A recent, two-part series by Boston Globe correspondent Kay Lazar about the use of antipsychotic drugs in nursing homes has Bostonians buzzing. The article examines the use of these powerful medications in residents that do not have a diagnosis of psychosis and how that relates to staff levels, number of residents on Medicaid and how many of those residents have behavioral issues. I applaud Ms. Lazar’s in-depth look at this important issue and wholeheartedly agree antipsychotic drugs are not necessarily the best solution for addressing behavior problems exhibited by nursing home patients with dementia.

Just last month I gave a presentation to the board of directors at Aviv Centers for Living. Although use of antipsychotic medications at our skilled nursing facility is already low, our history, philosophy and plans to provide cutting edge dementia care require us to further reduce the use of antipsychotic drugs. Our goal is to resort to medications only when all other non-pharmacologic options have been exhausted.

If a loved one in my family needed to go to a nursing home, I would want to know questions to ask to understand its philosophy and practices about administering antipsychotic drugs to residents. Here are the top ten areas I would address:

Meet with the Director of Nursing to gain an understanding about the facility’s philosophy about the use of antipsychotics drugs for behavior management. Come prepared with a list of general questions as well as specific concerns.

Check on the availability of mental health specialists.

Understand how staff is trained to manage dementia-related behaviors.

Ask about protocols for the management of dementia residents with behavioral issues.

Develop an understanding about the non-pharmaceutical approaches to meet individual needs of each resident.

Ask for a tour of the facility. Take note of the design of the floors and how staff interacts with residents. Look for signs that the facility fosters a patient-centric environment, one where the individual needs of the resident are being met.

Note whether the facility has secure outdoor areas where residents can enjoy the holistic benefits of fresh air and nature.

Ask to talk to the Director of Activities about daily activities as well as enhanced programming tailored to individual needs.

Inquire about how the facility records each resident’s personal history. Although elders with dementia have memory loss, they usually retain long-term memories.

Inquire about the members of the multidisciplinary team that will care for your loved one and determine his or her individual roles.

Although Aviv Centers for Living’s policy is to be extremely selective in administering antipsychotic drugs to residents with dementia, our belief is we must be vigilant in exploring new and creative ways to change the culture and further reduce the chemical treatment of behaviors. In fact, our new building includes a skilled nursing facility featuring intimate, non-institutional households; family type dining rooms and a preponderance of private rooms with personal showers. The design decisions were made with the best interests of our residents in mind. . We also have set up a Dementia Task Force and hope to be trendsetters in our practices. In my next blog, I will outline strategies we are currently employing to insure our residents live with a sense of dignity, meaning, purpose and delight.

Staying focused on fitness is challenging as anyone engaged in an ongoing fitness program can attest to. It takes diligence, motivation and memory to stay on track. Yes memory! Sometimes even the most dedicated and highly motivated individual has a difficult time with one thing in his or her fitness program – remembering what to do when he or she arrives at the gym!

Sometimes, and more often than not, entering a gym is so overwhelming (even for those that regularly attend) that unless you actually have your career working in one, all the machines and exercise options are too much for a person to figure out exactly what to do and when to do it. During these times, I simply say, “Let’s simplify and try to remember one word that will remind you of what you should be doing.”

Today’s word is ROLL, not the kind you eat with dinner or the type that you are trying to get rid of around your waist, but the kind that means the direction your body needs to go and some exercises that reflect that movement. In keeping with the “rolling” theme, the following exercises will help you identify and utilize the rolling movement to having a few exercises to do when you can’t think of what to do.

Roll Shoulders
Keep your hands/arms at your sides and simply roll your shoulders backwards to complete the circle movement. Only roll backwards and do this for a count of ten, three times.

Roll Knees
In a sitting position, lift your right knee and make a circle in the air using your knee as the starting point. Roll clockwise for the right leg and counter-clockwise for the left. Do this for each leg for a count of ten, three times.

Roll Ankles
Lift foot off the floor and roll your ankle. Roll the ankle clockwise for the right ankle and counter-clockwise for the left. Do this for each ankle for a count of ten, three times.

Roll Wrists
Hold your arm straight in front of your elbow bent. Roll your wrist slowly, again repeating the above pattern, clockwise for the right wrist, counter-clockwise for the left.

As you can see, fitness doesn’t always have to be very complicated, especially if you have some key tricks to help you remember. So remember to get rocking, just roll… and roll along the fitness pathway!

