Los Angeles, CA, October 23, 2000 — Decisions, Decisions
If the day were not on the cloudy side, explains Jack Peters, more people would be outside walking the grounds.
The inside/outside doors are open at Silverado Senior Living in Calabasas, one of six Silverado facilities built on principles of noninstitutional, multiple-option care for people with Alzheimer’s disease or dementia. Spending the day inside or outside is one choice that residents have. Another is where to eat: club dining room or 50’s dining room or formal dining room.
“We try to give people the same choices thatch they would have if they didn’t have the disease,” says Peters, regional administrator of the Calabasas facility, which opened a year ago. “Ofcourse, they can’t, to a pure degree-but they can to some degree. The more choices they have, the more they feel self-worth, self -esteem.”
Patterned on the “Edenic alternative” philosophy of senior homes, which says that residents should have as much contact with their human habitat as possible, Silverado positively bustles. Dogs, cats, fish and birds are found throughout the hallways, and young children frequently come to visit.
Nursing stations and medicine are hidden from view, and no matter how difficult residents get, they are never restrained. The cost is $3995 a month for a semiprivate room, $7895 for a private room.
“In general,” Peters says, “we’re trying to bring life to people who most other people have given up on.”
Founder Loren Shook is credited with being among the first to use such devices as memory boxes and “diversion boxes” to keep residents centered. Shaped like a decorative cabinet and located outside a resident’s room, the memory box contains memorabilia such as newspaper clippings or a picture of the resident as a younger person. According to Peters, the device helps a person find his room more easily than does a nametag.
The diversion boxes also contain common household gadgets mounted on wall that administrators can use to keep residents from aggressive behavior. If Bob looks like he’s about to hit Ben, a staff member will ask Bob to come over and help figure out this gizmo on the wall. A few minutes later, short-term memory has kicked in and Bob has forgotten his quarrel.
The boxes are part of what impressed researchers from UCLA and led them to select Silverado as one of two Alzheimer’s facilities-the Motion Picture and Television Hospital being the other-to include in its ongoing Alzheimer’s Disease Cooperative Study group.
“We identified a very small number of high-quality facilities that we felt were really making extra strides in offering the residents an exceptional care environment,” said Dr. Verna Porter, clinical instructor in UCLA’s Department of Neurology.
The literature for Silverado trumpets Alzheimer’s sufferers regaining walking skills, weaning themselves off medication and learning to feed themselves again. But medical director Dr. Dan Osterwiel says family members shouldn’t expect miracles, only compassionate, progressive-minded care.
“In terms of their medical condition, I don’t’ think we make any difference one way or another,” says Osterweil, who is also a professor at UCLA. “We try to manage these patients as if they were not mental. The family gets extra support. As they come and see the individual in a very nice environment, where they’re respected and not restricted, it makes the families experience less stress.”
Helping Both
Caring for a loved one with Alzheimer’s
-by Evan Henerson
A loved one is changing in frightening ways. He is forgetful of day-to-day events and routines and often seems moody, distracted or depressed. Once-guaranteed pick-me-up activities now give him no pleasure, and his driving a car is out of the question. Perhaps most alarming of all, he doesn’t always recognize you.
The diagnosis is Alzheimer’s, or some related form of dementia. His condition won’t improve, but he could easily live several years, and he’ll need full-time care.
Here’s your choice: Do you make arrangements to care for your family member at home, or do you seek out a skilled nursing or board-and-care facility?
If you ask someone at an Alzheimer’s support group, this is a choice without a wrong decision. But if you’re the one who has to choose, every decision feels wrong.
Nor is the question as simple as “at home or placement?” How advanced is the disease? What kind of care does your loved one need? Is it feasible at home? How much will it cost? Will health insurance pay?
And suppose your only available option clashes with the wishes of the person in need of care?
What if your father-who doesn’t remember what he had for breakfast this morning- is aware enough to remind you emphatically that he doesn’t want to be sent away?
“I respect each family’s decision to manage this illness so that they, as a family, can get by,” said Dr. Debra Cherry, associate director of the Alzheimer’s Association of Los Angeles. “As a general rule, the best place is a familiar place as long as there is no danger to the individual or to the family.”
