If I Get Dementia, Don’t Treat Me Like a Child

On behalf of those who have the disease, a caregiver offers requests for how to treat people with dementia.

On behalf of those who have the disease, a caregiver offers requests for how to treat people with dementia.

A woman who works with people with dementia knows how she would want to be treated if she had the disease and offers her own list of “16 Things I Would Want, If I Get Dementia.” Rachael Wonderlin, the director of Memory Care at Blue Harbor Senior Living, specializes in long-term dementia care. Her first request:

“If I get dementia, I want my friends and family to embrace my reality. If I think my spouse is still alive, or if I think we’re visiting my parents for dinner, let me believe those things. I’ll be much happier for it.”

— Rachael Wonderlin

She would also ask that you “ask me to tell you a story from my past” and wants you to know that she “still likes receiving hugs or handshakes.” Whatever you do, “don’t talk about me as if I’m not in the room.”

For a list of all 16 requests for how to treat people with dementia, visit the Alzheimer’s Reading Room.

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Sit Back and Relax in Your New Car

Electronic features will help you avoid accidents on the road and in parking lots, giving you time to enjoy your car’s entertainment center.

Electronic features will help you avoid accidents on the road and in parking lots, giving you time to enjoy your car’s entertainment center.

So you’ve decided to trade in your old sedan for a new one, one with all the bells and whistles. You might be surprised by all the electronic features, which not only make driving more fun but also safer—and more complicated. Many car dealers now provide classes for new car owners to learn about all the electronic gadgets.

While you had to read a gas gauge in your old car to see that your fuel tank was almost empty, new cars will tell you not only how many miles you can drive before you need to fill up, but also your current estimate of how many miles you’re getting per gallon—that is, whether you’re getting good fuel mileage or not. New cars will determine when to turn on and off your bright lights and the speed of the windshield wipers. Instead of having to test the air pressure in your tires by actually getting out of the car, monitors will let you know if they are becoming under-inflated.

Safety on the Road

In addition to driving efficiencies and conveniences, new safety features allow you to avoid accidents. For example, you’re in heavy traffic when you’re distracted by your dog gnawing on something that sounds suspiciously like your new car upholstery, and you turn for a split second to look at the back seat. Luckily, sensors on your car (using cameras, radar, laser or some combination) will warn you with either a visual or audible signal that you are getting too close to the car in front of you. If you aren’t reacting fast enough, and a collision is imminent, some cars will even help brake the car.

If you start to drift off into another lane, without signaling your intent to do so, maybe just as you’re reaching for your coffee mug, the car will either adjust your steering to stay in the lane or alert you that you’re drifting. It does this through the use of a camera that detects lane dividers and raised pavement markers.

To keep a safe distance between you and the vehicle in front of you, an adaptive cruise control will automatically slow your car down in traffic without you having to do anything. As traffic speeds up, the cruise control will automatically let the car accelerate to maintain the preset speed, letting you concentrate on your phone call home.

Care-Free Parking

Parking lots are notorious for fender-benders because of cars constantly pulling in and out, plus the always-present pedestrian. As we get older, stiffer necks and less flexible shoulders make it more difficult to see all around us. Plus it’s not easy to see down low or on the side of the car, where children or pets might be. Now, reverse backup sensors will let you know if you’re getting too close to another object—whether a car or dog—either by beeping at you or displaying what’s behind you. Similar sensors can detect a car on your side, such as in your blind spot.

Even the bane of most motorists—parallel parking— is now easier. On some new cars, a feature detects the size of a parallel parking space, guides you into the starting position, and then lets the computer back the vehicle into the tight space.

That’s Entertainment

All of these features leave more time for the real purpose of owning a car: your own personal entertainment and connectivity center. With Bluetooth, you can talk on the phone without taking your hands off the wheel or listen to music from your device, Pandora, Sirius or the radio that is booming over up to seven speakers (with an option for a subwoofer). You can add a video player to entertain backseat occupants.

Built-in navigation, shown on an 8-inch screen in the dashboard, helps you find your way, and voice controls mean not having to use your hands to enter your destination or even the phone number of the person you want to call.

