Galit, a nurse who works full-time at a geriatric center. She remembers very well the time when she had to communicate for the first time with a dementia patient from the department where she worked. She was a young nurse at the time and had just finished her bachelor’s degree in nursing. The patient she had to communicate with for the first time was called Shoshana. A 70-year-old woman, who was diagnosed in the early stages of the disease, about two years ago. After working in the geriatric department for several months, one thing was very clear to her: there are many caregivers who are still not sufficiently aware of how to properly communicate with dementia patients.
A nurse makes eye contact with an elderly woman suffering from dementia – illustration picture.
Tips for effective communication with dementia patients-
Remove all the environmental factors that may hinder you from communicating with the person with dementia such as: an open television, a beeping cell phone, a radio, and more.
Speak slowly and clearly, use simple words.
Ask him closed questions and make sure that all the questions you ask can be answered yes or no. Instead of asking, what would you like to have for lunch? Ask, would you like to eat a sandwich with cheese?
Speak clearly and use the names of the people and things you are talking about. Instead of using body words such as: she, he, they – did you like it? Ask did you like the cake?
Try to have short conversations with him. People with dementia may lose the sequence of the conversation, if you have long conversations with them.
Give the dementia patient time to respond to your questions. Try to avoid frustration, if the time you have to wait for an answer is longer than expected.
More tips for effective communication with dementia patients –
Talk to the dementia patient at eye level. Address him by his first name, to make sure you have his full attention.
Try to have one-on-one conversations with him. If you cannot avoid talking in a group, try to make sure that you talk to one person at a time.
Try to avoid finishing the sentence for the dementia patient. If he insists on finding the right word, think about the topic of the conversation and ask a question that should help and stimulate what he wanted to say. If the dementia patient tells you – I want… I want… ask a question such as – do you want to go for a walk?
During the conversation, never say to the dementia patient, “I told you so before.” It is important to remember that if the person starts repeating the things he said before, and asks you repeated questions. It is possible that, he simply forgot that he asked the same question before.
Try not to argue with the dementia patient, as this will make them feel anxious. It is much more effective to accept what he says as the truth and continue the conversation.
If the dementia patient has behavioral disturbances, help them gain control. Think of tasks or activities he can do that can help him feel appreciated. For example, daily activities that he used to do and enjoy. Activities he can do at home such as: folding clothes, or cutting vegetables before dinner.
An elderly woman tries to remember – photo illustration.
Latest tips for proper communication with dementia patients-
Give the person with dementia clear and helpful instructions. When his cognitive (mental) state continues to deteriorate, control must be maintained with him through simple and effective communication. If you ask him directly – “Can you make me a cup of coffee please?” The request can cause him frustration. On the other hand, if you offer him to make coffee together with you and guide him through simple instructions. This way, you can give him back his sense of control. Instead: “Can you make me a cup of coffee please?” “Please fill the kettle with water”, “Boil the water”, “Take the coffee beans out of the cupboard” etc.
I will be flexible to their world! Many people who live with dementia lose track of time. If the dementia patient is not ready to talk to you at that moment, try to understand the reason for this. It’s possible that he just woke up, or he was up all night, or he’s just not in the mood to talk, or he wants to rest and watch TV. It is important to remember that, if you do not receive any response from the dementia patient, you must continue to talk with him patiently and respectfully. All this, in order to avoid frustration and a feeling of lack of appreciation.
It is very useful to find sources of mental support! When dementia worsens, it is important to have someone to talk to. You have to take breaks and gather strength for the rest of the way.
Know when to walk away! If the dementia patient becomes irritable or threatening, take a deep breath and walk away. Remember that living with a dementia patient is not easy – you can always come back and try to deal with it later.
In conclusion-
You must remember that the dementia patient is not always responsible for his actions. It is the terrible disease that causes his behavior and the gradual deterioration of his brain functions. I really hope that one day there will be a cure for this disease. But, now you must learn how to deal with its consequences. The best way is to focus on the positive things you achieve with the person dealing with dementia. Try to spend every day with him as much as possible.
Written by Irit Rabinowitz – attorney with a master’s degree in the field of health and rehabilitation – with extensive experience with mentally ill and nursing patients.
I started my work in nursing homes, in 2008. First in small nursing homes, and then I moved to work in a relatively large nursing home in the northern region. I really enjoyed working in community, individual and group work with the tenants and also, I enjoyed helping the families of the elderly, both in emotional support and in exercising their rights in front of the various offices.
What did I enjoy least about my work in nursing homes?
From the gray exceptional events, from the fact that I could not always work according to the ethics rules of the profession, because I was subordinate to management that preferred to hide (not all managements).
But, of course, I didn’t give up and where it was necessary to report, I insisted on reporting even if it resulted in criticism towards me or even dismissal.
Lack of manpower in the wards and the fact that sometimes as a result, the work of the treating staff led to those unusual events. The reluctance of the care teams to receive training and professionalize, just because they had to stay another hour at their own expense.
All this, made me gradually lose my desire to continue working in nursing homes.
In this article, I’m going to scan the state of nursing homes in Israel, with an emphasis on long-term nursing homes. Of course, not all nursing homes in Israel are in the same situation, some are of better quality and there are less, and I am going to give general information about what is happening in the nursing homes in Israel both from the literature and from my personal experience.
