we discussed the symptoms of each condition, as well as why they might befall certain residents in your care.

As caregivers, we play an important role in an individual’s day to day life; our close relationships with those we look after allow us to notice changes in mood and behavior, and alert other members of the care team. Keeping everyone in the loop, especially the psychiatric professional who will provide the diagnosis and treatment, gives a resident the best shot at recovery.

Here are some of the ways we can help our senior residents when the black dog begins to growl.

Helping Residents With Holiday Depression

With proper planning and program design, it may be possible to shift a resident’s mood throughout the holidays, and prevent the Holiday Blues from taking hold in the first place.

Well before the holiday season or particular event arrives, try to make an extra effort to engage with those residents who may be at risk for experiencing a depressive episode. One simple way to start is with a conversation.

Have Meaningful Interactions With Your Residents

Regular, casual engagements with your residents can turn into lasting relationships, with positive benefits for the residents. These relationships can help toward stabilizing emotional highs and lows that may be experienced during particular times of year, like the holidays, where residents can tend to feel more isolated and lonely.

Initiating daily conversations with each and every resident may sound like a daunting and time-consuming task, but even keeping it short and sweet can brighten a resident’s day. It’s not necessary to have a long, sit-down conversation, but try to create an ongoing dialogue whenever you see your resident either in passing, during medications administration, therapy sessions, mealtimes, or other times you may have scheduled contact with them.

Not every individual will be responsive, for various reasons. They may be shy, have trust issues, or they may have a disorder or cognitive issue that makes it difficult for them to interact openly with you. These individuals may take some time to warm up to you, or you may need to change your approach. Gauge how the individual reacts to conversation; you may need to back off and take smaller steps for them to open up. You may be doing most of the talking at first, but over time, you might find it balances out to a more even exchange.

Begin inviting them to group activities or outings, but ever push a resident into something they’re. not interested in doing. Nonetheless, always let them know they’re welcome to join if they want. These relationships might take longer to develop, but for resident and caretakers alike, they can be truly meaningful.

Even for residents who have advanced dementia or Alzheimer’s, or other cognitive or verbal limitations, you making an effort to reach them can make all the difference. Singing to them, talking to them, or signing with them will help these individuals feel connected to other people. Their responses may be different, but pay close attention to their behaviors and body language for positive or negative feedback.

These are all important components of trust-building, which can help you with other times in the long-run. As a trusted staff member, the resident may look to you in times of difficulty or even non-compliance to remain calm or de-escalate a tense situation.

Involve Everyone in the Festivities

Most facilities decorate and have events correlating with the major holidays, which is a great start to creating a warm and festive environment. If possible, find out which holidays in particular your residents like to celebrate throughout the year, and make an effort to have those represented if they aren’t part of the mainstream/regular celebrations. Even decorating a common area or the hall near their room can help bring some cheer. If the resident(s) are able, they can help explain the traditions with which they’re familiar and share stories they recall from their past.

The winter holidays are also a great time of year to invite people from the community to interact with residents. Local religious organizations, youth musicians, choirs, a capella or other community groups, and even schools can come sing and/or engage with residents and bring light to their holiday experience.

If possible, outings to local community events, or even driving around looking at holiday lights in the neighborhood are great excursions as well — but if that’s not doable, reaching out to the community and requesting greeting cards for the residents is another simple way to bring your residents cheer.

Recuperation Time is Important

With all of the activities and bustle of the holiday season, down time or quiet time is crucial. Even if elderly residents are enjoying themselves with all of the festivities, it is a change from their daily routine, and may be more physically and emotionally demanding on them than expected. As we age, it can take us longer to recover from activities, especially those out of our norm, whether we realize it or not. Moreover, stress and exhaustion can depress one’s immune response, causing someone to be more susceptible to illness.

Switching things up by having partial or half-day activities with ‘regular’ days in between will allow for recovery, and help reduce the mental and physical tolls the holidays can put on elderly folks.

Treating Residents Suffering From Seasonal Affective Disorder

Many of us are familiar with the term Seasonal Affective Disorder (SAD), but may not fully understand its condition, or even that there are different kinds of SAD. While we mentioned that there is a type of spring/summer SAD, the depression varietal we’re discussing here is fall/winter — the physiological condition coming to bear in the cold months.


For the period that the resident is suffering from SAD symptoms, antidepressants can be helpful, especially if the condition’s pattern is known. If a patient has a history of SAD, the an antidepressant regimen can begin prior to the expected onset of either winter or summer SAD. By starting sooner, the medication will be more effective.

Light therapy has also proven beneficial for sufferers of fall/winter SAD, especially among seniors who dislike taking medications or whom are already on multiple medications. Light therapy is also helpful for elderly who are not as able to go outside for natural exposure to light.

For residents with executive cognitive functioning within normal range, Cognitive Behavioral Therapy (CBT) is another possible treatment as well. What works best for every patient is different, and treatment can sometimes take a while to gain a foothold. In fact, there can be a great deal of trial and error in finding the right cocktail of medications or therapies, depending on one’s personal preference and brain chemistry.

