Friday, October 10, 2014

Don't cut my trees......... Elder Abuse True Story

My staff called in panic. Georgia was having a meltdown. She would not let the gardeners do their job.  "I do not want to see the house in the back, it is disrespectful".

Georgia has Alzheimer's. There was no gardener and no, the trees were not being cut. Georgia has very short term memory, while her long term memory is very intact. Interestingly she remembers my name, even though I met her only 3 years back.

Georgia was going through an unfortunate time when I first met her. She has recently been victim of an elder abuse. When she needed some help at home, she talked to her friends and neighbors. As always someone knows someone and Virginia came to work with Georgia.

Virginia was quick to make friends with Georgia and within 2 months she moved in to live with Georgia. Often Virginia's son used to come to stay the weekends too. The neighbors got used to seeing them on the property and everything was going on smoothly.  Well Virginia was more than just helpful.

Virginia started helping Georgia paying her bills. Virginia would write the check for Georgia to sign. Georgia was very trusting and soon she had complete access to Georgia's bank account. The bank manager too was seeing Virginia regularly that he too did not see anything wrong going on.

Of course there was lot going on. Virginia would make small checks payable to herself and would get Georgia to sign. No one realized except Virginia that Georgia was losing her memory. Georgia was single and had no immediate relatives. Only her friends and neighbors knew that she existed. Soon Virginia started signing the checks herself.  Not many are aware of this but the banks do not verify signatures of small value checks.

Unknown to Virginia, Georgia had a distant nephew, Dan, who lived in Ohio. He was monitoring funds of his aunt. He started to see higher amounts of withdrawal in the last several months and he started to worry. Dan decided to investigate and to his dismay he found that Georgia was missing  about $175 k from her savings. He reported to police and soon Virginia and her son was arrested.

The court finally settled the case, Virginia will be required to pay $25 per month till all the amount stolen is refunded !!!.  Well that takes about 583 years to finish paying off the debt.

Well, we live in a society where when Justin Beiber eggs his neighbors 15 Sheriffs come down heavy to get to the bottom of the case. Whereas when defenseless seniors are robbed off their nest egg, the law looks in the other direction.  We have become a society that is more supportive of criminals and their hardships than a well standing citizen who has worked hard for their living.

If Elder abuse is to be taken seriously, we need new laws and we need to enforce the laws. Without which we will only be paying lip service to a problem that is already $2.6 Billion big and growing rapidly.

Wednesday, January 12, 2011

"Alzheimer's starts in your childhood"

"Alzheimer's starts in your childhood" Dr. Fortanasce was speaking to a packed hall. In all honesty, I jumped out of my skin when I heard this. Dr. Fortanasce was hosting this free seminar that helps us understand about what we can do, to change our lifestyles, to avoid getting the dreaded Alzheimer's disease. " Clinical studies have shown that 42% of the world's Alzheimer's population is in US". So the question is is it diet? or is it in our genes?

Dr. Fortanasce went in to details of our diet and compared diet of people from other nations. "Chinese don't drink as much wine as we do. Is that why they don't get Alzheimer's?  Wait a minute, Italians drink ten times more than what we Americans do, yet they don't have as many cases of Alzheimer's as we do".  Okay this was getting interesting.  How about Genes? Is it that we Americans are having it in our genes?  "Japanese living in America is having more chances of Alzheimer's than born and raised Japanese living in Japan".  Okay, I am confused. Is it the air we breathe? or the water we drink? Or is it because we live in our cars more than in our home.

"It is our lifestyle. Today's lifestyle rides on stress, bad diet, excessive TV, lack of sleep etc etc. We disturb our natural equilibrium and all these have a telling effect on our system. Alzheimer's is a direct effect of us abusing our own system". Our body needs nourishing and balanced diet. Our body also needs exercise, rest and relaxation. Our brain is like iron. If you don't use it it will rust.

Serotonin, Melatonin, and Sleep

In "The Secrets of Serotonin," Carol Hart explains that serotonin has a close relationship to the body's sleep-wake cycle. Serotonin levels are highest in the brain stem when you are awake and active, and almost completely absent when we enter REM sleep, the deepest stage of sleep. During sleep, the body's level of melatonin rises sharply. The production of melatonin is dependent on its synthesis in the pineal gland, which is powered by serotonin. While light increases the production of serotonin, darkness spurs on the synthesis of melatonin. Paired together, these two neurotransmitters are key in maintaining the sleep cycle.

