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Affiliated with the Rhode Island AFL-CIO “Fighting for the future of our members.” “NOW, more than ever!!!” Publication 2018 Issue 11 Published in house by the RI ARA

March 18, 2018 E-Newsletter

All Rights Reserved RI ARA 2018©

New Medicare Rights Analysis: What the Recent Budget Deal Means for People with Medicare Congress recently passed and the President signed a sweeping spending bill that funds the government through March 23 and paves the way for a longerterm spending agreement. The legislation—the Bipartisan Budget Act of 2018 (P.L. 115123, BBA of 2018)—also contains a number of health care provisions important to people with Medicare and their families. The Medicare Rights Center has analyzed the bill, with a focus on changes to Medicare and other programs serving older adults and people with disabilities that we support, those we oppose, and those we will be monitoring closely. Please click here for our full analysis, or go here for a one-page summary. Among the provisions we support are the repeal of the Medicare Part B therapy caps, the accelerated closure of the

Medicare Part D ‘donut hole,’ and the move to make Medicare coverage of speech generating devices permanent. These are significant policy shifts that will immediately improve the lives of people with Medicare, their families, and caregivers. While we were pleased to see these and other important advances included in the budget deal, we do have concerns with other aspects of the legislation. In particular, to help pay for its funding and policy changes, the BBA of 2018 includes a number of offsetting provisions. Troublingly, one such pay-for is an increase in the Medicare Part B and D premiums some beneficiaries (individuals with annual incomes over $500,000 or $750,000 for couples) will have to pay beginning in 2019. We strongly oppose this increase, which further means tests the program and undermines the Medicare guarantee. Read more from Medicare Rights about this

provision. In addition, several of the Medicare Rights Center’s priorities were not included in the bill, namely the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act (S. 1909; H.R. 2575), and a five year extension (S.2227) of the Money Follows the Person (MFP) program. We urge lawmakers to address these priorities in the final FY18 spending deal expected later this month. Next Steps As previewed above and outlined in our full analysis, the budget deal makes an array of complex changes to federal health care programs. And as with any new piece of major legislation, it is not yet clear how the bill’s revisions will interact. Accordingly, the Medicare Rights Center will stay engaged with lawmakers and the administration to ensure these policies are implemented in a way that prioritizes older

adults, people with disabilities, their families, and caregivers. Most immediately—as appropriators work to finalize FY18 spending levels by March 23—the Medicare Rights Center will continue to advocate for adequate funding for programs important to people with Medicare, in particular the State Health Insurance Assistance (SHIP) program. We also urge Congress to extend MFP and strongly support the inclusion of the BENES Act in this upcoming package. Please join us in making this important ask! Click here to weigh in with your lawmakers today. For more information on Medicare Rights’ advocacy around the final FY18 spending bill, please click here. For more information on the BBA of 2018, please see the Medicare Rights Center’s comprehensive analysis and one -page summary.

Opioid Maker Funds Efforts To Fight Addiction: Is It ‘Blood Money’ Or Charity? A program to give naloxone overdose-antidote kits and training to front-line officers. Funding for pill disposal boxes in pharmacies, clinics and police stations across North Carolina. A radio campaign in Connecticut warning of the dangers of opioid abuse. A new medicine to treat opioid-induced constipation. The money behind these efforts to combat the opioid

epidemic and its side effects comes from a perhaps unlikely sponsor: Purdue Pharma, the company that makes the topselling opioid, OxyContin. After years of aggressively promoting OxyContin as a safe and effective way to combat pain, the company is — equally aggressively — recasting itself as a fundamental player in the response to a crisis that many experts say it helped to create.

