Care - Comfort Concerns - Alzheimer's Facilities
- Published on Sunday, 25 October 2009 21:17
- Written by Stanton O. Berg
(Picture above at the Benedictine October 2007 - Photo Jim Gehrz)
"Caregiving is an inadequate term...it's really LOVE‐giving. You essentially need to be willing to give unconditional love to the person that's suffering from Alzheimer's." - Mark Shriver
Introductory note: It is common for family members who are caregivers to take a position that they will always care for their Alzheimer's loved one at home and never place them in the care of a "Nursing Home" or other care facility. Usually this is a position taken during the early stages or middle stages of the disease. These are the times of short term memory loss, confusion, lack of judgment etc. During the early and middle stages when home care is a very doable thing for the caregiver.
When the Alzheimer's victim progresses to the late stages, the care and management is beyond the physical capability of a single person caregiver. Most family and loved one's caregivers have no real understanding of how serious and demanding the symptoms of the late stages will become. This is the heavy lifting stage of caregiving. Most family members do not know nor understand that most late stage Alzheimer's patients are unable to walk. (Many have limited or no use of the arms.) Recently I conferred with the nurse in an Alzheimer's facility and asked her what percentage of the residents could not walk. She estimated it to be about 75% in wheel chairs and the remaining 25% needed a walker. Most private homes are not wheel chair friendly and have narrow halls, sharp corners and soft carpeting with limited areas for wheel chair maneuverability.
Many Alzheimer's residents are dead weight in moving them. In order to prevent injury, two persons are required to make transfers from bed to wheel chair or bed to bathroom etc. The risk of skin tears on the arms is very high with only one person making the transfers.
The late stage Alzheimer's victims also require movement every 2-3 hours at night to prevent bed sores etc. The best care for late stage Alzheimer's patients is a combination nursing home and family care as a joint project. I took care of June for over 7 years at home...Then her care became complicated - for a time she thought I was a stranger and wanted me out of the house - later on in the late stages, June required more than one person to handle transfers and bathroom breaks.
I joined forces with the nursing home and my days at the nursing home were eight (8) hour days in which I took charge of June's care but utilized the nursing home staff to make transfers and handle toileting needs. They did the heavy lifting for me!
I also did June's feeding during the day. Normally in the very late stages the Alzheimer's victim becomes almost non responsive and may sit with eyes closed. Some will have trouble eating and swallowing and some may even have seizures.
My daughter Julie, who has had experience of over 30 years in several nursing homes and was/is currently so employed, served as my consultant. The attempts to provide care by family members when the Alzheimer's victim is in late stages is frequently beyond the ability of the family member to do so and often and frequently results in the various forms of abuse as discussed below.
A little Philosophy
Caregivers should develop a friendly relationship with the facility Administrator and the Director of Nursing. (DON) If a problem arises with the care of your loved one, these are the people that are in position to help you and if necessary make internal changes. Remember, it is not you against them. It is you and them in a Partnership to produce the best results in the care of your loved one. An effective partnership of this kind will almost always produce a superior level of care to that resulting from an attempt to do so in the caregiver’s own home. Most facilities have daily activities planned for the residents, 2 and 3 times a day. Many have a small Chapel on the site permitting quiet spiritual times for the caregiver and the resident. Such was the case for June. A terrace with garden, plants and trees is usually availbable to permit fresh air with pleasant surroundings. When the nursing home takes over the heavy lifting aspects of the loved one's care, it leaves the caregiver free to do what they can do best, provide a loving comfort zone around the loved one. This is so important when one considers that the Alzheimer's victim is living with fear as a constant companion.
When a “Nursing Assistant” or a “Nurse” renders some very special, unique or superior care service for your loved one, be sure and acknowledge this event by a personal “Thank You.” Follow this up with a letter to the Administrator with a copy to the DON in recognition of this appreciated care service. If possible, post a copy on the facility Bulletin Board. These are hard working people who appreciate their efforts being noted by the family and caregivers. This thoughtful approach will also tend to encourage repeat conduct in the future.
While there are many good Nursing Homes and Alzheimer’s care facilities, there are always a few poor ones. I believe that a very high level of performance can be found more uniformly among the “non-profit” type of facilities and among the “faith based” facilities. I would rather not have the facility judge the cost of some care services while trying to achieve a profit for the organization. I also find that my objectives are always in line with the objectives of the “faith based” facility.