Most recently, some car makers are offering Apple CarPlay and Android Auto, which reproduce your smartphone’s features on the car’s dashboard, so you don’t have to learn a new interface.

Coming soon: driverless cars. Maybe drivers can even start watching videos in the car.

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Green Houses an Alternative to Nursing Homes

These small dwellings in residential neighborhoods provide a family environment with individualized care for the same price as an institution.

These small dwellings in residential neighborhoods provide a family environment with individualized care for the same price as an institution.

While surveys show that most older people want to live in their homes as they age, for many this is unworkable, as they face loneliness and lack of support for health and physical issues. Often, seniors don’t want to leave their homes because they fear losing their independence if they move into care facilities such as assisted-living or nursing homes.

That’s where the Green House Project comes in. For older adults who can no longer live on their own, this alternative nursing home provides shared living and 24-hour support, but with the ability to live as independently as you desire. A Green House (which is not green in color, doesn’t provide a place to grow plants and doesn’t refer to an environmentally progressive place) is a large house generally shared by seven to 10 adults (although some places have more). Each resident has their own room and bathroom, but shares a communal kitchen and living room.

The Green House Project describes itself as providing long-term and post-acute care. In the words of its founder, William H. Thomas, the Green House Project aims to create “a real home that provides care but also supports those seeking to redefine the worth and meaning of late life. [It] represents a massive shift toward the deinstitutionalization of older people. It generates human warmth, as opposed to institutional coldness, through its commitment to small size (seven to 10 residents in each house), its de-emphasis on hierarchy and its complete dedication to fostering a new expression of elderhood” (from Next Avenue).

How It Started

Film Documents One Town’s Efforts

With a strong desire to take care of their elderly, a group of citizens in the small town of Sheridan, Wyo., went through a 12-year struggle to establish a Green House project. The effort involved finding land and funding, having to change the local laws to make this kind of care possible and raising millions of dollars during the 2008 economic crisis.

A documentary, Homes on the Range, captured the struggle and ultimate success: the only independent, not-for-profit, purely grassroots skilled nursing facility in the United States, not affiliated with or dependent on a larger corporation or hospital. Four cottages were opened in 2013, with 48 residents and 65 support staff, and plans are to add more houses, including cottages for veterans’ groups.

The film has been shown on PBS stations around the country, and is available as a DVD. A short clip is available from the Media Policy Center

Thomas, a geriatrician, international authority on elder care and author of four books on the subject, cofounded Eden Alternative in the 1990s. The nonprofit organization partners with nursing homes and other long-term care facilities with the aim of deinstitutionalizing them. In 2003, he started the Green House Project, also a nonprofit organization, which puts into reality the philosophy of the Eden Alternative. The Green House Project partners with the Robert Wood Johnson Foundation, which provided a $10 million grant in 2005, and Capital Impact Partners, which provides technical assistance and coordinates financing. The first Green House Project home was constructed in 2003 in Tupelo, Miss. In December 2008, the project reached its goal of completing 50 houses by 2010. As of February 2015 there are 174 Green House homes in 27 states with another 186 in development (Wikipedia).

How a Green House Works

Unlike traditional nursing homes, which can be huge institutions, Green Houses are literally homes, usually situated in a neighborhood. They are centered on a large living room, dining room and kitchen in one great room, which encourages communication and community. Rather than residents eating at different, smaller tables, they share one large table, emphasizing the sense of a family or community eating together. Each resident, called “elder,” can furnish and decorate their room and bathroom how they want (unlike institutionalized rooms with largely bare walls).

Residents can get up in the morning and to go to sleep when they want, which provides a lot of freedom and flexibility. In contrast, nursing homes enforce a strict sleeping and eating schedule. In Green Houses, residents can eat when they want, although meals are often shared.

To ensure quality, Green House homes are trademarked and built to strict certifications. These dwellings meet federal and state licensing requirements and operate within existing regulatory and cost frameworks.