Such efforts come amid hundreds of lawsuits claiming that Purdue fueled the opioid epidemic by deceptively marketing OxyContin, as well as new government efforts to regulate opioids. In February, Purdue announced that it would stop promoting its opioid drugs to physicians. At the same time, Purdue is looking to partner with other companies and

expand its portfolio into areas such as oncology and sleep medicine. OxyContin accounted for more than 94 percent of Purdue’s sales in 2012 and was still over 82 percent as of last year, according to Symphony Health. ...Read More

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How Many Seniors Are Living in Poverty? National and State Estimates Under the Official and Supplemental Poverty Measures in 2016 Payments from Social Security and Supplemental Security Income have played a critical role in enhancing economic security and reducing poverty rates among people ages 65 and older. Yet many older adults live on limited incomes and have modest savings. In 2016, half of all people on Medicare had incomes less than $26,200. This analysis provides current data on poverty rates among the 49.3 million seniors in the U.S. in 2016, as context for understanding the implications of potential changes to federal and state programs that help to bolster financial security among older adults. The. U.S. Census Bureau currently reports two different measures of poverty: the official poverty measure and the Supplemental Poverty Measure (SPM). Unlike the official poverty measure, the SPM reflects available financial

below 200% of poverty under the SPM in 2016 (42.4%), compared to 15 million (30.4%) under the official measure.  Under both the official measure and the SPM, the poverty rate among people ages 65 and older increased with age and was higher for women, blacks and Hispanics, and people in relatively poor health.  Under the SPM, 4.4 million older women lived in poverty in 2016, 1.5 million more than under the official measure; 2.8 million older men lived in poverty under the SPM, 1.1 resources and liabilities, number) of older adults who are million more than under the including taxes, the value of in- struggling financially is larger official measure. kind benefits (e.g., food stamps), than is conveyed by the official  Under the SPM, at least 15% of and out-of-pocket medical poverty measure. people ages 65 and older lived spending (generally higher Key Findings in poverty in 10 states (CA, among older adults), and  Under the SPM, 7.1 million FL, GA, HI, IN, LA, NJ, NM, geographic variations in housing adults ages 65 and older lived TX, and VA) plus Washington, costs. This analysis presents in poverty in 2016 (14.5%), D.C. in 2016; under the official national and state estimates of compared to 4.6 million (9.3%) poverty measure, only D.C. poverty under both measures for under the official poverty had a poverty rate above 15% adults ages 65 and older. Current measure (Figure 1). for older adults in 2016. estimates of poverty based on the  Nearly 21 million people ages SPM indicate that the share (and 65 and older had incomes

CMS Proposes Additional Medicare Advantage Flexibilities in 2019 Call Letter

This week, the Medicare Rights Center submitted comments in response to the Advance Notice of Methodological Changes for Calendar Year 2019 for the Medicare Advantage CMS-HCC Risk Adjustment Model and Call Letter (Call Letter). The Call Letter outlines CMS’s payment and policy strategies for upcoming plan years. As in years past, Medicare Rights provided comprehensive comments and feedback, highlighting the concerns and issues beneficiaries tell us about on the helpline every day.

This year, many of the proposed changes involved allowing Medicare Advantage Plans more flexibility – in the ways they communicate with beneficiaries, in setting up cost sharing structures to incentivize certain behaviors, and in offering additional benefits. While many of these flexibilities could be used to benefit enrollees, we are concerned that these changes would be more likely to cause confusion; increase risks associated with mistakes; and potentially make it more difficult for CMS and others to evaluate differences between plans. Already, people with Medicare Advantage can find it difficult to understand what plan is the right choice for their circumstances. Piling on additional options does

not lead to more informed choice without some very specific informational resources. We encourage to CMS to move forward in a way that ensures people with Medicare have the resources and tools they need to make informed, timely choices. CMS also proposed some changes that Medicare Rights urges them to abandon. For example, CMS proposes to remove one component of the Star Rating score on how well a plan handles appeals and how frequently it issues improper denials. That component reflects beneficiary experiences with the plan. While plans suffer other negative consequences, like financial penalties, for poor beneficiary experiences,

Medicare Rights believes eliminating such experiences from the Star Rating, which beneficiaries are much more likely to interact with and rely upon when choosing a plan, might mislead beneficiaries into thinking a poorly performing plan is the best choice for them. Read our comments here.