The Assisted Living type facility is usually directed more towards the early and middle stages of Alzheimer’s or other dementias. The more intense care required in the late stages is normally a better fit for a nursing home. Many Assisted Living facilities are not Medicare or Medicaid approved by choice as such approval then requires adherence to the Federal/State regulations that go with Medicare and Medicaid approval. The Nursing Homes to my knowledge are all Medicare and Medicaid approved. This is something that should be determined early on.
Abuse and Neglect Concerns
There is much concern about possible nursing home abuse or neglect of a loved one. While this does happen in some nursing homes, it is far from common.
The matter of abuse and neglect in nursing homes was examined in US Senate hearings 18 June 2002. Their findings were that too few staff and poor staff to resident ratios are the main cause of abuse and neglect in nursing homes.
They found that many facilities have adopted policies or programs to prevent abuse or neglect. Those policies or programs related to Nurse staffing including facilities, particularly non-profit and some Alzheimer’s special care units that have staffing ratios of 1:6 or 1:8 for their direct care staff and have more staffing and supervision by registered nurses (RNs) then the average facility.
I am familiar with three nursing homes as a result of having both my mother and my wife in nursing homes, both with Alzheimer's. I was spending 8 hour days with my wife for most of her time in a nursing home. During the many hours I spent in nursing homes over a period of 3.5 years, (1660+ hours June's the last year) I was aware of only 1 case of abuse of an elderly man. The nursing assistant in that case was quickly terminated. In the 4-5 years that my mother Ellen was in a nursing home with Alzheimer's in a small town in Wisconsin, I witnessed one case of verbal abuse of another resident by a nursing assistant. In that case I filed a complaint with the nursing home. The NA apparently decided other employment was better suited to her temperment and she left that employment.
Recent studies show the greatest risk of abuse or neglect of a loved one with Alzheimer's or other dementia producing diseases is actually in the private home with family care. USA Today ran a story on 10 November 2011 under the title of "Protecting the People Who Took Care of Us." This story reported on research and findings by the University of California at Irvine. That study found that 47% of the elderly dementia victims cared for at home were abused or neglected when cared for by family members. They also found that 96% of such cases go unreported. Similar findings were reported a year earlier by a London University in the UK. (Abuse maybe one of five (5) types. 1. Physical abuse, 2. Mental/psychological abuse, 3. Neglect or lack of care, 4. Drugs/medication abuse or 5. Financial abuse.) I think that the reason for the high rate of abuse by family member caregivers is simply that the family caregiver is emotionally stressed out from attempting to provide care that is beyond their physical and mental ability to do so!
Unless the family caregiver has his or her own health concerns that would prohibit or restrict their further involvement, there is no reason why they could not continue to assist in the care of the loved one.
Nursing homes are not dumping grounds for a loved one's care that would thereafter excuse the family or caregivers from any further care participation requirements.
If you were the primary caregiver before the nursing home became necessary, you can still be a caregiver at the nursing home. You will have the most recent an intimate knowledge of the loved one's problems and needs and can be of great assisance to the facility. Unfortunately, Federal data indicates that nationally over 50% of nursing home residents have no visitors. While I was putting in 8 hour days in June's care, most other family participation that I observed was 1-2 hours once a week. Some families were spending 1-2 hours daily and some rarely appeared at the home. I set up a schedule so that all of our family members would visit June every week and each would have their own day for visitation. The objective was to have family members on site every day of the week. I did of course not expect them to spend 8 hour days like I was doing as they had jobs and had their own family responsibility!
Value of Written Documentation
I have always maintained a written record of my time spent at the nursing home caring for June. I did this by way of a daily log or journal. This dated log or journal contained my time of arrival and departure and listed the daily events in June's life such as meals, bathroom breaks, naps, activities events, and my care concerns. Also recorded were the names of the nursing staff's on duty during that time. Where appropriate, comments were made on June's condition and reactions or lack of reactions. Jobs that were well done by the staff were also noted. This daily record was kept on my computer, and was of great assistance in my participation in the routine periodic care conferences conducted by the facility. It enabled me to determine if there were any negative patterns in June's care. It also gave me the necessary documentation for specific discussions with the staff about such problems. I would recommend that all care giver's maintain written records and documentation for later reference and future guidance.
All references to June are one's taken from or based on my daily logs, journals and care conference notes. This essay will be a work in progress as I review my 3.5+ years of written documentation. What you see in this essay is the Alzheimer's nursing/assisted living facility from the standpoint of my experience with June and her needs (at two (2) different Alzheimer's facilities). It may also reflect observations made at my mother's nursing home. It is also the result of my observations and close contact of/with many other Alzheimer's residents in varying degree or stages of this terrible disease.
