Since most families need two incomes to survive these days there is often no one available to care for mom or dad, grandma or grandpa. Although most of us do not relish making this decision it is often done out of need and necessity. Once the elderly reach a certain point in life it becomes apparent that they are in need of more assistance with their activities of daily living. This is where elderly care in Bucks County comes in.

The elderly care in Bucks County will relieve you of your worries and put your mind at ease in knowing that your loved one is being taken care of by a member of a competent staffing facility. Elderly care in Bucks County offers services for your elderly loved one, such as vacuuming, dusting, and laundry assistance. Often the elderly become lonely and elderly care in Bucks County will fulfill their need for companionship, whether it be conversing with your loved one or involving them in an activity, such as playing games, doing puzzles or putting a scrapbook together of their past.

Personal care needs can also be given if desired whether it be something as simple as helping them with their hair or something more involved, such as bathing needs. Meal preparation is given by elderly care workers in Bucks County so that your loved one will have a healthy, nutritious meal. Since the aged often have memory difficulties, the medications that they take are often missed due to their forgetfulness. Elderly care in Bucks County will assist your loved one with their daily medications to take care that this very important health need is not overlooked. They can help your aged family member to develop a routine or make up a simple charting system to take their medications on their own. If your aging loved one is in need of transportation to a doctor’s appointment and you are unable to be there for them, the elderly care workers in Bucks County will provide this service as well.

The elderly care workers in Bucks County, Pennsylvania are there to assist you and your family in whatever aspect is needed necessary to help your family member maintain a good quality of life in their senior years. Let us assist you in helping to make their last years joyous and memorable while you are away from them. Our staffing for elderly care in Bucks County will help your family member be safe, happy, and healthy during this difficult time of their lives.

Independence vs. Isolation

Many of my elderly clients who were trying so hard to maintain their independence by living alone at home actually maintained nothing more than an isolated existence punctuated by the occasionally call or visit from friends and family. This type of isolation was also coupled with medication errors or abuse, self neglect and unsanitary housekeeping. A person living in this situation will often ?bloom like a flower? in the right retirement facility environment. It is amazing what three hot meals a days, social interaction, clean sheets and regular administration of medications can do for a person?s mind, body and spirit. A person who lives alone is more likely to fall and lay alone on the floor for days without being found. A person, who lives alone may make poor choices such as keeping, (or worse,) spoiled food in the refrigerator. If a person lives alone, there are many signs of illness that no one will notice during sporadic short visits. Medical appointments may be missed and prescriptions left unfilled. Many people feel that they are honoring their aging loved one by letting them live alone, even though all the tell tale signs of self neglect are apparent. There is no honor or dignity in being found on the floor after one has laid in their own excrement for three days. Unfortunately, many families will wait for this type of incident before insisting on either home health care or facility placement. If an elder is physically or verbally abusive to family and care givers, they are much more likely to be left alone to make their own decisions, regardless of how dysfunctional their situation may be. Elders with difficult personalities are many times more likely to be abused by caregivers. They need more supervision, not less.

American Family Dynamics and the Pressures of Today?s World

I hear people say ?Americans don?t take care of their elders like other countries do?. Well that is not my experience. The adult children who consult with Geriatric Care Manager or other eldercare professionals are very concerned about their parents. They love them and they want the best care their money can buy. That?s the clincher: what their money can buy. In America, caregivers, maids, etc,, are expensive. Perhaps in another country where slave labor is commonplace, people can afford plenty of care. But in this country it costs $12.00 per hour (or more) for a home health aide. At eight hours per day, that is $96.00 per day. That is $2,880 per month or $34,560 per year ? more than the average working American earns per year. The average woman gets a social security check of less than $500.00 per month. Do the math and you will soon see that unless you are wealthy, many people cannot afford to keep their elders in their own home with a part time caregiver or even in their children?s home with a caregiver.