Passover is such a special time at Aviv Centers for Living as we enjoy the seders and look forward to spring. Here are a few favorite recipes from the Woodbridge Cookbook.

Beef Brisket—Elie Noah, Woodbridge resident
 
5 lbs brisket
4 or 5 carrots cut in half
4 or 5 celery sticks cut into pieces
2 red, yellow, or green peppers cut in half with seeds removed
2 large onions, chopped
6 white potatoes cut into pieces
1 bottle of mild chile sauce
½ bottle of ketchup
½ bottle of good white wine
¾ cup water
Pierce brisket with fork and cook at 350 degrees covered for one hour.  Uncover and add remaining ingredients and keep basting until soft and tender (additional 3 hours)
 
Chocolate Passover Mandelbrot—A friend of Woodbridge

2 cups white sugar
1 cup pareve margarine
6 eggs
2 3/4 cups matzo cake meal
3/4 cup potato starch
1/2 teaspoon salt
1 cup chopped walnuts
2 cups semisweet chocolate chips
2 teaspoons white sugar
1 teaspoon ground cinnamon
Preheat oven to 350 degrees F (175 degrees C). Grease a large cookie sheet.
In a large bowl, cream together the 2 cups sugar and margarine until smooth. Beat in eggs one at a time, mixing well after each one. Combine the cake meal, potato starch and salt; stir into the creamed mixture. Mix in walnuts and chocolate chips. The mixture will be heavy. Form into 2 long oval loaves. Place onto the prepared baking sheet. Sprinkle the top with a mixture of 2 teaspoons sugar and cinnamon.
Bake for 50 to 55 minutes in the preheated oven, until a toothpick inserted into the center, comes out clean.
 
Passover Stuffed Cabbage—Sylvia Grace, Woodbridge resident
 
1 medium cabbage head, blanched
1 lb. lean ground beef
1 med. Potato, peeled and grated
1 egg
½ tsp. salt
1 onion, grated
1 carrot, grated
½ cup vinegar
½ cup brown sugar
2—8oz cans of tomato sauce
Dash of honey
Combine hamburg, potato, egg, salt, onion, and carrot.  Put a small ball of the mixture in each blanched cabbage leave.  Place stuffed cabbage leaves in a heavy pan and add remaining ingredients.  Cover and simmer for 1 ½ to 2 hours.   Hints:  This dish is delicious but tastes even better if it’s cooked the day before and then reheated.  Can also be cooked in a crock pot on low for 7 – 8 hours.   Serves 4 to 5.

Gifts, we are used to getting them for the holidays, our birthdays and special occasions.  Normally these gifts are of a material nature but there are much more important gifts that we all possess, some of us know we have them: singers, actors, artists, athletes the list goes on.  However, I am here to tell you that everyone has a gift, gifts that we are born with.  Sometimes we never really go that deep into ourselves to find what that gift is.  Sadly, there are a group of people that think that once you reach a certain age, you are “too old” to find out what those gifts are.  I feel badly for that group, since I know for sure that using some tools and techniques, even the most hidden gift can be found, utilized and enjoyed.  
Since I am in the fitness industry, I know that one sure fire way to find out what that gift is, will happen when a body is in good physical shape!  When a person works out or gets some physical activity, wonderful thing happens; the mind becomes clearer and calmer, yet more energized!  As a result,  one doesn’t have to spend his or her entire day (or night) worrying about his or her’s physical well-being, instead the feelings of pride, confidence and serenity seem to replace some of the worry which clears the mind to discover many things including what your “gifts” are and how best to use them.  You see, when a body is in good physical shape, you feel better and then you have the confidence and drive to do things you may not have ever possibly imagined!  Even better, if in the past a person has enjoyed a particular sport, such as bowling or tennis, feeling better physically will allow that person to try that sport again!  
There may have to be modifications done to allow this sport to happen, but I believe that doing something,  however you do it,  is much better than never doing it at all!  For instance, if a former bowler wants to try bowling again after many years, that person can go to the local bowling alley and give it a try!  If going to the bowling alley is a bit too uncomfortable, there are computer and online games that simulate the sport or one can even try table bowling. 
Trust me – if you want to do it – you will find a way!  Let your mind wander and think of things you always wanted to do and find your gift.  As a younger person, maybe you had family obligations or something else to prevent that from happening, but now as a senior, just get to it!  Reach into the deep recesses of your mind and think of what would make you happy.  You can always ask friends or family to help you in this endeavor and enjoy!  Remember, you’re never too old to do most anything so go ahead, give it a try……find that gift and enjoy it thoroughly!
 