Rhode Island Alliance for Retired Americans, Inc. • 94 Cleveland Street • North Providence, RI • 02904-3525 • 401-480-8381 •

Justice Department announces charges in $500 million senior fraud schemes Criminal General Jeff Sessions said in charges are announcing the filed against charges Thursday. more than 250  The DOJ coordinated with alleged other law enforcement perpetrators in agencies, including the FBI, mailing, telemarketing schemes. the Federal Trade Losses stemming from these Commission and state plots are estimated at more than attorneys general, in building $500 million. the cases.  The Justice Department  The perpetrators allegedly announced a broad used mass mailing and enforcement sweep targeting telemarketing to rip off financial fraud against the seniors, as well as identity elderly, resulting in charges theft and financial abuse by filed against more than 250 guardians. defendants.  In 2015, individuals made  "Today's actions send a clear 1,108 calls to the Senate message: We will hold Aging Committee's toll-free perpetrators of elder fraud fraud hotline. That number schemes accountable more than doubled to 2,282 in wherever they are," Attorney


Phony winners More than a million people, most of whom were elderly, these scammers, we send a were victimized, according to strong message to other con the Justice Department. artists that we will not stand In one case, the FTC and the by and allow older Americans state of Missouri filed charges to be victimized," said Sen. Bob Casey, D-Pa., a ranking against two men and their member of the Senate Aging sweepstakes organization. The FTC alleged that seniors Committee. would receive mailers claiming Targeting retirees that they had just won more than Older Americans are losing about $36.5 billion each year to $1 million or that they could elder financial abuse, according win a large cash prize if they answered a question and to 2015 data from True Link submited a registration fee. Financial. Since 2013, victims lost more Meanwhile, 3 in 10 state than $110 million to this securities regulators report scheme, the FTC said….Read seeing an increase in senior More financial fraud, according to data from the North American

 "By bringing cases against

White House pitch to bolster Obamacare includes tough trade-offs for Democrats The White House is seeking a package of conservative policy concessions — some of which are certain to antagonize Democrats — in return for backing a legislative package bolstering Obamacare markets, according to a document obtained by POLITICO. The document indicates the administration will support congressional efforts to prop up the wobbly marketplaces, in exchange for significantly expanding short-term health

plans and loosening other insurance regulations. The document also makes severalreferences to abortion language that will be problematic for Democrats. A potential stumbling block in passing any stabilization package is whether conservatives will insist on including language prohibiting the use of government dollars to pay for abortions. "Although congressional efforts to provide taxpayer

money to prop up the exchanges is understandable, any such efforts must also provide relief to middle-class families harmed by the law and protect life," the document states. The source of the document provided to POLITICO isn’t identified and it isn’t dated. The White House declined to comment on the document but didn't question its authenticity. A spokesperson for HHS said the department does not comment on leaked

documents. Two health policy experts who have been in contact with White House officials indicated that the document is consistent with ideas the administration has discussed for creating more stability and flexibility in the insurance markets.

New Technologies Help Seniors Age In Place — And Not Feel Alone Nancy Delano, 80, of Denver has no plans to slow down anytime soon. She still drives to movies, plays and dinners out with friends. A retired elder care nurse who lives alone, she also knows that “when you reach a certain age, emergencies can happen fast.” So, when her son, Tom Rogers, talked to her about installing a remote monitoring system, she

didn’t hesitate. With motion sensors placed throughout the house, Rogers can see if his mom is moving around, if she’s sleeping (or not), if she forgot to lock the door and, based on a sophisticated algorithm that detects behavioral patterns, whether her activity level or eating habits have changed significantly, for instance. “It gives both of us peace of mind, particularly as she ages and wants to live at home,” said

Rogers, who lives near Washington, D.C., hundreds of miles away from her. At $45-$60 a month (plus an upfront fee of $100 to $200),’s Wellness system is markedly less expensive than options such as hiring a home health aide to check on her or moving her into a retirement community. The average cost of nursing home care exceeds $95,000 a year, while assisted living and in-home care tops $45,000 annually, according to

a 2017 Genworth Financial report. The exorbitant costs of nursing home and assisted living care are driving sales — and innovation — in the technology market, said Dr. Eric Topol, director of the Scripps Translational Science Institute and author of “The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care.”...Read More

