Some questions about specialized Alzheimer's nursing homes

Back in the 1990's, I worked in a nursing home and since I've also visited several relatives in residential care facilities.

Based on my experience both as an employee (payroll clerk & supply) and as a visitor, here's my answers to your questions. I'm sure there are differences between some facilities and others.




* Does each resident have their own television or do they share? If they share how do you decide what shows to watch?

There is normally at least one "lounge" or "tv room" with a communal television set. The activity director or another staff member moderates what is watched, sometimes what the majority wish to watch, sometimes not.

Residents own the televisions in their rooms. If they have one, they have paid for it, brought it with them, or had it provided by a family member. I gave one older man who had no family an old small set of mine which delighted him.

* Does the nursing home have some sort of library?

Some do, many don't but the activity director may either arrange for a visit from the mobile library or Bookmobile in rural areas or provide some reading materials for those who are interested.

* Does each resident get to choose what they bring from their previous home or do family members often make those choices for them?

Some of both. A lot depends on the resident's mental and physical state. Some have some of their own furniture; others don't. What they can bring or have is limited, however, due to space.

* At what stage of Alzheimer's are people allowed to come to a nursing home?

That is going to vary with each individual.

* At what stage do people usually come to a nursing home?

That again depends. Some people come after a major surgery or medical event; others come for short-term rehab; others when they - or their family - feels they can no longer take care of themselves at home. There are many reasons and a wide age range.

* Do you have to take any test showing that you indeed have Alzheimer's?

Residents don't have to "take a test" to show they have Alzheimers to enter a facility; a diagnosis from their physician would help entry into a special Alzheimer's Unit. Every resident is going to have a medical chart with a primary and often several secondary diagnosis. The majority are going to have "dementia" which is often used in place of Alzheimer's as one of those diagnosis, be it primary or secondary.

Are there even any tests that can say that you have Alzheimer's for sure?

You would have to research that; it is very difficult - even for a physician - to definitively diagnosis Alzheimer's beyond any shadow of doubt and I'm not up on the latest in the field.


* Are there medications for treating Alzheimer's and if there are does the nursing home provide those?

There are medications that help slow or reduce the effects of the disease. Those drugs and any other required, prescribed meds will indeed by provided by the home, like everything else for a fee. Nurses will give out medications as prescribed but the resident will pay (or the family or the state).

The other thing to be aware of, if you're not already, is that most Alzheimer's and dementia wards are locked. That is, you can't go in or out without a key or a code, to prevent patients from wandering away and endangering themselves.

Redzilla said:

The other thing to be aware of, if you're not already, is that most Alzheimer's and dementia wards are locked. That is, you can't go in or out without a key or a code, to prevent patients from wandering away and endangering themselves.

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That's true in many facilities but not all. In the facility where I worked in the early 1990's, I often had to sprint out after a "walkaway", a resident wandering away. Since I worked in the front office, I was often the first to see that someone was getting away.

It's my understanding that there are no definitive tests at this time for Alzheimer's until someone has died. There is a specific pattern of microscopic changes in the brain that cannot be detected except through autopsy.

I've also worked in various nursing homes--first as an aide, then in the business office. Johnniesannie and Maryn both mirror my own experiences.

Yeah--the Alzheimer's unit was a locked unit. You could gain access to and from the unit as long as you knew the door code. (Although we once had a gentleman who was admitted to the unit while he still had moments of clear thinking. One of my coworkers got stuck inside the unit because he came in with another employee; when he wanted to leave he realized he didn't have the code. The patient walked up to him and whispered the door code into the employee's ear and then said, "Shhhh! We're not supposed to know it!")

In the facility where I was, if the patient got out of the unit, we had alarms on the doors that were activated by a bracelet the ambulatory patients wore.

If a patient came to the nursing home from our skilled Medicare unit, their first 100 days were paid for by Medicare in part. After that, he/she would either use up the insurance, if any, or would end up either private pay or Medicaid. Some places don't accept anything but private pay, around here--those are the residential places that have a special Alzheimer's wing.

dani4450 said:

I have a couple of questions about nursing homes for elderly who have Alzheimer's.

* Does each resident have their own television or do they share? If they share how do you decide what shows to watch?
If they own a TV, they can have one in their rooms. But usually a community set works best, because nobody wants the residents sitting in their rooms alone watching TV. I've seen them really enjoy talk shows and old movies.


* Does the nursing home have some sort of library?

There is usually a bookrack with books on it. While i have seen patients in advanced stage Alzheimers (stage 2) be able to read still - they aren't comprehending what they are reading. It's really odd. So if you hand them a newspaper and point at something, they can read the words, but there's no recall there.


