Diagnosis and Treatment Settings
Hospitals have memory clinics and psycho-geriatric clinics where you can meet with doctors that specialize in neurology, geriatrics, and psychiatry. Here patients can undergo a cognitive assessment, determining the type and stage of dementia they are at, and receive appropriate medication and monitor the development of the disease.
The Ramat Gan Alzheimer’s Research and Treatment Center runs a diagnosis and consulting clinic run by Prof. Michael Davidson. Cognitive assessments are conducted at the clinic and a file is opened for each patient for further treatment and monitoring, and guidance and evaluation is given regarding a treatment plan appropriate to his condition.
A Visit to the Clinic
A visit to the doctor may be uneasy and difficult. In order to make it easier for the patient and the caregiver accompanying him, prepare for the visit in advance:
Prepare a list of questions. Make sure you prepare a list of questions ahead of time and bring all the medical documents with you.
Report special problems. During the visit, describe to the staff at the clinic any special problems that you have encountered and consult with them on how to make things easier for the patient.
Tell the patient about the visit to the clinic. Inform the patient that you are about to visit the clinic around the time you leave home.
Bring food and drink. Make sure to bring food, drinks, or anything else that can keep the patient busy while waiting.
Bring a relative or friend along. Come to the clinic with a relative or friend that can stay with the patient if you need to speak privately with the doctor.
Overcome the unease. Try to overcome the unease and give the doctor all the information, even if it is embarrassing (such as verbal or physical aggression on the part of the patient).
Caring for people with Alzheimer's disease is difficult for anyone, especially spouses, who are generally older as well and not always in the best health. Alzheimer's disease is incurable and when a family member is diagnosed, the news can be very tough to accept. Here are a few things that may make the diagnosis process a bit easier:
Ask questions. Ask as many questions as possible about the disease, treatment for it, and how to best behave with the patient. You will probably think of more questions in the days after the diagnosis, so you should schedule another appointment.
Look up information. Look up more information about the disease – from organizations, government agencies, support groups, and websites.
Check eligibility for assistance. You should consider getting assistance through the National Insurance Institute or private caregivers.
Prepare for the future. It is important to remember that this is a progressive disease that constantly deteriorates. We recommend checking legal issues such as appointing a guardian, medical insurance, assets owned by the patient, financial status, and social benefits.
Every local authority has a social services unit with a senior citizens department, consisting of a staff of social workers who specialize in the care of senior citizens. The social workers in the welfare offices are proficient at conducting psycho-social assessments for people. According to this assessment, they will direct and guide the families about possible solutions, and the rights and benefits they are entitled to.
The local authorities offer day centers for those suffering from a degree of functional difficulties and/or dementia that allows them to continue living at home. Referral to a day center is done through the social workers at the municipal social services. Payment to the day center is made either privately or through the Long Term Care Act.
The day centers provide a daily, social, and therapeutic setting that gives the patient a safe daily routine and the family time to rest and get things done. Some of the services the day center provides include:
►Transportation to and from the center
► Hot meals
► Activities that stimulate the patient and a non-judgmental social framework that is compatible with their condition
► Advice and guidance for the family by a multidisciplinary team that includes nurses, social workers, and occupational therapists
► Bathing and nursing care if needed
Selecting the Institutional Framework
An institutional framework that provides solutions that the patient’s home does not is not fundamentally different than hospitalizing him for other medical needs. An institutional solution is inevitable as soon as the patient’s needs outweigh the caregiving resources available at home, and solutions that until then were correct and appropriate, now become insufficient.
A person whose mental functioning (insight, memory, orientation in time and space, language, and judgment) has deteriorated to a level that may endanger himself and his environment is defined as cognitively declined. In Israel there are private and public facilities for cognitively declined patients at different degrees of functioning. There are counseling companies that can help select the most appropriate framework for the patient and his family.
Gather information as early as possible. Start gathering information at the earliest stage of the disease rather than wait for a crisis. Thorough collection of information about nursing homes will result in better decision-making when the time comes.
Prepare a list of questions. Make a list of questions for the agencies handling the institutions where you are visiting. For example: What activities are offered, does the institution only care for cognitively declined patients, does the institution separate patients with different functional capabilities or is there only one general ward, and what is the ratio of patients to staff.
Visit the institution at different hours. You should visit during the late morning hours or in the evening, and not during rest or mealtimes.
Inquire about the number of staff members at the institution. Find out how many staff members there are at night, on weekends, and on holidays.
Look at the patients. Look at the patients at the institution: How do they look? Are they clean? Are they alert or very drowsy?
Make a surprise visit. You should visit the institution by appointment and again without an appointment, to test your first impression.
Inquire about the activities offered. Find out what activities are offered to patients and their families at the institution.
Inquire about the employees’ credentials. Inquire about the training the employees undergo and what is the attitude regarding the family’s involvement in the patient’s care.
Check the rooms. Check the rooms at the institution, and how many patients there are per room.
Check the costs. Check the price and method of payment. Does the institution admit patients privately or also through the Ministry of Health?
Examine the institution’s licenses. Does the institution have a license from the Ministry of Health?
Go over the terms of the agreement. Once you’ve made a decision, you should go over the terms of the agreement and possibly consult with a lawyer.
Get help from the supportive staff. Moving to the institution is difficult for the patient and his family. Get as much help as possible from the social worker and support staff at the institution in order to make the transition easier.