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Supreme Court takes away Case New Holland retiree benefits When Ron Crow retired from a 30-year career at Case New Holland in 1999, he thought he and his wife, Janet Crow, would keep their Case health care benefits for the rest of their lives. That’s allegedly what the company told them, anyway. Then Janet Crow saw a newscast on KWQC Monday night and learned that wasn’t the case. At least, not anymore. “That’s not what you want to hear at 10 p.m. at night,” she said. “That doesn’t make for good sleep.” On Feb. 20, the U.S. Supreme Court ruled Case New Holland retirees no longer will get their health benefits. The court ruled the health care benefits were tied to the rest of the collective bargaining agreements and did not cover former workers for life. The decision reversed an appeals court ruling. After checking with her

attorney, Crow learned CNH likely will send out letters Monday with the details of the health care changes. Those benefits were part of a 1998 collective bargaining agreement that provided a group benefit plan to certain employees retiring under the pension plan. The agreement did contain a clause that said those benefits would terminate in May 2004. When it expired that year, a class of CNH retirees and surviving spouses filed a lawsuit seeking declaratory judgement that their health care benefits remain vested for life. “This is unethical, to take people this age and take away their health care,” Janet Crow said. The case has been volleyed between courts since then, until it finally reached the Supreme Court. Former Sen. Tom Courtney, also a CNH retiree, said those same benefits nearly were taken away by a court decision four

years ago, until the judge reversed their own decision. “It was a good benefit. They paid for everything. We felt the company agreed there would be lifetime benefits,” Courtney said. “A lot of management people were retiring and they (CNH) were telling us that if you retired now, you will have lifetime benefits.” Courtney, who retired in 2002, said the Supreme Court’s decision will affect a lot of employees who retired from Case New Holland in the 1990s and into the turn of the century, but noted most of them are old enough to be on Medicare. Many will be forced to buy insurance on the market, which Courtney estimates could add $100 to $400 to their monthly bills. “I’m not bitter about it. But a lot of people will be bitter about it, and rightfully so,” Courtney said. Courtney said he saw the writing on the wall when Donald

Trump was elected and appointed a Republican justice, turning the balance of the court against Democrats. Courtney is a staunch Democrat and former union leader. “This is why I and others like me have been screaming for universal health care,” he said. Janet Crow said her family will be OK, but she knows many retirees who have moved to Florida, and they have no idea what’s coming. Some of them are widows, and Crow isn’t sure if they will have enough money to live on once they start buying insurance. “If my husband died, half his pension and all his medical benefits would have went to me,” she said. “You have widows out there living on half their husband’s pensions.” Neither Courtney nor Crow know the exact details of what they will lose, but they should know soon. “It’s a mess,” Crow said.

Alliance congratulates Conor Lamb in his victory. Retiree issues, combined with a strong Get Out the Vote effort by Alliance for Retired Americans members and staff, helped propel first-time candidate Conor Lamb to victory in the special election for Pennsylvania’s 18th congressional district seat. The Alliance has more than 22,000 members in the 18th Congressional district, and used a variety of methods to educate and mobilize them and the general public on the stark differences between Lamb and Rick Saccone on retiree issues. Lamb campaigned on a commitment to strengthen and expand Social Security and Medicare for current and future generations and to tackle the

rising cost of prescription drugs. He also promised to protect and defend earned pension benefits through the Miner’s Pension Act. Saccone, in contrast, said that Social Security and Medicare were “going broke” and “needed reform.” Saccone was also closely linked to House Speaker Paul Ryan, who continues to actively work to cut our earned benefits. “Thank you to our Pennsylvania Alliance members for their all-hands-on-deck effort,” said Richard Fiesta, Executive Director of the Alliance. “We showed candidates across the country that putting retirement security issues like Social Security and Medicare on the front burner is a winning formula for November’s midterm elections.”