A Light Through the Fog

The resident’s attending or personal psychiatrist/psychologist can determine the best course of treatment, depending on the individual’s needs, cognitive capabilities, and severity of symptoms. Even if the resident is receiving specific treatment from their psychiatrist/psychologist, it is pertinent to keep all doctors, therapists, dieticians, and other caretakers abreast of any adjustments to the resident’s routines, medical or otherwise. This helps maintain consistency and effectiveness of the treatment and resident care.

For residents suffering from Holiday Depression or Seasonal Affective Disorder, it might be a while before they can find their way to the bright side of life again, but always remember:  with your care and compassion, you are their light through the fog.

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Assisted Living Education is the leading provider of RCFE certification classes, licensing, products and services for assisted living. Our teachers are industry professionals with many years of experience that are engaging, entertaining and highly informative.

Holiday Depression and Seasonal Affective Disorder is a Painful Reality for Many Seniors (Part 1)

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For many, the holidays and winter months are the time of year for family get-togethers, traditions, friends, and fun. But this isn’t always the case, and for a large number of seniors Holiday Depression and Seasonal Affective Disorder are a painful reality. The causes for each can be numerous — both psychological and physiological — and often they present similarly. However, considering the more insidious nature of the latter, it’s important that caregivers know what to look out for, and the different factors that can play a role in their onset.

Spotting the Signs of Holiday Depression

The key to any effective individual care plan is in simply knowing your residents. Familiarity with their personalities and ‘baseline’ behaviors, disposition, and temperament are crucial in detecting any kind of change.

The following are typical depressive symptoms presenting in an elderly resident around the holidays:

 

  • Subdued or irritable mood; sadness
  • Fatigue, or difficulty sleeping
  • Anxiety
  • Loss of interest in daily activities
  • Change in appetite
  • Lack of attention to personal care, hygiene

Unlike other forms of depression, the Holiday Blues are situationally dependent. They begin in the lead up to the holidays, and fade in their wake. Rather than being physiological in origin — the individuals personal biology and brain chemistry — they are based in psychology and sadness. Sometimes, the thing triggers one’s holiday depression isn’t current. Instead, the holidays might dredge up trauma of some kind from a person’s past.

Even if your residents already present some of these symptoms, it’s important to note if they become more severe or if additional symptoms arise. If you notice the symptoms worsening, or if they continue beyond the holidays, this is very likely indicative of a more insidious form of depression.

Seasonal Affective Disorder

Seasonal Affective Disorder is a type of depression whose onset is triggered by changes in seasons. The most common form of SAD occurs in fall through winter, but there are some cases in which the condition affects an individual in the spring/summer months (sometimes referred to as Reverse SAD).

In both cases, there is marked change in mood and disposition, which start out mildly when the season is in its initial stages, but become more severe as the season progresses. Considering it can be easily confused with the Holiday Blues, we’re going to focus on the fall/winter end of the spectrum.

The fall/winter manifestation of SAD resembles the more classic symptoms of depression. Here’s what to look out for:

 

  • Irritability, trouble getting along with others
  • Fatigue, lethargy, low energy
  • Emotionally hypersensitive
  • Change in appetite, especially craving for high carbohydrate foods
  • Oversleeping 

People who live in regions with distinctive weather changes or where sunlight can be very limited are more likely to develop symptoms SAD. However, even in places like California, where the weather may not change as dramatically, the cooler temperatures can prevent more frequent visits outside, especially for elderly residents, and thereby makes for less exposure to the ever important sunlight.

For individuals with Fall/Winter SAD, symptoms persist for more than two weeks. The reduced sun exposure can lead result in deficiencies or imbalances in the body. For example, serotonin production drops with a lack of sunlight, and this chemical imbalance causes an individual to feel depressed. The cravings for high carbohydrate foods are the body’s way of attempting to increase serotonin levels. Vitamin D also plays an important role in our health, including supporting bone health, preventatives with certain cancers & conditions, as well as help with incontinence. However, Vitamin D is also found naturally in certain foods and also via dietary supplements. Sleep patterns can also be thrown off as well, since the body’s circadian rhythms depend on regular sun exposure. The disrupted sleep prevents the resident from getting quality rest, which can result in depressive symptoms.

Making the Call

While nurses and caretakers play a critical role in determining whether a resident is suffering for Holiday Depression or Seasonal Affective Disorder — considering the frequency with which they might interact with an individual — the ultimate determination must come from the resident’s attending or personal psychiatrist/psychologist.

Psychiatric professionals should determine the best course of treatment, depending on the individual’s needs, cognitive capabilities, and severity of symptoms. Even if the resident is already receiving specific treatment from their psychiatrist/psychologist, it is vital that team members keep all doctors, therapists, dieticians, and other caretakers abreast of any adjustments to the resident’s routines, medical or otherwise. This will help maintain the consistency and effectiveness of the resident’s treatment and care.