“The best place is a person’s,” she added, “but for some people, there comes a time when that’s just not possible.”
“Alzheimer’s disease,” agreed Rachelle Bloch, regional director of the Alzheimer’s Association on the campus at CSUN, “can tear a family apart.”
A degenerative brain condition that robs sufferers of both short-term memory and the ability to perform common tasks, Alzheimer’s disease is fast becoming an epidemic for seniors as baby boomers stat entering their senior years.
Medical research is coming up with ways to delay the onset of dementia, but we’re still nowhere near a cure. And with our over-60 population the fastest-growing segment of the population, Alzheimer’s Association officials are predicting a veritable dementia boom-from an estimated 12 million worldwide to 22 million by the year 2025.
Ten percent of people over the age of 65 suffer from some form of dementia, that number rising to 50 percent for people over 85. Which means, disease advocates says, caregivers need help.
“The illness isn’t about us,” said Deborah Franco, a singer and radio talk-show host who wrote the anthem for the annual Memory Walks. “The infrastructure needs to be giving support to the caregiver, and the caregiver’s focus needs to be on helping the person afflicted with Alzheimer’s retain the dignity and quality of life and not detracting from that focus.”
Franco, who is also the caregiver for a relative with Alzheimer’s, said she cannot envision having her loved one living in any setting other than with her.
“I can’t fathom how people who aren’t getting input and care and interaction can cope,” said Franco. “They must sink into the disease much quicker.”
Few will dispute the importance of an Alzheimer’s victim receiving as much human interaction as possible. It helps nobody to leave a person in front of a television set all day. But how many of us, doctors ask, are able to provide a sufficient amount of daily interaction and/or therapy? In most cases, the adult children of Alzheimer’s sufferers have to work while those who are retired often don’t have the stamina or financial resources to handle full-time care on their own.
On the other hand, many people find the thought of “warehousing” or abandoning their loved ones intolerable, particularly in light of stories about neglect or mistreatment in senior homes.
“In Los Angeles, you have very few humane environments that people feel good about,” said Dr. Dan Osterweil, a professor of medicine at UCLA and the medical director at Silverado Senior Living in Calabasas. “Guilt plays a major role. People feel that by brining them (to Silverado) or anywhere else, they’re abandoning them.
“The way you help (family members) is to help them realize how much of a burden it is,” Osterweil added. “By bringing them here (to Silverado), they’re still doing all the good stuff, but they’re delegating it.”
Before she took the job with the Alzheimer’s Association at CSUN, Bloch ran an adult day-care center in the Santa Clarita Valley for people with dementia. There are, she said, facilities-both day-care and permanent lodging-that will provide Alzheimer’s and dementia sufferers with better-than-average care, although that kind of care won’t come cheap.
“At the facility we ran, the patients got occupational therapy, speech therapy, physical therapy and an exercise program,” said Bloch. “You’re not going to be able to get that at home.”
Across the hall from Bloch is the office of Arnold Seretan, who is 81 but looks about 15 years younger. Both in his capacity as volunteer coordinator for the CSUN office or as a frequent participant at support groups, Seretan can empathize when he talks to people about caring for a loved one with Alzheimer’s. For 3 ½ years, Seretan was the primary care giver for his wife, Rose. By taking on this role, he kept a promise that as long as he was physically able, Rose would live with him at home.
An easy situation? Hardly. “That book they wrote ‘The 36 Hour Day’ (by Nancy Mace and Dr. Peter Rabins), it really does become a 36-hour day,” said Seretan. “It’s the constant demands: ‘Get me a drink, No, I want something hot. My feet are cold. Would you put some socks on me? I’m too warm. Would you take my sweater off?’ Over and over, anything you can think of, and it’s exasperating.”
When he learned that the father of his son’s girlfriend had died of a heart attack while being an Alzheimer’s caregiver, Seretan decided to start researching senior homes. Before he could place her, Rose died of a heart attack. She was 76.
“I was spared the problem of placing my wife,” Seretan said, “but I’m well aware of what people go through in making the decision. It’s a very difficult decision.”