Direct mail Thousands of Alliance members received mailings outlining the differences between Lamb and Saccone on retiree issues. Tele-town Hall A week before election day, the Alliance gave its members an opportunity to hear directly from the candidate on senior issues. Thousands of Pennsylvania Alliance members who lived in the district joined the calls and asked him questions about Medicare, prescription drugs prices, Social Security cost of living increases and protecting miners’ pensions. Get Out the Vote Alliance staff and members helped with the Get Out the Vote effort. Executive Director Richard Fiesta visited the district several times to help the

campaign and Maureen Dunn, Field Manager for the Alliance, directed the Westmoreland County Central Labor Council’s effort. She led an operation that knocked on thousands of doors and made thousands of phone calls as a cornerstone of their work. Pennsylvania Alliance President Dwayne Thomas, who lives in western Pennsylvania, and board member Harriet Ellenberger, who lives in the district, volunteered dozens of hours of their time and recruited others to join in. Digital ads Independent expenditure digital ads in support of Lamb by the Alliance ran on the three main local newspaper websites as well as on Facebook.

Rhode Island Alliance for Retired Americans, Inc. • 94 Cleveland Street • North Providence, RI • 02904-3525 • 401-480-8381 •

RI ARA HealthLink Wellness News


Poor Sleep May Heighten Alzheimer's Risk Older adults who are sleepy during the day might have harmful plaque building in their brain that is a sign of impending Alzheimer's disease, researchers report. A hallmark of Alzheimer's is the accumulation of a protein in the brain called beta-amyloid. It's believed that one benefit of sleep is to clear beta-amyloid, and poor sleep might allow it to build up, the authors of the new study pointed out. "Elderly individuals with excessive daytime sleepiness may be more vulnerable to Alzheimer's disease-related changes," said corresponding author Prashanthi Vemuri, an associate professor of radiology at the Mayo Clinic in Rochester, Minn. Vemuri noted that the new study is only observational and as such does not prove that poor

sleep causes an increase in betaamyloid. The association, however, is so strong that a link between sleep and beta-amyloid probably exists, but exactly what that link may be isn't clear, she added. It's also unclear how much poor sleep it takes to increase beta-amyloid accumulation, the researchers said. Although beta-amyloid buildup is a sign of Alzheimer's, it doesn't doom one to the disease, and might only be a sign of other aging processes, Vemuri suggested. "Sleep has been proposed to be important for clearance of brain amyloid," she said. "This study affirms that disrupted sleep may be a risk factor for Alzheimer's disease via increased amyloid." Vemuri's team studied nearly 300 people aged 70 and older who didn't suffer from dementia.

About 22 percent reported having excessive daytime sleepiness when the study began. Study participants completed a survey about sleep and had at least two brain scans between 2009 and 2016. The researchers compared the scans in search of changes in the brain. They found increased beta -amyloids in key brain areas in participants who reported being very sleepy during the day. The study was published online March 12 in the journal JAMA Neurology. The co-author of an accompanying journal editorial said consistent and untreated sleep disturbance appears to aid Alzheimer's progression and it can happen early, before any symptoms are seen. "These findings, however, further support the idea that sleep is critical for mental health, and that chronically

disturbed sleep may facilitate the development of Alzheimer's disease or accelerate its progression," said Bryce Mander. He's an assistant professor of psychiatry and human behavior at the University of California, Irvine School of Medicine. This is another reason you should talk to your doctor if you have sleep problems, because many are treatable, Mander said. Researchers now need to study whether treating sleep disturbances reduces plaque buildup, he added. "We know very little about how sleep treatments can impact Alzheimer's disease risk and progression," Mander said. "It is really important that we, as a society, fund and conduct the studies necessary to find out." More information visit the Alzheimer's Association.

