July 2018 Newsletter Print

President's Report

Greetings CMSA-SCC
As we head into summer let’s take a look back at the past two meetings.

February’s meeting was a great success with speakers who were cutting edge regarding improving outcomes, innovation in managed care and stem cell therapies. March we had our CCM prep course which was well attended, folks from all over, even out of state attended! Congratulations to those who are now CCM certified. This certificate is a major accomplishment!

In May, we met on the 17th where we had outstanding speakers and guests. We were honored to have Genentech host our breakfast portion of the meeting. Genentech has been following science for more than 40 years, seeking solutions to unmet medical needs. Please visit their website https://www.gene.com/. CMSA thanks Genentech for hosting.

Moving forward we are excited to be attending the upcoming CMSA national starting June 19th in Chicago. Hopefully many of you can make it. Some of the CMSA-SCC board members will be there including me and we are looking forward to learning and sharing ideas to bring back to our chapter.

We are having another CCM prep course at Torrance Memorial Medical Center in Torrance, CA on September 14th and 15th. For those who want to get CCM certification this is an excellent course to take.

Our next meeting conference is September 20th at the Sheraton Fairplex Hotel in Pomona. Please mark your calendars for the upcoming meeting. We are looking forward to seeing everyone.
Once again I want to personally thank our members, non-member and vendors who attend our quarterly meetings. We have a great time sharing issues, successes and information which is extremely valuable in our industry.

Finally, I want to give a huge thank you to the speakers who come and share their knowledge with us. As we move forward in health care as case managers, learning from those experts helps us educate our team and ultimately helps our patients and families have better access to information though us.
Have a fun, safe summer everyone

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Welcome New Members

Tara Ackley, Imelda Aguilera, Turma Alava, Lisa Bricker, Patricia Brydges, Liza Castillo, Martha (AKA Shelly) Collins, Mary Davis,
Richard Evangelista, Pamela Fant, Yesenia Ganzon, Victoria Hazard, Anita Johnson, Randy Kimsey, Catherine Kvasnicka, Robert Lanigan, Angela Matthews, Nicole McClendon, Carlos Moreno, Natalie Moy, Allisha Nazareth, Jana Nakamura, Tina Ochoa, Sarah Ordover, Marifel Pagkalinawan, Jason Pascual, Kiana Rutten, Diane Sanchez, Patricia Tager, Jacqueline Touch, Linda Violas, Elaine-Marie Walker, Earle Jacqueline, Ward-Rowens, Arlene Yabut

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Editor's Notes

Our July Newsletter includes an article which addresses factors and considerations when choosing a facility. In addition we have included a description of a special Alzheimer’s support group for Residents living in the community. Our next Newsletter continues with the theme to address community resources in the home including home care, home health, home resources available and additional information on special services.
If you would like to contribute to our next Newsletter please contact me at denrounds@gmail.com. 

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Articles

Most of us, most of the time, want to age at home. But the reality is not everyone can, or should. Sometimes staying in your own home as you become increasingly frail is a poor choice. It can be lonely and even dangerous. It can burn out family caregivers. And it even can be more costly than other options, especially for people with very heavy care needs.


Social Isolation is a Powerful Risk Factor Affecting Senior Health
“Aging in Place” is the phrase of the moment. But, sometimes, both the patient and the family would be healthier and happier living at an assisted living facility. Social isolation and loneliness are associated with increased mortality in older adults. Social isolation also has been linked to other adverse health effects, including dementia, increased risk for hospital readmission and increased risk of falls. However, research consistently shows that feeling connected and involved benefits both mental and physical health.

Caregiving Has Negative Impact on Caregiver Physical Health
High rates of depressive symptoms and mental health problems among caregivers, compounded with the physical strain of caring for someone who cannot perform activities of daily living (ADLs), such as bathing, grooming and other personal care activities, put many caregivers at serious risk for poor physical health outcomes. Indeed, the impact of providing care can lead to increased health care needs for the caregiver. In 2005, three-fifths of caregivers reported fair or poor health status, one or more chronic conditions, or a disability, compared with one-third of non-caregivers. Caregivers also reported chronic conditions (including heart attack/heart disease, cancer, diabetes and arthritis) at nearly twice the rate of non-caregivers (45 vs. 24%).

