Hospice is not a place. Hospice is a “concept of care” designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments.1 The goal of hospice care is to provide patients with comfort and dignity at the end of life with a special emphasis on controlling pain and discomfort and managing symptoms. The focus is on compassionate caring not curing. Hospice care neither hastens nor prolongs life, but this specialized service has been shown to increase quality of life. Hospice is covered by Medicare and Medicaid and most private insurance companies to eligible patients referred by a physician. Hospice services include care by professionals and volunteers and medication, equipment, and medical supplies. Families have no out-of-pocket expenses other than the cost of room and board. The patient and family are at the center of hospice care. The hospice team works with the patient and family to develop a personalized plan of care that respects the individual’s end-of-life wishes. A multi-disciplinary team of physicians, nurses, home health aides, social workers, therapists, spiritual counselors, bereavement counselors, and volunteers provides expert and compassionate care that is available 24 hours a day, 7 days a week. Physicians and nurses are specially trained to address pain and manage symptoms. The team works closely with family members to provide feeding, bathing, turning, administering medications, and monitoring changes in a patient’s condition. Some hospice providers provide alternative therapies such as Pet Therapy or Music Therapy. Spiritual counselors, therapists, and social workers help patients and families with emotional and spiritual concerns and provide bereavement support to family members after a loved one has died. Most people choose hospice care in their own homes, but hospice care is also available in hospitals, nursing homes, and residential care communities for the elderly such as assisted living communities and board and care homes. In 2011, 66.0% of hospice patients received care in the place they call “home,” including private residences (41.5%), skilled nursing facilities (17.2%), and residential communities (7.3%).2 When hospice care is not an option at home, nursing homes, freestanding hospice facilities, and residential care communities like board and care homes are places for families to turn for short-term respite or longer term care at the end of life. The Board and Care model, which provides residential care for fewer residents in a private home, offers a home-away-from-home in an intimate environment that provides a home-like routine and a place for family to gather. Board and Care homes can offer temporary hospice to residents and families who request it. These homes typically work with a number of hospice organizations to provide families with choice for high quality care. The board and care staff coordinate care with the hospice staff and they may provide bedside comfort tailored to the resident’s needs and preferences, such as soft music, reading, and aromatherapy. “Choosing a hospice to care for yourself or a loved one in the final months or even days of life is an important and stressful process,” said J. Donald Schumacher NHPCO president and CEO. “Each hospice offers unique services and partners with specific community providers – so it’s important to contact the hospices in your area and ask them questions to find the one with the services and support that are right for you.”3 For additional information on hospice and how to select a quality hospice provider, families may turn to online resources found at the National Hospice and Palliative Care Organization ( and the Hospice Foundation of America ( References: 1Hospice Foundation of America. 2Facts and Figures: Hospice Care in America. 2013 Edition. National Hospice and Palliative Care Organization. 3Choosing a Quality Hospice. National Hospice and Palliative Care Organization.   Trina Duke, Master of Science in Gerontology Concierge Gerontology Services
Dementias are degenerative disorders that develop primarily in the nervous system and selectively damage particular areas of the brain. Some dementias, like Alzheimer’s disease affect all areas of the brain simultaneously, while others, such as frontotemporal dementia, affect the parts of the brain involved in controlling one’s communications and emotions. Still others are caused by vascular disease, brain trauma, or chronic alcohol abuse (Korsakoff’s syndrome) By 2030, 20% of U.S. population will be older than 65 years of age – about 50 million people. Dementia affects 1% to 6% of those older than 65, and between 10% and 20% of those older than 80 years of age. In the next 30 years, estimated 10-20 million seniors in U.S. will have mild to severe forms of dementia. Seniors with history of moderate traumatic brain injury (TBI) have a 2-3 times greater risk of developing Alzheimer’s disease – those with a severe TBI have a 4-5 times greater risk. Even healthy seniors are at risk for falls and head trauma, so any fall to the head, however minor, should be seen by a medical professional and documented. Alzheimer’s disease accounts for 65% of all dementias. There is no direct diagnosis of Alzheimer’s – and while PET scans and other imaging techniques are being studied, none have yet been able to show the presence of Alzheimer’s disease. Alzheimer’s onset often surprises families because vision, movement, and sensation remain untouched while a senior’s memories begin to slowly decrease. Recent memories are affected first, leading to “senior moments” that appear innocent because all other memories, including those from decades ago, remain intact. Eventually those remote memories begin to fade, and lastly the senior’s “crystallized” memories, such as family member’s names and faces, are compromised.   By David L. Raffle, PhD Clinical and Forensic Neuropsychologist