Hart notes that anything that disrupts the rhythm of serotonin and melatonin production will disturb the natural sleep cycle. When you suffer from jet lag, for instance, your serotonin production cycle follows that of your home time zone and has trouble getting on track. During the winter, when sunlight inadequately triggers the production of serotonin, sleep cycles can also be interrupted.(source,

Science Daily reported in 2002 that research completed at the Brain and Behavior Institute at the University of Maastricht in the Netherlands found that depletion of tryptophan and serotonin "appears to impair memory and learning." The depletion of serotonin with age may increase the likelihood of diseases that affect the memory, such as dementia and Alzheimer's. (Source :- )

While light increases the production of Serotonin, darkness increases the production of melatonin. There should be a healthy balance between the twoo, not a situation of one more than the other. Watching late night TV shows and then getting up in the morning and rushing off to work is typical lifestyle in US. This contributes to  increasing  chances of getting Alzheimer's.

"35% of people who eat bread at a restaurant are more likely to go for the dessert. When it is time for dessert, desert the place" There was few laughter around the room. "When you go for a hamburger, what do you eat first? Fries? Studies shows that by eating carbs first, your ghrelin level goes up creating a craving for carbs and we consume more carbs than our body needs. Red Wine is good for you" I was happy to hear that. What tickled me the most was the picture of the evolution of man. We are all familiar with the ones from apes to neanderthal. This time there was one after the neanderthal, which was a fat sloppy modern man with a jar of soda in his hand. This way more than funny, little do we realize how we harm ourselves.   Speaking of diet, Dr. Fortanasce, gave us sufficient information on what to avoid and what is good for you.

"Do you know which three profession has the highest probability of getting Alzheimer's?"  Dr. Fortanasce was on a roll. "Doctors. Lawyers and policemen" He was looking around the room for agreement. " Do you see the reason? What do these professions have in common?  STRESS". I raised my hand from the back of the room " Doctor, can you add a fourth group, for Small Business Owners?" . The whole room burst out laughing. The talk by Dr. Fortanasce was very useful. I must admit that I learned a lot. Dr. Fortanasce is the author of the book "The Anti-Alzheimer's Prescription". It is a great book and I highly recommend this reading.
Dr. Fortanasce encourages D.E.A.R program as a way to prevent Alzheimer's disease. D.E.A.R stands for Diet, Exercise, Accentuate your brain reserve, Rest & relaxation. I learned a lot about the diet and the exercises that we should be doing. The lecture series continues every Tuesday and it would be wonderful for anyone with interest to participate.

Okay guys, I plan to go home now, it is almost 8:00 PM. I need my food, exercise and rest to star tomorrow with  fresh energy. Good night everyone.

Wednesday, January 5, 2011

Alzheimer's Care Giving

"What makes a good care giver for Alzheimer's"?  Dan was curious to hear about what made our services special. Dan's wife Lisa is suffering from Alzheimer's and they have been trying several agencies without much success. " My wife prefers to sleep in all the time and it is not good for her health. She needs to go out a bit more and also eat better. Right now the appetite is not there and she is losing weight".

Dan's concern is legitimate. The caregivers right now sit and watch the TV, because his wife is sleeping. " This is ridiculous. Isn't there a better way?". "Of course there is a better way" I told Dan. The most important thing to realize with Alzheimer's patients is that there are no standardized approaches that would work for all Alzheimer's cases. Each case is a unique case and the care plan has to be developed customized to work for that client. It may or may not work for the next client. Also the approach has to be one of constant improvement.

Caring for Alzheimer's and Dementia clients can be quite unlike caring for any other type of situations. A patient rehabilitating from surgery or muscular dystrophy etc are all capable of thinking and understanding. They can have good communication with you and understand your conversations. They can also tell what they need and what they don't. However, in the case of Alzheimer's clients, the caregiver has to do the thinking. Alzheimer's clients are like children and the caregiver becomes the parent.

Alright, Care giving for Alzheimer's is not just a regular care giving job. There are some unique approaches that helps in caring for Alzheimer's clients.


In many situations verbal communications does not get very far with Alzheimer's clients. Clara, one of my client's wife recently asked me to take her husband Paul to the doctor's office. Paul has been very challenging to handle, he does not understand any verbal communication. The nurse at the doctor's office asked Paul to sit on the hospital bed. Paul was not getting it. They tried several ways to get Paul on the bed. No luck. I then jumped up on the bed like a kid and started bouncing up and down like a kid, "hey Paul, want to try this?". Paul could see this was a lot of fun and he to jumped up on the bed. Next the nurse wanted to get his BP and Paul would not the girl touch her. I rolled up my arm showing off my biceps and Paul instantly did the same. Nurse could now take his BP, making it look like she was checking out his muscles. Here standard verbal communication did not work. But they can mimic your actions.

Change of scene, Nancy's dad has been driving away all the caregivers she hired for him. I covered this under my previous blog " I don't need a nanny". here the difference was the dad does not know the caregiver as a nanny or a caregiver. He thinks she is someone he knows and she is there to hang out with him. So the approach has to be constantly creative. Look for things that will connect with your Alzheimer's clients and develop from there. Don't be stuck to a standard approach.