The normal and usual chain of command to direct requests/complaints for corrective action would be:
a. The day or evening duty Nurse for the floor or group involved. (This is usually an LPN.)
b. The Director of Nursing or the Health Care Coordinator. (This is usually an RN.)
c. The Administrator or Director of Operations. (This is an executive office or front office person.)
In addition to basic family concerns for the well being of the loved one in an Alzheimer's care facility (Feeding, cleanliness, comfort and safety) there are a few basic but more subtle concerns that should have the caregiver's close attention. As June had progressed more deeply into Alzheimer's, I felt a greater need to be close at hand. I was fortunate in that the nursing home facility that June was a resident for most of her time in a facility, was only 1 mile or 4 minutes away in a residential area.
Comfort concerns are most critical in the late stages where the loved one must depend on the care and attention of the nursing assistant staff and their own personal care giver loved one's. In the late stages, the Alzheimer's victim is unable to adjust or move them selves into a more comfortable position. Most often they are unable to even communicate their needs in a normal manner.
Four (4) basic categories or areas of Care-Comfort Concerns.
1. Falls by a resident.
2. Comfort Level Care Concerns.
3. Infectious Diseases. (Colds, Flu and Gastro-Intestinal.)
4. Theft of a Resident's Personal Property.
Each area of concern will be treated in detail below. These are all areas for alertness and watchfulness by the caregiver in order to render whatever help they may provide to solving or controlling the problem. The Caregiver is in position to provide assistance by their awareness and their insight into ways of possible prevention or correction of a problem.
(Photo on right is June - month after diagnosis in 1998)
1. Falls by a resident.
Problem: Approx. 1800 nursing home residents die from falls each year. 10-20% of falls result in serious injury.
The scope of the analysis and discussion of this subject is such that it requires special treatment in a separate article. The subject of falls is one that impacts every nursing home resident and supporting family member. An in depth treatment of the subject is contained in the following article which also includes June's experiences with "Falls.": Please click on the below link:
2. Comfort Level Care Concerns.
Alzheimer's residents who are in the late stages of this disease, lack the physical or mental capacity to help themselves and are therefore dependent on the nursing staff and caregivers for their physical comfort. While most nursing assistants and other nursing home staff members are caring individuals who desire to do a good job, the varied and constant demands on their time is such that frequently and unfortunately, oversights occur with a persistent regularity. On occasion there will be a nursing assistant who is careless or otherwise unsuited for such an important job. The loved one's family caregivers can be of considerable help to their loved one by acting as a back stop in seeing that proper care is received.
The staff is frequently so intent on the job at hand that they overlook other events that may be taking place nearby them. Sometimes their focus on the job at hand is so narrow that related needs/concerns are overlooked. I am always reminded of the Sherlock Holmes declaration: "You see but you do not observe." My notes and journals are replete with comments such as "Does anyone look", and "Why am I the only one that sees this." All comments below were taken from my care conference notes or daily journals on June and are actual events.)
Please be cautioned about rendering judgment based on the care shortomings listed below. Unless the noted shortcoming is designated as "Routine" it would not be a daily event but an event over a period of a week or a month. It may also be an item I listed on my quarterly "Care Conference" agenda for discussion.
(Photo below right is June 7.5 + years later in an Alzheimer's facility. Her face now has a faded look.)
a. Bathroom breaks. (Normally procedure: - every 2-3 hours.) Many middle stage or late stage Alzheimer's residents are incontinent. If they are not taken to the bathroom regularly, it will mean that they are sitting or laying in soiled or wet under clothing or pants. Many are unable to ask for bathroom breaks or help.
Notes from June's Daily Log or Journal - 90 day period:
"Most of the time I request it." (First care conference note.)
"Bathroom breaks better but not today." (Second care conference note.)
I would automatically position June outside the bathroom near the dining area for proper bathroom timing whenever I was on premises and taking care of June. However many times the NA's would be waiting for me to finish feeding June in order to take her to the bathroom. I was usually the last one out of the dining room.
(Note: This is one of the few apparent success stories as the result of my corrective efforts. After the initial few Care conference notes - it ceased to be a problem.)
b. Wheel chair seating comfort. (Many of the middle stage and most of the late stage Alzheimer's residents are unable to move themselves or adjust themselves for comfort. If the nursing assistants or other staff does not place them comfortably in their wheel or Geri chairs, they are forced to sit that way until the next bathroom break when they are removed and replaced in the chair.) Wheel chairs have means of adjustment. The backs may be elevated or lowered and head rests adjusted higher or lower. The leg-foot rests can be elevated-lowered or adjusted for length. Arm rests are adjustable. Pillows and padding can be added for comfort and to avoid bruising.