Now couple this financial problem with another very real problem. Most middle income women in their fifties, who are caring for their elderly parents, are also trying to hold down a job, help their young-adult children and maintain a marriage. If a middle income woman stops working to care for her parents, she and her husband either cannot pay their bills or they must significantly reduce their standard of living. I know a few husbands who are fifty-something and feel they have worked too hard and too long to have their dreams of retirement evaporate because someone else?s needs are suddenly more important than their own. Now that Americans have come to grips with the concept that it takes two incomes to live well in this country, they are more determined than ever to have a retirement. Paying $35,000 per year for a caregiver can take a huge chunk out of the retirement savings. Frankly, most people couldn?t afford to do it even if they wanted to. Because most Americans? net worth is in the equity of their home, selling the family home is the most common way to finance elder care services. If the family home sells for $100,000.00 and the average cost of an Assisted Living Residence is $36,000.00 per year, an elder can afford to live in that Assisted Living for 2.7 years. Coincidently, the average amount of time a person lives in an Assisted Living before moving on to a nursing home is 2.5 years.

Many adult children, who do have the desire and financial means to bring their elders to live with them, still cannot. They cannot because the medical or psychological needs of the elder are beyond their capacity to manage. For example, if Grandma is sweet and docile by day, but ?sundowns? or grows agitated as evening falls, this poses a difficult problem for the caring family. When some people experience dementia or other medical issues, they may stay awake all night. They sometimes wander out of doors or rummage through drawers and closets. This behavior will keep the whole family awake at night. If a working family cannot sleep at night, this situation will become intolerable very quickly. Some adult children have been raised by violent, aggressive parents who are now violent aggressive elders. Children who have been raised under these conditions need not feel obligated to bring their parents to live with them, despite the pressure they may get from outsiders who do not know the real story.

Elders and their families who are trying to make difficult choices about elder care benefit from a professional assessment from a geriatric specialist. Professional care managers can offer an objective opinion based on a clinical evaluation of the physical and cognitive status of the elder. Physicians, hospital case managers, facility admissions coordinators and social workers can also offer advice about appropriate placement of an elder or even suggest how to set up services in the home to best meet the elder?s needs.

Home Health Care ? Stay Home without Being Alone

At the very least, any elder living alone should have a medical alert system. This is a necklace or wrist band with a panic button that can be pushed in case of emergency. If the button is pushed a dispatch center receives the signal and makes and attempt to communicate with the elder through a speaker placed in the home. If the elder needs help or does not respond to attempts to communicate, emergency services will be dispatched to the home. Many services will also contact friends and family to notify them that assistance is needed. A good candidate for this device is one WHO DOES NOT have memory loss as memory loss makes it difficult to learn to operate new appliances.

There are two basic types of home health care services: Medicare and Private Duty:

Medicare Home Health is free but can only be accessed if ordered a physician. Medicare will only authorize the free home health services if specific events have happened such as a recent hospitalization lasting three or more days, or a recent change in health status, etc. Medicare will send a Registered Nurse to evaluate the elder and that nurse decides if other professionals such as physical therapists, social workers, dieticians, etc. should perform evaluations. Each professional will determine what services they will render and for how long. Medicare services are temporary in nature and are not offered on a full time basis. The average visit by the nurse, aide and therapist is less than one hour each. Even Medicare home health aides only stay long enough to bathe and dress the patient.

Private Duty Home Health can be arranged on a full time, part time or live- in basis. Many Long Term Care Insurance policies will pay for home health care. The amount of care one can get and the duration of the services varies depending upon which policy they purchased. If someone does not have insurance, they must pay out of pocket (or private pay) for any services. Typically a private home care agency will offer services at a minimum of four hours per day. Typical eight hour shifts are 7am-3pm, 3pm-11pm and 11pm ? 7am. Many elders complain that an agency sends them a different caregiver each day. In order to avoid having the same aide, that as much as possible, order care every day for at least eight hours. This will allow the agency to schedule the same person for all your shifts. Because labor laws do apply and the agency would have to pay overtime for time which exceeds 40 hours per week, you will most likely have at least two to three caregivers on a full time case. The average hourly rate is $14.00 per hour. A live-in will cost about $150.00 per day. A live-in lives in your home and drives your car (or theirs for a mileage fee) and you are expected to feed them as well, even if you go out to dinner. By law, a live- in is entitled to two hours per day of free time. They can do what ever they like, including leaving the house during their break. If this arrangement will not work for your situation, consider hiring an aide around the clock. Around the clock care is typically delivered in two twelve hour shifts which are done by two different caregivers.

