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

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.

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

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.

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

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

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

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

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

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.


Assisted Living Education is a premier provider of classroom-based and online coursework for professionals in assisted living. We offer RCFE licensing, continuing education, and consulting in specific areas like compliance, staff training and licensing. Please visit our contact page to reach us for any inquiries.


Brain Injury Awareness in the Elderly

It’s a given that seniors are more susceptible to injuries from falls than younger individuals. Many believe the most pressing concern is the damage caused by a broken hip or another bone injury. However, both men and women over the age of 70 are three times as likely to suffer a potential brain injury than a younger individual.

While something as mundane as tripping on the curb or missing a stair may seem harmless, these falls can lead to serious brain injuries in the elderly. Seniors make up a significant portion of all concussion patients in the U.S, and falls are one of the leading causes of these traumatic brain injuries. That is why it is so important to keep yourself, your staff, and your patients educated on the most common causes and signs of a brain injury, as well as having a plan in place to handle them as quickly as possible. A fast and appropriate response can make all the difference.

Since March is Brain Injury Awareness month,  Assisted Living Education would like to review why seniors are at a higher risk of head injuries, and what you can do to prevent them.

What Increases the Risk of Brain Injury?


Even the most self-reliant seniors can be at a higher risk of sustaining a traumatic head injury. Many of your residents may be on various medications that can undermine the user’s balance, coordination, reflexes, muscle strength, or spatial reasoning. Even seemingly harmless drugs such as aspirin, Motrin or fish oil supplements can have unintended side effects such as dizziness or diminished coordination. These side effects can make the resident more likely to stumble.

Those who do suffer a fall while on blood thinners have a higher potential for damage to the brain because these medications raise the chance of blood pooling in the head. Residents who take multiple prescriptions or use over the counter medications on a daily basis are going to run a higher risk of experiencing these side effects. It’s essential that the healthcare team is aware of the possible side effects of medications that their residents are on, and keep an eye out for those who may be more vulnerable to those side effects.

Past Injuries

Individuals who have suffered from a hip or joint injuries in the past, those with a history of nerve damage, or those with weakened bones may also be more likely to fall due to strenuous activities. It can be difficult for some individuals to remember their limits as they age and it’s not uncommon for someone to push themselves too far and fall as a result. Guide your residents through more physically challenging tasks and when in doubt encourage them to take it easy.

Poor eyesight can also be a factor. Ensure your residents have proper lighting and prevent tripping hazards. If your resident wears glasses, regular visits with the optometrist can ensure their prescription is up to date. Some individuals might be aware of their worsening eyesight but unwilling to speak up. If you recognize any sign of a struggle seeing, such as: sitting closer than usual to the TV, or difficulty with reading, etc. If the resident is able to articulate any issues they are having, it would be worth inquiring if they are having difficulties with their sight. If they are not able to articulate, gather your observations and present them to the attending physician for review.

What to Look For and Do if You Suspect a (Traumatic) Head Injury Has Occurred

The most important thing to remember is to treat any potential head injury as if it is one. Be aware of the signs such as slurred speech, loss of memory, or poor balance. Look out for any visible injuries such as bumps or cuts on the head or neck, but don’t assume that an injury isn’t present just because you can’t see it. Alert the resident’s physician whenever a head injury is suspected. Urge the patient to remain still to prevent further damage or complications and call 911. The faster you identify a head injury, the sooner the resident can receive treatment. Every second matters. It’s also important to treat every fall as if there might have been an injury. For residents who have been aware, it is appropriate to conduct an orientation assessment (e.g., what year it is, the date, etc.). If the resident was not presenting this kind of cognitive awareness prior to the incident, close behavioral monitoring, a physical exam and possibly further testing may be appropriate, depending on the suspected severity of the incident.


The best way to keep your residents safe from head injuries is to take steps to prevent them in the first place. One of the easiest ways to do this is through movement and exercise. If the residents are independent and/or ambulatory, encouraging them to take short walks and stretch is helpful. Some residents may be enlisted in a physical therapy program if they require assistance or rehabilitation to maintain or improve their physical health. A proper diet and regular exercise can help your residents improve their muscle and bone strength to diminish the likelihood of secondary injuries that can lead to brain trauma. Remember to always check with your resident’s physician before making a change to their diet or exercise routine.

Another key to prevention is to make their surroundings as safe as possible. Look out for slippery surfaces or tripping hazards such as loose cords or rugs. Move frequently used items, so they are within easy reach. Work with your residents and other staff to make sure the environment they live in does everything it can to keep them safe.

Assisted Living Education is committed to providing the most up-to-date information possible. Our passion for helping caregivers enrich the lives of their residents is what led us to become a premier source for education, resources, and certifications in the industry. Explore our website, or reach out to us via our contact page with any questions you might have on RCFE certification, our online courses, or other assisted living-related services.


