A Caregiver Support Group Innovation Hits Its Stride
Sometimes a good talk with someone who understands helps relieve the stress of caregiving. In fact, that is the basis of most support groups.
Just pulling the chairs in a circle and sharing frustrations seems to work for many people. Now a California caregiver support group has taken this simple approach to the next level by adding on another simple idea. “Meet and Move” is a support group on the go — walking, talking and sharing.
Rather than sitting, the group hikes in scenic areas, and the exercise offers an added dimension of stress relief.
The New York Times New Old Age Blog tells the story of “Meet and Move” and its enthusiastic participants, who say they are becoming better caregivers by also taking care of themselves.
Ecumen Detroit Lakes Receives Grant to Advance Its Dementia-Friendly Work
Ecumen Detroit Lakes is among 12 Minnesota organizations receiving grants through ACT on Alzheimer’s to help create more dementia-friendly communities.
ACT on Alzheimer’s is a volunteer-driven, statewide collaboration preparing Minnesota for the personal, social and budgetary impacts of Alzheimer’s disease. The Alzheimer’s Association estimates there are 88,000 Minnesotans age 65 and older with the disease and many thousands more with other dementias.
“As the population of Minnesota ages, it’s becoming increasingly important to build support systems for people with dementia and Alzheimer’s,” said Olivia Mastry, executive lead for ACT on Alzheimer’s and also an Ecumen board member. “Some of the most exciting innovations will emerge from this community work.
“Creating dementia-friendly communities means that caregivers are supported and people with dementia are able to live in the community and stay out of institutional care longer,” Mastry said. “That helps everyone – families and taxpayers who pay for institutional care, employers who have workers trying to balance all the demands of caregiving, and the individuals themselves.”
Janet Green, executive director of Ecumen Detroit Lakes, said: “We have a long history of supporting community members with Alzheimer’s and their caregivers, and this generous grant gives us the ability to even further enhance our programs. What a wonderful recognition in our 50th anniversary year serving the Detroit Lakes community.”
Green said Ecumen Detroit Lakes has had Alzheimer’s support groups for more than 15 years, and started its memory care community more than 20 years ago. “We have a strong commitment to this work and have been in the forefront dealing with dementia care,” Green said. “This grant will allow us to take our work to an even higher level.”
Ecumen Detroit Lakes was part of the initial round of grant recipients and initially will receive $5,800 to implement support programs. The amount could grow to $18,000 based on the success of the programs. For a list of communities receiving grants go to this link.
Ecumen Detroit Lakes’ grant is funded through Blue Plus (an HMO affiliate of Blue Cross and Blue Shield of Minnesota), the Medica Foundation and Greater Twin Cities United Way.
More than 60 organizations are partners in ACT on Alzheimer’s. More information is available at www.actonalz.org
10 Key Questions To Ask When Comparing Assisted Living Communities
Thinking about an assisted living for yourself or a loved one? It’s a major decision requiring lots of due diligence. We take pride in helping you find the right solution for you, regardless of whether you chose one of our communities.
To help you start the process, below are 10 questions to get you thinking as you start to shop and compare. It’s just a sampling. There are many more questions you need to ask. For a more complete list go to Ecumen.org’s Resource section under assisted living.
1. Is the community attractive, inviting, and in a safe area close to important amenities?
2. Do the employees and residents appear happy and engaged?
3. Is this site easy to navigate, well-lit, comfortable and clean?
4. Does the site make it easy for me to talk with/interview other residents to get their insights on living there?
5. Can I see myself enjoying living here and doing the things that I enjoy most?
6. Is the staff accommodating and friendly?
7. What type of training do the staff members receive?
8. What types of amenities are available (i.e. media center, beauty/barber salon, library, exercise equipment, computer, convenience shop, deli, etc.).
9. Are dining areas convenient to the living spaces, and are there choices for dining times and menu items?
10. How much could my costs increase if I need more services?
See more questions to ask at this link. Or call one of our Ecumen locations to talk one-on-one about your specific needs.
Vital Aging Network Hosting Mayday Celebration
The Vital Aging Network, a nonprofit helping people 50+ live connected and vital lives, will host a Mayday Celebration May 1, 2014, to welcome spring with cool jazz, socializing and a silent auction.
