Therapy dog assists home care clients in Meriden

MERIDEN — A small plastic bag filled with dog treats was on Aurore Lagace’s kitchen table Tuesday morning and right below the table sat Sonny, a very patient 4-year-old Golden Retriever with his eyes locked on the snacks.

Very gently, Lagace pulled two small treats from the bag to present to Sonny, but before she could even pull them completely from the bag Sonny had already snagged both the treats from Lagace’s hand and ate them.

“Oh my, you got both of them,” said Lagace laughing as she stroked Sonny’s head. “Oh dear, now one more.”

Lagace reached into the bag once again and gave Sonny another treat. This time he waited for Lagace to feed him the snack.

“That’s it, that’s it. Oh my goodness,” she said, still laughing and rubbing Sonny. “Oh, that’s it. No more, no more.”

Sonny is a certified therapy dog registered with Pet Partners Therapy and works alongside his owner, Sharon D’Aquila, the president of Assisted Living Services on Broad Street in Meriden.

Assisted Living Services provides home care to thousands of seniors and those with disabilities throughout the state with personal care assistants, live-in aides, and homemakers.

They were visiting with Lagace, who is one of D’Aquila’s clients. Lagace has been seeing Sonny since he was a puppy nearly four years ago. Lagace looks forward to the visits and said that she “loves Sonny” and he brings her good company.

Sonny started training in a puppy class, then took an obedience class before finally going through therapy training for eight weeks. He is evaluated every two years, D’Aquila said.

Clients of D’Aquila’s can request Sonny to come to their visits. She typically sees about six clients a month with Sonny, not including the people who greet and pet him at the nursing homes D’Aquila goes to.

There are many health benefits with animal therapy, explained D’Aquila. Many clients take walks with Sonny and having him around helps decrease their anxiety depression, or feeling of loneliness. 

The positivity of Sonny’s presence rubs off on her clients, she said.

“It’s a bonus to bring him out with a client,” said D’Aquila. “It lowers their blood pressure.”

Sonny sees patients with dementia, who have suffered a stroke, and others with disabilities.

D’Aquila said one of her clients who had a stroke visits with Sonny and when they are together D’Aquila said “her face lights up” and she starts walking faster to see him. Another client sings to him.

Every time D’Aquila sees a client with Sonny, she leaves a card with a picture of Sonny with them. The card is from Sonny and says “thank you for having me visit today. Looking forward to another soon.”

For Lagace, those cards make her happy and she said she keeps them every time Sonny visits with her.

Tuesday afternoon Lagace was all smiles with D’Aquila as they sat around her kitchen table and enjoyed the dog.

“Come on, honey. Over here,” said Lagace as she called for Sonny who scooted up next to her chair. “OK, lovey. Aw, you’re a good boy.”

SOURCE: Farrah Duffany for Record-Journal

Too many delay seeking dementia diagnosis, charity says

More than half of those seeking a diagnosis for dementia have delayed going to their GP by at least a year, according to a survey carried out by the Alzheimer's Society.

The charity says nearly two-thirds of people fear a diagnosis would mean their life is over.

But it says an early diagnosis can actually help people to live as well as possible.

And it wants everyone to confront head-on the challenges posed by dementia.

In a survey of 2,000 adults, almost half thought they would have to stop driving immediately while one in five feared losing their partner or friends if they were diagnosed with dementia.

Nearly 60% thought they would struggle to join in conversations and almost half worried people would think they were "mad" if faced with a diagnosis.

But the charity said these myths about dementia were stopping people from getting the best possible treatment and also preventing them from planning for the future.

When to see the doctor

There are many possible symptoms of dementia, and anyone experiencing them is encouraged to see a doctor as soon as possible. Common symptoms include:

§  memory loss, especially problems remembering recent events such as messages

§  periods of mental confusion

§  difficulty finding the right words

§  difficulty with numbers or handling money in shops

§  increasing difficulty with tasks and activities that require concentration and planning

§  depression and changes in mood or personality

One in three people surveyed said they didn't go and see their GP because they thought memory problems were just a natural part of the ageing process.