How the House Is Staffed

Green House homes are staffed by a nurse 24 hours a day. Other staff include certified nursing assistants who perform all the duties found in a traditional nursing home, including dressing, bathing and toileting. Green Homes also provide physical, occupational and speech therapy, but often in a Green Home dedicated for that purpose. For example if an organization built six green homes, it would dedicate one to short-term rehabilitation, in order not to disrupt the routine of the main homes, according to Scott Brown, director of the Green House Project.

Residents with Alzheimer or other forms of dementia are integrated into the home, although some organizations have built homes specifically for those with Alzheimer’s. Although Brown was unable to provide a figure for the staff-resident ratio, he said the “time dedicated to direct care exceed ratios in traditional nursing homes.”

The relationship between the staff and residents is viewed as a partnership rather than the traditional nursing-home role of caretaker and patient. For example, the Eden Alternative’sdefinition of care is “that which helps another to grow. . . . It acknowledges that opportunities to give and receive are abundant and experienced by everyone involved in the care relationship.” Residents are encouraged to interact with staff and even develop personal relationships.

To emphasize the more informal relationship with residents, staff members are given playful names. The Shahbaz works with the clinical support team of nurses, therapists and dietary professionals to provide individualized care for each elder. The Guide is responsible for the operations of the home, while the Sage is a local elder who volunteers to be a mentor and adviser.

How Much It Costs

Despite the smaller residences, independent research has found that Green Houses cost the same or less to operate than traditional nursing homes, while delivering four times more personal and social contact (Next Avenue). One study found Green Houses cost $1,300 to $2,300 less in total Medicare and Medicaid costs per resident over 12 months than traditional nursing homes. At a Green House in Grand Rapids, Mich., a monthly stay is $10,230, comparable to a good nursing home (New York Times).

Organizations are making an effort to help low-income seniors get into Green Houses. Thanks to a $2.2 million loan through Age Strong, an initiative of the AARP Foundation, Capital Impact Partners and Calvert Foundation, a new Green House in Akron, Colo., plans to have 60 percent low-income residents who are covered by Medicaid. The Green House, expected to open this year, will replace an outdated traditional nursing facility.

Green House Project homes that are licensed as traditional nursing homes are eligible for the same Medicaid and Medicare reimbursements as a traditional nursing home. If the facility is licensed as assisted living, Medicaid reimbursement depends on the state’s assisted-living provisions. For Medicaid, the expenses are equivalent to the traditional Medicaid costs for nursing homes. For private pay, each facility determines its own cost structure.

What Research Has Shown

Several studies have favorably compared Green Houses to traditional nursing care. The Robert Wood Johnson Foundation Green House Workflow Study found that nursing home residents were hospitalized more often (more than 7 percentage points higher per resident over a 12-month period) than Green House residents. As such, annual Medicare hospitalization expenditures per resident were less in the Green House unit relative to traditional units.

A 2009 evaluation of the Green House Project’s care found it provided higher direct care (23–31 minutes more per resident per day) than traditional nursing homes and more than four times as much staff engagement with elders outside direct-care activities (Wikipedia). In a 2004 report presented to Congress, researchers from the University of Minnesota School of Public Health found that elders in a Green House Project home were able to perform daily functions longer than those in traditional nursing facilities. Among those living in Green House homes, there have been increased reports of mobility and social interaction, and fewer reports of weight loss and depression.

With Your Resume, Show You’re Up-to-Date

It’s a new world for seniors looking for work, so make sure your resume has the right words and avoids revealing your age.

It’s a new world for seniors looking for work, so make sure your resume has the right words and avoids revealing your age.

Whether you’re looking for part- or full-time jobs, your resume tells more about you than you might realize. For one thing, in a culture where anyone older than 50 is deemed “old,” listing too much of your work history will peg you as not able to function in a technology- and youth-focused workplace. For another, keywords will either get you in the door for an interview or get your resume tossed on the heap with others.

Whether you’ve found a job opportunity through an online job-listing site, your LinkedIn profile or the old-fashioned method of networking, an important first step is your resume.

