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Home safety for those with dementia and Alzheimer’s disease is critical for family caregivers, healthcare professionals, and those living with the disease.
Join Griswold’s Chris Kelly, M.Ed. & Director of Learning & Development; Bridget Scheidler, OTR/L & Occupational Therapist with Fox Rehabilitation; and Keith Lerner, family caregiver, as they discuss the innovative steps that you can take to create a safe and healthy home setting for people with Alzheimer’s Disease and their caregivers.
The workshop features three parts:
Part 1: Share the emotional side of home safety issues for people with Alzheimer’s Disease and their caregivers based on literature, advocacy and social media.
Part 2: Hear real stories from an occupational therapist and two family caregivers who have lived/worked through home safety issues.
Part 3: Present an Alzheimer’s Home Safety Solutions toolkit that drives effective home safety planning and quality of life.
Who should attend the webinar? People living with Alzheimer’s Disease, caregivers, and healthcare providers.
Derek: …welcome you today to the webinar titled “Alzheimer’s Disease and Home Safety: Finding Support and Innovative Solutions.. We have a fantastic workshop ahead with a record number of registrants, so let’s get started right into the agenda. First, a few housekeeping items. All lines are currently muted, and at the end of the webinar, there will be an open question and answer session with our panelists. The powerful component of this workshop are the presented tools, all the anecdotal stories that will be told by our panelists today, and with that, the recording of the webinar and all the tools will be made available within 48 hours of the webinar completion.
This week is National Home Safety Week, or excuse me, Safe at Home Week across the country, and this theme will drive a lot of the topic of discussion today. But we do know that this topic, while very helpful to a lot of families out there, can sometimes be very mechanical, and sometimes safety can be seen as a checklist. What we’re excited today is, to address the emotional part of home safety especially as it relates to Alzheimer’s disease. During the webinar, we invite you to type your questions, comments, maybe you have a tip to share, a personal story, a challenge or success story related to today’s topic, during the webinar using the Go To Webinar panel. Most presentations will ask you to wait ’till the end of the webinar, but we highly encourage you to include yourself in this process that we call brain writing.
During the webinar, our panelists will have access to view the questions and can respond during the presentation, or we will absolutely make sure that we address your questions and comments during the question and answer session. Joining us is a fantastic, all-star lineup. Let’s start introducing our panelists today. First, we have Bridget Scheidler, and she resides in Mount Pleasant, South Carolina, just outside of one of my favorite towns of Charlestown, South Carolina. Bridget has a Bachelor’s of Health Science from the University of Florida and also a Master’s in Occupational Therapy. She currently works as an occupational therapist, and with Fox Rehab. Bridget, welcome to the webinar.
Bridget: Thank you so much for having me.
Derek: Next, we also have Keith Lerner, who’s in the room with us today here in Philadelphia. Keith is a resident of Southern New Jersey, and was a family caregiver for his mother, who passed after battling Alzheimer’s disease just a short while ago. Keith will have some fantastic anecdotes to share with our audience today. Some other interesting notes about Keith, he was a detective for 26 years, reporting to the New Jersey Attorney General. He also is a part-time actor, and was recently in the movie “Silver Linings Playbook” and served six years for the United States Coast Guard Reserves. Keith, welcome to the webinar.
Keith: Great to be here, thank you.
Derek: And, our next panelist is Chris Kelly, Director of Learning and Development at Griswold Home Care. Chris is the architect of the Solutions Series Workshop, in addition to leading all the training and education for Griswold Home Care. Chris, welcome to the webinar, as well.
Chris: Great, thank you, Derek. Good afternoon, everyone. I feel very fortunate to be part of just a really, really important topic and really important month in terms of National Home Safety Month. We wanted to start by going through a really unique methodology that we use to develop our webinar topics and tools. We start by going through an exhaustive literature review of peer-reviewed articles. We look through 500 social media discussion boards and verbatim postings. We basically identify a topic that we think is critical and relevant, and confirm that through advocacy outreach and then also reaching out in this case, to Fox Rehab with the great expertise from Bridget. Finally, as Derek mentioned, we learn from you. That we, through this Solutions Webinar Chat and Toolkit, we want to make sure that we’re benefitting from your experiences as well.
Really important before we start, we want to thank and recognize our audience. We have, a great component of this webinar is we have a mixed audience versus segmenting by health care provider versus consumer, so we want to recognize our health care providers and franchisees for the great support and dedication you have for people with Alzheimer’s and caregivers. We want to recognize our professional caregivers, all the family caregivers out there that are, you know, persevering and supporting clients with Alzheimer’s. And also, those with Alzheimer’s, that have been diagnosed with Alzheimer’s that are joining the webinar.
I want to mention that if you’re new to Alzheimer’s disease, either as a client or a family caregiver, we’re going to talk through some very difficult stories and scary situations that have come up. Safety is a serious issue. Just want to emphasize that Alzheimer’s affects everyone differently. You may not experience any of these safety issues, but the goal of today is really to give you the entire scope of the things that can happen so that you’re prepared and you have the tools to manage them.
We’re going to start with just a basic overview of Alzheimer’s disease in the context of home safety. Alzheimer’s is a brain disorder; you might also hear it called a neurological disorder that causes real changes in the brain. Those changes, most people know, can affect memory, but for today, we want to focus on some of the other issues that can happen, number one, impacts to judgment and decision making, orientation to person, place, and time, so knowing who you are, where you are, and the year, motor skills, coordination, and reflexes, and then your senses, in terms of vision, depth perception, and ability to sense touch and temperature. Any of these areas impaired can create safety issues, and again, and some of these safety issues can be life threatening.
The first symptom that we’re going to talk about, one that we don’t hear too much about, is called agnosia. I always like to say, imagine if you woke up in the morning and went into the bathroom to brush your teeth and get ready for the day, and could not understand what any of the objects are on the sink, the toothbrush, the toothpaste, couldn’t understand what your clothing items were. This is a symptom of Alzheimer’s called agnosia, which causes many, many different safety concerns, basically, the inability to recognize the purpose of objects. This is a real quote from a person with Alzheimer’s that had insight into this challenge, and the phrase that really stands out for me is, “Everything looks foreign,” and how scary this must be for the person with Alzheimer’s disease.