Jeremy Hughes, chief executive of the Alzheimer's Society, said delays in seeking medical attention were something they wanted to change.

"Too many people are in the dark about dementia - many feel that a dementia diagnosis means someone is immediately incapable of living a normal life, while myths and misunderstandings continue to contribute to the stigma and isolation that many people will feel."

He said he wanted to reassure people that life doesn't end when dementia begins.

"There's no question that it can have a profound and devastating impact on people, their family and friends - but getting a timely diagnosis will enable people with dementia to live as well as possible."

There are around 850,000 people in the UK with a form of dementia - a figure that is predicted to rise to one million in less than 10 years and to two million by 2051.

SOURCE: NHS, BBC News

Rarer causes of dementia

There are many other diseases that can lead to dementia. These are rare: together they account for only about five per cent of all dementia. They tend to be more common among younger people with dementia (under the age of 65).

These rarer causes include alcohol-related brain damage (including Korsakoff's syndrome), corticobasal degeneration, progressive supranuclear palsy, HIV infection, Niemann-Pick disease type C, and Creutzfeldt-Jakob disease (CJD).

Some people with Parkinson's disease or Huntington's disease develop dementia as the illness gets worse. People with Down's syndrome are also at a particular risk of developing Alzheimer's disease as they get older.

Mild cognitive impairment

Some people have problems with their memory or thinking but these are not severe enough to interfere with everyday life. In this case, a doctor may diagnose mild cognitive impairment (MCI). Research shows that people with MCI have an increased risk of developing dementia; about 10-15 per cent of this group will develop dementia each year.

However, MCI can also be caused by other conditions such as anxiety, depression, physical illness and side effects of medication. Because of this, some people with MCI do not go on to develop dementia, and a small number of people will even get better.

Who gets dementia?

It is predicted there will be around 850,000 people in the UK with dementia in 2015. It mainly affects people over the age of 65 (one in 14 people in this age group have dementia), and the likelihood of developing dementia increases significantly with age. However, it can affect younger people: there are more than 40,000 people in the UK under 65 with dementia. Dementia can affect men and women.

Scientists are investigating the ways dementia might run in the family. In a very small number of people, certain types of dementia are inherited as a single gene that causes the disease, usually before age 65. A much larger number of people will inherit a combination of genes that increases or decreases their risk of developing dementia in much less direct ways.

How can I tell if I have dementia?

Becoming a bit more forgetful does not necessarily mean that you have dementia. Many people notice that their memory becomes a bit less reliable as they get older - for example they might forget someone's name. Memory loss can also be a sign of stress, depression or certain physical illnesses.

However, anyone who is worried that their memory is getting noticeably worse, or who has other symptoms such as those listed above, should discuss their concerns with the GP.

Diagnosing dementia

It is very important to get a proper assessment of problems with memory or thinking. They may be caused by a treatable condition such as depression or an infection, rather than dementia.

If the cause is dementia, a diagnosis has many benefits. It provides someone with an explanation for their symptoms, gives access to treatment, advice and support, and allows them to prepare for the future and plan ahead. Knowing the type of dementia (eg Alzheimer's disease, vascular dementia) may allow appropriate drug treatments to be offered.

Dementia will usually be diagnosed by a specialist doctor such as a psychiatrist (a mental health specialist), a geriatrician (a doctor specialising in the physical health of older people) or a neurologist (someone who concentrates on diseases of the nervous system). Occasionally a GP or specialist nurse will make the diagnosis, depending on their expertise and training.

There is no single test for dementia. A diagnosis is based on a combination of things:

• taking a 'history' - by the doctor talking to the person and someone who knows them well about how their problems developed and how they are now affecting their daily life

• cognitive tests of mental abilities (eg memory, thinking) - simpler tests will be carried out by a nurse or doctor, more specialist tests by a psychologist

• physical examination and tests (eg blood tests) - to exclude other possible causes of the symptoms

• a scan of the brain - if this is needed to make the diagnosis.