In our next article (Part 2 of this series), we’ll take a look at how you as a caretaker can help the seniors in your charge throughout the fall and winter months. While you might not be able to hold the effects of the Holiday Blues or SAD at bay, you can at the very least take steps make their days warmer, merrier, and bright.

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Assisted Living Education is the leading provider of RCFE certification classes, licensing, products and services for assisted living. Our teachers are industry professionals with many years of experience that are engaging, entertaining and highly informative.

Understanding the Unique Challenges and Needs of Aging LGBT Adults — Part 2

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This is the second part of a two-part article. If you have not read Part One yet, we recommend doing so first clicking here.

Bullying in nursing homes is already on the level of a national crisis; enough so that the topic warrants an article of its own. But for openly LGBTQ+ people, it’s even more insidious — and often violent.

A lawsuit submitted by Lambda Legal on behalf of Marsha Wetzel against her assisted living community, which failed to protect her on a systemic level, shows just how bad it can be. For 16 months, despite dozens of complaints to administrators, Wetzel — a 70-year-old lesbian woman — was subjected to cruelty and violence by her fellow residents. Homophobic slurs were commonplace, and she often found herself targeted by the same people.

One man, a former police officer named Bob, rammed her scooter with his walker “hard enough to tip her chair and knock her off the [wheelchair] ramp,” and in a later incident told her that her partner Judy “died to get away from [her].” The harassment from Bob was so frequent and severe, that she soon felt she had no choice but to eat alone in her room, do her laundry in the middle of the night, and avoid the floor he lived on.

Sometime later, Wetzel was attacked in the mailroom — hit over the head from behind by an unknown assailant. “She went back to her room and cried but did not report the injury to staff that day because she did not think they would believe her.”

The reason she thought that was because, as she learned after dozens of complaints, the administrators never did. She was spit on by residents, assaulted in the elevator, and told that she would burn in hell — and each time she complained she was either accused of lying or told not to worry about it.  Eventually, the staff began to retaliate against her themselves, falsely accusing her of smoking in her room (an evictable offense), making fun of her because no one visited her during the Holidays, and at one point slapping her across the face.

Marsha Wetzel’s experience is not unique. It’s something that the vast majority of LGBTQ+ older adults have had to deal with — if not presently, then throughout the past. Wrote Tara Bahrampour, “Older lesbian, gay, bisexual and transgender (LGBT) people, including those among the first to come out as a political and social force, are increasingly apprehensive about encountering discrimination as they grow older and more dependent on strangers for care.” (Washington Post)

This apprehension only highlights why it’s so vital for caregivers to approach these situations with understanding and belief; their fear doesn’t exist without reason.

Compared to their cisgender1  and heterosexual counterparts, LGBTQ+ older adults are already at a much greater risk of physical and mental illness. So stark is this health disparity that it’s been identified as one of the greatest concerns in public health. Says Karen Fredriksen-Goldsen, who led the pioneering 2011 study, “The health disparities reflect the historical and social context of their lives, and the serious adversity they have encountered can jeopardize their health and willingness to seek services in old age.”

In fact, 80% of respondents indicated that they’d been victimized “at least once in their lifetimes,” and nearly 40% had considered suicide at some point.

On top of the above health concerns and decreased care-seeking, LGBTQ+ seniors also have to contend with the following challenges that their peers do not:

  • Increased social isolation and loneliness
  • Decreased social support (less likely to be married or have children)
  • Greater rates of poverty (often due to a difficulty in finding employment)
  • Poorer nutrition
  • Increased likeliness to smoke and binge-drink
  • Higher rates of depression and anxiety
  • For older lesbians and bisexual women, an elevated risk of cardiovascular disease and obesity, and a decreased likelihood of having a mammogram
  • Higher rates of chronic conditions (including low back pain, neck pain, and a weakened immune system)
  • Heightened rates of stroke, heart attack, asthma, and arthritis
  • Premature mortality

Much of these differences were not known until recent years, which only serves as a reminder that there’s a need to develop prevention and intervention strategies so that lesbian, gay, bisexual, transgender, and queer-identified seniors and baby boomers can receive the healthcare and compassion they deserve.

In the coming years, you will find more and more LGBTQ+ elders in your care. Their differing needs, and also the need to be seen on a human level — with empathy, kindness, and an inclusion — means that we must build a foundation of understanding within the assisted living community. Across the country, facilities have begun to take note. Seminars are being held with residents and staff to reduce the rampant bullying taking place within their walls, and educational courses are available to teach nurse and caregivers how to interact with a community of seniors who have, for too long, remained invisible. At Assisted Living Education, we offer LGBT training and we are more than ready to shine a light on all the ways we can help make their lives better.  Please share with us your experience and feedback.