Common Types of Arthritis Seen in Elderly Residents

Arthritis is one of the most common diseases associated with aging. Nearly half of Americans over the age of 65 have been diagnosed with arthritis by their healthcare provider.

Many believe they are fully educated about the signs and symptoms of arthritis, but what you might not realize is that there are more than 100 different types of the disease, and each one has its own causes, symptoms, and treatments.

Some variations of the disease can affect more than just your joints. It’s important to stay informed about the different types of arthritis to provide the best care possible for your residents.

What is Arthritis?

The word arthritis comes from the Greek word athron meaning “joint”. Arthritis is not actually one single disease, but encompasses a host of issues that often present most obviously in the joints. It takes numerous forms and has just as many causes.

Surveys show that arthritis is the most common disability in the United States. Every day more than 50 million Americans have to cope with this degenerative disorder. It limits the ability to walk, climb stairs, bend over, kneel, etc. Over time, arthritis can be restrict the capacity of an individual to participate in every day tasks, which can potentially lead to subsequent emotional health problems.

The Most Common Types of Arthritis


The most common type, osteoarthritis, occurs commonly in the elderly due to the result of years of wear and tear on the joints. Past injuries or excessive physical activity (such as from a physically strenuous job) are often to blame.

To help residents relieve or manage pain from osteoarthritis, alternating hot and cold packs on the affected joints is one non-medicinal way. Hot packs help increase blood flow to relieve joint stiffness whereas cold packs can diminish swelling. Over the counter pain medications can also provide relief, but the attending physician and possibly other members of the team will decide to administer these medications. For chronic pain, a doctor or physical therapist may recommend the use of a brace or splint.

Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is an autoimmune disease and the second most common form of arthritis. Normally our immune systems protects us from viruses, and bacteria. However in those suffering from RA, the immune system goes on the offensive against healthy tissue. The immune system attacks the synovial membrane that lines the joints. The continuous inflammation eventually breaks down the joint beyond repair. Sufferers of RA also cite muscle pain, pain in the skin, chest, bones and ligaments.

Sleep is important for everyone, but for those suffering from RA, it is especially critical. That’s why it’s recommended you ensure your residents have the necessary atmosphere to get proper, uninterrupted sleep at night.

Naps during the day and regular exercise can also help alleviate RA pain, but always verify with the attending physician about any modifications to a resident’s sleep schedule, or exercise routine. In some residents, napping during the day can be enough to disrupt their sleep patterns at night.


While gout is often associated with middle-age, it is actually the most common inflammatory form of arthritis in the elderly with numbers increasing every year in both men and women. It is caused by a buildup of uric acid crystals within the joint, and often affects one or a few joints such as the ankle or big toe, and causes intense swelling and redness.

Although it’s often seen as mundane, gout can still have a devastating effect. A study of patients over the age of 65 in the United States found that those suffering from gout on average spent as much as $3,000 per year or more on medical costs than the control group. The expenses largely went towards treatment, doctors visits, and pain management.

To help relieve your residents’ gout-related pain, it’s important to ensure they consume plenty of fluids. Dehydration can often lead to an increased build up of uric acid crystals and worsen the affected areas. Avoiding high fat protein sources (such as red meat) can also decrease gout symptoms. The dietician on staff should be looped in to the resident’s medical issues so they can be sure to accommodate their nutritional and dietary needs.

Infectious Arthritis

In some cases, a bacterial, viral, or fungal infection can spread to the joints and trigger inflammation. Some infections that can cause infectious arthritis include salmonella, chlamydia, gonorrhea, and hepatitis C. With this kind of arthritis, receiving timely antibiotic treatment is key to preventing the infection from becoming chronic.

It’s important to make sure you have regular communication with your residents so that problems are addressed quickly to provide the best opportunity for recovery. Additionally, for those who may not be able to express their problems or needs, good observation skills are key to noting physical or behavioral changes that may suggest an underlying problem.

Our number one priority at Assisted Living Education is providing the highest quality education and educational resources for those caring for our senior population. We offer RCFE courses & certification, as well as online courses and continuing education. We believe that experience is critical to success, which is why we only employ instructors with extensive experience in the industry and have a reputation for creating engaging and real-world learning environments. Explore our website, or visit our contact page to learn more!


Special Feature: Michael J. Fox and Parkinson’s Disease

In the 1980s and ‘90s, Michael J. Fox became a household name in the U.S. His success in the TV series “Family Ties,” and cult classics including the Back to the Future series, Teen Wolf, Doc Hollywood and others made him a popular actor; a young guy full of energy and a lifetime of roles ahead of him.

However, it was his Parkinson’s diagnosis and drive to support further research that has really cemented the path toward his legacy.  At the early age of 29, he struggled with his Parkinson’s diagnosis for seven years before he went public with the news in 1998. He began his mission to bring awareness and advance more funding and support for a much-needed area of research.