Throughout the presentation, we’re going to talk a little bit more about the brain and why these challenges happen. Think of the brain as a company, and in a company, you have a number of different departments. Each department has its own function, but they’re all working together towards a common goal. That’s really how the brain works. In the brain, you have different lobes. When it comes to agnosia, it’s usually the result of changes in the parietal lobe, which again, helps to identify the purpose of objects. People who don’t understand what objects are, are often at risk for some of the challenges that we’ve listed here, eating or choking on non-food items, things like plastic food items, plastic fruit, grapes, strawberries, are a real challenge. We’ve known people with Alzheimer’s to think those are real and chew them and swallow them, and sometimes choke. Fire hazards. I worked with one client who, instead of putting the lid on a pot of boiling water, used a newspaper, which caused a fire which thankfully was extinguished. Ingesting hazardous materials or chemicals, and then finally, misunderstanding traffic signals and road signs. So, those are examples of some of the safety challenges that can occur.
As Derek mentioned, we also wanted to talk through the emotional side of these safety issues. So, people who are dealing with agnosia, as clients, often feel anxious, obviously embarrassed, because if these are objects that they’ve known their entire lives, confused about why this is happening, often become isolated because they don’t want others to know about it, which causes depression, loss of dignity, and I can’t tell you the number of people that were dealing with this that told me they felt like they, they felt like a child and that they were being treated like a child. So, it’s very difficult for the person with Alzheimer’s.
For family and professional caregivers, when you see this for the first time, there’s often a shock because it’s an adult that looks fine. At times, frustration, confusion, anxiety for the caregiver, especially, can cause a lot of exhaustion. Much like the client, caregivers often become isolated because the person with Alzheimer’s does not want to go out due to this symptom, which causes depression. And the one statement that you’re going to hear a lot today, it’s common for family caregivers to say, you know, when this starts, they feel like they can’t turn away for a second. And that, in many cases, drives a lot of the exhaustion.
So what are some of the solutions? A couple tips we have, number one, in the early and middle stages, many people with Alzheimer’s disease can still read. So, we’ve seen a lot of great success with putting up signs, Post-its with large print and short phrases to help people understand items in a drawer or in a cabinet or what an item is. As Alzheimer’s progresses, sadly, reading is impaired. In those cases, in many cases, we have to remove or hide any objects that would cause physical harm. Towards the bottom of your slide, we’ve identified one tool that we’re going to show you very quickly. The National Institute of Aging is just a great resource, and they’ve developed a great brochure, publication, called “Home Safety for People with Alzheimer’s”. And as you scroll down this tool, there is a very detailed checklist for you to actually walk through every room in the house and identify any challenges that might be a safety issue for a person with Alzheimer’s, and then you’re given tips to modify the environment. And I think, you know, even if you don’t think there are safety issues, if you’re living with Alzheimer’s in the home, I highly recommend that you take this tool, walk through the house, and just benefit from this great information.
So throughout the presentation, we’re going to, we just have the great fortune of benefitting from the real stories and experiences from Bridget and Keith. Bridget, we’ll start with you. Just from the standpoint of an occupational therapist, as you’ve gone out into the homes of people with Alzheimer’s who were dealing with agnosia, could you just talk about some of the things that you’ve seen and some of the solutions or tips that have helped?
Bridget: Yes. Some of the best solutions, I’ve noticed, is to just decrease clutter in the common areas. I’ve been in a lot of bathrooms where the bathroom vanity had a million items on it, and the best solution is to put just the everyday items on the counter that they use, such as toothbrush, toothpaste, one hair comb, and face wash, and label them if needed. And sometimes, I even put a to-do list on the mirror, such as a checklist to brush your teeth, comb your hair, use mouthwash, whatever they do every day that they’ve been doing for the past few years, don’t change it up. Keep the routine the same, but just simplify and decrease the clutter, and that seems to help out a lot. And make sure every item that they use is in plain sight, and they don’t have to go through drawers or closets to find it.
Chris: That’s great, Bridget. And Bridget, other than the National Institute on Aging checklist that we just shared, if you could let us know of any other resources or checklists or tools that might, that you’ve used or that might help families to just make sure that they have a safe environment in the home. Do any other tools come to mind?
Bridget: I use one that my company, Fox Rehab, created, which I can definitely share the link with, a link with you.
Bridget: But, the one on the National Institute that you showed is also a great list,
Bridget: For fire hazards and falls, which we’ll get into later.
Chris: Absolutely. Great. Thank you, Bridget. And then Keith, I know it’s really tough to go back and think about some of the things that have happened in the past with your mom. In the case of agnosia, could you just share with the group what your experiences were with agnosia, and then some of the things that you did to manage it?
Keith: Yeah. I cared for my mom for about ten years with the help of my dad and my wife. One of the things we did notice a few years into the disease is, she didn’t know what eating utensils were used for, and she would sit at the table, either, or at a restaurant and pick up food with her hands to eat. So, we had to, you know, kind of help her and guide her and reinforce her, not to embarrass her, you know, to use a fork or a spoon. And in most cases, she would just laugh about it. You know, she did keep her sense of humor throughout the disease, which was, I guess a positive thing with the disease. Some of the other things that we were concerned about, because early on, my mom was in her mid-60s when she was officially diagnosed, and early on, she would, she was taking a lot of medications for different ailments, cholesterol, things like that, and we had to take the medications away because she wasn’t taking the proper doses and things like that, so we had to hide that and kind of give it to her when it was necessary.
Chris: Mm. So, it’s sounds like just a lot of vigilance. You know, you had to, you and your dad and your wife had to make sure that not only was it safe, but that you were really keeping an eye on your mom.
Keith: Right. And just when you thought you had something covered, she found another way to get her, to create a safety hazard, and we would have to address that.
Chris: Yeah. People are very resourceful with Alzheimer’s.
Chris: Great. Thanks, Keith. Thanks for both Bridget and Keith. We really appreciate your stories. The next really important symptom that we’ll talk about is wandering. One of my mentors, Joyce Simard, said a phrase years back that, “Wandering is a search for something familiar.” As we mentioned earlier, people with Alzheimer’s go back in time, so the people in their lives and the places begin to look unfamiliar. And if you or I were in that situation, we would leave. We would walk out and try to find something that looks familiar, and that’s usually the trigger for wandering. Beth Kallmyer, the VP of Constituent Services at the Alzheimer’s Association, offers a great quote here. The phrases that jump out to me are number one, this can happen at any time. I always say, “You’re never a wanderer until you wander,” and it’s that first time where people have never experienced it before, you’re not prepared, you have no idea where you would look for that person. I also like that she validates how hard caregivers are working to keep someone safe, and that, you know, there’s this constant sentiment that if you turn your head for one second or walk out of the room for one second, a person can wander from home, which is obviously very dangerous.