* Does each resident get to choose what they bring from their previous home or do family members often make those choices for them?

Depends on the facility, but most like to keep the patients room or half of room, with familiar items from home. A wreath on their door, pictures of family members and quilts from home are usually present. By the time a resident gets placed in a unit, they are already in a compromised mental state.
* At what stage of Alzheimer's are people allowed to come to a nursing home?

Anytime after the family realizes that managing them at home is no longer feasible. When a patient roams the neighborhood, or locks his wife out of the house or tries to hit her in the head with a shovel, it's time to admit him to a locked unit and work on getting his meds stabilized.


* At what stage do people usually come to a nursing home?

Again, when it's not manageable at home.


* Do you have to take any test showing that you indeed have Alzheimer's?

Right, the only conclusive test is done after the patient dies and there is usually no reason to do it. Alzheimers is one form of progressive dementia.


Are there even any tests that can say that you have Alzheimer's for sure?

See above.
* Are there medications for treating Alzheimer's and if there are does the nursing home provide those?

Yes, there are medications that treat dementia - like Aricept and Haldol. Other drugs are given depending on the array of medical conditions the patient has, besides alzheimers - like blood pressure meds, heart meds, etc. Then they are usually taking a blood thinner and stool softeners (because constipation can be a problem due to medication, poor diet and inactivity, and dehydration) and sometimes a diuretic, and other drugs they need - plus vitamin supplements.

Thanks in advance!

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I did my clinicals in a nurse rehab unit.

dani4450 said:

I have a couple of questions about nursing homes for elderly who have Alzheimer's.

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I'll just go with the three below, since I'm not up to speed so much on the other questions. My mom has Alzheimer's and I think a nursing home is in the near future. She lives with my sister and I have her for one week each month to give my sister a break.

* At what stage do people usually come to a nursing home?

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This varies from family to family. Some families can take care of them for a long time, even up to the very end. But there are a lot of factors involved. Some can get too violent and need to be where they are watched at all times. Others do fairly well and don't get nasty or dangerous. Where we are now it's more mental exhaustion and Mom is where she needs a stable routine, which is messed up when she comes to my house.

It can come down to when the family doesn't feel they can take care of their loved one properly anymore.

* Are there even any tests that can say that you have Alzheimer's for sure?

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Yes, there are tests. First, the question test. It's just a list of simple questions: full name, age, date of birth, address, phone number, name of who is with them in the room at that time, do they know where they are right then, who is the president, and right now I can't remember the rest, but there it isn't a long list. This test can be done 6 months apart or once a year. We had to ask her primary physician each time we wanted it done. No, none of us were thrilled with her because she always acted like she didn't care very much.

It took me 2-3 years to talk my sister into taking Mom to a neurologist, who I felt was more qualified to diagnose Mom, although we did know she had Alzheimer's. He did the same questions but more in a conversation rather than just reading off the list. Then he ran a couple or so other tests on her.

There are some other tests they can do to rule out the possibility of it being something else. I think a thyroid test is one, but I don't know what other ones are checked for. Maybe someone in the medical field here can give a more thorough answer.

* Are there medications for treating Alzheimer's and if there are does the nursing home provide those?

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Namenda and Aricept are the two most used, as far as I know. There are, I believe, a few others but these seem to be the two most doctors prescribe. Sometimes they are used together, but the dosage has to be regulated for the individual. And sometimes it's only one of them. My mom takes Aricept.

I'm not sure I'd call it a treatment since there's no cure, but they can slow down the process for a time (for some), but eventually nothing will work.

Dani, feel free to pm me if you haven't gotten the answers you need yet. My dad passed away from Alzheimer's. Unfortunately, I am quite knowledgeable about the disease and care.

In the USA , it varies wildly ...

* Does each resident have their own television Some do, some don't. or do they share? If they share how do you decide what shows to watch? Usually staff.

* Does the nursing home have some sort of library?
Some do, some don't.

* Does each resident get to choose what they bring from their previous home or do family members often make those choices for them?
Usually family members. This is discouraged, BTW, because of theft problems.

* At what stage of Alzheimer's are people allowed to come to a nursing home?
Whenever they want to

* At what stage do people usually come to a nursing home?
When their caregivers are exhausted, or dead.

* Do you have to take any test showing that you indeed have Alzheimer's?
Doctor's statement

*Are there even any tests that can say that you have Alzheimer's for sure?

I think MRIs can spot the lesions.