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Assisted Living Education is the leading provider of RCFE certification classes, licensing, products and services for assisted living. Our teachers are industry professionals with many years of experience that are engaging, entertaining and highly informative.

Understanding the Unique Challenges and Needs of Aging LGBT Adults — Part 1

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Growing old is never easy, but for lesbian, gay, bisexual, transgender, and queer-identified (LGBTQ+) baby boomers — the overwhelming majority of whom have endured lifetimes of discrimination and prejudice — the process of aging can be particularly fraught. According to a major, 2017 survey published in The Gerontologist, it’s estimated that living in the U.S. there more than 2.7 million LGBTQ+ people aged 50 and older, including an estimated 1.1 million seniors (ages 65+).

The report came on the heels of several recent landmark studies, each intent on understanding the unique aging and health needs of LGBTQ+ older adults — an intersecting community of people who, until only the past decade, had been largely ignored and understudied by the field of gerontology.

The growing interest in this intersection reflects a shifting landscape within assisted living facilities and their concomitants (e.g. healthcare providers), and recognizes that increasing diversity among the senior segment necessitates a greater level of awareness, compassion, and inclusivity by caregivers and nursing homes:  by 2060, “the total number of older adults who self-identify as LGBT, have engaged in same-sex sexual behavior or romantic relationships, and/or are attracted to members of the same sex is estimated to increase to more than 20 million,” (The Gerontologist).

For a group historically underserved by policy and healthcare services, the relative invisibility of LGBTQ+ elders to researchers has been dispiriting — if unsurprising, considering society’s slow uptake of acceptance. But what’s become immediately clear from the studies done since is that LGBTQ+ older adults face a number of special challenges as they age, and have medical, social, and emotional needs that differ greatly from their heterosexual and/or cisgender1  peers.

It’s important that providers of elder care services be aware that these baby boomers and seniors — the aging faces of the Stonewall Generation, who in 1969 led the charge for equality following the powder-keg uprising at Stonewall Inn that propelled the fight for gay rights to the national stage — are now confronting an open ridicule as the first out members in their assisted living communities. And while they’ve proven their resilience, having also fought to reach an old age that too many of their peers never would — lost to the AIDS crisis at the height of young adulthood — few of these individuals will have made here untouched by trauma, and the punishing effects of stigma, discrimination, rejection, and struggle.

In the second half of this article, we will explore the kinds of challenges faced by LGBTQ+ older adults, and why it is so important that for us as caregivers to understand them.

To continue reading Part Two of this article, please click here.

In the second half of this article, we will explore the kinds of challenges faced by LGBTQ+ older adults, and why it is so important that for us as caregivers to understand them.

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Assisted Living Education is the leading provider of RCFE certification classes, licensing, products and services for assisted living. Our teachers are industry professionals with many years of experience that are engaging, entertaining and highly informative.

Dehydration In the Elderly Is A Year-Round Struggle, But Doesn’t Have To Be

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It’s been a scorching past couple of months. Across the U.S. and the world, temperature records dropped like flies this summer. Notoriously rainy London saw its picturesque green spaces burned to an unsightly, ocre crisp, with the rolling estates of Hampstead Heath looking more like a high summer’s African savannah. As people across the planet continue to experience heat waves and droughts the likes of which they’ve never felt, they’re finding themselves at a greater risk of dehydration than ever before.

In seniors, this is especially dangerous. The trouble is that with it’s oddball constellation of symptoms dehydration can sometimes be tricky to diagnose. Our body becomes less efficient as we age; things it did with ease when we were young—like hold on to water, or not make us groan when standing up—become challenging.

For a species comprised of at least half H2O (the percentage drops as we grow older, from about 70% to 50% over time), this is less than ideal. So with that in mind, considering dehydration is in fact a year-round risk for seniors, we wanted to take a look at how this serious condition can affect our aging population, and what can do to diagnose, treat, and prevent it.

Dehydration Risk Factors

As we age, we lose our ability to perceive thirst as keenly as when we were young. For the seniors in your care, this natural state means that they are less likely to consume as much liquid as they need to stay healthy. This quickly puts an individual who is already low on body water at an even greater risk of dehydration.

One study, which looked at elderly patients as they were admitted to the hospital, showed that 37% were dehydrated upon arrival. Additional research suggests that one in five older individuals living in assisted care does not drink enough fluids.

For individuals with Alzheimer’s or other forms of dementia, who may not remember to ask care staff for a glass of water, this risk is even greater:  they’re six times more likely to be dehydrated. This is especially problematic considering that even mild dehydration can exacerbate their cognitive symptoms, leading to increased confusion and worsened thinking skills.

In some cases, seniors may be reluctant to drink fluids out of fear of incontinence and the embarrassment that can come with it. Anxieties about toilet issues are very common among the residents of care homes, but it’s a worry that often goes unnoticed in care homes, because individuals are unlikely to want to discuss it.