So, some of the safety challenges, and there are many, and all of these are very serious with wandering, are traffic accidents, we talked about the fact that a person with Alzheimer’s may not recognize what a red light means or a green light, so may walk into traffic. Wandering during the winter months is very serious because as people are out and exposed, they can develop hypothermia. Some recent studies have shown, for whatever reason, that people with Alzheimer’s are actually drawn towards water when they are wandering, and there have been a number of drowning accidents around the country over the last five years. If people are in an area where it is more hot, there is heat exhaustion. If someone is taking, as Keith mentioned, cholesterol medications, heart medications, the longer they’re missing and the longer they’re missing those medications, it can create health issues. And then, we just wanted to call out, I know in my ten years at the Alzheimer’s Association, people wandered not only by foot, but by car, train, bus, and plane. So, as Keith mentioned, people remember how to use credit cards, they remember how to travel, they may think they have a past job they have to get to, or they may think that their children are missing. And if you were going to miss work or if you couldn’t find your children, you would try anything to get to those people and to that job, and that’s what happens with Alzheimer’s disease. So, all very serious safety issues.
The other issue we wanted to talk about a little bit different than wandering is pacing. So, with wandering, there’s a sense of intent. There’s something that people are looking for. With pacing, one symptom of Alzheimer’s is just a sense of restlessness, a repetitive need to move. And when people have that, it could go on for days without resting, without sleep. So, some challenges are heat exhaustion, obviously if people are not keeping up with their nourishment and intake, they can develop weight loss, and then exhaustion and fatigue just from what could be hours and hours and hours of pacing.
On the emotional side for people with Alzheimer’s disease, for a number of people that I’ve seen found after wandering, there’s a general anxiety that, “Why is this happening to me? Is it going to happen again?” And definite confusion around, you know, especially when people are missing in their own neighborhood, you know, how that could be. So, a lot of questions and concern. On the family and professional caregiver side, especially the first time it’s happened, a lot of shock and fear. As people wander more and more, even when they’re asked not to, there can be, even for the most dedicated caregivers, a lot of frustration. And then this, again, this sentiment of once someone has wandered and has been missing, caregivers often feel like they can’t turn away for a second.
So, on the positive side, some of the solutions that we’ve seen work, number one, try as much as you can in the home to create a safe walking path. Bridget mentioned trying to remove clutter, which is really important. A newer technique that has really served us well in facilities, and I think it can work well in the home, is to set up what we call “rummaging stations”. So, when people pace and wander in the home, if you can set up areas where there are hobby-related items or any past interest that they used to like in the past that would get them to sit and engage, that’s less time that they’re wandering or pacing and time that the caregiver doesn’t necessarily have to sit and watch them. Some examples are coupon clipping, folding clothes, for people that used to do business work, stuffing envelopes, those types of repetitive behaviors and rummaging stations can be really helpful. And then, we wanted to make sure that we called out that there are some cases where wandering is so incessant and so difficult to manage that, you know, during the time at the Alzheimer’s Association, we would recommend that a family think about an Alzheimer’s special care facility. All those facilities offer a specially designed safe walking path that allow people to move but also to be safe.
So, we have three tools that we’re listing at the bottom. We’re going to show you one, great, great partnership between the National Alzheimer’s Association and MedicAlert. This is something that has happened fairly recently. The National Alzheimer’s Association is really one of the premiere advocacy organizations and has had a great program called Safe Return, where a person with Alzheimer’s disease can enroll there by giving their photo, their name, they’ll have a number on an item of jewelry that they can wear, and that way, if they’re missing, they’re easier found, easier for them to be found, and then they’re also entered into a database where if the information is sent out to hospitals and ERs, the hospitals know to look for that particular person, also sent to law enforcement. So again, if you are dealing with Alzheimer’s disease, and even if you don’t think wandering is a concern, there’s always a first time, so we really recommend that you reach out and benefit from that program between the MedicAlert and the Alzheimer’s Safe Return program.
We also gave you a link here to the National Silver Alert program, which is also another great way to identify and return people with Alzheimer’s, and then Project Lifesaver, which is the third program. So, three great programs that, where you can be proactive and make sure that people are, they have an item on their person that identifies them and a system to try to identify them as quickly as possible and have them returned safely.
So Bridget, I know from our past conversations, you’ve experienced situations with wandering in the home. What are some of the situations that have come up in your past experience, and what are some of the things that can help?
Bridget: Some of the solutions that seem to work the best are just validating the person’s reason for wanting to wander in case of agitation. Usually it’s agitation and wanting to return to a familiar place, and making a memory book is a great way to do that, so when they do get agitated and want to leave, you sit down, go through their memory books, their old home. Revalidate that they’re safe in their current environment, that they don’t live in that home anymore, and also some other solutions are to keep up daily routines. The rummaging stations are wonderful, also. Think about what the person used to do for a living and used to do for hobbies or still does as hobbies, and use their way and their hobbies as part of the rummaging task.
Some other things I’ve had to do is we’ve camouflaged doorways, with shower curtains, and we have set up alarms in the house so anytime a door or window opens, there’s a little beep so the loved one doesn’t feel like they have to be right by, right around the person all the time and they can hear the door open and close and know when someone’s leaving or coming in. Another great success we’ve had at a facility with a wanderer was a prerecorded message of a loved one, such as a son or a daughter or a significant other, stating that such as, “Hi, Honey, I’m at the grocery store, I’m picking up a few items and I’ll be home, I’ll be back to get you in five minutes.” That way, when the resident wants to wander, the staff can play the message for them, and that should calm them and we can redirect them to a different activity. And usually, their memory at that time when they’re wandering is no more than five minutes, so you can play the message as much as needed to calm them down before they wander.
Chris: All great suggestions, Bridget, and you can see just the innovation and skill that an occupational therapist brings to the table with these situations. Bridget, just a quick question, because I know this comes up a lot. When I was with the Alzheimer’s Association, a number of people will ask if they should place locks on their door versus what you’re describing as camouflaging and using bells versus locks. Can you talk a little bit about just your perspective on locks and why the camouflage and bell approach might be safer?
Bridget: Yeah. Locks can be a fire hazard, especially there’s, depending on who else is residing in the home, you want to make sure there’s always safety exits for anyplace there might be a fire, and that all the locks are reachable. If your loved one with Alzheimer’s is never home alone, you can, and you have the ability to reach a higher lock or a lower lock, that can work, but I would do that as a last solution if the other ones don’t work as well because of the fire hazard.
Chris: Great. Thanks, Bridget. And then Keith, I know that there were two times your mom wandered very early on in the process, and both cases by car. Since we’ll be talking about driving later, could you talk about the first time it happened?