The event starts at 6 p.m.at Bachman’s Heritage Room at 6010 Lyndale Avenue South in Richfield. The Jim Ouska Trio will provide music.
Tickets are $15 per person. You can register online here, or go to vital-aging-network.org for more information.
The Vital Aging Network's mission is to promote self-determination, civic engagement, and personal growth for people as they age — through education, leadership development and opportunities for connection.
A Hero at Ecumen-Managed Colonial Manor Balaton Receives National Honor
Matt Schons, who works as a cook for the food service at Ecumen-managed Colonial Manor Balaton in Balaton, Minn., ran into a burning house after a gas explosion and saved the life of a two-year-old girl in September 2012. Last week, he was awarded the Carnegie Medal of Civilian Heroism. The prestigious medal is given throughout the United States and Canada to those who risk their lives to an extraordinary degree while saving or attempting to save the lives of others. Only 22 medals were awarded this year.
The girl he saved was the daughter of a staff member at the care center and the granddaughter of Matt’s boss.
“Matt is really a great guy,” said Colonial Manor Balaton Administrator Chuck Ness. “We have a bona fide hero in our midst. This is a really big deal.”
Fox 9 News tells the story in this video:
Church as an Alternative — by Ecumen Blogger Jim Klobuchar
The usual late afternoon snowstorm had mercifully subsided. From behind the steering wheel of my car, it was theoretically possible to make out traffic signals again and approaching cars with their headlights blazing.
In one of the distant Minneapolis suburbs an unpretentious little sign by the roadside of a chapel offered the traveler an invitation:
“Try Church Again”
There was no elaboration. There really wasn’t room for it on the sign.
Smaller churches today are hurting. It’s not exactly a secret.
The church sign’s suggestion had nothing much to do with the unsocial behavior of the winter of 2014. It was an appeal for passing motorists to consider the outside possibility that a return to church might make life more sensible again; and if not that, at least a little more orderly....
I would be among the last to argue. Church today is part of my life. But you probably need to know that I have not fallen into the clutches of the Amalgamated Ministerial Societies of Minnesota and its neighbors. I’ve spent substantial years on both sides of the question of whether organized religion makes sense or is relevant. I pick no fights with those who say it is not.
But in later life, especially, I find church-- beyond its other gifts—is, well, a renewal.
As a kid I grew up in the Catholic Church. In many ways the years were endearing. I’m still ready to break out in tears when Notre Dame loses. But I fell away entering adulthood, and later felt the pain and anger, along with ,so many others in the revelations of predatory priests—although I was aware there were and are thousands of priests who serve their church and its members faithfully and unconditionally. And I joined millions in cheering the arrival of Pope Francis from Argentina.
But I’m alive today because a church pastor I’d known distantly through my newspaper work invited me to attend services with his Lutheran congregation. I’d been drinking, looking for stability in my life and wasn’t smart enough to know that it was impossible unless I realized something had to change.
It did, with the intervention of a traffic cop, a hard-headed judge, my family and a reaffirmation of belief. After awhile I felt at ease probing the mysteries in my new comfort with faith and thought I would take some of those mysteries and imagine—in a small book I wrote—how God himself might respond to the usual questions about the dilemmas of faith. I created visualization. What would I ask God if God granted a one hour interview?
It would have to be a God with whom I could converse, and probably in the English language, this being a limitation of my human condition. In this imaginary meeting, God arrived in comfortable clothing and a reasonably cordial attitude, reminding me that He heard all of those Notre Dame prayers but had to be just as fair to the folks at Southern Methodist, to say nothing of Brigham Young in Utah. Pleasantly He granted me an hour. We talked about my fallibilities, but He suggested that I was still far from being a basket case.
I found this comforting. I brought up some of the mysteries one encounters trying to square faith with the realities of today’s world. After which God said, “One problem you have when you talk about mysteries of faith is that being human you have a limited mind.” This I acknowledged. “Don’t complicate it,” He said. I said I wouldn’t in the future. He smiled pleasantly and said, “I’ll be seeing you,” a farewell I viewed with a certain shaky optimism. We left, you would hope, on good terms.
One doesn’t want to get preachy entering the mixed bogs of faith, belief, worship and the unknown. What I know about the hereafter is minimal. I know that my renewal of faith and belief needs affirmation and that a place where I can receive it is in a gathering where I can raise my voice with others in a hymn, exchange greetings and, every now and then, hear the choir sing Mozart’s “Ave Verum” — a lovely motet he wrote six months before he died, music his wife cherished. It offers a serenity, in that setting, that is altogether beautiful.