And yet, studies actually show a positive relationship between proper hydration and a decrease in anxiety levels among the elderly. This might not correlate for individuals with continence anxiety, but it’s something to keep in mind when searching for ways to improve the mental health of residents.

Other factors that contribute to dehydration include mobility issues, medications (aka “water pills,” with diuretic properties) used to treat high blood pressure, acute illnesses (vomiting, fever, diarrhea, and infection all contribute to water loss), being a resident of an assisted living facility (where access to fluids is largely dependent on the availability and attentiveness of caregivers), and difficulty swallowing.

Diagnosing Dehydration

Dehydration can be very difficult to diagnose. The symptoms it presents with are all easily attributable to other conditions, and they may not always present in a clear cut way, so symptoms on their own are not a reliable basis for a diagnosis.

Some of the most common symptoms, and the ones that people are told to look out most with dehydration, include:

  • Extreme thirst
  • Decreased frequency of urination
  • Dark-colored urine
  • Fatigue
  • Dizziness
  • Confusion and delirium (either new, or worse than usual)
  • Racing heart (typically a rate exceeding 100 bpm)
  • Low systolic blood pressure
  • Sunken eyes

Rather than simply basing a dehydration diagnosis on symptoms, it makes more sense to keep on eye out for these, and then follow up with a more reliable test.

For older adults, a laboratory blood test is the most accurate method of diagnosing dehydration. Studies have shown that routine tests done by care homes to spot signs of dehydration (such as pinching the skin on the back of the hand, or performing a urine dipstick test) are also unreliable.

Prevention of Dehydration

Of course, the best method of treating dehydration among seniors is to prevent it from happening in the first place. With this in mind, there are a number of steps that a caregiver or nursing staff can take to ensure an individual receives enough fluids.

Here are just a few:

  • Make fluids available throughout the day, and on a schedule.
  • Since older adults might be reluctant to drink a large glass of water in one sitting (see:  continence issues), consider offering smaller quantities of fluid more frequently.
  • Provide a beverage that the individual in your care enjoys.
  • Ask whether they prefer to drink through a straw (this might be easier, mobility-wise, than having to lift a cup to their mouth)
  • Keep a urination log, and a log of their fluid intake, and note when instances of incontinence occur. Check in with your resident about whether toilet issues are a reason why they are reluctant to drink.
  • Consider placing the older individual on a bathroom schedule. This might be especially appropriate for someone with memory troubles or mobility issues.

Dehydration is a serious condition, and if left unchecked can lead to kidney failure and death. While mild dehydration is usually easily treatable by merely increasing fluid intake and electrolytes, the worst cases call for a trip to the emergency room for intravenous fluids, or even dialysis and other kidney-supporting methods.

Hospital visits are scary, no matter the reason, and they put an enormous amount of stress on an individual and their family. Making sure the older person in your care is properly hydrated is one of the simplest ways to ensure their health and happiness, and will go a long way toward improving their quality of life.

If you or anyone under your care is exhibiting symptoms of dehydration, or any other worrisome symptom, please be sure to contact a licensed medical provider for further assistance.

Assisted Living Education is the premier provider of RCFE classes, licensing, products and services for assisted living. Our teachers are industry professionals with many years of experience that are engaging, entertaining and highly informative.

Medical Marijuana and Seniors, Part 2: Things You Should Know

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In our previous post, Part One of our two-part series concerning seniors and medical marijuana, we explored the increasing use of cannabis among our aging populations.

As laws across the nation continue to change (allowing individuals safe and legal access to its myriad therapeutic benefits), and prior to considering it for themselves, it is important that both patients and their caregivers have a more complete picture of marijuana—one that extends beyond its oft depicted “bad boy” image as a dangerous, gateway drug.

With that said, prior to diving into Part Two of our primer, as always, we would like to impress on our readers that it is always best to consult a doctor first before making any changes to an individual’s treatment plan.

The Benefits

One of the conditions cannabis is most notable for helping treat is epilepsy, which we touched on in the last post. But the benefits don’t just end there. There are dozens of diseases and disorders (or their symptoms) that have been shown to improve with medical marijuana. Here are just a handful:

 

