108beads

Racial disparities in drug trials, and disparities in overall medical care, among other factors, make the recently-approved Alzheimer's break-through drug lecanemab less likely to benefit African Americans.

Interesting read on how media portrayal of people with disabilities shapes perception of them as "deserving" of accommodations under ADA, or not.

"The Vanishing Family." This is a "gift" link, so you shouldn't hit a paywall; let me know if you have any problems.

So my partner with Alzheimer’s is in a skilled nursing facility. She wouldn’t walk or exercise for several years; fell repeatedly; and after a stint in the ER, flunked out of rehab. She’s now in long-term care on Medicaid, in a place which I will call Roach Motel because (you know) “roaches check in, but they don’t check out.” They want her money. I am physically unable to care for her at home 24/7.

I don’t know that I could have gotten her into a better place than Roach Motel from a hospital ER. The ER was adamant: “we need to kick her out NOW, because she’s taking up space and we can’t do anything more for her. You have two choices, and they’re both wretched. Roach Motel is slightly less wretched.”

I didn’t know much about Roach Motel, but I document here how I was able to find the skeletons in their closet, in hopes someone with more time to consider can avoid voluntarily selecting a toxic waste dump for their loved one. Presumably, this roadmap will work for assisted living, memory care, and other types of care facilities too. This strategy works for the US; I believe it should be transferrable to other countries.

Yes, ideally you should visit, do the sniff test (does eau-d’-urine waft through the halls?), ask questions (do you treat patients with respect?), sample the food (it’s all institutional, but is there some semblance of palatable, recognizable food items?) However, good places will be honest, and garbage dumps will show-and-tell you what they want you to see. They will appear similar. How to tell the difference?

You can coax a lot out of online searches.

First, start with the facility’s full proper name; add city and state if necessary. Search online. You can use Google’s search engine for this first part—but for later searches, I suggest something like DuckDuckGo. Reason: some search engines accept pay to promote good reviews, suppress bad ones. It’s called SEO, “search engine optimization.” You want to see what they will pay not to show you.

Your first search results will show you the puff pieces: the glossy-brochure language, promotional articles, glowing (likely paid) customer reviews.

Next, add the following to your search string: "Medicare Medicaid." It doesn’t matter whether you have either in your healthcare portfolio. Both programs review and rate facilities based on complex metrics. Scroll through the resulting pages to see what the criteria mean, what they are based on. Pay some attention to consistency of ratings—if one month, they are at 5 stars (out of 5), the next month jump to 3, back up to 4, and a month later drop to 2, then they’ve got issues.

Next, use the facility name and add strings such as "complaints," or "reviews." The Yelp-style ratings system will always skew to extremes; they elicit comments from people who are either deliriously happy, or inconsolably angry. Take both with a grain of salt. Sometimes, a patient’s medical issues will overwhelm even the most meticulous of care, and that can leave loved ones looking to assign blame. But if you see a bunch of ambulance-chasers boasting of success “suing the pants off” of your facility, it’s not a good sign.

Next, using facility name, switch over from the “general” tab of your search engine to “news,” and sort by “most recent.” What does recognized journalistic reportage have to say about your facility? You may find reports of union strikes, egregious heath and safety violations. Or you may find the C-suite honcho or top manager bragging, prognosticating a bright future for happy patients with excellent care. Are the honcho’s comments realistic? Does it appear he or she thinks an increase in Medicare or Medicaid per-diem payments will fish them out of their current financial morass? (Ha! Dream on!) Read between the lines; why is this piece of reporting “news”? What is the honcho responding to? Bottom line, what pending financial instabilities do you see? (If they have problems looming, those problems won’t be reported; they’re speculation, not yet actual news. Make some intelligent guesses of your own.)

Finally, use the facility name and add "owner", searching with the “general” tab. The dirty little secret of most nursing homes is that they are for-profit entities, and that they are owned by a handful of people who are very well-off, and who bring family and friends into the business with them. Whatever their values, they will likely be applied to (and visible in) other facilities in which owners have s share.

From what I’ve seen, there may be a dozen or so owners. Each one owns a percentage share of your target institution, and a percentage share of many other institutions across the country. They’ve got empires going. One I read about purchased a whole airline for his son to play at running—where did that money come from?

Pick a few names from the top of the list, and start online searching those names. (If names are common, you may have to toss in a few qualifiers like “nursing.”) The people at the top have the biggest percentages. Chances are, you’ll start seeing other names appearing on the sites you turn up—the other co-owner investors listed as owners.