For some, it may be beautiful enough to try church again.
Duluth News Tribune Tells the Ecumen Awakenings Story
In today’s Duluth News Tribune, reporter John Lundy gives a sensitive and compelling account of how Awakenings works to calm dementia without drugs. Shelley Matthes, RN, Ecumen’s director of quality improvement, tells Lundy: “Our job is to identify things that bring people to a place of peace and joy.”
Ecumen Medical Consultant Dr. Tracy Tomac: A Psychiatrist Blazing New Trails in Dementia Care
New Ulm, Minn., 18 years ago: The bus from the nursing home moves through the below-zero snowy prairie to the clinic where a freshly minted young doctor has just started practicing. The bus attendant unloads the elderly patients in their wheel chairs and rolls them, one by one, into the clinic.
The doctor, a Mayo resident in psychiatry, feels well equipped to handle this, newly armed with a prescription pad and an abundance of optimism. The attendant quickly scampers away, and the doctor approaches the patients, who are in various stages of dementia. Each one has an envelope, attached by a pin, to their sweaters.
The doctor opens the first envelope and the note says: “Always gets agitated in the early afternoon.” The next envelope: “Cries out in the night.” A few short words about each patient, and that’s it.
Without anyone ever saying a word to her, the doctor understood the expectation: Fix this with a pill.
And Dr. Tracy Tomac said to herself: “This is not going to work.”
What she intuitively knew then, and what she now knows with considerable experience, is that you rarely “fix” an elderly person with dementia with a pill. Medication obviously has a place, but it’s not the be-all and end-all. And as she would soon see firsthand, it can often hurt more than it helps. Just as giving antibiotics at the first sign of a cold could be overreacting, so could giving antipsychotics or antidepressants at the first sign of agitation.
“But back then,” Dr. Tomac says, “this was just how medicine was practiced on nursing home patients.”
Early on, she decided it was not how she was going to practice. When she started rounding at a nursing home for elderly nuns, she started to understand her options. This was a close, supportive community able to give her lots of information about each patient. She was learning that truly knowing patients and their history could be a more powerful tool than the prescription pad.
Dr. Tomac soon moved to Winona, Minn., and her new job allowed for even more rounding at nursing homes — something she loved. Also, she was fascinated by the culture of caregiving in small-town Minnesota. Everyone knew everyone. Nurses and other caregivers were taking care of their friends and neighbors, and the background they had about each patient gave the doctor rich diagnostic information. Caregivers were like extended family, and Dr. Tomac was beginning to see how crucial “knowing the patient” as an individual is to practicing psychiatry the way she wanted to do it. She saw how important relationships were to the patients. Connecting on a personal level had a healing power all its own.
Dr. Tomac was captivated by the remarkable life stories of these determined, courageous people who had struggled through the Great Depression and World War II, and she saw how relevant these stories were as dementia progressed and communication skills declined. Dementia patients often were more connected to the past than the present, and behavioral episodes often were directly related to a person’s history. For example, patients who walked incessantly around the nursing home may have had careers requiring constant on-the-job walking.
The patients’ many engaging stories of hardship and triumph reminded Dr. Tomac of her Great-Grandmother Flo who had come to America from Wales in 1920 — with nothing — and carved out a vibrant, productive life. When Grandma Flo was in her 80s, Tracy was just a kid and would travel from Texas to visit her in Pasadena, Calif., during the summer. Grandma Flo was the “original little old lady from Pasadena,” always on the go. “She was a role model for active aging,” Dr. Tomac says.
Grandma Flo never regarded herself as old and was a serial volunteer at local nursing homes. As an octogenarian, she would say without a trace of irony, “Hey, Tracy, let’s go visit the old people.” Even then, Tracy loved going to the nursing homes. As the cute little kid, she was the center of attention.
And now, in rural Minnesota, Tracy Tomac, the psychiatrist, was still the center of attention in the nursing home — now because she had the prescription pad. The nurses called all the time asking the doctor to give patients something to help them sleep, something to calm them down, something to stop their outbursts. “Give them something” was a constant refrain.