Use the Right Keywords

In this electronic age, instead of a human looking at your resume, software will scan it for keywords—terms specific to your industry. That includes your work skills and background (such as human relations, research and planning, management and computer skills) and your proficiency with specific software and technology. To get an interview with a real person, you need to use the keywords that are listed in the job announcement. This also demonstrates that you know the language, are technically savvy and are up-to-date on current buzzwords.

Beyond industry buzzwords are keywords that are more action oriented than “my duties included” or “I was responsible for . . . .” About.com divides keywords into three categories. Examples of skill keywords include wrote, analyzed, quantified, planned, programmed, designed, created, built, taught and trained. Stress your accomplishments with results words such as increased, reduced, redesigned, upgraded, initiated, implemented, reformulated, generated and produced, as in “I reduced turnover by 20 percent by implementing a mentoring system.”

Third, recognition keywords emphasize your performance at past jobs, such as being awarded or promoted for having the best sales record. Other words include selected, lauded for, received a bonus for, recognized, chosen and credited.

Make sure you also include keywords in your cover letter.

Age-Proof Your Resume

In a culture that openly discriminates against older adults, you can downplay your seniority in several ways. At some point, your wealth of experience will become obvious to a prospective employer, but there’s no need to emphasize it.

Limit Your Work History

Experts advise that you only list jobs going back 15 years. If you have relevant work experience that goes back further than that, list it in another section titled “Other Experience” or “Previous Experience,” and don’t give dates. Some experts suggest prioritizing your resume, so the most relevant work is listed first rather than chronologically.

If you have volunteer experiences that are relevant to the prospective job, you can beef up your resume by listing your responsibilities, skills or recognition in these non-paying jobs.

Don’t List Years

If you include a summary at the top of your resume, don’t indicate your extensive background, as in “experienced manager,” or reveal how many years you’ve been working. Similarly, don’t include your high school or college graduation dates.

Finding Help

If your resume is not producing the results you want, experts advise hiring a professional resume writer. However,AARP encourages caution.

Check with associations. Resume writers can earn certification from theNational Résumé Writers’ Association and the Professional Association of Résumé Writers & Career Coaches, but certification is no guarantee that the writer will do a good job. Check the writer’s website for their experience, qualifications and recommendations.

Do an interview. Good resume writers take time to interview clients about their experience, qualifications and goals, rather than sending a template for you to fill out. Also ask résumé writers about their experience and understanding of your industry.

Ask for the price. Many résumé writers charge by the hour—between $15 and $250—so make sure you know how much you’ll have to pay. A good resume could take anywhere from five to eight hours to write, so be prepared to shell out some money. Upfront payment, which is tax deductible, is usually required.

Use the Right Resume

In the past, you may have used a chronological resume, but at this point in your career, a functional resume, which focuses on your skills (but can also include dates), might better suit your purpose. Experts also advise creating a customized resume for each job you apply for, which targets your accomplishments and skills to the posted job rather than revealing your entire experience.

Show You’re Technically Savvy

Make sure you list all the software programs you’re skilled at (but leave off ones that are no longer around) and professional development courses you’ve taken. Include links to your profile on LinkedIn or other professional social media sites.

Avoid Figures

Many employers don’t want to hire older workers because they assume they will have to pay them more. Avoid giving your salaries at previous jobs, and if the employer specifically asks for salary requirements, note in your cover letter that you are flexible.

Review Job Titles

Some experts suggest downplaying your job titles so you won’t seem overqualified. For example, use “senior manager” instead of “vice president.”

Don’t Forget the Basics

Some things never change when writing a good resume, like keeping it simple and focused. It’s a good idea to look at other resumes to get an idea of the standard for today.About.com offers free templates for various resumes. Other tips:

Make a Statement

Most experts advise a short statement about yourself and the kind of job you’re looking for, but avoid generic phrases such as “seeking challenging work environment” in favor of more specific goals.

Keep it Clean

Stick to a clean format—an easy-to-read font, lots of white space and no bold, italic or underlined words. Make sure to proofread (and use the computer program’s spell-check) and ideally have someone else check it also.