Our assisted living facilities, Los Angeles feel like home. Raya’s Paradise was featured in the Beverly Hills Courier, November 9, 2102: Most people do not know the difference between a large assisted-living facility that may house 150 or more residents and a smaller board-and-care home. Larger facilities are usually for more active residents able to enjoy all the community activities offered; and for those who can manage getting to and from the building’s dining room and common areas on their own. These large facilities carry the same license as the smaller board- and-care homes. In California in the early 1970s, the residential care system was established to provide non-skilled nursing-based services to the elderly. These homes are referred to as “Board & Care” or “Residential Care Homes for the Elderly (RCFE’s).” The governing body is the State of California, Department of Social Services, Community Care Licensing. These homes are not allowed to provide medical services. They can, however, provide assistance with all activities of daily living (ADL’s). Board & care homes are smaller residential homes that afford a safe home-like atmosphere and comfortable and dignified care where residents can enjoy the living room, backyard, kitchen/dining services, homemade meals, personal attention and social interaction. For those elderly who suffer from dementia, the small residential home can be an ideal setting because of the consistency in staff and constant super vision. Residents adjust faster and often do better than in the larger Assisted Living Facilities. Such a place is Raya’s Paradise, a residential care facility with five locations in L.A. and West Hollywood with 6-11 residents each. “We make sure your loved one feels at home away from home,” says Moti Michael Gamburd, executive director. “Our caring staff—many of which have been with the company for more than 18 years—provides personalized attention to each individual,” says Gamburd adding that the caregiver to patient ratio is 1:3. While all are welcome at Raya’s Paradise, the company is known for its care of those with Alzheimer’s, other memory disorders and those who’ve suffered strokes. “We offer a new approach to dementia and Alzheimer’s care,” says Gamburd “Our environment is designed especially for our resident’s to thrive. “The activities they do together create opportunities to experience and feel accomplishment and satisfaction for completion of a job,” adds Gamburd. “This team approach gives the security of knowing there is always a helping hand ready when they need it.” The daily routine has residents up for showers in easily accessible bath- rooms, followed by breakfast and a morning activity. Since some of the homes are near parks there are visits for those want ing to go by foot or wheelchair. Afternoons often see musical entertainment, like an accordion player and all holidays and birthdays are celebrated. “We try to keep it as homey as possible,” Gamburd says. “There’s always something to do,” Gamburd adds, “like cards, puzzles, reminiscing, big band music or bingo.” More alert residents often help set the table or help with the home’s laundry to keep them engaged. For an RCFE to accept a resident with dementia it must have a “waiver” from Community Care Licensing, as the Raya’s facilities do. The waiver means a variance to a specific regulation based on a facility-wide need or circumstances which is not typically tied to a specific resident or staff person. Raya’s Paradise also has waivers to care for bedridden residents—”the building has to meet certain licensing criteria,” Gamburd reports. Gamburd advises those seeking a board-and care home for their loved one to ask questions: • If you are placing your loved one with dementia into an RCFE, you should be asking the administrator for a copy of their waiver for dementia care. This will give you peace of mind knowing that this RCFE has the proper staffing, wander guards or other means to keep residents from wandering; and knowledge of how to manage their residents with dementia. • Does this RCFE provide 24 hour “awake” staff? Falls usually occur in the evening; and it is important that staff is awake and ready to help residents get to and from the restroom at night. Many small board-and-care homes or RCFE’s, do not have a 24-hour awake staff. They may have a hus- band and wife who live in the home and are working 24/7. Working that many hours is a daunting job and it is important that staffing is “fresh” and that they are going home to rest before returning to work. Night staff should not be working somewhere else during the day and then coming to work at night at your RCFE. Raya’s homes have separate day and night staffs to provide compassionate, committed care. Raya’s also caters to those not yet ready to move with its CARE (Caring, Assisting, Respecting Elders) program that provides in-home caregivers. View or download the published article here: Beverly Hills Courier Full page 11-09-12