Long-term Care Faces Challenges
The increased need for more long-term care, partially caused by an aging baby boomer population, is accompanied by a predicted shortage of care workers. At the same time, the premiums for long-term care insurance are rising, and one large insurer plans to charge single women more. Click here to view article.

By any measure, the current prospects for long-term care (LTC) are not encouraging. First, the sheer size of the aging baby boomer population will mean a greater need for LTC at the same time the pool of paid caretakers will be shrinking.

Moreover, LTC insurance policies are getting more expensive. Because of the high costs of paying claims, several insurance giants are no longer accepting new customers, and all are increasing premiums. In the face of rising costs of claims, most LTC insurance companies are becoming more cautious about who they insure.

One expert suggests ways to improve the labor shortage, while others offer ideas for lowering the costs of individual LTC insurance coverage.

Aging and Unprepared Population

By 2030 the number of Americans age 65 and older is projected to be about 72 million, or about 19 percent of the total U.S. population (up from over 40 million, or 13 percent, in 2010) (data from Society for Certified Senior Advisors webinar, “Baby Boomers and 65+: The Long Term Care Challenge,” by Robert Semro, a policy analyst for the Bell Policy Center).

By 2050, when the last baby boomers turn 85, the number of Americans age 65 and older is projected to grow to almost 89 million, or about 20 percent of the total U.S. population. At the same time, the number of Americans who need LTC is expected to increase from approximately 12 million today to 27 million in 2050.

Between 2004 and 2008, the number of seniors at risk of outliving their resources increased by nearly 2 million households. More than one out of every three seniors was determined to be economically insecure in 2008.

Many boomers are not realistic about retirement costs and, due to insufficient savings, are not prepared for their own retirements. Working longer may not be enough because many boomers are unaware of the potential cost of LTC and do not save adequately. (See sidebar for LTC costs.)

Shortage of Care Workers

Because the overall labor pool will be smaller in the future, compared to the increase in older people, experts on aging predict a shortage of qualified LTC workers. Today, families often take care of elderly parents, but because of declining fertility rates, fewer adult children will be available to handle that chore (“New Areas of Reform on the Long-term Care Labor Force Crisis,” presented to Society of Certified Senior Advisors by Lisa Rill).

In order to meet the demand for LTC services in the near future, a new pool of qualified workers is needed, Rill states. She believes that LTC workers such as CNAs and home health aides are undervalued and underpaid, partly due to society’s prejudice against the elderly. One solution to attract and keep better workers is to increase pay and benefits, as well as create more opportunity for career advancement. Just as crucial is redesigning the models of care, so clients have a bigger role in their own care. This would create a more efficient setting and would allow workers to become more directly involved in client care.

In 2007, Medicaid covered nearly half of the nation’s nursing home expenses, according to the Congressional Research Service. Because the government is a leading player in LTC, through Medicaid, experts say that the government needs to raise the training requirements for skilled LTC workers as well as work with public and private sectors to find solutions.

Changes in Long-term Care Insurance

In the last two years, many of the big insurance companies, including MetLife and Prudential, have stopped selling new LTC insurance policies. Experts blame declining revenues on insurers’ underestimation of the number filed claims; underpriced policies, particularly for those sold more than a decade ago; and low interest rates over the last four years, which means lower returns on investments made by the insurance companies and significant impact on the reserves needed to pay future claims.

To compensate for these losses, most major insurers are raising their rates for policyholders, requesting average increases of 20 to 28 percent. For those who can’t afford to pay the increase, this means dropping the policy and losing any money already invested.

For females, the news is even worse. Because women outlive men on average by five to seven years and represent almost 80 percent of the population in assisted living facilities, they cost insurance companies more. As a result, Genworth, the nation’s largest LTC insurance provider, plans to increase rates for females by as much as 40 percent for single women applicants. Married women are not as severely impacted.

Also, many insurance companies are now requiring a paramedical exam with fluids, the same exam required for most life insurance and disability income policies. It consists of your medical history, height and weight measurements, blood pressure, pulse and urine and blood specimens.

In the face of these changes, and the fact that LTC insurance is less expensive at a younger age, insurance experts recommend that those who plan on getting LTC insurance should do it sooner rather than later. While that gives the insurance carrier more time set aside reserves for future claims, that also leaves a longer period of time for insurance companies to raise their rates.