  • Cancer
    It’s one of the reasons medical marijuana laws were first passed in California in the 90’s. The ability of cannabis to alleviate many of the deleterious effects of chemotherapy, especially pain and nausea, seems nothing short of miraculous. But there’s more. Research has shown the marijuana can not only kill cancer cells, but also prevent its spread.     
  • Chronic pain
    There’s a fascinating bit of science behind the anti-inflammatory properties of cannabis, but sadly we don’t have the requisite space to dive into it. Many seniors suffer from debilitating pain from a variety of conditions, but it doesn’t have to be that way. Arthritis, nerve pain, and fibromyalgia are all conditions that seniors are experiencing relief from with the ingestion of cannabis. Its two most notable compounds, THC and CBD, both have been shown to inhibit proinflammatory molecules in our bodies, working together with our endogenous opioid systems to reduce pain.
  • Parkinson’s
    It’s one of the most astonishing videos on the internet. A man named Larry, who suffers from Parkinson’s disease, is seen with severe tremor dyskinesia. He struggles to speak, telling someone off camera that it’s been a rough week. He’s advised to take a single droplet of a cannabis-infused tincture, the first time this former police captain has ever tried such a thing. After rubbing it beneath his tongue, and on his inner cheeks, he lies back on a couch. Four minute later, he sits up, a smile breaking across his face. “So quickly,” he says. His tremors are gone, and for the first time in a long while, he can speak in a clear and controlled voice.
  • Glaucoma
    It’s estimated that more than 3 million Americans suffer from glaucoma, a disease of the optic nerve that can lead to a progressive and irreversible loss of vision. Glaucoma is the leading cause of blindness worldwide. Though clinical trials have been few, many patients have reported a marked decrease in intraocular pressure following the inhalation of cannabis, while other have found relief from CBD-infused eye drops.
  • Sleep
    You’d be hard-pressed to find someone who doesn’t enjoy dessert. With the medical marijuana industry in the midst of a massive boom, one of the most popular forms of ingestion is in the form of edibles. Pot brownies might seem like something of a joke, but in fact countless seniors are turning to their nightly “something sweet” as a way to relax and induce sleepiness. Individuals who’d previously suffered from insomnia have reported that cannabis not only gives them the ability to sleep through the night, but makes it so that they don’t feel groggy in the morning—unlike many users of sleeping pills.
  • Eating disorders
    It’s common for individuals to lose their appetites as they age (especially in conjunction with #7 on this list). Startlingly, a 2014 study by the CDC revealed that 78% of anorexia-related deaths were of seniors. It doesn’t have to be that way, though. It’s usually a punchline in a film, but the “munchies” is a real phenomenon. Cannabis can give seniors their appetite back, and allow them to enjoy food once more. 
  • Depression and Anxiety
    There’s a rising epidemic among our assisted living population, and it’s not always obvious. Depression and anxiety, among other mental health disorders, can be crippling. As we age, and our bodies break down, it’s not surprising that our mental health takes a turn for the worst. Grappling with these changes is difficult, and can really take a toll on our inner lives. Many who are diagnosed with anxiety or depression may choose to go on antidepressants, but that’s not always the right course of action for everyone, considering the side effects that come along with it. Cannabis has been shown to improve people’s mood, and alleviate symptoms of both anxiety and depression, offering up a viable alternative psychiatric medications.

Things You Should Know

It’s understandable that people might be hesitant to try marijuana as a part of their treatment plan, but much of this leeriness is likely to stem from common misconceptions. Contrary to popular belief, marijuana will neither lower your IQ or cause brain damage. In fact, in the case of Alzheimer’s disease, cannabis has been shown to actually prevent brain cell death.

 A lot of individuals are also concerned that cannabis is physically addictive. Unlike the opiates or sleeping pills that many seniors take, this is untrue. And, since there are hundreds of different “strains” of marijuana currently being cultivated, it’s easy to find relief without the high, depending on one’s personal preference.

Overall, and despite not being covered by medical plans, cannabis is safer and more cost effective than prescription drugs, while also coming in a wider variety of forms. While cannabis does exist in capsule form, many opt for one of the other methods of ingestion. In addition to smoking it, marijuana can be added to food and consumed (in the form of edibles), vaporized, rubbed into the skin, or taken orally in the form of droplets. The many different methods of receiving relief means that individuals can customize their personal treatment plans to suit their own physical needs and tastes.

Moving Forward

If one of the individuals in your care has recently expressed an interest in trying medical marijuana for themselves, the process of doing so is fairly straightforward, with countless resource online to guide them along the way.

That said, given that cannabis is still illegal on the federal level, insurance companies are hesitant to cover its use (or consultations specifically for its use). These does mean that all expenses will be out-of-pocket, though in the long run medical marijuana is often much less expensive than treatments traditionally covered by health plans.

We understand that marijuana, despite it being legal here in California, can be a controversial subject, but in the interest of furthering knowledge, we wanted to take the time to talk about the ways others are finding relief. Because ultimately, that education is what we are all about.

 

Medical Marijuana and Seniors, Part 1: An Introduction

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When you begin to dig into the origins of cannabis in the United States, you don’t expect to so quickly run afield of “the known.” And yet, for a drug so storied and culturally significant, its emergence into our public consciousness is perplexingly murky—like the wisps of smoke its name brings to mind, impossible to pin down.

“The known” (or its abundant lack thereof, rather), seems something of motif when it comes marijuana, but one particular detail is accepted as a certainty:  senior citizens are turning to its medicinal varietals in record numbers. According to a national survey by the Center for Disease Control, marijuana use by seniors (age 65+) rose 333% between 2002-2014, and by 455% among baby boomers (age 55-64).