What kinds of complaints, fines, lawsuits, violations, fraud, allegations or similar shenanigans do you see? The owners of your target facility almost certainly have shares in other facilities that have done bad enough things to become internet-searchable. If your target facility is not currently under the gun, that’s not necessarily good news. Chances are excellent they simply have not been caught and publicized yet. An owner of multiple facilities is not going to treat your target facility any differently than all the others they own.

And for 50 extra bonus points: set up a Google Alert. Search online for "Google alerts." Sign in to your Google account. In the dialog box “search for,” enter the full name of your target institution. My preferences from drop down menus (set to default unless otherwise indicated): how often—once a day; region—US; how many—all results. (If you get irrelevant info, you can modify these settings later).

I was on Farcebook earlier today, and caught not one, but two ads using the hashtag #dementiaawareness. (I was looking for something else.) I reported them to Farcebook as lies, and they disappeared, so sadly I can't share screenshots.

But basically, y'all know the drill: "Did you know you can cure dementia with this one simple thing?" I had to double-check—yup, it was "sponsored content." Someone paid to put it there.

Clicked through to a long rambling bunch of yadda yadda, coming from a Very Important MD with Very Big Credentials (you can read that in tRump's voice if you wish…), who has seen through the falsehoods of conventional therapies. Yes, all of the side-effects which the (white, male, pretty-boy) doctor lists for donepezil are truthful. Similar padding and truthful (but partial) information about other established medical interventions.

After pages and pages of half-truths, we get to the point: all you have to do to permanently reverse and cure dementia is buy our cannabis gummies! Here is a picture of Jane Doe with dementia, and here is a picture of Jane Doe after just one week taking our gummies! Wow!!!

Alz.org is the website for the US based Alzheimer’s Association. They focus primarily on Alzheimer’s, but also contain some material on other forms of dementia.

The site interface is designed to be easy to navigate for those who are not medical professionals, but digging through some of the menus will get you to refereed journal articles and other professional resources, as well as granular suggestions for caregivers seeking to offer dignified, appropriate levels of support for loved ones.

Of special interest: their phone hotline, available 24/7. From my experience, they seem to have a vast phone-tree of specialist consultants—so you can call in to vent, ask for tips and strategies, or to get pointed in the right direction for independent research.

I was especially impressed with their ability to get me connected to local resources—lists of adult daycare, nursing homes & memory care, checklists on how to evaluate offerings, and so on. So often, I’ve asked for help through insurance company reps, or doctors’ offices, or dug up stuff myself online—only to find it’s outdated or contains information that isn’t useful.

I tried posting on a Discord for people with/caregiving for those with dementia. Got a nibble of interest, got pinned by the mod, wrote out detailed instructions on how to get on Lemmy and find us… Possibly the geek level killed interest.

The Discord is pretty quiet, except for incoming bot posts, an IFTTT feed directly from r/dementia to the Discord. (It's one-way, we can see them on Discord, but they can't see us.) Is it worth posting in Reddit, do you think? I'm wondering if I even mention Lemmy, whether I'll get permabanned from Reddit.

Thank you, ZenGrammy! I don't have the time or the tech chops, and was hoping someone would start a community like this. I'm a Reddit refugee who was active on r/Dementia, r/Alzheimers, r/Caregivers, etc. (Edit: and a handful of Discords, an Alz.org Zoom group… lots of support!)

My sweetie—I call her my "Beloved Dementor"—was misdiagnosed for a good decade with psych problems. She does have those (anxiety, depression), but PCP & therapists brushed off refereed medical journal articles I tried to show them, as well as the info that Alz runs in her bio-family.

She's only at roughly stage 4 cognitively. But the effort of masking for so many years, the Alz erosion of executive function (motivation, cause/effect reasoning), the personality reversal from outgoing to shrinking violet—made her decide to stay abed for several years. Lost muscle tone from that, plus Alz-related apraxia and a Parkinsonian tremor.

Inevitably she lost ability to walk, fell, and from ER went to a Roach Motel of a skilled nursing facility where she flunked out of rehab. Incontinence and reliance on a Hoyer lift make it impossible for me to adequately care for her at home—my arthritis and age (pushing 70), inaccessible house, lack of backup community if I fall ill, shortage of aides, and her self-imposed social outlets all point to "nope, not gonna work, at least not longterm."

She's still my sweetie of 26 years. I visit daily. &

Best resources: Alzheimer's Association (Alz.org), and the book The 36-Hour Day.