Suggestions for Reducing Costs

Most financial experts say the best time to buy LTC insurance is while you are healthy, preferably before your 70s.. But if you’re too late to do that, options exist to reduce the high costs.

Coverage time: The average amount of time spent in a nursing home is three to five years, and the LTC insurance payout generally kicks in after 90 days of facility care. Financially it might make sense to get as much coverage as you can afford for a shorter period of time, say two to three years rather than five.

Hybrid products: Some life insurance policies offer the option of withdrawing up to a certain percentage, typically 2 percent, toward end-of-life care. These policies typically require repositioning more of the applicant’s assets to accomplish the same level of protection that a traditional LTC insurance policy would offer. Hybrid products allow the insured to make withdrawals for LTC expenses without penalties or charges. Similarly, some annuities are offering LTC benefits.

Marriage benefits: Some insurers are offering “shared care” policies that allow a married couple to take out separate but connected plans and transfer the benefits if one of the spouses needs LTC. For example, if the policies provide a four-year benefit period for each spouse, then the couple has a combined benefit of eight years, which either of them can use. Should one spouse die without ever using the policy, the survivor “inherits” the policy and has an eight-year benefit period.

For those who have assets to protect and who can manage the premiums, LTC coverage can be a useful component of a family’s financial planning. If you’re just starting out looking for LTC policies, financial experts recommend finding someone who specializes in LTC planning and is not restricted to representing only one insurance company. An independent representative can shop around because policies’ prices and benefits vary widely, and factors of age, health and where someone lives play an important role.

Sources

“Changes in store for long-term care insurance,” Dec. 2, 2012, Pittsburgh Post-Gazette

“Long-Term Care Insurance Becoming Tougher For Women To Purchase,” Feb. 2013, Forbes

“Navigate a Course for Long-Term Care,” May 2012, Kiplinger

“Studying your long-term care insurance options more important than ever,” May 25, 2013, the Oregonian.

Average Costs for Long-term Care

The U.S. Department of Health and Human Services calculated average costs for U.S. long-term care in 2010:

• $205 per day or $6,235 per month for a semi-private room in a nursing home.
• $229 per day or $6,965 per month for a private room in a nursing home.
• $3,293 per month for care in an assisted living facility (for a one-bedroom unit).
• $21 per hour for a home health aide.
• $19 per hour for homemaker services.
• $67 per day for services in an adult day health care center.

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New Research Explores Cure for Alzheimer’s

http://www.csa.us/email/spirit/ssarticles/0813MedNews.html
As scientists look for causes as well as preventative measures for this form of dementia, they are examining not just physical factors but also “social,” such as age of retirement and an individual’s own concerns about memory. Click here to view article.

Although Alzheimer’s disease is the focus of much research, the bottom line is that there is still no cure. Nor are scientists sure what causes this form of dementia, though several workable theories exist.

Most recently, a study by the French government agency INSERM found that people who delay retirement have less risk of developing Alzheimer’s disease or other types of dementia. The study of half a million people in France, the largest study of this kind to date, backs the general theory of aging that says” if you don’t use it, you lose it,” referring both to physical and cognitive function. In this case, working longer seems to keep people more mentally challenged as well as socially active.

Along those same lines of cognitive function, it was reported at the Alzheimer’s Association conference in Boston in July that people with certain types of cognitive concerns were more likely to have Alzheimer’s pathology in their brains and develop dementia than those who had no such complaints, leaving the conclusion that health care workers should listen to patients’ own sense of their health. For example, people with more concerns about memory and organizing ability were more likely to have amyloid, a key Alzheimer’s-related protein, in their brains. For this reason, leading Alzheimer’s researchers are identifying a new category called “subjective cognitive decline,” which is people’s own sense that their memory and thinking skills are slipping even before others have noticed (“Dementia’s Signs May Come Early,” July 17, 2013, New York Times).

A Growing Problem

Alzheimer’s is a serious problem, not just for the individual, but for society as a whole. More than 5 million Americans live with Alzheimer’s disease, and 15.4 million friends and family members provide care, according to the Alzheimer’s Association.