* Are there medications for treating Alzheimer's and if there are does the nursing home provide those?
Not yet, but there are some experimental ones.

For other meds: Patient's doctors wreite the prescriptions, the nursing home is responsible for filling them and giving the meds, bills paid by patient or insurance plan.

Just a few more things FYI:

In the business office where I worked, we kept money for each patient in an account and kept track of it. Medicaid would send a certain amount for the patient to spend, and if the amount got close to 3000, we did ask the family members to buy some things for the patient so the amount would be quite a bit less. Because if it went over that amount, Medicaid would consider that to be an asset, and they'd take it back.

If the patient did not have any family or friends to do that for them, one of our social workers would go shopping for the patient after visiting with them and speaking to whomever gave him/her a lot of care.

If a patient wanted cash for any reason, we kept 200 in petty cash and we'd take it out of that and record the transaction so we could subtract it from their bank account. (The bank account was all the patients' monies put together, which was nice because everyone got a bit more money in interest. We would keep track, though, of how much of whose money was there, and it was triple-checked and had enough security hoops to jump through that stealing would be pretty obvious quickly.)

We did have times when patients were able to go shopping, depending on their levels of lucidity. I think that the Activities department scheduled monthly outings for the patients. Social services would also get involved.

Oh, yeah--earplugs were kept in central supply, so if a patient requested a pair it was no big deal.

At this time, Alzheimer's can be diagnosed definitively only at autopsy. Tsu might be right, but no one has developed something yet that truly shows Alzheimer's that has been approved as a diagnostic tool.

Oh, one more thing--for our Alzheimer's unit, the patient had to be able to do some things by his/herself or to be guided through doing them. Also, the patient was not allowed to behave aggressively with the other patients--If he/she did, then he/she was moved to another unit in the nursing home. They also had to be mostly ambulatory or wheelchair without much assistance.

When caregivers are exhausted, yeah--we'd have a patient be admitted. Sometimes we'd get a patient for a known short-length of time; the caregiver wanted to go on vacation.

Dani,

http://www.alz.org/national/documents/brochure_basicsofalz_low.pdf

--is about the basics of Alzheimers.

--From www.alzheimeronline.info
Stage 1 - The individual tested shows no difficulties, either subjectively or objectively.

Stage 2 - The individuals shows some very mild decline. They complain of memory deficits and sometimes forgetting the names of familiar people and places. This might be regarded as a feature of natural aging rather than a progressive disease disorder.

Stage 3 - The patient exhibits a marked decline in memory. The Individual shows an inability to function in a demanding job situation. Anxiety from the inability to remember some pertinent information is noticed in an intensive interview.

Stage 4 - This stage is considered mild or early stage Alzheimer's disease. Clear-cut deficiencies in memory as it relates to current events or recent personal events. Changes in mood and personality may be noted. The individual is unable to perform complex tasks that involve planning and implementing a simple dinner menu. The decline in ability is noted as substantial when the person cannot perform mental arithmetic.

Stage 5 - Represents a moderate to severe decline in cognitive functions. There are some major problems with dates and time. Individual requires assistance performing daily activities. Individuals at this stage are unable to recall important but familiar details. An example is these individuals cannot recall their own address or telephone number. Confusion is present. The individual is able to eat and use the toilet on their own.

Stage six - There is a severe cognitive decline at this stage. Difficulties with memory become worse. Personality changes occur. Intensive care is required at this stage for help with basic daily activities. The person is unable to bathe properly. In some cases the individual may develop fear of bathing.

Stage 7 - Represents the most severe or late stage Alzheimer's disease. At this stage individuals lose the ability to interact with their environment. Individuals are unable to speak or control motor movement. These individuals need help with eating, toileting and daily hygiene.

Additional indicators include: Inability to walk without assistance. There is a steady decline in the ability to sit without support. Individuals at this stage are unable to smile or hold up their head. Motor reflexes are abnormal.

The brain continues to degenerate, the body and organs 'forget' how to function, eventually causing death. There is no cure.

If residents are in the home through private means, they can use their won money/credit cards/checks as long as they are cognizent of the financial end. If they have given up all means of support and are on 'state care' then they are allowed an allowance that varies per home/per state approximately $50-75/mo.

If no family member/friend is around to get extra things, like clothing or a radio, often a Patient's Representative in the nursing home will do the shopping for them.

Hi - lots of good info here which I didn't read in total so I am unsure if anyone mentioned this but you might want to change your wording from "nursing home" to something like "assisted living" or "supported care" or "adult community" or the like.

Good luck with this.

Judi