 

Do you know that falls are the leading cause of injury in adults over the age of 65? At Aviv Centers for Living, at the JRC, we treat many seniors whose injuries may have been prevented with thoughtful planning.  When patients are in our short-term rehab center, we take extra care to make sure we educate them on safety tips so they can return home safe and confident. Following are some helpful tips to share with seniors to prevent falls at home:
     
⁃ Wear non-skid shoes.
⁃ Avoid walking around the house in socks or bare feet.
⁃ Remove scatter rugs that do not have a non-skid backing.
⁃ Leave eye glasses and a telephone on a night stand at bed time.
⁃ Get your vision checked once a year.
⁃ Make sure your home is well lit, inside and out.
⁃ Continue to stay physically active, even in the winter months.
⁃ Install door locks that can be opened from both sides.
⁃ Install grab bars in the bathroom near the toilet and inside the shower.
⁃ Place a rubber mat inside the shower.
⁃ Leave a light on in your bathroom at night.                                   
⁃ Put treads on hardwood stairs.
⁃ Keep items you use daily in the kitchen at eye level.
⁃ Make sure banisters in stairways are sturdy.
⁃ Ensure that staircases are well lit.
⁃ Eliminate clutter in entryways, stairs, and walking paths.
⁃ Coil or tape electrical wires together against a wall.
⁃ Consider a medical alert system for 24 hour emergency use.
 
 

March is National Professional Social Work Month and this year’s theme, “Social Work Matters”, seeks to showcase the impact of more than 642,000 professional social workers in America. I would like to take a moment and share with you some information from the National Association of Social Workers.

According to the Bureau of Labor Statistics, social work is one of the fastest growing professions in the country due to an increased need for health and aging related services, as well as child, family and school-based supports.  From 1931 Nobel Peace Prize recipient Jane Addams to 2011 Nobel Peace Prize recipient Leymah Gbowe, social workers have been instrumental in achieving civil rights and human rights advances in the United States and across the globe for more than a century.

“The graying of America” has been a popular phrase in recent years as the number of older people continues to grow. Statistics project that by 2030, Americans 65 and older will actually outnumber their younger counterparts. With the aging of the “baby boomer” generation and the lengthening of life spans, both the number and proportion of older people are rapidly increasing. Many of the health related problems that contributed to decreased life span have been combated. Yet, this same achievement presents new challenges in meeting the social, environmental, psychological, economic and health care needs of older adults.

These shifting demographics have created a greater demand for professionals with specialized knowledge and expertise in aging. Social work is unique among the health and mental health professions in that it considers the physical, mental, and social aspects of individuals—an approach that is critical to providing services to older adults and their families.

Gerontological social workers, who make up about 5% of the nation’s half a million social workers, can help older adults and their families maintain well-being, overcome problems and achieve maximum potential during later life. Social workers serve as “advocates” for older people, providing a vital link between older individuals and the services they need. Indeed, a key function of gerontological social workers is to promote independence, autonomy and dignity.

Social workers provide services in a variety of settings, including hospitals, nursing homes, hospices, adult day health centers, independent and assisted living communities, public agencies and increasingly, in people’s homes.

Here are some of the ways we will be celebrating Social Work Month here at Aviv:

We will enjoy a Podcast – “What LICSW’s Need to Know About Section 12”
Jen Decker, an elder care mediator, will be speaking about the art of listening  
Mary Crowe, LICSW, from Hospice of the North Shore and Greater Boston, will present: Caring for Yourself – How to Prevent Burnout
We will view a film entitled “Beyond Kubler Ross” which gives new perspectives on death and dying
Laurie Grant, who is a specialist in hoarding, has created a short DVD entitled “Hoarding 101” which we will watch and discuss
 
I would like to take this moment to thank Aviv Centers for Living for recognizing that social work really does matter. We recognize the strong connection between body and mind as evidenced in our integration of social work services throughout Aviv.

As an occupational therapist in a skilled nursing facility, I am professionally trained to work with seniors to have them strive to reach and maintain their highest level of function.  While I am a firm believer in the science and medical aspects of occupational therapy, I am a strong advocate of utilizing the creative and artistic facets of the field as well. 
 