A common pattern is for the GP to make an initial assessment and then refer the person to a memory clinic or other specialist service for more detailed assessment. A specialist doctor will have more expertise in dementia and will be able to arrange more detailed tests and brain scans if needed. The diagnosis should be communicated clearly to the person and usually also those closest to them, along with a discussion about the next steps.

Source: Alzheimers Society

Alzheimer's disease could be treatable with anti-inflammatory drug

Alzheimer’s disease could be treated with a commonly used anti-inflammatory drug, which has been proven to reverse brain inflammation and memory loss, a new study has revealed.

Researchers from the University of Manchester found the common anti-inflammatory drug 'mefenamic acid' completely reversed memory loss and brain inflammation in mice.

The drug, mefenamic acid is a common Non-Steroidal Anti-Inflammatory Drug (NSAID) that many people have used in their lives already and is most commonly used to ease period pain.

The findings of the study have been published in the journal Natural Communications by author of the study Dr David Brough and his colleagues: Dr Catherine Lawrence, PhD student Mike Daniels, and Dr Jack Rivers-Auty.

Dr David Brough commented: “There is experimental evidence now to strongly suggest that inflammation in the brain makes Alzheimer’s disease worse.

“Our research shows for the first time that mefenamic acid, a simple Non-Steroidal Anti-Inflammatory Drug can target an important inflammatory pathway called the NLRP3 inflammasome, which damages brain cells.”

“Until now, no drug has been available to target this pathway, so we are very excited by this result.

“However, much more work needs to be done until we can say with certainty that it will tackle the disease in humans as mouse models don’t always faithfully replicate the human disease.

“Because this drug is already available and the toxicity and pharmacokinetics of the drug is known, the time for it to reach patients should, in theory, be shorter than if we were developing completely new drugs.

“We are now preparing applications to perform early phase II trials to determine a proof-of-concept that the molecules have an effect on neuroinflammation in humans.”

More than 500,000 people in the UK have Alzheimer's disease with symptoms predicted to worsen over time. The disease affects all aspects of their lives, including their ability to think, remember and make decisions on a daily basis.

Completely reversing memory loss

Researchers in the study set out to establish whether existing anti-inflammatory drugs could be used to block inflammatory activity of the NLRP3 inflammasome complex.

The team found that a group of anti-inflammatory drugs called fenamates blocked the effects of NLPR3 whereas others, like ibuprofen, did not.

Researchers studied transgenic mice to see if they developed the symptoms of Alzheimer's disease. One group of 10 mice was treated with mefenamic acid, and 10 mice were treated in the same way with a placebo.

The mice were treated at a time when they had developed memory problems and the drug was administered for one month to test the effects.

The study revealed that memory loss was completely reversed back to the same levels seen in mice without the disease.

Head of research at Alzheimer’s Research UK, Dr Rosa Sancho said: “There is increasing evidence of a key role for the immune system in Alzheimer’s, making it an attractive target for the development of new treatments for the disease. This research in mice suggests that an existing anti-inflammatory drug could have an effect on an important Alzheimer’s disease process. This finding is promising and will need following up to explore in more detail whether this class of drug could hold potential as a treatment for Alzheimer’s.

“Studying the effect of drugs for Alzheimer’s in mice is an important step that can provide valuable insights. However, carefully controlled clinical trials are vital for establishing the safety and efficacy of any treatment in people.

“Research like this is crucial as there are currently no treatments that can alter the progression of Alzheimer’s in the brain or protect nerve cells from damage in the disease. Drugs that act against the immune system have real potential to limit damage in Alzheimer’s and Alzheimer’s Research UK is investing heavily in this approach through our drug discovery initiatives. We desperately need to see greater investment in research if we are to find new ways to help the tens of thousands of people who develop Alzheimer’s in this country every year.”

The research was funded by the Medical Research Council and the Alzheimer’s Society, and could pave the way for human trials in the future.

'Promising results'

This is the first time a drug has been shown to target this particular inflammatory pathway, highlighting its importance in the disease model. However, Dr Brough warned that more research was required to identify its impact on humans and the long-term implications of its use.

