Why I Love PT!

Posted on May 18, 2016 by Anne Ellett

I am such a fan of the benefits of Physical Therapy (PT) for people living with dementia! Actually, I’m such a fan, I would recommend it for just about everyone! And it is very underutilized…..

How many medical therapeutics can you think of that really have no “down side”? If you are prescribed a medication or undergo surgery, there are always risks. If you read the accompanying literature for any medication, the list of possible side effects and risks of interactions with other drugs is very lengthy. If you undergo a medical procedure or surgery, reading the consent form is frightening!

I guess there isn’t anything completely without risk, but in my many years of working with elders, I have yet to observe any adverse effects from receiving Physical Therapy.

I was working with a client recently, a very active 75 year old woman who has had two minor falls. She exercises several days a week by playing tennis and walking and is in good health other than her osteoporosis. Worried about her recent falls, she asked me to put together a program to minimize her risk of falls and injury.

The first thing I recommended was getting a prescription from her doctor for PT. “I wouldn’t qualify for any therapy,” she said, “I didn’t have any injury from my falls”. This is a common misconception that you only qualify for PT if you’re recovering from an injury or surgery. Not true! Medicare will cover a PT evaluation for gait and balance after a fall and probably some ongoing therapy.

A physical therapist can assess your current situation and will set individualized goals to improve balance, gait and restore functional mobility.

Many studies show the value of keeping people affected by dementia up and active. If you observe balance or gait changes, or even minor falls, talk to your health care provider to get some Physical Therapy. The benefits are great, the risks minimal!


If you work in Assisted Living and want
To make your dementia care program even better,
Or if you need assistance in
Planning care for a loved one,
E-mail or call me for a free consultation

Have a great day!

Anne Ellett, N.P., M.S.N.
949 933-6201

Posted in balance, dementia, gait, medicare, physical therapy, PT

The Best Gift of All

Posted on December 02, 2015 by Anne Ellett

I invite you to read this holiday blog from a friend of mine, Pam Oldham, who writes about sharing gifts with her mother during the holiday season:


Many families will visit loved ones living with dementia this holiday season. Often, we make the mistake of trying to recreate family holiday celebrations of our youth. But over time, I’ve taken a new approach, thanks to lessons I’ve learned from my 87-year-old mother who lives in a long-term care facility far from my current residence.

Here are six lessons Mom taught me about holiday visits (plus a couple bonus lessons). I hope sharing them will help you and your family, too!

One really great present is all that’s needed. The family of my childhood celebrated Christmas and featured a massive stack of gifts under a tree. Carrying on that tradition is not longer appropriate for Mom. Too many gifts (and too many visitors) at once can be overwhelming to a person with dementia. Last year, I visited with Mom alone and gave her an interactive holiday ornament that came to life with lights and music at the touch of a button. Mom’s joy and wonderment was evident every time she pressed that button and the light and music show began. She played with the ornament every day during my week-long time with her.

Sing happy songs. Yes, sing and sing boldly. It doesn’t matter if you have a good voice or not. Holiday sing-alongs weren’t among my family’s traditions when I was a child, so I didn’t realize until recently how much Mom enjoys belting out holiday favorites. Sticking to songs with simple lyrics from old standards, like “Jingle Bells,” ensured Mom’s participation, to her great happiness. We began in the dining hall after dinner and continued singing all the way back to an activity room where a holiday event was about to begin for the enjoyment of residents. Hearing Mom’s laughter each time as we stumbled over lyrics warmed my heart.

“Selfies” aren’t just for the young. Mom first learned about smartphone cameras three years ago, and she loves our tradition of taking at least one official selfie during every visit. For our holiday pic, we don Santa hats that I bring and then we mug for the camera. As we check out the resulting images, we reminisce about past holidays and visits with Santa. I usually print the best image locally, frame it, and then give it to Mom before I leave for home.

Holiday lighting displays are still magical. Since Mom lives in a cold climate, it’s usually impractical to take her out to view neighborhood lighting displays by car. However, because her community is located in a residential neighborhood, displays can be viewed easily and warmly from inside the facility. We move our personal holiday party to an activity room with big windows facing decorated yards, turn out the room’s interior lighting, and then gaze with wonderment at all the beautiful lights outside.

It’s okay to be silly. Mom hates regimented exercise, but when I suggested that we take our song and dance routine to the halls of her facility, she eagerly agreed. I strapped some bells to her walker and we headed down the halls, singing holiday tunes and fancy stepping as went. Staffers and residents were delighted, and we had great fun. As an added bonus, the exercise invigorated Mom’s body and spirit at a time when she needed it most.

Your presence is the best gift of all. Visit regularly and often. During the holidays, a long-term facility can be a very lonely place for residents and staffers. Instead of planning one “big” celebration on a single visit, return several times during the holiday season for many smaller celebrations.

When I was a child, Mom taught me to be on lookout for people who need cheering up during the holiday season. Many long-term care residents don’t have any family members or visitors during the holidays. So, I always reserve time at the end of each visit with Mom to stop by open doors on my way out of the building. I greet each resident and wish him or her a happy holiday. Judging from their smiles and hand waving, this simple recognition brings them great joy.

Lastly, when you visit during the holidays, consider bringing some special snacks for staffers to share. They have sacrificed time with their own families to care for your loved one. It’s been my experience that cookies and veggie trays are especially appreciated.

Happy holidays!

Based in Austin, Texas, Pamela Oldham is a professional writer and care advocate for people living with dementia. Contact her at oldhamwriter@gmail.com and follow her on Twitter @pamelaoldham.

Posted in dementia, holiday visits, Pam Oldham, six lessons

3 Tips to Support Family Care Partners When Their Loved One Moves to Assisted Living

Posted on October 28, 2015 by Anne Ellett

3 Tips to Support Family Care Partners When Their Loved One Moves to Assisted Living

If a person living with dementia moves into a full time care environment, such as Assisted Living, the family is often assaulted by a myriad of conflicting feelings…..Guilt (I told her I would always take care of her), Inadequacy (I should be able to take care of her), Fear (will they really take good care of my loved one?), Anger (it’s not fair that I have to deal with these difficult issues), Exhaustion (I can’t go on like this) and Relief (thank goodness I’m getting some assistance).

When Assisted Livings or other LTC settings accept a new resident, they are also accepting the family.  Caring for the families of residents living with dementia can be as important and complex as caring for the actual residents!  All of their fears and doubts have to be addressed and the Assisted Living needs to have a program to “wrap their arms” around not just the new resident but also the family members.  Most likely the family has had a long struggle to find the right level and type of care that would be best for their loved one.  Recent trips to the hospital, changes of medications or health status, and finally the realization that they can’t continue to do full time care at home, can leave them emotionally and physically exhausted.

Here are three strategies that Assisted Living communities can use to support the family care partners and give them confidence in your care:

1. Assign one leader in your community as their case manager.
Every leader is assigned a group of residents that they “case manage” and are responsible for.  Initially the case manager is in frequent contact with the family, getting to know the family’s preferences, priorities and “hot buttons”. 

For the new resident and their concerned family members, moving into a care community can be like that first day at a new school – so many new faces and names.  By assigning a case manager, the family feels they have one person as the point of contact and don’t have to “tell their story” over and over again to many different people.  As they become more familiar with other staff and develop trust, the family will begin to talk with others.  Initially however, by assigning a case manager, they will feel they have a person who is accountable for the quality of care and will be their advocate and answer their questions. This can go a long way towards building family confidence in your Assisted Living community.

2. Have an on-site support group for family members.
From my experience of working in Assisted Living, I have utmost respect for the important role that support groups can play in helping families feel comfortable, encouraging them to take good care of themselves and begin to let go and trust you.

Invite new families to join the support group.  This can be a great source of comfort and information.  Other family members have an appreciation for the trauma and fears that new families are experiencing and participation in a group can give the members an outlet to share their emotions. 

Members of a support group also encourage other members to take good care of themselves.  A simple question such as “What did everyone have for dinner last night?” can bring to light problems such as sadness from eating alone, and risks of poor nutrition.

3. Plan fun social events for family members off site.
Sponsoring a gathering for Happy Hour at a local restaurant, a meet-up at a Museum or an afternoon of bowling, can add some normalcy for family members and give them something to look forward to.  For a short time, they are just a group of adults having a social time that is not necessarily linked to caring for someone living with dementia.

Many care partners have necessarily put their own lives and interests “on-hold”.  Friendships may have slipped away and they may be out of practice or not have the energy to arrange social events.  Inviting them to a fun occasion can give them permission to begin to enjoy life again and explore their community.

I’ve seen wonderful friendships forged from family support groups. 

If you work in Assisted Living and care for residents living with dementia, what is your plan of care for your family members?  Are you meeting their needs?

If you work in Assisted Living and want
To make your dementia care program even better,
Or if you need assistance in
Planning care for a loved one,
E-mail or call me for a free consultation


Have a great day!

Anne Ellett, N.P., M.S.N.
949 933-6201

Posted in Alzheimer's, Anne Ellett, Assisted Living, Dementia, Tips to support family care partners

Pioneer Network Annual Conference

Posted on July 28, 2015 by Anne Ellett

There’s an exciting event happening next week for those of us interested in change in long-term care. The Pioneer Network’s annual conference is in Chicago Aug. 2 - 5th.  Pioneer Network is a national coalition of people interested in changing the culture of aging and how the aged are cared for.  As advocates for older people, they are working for changes that allow the choices of older individuals to be respected, whether they live in their homes or in a nursing or community facility.  Their upcoming conference is all about culture change in long-term care.  

One of Pioneer Network’s Initiatives includes setting standards for person-centered training on dementia care.  Person-centered care moves away from impersonal, fragmented and regimented care towards care that includes the psychosocial, spiritual as well as the physical being. 

Imagine an environment where the caregivers are trained to stop and listen and validate instead of walking on past that person affected by dementia who is holding out their arms? A friend of mine who recently toured a nursing home told me he was so saddened by the tour director who focused entirely on him, ignoring the pleas of the residents for assistance.  While trying to impress him with their compassionate care, the director disregarded the needs of the residents.  My friend is continuing to look for a better place for his mother to reside.

There is free live-streaming from the Pioneer Network conference next week Aug. 3 and 4th.  Tune in and listen to a few sessions: http://www.pioneernetwork.net/Events/2015Conference/videostreaming/

Posted in dementia, pioneer network conference, videtostream

Are You Looking for Memory Care in Assisted Living?

Posted on June 22, 2015 by Anne Ellett

Memory Care in Assisted LivingRecently 2 different families contacted me about urgently helping them find a good location for care for their loved one affected by Alzheimer’s disease.

In one case, the gentleman was already living in Assisted Living but no one had picked up that he had a urinary tract infection (UTI).  The infection became severe and he required hospitalization (a hospitalization that probably could have been avoided if the staff had been attentive to changes in his demeanor and activity).  Now that he was being discharged from the hospital, his daughter didn’t want him to return to the same Assisted Living.

In the second case, the woman lives at home with her spouse and she has had a couple falls at night, one breaking her arm.  The family was looking for a place where both of the parents could live together, but have assistance during the night.

How do you know what to look for when you are looking for memory care in Assisted Living?

This is a very complex topic, but here are some quick tips:

Licensed or registered nursing, on-site, 24 hours a day, is a big plus! Over 70% of people living in Assisted Living have cognitive impairments and over 90% have multiple chronic illnesses, such as diabetes, hypertension, or cardiac disease that require regular monitoring.  If nursing is not available, small health problems (such as UTI’s) can become emergencies and the person is faced with the trauma and expense of what could have been a preventable hospitalization.

•  Beautiful buildings don’t necessarily equate to excellent care. We would all love to reside in lovely places but when you tour a location, pay extra attention to the number of staff, how they are engaged with the residents, the tone of their voice when speaking to residents, how the residents are groomed, and what type of activities are going on.


•  Good dementia care requires specialized training. Ask about what type of training both the leadership and the staff receive.  Is the training on-going or only when they are initially hired?  As you tour, stop and talk with staff and ask them about their training.


•  Ask for names and contact information of other families who have loved ones living there. Talking directly with family members can be invaluable – inquire how long their loved one has lived there, how responsive the staff is to care concerns, and how satisfied they are with the care.  What do they consider the positives and negatives of having a loved one live in that Assisted Living location?


•  If possible, start your search early and take your time.   Unfortunately, with these 2 families I am currently assisting, we don’t have a lot of time but I recommend that when possible, begin to visit local Assisted Living locations even if you don’t think you’ll be using them.


You’ll learn a lot if you visit places more than once and at different times of the day. You can stop in unannounced and see how you are received.  Ask to meet with the Administrator and the nurse to hear from them what type of services they can offer your loved one affected by dementia.  And review the cost of care in detail – if the Assisted Living charges for various “levels of care”, the monthly cost can be a surprise – be sure you have all the details on their charges.  And good memory-care locations may be full and have a waiting list – go ahead and put yourself on the waiting list!

If you would like to learn more about how to choose an Assisted Living location that can provide good care for your loved one living with dementia, contact me at:


Posted in Alzheimers, dementia, memory care, nursing

Can We Modify the Risk Factors for Developing Dementia?

Posted on June 11, 2015 by Anne Ellett

This is good news!  More studies are showing that there are interventions that can decrease cognitive decline.  A recent randomized controlled study out of Finland, published in the medical journal Lancet, March 11, 2015 notes that up to one-third of Alzheimer disease cases may be attributed to modifiable risk factors. 

You may ask…What are modifiable risk factors? Research is showing that lifestyle choices such as lack of exercise, diets high in animal fat, smoking, excessive alcohol, lack of cognitive stimulation can separately, or together, increase your risk of developing Alzheimer’s or other dementias.  These factors are modifiable because they are within our ability to change them.  You have the power!

In Finland, over 1200 patients, ages 60-77, who were at risk for developing dementia, were divided into two groups: the control group received general health advice and the other intervention group received focused counseling sessions regarding diet, cognitive training, exercise and monitoring for vascular factors such as hypertension.

The intervention group improved 25% more than those in the control group on scores on neuropsychological tests and those patients in the control group were at significantly greater risk for overall cognitive decline after two years in the study.

This month, let’s make a choice to assess our own lifestyle habits that may be increasing our risk for developing dementia.  We have a choice, we can make a difference in how we help our brains stay healthy!

•  What is the frequency of you participating in aerobic exercise? 5-6 days a week is recommended – choose something you like!
•  Do you have a diet high in saturated animal fats? Let’s eat more quinoa and fish and less red meat!
•  What’s the frequency of cognitive stimulation? Are you challenging yourself? Are you learning new skills, taking a new class, learning a new language?  Especially if you are retired or working part-time, you have the time to learn a new skill!
•  Do you have regular checkups with your primary care provider? If you have hypertension or diabetes, are they in good control?

This is exciting! It is great to know that are multiple things we can be doing to help our brain age in a healthy way while minimizing cognitive decline…..I’m making stuffed bell peppers with quinoa tonight for dinner :-), what are you having for dinner?

Posted in Alzheimers, dementia, risk factors

Setting Standards for Dementia Care

Posted on May 26, 2015 by Anne Ellett

It was exciting to read that at ALFA’s most recent national conference in May, setting standards for dementia care was identified as a critical issue for their organization.  Some studies indicate that up to 60-70% of residents living in assisted living have memory changes such as MCI (mild cognitive impairment), Alzheimer’s disease, vascular dementia or some other type of dementia.

It’s a credit to ALFA that they are making standards of dementia care a priority for their assisted living members.

Providing compassionate and life-affirming care for people living with dementia is complex.  The pervasive culture of “person-centeredness”, providing care that is individualized and respects the “whole” person, needs passionate leadership, adequate staff training and engagements that are stimulating and interactive.  This type of care is not easy to deliver.  ALFA’s focus on setting standards for dementia care will provide the “top down” support for dementia care operators to assess their programs and improve as needed.

Consumers, such as customers shopping for senior  housing, may assume there are already standards in place for dementia care. Almost every assisted living sells itself as providing “memory care” for their residents.  Unfortunately, not every Assisted Living community has done its “homework” and prepared a safe and life-affirming environment for their residents affected by dementia.

Each state has its own regulations defining which type of assisted living can provide care for people with dementia.  There are not national standards.  Most states have regulations that require some additional training, but it varies from 6 hours up to 40 hours of training.  Some states require that there is nursing on-site or other states may only require a nurse available “on-call”, or no nurse at all.  Most states don’t specify staff ratios for caring for those affected by dementia, but will write something vague like “staff must be adequate to provide for the health and safety of the resident” – interpretation is left to the dementia-care operator.

As consumers of dementia care services, it behooves us to ask questions.  If you’re moving into a memory-care assisted living, what are their standards?  Can they explain those standards to you and also explain how they operationalize them – how many hours of training does their staff receive?  What is the ratio of direct care givers to the residents? How do they handle emotional outbursts (behavioral expressions) by residents?  Do they have a medical director or other health care providers who visit the residents on-site?  What is their system for handling a resident who becomes ill?

As customers of dementia care, we can help improve standards of care by asking questions of our assisted living operators and showing them that compassionate care is the standard we expect!

Posted in alfa, Alzheimers, dementia, MCI, mild cognitive impairment