The shortage of nursing personnel in nursing homes –
A woman takes care of an elderly woman
It is no secret that the shortage of personnel in nursing homes and hospitals is high. As a result, the care given to the elderly staying in nursing homes is sometimes deficient. As proof of this, a quote from an article in Globes-
In the administrative petition, it was claimed by the Association of Nursing Homes in Israel that the reduction in the number of foreign workers in Israel, through the Population and Immigration Authority, resulted in a great shortage of nursing care workers for tens of thousands of elderly people who need it. According to the petitioner union, the construction industry did not suffer from the lack of foreign workers, because it was important for the state to solve the housing crisis in Israel, but tens of thousands of the state’s nursing and mentally exhausted elders were abandoned by it.
Lawyers Bombach and Ronen add and write, on behalf of the nursing homes, that
The population in the world, and in Israel in particular, is living longer and longer. But at the same time, the attention of the decision makers in Israel was not drawn to this, and the emphasis was not placed on finding a systemic-national solution for the treatment of the aging population.
The phenomenon of abuse in nursing homes-
The phenomenon of abuse of residents Among the staff members, it was found that the auxiliary forces are the group of caregivers who are at high risk of abuse of residents, as a result of the abrasive nature of their work (Shannan-Altman and Cohen, 2009).
These caregivers are professional support workers, who are required to exercise basic skills in care and their work involves physical care of the elderly, assistance in fulfilling their mental and social needs and maintaining their quality of life.
In studies carried out in the United States and Israel, it was found that the nursing profession in Israel and the United States is characterized by low status, little income, poor employment conditions, lack of promotion opportunities and low job security.
What causes therapists to become frustrated and how can this be overcome?
All that was said above, causes people involved in this profession a lot of frustration and confusion. They come to work reluctantly and have nothing to make them want to continue working.
Institutions, which have learned to understand this, organize fun days for those therapists, rewarding them with bonuses for good work. It will also not hurt to pay a salary that is above the minimum wage. Also, organizations that will give more paid training to those caregivers, will cause more responsiveness on the part of the caregivers to participate in that training.
Another testimony that causes the phenomenon of abuse in nursing homes was given by Dr. Tova Band Winterstein, from the Gerontology Department at the University of Haifa.
In the research I have conducted over the past 16 years, I have witnessed the high risk of the elderly population for abusive and neglectful behavior.” According to her, this is a population that depends on the staff members and is subject to the procedures and routine of life at the institution. This dependence, combined with stereotypical age attitudes that see the elderly as a burden, transparent, and irrelevant, allow in certain situations the existence of abuse and neglect.” She says and adds that Many times the atmosphere and the demanding organizational climate cause a great burnout of the staff, a great deal of stress and therapeutic burden that can cause lack of compassion.
Who are the factors enforcing this problem and how?
Another problem related to the phenomenon of abuse in the nursing homes comes not only from the nursing homes and caregivers, but also from the police and supervisory authorities. The police encourage family members to file complaints on this issue, in many cases it is difficult to convict due to a lack of evidence. In addition to that, the physical condition of the nursing elderly does not allow them to testify, or they are afraid to testify due to their proximity and dependence on caregivers.
Therefore, many times even the professional workers who come to talk with them, do not always receive information on this subject from the elderly. In addition to reporting to the police, it is also possible to report to the regional welfare officer, especially when it comes to grayer cases, where it is not possible to collect clear evidence from the elderly or his environment regarding any suspicion of abuse. Even after reporting to the relief officials, the cases are not always handled optimally, this is due to the heavy burden on the relief officials and the social workers handling this issue.
According to the data of the Ministry of Welfare in Israel, each social worker dealing in this field handles hundreds of cases. One of the important mechanisms to deal with this phenomenon is through a relief official in the elder service. Due to the load, the treatment is lacking and there is insufficient monitoring of the cases of abuse reported to the welfare officer.
It should be noted that there is a procedure that the follow-up will be on the part of the abuse committee, which is obliged to take place once every three months by the members of the committee for the prevention of abuse, which consists of the multi-professional team of the institution. Of course, it is mandatory that a lawyer, a doctor and a nurse, the other professional employees participate, depending on the reported case.
What is the process of hiring caregivers for the nursing home?
In addition to this, there is a very problematic phenomenon in the recruitment of caregivers to nursing homes. Due to the lack of auxiliary staff, there is no regulated and professional selection process for accepting people who wish to work as caregivers in the nursing homes. As a result, anyone interested in being accepted to work as a therapist enters the job, without a thorough examination of their personality and experience. In addition, many therapists who were negligent in their duties in a certain institution, were fired and moved to work in another institution.
They were hired due to the lack of caregivers. It should be noted that if it is a large institution – with several departments – if the caregiver is suspected of certain negligence, he will not be fired immediately, the first few times, he will be transferred to another department in the same nursing home. This is in order to preserve it, because again the problem that repeats itself in this case too: there are not enough experienced therapists who want to work in a nursing home.
Supervision of the Ministry of Health or Welfare –
The roles of the Ministry of Health and Welfare-
The Ministries of Health and Welfare, their role is to issue procedures to the institutions under their supervision and supervise them in the various controls. There are private nursing homes that are not supervised by these ministries and the clients pay for them privately and there are nursing homes that are under the supervision of these ministries and most of the clients who come to them receive funding through them.
The Ministry of Health supervises institutions for nursing and debilitated people and the Ministry of Welfare supervises institutions for the independent and debilitated. If you are interested in getting to know the different functional conditions and the funding process for them, you are invited to enter the article on functional conditions in the third age.
