Archive for category: News

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.

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.

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.

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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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.

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

Osteoarthritis

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.

Gout

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!