Dementia and driving When your loved one is living with dementia, it is important to recognize that their decline will inevitably impact driving skills and safety. If possible, it’s best to consider alternatives and have a conversation about relinquishing privileges early-on in the diagnosis, so that you and your loved one have time to come to terms with the upcoming loss of independence. Memory impairment can impact your loved one’s ability to recognize traffic signs and signals, drive too fast or too slow, or become confused while driving. As dementia progresses and memory impairment worsens, the senses are also affected. Visual agnosia, caused by changes in the brain, may impair the ability to comprehend visual images, although there is nothing physically wrong with the eyes. Also, their sense of

perception and depth may be altered. These changes will cause safety concerns – especially when it comes to driving. The Alzheimer’s Association offers the following signs of unsafe driving as evidence your loved one may need to consider staying off the road: forgetting how to locate familiar places, failing to observe traffic signs and signals, making slow or poor decisions in traffic, driving at an inappropriate speed, and becoming angry or confused when driving. Losing driving privileges is a huge loss of independence, and will inevitably be an emotional struggle for all parties involved. If diagnosed early enough, families should initiate a conversation with their memoryimpaired loved one about driving abilities. If the person

living with dementia is on board with maintaining his or her safety — and also the safety of others on the road — she or he will be more likely to accept the revocation of driving privileges. When this time comes, families should offer alternatives, such as helping with transportation for errands and doctor’s appointments, or offering public transportation as an option. Homewatch CareGivers also offers transportation assistance — help from a person outside of the family may be more easily accepted by your loved one. In the event that your loved one becomes angry or combative during this process, remember the 5 Rs. The Rs Remain calm. Don’t argue or try to reason. Take a deep breath before you act.

Respond to feelings. Validate how your loved one seems to be feeling at the time. Reassure. Remind your loved one that s/ he is safe and cared for. Remove. Remove yourself physically or distance yourself psychologically for a moment to regain your composure. Return. Return fully to the situation when your loved one begins to calm down. Remember, no matter how hard you try, you can never separate the emotional connection to your loved one from the irrational behaviors, but you can try your best to respond in a manner that won’t worsen the situation.

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Fire Safety for Elders with Special Health Needs Decreased mobility, sight, hearing or cognitive capabilities may limit a person's ability to take the quick action necessary to escape during a fire emergency. People over the age of 65 are twice as likely to suffer injuries or lose their lives in fires compared to the population-at-large, according to the U.S. Fire Administration, part of the Federal Emergency Management Agency (FEMA). If your elderly loved one has Alzheimer's or dementia, problems with mobility, or is vision or hearing impaired, there are certain precautions that need to be taken in the event of a house fire. These precautions go above and beyond the traditional fire safety guidelines for all families. (LINK) Here are some fire safety tips for elderly people with special needs, provided by the U.S. Fire Administration and the Federal Emergency Management Agency (FEMA): Mobility impairments If your elderly loved one uses a cane, walker or wheelchair – or is in a cast due to an injury – traditional escape routes may no longer be viable. One-quarter of victims with physical disabilities were unable to act to save themselves during a fire emergency, according to the U.S Fire Administration. Check all exits to make sure wheelchairs or walkers can get through the doorways. Make any necessary accommodations (such as installation of exit ramps) to facilitate an emergency escape. Install flooring material that accommodates artificial limbs or canes.  Keep a phone by the bed for emergency calls in case the person becomes trapped and is unable to escape. Put emergency numbers in the speed dial directory of the phone.  People confined to a wheelchair may want to have a small "personal use" fire extinguisher mounted in an accessible place on the wheelchair, and become familiar with its use.  When escape is not an option

due to impaired mobility, fire protection devices such as sprinkler systems, fire-safe compartment walls, and flameresistant blankets can be used. The key is to have the room fireproofed before an emergency happens. Blind/visually impaired  The most important thing a blind or visually impaired person can do to improve his or her chances of surviving a fire is to be prepared ahead of time.  Plan and practice two escape routes from each room in the home. By practicing an escape plan, a blind or visually impaired person can escape to safety, without losing time searching and feeling for an exit. Committing these actions to memory will serve as an instinctual map to safety.  A blind or visually impaired person will not see the fire, but must rely on other senses – the smell of smoke or the sense of heat emanating from the fire to know where the danger is. Test doors before opening them. Use the back of the hand, reach up high and touch the door, the doorknob, and the space between the door and the frame. If anything feels hot, keep the door shut and use the second exit route. A person may be forced to crawl along the floor to avoid smoke. It can be very disorienting to crawl when you are used to walking – especially for those who count steps to locate doors and hallways. Place tactile markers along the baseboard of exit routes to help a visually impaired person feel their way to safety. Hearing impaired Conventional smoke alarms that sound during a fire aren't effective for someone who is hard of hearing.  Many assistive devices are specially designed to alert hearing impaired people of an emergency. These include smoke alarms and appliances that use strobe lights and vibration equipment. Vibrating beds and pillows that are wired

