Contents

Disclaimer

Acknowledgments

Preface

Introduction

Chapter One: Coming to Terms with Dementia

What is Dementia?

Testing and Diagnosis for Dementia

Understanding Types of Dementia

Stages of Dementia

Stage 1: Mild or Early Stage of Dementia (Lasts Two to Four Years)

Stage 2: Moderate or Middle Stage of Dementia (Lasts Two to Ten Years)

Stage 3: Severe or Late Stage of Dementia (Lasts One to Three-Plus Years)

Treatment Plans for Dementia

Lessons Learned

Chapter Two: Care Facilities: Making the Right Move

Types of Care Facilities

Continuing Care Retirement Communities (CCRCs)

Independent Living

Assisted Living

Adult Family Homes

Skilled Nursing Facilities (SNFs)

Alzheimer’s and Memory Care Facilities

Guidelines for Screening Care Facilities

Making the Choice: Our Concerns in Selecting a Care Facility

Meals and Menus in Care Facilities

Social Activities in Care Facilities: What’s Available to Keep People Interested?

Moving to a Care Facility: Dementia and Disorientation

Dementia and Wandering Outside a Care Facility: A Choice of Safety or Independence

Switching Assisted Living Facilities: Making Sure It’s the Right Move

Conflicts with Assisted Living Staff

Lessons About Choosing a Service Area in a Care Facility

Memory Care: First Impressions

What Happens if You Live in a Different State?

Lessons Learned

Chapter Three: Can we Afford a Care Facility?

Paying for Long-Term Care

Long-Term Care Insurance

Reverse Mortgages

Veterans Benefits

Aid and Attendance Pension Benefit

Life Settlement

PACE Program

Income Tax Deductions

Medicare and Medicaid

Finances: Do You Really Know What’s Happening?

Comparing Costs: Living at Home or in a Care Facility

Facility Fee Structures

Cost Categories in a Long-Term Care Budget

Building a Five-Year Budget

What if a Family Cannot Afford a Care Facility?

Family Conflicts about Money and Caregiving Responsibilities

Lessons Learned

Chapter Four: Care Facility Agreements

Flexibility in Care Facility Agreements

Talking About Terms with Facility Staff

Care Plans

Attachments and Exhibits to Care Facility Agreements

Where to Turn for Help

Lessons Learned

Chapter Five: Advocacy in Medical Care

Unmasking Mom’s Medication Problems

Taking Responsibility for Someone’s Health-Care

Monitoring a Care Facility’s Medication System

Checkpoints for Monitoring Medications

What Happens When the System Breaks Down

Calming Drugs: Are They the Answer in a Care Facility?

Hearing, Vision, Dental Care, and Mobility

Lessons Learned

Chapter Six: Hospice and Palliative care

What Is Hospice Care?

Qualifying for Hospice Care

Role of the Hospice Team

Comfort Care for Dying Patients

The Importance of Educating Families about Dying

Lessons Learned

Chapter Seven: Advance Directives

What are Advance Directives?

Appointing a Health-Care Proxy

Shortfalls of Advance Directives

Five Wishes®: An Alternative to Traditional Advance Directives

Doctor’s Orders: Out-of-Hospital Do Not Resuscitate Orders

POLST: Physician Orders for Life-Sustaining Treatment

When to Take Action on Advance Directives

Lessons Learned

Chapter Eight: The Path Forward

Changing the Way We Look at Care Facilities

Neighborhood Alternatives for the Future

Dementiaville: The Answer to Future Care?

The Alzheimer’s Café

Current and Emerging Technologies

Epilogue

Appendix One: Examples of Cognitive Tests

Mini-Mental Status Exam (MMSE)

St. Louis University Mental Status Exam (SLUMS)

Appendix Two: Care-Plan Costs and Point Systems in Facilities

Appendix Three: Technologies—Now and the Future

In-Home Remote Monitoring Technologies

Tracking Technologies

Home Safety

Assistive Products

Cognitive Fitness Technologies

Education

Resources

General Resources

Chapter One: Coming to Terms with Dementia

Chapter Two: Care Facilities: Making the Right Move

Chapter Three: Can We Afford a Care Facility?

Chapter Four: Care Facility Agreements

Chapter Five: Advocacy in Medical Care

Chapter Six: Hospice and Palliative Care

Chapter Seven: Advance Directives

Chapter Eight: The Path Forward

Endnotes

Bibliography

Index