Compounding the human toll, Alzheimer’s is now the most expensive disease in the U.S., topping cancer and heart disease, according to a new study by the nonprofit RAND Corp. (“Costs of Alzheimer’s disease could bankrupt Medicare,”wcbv.com).

Researchers are still trying to fully understand the illness’s process and how to prevent or stop the disease, which robs people of their memory and the ability to function. Although scientists can’t be sure about which factors determine Alzheimer’s disease, the Alzheimer’s Association lists these hallmarks:

• Plaques, microscopic clumps of a protein called beta-amyloid peptide.
• Tangles, twisted microscopic strands of the protein tau (rhymes with “wow”).
• Loss of connections among brain cells responsible for memory, learning and communication. These connections, or synapses, transmit information from cell to cell.
• Inflammation resulting from the brain’s effort to fend off the lethal effects of the other changes underway.
• Eventual death of brain cells and severe tissue shrinkage.

Research Path

Research is taking several paths (“Alzheimer’s Treatments: What’s on the Horizon?” Mayo Clinic).

Plaques: Two strategies aimed at beta-amyloid are immunizing the body against it and blocking its production. An early Alzheimer’s vaccine to reach clinical trials mobilized a person’s own immune system to attack beta-amyloid. However, researchers stopped this study when some participants developed acute brain inflammation.

The second approach blocks the production of plaques either through intravenous (IV) infusions of a product from donated blood, which contains naturally occurring anti-amyloid antibodies from the donors; or by reducing the amount of beta-amyloid formed in the brain.

Tau: Researchers are looking at a way to prevent tau from forming tangles.

Inflammation: Researchers are studying nonsteroidal anti-inflammatory drugs, which have had varying results.

Insulin resistance: Researchers are looking to see if insulin changes in the brain may be related to Alzheimer’s. A trial is testing an insulin nasal spray to determine if it slows Alzheimer’s progression.

Heart-head connection: The risk of developing Alzheimer’s appears to increase after due to conditions that damage the heart or arteries, including high blood pressure, heart disease, stroke, diabetes and high cholesterol. To counteract this, researchers are looking at whether drugs used to treat those conditions may also help people with Alzheimer’s or reduce the risk of developing the disease. They are also interested in whether healthy living with known heart benefits, such as exercising and a heart-healthy diet, may help prevent Alzheimer’s disease or delay its onset.

In fact, one study reported that up to half of Alzheimer’s cases worldwide could be prevented through lifestyle changes and treatment of chronic medical conditions such as diabetes, as reported at the Alzheimer’s Association International Conference in July 2011 in Paris. Modest reduction in seven risk factors for dementia, including smoking, obesity, sedentary lifestyles and midlife high blood pressure, could have a huge impact, said Deborah Barnes, an associate professor of psychiatry at the University of California, San Francisco (“Researchers Say Reduction in Risk Factors Could Lower Rate of Alzheimer’s Disease,” July 19, 2011, WebMD Health News).

Cognitive and social activities: Researchers are looking at whether cognitive activities such as memory training or social interaction may help prevent or delay Alzheimer’s.

Current Therapy Options

Several different medications are used to treat Alzheimer’s symptoms such as memory loss, problems with thinking and reasoning, and issues with sleep (“Alzheimer’s Disease Therapy Options, WebMD).

These treatments boost performance of brain chemicals that carry information from one brain cell to another. Although these treatments don’t stop the underlying decline and death of brain cells, they can slow the progression of symptoms for a few months or even years. All of these medications can have side effects, which can be pronounced in older people.

The U.S. Food and Drug Administration has approved two types of medications to treat Alzheimer’s — cholinesterase inhibitors (Aricept, Exelon, Razadyne, Cognex) for the early to moderate stages of Alzheimer’s; and memantine (Namenda) to treat the cognitive symptoms (memory loss, confusion and problems with thinking and reasoning) for moderate to severe stages. Both medications have side effects.

Evidence indicates that sensory treatments such as music therapy and art therapy can improve Alzheimer’s patients’ mood, behavior and day-to-day function. By stimulating the senses, these treatments may help trigger memory recall and enable Alzheimer’s patients to reconnect with the world around them.

Similarly, storytelling can be therapeutic for people who don’t communicate well, according to research that reported people became more engaged and alert, happier and better able to communicate in general. At least two studies found that writing memoirs has therapeutic effects for those suffering from dementia, calming them down and increasing self-esteem.