Director of research and development at Alzheimer’s Society, Dr Doug Brown added: “Testing drugs already in use for other conditions is a priority for Alzheimer's Society - it could allow us to short cut the 15 years or so needed to develop a new dementia drug from scratch.

“These promising lab results identify a class of existing drugs that have the potential to treat Alzheimer's disease by blocking a particular part of the immune response.

“These drugs are not without side effects and should not be taken for Alzheimer's disease at this stage - studies in people are needed first.”

SOURCE: homecare.co.uk, Ellie Spanswick 

Families demand more care for loved ones in nursing homes

 “There’s a desperate, desperate need for more hours of care for people in nursing homes,” said Ann Dube, who has an 85-year-mother with Alzheimer’s living in a Windsor home, where workers are so overloaded they don’t have time — five minutes — to coax her to go to the bathroom. As a result, she refuses, she wets herself, and Dube arrives to find her mother soaked from her back to her heels. 

It’s just one example of frail, elderly people suffering indignities because there’s not enough staff to provide the care they need, said Dube. “If you go for a tour, everything’s hunky-dory — the rooms are clean, the place is beautiful. But when it comes to actual care, it’s shocking.”

She blames the rapidly increasing acuity of patients in long-term care, as elderly people stay in their homes longer (thanks to home care) and only end up in long-term care at an older age with much more complex needs.  

Most residents are in wheelchairs and most have some form of dementia, she said. “These people require heavy care. They’re not people who can walk on their own, dress themselves, shower themselves, toilet themselves.”

Since her mother went into the home in March, she’s witnessed three nearby residents worsen to the point they now must be fed by a personal support worker. “It’s deteriorating rapidly and there’s no change to the care being provided to them,” said Dube. “So it’s totally unacceptable.”

Evelyn Nevin, whose husband Fred moved into the region’s newest long-term care home, the Villages at St. Clair, in February, said the facility is “magnificent.” But she believes understaffing contributes to missed baths, meals and recreational activities, and increases the risk of medication and treatment errors.

“It is like warehousing, there’s no other word for it, that’s what it is.”

She’s been bringing the petition to the home and local seniors centres. “Everybody’s signing it,” she said, suggesting that families are simply trying to get what customers of child day cares already have: a legislated ratio of staff to residents.

There’s no legislated requirement that nursing homes provide a certain number of hours of care. Ten years ago, they provided about four hours, but that number has probably dropped to 2.5 hours while the need for care has risen, said Tom Carrothers, who chairs the advocacy committee of the Family Council Network for long-term care homes in the region around Hamilton and is one of the architects of the petition campaign. 

“It means that they are in a wet diaper for a whole lot longer than they should be, that no one’s there to help them walk so they’re put in a wheelchair instead,” said Carrothers, who had a mother and mother-in-law in long-term care until their deaths.

When residents don’t get help walking they lose their mobility. When they aren’t helped to the washroom and are left in a diaper they become incontinent, he said, recounting a recent letter from a woman upset over the lack of care for her husband. When she arrives to see him, he’s crying, unshaven, in a wet diaper.

“This man was a very proud person, a very good person, but his self respect has fallen apart because he’s been treated this way,” Carrothers said.

He also noted that some families are paying $25 an hour for extra help from outside agencies that send personal support workers into long-term care homes. But many people can’t afford that, he said, resulting in one resident receiving the care he needs, while the resident beside him doesn’t.

The four-hour requirement is the main focus of a private member’s bill re-introduced this fall by Ontario NDP health critic France Gelinas. “I want it enshrined, I want it written down,” so families can demand improved care from long-term care homes, she said. She estimated residents currently receive about three hours a day. 

Talk to the families of people residing in long-term care, she said. “Their No. 1 concern is there isn’t enough time for staff to care for their loved ones.”

Ontario Long Term Care Home Association CEO Candace Chartier agrees there’s been a problem with staffing to cope with a dramatic rise in patient acuity. For example, while 62 per cent of the province’s long-term care residents had dementia two years ago, today that number is as high as 87 per cent.  However, Chartier contends that imposing a four-hour care requirement wouldn’t help much. 