Keith: Just to add to that alarm,
Keith: Early on, my mom, with the disease, we went on some trips and were staying in hotel suites. And they sell these little $5 to $7 alarms at Home Depot,
Keith: That you stick right on the door, so at, during the night we could sleep, because a lot of times, my mother would be up all night long, so at least it would let us know if she wandered outside the hotel room.
Chris: That’s great.
Keith: The alarm would go off and wake us.
Keith: But early on, even before my mom was diagnosed, probably about six to eight months prior to, my mom used to go up to the local Wawa near her house, and one evening she got in her car, she was still driving, and she hadn’t been officially diagnosed. She went up to the Wawa, which was about a mile from her house, and my wife and I got a call around 9:00 at night, and my mom was just crying her eyes out. She said she was at the Wawa on 206 and she could not find her way home, so we had to go up and, you know, I drove my mom’s car home and Judy drove home with my mom. And at that point, we knew there was symptoms of Alzheimer’s, but we, she hadn’t been diagnosed, and at that point, we didn’t move to take the keys away or anything like that until, you know, another incident that occurred which we’ll speak to later on.
Chris: And just because we’re talking so much about the emotional side, when you, when your family member and your mom, you know, for how many years has been going back and forth to Wawa without a problem, what was it like to get that call and what were some of the ways that you, as a family, tried to support your mom?
Keith: For us, it was extremely upsetting, you know, that your mom, she was maybe 64, 65 at the time, could not find her way home a mile from her house, but we just kind of like reassured her that, you know, everything was fine, you know, it’s not a big deal, you know, it happens as we get older, it’s not, you know, not the end of the world, and if you need help, we’re here to help you, things like that. And, you know, it kind of worked. She was very upset, but not agitated, and you know, for obvious reasons with the disease, she forgot it even happened and didn’t even realize it happened, you know, the next day.
Chris: Okay. Thanks, Keith, for going back and taking, reliving some difficult days. The next symptom that we’ll talk about, again, I hate to be repetitive, but all these are very serious, is falls. Typically, falls occur due to impaired depth perception, so the visual field of a person with Alzheimer’s can be impaired. Things can either look closer than they are or farther than they are. So if you look at this graphic, if someone’s walking down the steps or a staircase, in many cases, the step will look either closer or further than it usually is, which can cause falls, particularly on steps. Also, balance and coordination are impaired with Alzheimer’s disease. So, this is a really moving quote that I could identify with. If you’ve ever been in the presence of someone with Alzheimer’s who’s had a sudden fall, the things that I, you know, grabbed onto with this quote are the fact that you just can’t get the sight and sound out of your head, and again, this idea that once someone falls, you feel like you have to be watching them at all times. And in this case, the person says the person feels that they can’t even sleep for a second, which speaks to, you know, the driver behind the caregiver exhaustion that we typically see.
So, in terms of the, you know, how the brain works, falls are typically caused by changes in the frontal lobe, occipital lobe, and in cerebellum. Frontal lobe is your orientation, the occipital lobe controls your vision and depth perception, and the cerebellum controls your balance, so each area has its own functions and if there are changes there, that’s what really drives a lot of these symptoms. Some of the challenges are that, as we mentioned earlier, even though someone might be a risk for falling, their disease might be creating a situation where they’re driven to move. So, even though they’re told to sit down, even though we know that they’re a risk and tell them that they’re a risk to fall, they may not remember and want to walk as much as possible.
The other thing that can happen is people might have other health conditions, as Keith mentioned with his mom, and they’re actually not moving enough because of heart failure, lung disease, you know, other issues that create a situation where a person can’t move. In those cases, the person becomes very weak and deconditioned, which can also cause falls. The most important point is that falls can lead to fractures and also head trauma, and both of those are very difficult to recover from for people with Alzheimer’s disease.
In terms of the emotions that come up for the person with Alzheimer’s, even with memory loss, it’s amazing how many people will remember the bad falls, and they’ll be afraid of falling again. Obviously, embarrassment that they’ve fallen, tends to be renewed fear of floors that are shiny, also floors that have busy patterns or any type of floral pattern, stripes, boxes, can be really disorienting. And once people are afraid to fall, that follows with isolation. People in many cases will not want to go out and will not want to be around their friends and family. On the professional and family caregiver side, number one fear is when is the next fall going to happen and what can I do to try to prevent it? And again, that exhaustion that comes with knowing that you’re not always going to be there, but you want to try to be there as much as possible to prevent that fall.
Some great solutions for falls, you know, you’re already hearing the benefit of occupational therapy through Bridget’s testimonials, physical therapy is great in terms of helping people to improve their balance and strength, yoga, Tai Chi, really helps with balance and relaxation. Generally, staying active can help to improve, strengthen balance. What we want to make sure we mention is if a person has not tried yoga, Tai Chi, or any type of exercise before, you should really talk to your health care provider to make sure it’s okay to start the activity. And then, in addition to the tools we’re about to go through, occupational therapists and physical therapists can really help to assess or adapt his equipment. That can give somebody additional support. We’re showing you here a cane. There are many other adaptive tools you can use for people who are walking, also people that might be in a wheelchair, to help the person have a little bit more support.
We have three tools here. We’re going to show one, which is the “Preventing Falls” publication from the Center for Disease Control. Again, a tremendous, very comprehensive publication, more for health care providers on the webinar, really helping you to design an environment in the community to prevent falls. So, a lot of the tips that you’re hearing from Bridget today are captured here, as well as others. We’re also giving you, from the Alzheimer’s Association, a Dementia Care guideline for ensuring a safe home setting for people who are a risk to wander, and then a website from the Center for Alzheimer’s that offers tips for starting programs such as Tai Chi, stretching, and yoga.
So, just before the webinar, a couple days before the webinar, we were going through the presentation with Bridget, and she had mentioned that she had a great book and resource that had a great quote, so we wanted to make sure that we included this, and I love it. It’s very positive. Number one, “Muscles don’t get dementia. They can still be strengthened to prevent falls due to weakness,” and this came from a book called “My Past Is Now My Future: A Practical Guide to Dementia Possible Care” written by Lanny Butler. And Bridget, any other comments around why this book stuck out for you, and just why it’s a great message for clients and family caregivers?
Bridget: Yes. I love this book, and I hand it out to a lot of my caregivers as it’s very short and simply written, and it goes through all the stages of dementia and what to expect, and more importantly, solutions to any problems that might come up. I highly recommend this book for any health care providers or caregivers that have loved ones with dementia.
Chris: Awesome, thanks. And Bridget, just to follow up, as we’ve been doing in the other section, I know a big part of your job is responding to falls in the home or assessing the home for fall risk. What are some of the things that you’ve seen in your practice and some of the things that can help?