What Dr. Tomac started to do was give them close attention. Like the time an elderly woman with dementia was screaming in the night, every night, that there were “baby heads” flying around in her room. Give her something, please, the nurse asked.
Dr. Tomac went into the room, sat on the bed and tried talking to the woman. And something caught her eye. She left the patient, went to the nurse, and offered this prescription: “Change the bedspread.”
While in the room, she noticed that the bedspread had a vivid design of “peach cabbage roses.” The head-like design could easily transform into “baby heads” to a person with dementia, with limited sensory input. “With dementia, the mind does the best it can with the sensory input it has,” she explains. “The mind takes whatever input it gets and tries to fill in the blanks.”
Removing the bedspread worked. Sure, a sedating drug may have worked too — but most likely with unnecessary side effects.
And there were more situations like this— enough to make Dr. Tomac think medication should not always be the first tactic. She was convinced, but the nurses weren’t. She knew she needed to some way persuade them, since they were the “boots on the ground” who she depended on for crucial diagnostic information.
So Dr. Tomac tried the educational approach. She would hold seminars at care centers over lunch and talk to staff about how to analyze the cause of behavioral outbursts and manage difficult behaviors without drugs. But this was slow going. Really slow.
“Once I was in a place for about two years, people would start to trust me,” she recalls. “Then I would begin to notice that the approaches I was advocating started to be fed back to me. Nurses would start telling me about a patient’s issues, then would say: “But I don’t think medication is necessarily called for in this situation.”
Dr. Tomac was now working at St. Luke’s Hospital in Duluth and rounding at nursing homes in the area. In 2008, while visiting what is now Ecumen Scenic Shores in Two Harbors, Minn., she met an Ecumen nurse manager named Eva Lanigan. They were “kindred spirits.” Eva had attended a workshop about the dangerous side effects of antipsychotic drugs on elderly people. When she looked around the care center, she saw too many patients in a drug-induced fog and wanted to do something about it.
Dr. Tomac was just the doctor to see about that. Together, they started going through residents’ charts, one by one. What drugs were they on? Were all the drugs necessary, given the diagnosis? What could they do to slowly wean the patients off the drugs?
This was the beginning of the Ecumen Awakenings program — two women determined to give elderly dementia patients a better quality of life. They went to work creating a collaborative program with the patients, the doctors, the care team and the family to replace sedation with an integrated, holistic program of care. They just did it—patiently and systematically with a clear vision of the outcome they wanted—but with no blueprint from official sources and with no certainty that it would work.
As their collaboration progressed, Eva began to formalize the program. The entire staff of Ecumen Scenic Shores — including housekeepers, cooks and dining room servers — received training in methods to calm residents when they became agitated, using non-pharmaceutical techniques like redirection, exercise, activities, music, massage and aromatherapy. The staff was taught how to listen to residents and enter their reality, responding to them without insisting on facts that those with dementia can’t grasp or won’t recall.
They started in the early spring of 2009 and by early fall that year, ALL inappropriate antipsychotics were discontinued and antidepressants were reduced by 30 percent. Ecumen Scenic Shores was no longer a quiet place. It had literally come alive. Residents who had been immobile began participating in balloon volleyball. People who had not spoken in years were becoming more verbal. Residents were smiling and participating in sing-alongs.
The dramatic results prompted Ecumen to start exploring ways to make Ecumen Awakenings more widely available. Laurel Baxter, RN, an Ecumen quality improvement nurse now retired, was appointed to formalize the program so that it could be replicated in all 15 of Ecumen’s nursing homes. The State of Minnesota awarded Ecumen a performance incentive grant — essentially venture dollars to support innovation in long-term care— which financed the implementation. Carefully monitored results showed dramatic reductions in the use of antipsychotic medications and dramatic increases in alertness, mobility, and laughter, more restful sleep, fewer falls, enhanced verbal ability, singing, ability to exercise, and reductions or eliminations of erratic mood swings, hallucinations and outbursts.
On March 17, 2014, Ecumen received national recognition for Awakenings, winning the LeadingAge Excellence in Dementia Care Award.
Coming out of this Awakenings collaboration, Dr. Tomac is now a medical consultant to Ecumen, helping nurses and other caregivers stay abreast of the latest developments in care and helping Awakenings continue to grow and evolve as it is expanded to assisted living communities. The consultancy is a way for Dr. Tomac to stay in touch with her geriatric interests, now that she has made a career change and moved to Regions Hospital in Saint Paul, Minn.