Take Charge
When the caregiver for Nancy's dad meets him, she would immediately take over. "Fred, are you ready to go on our lunch date", would be her opening conversation. She would take charge of the situation right away and orchestrate the activities. Remember, you are able to think and act and your Alzheimer's clients depends on your thinking ability. Take charge and please do not wait to be told what needs to be done.


Smile a lot and that brightens up your clients face and her demeanor. Show enthusiasm and drive to be there. In my experience, I have seen the Alzheimer's clients are very perceptive. They may not be able to express it, but it certainly reflects in how they connect with you or responds to you. Enthusiasm sends out a positive vibe and I have seen in most cases than not, they respond positively to it.

You will need a lot of patience. Many communication may be repetitive and in circulatory mode. Owing to their reduced information retention capacities, they are bound to repeat their questions or conversations. Don't be offended, it has nothing to do with you. It is a function of the disease they are going through. Also there are no rules of conduct that your Alzheimer's client is going to remember. We have have the patience to start the conversation all over again and again.

Let us be honest. Caregiving for Alzheimer's clients can be very taxing. You need to have good endurance skills. So make sure you rest well and you have fun doing what you are doing. If you ignore your health, there is only so much you can do to help someone with Alzheimer's.

Love & Compassion
Caring for Alzheimer's clients is like parenting. Your words and action has to come from a high point of love and compassion. Trust me, you are doing god's work taking care of Alzheimer's clients. If you are the chose one to provide care, you are already better than most people.

Have a good night folks and thanks for reading my blog. If you have any feedback, I will be delighted to receive them.

Warm Regards

Friday, December 31, 2010


"Sam, my dad does not know I am talking to you. I am not sure how to approach this, but we think he needs help. However, he refuses any help. He says that he does not need any nanny to look after him." Nancy used the tissues on my table to dab the tears. "Dad loves to do things around the home. He does not need any help there.  But he is very lonely. He needs to go out more and he cannot drive"

It is rude to say I have heard this conversations several times from different family members over a period of time. Nancy was choking with emotions and the situation was very real for her. Always this  question comes up about how to convince your parent. Honest answer to that is that there is no standard response to it. We have to see each as a unique case and develop our response.

"Nancy, we do not provide nannies" I said.  There was a curious look on Nancy's face, like did I come to the wrong place? " Tell me more about your dad so that I can develop the best approach to help your dad". During our conversation we developed a game plan. Our caregiver will be introduced as a friend of Nancy's. She will come in and take dad out for walks, movies shopping etc. Nancy liked the idea immediately.

I have heard it too many times that in the west, people abandon their parents. NOT TRUE. What I have seen here is no different than what I have experienced in other parts of the world. The offspring here are as concerned here about their parents as they are  in other parts of the world. They hurt to see their parents suffer, many go to great lengths to keep their parents healthy in their own home.

Earlier this week I met with a son who was completely emotional when we spoke of his parents. They needed care and cash was tight. Yet the son was willing to go to any lengths to provide care. During our conversation we found out that his dad was a Korean War Veteran. I asked him if his dad is getting A&A benefits. The son was not aware of it. So we helped them start the processing for A&A. On the way out, I kissed his mom's hands. I could see she was crying and thanked me profusely for treating her so humanely.

Okay guys, this is the last blog from me for this year. I promise to write again only next year. Have a safe new year everyone and let us welcome 2011. Yeah, it is going to be a great year.

Wednesday, December 29, 2010

I am thankful for.......... in 2010

As we approach the end of the year, it is always a good time to take a look back and see how far we have come, what to be thankful for and who to thank for everything. It feels like a cleaning service that we can do to our mind, make it fresh to start the new year with fresh energy and fresh perspective.

I have found this approach useful for many reasons. It is like doing new shopping all the time, while we do not put away the ones that should be removed. In effect we start hoarding things, new items coming in while the old one still remains. However, we rarely think about doing the same approach to our life, our mind. so let us take a moment to reflect on what went right, how can we be thankful to what we could accomplish in the year completed.

Recently I was attending a Geriatric Care Manager's conference. In one of the breakout sessions, there was a question about how we manage stress. AS GCMs, as care giving professionals and as professionals associated with providing care, we absorb a lot of stress that goes on in our clients life. This is only natural, the client sees us as someone whom they can open their heart to, share their problems and concerns. It is a gift that we can offer this to our seniors. However, as a result we absorb much of this stress and unless we learn how to handle this, it could affect our health. The speaker suggested a simple solution. Each night before she goes to bed, she meticulously writes down 10 things she is thankful for, in the day. It took a while for me to hit home on the impact of this suggestion. This was brilliant.