(Photo below right is June in her Geri Chair - Lap pillow and back pillow for comfort. Photo is by Jim Gehrz on 31 October 2007.)
Notes from June's Daily Log (90 day period)
1. "June was slouched to the right...chronic problem...needs centering in chair...foot rest needs adjustment.....M--- needs to issue instructions on proper seating."
2. "Seating continues to be a routine problem...most of time seated improperly...tight against left side and slouching to the right...."
3. "Improperly adjusted foot and leg rests."
4. "June's left arm dangling over side of chair and her head slouched over that side."
5. "Improperly seated - leg rests not appropriate...no pillows."
6. "Improperly seated...left leg was off of the foot and leg support and hanging loose behind and against the leg support."
7. "again improperly seated...right leg off of both the leg and foot rest and behind the rest with her shin bearing against the rest...Nurse standing there did not see it"
8. "Frequently not seated properly in Geri Chair...not centered...chair not locked in position."
9. "Chair not locked in elevated position."
c. Bed comfort.(Because middle and late state Alzheimer's residents cannot move them selves or change the position of their body, it is normal policy to have the resident's position changed by the staff every three hours during the night. This is a preventive for bed sores and at the same time provides more comfort for the resident. Obviously there are many other common sense items and practices that will contribute to the comfort of the resident.)
Notes from June's Daily Log or Journal (90 Day period)
1. "June put down for a nap with her shoes on and no cover blanket."
2. "No cover blanket - very cool in the room."
3. "Nap time...Drapes not pulled, overhead lights on, door wide open."
4. "Head of bed not elevated". (Because June would occasionally cough up food and fluids there was a standing medical order that the head of her bed should be elevated at 30 degrees to avoid possible choking on coughed up food and fluids and to lessen coughing.) This requirement was a simple common sense matter that was implemented at my request and with the agreement of the NP.
5. "Glasses not cleaned."
6. "June put down for her Nap - "glasses still on."
7. "Lights left on...covers not adjusted properly...glasses not removed."
8. "Body at an angle in the bed."..."Not elevating head of bed 30 degrees."
9. "Sometimes the nurse in checking vital signs will pull blanket back and fail to replace it...leave bright overhead light on and door open at nap times - frequently."
d. Clothing comfort. (Many middle stage and most late stage Alzheimer's residents are unable to adjust their own clothing for comfort. If the nursing assistants do not dress the residents carefully, they may be left sitting for hours with clothing exerting uncomfortable pressures on their body. Mayo clinic warns of clothing that binds or chafes or is constricting as a primary cause of boils. "The constant irritation from tight clothing can cause breaks in skin, making it easer for bacteria to enter the body." They point out that the main sites for boils are buttocks or thighs were most likely to sweat and experience friction. This is particularly important in the case of Alzheimer's victims who now possess a faulty immune system due to age and disease. June did develop a boil (left inside thigh groin) that required hospital emergency room care (9/2007) lancing and draining of the boil. When one views the below history, there is little question of why she developed such a boil.) This incident was upsetting enough for me to have an informal meeting with June's NA's to discuss the matter of clothing comfort with demonstrations.
Notes from June's Daily Log or Journal (90 Day period)
1. "June had her pants legs pulled up half way to the knees on both legs...her pants were bunched up behind her...tight in the crotch"
2. "Strange bulge noted on tongue of right shoe...tongue of shoe was doubled over and shoe laced up...one pants leg half way up.."
3. "Improperly seated -..pants legs halfway to knees...seam on right leg twisted from side to the top...big bulge of clothing protruding left thigh."
4. "Her left Bra strap and pad twisted and upside down."
5. "Pants bunched on left side and used as a handle" (lifting) "Pants legs partially to knee." Pants pulled up in back." (Used to lift.)
6. "Elastic TED stockings top bunched up and uncomfortable...pull trouser pants legs down properly."
e. Thirst comfort. This is a critical area for late stage Alzheimer's residents. Many are incapable or asking for water. May have difficulty accepting liquids or swallowing properly. A dedicated and patient staff is needed to ensure proper liquid intake and thirst comfort. This is an area that can be monitored and assisted by family members.