One aide comes to the home from 8am until 8pm and is relieved by the second caregiver at 8pm until 8am. Around the clock care can be delivered in many schedule formats. A live- in is expected to have their own private bedroom and bathroom although many agencies are flexible on this issue. The live- in is expected to be awake all day and have at least 7 hours of sleep at night. If the elder does not sleep at night, a live- in arrangement will not work. One option is to have the live in ($150/day) plus hire a caregiver to come to the house and stay up all night with the elder ($14.00. hour for eight nighttime hours). This costs $112 + $150= $262.00 per day. The only other alternative is to have around- the- clock care which will cost $14.00/hr X 24 hr=$336/day. Adding the eight hour night shift to the live in, saves about $3,000 per month. The Veterans Aid and Attendance Pension is available to qualified veterans who need a caregiver in their home on a regular basis.

Types of Adult Housing and Facilities:

Independent Living Facilities usually offer small apartments with some meals included in the price. A person who lives in an Independent Living Facility is expected to manage their daily care needs on their own, but the staff would readily recognize if needs increased and assist the resident in obtaining the needed help. Some facilities have extra care services available for additional charge to help the resident ?age in place.? Others may ask a resident to move out if their needs exceed the scope of that particular facility. Limited transportation is usually provided although many residents are still driving when they enter an Independent Living Facility. These facilities may cost anywhere from less than $1,000 per month to over $5,000 per month depending upon the luxury amenities and location.

Assisted Living Facilities usually offer hotel size rooms with the option to share a room or pay extra for a private room. Three meals and snacks are usually provided as part of the price. Residents are expected to need some assistance with their daily care needs. Medication administration is strictly supervised. The State laws dictate who can live in an Assisted Living. The State does not want Assisted Living facilities to house nursing home candidates or Nursing Homes to admit people who could function just as well in an Assisted Living Facility. Assisted Living residents must be able to walk and transfer ( from bed to chair or chair to standing) with the assistance of only one other person. An Assisted Living resident can be left alone in their room for two hours or more. Nurses aides are on duty around the clock. Registered nurses or Licensed Practical Nurses are on duty at least during the daytime. Many medical services may make rounds and visit residents at least monthly. It is not uncommon for an Assisted Living resident to never have to leave the building for a medical or beauty appointment. Prices may range from under $1200/month to over $8,000/ month, once again depending upon the amenities. Medicaid has a program called the Medicaid Waiver which can pay part of the cost of the Assisted Living. However, funds have been historically limited and waiting lists can be long. The Veteran Aide and Attendance Pension is designed to financially assist qualified veterans who need the services of an Assisted Living facility

Dementia Specific Facilities are designed especially for the memory impaired resident. The building, floorplan, furnishings, d

There can be many causes for this reaction to your plan. Perhaps they feel a loss of control in their lives. Maybe they resent feeling like they aren’t trusted to be alone at home any longer, and their self esteem is hurting. Maybe they’re afraid of having a stranger in their home. Maybe they want their privacy and don’t really understand why they need help in the first place! The way you respond to your loved one’s concerns may eventually determine if your “golden” care plan is going to be successful or not.

Before you even begin to initiate your care plan, include your loved one in the “research project.” Make sure they feel like they are a part of making the decisions as to who to hire, when the caregiver should come, and what type of care they may need. Even if they aren’t completely sure they need the help, it may give them the added confidence they need to know that you still value their input and respect their opinions.