In assisted living environments, a Parkinson’s diagnosis is not uncommon. Assisted Living Education will review the characteristics of Parkinson’s Disease, as well as developments from Michael J. Fox and The Michael J. Fox Foundation for Parkinson’s Research.

Parkinson’s Disease: Basic Facts

Parkinson’s Disease (PD)  is a neurodegenerative disorder recognized by many from its distinctive features, such as tremoring, slowed movement, changes in posture, speech, and more.  Often times, many people are more familiar with the classic motor symptoms of the disease, but The Michael J. Fox Foundation does a great job of highlighting both the motor and non-motor attributes:

Motor Symptoms:

  • Bradykinesia – a slow-down and loss of spontaneous and voluntary movement.
  • Rigidity – unusual limb stiffness or in other body parts
  • Resting Tremor – an uncontrollable movement affecting a limb when it’s at rest and stops for the duration of voluntary movement.
  • Postural instability – difficulty standing or walking, or impaired balance and coordination
  • Other Physical Symptoms, including gait problems and reduced facial expression

Non-Motor Symptoms

  • Cognitive Impairment – a decline in the ability to multi-task/ concentrate and possible decline in intellectual functioning
  • Mood Disorders – depression and anxiety
  • Sleep Disorders – REM Sleep disorders, in which individuals act out their dreams
  • Low blood pressure when standing
  • Constipation
  • Speech and swallowing difficulties
  • Unexplained pains, drooling, and loss of smell


It’s estimated that about one million Americans live with Parkinson’s Disease, with men being 1.5 times more likely to develop the disease than women. Most diagnoses come later in life, typically between the ages of 60-80, though symptoms can begin appearing around 50 years old.

However, as in the case of Michael J. Fox, there are people who are diagnosed much earlier in life. If diagnosed before the age of 50, it is considered Young-Onset Parkinson’s Diagnosis (YOPD). There are varying estimates as to the incidence of YOPD, but it may be around 10% of all Parkinson’s diagnoses.

Daily Life

Depending on the progression of the disease, therapies, and medicinal treatments are in place, some Parkinson’s symptoms are manageable. However, as the disease progresses, managing the symptoms can require more intensive treatments. 

When Michael J. Fox makes his public appearances, he still appears to have the same vitality as he always has. Obviously, his physical manner have changed with the effects of Parkinson’s and medications he’s on, but his drive and intensity are clearly still present.

Despite this, what strikes many who have PD is the level of fatigue they experience. There are physical and mental roots to this fatigue. The Michael J. Fox Foundation describes this fatigue as existing on a “cellular level” since the body is putting more effort into completing tasks that many other individuals take for granted. Additionally, coping with these changes in an individual’s body is mentally and emotionally taxing.


Some individuals with Parkinson’s develop dyskinesia, which are abnormal, uncontrolled, involuntary movements. The Michael J. Fox organization describes its appearance as fidgeting, writhing, head bobbing, or body swaying.

Dyskinesia does not manifest in all individuals with Parkinson’s. There are a few factors which contribute to its development, which include early-onset PD and complications of Levodopa use, which has been the primary medication used in the treatment and management of Parkinson’s. Parkinson’s develops in part to the loss of dopamine production in the brain.

Levodopa facilitates dopamine production in the brain and helps reduce the motor symptoms commonly associated with the disease. (Side note: Levodopa is also combined with Carbidopa, which helps enhance Levadopa’s effectiveness, in addition to curbing the nausea and vomiting side effects.) However, because the effect only lasts so long, Carbidopa-Levodopa must be taken several times throughout the day to help maintain the dopamine levels. Even so, a fluctuation in dopamine levels still occurs, which is commonly referred to as an “on/off” period; the “on” being when the medication is still working, and “off” when it’s worn off, typically before the next dose is due.

The Future of Parkinson’s Disease

There is no cure for Parkinson’s Disease yet, but Michael J. Fox has truly spearheaded efforts to bring awareness, funding, and more research towards developing new treatments. Since its inception in 2000, the Michael J. Fox Foundation has funded more than $750 million into research to expedite a cure for Parkinson’s Disease.  He’s hosted annual galas with celebrity guests, done numerous interviews, and of course, provides numerous educational tools through the foundation’s website.

In the meantime, much of the research being conducted in the field is producing new results in early intervention and factors in predicting or accurately diagnosing PD, as sometimes the symptoms can resemble other conditions in its early stages.

Assisted Living Education will continue to post developments in newer treatments or therapies involved with Parkinson’s Disease.

Assisted Living Education is a premier provider of classroom-based and online coursework for professionals in assisted living. We offer RCFE licensing, continuing education, and consulting in specific areas like compliance, staff training and licensing. Please visit our contact page to reach us for any inquiries.