What was once “that thing curious teenagers experimented with,” or a substance vilified as a dangerous gateway drug (see: Reefer Madness), has since been embraced as the newest frontier in the field of geriatric medicine. While clinical studies on cannabis have been limited in the U.S., given its federal status as a Schedule I controlled substance, they are being done elsewhere.

A recent prospective study published in the European Journal of Medicine, and performed by researchers at Israel’s Cannabis Clinical Research Institute Ben-Gurion University of the Negev, found that “therapeutic use of cannabis is safe and efficacious in the elderly population.”

Throughout the six month study period, 2736 patients aged 65 years or older received cannabis therapy for a variety of ailments, with the most common indications for use being pain and cancer (66.6% and 60.8% of patients, respectively) according to a questionnaire administered at the start.

At the end of the study, a whopping 93.7% of patients reported that their condition had improved, and that their reported pain level had been “reduced from a median of 8 on a scale of 0-10 to a median of 4.”

By the time the study came to a close, 18.1% of those treated with cannabis had either reduced their dose of opioid analgesics, or had quit taking them entirely.

With opiate addiction on the rise among baby boomers and seniors, the information gleaned here presents cannabis as a viable and non addictive alternative for pain management among America’s aging population.

With seniors being one of the fastest growing demographics showing a curiosity for cannabis, assisted living facilities — in states where medical marijuana is legal — are taking note.

In Orange County, each month about 50 seniors from Laguna Woods Village board a free shuttle to a local dispensary in Santa Ana. Some of the spritely folks taking the bus were detailed in an April article from CNN, including the 79-year-young Christy Diller.

“I’ve got rheumatoid arthritis really bad. That’s why I’m taking the marijuana,” Diller said. She eats a marijuana brownie every night, about two hours before she goes to bed. Before marijuana, she’d get about only two hours of sleep a night. “I was like a walking zombie, and that was almost every day.” Now, with her brownies, she gets a full night’s rest.

Like a number of the patients on the aptly nicknamed “cannabus,” the primary concern expressed by some seniors and their caregivers is that they might get high. One of the most common misconceptions about marijuana is that it always has a psychotropic component — the compound THC. This may have been true in the past, as the industry has grown, so have the options available to the curious. As cultivators and producers of medicinal pot continue to innovate, they’ve developed new strains with all the therapeutic benefits and none of the high.

The compound (or cannabinoid) responsible for many of these medicinal benefits is Cannabidiol, or CBD for short. It’s effectiveness in the treatment of epilepsy is one of its most remarkable qualities. Because CBD can be extracted from the cannabis plant, its benefits can be reaped without its users ever having to light up. And since CBD is not psychotropic, it’s now being safely used as seizure medication in children.

But the benefits of CBD don’t just extend to epilepsy. From glaucoma, to chronic pain, to Parkinson’s disease, there are dozens of conditions that the aging population lives with on a daily basis — conditions whose symptoms are tempered or completely treatable through therapeutic doses of medical marijuana.

We will explore these benefits in greater detail in Part Two of our series about Medical Marijuana and Seniors, where we will also discuss several things caregivers and seniors should know before they consider cannabis as a treatment.

On The Importance Of: Parkinson’s Awareness

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Within the next nine minutes, someone will receive a new diagnosis of Parkinson’s disease. In the time it takes you to finish this article, one more life will have forever been changed.

It could be that this life belongs to someone already in your care, or to an individual you’re soon to meet. But more than likely, it will belong to neither—the life of someone you’ll never be aware of, except in your knowledge of what this past month meant. Perhaps he’s an aging, heartland farmer who wouldn’t give up his tractor for all the soybeans in McLean County, or a 20-something bride-to-be who never knew the white of a wedding dress could be trimmed with early onset uncertainty:  grey, the color of the Parkinson’s awareness ribbon.

April was Parkinson’s Awareness Month, and by the time it came to a close, nearly 5,000 more Americans learned that they had PD. That adds up to an estimated 50,000 to 60,000 new diagnoses every year, each joining the already 1,000,000 individuals affected in the United States, and the nearly 10,000,000 persons worldwide.

April was Parkinson’s Awareness Month, but for the individuals living with the disease on a daily basis, so is every month. So as we move into May, and June, and on into next year, we’d like to reflect on this vital call to action, and the unique role caregivers and nurses can play on the front-lines of awareness.

Currently, there is no known way to halt or reverse the effects of this neurological disease, although there are medications individuals can take to manage their symptoms. Part of the problem is that scientists still aren’t sure what causes PD. The lack of answers providing a direction only makes targeting the disease more difficult, and therefore more expensive.

Thus, the main intent of Parkinson’s awareness is to foster a sense of public urgency. With an increase of attention, comes an increase in those providing money that researchers can draw upon in their push towards a cure.

In an effort to raise the public profile of PD, the United States Congress designated April as Parkinson’s Disease Awareness Month in 2010. Since then, what was once just a national campaign has grown into a multi-national mission each year, with a push for awareness in Canada, too, and throughout the rest of the world.