If your loved one is fearful of having strangers in their home, listen to their concerns and let them know you understand. When deciding who to hire, make sure you go to a reputable agency that does criminal background checks and has good referrals and testimonials. Reassure your loved one of those things when you make your final choice. Make sure the caregiver comes to meet them for the first time when you are there with them, and give them a chance to form an initial impression before you insist on keeping that particular caregiver. Usually after just a few visits, the apprehension dissolves into a cheery, trusting relationship that your loved one will truly enjoy.

If they just don’t agree that they need the help, you have unfortunately entered into the greatest challenge of all, especially if your loved one is suffering from altered thought processes and is unable to identify with your concerns. This may be the time to be loving but firm with them, and let them know that there really isn’t a choice when their safety is at stake. Reassure them that your motive is to help them live at home for as long as they can safely do that, and let them know you’re on their side. Make compromises if you can safely do so; for instance, have the caregiver come the same number of visits per week, but maybe for shorter time periods. Try referring to the caregiver as the “cook” or the “housekeeper” …let them know you want to pamper them! Make sure your loved one realizes they aren’t expected to entertain their “guests”, and they can go about doing whatever they would normally do if no one was there. On the other hand, if your loved one enjoys socializing, suggest a lively game of cards when their caregiver is there, or some other activity with them that your loved one would enjoy. Persistence is the key…in time, your loved one will grow to accept their new lifestyle and the friction will dissipate.

Remember, in the midst of all these issues, your own health and lifestyle are also important. Caregiver burnout can be a real threat to you and your family if your loved one doesn’t cooperate with the plan of care you have worked so hard to design for them. Don’t allow yourself to be manipulated by a false sense of guilt if your loved one has difficulty making these adjustments. In time, they will realize that you have their best interest at heart, and they may even grow to appreciate you for it!

As our parents age, we need to stay diligent and aware of changes in their mental orientation and ability to care for themselves. Are they just a little forgetful at times, or is it something more worrisome than that? If they are able to take their medications without being reminded, bathe alone, dress without assistance, prepare meals every day, and they are not experiencing frequent falls or sudden illnesses, they are probably safe to be at home alone. There are monitoring systems and personal emergency alert systems that can provide added security by making help available to them in the event of an accident or sudden illness.

However, if you notice that your parent’s health is declining, that they have increased weakness or weight loss, if they have had frequent falls, if they are not taking their medications, not eating properly, and not able to do their personal care without help, it may be time to look into other options. Sometimes the increased care is all they need to regain their strength and be able to continue living at home, avoiding placement in a nursing facility or some other major life change.

Finding the help you need is another obstacle. Knowing who to go to for help may seem to be an overwhelming task, but there are many resources available to seek information and counsel. Private duty organizations, home health agencies, and hospices are all viable places to start if you want to help your parent stay at home.

The Indiana Association for Home Care and Hospice (IAHHC) has a listing of all local agencies, both for private pay and agencies that accept Medicare and/or insurance payor sources. You can find them on their web site: www.ind-homecare.org.

When investigating which private agency to use, make sure they are licensed appropriately and that they do criminal background checks on all their employees. Their staff should be bonded and insured, and you should not have any of the burden for carrying worker’s compensation, tax liabilities, or social security. A new law beginning in January of 2006 requires all private duty, non-medical services to be licensed through the state of Indiana. Make sure the agency you choose has gone through this licensing process, and you will be safer in trusting that they have taken all the appropriate steps in ensuring good care for your loved one.

There are many financial resources available to help pay for private duty care, such as reverse home mortgages. The Veterans Administration can give you valuable information on benefits for veterans who need care at home and have served at least one day in the service during war time. These benefits are also available for spouses of veterans. Look on the web for more information regarding financial concerns; there’s plenty of information available. You can also contact private duty agencies and request assistance in finding funds that are available.

Private duty agencies can provide any kind of non-medical care needed to assist the client in staying at home. They will provide personal care assistance, medication reminders, cleaning, cooking, laundry, running errands, and transportation to appointments, and a variety of other services. They are usually available twenty four hours a day, including holidays and week ends, and do not require any doctor’s orders to initiate the care.