to a smoke alarm have been developed to awaken people who are deaf or hard of hearing.  Smoke alarms with a strobe light outside the house can catch the attention of neighbors or others who might pass by. Alzheimer's or dementia If your relative has Alzheimer's or dementia, know that even cognitively impaired people oftentimes have an innate understanding that something is wrong during an emergency, and may be more clear-headed than you would imagine.  Remain calm during an emergency. Explain what is happening clearly and simply, but don't expect them to remember specific details. Validate their concerns, but provide clear direction without condescending or losing patience.  Provide a picture book of emergency procedures. A cognitively impaired person may be able to follow visual instructions more easily. Contact your local fire department or the National Fire Protection agency.  Practice escape routes. Cognition tends to improve and worsen at various times for people with Alzheimer's or dementia. If escape is practiced continually, instinct may take over and guide the elder to safety.  The person should sleep in a room that has easy access to the outdoors in case the home needs to be evacuated. A ground floor bedroom is best.  If your parent is in the early stages of dementia and lives alone, alert the fire department ahead of time to their special needs.  Regardless of their disability, all elderly people should live in a home with working smoke alarms and sprinkler systems. A working smoke alarm can reduce the risk of dying in a fire by as much as 60 percent, FEMA says.  Practicing escape plans is also vital for all elders. Knowing

their escape plan is one of the most important steps elders can take to save their life in a fire. Plan the escape around your loved one's capabilities. Know at least two exits from every room. Make sure your loved one can unlock all doors and windows. Dementia If your relative has Alzheimer's or dementia, know that even cognitively impaired people oftentimes have an innate understanding that something is wrong during an emergency, and may be more clear-headed than you would imagine.  Remain calm during an emergency. Explain what is happening clearly and simply, but don't expect them to remember specific details. Validate their concerns, but provide clear direction without condescending or losing patience.  Provide a picture book of emergency procedures. A cognitively impaired person may be able to follow visual instructions more easily. Contact your local fire department or the National Fire Protection agency.  Practice escape routes. Cognition tends to improve and worsen at various times for people with Alzheimer's or dementia. If escape is practiced continually, instinct may take over and guide the elder to safety.  The person should sleep in a room that has easy access to the outdoors in case the home needs to be evacuated. A ground floor bedroom is best. If your parent is in the early stages of dementia and lives alone, alert the fire department ahead of time to their special needs. Regardless of their disability, all elderly people should live in a home with working smoke alarms and sprinkler systems. A working smoke alarm can reduce the risk of dying in a fire by as much as 60 percent, FEMA says. Practicing escape plans is also vital for all elders.

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10 Tips for Preventing Dementia-Related Fall According to the Centers for Disease Control and Prevention (CDC), falls are the leading cause of injuryrelated deaths for older adults. Those who live with dementia are especially at risk. Impaired judgment, decline in sensory perception over time and an inability tell others about their needs can contribute to an increased fall risk for people living with Alzheimer’s disease and other dementia-related disorders. The following 10-point guide provides easy-to-follow tips that will help family members reduce falls risks for their loved ones with dementia: 1. Arrange for adequate lighting. Dementia can damage the visual system and cause illusions and misperceptions. Make sure the home has enough lighting in each room to reduce visual difficulties. People with dementia might misinterpret what they see, so reducing dark areas and shadows is vital.