Beyond that, individuals can take steps to help Alzheimer’s patients (see sidebar, “Tips for Coping.”)

Tips for Coping:

Caretakers can take simple steps to make life easier for a person with Alzheimer’s disease.

• Monitor personal comfort. Check for pain, hunger, thirst, constipation, full bladder, fatigue, infections and skin irritation. Maintain a comfortable room temperature.
• Avoid being confrontational or arguing about facts. For example, if a person expresses a wish to visit a parent who died years ago, don’t point out that the parent is dead. Instead, say, “Your mother is a wonderful person. I would like to see her too.”
• Redirect the person’s attention. Try to remain flexible, patient and supportive by responding to the emotion, not the behavior.
• Create a calm environment. Avoid noise, glare and too much background distraction, including television.
• Allow adequate rest between stimulating events.
• Acknowledge requests and respond to them.
• Look for reasons behind each behavior. Consult a physician to identify any causes related to medications or illness.
• Don’t take comments or unkind remarks personally and remember that talking about your experiences with others can be therapeutic and lead to helpful insight and needed encouragement.
• Contact the Alzheimer’s Association for support and information; 24/7 helpline: 1-800-272-3900

Source: Adapated from Alzheimer’s Association

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http://www.alz.org/alzheimers_disease_facts_and_figures.asp?utm_source=DM&utm_medium=email&utm_campaign=fall_match_gen

Alzheimer’s disease is a rising epidemic. As the sixth-leading cause of death in the United States, Alzheimer’s takes a terrible toll on individuals living with it, as well as caregivers, families and friends.
These numbers are staggering but together, we can make an impact. We can put an end to Alzheimer’s and other dementias.
Today, you have the opportunity for your gift to go twice as far. The Pine Family Foundation of Austin, Texas, has generously agreed to give $300,000 to the Alzheimer’s Association if we can
raise that same amount by September 30.
Because you’re interested in research, I know you’ll appreciate the foundation’s strong commitment to fighting this disease – and to ultimately finding a cure. The foundation’s support has advanced our understanding of the molecular mechanism of Alzheimer’s pathology, and has driven the development of potential drug candidates for treatment or prevention of Alzheimer’s.

Ray Pine, Founder of The Pine Family Foundation

Help us seize this exceptional opportunity by making a gift during this special challenge match. Your tax-deductible donation of $50 can become $100, or a gift of $100 can become $200.
When you give by Sept. 30, your gift can have twice the impact and help us continue to advance vital research and enhance care and support for all affected by Alzheimer’s disease and other dementias.

An estimated 5.2 million Americans of all ages have Alzheimer’s disease in 2013.This includes an estimated 5 million people age 65 and older and approximately 200,000 individuals younger than age 65 who have younger-onset Alzheimer’s.

Prevalence

The number of Americans with Alzheimer’s disease and other dementias will grow as the U.S. population age 65 and older continues to increase. By 2025, the number of people age 65 and older with Alzheimer’s disease is estimated to reach 7.1 million—a 40 percent increase from the 5 million age 65 and older currently affected. By 2050, the number of people age 65 and older with Alzheimer’s disease may nearly triple, from 5 million to a projected 13.8 million, barring the development of medical breakthroughs to prevent, slow or stop the disease.

Alzheimer’s disease is the 6th leading cause of death in the United States overall and the 5th leading cause of death for those aged 65 and older. It is the only cause of death among the top 10 in America without a way to prevent it, cure it or even slow its progression. Deaths from Alzheimer’s increased 68 percent between 2000 and 2010, while deaths from other major diseases, including the number one cause of death (heart disease), decreased.

While ambiguity about the underlying cause of death can make it difficult to determine how many people die from Alzheimer’s, there are no survivors. If you do not die from Alzheimer’s disease, you die with it. One in every three seniors dies with Alzheimer’s or another dementia.

Impact on Caregivers

In 2012, 15.4 million family and friends provided 17.5 billion hours of unpaid care to those with Alzheimer’s and other dementias — care valued at $216.4 billion, which is more than eight times the total sales of McDonald’s in 2011. Eighty percent of care provided in the community is provided by unpaid caregivers.