“I Don’t Want to Leave My Home”
The biggest objection of older clients is that they don’t want to leave home. However, home is not giving them the life they once had. Friends have died, moved away, or are no longer mobile. Cooking is a chore, as is getting to the grocery store. Bathrooms may be unsafe. There may be stairs. As a care manager, suggest that your patient go and visit some assisted living communities. Often their preconceived notions are dispelled once they see that assisted livings are more akin to hotels than nursing homes with dining rooms, activities, amenities, housekeeping and often, very active seniors.

Guilt-Ridden Kids
Guilt is often the driving force keeping family members from broaching the subject of assisted living. Suggest to your client that taking care of their parent is making sure they find the best care. That’s caretaking too. Often, finding a proper assisted living for a parent is the most loving act that a child can do because it improves the quality of the parent’s life from medical and social perspectives.

But, Isn’t Assisted Living Expensive?
Unfortunately, most assisted living facilities, whether
they be small board and care homes or full-fledged communities do not accept Medi-Cal. Depending on where your patient lives, prices can run anywhere from $1800 per month for a shared studio to $15,000 per month for a prime Los Angeles two bedroom apartment. In reviewing whether a client can afford assisted living, remember that these prices are inclusive. They cover rent, utilities, meals and snacks, housekeeping, transportation, activities, 24 hour on-site care, and often extras like cable and personal laundry. Usually, the only out of pocket expense for the individual is their cell phone and out-of-pocket medical.

How Does A Family Get Started?
There are over 2,000 Residential Care Facilities for the Elderly (RCFEs) in the Los Angeles area. Senior housing referral agencies like Assisted Living Locators are experts in what is out there and provide free help in sorting through options. When recommending a placement advisor to a patient, look for ones that are “boots on the ground” consultants, not internet services. Assisted Living Locators only recommends places we’ve personally inspected and usually have existing residents who provide feedback on the good and the bad. A good agent will tour with the client to help them evaluate the facility and help negotiate rates, which can save substantial sums over the long term.

Assisted Living is an important piece of the senior living spectrum helping patients live healthier, more engaged lives. Understanding when to consider it and how to talk about it can make the difference in creating a record of successful discharge.


Byline: Sarah Ordover is the owner of Assisted
Living Locators, Los Angeles, a free senior housing placement company. For more information go to www. assistedlivinglocatorsla.com . She can be reached at saraho@assistedlivinglocators.com or 310-853-8282.

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Article

I have been volunteering at a day center for Alzheimer’s for the past three years and have been fortunate enough to get to know several individuals and their care givers at varying stages of this disease. There have been husbands, wives, daughters, sons and even grandchildren coping with the caregiving process. When the disease progresses the individuals are often placed due to safety concerns. Sometimes the concerns are due to wondering and, at times, it is due to combative behavior. For this article I have interviewed and received written responses to questions I posed to three of the families in writing.

Before going into their answers to me, here is a brief description of Alzheimer’s Disease, warning signs and medical treatment. Alzheimer’s disease can cause a person to exhibit unusual and unpredictable behaviors that challenge caregivers, including severe mood swings, verbal or physical aggression, combativeness, repetition of words, and wandering. These behavioral changes can lead to frustration and tension, for both people with Alzheimer’s and their caregivers. It is important to remember that the person is not acting this way on purpose, and to analyze probable causes and develop care adjustments.

Alzheimer’s disease is a progressive neurological disease that, over time, results in the brain’s inability to function correctly. Alzheimer’s disease causes changes in memory, communication, judgement, personality, and overall cognitive functioning. Alzheimer’s was first identified by Alois Alzheimer in 1906 in Germany and is the most common type of dementia, a general term for impaired brain functioning. Although many people think of Alzheimer’s disease
as something that only affects older adults, there are actually two types of Alzheimer’s disease: late onset (also called typical) Alzheimer’s which affects people over the age of 60 and early onset Alzheimer’s, which is defined by symptoms that begin before age 60.
As symptoms worsen over time, the disease will progress through 3 stages. 