“You’re not solving the problem that you’re looking after a very different population and you need more specialized investment,” Chartier said, suggesting a better solution is devoting dollars to initiatives that individually address behaviour problems (primarily by dementia patients) and find solutions.

The four-hour rule would cost $1.2 billion, a 30 per cent increase to the current government budget for long-term care, Chartier said. “That’s crazy. That money could be put towards specialized staff to look after that 87 out of 100 (dementia patients) who need that specialized approach.”

Since 2003, the government has almost doubled funding for long-term care, to $4 billion annually, according to a statement from Health Minister Eric Hoskins. Staffing has increased by 4,600 since 2008, and those new personal support workers and nurses have helped improve patient care, it said.

“All licensed long-term care homes are responsible for providing appropriate levels of staffing at all times based on the unique needs of each resident,” Hoskins said.  “I fully expect long-term care homes to provide residents with the quality of care that Ontarians expect their loved ones to receive.”

But Shelley Smith, a  personal support worker at a Windsor area home for 31 years, said long-term care residents are not being treated with dignity, “at all.” Though the mostly female workers are nurturing and do their very best, they’re burdened by a heavier workload, often working short staffed, she said. They work through breaks and past the end of their shifts.

“The residents get care, but it isn’t the care they deserve,” she said, citing as an example a woman with dementia who has forgotten where “her babies” are. If you don’t help her by looking for her babies, it only adds to the woman’s frustration. But you don’t have the time, Smith said.

“Everything seems like a production line.” 

Elderly residents require time, she said. You can’t rush them. If you do, it causes bad behaviours. 

“I feel they need to be taken care of properly, 100 per cent, and I think the owners (of long-term care homes) need to be looked at, the profits they’re making off these residents,” she said. 

“They’re allowed to maintain all this profit, profit, profit, and I don’t see it coming back to the home.”

Retired CAW national president Ken Lewenza regularly visits long term care homes to visit retirees and sees first-hand how PSWs and nurses “do not stop, do not stop.”

He sees patients sitting in a chair alone for five or six hours and it all has to do with lack of staffing, he said. 

“I think the problem is nobody every thinks about long-term care until they have a family member in there, and it’s a real problem.

SOURCE: Windsor Star, Brian Cross

'Helping new care home managers establish themselves in their role'

The care home sector has for some time suffered with a poor image despite the excellence that exists within in it. Like any industry, service or public sector there is good and bad everywhere.

Being a care home manager is not for the faint hearted and the transition from a public sector role to working in the independent sector takes more than a leap of faith.

How can we help people to make that transition?

Problems can arise from these roles being isolated and at times it can be “tough at the top”. Buddy schemes for new managers and an induction programme that creates a network of support from peers is crucial to help new managers find their feet.

In larger organisations, home managers have a chance to meet with area and regional managers and peers, but within in our communities many managers sit alone in small or single providers. For them in particular the network is crucial, not only to offer support in times of “crisis” but also to share the good work we do.

I am fortunate that my care home is part of the ’Teaching Care Home’ pilot programme. This has prompted me to think about learning in our home and how we can share this learning in our community and with others. Being a Teaching Care Home means we are striving to be a recognised beacon within our community and within Methodist Homes.

”We aim to be seen as a beacon of good support for newly appointed managers”

Our home is open to visitors from across the sector to share the changes we are striving to make and the culture of learning and continuous improvement we are developing. We aim to be seen as a beacon of good support for newly appointed managers to help them transition into the role, learn about systems, processes, team leadership and home culture and ultimately help them establish themselves in a new role in a very different and challenging environment.

This can be made more difficult by the complexity of the home manager role which is often poorly described or misunderstood.

It’s multi-faceted, complex and with a touch of the entrepreneurial about it. Learning about the process and interfaces from the care home perspective with regards to local authority departments, CQC, CCG and local health services is one thing. Internal compliance with new management, budget and governance procedures is another.

