If you have, dementia, then there are certain, nursing care, needs when, dementia, presents itself because it goes until death. Let's say that my mom or someone I'm responsible for starts exhibiting symptoms of, dementia.  How do I decide on whether to put them in a, nursing home, or to get, home care?

Listen to the full podcast interview here:

 

My guest today is MERRILY ORSINI, Pres/CEO of Corecubed, is considered a thought leader in the healthcare at home industry and is involved in numerous organizations, providing insight and advice. Merrily is a leader in the Help Choose Home initiative, podcast creator and host. She focuses on educating how and when to choose healthcare at home. Orsini won a Lifetime Achievement in Business Award at the 2017 Stevie Awards for Women in Business. Orsini’s business ownership began with a geriatric care managed in-home care agency, a venture that garnered her the prestigious Ernst & Young Entrepreneur of the Year Award in 1996

Myrna – Tell us your journey into your first geriatric care managed in home care agency.  Was it because you had a, dementia, parent who needed help?

Introduction to Home Care

Merrily – I sort of fell into it.  I have a master's in social work and an interest in helping people. I was in a personal situation where I needed to make more money.  So, I decided to become an entrepreneur and start my own Business.  Soon after I opened the doors of that business, I got a request from a friend of mine to provide what at that time we called a babysitting service for one of her clients whose wife had senile, dementia.

That began was a lifelong commitment for me to provide care for anyone who is suffering from, Alzheimer's.  We progressed with my first patient  from her early stages of, Alzheimer's dementia, through end stage.

We ended up caring for lots of other people with lots of other issues but the issue of, dementia, is probably the most frightening and the hardest care. I stayed in the, home care, space directly providing, nursing care, services from 1981 to 1998.

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Myrna – I don't have any personal experience with this, in my family but there's a lot of movies out there that address the subject of, Alzheimer’s disease. The most famous is the movie the Notebook.

When I started, menopause, I personally started forgetting things and I was very afraid of that it was the start of, Alzheimer’s disease. But I was reassured by my doctor that if there is no history of, dementia, in my family then there is a good chance that I would not get, Alzheimer’s disease.

 

What kinds of services do you provide in the home healthcare space for dementia patients?

Merrily – my business provides support to the industry.  I'm not in the direct provision of, home care, anymore.  The thing about, dementia, is that it's not a one-size-fits-all disease. It also manifests itself differently in different people.  Some people become very calm, quiet and reserved and other people become aggressive.

The disease progresses at different times,  it is a debilitating disease if you have an, Alzheimer’s,  type, dementia, or some of the other kinds of, dementia, it's debilitating and it gets worse.

For instance you mentioned, menopause, there are several things that do cause something that looks like, dementia.  For instance, medication mismanagement.  I had a client one time who was severely malnourished, and that malnourishment actually translated itself into, dementia.

The question of, home care, it is again it's not a one-size-fits-all because someone who has a, dementia, needs a totally different kind of care than someone who has a frailty or a disease. It's two totally different kinds of care and it's also takes different kinds of caregivers.

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Why Home Care is the best option for Dementia Patients.

There's different ways that you actually can talk to someone or be around someone with, Alzheimer’s, and there's a handful of generic kinds of rules for, nursing care; but the biggest one is this. It is hard for families is when someone starts forgetting and they actually have, dementia.

That's irreversible and it's going to get worse. the worst thing you can do is try to orient them to right now, because they're not there.  They're not mentally in the present and it's very scary for someone with the, dementia, to think that they're somewhere else and then have someone try to orient them today.

It’s like waking up in a dream and you know you you're dreaming you're someplace and if someone said you're not there it would be scary. The, dementia, patient  turns against them, because they quit trusting them.

They quit trusting them because the person is trying to orient them back to reality.

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Dementia Test

The mini mental status test is about five questions:

• It starts off with “what day is today”
• Who's the president of the United States
• Ask them to make you a cup of tea because that requires is sequential steps.
• Can they still dress themselves or take care of themselves. Oftentimes not because they don't remember.  Sometimes people with, dementia, take all their clothes off and run out into the yard.

So many of the normal activities of daily living processes that you that you would not lose unless you had, dementia.

 

Ways to prevent Alzheimer’s type dementia

If you have a healthy lifestyle and by that I mean eating well, exercising and getting plenty of sleep. All of those things can help you prevent that onset of, dementia, but if you actually have an, Alzheimer’s,  type, dementia, no matter what you do it is going to eventually come.

Keeping your mind active is the other way to prevent the onset of, dementia. We're creatures of habit so if you brush your teeth with your right hand, try brushing your teeth with your left hand.  Simple things like that.

Learning a foreign language that's one of the most amazing things you can do because it uses parts of your brain that you don't normally use.

So if you've done crossword puzzles your whole life and you think by continuing to do crossword puzzles you're going to somehow keep dementia at bay, that's not true.  You need to do something different like learn how to dance.  Do something that involves your body and your mind, that is different than anything that you've ever done before.

 

Is  Alzheimer’s dementia different from just dementia?

You characterize, Alzheimer’s dementia, from just, dementia, can you give us what the difference is?

Merrily – There are all different kinds of, dementia.  Alzheimer's, is what we most hear about; but it is a specific disease that has some specific characteristics.

 

There are other types of, dementia.

• Lewy Body dementia which is what Robin Williams had
• There’s frontal-temporal dementia.
• Alcohol related dementia that comes from overusing alcohol
• Vascular Dementia
• Mixed dementia and that is a combination of Alzheimer’s dementia and Vascular dementia.

 

Home Care for Dementia patients

If you have, dementia, then there are certain, nursing care, needs when, dementia, presents itself because it goes until death.

Let's say that my mom or someone I'm responsible for starts exhibiting symptoms of, dementia.  How do I decide on whether to put them in a nursing home or to get, home care?

There is no universal long-term care program for people in America, we have an overly complicated, home care, system.  Some of it funded by the government and some of it paid for privately, so it really depends on what your financial resources are and what your support system is.

Right now very few people want to go into a congregant, nursing home, setting because of the exposure. You look at the deaths in America where 40 percent or more happen in congregate, nursing home, care settings from COVID 19.

So, if you have a loved one with, dementia, the first thing to do is go somewhere where you can get a real good screening.  I would recommend a geriatric evaluation and treatment program through a teaching university.

The next step after they say you do have a progressive disease, is to really look at time frame, because a lot of people can stay at home with just a little bit of care as long as there, dementia, is not progressed to the point where they are endangering themselves.

Staying at home is probably the best place because people who have, dementia, like familiar surroundings and they also like a routine.

But the question between, home care, or, nursing home, really comes down to cost and support.

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Tell us about your podcast Help Choose Home.

The reason I started the Help Choose home podcast, is that what I have found is people don't actually look for any of these answers or even information until they have a need. Someone has a care need for a family member and then they start researching. So the Help Choose home podcast, is really just about educating people about how to choose, nursing homes, or, home care.

How can those listening and watching on YouTube connect with you?

The national association for home care and hospice which is one of the sponsors of my podcast has very good resources and you mentioned AARP.  AARP has excellent resources as well The home care association of America and the National Palliative Hospice and Palliative care organization.

 

My own website is www.merrilyorsini.com My business is corecubed.com

 

I'm inviting you to join my Facebook group called life coach and please subscribe to the podcast on our YouTube channel and where ever you get your podcasts.

 

Additional Resources