She currently works as an inpatient hospital psychiatrist treating adults. She finds surprising similarities in treating hospitalized patients and nursing home patients, particularly in an institutionalized setting with patients who have perhaps experienced many losses — particularly loss of control over their environments. All age groups are struggling to make sense of their worlds, she says, and their perceptions may be altered by mental illness or dementia.
She finds that the elderly are in a way easier to diagnose since they have a long history. If you can understand that biography, treatment options are much clearer. Younger patients' lives are more of a "work in progress,” she says, “and we have the opportunity to try to help the patient change the trajectory.”
"An elderly person with dementia or a psychiatrically ill inpatient is just trying to make sense of the world and get their needs met, just like all of us." says Dr. Tomac.
Regardless of age, Dr. Tomac’s approach is this: Accept people where they are. Talk with them, not to them. Try to put yourself in their place. Figure out what’s causing their fear and anxiety. Look at the entire environment, not just at the person. And look for the unmet needs. Yes, sometimes a drug is the answer. In cases of severe mental illness, prescription drugs can give people their lives back. But dementia is something else entirely . Rather than see the behavior of dementia as purposeless and disease-driven activity to be managed with drugs and restraints, we can see it as an attempt to cope with real problems that often can be dealt with by changing the patient’s environment.
Looking way back to those early days in New Ulm, Dr. Tomac says she knows everyone was just trying to do the best they could with the tools and knowledge they had at the time. Like everything else, the practice of medicine and the culture of care evolve. Ecumen’s nurses now frequently recite the mantra: “When we know better, we do better.” They now know a much better way of care than using chemical or physical restraints.
Likewise, new doctors coming to rural Minnesota now will be practicing on a whole different landscape.
Last year, the American Psychiatric Association issued an advisory saying anti-psychotic medications should not be the first treatments doctors think of when dealing with dementia in elderly persons, and this year the American Geriatrics Society issued a similar one. Plus, the Centers for Medicare & Medicaid Services now have a national campaign focused on reducing the use of antipsychotics in nursing homes.
Doctors, nurses and patients all have experienced awakenings.
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Read The New York Times 2011 story on the beginnings of Awakenings at this link.
St. Paul Pioneer Press Highlights Ecumen Awakenings for Excellence in Dementia Care Award
In a recent Opinuendo column the St. Paul Pioneer Press highlighted Ecumen’s Excellence in Dementia Care Award, a national honor received last week in Washington, D.C. Here’s what the Pioneer Press wrote:
On stage with a legend
Two nurses from Ecumen, a Shoreview-based nonprofit senior housing and services provider, shared a stage this week in Washington, D.C., with music legend Glen Campbell and his family.
They received awards at an Alzheimer's-awareness event, the Great Minds Gala -- Ecumen's Shelley Matthes and Maria Reyes for a program that uses nonpharmaceutical approaches to improve patients' quality of life, and the singer and his family for advocacy for continued research, education and support for those suffering with the disease.
Ecumen received the Excellence in Dementia Care Award from Ellen Proxmire, in honor of her late husband, Wisconsin Sen. William Proxmire, who died of Alzheimer's, and LeadingAge, a national association of nonprofit senior services organizations.
Ecumen was honored for its "Awakenings" program, aimed at reducing or eliminating the use of anti-psychotic medications among people with Alzheimer's and related dementias.
The program used behavior modification and other alternative techniques to reduce the use of anti-psychotic drugs by 98 percent in 1,200 patients in 16 nursing homes, according to a Washington Post report, saving $200,000 to $350,000 a month in Medicare and Medicaid spending on the medications and making patients more alert and active.
Patients "just became more alive and more awake, and that's why we called it Awakenings," Matthes told the Post. "It's not stopping the disease's progress, but it's improving the quality of life for the person, and the quality of the family experience, as well."
At 80 Gloria Steinem Continues to Change Aging
Feminist icon Gloria Steinem was never one to hide her age. Today she turns 80, and by all accounts she is more effective than ever. She has stood against ageism by the way she lives her life— openly embracing every milestone. Learn why Gloria says she loves getting old in this Fast Company story bemoaning the short-sighted ageism of Silicon Valley.