Nearly 15 percent of caregivers are long-distance caregivers, living an hour or more away from their loved ones. Out-of-pocket expenses for long-distance caregivers are nearly twice as much as local caregivers.

More than 60 percent of Alzheimer’s and dementia caregivers rate the emotional stress of caregiving as high or very high; more than one-third report symptoms of depression. Due to the physical and emotional toll of caregiving, Alzheimer’s and dementia caregivers had $9.1 billion in additional health care costs of their own in 2012.

Cost to the nation

In 2013, the direct costs of caring for those with Alzheimer’s to American society will total an estimated $203 billion, including $142 billion in costs to Medicare and Medicaid. Total payments for health care, long-term care and hospice for people with Alzheimer’s and other dementias are projected to increase from $203 billion in 2013 to $1.2 trillion in 2050 (in current dollars). This dramatic rise includes a 500% increase in combined Medicare and Medicaid spending.

Nearly 30 percent of people with Alzheimer’s and other dementias are on both Medicare and Medicaid, compared to 11 percent of individuals without these conditions.

The average per-person Medicare costs for those with Alzheimer’s and other dementias are three times higher than for those without these conditions; the average per-person Medicaid spending for seniors with Alzheimer’s and other dementias is 19 times higher than average per-person Medicaid spending for all other seniors.

Alzheimer’s disease facts in each state

The 2013 Alzheimer’s Disease Facts and Figures report contains data on the impact of this disease in every state across the nation. Click below to see the effect that Alzheimer’s is having in your state.

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Songwriter pens humorous musical to tell the story of mother’s Alzheimer’s

http://www.startribune.com/entertainment/music/218927241.html

Alzheimer’s is no laughing matter, but singer-songwriter Jonatha Brooke, whose mother had the disease, is trying to find the humor in it. She has written a one-woman musical that tells the story of a daughter and mother trying to cope during the final stages of Alzheimer’s.
Read the article >>

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Connections with friends, family and other Alzheimer’s caregivers can help

http://www.tulsaworld.com/article.aspx/Alzheimers_is_part_of_a_couples_love_story/20130811_43_D1_CUTLIN543853

Some caregivers may lose patience with being asked the same question 10 times because their loved one with Alzheimer’s can’t remember the answer. In addition to maintaining friendships and good family relationships, staying connected with other caregivers can help caregivers stay strong and patient.
Read the article >>
Join ALZConnected® >>

Originally, she wasn’t going to download a photo of herself to her page on the popular dating website. If men genuinely wanted to get to know her, based on her profile, she reckoned a picture didn’t matter.
Eventually, she relented and posted a photo – a beautiful one, which John printed off in 2006, two and a half years after searching. He kept that print-off, with her name scribbled in red ink at the top of the page. John fished it from a drawer in the bedroom and showed it to us.
“It was a godsend,” John said.
They were married by 2007.
“We agreed to be bound in sickness and in health,” John said. “After all, that’s life, and we are committed for life, here and forever.”
By 2008, the Broken Arrow newlyweds’ vows would become more meaningful.
“I’d notice occasionally she’d repeat herself,” John said. “I was just chalking it up to stress.”
Lois is in the early stages of Alzheimer’s, signs for which may include some memory loss, impaired ability to learn new information and small personality changes, among others.
John is Lois’ primary caregiver – one of an estimated 214,000 unpaid caregivers in Oklahoma in 2012, according to 2012 figures from the Oklahoma chapter of the Alzheimer’s Association.
The association provides family care consultations, art programs, a teen camp for young caregivers, educational seminars and conferences, and – a boon for John – support groups.
“Everyone who has a relationship with a person with dementia needs to contact the association,” John said. “The help in support and resources is beyond belief.
“And it’s free,” he added. “I would not be as open or as able to handle the anticipatory grief of losing my soulmate gift from God without knowing the Lord and having the Alzheimer’s Association as a resource.”
According to the association’s 2013 Alzheimer’s Disease Facts and Figures, more than 60 percent of Alzheimer’s and dementia caregivers rate the emotional stress of care-giving as high or very high; more than one-third report symptoms of depression. Due to the physical and emotional toll of care-giving, Alzheimer’s and dementia caregivers had $9.1 billion in additional health-care costs of their own in 2012.
“Caregiving takes a toll on a caregiver both physically and emotionally,” explained Ronda Roberts, programs manager for the association’s Oklahoma chapter. “Often they grieve the loss of their companion, friend or partner.
Folks in rural communities and those with limited finances don’t have access to many programs that would ease their load caring for their loved one, Roberts said.
“Caregivers have normal day-to-day responsibilities just like the rest of us,” she continued. “They work, pay the bills, go grocery shopping, take care of their children” – all in combination with the responsibility of physically taking care of another adult.
“They tie their shoes, brush their teeth, make sure they eat, anything they need,” Roberts said.