Bridget: Well, a lot of falls are usually caused by either weakness or a muscle imbalance, or a unsafe home environment. And I, we, obviously, as you stated before, we work on strengthening, as muscles don’t get dementia, so they can still be strengthened no matter what age. And, more stronger muscles, you have less falls, as you can support yourself better. We also work with a lot of adaptive equipment that someone might need, such as a shower chair, to sit down when they shower to prevent falls by bending over when they’re washing their feet, because if vision is ever occluded or if you’re ever bending over, you have a higher risk of a fall.
I also look at a lot of flooring. As you mentioned, different patterns on floors can be seen as different depths for somebody with Alzheimer’s, and they could try to step over or step under when they see patterns in floors, so solid color carpet for flooring is the best for anyone with Alzheimer’s, but you want to be also careful with that, because a dark color flooring, such as black or navy, can be perceived as a hole in the floor, and then they’re going to want to walk around that. So, the light-colored flooring is usually the best. We also assess for lighting. Proper lighting is important. Motion lighting is the best. I always recommend a night light or a motion light from the bed to the bathroom path, because people get up in the middle of the night a lot to use the bathroom.
And, we also look at types of surfaces that are commonly used, such as bed heights and chair heights, and making sure the bed’s not too high, because that can cause a fall because a lot of people get dressed sitting on the bed. And when you sit on the bed that’s too high and you don’t have the support of your feet, someone can easily slip towards the floor. And then, one of the most common ones that I look for in the home are loose rugs. Any loose rugs are a very high fall hazard. In the bathroom, I always recommend those non-skid rugs that stick to the floor easily, and those you can get for about $10, $12 at Walmart. And then…
Chris: Great, Bridget. And just, I’m just…
Bridget: Yeah. Go ahead.
Chris: I just was going to ask, all of these are really great suggestions. The other thing I imagine you must run into is just the structure of homes, the way they’re built in terms of steps and the amount of room people have to move around. Could you just talk about, you know, some of the structural challenges that you see in the home and, you know, the role that you might play or examples of times where you’ve actually modified the way a home is structured for safety to reduce the risk of falls?
Bridget: Yes. I’ve never done a home remodeling, but simple home modifications are definitely done quite often. One example is a woman I had just recently. She has a walk-in shower, but many walk-in showers still have a threshold about three to six inches that you have to step over. And a lot of the older homes have the sliding doors. So what we did, because she had difficulty getting in and out of the shower safely, was we just took down those sliding doors and put up a curtain. And that way, she had a lot more room to expect, to accept getting into the shower, which she had a seat in. And then, we added grab bars. Grab bars are really important, especially in bathrooms, because a lot of bathroom doorways, with anyone that uses a wheelchair or walker, are, with older homes, are not wide enough to allow that device in. So grab bars throughout the bathroom at correct heights and by the toilet and by the shower are also very helpful.
Chris: Great. And then, my last question, I know that, you know, ten, 15 years ago, when someone has a hospital bed in the home with a person with Alzheimer’s, the theory was if you put both side rails up that that would prevent a fall at night. And then, you know, over time, those can, have can, that’s actually considered a restraint in many cases. What are some ways that people could modify the bed or the rails so that a person is safer and not, you know, not maybe as much of a risk to fall, but we’re also not creating a situation where someone’s restrained?
Bridget: Right. The bedrails, I know state to state, the laws change and, but my professional opinion with safety is to have a half rail on the bed, not a full rail. In my professional opinion, that’s not a restraint because they can still get up. And actually the bedrail, I believe, helps them sit up more independently and safely if it’s just at the top of the bed. Each facility you go in will have different rules on that that you’ll have to work around, but having that one rail up, I think, helps prevent falls and helps the, your loved one be more independent getting in and out of bed. If it’s the falls are occurring more frequently, lowering the hospital bed low to the floor at night can help prevent… If they do fall out of the bed, it will decrease the amount of impact and injury he or she may have.
Chris: Great. Thanks, Bridget. Great, great, great expertise and feedback. So Keith, when you look back at your time with your mom, what were some of the situations that came up with falls and how were they managed successfully?
Keith: Well, we found with my mom, a lot of the medications she was taking for the Alzheimer’s, like Seroquel for the agitation, were causing her to lose her balance a lot. So, and medications, you know, sometimes do need to be adjusted from time to time, you know, with your physician’s help.
Keith: Because what we found is, on one occasion, you know, my dad used to help my mom get into the shower, which was a, you know, a regular shower where she had to step over, and she did have a shower chair. And she would, you know, my dad would shower her, and when she was done, this one particular time, he helped her out of the shower, and she was standing there, and my dad had forgotten to get a towel from the closet in the other room. So he said, “Stay right there.” And, as if my mom was going to remember that, but, “Stay right there. I’ll be right back. I’m going to get a towel.” He walked literally ten feet away into another room to get a towel out of the closet, he came back, and she was lying on the floor. She had fallen, and she had broken her foot and ankle at that time. And, subsequent to that, after she had gotten the cast off, she had physical therapy from Fox. And, like the quote says, she still had the Alzheimer’s, but she made a full recovery with her ankle. It, she got back and she was able to walk again with no problems.
Chris: That’s great.
Chris: Thanks for sharing that. And then again, on the emotional side, after someone falls for the first time, I imagine your dad was pretty startled. Is that something where you can shake it off and go back to your normal routine, or do you share it, what we’ve heard from our research that you feel like you constantly have to be watching?
Keith: You feel like you have to be there all the time. You can’t turn away for a second; you’re always worried about her falling or tripping or something like that, and you know, it’s very upsetting to us, but extremely, obviously upsetting to her, because she doesn’t really know what’s going on.
Keith: But yeah, it’s very scary, and you know, it’s, you just got to, you know, be vigilant about it.
Keith: Keep [inaudible 41:04].
Chris: Okay. Awesome. Great. Again, great, great stories. The next section we’ll go through is probably the most emotionally loaded issue. Just during my time with the Alzheimer’s Association, the issue of driving and independence and Alzheimer’s is just a huge issue, a lot of controversy. So, we’re going to touch on some of that, and then I’ll hear, again, a very moving story from Keith related to driving. But some of the reasons that driving is such an issue, we mentioned vision, judgment, reflexes.
There’s a great, great publication put out by the Alzheimer’s Association which is called “Voices of Alzheimer’s Disease”, and this was from a town meeting that was held a number of years ago. And it’s really one of the few times that you can actually hear the insights and the perspectives through the eyes of the person with the disease. So, this quote is so poignant, I’ll read it. “It was very difficult giving up things such as the car when I’m still working. Without my wife taking me to work in the morning and a driver taking me home in the afternoons, I would be pretty much stuck in the house every day.” So the, in many cases, the car, for years, has been a person’s source of independence. It’s their connection to the community, so it’s very, very difficult for a person, you know, to willingly give up something that is such, so important to their independence.
From the standpoint of the challenge, really, as you can see, several areas of the brain, the prefrontal cortex, which really helps the brain to organize your executive functions, which drives, which helps you to drive. Your frontal lobe controls your movement, parietal lobe controls your ability to identify the things like your steering wheel, the gear shift, the traffic lights, and signals, and then the occipital lobe controls your depth perception. So, all those things impact driving. If you have impaired depth perception, if you have impaired judgment and you don’t have the reflexes that you need to drive, then you can’t respond quickly to driving incidents, that’s where we see accidents, which obviously can be really serious. The one challenge is, Alzheimer’s disease often removes insight, so a person may have all of these issues and not really accept that they do and understand that they do, so when, you would think that when someone has an accident or a challenge with Alzheimer’s, that they look at you and hand the keys over, when in reality, most people don’t understand it and don’t realize it and think that we have the problem, if you’re the caregiver, and are very unwilling to hand the keys over. So, it’s a very, very difficult situation.
The driving issue is so complicated that we wanted to call out all the different people that are involved in the decision in terms of whether a person with Alzheimer’s is safe to drive or not. And it’s very important to point out that even the government, that it has acknowledged that there is a time in the early stages of Alzheimer’s where a person can be safe to drive. So, Alzheimer’s alone does not mean that a person can’t drive. It’s more as the disease progresses, and we start to see challenges with driving, that obviously you have issues with the person with Alzheimer’s, family caregivers are involved. In many cases, the family caregiver will go to the primary doctor to express a concern, and the doctor plays a role in writing a prescription to get driving testing.
Law enforcement can become involved, especially if someone has numerous accidents, which is a difficult place to be in because the person has Alzheimer’s. Legislators are involved because local, state, and federal government, a lot of advocacy out there for people to be able to drive with Alzheimer’s disease if they can, but it’s difficult to tell where the line crosses between safe driving and unsafe driving due to Alzheimer’s. And then, the other key player are the, in every state, there is an Alzheimer’s driving testing center where someone’s skills could be tested. And obviously, that’s a really stressful day for the person with Alzheimer’s and the caregiver.
Some of the emotional components, we talked about the fact for a person with Alzheimer’s, it’s the key to their independence. Many feel that they are safe to drive. Some are aware of their issues and they do have insight into their challenges, but are very much reluctant to give up the keys. Just a quick story, we had a gentleman who was unsafe to drive due to Alzheimer’s. His family had actually removed the car from his house. He proceeded to get his credit card and call a car dealership, and actually purchased a brand new car from the dealership, and they delivered it to his house and he wandered again by car and was found 3 hours away. He had run out of gas. So even though he couldn’t drive, he had the resources, he had the desire to drive, and he had the resources to purchase another car from a dealership, so it’s a very, very unique situation.
On the family and professional caregiver side, concerns about safety, when you do need to take the keys or even have the discussion about taking the keys, there tends to be a lot of guilt, which is understandable. You can become very frustrated when the person with Alzheimer’s doesn’t understand the challenge or doesn’t accept that they can’t drive. And, there’s a general sentiment that someone should own the responsibility of taking the keys, and some people say it’s the doctor, some say it’s law enforcement, some say it’s the family. It’s a very, very difficult situation if we’re really all involved.
So, we wanted to make sure that we showed a great tool that was published by the Hartford. It gives you some great information around the driving evaluation that you can get, and again, we do recommend that you ask your health care provider about a driving evaluation if you’re noticing challenges, but this is a, one of the most comprehensive tools that I’ve seen for number one, assessing whether there is a driving issue, recognizing that if there is, it gives you a guide to talk to your health care provider about what’s happening, and it’s very much inclusive, even in the illustration you can see on the brochure. It’s very much inclusive of the person with Alzheimer’s, which I think is very important, that they feel involved and not separate from the process.
So Keith, I know you had, we talked about the first time that you dealt with wandering by car. I know the second time is where you needed to actually step in and make some changes in terms of the car and just the whole situation of driving. Could you walk us through that?
Keith: Sure. And once again, this was just prior to her diagnosis, and this actually caused us to, you know, contact a professional to get an official diagnosis. Mom used to go to Philadelphia quite often to see doctors, and she’d always park in the same parking garage every time she was going there, and also the same floor every time she was going there. And, she had done this for years and years. So, I found out the day after this happened is, my mom had come out of the doctor’s office and went to a corner in Philadelphia and said to the Philadelphia police officer standing there, “Somebody stole my car. It was parked right there at that corner.” And, they ended up getting a hold of my father, who went over and picked her up. I found out the next day, and being a detective that I was at the time, I took a ride over, I went into the garage, and I went up to the top level, and there was my mom’s car parked there.
So, she had totally forgotten where she had parked her car. We knew at that point, we needed to take, you know, some action, because we couldn’t allow her to continue to drive. And, that’s where we took her car keys away, which was extremely difficult. She was very independent; she was still very young and became very agitated quite often with the keys being removed. And, we finally had to disconnect the distributor cap on the car because we were afraid she had keys hidden in other places, then she’d end up starting the car.
Keith: So, that’s where it, you know, where the driving stopped for my mom, unfortunately.
Chris: Thanks for sharing that. I know, again, that a very difficult time. So, you can hear, both from the information that we presented and just the story from Keith, how, number one, how prevalent this is, and how really difficult it is to manage, but that it can be managed, especially using some of the tools that we’ve shared. So, you know, we’ve talked about a lot of challenges. On the positive side, there are some great health care providers that are out there that can really be of support. And again, this isn’t a list of all the health care providers that you work with, but these are the most related to safety.
You’ve heard Bridget with occupational therapy. We have physical therapists, geriatric care managers or social workers, sometimes nurses that get an additional certification to actually come in the home to do a home assessment. Home care is really important because it gives the family a break and a respite from having that sense of vigilance, constant vigilance. Adult day care, visiting nurses, your family doctor or nurse practitioner, and then also advocacy and support groups. So, if you are dealing with Alzheimer’s and you’re not surrounded by some of these professionals, really recommend that you reach out to your primary doctor and try to get a circle of support. And we’re also a resource to help as well, if needed.
I also wanted to make sure that you knew that support groups can be, in some cases, the best practical source for strategies around safety, because these are people that are dealing with it every day. They probably have been through things that you’re already going through for the first time. So, we’ve given you two links to a very easy way to search for support groups. On the left is the Alzheimer’s Association search engine for groups, so you can search by state, and then on the right-hand side is the Alzheimer’s Foundation of America. Both great organizations that allow you to find a support group in your area.
Now I know, Keith, back in 2003, that’s where you and I met, 2002, for the first time, at a support group. Could you talk a little bit about, you know, what brought you to the support group and how much it meant to you, not even just from a safety standpoint, but just from the standpoint of a caregiver?
Keith: I’ll [inaudible 51:19] briefly, my wife actually found a support group through the Alzheimer’s Association, and Chris actually started the group at the asking of two women that are in the group that wanted a group like this that fit their needs, because we were all very young. We had parents that were very young, that the members of the support group were in their 20s and 30s with parents that have Alzheimer’s. And, a lot of the groups we were going to were elderly spouses, and we couldn’t make a connection, but we made a connection with this group in 2002, and it has to be the number one best thing that we ever did because everybody understood what you were talking about. Everybody was on the same page, you know, when you said something, they knew what you were talking about.
Sure, stories varied, you know, from person to person, but it was the best support. I still continue with the support group even after my mom has passed, to help others that are going through this journey, this disease. But I would recommend a support group that fits your needs.
Chris: And I just, I think this is a great place to call out how much courage it takes to be Keith and Judy, and the, all the people in the support group, that they’ve, you know, fought the battle for years with Alzheimer’s, and instead of walking away from it, which could be really easy to do, you stay in the battle and you try to help other people, and you come on a program like this and share what is, you know, very personal information, so we really appreciate your courage.
This next slide is a really important point that we wanted to highlight. You will often hear of the term behaviors when you talk about Alzheimer’s: Alzheimer’s behaviors, challenging behaviors. We wanted to make sure that we closed by noting that these are symptoms. When you have chest pain from heart disease, they’re called symptoms. When you have shortness of breath from lung disease, we call it symptoms. I think it’s a mistake to use the term behaviors, because it alludes to intent, that, you know, in some ways the person can somehow control that or they’re misbehaving. We really want, we want all of you to consider these as real symptoms that the person with Alzheimer’s disease can’t help, and that, having that outlook really helps you to provide empathy, patience, all the accommodations that we’ve talked about, and helps to validate the challenge that the person with Alzheimer’s disease is going through, especially when they can’t communicate that themselves.
I always like to end with a few key takeaways, just points to remember. I know we’ve shared a lot of great information. Number one, the symptoms of Alzheimer’s are caused by changes in the brain, and all of these can create serious safety issues. The good news is, there are things you can do to adapt the home setting. You know, please follow the great recommendations you’ve heard from Bridget and Keith, and we’ve given you some great tools to use, as well. And, it’s important to surround yourself with experts, and also, as Keith mentioned, with other people who are going through the same thing, and that can help you to make a safe environment and a improved quality of life for all of you.
Derek: Thanks, Chris, Bridget, and Keith. Again, gosh, I know. I have a grandmother who’s going through early, has just been diagnosed with Alzheimer’s, and I have a lot of tips just from today’s webinar, so thank you. I know that the material has been very relevant to the audience, as well. So, we already have a lot of questions that are typed into the Go To Meeting panel, so we want to open up a question and answer session to ask our panelists any questions, again, to share any tips, any advice that you may have gone through, that you may have for the rest of the audience if you’re a family caregiver. You can type those into the Go To Meeting panel by clicking the orange button, which expands the Go To Meeting panel, and you can type in any questions directly. While we compile the questions, we will start addressing those questions as soon as they come up. All right, great. We have a few questions, keep typing those in.
Chris: The first question will go to Keith. You mentioned the benefit of support groups, and I know one of the common barriers related to this question is just what to expect. You know, a lot of people don’t go to support groups because they’re afraid they have to sort of tell everything about themselves, that it’s complaining, you know, just, can you give people a sense of when they go to a support group for the first time, what they can expect? How the groups run, and you know, how you can sort of ease into the group versus putting yourself out there on the first day?
Keith: Sure. Generally, the facilitator of the group will introduce herself or his self to the group, and you have a choice. You can speak as much as you want about your loved one and about the disease, or you can just listen to everyone else speak. You’re not obligated to talk. You can say as much or as little as you’d like. Generally, people in the support groups that I’ve been involved with for 11 years, people aren’t complaining, they’re asking for solutions, how to deal with a specific symptom that came up, you know, over the past month, or “How do I deal with this safety issue?” Or, we talk about health care providers, you know, which type of provider I need to take my mom or my dad to, or my sister to. But, it’s a positive, very low-key type of support group, and like I said, you tell what you want to tell, or you can just sit there. You can introduce yourself, and after you can just sit and listen to everyone else talk, and you’ll definitely take something out of it.
Chris: Okay, great. Thank you. And then Bridget, a question for you. Could you talk a little bit about the process that a person would go through to access occupational therapy? I know it’s, I just know that in my years at the Alzheimer’s Association, people knew about OT, but they didn’t know all the services that were provided and, you know, how they could find and access and, you know, even pay for occupational therapy, because, so, could you just talk a little bit about how people could be introduced to your services?
Bridget: Yes. I just got this connected and I just got back in. But, I think you were saying just how to get therapy for your loved one?
Chris: Yeah, especially,
Chris: How people could access, pay for, just the process that someone would go through to access someone like yourself to come in and do a home assessment and do some of the modifications and teaching that you’ve discussed.
Bridget: Okay. Therapy, whether it be occupational, physical, or speech therapy, you can get a prescription from your doctor. And usually, doctors have referred provider lists of rehab providers in the area, and then they can give you that information. The doctor can actually send it to that rehab provider so they can contact you. And, how it’s paid for is, insurance does cover therapy. As you know, insurances are changing a lot these days, especially this year, but Medicare part B, if you have Medicare, that does pay for 80%, and then a secondary usually covers the other 20%. So usually, therapy services are paid for with Medicare. If you only have a commercial insurance, usually a significant amount is paid for with that, too, and any occupational therapist working with older adults can, is usually qualified to do a in-home assessment for your home and give you recommendations.
Chris: Awesome. Thanks, Bridget. I’ll ask this question. I think it would be great to hear from both Bridget and Keith. The question from Deborah is, “A person in the advanced stages of Alzheimer’s is very fearful of going into and out of the shower. What would be the best way of helping people, you know, doing this safely?”
Chris: Bridget, do you want to start?