  • In the early stage, you may notice some mild memory loss, but, as the disease progresses to the moderate and severe stages, you may notice new symptoms appear or existing ones worsen.
  • The moderate stage is often the longest stage, where your loved one will require a greater level of care and will typically experience the fastest rate of decline. Their symptoms will progress and you may notice new symptoms
  • When they’ve progressed to the severe stage, they may lose the ability to perform daily activities, like carrying on a conversation or even being aware of their surroundings, and may be entirely dependent on your help

    Some examples of moderate stage Alzheimer’s symptoms

  • Difficulty managing personal finances (paying bills)
  • Difficulty with household tasks (laundry, making meals)
  • Problems with personal care (bathing, grooming, toileting)
  • Wandering or getting lost
  • Changes in sleep patterns
  • Feeling moody, withdrawn, or detached
  • Forgetfulness about one’s own personal history
  • Being unable to recall their own address or phone number
  • Needing help choosing proper clothing for the season
  • Continuously repeating stories

    Examples of severe stage Alzheimer’s symptoms
  • May not recognize oneself or family
  • May not communicate
  • Lack of control of bowel or bladder
  • Groaning, moaning, or grunting
  • Needing help with all activities of daily living


Some of the medications that are being prescribed are:

Class 1: Cholinesterase Inhibitors
Cholinesterase inhibitors act by preventing the breakdown of acetylcholinein the brain. Acetylcholine is a chemical that facilitates nerve cell communication in the areas of memory, learning, and other thought processes. Scientific research has found lower levels of acetylcholine in the brains of individuals with Alzheimer’s, so the hope is that by protecting or increasing the acetylcholine levels through these medications, brain functioning will stabilize or improve. Researchers estimate that for about 50 percent of people with Alzheimer’s who take cholinesterase inhibitors, progression of Alzheimer’s symptoms is delayed for an average of six to 12 months.

There are three cholinesterase inhibitor medications currently approved and prescribed to treat Alzheimer’s disease:

  • Aricept (donepezil): Approved for mild, moderate, and severe Alzheimer’s
  • Exelon (rivastigmine): Approved for mild to moderate Alzheimer's
  • Razadyne (galantamine): Approved for mild to moderate Alzheimer’s


Of note, Cognex (tacrine) had been previously FDA approved for mild to moderate Alzheimer’s; however, it is not marketed anymore by its manufacturer because it caused some significant side effects.

Class 2: N-Methyl D-Aspartate (NMDA) Antagonists
Namenda (memantine) is the only drug in this class, and it is approved for moderate to severe Alzheimer’s. Namenda appears to work by regulating glutamate (an amino acid) levels in the brain. Normal levels of glutamate facilitate learning, but too much glutatmate can cause brain cells to die. Namenda has been somewhat effective in delaying the progression of symptoms in later Alzheimer’s disease.

Combined Drugs

In 2014, the FDA approved Namzaric, which is a combination of donepezil and memantine—one drug from each class above.

Nutritional Therapy for Alzheimer’s Disease
Nutritional therapists use diet to deter Alzheimer’s disease in susceptible people. Many practitioners now believe that certain nutritional deficiencies or excesses may actually trigger the disease. For example, free radicals, compounds in the body that can damage tissues and quicken the aging process, have been linked to the progression of the disease. Antioxidants have the ability to neutralize free radicals and are, therefore, typically recommended as preventive measures. Nutrients that are antioxidants or help in the antioxidant process include:

• Beta-carotene
• Vitamins C and E
• Selenium

Other helpful supplements include:
• Zinc
• Niacin
• Coenzyme Q10

Sound Therapy for Alzheimer’s Disease
Sound therapy offers several benefits during the many stages of Alzheimer’s disease. Sound and music are very useful in treating the “problem behaviors” that often accompany the disease, such as agitation, anxiety and insomnia. Sound therapy can be used to:
• Induce feelings of calmness and relaxation
• Lower blood pressure
• Improve the overall sense of well-being

There are unpredictable behaviors that challenge caregivers, including severe mood swings, verbal or physical aggression, combativeness, repetition of words, and wandering. These behavioral changes can lead to frustration and tension, for both people with Alzheimer’s and their caregivers. It is important to remember that the person is not acting this way on purpose, and to analyze probable causes and develop care adjustments.

Some of the Tips for responding to challenging behaviors given to caregivers. Remember this is a 24/7 responsibility.
• Stay calm and be understanding
• Be patient and flexible
• Don’t argue or try to convince the person
• Acknowledge requests and respond to them
• Try not to take behaviors personally
• Accept the behavior as a reality of the disease and try to work through it

How many of us would be up to this challenge??
The caregivers that I interviewed were between 65 years of age and 80 years of age. All were dedicated to their loved one. What the day care gave to them was a respite from the 24/7 challenge.