Format Correctly

Some employers have specific rules for how you should format and send your resume and cover letter. For instance, they may want you to paste content into the body of an email, or attach documents to an email. Most employers today want you to email your electronic resume or upload it to a company website. So, make sure to add an email signature that includes your email address and phone number. The job listing may specify what the subject line should say; otherwise list which job you’re applying for. Most importantly, don’t forget to attach your resume.

Screenings You Need and Don’t Need

While getting regular tests for certain diseases and medical conditions can prevent health problems down the line, two tests can do more harm than good.

While getting regular tests for certain diseases and medical conditions can prevent health problems down the line,
two tests can do more harm than good.

Many Medicare and other healthcare plans urge their clients, especially older ones, to get regular health screenings, such as colonoscopies. Finding serious medical issues early can mean a longer and healthier life, as well as financial savings for both you and the healthcare plan. Yet, despite all the recommendations, less than 25 percent of Americans ages 50 to 64 and less than half of those over age 65 are up to date on screenings (Next Avenue)

Two Tests to Possibly Avoid

Which tests should you get and which don’t you need? Researchers are questioning the value for older adults of two common tests—mammograms for women and prostate screenings for men. For those who think they have less than five or 10 years to live, it might not make sense to undergo tests that can be uncomfortable or even harmful, and are expensive. For example, men who test high for prostate cancer often have expensive biopsies that can cause infection and pain. If prostate cancer is found, doctors will recommend surgery or radiation therapy that can be painful, even though the slow-growing cancer would not have shortened the patient’s life.

Screenings and ensuing treatment could harm older patients whose health is already fragile, or who have multiple medical conditions. In fact, if the breast or prostate cancer is slow-growing, patients could die from another disease before the cancer affects them.

The U.S. Preventive Services Task Force, an independent panel that weighs evidence and makes recommendations about prevention tests, concluded in 2012 that prostate cancer screening isn’t beneficial at any age and that there’s not enough evidence to know whether women benefit or risk harm by undergoing breast cancer screening after age 74 (fromKaiser Health News)

Yet an article published online in JAMA Internal Medicine in October 2014 shows that many doctors still recommend cancer-screening tests for their older patients. Researchers from the University of North Carolina, Chapel Hill, found that among individuals with the highest risk of dying within nine years, many had undergone cancer screening in the two years before the interview (from Harvard Health Publications).

As mandated by Congress, the U.S. Preventive Service Task Force makes recommendations for 95 screenings that are intended to prevent or reduce the risk for heart disease, cancer, infectious diseases and other conditions. Organizations that focus on one disease or condition, such as the American Cancer Society, have their own recommendations, and different professional organizations, such as the American Medical Association, also make recommendations, which can differ from that of other professional groups.

Common Screenings

The National Institutes of Health and others recommend regular screenings for the diseases and medical conditions listed below. As always, consult with your doctor about whether you need evaluations more often, depending on your risk factors, such as a family history of the disease.

Blood Pressure

Prepare for Health Tests

Before you have a health screening test, ask your doctor these questions:

• Why do I need the test? What will it show about my health?
• What will this screening cost, and will my insurance cover it?
• What do I need to do to prepare for the test? (For example, do I need to have an empty stomach, or will I need to provide a urine sample?)
• What steps does the medical test involve?
• Are there any harmful or side effects from this screening?
• How will I find out the results of my test?
• How long will it take to get test results?
• What will we know after the test?

Source: “What Are Health Screenings?,”NIH Senior Health

Every two years, have your blood pressure checked to detect hypertension, which can cause strokes, heart attacks, kidney and eye problems, and heart failure. If the top number (systolic number) is between 120 and 139, or the bottom number (diastolic number) is between 80 and 89 mm Hg (millimeters of mercury, which refers to how high the pressure in the blood vessels pushes a column of mercury) or higher, have it checked every year.

Breast Cancer

Although there’s some debate about when to start mammograms, women over 50 should have them regularly. The American Cancer Society recommends that women ages 45 to 54 get mammograms every year. Women 55 and older can switch to mammograms every two years or can continue yearly screening. But, at 75, women at average risk of breast cancer can stop routine screening.