But Parkinson’s Awareness Month isn’t solely about driving fundraising efforts. It’s also about raising the overall public understanding of the disease.

Though many people have at least heard of PD, few know just how prevalent it is. Parkinson’s disease is the 14th leading cause of death in the United States, according to the Center for Disease Control, and more people currently live with it than those with multiple sclerosis, muscular dystrophy, and ALS combined.

What’s worse, though, is that ever fewer would know the symptoms of PD well recognize it in a family member, their friends, or even themselves. But you can help change that.

As caregivers and nurses, we are afforded the unique opportunity of interacting with dozens of persons in assisted living each day, as well as their family members and friends. In a sense, as we care for these individuals, we also help to provide care and peace of mind to anyone in his or her orbit. Though we may not yet have a cure at hand, what we do have at our disposal is knowledge, and an ability to educate anyone with an open ear. Our experiences on the floors of hospitals and assisted living facilities provide a unique point of view within the discussion of Parkinson’s disease.

But our voices shouldn’t just be adding to the conversation; they should be starting them. If we take up the secondary mantle of teacher, we can raise the flag of awareness to previously unseen heights. We know how Parkinson’s disease manifests, and what the common (and uncommon) symptoms are. In the battle for a cure, we can arm those around us with knowledge, and a newfound ability to recognize the beginning stages of Parkinson’s in their friends, their families.

Care doesn’t always take the form of one-on-one treatment. In the form of awareness, like a pebble in a lake, it will ripple outward to serve the greater whole.

Let it start with you.

For additional reading about Parkinson’s disease, check out our special feature about Michael J. Fox and PD from February!

Creating a Better Living Environment for Residents

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There’s a lot of psychology that goes into the design of marketing products and store layouts, drawing the consumer’s attention to different products, various shelving levels, or placing cheap, tempting items close to the register (i.e., “impulse buys”). Every product in the store has been designed and marketed to persuade your buying behavior.

A similar approach can be used in assisted living care, or other facilities which provide services to seniors, especially in memory care. Instead of inspiring residents to make purchases, carefully planned decor can make residents feel more comfortable and safe in their surroundings.

In the past, many facilities had used bland colors, similar to what you would find in a hospital. These neutral colors were thought to be non-offensive and less distracting, which they were, but sometimes tended toward bland. However, recent changes have been implemented in some memory care facilities that move away from mundane decor, and create environments that residents enjoy seeing and living in.

This doesn’t mean that anything goes; different designers have taken care in their choices of decor, including choosing colors and patterns that are not overly stimulating.

Mindful Designs

Designs for assisted living facilities should keep their main functional goals in mind, but there’s still plenty of room to add custom touches as well.

The design of common rooms should be open to flexibility, to accommodate different activities, gatherings, and special events like holiday parties or guest musicians.  These areas can also help build a bridge between the facility and the community, as an inviting space to bring in volunteers to engage with residents, put on performances, or other unique occasions.

At the same time, while it is nice to be able to rearrange furniture, it is useful for residents if those rearrangements are kept to a minimum, especially for those with cognitive or memory issues. Maintaining a familiar space can help avoid confusion, and even trips or falls.

Less is always more, especially in an assisted living environment. Rooms and common spaces should be clutter-free to help keep clear pathways and also reduce fall risks.

Color Coordinating

Attributes of the actual decor can also evoke positive (or negative) feelings and associations. Natural colors or colors associated with nature (brown/wood, green/foliage, yellow/earthy) are warmer and friendlier, while blues and greys tend to be cooler yet sophisticated.

Another thing to consider in color choice is that color/vision also tends to change as we age. Seniors see more yellow, and gray is often a common color used in institutional settings. It’s suggested that using greens and yellows can help enhance colors in seniors’ vision.

Bold or dramatic patterns are not typically the best for residents in an assisted living situation, as it may be overly stimulating. Subtle patterns, accent colors, and gentle contrasts are useful, however, and can help denote a transition or border from one room to the next.

Natural Lighting Benefits Everyone

When possible, take advantage of natural day light to brighten a room. Not only is it ‘friendlier,’ but it can physiologically help residents stick to a regular sleep cycle. Exposure to natural light could potentially increase exposure to Vitamin D, which encourages muscle movement, cell growth regulation, and helps the body absorb calcium – a crucial benefit in the fight against osteoporosis.

Using more natural light is also a cost-cutter in terms of electricity, a  financial beneficial to the facility as well – a benefit everyone can enjoy!

A Home Environment

Sticking to warm or lively colors can make the facility friendlier and more like home, which can have a positive effect on residents and their families alike. It can help the environment feel less institutionalized and more personal and therefore comforting.

Furniture should be comfy, but not too comfy; extra cushy chairs can be difficult for residents to climb out of. Firmer, supportive chairs at an appropriate height, for example, would be a better practicality.

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