When we take a moment to be thankful, we are displacing in our mind "what went wrong" with "what went right". Human nature is such that we all ponder over issues, we search for solutions. And if we cannot find solutions or not happy with the options, unconsciously our mind keeps roaming, searching for better alternatives. similar is the situation when we had disagreeable situations during the day. We continue to be irked about it and play out scenarios in our mind.  In short, we are not giving it any rest. Mind, like our body needs rest to recharge.

When we express our thankfulness, we are shifting our mind to more positive aspects of the day or the year. Our anxiety level comes down when we are able to appreciate the goodness in our daily lives. We tend to look at cup half full, not half empty.  So friends, let us take a simple step of reflecting on the good things that happened to us during the year. Free our mind of worries and approach the new year with energy, love and enthusiasm. Have a great night everyone.

Saturday, December 25, 2010

Respite Care for family caregivers

"I did not expect to go down like this. I am in a bind now, my wife is not keeping good health and I am not able to take care of her or myself",  Paul (not his real name) was sharing his frustration with me. I met Paul at a nursing home. The nursing home has declared that Paul is ready to go home, even though he cannot even move his own wheel chair for ten feet.

Paul has been taking care of his wife for about 7 years now. His wife, Andrea (not her real name) is a stroke victim and has one side completely paralyzed. Paul has been keeping good health and hence did not consider taking any help. Everything was going fine till recently when after returning from a doctor visit, Paul collapsed. He has been in hospitals and nursing homes for the last few weeks. He is very worried about the wellbeing of his wife and now himself too.

We come across several such instances. As family caregiver, the stress builds up progressively and  cumulatively. The family caregiver often associates guilt, when considering some form of help. They feel guilty and feel it is their  responsibility to provide care. Here is what we would normally tell someone like Paul.

You cannot be the husband, father and caregiver
You have the best intentions. However, you are as human as anyone else is, maybe a better human. However, if you try to do everything, progressively this would affect and ruin your health. Are you prepared for a day when you both will need care-giving? You should continue to be the husband and the dad and should consider getting some care-giving help. Getting some help now can avoid getting a lot of help later on.

Start with Respite Care

Paul, choose a day in the week where your wife can be taken care of by a care giver. Use this day to relax, and get your things done. Go out and do your stuff. Your wife will be well taken care of. Recently we were taking care of Janet for about 45 days when her daughter was away on vacation. Janet sends her daughter away on vacation every year as she has been the primary caregiver for her mom for several years. Janet sent her daughter on a world cruise, while we took care of Janet.

Consider few hours of help in a day
Try getting few hours of help every day. Remember out of the 24 hours in a day, you are still the primary care giver. Care giving services are there only for 20-30% of the time? You are still taking care of your wife for the rest of the time.

No Guilt Please
You should not have s sense of guilt that you are not doing enough. This often is the case. You are doing more than what others would normally do. More importantly, you are not the reason for your wife's poor health.
Hence there should be no reason for you to feel guilty about taking care of your self. In reality this is a pure act of love. You are taking care of yourself to take better care of your wife.

Always remember, stitch in time saves nine. You can contact me if you need help. I am just a phone call away at 626-639-0226

Sunday, December 19, 2010

Loneliness and Seniors

Of all forms of diseases and problems that man faces, loneliness is the worst. Loneliness can lead to both physical and psychological illness. Back in 2008, US News published a great article about "Why Loneliness is Bad for Your Health". Loneliness results in social and physical issues like alcoholism, blood pressure, stress, cardiovascular disease etc.

In the senior care industry, we often find that companion care is about 70% of the service needs. Mary Ann, a client of mine (not the real name), calls me at least 4-5 times a day. She always calls to talk about some problem or the other. However, the truth of the matter is that there are no real problems that needs to be addressed. So than what is the problem that we are trying to solve? It is loneliness. Mary Ann calls to connect with me, in some ways I am her life line.When she comes on the line, she stays with me for about an hour. Bless her heart, she just needs to talk to someone.

The feeling is felt more acutely during the holiday season. The media highlights all the fun and warmth of companionship, the joy of giving and sharing. Seniors who are lonely find this the hardest of all the seasons. Mark (not the real name), another client of mine asked me where I am with my Christmas shopping. He lingered on a bit longer to add that he is not doing any shopping this time. He does not have any known friend, relative or kids. I met Mark, when he was getting discharged from a nursing home. "Son, I am going home to die" were the first words he said. Mark had a very successful life and he lived his life to the fullest. Never married and he has outlived all his friends and family.

There are things that we can do to improve this situation. To start with we can all connect with one senior in our community. Visit them, share some time with them, bring them a nice wine or something appropriate. I cam across another excellent article about seniors and loneliness in this holiday season,"Adults and Seniors Combating Loneliness This Holiday Season", Companionship is priceless and we need to realize that we are all rich in our resources to provide companionship. Make a difference in one life, that is all it takes.  Have a great holiday season everyone.