Midstage nuances

Ames Righter can shower, shave and brush his teeth, but his wife, Jean, has to be right there with him.
Most mornings, she’s out of bed between 5 and 5:30, while Ames sleeps until 8 a.m. It’s her alone time, during which she’ll usually take a stroll, often with Willie, the Righters’ Bichon-toy poodle mix.
Then, it’s back home to feed the animals and make breakfast for herself and Ames.
“It’s very mundane,” she said with a laugh.
Ames is in a more advanced stage of Alzheimer’s than Lois – “midstage,” Jean said, having noticed Ames putting words in wrong places in his sentences. Three years ago, six after they had married, Ames was diagnosed with Alzheimer’s.
“He’s a very articulate, intelligent man, well-read,” Jean told us while Ames played solitaire on the computer. “He’s very outgoing, loves to talk, loves to be with people.”
The day we spoke to Jean, word came that a family member had died.
“Even today, in the sad state he’s in, he would say, ‘Who’s coming to visit today?’ or ‘Who’s coming to dinner?’ “
As time passes, Jean has realized she’s a stronger person than she thought with more patience than she knew she had.
“I’m OK now,” she said she’s told herself in the past few months. “It took a while to get here, and there are a lot of stages a person goes through – anger, some frustration. But, all of a sudden, I’m reconciled to who I am and where I am. … We take it day by day, and we’re doing OK.”
Some caregivers may lose patience with being asked the same question 10 times because their loved one with Alzheimer’s can’t remember the answer.
“You just need to take all that in your stride and recognize that this is a disease,” she said.
The Alzheimer’s Association has been “wonderful” help.
“I’ve made such lovely friends,” Jean said. “Something good comes out of everything, and that’s one of the good things that has happened.”
Staying connected is a boon for caregivers.
“When this is going on, you’ve lost your partner,” Jean said. “You don’t have a conversation. There’s not conversation at all.”
The disconnect is common with caregivers, and isolation can be a risk.
That’s why it’s important to maintain friendships and good family relationships, Jean said. “They really keep you bolstered.”
Beyond that, she recommends finding an activity you love to do and make enough time to do it. For example, she loves being outside, so she tends to flowers and a garden.
“I give almost all the vegetables away, and I just love doing that,” she said. “And that keeps me sane.”

Early onset

Lois knows the importance of a creative outlet.
She has to be doing something with her hands, she said. The day we visited, she showed us the bathroom she’d redone, including an old wooden baseball bat she repurposed as a towel rack.
Plus, she still maintains a business, Two Ladies with a Plan, with her best friend and fellow interior designer, Gayle Kauffman. Together, they refurbished Clarehouse, which provides quality end-of-life care and access to hospice services to people in need.
That’s not the only way Lois helps others, though. Before she was even diagnosed with Alzheimer’s, she responded to a newspaper advertisement John found about a drug trial for Alzheimer’s.
“I told them I’d do it for free,” Lois said, going along with the trial for 36 months until it was canceled. Currently, she’s on a new, 78-week drug trial.
In the meantime, she wants to see more support groups – and not just for caregivers.
“They have support for people like John, but what about me?” she wondered. Hopefully, one or two from his support group will bring spouses with early onset to the next meeting. Maybe that will start a new group.
Mostly, she’s not depressed, doesn’t get down, she said. But sometimes she asks, “Why me?”
Then, she started paraphrasing the Kris Krisstofferson song, “Why Me”:
“What have I ever done / to deserve even one of the blessings I’ve known,” she said.
Acknowledging those blessings is one of the reasons she does the drug trials, John said – to help others.
“If they can’t fix me, maybe they can fix the next person,” Lois said.

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