Cervical Cancer

Women should get a Pap test every three years to test for cervical cancer. If you get a Pap smear coupled with an HPV test, which detects the strains of the virus strongly linked to cervical cancer, you can delay screening to every five years. After 65, you no longer need the test if results in the 10 years prior were normal, according to the American Cancer Society. Once screening is stopped, it should not be started again.

Cholesterol

Your cholesterol should be checked at least every five years, but check it more often if you have high cholesterol, diabetes, heart disease or kidney problems, use tobacco, are overweight or obese, have a personal or family history of heart disease or blocked arteries, or have high blood pressure. High blood cholesterol increases your chance of heart disease, stroke and poor circulation. Ideally, your total cholesterol should be less than 200 mg/dl (milligrams per deciliter). Your HDL (the “good” high-density lipoprotein) should be greater than or equal to 60 mg/dl, and your triglycerides should be less than 150 mg/dl.

Colorectal Cancer

Between the ages of 50 and 75, you should be tested for colon or rectal cancer with either a fecal occult blood test done every year; flexible sigmoidoscopy (a routine outpatient procedure) every five years, along with a fecal occult blood test; or colonoscopy every 10 years. However, if you have risk factors for colon cancer, including ulcerative colitis, a personal or family history of colon or rectal cancer, or a history of large growths called adenomas, you should have the tests done more often. Ask your doctor which test is right for you. If you are between the ages of 76 and 85, talk with your doctor or nurse about whether you should continue to be screened.

Diabetes

If you are age 65 or older and in good health, you should be screened for diabetes (type 2) every three years. If you are overweight and have other risk factors, such as sustained high blood pressure, ask your doctor if you should be screened more often.

Osteoporosis

Women 65 or older should have a bone density test to make sure their bones are strong and to determine whether they are at risk for a fracture. An x-ray of your spine and hip will compare your bone density to that of a young woman in order to estimate your fracture risk. A score above -1 is considered normal; a score between -1 and -2.5 is classified as osteopenia (low bone mass), and a score below -2.5 is considered osteoporosis. While men are not as susceptible to osteoporosis as women, men age 70 and over should consider getting bone mineral density testing.

Prostate Cancer

Prostate examinations are no longer routinely done on men with no symptoms, because the potential benefits of routine screening for prostate-specific antigen (PSA) have not been shown to outweigh the harms of testing and treatment. However, other factors may tip the balance toward regular screening, so men age 50 or older should talk to their healthcare provider about the pros and cons of having their blood tested for PSA levels, which may indicate the presence of prostate cancer.

Other Tests to Consider

Depending on your risk factors, other screenings can be crucial in finding and treating serious health conditions. Talk to your healthcare provider if you feel you are vulnerable in these areas.

C-Reactive Protein

High levels of this protein point to inflammation and could increase your chances of having a heart attack, especially if you have risk factors such as high cholesterol or a family history of heart disease, or if you are overweight. If test results show more than 3.0 milligrams per liter, you are at a higher risk for heart disease and heart attack.

Depression

If you have felt down, sad or hopeless, or if you have little interest or pleasure in life for several weeks, ask your doctor to do a depression screening. This is essentially a series of questions, but your answers will inform your healthcare provider about whether you need treatment.

Hepatitis C Virus

If you were born between 1945 and 1965, have ever injected drugs or have received a blood transfusion before 1992, you should be screened for Hepatitis C, which can lead to liver damage, cirrhosis and cancer. Baby boomers are especially susceptible because of widespread use of recreational (and illegal) drugs during the 1960s and ‘70s. According to studies, boomers are six times more likely to have Hepatitis C than the rest of the population.

Thyroid-Stimulating Hormone

Women over 60 should be tested for an underactive thyroid (hypothyroidism), especially if you feel tired all the time, are more sensitive to cold, have constipation, experience dry skin and are suddenly gaining weight. Your result should be between 0.4 and 4.0 milli-international units per liter (mIU/L).

Vitamin D

Although vitamin D can be synthesized from sunlight, many people are deficient. This vitamin helps keep bones and muscles strong, may help lower your risk for cancer and heart disease, and may boost your immune system. Your test results should be between 20 and 50 nanograms per milliliter (ng/ml).