These are the questions I asked and a summary of the answers.
Is the diagnosed person male or Female: There were 2 males and one female
What is your relationship: One was a wife, one a husband and one was the son.
What age were they when first diagnosed: Ages diagnosed were between 65 and 68
What were the first noticeable signs: Noticeable signs included struggling to find words, unable to communicate needs, retreating into himself or herself and becoming frustrated due to the lack of being able to communicate.
What is their current age: Current ages were between 72 and 85.
How has their ability to communicate change over the years: At this the time of the interview, all were struggling to find words, unable to communicate needs, retreating into himself or herself and becoming frustrated due to the lack of being able to communicate.
What have been the changing roles of responsibility for couples and families:
How did it change your personal relationship: All stated that they went from their previous roles of wife, husband and son to being the caregiver/caretaker.
How did this disease change the relationship with their children: One stated that one of the children was in denial while the other showed a lot of kindness. Others just gave up trying to communicate.
How did it change the relationship with other relatives: Most of the answers stated that the relatives just gave up trying.
How did you cope with daily living i.e. daily chores such as cleaning and cooking. All of the caregivers gave up cleaning the house and hired someone to clean. One ordered already prepared meals. When asked how they felt the answer was exhausted.
What are some of the ways you deal with:

1. Travel – One had given up because of confusion on the part of their family member and the other two continue to try and gets both of them ready.
2. Safety issues – All have tried to make the home secure and accident free which has been difficult on a 24/7 basis.
3. Managing stress (yours as well as the person who is undergoing these mental changes): There were these – walking when there was someone to sir, breathing exercises, support groups and faith.
4. How do you preserve self-esteem for yourself and the person you are caring for – answers included support groups for affirmations that the caregiver is doing the right thing, trying to maintain the dignity of the person with Alzheimer’s by maintaining the social life as much as possible.
5. How do you maintain personal growth in spite of the growing needs of the effected person.
One stated that they were unable to have personal growth. That person felt they had sacrifices dreams, travel and relationships. Another was trying to remain positive and schedule activities they could do together like going to plays. Support groups were very helpful. The other was not yet challenged because he was the caregiver for only 4 months out of the year. His siblings were able to help with the care the other 8 months.
3. Managing stress (yours as well as the person who is undergoing these mental changes): There were these – walking when there was someone to sir, breathing exercises, support groups and faith.
4. How do you preserve self-esteem for yourself and the person you are caring for – answers included support groups for affirmations that the caregiver is doing the right thing, trying to maintain the dignity of the person with Alzheimer’s by maintaining the social life as much as possible.
5. How do you maintain personal growth in spite of the growing needs of the effected person.
One stated that they were unable to have personal growth. That person felt they had sacrifices dreams, travel and relationships. Another was trying to remain positive and schedule activities they could do together like going to plays. Support groups were very helpful. The other was not yet challenged because he was the caregiver for only 4 months out of the year. His siblings were able to help with the care the other 8 months.
6. When do you feel you will need some assistance in the home: All felt they could no longer care for their loved one when they were required to dress and toilet the individual.
7. How have you prepared for placement outside of the home: One has been placed, another is looking at facilities, and one continues to be at home. All felt they could no longer care for their loved one when they were required to dress and toilet the individual.
7. How have you prepared for placement outside of the home: One has been placed, another is looking at facilities, and one continues to be at home.
8. Did you discuss number 6 & 7 prior to escalation in the progress of Alzheimer’s disease. All have not discussed home care or placement with their loved one.
9. Was there any discussions of end of life issues early on in the diagnosis? These issues were not discussed prior to the onset of the progression of the disease process.
10. What are your feelings? One did not answer this question, one expressed sadness, the other stated exhaustion, sorrow, grief, anxiety, depression on insomnia.
a) Taking on the role of caregiver: All stated they were not resentful because this is what you do if you love someone.
b) Making decisions for care: All were concerned with the future but felt they did and are doing the best for their loved one.
11. What is your support system? Faith, family and closest friends.
Those of us that have not yet had to face these challenges cannot imagine the impact it has had. Persons with Alzheimer’s are being diagnosed daily. Many of these are being taken care of as long as possible in their home. Depending on the progression of the disease, many are placed. I feel fortunate to have known both the clients and their families and, in a small way, relieved some of their exhaustion by caring for their loved one by showing compassion and maintaining dignity.

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