Home health care requires a doctor’s order for services to begin, and the patient must be certified to be on “home bound status”. This means that they can only leave home to visit the doctor, go to church, or to the beauty or barber shop. A nurse will visit on a regular basis, and a home health aide will assist with personal care. Some home health agencies also provide physical therapy, social services, speech therapy, and occupational therapy as well. Most home health care agencies are not available in the evening hours, on week ends, or on holidays. The majority of home health agencies accept insurance and Medicare payments.

Hospice care also requires a doctor’s order, and the patient must have a life-limiting disease with expectations of six months or less to live. Patients can be re-certified for hospice every sixty days, and may live much longer than six months and still be in hospice care. Hospice care also provides nursing and home health aide services, along with extra

support to the family and patient during this difficult time. Comfort measures are a priority in the plan of care, and they have a variety of services such as social services, pastoral care, and volunteer services as well. Medicare and insurance usually are accepted. There will always be a hospice nurse on call twenty four hours a day to assist with any emergencies or special problems during times when the office is closed.

Sometimes the best plan is a combination of home health or hospice along with private duty care. Many seniors are resistant to accepting any kind of help at first, and will require continual reassurance effort to help them maintain as much independence as possible.

When addressing these issues, never “speak down” to your loved one. Remember, even though roles are changing, they still deserve to be honored and respected. Sometimes calling a care giver “the maid” or “the butler” rather than a “caregiver” or “home health aide” will help them accept the situation with a little less anxiety. It’s all in the attitude that it’s presented to them – help them feel a sense of control in the situation whenever possible. Try to help them understand that these changes are happening in their home because you love them and want them to be able to stay at home as long as possible and not have to live in a facility to get the help they need.

Don’t forget to schedule time for yourself during this intensely demanding season of your life. By succumbing to false guilt or unreasonable demands, you may be setting yourself up for a disaster later. Take time to enjoy your immediate family, your hobbies, and leisure time as well. Join in with other caregiver groups for extra support – you can find them at churches or on the web. You’ll be safeguarding your own ability to handle this long term role as a caregiver with a healthy mind, body, and spirit.

Health insurance fraud is a common event targeted to seniors.  Most of these scams involve the con artists submitting fake charges to the insurance companies and/or Medicare.  Unbeknownst to the individual, bills are submitted to the insurance company for unnecessary equipment, or for services never rendered.  Things to look out for are offers of “free” equipment and fake tests.

Medicare identification numbers and Social Security numbers should only be given to those who have provided medical services.  To avoid health insurance fraud, blank insurance claim forms should not be signed, and blanket authorization should never be given to a medical provider for services rendered. Doctors should be asked what they will charge to the patient and to the insurance company, and the insurance company’s explanation of benefits should be reviewed. Business involving health should never be done with door to door or telephone sales people, and insurance companies.

Another risk for aging adults is telemarketing fraud.  There are countless fake products and services being sold over the phone.  Some typical bogus products are vitamins, health care products, travel offers and prizes.  Warning signs that the product is not legitimate are if the caller says “you must act now,” or there is a free gift, or if money or a credit card number must be given.   If they refuse to send something in writing, or discourage one from taking the time to check with a family member or the Better Business Bureau, it is not likely to be a legitimate company. 

To avoid telemarketing fraud, customers should always buy from a familiar company, ask for information in writing (but also check this out), and check with the Better Business Bureau, or another watchdog group.  Consumers should get the salesperson’s name, company address and business license number, and check them out.  If they are not willing to give this information, it is also a sign that it is a fraudulent operation.  Time should be taken in making any purchasing decisions, and the offers should be fully understood.  Services should not be paid for until after they are delivered, and an individual should never be afraid to be rude and simply say “no thank you” and hang up. 

Other scams to look out for are counterfeit prescription drug offers, funeral and cemetery fraud, fake “anti-aging” products, internet fraud and investment schemes.  As wise as our aging parents, grandparents and friends may be, they need assistance and support.  It is important to communicate warnings to them, so that they do not become a typical victim. 