I was particularly inspired by the Museum of Modern Art’s “Meet Me at the MoMa” project that makes art accessible to people with dementia and their caregivers. It made me think about how beneficial it would be to integrate art into Aviv Centers for Living.  This led to the development of the Art Walk.  On the second floor of our skilled nursing facility, each wing has art displays with both descriptions and questions to evoke memories and conversations with caregivers, family members and friends. 
 
Here at Aviv, we like to say that our goal is to “create delight” for our residents and clients. I look forward to seeing how our art evokes emotional reactions through conversations, reminiscing about life and connecting with family. 
 
We have launched “My Life Story” books that are fantastic ways for residents and family members to paint a picture of a resident to enhance their quality of life and care that is provided to them. Another nice little delight some of our residents experience is a sensory hand massage; they absolutely love the sensation of having their hands massaged in a relaxing environment. 
 
When I look at our mission…to enrich the life of each of our residents and program participants, so that each can continue to live his or her life with a sense of meaning and purpose, I can see that integrating art into Aviv Centers for Living will organically bring meaning, joy and delight for our resident and clients.

As I start to write this current blog article, it is Valentine’s Day and I can’t help but think of love. Love is a wonderful emotion but at times the person we forget to love the most is ourselves. This is common and it’s not often we give ourselves permission to love ourselves and the bodies we have been given. Most (but not all) of the time a person needs permission to do this. So now, I am hereby giving YOU permission to LOVE YOURSELF! There it is done. Now how do we do that? Loving yourself is difficult but may I offer a suggestion? Get healthy or keep moving if you are currently living a healthy lifestyle! One of the easiest but the most difficult ways to achieve this goal is to start exercising! Easy to do because there are so many options available, difficult because the first step is to get started!

At Aviv Centers for Living at Woodbridge, there are many options. You can work out in Goldman’s Gym in the morning with me and/or participate in one or all of our daily exercise classes. Sounds simple right? If you don’t have a fitness class or gym down the hall from where you are – that means you have to go and find one. There are many gyms and fitness classes in our area to choose from but be assured you need to do your homework. First of all, make sure it’s fun and more importantly, safe. Make sure that the exercise instructor has experience and knowledge with instructing seniors. Ask the instructor whatever you need to that assures your confidence in that instructor and in the program. Remember, any instructor or trainer that won’t give you his or her background or education is probably not the one for you – in fact leave that gym immediately and find another one.

Another option to gain this information is to ask other seniors. You can probably pick out the seniors that regularly attend a fitness program or fitness classes. They walk with confidence, usually have a smile on their face and are pretty happy people in general. Yes!! They love themselves and show that love to themselves by taking the time to attend a fitness program that works for them, and as a result, these seniors are usually more than happy to share what they do, where they do it and how much they enjoy it! You just have to ask them and you’ll see! Remember, before you can give love – you have to accept love for yourself, one of the best ways is to take good care of yourself and then you can give to others. Much love and fitness wishes from Aviv Centers for Living!

Do you forget people’s names? Do you forget where you put things? Do you have to recheck whether you have done something you meant to do?

As people age, many are concerned about the subtle changes they notice within themselves and wonder if these changes are precursors to a more serious type of memory loss such as Alzheimer’s disease. There are real changes that take place as we age that can affect our memory. To comprehend the changes, one must first have an understanding of memory. The two words frequently used to describe memory; short term and long term are often misunderstood. Long term memory is not just our memory from long ago. It consists of the information we store in our brain for later recall. It could be as simple as remembering what ingredients we need for a recipe when we go shopping. The storage capacity of our long term memory is endless.

Short term memory refers to information that we retain in our conscious thought for short periods of time. If the information does not get transferred to our long term memory it will be forgotten. Severe cognitive impairment occurs when the ability to transfer information from short term to long term memory is lost.

With normal aging, there are several changes that should be expected. First, it becomes more difficult to retrieve information from our long term memory. As we age there is more information stored in our long term memory so it becomes more difficult to find it. Second, as we age it becomes more difficult to pay attention to several things simultaneously. Our capacity to learn new information does not change as we age, it just takes more effort.

There are some real physical and psychological factors that can also affect memory including: medications, stress, nutrition, depression and negative expectations. Once it is understood that real changes do occur to our memory as we age, solutions can formulated to keep the mind active and healthy. Memory loss is not inevitable. As we accept the physical changes that occur in our body as we age, we need to understand what occurs in the brain. Each one of us can draw comfort from knowing that we are not alone.