Bridget: Yes. I think the main thing with anyone with Alzheimer’s who’s fearful is just to validate their fears. Don’t just stay, watch, you sit down and talk to them first and validate their fears and talk about it, and talk about what specifically they’re fearful of the shower. And normally, it’s falling. And then, if you don’t have a place to sit in the shower, that could be one of the main reasons somebody is fearful in the shower, so, and getting a seat for your tub or your shower, installing a bench, is one way to really alleviate those fears. And then, demonstrating the shower for your loved one. You know, doing, depending on the comfort level and the relationship, doing a shower for your loved one, showing them how it works in front of them.
And also, installing grab bars. Anything textured to make it safe. And I notice a lot of people with Alzheimer’s are scared of the floor surface, because it’s usually slippery, so anything to make the floor non-skid is really good. They do have those stickers that you can get at Walmart, they even kind of stick throughout your bathroom floor to make it, the surface non-skid, and they’ll feel a lot safer with that.
Chris: Great. Thanks, Bridget. And then, the two things, just from my days as a nursing assistant helping people in the shower that seem to be reassuring are just touch. I noticed that when people were very much afraid, that I would always have my hand out, either on their side or on their arm so that they, just had a sense of somebody was with them, and it was orienting and reassuring. And then the other thing that I think is really important is that, and we didn’t really talk about this too much, is that typically, when the person with Alzheimer’s falls, a lot of times, the caregiver falls, as well. So, whether you’re a professional caregiver or a family caregiver, remember to pay attention to your balance, you know, that you have a nice, solid foundation before you make that transfer from inside the shower to outside, and, because what ends up happening is you’re focusing so much on the person with Alzheimer’s, that you don’t, you sort of forget about your body and your posture. So, touch, and just also, you know, focusing a little bit on yourself, which is tough for all of us, and making sure that you’re in a good place and ready to make your next move.
Chris: Next question from Andrew, “As my parents’ health care power of attorney, am I legally responsible if she has an accident and there are injuries?” Andrew, I guess what I would, my best response to this, and Keith and Bridget, you can let me know if you have any responses, as well, I think when Alzheimer’s is involved, I have rarely seen any type of legality or litigation around responsibility if someone does fall. The falls actually occur so often, that when we worked in health care facilities, we weren’t even allowed to say “prevent falls” when we did our documentation. We actually had to say “reduce the risk of falls”. So, I would say that power of attorney, your responsibility is to make the home as safe as possible, like, and try to do as much as you can that we’ve described today. But once you do those things, you know, the state, the government, the health department understands that falls happen with Alzheimer’s, and rarely is there blame placed. So, hopefully that’s helpful.
There’s a note from Kelly, “Taking the keys away can be difficult for all. We found it easier to disconnect the battery, and she would always call us to tell us the car was not working, and we would assure her we would be over to check it out. By then, she forgot she wanted to drive.” So, another great, great recommendation from Kelly. And again, there is always a lot of guilt for a caregiver for families who need to do these things. A lot of people have said to me, “You know, I don’t want to lie.” But, you have to remember you’re dealing with a person that is cognitively impaired, you know, so we have to be innovative and do things we wouldn’t do otherwise to make sure that they’re safe. And that’s the kind of tip that you’ll hear at a support group, you know, that isn’t in a book anywhere.
Chris: So, thanks for that, Kelly.
Bridget: There’s one client I had that worked, we had a solution that worked well for her. She was unsafe to drive, and didn’t want to have her cars taken away, so what the family did was they sold the car, and the money that they made on the car and the money they saved from the car insurance, they hired a local taxi driver and paid him monthly, and gave their mother the phone number. And anytime she wanted to go anywhere, she wasn’t at risk for wandering at the time, she was safe to take her dog to the vet and the groomer and go out to lunch, but the mother had access to the taxi driver’s number, and he would come pick her up and take her wherever she wanted to go.
Bridget: And that worked for her.
Keith: One thing I just want to add it, with, when dealing with somebody with Alzheimer’s, you never want to argue with that person, you never want to try and reason with them, because you’ll always lose. I learned that from Chris Kelly in my support group. And it’s true.
Chris: I appreciate that, Keith. So Bridget, we wanted to give you an opportunity to talk a little bit about Fox Rehab. As I mentioned, I had a very long-standing, great professional relationship with Tim Fox, the Founder, and a great presenter and great therapist, and we’ve been at a long, great relationship with Fox. It sounds like Fox supported Keith during some difficult times. So Bridget, just a little bit about your company and how people can reach you.
Bridget: Yes. Fox is in, I believe, nine states now, mostly on the Eastern coast. I know it’s New York, Pennsylvania, Delaware, oh, goodness, New Jersey, Virginia, Maryland, South Carolina, I believe we started in Indiana and Connecticut recently. But, the website will tell you exactly where we’re located, and the telephone number, if you are looking for any physical, occupational, or speech therapy for your loved one, you don’t have to contact the doctor, we can contact the doctor for you to get the order. And, we’d be happy to come out and help out as much as we can.
Chris: Yeah, and while this slide is up, I want to emphasize that, just the importance of speech therapy with Alzheimer’s, as well. We did a webinar a couple months ago on aphasia, and actually had a speech-language pathologist with us, so for this webinar, we wanted to talk more closely about safety, so we focused on the PT and OT, but the speech therapist is, again, a really, really important service for people with Alzheimer’s.
Bridget: Yup, yup.
Derek: Excellent. Again, many thanks to Bridget. Thanks for all the tips and advice from you and from, on behalf of Fox Rehab. On the Griswold Home Care side, you know, we’re again, very thankful to have our presenters and for, thank the audience for spending their time with us today, as well. Griswold Home Care is a purpose-driven care services company. We were founded here in Philadelphia about 31 years ago, and our mission is to celebrate, educate, and advocate the choice to remain independent at home. We currently have over 170 offices in 36 states, and we were founded by our founder, Gene Griswold, who was the wife of a Presbyterian minister who was diagnosed with MS herself and started the company as an entrepreneur over 31 years ago. We can be reached at the number and the website on the screen. And predominantly, what Griswold Home Care does is we refer caregivers into the home who can assist with the non-medical needs that might arise from aging or older or disabled adults. Typically, their services range from personal care, companionship, and light housekeeping services.
Again, we want to thank our presenters, Chris Kelly with Griswold Home Care, Bridget with Fox Rehab, and again, Keith, thank you very much for your courage and sharing all of the personal stories of your family and for making the commute over from New Jersey into Philadelphia today to join us, as well.
Keith: Thank you.
Derek: With that, we will end the webinar. Thank you, everybody. Have a fantastic week.
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