It is also important to provide elder care services for that extra support when necessary.  Visiting Angels provides senior home care that is bonded and insured, and is the nation’s leading network of non-medical home care services.  It is an alternative to a nursing home or an assisted living facility.  Some services provided by Visitingangels.com are hygiene assistance, meal preparation, light housekeeping, errand assistance, bill paying assistance, and companionship.  These duties can give a respite for family caregivers at affordable hourly rates.  Visiting Angels allows the family to select their caregiver for loved ones from experienced, caring and trustworthy individuals allowing you to maintain your schedule and get personalized care.

]]> http://personalhomecareservicestexas.com/blog/elder-home-care-service-when-your-loved-one-needs-long-distance-care/feed/ 0 http://personalhomecareservicestexas.com/blog/senior-care-north-carolina-improving-the-quality-of-life-for-family-caregivers/ http://personalhomecareservicestexas.com/blog/senior-care-north-carolina-improving-the-quality-of-life-for-family-caregivers/#comments Sat, 09 Jan 2010 19:02:13 +0000 bobcrabtree1 http://personalhomecareservicestexas.com/blog/senior-care-north-carolina-improving-the-quality-of-life-for-family-caregivers/ When the entire baby boomer generation has reached retirement age in 2030, an astonishing number of U.S. families will have faced the challenge of providing care to an aging loved one. Today, caregivers are present in one out of every five U.S. households. With over 80% of these being family members, and with demand for caregiving only expected to increase as members of the boomer generation reaching retirement age grows steadily, there is becoming increasing need for outside help.

For millions of Americans who offer informal care to ill or disabled family members, caregiving is a Catch-22. On one hand, the commitment to provide care is a very rewarding personal experience. At the same time, numerous studies have quantified how exhaustion, worry and ongoing caregiver demands can cause chronic stress, depression, anxiety, premature aging, high blood pressure, headaches and back pain.

Given that most family members begin providing care to their loved ones without training or counseling, they often are not aware of the overwhelming stress associated with it. For many, caregiving is not the only role they are filling as adults. Most are married or living with a partner, have a full time job and children at home. Thus, friends, family, spouses and even family caregivers themselves should be aware of the stress associated with caring for a loved one.

Fortunately for family members, there are steps that can be taken to help alleviate some of the pressures associated with caring for others. Most of these steps are centered around self-care and personal well-being, as staying healthy while caring for a loved one is of supreme importance. Some things that family member caregivers can focus on include: eating nutritious meals, exercising, engaging in social activities, finding time for personal relaxation as well as joining a support group.

It is important for caregivers to take the necessary steps to ensure that they get the proper nutrition, exercise and respite they need. On top of this, in-home care can also be a viable option for many families. Professional home care agencies have well trained staff available to provide support for a wide range of situations.

Rather, it is one of the dementing disorders, a group of brain diseases that lead to the loss of mental and physical functions. The disorder, whose cause is unknown, affects a small but significant percentage of older Americans. A very small minority of Alzheimers patients are under 50 years of age. Most are over 65.

Alzheimers disease is the exception, rather than the rule, in old age. Only 5 to 6 percent of older people are afflicted by Alzheimer’s disease or a related dementia?but this means approximately 3 to 4 million Americans have one of these debilitating disorders.

Research indicates that 1 percent of the population aged 65-74 has severe dementia, increasing to 7 percent of those aged 75-84 and to 25 percent of those 85 or older.

At least half the people in U.S. nursing homes and elderly care facilities have Alzheimers disease or a related disorder; in 1985, the annual cost of caring for individuals with Alzheimers disease and related dementias in institutional and community settings was estimated between $24 billion and $48 billion for direct costs alone and is probably higher today.

As our population ages and the number of Alzheimer patients increases, costs of care will rise as well.

Who Gets Alzheimer’s disease?

The main risk factor for Alzheimers disease is increased age. The rates of the disease increase markedly with advancing age, with 25 percent of people over 85 suffering from Alzheimers or other severe dementia.

Some investigators, describing a family pattern of Alzheimers disease, suggest that in some cases heredity may influence its development. A genetic basis has been identified through the discovery of several genetic markers on chromosomes 21 and 14 for a small subgroup of families in which the disease has frequently occurred at relatively early ages (beginning before age 50).

Some evidence points to chromosome 19 as implicated in certain other families that have frequently had the disease develop at later ages.

At the same time, data indicate that the likelihood that a close relative (sibling, child, or parent) of an afflicted individual will develop Alzheimers disease is low. In most cases, such an individual’s risk is only slightly higher than that of someone in the general population, where the lifetime risk is below 1 percent.

And, of course, many disorders have a genetic potential that is never expressed?that is, despite being at risk for a certain illness, one might go through life without ever developing any symptom of the disease.
What to Look for in Earlier Stages of Alzheimers Disease

-Inability to remember names, birthdays, or details of any sort.

-Sitting on the sidelines during conversations, answering politely but vaguely if spoken to, but never engaging meaningfully.

The onset of Alzheimers disease is usually very slow and gradual, seldom occurring before age 65. Over time, however, it follows a progressively more serious course.

Among the symptoms that typically develop, none is unique to Alzheimers disease at its various stages. It is therefore essential for suspicious changes to be thoroughly evaluated before they become inappropriately or negligently labeled Alzheimer’s disease.

Problems of memory, particularly recent or short-term memory, are common early in the course of the disease. For example, the individual may not recall which of the morning’s medicines were taken. Mild personality changes, such as less spontaneity or a sense of apathy and a tendency to withdraw from social interactions, may occur early in the illness.

As the disease progresses, problems in abstract thinking or in intellectual functioning develop. The individual may begin to have trouble understanding what s/he is reading. Further disturbances in behavior and appearance often seen in elderly care and skilled nursing facilities are agitation, irritability, quarrelsomeness, and diminishing ability to dress appropriately.

Later in the course of the disorder, the affected individuals may become confused or disoriented about what month or year it is and be unable to describe accurately where they live or to name correctly a place being visited.

Eventually they may wander, be unable to engage in conversation, seem inattentive and erratic in mood, appear uncooperative, lose bladder and bowel control, and, in extreme cases, become totally incapable of caring for themselves if the final stage is reached.

Death then follows, perhaps from pneumonia or some other problem that occurs in severely deteriorated states of health. The average course of the disease from the time it is recognized to death is about 6 to 8 years, but it may range from under 2 to over 20 years.

Those who develop the disorder later in life may die from other illnesses (such as heart disease) before Alzheimers disease reaches its final and most serious stage.

Though the changes just described represent the general range of symptoms for Alzheimers disease, the specific problems, along with the rate and severity of decline, can vary considerably with different individuals.

Indeed, elderly care professionals must remember that most persons with Alzheimers disease can function at a reasonable level far into the course of the disorder.

Moreover, throughout much of the course of the illness residents maintain the capacity for giving and receiving love, for sharing warm interpersonal relationships, and for participating in a variety of meaningful activities with family and friends.

A resident with Alzheimers disease may no longer be able to do math, but still be able to read a magazine with pleasure. Playing the piano might become too stressful in the face of increasing mistakes, but singing along with others may still be satisfying. The chess board may have to be put away, but one may still be able to play tennis.

Thus, despite the many exasperating moments in the lives of Alzheimer residents and their families, many opportunities remain for positive interactions. Challenge, frustration, closeness, anger, warmth, sadness, and satisfaction may all be experienced by those elderly care workers who work to help the resident with Alzheimers disease cope as well as possible with the disease.

The reaction of an individual to the illness?his or her capacity to cope with it?also varies and may depend on such factors as lifelong personality patterns and the nature and severity of stress in the immediate environment.

Depression, severe uneasiness, and paranoia or delusions may accompany or result from the disease, but they can often be alleviated by appropriate treatments.

The elderly care worker must remember that although there is no cure for Alzheimers disease, pharmacological and psychological treatments are available to alleviate many of the symptoms that cause suffering.