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!
Following on from the article on guardianship, should you be appointed and what are the roles of the guardian over body and property? Below is information on what needs to be done to start the guardianship process.
In order to be appointed as a guardian for a body and/or property in Israel, the following procedures are required:
A conversation to coordinate expectations before the start of the guardianship process-
1.A meeting should be held as early as possible with the person for whom you intend to be appointed guardians. As much as possible, talk to him in a language he understands, and according to his ability to understand. Explain to him what your role as guardians is, try to understand what his needs and desires are, and “coordinate expectations” regarding the period of guardianship. This conversation is very important, even if you are the person’s relatives. During the conversation, you may discover that your loved one has desires and needs that you were not aware of. If you are unable to find out with the person what his needs and desires are, find out what his wishes are as expressed in the past, taking into account his worldview and lifestyle. An application for the appointment of a guardian for a person, as well as an application for a replacement of a guardian, must be submitted to the family court in the jurisdiction where the person who needs the appointment resides (among the Muslim population – The application can also be submitted to the Sharia Court.
Filling out forms for the Family Court –
Attached is a link to the website of the judicial authority, where you can find forms and an explanation for submitting an application for the appointment of a guardian for the body (=personal and medical matters), for property or for a general appointment (for the body and property) as well as, an application for the appointment of a guardian for urgent medical intervention. These forms must be printed, filled out, signed by the family members who agree to the appointment or alternatively, the family members who oppose the appointment must be registered. Information recorded in these forms must be signed by the person who wishes to be appointed as a guardian in front of a lawyer. A lawyer’s signature can be done at any court for only NIS 50-60. You must bring IDs with you for the purpose of verifying the signature. The information recorded in the forms can be of great help to the welfare officer who is later supposed to write a report to the court and submit it with her recommendation as to who can act as guardian for the person who needs a guardian.
Contacting a geriatrician to perform a diagnosis…
A geriatrician or psychogeriatrician should be contacted in order to write a medical certificate – the doctor should provide a geriatric diagnosis, which will determine what the cognitive level of the elderly person is and whether he is incapable of making decisions in terms of his level of judgment. He was also given a mental test by an occupational clinic. If the elderly person lives in institutional housing, a geriatrician should definitely be consulted at the institution where the elderly person lives, as above regarding the occupational clinic. If the elderly lives at home, it is necessary to contact a geriatrician at the health fund or privately. If the elderly is hospitalized, a geriatrician and an occupational clinic at the hospital where the elderly is hospitalized should be contacted, for the purpose of the cognitive diagnosis. When the doctor’s certificate is written, it is necessary to submit it together with the application forms for the appointment of guardians at the family court in your area of residence.
Application to the court to start the guardianship process –
Applying to the Family Court and paying a court fee to open a case. A person interested in being appointed as a guardian must pay a court fee to open a guardianship case, the fee is usually between NIS 400 and 600. In addition, it is necessary to have a lawyer sign the affidavit from the guardianship case opening forms In court. The candidate for guardianship should submit all the required documents to the court and wait for the process to be carried out.
During the process, the welfare official should come to the elderly’s home and interview him, as well as interview the candidate for guardianship of the elderly. In fact, it collects information about the elderly and his environment and submits a review with a recommendation as to who is the most suitable person/organization to act as guardian of the elderly’s body and/or property.
The court’s decision – after all the documents required for the process are submitted to the court, a hearing will be held in court, usually it is behind closed doors and the candidate interested in being appointed as a guardian is not invited to the hearing. About the elderly, for how long and for what matters – body and property, or one of them. There can be up to 2 guardians for one person.
How do you appoint a guardian for an unmarried person (a person without children)?
The process on an unmarried person is carried out according to the following circumstances:
Where to start the guardianship process if the person lives at home?
If the person for whom a guardian is appointed lives in his home in the community, then a person from his immediate environment who wishes to be appointed as his guardian, should start the guardianship process through the social services bureau closest to the area of residence of the adulterous person for whom a guardian is appointed.
Where to start the process if the person is hospitalized?
If the adulterous person is hospitalized in a hospital, contact the hospital’s ward clerk, in order for her to submit a social report to the relief officer from the Bureau of Social Services in the residential area where the adulterant person lives. The report explains about the psychosocial condition of the arbitrator and a recommendation for the appointment of a guardian for him.
Where to start the process if the person is hospitalized in a geriatric/rehabilitation institution?
If the adulterous person is hospitalized in a geriatric/rehabilitation institution, he must contact the social worker who takes care of him in the institution. The social worker who takes care of him must submit a social report to a welfare officer from the Bureau of Social Services in the residential area where the person lives.
In the event that person needs funding from the Ministry of Health/Welfare at the institution. She must submit a copy of the report to the sponsoring office, so that when the petitioning candidate receives the guardianship appointment, his guardian will submit the guardianship order to the sponsoring office, and the sponsoring office will be able to begin financing the petitioner’s stay at the institution.
If there is no person who is interested or able to be appointed as a permanent guardian of the body and/or property for that minor person, the attorney or the relief official, will appoint an association for guardian services, the most prominent of which are: ‘The Foundation for the Care of the Confidential’, ‘Gag Lahusa’ and more. Associations It is their job to take care of all his needs and visit often.
Article: Irit Rabinowitz, attorney with a master’s degree in health and rehabilitation, interested in advice and guidance on appointing a guardian? Contact me – 0547758564.