It is common with most everyone to desire a drink of water before bed time. The late stage Alzheimer's resident can not ask for water. This was an area where I placed special attention in regard to June's care. One of my favorite nurses was a lady who took extra time every night before going off duty to ensure that June had a glass of fluids.
It is not uncommon to have Alzheimer's residents dehydrated to the point that they need hospitalization.
f. Bruising and Abrasions - skin tears. (Many middle and late stage Alzheimer's residents are on blood thinners or simply bruise easily because of their age. They may be helpless and unable to assist with their own transfer movement. It is common to see the elderly in public places with large purple arm skin blotches because of bruising and bleeding under the skin. This is almost always due to minor bumps and burises while on blood thinners or simply age sensitivity. The nursing home is particularly prone to such bruising because of the weakened and helpless condition of the residents.
(1.) They require careful handling to avoid injury.
(2.) Transfer belts are provided to help prevent such injuries.
(3.) Depending on the residents needs, it may sometimes be necessary for two nursing assistants to move the resident from bed to chair or chair to bed or bathroom. Two people can distribute and reduce the localized weight and the handling pressures that are normal when only one nursing assistant makes the transfer. Some injuries are inflicted in the dressing process. June was totally helpless and as a result needed 2 NA's to move her without injury...however, injury to her would still on occasion take place.
Notes from June's Daily Logs and Journals (90 Day period:
1. "Abrasion and open wound 1/4" x 2" on wrist.. not deep but it looked awful.. NA said it was a scrape by her watch in pulling over her sweater in dressing her. It later healed with a scar."
2. "Large bruise above her wrist...No one knew anything about it."
3. "Skin tear in area of large bruise.. required a dressing...bruise done during morning dressing process...healed with an "L" shaped scar."
4. "Large bruise on left hand...no one knew anything about it."
5. "Broken finger nail middle finger left hand...no one knew anything about it."
6. "Large nasty looking bruise....areas of purple pooled blood (below surface) 3" x 3.5"...No one knew anything about it.".
7. "Skin tear and flap on left forearm....no one knows when it happened."
8. "Large Arm Bruises." (Need pillow on sides to keep arms from wedging between arm rests and chair body.)
(Note: My complaints to DON resulted in change in procedure for transfers. Two NA's will be used for all transfers to reduce the localized arm pressures in transfers. This along with use of pillows on chair sides appeared to solve the bruising problem.)
3. Infectious Diseases. (Colds, Flu, Gastro Intestinal and Pneumonia.)
The National Institute of Health advised on April 2003: "The common occurrence and dire consequences of infectious disease outbreaks in nursing homes often go unrecognized and unappreciated. Nevertheless, these facilities provide an ideal environment for acquisition and spread of infection: susceptible residents who share sources of air, food, water, and health care in a crowded institutional setting. Moreover, visitors, staff, and residents constantly come and go, bringing in pathogens from both the hospital and the community. Outbreaks of respiratory and gastrointestinal infection predominate in this setting, but outbreaks of skin and soft-tissue infection and infections caused by antimicrobial-resistant bacteria also occur with some frequency."
Nursing Homes and assisted living facilities have special risk problems and challenges with the common seasonal infectious diseases. There are three main reasons for this. The first two are exposure risks.
a. The nursing homes have a wide variation of staffing help requirements. (Nursing assistants, nurses, doctors, activities personnel, maintenance personnel, kitchen staff, therapy staff, social services, housekeeping staff, delivery staff, religious workers and administrative staff. This staff comes from varied backgrounds, cultures, environments and are constantly and repeatedly coming onto, moving about and leaving the premises.
b.. The families and friends of the residents also come from varied backgrounds, culture's and environments and also are repeatedly coming onto, moving about and leaving the premises.
c. The residents themselves because of their faulty immune system due to age and disease present a very high risk for infection.
The practice of good sanitary procedures go a long way to prevent the spread of infectious diseases. Frequent washing of the hands. The nursing assistants are issued disposable latex gloves to use when handling residents, transferring residents or for bathroom breaks. The gloves are to be discarded immediately after use. Wall mounted liquid sanitizers for use on the hands are mounted in most of the rooms and hallways. Some facilities will isolate a resident when the resident comes down with the flue, cold or an intestinal disorder. Handling of eating utensils and drinking glassware is very important. Some staff members are very diligent, others are not. The resident's family members and friends can be of assistance by bringing obvious violations of good sanitary practices to the attention of the Director of Nursing or the Administrator of the nursing facility.