Reporting Obligation-
When there is any suspicion of any negligence or abuse, it is mandatory to report to the Ministry of Health or Welfare depending on the nursing home where the elderly person is staying.
The Ministry of Health or Welfare, their role is to contact the responsible attorney and the abuse committee at the nursing home and find out about the case.
Also, to follow up on the case and how it is handled. To tell the truth, this follow-up is not always done, but the Ministry of Health does check in controls whether the members of the abuse committee, which is also their role, do follow up on the reported cases of abuse.
The review of the Ministry of Health-
In addition to this, there is an audit by the ABA Nursing Homes Association on the conduct of the Ministry of Health in the nursing homes:
The Ministry of Health is the one that pays for most nursing beds Says Roni Ozari, chairman of the ABA (Association of Nursing Homes and Sheltered Housing in Israel), which represents over 200 public (non-profit) and private nursing homes and shelters where about 25,000 residents live. “But in fact he pays 30% of the actual expenses of the nursing homes. He wants to save money at the expense of nursing homes.
A situation has arisen where those who are not good survive and exist. It should be understood that this is not substandard.
The standards are correct, but there is no manpower to fulfill them. I expect the Ministry of Health to lift the glove and do two things immediately: He will approve another 2,000 foreign workers out of the 5,000 required for the nursing industry as a start and then he will establish a forum led by an economist, which will determine the rate for the day of hospitalization, so that we will not reach what we have reached so far. That way the criminals also knew they had something to lose.
Background data from the Taub Center for the Study of Social Policy in Israel on the subject of nursing care indicate that the system for long-term geriatric hospitalization has approximately 21,000 beds in 333 geriatric institutions.
About 70% of the beds are occupied by hospitalized patients financed by the Ministry of Health according to law. The rest of the beds are financed by the hospitalized patients and their families privately.
About two-thirds of the nursing homes are privately owned and the rest are publicly owned, but they all operate according to the professional guidelines of the Ministry of Health and serve as the operational arm of the Ministry of Health, that is, It is the state that is obligated to give the elderly the good, adequate and proper nursing care in the last chapter of their lives. It is she who determines the mandatory therapeutic guidelines through the Geriatrics Division of the Ministry of Health, which dictates the guidelines and supervises their implementation, and she is the one who bears the brunt of the ongoing failure.
In conclusion-
According to the data of the Population and Immigration Authority, in many developed countries there is a very serious shortage of local personnel in the nursing sector.
This is mainly due to the rapid pace of the aging of the population and a change in the family structure, which resulted in a considerable reduction in the informal workforce.
According to an analysis of demographic, economic and social trends, this shortage will get worse in the coming decades. As a result, policy makers must intervene in market forces and look for creative solutions in order to stabilize the level of demand and supply of personnel in the nursing field. Also, it is very important that the police treat the reported cases more seriously and not close almost every case reported to them by the nursing home due to lack of evidence.
Standards must also be increased among public service workers in the field of aging: more relief clerks, because their role is important and decisive in locating and treating cases of abuse in nursing homes. Paid therapist training, more bonuses, fun days, discounts and fair treatment of the institution’s management towards the therapists. Strict selection of employees.
And in addition, changing the way social workers are paid in order to avoid a conflict of interest: The social workers working in nursing homes will receive their salary from the Ministry of Health and not from the managers of the nursing homes. That way, they would be less afraid to speak up for fear of being fired. But, for now it’s just a dream
When our loved ones age and gradually turn from people who need help to people who need help, many questions arise about their future. But, the question that concerns the elderly and their families the most is, what are the housing options for the elderly? What is the most optimal residential option for them.
Answers to these questions can vary from family to family. So before you go looking for a housing solution for the elderly, it is important to consider three things:
The person’s age and functional status?
Is everyone in the family, especially the elderly themselves, still debating about suitable housing or have they formed an opinion on the matter?
Have you discussed with your loved ones all the housing options available to them?
There is a variety of housing options for the elderly, depending of course on their functional and cognitive condition.
There are 8 housing solutions for the elderly:
The first option of housing for the elderly is – sheltered housing for independent seniors:
Designed for seniors who can manage their daily lives, and can take care of themselves. In this case, assisted living for independent seniors may be the best option for them.
People who fit this arrangement can do their chores without help and still enjoy morning walks. Assisted living is a great option for seniors looking for a single apartment designed especially for them.
In sheltered housing for independents, there is a separate apartment for each tenant who comes to live there. Also, every sheltered housing has a variety of services provided to the elderly who live there. Services such as: transportation, nurse, social worker, various classes, lectures.
Sheltered housing for the independent, as said, is suitable when both spouses are independent. But, what happens when one of the spouses dies or becomes ill? So the responsibility for the treatment passes to the children of the sick parent, when in many cases their responsibility for him, becomes a physical and emotional burden for them. The decision on which housing solution to choose should be for the benefit of the elderly only.
A second option of housing for the elderly – living with the elderly family:
Imagine the following scenario, your mother-in-law, moves in with your family. The change is inevitable and you made room for her in the apartment. However, after a few months, problems start to emerge. Tension and conflicts suddenly arise and the marital relationship between you and your partner begins to deteriorate.
You miss the feeling of privacy and calm that existed in your home before. To be honest, your mother-in-law is gradually getting older, maybe it’s time to consider a new housing option for her?
A third option of housing for the elderly – care by a nanny according to the Nursing Law:
As stated before, the possibility of living depends on the health of the elderly and their therapeutic needs. In the long run, the years take their toll and your mother-in-law’s health deteriorates and it is difficult for her to live alone.
Daily activities such as preparing meals as well as monitoring the swallowing of pills become more complex activities for her.
There is no fear, because there is a way to still maintain most of her independence, with only one small addition: the help of an external caregiver. An external caregiver can be obtained through a nursing company or can be obtained independently. Today, the National Insurance allows you to get paid hours to get the caregiver you are interested in, independent of a nursing company, this can have advantages and disadvantages. To get more information about this, read the article about the new nursing reform.
A caregiver who comes to the elderly’s home according to the nursing hours given to the elderly, provides him with the help he needs, she can help him with household chores such as: cleaning, cooking and laundry, shopping, escorting to tests and of course the daily activities that the elderly need help with.
An Israeli carer can help a maximum of 28 hours a week and a foreign worker lives with the elderly, when he is completely dependent on the help of others.
The elderly living in the community can also receive nursing hours for a day center if they are interested. These hours are included in the total number of nursing hours due to him. As part of the day center, the elderly receive lunch and various social activities such as: lectures, creative workshops, performances, etc. The centers, open 6-5 days a week from morning until noon, are operated through local associations for the elderly, under the supervision of the service for the elderly at the Ministry of Welfare.
Services at the day center include:
Transportation from home to the center and back, in a vehicle adapted to the function of the elderly, including escort and assistance in getting on and off the vehicle.
Breakfast and lunch under the supervision of a nutritionist.
Bathing, shaving assistance, manicure, pedicure and laundry service (for an additional fee)
Social and occupational activity – classes, lectures, employment and crafts, movies, games, trips and parties as well as unique programs (computers, gardening, pets)
Physiotherapy, occupational therapy, physical activity, nurse examination, preventive care, social care and geriatric counseling for the elderly and their families
Activity to promote a healthy lifestyle (such as workshops on nutrition).
A fourth option of housing for the elderly – nursing homes:
A nursing home offers a form of housing that provides comprehensive care and service for all areas of life, according to the functional status of the elderly.
Each nursing home has a medical team, a medical and nursing assistant, a social worker and an administrative team whose job it is to take care of the elderly’s quality of life in the best possible way.
There are four departments that correspond to the four functional states: the self-employed department, the debilitated department, the nursing department and the debilitated department. The way the wards are combined, the style of the place and the cost vary between nursing homes and places can be found according to the financial capacity of the resident and his family members.
Departments for independents-
This housing solution is suitable for independent people, who need a framework that provides security and company.
Wards for frail people-
A framework that provides people who need a little help in their daily activities. To understand this functional condition, go and read the article on functional conditions in the third age.
Departments for the independent and frail
which are under the supervision of the Ministry of Welfare, it is possible to receive funding from the Ministry of Welfare for them. You must go to the social worker at the welfare office in order to receive this funding.
Wards for nursing and mentally ill elderly –
They are supervised by the Ministry of Health and you can get a code from the Ministry of Health, in order to receive funding for them. You must go to the nearest health office to your area of residence and receive advice and guidance on the process. Nursing people need help with most or all of the daily functions and the mentally ill are the elderly who have dementia or have had a stroke and their cognitive functions have been impaired.
Besides the medical services, the residents of the nursing home enjoy many social activities and circles. There are nursing homes that make sure to integrate the residents into the general community, through joint classes, voluntary activities and more.
A fifth option of housing for the elderly – vacation house:
A nursing home is an institutional setting for senior citizens who need care and supervision after discharge from a hospital and for those who cannot live in their own home for family or other reasons. The vacation stay is for a short period and includes accommodation, meals, personal care, health services, social service and social activity.
There are designated holiday homes for nursing senior citizens and ultra-Orthodox senior citizens.
To locate vacation homes for senior citizens according to different localities throughout the country, see the service database of Joint Israel-Eshel (you must select the type of service – “Vacation, RESPITE”).
Those who have reached retirement age, are self-employed, are defined as exhausted and answer one of the following:
He is after being hospitalized and needs help with day-to-day activities in a protected setting.
His family, or the person taking care of him needs a break.
Temporarily left homeless due to an emergency (such as a fire or flood).
Suffers from abuse and needs short-term protection, until a treatment plan is built for him.
The process of exercising the right: the senior citizen or his family members will apply to take him on vacation to the social services department next to their area of residence – to locate the nearest department.
The attending attorney will determine the eligibility, fill out a “Decision on Placement” form and have the applicants sign an undertaking that the arrangement is temporary and at the end of it the senior citizen will return to live in the community. It should be noted that the vacation is for a period of 15 days. It is necessary that it be approved on- by the Department of Social Services. In special cases, a vacation between 16 and 60 days will be approved by the district supervisor of the senior citizen service. In addition, in cases where the senior citizen cannot be returned to his home, and until an alternative framework is found for him, a vacation between 31 and – 36 days subject to the approval of the senior citizen service manager or his deputy. It should be noted that the senior citizen will be directed to vacation in a framework appropriate to his function and in accordance with his choice.
Sixth housing option – hostels – public sheltered housing –
The Ministry of Construction and Housing manages about 120 housing homes for the elderly, which include approximately 12,000 one-and-a-half or two-room apartments (to locate the housing homes for the elderly on the website of the Ministry of Construction and Housing). 50% of the vacated apartments are intended for immigrants and 50% for veterans and tenants moving from public housing. It should be noted that the housing estates are mostly operated by government companies and partly by private companies.
In addition, the staff of the housing houses includes a house mother, a maintenance person, a social worker, a social coordinator and a caregiver for the elderly. The tenants participate in various social activities, such as: clubs, classes, classes and trips. Also, living in the Golden Age House involves paying a rent that ranges from 8%-10% of the national insurance allowance or any other income of the tenant, apart from the allowance (rent) paid by the German government.
Who is eligible?
Individuals or couples who meet all of the following conditions: are homeless or tenants in a public housing apartment moving out of their apartment. Have reached retirement age and are eligible for an old-age pension upon supplementing income. Independent in their function (not nursing).
In accordance with a temporary order valid until the end of December 2019, the age of eligibility to enter a senior citizen home has been brought forward for those who are eligible for rent assistance: in the homes that appear on this list that have few eligible people waiting to enter them, the minimum entry age has been lowered to 60. In the homes that appear on this list that have no eligible people waiting to enter For them, the minimum entry age was lowered to 55.
An application must be submitted for a housing unit in the Golden Age House:
The tenants of the public housing will submit the request to the branch of the housing company that takes care of their apartment.
Homeless people will submit the application through one of the companies that provide services to rent assistance applicants.
The application must be accompanied by a valid confirmation from the National Insurance Institute of entitlement to an old-age pension upon supplementing income.
After submitting the application, you must go through an adjustment committee:
First, the functional status of the applicant will be examined by a doctor, to make sure that he is not nursing.
If the applicant is found to be independent in his function, he will undergo an admissions interview and suitability check by the admissions committee of the Golden Age House to which he wishes to transfer.
Those whose eligibility has been confirmed may wait until a place becomes available for them in the Golden Age home, a period ranging from several weeks to several years (depending on the locality where the home is located). During the waiting period, it is possible to receive rent assistance.
Seventh housing option – rehabilitation as part of hospitalization for a rehabilitation patient –
Rehabilitation is a therapeutic step in an ongoing healing process, the goal of which is to improve the specific motor and cognitive functions that have been impaired due to illness or injury. Also, increasing the patient’s personal independence so that he can return to leading an active and healthy lifestyle. It should be noted that the responsibility for providing rehabilitation is anchored in the State Health Insurance Law and applies to the health insurance fund that insures the patient according to the second addendum to the law.
The health insurance funds are obliged to inform each patient and his family about his rights to exploit the rehabilitation potential, while referring to the appropriate parties, as well as bring to their attention the existence of assisting parties. The rehabilitation process can be done intensively in a hospital setting or in the community.
A rehabilitation patient who meets the criteria for inpatient rehabilitation will be hospitalized for a period of up to three months. Hospitalization for a longer period is possible, with the approval of a professional committee of the HMO.
Who is eligible?
The criteria set by the Ministry of Health for inpatient rehabilitation for a rehabilitation patient
The family, social and environmental conditions do not allow treatment at home or in the community.
The patient’s medical condition requires long-term medical supervision and nursing care.
The patient suffers from motor, cognitive, emotional, verbal and behavioral impairments, the treatment of which requires professional knowledge available in dedicated rehabilitation settings.
Adequate rehabilitation cannot be given in the community.
Any disabled person (who cannot walk or stand for a certain period of time) will be referred to an inpatient rehabilitation setting, unless he has given his consent to treatment in the community. There is a possibility of that.
Patients after a stroke or patients suffering from other neurological problems will only be referred for rehabilitation if their functional status, as seen in a functional test, has significantly worsened.
The process of exercising the right
The referral to rehabilitation is made in the hospital prior to discharge.
When making a decision regarding the appropriate rehabilitation framework, the patient and his family must be shared and their preferences taken into account.
The decision on providing rehabilitation and its goals will be made by a geriatric specialist or by a rehabilitation specialist from the hospital, and in consultation with the representative of the hospital’s multi-professional team.
The decision regarding the rehabilitation treatment will be given to the health insurance fund, the patient and his family, at least two working days before discharge from the department.
The HMO representative will examine the hospital’s recommendation and provide a quick response (within two working days). A deviation from the hospital’s recommendation requires a detailed and documented reasoning, detailing the alternatives offered to the patient.
A person who lives far from his family and children, can request to move to a rehabilitation department close to their area of residence.
Refusal of the HMO to approve the hospitalization
When the professional body at the hospital has decided that a patient needs continued rehabilitation treatment in hospitalization, and the HMO refuses to accept this recommendation and does not approve the continuation of hospitalization, one must act in one of the following ways:
Apply for a rehabilitative assessment within the inpatient rehabilitative framework.
Seek another opinion from a specialist in geriatrics or rehabilitation, accepted and agreed upon by the health fund.
Any disagreement must be detailed and reasoned.
Important Information-
A pressure sore or tube feeding is not a reason to prevent receiving rehabilitation treatment.
Every decision made regarding the rehabilitation treatment will be reasoned and documented.
Eighth housing option – old people’s homes with complex nursing wards –
Elderly people who are in a complex nursing situation are arranged in complex nursing institutions through the health insurance funds. To learn what the criteria are for a complex nursing patient, go to the article – Functional conditions in the third age.
Institutional arrangement for a patient hospitalized in hospital :
When an elderly person defined as a compound nursing patient is admitted to a hospital and wishes to go to a nursing home, he must contact a social worker in the department where he is hospitalized. The social worker will contact the liaison nurse of the health insurance fund where the old man is a member, and she will ask the geriatrician for permission to arrange for the old man. The geriatrician’s answer at the HMO will be given to the hospital. Upon receipt of the approval, the social worker will inform the elderly in which nursing home he can be admitted, according to the instructions of the health insurance fund. After the payment is settled, the HMO will issue a bond and the elderly person will be able to move to the nursing home.
Institutional arrangement for the patient at home-
An elderly person who is at home and wishes to move to a nursing home, should contact his family doctor. If the doctor defines him as a complex nursing patient, he will forward the request to the geriatrician in charge of arrangements in complex nursing wards. Upon receipt of the doctor’s or someone else’s approval, the elderly will be told in which nursing homes he can be hospitalized, according to the instructions of the health insurance fund. After the payment is settled, the HMO will issue a bond and the elderly person will be able to move to the nursing home.
Payment to the nursing home-
The co-payment for an elderly person in a complex nursing ward is about NIS 116 per day (the co-payment rates are updated from time to time and vary according to the health fund and the type of health insurance of the elderly person).
An elderly person living on an old-age pension (senior citizen’s pension) in addition to supplementing income only, will pay 80% of his income for his arrangement in the nursing home.
Filing an Appeal-
If in the opinion of the elderly he cannot pay the deductible, he must fill out an appeal form.
The form must be accompanied by documents showing his income, his spouse’s income and his children’s income.
The forms must be submitted at the mother clinic of the health fund where he is insured.
If the elderly person is not satisfied with the appeal committee’s decision, he can file an appeal with the member’s rights department of the health fund where he is insured.
In conclusion-
All 8 housing options depend of course on his functional and cognitive condition. Also, how involved the elderly is in the decision, his thoughts, feelings and health.
Finding suitable housing for a person who raised us or we know him since he was young and energetic, is definitely not an easy task mentally.
Make sure that you do listen to the opinions of your loved one and yourself, before you make your final decision.
The elderly person needs love, care and respect in his advanced age. as you have received from him throughout your life. Therefore, make sure when you come to inspect potential housing that there is indeed an appropriate and respectful attitude towards the tenants. Pay attention to the personnel situation in the departments and check their standards in the government ministries, health and welfare. Check the inspection scores the nursing homes received either in satisfaction surveys on the Ministry of Health website or on the Gold Factor website.
If you would like to consult with me about suitable housing for your loved one, you are invited to contact me through the website or by email at irit@happyseniors.care or by mobile – 054-7758564 and I will gladly advise, free of charge.
Likewise, I can also help with the relevant housing entrance status both mentally and in terms of the bureaucratic processes for obtaining financing.
Alzheimer’s – one of the most common diseases in the world, and still incurable. Despite the emergence of new technologies in a wide range of medical fields; We are far from finding the solution that can detect Alzheimer’s in the pre-clinical stage or get rid of the disease. But, there is a wide variety of technological innovations in the treatment of Alzheimer’s;
Innovations that help patients and make their lives easier. This time we will talk about the most useful innovations that can help your loved ones live a better life.
1. Photo phone – one of the simplest, but most exciting innovations in Alzheimer’s treatment.
Alzheimer’s patients face memory loss that increases over time; Phone numbers are among the first things that become confusing for them. A photo phone, like the one in the Alzheimer’s store can be very helpful in these situations.
This useful technology is like the smartphone version of Alzheimer’s patients. Many of the models include the option to save a large number of dialing numbers for emergency services and the numbers of loved ones.
In the case of the phone the memory photos; The numbers have been replaced by large buttons where you can save small pictures of the nearest contacts. The patient can easily make a phone call to the desired number with one click on the picture of the person with whom they want to communicate.
2. Devices for detecting wandering
Alzheimer’s patients develop a tendency to wander in public places; There is a danger that they will get lost if they are not looked after properly.
Devices like Jiobit can be a real help when you need to locate your loved ones; To the extent that they forget their surroundings and get lost. Jiobit is a secure clip device with Bluetooth, GPS and WIFI connection that allows you to keep your loved one at home and outside the home.
This device also allows you to set a geographic limit (GEOFENCE) around a certain location so that you will receive an alert if the wearer of the device crosses this area. Jiobit also remembers the patient’s movement patterns and alerts when there is a change in them.
3. The Alzheimer Master – one of the social innovations for the treatment of Alzheimer’s.
Alzheimer’s Master is actually an application with the help of which you can record the voice of a familiar and loved person.
By recording your voice you can create a reminder to take medicine, drink water, eat, etc. You can also use these recordings as an alarm clock, so you will prevent your loved ones from a lot of anxiety that can be caused by a normal alarm sound. Hearing the voice of a familiar person can be much more soothing than the sound of an alarm.
Furthermore, the application can record the user’s responses so that you can understand how he is doing by examining the data. Alzheimer’s Master is available for all Android devices at a cost of $10 for full use. You can also download for a free trial period.
4. Amazon’s Alexa (voice activated assistant)
Alzheimer’s patients may reach a point where they feel like a burden on their caregiver or family. Sometimes even simple things like today’s date or time can be regularly forgotten. Dealing with this forgetfulness can create a stressful situation for both the patient and the caregiver.
A voice-activated assistant like Amazon’s Alexa can be very helpful in this regard. A voice-activated assistant can be used for alerts and reminders, playing music, telling jokes and just having an interactive conversation with the patient.
These devices can answer questions non-stop and the questions can be repeated as many times as the patient wants. These advanced technologies can help Alzheimer’s patients feel less alone, and experience more control over their condition.
They can also be used to control things like the temperature in the room and the intensity of the light according to the needs of the patient.
5. Silver Mother (The Silver Mother) – an innovative home sensor for treating Alzheimer’s.
when one of the family members is diagnosed with Alzheimer’s disease; These are the loved ones who find themselves on the standard of caregivers. They soon discover that caring for an Alzheimer’s patient is a full-time job.
You have to monitor the patient’s activity, keep them busy, take care of their safety, make sure they have taken their medication, help them with their daily chores and many other things besides these. The therapist can’t always keep track of everything; This is exactly the point where Silver Mother comes into action.
This device includes several sensors that can help monitor sleep patterns, medication alerts, activities, etc. of the Alzheimer’s patient. The sensors are small and simple and can be used to recognize the patient’s normal behavior patterns, and to receive an alert when there is abnormal activity.
All the sensors are connected to each other through a mother hub connected to the router.
6. Calendar apps
These apps are intended for caregivers; Apps like Google Calendar can be used to keep track of all the tasks the caregiver needs to complete.
The calendar can create automatic reminders for monitoring one’s medication intake; important visits and doctor appointments; And many things besides. Caregivers can also collaborate using the calendar and share tasks with each other; This way, several people can keep track of the appointments and reminders.
7. Improving the quality of life – Spark Memories Radio
– Music has been proven to calm and relieve anxiety and to help improve the mood of people suffering from Alzheimer’s and dementia.
Spark Memory Radio is actually an application that includes a collection of thousands of old songs. Tunes that take us back to the thirties and allow caregivers to schedule a playlist for their loved ones at the push of a button. The app is available for Android and Apple devices and costs $9.99 per month.
We probably have a long time to wait until the day when we wake up to hear about the first cured Alzheimer’s patient. But despite this, with the help of the appropriate technological innovations, we have the ability to make patients’ lives happier, less stressful and as comfortable as possible.
One of the most disturbing symptoms of dementia is: the person suffering from dementia repeats the same questions over and over. I will present you 6 ways that will help you maintain your peace in your communication with the patient. In addition, dementia patients will be helped to regulate stress and anxiety.
Why do dementia patients ask repetitive questions?
Most often, the dementia patient repeats the same questions, for two main reasons: a. He just forgot what he asked before. B. He feels anxiety, insecurity and tension which make him ask the same questions to calm the anxiety he is in.
For example: the day before Mom’s doctor’s appointment, Mom asked several times – whose appointment is and when is the appointment? On the day of the appointment itself, she asked the same repeated questions every 20 minutes. Also, a few hours before the actual appointment, she asked every 5 minutes, the same questions over and over again. This is because she became more nervous as the doctor’s appointment approached.
6 tips on how to deal with a dementia patient who repeats the same questions?
1. Live their current reality-
A very common and completely natural mistake is to correct the dementia patient. Also, to remind him that the reality that he forms as correct, is actually not correct.
Below is an example case: Shoshana (pseudonym), lived with her family in Haifa, in 2012, when her room was in the attic. Today, in 2019, her family moved to Nahariya, in an apartment without an attic. Shoshana, now with advanced dementia and asks repeated questions every day about the time when she still lived with her family in an apartment with an attic in Haifa, in 2012.
For example, questions like: “When will Bugs the dog come downstairs to my room?” or “When will you fix the banister on the stairs to my room?”
In the above case, Shoshana got stuck on certain significant events from her past, which causes her to remember them over and over again and therefore she repeats and asks about the same events over and over again.
The response that can be more helpful is to participate in her experience, for example: when she asks questions of the above type, you should respond as if we were still living in 2012 in an apartment with an attic in Haifa.
For example: “The dog is currently on a walk outside with one of the children.” Or one of the children will bring the dog to the attic, to keep you company.”
There can be situations in which the person with dementia will recognize where he is and what year he is living in, and there will be situations where he will not.
Below are interesting books on the subject of dementia:
2. Use white “lies”-
It is recommended to use them, especially in cases where the dementia patients wish to perform tasks that may endanger their lives. For example – let’s take the same lady Shoshana, if she insists on driving a car, because she is sure that she drives well. It is absolutely permissible, in order not to hurt her feelings, to tell her that the vehicle is now in the garage and cannot be used. It is better to give space to their feelings, than to try to explain things to them that they will not understand or remember anyway.
Another reason why you should use a white lie is to prevent them from pain or grief. For example: explaining to Shoshana that her sister has passed away may cause her pain and sadness, which the family members taking care of her will have to deal with. Instead, it’s better to tell her that her sister is out shopping now. Which will cause Shoshana, most likely about 20 minutes later, to forget that this fact has already been told to her and she will ask the same question again.
Using white lies, for the demented person, is a better way than telling him the truth that could hurt him and make him in a bad mood. Especially, when there is a reasonable chance that that person will forget the truth that was told to them about 20 minutes later.
You are invited to join our WhatsApp group – on old age diseases:
3. Distract them-
Dementia patients sometimes have a question stuck in their head and they can’t find ways to get rid of it. The way of action that helps them in these situations is to distract them with an action or a task that needs to be done. For example, let’s take Shoshana’s family, if Shoshana asks the same question over and over again, it is very useful to distract her with a sentence like: “Let’s make the sandwich together”. Or “come fold the clothes with me now” etc.
4. Prepare a white memory board for them –
It is very advisable to prepare a small white board for them, on which they will have a list of what tasks they need to perform during the day. When the tasks are written on the board, the demented person does not need to ask the same questions over and over again, because everything is written in front of his eyes. Even if he asks the same question again, just show him the white board with his tasks for the day and it can calm him down for the next few minutes.
The onset of dementia is not the same in all patients, nevertheless, doctors have managed to divide the typical course of the disease into seven main stages. The duration of the disease ranges from 3-20 years, with the average period of time being 4-6 years from the diagnosis of Alzheimer’s (dementia)Alzheimer’s (dementia) until the patient’s death.
In the first stages, it is very difficult to notice the existence of dementia. After that, the patient begins to forget small things, such as people’s names, the location of objects that have always been placed in a fixed place. After that, he forgets what he wants to say. Reads a story chapter and forgets that he read the chapter at all. Later, he forgets what he ate for breakfast. Begins to lose interest in hobbies that he used to engage in enthusiastically. Also, also loses interest in the environment in general. Does not recognize people in his immediate vicinity and from here the situation only gets worse.
In this article, the 7 stages of dementia will be detailed for you, so that you can identify which stage of the disease your family member/patient is in. This is in order to make a diagnosis and start treatment on time and also to know how to prepare for each stage.
Sad dementia patient.
Stage 1 of dementia – before the disease –
At this stage, there are no noticeable symptoms of the disease. The patient looks and sounds perfectly healthy. The disease cannot yet be diagnosed at this stage. After that, small symptoms, begin to give their signals. However, these symptoms still seem relatively normal and cannot be associated with dementia.
Also, some symptoms may develop gradually and go undetected for a long time.
Stage 2 – mild forgetfulness that is still associated with age and not dementia.
A slight forgetfulness begins, which does not yet cause the environment to suspect that it is dementia. The patient forgets things such as: forgetting where objects are, locking the door. At this point, it is still difficult for a geriatrician to diagnose dementia.
Stage 3 – mild cognitive impairment that begins to hint at dementia.
The environment begins to notice that a mild cognitive disorder begins, the cases of forgetfulness become more frequent. For example: forgetting where the keys are, finding them and after a few minutes forgetting where they are again. Placing objects in inappropriate places. For example, putting a garment in the kitchen cupboard. The patient tends to forget names, fails to learn new names, has difficulty functioning in society or at work, has difficulty reading and generally has difficulty organizing and planning in advance. This stage lasts between two and seven years.
Stage 4 of the dementia disease – stage of moderate dementia –
A stage where the patient begins to lose orientation in time and space. This is the stage where the geriatrician must give a diagnosis, because the symptoms start to become clear to the environment. Examples of this stage: forgetting what the patient saw and heard on the news. Forgetting what he ate for breakfast that day. Inability to concentrate on one thing for a long time. Losing interest in activities that the patient previously liked to do.
Damage to the ability to think abstractly in complex tasks, damage to the ability to plan activities or perform complex cognitive operations (such as managing a bank account). Also, difficulty remembering personal events from the past, and physical weakness.
Stage 5 of dementia – noticeable cognitive decline that requires getting help.
At this stage the patient suffers from a noticeable cognitive decline, which requires getting help. For example: forget what the address is. Forgetting exactly where the patient is and whether it is morning, noon or evening.
The patient is confused, his ability to perform complex actions deteriorates. In addition, his ability to decide and adapt his behaviour to social norms and rules is impaired.
Nearly 50 million people were diagnosed with dementia in 2017, worldwide. Most of them live in developing countries. The number is expected to double in 20 years.
Stage 6 of dementia – severe cognitive decline.
This is a stage where it is already very difficult for the patient’s family to take care of the sick person alone and in need of help. The signs are: forgetting the identity of his relatives and the people closest to him. Completely forget how to perform daily activities.
At this stage, the patient has difficulty sleeping, begins to lose control over the sphincters, becomes more suspicious, suffers from false thoughts, hallucinations and compulsive behaviors. Also, at this stage, many of the patients tend to go wandering, when they very quickly forget the purpose of going out and may get lost and endanger themselves.
Stage 7 of dementia – most severe cognitive decline –
The patient at this stage loses his ability to communicate and speak. He needs daily help with very simple tasks. He needs help with everything because his muscles and reflexes become inflexible – he cannot get to the bathroom in time, has difficulty walking, sitting and even holding his head and swallowing. This condition usually lasts a few months, but sometimes also long years of inability to function and the need for constant nursing.
In conclusion-
There is an estimate that 75 million people may suffer from dementia by 2030 and 131.5 million in 2050. In any case, only 20-50% of cases in developed countries are identified in statistics. In developing countries the situation is much worse, with the majority of the population remaining undiagnosed during their lifetime. Spreading awareness of the disease and its various stages can significantly reduce the pain and costs required to treat the disease. It’s all up to you, share the important information in the article and spread awareness of the disease today!