”Learning how to pace and plan is key”

The home manager role is often a combination of HR, finance, governance, catering, housekeeping, maintenance and PR, with external support in big organisations, but single providers may find they are also their own CEO. Therefore, learning how to pace and plan is key.

The pressures are often great and the clinical and commercial aspects of the role take enormous energy, determination, negotiation and sheer hard work to ensure an efficient safe and effective environment for residents and staff.

Having the ability to spend time with an established manager and gain insight into how a home functions could also be used as an opportunity for learning for potential future managers. At a time when we are struggling to recruit, “growing your own” has never been more needed and we could build capacity within our teaching care home to be a place of learning and a test bed for new career opportunities.

”We need to support each other and create networks”

Connecting across our communities is key in sharing the learning, developing skills, and building our future leaders.

We need to support each other and create networks to demonstrate how care home careers can be exciting interesting and changing. With a shrinking pool of talent we have to up our game and offer a new opportunity for the future.

Sustaining the momentum, spreading the word and describing both the challenges and many, many opportunities of working in a care home could help us remind people we are an important part of the health and social care system and a vital part of keeping it going.

SOURCE:Nursing Times,Siva Sivanandarajah 

How red bags are bringing NHS and care homes closer

Like many good ideas, the way the NHS and care sectors in the London borough of Sutton are working together more closely is a relatively simple concept.

When a care home resident needs to go into a hospital, a red bag is packed for them.

It contains their details, vital information about their health conditions, supplies of medicine, and a change of clothes for when they are ready to be discharged.

"You would not believe how many people face delays simply because clothes can't be found for them," says Mary Hopper, a senior NHS manager in Sutton. "You have staff going to lost property trying to find them something to fit."

The initiative also sees a member of the care home staff visiting the patient in hospital within 48 hours of admission.

And this all helps doctors and nurses treat them more effectively.

The result is older people are spending less time in hospital - eight days, which is four fewer than before the scheme was set up.

That is good for the individual and good for the health service.

But the red bag scheme is just one of the ways the NHS and care homes are working together.

Drop in A&E visits

GPs have also been employed to carry out regular visits of care homes, with each resident now receiving six-monthly check-ups.

A pharmacist is on hand to visit homes to carry out medicine reviews.

And district nurses have been used to train care home staff in dementia, falls and diabetes.

It certainly seems to be working.

Since the project started a year ago, there has been a 10% drop in visits to A&E.

Those running care homes are, unsurprisingly, full of praise.

Patricia Fyfe, the manager of St Jude's care home, says it has been really "eye-opening" to see what can be achieved through collaboration.

Sutton is not the only area where the NHS is forging closer links with care homes.

It is one of six "vanguard" areas in England given funding to explore new ways of working.

This has been done in recognition of the fact that the NHS has - in the words of Ms Hopper - turned its back on the care sector.

She says the closure of many long-stay hospitals 20 years ago means the responsibility for caring for sick older people has increasingly fallen on the care sector - with little input from the NHS.

The sentiment is one the care sector wholeheartedly shares.

Prof Martin Green, of Care England, which represents providers, says there is no reason why residents in care homes should get an "inferior" service to the one someone in their own home would get.

But all the evidence suggests they do.

The Care Quality Commission looked at the issue a few years ago and found most of the 81 care homes it asked did not receive regular visits from GPs.

The result has been that care home managers have had to pay GPs retainers to ensure they visit - with reports that some are as high as £20,000 a year.

So what is the solution?

If the experience of Sutton - and the other places doing good work in this area - is anything to go by, it is forging a shared approach.

Ever since the separate systems of social care and health care were created after World War Two, they have been treated as distinct services - one run by councils at a local level, the other organised centrally by government.

But, increasingly, as the population ages, that is looking out of date.

The government has set up a shared pot - called the Better Care Fund - to encourage local government and the NHS to work together.

The fund is worth just over £5bn this year - but that is less than 5% of the combined health and care budgets, which is why some people want the government to go even further and merge the two sectors completely.

Such a radical move is probably some way off yet, if it is to happen at all, but what is certain is that the futures of the two sectors are inextricably linked.

SOURCE: BBC News, Nick Triggle