The American Medical Director's Association's official publication, "Caring for the Ages", October 2009 had a number of articles that were directly in point on the subject of infection control. Below are some quoted excerpts.
"The Association for Professionals in Infection Control and Epidemiology (APIC), urged all health care institutions, including nursing homes and skilled nursing facilities, to require their employees to be vaccinated. If workers decline vaccinations, they should be required to sign a statement acknowledging that their action may put patients at risk"......"APIC cited survey data from 2005 to 2006...just 42% of those with patient contact had been vaccinated against seasonal influenza...all employees with direct patient contact should be immunized annually"..."All of the vaccination strategies studied that involved a 70% coverage rate could have a significant mitigating effect on an H1N1 epidemic"...A 50% vaccine coverage rate would mitigate an epidemic spread to levels similar to that of a relatively mild seasonal flu epidemic. But a 30% rate of coverage would not be effective."
"Clearly, combining vaccination with other mitigation measures, such as social distancing and targeted use of antiviral agents, could be quite effective."
"Other measures to control the spread of ...virus currently recommended by the CDC include wearing gloves and gowns when in contact with infected persons, practicing proper hand hygiene, covering coughs and sneezes and isolating individuals who appear ill."
One group of nursing homes has a special program and strategy for infection control..."At Golden Living, we have a flu "czar"...by designating someone specific to handle this, we make it clear how important this is. We have a great campaign for vaccinations."..."We don't see vaccinations as the end all...our strategy starts by building a moat to keep the virus from getting in at all. This involves consistent widespread use of masks and sanitizers, faithful reporting of warning signs and symptoms, as well as vaccinations....Golden Living put the video (DVD from AMDA "Influenza Immunization and the Health Care Worker") on its learning management system and made it required viewing for all staff...We have an Internet site that includes flu updates, ...we have facility flu-prevention checklists, and we push normal practices such as hand washing....flue awareness and prevention can be an upbeat, team building experience for staff. The 2009 slogan for Gold Living's flu campaign is "What will you do this year?"...produces buttons and posters and everyone is encouraged to get involved."
Notes from daily logs and journals for June (90 Day period) that best outline the scope of problem area.
1. "Residents with nasal discharge hanging from their noses....one blew in her hand and then flung it at the floor."
2. "Nurse sneezing into hand and then dispensing medication."
3. "Why are residents who are obviously sick permitted to sit across from people (same table) who are not sick and cough all over them?...M... has bad cold or pneumonia and was coughing all over the table." (Small tables of 4.)
4. "For a small (19) resident group there has been a horrendous showing of colds and pneumonia...".
5. During the height of a flu infection kitchen staff noted handling eating utensils with bare hand on the mouth end rather then the handle end. When I handed 2 clean unused glasses to a kitchen staff member she took them by inserting bare fingers inside the glasses.
6. "I use the 2 hand sanitizer's (dining room) several times a day - except for P.., I rarely see any one use them."
7. "A sick male resident in a wheel chair who had vomited during day was permitted to be seated at small table with three other residents for the evening meal. He almost immediately vomited onto the table. He was removed to his room. A few minutes later he was out moving about in his wheel chair among other residents and without restrictions. My complaint to the Director of Nursing resulted in instructions that such residents should be confined to their rooms." Note: My complaint to the DON resulted in the issurance of instructions that sick individuals should be confined to their rooms.
4. Theft of a Resident's Personal Property.
Problem: Theft from nursing home residents is a common and frequent occurrence that is quietly kept under wraps:
The scope of the analysis and discussion of this subject is such that it requires special treatment in a separate article. The subject of theft is one that impacts every nursing home resident and supporting family member. An in depth treatment of the subject is contained in the following article which also includes June's experiences with "Theft.": Please click on the below link:
Dan Greco - Facebook - 1/25/2012: "Thanks for all the information on the care of Alzheime'r's patients, as my Mom just had two falls in the facility she is at in a one week period. This information is so vital for all to know. I admire the way you all took care of June, and she seemed like such a sweet person, and I am sorry for your loss. God Speed to you all, and thanks once again for your efforts of taking care of June, and this most valuable article."
Laurie Rodosta Dupuy - Facebook - 1/28/2012: "Thank you so much for posting this - it is so close to what my family and I are going through right now. I'm printing it for reference."
June's obituary as printed in the Minneapolis Star Tribune following her death in October 2008 can be found on the top blue navigation strip under the label "In Memoriam" and on the drop down menu as item - click on: