Alzheimer's, Dementia, Emergency Preparedness, Health & Wellness, Senior Services

Emergency Room Environment for Alzheimer’s Patients – Denver Hospital Takes the Lead

I would not call the emergency room featured in the article below “paradise”, but I would say it is a vast improvement over others in terms of amenities and should be considered for all emergency rooms, not only for those receiving persons with Alzheimer’s and dementia.

There are large clocks to read the time, big white boards written with exactly what tests and treatments you are receiving and how long they will last, softer lighting, no disruptive noises from monitors, curtains with soothing scenes to look at such as waterfalls.

The report claims the floors are designed with falls in mind but the bathroom floor looks like tile. No to tile! Use linoleum (rubber) or other material which can cushion falls and is quiet!!

Wondering if I missed seeing guard rails on the bed.

The senior TV correspondent in the video in the link falls short of being articulate, but the TV station footage captured at the hospital is worth viewing.

Congratulations to Denver’s Lutheran Medical Center for taking this first step. May the world follow your lead.

Note: The article in the link below was found on an excellent free weekly newsletter (via a Denver TV station). Alzheimer’s Weekly.

Aging, Hospice, Mexico, Palliative Care, Senior Services

2nd International Palliative Care Congress in Guadalajara, Mexico – Oct 2015

Juntos Contra el Dolor, AC (United Against Pain) a palliative care non-profit in Guadalajara, Mexico produced its 2nd International Palliative Care Congress (II Congreso Internacional de Cuidados Paliativos) at Expo Guadalajara October 29, 30, and 31, 2015. Physicians, psychologists, social workers, tanologists, nurses, and hospice volunteers participated in a study of the theme, Health Crisis: A Threat or an Opportunity for Growth?

Juntos Contra el Dolor Palliative Care Congress, Oct 2015, Mexico
Juntos Contra el Dolor 2nd International Palliative Care Congress, Guadalajara, Mexico   October 2015

Dr. Marcos Gomez Sancho, pioneer and thought leader in palliative care from Spain’s Canary Islands, was the main speaker. He spoke of the History of Death in Different Cultures, the Agony of Death vs. Dying in Peace, and, Advice for Family Caregivers in Terminal Situations. In addition to his own conclusions, he chose quotes from poetry, music, psychiatrists, and authors, as well as art work, to illustrate his main points:

the family must allow the ill person to make their departure

the experience of the person who is dying can help those who are witnessing their passing

the worst deaths are for those attached to machines (extreme personal pain, extreme financial costs)

the care team must be inter-disciplinary for best positive outcomes (attending to psycho-social, economic, physical, and spiritual needs of patients and families)

Dr. Marcos Gomez Sancho of the Canary Islands, Spain
Dr. Marcos Gomez Sancho of the Canary Islands, Spain, thought leader in palliative care signing one of his books

Dr. Gomez played a tape of Greek singer Demis Roussos’ Morir al Lado de Mi Amor (To Die Beside My Love), which reiterates a common last wish. He also quoted Austrian neurologist Sigmund Freud, “If you want life, prepare for death.”

Here below are You Tube links to Demis Roussos’ music in Spanish and French. (The Congress heard audio only, it did not view photos): with Spanish sub-titles woman admirer’s production with no sub-titles  in French

Other compelling lectures included anesthesiologist Dr. Beatriz Angelica Flores Garcia’s controversial topic Morfina vs. Marihuana. She outlined how morphine and marijuana can be used for pain relief. No one on the panel of professionals, nor anyone from the audience, could agree about use of either or both, and/or effects.

Psychologist Ortencia Gutierrez Alvarez focused her talk about crisis in the family as it relates to decisions. Conclusion? Allow free will of the patient. Psychologist Fabiola Montoya Martin del Campo who has worked with youth with cancer for over 20 years shared stories of the bravery and wisdom of children facing crisis. Dr. Cristina Orendain, a well-known naturopath with a number of health food stores in Guadalajara, spoke about tryptophan for pain relief and as a mood enhancer in our food and in supplement form.

Juntos Contra El Dolor founder Dr. Silvia Susana Lua Nava, an expert in palliative care and a nun, was the guiding light behind the conference together with Sister Martina Zumaya Tamayo, a nurse nun with a specialty in bio-ethics. They offer an integrated model for Mexico including best possible professional care with support for both patient and family. They welcome persons of diverse socio-economic background, religion, age, and race at their hospital for care, counseling, or to arrange in-home services.


Hda. Madre Silvia Susana Lua Nava, MD
Hda. Madre Silvia Susana Lua Nava, MD

Dr. Lua offered her own account about suffering and pain as an opportunity for spiritual growth. In 2015 she experienced three invasive surgeries, one to correct a surgery gone wrong. From age 19 to 2015 she endured five other surgeries. The presentation of how she learned to confront and overcome pain and the unknown was both amusing and inspiring. Dr. Lua is also the author of a book about palliative care which shares her insights, El Enfermo: Terreno Sagrado (The Ill: Sacred Ground).

Dr. Manuel Centeno from OPD Hospital Civil Guadalajara (the new civic hospital Dr. Juan I. Menchaca) addressed the most frequent problems treating patients with cancer of the colon. Nurse Elisa Gutierrez Andrade spoke of placement and complications involved with surgically implanted PEG’s (percutaneous endoscopic gastronomy), stomach feeding tubes. In both instances, explicit photos were shown and the lessons about care were clear and convincing.

Maria de Jesus Gonzalez Romo spoke of home nursing care and a not unusual circumstance – attending to men who have two families – two “wives” and two sets of children all meeting at the man’s death bed. Gonzalez spoke of what the patient suffers physically, psychologically, and spiritually – and how survivors deal with the patient’s pain and their own. Lots of drama – anger, forgiveness, fighting – but also a lot of love.

Attendees earned 20 continuing education credits and a diploma from the Colegio Nacional de Cuidados Paliativos de Jalisco,

A note about palliative care in Mexico:

The Ministry of Public Health instituted a law in 2009 that all citizens should have access to palliative care (pain relief and comfort for chronic diseases and at end-of-life). In October 2014 the Human Rights Watch conducted a study which showed the availability of palliative care is uneven and limited throughout the country. There are also politics associated with obtaining opiods. See article at

A note about Juntos:

As with most non-profits, Juntos Contra El Dolor relies on donors – pharmaceutical companies, the Catholic church (which provides the housing), volunteers, and others. Throughout the year Juntos hosts weekly educational activities in an effort to support its professionals and its expenses. Dr. Nava and two other nuns are unpaid. Funds for cleaning supplies, diapers, kitchen items, linens, gasoline for in-home visits, nursing staff, nursing supplies, and upgraded office equipment are always in need. Juntos is registered as an international non-profit and all donations are tax deductible by deposit to the Juntos Contra El Dolor account at ScotiaBank CTA 01002517167. More information is available at tel. (52)(33) 3617-2417,, or at

The web site for Dr. Marcos Gomez Sancho is


Aging, Ecuador, Ecuador Senior Living, Health & Wellness, Senior Services

Cuenca, Ecuador Inaugurates New City Senior Center

Mayor Marcelo Cabrera, his wife, city dignitaries, employees, and approximately 150 seniors were present Sunday morning, April 19, as Cabrera proudly inaugurated one of Cuenca’s special projects, the “first free public senior center” also known at El Hogar del Abuelos (Home of the Grandparents).  Eight other city senior centers are in the planning stages.

See Cuenca High Life article at link below

Cuenca Ecuador's new city senior center in the El Vergel neighborhood
Cuenca Ecuador’s new city senior center in the El Vergel neighborhood
Aging, Alzheimer's, Assisted Living, End-of-Life Care, Health & Wellness, Hospice, Long-Term Care, Palliative Care, Senior Services

Institute of Medicine End-of-Life Care Conference March 20

I am super excited to attend this on-line conference (a webinar), open to the public, on Dying in America – what we can do for better communication with patients and their families, what education and development opportunities can be created and implemented, and most of all how we can create a future where palliative and hospice care is serene, comfortable, painless (should the patient wish this), supportive, and honoring free will. See link below for details.

IOM looks deep into end-of-life care.

Assisted Living, Health & Wellness, Mexico Senior Living, Retirement, Senior Living, Senior Services

Mexico’s AMAR Hosts Senior Living Convention w/ North American Investors & Retirees

AMAR, the Mexican Association of Retirement Communities (Asociacion Mexicana de Asistencia en el Retiro), is hosting AMAR’s International Convention 2014 at Rosarita Beach Hotel, Rosarita Beach, Baja California, October 23-25, for North American and Mexican senior housing industry professionals and the public. Rosarito Beach is 20 miles south of San Diego, CA in Mexico.

The event focus, part of a continuing dialogue, is how to attract a portion of North American Baby Boomers over the coming years to senior-friendly, affordable destinations in Mexico with ideal weather,  health services, infrastructure, and proximity to the U.S. It is anticipated that of 100 million boomers in Canada and the U.S., 4 million will consider living in Mexico. According to Internet statistics, there are currently 1,400,000 to 1,600,000 U.S. citizens living in Mexico, not all retirees.

Experienced Canadian and U.S. senior living developers, operators, and executives will meet to discuss collaboration possibilities with Mexican developers and investors.

Among the 22 scheduled speakers are Americans Martin Lakatos, VP and developer for California based Front Porch Development Company; Patricia Will, CEO of Belmont Village Senior Living (23 Assisted Living properties across the U.S. and one in development in Mexico City); and Matthew J. Downs of the Center for Medicare Portability. Javier Govi, Founder & CEO of AMAR; Ignacio Bernal of FONATUR (a Mexican government entity which plans and develops top tourist destinations); and Rodrigo Contreras Mejia of PROMEXICO (a Mexican government trust for international trade and investment) will be among the speakers from Mexico.

Subjects will include elements for successful operation of CCRC’s, active senior living, and Alzheimer’s and dementia care with holistic/wellness-based concepts, eco-friendly LEED-certified construction, universal design, and health information technology. Topics will also include the state of MOM and POP projects, aging in place communities where services come to you, and Medicare in Mexico. (Medicare is not yet accessible outside the U.S. unless under rare circumstances. American seniors can purchase Medigap emergency plans C, D, F, G, M, or N with a $250 deductible).

Lic. Javier Govi, Founder & CEO AMAR
Lic. Javier Govi, Founder & CEO AMAR

When asked about the current state of senior living and its future in Mexico, AMAR’s Javier Govi stated, “We currently cater to the mom and pop market, the parents of baby boomers. We are simultaneously transitioning to meet the needs of boomers who have begun to retire. We have spent years studying this market, looking at the history, and visualizing the future. The important components for boomers will be wellness, fitness, and a holistic approach.”

An adjunct part of the event is the 50+ Expo and Workshops for Healthy Living where the public can learn about senior living options in Mexico.

AMAR Friends Foundation, which helps retirees find independent or assisted living in Mexico, is sponsoring the 50+ Expo. Seminars are designed “to answer questions from banking to moving belongings, and what is involved in obtaining a residential visa,” added Govi. The expo also includes product displays and music. The foundation will soon be providing social service projects for poor elderly Mexicans through its North American volunteers. See

AMAR, founded in 2007, is the first national Mexican non-profit organization committed to educate and collaborate with Mexican government regulatory agencies and business executives in Mexico and North America on the potential of the senior housing industry in Mexico.

For more information on the event go to, write, or call San Diego, CA number (619)564-4007.

Alzheimer's, Assisted Living, Health & Wellness, Senior Services

Interior Design for Alzheimer’s/Memory Care Communities – A Successful British Experiment

For almost two decades, especially since I served as night time administrator and marketing director at an Alzheimer’s campus in southern California, I’ve been focused on universal design – how to create a safe, practical, healthful, and inviting environment not only for those requiring memory care, but for anyone, even those of us fortunate enough to be well.

What could be better than an immaculate, welcoming, protective atmosphere where ever you live?

Yesterday I viewed a video about interior redesign of a dementia wing at Elmhurst, an assisted living village in England. I like much of what was chosen. I might not have chosen laminate flooring even if it looks great and is easy to clean, I don’t find it eco-friendly.  I may have choosen linoleum, cork, or wood instead as there is no off gassing. These green products might be safer for falls.  But I imagine there may have been budget considerations. Other than that, a fine redesign job. Based on a visual site visit, even from afar, I would consider recommending this community focused on wellness.

Note the energy of light features, especially the use of skylights and large windows, and the secure garden area.  Also note the reason red prompts were chosen for the bathroom, and cerulean blue gray for the dining room plates. There is valuable information in the video at the link below.

   please don’t be shocked by the red, there is an excellent reason for the choice


Emergency Preparedness, Health & Wellness, Long-Term Care, Senior Services

CMS (Medicare and Medicaid Services) Proposes Stepped-Up Emergency Preparedness

In light of devastating and continuing natural disaster challenges throughout North America, the Centers for Medicare and Medicaid Services proposes increased emergency preparedness standards for long-term care facilities.  May this plan be implemented soon!!  Below is an article with more details by  for McKnight’s

January 03, 2014

CMS proposes more rigorous emergency preparedness rules for long-term care facilities

CMS proposes more rigorous emergency preparedness rules for long-term care facilities
CMS proposes more rigorous emergency preparedness rules for long-term care facilities

Long-term care facilities would have to meet more comprehensive emergency preparedness guidelines, under a newly proposed rule from the Centers for Medicare & Medicaid Services.

Events such as the Sept. 11 attacks, Hurricane Katrina and recent devastating floods around the nation have shown that current emergency preparedness requirements for Medicare and Medicaid providers are inadequate, according to the 120-page proposed rule. Therefore, CMS has drafted more robust requirements for providers and suppliers.

Long-term care facilities would be subject to similar requirements proposed for hospitals. These are based on the principle of “all-hazards planning,” the rule states. This means planning should not involve developing highly specific plans for every conceivable threat, but should focus on creating the capacity to handle a spectrum of emergencies. The government has identified 15 scenarios for healthcare providers to use in assessing their risks, including natural disasters, cyber attacks and biological attacks.

Based in part on a risk assessment, hospitals should develop specific policies and procedures, the rule states. These include such items as tracking the location of staff and patients, and ensuring that medical records are “secure and available” in an emergency.

Long-term care facilities would be responsible for meeting all the hospital requirements, with some specific adjustments and additions, according to the rule. LTC facilities would specifically be directed to account for missing residents during a disaster, would have to determine what emergency planning information should be shared with residents and families, and should evaluate the need for chargers or electrical outlets for items such as motorized wheelchairs.

Click here to access the complete document, issued Dec. 27. Comments are being accepted through Feb. 25.

Assisted Living, Health & Wellness, Senior Living, Senior Services

PBS and Scan Foundation Host Long-Term Care Discussion

Very exciting senior care news…

Today, in Washington, D.C., PBS and the Scan Foundation (health insurance for the 65+ crowd) host a conversation about long-term care models from around the world.  Panelists will discuss the possibility of successfully implementing some of these models, as well as regional ones, across the U.S. The taping event is sold out but keep your eyes open for the air date. Wish I could be there!

Here is the official announcement:

The PBS NewsHour’s Hari Sreenivasan will lead an exploration of long-term care, from across the global village to Main Street U.S.A. After looking at different models for providing long-term care and benefiting from expert commentary, the event will aim to answer the question: can what works there, work here?

The conversation will feature:

An interview with Dr. Bruce Chernof, President & Chief Executive Officer of The SCAN Foundation and former chair of the federal Commission on Long-Term Care
Video and expert discussion of models for long-term care, including examples from California, Minnesota, Washington, D.C., Finland and Taiwan
We will be joined by:

Dr. Laura N. Gitlin, Director, Center for Innovative Care in Aging, Johns Hopkins University
Howard Gleckman, Resident Fellow, The Urban Institute
Jennie Chin Hansen, Chief Executive Officer, American Geriatrics Society
Dr. Mark McClellan, Director, Health Care Innovation and Value Initiative, The Brookings Institution
Dr. E. Percil Stanford, President, Folding Voice LLC
Debra Bailey Whitman, Executive Vice President, Policy, Strategy and International Affairs, AARP

Assisted Living, Health & Wellness, Senior Living, Senior Services

John Gonzales on Emeritus Senior Living Exposure

Here below is a well considered article by Assisted Living insider John Gonzales brought to my attention by Steve Moran’s Senior Living Forum.   It is worth reading…

Dangerous Bridges – – A Commentary on the PBS Expose of Emeritus Assisted Living — 31 July 2013

I asked John, who has become one of my favorite writers if he would be willing to write an insiders perspective. This is what he sent me and it is terrific. – Steve Moran

When I was asked to write this commentary, I assumed I too would take the familiar position dictated by my “corporate instinct” and rush to the defense of our industry, because one of our own was being attacked. “Let him without sin cast the first stone,” right? Those of us who can claim the moniker of senior housing “veteran” know all too well the challenges we face with a transient employee base, 24/7 operations and the risks and potential for human error inherent in an industry that seeks the promotion of decision making and independence in a frail population.

After all, who among us can claim to be deficiency free in 100% of our surveys? Anyone receive a call or letter from a current or former employee complaining about being short staffed? Anyone else make decisions driven in large part by the requirement to make the bottom line?

I think we can agree that perfection may be something we strive for, but the reality of achieving and maintaining it is rare in any business. When I read and saw the expose on Emeritus, I felt that many of the criticisms arguably fell into the category of “reasonable imperfection.” Human error will be here as long as there are humans. I touched on this in my piece, “The Dirty Secret about Assisted Living.”

Come with me on a little metaphorical trip. You’re driving with your family when you come upon a sign that states, “Warning – Structurally Deficient Bridge Ahead! – US Dept. of Transportation” Would you drive yourself and loved ones over the oncoming bridge span? Maybe, if you were being chased by an angry international drug cartel firing bullets at your vehicle and this was the only escape. How about a bridge with the same warning sign that happens to be part of your daily commute? Fact: one in nine bridges in our nation are currently classified as “structurally deficient.” That’s roughly 66,000 bridges, on which more than 260 million trips are made each day. But, according to the Federal Highway Administration, the fact that a bridge is classified as “structurally deficient” does not imply that it is unsafe. I imagine that the people who lost friends and family in 1997 when the Interstate 35 Bridge collapsed in downtown Minneapolis might disagree.

Using the above scenario, replace the “bridges” with Assisted Living communities; cars and their passengers with residents; and the number of trips across the bridge with resident days. In our industry, we have to “do it right” 100% of the time – each day a resident lives in our community (each trip across the bridge) has to be safe. Does a survey deficiency, a complaint, a fall or medication error make a community unsafe? Does it make all communities unsafe? No. But I imagine that many of the family members of residents who’ve experienced negative outcomes – like those featured in the PBS documentary – might disagree.

Now, here’s where I take leave of my comfort zone. Maybe it’s my Jerry Maguire moment, although I hope not…I don’t like Tom Cruise movies in general. There are several very troubling issues highlighted in the PBS expose that from all appearances seem to be driven – either intentionally or not – from Emeritus’ corporate office. The either tacit or overt direction to disregard state regulations to expedite move ins, the low priority given to staff training, and the culture of revenue over residents are egregious and shameful.

Having worked in nearly every community-level position before moving into regional and corporate roles in the industry, I can tell you that there are many executives in our industry that have lost sight of our residents – if they ever had it. If you have a passion for seniors and work in this industry, hearing the term, “heads in the beds” should make you nauseous. A corporation can create brochures and beautifully crafted mission statements, but – as I point out in, “Pop Rocks for Dinner,” this is meaningless unless backed up with actions and resources. One truth I’ve learned in my 27 years in senior housing is that there are far too many people sitting around corporate conference room tables that shouldn’t be there. I can give you a few names if you’d like.

Before you think me naïve, I am all too well aware that this is a business; and no one benefits from a poorly run or failing business; not the residents, not the staff, not the stake holders – not us. I’m continually reminding colleagues that this business requires a constant balancing of the head and the heart; of compassion and business sense. If, as a community, regional or corporate level manager, you are not in a constant state of conflict, then you’re doing something wrong – something is out of balance. Ladies and gentlemen of the jury, something appears to be dramatically out of balance at Emeritus, and it’s to our collective shame.

I hope and pray that this public exposure of what can and will happen when a company gets out of balance, placing the desires of shareholders over the needs and rights of the residents, will be a wake-up call for our industry – especially for those of us fortunate enough to work in the decision-making positions of senior housing. A former company executive with whom I worked, would often respond to my residents-should-come-first objections to bottom-line driven decisions, with the trite phrase, “We follow the golden rule. Whoever has the gold makes the rules.” Hmm, maybe that should have been on our brochure. Besides, aren’t the residents really the ones with the gold? Someone forgot to tell me that our mission statement to “do the right thing” stopped at the door to the conference room.

What’s your mission statement? Is it being lived out? Prioritized? Funded?

No doubt this publicity will prompt renewed calls for federal oversight of our business, or for increased state regulations. If you’ve been in senior housing for any length of time, you know that the states are struggling to keep up with adequate oversight of assisted living. This lax oversight creates an opportunity for some providers to skirt safeguards and regulations in favor of greater expense control, occupancy growth and increased revenues. But, we can do better. Our staff deserve it. Our residents deserve it. Our shareholders deserve it.

I remember when our industry reached out and began serving the dementia population by developing secured care units and alarmed wings within our assisted living communities. We ratcheted up the stakes by expanding the scope of our services, and increased our rates as well as our risk. Caring for the most vulnerable of the senior population – those with high physical and mental needs – requires even more heart, compassion and care – but even more – it requires additional training, resources and a clear understanding and acceptance by providers of this great responsibility.

Many of us saw this evolution as a huge opportunity to provide innovative services and programs to a population that had been under served, in an environment that still promoted independence and dignity. I know many communities are striving to do just this. Unfortunately, some in our industry are all too eager to accept the increased revenue without ensuring their ability (or willingness) to provide the necessary resources under mounting pressure to perform financially.

Perhaps because of ignorance, perhaps driven by greed, and perhaps because of a disconnect that occurs once a company becomes too large to ensure that its vision, mission and priorities to the field aren’t distorted as it filters through the many layers of management; but for some providers, accepting higher acuity residents and those afflicted with dementia and related diseases – and all that goes with this – may have been going a bridge too far.

Health & Wellness, Senior Services

Dedicated, Loving, Well-Trained Nurses of Any Nationality Should Be Able to Work in the US

Please find below my comments an article from (health blog section) about a request from the U.S. nursing home industry to include a “viable” guest worker program in any immigration reform.

I second this request.

Dedicated, loving, well-trained nurses of any nationality should be able to work in the USA.  

North America does not have enough nurses and geriatricians as it is.  The work is hard.  It takes an open heart and deep concern for the well-being of all, especially the elderly and infirm.

It is my experience with most nurses from Canada, Columbia, Ecuador, El Salvador, Italy, and the Philippines, for example, that they are truly caring and connect well with their patients.  (I do not have experience with nurses from countries other than those mentioned).  

It goes without saying that the U.S. has a remarkable corps of nurses.  The point of the comments, however, is that there are not enough nurses to fulfill the needs, not to mention future needs with the ever-growing senior population.

Caring is an intangible talent that goes beyond borders.

It also goes without saying that all those who would be welcome on the guest worker program would be qualified.

By Sam Baker – 03/13/13 10:34 AM ET

The nursing-home industry said Wednesday that Congress should include a “viable” guest worker program in any immigration overhaul, and should also lift caps on employer-sponsored visas for healthcare workers.

The American Health Care Association (AHCA) said immigration reform should recognize the needs of employers — including nursing homes and long-term care providers, who rely heavily on immigrants for positions such as nurses.

“Members of the long term care community employ immigrants and boost the economy. Any visa program must give employers, not the government, the primary say in which workers they need to staff their businesses,” the AHCA said. “In addition, the labor market should also have the primary say in how many workers enter the country annually in a legal program.”
The group is scheduled to testify at a House hearing Thursday on immigration reform.

AHCA said the supply of skilled nurses in the U.S. will fall more than 30 percent short by 2020 if Congress does not act. The nursing-home group said immigration reform should allow employers to access “previously unused” temporary visas for healthcare workers.