Let’s start with an example from the field: on the subject of a guardian and his duties –
A client, who is not sure if it is worth starting a guardianship process for a mother suffering from moderate dementia, came to consult a social worker. The client told her that her mother is still able to recognize people but sometimes forgets what day it is. Also, her mother began to suffer from delusions as well. The client was sure that her mother was still sane and able to make decisions for herself. Despite the fact that it was explained to her that the disease is progressing quickly and may later impair her mother’s judgment. The daughter nevertheless refused to start the guardianship process.
One day, the mother fell and needed surgery on her broken leg, at the same time, the daughter discovered that her mother was in a much worse cognitive state than she thought. The doctors were not ready to perform an operation without the consent of the mother, since the doctors noticed that the elderly woman was not capable of this, it was decided to perform a mental test for her. The mother got a low score on the test. As a result, the hospital’s attorney-in-fact made temporary guardianship of the mother’s body only.
The process took several days until a guardianship order was received by the attorney general and during this time until the surgery, the mother suffered severe pain in her leg. The mother had to take painkillers to deal with the pain. Such a case could have been avoided if the daughter had started the guardianship process before the fall.
Why even start a guardianship process?
As people age, many of them suffer from dementia. As the dementia process worsens, the person suffering from the disease needs more help during the day. Elderly people with dementia are at physical and financial risk as a result of their vulnerability to physical, emotional, financial abuse and decisions without judgment.
These patients need more protection. For example, an elderly person who refuses to let a foreign caregiver enter his home, or refuses to enter a nursing home, may endanger himself and his surroundings, if the same elderly person has had a stroke, can no longer communicate and needs help 24 hours a day, he can no longer satisfy his opinion on the matter The help he gets. These are the reasons why he needs guardianship.
What exactly is guardianship?
A guardian is a person chosen to make personal decisions for another person. The other person is unable to make important decisions for himself such as: where will he live and what treatment will he receive? An elderly person can have more than one person as a guardian for him. It may be that he will receive a guardian for his body and property separately. There may also be a situation where there will be more than one guardian who is responsible for body and property together and each one separately. It means that if one is not available to come and sign consent for the surgery, the other will come in his place and vice versa.
Are you suitable to be a guardian?
If you take on the role of guardian, you must once every six months, update the general guardian on behalf of the court about the material condition of the elderly. You need to make sure with yourself if you really understand the role you want to take on before you become a legal guardian for the elderly.
If becoming a guardian for an elderly person is too heavy a responsibility for you, there are other alternatives that you can think of such as:
power of attorney in the bank.
Preliminary instructions.
decision supporter.
Lasting medical power of attorney.
*Details of which will be written later, it should be noted that the above options can be done as long as the elderly person still has sound judgment, that is, there can be a cognitive decline, but the judgment is still considered sound. In order to check the mental state, you must consult a geriatrician or psychogeriatrician.
In the case of an emergency, for example, of an urgent operation, if the elderly is unable to make a decision, his judgment is not correct, there is a possibility to make a temporary guardian for him for the required medical operation. The validity of the aforementioned temporary guardianship expires, when the aforementioned medical procedure ends.
The decision whether to perform guardianship over the elderly dear to you?
The family court needs proof that the elderly is indeed not legally competent to make decisions. It is necessary to prove that that elderly person is unable to make basic decisions for himself such as: where to live, unable to provide himself with food, clothing, take care of himself physically or make financial decisions for himself.
In what cases will it not be possible to be appointed as a guardian for the elderly?
Lack of experience in financial matters mainly.
Conflicts and interests.
low education.
minor.
Lack of legal capacity of the person who wants to be a guardian.
Advanced age (over 75).
The guardian has a number of obligations including:
Body guardianship versus property guardianship – are you interested in performing a body or property guardianship or perhaps even both?
When you ask to be appointed as a guardian for body and property, you are actually asking to be responsible in all respects for the elderly. Being a guardian of property means that you have to take care of that person’s property and assets in a way that best serves their interests.
“The court decides who to appoint as a guardian, while maximally protecting the interests of the person to whom a guardian is appointed, when several guardians can be appointed for the same person.” Taken from Reut – a caring family.
Evaluate confidential records and present them when necessary.
agree or disagree with certain medical treatments.
Agree or disagree with travel plans that the confidential, is interested in taking.
Choose a suitable place of residence for the confidential.
To provide personal needs and clothing needs.
Ensure that a doctor sees the insured once a year and provides a letter describing the insured’s health status.
to make sure that the confidential receives a response to his personal needs.
To take care of the rights of the confidential.
9. Forms that must be filled out for the purpose of follow-up by the general guardian-
Within 60 days from the date of appointment, a report must be submitted to the general guardian detailing the person’s assets and liabilities, known as a “statement”. The statement will detail all of the person’s assets, rights, and obligations. The information included in the statement must be updated and correct as of the day of appointment. The statement will be prepared on the attached form and must be Be verified by an affidavit. The affidavit can be verified before any lawyer. In any court this service is provided with a symbolic title.
A “living basket” form is also attached to these instructions. This form is intended for determining the person’s monthly spending budget and must be submitted for the supervisor’s approval. Determining a living basket will help you in budget planning and may make dealing with the bank easier. In the “living basket” form, you must fill in current monthly income and expenses that characterize one normal month, and submit it, as much as possible, within 90 days of the appointment.
For information on the execution of the guardianship process, see an article explaining the guardianship process in Israel.
Written by: Irit Rabinowitz, attorney M.A in social work, in the field of health and rehabilitation.