2. Provide visual cues. People with dementia can have difficulty separating similar colors (such as the same carpet on the stairs and on the floor) and setting objects and their background apart. It is helpful to define the top and bottom of a staircase through the use of contrasting colors. 3. Clear walking paths inside the home. Those living with dementia can have a hard time recognizing the danger of a loose rug, unsteady footstool or electrical cords stretched across the floor. Removing tripping hazards and keeping pathways clear can help prevent falls. 4. Decrease clutter outside. Areas outside of the home should be clear of objects (leaves, rocks, etc.) and there should not be dips in walkways or otherwise uneven ground in a senior’s path. 5. Information and reminders in a common place. Create a single place for any notes or reminders that can easily be accessed and read by a person with dementia. This can be a cork bulletin board or a dry

erase board. Using a single location simplifies the process and provides for an organized system, preventing the need for a senior to walk around looking for information. 6. Keep important things by the bed. A major issue for people living with dementia is confusion at night. Restless nights can leave them tired and unsteady. To help prevent wandering at night, keep important items on a bedside table, including water, a light source, eyeglasses, tissues and the telephone. 7. Consider unmet needs. A person living with dementia may start to wander as their condition progresses. This may lead them into unsafe areas. Wandering often signifies an unmet need a senior is trying to satisfy. For example, they may be looking for a telephone because they usually called their wife at 5 p.m. Instead of trying to physically stop the wandering, try distracting or redirecting their activity to avoid raising a person’s anxiety or frustration level.

8. Lower noise levels. As a person living with dementia may have more sensitivity to noise, you should try and decrease the level of white noise and loud sounds around them. If the noise level becomes too much, it can cause anxiety and nervousness – which can make a person with dementia unsteady on their feet. 9. Keep help at hand. For an older person who is at risk of falling, being able to quickly and easily call for help is vital. Consider various forms of remote care technology, such as a fall alert bracelet or auto detector, which can be used in case of an emergency. 10. Supply safe footwear. What a person wears on their feet can represent a major fall risk. If a shoe can easily slip off, it can cause them to trip. However, a person living with dementia may struggle with complicated articles of clothing that involve buttons or laces. Shoes with Velcro fastenings are a good solution, making footwear easy to take on and off, but also safely securing it to their feet.

Handling Dementia Mood Swing People with Alzheimer’s disease and other forms of dementia can often experience mood swings. These episodes can be trying on their caregivers as they try to help. “The best thing that a caregiver can do to mitigate mood and behavior changes is to know and understand the individual person — including history, likes and dislikes, favorite foods, music and activities, what soothes them, what upsets them, what time of day they are at their best, and so on,” said Ruth Drew, Director of Family and Information Services for the Alzheimer’s Association. “When you know the person you

can organize the day so that you anticipate and avert many problems before they occur. You recognize the signs of distress early and have several methods of dealing with them.” Some of these methods include filling the day with pleasant experiences in which the person is comfortable and comforted by sights, sounds and tastes they enjoy. This needs to be combined with plenty of “down time” to avoid feelings of boredom and loneliness. Proper management of diet, activity and medications can minimize pain that might also cause mood swings. “When someone with

Alzheimer’s seems upset or withdrawn, first assess for pain or discomfort,” Drewsaid. “Pain in people with Alzheimer’s is under-recognized and undertreated, because they may not tell us in the way we expect. When pain is the problem, rely on your medical team to diagnose and treat the cause. Sometimes the things we interpret as mood swings or challenging behavior can simply be a person’s reaction to uncomfortable clothing, being too hot, too cold, hungry, thirsty, bored or fatigued. Often, if we try to look at the world through the other person’s eyes, we can figure out what’s going on and

help to solve it." Drew reminds caregivers that “all behavior is communication." Know that sometimes there is only so much a caregiver can do and support for the caregiver and medical intervention for the person with dementia are necessary. The Alzheimer’s Association offers education programs and support groups in local areas, as well as online social media and eLearning sites, and a 24/7 Helpline at 800-272-3900.

Rhode Island Alliance for Retired Americans, Inc. • 94 Cleveland Street • North Providence, RI • 02904-3525 • 401-480-8381 •

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RI ARA March 18, 2018 E-Newsletter


RI ARA March 18, 2018 E-Newsletter

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